Full Transcripts

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please 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 healthcare plan or becoming bold with insulin. Welcome to ask Scott and Jenny. In today’s episode, I, Scott and Jenny Jenny Smith from the diabetes Pro Tip series and defining diabetes. You know, Jenny, Jenny works at Integrated diabetes. She’s a CDE, or registered pump trainer CGM trainer dietitian. She has type one, Jenny is the she’s the full pack Jenny’s the goat, I think that’s what we’re saying. Right greatest of all time. That’s why she’s here on the Juicebox Podcast. So we’re doing something new on Fridays, they’re still going to be some defining diabetes. But we’re going to go back and forth a little bit between ask Scott and Jenny and defining. Anyway, in these segments, Jenny and I will be answering your questions. This all began as Jenny and I were talking about new episodes for diabetes pro tip. And I said, Let’s do an Ask Jenny thing. She’s like, I’m up for that. I said, you know, I’ll ask people on the Facebook page if they have any questions for you. And they did. But the questions were sort of never ending and really good. It’s interesting how listening to the podcast is making people think about deeper questions. The day after Jenny and I recorded, I woke up thinking, well, that really went well. I love that we should do more of that, you know. And I got an email from Jenny, you know what it said? Jenny told me we should do that. Again, that’s a guy was thinking that too. So we were like, You know what, instead of making this a protip thing that happens once in a while, and we can’t just make it one episode. Because there’s so many questions in an hour, I think it would just get overwhelming. You’d forget what you heard. I said, Jenny, let’s break these up into smaller episodes, so they’re a little more digestible, and keep doing them. You know, I’ll put up a thread every once in a while and we’ll get new questions from people. Jenny was like, that’s a good idea. I said, Jenny, why are you talking like that? And then I realized I was texting with her. And she wasn’t really talking. I was just making up that voice in my head. Anyway, welcome to ask Scott and Jenny, answers to your diabetes questions. For those of you who think that Jenny and I have practice this ahead, you’ll know for certain in a second that that’s not true. I did send any of the questions so she could look at them. There’s no I don’t

think I did not. I think I looked at like a couple and I was like, Okay, we’ll just attack these as we get to that, because I can’t, and it was like, 945 at night, and I was like, my brain has no bandwidth, or reading or Okay.

All right. Well, I’m just gonna start what I see is the top right, so I think I can get first names. Lionni asks, she says, I just started listening to the series with Jenny and you in the last month and love it. My question, how do you combat that morning glucose rise, no matter what time of the morning, I wake up, as soon as my feet hit the floor, my sugar spikes, Basal increase causes lows, and doesn’t fight the rise quickly enough. I know hormones get released when you get up, but still haven’t figured out how to stop it from happening. So I’m not fighting highs all morning and delaying food. Good question. Good question. I have very little to add to this. But I think I should go first because I think it will lead you please. I have Arden’s you know Basal program set up for a normal day being alive, getting up at a certain time going and doing something summertime comes along or Saturday comes along and she sleeps in. Now all the sudden her Basal insulin that kicks in at like 630 in the morning, so she can get up for school demands too much at some point. So I wake up a little earlier. And I dial her Basal back for a very long time, usually by 30% Does it most days, if she’s trying to get low, there might even be moments in there for half an hour right to shut it off completely, to create, like, like there’s so I have to mess up on the loss so that she can. So that’s the sleeping in idea. But the reason I bring it up is because what it taught me is that opening your eyes, makes your blood sugar go up. And I know technically that’s not true. But I think there’s something about being awake and alive and aware and anxious and in a hurry and all the other things that come with being alive and having your eyes open, make you need more insulin. So now you can tell her like the technical reason for all

that. Yeah. I mean, you alluded to some of it really, it’s like, you know, what we kind of commonly referred to as the dawn phenomenon, right? And while most will say oh, it happened somewhere, you know, starting around maybe three or 4am and continues through, let’s say maybe 8am. Most people really see it heaviest. Once they do wake up, it’s almost Like the feet on the floor, and my blood sugar is rising, and I haven’t even like said hello to my dog yet. And my blood sugar is like skyrocketing, right? And this listener reader poster,

essentially, is a listener, but she follows okay for Facebook.

Awesome. So both fabulous. So essentially, it has kind of the right idea, we would typically say, go ahead. And if you are, in fact getting up at about the same time, every day, like Arden’s example, her normal school day, she’s getting up six o’clock in the morning, if that’s your typical, and you start to see a rise by 615, the accommodation in Basal is appropriate. But in this setting, perhaps the Basal hasn’t been adjusted high, soon enough to accommodate for when the rise is going to start. So you know, if the rise is starting at 615 in the morning, and you have your Basal set to increase at 6am 15 minutes of more Basal isn’t going to offset arise in 15 minutes, it’s not going to do it, like we talked about in the Basal, you know, setting episodes, you really have to get about an hour lead way before you expect to see a rise or a fall happening in your blood sugar. And so in this instance, again, you’d probably need to do a, an increase in your Basal around 5am. If you want an offset arise that you know is going to happen by six 615 To get started, because then by then the Basal be high enough, it’ll stop it from happening, you won’t have the spikes.

This is an example of like what I’d say about like anything you’re doing with Vincent currently isn’t for now it’s for later,

it’s for later, right. And if you are getting low, you know, she mentions, well, I’ve tried the Basal thing and it’s causing you to go low, it may be again, the timing, it may be that the Basal isn’t adjusted high enough, soon enough. And if you’re adjusting it six o’clock to accommodate for a rise 15 minutes later, but then it doesn’t need to be high anymore by 8am. By that’s why you’re low is because it’s high hitting you at a point when you now no longer need it to be too high. So it’s kind of a mismatch of timing. The kind of the other compensation like you bring up, you know, for Arden’s sleeping days for adults who are on their own. And I, I did this, you know, with my pump early on, I figured out the same thing. My work days were very different than my weekend days. Not by much. I mean, I’m not I wasn’t a teen, it’s not like I was sleeping until 11 o’clock versus getting up at six o’clock. But even if I slept in by an hour or an hour and a half, that Basal accommodation that I had set, it was it was too much. So I actually created weekend or day off profiles. And on Friday night, I would set my weekend profile to start running. And it accommodated for that time of day that was just longer in asleep,

I would say to for any pump companies that may be listening, you have to be able to they need to be automated. I agree. Or you can’t make me remember Friday night to turn on my Saturday Pro. I had

reminders on my phone. Yeah. And then my reminders specifically said it wasn’t just alarm going off. It was turn on weekend Basal. On Sunday night, I had an alarm that said turn on weekday Basal. Otherwise, I would forget,

of course, people for people who are thinking about it on this level, there’s no safety concern with allowing them to change their Basal programs automatically. So my last few thoughts about this are basically Liana, what what, what Jenny’s saying is, is that you’re throwing a punch an hour after the fights over, you know what I mean? You’re putting your insulin now, the extra Basal, but it isn’t working right now, all of a sudden, an hour later, when you kind of don’t need any more. Now all of a sudden, it’s there. She’s thinking maybe and by the way, right? You know, this is our guests off of four sentences. The other thing I want to say, right? It’s interesting to me like Leanna, she says, I know hormones get released. This is what I always talk about. Don’t spend so much time trying to figure out why it’s happening. Just stop it. You know what I mean? Like, when the bank robbers coming in the door, we don’t try to figure out the psychology of why he thinks it’s okay to steal from the bank, someone just really needs to stop, right from stealing. So I get it fixed, then if you want to, you know retcon it and think you know, analyze it, then do it. But don’t worry. In the moment you need more insulin when you need more insulin. Okay.

And another I guess another accommodation just to finish it to is for people who do have more shift kind of work and let’s say as you brought up it’s hard to remember to change a Basal pattern and to remember you needed on Tuesday for this shift in this, you know, Friday for this shift in a weekend and a day off and whatever. The other potential accommodation that does work for some people is it You know, by evaluating what the rise is that you get, as soon as you wake up, let’s say you always know that you get a 5070 30 point rise in blood sugar, you can actually use your correction factor in an opposite way, then you can say, Okay, if one unit drops my blood sugar by 50 points, and in the morning, I have this consistent 40 To 60 point rise in my blood sugar. But when I wake up, if I take a unit of insulin right now, I should be able to offset that rise, because we know it’s going to take about 15 to 20 minutes to get a Bolus working. Usually that rise is going to be seen, if it’s going to start it’s going to be within about 15 to 30 minutes of waking up in the morning. So if you can take that Bolus to offset with a figured amount of insulin, it’s another way to accommodate if your days are very different in when you wake up. So you’re over bolusing the morning. So you’re over Bolus in the morning without ever playing with Basal. You’re just accommodating for the rise that you know is going to be there

like that. Okay. Do you need a breath? Yeah. All right. I’m good. Here we go. Jennifer asks what I think is a really interesting question. She says so garden, did she, this must be a brilliant question, right? She says so carbohydrates begin digestion in the mouth and absorption can start in the mouth. But the amount of time that the food actually stays in the mouth before you swallow it isn’t that great? Then it goes to your stomach. There’s about three hours before it moves on to the small intestines for digestion finishes, and then the majority of absorption happens. So my question is, why do we Bolus for the insulin upfront? Why don’t we Bolus heavier on the end so that three hours afterwards to catch it when it’s being absorbed by the small intestines? Now? I think there’s a this is an interesting question, because I think it’s possible Jennifer asks, and answers her entire question. What she needs is someone to come along and tell her she’s right. Or maybe right so there’s a lot in here. So for food does not spend very much time in your mouth by now. The quickest way to stop a low blood sugar is your chipmunk. You just run around with your nuts. He pocketed your key. Yes. Run around with your nuts in your mouth and looking for a hole. That’s what a chipmunks right, saving for a rainy day. Anyway, jeez, this is gonna go off the rails, we need to be more structured than this. But so she’s you know, I just the other night, a person who’s been on this podcast, you guys haven’t heard her yet, but contacted me privately. And she said, I just Bolus eight units. And I meant to do point eight, and I’m alone. And I don’t know what to do. And I’ve drank juice, but my blood sugar is like I think it was in the under 40. And so I started like rattling off like, get some of this, get that get this well the person’s like, like keto or low carb or something like that. Like I don’t have any of that stuff in this house. I was like, okay, so I was like now I’m like, Oh God, now I’m on the hook. Like I’m really thinking right? I said, Oh, sugar bowl. And she goes, Yeah, I said take a teaspoon of sugar. Just melt it in the saliva in your mouth and keep it in your mouth. Like don’t smile, it just keep it there because your cheeks super absorb really quickly. Right? So I guess this is an interesting question. And we’ll get to Jennifer’s overall question, but how is it when my blood sugar is 50 and it’s not falling? And I drink, you know, 1015 carbs of juice? How does it pop up so quickly after that? Where does the majority of that absorption happen? Because I’d imagine that just doesn’t even make it to your stomach because you start seeing it hit pretty quickly. Do you know?

And well in that in her question, and this kind of bring up component of a meal, right? If you’re drinking something like juice, the reason for juice being recommended, or any very simple carb source being recommended as a true treatment for a low blood sugar. Or, you know, the reason that you want to Pre-Bolus if you just decide you’re going to drink juice and you’re not low is because you do need time, because that is going to work fast. That sugar gets absorbed. In the absence of fats and proteins and fibers and other things. Sugar itself gets absorbed pretty quickly. And it gets it gets absorbed essentially, you know through the whole passage and a liquid sugar source things like a gel or a goo or the juice or even like you said liquefying like in fact, something I learned years ago was if I choo choo choo choo choo, the glucose tablet up and needed almost like liquidity in my mouth and then swallowed it. It was a lot faster and why I came to this probably in those strange moments of low blood sugar where you’re like, oh, let’s try this and your brain is like floating through mud and like, whatever. But I figured, you know, I figured out what works a little better. So that liquid component to it, it gets absorbed a lot faster. And in a very simple sugar form, it’s going to get absorbed through the digestive system much, much faster. Now with a meal, she brings up a good point with a meal. Why am I taking this big upfront Bolus? For food, that probably is going to hit me at least some of it is going to hit me a fair amount of time later, right. Thus, you know, a lot of the reason that they truly built in especially for pumpers, that feature of a combo or an extended or a duel or a square wave Bolus, two pumps, that’s why it’s there. The problem is that you’ve been taught how to use your pump, but you haven’t really been taught how to use your pump, the insulin works, you’ve not been taught, this is how the insulin works. This is the component of a meal. This is why the insulin needs to be matched to this kind of a meal. This type of food, you know, together. This is the type of Bolus you might need. I mean, the science behind it is more in depth than the education that’s being provided it is. So again, this brings up a very good question and potentially, you know if that’s if that’s what this person is seeing, then yes, an extended Bolus, if you’re using a pump is probably in your best advantage to try to figure out writing down some of your common meals. Seeing what is your CGM trend look like trying to match accordingly. You know, maybe I need 30% of my meal Bolus right now. And maybe I need 70% of it drawn out over two hours to accommodate that kind of digestion.

I think I think this this question from Jennifer made me think she’s never heard an episode where I do Arden’s lunchtime, insulin and Arden’s blood sugar’s already like 80 Because that’s the exact situation where I go, Okay, we’re gonna use 13 units now. But it’s 0% up front and the rest over a half an hour an hour. Because I need I needed to start happening. But I needed to, I need the impulse out longer shot longer, right? Yep. All right. Yep. For now. I think that answers Jennifer’s question. I also wrote down that if this wasn’t a regular episode, I would call it floating through mud, because that’s the most interesting like analogy I’ve heard for being low ever, like the idea that you’re floating, but very slowly.

That’s how I feel. When I it’s one of the best descriptions that I’ve like been able to come up with for how I have felt long term because symptoms change for low blood sugar for many people. But I’ve always had this feeling that I’m sort of like, floating or slogging through mud. Like, I feel like I’m moving exceptionally throw the very slow, but my thoughts at the same time are running extremely fast. They’re like they’re spinning and spinning and spinning and spinning. But I feel like I’m just the slow like, I’m like the slowest, slowest slot on the planet.

For your life, but you’re changing your chair.

Yeah, yeah, it’s just, it’s, it’s a weird sensation.

The way you said that.

floating through IDs like that.

At the beginning of the podcast, I told you that this episode was sponsored by in pen by companion medical. And I want to tell you a story about how that came to pass. So things don’t happen as quickly as you might think. About a year and a half ago, companion medical came to me and said, we’d love to come on the podcast and talk about this new smart pen we have it works with Dexcom. It’s really terrific. And it’s called in pen. I said, Yeah, that’s nice. But I can’t have you on the show. Because my daughter doesn’t use it. I don’t know anything about it. And that means a lot to me. I can’t take an ad from somebody that I don’t really know. You know what I mean? You guys don’t even realize it. But there are people who try to come on the show all the time to push what they do in the world. You know, I’m a physical something, I do this for people. And if I don’t have direct knowledge of what they’re doing, I don’t let them come on here. I don’t let people just come here and sell to you. So anyway, I kept talking to in pen. And the more I heard from them I liked but I still didn’t have any like real world data to back up having them on the podcast. So I told them if you want to come on, that’s great. You’ll have to sponsor the whole episode. I want people to know for certain that this is an ad. No mistakes, right? I’m not saying I use him pen or I stand behind it. But if you want to come on and talk about it in pen, do it. Just make sure people know this is like a paid for episode and way back like a year ago. They did just that in episode 174. In the year since then. I can’t tell you how many of you I’ve heard from her like Scott, I heard about impact on the podcast. It’s amazing and everyone’s telling me about how well what’s working for them? And what a great thing it is for them. And not only that, but I’m going to talk past the music here for a second. But not only that, but major props to Omnipod for never saying to me, Look, you’re taking ads from us. So you can’t do like a pen to. Nobody does that this is a very open community. We’re building here on the podcast, and it’s very collaborative. It’s fantastic. So anyway, you know, Omni pod doesn’t stop me from taking other ads, you hear people come on here all the time and say I wear a T slim or, you know, I use a libre CGM. Nobody ever gives me trouble about it. When I set these things up with the sponsors, I was clear upfront, you know, I can’t stop somebody from saying they use a product that’s not yours. If someone starts saying something about your product that you don’t like, I’m not going to stop them. I can’t do that. And everyone agreed, which, you know, is great in theory, but it’s actually happening in real life, like in real life, none of the sponsors have ever called me sent me a note or anything and said, Hey, we didn’t like what that person said there, please, you know, could just stop that. That is never happened on this show. I would never let that happen, which I liked. Because I like this information to be, you know, unfiltered for you. Anyway, in pen came back a couple of months ago, and there said, you know, we really would like to buy ads on the show. Is it possible that you’d be open to that now? I said, I gotta tell you, I’ve heard from so many of your users such great experiences, I think I would. But let’s not just lay an ad in the middle of the episode and clog the whole episode up with these ads, right? Let’s do something interesting for my listeners. So what I decided was, I’d like to talk to an in pen user, and then break up their story kind of a mini episode, over a number of weeks. And that’s what I’m going to do on these Friday shows these episodes on Friday for a little while, are going to be sponsored by in pen, and you’re going to hear from one of their users. Now, I think we found a really cool user with a really amazing job. And I don’t think we have the person exactly nailed down yet. So if the wait a second longer to make sure that she’s on board, should I even say she I’m not sure. Anyway, I’m pretty sure it’s gonna happen. So this episode of The Juicebox Podcast is sponsored by in Penn by companion medical, and for now, there’s nothing for you to do, unless you’d like to learn more. And you can go back to Episode 174. And listen to the conversation I had within Penn last year. Coming soon, of course, the story of an impending user and some links, you can click on To find out more. Thanks so much for listening to ask Scott and Jenny. Be sure to go follow the Facebook page bold with insulin so that you can ask a question next time the opportunity arises. And please don’t forget that Jimmy Smith works at Integrated diabetes. Not only has Jenny lived with type one diabetes since she was a child, but she holds a bachelor’s degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. All of that is nice. But here’s what you really need to know. I like the way Jenny thinks about type one diabetes management. I love it. Actually, she fits right in with how I vibe. If you’d like to hire, check her out at integrated diabetes.com There are links in your show notes. And at juicebox podcast.com. Thank you to everyone who sent in their question. We look forward to doing this again and again. This is going to go on for a while guys. I have a feeling this is going to be pretty popular. I’m tempted here to sing along with the music until the end of the show. Because I hear from a lot of people that you like that. But privately I want you to know that I believe you’re mentally unstable for thinking that and I will not be encouraging this with anything today.

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to Always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. MDI users, this one’s for you. How would you like to live your life less complicated? You can do that within pen in pen is a reusable injector pen that has its own smartphone app. They talk to each other through the Bluetooth. that Bluetooth is magic, isn’t it? You know what the app does? I’m going to tell you a lot of battle over the next few weeks on these Friday shows. But for right now, dose calculator dose reminders reporting actually tells you if the temperature of your insulin has gone out of range. Not only that, it connects to your CGM. Ooh, I got you there tonight, an app on your phone that connects to your continuous glucose monitor that connects to your insulin pen. Now you want to know more about indepen don’t you? Check out companion medical.com Welcome to ask Scott and Jenny. In today’s episode, I Scott and Jenny Jenny Smith from the diabetes Pro Tip series and defining diabetes. You know, Jenny, Jenny works at Integrated diabetes. She’s a CDE, a registered pump trainer CGM trainer, dietician, she has type one. As a matter of fact, if it was the mid 70s, Jenny would be the Bionic Woman of diabetes care. She’d be Jamie summers. And for all of you who don’t get that reference, I hate you for being young. In today’s episode of the show, Jenny and I are going to be taking questions from you the listeners. In this episode, we answer questions about bathing and whether or not that affects insulin drinking and how to handle it. And the third thing not lying to you, I cannot make out my handwriting. Oh, you’ll have to figure that one out. I mean, it’s only like 20 minutes long. You can do it. I wish I was kidding. That is what just happened. Right? You’re ready. EDAA EDA is editor right EDA at its at a let’s call it says this is interesting because I think we kind of gone through this in our exercise episode recently. But she said okay, another doctor rule. When we got diagnosed, we were told not to take a shower and our past post insulin intake is I read this one is that is that true or false? My son’s eight years old needs a shower every night. But sometimes we have to alter our night routine because he was given insulin. This is interesting because I think this is a great example of doctors trying to give you boilerplate answers to life’s questions. And now doesn’t consider that for the rest of time in memoriam Ed his kid is sitting around dirty not go into because he had a snack you know, I get the overall. So I’ve never really seen it Arden showers in her blood sugar doesn’t get low is that because our Basal is right. And she doesn’t have too much insulin in her body when she gets in the shower. What is that about it? Because I’ve seen it happen to where she jumped in the shower and her blood sugar falls?

Yeah, it’s it’s really I mean, it has to do with the fact that in a shower unless you’re literally taking like a Polar Bear Plunge which you’re in the Midwest, you do in the middle of winter, right, that I guarantee is not going to cause your blood sugar to fall.

You guys now have a great image of what Jenny looks like going from her shower to her towel to her bed.

So, overall warmth to a site that’s infusing insulin warmth creates, you know, it causes the blood vessels to move closer to the surface of the skin. And since that’s where we’re kind of infusing insulin, you get more vasculature, you get more circulation, I guess is the easier term so that your insulin actions speeds up. So you can get drops in blood sugar now, does it happen for everybody? No, it doesn’t happen for everybody. The warmer the water, the longer the time that you spend in the water, etc. I know myself, you know, I mostly take showers now i with two little kids, they really don’t have time to lounge in the bathtub for like three hours and read a book so

Calgon commercials a lie, Jenny. It’s a

lie. It’s totally a lie. Sometimes. In fact, I’ve said I need a Calgon moment my husband like sort of laugh in the background like I seriously

fight. You know, now that he knows he could be replaced by dark chocolate peanut butter cups.

Actually, yeah. Forgot I told you about

that. Yeah, get in line and just laugh when Jamie says lamb.

So yeah, you know, if I spend five minutes in the shower, I definitely don’t see a change in my blood sugar now is my and I were Omni pod. So my pod is not like soaking in warm fits, you know I’m moving around in the shower, not just letting the shower water hit specifically that place. But for a kid who might be taking a bath, whether the if maybe the pump site is completely submerged in the water, if they’re like my six and two year old who loves to like, play in the bathtub until it’s literally like frigid, Ice Cube cold. And then they scream when they have to get out of, you know, if that’s the case, it may be a reason that doctor is being I’ve never heard that a doctor actually even bring that up. So I think it’s interesting that their doctor mentioned that

at all a lot. I’ve seen this a lot. So,

but really, yeah, I think it’s interesting. But you know, it’s, I think it’s a preventative for hey, let’s, let’s not have you have low blood sugars just because you’re taking a bath, but quite honestly, you know, if he’s taking a bath, and you’re doing an injection and his upper arm, technically, the bath unless he’s laying down in it shouldn’t cause a drop in blood sugar. Again, timeframe is also a difference there. I have noticed the difference. If I’ve been sitting in like a hot tub. I’m usually on vacation. If we do that I try to have my pat on the back of my arm so I can kind of hang my arm out of the hot tub and not like boil my insulin or anything. But even so just the warmth of sitting in that much, much warmer environment. I have definitely seen my blood sugar come down. So that’s it’s not odd. Your doctor was certainly not, you know, just blowing smoke. Yeah.

For clarity to you’re not saying that we don’t want to heat the insulin up because it works better. When the insulins warm. You’re saying that when your cells are warm, just like we talked about the exercise.

So absorption is faster and Yeah, exactly.

Okay. I like that one. This one’s interesting, because I said to someone recently, I have to find a real like professional like drinker to come on the show and talk about how to Bolus for booze, right? Because I don’t know but you live where it’s called. You must have to get liquored up to get through the winter.

So much. So people probably do.

So Jim says what’s general best practice considered for bolusing? For booze? I generally don’t Bolus with my adult beverages. But what but I’d like your take on this. And then and then Emily came in and said, Yes, I gave up beer for more than a decade because it was so difficult to manage my blood sugar. Lately, I’ve been allowing myself one beer, but I tend to nurse it. So should I do a Bolus and extended Bolus or Temp Basal? So what are you? I am not a drinker at all, and I don’t have diabetes. So I’m out on this one.

Yeah, it’s very, it’s a good question. So in in general, have an alcoholic beverage that has carbohydrates in it, you will require insulin to cover the carbs in it. That’s we’re not talking about alcohol part of it yet just the carb part of it. So a beer. Most beers in fact, the lighter the beer, like the pale ales and those kinds, they tend to in 12 ounces have somewhere between like 15 and 20 grams per 12 rounds. The darker the beers like the stouts. And the Guinness kinds of things, they tend to actually have less carb, usually only about like 10 to 12 ish grams per 12 ounce. So there’s a little card for you, beyond what you’d have to Bolus for. But if you are not a college, beer slam drinker in two seconds to see how long you know how quick you can actually get it down in competition with somebody else. If you’re nursing it and it’s a social drink. My assumption is that you’re probably drinking a beer over let’s say 30 Or maybe even 60 minutes. Let’s It depends. She brings up a good point. Yes, extended Bolus is absolutely very beneficial there, especially if you’re drinking the beverage on an empty stomach with no food with it was that mainly because food would help with the overall just it helps with the absorption that your body is also working on digesting the food and the beer or the alcoholic beverages sort of being absorbed and digested kind of along with the food. So you have less impact of like the alcohol component up front. So you have less tendency to have that drop first, even with a beverage that has carbs in it. But again, in a in a no food environment, just drinking a mug of beer. Essentially an extended Bolus would be a good idea, let’s say over 30 minutes even over 60 minutes just depending the other types of alcohol let’s say you’re just doing something like gin or vodka, or something that really doesn’t have a carb component to it. There’s no reason to Bolus for it since there’s not a carb piece to Bolus for. But does that mean that you shouldn’t consider the impact of alcohol at all? No, in fact, conventional pumpers, the typical recommendation that we give is, when you’ve finished drinking, let’s say you’ve consumed three beers or three, you know, drinks with vodka, that are carb free, or whatever it is, at the end of drinking, the goal is to take your Basal down a decrease of 40% for two hours per drink consumed. So at the end of the night, if you’ve consumed three alcoholic beverages, three times two hours would be six hours, you would decrease your overall Basal by 40% for six hours. And that helps to decrease the chance of lows, which are the end result of alcohol being processed in the body as a first response of the liver, the livers, that’s one of the livers many, many, many, many, many jobs is to process the alcohol out because it’s seen as kind of like a toxin, right? So in that same form, then the liver output of what your Basal insulin is supposed to be covering, if not outputting, that drip drip of glucose, that your body is supposed to be being covered by the Basal rate. So if you have lower output, you’re not going to need quite as much of that Basal and the alcohol content to then cause low blood sugars.

I had no idea. Yeah, and I here’s one thing I do know that I can add, even though it wasn’t asked, glucagon doesn’t help you. When you’ve been drinking, is that right? Or is it not? It’s,

it’s, it’s not as effective, it can be less effective. Yes, because again, the liver is first word, especially if there’s a fair amount of alcohol in the system, being one glass of wine. It’s very wise if God would be fine, but you know, you’ve had several drinks and whatever, and you’re kind of like tipsy and the glucagon would definitely have an impaired detail.

And that’s because your your liver is busy with other things, and it’s depleted in the glucose. So if people understand or not, glucagon releases glucose from your liver, it’s not a magic thing that brings your blood sugar up. It’s not it’s not Yeah, I don’t know if everybody understands how it works. So if you’re a power drinker, looking at your friends right before you pass out and saying hey, if I have a seizure, mix this up and stick it in my butt not going to be the only guy and I don’t mean in the button

all up right, right. It’s better to call the better to call the EMTs and you know even in that case, you know, like you brought up earlier with the glucose you know, kind of in the cheek even at that point, something like honey or like a glucose gel if the person is actually carrying something along with them squeezing it in their cheek and actually getting it you just massage their cheek is gonna get absorbed and it’ll help the blood sugar you know, faster so those are good options but yes, you know, overall, sure carb needs to be accommodated for in beverages especially if you’re drinking the fancy you know, my ties and whatever they are Bahama sunflower, whatever Bahama breeze or whatever. Exactly. A there’s a fair amount of carbon those.

I think that’s from Bahama breeze. I’m such I have probably not Jenny No kidding. I have probably not had the total of a case of beer in my entire life. I just does not occur to me to drink. I don’t know why just it’s never struck me. Let’s talk about the in pen from companion medical, first of all companion medical comm. That’s where you go to find out when you get there, there’s a little blue thing up in the top right corner says get in pen. If you want to just jump right to the good part, you just click on that. First, I should tell you why you should be excited. If you’re an MDI user. This thing is the bomb diggity, you understand. It’s gonna help you track your insulin. You know, all that fancy stuff that people with insulin pumps get, you could get that with your pen. Not only that, it talks to your continuous glucose monitor if you have one, and if you don’t have one. It’s all right. The app still works great. The app, of course is for iPhone or Android. It is completely free. And available right now on the Google Play Store. And on the Apple App Store is it they don’t call the App Store, right. They called the iOS App Store. They called the App Store. I think it was called the App Store. It’s on the App Store. Let me tell you a little bit about what comes in this app. First of all temperature alerts. It can tell you right it’s amazing temperature alerts limit the chance of extreme heat or cold impacting your insulin. And if it happens, the app will let you know Reporting is amazing. The summary of your therapy is spelled out right in front of you. You can share this with care providers or use it as a big picture look to help you make decisions. Do you have trouble remembering to dose your insulin in Penn provides you with an optional dose reminder. Right so you can decide to set up a dose reminder can also remind you to check your blood sugar in pen will not remind you to make dinner. The app has a dose calculator. Now listen, I know a lot of you who are on injections wish you had this because they’re on pumps and they’re really helpful in pen has it right on the app dose calculator to help you take the guesswork out of dosing. You enter your blood glucose and what you intend to eat. And the correct dose is recommended. It takes an account recent doses to avoid insulin stacking impact it’s currently available in the US you can head over to companion medical calm right now to find out if your insurance covers the impact. But even before you get your answer, head to the app store and get the app the apps free. The pen, you know, depends on free, I’m not gonna lie to you. Insurance coverage varies by plan, please visit the get Impend link at companion medical calm to submit your information and find out with a no obligation verification of your insurance benefits if you’re eligible for the in pen. Here’s a funny one. Because Jenny and I know what we did last week. Jessica, who’s another top fan? Jessica, thank you for being a top fan on Facebook says how do we concur? Or how do we handle a fat protein rise? When we know the blood sugar will rise again due to like Chinese food or mac and cheese steaks, burgers, etc? How do we learn how much to give at that second rise? And this one’s an easy one for me to answer. I get to say, Go back a month to the pro tip episode about fat and protein. So you probably have heard of an easy answer. Just like yay, we finally got one. We don’t have to do anything for Jenny and I just recorded an hour about fat and protein. So we’re not going to rehash it here. But you can go find that episode. Jessica will absolutely answer your questions. Let’s pull this one might be more like for me. Finally, ask Scott. Oh, yay. Actually, let me say this before I move on. One of the nicest replies in this one that made me feel really good about you know what the podcast does is Jessica said, goodness, you all do such a good job of answering questions that I didn’t even realize I had. So oh really great. Like I was like that’s that’s wonderful. Yeah, that made me feel good. That is awesome. Yeah. So okay, here we go. Scrolling. Megan. Megan says, when you talk about crushing a Hi, can you please give an example in a little more detail. For example, if my eight year old daughter finishes eating 45 minutes ago, had finished eating 45 minutes ago, and she’s 220 double arrows up. I either miscalculated the Pre-Bolus, the insulin or both? I love hearing people like they’re mimicking the like the words in the pockets really makes me feel like we’re getting through to people. How would you determine how much to give? This is Jenny’s gonna laugh? Because my answers gonna be so just basic. And if and in how much time? If she’s still going up? Would you? How would you When would you determine to give another Bolus, same amount this time, etc. So she’s talking about like, how to stop this like a blood sugar flying up? My daughter’s let’s hear Scott’s response. Responses just give her more insulin? How much more? I don’t know. But more than you used the first time, that’s for sure. Okay, so this, to me is one of those trial and error things. It’s where you have to use the information that you have from the past to make a decision today. And oftentimes, it’s information you don’t see as valuable. That’s why I always tell people, anything that happens. Anything that happens with diabetes is never a mistake. I know things don’t go the way you want all the time. But if you you can’t step back and go, Oh, I screwed that up, or that really didn’t work. You have to break it down and say, Okay, here’s what I did. Here’s where I put the insulin. And this is how much I did. This is what happened later. That’s the information that will tell you next time when my blood sugar’s to 22 up how much insulin will stop this. And you know, like and so there is a bit of that Megan, I think that you have to do it’s sort of pre work for you know, really kind of breaking down what you’ve seen in the past now. I can tell you how I do it. But the numbers are there meaningless to other people, right? Like how much insulin I would give Arden to stop a 222 hour show up first of all, Meghan and I don’t mean to brag but I don’t see a lot of two arrows. But but that I mean might be what you really need to look into like how are you seeing two arrows like how far off were you in amount or timing it could have it should be to arrow should say to you significant miss? Like I really missed somewhere. You know what I mean? Now

I can bring in what due to what does two arrows mean? We have a CGM. And you’re seeing two arrows. What does that mean? That’s a rate of change of at least three points. Plus, per minute. Yeah,

it’s flying. So

it’s a quick rise, just to define that.

It’s at least three. By the way, I know we’ve all done the thing. We’re Dexcom says 215. And then five minutes later, it’s like, 227. You’re like, whoa,

right. Right.

Right. So Right. There’s two thoughts in here. Megan, first of all, the one is sometimes you know, sometimes the arrows can, you know, throw you off a little bit and I like to look at the pitch of the line. I know that sounds may be strange to people but a a more gentle rising more of like a slope. I describe it as for people have seen the prices, right. It’s the it’s the, the unity, who the guy goes up the thing and like you’re guessing things, and then you know, the fall is little pickup, right? And the whole time you’re watching it, you’re like, Oh, the little like, is it Switzerland? Is that what I’m thinking of? I almost said Swedish, but that’s the Muppets. So it’s Switzerland, and he’s going up the Swiss Alps, they’re in this real steady climb, and you spend the whole game thinking he’s gonna stop, he’s gonna stop and he never stops, he falls off the edge and you lose. That’s what happens when you watch that line to me like that slow growing, but steady upward line that went to me says Pre-Bolus was probably pretty good. Not enough insulin, right? And so because if your Pre-Bolus wasn’t really good, you’d be shooting straight up, like, like, and so to me that the line is, the answer is helpful. Yeah. Is it? Is it going up? Quickly, but still on more of a diagonal? Or is it like shooting straight up shooting straight up? You missed on everything? How much more do you put in the back? Like, I don’t know how to answer that question. But I would I I’ve always said on the podcast I start with, when I need more insulin, back in the day, I would Bolus, like what what you would consider to be like life saving foods, like they were going to be eaten. So if I had a juice box that had 15 carbs in it, I’d say to myself, how much would I Bolus for this juice box? If I wanted her Arden to drink it as an enjoyable thing and not drink it as a way to stop a low blood sugar? Whatever that answer is for insulin. I know I can put at least that much in, right because I can cover it real quickly with a juice box. But you’re looking at a 220. So in my mind, you’re stopping the momentum, you’re stopping you’re covering a number, you have to account for the amount that’s still going to rise before the insulin kicks in, like so you can kind of do that calculation through your head and go Alright, well listen, I think like say 220, a unit of insulin would bring it to 20 back to 90. So I go, Okay, I need a unit for the number. Now. I got to stop the arrows too, right? So I’ll stop the arrows that probably going to take a unit. And she’s gonna go another 50 points before this thing even slows down because I’m two hours up. That’s how I sort of do the math, math math for me. Right. So Megan, I can’t tell anybody how much that is? I can tell you the answers more. And I can tell you that you can do it in a way where your safety is how do I catch it on the way back down again. And I think that this is scary for people in the beginning, especially probably with kids or adults who are by themselves. But there’s so much to figure out about this. And when you do figure out how to stop one of these things, the information you’ve learned that leads you to stopping this and bring it back level without a low. It will help you for years. And all other aspects of diabetes. Like when you really understand how to manipulate the insulin and smack that that high blood sugar down. It’s It’s It’s the stuff you’ll use forever. I think a gentleman might have a technical answer for this.

Oh, well, let me and maybe a little bit more technical, because I you know, from what we all figure out by by experimenting on ourselves, we do. I mean, that’s you’ve figured out many of the things that work for Arden, because of like you said, you do something you see the impact. And next time you’re like, Oh, it worked but not quite enough or it worked way too heavy. So let’s dial it back or let’s dial it up. And while there’s not really math there, there is an intuitive math that you’re kind of using, right? If you really are trying to use a math to work this issue out. One she’s right in considering Well, what was the problem to begin with? Okay, if you’re getting a pretty quick rise up, as you said, it’s probably the timing of the insulin in the Bolus. My my assessment would also be it’s likely that the insulin to carb ratio is probably not quite right either. I mean, if it’s still 45 minutes later When the insulin really should be getting active if there wasn’t much of a Pre-Bolus To begin with, if it’s still shooting up with a double arrow, there was missed insulin there as well. Right? How much one good and very, I guess, conservative way, if you wanted a conservative, you know, look of how to address how much is plugged into the pump. And see what is the pump recommending for this 220 blood sugar. Now, the pump doesn’t know that there’s a rise still happening, it just sees a solid, like written in rock number, right? And so you can utilize that and see, well, the pump is recommending you know, for a kid, it might be recommending something like point to your thinking will point to God, it’s like a drop in the bucket, that’s totally not going to touch a double arrow up with a 220 blood sugar. Okay, so intuitively, you know, something isn’t quite right there with what the pump is recommending, nor does the pump know that it’s still ascending. It’s such a crazy climb. So there’s where you can learn by saying, Okay, I know what the double arrows mean, the double arrows mean at least a climb of three, possibly more points per minute. So in the next 30 minutes, if you have a double arrow, and you do nothing about it right now, in the next 30 minutes, your blood sugar could be 90 points higher if you did nothing, right. So if you plug that number in as again, a way to use the math that’s already programmed in with all of the ratios into your pump to 20 plus 90 Gets you What 310? Yeah, right, if you plug in a 310 blood sugar, and you ask the pump now to say, okay, what are you going to recommend for a Bolus? Now to correct this, you were going to get a more robust recommendation. Right. So that’s a conservative way, it’s not quite as bold as you would attack it with. But if you’re trying to learn, it’s a more conservative math way of figuring it out. And learning from it. Okay, you took the extra that the pump now recommended. And now I’m watching and the arrows have kind of angled and oh, it’s now plateaued. But this is like that. It’s another like 60 minutes that it took, because you took this conservative amount, right? So next time, be more bold, right?

Because that can very easily lead to actual stacking. Yeah, so the difference between No, and let’s add stacking to our defined diabetes list to that’s a good idea.

That’s a good one.

So I, I got some feedback about the podcast once where this gentleman said to me, we the day I said, it’s not stacking, if you need it, he said changed his life. But it’s not stalking if you need it. So but if you put in, in this scenario that we’ve built here, if you put in a half a unit, and then wait 20 minutes and put in another half, and then get frustrated, and wait a half an hour and put it in a unit, and now it’s fit five, or you know, and next thing you know, you’ve put in three, four or five units over this hour and a half period, that is that you are going to get low later. But if you actually needed, say you actually needed three of those units. If you took it all up front, right, it wouldn’t you wouldn’t be stalking you. Because now because the impact of the insulin would be lined up with the with the carbs and what the carbs are doing right now. So the action of the carbs, the impact of the insulin are going to be lined up against each other, they’ll get to that fight we talked about, then they’ll all kind of dissipated the same time. But But thinking about the idea that insulin you use right now is for later, you keep adding later and later and later it keeps layering over top of itself. Eventually those layers are all going to be on top of themselves at the end of this timeline. And that’s where you get low. So I like crashing up front because it also stops stacking it stops slows later. And if you are drifting low after crashing a high blood sugar, they are much easier to catch without loads or rebound highs if you haven’t stacked Yeah, if you haven’t checked if you stack Absolutely. Now you’re stuck guessing how do I feed this insulin and not? Which one

is actually which dose was actually causing the drop? So how much do I use to treat

yourself a problem is what you’ve done. Yeah. A huge thank you to in pen for sponsoring this episode of The Juicebox Podcast. I hope you’ve enjoyed to ask Scott and Jenny as Jenny and I have enjoyed bringing it to you. Don’t forget to find out more about in pen go to companion medical.com There are also links in your show notes and at Juicebox Podcast comm I’m going to take the rest of this time to remind you that I have a Facebook page. It’s called bold with insulin. It’s on you know Facebook, because that’s where you keep the Facebook pages. Now there’s a public page you can go to bold with insulin but once you’re there is also a discussion group right? You got to kind of answer a couple quick questions that get in there so we know who’s in there. And there you’re going to find listeners from the show just like you talking about ideas about management supporting each other. It’s very cool. You should check it out. I’m also on Instagram at Juicebox Podcast the Twitter if any of you are still doing that. Where else I don’t know. Pinterest. I’m really I mean, I’m gonna be honest we I don’t put anything on Pinterest last thing thanks so much for your wonderful ratings and reviews on Apple podcasts or wherever you listen means a lot I really do like them I say it means a lot a lot. A lot a lot. A lot. I say I say it a lot so I don’t want you to think I don’t mean it because I really do I say it a lot because I really mean it. I want you to know I also now wondering how many times I can say a lot before the music ends. Oh Joe, jeez, almost forgot. Check out Jenny at integrated diabetes.com Or there’s a link in the show notes to her email address but integrated diabetes.com is where you can find Jenny Smith. Let her do the Voodoo that she do on you do a lot

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to Always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. MDI users, this one’s for you. How would you like to live your life less complicated? You can do that within pen in pen is a reusable injector pen that has its own smartphone app. They talk to each other through the Bluetooth. that Bluetooth is magic, isn’t it? You know what the app does? I’m going to tell you a lot of battle over the next few weeks on these Friday shows. But for right now, dose calculator dose reminders reporting actually tells you if the temperature of your insulin has gone out of range. Not only that, it connects to your CGM. Ooh, I got you there tonight, an app on your phone that connects to your continuous glucose monitor that connects to your insulin pen. Now you want to know more about indepen don’t you? Check out companion medical.com. Welcome to ask Scott and Jenny. In today’s episode, I Scott and Jenny Jenny Smith from the diabetes Pro Tip series in defining diabetes. You know Jenny, Jenny works at Integrated diabetes. She’s a CDE, a registered pump trainer CGM trainer dietician, she has type one. Her favorite candy is dark chocolate peanut butter cups. And if Jenny was a professional baseball player, she’d be Hank Aaron. In today’s episode of the show, Jenny and I are going to be taking questions from you the listeners. In this episode, we’re going to talk even more about understanding standard deviation and absorption times for loopers. Now that absorption time for lupus thing, don’t get confused and think if I’m not looping, this doesn’t work for me. It’s also going to be able to inform you about how to understand your extended boluses. Trust me, it’s all about timing and amount. mirdif asks one interesting journey after we did standard deviation in a defining diabetes. I get this question a lot now. So obviously we there’s something we didn’t say there. We caused more questions than then

then I think I read this one, what three day

target for standard deviation? And if you set your targets tightly for alert purposes, will it look like your standard deviation is greater? Will that not affect the value of murder? We did talk about this in the office? Because I’ve had the same thought. But I won’t. Yeah, I’ll let me go over it one more time in case we missed something in that episode.

Yeah, so standard deviation really speaks to the variance up down. So even if you had your target set, let’s say, in your CGM, you have your target set from 80 to 120, let’s say a very tight target, okay. But you have this roller coaster that’s happening this up, down, up, down, up, down, up down, you know, from, you know, on the low end, maybe in the 50s. And on the high end, maybe up to like the 120s, you’re still you’re going to have a higher standard deviation, because the variance even within that target that you’re still meeting, you’re still having a roller coaster. Now the standard deviation is going to get higher. If you have more variance, let’s say even if you’re your target is that 80 to 120. And you’re going from 50 all the way up to 300. And way back down and way back up to 250 and back down, then the standard deviation is even going to be larger than it was with a roller coaster within a target. The aim for standard deviation. I’m always kind of cautious to say we’re aiming for a standard deviation of this solid rock, you know, this one number. The lower the standard deviation, the better. That’s that’s the easiest way to say I mean, if you’re looking at a standard deviation of 70, you’ve got a heck of a lot of variance you do. Your CGM graph probably looks like a roller coaster at an amusement park, right? That’s not what we want to aim for. Even within a tight target. You still don’t want all of this happening. You want more gentle rolling hills from you know within less or within a tighter range, right? That’s going to bring the standard deviation down. So if you have you know, a target range set from 150 to 180. And you’re meeting it and your standard deviation is 21. That’s a beautiful standard deviation, but your target is leaving you high. Right? So you’re doing a good job of keeping things to a minimum as far as excursions, but you just need to ratchet your target down to keep that same low standard deviation. So I hope that makes sense. I’m going

to share what we do because it’s by no means the rule but it’s a place where I’ve become comfortable with living life and finding a balance. Right. So Arden’s target is set at 70. And 120. I’d love to be between 7120 as much as possible, it’s not as much a target as it is. alarms for me, like when do we have 120? So I know what to do, right. I love for Arden standard deviation to be lower than it is. But in honesty, I tried just not to go over 40 Like that’s like, and that’s not great. Yeah, but it’s, it’s I shoot for more like 35 I try not to go over 40 If you look at Arden’s graphs, they’re interesting in that 18 hours of the day, her blood sugar is like 80. You know, most of the time, there’s two meals that are varying cause a variance Right. And, and she’ll jump up usually, it’s like 181 60, conventional pumping, I was able to get down a little more quickly. But we’re doing now not as fast. But conventional pumping, I didn’t have 18 hours of ad that was solid. So in my mind, it’s a bit of a trade off, and I’m learning how to do the meals better. I think that you should think about standard deviation more in the context that Jenny put it in. You don’t want it to be 70. Not good. Right. But if you’re shooting for 20%, or something like that, probably not that realistic. So I’ve heard under 40. I don’t know where I’ve heard that from is that a reasonable like Mendoza line for

under 40? Absolutely. I mean, if you’re really it, I usually with the with the people that we work with trying to aim for, you know, the 30s or without consistently running just way too low with little deviation, the 20s can be great, as long as like Arden is kind of hovering at that at with little deviation. Great. That would be awesome. You might be in the 20s. But you know, 30s is kind of where we aim. Overall, with a little bit lower or whatnot. Depending on what situation in life you might be at two, with the women that I work with through pregnancy, we aim lower, tighter overall everything.

Let me give you an example because I’m looking at a live grant for art and for 24 hours, right? So in the last in the last one day Ardens a one C has been 5.8 with an average blood sugar of 119 that put our standard deviation at 42. Now if you go out over 90 days, Arden’s averaged a one C is 5.6. Over 90 days, her average blood sugar’s still 115. But her deviation will probably go up. It does. So it goes it says 45 Over the last 90 days now we are still learning some things and so we have some more prolonged blood sugar’s but for instance, in the last seven days, her standard deviations 38. Right. So as I get better at it, you know, over the last 90 days, because you know of this loop thing, you know, you see it come down, I will get the deviation consistently under 40. I think it’s going to be more consistently like 35 Once I figured out the meals, but then, you know, I think Jenny’s Right. Like once you have the tools in place and things are working. I see standard deviation not as a target. I see it more as See, I don’t want to call it a report card, because I don’t mean it like that. But I think of that more something you look at later to say, oh, things are getting better, not something right day to day. It’s like a comparison

almost to say this is where I was this is where I am now. Oh, it looks like it has improved.

I would look at if you’re looking day to day, I just look at average blood sugar, and I try to keep it lower. And then I look at at deviations like high high deviations. Obviously I don’t want a low blood sugar. So I don’t have a lot of problems with lows. But I don’t want to see big spikes that lasts too long or big spikes. Right. So Meredith, I hope that answers some question and then I’m about to tell you something about in pen. And I think I should first warn you it’s possible the information could blow your mind. So I don’t know what you want to do put a hat on or hold your hands in the side of your head or something like that, but When you Bolus within Penn say you’re having some food, right? And you look at your plate and you’re going 10 times, you decide that’s 35 carbs, you go into the in pen app, tell it 35 carbs, and it tells you how much insulin to inject, right? Hold yourself tight now because the here’s the rest of it. Now pen users, no, you have to prime your pen a little bit. So you prime the Impend, and then dial up the insulin that the app tells you, let’s say it tells you a 3.5 units, you inject those 3.5 units, the in pen actually can see the difference between the prime and the 3.5. And it doesn’t. So you know, I’m saying like, when it’s calculating how much insulin you have, it’s not saying like 3.5 plus the priming amount of insulin it know, how does it know? The fascinating, right, like just boom, I don’t understand. I mean, for a pen user, or somebody who’s doing injections, this is an incredible leap. Your insulin on board is being kept by an app on your phone. And it can see the difference between the priming of your pen and the Bolus. Get out of here. You obviously need to know more companion medical.com. There’s links in your show notes at Juicebox Podcast comm. And one more thing, starting I think next week, maybe the week after these ads are actually going to be a conversation within pen user and world champion, paddle boarder, Fiona wild. Fiona is going to tell us what she loves about it. And it’s enough of me telling you what I can, you know, read in a PR kit. Let’s hear from a real user. I’m wondering about carb types, oh, entering into a loop. I get confused about what to put when I’m eating a combo meal. For example, what if I’m having pizza and fruit or a burger and veggies or, you know, like yogurt fast carbs plus protein? She said I thought maybe since Jimmy was a dietitian too. This might be something she can help decipher how to Bolus for different combinations. So what Matty’s bigger question is and how this will work out for the rest of you is she’s really asking about absorption time, I think in loop right, to

an glycemic index to a conventional pump system. Yeah, in game

conventional pump system, it’s going to be glycemic index. And the idea of extending boluses or temporary or something like that. So it’s, it’s crap, slightly different tools, same reason. But to give people context, you don’t listen, who don’t use the looping system, you will tell the loop Hey, I’m eating 35 carbs now. And then you have to tell it how long you expect it to be in your system, how long you expect it to take to absorb is that one hour, 30 minutes, two hours, three hours, like that kind of thing. If you get that absorption time wrong, when you put the setting when you put the carbs in the loop, it really big causes a lot of high blood sugars when you get it wrong the wrong way. So do you have any thoughts on this? Because I’d actually love to hear them. I’m gonna sit back and listen like a listener for a second.

It’s a very good question. I think that the icons that are within the fast moderate and slow groupings, if you are a looper and using them are defined by like a glycemic index nature, right there fast ones are going to get absorbed pretty quickly loop says they’re two hour moderate or like a three hour really slow, which would be like high fat, really high protein kind of meal would be a slow absorption, right? icons like a lollipop, a taco or pizza. Okay. Now, most mixed meal, she brings up a good question. Most mixed meals that are a content of carbohydrates, and protein and fat and healthy fiber. Good example being something like grilled chicken, steamed veggies, and maybe like quinoa or brown rice or something like that, right? That’s a good mixed meal, a three hour absorption would be a good place to start. It’s mixed. You’ve got a little bit of everything. Now, on the flip side of that, let’s say you have like a thumb size of grilled chicken, one broccoli spear and a plate full of brown rice. Hmm. Question time there is based on the content, right the content but the portion that’s the glycemic load. It’s not only glycemic index, but it’s the amount if you’ve got a plate full of high index carb that you’re eating, very minimal little other things that’s no longer a combination meal. That’s more like a two hour that’s like it’s fast now rice is as an example in this can be a can be a bad example because some people’s experience with rice can be longer impacting same thing with pasta. Some people get really quick impact from pasta some people get really like long drawn out. And I mean if I went into it further, some of It has to do with cooking method and again what you eat with it and whatever. But in a simple answer, most combination meals that are not heavy simple carb should be about a three hour absorption for our absorption would definitely be those Merle meals like she’s saying, let’s say I’m eating a big old cheeseburger and french fries but I’m also having an apple on the side, that’s still a fairly long digesting meal. A trick or a tip that might work it let’s say you’re eating the apple First eat the apple, put it in as a 15 gram you know kar Bolus absorption two hours. And then when you go ahead and Bolus for the rest of the combo meal, or go ahead and rest as the rest as a four hour absorption. That way, you’re kind of addressing both types of food and the way that they may be being digested because of how you’ve kind of eaten them. Whereas the apple at the end of the meal sitting on top of the burger and the French fries and whatnot. Group it in and to for our absorption.

I was gonna I was gonna say to rice so at home. I only use a basmati rice. It’s okay, and that does not impact Arden nearly like if we were to go to a Chinese restaurant, she was just going to grab like white rice, right? It’s just it’s easier. You know, bread with no high fructose corn syrup. Great way to cut yourself a break. And pasta, I use dreamfields It does not hit Arden nearly like other pasta does. Both in intensity and time. So there are sort of ways to like cheat around it with certain foods and what you said about about cooking methods I just made I just made another another note for myself about something we could talk about in the future. Because that’s really interesting. Ask Scott and Jenny was brought to you today buy in pen from companion medical, please go to companion medical comm or click on the links in your show notes of your podcast player, or the ones you can find at juicebox podcast.com. For more information. Just think about what it would mean if your insulin pen could keep track of your insulin on board and so many other things. Just like a pump. The impact is fantastic. It’s like that little train that just keeps going get any mean climb and Chugga chugga chugga that thing you don’t I mean, it’s like no stopping us. Now that’s not the train. But if the train could sing, you know if the little engine that could could sing I imagine it would sing ain’t no stopping us now. What would that even sound like? I’ll leave you with that thought. As it fills your head all day long and torments you. You know what? That’s not fair. You need to get that out of your head. Do this instead, think about this companion medical.com with links in your show notes for juicebox podcast.com

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please 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 healthcare plan or becoming bold with insulin. MDI users, this one’s for you. How would you like to live your life less complicated? You can do that within pen in pen is a reusable injector pen that has its own smartphone app. They talk to each other through the Bluetooth. Bluetooth is magic, isn’t it? You know what the app does? I’m going to tell you a lot about it over the next few weeks on these Friday shows. But for right now, dose calculator dose reminders reporting actually tells you if the temperature of your insulin has gone out of range. Not only that, it connects to your CGM. Ooh, I got you there tonight. An app on your phone that connects to your continuous glucose monitor that connects to your insulin pen. Now you want to know more about in pen, don’t you? Check out companion medical.com Welcome to Ask Scott and Jenny. In today’s episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes. You know, Jenny, Jenny works at integrated diabetes. She’s a CDE, a registered pump trainer CGM trainer dietitian. She has type one. And if Jenny was a blanket, she’d be a quilt that you’ve had for like 10 years that’s heavy and soft, warm, but does it make you sweaty, all at the same time? That’s what Jenny is Jenny’s an old quilt. In this episode, we take two questions from you the listeners and I tell a little story about Arden’s YOLO experience. Today, one listener asks, How soon is too soon for an insulin pump? Do you really need permission from your doctor to do something like that? And the next is about basal IQ and how it seems to mess with your extended boluses. You tandem people are going to be up for this. It’s also kind of a looping idea. Honestly, it’s an algorithm idea. Arden I just made up all this that after after I pushed the FTC pushed a button I was like, Huh, I wonder if this a killer? Probably not. We’re gonna be fine.

Buffy a good meal. Yeah. Well, it’s

a weird confluence of situation. So today was like picture day. And so she goes in, they get out of the room, you know, you know, for picture day. And then they start to see in the cafeteria, and she’s like, Can I just grab a muffin real quick? And I was like, Yeah, sure. So I’m like, what kind do you think you’ll get? I don’t know. And I said, Okay, well, why don’t you put 20 carbs in now? And you know, let me know what you end up with. And she’s like, Okay. And I swear to you, eight seconds passed, and she says, I got a chocolate muffin. I was like, Wait, did you were you standing next to it when you were texting me? Like I didn’t understand. I thought she was like in a classroom, maybe thinking of going to the mosque, you know? Anyway, I’m like, Okay, well, you know, we put the rest of the the insulin in. hour and a half later, can I get a chocolate milk? And I was like, sure. What are you thinking of doing that? And she says, I already bought it. And then she goes YOLO and I’m like, you only live once? Is that the message today? Alright, so we Bolus for the milk and I thought everything was going great. And about maybe I’m gonna have to say 45 minutes after the milk. It just went a little curved up as like, Oh, 125 diagonal, a blitz. Just boom. 141 straight up. I was like, Ah, so I texted I’m like, hey, lunches in like, 15 minutes, right? She said, yeah, it’s like we’re in a bolus now like, really heavy right now for it. So we did, it caught the up arrow at 177. So it’s 177 diagonal up now. I just I can’t wait to see what happens then afterward. She’s like, I don’t know that I’m that hungry. And I was like, Oh, good. Good. Everything’s gonna be fine.

Don’t you worry.

I’ll get another one of those chocolate muffins and some chocolate milk for later.

If you get a juice box in your purse, right? And she said, Yeah, like, okay, it’s gonna be fine. Good girl. See you later. Yeah. Anyway,

have a good day. Oh, sure.

Go get them killer. So I don’t know what’s gonna happen. We, uh, Jenny, I think we are going to keep going with ask Jenny.

Okay,

I’ve changed it to ask Jenny Scott because I started feeling bad about myself. Now, some of the questions came in that were directed. Okay, let’s do this. Okay, so Rachel says, this one’s interesting. She said My son is seven years old and he’s had Type One Diabetes for only seven months. He still honeymooning pretty hard, and is only using two units a day. I spoke with our CD who she loves when she mentioned waiting until bazel needs are greater. But I’d really like to get a pop. But it sounds like it’s not a good time yet. Any thoughts or advice? There are time that I think I get this, right if you’re if your basal needs are so low that a pump can’t approximate them. You can’t use a pump, maybe. But I don’t know. You know what I mean? Like, I’m if you want a pump, I think you you can find a way to do it. And I’ve seen people find different ways to do it. What do you tell people in this scenario?

Right? Well, I mean, you know, to you, and it’s an hour or two units a day of just the base bazel is essentially what she’s saying that she’s or her child is on, right? So really, I mean, even if you divide that into 24 hours, it comes out to a basal rate of point 08 an hour, which in pumps usually do either point 025 or point 05 per hour, right? So technically, yes, there’s definitely at a point that they could be using a pump, I would recommend if they are looking at a pump to get a pump that has the ability to have increment of probably the point zero to five or even the point 05. But with the ability to have the point 00 as a bazel. segment.

Good pimps do that, at this point.

All pumps on the market. Do that at that, at this point, Omni pod dash does that at this point, but not the current PDM pod. So if they wanted a tubeless pump, they would have to choose the gas pump to begin with because they couldn’t get less than point 05.

Rachel’s question makes me think, I don’t know, maybe I’m cynical. But sometimes I think doctors are just looking for an excuse to tell you something like, Oh, you don’t use enough insulin yet. You don’t need a pump. Like I know a lot of doctors add just these arbitrary lines on things like you have to do this for a year. And then we can give you a pumper. You know, I want to see this many a one sees in a row, or the one that always fascinates me is you’re not taking

any stable.

Yeah, you’re not taking care of your blood sugar correctly. So we’re going to take the pump away from that one fascinates me. And I’m like, okay, just so a lot of this doesn’t make sense to me, a lot of this always makes me think about my experience, where we asked for an omni pod at our pump training. And we were told no, you don’t want that pump. And they were adamant about it and threw a ton of reasons at us, right? Your daughter’s too lean? You, you know, I forget there was all these things, you have to carry this thing with you like they did everything they could to get me not to try it. We tried it anyway. It’s a story I’ve told in the podcast. But then a number of years later, we were told by the hospital Hey, listen, we apologize for trying to get you away from this, but we just didn’t understand it. We didn’t want you using something we couldn’t support. So instead of saying that, it was excuses, don’t do it because of this, that this or all these things I thought about. I wonder how often that happens to people because Rachel’s predicament is interesting in that a pump could accommodate her kids based on needs.

Yes, so it could are they going to change because they’re very early in this, they’re going to change. But the benefit of the pump, outside of an injected amount that you can’t change, once it’s there is that you can adjust the pump right now, you can adjust the bazel. And with the ups and downs that are coming, so soon in a diagnostic era, you know, in a diagnosis time, the pump could be very advantageous.

That seemed like a no brainer to you really, because you could go off, you could set basal rates with insulin for hours at a time. Like that just makes sense. Correct? Yeah, right. So I always tell people, look, it’s your kid, it’s your diabetes, whatever it is, you know, you’re not asking. I know it feels like that in the doctor’s office, you’re asking for permission, but you’re not you say look, I want an insulin pump, write the prescription. And if they don’t want to write, I say find a doctor that wants to, you know,

but Right, exactly. Find somebody to support. It’s kind of like you’ve mentioned before, just with the as a supportive component, if you’re being told that you are not well, well enough control B on a pump. That doesn’t make any sense whatsoever. It’s also like the offices that only prescribe one brand of pump. Well, the reason that they do is because they’ve only been educated on that and they’ve got to a comfort level that they don’t see the outside they are on this narrow path of must prescribe this pump because that’s what we’ve been taught to do. But that’s not addressing people’s individual needs. It’s not aesthetics with a pump, pump, are chosen by the user for very specific reasons. And when you as a user like up this comp isn’t fitting my need anymore, I’m going to go on to this other pump. I mean, that’s what I did. Originally, I was on an animist pump. I had started Doing triathlons. And I was tired of disconnecting. I was tired. And so I had a friend and she was like, Hey, you can wait just a couple of months, there’s gonna be this great tubeless pump that’s on the market. And I was like, really? She’s like, yeah, she’s like, I can get you connected with a rep and talk to him and everything. And I didn’t from there on it was Omni pod. Because, you know, it fit my life.

So, and I know people who for instance, love a T slim, and aren’t looking for an omni pod. And good for them, you know, but yeah, so Rachel, don’t let your doctor make that decision. I think you can. I think you can do it now. Right? I guess speaking at t slim Bailey says. My question is, if there’s any advice for those of us with the tandem x two with basal IQ, says we when we extend a bolus, it almost always cancels that before the extended bolus is finished, because it predicts we will reach 80. But then we do the math and dose the rest because obviously, they call it the insulin. Oh, but now we have to remember to do that. You know, that’s a that’s my world with looping right there in a nutshell. So I think what we’re talking about here is this algorithm based, you know, system, all these systems are making, you have to understand because they’re working by adding and subtracting insulin, they don’t have a way to magically make your blood sugar come up. So they are trying to keep you from getting well,

right. Um, and the basal IQ specifically is trying to prevent a blood sugar less than 80. So really, you know, it predicts out into the future over the next 30 minutes where the trend in glucose is coming. And visa like us job is only to suspend and prevent a low it’s a predictive low suspend. It’s not quite there. declaration just called I think it’s control IQ is what it will essentially be. But their their basal IQ is essentially just to prevent a drop. So with the extended bolus, they’re correct. What ends up happening is, if the trend in glucose is coming down with that extended bolus going days, like you kicks in, and it turns off all ads, not just to bazel. But it also cancels that extended Bolus. So to get around it, extended boluses from what our our user in the office, our educator in the office, who uses tandem and has used it a long time herself, for extended boluses, she recommends turning basal IQ off when you’ve got that extended bolus going. Because it’s it’s kind of just allowing the extended bolus to work in a time period for what you know the purpose for it being there, right? You’ve used it before, you know, you need to use it for this purpose. You don’t want the bazel or any insulin to be kicked off, because you know how it’s supposed to work. And so none of these systems are 100%. Perfect. None of them are cut and dried and forget about it. So what you just said turn off the predictive system. That’s the same as in a looping scenario where I would open the loop because I want the loop to stop working for a little while because I’m trying to bring a blood sugar down. Okay.

All right. I think I lost you. I don’t think I can hear you. Did you lose?

I hear you.

I was shaking my head. I do not even have to remember nobody sees this. They hear it. So yeah.

That was like, Oh, we’ve lost our audio. Anyway, I think I think Jenny’s description is perfect there is that there? There’s just some things that these algorithms can’t see. Right? And variables are only one of them. And so you, you’re gonna have to be you know, one of the things I end up telling people about looping is you’re still got it you still have to be involved. It’s you It’s not gonna be like set it forget must interact. Yeah, you’re still it’s just a different different interaction.

Interactive system. You just get Yeah, it’s just different.

Yeah. Thanks so much to in pen for sponsoring this episode of Ask Scott and Jenny. And don’t forget, please, that you can actually hire Jenny. She works at integrated diabetes. There’s a link in your show notes and there’s links at Juicebox podcast.com. But you really just need to go to integrated diabetes.com. Go to the staff find Jenny, there’s her email address, and you’re on your way. Alright, little bonus here at the end compliments of in pen. Now in pen, of course is available at companion medical.com. There’s also links in the show notes. And what you get when you have an M pen is an insulin pen that speaking to an app on your phone. What you get from that is all of the functionality. Well, almost all of the functionality that you can get with an insulin pump. You can’t mess with your basal insulin obviously. But the other stuff like insulin on board, helping you with your carb ratios when you’re doing meal boluses. All that’s right there. And as you know, these episodes for these couple of Friday’s here are going to be sponsored by in pen. Part of what you’re going to get is little snippets of a story from one of their users. Fiona Wilde, who is a professional, wind surfing, paddle board. She does something on the water with a big board and sometimes she has a stick in her hand. But what she always has in her backpack is there in pen. So here’s a little bit about Fiona’s diagnosis. And then of course, in a few weeks, you’ll hear the entire episode with Fiona companion medical makers of the in pen brings you this story with Fiona Wilde. And there are links in the show notes and Juicebox podcast.com. If you’d like to check out the in pen for yourself.

Hey, this is Kiana Wilde and the Juicebox Podcast is super cruzi.

When you’re first diagnosed, I’m assuming you leave the hospital with like, like pens or syringes and insulin and a meter. Right. That’s about it.

Primarily, because I didn’t really think that anything was you know that wrong? I knew I wasn’t feeling great. But, um, basically, I just went into my family care doctor. And, you know, I explained that, you know, I hadn’t, you know, had dry mouth, I’ve been losing some weight, you know, I had that infection and this and that, whatever. And he looked at me, and he’s like, Is anybody ever tested your blood sugar? I was like, no, what, what is that? You know? And I was like, you know, thinking, Okay, all sorts of tests, you know, what’s involved? And he just pulled out a meter. And he said, let me prick your finger.

I was like, No, thank you.

Okay, and then he pricked my finger. And the number that popped up on the screen was 586. And I was all happy, because I just graduated high school that morning. So I’m like, great. What’s that out of like? 1000? And he goes, No. Yeah, I’m really sorry. But you pretty much have type one diabetes, tears, and I didn’t know what that meant. And, you know, I had no idea what diabetes let alone type one was. But I live in a small town and he pretty much said go home, because I just went to the doctor’s office on my own. He was like, go home, talk with your parents. And he gave me his personal cell phone number and was like, have them give me a call. And I can talk and you know, help you guys out if you need anything. So then that night, it pretty much I didn’t get any insulin didn’t do anything. I actually never went to the hospital. Because I was 18. So I wasn’t an adolescent. I guess I’m more just kind of strange. But um, yeah. So then I went, and the next day got connected with a diabetes educator. And she went through absolutely everything and you know, explained how insulin works, what diabetes is, and she was spectacular. And she’s the one, you know, who showed me how to prick my finger and how to, you know, calculate carbs and give myself insulin for that. And that’s when it all started. But the problem was that I was supposed to go to Europe to race for the first time, five days later. And I was like, oh, my goodness, you know, like, first go diagnosis. I was bummed because I was like, okay, like, obviously, you’re not going to go like, this is not my priority. Right? Now. My priority is my health. But then after getting influenced started, and like, you know, immediately coming out of the five hundreds, which is good. Oh, you went and spoke with my doctor. I was sitting there with my parents. And I was like, Okay, so, here’s the thing, like, I was supposed to go to England to race. My dad was already planning on coming with me. But you know, if it’s going to be any problem for my health, like, you know, please tell me and I absolutely will not go you know, that’s, I don’t want to put myself in any harm. And he looked at me and he goes, that is not the decision for me to make a it’s not gonna hurt you. So I think you can make that decision as a family. And I was like, Okay, dad, we’re going to England. And then we got on a plane two days later.

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please 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 for becoming bold with insulin. The pen is America’s only FDA cleared smart insulin pen and app system. In pen works like other pens, it’s just a lot smarter, you can use it in pen, like any other injector pen. The difference in pen is that it tracks each dose and delivers your data to a secure app on your smartphone. So finally, there’s no complicated math and no log book to update. In just a moment in pen user, Fiona Wylde is going to tell you a little bit about why she loves her in pen. And then we’re gonna get right to ask Scott and Jenny. But if you’re interested in finding out more, I urge you to go to companion medical comm or click on the links in the show notes for the ones that are available at Juicebox podcast.com. Welcome to Ask Scott and Jenny. In today’s episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes. You know Jenny, Jenny works at integrated diabetes. She’s a CDE, a registered pump trainer CGM trainer dietitian, she has type one, I bet you that Jenny’s the kind of person that would never throw a piece of gum in a wastepaper basket without wrapping it in a tissue first. Right after in pen user, Fiona Wylde tells us how her in pen helps her remember her basal insulin. Jenny and I are going to talk about your a one c test. What’s better? Is it the clarity report from Dexcom? What that tells you? Is that what they give you in the office? How do you know what the trust and what not to? It’s actually a bigger topic than you would think. And then in the middle of that Jenny ends up having her own question for me, which I answer.

They also give you your long acting reminders by take lantis. So it’ll give me a reminder of like, Hey, we need to take your lantis. And then you can record that in the app as well. So it says okay, I just gave myself X amount of units of lantis. Like it’s all recorded in there. And that’s good, too, because that kind of goes back to my thing of Oh, oops, yeah, I forgot to, you know, give myself an answer, give myself that. Because with pens, it is kind of easy to forget. Or it’s easy to just like give yourself insulin and walk away from it. Because you don’t have something attached to your body for the constant reminder. I definitely feel a bit more free, which is really nice. But it’s easier to skip some things too. And that’s why the in pen, make sure that you don’t skip steps that, you know, maybe are easy to forget, but helps you plan for the steps that you didn’t forget. And then it helps you plan for the future as well.

Okay, now, Jenny, this one’s interesting, because you said you wanted to do a pro tip episode about this, but it’s a

well answer the question maybe Yeah, the one I’m thinking of Lissa

asks, my agency in the doctor’s office is always much lower than my Dexcom. GMA, for example, my doctor said my agency was 5.7. But my GM for 90 days is 6.4. Which do you think is more accurate? Is that the one you were expecting?

That’s the one I was expecting. And it’s a very, very common question. In fact, it’s, it’s a question that I get a lot from also from people that I work with. They’re like, I see my CGM is telling me this and I went in and I got this a one c done. And my a one C is higher, my agency is lower. Right? So, you know, essentially, GMA and do you do Scott know what GMA stands for? Sure.

It’s gross mountain infrastructure. No, I don’t know.

Gi is glucose management indicator makes belts. Right. And if you remember with that within Dexcom for a while they had IE, a one c estimated a one C, right? Well, and then for a while, they got rid of any estimate whatsoever that was completely gone from any of your clarity reports. And then they they they did all of this, you know, hashing and thinking and putting together something new and they came up with this GM I termed concept, glucose management indicator and really what it means is clarity kind of has its own secret sauce, sort of algorithm that it takes your glucose within a range, you know, whether it’s a 14 day 30 day 90 day, and it estimates based on where your glucose trend has been within that defined time period. So one, if you are looking at a time period of 14 days, and you’re getting your GFCI, perhaps you’ve had really, you’ve taken all of the pro tips that we’ve done, and you’ve put them into work and you’re like, I am knocking this out of the ballpark, I’ve got this beautiful like looking average, it’s come down considerably. Your GM I, for that 14 day is going to look great. And then you go in, you get this agency and ah, e one C is higher. And you’re like, well, that, that doesn’t look great. Why is that? Well, the timeframe is different, we have to remember that a one C is averaged over a 90 to 120 day time period. Right?

So is that what 90 to 120? Because some people get it done every 90 or every 120? Or is it because no it because it bleeds into that period, right?

It has to do so 90 to 120 days is a one C is where a one c comes from mainly because of the life of the red blood cell. So doing a little biology for you, your red blood cell has hemoglobin attached. And when we look at how much glucose has attached, that hemoglobin part, we read a one c over the time period of life and have your average blood cell your average red blood cell which is about 90 to 120 days for most people. So we have this long timeline of how much glucose has kind of stuck there. And you can tell an average blood sugar value then based on that. So the problem is that of course, as we’ve talked before, a one c isn’t the end all be all of glucose management, right? It doesn’t give the time and range it doesn’t give how much variability you’re having to get that average it’s just a one spot check in right and same thing with this GMAT. The GMAT is also just an average of where your CGM data trend has been over the course of whatever defined time period you have populated into your clarity report for that evaluation. So if you’re looking at 14 days might look phenomenal. Or if you’ve been on vacation for 14 days, and you’ve been eating all of the pizza and Margarita is on the beach and whatever and not paying attention. You could have this high looking and you’re a one c could actually have been much better because your time period before that you were doing a phenomenal job. So therein lies some of the difference there. Um, I guess

I have a question. Wow. Okay. So imagining in your mind this, I think most of us think of it as a as, excuse me as a 90 day period, we had our agency checked and 90 days later, we do it again, if I had what, what you just described, not 90 days ago, but three more weeks past that if those three weeks were magical for me, my agency was five in those three weeks. And then the next 90 days, it was more like Melissa is describing it, you know, the GM is telling me the last 90 days was 6.4. But when I got it back, it was 5.7. Is it because some of those first 14 days might still be? Do you see what I’m saying? Like is the blood looking back further than my last doctor’s appointment?

possible? Actually, it’s actually waited, I think what you’re asking a little bit opposite. So if you the older red blood cells don’t have as much impact on the ANC value right now today as the ones closer to today. So if you’re a if your glucose was like, not where you want it to be three to four months ago, but in the past month, you’ve really reined things in and you’ve gotten it down and you’ve nailed it and you’ve got this beautiful looking standard deviation and everything is in range. This time period in the past month has more weight on actual a one C then 234 months ago because there aren’t as many of those red blood cells hanging around to give data point two does that make sense guys?

But then how is she seeing a 90 day GMA, that’s higher than her actually one say. So take her out of it for a second when that happens. What what’s the likelihood of the like what is like

if her well, and that could have relevance to accuracy that has her CGM.

I think I think Jenny hasn’t had a signal on her Dexcom for a while. Is that what that?

Oh, I haven’t. I’m really really annoyed right now. This is I actually called in a sensor. We talked about this. I called you yesterday really annoyed, right? So, um, yeah, and this sensor has been wonky since I put it in yesterday. I’m back numbers. And now I have signal loss. And I’ve had signal loss three times this morning attempting to reconnect, wait up to 30 minutes,

really put your phone up, shut off the Bluetooth, and then turn it back on again. So open your phone, close all your apps that you’re not using except for Dexcom. Where you can close them off you want right now for a second. And then you know that you can leave. Then go into your settings. Oh, yep. And shut off the Bluetooth. Yep, then turn the Bluetooth back on. Open the Dexcom back up. And then this is where I tell Artem because Arden wears her Dexcom sensors on her hips. I’m like shove that phone right up your ass. Just stick it right next to the to the next to the transmitter. And leave it there for a few minutes. I bet you it’s back in five or six minutes.

Okay, that’ll be awesome. If you are I see. Good to know people in the right places. Right?

I’m right about that. I’m amazing. So and by the way, you just said something. I’m gonna ask Jenny a question. I’m gonna make myself a note. Okay, so I’m so sorry, with where the heck were we with?

I know we’re talking about accuracy. Yeah, I and so that’s where some of that may have relevance. You know, I some people have really awesome consistent accuracy. They could do a finger stick occasionally. And they’re like, yep, my CGM is right on with that finger stick. But you know now in today’s world with G five, and now g six and whatever is coming out after this. with FDA approval without having new finger sticks. Many people literally aren’t doing finger six anymore. Whatever is appearing on their CGM is what they’re using. Well, unfortunately, CGM can be off. They may not be as accurate as what your true body blood glucose your blood cells are telling. So let’s say this person’s a one C is higher than the actual a one c comes out to be CGM, GM is higher. It could be that the CGM is actually reading higher than their true glucose trend is reading in their body.

Yeah, I’ll tell you that. Um, so that’s an interesting issue. And what it made me think was what if she’s she doesn’t say here, whether it’s a G six or a G five, right? What if she’s calibrating with a meter that’s less accurate than the CGM and she’s lying to the CGM and to the CGM, like. So there’s a lot of scenarios here. I’ll tell you right now, that’s why you have to put effort into getting whatever the best meter on the market is just get it I’m we have the,

the Contour. Next One, that’s

the one I have. It’s it’s I don’t think I’ve ever tested with that contour. And it hasn’t agreed with a CGM that I believed was accurate at the time,

the next most accurate is going to be the Accu check guide me. That’s another one. That freestyle light by Abbott also does a really nice job accuracy wise, I think within the first with the top five that are on the market, those three are within that as far as accuracy rating.

Because it’s small, and yeah, it’s it’s got a nice bright light. For me, it doesn’t take much blood to get it to go, No, and it’s got second chance, I forget what they call it. But if you hit some blood, and it’s not enough, you have like a fairly long

time period, I think it’s like 15 to 20 seconds to get another

prop on more time than you need. So. Okay, and plus, I guess the other thing we have to consider, too, is and Maddie comes in and says that a nurse practitioner at her work told her that the A ones c machines are actually allowed to be up to point 5% off. So even there, it’s just a bunch of things you don’t consider like what if it’s a little bit of all those things? You know, I don’t know that to be true. And

is it clear clarity? Therefore, the a one c machine would also be Is it an A one c machine that’s an office a one c where they do your finger stick in the office and derive it, you know, within the next 10 or 15 minutes? Or is it a lab value a one c? That would be a good clarification to make for which a one fee is allowed to be your have such variants

which would we prefer lab value right to for accuracy,

lab value

for accuracy?

What about the finger sticks? How close are they do you think? in the office,

the finger sticks can be a little off. I know my office when I when I used to see my endo in DC, they always did an office a one C and I always asked them at the same time to do a lab because I just I wanted I wanted the accuracy from it. There was always for me, my average change was about a point three. So if my agency was like, six in the office, it was usually like a 6.3 if it was like five Point either off, it was usually like a six from the lab value.

I’ll tell you how I think about it too. Like I listen, I don’t I don’t make any secret of an art and say when Caesar are fantastic, right, and they’ve ranged between five, two and six, two for over five years now, if we go in, and it’s five, two, and then three months later, it’s five, four. I’m not like, Oh, my God, I’m just like Arden say, once is great. You know, I mean, you know, I don’t see a difference between a six two and a six, four, you’re doing terrific. You know, like, it’s not a lot to knock yourself up over, you know, not an OT, and then can Ott. Cool.

By the way, I just want to let you know that your trick work. Of course, it’s all have data. Yeah.

Don’t you worry, Scott,

why not know that trick.

That’s how I got the podcast. That’s fine. Good, too. All right. So Jenny’s got her data back, we’re all good. And that’s a good Listen, there’s a good one for all of you if you’re using the Dexcom g six right now and you experience a signal loss and it tells you wait up till 30 minutes to reconnect close all the apps on your phone like crash them you know how to crash an app right? And then shut off your Bluetooth and settings. Wait a spilling off the wait long, turn it back on reopen the Dexcom app and then take that phone and stick it near the transmitter.

The transmitter if

people are apt to blame Dexcom which I’m sure they have culpability in this in some way or another but Bluetooth is a very in faxing problem call there’s a lot it’s a big part of this. So Bluetooth is is you know, it’s got its problems. So that’s why some people see better or worse results with different phones. If you’d like to learn more about the in pen, you can always go to companion medical comm where there are links in your show notes or at Juicebox podcast.com. And if you’d like to check out Fiona on Instagram, her latest picture is of her racing in China. She says it’s pretty cool to be racing at the 2008 Olympic sailing center. She’s Fiona underscore wild on Instagram. Fiona the classic way ephi Oh Na underscore, you know is like a dash but it’s lower. And then wild Wi l d. Check her out. If you’re on MDI and you want to stay that way, but you wish she had a little more control. Check out the in pan with your internet connection probably on your phone. companion medical there terrific. If you’d like some perspective on how not musical I am if that didn’t just do it for you. Consider this in my head. The tune to Sweeney Todd was playing when I did that. I know right? There’s no correlation whatsoever.

This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please 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. The pen is America’s only FDA cleared smart insulin pen and app system. In pen works like other pens, it’s just a lot smarter, you can use it in pen, like any other injector pen. The difference in pen is that it tracks each dose and delivers your data to a secure app on your smartphone. So finally, there’s no complicated math and no log book to update. I urge you to go to companion medical comm or click on the links in the show notes are the ones that are available at Juicebox podcast.com. Welcome to Ask Scott and Jenny. In today’s episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes, you know Jenny, Jenny works at integrated diabetes. She’s a CDE, a registered pump trainer CGM trainer dietician, she has type one, if Jenny caught a foul ball at a baseball game, she’d give it to your kid. Today, Jenny and I are going to talk about the importance of hydration. And we’re going to have an extended conversation about the impact that blood sugars have one function mood, and just living with Type One Diabetes, it becomes a really longer conversation than I expected it to. But we’re not just going to talk about how low blood sugars make you feel, but maybe why they make you feel that way. As well as highs, then I’ll kind of tell a story about art and seizure and actually cover something in my own health. It’s comprehensive already. Please 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.

I’m gonna ask my question.

Yeah. So Arden started school up last week. And first two days were great, you know, and then there was the weekend and then Monday came. And her blood sugar went up to like 140. I couldn’t get it back down. Then she ate and I couldn’t get it under 180. And then it sat there and sat there and sat down is like, Huh, what’s going on? And tried everything that you would think of? Until they landed on the answer. And the answer was, Arden gets up in the morning. She leaves for school gardens, not a breakfast person. Not when she goes to school. She is on the weekends, but not when she goes to school. So she’ll run out the door. She goes to school, sometimes breakfast, or sometimes they she has lunch this year, two different times 1030 and 12 o’clock. So every other day it changes just to make things fun. Yeah, right. So here’s what ended up being the issue. Arden was dehydrated. I stuck a bottle of water in front of Arden and I was like drink the water. She takes a little sip of it. Like a demure princess at a tea party. And I’m like no no, no slug the water back. Now like I need you to get a half a bottle of this water in right now. So she complained and bemoan This is not what it is. Leave me alone, blah, blah, blah. She didn’t do it didn’t do it. Blood Sugar climbs and climbs and climbs, we’re bolusing nothing’s happening. I finally she starts getting a little surly because her blood sugar’s higher. And I get more direct and I’m like, Look, drink the water. Or, you know, I’m gonna kick you out of the house. I forget. I forget what I said. But I you know, I was just like more direct about it. So she bangs this water in. And 10 minutes later, diagonal down arrow and here comes her blood sugar down and levels out and we’re good. The next day she gets up for school. She doesn’t drink water, her blood sugar’s difficult. As soon as I get her to push water, it’s now all the sudden, the pump does what I expect it to I don’t know if you know that phrase or people listening have that idea. Like I always think of it like, is the infusion site acting the way I expect. That’s one of the ways I kind of inspect the infusion site, in my mind is exactly what I think it should be doing. And this was the same thing. That’s why I was like, Oh, God, is it the infusion site? Is it you know, you know, people start going through? Yeah, Moon out of phase like, you know, you start to start running through these litany of things that are probably not at the core of what’s going on. Anyway, that’s it, it was dehydration, but I really would like you to talk about that a little bit because I think it is. I think a lot of people are not hydrated properly. And I think we spend a lot of time chasing blood sugar’s around that might be fixed with a bottle of water.

That’s a great, great one to bring up and I I in fact, I just I just had a conversation with a mother of an athlete who I specifically addressed the hydration component with. Also around like CGM and to you know CGM is remembers CGM or reading interstitial glucose, not reading blood glucose from your bloodstream. It’s reading your interstitial glucose, which means that hydration makes a difference for how well the CGM is giving you data. Same thing for hydration in the body and influence flow and insulin action and movement and everything. You know, if you think about, we all wake up dehydrated. Unless you are somebody who drinks water through the night, you know, every time you get up to pee or whatever. 99% of people wake up dehydrated in the morning. That’s why

I weigh myself in the morning.

Yes, exactly. Call the driveway. Absolutely. driveway dehydrated with no clothes on is the best time to wait yourself. There’s another little

tidbit to get my arms trying to make like maybe this will get me off the ground a little bit.

That I that is a really humorous

mix of you’re just imagining that I’m actually flipping.

But yeah, hydration. In fact, it’s a it’s a trick that I came across myself. In starting to do like workouts in the morning. Knowing that I was dehydrated, I was drinking some water before I would head to the gym and I was like, Huh, blood sugar, even on mornings that I wasn’t then going to the gym, and I was drinking my big slug glass of water, you know, like probably it was probably at least 12 ounce glass of water in the morning when I got up. I didn’t have that weird, dramatic change in blood sugar, I didn’t have the problems post meal that I you know, was trying to beat down with extra insulin before. And hydration is huge. If you drink the big thing of water when you wake up in the morning. Oftentimes, not only does it wake up your digestive system, without a carb component being there to cause a significant rise. But you’re also adding hydration to a system that needs it. Your insulin can work better, it can flow better, you’ve got better circulation.

Yeah, it’s one of those situations where you can see yourself as diabetes, when you should still be thinking about yourself as person two. And I just gave privately advice to somebody who said they were fighting with what they you know, they were calling it the dawn phenomenon. That’s what anybody calls any blood sugar between 4am and 8am that they don’t like I guess the dawn phenomenon, like you’ve no idea, but if it is or not. Okay. And so my we talked through this guy’s problem, and I said, I’ll tell you what, for about a week, why don’t you put a glass of water at your bedside. And when you open up your eyes, just bang it back. And it’s my son gets up early in the morning to play baseball, and I tell them all the time, like hydrate yourself right away, it wakes your brain up. It you know, while it does so many things for you. And one of them are a lot of them are the things Jenny just said. And, you know, I started off by talking about how it could stop insulin from doing what you expect. But Jenny makes a great point. And Dexcom would be the first to tell you if you’re not if you’re not hydrated, your CGM might not work correctly. And maybe so maybe that even goes back to Melissa’s question. I don’t know. I don’t know how well Melissa drinks water.

It could be pieces of a lot of Yeah, absolutely. I you know, hydration, even just from that standpoint of overall health. If you think about you know being dehydrated is like having like molasses in January running through your blood running through your system, right? If you think of all the things that are supposed to be circulating in your body, in your bloodstream, all the nutrients and the wonderful things that are supposed to get to certain parts to heal and rebuild and restructure the body and keep you running healthy. If you’ve got like mud running in your system, think how hard it is to heal and repair your body. Yes,

yep, there we go. I fixed all your problems. Have a glass of water.

Drink your water to the finish. I agree. Yeah. That my kids don’t know anything. Honestly, they’re they’re excited when they get to have like a glass of juice at grandma’s house because they only know water. That’s, that’s all they drink. They’re like

this is amazing.

Like, what is this mom? I’m like this is called juice. Yeah. No.

But it’s amazing is that you enjoy it. That’s why

grandma’s great. And that’s that. I have one here. I have one here from Rebecca. And you She asked if you could explain the biology behind blood sugar changes in relation to mood. So the actual biology of it. I mean, I think it’s I think it’s Something we all recognize, right? Like, the simple one to point out is, if your blood sugar gets too low, you know, I’ve heard stories that are, that are, are massively sad, you know, from adults, you know, a spouse of a man, especially whose blood sugar gets low and they’re still as strong as they were, but now they don’t know what they’re doing. And they can get, you know, violent even sometimes if your blood sugar’s low enough, you know, besides, you know, the ones we know you can get dizzy, lightheaded, sweaty, you know, there’s these things that happen. Those are the obvious ones I don’t think we talk enough about and I tried to make a point about them on the podcast, because I think a lot of parents don’t. I don’t think a lot of parents lend enough credence to the idea that their kids are acting like jerks, but but you know, you’re also you know, their blood sugar has been 250 for a week. But can you do it? Do you know? Like, can you speak to it on a on a biological level?

On a biological level? And I don’t know if she’s asking if she’s asking, like, the biology behind how you feel when blood sugar is too high or too low, or the biology behind? What stress and mood due to blood sugar?

Well, I think here’s what I took out of it. Wow, Rebecca, we’ve got three different questions out of your question. Here’s what I always want to know, we’ll start with me because you know, it’s my podcast. So let’s go with what I want to know first, what is God? What happens in the brain, like, so when you’re low, I realized there’s less blood or less sugar in your blood, and that sugar is sort of the energy your brain works off of right? So why do you start losing functionality when it gets lower? And it’s not even a diabetes? Question? Really?

Yes, I mean, from a I mean, from just basic physiology, your brain does it. It works off of Google’s or, you know, sugar, so we have to make sure that we’re maintaining his base level, so that our brain can send out all the signals and perform the way that it’s meant to essentially that we’re thinking about the way that we’re supposed to think as a normal human being. If there’s not enough glucose there in the brain is deprived. And so it’s almost like, almost like the effect of alcohol on the brain. Right? You sort of get this like loopy, inability to put thoughts together, sometimes not very cohesive language that comes out. And you might be talking about very weird things. And people are like, Oh, that’s totally not what we’re talking about. Are you okay? You know, so when the brain isn’t getting that sugar energy that it needs, if it can’t perform, it’s doing the best that it can. And it’s almost like the signals of just are not connecting quite the right way. Or, and that can lead to some mood components. There are many people who have said, especially when I used to work clinically, in patient, there are some older people with type two, who would come in am I, my husband gets belligerent when he has got these low blood sugars. And he tries to throw the jars at me from the kitchen and whatever. And I’d be like, well, don’t get too angry at him. One is not thinking clearly, this is what happens with a low blood sugar. You know, these are the ways to prevent it, blah, blah, blah. But that’s pretty normal. Some people do have like this brute strength, they get violent when blood sugar gets so low. And again, from a from a true physiology, I don’t know all of the real reasons that that happens, other than the fact that the brain is just not getting what it needs. And it It can’t think the right way, I have

one thing to add. And I have a theory which is based in nothing. But my thing to add is that Arden had a seizure from too much insulin when she was two right after she was diagnosed, like I gave her too much insulin, she had a seizure. And one day, we were talking about it in the kitchen, and I had a video camera out for a completely different reason. And I just pushed record on it. And let her tell me about the the seizure. It’s on YouTube, and a lot of people have watched it but a point she says that she sounded like a monster. And she’s too and she said she saw colors. And so her eyes didn’t work. I saw colors and then they were back or something like that she talked to so she lost her sight during it. I saw it happen because I reached out to put my hand on her and me touching her scared the crap out of her. You were there. I didn’t know I was there anymore. And she says she sounded like a monster because she couldn’t talk. She was growling. So in her voice, you can hear it in this video. She’s like, I couldn’t talk. I sounded like a monster. So she was grunting. It was really something in Iowa. wondered, is that your body? saying? Is it confused? Like you’re saying like things are just going haywire and I’m about to short circuit and shut off? Or is it shutting down unnecessary systems trying to keep you alive for right? Because it can it’s just trying to do your basic function stuff and keep you alive? Like I don’t know the answer, but in the in that space has got to be the answer somewhere. Mm hmm. So, yeah. Now that I bummed everybody out, going, by the way, she was fine, but put glucose in her cheek and she woke right up. It was really not that much trouble. I tried Chinese food before I knew what I was doing. I’m better now. High blood sugars though. Cause so I just talked about it. I don’t know if it’ll make it into this episode or not. But Arden was really dehydrated, her blood sugar got high. And then she got combative. I was like, the more I asked her to drink a bottle of water. By the time our blood sugar was up in the high two hundreds. She was you know, a million with you asking her to drink that water is like I told her to get up fly across the room. And you know, and she was like, I can’t do that. You can’t it’s right there. Just drink it. You know, she flew. Now, I’ll tell you the amazing part is she drank the water, her blood sugar came down. We talked again, 45 minutes later, and her personality was right back again. Yeah, why does that even though

I mean I, again, everybody’s symptoms, and what comes out of them high or low are a little bit different person to person. But from the high standpoint, it’s kind of similar highs. And kind of almost what we talked about with the hydration component. There’s this like, slog of like mud and muck kind of gunking. Up there, right? There’s way too much glucose, so many people complain about, like the fatigue and inability to, like really put the thoughts together and the fatigue component being different than, like, gosh, I just didn’t sleep very well. Last night fatigue. The fatigue is an all encompassing mental fatigue, and it feels like your body is weighed down by bricks, and you’re trying to walk through mud. That’s high.

Do you know at all if you stay high, we all know if you stay high long enough, your body tries to get a client listen to it. Does that go away eventually? That like? Or is it is it just a level of effort that you’re used to living with?

I would say the ladder it’s a level of feeling that you get used to living which with which is why many times if people have been living high, and they bring blood sugars down or bring them down too quickly. They can actually have low blood sugars, simple, low blood sugar symptoms at a more normal value until their body again gets accustomed to that more normal value. And they realize then, well, gosh, I feel better. I’m performing better my test results. If I’m a kid, I’m performing better in school, I’m learning better. It doesn’t take me three hours to study two math problems I can get through it like this. So there is you know, a deaf a definite difference there. But from from the mood standpoint, you you would be very cranky to if you had this sort of like sluggish. I just why are you bugging me go away, stop bugging me kind of

hard to react it.

Yeah.

I’ve said this a couple of times in the podcast. And I don’t know how comfortable people are when I get really emotional and talk very seriously. But I think that one of the reasons I love making this podcast is because I think everyone deserves to be who they authentically would be if they’re not being impacted by low or high blood sugars, or variable swings, or any of the things Jenny just explained. So you know, I mean, think about it like that, when you’re struggling to figure out how to make a bolus or how to you know where to do Temp Basal. The end result for you is going to be like this person like who they would have gotten to be if they didn’t have diabetes and their blood sugar’s bouncing all over the place like you owe that to yourself and, and to the people you love is and try your as hard as you can to get to that spot. It’s just it’s it’s unfair to think like a, you know, I talk to people sometimes who are adults, and there’s a one that always pops into my head. It’s this woman in her late 30s. And she’s a single mother of a lot of children. She told me her eight one sees her over 12 years. And I helped her and she got her blood sugar’s down in range and very quickly and as happy as she was to see it happen. You could see how devastating it was to her that it was that easy, and that she had lived all that time and you could hear When she was talking to me, that she was beginning to wonder, like, what did I miss in my life that I don’t even know, I missed, you know? And so I don’t

and are some of the mood component if she’s got many children that she’s managing on her own? What did she Miss in being able, like different communication method or different way of working with and through problems with her kids and addressing things, and even helping them learn and all of those things, you know, along the way, and I mean, now she can thankfully go forward and do what she wants to do and feel good about it and feel good doing it, you know, but

I don’t talk about my own health on here very often, but I, for some reason, don’t retain iron. So a couple of times in my life, I have my irons gotten very low. The last time it happened was in 2019. So you know, you go to a doctor, and you try a new doctor, you think, well, the last time this happened, like I was just like, gave me a bunch of supplements, I never really felt like I bounced back, you know? So I try, I’ll try a different doctor. So of course, anyone who knows anything about low iron, the first thing he thinks when he sees my low iron is so you have cancer, because obviously, you’re bleeding internally somewhere and we can’t see it. So the guy’s face changes. And I’m looking at like, in the logs. I’m like, man, I don’t have cancer man. Like, I know, I know what you’re thinking and all but this happens to me. Can we just get past it? Well, he goes through all the steps. And those steps take months, he wants to do a capsule study of my esophagus, I have to get scoped from both sides, right. That was fun hormones, and drugs. Oh. So I got scope from both sides. I had to swallow a camera. I had to stop eating corn.

And gluten.

None of those things had any impact on my iron, by the way, actually, there’s not even the corn and gluten actually made my iron go down. So now they ruled everything out. And I said the whole time. I’m just I’m like, Look, can you just like get a bag of iron and hang it on an IV and jam it in me? Like, that’d be great, you know? Oh, yeah, we’ll do that at the end. If none of this other stuff calls, I could never figure out why they wouldn’t do it then. So I over this six month period of getting all these tests done, I’m declining, like really looking bad, starting to gain weight for no reasons. And it turns out after I got two bags of iron Finally, and I’m back to my own peppy, happy self. I was and I’m gonna have to bleep this out. I apparently was quite an at around my house. And so I had no ability to like, handle anything. Like Like, if something got annoyed, I was at 100 if I was mad, I was mad if like, you know, if you were irritated me, I was completely irritated. I had no ability that who would even know this, right? And so I was I was terrible. I’m telling you, they put that iron in. And it was back to you back to myself right now. Now, here’s the problem. And the reason I bring this up, even though my family knows that, intellectually, it didn’t stop them from having to live through it. Of me just being unpleasant. And I think that that’s something to keep in mind too in extended families, like with diabetes to have blood drawn, always lower, always high. Even though you know cognitively Oh, it’s because of their blood sugar. It doesn’t mean that you don’t feel it the same. Like you

know, like it could handle it.

Yeah, it could mess with it with your relationship. So yeah, all the time. I tell you, it’s far easier to stay in range and all the good things that come with it. I think this is another good thing that comes with it. I think you get to be yourself and get to have the relationships you are going to have then you can just hate each other for the right reasons.

Right? Absolutely. You can be angry because of spilled milk because it really is spilled milk. Yeah,

but at least you’ll be

released. You’ll hate them for the right reason. Damn it, there’ll be clarity. Right? That’s all right, exactly. That’s fun, Jenny.

Iron you. Do you get enough vitamin C?

I believe I do. Although By the way, now that I stopped they made me stop eating gluten and corn. I was just like, huh that’s cool. Now I have a hard time eating food anymore. Like I’m almost a vegan. I’ll tell you what stopped me from being a vegan. I don’t like vegetables. But I seriously like now my body doesn’t even like i don’t know i don’t i don’t do that well with like meats and proteins anymore. Like I’m just an easier when I’m not eating. I did a baked potato fast one time. I’ve never been happier.

Just eat bacon.

I was thin as I’d ever been nice. I felt great. some wonderful. It has all the vitamins and nutrients I needed anyway. I don’t know what happened.

Well, I’ve never heard of. I’ll tell you about it privately. Never heard of the big potato fast. Yeah, that’s okay.

huge thank you to in Penn for sponsoring this episode of Ask Scott and Jenny Check them out at companion medical comm if you’re an MDI user looking for a smarter insulin pen, or you’re just a person who you know, doesn’t want to pump, this is the way to go in pen. Rox companion medical.com. If you’d like to see the in pen in action, you can see it and Fiona Wilds hands a lot. At her Instagram page, it’s Fiona fo na underscore wild w YLD. Go check her out. At the end of this, I’m going to put in the audio from that YouTube video I told you about about art and describing her t shirt. It’s a little noisy. So you can try it. If you don’t like it, skip out on it. And then you can maybe find it on YouTube. But uh, I just thought I’d put it here in case you’re interested. But it’s old audio from like an old video camera. So, you know, let’s not expect the clarity that you’re getting right now in my voice. Are you talking about when your blood sugar gets low? Like you weren’t able to talk? Right? And then what happened? Did your voice make a different sound? Do you remember that?

It means like

evil.

How did your eyes work when you’re having your seizure?

Free by doing so.

It was real dark and it was scary. You feel like you turned into a monster? Yeah, you didn’t turn into a monster sweetie. You couldn’t see. And you couldn’t talk? Yeah. You didn’t know you were doing it. No, we don’t think you knew you were doing it. It happened because your blood sugar got low.

My eyes got

trick I created I changed colors again. Yeah. Oh, what? Oh, you just saw that the camera was pointing at you. Yeah. Yeah. You don’t want your picture Dagon? No, I just thought people would think it was interesting to hear what it sounded like when you’re having your seizure.

This episode of Ask Scott and Jenny on the Juicebox Podcast is brought to you by companion medical makers of the in pen. To learn more about in pen, go to companion medical.com or click on the links in your show notes, or Juicebox podcast.com. Are you wondering why I want you to visit companion medical.com? Well, that’s simple, because in pen is America’s only FDA cleared smart insulin pen and app system. When you get to companion medical.com, you’ll discover that in pen combines an innovative diabetes management app with a Bluetooth enabled pen injector. This will simplify the constant tracking monitoring and calculating required for insulin therapy within Penn MDI users are able to live life less complicated. Welcome to Ask Scott and Jenny. These are the episodes where Jenny Smith from integrated diabetes services. Now Jenny, you may know has had diabetes for decades. She’s a pump trainer. She’s a CDE. She’s I think once she went to the moon, I don’t remember exactly, but she’s done a lot of different things, right? She’s also a nutritionist. Listen, she’s everything you want. Why are you arguing with me? No, you’re not arguing me. And anyway, Jenny and I. We answer questions from you guys. They’re left on the boat with Vince on Facebook page. I asked for them every once in a while. I do it real slick. I go like this. Yo, does anybody have any questions for me and Jenny? And then people leave questions and then we answer them. Anyway, today we’re going to talk about growth spurts, the 670 g from Medtronic loop tips and a little bit about control IQ. What do you think of that? Hmm? Okay, then. Please 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. Laura says kids and growth spurts Is it a gradual increase or an all at once change? Is that something that you notice they need more of all the sudden that she gives her example toddlers for him was five, still close to some still close to the same ratios? ISF and bazel. From when he came out of honeymooning. I know he’s gonna hit a growth spurt soon. And I guess she’s looking for like, How do I know when it happens? And what do I do? And I think this falls under the auspice of those of the idea that I just want somebody to tell me how much or when, like, you know, do you mean like, give me a number or an idea? And I don’t know that there’s a specific answer. I have a general answer. But I wonder what you think about and what you see.

Yeah, and my answer is probably similar to your general answer, honestly, there’s not a, there’s not going to be a specific like, you’re always going to see 25% more insulin needed, right. I mean, it could be over several growth spurts that you notice, gosh, he always need like an extra point one added or an extra 25% or whatnot. But it’s, it’s not that cut and dry by any means. one specific time though, that most parents with kids with diabetes, and parents of teens with diabetes will notice the heaviest impact of growth. With a surge for only, you know, a short amount of time is evening, where their kids go to bed, they’ve had things really nicely contained. And all of a sudden they get these like spikes. Almost as soon as the kid is snoring, like their head hits the pillow, they’re snoring, and up it goes they’ve been at this beautiful 111. And up it goes and they fight it and fight it and fight it. And it could be an all night fight depending on how strong the growth surge is. And in those instances, it’s okay, let’s try it. I usually encourage people to try first a temporary bazel increase rather than shooting it with like a dose of three units of insulin and then chasing the drop down. Attempt bazel increase, you know, that might be significant. Maybe it’s 50%. Maybe it’s 100% more for a time period. See where it levels off? When does it start coming down? You can always shut off attempt it is all right. So and then if you learn from that, let’s say two nights in a row, you start to see this surge on the second night when it gets going. You hit that Temp Basal again, similar to the night before if it controlled Well, if it wasn’t quite enough, and you still fought a high pump it up even more. But then once that growth spurt is sort of reversed They may need not as much like as the Temp Basal you are giving to offset the rise. But their overnight needs may definitely go up, you know, they were at point to their growth spurt needed a 50% increase overnight for that time period. And now instead of being at point two an hour, now they’re at point three or point three, five. And that might be where they sit for a time period until another growth spurt happens is

that going to be because there’s more body mass, like you’ve actually grown? There’s more of you, or

potentially or just the changes that right? I mean, in little kids, especially little kids, I sometimes, you know, with mine, especially my almost three year old, sometimes he wakes up in the morning, and I’m like, you grew right? You just like, all of a sudden, he just let you look bigger, you look like your cheeks are slimmer, or you know, he just looks bigger. And, you know, so sure it can I mean, it wasn’t technically overnight that he just shot off. But those, you can suddenly kind of see it and people who are attuned to their kids, especially parents, with little kids who you’re following so many more things than just which truck they want to play with, you know, staring at them constantly. And, you know, I mean, with diabetes, you pay attention to so many things. So you could like I said, you could see a tremendous need in a spur period, and then it levels off, but it doesn’t come back down to where they were before the growth spurt. Right?

I have to say, I think the idea of looking for physical clues is brilliant, because I know our son, his calves would get thicker. Like all of a sudden, you’d look at him and his calves would be out of proportion with the rest of his body larger. And then sure enough, he would get taller. It was almost like his body was like, okay, we’re getting ready to do this. You know, like, and it would store things in certain places or something would get bigger sooner. It was just really it never failed as he was growing and I have to say to door jamb that you don’t mind drawing on with a pencil is great as you have children, a few people have younger kids. I’m sure you’re doing this, but it gets really fun. A decade later, when you’re like stand there for a second, you know, and and you get to see how they move up. I would say the answer to this question to me, is the core of the of the podcast, right? Oh, hold on a second. Arden needs a little help with their balls for a second.

That’s okay.

What is six times

we don’t use the door jamb we use a my mother in law when our first was born bought us this like measurement tree, and you put it on the wall and kind of pop it in. And same thing, same idea, you just push the hash marks on to the tree as the child grows. But the nice thing is that we’ve used one side of the tree for Oscar and the other side of the tree for Conan. So we can see where they both are. And it’s kind of fun to now be able to see where was Oscar? And is Conan meted out the same? Or is he getting bigger faster? Or are they growing about the same? It’s kind of fun? It really

is. I have to say my wife has told me without a doubt if we ever sell this house, she’s like, you have to pry that board off the wall and replace it for the new owner because I’m taking it with me. And I was like, Okay, yeah. So anyway, what I was going to say is that I think this is one of those questions that if you just caught me, if you texted me real quickly and asked me this question, I would say to you, this is why the podcast is terrific. Because you are running into an insulin need. And it’s saying to you, I need more insulin, give it more insulin. Try not to worry about why just it does. And when’s it gonna start? When’s it gonna stop? I don’t know. It does kind of suck. I’ll tell you like, you know, because after four or five nights of this, and it goes away on that six night when you’re finally like, I trust this is going to happen, jacking up bagels and bolusing and everything. And then it turns out, the growth spurts over now you’re waking up somebody at one of the morning going, hi, would you like a chicken sandwich in the banana? It’s a it sucks. But it works well for those six days. And in my opinion, it’s better than being high for six days and just saying, oh, it’ll come back again. Right. You know, I just think that’s how I would handle it.

Correct. And anything, you know, you bring in a good point, in just the comment of when it comes back again, because it will little kids grow and grow and grow and grow and even teens, you know, up to a certain point, girls grow for less time than teen boys do. I mean, teen boys can grow up and into even like 18 to 20 years, some boys. I mean, most often majority is done by like 18 years. But most girls are pretty done growing up by about 16 years old. You know, they look

so much older than the boys even when they’re 1314 like in that range toe,

right. So you know know that In the nature of all the testing and the things that we’ve talked about in the other podcasts and the figure out the bazel, and figure out the ratios and all that kind of stuff, it’s it’s not a number that’s gonna sit there until they’re well into their adulthood, when maybe a variable component of their lifestyle changes, where they will need to make an adjustment. Kids needs change. That’s the simplest way to say kids needs change. So don’t think you’re crazy. If you go for a couple of weeks, you’re like, I got this. It looks like it’s working magically. And then, like, professionally, I get these emails. They’re like, I thought we had this all figured out. It was all working beautifully. And now the last three nights, this is happening again. I’m like, Okay, well, we need to adjust. Right.

So Jenny answers those emails by how do you think we stay in business? It’s gonna keep it’s gonna keep changing. But But no, I genuinely think that’s a great answer for that. Okay. Richard says, any tips for being bold with insulin while using Medtronic 670 gene auto mode, you basically can’t adjust the bazel other than temporarily turning on the target of 150 bg instead of 120. And it auto calculates bolus based on carbs, BG or a combination of both. It won’t do a correction bolus, unless you tell it your BG is above 150. It adds up to great time and range stats for me range being 70 to 180. But I’m spending a lot of time at the upper end of that range. And I’d like to be closer to the 120. I know Arden and Jenny are Potter’s but I think Jenny’s colleague, Gary uses 670 g maybe? Well, Richard, I don’t know how comfortable I am with everyone knowing so much about our lives. But But I am going to have, I finally have some insight into this automated pumping thing. My brain is starting to almost get all around it. But Jenny is going to go first because I’ve never seen the 670 g before.

Yeah, so the 670 G. M. I said it’s hard to sit too long, if it is a long pause, because I have to, I have to be kind of, you know, good in the way that I explain it. Because the 670 g can be phenomenal for some people knock the majority of people. But for some people, it does work quite well. Who does it work quite well for? If you have a pretty structured life, if you have a pretty typical breakfast, lunch dinner, you always go to the gym between four and 5pm. You know, it can be a really good system for holding you a lot more stable, it does do a really nice job, for the most part, again, in those in that type of a life for the overnights, similar to the other, you know systems that do something like this with the augmentation to the bazel and how it goes up and down. But I can see that the 670 for a good majority of people with the variability of today’s lifestyle. It doesn’t meet need. And for run really specific group. Women in pregnancy it doesn’t meet need because it doesn’t target the right blood sugar, at least not right now. Nothing Medtronic isn’t working on that, from what I understand future iterations will have lower targets and different things to it. But the current 670 You know, it targets the 120. I would say for most people who are having success with it. They’re typically getting an average blood sugar of about like 130 ish, not really 120 even though technically it’s targeting that. And this question kind of alludes to that piece is that it’s really not allowing any corrections unless you’re above a higher number than you really want to be at anyway. Right. Right. And it’s only correcting you down

to 150.

Yeah. Okay. So it’s

never really getting you too that that technical target. The other component to the system is that it’s, it’s not using your current manually set bazel profile to work off of with its increasing and decreasing of insulin dosing through the course of the day based on glucose change. It’s I we kind of call it the secret sauce of whatever Medtronic has figured out in their algorithm. The system a couple of days of manual mode use gets an idea of your average of insulin need and kind of like a sensitivity and your sensitivity to insulin and what it does, then use it Essentially doses your insulin along the course of time in a day, based on what it is seeing your sensitivity look like. So really the only factor that in auto mode 670 is using is your insulin to carb ratio. If you’ve got it set at a one to 10, you’re going to get dosed off of a one to 10 along with where your blood sugar is, and that kind of stuff. But even your ISF or your sensitivity correction factor, that is not what auto mode is using. So, you know, it’s kind of a long,

but it’s a limit. It’s, I mean, I guess you’d call it a limitation of the system. But not a limitation. I guess it’s how it was designed to work. It’s not working the way and I see the problem. If you’re at that top end of that range, or 175, and you’re heading up. And without intervention, you’re going to get to 240. But it only intervenes enough to try to get you from 175 back to 150, then that’s where it won’t work, right. Don’t forget what companion medical wants you to know, they want you to know about the in pen. The pen is not just this beautiful Bluetooth enabled insulin pen. It’s also an app that works in Congress in Symphony in think of another word that means like all together between your app, the pen, and your dexcom continuous glucose monitor. The app is going to give you an at a glance, look at your current status, from last dose to active insulin to recent doses. It has a dosing calculator to help take the guesswork out of dosing. That’s a huge help for MDI, right. You’ll be able to enter your blood glucose and what you intend to eat. And the correct dose will be recommended to you by the Impact app. I come on. If you’re MDI, you got to admit this seems it seems like a leap, right? Here’s dosing, reminders and reports and temperature alerts, there’s a whole bunch of stuff but you’ll learn all about it when you get there. When you get to companion medical comm so for those of you looking to take a pump break, for those of you who are already doing injections, and just wish you had a little more judge get out I mean, in pencil way to go. I want to thank them, of course for sponsoring this episode of the Juicebox Podcast. And I will thank them by reminding you to go to companion medical comm to find out more. Oh, there’s extra time in pen is terrific. Why are you not trying the in pen, go get in pen today. companion medicals.com or on the links to wait hold on a second get even deeper. Check it out today at companion medical.com.

Many people who will complain in auto mode about getting what we call kicked out of auto mode and kicked back to manual. What two scenarios one in the example you give as blood sugar is rising, and the system is micro bolusing. Along the way, they don’t call it temp increase, they just call it this micro like bolusing along the way that the system will only micro dose for a set amount of time. Yeah. Before it says Nope, can’t help you anymore. And out of auto mode, you get kicked back into manual mode. Okay. So on the opposite end of that if you’re like low, and it can only adjust so much in a low time period. So you could get kicked out of auto mode as well.

On purpose,

you can you can choose to turn auto mode off going back to manual mode, which is I’ve got a couple of people that I work with who’ve been using 670 for a number of years already. And they’ve figured out the tweaks and the tricks and the things which we actually have on our website. I’ve got a lot of little tips for you if you are using the 670 These are some of the little nuances and this is how to like do it better essentially. But some of the people I work with just when they see a higher blood sugar and they know that this system isn’t gonna adjust it as well. They just go back to manual mode, they add a corrective and they take care of it and then they go back to auto mode once the cyst once you’re brought back to where you kind of want to be. Yeah,

I see with what I see with lupus. I now have figured out two things when it looks like it isn’t going to stop arise and how to get out of opening the loop. So as soon as I see that up, then I go Hmm, that’s not working. For some reason. I bolus what I think is a significant amount I bolus an hour’s worth of her bazel Plus, whatever I think the rise needs to correct. So it’ll be sometimes sometimes I’ll be like, open the loop and bolus four units, which is, which is a lot of insulin to try to stop. Because what you’re really looking at is a 135, diagonal up, which doesn’t make any sense to put in for it. But it does if you understand what the algorithm is going to do next. So you’re going to open the loop, it’s going to go back down to your base, you know, base, I’m going to try to stop the rise anymore, it’s just going to go too far. Now, I think it’s like 2.4, something like that an hour. So it’ll go to that. So I’ve put in enough insulin to stop the stop the arrow, stop the momentum, bring it back. And then when I get momentum coming back down, I figured out and I can’t obviously pass this on to any of you. But I can look at the Dexcom graph and go close know when the court follows it now, right? And so you close it now. And it’s almost like, it’s almost like flying or landing an airplane without your, without your gauges, I guess like you just look at the ground and you go, I gotta start pulling up right now this is it. And, and it works. I can’t believe I can’t believe I figured something out about looping, to be perfectly honest, you know, a workaround for it. And it’s a workaround, that doesn’t cause a problem later. The only way you can get messed up coming out of open loop is if you’re if you close the loop, and then go right into a meal again. Because then right, then you’ll put in, and this just happened while we were doing this, you’ll put in art and just put an ad carbs for a large lunch and had a bagel involved in it. And she said, it didn’t give me any insulin because we just came out of open loop. And I was like, That’s alright, because I wanted this to be 11 units. So still put in the car absorption is 40 over two hours, 40 over three hours, which by the way, spreading out your carb absorptions stop multiple different stops, it stops it from shutting off bazel because it thinks oh I have to stay on for a long time you trick it. You’re smarter than the loop, damn it. And then so you get up 40 and 40. And then I just told her Bolus all 11 units. So now it has the 11 units to work with. It has the absorption times in and then it will make decisions about bazel based off of those other two things. And more importantly, I win Jenny. Speaker 1 22:25 Important. Right? Oh, wait, yeah, Arden wins because she’s healthy.

I defeated that damn thing. I feel like I beat a robot in a sci fi movie. You know, like, like, it came at me with like a spitting action a torch. And I was like, I’m gonna die. And then it was over. I won.

I was just like, I can’t move on. Yeah, but that was I know. And why why are you winning? You’re winning, because you’ve watched and you’ve learned?

Absolutely, it took me a while. I am telling you this in October. And when did Arden go on loop? It’s got to be like six months ago a while right? And, and people at that time were like, oh my god the boat with insolent guys looping. We’ll all have great directions for looping in just three days. And then you all emailed me for months. Like tell me what to do with looping. I was like, I am still. And so when I tell people, it, they’re never mistakes. It’s always a learning situation. I that’s exactly what I did. I hate to say it because I think it sounds a little douchey. But when I don’t know what to do with diabetes, I go back to what we talked about in the podcast, I just, I revert back to the basics. And I go, okay, what’s happening to me here, and then I apply one of those protip episodes until I know, it’s, it’s a little strange, because I’m the one that said it the first time but it’s a great example of how in the middle of life, you can forget things you know, you know, like just because it comes at you from a slightly different angle all of a sudden, and it doesn’t look the same as you expect it to you panic and you go different thing don’t know what to do, and it’s over. But I just kept applying the tenants of the podcast until I figured out the loop thing. So I am so close to us doing that.

You know the same thing. I mean, I learned I’ve learned a lot over now two years Actually, today is my two year anniversary of using loop.

This is your loop version started

on Halloween.

Yeah, by the way,

it was what actually you know, to be quite honest, as most people do, you know, I actually I started in closed loop the evening of October 30. And by like the morning of the 31st I was like

coupon open loop like

so I closed it and it was it was actually really great. I mean, I got a chance to trick or treating with my boys and whatnot. That evening. It was was really cool to be able to watch the system and I would have usually applied like some type of temporary bazel or just plan to like steal candy out of there like buckets as We are treated along the way. And it was really fun that Halloween because I didn’t feel the need to pay attention, nor did I get any alerts while we were trick or treating, because Luke was doing a great job. And so I don’t I think it was kind of a fun day to have started it. So

don’t test yourself a little bit, right? Don’t Don’t

Yeah. But again, learning, you know, I learned, you know, like my coffee in the morning, I typically found pre loop I had they have a half a unit of insulin to cover. Well, that wasn’t based on carbs. It was just what I had learned to utilize. Right? Well, now in loop, I had to actually go back and figure out how much does that equate to as far as like a carb entry for loop to really cover this? Yep, the right way to offset that like caffeine rise and everything. So there is there’s relearning to using these hybrid closed systems, whether it’s the six, seven dg or loop or open APS or whatever, there are pieces of things to learn that you weren’t applying before. Or maybe you were you just have to learn them in a new way with the system. I

think that’s that’s it. Arden right now is at lunch. She’s 75 her blood sugar 75. Here’s how the morning when she got up in the morning with a pod that only had a couple of units left in it. So we swapped it running out the door, swap it as she’s getting that little bit of a rise from the morning, right. So I see like a 120 is starting to creep up. She was one on one while she was getting dressed all sudden, she’s 120. I threw in a unit from the old pod because I didn’t want to waste it took off the old pod put on the new pod, looked at what insulin was pending for lube, bolus pending insulin. Then she started we drive into school and I just noticed that I felt the number jumped too much. And I was like open the loop and Bolus two units. So now I’m thinking about pod change insulin right. So we Pre-Bolus two units I comes in perfectly forget to close the loop this morning, I’m running around doing a bunch of stuff we forget to close the loop. So then something hits her where she needs more bazel loops, not closed doesn’t work, she starts going back up again. 134 diagonal up at 9am. Now I’m like Oh, she’s got to eat an hour and a half. reopen the loop Bolus more 91 diagonal down when she wants to eat. And then you heard the rest. We closed the loop tried to do 80 carbs, it didn’t want to it didn’t want to give it to her. So I gave him the sweet we set up the the absorption times and gave the insulin anyway. And now she’s eating and she 75. And I’m telling you two months ago I don’t even know where her blood sugar would be with loop right now it would have been a disaster. But I needed that disaster to happen. So I could wrap my brain around the whole thing really. So I’m very, I’m doing very well with it now. Like I can’t wait to see what hurry once he ends up with being three full months of this kind of new space. Alright.

And it kind of goes along with I think one of the last times we did a we did a chat like this there was we kind of both talked about like taking a hit. Right. And so I actually for our newsletter for October newsletter, I actually did an article about what you can gain like taking a step back in order to take two steps forward. You can learn from the hits that you end up taking Well, my blood sugar did do great for, you know, this five mile run that I planned. Okay, well, what did you do? What didn’t work and plan accordingly for next time you you can learn from taking some steps back

hundred percent you have to stop every once in a while you just have to broaden your scope and stand back and see the whole picture. Because you’re just telling the fight. You know, it’s funny. The it’s a completely strange, I thought but I think in my mind, it’s the same thing. Phillies hired a new manager the other day, Joe Girardi he was really successful manager with the Yankees for a decade, you know, left there. And it’s been out of baseball for a couple of years. And he said, I heard him in an interview. He goes sometimes when you’re in it, it’s hard to see it. You know, he’s like you’re in this fight. And you’re so focused on winning, or I guess in this situation, you’re so focused on your blood sugar being where you want to be, you don’t see how it is you’re losing or winning. You don’t know why anything is working or not working. You’re just swinging hands, you know. And so I think that’s a perfect scenario. I think you got to step back and just look at the big picture sometimes. All of these things that have been on T shirts for the last 50 years have been there for a good reason. It had everything we just said about 670 G and looping. does it apply to basal IQ as well?

I think it probably will apply more to control IQ. Okay. Which is basically like you really is only a predictive low glucose suspend, right? So the system is looking for glucose to be less than 80 within the next 30 minutes. And if the trend in glucose is happening such that that’s going to be the case, then it predictively suspends the insulin delivery on a basal level. But the interesting thing about it is that it actually doesn’t do only bazel suspension. It also suspends an extended bolus. So if you are using bazel, like you, and you have a trend happening, and basal IQ kicks in, and you’ve got an extended bolus, your extended bolus will be stopped. And so once these like you kick things back on, you have to remember to go back in and either resume an extension of what was missed, or just Bolus for the rest of what was missed, depending on how long bazel iq was kicked off. So that’s a kind of a nuance to that system and control IQ will be, I would say, closest in similarity to 670 G. Neither of those systems are by any means close to looping in any sense, you know, loop open APS, Android APS, I, the the current approved, hike, sort of hybrid clothes are just not, I mean, from the basic information about the research of the control, like you, and the people who have used it in the trials, it seems to do a good job. Again, it’s conservative, similar to the six, seven dg in what it does, but some of the factors that it uses to adjust. From what I understand it does use your set bazel in the background to adjust off of rather than its own secret sauce of applying a bazel does use your current sensitivity factor as well as your carb ratio. So that, in my opinion clinically, and like if I was going to use it personally, I think that those are big steps beyond 670. Because it’s using some things that is, as we’ve talked about, if you know that your settings are good, why wouldn’t you want a system to work off of what you already know, is working to a degree, right?

It seems like these systems are, are set up. I’m sure there are people who have been living their lives in the two hundreds and the three hundreds who are on these systems and think this is amazing, right? It’s just not the next level of what can be done. Okay, and I’m assuming they were set up on purpose like that. That’s what they were made for. And they’re probably doing a really good job for the people that are working for.

Correct. Yeah.

Huge thanks to em pen from companion medical for sponsoring today’s show. And of course, the Jenny Smith from integrated diabetes. Did you know you can hire Jenny, you can go to integrated diabetes.com and then find Jenny. I don’t know what you’ll do it. You’ll figure it out. And then you can email her also right there in the show notes. There’s Jenny’s email address. That’s probably easier. You click on that you send an email. Here’s the email says, excuse me. Hmm, I’m composing. Dear Jenny, I heard you on the Juicebox Podcast comma. I love you exclamation point. Can I please give you money to help me question mark, and then you sign your name and she’ll get back to you

friends, neighbors, countrymen, lend me your ear. This is Episode 291 of the Juicebox. Podcast, a super sized ask Scott and Jenny with how many ads? Zero? That’s right, baby, we reached the end of the year. So instead of ads at the end of the podcast, a little Christmas cheer. Here’s what we’re gonna do today and ask Scott and Jenny, we are going to talk about, I’m looking well, you would think I could read my own writing, especially notes that I’ve taken in the last hour. Well, this is a letdown.

Okay,

we’re going to talk about micro bolusing, glucagon, like around the flow. So there’s going to be a tiny bit of conversation around being sick. Similar to what you just got in the episode about illness, but it’s more about many glucagon boluses. So we’re gonna deal with sick lows, like how to deal with sick time lows. We’re going to talk about how Jenny speaks to people about addiction, and

you eating disorders.

We’re going to talk about how you can discuss with young children what feeling low, feels like. So maybe if they don’t understand that they can learn and Jenny’s gonna describe her pizza bolus. Plus just regular Scott and Jenny goodness. Please 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. Okay, so here’s a question from Trina that I don’t know if there’s an answer to but I’m incredibly interested. Maybe you’re just going to say there’s no answer to this. But she’s not Trina says she has a fairly newly diagnosed seven year old. That can’t recognize being low. Uh huh. And somebody else comes in and says, You know, I, you know, I have a daughter who doesn’t feel low to ardens always felt her lows at, you know, I could tell by what she would say to me, I could I could probably tell you what her blood sugar is by her response, you know, from 65, to 60, to 55, to under 50. I know. But is there a way to teach people to feel low? Like that? Doesn’t? I don’t feel like you could? And if not, then what are the reasons why some people feel it and some people don’t? Or is there not even a reason for that.

It’s not uncommon for younger kids, to not really be quite aware of what their body is signaling and telling them, I mean, outside of like, like a big gash cut that they get in the backyard or something or like, Oh, my God, I’m bleeding, you know, or it hurts, you know, pain sensations are typically felt by all people, right. But from the low sensations, kids are usually not very good with how their body is doing, you know, unless they’re like, Oh, my God, I’ve got a toothache or my ear really hurts, you know, and even little, little kids, like, you know, under the age of, I would say, three, an earache is typically like their rubbing their ear or their like, they don’t want to lay down on that side. So as a parent, you can kind of tell, as far as I mean, a seven year old, technically should be coming into some body awareness. Being able to send some things, but as a, as a parent, you might need to discuss some of what the common symptoms are, you know, maybe they don’t know how they’re supposed to be feeling if their blood sugar is low. And maybe when it is low, saying, Hey, you know, do you? Do you feel kind of shaky? Or do you feel sort of, you know, like, you can’t really, you can’t really do math, I mean, by the age of seven kids or kids know how to add and subtract at least the basic numbers like, you know, 20 and last, right. So in that sense, maybe it’s not a symptom, but maybe something you teach them is, hey, do you know what two plus two is? Yeah. And most kids of the age of seven, should be able to sit out for pretty quickly, right? If they can’t, maybe that’s something you teach them to think okay.

to press to?

I don’t know what it is. And I mean, since we’ve got sensors, kids nowadays can actually visually see And they can start to associate a value with something in their body. That’s not quite right. You know, asking them, does your tongue feel kind of funny? Do your lips feel kind of tingly? You know, when you put your hand out? Does it kind of shake a little bit? Or do you feel sort of like, you know, topsy turvy on your feet? Sometimes it takes talking to kids about what they could be feeling to get them to start paying attention.

Yeah, that makes sense symptoms. I think that I think that makes a ton of sense. Actually, please, you said something in there that just made me think we’re expecting them to say I’m dizzy. But they may have no, they may have no context for dizzy. So maybe you take them at a time when they are absolutely at a good blood sugar and spin them in a circle a couple times, then go, Hey, if this ever happens, if this feeling ever happens, let me know.

And we haven’t spun you around like a twist the

right? Yeah,

you know what I mean? Like, if we haven’t spun you and you feel like this, let me know. Or I think that’s a great idea like, and I would caution when you try to teach them these sensations. Maybe don’t tie them to diabetes, because then it’s possible. They could make them up at some point to like, teach them the sensations. Don’t mention the diabetes, and then just tell them hey, if you ever feel like this, we want to know, right? You don’t want to do the I always used to say to my wife, like when we were first billing, we first had Cole, if he fell over, she would like go at him and say, you know, like, you know is your leg hurt? And I’m like, don’t put thoughts in his head. You don’t mean like, you know, you hit your head? Are you hurt? Well, then you’re like, well, I guess I am yet. You know, like, so you can put that thought into someone’s head. But that’s a great, I did not think we were going to have an answer for that this podcast is excellent. All right, let’s go. As the end of season five comes to a close, I want to take a couple of moments throughout this episode, the Thank you. There are 508 ratings for the podcast on iTunes today. And I took some time to jump around iTunes all over the world. And in maybe six to eight other versions of iTunes, like Australia, Canada, there are amazing reviews for the podcast. I’m so touched by all of them. And I appreciate all the time and effort that it takes to put them up. They’re really thoughtful, and heartwarming. And I definitely think they go a long way towards helping other people find the podcast. So every time I say to you guys, please help someone else find the podcast. Just know that I appreciate it, that you’re doing it. And it’s work. You know, I saw somebody talking about something online the other day, let me see if I can figure it out. I might have a question for you, Jenny on the second. Awesome. Well, I am going to hit this first though, because then how do you? How do you help people who have type one, and also have an addiction? So let’s see. And let’s keep it to a drug addiction, you know, is there? Are there things that those people can be doing when they make the decision? Like, I have to do better with my diabetes? Like how it seems like such a crazy thing. But at the same time, any kind of addiction could mess up diabetes, obviously, I think, you know, drugs, and alcohol would probably be worse. But even if you had like a food addiction that would throw off managing your type one a lot like how much do you end up having to talk about that with people?

I would say that it’s more the anger that you brought in food as a piece of it. While it’s not I mean, addiction isn’t there’s a lot of disordered eating. That comes in with diabetes, because our management is from the get go very centered around food, intake food and you do food and you become food becomes almost a control piece. For many people with diabetes. As I think it’s good, it’s right to kind of categorize it in with drugs and or even alcohol. Those are pieces that we end up talking to people about but not really managing that piece for them. And so far as our explanation about things like for example, alcohol, right as an addiction. Alcohol can have major impact on blood sugar control, and what happens within being drunk right Your ability to mentally decide things and make appropriate choices and what to do. And even, you know, if you were high or drunk or whatever, and you were even changing your pump site, you could totally inaccurately do that. And you could have a major problem. Right. So I mean, those are pieces that we, we do bring in as far as discussion. We encourage people to continue with their, you know, their therapy, if they are in most of the people, I would say 98% of the people that we work with, who have either had an addiction, or a managing an addiction of some kind, already have a therapist that they’re working with. Yeah, I have not personally work with anybody that has a known issue, and hasn’t had somebody that they’re getting help with from it or for it. But I think that’s a big piece of it, it’s also from the standpoint of their therapist, or who they might be working with, that person also needs to understand the diabetes component to it, because it needs to be brought in to the overall picture of discussion. You know, the diabetes is a stressor, and that’s going to be part of how they manage the raw.

Yeah, I so I don’t know if you saw recently, I did a, something I called after dark drinking addiction edition, excuse me. And it was a piggyback off of a conversation you and I had and we talked about how to Bolus for alcohol. And then I said, You know what, Jenny, I’m gonna get like a professional drunk on here to talk about this, right? And actually, the funny thing is, is that, uh, the person, Maya, who ended up being on the episode, two different people in her life, who listened to the podcast, separately of her, contacted her and said, Oh, my God, it’s your turn to be on the juice box. He’s like, she’s looking for somebody. Scott’s looking for somebody who knows how to really drink and take care of their diabetes. It’s your turn. And she sent me a message. And she’s like, I don’t know how to feel about this. But apparently, I’m the professional drunk you’re looking for. And I was like, gotcha. So she came on, and we had a really honest conversation about how she manages. She’s a person who drinks she’s not a she’s not a blackout drunk. Do you know me much, but she drinks a lot more than probably most people do. Like, you know, she’s at least having a couple of glasses of wine a day at her meal. And she is a person who finds a lot of pleasure going is she described going to like, out to a lake and tubing around and drinking a case of beer and that kind of thing. And she talked about all how she did it. super interesting. When I asked her what she thought the most dangerous part about drinking with diabetes was, she said, it was about making a bad decision with insulin when she was too drunk correctly. And she was like, that’s my biggest fear. She’s like, I figured out the rest of it. Like, I’m not super afraid of falling asleep. And getting too low. Especially because she has, you know, she’s got good technology too. But already, but she said I would think the biggest concern and it’s funny, it’s exactly what you said, like, what if I make like a grave mistake and give myself too much insulin? That’s really that there’s a lot of consistency in that.

As you listen to that episode, actually, because that sounds It sounds very good. And I’m always I love to, I love to learn it, you know, more even. Yeah, no different insight Exactly. Because it helps me to help people better. Well,

the next one we’re booking right now is with a legit waken Baker, I found a 26 year old kid who smokes every day and has diabetes, I’m gonna have him come on and talk about that. And as we’re sitting here talking, I think I know somebody I’m going to reach out to about addiction, see, if I can’t do one with them to maybe they could add some more context than you and I are going to be able to be free. Because even as you’re talking about it, I realized that everything I thought to say, was conjecture. I have no real life experience whatsoever. Like I can imagine what the problems might be, but I don’t really understand what it’s like to be addicted. So. So the answer to that one here for Ana is that I think we’re going to try to do an after dark episode about this and get you more answers. Awesome. Cool. We’ve done some of you are asking questions that are already listened to listen to more of the podcasts are already out there.

Go search. There’s more on there.

to them. I don’t really label them that well. I want to wish everyone a Merry Christmas. Happy Hanukkah. Happy New Year, wonderful holiday season. Hope all of your dreams come true. Hope you find some time to relax. May you find time to be with your friends and family. And just reboot, you know, let your brain go limp for a couple of days. So you can reach out And I hope during all this eating and celebrating that’s going to happen over the next couple of weeks, you keep in mind the things that we’ve talked about so far on the podcast, because I think they’re going to help you. It’s flu season. And this person’s asking about something I have absolutely no experience with. How do they micro dose glucagon? In scenarios where they have blood sugars that are so low that they can’t, they can’t get them to come back up and the person’s may be too sick or can’t keep down food? Like what a good I guess not just around glucagon, but what are good practices about addressing lows when you’re sick? Oh,

sorry, you cut out a little bit. They’re addressing

low low blood sugars when you’re sick, you know, when you’re stuck. Yeah.

So I mean, low blood sugars in illness are much more typical for stomach or digestive bugs. not as common for like, the cold or, you know, like a bronco infection, those usually spike your blood sugar. So those aren’t as common. If the flu includes some digestive issues, then we usually say a temporary bazel decreased to begin with, can help to cut the risk, especially if you’re not eating very often, or can’t eat more than like a chicken or vegetable broth, you know, or eat a popsicle every, you know, couple of hours or whatnot. So taking your bazel down temporarily, anywhere between 10 to maybe 25%, less is a good place to start. If you have a blood sugar that you notice is starting to trend down and you literally You’re so nauseous that you can’t take anything in turning bazel down by 80%. So you really only running about 20% Normal bazel for about one to two hours, really cuts off insulin significant enough that it should help that glucose to stabilize, and not get too low in a time where you can’t take anything in at all. So those are, you know, some, some adjustments that can be done. Other ones certainly, if you find something that you can sip on even a little bit of like, honey in the cheek, or, you know, cake frosting, I know is another one that’s commonly you know, mentioned, maple syrup is a very curvy. So those kinds of things, even in a cheek and sort of massaging can help to get it to absorb through the the like oil area

without you having to maybe swallow it and affect iraq feels Okay,

correct. I mean, you’re certainly not going to get 100% of carb absorption, but you’re definitely going to get some carb into the system by just putting it in the cheek and massaging it. So that’s another good option. electrolyte beverages, especially for stomach bugs are also a good place that you can get a little bit of carbohydrate. There’s one that’s got a minimal amount of carb. It’s called drip drop, okay, it’s an electrolyte replacer you put it in water, I think per serving, it’s got like eight to 10 grams of carb. So again, not a lot, but enough that it could help to stabilize blood sugar some. And then, you know, in a scenario where you really may need to use glucagon. If you don’t have if you don’t have the current and newest back semi, you know the the nasal sort of glucagon that be many dose unless somebody figured out how to do that already. I don’t know. But I mean, it’s a one, pop it in and it’s there. You can’t like micro dose it. But there are some rules of thumb for micro dosing the injectable glucagon. Essentially you would mix up the glucagon. The mixed glucagon is good for I believe up to 48 hours after mixing. So if you had to use more of it over the time period of and stomach bugs usually don’t last very long, somewhere between 24 to 72 hours at the at the longest. You would mix it up but you’re not going to inject it with a glucagon injector syringe, you’re essentially going to use an insulin syringe. So for those people who are using insulin pens with needle caps, get a one time prescription from your doctor for insulin syringes. Keep a box around so that you could go ahead and micro dose your glucagon

I would say ardent hasn’t has been pumping for like ever. And we still have syringes in the house. I always make sure we have some just in case. Yeah, that’s all it just needs to be there just in case I need it. So So

don’t really go bad. I mean, your syringes. I mean, they do have expiration dates on and I always think it’s funny. I’m like, is this it’s not like cheese

with a piece of metal on it. I haven’t got

I have some that are so I had so many at the end of MDI that I gave a number of them away to somebody because I thought in a lifetime, Arden won’t use all these, you know, so we held on to a few and they’ve lasted for a decade, it’s you know, but been incredibly helpful when they were needed. So when I so when someone goes to micro bolus glucagon, is it just? Is it a testing thing? Are you just trying it and seeing are you so there’s a rule of thumb or

there is a rule of thumb, and I’m actually off the top of my head, I don’t know, I’m actually looking in my education materials right now. Because it’s something that I actually send to people.

Core ability to squat,

you’re looking at that, let me say this, the idea of sipping tiny, tiny little sips, while you’re sick of you know, something that has a little bit of carbs in it with the electrolytes, first of all, it’s going to help you being sick anyway. But it’s really no different than when I was talking to someone, a month or so ago, somebody I know, personally, whose child has type one playing ice hockey, ice hockey, and was getting low. And I said, look, I think he should have some sort of a Gatorade and water on the bench. And then when he sees himself dipping a little low, that’s the time you take a couple sips of the Gatorade. And then the next time if the arrow levels out, you go back to the water. And maybe you have to go back and forth a little bit to to, you know, kind of bump and nudge with the glucose from that drink, you know, right. And it worked out really well. For him, I think you’re basically saying the same thing. If you’re sick and your budget is just trying to get low all the time and cutting your basal back’s not helping, then you just have to kind of it doesn’t have to be a big drink, don’t get into a situation we need a big glass of liquid just write a little bits, little bits and little steps.

And with nausea, and everything those little sips can sometimes still be tolerated enough that you can, like you said, you can get in just a little bit incrementally, I mean, stomach bug to really help to get in some power that you are bolusing even a micro amount for because it really helps to prevent starvation ketones, and anytime you’re ill, you really want to prevent ketones of any kind, because they could even at lower blood sugars. I know we talked about this before, as far as ketones, even with lower blood sugars in a time period of illness, it can lead to decay, even at numbers that look more normal. So if along the line of a stomach bug, you’re micro dosing for, you know, a popsicle, that was 12 grams and you only Bolus for three grams of it, it’s getting enough little bit of insulin in that you decrease significantly the risk of ketones

you do not want to go into DK and if you go into DK or you lose control of it, you got to get to the emergency room. So correct yet don’t correct. Especially going into like overnight, like like don’t don’t you don’t mean like it make a decision. My wife wasn’t feeling well the other day and I was like, don’t wait till Saturday to decide you need to go to the doctor. It’s so don’t wait till midnight to decide, you know, I don’t think I’m doing well then fall asleep and find out you aren’t decay overnight. Like, you know, you have to make it sucks being sick. Hopefully everybody and it

kind of, you know, blood sugar wise, it kind of also in an illness goes along with Where? Where should you look at the potential for needing something to help prevent a further dip, right? So if you’re starting with somebody who’s Ill really nauseous, unable to keep things in, or things are coming out kind of like both ends. Not to be gross, but you know, they really can’t keep anything in. You mean need to utilize something more than just taking bazel down temporarily. Right? That might not cut it completely. So Then where should blood sugar safely be? We usually say especially for kids, not letting blood sugar get less than like 85 to 90. Only because less than that you’re really risking a quicker drop to being a time or a glucose value that you can’t really recover from when somebody can’t take anything in right, so many glucagon. And there are a lot of really good resources online. I mean, there’s one at diabetes in control. There are some from the NIH. Typically for kids, we would recommend if your child can’t take anything in literally at all. And glucose looks like it’s dropping. It’s not like that nice stable, but it looks like it’s trending down, we’d recommend that the mini dose mixing it up that vial, push the liquid and mix it up, get your insulin syringe. And using an insulin syringe, it’s kind of based on age. So the mini dose of glucagon. Each unit on an insulin syringe is 10 micrograms of glucagon. So that’s the conversion. If your child is under the age of two, you would need to units on the insulin syringe, which is 20 micrograms of glucagon. If your child is between the ages of three to 15, you would need one unit per year of age. So one unit of an insulin syringe or 10 micrograms of glucagon per year of age. And then over the age of 16, it’s 15 units, or 150 micrograms. And you’d inject it essentially the same way you’re going to give insulin. Pinch up injected in AI, we typically still recommend similar to low glucose, you know, we still recommend checking blood sugar every 15 minutes and definitely doing it with a finger stick. Don’t just rely on your CGM value, do a finger stick, get an accurate value. And if it’s still lower than that 90 or if you’re someone listening from outside the states, and you’re in millimoles, that’s five millimoles or less, then you can give your child a second injection of glucagon and you would actually double the dose from what you gave the first time.

Now, are they going to experience any of the kind of bad side effects that sometimes come from glucagon when you’re mini dosing?

typically not in fact, those symptoms which common symptoms would be nausea and vomiting, which is pretty significant to give that whole entire syringe full of glue good on, which to my understanding is at least what I initially learned was that syringes meant to treat somebody up to 250 pounds. Cheese. So if you’ve got a little, you know, four year old who is like 30 pounds or 40 pounds, no wonder they’re getting such a significant, like, nauseous. With Yeah, we have a micro dosing of it. You shouldn’t

Arden’s emergency one at school up until I think she was over 80 pounds, just that just give half of it if you can, you know, just eyeball it. I mean, if if Wallah seven year olds having a seizure, and you as a teacher who really never wanted to be a part of this can stop the thing. I just want to put it in half of this. Well, you know, good luck and everything. Right. I think you’re in an emergency situation that and maybe the nausea afterwards is is the price of doing business, you know, but I just wondered if it came with a micro dosing to Okay, so I had one more question. I don’t know if we can get through it in 10 minutes. Sure. But um, what are we okay, well, we’re gonna do one more by the way, Arden’s blood sugar 77 and stable. Nice job. Thank you so much. Banana bagel, three molano cookies. Oh, my gosh, big bag of grapes have no, I have no idea how many. And a yogurt. I’ve even come to the idea of I can now put in more food to give her choice knowing she won’t eat at all and still hit the but the Bolus, right? So seriously. Alright, so now we’re gonna test this right? We are going to answer someone’s question here. Gosh, why can’t I just see it? I’ve been looking at it for 10 minutes while we’re talking about moving on. And now all of a sudden I’ve lost track of it. But this person says, I don’t know how to Bolus for pizza. So given that everyone’s going to be different. Still. I would like to ask you, you’re a grown person. I’m assuming you eat pizza sometimes. How do you Bolus for pizza?

Oh,

assuming this person is using conventional insulin pump.

And we don’t know.

I don’t really see Tam on injections or I’m pumping or I’m you know, using a frezza nasal nasal insulin or whatever you’re doing right? I don’t know. So let’s assume a conventional pump. Yep.

In that case,

the pizza bolus sort of became the term for an extended bolus, right? It was the first reason that we started to use extended boluses or have that feature on a pump. And the reason being pizza is high carb, very, very high carb unless there’s somebody making a cauliflower pizza. across, then whatever your pizza is high carb from the grain nature, but it’s also really high in fat. I mean, unless you’re doing a vegan pizza that has no cheese and sausage and whatever on top of it, your pizza is high fat. And if it’s a pizza from a source outside, the crust probably has fat in it, as well as the toppings that you’re adding on top of it.

So

the high fat nature along with the high carb component to it really mean that if you Bolus 100%, right now, for pizza, with a Pre-Bolus, as we’ve talked about before, the benefit of that

you’re going to get low,

and then your blood sugar is going to get high. And then it’s probably going to stay high for a while. Right. So there are a couple pieces to pizza food management. And let’s kind of tie in nachos and you know, fish and chips and like a cheeseburger and fries or a real Italian pasta meal with all the good cheese, sausage and cheese and oil and whatever. Right. So high fat, essentially an extended bolus. And again, it takes a little experimentation to see what type of extension you need. For the most part for pizza type of food, you would use about a 60 or 70%, upfront possibly, and the rest over at least a two hour time period.

So

what you’re doing is you’re giving insulin up front, but then that extension over about a two hour time period and the back end is grabbing on and hitting the food that’s more slowly getting into the system because the fat isn’t letting all hundred and 20 grams of that pizza. Get in right now. Right? Some people do a 5050 50% now 50% over two hours that works very well. Um, I think the upfront amount from my experience really is specific to how much is on top of the pizza. You know, if it’s your Margarita pizza that has a couple of blobs of real mozzarella on top, but it’s not slathered in cheese, and sausage and Canadian bacon or whatever, it’s probably a lot lower fat pizza, right then something like the meat lovers, right? So that breakdown of percent now percent over time, kind of goes along with the nature of what you’ve got on your pizza. But that’s that’s the gist of pizza. And again, it takes a little experimentation. Sometimes you got to take a hit

and learn and then move on from it. Right? I would say so Arden just had a slice of pizza going out the door to a party last weekend. And it was more the way you describe in some ways. So it was a thinner crust, but it had less cheese. Like it’s not completely covered with cheese, you know, and I, you know, I come to realize too. I live in a portion of the country where, you know, I’m eating pizza that somebody in the middle of the country might have never seen before to me I’m not it’s not Domino’s, or you know, some restaurant chain pizza. This is you know, this is a Sunday night real pizza 90 year old Italian man who has, you know, the, the, the recipe for his pizza chained in a box around the killing to get it from him. So, and I happen to live in that part of the country where a pizza like that exists. And so she has this thing, but it does have sausage on it. So I looked at it and I thought okay, Arden’s blood sugar’s like 105 I believe back then, because she was she was a little on the lower side, because she was spent a lot of time getting ready with a costume party and everything. She’s moved around the house a lot. blood sugar’s nice and stable. I’m going to have a slice of pizza. I didn’t worry about Pre-Bolus. And partly because I thought she might be trending down to begin with wasn’t but because it’s pizza too. And my idea about these carby things that hit hard. And then last is I kind of just think about it as getting my insulin up front to stop a rise or a spike. So I have so much, I have so much up front, that there’s no way for your blood sugar to spike. And then as time goes away, I can take insulin away and let what’s left over from the big push at the beginning act as the bazel going through it. And that is one way I do that. The way you just described I do as well. I don’t need to read describe it because you did such a perfect job of talking about it. But But another way is, is that like it’s just I bring in so many blockers up front. You can’t sacked my quarterback. And then later later in the game when you stop blitzing, I send them away, you know, so and so I sometimes get in so much upfront that the it can not only handle the food, but it can be part of the bazel rate going away. And then I take the bazel way I trade I trade Bolus earlier for bazel later to leave the Bolus tail end acting as bazel later, yes, yes. Yeah. Yeah, that’s, that’s one of the ways I think about manipulating insulin. So

but then the other component

to pizza too, is again, the fat content, right? Like I said, before the Margarita pizza with a couple blobs of buffalo mozzarella on top, probably not high enough in fat that you’re going to have that long duration extended high blood sugar for six, eight hours after, however, bringing the neat lovers and you not only probably need the extended bolus, but you probably need a temporary increase to your bazel for hours after right to avoid the sustained high. So again, scenario to scenario you may have to decide what your strategy is going to be. But those are the typical ways to manage pizza would have grabbed another slice,

then I would no longer have been thinking about a bunch up front and no more back now I would have been as soon as she had the second slice, I probably would have bolused thin thin crust pizza, my guesses like 25 carbs, like I probably would have, I probably would have Bolus 25 carbs and probably done zero upfront and the rest out over like an hour and a half. I will as soon as she grabbed another one, I would have started thinking about the future. Yeah, right. But it looked like one and then she was going somewhere. She actually did have to Bolus once while she was at that party. We did not end up taking it away. I did a pretty good job of balancing it. And so while she was there, we had a nudge like a 134. Diagonal up at one point. She did not eat anything at the party, though. Oh, yeah, I think at a certain age kids just stand around and look at each other. So. So you’re here I’m here to and then they that’s pretty much the end of it. And I did not see Luke doing any gyrations during that time. Like there was no technical way away or way up, you know. So I was in a fairly traditional situation there too, because we’d hit the ball. So well, in the beginning. It just didn’t. Luke didn’t really have to do anything. It just sat with her base. Alright. Nice. That is really kind of fun when you can see that when you’re on an algorithm. But you’re like, wow, we did such a good job with the Bolus, like the algorithms not doing anything, you know. Yeah. Wow. That’s really like, that’s right.

You don’t see the down or the off the you know, cityscapes kind of thing. You just riding along your leg is looping. Is it working? is it doing anything? No, it’s just got me hovering. Nice.

We really hit this one. That’s crazy. All right. Okay, so hopefully that was helpful. My Eternal grateful thanks to Jenny Smith from integrated diabetes. Don’t forget, if you would like to hire Jenny, go to integrated diabetes.com to contact her. Also in the show notes of your podcast app. Jenny’s email addresses right there. It also exists on Juicebox podcast.com for this episode. And I know this was ad free, but I’m feeling very festive. On the pod Dexcom dancing for diabetes. companion medical makers of the in pen. All the sponsors that supported the show this year. Happy New Year. Merry Christmas. Thank you so much. And now I’m going to try something that may or may not go well for the holiday season. We’re about to find out. This is for all of you who listened with your children. And for those of you who may still be children. Somewhere inside the Grinch by Dr. Seuss. Every who down in Whoville liked Christmas a lot. But the Grinch who lived just north of Whoville did not. The Grinch hated Christmas the whole Christmas season. Now please don’t ask why no one quite knows the reason. It could be perhaps that his shoes were too tight. It could be his head wasn’t screwed on just right. But I think that the most likely reason of all may have been that his heart was two sizes too small. But whatever the reason, his heart or his shoes, he stood there on Christmas Eve hating the who’s staring down from his cave with a sour grinchy frown at the warm lighted windows below in their town. For he knew every who down in Whoville beneath was busy now hanging a Holly who reef and they’re hanging their stockings he snarled with a snare. Tomorrow is Christmas. It’s practically here. That he growled with his Grinch fingers. nervously drumming. I must find some way to keep Christmas from coming. For tomorrow I know all the who girls and boys will wake brighten early. They’ll rush for their toys. And then oh the noise. Oh the noise noise noise noise there’s one thing I hate. All the noise noise noise noise they’ll stand close together with Christmas bells ringing they’ll stand hand in hand and those whose will start singing far who for $1 who don’t? Ray welcome Christmas Come this way. Bar who for a DA who don’t raise well gum Christmas Christmas Day. Welcome Welcome, fall Who? ramas welcome welcome Doctor Who does Miss Christmas Day is in our grasp. So long as we have hands to clasp foul Who’s Who? For who? And they’ll sing and they’ll sing and they’ll sing, sing, sing sing. And the more the Grinch thought of this who Christmas sing, the more their Grinch thought I must stop this whole thing. Why for 53 years I’ve put up with it now. I must stop Christmas from coming. But how? Then he got an idea. An awful idea. The Grinch got a wonderful, awful idea. I know just what to do. The Grinch laughed in his throat. I’ll make a quick Santa Claus hat and the coat. This is stopped number one, the Grinch claws hissed as he climbed to the roof. Empty bags in his fist. Then he slid down the chimney. A rather tight pinch. But if Santa could do it, then so could a Grinch. He got stuck only once for a minute or two. Then he stuck his head out of the fireplace flew where the little who stockings hung all in a row. The stockings he crunched are the first things to go. And he slithered and slunk with a smile most unpleasant around the whole room. And he took every present. It was quarter of dawn all the who’s still a bed. All the who’s still a snooze. When he packed up his sled, packed it up with their presence, their ribbons, their wrappings, their sniff and they’re fuzzles their tree anglers and trappings. 10,000 feet up. up the side of Mount crumpet. He rode with his load to the tip top to dump it. Poo Poo to the whose he was Grinch Lee humming, they’re finding out now that no Christmas is coming. They’re just waking up. I know just what they’ll do. Their mouths will hang open a minute or two. Then those who’s down in Whoville will all cry boo hoo. That’s a noise grin The Grinch that I simply must hear. He paused and the Grinch put his hand to his ear. And he did hear a sound rising over the snow. It started in low then it started to grow. But this sound wasn’t sad. By the sound sounded glad. Every who down in Whoville the tall and the small was singing without any presence at all. He hadn’t stopped Christmas from coming it came. Somehow or other it came just the same. And the Grinch with his Grinch feet. Ice cold in the snow stood puzzling and puzzling. How could this be so? It came without ribbons it came without tags. It came without packages boxes or bags. He puzzled and puzzled till his puzzler was sore. Then the Grinch thought of something he hadn’t before. Maybe Christmas he thought doesn’t come from a store. Maybe Christmas perhaps means a little bit more. And what happened then? Well, in Whoville they say that the Grinch is small heart grew three sizes that day. And then the true meaning of Christmas came through and the Grinch found the strength of 10 Grinches plus two. And now that his heart didn’t feel quite so tight. He whizzed with his load through the bright morning light. With a smile to his soul. He descended mount crumpet surely blowing hoo hoo on his trumpet. He wrote into Whoville, he brought back their toys. He brought back their floof to the who girls and boys. He brought back their sniff and their trailers and fuzzles brought back their petard cuz they’re daflores and muzzles. He brought everything back all the food for the feast and he himself, the Grinch. carved the roast beast. Welcome Christmas, bring your cheer. Cheer to all who’s far and near. Christmas Day is in our grass, so long as we have hands to grass. Christmas Day will always be just as long as we have we welcome Christmas while we stand, heart to heart and hand in hand

Hello everyone and welcome to Episode 297 of the Juicebox Podcast. Today’s episode of Ask Scott and Jenny is brought to you by the Contour Next One blood glucose meter. This is the blood glucose meter that Arden has been using for coming up on getting closer to year and a half now. Absolutely fantastic. Wonderful. Actually, let me tell you why. First and foremost, in my mind the Contour Next One has remarkably accurate testing demonstrated proven accuracy with the Contour Next One meter, and Contour Next One test strips tell us that the smallest error range demonstrated by the Contour Next One meter system was determined to be 95% of results met. Right? That’s like plus 8.4 milligrams per deciliter, or plus or minus My gosh, there’s a lot of information here. Hold on a second. Wow. I might not be smart enough to tell you about this. I’m reading it and I’m not sure if I’m smart enough. Hold on a second. Anyway, the things really really accurate. But Contour Next One wants you to know that I’m going to read it again meter system was determined to be 95% of results met plus or minus 8.4 mega boy versus reference for glucose values under 100. per deciliter or above 100%, respectively. For subject fingers testing is Alright, listen. I think here’s what you’re gonna need to go to Contour Next. one.com read it for yourself. See if you have better reading comprehension than I do. You know, me, I just dumb things down. I know the Contour. Next One is incredibly accurate. I’ve seen a lot of testing, it comes right up at the top of every chart I’ve ever seen. And you know what? A listener just reached out to me like 10 minutes ago. No lie on one second. But this is an ad. Hmm, this is what the company was looking for when they throw in with me. really concise ads like this. was like it’s gonna go with the episode. Hey, Linda reached out right? She’s telling me about a little bit of about the podcast asked me for somebody to come on if I could. But but in the middle of her note said, let’s see what she say, Oh, I wanted to let you know a tidbit about the Contour Next One app. So the app that goes along with the Contour Next One, it works with voiceover users on iPhone for the blind and visually impaired. Isn’t that great? Thank you, Linda for telling me that. Okay, well Contour. Next One, if you know, they’re still advertisers, next week, after hearing this go to Contour Next one.com. There’s links in your show notes and Juicebox podcast.com. The meter is incredibly affordable, covered by many, many insurance companies. And Arden is just having a great experience with it. As Am I let’s put it this way. The Contour Next One is a million times better at being a blood glucose meter than I am at reading an ad about the Contour Next One blood glucose meter following that. Okay, listen, this isn’t ask Scott and Jenny. I don’t want to give it away. But I leave a little bit of like preamble Jenny and I talk sometimes before you get to Harris. And Jenny brought up something about a Reilly link for loops. So I left that in. I thought that was interesting. We talked a little bit about site rotations. And you know the importance of being prepared. We will even remind you to change your smoke detectors at some point and then we’re going to get into some basal insulin talk. It’s a little more deep dive. And that comes from questions from you guys. Please 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. We’re becoming bold with pencil. Ask Scott and Jenny are questions directly from you the listeners that Jenny and I answer Jenny, of course, is Jenny Smith, who works at integrated diabetes.com. And you can always go there and check out what Jenny does. You know, you could you could pay Jenny and she’ll help you with your diabetes. She’s She’s good like that. It’s her job. You know, I mean, it’s not like you, like weird or anything like that. Jenny is a contributor to the podcast. For those of you who have not heard this before, and she’s just absolutely amazing. So check her out. Jenny Smith had integrated diabetes.com Let’s jump right in.

Hey, no.

Hi.

What happened your Riley link died died like gone.

Yeah, like this morning for 13. So my Oscar he’s got a cold and he woke up coughing this morning at like 430 so I went in and gave him some cough medicine, some water and whatever. And I noticed that I always have my like Riley link and my pot my phone right next to my bedside. table and I noticed that my Reilly link was like the green light was not solid It was like green. Green.

Little Blinky.

Like, that’s not right, you’re not supposed to be doing you know. So I turn it off I turn it back on and then there was no green light. And then now I have like this, like I just I I unplugged everything to like try to plug it back in. I like did all this like trying to figure out it’s like this flashy Christmas blue, green, blue, green, blue, green, blue, green. And like, That’s not right, as I go to the website and look at you know, like Riley link like errors on the get Riley link. And the only things that I can find, seem to indicate that I have if I have like a solid blue, and it stays on that the board might be dirty. So it says to unplug the battery, clean the battery thing out, well, I don’t have like one of those little air can do it with. And I don’t have an old toothbrush. They’ve all been like in somebody’s mouth in the house. And so I’m like, screw it. I don’t have time for this. Today, I will just use my PDM and figure it out later. I think I have a feeling that it’s just that it’s just gonna work because I I took the old battery from my Medtronic, Riley link. And I plug that in, and I get the same response. So I have a feeling it’s the Riley or that it’s actually the motherboard that it’s has nothing to do with the battery or the connection. I think something’s dirty. So I don’t know. I mean, I just ordered it in. April. I don’t know if I should send a message to Jeremy and be like, Hey, I haven’t I’ve only had this like six months, would you replace it? Or if I should just go ahead and buy a whole new one.

So

this is what I get for not having a backup.

I was gonna say in a very unlike me fashion. About two months ago. I just ordered another one. And I thought if I never it’s sitting right over there in a box. I thought if I never take it out of the box, I guess I don’t care. And then every time hers acts a little wacky, I’m like, ah, I don’t care if this breaks. I have another one. Right?

Exactly. And right now it doesn’t look like there any holdups as far as like getting another one quick. So hopefully I can just get one and get up by next week again.

I got a note from a woman this morning, it said that she moved to loop because of the podcast. And then oh begged me to do a follow up. She’s like, I need a best practices podcast for loop. And I was like, Yeah, well, as soon as I know what the best practices are. I’m happy to tell you what they are. And I think I’m close by the way we are. We’re in a good spot. Hey, I just finally, after a long time of trying. I finally got Arden to try a different site. Okay, the one thing

what she what she had, what had she been using?

Arden was thighs. And she’s belly canula pointed towards her belly button. And she does not like me. No, no, no, no, no. Like, you know, if you said like, Hey, you should try your arm. She looks at you. Like you said, Hey, you know what we should do? Let’s shave your head and your head bald, paint a face on the back of your head and make you walk backwards. Right? Right. Like really looks at you weird. Because when she played softball when she was little, and it was on her arm, she could feel the pod wiggle around when she threw her arm. So she got in her head at a young age. That that’s not good. Yeah. And Arden is really, for all of the amazing things that she is. Every insertion of every pump is treated like It’s never happened before. Even though when it’s over, she’s like, it doesn’t hurt. It’s she it’s hard to put into words. But as it’s clicking, she just tenses Oh, my god until she’s almost at a ball. And then when it gets to the fifth click, if it doesn’t happen, she goes. There’s a little shake it. It’s It’s It’s not funny, but it is yeah. So she’s just like, it’s she’s just incredibly the Dexcom she doesn’t do the thing because there’s no click. Yeah, I know. That’s what it is. It’s her. It’s her hearing the clicking and it’s ridiculous. And she knows it’s ridiculous. Like if you had her here, she tell you. I know. It’s not a real fear. But my goodness. So. So what she’s done is by keeping the same couple of sites, she’s a little numb to the insertion, right? So it feels different on a new site. And but I got it To finally I mean by the by God or I don’t know what I might have like, I might

have thrown Mercer a read for.

So she spun the pod on her belly 180 degrees the canyon was going the other way now. And it works so much better because her her thighs were really like we don’t have propped up. Oh, no, I don’t know, they just don’t work well, like like, because we try all different places I never have

my thighs have never worked.

So better blood sugar is not on her thighs. And I told her, she’s like, well just use my belly. And I was like, you only have two spots. And even when I say to her, like very up and down, she moves it like a quarter of an inch. Right? Like our night a little farther than that. Yeah. So anyway, I got her to move. And finally, it was not without some tense moments, but it’s done now and her blood sugar’s are way better. So

Wow. So you can speak to the benefit of rotating site. Yes.

This is gonna seem disjointed. But Jenny and I jump back to talking about the Reilly link for a second. And the bridge we got back to it with wasn’t interesting. So this is me telling you little more about Riley link. And then we jump in ask Scott and Jenny. At the very least you haven’t had it that long.

I haven’t. And that’s the thing. I mean, if I had had it, like two years, I wouldn’t even ask, I would just order a new one. But I haven’t had it for very long. And I feel like I mean my other one, the one that I have had for Medtronic, the battery still works, I can still turn it on. It still connects, it works perfectly. And I never replaced that one. So and I’ve not done anything different. Like I’m not like cleaning out attic spaces with whole bunches of dust in my Riley lane. Collect all the dust you can you know, I like

sometimes just stop swearing. I actually, you know, we had a smoke detector that started like chirping. And I just was like, you know what the thing seven years old? Like, I just throw it out and put another one up. You know, I

actually recommend replacing them every three years.

Yeah, so I had just done a bunch of the other ones in the house with these. There were these two that were like, they were going strong. And I was like I’m writing these out. And then when they started because you know, as an adult, what’s the worst thing is to spend money on stuff like that, right? Like, I always tell people the worst part about owning a house is that I once had to have a tree cut down. I had like, like, there was this day that I had 1500 dollars in my bank account and a tree. And when the day was over, I did not have 1500 dollars. And I did not have a tree and that I had less than when I started. Not even like I had a new and improved tree, or you know brakes on my car or even when it was just one of those like the money’s gone and the thing is gone. Being an adult is terrible.

Yes. adulting is hard.

Not fun. All right, you ready? Sure. All right. So it’s hard to know where to start when there’s this many. So I think the top is probably where to start. I’ll go with Stacy who says pros and cons of using a Temp Basal increase versus a Bolus. She says that she tends to do extra boluses if her son doesn’t have any insulin on board, but her husband tries Temp Basal as more often. Now, I think this is more of a situational thing. Mm hmm. You know, because there are moments where, and this would feed right into another question. But there are moments where I don’t have time to wait for Temp Basal to start, right, right. It’s a timing issue. So if it’s, if it’s after a meal, and there’s a creep, right, like, it’s just like 85 becomes 89. But there’s never an arrow and then 10 minutes later, it’s 93. And all that, then maybe I would be like, Ooh, this is so close. Maybe I’ll try to tamp it for a little bit to get away. Yeah. But if this was a diagonal up arrow, and it was, you know, 115 to 121 to 130, I would think I need the more immediacy of a bolus correct. So I think that’s the

right way to think about it. I mean, it’s a bolus is going to go in, it’s a big depot of insulin right there right now, it’s, I mean, it’s still gonna take some time to get absorbed, there’s a large amount of it at one time to get absorbed. The only caution to that is, especially for those who have really big boluses at a time to begin with, if you just bolused 10 units for a meal. And now it’s 30 to 40 minutes later, and you see these arrows going up, and you’re gonna bolus, you may, in fact, really not, you may not reap the benefit of an additional extra bolus to offset that on top of the large amount of insulin sitting under the skin already, because it’s still absorbing especially if you didn’t give enough Pre-Bolus timing, you know, all of those other considerations. So there are, there are lots of variables to both uses. I think

I think too, it’s what it comes down to a lot of like, again, timing. So if you if you have a quick rise, like you said, but it’s happening 45 minutes an hour later, and you Bolus You’re so off time now that maybe you’ll cut something out of that rise, but you probably most definitely make a low later, right. That’s why I like to get as much of the insulin upfront as possible, because at least at least when that battle happens between the carbs and the insulin, you know, you’re gonna know there’s not a ton leftover afterwards

at the end. Exactly, yep. And that’s the whole purpose of the Pre-Bolus, as well as more of like that super bolus consideration is up front loading of insulin, gets the insulin connecting with the sugar that it needs to connect with to get used. So in the back end, there’s less of it.

I’m sorry, I know you couldn’t hear that. But that’s okay. I was getting a phone call from my doctor’s office. And for some reason, it came through my computer too. Could you repeat that really wanted to reach you, I’m a guy bounce through everything I own just oh, my gosh. But But would you say that again? I apologize.

No, I was just, I don’t even know exactly what I just said, Ah, oh, yes. So the larger amount up front, it’s, you know, if you if you do a big Bolus up front, and you do it with more, just because you see a rise, or if you initially do like a Pre-Bolus in your front loading, or you do that super Bolus concept, where your front loading with a lot of insulin with the meal as well as the bazel behind it, you’ve got more action in the beginning for the insulin to connect with the sugar and to prevent that rise so that in the back end, majority of that insulin should be kind of used up that back end impact isn’t as heavy. So

I think the bigger response to Stacy’s question and by the way, Stacy did not get her question as first because she bought a bunch of gear from the merch store today. Just because hers was at the top. But But I think the answer is it seems like early on, you probably had success with your Bolus, your husband had success with Temp Basal. And now you both think it’s a tool that works best for you. But the truth is, in certain situations, it’s one or the other. It’s not like it’s not like one. It’s not like two tools that do the same thing. And you prefer one and he prefers another? I think that it’s there are two different things because of the timing aspect. And this rolls right into another question. Another question that I’ll let you here in just a second after I tell you again about the Contour Next One blood glucose meter. Okay, so I did a pretty poor job at the beginning of telling you that it’s really accurate, but it’s super accurate. You can go to Contour Next one.com to see how they figure that out. It also has something called Second Chance sampling. This prompts you to reapply blood if the first sample is insufficient to take a reading, it helps to avoid lancing a second time. And more importantly, maybe wasting valuable test strips works terrific. Other top features of the meter that you can add events to your readings. You can record events such as diet activities, medication, also add photos, notes, or voice memos to help put your results in context. Hmm, now we’re talking right? voice memos, photos. So wait, I could take a picture of a plate. Oh, now you’re getting that right, and put it into the app and say this was the meal I had. This is how much insulin I used this but my blood sugar was when I started watching see what the Bolus does how it works. Next time, got some Delete on their smart alerts, you can get alerted when your blood sugar levels are at a critical high or a critical low level with the Contour. Next One. It’s very cool the way it does it was sort of colors and lights and everything you’ll see. You can also easily share your results with your doctor in person to before your checkup, you are getting a lot out of a tiny little meter accuracy, alerts, reminders, an app that you can interact with, it’ll actually help you with your blood sugar’s And best of all, this meter is teeny tiny, but not too teeny tiny. So it’s not a pain to carry. And it’s not a pain to use Arden and I love it. Go to Contour Next one.com where the links in your show notes. Were the ones that you’ll find at Juicebox podcast.com. People wanted to know about how long it takes for a Temp Basal increase to start working. And even though I told him like, Look, we’ve I feel like we’ve answered this a bunch of times but it’ll it’ll but right up nicely with this question. So Let’s start with the idea of I bolus insulin. And it takes whatever 15 or 20 minutes to start working for, you know, whatever your your your truth is five minutes, 30 minutes. That’s going to, of course, vary depending on your hydration, how high your blood sugar is, like all these different ideas. So okay, so let’s just say it’s 15 minutes. And that’s a pretty consistent thing for you. But what if in that same scenario, my blood sugar’s 95. And I suddenly do a Temp Basal increase? How long do I see before it starts impacting? I know, you’re gonna say 30 minutes to an hour, probably right? Or even longer?

Well, it’s, it’s interesting, because, you know, as we started with the Temp Basal increases a slower creep up in dosing and amount of, of more right of more insulin. So as soon as you increase by using Temp Basal, you do have to wait for the next pulse of bazel that the pump is going to deliver out for it to incrementally adjust that up. So with the next pulse of bazel, that comes out, it’s going to be boosted up in the temporary amount you told the pump to increase by, but that pulse, then that initial little extra pulse is still going to take time for that larger amount in it to get noticed in the circulation and to start impacting the blood sugar. So as you do a temporary bazel increase, you may get more, if I’m talking about just Omni pod, in general, the pulses go out as point 05 pulses, right? So the more or the higher your basal rate is over the course of a one hour time period, the more point 05 pulses, you get to deliver a bazel. So if your bazel is normally at point zero, or point five or point six, you get 12 pulses over the course of an hour, right? If you do an increase to that point six, and now you’re getting 1.2 units an hour, you’re going to get more pulses over the course of an hour to drive that temporary increase that you’ve told the pump to provide to you. But it’s still going to take time for each one of those pulses to get circulating. As far as absorption. So it’s, it’s kind of hard to define exactly when you should start to see an impact. But I would say some of its dependent if you’ve got a load of insulin, again, from a bolus sitting under and you’re doing a temporary bazel increase. Sure, you might see in in, you might see a change in blood sugar faster, especially if you’re doing a really huge temporary basal increase. If you’re doing just this minor little temporary bazel increase, and you don’t really have any insulin on board at all, it’s probably going to look like it takes a lot longer for that temp increase to make an impact.

Interesting, because I think this is one of those scenarios where people really do want a concrete answer. And I don’t know that there is a concrete answer. I find that when especially when I’m speaking and so you’re in really in front of people who are, you know, really trying to figure out something new. They there’s always someone who’s like, how long how much when, you know, my head, listen, you know, I can, I don’t know,

the definitive cut and dry and there is no definitive cut and dry

exactly how long would I do a Temp Basal increase while I started seeing an impact? And the truth is, you know, so situational and personal and, you know, where’s your site, get a good site, you got a bad site, got an old site, get a new site, like there’s so much going into it. The other thing that I wanted to mention here that I find shocking, and, and not because I would expect people to know because anybody would tell them. But I don’t want to insult anybody, but it seems like a common sense thing. The amount of people who believe that a basal rate is put in once every hour, like if your basal is one unit an hour it like that they think at like 12 o’clock, you get a unit and then one o’clock you get again, that if you really stop just for a second Think about it. That doesn’t make any sense. But I guess it does, if no one’s ever explained it to you like why and unfortunately

at pump training, it isn’t often explained to how that bazel rate is delivered. I think it’s it’s expected as an underlying under understood but not specifically stated. You know, yeah, it’s just not it’s not commented on unfortunate. In fact, it kind of also relates to an extended bolus. I don’t know how many people I’ve had asked me or kind of explained me Why give this extended bolus. And I gave 50% now and then I did the other one in two hours. So you know, but then I cancelled it an hour later, so I didn’t really get any of that that extra drove that I extended for two hours. I’m like, Nope, that’s not how it works. Yeah. As soon as you’re up front part of that, let’s call it a dual wave where you get some now and some extended. As soon as you get that your pump starts delivering in drip, drip, drip drip over the amount of time you told it to extend it, it’s dripping in that second part of the Bolus. told it. You need it longer.

Yeah, right. Yeah, no, it’s

if you extend to Bolus, and I know this isn’t the first question, and let’s just use round numbers, that’s understandable. Using 10 units, and you want 50% up front and 50% over two hours, then five units goes in, when you push the button, and the other five units gets broken up evenly over those extended amount of hours. It’s, it’s, you know, it’s whatever that ends up being, if it’s point two, five every 15 minutes, or I don’t know what it ends up being, I’m not doing the math on it right now. But he just breaks it up evenly over the over the amount of time you tell it to extend it out over. And I don’t know, I guess for a lot of people, that’s just not something that anyone’s ever brought up to them, and they can be confused about it. I’ve been talking about temp basals like, you know, the idea like I got a message the other day, somebody’s like, you know, I just realized that what Scott says about like turning off bazel sometimes to catch like a, like a real drifting low work so well. But they were talking about that they can only do it for a certain amount of time they figured out or they’ll close the highlighters. It’s great. They’re figuring it out.

Yeah.

When I was in Kansas City, I was up on stage. And I said something that I’d never said before, because I was like, Look, think of turning off your bazel as creating a pothole in the future that your blood sugar is going to hit. Right. And then someone from the audience said a black hole and Oh, that’s so much better. Like let’s say that. Okay, so, you know,

good. Yeah, I think better one because

it’s because it’s just a complete, it’s a vacuum, right? So, so you’ve got this layer of, you know, one unit an hour of Basal and so on, that’s, that’s exists in you. But if you shut your bezel off for an hour at noon, and say it takes an hour for your bazel to go out of you, that means around one o’clock, there’s going to be this vast nothingness of bazel right and so if you had a drifting blood sugar, and it hit that black hole, it would all of a sudden it would be weightless, right? It wouldn’t have anything pulled the gravity would be going down and then you can hit that spot and stay level. And I so like I got done saying it and I celebrate a little bit and I could see a person down front looked at me and I’m like, I just thought of that just now. So I’m it’s a good example and I’m just happy with myself. Just give me a second.

A little celebration, we’re gonna move on it’s gonna be fine.

You know, we should have we should have those little What are those? Those little popper packages, right where you can like pull apart, like, explode like whenever you go to your kind of your conferences, you should bring those along. And if you have those, like aha moments, you should pull one it surprised the audience. You’re like, I

just had a moment I think the surprise would be they’d stopped coming. They’d be like, this guy’s like, doing Gallagher up here. It’s gonna it’s gonna break a watermelon since there’s an old reference, nobody’s gonna get.

I get it.

Jenny really does get it doesn’t she? You know, she gets education. Jennifer actually holds a bachelor’s degree in human nutrition and biology from the University of Wisconsin. She’s a registered and licensed dietitian, a certified diabetes educator, a certified trainer on most make some models of insulin pumps and continuous glucose monitoring systems. She’s an active member of the American Diabetes Association, American Association of diabetes educators, and Team Wild. She is also a contributing author for diabetes sisters. What isn’t Jenny? What isn’t? She? I don’t know. If he even likes cooking, did you know that? Alright, luck. Now I’ve basically just read you like what they write about genuine integrated diabetes. If you want to hire go there, look for that information and click on email, Jennifer. There’s also a link in the show notes of this episode, where you can email Jenny directly. She really is terrific. I appreciate her coming on. What else do I appreciate? I think you know, I’m gonna say the Contour Next One blood glucose meter. Give it a try today, at least go check it out. Please use my link if you do. If you can’t use the link that’s in the show notes or Juicebox podcast.com. Right on just type in Contour Next one.com into your browser. How about a little bit of an announcement about where I’m going to be upcoming in case you want to get some tickets and show up and be like, yo, that’s Scott, the guy from the podcast, you can do that. On February 16. I believe that’s a Sunday for the greater Dallas type one nation event. If you want to find that without googling, you can go to my Facebook page and go to events or go to Juicebox podcast.com. Scroll to the bottom and click on events. There’s links there so that’s the greater Dallas type one nation I’m only doing one hour there that They not the whole Juicebox Podcast extravaganza like you’re gonna get on February 29 in Georgia at the type one nation event. You guys are really gonna love this one. I’m doing an hour on my own and then a second hour, you know who comes to join me? Jenny Smith in that cool Jenny’s gonna go off do her own thing. I’m gonna do a little talky talk, and then as mine and she’s gonna roll in, we’re gonna do a q&a together. Now, that’s exciting. If you’re in the Atlanta area, forget me. Honestly, meeting me is quite a letdown. But Jenny Hmm. That’s what you’re looking for. That’s at the Georgia Tech hotel and Conference Center. Actually, I’m sorry. The one in Dallas is in Irvine. The Irvine Convention Center is at Irving. I don’t know what you guys say in Texas. It’s spelled Irvine, it might be said Irving. shimmy OSHA Maazel. I don’t know. After that on March 26. Speaking of shimelle show Maazel in Appleton, Wisconsin, Tickets are available now for that too. That’s a three hour build with insulin talk on a Thursday night, I think 530 to 830. Straight through great conversation q&a with me all about stuff you hear on the podcast, if you’re out in Appleton, Wisconsin, or somewhere nearby, or you have a sled dog, and you can get to it, really would love to see you there. Those three events are all jdrf sponsored events. Very cool for them to have me out. stuff in the future. I don’t know if you can get tickets for yet. Maybe you can maybe you can’t touch by type one in May the end of May, in Orlando, Florida. And on August 22, to type one nation event in Richmond, Virginia. I am currently talking to people about doing something in October somewhere I won’t mention yet. Might be a couple of them coming in October. But anyway, these are my events. I hope you can check them out. They’re wonderful. And I’m not just saying they’re wonderful, because it’s me and I believe they’re wonderful. Other people say they’re wonderful too. So I obviously I think they’re wonderful. Because, I mean, what I really show up and say something that I thought like, Ah, this is just okay. It would be silly. I am not you. I don’t know me that well. But I am not getting on a plane flying somewhere to do that’s just okay. We’re gonna deliver the goods when we show up. Okay, you’re gonna leave with some info. I’m comfortable saying that. A because obviously, I have a narcissism that allows me to do that. I’m kidding. For those of you who will now leave reviews and says, this guy’s really narcissistic. He even says it on the podcast, how wonderful of you to pick up on that. Those of you who don’t seem to understand sarcasm, and the but the real reason I can say that is because I just got back from Oklahoma, and I saw messages online, one of them was really touching. It’s like a vlog a vlog for you older folks is when people blog, but with video, you get it vlog. It’s really Oh, anyway, and this person put a vlog out that was just touching about the talk that I gave. So I’m there to motivate. I’m there to inspire. I’m there to answer as many questions as I can to try to set you on the ideas of the podcast. And of course, to take an incredible amount of selfies that make me feel self conscious. That’s why they call them selfies. Thanks very much for listening to the Juicebox Podcast this week for leaving the really cool reviews that you guys left on iTunes recently, the social media posts, you know, that I see on Instagram and Facebook, for your participation in the private Facebook group where people are trying to help each other both adults and parents of children with type one, I really just appreciate the support overall. The reason I bring that up is because when I go out to these public events, I meet a lot of different people, different ages, different situations, different agencies, different goals. And I can tell you that when I leave, a lot of these people are better off than when I got there. And when you see some of their situations, it’s hard to it’s just hard. Not everybody’s having the same success. So to be able to go around the country and find people who wouldn’t find a podcast. And to be able to help them or get them started or move them in the right direction is an incredibly and this is overused by people all the time, but as an incredibly humbling feeling. And the fact of the matter is that I would not be in that situation, to meet those people to potentially help them if it wasn’t for the success of the podcast. So every time you tell someone else about it, and the lore of the podcast grows and it gets more downloads that motivates people to ask me to come out and talk. So for the really good feelings I’ve had recently meeting people in person, and for the private notes that I’ve received afterwards from those people after they see improvements in their health, I thank you for them. I thank you for myself. I really appreciate the listen. And I did a pretty good job of ending this episode on a real bummer. So let me say something happy at the end. And it’s personal. But still, my son is still home from college. He actually goes back in a couple of days. And I was sitting at my desk late last night, getting this episode together a little bit, getting ready to edit it today. And he came in and he sat with me for a little bit. We got talking about a bunch of other stuff. And he asked me what I was reading. And I was reading an email from one of you. And it’s lovely and personal. But my son got to see what I do, which was very nice. He doesn’t know really, you don’t I mean, like, he knows I have a podcast, he knows it’s about diabetes. But he got to hear from a person who said, some really kind things about the podcast, and I think he was proud of me. So that was really nice. You guys did that to keep sending the emails, keep being bold. You’re all going to do fine. It’s going to get better if it’s not going better. And if it’s going great sky’s the limit. Keep going. I’m proud of all of you. I’ll see you soon.

Hello, everyone, welcome to Episode 299 of the Juicebox Podcast. Today’s show friends is sponsored by the Contour Next One blood glucose meter, this is the meter my daughter uses, it is incredibly accurate, easy to carry around. And if you go to the link right now that’s in your show notes are the one that’s at Juicebox podcast.com. And click on it, it will take you to Contour Next one.com. When you get there, top right corner, there’s a yellow button says about getting a free meter, click on it, scroll down a little bit, fill out a little bit of information. And you’re on your way. There are some limitations and restrictions that apply. But it’ll only take you a second to find out if you’re eligible. If you’re not go to your doctor and be like, Yo, I want to try the Contour. Next One write me a prescription for that. Think about it. How long have you had that meter that you’re using? Is it old? Is it out of date? Is there technology that exists? It’s better than the one you’re carrying around right now? I bet you there is. And I bet you it’s the Contour. Next One. Welcome back to another episode of Ask Scott and Jenny. This is sort of a super sized episode. What are we going to talk about today? Among other things, how to help yourself coming back from high blood sugar. When should you adjust your basal and bolus rates, different types of insulin the impact diabetes can have on your dental health, which sounds boring, but isn’t. And Jenny talks about insulin pumps, she kind of rates them it’s fun. Please 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. We’re becoming bold with insulin. And if you’d like to get Jenny Smith, working for you go to integrated diabetes comm and click on Jenny’s email address. Actually, the email addresses in the show notes. It’s the Juicebox podcast.com On this episode, and all the episodes Jenny’s involved in so you just want to email Jenny and say something like hey, Jenny, I’d like to hire you. And then you’ll start that conversation with her. Now you guys ready? Here comes don’t? Don’t it’s gonna jump up now. Done ready? I haven’t asked Jenny question. My wife met somebody recently, who said that their adult child lived for a fairly long time with higher elevated blood sugars higher a one C, they kind of pulled themselves together, all at once out of nowhere, got it come to come down quickly, but then had like neuropathy problems that the doctor told them was from a fast drop. I’d love you to explain that to me, because I only heard that one other time, but not even put that way.

And from the physiology standpoint, I mean, I’m certainly not a neurologist or anything to explain it from the physiology component. But it’s the same as I think not that long ago, we had talked about changes in AI as well, with really fast changes in blood sugar. So it’s the same thing it’s your body has adapted to the high values. And as such, the neuropathy if it was probably there, as well as probably getting worse along the time of the blood sugars being too high. Now with the quick change in blood sugar. The change to how the sensation of those nerves are, I guess, feeling things because of the change in the glucose level, which has been impacting the health of the nerve cells. That’s what brings on a more significant and more profound pain than they may have been living with when their blood sugar’s were just high.

So is that a bit of a false narrative then then the queen? Yeah, it was coming anyway, it might have just come a little quicker because you took this thing that your body was accustomed to, and so greatly changed it

and greatly changed. Exactly if

I’m diagnosed today with an 11. And I somehow end up with a five, two months from now, I’m not going to give myself neuropathy.

No, no, no, the neuropathy was there to begin with the pain symptoms were something that were exacerbated essentially, because of the major shift in glucose that the body was not used to again it I mean, it does take some time to bring blood sugars down and you know more power to the person who was like gosh, I can’t live with you know, 400 blood sugars anymore. I’m going to get them down to be like 150 Now instead, but still, that’s a major shift for the body to handle. If you do it all at once great but you you may have some of those typical symptoms like again, you may have major shift in the way that you see things, you may think that you are seeing things great when your budget was at 300. And now one is down in normal, now you can’t see anything, we have to give your time your body time to a climate to that new, what is healthy value, and then go see the doctor, if it doesn’t. If it doesn’t get better, you know, within like a month or so of being in target. Same thing with the neuropathy. While it may help to go and see, you know, your neurologist, or whoever’s helping you to manage that, likely, they’re not going to change too much other than potentially maybe prescribing some additional pain management strategy for you until the glucose levels are stable enough at that target value. And the symptoms kind of go away, or they come to a more normal stable, you know, range. And at that point, then of course, they’re preventing further further damage from happening. So okay,

well, I’m keeping stuff together here in a little bit of a blend. So elanco wants to know about helping her body recover from high blood sugar. So she’s just talking about I think, a day, you know, where you have six hours and you’re elevated, and you finally get back down? Is there something she could be doing to fortify yourself to feel better sooner to? Like, I don’t know, like other than hydration, I wouldn’t know what to say. Like, how do you make that blog go away?

Yeah, if it does, it takes some time. I don’t think there’s necessarily any one cut and dry kind of strategy. Hydration certainly is a big one. Absolutely. Also, you know, if things like regular food intake, or snacks, or even activity, sometimes those can sort of help you clear. That mental fog, as things are changing to even just getting out in sometimes the fresh air and getting a walk and getting movement and whatnot can help as well. So

is it a diabetes thing and more of just a human thing? Maybe because you’ve been put through this situation. And now you got to kind of bounce from it’s like, almost like, I guess, like being sick. And then you wake up and you’re like, Oh, you have that weird, like, lost feeling. I don’t know what being obviously, I don’t know what being high feels like. So my job, I just know people’s descriptions of it. Okay, let’s see, I feel like we’ve said this before. But correction factors, and insulin sensitivity, basal rates? When do you

adjust? Like, like you said, when you know what? To a job?

Yeah, yeah. Well, when do you When do you know when to adjust? Like, let’s say, you know, it’s your base, or, you know, it’s your insulin to carb ratio or something like that? How long do you wait before you save yourself? This is my new normal, I need to make an adjustment in my pump to cover this is it? To me, this is another one of those like somebody wants you to tell them how much time? I don’t know how to answer that. Like, I know doctors will tell you what three days is that sometimes

even longer than that some doctors want like a week’s worth of data to see that it’s a definitive trend. I mean, I usually, I usually say, you know, if you know that, now, all of a sudden, whatever reason is happening, you’re waking up at 150, when you used to wake up at 100. And it’s been happening in the last three nights, and you have literally not changed anything, clearly something changed. So go ahead, make a change to the Basal or if you’re kind of wary about changing your profile set at Temp Basal. In this instance, set a Temp Basal increase at bedtime of a certain percent and see if it hits the mark. If you wake up where you were great. Go in see how much the pump was delivering based on the temp you instituted and make that change into the Basal profile.

Great. I would say that this is one of the things that led me to say things like more insulin, because I just kept looking at these scenarios like Jennifer’s talking about here. And I just thought there’s not enough of a rhyme or reason to this, that I can say to myself, okay, what I’ll do is I’ll wait X amount of days every time this happens. So just I just decided like, I’m gonna stay fluid. And if it’s like this today and tomorrow, great, and if it changes, you know, the next day, right, what am I gonna do? I know, I’m, I’m gonna have to do what I have to do.

Right? I mean, sometimes it takes I would say, for me personally, I always look at things after like a two day, you know, if it’s tonight, for some reason, in the morning, I wake up in the morning higher than normal. And that’s one night, I don’t know. Let’s see. I’m gonna go to bed at my normal rate where I would usually go to bed. If I see a rise again overnight tonight, in the middle of the night, if I wake up, I’m probably going to pop in some change of some kind, just that I don’t wake up high again. And tonight, then I’m going to say, I’m going to go in and change my Basal profile, I’m not going to deal with this, right, I’m not going to wake up to alarms and alerts if I don’t have to. And you know what, if I end up dipping down, then well, just two nights that I needed some extra insulin. And I’ll go back to what I needed. But an overall change, usually, most people have had diabetes, a number of years, kind of get this intuitive sort of feeling about something has shifted, I know that something has shifted, I don’t know why it shifted, I just need, quote, unquote, more insulin.

Put that in there. I genuinely think that that’s, that’s one of those scenarios where you just have to, you just have to stay fluid and take care of it. You know, right? It comes. Because I would rather because I know what the fear is, right? Like, what if I turn it up, and then all of a sudden, five days now that causes a low? In my mind, that would be another time to adjust? And at least for the last five days? You haven’t been high? Right? You know, I think it’s all in the way you want to look at it. Right? Hey, welcome to the new age of smart diabetes management. Welcome to the Contour Next One blood glucose meter. By integrating your blood glucose meter with a smartphone app, you can simplify the management of your diabetes, blood sugar results captured through the day can be automatically synced and logged in over time, the results may create meaningful insights into how your activities affect your blood sugar levels, which can help improve your understanding of your diabetes. All of this while being on the same platform you use for so many other aspects of your life. Yes, smartphone. So check out Contour Next one.com. There’s links in the show notes and a Juicebox podcast.com. That’ll take you right there. When you get there, you’re going to find out about the simple to use, and remarkably accurate Contour. Next One smart meter, and the contour diabetes app. It seamlessly connects via Bluetooth technology to capture all of your blood sugar readings, and help you to manage your diabetes smarter. When you combine the Contour Next One meter with the contour diabetes app, you’re going to have a smart system that allows you to engage the level that is right for you to manage your diabetes. All right, so head into the show notes, hit the link, check it out, some people will be eligible to get the Contour. Next One meter for free. There’s a little yellow box at the top of the page, check it out, you might be the one where if you’d like to talk to your doctor about the Contour Next One meter, just be like Yo, I want to use the same meter that the guy on the podcast kid uses. And then tell them it’s the Contour. Next One, you will not be disappointed this meter or rocks. Please use my link. It’s available at Juicebox podcast.com. We’re in the show notes of your podcast player. Okay, very quickly. I’m not going to seem to make sense when I start talking in this next bit with Jenny. But what happened was while Jenny and I were talking Arden’s pump ran out of insulin at school, and Jenny and I took a break, I ran across the street, and we changed the pump real quick. Right? So now that’ll make sense for you. Ready in 5432 you have to be a little impressed.

I’m actually really impressed. Like, your school literally must be like right across the street.

It’s um, that’s pretty close. It really is across the street, right? it’s it’s a it’s a four minute ride. You know, she met me in the office, we rolled down to the nurse and and bing bang, boom, I’m back. So eight. I think I think I was going for 18 minutes total. So

yeah, it wasn’t long. So awesome.

Next time I do an on the pot. And I tell you, you can swap it on the pod fast. you believe me? We’ve done Arden’s on the bench of a softball field. Keep the dust away for a second, right. Anyway. All right, I think we can get through a couple here. Okay. I like this one. Tara wants to know, about bazel bolus ratio. So she says that her endo tells her you know 5050 but then Becky comes in and says we’re 30% bazel 70% bolson. Are those fine with it? I feel like I’m gonna say if you are too heavy on the Bolus side, you’re probably bumping in nudging too much. And you could probably get some back from Basal. But what is the like why do people say well, what do you say? Because I’ve heard 5050 to

5050 is a starting place It really is. And that’s why endo is kind of look at that as a place to start with potentially where adjustments might need to be made. But you also have to consider some other things from the standpoint of like, metabolic bazel insulin need, what I’ve seen in practice, and seems to you know, be kind of correct is that If you have a pretty active lifestyle, metabolically, you are probably more at an appropriate body weight, and you will respond to insulin better. So sensitivity will be higher. So from a standpoint of background bazel insulin, your basal insulin and an active life may actually be less, you may be kind of one of those people whose bazel bolus ratio is more like 4060 40%, coming from bazel. Because without food in the picture, your body just responds nicely to insulin, it could even be more than that. Maybe it’s 35. Or you know, whatever. More commonly, though, for most active, it’s about like 4060, give or take kind of thing. On the opposite of that, if you have a really busy life, but you’re mostly sedentary and you really are only able to get to the gym once or twice a week, you’re probably on the other end of that you probably have a higher metabolic need, because your body’s just not responding as well to insulin. So your basal needs may be a lot higher. And it may seem like your boluses aren’t really that heavy, then, as far as like an analysis, another good place to look is at the breakdown of your bolus insulin, like how much of your bolus is truly derived from just covering the food that you’re putting in. And how much of it is actually corrective. Because if you’re constantly like you just said, if you’re constantly nudging, by correcting with little bits, because it’s just not getting down to target, it may very well be that your background is also not high enough, it could be that you’re covering with more Bolus, because in the back, there’s just not enough there to keep you you could be using more Basal,

right. And so there’s a lot of different scenarios. This is interesting. So you know, your activity, if you were a person who didn’t need very much bazel to keep you stable, but you had big meals, you might even see a swing like that. Right? Right. Right. So then there is no right ratio, there’s no correct ratio, there’s a correct ratio for you. But there is a way to check to make sure, hey, let’s make sure that we couldn’t be doing some of this with Basal and take away some of that bumping in. And I think that’s specific to people who listen to the podcast, like the bumping and nudging is great. But if you’re bumping and nudging, and your kid puts on 10 pounds, because they’re growing, you’re going to just keep pumping and nudging when you should be thinking more based

on a problem or bazel. Exactly. Yeah, yeah. And you’re right. I mean, from the standpoint of somebody who, like I think I commented, I don’t know when we talked a couple times before about mango man. He’s a type one who is an expert in like nutrition. He’s got like a PhD. I don’t, I don’t remember too much more about him. But he, I mean, he eats like hundreds of grams of carbs in a day, but he’s also really, really, really active. And so I would, I would estimate that his Basal needs are probably pretty low. But his boluses are probably fairly big, given that he eats so much carbon at a time. And then it covers it, and it drops him back down to his target. And his bazel holds him there until the next time he eats you know, 200 grams of carbs.

I think that that makes 100% sense. And I think that is the clarity for this question. So I think we did good there. Okay, so here’s one that I don’t know that there’s any truth to this one. Katherine’s asking about figuring out what type of insulin they should be using. And I know that technically, there’s not a big difference between the insolence right, the fast acting insulins, but some people do see differences differences when they use them. But is there anything that we could like literally say, like humalog novolog, a Piedra? Are there fiasco? I mean,

are there discernible differences between them? I mean, the fiasco obviously, there, there should be a discernible difference with fiasco. If you get response by using it. Yes. For the most part, the two that are the most similar and action that I would say a good majority of people who’ve switched between novolog humalog novolog because now their insurance covers it up. Now you’re covering human logs. So let’s switch you back. They usually don’t notice much of a difference in its action. There are people however, who do notice a difference. I personally don’t notice the difference between novolog and human log at all. I tried to Piedra and it it didn’t work the same for me at all, I especially noticed it when I was using extended boluses, it just didn’t have the same emphasis or work the same in an extended fashion as my human log normally did. I’ve got a friend who she knows that if she’s on human log, she uses more insulin on human log than if she goes back to novolog. She knows that. So I, you know, definitively again, majority of people don’t notice much of a difference novolog to human log, I think the two outliers there, a Piedra may work a bit differently for you. Again, there are people who can use interchangeably all three of Piedra novolog, humalog and have no difference whatsoever. fiasco is kind of in its own category, really, I think there is there’s a definite difference, mainly because it’s action is faster. And then there are some people of course, with ABS, but it works great, like me, worked for five months, and it was done. It didn’t want to work for me at all anymore. I’m done. That’s it. Yeah.

I you know, I would say for Arden, she used novolog. And she she used a pager. With novolog, we saw a ton of like double arrows up double arrows down, you know, big spike after a meal, then a crazy crash later kind of a feeling. And for Arden, I’ve only ever been able to explain it that a PG appears to just work smoother for her. Like it’s just more constant and it and predictable for me. And that’s it. You know, I don’t know that human log wouldn’t be better. I never tried it. Right. And and you know, people all the time, like, you know, don’t you want to try fiasco? And I’m like, Well, I don’t I want to hear about fiasco is that it works for the people it works for and others don’t. And here’s the other thing about crowdsourcing this information, right? It’s that we don’t know everybody’s other details that they don’t share with you like, oh, you’re all you see someone line who says, human doesn’t work for me. They don’t say, by the way, human doesn’t work. For me. My blood sugars are mainly in the 250s. Most of the time, I eat an incredibly carb heavy diet. And I don’t have a CGM, like you don’t mean like, they don’t give you all the details about their life. They just say something like, you know, I didn’t like that television show. But you know, you don’t I mean, like, you don’t get enough of the details to know why crowd sourced information is tough sometimes, because it lacks the details that you you often need. The one thing I’ll say is that it can’t hurt to try, you know, a reasonable endocrinologist should let you try if you want to. Right, Arden did need more a pager than she needed. novolog. So her ratio went up a little bit when we switch,

but it worked better, but it works way better, less spiking, dropping. So yeah. And I think that it takes evaluation, you know, if you if you have a sense that there are that there’s something that just doesn’t seem right. Ask your doctor for, you know, as many doctors have some sample bottles, ask them for a sample bottle of the opposite type of insulin and see if you don’t get better response from it. I mean, if and if you don’t notice anything different well, then maybe something in your settings needs to change or something in your strategy needs to change, you know, but at least you’ve tried and you’ve kind of addressed

to see whether or not I will just tell you that for Arden with a Piedra I have. I don’t I mean double arrow in either direction. I don’t remember. Like it just, it just does not happen. So, um, okay. Uh, let’s see. We’re doing well, by Well, I mean, we have time left. That one seems like it’s a little too much for now. Let me uh, that one’s pretty obvious. I could get answered there. Oh, okay. Here’s a pretty simple one. What are the impacts that type one diabetes, if any has on your dental health?

Um, well.

Overall, we know that diabetes can affect most places in the body. Here oral health included. People with diabetes more commonly have a potential for bleeding gums, more ginger vitus gum diseases, more potential for receding gums. And, you know, the interesting thing about it is it seems to be for the most part, the higher blood sugars again, can cause more oral health problems. So long story nutshell short, just keep your blood sugars contained to try to avoid dental problems. Does it mean that everybody with diabetes is going to end up with some type of gum disease because of, you know, mismanaged blood sugars. Not necessarily, you know, but it is certainly one of the potential, I guess complications of, of life with diabetes. Now, the interesting thing is, I mean, I have receding gums myself, I’ve had them for years. But the interesting thing is that, to me, I don’t know how it could relate to my blood sugar control.

Pills really good. Yeah, it’s

good. I haven’t let my blood sugar’s run at like 300 or 200. Even, you know, for years and years. The interesting thing is that it actually started after I had kids. In fact, I didn’t have my first cavity. until after I had a child. And my I asked my dentist about it actually, at the time, I was like, are you sure there’s a cavity there? Are you sure? Like, I’ve never had a cabinet in my whole entire life, you know? And he, he said, Well, interestingly, we do know that the oral health of women during pregnancy, because of all the hormone changes, there are some things that can impact like the natural bacteria in the mouth of a pregnant woman. And so he said, it can provide a better environment for bacteria to start causing

problems. That’s a technical way. Yeah, let me let me tell you what I’ve witnessed in my life, making a baby drains the life out of you. And for women worse, your feet get bigger. That’s not a good thing. anybody whose feet get bigger while they’re pregnant, it doesn’t go back. So congratulations for that one. And I just think of it as like a demon in a movie that sucks. Like, you know, they go face to face, you can see the life pulling out of like the live person and bringing in the demon back to life. That’s what happens. That’s what your kids are their life suckers. So um, I will add this, and this isn’t specifically about diabetes. But if you are bouncing around on that roller coaster and correcting a lot with sugar, especially overnight, that could impact your dental health.

Absolutely.

Because you’re taking this juice in your mouth. And then it sits in their mouth and gives them cavities when Arden had baby teeth. And we were not good at this. I’m almost horrified to tell you that I think she had they were on her baby teeth. But I think she had 10 cavities one time, like all at once. And you know, she had to, she actually had to go to the hospital to be put under because they were so worried about blood sugar, because we were so bad at her blood sugar back then. You know, like, like now when she goes to the dentist, I’m like, it’ll be fine. I’ll take care of it. You do your thing. I’ll do my thing. Her blood sugar will be okay. But back then had to go to the hospital insurance didn’t want to cover it. Yeah, my wife’s company actually stepped up and forced the insurance company to do it, which was lovely at the time. It was like a $15,000 bill to put her in the hospital to fix it was crazy. But it was just from the juice. Now. We had it all worked out. And then one time she told me she was sick of the juice she was drinking. But I had found this kind of like impactful juice that wasn’t it has fairly natural stuff in it. So I switched her to something else. And in that six months, she got a cavity. And nothing had changed about it. She wasn’t using a lot of juice, but that so we switched away from that juice. And she hasn’t had a cavity since then. Hmm. So interesting. Yeah, it’s not from diabetes directly, but it is indirectly from it.

Correct? Correct. And that it’s also a hard thing, that overnight component and I’m glad that you brought that part up. Because who overnight really, even as an adult, a knowledgeable adult who wants to treat their low blood sugar and then oh, yep, got to go to the bathroom. I gotta brush my teeth, we got to floss and like chewed on gummy bears, right? Eat the juice or whatever. Nobody wants to do that two o’clock in the morning, right? I don’t want to do that.

You’ve already and I do know, some people keep water next to the bed just to swish at least to try to. And that’s better than nothing, right? But yeah, to your point. I mean, you’re gonna drink juice and then Go brush your teeth. And then imagine 15 minutes later you get low again, a drink some more juice, you’re brushing your teeth again. And, and at the same time, you know, to avoid a cavity. Maybe it’s not a bad idea. But I mean, I, you know, I’m supposed to take like, one over the counter and acid before I go to bed at night. And sometimes I’ll brush my teeth and then I’ll take it. I’ll be like, oh, like do that for and now again. You know, it doesn’t have to be constantly it happens every once in a while, you know? A great while. Okay, well, that’s a big question. I’m skipping right over that. We get to that one later. But that’s a huge question. That’s not a that’s not an ask Scott and Jenny. that’s a that’s a bigger one. Um,

that’s an episode one is

a complete episode. I don’t know that. I have an answer to any of It. So

that’s a you need an appointment to discuss this

girl again, therapist and six friends. Oh, I see Chris here says that I should just say what are a couple of times so you can make fun of my accent. He doesn’t care what we talked about there is satin Jenny as long as I say whatever. And by the way, I’ve noticed I’ve never brought it up but when Jenny accesses her brain so when I ask her a question, she accesses her brain to think of it. her left eye closes more than a right eye. And I wonder if she? Oh, yeah, I don’t think she knows that. I don’t know. It’s almost like she’s a supervillain. And she’s got information somewhere. And she’s like, Huh, and she pulls it right out. Because for you guys listening. I don’t tell Jenny this stuff up. Like I’m just throwing questions at her. And she’s like, okay, answer you like on the spot. Yeah, yeah, it’s it’s like a driver’s test. But you’re driving in a car. And you know, they’re like, turn now turn now.

That’s really funny. I’ve never noticed that.

Yeah, exactly. So Alright, so here’s one that I think we could finish up our time with. Is there in your mind? Because you deal with everybody in the you know, who uses all kinds of different pumps? Mm hmm. And obviously, you use Omni pod? And that’s to you, the best for you. But But is it the best for you? Or if I got you secretly off in the corner? Is it the one you think would if I made you the king of the world? But you put one on everybody or no? And what are the pros and cons of the other pumps at all of them? Actually?

Yeah, this is actually a great question. Because I think it’s also a big part of the reason that oftentimes people end up coming to work with us is because we, we don’t push to one specific direction when somebody comes to us and says, Hey, you know, I’m considering a pump coming from MDI, or, hey, I’ve been on this pump for like, eons. And do you think that there’s something that would be better for me? Should I be considering this one? Should I be considering this one? What’s coming out? What’s, you know, which company is heading development and kind of moving the fastest and blah, blah, blah, blah, blah? Um, I, I personally would, I’ve got reasons for staying on Omnipod right now, which, you know. And there, I mean, the reasons really are such that it provides me with a system that allows me to get the best management.

So So Jenny is talking around something so I can put ads on my epic, correct? Yeah. So um,

so I’m trying really hard. If, if that wasn’t a potential, I would say, put on the spot about another pump that I would consider changing to I would consider changing to tandem? Why would I think they are being the newest pump company of the three that are currently on the market? I think tandem has stepped up, they’ve done a fantastic job of development of making a product that’s user friendly, touchscreen, small, convenient to use. And they’re continuing to quickly move ahead with their technology. They’re they’re trying to bring to the table management that can help people better they are. So I mean, if I had to choose, you know, within the next month, because my current setup was no longer going to be available to me, I would say, yeah, I’ll, I’ll choose tandem, I like it.

And so what you think tandem brings overpowers the tubeless nature of Omni pod for you.

That’s the only drawback I can definitely say the tubeless nature of Omni pod is a huge step above the other two companies on the market. But from I feel like that tubeless piece is it’s more aesthetic. It really is. It’s something that I as an adult, I can get over it. I don’t I don’t love tubing by any means. But I can get over it. If a system provides me with something that helps my management, the to versus non tube. I don’t really think it has anything to do with what I get from a control perspective. Right. It’s more my lifestyle that the tubeless is huge benefit for but I can deal with the tubing. If it means the pump provides me with what I need for good management a

gun to your head right now though. Pick a pump,

Omni pot okay.

Good second for you.

tandem is a good second and I hate you know, saying I mean Medtronic has been on the market a long time. They’re they’re also, it’s a really good pump it truly is. But for I think for a fair number of people with the current system they have on the market. I’ve got a lot of people I work with who they like their Medtronic pump, but they choose to use a different CGM, because they’re CGM is just not meeting the mark. For many people, myself included I did the pump was okay. It was fine to use. It was a tube pump, it did what it was supposed to do, blah, blah, blah. But their sensor has never worked for me. So you know, from an all around, encompassing, that’s why I said, you know, if I had to choose because I no longer could use my Omnipod. I would choose tandem, because at least it still connects and works with Dexcom.

Okay, if so, Omni pod ads, say the FDA goes to phone control. And that’s okay. That pretty much levels the playing field, and tilted towards on the pod for you away from tandem. Like if you get the same kind of like one screen touchy feeling from it,

the ones green touchy feeling getting rid of a PDM that feels like

you’re carrying a thing? Yeah,

I’m carrying like a thing around like, it’s even bigger than most glucometers

are the new ones. You’re so you’re, you’re you’re stuck with the PDM because of what you’re doing. And so and, and Right, so the dash is smaller. Right. But still, it’s you’re carrying an extra thing? Right. And I think to this, this whole question becomes moot, probably within the next 1012 months. Right. Like when, when horizon, you know, if if horizon comes out and, and the other companies are going to, you know, they’re going to make their changes again, and it’s just a lot of stuff is going to change. The insulin pumps are gonna change a lot in the next year and year and a half, I think.

We hope

Yes. Yeah. Well, yeah, those are their timelines, right? Like, or what if it all comes out? You’re just like, sort of the same?

right? Exactly. I do know that there are there are definite nuances between the three, what are considered kind of those hybrid control hybrid, closed loop systems with the FDA approved pumps, right? I mean, 670 G is already out, control, like you, hopefully will be out sometime soon. Even that compared to Medtronic, it’s different, the system will work a bit differently, the you know, what it does for you will be a bit different and horizon from everything I know about it, which isn’t a heck of a lot. It will also have its specific pieces that are different compared to control IQ and six, seven Digi. So I think each system will do something better than a current conventional pump does. But you know, you’ll have to figure out which one is best for you.

Yeah, there’s gonna be a lot of choosing and I think to a no, I can say that. What I thought was really cool with the pod said was, look, when, when our horizon system comes out, we’re gonna have an algorithm. But if you want to use the tide pool algorithm, then use that one, like, they don’t care which algorithm you use, which is a is is a huge step towards trying to give you choice. Now, having said that, I don’t exactly know when tide pools gonna make it through the FDA either. So there’s a lot happening and at the same time, it’s unsure. It’s uncertain until it actually happens. So all right, well, that was good. I have a bazillion more for next time.

Okay.

Okay is right Jenny. Thank you so much, Jenny Smith for coming on the Juicebox Podcast and sharing your wealth of knowledge with everyone. Don’t forget, you can hire Jenny at integrated diabetes.com or right there in the show notes is her email address, you can just send her an email. Thank you so much to the sponsor, Contour. Next One meter, this is Arden’s blood glucose meter, it is terrific and it can be yours. Click on the links in the show notes go to Juicebox podcast.com. If you don’t have shown us that you can find by the way you do you just might not know how to get to them. Or you can go to Contour Next one.com to see if you’re eligible for a free Contour Next One meter. mm meter scrape I swear to God, it’s amazing. You’re thinking like it’s just the blood sugar meter but new stuff bomb diggity. Hey, friends, couple of things coming up on February 16. I will be speaking at the type one nation event in Dallas. He says questioning whether or not he knows where he’ll be. Let me click on the link. You get to Juicebox Podcast com scroll to the bottom of the page, click on events and you’ll see these there. Type One Nation summit North Texas they call it the greatest Dallas and Greater Fort Worth Arlington chapter. This event is on Sunday, February 16. I’m doing a one hour talk there about being bold with insulin. You can also see me coming up in Atlanta, Georgia, Saturday, September, Saturday, September, I said September. Let’s try again. On Saturday, February 29. I am doing a ton of speaking there that day, I’ll be speaking in a bunch of different sessions. And one of my sessions will actually be with Jenny, Jenny and I are gonna do a q&a together. That’ll be fun. Come out and witness Jenny and I meet each other in person for the first time. You can still get tickets. There’s links again here on my page. I’m going to be at the jdrf in Wisconsin on March 26. It’s a Thursday night from think five to 8:30pm. It’s just three solid hours of me chit chatting about the stuff on the podcast, show up at five leave at 830 a new person while we’re rolling through the events, Saturday, May 30, had touched by type one in Orlando, Florida. And they will be at the type one nation event in Virginia. That’s rich from Richmond, Virginia, August 22. That’s a long time from now. I just had to turn one down the other day that broke my heart. I wanted to do it so badly. But it conflicted with a date. I had something set up on already, but we’re trying to figure out something else to do. So I can come out. I can’t tell you where because you’ll all be bummed out and they really wanted me there and I wanted to come so you can’t be like, you can’t be like up their butts about or anything like that. They really tried. It was my fault. My schedule didn’t link up but I so wanted to go. I love that part of the country. Okay, so yeah, Juicebox podcast.com, scroll to the bottom, click on events, get yourself tickets. Thanks so much for listening. I hope you have a terrific weekend. I hope I see you at one of the live events. I can’t tell you how much it means to me that you are listening to the podcast and sharing it with other people. January is well on its way to being the most downloaded month of this podcast. So that’s because of you guys. And I really very much appreciate all the effort you put into getting the word out about the Juicebox Podcast. I’ll talk to you soon.

Hello and welcome to Episode 317 of the Juicebox Podcast. I’m your host Scott Benner. Today, Jenny Smith and I will be answering questions that you the listeners have sent it. Three questions today. The questions three. As you can tell, I’ve been locked in my house for a number of weeks now, I’m getting a little weird. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. And by touched by type one, you can go to touched by type one.org or Contour Next one.com to find out about these wonderful sponsors. My friend Jenny Smith has had Type One Diabetes for over 30 years. She’s also a certified diabetes educator. She has a bachelor’s degree in human nutrition and biology from the University of Wisconsin. Jenny’s a registered and licensed dietitian, a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. And as you’ll find out later, very well may be a person who can talk to wildlife. But one thing Jenny definitely is, is a person who would want to to know that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, she’d want you to always consult a physician before making any changes to your health care plan. We’re becoming bold with insulin, and he’s just good like that. She’s rock solid, you know what I mean? She wants what’s best for you. In today’s show, Jenny and I are going to talk about when to change bazel rates you know when to do with Temp Basal, and when to put, you know, a firm change into place. We’re going to talk about the measurement for success in diabetes management. And what a good standard deviation might be not just for you. But for everybody. Bum Bum, bum bum bum, bum, bum, bum, bum, bum, bum, bum, bum bum bum. The highlight of my entire week has been that the Costco near me had paper towels. Hey, sorry, I was moving my microphone stand a little.

That’s okay.

I think I have a like, I think I have like a problem with like, I did a finger stick. Okay. And my finger really hurts. really hurts. Like, like, and it’s kind of like, puffy. Like, can you see that? It’s like puffy and red again.

We’re on the top. It’s puffy, but you didn’t stick yourself?

No, I stuck it on the side where I always does do and yeah, like I can’t see anything from it. I also need like bifocals, because I have to go like this every time I have to like see something up close. My son brings me like the directions for a game. And I’m like, like, seriously, who wrote these directions? Like, come on.

You have no idea how many times because Arden’s a side stick like she sticks on the sides of her fingers, too. Yeah, you have no idea how many times like in the middle of the night when I do it. I’m so close to a cuticle. I’m like, how did I miss that? Yeah, and I looked down at her and she’s not awake, and I go ooh, she’s never gonna know about this.

never happened before like, and it’s it like it hurts it physically. Yeah. I’m like, I can’t there’s like no hole. I can’t tell if there’s like gross underneath or anything. But who knows? I don’t know. Maybe there’s like an alien growing underneath

there. Listen, if it’s too fast for you to get an infection, obviously. So it’s not that I did you maybe just hit a nerve. I just

responding must have just hit something that was just a much more sensitive spot. Or maybe I hit a spot that I had already hit. It’s wrong. It’s time it’s kind of a favorite thing. Like

Yeah, her sleep. Right. This is fascinating. In in Arden sleep, I will try I will go to fingers that she doesn’t use figuring she’s asleep. She won’t know in her sleep. She’ll pull the finger back and give me a different finger. That I’m always impressed by because sometimes I’ll be like Arden and she’s not awake. Right? she just she feels you in her sleep. Take the wrong finger. She’s like, No, no, no, this one. Or she’ll do two of them. She’ll like either one of these is fine, but not like I try to use her thumbs when she’s asleep. Yanks him right back holds him up in a fist. I’m like, That’s hilarious.

That’s super funny. So So how are you? How are your older older kids? I hate calling them kids because they’re really not kids anymore, but like, how are they doing with everything? I’ve got 17 nieces in Milwaukee, and they are just like, they’re like climbing the wall really learning to up brother in law says they’re just like, I cannot be inside anymore. I need to be not near my parents.

I’m bored. Well, we’re gonna turn your question. You’re very kind. How are you question into part of this episode. And here’s here’s why Arden’s insulin needs have gone way down since she stopped going to school.

Do they go down in the summer too?

Yes, she doesn’t like being at school. That’s just what it is. So now this whole the the, the incarceration is actually freedom to her. She can go to bed when she wants get up when she wants handle her work when she wants to. She’s much happier. I’m seeing more smiling. I don’t think I should ever send her back to school.

The reason a lot of a lot, I’ve got several people that I work with who homeschool their kids. One who I started working with. I was telling about her she’s the pilot. Yeah. And her parents school homeschooled her. She’s now like, out of college, she’s actually doing an internship with one of the airlines doing wonderful, but she was homeschooled. And they didn’t see the fluctuations. Like comparatively with the other kids her age that is working with who were in school. clear difference from a weekend or a holiday away to actually being physically in

school. Right now. There’s there’s been, even the summer takes time for her to like ramp down. Sure. But this was one day, the first day, which she was unsure of how this was all gonna work, her blood sugar didn’t change. And then after she got her work in on time, she was just like free and easy and really happy. So it’s interesting. Now my son. He doesn’t like the lack of activity. Like we were outside in the driveway throwing a baseball yesterday for half an hour. He brought us. He said, He’s the my kids are both very good with money. They don’t ask for a lot of stuff. And he’s like, I need a squat rack. For the basement. He’s like, I need to be able to like exercise. And I was like, okay, and the other end, he walked outside just sat on the front step for a while, you know, just the hate, I need to get outside, because he’s also a boy. So like, he’ll start playing a video game and lose a day to it if he if you let him, you know what I mean? And last night, he told me around midnight, I’m going to get a shower. And then I’m going to read for my economics class. And I was like, Oh, that’s great. And he’s like, it’s not. I was like, why is it not? He goes, because I’m going to read for an hour to get what I could get out of a five minute explanation for my professor. And I tried to do like I did the dad thing. I was like, oh, there’s nuance to the reading. You’ll appreciate it later. He was looking at me like, I don’t care what you’re saying. And I was like, I was like, I tried not to be, you know, I just was like, you know, this is it. It’s good. And, but he wants that he’s also concerned about how much we pay for school. And that now he’s basically learning through, you know, yeah, really fancy YouTube videos. So he’s like, why are we paying for this? And I said, coal, this time is going to turn. It’s one of the strange things about about the United States at least, that I’ve never understood. Like, why has quality distance learning not become more? I don’t know, like acceptable, especially in college. Right.

Right. Right. Yeah. I mean, I think it’s getting better now. How people viewed the distance learning like the University of Phoenix or whatever it is, yeah, all the commercials for but there, there are quality programs, and my sister in law actually did an online master’s degree in business management. And she she does a great job. She’s a wonderful job because she did that. So there’s nothing wrong with

no, no, no, but why is it not more popular? Why? Why not? Yeah, it is. It just is like, his level of embarrassment. Like I went to school, like through the mail. Does it feel like that or something like that? You know what I mean? Like 1960 took a writing course from Hollywood.

Yeah, I don’t know. I think I think in today’s technology world, it’s getting better. Um, in fact, some colleges as I’m sure you’ve seen with even Cole, I’m sure he probably has some things he needs to submit online and do that way already. But I think it’s such a big change from the quality of as you know, in high school and even in college. There’s a lot of social networking that goes on that you you don’t get that when you have it at

school. You just don’t and we talked about that. There’s, you know, you sometimes meet guys You know, he’s playing baseball with or he’s met through school. He talked to them a little bit, you know, that’s an impressive kid for 20. It’s going to be an impressive adult. And you don’t know when 10 years from now that kid or your son’s going to wake up one day and go, you know, I have a position to fill, you know, who would be great for this? Yeah, yeah, that guy played baseball with 10 years ago. And so there’s that piece and there’s the social part of it. Like, I’m not, I’m not discounting that. But for some people, they just want their degree. They’re not looking for you know,

they could care less about sitting in class next to the guy who doodles pictures of his dog.

Right? Yeah, I met the most interesting guy in college yet. No one cares. But anyway, it’s just it’s it’s interesting that they both are, they’re not happy. We spent a number of hours playing poker the other day. You know, there’s, we keep talking about having a movie night, but it hasn’t happened yet. Everybody said we’re, I think we’re kind of quietly keeping things. Activities aside for when everyone loses their mind. And we really, like need the activity. So far. Everybody’s been okay. And Kelly’s under the weather, but Oh, it’s not um, you know, it’s nothing related to all of us. Yes. Yeah. It doesn’t feel well,

just a normal thing. I know. And that’s every time you hear somebody like,

like, Oh, my God, get back 30 person get away.

The cough. Maybe they were eating a granola bar that didn’t go down the right way.

We’re doing it on purpose for comedy reasons. Oh, yeah. Yeah,

that would be my husband.

Yeah, just everybody runs out of the room. Mom’s like, Don’t touch her. She’s like, I just I got a dry piece of wood. Like that bringing us down with you. So, and she cut caffeine out. But she did it too fast. So now she has a caffeine headache, you know, and I gave her a little tea. I’m like, here have a little that’s not from soda. And this, she might

even do better if she if she’s willing to do tea. She could even do something like a matcha which has a little bit of caffeine in it and could kind of ease down

help her the caffeine.

Because it’s also much smoother caffeine than coffee coffees. Like you get this big like, Whoa,

yeah, we don’t drink coffee. Nobody here drinks coffee. Actually, I think the truth is that I don’t believe Kelly ever has, but I’ve never had a cup of coffee in my life. So I wouldn’t even know what it is. Jenny takes a large as well.

I drink tea every morning. Usually a couple of hops, but

I’m drinking Earl Grey with a little bit of honey.

Oh, I have a very good friend in Colorado who Earl Grey. And lady grey are like her favorite.

My favorite thing? It really is. Alright, so Jenny, we have a ton of ask Scott and Jenny questions. And we are going to do like three recordings in a row over the next two weeks so that we have them all set up. Yes. Before we start, let me tell you that and there’s no pressure here. But tomorrow at 3pm I’m doing a like it’s just a social meetup online. And if you’re free and you jumped in for a couple of minutes, I bet you these people would be very excited to catch

up on were zooms on zoom.

Yeah, you could sit like this, click on a link pop up.

What? Yeah, we zoom for our staff meetings on Wednesdays. But

what at what time, three o’clock tomorrow? Three to 430 it’s gonna run. It’s gonna be like a free thing. Like people can come it’s your

time. So like, two to 330 my time. I should be around. Usually I’m working on emails at that time. So send me the link. I will

even if you just popped in and you were like, yo,

and send me a quick text while you’re doing it so that I remember you

will. You’re gonna find out what it was like to be Elvis in the 60s.

Ah.

Interestingly, um, are you recording right now? Of course. Okay.

I just wanted to read you want to say something private? Hold on a second. Bye, everybody. Well, Jenny, I hope nobody finds the body. I think you’re gonna be okay with where you hit it. I mean, it’s Wisconsin. There’s so much snow on top of it. No one’s ever gonna find it.

We’ve got lots of bogs, too, you know?

Yeah. Should we just start at the top of this list? Or do you have a favorite in here?

No, I the one that I think we had commented briefly the last time we talked was it last week already? Um, was about there was somebody who asked about artificial sweeteners. And that one was curious to me. But there’s a good list of questions. So wherever you want to start, it’s totally fine to me.

Okay, well

can you like

there’s so many guys first of all, Rudy was so nice to send in so many questions. Yeah, let’s just roll through the top. Okay. Okay. Sarah asks, please address puberty specifically. I think Sarah wants eight question answered for her specifically, but 12 year old, pre period girl spikes and drops are insane. They’re on Omnipod Dexcom. So I think the question here is when to change bazel? And just Temp Basal. Okay, so she’s seeing drops and spikes. And she’s looking for when is this a change I make forever? And when is this just something that’s happening? Well, that’s interesting.

It is. And it’s a great, I mean, given the age of the preteen and and you know, her being a female, obviously, there are going to be, as I’ve talked with a lot of the people I work with who have girls about this age, who have not started a cycle yet. There are often about like a six to maybe 12 month time period before a cycle actually shows up. Okay, that if you start to track these resistant and sensitive times on a month to month basis, you may find anything to answer her question, you may find that it actually flows around the same time every month. And if you can catch that, then yes, you may be able to put a pattern in, you know, Omnipod, all the pumps out there allow you to actually set up different Basal profiles to turn on at certain points. So if you can track enough to say, Okay, this cyclic nature of resistance is always coming around the 15th of the month, or whatever it is, right? If you track a couple of months, and you see that, and you say, Okay, last month, we used 50% more this month, we’re using 40% more, you should be able to set up a bazel profile, then that essentially is that much more at least in bazel delivery. And then just enable it for that time of the month and the duration of days that you see it typically lasts. That’s you know, that’s kind of then going forward into once a cycle does start, you’ll be able to utilize that same kind of pattern. And once the cycle becomes regular, which is usually it takes about a year, yeah, give or take for most girls once they start their period to have kind of a consistency to it. So you should be able to use a pattern then, rather than just always employing a temporary bazel. It does take using the temporary bazel up front though, to figure out which amount extra you need to actually create a profile from

okay. So last night, I learned that Arden has a name for her period and she won’t tell any of us what it is. It has a human name, apparently human

name. Yes. Awesome.

I think she likes to feel like there’s a person who’s inflicting this on her so that she can be focused on the person doing the problem that’s on the side. Yesterday I showed Arden’s friend Jani, who has not been on the show yet, but will eventually she’s somebody whose blood sugar on tracking. I showed her how to see that her pod site went bad. So she’s rolling along great in the 90s just kind of bouncing, you know, at 996. Like all day long, three o’clock in the morning, it shoots up and levels off at like 220. And just stays that way all night till she wakes up at like four in the morning realizes that Bolus says the Bolus takes her down a little. And then she levels off and kind of rises back up again. And so I just pulled up a 12 hour graph. I showed it to her and I said just look at this. This is a bad site. And she’s like, why? And I’m like, doesn’t matter. It just is like look at it. Look at it. This is what a bad site looks like all the sudden, your insulin pump is not doing what you expect of it. Mm hmm. Common sense here says bad sighs it is this the last day of your set. And she goes it is and I was like, okay, change your pump. Get yourself down and start over again. The reason I bring that up where it doesn’t feel like it maybe fits here is that the way I would handle Sarah’s question is I would just do it over and over again until I had that feeling of like, Oh, I know what this is. And I really believe that it’s not just me. I mean, I think the podcast has proven that out right? That eventually after you do something enough, you just see it. And then all the thinking goes away Jenny’s what Jenny said is all perfect do that. But I think that one day, it’ll just be a situation where you go Oh, this is a Temp Basal increase or Wow, this is not giving up. This is more. Right. Sorry. Exactly. long game.

It is a lot. It’s a marathon, not a sprint. Yes. entirely. And you know, in the beginning, though, when you’re really trying to figure out the difference between a temporary or a true solid adjustment. Yeah. I think you know, when you make let’s say you make you decide you’re going to make a profile change. Oh, sorry. Ringing it shouldn’t arraign I had it turned off.

I didn’t hear it on the sensor. You’re good.

Oh, good. Good. Good, good. So, you know, overall, you might make a bazel change. And then you’re like, well, what, what gives Three days later, you’re like, that’s not working anymore. And now I’m way back down that might overtime again, prove, I need to maybe make a temporary adjustment, rather than a permanent kind of an adjustment, kind of similar to growth patterns and kids, you know, where you see a temporary need, because you’re now fluxing up and Okay, all of a sudden, this is gone now. And I’m staying a little higher, but I wasn’t at the rate of need. Like I was for three days. Yeah, it’s come back down a little bit. But now it looks more stable. It’s a little higher, but not quite. So. Yeah,

yeah, I think that somewhere in between, stay flexible, be and reactive, not in a negative way. But in that sort of, don’t wait around way, you know, like, and there’s drifts Sarah that you’ll start seeing on the Dexcom line. And just by the angle of it, I don’t know how to explain it to you. But you’ll start to look and go, this isn’t going to stop, like this shouldn’t be happening here. I’m going to try a Temp Basal increase right here. With Arden’s period yesterday, I used a lot of temporary increases yesterday, because she was sitting stable at 190 boluses weren’t moving or, and so to me, that meant, you know, bazel jacked it up, it worked a little but not enough, it was the end of her pump. So we swapped her pump, you know, we just went through the steps of you know, what it could be and, but we didn’t wait around, like once you saw it, we moved on it. Well, we all have one thing for certain. And that’s an abundance of Time, time that can be used in many different ways. You could perhaps spend your time at touched by type one.org. Or maybe you’d go to Contour Next one.com to find out if you can get a free Contour Next One meter by just clicking on a link and filling out some information. So here’s what we’re gonna do. Touch by type one.org has a mission of elevating awareness of type one diabetes, they also want to raise funds to find a cure. But mostly they’re looking to inspire people to diabetes to thrive. They have these beautiful programs and services. They’re helping kids all over the world with their D box program. And they put on one heck of a dance program every year in Florida. Go check them out, touched by type one.org. And once you’ve done that, you know what you need. You need the best blood glucose meter My daughter has ever used. And by best I mean, the most portable the handys fits well in your palm lights up nicely at night super duper accurate. And blood sugar test strips, the little strip things you get a second chance with if you mess up, you know when you go into the blood, sometimes you’re like I got it, I got it, and then it doesn’t beep and you’re gonna throw away the test strip, not with the Contour. Next One, he does dive back in again, beep beep looking at your blood sugar. I absolutely adore this meter as much as anyone could adore a blood glucose meter. But Contour Next One is it. So head over to Contour Next one.com and see if you’re eligible today for an absolutely free no obligation meter. And if you know you need a prescription, contact your doctor. They’re just sitting in their living room to no one’s doing a damn thing. Just throw them an email be like Yo, what’s up? Let’s try this new meter. send out a prescription. I’ve got nothing but time. Contour Next one.com touched by type one.org. Those links are in your show notes right there in the app, right that you’re listening in now. And it’s Juicebox Podcast comm check them out support the sponsors. Okay, well, it’s so funny. It’s another Sarah but a different Sarah.

There are lots of stairs just like Jenny. Yeah, it was a popular name. So

they’re even spelled the same way. It’s not even helpful. What would you consider the most meaningful metric or measure of successful diabetes management?

Oh, that’s a good one. I think we’ve actually got we went over that a really long time ago. Any of the of the pro tips or any of those kinds of things? I think if you’re looking at measurement from a site like clarity or one of your pump upload sites that gives you all of the metrics of this is your you know your average or standard deviation. This is what your glucose management indicator showing you what not what’s the best indicator is time in range. That’s it, I and second to that really would be that standard deviation, right? Because the lower the standard deviation, the more smooth management is rather than the jig up and down kind of Rocky Mountain. But definitely, I would say time in range. Our goal when we work with people is always new, at least 75% time in range less than 5% of the time low. pregnancies a little bit different. But

yeah, so ranges, what are the ranges you give people? But is that range?

I work with people on their target range, because everybody is individual. Mm hmm.

So okay, so if Do you feel like most people are being told at 180? Something like that? 7180 Yeah,

70 to 180. Like, if we look just at tide pool, tide pool has automatically set up as a timing range target, as 70 to 180. You can in your settings, go in and adjust that to get it tighter or make it broader or whatever. But yeah, most most practitioners, I would say, are aiming for about an 80 to 180. That’s the most common that I hear. Um, so again, if you just aiming for what the standard is. That’s it? Well,

I think that these companies should expand this a little bit. I’ve been thinking about this, I need a time in range. And a time in Nirvana, like kind of mess, right? Like, I want to know,

I want to know, the end range, but I really wanted this sweet spot. Like I’m not I’m

not, I’m not upset that Arden’s blood sugar’s 180 for an hour, right? I’m going to get it back down again. But I want to know when I’m 70 to one to one, or, you know, at 130, once we’re in there, I want to know when I’m, I even want to know, like 65 really like because if I’m because if she’s 65, for a couple of minutes after Pre-Bolus? Yeah, I’m already with that, right. And so I think that everyone needs to remember that when we talk about this stuff, there’s context that you need to give it. And you see all the time there’s people online, or Look, I was in range 100% of the time today, and somebody will come in and say, you know, what’s your range? And then suddenly, they don’t come back again? Because you know, they never went over 350. And we’re never under 50. I’m in range all day. And even you know, what, if that’s for them a success? I’m not taking that from them. I’m just saying that when you’re trying to share it out loud in public, you need to tell people what that range is, right? It lacks, you know,

weight. And I’ve even seen something that goes along with it. I’ve even seen people then question, well, what are you eating? Because when we’re looking at sharing our own information, and kind of patting ourselves on the back, what’s good for us? Absolutely, it takes work. So go ahead and pat away. But you also have to, when you’re putting it out there to the public, you have to give all the information that went along with that. You can’t just say look at this nice flat line. Well, people then ask, Well, what are you eating? How did you get that? Because there are so many different variables that go into meeting that.

So my blood sugar has been between 82 and 86. All day, I’ve had four hard boiled eggs yet like, like tell somebody the whole story.

Right? Exactly, yeah, because it feels

bad. Otherwise, like, otherwise you’re looking at it, you’re like, Oh, my gosh, you know, this person’s blood sugars like this, I try to remember as much as I can to say, you know, ardency, one sees been between five, two and six, two, by the way, coming up now on six years. And she doesn’t have any diet restrictions. But I always think the important thing to add is, for all of you that are imagining that her blood sugar is just at three constantly. That is not the case. You know, we just don’t look at high blood sugar’s very long and she’s not low. So, you know, I would say that ardens deviations never where anyone would want it. Hers is usually like 40. You know, and

but within range,

it’s being measured between, it’s being measured between 70 and 120. Right. So, you know, and, you know, and I know, I still don’t want her to spike up, but she sort of doesn’t, right, you know, so. And not that she doesn’t ever she does a couple of times a month or you know, a couple times a week or whatever it ends up being, but she just doesn’t jump the 300 and stare at it. So I think that while the measurements are really important, the way we talk about them are is possibly even more important. So I don’t see anything wrong with a one see if it’s being done correctly, meaning no protracted lows that are giving you a false sense that you’re a one C is lower. But what Jenny’s saying is you do not want your blood sugar bouncing up and down. That is just It’s not good for you, it would probably be better for you to be steady at 150 than to go from 70 to 300.

Correct. Exactly.

Right. So there you go. Actually, the funny thing here is the next question from Nicole, is, what are your thoughts on a reasonable standard deviation for a growing five and a half year old? Hmm.

Yeah, that’s an, I think you have to have a little bit of expectation that there is going to be more variability in certain periods of life, there will be I mean, kids, I mean, she’s is growing five year old kids are growing considerably from birth, I would say, honestly, until about the age of like, 10 ish, things are kind of similar and patterns of growth, they really speed up, I mean, you can see the difference. You know, we’ve got one of those, like tree growth charts for our boys. And I usually turn every couple of months to see where are you because I know, you look like you’ve grown or your pants look way too short again. And I swear, I just bought new one last month, you know, but at some point that growth slows down. And certainly the teen years are a different amount of growth, not the same as far as like height or anything, although it could be for boys differently than for girls. But hormones are a bigger impact there in the teen years. for little kids like that five year old age, you can expect that eating for a standard deviation of something like 20 might not be in the cards, because you may have a lot more variability. Even if your timing range is kept very good, you still might have a little bit more variability in there. Because if your five year old is like my who is now seven, when he was five, I mean, he could be like I want to eat, I want to eat, I want to play I want to eat Nope, I’m not going to eat all of that. So when you mix diabetes in there, and you have to bolus and strategize and Okay, now I have taken a little way. And now I have to plan for this and whatever, there’s going to be a lot more variability perhaps. But aiming, that’s why I said that metric of time and range would be really more what to look at. Yeah, we don’t want your standard deviation to be 80. But if it is going up a little bit more, you know, up and down. That’s kind of par for the course with littler kids.

I think that common sense is incredibly important here too. Because as you’re listening to Jenny, explain this, from a clinical standpoint, you’re thinking about what is or isn’t said to you by the American Diabetes Association, or by your endocrinologist, all that stuff, you have to remember that they’re just trying to give, they’re not with you, they’re not always whispering in everybody’s here, right. So they’re just giving a baseline like, you know, your standard deviation should be less than blah, your agency should be here, your variability shouldn’t go but like, they’re just giving you a place to start. I think that it’s a, it’s kind of incumbent upon all of us to take what looks like the rules, I’m making little quotes with my my fingers, and realizing that that’s probably not the best you should be shooting for. It’s not It’s not the top, they’re just trying to keep people. I don’t know how to say this. There’s a there’s a way that if your own? Well, I’m struggling here, anyone, anyone who’s been in a position of power in an organization knows that you’re giving common denominator advice to your employees to you know, the subjects of your kingdom to like to whom ever you’re talking to. And and to hear that advice and take it as gospel, I think is a mistake. Do you know what I mean? Like, you know, yeah, you ever go around a corner and the speed limits 25. But you’re in a sports car, and you’re like, I could go around this corner of 45. And it would be you know, that’s you you’re in a different car. They put the 25 there for the guy coming through in the 1975 Datsun like do you mean like his car can’t handle this curve at 25?

He will roll the car and right yeah,

so for us, for instance, my standard deviation doesn’t look good on Arden compared to what people say, except those people have a range between, you know, 80 and 180. While I’m shooting for a range between 70 and 120. And so, my I, I know where our standard deviation sets when I’m happy with our blood sugar, right, and I don’t care what anybody else says that works well for us, right? And then people are like, oh, but then or health or health or health is going to be great. Like if you tell me that a person growing up with diabetes, who’s got an eight one C and the fives constantly eat whatever they want, doesn’t spike Hi, you know, maybe sees one ad twice a day for 45 minutes. If you’re telling me that’s a problem, I don’t believe you, you’re I mean, like I were, here’s this, that’s the best we can do. So, you know, we keep trying to tighten it down and make it better. But at some point, that’s when you get to the life versus management trade off, like I got to be alive to

weed. Right? Exactly. Right. Yeah.

And so the problem with asking these questions are and getting the answers is that no one’s going to give you a real answer. They’re just gonna say what feels safe. Right. And so that’s the most part common topic,

what I can kind of say about standard deviation, though, even in, let’s say, your timing range of whatever range you have set. Even for a five year old, for example, you know, if you’re constantly having these big old climbs, and then constantly attacking then and then having a drop that you’re getting into the red zone, and then you’ve climbing again, because of the red zone, and then you’re dropping again, even if you’re in range in doing that, that standard deviation, still, it requires improvement, right? You don’t want this mountain peak, you know, up, down, up, down, up down all day, because even in range, it doesn’t feel good for any age person. So the smoother that is, the better the person, the child to whoever feels.

And if you’re looking it up and down and up and down like that and worried about time and range or standard deviation, you’re missing your Miss focusing your concern, your right turn should be Pre-Bolus thing and carb ratio and understanding glycemic index and stuff like that.

And also effective insulin right duration of insulin. Yeah, understanding how long is my insulin actually working? You know, we’re under I mean, that kind of takes it a step further in that variance that you see that standard deviation, because we’re kind of in the understanding that our rapid insulin is rapid. And we’ve talked about this before, and that it also clears very rapidly. That’s not actually the case, if you follow it out, right, there’s actually a lingering dribble of impact. So if you are getting that up, down, up, down, up, down, it’s very likely that even with using a pump, you might unknowingly be stacking insulin because your duration of insulin has been too short. And with modern day conventional pumps, what you set it at is what it uses, it doesn’t know anything else beyond that, right? So it can’t say okay, there’s still insulin left here, make sure you take some of this off. But yeah,

Chinese talking with her hands while I can hear birds outside of her window, and she looks like Snow White. I talk with my hands a lot. I don’t mind the hand talking. I’m just telling you like Snow White for a second. Listen, here’s what I think. Don’t worry about your algebra grade worry about understanding algebra, right? You know, the grade will come if you understand the math. And with this, if you know how insulin works, the standard deviation of calm, the time and range are commonly a one seal come like you can’t, don’t focus on the grading focus on the work. And, you know, I don’t know how many more times I can say this, I keep thinking I’m going to sync the podcast, it’s timing and amount. It’s understanding how insource use the right amount of insulin at the right time. And the rest of this becomes unimportant, you know, its background all of a sudden.

And the important thing about that timing and understanding is that it is individualized right for you not to cut and dry up here. The doctor told me that this should last three hours. So that’s what it should last. That might be the case for Johnny. But for Susie over here in the corner, maybe she’s figured out that three hours the doctor told me Ah, it looks like it’s four hours for me. So it does have to be individualized,

right? I don’t know where I was where I rolled up into a talk and I told people look, here’s the truth. I could have flown in here, got up in the morning, got showered, jumped up on the stage, grabbed this microphone and said, Hey, everybody, it’s all about timing and amount. Just understand how insulin works and you and you’re going to be fine. Thank you. Good night. I could have left. You know. Well, you know what I left out some of the details about how to get to that but that’s still the truth. Correct. Jennifer Smith is available to work with you. Check her out at integrated diabetes.com Thank you very much to the sponsors. Contour Next One and touched by type one. A lot of ones in there. Two ones you know you get when you add up to ones. One on One is equals to.

I’m completely alone in this room.

I just want to go outside, touch a handrail. Don’t walk past somebody who sneezes and not have a stroke. Soon, probably a couple more weeks, couple months at the most, it’ll be fine. I’m still wearing pants or you don’t judge me. Listen, I put this up a little early. Right? Because on March 26, at 3pm going to do a big zoom meetup. And I have an idea for that I think you guys are gonna like, so if you’re hearing this in the moment, check it out. And if not, the video will be running on the Facebook page, you can go back to it. But here’s what my thought is, when you get a bunch of people together. And we’re all going to, you know, just chit chat, see how things are going make sure nobody’s like, you know, go and do it because they’ve been locked in their house too long. And after we all do a little Chitty, chatty like that. We’re gonna talk about getting people’s bays on its own right. So like a big group thing on everyone’s basal insulin. And then we’re gonna come back the next week, see how people are doing and then add another step. And maybe during this whole Coronavirus thing, we can bring everyone’s variability and standard deviation and a one seat down, when that’d be cool. If we just all got together in a group and did something like that. I hope you think it’s cool, because I’m pretty excited about it. March 26, Thursday, 3pm Eastern time. There’s links right now on Facebook, I think the links on Instagram, send me a message if you don’t know how to get to it, get there gonna go through people’s bays or it’s just like it’s a private phone call. We’re all gonna be there, kind of kicking in our two cents, helping everybody out. You know, if the listeners of the Juicebox Podcast can’t count on each other during a time like this, then I don’t know who we can count on. So while we’re all busy being stressed out watching bad Netflix shows, I figured we could spend a little bit of time doing something for everybody’s health. I hope to see you there. Hey, last thing if you’re not a subscriber to the show, like if you just count on remembering the shows on it would help me out a lot if you hit subscribe in your podcast app would help even more if you share the show with a friend. And if you’re not up to like sharing the show, maybe just share the zoom with them get together and maybe they’ll see something they like and they’ll check it out on their own. The podcast is growing so quickly because of you guys. It isn’t even letting down during this Coronavirus thing. I’m super impressed. I thought for sure. Like oh, downloads will slow down but they haven’t. And that’s really very touching. Oh, by the way, last thing next week. So the next show that comes on. Let me take a look. On the 30th of March, it’s going to be an after dark episode. Sexuality from a female perspective. So if your kids usually listen, don’t let them listen to that one. Because there’s not a lot of bad words in it. But there’s a lot of clear talk. So unless you want your kids to know exactly where the round peg in the square hole are, I think you should. I think you should make sure they skip that one. I didn’t believe a lot of kids listen to until recently but apparently they do. Which I think is great, but not for this one on Monday. So there’s an afterdark coming up on Monday. Make sure you kids. don’t hear it.

Hello, everyone. Welcome to Episode 321 of the Juicebox Podcast. Today’s show is an ask Scott and Jenny. And in just a moment, I’m going to tell you what the topics are and who the sponsors are. But first, I’d like to spend a brief second, discussing how I’m programming the show with consideration to the Coronavirus and what’s going on in the world. So my family and I’m sure many of you have been held up in your homes. My family’s been here at home for almost a month now. And in that time, I’ve been paying attention to the Coronavirus maybe more acutely than some parts of the country because I live in the New York Philadelphia metropolitan area. And it struck here pretty quickly. Now, some of you may live in places where it might not reach anywhere near that it has in New York. And I hope that for all of you. And some of you may just be a little behind where New York is right now. One way or the other. I felt like it was important for people to understand what Corona or COVID-19 is. So you know, back in mid March I had Adam Edelman Come on. He’s a doctor we discussed Coronavirus, kind of in a broad way. Jenny Smith and I talked about Corona The following episode. So these are episodes 314 315 There were a couple other episodes came up. And before I knew it, Sarah who’s listening to the show, reached out and said she’s a nurse in New York City. And she’s got Corona very mild case of Corona, she came on and told us about what a mild case of Corona was like. Adam came back on Dr. Needleman came back on again, just recently did a little bit of an update. And in that time, I was able to interview a gentleman named Justin, who’s become kind of famous online for being one of the first people to put a picture of themselves up with a mask on saying that they had Coronavirus and asking everyone to be careful and, and follow the rules. Because it was serious. Justin happens to have type one diabetes, so I couldn’t pass him up. Even though I thought I don’t want too much Corona stuff on the podcast. Now Justin had a more significant more severe case of Corona, and I interviewed him just the other day, his episodes going to be out after this one. So what I’m gonna do this week is put an extra episode out, I’m gonna try to strike a balance, I don’t want people who aren’t interested or maybe are having anxiety around Corona to feel like they’re not getting content. And for those of you who are interested, I don’t want to stop providing the content. Now I can see the downloads and the corona episodes are very popular. And so I’m going to kind of override my inner voice that’s telling me too much Corona. And I’m just going to try to continue to provide good solid information that’s not click Beatty, and not meant to make you upset, you know, so that you’ll come back and get more, which I think is what a lot of media does just want to offer you good information. You can do with it what you want. But there’ll be three episodes this week, so that everybody gets what they’re looking for. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been wearing now for a very long time. Now, since she let’s think, already got an insulin pump around the time she was four and she’s gone. And she’s 15. She’s going to be 16 this summer. That seems like 12 or 13 years, it’s hard to know because my math skills are limited. Anyway, Arden has been working on the pod every day for that time. She’s also been wearing a Dexcom CGM. Currently Arden wears the Dexcom G six continuous glucose monitor. And we absolutely love it, you can tell that if you listen to the podcast, that’s sort of a no brainer, I don’t really need to tell you her meter the Contour Next One blood glucose meter super small, super convenient, lovely and accurate, like they talk about and of course you know near and dear to my heart touched by type one. And I asked you to check them out at touched by type one.org. There are links in the show notes of your podcast player to all of the sponsors. Or you can type their links in yourself. My omnipod.com forward slash juicebox dexcom.com forward slash juicebox. Contour next one.com And of course, touched by type one.org. Let’s play the music and then talk about some stuff with Jennifer Smith. In today’s Ask Scott and Jenny, we answer 123 questions. Wait. Yeah, three questions couple more bigger. I asked me a question. We chat a little bit about the Zoom meetups I’ve been doing on Thursdays come on out and check them if you want. There’s one In the Facebook page, this Thursday is going to be at 7pm. Eastern time, I guess I should tell you that Thursday’s date will be April 9 2020. In this episode, Jenny and I are going to answer a question about shutting off Basal, and how long you can do it safely. I’m going to tell a quick story about meeting some fans in public. I Muse a little bit with Jenny about the social meetups and whether or not they’re valuable ways to help people make improvements. And I’ll talk a little bit about that at the end of the podcast as well. And then we talked about extreme management. I put extreme in quotes here. Because is being healthy extreme. And why do people think of it that way? Sometimes. I’m going to want you to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to please Always consult a physician before making any changes to your health care plan are becoming bold with insulin. Helen says, I hear Scott say he turns Basal off. If Arden is running low, we started to do this for my daughter, Ella. And it works amazingly well. However, we only dare do it for about 30 minutes. We were told ketones develop quickly if she doesn’t have background insulin. How long is safe to do? I have my answer. Let me go first this time. Let’s see how wrong I might be sure. Well, you’re not wrong. Yeah, I could be wrong, you hold tight.

Hold tight,

I’ll wait. Here’s my thought. If your background insulin, if your Basal insulin is dragging you that low, then taking it away for a little while. It’s not really gone, because you probably have too much to begin with. Now, if you take it away for a long while, and create an absolute black hole where no background insulin exists, then I think DK can come on very quickly, depending on a lot of other physiological implications. How was that?

I was actually pretty, pretty good. Not bad. Not bad. Not bad at all.

I gotta get you know how some people are like online ministers. I just need one like company to start online CDE. And I think I could get one wouldn’t be like real, like, you know that while you’re being married by a minister of the like, bah, bah, bah, live charge that got something by filling out a form online. It’s not really a minister but it’s legal. It’s legal. I think if somebody would start that around diabetes, I’d be okay. Go ahead.

Yeah, no, but you’re I think that’s a really good like baseline, and even a little bit more. It’s a little more in depth than baseline even because you did go into the fact that if you’re on Basal alone, there’s little, literally nothing else left such as like an overnight, you go into bed, your last meal in Bolus was around six o’clock, it’s three o’clock in the morning. And you can see that, like you said, before Arden’s friend, she had a bad pump, or a bad pod site, or whatever it was, and she was middle of the night, you could see blood sugar was rising. There was no other reason for it to be rising. None at all. It was a bad site. So that kind of a deficit of insulin was likely started a couple of hours prior to the rise starting Yeah, right. Because anytime you’re at a deficit of Basal, you can shut a Basal off right now, you still have circulating Basal insulin going for at least another hour, perhaps hour to two hours, right. So you’re really not at that complete, utter zero level of Basal yet. So a 30 minute shut off, is really it’s nothing, it’s, I’m glad it’s helping for the reason that you’re using it for, but that 30 minutes is really like a drop in the bucket of nothing, as far as impact for causing decay a right. And the other, you know, piece that kind of goes into that as well. In this scenario. For example, let’s say this low is happening during the daytime, and you shut the Basal off for just 30 minutes. And it helps for whatever reason that 30 minutes is really stabilizing things, evening things out into the next hour or two. So you don’t stay low or go lower. Great. But you also have to look back and say if this was during the day, the low was probably as long as you’ve got Basal figured out. It was probably not from Basal. It was probably from insulin on board from a Bolus that drove things too low. Yeah, with whatever other variables in the mix that caused it to happen, right. So just that 30 minute deficit again, of only Basal it’s not deleting any insulin on board from a Bolus that might still be in the picture. So again, the risk of decay a while it is higher on a pump than it is with multiple daily injections. Because once you take your injection of Basal it’s there, you know it’s there, you’re never at a base at a deficit of it. With a pump though, you do have to be careful. And our baseline is when it usually comes in and discussions in summer when kids are going to the beach and using their pool a lot or you know, whatever it might be, they disconnect from a lot of pumps that are tubed. We usually say do not disconnect for more than a two hour time period, come back check blood sugar, take a Bolus of at least 50% of the missed Basal amount in that disconnected time period so that you don’t have problems with a deficit leading to potential decay in the next several hours. So So yeah, so there’s my long explanation.

Oh, that’s a great explanation. And and it brings up you know, what it reminded me of, you reminded me of how proud I am of the podcast, and how we can have long conversations about stuff like this, because 15 years ago, in the diabetes space, this was the message, you’re more likely to go into decay with a pump. Because what if something happens and you stopped getting your insulin, and then that became the rule pumps are dangerous. And then people thought that for years, until people got other people bought pumps, and wore them and proved everybody hey, look, I’m still alive. I have a pump. So saying something, and it’s not a wasn’t a, an incorrect statement, right? You could be sleeping and Rick, rip out your site. And now you’re not getting insulin. And that is a

danger that could chew the to but you don’t know it. I wish I could name this

episode, the cat that chewed the tube, but no one would listen to it. But but but the point is, is that we used to say these very basic things, because that’s what communication allowed. And then people were allowed in their minds to take the scariest part of that and run wild with it in their own imagination. Yeah, so I like that we can talk more about this. I like that. Helen can now think if I give a Bolus at noon, and I need to make it more aggressive upfront because of the nature of the food, but I know that at three o’clock, my kid’s going to get low. I can still make that Bolus at noon. Turn Basal off at two o’clock, create a deficit of Basal at three when the Bolus from noon peaks and balance those things out. That is so cool that we can talk about that like that.

That’s great. Yeah. So I appreciate your tools, more tools for the toolbox.

It’s just more stuff to understand. I saw Jeremy in the Facebook group. He’s being helpful and making fun of me at the same time, which I appreciate. Oh, because when people sometimes people are like, I don’t know, like, how am I supposed to get to this place where a lot of you are what Scott’s talking about? And my answer always is, you got to listen to the podcast. Like just listen through it because these things will build it’s not it’s not a checklist of five things you just do. And it all of a sudden works. There’s you know, variability and, and nuance and everything. And Jeremy’s like Scott’s gonna say to listen to the podcast and, and he’s like, but try this year. And he’s both right in making fun of me. And he’s right about what he said, too. Because this is not a quick fix. And it’s not information that your brain just learns. Hearing it one time, you know. And

when you since we’ve got some time now

turn it up here.

On those headphones, go for a walk with your dog, push your stroller, listen to it while your kids are running around in the backyard and whatnot. Actually, somebody yesterday that I talked to she and their family, they had come down to Atlanta for the JDRF conference to hear you, which was great. But all the way there and all the way back. They actually listened to the podcast to the podcast, because they had like I think she told me it was like an eight hour drive there an eight hour drive home. So they drove there and back listening to the pod.

That’s really nice. I thought was really cool on my way to Atlanta. I was I had to park my car to an airport, and I got a little shuttle bus to get to the airport. And there was this woman and her like 17 year old ish son sitting next to me, and we start driving out of the lot. And she just stands up and like goes way, way, way, way way. And like everybody’s like, Oh, you know, what’s this? She was I still have my key. So she was valet parking. So her car still running somewhere. But she left with her key, right? So she the driver stops, she runs out takes the key to the valet. And I turn to the boy and I say is that your mom? And he goes yeah, I said, my wife and I embarrassed our kids all the time. And he looks at me really strange, to the point where I thought Ooh, did I just offend this kid? Right and I felt bad. So I kind of withdrew back into myself and stopped talking to him. She gets back on the bus and begins to very kindly apologize to everybody on the bus. Oh, I hope I’m not making you late. Meanwhile, it was 30 seconds. You know, she just I hope I’m not making you late, Bob, I’m sorry, but and I looked up at her and I said, I just did something really stupid with my key two weeks ago. If you sit down, I’ll tell you about it. It’ll make you feel much better about this. She looks at me and goes, Are you Scott from the Juicebox Podcast? And I went, what? Because you know, we’re on a bus at an airport with only eight other people. And I said, I am. And she goes, Oh, I saw you speak at this thing. And we listened to the show. And just as that happens, the kids CGM beeps, and I turned to him and I go, Oh, hey, and he looks at me. And he goes, I thought your voice sounded familiar, but I couldn’t place it. My mom and I listened to the show together. And I was like, just think he wasn’t mad at me. He was like, oh, man, why is this guy’s voice seem familiar to me, you know, and it was just absolutely crazy. And then days later in Atlanta, I literally walked into them in a hotel lobby. I was like, they’re there again. Funny, it was very, very strange. But, but nice. It was it was lovely, actually. So it might be different. You’re being kind, but I appreciate that those it was very strange. It happened two weeks after I was recognized in an airport in Dallas. And that threw me for a loop. That was a woman approached me. He told me about Yeah, you’re just sitting. Like, I was getting ready to get on a plane trying to decide when I was going to change my shirt, my sneakers, you know, like, and a person I have music on. And this lovely woman comes up to me, she kind of puts her hand out. And you know, you’re just like, what’s about to happen? You don’t I mean? So I’m like, Hi, how are you? And she goes, good. I’m like, Can I help you? And she goes, Sure. Are you Scott? And I’m like, Uh huh.

And who are you?

And I was like, Were you just at my talk? And she goes, No, I’m in town. My daughter’s running a marathon. And we’re here to support her. And I was just like, wait, what? Like you weren’t just at the thing I spoke at? And she’s like, No, she says, My husband and I were sitting over there. 10 minutes looking at pictures of you online trying to decide that he’s finally I think that’s him. Go say hello. That kind of stuff. I gotta be honest with you. From diabetes podcast, I never thought and now it sticks in my head when I’m in public now. Now I’m like, Hmm, is there?

Anybody knows what I look like?

You just got to keep a lower profile. Because Because now I find myself thinking like, do I have to be nicer in public? Not that I’m not but like, am I gonna be judged by? Like, is there gonna be a story online one day, we’re like, I saw this guy from this podcast, and he was being so he was being rude to a lady, you know, which I’m not. But now I’m worried about it. Right. So silly. Absolutely. So So I said, Jenny, let me ask you a question. I haven’t asked Jenny question. I have. I’m doing that thing tomorrow on tomorrow, the first, you know, kind of group meet up for people. And I was thinking during this Coronavirus thing of starting like some sort of a challenge to lower your a one, see your deviation, your variability, like all that stuff, like we’re all just sort of sitting around. Like, I wonder if we shouldn’t, like try to help people like, right, like, I’m wondering if when everybody comes on this, this zoom later, if I’m not just gonna go through one by one and be like, Alright, everybody hold up your 24 hour graphs. Let’s look at your Basal insulin. And then, and then talk about getting Basal adjusted for people, and then maybe see if we can’t get back together once a week and see what we could do about like, I do a cool thing to do I do it with single, like people by themselves. Like, I think I could do it with a group.

I not do it together and teach a big group. Right? Yeah,

that might be fun. I think that would work.

I do. And I think from the standpoint of looking, you know, I, in terms of looking at data, when you look at so much data, as I do, every day, lots and lots of data, lots of people’s different kinds of data, you actually start to notice more things, right. And from a teaching tool, sometimes when it’s only your own data that you’re looking at, you can kind of get lost in it. Right, right. But when you bring together a big group, kind of like, like a kids for diabetes camp, or kids with diabetes kind of camp, you know, they they do a lot of things that are interactive like that, and they bring the information together and that sort of camaraderie. in a setting like this, yeah. where everybody’s showing a graph. Somebody might be like, Hey, that looks like this is happening, right? Or, Hey, that looks like this is happening. And not only is it like a learning experience, you’re also helping other people. You don’t necessarily know.

I just, I see it in the private Facebook group. So if you go on Facebook and search juicebox discussion group, I think that’s what it’s called. I named it, I should probably know what it’s called. But it’s a private group where people talk, and there’s times people put graphs up. And I’ll like jump in to say what I want to say, and somebody will have settled already, like, oh, great, you know, and I’ll like, like, somebody comment and put a finger under it, like pointing to it. Like, this is what I would have said, Yeah. And then there are other times where somebody makes an explanation. I think that’s better than what I was gonna say. And, you know, terrific. So I’m thinking like, maybe we can do it. Like, again, a mass like, you can get 100 people together and bring everyone’s blood sugar down, Louis, Zoom call. I’m like, I’m like people. Yeah, I think I can. It’s so and then like, yeah, I hope so. I really hope it works out. So I’m gonna even have

like, focuses, like you said, kind of like Basal or like, even like a challenge of, okay, your challenge today is to go home and just Pre-Bolus for all of your meals. Right? And let’s look at what that did from today. Compared to tomorrow. What did that do?

That’s what I was thinking. Alright, I like that you are doing. Jenny makes me feel better about myself. Sometimes. Like you said, one, though. Seriously, you said one time, I forget how you put it. But you said something about, like, you could do this for a living. I know you don’t have the credentials, but you could. And that made me feel really nice. I just I never told you that. So thank you. Okay, let’s see. How are we an hour and a half today?

I set up for about an hour, hour and 15 hours.

Okay, so let’s do we’ll do one more. Um, ah, Kelsey, I’d be curious to hear Jenny’s thoughts from a clinical perspective on the post from earlier regarding extreme she without in quotes, management tactics versus being bold. And what her take is on lower a one sees and the pushback in the medical and sometimes social community based on available studies showing no benefit. Also thoughts on lag time of published studies and the advances made in the last decade? Have we talked about this? I brought this up in passing with you once. I just mentioned it as an article. I don’t know if you’ve seen it or not. Right. But so I guess what Kelsey wants to know if I’m, by the way, that’s a very well written question, Kelsey. It is no, so many smart people are listening to this podcast.

They’re all smart. Everybody’s smart in different ways.

Yeah, no kidding. But I’m saying this is a really well written question. Usually people’s writing doesn’t read. Well, Kelsey can write is what I’m saying. So, but but to boil down what she’s asking. I think what she’s saying is that there’s a way that you know, the medical community generally talks about this, right? Like, oh, a seven a one C is fine. And then you see somebody say, Well, you know, me or somebody else. My kids got a five five and I just handle that by stopping spikes you know, making sure her blood sugar’s Well, I don’t think anything I’m saying is crazy, right? Like it’s and, but to the, the masses, it seems like over management to them, because they’ve been given such a baseline of like, just do this, and whatever happens is fine, and go live your life. Right? So is her question really? Well, her, you know, let’s ask answer a question first, like, what’s your take on doing what you want, you do what I do with art, and with a lot of people listening to this do and what happens when those poor people then go into their doctor’s office and then get sometimes really chastised for it? Like, like, I know, that’s a hard thing to wrap your head around you and I talk about this privately, sometimes, but a lot of people that listen to this podcast, their next leap to make is to then talk their doctor out of being upset about it. Correct?

Correct. And he we even get, sometimes not often, but again, a lot of the people that end up coming to us to work with us is because with all the information that is out there now and is so available online, we can not only see what other people are doing, but we’re also reading such as she refers to, you know, these studies about lower isn’t necessarily proving to be better in the long run, etc, etc, whatnot. But people want to do better, and they want to do better from the standpoint of understanding and I know that we addressed this somewhat in another podcast, there was a brief talk about this because I had referenced the fact that a one C for the population of people without diabetes is under 5.7%. Yeah, Why are we not aiming for that in a safe in in safety, right? With safe constraints? I’m not saying run at a blood sugar of 55. So you can get an A one C of 4.7. By no means, however, why are we not aiming for the goals that people without diabetes already have? Because their body does it for them? Right. And I bring it in to and I think I commented before as well about like pregnancy targets. If pregnancy targets are what, what we’re aiming for, which is the normal blood sugar that the population of people without diabetes already has naturally, if we’re aiming for that in pregnancy, why should somebody go back to aiming for higher or loosening that up? Once they’re not pregnant anymore, but the baby’s healthy? I guess I can, like, you know, lighten up on everything,

go back to racing to my death,

aiming for a target, you know, under 250. Target under 140. I, I don’t I mean, from my personal and my clinical perspective, I don’t know why that is the recommendation other than as we’ve also sort of alluded to, or really commented about previously, a safety factor from the conventional system of management that we have kind of that we’ve had to use, because that’s all there is. There is a safety component that I think many, many, many practitioners, they, they don’t see the every day. And so when they see data that’s showing them and they’re only looking at an AE one C, somebody comes in with an A one C that’s 5.7. They’re thinking, Well, gosh, this person’s got to have a whole bunch of lows, or there are this a one C would not be 5.7. But if they looked at the actual data, and now that a good portion of people are using CGM, we should be looking at that to go along with the actual glucose management indicator, or the a one C or the average glucose, because if they’re achieving an A one c that is phenomenal, 5.56, you know, 5.1, whatever it is, and their time in range is phenomenal. And their percent low is not more I mean, we as a practice, aim for less than 5% low. So if they’re achieving that, why are you? Why are you upset that they’re managing something? So well, a lot of preventing problems, a lot

of people that reach out to me with a story indicate that the doctors even presented with the data, it doesn’t stop them from being upset. They’re so pre programmed to believe if you’ve got a great day one, see you did it wrong. And that no one can get that. And

I’ll tell you that I’ve had I had one really, really, really phenomenal Endo. In, I’ve had a couple of really good ones. But one really phenomenal one. When I lived in DC, he was fantastic. He he could side by side power with me on the level of information that I needed to talk at. And he was like, he was like a go for it. You know, it’s here, let’s attack this, I see this could be a problem area, he was happy when my a one C was like 5.4%. He’s like, That’s phenomenal. And your lows are not in the picture causing this. I mean, he could really talk on that level. And he was comfortable about that. Because I was also and I think maybe this is also a piece too. If you have the ability to talk back to your doctor about what you’re doing to get there and to manage that. I mean, if you go in being like, I don’t know why I’m here, I don’t know how I achieve this, or whatever they’re gonna be like, well, that’s this isn’t this isn’t safe, I don’t see data that’s proving that this is safe. You don’t really know what you’re doing, obviously, but from the standpoint of many of the listeners, and many of the people that I work with. I don’t love the data that I read the report that you mentioned the research report. I don’t don’t love that it’s kind of telling people that they should aim higher when we know and diagnose pre diabetes and diabetes at certain emergency levels. If you’re pre diabetic above this level, if you’re diabetic at this level, why? Why is that then healthy for somebody to maintain once they do have diabetes?

I think to that anecdotal evidence is more valuable in a time where we can all talk like this. Because, you know, calcium makes the point. You know, when was the study even done? You know, and just because data collaborate, right didn’t look right, that study could be years old, just to get it out the way that’s, that’s and I’m not saying that the scientific community shouldn’t do their studies the way they do. But the problem is you do a study with, you know, the proficiency of starting a fire with matches. And five years later, when you put your your data out, there’s a flame thrower Now, that doesn’t match up anymore. You know, you mean, I’ve got a flame thrower. I’m not using matches. Your dad is 100%, right about the thing that you thought I started thinking about four years ago, except we are in a different world now. So you’re using CGM, and pumps, and you know, algorithms and everything else. And they’re giving you you know, they’re giving you advice from five years ago? Correct? I think too, it’s important to remember. Not everybody’s a bad student. Sometimes there’s bad teachers. And so if you’re failing, with bad information, are you failing? Or are they failing you? Right. And so if you start with a person who Jenny mentions having a great endo in Washington, right, so she met a person through happenstance, who really wanted to be a hands on endocrinologist, and sunk in and found out things and learn things, and was good at sharing them with other people. For every person like that, there’s going to be a handful of people who, you know, we’re coming out of high school and going, what should I do for a living, I’m good at math and science, I’d like to have some money, I’ll be a doctor, my doctor goes on vacation twice a year, this is perfect. You don’t just like there are some people who really want to teach children. And there are some people who just want to have off in the summer, they both end up being teachers. You don’t I mean, and so not everybody’s the great doctor from Washington. So if I’m just giving you look, I read the articles, this is what it says to tell people with type one diabetes. So this is what I say to them. And if they’re failing, that’s their fault, because I gave them the directions. You didn’t tell them how to use the directions you didn’t you left out all these other things. And so again, I used to talk about this a lot more in the podcast years ago, you have to just believe in yourself a little bit and what you’re seeing, you know what I mean? Like you can’t keep having outcomes that you know, are bad. And then turning back to the guy in the white coat. And he says, No, you’re doing great. And then you swallow on that big fat pill and just going okay, I guess it’s alright, the guy said, It’s okay.

And I think sometimes it’s also hard. I mean, I’ve heard from many people, not many, but some people who’ve actually said, Well, if I, you know, if I choose, I choose to work with you or your practice, my endo doesn’t want to see me anymore. Or if I do all of these things, and make my own adjustments, I get hand slapped every time and that doesn’t change. Well, you know, in our healthcare system here in the United States. Thankfully, many of us with our providers, we’ve got the ability to change providers, we can look at our network, we can see who else could I go to, with social, you know, connections and whatnot. Now we can even ask, Hey, in your community, who has a really good Endo, who’s a really good pediatric Endo, who do you love? What do you love about them? I mean, we can like network that way and actually make some different connections. I mean, I got an email from a woman in Canada, actually, probably at least a month ago, who she was asking how they could work with us, because she said, our endo makes all the pump adjustments. We literally get hand slapped. When we come to the office, if we made any adjustments. She’s like, I even like, I save the adjustments My My doctor gave, I go home, and I make my own adjustments. And we go back to the office, I make them to back to what the doctor recommended. She’s like, I know, he’s also not really looking at the data, because otherwise the doctor would see that clearly. We weren’t running on the profile that they told me to run on. I made my own adjustments or no, but they’re also being told that a glucose value, you know, that’s in United States milligrams per deciliter term was like a blood sugar of 105. They were being told overnight, was too low, to run their child at overnight. And so from that standpoint, you have to say, you do you have to say enough is enough, but I can’t work with this practitioner. They’re not willing to expand and allow me to manage something that’s 24/7. It’s not every three months of management that I come in, and I get your feedback. I look at this every single day. Every hour of the day. There is no shut off.

Yeah. And at some point, you just have to The, you just have to say I can’t change this person’s mind. And the reasons why are unimportant. Like what it be, maybe the doctor doesn’t understand, maybe the doctor is lazy, maybe, maybe, maybe, maybe who cares why it’s happening to you just, you know, you have to remove yourself from a bad situation. And it’s tough because some people will say, Look, I don’t live near that many doctors, I need these prescriptions. And, listen, I don’t know what to say about that. If you’ve got to suffer a fool to get your prescriptions, then you’re gonna have to find a way around it. But stop trying to stop trying to make it. What do I want to say here? I have my example popped into my head, but it’s too personal to share, because it’s not about me. Not everybody does the right thing. And a lot of people want people to do the right thing. You can’t make the fight, teaching someone else what’s right, sometimes you just have to get through it on your own. And so if you’ve got some chucklehead, but they’ve got a prescription pad, then you’ve got to put yourself in that mindset, I’m going to go play a part for 15 minutes, and then I’m going to get out of here, and I’m not going to worry that he’s wrong. I’m not going to worry, I’m just going to do what I need to do for myself. And I’m sorry, if you find yourself in that situation, but if you do still got to protect yourself. Yeah.

And I think from the standpoint of even, you know, her question going further into like the research part of it, I think, if this is the kind of information that doctors are looking at and saying, Well, gosh, you know, running with an A one C of 5.5, doesn’t seem to be any better than running with an A one C of 7.2. So why why would my patient want to get down here? I’m going to just tell them that that seven 7.2 is just as good? Well, again, we don’t know necessarily where and when was the data collected? From what kind of information? What was the lifestyle of these people, etc, etc. I mean, we do know that glucose values that are well controlled, decrease, and for the most part, do limit potential complications down the road. We know that right? Now, is that to say, you’re never going to get a complication, even if you did this sweet management your entire life. No, of course not. Now, sometimes things they they happen, right? We don’t know necessarily everything because we we don’t know 100% of how the body functions, right?

We don’t, don’t you find that most questions around management are probably at the very core of their question. Hey, Scott, Hey, Jenny, how do I stop from anything bad ever happened to me or my kid because I have diabetes. And it’s such a sad thing. But you have to, you just have to say to yourself, I can, this is my situation. And I’m going to do the best I can with it. And put myself in the best position to hopefully thrive for as long as possible. And that’s sort of it you know, the rest is sort of out of your hands. Right. But the part you can control. That’s the part you should focus on, I think. All right, Jenny, I’m gonna let you go live your life. Okay. This was excellent. You do? Yeah. Thank you. Oh, I’m gonna record again in 45 minutes with somebody.

Oh, good. That’s fun. Yeah,

I’m doing today. Jenny Smith works for Integrated diabetes calm. She’s also lived with type one diabetes for over 30 years. Jenny holds a bachelor’s degree in Human Nutrition and biology from the University of Wisconsin. She’s a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. She’s also pretty damn lovely. Check her out at Integrated diabetes that com if you’d like to hire her to help you with your type one, diabetes management. I have more to say you want to chill out for a minute. Okay. So we did a meet up? Two weeks ago, there’s been two already. There’ll be a third one this week. As I told you on April knife that I say the knife. Yes, April knife. It’s a Thursday going to be 7pm Eastern time, not the point. Point is did the first 175 People rolled in very cool. And I thought people would just hold up their graphs or ask their questions and we’d roll through their answers and their answers may help may help other people and other people may have helped for them. And it did mostly go like that. But there was something that happened. I didn’t expect. And I don’t know why I didn’t expect it. Because now in hindsight, of course, it seems obvious. But some people were very quiet. And they were not wanting to hold up their graphs. As a matter of fact, the amount of notes that I got out that I got afterwards. That said I was embarrassed or ashamed or nervous or a lot of different words to describe how people felt to talk during the thing but could you help me now? That piece makes me feel like that what you heard me say to Jenny about like we should all just come together and do a challenge. Like it would be, you know, I maybe that doesn’t make that reasonable. Perhaps most people aren’t interested in sharing that much. And I get that. So in the second meetup, I just realized, let’s make it informative. Some people will speak up, some people will be willing to share their data, and some will learn from watching. So while I like the idea of a challenge, I don’t think it’s reasonable. But what I found afterwards was that getting together is hugely beneficial for everyone there, no matter how they choose to participate. So I hope you come out. Like I said, there’ll be links in the Facebook page for bold with insulin. I’ll try to put something up on Instagram to remind you there, but here’s a reminder right here. I think it holds 100 people. So it’s kind of first come. The two we’ve done so far have been in the afternoon. So I’m going to shift it to the early evening to help accommodate other people. So 7pm April 9, it’s on Zoom. Anybody can come and hang out. Just look for companionship, meet new people. There’s a chat people can go off and chat on their own. Listen to the conversation. It’s just a nice way to distract yourself during this time of crisis. Today’s Juicebox Podcast was sponsored by Omni pod makers of the tubeless insulin pump that my daughter has been using for most of her life. You can get an absolutely free, no obligation demo of the Omni pod sent to your home by going to my Omni pod.com forward slash juice box and filling out a little bit of information. You can learn about the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box and to see if you’re eligible for a free Contour Next One blood glucose meter go to contour next one.com Learn more about touched by type one at touched by type one.org 10 second dance party

Hello, everyone, and welcome to Episode 328 of the Juicebox. Podcast. Today’s show is the audio from a recent ask Scott and Jenny, Facebook Live. Now the audio is super good. It’s clean, clean the way you like it on a podcast. Don’t worry, it’s not all Facebook. It’s not like Jenny’s like, I think that we should do this thing with the input doesn’t sound like that at all. Sounds crisp and clear. Right? Imagine Wolf Man jack and your house is like, hey, their kids. No one knows who that is. But that’s not the point. The point is, it’s a good recording for podcasting. And I didn’t want you guys to be left out. So I was just trying to do a little live thing on Facebook if people you know, something to do during the day while they’re trapped in their house. But then I wanted to get that audio right up here for you guys to listen to, in your ears the way podcasts are supposed to be heard. Anyway, Jenny and I started with one question from my ask Scott Jenny list. And then we let the viewers of the live ask the rest of the questions. I thought it went great. actually had a fun time was nice to hear from everybody. I’m giving you this episode. As a bonus this week. This is the third episode this week. So there won’t be any ads on it. But it isn’t going to stop me from mentioning the advertisers so that you remember that the good people at Dexcom on the pod Contour Next One blood glucose meter and touched by type one are the reason why I could be messing around yesterday doing a Facebook Live. So I’m gonna put links at the end. And they’re going to be in the show notes here. If you’d like to check out any of the sponsors, clicking on the links is very helpful to me. And I appreciate when you do it. Alright, so let’s get to it. This is episode one. I say 328. It’s a live ask Scott and Jenny from Facebook. And you need to remember while you’re listening to it that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We’re becoming bold with insulin. And just like that, you’re listening to Scott and Jenny. redirecting to Facebook. Oh, there it is. I’m making a funny face. There we go. We’re alive. Oh, that was easy. Okay, so obviously, it’s gonna take a couple of minutes for people to get on. Gonna first say that. I’m Scott Benner. This is Jenny Smith. You may know Jenny and I from the diabetes pro tip episodes on the Juicebox Podcast. Jenny also does ask Scott and Jenny and defining diabetes. And today we thought we would do an ask Scott and Jenny live. Now we have a question to get started with that came from one of you. But we’re totally willing to see some questions from other people. So first, I need somebody in the chat on Facebook. Tell me if you can hear me and Jenny Say something. See if I can hear you.

Hello. Okay.

Just somebody tell me in the comments if if you can hear us. Oh, hi, Maddie, how are you? Have you never seen Jenny live before? We already have 18 people? Awesome. 24. We’ll start right at three o’clock because you guys are on time. I like prompt.

You got a minute or maybe less? I don’t know my plaxis 150 or 259.

They should definitely be everybody can hear. Cool. All right. They should definitely be rewarded for being on time that people will come later. Gonna have to watch, you know, watch the replay or hear it on the podcast. I can hear both of you. All right, Laura. Thank you. Whoo. All right. So if you guys have questions, throw them in there. And we’ll see what we can do. But Jenny and I thought we would start with let’s see, I have it here. I have it here. Here it is. Um, oh, you know what, before we start, did you guys know that? I’m Jenny. I’m gonna give your phone a few days here. Jenny Smith is an RD LD CDE T one day. She has a bachelor’s degree in human nutrition and biology from the University of Wisconsin. She’s a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes a pumps and continuous glucose monitoring systems. Jenny has had Type One Diabetes for how long journey

on May 15. It will be 32 years. Okay, so that’s a long time.

And that is definitely a long time. So any of you who have heard us on the show before? No. This is basically what you know, it looks like for Jenny and I when we record and you guys just don’t usually get to hear so we’re gonna get started with the first question. Yeah, it’s how do I attack meals or times of day that cause a huge spike, but come down eventually. If more insulin is added, I go low later, when I wait longer, like when I Pre-Bolus I go low earlier in the meal. Now by the way, guys, there’s a disclaimer here. We’re not healthcare professionals. This is not advice in this cause, just us talking and you hanging out so if everybody’s okay with that. Cool if you’re not jumping, all right, I went, we did not do any problems for you people just get it. You don’t like it? Okay. All right. All right, Jenny. So I, you know, I hear this question a lot. I tried to Pre-Bolus. But I got low before I ate or, you know, I tried to shorter Pre-Bolus. And I just got high later, what are some of the reasons that can happen?

So to begin with beginning of the question would be your bolusing getting high, and eventually, without correction, it comes down. That initially would be a bolus timing thing, right, where you need to Bolus sooner to stop the rise. It’s an indication that there is enough insulin there because ultimately, the Bolus you took does get you down to where you want it to get later after the meal. There’s just not enough time between taking the insulin letting it get started, and the food actually impacted blood sugar. But the further part of the question sounds more like if you add more insulin, like upfront thinking there wasn’t enough to begin with or you correct, and then you end up going low in either of those scenarios. Clearly, there was too much insulin, right, you didn’t need more insulin, you just did it in a different bit of timing for taking it right. The third part of it. So like little segments here. The third part of it really is, if you do take the amount based on your ratio, you end up climbing, or you Pre-Bolus with enough time, and you end up sinking within the time period after you Bolus, but then you still climb up later. That could be especially for those who are using an insulin pump. That could be not only a timing issue, but also a delivery of insulin issue. Okay, right, where you would probably need to use all the pumps have some type of extended bolus feature. Could it be combo bolus extended bolus dual or squarewave. bolus, all the pumps call it something different. But essentially, it allows you to take a certain percentage up front, potentially in this scenario to stop the bump up, gives you let’s say you decided to take 50% of the Bolus now and then distribute the other 50% in the back end, what it allows is the 50%, you take now you can Pre-Bolus thus decreasing the amount at the beginning that you get. So you don’t have a drop, but you also get the Pre-Bolus benefit of not having that rise up after the meal. And then the later impact is that you still get a finish of that end of insulin, which you knew was enough. You just needed to distribute it a little bit longer to impact, you know, the full content of whatever this meal, I guess, added.

Okay. And I like obviously I agree with you. But what I was gonna say is that when when I see that I don’t often see a Pre-Bolus It’s so like heavy that she crashes before she gets low. And so I think that ends up being a situation where people are like, well, I Pre-Bolus and then I got high anyway. So I’ll keep trying longer and longer and longer. But it’s not at some point, the length of the Pre-Bolus is just not your issue. You know, and and I hate to I don’t want to put a number on it. But you know, if your Pre-Bolus thing, 30 minutes in the future, you’re probably coming out of a much higher blood sugar to begin with, and you have issues on the back end that you’re not dealing with. I find myself saying a lot that diabetes, using insulin specifically is like time travel, everything you do now is for later, right, right. But everything that’s happening to you now is from before. So if you’re putting in a healthy Pre-Bolus, like you said on a good site that you can count on, etc. And you’re you know, you’re still climbing afterwards. I mean, the Pre-Bolus probably at this point isn’t the question. And there’s little things for CGM users, you can kind of look at the trend, the angle of the trend, right. So if you’re, if you’re shooting straight up like this, you’ve either missed, I think, huge with the amount of insulin you’re using, or you know, if you just bolus and five minutes later start eating a real sugary thing. You’re going to shoot straight up, if you come more on that, that kind of gentle rise that I tried to describe as the it’s the minor or no, not the minor, like the the mountain climber on the prices, right? Any guy keeps like rolling back and forth like this, right? Because when you have a Dexcom and you you have that gradual lineup, everyone’s done it, they stare at it, they’re like it’s gonna stop, it’s gonna stop, it’s gonna stop and then eventually that guy falls off the end and true Carrie says you can’t have the money and it’s all over right and your blood sugar’s 280. And, and then that’s sort of the end of it. So like Jenny’s saying, there’s just 1000 different ways. But in the end, what you’re trying to do is manipulate your insulin and put it where it’s needed. So you need that nice Pre-Bolus but if an hour later You started having this crazy rise, like she said, an extended bolus, or even coming back and readdressing with more insulin, at some point is the answer you get low later, when you put so much insulin up front, to control that line, that eventually when the impact of the food goes away out here in the future, the insulin still leftover and you crash low. So you’ve got to, you know, for the lack of a better term, you have to put the insulin where it’s needed. I always say when you’re about, you know, you have to address your body’s need with with the right amount of insulin. So, right, that’s cool. That’s a really it’s a great question. I appreciate that question. And people have left other questions. So dig in here, and see what I can

love questions, right? Oh, yeah. But I’m

on the wrong browser to see I got to get into it. Everybody chill out a second, this is my first time doing this. So a lot of pressure, like running the show, and

like asking the questions.

I was gonna feel under pressure here. Alright, I’m on a different browser. So one browser is sending you guys the Facebook Live? And then I’m going to look on a different one. Where am I looking at? I mean, the wrong I have too many Facebook groups.

While you’re looking, I’m going to add something extra to that comment. And question from before to it you were talking about, you know, the trend kind of even coming into the meal. And that can definitely determine things, you know, if you were if you were at an excessive insulin coming into a meal, and you are already on this slope headed down, right, and or if that’s commonly happening within the same meal time, it could be that your Pre-Bolus thing with a load of extra previous insulin on board. Thus, you’re consistently coming down in this time period of the day. And so any Pre-Bolus, it’s going to look like that Pre-Bolus is causing you to drop within the first time period of that meal. So you’re less likely to Pre-Bolus as much as you need to from previous experience. And thus you’re getting this rise up that you wouldn’t have if the hours leading into this meal. Again, if it was a consistent problem at this time of day, it sounds like the hours ahead in this setting, could need to be evaluated. Maybe the bazel is too high heading into this meal, okay, or maybe the insulin to carb from a snack three hours ago, is also giving you too much insulin. So you’re consistently coasting down into this meal time. So you’ve got this excess behind the scenes insulin. So are some other things that could be evaluated to cool.

Alright. And somebody said I was lower than you. So I just turned my voice up. So if I got if I’m now too loud, somebody told me. All right, Anna asks, I have been having trouble with the accuracy of my freestyle libri. Sometimes there’s a big difference. I think I will change Dexcom was I finished? The my inventory I currently have at home. But do you have any recommendations in the meantime? While I’m using these?

That’s a good question.

Yeah. Is there an answer?

Well, is there anything to adjust? There’s nothing from our, from our practice, all all of us within our practice. At integrated, we’ve all used the libri all got our like trial, you know, couple of sensors to try out and I try to as many people often do you make yourself the guinea pig, right, you try a couple products at one time to see what’s actually Right, right. So I wore my Dexcom along with the lever a and the three sensors of the libri that I wore, they were all consistently reading lower than my actual sensed Dexcom and fingerstick values were consistently center to center they were all consistently different. And enough that from a blood sugar and a meal bolus and a correction standpoint strategy, it would have been enough of a difference to make adjustments kind of diff difficult to base off of, is there anything that you can do about it? In this setting, what we usually recommend is for the prime times that insulin is going to be dosed based on a glucose value, do a finger stick, get a finger stick and dose off the finger stick don’t dose off of your libri what you can know from any sensor system that might be reading a little bit off or different than you know it should be is that while there is a difference in the number, the trend is still a good, it’s still a value for you. So you can still tell whenever you’re trending up or trending down, and you can use that to your advantage for future planning. Okay, so but you wouldn’t necessarily dose off the value.

So um, I guess what he’s saying is when you find you’re not trusting the device, test, but still look for I mean, I guess I’ve never used the library but arrows and direction and rate of change and stuff like that. And then when you really need to know I guess what we’re saying? Is that if it’s a pre meal, and it says you’re 120, but you think you might be 150. That’s important to know when you’re making your Bolus, right. Okay. But Hmm, it’s still important. I don’t want to minimize the idea that a big a big difference is a problem, but at least you can be safe. When you’re when you’re putting in like more when you’re

putting in insulin. Yeah,

yeah. Cool. So,

to let her know that that’s not uncommon. Gotcha. A lot of people find the variants,

it’s gonna be hard to keep. See, I want to, we only have an hour, so I need to keep Jenny movie but Jenny will talk and like, get all her knowledge out. And then we’re gonna answer one of your questions if we do that. So Maddie, how do you Jenny see CGM being used in patient hospital settings now that we’re seeing COVID-19 error How is going to help diabetics? And Maddie, what I’ll say to you is, did you hear the episode of the podcast that went up today? Because Dr. Dan disalvo came on and talked about how decks coms are being used in hospitals right now. But so I have something to add, but you go first.

That’s pretty awesome. Because I have I’ve not obviously listened. I’ve been working with people all day. So I’m, so I have I both pro and con feelings to it. Okay, so from the standpoint that great, there’s a lot more information, there’s a lot more data, it can be beneficial. On the con side, however, there’s a lot of data, and healthcare workers in hospital who we already know, have have little experience with type one, consistent glucose information management, they are used to doing finger sticks every several hours, to base decisions on right, whether it’s dosing or whatever adjustments in doses. With all of this extra information, the trends, the alarms, the things that are going to be visible to them. Yeah. There’s no, there’s no quick education that can be done within 10 minutes to the thousands of health care, nurses, doctors, whoever that’s looking at this information to help the person wearing it. Yeah. I feel like there’s a lot of information, they’re not going to know what to do with it. So that’s what I feel like I feel like it’s good. But it’s also, I don’t know,

let me share with you what Dan said. Dr. salvo told me that what it was really helpful with in the moment was, it was preserving PP for nurses because they were, you know, they do finger sticks on patients a lot. And now you’re asking them to go in and out and change their gear every time. So now they’re, I guess, Dexcom. If I, if I heard him, right, gave the patients like Android phones. And so there’s a cloud service. And now the nurses are able to look at the patients through the share and follow, right? And then they’re like, okay, you know, they come down the line. And here’s Mary and Mary’s blood sugar’s this, it seems pretty reasonable. I don’t need to go in there. So that was the idea. What I heard while he was talking was a great opportunity nationwide for health care professionals to see how glucose monitoring works, right. And maybe, maybe in the future, things will go better. I told him a story of when Arden had a surgery. And you know, the nurse didn’t know anything about it. I just kept talking to nurses till I found wonders like I have a friend who has diabetes, I go, you’re my friend. Now come over here and explain to all these people why we need to leave the CGM honor during this procedure. But anyway, that’s what I thought of it, Matty, I thought it was I think it’s, um, it’s great for that saving of the PP. And on the other side, I think it’s a good first step in bringing the technology out to people. So

yes, yeah. I also think, you know, in that scenario, as if they’re using it based on the protocol that they would have used finger sticks, and they’re only checking at certain points to see what the values are or responding to alarms. Yeah, it’s absolutely valuable. I just hope that I would expect somebody has schooled them in what to pay attention to what not my, my

thought was that it was, it was going to be used in a really, I don’t know, like a limited way in the beginning. Just to keep you know, from being with people. I saw Donnie ask about managing weight with type one. So and he said, Thank you for being here. So thank you very much, Danny for being here as well. Yeah. Best way to tackle losing weight for type one. Why do why can people with diabetes who are using insulin have trouble with weight loss?

The first thing is definitely insulin management. That’s that’s a huge piece of it. Because insulin is a storage hormone. It’s meant to move food glucose out of the system into the cells, either it gets used by your muscles or it gets packed away into fat, right? So from a physiology standpoint, even if you look at a body that doesn’t have diabetes, if you out eat what you really need, then overall your body can only pack away that extra calorie, right? Okay, and it does it with insulin. Right to manage the normal blood sugars that should be there. Same thing is happening though. And so person, even without diabetes can gain weight, that that’s how they gain weight. Essentially, their body should packing away more than what they needed because their body is managing blood sugar the right way. In a body with diabetes, though, because insulin management is something that we control, body’s no longer doing it for us. It’s something that we have to, we have to adjust more precisely than people are often given tools to manage. Right. So overall, one, make sure that your baseline dose that bazel is right to begin with, it’s in the right place, then the next thing to tackle is the food management, strategizing around meals timings, you’re not using more insulin to cover then you actually need to, you’re not covering with extra food when drops happen, because you used too much insulin that you didn’t really need to have there. And then the other piece, of course, beyond that is, are you eating what your body needs to eat? You know, because if even in this case, if you’ve got great looking blood sugars, but you’re constantly like popping food in and covering it with insulin, you could have wonderful looking blood sugar values, you could still be out eating what you need.

Right? So I usually it’s funny, I saw john pop in and he said, Don’t feed your insulin, which is this is what I was gonna say. I think I think that when people who listen to the podcast have, there’s two trains of thought, when you’re learning how to use the insulin in the beginning, I will say be more aggressive, you can always have juice later. I don’t mean that for the rest of time In Memoriam. I mean, while you’re figuring it out, like if you continue to bolus and get low, fix the bolus, don’t keep fit, you know, don’t keep drinking juice. But it’s a great point. Because people with type one can start to think of diabetes first. And instead of health, right, so all of a sudden, an Oreo cookie is not a bad thing, because I need it because I’m getting low, except your real issue is you need to stop yourself from getting low. So you don’t have to eat an unscheduled Oreo. And by the way, don’t eat Oreos, they’re, they’re poison. But But you know, like, I really I don’t think there’s any food in them whatsoever. But my point is, is that don’t feed the insulin, but learn the steps so that you can do that. And Jenny, this is a wonderful place to say that diabetes pro tip calm is now open and available to find all the diabetes pro tips with Jenny and I all in one place in case you guys have had trouble finding them in the podcast player.

Yes. And we’ve also gone over that weight piece in there. It’s a great episode at least one if not a couple mentions.

Yeah. All right. I have. I have one for you. And one for here’s a quick one. Yeah, Jenny, you are g six. And so does Arden. Do you ever calibrate on day one? If it’s off? No, you don’t you let it go?

Let it go.

And how do you manage that with your algorithm that you’re using?

I manage it by doing finger sticks. Because I have had, as we talked about right away. I’ve had diabetes long enough that finger sticks have always been a norm. Even once things got approved for not having to do that anymore. I still do that. So that’s my thing. And with the algorithm that I use for my insulin management, I can I can populate in my finger stick value for my algorithm to use that value rather than the CGM value. And then I get proper dose adjustment.

And you have an apple iphone, right?

I do. So you go Apple Health,

you go into the health kit, and you tell it, you add your blood sugar there, and then that program you’re using, yes, the loop app will see it and then it knows what your posture is. Correct. And so my my way of dealing with it is if it’s close eye roll, you know to me like if and I test to their their advertisers on the show, but we use the Contour Next One meter, I find it to be incredibly accurate. And so in those first number of hours while the sensor wire still you know, baking in, I will test but I’m going to tell you that if it says she’s 70 and she’s really you know, and she’s really 90, I might let it go a little longer to see what happens. But there are times I do calibrate to get it together. It’s not a frequent thing. I probably only calibrate on day one when I calibrate but having said that we don’t do it very often law we leave the finger sticks though

and there are a There’s your so many that trains of thought in terms of that that I’ve run into in working with people, some people who’ve got this like system, it works really well for them. Awesome, great, even if it’s not what’s recommended if it’s working for you. I’m not going to tell you this Stop doing that. Right. But from the standpoint of education, you know, we recommend following the recommendations of Dexcom. Don’t calibrate in the first 24 hours,

you would never do anything like that. Somebody asked for links, I just put them in the comments. And honestly, Jenny and I are not used to being seen we, you know, I mean, for those of you who are new, I have a podcast called the Juicebox Podcast, and Jenny is a frequent contributor to it. And she’s not on every episode. So if you really like her, and you hate me, you’re gonna be pissed when you like tune in today, and she’s not there. But anyway, calibration day one. Actually, that’s sort of covered. The next question I had for you. If there’s a person who is excited about algo, their algorithm pumping in the in the future, right, but is worried that because they don’t always see their CGM rock, you know, rock solid, and they’re afraid of what’s gonna happen next, what I would say to that is, you know, Arden has definitely done both ways. And it’s never been an issue. Like, I’ve never ran around the house going, like, Oh, my God, everyone’s gonna die. Because you know, Dexcom was off and we’re using an algorithm, it just, it’s a it’s a reasonable worry if you’ve never done it, but once you do it, I don’t think it’s something you’ll think about again, does that strike you like that?

No, it does. And it’s actually a question that I’ve gotten more than a number of times from people that I work with, especially parents of kids, you know, wondering, Well, what about those? compression lows? Right? What happens if an algorithm is using that? And now it’s not really low? What will have happened? Well, you know what, because the system if you’re using one of these hybrid types of systems, whether it’s, you know, on the market, or yet to be on the market, um, if you’re using one of them, it’s going to adjust based on that change in blood sugar, that’s being seen, right. But most often, especially in this example, of a compression low, that writes itself pretty quickly. In fact, you can tell it’s a compression low, because it looks like your blood sugar is literally like nosedived off of a cliff. Yeah. And then it comes back up very quickly. I mean, you could you can tell it’s wrong. Well, yes, the system will have reacted to that drop in blood sugar, it may have taken away insulin where it was supposed to, but within the quick timeframe of it writing itself, that algorithms also going to write what it took away behind that, right. So I’ve personally, I’ve had sensors that have been off, thankfully, not very many, my Dexcom, thankfully, has been very accurate for me. In all the years, I’ve used it. But I have had compression lows. And since I’ve been using, you know, this algorithm, I haven’t noticed that that’s honestly been an issue. I’ve never had any problems of excessive high blood sugars or no problems with like, strange, odd low blood sugars that shouldn’t have been there because of this sensor. You know, okay, she being off.

Yeah. I hear you. I’m, I’m down. I think it’s, it works. I mean, I’ve I’m not gonna tell you I haven’t gone Norton’s room been like, She’s like, the first thing I do if she’s laying on her side, because she wears hers on her, like her body, her hips. So I’ll touch her hip that she’s not laying on. And if it’s not there, I’m like rollover. Just kind of like shutter and, and then you’ll wait a minute, it comes back. interesting side note about a compression low with a CGM. The number it’s reading is actually correct still, although not indicative of what your blood sugar is. So it’s reading your interstitial fluid, which is you know, freely running through your body. But when you press down, it disperses it. So it’s dispersing some of the glucose that it’s reading. So it might tell you your blood sugar’s 60, all of a sudden, the truth is, the interstitial fluid around the wire, the glucose value is 60, your whole body might be 110. But that’s why when you roll off of it after it gets to the algorithm gets to think a couple more times, it’ll come back and tell you Oh, no, you’re one time. And that’s it. How does that engineer makes a great point, if that happens, the worst thing that’s gonna happen is the algorithms gonna take insulin away, you might get hot, but you know, you might get a little higher, but you’re not going to be in a dangerous situation. And that’s a great trade off, I think, yeah, you know, Jenny, I’m gonna ask you, somebody jumped on and said that I recently said on the podcast that I don’t abide a bad pump site that I get, I get away from a by a pump site pretty quickly. But she wants to know, how to, you know, it’s not just your period, or, you know, and so I’ll you know, because you and I deal the same way about that we don’t stick around for like,

I don’t stick around. And and I guess, you know, from a female perspective, if you’re like, well, gosh, is this my period? Or is it you know, a bad sight or whatever? I mean, most women, most not all, but most women have a pretty consistent timing rhythm to their cycles. Yeah, right. So if it’s You know that it’s probably coming into that time, or you know that it’s that time and your high blood sugars are usually associated with that. You wouldn’t necessarily think that this is unless you, you haven’t changed your, let’s say, your settings or your insulin doses as you needed to for this time period. And if you forgot to do that, obviously the high could likely be associated with that. The best way to tell though I mean, because even in your period, you could certainly have a bad sight. Like two things hitting you at one time. That’s not fun, either. It’s

okay, hit from both ends. Right? That’s not

that’s not joyful at all. So, you know, if that’s the case, I think, regardless, for anybody, whether you’re male or female, if you’ve got an odd looking high blood sugar,

yeah, that

shouldn’t be there. Right? You know, you’ve done everything you would normally have done. And this is just a weird, all of a sudden, you’re like, double arrow up and you’re to something. You take a correction, right? In my case, and what I recommend, if it’s not coming down within the next 30 to 60 minutes, that’s it’s done. Yeah, it is done. I don’t play with it, even if I pull it off. And I’m like, well, it doesn’t look like I don’t know, whatever the problem was, that the candle is not bent. It’s not bloody, it doesn’t look weird. Sometimes it might look a little bit wet, or mediawiki. So maybe for some reason, the site was like leaking up along the canula. And you didn’t really get as much insulin as you should have. Yeah, um, but yeah, I don’t, I don’t play with like numbers that aren’t where they want to be. Right. And

there’s a couple of ways that the way I taught myself so the answer to a lot of these questions ends up being repetition, you do something over and over again. And one day, it just makes sense to you, right? And you don’t you lose that checklist in your head, like, well, I said, this is it, this, like you stopped doing that. You just see it, you recognize it, and you go, so before I could recognize it, I would inject with a needle. So if the pump didn’t act the way I expected it to, I’d come back with a syringe. Now if there was no reaction after that, then I was pretty sure that my site was over also, last day of a sight, you know, or you just put it on and it just never ends up working. Because I know some people switch their pumps and they, they they’ll experience a little bit of a high when they put it on. There’s a lot of you know, talk about why that is I part of me thinks in children that it’s anxiety. It’s the you know, it’s the that whole thing kind of gets you jacked up a little bit. That could be it. That’s what it used to be for Arden. She’s obviously much more relaxed around it now. But we’ve changed upon this morning, it went on and we did a more aggressive bazel rate for the next hour to try to her blood sugar was good at like 110 but to try to mitigate any kind of arise you know, same thing on the other side, if you think it’s not working anymore, once you get it back on, you have to really think about for a second How long has this like not been working? And now I’m just going to slap on a new site and go oh, everything’s fine now because the insulin deliveries back it’s not because everything for now is for later and everything that’s happening to you now is from before I get insolence always from before, go back to the beginning if you’re falling late, but that’s really it. Now the next one is more for you. Although people are asking follow up questions, so hold on. This is great info inside. Oh, great. Okay. Oh. By the way, there are people in the comments helping each other somebody was like, what’s the compression level before we could explain it they jumped in You guys are awesome. Jenny, I drew a picture of a lady with a big belly to remind me that someone asked about good tips for thinking about getting Speaker 1 33:41 everywhere just didn’t write down pregnant. But anyway, I’m not showing anybody it’s not a good drawing but

good tips for getting pregnant. So preconception time. Um, we we kind of define preconception time, the three to six months, potentially even a year up to when you want to start trying to conceive. And the goal there is to aim to get glucose values into the pregnancy target. If you think about and or don’t know what the targets are for pregnancy. The goal is to be under 7%. And then in pregnancy and even see more around 6%. Within the fives if lows aren’t the big reason for being in the fives. But typically, most practices will say under 6.5%. through pregnancy more around six is the preferred just from the standpoint of health of you and the developing baby. For the preconception time then it’s really focusing in quite a lot on what are the variables that you can learn and manage better in your life. And if some of the variables like every Friday night you eat the whole box of chocolate, you know ice cream bonbons And you can’t manage around that. You know what, for nine months, you can manage not eating your bonbons on Friday night? Yeah, I mean, that’s, you know, those are the things those are the strategies that you sort of learn in that preconception time. I mean, the beginning tips really are, look at what preconception or look at what pregnancy targets for blood sugar should be. Because aiming to get those as close preconception will make it so much easier. Once you’re pregnant, as you don’t have to shift this whole mental. Oh my gosh, now my blood sugar has to be 90, and it’s been riding at 150.

Just count on, I’m going to get knocked up, and then I’ll do this better. Right, right, just and that probably wasn’t the right way to say that. But you know what I mean, thoughtfully and through love, make a baby and then trying to get better at your blood sugar, get better first, prove it to yourself that you can do it over and over again, Jenny, if you had to say to somebody, how a way they could get better at this, what would you tell them to do? Speaker 2 35:57 What would I tell them to do? Like a web address? Yes, well, they can call me

just put Jenny’s email address in the comments.

They could. They could also i we’ve got, I wrote a book with a good friend of mine, Ginger Vieira, who’s written a couple of her own books. It’s, it’s pregnancy management for type one diabetes. You can find it on Amazon. And we actually have a big preconception, month to month guide for pregnancy management, postpartum lactation, we’ve got all of the information in the books, I would

also bet that sometime later this year, there might be a pro tip episode about being pregnant with somebody too, because that just sounds like a good idea. And I typed it into our running list of ideas for the podcast. Awesome. Yeah. Okay, that’s a great answer. I wanted to just say that.

I think

I think that once you figure this all out, you get pregnant, you keep your blood sugar, super stable, and you’re a onesies nice and low forever. It’s gonna be difficult, but try not to lose track of it after the baby comes. Like, just you can do it. If you did it, then you could do it forever. You know what I mean? Like, you know, it’s interesting, as I interview more and more people over the years, to see that some people who have trouble managing their diabetes, for themselves, don’t have trouble managing it for someone else, you have no idea how many people have come on and said, I met somebody and I fell in love. And I got married, and I wanted to be healthier, so that our relationship or I had a baby, and I realized I wanted to do more. That’s not specific to diabetes, by that it’s a very human idea. But yeah, keep putting yourself at the top of your list of things to worry and be concerned and

he can take care of you. You can take care of other people.

100% I think and Wait, do you see having a baby? It’s It’s wonderful. Nothing like having a kid my wife and I were just sitting on the other night going, we think having these babies was really, really good idea. No, we were choking, because they were both being annoying at the same time. People are thanking us, which is very lovely. Thank you very much. We really appreciate that. You guys listen. evany asks a question back about bolusing. That I feel like I have something to say he said, Is there anything physiologically wrong with a post meal spike? If it comes down later, without extra insulin? Would you try to master that meal? I think you probably can. I mean, unless it was, like you said, Well, you know, I can’t even say unless it’s cereal, because I can get cereal, right? Sometimes, too. So yeah, I have an In my opinion, if you’re going up, hanging up, coming back and leveling out again, and never getting low, there is a way to get more insulin up front. And you know that and we talked about it earlier that really Evan should go back to the beginning of the live, right.

Yeah. And I also think, you know, from the standpoint of that kind of management, what it also leads into longer term, if you consider, for the most part, you’re looking at your day, let’s say you’re using a CGM, and you can see how much of the time you’re in range and where you want to be. And you’re only, let’s call them problematic times are these spikes above where you really would want to be after a meal. Yeah, but the end result is that you’re back in target. And that looks awesome to you. Right then, one managing the timing, again, it’s all about timing the insulin right, but to that peak is still leading into your overall a one C, okay, it’s still leading into time out of range. And those post meal spikes also lead towards things like some of those many things people don’t want to talk about, but the complications, more of those microvascular complications with these peaks that come into play, the more you can minimize and have more gentle roles, the better long term, so right.

To do your best and keep messing around little sooner, a little later. Little more or a little less in there somewhere is the answer. It sounds like he’s got the amount right and the timings off. Listen, even if you don’t listen to podcasts, I maintain that most of managing insulin is timing and amount, it’s just about getting the right amount in the right place where the need comes in. If you can get more up front to stop that initial spike, it might not have to be that much more, you’d be surprised it could end up being a couple more minutes of a Pre-Bolus or another half a unit of insulin or something random like that. That’s still because that momentum from the food is so great. At that moment, it’ll eat up that insulin, it won’t leave you extra on the back end that will make you low. Right, hopefully. Julia asked, What do you consider a gentle roll? Did you just use the words gentle roll? Okay. Do you mean like one of those little Pillsbury things with the?

Oh, no, no, no.

Julia, I can I can talk Jenny as a matter of fact of Jenny’s husband ever leaves her we’re perfect for each other. what she means is not like, not like sharp, sharp down. She means like, it’s cool if you go like this a little bit. By the way, this. So much of what we do is, is easier when people can see our hands moving Jenny and my hands move a lot while we’re talking.

And the funny thing is, nobody can ever see like our expressions or anything because it’s just all voice. There are times when Jenny goes, I wish

people could see what we’re doing right. And I’m like, Yeah, they can’t so Oh, Rachel, it is the best podcast ever. Thank you for saying though. I asked if the group earlier forgot. I would ask here. I had been pumping on the pod for six months. And I’ve just noticed the pattern. Day one runs high. Day two, good day three low. Any ideas how to combat this? More or less insulin? She’s heard of the opposite problem. Brittany has a day three being a little higher. I would say that’s if I see anything. It’s day three higher Ardennes pumps either work, right out to 80 hours, or right around

two and a half days.

Yeah. 70. I was gonna say right at 70 hours ish, then I have to start paying attention more.

I’ve actually personally noticed that when it does, it’s not a time factor. It’s more of a when my pod gets to about the 20 unit mark, I can almost guaranteed if I continue to use it after that for boluses or anything. Yeah, I will ride higher. Even though the pump tells me I’ve delivered the insulin. And it’s the same way it’s the same factors ratio is everything that I’ve used. It’s it’s a, it’s a dose amount from what I and I’ve used Omnipod since 2006. So I got a lot of experience of yours.

Yeah.

I was telling Jenny the other day Arden’s been using it since 2006. And it’s, it’s amazing. Like, I have nothing bad to say, uh, you know, a number of people asked, they said, they have the opposite of the feet on the floor up, they have a feed on they wake up in the morning and their blood sugar drops pretty drastically. Have you heard about that? from anybody?

I’ve actually not.

So so then would we consider maybe that the bazel leading up to their wakeup time is too strong?

The question would be first, which is always my question to people are is your wakeup time the same? Please, it is the same. And you’re noticing that drop, as soon as you get out of bed in the morning, okay, then the next thing to do would be try to sleep in and see if the drop happens. Because my guess would be the drop is there. Because you’re getting up at the same time you think it’s because you’re getting out of bed. But it’s because as you just said, the bazel in the hours preceding that are probably too high, and the drop was going to happen anyway. Um, so If, however, you find that when you wake up in the morning, and or sleep in completely different, let’s say the sleep in stays totally stable. And when you wake up and get out, that’s when the drop happens. Yeah, that’s it. I mean, it’s the complete opposite of what a good majority of people see. I’m not saying that it’s not your personal experience. I’ve got friends who have a drop in their blood sugar with adrenaline rather than the typical peak in blood sugar because of adrenaline. So it could be the case, it, I would say that it’s going to be a little bit, it’ll be a little bit harder to maybe manage a drop. Because if it’s related to when you get out of bed and not really wanting to like eat glucose tablets, or drink some juice just to stop the drop, though only a couple of options would be, well, if you can get up at about the same time, you could technically decrease the bazel leading into that time. So the drop doesn’t happen. The only thing there is if you if you get up later, then you’re not really going to need that

decrease higher than listen because of this whole Corona thing Arden has been she shifted her life drastically. She’s staying up way later and getting up way, way late. Yeah. And so I know if by 6am, I don’t take away the power of her bazel by half, she’s going to be low by eight o’clock. Like, because her daytime numbers are, you know, the insulin we use during the day is just different than what we use at night at night. She needs far less. I don’t know, I hope that was helpful. Let’s say I know I have a drop because I’m not waking up at the same time. Every day when I had a normal work schedule. There was no drop when I wake up. So then Laura, look is did you do you have a stronger basal rate in the time you’re supposed to be awake? Because if so then that’s it. Your bazel is just building up and building up and you have nothing going on inside of your body that needs resistance from extra insulin, then, at that point, a bazel. could act like a bolus eventually. Yeah, right. Okay, cool. I like the way I said that. Well, Melinda, thank you for loving the podcast. Thank you. This morning, I was 111. Justin says when I woke up later in bed and read the news got up 45 minutes later and went to 72. Hmm. And that’s not Justin, it’s tough. I can’t have a conversation. But was that not bazel related. Somebody here said they have a new bazel program that’s called pandemic. So that’s a good point, too. Don’t just change your settings, you can make a new program so that when this is all over, you can switch back to the way it was. I’ve had to you know what, I have a question for you, Jenny. This happens sometimes when we do the podcast. Let’s do it now. And then I’m going to get to a question about kids and growth hormone. I was interviewing someone today who talked about when they got pregnant, they suddenly needed much less insulin. And I was saying to them, it’s interesting, because for three days before Arden’s period, she almost needs no insulin to and I’m wondering what hormone we’re going to figure this out, I know this isn’t going to something you’re going to know now. But we’re gonna figure this out and talk about later in the podcast, there must be some hormone that’s released. For oscillation. That must also exist while you’re pregnant. And maybe I’m wrong. But I’m going to find out if that’s true. Because those two things like a bell went off my head as Ooh, maybe this is it. Because Arden Will you know, Jenny and I’ve talked about it privately, Arden will use like almost no insulin for a number of days before some of her periods. Not all of them, you know, just to keep things interesting. But do you think? Did I just say something you’ve never thought of before?

No, it’s well, and typically, oops, some reason went off my screen. There you are. Hi, hi, sorry. Um, I was gonna see the horrible and that’s present in the lead up to your cycle, as well as the horrible and that’s present very heavily prevalent in the first part of your pregnancy in that first trimester up to about like, six weeks is progesterone. Your body is having this ramp up, almost up a hill climb. And when you get your period, because your body’s like, hey, you’re not pregnant. So then the progesterone kind of like falls off the cliff, right? You come back down to this normal level. So most women, not Arden, but most women have a right up in blood sugar in the days before their cycle starts. And then it calms down. Same thing in those early weeks of pregnancy. Typically, women will actually see a heightened need for insulin in the first about six to seven ish weeks. And then around eight weeks of pregnancy, there is a bit of a dip off for a couple of reasons. Um, you know, hormonal II and what the body is doing, why there would be a dipped in blood sugar prior to the first day of a cycle, or maybe in the first part of pregnancy, when normally most women are experiencing a rise, the hormone, hormone drive there, I can’t say that it’s different. I would have to research let me give

you a number another variable for this story. And I guess this is me ruining an upcoming episode. But what if the pregnancy didn’t last much longer than eight weeks? Maybe there was something else going on? Sure. Yeah.

In fact, that is if you’ve had a normal increase in insulin in early pregnancy, and if prior to that eight to 10 ish week point where usually your insulin needs at least stabilize and or dip down a little bit. If that dip happens sooner. Oftentimes, it can potentially be an indication of like miscarriage only because the hormones are not staying steadily, you know, there’s not a steady climb. There’s also you know, an early pregnancy. If you’ve ever had miscarriage before and or you’re just worried. You can always get this the HCG hormone tested, which is the early pregnancy hormone that’s released that actually gives you that positive result in your pregnancy home pregnancy test. So that hormone should add Actually, mostly double, sometimes triple in those early weeks of pregnancy, which is, it tells you is that your pregnancy is progressing the way that it’s supposed to. Okay. Um, so those hormones, you know, that might have some indicative factor too. But that would be something I’d had, that’s a great way to look into

a little more research sound like there’s more in there for to understand, hey, I want to go back to Justin for a second talking about getting up and getting low. Justin, I just had a thought maybe you should do a bazel test day, maybe you’re eating enough to feed a basal rate that’s too strong. And that way you sat in bed, you looked at the news and everything, maybe that is what’s happening, maybe it’s not, but if you bazel test and find out you’re always low, maybe, you know, like, when I talk about, like, you know, manipulating bazel rates, sometimes when you manipulate them too much, Justin, you’re in some belong somewhere else. So you can you might be I could be wrong. But you could be in a situation that a lot of MDI people find themselves in where when they switch to a pump, and they realize that their basals way wrong. But you know, people are like, Oh, I switched to a pump, my blood sugar started going up. Well, it’s possible, your bazel, you know, before was too strong or too weak, you know, one way or the other. And so, I guess the way I like to talk about it is, so then what’s happening? You can’t draw a parallel to the things you think they’re attached to. So I don’t know, Justin, that’s maybe worth a shot. Somebody here said I’ve been diabetic for 31 years, Melanie. Hi. And you guys have changed my life. That’s lovely. Isn’t that nice? Thanks, Jenny. I feel nice.

And they can see a smile.

Yeah, because we really do smile. Yeah, cuz I read those two jenine. And you probably think we’re just all like, just jaded and like a doesn’t matter. But no, it makes everybody really happy. It does. Sabo. Can Type One Diabetes go into remission, I can answer that one. No. That it definitely can’t. Oh, what’s the proper way to bazel? test? Caroline? In my opinion, that’s a long conversation. It’s not an easy conversation to have. But Jenny and I have had it in the pro tip episodes. So find the link, go to diabetes pro tip comm and look for the Basal testing episode. I listened to all of them If I was you, but at least to get to that one. Justin says, like, maybe we’re onto something. All right. You’re good to go for a little longer. Yeah, Caitlin. My toddler has decided to wait, we’re gonna go somebody else said something about Caitlyn disappeared, my toddlers decided to pace himself differently during meals resulting in dipping down into the 60s mid meal. I’m concerned about our low percentage has hiked to 6%. and wondering if we should make changes.

So if your toddler is now decided to like, pick it things like he’d rather he or she graze like over the next one and a half hours instead of like slamming it all down within 15 minutes. That was the case. You know, kids are different. I’ve got a three year old, they sort of roll and change without telling you they’re going to Gee, sounds like the dose is probably not wrong. It would be again, the timing of the insulin distribution. So if the picking of the food he he or she ends up eating everything, but it’s in a slower timeframe. If you’re on a pole and extended bolus,

yeah, so extended bolus you could do two different boluses if you wanted if that’s get that idea scared you. Kenny says try to get them to eat the carbs first or the shorter to help it there’s a you can manipulate the food. You know now you’re going to get me into my my coma when I’m on stage and I start talking. Too often with diabetes, we think of just one thing, how does the insulin impact the number, but you should be wondering about how the food impacts the insulin, how the food impacts the number, how the insulin impacts the food, like there’s all different sort of perspectives you can use to think about it and one of them in there is the answer. And Marcel makes a good point. Maybe the person who asked if diabetes could go into remission maybe they were asking about honeymooning and, and so, so back to that some people really can. Maybe we should go over honeymooning real quick, but honeymooning is a spot where you have Type One Diabetes you have this insulin need. And then sometimes for a day, three days, three months I’ve spoken to people it’s gone on for years for suddenly it feels like their pancreas is shouldering the burden a little more again, and then they call that a honeymoon. Well, I think that’s a fairly good explanation of what honeymooning is so it does eventually for most people go away.

Right and you’re eventually you will return to using insulin completely

right for right. If I go away, I mean, your pancreas is gonna, it’s gonna give up finally poop out go down like Bugs Bunny eventually. And then for those

who are diagnosed as adults or What we call often call ladder. Some adults, it can actually have a very long honeymoon Yeah, where they may very well be able to control even without insulin for months at a time after they’re initially diagnosed with just lifestyle changes before they actually start to need to use a basal insulin and eventually a bolus insulin, etc. So

let me address this one question. Then there’s another one here. I like that I want to go to back to Sabah because he’s asking, Is there a cure on the horizon and near future? I don’t know that there’s any cure on the in the near future. I have a very simple concept around this. I live with a lot of hope for advancements, but I make decisions day to day like they’re never coming. Because far too many people I see ignored thinking, Oh, this will be over soon. I can my body can take bad management for a little while. I that’s how I feel about it. I act like it’s not gonna happen. I hope I’m hopeful. But, you know, somewhere in the middle there i think is the answer. And Jenny, do you know of any cures on the horizon?

I don’t there’s, as there have been long term, there’s a lot of research, there’s a lot of animal based studies that show some warrants some benefit. But you know, 32 years with diabetes, I explicitly remember my doctor telling my parents not to worry that within seven years, it was seven years when I was diagnosed within seven years, right? You won’t have to worry about this anymore. And, you know, even into my teen years, then my team brain even started to tell me, this is like lifelong, right? Just the hope has always continued to be there that maybe there will be some grand discovery, and it’ll get through and everybody will benefit from it. You know, I am, I’m hopeful more in technology, and where the technology piece is going for helping management. But I am hopeful, but I don’t see it.

I agree. I hate saying that. I know it sucks to say it, but I’m on the same page with you. And not for any nefarious reason, just that if you really if you go look, I think as a species, we’ve cured like eight things. And a few of them are just inoculations. They’re not even really cure. So I’d live like, I’d live like it’s not gonna happen with my actions around diabetes, but I’m always hopeful. I and here’s another thing not to make light of it, though. But somebody said on the podcast recently, no one’s going to cure diabetes, and you’re not going to know about it. It’ll be on the news. You know, you’ll figure it out or turn yourself into a mouse because it seems super easy to cure them from type one diabetes. Maybe that’s what we should be doing. Looking how to turn people into mice. Hmm, now we’re getting somewhere. Yeah, I’m sorry. I feel bad about that. But all right, Mallory says, No, wait, Mallory. I’m sorry. That’s not the one I was gonna read. And I’m like, Damn, they almost got the mind. A Kelly said nearly every night after my son falls asleep, he shoots the 300. I’ve increased bazel by as much as 95%. But once he’s there, I can’t bring him down. When he wakes up, can I answer first?

Sure.

Hold your thought, I’m just gonna put something on that you can come through with Trust me. Just because your kids bazel rate is I’m going to make up a number here, a half unit an hour and 95% puts into a unit an hour doesn’t mean that’s how much insulin he needs in that time. So you may have to extend on your pump, the amount of bazel you’re allowed to use to get to the point where you can keep him down because there is an amount of insulin that will stop that kid’s blood sugar from going up and hold him steady. What were you gonna say?

What I said, You’re so funny. So

pretty much along that line? Yeah. One is, you’ve got data that shows you that this is happening every night, right? You’re not like, Oh, this is only two days. And now it’s not happening anymore. This is it sounds like it’s every night. So one, you know, insulin needs to change to right along with what you said. It’s in very low level bazel rates, especially in many kids. If you’re turning Bayes a lot by 95% at a bazel. That’s point one. You’re not hitting the mark, by any means.

Remember, you’re not going to

write it. That’s that’s not hitting them. You can even look at it a little further if you take into consideration. What what’s the climb in blood sugar. Let’s say the child is starting at a blood sugar of 91 at bedtime and climbing up to 303. Right? That’s a huge increase in blood sugar. You can also take a look at Well, what is your correction factor? Most little kids have correction factor somewhere around like one unit changes their blood sugar by 150 points or by 200 points. If your kid is climbing 200 points, that little notch up 2.2 When your kid really needs a whole unit to correct a 200 blood sugar climb, right? That’s how much you need to change the base and why

Yeah, here’s the thing, you’ll hear me say this a lot. If you listen to the podcast, you need more insulin. That’s it. If you have more insulin, it wouldn’t happen. And by the way, for the person who asked about the group, and by the way, too, for a little kid, that could be growth overnight. Right? And for the person who jumped in and said, their kids in the teens and going through growth, and they can’t keep their blood sugar down. Here’s my answer to that to use more insulin. Because there is an amount that will stop it. Trust me, there’s an amount like, now the question is, how do you get to that amount in a way that doesn’t feel frightening? Especially for somebody who’s now talking about Look, it’s supposed to be point five, I made it one, how am I possibly going to go higher than that? That feels frightening. I’ve told the story in the pious, long time, so I’m not going to waste it here. But there’s an amount you can do just find yourself being more aggressive cover with a fast acting is used if you’ve gotten too much, but the truth is Peters bazel up a little too high. He’s not going to go from 300 to negative 10. Out of nowhere, you know, and keep in mind too, that if you see arise at midnight, that doesn’t mean change the bazel at midnight, it could mean change the Basal at 11 o’clock even or it could be a little earlier a little sooner, depending on how his body or her body reacts to the increase of bazel. Just like you putting in a bolus doesn’t start working right away. Putting in a bazel doesn’t start working right away. There are more thank yous in here. Those are nice. Thank you. Jen, do you have to go at the top of the hour?

Oh, no. I’ve got about 15 minutes.

Jenny’s giving you her personal time. That’s lovely. The takeaways more instant mirror it always is. Kara? I’m glad you think this is awesome. Okay, so she got correction factors thinking about it so that way. Jeff is saying protein and fat that are hitting around dinnertime. Okay, Scott. Jamie said, Scott, I’ve heard you say things about being an insulin deficit. From overnight, I’m pretty sure I understand what you mean, I suspect it’s a reason why some people go higher than expected in the morning. It was a lightbulb moment for me. So I’m sure others may find it helpful. Anyways, I love you guys to explain what you meant here. I’ll let Jenny explain what I meant. So I can drink something.

Yeah,

I see what I mean, afterwards, just you go first, relax.

So if you’re at a bazel deficit, essentially, you’re coming in to a time period when first thing in the morning most people are trying to put food in right away, right. And if you’re coming in at a deficit of insulin behind the scenes, then the impact of that food even with potentially a Pre-Bolus, it, you’re still going to rise because there wasn’t enough behind it in the hours leading up to that meal time. If you’re at a deficit of insulin as well, you’re likely seeing that you’re writing in at a blood sugar that’s higher than you want to be or it’s higher than the target, you’ve had your your pump set to keep you at. And that’s a telltale sign right there. And that’s only then going to lead into that real time, also causing more of a rise up than you want. Because you’re already starting higher than you wanted to begin with.

I would and I think of it, if you want a different way to think about it, it’s like eating a meal without a Pre-Bolus. Right, because there’s just you, if you don’t Pre-Bolus a meal, you start eating that foods gonna win way before the before the insulin starts working. Same idea, like Jenny said, people jump out of bed and they eat. And you know, we just explained to the last person that you turn, you put a basal rate on at, you know, not at midnight for a jump up at midnight. So if you’re getting up at seven in the morning and beginning to eat right away, your blood sugar’s jumping up, it’s possible your basal needs to be stronger, starting at 6am. And you still have to Pre-Bolus it’s not all the base, or you’re gonna have to Pre-Bolus and you’re gonna have to have the base. All right, it’s all just the timing and amount. Everything you see with Type One Diabetes, in my opinion, is about the balance of insulin and using it when it’s needed. And you have to be able to step back sometimes to see the bigger picture. People get hyper focused on what’s happening in the moment. I get up in the morning and my blood sugar gets high. That’s it then they stop there. It’s not about that. It’s about before I’ve now this is going to be the third time I send everything. Everything you do now with insulin is for later, but remember now is always some other times later. Ah, that’s how Arnold Schwarzenegger tried to kill those people in that movie. Right. Time travel time travel.

Okay. Yeah, that’s all. I think

the other part of it too is that there is a very there’s a very emotional level to managing your diabetes. Managing somebody that you love. Diabetes, yeah, right. And so, as hard as it can be, sometimes you have to step outside of yourself. And you have to kind of say, especially for the person who’s managing their own diabetes, you kind of have to step back, take the emotion out and say, Okay, um, hi. I love being high, but I’m high. Let’s, let’s look at the information and see what I can do to fix it. Right? Um, sometimes taking that emotional piece out of it also makes you think a lot clearer about what you want to do. I mean, that’s, that’s the big reason for baseball maker.

I maintain, I maintain that I’m as good at this as I am, because it’s not happening to me. If I had type one diabetes, I wouldn’t have this podcast, I’d be a mess. I’d be on the floor with my 10 a one See, God, I gotta know what’s happening. You know, but it was for my daughter, right? Like, no, I don’t know, like I you know, it’s for her. So that I’m able to, I’m able to be more aggressive because I have a bigger fear of letting her down than I would have letting myself down. I think. So a lot of the things you’ll hear about on the podcast, which by the way, you can listen to on any podcast app, absolutely. For free, just search for Juicebox Podcast, there’s over 325 episodes, the podcast has been up for almost six years. You know, if you don’t have a podcast app, they should be free. If you can’t find one, go to Juicebox podcast.com. Scroll to the bottom there are links to all your different phones to get you on. And someone just asked a question here, how to manage unexpected activity, but a bunch of people just jumped in and said have a snack. decrease your bazel Yeah, that’s it. Now listen, something somebody said was amazing. I’m gonna assume it was me and we’ll just move on.

I don’t really know what she’s talking about.

Yet, so they’re talking about that they’re talking about activity around all this. Also, I want to bring up around you know, a lot of people stress, anxiety, or all of a sudden sedentary lifestyle because you’re not going to work anymore. All those ideas somebody in here asked about they said their blood sugar’s jumping up at night, not always, since the pandemic has started. And I wonder if when your brain slows down after your days over, do not find yourself thinking or worrying about Coronavirus because stress, anxiety, pain, there are a lot of things that can make your blood sugar go up. So I would I would look into that a little bit.

In fact, there’s it’s really funny that you bring that up because, uh, somebody that I work with, she actually just emailed me. It has nothing to do with diabetes, but my brain was right away, like bringing diabetes into the picture reading it, it’s all about dreams, since Coronavirus became the thing that it is, yeah. And the fact that dreams are, they are the way that our our mental self kind of manages through things. And we can learn some things, you know, if your dreams are kind of scary, or if they’re really scary, or if they’re just sort of like hinting at weird things. You know, I mean, it’s the way that your body manages to sort of work through some of the thoughts that it didn’t have in the daytime, right? Or that were sort of in the background. And with diabetes in the picture. Some of those can be very stress inducing in the overnight time period. So you know, if you’re looking at, you know, many of your overnight values and you’re thinking Whoa, why is this weird? This night was really weird. I had this strange rise and I woke up high and that’s usually not happening for you. Maybe you had a horrible dream about Speaker 2 1:08:37 something that you know, and it’s not about never hugging another person again.

Could be I had a I had after all this started I had a horrible dream about zombies. Did you? Horrible like I woke up in like a panic. And I usually I don’t remember many of my dreams. I usually see sleep pretty soundly. Yes. Dream had me like, I was like all levels.

When Natalie just jumped in and said playing video games makes her teenage son’s levels go up. That’s adrenaline, I would imagine. And Natalie I bet you they come back down again. Right? And because that’s that’s another thing. So stress, anxiety, those sorts of things are always going to well always have the ability to impact I’m sure there’s some people get stressed out in their blood sugar’s don’t go up. But it does happen to a number of people enough that it’s worth paying attention to.

Yeah, and

sometimes you can address the rise. If you know that it’s not going to come down sometimes sometimes you have to correct for it. Many times adrenaline rises, though. We often don’t have to touch oftentimes once that stress factor or the adrenaline like surge sort of passes. You’ll see things come back down.

You know it’s funny somebody jumped in as you were making this and said a bedroom could make your blood sugar go up at night, mira said and there people my daughter’s goes up with Xbox so if you know, listen, it’s not the easiest thing to to Guess schedule. But if you know, Xbox time is going to be in a certain place, you probably could do with Temp Basal increase. Right. And that would

that would definitely kind of like weightlifters if you know, you’ve watched enough to know how much blood sugar typically rises during Xbox use, you could technically take an amount of insulin as a bolus to offset the typical rise that you see based on what your correction factor is.

Let’s see if we can get one more thing in, because we have to go so somebody asked about their Dexcom user, and they’re talking about Pre-Bolus. And when do you know when to start eating. So for my daughter, in a perfect situation, I like to see a diagnose Down Arrow before she starts eating. And you also have to get right in your head what’s high and what’s low, too, you know, for me, I don’t want my daughter, I try very hard for our not to go under 70. That’s my goal. And I try for not to go over 120 do we always do that we do not always do that a number of times a day, she ends up higher, it just happens sometimes. Okay, all the things that you just heard about happened to us to my daughter’s a one C has been between five two and six, two for almost six years. But she got out of bed didn’t have enough insulin going because she slept in try to eat something with a lot of carbs and her blood sugar’s 200 right now. And it’s and we’re going to get it back down as fast as we can without it getting well it’s not you’re not shooting for perfection. You’re just shooting for as much time and range you can get in there. But back to the initial question, I like to see a diagonal down arrow. But now I know how fast the food is going to hit or just you just have to practice right like, started 100 put in the blood sugar when you get to 91. Diagonal down, eat, see what happens? Did you go up to 150? But then level back out? Cool. Maybe you could have waited till 85 diagonal down. Maybe that would have taken you do 130 c? It’s just trial and error. You have to go over and over again.

Experience teaches you? Yeah, a fair amount.

JOHN, I don’t know that. Jenny knows this answer. But I’ll ask before she goes john wants to know if you know what factor? What factors affect the hypest hypoglycemic risk value on the dexcom clarity app, you know what it takes into account to come up with that? I don’t,

it I don’t, but my assumption is that it calculates the percentage of time that you’ve been low, within the timeframe that you’re looking at, to classify what your risk is, you know, if you’re, you know, 1% of the time low, I guarantee that your risk factor for most is not high. Whereas if you’re pretty consistently at 10%, low, even if it’s not really red low, it’s just that pink low, right? Because there’s a different designation. There’s a 55, red low, right? But I mean, if you’re really low, pretty consistently, that risk factor obviously goes up. I don’t know exactly what parameters they’re using to establish that percentage value for you. Um, but

Alright, so let’s roll through these last three, Jamie brought up that if she waits for a diagonal Down Arrow for her credit goes lower, so it’s gonna be different for everybody. Yeah. Lisa is saying hello to us from Sweden and said, we’ve both been very helpful in her first six months of being a type one mom. Hi, Sweden. That’s cool. And Sue asks, do we recommend the in pen which I think we both though?

Yes,

yeah. If you can’t pump, you can get a lot of the knowledge that a pump has from in pen pairing with their in pen app and your your glucose monitor and even a meter. Not as much luck and Jenny’s holding one right there.

I’ve got the pink. You can get them in different colors.

Yeah, I’ve got blue in here somewhere. But it’s a demo. So. Yeah. Okay, so listen, Jenny was only supposed to be here for an hour. It’s 409. She got to go back to her life. I want to say that at one point. This was up to 120 people and it never got below 80 even 15 minutes after it was supposed to be over. So awesome. Really appreciate all you guys. Thank you so much for listening to the podcast. If you enjoy the podcast, please share it with somebody else. It’s the only way it can grow. I do not have money to to do any kind of meaningful. You know, advertising for the show in the last comment here again is Jenny’s email address. You can hire Jenny. She works at integrated diabetes services. You can have one on one calls just like this with her. Check it out. See if your insurance has covered it or if you want to pay cash, whatever you want to do. Jenny is very cool. She is 100% my diabetes spirit animal. I’ve never heard her say one thing that I was like that’s wrong. But as I’ve mentioned on the podcast before, that might just be my narcissism because she agrees with me. I think she’s terrific. But who knows exactly, you know, this will be available on the podcast soon. And it will be running on Juicebox podcast.com as well. And it stays here on Facebook. So thank you everybody very much and Hope you guys have a great day. And Jenny, I really appreciate you doing this. Thank you.

Yeah, no, this was great. Thanks to everybody who commented back and forth to each other as we were answering. It’s a great way to help each other. Yeah.

Very cool. All right, guys. Wash your hands. Stay safe.

I why.

Don’t forget even though this episode was not sponsored, the podcast does have sponsors like Dexcom. The Contour Next One blood glucose meter, touched by type one and Omni pod. There are links to those sponsors in the show notes of this episode, and at Juicebox podcast.com. If you’re not looking for those types of things, go into your podcast app and leave a glowing review of the podcast. It would make my day and Jenny would smile about it too. Alright, let’s turn off the music and we’ll dance our way out of this

Hello friends, welcome to Episode 355 of the Juicebox Podcast. Today’s show is an hour of ask Scott and Jenny. I’ll tell you about Jenny in a second. But let’s look at my notes here about what’s involved in this. Out.

Increase babies.

I can’t read my own writing, but this is a thing. Well, alright, hold on. Let me count the scribbles. 1234567. Jenny and I are going to talk apparently about seven different things about type one diabetes today. And all those questions were sent in by listeners just like you. I’m sorry, I cannot be more direct than that. I tried to make a list. I wrote them down. I just hold on. Air travel with a pump. Alright, that one I got figured out our kids easier when they get older. Maybe that’s what that means. My writing is terrible. Is there a method to bazel increases Temp Basal increases? That might be what that is. Order. ordered. Cathy, that can’t be right. Um, figure out bumps. I guess that’s about how do you know how to bump and nudge. Bad. Turn COVID. Court Li issues Wait, what? Between Okay, not bad turn between old something issues. Health beegees that health? halt all halls.

Okay.

Um, anyway, it’s gonna be a surprise. It’s a great episode. I just edited it. I really loved it. I just edited it. The other day is edited a word or do I say it wrong? It’s hard to know, I guess. All right, hold on a second. Let me tell you a little bit about Jenny Smith. You know, Jenny, of course, from the diabetes pro tip episodes from ask Scott and Jenny, and defining diabetes. Jenny has type one diabetes now for over 30 years. I wonder if I could do this off the top of my head. I’m gonna go to where I have the information. Give me a second. I’m gonna go to where I have the information about Jenny. But I’m going to try to say it off of the top of my head first. So I’m near Jenny’s thing, but I’m not looking at it. Alright, ready? Off the top of my head. Jenny Smith has had Type One Diabetes for over 30 years. She’s a certified diabetes educator. Something nutritionist, a certified trainer on most makes and models of pumps and continuous glucose monitors. She’s a terrific person. Alright, hold on. Ready? Now let me go to the thing. Jenny Smith has lived with Type One Diabetes for 30 years. She holds a bachelor’s degree in human nutrition and biology from the University of Wisconsin. She’s a registered and licensed dietitian, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. But of course, most importantly, she is the best Juicebox Podcast Guest ever unless you’ve been on the show. And then in that case, you’re the best one and Jenny’s the second best one. I wonder how well I got that from the first thing. We are four minutes into this now are you guys listening to this? I’m so sorry. This episode of The Juicebox Podcast is sponsored today by Dexcom. On the pod the Contour Next One blood glucose meter and touched by type one, there are no ads in the show today. I’m just here to remind you that these are the advertisers and that they’re lovely. And if you’re interested in them, using my links helps the podcast and I appreciate it. Usually I tell you dexcom.com forward slash juice box, my omnipod.com forward slash juice box touched by type one.org. And I usually say something about Contour Next One but I’ve got my own link now. So you got to remember this one now. Contour Next one.com forward slash juice box. And now I’m just gonna make sure that that’s actually correct because that feels wrong. Nope, it’s right. Contour Next one.com forward slash juice box. Check out the Contour Next One blood glucose meter and all of the meters that contour cells. Also do you know it’s possible that you’re paying more to your insurance than it would cost to buy test strips in cash. You should check that out at the link as well. Do you want a free no obligation demo of the Omni pod sent directly to your home? do that at my link to my omnipod.com forward slash juice box. Dexcom is Guess where all the great information about the G sexist, but that’s a lot. So go check that out too. And when you’re done, you’re gonna need some energy because you’ve been on the internet now and you’re getting sleepy. Touched by type one.org. It’ll lift you’re right back up again. Let’s get to Jenny and the Ask Scott and Jenny questions. Thank you everyone for sending in the questions that you sent. I am sorry that at the moment, I don’t remember what any of them were. But I do remember that they were wonderful. Jenny was fantastic. I of course, was delightful. Hey, now please remember, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. One last thing juice box. docs.com is an ever growing list of doctors and other helpful people in the medical industry that you found you the listeners have found and shared with me. We’re making a beautiful list. You can add to it if you want or go take from it. It’s like that Penny thing at the convenience store. Give a penny take a penny. Give a good doctor. Take a good doctor. When Jenny and I record we usually catch up for a few minutes first, and I don’t record it normally. But this time I did. It’s just us talking about weird stuff going on around Coronavirus in our lives and I left it in for you. You can eavesdrop on the silly things we say to each other when no one’s listening.

Because their haircut had been delayed twice. We had had haircuts set up right including my own. You got a friend who has her own shop. And so she was going to do the boys it’s in with the boys watching a movie with their little girl who is just a little older than Oscar is. And she was going to do my hair all set up. Now we rescheduled it because things had been like postponed. Now we’ve rescheduled it again for like mid May. Who knows whether that my boys look like shaggy dogs. Like I was like, even my husband was like their hair needs to be cut like it was getting to the point of like they’d sleep. And that bed head was like just not culpable. How did you no matter how much I just I caught it. Have you ever cut anyone’s hair before? Um, I’ve trimmed their hair before in a pinch like this, okay, but like this was really like it was a haircut. And I it’s fine.

Kelly, Kelly sent me the other day, time to go to the heavier hair product. And I was like, Yes, I’m gonna need something with a little more control. I had my hair kind of short recently. And so I was just using like a little paste or rod or whatever, just like just a little bit. And now I use it, my hair is just like weak back, we can overpower that. And you know that I’m gonna have to go to a baseball hat pretty soon. And I don’t think I have the head to shave my head just to start over again. So I’m not doing that.

It’s kind of funny. I actually I refer to like those days with diabetes, where you’re just like, I don’t know what’s going on today. And it’s just weird and bizarre. I called them I call them bad diabetes hair days where there’s no amount of like mousse or gel or whatever that you can throw at it. That makes it like flap down the right way. That’s how I count for that.

How long have you been in your house by now?

This is in three days. I’m on to three solid weeks.

Yeah, by the end of this week, it’ll be three solid weeks. Yeah.

Can I make them? admission? Yeah. I know a lot of people say this. But I haven’t really noticed that much of a difference in my life, which I’m assuming is bad for me. But, but also, I find it incredibly relaxing

that you don’t actually have to physically go anywhere.

what the expectations are gone now

are gone. Right? Yeah. Like, you’re not expected to attend the ball down the street or go to some fees like hoopla right?

My kids keep my house clean. Talk to my wife the way we always do. There’s nothing there that would change and put this podcast out in the schedule. Nothing else in the world matters right now.

Yeah, that’s the only the biggest things I mean, that are changes for us. Like I love. I love grocery shopping. I love grocery shopping. And at this point, my husband is the one that’s actually going now to the grocery store, pick

the person

because we pick the person and I’m the person that doesn’t have you know, so. So yeah, so he’s the one going to the grocery store and doing all that I like, I feel kind of a sense of loss.

Oh, wow. Now I hear you. I’m the one having to go to the store. So yeah, and I’ve been twice now. And I’m like a ninja. I just have a little schmutz in my pocket. You know, I’m sure there’s a real word for it but the stuff that kills the germs. And I hadn’t, you know, I don’t touch anything, bang, bang, bang and grab my stuff. Get out of there gela hands, move to the car, get the stuff into the car gel the hands again, get back in the car. You know, get it home, I strip away the packaging and do all the things you’re supposed to do then clean the place where I stripped away the packaging, clean my hands again, and I’m done. I’m just like, hmm, probably should be doing this all the time. Not this intensely. But.

But something similar. Yeah, actually sounds very much like ginger. You know, she actually posted something the other day about this is, this is what I do my one trip out of the house like and we also in, we’ve been really trying to like, we get the load of what we need. And then we really like our refrigerator right now is on the minimum. I think the only fresh vegetable we have left in our fridge right now is celery. Like we got to get to the refrigerator or the grocery because I need more than celery and hummus.

That’s a Facebook post for us. Anyway, we’re down to celery, it’s time for the celery. It’s time,

right? But so ginger actually takes she has gloves. She wears them, she actually takes in paper bags to the grocery store so she can get her groceries into the paper bags. Rather than having to push a cart that somebody else pushed, she takes them to the self checkout. So nobody else has to touch her groceries. She puts them into her bags. And then she actually doesn’t even take those bags into the house. She like, takes the stuff out, puts them in a new bag to go into the house. And she’s like, and I wash and scrub and I sanitize and I she’s like, that’s what I do.

So my friend washing a brand new bag of potatoes in their sink yesterday. And I had two simultaneous thoughts. I thought that’s a great idea. And I laughed a little bit. So but I when I put the hand sanitizer on I hand sanitize me and the cart. But But again, I got lucky because when we moved my son out of college, he had a 40 ounce jug of hand sanitizer that he hadn’t touched. Oh, it was like finding a gold brick and the top of his like I was up in the top of the shelf. I was like, Oh my god, I’m so glad you’re coming home. You’re saving all of our lives Look at this. And and and then it made me think like, why does he buy stuff like this and then not touch it and use it for anything? Because he we didn’t give it to him. He needed it for something. He got into his head at some point, you know,

yeah, he put it in the back of his closet.

Yes. There’s a 20 year old boy for you. He heard about what was going on. I do remember sending him a text. And I said, Look, I know I bug you sometimes at school about sanitizing your hands, please be a little more mindful about it. Like I was trying to get him moving before this all exploded without worrying him. And so I guess he went to the trouble of buying it, which was not using it away rather.

I’ll use it when it really gets. Alright.

Now he did say he had a little one he been using. So I’m like, maybe he was using I mean,

or maybe he was using the big one to refill his little one who wasn’t open to me. So

let’s try not to be too full for

giving him a little credit.

He’s two years into college. He just committed to his major he the other day. He’s not exactly out in front kind of kid. Yeah. So anyway. Oh, I want to tell you something real quick. And then we’ll start this recording. And All right. Let’s get back to our Ask Scott and Jenny list. I say what’s

on the plan today? Well, I gotta tell you, oh, no, I never know. I appreciate

that about you, by the way that you’ve never once been like, exactly what we’re gonna talk about before we talk about, which is why it is a surprise. This time, I actually marked the ones we did with a little word done next to it, which trust me is a major, major consideration for me because I’m not normally even that smart.

You’re smart. You’re just not that organized, right?

Well, sure. I keep a lot of stuff in my head. I don’t write stuff down. I’m not I don’t check boxes and stuff like that. But sometimes like this is a necessary thing to me. All right, I’m gonna start with

Well, our list here is also very long. So putting done next to them was Oh, yeah,

it’s a long list. I’m just telling you. I’m not normally that smart. Bethany asks, Is there a way to estimate how long an increased bazel will be necessary based on the amount of fat carbs or protein in a meal? So she’s looking for if there’s this many carbs then do it for that long, but I don’t know if there is or not,

not typically I and that’s why we have the we have a standard of what we say start with right for fat end of the meal increase the bazel by 50% over the next six to eight hours. experience will show you whether or not that works well. I for one have found that an increase in bazel for a while That meal in the daytime, I don’t need as much of an increase, and I don’t need it for as long at night. So for example,

if I think,

I think it’s because during the day I’m, I’m up, I’m moving after the meal time, like if I go and I have a higher fat type of lunch, let’s call it pizza or whatever, right? That’s the typical example. Usually in the evening, I would need that 50% increase, and I typically need it for about six hours, during the daytime lunch, I usually need maybe a 30% increase, and I only need it for about three or four hours. Okay. And I I have to save from just experimentation. I think it’s truly because after lunch, I’m not going to lay down for a four hour nap. I’m up, I’m moving, I’m doing things. I’ve got things to do around the house or with my kids or whatever. I’m just busier were in the evening time after a dinner like that. Well, I might be doing some things like putting my kids to bed or doing the dishes or maybe in the laundry or something. But for the most part, a lot more like sedentary. I went to the evening.

Yeah, that makes sense. I listen, obviously, I think about it in pictures. But in my mind the basals a, it’s a heavy jacket. And you mean you put it on while you need it. And when you get too warm, you take it off. So it’s easy to say if you have a CGM. But if you don’t then just test at more at intervals, I also believe that after experience, you know, the answer will come to you. Let’s say it ends up being four hours that you need this basal rate for, you know, the second and third time it ends up being four hours. Well, I mean, then I stopped testing and I assume it’s four hours. Right? You know, but you have to try it to know,

to know, and the same thing kind of goes for protein, you know, the, the bolusing strategy for the most part, not bazel increased. But the bolusing strategy for protein says try to start it at the end of the meal extend the whole bolus out over the course of a three hour time period. Well, on average, people probably needed somewhere between two and four hours, depending on the portion of the meat, you know, if you’re only bolusing for 12 extra grams of protein versus the night that you go for your 16 ounce pound of steak and your bolusing for 40 grams of protein. Very likely, that’s going to also define a time to extend it out over Hmm. Because of the portion, right, it’s kind of like the load impact versus just, you know, yeah. So that that can help with that too. The other thing for protein is kind of the kind of protein, you may find that leaner proteins such as, like a lean chicken, or even most fish tend to have a lower impact on blood sugar over the hours after even if the quantity is large, you might still have to cover it but maybe not quite as much as something like red meat. Okay. Red meat has not only does it take longer to digest, but it also has a lingering impact. Yeah, so those are some things to consider. I wish people

could see that out last night Arden had a an avocado salad and edamame a for dinner. Yeah. And I want to say that i bolused 40 or 50 carbs for that. Like, and that I think is stuff people look at and go there’s, that’s free, almost that’s a vegetable. And then I looked at the fat and the avocado was a big part of it. Like I think the true carb count, if I was really paying attention was probably more like 30 carbs when she put the dressing on and stuff like that, which she didn’t use a ton of. But I looked at the fat and I was like, all right, like we’re gonna need more power here. This there’s going to be more glycemic load here from the fat and not in the way you think of it normally not, not from carbs, but just from its ability to hold it up which I think yeah, I think that might lead us into Jamie’s question here. Now Jamie bemused, Jamie says maybe this is a pro tip and you tell me if you think it needs its own miniature discussion? Because this is something I’ve I don’t think we I don’t think I put a ton of effort into understanding but I know that some people do. She’s asking about eating food in a certain order. Her examples last saving fruit for last, when you aren’t as low as you would be when you started the meal or like the other way around, like what do you do? You know? So the

timing or the placement of the food intake?

Yes.

Is to a degree, there is some there is some strategy for what she’s kind of talking about. You know, if you are starting on the higher end, blood sugar wise, and let’s say you didn’t have as much time to Pre-Bolus as you would have really liked to Sure. If you Start the meal with, like, Iceberg lettuce and the protein part of it right, you’re gonna have that sitting in your stomach first getting worked on first before you maybe get to your baked potato or your rice peel off, or your fruit on the end or whatever it might be, starting with the lower glycemic or almost no carb kinds of foods first, yeah, puts that into the stomach to get going. We know that proteins and fats take longer time to process and digest to begin with. And well, I mean, I kind of always think of my stomach kind of like a cement mixer. Right? It’s not just taking your chicken and digesting it, and then moving on to your berries and then digesting those. I mean, it does all get churned together and processed, you know, with stomach acids and whatnot. But for the most part, yes, if you can start the meal with the things that you know, are going to be slower, letting the insulin kind of get working and going, and then add in the carbs at the end. Absolutely. That’s a strategy strategy to use. Yeah.

And I mean, I’ve had I’ve sent Arden into a meal more times than, you know, I can count where she’s, you know, 70, or 65. And the last thing in my text was like, start with, you know, whenever the simplest sugar is, right, is that

what the right the apple or apple sauce or whatever,

right? I’ve said before eat the banana first. And I know that’s not exactly. I don’t think she looks at it and thinks I should eat the banana first, although I don’t know. Because yesterday, what did she say to me yesterday? That was she said, Can I have a snack? And I was like, yeah, sure she goes, so what do you want? And she said, Oh, no, wait, it was at the end of breakfast. And she’s like, Can I have a little more food? And I said, Sure. What do you want? She said, can I send bacon and an orange? And I was like, yeah, you want a bacon with orange. And we had a little bacon left on a plate. And I had oranges. And I thought, all right, and she looks so happy. She’s like, the orange and picking it the bake? And I was like, well, that’s a weird mix. Definitely what she wanted. So, you know, I mean, I think that’s, I think it’s reasonable to be thoughtful about it. Now, I do know, there are some people who steadfastly eat their meals and orders to keep these incredibly stable blood sugars. I don’t know, I can’t speak to it. And I don’t know that I would want to live my whole life that way, either.

Right, you know, strategy wise that what you found works, and that makes you happiest, because then you’re not dealing with the flux in blood sugar. Great, if that’s your strategy, have at it, keep up with it, you know, everybody finds what works, or hopefully, they’re learning to find what works, right. But I mean, even even in consideration it if you’re looking at a dessert, like at the end of a really big meal, a good example is something like a Thanksgiving dinner, or a holiday meal, or you’ve had all of these like, heavier, more dense types of foods. And then at the end of the meal, you add like grandma’s apple pie with like marshmallows baked on the top of it, or whatever it is, you know, you’re thinking, Oh, my gosh, this is all sugar. Well, what else do you have to consider, you have to consider all that other food that’s sitting in your stomach. So, so heavy, that might actually be a time that while normally you’d take Bolus and Pre-Bolus everything, not even choosing an extended Bolus. Yeah, at this point, you’ve got all this extra food sitting in your stomach. And while this is simpler sugar, its impact is going to be drawn out. So you may actually want to do an extended bolus for this dessert. Because otherwise you’re going to go low,

because it’s flopping into your stomach and laying on top. It’s not part of what’s happening. Right? Correct. Yeah. See, that’s the stuff that is it’s smart to understand. And I just think I think of it is experiential, like I just might go I know from experience this doesn’t need a Pre-Bolus the way it would normally we already and I think of it as like, we already have so much insulin in the processes or I guess what we’re saying the same thing. The process is already happening. Now we’re just throwing in, you know, like another teaspoon into a gallon of water. And yeah, okay. By the way, all of Jamie’s questions are like I think this would be a good pro tip. I think she’s trying to produce the podcast here which by the way, there’s some really good questions here. I don’t think this one needs its own episode. So I’m gonna ask one more of Jamie’s questions because she asked specifically. I want to know Jenny’s take on artificial sugar. So artificial sweeteners. I know they affect people differently. But in she said In your opinion, which ones seem to have the least impact. She said, I also feel like a lot of people don’t realize you can see rise from zero carb drinks. I will tell you that Arden doesn’t drink a lot of soda. But if I start seeing her blood sugar gets sticky. I look to see if she’s gonna Diet Coke. And that sometimes that holds her up a little higher. It’s not like don’t get me wrong doesn’t make her 300. But it could make an incredibly difficult 140. Right? It doesn’t want to give up.

So there are I mean, if you wanted, gosh, I’m trying to remember what the university was that did a study on. Like, how much of the on the market artificial sweeteners is considered safe, according to the type of artificial sweetener in the product. Right? So if you’ve got something like equal, you’re talking about the artificial sweetener, aspartame, okay, right? If you’re talking about Splenda, you’re talking about sucralose. So and then, of course, there is sweet and low, which is this the saccharin kind of component right? Now, there are also what I call alternative sweeteners that I think sometimes get falsely right, that get falsely kind of categorized with artificial stevia, being one of those alternative sweeteners. It comes from a plant Yes, it is processed the the sweetening pieces that come out of the stevia plant get processed in order to make a product that you can like, you know, put into your, your drink tea, coffee, whatever sweetened beverage, you know, sweetened a baked product, with what with whatnot, but the studies around impact from stevia, comparative to those that are truly artificial, by artificial, I mean chemical in nature, they don’t come from natural, outdoor plant life. Right, they are created in a lab. So those, there are acceptable limits to like how many packets a day technically you should have, or how many soft drinks you should have with how much or, you know, beverage or how much how much per packet or whatnot, and each of the different sweeteners does have a limit to it. I mean, it’s, it’s a lot. I mean, most of them, it’s like 15 packets a day, you’re 25 packets a day. I mean, maybe some people are having that much I,

I hope to you,

it seems like an awful lot to me. And I

know, can I say something now that we’ve met in person? Yeah, not that this doesn’t come across the video, you’re in really good shape. Like you take really good care of yourself. And so like Jenny’s fit, you know, she she’s trying to embarrass us right now, only only I can see her and she’s still embarrassed. But I mean, I thought you’d have a take on this, like, you know, I guess some people might be like, here’s a glass of unsweetened tea, I’ll put five packets of Splenda in it or something? I don’t know,

you know, right. And I mean, that it’s a it’s a question that she asks a good question, because it’s something that whenever I’m talking nutrition with people in a visit, it often does come up, you know, what do you think about the artificial sweeteners, especially in the women that I work with through pregnancy? Right? It’s a very common question, should I be you know, should I stop drinking my diet coke, blah, blah, blah, or whatever it is, you know, I, you know, we there are studies, I think that they’re kind of like a 5050. There are studies that kind of err on the side of these are chemical in nature. They’re, they’re not natural. They’re not like going out and pulling the broccoli off of your garden stock, right? It’s something that some very smart lab chemistry person put together and hey, it’s got a sweet taste. And hey, it doesn’t. For many people, it doesn’t raise blood sugar. I can’t say that’s 100% true for everybody. Like you said, Yes. Sometimes you’ll see a rise and sometimes no sweetener sweetener.

Yeah, I don’t know if it’s the I don’t know if it’s the artificial sweetener specifically, or if it’s impacting or in a different way or I don’t know what it’s doing to her but her if she drinks too much Diet Coke, her blood sugar gets more difficult.

Right? Right. Yeah. Right. And, and I’ve actually had some people I used to tea but teach a an in hospital type to class for people with type two diabetes. And even they, it was a very common question, and I can very much remember one older woman. She was like, in her upper 60s, the cutest little lady. And she was like, I can’t drink those diet beverages. I just can’t drink them. I’m like, Okay, well, why you know, the class is always like a discussion about you know, what works for you, blah, blah, blah. Just like every time I have them, my blood sugar goes right up and So and then obviously didn’t have a continuous monitor or anything, she was really only doing it by finger stick analysis, you know, and whatnot. But I mean, she, her records actually showed I mean, she’d have nothing in the afternoon except her diet soda. And by dinnertime, her blood sugar was going up. If she didn’t have it, it wasn’t going up. It didn’t happen. So, yeah.

So aside from what you just said, which makes total sense that, you know, limiting the chemicals going into your body, probably a smart move. I don’t eat that much sugar to begin with. So when I have a cup of tea, if I use two teaspoons of sugar, I mean, whatever, right? Like it, if Listen, if two teaspoons of sugar in a cup of tea is going to take me down Jenny, then I guess that’s gonna take me down. You know, I mean, I, I just feel like that it wins. But

I think eight grams of carb there.

Yeah, I don’t love I don’t I don’t need a lot of sugar at all. But, you know, at least it feels natural, to some degree, you know, so I didn’t make it in a lab.

You know, that’s kind of what I say even about like the sugar free like the sugar free candies and whatnot that are out there. I mean, it kind of brings in along with artificial sweeteners. Of course, there’s also then the alternative, like I said, the stevia. But then there’s also another sort of bank of sweeteners, which are those sugar alcohols, right. And sugar alcohols, again, they come from, from plant based foods, most of them come from fermenting fruits and vegetable, carbs or sugars, so that what ends up happening in the body is the fermenting process allows a much slower impact on blood sugar than you would get from all out sugar. So most, you know of those sugar alcohols they provide only about half the amount of impact that true sugar does. And it’s kervin action is very very slow. They also if you eat too many of them are not very nice digestive Lee on you. But I always feel like you know if you’re going to eat three sugar free Hershey candy kisses, I would rather have the real thing. Yeah. And that’s purchase personal at like you said you’d rather have the real sugar in your cup of tea than something that’s artificial. And if you account for it in your day, total, you’re keeping track of things. calorie wise, most of those sugar free products aren’t lower calorie overall than the counterpart of regular things. Oftentimes, when they take sugar away, they have to add back something else that tastes a little bit better. And it’s often fat. Yeah.

Well, I listen, I will have chocolate once in a while. And there’s a company that makes a chocolate chip that I find to be like a really quality chocolate chip. And instead of having like a Hershey Kiss, or something like that, not there’s anything wrong with a Hershey Kiss, but there’s a, you know, there’s a quality issue there, like market chocolate versus, so I’ll buy like a bag of chips. And if I want chocolate, I’ll take like, I don’t know, four or five chocolate chips. Yeah, by the way, the bag of chips is like $3 and it lasts forever. You know? So there’s ways to, you know, substitute things and and correct and get more. I don’t know, this isn’t English, but more real food into your snacking. Even snacking like this, you know?

Right, right. Okay. And I do know, I remember, if somebody wanted the actual information about how much artificial sweetener they can take in. It was a study done by the University of Alabama at Birmingham. You can actually go to their website and they give you information on how much saccharin aspartame and sucralose is appropriate. It’s based on 150 pound person.

So yeah, so be 150 pounds. You’re taking this that into effect,

FYI,

restructuring your multiplications and your divisions in your business. Well, all right. Well, this question from Libby may not apply in our new world. But flying in an airplane and pumping with an insulin pump. So does air pressure deliver insulin? Is that why some people find themselves lower after a flight if they’re wearing a pump? Jenny Jenny has read she just readjust her jaw six different times and a word. Yeah.

Well, I want to I want to address it in terms of being true in also that there are no

studies. There

are no true studies that are approved by some fancy university or research laboratory that has actually done this. However, there is anecdotal let’s call them evidence from people have diabetes where insulin pumps, and they’ve actually documented what happens when you fly with especially a tube insulin pump, okay? It’s more, it’s more of a known issue with a tube insulin pump, that in the ascent and descent with a tube pump pressurization can actually either withdraw insulin back into the reservoir, thus creating an air bubble in the tubing, and potentially then causing a lack in pumped insulin. Some people experience not only a high at some point, or a rise that they can’t explain because they haven’t had any food or anything else happening on a long flight. Or, in this example, a drop down often, and a lot of people refer to them as like the baggage claim lows, where they finally get to the baggage claim. And as long as their hike through the airport hasn’t been like six miles, you know, they’re huffing it. For the most part, people end up waiting for the bags and have a low blood sugar. And why it’s because potentially on descent, there is a pump out of insulin from that piston from the pressure that pushes the insulin through the tubing and delivers almost a bolus of insulin, then that’s it’s not registered by the pump, you can’t go into your insulin dose history and see oh two units was accidentally delivered. The pump doesn’t give you that because it wasn’t there were no button pushes get it.

So it’s like having a like a like a flatbed hose full of water and the water is just sitting in it, but you grab one side and give it a squeeze and it runs out the other side. So the air pressure increases and forces the insulin through an air to come out of your set. So that’s where it goes

correct. And our recommendation to kind of counter it is on ascent and descent, essentially, you disconnect. So for those with tube pumps, you would disconnect disconnect from your sight as soon as your rising or taking off. Once you get to cruising altitude, you go ahead, look at the tubing, if there are any air bubbles, prime the tubing, flush the air bubble out, reconnect cruise through, you know your three hour flight or whatever it is, as soon as you start your descent, go ahead and disconnect when you land. Go ahead again, take a peek at the tubing. If there are any air bubbles or anything, you essentially flush them out and reconnect. Yeah, that way you get rid of both potential problems makes sense.

I happen to I’m googling while you’re talking. And Medtronic has a little update on their site about just being more like attentive, which I think is any company’s way of being like, you know, we don’t really know what’s gonna happen. So you pay better attention. And I’m not picking on Medtronic, I’m sure there’s a version of this language is probably on everyone’s site. But you’re saying with Omni pod it might not exist?

Yeah, there’s I’ve only had, I’ve only had one person that I work with. Who has definitely she’s noticed something happens. She always she never has highs. She has lows.

But that’s right. So

but again, that’s an N of one with one pump. And I you know, I’ve I’ve flown often enough I’ve worn Omni pod since 2006. I’ve flown a lot in that what? Almost 14 years ish, right? And I can’t say that I’ve noticed anything. That’s a trend when I fly. That would indicate Yeah, this is definitely happening three quarters of the time. We

don’t treat them differently during air travel at all. I mean, you know, maybe when you get out of the car at the airport, we’re not I wouldn’t bolus a 120 you know what I mean? Like I want to get through security and all that stuff with nothing going on. But as soon as we’re back through, everything goes back to normal. We bolus normally on the plane and every other Yep. So yeah. Okay.

The only thing that I guess it’s not really in answer to this, like pressurization. But the one thing I do Do for travel and a lot of people notice is that many times when you’re sedentary for more than about a two hour time period, you might actually need a temporary increase in your bazel just from the sedentary nature. You know, when I fly long distance, and I’m going to be sedentary for more than that two hours, I find that I need about a 15 to 20% bazel increase just

to cover the fact that you’re

just not active anymore, just to do right.

Okay. So, all right. What else?

Well, Shannon has one here. Okay, that I don’t know if we’re gonna have the answer to or not. But let’s take a look. It’s a long one. So I’m going to synopsize she’s curious about the health of older people with type one who have had what she’s calling wild blood sugars in the first part of their life, but then learn tighter control later. Will they have you know, issues like that? or other health complications. And the last part is people who had to survive without CGM. Okay, so people who lived before all this technology, you know, like me? Yeah. Like

I lived before all this

fallacy. Oh, you know, I mean, I would I would say what we’ve said in the past is you can’t bank health. Right. So you, but

I don’t know it also is not a like it, you know, the question really did really poor control leave lead into issues now that even with good control won’t negate them all? we don’t we don’t know. Right, right. I mean, for the most part that earlier, less than optimal management wasn’t good. I mean, it wasn’t helpful, right. But does it mean that down the road with more optimized control, especially with the technology that we have, likely the control now is a huge benefit. And the fact that you were likely younger, and had the benefit of youth at that point, versus being older and now having really tight management, that’s the benefit now that you’re older. And as body systems age, things can break down faster? It is. It’s just the life cycle. Right? It would

make sense that while your body is older, and you know, by definition, more frail, that the better control, the better off it would be. I also do you remember back when they used to tell you like, Oh, you know, don’t worry about blood sugar control in the first couple years when outlawed little kids even when Artem was first diagnosed. I was like, that doesn’t make any sense to me, like a little bit it does. Now when I look back on it, like the idea of like, okay, she’s young, and hopefully she’s vital and healthy. And if you know, we scratch her arm, it’s going to heal back over. And so if we scratch some veins on the inside of our body, they should heal. Okay. I don’t know that that would be true for everybody. But I get the overall idea. But I think the danger of that idea back then, at least the way I saw it was that you were giving people the idea that blood sugar management didn’t make a damn bit of difference. If you were young enough. You know, you’ve got five years to figure it out. Like I remember being told that when she was two, like, Don’t worry, she’s little. This won’t hurt her right now. Like that does not make any rational sense to me.

Yeah, my nephew was actually kind of the same thing. He was diagnosed when he was seven. And that was actually something that their pedes endo actually told them where I heard it. 100% it was, you know, don’t worry right now he’s not, he’s not in his teen years. And you don’t have to worry about anything? Well, from a, from a true standpoint, what I know is that we want to aim for more optimal, regardless of what age you are. Yeah, there are, there are some, like factual studies that have actually shown that once kids get to the teen years, with the hormones of growth within the teen years, that starts to make more impact on potential future complications. If glucose levels are poorly controlled, in that timeframe of life, comparative to earlier on, when the hormones are different, there’s still growth going on. Obviously, you can see it in your kids as they grow when even when they’re little, and they’re not a teenager. But the difference being more of those like sex hormones really into the teen years have more of an impact. For whatever reason, I’m in the standpoint of glucose control being better or worse, and then what happens down the road? So

trying to imagine like, you know, changing the sentence slightly, like, how about this one? Your four year old can smoke cigarettes, they’re young enough, their body will fight it off. Would you say that? No.

How about No, Speaker 1 44:14 no, no, just a little crack cocaine. She’s only six. Yeah, like, she’ll bounce back from that

wants to have the beer for dinner every night. Let her have

a little she’s only eight. It’s never gonna impact her long term. Like, none of those things make sense to me. Don’t right. And so when I was told that I was like, Listen, I am not buying into this mess. You know, uh, but at the same time, it didn’t go well for you in the beginning. I think it is a lot akin to smoking cigarettes. The sooner you quit, the better off the rest of your time is gonna be.

That’s right. That’s I mean, that’s the reason that you know, parents are told not to smoke at home with their kids.

Right, everybody.

I mean, it’s actually something for my nephew. I told him parents when they said, well, the doctor says it’s okay, if you sit at you know, 200 all night, it’s pretty safe. And as long as you staying under 250 That’s okay. And I’m like that that’s not okay. I mean, I really had to, like, emphasize to them that that that’s not okay. He might only be seven, eight years old. But these numbers are not where you want him to be.

Right? Well, um, here’s what it reminds me of. And I probably said this once before, but it fits right here very well. I once helped a person in their late 30s make a pretty drastic transformation to their management pretty quickly. And when it when it kind of, you know, our time together came to an end, this person was really grateful that their blood sugar’s were now, like in range and controllable, and, you know, not so variable, but angry and sad that someone hadn’t told them about this sooner because they had had diabetes for you know, the better part of 25 years. Right. And and we’re really concerned about exactly this question, like, What’s going to happen to me in the future? Based on what happened to me, you know, in the beginning, and why would nobody have explained to me that, you know, Pre-Bolus things important, or any of the other little things that we talked about together? And the best I could say, in that moment, because I was out of my depth, you know, what I mean? Like, I don’t have diabetes, no one’s ever lied to me about my health care for dozens of years. And so I just said, Listen, you know, now, just do a good job, move forward. You can’t change the past, you know, any other birthday card euphemisms you can think of, there’s no sense in hanging on to anger about this, like you have a real chance. Like, let’s see what happens. You know, I keep doing it. And and let’s hope for the best and right. I mean, do you really have any other options than hoping for the best?

No, there’s not. And even, you know, if you knew what wasn’t working in the past, it was likely because technology wasn’t where it was today, right? I mean, my my mom definitely says, as I’ve said before, if she had the technology, now, she would have felt a lot more comfortable sending me off to a sleep over that the parents weren’t given like a two page sheet of instructions of what to do, you know, she would have been able to follow things from home and felt a lot safer when she sent me to sleepaway camp. And, you know, all of those pieces of management that were there, we did the best that we could, but I’m quite sure that in between the finger sticks, I had a date, I’m sure it looked like a roller coaster, because we didn’t know what was going on.

I think that at some point in the very beginning, the statement 200 safe overnight, don’t let it go over 250 I think that was probably reasonable at some point, you know what I mean, because of the lack of technology. And when they say safe, they didn’t mean safe to your health, they meant safe, that you won’t drop too far and get really low. Like that was the that was just try to understand that at some point, because of where the technology was, in the past, the entire focus of type one diabetes management was don’t have a seizure, right? And don’t go into DK, it was literally these two opposites. They didn’t care about anything else, because they didn’t know to care about anything else, because they didn’t have the ability to care about anything else.

And for little kids who don’t often have symptom awareness.

Even more important, even more important back then. Right? They can’t tell you the problem ends up being is that as we leapt forward and leaped forward and leapt forward with technology,

the education didn’t

Yeah, and and, and these, you know, tried and true methods of well, 200 safe and don’t go over 250 they got passed down generation to generation. So what you’re really seeing is that there’s one group of people, health care providers, right, who have an origin story. And that origin story builds on how they talk. But a different group of people over here, device manufacturers, right? They’re trying for something different. These two people do not intersect in their day to day business and the way they talk with other people. So while this guy’s telling you to hundred safe, this company is over here telling you Hey, I think our gear can keep your blood sugar at 85. Which one sounds scarier? When the doctors telling you just to hundreds, okay, you don’t want to get low and then the next person is like, Hey, 85 is possible. That sounds scary. Right? And so you’re never going to reach the masses. Until healthcare professionals have the ability to believe that the technology does what it does, and are willing to say it out loud. And you know, I don’t know. Good luck with that. Good luck getting a bunch of people to say what they think you know, instead of what they think is safe to say. Luck. That’s gonna be very interesting. You know, if the FDA would let not let but I guess if if device manufacturers could get into the business of teaching their devices beyond, this is how it turns on and the sound turns off, then they might have the, the onus might be on them to show you how to use it correctly. Right? And because then they could really market their their devices as living healthier, not just easier, because that’s how that’s how they’re stuck. That’s how they’re stuck marketing right now. It’ll make your life easier. It’ll be a smaller part of your life flexibility. Yeah, yeah. You don’t want to have to disconnect to do this right on the pod. And like, like, and that’s the stuff there. I don’t want to say stock saying cuz that’s a lot of valuable information in there. Yeah. But they don’t get to say the rest of it. Like, why don’t you try the Basal increase when you have pizza? Like, they can’t say it, they can say the pump does a Temp Basal increase? They can’t tell you why in the heck you might want to try. Try it. And therefore it’s a tool you don’t really it’s a screwdriver, and you don’t know how to use it. You don’t know what it’s for, you know, just know you have it. Anyway. Alright, that went down a weird road. Um, let’s see. Sarah says, Sarah has three names. And her middle name is fun. Sarah says, I’m not sure if this is big enough. There’s nothing too small to Jenny and I won’t talk about. But is it true that younger children are harder control to control compared with older ones in terms of their blood sugar? Does body size make a difference? I always look at people stable graphs with such envy, as we seem to go up and down so much. That sounds like their daughter’s two years old. Is that more normal in younger children? Or is that more proof of my inexperience? Because we’re only about a year and a half into this? Well, I think it’s probably both an indication of your inexperience and normal. I always tell people, you know, figure out how to use the insulin so you can feed them so you can fatten them up because this is easier when they get bigger. But I don’t know if that’s just me, or if that’s true.

Ya know? And they’re they’re kind of a number of questions within the question, right? There’s, there are a number of things to kind of bring about our younger kids harder to manage than older kids. I think it’s, it’s a different strategy of management. Because variables through the life cycles change whether you’re two or 82, there’s always going to be something that’s a little different in young children, you know how fast growth happens. So growth, impact is always going to be more profound than when you get to, let’s say, the teen years, especially for like a teen girl, let’s say, who’s not growing anymore. But now she’s got hormones and a monthly cycle and things like that. So that’s in the picture, despite growth not being in the picture, right? You know,

we talked about it wrong, though. We always say diabetes is always changing. Diabetes is the same, their bodies are changing. That’s right. Right, right. So you know, when your kids littler, and like Jenny’s saying they’re putting on a pound or two every couple of weeks, that’s making your bazel not correct, as they get bigger and bigger, right? Or at the same time, they become more active, they start to walk or they start to do more things. That changes the impact. And, and so is it harder, it’s the same, it just changes more frequently, or growing, right? And then right, when they get to that point, you’re talking about where they’re like a, you know, an adult woman who’s getting their period. It’s still happening, but it’s happening cyclically by week, this week is different than that week, and that week is different than this week, and you have to know what week you’re in.

Correct? Yeah. And then, you know, with little kids too, you know, the other the other part of little kids that can increase the amount of variability which she brings in, you know, I feel like we’re all over the place versus some of these graphs that I see it that are just nice and flat. Well, the variability with a small child, 235 years old or whatnot, you know, and I mean, I know myself with even the way that my three year old eat, he could love the same exact breakfast and eat it 100% for five days in a row, and I give it to him On the sixth day, and he eats three nibbles, and he’s like, I’m all done, mom. Okay, well, great. Now, if I had to, like Bolus for that, and I work with so many kids that I see this as a consistent problem, right? I mean, that as variability. Now you’ve bolus for this amount of insulin, and there’s not this amount of food there. So you have to offset it in some way. Well, that brings in a potential roller coaster. If you haven’t quite yet figured out how to offset what you sort of front loaded with.

Right. I I always say that I think the key to Pre-Bolus in kids is to choose what ever amount, you know, they’re gonna eat. Like it might just be five carbs, but nope. But have you ever sat your kid down, they’ve just been like, I’m not eating this at all that they put something in their mouth, right or they switch to something. So if it’s a 20 carb meal, and you have that feeling of like, I don’t know is this the day the kid just doesn’t eat their breakfast Pre-Bolus five, you know, carbs have it right and get some insulin on your side. And then when you see Oh, this foods going in, then put the rest of it in right away, or they throw up their hands or like not today, lady, then you’ve got some time to decide what else they could eat, you haven’t personally insulin for the entire 20 carbs. Now you’re sitting there, just staring through the wall going, Oh, my God eat food. Because there’s, because there’s reasons you don’t want to do that. You know, because you don’t want to cause a weird relationship with your type one diabetic and food, you don’t want them to feel like food is the thing they have to do even when they don’t want to. There’s some really good psychological reasons not to do that. Ah, you also don’t want to get into the roller coaster situation where their blood sugar goes to 300 and then comes crashing down and then they have to feed them and that becomes your day. So you have to Pre-Bolus something. You know, it’s so funny that I was corresponding with a person who was gastroparesis one time. And they were saying I really want to Pre-Bolus but I don’t know how because some days my body starts to digest my food. And some days it doesn’t. Right. And after a long phone conversation, I said, you should do what people do with little kids, and just get a little bit started. And then as you see your blood sugar, wanting to go up getting the indication that your food is being digested, then throw the rest of it in, right, that ended up working for that person,

or throw some in and extend the rest of it, or keep

eating it out into the future. But get it

moving. Get it moving.

And when I said that she’s like, That’s brilliant. I was like, that’s not brilliant. That’s desperate. I did not know what else to say. Like, well, but you’ve

had enough experience with other situations in which that that sounded like a good alternative.

parallels to try it. Yeah, yeah,

absolutely.

Absolutely. I was gonna say that I think that a pit that we all fall in it’s one point or another with diabetes. Or maybe life in general, is feeling like there are rules that we don’t know. And that we have to find those rules so that we can follow them when obviously, that’s not how life really works.

There are guidelines, I always feel like it’s like this is your guideline to like, the exploration of the woods behind your house, right? There’s no rules to follow. It’s just don’t go near the growling bear in the bush over there best practices, maybe some best practices, you know, that kind of a thing. The other thing that I did want to say is, you know, it’s really hard with today’s online community with diabetes, which is phenomenal. It is great. I wish I had had it as a teenager and even an adult into college. It would have been fantastic. But I also think that we unfortunately, start to compare to what other postings show. Right? And I I don’t think that’s fair to do. So in this case, you know, this mom was like, why see these straight graphs all the time? You don’t know what went into that straight graph. Yeah. You don’t know the food intake, you don’t at the activity level, you don’t know where they are in diagnosis, or whatnot, there’s, there’s a lot more that goes into that flat or that curvy or that, you know, up down roller coaster or whatever kind of graph. And so it’s easy to stay, it’s hard to like, accept, but don’t judge your own management off of what somebody else has posted.

Yeah, the things that they say are the important parts of getting that so I’m going to show Jenny something that she doesn’t see they’re gonna see versus that where’s my camera? Can you see that? Mm hmm. Okay, so that’s three different people I’m tracking on Dexcom. Wait, what are their blood sugars?

Ah, one is 98 with a horizontal, straight, steady, and other one is 93 with an angled arrow up, and another one is 130 with a steady straight horizontal arrow,

okay. Do you know what those three people have in common? They all have diabetes. They’re managing their diabetes. This is gonna sound horrible to somebody. But trust me, I’m not trying to be like that. I’m not being pompous. They’re using my style. Sure, that’s what they have in common. They’re reacting to certain things, doing certain things, not letting some things happen. Like that kind of stuff. There’s a it’s a system, they have a system on their head. They’re following that system. And so at the same time of day, those are three people blood sugars that are pretty much the same, you know, they’re there. They’re stable in a great spot. Yep. It’s because it’s, it’s the style. It’s your style of management. So when when Sarah asks, Is this my inexperience? Not my circle, it might be an experience, it also might be that you’re very experienced that something that doesn’t work, right, you know, and now you’re just beating your head against that wall going out, understand, this is what I was told to do. Why isn’t it working? So there’s one of those kids on there, I was texting with their mother last night. And I was like, you know, you need to give her some insulin right here. And she’s like, I don’t want to her blood sugar is only 140. And I was like, I don’t care. Like, if you don’t stop this 140 and make it 90, then two hours from now, when she goes to bed, she’s going to be 200. And then you’re going to get into a different space. And so my concept is, if you don’t get high, you won’t be high, you will be high. Right? And and it turns out if you put those concepts into practice, I mean, the pro tip series you and I did is just it’s that’s it. Like that’s the whole thing right there. If you do those things, that’s it. If you if you gave me three more kids, their blood sugar’s would be right around there right now, then there’s anomalies that happen, like, you know, I don’t sometimes, you know, people eat things. They don’t say what they eat, or they miss count carbs or don’t don’t aren’t intuitive enough about glycemic load and index and stuff like that. But for the most part, you take the steps. It usually works,

right? I mean, I don’t

know another way to say it. Like, I’m not trying to say it’s easy. It’s not easy. But there there is a formula in there to leads to that. Mm hmm. So that’s two kids in there that are, you know, one of them’s probably still asleep, one of them they’re in, they’re in different time zones, but they all have the same experience

strategy.

Yeah. So Sarah, I think you figure out what works. And then stay flexible while your kid is growing. And keep applying the tools. Understanding that the game is changing, right? A little bit. So yeah, if that makes any sense or not.

And certainly reach out, you know, for help. Remember to ask more. Remember to ask more questions, even at your doctor or endo visit or CDE visit or whatever it is. Remember to ask more in depth questions in order to get more in depth help. Oftentimes, I think people end up going in not really knowing what to ask because they haven’t gotten help before. So they just leave it up to the doctor to kind of give information, and then they get nothing back. And they think Well, my bad, dark, dark doctor is not very helpful. But if you don’t bring in more I see this happening around gymnastics every day. I see this happening every Tuesday, Wednesday, Friday. Can you help me? Great. Now the doctor has more to go into the data and pull and get a trend. Yeah. And offer better suggests you have to

you have to step back and have a macro view of diabetes. But you have to have micro questions. Right? Like, right, so like, you can’t just yell. I don’t understand every night at midnight, her blood sugar’s high. But that’s your macro view of it. That’s not helpful to the person trying to help you. What’s your micro view of it? What’s happening in the hours just prior to that? Those are the things you need to know. You know, it’s this one kid’s blood sugar’s were not great. Three days ago. And if you looked at the tech, I did it through texting. If you look at the questions, I asked them, most doctors would not look and go, Oh, well, those are the questions that need to be answered to fix this kid’s blood sugar. I ask really odd things that answer the questions I need answered. And so my point is, is that those are the questions to me, you ask? Those are the like the micro specific questions. Yep. And I don’t know how you Sarah, I don’t know how you figure that out other than experience time and don’t give up. But I can tell Sarah and anyone listening this? My experience has been that people who are thoughtful and concerned and care and ask questions like the one Sarah’s asking, those are the people who make out well, because they’re there, they’re interested.

Right? And they’re trying and they keep looking until they get an actual answer that helps.

That’s it. They’re interested in, they’re trying and they care. And to be honest, that’s pretty much what you need. Right? As long as you don’t give up. You’ll find it at some point. You might not find it for me, you might find it somewhere else. But right you’ll find something that somebody says that clicks with you and makes it all feel kind of easy at that. Right. Jenny are we at a time?

You have about nine minutes left nine minutes, or something easy for nine minutes?

Um Oh, there’s no answer to that one at all was like, oh, half an hour conversation and a lot of people asked it to, uh,

maybe it’s a maybe it’s a

Well, let’s find out what you think. How do you calculate your bump and nudge ratios? So when I say to somebody, hey, that blood sugar’s 140, I’d like it to get back to 90, bump it back down. That’s not a, it’s not a measurable idea to people, I guess. Okay, so I usually say how much insulin Do you think moves it from there to there and just go with your gut.

Right. And it kind of starts then with kind of brings you back to the pro tip series of figuring out things like bazel and sensitivity factor. And even, you know, that kind of stuff. Because really, anytime you’re playing with the bump the nudge, you’re playing with the assumption that you know, a certain amount of insulin, let’s say one unit will move your blood sugar, a certain number of points, right. So if you know one unit changes your blood sugar by 60 points. And you know that your cup of coffee in the morning without bolusing. for it, you’ve noticed that it kind of raises your blood sugar by 65 points on average, well, you know what, then you need to start taking a unit of insulin to stop the 65 point rise, because one unit offsets you by 60 points to drop you from too high, right back to where you want to be. Right. So the bump and nudge is kind of if they’re looking for a math, it goes along mostly with sensitivity factor or correction factor. It goes along with how much do I want to knock this down, and how sensitive I am I to insulin at this point in the day, because many people also have sensitivity factors that differ based on nighttime daytime, afternoon or whatnot. I myself have two sensitivity factors, one that lasts through the day time, one that’s overnight for me. So you know, I’m more sensitive to insulin overnight. So I don’t need a load of correction. If I choose to Bolus for a higher number that gets up there overnight. I don’t need as much overnight as I do during the daytime. Yeah,

I have to say I don’t think I take it for granted because of the podcast. And but if I wasn’t talking about diabetes as much, I probably would, that idea that I can look at Arden’s blood sugar to 11 o’clock and say, that needs a half unit and look at that same blood sugar at 7pm and say, hey, that’s a unit or at four o’clock in the morning. It’s point two, it just, I don’t know how to explain, other than to say, I look at the blood sugar, I look at the situation. And then I know how much to give her. But I don’t know how to tell you what I saw. And how it led me to that answer decision. Yeah, other than to say have diabetes for a while. And all of a sudden, you’ll just sort of know.

Some of it is some of its experienced definitely like I you know, I can say that. Gosh, if I know that one unit again, changes my blood sugar by 60 points. But I’ve also got like a load of fat in the picture. Well, gosh, yeah, need a lot more of a nudge than you would if it was just because of miscounted carbs.

And I’m not saying that I haven’t adjusted a blood sugar at 1am at an hour and a half later been woken up by the same high blood sugar and then thought, oh my god, what we ate for dinner. Now I remember like that’s gonna happen, you know. But the good news about that is, is that I was trying to stop at 140. And it’s still 140 I didn’t stare at the 140 hope for the best watch it turned into a 220 Bolus for it, forget about the pizza, get up again at three o’clock when it’s 250. Like didn’t even like eat right, don’t let it get out of hand so that it’s manageable, and then the bumping in the nudging becomes less, in my mind dangerous because you’re using less a less a smaller amount of insulin to accomplish something. So I say if you ever seen me speak, which might never see again. But that jokes funny for a couple of reasons. And everyone listening is only gonna get one of them. But that’s okay. Yeah, thank you, Jay. which you may never see again, if you know, I’ll say look, I’d like to see a stop a 110 or 120 diagonal up because you might stop it with point two or point three or if you’re an adult with a unit like a tiny bit of insulin, you come back to 90, and you sit stable again, the likelihood of you getting low after that is small because you’ve used such a small amount of insulin to begin with. So that’s how you keep from overcorrecting. And that’s how I think of bumping and nudging. But and

that is that is really where our where our hybrid closed looping systems, like control IQ, you know, with tandem, that’s really where those systems are going. The idea that the bump and nudge becomes less of your play and more of the pumps interaction because it’s got CGM data to interact with and it can see a rise happening. It knows Okay, I’ve got this value, I don’t want this person to get above. So it starts nudging it either with a temporary bazel change, or with these little micro, you know, boluses, the control IQ system is in a system so far in what it can do, but I think that’s where, you know, further progress into the pump company. Is that where they’re going with the technology? Yeah, because they don’t want Well, they don’t people with diabetes don’t want, while you know how to pump and nudge now, you don’t want to have to pay attention so much to have to do it all the time.

I always tell people to bumping and nudging is a teaching towards some point, you should learn from the bumping that you should have done something different meal, you know, like it’s not a it’s not a long term idea. It’s part of a bigger teaching idea. And having said that, when I watch an algorithm change basal rates and you know, put insulin in, I’m like, that’s what I do. Wow, I’m not gonna have to do that. And exciting. And by the way, bumping in nudging is, you know, it’s my idea, the words, and they’re for sale. Like if a pump company wants to buy them for marketing materials, I’m open to having a conversation, you know, just let me know. Anyway, Jenny, I’m gonna say thank you. Hold on one second. Thank you. You can actually hire Jenny Smith, did you know that she works at integrated diabetes. And they have a website aptly named, integrated diabetes calm. So that’s where you can find more about what Jenny does in the professional life. I don’t know how often I mentioned this, but I like to bring it up once in a while Jenny is not a paid contributor to the podcast. She just really likes being here. So this is not an ad. She’s just a friend who likes being on the show. But that doesn’t mean you can’t you know, there are a couple of bucks. Get some help with your blood sugars. That’s what you need. Thank you so much for listening to the Juicebox Podcast. Thank you for supporting the sponsors sponsors like Dexcom that you can find out more about@dexcom.com Ford slash juice box. And how about tubeless insulin pumps? Well, there’s only really one, but it’s called Omni pod. And you can find out more about that. And get yourself a free no obligation demo sent right to your home by going to my Omni pod.com forward slash juice box. And to find out more about Arden’s blood sugar meter, the Contour Next One, you go to Contour Next one.com forward slash juice box, you’re seeing a theme here you get it. And of course touched by type one is that touched by type one.org great organization doing wonderful things for people living with type one diabetes, and all they want is for you to know they exist. So go check them out. Touched by type one.org you think we’d get a juice box slash in there, but it’s not happening? Okay. I’m not hurt. Oh my god, that was exhausting. I’ll see you guys later. Bye. It’s hard to talk like that for a long time. Everything’s real deep and you’re trying to enunciate and to not over speak or understand like, Hello, this is the word of God. You know, all fields like that a little bit. It’s been a long week, too. It’s Friday. I need to get to the weekend. Actually. I’m turning 49 on Sunday. And I’m feeling every moment of it. I’m not I’m okay. Am I it’s hard to tell. Who am I arguing with

Hello, everyone, welcome to Episode 369 of the Juicebox Podcast today on Ask Scott and Jenny. And these are questions that Jenny and I did our best to answer that came directly from you. Today we’ll be talking about sleep overs, relocating, finding new doctors, blind management, which is the idea of being able to manage Type One Diabetes without being with the person that you’re helping. And what are those other doctors that people with type one diabetes need to visit? Now you guys know Jenny, by now, Jenny has had Type One Diabetes for over 30 years. She’s a certified diabetes educator and a lot of other cool things. But mostly, she’s the first you know, from the pro tip series from ask Scott and Jenny, of course, and defining diabetes. Jenny really is just the cat’s pajamas when it comes to type one and a couple of other things. Please remember, while you’re listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin. If you hold on for just one second, after the music, I have something for you. So today’s show doesn’t have a sponsor in the classic sense, meaning that no one has you know, paid a fee to put an ad on the podcast today. What I do have, however, is an opportunity, one for you. And one for me. One for everybody living with Type One Diabetes, actually, but let me explain a little bit to you. If you remember back a number of weeks ago, maybe it’s months now, the CEO of T one D exchange came on. It’s a nonprofit that does data driven stuff to help people with type one diabetes. Anyway, after that episode, I maintained a relationship with T Wendy exchange, we’re talking back and forth about a couple of things. And they asked me if I’d be interested in helping them gain participants for the T one D exchange registry. So see the T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters for like the parents of somebody with type one as well. The participants are volunteers that provide their data for research by just answering these questions in an annual survey. Once you’re enrolled, registry, participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one diabetes, help accelerate the discovery and development of new treatments, or to generate evidence that supports policy and insurance coverage changes that help people living with type one. So if you’re not just paying for me to tell you this, how does this work? This is important for me to tell you, I want you to understand this. Every one of you that goes to the link, T one d exchange.org. forward slash juicebox enters the registry, answers a couple of questions to see if you’re eligible. And it’s really just about having diabetes, couple other things. And then complete the questionnaire, which I’ve done already took me about seven minutes, I actually did it live. And I recorded it. So it’s at the end of this episode. So you can hear took me about seven minutes. The questions are very basic and completely anonymous, your information will never be attached to the answers, they will never know that you. Let’s say your name, for instance, is john. And john, your information, the answers to your questions will never be attached to your name. It’s taken very, very, very seriously. HIPAA regulations are followed to, you know, the nth degree. Anyway, this information impacts all kinds of things. For instance, you know how Medicare started covering cgms. They used the data that the T one D exchange was able to pull together to show how important that was. And it helped move that legislation forward. It’s helped coverage for test trips, it’s helped to show that Dexcom can work without finger sticks, all of this different stuff. But but here ends up being the real problem. The more data that they have, the better. They can do their job. And the T one D exchange is having trouble getting enough people to do it. That’s why they came to me they thought that this podcast could reach more people. It’s not a situation where people don’t want to do it. It’s that they don’t know it exists. So they don’t know how to do it. So they don’t just need 25 of you to do this. They don’t just need 100 of you to do this. They need thousands of you to do this and it’s super simple. Again, you’ll see at the end, but you go online, the website is really clean. It’s very intuitive. It’s easy to get through a couple quick questions. Am I okay to do this? Yes, comes back immediately through your email, you keep going, right there on the web page, answer the questions, I go over every question. So you know them. And then that’s it. And then annually, so yearly, you’ll be asked to kind of update your answers to some things and maybe ask different questions. I put a lot more information at the end of the episode, so you can understand this. But that’s it. It’s super simple, and incredibly valuable for people living with type one. So if you’ve been looking for a way to support people with type one diabetes, and if you’d like to support the podcast, this is going to do that, you know, with one one effort two birds, one stone, think of it any way you want to, you’re going to help people with type one, you’re going to help yourself, you’re going to help your child, you’re going to help the future with type one diabetes, and you’re going to help support the podcast. T one D exchange wants you to know that the purpose of the study is to collect the information from individuals with type one diabetes, and parents of children with T one D to learn more about the management of type one diabetes, how it may change over time, and how different management approaches relate to glycaemic outcomes, acute complications and the use of health services at this time, there is no end date in sight for the registry. T Wendy exchanged hopes to follow a large group of people with type one diabetes over many years, so they can get a very firm grasp of what all this data means. Anyway, I think the people listening to this podcast fit perfectly into this idea. And I know we can reach a lot of people. So if that sounds good to you, and you can spare a few minutes, T one d exchange.org. forward slash juicebox. Links near show notes and links at Juicebox podcast.com. us residents only. Oh my god. Hi.

Hi.

When you texted I was like leisurely. Just you know,

like getting a cup of coffee or no tea. Don’t drink coffee. Tea. Yeah, I was.

I had a Arden’s blood sugar got low on me at 4am Oh, no, just two seconds. I got up and I fixed it. But I I stayed awake to make sure. And then the dogs barked. And then before I knew it, it was 630 to get out. I hadn’t been up yet. And Kelly let me sleep. So I just like 10 minutes ago, my eyes was like, Huh, it’s morning. Funny, I don’t sleep in ever. I never get to sleep in. So I was like,

well, that’s a long sleep. And it was.

And so I was like, Okay, cool. Like, I’m gonna go set up and get ready. I’ll take a shower. And then you’re like, I’m ready. Lady, what’s going on? All right, Jenny, let’s actually get to the questions here, shall we? Get Megan Megan goes, I’ve heard Jenny talk about when she was little. This is about little tiny Jenny Oh, and did sleep overs. I’ve never let my daughter go to someone else’s house overnight. She’s nine years old. Any helpful hints? She doesn’t wake up to her phone alarms. So it would have to be me calling in other parents when she needs something. Well, I know what I do. So you’re in a different position. You’re, you’re not little Jenny anymore. But like, let’s talk about that for a second back in the day. Like why was it easier when people knew less about diabetes? Like and I mean about the data and what was actually happening? Because

Yeah, I mean, did you because nobody could follow anything. I mean, there was there was literally no continuous glucose monitor. And while there were pumps, they were they were nothing. So I didn’t I didn’t have one. I was only on daily injections. I mean, this lipo was first that I had, it wasn’t like some random person down the block that was like, Hey, I met Jenny at the playground. Let’s have her come sleep over. You know, I mean, these sleep overs were with good friends that knew that I had diabetes. I mean, they didn’t know much about the management of it. But you know, what my parents essentially my mom really did. And she was like, the order keeper in our house. Was she just kind of hyped up a plan, right, she was, she called the parent ahead of time. She knew kind of like what kind of snacks and things what we were going to be doing, whether it be like playing outside or whatnot before or if it was just an evening kind of thing where we’d be watching movies and then talking all night or whatever it was, you know, and she essentially just gave a guideline for Jenny needs to check her blood sugar at these times. Again, we had no continuous monitor just so I had to do a finger stick right and you know, has to have a snack at this time because actually at the time of doing sleep overs, and even In through high school, the insulin that I was on required very regular meals and snacks, I didn’t have the option of using a human log because it wasn’t available or a nova log because it wasn’t available. There was no rapid there was our right, which was longer acting. So I had very time two types of things. So I always had an evening snack plan. And it was just that my mom had to make a consideration for what that was going to be at the friend’s house. Now compared to what I usually had at home,

did you deal with the lows, the way people deal with lows now on that insulin.

Um, only if you didn’t eat only if you didn’t eat correct, because on regular insulin, you usually mixed it in a syringe with an intermediate acting insulin, which was cloudy, right? And that had about a 12 to maybe 16 ish hour impacts, you took that kind of insulin with the our insulin every 12 hours morning, you didn’t take any insulin at lunchtime, because the cloudy insulin was supposed to peak in action. And so the lunchtime met the peak of that insulin, so you didn’t take insulin to cover lunch. But again, meals were also very structured, like I had a certain amount of fruit and vegetable and protein and fat. And, you know, everything at the meal was very sort of sketchy, you know, a schedule that was regimented. So I think that might have actually made it a little bit. A little simpler. I would say

I’m honestly, I’m thinking your mom’s real concern was eating at certain times, right testing to make sure we’re not way crazy off one way or the other, and, and maybe having to adjust the insulin a little more aggressively for party foods that you didn’t eat every day.

Right? Right. And potentially knowing that, you know, the next morning, I mean, the call was always this Jenny’s blood sugar. It wasn’t that the parent of the house figured out what to do. It was that they called my mom and they were like, this is Jenny’s blood sugar, and that we did the math, and we figured it out. You know, we knew how much to take them in. Because we did have a correction. Yeah, you know, to be able to add in. But as far as overnight, I believe I remember the parents at night, waking me up in some cases, but I can definitely say not all the time to test. I mean, that was a, that was a thing that my parents did do at home. But I’m quite sure that my mom didn’t have them doing that all the time with,

it’ll be okay. It’s usually Okay, that kind of thing.

And she went with that, because she knew the kinds of things I was going to be snacking on at a party in the evening, were likely actually just going to drive my blood sugar higher than we would want them anyway. Yeah. And we just left him sit there. So you know, we didn’t know really,

so. So I think the two things here that make your experience different than Megan’s question is the type of insulin right that we use now versus back then. Right? And that your mom had things pretty well structured, right? Yeah. She wasn’t like, things weren’t a mess at your house for your diabetes. Your mom was like, well, we’ll just roll the dice and let her go. You’re like, shoot, right? She had a plan? I think it sounds to me, How old is your mom?

Um, my mom is

70. How would she do on one of these interviews? Do you think I just thought it might be. might be interesting to talk to your mom one day. But, but you’ll decide if that’s a good idea or not. I don’t I don’t need to know. But But my thought was, is that she was she was more like us, the people listening to this podcast, probably. But back then. She really, like dug through it. It wasn’t just as easy as you know, like, blah, blah. Like, I know, I had friends who had diabetes, you know, that long ago. And it was just sort of like, Hey, this is what they told me to do. And this is what I do. Right? They weren’t looking at it any farther than that. Right? And so

today’s technology has brought in the ability to see so much more. I mean, I mean, even my mom says, today, gosh, I wish that I had had this type of visual information. When you were little right. The things that we could have done differently is kind of, and I’m like, you know what, Mom, I’m alive. I am complication free. You did a really good job with what you had. And that is what it is, you know. But in today’s world with the technology we have, you kind of have to take it and say, What do you know about the people where you’re sending your child’s sleep over?

Right really going to do this thing that you’re asking to do? Or will they not see it as being important? But I also think that if Megan has a CGM, if she has a dexcom and she has shared I mean, which I think at this point, they all share like there’s not one that I don’t think anybody’s using one that they can’t see on a phone or, or something like that remotely. So is the idea for me. I mean, here’s how I did it. I think I thought, okay, I can’t not let Arden spend the night at someone’s house, right. And I’ve had two different experiences. I’ve had parents who lets you know what, I’ve had three different experiences. That’s interesting. I’ve had parents who just listened to what I said, and didn’t over or under think it. And that always went well. I had a guy who had struck him so hard. The Father, not the mother. He just stayed up all night long. He couldn’t bring himself and go to sleep. When I got there in the morning to pick him up. He hugged me, and we did not know each other. And it was a I’m sorry, Your daughter has this hug. Oh, like it was like that.

Like, I’m sorry that you stay up all night? Yes.

He just assumed I think that I probably know, he probably looked at me. Like, that’s why that guy looks so bad. But, yeah, I mean, I wouldn’t be I wouldn’t be okay either if I never slept, but no, he just, he cared so much. And he and he took it so seriously, that he couldn’t bring himself to have a moment he slept through. And he just sat up. Sure. And I’ve had people this one woman comes to mind. Who, if something would go wrong, it was fine if it went right. But if something went wrong, if Arden’s blood sugar got out of toe a little bit, she’d call me and say you have to come get her. And she made me pick it up at three o’clock in the morning, once. So I’ve had all the different experiences. So the people you’re sending them to, are a big part of this AR because you don’t know how they’re going to react to being able to see the data. Right?

And I think you may want to in that, in that sense, you may want to even start with the people who really, you’ve come to know them, well, you don’t only know their child, but you’ve come to know the parents of the child, right? You’ve gotten comfortable with them, they see your strategy of management because you’ve interacted socially, hopefully again, at some point.

What right.

video now. Right, right. So, you know, I think once you get to know people, they have a comfort level, because they can see how you strategize. And they can see your comfort level with it. It’s throwing a child into a setting where again, it’s like, the parent of a kid who’s kind of newer, to the group of kids your child hangs out with, and you’re like, they’re trying to get to know people. So they’re going to have a party and whatever. Well, you know, what, maybe call the parent talk, see what their comfort level really is with everything. Because people I’ve learned people get a sense of comfort from what you exude. Right? They, they, they feel eventually what you’re feeling about it. So if you’re like, oh my goodness, wow. I mean, they’re gonna be all like, anxious and like, ramped up

to, every time I talked about school, I tell people do not come off as crazy, because they’re just gonna think you’re crazy. And that’s going to be the end of it. Now, the person who made me come get Arden at three o’clock in the morning, let me say this. I was not surprised that she was the one that that happened with. She was a me person. And when it got hard for me, being her she didn’t want to have anything to do with anymore, but her kid was popular and art and was trying to, you know, get along. Yeah. Interestingly enough, now I think Arden’s popularity has changed a better way. Yeah. So I don’t see Arden trying to, you know, make friends anymore. It’s she’s just comfortable with the people she’s comfortable with now, which is really nice. But But this bigger idea. And Megan, you’re lucky you answer the SS question here. Do you know, years ago before all this fun technology, I actually sat in Manhattan for 12 hours in a television studio in a chair, and a light would come on. And someone would say you’re live in Indianapolis on CBS three news in 54321. And then I would talk about sleep overs. And I did it for Lilly. And then you’d sit back and say this one’s a radio, you don’t have to be on camera and you sit back and then you do a radio interview. I forget what they call them. But I did one one time for Lilly diabetes, when they were putting out this little book, it was like kids books or something like yeah, like the CoCo bucks. Yeah. And it was interesting, because I got to talk about sleep overs over and over again, it was a little more like, Listen, you really need to let your kids do this, because it’s a weird thing to restrict. Now, having said that, I know people who think that sleep overs are weird, and would never let their children sleep in someone else’s house. And I don’t know that I can argue with that. Like, I mean, if that’s your feeling then right on, but what I think is, is that if this is something your kid wants to do, and something you want them to do, having to restrict them because of diabetes is gonna have some sort of psychological impact. It might be a little But it’s not a good thing moving forward, I was never allowed to go anywhere, which will later build into I shouldn’t go places I’m scared like it could, it could pet right it could build, some people might not care. So I think if you’ve got the technology, the way I ended up eventually being good at letting art and go anywhere, was I would practice managing when she wasn’t with me through Texas Rangers, right, and then we got so good at it, I don’t need to be with Arden to help her with their blood sugar, right, then it becomes the overnight spot, then you have to have a person who’s willing to take a phone call, and knows it’s possible the phone’s gonna ring overnight and will wake up and can take direction from you over the phone. Correct me though.

And all kids too hard, a very different level of their own ability to manage, right? Some kids from early on, can wake up to their alarms, and they may not know how to treat it, but they wake up to it, they go shake their parent, they’re like I’m low, or their parent is already in the kitchen getting themselves think or whatever. Some kids sleep through everything. And it’s a good majority of kids who actually sleep through everything, you know, because they just kids have a very deep sleep, which is a good thing. But from the standpoint of alarms, especially when you’re trying to communicate with your child at three o’clock in the morning, and they’re, you know, six miles away. That’s it’s hard. So again, you have to have that communication piece with the parent, not necessarily saying hey, if to sit up all night and watch my child’s blood sugar, but if I call you, I would hope that you’re going to answer you know,

two other things with technology that helped with that. One Find My iPhone for people with iPhones, if you don’t know what find iPhone is it sends a piercing signal through another phone. So you know, you could send that. The other thing is to I would you know, after dexcom share was was you know, a thing. I put the the follow app on the parents phone, right? But only give them alarms for low extreme

high or really

percent right, I would put an extreme high or at 55. I said, Alright, listen, if this thing beeps you know, kind of deep and twice. Her blood sugar’s too high. And if it beeps, like faster, I can’t I said dumb and you’ll see like, it actually sounds more panic the low beat Yeah, it feels like it’s killing you, oh my god, you’re low do something. Or my brain is, you know, you know, attributed that to the sound at this point. But and I said, you know, it’ll be beep, beep, beep beep for really fast that’s low. Low means do something right now don’t wait, hi means we really should be getting her blood sugar down. And those were simple, like directions that I think they were able to understand. Yeah, maybe my

mom, my mom went as far as all the sleepovers that I went to I always had my glue gun kit with me. I did. I mean, the parents again, were knowledgeable, good friend, parents. And they, they knew how to use it. They knew the purpose of it. So I just I brought it along. But again, never had to use it in those circumstances. Thankfully, the parents never had to try to read the directions at two o’clock in the morning. And

it’s a tough thing to look at another human being in the face, pull the thing out and go, if she has a seizure, what I need you to do, like, wait, what a second now. Yeah, and you’re like, Oh, don’t worry, that’s not gonna happen. I used to say aren’t had diabetes for five years, six years, eight years, that’s never happened. We’ve never used one of these, I buy these and throw these away all the time, blah, blah, blah. Right. Having said that, if she should have a seizure, it’s not a not a reassuring thing to say to another person. But it’s a good thing. And so my point is, maybe have that this is how the glucagon works conversation, not at the drop off. But prior to that, so that you don’t put them into shock. You know,

and I think you’d actually just said something very appropriate. It’s the prior to, it’s the planning. Yeah, right. Most people don’t have any plan for dropping their child off at a sleep over. Other than just saying, yes, you can go get everything ready, and they drop them off. Yeah, as a parent with diabetes, you already know that you have to have a plan for a plan and plan B for Plan C and whatever else. Yeah. So it’s the plan ahead, the talk ahead, don’t expect to spit everything out at the parent as you’re dropping your child off at the curb and then be like, bye, bye.

This is not something you should be yelling out the car window. I’m actually thinking we should add a couple other things to this. So parties, picnics, things that you don’t go to because you don’t you know, you don’t like the parents. So you just I can’t spend the afternoon over there with those drunks, you know, like gigs or whatever. Whenever you know, something you Won’t be at. I think a lot of these ideas fit right along. And they’re actually simpler because people are always going to be awake during them. The one thing that I know causes a hiccup is a pool party when you go in the pool, now you’re not, you don’t have a signal for your CGM anymore, right. And so I think still, one of my, one of my most valuable diabetes skills, is being able to blind manage diabetes, like not to have to be with the person or see exactly what’s happening, to infer, from what I know about the situation or what I can see in the data. I think that’s why I’m good at looking at someone’s graph and being like, hey, blah, blah, blah, you know, do this and this and the way I think of it, the way I thought of it originally, when I realized I need to be better at this when I’m not with it, is I was always impressed by customer service people for computers. Like they’re not looking at your computer, but they’re walking you through the computer, right? Like they’re like, you know, see that thing over there. Click on that,

you know, the parts, they know where they are, they know where to poke it, they know exactly on a list of a drop down which one to write,

right, like, in my mind, make yourself a marine that can take apart and put his gun back together, blindfolded. Like, like that sort of a thing with diabetes. Like I feel like I’m there now, which will help you in your own life too. But it definitely helps you when you lose the signal. And you can calmly say to yourself, okay, the signals last Arden’s in the pool now, yeah, she’s not gonna swim that long, she doesn’t usually swim this long. So in about a half an hour, you know, she was 105 and a half an hour, if I haven’t heard from her, I’m gonna send her a text and ask her to get back near the transmitter for a minute. And be okay with that. And not be sitting around your house, you know, scrolling on the walls in your own excrement because you’ve lost your mind. Billy’s a nice boy. Like, you know what I mean? Like, like, try to hold it together is what I’m saying. And if you can’t hold it together a nice phone call to the host parent who’s willing to take that phone call or text just say, hey, I need you to have Arden test your blood sugar. Right? That’s all

and tell her to get out of the pool for five

minutes, text me afterwards. That’s, it’s all very reasonable. In the end, as we’re talking to Megan and talking to each other, and I’m recollecting all these things I’ve done throughout time with diabetes. In my mind, I feel like I’m like, I almost feel like I’m getting away with something or having a podcast, because is anything we’ve just said not common sense. Like, right? It’s just that what happens to us around diabetes, is the fear literally knocks that common sense right out to you. Correct? Yeah. And then and you cling to I need rules, give me rules to follow, if I have rules, then nothing will happen to my kids not gonna have something happened to him, I don’t want to happen. I don’t think that’s it. Like I don’t, I think those rules are just there to make people give them like a, almost a false sense of calm, where what you really need to do is understand it, and is different than anything else in the world really. You know, also making keep in mind is your kids nine, now she’s going to get a little older skin and want to go to a dance at the school, this is going to be the same, the same muscle you’re going to use there, you’re going to start sending her to parties, I hate to say this in the 1314 range, some little malcontent and your town is going to start drinking and think it’s really super cool to bring alcohol to a party. And hopefully your kid won’t be the one at 14 years old and artist that wants to try it right. But you know, by then I’d like to see you have a firm grasp on this. Because, you know, right, everything gets a little harder when they hit that, that age in there.

And I think you brought up a point to before about, you know, it’s your decision that you just don’t agree with sleepovers at all has nothing to do with diabetes, then for the child who has siblings, those siblings also follow the same rules. So it’s a little easier for that child to feel like has nothing to do with diabetes, it’s just because mom and dad don’t really agree with going to sleepovers. Whereas if your siblings are going to parties, and they’re eight years old, and you’re 12 years old, that’s really that’s not fair. It’s not your call, and you’re causing a problem that could be a problem later on for how that child continues to grow and feel about sharing about diabetes and being open about it and even managing it a little bit more on their own in an open way.

Diabetes is already an already has the possibility of being an issue in your kid’s life. You don’t want to turn it into that cousin that you talk about behind their back. Where you know, I mean, where you’re like, oh, yo, Patty’s great. And then at home, everybody’s like, Patti. So where am I? Right? You know, maybe like you, you know how it goes with family, right? Like because that’s, you don’t want your kid you don’t want to be telling your kid. It’s fun. This is manageable, you can have a normal life. And then, you know, three times a year be like, but you can’t go because of this diabetes. It’s not my fault. I’m not the one keeping you out of it. Because now you now know Nobody. Nobody likes Patti, and not therapy, and right, not gonna help you throughout your life.

No, no, I mean, I can, I can remember only one. And as an adult now, well beyond my teen years, I still remember this one time that I was not allowed to go to do something. And it was in high school. And I know it had to do with diabetes. I do. Yeah. And I know, because my brother who’s four years younger, so we were never in high school together, right. I finished I went to college, he started his freshman year, so we were never together. My senior year, our basketball team went to stay. And that meant that we wanted to travel with our team. And we wanted to go to state and watch them play a weekend tournament. Right? My mom wouldn’t let me go. All my friends were going my known friends, good parents that my parents knew were going to be there. My mom wouldn’t let me go. Yeah. And I knew the reason, despite her letting me go to a million other things, sleep away Girl Scout camp, sleep overs, all those things. But I was in high school. And she didn’t want me to go out of town to sleep in a hotel, along with this like, and again, I think from a visual had she had some information technology wise, she would have been okay with it. But yeah, that was the one instance and I know it was diabetes, because my brother when he was in high school, they also at some point went to state, the varsity team, and my brother got to go

could this has been a gender thing, as I’m asking was, was was your mom trying to keep Jenny pure another week? I don’t know. Why, why did you really want to go to the basketball tournament?

And that’s the funny thing that was a really like, I was I still am pretty much like a follow the rules. There are many things that I don’t, you know, follow strictly everything kind of go my, but I’m pretty much like the rule follower. And I was I growing up my brother was the one that pushed the buttons. He pushed the limits. He did not me. I was the firstborn and I did it. Like I was told I’d be home by 1130. I am home at 1120. I was told to be home at 1130. I I don’t know if it was the gender component. Perhaps it was. I maybe don’t

I don’t know, either. I’m just wondering. That’s all

anyway, that’s the only one situation that I

can remember if your mom was like, I’m just gonna pull this diabetes card out one time here to keep Jenny a virgin.

Boyfriend at the point.

Don’t need one of those at a basketball tournament. Anyway, that’s nice. Do we want to talk about relocating when you have type one, like literally moving somewhere else? Or do we want to talk about it or

have you? Oh, I’ve done.

Alright, here we go. MC pres what to do or what to consider when relocating, especially if you’re the caregiver of a younger kid with type one, what should I do before leaving? And when I get to my new location? All right, Jenny, you married somebody in the military. All right.

I did. My husband is a retired Marines.

So he actually probably does know how to take a gun apart with his eyes closed. And what else can your husband do in the dark? And? And

we’ll go with guns.

Yeah.

We’re just gonna talk about Jenny’s husband’s pistol for a couple more seconds. And then we’re going to talk about reload. I’m just kidding. Go ahead. What do you do to read now that I’ve got her?

Yeah, we’ve, we’ve relocated a lot. I mean, since we got married. We have moved many numerous times, within cities as well as out I mean, we grew, we moved. When I did my internship out to Colorado, that I took my first job and we moved down to Florida. Now we, that husband took a different job. So we moved up to Washington, DC. And then the area was very busy, and we wanted to be closer to family. So we moved back to Madison, Wisconsin to be closer to family when we wanted to have kids. So we’ve moved a lot. And in each instance I can say that prep ahead of time and so that this is a great question. I somebody is thinking ahead here, they’re thinking I know I should be planning something, but what should it be right? I mean, as as the person myself with diabetes, I always very quickly established, who to go to write with whoever my insurance was. Once we got there who I could see I called a bunch Have people I called around to see, you know, as an endocrine practice for adults? Do you see a lot of type ones? Or are you mostly type twos and you just dabble in type ones, or, you know, you’re only like, this friendly to this particular pump, and you don’t want to help anybody with anybody, anything else? I. So I guess, in that it’s asking questions, right? In within, again, kind of your network of provider availability, yeah. As the caregiver, those are some things that you can do ahead of time, that, you know, if you’re, if you know that you’re moving someplace, obviously, you’ve got a location that you’re moving to, you’re not just going to like live in your car on the street corner until you find a place. So you’ve either got an apartment, or a home that you’re renting or a home that you’re buying and your new location. You know, consider distance in a city, if the best provider is 20 miles across the city, but they’re the best. And you’ve heard the, the greatest things and they’ve got openings, you have to kind of fit that into your I can do that. And in the moment to see the person every three months or every six months. So I can do that? Or do you want to be closer? Do you have a lot more issues that you need to discuss, but calling around as well, like I said, if you know, especially because insurance dictates a lot of what you can do. So if you know what your provider is going to allow in the new location, look at the network of providers on that plan. Yeah, start to pick out some even even you know, with so much social networking online and the diabetes online community, there’s so many Facebook groups, especially available that can give you you know, parents of kids with type one, ask a guarantee, at least in some of the big major cities, and in most of the states, you’re gonna find somebody who answers you back and says, Hey, I live in this city, and I see this person and they’re really, really awesome.

You know, mine when you do that, though, everybody, everybody grades differently, like they do. What is awesome mean? Like, you know, in the back of someone’s head, awesome could mean you know, I come in there with an 8.1. And they don’t give me a hassle. I like that. It’s awesome, which probably isn’t is a good thing. I’m just saying that people’s expectations are varying. But I do think it’s a valuable way I just used my breach to try to find a an endo, for a girl in New York City. Yeah, you know, and I’m wondering as we’re talking, if you don’t, I wonder if you couldn’t set up a short conversation, not an interview, you wouldn’t call it an interview to the doctor, because they wouldn’t like that. Right there. God complex would definitely not like that. But um, but you know, I conversation where you say, look, this is how I manage? Would that be okay with you? You know, like, would you be open to helping me on this path, because I don’t want to take all the effort of coming to the PAC practice sitting down explaining to you what I do, and having you say, you can’t do it like this, or, you know, I just don’t waste your time or my time. I wonder if that’s not valuable?

I think that’s kind of the it’s sort of a more in depth. thing to do, I think more the tip of the iceberg for for filtering. Yeah, which is kind of what you’re doing is calling the providers that you can see, you know, on your plan or whatever, and assessing, most likely you’re going to get in contact with their nurse that helps them rather than the actual practitioner and ask ask them Yeah, right, you know, have a line of questions that are essentially, I use this kind of product, I use this kind of continuous monitor this kind of, you know, I use this software. Does your offer, is your office, you know, kind of allowable for these types of things. Do you use these? Would you allow me to bring in reports, if you can’t physically see them? How much time will you spend with me? I’ve got a lot of questions. I’ve got other things besides diabetes, maybe they’ve got celiac as well. Or maybe they’ve right can you work with them?

how flexible would you be if I said, you look, I you know, I don’t wait three hours to correct the high. You know, because there’s a there’s some places who’d know, I’m starting to believe they know so little about it. In regard in terms of like, looking at the data and making a decision, they need to know when things happen, because that’s how they think about it. I’m starting to think now that’s what it’s about. It’s not about I don’t want you correcting a high probably in the back of their mind. They’re like, geez, get this blood sugar down. But if you did, then they don’t know how to look at your graphs and make sense of them anymore. Right. And and so, you know, if I did that, yeah, right. I need these notes to say what I need them to say so that I can help you. Otherwise, if you bring me different data, I’m, I’m useless to you. You know, I’m starting to think it’s a little less about them wanting you to do something a specific way just to control you or because they think you’re wrong. And it’s more about them, about you getting them out of their element. By doing things differently than they’re accustomed to, right, right. But But and

that’s, that’s the notes component that I always talk to the people that I work with about. Your doctor isn’t necessarily like a bad doctor. Yeah, it’s just that one, they have a time constraint. First. Secondly, if you only give them your pump to download, there are no notes. There’s no history, and there’s no information about it. They can only take the information there and make suggestions based on data, right, but they don’t know the variables of your day. If you come into the office, and you’ve been in Aruba for the last three weeks drinking my ties on the beach. They didn’t know that when they looked at your data and said, well,

gosh, right,

what was going on here?

Sometimes people don’t know, I have to say, That’s weird. What’s happening right there. You know, I, you know, what made me think of this. And I’ve never considered this before. But I think it’s a good idea. Like you’re saying call head talk to a nurse or practitioner or something, get a feel before you lock yourself in, and then then have to go through that trauma. It made me think of, when my son was recruiting for baseball, we went to a meeting. And I think he wanted to go to this place. And the guy started saying weird stuff. And it was like any any we walked out, he goes not here, not this guy. And I went, Okay, why he goes, I don’t know, man, not here. And I’m like, all right, you know. So he just, he got some feedback back from this man that made him feel like this is not where I want to spend four years playing bass. Right?

Well, and you bring in a good point there too, from you know, this, this person is asking specifically for their child, they don’t know how old this child might be a young or might be a teen or whatnot. But I think especially for all ages, finding this would be a pediatric and no practice, right? But finding one that the doctor really has interaction with the child and expects the child to be a part of the conversation too. Even if it’s you, right? It’s it’s not just I’m talking to your parent, and you’re off in the corner playing on your iPad, because I don’t give two hoots about talking to you. I’m just going to look at your data. In my opinion, if it was my child, that’s not the kind of practitioner I want. My child needs to be engaged in that visit, even if they’re three years old. And the doctor just asks, Where do you like to put your pump? Or which finger Do you like to stick or write? I mean, there needs to be and that those are questions again, that you can ask ahead of time. How do you work with kids? Yeah,

and that’s good, because it might not be so important in the moment, but it’s important for when your kids 25 and feels comfortable talking to their doctor about their diabetes, right? Yeah, I our endo is very good about that with Arden. Because, you know, in honesty, Jenny’s right, they’re just they’re honestly those kids are really there. So they can check their sites to make sure their sites aren’t going bad. And like, you know, right, ask them, you know, the rest of the questions or to make them comfortable. And now you’re making a point, though, about being an adult. I think about this all the time for Arden. I wouldn’t know this if I wasn’t so involved in community. But adult endos are a bit of a grab bag. Right? It there’s not a ton of really good ones. And so, unfortunately, I want Yeah, I wonder how long I have to start prior to art and getting booted from a children’s hospital. How old? Do they let you be at a children’s hospital? You’re done college 18. Is it not? If you go to college, you can keep going there because PD pediatric? That’s a good question. Yeah. also find out about that.

Yeah, I would definitely ask about that. Because I know it used to be like, when I was kicked out of my pedes it I was 18 Yeah, it didn’t matter. That was in college. I was 18. And I had to switch over to a an adult and oh,

yeah, I’ll tell you, I might very well lead with Listen, here’s Arden’s records for all these years. I just need you to write some prescriptions. Can you do that for me? You got an A one c machine back there somewhere, you know what I mean? Like, like, that sort of thing. Without being cocky in a way that will make them be like not like you to like there’s that’s the other part of it is like you have to realize you’re building a real personal relationship even though it only happens 20 minutes at a time every three months. You don’t want the doctor to walk in and look you in the face again. This one? Yeah. I remember him. He didn’t need me, like didn’t mean like you’re you need to avoid that kind of stuff. So. Alright. That makes sense to be cover that,

I think All right, cool.

So here’s a pretty simple one. And now you got you go.

Oh, I was gonna say the one. The only other thing that I would add to the end of that would also be from a prep standpoint, which is the quote, you know the question make sure that priority tubing, you have enough supplies that you’re not in a rat race of establishing with a practitioner to actually get new prescriptions for things. Yeah. Because that a new new provider will usually not do, right. If they don’t know you from the corner, man. They are not going to write a prescription for you just because you’re in urgent need of one, but

the person you’re currently with would probably be happy to load you up before you moved. Yeah, right. I know. Um, one time, Kelly switched jobs, unexpectedly. Nice way of saying that, isn’t it? One time? Oh, and don’t worry, we’re fine. But but but you know, she switched jobs unexpectedly one time. And I was right on the phone, nurse practitioner, I was like, Hey, we might have a gap in medical insurance. And she’s she, I didn’t even have to like, finish my sentence. She’s like, Oh, okay. I’ll just send all the scripts here because we bought online pharmacies. Like I’ll send everything in right now. for it. I was like, thank you. There was it. So what I’m saying is that while my wife was transitioning, there was a stack of insulin in my refrigerator big enough that like, we couldn’t buy hotdogs get on me. Yeah, so we’re a little low on space. And, and, and that’s because we had a great relationship with her. But you know, she’s the one we know. So if you’re going to relocate, stopped up with the person who knows you beforehand. All right. We I think we can do this one before you go. Brittany said, all of the other. By the way, there’s a before I start, there’s there’s a question here that I don’t know if we can ever, I’m going to read your question, and we’re not going to do it. But it says I feel like so many of us struggle with finding the right balance of explaining diabetes, like fitting in the right amount of details. So they understand it’s more than a couple of shots, but not too many details where you give, but they give you the glazed over last

is like explaining to somebody else about

just like not necessarily the how or the why or the scientific medical part. But like a, hey, if you’re listening to this, someone you know, love has type one diabetes feel they need insulin for food they eat but not all carbs are equal, you know, and she goes, this is really interesting. She goes, basically, you know, could you roll all of the episodes of the podcast into a quick 30 minutes that I can hand off to another person? I don’t know. I don’t know if we could and at the same time, I’m I’m invigorated by the idea of trying.

Well, actually, that strikes of funny because I had a thought the other day, like as I was, I usually try to like read or like do a little bit of journaling before bed. Just like my down mental shift. And I was thinking, we’ve done a lot of like informative, I was like, I wonder if somebody would take all of these and like write them into a book. I make a book for

waiting for somebody to ask me to make the podcast the book. And to be perfectly honest with you. I started having that conversation with someone last year, and then it died somewhere along the way. But interestingly enough, for you know, I’ve written a book, I have this podcast, there’s a couple of things I’ve done throughout my life. If you knew how many things how many irons went into the fire and never came back out of the fire again, you gotta throw a lot against the wall to make something work, you know? Yeah. Yes, you do. I’ll tell you what I you know, hold on. Let’s do one more quick question about that. Okay. So Brittany says all of the other type one diabetes related appointments we need to make diagnosed for nine months and just heard last week, we need to make eye appointments for my four year old what else Don’t I know about? So I appointments are the, you know, the big one, right? They dilate your eyes, and they look all the way back there and they get a baseline for the health of your eye? And then you go back every year and do it again and again. Yep. Right? And what do they just tell people what they’re looking forward to that.

They’re really looking at the vessels in the back of the eye? Anytime you go to an ophthalmologist, not just an optoma optometry, you know, Dr. omala, just actually has studied enough and knows, like, kind of the diseases of the eyes. And also can really focus in and do that where they dilate the eye. They look at the back of the eye. They’re essentially looking at the vessels and they’re looking for what are called micro like hemorrhages, or big hemorrhages, potentially, but they’re looking for those vessels to have kind of opened, right. And when that happens, the eye tries to heal itself and it makes these tinier little vessels. But unfortunately, in that healing and making of little vessels, those little vessels are not as stable so they have more potential to break and or hemorrhage yet again, creating more problem in the eye so that you just we really want to establish and when I was first diagnosed, my doctor told my parents Not to have me visit the eye doctor until my blood sugar’s had actually stabilized after diagnosis. Because those high blood sugars can affect so much early on, it makes

it look wonky right there,

it makes it looks wonky. So you, you really want some stability after initial diagnosis to go in and get an eye exam, right. So, you know, nine months post diagnosis certainly get been established, where is the eye health right now, whether the child has to or 80, or 96, you want to have kind of an established, this is where your eyes are, because then every year at least, you should be having new checks. And if there are problems that do end up coming up, they’ll have you come in more frequently then, and there are therapies and things that they can do if there is a problem down the road. But that early on, gives you baseline, right. And for little kids, it’s it’s really mostly the eye doctor, really, I think of one two that many people don’t really consider relevant to diabetes, but it’s the dentist. Yeah, if you don’t have a regular dental routine for your children with diabetes, get on board with that right now. They should be having a cleaning evaluation checkup every six months at least. Right?

Yeah, it’s a for a couple of reasons a diabetes, but by your kid is, you know, we always talk about it, like, you don’t think of juice is a bad thing. Cuz it’s medicine. You know? Oh, my kid takes Smarties by do. You know, like, there’s a lot of simple sugars, especially in the beginning, when you’re really learning how to keep things, they are a lot of sugar that is not followed up by much teeth brushing. So you really have to be ahead of it. And I’ve talked about it on here before we just one time switch juice boxes, because Arden just was sick of hers. But I had the right one meaning I could track it, it did what I wanted, it didn’t have too much sugar in it. In the six months, she used the other box. And thank God she had baby teeth, teeth still, she developed 10 cavities from this different juice box. So you know, yeah. T says, Is there anything else you should be doing that she can’t think of right now.

I mean,

you know, we always talk about like, foot health as well with diabetes, right, just from the standpoint of like nerve health and everything. podiatry. I mean,

you know, taking your No, no, your four year old to the house. Yeah, this

unless for some reason they already have been established with flat feet, or something else, or they’ve got shoe inserts or whatnot, obviously, you want to talk to your podiatrist and inform them. Well, now we have a diagnosis of diabetes in the picture here, as well, just to you know, I obviously chart should show them that, but you just want to bring it up.

Yeah, if you don’t understand the reason, foot health is so important for diabetics, if you should develop neuropathy, and you can’t feel your feet now suddenly a small wound that you’d be aware of you might not be aware of any more wrapping that could be your fat goes on long enough, that can be a really terrible problem.

Correct. And in the same vein, you know, kids are kids. I mean, sometimes my kids run around in the backyard in the nice grass without shoes on. Yeah, I mean, technically, as somebody with diabetes, and technically, you know, we’re told Don’t, don’t not wear shoes, you know, walk in the backyard without shoes, and walk out to get the mail in the morning or whatever, you know, without my flip flops on, and, but I have feeling in my feet, no

buttons, nobody dresses.

But even for kids, you know, kids, sometimes they’re not very like a tune to their body, right? So check your kid’s feed every time you give them a bath or at night when you’re taking their socks off to put them in bed. Just check their feet. And that’s better than anything but don’t have

a paranoia around it puts don’t happen. Right, right. I mean, the only thing, the only other thing I would say to Brittany is that through the years, you know, I pay a little closer attention to blood tests. I think I don’t just take it’s in range as an answer. So, you know, what does that mean? Am I at the low end of the range of she thought, like were in that range? Is she and you know, I’ll go into it in another episode. But, you know, Arden has hypothyroidism but her labs were quote unquote, in range, but we were watching her like, shut off like a, you know, like a light. That battery was dying. Yeah. And and the doctor is like, no, she’s fine. We don’t treat in this range. And I was like, ooh, you treat my kid in this range. So make make with the Synthroid, you know, right, but right. I’ll talk about that at some point.

Yeah,

I think the the only other thing I was gonna say would be um, this is a, I feel like this is a missed point entirely. And I know I’ve talked about it, we talked about nutrition, and kind of impact of foods and whatnot. But for kids who have diabetes, working with A good dietitian, who’s a diabetes educator. Yeah. It’s a great way to establish what are your child’s needs? Not because they have diabetes, but as a child, what should your child be eating? How much and it’s not, you know, work with somebody who really understands that it’s not all about, I’m not here to talk about carbohydrates, I get it, I know how to count my carbs don’t teach me how to read a label. I want to know what my kid needs, how much extra protein do they need, they’re in gymnastics for hours, three times a week, or they’re playing soccer, you know, two hours, four times, whatever it is, those are really important, because then the diabetes management works in to what you’re

feeding them. We really don’t talk about, like, food as fuel. No, in America at all the way we should. And sometimes you’re pushing through activities. And your body is, you know, it’s it’s lacking. It’s eating itself to get through what it wants to do. And you’re like, Look, they’re fine. They’re kids, kids are resilient, you know? Right, whatever stupid thing people say. Hey, huge thanks to everybody out there for sending in their questions. And of course, the Jenny from integrated diabetes.com for coming on and checking it out. If you want to hire Jenny, you can do that at integrated diabetes.com. Okay, if you want to join the T one D exchange registry, just go to T one d exchange.org. forward slash juicebox. And you can do everything that I explained at the beginning of the podcast episode. But if you’d like to actually hear me go through the questions first, that’s going to happen right now. So settle in and keep listening or jump over there to T one d exchange.org. forward slash juice box right now. And get started. Okay, guys, I’m gonna sign up for the T one D registry right here. My name is Scott, enter. My email address is Scott Juicebox podcast.com. password, phone number for added security for a one time identification code to your mobile phone. All right, do that. Who am I completing these questions for my child who is under 18. The other option is myself over 18 because I picked my child I put in hardens name. Sign up. Well, that was easy. confirmation code. That quick submit success. Your account has been created. Let’s get started. Okay, now I’m going to answer the questions. Start the study. Are you and your child able to read understand English? Yes. What’s your child’s date of birth? was easy. I knew that. What is your child currently live which state? Okay, was easy. And the code you can also answer my child does not live in the US or US territory. Let’s say. Has your child been diagnosed with Type One Diabetes? Why she has been easier child currently using insulin? Yes, I’m finished. You are all finished the screen questions? That was easy. Once you’re ready, you can submit your answers. I have submitted my answers. But this is going to tell me if I’m if Arden’s eligible for success your child is eligible to take part in the registry, you will now move on to the informed consent and decide to go to consent. There’s some legal stuff here I say continue what is good for my son? Can I stop being the study? You or your child can stop participating at any time you will be told about new information or is there a cost related to being the study no cost? Is there a payment for taking part in the study? There is no payment for taking part in the study at this time. How will my child’s or my information be kept confidential? Very, very, very. There’s a lot of stuff here confidential. Okay. Now consent, I agree to take part and then type your name like a signature and agree received an email says, Oh, it’s a copy of the consent form. That’s lovely. That was easy. And you do a cent you’re being asked to be in a research study. The purpose of this asset form is to help you decide if you want to be in the research study then you should not join this study until you’ve answered all the questions are answered. Okay. Who’s doing the study done by the T one D Exchange and is being funded by the Helmsley charitable trust. He went to exchange we use the funding to organize the study. purpose of the study is to collect information from individuals with one D and parents of children went to India to learn more about the management of T one D, how it may change over time and how different management approaches relate to glycaemic outcomes, acute complications and use of health services So at this time, we do not have an end date for the registry, but we hope to enroll and follow a large group of people with T one D for multiple years. That’s cool. And I hope that a large amount of those people come from this podcast. Alright, so we say yes to assent we have your consent you have completed the informed consent process, you are signed and dated consent form has been sent to your email. Oh, there it is. Okay, now there’s a questionnaire. Before you start, you will be reading and answering the following questions on behalf of a minor. Okay. What’s your child’s biological sex at birth? They identify race and ethnicity. What percentage of the time does your child reside in your home? When was your child diagnosed with Type One Diabetes? You know, I don’t remember the exact day. What’s interesting, just put month in year how was your child diagnosed? Or it was in DK? What was your child’s last day one see this one? I know 5.8 How did you or your child find out about the registry I found out from the Juicebox Podcast that’s other juice box make sure you put that in their podcast Cool. Thanks. What’s the highest level of education that you the parent of the parent or caregiver completed Please select only one answer. What is your the parent or caregivers current household income from all sources? How would you best describe your the parent caregivers current employment status? I think I’m employed right here on the podcast. Call that part time. What kind of health coverage does your child currently have? Who does your child see for diabetes care? And you can choose more than one like she has an endocrinologist but also a nurse practitioner he which of course we go by Be specific match practitioner got it in a certified diabetes educator. How tall is your job? I know this to Arden is five seven feet seven inches.

wants to see why. I know that as well.

Just any of her immediate biological family members have diabetes. Does your child have any other immune diseases? Seems so hypothyroidism? I look at this psoriasis is listed there. It’s interesting.

Is your child currently pregnant?

No. How many biological children does your child have? Zero? Has your child ever been treated for and or diagnosed with any of the following frozen shoulder? anxiety Alzheimer’s substance abuse I’m not gonna read all these let me just roll through here real quick cardiovascular disease

No, no, no, no.

It feels pretty good to be able to say no to these things. That’s cool. No I should child had an ice slit transplant. No. pancreas transplant No. Types of insulin does your child take a pee next How does your child usually take insulin? insulin pump tubeless Omni pod it’s very specific was also on here for if you loop you can put on here open APS Android. Oh, there’s very uh, insulin, pens, oranges and helbling. Everything’s here. addition to insulin. Is your child currently using medications to lower blood sugar? No. Child ever used a real time continuous glucose monitor? Yes. The dexcom g six. How many times per day? Does your child check their blood sugar with a glucose meter? Doing a little averaging here? Which glucose monitors your child use? Oh, that’s easy. Contour. Next One blood glucose meter. Where’s that? From a sensia Contour. Next One. Got it. Next, describe your child’s experience starting in January of 2020 with Coronavirus. No, my child has not had symptoms. And then okay. And my child did not get tested. Okay. I finished it was it I submit my answers. I’ve done it. I have successfully joined the T one D exchange and completed the questions. Now what’s gonna happen is once a year they’re going to reach out to me and ask me to update some questions. And that’s it. That’s all this is completely complete. pletely blinded meaning no one knows who you are. Nobody knows who your kid is. These are just questions that you’re answering to help other people with type one diabetes. The T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters. Participants volunteer to provide their data for research, for example, by answering questions in an annual survey. Once enrolled, registry participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one, help accelerate the discovery and development of new treatments, and to generate evidence to support policy or insurance coverage changes that help people with type one diabetes, all participant information is kept confidential participation is completely voluntary, your information will be kept in an encrypted database in an anonymous way, this means in place of your name, you will be issued a randomly generated identification number, opting out at any point will not affect your care. By sharing your opinions, experiences and data, you will help create the most comprehensive data set of those diagnosed with Type One Diabetes in the United States. This will advance meaningful treatment care and policy, all participation information is kept confidential. And participation is completely voluntary. This questionnaire can be done from your mobile device on the go or in the comfort of your own home. It is fast as you just heard, easy as you just heard, and confidential. As I’ve promised you now three times, and the T one t exchange has promised me over and over again, I asked them a million times before I did this, the online platform is very easy to use. I just did it in front of you. But I’m telling you super simple and clear. The screens are clear what to do next is clear, there’s no you know what I mean? Like it’s not a messy setup online, you can really see what it is you’re supposed to be doing. It is not difficult to get through this. The T one D exchange, of course takes your data very seriously. That’s why they are HIPAA compliant. When you register, you’re assigned a unique identifier. So none of your personal identifiable information will ever be linked to the data, you provide your what I’m saying, you and the data, even though I mean, you heard what they just asked me it’s not like it’s a big deal or anything but you and the data are never associated to each other within the database. Nobody could. I’m so nervous talking about this, because I’m going to keep saying data and data because I jump between data and data just like it’s super easy. Oh, by the way, everything you do with T when the exchange is online, you’ll never be asked to go to a doctor or an in person study or anything like that. But if they have something like that in the future, that’s going to be completely optional. So if you’ve ever wanted to support the Type One Diabetes community, and didn’t know how this is a really super simple way for you to do it. And full disclosure, it supports the podcast. But I want to be absolutely clear. This is an ad. Now it doesn’t mean that the T one D exchange just said Look, I’ll pay you some money to be on this episode, you’ll tell people about the exchange. It’s not an ad like that you just hearing this is not is not making money to understand I’m saying I’m going to get some money every time one of you completes the survey. So if you’re looking for a super simple way to support the T one D community research development, things like that, and the podcast without having to buy anything, right. So here’s a way for you to support the podcast without $1 leave in your pocket. You don’t have to get yourself an omni pod tubeless insulin pump, you don’t have to get yourself a dexcom g six continuous glucose monitor. You don’t have to get yourself a Contour. Next One blood glucose meter. You don’t have to buy Lily’s chocolates. You don’t have to get some GMO glucagon through a link. Like none of that just do this thing. You’ll support the podcast. Obviously, supporting goals of people with type one diabetes comes first. But if you can help the podcast at the same time, I mean, double bonus. Right? Like Bingo. I just want to add that as you know you hear me say all the time I’m very careful about the advertisers that come on the podcast. I think you know that I believe on the pod Dexcom Contour Next One to be gold standard in their spaces and the T one D exchange gives me that same feeling. I don’t know if you remember back a little while ago but the CEO of the T one D exchange, Dave Walton came on the show and I had a really interesting conversation with him. That led to more conversations that led to this opportunity. So being superduper honest, the T one D exchange has thousands of spots open and they need this data from the from thousands of people and they’re not getting it. So they came to me and said we were hoping you could reach a broader audience with more people and fill these slots. So Everybody, please go. They don’t just need 50 people, they don’t just need 500 people, they need thousands. And I know you’re all out there, I can see, I can see who’s listening. So if you guys could just jump in and do this, you’d be helping them, helping me helping the podcast, helping yourself helping other people with type one diabetes, it is a win, win, win, win, win, win, win. Okay, guys, T one d exchange.org, forward slash juicebox. I put that link right there in the show notes to the podcast app. And there’ll be a page at Juicebox podcast.com. But all you need to do is go to T one d exchange.org. Ford slash juice box and do the things you just heard me do. It’s that simple. Thanks so much for listening to this episode of the Juicebox Podcast. We’ll be back very soon. With more interviews, information, and fun. Oh, hey, I’m glad you’re still here. Listen, I bought any new microphone and we had a time set up this to get it all set up for and it happened to be as I was finishing up this episode, the editing of this episode, so I recorded it. I don’t know if you want to hear Jenny and I set up a microphone. But if you do keep listening,

stay in place. And then I hooked on the microphone and just see where it was supposed to be. So I was

like, clearly that’s all I had to do. By the way a second ago. I decided I’m recording this because I’m going to put it at the end of the episode. I was trying to hook your microphone and microphone. So if you want to curse I’ll BPL Okay, so you already hooked up your one mic, it shouldn’t be that hard. This is just a USB cable just like the other one, right?

Um, yes, it’s got a USB cable. Again, I didn’t like connected or plug it in yet. And it looks like it’s got a place for like, it just got a headphone jack to

Yes, that is not something you’ll need.

So just keep doing my headphones through the computer like I do. 100%

that’s for if you were doing recording and you wanted to do something where you could hear yourself before you got processed through the computer, you’d listen to that. And that’s actually those dials are for that as well. So you won’t need those dials either. Okay.

So I don’t really have to play with either of these, which I don’t really know what they mean nothing

for you to do there.

Okay, so just plug this into the computer and then hopefully the microphone goes through this. I

think it’s gonna magically begin to work. Let’s see. I’m just finishing an episode that’s gonna go up now, but with you and I, oh, yeah, I can ask Scott and Jenny episode.

Oh, nice. Yay. Okay, I’ve got like a little blue light on this thing in the jigger. Okay. It’s all fancy. Like I walked into my office, I set it up, like, at night, it was like 10 o’clock, because then everybody’s asleep, right? And nobody bugs me. And little boys aren’t like, Can I play with the buttons and like, dial everything and like, see how the arm works and whatever. Yeah. And so then I walked into my office the other day, and I was like, outside my office being completely deranged right now because we’ll be doing the floor and everything in it. So everything works for it. This is art and stuff from

her room or painting her room. Everything of hers is behind me right now. So I hear you.

Yes, if you could see the floor, it looks it’s like a disaster. for it. They walked in and I was like, outside of the horrid stuff. I was like, my desk actually looks like it looks like like a studio.

Kind of is. So um, alright, so I think what you need to do is go you’re Are you in zoom the application? Are you on zoom online, you have the application zoom on your, on your computer, right?

I do have the zoom app on my computer, and that I clicked the link that you sent me in the the message and I just pulled up my messenger messages on my computer. And I just clicked the link through the messages. So I’m assuming it’s coming through the app on my computer.

So top left of your so when you click on the zoom window and activate it, you should see on the top left of your screen and your Apple it should say zoom.us next Yeah. Okay, good. So go up to that and then go down to preferences. Yep. And microphone. What’s the show?

I have? Oh, yeah. So it’s on audio already. And then

this is a microphone microphone on turn. All right now,

it looks like it says built in microphone. internal microphone. Yes.

Click on that. And then the new microphone should be there as well.

Yes. And click on there.

Yeah. Okay. Oh is the volume all the way up the volume slider underneath of it.

The volume slide is like a little bit down lower than half. We should

all the way to the top. Let’s see what happens at the top.

Hello, move, move, move, move, move. almost to the top. Wow.

Okay, let’s try halfway.

Alright, let’s see here. Oh, I don’t know what it’s, it’s not sliding down. Now, let’s just

click on it. You can click on the dot and then drag it.

It’s not dragging for me. It’s not doing anything. It’s kind of weird. Did you click on automatically adjust microphone volume by mistake? Oh, let’s take that off. There. So now it’s in the now it’s in the middle.

Okay. So, now you can see, I my microphone is different than yours, but I’m up on my mic, right? Yes, I’m like, about next to it like next to him. I don’t want you to have to be that much. So let’s try bringing it How far are we from your face right now, I guess. Jenny’s measuring with their fingers, probably about 434 inches. Okay, three inches, so try bringing it a little closer. But there are that,

hey, that’s like, two inches right

there. Whoo. It sounds really good.

Okay, I’ll have to just mark this little like, space. Well, like, I feel like I like cfcu. Because the microphones like covering. I know,

I feel the same way. Sometimes. Actually, there are times when people say you go away from the mic. It’s because I’m looking at a person and I kind of turn my face to try to feel more like something which is not the there’s not good, better, better, they can hear us. Cool. So I’m with you at that desk. Here’s why I like you at that distance. Because when that slider was higher, we were getting a little noise but but slide that slider up just a little bit more. And let me see where the noise comes in.

See.

So now it’s at like three quarters.

And there’s a little bit of noise. So slide it down. Go back a little bit. I’m trying to get it so that’s louder, and you can take the mic a little farther away from your mouth, if that makes sense.

So now it’s probably at like 60% of the way towards full volume. I love this.

This sounds terrific. It really really does sound good. Yay. Oh, I’m so excited. I’m glad it’s because this good.

I don’t I don’t hear anything like different but I also don’t do this, like, you know, I don’t record and do all of the listening and the editing. So I don’t hear the differences. Yeah,

it is literally not going to sound any different here, but it’s just gonna be way better for the people listening. So this actually ended up being Oh, I lost my ears for a second. But I know why give me a second. Um, hold on one second.

Yeah, thank my my tea and like slosh around the ice cubes anymore. While we’re actually

because the irony here everything The irony is, is that microphone is going to hear less of the background in your room than they did. So that one is more just right here around your mouth. Because interest. It’s so odd the way this worked out. Because you and I set up this microphone test randomly. And I spent the morning editing an episode, the episode that made me think I am buying Jenny a new microphone. Because there was something I don’t know if you remember we must have recorded How would you remember this was like April right? As Corona was starting. We did an ask Scott and Jenny, which is this episode right here. Okay, um, because I’m just going to leave this conversation at the end of it so people can hear it. And there was a noise behind you. And we couldn’t get rid of it. And we were like, Is it the fan from your computer? You remember? So there’s some small noise in the background? That that microphone was just picking it up? Right?

Yeah, I remember picking up the mic that I had, which is a much better mic than I had ever had before. And I was like moving it around. You’re like Yep, nope, I can still hear it. I can still hear I don’t know what else

was picking something up in the room, right like a background noise in the room. And so I’m getting a text that Arden is hungry. One second. Apparently I’m the short order cook. today. I would never say this in front of my wife. But when we’re both working for home, I think to her Her work is more important than mine. So when something like this comes up, I tend to be the verse that takes a break and goes and handles it. But I’m not complaining. It’s fine. No. But anyway, yeah, like so we’re recording and there’s this background noise and you’re talking I’m really interested. And then I’m just annoyed by the noise and I thought yeah, I have to get any better microphones so you have a much better microphone now. And you sound super clear. As a matter of fact, in an hour or two when this is on the internet, you should go listen to some of it from the beginning and then and then listen to this you’ll be totally different in the difference in it. I am jacked up excited about this. This is a really great thank you and you don’t have anything else to do so. Is it okay like you’ll be able to keep it out of your way when you don’t need it like or Yeah,

absolutely the arm is really actually quite nice because I it did come the microphone itself came with like a stand to pop it up.

I saw that. I didn’t like that though, for you

that Yeah, the nice thing is that this I can just slide off to the side and pot often over. Um, so yeah,

plus Thank you very much. No, please, thank you. Here’s some stuff you don’t know about yourself when you’re being when you’re making a point. You bang the table. Do I really you get excited? You’re like, you bang the table. So I couldn’t give you the mic stand on the table because it would like go think when you were doing that that was and so I’m like, I she can’t have that. That’s why when I didn’t by the way for anyone listening I did not force Jenny. I said Do you want a boom arm? Or do you want a table? She got the pic. And but when you said you under the boom arm? I was quietly like, yes. Okay, that’s gonna be better. But you’re gonna use this now for your calls. Now? I would imagine, right?

I guess I certainly could try it and see if the call like, if the noise and everything is certainly better, especially since you said that it deletes much of the noise in the background. I mean, I do work from home. So especially with everything the way that it is now and the fact that my upcoming second grader will be virtually school from home.

I’m ever feeling it was gonna be on the podcast sometime this year.

Or noise? background.

But that’ll be kind of nice. Because if I do use this, I would expect that then maybe some of that background noise will be less Yeah, I’m can’t guarantee that my 85 pound chocolate lab barking will be completely gone. But

no, no, this is a way to you just hear those a clarity in your voice now. And like a like a, I think you would call it a timber. Like there’s a depth to it that didn’t exist before. So isn’t there’s perfect? Listen, we never do this. But when we’re going to record on Friday, let’s see. Can we do an episode of you and I talking to significant others in people’s lives, teachers, co workers, family members and explain diabetes to them. Like this is the first time they’re hearing about it.

Like layman’s term? Well,

well, so like imagine you get diagnosed or you have type one and you have people around you who want to know more, but it’s overwhelming to explain it to them. I want them to be able to say here’s an episode of this podcast. It will explain diabetes too. Can we do though? That sounds fun. I think we can. Okay, absolutely. All right. You go back to your life. This is super exciting. I will send you a text when this is available so you can hear it. Thanks Scott. CJ, you want to say goodbye to the people are gonna hear

Bye bye. Bye

bye. See you

Hello friends, and welcome to episode 685 of the Juicebox Podcast we’re gonna do something today that we haven’t done in a little bit. It’s an ask Scott and Jenny episode. This episode is full of questions from you the listeners that Jenny and I sat around and mused about. Please remember, while you’re listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. The T one D exchange is looking for US residents who are caregivers of someone with type one, or have type one diabetes themselves to fill out a short survey. It’s AT T one D exchange.org. Forward slash juicebox. Your simple answers to simple questions will go a long way towards helping people living with type one diabetes, T one D exchange.org. Forward slash juicebox. I just looked and we haven’t done an ask Scott and Jenny since 2020. But this one will be the 15th installment. I hope you enjoy it. Today’s episode of The Juicebox Podcast is sponsored by us med. US med is a supplier of diabetes supplies. And all you have to do to get a free benefits check from them is go to us med.com forward slash juicebox. Or call my number 888-721-1514. The podcast is also sponsored today by Ian Penn, from Medtronic diabetes. Do you wish you had some of the functionality of an insulin pump, but you like injecting, if that sounds like where you’re at, you really might enjoy the in pen. Learn more and get started today at in pen today.com

really wasn’t what we talked about before we

really get talking people are like what’s happening? Well, they don’t, you know, so we just chatted before we started recording. And I think that’s important for people to kind of relax and get into a flow, which I think if you look at the episodes where I’m interviewing people, it’s why the first 10 minutes are sort of like the way they are just trying to get calm and relaxed. And I know there’s a world where you can edit all that out. But I think it’s interesting to learn about people that way. So anyway, when I think

when you’re talking to somebody for the first time, honestly, right, you might have emailed with them or whatever to kind of get things set up. But you’ve probably never really talked to them before. And it’s you have this sort of get to know somebody, you can’t just really just start talking about a topic.

The top I do not talk to people before I interview them, they fill out this very short form. It says What’s your connection to type one? Have you been on another podcast in the last six months? What would you like to talk about? I understand that this is for entertainment purposes only. That’s it and then they jump on and I meet them right in that moment. And we start talking so I love it like that. I wouldn’t. I mean, I’ve interviewed people that I’ve known about, I interviewed Robin ORS on the other day, and the peloton, girl that has type one. And yeah, I mean, everybody loves her. I 100% That’s what I tried to tell her. She didn’t seem to know. But I, I had notes and you know, she had notes about me. And we had we had in I’d interviewed her for print years before she of course, with no reason to didn’t remember me, but her people filled her in about it. And like I don’t know, like I would have much rather us just felt like we were like grabbing a drink together, you know? So anyway, it still was a really nice conversation. But Alright, so here’s what I did, Jennifer. Last night, I was up editing the show rather late. And about two o’clock in the morning as I was going to bed. I thought I don’t want to do a defining diabetes tomorrow and Jenny calls. Oh, so I never know what we’re going to talk to Scott brings to the table today. Let’s see, I don’t treat you much different than anybody else. So. So I put this little post in the Facebook group. And I’ll tell you, it just shows how things have grown because you and I’ve done this before where I’ll say Hey, Jenny, I got questions from people. We have eight 510 questions. So I put up a post eight hours ago in the middle of the night. That said, I’m thinking about recording and ask Scott and Jenny episode tomorrow, but it all depends on if there’s questions here when I wake up in the morning. There are 100

That’s like putting something out into the universe, like expecting nothing to ever come back.

I’m like, oh, we’ll see what happens. Right? It’s overnight. But anyway, there are 116 questions in this. It’s I don’t think we’re gonna get to all of them. But now we have something to do for the next couple of times that we talked for sure. Because there’s great question. So you want to just kick back and do this together? All right? Do you ever sleep? That’s for me? I’ll answer that later. Is a simple question. Someone said they’d like to know where you put your pods?

Me personally, yeah. Oh, I get asked that an awful lot. So that’s actually easy. My, I guess I don’t really have favored locations, although they’re the locations that I’ve rotate through, I’d say favored in terms of like one versus another that is better in terms of absorption, because I know some people do notice that. I use the backs and kind of the sides of my arms, and never use the tops of my arms or like the bicep area. I note that people do, I don’t I use the front of my abdomen, either above or below my beltline. I use my lower back. Those are my go to places. I do not have luck on my legs. I don’t love it on my upper but they just, it’s almost like I’m not taking enough insulin there. It’s an absorption thing. And I just prefer to not go to those places. So

yeah, it’s that’s a lot of moving around, which makes me think what I wanted to say was Jenny takes her own advice. Like that’s, you know, you know how some people give advice, but don’t live it. You know, I rotate. Yeah, you really are rotating your sides. I don’t know if you’re doing it because you think it’s right, or because you tell people to rotate. You don’t want to be a hypocrite.

I think it’s probably both I and I’ve said before, I think it’s really important to be a good example. And if you’re not going to do the majority of what you’re telling people to do, then why are you talking about right?

No one asked, but Arden wears hers either side of her belly button, kind of in line with her belly button off to the side a little bit. She prefers the cannula face towards the belly button. But we will also turn it 180 degrees to face away. She uses her thighs, tops not so much more to the outside, she used to she overused the tops of her thighs. So she moved it sort of to the the the outside of the outer part of her legs. And I recently in the last year finally had luck getting her to put it back on her arms. So we now have the way I think of it as the legs are kind of there are a ton of spots because one spot on your thigh an inch over an inch higher an inch lower like becomes a lot of different spots, but her thighs, her abdomen and our her sides of her upper arms. She doesn’t like it on the back. Okay, so I think it wiggles too much back there for

like she’s my I actually have a good friend years ago when I started wearing Omnipod. And it was probably a couple years after that, that I met somebody through like the diabetes community, who I’ve gotten to be good friends with now but she out of like swimsuit material, she actually made bands that I can put over almost as like a three inch sleeve kind of like a free arm, like a headband for my arm and like I’ve got my pump my pad on my arm now. And when I run longer, like longer than a 30 minute run, I will typically use one of those because kind of like Arden it it does it wiggles I mean, not enough that it’s irritating in terms of the actual site. But just it’s something you pay attention to. And it’s like change jingling in your pocket, right? Just can’t stand it after some time. So

for Arden this goes all the way back to when she was young and she played softball, and she couldn’t put it on her right arm because when she threw the pod would really kind of like torque around. And sure after that it was just, you know, the I think the funniest thing that happens with people, kids, maybe adults as well is they get rules in their head, like so after a while. She just thought, Oh, it doesn’t go on my arms because we don’t put it on my arms. And there was a reason that we stopped doing that. And then I had to show her one day I was like you’re not throwing a softball anymore. So please,

let’s try the arm again. Yeah, I will say though, from a site rotation, those sites that I don’t use for my pods or infusion from any pump, honestly, not just my pods, or when I when I’ve used a tube pump to but my upper thigh and my my upper but also they work really well for my sensors. So it’s not that those sites don’t get used. It’s just that they don’t use them for insulin. Okay, and Artem

Arden puts her CGM on her hips, kind of on the side. So I was gonna say longitudinally and let but I don’t, I’m not sure which is which anyway, sort of like, the top of her butt crack and you kind of draw a line around to the her sides and there’s sort of like a flat spot in her sides and you can put it there. She just goes left, right, left, right. She’s been doing it for years like that. So yeah. Okay. All right, next question. Thank you for that question. Blue. Next question is from Christine. And she said At what age do teenage years and and having fluctuating blood sugars due to hormones get better.

So, this isn’t like hormones relative to either male versus female. It sounds like it’s just in general. I can say though, from female hormone standpoint, is that the cat is the cat that would like to be let out of my office. I’m gonna let the cat or the cat doesn’t keep banging on the door

you know what arrived at my house just the other day, the Omni pod five. It came to us directly from us men. Here’s what I did. I contacted on the pod and I said I would like to get on the pod five. I did it just the same way you guys are gonna do it didn’t get any special treatment. On the pod contacted us Med and said I have a customer here that would like to get there on the pod five supplies from you. Okay, not so tough. I think on the pod then contacted my doctor had a script sent and Bada bing bada boom, a box showed up at my house with the Omni pod five starter kit. And we’re already set up for future deliveries of the pods that will need to continue with Omni pod five. It was in fact exactly that easy. They can do that for you as well. Maybe you’re looking for libre to wear the Dexcom G six. How about the Omni pod dash? US med has it and so much more. At this point, you’re thinking Scott, I’m in how do I try it? Well, you’re in luck. You can either use the internet us med.com forward slash juice box to get your free benefits check. Or you can use this phone number that US Matt has provided just for Juicebox Podcast listeners. It is 888-721-1514 us met accepts Medicare nationwide and over 800 private insurers they always provide 90 days worth of supplies and they have fast and free shipping. I will now make a seamless transition to the in pen from Medtronic diabetes, are you using an insulin pen but wish it did more? The M pen is probably what you’re looking for. Because the M pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to a mobile app. This offers us support with those calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started with in pen today at See what I did there what you don’t know yet, but you’ll see the second you can get started within pen today at in pen today.com. Take the guesswork out of your dosing. Your in pen app will show you your current glucose levels, your dosing calculator, active insulin remaining meal history, dose history, glucose history, and an activity log. And other reports. The pen itself, it’s just what you expect. It’s a pen with a cap, an insulin needle, a dosing knob, a dosing window, and a button to do your injections with the implant is also surprisingly affordable. I hope you check it out in Penn today.com. All you have to do head over there right now. There are links in the show notes of the podcast player you’re listening in right now to in Penn us Med and all of the sponsors. You can also find them at juicebox podcast.com. When you click on the links, you’re supporting the show us med.com forward slash juicebox in pen today.com I’m now going to get you back to Jenny who by the way works at integrated diabetes.com If you’d like to hire her

That’s too funny. I totally thought that she was out of my office.

I heard that noise and I thought hopefully that’s Jenny’s cat where she’s she’s abducted a neighborhood child and they’re locked in the basement.

Oh no, no, no. She thinks on my closet doors not the actual door to get out. She Bangs on the closet doors when she wants I don’t know if she’s

good sound. Me Pay attention anyway. Sorry. So no, I

was, I can’t remember my thought. Now I was on a pattern. Say

you started talking about when I guess we’re not talking about hormones for gender specific. Right?

Right, right. So hormones from a female hormone perspective, with monthly cycles, I’ve found that it’s when the cycles tend to get a lot more regular, that things tend to get more stable girl or females also tend to stop growing sooner than men do. So from that perspective, when a growth phase for girls like they’re no longer getting taller, you can tell visit after visit at the doctor, they’re just not growing in height any longer, they might have a very regular cycle, that’s when things do tend to even out more, there’s not as much of that flux. If the cycle isn’t very regular, then it could very well be that you’ve got a lot more ups and downs still, because those hormones are still so much on a rise and fall. That’s not sort of a pattern, right? Guys tend to grow longer than girls do. In terms of the male hormone effect, and growth patterns, so you could have fluctuations, you know, through and up to about the age of 18, sometimes beyond, obviously, but again, some of it also has to do with have they finished growing? Are they more into a pattern of life, all of those kinds of things, because I think a lot of the variability in those teen years is just life as well. I mean, most teens don’t have a very rigid schedule outside of a school schedule where you know, the typical pattern other than that sports come in, in the afternoon, extracurricular activities, weekends are completely different. You might have sleeping in compared to getting up early I there’s just a lot of stuff in the teen years that I think causes a lot of fluctuation. That because we talk so much about growth, a lot of people think it’s just growth. And some of it may just be the variables of

the unexpected left turns, you take in the middle of an afternoon, like I’m gonna go run, jump on the trampoline now. Or, you know, my friends came over and we’re gonna go play baseball in the backyard. When you’re 37. You don’t randomly get up at 330 in the afternoon. And go not usually, no, no, if you have kids. If you are, you’re an Instagram influencer, and you’re living an amazing life, because I just sit here and make this podcast and Jenny sits where she’s sitting talking to people about their diabetes. So yes. So let’s see. Next question is from Denise, I would love to hear about how you handle times when there are Dexcom sensor issues. How many times would you calibrate before giving up on a sensor? Do you calibrate? And if so, when Jenny and I did an entire episode about calibration, which you should definitely check out? But good. Um, to answer the question. Arden doesn’t have a lot of problems with Dexcom it jives with her body chemistry pretty well. I would say that with GE six. It’s interesting. I don’t know this for certain, but they must make improvements to that device as they go. Like with the algorithm they must. I don’t know they must. Because it’s never the same. The products always better at the end of its product life. Like as they’re getting ready to launch the new one than it is at the beginning. I feel like you sent it to you ever see that? Like it? Maybe I just get better at using it over time? Is that pi d? Right? That could be Yeah. Because I’ll tell you like, Arden puts a sensor on. I wish we planned better, but we don’t it usually happens like this. someone hears the noise that which is like the out of you know, there’s no, there’s been no data. And then everybody’s head drops and goes oh, how long has it been since we put on a sensor you started thinking and when you can’t remember you like this must be it. And you know, like, as an example, we put a new sensor otter at 130 in the morning, Friday, I would have been nice to do it. Put it on came on was pretty accurate, was happy with it. I have had them come on and be wildly off, you know, 8090 100 points sometimes. When that happens. I do what I talked about on the calibration episode is I just kind of I slow calibrate it back to where it needs to be if it’s if her blood sugar’s really 100 and the things that she’s 200 I tell it, she’s 170 and then it agrees with that you let it go a little longer that I tell it she’s 150 and I calibrated. I kind of move it on my own. I don’t know if that’s right or not, but it works and we have a lot of success. As far as sensors just going bad. I hate to say this Arden’s last ride out 10 days. I mean, constantly, you know, yeah, so

I know I, and that’s where I really do think that there’s more about body chemistry, then there’s any information about I think people get the sense that a sensor just doesn’t work very well. And they may come from a previous brand to another brand and say, well, it’s better, certainly better. But it’s still not quite perfect. You know, I also, thankfully don’t have a lot of sensor issues, at least not, not recently, the previous two g, six g, five G four in the seven series, I didn’t really have much issues with those at all. In fact, my G fives, I could restart for three, three weeks and get like 21 days out of a sensor, and then it was like falling off. So I finally had to change it, right. But the G six, initially, I would almost like clockwork, eight days, I would get the three hour sensor error warning, it would start back up and get it again, I would call that I was calling Dexcom. almost weekly, because it literally was dying on day eight. And, and I don’t know what shifted kind of goes along with, maybe they’ve changed something algorithm or the the sensor coating on the outside of that filament, I don’t know. But I’ve not had that problem. And I can’t say that my body chemistry is just decided to do like, you know, a 180 and sort of be completely different. And now it just works better. For me, I don’t know, I’m mostly now get 10 days, I typically if I’m going to have a bad sensor, it’s usually only bad for about eight to 12 hours after starting it up. And my trend is that it’s not high, inaccurate, it’s low inaccurate. If my sensors are going to be off, they’re going to be off and they’re going to tell me that my blood sugar’s like 42. Consistently, even though it’s in the 80s 90s, low 100. It’ll just keep telling me I’m low. And I avoid calibrating at that point, right? Because I’ve had enough issue with trying to do it in that first kind of startup time that, then I’ve had sensor fail. So I just I leave it alone, I just opened my algorithm. And don’t let my pump adjust off of those funny values. And just go ahead.

So it’s funny when you’re you, you said something that really made me think when Ardennes is off for an extended amount of time. It’s lower, when it’s high off, I can bang it back down again. And it works. When it’s low off. She’s 5355 56. It just thinks that’s what she is. You text her she’s 85 Doesn’t matter what she is, right? It does just sort of come online. And just it’s kind of magical. And then works great after that, if you’re using an algorithm like Arden is and like Jenny was just saying that I just made for this, I opened the loop. And we test. We test like every 90 minutes or so. And then through the health app on the iPhone, just enter it you enter her blood sugar on the health app, and the loop app pulls the number from there, and it’s usually enough to get by until it straightens out. That is that concern from people who are new. Or even sometimes I see older people, the idea of I can never go on an algorithm because what if the sensor is wrong? It’s gonna kill me. You know? Like, it just doesn’t go that way.

Yeah, unless there comes to be a system that doesn’t allow you to go back to manual use mode. Quite honestly, you came from manual pumping or manual engine. I mean, you have something to go back to. If you know enough that something is inaccurate. Don’t use it while it’s inaccurate. Right? Do what you know how to do. Even if it means you have to go back to a little bit more old school. Don’t use a system that’s gonna adjust off of a blood sugar that’s 42 When you’re not sitting at 42 I

think sometimes that people get stubborn. Meaning they have this feeling like this thing that I paid for supposed to do this and it’s not doing it so I’m gonna be mad at it. You’re like, cool. Yeah, of course, absolutely. I see it. I’m just like, open the loop and test every once in a while this thing will work in a little bit. We’ll be fine. It sucks. If it happens overnight, because it’s telling you you’re low, you’re low and you’d like you’re not but even that’s a mindset thing. I have to say. When Arden was really young, I met this person in the community who had an older child already. And they would tell me, you know, it’s great that you guys have the CGM and I think they’re amazing, but you know, my daughter never had one. And there she is. Isn’t she’s fine? And what that made me think was, Oh, okay. Like, it’s alright if once in a while, Arden goes to sleep and her blood sugar’s 135. And it climbs to 150 overnight, and I fix it at four in the morning or when we wake up or something like that, like, that’s not the end of her life. If that happens, you know, but yeah, don’t like it back then. When she was

young, because you were used to having so much information to utilize to keep her where you really know, is a safe value long term to be sitting. Right. Yeah, but I mean, I, you know, and that’s a point that I bring up with people all the time, too. I mean, I had, I had nothing fancy in technology growing up, right. Heck, I made it through college without anything fancy.

But you’re still paying attention to your health, right? Oh, of course. I

mean, I use probably more more test strips in my life prior to a CGM, then yeah, probably was necessary. But I was a little bit OCD. Must Know What My blood sugar.

Let’s get to. Let’s see, the next question just says it’s not really formed as a question, but that’s okay. It says breastfeeding a type one baby or toddler. So is that do you Bolus?

I guess that’s, that’s a hard one. So talking about not the mother has type one, but the baby or the toddler actually has type one. Yeah, it’s a it’s a difficult scenario, honestly. Because unless you have a very rigid schedule of nursing, or even formula feeding, I mean, this kind of goes along. Because that age, that’s a child’s mean nutrition intake, it’s either breast milk or formula, right. So unless you really have an idea of how much the child is eating, there’s not really a way to carb count that per se. If you have a little bit more regularity, a lot of people tend to sort of coat with a Basal insulin. Knowing that nursing, especially an infant, typically is going to be nursing every three ish hours, until they get a little bit further out into post newborn stage, right. So sometimes there is a coding with a basil knowing that you have a regularity, to nursing or formula feeding. If you have a known amount more like formula, and you can gauge how many ounces the child is going to take at a time. You could base that on a dosing strategy then with rapid acting insulin. The big thing with that is we would usually, as much as we talk about Pre-Bolus ng for something like that. You just you don’t Pre-Bolus There’s no way to know how much a child who usually drinks, you know, three ounces at a feeding time. Today, for whatever reason, they’re fussy, and they’re only taking one ounce, but you can’t Bolus or do anything for that until you know

we’re talking them into it if they need more. Right. And there is no more food. What are you gonna do with gummy bear? Yeah, right. Yeah, well, yeah,

I mean, it’s not really until that child is and I’ve worked with a couple of people, you know, more recently, who have littles who have either just weaned off of nursing, in that case, their Basal needs actually have gone down. Because what we were doing were We were coding the overall nursed milk intake with basil knowing that it was very regular night and day. And until they were weaned, and we had a little bit more in terms of a breakfast, a snack or lunch or snack and how to kind of coax that with bolused Insulin it and I know it’s a difficult time. So

it sounds like to me that you adapted that. So there’s that. There’s that old timey endo idea for people who they think don’t Bolus for their meals, right? They jack them up on basil. And then they know they’re going to eat. So they’re feeding the insulin, they’re not really feeding the insulin, they’re feeding the drop before the drop happens because they’re eating on a schedule. So you keep the baby’s Basal at a spot where it’s impactful of those every three hour feeding schedules. Correct, right. Yeah. And are you shooting for? What blood sugar are you shooting for?

Yeah, it’s a good question. I mean, most doctors are happy as long as they’re not dropping usually below like 120. Honestly, most most parents find that littles like that will often drop very rapidly. If they get under about one to 101 20 ish. It’s a very rapid drop and depending on then what they’re able to tolerate in food intake, where they are in their intake of, you know, this kind of food versus that. It becomes really important to know how much does it take to turn that around and Um, yeah, it’s a, it’s a hard thing a corrections. Correction insulin often is very, very, very tiny. In fact, we often end up dealing with diluting insulin, so that you can actually get a larger dose because again, pens and pens and even syringes, the littlest that you can dose is about a half a unit. I mean, if you’re really good on a syringe, you might be able to get, you know, a quarter unit kind of in there. But it’s a little bit easier to see volume doses, if you dilute the insulin in a larger volume, you get the same dose. You know,

I, there’s two things that makes me think of the One is I, at some point, when Arden was super small, I took insulin, and I put it in a dish, and I colored it with food coloring, so I could see it. And then I practiced pulling on the syringe enough to get a drop in. So I could ah, and so it wasn’t by eye anymore. It was like feel. So I taught myself how to just pull on it enough to get a drop of insulin out of it. And then I would I would try to correct her with a drop of insulin. That was not fun. I don’t know. I don’t remember any of that fondly. Yeah, okay, that’s a that’s good information. And I’m assuming if you can afford it, or have insurance, a CGM with a baby is probably going to be like the best thing you could do, right?

A CGM above. I mean, above even a pump. A CGM is by far the best technology that you could possibly get. And even at that age pumps are not necessarily the greatest thing for some kiddos. either. It’s a wearability issue, or it’s a pull it and target and pick at it. And it’s not worthwhile putting it on when it gets picked off by the end of the day anyway. And there’s only so much hiding that you can do with a child’s gonna

find it. Yeah, yeah. All right. Well, that that makes sense. Thank you. Let’s see, what does Monica say here? Oh, Monica is going to ask a question. And I’m going to answer by saying, You should listen to the Pro Tip series. But we’ll go How can I reduce post meal spikes, my six year old is on an MDI. Hold on a second. This is it. I can’t some water, water, a frequent tea I’m drinking alone. My six years, my six year old is on MDI, we always make sure to Pre-Bolus before food, she dips into hypo, but we almost always still spiked over 180. I listen to the podcast, I believe the Basal levels are good. Anything else we can improve or work on to reduce spikes? Also, this is not a question. But I want to say thank you to you and Jenny for all that you do. So that’s very nice. Thank you very much.

Yes. All right. Yes, you’re welcome. Absolutely.

So she’s Pre-Bolus thing on MDI, dipping down dropping up. Pre-Bolus is too long,

I would say either Pre-Bolus is too long. Or to get rid of a potential spike, you could Pre-Bolus the length of time on MDI, you could always do a split Bolus plan, especially if this is for a child that you don’t necessarily know if they’re actually going to finish everything, right. So you can Pre-Bolus the amount that they that you know that they’ll definitely finish up eating. And then you know, by the end of the meal Bolus, the rest of it so you don’t you kind of take care of getting rid of that ultimate dip that you end up having to treat. And there in may also be if you’re treating a low, and then having a rise later, the rise actually might be going up higher, because you’re having to treat the dip first, along with the food being there, right. So it’s kind of a double whammy of, well, I have to take care of the lowest something quick because the food isn’t obviously all hitting yet. But then the food does catch up. So it could be a double Bolus strategy still with Pre-Bolus or first thing may just be to decrease the Pre-Bolus time. Yeah,

I mean, I would either. I mean that’s how it occurs to me like just from this small description. Shorter Pre-Bolus Maybe maybe even shorter. Pre-Bolus a little heavier on the carb ratio maybe depending on what happens you know what you see next? Or split it I put some in gets a treat it like a baby, right? Like, baby it’s funny, I think of babies and or young people and gastroparesis is the same thing. Put it in enough to get the insulin on your side. And if it starts happening the way you expect them putting the rest. That way you kind of stay out of a spike. Okay. Helen asks, How do you and Jenny deal with fat and protein using the loop? I’ll tell you what, as I said it out loud. I thought to myself, does Jenny eat fat by the way now, just now for my description. People believe that you 86 pounds and you’re just one muscle wrapped around a bone but no, no I just mean, you’re a healthier eater, but you think have french fries? Sometimes I imagine. Oh, of course. Okay. Yeah. Sometimes, sometimes,

not often,

at the fair, Jenny, is that when you do it, maybe?

Yeah, I mean fat and protein. And, again, I think this is where an individual nature of evaluation first needs to be done. How does it seem to impact you or your child or whoever you’re caretaking for? Right? There are some sort of starting rules of when to start adding in extras for fats and proteins. And how much of each you should add in, in general, in a looping situation, since that’s what the question is really asking about. Forward stamp damping, a fat or protein amount into the future, from the actual meal time. So let’s say you have, you know, a whole pizza for dinner like many of my college students may definitely, right, there is a large amount of fat there, there may even be a very large amount of protein depending on what was on that pizza as an example. bolusing for the carbs right now is an important thing that has to get going. The absorption time is also really important here. So you’re not going to put in one or two hours for pizza. Because despite the crust being a lot of carb, you’re going to have a lengthy digestion of that, because of the slowing factor of fats and proteins right. Now fat and protein then can start to hit later in the aftermath. So one to three hours after a meal protein starts this climb, if you’ve eaten enough of it, somewhere between two to four hours after a meal is where fat climb typically starts to hit. So determining first how much you might need to cover, most often protein somewhere between 30 to 50% of the total amount of protein might need to be put in as if it were a carb entry, right. And then determine where into the future to timestamp. Let’s see it’s you know, 5pm, and you’re having your pizza, expect protein to probably start hitting somewhere around, let’s say seven o’clock, two hours later, give or take, whereas fat, large amount probably is going to take about three to four hours to kind of come into play. So again, how much fat 1020 30% of the fat to maybe get going again, grams of fat are important grams of protein. So this becomes less carb centric counting and more overall macro neural, knowing how much is in the actual portion that you’re eating, which most people have never been taught, we are taught how to look at grams of carbs. So it’s something new to learn about if you’re planning to start using this strategy, but time stamping it into the future. So then loop has an idea in terms of the system loop will see that you stamped this coming forward into the hours ahead. And especially if you save without bolusing then loop will see missing insulin for the carbs that you’ve already entered. That it’s it’s watching for because remember, it’s predictive glucose line is going out hours into the future beyond this point. Yeah, so it’s looking for the impact of that. And if you can give it information about what may be coming into the picture to hit you

should aggressively Bolus. It could either aggressively

Bolus if you’re using auto Bolus or aggressively increase basil if you’re using it the basil branch right?

I so I know what you do. So there’s two ways that you can set up I have in the past set up exactly the way you think way that you just said that the other way, I just sort of think of it as this, that they’re just different impacts. So there’s an impact from the carbs, there’s an impact from the protein, and there’s an impact from the fat. They’re basically just three different Pre-Bolus and opportunities in my mind. So you Pre-Bolus The meal around 80 minutes later I know the first rise is going to come then you Pre-Bolus That rise and then it’s a waiting game. I either do it so well that I see this like 85 blood sugar and I’m like I done it I won this is over like others enough insulin there and the fats hitting at the same time and it’s having this fight and we’re winning. Or I start seeing the drift up. And then I I’ll reevaluate and Bolus for the fat impact as well and add more Yeah, and I’m in my mind I’m thinking of this one specific difficult foods situation. It’s this barf Whew that Arden has a number of times a year, she’s basically getting a bowl of nachos with cheese steak on top of it. And like guacamole and sour cream, right? Everything it’s hard to Bolus for all put together. And then there’s french fries. So, you know, so it’s fat from the fries. And then it’s the french fries are processed. And you know, they’re not like, it’s not like we cut up a russet potato at home, baked it. Yeah, some frozen thing that shows up in a bag in a bar. You know. That’s the I’ll tell you what if you can Bolus for that. I’ll give away a little bit of where the country I’m in if you can eat. If you can Bolus for cheese steak nachos and crab fries at Chickies. I think you’re a ninja, because it’s hard to do. But that to me, that’s it, I just think of it as impacts. It doesn’t matter to me that it’s fat or that it’s protein. It’s a it’s a known quantity that is going to happen. I know it’s going to happen. I just Pre-Bolus it. Right. So

and how much how do you know how much is a try? Right? Because that’s that’s really the behind the scenes question here. As I said, we’re really carb centric. With diabetes and education. We don’t talk about fats and proteins, I would say that the majority of people that I talked to, don’t even know what a portion of protein is supposed to look like. Some people don’t even know outside of butter, don’t realize where fat is in the food that they’re eating. So then taking the step further to say, well, how to how to add quantity, like what am i How much of this isn’t my my eating? How many grams, now you’re telling me I have to go back to school to learn again, right?

I develop those ideas after you and I, you know, talk through, I have a list in front of me here, actually. And at the end of this episode. If I don’t die. At the end of this episode, I’m gonna list other episodes that I think will help people with these questions. Awesome. But here, I’m going to tell you that you and I did a pro tip back at 263 fat and protein, then we defined it again at 360. I had a really great conversation. And in Episode 264, with the person who Bolus is for their keto diet that actually helped. That helped me a lot with the protein. And then in 471, we had a long conversation about the Warsaw method. And about bolusing for fat. It’s all of these. Like, I take this question, and I know that how important this is right? And I want to talk about it. But to the person that asked this specific question, Helen, I’m good at this, because I’ve had 1000 conversations with people about it. And I tried it over and over again. Like it’s not because someone walked up to me and said, Hey, fat impacts and protein impacts, you got a Bolus for like, I wouldn’t know what to do with that information. You know, right. So

Right. Well, and that’s where I think even the information in the the Warsaw method, which is really well done in what does it waltzing thing, the dragon, right? I was gonna say dancing the dragon. I was like, That’s not.

That’s the person I did that episode with.

Yeah, they have a very good descriptive because they go through all of the calculations and protein and fat. And then at the very end, they kind of give real life and they say, Well, we found that if we cover all of this, as this method suggests, we end up with these issues. So we’ve found that we have to cover only this certain percent of, of protein, and not very much fat, and it ends up working best for us. So again, there are some starting places some tools to begin with. And then you really have to evaluate, how does it work for you. I mean, I myself have found the meals that I make, like I said, before I make homemade pizza, right? And I typically make like an almond flour crossed or a cauliflower almond flour across, which is almond flour. In general. It’s high fat, because it’s made from nuts, right? So it’s not like I’m pouring in loads of butter and oil. It’s just that the nature of what I’m using is high fat. So I’ve found with that particular meal, a certain strategy that definitely works. My pizzas are not terribly high in protein. They’re just a lot higher in fat because of what they’re made from. So it’s more the fat effect that I ended up covering. Yeah, I don’t really even worry about protein there.

Right, Jenny? If this was just a regular episode, I would title it fatty nuts. A great title or Jenny has fatty nuts. I don’t know.

Jenny eats chatty.

That’s it. Yeah, we workshop that one right to the right when Jenny eats fatty nuts would have definitely been the episode title. Oh, that’s funny. Because I’m a child of my mind. Okay, so I think we have we can do one more or you will have time? Yeah, I’ve got a little time Christina says. This is about her college age type 112 and 12 and a half years live with type one my 18 year old son forgets to Bolus before he eats at least once a day. And she’s very clear. She said, this isn’t a refusal to use insulin. It’s not bad behavior. He just right out forgets. She’s not a type one, but she gets frustrated. It makes her angry. She said that she realized the disease sucks. And despite being manageable, it’s still not easy. And this is all coming from a place of love. She’s just trying to get him through college. Sure. This is tough.

So this is a college student.

Yeah. Who’s had diabetes? A good part of his life

a long time. Okay. Is so my first starting things would be since it’s not, because this adult child wants to forget, it’s just there are a lot of things being a student in general, as well as a college student. There are a lot of there’s clutter that gets in the way, there just is. So one, if it’s a regular time of day that the Bolus is often forgotten, it doesn’t sound like it’s what it’s every day or it’s a couple days a week sounds

like it’s everyday like like once a day, once a day, the kid flakes and just doesn’t Bolus Yeah, okay.

Because I was gonna say if it’s a regular meal of the day, then perhaps setting a timer. Around that time of day, just as a suggestive even on the phone just. It’s noon, I usually eat somewhere between noon and one o’clock. Sometimes it can jog the brain enough to just remind you. Yeah, that’s one thing. I mean, the other one that’s

right on your top of your hand.

Oh, it’s for food.

Yeah, I’ll tell you what, this has nothing to do with diabetes, but I’m gonna share this here. My son is 22. He is a senior in college at this moment, he is about to graduate. Yay. We’re very excited not to send that college money anymore. And, and oh, for all of his success, etc, but mostly about. Here’s something I’ve noticed over his four years of college. It’s fascinating. We don’t see him constantly, obviously, right. I talked to him. Every once in a while I text with them sometimes. Go see him here and again. He will tell me the same stories over and over again. He is not that person. He’s never been that person when he comes home for the summer. It does not happen. And so I used to think at first I was like, Oh, this kid’s doing smack.

He’s losing brain cells. Something is not right. Yeah.

I had a drug thought from the mid 70s. No, but I realized it’s not that it’s that he is so busy. And so tired. He doesn’t even remember having told me the story the last time. And I think this is probably part of this, like 18 years old. This kid sounds like a freshman. Right? It’s a lot of adjustment. I think you I think if you want to come from a loving place you say to him, Look, this is going to become it’ll become commonplace for you at some point. But until it does. Maybe we got to make up a code word for Bolus and need to write it on the top of a book or I don’t know what are your fingernails read so that when you look at it, you think why is my one fingered? Oh, it’s because I don’t always remind me I don’t know something you don’t I mean, but that’s why I said the

alarm. As a reminder, if it is a typical time of day for it to happen within sometimes just that cue in to the brain can, like you said wake them up, in a way as a reminder. College is hard. It’s hard. There’s sleep patterns are disrupted, you know, at home, if he had been living at home, mom and dad or other caregivers were likely there and or in high school, maybe he was one that had to go by protocol to the school nurse. And it was this pattern of consistency that helped the Bolus always be put where it needed to be right. In college. They have to remember do everything. You have to remember to get food for one thing, actually remember to put themselves to bed, right? Do homework, do their laundry, I mean, all these things,

my son plays a sport on top of that. I don’t even know how he’s staying alive. I’ll tell you if he ever hears this or somebody he knows ever hears this in the future. I am going to tell him about this after he graduates. I have never brought it up to him. I just let him tell me the story. And I’m just happy to be with him. And he’s just like, he’s got a lot going on. You know, right. So yeah, it’s just a lot.

Yeah. So yeah, reminders, I think are the best little nudge that you can probably do.

So about the getting frustrated and angry part. I understand that too. But I think earlier in this episode, we talked about something where I said I realized Is that a 140 blood sugar for a couple of hours isn’t going to be the end of Arden. I think that’s how you almost have to think of this too. Like, this is not a kid slipping off a slope. This is to me, and don’t get me wrong. I’ve interviewed people. And there are people that are going to ask questions later, where they did fall off that, that edge, they just stopped paying attention and it got easier to ignore and stuff. But in this specific situation, I don’t think this sounds like what’s happening here. So no,

it was she kind of states you know, he’s, he takes care of himself. Typically, it’s just and that’s why I was wondering if it was a time of day because if it was an especially busy time of day, or the first thing in the morning, he’s forgetting to Bolus for breakfast pretty regularly. It could very well be he’s just like, like getting up. Oh, my goodness, I’m five minutes late. I have to get out the door and I’m going to grab you know, by Apple on the way out the door and Oh, I totally forgot to Bolus last

time I went to my to see my son I drove with a bottle absorbtech with me, I took a bottle of Zyrtec 180 miles and a two and a half hour car drive. And I said to him, you know, there’s a pharmacy up the street from your dorm, and you have a car, just drive there and by Desertec and he said to me, in all honesty, I would not know when to do that. And I was like, Okay, I got you, even when I take it, like I took them out to dinner the other day after a baseball game, like where do you want to go? Because I don’t know this town. I was like, you’ve been here for four years. He goes, I play baseball. And I go to class, and I sit in my room and I do my homework and I pass out. He’s like, I don’t have time for any of this.

I don’t take Well, that’s actually from a parental standpoint, you’re like, great. All the local bars are local. Right?

We walked into a little bar restaurant the other night, he goes, I’ve heard this is a good place. Let’s try this for years. He’d never been there. I was a little happy. A little happier as a parent. Yeah. But can we roll through one more? Are you done? Absolutely. Are the card values you enter into loop usually close to the carbs listed on the nutrition labels? So it does, yeah,

yes. Yeah. Yes, absolutely. Yes. And you also, obviously, I mean, we’ve talked about fiber before, you also have to take a peek at fiber amount, depending on the kind of food that you’re eating. But again, all of that is nutrition information. That’s it’s yours for the picking. Right there. It’s not an estimate, there is as much precision as there could possibly be in this carb count. Compared to just staring at the plate and wondering because you have no label. Yes, absolutely. So

go into that fiber thing a little more you subtract for what do you do tracked

for fiber? I do take it as a little step further, because there are there are added fibers to a lot of the foods in the grocery store today. Because companies kind of have latched on to that, well, gosh, if it’s high in fiber, more people are gonna buy it, it’s gonna be so much better for them, right? Well, those fibers oftentimes are very soluble added fibers that don’t have the same slowing impact as unprocessed fibers, fiber in fruits and natural vegetables and lentils and beans, and some of your whole grains and oats and those types of things. sprouted grain breads, like, like the Ezekiel bread, I mean, the per slice has like five grams of fiber per slice, I think it is just an exorbitant amount. So in terms of subtraction, if you’re going to subtract fiber, I recommend subtracting definitely from more of your unprocessed types of foods. Some of the ones that are more like your fiber one types of products or something like that, you’ll likely find that if you subtract that fiber, you’re going to end up with a higher blood sugar than you want. Because most of that fiber is more of a soluble type of fiber, it’ll have a little slower impact. But it’s very likely you’re still going to need to cover it. There are some more of the like, keto, or those types of breads and grains that are out there that do have added fibres, they may be more like the word is going to escape me now. Like the unprocessed like corn starch, kind of where it has a slowing impact on blood sugar. And it doesn’t really get digested if you will. So that’s why they can consider it so low carb you know, they list the net carbs as like two grams per slice instead of eight or nine grams per slice. So because the fiber on those labels can definitely mean you would have to subtract it. The big thing is you kind of have to give it a try and see what it does for you.

Actually you don’t know this but Arden has been eating gluten free for five days now. And we all are doing it with her as a show of solidarity. It’s one of the things that her Her doctor, actually Dr. BENITO asked her to try. So like we’re debt, we’ve now like Arden’s had a blood test for everything that exists on the planet for like joint pain and stuff like that. And it just, she just luckily keeps coming. You’re, it’s a happy day When someone says your kid does not appear to have RA, you know, you’re like, that’s great, but at the same time, you’re like, could someone say something, find something helpful, please, you know, so we’re giving this a whirl right now. And, and anyway, we’ll see how that goes. Thank you for doing this. We there are a lot more here. I’m gonna, I’m gonna save them. And I’m going to tell you that I think the next number of times that we we do this, we’re going to do this. So awesome. I like to thank in pen from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast and remind you to go to in pen today.com To get started. I’d also like to thank us med head to us med.com forward slash juice box or call 888-721-1514 To get your free benefits check. US med has served over 1 million diabetes customers since 1996. Check them out online or give them a call. Jenny works at integrated diabetes.com. And don’t forget to please consider taking that survey AT T one D exchange.org. Forward slash juicebox. If you enjoyed this and are looking for other ask Scott and Jenny episodes, I believe there are 14 previous ones. There’s a great list in the private Facebook group. It’s Juicebox Podcast type one diabetes, you go to the feature tab at the top, there’s lists and lists of the different series within the podcast. Ask Scott and Jenny is one of them. You’ll see the episode numbers there and then you’ll be able to go back into your podcast player and find them. There’s tons of topics. I think somewhere Isabel’s made a list of them with what’s actually inside of them. But that’s beyond my paygrade so I’m not sure what else Oh, if you’re enjoying the podcast, please subscribe and follow in the app. You’re listening and say you’re an Amazon music or audible. Apple podcasts. Spotify doesn’t matter what app you’re using. Hit subscribe or follow, please. And if you’re listening online, I’m glad for you if it works that way, I’m not trying to change you. But the cool kids would listen to the podcast that I’m just saying. You might be falling behind the times. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 689 of the Juicebox Podcast. On today’s episode of the podcast the 16th episode of the Ask Scott and Jenny series today, Jenny Smith and I will chit chat and answer questions sent in by you, the listeners. While you’re listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We’re becoming bold with insulin. If you love Jenny Smith, you actually can hire her she works at integrated diabetes.com. If you’re a US resident who has type one, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry, take the survey help people with type one diabetes in fewer than 10 minutes, all while supporting the Juicebox Podcast, T one D exchange.org. Forward slash juicebox. I got that done so quickly. And in one take. I’m very proud of myself, swell of music. And then we’ll get going this episode of The Juicebox Podcast is sponsored by touched by type one, head over to touched by type one.org and find them on Facebook and Instagram. They’re a wonderful organization. They’re helping people with type one diabetes, and they’d like you to take a look and see what they’re doing. Touched by type one dotwork. Today’s show is also sponsored by us med. That’s right us med is the place where I get Ardens diabetes supplies, and you could to us med.com forward slash juice box or call 888721151 for us med wants to give you your free benefits check and get you started today, use the number or the link. Actually, there are links in the show notes of the podcast player that you’re listening in right now. Or at juicebox podcast.com. If you can’t remember touched by type one.org and us med.com forward slash juicebox.

We’re doing questions, right? Just questions. So these are always fun, I like to

so I will share with you and I’m recording this so maybe it’ll put put me on the spot that in my mind I imagine a scenario where you and I on video live. Do ask Scott and Jenny’s online one day. That would be kind of fun. Okay, and I have it’s so close to figured out though. Here’s the problem.

See, I didn’t run away.

You didn’t click off now. That’s enough, buddy. Think bridge too far. Thanks. But no. So yeah, it’s it’s in the future idea. So what I want to do is like, I would do it in the Facebook group at Facebook allowed for the technology to put your mi video in there live and let people interfere but it doesn’t. But there are some third party things like Facebook who do support this. And if people will say, well just do it over zoom the way you always do it. That’s nice. But you only get a couple 100 people that way. I think that I imagined my Facebook group with 25,000 members in it. And I think geez, what if even just, you know, a small percentage of them happen to be online, you know, you’d get a few 100 People who RSVP and maybe you’d grab hundreds and hundreds more who happen to be online when it happens. So that’s my idea. But the technology needs to catch up to my idea, but I think it’s getting close. So cool. Keep your fingers crossed for that. In the meantime, how can I successfully encourage my 35 year old son to manage his type one and try technology? I lost my twin sister who was also type 120 years ago because of mismanagement, and he’s following in her footsteps. I don’t know how to approach him without causing him to become defensive. And he magic words. He’s an ostrich who keeps his head in the sand. Yeah,

that’s a that’s a hard one because it’s from the standpoint of it being an adult that you’re trying to usher some change into their life. People have to be wanting of information to begin with. Right. And sometimes the road to that starts with acknowledging something that’s really important to him. That is more directly in his line of vision being impacted by the way that he’s currently managed. During his diabetes, write, like your whatever it is, if it was, I really love running. And every time I go out for a run, I’m really frustrated, because I just haven’t like figured out that piece, right? If you can find something that he really loves in his life, and bring in how that could be better, especially if he’s frustrated with an aspect of that, that may be an in of sorts to getting him to see the ability to even use just a CGM to be able to better follow how he’s planning, you know, to move forward through his day. I mean, I would say, certainly, maybe send him some of the podcasts, get an email and say, Hey, this might be a really good one to start with listening to you. But again, for an ostrich in the sand, sort of, you probably wouldn’t really click on it. It’s a hard, it’s a hard situation,

let me tell you that we we received as you know, a so many ask Scott and Jenny questions recently, but I chose about five or six of them and move them over to talking to Erica Forsythe about them, because she’s a type one forever. She’s a therapist on top of that. This was one of them, that I think I’m going to leave in both folders. I’m gonna I think I’m going to ask you this. And I’m going to ask Erica, this one. And I’ll tell you why. Because I have no, obviously my oldest child was 22. And even at that age, I understand what this person is saying. Like they’re people are adults, whether they’re doing something good for them, or bad for them or right or wrong, or however you want to think about it, you’ve probably lost the ability to impact them by just saying, Hey, you probably should be doing something different, right? Correct. I don’t think humans in general learn that way, which is my my go to example from my childhood always was, how many 14 year old girls have to come on Jerry Springer pregnant before other 14 year old girls go, you know, I probably should not get pregnant. And the truth is, it never happens,

right? Like I should maybe not do what’s causing the pregnancy,

or just look up and think that I don’t want that to be my reality. Right. Right. And so my point is, is that even in the in the face of good information, or good fellowship from people who care about you, or even seeing it happen in front of you, and you go on, like, Oh, that’s a dumpster fire, it still doesn’t stop people, people still have to go through whatever their path is. And some people find their way out, and some people don’t. And it’s a shame, but I think it’s kind of true. And so, when I looked at this question, I related it back to what I tell people with younger kids, because in my mind, this guy is is in some way burned out on diabetes. But my expectation always is that, alright, sure, maybe there are people who are just flatly going to ignore it. But the truth is, they don’t completely ignore, because if they did, they’d be in decay. And a couple of days they’d be gone. Right? Right. So they’re putting some effort into it. It’s my expectation that if the effort translated into reward, that that would be how you’d build more excitement, like they need to see something happen that’s positive. And I just think that some people are caught me, you could just take one aspect of diabetes, right? Chasing blood sugars. If you start chasing a blood sugar on day one, and you don’t know how to get ahead of it, you could do that your entire life. Correct, right. And I’m sure you see people that happens to all the time, I’ve seen people that happens to all the time. So if I had any advice in this, and this would be just me, literally reaching into my brain and pulling things out that I’ve seen before. I would wonder what would happen if this mother went to her son had a launch, sat down privately and said, Hey, I know how much you’re struggling. And I see that it’s not getting better. And it’s got to be incredibly frustrating for you. I’ve learned how to do a couple of things that I didn’t know about when you were younger. But I understand now, let me just lay a couple of ideas out here for you. Can I move in for a week? Can we get into a text chain can like let me be your lifeboat for a little while. I think we could get this going a little better. And then let’s see where it takes us from there because maybe even just stopping the bouncing blood sugar, so the high blood sugars might bring more clarity to this this gentleman and maybe then the idea of a Pre-Bolus thing would start to make sense and you go hell if I’m gonna feel this much better. I’ll put insulin in 15 minutes before I eat, you know what the heck? Right? I just think that there are times Let me rephrase. I think it’s interesting that we would see a person who was addicted to, I don’t know math and say, Well, I can’t help them, somebody else has to help them, they can’t help themselves, we have to take them to a professional. The problem with diabetes is there’s no professional where you can drop off your mismanaged loved one. And say, right, can you can you get them straight for me? Right? So I think it’s up to this, I think it’s up to the person who asks the question, to just say, I’m going to become part of this. In any small way, I’m going to take a long look at this, I am going to help this, I’m gonna help my son chip chip chip away until he gets to a better place, I actually think it’s possible just I think it’s a lot of work. And you need a really long vision of what it is you’re trying to accomplish. You’re just not sending somebody a text and saying, listen to episode 11, you know what I mean.

And then also, maybe from an understanding or a knowledge base, as well, right? If this mother has learned more than she knew, in his life, growing up with diabetes, or whatever, and she knows now knows more now, she may also be able to recognize some of the deficit in information that her son hands. And so from an information standpoint, like you said, sitting down and saying, hey, you know, I learned all of these, like new things. And I think, if you’re willing, I’d like to help you start here. And or, if you don’t want to work with me on it, maybe I can, maybe I know somebody that you could start working with it kind of develop a relationship, again, with a better clinician than he may have, you know, if it and again, that’s where I think sometimes clinicians are at a loss because they, they don’t have a very long visit. And they don’t have a lot of resources, right? For something like this, they just often dump on more insulin, because something might be stuck high, for the most part, in a situation like this. And they think that they can at least smooth things a little bit. But they’re not really addressed. It’s like putting a bandaid. It’s not addressing the issue.

You know, I don’t think I’ve ever directly said to somebody, you should go see Jenny. But this is an example where a person like you would be helpful, because even as I say, maybe the mother could do this. I don’t know what their relationship is. And I’ve seen it. I’ve seen a lot of men walk out the little boys on a baseball field and talk to them and it goes well, and then the minute they walk over to their own son, they’re yelling and screaming at each other. Right? So maybe it’s not okay, maybe it’s best not to coach your own kid. But But yeah, I think you have to think wherever we are, we’re so far into it now that a well meaning handwritten note, or Hey, buddy, I love you, you can do it. Like you’re beyond that. Now, you know, this person needs to see some stability in blood sugars, that makes them feel better and right. And they’re saying they don’t want to try technology. I mean, so then, could you talk them into eating a lower carb lifestyle for a couple of weeks, you know, just to just to kind of reset everything and learn about how insulin works first, right? I don’t know that this question is any different? Interestingly enough, aside from the part where there’s resistance from the person with diabetes, I don’t know if this question is any different than how people feel when their kids are diagnosed, and they don’t know what they’re doing. And it’s frustrating. And, but you know, you have little kids, I was talking to this woman the other day, I said that 11 years old, her son was so like, easy to manage, because he did what she told him, and then a little, little bastard got a little bit of testosterone going, you know, then all of a sudden, he’s like, I ain’t listening anymore. And, and she’s like,

independence, right? I mean, there’s a reason that we move through stages of independence from little on. And that’s

right. Going back to this example, this lady said, look, here’s a kid with a five a one, see, from what I learned on the podcast, hits, you know, a little bit of gets a little older. So armpits start to smell a little bit. And as a once he goes into the sevens, just because he doesn’t do the things that they all know we’re going to work. So, you know, and then she’s going to be there because this is still a smaller child, and she’s going to keep pushing and pushing and pushing and getting back to where he needs to be. But this is a different situation. I mean, if it is, you know, if this man is 35 years old, I’m guessing his mom’s at least 55 years old, most likely in her 60s and, you know, the dynamics

and may not live close enough. I mean, they may live across the country from each other and she only sees the downward trend. And unfortunately, she has a very bad like, you know, history of seeing I think she said her sister, right. So, that’s hard to see, especially in your child. Yeah. Then

well, and To your point I take to heart and I want to add to it for the kid. That means that when he was 15 his aunt died of type one diabetes he either had it then or got it at some point. And you know how people think like my dad died at 49 from a heart attack and people then don’t expect to live past 49 when that’s their story, right? You know, it’s, I mean, it’s silly but all right, you know, like I understand how it could make you feel that way. I appreciate you talking about this but yeah, okay. Let’s do something slightly not as depressing Jenny here’s a very simple question Yeah, to see that common right little ad break us med this place, I love it. US med is the place where you can get your diabetes supplies. You go to us med.com Ford slash juice box or call my 888 number which is 888-721-1514. And us med will give you a free benefits check right now and get you started. US med accepts Medicare nationwide and over 800 private insurers. They have an A plus rating with the Better Business Bureau and they carry everything from your insulin pumps and diabetes testing supplies the latest and CGM like libre two and Dexcom G six. US Matt is proud to always provide 90 days worth of supplies to you and they give you fast and free shipping. So if you’d like to work with the number one rated distributor index com customer satisfaction surveys, the number one fastest growing tandem distributor nationwide, the number one specialty distributor for the Omni pod dash, the number one distributor for FreeStyle Libre systems nationwide. And the place where I just got Arden’s on the pod five from you want us met us met.com, forward slash juicebox links in the show notes links at juicebox podcast.com. To these and all the sponsors of the Juicebox Podcast. When you click the links, you’re supporting the show. What are your thoughts on service dogs for type ones?

Oh, that’s a great question. In a simple answer, I think they can be a really wonderful again, tool, if you will. I do think that there are there are people that they are really valuable for. And then there are people that like I’ve I’ve never really considered getting a service dog. I haven’t. That’s me, that’s my personal. But I have a number of friends who have service dogs. And they are a large benefit. And I think not only from the diabetes aspect in terms of acknowledging and alerting. But also from an emotional standpoint, the fact that you have a technology like CGM, that do already give you alerts and alarms. We know that technology can be wrong at times, it can fail, we can fail to hear an alarm, especially overnight, I hear that a lot from kids and teen parents, that the alarms are just if they weren’t there, the child would just not wake up to the current alarm, they just wouldn’t, right. So from the standpoint of an alert dog that actually works and works and works and works and works until you’re physically like up and or some of them can be trained to go and get another person if there’s another person in the home. I mean, they’re I think they’re a positive thing. That’s but I also think from knowing about them. I think it’s really important to do your homework on where you get the service dog from Yeah. I have, you can not only get ripped off, but you also have to know what, what do you want the service dog for to begin with. And then from a training standpoint, there are places that will do 100% or so of the training for you. You come and you learn how to interact you are almost paired or matched with that service dog. And you learn how to continue and foster the training in order to make sure that they stay alert to you and your needs. There are some service dogs that you can can get where the training is more of an online and it’s more the person with diabetes that goes through the majority of the training and, and does it with their service animal. I, I have had I’ve had friends who have done it both ways. And for them, their decision was right the way that they did it for what they really wanted to use their service dogs for. I’ve got friends who literally don’t go anywhere without their service dogs travel with them on a plane or a train. I have one friend, her service dog actually just passed away said, I know her service dog because I’ve met her service dog but I mean she is she rode for like the JDRF bike rides and everything. She actually bought a special trailer for her service dog to pull behind her bike Wow, to go along with her. So in that, you know, a guy guess you have to again, consider how much contact do you need or want within your diabetes life, I’ve got another friend who her service dog is with her. But when she flies or goes to a conference or something, she does not bring her service dog along. her service dog is mostly for her home based area or anytime she drives someplace. So do your homework, get from a really reputable place? And know what you need your service dog for what your what are your expectations that that that will provide for you or for your child or your TN? So Well,

I think everything you said makes 1,000% sense. And I kind of agree with you. It’s not it’s not a thing we ever considered seriously. I do know in the beginning my panic, my wife was like, mate, you know, maybe we should do this. Maybe we should do everything you know, right? I would just say this, I’ve never done it. I know a couple of people who have them who are absolutely delighted by them. It is a way of life. You know, it’s not the service dog, it’s not a thing you put on a shelf when you don’t want it, you know you’ve cracked, it’s a it’s basically another person that exists with you. And you’re responsible for them. And there’s a ton of upkeep and training and and love and everything else has to go into it. All I’ll say is that Arden’s Dexcom has never vomited on the carpet in my foyer. So both of my dogs have.

Oh, that’s interesting. That’s kind of funny. I our current lab has only I think he’s almost eight. And he’s only thrown up like once in his whole life with us so far, I think so

I’m just Dexcom is not gonna poop in,

they won’t, or fart in the middle of the night and have this horrid smell.

Or if you go back to any number of the beginning years of this episode of the podcast, you will hear them snoring in the background and everything else. So anyway, if I think I think you’re right, I think if it’s something you want to be involved in, and you understand the level of commitment, and it’s something you’re willing to do. I see it as being a great, a great idea, you know, but it’s also a cost. And I do want to say I’ve seen people ripped off by training companies that are not reputable. And I mean, the cost is significant, too, right? You’re talking about 10s of 1000s of dollars. Am I right?

I don’t even know honestly, what the cost is, I would have to go back. In fact, you know, for some references to some good places, I can certainly ask my friends where they got their service dogs from for some references. And you know, then I’ll give them to you to supply. But yeah, it’s expensive in terms of cost. I don’t really know what the cost is. But it’s it’s not $2. Yeah,

no. Okay. Hey, I think we have time for one more. Cool. Why does lack of sleep make blood sugars less stable, even away from food exercise active insulin, I usually see a lot of 9095 9100s, etc. With lack of sleep, when otherwise on just basil, my numbers are a lot more steady. Well hold on a second. I don’t know if I understood. Let’s go back to the beginning. Because yeah, I don’t think again, I don’t understand her explanation. I understand your question. Why does lack of sleep, lack of sleep make blood sugars less stable? Do you think that’s true? being tired makes your blood sugar less stable,

less stable. Typically, what we see is with a poor night’s sleep or consistent poor sleep, that your blood sugar’s will be higher on average. And if that’s what’s meant by less stable, possibly, you know, especially if their roller coastering up and then you’re correcting and they’re coming back down. I mean, that could be less stable than what this person sees when they have good sleep overnight. Typically, yes, we see higher blood sugars with less sleep. That’s the general

I mean, listen, I don’t have diabetes, but if I’m tired, I’m more likely to be distant. I get a little foggy, I can be more irritable, right? Like there’s, there’s a lot of things that come with not sleeping, you need to sleep. Obviously, if you didn’t, I mean, life would be twice as twice as long. Right? But, you know, it’s just so I’m not understanding the question afterwards. I usually see a lot of 9095 9100s with lack of sleep, when otherwise on just basil, my numbers are a lot more steady. See, I don’t understand because 9095 9100 seems to me it would

be steady and very good. Well, I wonder, yeah, I’m not quite sure. I mean, one big piece in terms of lack of sleep and unsteadiness or again, a rise in insulin is or a rise in blood sugar, excuse me, is relative to what happens to cortisol. Right? When we have when we are sleep deprived, if you will, cortisol increases and with that impact, typically can increase insulin resistance. So it sounds almost like steady numbers on Basil is what the person was trying to say. But with a lack of sleep. The numbers get jumpy. I wouldn’t say that the numbers that were stated sound jumpy. They sound actually very stable. But overall answer to Question poor sleep higher blood sugars, insulin resistance, typically, that’s the gist of it. Yeah,

it almost makes me feel like when I read her description at the end, she says with just basil. My numbers are a lot more steady. I almost feel like they wanted to say a lot less steady. I I’m trying to decide this person saying that when they have lack of sleep, they have better blood sugar,

better blood sugars. Yeah. Which wouldn’t be the case typically.

That doesn’t make sense. Okay, but so but still lack of sleep can impact your blood sugar’s you would normally see it as a rise as a rising.

And if it was a really poor night of sleep, you may actually have a lot of other hormones are, are thrown kind of loopy in terms of the whole rest of the day, you may actually have a change in the regulation of hunger hormones, which might mean that your hunger is disrupted through the course of the day. And you may nibble more. And I mean all of these. Again, we’ve discussed variables. Yes, all of these variables could have an impact on overall blood sugar, just because of a poor night of sleep. Right.

Okay, so All right. Well, thank you. I appreciate it. Yes, with me, sure. First, I’d like to thank all of you for sending in your questions over on the private Facebook group. That’s where I got these questions from Juicebox Podcast, type one diabetes on Facebook 25,000. Members, just like you head on over. I also want to thank Jenny Smith, my friend, and diabetes guru, integrated diabetes.com If you’re looking for Jenny, and a special thanks to us med for sponsoring this episode of the podcast, US met.com forward slash juice box or call 888-721-1514. And of course, don’t forget, touched by type one.org. I have a link here about service dogs that Jimmy sent me. It is. Oh, it’s pretty easy. www care. Es que es.com. So it’s C A R E S k s.com. When you get there, you’re going to be at Canine assistants rehabilitation education and services. This is the website that Jenny was talking about earlier. Hope if you’re looking for a diabetes alert dog, that this will help you. There are like 15 Other ask Scott and Jenny episodes right now if you’re looking for a list of them, the private Facebook group is the place to find them. There are these wonderful lists that Isabelle made for me. They’re up in the featured section of the Facebook page. And that’s pretty much all I have about that rollout theme here a little bit. That’s okay. Scotty started a little bit. Tell you what, let’s just say this. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast.

At the beginning of every episode, I tried to record a different opening. And I always just end up back at Hello friends, and welcome to episode 693 of the Juicebox Podcast. It’s classic. Today, Jenny’s back for chapter 17 of ask Scott and Jenny and I think this is the last ask Scott and Jenny for a little while. So dig in and enjoy. Please remember, while you’re listening to Jenny and I, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please Always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you’re interested in hiring Jennifer, she works at integrated diabetes.com. Also, if you have type one diabetes, and are a US resident, or are the caregiver of a US resident who has type one diabetes, you can go to T one D exchange.org. Forward slash juicebox. Join the registry, take the survey help people living with type one diabetes, it’s completely HIPAA compliant, absolutely anonymous, and supports not only people living with type one, but the Juicebox Podcast. And I’m Juicebox Podcast so you’d be helping me out. T one D exchange.org. Forward slash juicebox takes fewer than 10 minutes. This episode of The Juicebox Podcast is sponsored by us Med, go to U S med.com. Forward slash juicebox. Or, or call 888-721-1514. Whether you go to the link or call the number, you’re going to be chatting with us mid and finding out about your benefits. That’s right, you get our free benefits, check out that phone number, or at the link. The podcast is also sponsored today by Ian pen from Medtronic diabetes in pen is an insulin pen that does a lot of stuff that a pump does when you pair it with the app that comes with it. And it’s pretty darn nice. Check it out at in pen today.com I’ll be talking more about in pen and US med a little later in the show. You don’t want to miss it because it’s late at night here where I’m recording and I’m probably gonna say something stupid. That’s the thing that happens when I’m tired. Hey, Jenny, how are you?

I’m fine. How are you? Scott?

Good. We’re gonna do more ask Scott and Jenny today. Oh, yay. Yeah, people tell me we seem very relaxed and happy while we’re doing these.

I hear you can see our faces. We are pretty happy people don’t really frown too much.

I just somebody told me that we seem like it’s fun. And I said it is fun. And then I thought Oh God, are we like diabetes? dorks like we’re just having fun like, going like, hey, it’s an interesting question. Let’s think about it for a second. So apparently, that’s what that’s what we are. Alright, let’s just start a Start Here. There were a lot of questions. Questions, right? Um, which one do I like to start with? Alright, here’s a very simple one. What number do you correct at during the night?

Ah,

so do you think this question comes from people who were pretty much told not to correct their high blood sugars at all?

I would say maybe it started there. Yes. Because that is certainly something that’s still taught not to correct. I think sometimes it’s in the beginning stages, maybe after diagnosis, because they’re still trying to sort of figure out how much insulin works. And in a time period where you’re supposed to be sleeping, it’s kind of a worrisome thing to have to sit up and wait to see what happens when you take extra insulin. But honestly, it kind of boils down to knowing that your settings are right, it’s knowing how insulin works for you, how much does it take for this amount of insulin to do the job, and overnight, I mean, unless you talked about a lot of the variables. We’ve already talked about things like pizza and fat and do bla bla bla, or exercise overnight. If you’ve got your insulin sensitivity factor pretty dialed in, you should be able to correct a value and take the doses if you’re using a pump. First, you should be able to take the correction offered and it should get you to the target that you’ve got set in your pump or pretty close to it right. So I I think in terms of defining a number, it also starts with the Finding what’s the target you’re aiming to sit at? If you are comfortable at 110, then you’re probably not going to be correcting a 115. Right? But if you really want to sit at 85, then you’re probably going to correct the 110 to be able to get down to that.

So I see this question like coming from two different perspectives. So if you were to ask me, where would you correct? A blood sugar? I would tell you, it wouldn’t matter if it was overnight or during the day, or if we were in a car ride or at the top of, you know, a mountain. Although the top of the mountain, maybe it would, because there would be some difference. Yeah, there’ll be differences there. So there’s a bad example. But, you know, Jenny makes the point already. If you trust your settings, then you can correct a 95 blood sugar without making yourself low. Right? Correct. And Arden’s using DIY loop. So I mean, her loop is correcting at 90, you know, like, so there’s the answer. If your settings are super tight, and you know what’s going to happen, is gonna happen, then you can correct anything. But I tend to think that this question comes from people who are maybe more new to the podcast, maybe or, or have are seen, like wildly out of control blood sugars. I read this question as what number is high enough that I put in insulin? I’m not going to make a low blood sugar later? And I have to tell you, I think the answer to that question is go listen to the protests. So that that stuff doesn’t happen to you.

Agreed, at least not all the time, or Yeah, often, right. I mean, those random i, we talked not long ago, and like I had this horrible high blood sugar overnight, they didn’t hear my alarms, and you know what I mean, things like that they can and and will happen. But overall, as I’ve said, and as the pro tips different definitely cover, it’s if you know that your settings work well. And you’re not happy with the number that you see, when you wake up to go to the bathroom at night or your alarm goes off or something, you shouldn’t be able to correct that number and get to the one that you really want to sit at. So I don’t I don’t think it’s necessarily defining what number to correct above. It starts with Where do you want to be? And if you’re not there, do you know that taking extra insulin to get you there, we’ll do it without causing alone.

Now, some practical thoughts from me on this would be if you see a 200 blood sugar, and you aren’t sure how to safely bring it back to 90, if that’s your goal, at least wax something out of it, like throw in something like if you could make a 191 50 doll better than 190, right? You know, take something out of it put in put in some sort of a Bolus. And actually these moments are where you really learn, because I can’t tell you what number to correct that or how much to correct. But if you do it over and over again, you know, you can look at that 190 a stable 190 At two o’clock in the morning, put a half a you in London as an example. And it ends up being 170. And you think, Okay, well, I wonder what would happen if I put a unit on it, maybe it would end up being 140. You know, you’re gonna learn from trial and error. So that’s it. It’s a roundabout way of answering that question. But I think there’s more. Like there’s more good, good, good, usable thoughts in there than there is? I mean, I can’t tell you what number to correct that that just, that seems like something that seems like something a newer diagnosed person would ask an endo, and then the endo would pick some huge number that they thought there’s no way they can make a low out of you know, correct. Yeah. So anyway, all right. It’s an interesting question. It says, when you do the thing that you know is going to happen, and it doesn’t happen over and over again. How do you adjust to the new normal? And the question ends with is it just time? So I think the question here is, you know, I’ve been using a unit to make a 150 100 for a year and now all the sudden it’s not working, how long until I? I assume it needs more insulin in that example.

I mean, I would go about it the same way, a dress a lot of adjustments that I work on with women in pregnancy. Three days, we have a trend, let’s make a change because something clearly has. It’s not working the same way any longer, right. I think a lot of times if you have been stable for a really long time, it can seem almost like something else must be the problem, right? Maybe my insulin went bad or it’s got to be a bad site or something else was the issue. It’s it can’t be that my setting has all of a sudden just needed a change, right? But it could be Yeah, I mean, we know that diabetes is not this, you get to a point and everything just sits there. Right? If it was man that would be easier to test things and be like, great. I’m done for life. Now I just have to count my carbs.

That’s it whole podcast would be about how to get to that point. Right,

exactly. So. So yeah, I mean, a couple of days of a trend, as long as you have considered variables, you know, even illness in the picture or a change in your schedule, a change in your sleep schedule could certainly mean and we talked about sleep a little bit before, that interrupts your sensitivity to insulin, more to the case of being a little less sensitive than more sensitive. So if there aren’t any known variables in the picture, nothing that you’ve really changed, then I expect that you probably need to retest and say, okay, one unit doesn’t drop me 100 points anymore. I guess I’m going to have to use a little bit more, I’m going to change my ratio, or my normal sandwich at lunchtime, or salad used to take two units of insulin. And now I’m getting higher, or lower, maybe after and it’s been a couple of days.

Yeah, I injure ratio

in my mind I, I’d look at so the first thing I always do is I go to gaps of time, where there are no active meals or active boluses. And I look for stability. Because that’s how I think about base. Yep, like basil should. Basil should be pretty easy to check in those moments, especially if you have a CGM is I guess what I’m saying? So if I find stability in those moments, and that’s the ability existed a number I’m happy with, I think, okay, then Basil is good. Maybe this is just carb ratio. You know, maybe I’m not Pre-Bolus thing enough all the sudden, like, who knows? Like, that’s great. Why would end up looking after that? Yeah, I think so. And as far as time goes? I don’t know. I mean, if three days seems to be the standard for people, you know, I and then the question is specifically about once it’s set in stone that this is new. So yeah, I mean, three days is reasonable to me.

Yeah. And I would say within that defined time period that you’re analyzing, it’s not like when I notice things that change, it’s not that I’m just letting things sit higher or lower. To actually see, I am adjusting within that time period, so that I’m not left consistently high or consistently too low. And sometimes enough of those changes within the analysis time period. Gives you a good vision then for how to change the rate or the ratio by day three,

let’s say and I say Just don’t forget what you changed it from because if magically a day or so later turns out you are sick and or something like that you didn’t know it. You don’t want to forget what your ratios were. So you can go back to them because that has happened to me before. Mike. Wait, it worked before what was it?

Change it from? I was it’s funny. I’m, I’m, I am getting a new phone. And I was going back through all of my pictures and I’m amazed how many of my like screenshot photos all right, like diabetes stuff. Like I changed this to this or look at this super awesome, like completely just flat day or whatever. I was

awake. I was away for a few days, and we had to change Arden’s insulin sensitivity. And I said screenshot those, send them to me and then change them because yeah, I’m not gonna remember either you. Oh, here’s an interesting one. Well, here’s one thing that I know for sure, if you have diabetes, you need to get supplies and a lot of the places where you get supplies are a lot of fun to get supplies from. But at US med they take their A plus rating with the Better Business Bureau very seriously. They want you to get better service and better care. You estimate has been serving people with diabetes since 1996. And they’ve helped over 1 million people. Ardennes on the pod five just arrived the other day from us med it was very very very, very smooth and effortless process. I really I gotta say I didn’t miss that other place where we used to get the stuff from anyway. I’m not gonna say anything more about other places. Let’s tell you about us med number one fastest growing tandem distributor nationwide. Number one distributor for FreeStyle Libre systems nationwide, the number one specialty distributor for Omni pod dash, the number one rated distributor index com customer satisfaction surveys. What do you think of that? All Always, always, always do get 90 days worth of supplies from us med. And they offer you fast and free shipping. They’re going to have everything from your insulin pumps, your diabetes testing supplies and CGM, like the libre two and Dexcom G six, I don’t know what you’re waiting for us med.com forward slash juice box, or give them a call at 888-721-1514. Next up, another great sponsor for we’re going to talk about the ink pen from Medtronic. diabetes, I’m going to type into my browser in pen today.com. I’m going to hit Enter. I’m just going to read the Internet to people. That’s all you need to know is what you’re gonna see when you get to in pen today.com. Right away. Beautiful photography. I know you don’t care about that. Listen, take the right insulin dose at the right time. The right pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to a mobile app. Mobile App. I wonder what they do there? Well, that mobile app offers support with those calculations and tracking impact helps take some of the mental math out of your diabetes management. You’re going to be finding a dosing calculator dose reminders, carb counting support digital log books over there on that app. There’s no what I’m saying to you right now. It’s an application that goes on your phone, Android or iPhone shows you everything right on one screen, correct glucose dose calculator, active insulin remaining active insulin or meeting that sounds like a insulin pump kind of a thing, doesn’t it? Oh, look at you getting extra functionality out of your insulin pen. And it’s a great pen. I don’t need to tell you more, you’re gonna see it when you get there. In pen today.com You go there, and then you make the cookie. Okay, good to keep getting lucky. I’m going to read you something from the bottom of page. Now this is an offer that it says is only available to people with commercial insurance, it says offers available to people with commercial insurance terms and conditions of life. But how about this pay as little as $35 for the pen? What it says it right here they do not want cost to be a roadblock to you getting the therapy you need. And with the implant access program, you could pay as little as 35 out you gotta go take a look. Go see the thing. They the pictures. They’re really nice pictures, very colorful. In pen today.com. I am now contractually obligated to say the following in pen requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed where you can experience higher low glucose levels for safety information visit in Penn today.com. If you knew how late it was here, you’d be impressed by that. It’s gonna sound very specific, but I think it’s a bigger conversation. So how do I manage Pre-Bolus sing when I have gastroparesis, sometimes it works great. Other times I stay low for over an hour. And by the time the food hits, I have no act of insulin and I skyrocket. I never know when it’s going to hit. So this is a question that I’ve actually been asked a handful of times over the years. And the first couple times somebody asked me I thought I don’t know anything about gastroparesis. I can’t answer this question. I have no idea. And then I spent some time talking to people who have it. And my understanding loosely ended up being that sometimes I eat and my body starts to digest food. And so I get the impact that I expected. I know how to line up the insulin. And sometimes that food just sits in my stomach doesn’t get digested. And like the question says, I have all this act of insulin. How do I know which is going to be which and one time I said to somebody, oh, maybe you could try bolusing the way that I think of bolusing for infants and smaller people, like get a little bit going. And then when you see the impact, quick Hurry up, throw the rest in. And I’ve never heard back from anybody that that didn’t end up being valuable for them. But I am wondering what use help people

know that it is similar because it’s like a small child where you don’t know exactly like they love their favorite plate of food and you put it down today and they eat three nibbles and they’re kind of done right. So it’s a question of how much and when is it actually going to completely get digested in this case? Or absorbed I should really say and a timeframe that may help as I’ve worked with a number of people with gastroparesis is that on a more empty stomach, which for most people is first thing in the morning, you’re going to get more more consistent, absorption, digestion because there’s nothing there’s nothing left over in the stomach. by them, right? By the morning time, we have, for the most part this like clear route system, if you will, right. And the body is more likely to also, as everybody with diabetes experiences want to get that food in to get your body some energy to get going for the day. So if there is a time period of the day, if you expect a need for a real Pre-Bolus, because of sooner, quicker absorption of the food, it seems to be morning time. And then as the day rolls on, and as you put more food, whether it’s meals or meals and small snacks or whatever, through the course of the day, it tends to be the end to be all of the night, that is often the hardest to gauge when to dose the insulin, because by that point, with a with a slowed down digestion and absorption of the foods earlier, you’ve already still got stuff sitting there. So that may be in a timeline through the day may give some visual as to or a structure, I guess, to looking at what this person might be seeing happen, saying sometimes I seem to need the Pre-Bolus and it works just fine. And other times maybe it’s a time of the day. Okay, so begin with first

kind of track that to see if you’re seeing it more at one time a day than the other. Possibly most likely, at the end of the day, I guess as the body is having more and more food added and more and more trouble dealing, right. Okay. Right.

I mean, the other thing would be the case of also just trying to figure out your more typical foods. And if they are more causative to immediate need for Pre-Bolus. Or I just have to follow this kind of a meal out. And as you said, Put the insulin in in a slow duration. You know, an extended Bolus, for example, often works fairly well, if you’ve tracked enough around particular meals to know what their action seems to be like most often for you.

Is this a mimicking of like pizza? In a person who doesn’t have guests? Or is that a similar or not?

It’s that’s a similar thought. Yes, I mean, not for the reason of fat in this. It’s just a slowdown in the body’s ability to digest the right way and absorb the food the right way to give the glycemic effect that you would expect from that particular food.

I’m always kind of in the back of my mind when we’re talking about timing. I always think I always wonder how many people are listening thinking I never considered that before. I just thought I just thought it was just you know, I count the carbs. This is the insulin for it all goes in all works out doctor told me to do it, it’ll be fine. You know, in considering this. I mean, it’s, I mean, for the people I’ve spoken to it’s a terrible thing to be afflicted with it. Really, it really sounds difficult.

Another consideration that I know people have tried to as you know, today’s rapid acting insulins, while I don’t love the name of them, because they’re not really rapid. Right? A rapid is like, Okay, right now, it’s done, it’s working. But they are certainly more rapid than the AR that I was on when I was first diagnosed, right. But in the case of potentially needing that lingering effect of an insulin, some people actually do better with a regular insulin. So that it’s it’s creep out in action is longer in taking effect. And again, timed right with meals that are well planned or, or well evaluated. Almost like the same thing for breakfast, lunch and dinner. That type of insulin could meet the food better than a rapid insulin could.

So back to the old timey insulin.

Sometimes that can work better.

Yeah, great. Well, good question.

Yeah. Here’s one. How do I find a great CDE in my area who is open to all of these ideas and works well with teens? I have. I’m gonna I’m gonna ask you first. What do you think people should be looking at when they’re looking at doctors?

From I’ll give my adult perspective, first, adult perspective when I call to get into a new endo office. Some of my first questions include things like how many type ones does your practice see? Oh, okay. Yeah, comparative to type twos or other types of diabetes or other types of endocrine disorders, right. I mean, you have may have an endocrine office, but they may be more heavily thyroid based. I mean, they made you know, I would say dabble may be the word in diabetes only be because that’s in their realm that they don’t necessarily do that most. So that’s a question I ask is, what’s your population of people with type one? And then what goes right along with that is? How much technology do you do you use in your office? Do you use one pump? Or you recommend recommending only one type of device? What type of data like evaluation software do you have? How can I send my information to you? How often are you going to get back to me? I have a lot of questions. I’m trying to really do better. I need somebody to answer questions weekly for me. Is there somebody in your office that can do that? Do you have another question about just the endocrine office? Do you have a CDE? In your office? Do you have an educator who works physically in your office with your practice? Because again, then there’s a little bit more collaboration in terms of the endo and that educator, they know each other, they’re going to be more on the same page, if you will, you’re not going to get information from one that’s kind of contradicted by the other, which can make your decisions hard then because then you sort of feel like you’re stepping on somebody’s toes. If you’re going outside of what one recommended.

It’s a terrific response. Because I, because Arden still goes to a, you know, to a children’s Endo, I never I it’s as you were saying, and I’m like, Gee, Scott, that’s so obvious. Like, how did you not think that but it shocked me, I thought, oh, an endocrinologist might not be well versed. And they in even in diabetes, right? Like it’s they could be doing Oh, anyway, I was like, wow, that’s such a great answer. I never thought any of that

know, when we lived when we moved to Northern Virginia, or the DC area. And I was on the search for an endo there. I went through three endos, before finding an endo who actually met my need. Because

what were the reasons you didn’t like the ones you found?

The initial the initial person just was not up to date, that’s the best way to say it. They were just not up to date with keeping up with how people were managing today. They were very much to old school. And the second office was, it was not enough. They had technology, but they were very much toward one type of technology. Gotcha. And just really were not keen on the others. Not that they wouldn’t allow prescribing, but they just didn’t know enough about them. And that wasn’t cool to me. So

one of the one of the one of the companies sent really great bagels and pens that wrote really well. And so that was the pump they talked about. I got Yes, I got pretty much. Yeah.

So yeah. And then the office that I eventually ended up going with was, it was a small private practice. Actually, it wasn’t affiliated with any, like, hospital system or anything. And he just he really, what got me with my first visit was that he took the time to sit down and ask about my life, and how I manage specific things. It wasn’t just a generalized visit

the the things that you know, that they need to know to actually answer your questions, right. Okay. Yeah, not just you have, what’s your carb ratio?

Right? What’s your a onesie? What’s your carb ratio? Let me take your pump from you and physically touch your device and change everything and handed back to you. Hey, go run, run, run from those offices,

eat healthy and exercise. I’ll see you in three months. Thank you. Well, I will just throw in here, that if you go to juice box docs.com There is a growing list of doctors that people who listen to the podcasts and an end if you have a doctor who fits the bill, please send it to me so I can add it to the list. I would say for Arden, you know, we went with a big institution that was near to our house. And I don’t know like I I don’t I can’t I’m such a bad person to ask about this because I’m me. So I don’t know how valuable it is or it isn’t. I really couldn’t tell you. I can tell you that I’ve been in situations where I’ve been asked to go talk to other patients, which is weird. And I often there are times I get asked more questions than I get to get ask in a visit. So sometimes my answer is if you know what you’re doing. Good doctors are the ones that stay out of your way and write you the scripts when you need them.

and can support and discuss, especially if you’ve come prepared to a visit, to talk about, I’ve made these changes, these are these are the reasons that I figured out how and why to make these changes. Do you see anything else? Do you think I’m on the right track? And if you’ve got a good doctor who can sit down with you and go back and forth and discuss, then you’ve got somebody who, you know, is good, right? If not, and all they really just want to do is look at data without any explanation to it, then,

hey, I find value in the fact that Ardens doctor can do her a one C, and it goes through my insurance, okay, and we don’t have to go to another lab to do it. Like, to me that’s like a bonus. Yeah. But I would say, I mean, I would say we’ve covered it here. But how do you find a doctor, that’s going to work well, with teens, it’s you’re going to talk to them and see if it works well. And if it doesn’t, you’re going to need to have the nerve to move on. That’s all.

And honestly, in today’s world, like I had none of as a growing up child teen. The online community is quite a good resource. And people give their honest opinion. And I think in especially in in our diabetes community. If somebody’s had a good experience with a doctor fourteens or a doctor for kiddos or a doctor for real little littles or college kind of connection doctors. It can that’s one thing that I think it can help to ask, because people are very happy to share when they’ve had a good experience.

Yeah, listen, feel free to go into my Facebook group and ask specifically about certain doctors. I don’t mind if you do that and be surprised that that group has gotten big enough now where you might actually get a couple of answers I we’re starting to get to the point where people are bumping into each other in like cascos and wearing shirts from the podcast going, Oh my God, listen, that podcast too. So you might actually find more people than you think. I mean, unless you’re in a very rural place, but you know, okay, well, thank you. So here’s the question, I have no idea how to answer. There’s a stomach bug going around. This person asks me directly have I ever had to take art into the ER for not being able to manage blood sugars and ketones when she was vomiting? Seems like it’s a common thing to have happened with illnesses that cause vomiting. I will tell you that when I see this time of year comes up and people start posting about my kids throwing up what do I do? I’m thrilled that I made that Facebook page because people who know what to do come pouring in. I don’t think Arden has ever vomited in her life. Wow. Yeah, she doesn’t get Yeah, that’s amazing. She doesn’t get sick. I don’t know when here throws up like it’s we’re not a throwing up family. So Arden’s never vomited. She gets sick incredibly infrequently, which I think is just obviously hurt her stellar auto immune system is very strong. Kill nearly anything, Jenny. One way your thyroid, your pancreas an illness, it runs roughshod over everything. Let’s get rid of, but she um, she just doesn’t get sick like this. She’s never had a stomach virus. And Arden’s also, she’s a bit of a warrior at me, she she would choke something down if she had to, she wouldn’t like it, but she would do it. Having said that, she has had the flu as a small child. And I do remember that week of my life, very unfriendly, which I don’t think it’s a word, but it was not. I also had the flu. So she had the flu, I had the flu, and she was only a couple of years the diabetes, we were still using needles in a meter. And I remember giving her like small sips of Gatorade to try to keep him. Basically what I did was like flip the whole process around in my head. And I started thinking of instead of how does insulin bring blood sugar down, I started thinking about how does how to carbs bring blood sugar up, like how do I bump the bump nudge the other way, basically. And that is what we ended up doing. There was a time I actually gave her a lollipop to suck on. Because I thought this is it. Like she gonna she’s going like like her blood sugar was falling during this flu. She wouldn’t eat anything. And I pulled out a lollipop and I was like you’re stuck on this. And that worked. I don’t know, though. Like I saw a lot of people talking about it recently. So has it been going around?

It has honestly I would say in the past month. I’ve had so many kiddos who have had some stomach bug of some kind and I think defining to I would hope that these days most people realize that the flu is not a stomach bug, right. Two different things. They’re very much two different things. Which is why when you said she had the flu she did not have a stomach bug.

No she He just was he how sick she couldn’t eat anything? Yeah, that’s correct. Yeah, that’s a similar problem, you know, correct. Yeah.

But it’s a true stomach bug usually runs its course pretty quickly. For the most part, it’s usually about 48 to maybe 72 ish hours. One, the two of those days being the real, like vomiting and possibly like diarrhea, not being able to take very much in, if that’s the case, insulin adjustment, for the most part usually needs to be taken down. If you’re thinking about digestion, you don’t get as much absorption, even with the things that you are able to possibly take in. It just gets passed through. So which brings in the concept of well, what do I do about dropping blood sugars, right? Overall with a stomach bug where food intake has really taken a nosedive, taking insulin doses down by 2025 30%, and a base Basal amount. And then for any food that is able to be taken in whether it’s Gatorade, or popsicles, or jello or you know, some type of electrolyte beverage with some carbohydrate in it. Don’t dose unless you know that it’s going to stay in.

Yeah. Yeah, really? No, I that was the one that those are the that was the moment where I thought, I mean, if our blood sugar goes to 150, or 180, or 200, I’ll bring it down slowly from there. But I’m not going to try to get ahead of it when I don’t know what’s going to happen. Right. Yeah,

exactly. So it’s, it’s cautionary and kind of the question of, well, when do we end up going to the emergency department, right? I mean, the sooner that you start, not that you’re not paying attention already to blood sugar, especially with the technology we have today, it’s kind of hard to ignore what a CGM is showing you. But in the case that you’ve been paying attention, and you can start to see things happening one way or another, make adjustments sooner than later. Is is really it right? fluid status is also really important with a stomach bug. Because if food or anything is coming out either way, you’re really losing hydration, you’re so you have to make sure to replace that. Hydration often is more of the reason that I see people end up going in, because they literally can’t keep anything down. Okay? Which then with diabetes, water or anything, they just can’t

keep that up, we’re looking at DKA, right?

We’re looking at even DKA at a much lower value based on the fact of ketones, right? I mean, you could be in DKA at a lower glucose value. Because ketones have climbed so much, because you’re dehydrated, you’re not putting any food in your right. So they’re, they’re bigger things in the picture there that do need to be managed. I always also recommend that if with diabetes, you go to the emergency. As soon as you get there, and you know that you’re going to be at least admitted to the emergency department, ask for an endocrine consult.

Okay, right away. Yeah,

right away. Because, I mean, emergency doctors, they see everything, they’re really good team of people, but diabetes is not their specialty. It’s, it’s just not, don’t let them take your insulin pump off. Don’t let them disconnect your insulin or not give you your insulin if you’ve got a Basal injected insulin, you know, bring it along with you. For the safety of knowing that you you could give it if you needed to. But I think that’s the big reason that I always say let’s get an endocrine Council going there because you need somebody on your team who really does understand

because a bit better, right? Because you can’t, you can’t even though you’re in this fairly dire situation. You can’t stop taking insulin because you’re you’re going to go into DKA and it could be a person who sees a low blood sugar their first thought might be we’ll take the insulin away but your thoughts got to be IV glucose drip will fight this that way. Right? Yeah. Okay. You know, it’s funny as you were talking about this, I swear to you all of my anxiety from the first time someone explained this to me when Arden was first like diagnosed came like rushing back into my chest because I remember thinking so there’s going to be a time when this process and her body that we have to keep going artificially with this insulin becomes impossible to keep going and if we stop the insulin, she’s going to just die a different way. Like you like that is how it how it felt when she was little, you know? Yeah, you really made me I got flushed while you were talking. Sorry. I don’t know why I wanted to ask the ask the question because I know how scary it is, especially in the beginning, and especially if you’re prone to this sort of thing. And I do see that sometimes kids get this illness sometimes. Some of them get it every year. Yeah. And so.

And I think another one too, depending on as you just said, Your child is one who you know, is going to get this at some point. Make sure that that’s a discussion within your endo visit at least once a year to revise or revisit what your plan of action has been. How has it worked? Yeah. Because then if you can see what didn’t work, you can improve upon that for next time. We did this and we did this. We still ended up having to go to the emergency department. We still couldn’t get around it at home. What can we do better or more aggressively next time? To avoid going to emergency?

Yeah, I’m gonna, I’m gonna go right into another question that’s similar, but I’m gonna say first, that the first time someone, you know, through the emergency line told me, I had to inject a unit a half of insulin to clear Arden’s ketones. When I couldn’t get her to eat anything. I was like, no, no, no, no. I think you’re wrong. Lady on the phone, I’m not doing that. And then I just I said to Kellyanne like, they told me I have to give her insulin she’s like, but she can’t eat anything. Oh, my God, I’m gonna do it. And I did it. And it worked. And, you know, so knowing? Yeah, it really is. So your to your point about constantly being aware of what you’re going to do your steps, that ratio is a good thing to know about as well. You know, how absolutely how much insulin we’re going to use to clear ketones. Next question is, I feel like my son has been sick more in the last year since diagnosis than any other time in his life. Is this in my head? Or do type ones get common colds easier? When do you feel like you can trust that the other important adults in your life to care for you? This is a two part question how long? Alright, let’s go with the first part first. Okay. Two people with type one gets sick easier, Jenny?

I’m going to say no. But with a little added note there, okay. Right. So people with diabetes in general, that is well managed, with lower variance would be less likely to get sick frequently, only because the stress factor of variable blood sugar, and or numbers that are higher, which leaves your body stressed already, those aren’t in the picture, right? So the more variable and the higher your blood sugars are, the more likely that that stress on your body is allowing an illness to actually also make its entrance and that your body can’t fight it effectively. That’s the easiest that I can kind of describe

that. So because we’re slightly post COVID Right now, post COVID, or post COVID ish. Let’s say that. I’ll use this as an example. When COVID first happened, everybody was yelling, why someone calling me Do not call me. But you’re so important to talk to, you know, stop it. Everybody was like, you know, remember it was you know, it’s like, well, we want to vaccinate the people who are at risk. And then there’s that big argument that you hear people say, Well, I have type one diabetes, I’m at risk. And then someone says, I have type one diabetes, that doesn’t put me at any more risk than anybody else, you know, like, okay, great. That’s gonna be fun online. Anyway, to your point, that someone, I’m going to just use you as an example, who you know, eats a pretty clean diet and whose blood sugar is very stable and managed and lower. almost normal. We’ve never asked her anyone say that interesting. You know, we’ve never once said that, wouldn’t it be great if it was a great if you’re like, I’m pretty steady. 788 right around there usually get everybody be like, Why have I been listening to stupid podcasts?

Like, oh, my God.

You’re not coming on anymore. What? But I’m not gonna ask anyone. But, but somebody who’s just cracked me up. I never thought of that before. Isn’t that funny? We’ve been doing this for years. It is never occurred to me to ask you. Yes.

Well, I’m happy. I mean, I don’t care. I’ve talked about it all the time. My patients asked me and I tell them all the time. So my last one was 5.5. By

God, I mean for me, not for you. That’s very nice. But so but so somebody in your situation. I would think that for reasons you just stated your They’re healthier to begin with, right? And that I don’t know that other people see one ad all day as cuz it might be the best they’ve ever been able to accomplish, you know, but to give an example, last night so Arden’s working on this big project for school and she got all like, hunkered down with it, I wasn’t home, and she has been doing more on her own. And I think her site went a little funky, where she was too sedentary or something happened. And Arden had like a 175 blood sugar for like six hours. And, and by the end of the night, she’s like, my back hurts and my ankles sore. And she did not feel good from her blood sugar just being 170 for like six hours. So you know, if you can think about what that could do to somebody over six hours. What if you’re always living like that, you know, like, what else is happening to your body? So So just getting type one diabetes does not make you automatically have more cigarettes, right? No, it does not if you’re not maintaining your your blood sugar’s that could be difficult on you could be difficult, correct? Yes, I we have so many questions here that are right around this. And we have a couple of minutes left. So why does blood sugar either go low in sick or high? And then after illness? Sometimes you need a higher Basal. Is that higher Basal temporary. So isn’t this different for everybody how illness that impacts you or not really,

I’ve found that it’s definitely different for everybody, I would say the grand majority of people it is if you have something like a respiratory bug, sinus infection, some type of bronchial something or another, you will usually experience a rise in insulin need during the illness. In fact, after having had diabetes long enough, you might even find that going back in your records, before you even had symptoms. You had higher blood sugars for a couple of days. And they may have seemed odd. And then finally, one morning, you wake up with stuffy head kind of sore throat, you know, not feeling the greatest, those climbing blood sugars even before you were symptomatic. Or often because your body was fighting something off, it was trying to manage and deal with something right. But most people have a higher insulin need during an illness, especially the height of the illness really where you’re not feeling well at all. And then sort of a slide back down to where you were before, a baseline of need. Stomach bugs can be a little different stomach bugs could reduce your insulin need during and because it takes some time for your digestive system to recoup. In the aftermath, your insulin needs could actually stay low for a week, give or take. And then they start to go back up to more normal. If you’re the kind of person who is found that an illness really drops your insulin needs, and then after your insulin needs climb up, I mean, do they climb back up to where you were before you were sick? Then they’re not necessarily higher. They look higher than they were while you were sick, but they’re just kind of going back to where they were

right. This is an offbeat question. But do you take probiotics?

Where do you I do take a probiotic you

do? Like every day?

In the morning in the morning? Okay.

A refrigerated one.

Do you take

there you take refrigerated ones.

You’re always told to take refrigerator ones? Yes. Okay.

Oh, that was for my naturopathic doctor. That’s not like, you know, just Googling information or whatever. But that was my naturopath had said, if you’re gonna get a really good probiotic, get one that’s been refrigerated that you keep refrigerated. Speaker 1 48:52 So you take vitamin D, do take vitamin D, zinc, every day, I take sync.

Okay, we’re gonna talk about that one time. It just popped into my head just now. And I was like, we’re gonna talk about this. Not now, but but

I’ve taken them a long time. It’s not just been the past two weird years or anything. Right. And those have been things that I’ve taken for a while.

So yeah,

I I even notice if I don’t take iron. It takes a couple of weeks of me forgetting iron for my nails to start breaking. Breaking. Yeah, like it just out of nowhere. Like I’ll touch something and they’ll just split. And then when it happens, I think oh, why have I not been taken that iron? And then I go right back to it. It’s that’s very interesting. Okay, we’re gonna have to do supplement conversations at some point. Okay, well, Jenny for now. Thank you very much for doing this with me.

Absolutely. It’s always fun.

Candy Smith is on the show. And everybody loves Jenny. Thank you, Jennifer. Integrated diabetes.com That’s where you can go higher Jenny. Thanks also to in pen from Medtronic diabetes. Don’t forget to go to in pen today.com I did that great ad read in the middle. Don’t make it a waste okay, like let’s let’s not make me look silly here I did a good job you go do your part. I also want to thank us men remind you to go to us med.com forward slash juice box or call 888-721-1514 Get your free benefits check today. Getting your diabetes supplies does not have to be a hassle links to the advertisers or the show notes of your podcast player and at juicebox podcast.com. If you can’t remember the links that I have said ad nauseam in this hour. Before I go, I’m gonna remind you that the Facebook group is poppin Juicebox Podcast type one diabetes on Facebook, it’s a private group. So you’re gonna have to answer a few questions to prove to the Facebook overlords that you’re a real person. But then after that, you’re right it Did you hear that I gave you a it’s like a sound effect really, but it’s just my hands rubbing together. But right in what else I want to tell you diabetes pro tips are available at juicebox podcast.com In your podcast app at diabetes pro tip.com. But if you’re gonna use your app, just go back to Episode 210. That’s where it begins with an episode called newly diagnosed starting over can’t remember that join the Facebook group. Go up to the featured section. There’s beautiful lists right there of all the series, not just the protip series, but defining diabetes defining thyroid, the variable series, how we eat, there are so many to choose from. Actually, I can’t remember them all now, which is why I just said there’s so many to choose from. What else do I need you to do? Well have a good day. I mean, I definitely want you to do that. Have a good day. I had a good day today. Drink plenty of water. You don’t I mean like stay hydrated. They say it’s good for the skin, your eyes, clarity of your views, and insulin keeps that insulin moving around your body. Very nice. So you do not want to be using manmade insulin without being hydrated. It’s gonna get Funkytown on you drink a glass of water. And then I have another one. What else? Have you said hello to a stranger recently, I always find that to be uplifting. Maybe some eye contact you know hey, how are you are good day, that kind of thing. That works. Let somebody in in traffic. That’s a good thing to do till somebody wants to get over just guy. Yeah, come on over. Makes you feel good. Makes you feel relaxed inside. Like I did a good thing. You know, and it doesn’t hurt you it really you can just pass them later. Anything else? What do you do to to kind of give back to the world and yourself to yourself personally inside your deepest, darkest self? How do you light Matt load? Right? You go for a walk? You sing in the shower? Do you sing in the shower? You crazy kid you do, don’t you? I don’t have watch YouTube videos in the shower. That nobody else does that and my being mocked silently through the either. I don’t appreciate it. Yeah, like throw up a YouTube video. Throw it up on the side of the shower. You know, check it out. Learn something new. Sometimes I’m learning about like computer stuff I need for the podcast or cars or I don’t know. Comedy. A lot of times it’s comedy. Yeah, I just found a guy the other day I really liked his name. Sadiq Ali Ali Sadiq. I think it’s Elise Sadiq. I found him I found him interesting. Totally good story. Let me see what his name is. I’m really sure it’s Ali Sadiq. It is really funny guy. Actually just put up his last special on the YouTube. I really enjoyed it. This is it’s not usually what we talked about here. But at least Siddiq. I thought you were funny man and tell other people about it. You told a great story. good storytellers are hard to find. What else do I want to say to you? It’s very late here. My eyes are bugging out of my head. You know when your eyes get like, hot because they’re dry. I’m up to that part right now. I should go to sleep right? This is the last thing I have to do tonight. So I’m going to do that. I’m going to say this. Thank you so much for listening. I really appreciate it when you leave ratings and reviews for the podcast especially when they’re good ratings and reviews like five stars and you’re like oh my god I love this podcast like stuff like that. That’s stuff I love. I love it when you join the Facebook group Facebook group very proud of you catch me on the Instagram if you want to please go to the T one D exchange and take that survey for me. He one the exchange.org forward slash juicebox are really honestly can I speak the like people for a second? Like I know in the beginning I want to kind of time limit on like T one D exchange. But it really is easy to do. And your answers, which are also simple answers to simple questions genuinely help people with type one diabetes. It really genuinely helps people and I get money And then I take that money and I, I buy computers and I pay for my electricity, I get food, I send my kids to college, I buy gas for my car in I mean, I keep myself going and then like me, I’m like all like kind of like, you know, financially okay. And then that allows me to make the party. Yes, you understand commerce, I imagine. But this is why that’s important. I get money for the ads, I get money when you fill out the survey, the survey actually helps people. It’s not like I’m doing some crap thing where it’s taken advantage of you or something like that. It’s meaningless, or you’re gonna get like, you know, emails from like, I don’t know, people bugging you about buying solar panels or something like that. I mean, it’s about diabetes. It helps people diabetes, it helps me it helps everybody. In 10 minutes, T one B exchange.org. Forward slash Juicebox. Podcast a bit of a tangent. Are you still listening? Since usually, I haven’t done this in a while or I’ve just rambled on at the end of the show. I mean, if you’re still listening, you’re a fan and I appreciate you extra that people stop listening. They’re great, but you’re better

Hello friends, and welcome to episode 845 of the Juicebox Podcast. It’s been a minute since Jenny and I have done an ask Scott and Jenny episode. But here we are back answering your questions. That’s right questions from the listeners, right the Jedi and just got answered for you to the best of our ability. Today we’ll speak about smart insulin hydration has Jenny ever smoked, and much more? Check it out. Stay with us enjoy. While you’re listening, staying with us and enjoying. Please don’t forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please Always consult a physician before making any changes to your health care plan or becoming bold with insulin. Now if you have type one diabetes, or are the caregiver of someone with type one, you know what I’m going to say? Go to T one D exchange.org. Forward slash juice box and fill out the survey. It takes fewer than 10 minutes. It’s completely HIPAA compliant. Absolutely anonymous, easy to do. And once you finish you’ve helped with diabetes research. You may have even helped yourself, like the T one D exchange might come back to you and be like, Hey, are you interested in doing this? Right. And then if you are sometimes they offer gift cards. Just go check it out T one D exchange.org. Forward slash juice box. This episode of The Juicebox Podcast is sponsored today. By the Contour Next One blood glucose meter. You guys are always so generous about clicking on the Contour Next One link, I can only assume that you love it as much as I do contour next one.com forward slash juicebox. You owe it to yourself to have an accurate and easy to use meter. The Contour Next One is just that. today’s podcast is also sponsored by touched by type one and guess what I did yesterday. I asked her to save the date from touched by type one. See if I can find it here. It’s February now. But I could find it. Save the date it says, Hey, Scott, I hope this finds you. Well, we have begun planning our next touch by type on annual conference. And we’d love to have you join us again in 2023. Our conference will be held on Saturday, September 16. Well, that’s a little something you can plan for. Check it out at touched by type one.org touched by type one does way more than this event. You can check it all out at the website. But um, I’m just saying if you can plan to come out, I’ll be there making all kinds of talky talk. We’ll have a great time.

Yeah, I’m up for whatever.

Since the end of the year, almost almost well, for in my mind it is because I’m making the podcasts like way out in the future. And I just edited your how Jaime eats episode, which came out really well.

I thought of so many additional, like, additional things that I would have really added to that like, like I you know, they’re just everything that you think in excess, like, I eat this. And sometimes they eat this and sometimes I gave you like this general idea.

Don’t be in a hurry, we can do another one. I make a lot of episodes, so don’t worry. Yeah, we can come back and do a part two. Fabulous. It’s like getting all that stuff together and everything and

I’m glad it turned out well for what it was there. No, it

no it definitely did in the end. I feel like they’re less of a, like a checklist and more of a vibe. And I thought you did that really well. Like I think the way you think about food came across and what you eat in general comes comes across, you know what I mean? And yeah, it made an impact on me the other day i i was in between something and I walked through the kitchen and there were cookies from Thanksgiving and I grabbed a Clementine. I was like oh, I think this was what Jenny would do. So good. Very good. Yay. And by the way, very good. This is the time of year for clementines. I don’t know if people know that or not. But

it is absolutely actually growing up. My mom always had like more tangerines or oranges or something and I asked her when I got old enough. I was like here we have them more often this time of the year and she’s like when we were little and my mom grew up on a farm right so they didn’t have a heck of a lot. But this time of the year her dad would always go into town. Right? And like get some tangerines and they were like the best treat my mom said at this time of the year

yeah, they’re just for some reason. Ended November December January I must be where they where they’re grown in the world. It must be the right timing for it, which is what I assumed. But yeah, they’re definitely better because in the middle of the year you get them and you’re like these are

my mom always called them punky is how she said the rest of the year, they’re not as juicy. The flavor is not what it’s supposed to be. And you get the ones like half of your bag might be really like, dry, rather than that really big, like burst of juice that you should get your like, dry.

You know, I was I know, we’re not talking about where we’re supposed to, but, but it’s okay. Listen to people listening will decide if it’s okay, if I see them clicking off, I’ll know this wasn’t okay. But I was in the in the vegetable aisle the other day. And there’s this sign that’s been there forever that I’ve, I mean, I don’t know how I haven’t seen it before. But it’s tattered. That’s how I know how long it’s been there. All of these, all of these vegetables have been sprayed with a wax coating to extend freshness or something like that. And I was like, Oh, I didn’t know that happened. I did. Did you know that happen?

Well, you can tell though, I mean, even even like oranges and that kind of stuff. You can tell when you peel it sometimes the ones that have been coated, you can tell because it comes off on your hand. Apples as well are a common one that have that like, like, you can feel it you can almost rub it off. Because of the amount of time it goes between picking and actually getting to the supermarket, and then getting home with you. They have to do something to keep it

Yeah, that’s what occurred to me is that none of these things are grown here in New Jersey. I imagined. Oh, no, yeah, I’m sure. At some point they were

right. Do you have tangerine trees in New Jersey? No,

no? Well, you know, like, when I grew up, it was it was the stuff that you could grow here was grown here. In the winter, there was less of it. And we got it shipped in from the south. And anything sweet and round and yellow or orange came from an island somewhere or Florida. And that’s just how it was. So now I’m realizing that they might be shipping in bell peppers from Uruguay and covering them with wax that they don’t go ahead. I did not know that before. I also don’t know where your way is. For clarity, just the name of the country. I mean, I pulled out of my butt, right. Anyway, Jenny, I’m going to go to our ask Scott and Jenny list. Cool of which is It’s oddly extensive. Yes. And, and just scroll through a little bit, ask you a couple of questions that have been sent in by people. And we will answer them, hopefully, and move on to the good. So hopefully, if it’s possible, we’ll be like, I don’t know the answer to this. I

can’t help you there.

Do Okay, who knows? This is from Lisa. Do you know if an insulin that acts like endogenous insulin, meaning is it quicker acting than current options? is in the works. So that’s a good question. Our pharma companies I mean, fiasco is here and loom Jove and a Frezza and a threat? Yeah. But are there more? I don’t know the answer to that question at all.

I know, I can tell you that there are things in in that are being researched? Yes. Where they are, I don’t know. I know years ago, I attended JDRF used to have like these scientific sessions, sessions where you could come as like people with diabetes. And you could see what was in the works, right. And this Gosh, this was like 12 years ago, there was a company on the East Coast that was working on something called smart insulin, smart insulin from what I remember to the degree that this insulin would be taken once a day. And it would have almost a almost like a thermostat if you will, but but not relative to temperature relative to the glucose levels in your body. So it would see when your glucose was going up and going to rise sort of above this sort of setpoint and it would turn itself on. And then once your glucose was dropping and coming down into that setpoint it would essentially turn itself off and it worked on and off sort of all day long like that. From what I remember, it was in like the, the animal based studies, but since that time, I have literally heard nothing about it. So that’s like It’s like research. It’s like we hear all these things. means and then there’s no more news about it like where did it go? Did it get like shuffled off to Mars or?

Exactly, there’s the the most recent article I found online is from diatribe and it’s from June of 2022.

Okay, so not too long ago.

Oral it’s an overview of a smart insulin. The development of smart insulin options means designing an insulin that responds to glucose levels. Okay. We got it all that. Dr. Weiss distinguished professor at Indiana University School of Medicine explained to potential ways that glucose responsive insulin could work. Though we are still years away from smart insulins making their way to clinical trials, Oh, okay. We are years away from clinical trials. Right. Which means, what, 15 years?

We’re at work. We’re nowhere near getting it into the human body to Yeah, yeah. So I think the answer to the question is, what we have right now is called Rapid insulin. It’s much more rapid than it used to be years ago, and it was just regular insulin. But we’re nowhere near smarter insulin that’s more instantaneous, right?

Like, reacts. Right? Yeah,

it’s just not.

Okay. Well, sorry, Lisa.

I know I’m sorry, to everybody. I that’s just not an uncommon question. I’ve, I’ve gotten that a number of times, you know, when are we going to have insulin that just works now? And I don’t have to wait and it does it faster. And it finishes when it says it’s going to be done working? We I don’t know.

Yeah, sorry. Well, way to start off with a bummer. April wants to know, about hydration. She says she she hears people talk about it, you know, like they see a bad pump site or something or you know, blood sugar, excuse me, that’s not moving. And people always come in and say, Hey, are you hydrated? Because hydration is super important. We’ve talked about in the podcast for a long time. What she wants to know is, how long does that take to work? Like she’s saying, you know, say I am actually dehydrated. And that’s the reason why insulins not working well. Is it a glass of water and I’m on my way is it I have to rehydrate my body and it’s ours, I guess it would depend on how I would expect

it’s a min an average of about an hour to rehydrate. I mean, a good way to determine hydration is really the color of your your urine or your pee, right. So should be very, very mild, like a light lemonade color, if you will, right. It should not be dark. Now there are also some supplements, B vitamins and whatnot. If you take them, they can also sort of discolor the color of your urine. So that’s not necessarily a good time to check. But, you know, hydration is where 60% of our body is made up of water, right. So if that’s the case, hydration also means that all of the nutrients in your system that flow through your blood and need to get into the cells, they need, consistently moving bloodstream. If you are dehydrated, your body tries to pull water from other parts of your body to rehydrate and keep things moving. And so if you’re not adding water back in, and you’re more prone to drinking things that are more of a like a diuretic that are making you pee it out, but you’re not putting it back in, you’re more likely to be dehydrated, so with less fluid in the body, especially from a standpoint of a CGM. CGM is work off of monitoring the glucose in your interstitial fluid.

Here’s something interesting. This is NIH. Just a simple sentence. 75% of Americans are chronically dehydrated. That’s it. Wow. That’s a statement from October of 2022. Why is the dehydration so common? This is from Mayo Clinic. Sometimes dehydration occurs for simple reasons, like you don’t drink enough because you’re sick or busy or because you lack access to safe drinking water. So is this really just people just don’t drink enough water? That’s it?

No. In fact, many people you know, a good strategy we talk about even in just general weight management is if you feel like you’re hungry. Drink a glass of water first. Okay, most often, you your body is giving you a signal that you’re misinterpreting right? You’re actually not hungry. You’re thirsty. So if you drink a big glass of water wait another 1520 minutes. Many people find that they’re actually not hungry.

Some early warning signs of dehydration include feeling thirsty and lightheaded, a dry mouth tiredness having dark colored strong smelling urine or passing urine less frequently than usual. What’s now I want to know how often I’m supposed to pay.

How often do you get to look up? How often should I go to the bathroom? Well, I mean, in general, six to eight glasses of water intake a day. And if you’re hydrated enough, you should be probably going to the bathroom, every couple of hours, at least every two hours,

bladder and bowel.org. Which I don’t, oh, just the first one that came up. Not a number of normal urination is per day, between six and seven and a 24 hour period between four and 10 times a day can also be normal if that person is healthy and happy with the number of times they visit. So if you’re not paying a lot, so then back to the person in question, I would think that rehydrating would have a lot to do with how dehydrated you are to begin with. True, right,

right. Absolutely. You know, if you’re just mildly thirsty, drink a glass of water, that probably takes care of it. But knowing as well that mild, even moderate levels of dehydration can also increase your blood sugar levels by a certain amount. And I know you’ve said it before, when we’ve talked about things like just higher blood sugars, like you force art and drink some water, drink some water and you can almost at some point, even without additional insulin, sometimes you can see a curve. Yeah, right. As you get things moving hydration that helps your body pass the sugar out of your bloodstream and you can actually pee some of it out if your blood sugar is high enough to need to do that. So yeah, hydration.

Alright, I’m gonna add a little more here. How much fluid does the average healthy adult living in a temperate climate need? The US National Academies of Science, Engineering and medicine determine that an adequate daily fluid intake is about 15 and a half cups are 3.7 liters of fluid a day for men, about 11 and a half or 2.7 for women.

Which means it goes right along with the recommendation of 60 glasses. Most people’s glasses are about 12 to 16 ounces. So that goes it fits right in there.

Is it the same not for children who on how much water should

a child

stay well hydrated children ages one to three need approximately four cups a day. Older kids five cups four to eight years old seven to eight cups for older children. Okay.

And, you know, I think an important piece to bring into that too is that may be a baseline. This is just you in your normal day, right? If you are active at all, or you live someplace that is very hot, very humid, and you are active, it’s very likely you need more than just the base of six to eight glasses a day.

My so my daughter’s home from college right now. Which means all of our girlfriends are starting to flood back in the house. Lynn, one of the girls is playing God. I hope she never hears this. Because I’m not which which is the one with the little stick. And field hockey, right? The little stick with a little curve at the end. Jenny’s that field hockey field hockey, yeah. Okay, she played field hockey at college. And she’s walking around with a jug of water all the time. And she’s just constantly drinking and I think back to when my son was in college playing baseball, and the boys would all carry around like a one gallon jug of they were constantly drinking. Right? And these are the healthiest people I know college athletes so I don’t mean I’m not I don’t think I’m gonna grab a milk jug and fill it with water. But I am motivated from this conversation to do better, even though I better yes. Because I’m thinking about like, how much do I drink a day and does and by the way, let me ask you this. Does it count if it’s not water, like

you don’t ensure you get some water from again it goes along with healthy eating right so you get some amount of fluid by eating fruits and vegetables because a good portion of them is made up of water. You know if you have soup that’s not terribly salty. Sure that’s made in a broth that is part water right? You can get it by drinking non caloric and like sparkling waters, right something like that. You’re getting hydration that way. If you like herbal tea is or you know, decaffeinated tea or something like that. You’re getting hydration that way so it doesn’t have to be that you’re drinking it eight glasses of plain old, no flavor water,

right? But this doesn’t count if I’m having a Diet Coke or a Gatorade or

like the Gatorade would be hydration or it wouldn’t be an electrolyte drink that they you know, Gatorade. What’s the other one? Powerade. They give them to athletes, obviously. I mean, Gatorade was developed in Florida, if I remember correctly for the Florida Gators.

That makes sense. I don’t know that that’s true. But I believe you. And but like, what about soda drinkers? Like I, I? I don’t drink a lot of soda. Meaning that it’s possible that a half a dozen times every two weeks, I have a small glass of some diet soda. Like you don’t need me like I’m just not a soda drinker. But it’s not I mean, I think we all are aware that soda is not good for us one way or the other. But am I hydrating when I’m drinking it?

Yeah, you certainly are. I mean, there’s a portion. I mean, it’s not just like I hesitate to say this, because most soft drinks that are sugar in are like drinking liquid water, but are liquid sugar. But why is it liquid? It’s liquid, because there’s, there’s water, there’s fluid in it, which does provide you with some hydration, despite the fact that the other stuff that’s in it isn’t good for

it a little like I come up on my home is burning. And I find a bucket and it’s half water and half gas. And I’m like, Well, I wonder what will happen here if I just throw this off. So you’re getting you’re getting hydrated, but you’re also getting a lot of stuff you don’t need don’t need and don’t want. And correct

and some of some of these beverages, too. could certainly be more of it what’s called a diuretic, right? Which just encourages you to actually go to the bathroom even more than you would normally go to the bathroom. Which means that you have put back in what you

sow coffee. Do you drink coffee? Yeah.

Um, yeah, I like coffee.

I’ve never had a cup of coffee in my entire life. So I’m outside of my

you’ve never had a cup of coffee. Never. I don’t think I’ve well other than kids. I don’t think I’ve ever met another adult.

No, I just my parents drank so much of it. And I can smell it still. It was terrible. And I associated with cigarettes too. Because it’s always like a coffee and a cigarette for my father and like I just not interested. But my point is, is don’t something’s dehydrate you even though they’re liquid, like alcohol dehydrates you. Right.

Yeah, I mean, in many cases, it’s really the caffeinated effect, right? That is more of a diuretic, which is the reason that if you really want the complete hydration, you’re going to do things that are not full of caffeine. So you know, the typical dark cola based sodas, regular coffee, again, have a tendency to have more of a sort of a mild diuretic effect. Okay,

because I had I recorded today before you, which I feel like I’m cheating on you. No, no. I had a cup of tea, and a glass of water with me. And I couldn’t drink the tea because the tea was driving my mouth out. And I was like,

oh, black tea. So it was a caffeinated

tea. Yeah, it was and so I had to get away from it while I was drinking. Anyway. I just Googled Why does coffee make you poop so we can round out this conversation? Because because this is a integral part of some people’s lives, right? So coffee sends a signal to your stomach to release gastrin this kicks off a wave of cause of contractions in your gut called PERS WHAT THE HELL peristalsis Thank you. It moves that that thing Jenny said moves food and liquid through the intestines. For some people. This leads to a trip to the bathroom in just a few minutes. Get me here seriously? Now when you go I mean next time I have to go maybe I’m gonna. I don’t know. Then you need some coffee. I don’t think I’m doing that. I really don’t think I can. This one. Make sure it’s good coffee. Well, what’s good? Some people tell me Dunkin Donuts is amazing.

How do I if I’ve heard the same thing? I mean, I can say that Dunkin Donuts is to me, it’s okay coffee. I have grown very accustomed. After having lived in DC. I’ve grown very accustomed to like coffee houses that do their own roasting like in house. Okay, like I consider that good coffee.

Is coffee and cigars kind of in the same vein. Like I don’t know. Maybe. Have you ever smoked a cigar?

I’ve never smoked anything in my life.

Anything through it. Cigarettes. No cigar. No crack. Okay. Nope.

Marijuana No, nothing I have never has anything passed my lips. Now I’ve probably and I’m sure I’ve inhaled quite an amount of secondhand smoke. In fact, I’m quite certain in my freshman year in college, my roommate who would smoke out the window, not cigarettes. I inhaled a fair portion of marijuana. Yeah.

But as I get older, I just keep waiting for it to come get me the secondhand smoke. Because my dad, my son and I were talking about the other day. And he said, your dad smoked a lot. I said my father would smoke three packs of cigarettes a day, three packs of unfiltered cigarettes every day. And I mean, he would open his eyes in the morning, and light a cigarette. He’d have it in the bathroom with him. If he took a shower. He had it right till he got into the shower. If he was driving, if you if you got to a if you got to a restaurant, and they didn’t allow smoking, he sometimes couldn’t make it to the meal. He’d have to go outside. Like it was, like really bad. That’s yeah, yeah. And he still I know him seven days, by the way. So

I know it takes I know, it takes a certain number of years to recoup. I mean, the body is a self healing machine, right? As long as you don’t continue to batter it up, was only

around me till I was 13. So okay, maybe.

So maybe you’ve got a lot of healing that’s taken place and your lungs are back to a base.

I also had a crappy job when I was a teenager. So I don’t know what I buried there. But anyway, I just think about it all the time. I’m like, This is what’s going to happen. I’m not going to even drink a cup of coffee. I’m gonna end up with lung cancer one day. You don’t I mean, this is my Yeah, I know what’ll happen. Alright, we’ve gotten way off the hydration path anyway. Drink water. Drink water. Yeah, it’ll make. It’ll make your insulin work better, and it will make your CGM more accurate.

Well, and I think you brought up a good point, if I’m going to plug for not doing something the not smoking thing. Yeah, there you go.

How much? How much more dangerous is smoking to a person with diabetes? Like what are the added risks? Friends, there is nothing like the Contour Next One blood glucose meter. This is a world now where a lot of you have continuous glucose monitors. And you might think, well, I don’t really need a meter Scott. I’ve got a CGM. I’ve got Lee Bray, I’ve got a Dexcom. But there’s still reasons in times when having an accurate meter makes a big difference in your care. You just don’t want to be caught short, we all have a meter, we might as well make sure that meter is our best option. And you can learn more about the Contour Next One at my link contour next.com forward slash juicebox. The Contour Next One is easy to hold. It is easy to travel with it is easy to read. It has a bright light for nighttime viewing. And the test strips offer Second Chance testing which means you can touch the blood not getting off, go back and get more without messing up the accuracy of your test. We’re wasting a strip and all that might sound like oh, what do I need a lot of blood No, a very small drop of blood. I’m just saying if something happens, what if you touch the blood a little bit and sneezed and through the meter that can happen. He’d go pick it up, touch it back to the blood. Tada, you still have an accurate test, contour next.com forward slash juicebox. Please go check it out. That’s actually a website full of great information there you can actually buy the meter and the strip’s online if you want and they may be may be more affordable in cash than you’re paying right now for another meter through your insurance. All this is for you to figure out at contour next one.com forward slash juice box head over support the sponsors click on the links. Thank you very much. Don’t forget about touched by type one there also there on the Facebook machine and Instagram find them follow them be enveloped in their wonderfulness links to contour and touch by type one or in the show notes of your podcast player. And at juicebox podcast.com. If you can’t remember the type the type, you know, I mean like touch by type one.org You might forget that or contour next.com forward slash juicebox if you forget that you can click on it and you’re still helping the podcast. I will see you back in the conversation in just a second

well, many of the things have relative relevance to what smoking does to the blood vessels which we know that So we already are at risk with increased potential for damage to our vessels and to our nerves and to how our body reacts to stress. Smoking creates inflammation in the body. And those are all the things that we’re trying to bring down by having optimized blood sugar levels. So it’s like, You’re doing all these wonderful things to manage your diabetes. But if you’re also smoking, that’s kind of putting some of those. It’s counterproductive. Thank you.

Also, you have an autoimmune disease. So inflammation is already coming for you. So yes, no reason to give me a helping hand. I don’t think this one is aimed towards me, but doesn’t mean we can’t talk about it together. PIPA asks. Oh, oh, that’s nice. I’d love to hear more about how we moved art in from relying on a school nurse to directly communicating to me, How does she know when to Pre-Bolus? Does she have alarms on does she rely on her alerts? How does she handle texts in class? Does she wear a watch? What’s your process? If she misses a text? How old was she when she was able to treat her own lows? What’s your field trip? Protocol? Cheese? pipa. All right, hold on. Does she carry an extra pod with her? Let’s go through it one at a time. Cool. Well, I can tell you that, you know, the story of you probably know if you’ve listened long enough is that I realized in the summer between art in second and third grade year that I could manage Arden remotely, which had everything to do with me and nothing really to do with her. She was capable of like receiving a text and carrying out a thing in a way that I could trust. So I don’t think the age is important Arden’s age, I think it’s Arden’s ability, because if you’re translating it to your kid, you know, kids are gonna be analyzed what your kid can do. 100% So, one day, I just was lazy. I didn’t feel like walking upstairs. She was upstairs. And I texted her to Bolus and she did it. And I was like, oh, like, why? Like, I can imagine diabetes in my head. Now, if you don’t I mean, like, you know, I don’t know, like, one of those movies like beautiful mind or something. I have no idea which ones I’m thinking. I can see her blood sugar in my head. I know how much insulin is happening. If I know what she ate, I can reasonably manage her without being with her.

And you have the benefit of looking at a CGM, as well, you’re not guessing. Well, her blood sugar was at 615 minutes ago, and she was down here. I don’t know if it was going up or down. You’ve got to CGM to be able to see where is she? I can easily text her and tell her because you also know the context that’s going into the trend.

Yes, but back then no. Like back then, oh, she didn’t have a CGM when she was that night. Yeah, it was just coming at where it couldn’t share by then. We might have a follow, we might still have it in the G four. Is that the the egg receiver? So?

No, the Ag receiver was? Seven. That was the seven. Yeah, the seven system and then it went to the G four. And then it went to the G five and then it went to the G six.

What a naming system Dexcom way to go. And so fancy back then they were probably just like, here it is. But But anyway, I realized I could do it without being with her. And that the only tripping point for me was my own fear. Because I kept thinking like, why would I do this. So we just started practicing in the house. I would just text her diabetes. Even if she was just in the other room. I was really practicing for myself. And then she went back to school in third grade and stopped going to the nurse because of that. So she could test she could send me her blood sugar’s she could look at a CGM. Once it was available telling me the number that was on it. I just kind of bounced it all in my head. Did that make dependent? No.

I think another question within that, which is sort of implied in a way here as well might be, how did you navigate that with the school nurse and the system? Right? How did you navigate saying, We’ve got this? These are the hit points that you have to know being the school nurse. And if needed, you would step in, but otherwise, please hands off because we have this Yeah,

I might go to was usually just I just assumed they didn’t really want to be doing it. And that they didn’t really want to be responsible. Right? Like if you gave a school the choice between being responsible for somebody’s blood sugar and not I figured they would rather not. So what I told them was, it’s on me, like if something goes wrong, I did it. You’re not at fault. And they were like, cool, and that was the end of it. So we did re kind of massage what what my expectations were from them. And from there, and we adjusted her 504 plan for it. But really, I have to, it sounds cynical, but the idea that they weren’t on the hook anymore, I think was attractive to them. It’s just always kind of how it felt to me.

I wonder, you know, having worked with so many families, I have heard probably a good 50 different ways that school systems will or will not let things happen. I mean, whether or not they prefer to be doing it, some school systems really seem to have this, unless you don’t tell them your child has diabetes at all. They have a plan that has to be followed, and much of it relies on the kid having to check in with somebody at some points in the day. So and it’s hard because that many people probably want to do what you’re doing.

Yeah, I would, I would say that. I am not, I am not wildly different in my personal life than I am on this podcast. But I am more direct and ne than maybe some people are, and I don’t be, I’m not pushing you. I’m direct. I’m like, This is what’s going to happen. And then it’s not open for conversation discussion. Yeah, and not in a mean way. But just, I don’t leave. I think that it’s, I kind of think of everything as a negotiation. And if you stop and think about how to negotiate anything, the last person who speaks wins. And so if you don’t set the conversation up, where the person across from, you can respond, you sort of win by default. I don’t know. That’s a little. They, you know, I don’t know, that might be outside of what people are comfortable with. But you have to be comfortable in the silence. You have to be comfortable saying this is what’s going to happen. It’s not open for discussion and be able to sit there without feeling because as soon as you feel the thing in your chest, it’s when you give something up. You go okay, and then you get nervous and you give something away. And then it goes back and forth. And before you know it, you walk out you don’t have anything. So anyway, going through her. How did Arden know when to Pre-Bolus? Well, that was easy. I set a lot of timers on my phone. And in the beginning, Arden had those timers on her phone as well. So her timer would go off and then we would text each other. And I’d say What’s your blood sugar? If she had to test she test? If she had to tell me what was on her CGM? She would tell me and then I would just you know, say, Okay, what’s Bolus this much right now Arden was using on the pod and you know, we didn’t let Arden go to school on MTI. So she’s been using Omni pod since she was like four, four and a half like right before she went. So that’s how we did Pre-Bolus thing. It answers the question about weather alarms. How does she handle texts in class? Arden handles texts in class the same way you hear me say? Like, what I just said, basically, this is a necessity for her. We’re not embarrassed by it. She wasn’t, you know, she she didn’t try to hide it. I mean, she doesn’t love. Like she was still a kid, you know, like she wasn’t looking to be texting with her dad and stuff like that. So we also kept it to a real bare minimum. Sure, yeah. That was that was that she just never want to watch. If she misses a if she missed the text, and it was, what’s the process if she missed the text, depending on the context. So if it was important, or emergent, then I would go from texting to a phone call. And if the phone call didn’t work, then I sent a find your iPhone signal, which is very difficult to ignore. If that would have cascaded through then I would have called the nurse’s office. Sure that would have been the the last thing. How old was she when she was able to treat her own Lowe’s, that was your husband, he just walked in, saw you were doing something and walked right back? He got this look on his face like oh, no, not now. And then. I don’t know the answer to that question. How old was she when she was able to treat her own lows? I mean, I guess she was in third grade. Because

I wonder if it’s a little bit more depth of the question in terms of most kids can when told treat your low blood sugar by someone? They do it without question. Well, many times without question, right? They’ll just eat or do what they need to do because they’ve been told but I think the question is really asking, would she treat her lows by acknowledging and alarm that went off on her CGM without you having to follow up and text or if you did texter, she said, I’ve already got it.

Yeah. Oh, so if that’s the question, when did I stop wondering if this is not happening? Like it’s She’s not handling this. Hey, I don’t know, I still want her son.

You still wonder? Right? That’s

a hard thing to shake, you know? Right. But I

wonder, you know, well, if she was playing with a friend and you saw her blood sugar was where it shouldn’t have been, or it was dropping fast or whatever. What age would she have already taken action on that? And said, Dad, I’m fine. I got this.

Yeah, I think the answer is I don’t think the answer is that clear. I, as far as timelines go, I think that I’ve always I mean, since we’ve had a CGM that shared, like Dexcom does now. I’m fairly aware of hardens blood sugar all the time. You know, like she’s in college, and I’m still fairly aware of her blood sugar, you know?

Well, you’ve got follow and you’ve got all the things to be able to watch. I mean, most parents do. So I have a

lot of things on my computer. I don’t even know what this is called. But I have a pulling it up. See if I can figure out what it’s called. Oh, actually, it’s just I have sugar me on my desk. I was gonna say sugar me. Yeah. So up on my I’ve a Mac computers, but up on the on the bar. Artists blood sugar is there along with

the trend arrow? Yeah.

Yeah, everything that it needs. So that’s there when I’m working. But the question about when does she? So I think when she was 12, like 1011 1213. If she felt low, she would have done something. The alarms, I’ll tell you, Arden and alarms. The you know, like, I don’t know. I can’t tell.

Did she ignore them more?

Well, how about the other night, her CGM just shuts off after she’s home? And I’m like, What do you How did you? How did this happen? I’m like, it tells you all day, it’s shutting off in six hours. It’s shutting off. He says he’d never said that. I was like, You’re out of your mind? Of course it did. No, it didn’t. I’m like, Yes, it did. And so you know, like, I

promise, that’s how it’s set up to do it.

She swipes things away so quickly, she doesn’t even know what they are. What I will tell you is that my confidence level is at an all time high, as she was learning to drive. So when she got her when she got her permit, we had a really serious conversation about that. And since then, so I guess 16 and a half right in there. I don’t think about it as much anymore. Like, I know she’s paying attention to it. Does she push her high blood sugar’s down? As much as I wish she would if I don’t bother her. Not always. So, you know, there’s that. Let me just get this last little question on here. What was our field trip protocol? I went on the field trips. Does Arden carry an extra pod with her? No. The way we handle extra stuff is at school, there was supplies, but not a pump, but but not insulin. And then if she needed a pod change, I would go do it just didn’t happen that often. And we didn’t like leaving insulin at the school. But I guess we could have she easily could have changed it on her own. And

now you also though it just for context, you also live pretty close to her school. So it was convenient, right?

It’s a couple of blocks from my house. So if if she if it was farther than I would have put insulin in the school, but I always was trying to give Arden the feeling that that that the nurse’s office was not a place that she belonged. I don’t know if that makes sense or not. But like I never wanted her to feel like oh, I have diabetes. So I’m one of these kids who’s always in the nurse’s office. Like I try not to give her that feeling. Sure, in regular life, there’s like a distance in my head. If we go to the mall, it’s 20 minutes away and doesn’t carry supplies with her. If a pod blows up, we’ll drive home. Once the drive becomes irritatingly long. You know, you go into somebody’s house, it’s 45 minutes away than we bring stuff with us. So

that’s well and in context there. You know, you’re going to the mall, who cares if you have to drive 20 minutes back home, you’re going over by a friend or something that’s more of a lengthy social kind of setting. Bringing it along as in, in I guess your best interest because otherwise you’re going to ruin that event. Right? Not not for the other people but for yourself and why? Right? I just have to go big just grab it when you walk out the door and just take it along.

Now that she’s getting older. And I’m not always with her college. Now there are times when she goes somewhere. She takes stuff with her because for that same reason because there’s not a person who’s just like, oh, well, I’ll bring it to you right now. And that’s been pretty important

or it’s a bus ride across town in order to get back to where she needs to get back to to get her stuff and then a class might be missed in the inch. You’re on there. And that’s not purposeful either.

No, no, it definitely has a lot to do with her age and, and the amount of people who are around her to help her. Oh, cool. Cool. Let’s see if we can find another one here. That doesn’t make any sense. Molina I’m sorry. Does a blood transfusion impact your blood sugar?

Oh, that’s a really good question. I think we’re gonna I know I can answer a question that often comes up outside of this one is, can people with type one donate blood? Yes, you can. Okay, so but blood transfusion? That is an interesting question. So what’s your what answer do you find?

I’m looking right now because my idea is it must. Right if my blood sugar was 200. And you infused me with some blood, that sugar was an ad? Wouldn’t my blood sugar go down? But would it go down that much? Does a blood transfusion or this one? Or, or change I guess impact? I mean, my guess is it’s not enough for that matter. You don’t I mean?

Yeah, there’s a correlation between blood transfusion and blood glucose.

Yeah, blood transfusions of bank blood products are blamed as one of the causes of hyperglycemia because they are stored in

a glucose solution probably. Or they have glucose added to them within the other additives.

I mean, I could try to say these words, anticoagulant citrate phosphate dextrose, then I mean, add it. Yeah. Good job. Good. I get through that a little bit. So here’s the answer. It looks like yes, it could make your blood sugar lower. It looks like

it could make it higher heart rate.

Yeah. Conclusion we conclude the blood transfusions does not cause significant changes in blood glucose levels in the study. That’s from NIH. And the question was, does sugar level increase after blood transfusion?

But not a lot? Yeah.

Does blood transfusion affect your agency? The effect of blood transfusion on a one C levels might be summarized as follows. And patients with pre transfusion a one C levels of over seven, a one C tends to fall at once, even when your agency is under seven, it rises minimally or not at all. I mean, it sounds like it has an impact, but not not a great one. And if it does, it might be on the lower side. I don’t know that’s a lot of information. That doesn’t look like it’s studied that often either. No, because here’s another one, the dextrose and bank blood products does not seem to affect. So here’s the answer. All the answers you can think of somebody says

yes, it can. No, it can’t Yes, by just a little bit. So in general, I would draw out of this, that it could have a minimal effect. But minimal is the important piece there that you’re not going to have this exorbitant rise or drop in blood sugar because of a transfusion.

Yeah, that would be okay. That was interesting. Here’s one looping. Oh, God, we’re up on time. Are you okay? I have five minutes. All right. One more looping. Helen asks, what are the settings that most often need changing when starting to loop? And more or less aggressive? Okay, so this is, I mean, I don’t know about when you’re starting? Like, I don’t think there’s an answer to that question. Right. You gotta get your settings, right. And then once they’re right there, right, but I’m gonna go from the, from the perspective of once you have good settings, what do we touch most frequently? Because Arden’s a girl, and she has fluctuations from hormones. I would say that most frequently we touch insulin sensitivity. And basil. Those are mine. What do you think?

Yeah, I would agree. I think, as you said initially, starting with settings that are optimized before enabling any algorithm driven system, including loop gives a good base for the algorithm to then work for you. And then once you have been using your current settings, and you use loop or with loop, you probably need a good week or two to compare to the previous two weeks of CGM data and see what looks a little bit different, right? More Most common, I would say honestly most common is ISF or the sensitivity factor the correction factor, which honestly gets under adjusted in manual or conventional pumping, oftentimes the correction factor, it’s like this poor little like, in the middle of nowhere, but I’m not going to consider it factor. And it doesn’t get adjusted, we’re probably needs to much more heavy we adjust the basil and oh, we might look at the insulin to carb ratio is but your correction factor it’s not even talked about. I’ve even talked to many people who are like, I don’t even know what this does. That’s the purpose of this setting and my pump, right. But when you loo, yeah, it heavily relies on how sensitive your body is to the insulin that you have present, that it can readjust. Its predicted glucose and, and the outcome from everything that it knows about what it’s given you so far.

Yeah, I could make it. I don’t know if I how right I’d be. But I can make an argument that your sensitivity might change meal to meal can be you know, if you’re varying greatly on the kinds of foods you’re eating, if you went from a salad today to, you know, chicken wings and fries tomorrow, I can see where a heavier or more aggressive sensitivity would help the french fries. And it’s just, it’s a weird,

maybe too aggressive when you eat the salad, or eat the broccoli. Right? Yeah. And, and the more true image of physiologic sensitivity would really be eating clean, not terribly high fat, you know, eat a nice salad with, you know, maybe a little bit of like salad dressing on top of it or something and get an idea of how if you did get a high blood sugar? How was loop working to help you with that rise? Does it cost you back down to your target? Do you settle out there, right. And if not, then looking at another meal that did work out one time of day. And the next day, you had the chicken wings and the French fries, and doesn’t look like it’s working at all and you’re beating it down with extra, like fake entries? That’s probably not really relative to your setting being wrong. It’s relative to loop working against something that’s so resistant. Yeah,

yeah, that’s the that’s the mind space, you have to put yourself in like your settings are great. If you’re not, you know, for general days, if you’re not over taxing, suddenly, when you over tax with a a tough meal, the settings aren’t going to work for it. But we can’t think about that way because people can’t be changing their settings constantly. So that’s when you have to start saying, Okay, I see that this food falls into a different glycemic load or index scenario, and it’s just going to need more insulin than on a regular day when I’m not eating something so difficult. That’s where the that’s where the understanding comes in. You don’t have to move settings. This person is talking about what settings move. I mean, around like I said around hormonal stuff. I like Arden’s basil. I mean, I try to keep Arden’s basil in a place where I don’t see the algorithm having to constantly take it away or constantly add more right, you know, right where the basil seems to be working. And in the moments when it doesn’t work. The adjustments that the loop has available to it are such that it can stop spikes and lows. Makes sense. Yeah. Okay. All right, Jenny, I appreciate you doing this with me today.

Always. Absolutely. Thank you. Okay, have a good day.

A huge thanks to all of you for sending in these questions. And of course to Jenny. You can find Jenny at integrated diabetes.com If you would like to hire her, she does this for a living. I also want to thank I’d also like to thank the Contour Next One blood glucose meter and remind you to go learn more about it at contour next one.com forward slash juicebox. And of course, touch by type one.org find their website and check them out on Facebook and Instagram. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast don’t forget to go find the private Facebook group Juicebox Podcast type one diabetes, always free 34,000 members and counting. If you’re enjoying the Juicebox Podcast, please share it with someone else who you think might also enjoy it.

Hello friends and welcome to episode 1177 of the Juicebox Podcast. Today, Jenny and I will be answering listener questions in another episode of Ask Scott and Jenny. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. When you place your first order for ag one with my link, you’ll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you have type one diabetes, where are the caregiver of a type one and a US resident? I’d love it if you would please go fill out the survey AT T one D exchange.org/juice. Box this survey helps move type one diabetes research forward. It’s very simple for you to do. You’ll know all the answers to the questions. It won’t take you much time and you’ll be helping T one D exchange.org/juice box. If you’re looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. Don’t forget when you use my links you’re supporting the show. So look right there in the show notes of your podcast player or at juicebox podcast.com and make the clicky. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. Today’s episode is sponsored by Medtronic diabetes, a company that’s bringing together people who are redefining what it means to live with diabetes. Later in this episode, I’ll be speaking with Mark, he was diagnosed with type one diabetes at 28. He’s 47. Now he’s going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Jenny and I have recorded an entire episode before we hit record. So we should there’s part of me that thinks that one day I should just like wine Jenny up and want to let her talk. And then we should just record that. But

we’re back. Katherine caffeinated me,

Danny, we are back to do an ask Scott and Jenny episode which we have not done in a hot minute. Let me see if I can tell you when the last one happened. But while I’m looking you consider this. What should I do if I miss my MDI Basal dose?

Oh, that’s a really good question. And I like that that’s actually an injection question. We don’t get a lot of No, we don’t we don’t get a lot of them. And I think that there are definitely a lot of people still doing MDI that have great questions. I wish more people would ask them. Yeah. But yeah, so I mean, it does depend. So you know, if you miss, let’s say, you’re taking your Basal insulin in the evening, you wake up in the morning, you’re like, Oh, my goodness, I missed my Basal insulin, right? Me You could down dose your Basal insulin by taking some in the next morning when you wake up, right? Okay, if it’s well beyond it, let’s say you take your Basal insulin in the evening, and you realize at one o’clock in the afternoon that you missed your Basal insulin. And that’s why blood sugars look strange, right? At that point, you are beyond taking that Basal dose, even a portion of it. And what you may end up needing to do is just manage with more rapid acting insulin, right, we’re gonna need to cover correct, you may need to even increase a slight amount the amount of insulin that you give, or your carbohydrate or your mealtime coverage, because you’re missing that baseline. So you could expect your rapid acting insulin doses to try to be making up for that missing background. You can even see this when you’re when you’re trying to do Basal testing. Yeah, and you’re evaluating and you’re seeing well, when I don’t eat a meal, my basil causes my blood sugar to go up where it shouldn’t. That is a basil deficit. But when you do eat a meal, it looks like everything is perfect. That means that your rapid is covering some of what the Basal should actually be covering.

I have a couple of thoughts here in questions too. So there are older and newer infill Basal insulins too so like older like love Amir Lantis, newer like Joseba and what’s the other one to

jail basic lar. Okay.

So they work on so that the knock on the older ones love Amir Atlantis are that they don’t really last 24 hours sometimes so you’ll even get he’ll hear people splitting insulin so I can say that Arden us love Amir, but I’m out of okay, I’m out of the old ass basil game at this point. But if I missed Arden’s love Amir at 8pm. And she woke up at 8am. And I was like, oh, hell, I missed it. That’s too long at that point you think?

Or something like and that’s, that’s great that you brought up the kinds of insulin for love Amir Yes, it’s too long, essentially. Love Amir, for the most part who you those who used it found essentially that they did need to dose it twice a day. Yeah, we thought it was a you split it too. Yeah. So you know, have you missed it at 8pm by then you’ve missed the window of its most beneficial time period. So if you’re going to dose again at 8am, go ahead and just dose with what you dose normally,

and just start over like now we just do it at 8am. Now,

well, if you just said you were dosing twice a day? Well, we wouldn’t. That’s why it was yeah, my

scenario, I would, I would have just given her half at 8am. And then back again at half at 8pm. But for people who were doing it every 12 hours, or every 24 hours, excuse me, now they’re 12 hours behind, and it probably didn’t work up to the to the 24 hour mark to begin with. So, I mean, you could if it was live from your Lantus, you could just say, Oh, I guess we do our basil in the morning now and do it right like and start in the morning? Or would you have lows that day from that

deal? With love Amir with love Amir, I think that that would have definitely been okay to navigate that way again, because for for most people who had been using it, it was definitely a 12 hour. So they took it and then they took it again, within 12 hour time periods, you miss one dose, you’re kind of like over it, you just wait until the next 12 hour dose. If you were more of a Lantus user, though, which is definitely longer lasting, and most people got at least 20 hours of action out of their Lantis, or saw it start to sort of peter out by 18 to 20 hours, right? Yeah. So therein lies the question, you know, you miss it into the next morning, now you’re 12 hours into missing your Basal insulin, you could take some how much you could take a quarter, you could take a third of what your total dose had kind of been a helping hand in a helping hand and then essentially take it again at the next you know, the next time period or downplay that a little bit to kind of just coast you through the overnight without being too low. Yeah.

And then I guess, be careful for like that 36 hour period that you’re not seeing. By the way, I’ll point out that in episodes about splitting and so on, you very firmly came down on the side of not splitting Lantis

for the most part. Yeah, I Lantis is it’s definitely longer than a 12 hour action. So if you’re going to split it, you really have to be kind of cautious. I’ve seen some people with tinier doses, do well potentially splitting it because they get the heavier dose in a time of day where they really need that background insulin for whatever the reason, and then maybe they just need a hint more to nudge them over into that. Let’s say you can take it at breakfast and at dinnertime right? heavy dose in the morning, it covers behind the majority of the activity and the variables of the day. But the overnight, they need just a hint more of it in order to not run high overnight or to graze up before they take their morning dose. So you might see something like, you know, eight units in the morning and maybe a unit and a half in the afternoon or the evening time. Right. But that’s not the typical for

that. And to go to the more modern insolence, they actually seem to lap that 24 hour period, right. So

ya know, yeah, and I think you’re just gonna say essentially that if you take it and you missed your dose, you may have up to about 36 hours.

You might get some coverage in there. Yeah, you might. Yeah, if you did that, say you Mr. CBOE and you waited the whole 24 hours to shoot it again and you just managed on the you know, with fast acting until you got back to your tear tear injection time. Do you think the next day would look a little resistant to or do you think you’d be back to good after you injected it? If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G vo Capo pen. My daughter carries G voc hypo pen everywhere she goes because it’s a ready to use rescue You pay for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn’t be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk. For safety information.

You should be back to fairly good after you injected it assuming that the dose that you had been using before missing a dose was pretty good. Okay. Yeah.

All right. So the first thing that came to your mind, it’s a good conversation, but the first thing that came to your mind was manage it to your next injection time with fast acting insulin. Okay, so is there a one to one thing they’re like if I like if I’m injecting? I don’t know. 10 units of true SIBO? Is there an amount of fast acting every couple of hours that would like kind of keep me in the game? Not really

not really we would what we would usually recommend is with mealtimes depending on where your blood sugar is, right? And possibly where it’s trending again, the beautiful thing about having CGM now is you can actually tell how things have been being held without a piece, you know, behind that would normally be there. Okay? So if you’re rising, coming even into a mealtime, you can think ahead and say, well, the rise means I’m probably missing at least half a unit of insulin, give or take person, you know, sensitivity versus resistance. And I’ve not even like eaten or Bolus for my meal time yet. I need to nudge this up minimally. And I’m going to be conservative about it because I’m not quite sure how much more I need behind this. Okay, right.

What’s your timeframe for I forgot my 6pm You know, Basal insulin injection, but it’s only 730. Just throw it in then. Right? Absolutely. How far away from that six before you can just go hell and just do it. I mean, I know. Three, four hours, maybe I would

say four hours, quite honestly, like if you’re normally dosing 6pm. I mean, a lot of people take evening Basal insulin, it’s like eight to 10pm. Typically, unless they’ve been told to take it with dinner or around dinnertime. It’s usually like

more why I think of it that way. Because it was because Arden was so small, it was part of the safety like oh, shoot it near a meal. Plus, you’re giving her a needle than anyway. So it’s not as that’s kind of how we used to think about it.

Yeah. Okay. But yeah, if you are normally dosing it at 6pm, and you remember at bedtime at 1030. Darren I missed, you know, go ahead and take it at that point. Absolutely. And then just back it up the next day,

where your thought is that because if you forget it at 10, if you remember to you’re not awake at 2am to remember it. So unless you wake up in a cold sweat and go oh my god. Right. Yeah. All right. That’s okay. I appreciate that. And that was good. Yeah. Well, let’s stick with this theme for a second in the inside of the theme a little bit. What should I do if I inject the wrong insulin? So I’ve seen

this so many times. And you know what, it seems to be more of an err on the side of I was supposed to take Basal insulin. And I injected 30 units of rapid insulin, instead of taking my 30 units of Basal insulin. That’s the one that I see. 99% of the time

never goes the other way. I was making a two unit correction. And I use basil instead of my fast acting. Right, right. It’s almost like you just said like this giant dose, even if you’re a little kid, you don’t you mean like, you know, three units of you know, is is a giant though. So in case this isn’t clear to everybody, some of the most, I find interesting and heartfelt posts I’ve seen on Facebook, or somebody who jumps on and says, Hey, I just shot 20 units of Novolog instead of 20 units of Lantis. And I’m MDI and it’s in and what do I do? And I always think what a great opportunity to understand how insulin works. I never say that out loud. Right? Because they’re usually running in circles like a chicken without their head.

You’re not just like, hey, just sit watch what happened.

wonder like, you know, like, so for my money. I do the math. I just say, you know, I shot 20 units of insulin. My insulin to carb ratio was one per this. That’s how much food get to eat now, maybe add some fat, some ice cream, what a great time for a milkshake to, like, you know, that kind of stuff.

Ya know, and that’s it depends, you know, if you have a fairly aggressive insulin to carb ratio 20 units might not be a terrible amount, despite not necessarily wanting to add extra food. Yeah, 20 units might be something you can clearly take care of and navigate and manage that problem, right? If you however, usually take one or two units to cover a meal of 30 grams worth of carb, why units is a whopping dose

your insulin glucagon time, then, yes,

that’s that’s glucagon time. Or it may even be potentially that with enough sensitivity, you may end up actually just needing to go to the emergency department to be able to say, You know what, this is what I did. I definitely know that I’m going to need a glucose drip, I know that you’re going to need to navigate this because I can’t eat enough that I see often with kids, where they just their tummy is so little. They can only take so much juice. Sure.

Yeah, there’s there’s no yeah. And yeah, I actually it wasn’t making light of it. It’s usually it’s usually adults, but like, you know, that I see are like, ah, but I’ve actually managed one of these through, personally. So a girl, I don’t remember her name anymore, came on the Facebook group and said, I just did this and she was in a panic. Yeah. And she’s home by herself. She was in her early 20s. Right. And then the first comment that came to the Facebook group was call 911, which I think sent her spiraling. By the way that’s, that’s always like, you know, you always get one or two people are like, Oh, I know, you asked for what color is the sky, but I’m going to call it tell you to call 911 instead, and like, you know, like, so she starts panicking. I can see her panicking. And I just said, Give me your phone number. And I called her and I was like, Hey, what’s up? And she was she was upset, or Yeah, I mean, she was panicked. And with good reason. What I did was I said, Alright, look, you know, what’s your insulin to carb ratio? It’s interesting that she went, I don’t know. Oh, so I was like, you know, many people don’t know stuff like that. They’re like, I just usually do about this much for dinner and like, blah, blah, blah. So I said, Okay, I picked something that I knew how many carbs are in it. I was like, how much would you have Bolus for this? Yeah, that you really like firmly understood. And I said, Okay, so we’re gonna put your like insulin to carb ratio at like, one unit for 15 carbs. And she’s like, okay, and I said, Well, how many units did you shoot? And then she told me, and then we did the math. And I said, alright, well, you get to eat 125 carbs right now. Like, you know, and then I was like, let’s but then she was like a healthy eater. So then that wasn’t that easy. You don’t I mean, I was like,

I might get the honey nut cheerios out.

That crap. And I’m like, Oh, God. Okay. So like, I was like, I might Hi, header, open the refrigerator. And we just went through it. Like, yeah, shelf by shelf, line by line, we open cabinets, we found enough stuff. At one point. I said, even if we don’t find anything, don’t worry. I was like, there’s a five pound bag of sugar in the house somewhere, we’ll start eating that, don’t worry, we’ll have it’s gonna happen. We’re gonna be okay. You know, I said, well mix sugar with water. There’s all kinds of things we can because they didn’t keep a lot of juice now, so she didn’t have a lot of stuff. And she got through it. She was okay. Yeah. So

in that instance, in terms of the portion that it might need to take somebody, again, with a stomach capacity to handle sometimes small, heavily packed carb types of foods are often a little bit better, you know, people think juice first, right? But it was also think despite being kind of panicked at that point, you have to say, well, am I like pretty stable right now or where is my blood sugar, you know, my sitting already at like 72. And if you are, okay, we need to get some quick something because it’s a rapid acting insulin, and it is going to start working pretty quick, right? Whereas if you’re sitting at 180, you’ve got a little bit of wiggle room there to navigate. And you may actually progress through rather than sitting down to the bowl of 125 grams of whatever it is gonna be, you

know, that’s not as clear thought to some people as you might think, because a lot of people see 180 and pick almond range. Like, you know, they don’t think about the way you and I think about I’d be like, well, we’ve got 100 points to play with here. And yeah, also, the thing you said about juice, you can get you sick, really easy like that, like that nauseous feeling in your stomach, really, I can’t do this anymore. And a big Bolus will burn through a fast acting carbs very quickly to like if you put in, you know, 10 units that aren’t for anything and like you said, you’ve only ever put in two units for your biggest meal in your whole life. drinking juice isn’t going to do crap it’s going to be it’s going to be like Jenny and I tried to stop like a NFL running back. We’re gonna be like, Hey, don’t don’t do this. You know, that’s gonna be the end of it. Right? Yeah. For two seconds. dense foods slowly digesting stuff. That’s the kind of like, think about those foods that when you eat you always end up bolusing more for have a little of that at this point. Yeah. Oh my gosh. And then, but you said go to the moon. Wanna see room if you’re, and I agree with that. But you can’t just get in the car and drive to the emergency room. Because before you get there, it’s me you in about 15 minutes. If you’re lucky, I would imagine it

right. If you are the one and you’re alone, as this young woman that you are helping was clearly, that’s probably not the best idea, especially considering she was very worried about what was going on. It’s better to actually get to at least a stable enough place with enough carbs to be able to get to the potential of an emergency department to be able to help again, only as the last and kind of need. And, again, what’s the goal between in there? It’s glucagon. Yeah, we have glucagon that absolutely can be used in the case of need, you

gotta have it with you. By the way, she did not have that either. She didn’t have that she couldn’t reach her parents. Like it was like a dumpster fire of like, bed, you know, variables for Oh, lo food in the house. Like the whole I don’t know, I’ll never forget, like, also never forget feeling panicked about it, because everybody was like, just do this. And I’m like, somebody’s got to actually help her. Right? Like, you know what I mean? Like, she can’t, she was panicking. And she was young. And she was by herself. And I was like, I’m gonna, like, just call me or I’ll call you or whatever.

And that’s what she needed. Rather than reading and reading and reading the 50 comments that came in, I got worried about that. Yeah, you start to go down this and instead of doing your reading, start

wondering which one of these is the right thing to do? Yeah, correct. Yeah, so just

like one person to take into you need that verbal, that human connection, which is by the

time we were done, she was eating bread, obviously, keep bread, that’s good. Some bread? We’re gonna I that’s what I did I mix bread jam on their bread was sugar and peanut butter. And like, anything like that, like I kind of I kept hitting her like fast and slow digesting carbs at the same time. Anyway, honey is

a pretty packed one to honey and maple syrup. From the standpoint of the content of car, I mean, a tablespoon of honey is like 17 grams of carb. And maple syrup is even heavier. Yeah,

that’s a consideration to like bulk of food. Like, I feel like this has been said, but it’s worth saying, again, you can’t just start with like, I’ll eat grapes, like because you’re gonna fill up before you get to the car number you don’t I mean, like, you need some that’s gonna hit you really? Like. And by the way, once you get through that, three hours after you’ve injected it, let’s start over again. You know what I mean? So, right, yeah, just trying to stay alive at that point. diabetes comes with a lot of things to remember. So it’s nice when someone takes something off of your plate. US med has done that for us. When it’s time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It’s a big button that says click here to reorder. And you’re done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we’re done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 8887 to 11514 or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast. Right now we’re going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is

Mark. I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How

long had you been in the Navy? Eight years up to that point? I’ve interviewed a number of people who have been diagnosed during service and most of the time they’re discharged. What happened to you?

I was medically discharged. Yeah, six months after my diagnosis.

Was it your goal to stay in the Navy for your whole life? Your career was Yeah,

yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved

the most. Was the Navy, like a lifetime goal of yours. lifetime goal.

I mean, as my earliest childhood memories were flying being a fighter pilot, how

did your diagnosis impact your lifelong dream?

It was devastating. Everything I’ve done in life, everything I’ve worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family care givers you know, for me to Medtronic champions community, you know all those resources that are out there to help guide the way but then to help keep abreast on you know, the new things that are coming down the pipe and to give you hope for eventually that we can find a cure. Stick

around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic. diabetes.com/juicebox. Jenny, this one’s interesting. I always have a weird feeling when I see people worried about this, but it happens all the time. So let’s talk about it from a technical standpoint. Oh, okay. What should my what should I be doing? What should my kid be doing in the event of a school lockdown? My first thought is always what I told Arden was turn off all your alarms first. I was like, because you’re gonna get upset, your budget is going to shoot up and we don’t need a beacon going off over your head if there is actually a person wandering around your school with a gun. I mean, I guess that is part of it hot like you got to quiet your stuff. Your technology? Yeah, I

I was actually going more from the what should you have on your person was

thinking you’d go that way. So I went this way? Yeah, yeah, no, or the easy

to grab bag, right? It’s almost like the the T one D to go kind of bag that you have next to your, you know, garage door or in the back of your car or whatever. It’s got packed with like everything. And I think at school for any age kid, especially maybe the the high school age, even middle school where they’re probably more so taking care of themselves. They don’t have a checkpoint really, right. And so they need to be ready to grab something and run and go wherever they’re being told to kind of come together. Right? Yeah. But the alarms that’s a that’s a great one.

I mean, so what we did for Arden was like you said in younger ages, they don’t leave a room, usually they stay in a room, they do everything in the room. But once she started moving around room to room, we stocked every room with a few juice boxes, and some snacks fast acting, you know, sugar and something a little more substantial. Something that was you know, is all, like wrapped in a package wasn’t gonna go bad the whole year, like that kind of thing. Right? We also started to notice, there were times of day she was low and times a day she wasn’t. So we would ever more heavily stock some classrooms than other classrooms. But that’s my first thought is, this isn’t something you do in the event of this is something you do ahead of time. You know, my pain? Yeah. So I would have each classroom have some stuff in it. Now the the insulin part, I hear what people are saying, because I’ve watched them have these conversations online. What if this goes 12 hours? What if this goes two days? Like, you know, that kind of thing? I mean, I don’t know how you’re supposed to plan for that. You can’t have insulin in every room? You know what I mean? Like, no, I am a big fan of the kids carrying their stuff on them, right? You know, your controller for your fear pumps, you know, glucagon should be with you not in the nurse’s office, you should be in the nurse’s office too. But with you, I think you will also start going into like survival mode. Yes. Maybe, you know, dial back your Basal a little bit. If you’re on a pump, like, keep out of a low situation, you know, like nothing wrong with 150 blood sugar for 12 hours while you’re sitting on the floor, if that’s what’s gonna happen. Correct. Do you have any other thoughts about that?

No, I mean, it is it’s a, it’s a really, really good question. Honestly, I don’t have any other thoughts, I guess, I would say to maybe in terms of what you’re talking about, and how you had stocked your daughter’s sort of school rooms accordingly. I wonder if also discussing with your school? Where is the place that in an emergency, you would bring the kids right? Or where does her grade go compared to the other grades? Evacuate the kids, if they evacuated them to a safe location or something like that? You need to know where to stack extra beyond the classrooms that she would normally be in she or he would normally be in?

Yeah, this is not diabetes related. But I’m interested if you have you spoken to your boys about this, have you ever talked to him about something like this? They’re pretty young, but

they’re pretty young, but they have their schools have done age appropriate education and about what it would mean, if there was somebody in the school that wasn’t supposed to be there. That’s kind of how it’s addressed to be less scary, right. And they’ve done drills. I mean, that’s the schools at least the ones that my boys have gone to, they’ve done drills, almost like a tornado drill or, you know, something like that to say, this is where we go, this is what we do. The all of those kinds of things are typically practiced Unfortunately, these days. I mean, the most that I had when I was little was like a tornado and a fire drill.

Yeah, stop, drop and roll and sit on your desk so that they’ll find your body under the desk. And I’ll tell you what, I’ve told my kids now they’ve both been through high school already. And I will say The caveat is they mostly were in a school with one level. Okay. But the high school did have two levels. I very clearly told them, run to a window, jump out the window, zigzag to the tree line find your way home. That’s pretty much what I told him. I was like, Do not sit around waiting for Mrs. What’s her name over here to save you? Like she don’t know what to do. Okay, she barely understands English. And she’s teaching it get out of the room. I says, I swear to God, if you’re on the first floor, up on the countertop window, open out the window, zigzag into the trees, get the hell out of there. Like I that’s probably not the right thing to do. But I swear to God, that’s what I told both of them. And I wasn’t kidding. Like, one time they looked at me like really? I’m like, Yes, run away. Run. The hell, you don’t have to be faster than everybody just the bare. joking matter. But Jenny? Seriously, like, that’s what I told him. I was like, get the hell out of the building and run. So

if you can, I mean, in certain circumstances where you’re not quite sure where the trouble is coming from? Is it still outside the school? Is it in the school already? Can you hear noises? What I mean? It’s it’s just a completely unknown. Yeah, yeah. Right. So I don’t even know if all schools have windows that open? Well, listen,

if it doesn’t throw a desk out the window, then follow along, after I’m doing like Get the hell out of you, you know, in, but back to the diabetes portion of it. You can’t have insulin everywhere. No, you just can’t. So if you have a pump one, I think my my best thought is you go back to very low settings, so that you don’t go into you know, you don’t waste your insulin, Oh, yeah. And don’t go low. And just try to stretch it out as best you can. Yeah, and have food and have food wherever you are. That’s my thought. I would even say, if you got into a dire situation, and you didn’t have food, and the time really started going on, you know, your kids should probably know how to like Temp Basal off for a while, let their blood sugar rise a little bit, put it back on again, like I mean, it all depends on how much you want to like, talk to them about this stuff, honestly, you know,

correct and what and at what age, I guess an age appropriate way. And depending, as you just said, on what they know about their system, do they know enough to be able to go in and these should be things you’ve practiced ahead of time ahead of a very emergent situation, you should have practiced how to suspend a pump, or how to set a temporary rate or how to take the algorithm off and go back to manual mode so that you can actually do some of these manual kinds of considerations. And some of them, you know, you might have an eight year old who’s really awesome and can do all of these things, understandably. And you might not.

I also want to say I just did a quick googling. This is a number from November of 2023. I hate to say this, but the odds of a child in the US being killed in a school shooting are one in 614 million. So I mean, it’s sad for the people that happens to of course, and obviously but I mean, I think if you’re planning on this one, you’re you’ve run out of things to plan for. He’s kind of my opinion. But anyway, let’s find something more upbeat of the Oh, Jenny. Oh, we’re talking I just realized we were saying just realized we’re talking about diabetes. When I said that I looked down. I see the word gastroparesis. I see LDL and I’m like, what upbeat things are gonna be here. I’m gonna pick the one up b thing. Okay. Have the latest advancements in diabetes cures, which is in quotes? Which one? Jenny, do you find the most intriguing? Oh,

I think the most intriguing for me are the insulins that are the smart insulin type. That’s very intriguing to me. Years ago, I attended a I attended a technologies and scientific advancement, sort of presentation in which a gentleman presented on something that he was calling smart insulin. And it worked almost like a thermostat. It was injected once a day, it covered basil and Bolus insulin needs. And it turned on and off based on the glucose level in circulation. So it was it was something that in terms of, you know, navigating, you don’t necessarily need even a pump at that point, right. So that type of science is very interesting to me, because outside of a true a true cure for solving the issue. Something like this would, it would definitely take care of a lot of the variables that most people are trying to navigate around. It’s not the baseline understanding. That’s so difficult. Yeah, it’s the navigating all the little individual day to day things that could impact what you know about insulin action for you All right. So that one definitely. And then I think the other one, it’s similar, it has to do with insulin, but it’s more the encapsulated beta cells. You know, the the, the person who receives them actually doesn’t have to have the immunosuppressive drugs that are most typical when you get a transplant. of sorts. Yeah. Right, in order for the body to not get rid of them and see them as foreign. And that’s the encapsulation component of it, is to prevent the body from seeing it as foreign. Yeah. That also,

so that one was on my list of like bear attacks is one of the, like, one of the companies, but actual, like, beta cells, like inside of a pack of bubble wrap. Yeah, that they put under your skin and your, your immune system can’t see through the package to see that there’s somebody else’s cells in there. So they’re working, but they can’t get attacked. That one’s been they’ve been at that one for a while. And I have had someone on this podcast, who was in a double blind study. Oh, so they did not know if they were actually having it or not. But she said that by the time they removed it, she was sure she was actually she had it in her insulin needs were pretty much gone. Wow. So yeah. And isn’t that crazy, though? She was in a study. So it was working. And they took it out of her and

they took it out? You’re like, no, no, I’d say that’s where I’m like, I find my own island somewhere, you know, where I live, she

she was lovely. She’s like, I love helping research, I was like, I would have run away, I would have been like, you aren’t not taking this back. For me. I wouldn’t give you my TiVo back. Definitely not getting this cloud DVR, you can’t have that back. You’re not getting back my back. So I was gonna say that one as well. And again, I think it’s important, we talked about this stuff to say I first started hearing about this, like 15 years ago. So like, don’t, you know, don’t start saving your nickels up for it just yet. And that is going to be the next part of it is and you can see what GLP is right now. The people with the best insurance are the people who are hooked up or the people of cash are going to go first. And he is going to be for the first week and a half. So just you know, don’t get too excited. I will throw in tz yield. Because yes, I’ve interviewed people from that company a number of times, and they’ve never said it. And now Sanofi owns it. So I’m not talking about you, Sanofi, I’m talking about the people I spoke to spoke to before who worked at prevention bio, I could always hear in their voice. This is what we’re using it for now, to kind of like hold off the diagnosis. But we really wonder if there’s not more to it than that. The IG so that to me, was really interesting. In that same vein, one of the prevention bio, Francisco Leone, he said to me, I would love there to be a vaccine for hand Foot Mouth. I was like, what? And he goes, well, so many people are diagnosed with type one after getting Coxsackie virus. I wish there was a Coxsackie vaccine. Because I think if we could slow down people from getting coxsackievirus maybe we could put off people getting type one diabetes, the percentage that we’re going to be affected made me cry, because my kid had coxsackievirus when she was two, and then she got type one diabetes. So I’m a he’s talk and I’m crying. I’m like, it was a good idea. You know?

That must have been the one that was it was a while ago you to him because he came up with the idea of its application in autoimmune disease not specific to type one initially. Yeah, he was looking at something else if I remember correctly, right. Yeah.

So if you want to pick through my brain that to me, like it’s nice that somebody’s trying to stop type one or something like that. I think that if you want to push mankind forward, you got to figure out why our bodies react oddly to things and figure out how to stop that. Yeah, that’s absolutely the bigger problem. There’s a gentleman on the show today. sarcoidosis, which is an autoimmune coisas. Yeah, had to have his colon removed. And the sarcoidosis is still going after him in different places in his body. You know,

quedo, Asus is one of those that affects each person who has it differently.

Ya know, it’s it’s a, it’s a hell of an interview. I think it’s like, it’s in the 1100s. Maybe. But my point is that that’s an autoimmune issue. Yeah. Whether you have hay fever, or you get hives, and you don’t know why, or your body’s attacking your thyroid, or your pancreas or anything, that’s the thing. I mean, I think we should be dropping everything and looking at that, because that fixes everything else, you know what I mean? Among

many other things, what should we be looking at? And what should we be doing in our world? Rather than looking for aliens in the outer space? Listen,

if we don’t get hit by a comment, I think 500,000 years ago from now, we’re gonna have all the answers we need. So I’m hoping a actually, I mean, you know, let me be serious here because we’re kind of coming up on the end here. Yes. I think if you want to hope for something, hope that AI can get to the point where it can run these tests and get smart enough to break them down because much like everything else in the world, what slowing us down is us. We’re only so smart, we only, you know, we only work nine to five, you might have to live a whole generation of people to get an idea weeded out of education to get back to somebody focused again, like you want a computer running and re running and running and re running and go and hear, hear hear, like, I think, you know, if you know, that would go much quicker, I’ll use as an example. I don’t know how many people track stuff like this, in a Tesla in a car, they have self driving, a lot of cars have self driving now, but Tesla’s is pretty far ahead of the rest of them. And one thing that that company did was they built their own supercomputer, just to look at the data from self driving to teach self driving, how to get better, to get better. That’s what you need for health care. You know what I mean? You need something smarter than us running and rerunning ideas over and over again, I think that’s actually the thing you should be hoping for. Yeah.

And then maybe it’s interesting, because I, if you had something like that, pointing out exactly what some of the things we know about health care and longevity, and overall body systems and how to keep yourself healthy. Maybe people would take it better from a computer algorithm instead, in terms of pointing out, Hey, if you do step one, step two, step three, and do this in your life. You don’t have to take XY and Z pills, because you can already solve this without putting money out of your pocket. Right? So maybe they would take it better.

Yeah. Also, if you thought that at the end of 60 days of taking vitamin D, you’d actually feel better. But that’s not what happens. You take it one day, you don’t feel any better. Right?

Right? Historical data that maybe would be compiled by a system like this, you would read it and you would say, Oh, I understand. I

have to do this for 60 days. Jenny, listen, I’m now months and months and months into a better health regimen. Because of the GLP medication. I’m actually absorbing my nutrients now in my in my my vitamins and everything. Before I think I was taking them they were just like, kind of flushing right through.

You had expensive poop essentially,

I am expensive, not half the workforce. But But that’s very funny, but I am. I’m gonna tell you now, my energy is such that sometimes at night, I think I’m not even tired. Like the end of the day comes and I’m like, I can keep going. Like, I’m like, I go to bed. But I lay there. I’m like, What could I be doing? Yeah, I’m gonna close my eyes and go to sleep. But if I wanted to get up, I could do something for two, three more hours. I’m like, Okay, it’s crazy. Like, I know that some of that’s weight loss, but I actually think I’m taking in these, you know, this stuff now. All right, we have like, a couple of minutes left, is that right? Yes. This might end up being with a called tickle your with a feather? I don’t know if you know that phrase or not? Because I think this is a bigger, bigger thing than we can tack on a couple of minutes. But I am very interested in this conversation. Should people be on statins? If their lipids are okay. Oh, we can’t do it now. Right? Maybe the next test Scott and Jenny. I

like to tickle with a feather. It’s called tickle my

eyes of the feather because then you think oh, the next time this asks any chumps on they’ll talk about lipids and then I’ll go back to it. Yeah, it’s like, it’s my, it’s my own who shot Jr. Which nobody understands? Yeah,

I feel like I can be very honest, in terms of what my perception from a medical like physiology standpoint is with that, I hold nothing to any company or whatever. And if you have a healthy lifestyle, and you have healthy intake, and you have healthy lipid numbers, and all of those types of things, you are not the population that a lipid or that a statin is going to be beneficial for you. In fact, there are multiple reasons that you probably shouldn’t. Now, I know somebody is going to beat me up about this. I don’t care, quite honestly. But these are, these are medications that are to begin with their band aids. They’re meant to fix something that isn’t quite right in your body. Many times it’s lifestyle. Truly, right. And there’s a whole there’s a whole like host of navigating things. And if you really do your research, and you really look at where funding comes from, you will find the reason

Are you saying that if I manufacture a statin and I get insurance that covers that and if you have diabetes, then what’s the phrase I’m looking for? Everything looks like a nail if you all you have is a hammer. So, so the doctor goes I was told to give people a diabetes statins.

Thank you for saying it. Sure. Go 100% Like, I am not 100%. Like I said, there,

you might need them. There are people who need them to get correct. Yeah, there are

people who may need them. But the bulk of people, the bulk of people who are being prescribed them, they don’t need them. They don’t need them. And there are a whole host of reasons around the world of people who have diabetes, that they are 100% prescribed, even to those. And a lot of people question they say, Well, I told my doctor, I’m healthy. All my numbers are in range. I’ve never taken this before. Why are you prescribing it? Oh, but it’s preventative. Those

are the people I’m talking about, then to tell you listen, but it’s preventing me from one from in case, this happens one day, maybe? Yeah, no, it’s I think it’s preventing you from being able to afford a cup of coffee because you’re buying the statins. Now, listen, I have long not answered this question. Because I’m not a doctor. And I have no idea. And I know it’s gonna get confused, because there are some people who need statins. Okay. Right. But yes, I think that what happened was, is they became prescribed bubble and covered by insurance if you have diabetes, and so it becomes whisper down the lane. And before you know it, we’re five years into it and a doctor’s handouts that it’s like, like candy, and they don’t even know why it’s just what we do for people with diabetes. You know, and

a lot of them do. I mean, a lot of them know the baseline of what they’ve been told about prescribing it, it is called preventative medicine, right? I mean, the other one that very similarly, our blood pressure meds for people who come in who again, healthy lifestyle, healthy intake, all of their, you know, their lipid panel looks lovely. Their blood pressure is nowhere near needing treatment, and they’re taking it anyway because they have diabetes, and they’ve been told to take it because it’s preventative. Yeah, just let’s

say Jenny’s not walking around with her man wearing a condom 24/7 They put it on when they need it. Oh my god be so uncomfortable. That’s so funny. We’ll talk more about that in the next one. And here’s a little highlight for people in the next one. We’re going to answer this one and the next one, too. Hey, Scott, I’ve listened to your episodes on GLP and your diaries about your weight loss. Well done. Congratulations. I know you said that you think that GRPs or meds like them will become much more frequently used for people with type one can you please go into more detail about why you think that? Oh, and then this one I’m hearing rumblings about them potentially causing gastroparesis. They cause gastroparesis on purpose. They slow down your digestion on purpose, which is called guest or gastroparesis, just not in the way you’re thinking of it if you have type one. Okay, so we’ll do that when going down

digestion definitely is different. In terms of what’s happening right then having actual gastro paralysis

caused by type one as a side effect of type one diabetes. Oh, look at this. I’ve heard Jenny competing in an Iron Man. Oh, there’s gonna be plenty of stuff next time. All right. Thank you

to half so I want to clear that to half Ironman. They were not full Ironman.

Oh my god that you’re more worried about than getting yelled out about the statins. Like I don’t need to hear from those Iron Man people Jesus.

I think

a huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don’t forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today’s sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that g VOKEGL. You see ag o n.com. Forward slash juicebox. Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we’re even stronger. To hear more stories from the Medtronic champion community where to share your own story, visit Medtronic diabetes.com/juicebox Don’t forget, we still have Mark’s conversation at the very end. It’s a terrific kind of mini episode about 10 minutes long, that goes deeper into some of the things that you heard Mark talking about earlier in the show. If you’re not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you. So So much for listening. I’ll be back very soon with another episode of The Juicebox Podcast. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise to hydration and even trampolines, juicebox podcast.com, go up in the menu and click on diabetes variables. Right now we’re going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark. I

use injections for about six months. And then my endocrinologist and a navy recommended a pump. How long had

you been in the Navy? Eight years up to that point? I’ve interviewed a number of people who have been diagnosed during service and most of the time they’re discharged. What happened to you?

I was medically discharged. Yeah, six months after my diagnosis. Was

it your goal to stay in the Navy for your whole life? Your career? It was Yeah,

yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we’ve made the decision despite all the hardships and time away from home, that was what we loved the

most. Was the Navy, like a lifetime goal of yours? lifetime goal.

I mean, as my earliest childhood memories were flying, being a fighter pilot,

how did your diagnosis impact your lifelong dream?

It was devastating. Everything I had done in life, everything I’d worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure.

Stick around at the end of this episode to hear my entire conversation with Mark, and you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juicebox. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com

Hello friends, welcome to episode 1183 of the Juicebox Podcast Hey everybody welcome back we got another episode of Ask Scott and Jenny here not much more to say than that there’s listener questions and Jenny and I try to answer them. While you’re listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. You want to help. It’s easy. If you’re a US resident, you have type one diabetes, or you’re the caregiver of someone with type one, you can advance type one diabetes research by completing the survey at this link, T one d x change.org/juicebox. That easy 10 minutes. And just like that, you’re part of what’s propelling us forward. Don’t forget to save 40% off of your entire order at cozy earth.com. All you have to do is use the offer code juice box at checkout. That’s juice box at checkout to save 40% at cosy earth.com You should go join the private Facebook group for the Juicebox Podcast Juicebox Podcast type one diabetes on Facebook. Everyone’s welcome. That’s just the title. There’s links in the show notes and links at juicebox podcast.com. Check it out. Fantastic community I’m sorry I went into the deep voice therapy. It’s really great. This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. US med is sponsoring this episode of The Juicebox Podcast and we’ve been getting our diabetes supplies from us med for years. You can as well us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med Today’s episode is sponsored by Medtronic diabetes, a company that’s bringing people together to redefine what it means to live with diabetes. Later in this episode, I’ll be speaking with Jalen, he was diagnosed with type one diabetes at 14. He’s 29. Now he’s going to tell you a little bit about his story. And then later at the end of this episode, you can hear my entire conversation with Jalen to hear more stories with Medtronic champions. Go to Medtronic diabetes.com/juicebox or search the hashtag Medtronic champion on your favorite social media platform. Hey, Jamie, welcome back to a another ask Scott and Jenny episode. How are you?

I’m good. How are you?

I’m very well, thank you. Yay, I’m gonna start where we left off in the last one. But we’re just not gonna parse words. And we’re gonna jump right into it. Because I think we talked around it a little bit last time.

I think last time we ended, because we thought it was a little bit longer discussion than we had time left or something if I remember about, I don’t remember exactly what it was. But oh,

yes. Yeah, it was that and so.

Oh, that’s right. And I give my, my opinion.

Do you did you got a little crazy. So like, I like it. And I want to dig a little deeper into it. So I’m listen at the beginning of every one of these episodes is going to tell you this is not medical advice, you know, talk to your doctor. And I’m not a conspiracy theorist. But you started to dig into it a little bit the last time once they get the okay to use the medication. Now, it’s something that just gets distributed, like, you know, oh, you have diabetes, here’s a statin, even if you don’t show any reasons, to be honest, that that’s happening now and a lot of practices. Right.

Right. I mean, and that’s, that was the baseline for my concern with it’s, it’s given out almost like, we’ll just take this, that’s in a general sense, right? You have this condition, type one, diabetes, type two diabetes, whatever, right? And that has predisposed you to these types of things. And so we are trying to be preventative, they’re calling it preventative right in prescribing something like a statin went in the case of actual individual looking, you can see that somebody’s already got the lifestyle habits that are preventative. It’s such a hard thing to navigate recommending being in a medical field to say, just because you have diabetes doesn’t mean you have to be on a statin. So

I understand. I understand where it comes from. If there’s so many people for so long, who have such poor care, and they all eventually end up with, you know, something that requires a statin why don’t we just paper the community with it and keep it from happening? But that’s I don’t know that’s like saying that a house burned down once a month in our town, so every night, I have to go outside and close my house off before I go to sleep, it gets a strange decision to make, I think and now if it saves the person, then I guess it was a great decision, you know, but is that the I mean, we don’t want to glance over your point about there are going to be some people who are going to lead a lifestyle that will never, that will never lead to elevated levels. Correct.

And that’s where, you know, in terms of just blanket prescribing this as a medication, there are some standards that are followed, obviously, there have to be, and they’re not just prescribed solely on like blood tests anymore. Right, there are parameters that are looked at, there are health risks, you know, even some stats that are being put together by data collection systems that say, this suggests that this person is at this percent of a risk based on these other conditions that are already present, or their health factors or inclusive of lab values, and all of those types of things. Those are considered, you know, in terms of heart attack risk and stroke risk, really, those are the reasons that statins are going to be prescribed. But when we talk about diabetes, they’re also being prescribed as I said, preventatively. Yeah.

So then that gets into the next question. We have a bulk of questions here from people. Should I be on a statin? If my lipids are okay, what about my numbers are good, but they still want me to be honest that and can we please get someone to talk about statins and whether LDL is really a reliable indicator of heart risk, as some doctors would have you believe so that’s the next thing, right? Like, can’t you just genetically be predisposed to a higher value, but it doesn’t necessarily mean it’s going to turn to something or is that not the case. So they

look at ratios as well, right? So it’s not just total cholesterol anymore, they’ve broken it down into different measurements, LDL, you can easily remember LDL versus HDL, LDL is lousy cholesterol, that’s the one that you want to be lower. HDL is your healthy cholesterol, that’s the one you want to be higher, right. So it’s kind of easy to remember. But in terms of that, when they look at ratios, they’re also looking at cholesterol and LDL and cholesterol and HDL ratio is and they’re looking at even VLDL, which is very low density, sort of lipo protein, another component of your total lipid panel, and all of these pieces, along with the other conditions that you might be living with smoking, drinking, you know, lifestyle, activity, all of those things have to go in, when you’re considering the potential of prescribing.

What about having diabetes makes this worse? So if I have a high, lousy, you know, LDL, the doctor looks at me in between the bloodwork and his assessment, her assessment, it looks like I’m going to end up with actual problems from this, what are those actual problems and how to diabetes make it worse?

Yeah, I mean, in terms of diabetes, remember, blood sugar is the thing, we’re trying to manage blood sugar being too elevated for lengthy periods of time, or ongoing higher blood sugars than our with a where a body without diabetes would be. It’s kind of like rust on a car, right? So the more sugar you’ve got in your bloodstream that shouldn’t be here, causes damage in your vessels, it can cause damage on nerve cells, and all of the different little vessels in your eyes, etc, thus, all of the complications in those areas. But the more elevated the blood sugar’s are the more damage and so then the body has to try to repair that damage, but comes in the form of patches or almost like band aids inside of the vessels. And that comes from livers production of cholesterol, it’s trying to help the body is a self healing machine, it’s trying to help itself get better, right? But you’re not helping it with high blood sugars. So that’s where it comes in. The more optimal blood sugar management you have, the less or likely no damage that you’re causing on the interior parts of your body. And so there is where that risk factor should really be considered. Your blood sugar’s are well managed, you’ve got an E one C, well within target or you’ve got, you know, a very low standard deviation, which means you don’t have a lot of ups and downs and you’re well within range. You’ve got lifestyle that proves all of the things that you’re doing, you’re at very low risk for anything like that. So then, you know, I mean statin drugs, essentially they they lower cholesterol liver levels by essentially decreasing the livers enzyme output of a particular type of little substance that it kind of puts out, okay, which is kind of something that goes along then with cholesterol production in the body.

Now, you would take one if you needed it, right. If

somebody could prove to me that I had particular risk factors and a lifestyle that was not proving to be preventative Have enough? I would take what was needed. Okay. Absolutely.

All right, I just want to make sure. I’m not telling people not to do it. I’m telling you that there’s some ambiguity ambiguity here in between, like, what happened basically was, it became in vogue to gives that into the people with diabetes. And I think it started to get in, it just started to get blended, where people are like, Oh, you have type one, take this. And people are like, I have no risk factors that I can see my bloodwork is not even bad. And they want me to take this, what should I do? That question comes up all the time. So I’m glad, I’m glad we talked about and that’s I

mean, it’s good to clear up because obviously, you know, if taking it because of risk factors that are there, when you do take it, there is good information that says, you know, your bad or your LDL cholesterol can be reduced, it helps to decrease that build up, or that plaque development kind of inside of the walls of your vessels. I mean, all of those types of things can be mitigated by using it, but it’s really in terms of whether or not it’s necessary. If it isn’t, then why are you adding something to the mix that could actually have I mean, another question that probably comes up is what are some of the side effects?

Yeah, if I take this and I don’t need it like because it’s always a give and take with a medication to some level, right, you’re gaining something you might but you might be losing somewhere else you get to decide where the value is. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes, because it’s a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use G Bo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn’t be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information. diabetes comes with a lot of things to remember. So it’s nice when someone takes something off of your plate. US med has done that for us. When it’s time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It’s a big button it says click here to reorder and you’re done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 808-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we’re done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the ducks comm G seven. They accept Medicare nationwide, over 800 private insurers and all you have to do to get started is called 888-721-1514 or go to my link us med.com/juicebox using that number or my link helps to support the production of the Juicebox Podcast. Right Yeah, well speaking of that, let’s jump into this very next one. This person said I’ve been listening to the episodes on GLP so they’re talking about my weight loss diary. So I started off by going we go V so I caught it we go V diaries very recently it’s changed over to set boundaries, but I decided I’m just going to call it weight loss because I don’t know if set bounds gonna be the last glpi use or what so this person says I know that what you’ve said about we go V and meds like that being much more frequently used maybe one day for type ones and can you go into that a little bit. They also said you know I also hear rumblings about people worried that it causes gastroparesis. So okay, again, not a doctor. But here here’s my view of it and Jenny has one too because she’s worked with people who are are using gel PISA of type one. For me, I started with for myself. So I sit here before you today for 47 pounds lighter than I was exactly a year ago. Wow. It’s crazy, right? And Jenny can tell you she looks at me probably more than anybody else. I look really different. You do. Yeah. So I don’t have type one diabetes I started with we go V, which is just ozempic. To be clear for people it was epic is a medication that was FDA approved for people with type two diabetes. During the trials. I think they looked at each other like wow, people are losing a lot of weight on this. And so they moved over and did another trial for just weight loss that drugs called weego V. That’s Novo Nordisk Eli Lilly has Manjaro, no type two diabetes, same idea. Is that bound for weight loss. I’m on Jarno and set bound RG LP with a G Ip, we go V is just a G lp. And by the way, the other day I saw news about Novo working on a daily pill to step in for the weekly injection. And they seem very excited about what they’re seeing in trials for that. Now, all that aside, I don’t have diabetes. So I take it, it tells your brain you’re not hungry. It makes your stomach feel full by slowing your digestion, which impacts your insulin usage. I’ve had a number of other valuable things happen. But I watched it work for me. And then I cajoled my brother who is a type two. And I was like, Hey, man, come on. So he did it. His agency dropped two points, which is huge. The sevens into the low fives is a type two, he lost 35 pounds. But then I started talking about it on the podcast. And so now a week or so or so ago, I interviewed the mother of a 13 year old type one who had had type one that has had type one diabetes for three years legitimately has type one diabetes. Who On we go V for weight loss? Probably not why she took it she probably took it more because this is gonna sound convoluted for a second. The mom has PCOS. The daughter is showing signs of PCOS and GRPs are showing signs of helping women with PCOS. Correct. So she was able to get it through her insurance because of the weight. She really wanted it for the PCOS. And I’m not kidding you that yesterday, the mom sent me a 90 day clarity report 90 days, the kid has not bolused for a meal in 90 days. Wow. And her total daily insulin has gone from 70 units to seven.

And that’s it’s only Basal then she took her

pump off even Yeah, she’s just shooting Basil is that I’m gonna pull it up so I can cuz I have it right here because still in my message is, again

in for clarification to you know, from a listener standpoint, this is a very specific case of multiple components being in the picture. That it’s not, it’s not the solution. No, this just

little girls probably has a very slow onset that just didn’t look like a slow onset because of insulin resistance is my guess. Right? Yes, but you’re not going to like have had diabetes for 30 years put it and drop your insulin uses 90% But you might drop it a little bit so

or even more than a little bit. Again, in person in personal use, not personal me but personal with the people that I’ve worked with who have used it that a number of people have had diabetes 20 plus years who have started use of it and their insulin needs as well as that appetite suppression piece that goes along with it is very definitely it’s something that the medication brings into the picture. People whose insulin needs have gone down. One of the women I work with her insulin needs went down 50% That’s not even a therapeutic dose. Oh,

so art and my daughter’s doing the same thing she’s only using right now half a milligram of ozempic a week. Her Basal went from 1.1. During the day to point eight five, her insulin sensitivity went from one unit moves or 43 to one unit moves her 83 and her carb ratio is now instead of one to four it’s one to eight and she lost weight and know her insulin needs didn’t drop because of the weight loss because the needs dropped before the weight came off. Before

the weight came Yeah, I would imagine the weight eventually came off mainly because it is such a it’s such an activator in terms of that not an activator but more of a suppressor really, I guess in terms of the digestive impact.

For sure she’s not eating as much but last thing about this little girl last 90 days average blood glucose 109 G mi 5.9, standard deviation 23 98% and range range of 65 to 180. Wow, I don’t know how long that’s gonna last but God bless her as long as it does. You know what I mean? Like fantastic. Right? So I would Oh, sorry. No, I was just gonna I want to remind people that that these GLP meta gauges are not FDA approved for type ones, and you’re not gonna get it through your insurance. If you’re just the type on the

right there have to be some specific diagnostic codes and or reference notes and letters relative to a reason for prescribing and trying that could get it covered. I know there are a number of people who at least, you know, monetarily have the ability to pay out of pocket for it. Yeah, I know a number of people are already also going to Canada.

That’s how we’re getting Arden. So mine is covered for me. My wife uses it too. By the way. My wife story is her own to tell. But I’ve spoken enough about what happened to my wife when her thyroid went poorly and nobody would give her Synthroid for seven years. And my wife has been doing this one week shorter than I have, and she’s lost 70 pounds already. Wow, that’s amazing. Doing so she does she just looks like a completely different person.

And initially, it was very slow for her your weight loss was very quick to begin with. And hers took time if I remember, right, yeah,

it’s different for everybody. And I’m not going to tell you. It’s not magic. Okay. No, I felt some people call it nausea. I felt like my food stopped somewhere like in my breastbone when I swallowed it. Like it didn’t really, but that’s the feeling I had. But then I’ll say like three months into it, it just disappeared. And I really just, I was like, I’m losing weight. I’m powering through this, like, you know, they kept telling me it’s gonna get easier. We go V, they also say may have a couple more side effects than SAP bound. It’s one of the reasons I moved. I also plot toad. I think I plateaued at 194 pounds on weego V. And I was like that for months, like I would gain and lose the same two pounds every week. So my doctor moved me to zap bound where I quickly lost six more pounds. And then I think I’ve lost two more since then I’ve only been on it like six weeks or so I have I have more weight to go like, don’t misunderstand. But then do I have to stay on it people are well, you’re gonna have to stay on it forever. And here’s what I say. I don’t care. Like yeah, if I do, I do, like, you know what I mean, but I’m just gonna have a heart attack. So this got to be better. You know? Right,

right. Absolutely. Well, and in terms of, as you just brought up, do I have to stay on it forever. I’ve worked with a couple of women who have used it. Right

now we’re going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How long

had you been in the Navy? Eight years up to that point? I’ve interviewed a number of people who have been diagnosed during service and most of the time they’re discharged. What happened to you?

I was medically discharged. Yeah, six months after my diagnosis.

Was it your goal to stay in the Navy for your whole life? Your career? It was? Yeah,

yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we’ve made the decision, despite all the hardships and time away from home, that was what we loved

the most. Was the Navy, like a lifetime goal of yours? lifetime goal.

I mean, as my earliest childhood memories, were flying, being a fighter pilot, how

did your diagnosis impact your lifelong dream?

It was devastating. Everything I had done in life, everything I’d worked up to up to that point was just taken away in an instant, I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to help guide away but then help keep abreast on you know, the new things that are coming down the pike. And to give you hope for eventually, that we can find a cure, stick

around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juice box,

sort of prior to preconception time. And then because it is ABS, it’s not approved. While there are some studies in the preconception time in in first trimester in those who have type two, who have continued to use it with with results that are interesting, I’ll say it is not approved in pregnancy. So the idea is if you’re going to use it, use it well prior to preconception to gain whatever loss really might be in the picture. I know a lot of women in preconception or may have difficulty getting pregnant, if weight is a big piece in the picture. And once that part is, you know, down to more optimal weight for their body and insulin needs, especially the resistance that’s in the picture oftentimes there. Once the resistance has come down. It really does lead to a more optimal environment to actually allow conception. Yeah, which is lovely. But then we end up turning around as I’ve seen in a number of women, where we end up needing to refigure settings and doses because without the Met Vacation. Your needs will go back up.

Oh, you have no idea Arden’s in the middle of her finals right now. And three days ago, I said, Did you shoot that? GLP? And she goes, Oh, I forgot. I’m like, I can see it on your graph rd like in days. So I think they it’s a once weekly, but I was listening to this doctor online who says that the life that half life’s about five days maybe? Yeah, right. Yeah. And I noticed that too.

It peters out pretty quickly. Yeah. So again, from a preconception standpoint, it gives you enough good time to be able to say, okay, I can take it up to this point, I can kind of figure things out, trying to conceive, et cetera. We’re at

the very beginning of something here with this because you can find there’s Facebook groups where they talk about having ozempic babies, like people who could not get pregnant, their entire adult lives. Go on to GLP and end up pregnant in two months, right? Like crazy. There was this crazy thread in Reddit. I know people are like it’s read it, but no, it’s where people are talking. You know, people who have I never pronounce this right, Jenny, here’s danlos. Damn. What’s that? Autoimmune issue with the joints? Eres danlos? Oh, I don’t I never say it right, hold on a second. It’s not very common ears. It’s e h r s o l e r s Danlos Syndrome, a group of illnesses passed from parent to child notice inherited defects, skin joints and blood vessels. It’s a very rare condition. Right? But there’s this group of people. It’s like your connective tissue, right? Yeah. Like if you can, like hyperextend your joints and stuff like that. Some people have like real pain from that. And I found this group of people on Reddit who are like, Hey, I have this and my symptoms are going away. And the only thing I’ve done differently is taking a GLP medication. And it got 15 people in the group were like, Oh, my God, I thought I was crazy. Like, I think that’s happening to me, too. So inflammation may be like, who knows where this is all going to like, eventually, like shake out? All I can tell you is it saved my life. Like for sure. And you know, and what I’m seeing it do for Arden is huge. It really is. So I don’t know where this is all gonna go. But if we wake up in the world one day where you’re getting a GLP along with your type one diabetes, I’m not going to be surprised when it happens. Yeah, right. You

know, it always makes me I had a conversation with a friend the other day, also an educator with type one herself. And it just makes me really consider in the, in the grand scheme of things, what what have we really shifted so much in our recent, let’s say, even the past 50 to 75 years of what we’re doing. That’s something that is naturally produced, interestingly, right? It’s naturally supposed to be there working the way that we were created in the human body for it to work. Why is it not doing what it’s supposed to be doing any longer? How

do we kill it off? Yeah,

how did we kill it off? How did we kill off the function of what and why? For some people? Is it so necessary? What are people who aren’t using it? And who will find no real reason to even use it? What’s the difference? Yeah, like that, like the rabbit hole of thoughts is where this life leads? No.

Well, why are there so many autoimmune issues? Why there’s so they so much more frequently? And like how is this? Listen to me, between you and I, I think when we start genetically modifying seeds to grow in weed killer, I think maybe you’ve got part of your answer right there. You know. So, yes, that’s all the I don’t know. Thank you said Yeah, well, I don’t know if people realize that or not, but they make weed killer. And then they genetically modify the seeds. So the weed killer doesn’t kill the seed, so that you don’t actually have to pay someone to go out there and pull weeds to choke out the thing. You just plant the stuff, spray the field, everything dies, except the modified seed and your corn comes up or whatever. And that can’t be good for us. I know. I know. Like people are like, don’t click on Teflon. I don’t don’t microwave your plastic. I don’t like you know what I mean? Like, you know, I try to avoid all that stuff, too. But big picture there. Plenty of people have autoimmune issues and never had a Teflon pan. So I think maybe we’re unit I mean, like Yeah, that’s gotta be something systemic like that. And so my point is, I would like that fixed. But I also understand that by the time they fix it, I’m going to be dead already. Yeah, yeah. So I gotta live. I gotta live now.

And hopefully at this at that point, you’re not gonna be dead from heart disease.

Not now. I thought, Oh, come on J but I had a stomach. That was that would have been clearer. If I had a heart attack a doctor would have looked at me went Hmm, that makes sense. Like, yeah, and now I don’t, so maybe I get to live longer. Makes me make more. For me. I don’t know how good is for anybody else.

All right, good for everybody. Yeah, absolutely. So

that’s where I’m gonna land is that I’ve seen a number of type ones using GLP is at what would not even be considered a therapeutic dose. They’re having a lot of gains. Now look To the person’s last point, it’s not for everybody. Nothing’s for everybody, right? And there are side effects that are on the label. gastroparesis. I’ve seen intestinal blockage, stuff like that. You also don’t know where those people were before they started the medication, or how they ate once they had it. And I’m going to give you an actual example of a person I spoke to in public. Awesome. I saw them a year ago, I saw them recently. They’ve lost a ton of weight. I said, Oh, my God, we looked at each other. And he was like, you lost a lot of weight. I said, you did too. And I said, How’d you do it? He goes, GLP medication. I said, that’s how I did it. And then he goes, How do you like it? And I was like, I was great. I went over everything about it that, you know, pros and cons that I saw, how was it for you? I said, he goes, I vomit all day on it. And I’m like, wait, what? And he starts talking, and then I recognize he shooting the GLP. But he’s eating these high fat, like meals and like, he’s, he’s, I don’t know, you know, I don’t know what to say he’s doing. But it’s not in the spirit of the idea is what I’m gonna get like, it’s not magic. You can’t like you can’t shoot the stuff and then eat a five pound bag of sugar and lose weight. It like doesn’t work that way. Right? Right. He’s slow, just digestion down. He’s had type one diabetes for a pretty long time, it was not greatly managed. I don’t know what nerve damage he has or doesn’t have, like, so know who you are before you jump into this. But you know, I don’t know. I just my, it’s just my experience. So yeah, no,

that and you bring up a really good point. Overall, you’ve had success. But I also know, you know, just in our discussions privately that you do a very good job of awareness in terms of what you eat.

I’m not taxing this, this situation. Yeah, you’re working

with it. I guess that’s that’s the thing. It’s like anything, you have to work with a system even, you know, automated insulin delivery systems, you have to work with the system, it’s not going to do everything for you. The same thing with medications in general. They’re a piece of the pie. Even as we started out talking about statins, great amount of statin now I can go out for burger and fries like it because it’s gonna No, no,

no. I know that that’s it happens a lot more than you might want to believe to. Yes, yes. The number of people who have basically told me I eat through my GLP. Like, yeah, it tells me I’m not hungry. But that doesn’t stop me. I’m like, oh, okay, that maybe see a therapist then? Not up. Like if you’re not hungry? No, and you’re still eating? That’s a different situation. Let’s jump. Let’s finish this one up, because I think this will take a little chunk of time. Okay. Exercise. Oh, exercise with type one diabetes? Oh, that’s a broad topic. Oh, well, let’s pick through the three questions I have here. This one was interesting to me, how high of a blood sugar is too high to exercise with. Go ahead. I’m interested in what you’re going to

say no. And that’s I’m trying to frame the way to say it. Because

you know, everybody gets told, don’t exercise when your blood sugar gets high. Correct.

So if we’re talking about it, just from, from an angle of overall performance, there were some really good studies done. It was a doctor at the Barbara Davis Center, if I remember correctly, he did studies within the realm of athletes with diabetes and athletes without diabetes and optimized performance with blood sugars in certain ranges. And what was found is a blood sugar range of somewhere between like 100 and 180 was where performance worked well, right there, muscle performance, their endurance and all of that kind of stuff. So in terms of targeting, when you’re looking at performance, there’s a range to kind of work with. But a lot of people also as you said, they need to they feel they’re also needing to start with a high blood sugar in order to allow the fall that they know is going to happen in their blood sugar. So then comes in the question, well, how high is too high? What should I be looking at? If my blood sugar is too at do I have to wait for it to come down to get my blood sugar moving? Not necessarily.

Have you heard people talk about that? They’ve been told it’s dangerous to exercise with high blood sugars?

Yes, and that’s the clarification there is relative to whether or not there are ketones present. So

if there are so if I have an elevated blood sugar for a long time and I have high ketones, I should not be exercising, you

should aim to clear the ketones and get blood sugar moving and both of them require insulin. Okay, right. If to clear ketones ketones require some extra hydration, electrolytes as well as extra insulin to get the ketones to move. High blood sugars also require more insulin, so you’re kind of adding extra on top of just bringing blood sugar down and at that point, then, if ketones are present, again, we’re talking in a normal realm not not ketosis or whatever you might be living in naturally. You’re aiming to get those ketones down. Now if you check ketones, your ketones are barely visible or not even there at all and your blood sugar’s to 80. Go ahead and take a walk.

Yeah, I was gonna say this doesn’t mean I can’t miss a meal balls and go for a walk afterwards, just because my blood sugar went to 250 or something like that. Exactly what happens if I exercise with high ketones like that. So if you exercise with high ketones,

the idea is that the way that your body is going to you’re at a deficit of insulin, high blood sugars, and high ketones mean that you’re operating without enough insulin in your system, and without enough insulin in your system, what ends up happening with when you add exercise, your body is trying to drive energy or glucose into your cells in order to be used. Well, if there’s not enough insulin there, even exercising isn’t going to help because also the ketones are present. So you can actually make blood sugar go up. It’s a huge stress on the body with ketones present, as well as the high blood sugar oxygenation, also at high blood sugars with ketones changes. So you may find effort much, much harder. And there are a lot of things that are the reason that the general recommendation is if your blood sugar’s above 250, you don’t go and exercise. I mean, that’s, that’s the baseline. That’s

a very clear explanation of that. By the way, the best one I’ve heard so far. I appreciate that. Oh, yeah. No, seriously, because I’ve been janky on it, too. Like people are like, why you’re not supposed on like, well, you’re not supposed to have there’s ketones, but you can’t if your blood and I’m like, I don’t know, it’s hard to explain, you know, it is here’s the next exercise question. What are the preferred numbers for exercise or sports? When high at the threshold? Should we let the kids sit? So it would you set that again, but go over that one? Where do they what numbers? Should they not be running around? And where should there be testing ketones? That is it a number or is it an amount of time high, or a little bit of both?

It could be a little bit of both, I mean, high blood sugars. That’s the reason that most meters and even insulin pumps these days still remind you to check ketones and blood sugar if you’re if your blood sugar is being recorded at 240 or greater, right. So that is kind of that that that level of evaluation, but also, if you are used to running blood sugars that are well within target, and now your blood sugar has been sitting at 200 or 220. For hours on end, it’s a good idea to check ketones no matter what, yeah, no matter what, right. You know, there are certainly reasons that you could have ketones at lower blood sugar numbers as well. And you know, in that instance, maybe your blood sugar’s high, when it normally isn’t, because you are at a deficit of insulin because your pump sites partly pulled out, or it’s leaking or something is wrong. I mean, there are evaluation steps along the way that you definitely have to take into consideration. Yeah, and you know, just an hour of a high blood sugar. Technically, you shouldn’t have ketones from an hour of high blood sugar, especially if it’s not a pump, or a site or an injection issue. It’s probably you just didn’t Bolus enough or you timed it wrong, or whatever it is, right. Yeah. So then in exercise, I think another one that kind of always is in the same line here in my thought is, well, what if exercise causes the high blood sugar, right,

okay, like lift, like lifting,

like either lifting, lifting those anaerobic exercises, right, they drive adrenaline, you might have a quick rise in blood sugar, or over the course of the time that you’re lifting, you might have a rise in your blood sugar, which requires insulin, many people find that especially lifters, they need to take some injected insulin or some Bolus insulin with their pump or maybe a Temp Basal increase or something to accommodate for what’s going to happen. Some people however, and I see this a lot, you know, kids and adults alike, sort of that a game or they’re a the race that they’ve been working so hard, and they get there. And all of their training has been well managed. They haven’t had high blood sugars or issues, but they get to that like, really, like, hacked up energy level of this is my game, and up goes the blood sugar. And what do you do with it? Right? Do you correct for it ahead of time knowing that this is a aerobic exercise, and that you will be moving for a fairly long period of time? Do you just let the high happen? And then let the exercise bring the blood sugar back down? Or does that rise leave you set high? So you may have to analyze and this is where some experiential sort of watching to see what should we do

figure it out over time? Yeah. How good is the blanket advice. If you don’t want to fall during exercise, try very hard not to have active insulin in your body before you exercise. And wondering Is that pretty good advice like exercise without active insulin if you can, if

you can, right. That’s pretty good. Exercise now, are you completely at a deficit of insulin? No, because you’ve got basil there. Yeah,

no, I don’t mean no basil. I mean, like, don’t eat a sandwich two hours before you go out and run around iob.

Yeah, in general, that’s an if you can plan your exercise that way, that’s a great way to mitigate that having to snack not having to, you know, adjust in another way, or having to eat along the way to prevent a drop in blood sugar. Absolutely. That’s, that’s a great recommendation,

I’m gonna throw in one question for myself. How do I mitigate the idea of I’ve exercised today or played a bunch of games or done something like that. And then I don’t get low until like one or two o’clock in the morning. Why does that happen? First of all, this kind of like late and lows. It’s

called delayed onset hypoglycemia. It’s got a name. It’s got a name, dope. You’re a Simpsons fan, delayed onset hypoglycemia. Most people are like, Why? No.

So I know you’re saying

you say it better than I do. But the reason that it happens is, you know, in the aftermath of exercise, this is often exercise that’s more around an hour or longer. And often exercise that can be more in the afternoon or the evening, you may see the later hit of the mobilization of insulin and faster uptake and better use of it. Hours after that exercise kind of is finished. And some of the reason you may not see it initially is because afternoon evening exercise is often coupled with meal or food that comes right after it. And so you may sort of miss the sensitivity that’s coming. And exercise. I mean, aerobic exercise, especially, I mean, it’s x, its effect could certainly be eight to 12 hours. Yeah. So I’ve got, you know, one team that I worked with a while ago, and he he was on injections worked better than pumping for him. But because of the buildup of activity through the course of his week, we actually found through testing, we found adjustments in his Basal dose that needed to be paid by Thursday, so that by Friday and Saturday, he wasn’t just eating, eating, eating to feed his insulin, because so much of the activity had built up through the week that he just was needing a lot less.

Yeah, I just spoke to somebody who added swimming to the regimen. And they had to make adjustments to their insulin because they were swimming every day. But then they said if I miss swimming even a day or so then my blood sugar’s shoot up again. Because their their sensitivity changes just from the loss of that. Yeah, it’s really interesting. I wrote down two words that you’re going to say next, we’ll see if I’m right. Oh, I’m gonna read a question. And then I believe the next words you were utter out loud, are these two words, I heard Jenny completed an Ironman marathon. First of all, I think that’s amazing accomplishment. But what did she do to prepare for diabetes wise? What did she eat? How did she set her pump? And what do you suggest for longer periods of exercise? And you’re gonna say,

I tested things.

I thought you’re gonna say, I thought you’re gonna say half marathon Half Ironman.

But you are correct, it is. I did a half Ironman.

She doesn’t want you to think she did a full Ironman when she did a half one I thought that was

I do have to say that I did the mid my husband did a full Ironman. And I did the majority of training with him. So I guess despite not competing in the actual thing, I did a lot of the training with him. Do you think before I could have done it, the actually the funny thing about it is that we were actually we were planning kids. And the team that I was planning to do the Ironman with. Just happened to pick the timeframe where we were planning to have kids and like planning kids and training for an Ironman. Could they go together? There are plenty people out there who do it. Absolutely. But that was not in my wheelhouse of managing. So he actually did it with the team that I was going to do it with. But again along the way, I did a lot of the trainings. So could I have done it? Yes, I loved I wish that I still had time in my life to do triathlons. Because they are they’re super fun to train for. But yes, half Ironman

environment. Okay.

I’ve done a couple of full marathons though. Yeah. For clarification. Yeah.

I want solid on television. Okay, so people are running everywhere. Yes. So what did you what how did you prepare for it? Like what what steps you took to to get it accomplished?

Yes. So I already had a fairly good base for running and for biking. Because I had done enough distance up to the point that I signed up to do the Half Ironman. The first time. I had done, century rides for are cycling. And I had not yet done a half marathon I had done 10 milers, but I hadn’t done even a half marathon yet. So I had a good base for how my blood sugar needed to be managed and insulin adjustments and fueling for that type of endurance movement, what I needed to add to it, and what was the most trying was adding them all together and learning my adjustment for swimming. The swimming piece of it, thankfully, I wearing Omnipod, I didn’t have to take my pump off, which made it a lot nicer. But a lot of it was experimentation. It was go in with this expectation based on what I know about my response to movement and do this, and what was the outcome and tracking that I kept a lot of notes, a lot of records. I kept what worked well, in terms of nutrition, like if I was going to go for a run in the morning, how did my stomach feel when I headed out based on what I had for dinner the night before? What worked well for fueling during long runs and long biking. So all of that had to be then pieced together because you do swim, and then you jump on your bike. And then you run. So you

had to figure out not just how to go into swimming from the day before but after you did it successfully. Now how do I go from that to the next thing? And then when I do those two things in a row, how do I get to the third row? It’s a lot of prep months, right?

a month? Absolutely. My In fact, my prep started I would it was about a year ahead that we had all as a group we had signed up to do a half Ironman together. We did the Longhorn in Texas was a lot of fun. Okay, was very hot.

And humid, right, was humidity. It was not it

was just it was just just dry. It was in Austin, but it was mostly dry heat. Yeah. But overall, it’s a lot of trial and error. And I think the biggest thing that I found in the endurance part of it was that insulin adjustments for that length of movement, meaning time of movement was it was not as much insulin adjustment off in terms of Basal. Because what I was filling the space with for maintaining my muscle performance was fuel. And that fuel was for a purpose of movement. But when you have diabetes, that fuel also has to work with your blood sugar management plan. It’s a strategy that you definitely I mean, it’s beneficial to work with somebody to kind of look at all your records, with perspective that’s not your own and be able to get feedback. But yeah, I found fueling things that worked and fueling things that I was like, oh my god, I can’t even I can’t eat this, you know,

you know, you just made me think of something, I have to say, Oh, we eat like you get up in the morning, eat breakfast. And that fuel keeps you going for a number of hours until you run low and have to put some more back in. But there’s I didn’t it never occurred to me, I don’t know why. To think of it this way. That there’s an amount of effort you can put your body through that it needs fuel almost constantly, because you can’t over fuel it or you won’t be able to make do the running or whatever you’re doing the activity. But you also can’t go large gaps of time without any so you have it’s little bits along the way. I see. Okay, yeah,

that was a learning that’s a really good thing, just for you to notice in terms of endurance exercise, the way that you end up fueling is not like, oh, it’s, it’s on the hour, let me take in like, you know, three goos, or whatever you’re using, right? It is an it from a blood sugar management perspective. It’s a strategy, I had a watch that had a timer set. And it was a timer for both hydration, it was a timer for my next fuel, so that I constantly had the reminder that, Oh, it’s 15 minutes, it’s 20 minutes, it’s time for this and I had it, packet it out essentially in the right amounts for the whole time through that long duration of movement. Alright, I’m

gonna ask you one last question. Don’t be embarrassed. Okay. I’m gonna look away from you. When I say how much of training for this? How much of the information that you got out of that? Do you use in other parts of your management? And I’m specifically thinking about sex? Because it seems to me right now you’re an active person. So I would imagine that I would. I would imagine that there’s not a big activity difference between your activity already and you being intimate, but for people who are maybe sit around a lot or don’t move around as much, and then suddenly are working very hard for short spurts of time. I shouldn’t have said for short periods of time. Damn it

sure that I’ll get a laugh. You got me.

I didn’t I didn’t mean it. But but the Is that? How it’s got? I can’t think but that’s got to have that feeling right. Like, that’s why I had people on are like, I have to stop in the middle and drink a juice or like stuff like that. That’s why right? It

would be different. And I would expect that it’s probably, as you said more relative to the activity level that the person is already at. Right. Right. And or in their intimate time with their partner. How active? How active that gets or how fast it is, or how slow it is, or whatever they’re doing together right, Thursday,

or is this a party? Right?

Exactly. So is this vacation in Paris? Or is it like? I don’t know. I’ll jot

that down and send it off your husband Paris, we’ll get it done.

We’ve been there already.

Okay. I didn’t know it was a memory. Okay.

Not really. But that’s a really good question. Because it is something that again, working with the large amount of women that I work with, it is definitely something that comes up. I don’t know that I’ve ever had that conversation with a gentleman. Yeah, I

have.

Yeah, but women definitely it’s, it’s something that gets brought up because it is a consideration. And also, I mean, the consideration of the ability to actually feel good if your blood sugar is sitting at 52. In that type of setting. Yeah. Yeah. Probably not able to enjoy as much as you should be able to. Because not only is your alarm going off, but your brain is not really I mean, there’s a whole host of things that are done. Yeah. And then

on top of that, if you’re foggy because you’re high or you’re dizzy because you’re low. And yeah, okay. All right. Oh, that was a good way to

go. I never I never really thought about my exercise prepared me.

Well, I mean, you, you know a lot about it. Now. I do. So if I have type one, and I go to my, my, my mate, and I say listen, I’ve got to get this right, I’m gonna need a lot of experience. And he told me if I just trial and error, trial and error, I’ll really figured I probably just need six months, I’ll get it straight. Don’t you worry. I just need your help.

I’m quite sure that they’re made is going to be like

alright, thank you for doing this with me.

I appreciate. Thank you.

Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes define you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we’re even stronger. To hear more stories from the Medtronic champion community or to share your own story, visit Medtronic diabetes.com/juicebox Don’t forget, we still have marks conversation at the very end. It’s a terrific kind of mini episode about 10 minutes long. That goes deeper into some of the things that you heard Mark talking about earlier in the show. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don’t forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today’s sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you are a loved one was just diagnosed with type one diabetes, and you’re looking for some fresh perspective. The bold beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC es a registered dietician and a type one for over 35 years. And in the bowl beginning series Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. This series begins at episode 698 In your podcast player, or you can go to juicebox podcast.com. And click on bold beginnings in the menu. And now my full conversation with Medtronic champion, Mark. Mark. How old were you when you were diagnosed with type one diabetes? I was 2828 How old are you now? 4747. So just about 20 years.

Yeah, 19 years.

What was your management style when you were diagnosed?

I use injections for about six months and then my endocrinologist and a navy recommended a pump.

How long had you been in the Navy?

See eight years up to that point.

Eight years. Yeah, I’ve interviewed a number of people who have been diagnosed during service. And most of the time they’re discharged. What happened to you?

I was medically discharged. Yeah, six months after my diagnosis.

I don’t understand the whole system. Is that like, honorable? Yeah.

I mean, essentially, if you get a medical discharge, you get a commensurate honorable discharge. I guess there could be cases where something other than that, but that’s that’s really how it happened. So it’s an honorably discharged with but because of medical reasons,

and that still gives you access to the VA for the rest of your life. Right?

Correct. Yeah, exactly.

Do you use the VA for your management? Yeah, I

used to up until a few years ago, when we moved to North Carolina, it just became untenable, just the rigmarole and process to kind of get all the things I needed. You know, for diabetes management, it was far easier just to go through a private practice.

Was it your goal to stay in the Navy for your whole life, your career? It was? Yeah,

yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision, despite all the hardships and time away from home, that was what we loved the most. So that’s what made it that much more difficult

was the Navy, like a lifetime goal of yours or something you came to as an adult,

lifetime goal. I mean, as my earliest childhood memories were flying being a fighter pilot and specifically being flying on and off aircraft carriers. So, you know, watching Top Gun in the 80s certainly was a catalyst

for that you’ve taken off and landed a jet on an aircraft carrier, hundreds of times. Is there anything in life as exhilarating as that stat No,

but there there’s a roller coaster I wrote at, I think it was at Cedar Rapids up in Cleveland Sandusky, and they’ve got this roller coaster rotation from zero to like, it’s like 80 or something, you go up a big hill and you come right back down. So the acceleration is pretty similar. I would say to catapult shot, I’m

gonna guess you own a Tesla.

I don’t I I’m a boring guy. I got a hybrid rav4 I get made fun of I get called. You know, my wife says I drive like a grandpa on the five miles per hour over the speed limit person. No more than that. So yeah, in the car. I’m boring Scott. So

you’ve never felt a need to try to replace that with something else.

You can’t replace it. It’s irreplaceable. That’s what I thought. So up until the point where someone you know, buys me an F 18. Or allows me to get inside a two seater and fly it you can’t replace it? How

did it make you feel when you saw or maybe you haven’t seen? gentleman named Pietro has his large aircraft license. He’s flying for a major carrier. Now he has type one diabetes. Does that feel hopeful to you?

Yeah, it does. You know, when I when I was diagnosed, that wasn’t a possibility. The FAA prohibited commercial pilots who had type one diabetes, but I think it was 2017 when they changed their rules to allow type one diabetics to be commercial pilots. And part of the reason I did that was because of the technology advancements, specifically in pump therapy, and pump management. So I don’t have any aspirations of going to the commercial airlines. But one of my sons who has type one diabetes very much wants to be a commercial pilot. So, you know, in that respect, I’m very hopeful and thankful. Yeah.

Do you fly privately now for pleasure?

I do. Yeah. One of my favorite things to do is fly my kids to the different soccer tournaments they have all over the southeast us so last week, my wife and I and two of our boys flipped to Richmond for their soccer tournaments up there, and Charlie, who’s my middle child has type one diabetes, so you know if I can combine flying family and football and one weekend to me that’s I think I’ve just achieved Valhalla.

So then it sounds to me like this diagnosis was a significant course correction for you. Can you tell me how it affected your dream?

Well, I you know, if I guess three words come to mind first, it was devastating. Everything I had done in life, everything I’d worked up to up to that point was just taken away in an instant. And I was not prepared for that at all. The second emotion was, it was scary. I hadn’t thought much about life outside the Navy, certainly not life as anything else, but a fighter pilot. And Heather and I were getting ready to move to France, I was going to do an exchange tour with with the French naval air force. So we were taking French classes. So pretty quickly, I had to reinvent myself. And then probably the most important thing at the same time that all that was going on, I had to learn how to how to deal with type one diabetes and how to manage it effectively. The third thing that pops into my mind, I guess, is challenging, you know, new daily routines, I had to establish first with injections, and then eventually, you know, through pump management, and then learning how to count carbs and recognize highs and lows, how my body reacts to blood sugar trends based on exercise and stress and those types of things. And my goal at that time, and it still is today is to leverage technology and make sure my habit patterns are effective so that I take diabetes management from the forefront to the background.

Have you had success with that? Do you feel like you’ve made the transition? Well,

I have I mean, I believe in continuous improvement, so there’s always more to do. I will say the technology since I was diagnosed specifically with pump management is just It’s just incredible. It takes less of me intervening. And it’s really done by the pump itself and by the algorithms through the CGM, and to me again, that that should be the goal for everybody is to not have to focus so much on the daily aspects of type one, diabetes management, you know, we should let technology do that for us.

What else have you found valuable? I’ve spoken to 1000s of people with type one diabetes, the one thing that took me by surprise, because I don’t have type one, myself, and my daughter was very young when she was diagnosed. I didn’t really understand until I launched this podcast, and then it grew into this kind of big Facebook presence. I heard people say, I don’t know anybody else who has type one diabetes, I wish I knew more people. But until I saw them come together, I didn’t recognize how important it was. Yeah,

I think similarly, I didn’t know anyone with type one diabetes growing up as an adult up until when I was diagnosed. And then all of a sudden, people just came out of the woodwork. And when CGM is first hit the market, certainly within the last five years. It’s amazing to me and my family, how many people we’ve noticed with type one diabetes simply because you can see the CGM on their arm. I mean, I would say, a month does not go by where we don’t run into someone at a restaurant or an amusement park or a sporting event or somewhere where we see somebody else with type one diabetes. And the other surprising aspect of that is just how quickly you make friends. And I’ll give an example. We’re at a soccer tournament up in Raleigh, this past Saturday and Sunday. And the referee came over to my son Charlie at the end of the game and said, Hey, I noticed you’re wearing pomp. And he lifted up his shirt and showed his pump as well and said, I’ve had type one diabetes, since I was nine years old, I played soccer in college, I’m sure that’s your aspiration. And I just want to tell you don’t let type one diabetes ever stop you from achieving your dreams of what you want to do. And this gentleman was probably in his late 50s, or 60s. So just having that connection and seeing, you know, the outreach and people’s willingness to share their experiences. It just means the world to us and just makes us feel like we’re part of a strong community.

So would you say that the most important things are strong technology tools, understanding how to manage yourself and a connection to others? Yeah,

technology for sure. And knowing how to leverage it, and then the community and that community is your friends, your family, caregivers, you know, for me to Medtronic, champions, community, you know, all those resources that are out there to, you know, help guide away, but then help help you keep abreast on you know, the new things that are coming down the pipe, and to give you hope for eventually, you know, that we can find a cure. You

mentioned that your son wanted to be a pilot, he also has type one diabetes, how old was he when he was diagnosed.

So Henry was diagnosed when he was 12 years old, was just at the start of COVID, we are actually visiting my in laws in Tennessee, we woke up in the morning and he had his bed. And several years before that, we had all four of our boys tested for TrialNet. So you know, predictor of whether or not they’re going to develop type one diabetes, and whether or Henry and one of his brothers tested positive for a lot of the indicators. So we always kind of had an inclination that there was a high degree of possibility he would develop it. But we always had at the back of our mind as well. And so when that event happened, at the beginning of COVID, we had him take his blood sugar on my glucometer. And it was over 400. And so right away, we knew that without even being diagnosed properly, by endocrinologist that he was a type one diabetic, so we hurried home, to get him properly diagnosed in Charlottesville. And then we just started the process first grieving, but then acceptance and, you know, his eventual, becoming part of the team that nobody wants to join. How old is he now? He’s 15 years old. Now.

When’s the first time he came to you? And said, Is this going to stop me from flying almost

immediately. So like me, he’s he always had aspirations of flying. In fact, he out of all four boys wanted to be in the military, that was a difficult part of the conversation and maybe something that we don’t talk about as a community. But there are some things you cannot do as a type one diabetic, and that’s a hard fact of life. And unfortunately, joining the military is one of those hard and fast things you cannot be you cannot join the military as a type one diabetic. So it was very difficult for him and for me and in my wife to get over. Then we also started talking about being a commercial pilot. So I saw that same excitement in his eyes because like me, you know, he can be an NFA teen or a 737 or a Cirrus SR 20 That I fly and be just as happy. So he still has that passion today and still very much plans to eventually become a commercial pilot.

I appreciate your sharing that with me. Thank you. You have four children do any others have type one. They

do? My oldest twin Henry has type one diabetes and my middle son Charlie has type one diabetes as well. The boys are twins. The oldest two are twins. One has type one diabetes, my middle son who is not at When has type one diabetes,

I see is there any other autoimmune in your family? There isn’t I’m really the

only person in my family or my wife’s family that we know of with any sort of autoimmune disease, certainly type one diabetes. So unfortunately, I was the first to strike it rich and unfortunately pass it along to two of my sons with celiac thyroid, anything like that. Not at all, nothing. We’re really a pretty healthy family. So this came out of nowhere for myself and for my two sons.

That’s really something. I appreciate your time very much. I appreciate you sharing this with me. Thank you very much.

Anytime Scott,

learn more about the Medtronic champion community at Medtronic diabetes.com/juice box or by searching the hashtag Medtronic champion on your favorite social media platform. If you’re not already subscribed, or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

Hello friends, and welcome to episode 1190 of the Juicebox Podcast. On this episode of Ask Scott and Jenny instead of the listeners asking the questions, which we’ll get back to in the next episode, I asked Jenny a question and she asks me a few. Please don’t forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin. There is an incredibly simple way for you to lend your knowledge to diabetes research without leaving your home. That’s right, if you’ve ever wanted to help type one diabetes research but didn’t have the time or couldn’t make the commitment. Now you can t one D exchange.org/juicebox. Head over there and take the survey. The survey takes about 10 minutes. They won’t ask you one question you don’t know the answer to and you should be in and out of there in like 10 minutes, you need to be a US resident who has type one diabetes, or is the caregiver of someone with type one. Go lend your knowledge to the resource that helps them get help, maybe even you and while you’re online, go check out the Juicebox Podcast private Facebook group, where you’ll meet 50,000 members Juicebox Podcast type one diabetes. This episode of The Juicebox Podcast is sponsored by ag one drink ag one.com/juice box. head there now to learn more about ag one. It’s vegan friendly, gluten free, dairy free, non GMO, no sugar added no artificial sweeteners. And when you make your first order with my link, you’re gonna get a G one and a welcome kit that includes a shaker scoop and canister. You’re also going to get five free travel packs and a year supply of vitamin D with that first order at drink a G one.com/juice box. US med is sponsoring this episode of The Juicebox Podcast and we’ve been getting our diabetes supplies from us med for years. You can as well us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits check it get started today with us med this episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed ever since cgm.com/juicebox. All right, Jenny. Welcome back. How are you? I’m good. How are you? Excellent. Thank you. I had an idea this morning. Yay, in the shower, and I texted you. And I knew we were going to recoil in the shower. No, I mean, I want to say respectfully I waited till I was dressed. Because I do think that would be weird. Even if you wouldn’t know that I was naked when I texted you.

I was thinking about the water on your phone while you’re trying to do things.

You don’t do this, like Arden calls us from school from the shower. She facetimes from the shower, all of her friends. They FaceTime while they’re showering all the time. The girls do. Yeah, that’s bizarre. They put it up high enough that you can just kind of see their shoulders and their head and they shower and talk to each other. Think it’s the only time they have time to talk to each other actually, because they’re all in college maybe I don’t know. But anyway, that’s anyway, I just want you to know I was fully dressed before I tech. And

you had an idea. Also, I

want to say this. My mom has passed on now but my mom had an incredible way of calling me or texting me as I was getting into the shower for years. And she passed away and I thought well, at least that won’t happen anymore. Except for Isabel from the Facebook group. She picked right up where my mom left off. Doesn’t matter if it’s like, if it’s like right away in the morning and I’m like get up out of bed and I jump in the shower. If I get up and I mess with the dogs and two hours later I get it doesn’t matter. I find myself reaching for that faucet or I just got in and Isabel’s Hey, can you look at a post on the Facebook group? Or did you mean for this to happen in the episode today? I’m like, How do you know I’m in the shower?

You look around during my meet one

moment I get no hot water hits me and I have a good idea like the one I had today for us. So we’ve been doing some ask Scott and Jenny stuff lately, which we’ll get back to the next time you and I talked but today I want to ask each other a question and just see where the conversation goes. Okay, so I texted Jenny and I said come up with a couple of questions for me. And then I came up with one question for you. Only one well, I feel like there’s a conversation and so I don’t want to eat up too much time and I wanted you to have like something to pick from That’s why it was like your you get more. Oh, and I’ve tried very hard not to consider your answer or what you might ask me today, because I just want it to be kind of free flowing. So anyway, that’s the amount of effort that goes into the podcast do you guys love? Can I ask my question first?

Sure. Do

you want to go first? Do you have like, Oh,

good. I came, you said, let’s think of five questions. I thought of six. You

have six questions. All right. Well, I’m gonna ask my ego first. Well, okay. So you have to listen to the podcast pretty specifically, I think to know this. But the moment that I began to think about getting better at diabetes, started with me asking Ardens nurse practitioner CDE, maybe Which one did I ask maybe the CD?

She could have been Bolus? Or he I mean, it wasn’t she

and I maybe she has both. I don’t know. That’s neither here nor there. Okay. Anyway, she’s definitely a CTA. And I said, If I gave you a magic wand, what would you make people with diabetes do one thing, you’d only make them do one thing. And she said, without much thought, I’d tell them not to be afraid of insulin. And that went on a whole thing. I wrote a six part blog series for back then it was on the pods blog about not being afraid of insulin, but the truth was, I was afraid of insulin. So it wasn’t like a blog from like a learned person who was like, here’s some tips about how not to be it was me talking myself out of being afraid. And I think it helped Arden immeasurably. And then I think it spawned a lot of what people hear now on the podcast. So my question to you is, if I gave you a magic wand, and you could make everybody with diabetes, do one thing. What would you make them do? This episode of The Juicebox Podcast is sponsored by ever since and ever since is the implantable CGM that last six months ever since cgm.com/juice. Box. Have you ever been running out the door and knocked your CGM off or had somewhere to be and realize that your adhesive was about to fall off? That won’t happen with ever since ever since won’t get sweaty and slide off, it won’t bang into a door jamb. And it lasts six months, not just a couple of days or a week. The Eversense CGM has a silicone based adhesive forged transmitter, which you change every day. So it’s not one of those super sticky things. It’s designed to stay on your forever and ever, even though we know they don’t work sometimes. But that’s not the point. Because it’s not that kind of adhesive. You shouldn’t see any skin irritations. So if you’ve had skin irritations with other products, maybe you should try ever since unique, implantable and accurate. So if you’re tired of dealing with things falling off, or being too sticky or not sticky enough, or not staying on for the life of the sensor, you probably want to check out ever since ever since cgm.com/juicebox, links in the show notes links at juicebox podcast.com.

That’s a great question. Oh, and I make them do. I mean, I would have referred to insulin had you not already brought it up. But being a dietitian, and not a nurse. Okay. I would. And I don’t want this to sound judgy. But I would really write like, there’s no judgement. In fact, I say to people all the time, when I’m like, this is like the no judgement zone. I’m here, you know, to help to cover to whatever we’re going to discuss. But I would really love for people to truly understand what the impact of food outside of blood sugar does to their overall health. Okay? Because, you know, with diabetes, we’re really focused on blood sugar numbers, right. And food is a big part of that. There’s kind of three tiers exercise food and insulin and food being a major piece of that. I think we focus too heavily on not being afraid of the insulin. But because of that we sort of lose the overall in, in what is our body really need just from a longevity a health perspective.

Okay, so are you saying that, because we try so hard to tell people at diagnosis, this isn’t going to change your life. You can do whatever you want. You just count the carbs and put in the insulin right now, of course, knowing that it’s not that simple. And that advice never really helps anybody but the intent of it is there is an amount of insulin that covers your food. Yes, but you’re saying it takes out the piece. We start considering the impact of the food outside of the blood sugar. Right, right, because I know how to Bolus for Marshmallow Peeps so I can eat them because I can eat them. I can eat whatever I can Bolus for. And so some people might be hearing that and going, I definitely thought Scott would disagree with that. Because he says, I don’t care what you eat, just know how to Bolus for it. So this is interesting because it breaks apart like the the sort of tear structure that people who are passing information on to other people have to consider. Because you have to think about everyone you’re talking to, like whatever you say, has to work for everybody. It’s hard, or in general, like you don’t I mean, Jen is a general, yes, but yes, when you’re in the public eye, you can’t just start saying something that would really work for a low carb person, but not work for somebody else, because then they’ll be out there trying to, I just think I don’t I don’t imagine that people listening would know, the kind of like, back of the brain pressure I have. I can speak for myself about what I say out loud, you know, and so we make this one comment. You can cover it, you can eat it. What’s the I almost said stupid, saying, but I’m sure some of you like it. So I don’t want to say stupid saying but sorry. What’s the saying about? Uh, I can eat anything except poison and cupcakes with poison on it. Have you ever saw that diabetes meme? You’ve never seen that? I’ve ever seen that? Yeah, it’s in response to Oh, can you eat that? Okay, okay, you have diabetes? Can you eat that? I can eat anything but poison or cupcakes with poison on them? Like that’s the response. Right? And, yes, you absolutely can. But it covers the initial problem. Because you don’t want people to run into eating disorders. You don’t want them to know. Yeah, exactly.

And that’s a very, it, there’s a really hard line to honestly walk. And I think there’s a broader, there’s a broader issue there. But when you do have diabetes, because blood sugar, and the stuff that we use to manage blood sugar can have effect on overall health. I mean, everybody knows about the complications. That’s one big thing that everybody’s told about right. But not only does blood sugar impact your overall health, we have nutrients that are a basic necessity of life that we’re supposed to be putting in to fuel our body to fuel the energy that gets produced in all of ourselves. I mean, I heard something the other day, which just It struck with me, it was some it was a podcast, someone who was talking about, like the most complex computers, right, and was comparing them to ourselves. Our cells are unbelievably complex, like self driving computers, and the way that they work to keep our body like energized to keep blood flowing, to keep organs working without conscious effort. It’s amazing. But what we also put into our body due to our body, the activity that we do with our body, it all plays into that health. So if we’re only focusing on managing blood sugar, and covering whatever food we desire, eating with insulin, sure, you may have lovely looking blood sugar numbers. But if you’re only eating as your example, peeps all day,

there’s no nutrition. And so I think it’s this kind of like cascading tear, like, you have to take the humanity out of it for a minute. And just think of yourself as a person sitting across from a doctor, their number one goal is for your blood sugar to be stable and low, whether they can accomplish that or not. That’s the thing they’re thinking of, they want that. And then they don’t want you to have diabetes, complications, these are the things they’re thinking about. So they’re saying learn how to use the insulin. There’s no doctor in the world that thinks that, oh, I’m going to talk you into eating healthfully. If you haven’t been already, you know, on the day, you were diagnosed with diabetes, right? Like, so that runs into the where I come from, when I say, Look, I don’t care what you eat, I want you to know how to use your insulin. I don’t mean I don’t care what you eat. There are plenty of things I don’t think you should eat. But but it’s not my job to explain it to you. And it’s to me, it’s my job to talk to you about how insulin works. So this is like this supercomputer is sitting up there. And it’s crunching numbers and doing all this stuff. And then I’m like, You know what, I should try to make this harder. I’ll throw a shovel full of dirt on the monitor and pison to the keyboard and see if this thing could still do it. It’s still going hold on a second. started throwing the mouse across the room, like can you do it now? And that’s where the body is, is really astonishing. Yes, yeah. You can pee into your keyboard for years and it’ll keep chugging along and then one day, it craps out. And then what do we do? We always go I don’t understand what happened. You know, right.

I mean, the body is meant to be again, a self healing machine it it does the best that it can. It’s the reason that wounds heal. It’s the reason that we can get better from you know, the common cold and all those kinds of things, but If the basis of what it’s working off in order to run smoothly that with pianist computer

just popped into my head, but yeah, good.

Right. So what we put in makes a big difference in the running of that. And we talk about ages, you know, age levels of diabetes are very, very, very young to very old. And so what you start out with in terms of putting in, for somebody who is diagnosed young, can make a really big difference in their long term health. Right? If

you think about your cells in your body, or you as a whole person, like, imagine if you were just walking in a straight line forever. And every day, I hung another one pound weight off your back. And you’d be like, Oh, I can do this. I can do this. And then there’d be a day where I just hang one more, and you could not move forward anymore. Sure. I think that’s a way to think about poor poor eating choices. Like really, like, you know, I can get away with it today. But then we run into that psychological thing, which I talk about, pretty frequently through the podcast, I think, but people are so hopeful, which is lovely and necessary, I think hope is what keeps you from losing your mind, right? Yeah. And, but that hope, misguided, makes you feel like I could smoke a cigarette today and be okay, like, that’s not gonna hurt me, right? I only did coke at a party on Saturday nights in college. Like, like, no kidding. Like, like, I’ll be alright, like that. It’s gonna be okay. It’s just a soda. It’s just this it’s only a grilled cheese sandwich with bacon. I skipped the french fries. Like like, you know, like, yeah. And so yeah, that coke instead. Yeah. Have you ever, like had a stick of butter out and use it for cooking, and then look back and thought there’s a half a stick of butter gone. That’s in me now. You know, like, even like deep frying things. You don’t mean like you deep fried. I make potato chips here. Sometimes, you start with a gallon of oil and dumped some into the pan. And when you’re done, you eat the potato chips. But there’s a quarter gallon of oil gone. You don’t think about where that’s at, you know? Right? Anyway, if you could magic wand everybody listening. So I’m assuming if you could really magic wand them, you’d make them not remember it. And then they would eat kale salads and like all things that were really good for them, and they would just be happy with it. They feel like they were having Twinkies while they were eating whatever god awful things you eat. And then

I’m gonna say, Gosh, you imagine that I eat kale salads, like all day long.

I think you’ve washed your keen wild down with fresh something. I don’t know exactly what

I do like kale. I do. And actually, my boys really like that, honestly, in place of potato chips. I make kale chips. They’re very tasty. And they’re good for you. So

it is a lot about training your tastebuds though to true. Yeah, yeah. So you started your boys early enough that they don’t know from anything else.

Now that they’re older, they’re aware of they’ve been to parties, they’ve been to kids houses and you know, that kind of stuff, they can definitely identify the differences in what we have and what we allow in our house. Yeah, versus what is available. And what I like to see, the majority of the time if we do eat out like we have a favorite restaurant here, that’s, it’s like a salad kind of place where you can put your own salad type of dishes together with the proteins and the vegetables and the toppings and that kind of stuff. And I like to let them choose. Because I really like to see, what are they going to put together? Yeah, now of the choices on the bar. There’s nothing really that’s, quote unquote, bad, right? But I love to see that they choose a little bit different each time. Sometimes they want to choose something that they’ve not tried before. Like the last time we were there. My little guy chose artichokes, because he was like, Mom, what are those? I’ll pick those are artichokes. He’s like, delicate, interesting, but those aren’t there to

get home peeled and are just trying to figure out what to do with it. I would.

It starts early. I mean, and if I was on a grand scale, if I could wave the magic wand, not just in the realm of diabetes, but it would be for a much bigger scale change to education. I’ve always said if I were gonna go back to do something within my degree, but do something different. I would absolutely go back to do something about childhood education about health and nutrition is I think it it’s sad that it starts it doesn’t start at the right place. And that if they’re not getting something at home, they’re clearly not going to get it in school because that’s not a focus at school.

I believe that for many people thinking about food begins when they are in their mid to late 20s and their stomach starts to hurt or they have a kid and they think oh I don’t want this kid to eat the way I eat. Like seriously because we don’t do a good job of You know, of teaching. And we’ve talked about this before, but there are plenty of things that people actually genuinely believe are good for them that are garbage. And they don’t know it. Absolutely. They have no idea like so. And I’ve been guilty of that before. I’ve eaten things and thought like, this is good for me. And I remember I told the story one time if I was eating the veggie sticks, yes. My wife’s like, what are you doing? I’m like, There’s vegetables. And she was a no, there’s not just like MB there, potato chips acuity. And I was like, Oh, I wonder why there was so good. As far as talking about changing your palate, like, my palate has changed slowly. Over the years, I’ve cut things out. We’ve talked about it cut out oils, at one point. I’m very, very steadfast about that. But even in this last year, on the GLP, medication, there’s just some things now because you feel like it just feels different. Like I was at a party once there was a chip bola and I grabbed two potato chips, and I was eating them. And first of all, they were crappy potato chips. Like, I know you’re having a party and you’re trying to save a couple bucks. But you invited me to your house like could you give me mean but never neither here nor there? I found a Trash Can I spit them in a napkin? I was like, I don’t want to eat these. Right? Yeah. And that’s different world for me to some degree. Okay. So you would help people understand nutrition better? I would, okay. But let’s say, I’ll go back to your initial thing. You’re not judging anyone? Like I am. No, yeah, it doesn’t matter. I’m gonna go back to the beginning of it. I don’t care how you eat. Your body’s not gonna have time to urge to reject life because of your poor nutrition if your blood sugars are all over the place. And that’s what’s when we’re talking about diabetes. That’s the first step. Correct. If you need to eat a Twinkie, and you can’t stop yourself, let’s at least learn how to Bolus for it. We’ll talk about not eating the Twinkie later, or under percent agree? Yeah. Cool. All right. Well, what’s the question for me? I used to hate ordering my daughter’s diabetes supplies. I never had a good experience. And it was frustrating. But it hasn’t been that way for a while, actually for about three years now. Because that’s how long we’ve been using us med. Us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omnipod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor index com customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514 get started right now. And you’ll be getting your supplies the same way we do. It’s important to me that the supplements I take are of the highest quality and that’s why for a number of years now I’ve been drinking ag one. Unlike many supplement brands ag one is researched and developed by an in house team of scientists doctors and nutritionists with decades of experience in their respective fields. For ag one quality isn’t just a buzzword. It’s a commitment backed by expert led scientific research high quality ingredients industrial leading manufacturing and rigorous testing. At each step of the process. Ag one goes above and beyond industry standards. And that’s why I know I can trust what’s in every scoop of ag one ag one supports the Juicebox Podcast with their ads and they also support my immune health. So if you want to replace your multivitamin and more start with ag one try ag one and get your free one year supply of vitamin d3 k two and five free ag one travel packs with your first subscription at drink ag one.com/juice box. That’s drink ag one.com/juice box. Links to AG one US med ever since and all the sponsors can be found at juicebox podcast.com. Or in the show notes of your podcast app. Using my links help support the podcast production and keeps it free and plentiful. Oh, I’m excited. Do you text people naked in the shower? No, I don’t already answer that one. What’s the next one?

I do not do I turn my phone off. Do you really? I don’t take it in that like that’s, I just keep it outside because you know I use I mean using loop obviously if be close enough in terms of like keeping things running but I have a watch. I can see where my blood sugar is. I don’t need it. Air I don’t need visual or noise. My husband is the one who he listens to podcasts. He’s always got music going in the shower and like, I like the noise of the people are gonna be like, this is weird, but that’s like the noise of the shower. Jennifer,

you said you ate kill. You’re not going to get weirder for most people than that. So I want you to videos in the shower. I listen to podcast this morning. Oh, yeah, no. Oh my god, you’re ready. Hold on. I was a little worried that I left something in an episode that I wasn’t supposed to leave in. So I listened to myself in the shower this morning, which is, I don’t know if you know the word douchey. But it really is.

Well, you were trying to work at the same time to work. Yeah. Yeah, I will say that if I could do something in the shower, which there’s no way to do this. Like I love reading, you would read in the shower, I would entirely read in the shower. In fact, I would be the person who would finally realize that this shower is probably too cold. Or you get what I’m reading is lost in reading. That’s like

waiting in a hot tub. Would you like that? If

I had a hot tub, that would be lovely.

Let’s get Jenny Awesome. That’s all the year Wisconsin Cognos, by the way, did it snow like Snowmageddon there this week?

It did actually the funny thing, so it snowed on. Was it Tuesday, and then Wednesday, and then it stopped. It was raining like downpour Tuesday morning until about noon. And then I looked outside and it was snowing. And I was like, well, that’s

my brother’s job got closed down. It’s snowed so much. And in Wisconsin, that’s saying something. So

it is especially I mean, you know, we can have snow until the end of April here, quite honestly. But this was definite snow and it was heavy and thick and really wet. But today, like a good probably at least 75% of it’s gone. It’s sunny. It’s like almost 50 degrees outside. And it’s

beautiful. You know, we had here this morning. Rain earthquake. Seriously 4.8 on the record, feeling I was in here going? Okay. Like everything was shaking. It went on for at least a minute, like so it started, it will get to your question for me a second. Oh, yeah, it was your first question is, have you ever been in an earthquake hazard? Because if so, then we’re recovering everything here. At first, I’m like, is the washing machine unbalanced? And then I thought, I don’t have anything in the washing machine. And then I was like, Oh, this is an earthquake, because I’ve lived through one other one in New Jersey like 10 years ago. Like everything, exactly what you think of like, and everything’s rattling around. And then at the end is it dies off? Your feet are still vibrating on the floor for like the last 30 seconds. You can feel it under your feet. It’s really interesting.

I’ve never been in an earthquake. Well, I’ve

been into, but there are East Coast earthquakes. I don’t know if they count or not. All right, I’m sorry. What’s your question for me?

I’m trying to decide between, they’ll get to here that I think would be a good one. Let’s see. So, okay. You’ve, you’ve talked to a lot of heads of diabetes tech kind of companies. I’ve heard them, you’ve told me about them. Right? We’ve all heard you talk to them. And what do you get as the main reason that the companies don’t tend to hit the whole market of desire for everyone? Yeah, with diabetes, right? We see products that aim for safety. But when we look at what the systems that aren’t approved, provide safety is already in there. Right? Do It Yourself covers this and it allows for more flexibility and more self adjustment cetera. So why are we still focusing on safe numbers? Who somebody deems safe? When many people I know it’s a small percentage of what the big market is really? Why can’t they just make products that cover everybody and your desire to sort of streamline it the way that you want? There you go, I

have to ask you first did you ask this because you saw people talking about what pumped by in the Facebook group? That’s not why you thought of that. Oh, cuz I’ve been thinking about it. It’s so interesting us because I’ve been thinking about this to some degree for the last two days, there’s been two big, like, really like, lots of 130 Comment, like, you know, post, okay, it’s a great group, you really should join it. If you’re not at where people are like, Hey, I’m about to get a pump give me the pros and cons of all of them. And as I’m reading through them, I had the same thought you did each one of these devices. It’s like it chose a third of a pie. Right? How do I mean that? I mean, like, it feels like, I’m just gonna come out and say it, it feels like on the pod tandem, Medtronic and I Guess Island, it’s almost like they looked at a pie. The pie was split into quarters, and each quarter was a goal, right. And each one of them picked a goal and then ignored the other three goals is kind of how it feels. Does that make sense? Yeah,

that’s absolutely what I’m getting at. And then the broader scope, the, you know, the my PI piece, and all the people that I would definitely put in the same, you know, you Arden goals and everything, kind of in the same pie piece of desire and target and independence and wanting to work with your system and have it work to your goals. I don’t understand why with the safety that we know how to achieve. We can’t get systems that allow people to do all of that in parameters that are personalized, right? Right now, the lowest target blood sugar that’s on the market in a system is Medtronic and what’s their target? Their target is you can go as low as 100. Is that the seven? ATG? That’s the 780 G. Okay. 5.5, if your millimoles

what is on the pod five 110 110,

which is similar to control IQ tandem, which is 112

and a half or 113 and a half, right? Some crazy like that. I love that. Although

if you’re setting up the pump, it actually is 110. Okay, you don’t set it up as one 12.5, which is just it’s part of like, somebody explained it to me the other day, and I can’t remember exactly what she told me. But yeah, it’s not what gets set in the pump as the target, right. But it is essentially 112.

And the islet is shooting for an A onesie in the seven, it’s

shooting for that. And you do have the ability to navigate, low, moderate and high target as one pivotal kind of point. The only other point that you can put into eyelet is your weight. That’s it. Those are those are your pivot points.

Oh, Jenny, are you saying I could lie about my weight and make it more aggressive? I feel like that’s what I just heard you say? You didn’t say that. You would never say that. Nothing you hear on that Juicebox Podcast should because I actually don’t know that that that works or not. That’s just popped in my I want to be very clear, I’m not joking around. I have no idea if that would work. But as I’m sitting here, it makes little so you

are thinking about it in the right way. Because it’s basing its basing it off of your starting weight that you enter. So

I wonder if you had insulin resistance like PCOS, if you could make it. Alright, that’s for another podcast. So I drew my pie right in front of me. And I wrote more aggressive and I gave that to tandem. No tubes. I gave that domine pod. low effort. I gave that to pilot eyelet. And I don’t know what to call med tronics version because I haven’t seen it enough. You

know, I would say of I don’t know what to call it either. Because I would say it’s

is it pretty equivalent to the control IQ or where do you would you choose the tandems algorithm over it?

For the correct ability feature? I would actually choose Medtronic interestingly, okay, Medtronic correctives are more frequent, its corrective boluses. It also does do Temp Basal increases, similar to control IQ. But based on blood sugar, it also is willing to give corrective pulses, like the standard control IQ algorithm setting. Yeah, but it does it more frequently, which means that you can get around high is much better for some people much better with Medtronic 780 than you can because tandems just slower in its Dilip decision to give you a pulse out,

you’re gonna see an ad on social media that says Jenny Smith says I would use Medtronic before tandem.

Actually, that’s it for some reasons. Yes, for some reasons I would actually choose tandem tandem is the only one that’s approved that you can actually, if you know your basil is are well said if you’re that type of person who has really awesome, you know, settings, and you want the system to just work off of them. Control IQ is a beautiful algorithm because it it takes your settings and adjust up or down off of them. Yeah.

So your question back to me. Sounds more. Here’s how I was why.

What do you think is the reason I’m gonna

give you my why in a second. And I could be guessing but what I really feel like you’re asking me is how come Omnipod fives algorithm isn’t more aggressive, like control IQs? Because that fixes a lot of like your concerns, right? Yeah,

it does. Yes. One really big negative to me in terms of Omnipod five, which I think has a host of really wonderful pros. But one of the big cons is that Omnipod five only suspends it doesn’t take away slowly, as it sees something happening. That’s a drift down under a target that it desires. Okay? Instead it stops and that creates a lot of issues for people with rebound actually with rebounds, especially when you’re coming into a meal.

Yeah, yeah. Cuz it could tell away coming into a meal because it doesn’t know you’re going to eat two hours from now if it’s trying to stop a low. But if it’s trying to drift, you know, I get your point. So, listen, I’m no business executive, that’s for sure. If you guys could sit in on any of the business meetings I have with the advertisers, you would do the same thing that I’m sure they do in the meetings and and the cameras go off, I’m sure you would say to yourself, I can’t believe he is doing business with those people. I talk just like this in business meetings, people stare back at me like what’s happening? So here’s the here’s the funny thing that we’re not talking about. Is that that pie, except for low effort, three quarters of that pie belongs to any of the do it yourself algorithms that exist on the internet?

That’s my point. Yeah, I don’t understand with everything that we have in the do it yourself world, all of the research and the proof in the pudding that they’ve put together. I don’t I don’t get why, at the top level, these big companies are not just saying, You know what, this is lovely. It’s all put, why don’t we just deal with them and put this into?

I will tell you something that I said, because the person I think I set it to doesn’t exist at the company anymore. But this is gonna have to go back. I mean, four or five years ago, right? So I think everyone knows that Omnipod was a little behind the pace getting to an algorithm, right? Yes. And I think the reason for that is probably an upper management, they were a little unclear about the direction they were going until they brought these people in and got very solidified and decided, like, you know, on the path that they’re on now, that’s my perspective, having worked with them, you know, a little bit over the years. So they got the management in there that was like, Hey, listen, let’s make insulin pumps, and let’s go. And then they were behind by them, because tandem was already moving. Medtronic had already been through their first generation, we also don’t give Medtronic enough credit for going first in the repeal algorithm market, because you knew they’re going to take it the ask because it wasn’t going to be perfect. And it was the first time and people certainly gave him a lot of crap over it. But

the data that they got in order to move forward and build, yeah, give data to other companies to actually say, what can we improve? On this, right?

The Trailblazer doesn’t usually get the credit. And I definitely think in retail algorithms, Medtronic took one part for that. But I was sitting with somebody one day on a call. And like I said, These people don’t exist it on a pod anymore. So I’m not worried about saying this. And they’re like, Hey, we’re gonna we’re building an algorithm, like we’re gonna they were talking about how they were going to go about it and everything and and I said, whatever you’re doing, stop. I’m like, stop, put two people who speak Russian on an airplane, find a guy named Ivan, give him a bag full of money, get him a visa, bring him to Boston and let him build your algorithm for you. Please, like, please go get the guy that wrote this code that this loop thing my daughter is using just go get this right now. And, boy, I said it every time I could to anybody who would listen to me now listen, are they going to do that? No. Is that even reasonable? No. But it also like, you can’t tell me that all these companies haven’t picked through that code. You know what I mean? Like, just correct. Yeah. Make it like that.

And you know, the other thing I know, all these companies have people who have diabetes on their teams, right? I know that they do. Are the people without with diabetes, not the ones who are like, are they not able to give feedback? Are they not able to say, Hey, do you see this big group of people? Knowing love? Like, shouldn’t we be thinking along these lines? No. I mean, if they ask me crap, they don’t even pay me. I’m just going to tell them, I’ll give you my opinion. Yeah, it

was really offering my opinion, I was like, just do this. And because loop is an example. You can choose a version of loop that makes Basal adjustments to try to stop highs. Or you can flip the switch the other way and decided to let it make larger bonuses like Right, I’ve always said to people, like set up algorithms the way Adobe Photoshop is set up. There’s beginner, intermediate, and advanced. And when you click on one of those tabs, you get more features. Just make your algorithm like that start everybody at beginner tell them you got to be in for six months. And then you know, if you have a certain percentage of under whatever lows I don’t care how you do it like to legally Cover yourself. Let them move up to our intermediate, make them take a test let them move up to intermediate. Can you think it would be so sick? I mean, I really believe it would be very simple to do. And so the question is, why don’t they? I think that comes down to time. Limitations of humans and money. So, but what limitation is going to be completely out of the limited in my opinion, what

are the limitations quite honestly, come on limitations. So keep this

here but see your job, see your job is different, right? Your job is everyday you sit down, you look at a person. And if you do a good job helping them do better with their health, you one your employers happy, right? And the people who are paying your happy Chinese, I don’t know if my employers are happy, but you understand, like, we all have jobs, okay. But these people are saying, we’re going to make an algorithm, for example, it’s going to take so many years, and then it’s going to have to go off to the FDA, and it’s going to take so many years, and then we’re actually gonna have to make it and it’s going to take so many years, we’re looking at five years before we start getting our money back. They gotta spend money for five years, they gotta run that whole organization with no return on on their and what if it fails, like so let’s do something we know for sure is going to work. And we’ll lean into who we are. And on the pod listen on the pod is tubeless. My daughter’s only ever one an omni pod, right? loop works on Omni pod. So

in this day and age, I’m not saying years ago, I’m saying at an age, we already have the we already have the information. Nobody needs to sit in a little back room not getting paid for anything and make it up. They’re not making anything up. It’s already out there. It’s it’s free. It’s freely out there. Jenny,

I’ve heard that this island guy because of the war in Ukraine can’t even use he can’t even like be involved in making a loop anymore. Like I mean, I think we could have got him out of there for $25,000. And like a can of Coke. You know what I mean? Like here, so I don’t know, maybe he probably lives in Dallas. He’s probably listening right now. I’m like, s hole. I live in a very metropolitan area. But seriously, like, there’s been other people since him. Oh, yes. Like there’s

there are many, many people in the whole

basically people with type one diabetes who know how to code who sit down and say, I want to figure out how to do this and in their person. Like Arden is not even using loop anymore. She using Iaps. Fantastic. Like, just fantastic. And like, I don’t know, like and then you saw tide pool. They tried to do it. And I mean, God bless them. But that ain’t going nowhere. You really mean like like that at

this point. I

mean, Holy Hannah, we’re gonna be I’m gonna be dead by the time it like, you know, like they told us that driveable pump. Yeah, and listen, and maybe that’s even the pump companies saying, maybe we don’t want to be involved in that. I don’t know, I don’t know the business of that. But that Business Plan to Eat taken too goddamn long is what it is, by the time they the time they get that mainstream enough that algorithm is going to be I’m not gonna want it anymore, you know? So yeah. But ya know, your points not lost on me, Jenny. I mean, somewhere between money time, limits of people. And by what I meant by limitations of people is that everybody in their job, they got to succeed every year to get a bonus to get to keep their job to move up. And they can’t sit around for five years going. It’s common, it’s common, because they’re looking out for themselves, too. So, yeah, I don’t I mean, I don’t know, I’ve interviewed a lot of people. And I generally think they’re telling the truth when I’m talking to them, like I really do. But I also think you’re only talking about the things that they’re willing to talk about, or

the things that they know about from a department angle, right? Not everybody is able to share all the aspects of all the things that are going on with a particular product, you have your job, somebody else has another piece of that job. And you may not be allowed to talk about certain features or things.

So point, by the way, that code is open source. Like, I’m going to tell you right now, if you made me the king of any one of these companies, I’d go in, I’d sit down and go, Hey, everyone, stop what you’re doing. Go get that algorithm, get it into our goddamn pump, because we’re going to take this market over we are going to like it would in six months online, people would know, yours was the one. And you know, they all know it. They know because they all talk about like, well, we’re this but they’re that, like, you know, they do it in their marketing back and forth. But the truth is, is that it’s none of them are talking about the real truth, which is that loop is just way better than all of them. Yeah, that’s all, you know, but people ask me, What’s the best algorithm? I tell them? It’s the one my daughter’s using right now. And if she’s using a different one, six months from now, I guarantee you that’ll be the best one because I ain’t sitting around. You know,

I haven’t built on my phone. I just don’t I haven’t played around ups. Just put. Okay, I haven’t played around with

lots of things. But it’s also scary. Like I’m counting on like a guy named Ivan not to be impacted by a war in Ukraine. Like you don’t you mean like is the Ukraine? No, it’s Ukraine. Right? And like so. Like, that’s crazy. I know. That’s crazy. Like I know, that’s insane. But I don’t know how to tell you that. Like the other night, I watched Arden come back from class and by watched I mean I could see on her Nightscout she got back from class. And I think she just was really hungry and she walked in her dorm room and she ate I think she pushed the button and she ate right. And her blood sugar climbed to like 185. And I watched that algorithm just Bolus and Bolus and Bolus and crushed it and bring it back down and she didn’t get low and it was over. And that was it and or we put her on a GLP medication. Jenny knows this Ardens I’m gonna go through the whole thing. But Arden’s insulin sensitivity went from one unit moves her 43 points to one unit moves her 90 points. Because of this GLP she’s on. I don’t have to wait for it to relearn. I gotta call my doctor, I just went to a manual. I was like insulin sensitivity when they just kept I told her I’m like, Just keep moving it until it works. And that’s it. That’s all we did. That’s how technical I like I said, Hey, try one to 53. And then a day later, I said make it 65. And we moved up the GLP medication a little bit. I was like, make it at, like, you know what I mean? So what’s

funny about this is that that was actually a question on my thing for you was I was gonna ask, how many days do you watch for a trend?

Day? So I watch for a trend, I do it till it works. Like I don’t know how to like. So there’s a weird when going back to what we talked about in the beginning? How would I talk about that in front of other people? So you know, what you and I usually do when we talk is I let you give the very technical answer. And then I just tell people what I do. And then they can figure out where in between that works for them. Sure. Yeah. So Arden injected a GLP medication. She started with point two, five units of ozempic. And her at that point, her insulin sensitivity is one to 43. Two days later, we were seeing low blood sugars already, which is uncommon, like you know, there wasn’t it’s not even a therapeutic dose of that medication. But here it was right. She felt a little full. She wasn’t eating as much. I thought oh, it might just be food. I watched it. She had a low, the algorithm couldn’t pull her out of the low. And so I changed her insulin sensitivity. Right. Then the next day, I changed her basil. And I think I had the whole thing set up three days after she three and a half, four days after she injected the ozempic. The first time I watched that work, I made little tiny adjustments like the turned insulin sensitivity, like two more points or made the Basal like point five less than I watched her meals, I made her insulin to carb ratio weaker. And till I didn’t see Lowe’s before she started eating. And then I left it there and watched it. So I mean, I had the whole thing adjusted out in like five or six days. Right? But how long would I wait? I knew what was happening. There was a variable and play here I had, I had set settings up for Arden and her physiology. And then we changed fundamentally how her physiology worked with this variable and I changed it immediately.

Right and you had a variable that you were paying attention to. It’s not

like out of nowhere, she started exercising I didn’t know or something like that. But that’s where we started talking about real world stuff. Where if I just noticed on like, on Thursday, she was low. And I was like, I don’t know what happened. I’d wait. I wouldn’t do anything. If it didn’t happen on Friday, I’d go ha if I came back around next Thursday, and it happened again. Then I started being like, Hey, what did you do at school on Thursdays?

Right? Yeah,

that’d be my first question. What do you do at school on Thursdays? And have you been doing something different running around more blah, blah, blah? Are you eating lunch? Like like is that the day is like something? And then if I couldn’t see a variable, there’d have to be one. If you were only low on Thursdays, there’d have to be one. You know what I mean? Yeah.

And that’s where looking historically at information, which I know that you do, you know, at her information, but I think that’s where it becomes really important and trending, to look at some data from the past to spot some of that. Because if you are really trying to make a baseline change, because you sense that something needs to change, then, you know, a couple of days of a trend around a particular time of day, can sometimes give you a foot in the door about okay, I can change it this way. Kind of like you said, I change it the next day. It’s not enough, but there was a trend to start with. So I know that incrementally now over the next couple of days, I can make little daily changes. But you have to first start with a trend right I

also set up some profiles for Arden when we were with her two weeks ago. She was starting to get low overnight, and it was always happening at like 330 in the morning, which means that she’s eating around 10 And that last Bolus is messing her up somehow. And I didn’t want to change all of her settings because it was only happening at some points in her menstrual cycle, not the whole thing. So I built a 90% profile and an 80% profile. So she can be like in the bottom of the Iaps app, it just says normal. I think you can touch that and then choose other ones that your program. So I said, Listen, I said, see where you touch this. And then this comes up. She goes, Yeah, I’m like, if I text you 90, touch that touch 90. And she goes, Okay, so I started like, a week and a half ago, I texted her at night, I was like, I just sent her 90. And that was it. And then in the morning, I sent her normal. And so I was kind of practicing overnight, and it stopped the lows. And then I waited to see if she’d remember to do it. And she didn’t. So then I was like, Hey, I think we want to do 90 overnight, as long as you’re on this injection. And then we’ll see what happens after that. But yeah, I mean, how long would I wait? I mean, there’s no way, you know what they always say, they always say, wait three days. And then people’s responses. If I wait three days, it’ll change again, by the time it happens, or it’ll go away. Or I think that’s what happens. I think people think it’s going to go away.

And I think that’s where spotting. That’s why I asked like how many days I mean, in many doctors offices usually actually say let’s wait a week, right? That is too long. Right? It doesn’t mean though, that you you just let things happen while you’re watching for a trend to appear over a couple of days, right? So a bedtime, you’re always having a rise in your blood sugar, okay, correct the rise. But if it’s only tonight, and doesn’t happen for the next six nights, that’s not a trend. So you don’t have a profile change to make. You need to accommodate around whatever variable created that high to begin with. Versus okay, I’m high, I corrected it. Tomorrow night, I go high again, I correct it. By then it’s more like

anything, Yeah, something’s happening. You’re I’m always very careful of not making band aids all over the place. Because you can make so many different little blind adjustments and everything gets so messed up, the only thing you can do is start over. Because you can’t even tell what the end that’s what doctors are notorious for, is like where you’re getting lowered to aim, but will turn your Basal down to aim, you know, a sooner than that. And be like, Look, I guess the way I would want everybody to think about it is the way I talk about all the time, which is insulin for now. Insulin taken now is for later. But more importantly, what’s happening now is because something because of something you did previously, right? Yeah. So it’s the same idea. But it’s a different way of thinking about it. Like when something’s happening at one o’clock, please go back backwards hours and look to see what got you there. Do you have time to ask me the other one? Are we done? Are you are you? No, no,

I’ve got about 10 minutes. Let’s see. I actually came up with a whole bunch. Which ones do I want to ask though? Well, this one, how do you feel about AI in diabetes specifically? And do you ever think that it will completely 100% hit the mark of people with diabetes? Not really having to think about more than like, putting their pump on? Okay. I mean, I have some thoughts about that. But I was curious what you think, oh, I

want to hear what you think, too. So you have two different questions, kind

of I mean, it’s all within the same framework, though of AI. Right, it’d be the first part. How do you feel about AI specifically in diabetes?

I have a company right now indexing the entire podcast for me. Okay, so my goal is that you’ll be able to go to a website and ask a website, ask the website a question. And it will only answer based on everything that we’ve all of us have ever said to each other on the podcast, all 1200 episodes, and it will continue to index into the future.

So the be the next question leads into that concept. So that idea, I think that’s actually easy for AI to do. Yes. At a deeper human level, though, I think more in terms of like educational, right, not even necessarily the techie part, but like, educationally, when you have someone that you’re working with who has like, one concept to manage what happens when now AI is doing the instructional and they have multiple medical things, some of which could actually have completely opposite parameters of management. Yeah.

So other things could be impacting that there’s no way the AI would even know about

right and that takes a human. Do you think that AI I guess we’ll ever get to the point of thinking more human like because this takes it takes analysis on a different level than computer Hey, out

without input, though, because like, you have to teach the AI, the podcast so that it can answer questions that have been answered in the podcast already. Okay, if you want an app to tell you, Hey, you got low here, like we see your low. I think you should have eaten 15 grams of carbs at this time or four to say, hey, we see a low coming. Go ahead and eat this. I think that’s going to exist pretty quickly. Sure. But if you like I actually think that you’re well, I don’t just think I’ve been I actually was just it’s so funny you how are you reading my emails? Jennifer, what’s going on? I’ve been approached recently by a company, I’m still assessing it. And they want to be partners, like they want to get involved a little bit. And they have an app that is going to look at your pump and CGM data and say things to like, Hey, you should probably have 10 grams of carbs right now to avoid a low. And they’ve asked me if I want to learn more about it.

I wonder if it’s tough to tell me later? If you can, I’ll tell you right. Now that to me?

No, not that one. No. Okay. That’s the one that I know about that had to be so frustrating for people listening. I’m still assessing how I’m going to answer this this inquiry? Sure. I think it can get to it. But the problem is, it’s the same problem as Why don’t the pumps all do what they should be all doing? Because you need somebody to put that effort into it. And that’s where it never happens. Like because yes, I listen, there was a guy on here one time talking about, you know, if you had location services on your phone, and you went and got pizza at Pizza Hut, and you said, Hey, I had three slices of pizza. And this was the Bolus. And here’s what happened to my blood sugar afterwards, I needed more insulin and blah, blah, blah, then the next time you went back to that Pizza Hut, the location services would say, I’m at that Pizza Hut, where last time this happened. So this is how much insulin you should use for a slice of pizza. That’s very doable. But somebody would have to do it.

You don’t I mean, somebody has to collect all the data to essentially teach it, how to navigate that you

first have to teach it for yourself. But I’m saying someone actually has to go to the trouble of putting it together. And what I usually find is that the end users don’t want complicated when it comes to diabetes. So if there’s a big setup where I have to always wear a watch, that tells me where I’m going, or I have to remember to tell it, hey, this is Pizza Hut, and that’s my local, like pizza place. They’re different, like that kind of stuff. No one’s gonna do that stuff.

I would I would,

I’ll say something like I’ve done, I’ll tell you something that I’ve very privately told any person who’s ever come at me with a diabetes that and then like, can you tell me what you think of this app? I’ll tell them all the time, the same thing? I don’t think this is what people want. I don’t think people want more involvement. Yeah, I think even if your app does what you say it does, you’re not going to be able to get it widely adopted. That’s good.

I think that you looked at all of my questions somehow. Because that’s actually, one of my last questions was, with all the tech and the info and the apps and everything that we have collecting? I guess, do you think it’s created more mental health stuff in the diabetes realm, because

won’t change a goddamn thing. It’s like everything else, there’s 10% of people who are going to really pay attention to it, they’re going to love it, they’re going to use it, a small percentage of them, we’re gonna go kuko nuts over it. And everyone else is going to just go like, I just shoot my land as it all works out. Like get it. I mean, like, people, again, are always the last speed bump. Right? So you’re asking, Will AI get to the point? Like, it isn’t a movie for diabetes? And I would say not in my foreseeable future. But here’s the caveat, I do have a lot of hope about this. The way things are figured out now for medicine, like, you know, people become researchers, like not every doctor is that is see somebody with a stethoscope, right? Some people work in labs their whole life. Some people work very hard and do good work for an entire lifetime. And they’re actually going in the wrong direction. And they don’t even know it. They’re just going through the scientific process. They’re doing what they’re supposed to be doing. They get to the end of their career, and they go, Huh, I zigged when I should have zagged How about that? And it’s the amount of waste of time it’s how it works. I don’t see how it’s not possible that in the next 10 years, we don’t have AI, running tests, and and doing decade’s worth of work in a couple of days in short time. Yeah, yeah. And saying, Oh, we tried that path. It didn’t work. Throw that away do that or here’s what we learned here. And to keep compiling it together, that I actually think is gonna happen

as a time saver in research and information and bringing together faster you My

lifetime, we’re gonna see things happen with medicine that we didn’t imagine because AI is going to be able to run the lab workforce, like, that’s my expectation, and that that I actually kind of believe in. So none of us are gonna have jobs, if that works, we’re all going to be button pushers, like or algorithm askers, or something like that, you’ll be the vice president of, Hey, Siri, tell me, I shouldn’t say that out loud. And so but like, you don’t mean like, eventually, you’ll just be able to run tests over and over and over again and validate them and validate them and validate them and come up with life lifetime’s worth of work in in very short order, and then make some decisions that I’m hopeful about actually. And I don’t think that’s crazy to say, if I’m if I’m being honest, but these apps the way they are right now, they’re gonna tell you, Hey, eat something to avoid a low or right you go for a walk right now for this many minutes, we think your blood sugar will fall this much. I mean, that’s,

again, they still require input from the user. And that’s where it’s the more factor in a lot of these, that could give you some, I guess, some decision tools, but you have to take the effort to tell it what you’re gonna do, or what you’ve done in order for it to make enough and I guess, to gather enough to tell you what to do next time. And like you said, it’s a great concept. But a lot of people it’s just it’s too overwhelming already know,

we live in a society now where kids in their 20s Don’t have sex anymore, because it’s too much effort. Like if you can’t put the effort into getting laid Jenny, I don’t know how you’re gonna put the effort into bringing down your fat rise on your, your pasta Bolus, right? Like, I mean, seriously, like, like, we’re very insulated at this point. And people have a very high expectation that things are going to happen quickly, and just happen without a lot of input. And this is always because of all the variables we’re talking about all the time. All these variables that impact your blood sugar, that the thing, the algorithm, whatever is going to need to know all these things are happening to give you back good data. And more importantly, companies that make money aren’t going to put themselves in legal jeopardy by promising that if you forgetting to tell, if you saying there’s 30 grams of fatness when there’s really only five is going to give you a four unit Bolus that you didn’t need. And then you’re going to turn back to the company go hey, you’re you’re working. You’re working on this machine tried to kill me just now. No one’s gonna get involved in that. True. That’s it. You want to fix people with diabetes right now in a way that is value fix people help people with diabetes in a way that’s valuable right now. I’m not kidding. Two guys have briefcase full of money, fly to Russia find Ivan drag his ass back here and have him put his algorithm in your pump. And I guarantee you a year from now I’ll be doing ads for your pump and everybody will buy it and that’ll be the end of it. I fixed your whole game and I want a piece of that money by the way, damaged by

give you the idea on a piece or find a piece

of the money to Jesus, I just lost half my money just like that. All right, thank you. We’re gonna do more of these because you and I are. Yay. I don’t want to say during the recording because it will sound pompous. But I want to say we’re very good at this. And I found this enjoyable. Yeah, we’re gonna do more of this. I like okay.

Yeah. Okay, bye.

I’d like to thank ag one for sponsoring this episode of The Juicebox Podcast and remind you that with your first order, you’re going to get a free welcome kit. Five free travel packs in a year supply of vitamin D. That’s at AG one.com/juicebox Arden has been getting her diabetes supplies from us med for three years, you can as well, US med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode. And for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com. To us Med and all of the sponsors. A huge thank you to ever since CGM for sponsoring this episode of the podcast. Are you tired of having to change your sensor every seven to 14 days. With the ever since CGM you just replace it once every six months via a simple in office visit. Learn more and get started today at ever since cgm.com/juice box. If you’re looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn’t matter to me. If you’re impacted by diabetes, and you’re looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. You have questions Scott and Jenny have answers. There are now 19 ask Scott and Jenny episodes. That’s where Jenny Smith and I answer questions from the audience. If you’d like to see a list of them, go to juicebox podcast.com up into the menu and click on Ask Scott and Jenny. Actually, I think there’s way more than 90 At this point, but you get the idea. If you’re not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com

Hello friends and welcome to episode 1203 of the Juicebox Podcast. Today, Jenny and I are back with another episode of Ask Scott and Jenny. And if you’d like to hire Jenny, you can at integrated diabetes.com. Please don’t forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. If you’re a US resident who has type one diabetes, or is the caregiver of someone with type one, please do me a favor and go to T one D exchange.org/juicebox. and complete the survey. That’s all I need you to do. It’ll take about 10 minutes and your efforts will support type one diabetes research. When you place your first order for ag one with my link, you’ll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box and don’t forget the 40% off offer at cosy earth.com is gonna go away soon. It’s gonna go down so cozy earth.com use the offer code juice box right now to save 40% off of your entire order. But in June of 2024 I don’t know what that offer is going to be. Get yours now cozy earth.com use the offer code juice box. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since it’s gonna let you break away from some of the CGM norms you may be accustomed to no more weekly or bi weekly hassles of sensor changes. Never again will you be able to accidentally bump your sensor off. You won’t have to carry around CGM supplies and worrying about your adhesive lasting. Well that’s the thing of the past ever since cgm.com/juicebox. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us med this show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Jenny we’re back doing another ask Scott and Jenny episode. And I’ve been on vacation for like 10 days. So I just joked with you. Let’s see if I can remember diabetes. Yeah, the truth is even though I haven’t been recording for you know, over a week, I was actually with Arden. So a lot of like hands on diabetes stuff happened this week. Actually, I think I have kind of a theme question I’m going to start with because I don’t know how much of this it’s going to take up. It’s a bit deep for Monday morning. But how do I support someone who was recently diagnosed but in denial of their new life responsibilities? How do you help someone you love? Who isn’t ready to accept help, but it’s hurting themselves without realizing it? Let’s just jump right in on that one.

Gosh, that that is that is deep. This is a Monday? No, that’s that’s a really hard one. Because I think it also depends, it sounds like they’re talking about somebody who is an adult that they’re trying to support to this isn’t it doesn’t sound child? Because that’s a little bit different. Obviously, you’re you’re the main supporter, and you essentially tell your kid what to do. Adults. I mean, you can support as much as you can, but also being the dictator isn’t going to help, obviously being the one that says you have to do it this way. And did you take your guns? I mean, all the reminder statements that you probably would love to say they’re only going to make them sort of retreat farther. Yeah. So Acceptance comes with the person’s own ability to, to find what really matters in life to them, I think is a big piece. You know, you really like going golfing for four hours Saturday morning. Well, you know, this happened. And this happened. It would probably be a little bit better if you did some of the things that you know, to do at this point. But even those statements are more of a blame, right? That sounds like well, you caused it and that’s not really what you’re trying to get across. It’s you’re trying to show, if you took some of these steps, you could do many of the things that you really want to be doing. And this could be less of a burden, but it’s hard to get somebody to reflect that way when they truly just hate what’s going on. So

while you’ve been talking, I’m sitting with my whiteboard in front of me writing down the names of people that I can’t get to take care of themselves. And I think if I could sit here longer, I’d probably be able to write down more names. So I wonder sometimes, I mean, I don’t think it’s as cut and dry as you’re either going to do it, or you’re not going to do it, some people are going to fail, and some people are going to thrive. There’s people on this list, who eventually listened. There are people on this list, who listened, and then didn’t have the tenacity to make it through the treatment. I guess, if that makes sense. And then back down. And I see a lot of people here, actually, you use the golf reference, and I wrote someone’s name down. Oh, actually happened to them. They couldn’t play golf anymore. And I thought, Oh, they’re going to take care of themselves now. But you know, instead, what they did as they start playing golf. Yeah. And, and then I have the names of two people here who are just acting like it’s not happening. And you know, and then of course, I have my friend Mike, who, you know, would never listen to me, you know, and he would actually get angry. If you tried to talk to him. And I wonder back now on whether or not that was his blood sugar sometimes, you know, sure. Yeah. Yeah. So, so listen here, someone says, Listen, I couldn’t come up with a question for ask Scott and Jenny. But I want to say that I’d like to hear more about this too. I have type one, but my partner has typed to and won’t do anything except take Metformin. They won’t test their blood sugar won’t ask for a CGM and won’t will not change anything about how they eat. It can be hard sometimes to see someone care that you care about not take steps that you know would help them think you should talk about this topic. People would benefit from a great I don’t know what we know to say about it. My brother was this way and now is suffering consequences. Now he’s suddenly interested in being more healthy, but his kidneys are shot. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes because it’s a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G vo Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store G vo Capo pen and how to use it. They need to know how to use G voc hypo pen before an emergency situation happens. Learn more about why G voc hypo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn’t be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information.

And sometimes it comes to that point during you know your life with diabetes or many other health conditions to that truly need to be well taken care of via lifestyle or you know, I guess less cumbersome medications that don’t really require more than just taking it but lifestyle changes that go along with that medicine doing what it should for you. It really is it’s a personal thing. It’s the reason that we that’s the reason that everybody can’t just get along. Like, like if we could really help to change somebody to the positive without making them feel like we are offering you know, what we expect are the solutions to the problem. And sometimes I think is you take it from the side of the person who has the condition or diabetes? Well, you’re not living it. So sure you can come up with all of these solutions for me, but I’m the one who has to apply them. And in doing that, it almost like I said it comes for some people down to a matter of what really matters and getting that as a kind of a hit point of Oh yeah, I guess I could feel better by doing this or adding this. Sometimes I mean the example of somebody who’s living with type one and has a significant other, you know, with type two, that’s an interesting living dynamic, because clearly I would expect that their partner with type two see is how they take care of themselves with type one, right? They see the actions of the person they’re living with, and yet still are very resistant. To making any changes for their own life. So that’s an interesting dynamic.

Yeah to live with. I met a young person recently who has type one who doesn’t use a CGM doesn’t use a pump and doesn’t know what their a wands he is, but he’s perfectly sure that they’re doing well. How are you doing? I’m doing terrific. And I was like, Oh, that’s great. What’s your one says, I don’t know. You have a CGM. Now to get low often not that often. You know, Mike, I mean, I don’t think you could be lucky. And but if if you’re getting low and getting high and don’t know what’s happening, like it’s, you know, until it’s until it’s too late. That’s the first time you’re gonna I mean, if you’re not looking, you can’t see it. It’s

called it. I mean, it’s called denial. Yeah, yeah, there’s a word. And that’s, that’s the hard part of being the person seeing this happen. And not wanting to say something that, again, is placing blame, right? You want to you want to be able to tell the person, you’re completely in denial, you have to face up to the fact that one, this isn’t going away. And to be better if we just hand in hand navigate this together, I’m happy to be here. I’m happy to help you. What can I do for you? How can we do this together? If we’re going to change our food structure or activity structure, whatever it is, I’ll do it with you. I mean, these people are asking because they want to be a partner.

I mean, what this really boils down to, like you said, it’s personality, but psychology, and you don’t just make people do something that they’re not going to do the last thing that I read about the person’s brother, at the end of her statement, I think it’s a statement by the way, it’s from a woman I think, by the way it’s written, it says, maybe showing him the consequences of people who didn’t manage well, and she lists amputees, retinopathy dialysis, maybe that would help him. And all I can tell you after interviewing 1000s of people is it helps some people and doesn’t help other people get and it actually pushes some people away, because it just it pushes them deeper into their denial. That’s not going to happen to me. I always use the example of like, people smoke. They know what smoking cigarettes does, like, we all know that it’s not good for you. But people are like, ah, and my father was all out. He’d come up with a doctor doctor said I’m good. I’m like, yeah, oh, yeah, I’m fine. I’m fine. And my dad dies of COPD or congestive heart failure. I don’t remember congestive something from can smoking. Right? And like it’ll eggs, like, and he’s, you know, I’m good. I’m good. I’m good, right? Until he wasn’t. But your point about it being somebody that you care about. I think the the irony is that if, if Jenny, if you had type one, and weren’t taking care of yourself, and I loved you, and I knew to talk to you about it, and you were like, leave me alone, you could also look over at me and go, you have things you could fix in your life, buddy. And then like, you know what I mean? Like, what’s that? Cast the first stone to I don’t know, I didn’t read the Bible, but like, you know, like, there’s something in there. Right? We’re caught in an age old human conflict, right, like, so this isn’t just I got diabetes, and he doesn’t want to take care of it. I mentioned it to him three times. He didn’t want to do it. So screw him. Like, that’s, listen, I will say this, and I’m happy to use my brother’s name. I don’t know if I’ve ever said Brian’s name on here or not before. But Brian has type two diabetes. And I parented my brother, you know, but very kindly and not, not in a way that he would feel parented. And he knew what was happening, but I was never like insulting about it. He and I don’t live anywhere near each other. Actually, he could probably walk to Jenny’s house, but you know, it would take me 15 hours to drive to

him. It would take him a couple of hours.

I don’t know that the whole place. Anyway. He had type two, and he was carrying weight. And I’d say Hey, Brian, what are you doing? You know, how’s it going? My onesies in the sevens? Oh, my God, what are you gonna do for that doctor wants me to are you going to? I think you should, you should try. Let me know if I can help you. And I’m going to tell you years. It took me years. And finally, I have to be honest, I think what really got him is I stuck a CGM on him when I saw him one time. And then he was like, oh, hell, and I was like, right, he goes, so I eat this and my blood sugar goes right up. I was like, yeah, he goes, I didn’t realize that. Okay, so then he started to do it again. And I thought, Oh, this is it. And he started, he died a little bit. And then it went backwards again. Anyway, back and forth, and back and forth. So then I said, Hey, Brian, I think you should talk to your doctor about a GLP. You think so? Yeah. It took me a year to get him to do that. You know, but now Brian, say once he’s in the fives, and he wears a CGM, and I think he’s gonna be okay. And he lost weight and like everything, you know, but I never want to beat him over the head with a stick about it. It was always just I care about you. I hope you do something about this. I didn’t try to scare him and he picked it up eventually. I also think that very possibly could have not worked, you know? Correct.

And I think what you said there is like you didn’t try to scare him and that scare tactics never work. I mean, that’s something that age old a lot of practitioners do. I think without thinking about it. I don’t think their goal is to scare but I think their goal their their idea is well if as the the person stated But they just show them the complications or if you talk to them about these and make it very forceful in explanation if this is going to happen, you know, some people may take it upon themselves. Well, you’re right, I have to do something. There’s that’s a person that’s very willing, and probably already in the stages of like contemplating a change, yeah. willingness to accept some information. But the other type of person is going to say, well, it’s going to happen anyway, I guess. So. Why should they care? Just keep doing what I’m doing. Because essentially, they’re missing the point of action now means prevention. They’re completely just skipping over to you while you’re telling me about all these things that are coming. Well, crap. I’m just going to enjoy doing what I’m doing the way that I do it right now. And I’ll get these anyway. So what does it matter?

I used to hate ordering my daughter’s diabetes supplies. I never had a good experience. And it was frustrating. But it hasn’t been that way for a while, actually for about three years now. Because that’s how long we’ve been using us med. Us med.com/juice box or call 888721151 for us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor for Omni pod dash, the number one fastest growing tandem distributor nationwide, the number one rated distributor in Dexcom customer satisfaction surveys. They have served over 1 million people with diabetes since 1996. And they always provide 90 days worth of supplies and fast and free shipping. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and Dexcom G seven. They accept Medicare nationwide and over 800 private insurers. Find out why us med has an A plus rating with the Better Business Bureau at us med.com/juice box or just call them at 888-721-1514. Get started right now. And you’ll be getting your supplies the same way we do. How many times have you thought it’s time to change my CGM. I just changed it. And then you look and realize I got it’s been 14 days already a week, week and a half. Feels like I just did this. Well, you’ll never feel like that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings, giving you more convenience, confidence and flexibility. So if you’re one of those people who has that thought that I just did this didn’t know why we’re gonna have to do this again, right now. If you don’t like that feeling, give ever sense a try. Because we’ve ever since you’ll replace the sensor just once every six months via a simple in office visit. Ever since cgm.com/juicebox. To learn more and get started today, would you like to take a break, take a shower you can with ever since without wasting a sensor, don’t want anybody to know for your big day, take it off, no one has to know have your sensor has been failing before 10 or 14 days. That won’t happen with ever since. Have you ever had a sensor get torn off while you’re pulling off your shirt? That won’t happen with ever since. So no sensor to get knocked off. It’s as discreet as you want it to be. It’s incredibly accurate. And you only have to change it once every six months. Ever since cgm.com/juicebox. I’ve seen people treat health just like it’s money or social status to like, like generations where you’ve been broke for generations. I’m not getting out of this. You know what I mean? So I’ll just take my crappy job and I’ll do my thing. And that’ll be it. You know, I’m the I can’t, I can’t get out of this house. I can’t do that. Like, look around me. This happened to my brother. It’s my mother. You don’t think it consciously but you look around you think this is my lot in life, like this is what’s gonna happen, you know? And if everybody’s got diabetes, then you know, it’s colloquial. Like I, we got the sugars, you know, my family’s got the sugars, it’s gonna get us and I’m like, oh, geez, that’s not right. You know what I mean? Like, yeah. And so anyway, all right, good conversation.

We don’t have like, I still want to like have an answer. I so want to be able to say, hey, just do this for the person that you’re trying to support. And it’ll get them to turn around. But unfortunately, that’s just not it’s not human nature. And I wish there was an answer.

You have to not give up. If you really want to help the person I think you have to not give up and you have to assess who they are like what keeps you in their life to keep saying Hey, check it out. And by the way, in this one statement here, you can read where people get frustrated. My brother was that we heard this already but my brother was this way and now is suffering consequences suddenly interested in being more healthy. There. sarcasm and suddenly, you know, suddenly they’re interested like, Yeah, well, my dad stopped smoking when he got heart failure to, you know, like, until then denial and hope mixed together is pretty strong. I won’t I probably not gonna happen to me and especially with diabetes where it’s not happening, smoking is the same way. It’s not happening right now while you’re doing it. It’s not like falling. You don’t I mean, you don’t go on bleeding. I’ll try not to fall again. It’s very simple.

And I think there’s a difference here too. I don’t know. I mean, the grand majority of your listeners definitely have type one diabetes, right? Yeah. But in all of this, nobody sort of blatantly said type one. Right. And so what we may be able to also understand is that with type two and with some of the meds that are not as directly impactful on blood sugar, like insulin, right, you take it, you can see what it does this way, this way, whatever. Whereas with type two diabetes, and some of the oral medications and the other kinds of things, sometimes it makes it a little bit harder to make a change, because along with lifestyle, those medications, they sort of require a partnership. And then you start to see results, they may not be as immediate and so somebody who is trying to make a change, may be making it and may not have the right medications to help with what they’re doing. So they’re not seeing any results in there thinking well, what’s the purpose like

taking a vitamin or exercise? You know, I did a sit up where my where my abs? Like, I took this vitamin D for a week, I don’t feel any different, like, oh, okay, I’m gonna try a little longer now. Like it’s, you know, but I agree. Like, it’s just it’s a tough scenario to be put into, because if somebody hasn’t already made you believe that even though you’re not seeing it, it’s incredibly important, then you’re the person I met earlier, who’s like, oh, I don’t have a CGM. I don’t know what my blood sugars are. But I’m good. Like, you actually don’t know if you’re good or not, you’re living like it’s 1980. And you have type one diabetes. And I don’t think it matters. By the way, if it’s a type two or type one, I actually think we could have this conversation, take out all those words, and you could insert the one that’s impacting you could be diet, exercise, diabetes, you know, saw the same conversation. Alright, let’s let’s, let’s go to something a little more a little easier light. I don’t know how light this one is, what do you do if your doctor won’t prescribe a certain medication that you need? Or if your insurance won’t cover it?

Well, I think the doctor side is potentially a little bit easier. I don’t love using the word easy in many places. But I think that is if you’re in an area where you have multiple practitioners to pick from, and allowance on your plan involves a bigger network of people or, you know, doctors to choose. Absolutely, you could switch doctors, right, because if you need a medication, that someone is not willing to prescribe, and you’ve brought in enough information to support your reason for believing this medication could be to your benefit. And the doctor is still not willing to discuss, right? I mean, working with any healthcare practitioner, it’s a partnership, you both should be putting something into this effort at your health. Yeah, it’s not one sided. And so if the doctor is not helping, then find somebody who will write the other side of it is a little bit harder, honestly, I mean, insurance coverage varies based on the plan that you have the type of coverage you have for prescription versus durable medical equipment types of product, sometimes it can be gotten around with insurance coverage, where the doctor writes a letter of medical necessity, stating reason as to this product versus that this medication versus that I mean I myself with using a pump for years and years, one type of rapid acting insulin, I can use it as an injected injection, but if I take it and infuse it with a pump, I get a really hard not under my skin. And so I can’t use that particular rapid insulin and so my doctor has written over the years when I’ve had a preferred for that type of medication or that type of insulin. My doctor has written a letter that says but this this in this happens, my patient needs to have this alternative rapid insulin and so I still I pay a little bit out of pocket but it’s nothing comparative right to what would how many little

things you don’t realize until stuff like that, like Arden’s using the GLP through a pen right now and she said that the needles that come with the pen hurt but the BD like the there’s another type of needle she gets she gets doesn’t hurt as much and I’m like oh cool, or you know, she shoots V ASP. We tried V Aspen a pump, and she would get like what she would call it felt like bruising. So I don’t know why it made I feel like it might be the additive that speeds it up. I don’t know I will do they usually vitamin B or something like that? I forget. I listen, I’m not a doctor for sure. But like, you know, fee asked makes her site feel Bruce she could talk through it if she wanted to. But she’s like it hurts. Whereas loom JEV because we tried everything that she can. Maybe the pumps on for an hour, she’s like, this has to come off right now. Like she just yeah, it burns and she can’t take it. You know? No vlog works. Okay for her, but not great. You know, so we use a pager, a pager works terrific. It’s in her, it’s in her notes. Like we had a doctor like note her her her account like that. Her account her chart, I will say this, this is gonna sound a little cynical, perhaps you can find a doctor to help you. You just?

Absolutely, yeah,

they’re not all like, you know, what do I want to say? Okay, just, you know, I think this will help in some doctors, if they don’t think it’s gonna hurt you. We’ll go. Sure. Let’s try it. And you know, and that’s not a bad thing. There’s also some, I don’t think you should push your doctor around. Because, oh, there’s a there’s a high chance you’re wrong, too. You know, like, but with the things you know, about like this insulin is better for me that kind of stuff. But you know, you know, Jenny, we’re going to live through this. This GLP not being covered thing for type ones for probably another year or two. I would imagine, even though the studies are happening now. And we’re seeing it already, like you, you’re seeing you work with people are paying out of pocket for it, right? Absolutely.

Yes. People who are paying out of pocket people who are actually paying out of pocket but going to Canadian pharmacy because it’s less expensive and less cumbersome to actually get it. Yeah. So

I had to do that for Arden. So Arden just got an ozempic pen that was oh my god, you shouldn’t see how it works. You call a company that’s based in Canada that I’m pretty sure I’m not talking to a Canadian. Then the pen comes from, oh, God, maybe from Taiwan where I know Taiwan, like something like that, like it’s on this long peg. It’s crazy. Like it’s absolutely crazy. But she doesn’t use very much of it. So out of pocket. It’s not. It’s not cumbersome for us. If I had to buy that pen every few weeks, like I couldn’t afford to do that, you know, and her doctor wants her to have it. And it doesn’t matter. The insurance companies like it’s that right now. They’re hiding behind. It’s only approved for type twos, right? Yeah. But then I have a, you know, my weight work. So I can have that bound? No problem. I literally don’t pay a penny for that. Right? Yeah. But I can’t, I can’t give a dart and it’s measured wrong. And it’s just it’s a disaster. So change doctors to find somebody with a little bit I’d like to add on to that is don’t just pick another doctor and have the yellow pages. Rack tall ahead, have a conversation with the office manager, make sure you’re not wasting your time by going to a switchable place is not going to help you either.

And if they’re not, you know, some of the medications or even some of the things like CGM, sometimes if you have a really good primary care doctor who you’ve had a really good relationship for a while already, some of those could be written by primary care if they’re willing. Right. So that’s another source of sort of securing a prescription for something. Now, some of the, let’s call them fancier meds that are very specific to diabetes, your primary care is very likely not going to do that for you. But again, just as a potential options, some some will,

I’ll say to if you can afford it, or, you know, a concierge doctor is a good way to go. You know, for those who think, Oh, am I paying a doctor cash, that must be crazy. I use a concierge doctor, but our insurance covers it. So we see her, we pay out of pocket, she sends us a bill, I submit the bill, I get almost all the money back, they just for some reason won’t cover it the first time I don’t I don’t even care why,

you know, sometimes those are relative to how it’s written. Sometimes I know that insurance will be very willing to reimburse if you can provide the fact that you’re in network providers will not provide the same type of service, or the same type of education or care if that’s not available in one of their in network providers. Many times they will reimburse. Yeah.

So eventually that’s going to change to by the way, because I hate to say this, but like, doctors are doing this more and more. Yes. You know, like it used to be like we’ll all get together in a group and we’ll pull together and now they’re all running from that. So you’re gonna see a lot more of this kind of shared stuff. But, you know, the other problem here is we’re talking basically about this issue from our perspective, you know, correct. Plenty of you are gonna have crap insurance and it’s not going to matter what you do or who you beg. They’re just going to Stonewall you the whole

way. Right. And I won’t even get into Medicare. That’s a whole nother like, box of worms to open up, quite honestly, in terms of what they cover, how they cover it, how things are written when lab tests are done and going over a certain time. There are so many rules and regulations within Medicare. It’s astounding.

Yeah. All right. Let’s go. Maybe the next one is going to be upbeat when you it’s not just asking us questions when you’ve been focusing 24/7 on diabetes management for a long time, and then things start to settle in. How do you get yourself out of feeling like you still need to focus on it? 24/7 I have. Oh, wow. Okay, this is apparent. I have blood sugars readily visible in every room of my house. Should I turn some of those screens off? Yet? You? I think you definitely. Yeah. Oh, Am I destined to forever be watching this? I know if you put it on every screen in the house, you are destined to be watching it forever. But like, look, I sit in front of two computers all day. And on one of them up in the corner, there’s a little number from sugar pixel that tells me what Arden’s blood sugar is. I don’t think I ever look at it. As a matter of fact, when I need to know what her blood sugar is, I frequently forget it’s there. I do have the glucose globe. I do too. I have one in here, because I’m working and I and all my alarms are shut off. So if Arden has like a flashing red problem, I won’t know because I’m recording. And I have one in my bedroom. Because when I wake up at night, it’s easy to just look and go, Oh, it’s green. I’m okay. Like she’s fine. And I don’t think about it again. I think it’s a really terrific tool. Now if I had one in my hallway, so I wouldn’t miss it. If I was going from my bedroom to my office, then I’d be worried about myself. Yeah. And I see people do this all the time. Like some ingenious there’s always some ingenious engineer dad, who turns like the wall clock into a CGM or some you know, it’s really cool. But

I think it boils down to how much data do you need? Right? Are you I guess I look at it from Are you in a time of trying to figure things out? Are you making a lot of adjustments? Are you trying to watch so that you can see whether the changes you made have made a difference? Or are you in a time where as this person states, things have been pretty good, and I just can’t step away? Yeah, it’s a you have to consciously then step away, right, turn off half of the rooms with the sugar pixel or whatever, you’ve got glowing, right? Turn half of them off, right? Because they’re not needed at this point when something shifts and changes. And again, you’re trying to put in adjustments and make sure that they’re working rate

or vigilant. The difference between you’re trying to assuage your fear, and you’re trying to help yourself make a good decision. Like I think you’re right, like when you’re first learning something or dialing something in, you do have to be a little hyper aware of it, because you’re making those kinds of decisions. Like, I don’t, I don’t know if I talked about it on the podcast or not. But you know, my kids got me that chameleon behind me for Christmas. And for the first four weeks, I was staring at the thing waiting for it to, you know, like,

you gotta poop, can you eat the worst

thing? Or she right? And then like, but no kidding, like, Listen, this is neither here nor there. But the way you can tell if that poor thing is hydrated correctly, is when it goes to the bathroom, you have to assess two different things that happen. And once you have those things, right, then she’s healthy. And but that stuff comes from humidity, and misting, and how long you do it and what time of day you do. And you’re like, oh my god, like so I’m turning knobs on humidity at 2am to see if this comes right out on Thursday. So for a while, I started giving a lot, like but but then I figured it out. And I don’t do that anymore. I check in once in a while now. Hey, you know, right.

I mean, it as far as you said, you know, you’ve got your little sugar pixel notification, you sort of, it’s when something is around enough that you really don’t pay much attention to it. Yeah. Unless it’s blaring noise or an alarm or something at you to pay attention to people ask me, Well, how often do you look at your blood sugars? And where are your alarm set and whatever. And I mean, I have my stuff turned off. When I’m working with people unless I get an alarm for something. My phone is off my you know, all of that is it’s turned off. I used to when I first got my glucose, which I also love. I think it’s a fabulous little tool. I carry it around because I thought it was kind of fun to have it like in different areas and be able to see rather than even like open up my phone or look at my watch to see where my number was. And now it lives in our bedroom on my bedside table because like you said, it’s a nice way that if I wake up I can easily glance I see a color and I’m like great. I don’t even have to open up my phone to look at or

whatever. Right I agree. Yeah, you Come

to feel a confidence. And again, unless you need to adjust something, you’re really trying to pay attention to a time of day. And maybe open everything up for a time of day that you’re having problems with. But don’t open it up. 24/7 Yeah,

you can’t always be looking and staring at it like that, like, you know, the feeling, you know, the feeling is like my kids about to die. I got to make sure that doesn’t happen. Here’s my best advice on this. And I, I’ll stand behind this segment like 100%. If you’re just diagnosed, listen to the bowl beginning series. Once you understand that, maybe at the same time, listen to defining diabetes, so that you have all the terms down, you understand the words. Once you’ve understood all that you’re ready to move on, listen to the protests. And then about six months from now, you’re going to be good at this. And then set your alarms where you know, you want to catch them. Right, Arden’s low alarm is at 70 Because I know from her settings, if we make it to 70 and it’s falling, she may be is going to keep going. Like that’s just what I know from you know, history. And then I like my phone to be but 120 And I like hers to be but 130 going up. And and that honestly is getting less and less important as the algorithms get better and better. But my rule of thumb is if that thing doesn’t beep don’t look at it. Right after you know that you’re making good decisions where you’re not vacillating up and down wildly now if if I don’t know, what’s a good example, I just told you about it. Art in Mr. GLP. For I told you about before we started Yes, Arden spinales came up she Mr. GLP for like three days. She just didn’t shoot it. Of course. Now the setting she has are not heavy enough because without the GLP her her insulin needs go up. So her insulin needs are going up. But Arden’s using Iaps. So I EPS is getting more aggressive as it’s happening. Then she shoots the G. So they’re I’m fine. I let her go. Because she’s finals like she was seeing 180s and two hundreds, but it was after meals, they were coming back and she wasn’t getting low. So I’m like, literally let’s let her get through her finals. You know, I don’t want to like I’m not gonna bother right now barred her? Yeah. As soon as she shot that GLP again. I mean, like, almost as soon as now suddenly, the algorithms being aggressive on the pod five people are gonna know this too, right? Like if you’re super active for days, and then suddenly you’re sedentary, you might, you know, yeah, you might see a shift in in how your settings are less valuable after you had a big change. And so she shoots it again. And now I pay closer attention to it. Because now it’s not a 180 Blood shirt or for an hour. Now it’s 55 if something gets sideways, right? Right. And so then I paid more attention to it. I actually looked at it. And I was like I was with her, which I hadn’t been for a while. It’s like I’m gonna turn a couple screws here. And this algorithm, you mind if I move things around a little bit, and changed her by the way her insulin sensitivity is now like one loser 90, from from one moves her 43 Where she started before GPS, and I made a couple of adjustments. I watched it for a day and a half. And I was like, Alright, this is good. And then I stopped looking at it again. So I mean, I think that’s what you and if you can’t do that, I talked to a therapist, not you know, I wouldn’t ask me, you know, because it sounds like you might have gotten yourself into a into a bad pattern, maybe.

I think technology adds a bit to it as well. Because technology allows us all of this information and makes you then think, well, goodness, if it’s giving me information every five minutes, I really need to pay attention every five minutes, it could absolutely change. It could. But it doesn’t necessarily mean that you have to react to it. I think technology has brought in a world of benefit. But it’s also brought in a lot more reaction versus sit back, watch, make an adjustment and watch again, the reactive nature of managing any slight blip up or any slight blip down ends up creating a lot more roller coaster when truly with a lot of the algorithms that we now have. The algorithm needs time. Yeah, to accommodate for any slight rise or slight fall, you have to let it work. And again, you have to work with it

because the algorithm is working on its own timeline. And your timeline is not the same as it so if you step in, you are most certainly going to mess it up in the future. Unless your settings are so bad that it needs intervention. That’s the thing you need to know not just guess about because you know otherwise, and you can use it and like Arden got low overnight last night. And what I mean by low she went to 65 So she hit 65 So I get an alarm because it went pretty quickly from like 75 to six o’clock and alarm I woke up was like four o’clock in the morning. And I’m like I looked at it. I was like Oh, I wonder if she’ll hear this. And then I was like I don’t want to wake her up. If she’s going to like I don’t want to call if she’s already taken care of it, right? There’s a lot that goes on into this all the sudden is that dynamic here, you it’s tough. You know, if she’s already done something about it, I don’t want to wake her up. I don’t want to not to wake up if it’s a problem, and it’s still falling. So I would look at, I know this is a little unfair, but I have Nightscout. Because Arden is using Iaps. And I look back, and this thing did not think she was gonna get low. It had not been cutting basil like she was coasting really well, but also hadn’t Bolus or made any like, pushes with her basil. And then I looked at insulin on board, and I’m like, she shouldn’t be low here. I wonder if she’s laying on this thing. Maybe this is a compression low, right? Like, maybe let me wait a minute. And

especially since you said it changed pretty quickly between five and six. Yeah, but

it had happened. So I woke up so quickly that I didn’t have I couldn’t look back. And because you can see a compression low after they happen. But as they’re happening, you can’t 100% Be sure. And so I’m watching it. And then it did this thing that I know means she’s laying on her sensor. So it was 65 stable, then all of a sudden it was 59. And it was diagonal down. But then on the next time it said 62 Diagonal down. And I went, Oh, it’s trying to figure out what’s going on. Yeah. And I don’t know how to explain to you that. I know that that’s what that means. But I just know because I’ve seen it a couple of times. I stayed up watching of data. That’s all I watched one YouTube video about chameleons. And then I went back to sleep. I’m still trying to learn things about chameleons. Don’t, Jenny, let me just tell you why right now. And then we’ll do one more question. Oh, God, this is not part of our satin Jenny. But

my kids get me fun information.

My kids get me this. I love this chameleon. It’s fantastic. I’ve wanted to chameleon my entire life. I’m sure I’ll talk about on the podcast. It’s

like boys love this Lobo videos, you text me some

Chinese boys slomo videos of it eating and it’s a lot of fun. But I’ve always I like how slowly they move and how specific they are. I like that they’re difficult to take care of. And if I’m being honest, I miss taking care of my kids a little bit. So like, so this is a nice thing for me to put that caregiver energy into I mean, I put most of it into you guys, but it’s a hairless child. So we’re the kids in airborne. Oh my god. So a couple days before Christmas, we were standing around talking about things that we wished we had done or won’t want to do in our life. And I went around the room I had the kids say something my wife dies for some friends over. And then they asked me and I very quickly blurted out, I want to keep a chameleon as a pet. And everyone looked at me like I had seven heads. Because I’ve never I’m 52 in my life mentioned this to anyone, right? It’s just the way I felt since I was a kid. Oh, my family lovely. They go out and get me a chameleon. But that’s not it also

means up to that point. They hadn’t gotten you a Christmas gift.

Oh, finally, just something for this jackass. Because I didn’t know what to get him. But yeah, by the way, I’m the dad. I get like T shirts. And like thing. My wife got me a Squatty Potty for Christmas one time. I was so getting mad. And can I tell you something? I love that. aleria held it I was like, this is a Christmas gift. She goes you’re gonna love it. I’m like, I don’t care. Don’t give me this for Christmas. Like anyways, but one of the best Christmas ever gotten in my life. This is neither here nor there. So anyway, the thing is, there’s a lot of different kinds of chameleons. And if I’m being honest, this is not the one I would have chosen. But it’s fantastic. And I love it. And honestly, it’s a good starter because it’s a little more forgiving with its health and stuff like that. But there is this kind that I want. They’re expensive. And they’re very, very rare. And they’re hard to find. And so what I thought was, I’m going to take care of this one, this one will live six, seven years. If I do a really good job with it. I’ll really understand this then. And then I’m going to get the next one. I started to get worried because I’m 52 and six years from now I’ll be 58 and the one I want could live 12 years. And I started going 60 Do I want to be taken care of a chameleon when I’m 70 years old, like I don’t know, you know what I mean? Like maybe and maybe not. And so like, you know, and maybe

you’ll put it on Pet Carriers and put it under your seat when you travel on the air.

Imagine and so like, you know, it’s so soon I’m like, tell people this is my it helps me when I get nervous. But did they call that? I don’t know. I don’t

know. You’re like little lifelines. Yeah, I

don’t know. Some people have ponies. I didn’t like a million. Anyway. So I look into it. I find that there are really only about three people breeding these chameleons anymore. The one that I really want, right? And I Okay, identify who they are actually make a little note on my computer, and to myself, like four years from now, go check into this. But as I’m looking into it, the guy who’d like breathe Some of the best is like, I’m not doing this anymore after these, and I’m like, you have to be kidding me. And I was like, I’ve been doing this for 20 years. But this is the last clutch I’ll ever do. I’m like, Can you wait a minute? I just figured this out, you know? And so anyway, I bought another one. I even had two big Yeah, he’s on his way. I’ll be here in like a week and a half.

How do they come given that? I mean, you’ve explained enough to me, like the humidity and all of that kind of stuff, how do they overnight

mail pill, put it into a box packaged a certain way with, like, I guess just moist towels to keep enough humidity in there. And he goes to the post office at the end of the day, and it will be across the country from I’m going buying it from California, I’m in New Jersey, it will be at my post office at 10am the next day. So you pay a really hefty, like amount of money to get it moved quickly. And the guy told me he goes, you’ll open it up and it’ll just be like, Hey, what’s up, and it’s not gonna, it’s crazy. He’s like how well they ship like that. So anyway, I have another chameleon coming. So at some point, this tank behind me will actually be slid over that the other one could fit behind me. And then I’m gonna feel ridiculous. But it really is. It’s the only thing that I was like, I don’t want other pets, our dogs are older, like this is gonna be good. At

some point, I will only be worried about you. If I sign in at some point, and you are surrounded by jungle leaves, and I can no longer see you, then I’ll be a little bit worried. The

breeder says to me, I got a nice female too. And I went, are you upselling? Me? I was like, No, that’s okay. Oh, you want to hear something crazy. The breeder this, this chameleon, I speaking to him on the phone to set the whole thing up. And as he was talking, he was so knowledgeable about this thing that just is not. It’s not information. It’s out in the world really, like, the certain kinds of breeders for the certain they’re very private, they don’t Okay, share their information really? Well. I and he’s like, um, so, you know, kind of said, like, you know, I’m gonna stop doing this. Now, I’m worried that you know, what’s going to happen to the population of these things. And I said, you want to make a podcast, and just dump all your knowledge into it about breeding them and put it out in the world. And maybe somebody will pick it up and figure it out. And he has a podcast. And I was like, yeah, he should like, you know, I said, I make a podcast. And basically, I do the same thing. I have a bunch of information that a lot of people don’t have, and I let it out through conversation. I said, Hell, man, I’ll host it for you. I’ll interview you. And you know, you can get all your stuff out and put it up online. And I don’t know that he’s interested or not. But he says to me, what’s your podcast about? And I said, type one diabetes. And you know what he said? My daughter has type one diabetes. And I was like, Oh my God, how old is she? And he’s like, 20. And I was like, Oh, my daughter’s 20. She has type one diabetes. It’s the weirdest thing.

That is weird. That’s the universe. I don’t know what it is. You can like you cannot. You cannot. I don’t know, I always feel like you can’t believe that. We’re just randomly like sputtering around the universe.

Odd that there’s a handful of people like dishing out good diabetes advice in the world. And there’s a handful of people talking about this specific community chameleon, and like, both of our kids have diabetes, and we’re talking to each other. And then he, by the way, texted me later. And he goes, Hey, my daughter says she’s heard your podcast. And I was like, well, then I thought, of course, but no, no. Who hasn’t? Any? That’s not the point. I mean, that was obvious, right?

You’re like what you give me an extra chameleons for free? Discount?

He said no. So I even asked, I was like, What about cash? Is there a cash price? Because cash the same as everything else was like, okay. But I understand it’s a two year process. I think by the time he sells them, I don’t even know that he makes any money on it. Like it’s, you know, it’s a labor of love. Like he’s doing it to help people. It’s really kind of nice. Anyway, we’re low on time. So let me tell you this. Yeah. I, of course, didn’t know anything about your this is going to be about diabetes, I promise. I didn’t know anything about chameleons when I started and it was a bad idea to get one and not know, I just want to caution people. These are not impulse buy items, I had to put an insane amount of time and a fair amount of money into doing this correctly. So don’t just jump into it. But once I was in because my kids were like, surprised. And I was like, oh God. Like once I was in I had to figure it out quickly. And it was not dissimilar to being diagnosed with diabetes and not getting any information i and that hit me right away. I’m like, Oh my god. This is what people do when they find my podcast. So my first thought was, my Facebook group is so helpful to people. I’ll go find Facebook groups about chameleons. Well, that was less than helpful. Because they were a little judgmental. So word I’ll use and then I thought, oh, that’s why people like my facebook group because we’re not in there. Not each other and being judged and everything like them. They call it’s interesting. And then I watched how they talk and then I finally found a guy with a podcast. Esther who had really good information and was good at expressing it. And that’s where I started getting my chameleon information from. And then I started hearing him talk about community and I was like, Oh my God, he’s having the same conversation about people helping people that I’m having. Yeah, I’m not just adding a little bit. It’s exactly the same. And then I’m like, oh, people are the same no matter what situation you put them in. There’s gonna be a couple of nice ones. There’s gonna be a couple of assholes. There’s gonna be it’s all going to be the same every time. Fascinating. Absolutely.

No, is he the one that told you how to look under the chameleons leg and look for bumps and horns and whatever?

The sheer here, so Jenny, me on the back of their back legs, I have a Veiled Chameleon right now a little bump on the back leg means I think it’s called a tarsal. Maybe is a male without the bump is a female. Also, they have that kind of cast on their head, the ones that kind of stick up in our larger generally males, but when they’re younger, it’s really hard to tell. And there’s no bits and pieces to look for. You know what I mean? So it’s her name still,

Princess.

I’ve been calling her big mama. Big Mama. Yes. My wife is pushing me very hard to name her after the character from the movie Sing. I’m concerned that my wife is 50 years old and really loves that animated movie where the animals are singing, but nevertheless, she wants me to call her Miss Crawley, which I won’t be doing. But she calls her that. My son’s girlfriend calls them calls her one thing. My son’s girlfriend calls or something. Kelly calls or something. I call her something my brother’s wife calls her Kanye. That thing’s got like 75 names. So I gotta be honest with you. It’s a chameleon. I don’t think it needs a name.

It’s actually my husband, I had this conversation one day we’re sitting just, you know, pets are are what they are. Right? And we’re talking like just about how creatures like, we inherently know that we’re human. Right? Because we have the intelligence level and the understanding at a certain degree, whereas we’re looking at our dog who just is I mean, he’s the greatest Chocolate Lab. Right? And Nathan was like, you know, he’s a dog. That was like, no, no, he has no idea he has no, he knows what he is from an evolutionary like all the things he’s supposed to sniff and whatever, but she has no clue that dog means him. Yeah, no,

please. We made that word up. First of all, yeah, we’re frontal lobe and thumbs are we’re probably in that dog situation, pretty much. But ya know, I mean, it’s not like if I was like, Hey, Big Mama, the thing would turn it Look at me. Like, it does the same thing. Every time I get close to it. It goes, is this thing gonna kill me? And then it goes. I don’t think it’s gonna kill me. And then she calms down a little bit like it’s, you know, her life is avoiding. She’s programmed to avoid being captured by birds and snakes. And does she

react differently though, in a learned way? Yeah, you versus your wife?

No, she’s now good with people, but not fast movements. You can reach into the tank slowly, but you have to come from under her. And there’s like a meter like this little box that I need to test the light with to make sure that Jenny to make sure she’s getting enough like ultra violet be like Jesus, you’ve no idea. And so like, and so if you reach in there with that meter, she gets defensive. Like she puffs herself up turns her head a little opens her mouth makes a noise to make. Like that kind of thing. You I reached in the same exact way without the thing in my hand. She’d be okay. Interesting. Yeah, she this type of chameleon are they’re very difficult to hold like you, they probably won’t even ever probably never, like be on my hand ever. So the other one that I got will probably be more handled by sale. I know. They’re very, very, very slow. Like just it’s incredible. I love them. They just look like dinosaurs.

So yeah, they’re I love them. I think my favorite thing is their eyes. Yeah, I love the way that their eyes move. I just it’s so cool. Super cool. If

you approach her from the back, her eyes turn completely around to look backwards. I know. All I want to know is what does that look like to her? Like, I would love a video of that. I know you can’t do that. But I would love that. Alright, well, she’s a lot bigger now than the last video I sent you. So I’ll get you one today and send one over for the boys. Cool. Thanks for doing this with me actually, the chameleon thing. I didn’t just talk about my chameleon because I wanted to I really wanted to say I’ve just been having this overwhelming experience watching a chameleon community work the same way as the diabetes community does. And I said I’ve seen I’ve seen good examples of it work well, and I’ve seen good examples of it worked poorly. And I’ve seen the exact same thing and diabetes. It really is. If you can find somebody that can be valuable to you that won’t be judging you. You just have to look around for it a little bit. Right. So anyway, Alright, thanks so much. I’ll talk to you I want to thank the ever since CGM for sponsoring this episode of The Juicebox Podcast and invite you to go to ever since cgm.com/juice box to learn more about this terrific device, you can head over now and just absorb everything that the website has to offer. And that way you’ll know if ever sense feels right for you ever since cgm.com/juice box. A huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don’t forget us med.com/juice box this is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today’s sponsors G voc glucagon find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juice box. You spell that? G v o KEGLUC. Ag o n.com? Forward slash juicebox. You have questions Scott and Jenny have answers. There are now 19 ask Scott and Jenny episodes. That’s where Jenny Smith and I answer questions from the audience. If you’d like to see a list of them, go to juicebox podcast.com up into the menu and click on Ask Scott and Jenny. If you’re looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn’t matter to me. If you’re impacted by diabetes, and you’re looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. The episode you just heard was professionally edited by wrong way recording. Wrong way recording.com. If you’re not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I’ll be back very soon with another episode of The Juicebox Podcast.

Hello friends, welcome to episode 1232 of the Juicebox Podcast welcome back to another episode of Ask Scott and Jenny today Jenny Smith and I are going to answer the questions sent in by you the listeners. And don’t forget, you can hire Jenny at integrated diabetes.com Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. Don’t forget if you’d like to save 30% at cozy earth.com You can use the offer code juice box at checkout to save 30% off of your entire cart. But if you want an extra little surprise go to juicebox podcast.com and click on the link on the front page. When you place your first order for ag one with my link you’ll get five free travel packs and a free year supply of vitamin D drink ag one.com/juice box guys the surveys were down last month at T one D exchange.org/juice. Box I’m not blaming anybody you were probably busy school was ending etc. But now you’re just sitting around staring at your kids and wondering when the hell they’re gonna leave you alone. So go find 10 minutes where you can be all by yourself T one D exchange.org/juice box take that survey please. This show is sponsored today by the glucagon that my daughter carries G voc hypo penne Find out more at G voc glucagon.com forward slash juicebox. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us med Today’s episode is sponsored by Medtronic diabetes, a company that’s bringing together people who are redefining what it means to live with diabetes. Later in this episode, I’ll be speaking with Mark, he was diagnosed with type one diabetes at 28. He’s 47. Now he’s going to tell you a little bit about his story. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. Jenny, we are pushing through our ask Scott and Jenny questions I think pushing through is not the right phrase doesn’t make us sound like we’re here willfully.

Correct. It does not even remember that I’m always like, what are we doing today? Scott?

Yeah, that’s okay. Well, we’re gonna we’re on topic or whatever. Well, there’s no topic. We’re just gonna go through people’s questions. I’m just going through this document full of questions from people who listen to the podcast, so you’re ready to jump in? Yes. Let’s start with something a little nebulous. How do you keep a straight line on the CGM? Seriously, I am listening to the podcast and we are continually improving. And we’ve come so far, primarily because of the podcast. That’s nice, truthfully, but the line just isn’t straight. I just would like it to be straighter. And although our highs are less high, now, they are still higher than I’d like. So how do you keep a flatter graph? I mean,

this is the one thing that I hear over and over and over and over in questions. Look at my numbers. They’re not stable. They’re not flat, and like you kind of standard deviation of 19. And you’re averaging a 102 blood sugar. How much more stable? Do you want that to be? Exactly? I mean, I’m not saying this from a you know, it’s not judgment, but it’s like, we have to look at this as well, without any information about what this person’s data or their data for their child. Maybe it is much more variability or much higher standard deviation than they really want. Great. Could you contain that a little more? Probably. And it does take work. It takes effort. It takes some experimentation with sounds like you know, this person is doing but a straight flat line. Even in somebody without diabetes. That’s not the goal. The goal isn’t straight straight. Yeah. Nobody’s I mean, overnight, maybe right overnight, where there aren’t the variables of exercise and food and extra Bolus, insulin and everything. Those are the drivers of the up and down. But in that environment, sure. Stable straight. Absolutely. That would be lovely to aim for. During the daytime. You’re looking for more gentle rolls through the day, with a lot less variability a lot less. I started at 100 It goes to 190. Maybe it starts at 100. And it only goes up to 150. That’s, that’s improvement. Again, you’re not looking at 100 stays 100.

Yeah. So I think what can happen if you’re listening to the podcast is that I don’t talk about diabetes from like, this is kind of okay situation, I give you what looks good, right? You know, right, golden, and you try to get to it on your way to it. It’s not going to be perfect right away. And so what I see in this question is progress. You know, that’s, yeah, absolutely. I started somewhere, it’s getting better. How come I can’t get to it? And I just think that the answer is time and experience. Yep. If you have the, the nuts and bolts, if you have Pre-Bolus thing, and, you know, timing and amount, and using insulin and stuff like that, then it’s just at that point, it becomes repetition. Rack, you know, it becomes not getting complacent and saying, Okay, well, when we eat this, my blood sugar goes to 250. And that’s just going to be that. Like, it’s like, I wonder what would work here? Is it more insulin? Is it a little longer? Pre-Bolus? Do I should I come back in 45 minutes an hour later and try to get ahead of a fat rise, like that kind of stuff. But I do take your point, too, that some people can get overwhelmed with the idea of just this incredibly flat, right line that’s supposed to be at I don’t know, 85 forever and ever. And I mean, a person who doesn’t have diabetes won’t see that. Correct?

Yeah, right. And even if you look at those who are following more of the low carb or even the ketogenic, their lines are not flat, so to speak. I mean, flat really means almost no, no variance. Yeah, at all. Right. So while their numbers look more stable, and I guess within a smaller, you know, standard deviation, there still is some little bit of up and down to that. So agreed. Sounds like progress has certainly been made for this person who’s asking. And the goal again, then is I think it’s even more defined by what are your target goals? Yeah. Where are you aiming to be above on the lower end? And where do you really want to try most often, to kind of hit a top end and not really sit there, but to have it come back down to the mid ground,

I take a lot of direction from something you said to me a long time ago, about more like rolling hills, getting rid of sharp peaks, that kind of an idea. I mean, obviously, if you have a meal and your blood sugar jumps to 250, and you know, in 15 or 20 minutes, you didn’t meet the need, you know, and it popped up. And now our goal was, let’s get it back down without getting low, you know, as quickly as we can. I mean, listen, if you’re eating a standard diet, right, like, I mean, I’m not talking about that either, unless you’re gonna be like, very ultra low carb or something like that. And probably mixing in some old timey insulin in there too, and doing some other things. Yeah. Which is not not doable. I always kind of look at, like, thresholds. So for me, if Arden goes 141 50 and rolls back down again, at food I go, I wasn’t perfect, but it’s very good. And reasonable. Also, I don’t want the 150 to be for three hours. I’m talking about, right, maybe a 40 minute window, you know what I mean? Just like kinda up and kind of down. Okay, right. And

the exact in that example, too, if she’s starting at 140, she grazes 150. And then over, you know, an hour she comes back down and she lands at 140. Bolus did its job, right. And your timing did its job, something else might not be quite right. If it doesn’t get back down to target, which might be 100 instead of 140. Right. But again, your little bump up and down. Yeah,

was lovely. My example actually, I’m maybe I misspoke. I’m talking about she’s between 80 and 100, or something and she eats and she rolls the 140 and goes back if Arden was 140 all day, I would definitely I would be like yes, I know you’re missing something.

Something’s not right. But

again, not messing it up. Just something’s you said it better. There’s something’s not right. Basil is not right. We haven’t corrected in the right place. There’s food we didn’t account for somehow with insulin, right? Because if I’m stable at 140, all day, I certainly could be stable at 90. Yeah, you know, it’s just somewhere along there, something’s moved. So I would say to people, like, if you’re on it, if you if you’ve got a background, you’re building your understanding. I think the next goal is just to kind of give yourself some grace and just chill out and let time pass a little bit. Now if it’s getting worse and worse and worse, higher and higher. You might have to worry about your weight, what you’re doing, I think, correct

and doses maybe things have adjusted maybe if this is a child the child is grown or they’ve added something else into the mix in terms of activities, or stress or whatever it might be right. But again, I know the big bottom line is that flat, completely flat with no variance is really not. It’s not the goal that you’re aiming for unless you really just don’t want to eat anything.

Never have a carbohydrate again in your life which is again you want to I’d start with me just you know Yeah. If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G voc hypo pen. My daughter carries G voc hypo pen everywhere she goes, because it’s a ready to use rescue pen for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily, G voc hypo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you store Chivo Capo pen and how to use it. They need to know how to use G Bo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn’t be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma visit G voc glucagon.com/risk For safety information. diabetes comes with a lot of things to remember. So it’s nice when someone takes something off of your plate. US med has done that for us. When it’s time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email to big button it says click here to reorder and you’re done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we’re done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 888-721-1514. Or go to my link us med.com/juice box using that number or my link helps to support the production of the Juicebox Podcast. Right now we’re gonna hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark.

I use injections for about six months. And then my endocrinologist and a navy recommended a pump. How long had

you been in the Navy? Eight years up to that point? I’ve interviewed a number of people who have been diagnosed during service and most of the time they’re discharged. What happened to you?

I was medically discharged. Yeah, six months after my diagnosis. Was

it your goal to stay in the Navy for your whole life? Your career was

Yeah, yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved the

most. Was the Navy, like a lifetime goal of yours?