Full Transcripts

Hello friends, and welcome to episode 698 of the Juicebox Podcast. Today's show is going to be slightly different. Jenny and I are discussing the next series that's coming up on the podcast. The series is going to be called Bold Beginnings, and it's based on listener feedback. In this episode, you're going to hear me tell Jenny the idea that I had explained to her about the feedback that I got from the audience. And then we take the big ideas from the feedback—almost like bullet points—we go over them, put them in an order we want to record in, and talk about them as we go. So basically, you're going to listen to a meeting that Jenny and I had about the next series of the podcasts, but think of it more like a trailer—an extended trailer for a new series. 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. This episode of The Juicebox Podcast is sponsored by inPen from Medtronic Diabetes. Find out more and get started today with the inPen at inpen.today. The podcast is also sponsored by US Med. US Med is a place where you can get your diabetes supplies, and US Med wants you to have better service and better care than you're accustomed to. Get yourself a free benefits check right now at usmed.com/juicebox or by calling 888-721-1514. If you're a US resident who has type one diabetes, or are the caregiver of someone with type one, please go to T1DExchange.org/juicebox. Join the registry, take the survey—it will take you fewer than 10 minutes. When you do this, when you complete the survey, you'll be helping people with type one diabetes and supporting the Juicebox Podcast. The survey is fast. It's easy. There's nothing on there you don't know the answer to. It's HIPAA compliant and absolutely anonymous. T1DExchange.org/juicebox. I have an idea for today. So, in—you're, so we're recording already. So if you say no, it's fine. We'll just not do it. But okay, I don't think you're gonna say no.

Yes, you don't usually. So far, you haven't said no. I've said some weird things. But once or twice, you've been okay with it. So I had this idea a couple of months ago, and I kept thinking—the private Facebook group is just a fount of information, because you can see what people are thinking. Right? Sure. And then eventually, if you see people think the same thing over and over and over again, you think to yourself, “Well, this must be a question a lot of people have.” So I put this question out, and I said, “What do you wish you would have known at diagnosis?” And what I got back turned out to be an 80-page Word document full of information. Now, Isabel has gone through and she's taken out duplicate questions and things. I was gonna ask, “How much was duplicate?” Not as much as you would think when you hear it. But a fair amount was duplicate stuff. And she broke it down into sections, like putting people's questions under headers. And I was thinking that we should do individual episodes based on those headers—sure—and then combine the episodes together in a series. I don't know what I'll call it yet, but it'll be something about questions that newly diagnosed people have; like frequently asked questions of newly diagnosed type ones or something like that.

Yeah, I'm curious—how did you read through all 80 pages, or you're like, “Oh, this is 80 pages. That's a lot.”

I've been making my way through, section by section.

And because I'm curious—if some of the questions are, “Gosh, I really would have liked to know this because, definitely, right up front, this would have been super, super duper beneficial,” whereas some questions may be, “Well, gosh, this would have been nice to know upfront,” but it's a little bit more—like ninja level, right? It's a little bit more down the road. Definitely you would use this, but you're not going to use this two days from diagnosis.

And see, the way you're thinking about it is the way I was thinking about it. And so what I thought was, if we take each header and almost handle it like it's an “Ask Scott and Jenny” episode—sure, right—and then go through them, have conversations, like, “Why does my voice break only with you?” You might say, “Because we're on Mondays.”

That could be. I was actually gonna say if my voice today is very scratchy—I actually canceled clients like two days last week because I had laryngitis.

No kidding. Oh, why don't you want to talk?

No, no, no, no—I think I'm definitely better. My voice is not, like, gone for five minutes. So yeah.

So what I thought was—and this is good for your situation—is I just want to talk through the document with you. But we're gonna record it. So I sent you an email, which will open up into your Apple Notes.

Okay. Let's see—we'll go to my email and see where your email is.

I just think that conversationally is the only way to work through all this. Because otherwise, you know, what most people would do when they are creating content for diabetes—they read these, they choose a handful of questions, and they turn it into some bulleted points—less than they put a, you know, two sentences after each one. But I think that when we're talking about it, the length of time that we decide to talk about a question is usually pretty accurate to answering the question. So for the most part, I think we do a good job of seeing the big picture when we hear people's questions, I guess, is what I'm saying. So, do you have my email? I don't really know. Second...

Do you not talk a lot on weekends? Is that why you're saying that? Maybe it's because it's Mondays that your voice cracks a lot?

I don't talk as much over the weekend. My wife would disagree with that, I imagine. But I don't think I do—not nearly as much, as I mean, I record this show. I mean, the last couple of months have been crazy. I've been recording like five times a week. So I talk a lot—a lot. And then I put ads on things. I probably sit and talk directly for 10 hours a week, just like constantly talking. There are times when my throat feels sore. It's not unpleasant. Okay, did the tag...

I'm right there with you. I talk all week as well. Sometimes at the end of my really long days, which are Mondays and Fridays, I get done. I have to take a couple of breaths before I walk out of my office space because two children—like, they just—they want, you know, they want to talk to you. And kids my age have no inner monologue whatsoever. And it just all comes out. And I'm like, “Oh my gosh, Mommy needs a quiet time with a bubble bath.”

I'm in a mood right now. If you want to know how to Pre-Bolus a bagel, that's all I can tell you at this moment. Does your head get swimming afterwards? Mine does. Yeah, if I sit down and do a talk—for hours—or even when I'm the one of the reasons I don't like people to look at me when I'm recording with them is because I stare at a spot on the desk, accessing what I understand about diabetes, and I just—I talk like...

Plugging yourself into a file, right? Yeah, here's my file. I'm gonna connect to it. I download everything I need for this circumstance. And then you unplug. Yeah, I do.

I wonder if people who don't do this would understand that there's, like, a lake—a damned-off lake—full of information in my head. And if you get me to open it up, I can just let it out. But if you ask me right off the cuff, I'd be like, “Oh, hold on a second.” So you're saying this happened, but once I started talking about it, it just comes out smoothly. So now why is that?

And that's kind of sometimes the reason that I get a little thrown off when people who are not in my diabetes world—whether it's friends with diabetes or people I'm working with or colleagues like you or whatever—the general public without diabetes, when they ask you these very random questions, I have to be very careful about how I start talking about something because, like you said, I will go off and then you get the “glassy” look, like a deer in the headlights. Like, “Really? I didn't want to,” and all this information, and I feel like you're speaking alien language to me.

I find in that scenario, my explanations are so childish and simple that if the next thing I said to them was, “I have a very popular podcast about diabetes,” they wonder why—because I'm like, “Oh, yeah, she's fine. She hasn't outgrown it yet.” Right. Yeah. You know, that's not—hey, you know, what, forget it. Like, you know, so it's just—I don't know, I don't get too deep into it. Otherwise, like you're saying, I'll just start to talk. Right? And then...

I don't know when I get going, yeah. It's hard to like find the endpoint, right?

No, because the explanation—and I think, I mean, to bring it back around—the explanation is always conversational. I'm starting to believe that's sort of why it's harder for doctors; because they fall into that same category as a person writing a blog about it, which is, “I have about 350 words here before I lose people, and I run out of time or whatever the reason—I gotta get it out succinctly.” And this stuff's not, generally speaking, cut and dry, you know? No, you need the big conversation.

So, well, I think that's why the conversational learning you do is very helpful to many people. Because they're already in the realm of something that they are trying to understand—or they understand because they're living it—when you're trying to have a conversation with somebody who doesn't live in the diabetes world or has no connection from family or a friend or whatever, the conversation becomes very one-sided. You become—whether you want to or not—the educator, right? And then it's less of a conversation and more of a tutorial. And it's not a fun conversation.

Right? No, no. And the self-editing that happens—whether it's by the doctor or someone writing a blog—is, you know, you get to a point and you're like, “Oh, I don't want to tell them that because they might misunderstand,” or, you know, “I wouldn't want anybody's blood sugar to get too low.” The way I think of that specific thing is: people's blood sugars get too low all over the world using insulin, but most of them don't know who I am and will never hear this podcast. But if we give them enough information, they maybe could stop it from happening. And I would prefer for them to have a chance rather than not have a chance. It almost feels like— I don't know—it feels like an action movie to me. Like, you know, we've got to jump over this lava. If we don't, the monster's gonna eat us, right? Well, we might as well jump and see what happens, right? Maybe we'll make it over the lava. And that's sort of how I think about this: that you should have the opportunity to succeed. It's not going to work out right for everyone, or it might take longer or shorter for some people, but not telling everybody so that some people don't fall into the lava—does that make sense to you? Because everyone's gonna get eaten by the monster. Correct. That's just...

And at some point, somebody's going to be ready enough to jump. Maybe they weren't when you first gave them the information. But if you gave it to them, at some point they're likely going to try to use some tidbit that you provided, right? They'll...

Have this recollection—they'll think, “Oh, you know, I listened to that.” Like, again, I swear I didn't bring this up on purpose. But this idea of talking about these people's questions after being diagnosed—you can listen to these, and maybe three months from now you'll say to yourself, “Oh, I remember someone said that in this thing. I could go back and look again—I could maybe just go with my recollection.” But isn't that better than them being blindsided by it? Another great example, I think, is that this morning, in the Facebook page, someone—someone's kid had a seizure; their Dexcom was, I don't know, if it was starting up—they didn't have access to their Dexcom data for a little while. The kid had a seizure. She grabbed the G-VOC hypo pen, she stopped the seizure, she took the kid to the hospital. He's recuperating. Now, my point is, is that she did it—like, you should see her recollection of it. She had the information about what to do. It's not, it's not this harried, “Oh, it's not the Scarlett O'Hara post where she's like, ‘It’s the world happening to me again, you know, come pray!’” She's not asking for prayers. She's like, “Look, this thing happened. It sucked. And we took care of it.” And here he is—he's fine. And I thought I was proud of that. I wish it wouldn't happen to the kid. But I mean, as a person whose child's had a seizure, it can happen, you know what I mean?

Happen, right? And I think another thing that you bring in there without really saying it is that, in this circumstance, the parent didn't get emotional—the parent was rational. They said, “This is what's happening. This is what I have to do about it. And this is the next step.” And that's what you have to do. I mean, if I had a T-shirt that said anything, it would say “Be calm and think like Spock.” Seriously, all of these things that you learn along the way—many of them are very rational “do it” decisions, right? Don't put emotion into it. Because despite there being feelings about diabetes and how cruddy it can be to manage things at times, a lot of it is decision-making that is, right now, this is what I have to do.

And someone brought it up to me recently, and I'm gonna have to look into it more because it keeps popping back into my head. They talked about thinking like an astronaut, because everything that an astronaut comes up against is trying to kill them, right? So when everything that you say—you put it in order, like, “This one's gonna get me first, we'll take care of this, then that one, then that one—the seventh thing on that list's gonna kill me.” It might.

But if I clear up one through 69, it might not—it

Might not. And maybe it will—something will change or whatever. And I just, I don't know—I think about life that way. Honestly, not just diabetes. So you know, whatever's our most emergent problem—I spent years trying to explain to my wife that my to-do list was fluid. Like, she would write a to-do list, and if you didn't do number one yet, I'd be like, “Well, number six is on fire. So I can't get one through five done before six burns the house down.” I'm gonna have to move the list around a little bit. It's one of the reasons I enjoy making the podcast by myself—not because people are like, “You could get an assistant,” or “You should do this,” or “What about an editor?” And I was like, “Huh, I don't know. I like the way I think about it.” You know? So anyway, did you get my text? 20?

Yes, that's right here. I thought I said yes—it came through perfectly fine, and I was enjoying our conversation. It's probably the longest text message that I have in—but I should say it's the longest texted note I have. No...

Did it open in your Notes? Yes. Okay.

It opened in my Notes now.

Yes. It's all good. Well, trust me, it's the longest one I've ever seen either. So scrolling through it, she's got it broken down to carb guidelines and impact of food. This is Isabel who took care of this—she has, which is a pretty long list. Then there's “stacking,” range, food choices, Pre-Bolus and the 1515 rule, fear of insulin highs and lows. Isabel, you did such a nice job of this: honeymoon, terminology, flexibility, guilt, fears, and hope expectations. And I'm still scrolling—wow, that's a long one—about the podcast and the community around the podcast, medical team, Holy Hannah, technology and diabetes supplies. Jenny, I'm gonna need you to quit your job so we can do this. And insurance—and insurance, long-acting insulin, exercise, journaling. That's interesting—being diagnosed as an adult, family, extra topics, and then stuff that she...

...wasn't relevant to that.

She didn't find would be relevant to this idea.

Or maybe they didn't fit into a category. So, I mean, they might be things that we can look through and see if there...

Yeah, and the rest we'll call that at some point if we get to it.

So now my brain—like I did when we first did the Pro Tips—is like, we need to rearrange this listing, right? I would probably go through this and list them out according to what I think would be really important: first, newly diagnosed—really go here first, and then “next year” and “next year” kinds of thing.

I was hoping you would think about it. Honestly.

I mean, things like a medical team, and...

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Maybe even food choices—before, like, the carbs and the carb effect kind of thing. I think that the 1515 rule could definitely go along with the lows and the highs; I think they can be kind of included together. Gosh, there's so much in here—honeymoon definitely up at the top. I think that honeymoon is really poorly explained from the get-go, and it's almost like it's skirted over—a sort of comment that's not explained very well. And so people get lost in whether it's going to happen or it's happening or how to know what's happening or what to do about it. You know what I mean?

Yeah, okay, well, let's do this together now. Okay. Okay. So I'm—you tell me and I'll put them up at the top.

Well, I would definitely say honeymooning would be a good first, because that's going to mean for the most part, within a very quick time post-diagnosis, if honeymoon is going to happen, that's where it's going to end up. So that would be probably first. And then I'm kind of curious—you know, terminology is almost like the defining, yeah, diabetes, right? So terminology—these are really good. Maybe just the ones specifically post-diagnosis that would be very important to have information about. So I would say right along with honeymooning, the terminology...

Okay. I have it there. I am putting it in your order.

And then I don't know—I'm kind of thinking the medical team could maybe be placed before we move into a little bit deeper, but I'm wondering—like the highs and lows, especially, because there's a fair amount in the fears around highs and lows, and then specifically the 1515 rule. I don't know how many people post-diagnosis I get to talk to who specifically asked about that. So clearly, this rule is still being taught. Yeah.

Exactly. And it becomes obvious to people pretty quickly that it doesn't make sense, and then they get stuck, frustrated. Yeah.

Yes. So I would definitely say that—mmm hmm—I think right along with is there's one about insulin in here, and I think it might even be able to be included around fear of insulin, as in the Pre-Bolus thing. And the reason I put it in there is, I think, because from the get-go if people aren't taught about timing, you do start to fear insulin. Yeah, because it seems erratic. Exactly. So I would say, you know, within that 1515 rule, the fear of insulin highs and lows, explanation of insulin, and then moving into the Pre-Bolus—thing—could then move more so into wondering like carb impact, because they kind of go hand in hand.

There are so many categories here.

What about, what about stacking?

Well, stacking is going to be...

I mean, that kind of goes along with fear of insulin. It goes...

...along with everything. It goes along with, right—1515. It goes along with fear of insulin, Pre-Bolus thing. You ever have somebody say, “I had dinner, and I Pre-Bolus, and then I had seconds. What should I do?” And it's fascinating—they're stuck. They're like, “I've never had a meal inside of a meal before. What goes on? I can't just bolus again.” And it's funny, because in my mind I'm like, “Well, you're taking in more carbs. Why not?” And then I think what they think is, “Well, that's so much insulin,” and I just put it—someone might be thinking about stacking without ever having been told the word, because it seems like too much to them.

And I think the real definition of stacking too is in there—or a better definition of stacking—because what you're talking about, in a way, is stacking, but it's not stacking without purpose, right? You know, everything that you eat is going to require insulin, right? And it goes back to the timing of the insulin. And also now that we have wonderful technology, like a CGM—what's your CGM telling you? Yeah. Are you stable? Are you already rising? Are you falling? Are you low, falling? Right.

So this lady posted a graph the other day, and it was a 12-hour graph—was beautiful—and there was like, I don't know, she took the kid out for waffles and ice cream or something like that. And she said something like, her child had like 250 carbs in this giant, you know, food, right?

That's a lot of food. Holy cow, right?

I was like, “Wow, no kidding.” But she—you should have seen the line. And it was so flat. And then everybody comes in, and their first thought is, “That's so many carbs. That's so much insulin.” How much insulin was—a smaller kid, right? And she says it was, like, over time, I think 17 units she used. Over—out the kid didn't like horsepower. Yeah, this happened in stages over a couple of hours. And I kind of chuckled to myself when I read it, because if Arden has a carb-heavy meal, she could use 17 units for a meal. And sure, it's a lot—like, you know, I'm not saying it's not—but it's not a lot for that food. It's just—it was interesting that people's first thing isn't, “Wow, you did that? How can I do that?” It was back to their preconceived notions about things. That seems like a lot of carbs, that seems like a lot of insulin. It seems like, you know—and that's all relative to, say, 17 units. I mean, listen—if you had type one, and you weighed 350 pounds, you might be used to 17 units to move a number, you know, like—there are all different reasons why the numbers should be what they are. You know, if Arden goes out, has nachos with cheesesteak on it and french fries, you know—we're somewhere near 17 to 20 units. It's, you know, because of the fat and everything—there's a lot, you know.

I don't think I've ever taken a 17-unit bowl. Oh, my.

Like, yeah, well—you eat like a healthy bird.

I don't know. Even growing up, though, I had definite high insulin needs as a teen—I all teens do. But yeah, I don't know, maybe it was more just from the standpoint that I also started in a very different school of thought and education than we have today. Yeah. I mean, I actually went to my mom's on Saturday with my boys just for an early Mother's Day, and she's been trying to do some cleaning and whatnot. And so, you know, for my brother and me, she kept really organized files—like every report card we ever had. And of all these things—I found in there a scrapbook that I had, at some point, put together after my diagnosis, with all of my cards, all of my mylar balloons taped into this scrapbook and everything. And I found three of my hospital menus with my choices during that week. You kept all of...

...that. I didn’t—my mother. This is my mom. Yes, this is what she does. But it was snowing.

Yes. But it was amazing to me—and in terms of this, that I had a very structured plan that was based on portions and the insulin that went along with it. There wasn't as much variety or variability—and that's just not how my mom did it either. I'm sure other people probably at that time may have. It's just—everything was very structured.

It makes clear that the technology wasn't there to track anything you did. I mean, if you started—if you tried to eat 250 carbs back then, you would have—I mean, you would have been high. I don't see another way. Oh, yeah, your blood sugar would have been high forever. I think that's why some of the old-timers with type one in those groups—see that? And it fries their mind—yeah, you know, like, “You can't do that”—is always there. I wish the internet was audio, because I think you can't do that. In typing, you know, typed out doesn't mean the same thing as how it would sound. You know, it sounds like a direction typed out. You can't do that; you're not allowed to do that. What I think they really mean is, “Holy hell, you can't do that.” Right? Yes, that's not gonna work. But, but I mean—it does. You know, and again...

It goes along with the timing of insulin and when to put it in, and what you're seeing—again, our technology today allows you to do some of these types of things, as long as you're paying attention.

Yeah, right. So, all right, so we got some stacking in there. So right now we have: honeymooning, terminology, highs, lows, kind of all the insulin stuff together. I think maybe within the insulin section we should also put—probably where's range? Because the highs and lows kind of go along with range. Okay, so right—maybe highs and lows and then range. All together.

And then I think I would put—do we put food choices somewhere in there? Not yet.

Um...

...sort of has to go before Pre-Bolus, and doesn't Pre-Bolus...

...thing. Yeah, I would definitely put it in before Pre-Bolus. And then I'm wondering if I was just reading range—I'm assuming we're talking about glucose ranges here.

Let me look. Next, make sure I see it the way you said: what range to be out or shoot for. How being 200 for weeks is okay as the body adjusts, but to taper down to a more realistic, healthy range—it may take a while to normalize blood sugars that have been high. So it's kind of broad, it is. Yeah.

I would probably break it down to range based on what's considered healthy range, what's considered a normal range outside of having diabetes—what is the human body typically aiming for—and then I would move into ranges that might even include things like safe ranges for activity and safe ranges for illness, and ranges that you might hear from your medical providers versus what you're really trying to aim for. Along with, where should your glucose be? What should your target be? Fasting first thing in the morning? What should it be? Or what should you expect after meals? All those things, I think, fit within range.

Well, we could do it as one episode, and just break it up within the episode, right?

Yes. And I think I'd move into, then definitely maybe even terminology—and there's one in here that's about, I think, the medical care team, right? Because I think they all, in a way, go together. The medical care team—in terms of ranges alone—is going to have a very similar range for everybody. They're just going to give you their blanket statement: “You should be here. That your alarms are here.” Yeah.

They're gonna say whatever the ADA said—right? For the most part, 70 to 180 right now is what the numbers are.

That's the numbers right now. I mean, even most of the CGMs have that set as their default in terms of data collection—70 to 180—unless you go into your own settings and physically adjust them to see your cumulative information that's scaled to your target range. And again, a lot of people don't even realize that they can do that within their software, like Clarity or whatnot. But then even discussing within the medical kind of piece, how to pick a medical team, how to ask questions within the medical team—I mean, I'm assuming some of these are the questions within that medical team.

So what if we didn't worry? What if we put these in order—which we're doing now—then after we have it in order, then I will assign a topic to every one of our recording dates coming up? Perfect. And then we can have them read ahead, and then just sit down when it's time to record and have the conversation. We're actually well planned. Jenny, what do you think of that?

That's a great idea.

Listen, I'm gonna tell you—we don't...

...usually ever. In fact, we never do. I never know what we're talking about until we click in together—and I like gardening—and you're like, “Let's talk about this today.”

I'm gonna tell you right now that one of the things about the Pro Tip series that I'm most proud of is just that it really is—we made a bullet-pointed list, and then we said the topic out loud and then did what we did. And it's been so valuable for people. I think this is going to do something similar. Now, here's a question for you. This is more of a pocket podcast question, but I'm interested in your opinion: Do we just make this part of the Pro Tip series? Like, remember I said I wanted to go back and revisit the Pro Tip episodes. Right? Maybe this is going to do that?

It may, it may do enough of that. I think the Pro Tips—I don't know what the longest Pro Tip episode was, maybe an hour.

Yeah, there might be one that's more like 15 minutes or something like that. But pretty, pretty close to that.

Because I think those were very, very specific. And while we talk and veer off and whatever within our conversations, I think if I were to do it, I might actually put this as a Pro Tip category—“Pro Tips for the Newly Diagnosed”—and then put these all up, definitely as Pro Tips, but these are the things within here: if you are newly diagnosed, go here; and if there are additional questions based on one specific topic, maybe go to the regular Pro Tips and look up that, you know what I mean?

Yeah, no, I do. That's a good idea. All right, so I'm still pulling topics and bringing them up top so that I can see them. So you know, there's a lot of—yeah, hold on a second—okay, so we still have flexibility, medical care team, guilt, fears, and hope, expectations, podcast community, family, journey, school, journaling, exercise, long-acting insulin. I know that after the topics came back—so I eventually close the thread and I'm like, “Okay, this is enough. I'm good. Thanks.” And it was very generous of people to come in and spend time giving real, clear explanations of the things that were confusing to them or that they found helpful, etc. And then I put it all into this Word document, and I was like, “I don't know what to do with this,” you know, so I didn't have time. And I thought, “This is such an asset—I don't want to lose it.” But I was like, “I don't know what to do with this.” And Isabel said, “I'll go through it.” And I said, “Thank you very much.” And it took her weeks to, like, you know...

I'm sure—a lot of information. 80 pages is no joke.

No. And so she went through all of it. And I thought, it's a lot. And most people wouldn't put this much effort into their content. And I think that's why it's gonna be good, you know? Yeah. So it's even—why I'm not scared to discuss it here with you. I mean, honestly, this episode is going to serve as sort of a primer to let people know what's coming. They probably, they probably won't hear this too. We have a number of these recorded already—I’ll probably put out the first ones to get them ready for when it's coming. But there's a voice in my head that says, “Don't let people hear you and Jenny talk about this, because they're gonna rip you off.” Because that does happen. Jenny, I put up content, and then a week later, everybody—somebody else has to talk about the same thing, like, “Oh, wow, what a surprise.” And but I don't care, because I think, first of all, the effort we'll put into it won't be matched by anyone else. And the information, you know, I would hold up against what anybody else could come up with. And the other thing is, I just don't think that this is how—I don't think people put this kind of effort into stuff. I just don't—you know, even going all the way back to the Pro Tip series, like the amount of hours that we spent recording that stuff—you know, a lot. Yeah, and you know, we say this all the time, but you don't work for me; you're not getting paid to do that—like, you know, where are you gonna get somebody with your knowledge, and your understanding of how to explain things, and an ability to talk to me because you and I, like, we get along really well and we vibe off of each other, but we're not similar. You know? And it just works, you know? And you're not gonna get that. So I think we can do this. I think this will be terrific. No, this is really great. Yeah. Okay. So does it repopulate when I move words? Do you see it happen right away?

I see it happen on my screen. Okay. Okay.

So you saw me misspell a word. That's embarrassing. Never mind.

Actually, I was gonna ask you—what? You had the word “long” after exercise, and I was like, “What else goes along with that? I don't know what ‘long’ means—long time without insulin, long time...”

...to scroll to make sure we have them all. So I mean, there it is, right? It's—I think that's everything. I'm gonna go back down and go through it when we're actually—if you stay up there where the list is—and I'll scroll through and tell you what's here. You can tell me if we have it up top or not. Extra topics—I’m not worried about that right now. Family—is family up there? Family is up there. Yep. Being diagnosed as an adult—I don't remember typing...

That is not up there.

Can you add it, and we can rename these topics, because you know, Isabel's first language isn't English.

Oh, you did tell me.

And I only said that so when she hears this she'll be mad at me for saying that. School.

School is in there.

Journaling—yep. Exercise—yes. Long-acting insulin—yes. Technology and diabetes supplies—that's out there. I can add that, okay. And then insurance—which I know I didn't put up there either—insurance and the medical team. Yes. Yes. Did someone add—did I add podcast and community? Yes. While this topic—so long, I can't get the header—what is it going to be? I'm still scrolling.

I think the long one.

It's “guilt, fears, hope, and expectations” is incredibly long. That's here. Okay, there's probably a reason for that; it's likely going to be that there are a lot of personal anecdotes in here, which took people a long time to type out. I'm gonna...

I wouldn't expect so, too—and some of that, you know, we'll go through these obviously ahead of time—but I would expect some of the things within that, especially the fears, may be addressed within the other topics.

Right? Yeah. Yeah, I don't think we're gonna—I don't believe that we're gonna have to go through all these and read everyone's thoughts and answer them. I think the way I see this happening is that we prepare by reading them, make our own couple of notes, and then we can have a bigger conversation around that and interject people's thoughts when they build on everything. Flexibility is up there; terminology is up there; honeymoon; fear; events on lows and highs; 1515; Pre-Bolus thing—I’m getting close to the top; food choices; range; stacking; carb guidelines and impact of food; carb pack gifts...

...is current guidelines and actual...

I think that's a topic. Yeah. “All carbs” isn't a topic—better education on how insulin works with specific food groups would have been beneficial.

The hospitals—there's, there's curb impact—is that the headlines?

But hold on a second—you typed it in...

...here already?

I see what you're saying. You're saying it's possible that I—I shortened it, and I should have written that. So I'm gonna put that in there and change it. And I'll change that. Yeah, because this is really interesting. The hospital made it seem very black and white: you eat X carbs, you take this much insulin, and go on with your life. Another person said, “The impact of food—nutrition component on blood sugars. Why isn't her blood sugar tracking the same for breakfast day after day, even with meticulous carb counting?” You're right—a lot of these are going to be able to give an explanation and then point somebody to a different episode where they'll be able to get help counting carbs. Easy ways to count carbs and how different things hit you differently would have been great. Yeah, so basically these last three statements sort of say the same thing. So, okay, great. But my point is that the luck of having such a large group of people—one of the things that's great about it—is that this is not just a random person saying something; now, like, we have consensus...

...this is a pool. This is a pool of—if you were doing a research project, you would have a lot of participants. Yeah, right. Our research wouldn't be, like, n of 10, which then the general information about a study like that is, like, 10 people—great—but the world has how many billion people in it, right? And now many of them have diabetes. So how relevant is this? But this is a very good—yeah, a large amount of people's comments.

Right now, I think this is going to be good. And then some people go into more detail. My biggest frustration is that at first they send you home and tell you that your child can only eat carbs during the three main meals. They talk about free snacks outside of it, so you spend hours researching free snacks and loads of money buying them. And then two weeks later in class, they say, “Oh, by the way, she can have carbs whenever she wants—just those for it.” Here's your new chart, even if they just said, “We want you to wait a couple of weeks.” But at that point, we'll teach tricks, and I say, “Okay, yeah, this is gonna be good.” All right. I'm excited. This is cool. This is what I was hoping would happen. You're up for it. So yay—do we want to try this in the last couple of minutes we have? Do you want to try to put the rest of them in order, or?

Sure, let's see. So we have order already for honeymooning and terminology, highs, lows—kind of all the insulin topics together. I think maybe within the insulin section we should also, maybe, be—where's range? Because the highs and lows kind of go along with range. Okay, so right—maybe highs and lows and then range—all together.

Got it. I feel like “guilt, fears, hope, expectations, podcasts and community” is last—like towards the end—may be correct. Those things, so I'm gonna chop those out and put them down lower to make some space here. I think flexibility is a huge part of it, to be honest. I honestly think your medical team is towards the end—newly diagnosed people are not going to break away from a new medical team. If it's a bad one, they're not going to even know right away. So, correct—maybe put that more towards the end as well. Oh, great. All right. And long-acting insulin could just...

...I think long-acting needs to be around the same area as the fear of insulin, highs and lows. Because you can also define rapid-acting insulin within that, even though it wasn't a question asked. I think it's going to be a piece of that fear of insulin.

I put it before because I can see myself talking a lot about basal in there. And, correct—I just think that basal gets ignored by everybody, doesn't it?

It gets ignored by everybody—except it's the first place that most clinical people adjust first. Yeah, they just don't—some are basal here. Yeah. Hi, here. Let's just put some more basal insulin here. Yeah, probably not. But...

I'm starting to work backwards. I put journaling and family towards the end, correct? Sure. And so I'm going to put, towards the end, we can rejigger these as we need to: technology and supplies—that one...

...I might put that maybe before or after insurance. Okay.

Being diagnosed as an adult.

Um, that might actually—I’m wondering if that wouldn't be too bad to put after honeymoon.

Yeah, so that everybody can feel like they're a part of the series as it comes out, right?

Right. And because being diagnosed as an adult, you may actually have a more pronounced honeymoon; you may have more of a real honeymoon, depending on how you learn to manage things from the get-go. So I think that's good there.

And then we left flexibility, school, and exercising. So now, I would like to put flexibility—at least in front of, I think, flexibility and stacking—right before guilt and fears might be valuable. Then school and exercise. So now, school is interesting, because I haven't read them yet, but I'm gonna guess that a lot of these questions were about, “Hey, how do I just send my kid to school five minutes after they have diabetes?” So I don't know about that. And exercise is kind of the same thing. You see people get sedentary after they're diagnosed because they don't know what to do.

Well, I think school and exercise—there's something, some of these are as well—but they're more visible variables. School is a variable; exercise is a variable. So...

...choices, maybe.

Maybe right after school and exercise, or right after flexibility, put school and exercising—because those both really do require some flexibility in what your typical management style would look like.

You see what I'm doing now? Um, yes, I'm gonna put them in an easier-to-look-at format. All right, well, this should keep us busy.

Along with all the other things that you had scheduled out for the rest of the year, right?

I'm gonna, I'm going to put an end to “Ask Scott and Jenny” because the thing about those is that they're great—they can just go somewhere. They're really valuable. They don't need to be attached to anything else. They're great, standalone episodes. Right? So I'm going to—basically, at the moment I have about three “Ask Scott and Jenny” episodes, a couple more defining episodes, so I'll put up the defining things till they're done. Then I'll put up the “Ask Scott and Jenny” episodes while we're recording these, and then when the “Ask Scott and Jenny” episodes run out, we should have enough of these to get going. Okay, that makes sense. Fabulous, right? Neither of us can get sick or get a life.

I will promise to try not to get laryngitis again. Yes.

Sometimes I look at—I was getting ready to go under for my surgery—and I said to my wife, “If something should happen, hire an editor. I have like 70 episodes of the podcast that need to go up. I was actually, like, concerned or worried no one would ever hear them, you know.” So... anyway, all right. Well, thank you. This was true. Yeah, I enjoyed listening to this talk-through of the idea. We'll find—I'll find out if I get notes like, “Could you guys not record your meetings, please?”

Well, you know, but I think even if you put it up as the preliminary Pro Tip for honeymooning—this is what's coming: if you are newly diagnosed, we promise we are getting to some of these big questions that you really want to know sooner rather than later.

910—I'm counting—1112, 1314, 2020. Okay, so yeah, even the way the podcast runs, usually your episodes go up once a week on Friday. Okay, you're, you're like—you’re the Friday girl. And maybe I don't put episodes up on Thursdays so that I can get them out more timely. Maybe I'll put them up Thursday and Friday for 10 weeks, and then we can get them up more quickly. Okay. Thank you so much.

Yeah, absolutely.

A huge thanks to inPen from Medtronic Diabetes for sponsoring this episode of the podcast. Learn more about the inPen at inpen.today/juicebox. Also, I'd like to thank US Med and remind you to go to usmed.com/juicebox or call 888-721-1514 to get your free benefits check. Take the T1DExchange survey at T1DExchange.org/juicebox. The very first episode of Bold Beginnings will begin in just one week on Friday. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you'd like to be part of the Facebook group—where we got all the information for the Bold Beginnings series—it's “Juicebox Podcast Type One Diabetes” on Facebook. It's a private group, so you'll need to fill out a little bit of information, just answer some questions to prove to the algorithm you're a real person. And just like that, you'll be in and talking with 25,000 people who use insulin—Juicebox Podcast Type One Diabetes on Facebook. And if you're enjoying the show, please leave a rating and review in the podcast app that you're listening on right now. And if you're not listening in a podcast app, please think about doing that—following the show in a podcast app or subscribing to a show and a podcast that really does help. It helps very much; you have no idea—it raises the ranking of the show and makes it more visible to other people. So you can tell somebody about it. Subscribe or follow on a podcast app, and don't forget to follow the Facebook page. And that's pretty much it. I'll see you soon.

Hello friends, and welcome to episode 702 of the Juicebox Podcast. Today is the first episode in the bold beginnings series. While you're listening to this episode, 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. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash juicebox. To take the survey, the T one D exchange survey benefits people living with type one diabetes, it's incredibly easy to do and will take you fewer than 10 minutes T one D exchange.org forward slash juicebox. Also today you're going to hear Jenny Smith. Jenny is a CDE. She has had type one diabetes for over 30 years. And she works at integrated diabetes.com If you're interested in learning more about what she does. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes in pen is an insulin pen that talks to an application on your smartphone and gives you much of the functionality that you will get from an insulin pump. In Penn today.com. The podcast is also sponsored today by us med. Don't just get your diabetes supplies from anywhere. Get them from us med Call today for your free benefits check 888-721-1514 Or you could just go to us med.com. Forward slash juicebox. Us men always provides 90 days worth of supplies, and they give you fast and free shipping us med.com forward slash juicebox. So we did this little episode recently where we talked about we're going to go through the steps of the questions that people sent in about being newly diagnosed. This is going to be our first episode about it. We have it broken down. It's not really it's still it's gonna be a lot of episodes, but we haven't broken down to honeymoon. What it's like to be diagnosis and adult. different terminology. highs and lows, the 1515 rule long acting insulin, fear of insulin, range and food choices Pre-Bolus ng carb guidelines and impact of food stalking, flexibility school exercise guilt, fear and hope. Podcast the community medical care team journaling, technology and supplies, insurance. And that's it. So that's it. That's it. I have it narrowed down to like I don't know, 15 or 20. Yeah, so we're gonna go through and have these conversations. So you and I put these in order, and we thought honeymooning went first. So we're gonna have to feel our way through this a little bit, because we've never done this before. In the past, I just started the conversation. And then we chatted to where we wanted it to go in the in the in the pro tips. But this one, we have questions from people. So why we thought this was important, is because going into the Facebook group with 25,000 people on it and asking them, What do you wish you would have known or someone would have told you when you were newly diagnosed? So under the heading of honeymoon, the first thing that we have here is a better explanation of the honeymoon phase would have been helpful. Let's talk about what that is.

Yeah. Better is is a it's like a rabbit hole of consideration. Right, though, like, better explanation kind of starts with Well, how was it explained to the person or to the majority of people to begin with? Yeah, and I do think it's a concept that's really it's a gray area, have known, honestly. Because it's a time period, essentially, where after diagnosis, you've got some remaining beta cells, at least many people do. Not everybody but many people do. It seems like the sooner you get containment of the blood sugar levels, the more likely you are to have if there are remaining betas, their assistance and they come I'm back to help and that may eventually reduce your overall insulin needs. I mean by how much again, this is a person to person, you may need less overall dosing for mealtimes. Maybe just Basil is holding things really, you know, tight for you in that honeymoon phase. But I think a good word to go along with honeymoon is unpredictable. Honestly.

So, the, you know, let me jump to another question, because I think it'll pull the conversation together, right? This person says mi honeymooning, how will I know. And I think that's such a good point. Because you really don't know what diabetes is to begin with. So whatever it is for you on day one is how you imagine it is and a lot of people get caught up in thinking, well, this is it. You know, and someone can tell you in the moment, hey, you might experience a honeymoon, and a honeymoon is going to be, you might have some beta cells that are still helping along with insulin production. That might be great. Because if it's stable, then we'll use you know, less insulin. But it also could wax and wane. It could be one day, you're getting help. And the next day, you're not the next day you are and you know, especially you're probably going to be MDI at that point, right. So you've got to for the most part, right, you've got a fixed amount of insulin in us a basil. And then one day, you're, you know, your pancreas is like, I'll help and no thanks. I already put the insulin in today, and you're feeding insulin all day. So it's a lot.

It is a lot. And I think a misconception too, is that it shouldn't really be mistaken. And it could be easy to think, Well, gosh, maybe i i was incorrectly diagnosed. Right? Maybe I am really getting better. Maybe I was just sick or something was going on this downplay in insulin need. Especially being tested. I mean, most people who are who are diagnosed with type one, or assume type one, get the antibody testing and all those things that we've already talked about to to really give a positive diagnosis. But once that's there, even if your insulin needs go down in this expected honeymoon time period, you're not you're not getting better. And that's sad to say it is

because it'll hit you that way. Because it happened to me. Yeah, there was a couple of days where art in just out of nowhere did not need insulin. And or at least that's how it felt like, you know, my memory on it could be, you know, right. I'm getting pretty old those long time ago. But right, my recollection is there were two days where Arden didn't need insulin, and I and I've told this story before calling our pediatrician who's a friend. And I preface what I said by going I know I'm wrong. But I have to say this because it feels imperative that I tell you that I don't think Arden has diabetes, somebody made a mistake. Right? And he sat very quiet and sad and said, she asked diabetes, this could happen. You should call the endo and talk to them. And I was like, okay. Yeah, but the problem day to day and why the question gets asked by people who are like, you know, when you ask somebody, what do you wish you knew? I think first of all, you need to know what could happen, you need to know it might not happen. Correct. You know, you might catch diabetes very early. And then your honeymoon might be longer, you might catch it later, it might be shorter, and 1000 other variables that could influence if there's a fluctuation, and if there is how big it is. This person says the lows were horrible. And we had a scary middle of the night, barely conscious, 32 blood sugar, about three weeks after diagnosis. So this is a person who didn't have this information was never told.

Right. And that's I guess it also brings in a timeline of when, and that's a that's a major question that's also often asked is, well, how long can I expect this to last for? It could be a week, it could be a couple of days, it could be weeks, it could even be years. And for the most part, the years that length of time in honeymoon. I more often see in adults who are diagnosed who research has has shown as an adult diagnosed you more often have a reserve of betas after diagnosis that's a little bit larger than really young children or even kids or teens really. In fact, there's there are a lot of good studies for kids diagnosed under the age of five. I believe that actually so it's that the onset of type one is much more rapid and much more aggressive. And that there is more likely that there's less or almost no beta cell action left in really little kids were diagnosed very quickly. Yes, yeah.

Artem was to and, you know, besides those two days, well, here's the rest of me right. Besides those two days, I'm going to tell you that I didn't notice. But I also was a guy holding the meter and a handful of syringes and a vial of insulin right? There were no CGM, I couldn't see anything happening. And these people who are listening very likely are not being handled a CGM right away either.

Many of them are not I've had, in the past couple of months, I've had a handful of people who've actually left the hospital with a CGM on their child. Okay, well, that's fine. But again, that's it's a small percent, but it is encouraging to see how that's progressed in importance for visibility. And or they've left with a prescription to get it within a week or two after leaving the hospital or after diagnosis, which again, is, in my opinion, pretty quick turnaround,

the context that the the glucose monitor line gives you, it's just, it's different. Because otherwise, in your mind, it just feels like the blood sugar is coming in and out of hyperspace. Like, it's you know, it's 78. And then the next time you look up, it's 250. And without context for how it got there, your brain struggles to make sense of it, you know, especially when it's very likely that the doctor has given you basic ideas of what to do count these carbs. Use this, you know, use this formula, inject this insulin, if you're lucky, you got that right information. Right. And because we're talking about newly diagnosed and not just children, I've interviewed a number of adults, you know, you know, over and over again, but lately, one that's sticking to my head where they just told her like your take 10 units of this and eat. Yeah, that was it, you know? Right, right, exactly. consideration about carbs or anything. Honestly, it's more

than for adults, I've seen many more adults being diagnosed, let's say correctly with type one, but given more of a really old school, way to dose insulin, and prior to giving them any, you know, real information or education, if you will, it's like you said it's eat your meal, take 10 units of insulin, take it three times a day with each meal time and go about your business until you actually see an educator or somebody who can help adjust this for you. Where again, that's it's that's really old way to dose.

But you're seeing it more and more you're saying. US med takes over 800 private insurers and they accept Medicare nationwide. They have an A plus rating with the Better Business Bureau and they always provide 90 days worth of supplies. US med carries everything from insulin pumps and diabetes testing supplies to the latest and CGM like FreeStyle Libre two and Dexcom G six, better service and better cares what you're gonna get from us med head over there now to us med.com forward slash juice box or call 888-721-1514 To get your free benefits check. And to get started, you're gonna get white glove treatment at US med. They are the number one fastest growing tandem distributor nationwide, the number one specialty distributor for Omni pod dash. They're where we get our hands on the pod five suppliers from they also are the number one distributor for FreeStyle Libre systems nationwide, and the number one rated distributor index com customer service satisfaction surveys. Come on us med.com forward slash juicebox. Everybody gets your diabetes supplies from somewhere. And everybody knows how much of a pain it can be. US med says they're gonna give you better service and better care than what you're accustomed to. Today's episode of the podcast is sponsored by Ian pen from Medtronic diabetes. And I would like to tell you a little bit about it. The pen is an insulin pen, but it's not just an insulin pen. Yes, it has a cap. And yes, it has a needle and a cartridge and a little window where you can see how much you're dosing. little knob twist at the end and a button you push. It's an insulin pen, right just like you expect. But here's the stuff you don't expect. How about an app on your cell phone that shows you reports easily shareable reports with data that is generated for up to 90 days in pen can do that because it's connected to that app by Bluetooth. The impact app is also going to give you an activity log so you can see a list of recent actions including doses meals and glucose readings. Your active insulin remaining is right there on the screen. With that in pen app, see how much insulin is still working in your body. And in Penn has a dosing calculator to help you take the guesswork out of dosing your insulin. The app uses your glucose levels and a carbohydrate estimate to recommend the dose that's right for you. That sounds like a thing you get with an insulin pump. It even considers the amount of insulin that's still working in your body to help you avoid lows in pen today.com. Forward slash juicebox. Want a digital logbook, in pen has that one carb counting support Oh, well, the pen app can help you estimate carvers based on your meal size. There's also a fixed dose option that allows you to choose the same carb amount for a specific meal each day seems too good to be true. It isn't in pen today.com forward slash juice box, head over there now get started today. There are links in the show notes of your podcast player, and links at juicebox podcast.com. To the in pen, US Med and all of the sponsors of the Juicebox Podcast when you click the links you're supporting the show. In Penn requires a prescription and settings from your health care provider, you must use proper settings and follow the instructions as directed, where you could experience high or low glucose levels for more safety information visit in Penn today.com. Yeah,

I see it, I see it often enough that it sort of frightens me, given all the technology we have today. And the types of insulin we have today and the way that they are meant to work to specifically especially our rapid acting insulins to mimic sort of digestion for the food that it was formulated to cover which is carbohydrate. So why don't we just educate people? Well, give me an idea what your meals look like. I mean, this is pretty easy question to ask people upon diagnosis, okay, your meal seemed to be this. And as an educated clinician, you should really have an idea about how to carb count, especially if you are in the profession of diabetes. And that's you should be able to say okay, let's start easy and just say, for every 15, you take one, right, at least

it gives people context,

something's starting to work with a starting point, even if it's completely wrong, and they need to be a one to five, at least, then in a couple of days, you can say, well, that's clearly not working, let's adjust it, but they already have the concept of counting and dosage.

Your, your your story makes me think that maybe at diagnosis, people are like, well, they're gonna get great technology. And then now this is going to matter. So I'll just say something that won't kill them today, then they can go to the next person, and the next person will do a better job of this. But your point is, I mean, listen, it's not a brag, but I think you could bring me up to any person using insulin. And I think I could probably ask them four or five questions and make a pretty educated guess about how to cover their meal. Yes. So absolutely. Yes, it just doesn't it's not I hate to say it's not that hard. But you know, it shouldn't be if you're a clinician, I guess. Just this next thing here says, What do I need to know, during the honeymoon stage, you really have to put yourself in the position of a person who's just been whacked over the head with a shovel while someone's yelling, you have diabetes. And they're like, wait, what she's she said before they teach carb counting. Like when do I know if it's a true DKA? Or hold on a second? These are broken up questions. So let's skip the car panic and go. When do I know if it's a true DKA situation are just part of the honeymoon stage? What do you think they mean by that?

Well, high blood? It's a good question. Because if high blood sugars are just sustained high,

and then they again, do ketones because somebody told them if you're over this for a certain amount of time test your ketones, right. And they're fresh from a traumatic moment in their life where these kids had or they had a high blood pressure and they were in the hospital for it. Right. Oh, I see. Okay.

I mean, that's what I that's what I would certainly expect but it is it's a it's a good question. But I think it's a pretty complex question. Because if you're in this window where honeymoon could be the case, and all of a sudden you're running high blood sugars, okay, great. Go ahead, do the steps. You know, test for ketones. dose, call your call your doctor and say, Hey, we've been running higher all of a sudden, it seems like without visible illness or stress or anything in the picture. Seems like you're likely at that point then coming out of honeymoon and you actually need To increase your doses, potentially basil to start, maybe the doses that are covering mealtimes, especially if they've been very, very, very conservative. But I mean with high blood sugars, regardless of what point of diabetes diagnosis you're in, if it's a stain high test for ketones, right, good first step.

You know, it's funny, I always think about these things, all these topics about I think of them as like, if we were in an elevator for three minutes, and you said to me, Scott, honeymooning, what do I do? I think, and I don't want to give away that I've watched more than one season of Big Brother, which I'm embarrassed by, but I think you have to expect the unexpected. Like, if Thank you, if you just need to live in the in the reality for a little while, that things are going to change more frequently. Or they could change more frequently, I should say. Then you hope and right. And that's where you hear people online, say stuff that I don't like that they say, but I understand where it comes from, like, you know, carbs, times this plus this equals elephant, you know, or when they say like, nothing makes any sense, right. But if you expect it to be varied, then it does make sense, but it's varied. Right, you know, if you if you put yourself in a position where you say, This is what should be happening, I did what the doctor told me, I measured it correctly. This is wrong. None of this makes sense. I give up. You're gonna, you're gonna make yourself crazy. Right? Yeah, you just have to stay very flexible in the beginning.

And I think that the flexibility and especially in terms of what people should know, after diagnosis around honeymooning is that expect that it may be in the picture for you at some point, sooner than later after diagnosis. And that once you're exiting the honeymoon, it doesn't necessarily mean that you're doing anything wrong. Right? This isn't it's not really, it's not your fault, that you're coming out of the honeymoon time period that you need more insulin. It is what it is. Yeah. So I mean, there's a lot of, I mean, in the grand scheme of diabetes management, there's like, a lot of psychological stuff anyway. But I think this is a, this is a period where you may feel really, really confident. And honestly, during a honeymoon time period, it may seem a lot easier for some people because they have these really tiny insulin doses is they're only on basil. They feel like oh my gosh, I'm an eating and checking my blood sugar looks like it's in this target range. And they may not even be dosing mealtime insulin, maybe Basil is just cutting it for them, right? And then it starts to inch and creep and change. And that's where again, like that psychological piece of management kind of comes in, because a lot of people think, well, well, maybe I need to cut back. Maybe I'm doing too much, maybe I'm eating too much. So I'll just eat iceberg lettuce. And that means it's okay.

It's such a good point that in the beginning, you're very likely using such a small amount of insulin and it can make you feel like I've got this it's so easy. But if your Basal is point one an hour, and you know your whole meal, insulin is like a unit for a meal or something like that, like, I'm not belittling, it's hard, and it's scary and everything else. But you're basically playing wiffle ball in the backyard with your dad, you're not hitting up a Clayton Kershaw right now, yeah, go crazy. When you put the ball over the hedge line, you know, they may just say, okay, and to me, it's all experiences. I mean, I don't know how many times I could talk about it, but you have to do a thing. You have to see how the thing works out. And then you decide, do I need a little more, a little less, a little sooner? A little later? How does this insulin work? And you do it again, and again and again, until one day, it just makes sense every time you do it? And? And the truth is, is that, you know, in the beginning, you do have more going against us than just understanding that you have the other parts, the psychological aspects of it, and what could really be, you could be suffering with depression at that point, or, you know, there's a lot happening. I interviewed an adult recently, she's in her mid 30s. And she said they were explaining to her about her diabetes, and she just sat there thinking I don't have diabetes. Like she wasn't listening to anybody. You know, she's like, a young fit person. And she's like, I don't this is wrong. Like she couldn't get past the I think they're wrong about this. You don't know how many important things were said to you. While you were staring at the wall thinking, hey, what was wrong? Yeah, what the hell just happened to us? Yeah. Okay. Yeah. Is there anything here we're missing? I do want to go to one more question here. But I want to make sure you have everything out that you want to say.

Um, I don't. I don't think so. I mean, outside of just one other question that I think has come up in conversation in discussing with some newly diagnosed people that I've worked with, a lot of people end up asking, is there anything that can sustain this honeymoon? Right? And there's, there's only one study that I know of, and it was done in adult men. So not even a broad spectrum of, you know, gender or anything. But it showed that exercise in newly diagnosed men proved that the honeymoon lasted a fair amount of time longer than those who didn't include exercise in that time period post diagnosis.

I wonder why that is. So

again, I mean, something like that, certainly, you need to study it in more people more, you know, kids, teens, women, but at least it was a good visual that there is that one thing that was shown that could potentially prolong it, and I would, I would expect, it's just from a sensitization standpoint, right building muscle making the muscles work, which makes your insulin work better. And if your body is more sensitive, your pancreas also doesn't have to work as long so maybe it preserves the beta cells longer, right would be my expectation

what let's put this part in here to like, so we know about like Tomislav, for example. Right. There's that drug trial. Yeah, about a long gating people's honeymoons? What's the real benefit of that? For the patient? Beyond that you don't need to use insulin, and you don't have to have diabetes, as soon like, I mean, the lesson to think of put off three, four years, then hey, you know, I'm saying, that's amazing. But if I'm just doing something that's going to extend my honeymoon by a week, or a month or two, like, what's the real benefit of that? Is there one?

I guess the benefit to me especially would be for if it's even keeping people from some type of diagnosis, you know, in those who are tested with antibodies and are given the drug in order to extend the time without diabetes, any years without diabetes are definitely a benefit.

I get that one I'm talking about, like, if running around like a lunatic makes it take three less. Like, if it gives you three weeks back, you know what I mean? Like, like, you've had diabetes for over 30 years? Yes. Would it be any different if you had it for three weeks less? No, no, right. But I would not, but three, three years less, God bless we would like that. Right.

Absolutely. Three years less. Absolutely. And, you know, from the standpoint of ease to the body and whatnot, I think more information needs to be gathered as to people who were diagnosed without use of something like this. What type of outcome with control, like healthy management long term? What was their end outcome compared to people who got the use of this drug and had an extended let's call it honeymoon time, where their body was allowed to help them a little bit more. They had to use less injection, less pumped insulin less, right? What did that bring in down the road? Did it improve anything down the road? And that's going to take years to look at differences

from I think, from my perspective, from a person who talks to a lot of people. When I hear about people wringing their hands about honeymooning what I really hear from them, mostly, they just wanted to stop. They just they just like, can we just get to the part where this is reasonably predictable? Please? Like, like, what what is happening, Jenny?

I don't know. That's not me. It sounds like you're getting a weather. Emergency weather alert.

Maybe a tornado here. Oh, great. Now live, you're gonna ever hear this episode? Scott, he's on his way up.

I was gonna say do you need to go to the basement? I don't live

in that kind of an area. This is the kind of an area where people go like, why don't we get these tornado alerts. But But, but to go back to my thought that was very odd. They just, I mean, listen, if it's a situation where one day your kid can go to baseball practice and the next day, they can't because one day the pancreas isn't doing anything and the next day it is. It's it's it makes you nuts. Like it just does. And I you mostly hear people say I just want to get to the next part at this point. All right. And I don't you know, I don't not understand that. I think but but this person asked this last question that says they're talking about a two year old who overnight is experiencing lows with no insulin at all. And they say he can hover at 90 for hours and then slowly creep down to 70. But here's the thing. Isn't this interesting? If Jenny's blood sugar would hover it 90 For hours overnight, and then slowly creep down to 70. She would text me in the morning, a picture of her CGM ago, look how good I am at this. And that's the thing you don't have context for when you're looking at your two year old baby who's had diabetes for two months. Right? That, you know,

there's not enough history to it for it, this example, this family, this person, there's not enough. I, I have a sense of, of what that means to me. I also have a sense, if I got an alert overnight, and I saw what was happening. Even without using the system that I'm using previous to this, I would have a strategy that I 99% of the time would have worked, right to say, Okay, it's drifting, this is happening, this is what I need to do, or I can go back to bed, because I know that it's all gonna be totally fine. Right? So knew there are, there are a lot of kids, especially kids that I work with, who are still using multiple daily injections or MDI. Because once that Basal injection is there, you can't take it away.

Yeah, this is an example from someone who obviously pumps because they were able to turn their basil off off, right? If they were MDI, they would continue to get low. It's funny, yes, I just was explained to somebody the other day, a person who just doesn't know anything about diabetes, and we're talking about low blood sugars. And they said, Why does it keep getting low? And I said, well, the insulin is dumb, it doesn't know. I think that the insulin is pulling glucose out of your blood, pulling it out, pulling it out, pulling it out, it doesn't get to a number and say, Oh, good, we're done. It just, it will continue to take glucose out of your blood until the power of the insulin is gone. And it doesn't care that you are where you want to be too low, having a seizure doesn't matter, it's going to does taking

correct. And that's, you know, on pumpers if it was happening enough, again, in this particular example, you could say okay, well, this has happened night after night, I've had to turn the basil off. But if you've got a pump, you can program it just program is zero basil from this point of drop to this point of leveling out and and take care of it. You know, but on again, injections, it's it's really difficult. And so often, what we end up having to do is really make sure that the morning is when the Basal is adjusted, assuming that the overnight lows in this case, and assuming it's honeymoon in this case, is the pancreas is just kicking out at this point. Yeah, this is where it's taking most of its action. And so you don't need any injected or pumped insulin here, because your body is helping.

And then the last question that people constantly ask is, How do I know when it's over? And yeah, that one's easy, because you need a lot more insulin,

your insulin needs go up. And it's again, this is a visible Okay, was it today because it was a birthday party or a cookout or something? And so we just had a lot more that was different, or is it ongoing in the next? Okay, this was today, tomorrow looks similar. The next day, it looks similar By day three of needing more insulin and nothing else has really shifted or changed. You're probably getting to that point of honeymoon is ending

experience after experience day after day showing the same thing. Yeah, you're probably not being helped by your pancreas anymore. The other thing too, is I don't want to be like ham fisted about it. But you know, when you have type one diabetes, and you're not getting any help from your, uh, you know, the way I used to explain it to one of my daughter's teachers when they wouldn't understand I said, Look, here's Arden right now, her blood sugar is perfect. If I take this pump for her, take it from her, just she got no more insulin, and we give her a half a bite of this cookie. She's going to be dead in four days. And you're like, I'm laying there like what? And I'm like, Yeah, her blood sugar is going to continue to rise and there is nothing her body can do about it. I said it will put it into decay, it will end her life a bite of this cookie without insulin. And so you can see it. When you don't have insulin, your blood sugar wants to go up. And if you you know if you can, you know, if you have some stability, say you are using a CGM and you have some stability at 120 and then you eat something and you know, you Bolus for it and three hours later, you're 120 Still but then it keeps rising and keeps rising and keeps rising. Your Basil is probably not strong enough. And then you need to probably go over and listen to the pro tip episodes about how to get going and taking care of your blood sugar. So alright, did we do it? Is this good?

I think this is pretty good. Yeah,

I you know, every time we do this, I wait for you to look at me and go, Dude, you're so wrong. Stop talking.

I don't think I've ever said that to you.

You just keep there's that little kid inside of me. It's like I'm gonna mess up eventually. And Jenny's gonna be like shaking her head at me and be like, What are you talking about? Stop but I think

the only one time that I did correct you is when you told me that I wasn't nurse and I'm like, Yeah, I'm not a nurse, dietitian.

I misspoke and there's the truth right now. We're still recording she would stop me if you I misspoke one time in how many years have we been doing this together? Oh my god, you're like, I'm not a nurse. Oh my god, I felt like I was married to you for a second. I was like, Oh, she finally got me he's so excited new episodes of the bold beginning series will come out every Friday. Thank you so much to Ian pen from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast. Please remember to head over to Ian pen today.com. If you'd like to learn more about that insulin pen that talks to that app, through Bluetooth, I also want to thank you s Med, and remind you that you can get a free benefits check right now at us med.com forward slash juice box or by dialing 888-721-1514. It would be a great companion to these episodes to become a member of the private Facebook group. For the Juicebox Podcast. It's absolutely free. But it's a private group so that you can feel comfortable speaking openly with other people who are living in a similar situation as you it's called Juicebox Podcast type one diabetes, you'll just have to answer a couple of questions to prove to that Facebook algorithm that you're a real person, and then you'll go right in to a space with over 25,000 members. There's so much activity on that Facebook page every day, there's bound to be a conversation. That's about something you've wondered about something you're experiencing, or something that you know enough about to help someone else with Juicebox Podcast, type one diabetes on Facebook, in that same group, at the feature tab at the top, you'll see lists of other series of the Juicebox Podcast, like the diabetes pro tip episodes that have been mentioned, or the defining diabetes series, which will also be mentioned here. If we haven't already, everything you need to know is it juicebox podcast.com are right there in that private Facebook group Juicebox Podcast type on diabetes. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Let me just remind you again, before we go that Jenny works at integrated diabetes.com If you're interested in hiring her, she's interested in helping you. Also, for US residents, T one D exchange.org Ford slash juice box, it really is a valuable thing for you to do to complete that survey. And it genuinely helps people with type one diabetes, and it supports the Juicebox Podcast. So if you can spend just 10 minutes today taking that survey, I would just greatly appreciate it t one D exchange.org. Forward slash juicebox. I've seen listeners of the podcast be involved in a number of different trials around diabetes, they got the opportunity from the T one D exchange. The one that comes to mind right now is that there was one person involved in a new adhesive study for the Dexcom G six. But there are many other opportunities. So beyond answering the questions in the survey and helping people with type one by lending your your data to the T one D exchange and I don't mean like super personal stuff. I mean simple questions about type one diabetes, which by the way, are HIPAA compliant and anonymous. Anyway, by by answering those questions in the survey, you will also give yourself the opportunity to hear about trials and studies. T one D exchange.org forward slash juicebox

Hello friends, and welcome to episode 706 of the Juicebox Podcast. Today is going to be the second installment of the bold beginning series. While you're listening to this episode, 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. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash juicebox. To take the survey, the T one D exchange survey benefits people living with type one diabetes, it's incredibly easy to do and will take you fewer than 10 minutes, T one D exchange.org forward slash juicebox. Also, today, you're going to hear Jenny Smith, Jenny is a CDE. She has had type one diabetes for over 30 years. And she works at integrated diabetes.com If you're interested in learning more about what she does. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes in pen is an insulin pen that talks to an application on your smartphone and gives you much of the functionality that you will get from an insulin pump in Penn today.com. Today's show is also being sponsored by touched by type one, I need you to go to touched by type one.org. When you get there, go to the program's tab, click on annual conference and get your free tickets for the 2022 touched by type one Annual Conference, which will be held on August 27. in Orlando, Florida. I think last I heard, I'm going to be speaking, I think in three or four different sessions there. So come on out. Let's talk about some diabetes touched by type $1. Work. So Jenny, here are the questions that adults asked in the Facebook group. And that is, here's a statement. This one says that newly diagnosed those are often treated as type twos for a while, then we get tested and learn why nothing ever quite worked. I think a lot of should be more widely known about. So if you're diagnosed as an adult, I mean, Fair's fair, what I hear from most people is and it's, it's wrong, but doctors look at them. And if they look like they're reasonably in shape and fit, they think they have type one. And if they look like they're not they think they have type two, and it's very common to be to be stuck into a category without anybody.

Correct. And that's in a I mean, what you just said is also in an environment with doctors who really are thinking type one thin, normal size looks, you know, like they maybe are an athlete or something like that. I'll actually say I mean, I've got a number of people that I've worked with over the years that are athletes, like I've worked with a couple endurance athletes who were initially misdiagnosed in the emergency department, as type two and sent home with completely a lack of information and a prescription for oral meds that were not going to do anything for them.

Yeah. Yeah. You'd be surprised how many people I've spoken to who are dismissed at their diagnosis because the very next statement here on in our questions is, when I was first diagnosed as an adult, I couldn't get in to see an endo for a while because I wasn't quote unquote, critical and I wasn't hospitalized for DKA. And one of their first questions was, how do you even know I'm a type one. And you know, nobody does antibody testing right away for you. And this person says I just wish I would have known to ask for a C peptide test. When this was starting. It is not uncommon at all handful of metformin get home, take these come see us in a month, let us know how you're doing except you don't have type two diabetes. You have type one diabetes, and that's not going to help you. So and then you are in a real you're at a risk then a significant risk. Yeah.

Yeah, absolutely. And I think that the issue there too, is adults. We're we're very misinformed when it comes to our education system. All right, we just we really are in terms of many health conditions, but diabetes included, there's still a lot of really good misinformation out there about diabetes. And so as adults, if you have all these symptoms, and you have no knowledge of diabetes, no personal history from family member or friend or anything, you may go to the doctors because you don't feel very good eventually. And then you get diagnosed, we are told your type two diabetes, well, maybe you don't even know there's type one diabetes, or you don't even know that you should ask to say, Well, gosh, this doesn't seem to be what I you know, what, what I would fit into for a diagnosis? I think so I think teaching is important. Yeah, it's

important to know that you can be thin and lean and healthy and have type one or type two diabetes. Correct, right? I mean, and there's just so many in here, like I was diagnosed a month ago, at age 55, a week after my birthday. How was that possible? No one in my family has this. I was 50. My first question was, what the this person is obviously shocked. And then the next thing I want to get to, which I think is super important is, and I won't read the whole thing, but diagnosed at 47 years old, full time job, fast paced lifestyle. They can't get started, really, they don't know anybody that has diabetes, they're busy, they get up, they go to work, they're counting. They're I mean, people end up being hopeful, right? Like this person probably lived their whole life, you get sick, someone gives you a medication, you take two a day for seven days, you feel better. That's that, right? What you expect when this happens. And then when that's not the case, they say, look, it's almost five years later, I still struggle with my Basal with my Pre-Bolus times, this person doesn't know what they're doing. And so

and I think a big thing of it goes a little further than not necessarily knowing what they're doing. One, I've found, definitely, that adults diagnosed with type one and absolutely with type two, are very poorly educated from the beginning, in terms of what to do, but along with that is they've already had a life and a schedule and a structure to that life, adding in something that they haven't been given the right information many times from the get go. And now they have to disrupt a lot to learn how to fit this in, to what their schedule was. Whereas kids are, they're different. I'm not saying that it's not difficult, but it's different, because who's helping the child

write it because when you're diagnosed as an adult, it's on you, it's on you. And when your diet when a child is diagnosed, some person I mean, hopefully, right? A caregiver basically stops the rest of their life to figure this thing out, because the diabetes is really a newborn baby, all of a sudden, correct can't help itself. If you don't know what you're doing yet. And it's a it's a very slow process and a scary process and, and a process where you feel like you're about to drop the baby every five seconds. And, you know, you just sit on the sofa. But, you know, it's funny to piggyback on what you just said, and the next question, somebody said that they got a ton of code, they got a ton of information in their education at the hospital, but none of it's happening in their real life. So what they, they felt like they left completely prepared,

which is great to hear that yay for whoever educated you.

And then there you go, you shop at home. And there's nothing there, the person actually said I had to start listening to the podcasts and reading posts in the Facebook group, but that they still feel out of control. You know, please do a show for older diagnosed people, a different issues like work pressure schedules, exercise, cycles, evening events, etc, etc, all these things, and it's very liquid. It's very true. I mean, Jenny, you know, like, if my daughter runs on a schedule, I can run her blood sugar, like it's nothing but if you start throwing in a bunch of different problems, ya know, and variables like this adult issues, it changes and I never go ahead and say that, you know, Sam, so no, I

was gonna say you're AB you're absolutely right, adult issues are your own to manage to begin with, and many, thankfully, there are a good number of people who have a very supportive, significant other spouse, or a really good friend that, you know, gives them some support or help. I think one of the, not everybody has this option, but I've had a couple of people who've actually after diagnosis, they actually decided to do the best they could for themselves to really get an idea. They took one or two weeks off of work. And they said I am I'm just gonna I mean if I'm going to really nail understanding this as much as I can, and then I'm going to add this other variable back into the picture. I'm going to add work back. Now I'm going to add exercise back. It's but there are a lot of adults who don't have that option, you don't have the time you can take off. So you have to do diabetes, along with what was already in your life. And it adds a layer. I mean, I can say, as somebody who had had diabetes, long time before I had kids, adding kids into the picture has added a layer to my management that is very different than I did before.

Yeah, I saw a woman walk out of an elevator yesterday with a libre on her arm, and she was lugging a baby, and had a four year old behind her. And I thought, oh, that's different than just walking off the elevator. It really is. You know, it's, there's this this next person said it this is very interesting, because I brought it up in the honeymoon episode for newly diagnosed but this person says, I thought I was doomed. I was in denial. And I spent days researching articles about potential cores, cures, excuse me supplements to prevent disease progression and everything. So they fell down a rabbit hole. Then they said they went into a depression, hopelessness. And on top of all that, blood sugar is all over the place. Yeah, yeah, let me keep reading, I kept calling my doctor when numbers didn't make sense. And they repeatedly told me it's okay, if you're 180 to 200 for a few hours after you eat, you're not damaging yourself unless this occurs for long term. Today's episode of the podcast is sponsored by Ian pen from Medtronic diabetes. And I would like to tell you a little bit about it. The pen is an insulin pen. But it's not just an insulin pen. Yes, it has a cap. And yes, it has a needle and a cartridge and a little window where you can see how much you're dosing, little knob twist at the end and a button you push. It's an insulin pen, right, just like you expect. But here's the stuff you don't expect. How about an app on your cell phone that shows you reports easily shareable reports with data that is generated for up to 90 days in pen can do that because it's connected to that app by Bluetooth. The impact app is also going to give you an activity log. So you can see a list of recent actions including doses meals and glucose readings. Your active insulin remaining is right there on the screen. With that in pen app, see how much insulin is still working in your body. And in pen has a dosing calculator to help you take the guesswork out of dosing your insulin. The app uses your glucose levels, and a carbohydrate estimate to recommend the dose that's right for you. That sounds like a thing you get with an insulin pump. It even considers the amount of insulin that's still working in your body to help you avoid lows in Penn today.com. Forward slash juice box. One a digital logbook, in pen has that one carb counting support Oh, well, the pen app can help you estimate carbs based on your meal size. There's also a fixed dose option that allows you to choose the same carb amount for a specific meal each day. seems too good to be true. It isn't in pen today.com forward slash juice box, head over there now get started today. There are links in the show notes of your podcast player and links at juicebox podcast.com. To the in pen. And all of the sponsors of the Juicebox Podcast including touched by type one whose annual event is coming up in Orlando on August 27. And the Tickets are free. Did you hear that at the beginning of the show. Don't forget touched by type one dotwork. In Penn requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, where you could experience high or low glucose levels for more safety information visit in Penn today.com.

Right, but how do you stop it now? Like if it's occurring, and it's damaging long term? Well, then tell me what I should do. So I can stop it from happening long term. Yeah, excellent. Right. Like it's

like, they feel like they're like, you could do a little math, you'll be alright. But that leads to a meth problem. Right, right. And it really is the same thing. Like I didn't I'm sorry, it's such an odd if anybody has a math problem, I'm so sorry. But like, I mean, it's just like, that's how it seems to me. It's just like, Absolutely, Hey, it's okay. Don't worry about it. But it's okay. Don't worry about we have so many episodes where people say, listen, they told me it was okay if I was up to 180. And then one day it was 190. And I thought well, that's only 10 More than one ad and then 200 was only 20 More and then 250 was only 50 More than 200 and I was okay with 200 Before you know it, blah blah, blah, blah, blah. Right and it's not it doesn't help you in this moment when here you On your house hopeless, alone, feeling depressed, unable to manage diabetes? I think the one of the, you know, I'll tell you a genuine I don't know if I would have said this five years ago, but having that Facebook page really teach me like you have to go find other people. Because for a little while, you need to know that other people live with this, and they do a good job.

Because I was gonna do the same thing. Yeah, yeah, hope is incredibly

important. And I'm not saying you got to go to some like type one retreat with people or something like that if you want to you can but but just knowing it I, I interviewed a girl this morning. I see if I can tell this really quickly. Last year I ever interviewed a girl from Canada who was allergic to insulin. i Yeah, figured it out. A doctor in Texas heard the podcast, she had a patient who was going through something similar. The doctor called me I put the doctor in touch with the person from Canada. conversations went back and forth. Long story short, the girl in Texas started using a Frezza. And she's doing much better now. During the conversation that I just had with her the girl from Texas, which is in the podcast summer, like go find I think it's called allergic dance on Park.

All right. That's my alert that I should have turned off for going to pick my child up from the bus stop, which is not my job this afternoon. That

kid can wait, Jenny, we're making a podcast. Wait, tell him to stand there a little longer, he'll be fine. But in the course of interviewing this girl from Texas, the mother spoke about how this is such a rare thing. But that she found a Facebook group with seven people in it who are allergic to insulin. And it was everything to her. Yeah, everything to find those other people, right. And I just think that it's not. For some people, it is not going to be intuitive to go look for other strangers and find comfort in them. But I am telling you, I've been doing this a long time. And not nearly as long as Jenny has been. And it's incredibly important.

No I and I wouldn't 100% agree with that I would include for adults specifically too, don't be afraid to reach out for some type of mental health support to there's a lot that you have to navigate and it really helps to have somebody to even maybe help you get some structure or an idea of how to restructure things. I asked an adult as you said from a touch point, I I did not have diabetes friends, really, until I was an adult. I didn't. I had the people that I got to work with on a clinical bases. But I really didn't have anybody I connected with until I went to a diabetes like athletic training camp. Right.

And you met people there

and I met you it was it was like diabetes disney world to me. Everybody was beeping and buzzing and complaining about blood sugar's and how are you going to adjust before the five mile run? We're going to go on? I mean, it was I smiled the whole time that was there. Because it was exciting to connect.

As as crazy as this might sound. I know this is a weird statement. But for you personally, if everyone in the world had type one diabetes, that would be better for you. You'd,

right? I mean, the whole the whole world would just, it would just understand it wouldn't be a oh, well, you know, I'm gonna bring that special dessert for you because you have diabetes, kind of like the weird comments that you end up getting, right? No, just you don't understand. So sometimes that is even off putting for you as an adult to try to explain to somebody because there's so much missing that you can't explain in just five minutes of why you could actually eat the regular dessert if you wanted to. You just don't bother and you're by yourself. And then you're by yourself. And

listen, I only have the context of a parent but I can tell you that when your child is diagnosed, you have no recourse you're not you know, I'm not I'm not I'm not dropping her in a in a basket or a fire station. She's my kid I'm gonna figure this out right

she's not Moses you're not gonna let her go down the street

I'm not very religious Jenny So I don't know that whole thing but it did pop into my head about should I say I didn't float it out or stream but I couldn't remember the whole parable. Anyway. The it slowly you understand it? And you don't you don't you give yourself over to it. It's a life change. As much as you won't want it to be at first, and you may do a really good job of giving diabetes, a lower impact in your life, but it's going to have one of the only, like, the only thing I can say is, you know, when you get a bad cold, and for three days, you just the world understands, you're going to lay down, you're going to be sick, and nobody's going to hear from you. And you find a way to make that time you do that when you're the parent of a child, you okay? Well, we're, you know, as an example, we were in the we had just renovated a portion of our home when our son was diagnosed, we'd done it, and we had it broken into two phases. For five years, while I learned about diabetes, my children had to jump out the front door, because I didn't have steps. And that is one, that's great. Yes, that is one of the things I put on the back burner, while we were figuring out diabetes, for Arden. And but when you're going to be an adult, and this is going to happen to you, there's no one there. I mean, maybe you have a spouse if you're lucky, right. But you'll be surprised at how many adults I see who try not to share their diabetes with spouses, which is a personal decision, you know, so you're going to have to say to yourself, I got to look at this 24 hour clock at this seven day, calendar this 30 day month, and find some time in here to just learn about this, and find a way to incorporate it because unlike a bad cold, it's not going away, but it will get you know, if I if I had something hopeful to say I would say that diabetes doesn't get easy. But sometimes you get so good at it that it can feel easy, some days. And those days sometimes grow into weeks, where you just go, oh, this was an All right, you know, you're gonna have to make that time in your life, you can't just put your head down and run through it, because it's not going to work that way. And you

can start in from an adult perspective of a major change to your structure or your day schedule. Even if you just start with a basic of kids, then given this medicine called insulin, and I was told to take it, here. And here. If that's where you start, then that's That's it? Yes. Just take what you were told to take. And then moving on, you can kind of build on that. Especially if you've got technology, I would say that's another big one that adults should definitely ask about. I know, parents are definitely the ones to beat down knocked down camp outside the doctor's office until they get the products and the technology that they want. Adults do the same thing. Yeah, I asked for a CGM right away on diagnosis, you know, ask for a pump. And or start the discussion sooner than later, depending on you know, what you think you can handle

to, to use a phrase from the podcast or something else, you should dictate the pace? Don't Don't let a doctor say, hey, we'll look at it three months back. No, no, let's do it. Now. You know, I want to get an insulin pump. Let's start that right now. I don't want to talk about it three months from now, you know, the other thing is, too, is you know, I tell people all the time, you might get a clunker of a doctor. Don't, don't don't suffer with it if that happens, right. And it's you know, I have a note here to myself, that children get treated better than adults do in medical situations. And it's because in my mind, it's a business. And if and if I see you treating my kid poorly, I don't want to come back here. So everyone's very nice and accommodating. It's how kids get treated adults, do not get treated that way. And by the way, if you are if your husband's a doctor, or your wife's a doctor, or you're a nurse, even if you're like you know, an OB nurse and know nothing about diabetes, your doctor is going to assume you know all about it. Yeah, and not tell you anything, because you're gonna think other nurse they know. And we know that's not true, too. So,

in fact, in hiring my own Endo, or endos, you know, in over the past years as an adult on my own. I think since I've been in the profession of diabetes education. I've had more doctors who seem they seem almost standoffish, kind of scared to suggest and or talk about things. I'm usually the one to bring up the questions or hey, look at this. I'm thinking about this. What do you think about this? And I don't, I don't want that I'm paying you to help me. I don't want you just so you can write my prescriptions for

me, I still need help with just a guy with a podcast. And every once in a while I get that I get the like, Well, what do you think I'm like, you saw what I think like that's the best I can do. What do you think? I'd love to hear what you think? Let's collaborate a little bit. It's it's not undoable. And I would I'd want to I'd want to finish this up by saying that I've interviewed you Dozens of people diagnosed in their 30s or 40s, their 50s and their 60s. And they're doing well. It's so possible to do. I would. I mean, listen, I'm biased. I'd find Juicebox Podcast type one diabetes, the private Facebook group and just lurk around and watch people talk. You can learn a lot that way. If you have a question great, if not just sit back and watch. And the Pro Tip series from the podcast that begins at Episode 210, with an episode called newly diagnosed or starting over, I think if you listen to the Pro Tip series that Jenny and I put together, it's absolutely free. I think you could get your a onesie into the sixes pretty comfortably. If you need any help find me and ask and I will absolutely ask. And if you're really, really lost, Jenny works at a place called Integrated diabetes, and it's at integrated diabetes.com. So you could

thanks yeah, I was actually going to bring in the the fact that you've got a really wonderful list of endocrinologists. And I think there are even some diabetes educators within the list on the website on your website, right?

juicebox, Doc's dot com.com Voc acids a list. It's curated by the people who listen to the podcast, who say that my doctor is cool with how I manage. I manage through, you know what I've heard on the podcast and you know, so other people can find them

and you have some pretty good connections in a good majority of the states and bigger cities

is getting bigger and bigger. It's not. It's not not worth your time to go check it out. You might find something near you for sure. Yeah. Okay. All right, Eddie, thank you so much. Thank you real quick when you get a dog.

Oh, we've had a dog a long time.

I know. I thought you have cats. Oh,

well, we have a zoo. We have two kids. We've got a chocolate lab who's like 85 pounds. We've got two fish. We got two cats.

I'm still recording, by the way, but I did not know your dog.

Oh, yes. We've got more hair like floating around.

That dog bark and I went, What the hell is Jenny dog sitting? I've never heard a dog barking all the time. I've talked to you.

I know. Usually. In fact, I've heard your dog's bark before. And I'm I am surprised that in all the years he has not ever bar

I swear to you, I thought you were dog sitting with that happen. I was like, although true.

We often we most often do these more in the morning. And usually if we're getting deliveries, which I expect, probably something came and somebody knocked on the door, they usually come in the afternoon. So that could be why today

you and I almost never do this in the afternoon, actually, that ever is the big deal. Sorry. Well, it's it's a holiday weekend. So I hope you have a great time. Thank you. New episodes of the bulk beginning series will come out every Friday. Thank you so much to Ian Penn from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast. Please remember to head over to in pen today.com. If you'd like to learn more about that insulin pen that talks to that app through Bluetooth. I'd like to remind you again about touched by type one, it's touched by type one.org. Of course, Jenny Smith works at integrated diabetes.com and bold beginnings episodes. And all of the episodes of The Juicebox Podcast are available at juicebox podcast.com. And in any one of your favorite audio apps, like Apple podcasts, Amazon, Music, Spotify, and stuff like that. If you need a list of apps that are free to use, by the way, I also have those at juicebox podcast.com, where you can head over to the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. There are links there to all the series, tons of questions and answers from people living with diabetes, and links to audio players. If you're enjoying the podcast, please hit subscribe or follow in whatever audio player you're using right now. 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 711 of the Juicebox Podcast, a special two part episode that concludes on Episode 712, which is available right now to download Welcome back to the bold beginning series with me and Jenny Smith. Today's two parter happens in Episode 711 and 712. This is bold beginnings terminology part one. In these two episodes, Jenny and I define every word that's available to you in the defining diabetes series. At the time of this recording, there were over 40 definitions. We did a quick definition for newly diagnosed people and left you the episode number. So you can go back and get a more complete definition. If you've just been diagnosed. Or if you're trying to figure things out, it is our estimation that this two part episode, part of the bowl beginning series will catch you up on terminology very quickly. If you're looking for the defining diabetes series, it's available at juicebox podcast.com diabetes protip.com. And in any audio app that you listen in, join the Facebook group Juicebox Podcast type one diabetes to find the lists of all the series in the featured section.

it is a beginning and we very much explain. I mean, the title of it is good in terms of the beginnings part of it, because obviously, somebody has who's even six months in who has not put any not that they haven't put work in, but they haven't put the kind of like, evaluate thing kind of work in yet. They need to know some of how to begin.

Yeah, I mean, you have to start somewhere you need to, you know, it's so funny as I wanted to call it like, it's funny. I know, it would have been confusing, but a part of me wanted to call it basil, because of it being sort of like, you know, the base. And, and I was like, Oh, that'll be to

foundation would be another good word. Yeah,

I know. I thought that'll be too trippy. So let's just go with alliteration bold beginnings. Perfect. So today, we're going to talk about terminology. Great. And I have the list in front of me. Do you have it?

Let me bring up my notes so that I can

we have 14 pieces of feedback that are under the under the heading terminology. I'm going to about you're looking I'll give you the first one person says that all of the terms were so confusing. MDI carb ratio correction factor, Basal Bolus Pre-Bolus. And she says, I really thank God for the defining diabetes episodes. So that's nice. That's not a question. That's a bit of an answer. But we'll talk around terminology for a little bit. Okay, perfect. So what ends up happening, right, you get diagnosed, you're in a doctor's office. They use words, as a matter of course, we all have a friend who's in it, or, you know, a therapist, you know, buddy, and they everyone uses buzzwords. That to them are everyday words, it's, you know, to these people saying Bolus and basil is like you saying, you know, sunshine in the moon, we think, Oh, everybody understands this, right?

Or what's very common now, especially with texting are all of the, you know, the three letter means three words of right, those acronyms? Sometimes I have to look it up. Like, I don't know what that was.

My wife texted me yesterday. And I said, I will answer you as soon as you tell me what that emoji means. Right? I don't know. And I'm not in a position to find out. So you know, it's so it's gonna happen. You're in the doctor's office? You know, you know, for me, one of the things that I maintain is that when doctors try to tell you about glycemic index and glycemic load, I just think the words are off putting. And they are. And that's why I end up saying, you know, you have to understand the different foods impact you differently, because I don't know, it's just from my perspective, I heard glycemic index glycemic load sitting with the nutritionist at the children's hospital, I was like, this is the part I'm going to ignore.

Because it wasn't, well, and I don't want to it's not. It's not saying it mean, but you needed it simpler, right? Those big words can be really scary when you've also just been introduced to something that can be scary, right? Right. So you bring in all of these big words like, what happens with this hyper or situation or this hypo situation, or whatever is going on. And all of a sudden, like, you get these like, this increase in your heart rate, and you're like, what, what, what, what is it?

I don't know what I'm doing. And then and then it's juxtaposed against the pressure you feel, to figure it out, and to do it correctly. Because I mean, it's either you as an adult, and my goodness, then you're like, I'm on my own here. And if I don't understand this, there's no one else. Or it's the pressure of, I had it, I had the thought directly in my head, I'm gonna kill her. I know I'm going to make a mistake, and I'm going to kill Arden and that's how it felt when she was first diagnosed. You know, again, here, all the terminology was so confusing. One person said, I needed a way to remember the difference between Bolus and basil. She said she made flashcards for herself. That's not a bad idea,

actually. Right. That's not a bad idea. No, not at all. I

interviewed a woman the other day. She was wonderful. I enjoyed it so much diabetes for over 40 years. And when I asked her what her Basal insulin was, she told me the name of her meal and some 40 belly. Yeah, yeah. And so

well, do you if from the Bolus Basal aspect Do you want to really know the reason for Bolus for food?

So I was thinking, do you know it? Well, well, what I was thinking was let's run through these people's thoughts a little more here and the feedback that we got, and if the feedback sticks with just like, hey, I need to know the difference. Maybe we can Do a condensed speed version of defining diabetes and roll. Awesome. Sure. Okay. Okay, as dumb as it may sound, the difference between type one and type two is confusing to me. Another person said insulin resistance, how do I figure out what that is? What is the dawn phenomenon? I think in an episode for being newly diagnosed, it would be really helpful to use full terms for things rather than just acronyms and jargon. And we'll all eventually learn them. That's interesting, too. Okay,

that's not a bad. Again, if somebody's asking anyway, and really wants to know, then they will be more informed the next time their clinician says a word. Yeah, they'll actually know what it means.

And I think that, well, I think the way we listen, we didn't just make defining diabetes by mistake, like it really seemed the way to go. And people on the other end, have to be willing to listen to it to learn, and they have to know it's there, which is difficult. You know, it's funny, not to take too much of a sidebar here. But the other day, I saw a person talking about the bolusing, insulin for fat episode, and how life changing it was for them, and that they had been struggling for a really long time. And I thought, but that episodes been up for years. And then I remembered, just because I put it up, doesn't mean everybody see. But from my perspective, you're like, I did that already. So I take the

especially if somebody's starting with Episode One, and just being very, like just moves through the episode, one episode took a long time to get to the other episodes,

this person makes the point that a lot of the episodes feel pump specific, but that most people don't get pumps in the beginning. And it's funny. I want your opinion of it. I don't think the pro tips or pump specific, I think that you could listen to the pro tips and just apply it to a life with MDI. But maybe when people hear it described through pumping, they don't think it would be backwards compatible, maybe.

Right? I think the biggest thing that you could learn from the pro tips, if you are using MDI are the strategies for especially bolusing remain pretty much the same in terms of understanding the timing of insulin. It's the delivery of how you would do it with an injection comparative to the fancy features of a pump that might you tell it to do something and then it continuously does it versus on MDI, you may have to feed a little insulin feed a little insulin feed a little insulin, it's the same concept. It's just you may have to do a couple more injections with MDI, to get the same impact. Yeah.

Alright, so I'll tell you what I'm gonna do. Because I'm looking through everybody else's information here and overall, around terminology, it's Look, I need to know what this stuff means I need to know quickly and the one woman makes there's, I say, woman, by the way, like 75% of the people that listen to podcasts are women. So I'm just assuming they're women, I guess. But it could be a guy. The one thing that I'm seeing is I was overwhelmed. The default I found the defining diabetes episodes eventually, but it felt like a lot. And I didn't know what to listen to. So I think we're going to do exactly what I just said, Here, we are going to play a speed round of defining diabetes. To an eye, this is gonna be a fun test. Alright, so I have

we make this into a game that we can, like, you know, put out there.

Well, here's the, you know, we should first of all, and here's the thing, I'm looking at the list. It is. It's long, it's gotta be 40. Oh, my goodness, hold on. I'm gonna pull up Isabel's list. Do you know that every time I make a new episode, that fits on the list is about re does the list and says it's awesome. She's a pretty cool person. So our defining diabetes. Here it is. I wonder if I put it in this document? If you would see it? Does it update in your notes under the Dr. Jack's or diagnose January comment? If not, it's okay.

I saw something pop into my notes.

Well, I'm gonna I'm gonna look through it. Is it a image? Yeah. Is it an image? It's an image? Was it not coming in clearly yet?

Let's see. Oh, there it is. It's under Yeah, it's the Juicebox Podcast defining diabetes series with all of the Yes. Okay,

so, alright, so this is what we're going to do and there are 44 terms on this list. So right now the Define diabetes series begins at episode 236 and runs intermittently all the way up to 677 was the last defining we did. All right. Yes. You ready? What do you think? All right, so it's 11 o'clock now we have 30 minutes and 44 things that define.

I could actually go a little beyond a little time between between people. So yes.

Taking the fun away but I appreciate it. Yes, we

will try 30 minutes. Go.

Okay, Bolus. You go Bolus.

Me to go we'll go. Bolus is the amount of insulin you take to cover food that you put in your body.

And if somebody says What's your Bolus insulin, they mean your mealtime or your fast acting insulin? Correct. Some examples might be Novolog, a Piedra fiasco humor LOGG. Did I miss any little jab loom JEV. So those are insolence you use to correct high blood sugars or to cover meals. Correct. That's good. That's what that means. All right, that's what Bolus means Basil is a slower acting insulin. It's either injected for people with MDI. The way I always think of it, whether it's right or not, is that it kind of goes under the skin and a crystal form and then sort of melts away slowly over time, giving you a base level of Basal insulin Basal insulin is meant to control your, your blood sugar away from food. And it if it's dialed in correctly, it should hold your blood sugar fairly stable at a place Basal insulin shouldn't drive you down. It's not its job to overwhelm meals. It's a baseline of insulin if you're using it. Good.

Oh, I was gonna say one. In fact, to add on to that once your Bolus is done working, your Basal should hold you where the Bolus left you. If the Basal is right,

that's a great way to put it. So Basal insulin is let's see love a mirror Lantis. What are the new

Jao? Trust Siba basic lar. I might be missing one

you had to pick one if you were if you were giving a person on MDI a Basal insulin. Which one would you pick? I have an answer. What is yours?

To in today's world, I would pick receba.

Me too. And that's only based on feedback I see online from people.

And that's based on my feedback that I see actually from the people that I get to work with. It seems to be much better and in from I know a lot of people probably say Well, is it good for age, you know, a specific age. I have kiddos using it and adults using it and it across the board seems like a very good true 24 hour insulin.

Oh, you know what we should do while we're doing this? I'm glad I thought of it after only the second one Bolus. The defining diabetes episode for Bolus is episode 236. The defining diabetes episode for Basal is 238. The next defining diabetes is 241. Honeymoon. It's your turn. Awesome. Honeymoon. Yay. Wait, no, no, no, hold. I did that already. No, no, I tricked myself. Basal insulin in a pump is different. So if you're pumping, right, you don't inject Tresa are another thing. Your pump just takes the fast acting insulin, your NovaLogic for example. And it not only you know, can you tell your pump I just had 30 grams of carbs. And your pump might say to you, well, that's three units and you put it in, but you tell your pump I need 20 units of insulin every 24 hours for as a Basal insulin and it breaks those 20 units down into very small, tiny, like blip pulses. Yeah, like pulses. And so instead of injecting insulin, like you would with MDI, for your Basal, and letting it work on its own, the pump puts in a little bit a little bit a little bit constantly, it creates that baseline. Correct. Right. So

and that is the beauty of a pump is also using only what we consider rapid acting insulin or Bolus insulin. Your body doesn't have to sort of figure out the action of two kinds of insulin right? A Basal injected insulin like to receive our Lantis and then a Bolus insulin like Novolog, for example. You should however, always make sure to keep Basal injected insulin in your refrigerator in case your pump fails, right. That's my little educator, thing for you appreciate that.

One day, I will actually do that. Maybe when Arden least or college will be the first time we actually do that because that would be a good idea.

So when your pharmacy isn't like two seconds away from your house, right?

So then once you're in so when you're injecting insulin when you're MDI multiple daily injections, which we'll get to on this list at some point, Bolus is a thing. Like your Bolus insulin is that thing, your Basal insulin is a thing. But when you're pumping their concepts you Bolus because the pump just holds insulin and when you Bolus it puts in insulin, and it also creates a Basal level. I don't know if I'm saying that right. But do you really mean like that it's not as tangible when you talk about it in pumping their functions. And when you talk about an MDI, their vitals, does that mean I think

it's because of the difference, as you just said, there's a defined Basal injected insulin. And that's a kind of insulin. It does the same thing as your drip, drip pulses of basil coming out of your pump. But you're right, I guess I never thought about it that way that, you know, pump. It's the same reason for using the insulin, even though you're using two different kinds of insulin to do the same thing. It's

almost like the difference between writing on paper and typing on a computer. Like yeah, right. It's a thing is happening when you're on a pump. But when you're writing on paper, you're physically accomplishing it. Oh, I'm good with that one, episode. 241 honeymoon. Sorry, it's your turn. Already six minutes into it, we've only done so

we're good. That's okay. Oh, is that phase after diagnosis, where your insulin needs may come down by how much is really, completely individual. It may happen soon after your diagnosis. It may happen a little bit later, like weeks after diagnosis. It may last for a short period of time, short being maybe a week, and it may last longer. Some people it could be an entire year of honeymooning. So it's something that happens essentially, once your body has enough insulin from injections, or maybe you've started a pump pretty quickly. It gives your beta cells a little bit of a break. And so you often get a little bit, outcome, or output I should say from those data's again, they start to help, because they're not as stressed as they were pre diagnosis where they couldn't keep up with such high blood sugar levels. And so you end up having this drop off in insulin need. Some people require only Basal insulin, they don't take any Bolus insulin for their meal coverage. At first, and then some people may take just really tiny amounts of both kinds of insulin, Basal and Bolus insulin.

So the way you see it kind of in the real world is the doctor set you up with insulin, it feels like it's working. And then all of a sudden, you wake up one day, and it feels like you don't need as much of it or sometimes at all, or somewhere in that spectrum. The reason it's a term that people know about in diabetes is because it's incredibly frustrating and confusing. Because if you think about it, you've made the decision. I need insulin to cover this food. And then what happens if all of a sudden there's another entity also giving you insulin, your beta cells right now you've got twice as much as you need, your body doesn't see manmade insulin and go oh, no worries, we don't need it. So yeah, right. So two things are happening at once. Is it possible that someone never experiences a honeymoon? Yes, okay.

All right, adores that it's so mild and things are not quite contained as much that it may not really

notice. That is what I thought when I wrote down to people never Are there people who never experienced it. What I thought was, I wonder if they're just people who never notice it? Because maybe their management isn't even such like maybe put yourself in a scenario where your doctor is like shooting for a 200 blood sugar. Right? And maybe you're experiencing 150 blood sugar because of the honeymoon, you would never know that your pancreas was helping,

right? Because you're not necessarily getting too low. So it's not worrisome. Right?

Right. It's the outcome that makes you worried about it. Like if you have a if you have a great doc that sets you put your settings together where your blood sugar's 110 all the time. And then your pancreas kicks in and make sure 80 or 70 or 60 that you would notice. Absolutely, yeah. All right, honeymoon episode 241. Episode 243 is a one C. Say the real words. What do they mean?

Well, a onesie is hemoglobin a one C.

a 90 day that's it. The blood test can be done by a finger stick in the office or a blood draw gives you a 90 day average of what your blood sugar is or was correct. It's weighted differently though, right? Like if you had an average blood sugar of 150 in the first 45 days, but an average blood sugar of 80 and the last 45. It might show lower is that right?

That's correct. It's weighted heavier to the more recent timeframe. And the reason is because of the cycle of red blood cell life, of which hemoglobin is a piece of that. And glucose has an affinity for hemoglobin. So the more glucose you have in your system, the more it gets stuck to the hemoglobin. And the life of the red blood cells essentially has a memory, if you will. So, older red blood cells will not be in as large of a concentration or percent as the ones that are closer to the time period where you got your blood drawn, or had the fingerstick done.

Okay. Back in the day, once he was the only way that people using insulin could track their successes or or see where they might need adjustments. Today, we don't just talk about a one see their journey. What else do we talk about?

We talk about time and rain, I'm in

range, which by the way, as I'm looking at our defining diabetes series, we might not have defined. So really, it's possible we're gonna we are making more work on ourselves. So now I'm thinking, so, but But listen, here's why your agency can be fooled. And it's a great measurement. I'm not a person who says it's not a great measurement, I think it's a it's a reasonable way to see where you're at, except if your blood sugar is 400, for 12 hours of the day, and 50 for 12 hours of the day, your agency is going to look lower because of the average. But that is not healthy. And that is not the right way to achieve a seven a one C for example, you can get to a seven the right way or the wrong way. And that's and but but go to Episode 243 For a more complete description of a one C, but find the diabetes pro tip episodes eventually for an idea of how to keep stability so that you can trust the agency that you're seeing when you get it tested.

Correct. And I think he was he was one of like the first episodes we did together, wasn't it?

Yeah, it was, before we did any series, I asked you to come and talk about it. So there is a there is an all about a one C episode. That's just you. And like a young Jenny and Scott talking. This is a little embarrassing. But the next defining diabetes episode 245 Is time and I looked right past it on the list as I was like, I don't see it anywhere. Go ahead, give them time range.

Yes, time and range is a, it's a good visual of a defined bottom and top value that you want to stay within the typical defined time, especially if you're using Dexcom, or many of the other continuous glucose monitors, they have a default of 70 to 180. So if you are looking at your CGM data, especially the amount of time that you spend between that bottom and top is going to be your time and range the time you you know, a percent of the total time in glucose overall, you'll also be given a time above that and a time below range to how much percent some some of the databases also do. Time wise, like how much time did you spend above this in hours or minutes? Which is kind of interesting to define it that way too. But yeah, time and range. I think also, it goes along with what do you want your target to be? So you have to define your target range to be able to then say, Oh, I spend, you know, 90% time in range? Well, that's great. What's your target that you're setting that for?

So anyone see time and range, and the next defining diabetes episode, Episode 247, standard deviation, these are sort of the three things you use to measure your actual outcome. You can't just look at the A one C because as we said, it could be fooled. You can't just look at time and range. Because what if you set your range from 60 to 300? And you're like, I'm always in range. That doesn't count. Okay, that's not fair. You got it, you got to play you got to set up some rules, right. So for instance, Ardennes is well, I guess Ardens is 70 to 150. In her clarity report and clarity is just the software that that Dexcom uses to help give you a feedback. And so if Arden's 151, she's high out of range, if she's 69, she's low out of range, if we keep her between 7150 to 24 hours that would say that we were in range for 100% of the time, right so anyway, don't like don't lie to yourself, I guess like like set it up like and so you can see where you really are. I find it incredibly valuable to look at those numbers every other like few days I just pulled up on my phone real quick. I'm like alright, we're where we're at. I expect If it's B or G, something's happening, you know, right. Here's the thing. I'm embarrassed. I need you to explain standard deviation. Oh, because the math thing, I know what it is, I can't explain it. And you're, you're like what?

Well, I also think that standard deviation, I mean, well, you can essentially explain it as a math thing. It's similar within diabetes, but you'll also see that value represented as milligrams per deciliter, or for those who are millimole as millimoles, and especially looking at your clarity reports, because they will give you a standard deviation. And really what that indicates is variance. Right? A deviation from, from your average, up and down. Correct? Yeah. So if you're saying, okay, my standard deviation is 60. That means that you're having a wide variance up and down from where your like stable midpoint is. If you have a standard deviation, that's 22, then you have a very small variance up and down from where you're kind of averaging.

So smaller, the number of better you're doing,

the smaller the number and another one that kind of goes along with it, which we don't have on our defining list. But people consider similarly is the coefficient of variance, right? This is that CV. I mean, that's located within there as well. I think many more people pay attention to standard deviation, though, to try to say, am I improving, and that kind of goes to goes along with that time and range, you know, defining your target range. And let's say you've had it set really high, you've had it set from 70 on the bottom to 250 on the top, and you're looking to improve, you're taking tips and things and you're learning more, bring that top number down, right? And compare time periods so that you can actually see, okay, I had this much time in range, but now I've tightened my, my range, am I actually doing better, even though I've tightened things up, and that's also where standard deviation should come in. Because if you've tightened things up, but your variance has not changed, it's gotten a little bit worse. That's not doing better than

right. So that's an episode 247, where Jenny and I do a better job of explaining standard deviation than me just going I don't understand it. And if you want a bonus for that one, episode 343 is called standard deviation and her friends. It is a conversation that I had with a doctor who works for Dexcom, John Welsh, and we do a deep dive into standard deviation, coefficient of variation, a one C time and range and more like we really dig into it if you want to, like do a data geek diabetes. Deep Dive, it's episode 343 on

I might have to listen to that. Oh, he was I don't think I've listened to that one. He

was very interesting. Okay, Episode 249. To finding diabetes, extended Bolus, I can do this one. Awesome. Alright. So if you have a pump, and you know, you could kind of mimic it in a MDI. But if you have a pump, you could say to yourself, I'm eating pizza, which I think is going to be 60 carbs. But I know that when I eat pizza, I don't feel the impact of pizza in my blood sugar for an hour. Let's just say that that's your experience. It's probably longer than that. But okay, we'll say an hour for your experience. But I do know I need some insulin when I start to eat but not all of it. If I put in too much, I get low. So what I'd like to do is extend my Bolus. So this 60 carbs, I've decided this is let's just say your your ratio is one to 10. And you need six units, what you really want is for, I don't know three of the units to go in when you Bolus, but you'd like the other three units to get stretched out over an amount of time. So you can tell your pomp, I'm going to extend this to three now and do the other three over 90 minutes. And that it will take the remaining three units that didn't put in and stretch it out almost like a really heavily heavy Basal program, like we just discussed five minutes ago, how Basal on your pump is spread out little bits at a time little bits at a time constantly. In this scenario over those 90 minutes, it would take those three units, break them down over 90 minutes and put them out in small boluses over those 90 minutes, and that would be extending your Bolus. Is that fair? Is that fair? Not bad. All right. There's nothing to add to that. I did it.

Right. No, you did it.

Here's the thing. Perfect. Here's the caveat. They're not easy to figure out. Because if you extended over two hours and you really needed it Over an hour, then you're too weak. If you extend it over, you know, over an hour, and you really need to extend it over two hours, it's too strong. It is a to me it's a trial and error thing to learn how to do an extended Bolus. If you're on MDI, it's not the same, because you can't slowly stretch it out. But in the example of food that is going to cause a rise later, you can Bolus some up front and then inject again, a little later act almost Pre-Bolus thing the rise, which is sort of what you're doing with an extended Bolus as your Pre-Bolus in the next rise that you expect,

correct. And a lot of that on MDI. I mean, along with pumping to it takes some analysis of some of the similar things that you've done over and over to see enough of a trend to say, Oh, well, this always happens when we have peanut butter and jelly at lunchtime. So we'll have to try an extended Bolus or we'll have to try a double Bolus sort of plan.

Can I do the next one and then you can do the one after? Sure. 251 is algorithm you're going to hear people say algorithm you might think Oh, I hear people say all the time, Facebook algorithm algorithm, it computer program, think of it that way. Right? In terms of diabetes. Let's see on the pod has the Omnipod five tandem has control IQ Medtronic has the 670 G that right there all

777 Their newest, and in Europe 780

Do It Yourself versions loop. What's the APS one called a free

APS, there's Android APs. I'm sure that open APS I'm sure that I'm that there are lots of the APS like little offshoots that I don't really know as much about honestly

doesn't matter. The ones Jenny just ran through are literally do it yourself. Someone on the internet made it and made it available to somebody else. Some people choose to download them, you put it on your phone as a as a program, as an app, I guess would be what the young kids would say. And you're somehow this app, I'm not a computer person talks to your Dexcom CGM, for example, and to your pump, and it makes decisions about insulin dosing and handles those decisions, the algorithm is handling those decisions, whether it's on a do it yourself unit, like the loop which Arden uses, Jenny uses Jenny loops, or it's on the new AMI, pod five, or control IQ from tandem or any of the others the algorithm is just the computer, program app, whatever you want to think of it, taking in your data, making decisions and then telling your pump make your basil higher, make your basil lower, we need to Bolus here, that kind of stuff.

Correct. And all the algorithms, they're a little bit different for each of the different system. Right? So swapping from one to another, you may have some reworking to do. And or that really starts with relearning this system versus the system that you're coming off. Yeah.

All algorithms are settings based if your settings are bad algorithms are as useless as you not understanding where to Bolus if you're on MDI. But that's what algorithm means specifically, can you do episode 253 non compliant?

Oh, this is such a word that I, I so hate this, this one. But yes, I can do it. So non compliant, if we look at it just as a simple non emotional, this is what non compliance specific to diabetes and or really any health condition means, right? You are intentionally neglecting your own care or your child's care, right? That you're really refusing to take good steps to do better to remain in the target that you've been given to aim for. That's non compliant, whether it means not taking your medications, just not appropriately managing and covering for food that you're eating, or you're missing your doses or whatever it is a I don't love the word non compliant. In fact, I really hate it. Because I don't think I don't think 99% of people are willfully choosing to do themselves harm, right? I don't that would

be my that's my experience from talking to people. What I see mostly like, I'm not going to tell you there aren't some people who just have breakdowns and just like I'm not going to be diabetic anymore, which gets you to the hospital in a couple of days. But mostly most of the time what I see what happens is, the doctor gives orders to the patient The patient either doesn't understand them or understands them, and they're not good orders. And then you come back to see the doctor three months later, your numbers in close aren't where he expects him to be. So the or she so they make the assumption that you're not doing what you were told, and therefore they believe you to be non compliant. That's pretty rad. Yeah,

exactly. And, and therein lies I think a big, big problem really is. There's a rabbit hole here. But in many office visits, there's a limited amount of time that can be spent in discussion, and really digging into what the data is showing. And when you only really look at data, and you don't ask more about what's happening in the person's life. You may certainly think that somebody is quote, unquote, non compliant. Yeah, well, maybe this big life, upheaval ended up happening. And that doesn't mean that the person doesn't want to take care of themselves. It just means that something has happened that is sort of taking over and they're trying to do their best. So yeah,

here's, here's, what I would say is if somebody's calling you non compliant, and you and your heart are like, No, I'm really trying, you can express to them. I'm doing what I've been told it doesn't seem to be working. Can we try something different? You could run into a doctor who's like, yeah, great, let's make a change. You could run into an ego that says, oh, no, no, no, what I said to you was right, you must not be doing it. That's them. And that does happen, I'm sorry to say, but that's them, not knowing what to do next. So they just push it back on you. Correct. There are even people who will go listen to these defining diabetes episodes, they will listen to the Pro Tip series, they will show up with an A one C five, five, and the doctor might say to you, that's too low, and call your non compliance because they want you to be at six. There's a lot of self care in diabetes. And if you ever experienced any of these things, you're going to realize that you need to be the arbiter of what success is for you that you're not, you're not noncompliant if you're trying. Can we move on? Do you want to say more? Yes. Episode 255, the famous glycemic index and glycemic load. And by the way, by the way, Isabel, if you're listening, you have misspelled glycemic on my list. I want it fixed immediately.

Because probably an honest little mistake. On the see on the keyboard right next to each other,

fired, fired this lovely woman who makes these lists for free out of the goodness of her heart, she can't do it anymore. Episode 255, glycemic index glycemic load? Go ahead.

Yes. So glycemic index is the first, glycemic load takes it a little bit further. But really, glycemic index tells us with diabetes, whether a carbohydrate containing food or not, how quickly it's going to raise your blood sugar. That's really it. So white rice versus green kale leaves, they both are carbohydrates, they both have a certain amount of carbohydrate in, you could eat the same amount of carbs in both of them. 10 grams, 15 grams of both, and they're going to have a different impact on your blood sugar in terms of a timeframe. Okay, so the slower or the lower glycemic sort of numbered foods are going to have a slower overall impact on your blood sugar in a defined time period of about two hours.

Take off, take a bite of pizza, and it's three carbs of pizza, your blood sugar rises at one rate, take a spoonful of sugar that's three carbs or sugar, it will rise much quicker. Correct? Exactly super important to understand when you're boasting for your meals glycemic load is

glycemic load is the amount of that food that you eat at a given time. So honestly, glycemic load is the bigger impact. In my opinion. If you look at portion, a good example is watermelon. Watermelon has a really high glycemic index somewhere in the 70s. Anything above 70 up to 100 is very high. So if you take a small half cup of watermelon, compared to four cups of watermelon, they have the same glycemic index. But the load effect of the smaller portion is going to downplay its impact on blood sugar comparative to the four cups of watermelon, which is going to have a very large impact on your blood sugar.

Okay, so the the load kind of a way to think about it is so the glycemic index is how quickly it punches. The load is how much it hurts.

Yes, yeah, yes. Okay. All right. Yeah. That's a good way to explain it. Yes, I like that.

That's how I got the podcast. Okay, so that's 55 Pre-Bolus. I'll do 258 is Pre-Bolus. It's just the idea that man made insulin even though Jen Jenny hates if you call it fast acting insulin cuz she doesn't think it works fast enough. And she's right, it does not work quickly enough. But in, in, depending on your situation yourself, how hydrated you are in a million other things. Insulin begins to work slowly, right. So when you put it in, it's not like it's doing its full job. Immediately, it takes time to kind of ramp up the best way I can explain it very quickly. It's like watching a locomotive pull away. It's putting all of its energy into it, but it's not going 100 miles an hour, it takes it a half an hour to get up to speed this this locomotive I'm making up a number. I don't want to train people calling me going it takes a locomotive 23 You know what I mean? So you put,

I'm sure that there are people with diabetes, who are locomotive drivers, who probably would know the direct answer. So

it's occurred to me as I said it so. So you put the insulin in, you sort of let the Pre-Bolus you Bolus before the food, pre the food, so that when the food starts impacting when the glycemic index of the foods starts slamming into you, at the same time, the action of the insulin is also occurring. And that there's a great episode in the Pro Tip series that I'll talk about tug of war and all this stuff, and you will understand Pre-Bolus And when it's done, but as at the definition Pre-Bolus Is the idea of putting in your insulin before the food so that the impact of the food and the action of the insulin can happen at the same time. Correct? Right. I think I'm gonna have to do the next one.

Next one. Because it's your

term, yes, please do episode 260 is called trust will happen. And it exists because because at some point, you'll get to believe that what you know is going to happen is going to happen. And it's a big deal when you're using insulin, like we just talked about when you're putting something in your body or your kid's body that could make you so low that you could have a seizure. And you're trusting that the Bolus will start working when you think it will and that the food will hit when you start when you when you know it will. And even though you see it over and over again, it's it can be difficult to give yourself over to it. So I like to tell people that eventually you'll, you'll trust it and trust will happen. And what you know is going to happen will happen and it's a it's convoluted, but if you listen to it, it's a it's actually a big deal. Because otherwise, you can't do it. It's it's like I guess the simplest ideas. If you're parachuting, you can't jump out of the plane unless you believe the chute is going to open. Correct. Right. So trust will happen. All right, Episode 269. lobe Oh, Jenny, sorry, hold on. This is gonna be me talking for a while this is another episode 269 is called Low before high. Super simple. I'll give it to you in two sentences. When I wake up in the morning, every day, and I think about diabetes, I have a mantra, I would rather stop a low or falling blood sugar than fight with a high one. It is a staple of how I keep my daughter's blood sugar down. It's just a theory. It's a way to think the minute you start accepting the higher blood sugars, things get out of whack. So you're shooting for low understanding that the old make a mistake at some point. But fixing that mistake is far, far more palatable than fighting with a high one. Okay, and then the next one is episode 284. Jenny brittle diabetes.

Yeah, that's another good thing. Like give me the nasty one. That's not very fair.

This is like when you make the nurse give you you know how the doctors make the nurses do the shots and they leave the room. So the kids of course, yeah, I'm doing that with you right now.

Right? Yes, exactly. That's not very fair. So brittle diabetes. Again, it's it's a term that is really an older term. In my professional opinion. It's meant to describe somebody who appears to really have very difficult to manage glucose numbers, where there are very severe swings up and down, and nothing seems to be able to contain them. And that essentially is Bertel diabetes. Yeah. Is it? Is it really a thing that is truly yet to be defined in terms of research urge, I mean, brutal diabetes, if it is truly happening, somebody should have worked through all of the pro tips. And said, I've, I've done all of these steps, I've gotten help from somebody who really has spent time with me. And I still have these time periods where I just don't know why it's not working. Right, right. And I think that many times brittle is being it's defined in a clinical setting, to somebody who hasn't had the greatest

assistance whose blood sugar's look very variable for no reason. Correct. Right. But I generally believe there's a reason you just don't know what it is.

I generally really, really, really Yes, believe that there is a reason and some of the meat the some of the reason may also be undiagnosed other conditions, that nobody's taken the time to ask enough questions to the person to say, Well, hey, this is happening. And it started happening about here, let's take some lab work. Let's look at your digestion. Let's you know all of these other pieces that could actually be creating this variability. I would say 9.9 times out of 10. You don't have brittle diabetes, right? There's, there's something that needs more assessment. Yeah.

So if I was I, at some point, in these episodes, you'll hear me just say, you know, the worst thing I think you can do is just throw your hands up and go, Oh, that's just diabetes, you know, my blood sugar falls out of nowhere. It's what happens. Usually, it's because you didn't Bolus for a meal correctly. You got your insulin out of balance with the food you drop really quickly. And then doctors look at that, you know, think about 20 years ago, versus now even you still have trouble getting people understanding how insulin works, even at the physician level, but 20 years from now, they're like, I don't know, you're fertile. Like it just it to me, it seems like an answer out of the 1940s. You know what I mean? Like, like, Absolutely. Like, like, I don't know, like, like, put yourself back in that time. Right. And, yeah, there's a man and a woman and they're married, and the man does something terrible and the lady gets upset, and they go, Oh, she's, that's how she gets, you know, they mean, like, you know, it must be her time of the month, like just these general throwaway bullshit answers. I didn't mean to curse during this, that that are, the way I hear them is I don't know what's going on. So I'm just going to say that this is something unforeseen and uncontrollable. And it's just the way of the world but might not be the truth. Someone's calling you brittle at this day and age. Go listen to the Pro Tip series. Oh, okay. Here's another one for me. Episode 286. Stop the arrows. Again. It's just a theoretical thing if you have a CGM. I prefer to say that sometimes we all get stuck wondering what's happening, instead of just stopping the arrows, right? Like, well, my blood sugar's jumping way up. I don't know what and then the people sit back and they go, Well, I guess I Bolus that this time for this while you're talking to yourself, your blood sugar is shooting up, right? Just stop the arrow. Again, in much more detail in the episode, we don't need to spend a lot of time with it. I'll talk about like keeping your car in a lane and stuff like that. You'll love it. It's going to be great fun for you. So 288 ketones, not as easy as it sounds, Jenny. So I'll give it to you. Again. Nice, hard one.

Yes, no and ketones specific to diabetes now, right? Because that's what we're talking about. They are chemicals, if you will, that the body makes when it breaks down fat to use for energy. So could you have ketones and could they not be dangerous? Yes. You could, in fact, have any people wake in the morning in a fasting state and have what are overnight sort of fasting ketones, right? Those are not the dangerous ketones that we think of when you get diagnosed and you're told all about all of these things. And one of them is ketones. Watch out for keto.

You're in DKA, diabetic keto ketosis, right. So, right.

So I mean, DKA, those types of ketones are very different ketones and those are not the ketones that you want. Obviously, that is a very serious complication. That occurs essentially, when your body has a very high glucose levels and not enough insulin. Then you could very easily move from high ketone levels into diabetic ketone. acidosis which

is life threatening, so it's a big deal. Yes. But it doesn't stop it from being true that if you eat a low carb lifestyle, you might see some ketones. Correct? Yeah. Okay.

So and that's actually a good point to make in terms of like a little clarity, I should say. The level of ketones very much defines DKA versus nutritional ketosis, which is really what if you're on a low carb or a ketogenic diet? It's really what you're aiming for. Your goal is to get your body burning fat for energy instead of carbohydrates. Okay,

yeah. So, alright, Episode 295. And by the way, there's a really deep dive ketone talk in the defining and in other places in the podcast, so it'll get explained much more episode 295 is called insulin resistance and over Bolus, now these two things aren't the same thing. It's just, we set out to make a defining series about insulin resistance, and we started talking about something else, so much so that it belonged in the title, but let's just stick with insulin resistance here. I'm going to ask you to do that one, too, because it's a term I rub up against, and then I get on a soapbox, so I'm just going to let you do it.

Sure. I mean, insulin resistance really is the body's inability to utilize insulin at a silly cellular level. At a certain amount, so you need more insulin to overcome the cell's inability to recognize and allow insulin to work. Okay, and there are many, many reasons for insulin resistance to happen. So, I mean, I don't know how much more Yeah, we can't sanative definition.

Go listen to the episode, because you're gonna hear it like, if you have type two diabetes, insulin resistance is different than if you have type one diabetes. Right? It's not different. But structurally,

it's the same reasoning. I mean, if you have insulin resistance, whether you're type one or type two, insulin resistance is there because your body is just not using insulin the right way? Quite honestly. Could you be? Could you be a lean individual and have insulin resistance? Yes, you could. So I think that's a hard one, especially in terms of defining between type one and type two. Insulin resistance is just you need more insulin to overcome your body's inability to use what it should metabolically be able to use. At a lower amount.

I think you should listen to the episode because the words can be used as a crutch with bad settings. So Correct. Yeah, insulin resistance is exactly what Jenny said. But what if you're your ratio, carb ratio, right? Your one unit per 10, carbs should really be one unit per five carbs, and then your blood sugar goes up, and then you correct and your correction ratio is not right, you won't come down, the doctor sees that and goes, Oh, you're insulin resistant. You're not insulin resistant, you're not using enough insulin. So right, so anyway, there you go. episodes, yes, Episode 344 is called feeding insulin. And in my recollection, you have two minutes, I have two minutes. In my, my recollection, that is about when people have too heavy of a Basal profile. And you find yourself constantly feeding the insulin, meaning you're getting low, and you have to keep putting in food to bring it back up. So you don't want to be feeding your insulin. You want the insulin to be set at a place where it works without needing to be offset with carbohydrates.

Correct. And you could also feed Bolus insulin. I mean, the first idea is evaluate basil. Absolutely. Especially if you are without insulin on board and you're constantly nibbling to keep your blood sugar up. That's a first analysis Basal. Absolutely. But if you're feeding yourself and snacking, without having to Bolus again, after you've Bolus for a meal, and there is insulin on board, then you're probably feeding your rapid insulin or your Bolus insulin. And that would be an analysis point

don't want to feature so So Jenny, we're gonna stop here. The next time we record we're going to pick back up with 347 Bumping nudge. I've loved this. I think this is terrific. So we got through a number in we got through about half of them wasn't Yeah, it did a good job. There was a couple of times I was like, we're just getting chatty. But but but we didn't. We kept we kept it really short. I think this will end up being an episode about an hour and a half long. That will do exactly what all of those people who talked about terminology wanted. So right, excellent. All right. I'm sorry, go live your life and you know,

that's okay. I've just got a patient I have to get run. And so anyway, I'll see you next time. Awesome. Thanks. Bye.

Hello friends, and welcome to episode 712 of the Juicebox Podcast. This is the second part of a special bold beginnings episode, part one is already available, and episode 711. Welcome back to the bold beginning series with me and Jenny Smith. Today's two parter happens in Episode 711 and 712. This is bold beginnings terminology part two. In these two episodes, Jenny and I define every word that's available to you in the defining diabetes series. At the time of this recording, there were over 40 definitions. We did a quick definition for newly diagnosed people and left you the episode number so you can go back and get a more complete definition. If you've just been diagnosed. Or if you're trying to figure things out, it is our estimation that this two part episode, part of the bowl beginning series will catch you up on terminology very quickly. If you're looking for the defining diabetes series, it's available at juicebox podcast.com diabetes protip.com. And in any audio app that you listen in, join the Facebook group Juicebox Podcast type one diabetes to find the lists of all the series in the featured section. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. And because of the format of this episode, I'm going to put the ad right here for you so that you don't have to take a break while you're power listening through these definitions. Isn't that cool of impelled to let that happen? Thank you and pen, even though I didn't ask you, but I know you're listening. So just be cool. All right. All right, ready the pen. It's an insulin pen. But it's more than that. Because it's attached to an application on your iPhone or Android phone. This application is going to do many of the things you've heard about people getting from their insulin pumps, you'll be able to see your current glucose right on the screen, a dosing calculator, active insulin remaining meal history, dose history, glucose history, activity logs, and you can generate reports based on your data. Not only that, but you're getting a great insulin pen, everything you expect the cap the needle, the insulin cartridge holder, it's an insulin pen, just like you've come to expect. But it gives you more with this attached app. You can go right now to N pen today.com To find out more and get started. And I'm gonna tell you what terms and conditions apply, but you may pay as little as $35 for the in pen. Medtronic diabetes does not want costs to be a roadblock to you getting the therapy that you need. Within Penn's Access Program. You may pay as little as $35. Where will you find that out? At in Penn today.com. On this site, tons of frequently asked questions that you're going to be interested in just scroll to the bottom. What is the M pen? How much does it cost? Our insulin cartridges included? Does M pen work with long acting insulin? Can I pair more than one M pen to an app? You want to know the answers to those questions? Go right now to in pen today.com and get your answer if you're ready to try the M pen when you're at the link. Just follow the easy instructions it says ready to try you complete a short form. And just like that you're on your way. In pen today.com forward slash juicebox in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in Penn today.com. Yeah, okay. Haha, there it is. So Jenny and I are back. This is another day we recorded from Bolus to feeding insulin. And now we're gonna go to Episode 347 and the defining diabetes series. This is another made up I think this is one of the last ones that I made up for a while. Yeah, it is. But this one's called bump and nudge. So, you know what, Jenny, I've described how I think of it all the time, but you've heard me talking about it so much. How do you think about it? Now that I've explained it to you?

Well, it's just, I mean, I just think it's learning how to use insulin. Better to bring your blood sugar into the place that you want it to as well as not only insulin, but food, right, because it's kind of a both. It's a both system. Use insulin to get your blood sugar to come down. Until where you want it to. And if you maybe use just a little bit too much, then you're using a little bit of food to kind of keep it stable, avoid it from dropping too low.

So there's been this. There was once a discussion online where people said, do you think of somebody asked me one time, do you think of bumping his insulin or bumping his carbs, and everybody, because I've never really said it before, but in my mind, I nudge with food and bump with insulin, I think and I'm the opposite. You think of it the other way, it doesn't really matter the way in 20 seconds. The way I describe it to people is when you're driving in a lane, and there's a line on your right, a line on your left, if you start to slowly drift towards the line, you don't quickly yank the wheel back the other way, you just sort of bring it back just ever so slightly to come back into toe again, right? To be straight again. So instead of waiting till your blood sugar, 60 and falling, what if when it was 85, and it was just sort of drifting down, if you just had a couple of carbs, if you just sort of nudged it back up again, or bumped it back up again, it really doesn't matter which one strikes you in your mind. And similarly, why not lower your CGM alarm to more like 120 so that when you're kind of drifting up gently, you can give a small amount of insulin and bump that number back down. Because a lot of times less insulin gives you less of a chance of a low later so just instead of waiting to your wildly, you know, instead of waiting till you're off the road in the weeds and bouncing through the holes, when you see the line just sort of come back a little bit bumping and nudging. It's really the whole thing. So that's episode 347. And Jenny episode 352 is rage Bolus. Go ahead, do Rachel.

Yeah, rage Bolus, everybody with diabetes. I would think honestly, everybody with diabetes or caring for somebody has raged Bolus, at some point, essentially, you've gotten so frustrated by a high blood sugar or even a climb that you didn't expect. That looks you know, those double arrows up like I'm just gonna get on top of this. Now this is not bumping and nudging. This is completely like the other end of I'm just gonna take a lot of insulin, and I'm gonna get my blood sugar come back down,

but you haven't done it. You end up using so much normally, that you create some sort of a fall

later. Correct. A pretty dramatic fall for the most part. Yeah,

so it's like taking a bucket of insulin. Just be like, I can't take this anymore. It generally doesn't go well. There there is. We'll wait till we get to it. So that's episode 352. Rage Bolus. Episode 358 is compression low and interstitial fluid. I think we started off making a compression load defining and ended up explaining what interstitial fluid is because I compression low if you're wearing a CGM, you've got this wire under your skin, the sensor whatever they call it, filament, doesn't matter. It's a thing. It's under your skin. These are all things that they've been Yes, those are all good words. It's measuring your interstitial fluid.

And if you glucose in your interstitial fluid,

thank you. And if you lay it right on top of the of the sensor, it compresses into your body. When it does that, it pushes the interstitial fluid away from where the wire is. And therefore, your you get a low reading that isn't real. Correct? Because in that area right around the wire, there is actually less glucose. Yes, but there may be not your body's idea of it. Right. So what else? Yes. And on a Dexcom, at least when it happens, you sort of teach yourself you can almost see it, like you know what I mean? Like you're like, Oh, that's a weird break. I bet you that's a compression low. And it's not always I mean, I would still test to be certain. But anyway, that's what a compression low is. It's a it's a blip that comes up on your CGM out of nowhere that looks like you're falling, but really just might be that the transmitter and the sensor had been pushed into your body and disparate and displaced your interstitial fluid. Yes,

and a good as you brought up, you can really see a compression low pretty easily on CGM data, because it's it's the glucose data is tracking really smoothly. And all of a sudden, it looks like things just like dropped off of a cliff. And even those little pinpoint dots of glucose value will often have a disrupted area between the last one that looked like it was pretty stable in in target. And the next one, which looks strangely low. Oftentimes, parents will move their kid and roll them over in bed and it writes itself.

Yes, I've definitely walked into Arden's room and been like rollover rollover going on. Like what what am i You're laying on your sensor, and then she flips over. But in the beginning, I mean listen I would never say not to test for it like, you should, because also a drastic drop looks like a drastic drop. So I'm just saying you can kind of start to see them after a while. Episode 360, fat and protein rise. So I guess to define that, in just a moment, it would be that you're going to be diagnosed, and somebody is going to tell you that you count carbs, and you cover carbs with insulin. And that's it. And there are free foods, free foods like cheese, and meat, and things like that, because there's no carbs in them. problem becomes with the protein, specifically, your body digests the protein turns it into glucose, right? So later in the, in the process, you could see a rise from that fat, however, has a slightly different scenario, can you tell people like that,

it's more fat, it's more resistance with fat, where I think of a simple thing to think of is, if you're, if somebody's like, taking insulin and sitting on it and not letting it work quite as well, that's what fat does. That decreases your body's ability to use insulin by about 50%, give or take. And so in there, multiple ways of attacking coverage and all of that, when are you going to start to see fat impact, it's usually two to three hours after a meal, and it will last a long time. Whereas protein, protein starts to impact blood sugar somewhere one to three hours after a meal. If it's a large quantity, or you've had a small carb containing meal with a fair amount of protein or a large amount of protein, then you may need to actually cover protein. So this isn't, you're always going to have to Bolus or cover fat and protein. That's not really the truth. But there are some specific scenarios in which you would have to cover both of them or just remain high.

Right? There are multiple episodes throughout the podcast that go deep, deep into how to Bolus for fat and protein, Episode 378. Don phenomenon. I might have to really get you to lean in on the technicalities of the next three really. So really, yeah. Because I know what the dawn phenomenon is, like, I know that there's this time around, ready, you're testing me two or three o'clock in the morning, right? Where your body kind of gives off some glucose glucagon from your liver, something from your liver. Is that right? Or

it's also kind of the beginning of like, cortisol sort of, I mean, it's two o'clock early. So most people it's somewhere between three and 8am. I mean, for like the widest swath of time potential, right? I mean, there are multiple thoughts for why do some people see it more considerably than others, but most people who have tested will definitely find that as they get through and into sort of later, early morning hours, things start to kind of creep up a little bit. And it may also then go along with the foot on the floor, which I don't know, did we do that one already? We're gonna go, we're gonna get that. Okay. All right. So yeah, Don phenomena is really that early morning has nothing to do with getting out of bed. It's the body's need for a little bit. A little bit more insulin, based on your body's preparation for you getting up to get going in the beginning of the day.

Okay, then 379 is smokey effect. Smokey. You always say differently than I say.

I always say smokey, the fact that people say some Oh, geez. Smoky red. Yes, it's yes. All I know

is I don't know what it is. We've done an episode about it. And I have no recall that whatsoever.

Yeah, well, I think actually, it was really kind of funny. In that episode, we, we actually looked up where the name came from. It was a doctor and it's a doctor. Yeah. So smoky effect, or phenomenon or whatever is really, when your blood sugar gets too low. Overnight, specifically, you get this dump of like glucose or not really glucose, but your body starts to break down its stores of glucose sends it into the bloodstream. It's a it's a good effect. That's supposed to save you from the low right. But on the opposite of it, the trigger of those hormones can then send your blood sugar's rebounding high later on with a CGM, and thankfully, many people have the option to use a CGM. Now, we can really catch is the high blood sugar you're waking up in the morning? Because you've had lows overnight? Or is it really because nothing low happened and you really just need more insulin put in. Basal.

It's really interesting that that the advent of a CGM takes away that. I don't know what's happening idea. Yeah, it's really cool. That episode three ad is feet on the floor. So the way I see it with Arden is she can be super stable, right like at overnight, and her alarm starts to go off art and say, let the alarm go off 16 times kind of person, right. And then she's got snooze herself. She's losing herself into reality. And so as she's losing herself into reality, I begin to see her blood sugar pick up, then she just a little bit at 80 to 85 over like 30 minutes, right? And then she wakes up and her feet hit the floor. And I believe that what happens is your brain and your body start preparing yourself for the task ahead. And I guess that's adrenaline and some other things and and then you just start seeing arise. And then the problem ends up being is that is how it gets caught up in everyday life. Like because breakfast can sometimes be difficult for people to Bolus for. And on top of that they have a rising blood sugar perhaps from feet on the floor that they haven't covered with basil. And anyway, that's feet on the floor. Am I right?

Yes, it's you got it, it's typically noticed right upon getting out of bed specifically, especially if you've kind of curtailed the dawn phenomenon, you may actually find a secondary need to add some extra insulin as soon as you actually get out of bed. Yeah. And that, for the most part isn't really well covered with a Basal change. It's much better covered with a Bolus to accommodate for what you know is going to happen.

Go check out the episode. I think this is a good time, Jenny, for us to just interject for 12 seconds and say to newly diagnosed people. I know this seems overwhelming. But these things will just sort of like you can go listen to these defining episodes, get a firm idea of what these things are, you're not going to remember every one of them right away. And eventually, as crazy as it sounds, all these things that I've listed here. So far, my brain just does the processing on all of this in the background. I don't I don't I don't stand in a situation where my daughter's blood sugar randomly jumps up and down and think I wonder if she's brittle. Like you know what I mean? Like it just right, you just start to you know, when I see a drifting blood sugar, nowhere near a Bolus, I don't think over feeding the insulin, I just think, Oh, the basil looks heavy. And so you know, eventually it does sort of begins to just make sense without you having to think about it. So Episode 408, insulin sensitivity factor, which people could see in their devices as I S or ISF,

right? Or even correction factor, CF or CF, right,

in general will get me I'm on a roll here. The Jenny's like why am I here? If you're not gonna give me? Because I don't want to do it. I don't want to do that. Excellent. That's why

I'll just, you know, make little little comments along the way. That's all right.

So one unit of insulin moves your blood sugar blank amount of points. That's your insulin sensitivity factor or your correction factor, depending on how it's written in your pump or algorithm. That's it, right?

Correct, exactly. It's the way that one unit of insulin will navigate your blood sugar down.

So if your insulin sensitivity factor is 50, and your blood sugar is 120, giving yourself a unit should get you to 70. correctly, in theory, there are a lot of other variables that would stop that. And if you're just listening first, and you're not going to get a chance to get to that episode, I do want to throw in here, as your blood sugar gets higher, that may become less effective. So it's possible that a 120 will move to 70 on a unit in that example, but not probable that a 250 would go to 200 with the same unit of insulin does that it's Yeah,

and most most people who watch and pay kind of enough attention when they're starting to try to figure things out more. They will notice it really works. It really works. And then all of a sudden they've got a bad site or they've got, you know, a missed dose of insulin, their blood sugar climbs, what I find it's usually above like 220 to 250. above that. It seems to take a little bit more insulin than what your correction factor or sensitivity factor would calculate your correction dose to be

okay. Well, you tell people what episode 415 is

for 15 adrenaline highs. Oh, well, you know, adrenaline is a fancy hormone that kind of goes right along with fight or flight right. So what Does your body do your body's stimulates with adrenaline to really give you this rev up? I mean, you know, your heart rate increases your body is just in this ready state. Well what ends up happening, adrenaline spikes your blood sugar for most people. Now whether or not you actually have to correct that adrenaline spike is another thing to pay attention to. A lot of people see these adrenaline spikes around like you're a game, like the coolest team that you're going to play against, you know it this coming weekend, and you get this spike up in blood sugar that you've not ever really seen before. Very likely, it's adrenaline, or just excitement. I know that before. When I first started doing some of my my initial like, races, which were not very long, they were like 10 K's. But it was exciting. And I'd get there with this nice smooth like blood sugar. And then like 10 minutes before the gun was gonna go off, I get this crazy quick kick up. Really what's going on? Right? So

I think also go listen to that episode seriously, because there are also situations that you can't imagine yet where it might not happen. For instance, a baseball game might make your kid excited, but baseball practice might not. And also, adrenaline needs insulin most of the time. But when adrenaline leaves and insulin remains behind. That's a Oh situation. So adrenaline holds up your blood sugar really well, when it's there when the adrenaline goes away out of nowhere. If you've Bolus for that insulin still active, and the adrenaline is gone. Now it's almost like it's almost like an unseen hand reached into your stomach and snatched your lunch out and it just isn't there anymore to correct to combat the insulin episode for 15. I realized now I'm going to have to edit out every time I went before every one of these numbers are now just leave it in who cares? Adrenaline highs we just did now that the next one episode 423 Insulin deficit? Do you remember? Did we put this in to sort of give a description to people of why their blood sugar's kind of drift up? I almost don't remember making this one for some reason?

I believe so. I wonder if the other one was was this? Oh, no, because black holes is

down farther? Well, let's just define insulin deficit, then. Sure. Just yeah, probably an insulin deficit

is missing insulin. And the result is typically that your blood sugar is going to go up. That's, that's it.

We probably stuck it in there. Because you'll hear me say throughout the podcast, you know, if your blood sugar is high, you're probably didn't use enough insulin and slow, probably use too much insulin. So you know, like it's a good place to start. So insulin deficit is just what it sounds like. growth hormones, Episode 426. I mean, the reason we define that around diabetes is because when your kid goes to sleep at night, and is inundated with growth hormones, their blood sugar is going to go up. So I don't know that growth hormones needs a description here from us. But it does need us. I think it does. Ask us to tell you to go to listen about it. Because it's really important, it is going to impact your use of insulin.

Especially in in all ages. I think most specifically for those who have kids with type one teens with type one. Women who have not quite figured out their monthly cycle yet around their hormones that go up and down. So it's definitely an important one to understand. Yeah.

Okay, stacking insulin is episode 440. And it is very likely that you are going to be diagnosed, and a doctor is going to look at you very sternly in the face and tell you never stack insulin, right? happen without much explanation, right, they're just gonna say don't stack. Stacking Insulin is the idea of you just sort of layering new boluses on top of each other blindly, because you see because it's almost it's almost raged bolusing and steps. Does that make sense? Like instead of like, like, instead of throwing in five units all at once it's a unit than a unit and then a unit and a unit, you just keep stacking them up on each other. It's kind of the same idea. I've never thought of it that way before until just now. But here's the thing, you really don't want to stack insulin. You want to Bolus correctly for what you're eating or for the correction you're trying to make. But it's not stalking if you need it. So if your insulin is well proportioned and your understanding of covering your foods is good, and you eat at three o'clock, and at 325 go I'm gonna have another serving of that. That's not stalking. No, that's Bolus correct. And the problem is, is that when you get when you're in your first week of blood sugar's and people say don't stack insulin One A lot of people here as don't use insulin frequently. Do you agree with that?

Right. And I, I've also heard it in terms of the comment about don't stack insulin, many will be given sort of a timeline of use of insulin, like, if you take insulin here, don't take insulin for another three or four hours, right. But that lacks a lot of good explanation, as you just tried to do you know, if you or your child eats lunch now, and then you decide, well, I'm still hungry, or he or she is still hungry, and they really want something more, there's a reason to take more, even if it's within an hour of having just Bolus for other food. If you're eating again, you need to take more insulin for that that's not stalking. If you take insulin for a meal, blood sugar is rising, and you think, Well, I'm just gonna give more insulin because my blood sugar's rising, you could potentially get into stacking insulin because you really haven't seen the true impact of that. Let's call it a three to four hour active insulin window of the first Bolus, right?

Or you could just be right, you might have miscounted carbs where the glycemic index or load might be wrong. Here's what I'm gonna say, listen to this episode, because it's important, but these episodes should probably at some point lead you into the diabetes Pro Tip series, which will make all of these definitions make a lot more sense. Episode 442, hydration, I think we all know what hydration is. So I don't know that it needs to be explained here. But you should go check out the episode because hydration has a huge impact on how insulin works. That's that's why it's in the defect in the definitions,

insulin movement of any nutrients around your body. It also impacts CGM accuracy significantly, significantly So, absolutely. Listen to hydration.

Yeah. For 55 Lada diabetes, latent autoimmune diabetes in adults.

Yes,

yeah. If you guys could just see Jenny looking at me right now going, he's not gonna get this.

I was, I was like, I know we've done this so many times. That you know this constantly

and it's, you know what the problem is where it breaks my brain is that it's latent autoimmune diabetes, la dee, but then it goes in adults, and there's no either.

Yes. I mean, it really what, right? It's just a slow progressing form of autoimmune diabetes, or a slow progressing form of type one, for the most

part, which you mainly see in adults.

Correct. Exactly.

Then we have Modi diabetes, which I'm going to admit, I couldn't define if my life depended on it, which I'm sure you're disappointed in right now. But can you please do it?

Nobody diabetes, yes, maturity onset diabetes of the young.

There you go. So is it a lot of for young people?

Not really. It's definitely different than Lada. And Modi has many different, it's genetic. Od has many, many different types of Modi, if you will, that's the easiest way to say it. And getting the proper diagnosis of your type of Modi becomes really important for getting the right type of medication and management strategy.

So it's one of those things that often if you have it, you're not going to know right away because doctors are gonna have trouble figuring it out, too. Yeah. Which is why they're specifically episode 463. Crush it and catch it. That is the thing I made up. So it is and you really don't start with crush it and catch it right like listen to these listen to the pro tips then come back to that when maybe but it for to define it. It's the idea that sometimes you have a high blood sugar that is so high. And if you have a CGM I sort of just learned how to like Crush It, like crush it with insulin and then catch it so that it comes in for a smooth landing without creating a high later and without getting a low. Anyway, it's not a day one idea for 60 days, like no, I'm not even saying anything about this.

Hey, no comments there whatsoever. Well, I the comment I was gonna say is actually it kind of goes a little bit along with rage bolusing but crush it and catch it means that you really are. You're not. You're not anger bolusing you're like I see the problem happening. You're taking emotion out of it. I'm going to do this, but I'm really going to be diligent about paying attention. And I'm going to catch it later because I know that this is likely more than I need it.

It's a it's an aggressive has fought for move. It's it is yeah. And yes. And again, don't do it on the first day for 66 C peptide and beta cells, C peptide, what is that. So

C peptide is a substance, it's made by the pancreas along with insulin, they're sort of both parts of a big molecule, right. And when insulin gets released into circulation, the C peptide kind of gets cleaved, or broken off, if you will. And it's kind of C shaped from what I understand. And so it doesn't do anything. The insulin is the piece of that molecule that we want. But C peptide is measurable in the bloodstream. So when you're diagnosed with autoimmune diabetes, or type one diabetes, C peptide levels can be tested to see that they live below what would be expected to be normal pancreatic output of insulin. And if the C peptide then shows what's actually coming out of the beta cells in the pancreas. If they're low or under a value, then usually, you know, goes right along with a type one diagnosis along with antibody testing and that kind of stuff. But see, peptides can be measured in somebody who has type one and has had type one a long time as well. And a lot of people ask, well, I take insulin, you know, I injected I pump it, isn't that gonna mess? The tough stuff, not at all. The A C peptide is really only something that comes with your own beta cells, that molecule that's made along with insulin, it's only coming from that it doesn't come from our formulated insulin, but you're

gonna hear the word around because people are gonna say, if you're newly diagnosed, and P sometimes people like I'm not sure if I have diabetes, someone's gonna say to you, Well, have you had a C peptide test? And that's, you know, to pretty much tell you if you have type one diabetes, right, right. And a lot of times the, the reason that comes up is a lot of times type twos, can be misdiagnosed, or type ones can be misdiagnosed as type vice versa, that yes, breaks down, we also hit beta cell and their beta cell is the cell in your pancreas. That makes sense Elon, and you can go learn more about it in 466. Episode Four, excuse me, Episode 648. Insulin onboard. To so just to define it, it's a once a year pumps, your algorithms in pen, for example, a smart insulin pen will tell you based on your settings how much insulin you have active in your system, the insulin on board, you being you being bored, and it's on you. Here's the weird thing, isn't it on board, it's a it's such a it's such a commonly used phrase and diabetes. And yet, it's not actually specific to human beings. If you think of it outside of this, not the point anyway. And so on board is how much insulin you have active in your body as measured by your device. And it's based on your settings. Learn more about it in there because if your settings are different, your insulin onboard might look different. And,

and that one setting is your duration of insulin action, or your active insulin time. That's really where insulin on board, anything your system is telling you about an amount. It's coming from a setting that you set or that your doctor recommended that

you set. If you switch to a pump, you may remember your pump training when he came up on it and it says, What's my insulin action time and the nurse went, Ah, I put three or four hours in there. Because they don't know. And you never get told to go back to it. But you should and you should understand it better. I just had to throw away a phone call from my mother who calls always at the worst times. she I think she has a camera in my bathroom and knows when my when I step into the shower, I'm pretty sure. Episode 652 is pump break. Some people use insulin pumps and take a break sometimes. That one's pretty self explanatory. Episode 656. Jenny, we're gonna get through this whole list. Yay. Episode 656 is about barriers. So I don't use barriers. Arden doesn't use them I should say but a lot of people do. Jenny, could you highlight? Yeah.

Barriers essentially are for people who have irritation to any or potentially all of the adhesives that are used to put a product onto the body, whether it's a CGM of any kind, a pump and pump infusion set or Omni pod the infusion or the the adhesive around the pod. It's essentially a way to create a barrier between the skin and the adhesive of that product. Some of the barriers are a spray or like you know something like Flo knees let's say or like a spray Benadryl or something enough to create them a little bit of a barrier to prevent irritation from the adhesive. Other barriers, though, are another sticky sort of tape, if you will type of product that you would put on to your clean skin. And then you would put your product on top of that, to prevent that adhesive from causing a problem for you. And the

truth is some people have trouble with things sticking some people have trouble with irritation, some people aren't bothered by it at all, and we'll find out who you are. And then that'd be a great episode for you to listen to. Yep. All right, Episode 660. Oh, the next to actually I made up Episode 660, as Jenny is gonna get the finished strong with the rest of them is called black holes. And so it is a look into how my brain thinks about creating deficits of insulin in the future. Is that fair? That's fair. Okay. Yes. So again, that might not be day one. But it is a is an episode that a number of people reached out and said you talk about black holes in the episode, but you've never defined it as like, well, I will make a defining episode about it for you. Much the same as episode 664 dictate the pace is, it's again, it's just a look at how I think about diabetes really where I think you should sort of be out in front of it strike first however you want to put it. It's I don't think you should cover up and let diabetes happen to you. I think you should happen to it. So that the next thing that happens is quantifiable. You know, instead of Oh, diabetes happened, this happened, my blood sugar went up, it went down. I don't know why I like saying I Bolus and then I got low. And at least I know now I can change that Bolus. I see. You know, I see I did something and then something else happened? Correct. 664 dictate the pace. Okay, Jenny 668. For you carb absorption and digestion. Yeah,

so we're taught a lot about carbs initially, or you'll be taught a lot about carbs initially. The simpler the carb, the faster the impact on blood sugar. And then what you eat with that type of carbohydrate could also lead to a shift in how your body digests or processes that food to make it visible in blood sugar effect, right? So simple food being something like a big bowl of green grapes, versus a big bowl of kale chips. They both have carbohydrates in them, but they're both going to absorb differently, you're going to digest them a little bit differently. So to speak, right? It's not like your body changes how it digests but because one is simple, pretty simple carb, you're going to get much more rapid impact from some foods than from others. So

yeah, the carb absorption and digestion impacts the timing of the insulin, sometimes the amount of the insulin, it's important to understand what it is and how it works. Do another one Jenny 672 antibody,

antibodies. So antibodies in general, are just a protein in your blood that's essentially produced to counter a specific bad guy that's come into your body, right? Like an alien, a foreign substance, something, something that's not supposed to be there, right. But we take that into diabetes specifically. For some reason, especially for type one, autoimmune diabetes, you will have your body respond, unfortunately, in the wrong way with the destruction of the beta cells, but there will be antibodies that show whether you've had an auto immune response, and that's the reason or you won't have antibodies. And a marker in the blood essentially, that will tell you

and it's generally possible now that you have an autoimmune disease that you might see others and antibodies are going to be words that come up again, if you end up with something like hypothyroidism and or celiac or celiac or something to that effect. And speaking of hypo Episode 677, hypo and hyper just defines hypo and hyper hypo, low hyper high. Still feel like you should go listen to the episode

glace glycemia, because they are together right with hyperglycemia. Hypoglycemia is just glucose,

we sort of go through the words or the prefixes and you can see how like you can have hypoglycemia, you can also have hypothyroidism, you can have hyperglycemia, hyperthyroidism, etc. It's interesting, Jenny and I are we're delightful as we record these, so you should definitely listen to it no matter what. And so far on June 13 2022, the last EPA sort of defining diabetes is Episode 681, where we just go over all of the different types of diabetes. You heard a couple out here in this list. Yeah, we like you know, we really dove in. And we found we found all the diabetes, not just Lada and moody and type one and type two. But there's there's other stuff and it's interesting. As you can see, Jenny, as we wrap up this episode, you and I started making these defining diabetes episodes at episode 263. Bolus, I'm going to look just real quickly. If you'll indulge me for a second. Of course, I can look very quickly and see. 236 Excuse me? Episode 236, which was defining diabetes Bolus was the first one. June 21 2019. That is nine days shy of three years ago. Wow, that crazy? Am I wrong? 2021? No, I'm right. But you make the same level of sad excitement is when I do a lot of it. Everyone listening is like the guy with the podcast wasn't 100%? Sure. But a lot of it. Yeah, I can't know everything. I knew what it

meant. It was just the words to know what the actual acronym was right? To know, you have to give yourself more credit,

defending me like my grandmother, thank you very much. Scott Aloni knows,

only because I like you.

But I mean, the point is, is that when we started it on 236, did you really think we would have done another one last month?

I don't know. I didn't know how many you're like, we're just gonna keep getting ideas. And then we're just gonna keep doing this. Like, that's great. I like doing this.

But 681 types of diabetes we recorded in May of 2022. I'm just saying that's a long time, it's a long time and expect the list to grow. Because I think Jenny and I both completely agree that management of diabetes is, at first, its understanding, it's understanding that you have tools. And these tools are sometimes thrown around as words that you don't know. And you can't possibly you don't I mean, like if the word ketone never came up in your life, and then all of a sudden, someone's like, you have diabetes. And by the way, ketones are bad. You don't want to go into DKA. You're like, oh my god, like, right, what? And you know, so the way I like in my mind is, you can have a screw and a screwdriver. If you don't know what a screwdriver is, it might not help you. So learn these the definitions. And hopefully, one day when someone shows you a screw, you'll be like, Oh, I know what to do. And you'll reach in your pocket and pull out your screwdriver and just whip it right and that aboard and you'll be on your way. And, and I think these go a long way towards doing that. I also think they go a long way towards preparing you to listen to the Pro Tip series. You know, so Jenny, if you just heard her say a second ago, she enjoys doing this? I know you do. She loves helping people with diabetes. And I'm very proud that you're involved in these. I don't tell you this stuff off and on the podcast. So let me just do it. I'm looking at her. So it's embarrassing. These definitions, and you know, the Pro Tip series like I know, I'm the one who said like, let's do this, and let's do this. But let's be honest without you. They're not what they are. So I would thank you I would clap, but it's a podcast and it's meaningless. But right now, there's noise while I'm listening. Yeah, you've just been an continue to be such an asset to people with type one. And thank you. I feel I feel as

Yeah, and I'm glad that you've started something that's grown into such a community of support for people. And that's the reason that I enjoy continuing to help you to put good information, I think that we're good is really important, because there's, there's a lot of misinformation. I'm not gonna call it bad information. But I think especially in doing these definitions, it's really important for people to understand what things mean words they might have heard, and they may be too embarrassed or too overwhelmed to ask, well, what does that mean? I don't get it. Can you explain that differently to me, and that's really, really important for you to live better.

Yeah, I want to say that part of the value and kind of why I brought up how long it's been since we did the first one. And by the way, 236 was still 236 episodes into the podcast is yours for the podcast. It's because I saw someone online the other day. I don't want to say they were ripping me off. But let's say they were okay. They were doing their own defining thing. And I and I never listened to other people's stuff. But I thought let me just see for a minute and I looked and this person hadn't been involved with diabetes for very long. They hadn't been making their content very long. And then they did a a haphazard job of explaining the thing. It's still I think for their level of understanding, I think they did a great a great job. But there's something to be said for you. With 30 plus years of living with diabetes, plus your CD plus you, you talk to people literally all day long, every day of the week about type one. And me who's been making this podcast forever? I have. I mean, besides doctors, there's nobody who talks to people with diabetes more than I do, I don't think right, I record six, seven hours of conversations every week. And there's something about knowing, like being able to say something with confidence and put it into context, which you do for me all the time, because I'll say things. And you'll come around and be like, yes, in this specific situation. This is exactly what I just said. But don't forget about this aspect of it, which is not how my brain works. And so there's something between all the experience all of your training, my ability to tell a story, your ability to keep me honest, like it all just, it's why it's good information, I think, right? That's what

I think because you also have a lot of pieces that people can go to specifically. And in many I've heard you say, in many of the episodes, or many of the ones that I've listened to myself, you'll say if you want more about this, go here, we've explained this a little bit better, or this whole episode is all about this. It's not just something that's brought up, and then it's gone. There's no worries, the person hanging in there listening to the rest of the conversation, but really, they wanted that little nugget that you kind of just accidentally brought up. They wanted that. And that's that's a really big piece of tying something that's very beneficial. Like in terms of education, together, you have to be able to send somebody to the right place for exactly what they want.

We've been able to do this for so long. And I really served sincerely, maybe the sponsors like kept this podcast going and keep it going. But we've been able to do it so long, that it's now a compendium of information, not just an episode about what honeymoon means, right? Yeah. And I just got to note, I know you have to go. I just got a note from a woman online the other day, she said, I just finished the last episode of the podcast, she listened from one to at this point, she listened to 698. Right, like straight through and then showed a graph and talked about our agency and our success. And she said, I listen to this podcast straight through and look at my blood sugar. And, you know, it's because of this. So if you want it if it's in here,

that's like almost a month worth of like, continued like, that's 24 hour day after 24 hour day, that's 28 straight days of 24 hours, you know, assuming I know some of the episodes aren't quite an hour, and some are longer than an hour. But in general, that's 28 days of not stopping listening. Yeah, that's a lot.

That's a person I don't think you or I could sneak up behind on the street and talk and they would just spin around and go oh my god, Jenny's here. So anyway, my point in saying that is the information you need to live with insulin is inside this podcast. If you go get it. I think that's great. If you jump around, I understand. But I mean, listen to these defining episodes before you go to the Pro Tip series. I really actually think that's important. So agreed. Anyway, thank you very much, Jenny for doing Yeah,

you're very well thank you for asking me continuing to have me Well,

when I asked Stop it, you're making me embarrassed. A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Head over now to in Penn today.com To get started. And while you're doing that, make sure you've heard episode 711 which is the first part of this conversation. Hope you're enjoying the bold beginning series. If you are gonna look for other episodes that you think you might also enjoy. Jenny Smith works at integrated diabetes.com In case you want to hire her, and I'm gonna leave you a little bit of information after the music about how you can find out more about the podcast subscribe, and other such things alright, some quick stuff you'll want to know. The private Facebook group now has 26,000 people in it Juicebox Podcast type one diabetes, people using insulin. You can hang out watch what they're saying talk, ask questions, pick brains, or just lurk whatever you need. It's there. Juicebox Podcast type one diabetes, including lists like the bowl beginning series, defining diabetes, the diabetes pro tip episodes, diabetes variables, all listed in the feature section of the Facebook webpage Juicebox Podcast, type one diabetes it's a private group, so you'll have to answer just a few questions so that we know you're a real person. Everything else you need to know about the podcast can be found at juicebox podcast.com, or diabetes pro tip.com. If you're looking for a great endocrinologist, we have a list at juice box docs.com. It's curated by the listeners, doctors who are down with how people who listen to the podcast they care their type one. You want that part to be easy to write juicebox docs.com completely free. Everything's free by the way, find me on Instagram, find me on Facebook, find me somewhere. If you're enjoying the show, please leave a beautiful rating and review in whatever app you're listening in. Like five stars. This is amazing. And then give a really great description. So the next person who sees your review will know that it's worth listening to. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast and don't forget that episode 712 The second half of this episode is available right now in your podcast player or at juicebox podcast.com.

Hello friends, and welcome to episode 715 of the Juicebox Podcast Hello again and welcome back to the bulb beginning series today is actually the fifth episode but third installment. The way that happened was that episode 702 was about honeymooning 706 was about adult diagnosis. And then 711 was supposed to be terminology, but it got a little long. So that ended up being terminology part one at 711 and terminology Part Two at 712 which makes today's episode 715 bold beginnings fear of insulin. 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. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, you can complete the survey AT T one D exchange.org. Forward slash juice box. Your answers to these simple questions will help people living with type one diabetes T one D exchange.org. Forward slash juice box this episode of bold Beginnings is sponsored by Ian pen from Medtronic diabetes. You can get started today with the M pen at in pen today.com. The podcast is also sponsored by the Contour Next One blood glucose meter. Learn more about Ardens blood glucose meter at contour next one.com forward slash juicebox jetting so far we have I think three episodes of the bull beginning series are out or today actually, as we record this the dolt diagnosis one went up. And today we are going to record fear of insulin lows and highs. And there were a ton of a ton of feedback that came from people again, these are statements from people in my private Facebook group, when asked what do you wish you would have known at diagnosis and surrounding the fear of insulin, low blood sugars, high blood sugars, we got this back. So just a couple of them here in the beginning, it's going to set the stage that don't really need a response, I was scared of insulin. The next one says seriously, the fear of insulin was real. We were scared of insulin as the next one, we had to wake up twice a night for finger sticks. And it felt like we were chasing a blind number. I'm really glad they did have me practice with glucagon. Because when I had to use it, even having to think about it. You know, the person said they wanted to understand glucagon so badly because when they actually had to use it, they were having an experience that was so surreal that there was no time to think my daughter's had a couple of seizures. And I know what that feels like you're like, you just you look at that package. And you just hope your your body remembers what to do, you know, right? The first thing I really want to talk about here is this statement from a person who said, I was handed a bunch of pamphlets and they said read these and oh, by the way, this insulin stuff, it can kill your kid. So don't do it wrong. But don't worry, because we've given you all the tools you need. And this person said they were freaked out instantly, rightly

so with that type of explanation. Because I'm really you're given pamphlets to explain something that for the most part, a lot of people who are using insulin, are completely using it like off the Standard label of prescription that their doctor told them. Right? I mean, eventually you get to the point of or many people do have, there is no fear and you understand the action of insulin, you understand how to manage around it. And that takes fear out of the picture. Because you you get it but initially to just be given these pamphlet that's like here. Oh, and be careful because this could kill you. But clearly, exactly. There's no fear here.

Everything's Don't worry. We taught you everything you need to know. And you're sitting there thinking, I don't know anything. So how could that be true? It isn't really weird situations like hey, here's a car don't worry, they're super safe, but wear the seatbelt and drive 45 And don't hit anything for God's sakes because you're gonna fly through the windshield and die. But don't worry, we thought you were the brake was so it's going to be okay. And it just a lot of this does end up boiling down to the person that you luckily or unluckily bump into when you're diagnosed to you know, just their ability to explain some because that's statement, you could just say it in reverse. You could say, Hey, listen, we've set you up with all the tools that you need. I know you don't feel comfortable with them right now. But trust me experiences are going to make them feel more and more just just real to you things you don't have to think about. But until you get to that point, it's important to remember that too much insulin could make you low, could give you a put you in a seizure. I mean, if you gave yourself way too much he could kill, you just have to say it backwards. Yeah.

And also bring in and these are the preventative things that we're doing from the start. So that that doesn't happen sooner, eventually, you will have low blood sugars, eventually your child will have a low blood sugar, it will happen. I mean, they put out this, like insulin will, can can cause a low blood sugar, insulin will cause a low blood sugar. At some point in your life with diabetes, you will have a low blood sugar you will, right? So just tell somebody that right? That takes it out of the picture of Well, is it going to happen? Yes, yes, it's going to happen. But this is what to do. These are the tools you have, you've got simple carbohydrate, this is what you can expect it to do. You've got glucagon, this is what you can expect that it's going to do for you. You've got these pieces to manage. When that happens, right, which should help somebody feel less fear in using it right. It's not like they're dropping you off in the middle of the desert with nothing around and up. Here you go. But you got to take your insulin.

It's like when you do send your kids out driving the first time you're like, listen, drive very safely be aware of people around you. When you have an accident, which is going to happen one day, here's what you do next. You know, do you don't say if because it gives you that feeling of like, well, maybe I'm gonna be one of the people who never happens to. And then you spend your whole life kind of paranoid, paranoid. Aliy that's good. Can't be a word, but you're paranoid, and is now I'll make up words. But you get in this situation where you're constantly trying to stop a thing. It's like trying to stop the sun from coming up. Like one day your blood sugar's and look, the next person says, I wish the doctors would have explained to us the likelihood of lows and how to treat them. No one told us about that. And my son had a bad low first time we came home sounds like the kid was gonna libre to wanders into their bedroom at 1130 going, hey, something's making noise in my room, because you remember that the poor kids only had diabetes for two minutes, you know, right? His blood sugar's 45. And then this poor lady sleeps in his bedroom for the next month. And then she gets a Dexcom that gives her like, you know, alarms that are a little more in the moment, and but a month, she's on the floor or on a bed or something, because now she doesn't know the kid doesn't know. They're all in a panic. Why? Because somebody didn't just say what you just said, you know, the first day my daughter went to kindergarten, I went to the nurse and I said, let me explain all this stuff to you. I explained it all to her. And she goes, Don't worry, we won't let that happen. I said, No, you misunderstand. I'm not telling you this stuff. So you can stop it from happening. I'm telling you this stuff so that when it happens, you know what to do. Right? It's like it's diabetes. We're not going to stop diabetes from being diabetes. You know, right. This lion is going to bite your face one day. Yeah. I don't care how many times you go into the cage within. It's fun. And you're in Las Vegas me like, is that a Siegfried and Roy reference? It is? Yeah, one day the lions going to kill you. Okay? It's at least gonna come at you. At least bite your arm. You need to know how to hold up the whip in the chair when it happens, you know, right? Well,

there is actually what I was gonna say, you know, you need to know what to do. But in some cases, I think people get really good tools, and really good explanation. And in other cases, people do not they get these rip off pages that say, well, here you go. This is all the information that you need. Just make sure you read through it. Oh, and here's your medicine. It's called insulin. You have to take it here, here. And here. Oh, and you know, you might have low blood sugar. But then again, what can you do about it? Or what are even some of the tools? Or I guess what are some of the variables that could cause a low blood sugar? So you're ready, right? You can say okay, well activity will cause your insulin that you have to take to work better. So be careful for low blood sugars. If your child eats a meal and then goes and plays soccer for three hours, right? All these things that they should know are sometimes the definite causes of low blood sugar because then at least people are aware of where they might see a low

well and everything you're saying supports this next statement, the person said there was so much anxiety my child had a fear that the ambulance was going to come take him away constantly. Your took months to wear away she said so. You know, everything you just said would have given this person, a little bit of calm or even something to say to the kid because that gets Like what's gonna happen? And when you're when your answer is, I don't know, you know, like, that's not supportive in any way for people. One person is this great excuse. We're gonna kind of segue here a little bit. Before we do, though, I want to say, I think it's, it can be worse for adults that are diagnosed, because I think they get sometimes even less. And we talked about this the adult diagnosis episode, and it's fresh in my head, because I just put an edit on the show, and I just heard it again. But that when you're an adult, sometimes you're like, here's the insulin, go to the store, get this prescription filled for needles, and then go see your Endo. And then you call the Endo. And then it was not available for 45 days,

or worse, like six months. And in the meantime, they have you visit with, like, a nurse or somebody in between who, you know, there's, there's a definite disconnect for adults. Absolutely. And I think the other piece for adults is a lack of enough initial good information, but also, many times that adult is on their own. Right, they may not have a spouse or a significant other, or a family member who they're close enough with, that they could share this with and get someone to look in on them if you will, right. And that makes it harder, because kids who have a parent or a caregiver, there's somebody that's got their back, right consistently paying attention for them. Adults don't have that it is it is on you.

And you can slide into a depression, you can just slide into a complacency. Listen, completely disconnected from from diabetes, my son just graduated from college, it's got a really good degree. It's a bright kid. And we told him, like come home from school, like, you know, just take a little time decompress, and everything, but now he's been home for about three weeks. And I had to go into him the other day and be like, Hey, let's get going now, right? Like, you know, he's he hasn't had your break. Like he doesn't, it's just as simple as situation where he doesn't know the next thing to do. And you kind of turtle up sometimes. And then this is about and then on top of that you're scared of low blood sugars are hot, you know, whatever. Anyway, this next person says, I wish someone would have just told me that you can drink water when you're high. And that will help you know. So that's an example. They don't even understand how hydration affects the way the insulin works. Right? Absolutely. So okay, I wish I had known that it would take some time to decrease a blood sugar, the initial one from the diagnosis number. And I really wish someone would have told me that my daughter might feel low in the hundreds. And and that even though the number was normal, she would feel like she was low, like that was never explained. Do you think people even understand that for the most part? I don't

think so. And it's a it's a very good point that this person brings up absolutely, you know, when you when your body has grown accustomed to a glucose level, right. And at initial diagnosis, your body has gotten used to feeling nasty, and it just thinks that that's the norm add a blood sugar of let's say, 300 Plus, potentially. And with that being the case, once your blood sugar starts to come down, now that you're taking insulin, even drifts in blood sugar, not drastic drops, but just a drift under where your body's kind of been residing for a time can start to feel like a low blood sugar. Do you need to treat that? No, but it can be scary. Because it feels like all these symptoms you've been told to watch out for which indicate, oh, my goodness, my blood sugar is too low. But you look at your numbers, whether you're already on a CGM, or you're just doing a fingertip finger stick because you're curious what is going on, then the number doesn't look like it's in the low range. It can be very hard to know, well, what do I do about this? Yeah,

and the idea that you will get your body will get accustomed to it after a while but you can't forget while you're explaining all this to people, the feeling is still real. Yeah, you you feel like your blood sugar's 35 and your blood sugar's 110. And it's it can take sometimes days and weeks depending on how long you've been high for your body to get regular. And feel that feel that way when you're in a regular number, I should say.

In fact, when I was when I was diagnosed eons ago, things are very different. But there's no fancy stuff.

My mom had to go outside and wind up the car to take her to the

me sound like I'm like 90 No. But you know, I was in the hospital for a week, a full week. And they wanted me to have a low blood sugar while I was in the hospital, so that I could experience lows or a low symptom and know what to do about it with I'm assuming the idea that there was somebody there with me, and that they could help me see Yeah, how quickly it could be treated? how it would feel different once my blood sugar was normalized again. So I mean, that was part of my week long hospital stay

was, did they announce? Or is it just like? Did they tell you? We're gonna make you low while you're here? Do you remember? No, no. Okay, just know. And then you realize

I do? Well, they did say that I remember the discussion, you know, with my parents, we would like for there to be an excursion to a lower level, so that Jenny can get an idea of how that feels that you can hopefully be here at that same time. So that you can see how we treated and everything. And I did have a lower blood sugar. I mean, it was by no means low, low, but it was certainly low or dropping. I do remember how I felt. And but the good thing was that I got explanation. Yeah,

right. And for the little things, you end up figuring out on your own like sub first, a lot of people you can feel a fall. So yeah, so you feel the fall before the numbers an issue and correct, you know, just stuff like that. It's great to learn these next two statements are interesting. They're made by two different people. And it's a great perspective in into what someone thinks before they've heard the podcast and what somebody thinks after they've heard the podcast. Oh, awesome. So this first person says, I wish they had taught us to use insulin without being afraid of lows. So that's a person who's now been listening for the pot to the podcast was like, I know now, how important using insulin is correctly. You know, the fear of loads is what was stopping me from using etc, etc. But then here's a person who is giving you a perspective from before they heard the podcast, I had way too much fear of insulin, they pretty much had me feeling like I was going to kill my son, probably within the first week. So so there you go, right. Like there, there's got to be a better way to. And I think we've gone over a lot of it already. But there's got to be a better way to let people understand how insulin works, other than just to say to them, don't do it feels like it's 1950. And they're like, if you smile at a boy, you're going to be pregnant. Yeah, exactly. Right. So there's the so if you're getting if you're listening to this, and you got that kind of information, I think you have to, you have to make the leap into the Pro Tip series and and listen through, so you can get an idea for how insulin works. So you can be use it in a more targeted way or a more meaningful way, you know, any way you you kind of want to think about it.

Because then it does, it does for many people. And I would say, you know, with this topic of fear of insulin. I think I've seen more adults who have had a fear of insulin, tied with a fear to things being too low, then kids, and many times parents are very, I would say parents are very good about not projecting their fears onto their children write for them. For the most part. I mean, there are some that that's not the case for but I think parents are, they try very hard to internalize worries and fears so that their child doesn't see that as well, in terms of how to feel about something they're going to be living with right. Adults, however, again, are the ones managing their own health there, there may not be a secondary assistive person there for them. So the fear of insulin can be very real, when you're the only one who's got your back. Yeah. So you know, in that I think it does, it's learning about how does insulin work? And how does it work for you. And sometimes, as I've worked with people, sometimes it's getting used to even just knowing what small doses do. And then you can build on that, especially if you really just don't want to eat lettuce salads your entire life and who want to gravitate into other things that may require more insulin. Learning how to use more insulin should start in smaller doses then so that you can get a comfort level with what that does. And with less need to over treat, because there's not as much insulin left laying around. Yeah, right.

Well, so here's the other side of it. Here's a comment one piece of well meaning but bad advice that I got from another type one was that a high blood sugar will not send you to the hospital, but a low blood sugar can so it's best to leave yourself high. So it's now it's better high than low, which you know, and then

has very bad advice. Yes, very bad advice. Do not listen to that piece of advice.

But But it's an interesting way of showing how when you get bad information at first it leads to fear and then you go out into the world. Because you think oh I know this thing that's going to save someone analogy. I have to go tell them. And now you the internet's interesting because when you're listening to someone talk, you have no idea if they've had diabetes for three minutes longer than you were three years longer than you. And when you don't know what you're talking about the first thing that said, you often you go, Okay, well, this person must know better than I do. You know, and that is the one. That's one spot where I'm proud of my Facebook group where people do speak up. And so you know, if someone comes in with a kind of a new idea, someone else will nicely say, hey, look, you know, we all get told that in the beginning, but here's the reason why you don't want your blood sugar to be high, you know, highs, cause lows, and etc. and stuff, you'll find out listen to the podcast.

Though I do like in the group, too, that a lot of people are very able to point to either some of the episodes that you've done about specific topics and said, Hey, for a lot more in depth information. And really to clarify this question, listen, here, go here. Try this, right.

There's a lot of I tell you, there was a moment where I realized I can't keep up with this, because it used to be me. Like during the day, I'd pop in and out and be like, Hey, look at episode this to do that. Or this? Have you listened to the protests? And one day, I was like, I can't, I can't, I don't I don't have the bandwidth for this, you know, and now, it's 24/7. Isabel helps me with it now, which is terrific. But at one point, I just said to the people in the group, I was like, if you see a question that can be answered by an episode, share the episode. And that's been very helpful for people. Okay, so then you see, the next person knows this and says, Don't accept high blood sugars as a norm, because you'll start looking at numbers and just going out 200, it's not that bad, you know, and that turns into 210, which turns into 250. And on the way, here's an interesting one, I was just told to take my insulin 15 minutes before my food to Pre-Bolus. So I injected 10 units of Novolog. On a 15 minute drive to get my food. I had a low on the highway. And and here's the kicker, I didn't even know insulin could cause a low, I wish someone would have mentioned that. So, obviously, obviously Pre-Bolus thing is very important, right, and to get your insulin timed well, and you'll hear that in other episodes. But this person, the information they got was almost good, like you need to Pre-Bolus. But the person never in their mind thought that the insulin could take them lower than they want it to be like imagine that like, it's right. Jenny, there's an app on my wall hold, I was gonna say it looks like you're looking at like this has to die give me a second. If you're using insulin and not ready for a pump, or just don't want one, you should consider the in pen from Medtronic diabetes. Now you can imagine an insulin pen is a great way to deliver insulin. But it doesn't give you have a lot of the functionality that you'll get with an insulin pump. But the Impend from Medtronic diabetes does offer a lot of functionality. It does that by hooking to an app on your cell phone. This app is going to give you a dosing calculator dosing reminders, carb counting support, a digital logbook, it will show you your current glucose values, your meal history, your dose history, and activity log reports glucose history, active insulin remaining all in an attractive and easy to read application that goes right on your iPhone or your Android. You can learn more about it at in pen today.com. And if you're ready to try it and just fill in a little bit of information and hit submit. Medtronic has an offer on the pen that is available to people with commercial insurance of course Terms and Conditions apply but you may pay as little as $35 for the in pen, the ink pen that you can get at in pen today.com links in the show notes of your podcast player and at juicebox podcast.com for the ink pen. And for the Contour Next One blood glucose meter contour neck next one.com Ford slash juicebox. I just typed it in right now. When you get to the site, you're going to be met with something that says what do your test strips really cost you? It may be cheaper to buy contour next test strips over the counter without a prescription. Can you imagine that? Can you imagine if you're paying more through your insurance than you would in cash? That'd be nuts, right? Maybe not contour next one.com forward slash juice box. Learn more about the Contour Next One blood glucose meter and all the products that contour offers. You know this website's really something if you go to coverage and savings and then click on copay savings. There's a whole little thing here contour choice copay savings card eligible privately insured patients can save every month on test trips, you should go find out if you're eligible for that. That's pretty crazy. And it tells you more about the meter. The meter is terrific. By the way, I use it every day. daughter loves it fits easy in your purse or your diabetes bag. Bright light for nighttime viewing test strips, of course have Second Chance testing, and the screen is easy to read. Go check out the Contour Next One blood glucose meter. And everything that's available on this website is kind of very comprehensive, not kind of very comprehensive, it's actually very comprehensive. Anyway, contour next.com forward slash juice box. It's the best blood glucose meter I've ever used. And it might be the best one you've ever used as well. And there's one way to find out, you click on the links in pen requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed where you could experience high or low blood glucose levels for more safety information visit in Penn today.com.

I thought perhaps you had like water leaking from your ceiling or maybe ghosts on your ceiling or something.

I'll tell you I might prefer to ghosts because I don't believe in those. And I would have just thought I just like dizzy. But I kept thinking like that thing's gonna crawl over my head and fall. Sorry. So you're big black and I've never had a plant in this room. I'm gonna have to sell this house. Okay.

Now in the house. It is stinkbugs I don't know. I don't know where they have decided that their home is outside that they don't like but they come in our house and I don't care. I just take them outside. I boys who love bugs and love stuff. They hate stink bugs, they will come flying in and be like, ah, there's a stink bug on the ceiling in my bedroom. And I'm like, okay, who's bigger? You bigger?

Think bigger? You know, they're an import. Right? They came here. Are they really i This is not what this is about? Okay, I want to say China maybe. But anyway, look it up. Have fun finding out. Okay. So the expert says safe numbers are not high. Even if doctors tell you that. I wish someone would have been, you know, clear earlier. Another person says I wish someone would have started in terms of telling me where to bring those numbers down. How do I do it with basil? Like, where to carbs fit in? Like they didn't have any? You don't? I mean, like the stuff that seems kind of obvious after you had diabetes for a while in the beginning. None of that's going to feel obvious, right? None of it like you know, when you

because it's brand new. This is a concept that nobody has taught about at all you may learn in I mean, I remember learning about the tiny little I think it was two paragraphs in my human biology course in high school. And I myself having diabetes at that point, I was like, What is this bunch of like silliness? I was like this dude, no way describes, but I'm supposed to learn something from it.

Yeah, in a way, it mirrors how little we tell people about nutrition even and like crap fueling their body. Everybody just is like, Look, I get up, I washed my butt. I get hungry, I put something in my face. And then 10 years from now, when I'm 40 pounds heavier. I go what happened? Right, you know, like, they get it. Yeah, nobody really understands how things work. And listen, I grew up really poorly. I grew up broke, like, my mom had $60 to buy food for three people, right for a week. And we ate, whatever, whatever we could. And it was Yeah, crappy food. And by the time I was an adult, as I was heavy, like I was just like, Mike Kelly and I were together and like, we didn't know what we were doing, we started over again. And you know, we were able to take care of it. But it's amazing how through your life. It's pervasive. You know, like we, how hard how easy it is to have a feeling of hunger and want to grab something that's easy in a bag or something like that, versus like, I'll let me have this orange or something to that effect. It just it gets burned into and you don't know it. And that happens with people with diabetes all the time. Because as we're talking about these newly diagnosed problems, I can tell you that if you don't figure them out early, you're going to be one of any number of people in their 20s or 30s or 40s or 50s who come on the show. Hold on.

Jenny, somebody somebody was very importantly wanting to get in, you know, in touch with you.

Walgreens again. So, so I've talked to too many people who have had diabetes for decades, who are still making the same. I don't want to call them mistakes but decisions over and over again. And when you then present them with this information. It's sad, because they think well, why couldn't someone have told me this five or 10 or 20 years ago? Like, I can't get this time back now, you know,

and I, I think, and this is kind of a, it's a slippery slope to kind of, to walk on, honestly, because I truly believe that it starts when someone is diagnosed. And they are told if we're just talking nutrition, right? They're essentially told, you can eat anything you want, right? And just take insulin, when you're supposed to

take it. I mean, that powering statement, correct, it's supposed

to be empowering in that. You don't have to worry as long as you just take this thing called insulin. Well, I mean, it brings in a whole nother rabbit hole of discussion, though, of, well, you want your child or you want yourself to be eating and doing what do you see every other child doing? But is every other child eating the way that they should be eating? Right, whether they have diabetes or not, or as an adult? Are you eating the way that your colleagues are eating? Because that's what they're doing? And you're only following suit? Is that really? Do they look healthy? You know?

Do you know? I don't know, do you know that there are three aisles in my grocery store that I don't go down, just based on the physical appearance of the people I see in the aisles. I just think I just look at them. And I think I don't want my life to be like that. I clearly don't need this is something in those aisles, is because because then they're I know, I'm I know, this is probably a weird thing to say. But then I look at other aisles where people see more fit. And I don't see them, I don't see these two people in these different aisles. And I'm like, I'm gonna go follow the guy around with the nice calves and see what he buys. You don't I mean?

Sure. I mean, if you look at pictures, I mean, honestly, in the ages of development, since I would say, maybe the 1950s or 60s, potentially, when more like processed packaged convenience, stuff probably started to become more than the norm. If you look at pictures like beach photos from like, the shore or something, it is very difficult to see a body that isn't somewhat fit. Most of the bodies look like healthy bodies. Today's pictures would look very, very different. I mean, there's there's got to be something in the food, and how we are packaging what we are eating. That's creating a lot of issue within diabetes. Yeah,

and how does it fit into this subject? It fits into this subject, because when you first have diabetes bolusing for real food is easier than bolusing for processed food. And no one's gonna mention that to you. No one. No, you this person says not knowing how fast or slow insulin could hit or not knowing that, hey, this could kill you. At first I was under the impression this is the part that's important. I was under the impression that okay, my kids going to eat and I got this robotic insulin dosing strategy and everything is just going to be fine. And so they were you know, they were told count the carbs, give the insulin, do it like this all just gonna work out. And it doesn't go the same way. And that leads people to say things like, Oh, it's just diabetes, or, you know, one day I eat the same thing. And then the next day I eat and it's all different. No one tells you that the next day your insulin site is a is a is a day older. No one says, you know, you had a, you know, you don't know, right? Nobody gives you enough the details. I had a burrito one day, and I did well with it. But I had a burrito the next day and it didn't work. Well. What did you make the burrito? The first thing was the next day was it from Taco Bell? Because, you know, that's but in people's mind, it's burrito burrito. And, you know, it's just anyway, it's important. This person says, and I'm proud of this, I wish I would have known what Scott says that trust. What you know is going to happen is going to happen for Lowe's. When I treat Lowe's i You need to trust that it's going to work the way you know it's going to work. Otherwise, you're going to create a rebound high afterwards, right? Which can ruin a day. Safe numbers aren't high numbers. My first big concern was hypose. It's what they really hammered home in the hospital she needs to eat this exact amount of food has to be weighed or she's going to have a Hypo. And the person says But what I learned is this hypose are actually pretty straightforward. And they're only a massive pain when my daughter's asleep. High blood sugars produce far more fear me now. I assume there was only an issue with high blood sugars with the out she assumed that high blood sugars were only a problem if there were a presence of ketones and now she He realized that that's not right. So they didn't think a high number was a problem in less ketones were present. Right?

Which is often when I mean, there are two angles, right, really low blood sugar fear that really high blood sugar, ketones fear the potential of DKA. But you may have high blood sugars that are just within the realm of high enough without producing ketones, that now you're leading into, if there's enough consistency to it, you're leading into continued damage, right? Long term,

this next person says, I wish I would have known that every time the blood sugar shot up, I didn't have to check for ketones every single time like every time this kid gets a blood sugar for like 200. There, they're testing ketones, and there's episodes on ketones and how to understand them. This person's quoting the podcast says instead of beating yourself up When blood sugar shoot up or down, figure out why and try to prevent it next time take this as a learning experience. But you have to know it's not going to be perfect. You know, maybe never, and definitely not in the beginning. You know, and just to speak about that for a second. These things are going to happen right there, you're not going to stop them from happening. There's two, in my mind, there's two responses, you can panic and beat yourself up and be like, Oh, I did it wrong. This sucks. I'm never gonna figure this out. Or you can just realize there's a learning experience happening in front of you, when you step back, take yourself out of it for a second and look at it, I put the food in here, I put the insulin in here, this is what happened next. I bet you if I would have done the insulin a little sooner or a little later, the food, you know, etc. If I would have just slid these things around in the timeline of my eating. I wonder how that would have impacted these bell curves that I'm seeing all my CGM? Are these numbers I'm seeing right here. Right?

It is I mean, diabetes, I've I've thought for a really long time how diabetes is it is like a daily science experiment, if you will, right. And sometimes those days, you're given the same little petri dish with, you know, like orange growing spots. And because your day is similar enough to the days before, the dots keep growing purple, because you got it, you've kind of figured it out, you know, your timing, you know what ends up happening if you do it this way, or that way, and then comes in a day where the dots turn orange and purple for free, and whatever, by the end of the day. And usually there's a variable in the picture that you've not encountered before, or was something completely different that you've just, you know, you've never had that burrito from Johnny's corner spot. You know, so

it's pretty learn as the person says, I wish someone would have told me to always carry snacks, supplies and emergency treatment with you. I am frequently thrown by how many people don't travel with at least a juice box extra or their meter. Sometimes there's stuff like that, like, I've talked to people, like I don't need my meter. I'm like, How do you know that? Like, if you know that, then this whole thing is easy. Like, like, because you can predict there. It freaks me out a little bit like, you know, yeah, if we drive. If we drive more than 30 minutes from my home, or we're doing something like you're going to go somewhere 2030 minutes away, but you plan on being there for three or four hours. I always say to my dorm, I take a pump with you a little bit of insulin to pump up like you don't want this whole day to be ruined. If something you bang into a door and your pump pops off or things stops working. You don't want to have to stop what you're doing all the way back here. That's big picture stuff. Little easy picture stuff is you need your meter with you all the time. You need your like, I'm fascinated by people who travel without the controller for their insulin pump. Like Well, what if you need insulin? I'll do it when I get back. When you get back. What are we talking about? Like, like, but no, like, and but for lows? You have to have a way to stop a low with you. Yeah, and not just one way. Like, like, many maybe yeah, because what if you drink the juice and it keeps going? Is you know, like, I mean, there's a difference between being paranoid and being prepared? Correct. You need to be you know, in a modern society. You know, somebody in America, who's living in a house where foods readily available, I get, you know, go into your neighbor's house or something like that. Not feeling scared, but you don't start getting into cars and driving to locations where, like, yes, there's a Wawa on every corner. I mean, you know, we're some sort of a convenience store but you're not in there if your blood sugar starts dropping and you're driving your car,

correct. So absolutely. I know at the in the turn of a season usually like from from winter into like spring summer. I have different persons, if you will, that I might use and I always end up having to like dig in the pockets of the purses, and fish out like the really old glucosuria cuz they're like, you know, the sugar sort of starts to get harder and whatever. And I'm like, yeah, it's time to change those out. I would eat them if I had to, but they probably aren't gonna taste very good.

juice boxes in the pockets, the door pockets of our cars, right? Yeah. And one time we got down to the one where you, you're looking at you think I can't believe this is holding the liquid anymore like this should have been thrown away and replaced. It's like the squishy. Yeah. And we had to give it to Arden. And even when she took the box, she went, Oh, this is gonna be horrible. And I was like, sorry. And you know, and it'll work. It'll work. But it was like syrup. It wasn't even like it was bad. And she's she was looking at us like, You got to be kidding me. I was like, I tell you to replace these things. No one listens to me. So there you go. Here's an interesting one. I felt like I was bringing home a newborn baby. We talked about how diabetes can feel like a newborn baby. But she said that the first low that that she saw was a 74. And they were running around their house like a lunatic. Like we have to stop this. 70 for every minute, which

can be scary if it was falling fast. Or if you'd never seen that valley that's absolutely contextually.

Absolutely, but in a situation where you're looking at a fairly stable 74. And you're thinking like, life is just about to end. You know, like, you know, it's when I say this sometimes because it's the one thing that I feel sad for people, but it does make me like laugh a little having been in this game for so long. It's when you see somebody like show a graph. And this kid's you know, blood sugar super stable, and then it dipped down to 80. And then the caption says, like, I saved their life with a cookie and like, what

it could have, how much it was gonna dip out?

Yeah, but but like that idea. But it really what it outlines is that people just are not given accurate depictions of what a good blood sugar is. And, you know, right, I have an email that I've been going back and forth with this gentleman about that. I think this is a great place to put this. He said, I've been trying to keep my kids a one C as low as I can blood sugars as low as I can. But then I ran into this person in the diabetes community who said, No, you can't do that. Because, you know, a blood sugar under 55 causes brain damage. And I always hear those conversations. And I'm like, I'm like, I don't think anybody really knows. But it's a hard thing to respond to. Because I don't want to be the person who says I don't think a 55 blood sugar is gonna give you a brain damage. But I don't want to say that out loud. In case I'm wrong, you know what I mean? But I mean, I don't want my daughter's I don't want your blood sugar to be 55 Jenny, right. No, no, I don't want it to be 55. Doesn't feel nice. But should it sit there for a couple of minutes?

That is the couple of minutes. It's kind of in theory, the idea of cumulative time is just like highs, right? So the idea of deprivation to the brain, over long periods of time are consistent over days and days and days of consistently having hours worth of low blood sugars. There is research about brain health, especially in kids. Absolutely. But if your blood sugar dips to 55, and I've certainly had 55 blood sugars, and I don't think that I am brain damage, do I sound brain damage?

No kidding. No, you don't set yourself okay. Well, the way I ended up responding was I said, Look, you know, as we went back and forth, and I got contextually better what they were saying. I said, Listen, no one is saying that your blood sugar should be 55 for hours or right. You know, like I said, low and stable. A one sees not not like a life where you're like, oh my god, I'm 40 Oh my god, I'm 400 Oh, my God. Like, that's not good for you. I said you want stability? But if you can't, if you can't achieve an 80 blood sugar without it becoming a 55 you're not using your insulin correctly.

Right. Right. And something needs adjustment. Absolutely.

Right. So anyway, I mean, I don't know about I agree with what you said, I would not want any, I would not want any measurement in my body to be way off for a long time, right, your thyroid, your thyroid hormones too high for a long time. It messes you up as a human being right? If it's too low, it messes you up as a human being your blood sugar the same way. But you know, we talked about it earlier, you have diabetes, you're gonna get low at some point, like, it's just you're gonna get you're gonna, you're gonna do something, and your blood sugar is gonna be 401 day and it's just gonna happen and your blood sugar is gonna be 55 one day and it's just gonna happen and you are going to be in a situation more times and you care to count your life where you actually think you saved your life with a cookie. Right? Like it is. It is gonna happen. And yeah, you know,

I think that's a value to these days of definitely having the technology specifically the CGM technology that we have, because you do have a little bit more visual in terms of that line of sight, right? Where are you? Where are you? Are you stable? Are you stable and sitting at home doing not very much, okay, then great. If you're sitting at, you know, 82, you're probably not going to treat that. Because you're stable. What's wrong with that? If you're 82, and you're going to head out on a 10 mile bike ride, you probably don't want an ad to blood sugar unless you've done something that you know, is now going to hold that sable at that level, right?

Here's a couple of other things that are interesting to look at people's brains and how they work back and forth, like people are different, right? This one person says, I wish someone would have told me what happens when you go low, how low is gonna make me pass out what's going to happen in my body, then I wanted that information. But the next person says, here's the thing that messed me up, I thought the smallest mistake was going to kill me. And it created panic attacks. And so they go to different people in a similar situation, they want different things, different things. And that is, in the end, why you have to go out and advocate for yourself and look for information because the doctor doesn't know if you're the the person who's gonna have a panic attack. Or if you're the person who says, Hey, what's gonna happen to me after I pass out? When's that gonna happen? And those numbers are different for everybody. I've seen Arden have a seizure at at, I think 20 was a blood sugar. And I've seen her talking to me when she's 28. Like, there's nothing wrong. So I don't know what to tell you, you know what I mean? It's, it's, there's a it's a theater line, like it's, it's like you're, you're dimming a light. And there's a moment where you still have plenty of room left on the dimmer, but the thing just goes off you go, Oh, that was weird. And, you know, so here's what I would tell people is, I don't want my daughter's blood sugar under 70. If I can help it, I treat it when it looks like it's gonna go to 65. I treat it more urgently when it's under that number 6065 55. I think we've messed up pretty good here. And you know, lower than that, she's going to start becoming incapable of helping herself like it's going to start to get worse and worse. So Right. You know, to me, 70 is, I

think another thing that goes along with this too, especially for kids is I've had a lot of parents tell me. I asked my child how they're feeling. And they say I'm fine, Mommy, I feel just fine. The kids, kids don't really I don't know that there's necessarily an age of awareness of symptoms, that they're, you know, that it starts to be like age eight, they'll definitely know what a lo feels like, right? thing for every child or teen, it's probably going to be a little bit different. But a lot of parents worried because their children just have no self awareness of symptoms. And that's hard. Because, you know, I know myself when my little kids get really busy with their Legos or whatever like they are, sometimes I have to call to them like three or four times and get their attendees are so into what they're doing that that awareness of other things is completely not there.

And your kids don't have diabetes on top of No, so no. Do you have a little time or you have to go? Get a little time? Okay. The other person's I guess we need an episode on this the research about blood sugar numbers, what is actually less likely to cause long term health highs or lows. I mean, I, I don't know how scientific it is. But I I'm more worried about highs than lows. You know, for a long term health especially, I mean, short term, a low blood sugar gets right now, but you know, long term, I think it's I this is interesting, I focused so long on this, and I don't think I should have the perfect math. She says we were seriously so scared to give a little too much insulin like even by a tiny bit. And then quickly, they realized that everything was sort of a best guess to begin with. I used to on the old Omnipod PDM, you had to hold this arrow up to make the carb count go up. And yeah, and it would like get to, you know, I didn't really count carbs at that point at all. So I was like, Oh, I'm gonna do four years for this. And I'd hold the button. And if it's not there, four and a half hours I can that's fine. It's close enough. Now for little little kids a half a unit. It's a big deal. Actually, a woman made up point in an earlier statement that I never brought up. She said I once took a unit of insulin out, put it in a spoon and then I took 10 units of insulin out put it in the spoon she goes and it freaked me out at how similar those two amounts look. And I thought Yeah, it's it is interesting, isn't it? But in the you know, obviously in a syringe, you can see it better, but Right. That's just an interesting one, right? Like it is. I see people all the time, like, well, I made a Bolus that was 4.1 and I think it was too much and I'm like, but I guess all right, you know, as your as you get bigger and you require more and more insulin, those times

one isn't going to make Hello. Which is the reason that many people, you know, especially pumpers get frustrated when they're trying to correct higher blood sugars. And their pump is recommending something like point two units. And they think well point to like, 1.2. What's the purpose of that? It's not going to do anything to help me at this point, right? Yeah. And that's when they get more aggressive. And then you're like, Oh, well, I clearly should have taken the point too. Instead,

this person says, I wish someone had told me that my eyesight was changing when I got low, and that it would come back. Like I guess, from dizzy. And also, she said, conversely, I had been high for so long, that my eyesight had gotten bad. And that as I brought my blood sugar down, that change, that was scary. A person here says, I remember thinking that if she's still low, like, do I still do insulin, like when I feed, you know, like, like, okay, she's 60. But she 20 carbs. And we talked about pipettes all the time, you need to cover the amount, there's an amount of carbs to fix the low, and then there's amount of carbs, you don't need some of that needs insulin correct. And, and this one's interesting. I was told there was a three hour rule that we couldn't give any insulin unless it had been three hours since the last dose, this caused many high blood sugars for us, was not explained well. And and it seems like a big one for newly diagnosed people. And I think you should bring it up. She said, so. Yeah.

And I think I mean, we talked about stalking, I think recently in an episode, but that kind of goes along with initially, the idea that once insulin, it upon diagnosis, once insulin is starting to be injected, they're very cautious, assuming the potential for honeymoon. So what they're looking for is, let's give a timeline of what we're expecting this rapid insulin dose to work over. And let's be careful about not adding extra within this. But as you know, you always say if you've done it enough that you know that, oh, yesterday and the day before I didn't do anything, except after three hours. And her blood sugar just sat high. Yeah, clearly, there was more insulin that was needed there. So more insulin,

you're gonna get into that in the next episode of this, because the next thing we're going to do is the 1515 rule. So we'll get to talk a lot about that. But we're done. We made it through there were a lot of questions in this one. And we chit chatted in the beginning about personal stuff. So I'm pretty before we started recording. So I'm very happy with what we got today. Thank you very much. Yeah, absolutely. A huge thanks to Ian pen from Medtronic diabetes, and the contour and the Contour Next One blood glucose meter, head over to Ian pen today.com. And contour next one.com forward slash juice box to learn more about the ink pen and the Contour Next One. Just check them out. They're both terrific. Thanks to Jenny. Don't forget Jenny works at integrated diabetes.com. If you'd like to hire her, I hope you're enjoying the bold beginnings series. There's much more to come. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, if you're still here, don't forget that juicebox podcast.com. diabetes protip.com is a place where you can learn more about the podcast in general find all the different series. There's a Facebook group for the podcast that has I think 27,000 people in it. Now we're getting close to that at least Juicebox Podcast, type one diabetes on Facebook. It's a private group. So you'll have to answer a couple of questions before you're led in. Oh, oh, you know what else in that Facebook group at the feature tab at the top, there are complete lists of all of the series that exist for the podcast. And I guess I gotta find a way to get those lists on juicebox podcast.com to I'll work on that. All right. That's enough Chitty chatty right. I hope you're enjoying the podcast. If you are tell a friend. And don't forget to subscribe and a podcast that don't just listen, subscribe or follow in like Apple podcasts, Spotify, Amazon music, something like that. You should be able to find a great free app that you can listen to the podcast in. Alright, I've said it before. I'll say it again. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to another episode of bold beginnings. This is episode 719 of the Juicebox Podcast. On this episode of bold beginnings, Jenny Smith and I will talk about the 1515 rule. If you've been diagnosed with diabetes, and given insulin, someone has said to you 15 carbs 15 minutes. Jenny and I are gonna break it down right now. 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're enjoying Jenny, and you'd like to see what she's doing professionally, checkout integrated diabetes.com. That's where she works. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box. Join the registry complete the survey support people living with type one diabetes T one D exchange.org. Forward slash juice box. At the end of this episode, I'll list all of the bold beginnings episodes that have come before it, just in case you have missed one. This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes. And because this is a short episode, I'm going to give you the entire ad right now. lickety split real quick, you ready. The pen is an insulin pen that connects to an app on your cell phone. When that happens, it gives you much of the functionality that you would get with an insulin pump. It's also completely possible that the in pen may only cost you $35. Head to in pen today.com To find out more. When you get there. If you're ready to try it just fill out the form where it says ready to try and hit submit. But if you want to learn more, do some reading, find out about the pen, insulin cartridge holder dosing window a knob and injection button and a cap just like you would expect from an insulin bed. But then it connects to the app on your phone through Bluetooth, giving you your current glucose levels, meal history, dosing history activity log reports, glucose history, the act of insulin remaining and your dosing calculator. Also I also while you're on the page in Penn today.com You can learn more about the offer that is made to people with commercial insurance terms and conditions apply of course, but you may pay as little as $35 for your in pen. You know what else in Penn offers 24 hour Technical Support hands on product training and online educational resources. All of that is something you can learn about in more depth at in Penn today.com in Penn requires a prescription and settings from your health care provider you must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information again, visit in Penn today.com There are links in the show notes of your podcast player and at juicebox podcast.com. To in pen Dexcom Contour Next One on the pod the T one D exchange G vo glucagon touched by type one, US Med and those are the sponsors for right now. But if you're interested in buying an add on the Juicebox Podcast, find me and we'll see what we can work out. Bold beginnings series is going well people are enjoying it today. Jenny, I put up our terminology episode as a two parter because it was like an hour and it was like an hour and 15 minutes long. So I just kind of cut it in half. I thought it would make it easier for people to be able to find terms within them. But this morning, I was hoping to do the 1515 rule. Ah, so let me find people's feedback on 1515.

I am I'm first very curious what people have to say about

that. It's it's it's repetitive and and is it Yeah, so you know, just a number of 15 carbs 15 minutes rule one just says no. 15 carbs for a low is probably overkill. Not everyone treats I've learned with 15 carbs, we still only use two or four carbs to do a kind of watch and weight thing. So then a longer piece of feedback is the whole premise of the 1515 rule just does not do well for most people. If we had followed that consistently our toddler would have been consistently over 400 and we would have been having rebound Hi is because of these uncovered carbs. For example, 30 grams can move my child all the way up to 300 blood sugar. Now, I guess we should go over very quickly. 1515 Roll means if you find yourself low, your doctor will probably tell you have 15 carbs, and wait 15 minutes, correct retest. Now, do you think that that's a pre CGM? Theory?

It's a, yes, that's where I was going to entirely. It's old. It's old. Like, I think the term brittle diabetes is old and not a purposeful explanation at all. But the 1515 really came from lack of any technology outside of a glucometer, that you could actually do a finger stick to confirm symptoms and see where things were going within another 15 minutes, right, because it is going to take some time for a finger stick value to show a difference in that era of, you know, that kind of use of limited technology. But we have so much information now with the technology we have, that that rule is explained very well by these comments. Absolutely. It's, I know how much it takes to bring my blood sugar up this much when I'm hovering here, or if it's a really quick like jump over a cliff drop in blood sugar, I might need this much more. I think we also understand insulin a little bit better, at least, you know, a lot of the podcast listeners understand insulin a little bit better, and the action of it. And you can say, well, I'm in the clear of any insulin on board. This low is being driven by Basal insulin only. And maybe because I got a little bit more active or busy or whatever, in this timeframe, I probably could get away with three or four grams of carb, and even this out and be totally fine. Versus again, 15 grams that you don't need,

it feels it feels like to me even meters not that long ago. I mean, I want to sound like an old person. But not that long ago, even meters weren't all that accurate. And some still, actually but you know, I think now what does the FDA push them towards? Is it is it. You know, the percentage, like if your blood sugar is actually 100, the meter has to report back at least like 85 or 115 are in that range somewhere.

There's a percent it's actually the the average difference that's allowable for the FDA to approve the meters each of the meters. I mean, if you're really interested, and you really want the information, don't throw away the little pamphlet that comes with your test strips, because it has that direct information for you. How much off could it be?

Well, and but in the past, I mean, I remember people advocating for meters to get better and better to where they are now. And I can remember in the past where people are like my meter can be off by 20 25%. It's on correct. So with all this unknowable data happening, what is your blood sugar really? Is it falling? Or is it you know, is it rising, you would have no idea without a CGM. So this very, it's a safety feature from back in the day where the doctor is like, if you're low, eat 15 carbs, wait 15 minutes and test again. And if you're still low, eat another 15 carbs, right would be the next thing. And yeah, and now hopefully, you know more and more people but so is so I guess here's the question, if you don't have any good tech is 15 carbs 15 minutes still the way to go.

From a safety standpoint, yes. Okay. Um, from a standpoint of even newer insolence are more rapid acting insulins that do have a little bit more definitive timeframe of action, it's a shorter timeframe of action. Again, I think that there's more consideration that you can still do even if you're just taking multiple daily injections and using a you know, a meter to check your blood sugar's fingerstick wise, you can still start out on the low end of treatment. If you're willing to go about a little bit more testing to evaluate the need for more. It will it will tighten your ability or it will tighten your range after treating you're not necessarily going to always need 15 grams even if you're blind with you know with no CGM data, let's say I in fact, I would say that many people could probably do well with five to eight grams of carb and not get into trouble with excessively high blood sugars. Again, that's outside of exorbitant insulin on board wording that kind of thing. But outside of that, I still think 15 is an overshoot. But it's a safe enough overshoot that it's definitely going to raise your blood sugar.

So I want to kind of bring a couple of different thoughts in here. So first of all, if you're listening to this, because you are more more newly diagnosed, it's important to know that carbs will hit you at different speeds. So, you know, taking 15 grams of a baked potato for a low blood sugar is not going to be a good idea, right? You need fast acting easy to absorb simple sugars, things like that. You also have to be aware that if you have if you have, let's say you have enough insulin working, where you're low falling, and you're going to need 30 carbs to stop it. But you take 10 of a simple sugar, it could look to you even on a CGM, like the insolence just, it's just running through the sugar, the sugar is not even slowing it down, it is slowing it a little bit, but it might not be enough. So the speed, it's we're understanding glycemic impact and load a little bit helps with with stopping low blood sugars, you can eat a baked potato is going to take forever for your body to absorb, which is why the emergency gel for instance, gets rubbed on the inside of your cheeks, right gets absorbed very quickly. I know this is like a scary time for people. You know, so you're you're newly diagnosed, you're falling, here's how this goes. You do the 15 carbs, 15 minutes, eventually, you're happy because while I stopped the low blood sugar, and then you start seeing the next step and thinking well by now but my blood sugar's to 20. Now afterwards, I don't want to I don't want to stop a 70 and make it a 220. And by the way, some people are treating low blood sugars, and they're calling them low when they're first diagnosed at 110. They're like, Oh, no, I'm getting low, you know, right. And so then they see the next piece of it. And you're trying to make sense now of how do I stop this low blood sugar without creating a high one, I would even say to you, I would jump past that idea and say how do I get into a world where I'm not stopping low blood sugars all the time? Yeah, correct. Yeah.

Right. And that's what we focus on. Even in education, we first look for lows, or percent of time, lows, are they frequent? Are they at a consistent time of day? Is there a trend to them, for example, and if there is, we go to meet those first, most people who want tighter control, they're actually much more worried about the highs than they are about the lows. But if we can take away a good number of the lows that are occurring in a in a pattern, we can also take away a lot of the highs because it's it's hard to not over treat, especially I think in the beginning when you're really learning about things, and trying to judge how your body is, you know, I guess reacting to stuff. And also how your brain is able to overcome the low and the symptoms and being able to tell yourself, well, I don't need that 15 grams, I feel these low symptoms, they're horrible. I'm only going to treat with this much

right. It's all it ends up being that understanding the bump and nudge ideas from the Pro Tip series will help you understand this. In simple simple terms. If if you're standing on the sideline of a football field, you're out of balance and somebody's inbounds and they're just wandering out of bounds, you might just put your hand up and stop them without pushing them. But if they're running out of bounds, you're going to have to shove them to keep them in correct. And so if your blood sugar is and this is where having a CGM becomes really valuable if your blood sugar is 65, but it's super stable at 65, a few carbs and there's no active insulin, a few carbs might move you up to 90 no trouble. But there's active insulin or if the 65 is falling, then you'll need more carbs to counterbalance that. But in general, the blanket statement 15 carbs 15 minutes is either going to lead you to a life of bouncing blood sugars and not understanding what's going on or it's going to lead you to the the idea of like, Hey, I think there's more here for me to understand. Right, just running through people's statements again, the 1515 plan can be too many carbs for those 15 carbs was way too much for me. overtreating lows was a big problem in my management. You don't need 15 carbs for low is something I wish someone would have told me. I mean, you might, but it's not a hard and fast rule. Right. And then this person says that the 1515 rule was drilled into us. And so early on to combat minor lows. They're just doing it over and over and over again. They're seeing what's happening. But they can't, in their mind make the leap. They shouldn't be doing it or they should be adjusting it somehow because of how fervently it was it was drilled and recommended.

Yeah, absolutely. And again, I think it's the biggest takeaway, right? Now is if you're using any kind of technology, I guess CGM specific or if you're just really, really on top of doing finger stick after finger stick, because that's what you're choosing to do, then you've got enough information, and enough accurate information to be able to say, in the past couple of weeks, I've done the 1515 rule. It's created this roller coaster up and down that I no longer want. What if I just treat with 10? Instead of 15? Right? What if I treat with eight instead of 50? Right? I mean, there, there's some navigation that eventually you're going to learn how to do your own self experimentation that say, Well, you know, this is what I'm gonna have to do, because that's clearly not working with 15,

right? And you're gonna hear people say to you constantly, like diabetes is a science experiment, you're gonna figure it out, etc. That's all they mean. They mean trial and error. Don't do the same things over and over and over again. You know, once you see something and it proves itself out, trust it and do something different. Correct. Okay. So there you go. The 1515 rule, which is not really a rule it's just get says the people so many times people like it's a thing. A huge thanks to Ian Penn from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast in pen today.com. To get started, where to learn more. Thanks also to Jenny Smith, who works at integrated diabetes.com. If you're interested in procuring her services, that's where you would do it. I also want to thank you for listening, for sharing the show, and for being terrific. The other day, I received a photograph from the ninth listener who's bought a vanity plate for their car for the Juicebox Podcast. That is, um, that's some cool listeners. It's some great dedication from you. Thank you so much. If you head over to the private Facebook page, which I'll do right now with you Juicebox Podcast type one diabetes. Get yourself in there scroll to the top click on Featured Isabel has all the lists set up for you Pro Tip series variables, etc. One of those lists is the bowl beginning series. I will read from it. Episode 698 defines the bowl beginning series lets you know what we're planning on doing with it. Episode 702 is about honeymooning 706 adult diagnosis. 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin and today's episode, Episode 719 is the 1515 rule. There's much more to come. But that's where we're at right now seven episodes deep in the bold beginnings series. There's also a list there for defining diabetes that's 44 episodes of terms defined for you that you use every day with type one and type two diabetes very often. How about a nine episode series talking about celiac, and type one, or a 10 episode series about disordered eating 19 episodes dedicated to just me talking with kids, lots of interviews with me and the children 26 episodes Excuse me 27 episodes after dark series everything from drinking to disordered eating psychedelics living with bipolar. People who have type one diabetes, and other extraordinary challenges often will be found in the afterdark series. There's a 411 list called juicebox asst that has 16 Very popular episodes in no particular order. How about a 14 episode series about algorithm based pumps from loop to Omni pod five control IQ and there's way more coming in that series very soon. You can learn how to Bolus for fat and protein. And there are so many ask Scott and Jenny episodes where Jenny and I just answer listener questions. There is a growing list about mental wellness and type one many of the episodes are with licensed Marriage and Family Therapist Erica Forsyth a type one herself. We have a small but but but strong list of type twos. I really would like more of you to reach out to be on the show. Always looking for type twos to be on the show. Please reach out if you're interested in coming on and building that series up for others. Defining thyroid is a 10 episode series that will help you understand thyroid disease. And our pregnancy list has just grown no pun intended to 12 episodes. There's a how we eat series where people come on to talk about their eating Tao carnivore plant based low carb Bernstein FODMAP keto flexitarian intermittent fasting vegan, that list is also on the move, looking for more people to come on and talk about how they eat. There's a quickstart guide episodes from episode four all the way up to episode 100. These are the episodes people say if you listen to you'll get a vibe for how I feel about type one, and it gets you into the podcast. And that's the Quickstart list. Don't miss the diabetes variable series 22 episodes, giving you look into things that impact your blood sugar that you would never think of like hydration, sleep, weight gain, and more. And of course the diabetes Pro Tip series 25 episodes with Jenny and I starting at episode 210 newly diagnosed or starting over taking you through all the steps that I believe will help you bring your agency to where you want it to be. I hope you check them out. 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 723 of the Juicebox Podcast. When Jenny and I pressed record on this bulb beginnings episode, we thought this isn't going to take long at all. And it didn't take long, but it didn't. It didn't go as quickly as we thought. What I'm saying is, there was more to get into than we initially considered. And that's why I like these conversational episodes. Today's is about long acting insulin. 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're enjoying Jenny, and you'd like to see what she's doing professionally, checkout integrated diabetes.com That's where she works. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry complete the survey support people living with type one diabetes T one D exchange.org. Forward slash juice box. At the end of this episode, I'll list all of the bold beginnings episodes that have come before it, just in case you have missed one. This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes. And because this is a short episode, I'm going to give you the entire ad right now. lickety split real quick, you ready. The pen is an insulin pen that connects to an app on your cell phone. When that happens, it gives you much of the functionality that you would get with an insulin pump. It's also completely possible that the in pen may only cost you $35. Head to in pen today.com To find out more. When you get there. If you're ready to try it just fill out the form where it says ready to try and hit submit. But if you want to learn more, do some reading, find out about the pen, insulin cartridge holder dosing window a knob and injection button and a cap just like you would expect from an insulin bed. But then it connects to the app on your phone through Bluetooth, giving you your current glucose levels, meal history, dosing history activity log reports, glucose history, the act of insulin remaining and your dosing calculator. Also I also while you're on the page in Penn today.com You can learn more about the offer that is made to people with commercial insurance terms and conditions apply of course, but you may pay as little as $35 for your in pen. You know what else in Penn offers 24 hour Technical Support hands on product training and online educational resources. All of that is something you can learn about in more depth at in Penn today.com. In Penn requires a prescription and settings from your health care provider you must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information again, visit in Penn today.com. Today's episode is also sponsored by touched by type one, they'd love it if you'd find them on Facebook, Instagram, or it touched by type one.org. Jenny we have on our bold beginnings list. long acting insulin. It's a pretty short episode, I think based on the feedback but based on people's questions and statements about what they thought would have been helpful to know at diagnosis, we're going to include it here. Okay, so long acting insulin right away hits my brain wrong because I want to call it Basal insulin in my head, right? Same thing though long acting Basal we talked about a long time. Some examples are level mirror Lantis receba God give me more to jail,

Basil Glar. I'm Yes. There's also if you want to include it in the same category in terms of considering long acting and basil as one thing, then we also have to include what was the old version of a Basal insulin, and that we now refer to it as more of an intermediate insulin, okay, it's an or NPH it's the kind that looks cloudy in the vial. And that has it has a shorter life. You have to dose it twice a day, but it's still considered long acting in terms of it covers that Basal insulin need, just not as long.

I'm realizing as we're talking Get it this is going to be more than just about long acting insulin. So there are places in the country in the world where you may still be given mph when you're diagnosed. That's right. Okay. Absolutely. And that if people are given mph are they going to hear the word sliding scale every time?

Many times, yes. Because of the way that that intermediate acting and or NPH works, it does. Today's Basal insulins or long acting are like a flat scape right there like a horizontal kind of, they go in, they start working and they have a flat impact once they're in a steady rate of action, whereas the intermediate acting insulins are dosed twice a day, because there is a bell curve or a peak in action, and then it floats back down, and then you take it again, and there's a peak in action, and then it floats back down. So sliding scale goes along with that, because oftentimes, if you're using n or NPH, you're also going to be using the more short acting kind of insulin called regular insulin. It takes a little longer for it to start working, but they're often dosed together, okay to to take care of two things, one mealtime coverage initially, and then the long acting insulin or that intermediate, and it's going to peak around the next meal time, or that's the goal of dosing it. So you may have short acting, and the intermediate together, the peak of the long or intermediate acting is going to be around a mealtime where you may not take extra insulin, because that peak is supposed to be covered by your next food intake. And thus, the term sort of sliding scale, take this much if your blood sugar is between this value and this value, this number of units of insulin, it's it's not precise. It requires you to get some information from the doctor prescribing that designates a specific amount of food to eat at each mealtime. Because those that sliding scale is specific to an amount of food that cover or an assumed amount of food to cover. And if you vary from that, you're going to have more erratic glucose control.

Can I ask you why in 2022? Would people be given that insulin still

depends where you are in the world? Okay. And we live in a very, I mean, we have a community here in the United States. That is, we complain about what we can get, but we can really get we shouldn't have complaints compared to third world countries and places that just really, I mean, they may not even have a glucometer to use in their own home. Right?

Well, even beyond that, I still hear from people in some provinces in Canada, who are given mph when they're diagnosed and sliding scale and told shooted at this time of day, eat this many carbs at this time of day. And that's I mean, that really is management. Like you're saying based on modern management now, that's managed from the 80s.

Yes, yeah, that was my management. Yeah. Hi, I did it.

But it leaves you it leaves you open to a lot of, I think unknown sweat. Like I can't imagine doing like a regular and mph regimen and wearing a CGM. Because you probably see your blood sugar's get pretty high, stay high, come down low get low, like the whole thing.

I believe that there will be a lot of frustration. Another reason that in again, a good number of the people that I get to work with are pregnant women, right. And there are still some OB practices that move towards the potential use of the n or the MPH at a specific time of day to cover a hormone impact that may not be being offset the right way, even if the woman is on a pump. Or we've navigated by adjusting doses and everything. Because the short action time of that n gives the allowance for peaking at the point of where you want more insulin really heavy hitting and sometimes it can be a beneficial added tool in that particular you know population

but if I'm just a person diagnosed now modern times and somebody said here's it's regular an MPH and you're going to eat on a sliding scale, that's a red flag. To me, right? Yeah. We give like a lot of it's funny. I don't think of this as an advice driven podcast at all. Like, I never think to say like to somebody like don't. But if somebody says that to you, if you want my opinion, either tell the doctor, I want more modern insulins like the ones we're going to talk about in a second. And if the doctor doesn't know what you're talking about, you're looking for another doctor.

Move on. Yeah, exactly. Yeah. Because especially if, and this again, is speaking to the terms of access, right? What people with good health care coverage and whatnot do have access to you should not be being put on an MPH and and regular insulin from the get go, you should have the option to do a much more flat acting insulin. And the oldest on the market is Lantus, at this point, followed pretty closely by love Amir, and then the newer ones are the two Jao and the truss EBA and the basic glower and you know,

we're going to talk about them. Now, I just, I'm just going to add here, if for financial reasons, you're on regular and mph. I mean, Jenny's talking to you right now, many years later, after using it, it can be done. It's just not, it's not a preferred method at this point. So if you can get

Yeah, and the biggest thing there is a little bit more scheduled to your day, can it be done? Absolutely. It can be done, and it can be done with success. If that's the case, then I you know, encourage trying to figure out a set structure to where you put your food in the day, because that's how your insulin is working.

How much I don't mean to get off on a, like a personal conversation here too long. But how much of your, the cure Am I think of you as a person who eats without trouble? Like, I don't think of you as a person who eats healthy foods and is like the moaning at the whole time? Or does what they're supposed to do? And they're like, I really wish this was a flaming hot Cheeto. I wish I tried once, and I don't understand why you people like those. But that's okay. What I'm saying is this, how much of your regiment as a child, do you think impacts your eating style now? Has to write

absolute? No, that's a, it's a great questions. question I've been asked a number of times, otherwise. I think it influenced a lot. And I think it influenced a lot because that was what my parents had to go by the I mean, the information was like, this is like the Bible to follow, right? You will feed your child and get her up at this time, and dose her insulin, she will have a snack here, it can be these types of foods. And it was figured out according I mean, you know, my my macro needs based on my growing body, it was figured out in that realm from a dietitian standpoint, as well as from a diabetes need standpoint. And I think a lot of that definitely moved me into kind of where I am today, as you I mean, as it is, I still get up. I am quite certain that the reason I'm an early riser, is because I had to take my insulin in the morning at a very specific time. Because my evening insulin was also a very specific time, and it had to be like 12 hours apart. And my parents were very strict about you know, so I don't get up early

your health now is a is a testament to their taking that sliding scale seriously and really sticking to it. But it just occurred to me now it's like, oh, that's probably why your regimen you're regimented person because of that, you know? Okay, so

it's also just my personality, and wherever it came from, I don't know. But yes,

like your parents, obviously, were regimented to some degree too, because they were able to put it into I mean, listen, someone came along, like, Hey, your kids got all this stuff. And they're like, no problem. I'll have her up at 603. She'll be eaten at 645. It's gonna be 17 and a half carbs, you know, and we'll inject this and it's gonna, I interviewed a guy the other day, who grew up with a type one dad back in the was that was born in the diagnose the 50s. So it was a long, long time ago. And he said, one of the things he remembers and almost resents from childhood is that they had to eat at the exact same time dinner every night. So it didn't matter if he was playing. Everybody else would be like, Oh, come in later. It's like we had to eat because of my dad. Yeah, yeah.

But I think it helps eventually. I mean, my dad was diagnosed with type two diabetes later, you know, in life. I was in college once he was diagnosed. And I think that sort of helped my mom move into that management with and for my dad, too.

So she probably didn't have she was probably like, oh, this will be easy. Like I got this Hold on, let me get out my old books and Ledger's. But so Okay, so you're diagnosed. Hopefully you don't get mph and regular. Hopefully you get some sort of a Modern Basal or long acting insulin. Jenny just went over them lever Mir and Lantis are the older ones to Jao and TriCity Barsi. But the newer ones, depending on which one you get their action times are going to work differently. So the story I always tell is that Arden got that's funny now that I think about Arden got Lantis and it burned. So they, so they moved her to love Amir. And I remember being told that either Lantus or levemir definitely lasts for 24 hours, blah, blah, blah, this is how it works. You inject it once a day, and 24 hours later, you injected again, but we were seeing these highs on the level mere about 18 hours after she injected basil. And that's the first time somebody told me oh, you should try splitting your Basal insulin putting in some of it now and some of it 12 hours later to keep the coverage. more even. That was a big deal for us when she was MDI you know, splitting that love Amir, but now the more modern ones. You like I know you don't you're not in favor of splitting Lantis right. Personally,

I'm not personally in favor of it. I've had probably definitely less than a handful of people that it did seem to work. Okay and and better for, but in general know, the Lantus, the two Jao, the, you know, trust Seba, all of those they are definitely supposed to be a 24 hour acting insulin right. Some people do find that Lantus doesn't quite get them to that 24 hour mark, that it sort of legs off, maybe somewhere after about 20 hours, and they have a little bit of potential need for more insulin, and that may be accomplished by just adjusting the dose of the rapid acting insulin if a meal falls within that time to make up for that little bit of deficit before you retake it. But the newer insulins definitely especially true Siva, Siva has a definite 24 hour and often in other in many people, it actually has a longer lingering effect.

So I've anecdotally heard a few people who split Atlantis and say it works but you are very steadfast about saying that you don't so love Amir. Sure, you could split it if you don't think you were getting 24 hours. It worked for us, Lani, people need to split love Amir right. Lantis maybe not. Now those others? Definitely no. Yeah, they're just a no, don't split your Seba. Don't none of those they listen, you're saying they last 24 hours. I hear from people who say that it feels like it overlaps into the second day sometimes Correct, right?

Yeah, in fact it in. I worked with a couple of like high school athletes, boys, who were MDI chose to be MDI for a number of reasons. And we worked it out, you know, to the point that we could navigate but what we ended up finding was that with the dose of True Seba, they actually needed a titration down in the dose by the end of a full week of athletic overlap, because there was so much overlap of the truck Seba and the activity factor that they were running in the toilet almost able to eat without bolusing for meals days by the end of the week, because because of the action.

Oh, isn't that interesting? So So here's the thing. These are all injectable insolence. If your MDI are using an insolent, you know, or a pen or syringes, it doesn't matter which way multiple daily injections if you're using, you know, needles and not an insulin pump. So if you're using again, like with the mph, if somebody says, Hey, here's mph, say please don't please give me more modern insulin. And if someone says to you, hey, here's love America, please don't Can I have a more modern Basal insulin, please? Yes, you know, it's going to make things easier. Because Basal insulin, long acting insulin, whatever your doctor is going to call it is the background insulin that is working on. Basically its job as body functions, right body functions to try to push up your blood sugar, it's trying to keep you stable somewhere it's got it should have nothing to do with how you're impacting your food. In a perfect situation. You don't you know, you inject it once a day, it kind of think of it as time release, it kind of stays in your body and slowly gives off itself and works over these hours. It's, it's really, really important. And if you go back and listen to other episodes of this podcast, you dig into the Pro Tip series or any other stuff, you're going to hear me Jenny, anybody who's talking about say, Basil first, you have to get your basil right or other things are not going to work. And so you these First couple of leaps you have to get past are you giving me love Amir? Or are you giving me true SIBO? Are you and by the way, I don't know who makes there's there are different companies and etc. And you might have to work a little bit to find the insulin that works best for you. I don't care which one you use, I'm just saying you're gonna have different expectations, depending on which drug you have. Correct. If you don't have your basil correct, it's going to impact everything else, it's going to impact bolusing for meals, it's going to impact sleeping activity, it's going to mess with everything.

Yeah, it's it's like building the foundation of your house out of straw instead of concrete.

We did a nice stable base and is your long acting or Basal insulin. Now, some statements from people correcting overnight or splitting my Basal insulin was a huge help. So they were it sounds like they were correcting. They were probably shooting their basil in the morning. And by the late night, it wasn't working as much. So they were using corrections which now that's not long acting insulin that's fast acting insulin or meal insulin, but you may hear it called like Novolog a Piedra fiasco looms Avalon compute a few Milan for some reason, which is weird. And sudden this person realizes Oh, I don't have to correct your Bolus in the evenings if I just get my Basal insulin right. Yeah. Next person says, I wish I would have known the onset of action in the duration of action. From my long acting, considered splitting if appropriate, some long acting insulin so they're making our point for us. Since newly diagnosed will be MDI a nutshell summary of long and short acting insulin, perhaps with the end for emphasis on how Basal insulin impacts everything. So these this these are people who love the podcast are like if this is what I wish I knew now that I knew before. Okay, so let us dig into that for just a second here. A Nutshell summary. I think we've kind of done it long acting insulin Basal insulin. The ones we mentioned, short acting insulin meal insulin, again, the ones we mentioned, but what are they for? Basal insulin, again, is a base stability for your body function, you know, other stuff. Meal insulin is there to correct a high blood sugar or to combat food that you're eating. Correct. That's it, right? Yes, absolutely. One of the most frequently confused things the beginning of diagnosis is Basal and Bolus is Basal and

Bolus. Yeah. And I think the words are, again, they're really clinical words, if we just broke it down to say, this is what this kind of insulin I'm prescribing is going to do for you. You must take it every day at about the same time, every single day, this is going to give you this background coverage that has nothing to do with food or anything else. You need it because your pancreas would be dripping this all day long. You know, and then the other explanation just being this one is going to work when you choose to eat food. If you don't eat, you don't take it unless you're high. And then here is your correction scale, blah, blah, blah.

Yeah, it's just over the years, all the words have been co opted, you know, people explained the mountain and said Oh, correction insulin, that is a good way to think of it. I'll call it that. Instead of calling it Bolus insulin or mealtime insulin or and you'll The truth is, I don't know, Jenny, a couple of months into this. That's all going to make sense to you. Right? Like we're talking about it now. Like we're just like, you know how green is grass and blue is the sky everyone. When you're first diagnosed, you're like Basal Bolus long acting short acting. To Siva, who names that things

when you want to take with you. In fact, for newly diagnosed I often recommend when you get those prescriptions home, make sure you read how to take them when to take them in the refrigerator, put a note on them a sticky note, something that specifically says this is your right away 6am In the morning long acting insulin. This is my take with food, correct blood sugar, insulin, and as long as you need to keep those sticky notes on there until it clicks in your head. Which one is for what? Keep them on there? I mean,

once a month without fail. In the Facebook group. There is a long thread where someone says, Hey took the wrong entrance with the wrong insulin. What do I do and it always goes this way. It never goes the easy way. It never goes. I meant to take four units for a meal when I put it for extra units of basil. It's my basil 20 units and I just took it I just took 20 units of Novolog instead of 20 units of land. Yes. And what do I do? Beautiful watch people come in. They talk them through it real quickly do the math 20 units. So I know it sounds like a lot on how many carbs covers 20 units, it's snack time. You know, like, that kind of thing. And people I watched them get each other through it. It's really it's, it's, it's beautiful.

At some point, I mean to delve down the rabbit hole a little bit, honestly at some point, there will hopefully be micro dose glucagon. That would help in an instance like that mistake that you know nobody intended to do, but that you wouldn't have to end up eating 200 grams of carb to offset what you did accidentally, right that, oh, I can do this much glucagon. And this will take care of this much of it and right

without eating a pint of Ben and Jerry's ice cream or something like that. Yeah. Now, here's the thing, right, you're newly diagnosed, this all is probably what you're hearing because you're MDI, but long acting insulin, when you move to an insulin pump, if you move to an insulin pump will be replaced, you will not use with a pump, you will not use long acting insulin anymore. You'll use short acting meal insulin Bolus insulin in your pump, and your pump will replicate a Basal program for you, giving you tiny little bits constantly throughout the day to create. So instead of you kind of putting in that quote, unquote, time release Basal insulin and it being let go, you know, pharmaceutically, it's going to go into a pump and be electro mechanically

Correct, right? Think of your pump like your pancreas. Honestly, yeah, your pancreas doesn't use two kinds of insulin. It uses the same type of insulin that those little beta cells pop out. And it does it for different reasons, right. So the pancreas or the pump is going to do the same thing. Use one kind of insulin, but in a different way. And here's where in vs. Big dose in,

right. And here's where you start gaming. You know, if you asked me what the difference between pumping and MDI is, the first thing I think of is having agency over the Basal program and being able to change it. So earlier in this episode, Jenna use an example of young guys, athletes who are on MDI, who have a Basal an amount of Basal they're shooting Monday, Tuesday, Wednesday, Thursday, Friday, but because their activity is getting greater and greater as the week goes, the truth is that their Basal needs get lesser at the end of that active week. If you were on a pump, you could I'm just gonna make up numbers, you could be using one unit an hour on Mondays, one unit hour on Tuesdays, and Wednesdays point eight Thursdays point seven, right and to, to make adjustments based on what you know, that activity was going to do. Right? I'm not trying to tell you, you have to have a pump, I think any way you manage is is great if it works for you. But you do get more control over your Basal profiles once you're on a pump. And it is really amazing. And if you ever get past regular pumps into algorithm based pumps, you can really start seeing how manipulation of basil creates the

precision comes in. Yeah, even Yeah, much clearer, because you

go it's funny, we kind of made a timeline here. I want to say by mistake, but I was kind of thinking about it. So I'm gonna take a little bit of credit, but I'm back from the mph to the more modern Basal insulins to the idea of pumping to the idea of algorithms. Yep, just all those things are different levels of insulin being used in the correct amount at the correct time. Right.

And it's an evolution definitely, I mean, what you're talking about is a is a movement forward from what was to what we have the opportunity to use now. And I think it's interesting having lived you know, 34 years with with diabetes, I have evolved through all of this now, I didn't start that with like boiling my needles and only peeing on a urine strip. Thankfully, I had some technology at my hands when I was diagnosed, but I feel like I've lived through a lot of the the true technology shift and change. And it's, it's amazing. It really is. So

so I'm gonna I'm gonna recap, which I don't ever do. Someone gives the MPH go. Can I please have more modern insulin someone gives you Sorry? Pharmaceutical companies, although I don't not apologize, though, pharmaceutical company. They're doing okay. You know, if someone gives you 11 Mirror Lantis say, could I get something more modern than this? Once you've got that figured out. If there's more that you want, well, then you're probably interested in an insulin pump. And after you have an insulin pump, and you understand how that works, you might be interested in an algorithm. So this is an I don't know what comes after algorithm.

I don't maybe a truly closed loop system that requires very little thinking other than Oh, it's the day that I have to put on my new pump and fill it up with insulin. Here you go.

So in your mind, is that like a dual chamber with glucagon and insulin?

That's what it would have to be, honestly, for it to truly work the best way possible. Yeah.

Okay. All right. Well, if you're just diagnosed, don't bother thinking about that yet. I've been hearing people talking about that for 10 years, and I don't think we're anywhere near and so just

the basic, learn the basics. Just be happy.

Understand your insulin today and go about your. Alright. Thank you very much. Cool. Absolutely. All right. So we got that one out of the way. I just as I was reading, and I was like, There's way more to this than what the people asked

what it's good to have brought in, I was hoping that you would bring in the fact of pumps, because we refer to Basal Bolus and a pump. But it's a change in mindset. I don't know how many people ask, even in today's world, when they're starting on a pump with you, they're like, well, when do I do I still keep taking my Basal insulin at the same time. I'm like, Yep, no, put it in the fridge, put a sticky note on it that says Do not touch

Done with this now. Done. Yes. I mean, I told you the story recently, right of I don't mean to use her twice in the same series, but a woman who had had diabetes for like, 40 years. Yeah, I asked her about her Basal insulin, and she told me the wrong insulin. It's no, that's, that's something else. I mean, that's basic stuff there. We need, we need to understand that.

Well, and that also speaks unfortunately, to whoever her practitioner is, has clearly not asked enough in terms of discussion, that's a back and forth discussion, to hear that this person was completely missing, or misunderstanding or whatever it was, I mean, that should have been addressed in the clinicians office.

Yeah, you know, we're still recording Jenny, just because I didn't stop it. But and this is going to come up later in this series about picking medical help. But there there is definitely something to be said for that. Like, not everybody knows what the hell they're talking about. And it doesn't stop them from talking. You know, so you're you are newly diagnosed, you don't know what's happening, and you take everything as gospel out. You know, my my little story about insulin that I'll add at the end of this episode is that Arden uses a Peter to works really well for her. But we were given Novolog in the hospital, which is fine. But the point is, is that when someone handed me Novolog, and said here, this is insulin, I thought, well, this is insulin, there's this is it, there's no other insulin,

insulin is just insulin, right? The word insulin indicates one thing.

I even think it's ridiculous when we're rattling off, all the names are different than something how many of these do we need? Exactly. But you know, like, I just thought Novolog is insulin. It's for her Mealtimes are her corrections. And when NovaLogic didn't work, as well, for Arden as it did for other people, it never occurred to me that I could just say, can I try a different insulin, please? Yeah. And it? Because that's the I mean, to somebody's point earlier about having something drilled in your head in the 1515 episode. It was it just I believe them, like a person in a white coat, handed me over log and said, This is insulin, and my brain just said, Okay. You know, and then that stops you from asking questions. Yeah, yeah,

absolutely. And I think I think there too, is the word insulin. And it really encompasses a lot. And there's a lot to understand about it, as we've just talked about. I mean, my understanding of insulin definitely shifted. Once I had done my own research when rapid insulin came on to the market. And I was reading more and learning more myself. And I went to my own doctor, and I said, Hey, I have to take my insulin, like 45 minutes before I can start to eat. This doesn't work with my life. There's this fancy new, more rapid acting insulin, can I please get a prescription for it? My doctor was like, Sure. Here's your new blog. Right. And before that I had been using our I mean, that dramatically changed. And my doctor knew about it, but I don't know that my doctor would have brought it

up, right? No, because it's working. And why by the way, did you ask that question with a perm? Did you have a perm when you were saying that? I actually way up in the air. Well, I actually

have naturally curly hair, so I've not ever had a perm. Is your hair straightened? It straightened right now? Yeah. I never think of it that way. But it's naturally curly. Otherwise,

yeah. And to your to just tack on to that idea. The looms?

They did have the big big bangs.

You have big metal here. Did you have metal hair at any point?

Oh, I guess maybe that I don't know that it was metal hair. I don't think my dad had would let me leave the house looking like that quite honestly. But I had the big bangs like the get it up there.

A lot of girls I grew up with looks like that they put their finger in a socket and when their hair shot up in the air, they just sprayed it. They're good. All of us had molds at some point or another. But what was I gonna say? Oh, fie Aspen loon Jeff mealtime mealtime insulins that have a quicker onset? Yes, if they work for you. That makes Jenny's point right Jenny used to have to take regular and mph Wait 45 minutes to eat. Somebody gave her human log and suddenly you only had to wait what? 20 minutes to eat maybe? Right? Yep. And we'll talk about this in the Pre-Bolus episode that's coming up. But at the same time fiasco loom Jeff more modern fast acting insulins they hit even quicker. And you know, and who knows what comes next. I always think about when I was first getting into this interviewing people, I think I was talking to Aaron from the JDRF and he said we need faster acting insulins and better cannula material and I thought like huh, that's interesting, you know, like what he's seeing the other part like because your cannula from your pump to explain that idea looks like a foreign body to your to your body so kind of gets attacked by white blood cells. Eventually it could stop the insulin from working as well as you want to bring but not infection but just the inflammation to the air information which slows down the the absorption of the anyway, Aaron's like we need better cannula material and faster acting insulin. And those are two things you wouldn't think to pray for at night when you went to bed. But if you have diabetes,

and smarter insulin I'm it's interesting from a JDRF perspective, it was years ago when I attended a JDRF. It was like a scientific presentation in the evening. And there was a gentleman from the East Coast, I think he was somewhere in the Boston area. A scientist who had done enough studies to get it to the animal based study of insulin that had almost an on off switch or a thermometer, if you will, that you injected it. I believe it was once a day. And that dose allowed your glucose level to stay within a determined target range turning on when it was climbing and going above that turning off when it was falling and coming down to the lower end of the target.

Yeah. Which well make no mistake. That's the that's the golden chalice right there. Right? Yeah, yeah, I mean, and we can stop doing this podcast and I bad news for all the pump companies. You're out of business to

be living on the beach in Tahiti? Well, probably not because that's pretty expensive.

Chinese, like I'm taking whatever money I made telling people about diabetes, I'm going to the warmest place I can find I'm writing the rest of this thing out.

So read books and

does it I'm gonna let you go. But it feels like that. Right? Like, if somebody just took diabetes away, you'd be like, I've done enough for one lifetime. I'm good.

Yeah, absolutely. I mean, I if there if there were there is a need in diabetes. I, I hope that I can continue to work and help. But if there is ever something that comes out, that's like, no, people don't have to think anymore. You still have to eat your food and drink your water and get exercise. But here it is. I'll be like, fantastic for everybody.

Big Mike drops, and he's like I'm out of here. You get in the car or you're not coming because I'm leaving. Excellent. Alright, thank you so much. A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast in pen today.com To get started, where to learn more. Thanks also to Jenny Smith, who works at integrated diabetes.com If you're interested in procuring her services, that's where you would do it. I also want to thank you for listening for sharing the show and for being terrific. The other day, I received a photograph from the ninth listener who's bought a vanity plate for their car for the Juicebox Podcast. That is um, that's some cool listeners and some great dedication from you. Thank you so much if you head over to the private Facebook page, which I'll do right now with you Juicebox Podcast type one diabetes. Get yourself in there scroll to the top click on Featured Isabel has all the lists set up for you Pro Tip series variables, etc. One of those lists is the bowl beginning series. I will read from it. Episode 698 defines the ball beginning series lets you know what we're planning on doing with it. Episode 702 is about honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin and episode 719 is the 1515 rule. And of course in this episode we talked about long acting insulin. There's also a list there for defining diabetes that's 44 episodes of terms defined for you that you use every day with type one and type two diabetes very often. How about a nine episode series talking about celiac, and type one, or a 10 episode series about disordered eating 19 episodes dedicated to just me talking with kids, lots of interviews with me and the children 26 episodes Excuse me 27 episodes after dark series everything from drinking to disorder to eating psychedelics, living with bipolar people who have type one diabetes, and other extraordinary challenges often will be found in the after dark series. There's a 411 list called juicebox Asst. That has 16 Very popular episodes in no particular order. How about a 14 episode series about algorithm based pumps from loop to Omni pod five control IQ and there's way more coming in that series. Very soon. You can learn how to Bolus for fat and protein. And there are so many ask Scott and Jenny episodes where Jenny and I just answer listener questions. There is a growing list about mental wellness and type one many of the episodes are with licensed Marriage and Family Therapist Erica Forsyth, a type one herself. We have a small but but but strong list of type twos. I really would like more of you to reach out to be on the show always looking for type twos to be on the show. Please reach out if you're interested in coming on and building that series up for others. Defining thyroid is a 10 episode series that will help you understand thyroid disease. And our pregnancy list has just grown no pun intended to 12 episodes. There's a how we eat series where people come on to talk about their eating style carnivore plant based low carb Bernstein FODMAP keto flexitarian intermittent fasting vegan, that list is also on the move, looking for more people to come on and talk about how they eat. There's a quickstart guide episodes from episode four all the way up to episode 100. These are the episodes people say if you listen to you'll get a vibe for how I feel about type one, and it gets you into the podcast. And that's the Quickstart list. Don't miss the diabetes variable series 22 episodes, giving you looks into things that impact your blood sugar that you would never think of like hydration, sleep, weight gain, and more. And of course the diabetes Pro Tip series 25 episodes with Jenny and I are starting at episode 210 newly diagnosed you're starting over taking you through all the steps that I believe will help you bring your agency to where you want it to be. I hope you check them out. 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 727 of the Juicebox Podcast. Welcome back to another episode of bold beginnings today, Jenny Smith and I will talk about the target that you're trying to keep your blood sugar in that range that we're all hoping to stay in. 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. Hey, can I bother you to please go to T one D exchange.org. Forward slash juice box join the registry, take the survey, that's all takes fewer than 10 minutes. You just need to be a US resident who has type one diabetes, whereas the caregiver of someone with type one head over there today. It's completely anonymous, absolutely HIPAA compliant, and all you need to do is complete the survey to help people living with type one diabetes. The bold beginning series began back on episode 698. And there is a complete list of episodes available on my private Facebook page called Juicebox Podcast type one diabetes, it's up in the featured section should go take a look if you're enjoying this series, you probably should head over to the defining diabetes series and the diabetes Pro Tip series to learn more. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. And you can learn more about the in pen right now at in pen today.com

thanks sorry, I was late. I was changing a screaming pad.

So it's no trouble at all. The fun stuff life. We we were recording so cool. Ardens Dexcom has been expiring at 11:30pm for like, seven months right? Like we just I don't know what happened. You know, we ended up changing it

like that like the ad hour like you let it go and or is that like the empty hour or

the Dexcom? Dexcom. Not to CGM is Dexcom. Not okay. Now I see. Yeah. So we ride that thing right to it like right till the end. Yeah, I am, too. And every, every time we've changed it over the last six, eight months, however long it's been I might have lost track. I walked to her, she texts me whatever. And we look at each other bleary eyed, so tired. And I realize like, Oh God, I'm up for at least two more hours now. Right? And I look at her and go, the next time this is done. We're just going to change it a few hours earlier. She goes That's a good idea. We should definitely do that. Right. Yeah. This time. I set an alarm. I like told my phone basically. Hey, Siri, in nine days, and blah, blah, blah, hours remind me to chase. So yesterday afternoon, it goes off when I Oh, cool. We're gonna finally do this. And then we forgot.

Because you turn the alarm off, right? I do that I turn the alarm off. And then like, Oh, what was that? Again? This was due four hours ago. We

had a whole conversation about it yesterday. And I said, Listen, let's change it around five o'clock. That's a good idea. We'll do that. And then next time, we can adjust it into the three if we want her to the seven if we want we'll decide, right? And she's, she's like, Yeah, 1030 Last night, I texted her, I feel bad. I just texted her the F word. She's like, what's wrong? And I was like, we didn't change that. Thanks, God. So we ended up doing it like 1030 Last night.

Well, let's do was an hour earlier.

You're trying to make me feel better. But that's not

ours better than you know. i You try.

I'm old. I can't be up that late anymore. It's not good for me. So anyway, today, for the bulk beginning series, we're going to record the topic of range. So, so far, Jenny, I know it doesn't seem like it has been together is so delightful that it doesn't feel like time has passed at all. But we've recorded honeymoon, being diagnosed as an adult terminology would end which ended up being two episodes because it was long. There was lots in there there was we've recorded highs and lows, which basically is fear of insulin. We've recorded the 1515 rule, long acting insulin, and today we're going to do range and maybe we can sneak in food choices if we have enough time. Oh, that puts us only 1-234-567-8910 1112 just 14 more topics away from buttoning the series right up so we're doing terrific. I know as

you said the the other than not that today his tactic but the food choices in my head right away flashed this like this like dangerous.

We're gonna make people hate us. It's like Oh Please don't hate me. We I think in one of the the fear of insulin we we drifted into it for five seconds and even if we were talking about there I thought some of them's not gonna like hearing this but whatever. But for right now, yeah, range is a nice easy one. Great Yeah, no one's gonna be mad at us for talking about this probably. Okay, so again this series is for people who are newly diagnosed. And the way it began was we reached out to the Facebook group and said to them, what do you wish you knew in the beginning? And here are some of the responses that fit in this topic. What range to be, or to shoot for was really hard to understand. I would have been, it would have been easier to explain that they want him to run on the high side. So let's see right away. This is interesting, because we're getting a look into what doctors say, right? Apparently, they wanted the kid to be higher. But the mom found the online world pretty quickly and decided that wasn't a good thing. So what did she say here? Okay, they wanted him to run higher as his body adjusts for a few weeks was what she initially found out is what they meant.

As they said, it probably wasn't explained that way.

No, she's like, clearly what was going on is they wanted to figure out the doses. But none of that was communicated whatsoever.

Correct. It was a poor communication. See bad pod? Sorry, my noises are going.

even heard that one in a while? No, I

know, my my high alarm, which isn't really I mean, it's not high. My high alarm is set for 130. Really not high. But it's just telling me clearly. Anyway. Yeah. So you know, initially, she should have been told, Hey, this is what we're aiming for. Here. Because of these pieces, we aren't quite sure how sensitive your child is going to be once we introduce insulin. And as the body starts having like more normal looking blood sugars, the body starts responding or coming out of DKA or whatever, right? And then we're going to transition down to a healthier target range, right. But that's it's not usually clearly explained.

And obviously not because the very next statement is someone said, I wish they would have told me that being 200 for a few weeks was okay as the body adjusted, but that we were going to taper down to a more realistic and healthy range. That it may take a while to normalize blood sugars. So yeah, you're right. This is this is the thing that people don't get told. So let's kind of break that apart for a little bit. So I mean, you're diagnosed, I'm assuming most people are diagnosed with a higher blood sugar that's probably been higher for a while. And they even though they get you down in the hospital, you know, it's funny, I say that, like, that's the norm. But how many people have I talked to who go to a hospital or sent home right away, or were diagnosed during COVID and weren't even allowed in the hospital? Right? So what happens is there? I mean, obviously, you don't walk into the hospital with a 700 blood sugar, and they're like, we'll just fix that right now. Like there's a very slow type titration that takes place in the hospital, if you're if you're there is that for safety reasons.

It is for safety reasons. You know, if you adjust the body from the idea that you're not quite sure how long blood sugars have been so elevated, right? For kids, it's probably not been that long of a time. It happens very quickly that turnover or that transition. But there is a slow progression of beta cell loss. I mean, if you look at the research in the development of type one, there is this progressive nature to actual diagnosis. But the high blood sugar's aren't really until that very end point near diagnosis, but you still need to be very careful about bringing those blood sugar's down. Because the body adapts pretty quickly to its new set range. And if you've been running at 300 Plus for a week or two weeks or three weeks, that needs to be certainly brought down slowly not to the point of you're waiting eight weeks to bring those high blood sugar's down but in the hospital if you have had a chance to have an inpatient stay, or a closely followed outpatient, you know, diagnosis and, you know, collaborative work with a with a health care team. They will still try to really bring things down slowly because again, once you add insulin into the picture via injection, whatever betas may be left, actually, they get a little bit of a rest, and then that we've talked about honeymoon already, that honeymoon could kind of come back into the picture. So they do have to be very careful.

Yeah. And I'm assuming that the wider range is because of that partially. And because of also partially, they're not sure if you're going to get home and get a little, you know, rejuvenation out of those beta cells and suddenly went down. They don't want to tell you, it's one unit for 10 carbs, and then get you home and find out that, you know, it's a half unit for 10 carbs, because you're getting some help on your pancreas. Right? That's, that's, that's the one half of the reason why they would show you a wider range with a higher ceiling. But the other one could be, they just don't know yet. Right? Like, they're not sure what's going to happen. And Correct, right. And so this person here says, one of the most useful things that I learned from the from the podcast was that I didn't have to accept these out of range spikes at meals, just because she had diabetes, that I can make adjustments to flatten those lines, etc. So I'm going to hold hold the half of her thought there. So that's the next part that I think is important, because you said it a moment ago, if it's not communicated to you, well, this is a completely new thing for you. And they could tell you, I don't want your blood sugar to be under 100. Or, and but it's okay. If it goes up to 200. After meals, they might say something like that. I say this all the time. Like if you don't give more context, your statements in the beginning, when you're teaching something to somebody, they're going to assume that's the rule for forever. And that is what I see with people is that they don't think the people who don't make it online, the people who don't find somebody to talk to just assume, Oh, it's 100 to 200. And these are people you will hear from that have had diabetes for three or four years who are treating low blood sugars, you know, air quotes at 110. Because they're trying not to go under 100. And, and it just skews your way of thinking about it forever.

Absolutely. In what you learn, in many things, not just diabetes, but it definitely makes sense when I'm talking about a health condition that's so dramatically impacting right now. And kind of forever. What you teach in those beginning stages, becomes almost a very hard rule that it's very hard to clear out of your brain. I kind of think of it almost like when my little one was starting to ride a bike. My husband, and he, he disconnected the front brake. And he taught my son. The reason was because he didn't want him squeezing as hard as he was. And he was like four years old, right? And like any explained, I don't want you flipping over the front. Well, now he doesn't he still doesn't like that front brake connected, because he was taught that he could have an accident in which he flies over. First, right. That was what he learned initially. And it's hard to unteach

I also think that with people with diabetes, you see that with where they where their devices, like the the first place they put it is the place they think it belongs, you know, and that happens to kids a lot too. It still happens to Arden I moved Arden's Dexcom for her yesterday's we were talking about in the beginning, which I think will be in the episode. And she wears them on her hips. That's it. And I put it on and she goes, That's too high. And I'm looking I'm like, it looks fine to me. You don't I mean, and if it was higher than the last time it was there, it was by a half an inch, you know what I mean? But she acted like, and she's pretty reasonable. She's like that, like it

was on her forehead instead of like,

what are you doing? It's under my arm, you know, like, like it was. So it's just in her head. That's where it goes, I think. Okay, so back to this lady's point about I wish I would have known that the blood sugar's don't have to spike up after meal. She also says on the flip side, I would have liked to have known that we that lows weren't a thing that happened. Her main message here is she left the hospital believing spikes and lows were part of it.

And we're going to be what she should see.

Yeah, yeah. It's funny her description. It's not well written, I'm sorry to the person who wrote it. But But because so reading, it's not going to help you much. It's why I'm picking through it. But the intent of this statement is, it's almost like she's in a bad relationship. But somebody told her this is what it's like to be married. So you just have to deal with it. Like, right? Yeah, it's, um,

it's interesting. That's too bad.

Yeah. Right. Like, I mean, you know, way back in the Pro Tip series. You know, I said all the time, and I haven't said it enough lately, but it's my least favorite part about diabetes is when people get caught in a situation where they find themselves saying, well, that's just diabetes. That's how it happens. You can't avoid that. And you can and she's like, I wish someone would have told me that it was possible, even if even if I wouldn't have been able to do it right away the knowledge that it was on the horizon would have been a nice idea. Right? Absolutely. Now, I think the reason people don't get told that is that many times, they're with physicians who don't know how to stop spikes and highs and, and that's why you don't get told it's possible to fix.

Well, and I think when you're talking about range to range is something that will evolve, so to speak, as you become more comfortable, and comfort comes from learning more, and experimenting more and paying attention to what happens for yourself or your child or the person that you're helping to care for. So that range may tighten, and be different than when you were first diagnosed, or even different than when you were six months out from diagnosis, right. And they may shift through life or through each variable, you might have different ranges that you're aiming for. So I don't think that there's a, there's not a hard and fast range.

No, I imagine that you probably talk to people who are older, elderly people, you probably start shooting for a wider range. And, and that makes sense to and younger kids who I don't know run around a lot during the day and you know, get bursts of exercise that you don't expect, you might have a different range for them. But none of that changes. The goal, right should be the goal range, and the places you have to adjust that range for your specific situation. Again, I just think the biggest problem with this, this this piece is that is it, nobody tells you the first numbers I said out loud are not the thing you're going to be doing your whole life. There's some other statements here from people. I wish someone would have told me that everything seems to affect my blood sugar. So the I think the variable series does a good job of shining a light on that if you want to know about some things that that that can impact your blood sugar that no one at the hospital or a doctor's office might bring up. This, the next statement is I would have liked to known what main factors can increase or decrease the need for insulin. And then you know what I mean? So food

again, there's variables, that's certainly relative to the variables too.

But I think I think that it also it shines a light on the, you know, all carbs aren't created equal idea. Yes. Because the in the beginning, in the beginning, when you you're told that formula, which is what the next statements about them trying to lead into that. And then it you know, one day eat, I don't know, doesn't matter have french fries, the next day, you eat a salad that has some carbs in it, and it doesn't work out the same way. It fries your brain. You're just like, Wait, yeah, it was 12 carbs, they were both 12 carbs. Right? And then you start saying silly things like I did the exact same thing today that I did yesterday. And it didn't work except you didn't see all the variables, and it really wasn't the exact same thing. You know. So this, this person says, What did those numbers and that correction formula even mean? My son was diagnosed, and we were sent home with a mathematical formula. We're told to follow it daily. But I still don't know what the numbers are even referring to. And John, Jenny, as you know, that feeling is what spawned my blog in this podcast. So do you know what formula she's talking about? So you're using multiple daily injections for an insulin pen, and you want more, but you don't want to move to an insulin pump. That's okay, because the option of the in pen from Medtronic diabetes might be the perfect solution for you. The in pen is an insulin pen. But it does more because it connects to the app that gives you your current glucose readings, meal history, dose history, activity, log dosing calculator, active insulin remaining glucose history and reports for you or your doctors to look at. Doesn't that sound like a lot of good information to have right there on your smartphone? I think it is, too. So how do you get started with the M pen you go to in pen today.com. When you get there, you're going to be able to see everything that I've already told you about and more. Not only that, but if you'd like to talk to somebody about the M pen, right? If you'd like to schedule an online health care provider visit, you can actually do that at my link. And you can also just get started in pen today.com. If you'd like to see how the dosing calculator works, there's a video there. You can click on it and watch it. I just clicked on it now, but I'm not going to watch it because I've seen it already. Plus, you wouldn't be able to see it. Anyway, to go learn More about the dosing calculator dosing reminders, card counting support, and the digital logbook, head over there and watch the videos. You may even be eligible, right? It's possible. And this means here's what this means. There's like a little disclaimer here. This offer is available to people with commercial insurance, and Terms and Conditions apply, but you may pay as little as $35. For the embed, go check it out. There's so much on that link, you can't go wrong in Penn today.com. In Penn requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, or you could experience high or low glucose levels. For more safety information visit, you guessed it in Penn today.com. Hey, this isn't an ad, this is for the podcast, I'm gonna put this in here, I don't usually do this. But if you're listening to the bold beginnings episodes, when they're over, you might want to move up to the defining diabetes episodes and the diabetes Pro Tip series just like I was talking about earlier in the episode, you can find all of them at diabetes pro tip.com, or juicebox podcast.com. When you get there, you're gonna see something that says type one diabetes Pro Tip series from the Juicebox Podcast. And there's a little introduction there from me. And basically what it says is, look, my daughter has had an A one C between five, two and six two since 2014. With zero diet restrictions. This information works for children, adults, and for the newly diagnosed. And for those who have struggled for years, I believe that anyone living with type one diabetes can use these simple concepts to stabilize their blood glucose levels, lower agency and improve glycemic variability. Again, with zero diet restrictions, check out those episodes, diabetes pro tip.com, or juicebox podcast.com. And of course, they're right there all the episodes in a podcast player of your choice, whether you're on an iPhone, or an Android. And please keep this in mind too. All of the content within the Juicebox Podcast is free. And it's always going to be there's no need to pay for this information. I just want you guys to be as healthy as possible, support the podcast in any way you can through the advertisers filling out the survey at the T one day Exchange, or just telling somebody else about the show, will you support the show, the content keeps coming and it stays free

I would expect they were sent home with a little bit more of a specific or a precise, I wouldn't necessarily call this a sliding scale that's more of a hard and fast if your blood sugar's in this range, take this many units of insulin right. Where this gives a little bit more precision because that formula gives you a way to calculate a dose just for correction insulin When blood sugar is high. So they may they will give you a target blood sugar. So your formula should say current blood sugar meaning where it is right now whether it's from a finger stick are from your CGM, your current value right now. And then you're going to subtract from that target your target. So if they told you to target 150, great, you're going to subtract your current 250 blood sugar. And then you're going to take away the 150 target, which leaves you 100. Right. But that number looks odd until you factor in what they've given you. And it's called a correction factor. That correction factor is how many points one unit of insulin or for some little kids, they might have said how many points or half a unit of insulin may drop your blood sugar, right. So let's say your correction factor that you've given been given in this formula. Target blood sugar 150 correction factor is 100. So, so we're going to take 100

If you had a 300 blood sugar, you would subtract 150, which is your target which would leave you with 150 Correct but in your in your thing you need but

and then you have to divide that value by the correction factor they

gave you to use. In this example, we're using a correction factor of 100, which means we're assuming all unit of insulin is going to bring your blood sugar down by 100 points. So 150 divided by 100 gives you how many units to take. And that would be 1.5 1.5 units exactly based on all of that and then the problem is that all seems so like specific. And then when that when it doesn't work, you're like, it's impossible. I've got this mathematical formula that gave me all the people in the white coats for like, here's what you do. And they explain it hopefully the way Jenny did, which was very clear. But they don't tell you something in this example, like, when your blood sugar's really elevated, you may need more need more insulin, right? Right. And then you could

or if it's right after you finish playing three hours of soccer in, you know the field with your child during a tournament, and now you're correcting a blood sugar that's too high. Well, activity is the variable in the picture now. So you may use this formula. And you may see a really dramatic drop in blood sugar and think, Well, gosh, it usually works. Maybe something's changed and nothing's changed. It's the fact that there's no exercise in the picture that makes the insulin work better. So these formulas are a place to start. Right. And they do need some adjustment. Pretty soon after initial diagnosis.

I've also found over the years that having a CGM Arden has the Dexcom that it takes away. I don't think about the the range as much anymore. As soon as I think about, like rolling. Like gentle lines. Yes. Right. That's more how that's more how my brain thinks about it. Now, instead of like, I'm trying to stay under this number or stay over that number. I just think I'm really trying for there not too many sharp falls, or sharp peaks. And they, you know, I don't know like, I don't even think of them as numbers, I think them as lines. Right?

It's exactly it's almost like the sky and sort of the ground, if you will, and you have this range that you're trying to fly like a glider plane through, and you want this nice, gentle rolling effect rather than these big JJ like roller coasters is not what you want. It's also

really interesting how a visual representation of it changes your feeling about it. Because you know, if your high alarm just went off at 130 Arden's high alarm is 130 on her phone. And it's i It's 120 on mine, so I can react a little quicker to if I guess I have to find or somewhere or something. But it's funny that when you look at it visually, you're like, Oh, my God, what's this crazy spike here. And then you go back and realize it went up to 120. Right, because it visually looks like a crazy spike. But that almost trains your mind to work within the range that you've set up. Anyway, if you're lucky enough to get a CGM, you'll, you'll see what I mean. Last thing here for range, someone says the quicker that you can learn about your glycemic sensitivity and insulin sensitivity, the quicker you can use that information to make broader changes. And this does really affect your time and range. So I'm guessing we've already talked about this, right? But they probably were eating some foods that hit a lot harder than than the ratios, their insulin ratios could handle. Right? All right. So find that in an episode called food choices. That's either out now or will be out very soon, depending on when you're hearing this. Yay. All right, Jenny, take a deep breath. We're gonna do the food choices. Fantastic. So much here too.

I am quite sure you got the gamut from one side to the other. And in some of it, I think it's interesting what you texted to me the other day because some people are so quick to latch on to one nutrient being the the the end all be all of this is what solved it for me.

Jenny and I are going to continue that conversation in the next bowl beginnings episode called food choices. But for now I'd like to thank in pen from Medtronic diabetes, and remind you to go to in pen today.com To get started right now with an insulin pen that talks to an app on your smartphone, giving you much of the functionality that people have come to expect from insulin pumps. If you'd like to check Jenny out, she works at a place called integrated diabetes.com. Her services are for hire. 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 731 of the Juicebox Podcast. Today we have another edition of the bull beginning series, a series that began back on episode 702 With honeymooning, and then it went to 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 bold beginnings fear of insulin, Episode 719, the 1515 rule episode 723 long acting insulin episode 727 target range, and on today's episode, Jenny Smith and I will discuss food choices. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. We're 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 consider going to T one D exchange.org. Forward slash use Box join the registry take the survey when you complete the survey which will take fewer than 10 minutes, you'll be helping people with type one T one D exchange.org Ford slash juice box this episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash and the Omni pod five, you may be eligible for a free 30 day trial of the Omni pod Dash. And here's how you can find out on the pod.com Ford slash Juicebox Podcast is also sponsored today by Dexcom. And the Dexcom G six continuous glucose monitor, head over to dexcom.com Ford slash juice box to find out if you're eligible for a free 10 day trial of the Dexcom G six. When you use my links, you're supporting the show. Hi, Jenny. And welcome back to the bold beginnings. I can't pretend that we didn't just record another episode. I'm sorry. Nevermind. Scott, it's very lovely to see you again. And I just finished one we're moving into food choices. So there's a ton of feedback here from people, I really enough that I'm not certain we're gonna get through it, but we'll give it a shot. And I'm going to start the conversation based on based on the conversation that I had, just recently with a young person in their 20s with type one diabetes, and just we're talking about all kinds of stuff. And in the middle of it. She said having diabetes, diabetes really messes up food for you. She's like it just you start looking at it, like what is that going to do? And you know, is this or you know, maybe I won't eat that because of what it's going to do or it doesn't feel worth it to me to fight with this for three hours. She said she never thought about food like that prior to diabetes and right, it's a fair statement. So let's dive right in. Because there's a ton here. This person says that grocery shopping seemed incredibly difficult at the beginning. And it was also emotional. She said they were trying to eliminate some of the kind of quote unquote, not good for you foods that my daughter was getting. But then she saw me crying as we went down the aisles. Wow, that sounds like really in the beginning. Because you're feeling I'm gonna guess not a therapist, Jenny. But that's a sense of loss. Right?

It is. And there's a sense of loss. I think in many things that because food is food is a major part of diabetes management. It is because food is also a basic necessity of life. We have to eat, we can't just say well, I've got affects this. So I'm just going to just not do that anymore, right. But we have to eat food. So what you've been used to doing may need to change. Now, you know, one step into that is was what you were doing? Not the greatest, or was it not as healthy anyway? And could you start to see some of these changes once you mentally get over all of the hard stuff that it takes to navigate through all these thoughts. It can you start to see this as a well gosh, as a family, we could clean this up. We could be doing this versus that and it would be better for all of us. Right? But it is it's it's hard.

And not everyone's going to take that path either. You know, and I will tell you that some people see it as a challenge to like I'll just because we have died videos now doesn't mean I'm gonna You can't change me. I'm gonna figure this out, right? It's funny because I'm somewhere mixed into that idea, I'll probably figure it out as we're talking. This first and biggest worry I had was limitations of food. What in the world was I going to feed my kid? Because she only really ate a few things to begin with. Yeah. And those things all had carbs.

And that's where then you work with that, because so much has changed with the child's life to begin with. That that's not a starting place for being like, well, you're just gonna eat broccoli today? Because that's so much better for you than whatever it was the child. No, no, that ain't that's not appropriate. But it's then learning Well, the 10 things that your kid does eat. figure those out, yeah, eventually move

on. The same person said that they then had an appointment with a dietician a number of days later, where the dietitian lifted the fear by just saying, Hey, listen, you can eat what you want, but you have to cover it with insulin. But then they didn't give them the rest of the information, which is, you know, what this whole thing is about, right? Like is, you know, 10 carbs, this and 10 carbs that might not hit the same, right? So they went from, oh, my God, there's nothing my kid can eat to Oh, doesn't matter, they can eat anything to then realizing we don't seem to be very good at Bolus thing for them. Right? Then Then they ran into that idea of like, well, well, this must be what it is. Now, this next person says I was confused about the different views between low carb and like a regular diet. And I didn't, I didn't realize that you could use insulin skillfully. And still, and still have a great day one, see. And we do that now. But there still are times that we might not want a bunch of insulin on board. So we eat appropriately around that. Correct. So that's, that's a really thoughtful, that's the, that's somebody who's been through it already, and figured it out, you know, or has

kept enough, even in a shorter period of time, has kept enough notes, or has done some trend analysis, or looked enough at what is going in and has seen. But when we do this, this works out pretty well. We've got it figured out whether it you know, is an apple or fruit snacks. They've figured it out, right? But then comes in, you know, the other types of things. And they say, well, these are the variables, I think it would be easier if we just have less overall insulin, maybe we could go this route for this type of setting. And it works better for us. Great. That's it's probably adding a good amount of variety anyway, which is healthy in your nutrition intake overall to begin with

this next person's point I agree with completely. So, you know, they talked about, you know, I'd never thought about glycemic index and foods before this obviously said the podcast helped her think about it. But that she did make some pretty what she thought were obvious decisions on some things. And she puts a little list here, but I'll tell you for certain little things, like if you have pancake syrup in the house, get a sugar free one. Like that's me just like Why are you punishing yourself for right? You know, like, like, first of all, I don't know if you've ever really thought about it, but you start squirting that syrup on everything. By the time you're done. You have a half a cup of it in there, you're basically drinking 40 carbs of sugar, you know, at a know so

much more. Much more. But yes,

so so if you're gonna have pain, so Okay, fair enough. I still want to have pancakes, have pancakes, use the sugar free syrup. It makes it easier on you. Do you have to know? I mean, there are people listening this podcast who think this podcast is about the idea that you can eat whatever you want. I mean, I think the podcast is about understanding how insulin works, but fair enough. So but yeah, that kind of thing. Or, here's a super easy one. No one's ever going to tell you make sure you're buying bread that has no high fructose corn syrup. Super easy decision to make makes things much, much simpler.

And if you go a step further, get sprouted grain bread. So much easier glycemic li than even the typical white breads that might say they're organic with no added corn syrup or whatever. But the more the more unprocessed something is, the better you're going to find your glycemic kind of, you know, outcome

if you're a person who absolutely has to have soda and I have to admit, I don't understand that. I don't ever drink soda really. But aren't that I went out to lunch the other day and we're like, can we have two unsweetened iced teas and she goes we're out of unsweetened iced tea and I was like supply chain issues. And we were both like we'll have a Diet Coke and at a meal where I I probably would have drank a couple of iced teas. I did not get through the Diet Coke. It just it's not for me. But if you have to have soda, God bless, drink diet soda, and then you don't have to worry about that thing. Like, there are simple places where just for health in general for that if you don't have diabetes, you could be cutting out sugar. And, and at the same time, it just makes this whole thing easier, especially in the beginning. There's still times when people send me graphs and I'm like, Look, do yourself a favor, eat a simpler diet for a couple of days while you're figuring this out. Like you don't know what you're doing. And on top of that, you're trying to Bolus for Lucky Charms, like you know. Yeah, that's like, that's, that's an angel level decision you're trying to make here. And you just started yesterday, you know, right. Yeah, that kind of an idea. You okay with that you? Like I'm not saying to restrict your diet, I'm saying. Okay, let's head together to Omni pod.com forward slash juice box. The first thing we'll do is brace ourselves because there's a photo of me there. And it's not. I mean, it's not pleasant. It's the best picture I could take. I don't know what to tell you. Anyway, I apologize. On the pod. They're makers of the AMI pod five. It's the first tubeless automated insulin delivery system. It's an algorithm based system. It's probably what you've been waiting for on the pod five is the first and only tubeless automated insulin delivery system to integrate with the Dexcom G six. It is now available for people with type one diabetes ages six years and older. Featuring smart adjust technology. The pod adjusts insulin delivery based on your customized targeted glucose helping to protect against high and lows, day and night. Where do you find out about this Omni pod.com forward slash juice box. Now if you're not in the market, for an algorithm based system, you might want to take a look at the Omni pod dash and you may be eligible for a test drive a free 30 day trial of the Omni pod dash, you can also learn this add on the pod.com forward slash Juicebox Podcast scroll down to the big purple box and start reading. After that you fill in a tiniest bit of information, and you're on your way. So whether you're looking for the Omni pod five, or the Omni pod dash, you want to go to my link Omni pod.com forward slash juice box. there everything is well explained and easy to understand. A tubeless insulin pump is within your grasp, head over there. Now. When you're done, I'd keep going right to dexcom.com Ford slash juice box. Now here's the good news about this next calm.com forward slash I'm typing I'm sorry, Ford slash juice box. Here's what you're gonna get there are Moreover, not get a photo of me. So it's a nice relaxing and calm experience. No pictures of Scott. Instead what you're gonna get is the breakdown about the Dexcom GS six, you're going to learn about zero finger sticks, glucose readings that are right on your smart device, customizable alerts and alarms and how to get started right now with the Dexcom G six. You can make better diabetes treatment and diabetes management decisions with zero finger sticks and no calibrations. The Dexcom G six lets you see your glucose numbers with just a quick glance at your smart device and receiver get alerted when your glucose levels are headed high or low and share your data with up to 10 followers. And the Dexcom G six is covered by most insurance plans. There's details surrounding all of what I've just said. But those details are@dexcom.com forward slash juicebox you don't want to I mean listen. You don't have to listen to me, right you can do whatever you want. My daughter has been wearing an omni pod since she was four and she's 18. She's been wearing a Dexcom since I don't know she was six or seven. And she's 18. These items are at the core of our decision making process, moment to moment, hour to hour day to day with type one diabetes. And you know what, they could probably help you a lot with type two diabetes as well. dexcom.com forward slash juice box on the pod.com forward slash juice box links in the show notes links at juicebox podcast.com. I am contractually obligated to say that for full safety and risk information about the Omni pod Plus Free Trial terms and conditions you can visit omnipod.com forward slash juicebox. I'm going to get you back to Jenny now who by the way works at integrated diabetes.com In case you're interested in working with her like I'm not saying to restrict your diet I'm saying

make make potentially wiser decisions and Dorsey what you're doing Are you constantly having problems No matter what you're trying, maybe you're at the level of getting the majority of stuff. But there are a few things where like the maple syrup, or the regular sodas or you can't get over drinking juice. Okay, we know what I mean juice is recommended for a low blood sugar treatment. Don't drink juice. Just drink juice, eat the fruit don't drink the juice.

I grew up in a house where nobody understood nutrition and orange juice was seen as healthy as hell. Yeah, yeah.

I'm sure it was yeah, you know, better than soda from an from a from, I guess nutrient quality, especially if you're getting the not from concentrate, whatever. Okay.

That is not a good marketing line. It's better than soda that does not breed. But in all of your foods. I mean, I'm telling you right now, no high fructose corn syrup. If you just cut that out of the things you're buying huge deal, if you can. I know. Listen, it's time consuming. But it's try to stay away from things in bags or boxes. These things have preservatives in them that make them more difficult to Bolus for. I made my own potato chips last weekend, which took hours but I found relaxing people made fun of me, but that's okay. And you should see how much less impact that had on Arden's blood sugar versus any kind of potato chip that would come out of a bag.

And you would because you know what you did to them. It was a rough

was soft on it. That's what it was like that. There's nothing else in it. I mean, except for whatever they sprayed on those potatoes before we bought them.

Oh, you didn't buy organic potatoes.

I don't know if I did or not. I was just for the situation teasing.

Well, you know, who knows the organic versus non organic? Who knows what floats through the air? And

I'm sure there's a way to get around that distinction already here. Yes. A lot of statements here about my first food shopping was completely overwhelming. We weren't carb counting. And we had to work in 15 grams of carb portions, oh, poor person was not carb counting. So they were eating either 1530 4560 That's a lot.

And that would be more of like a sliding scale kind of concept of this many carbs. Take this much insulin. And that's all then use this correction if your blood sugar's in this range.

And then the end of her statement, I've seen online a million times and heard from people in general, which was That was way too much food for my kid. My kid wasn't eating 30 carbs at a sitting they were a little but they wanted more than 15. And now they're forced feeding. They're telling the kid you got to finish this because we Bolus for it, which is not a good start to your life. That's for sure.

Not at all. I mean, uh, you know that that's really old. I mean, that's, that's really what I learned. And that was really old, old school education. I mean, I could remember when I was taught, I was so excited when I was taught to read a food label. And I could cover carbs with insulin better. I was so excited about that, because it just, I don't know, it widened up things. I still wasn't the grocery shopper. I mean, it was still my mom. But I don't know, it just made a difference.

This person said that they ran home from the hospital throughout everything with sugar in it based on no no information at all from anyone just thought that was the right thing to do. And then it took them months to realize that this stuff still had carbs in it. And it probably didn't matter one way or the other. People said I wish someone would have told me the best cards to carry with me. That's a good Yeah, yeah. Because I do. Do you ever see, like, here's one that floors me right? Chocolates not good. A good treatment to stop a low with right? Not at all. It's still a fat, but people do that all the time. Right? Like so you want simple sugar that's absorbed easily through your body. Think about like if you ever had that emergency gel, they tell you to rub it in the cheeks, inside of your cheeks. So juice works really well. A lot of people

another really good one are the honey sticks. Okay, especially if you're someone who really doesn't want to do all of the processed Color Fill candies and that kind of thing. The long skinny honey sticks work really well. I've seen a lot of people comment about and I've done it myself when I've had like lack of something in a purse is just the sugar packets at a restaurant. Yeah, they work. Awesome. Dump it under your tongue. It dissolves right away and it is quick. It works.

I remember having to do that with Arden one time. And she was like, you know and I said well just pour it on your tongue and I was like melted in your spit. Hold it in your mouth for a little while before you swish it around. You know, get it make sure you get on all your teeth so we can end up with it. But that's also a great Good example, if you're giving people sugar overnight, you might start seeing you might start surveys. Yeah, dental problems. And I've had a dentist on actually, his episode will be out pretty soon. So by the time this is out, it'll probably have been out where he said, you know, look, I'm not telling you to jump up in the moonlight and brush your teeth. He's like, but have water by the bedside. And when you're done, just swish it around your mouth and clear your mouth. That would be a big deal to do that. Yep. Okay, so best cards to carry around simple sugars that were quickly.

I wanted to say simple sugar too, if people are looking at labels, the simplest, like most most easily digested carbohydrate is is is glucose, right? Which is why we have glucose tablets. But glucose is dextrose. So on candy labels, if you're looking for a candy, look for glucose, or dextrose, within the first three ingredients, and then you've got something that's going to work really quick,

okay. And then after that, I think find what works for you, too. Right. And and let me say this, just don't think that because you open the package, you have to eat them all. You know, if you have a little single serving, like, I don't know, gummy package, and there's 10 pieces in there, five of them might fix your low blood sugar, you know, don't feel weird about throwing the other five away or twisting it up for later or something like that. You don't have to eat them all because you opened it up, which is the thing that people fall into all the time. All right, now's the time. Let's say hold on a second. This person actually made your point earlier that this might be a good time to make a sweeping change in how you eat. If you if you looked up and saw that your diets not a healthy one, it's a good, it's a good excuse to do something about it. So that was yours.

And as you said earlier to you know, the least processed or the less processing of food most often means the food is is clean, if you will, right. There's not a lot that's been added to it, whether it's corn syrup, or all of the additives that they keep to preserve it on the store shelves mean the best places to shop and the grocery store. It's around the perimeter. You've got your fresh produce lots and lots of non starchy great vegetables, healthy fruits, you've got your protein sources, it's it's the aisles that are the danger zone.

I know. I've seen it. I've seen it before they're there. The grocery store is actually set up. Just the way Jenny said like, look at it one day, they you know, they concentrate kind of the crappy food internally. Yeah, it's interesting. Here's one, what were the free snacks, I wish somebody would have given me a list of free snacks. And that's a funny statement to me. Because, because it's not always free. Right? Like, you know, I understand the concept like a like a cheese stick might be considered or a Slim Jim or something like that, you know if you're but if your blood sugar's I don't know, 120 and having a cheese stick, you know, doesn't have carbs in it. Okay, I get your point, maybe you don't need insulin for it right away. But if you really listen to the podcast, and if you've lived with diabetes for a while, you start realizing that, you know, the fat and the cheese could slow down your digestion, which could push up your blood sugar, or you could eat meat that later would be broken down and stored as glucose that there's nothing that's like legitimately free. I don't think

Iceberg lettuce. There you go. Okay. I mean, unless you literally eat the entire head of iceberg lettuce. And I'm not saying that that doesn't have carbs in it. It does. But I mean, Iceberg lettuce, and many of the greens will have very limited if any impact blood sugar wise, right? I mean, on a whole big dinner size plate size spinach salad. I might add to what I'm kind of swag calculating on that. Maybe five extra grams for all of the greens that are there. Really, the rest of the stuff that you add on top of that is what needs counting all of those other nonstarchy you know, bell peppers and onions and mushrooms and cucumbers. They have carbs in them. They were I mean the concept of free again is kind of an old concept. It kind of is like that 1530 45 grams per meal and you take this amount of insulin. I got to know free foods as as a newly diagnosed as my aunt and uncle would bring to family gatherings big vegetable trees, because Jedi could eat those foods for free. And man did I eat them? I'm quite sure if I had a CGM. My mom would have been like man we got a dose for cucumber.

Garden goes on kicks for sheets, tons of carrots. And we believe we Bolus for the carrots like

oh yeah, Carrots are one of the curvier, non starchy type of vegetables. Definitely,

the point is this is that in the beginning, you might not know what you're doing, you might have your Basal too high. And so you don't notice things like this. But as you start to get your settings, right, understand diabetes more, you're going to start seeing the impacts of those so called free foods. Now, don't get me wrong, if you've got a four year old and they want a snack six times a day, I take your point, and you should definitely find those ideas. You know, a little piece of cheese is definitely going to be less of a hassle for you blood sugar wise than given them an orange slice.

And for a four year old from a standpoint of portion, the cheese stick or the Slim Jim or you piece of you know, grilled chicken or a boiled egg or whatever it may be, it's probably couldn't have pretty little to no impact whatsoever in the portion that that child is eating, versus the adult who's like, Well, I'm just going to eat a big ol six ounce chicken breast because there aren't any carbs in it. Wow, that's not going to work out so well.

And that makes me think too, if you do have a toddler or a kid who's running around all the time, there may be an amount of, of carbs they can take in throughout the day that will look free. Because they were going to go low, and you're just kind of counterbalancing it before you see it.

Yeah, you kind of bolstering with little snips in between. And that's often the way that toddlers eat too. Right? Little bit here a little bit there. They may eat two strawberries, they might eat, you know, a bite of cheese, they might that's just what they do,

right? So if you're in a situation where you think, Oh, my God, my kid eats throughout the day, and they never eat insulin, try thinking about like this, instead, it's not a free food, you're pre carving a low before the low happens, right? You're treating before it happens, and you don't even realize it. Yeah, could be the situation. I wish somebody would have given me a list of foods. That's interesting, because then that's, you know, we get into eating styles. And I don't know that doctors would want to be pushing an eating style on you one way or the other. But, I mean, you should definitely see a dietitian who could help you with that. You know, and I

would, I would request a dietician, who specifically is a diabetes educator, if possible, if where you live, that is a possibility. I will say that being a dietitian, myself. I know diabetes, for many reasons, obviously. But had I gone into the realm of cancer management. As a dietitian, even my life with diabetes would have taught me something. But I may not be quite so good at education outside of that, because that wasn't my realm of professional work. I've learned a lot by working with so many people with so many different needs and interests and requests and whatnot, to kind of draw on, so definitely do your homework, as we've said before, with any clinical team, do your homework and find somebody that can work with you,

this person said, you know, there are just days when I need a break. And so I eat very low carb, or, and I think that's completely reasonable, first of all, and said, there should be options that people know how to do that without being scared. Because if you if your settings are set up for a lifestyle, and then you suddenly swap that lifestyle to something else, your settings are going to be too heavy, then, and you're going to have trouble. But she's like, it would have been nice if someone would have explained to me that, hey, if you just don't want to eat a bunch of carbs today, switch to this basil program and do this. And I take your point, I think that's a really good point, actually,

indoor cover your meals, you know, learn how that learn what that means in terms of meal coverage, because it really should be a swap out of okay, my Basal does this because I've tested it, that should be worked pretty well. I mean, I've got a lot of people I work with who for religious reasons, do all day fasts, right? And so we've been fine with that having tested basil, that sometimes on a fasting day, they may even need a 10% reduction in their base basil, these there really is no food impact whatsoever through the course of the whole entire day. But the meal times themselves. If you're doing a type of fasting, that's more vegetables and protein or just a little bit through the course of the day or if you're doing any intermittent fasting where you're really only eating for six hours of the day, or eight hours of the day. You may see different impacts than you do with all day food intake of more, you know, mixed meal

Yeah. Do you give time or do you have to go No, I've

got let me check me. Let me check my schedule. I have five minutes. All right,

so we'll do one more. And then we'll kind of come back to this one. This person says, I wish someone would have told me that it's okay. Right to eat one way to eat another way. But instead, I got a very restrictive care team that shamed us. And it was it was really tough. You know? That's the I'll tell you though, of all the things like I'm really freewheeling on my Facebook page, meaning like, I let people talk like adults, you know, there are very few rules, but shaming people about their food choices. I am not okay with ever, no, especially around diabetes, you can you can cause eating disorders with very easily. You know, eating disorders with people with type one is, is you know, more common. If someone wants to eat Kentucky Fried Chicken every day and learn how to Bolus for that's their life, you let them do that. If someone never wants to take a carb and once their blood sugar to be, you know, at 24 hours a day, that's their decision is their decision. Yeah. And then I see then everybody's tries, you know, everybody tries to make their point. And the one thing I wanted to ask you before we go on this one is do you I mean, you're listening, you're a trained dietician, right? So you have type one diabetes, do growing children need carbs to grow correctly? Freaking word?

Yeah, that's a very good question. I think the bigger the bigger piece to it that I always look to analyze, when I get the questions from parents is calorically, what's necessary. And within that then also becomes food preferences and what they currently look like, and what you're considering transitioning into for your child, let's say, you think that it would be easier to just be carb free, or to be low carb, let's say, I mean, most people who are not entirely carbon free, children do need a very set amount of nutrition, intake through the day, carbs, proteins and fats, proteins and fats are really the very essential. I mean, they are protein is the building block of your body, you need fat for a lot of different functions, hormone, and all that kind of stuff in the body. And carbs are the preferred energy source of the body. They are, they're fast, they get in, they give you this energy boost, and then they kind of digest and they come out. And that's sort of the reason that we eat every several hours, if we are eating more normal carb types of meals. So our carbs necessary, carbs are necessary, I think in a certain amount, what that amount is boils down to, what are you looking at doing? And how can we meet the overall nutrition need of your child where they are? Are they heavily into sports? Are they more sedentary? What is their growth percentile? Are they growing on par with where they started out prior to diagnosis? Do we need to make any adjustments and then we can look at you want to aim to try lower carb because it might be a little bit easier in terms of glycemic control. Okay, but then we need to navigate those other pieces to make sure that they're meeting their growth needs.

Okay, the fat and protein stuff fatten, right, it's funny, you're making me think of Arden's friend who is a she's like I'm a vegetarian are, you know, and but then she basically just eats like, potato chips and stuff like that. Yes, that's not I think you're missing the point.

I don't be a vegetarian, but

it's, um, I think that's what you just said just resonated with me so much. It made me feel like if everyone had you with them, I don't even mean diabetes, or a person like you to stand behind you and go, Okay, look, here's your lifestyle. Here's your need. If we eat these things in the course of the day, that's going to put your body in the best position possible. Right, right. And then the problem is that people don't get caught up in what you need carbs to grow, like, okay. Okay. Maybe you do and maybe you don't maybe let's just say you want to have carbs in your diet. And then there's a person over here is eating like a pretty keto diet and they don't want that. Just let live and let live like just let it be your name and their

their parameters. Most often the people that I've seen who are keto or more paleo, or more just considering low carb. They've done enough homework or they've come in with I'm trying to do this. This is what I really want to stick with. I'm missing something. Something isn't quite right. I don't feel quite right or whatever. So then we have some things to look at to make sure we're meeting glycemic goals as well as for kids, especially again, bro. Schools. I mean, protein is it's a big piece of piece of growth and change. And kids are growing rapidly. They they need a good quality, you know, nutrition intake. I think the bigger thing if you're looking at carbs, are you looking at going low carb and getting an answer to whether carbs are necessary carbs, like celery and cucumbers and kale and spinach, and berries, if you're going to add carbs in small amounts, those are the ones you want. You don't want the processed, like keto carbee foods that are just like tricking the body.

The only time eliminating carbs from someone's diet makes me sad, is when I see them do it because they can't figure out insulin. Correct. That's all like if you want to do it as a choice, I understand. And if you figure out insulin and then decide I still want to be low carb, I understand. But I feel badly when someone just didn't you know, all the things we've talked about in this podcast forever didn't learn how to Bolus didn't learn how to Pre-Bolus Didn't understand glycemic load all that stuff, you don't understand any of it. And you're just stuck in a space where you like when I eat carbs my blood sugar goes way up. I eventually give myself insulin I get super low and I'm bouncing all over the place in the dam and I'm not eating carbs anymore because I don't want to be on unwell. That That to me? I don't know. I wish they knew if they knew when they decided to do it. I understand. But if they don't know and they just are being pushed into it because they're scared. Well, I would rack you know, I would hope that somehow they could learn before they made

that decision. No, I 100% agree. They're 100%.

Alright, so Jenny, the next time we do this, we'll come back and make sure we're done with this list. Before we move to the next one, you can go back to your thing. Sounds good. Have a great weekend. Thank you, you too. Thank you. First, I'd like to thank Jennifer Smith for helping me again on the podcast today and remind you that she works at integrated diabetes.com. I also want to thank Omni pod and Dexcom for sponsoring this episode of The Juicebox Podcast. Go check out all the trials and offers at Omni pod.com, forward slash juicebox and dexcom.com forward slash juicebox. Those links, of course are available in the show notes of your podcast player, and at juicebox podcast.com. I hope you're enjoying the bold beginning series. There's way more coming so keep downloading them every Friday. If you've been enjoying the podcast, here's a couple of things you can do. That will help me you can leave a great rating and review wherever you listen. You can follow or subscribe in the podcast player or audio app that you listen in. You can tell a friend about the show. If you see a question online where people are like, I don't understand this. You could say oh, you should try episode bla bla bla of the Juicebox Podcast. That would be lovely as well. What else? Hi, listen, subscribe. Tell a friend. Oh, here's another one. You could join the Facebook group Juicebox Podcast type one diabetes now with over 27,000 1000 members, over 110 new posts a day. What am I trying to say? It's jumping over there, full of great information. And great community members go meet somebody just like you. I'm going to share a little something here at the end, I assume you're a real big fan. If you're still listening once you know the podcast is over, but we're at the halfway point of 2022. The podcast is now as popular by download or stream you understand you can download an episode or stream it while you're listening a download or stream count the same for me. And in 2022 The show has as many downloads or streams already at the halfway point of the year as it did in the entire year of 2021. Now, not only is that true and amazing, and I thank you very much. But the best day in 2021 like the day with the most downloads, it was the day of the year I was like I cannot believe this many people downloaded the show today. That kind of thing. Right? That amount. The best amount from 2021 is now about I'm not great with percentages. Give me a second. Hold on a second. I'll be right back. I'm back I use the calculator. Okay, sorry. So the that that show that one show that had the most downloads in 2021. It has As about 21% fewer downloads than an average day in 2022. Does. That is bananas? As a matter of fact, what I would consider a slow day on the podcast is now only 14% lower than what the best day of 2021 was. That is crazy growth. It is because of you. It's because you're sharing, you're listening, you're subscribing. I can't thank you enough. It's really astonishing. And really, you could knock me over with a feather when I see stuff like this. Absolutely wonderful. I really appreciate you supporting the show. I hope you're enjoying the bowl beginning series. Don't forget, there's a ton of other series within the podcast. If you go to that private Facebook group, scroll to the top click on the feature tab. There's lists of all of them. I'm not going to bother you here with all of them. But there's so many about how people eat and the Pro Tip series defining diabetes stuff. Stuff about thyroid and pregnancy, mental health, on and online. Go check it out. 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 735 of the Juicebox Podcast. On today's episode of bold beginnings, Jenny Smith and I are going to be talking about Pre-Bolus simple concept that not many people learn about. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, 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, or becoming bold with insulin. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app. This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, 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 your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously, in pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you could experience higher low glucose levels for more safety information visit in Penn today.com. And just like that, I've gotten the ads out of the way for you. So you can listen straight through to Jenny and I talk about Pre-Bolus. Jenny, our bowl beginning series is going along well. We are making our way through so far we have recorded and put up honeymoon being diagnosed as an adult terminology which came out in two parts. Fear of insulin, the 1515 rule, long acting insulin, time and range like what range is shooting for and food choices. today. We're going to talk about Pre-Bolus Oh, yes. So I hope you're ready. I'm gonna scroll down to people's,

I'm always ready. I never know what we're topic going to kind of address here like here, this is today.

Like you're like You're like a member of my gang. You're like we can do it. Let's just go out right now. Always ready.

What's the plan?

Nevermind. We'll figure it out as we go. So the first person just says, I wish we had been told about Pre-Bolus Ng and I'll have to tell you, I'm reasonably astonished when I see people who for days, weeks, months, and sometimes years of their lives using insulin, run into the idea of Pre-Bolus in one day, and they just go I've never heard of this before.

Correct. I've gotten multiple comments like that. And the assessments that come in for the people that I get to work with. That's one of the big things there like I had somebody just told me about this, or the emails that I get, you know, asking about, like working together. Nobody had told me about Pre-Bolus thing I've been you know, I've had type one for 40 years and nobody told me

like, I talked to somebody recently diabetes for 50 years. And I said how do you handle your meals? You're like, you know, I just sit down and I Bolus the night. And I was like it was like like a Pre-Bolus No, I mean, just you know, just do it at the same time. Why do you not do it earlier? Why would I do that? Right? Well, what about this? And they're like, Oh, that makes sense.

Well, and usually, I think the first piece of that comes with the rapid acting that we have had around for a number of years already has the idea that rapid means rapid. So when it's prescribed to them in terms of what the doctor or educator has given them an information it's take the insulin, start to eat your food, this is a rapid acting insulin. But we've talked about for rapid is not rapid, I think still needs time,

especially for people who've never used to CGM or worn one, that you can't really see how food impacts blood sugar, and how long it takes for it to start moving. And you can't see the differences between different types of carbs. And so if like, you're saying, if somebody says, well, it's rapid, I couldn't take my rapid insulin 15 minutes before I eat, because sounds like I would be in trouble. I don't want to get low, and they've probably seen themselves get low at some point. And then it then some, you know, probably not for the same reason. But then anecdotally, they believe I couldn't possibly ever do that. So the next person says, it would have been nice, if someone would just would have explained the importance of Pre-Bolus thing. So I think we should. So if you're newly diagnosed, someone's giving you insulin, and they're telling you probably count your carbs, you know, this formula will tell you how many you know how much insulin for this for this amount of carbs. The thing you need to understand different, I think, big picture is that the impact of the carbs happens over its own timeline, just as the impact of the insulin kind of happens over its own timeline. So if you just sort of like picture in your head, you know, a flat line going along your blood sugar at any number, it doesn't matter where 8590 110 200 Wherever you start eating at, you have like some stability, and then all the sudden the food starts to push your blood sugar up. There's sort of a bell curve that happens, they're going up yep, at the same time, the insulin tries to push your blood sugar down. So there's a bell curve going down, you need to line up the the impact of the carbs and the action of the insulin so that they're fighting with each other instead of just working unencumbered, I guess it's correct way to say, All right,

yeah, you want to time them appropriately. And I think they're in brings, I think, brings in another piece, potentially, to timing, from initial diagnosis. Most people are told, you don't have to change a thing that you're eating, you don't have to change a thing that you're going to feed your child or your teenager, just remember, you have to take insulin for whatever is eaten. Yeah, well, if if that's the case, then in they're not really transitioning at all from what they had been eating, which may be very high carb or very high glycemic types of foods. But you're also told rapid insulin, just take it before you start eating. As you just said, the timeline there of action is going to be very displaced. And you want to, you want to line those up or overlap them, almost overlay them so that the insulin and the foods start to work better together.

I also think that it's possible that the statement from a doctor, you're not gonna have to change how you eat is true. But if they don't give you more context about how insulin works, that's not going to be very helpful, because it will seem like you have to change how you eat. My point is that I believe, I believe that if a doctor says you don't have to change how you eat, and here's how you use insulin to make that true. That's one statement. But you are also going to run into doctors who are trying to soothe your soul with with that, right, you know, they're, they're just trying to they're trying to say, Look, I know that you've just found out that you or your kid has diabetes, this is all very shocking. We're talking about insulin for food. But don't worry, you don't have to change how you eat like, you know what I mean? Like that's more it makes

it it makes it easier, right? Like, there's one easy piece it's a comfort to know, well, I can keep eating, you know, Froot Loops for breakfast.

Well, and that's the other thing is they don't ask you how you eat, you know, they just like don't worry, you won't have to change your over and they're like, Wow, this is great, because I eat Popeyes for lunch. And I have this and I love it crispy chicken sandwich. Oh, it's gonna be like, and so it's a lovely thing to say to somebody and I happen to believe it. You know, I think you can manage insulin for different eating styles. But you can't just tell somebody, oh, don't worry. You don't have to you don't have to change how you eat, but not give them any more context than that so correct that Pre-Bolus thing. I mean, I guess the last thing I'm going to say before I move on to my next thought is that we did the these episodes are in an order for a reason honeymooning happened first because Pre-Bolus thing if you're honeymooning This is gonna look different than if you had diabetes for a while to, you know, so you have to be careful about that. Because you might have, I mean, you see people worrying about it all the time, go back to the honeymoon episode if you don't know what we're talking about. But if your pancreas is still making some insulin, you don't want to like, be out ahead of the charge, don't like, Don't worry, I'll take care of it too. Now we got everybody trying to get your blood sugar

down. And the reason that concept of Pre-Bolus in comes after we've talked about the impact of food becomes even more beneficial than it sort of adds a layer to understanding, oh, I guess this discussion around like nutrition intake or food intake. Looks like I really do have to pay attention to insulin, and oh, look, Pre-Bolus is the next thing to really bring into the picture along with what I choose to eat. So

yeah, I mean, there's, listen, there's a level of of proficiency, you need to Bolus for more difficult foods, right. And yours. And Pre-Bolus thing is a big part of it. This person says here, I was really confused on whether I should Bolus before or after a meal. It's interesting. She says, they made this sound like a preference and not what would work best. It took me five years into diagnosis to learn about Pre-Bolus Singh. And I only learned because of the podcast. So no one, no one really told me about told me that insulin doesn't work immediately that it has a lag time, whether I'm injecting it or pumping it,

which is really interesting, because it Pre-Bolus thing is not it's not a new concept, by any means. When I was initially diagnosed, and I was using our insulin, regular insulin, which is short acting, takes a longer time to get moving in your system that was told to my parents and explained very well from the beginning. If you're going to eat at noon, Jenny needs to have her insulin by 1130. At the latest in order to make sure that it's moving along with the food. So this concept of Pre-Bolus is certainly not. It's not just because we have rapid acting insulin. And we it's it's been around for a long time. But it seems like there's a disconnect in terms of who teaches about it, or who doesn't.

I think you're you've I mean, for all of time, you're you've been trying to balance the action of the insulin against the impact of the food, it's just that the amount of time that it takes for insulin to begin working has changed over the years change. Right. Right. And so it's the same game. It's just different parameters. Right? Yeah. It's just It's fascinating that I mean, it's somebody could get five years into this and have to find a podcast to learn about it. Because guess what they fall into is that, well, this is just diabetes. This is what diabetes is I eat my blood sugar goes to 250. It stays there for a couple of hours. I mean, it comes down rap, and it comes back down again. Yeah. And that must be what this is, because it happens every day. And so that's that. Here's a great, but yeah,

and those are also the people that ended up getting sort of hand slapped at visits with the doctor, for why are your blood sugars not like more contained, let's add more insulin probably in the wrong place? Because of the mismanagement of insulin specific to food. That's unfortunate. Yeah,

it's that concept of Listen, I'm not trying to be funny here. But if you're married, you know the concept of moving the goalposts, right. Yeah, yeah. You're told that the goal is here. And then you start working towards that goal, and someone comes in and goes, none of the goals over here now. So no, no information about Pre-Bolus thing. And then it's your fault. Your blood sugar's high. Well, what are you doing? What are you eating? This, you know, and when you start getting questions like that, my opinion is you're either with an under skilled clinician, or a lazy one, one or the other, who's putting it back on you. They either don't know or they don't want to try. It's one or the other. Because if you knew how to use insulin, your blood sugar would knock up to 50. FDA correct. Just wouldn't tip here from this person Pre-Bolus thing ahead of time, like when I'm finishing cooking, so that it doesn't feel like I'm waiting forever to eat. So this is a big part about Pre-Bolus thing that we never talked about. There's a little beautiful post this cute little like cherub face girl on my Facebook page the other day, she's like four years old. And the moms video is showing us a video of her and this girl is just like, I don't want to wait.

That's so cute. It's cute, but it's sad.

It's both things. And so it kind of sucks because yes, you do sort of have to Pre-Bolus ahead of time and think about it like when you're driving to the restaurant is That time, or is it when I get out with a car at the restaurant? Or is it when I order you know, because I don't know how long it's going to take for the food to come. And that's one problem. And when you're cooking at home, it's one busy cooking. And so I don't I didn't remember to do this. Now what am I gonna sit and watch the food get cold? I'm not going to you do have to think ahead. I'll tell you. There's all kinds of strategies if, if we're on our way to a restaurant, and Arden's blood sugar's terrific. Then I don't nothing right heart, right. But when we pull up, I know the restaurant a little bit. I know we're going to be eating 20 minutes from now, or 30 minutes from now, and about what she's going to eat. What are we gonna have? I might be like, Hey, why don't you Bolus like five carbs 10 carbs now then after she eats, we check again, put in a little more, I'll tell you with that strategy. We went to a place the other day, Arden had her period. I haven't said Arden had her period in the podcast for a while. So I think it was about time. We're going into this diner kind of place where she is going to get something not good. Like, like, quality wise, this is going to be a French toast and real syrup. And or a macaroni and cheese situation. She's just juggling the possibilities in her head on the way to the place. Right. And on top of that she had a little ice cream while we were waiting to leave. And so she missed on her ice. I said did you Pre-Bolus This ice cream? She goes look at my graph. Does it look like I did? I said no, it doesn't. So heading up 141 50 We're trying to Bolus it. And we roll into the place where already bolusing in the in the parking lot because this one, it's 170. Now like she totally just booted the the ice cream, and her blood sugar leveled out at 200. But still, with all that Pre-Bolus thing, we she ate a massive, I'm just gonna call it a pile of macaroni and cheese like all kinds of cheese. And within a two hour window, she went from not Pre-Bolus and ice cream to eating macaroni and cheese to back to 95. Right. And it's because of where we thought to put the insulin correct nothing else. It's I mean, well, and

where to put the insulin with a little bit of good information or attention to the information you have. Right? Had you only had finger sticks, that would have been harder to do? Oh, of course. Right? We we have access to where our levels are trending now because thankfully, a lot of people have access to using a continuous monitor. Right. So that's a teaching piece in terms of Pre-Bolus. And the idea behind it and a comfort level around starting to do it if you've never had that, you know, in your habit before for food is where's your blood sugar, like you said, if it's level coming in or on the way to a place you're going to eat. Maybe you don't Pre-Bolus until you get to the parking lot or until you actually get seated especially you know, if it's more of a sit down kind of place, you have this waiting time. Whereas, you know, if your blood sugar is already heading up, you're going to do something about it, even if it's just the corrective insulin that you take right now. So that you can get some things leveled off before you actually sit down and Bolus for the food. So there's a lot that you can use your CGM in a high level way to learn how to put insulin in in the right place.

That story is a collection of my I mean, 14 years of knowledge having a CGM, knowing how to Bolus for foods not the first time she had macaroni and cheese. You know, like there's all kinds of stuff that I knew about that it is not the story about the time we Pre-Bolus in the parking lot of a restaurant and then walked in and found that no one brought their wallet with them. Oh, that's fine. Yeah. So we were like, just back in the car, just hammering home, trying to get some food before the Pre-Bolus word still worked out. It was just a little more stressful.

My strategy would have been like, somebody goes home to get food, get the wallet, the rest of us go into the restaurant and order. And that would have been my strategy

with me and kids at that happened a long time ago, I would have been abandoning small children in a restaurant, but which by the way, they probably would have been fine. I mean, look where they ended up with my help. So this person says, Oh, this is about timing of a Pre-Bolus. And I'll tell you, you know, this is the next step. When somebody wraps their head around, I'm going to Pre-Bolus They want to know how long, five minutes, 10 minutes, 15 minutes. And to me, I mean, it that has a lot to do with where your blood sugar is at the moment. What it is you're going to eat next. And then you got to practice. I mean, right. You know, if you have more to add to that, go ahead, but I haven't been able to figure out any more than that in all these years.

No, I mean there is there's an assumed strategy to get going with again, a lot of it is relative to the content of the meal and You know, if you're sitting down to a chicken caesar salad, you're probably not going to have a really long Pre-Bolus Again, depending on where your blood sugar is sitting. But even then a meal like that being lower on the scale of glycemic index comparative to a big bowl of rice and grilled chicken. There's a difference there, you know.

So well, Jenny, somebody said something I want to pick your brain about, they said, there's a rule of 10 that they were taught. It said, take the blood sugar you have now and divide it by 10 for your Pre-Bolus time. Have you ever heard that?

I have not. That's an interesting concept. So if your blood sugar is 180, you should have an 18 minute Pre-Bolus

s3 Pre-Bolus a half an hour before? So I

guess. I mean, to a degree on the lower end of blood sugar, it still tells you, you still need some whatever. Pre-Bolus you know if your blood sugar's 70. That's still a seven minute Pre-Bolus time.

Yeah, I that's the one thing I still can't hammer through Arden's head, like without me there. Going back to the ice cream store. I said, Why didn't you Pre-Bolus The ice cream? She said, Well, my blood sugar was 90. And I said, that don't matter. You still need to Pre-Bolus

good blood sugar,

good blood sugar. We're trying to keep it here. And right. And she just was like, okay, and then that was it. But she's 18. And, you know, yeah. But anyway, Pre-Bolus your meals? Like, I'll tell you right now with no, I have nothing scientific to back this up. You start Pre-Bolus In your meals, I think you're a once he goes down a point. I just think it does. You know, I think if you wonder why you can't get into the sixes, and you're not Pre-Bolus eating meals, that's probably a large reason why

this, especially if you're a one C is if it's under eight, but not quite where you want it yet, let's say in some range of five and a half to six and a half. If that's your pie in the sky kind of place to get to. If you're higher than that. Pre-Bolus I would agree with you. It's a lot of the reason that that a one C tends to be higher is the post meal time period that's left higher than you want it to be. Especially if your overnights are really solid value that's in target and right where you want it to be. If you're having post meal excursions, getting those contained with just the concept of a Pre-Bolus If you hadn't been doing any at all will likely bring your agency down.

I like that you've been saying excursions lately?

Oh, yes. I like that word.

My new favorite. It's my new favorite thing. I don't know why exactly. We left anything out here. Are we good?

Um, I don't think so I think from a base level, it gives a good idea of the Pre-Bolus concept. I mean, there's certainly a deeper dive into it. But other than that we've given a good,

right click go head over to the, to the protests to learn more, but I'm just going to tell you right now you got to Pre-Bolus your meals, like there's situations where you can't if you're eating when you're 60 I get it if you'd be scared. But generally speaking, please Pre-Bolus Your Meals thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in Penn today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app and helps the show and honestly it's easier for you. The episodes come right to your phone and the Phone is right with you constantly. Mine's right here. See, I just picked it up. Everyone always has their phone or just blood sugar's 126 In case you're wondering. So let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there of course, right in your podcast player, just go to all episodes and you scroll around and you can find them or search and find them by searching for something like diabetes, pro tip or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're going to find a Facebook group with 27,000 members in it, people just like you who are sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series but all of the series It exists within the podcast and there are many. There's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are, even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes protip series you don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. 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 739 of the Juicebox Podcast Welcome back to the bold beginning series, today's episode with Jenny Smith and I is all about carbs. I think I'm just gonna call it carbs, carbs. Anyway, while you're listening today, 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. If you're a US resident who has type one diabetes, 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 that survey taking part less than 10 minutes easy questions about type one diabetes, your answers help people with type one diabetes and they might help you as well go find out T one D exchange.org. Forward slash juicebox. And if you're looking for Jenny Smith, she works at integrated diabetes.com You can find her there this episode of The Juicebox Podcast is sponsored by the Dexcom G six continuous glucose monitor. Get started today@dexcom.com forward slash Juicebox Podcast is also sponsored by Omni pod makers of the Omni pod five, learn more ami pod.com forward slash juice box the show is also sponsored by the Contour Next One blood glucose meter contour next one.com forward slash juice box and by us med get your medical supplies at us med.com forward slash juice box or by calling 888-721-1514. The podcast is also sponsored today by Ian pen from Medtronic diabetes. You can find out more about the in pen and ink pen today.com. Last but not least, the episode is sponsored by je voc hypo pen, je voc glucagon.com forward slash juicebox. Now don't worry, I'm not going to start piling up 17 ads on every episode I just had a thing this week. So instead of two longer ads, you're gonna get more shorter ads. Just this one time on this episode right here. I hope you understand I hope you'll listen it's going to be fun. I'm going to try to do them without stopping the recording. It should be crazy. I'm gonna need a stopwatch to Anyway, I'll see if the ads we'll see how I can do with this. And to the advertisers. I'm sorry, I didn't clear this with you. But things come up. You know what I mean? Pico? Hello, Jennifer, how are you?

I'm great. How are you?

I am I'm doing okay, I am looking through our bowl beginnings list. We are little more than halfway through recording. And we are upon carb guidelines and impact of food. But just how the statements, questions and concerns sent in by people were categorized by our dear Isabel. So it's a bit of a long list. But I think we can get through it. Cool if we try. So there's two. There's no There's two thoughts here. Right carb guidelines like what does that mean impact of food? What does that mean? I think we're gonna see by listening to people's statements first first one out of the box. All carbs are not created equal. That comes directly from the podcast. So somebody is speaking from a perspective of having been diagnosed, listen to the podcast and looking back now thoughtfully and saying what do I wish people would have told me the beginning that all carbs aren't the same? Correct. Okay, now, you and I talked about this. It feels like constantly to the point where sometimes I'm embarrassed that I don't have other examples. When I pull up like two foods, there's two foods that pop into my head every time and I I'm always like, I should come up with different foods. That's a conversation. I'm having these. There's consistency there then, right? Yes, my brain is pulling from the same place over and over again. But you know, the basic idea here is that you're going to be told to either count your carbs and Bolus for you might be told to eat on a schedule or eat a certain amount of carbs. But no one ever explains to you that all carbs don't impact blood sugar's the same way. You're taught the number. Right right. And that is come forgetting in the beginning to people like, Oh, you just count, you know, and that's why you'll hear some people go like real, like, heavy into, like, I bought a scale, it goes down to the like, the gram, you know, like, if I if I measure this correctly, you know, that works mostly. But it's not a perfect system, right? Correct. From a different person counting carbs was a huge stressor for us. We needed easy ways to count carbs. And we needed to understand how different things would hit differently. So let's talk about that a little bit. What do you think, is the benefit of telling people that and what do you think the problem is with telling people that

I think initially the benefit goes along with the first line of information, which is counting carbs, because you have to learn, many people don't read labels before they're diagnosed, right? They may look at certain things on it, but they're not really looking specifically at carbohydrates, and learning how to count the grams of carb. But I do think that along with that conversation, if you're going to show somebody and tell them how important it is to count carbohydrates, and give this medicine, that's, that could be really heavy and action based on what the what they know now about food and how the food works with their insulin, you essentially should be telling them or giving a baseline list of these foods are slower, these foods act a little faster, these foods act really, really fast. They may all have the same carb amount, based on portion. But they may have a very different onset of action in terms of what you see happen to your blood sugar. So I think, a simplified chart, not only for carb counting, which is a really basic easy concept, for the most part. Moving into that though, the bigger discussion should be about how those carbs could show up differently in terms of your CGM trend, especially or even fingerstick values if you're doing enough of them, because you don't have a CGM yet. And I think, you know, taking that one step further, if, if you do have a really good educator, they should really sit down with you. And they should ask you what, what are you eating, not give you a random list, and you maybe eat three foods out of the 50 that are on it. And you say, well, this wasn't very helpful. Sitting down and giving them what you eat or what your child eats and getting feedback on. What should I expect of these foods? Do

you think that sometimes when clinicians give lists of foods, they see it as an opportunity to change your eating habits to better things? So they write stuff so the list consists of like broccoli, and you know, things that they're like, I'm pretty sure people don't eat enough broccoli. So we'll put there's one that you say all the time that I stopped myself from laughing constantly. Quinoa. No one eats Kean rocket Jenny, just you and four other people. Right? My kids like, Alright, listen, but you know what I'm saying? Like they think sometimes they give you the list they wish you ate not the list you actually ate. Right, right. And

which is, it is unfortunate, I would say, I don't know, I would have to ask honestly, like how many people were really given this random list of stuff that looked like it was supposed to be healthier, but they never really ate versus just the typical list of carb counts for foods. That's like a general list, right? The 15 gram per portion kind of list. And I can tell you those lists from when I was a kid are there there. Many of them are not like great foods, many of them are

processed. I just find myself wondering how many nurse practitioners who on a set on a on a Saturday morning hungover eaten honey smacks would never tell you how to Bolus for honey snacks. So because it seems like you'd be saying, hey, it's fine to eat a Twinkie. You know what he mean? Instead of saying, Look at Twinkies not great for you. There's here I could sit for 20 minutes and tell you why not eat this thing. But I think it's possible you're going to eat it. And it would be nice for you to know how to Bolus for it. And I don't think that conversation happens. But I want to know want to go back a little bit to something you were saying a minute ago about how nice it would be to explain to people, here's a list of foods that will kind of impact at this level. And here's a list that might hit a little harder. Here's a list that might hit a little quicker. Whatever it is. It made me feel like the problem with doing that. If I'm thinking about how to explain things to people, is that you're in this short doctor's visit. And now you're going to start telling them that foods not food. This food is Mike Tyson and this food is Sugar Ray Leonard and this food is You know, 150 pound guy who's only been boxing for three days? And or I don't know how so I'm trying to think like, what would you say to somebody would just say, Look, when you think about speed, there's the kind of speed that a Camry creates, there's a kind of speed that a Mustang creates, there's the kind of speed that a Tesla creates. These are all cars. But the way they generate speed is differently, I don't know how you could save to someone and explain to them, you're going to eat a baked potato. And it is going to make your blood sugar higher in the future. Right, it might make it really high, because it because of the impact that's going to have for the lasting effect it's going to have in your system, but it won't jump up in the air. Like if you took out a ring pop and just started sucking on it.

Correct. In fact, one of the ones that I explained that way. It's grapes. I call them Sugar Bombs. I mean, they really are they are you eat them. It's why raisins are also one of the like, treatments for low blood sugar, because they impact so quickly, that they will cause a quick spike. So I that's a, it's a good way to think about kind of reaching somebody at a level that they can say, Oh, I understand that. That totally makes sense.

Around this time of year, cherries come into season. Yeah. And Arden will just take a bowl of cherries. And I swear to you, I think sometimes she might take 10 or 11 units of insulin to eat a small bowl of cherries, right? It just, it's like she's having a popsicle over and over and over again. Like as she's sitting there, right? It's funny, because before diabetes, I would have thought cherries, that sounds healthy grapes, that sounds good for you. You know, like I didn't pay much attention to nutrition. Prior to diabetes. I was not raised well, in many different ways. But around food was just really broke. You know, like it was like meatloaf night you got potatoes. But that night was chicken with chicken came green beans, like we were just my mom was trying to make $70 Last week, you know what I mean? Like she didn't, she just didn't want us to die. And she didn't want us to be broke. So you know, like, so? It is, um, I don't know, like I said, kind of like circling back to it. There has to be a way right now to explain to people that more than all carbs are not created equal. Although, after doing this podcast forever, I don't know that that's not the best thing to say is that you have to be aware that these foods are going to impact differently. And you start to talk about it a second ago, that processed food is going to be more difficult to Bolus for than

simple simple style real food. I mean, to be quite honest, it food that is real, is not broken down. It hasn't been processed through a factory someplace transformed into this dinosaur shape. You know, I mean, I use the phrase which has been well overused in on online and describing food. But if my grandma didn't know what it was, then it's probably not real food or it's probably processed and started out as food.

Well, so the way the way my brain does it because it's funny you said dinosaur shaped, which it's really funny because when Cole was little, one of the first nutritional decisions I made as an adult, was if I'm gonna give the kid chicken nuggets, I'm gonna buy chicken and a bread at myself, and I'll bake it in the oven, and I'll give him nuggets. And when we first did it, you might have thought I don't know if you saw this. This video lately. Apparently, there's an aquarium overseas because of budget cuts. They had to go to a cheaper grade of mackerel for the penguins. And they hold them out and the penguins turn their heads away and won't they like won't eat them, like, like, and so that was cold when I first gave him fresh real chicken nuggets. He ate them and he was like, What is this garbage? Gold this is just a I overspent I bought chicken breast i cubed it up nicely. I even I don't know if you know this, but when you slice meat, there's a direction you can slice that makes it easier to chew right? Even I went that far Jenny breaded it nicely. I put seasoning on a nice daddy mother Jennifer, you know and then then the kid then he acted like I was trying to give him one of these cut rate macros. And but after a long time, it just switched and just noticed how his palate just changed. He doesn't want a frozen dinosaur that somebody said has chicken in it because I'm not certain it was chicken. You know what I mean? And so we did that. And then we did it in as many places as we could but but my thought here You're for people. And you were just saying that a second ago, when you look at something, you look at a piece of chicken and somebody says you what's in that? Your answer is? Chicken, Chicken. Yeah. When someone says, that's a grape, what's in that? Your answer is, it's a grape. When somebody says, hey, what's in that Oreo? You don't go Oreo.

Let's look at the ingredients on the package. How many are there? Can you read them? Do you know what they are?

Right? If you there are, I don't know how many things and I don't even mean to just pick Oreos, but anything like that. There's 2030 things in there. And you don't know what any of the more and this is this oversimplified thing I've been hearing people say for decades. And it just becomes more important when you're the one that has to figure out the insulin, not your pancreas, because you can your body can hammer through a lot of crap. Like I'm pretty sure we could eat stones and get away with it for a little while. Don't need stones. But you don't need mean like like, we're not birds. Birds eat stones,

birds, some birds, it helps their digestion if you see birds on the side of the road. Totally random thought. But yes, they're like picking stones you'd like why is that bird picking through the stones? It's because the stones in the digestive system help to? Oh, I don't know that it's all birds. So if you are a bird expert, I am certainly not stepping on toes. I I know that birds eat stones, not all of them

do. I thought you just said birds because I said penguins earlier. But no. But my point is, first of all, I can't believe I have to say this, please don't eat stones, your body cannot process. But my point was is you can put a lot of crap in yourself, especially when you're younger, and your system can fight through it. It doesn't mean it's good for you. And it doesn't mean you're not going to have short term or long term, like health effects from it. But I think that thing tricks us a little bit. You know what I mean? Like, you go out on a Friday night, and you have nachos and this and you have pizza and you're drinking beer, and the next day, you know, someone says Are you okay? And the answer is no, I'm not okay. And then more of the answers, you probably shouldn't go in the upstairs bathroom, you know, like, like, five or six hours later, you feel okay again. And that somehow, I don't know how humans think Jenny, but somehow we don't think about the time spent in the bathroom, clutching the wall. Talking to Jesus.

It's almost like our taste buds when out, right? The memory of the of the taste, and maybe even the social experience that went along with the taste and the enjoyable like eating experience. All of that is more of the forefront of the brain. And Out goes the experience of the bathroom that you spent four hours in. Yeah, you know, it's it is I humans are. We are interesting, right? And really interesting.

And what I see anecdotally is when people are diagnosed with diabetes, their first thought is generally I don't want to lose my freedom, about how I eat. And I don't want you to either. I mean, if you listen to this podcast long enough, you'll know I think you should eat whatever you want. I just want you to know how to bowl a sport. So that's what we're talking about here. Whether you're going to eat the Twinkie or have a pile of nachos, or eat rice, quinoa, you know, or somewhere in between, right?

And I think what it boils down to honestly is given like the more newly diagnosed and this information coming to them, carb counting, know that the carb count is like, it's like the base step right? Now you know how to count how much you're eating. But the next step of that and very close to it really is, what kind of food is it? Is it a slow action kind of like a turtle? Or is it fast? Like the hair, right? I mean, if you imagine those two, just simply, it'll help you make more sense. And then look at what you're already eating. Regardless of what somebody told you should be eating or shouldn't be eating anymore. The easiest thing to not change yet another piece of your life. Take what you're eating, and see how things look after you eat those foods, and you can say, Okay, I think this is enough insulin, but it looks like my blood sugar rose up too quickly. Gosh, Scott was right. Maybe I need a little bit more Pre-Bolus Right. So let's try that and be this is more of a high glycemic food. It's not really so slower medium like I thought it might be.

So yeah, you know, I'm funny. I'm looking at two different statements here from two different people. And if you want to know why it's easy for people to get confused. These are two statements that are I think, pretty consistently told to everyone and they completely they they clash with each other right? The one person says the hospital made it seem very black and white. You eat X amount of carbs and you take x amount of insulin and just go on then live your life. And the next person says, it would have been nice to understand that all the free carbs they were telling me I could eat weren't really free. And it's it you know, so what? Which is it? Are there free carbs? Or are there not free carbs? And every card gets covered? The real answer is in between? It is

yeah, it is. Absolutely, I think the first statement is take this amount of insulin for this amount of, of black and white carbs, regardless of what it is, and it should cover that amount of food. But now we're digging deeper into insulin action and food digestion. So it's it's a, it's a road kind of that veers off of take the insulin to cover this amount that you counted. It may be a timing thing, you know, something like a big bowl of cherries, for example, you definitely need that insulin. Now, the same amount of carbs though in a grilled chicken caesar salad. You may need that same amount of insulin, but I can guarantee you don't need it all up front.

Do you think that they talk about free carbs more with kids, because they've they've already given the kids a wide target range to begin with. So if your kids at and drifting down, you can give him this, I don't know a certain number of these things. And it's free. Don't bother giving insulin for it because they know you need it to fix the blood sugar. And the bigger idea about insulin you don't have yet. All right, ready, this is off the top of my head. I don't have anything in front of me. 30 seconds. For each one, I have a stopwatch in front of me and go the Dexcom G six is a continuous glucose monitor. You wear it to see your blood sugar's speed, direction and number. For example, my daughter's blood sugar is 104 right now, and it's steady. I just saw that on my iPhone. You could actually do that on your iPhone or your Android device. dexcom.com forward slash juice box. Check it out. It is absolutely one of the greatest things I've ever seen managing insulin dexcom.com forward slash juice box 30 seconds. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Go to contour next one.com forward slash juice box when you get there, you're gonna know everything you need to know about the greatest blood glucose meter I've ever seen, held or touched fits in your hand wonderfully. It's an amazing size. It has a great light, it's easy to read and it's incredibly accurate Contour Next One, go to contour next one.com forward slash juicebox that was 30 seconds. So okay, now oh my gosh. US med go to us med.com Ford slash juice box or call 888-721-1514 To get your free benefits check. US med is where I get Arden's diabetes supplies. They're the number one distributor for Omnipod dash, they have over 1 million diabetes customers worldwide. And they always give you 90 days worth of supplies and fast and free shipping with that one over 30 seconds. Sorry, they carry everything from CGM to all of your diabetes needs us met.com forward slash juice box links in the show notes links at juicebox podcast.com. This one's not going to be easy. I have to say certain things. Okay. There's no way I'm gonna get this done. You want it? Oh, I'm scrolling up. Do you want an insulin pen you're not quite ready for an insulin pump, but you'd like to get some of the functionality that insulin pumps offer. If that's you, you're looking for the in pen from Medtronic diabetes. You can learn more and get started today in pen today.com in pen pairs with an app on your phone to give you much of the functionality that you see with type one diabetes and insulin pumps but you get it with a pen. In pen requires prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in pen today.com The Omni pod five baby it's here automated insulin delivery system it is available on the pod five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM and it uses smart ingest technology to automatically adjust your insulin delivery every five minutes helping to protect against highs and lows without multiple daily injections. The Omnipod five is currently cleared for people with type one diabetes ages six and older and if you have the option, and you have the option, dammit to control it from a compatible smartphone, Ali pot five is also available through your pharmacy which means you can get started today. Damn, which means you can get started without the four year Durable Medical Equipment contract that comes with most insulin pumps. Even if you're currently in one RT with another system. So to get started today with the Omni pod five, go to omnipod.com forward slash juice box for full safety and risk information, a list of compatible phones as well as clinical trial claims data, go to omnipod.com/juice box. Alright, I don't think I'm going to get this last one in. But it might go a little past the music already. G voc hypo pan has no visible needle, and is a premixed auto injector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above, find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. And the bigger idea about insulin, you don't have yet

it could very well be and remember a lot of kids initially diagnosed are very sensitive to insulin, and may have a ratio that's something like one unit for every 50 grams of carb, well, then really, if you're starting out, you don't have a pump yet. And you're using multiple daily injections, and your child wants to eat five grams of cucumbers. That that's free. There's there is no way to dose for that. Right. You know, well, I shouldn't say that. You can dose you can dilute insulin, you can get micro doses of rapid insulin, but that's another that's another regular.

Yeah, it's funny, as we're talking, I think, here are the words that are missing when people are talking to clinicians, right now. These foods are going to be free. But that probably won't be like that forever. It's the it's the those things are the things that no one tells you. Because as I'm reading the I mean, we're going through these bold beginnings things. And the thing that sticks out to me most is that what you get told in the beginning really, really sticks in your head. Yes, you know, and then when things morph and change your honeymoon ends, or your kid gains 20 pounds, and all of a sudden, a half a unit, it's not enough to you know, just tank them completely. Once things change. People hold on to the rules they were given at the beginning, and then the rules and reality don't match any longer. And no one ever comes by and tells them Oh, that's fine. This stuff changes, you know, be flux.

Excuse me, I think also that goes right along with that is it is the concept of change. And people rightly so they take the information they have been given as if it's written in stone. And this is not going to shift. Again, some explanation needs to go along with it in terms of especially kids who have very fluxing needs for many, many reasons. Not that a newly diagnosed adult doesn't initially to, but I think more so for kids, especially since their insulin doses may be microscopic. To begin with. You have fried foods for a child who's really residing on just a couple units of Basal insulin, and really doesn't seem to need coverage at all for meals yet. Yeah. Eventually, those foods that look like they're free, will need to get covered. Eventually, as their insulin needs creep up that five gram treat or snack in the afternoon, as their insulin to carb ratio becomes more aggressive, they're going to need some insulin to cover what you didn't really need to give insulin for before

this other thing that happens to people where they get told to eat a certain amount of carbs at a meal. Even when they're using a fast acting meal insulin, that again, I think of his lazy, the description that was given to them because I think what's really happening is the clinician saying to them, Look your kids so small, I don't know how to break this down beyond a half a unit of insulin. So you're gonna have to eat 20 carbs. So you can give this kid a half a unit of insulin correct. But instead the takeaway from the family is he has to eat 20 carbs every time he sits down. And then they start getting into the like, Well, how do I eat 25 carbs, no one tells me that. So now if I want more than 20, I have to eat 40. And then and then kids can't do that. And because it's too much food for them. And again, if someone would have told you the reason we're doing this right now is because we just can't get the amount of insulin low enough to tell you how to Bolus for eight carbs. But don't worry, kids gonna gain weight, this is all going to change, honeymoon is going to end etc, etc. Again, I think it's the rest of the words that nobody speaks that are always what causes the problem.

No, yeah, that's absolutely correct. Especially, you know, again, for a kiddo who's like a one unit might cover a warming meal, but they're three years old and they're not going to eat that large amount of food. Then you have to break it down a different way for them and it takes It takes individualizing the care from the start. It does.

What do you think about the idea that most people newly diagnosed are going to be MDI. And that the way I heard somebody told me the other day that the podcast is about, it's for pumpers. And I thought, I don't think that's true. Like, I think that what we talked about works fine. If you're doesn't matter how your insulins getting in, like, you lose, right, can't do an extended Bolus, you know, without a pump, you can't shut your Bayes law for Jack it up without a pump, okay. But the rest of the stuff is just about putting in insulin at the right time using the right amount the right time.

I, I wonder if some of that timing though, I can say I mean, we do refer to things like extended Bolus and Temp Basal are using, you know, the fancy features of all the other algorithm driven kind of systems that are out there. But from a timing perspective, it covers both bases, it covers MDI, and it also covers pumping. But in a sense, you have to be okay with potentially giving more injections, on MDI, in order to cover the food the way that you want, and get the sort of out, you know, the aftermath covered the way that you need it to be. So you can do that. And from the beginning, again, we've talked about this in stacking right, from the beginning, people get scared of stalking their insulin, and they need to learn from the get go that if you're going to eat little bits, as many little kids do a little here a little here a little here, you may have to figure out how to get the insulin in in the right amount to cover that little bits of nibbles along the way. Yeah.

I have this thought from this person here that I don't I kind of don't see how it fits into this conversation completely. But it is really interesting to me. So I'm gonna mark it and come back to it at the end. There. Oh, yeah. Okay, hold on. We were told snacking under 15. Carbs was free, just so this person was just told anything under 15 carbs was free, not just certain foods, like you can have a cheese stick, or you can have chicken or something like,

I wonder what their initial dose of insulin was like to his I mean, 50. And as we've the 1515, right, anything under 15 is free, but I can use 15 to treat a low blood sugar. Right? I that's confusing.

Yeah. I and then you wonder if this is what they were actually told, or if this is how they remember it. And or if this is exactly what they were told. And the person telling them was, was conflicting ideas. Yeah. Not all carbs are the same. This person says, I had anxiety about food and insulin, it took weeks to really get an idea of what a balance look like for me. So I, I can't tell you, I mean, I don't have diabetes, right. But I can't imagine what it feels like to be given this medication being told, Look, you have to use it. If you don't use it, you're gonna die. And if you use too much of it, you're gonna die. And it's connected to everything you put in your mouth. I don't know how that that must freeze people. The idea that that eating disorders come out of type one diabetes frequently is very easy to see. It's not at all shocking, right? Because of that feeling, like this paralysis of analysis that you must get I hate using terms like that. But But that idea of just like, What do I do? And then everything you've been told, is scattershot. It seems, I mean, some people come away with great, you know, with great information up front, but for the most part, I don't get to talk to those people very frequently.

Right. And I think it also speaks to the very individual nature of how you first teach somebody about their diet, you know, their diagnosis with diabetes, you can't, from my perspective, you can't approach somebody the same way as you did the person three hours ago, there is no way to do that from a newly diagnosed standpoint as well. You still have to ask enough questions that help you to individualize the care so that their lifestyle while it's going to be impacted, is a little bit more. It's a little easier to get them to understand how to do these things within what they had been doing before diagnosis from a from a comfort level and there are some personalities that certainly require some additional assistance sooner than later.

Yeah, no, I mean, obviously, there are some people who just get like, I'll do it tell me what to do. I'll do it right and there's some people are like you're not changing my life. And again, Anywhere in between a we just tell them all the same thing and sent them home? Right? Is this accurate? This person says, the kids are hungry for a few weeks after diagnosis, like overly hungry.

That's in a general sense, especially if they have lost a fair amount of weight. Because their body was essentially eating itself. That's the easiest way to explain it. You know, when the blood sugars are running so high, obviously, they are losing a lot of calories through urine excretion. And so after diagnosis now, when their body actually is able to, gosh, I can grab this food and I can pack it away, I can store it, absolutely. Kids can get very, very hungry. They're also in a stage not to say that adults or you know, those over the age of growth couldn't also be hungry again, especially if they've experienced that extreme weight loss before diagnosis. They may also their body is just telling them, Hey, we need to put this back on. You lost a lot. We have to sort of recoup what what was kind of given away, but kids are growing already. So you could expect them to be hungry,

right? Even if they're just more feeling healthier, because they have insulin, and they're getting back to where they were. But I mean, Artem was down, excuse me, Arden was down a fair amount of weight, she was small, and she was ravenous for a little while as well. Somebody just says here, it would have been nice if somebody gave us the rundown about the glycemic index and glycemic load. If you go to the Pro Tip series, there's an entire episode about that. Earlier in the podcast. Jenny touched on a little bit about giving you lists of foods that impact differently. But if you I was going to say if you want to understand but you really have to understand it. So go find that episode. Understand you know how how words that seem a little weird and confusing and stuff you haven't heard before are really important glycemic index and glycemic load. While we were in the hospital, we were told not to do more than 45 carbs a meal. So she says this was clearly BS. We felt the need to go to the store and buy a ton of diabetic food. Of course, we haven't bought any of that sense. So it's just a it's just an insight Jenny into how saying something to someone incorrectly or not conversating with them to make sure they understand your intent can send people down these crazy rabbit holes. I don't know that people can afford to go to the grocery store and spend hundreds and hundreds of dollars re fitting their home only to find out later that magic spoon cereal tastes like not good. I'm sorry for those of you who like it.

I like magic. Cereal is the one process thing and I will say it is processed I mean it there is no doubt about it. If and when I have it we do it for like a road trip or like to go camping or something because it's it's a little bit easier. And it certainly doesn't have bad impact on my blood sugar. I have tried some of the other brands out there, which I will not name. But the magic spoon is definitely one that I can I can say works like it says it's going to work glycemic ly. And many of the flavors. I won't say all of them, many of the flavors are palatable.

Art we tried one said, I'm gonna have to bleep this out. Arden said where are they trying to approximate Hold on a second. I'm making myself laugh unintentionally, or were they trying to approximate what a unicorn say, almost tastes like he did not like it at all. He didn't like the garbage. But that's fine. There are a lot of people who love it. And I think that's terrific. But but the point is, is that if you say something specific to somebody, you can never have a meal again, that goes over 45 carbs. They think well, how are we going to accomplish that? Right? You know, now they're in that one aisle at the grocery store that nobody goes into?

is unfortunate. If you go back, you know, I don't know, 15 minutes ago when we're talking about real food versus processed food, all of the all of the food that is labeled diabetes friendly or whatever they're calling it now. It is processed Yeah, there is nothing. There is nothing in it. That is there are a few pieces, I guess a few ingredients but most of it is artificial sweeteners of some kind added fibers of some kind or some nature added protein powders of some nature, right? I mean, so you're better to go home and at least just keep eating what you've been eating and maybe then asked for help cleaning it up or figuring it out or whatever. Or just go to the produce

weighed real food. Yeah, what is that they put in the diabetic. I wish people could see me making the finger quotes, but diabetic case sort of a tall, right. And if you get too much of it right,

the bathroom will again be your friend. Yeah.

Because things will be flying in all directions. Don't eat too much candy. Just eat regular candy, learn how to pull it sport for God's sakes. Right? Yeah. This is interesting. This person says that they were told that anything was free under 15 carbs. On top of that they were told not to Pre-Bolus their meals. And they said that these two things together made any kind of stability in their blood sugar impossible. Absolutely. Yeah. Right. I mean, and I wish someone would have given me a comprehensive list of actual zero carb snack. So this is the I

don't know, I don't know who would have said, I really don't that. It makes me really, really sad that there are that there are education teams out there that are giving this kind of information. Really, I am like, I have nothing. I don't really even know what to say about that. I really don't. Jennifer's mortified. Yeah, I am. I'm mortified. Honestly, from a professional level, I am mortified that somebody would have given that information.

Yeah. So here's the next thing that's gonna happen. Pizza's gonna get ruined for you. You've been diagnosed with diabetes. And, and there's this thing that through 35 minutes of talking here, we have not gone over which is yes, food. One broccoli hits your blood sugar in a certain way. And yes, mashed potatoes hit in a certain way. And yes, mashed potatoes will hit differently if you put butter on it. And if your meatloaf is just meatloaf, that's one thing, if you put gravy on it, it's another thing. What happens when you eat them all at the same time, right? They're all in a mixed meal where they all live. The way I like to think about it, when I'm thinking about insulin is where they all live on their own kind of timeline of existence in your body. Like an impact timeline, the broccoli impacts with a certain amount of force over a certain amount of time, as does the butter, and the potatoes, and the beef, and the flour and the gravy and all these different things. And you just thought it was gravy and mashed potatoes. And now you're realizing, oh geez.

I think one concept there is the the typical, the typical mixed meal of proteins, carbs, and fats, right? All the macronutrients in a portion that should be eaten. Should should have a typical absorption or digestion that goes along with the Action Timeline of our rapid acting insolence. Okay? The, the larger the portions get, or the higher in one macronutrient versus another, like, really, really large amount of the meatloaf and like a spoon of the mashed potatoes and maybe one stalk of broccoli, right? Do you see there's a there's a definite difference there. And that goes back to impact on blood sugar and what you may end up seeing happen. So portion comes into play, to not only just carb counting, but a portion of a combined mixed healthy meal. And the impact that you're going to expect to kind of see Yeah, so

the idea being, we'd all be okay, if we took a handful of potato chips once in a while. Eating the entire bag of potato chips has a different impact on your body. Yeah. So alright, so back to pizza. And Pizza gets described throughout the podcast a number of different ways. But pizza is not just pizza, it's flour, and it's cheese. And it could be meat, right? Or it could be vegetables, it gets the sauce. There are all these different things on this one delivery system. When you understand how to Bolus for pizza, that will actually open your mind up about bolusing for a mixed meal too, right? Because why? Because you look at a slice of pizza and you say, well, the box tells me or the pizza place told me this is 35 carbs, you Bolus for it. The food goes in your body doesn't start breaking it down right away. So your Bolus makes you low. Then you end up drinking a juice because you get so low and then all of a sudden 45 Yeah, the pizza hits you and now you're you're just you're lost because the insulin you put in was for the pizza. You didn't cover the juice because you were alone, etc, etc. And then you learn when to Bolus for pizza, right? Like when does the insulin go in versus When's the food going to hit? How do I balance these things up? This is what you're going to learn in the Pro Tip series for certain, if you go listen. And you'll also be able to see bigger picture about other meals, you'll be able to look at a plate at a mixed meal and say, Okay, this turkeys not going to hit very hard. It's five or six carbs, maybe. But here's the stuff that is going to hit me. And you just I don't know, at some point you just learn, right, Jenny, it's not a

you do and that it kind of in. In that example, it kind of also goes back to figure out the foods that are pretty normal for you because that that base knowledge rolls over into other meals that may not be your typical, but appear to have similar enough content that you could expect to try to use your insulin the same way around this newer meal, right. Pizza as an example. On Nacho dinner, right nachos and meat, cheese and guacamole and whatever else comes on that they are all similar monsters, if you will. A burger and fries or a cheeseburger and fries, for example. They all have a lot of mixed nutrients that are going to be similar to pizza. So if you have the most experience with pizza, and your friends are like, Well, hey, let's go out for Burger night on Friday. You know, like okay, well, it's definitely high fat, just like my pizza. Let me try the pizza strategy. Right? Let's see, right?

Yeah, even even you find yourself in a place where you get a burger. And then you grab a milkshake. And you probably think ice cream sugary fast, right? More, really, it's the fat in the ice cream that's gonna kill you right later later. Yeah, a whole bunch of episodes about how to Bolus for fat and protein. And that's the next part of this really, is that this whole conversation is based around carbs, because that's people's understanding that they're given. Except protein breaks down in your system and turns into glucose. And fat slows down digestion, which changes Bolus timing. There are other things to think about not just carbs, I'm gonna roll through some people statements here just so you can hear them right. I cried about never being able to eat cake again. I know it's ridiculous. But that's what got me. And now I learned how to eat up because of the pocket. Oh, I wish people would have told me about the glycemic index again. I wish people would have told me that my kids will be starving because of the way they set this up. And that's how it's going to feel. So now the kids are running around asking for food asking for food. And the parents like I'm sorry. You can't eat for three hours or we already Bolus for something you should have told me before. And all the stuff that they get messed up when these are some of these are really sad. Oh, my first couple of weeks, I thought I needed to have three hours after dinner before giving my Lantis like Ha he. So he's eating dinner right now. And at 9pm. I was leaving for work early. And this was stressing me out. So isn't that interesting, just a misunderstanding about when somebody told them to shoot this Lantus at a certain time, they get stuck in their head as a rule. And it creates all this anxiety for this person down to like they're now making meals when they don't want to have them to. To right.

And again, there's lack of proper information given Yeah, it's your Basal insulin might be a very defined time of the day. But dosing that at that time of day doesn't go along with your whatever rule you've been giving about the dosing of the rapid insulin Yeah, at all, that they are independent.

Right? This person says I wish someone would have just told me a little bit about how to visualize portions. Ah, see what to what you just said. Because apparently prior to that they were eating, what occurred to them and not, you know, they know people don't really think about it, right? Like, we don't talk about that, like a scoop of mashed potatoes is probably Oh, no. See you.

I mean, you do you do or did a lot of assistance for Arden. She's been growing up, you could sit down at a dinner out, and you're focused on what's coming on to her plate. But when it comes to your own plate, are you also like, oh gosh, my burger? And is it about the same? No, you just start eating.

I'm saving. I'm making her live forever. And I'm killing myself with this.

There is no care for what's on your plate in portion.

Right. And so that really is the I mean, listen, that's a bigger conversation, obviously. And I don't want to just say like Americans or anybody you know, like, is that we don't think about stuff like that food is plentiful in this country. Right? You don't think about like, well, I'll just have a little bit because I want to have some more for tomorrow, right? I mean, how many times you eat something you don't finish it again. You throw it the trash, you don't think twice about it there. You feel like there's always going to be more Food. So that feeling there's something about finances and food that go together, I haven't had I don't have this all worked out yet in my head. But when you can afford it, you stop thinking about it as nutrition and you start thinking about it as a thing you need. And because you can afford it, you can eat it, if that makes sense or not

possibly and, or if you can afford it, you can do a little bit more specialty, or you can choose to do a little bit more quality, let's call it from specialty items. Whereas if you can't necessarily afford it, or you have just a budget that you really stick with, right, then what comes into the house may be very different.

And I think that thought works in two different directions. Maybe if I can afford it, I can buy better food. And I can show it right? I should because I can afford it. But also the other side of it, I can afford it, so it doesn't matter. And the personal, like, the thing I can say is that I have found myself sometimes he's like a little candy dish. And I'll sometimes take candy out of it. And I don't want it. And at first I thought like, okay, like that's a snacking function. But I also realized back when I was broke, I wouldn't have touched it. Because the candy would have been so special. It wouldn't it was, it's almost like a favorite. It's almost like, I never missed the Charlie Brown Halloween special because it only came on once. And if I missed it, it was gone. But now I could stream it anywhere I want. And so I can just grab it whenever and the food almost falls into that category. Sometimes I can afford it. And it's here. And I stopped thinking about it as nutrition. And I just sort of I think about it as a possession almost right. That makes it

does Yeah. You know, the other day I was I was chatting with somebody and they're like, Well, what would you have done if you wouldn't have gone this route of like, nutrition and diabetes education and whatever. And I said, you know, I, I have a very big health connection. And I said, I think I probably would have gone into the realm of educating on school information, that's health specific, to start with educating from kindergarten forward, each year builds on itself with what the kids learn in terms of their health and what they put in their body and exercise and how that builds into an adult healthy level of living, right. I mean, my, my little guy the other day, we've made a stoplight thing for our pantry. It's got a red, yellow and green light on it. He made it and we put it in there. And he knows the green foods, he can have those. As long as he's hungry. He doesn't really have to ask much about them. The yellow foods he needs to ask about and the red foods are absolutely I mean, they're not even typically in there, or they're very much on the top shelf. But it's a good way to start educating on a very early level of these foods we can go to because they're really good. They serve our body these foods, they don't need as much of them. They're still good. Or we don't really need them as often. And then, you know, but if we did more of that,

right? And then it would work like the chicken nuggets with my son. Yeah, eventually his palate would just desire something that was better for him. Right? Yeah. Jane, do you have a minute or do you have to go? Yeah, I've got a minute, just unroll through a couple of things here. It would have been nice if somebody would have told me the difference between a correction Bolus and an insulin to carb ratio. They didn't understand that. That one person said that they gave me a Basal Bolus doses just excuse me, they set up Basal and Bolus dosages for my kid, but never asked about their physiological activity. And the kid was a super aggressive like active person. And so the kids always falling always falling. And of course, the mom is so new to it. She never puts two and two together. Just thinks this is what diabetes is. My kids got a thing now where his blood sugar's low all the time, right? Because

there's no explanation to why it's happening. Right? You know it Yeah,

yeah. So then she comes online and learn stuff and and then puts two to two, two and two together on her own and figures it out. The last thing was, I said I was gonna go back to something.

Oh, yes. I don't know what it was because you

didn't know I haven't. wrapping my head back around that again. She was just talking about that prior to insulin. Her whole understanding of medications was in pill form. And somehow that that predominantly made her believe that every thing was super regimented, because you take the pill in the morning with food, and then you take it again at lunch with food and everything she'd ever learned about about medications was based on timing. And then she couldn't make the insulin work the same way. And it was frustrating. I don't know why I wanted to bring that up other than,

well, I wonder if the person is an adult who was diagnosed initially with type two diabetes?

No, it's for a kid, I said, the kid, the beginning of the statement is my kid was starving, because I was trying to keep a schedule.

So they're in again, should have been better explanation in terms of timing of insulin, it really is, because it oral oral medications, or even some other injectable medications. They all have a timeline of action, from time of giving to expected time to give the next dose, right. But they are, they are not as precise in terms of what we can then control versus insulin being much more in our realm of controlling. Because we can put it in when we know that we're going to need it based on what we're putting it in for. Even if it's for food, we do it this way. If it's for correction, we do it this way. And we might even do something else along with it. Right. So I think insulin is definitely very different than pills. Yeah. And that is that's unfortunate, too. And I don't think the doctors maybe, obviously, maybe they didn't ask enough questions in terms of understanding of medication use.

It made me think about people with thyroid issues. Because when you get a thyroid issue, a doctor is going to explain to you very clearly, you have to take this medication at a certain time of day, you have to take it with, you know, an empty stomach, you have to take it not with other pills, like and or you can take it with some pills, but not all of them. And here they are. Because if you don't, your body will not take up that medication correctly. And you're going to have a deficit that will come on you slowly. And you'll just sort of your your functionality falls apart. And you don't see it happening because it happens so slowly. And still, if you go through the forums and look at people who have thyroid issues, most of their problems are because they don't take their medication correctly. correctly. Yeah, right. It's all about like, you know, I don't know, like, I just take it when I think to take it no, take it at the same time every day, because it only lasts for 24 hours. That doesn't seem to matter to them. I don't understand, I take it every day, I never forget with my vitamins, and then you look at their vitamin list. And they're taking vitamins that are blocking their absorption, the absorption of the thyroid medication. If you can think about that pill correctly, you can think about insulin correctly. And because insulin is not going to work the same in every situation. And in the beginning, that seems incredibly overwhelming. But if you I can't believe I don't I just I mean this the way I mean this, if you listen to the podcast, you'll understand those different situations eventually. And not because the podcast is magical. But because you'll hear conversations and scenarios and experiences that will eventually teach your brain like the stop and go like that your son made that. Yeah, I'm gonna do this thing, because this thing is what works for me. It's not because you've beat it into your head, or you wrote it down or you, you know, you remembered it's because it happens. You just do the thing, because it's the right way to do it. And you've heard it enough times where that's how it happens.

Well, I think the biggest thing to within many of the episodes. Actually, I'd say all of them is something to do with a variable. Right? Yeah, it is. So if you if you pay attention and learn whether it's learning from somebody else's experience and saying, Well, I have this same sort of lifestyle, maybe I could give that a try, or that sounds like it would work better. Maybe this is why it's not working for me. Right?

Well, you know that you said that. I skipped over a statement from a person here who said I wish someone would have just told me that breakfast will have a different impact every day. Even if I eat exactly the same thing, and I thought I don't want to go through that because that's not really true. It feels like that. Because that's what you see. You see the I put the insulin and at this time they ate the same food and then something different happened. But you don't see how much insulin did they have over Night. Is this a moment where there is a growth spurt or there's not a growth spurt? Is my period happening? Is my period not happening have less I very active yesterday or very sedentary? All of those variables. People who ask questions like that in the beginning, they don't see that the truth is, is that the meal and the food that didn't change something else change and you don't realize it, maybe you're on a prop and you're at the end of a pump site and it's going bad. Or, Jennifer Smith, CDE 1:00:27 or maybe you're on an algorithm driven pump. And because settings aren't quite navigated appropriately, the system is doing one thing, some mornings giving you a load of insulin getting you ready. And so your aftermath of breakfast looks a lot better, right versus taking away. And now you're left with, you know, this deficit of insulin and then things look the opposite of what you really wanted. Scott Benner 1:00:47 Yes, there are so many variables, yes. And the only way to learn them is to live through them. And to not put yourself in that exact mind set of that question, which is why I didn't ask that question out loud. Because I don't want people to think that I don't want them to think that diabetes just magically happens to them. Because, Jennifer Smith, CDE 1:01:08 yes, there's nothing magical about right. Scott Benner 1:01:12 It's all pretty, it all happens for a reason. The reasons are hard to see. And again, you keep listening to people's conversations and they say something and finally, like it pops in your head, you go oh my god, and then you relate it to something in your own life. And before you know it. That's another thing you've got in your tool belt that you don't have to wonder about ever again because it's just there when you reach for it. So anyway, I thought this is a great conversation. I appreciate you. Absolutely. Thank you. A huge thanks to you all for listening and to Jenny for coming on the show. I'd also like to thank in pen from Medtronic diabetes and remind you to go to ink pen today.com Us med.com forward slash juice box or 888-721-1514 Get your free benefits check today. Don't forget the Contour Next One blood glucose meter is available at contour next one.com forward slash juice box to get the glucagon that my daughter carries go to G vote glucagon.com forward slash juice box Omni pod five. Are you interested where the Omni pod dash doesn't matter which one you want? You get them@omnipod.com forward slash juice box and get the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box. I appreciate you guys putting up with all that today. I want to remind you that there are more bold beginnings episodes in your audio app. And they're also available at juicebox podcast.com diabetes pro tip.com. And at the private Facebook group Juicebox Podcast type one diabetes. The bold beginnings episodes begin at episode 698 Defining bold beginnings. Then at 702. honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus And today's episode, carbs. There are more coming, check them out. There'll be there in your audio apps on Friday for subscribers. They just pop up if you're a subscriber, a subscriber or a follower, by the way, in whatever app you're listening in. It'll just magically be there. So subscribe and follow, follow and subscribe. 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 743 of the Juicebox Podcast. On this episode of bold beginnings, Jenny Smith and I are going to talk about stalking. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, 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, or becoming bold with insulin. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app. This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, 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 your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously. In pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed or you could experience higher low glucose levels. For more safety information visit in Penn today.com. What do we have here?

I closed my exercise ring for the day. Just to be right there. I just want to tell you that.

They got a little notification on my watch that popped up. It's like your exercise ring has been closed for the day. Like great.

It's 11 o'clock. Jenny's done exercising Alright, already. Oh, it's

10 o'clock my time.

Oh my goodness. That's true. I've so far accomplished showering and letting the dogs out.

Well, my dog gets very fussy if he doesn't get a walk. So you know, oh, you walk in the morning time and walking treadmill helps. And

yes, that's true. Sometimes when Jenny pops on the camera, she's bouncing up and down a little bit.

Because she treadmill. I love my desk treadmill. It's awesome.

I know you do. By the way you should have seen when I was doing the AMI pod five series with Carrie. And we were doing different modules basically. And she'd never done this before. So when I started up the second one, I'm like, Hey, Carrie, how are you? And she was like, Why? Because I was like, like acting like we were starting over. I just went through and I was like, Alright, you're right. Probably the people listening know, we recorded this all in one day. She's like, Yeah, I think they would like

but when they go up as different episodes it it's important to sort of have an intro. Hello. I'm back to talk to you again.

You know, how are you? Great. So hello, Jenny. I'm back to talk to you again about the bold beginning series. Today we're going to talk about stalking. So I think if people listen to the podcast long enough, they're going to hear me or you or any number of people say it's not stalking if you need it. That's Bolus thing. But Correct. You're going to get told by a clinician not to stack your insulin. Correct,

right and you'll get get told that whether you're MDI, multiple daily injections, or you are on

a pump, yeah, no matter what,

no matter what, and I think that there's an interesting learning piece here, that goes a little bit deeper. But if you're at all on an algorithm driven pump, you will learn a little bit more about how stacking when, as you said, when it's needed, actually becomes really important. Because you can see when your algorithm is starting to give more, and you can learn from that, even if you ended up going back to manual, like insulin delivery. So I think the concept of stalking unfortunately needs to be revisited in terms of how we teach people about it. And I love the fact just what you said about if it's not stalking, if there's a reason for you to give extra insulin, right?

So let's give some historical context. Because you just said something I've now hearing you say a number of times over the over the past couple of months, is that back in the day, when people were just using meters, and probably not even using them that frequently. Right? The idea of you just putting in insulin and putting in more insulin putting in more insulin, because you saw a high number was purposeless, really right. You know, because you didn't you didn't know why you were doing it other than I have a big number, and I wish it would come down. Correct. And so doctors would tell you Look, don't stack because let's be clear why right? Say you eat a meal. And the meal should have gotten six units of insulin, but for whatever reason, you gave it three units of insulin, then you test your blood sugar two hours later, and your blood sugar's 300, you put in a whole bunch of insulin, you test again in an hour, because now you're worried your blood sugar is still 300. So you put in a whole bunch more insulin, and then eventually everything in your stomach gets digested, it's gone, there's nothing left to hold that blood sugar up, and you come flying down because you have way too much insulin in you. So that's an it's a simplified way to think about it. And there are reasons. And there are ways I should say, to understand how much insulin would impact that high number. You're not going to learn that in this episode. But that's what stacking is. It's just stacking up insulin on top of itself more and more and more now.

And I think what it brings in is the concept of understanding insulin on board then. Right? In the past, we weren't really in years or years ago, in the past, we weren't taught about that active insulin time period. So stacking was a really important piece. That was there was a lot of caution to it. Yeah. Because people weren't told, Hey, if you take insulin now, it's going to be working for this many hours going forward. If you correct, this next amount of insulin you take has its own timeline of action beyond that first Bolus that you took.

Yeah, I want to say that I saw a lot of content creators, now I'm making air quotes, because of because of apps like Tiktok, and things like that. And it's it's seeped into the diabetes space, right. And everyone knows that content. That's scarier, you know, is more interesting than telling everybody that puppies are nice, and the world's a good place to be, that's not a good way to get people to watch your stuff. So I'm seeing a number of people younger people feeding their low, they're scary low blood sugars on, you know, on apps and stuff like that. So these are probably situations where people used way too much insulin or didn't understand the impact of their exercise or of the different foods that they were eating. And so I don't want to, I don't want to, I am not a person who's like blindly like stalking. That's not real. It's very good. Yeah, you definitely could do yourself in was stacking very easily. But there are other things to understand. And then once you understand them, there is a way to use insulin, where you're not just mindlessly doing it. And it's going to end in some super low blood sugar later, there. There is a way to use more insulin effectively. So absolutely, yeah. So let's see, somebody told me I wish somebody would given me the actual definition of stalking. And that insulin to cover food can be at any time. See, this is a big one. That's

a huge that's absolutely it's what you started out with. If you're giving insulin for a reason, right? You need the insulin. Yeah.

Because somebody told the event of I think, originally you get told you can't stack up insulin, and that you should check. After three hours view Bolus. They make it seem like you eat and then you can't do anything else for three hours. Right. But what are you what if you made a great Bolus that was really working and three hours from now you were going to see the blood sugar that you desired, but two hours after you ate you decide to have a handful of great Oops. The people that eat the grapes and don't Bolus because they don't want to stack their insulin, right? Yes. Because somebody was not clear about what stacking is. That's bolusing. Right? The thing I said in the beginning with a 300, blood sugar, that stacking? Yes, yeah. So

thankfully today we've got a number of devices and things that can help you to keep track of the insulin that you have dosed at a specific time, that can help you to remember visually see how much insulin is left from that Bolus at noon, now that you want to eat grapes two or three hours later, and we'll help you determine what is a safe amount of insulin to take. Yeah, right. But again, I think some of those are under under reported in terms of benefit of use.

Well, the the, the attempt to not stack insulin by people has, I've seen it ruin some holidays, that's for sure. Yes, Thanksgiving, Christmas days where there's spreads out and people are grazing and things like that. And you're, you know, running around telling your kid don't touch that don't eat that you can't have that now, like, you know, you can totally have all that like, oh, absolutely

holidays or anything like that. 100% of stalking episode for me, and I don't consider it, it's not stalking that's, that's right, it's I'm going to eat this, I'm going to nibble this and then I have some of that. And each of them requires its own little amount of insulin,

right. So if your settings are good if your Basal is right, and your insulin to carb ratio is close, and you understand different impacts of different foods, which I know already sounds like a lot. But if that's the case, you can wake up in the morning Pre-Bolus your meal, eat your breakfast, eat again, two hours later, you can eat constantly throughout the day and Bolus every time you eat, I would still, you know, depending, I guess I would say unless you're low, I would continue to Pre-Bolus like snacking along the way. Because all things being equal, meaning all the settings are correct, and you're understanding the impacts of your food. Insulin works, the way it works and the carbs that your system the way that your carbs hit your system. That's it correctly to change.

And there, there are some concepts too, especially once you start using a smarter device, let's say a pump instead of using just multiple daily injections. And if you're trying to be a little bit cautious while you're learning to give insulin more frequently, the idea of using things like an extended Bolus or whatnot, still allows you to give the insulin without it all being given at one time. So you can see the effect did it work? Should I have given it all because well, gosh, now I'm having a rise in my blood sugar. I was trying to be cautious. Those are some of the things that you can do to learn to feel okay about adding more insulin for when it's needed.

I mean, the statements here, please explain stacking, tell people they should learn about stacking, or this person who said I only I wouldn't let my kid eat except for after a certain amount of time had passed. And so you know, kind of sad socks. Anyway, do you see anything else to add to that? Because it's not? I

think that's a good overview. Yeah,

I think you can definitely learn more in the Pro Tip series in the defining diabetes series about stalking. And there's an episode somewhere called crush it and catch it, which would be kind of like advanced understanding. Yes,

that's definitely advanced.

That's what advanced but it is a little bit of how I it's funny, because in an earlier episode, right, we were talking about we're talking about Pre-Bolus thing in the, in the beginnings, and I told a story about how I took a high blood sugar and ate a high carb and I took Ardens, high blood sugar, and an incoming high carb meal and used Pre-Bolus thing to get it down. But in truth, I also use stacking a little bit I also stacked up a bunch of different boluses but not in a bad way I put them in like places where I knew they were going to do a good job for me thanks so much to in pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in Penn today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app and helps the show and honestly it's easier for you. The episodes come right to your phone and the Phone is right with you cons Like Minds right here. See, I just picked it up. Everyone always has their phone so let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there, of course, right in your podcast player, just go to all episodes and you scroll around, and you can find them or search and find them by searching for something like diabetes, pro tip, or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're gonna find a Facebook group, with 27,000 members in it, people just like you who are sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series, but all of the series that exists within the podcast and there are many, there's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes Pro Tip series. You don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. 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 747 of the Juicebox Podcast. On this episode of bold beginnings, Jenny Smith and I are going to talk about flexibility. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, 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, or becoming bold with insulin. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app. This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, 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 your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously, in pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed. Or you could experience higher low glucose levels. For more safety information visit in Penn today.com. I don't have the energy to pretend that we haven't been recording for the last hour, Jenny. So we're back. We're back with the bold beginning series talking about flexibility. Maybe an unsung tool along with texting as far as I'm concerned about diabetes. So yes, this first person says that in the beginning, we were not educated on the needs of insulin, and how they would change over time or with exercise or with growth. It was just about finding the settings that fit at diagnosis at diagnosis. I wish I was told that these things would change and the diabetes was a marathon and not a sprint. And that I would need to be flexible. So do you see that a lot with people they're stuck in like this number used to work, I don't know what happened.

I do especially for people who have a level of an endo I would say or a level of somebody that they are only really only checking in with, you know, every six months, they're kind of left to their own ability to manage. And even though what was working isn't working anymore. They don't have the tools to evaluate how to make a change, or they don't necessarily maybe feel safe making a change because they've had enough. I call it hand slapping when they go into their physician's office. Well, why did you change this? You know, this number is different in your download. Why did you not do what I recommended six months ago? Well, I mean, there's some explanation something changed. Yeah, I tried to navigate it. Right. So I think that's a reason that some people end up sticking with where they are even though they know it's not working or they realize that something's changed. Because they may not have the know how or the care team to really help them.

I think to add to that one of the sadder things I say is when people know that they should be doing something and they let their fear of what's going to happen when they get to the doctor's office stop them. That takes me into this person's statement. I thought that insulin, the initial insulin dose was it and it was set in stone. And then we know we learned very quickly, that the more flexible you are, the more successful you could be that you could change a dose if it's not working. Or, you know, if you're worried about changing themselves, or call the doctor, the nurse, she said she called her CD every day for two weeks. But her takeaway here is don't suffer, try something else. And you will find something that works. I mean, that's just that's a great statement, you have to just keep experimenting and trying things. And if something doesn't work, try something else. And I think the way I put it in the Pro Tip series is that when you're learning to Pre-Bolus a meal, you can if you have a CGM, see what happened. And then the next time say, Well, look, I'll do a little more, a little less, a little sooner or a little later, you adjust your timing and your amount until it starts working for you the way you expect it to or the way you want it to forget. Expect it like the way it the way it can work.

Right. And I think the comfort level, from another piece of understanding can you can get comfortable faster, if you understand that. You're going to try something. And if it goes the wrong way, meaning you're not higher, but you're actually lower than you ended up being. You are not in the middle of a desert without tools to help write that drop or that low. Right. I mean, maybe you are in the desert. And if at that point, you clearly need to have supplies.

Someone stuck in the desert, they're listening to this podcast they have they're misusing their, their their resources, are resources at their disposal. Use the phone to call someone.

Yes, exactly. But you know most of us have, thankfully have something to treat that drop with. And if you are experimenting, have those things on the ready, right? Have them in your pocket, have them in your purse, have them in your glove compartment, whatever. Because you may with experimentation, find that things don't necessarily the first time go the way that you want them to go.

Yeah, yeah, be ready for it not to go. Ready. Ready, that's for sure. Be ready. That's right. Yes. Well, here's this next statement says that what I didn't understand was that the carb ratio was a guide even. And the Basal insulin which needs would change, she said, I had a magical idea that if I measured everything, I would nail down the doses. And that would be it, they'd be done. Right. Like she just wasn't measuring the food correctly, she wasn't assessing the amount of carbs. But go to the pro tip about glycemic load and glycemic index to understand that all carbs aren't created equal. She said that we would glide through diabetes with no problem was her expectation, if she just measured the food correctly, the endo made it seem like that as well. And I wish someone would have told me that you have to be flexible, and that dosing changes would have saved me quite a bit of time and stress.

And in terms of like clearing that up dosing changes, there are a couple of thoughts around that right dosing changes, meaning as you grow, or as your child or your team grows, their doses will change. Yes. But another like way to think about dosing might be the strategy of the dose might not be the amount that changes meaning your insulin to carb ratio. But this type of a meal may use this type of dosing strategy for insulin. So doses will change. Many people have different insulin to carb ratios through the through the day, depending on the time of day. And as precise as you can be, with a label or with estimation. Absolutely. That goes a long way. But

Arden doesn't eat a lot of like sugary candy, but when she does, it requires a longer Pre-Bolus with less insulin than the carbs would indicate. So if she's gonna eat 15 carbs of gummy bears for fun and not for you know, as as low, then, you know, it might not be the exact like in Arden's case, 15 cars would be like three units and 3.2 units or something like that. So she probably doesn't need the whole 3.2 She might need more like two, but she's gonna need it with a longer pre loss because the sugar is gonna hit her so quickly. And but it also doesn't punch with the same weight as a baked potato does. So you don't need as much insulin that might sound in the beginning you that might I might have just somebody who's newly diagnosed could have heard that and thought, why don't you just tell me I have to build my own rocket and fly to Jupiter. Because I don't know how to do any of those things. But this stuff is not difficult once you get it's

not and I think one thing to kind of clean that up in terms of the insulin to carb ratio is B Because most people eat a complex type of like meal, there are a little bit of all the different macronutrients carbs, proteins, fats within a meal time. ratios. For most people are really adjusted with that idea in mind of a lingering effect of a meal. So ratios are often more aggressive than they would need to be if we just lived on simple carbs. Simple carbs have a very quick process, they go in fuel the body, they come out. And that's why if you really eat only carbs, you're constantly driving this hunger road, right? So that might explain the difference between ratios for a meal versus ratios for a handful of gummy bears that I just want to eat.

By the way, there are some brands, gummy bears are better than others. But I'm not here to push up gummy bears. This person just wants me to make the point that because things are dynamic, and flexibility is important. It's another reason to say that a person who you only see every three or six months might not be the best judge of how to make adjustments was a nice way of saying that. I think the most important thing that someone could have told me is that insulin to carb ratios, Basal rates, correction factors will change forever. I don't know if they change forever. But it changed a lot when you're young. And you're growing. Because I had this notion again, that they wouldn't change little things like Right, like, why would? Why would these things change, you could have been a more sedentary person and suddenly become more active, those things would change. You could gain weight or lose weight, those things would change, you could change the way you eat from more complex meals, like Jenny just described, to plant based or, you know, correct, whatever these things would all change how much insulin you're using. These are not. These are not like set in stone numbers that no matter what happens forever and ever are going to work. This person says My biggest help was just hearing on the podcast that I needed to be fluid that nothing was going to be absolute. A lot after I was diagnosed, I spent five and six hours a day researching how why? What can we do like just everything I didn't know what to do. And after my daughter got her Dexcom we would watch the numbers all day just and it burned them out. Yeah, this is flexibility coming from a different like we've been talking about flexibility about using insulin, but this person is talking about flexibility. Yeah, for life and to pace yourself. It was you know, I would say that took me some time as well. Because I was at one point not good at diabetes, then got much better at it. And then as my daughter started having impacts from hormones, it got hard again. And I had this expectation set in my head that I could keep her blood sugar under 140. No problem. And then all of a sudden, it started to go up more. And those higher numbers gave me made me stressed. Yeah, you know, and I had to say to myself, I'll figure it out. But while it while we're figuring it out, I can't torture myself the whole time. And so that is sort of flexibility with how I was thinking about the numbers, you know,

right hand because people get a CGM. Many people not everybody, but many people get a CGM very quickly after diagnosis. Now. So you have you have this scale of information to be able to watch. And I think, you know, in this person's case, obviously, it was the watch from a well, I don't know what any of the variables are going to do. So I just have to watch. All day long. I just I and maybe they were doing it initially from a standpoint of learning. But then you can get into this almost OCD habit of if I don't watch it, what if something happens when I don't see what's going on? Right?

Right? Yeah, for me, if you have a CGM, the the key to losing that feeling is to set reasonable alarms high and low. And do not think about that thing. If it's not beeping, just correct. Let's go Yeah,

absolutely. And that they meet those targets might get, you know, a little bit more narrow or narrower as you feel more confidence and more comfort and understand insulin a little bit better. Understand. I treated the low. It's good. I know that this amount works. I don't have to worry about it. You know, again, I can say that. I mean, I did so many finger sticks before I got my first CGM so many finger sticks today. Mine might have back They looked like a line of CGM over the course of the day. But I, you know, I was constantly setting an alarm. Oftentimes, I didn't even have to wait for the alarm to go off for an overnight like fingerstick. Because I, I did worry about overnight lows. Yeah. And without a CGM, I had no way to know other than what my blood sugar was at bedtime. And then what it was at like two o'clock in the morning, which when I was on injections with a Basal insulin was my time to go low. And once I was on a pump, and then I started on a CGM, not too long after I had my pump, it became very, like, visible to me that I didn't have to have that alarm anymore. Okay, again, with the alerts and everything that I set well in my CGM, I stopped setting an alarm. I was like, if my blood sugar goes above or below, like you said, I will get alerted. And if I don't get alerted, I can just sleep. It's great.

I think it's a great way to just alleviate that stress. It's just I mean, our hours are very tight, I think 70 and 120. But when it's not beeping, we're staying between 70 and 120. And there's no reason to think about it. And they're so tight that if she gets the 120 and she's rising, it's not difficult to come back around and fix it. It's not like you can't, you can set it like, you know, 70 and 300. And go I don't know, I don't have to worry about this thing's not making noise. But yeah, flexibility around diabetes. I mean, listen, flexibility around everything is really important. But around diabetes, it's going to, it's going to help you. I mean, you just heard it a number of different ways, not just dosing, but I think psychologically, too. Absolutely. Cool. All right. Well, Jenny, thanks so much for doing

absolutely always fun.

Thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in pen today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app it helps the show and honestly it's easier for you. The episodes come right to your phone, and the phone is right with you constantly. Mine's right here. See, I just picked it up. Everyone always has their phone. So let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there of course, right in your podcast player, just go to all episodes and you scroll around and you can find them or search and find them by searching for something like diabetes, pro tip or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're going to find a Facebook group, with 27,000 members in it, people just like you were sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series, but all of the series that exists within the podcast and there are many. There's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes Pro Tip series. You don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. 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 751 of the Juicebox Podcast. Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about sending your type ones to school. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com You can check her out and higher if you like, and to 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're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them this episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. This episode of the podcast is also sponsored by in pen from Medtronic diabetes, get yourself the insulin pen that gives you much of the functionality of an insulin pump in pen today.com. Jennifer, we're back. Yay. We're gonna do for the bowl beginning series today. Just the very simple headline here school. Now I was surprised. And then I thought about a little bit. There weren't a ton of questions about school. And then I thought oh, maybe that's because they didn't know the questions they ask. So I started adding more stuff to the list because it hit me pretty quickly. Okay, all right. So what ends up happening, if you hear most people's stories, they're diagnosed and school starts a week from now, it's always it's always that story, right? Like you don't get the whole summer to figure it out or something. It's like,

it's over a break. Often, right? It's like somebody comes home for like Thanksgiving break or like the the winter holiday or something. And parents, especially for kids who have just gone to college, their parents are like, you don't look, do you feel okay? You know, and, and there's a new diagnosis. And now you get to go back to school two weeks later, let's figure it all.

Anecdotally, I've always believed for like, a long time before I'm started making this podcast, just hearing people's stories and writing about diabetes, that people's lives are very like frenetic. And then when you hit a holiday or a vacation, or a long weekend, even you slow down enough to look up and go, there's something wrong with that kid. You know what I mean? Right? So

right, well, and I think when kids go away, you also you miss the everyday visual that you usually have of them. So then when they do come back, and they look very different. I mean, not just like hair color, or how they're dressing now, there's a very visual, physical difference. And you can say, you didn't look like this. When I sent you to school in September.

It's the same problem I have is when I'm walking through the house, I'm like, no one's gonna notice I've lost five pounds. So you just go up somebody's like, do you see it? Do you see the five and they're like, You look exactly the same. Thanks a lot.

So take a beach vacation and then come back. And they'd be like, See, I do look different.

So you know, just people say, Well, how do we transition? Back to school? Two big question. People want to understand about 504 plans, which I think are I always thought were widely understood. But then I I just realized I only know about them because of Hardin. And so we'll start but we'll start here. This person said it was crazy to me that after diagnosis, I was teaching my daughter's teacher about her care when it was so new to myself, and I didn't really know what I was doing. So I felt like I needed support and resources about transitioning. And she just said she said the schools can't really do much and they don't know anything. I either. And I will say from my own personal experience, the schools would try to how do i mean this? Sometimes principals are politicians, and it's their job to go, everything's fine, you're going to be fine. Your kid is going to be fine. Leave your kid with us. But they're not used to dealing with diabetes. It's always like, like, my, my daughter had a principal one time I swear to you, if you showed up at the front door, and the building was on fire, and people were jumping out the windows, she would have said, Go home, everything's fine. We've done this before. Oh, okay. She's just glad handing you right into, right into hell, you know, so, but when it's diabetes, specifically, what I find they like to say is, uh, we had a kid here last year with diabetes, or there's cars where there's two kids here. And it, it struck me finally, I don't know, the management style of these two kids at the level of their health, like, you know,

absolutely. That's what I was gonna say. And it's a big one that a lot of when parents asked me, How do we approach this? What do we do about it, and that's one of the first things is to make sure that you have structured the needs to your child, like you said, Many schools have had experience or the nurse has been there long enough that they've had at least one student probably with, with type one diabetes. Again, the school might have a couple, but your child's plan is your child's plan, just because this other child doesn't seem to need accommodation or assistance with things. Their management style is very likely different than what you're doing with your child. And so they're very well we'll need to be some instruction and schools differ school to school system to system private versus public what they have in terms of resources, and allowances, some nurses travel between schools, and they're not always there. So it means establishing somebody that is always at the child's school, for the really young kids who may need somebody to check in with, versus the nurse that's always there. There are so many things that I've heard and seen that I mean, there are 1000s of ways that people address the needs. Yeah.

And it does really begin with the scenario you're in. I mean, you just said it. But it's, you could be in a school where there's literally no nurse, and right, they're telling you like I don't know if you've ever met Mrs. You know, Smith, she works at the front desk, she's lovely. She'd be happy to give your kids a shot before from you're like, Okay, who she was, she answers the phone. And, you know, and she might end up being a godsend to you like, I have no idea. And but you have to you can't run in there and have all these expectations, and they don't have the infrastructure to handle it. Correct. Right. And you can't just force them. What I've learned dealing with schools, is that they're just people at work. Like you want to think of them as special somehow, because they're a teacher and etc. But they're people, they're at their job. They're not look, I mean, imagine if someone came to your job, Jenny, and they were like, Hey, we saw the things you do every day. That's great. Here's what else I'd like you to do. Right? This is Billy, don't let him die. You're like, Wait, hold on. I don't want that to be my responsibility. And that's what I would run into all the time. I had trouble finding people to be glucagon delegates, because they were like, wait, I'm like, Listen, if this should happen, if Arden has a seizure, you stick this thing in her butt and push the plunger, and you're going to say that's it. Yeah. And you're gonna save, you're gonna wait for 911 and hope and try to keep it from hitting your head on something like, You know what I mean? Like, nothing different than you would do if a kid needed an epi pen? Or? Oh, no, no, I don't want to be involved. The our school nurse had to search the school to find a handful of people who were willing to do what do it. Yeah. And I think,

oh, sorry, go ahead.

I didn't blame them.

Right? Not at all. And, and you do. I think there are two definite, like mindsets that you have to have when you're coming up with a plan for your child one, a teacher is first a teacher, that is what they are, therefore, they have all of the other students as well. That doesn't mean that the needs of your child are not important. But you do have to understand that there's there's teaching that needs to happen. There's a purpose for going to school. So then establishing people that can be the check in person. Many times I've found that it's it's a little bit easier when schools have or your child's classroom has a designated like Teacher's Assistant. That's always there. The teacher has the instruction but has the chance to keep teaching where the TA is kind of there to help and assist behind and maybe more the one that you end up teaching more to because they've got a little bit more ability To help, right. But again, each school I think the biggest thing to go to first is whoever the head of the administration is, whether it's the principal or whatnot, what are your accommodations? Have you experienced this before? What What have you seen as protocols, this is what we like for our child. This is what we do. This is how we navigate and manage and have a plan or an idea already. And again, newly diagnosed, you may not know where to start. And that's where the community is very beneficial. And I've seen many, many plans posted, we've done this for our child, or we have these instructional like, you know, decision matrix that if this, then this, and it's very cut and dry and very easy to follow. Some teachers and people in the school are very willing to follow the CGM data, others don't want to do anything other than just respond to an alert message. So again, everything is very different. You kind of have to see what the school can accommodate. Yeah,

we had a wonderful woman who was like, I have diabetes, I can help. And then we're talking to her and she had type two. And you know, she had never taken insulin before. And she was on Metformin, or something like that. And I was like, Oh, sure. Your skills are not going to translate here. But thank you very much. But we still, you know, she was willing to listen, and so there and learn people, and those are the people we taught, and I think that expectations are important. But it's always the seasol to me, you know, it's like, Well, I think my kids should have stable blood sugars at school. And then your school might say, Look, we're not comfortable bumping 150 blood sugar for your kid, like we're not going to do well, we'll treat over whatever the the orders from the doctor say. And that's, that's where I'll tell you, there's a simple sentence that you can put in your order from your doctors, if you can get your doctors to write this. Like, I don't you'll learn it any way you will. But basically, what it says is, these are the rules, unless the parents say otherwise. And then we and then we defer to the parents, and that way you can make to help make decisions. Yes, but you still might run into a nurse or somebody at the school is like, look, there's five kids that have diabetes, the school, we don't do this for any of them. And somehow they think that's a rule, then, you know, and so the way I always think about it is this. School is a long process, you're going to be in the same building. For a number of years, you might move to another building for a number of years, it's still the same system. These people work with each other, they know each other. You have to find a way to get what you want. Without being a pariah. You can't be the person that when you walk in the front door, they look up and they go oh, God, it's Jenny, you.

Oh, right. Oh, yeah. Absolutely.

With this Johnny, with a

fake smile on your face, and like, Hi, how are you today? In the back of your mind, you're like, oh, no, hate

me. Because I because I'm in here going, like, you know, I need you to correct a 120 blood sugar because I don't want my kids blood sugar to be that high. Right? I think that in the end. To break it down. You need, you need to have a plan that you can teach to someone else. Correct. If you're newly diagnosed, I think you need to explain to them, listen, we're just figuring this out. This whole thing is going to be kind of malleable for a little while. I'd appreciate it. If you could roll with this a little bit. I'm also figuring it out. I think you have to understand I don't want to say this. I don't mean this poorly. But I don't imagine that there are many nurses who are one minute at the premier children's hospital in the country working in the PICU that wake up one morning and go you know, I think I want to be a nurse at a middle school in my town. Like, these might be people towards the end of their career. Their training might be older, who knows what what the situation is right? But they're probably not Doctor House is what I'm getting at? Probably not Yeah, it's so they might have ideas in their head that are from a kid they helped three years ago, years ago, five years ago, 20 years ago, you have no idea. So you're, you're educating yourself. You're educating them along with them. But what I ended up figuring out, and then we'll go to some people's questions. I know I've said this in different places on the podcast, but it belongs here in this episode. For kindergarten, first second grade, Arden went to the nurse on a schedule. There was no there's no CGM at that point. So she was she was just going to nursing finger sticks shooting we had her like broke. I basically broke up the day in a way that I thought it seems unreasonable that she'll be she'll get low in my gaps of time, and I look back she never did get low. Oh, of course Ray once he was like eight, so her blood sugar's were pretty elevated to begin with today's episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes in pen is an insulin pen that offers some of the functionality that you've come to expect from an insulin pump. I know you're thinking, Oh, Scott, please tell me more. Well, I will. Yes, the pen is a pen. But it also has an application that lives on your smart device. This app shows you your current glucose levels, meal history, dose history, and activity log glucose history, active insulin remaining a dosing calculator, and reports that you and your physician can use. While you're trying to decide what your next step is. Well, well, well, it's not just an insulin pen, now is in pen today.com. That's where you're gonna find out more information and get started. If you're ready to try the pen, just fill out the form at him pen today.com. Or do some more reading. There's actually some videos you could check out too, about the dosing calculator, the dose reminders, card counting support, and the digital logbook. So if you want to lighten your diabetes management load, but you're not ready for an insulin pump, in pen is probably right for you. In Penn today.com. In Penn also offers 24 hour Technical Support hands on product training, and online educational resources. And here's something else that you'll find it in Penn today.com. That is actually very exciting. Now this offer is for people with commercial insurance and terms and conditions do apply. But you may pay as little as $35 for the in pen. And that's because Medtronic diabetes does not want costs to be a roadblock to you getting the therapy you need within pen $35. How crazy is that? In pen today.com in Panama requires a prescription and settings from your health care provider, you must use proper settings and follow the instructions as directed, where you could experience high or low glucose levels. For more safety information where to get started today, you can go to in pen today.com.

But you started I think what you're saying here is that even a couple years in, you were really going off of not only technology that you had, but also a baseline that you could teach. That worked easily because it was a structured schedule. And for the newly diagnosed going into a school type setting, I think that's the best that you can really start with is these are the basics that need to be done to keep my child safe. And to allow learning because that's obviously the reason you're sending your kid there to is is to learn. Yeah, and if they're getting interrupted all the time, because of of alerts and alarms and things that are too aggressive for this point in diagnosis. It's not helping anybody

well, and and what ended up happening was I basically spent the time from an origin was to till she was five, figuring out an ebb and flow to the day where she wouldn't get low. And then I sent her to kindergarten with that. The school was resistant about some of the things I wanted. And they didn't help her with a couple of things I'll bring up in a second. It happened, we had it set up where she tested, tested, tested, then at lunchtime or snack time even she'd go to the nurse's office, they would test her call me Tell me the number. And I would tell them how much insulin to use. And then they would send her back on her way. And she'd come back and test again. And this would happen before it would happen before snack recess at lunch where she'd get tested. And one day, my timer went off for for recess, and no one called me. So we did a couple of minutes. And I waited a couple more. And I have to tell you, I mean looking back on it. It was I was in like abject horror at that point. It just like we haven't total panic mode is going on, you know, is she is she having a problem? And they're helping her is like, I don't know. So finally I just call the school and I was like, Hey, Scott, you didn't call me about Arden. And the woman. The nurse said, Oh my god, Arden and she slammed down the phone and she was gone. And I was like, and you're like okay, what uh, what is that mean? So I sat there for a second and I thought, well, now she knows I know. And she knows she seems to know something to our way. Right? And she calls back and she goes Hi Arden's with me. She's fine. And I'm like, okay, And then they test her. So a little boy came in with a heart issue and had to be put on a monitor. And they just forgot Arden. And Arden went right from school. And because the nurse didn't come together, she was in kindergarten, she went right out on the playground. So they chant, they plucked Arden with a 50 blood sugar off the top of the monkey bars, and brought her inside. And I then went to the school and said, Look, this is what I was telling you about. Like, we can't just hope that the nice person in the nurse's office remembers to save our son's life every day at 1015. Like, you know, like, we need to and then they were more willing to listen to the ideas that I had. Right. When Arden left second grade, maybe one of the luckiest things that ever happened to her was that her teacher and teachers will know this phrase, I don't know what it is, but her teacher wanted to move from second grade to third grade with the kids. Okay, so she did that. She taught the kids in second grade, went to third grade and taught the same group of kids.

That's a nice school that does that was very cool. And a frequent thing. By

the way, that person that teacher was that Arden's graduation, like she showed up at her high school graduation and went around and found every one of those kids and took a picture with them. It was very, very nice. But what ended up happening for Arden was, we had we had fresh eyes that also knew the past. And Arden was struggling in math. So the woman calls me one day. And she says, I know why are you struggling with math.

And I said, why she where she is with her blood sugar at that time of day

when we sent her to the nurse. So the math instructor would start five minutes into it every day, Arden would get up and quietly leave the room and go to the nurse's office, come back five, seven minutes later missed the instruction, and then put her head down and try to do the work. Yeah, no one ever noticed. It just it just because it was such a part of the day. And it took her a couple of years to rebound and catch up from that because they were still moving forward. She had to learn the back stuff. And it was that moment. I was like, Okay, we're done. And that's if you go to episode for the podcast, I talked about how I figured out how to text diabetes. And Martin has never been to the nurse's office since that that moment. So the last day of like the last day of second grade. Because she contacted us over the summer and told me that.

And that's something to navigate to, you know, because some school systems again, with these plans, you really have to think about how they're written. Because if they're not written specific to what you have worked out and is safe with your child to do texting, diabetes, not having to go to the nurse, the nurse is there in case of need or somebody else. But otherwise, it's just navigated between you and your child. I would say that that's, that's less common. And it's it's kind of a special school or a special written plan that really worked out that way. I've seen much more the, the child has to check in with somebody. And even if your child is very able to do majority of what they're doing on their own, because they do it in the summer, on their own or on weekends or whatever. You have to kind of almost prove that they can do that. Before they'll let you not check in with someone. Yeah,

no, I mean, I very specifically on my end, I don't I didn't you know, I was a stay at home parent. So I wasn't at a job. But I could make that part of my day. I mean, if right. I don't know how it would work for other people. But it it definitely. It definitely freed her up to move around the building better. It actually helped us fix problems more quickly, right? Like she didn't have to go to the nurse to find out that she was low and get something like we would do it in the rain. It's how she started bolusing like she would Bolus in class before going to lunch stuff like that. It's not going to work for everybody, for sure. But it was the way I found to get around this stuff that just kept coming up, you know? Yep.

And that's it. I mean, that's important. Absolutely. I've even seen many comments from parents who have problems with any accommodation at all. My my teachers won't do that. They don't have time to do that. Your child isn't special. They don't need this kind of accommodation. I mean, I've seen the total opposite in terms of assistance, which obviously is not what you want to walk into.

Why what I would do is every year in the summertime, I'd go and meet with Ardens teacher, and I would explain diabetes to them. Because they're not going to know right? And so you say things like you don't want their blood sugar to get low. They don't know what that means. Yeah, like a great like, why? Because when I'm 60 I don't feel well and when I'm 50 I'm dizzy but do they know like your brain will shut off when you're 20 like I don't know what they know and you will also want to be able to tell them listen And this is a real concern. And we need to guard against this. Having said that, I don't imagine it's going to happen. But then again, correct, yeah, a light doesn't go off on your forehead before you're going to your blood sugar goes to 35. Like, it's just no, nobody tells you ahead of time, you know,

well, and one thing that does hit from a teacher level, obviously, that's their job is to instruct, right? One thing that really sort of comes across in terms of the importance of glucose. And what their job is supposed to be is giving some baseline information about blood sugar level, and learning ability. blood sugars here and here outside of this range, are going to mean that my child may be fidgety may not be paying attention may be causing problems, when it's not, it's not what they want to be doing. It's because their blood sugar isn't right. Thus, my kid isn't going to be learning what you're trying to teach them, it's going to be disruptive. So if you help us to keep their blood sugar in this range, you can continue instructing better, my child will keep learning better. And it's a win win. Right? That's a point that often makes sense from the teacher angle is the association between learning ability, attention ability, and glucose levels.

And I, I shone a light on security and, and health and I told them about long term health too. I said, Yes, we because they're like, Well, why don't we just leave our blood sugar higher? And I said, because, you know, there's, there's damage that comes from that, to that it's more long term. I think the way I put it in one meeting one time is I said, Listen, if you want to keep Arden's blood sugar at 200, all day, why don't I just pull her out of school, send her to an island and let her live her life? You know, it's like, because at least she'll be healthy. Like, maybe she won't have an education, she won't know how to, like,

work or help herself or know how to pick coconuts. But she'll be

alive. And you know, like that. I'm like, That's not okay, either. And they're like, Well, I don't understand why this kid. We don't we don't help this kid until their blood sugar gets to 200. I was like, well, that's their decision, like, No, it's not okay. And you're right, you have to, you kind of have to be both sides of the conversation, you need to get what you need, without upsetting anyone. And you have to be helping them. It's in negotiation, that you're the only one who cares how it goes. I don't know if that makes sense or not. Right. So you almost have to defend the person who you're negotiating with the same time I used to put, every year I would find something in Arden's 504 plan that we didn't need any more. And I would give it away at the 504 meeting to make them feel better. I'd be like, no need to do this anymore. Like you know, you're doing this, you don't need to let's make this easier for you and get rid of this. And then that we'd leave the room and they'd be like, Oh, good. I got. And, and, and meanwhile, you were never really adding things to 504 plans, you were kind of just manipulating them to make them work for the age range, like all the sudden, like standardized tests, or the technology

that you now have. Right, right, right, God, yeah. I mean, as that changes there, and especially with the technology that's changing the way that it is right now, with all of the FDA approved products, there is less attention that a teacher or a nurse may need to give, it doesn't mean that they don't need to know how to help in the case that it comes up. But this technology can certainly be something to educate them. While their system is going to do this, it should be catching these kinds of things, they still need to touch base, or they still need to check in with you about this. So again, those might be the touch points, kind of like you're saying that you don't have to really do as much. They got something here helping but we still need this in this in this.

In the end, you can set up a 504 plan, which is going to give you some legal backing, like once it's in the 504 plan, they have to do it. But there are you do need to understand private schools don't need to accept kids no matter what. Right.

That? That's an interesting question. I mean, private schools typically have different rules than public schools. And if they don't have accommodations, it often falls to the parent to find the accommodation so that their child can stay in that private environment.

And preschools fall into that heading to Yes, it's might be hard difficult to find a preschool who's willing to do this for you. Right? Yeah. Yeah, it is very interesting. Okay. So some of the things that I've run into no matter what you're gonna Get your kids schedule, and they're gonna have gym right before or after lunch or lunch and you're gonna be like,

a lot of fun, I've got a couple little kids who got, they've got recess, then they've got snack time. And then they go to gym class. That's fine, yay,

write it off, and then pour it in, then put insolate in, and then have him run some more. Yes,

that's fun. And it's not every day. So you can't even accommodate like an everyday like, pattern or something. It's like Tuesdays and Friday. And this is what

I know, I actually did have in one of Ardennes accommodations that they couldn't put activity right next to lunch. But it took me a couple of years to get them to agree to that. And so and it was hard. I mean, it was hard to get them to do that, to be perfectly honest, that was every year,

because it's a manipulation of what the schedule is going to look like for everybody, then it doesn't just affect her, every kid in her class is going to also not be able to have

or you have to put a class where she doesn't belong to make it work, etc. And in the end, I never made them do anything. We always did come to an agreement along the way, because I was never looking to be like I I mean, I don't know if I was or not. But I was trying very hard not to be like, Oh God, here he comes, you know, like, I don't want to talk to that guy hide. When Arden went into high school, and the nurse said, I actually brought along the nursing staff. So I learned this in elementary, from elementary school to middle school, I brought the nursing staff from the elementary school to my first meeting with the nursing staff from the middle school, that's a great idea. Because I was like, I'm gonna say I do a bunch of stuff, it's gonna sound crazy to you. And this person right here knows how it works. And so that made the next person. So when I got to the high school, I did it. But the nurse was just like, well, that's not how I do it here. And she pushed back and she had like a big personality. And she goes, I like having a relationship with all my type one students. And I said, Well, that sounds lovely. But in my world, I would love it if my daughter didn't know you. Right? That's what we're shooting for. Okay? Just like every other kid in the school does not want to end up in the nurse's office. I don't, I'm sure you're wonderful. I bet you make it fun for the type ones. But that's not our goal here. So she pushed, she pushed back and pushed back and I was like, listen, it's not what we're doing. Like, it's not gonna happen, like, we're gonna bring some supplies. And if something gets completely upside down, or Arden has to swap a pump or something like that, you'll see her, right. And that's how it ended up going. And she was okay with that after a while, you know, but it took way to talk about it. They had to they had to wait and take time. Nobody ever yelled at each other. That's the other thing. If you're yelling, it's over. Like don't don't lose your don't lose yourself there. I think. You know, as we're talking about this, I wonder if I couldn't create a place online where people can upload their 504

plans. That would be I think, a really great resource. I mean, kind of like, kind of like you have a place online for people to look for good endos, or good doctors or good educators? That would be a really great resource.

Yeah, I wonder if we couldn't just turn them into PDFs and put them so people could look at them can look at them. Because

you I would even say maybe categorize them, like, toddler age, like almost preschool, you know, grade school, middle school, high school, so that as you filter through them, you can go age appropriate. Yeah. For what your accommodation might look like, or how it might change. Like you said, you took your nurse along to prove to the next entry level of kind of school age, this is what work this is what we did, it is just fine. You know, please accommodate.

I'm thinking that because like I'm looking at a question here, like, what do I do if my kid wants to skip lunch at school? Like, I don't know how to answer that question. Like, yeah, I mean, I do. But it's, it's not something you're going to put in a 504 plan or something like that in so there's going to be more, there's going to be more scenarios that are really going to be on you to kind of like dance with then just hoping that there'll be in this document and that fixes everything.

Right? The document really should be very specific needs, right? Not what ifs. In right in what if my kid doesn't want his snack in the morning or doesn't want the snack that was packed and prefers the cupcake that came in as the birthday treat? Yeah, what if what?

Yeah, no, the 504 plan can't incorporate everything that your anxiety might put into your head on from day to day like it's like Ardens was stuff like Arden has a bag with her. It'll have these things in it. If there is an emergency in the school, you need to make sure that bag goes with Arden and that was when she was younger. Right? And then as she got older, the language changed slightly to like you can't restrict Arden from taking the bag, you know, once it was on her to remember the bag, right? You know if Arden's load, do this, then do this then call 911, after you've done that call the parents or we had stuff like you have to get the school bus driver trained to understand basic, like stuff like that. Yeah, it wasn't like if Arden decides at 3pm that she wants to x, then you have to, like you can't. I know, that's what people want. But this documents not going to be. It's not everything, you know, it's just it's, it's the stuff.

And if anything, that kind of detail may make it very confusing as to the very, very real and important things that really should be being done every single day. The same way.

Yeah, right. But little things like as Arden got older, she would write her blood sugar on the top of a test before she started taking it. So she'd look at her CGM and write her blood sugar on the top. And that way, if the test came back, crazy, wonky, different than you expect her skills to be, we could say, hey, look, her blood sugar was high, maybe you could let her take it again. Right we've ever

done with a CGM, you could have followed what happened to the blood sugar, you know, maybe blood sugar started out fine at 101. But then in test taking, she's not really paying attention. And it really starts to dip there too. You can follow that information to be able to go back and say, you know, could we potentially do you do this?

It's funny. So if I, if I started this episode over and decided to make it two minutes long, I would say you're in a relationship with these people. Now. It needs to be harmonious. There might be times where you have to bite your tongue. You don't want to get into a fight with anybody. It's a long process. You might be with them for 12 years. And there are going to be times they're gonna say things that you're like, that's not right. But you got to understand their perspective, too. And make it work. Yeah, it's like being married. Except I'm just gonna say without the sex. But you know, if you've been married, I've been married.

Yeah, there's give and take. Yes, exactly.

You give a lot and somebody takes a lot. If you're lucky, your kid gets his lunch on time. Okay, all right, Jenny. Well, thank you very much, of course. A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com. In a few moments, I'll tell you a lot about the show. But one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. I'll be telling you about it in just a second. If you're into helping people, especially people with type one diabetes, I'd like to ask you have to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody, all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org Ford slash juicebox. Join the registry, complete the survey, help someone with type one diabetes, help yourself perhaps, and support the Juicebox Podcast, you will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple. You'll know all the answers to all the questions. It is also HIPAA compliant and completely anonymous. T one D exchange.org. Ford slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com. To all of the sponsors. And to T one D exchange. When you take the time to click on my links or to type them in a browser. You're telling the sponsors that you came from the Juicebox Podcast and that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. The group has over 28,000 members and those members are responsible for between 70 and 110 new posts every day on the Facebook page. Every conceivable count conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit if you're looking for the diabetes Pro Tip series, or the defining diabetes series are any of the other multitude of series that exists within the podcast. You can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes protip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the potter Dexcom are supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. 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 755 of the Juicebox Podcast. Jenny Smith and I are back today with another episode of the bull beginning series and today Jenny and I are gonna talk about exercise. While you're listening today, don't forget two things. One, Jenny works at integrated diabetes.com. You can check her out and hire if you like, and to 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're a US resident who has type one diabetes, or is the caregiver of someone with type one, in fewer than 10 minutes, you could go to T one D exchange.org. Forward slash juice box and fill out their survey. When you complete the survey. You've helped the podcast, you've helped people living with type one diabetes, and you may just have helped yourself T one D exchange.org. Forward slash juicebox. Hope you're enjoying the bowl beginning series. It's not done yet, there's more coming. If you've missed the earlier episodes, you don't even have to listen to them in order if you don't want to just go find them. This episode of The Juicebox Podcast is sponsored by touched by type one, please go learn about my favorite diabetes organization at touched by type one.org and find them on Facebook and Instagram while you're at it. Today's episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes in pen is an insulin pen that offers some of the functionality that you've come to expect from an insulin pump. I know you're thinking, Oh, Scott, please tell me more. Well, I will. Yes, the pen is a pen. But it also has an application that lives on your smart device. This app shows you your current glucose levels, meal history, dose history and activity log glucose history, active insulin remaining a dosing calculator and reports that you and your physician can use while you're trying to decide what your next step is. Well, well well, it's not just an insulin pen, now is in Penn today.com. That's where you're going to find out more information and get started. If you're ready to try the M pen, just fill out the form at M pen today.com or do some more reading. There's actually some videos you could check out too about the dosing calculator, the dose reminders, carb counting support, and the digital logbook. So if you want to lighten your diabetes management load, but you're not ready for an insulin pump in Penn is probably right for you in Penn today.com. In Penn also offers 24 hour Technical Support hands on product training and online educational resources. And here's something else that you'll find it in Penn today.com It is actually very exciting. Now this offer is for people with commercial insurance in terms and conditions do apply. But you may pay as little as $35 for the pen. And that's because Medtronic diabetes does not want cost to be a roadblock to you getting the therapy you need within pen $35 How crazy is that? In pen today.com in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you can experience high or low glucose levels. For more safety information where to get started today, you can go to in Penn today.com What's next, Jenny? Hey, we're back with the ball beginnings series. And we're going to talk about something today. That's going to happen to everybody I hope exercise, but we're not gonna dig super deep into it. We just want to make sure that newly diagnosed people understand the impacts.

Right? Absolutely. They think it's a neglected topic. At that initial like diagnosis and the overwhelmingness of everything that you're trying to learn about. Exercise is like way, way at the bottom and what to expect to try to learn right and also,

I also think that when people think of exercise, they think of at 11 o'clock I'm gonna go to the gym and I'm gonna run on the treadmill and I'm gonna lift these things then I'm going to do this I'm gonna go back but exercise could be cleaning the house or cutting your lawn or your kid going to a store. Yeah, walking around it whatever. Do we say Walmart in the variable series? Yeah. So yeah, shopping, anything that takes your, your level of activity from where it kind of normally is to an elevated place because your settings for your insulin are usually set up for when you're sitting in school or at work or sleeping or whatever. And then, let's just explain. I'm going to ask you to do it. What happens when there's two kinds of exercise? Look at me, anaerobic, and your aerobic. What is

it and the other one? You're so funny. Oh, my goodness.

I made weightlifting like sign like movement.

Yeah. Anaerobic. Yes, like resistance and weight training. In which you're not increasing or not for long periods, increasing your heart rate, right. And then there's cardio kind of exercise or aerobic where you're using oxygen at an increased rate, right. And they both do something different to your blood sugar

or could Alright, so anaerobic like from my childhood, Lou Ferrigno, lifting weight. There you go, and aerobic. What's her name? married to the guy from CNN. Oh, yeah. Oh, my God, famous actress. Did that thing in Vietnam? People didn't want that. There you go. There you go. I knew how was it possible? I could, I could give you her entire litany of what she did throughout her life couldn't think of her name. That's ridiculous.

I actually am very, very proud. Because my husband is like the trivia man. He knows. Like, he knows. He can look at somebody be like, he did this. And he did this. And this is his name. And like the song that I I'm like, I know the song. I tell you all the words and the group is hmm, I don't know who the singer is.

I'm worried that I didn't go to Olivia Newton. John. I was just trying to think of like people who used to make VHS tapes of them working out in leotard. So you would work out in your living room. But but so the point is, is that you're there's two different kinds of exercises you might get involved in. And they have two different impacts. Is that correct? Yes. Okay. So aerobic exercise may make my blood sugar drop down. Yes. And weightlifting and resistance stuff could make my blood sugar go up? Correct. Okay.

In fact, the anaerobic or the weightlifting resistance. The heavier the load, the more that you're doing in that is more of an adrenaline kind of released, right? It's the more pumping kind of and so that can be the reason it's causing a rise in blood sugar. And the others, typically, aerobic, whether it's running or jumping on the trampoline, and a trampoline and the past couple of years. I've heard more comments about trampoline, blood sugar than any other sport for kids.

I think they cuz I think it's the, it's kind of what I was bringing up at the beginning. Like your kid is like eight. And they're like running, you know, sitting down watching TV, and then all of a sudden, they look up like a puppy that saw something, jump on the trampoline now. And then they run outside and do that. And you're like, Wait, stop.

We just hit they're all shiny dangly objects. That's what it is. They're they're here, you they look content. And then they're like, Oh, look at all it is. It's like a puppy. It's like it, there's a squirrel over there. So there's

these two situations, you might fall in one, you know that soccer practice is at six o'clock. And you can prepare for it in one way and to have your kids start chasing each other around the house and run up and down the stairs 75 times 45 minutes after they ate with a bunch of active insulin inside and your blood sugar tax. Right, right. So no one tells you about that when you're diagnosed with diabetes.

No, not at all. And if you are, again, in the kid category, or even the teen category, and teens are very much in that sedentary might move up, somebody comes over. It's the same really. And so you have to consider those really, like quick spurts of activity could be lengthy. They could be 10 minutes and your kid is done. And they're like, I want to sit down and read a book again. Right? So paying attention in those times, can give you like future vision then to what to maybe do. But it's it's all learning. Really. It's it's paying attention. It's not going to be perfect. Don't expect it to be perfect. Know that you have the tools to manage and some idea that if something's planned, you can try to accommodate and see how it works out. If something's unplanned, one of the best things is just making sure you got some carbs to manage. Because that's all you can do to fix it.

Yeah, I. So kind of the way I think about it is, you ever see those beach houses up on the stilts? Okay? Those people said, I know that one day water is going to come rushing in here. And I'm gonna put my house up where the water can't get to it. And I think it's water. But I don't understand how to say. So that's fine. It's pre planning, right? Yes, somebody else built their house in the ground, the water comes rushing into the house goes back out into the ocean. They're like, I don't know what happened. What happened? You didn't plan very well. So the way I see all this is not that Arden doesn't have fluctuations around exercise if she's not prepared for it. But rock solid settings, and rock solid understanding of how to Bolus for meals so that you don't end up with a lot of insulin. In the body. It's not accounted for correctly for need. So if if Arden does not prepare to like, go downstairs and get on the treadmill and run she will get low? Absolutely, absolutely. Well to Yeah, but she'll get low like 66. And then she'll need something and it'll bring her blood sugar back up. She doesn't go from like 95 to 20. Like it's not like some crazy drop, because she won't go running when she's got meal insulin active, because she knows better at this point. Right? Right, because that's going to make her blood sugar low. So I think most of activity is not having active insulin, or cutting your Basal, if you're on a pump in a way prior to the activity, where you kind of create one of those black holes so that the drop, can't drop, because there's nothing there to pull it down, because we call it a drop. But it's not really a blood sugar drop in this scenario. It's a poll. But that doesn't make any sense, right? Well, I

think what I've seen in a timeframe, which might make sense for again, more newly diagnosed is the common time period when you haven't accommodated before more spontaneous exercise. Whether it's insulin or extra food, or however you're going to do it, if you haven't accommodated 15 to 20 minutes into movement, that aerobic is a drop zone, and again, not dropped, like over a cliff, it's you might have been floating along pretty stable. And it's definitely going to start nudging down, right. Yeah. So that's a timeframe at least that may give a little bit of reference to people who are new to trying to figure out what to watch for,

right. And I think if you find yourself in a scenario where blood sugars are dropping and rising, and you don't understand why you're going to be more susceptible to a problem during exercise as well, right? It just really did strike me as I just said that. Calling a blood sugar drop a drop makes it feel surprising, the word usage makes it feel like it's unknowable, it just happened, it just dropped out of nowhere, like those are the phrases people use. But that's not really the case. In most situations, it's you have some active insulin, it's, it's taking sugar out of your blood, your blood sugar number is falling because of that, then suddenly you start exercising. And there it is. I mean, I would think that if you made me just give one piece of advice, I'd say do not exercise, aerobic ly with active insulin on board.

And if you do know how much carb you may need to cover, the active insulin that's there with, again, spontaneous activity and whatnot in kids is pretty much the whole day, I would say to what you can play on in schools and that kind of thing. But if it's spontaneous, and you've got active insulin, because you didn't plan to go out and jump on the trampoline with four friends after lunch, you got this insulin, it's going to need some additional food beyond what it was given to cover. Yeah, because the exercise is mobilizing that insulin faster

and not just in a situation where you unexpectedly find yourself doing something but what happens when you eat dinner and then go to baseball practice. Right, right. Like that's what here's a plan. Yeah, there you go. You can also you have to sort of understand Jenny mentioned adrenaline a little while ago. Baseball is a good example. Because it's not a ton of running around for the most part, right? But people will say how come my kids blood sugar gets high in a baseball game, but not at a baseball practice. And it could just be because there's no competition at the practice. They don't feel a sense of competition. So there's no adrenaline rise. These things take time to figure out honestly do but I and I'm not just self promoting here. But if you listen to the Pro Tip series, that should teach you how to keep things more stable. And then you should have an easier time being able to see what's going on in these situations so that you can adapt to them. Absolutely. Some stuff from people here, how do I adapt existing routines and lifestyles for diabetes, like swimming, summer camping, hiking, that's what we're talking about. It might be what you're eating, you might eat something with more protein in it more fat in it to hold your blood sugar up longer. You may do Temp Basal decreases before activity to help that, again, all that's in those episodes. But I just think it's important for people who are newly diagnosed to understand that it's going to happen because people don't tell you that and no, then there you go. Right. So

and then it's scary. It becomes scary, because nobody told you to expect that this activity that your kid loves to do, but it's sporadic is going to do this versus this.

And you see this this feedback from the person said, My son was in baseball and swimming, when he was first diagnosed, the doctor flat out told me he would have to rethink the sports he was playing. And that crazy for things that would work around his diabetes. While we were learning how to manage the disease. I was led to believe he could not live a normal life with sports. Oh, but of course, he

could oh my gosh, I'm, I feel so bad that they were told that Yeah, that's really

terrible. It really is. Meanwhile, the tight end for the Ravens has type one diabetes, and you have type one diabetes, and you run for some reason I don't understand why. And it's so to a lot of other people right there professional has been professional baseball players on this podcast, who have type one, it is very doable. But you need to, you need to do the things you need to do that you you have to have your basil, right, you have to understand how to Bolus from meals, you have to understand the impacts of different foods. And now you have to add understanding how to keep active insulin away from certain activities. Or you if you become a bodybuilder, you might find yourself bolusing before you workout,

correct, absolutely anaerobic exercise, can for many people, not always, but it can depending on the length and the weight. And you know, all of that it can drive blood sugar's up again, when it's going to be based on on your response, it could be that you start out in a really great place. And by the end of your lifting session, you're riding high or you're kind of nudging up, essentially. But overall, you have to just pay attention to you. Some of the lifters that I've worked with have taken a Bolus at the beginning of lifting session to accommodate and avoid and avoid arise. Some of them have set a temporary basil to accommodate for that. Some of them end up doing a little bit of both anaerobic and aerobic exercise, knowing that their blood sugar is going to get driven up by weights, they end up allowing that drift to happen to a certain point, and then following it with aerobic exercise, which they know is going to navigate it down and tends to kind of smooth things a little bit more on the back end rather than a dramatic drop, like we often see with cardio. Yeah. So

you also have to, you know, when we talk about mixed meals, right, like it's easy to pick one food and Bolus four. But what do you do when you're having meatloaf and mashed potatoes and applesauce and these all have different impacts. Also, you could head out into the backyard to move a pile of rocks, which you would think well that's lifting except what if the pile of rocks is 45 feet from so now you're lifting and then you're walking, right and then you're lifting and you're walking, you're you're having two different impacts, you could end up doing something like that in the backyard for example, and it not looking on your blood sugar like anything happen, because you could be getting a pull down from the aerobic and a push up from the anaerobic and this all you know what I always say the podcast makes things seem simple, but Jesus. But it's very doable. And I think that's the important thing. But everything starts, in my opinion with understanding how insulin works, like with Absolutely. Well thank you very much. I appreciate course, always I'll talk to you soon. A huge thank you to Jenny Smith for being here with me again today. And I'd like to remind you that you can hire Jenny integrated diabetes.com. I'd also like to thank Ian pen from Medtronic diabetes. If you're looking for an insulin pen that does more, you're looking for the in pen in pen today.com In a few moments, I'll tell you a lot about the show, but one of the things I'll tell you is how to find the series. So if you've just stumbled upon this one, and you'd like to find the rest, there's a way to do that. And I'll be telling you about it in just a second. If you're into helping people, especially people with type one diabetes, I'd like to ask you to go to T one D exchange.org. Forward slash juicebox. When you get there, fill out the survey completely. And you've helped somebody, all you need to be is a US resident who has type one diabetes, or is the caregiver of someone with type one, t one D exchange.org. Ford slash juicebox. Join the registry, complete the survey, help someone with type one diabetes, help yourself perhaps, and support the Juicebox Podcast, you will do all of this in the fewer than 10 minutes that it will take to go to that link and complete the survey. The survey is very simple, you will know all the answers to all the questions. It is also HIPAA compliant, and completely anonymous, T one D exchange.org. Forward slash juicebox. There are links in the show notes of your podcast player and links at juicebox podcast.com. To all of the sponsors. And to T one day exchange, when you take the time to click on my links or to type them in a browser. You're telling the sponsors that you came from the Juicebox Podcast, and that is a wonderful way to support the show. Are you looking for a vibrant and intelligent community around diabetes? look no farther than the Facebook page, the private Facebook page for the Juicebox Podcast. It's called Juicebox Podcast type one diabetes. The group has over 28,000 members. And those members are responsible for between 70 and 110 new posts every day, on the Facebook page. Every conceivable conversation around diabetes is happening at Juicebox Podcast, type one diabetes on Facebook, you're gonna see great questions, thoughtful answers, and supportive people. No matter if you're an adult living with type one diabetes, or the caregiver of someone with type one, this group is for you. Doesn't matter if you eat low carb, or high carb or somewhere in between your questions and thoughts are welcome on our Facebook page. I hope you check it out. Last little bit if you're looking for the diabetes Pro Tip series, or the defining diabetes series or any of the other multitude of series that exists within the podcast, you can find them in a number of ways. They are at juicebox podcast.com. They are at diabetes pro tip.com. And if you belong to the private Facebook group, you can find them listed in the featured tab. Now if you're enjoying the podcast, please consider sharing it with someone else that helps the podcast grow more than anything word of mouth is definitely how the show has become what it is. If you have already shared it with everybody you can think of and you've bought it on the pod or index comm or supported one of the other sponsors. You've done the T one D exchange survey. And now you're looking for another way to give back to the podcast. Super simple. A five star rating and a thoughtful review in whichever audio app you listen in would be amazing. 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 759 of the Juicebox Podcast. Jenny Smith is back. And today we are doing another indie bold beginning series. Today's topic is interesting. There were a ton of questions that all revolved around guilt, fears, hope, and expectations. So Jenny, and I just sort of sat back and had a conversation about those ideas. We worked in the questions from you, the listeners, and we shared our own. I don't know remembrances of different things that we thought might help you get more comfortable with type one diabetes. I appreciate if you consider going to T one D exchange.org. Forward slash juicebox. And completing the survey. That's it. I won't give you a big thing you hear about it every day on the podcast he one D exchange.org. Forward slash juicebox. completing the survey will take fewer than 10 minutes. It'll help a bunch of people, including you, me and other people with type one T one D exchange.org. Forward slash juice box. And if you want to hire Jenny, she works at integrated diabetes.com. type that into your browser. Go find out about Jenny the Omni pod five automated insulin delivery system is here. And they're the sponsor of today's episode. If you'd like to learn more, or get started with Omni pod five, go to Omni pod.com Ford slash Juicebox. Podcast is also sponsored today by Ian pen from Medtronic diabetes. The in pen is an insulin pen that has much of the functionality of insulin pumps. To learn more and get started go to in pen today.com. Jenny, we're just going to do one big thing today. And that's it. Awesome. All right. So for the bold beginnings series, which by the way, I'm starting to see feedback about online, which is very exciting.

Yay, we're finally, hopefully it's yay, feedback.

Do you think if it was bad feedback, I would have brought it up while we were recording another?

Well, you know, you have to give honest feedback when other people would really like to hear a little more about this or didn't really agree with that, or what, uh, you know, honesty is

that made me laugh. I mean, I would have that conversation. I'm gonna be honest in front of people, I would have that conversation with you privately, privately. Giving feedback, and really no one likes this, I didn't realize that people are finding it useful in the way that he intended. So that's perfect. Very excited. So today, we're going to hit this one doesn't seem like fun at all. It's a Monday morning. But this one is, is titled guilt, fears, hope and expectations. And there are a lot of

questions are mostly like comment, oh, let's

dig right in and find out I'm sure it's full with honestly. So I think, you know, I don't even want to give my opinion yet. Like, let's just talk. So the first person said that they're that they experienced immediate grief around diagnosis. Just immediately, like, like a loss had happened. I've talked about this on the podcast before, I've tried to have therapists on to talk about how you manage grief. Because I don't know from a technical standpoint, but it's so strange, isn't it? We just talked about this before we were recording it. Yeah, we did. Yeah. I guess I'll say it here while we were recording. There is a reaction that you have when you get bad health news and bad health news that isn't going to get cured. You know, it's not like, well, you have the flu, just try not to die for six days, and you'll be okay. Again. That kind of stuff. There was

when I go back to being the tennis pro or whatever, you go, go go

back to your life, this is all going to be fine. But when I was diagnosed, I remember just thinking, Oh, well, we're not going to have the life I thought we were going to have right like like and then over time that you realize that diabetes isn't as difficult as you imagined it's going to be hopefully you get some things figured out. And that it's not. It's not. I don't know, for us at least it's not like somebody chained to art into a post and we couldn't get her off again. You know, we had to just live our life here in this little space. But it still is true that we're not living the life that like when Arden came out and we were like look, we have a baby like in our symbol. You know what I mean? We're holding the baby up and on the hill. This is not my fault was gonna happen. And so you I think that's the loss. I think, I don't know what you think, though, because you were diagnosed at a different time and a different age.

I was. And

I don't, I

don't know that I so much had a sense of loss as a sense of significant change. When I was diagnosed in, in the hospital, the nurse educator, was very quick to tell me, I could do mostly anything that I wanted to do. What she told me I couldn't do, she said was very limited. And boiled down to essentially being was something like a bus driver, a pilot, and I couldn't be in the military. She's like, so think of all the things that you really liked doing, and might want to do at this, you know, age that you're at, and realize that you can still do all of these things. And I was like, Well, I probably was never I was not thinking about being a pilot. I wasn't thinking about being a bus driver, or, you know, whatever. So I just felt like, okay, I guess I just have to do these additional things. So my personal sense wasn't so much of a, obviously, I didn't feel guilty. I mean, I didn't have anything to feel guilty about, I'd have to ask my mom, if she had any guilt, or my dad felt any they'd never voiced it if they if they did. But that guilt and sense of loss, I hear a lot of that in the families that I work with. And it it can stick around.

Yeah. So Yeah. For me, I was a stay at home dad at that point. And they, we pretty quickly, even though we didn't understand the link between coxsackievirus and maybe being diagnosed. And even at the moment, in the beginning, I didn't understand that Arden had, you know, markers that made her more likely to get type one, two, I didn't understand any of that at that time, right. But I did see, anecdotally she was sick, she had this Coxsackie virus, and now she has diabetes. And I beat myself up pretty hard about that. Because I kept thinking, like, Did I not wash your hands? Did I not wash my hands?

Did I expose her some way that could have been prevented? Kept thinking

I took her to the wrong place. Like, like, did I get in my car one day and drive to this place for lunch instead of that place for lunch. And that's why Arden got coxsackievirus. And now we're here at the hospital in Virginia, like, you know, and as it's crazy, because it's twofold. It's not something you can control. And it's obviously not something you have vision for that you could have not done. But yet there's that part of your brain that goes if you What is it instead of zagged maybe this didn't happen. And it's hard not to feel that it's almost like you're gonna have a car accident and think if I would have just left 30 seconds sooner this wouldn't have happened. Yes. You know, absolutely.

Yes. I've only ever had

one car accident in my life. I was coming home from from college and the the roads were clear. Except you know what black ice is? Right? Yes. So driving home. And instead of taking the highway highway, I took a road that cut some of my time off. And it was more of like, let's call it a country road, right? I mean, it was paved. It wasn't like weird back country or anything, right. But I had this little renewal Alliance. That was my very first car. The back tires hit this patch that I thought was snow because it was like lightly covered. And I dashed like across the other side of the street and across the ditch. I hit a mailbox and I ended up in somebody's backyard. Wow. So yes, I did. And at that point, I was like, Well, how could I just like, slow down when I saw that snowy patch in the road, knowing Wisconsin weather and whatever, but you can't go back just have to be like, Okay, now I'm more aware at this point, I realized

that you'll black ice out of context. When Kelly and I were very young, she would tell me all the time, be careful of black ice. And one day we were driving. And I just started to wiggle the steering wheel and I yell black ice and she and me and jokes are no wondering how we're together. How she didn't just like say like pull over and let me out now You idiot. I've done you know, it's funny. You were talking about the things that the doctor told you or the the educator told you you couldn't do and you're like, Well, no problem. I don't want to be these things. Anyway. Have you ever heard the lady that came on the show whose husband was a fighter pilot, I think and the person told her kid when the kid was diagnosed, don't worry, the only thing you can't do is fly a jet. And it's the only thing the kid wanted to do because that doesn't you know And of course, you know, I think even in that conversation, the woman's like that poor lady like she was like, so sure she was gonna reinforce to my kid that you can do anything. But there's this one simple thing you can't do,

you can't do. And that's exactly what it was. Yeah, they wanted to know, so.

So it takes me into these next couple of statements, people said, I really needed a lot of hope in the early days. And that is what people are trying to do. And they say, Don't worry, there's only three things you you know, etc, or you'll live a normal life. Just have to count your I think, I think, oddly, that so much of the poor management information that people get in the beginning stems from someone trying to be kind to them. Does that make sense? Because, like, Don't worry, your carbs and do it like they're trying to make it seem easy? Yes. Right. And maybe that's the maybe that's the only thing you can do in that spot? I don't know.

I know, I would agree is and especially boils down to the one comment that, I think is it's hard to understand, once you get further into understanding management is the food tide one, you can just you can eat anything, just take your insulin, right. And that is, it's a way to tell somebody, not much has to change. Look, you can keep doing everything that you have been doing. You have to just add these little extras in to the picture. And there's supposed to be a sense of relief, like thank goodness, I can keep, you know, eating whatever it was for lunch that I love to eat. But it doesn't take away from the feeling of the additional things that are really big additional things that we're teaching somebody they now have to do.

These next couple of statements. Kind of they kind of hinged together a little bit. This one person said they kept hoping the doctors were wrong. Like they sent them home. I hear that a lot from people. I only went through it for a day. And I know Arden had some sort of crazy honeymoon Day, which I look back now and think probably wasn't even a honeymoon. She just really just didn't need insulin. This one. Right, right. Like they were wrong. And I know they were wrong. I immediately was I called my friend who's her pediatrician. I was like, Hey, she hasn't needed insulin all day. I think they're wrong. And he was so sad. He was like, oh, Scott, like she has. She has type one. She's he's like this will change. Like, just keep watching. You know? Yeah. There's that. And there's this other part here. This person said that there was so much confusion in the doctor's office. And looking back the way she sees it is they weren't 1,000% Sure the kid had diabetes, but they were sure. And she said I just kept seeing the medical people looking at each other and nodding and kind of like talking to each other with their faces, but not saying anything out loud to me. She said she found it very scary. Like what is in that space?

And scary in terms of? Are they confused? Are they actually the right people that I should be talking to? I mean, really, you don't want a confused? Look, or these exchanges of eye movement, facial expression between what you're thinking is an educated professional to get an opinion or a diagnosis from you just want the direct information. Tell me what you think it is. What are you going to do to prove that it is or is not this? Just be honest,

it's super interesting that I'm going to tell you something personal has nothing to do with diabetes. My mom's blood pressure started to go up a few days ago. So I get a message from her. Hey, Scott, my blood pressure has been high the last couple of days. I call the nurse where she's living and talking to the nurse. And I said, Hey, my mom's blood pressure has been high for four days. Now, what are we doing? And she said, All the doctors gave her a little more medication. We're waiting to see if that worked. And I was like, Well, what else are we doing? You know, are we just gonna keep medicating or until you know, it's like, and she says, I want to get this word for word. She says, Well, your mom has a heart condition. And those don't get better. They just get worse. And all I could think was what in the hell are you thinking saying that to me? Like, like, Hey, you don't know me? Like I took it. I was like, Yeah, I know. Like, but like, that doesn't mean we're giving up on her right? Like she could see the cardiologists couldn't see. But all I could think afterwards was like, the lack of bedside manner. In that statement is fascinating. Absolutely. He was like, hey, what do you want us to do? That's right. What? Something? Could you do something? You know, it's just it was I just couldn't believe that it occurred to her to speak like that.

Absolutely. And I think what we've lost actually, not everybody, but I think what there is a loss of in healthcare is a sense of being human. Right? It's a sense of, how would I want this presented to me? Yeah, imagine you're the person sitting there. And I think doctors, you know, and or other clinicians, not just doctors in general, but other clinicians have become so very just blunt, for lack of a better word about this, is it? And no, it's not going to get better. Well, you may want that information eventually. And you may actually sort of know that, you may understand that as an adult, especially, but to have somebody so very cut and dry be like, Nope, this is it. This is, this isn't going to get any better. And we've put a little bit of empathy in that rather than just being so

yeah, Jenny, I don't want her to lie to me. But oh, there had to have been a few better ways to say,

I mean, even to be able to say, well, we're going to use these types of medications. And as you understand the medications, we may need to titrate we may need to change them. As things change with this type of a health condition. We do know that it doesn't typically heal. And so we're going to have to try things to keep your mom comfortable to keep her feeling well enough, but it will progress. Yeah, I mean, I think that was much nicer.

No kidding. I fascinate anyway, so there's a balance between being told the truth and being slapped in the face with some horror, there's better ways to talk about and I don't, there's one,

I think, as you say, slapped in the face, kind of with a diagnosis, oftentimes, in a very immersive, you know, emergency type of diagnosis for type one. Many times it's not that somebody's caught symptoms early enough and just come in to the pedes office or to their typical primary care doctor and said, Yeah, I'm not feeling so great. Could we, you do some tests and have some discussion and whatever many times it's very emergent. And then like mine, I went to the emergency room, and I was right there when the doctor told my mom and myself what was wrong? Yeah, there was no like, time in a nice room someplace with like birds outside the

human. That's all like, just yeah, that's all I'm looking for from anybody. I'm going to read this person statements pretty big. The Omnipod five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM en uses smart adjust technology to automatically adjust your insulin delivery every five minutes, helping to protect against highs and lows without multiple daily injections on the pod five is currently cleared for people with type one diabetes, ages six and older, and you have the option to control it all from a compatible smartphone. On the pod five is also available through the pharmacy, which means you can get started without the four year Durable Medical Equipment contract that comes with most insulin pumps. Even if you're currently in warranty with another system. Wink wink, you know what I'm saying you can switch to get started with Omni pod five, go to omnipod.com forward slash juicebox. If you're not ready for an automated insulin delivery system, go check out the Omni pod dash, a wonderful pump just not automated. And you can do that at my link as well on the pod.com forward slash juice box, you may be eligible for a free 30 day trial the on the pod dash. Did you know that full? Well, it's true. For full safety risk information and free trial terms and conditions. You can also visit omnipod.com forward slash juicebox. Now if you just don't want an insulin pump, but you also don't want to just be using needles or just a regular old pen, you should consider the in pen from Medtronic diabetes. The M pen has some of the functionality that you come to expect with an insulin pump. I'd like to tell you about it right now. But first, let me tell you this in pen today.com. Okay, now now that you remember the link in pen today.com I'll tell you about the N pen. So with the M pen, you get the pen and you get an app. Now here's the thing about the pen, Terms and Conditions apply but It's possible that you'll pay as little as $35. For the pen. That offer is available to people with commercial insurance, you should go check it out. While you're there, take a look at this in pen offers 24 hour Technical Support hands on product training and online educational resources. The M pen is an insulin pen, but it does more. For instance, it has a dosing calculator reminds you of when doses or do carb counting support and a digital logbook. It also has an activity log meal history, your current glucose, a dosing calculator, active insulin remaining glucose history and reports for you and your doctor. Pretty cool, huh? If you're ready to try it, head over to in pen today.com. There's a form there just asks you for your name and your phone number and tell them what kind of insurance you have like private insurance, government insurance, click Submit, somebody gets right back to you. It's pretty easy, and pretty cool. In pen today.com. So whether you're looking for an insulin pump, an insulin pen, glucagon Dexcom, the Contour Next One blood glucose meter, whatever you're looking for, check out my links. They're available at juicebox podcast.com, where they're in the show notes of your audio app. When you click on my links, you're supporting the podcast, and you're being connected with quality, quality devices and products. I'm gonna get you back to Jenny now, thank you for listening to the ads in Penn requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, or you could experience high or low glucose levels for more safety information visit in Penn today.com. I felt an incredible grief, we had no family history of diabetes, it was a surprise. And I was extremely scared on the way from the urgent care to the hospital, following an ambulance that my daughter was in. Or excuse me, followed by her ambulance ride. My daughter asked what diabetes was. And she said I was like, it's sort of like being allergic to sugar and you need shots. I didn't know a lot. She said she said I wept all night. When she wasn't looking, I thought I can't do this, I really just can't do this. She said I wanted to I wanted someone to come and give me a hug to validate my feelings and my fears, but also that told me that this was going to be okay, that she could live a great life. And that I would be able to do it. A lot of parents have learned to manage well. And you can too, she said that I would have been would have been great if somebody could have said that to me. She can still do everything you hope, etc, and so on, I would have liked someone to tell me that the next few days were going to be hard. And that it would involve sleep deprivation, it would have felt good to know that I could have done it one step at a time, maybe one day at a time that I could have found a Facebook group that I could have shared my struggles with somebody else that somebody else might have known the difference. Sure, yeah.

And I think some of that also ties into the rapid nature of discharge upon a diagnosis like this. I mean, in today's world, unless, unless there's something really detrimental within that diagnosis. And they really have to keep you for many, many, many days. Most often. It's an in you might be there one two nights, and you are out and you get rapid fire information. First you get a diagnosis that you had no idea even what it was many times, and now you're getting education, if you will, and you're getting information about all of these things that you're going to have to do again, the factors of life changing, become like a quick like knock on the head. Yeah, here you go. All these things. You know, when I I think that when I was diagnosed, I was in the hospital for an entire week. And day after day, there were new things brought in different pieces of education in a nature that I could swallow and my parents could swallow. Because it wasn't all rapid fire.

Yeah. I have a note from a person that just I just randomly got this note a couple days ago and just says Hey, Scott, thanks for everything. You've helped me more in two days than anyone else helped me in the last 20 years. And what I responded back to her was I was like, well, that's really wonderful. Thank you. I appreciate that. I'm glad that the podcast is helping you. But I didn't have to tell you those things while you were sitting in the hospital. And it still felt like somebody hit you in the head with a frying pan. Yeah, I got to tell you when you were relaxed and at home and and I think in

a different way though, like there's a slap in the face with something that You never expected again, a type one diagnosis or a type two diagnosis or you know, whatever. But then there's a slap in the face kind of with, well Darn, this information spin around. Why didn't I have access to it? Why did nobody told me about this? Nobody told me I could do this way, or use this product or whatever. So I think they're, they're similar but different enough that you've been already navigating through something. And now you're a little bit more irritated.

What? Why didn't nobody tell me that?

Hers has another layer. And that definitely is that, you know, if she would have found the podcast, you know, six weeks after she was diagnosed, she'd be like, Alright, cool. Six weeks, I didn't understand what I was in 20 years is hard. Because you start doing that reverse math, you're like, I've done damage to my body now that I can't get out of, and you're telling me this all existed? And just no one told me about it? Right. So it's a strange balance. How do I explain type one diabetes to a three year old? And I mean, I don't know. I don't think you can. What

did you do with I mean, Arden was to right? Yeah, she was how did you guys talk to her about it?

You look her in the face. And you say, I'm sorry, I have to give you this needle. And you try not to cry? Like, I mean, what else are you gonna do? Right? Like, it's, she's two or three years old in this in this person's situation? What are you going to say? Like, correct me? What are they going to understand?

Hi. And that's where you have to look at is the understand level. Yeah.

I mean, eventually, we told her, there's a thing inside of her body that makes the stuff inside of this needle. It's not making it anymore, and she needs it. And so we're gonna give it to her this way. And she then saw the needle, put a big smile on her face and ran away from us, just like, took off. She just told me. Two nights ago, we were sitting around online, googling what are people's biggest fears. And guessing people's top fears, like by state by country was actually kind of interesting. Yeah. And she said, Oh, this is one of mine. And so we're all like, trying to guess what it is. And she's like needles, she's like, I'm afraid of needles. She's like, I really don't like needles. And I'm gonna try to get on the podcast and to talk about it. But Arden's only ever given herself one shot. One. And it was you did

it for such a long time,

I switched to a pom pom, and we switched to a pump when she was four. And she gave herself one recently, because she's going to school and I was like, listen, you're going to hit a spot at some point, while you're at school where you're gonna have to clear something, you're gonna need an injection here, do this one. And I'll let her tell the story. But she, I think she took the better part of 90 minutes to put the to put the needle on her thigh. But she had to go into a private room by herself and like psych yourself up to do it. But if you take her she'd gets blood draws constantly sure hates them, but has to watch it happen.

And somebody else is doing it though. Yes.

But she stares at it. She oh my god and look away she goes, I need to see it happen. I'm like, All right. I don't even know how to explain that. That thing, right? So it's not just as simple as nobody wants to get stuck with a needle, because nobody wants to get stuck with a needle. But she really, she hates it. You know, but how do you explain to a three year old? I don't know. Like, I think the best thing I can say is that after a while, it just becomes commonplace. And a three year old doesn't remember, five months ago, the first day you were like your Give me your arm, you know? Right?

Well, and as you teach kids, anything, I think, I think parents who are very verbal and explanation about we're going to do this, because of this, like, I'm gonna go outside and I'm gonna mow the lawn, because the lawn is long, and it needs to be caught. And, you know, we don't want

bugs growing in our backyard, or whatever it is, I mean, at a level that a

kid can understand. And then you continue to progress through. As kids grow, you keep explaining more and more. And oftentimes, they end up coming back to you with the endless flood of questions that over the age of like, four comes into the picture, right? And as they ask more, you get a little bit deeper in, I guess, explanation. You have to start at a really like, dumbed down level. Yeah.

And you build on it. You really do because I mean, even even saying, There's something inside of your body that makes this stuff but it's not working anymore. I don't even know if there's context for that. Really. There's stuff inside my body. You don't I mean, like what like this is because for a young person, you're you you're this the village that you see out front you're not your intestines and You know,

if the child is interested in books already, and you read often, there are a lot of really good kid based books that are all different levels of knowledge to be able to start with an explanation. And I guess I would probably start there. Yeah.

And I think understanding that it's not like you're, you're not talking to a friend, you're not going to explain to them right now. And they're just gonna get it. It's going to be like a process. And, you know, you have to be patient with it. This person said, will my child live a normal life? I know the answer to that now, but I absolutely did not know then. So we covered that. This person said what you said earlier that the simplest advice is still incredibly difficult to comprehend in the early days. It would have been great if somebody would have explained a honeymoon to me. You know that there's one. How about this one? Will I ever sleep again, they just talked about checking every two hours with no end date, and did not discuss CGM with me at the time.

That's where with today's technology a you as the parent or caregiver, you go back and you say, You do realize that not only have you loaded me with this thing, not you, you know, by decision, but you've given me this thing to now help me manage for my child, you're telling me you have to do this, I know that this technology is available, you will risk you will write a prescription for this, right? I mean, you will give this to me, there is no reason not to. If I have the ability to sleep, I can make better decisions with all the things you told me to keep track of in the day for my child,

but you were thinking about what she said like you're gonna check every two hours. There we go overnight, though. Yeah. Well, what? You know, right. And then there's some doctors who used to say, Don't worry, like, it's very important to check during the day, but overnight, don't worry about it, as well. Because that's what I was told. I was like, how the hell is that reasonable? Like, they told you to not check overnight? Overnight was fine. But during the day, you need to check. And I was like, yeah, and then I stopped. And I didn't do that. And that's how I Well, first I listened to them. And then eventually, I was like, wait a minute, that doesn't make sense. And then, you know, that's how I learned that I was putting Arden to bed at like 180 blood sugar. She was waking up at 90, and I thought I was doing great. I checked overnight and saw she was like 58 At some points.

Right? I mean, that's very similar to being like, your newborn baby needs to nurse every two to three hours or get a bottle every two to three hours. But at night, go ahead and sleep about it. They'll be fine until you wake up at nine o'clock the next morning.

Exactly right. And it freaked me out. I when I figured it out. It would have been nice. This person says if a medical person would have just talked to me like a human being. And this next person says the favorite thing that an endocrinologist told me early on you see this, people say this all the time online. But there's two things you can no longer eat poison and poisoned cupcakes is what they think. Yeah. It made us realize we could do what we needed to do and succeed. The mental load of it all. For me. My My son was for a diagnosis. And I was able to work from home with him until we became more stable with our sugars. And that helped her with her the mental strain just taking another thing away in life and being able to focus more on that we got super lucky. I was a stay at home dad already

already. Yeah. When I think about especially in this I have a number of single parents, you know, single really single like there is no other person father or mother caregiver involved. And or just the sharing families, right? Sometimes you're with mom, sometimes your dad, sometimes you're the grandma and grandpa or whatever it might be. And in a diagnosis setting where there really is only one caregiver. Now you have added when you talk about things changing, you've added another layer of change that they may already be pretty overwhelmed.

Yeah. Yeah, no, no, it's not everybody is in my situation where I was like, Oh, well, I don't have a job. I have plenty of time to figure this out. Right. You know, I tell people all the time. They're they, they thank me for the podcast. I was like, thank my wife, like she made enough money when we were younger that I didn't have to work and that's part of my free time. It was around figuring out diabetes. I wouldn't call it free time like you think of but you know,

right. Like you're baking cupcakes for the neighborhood.

Oh, you know what I'll do with my free time. But I mean, I wasn't at work, where I had to disconnect myself for my family's problems so I could get a thing done so I can collect a paycheck. You know. This person said I needed somebody to tell me it wasn't my fault repeatedly. In the beginning I'm here, this is interesting. We just talked about needle fear. And so I kind of want to come back around to this for a second. This person saying needle fear was really tough for my kid. They figured it out. It's no big deal now, etc. There's this thing that I did that I believe is worked for us. And I think it's worth people paying attention to because in the beginning, you can do this thing. Where you're like, well, we'll use the numbing cream. We'll get a buzzy, we're gonna do this. We'll do that. We're gonna make it easier. Oh, it's time for your shot. Not yet. Okay, buddy. Let's wait like I am more of the School of like, draw the insulin, stick it in push the thing over with like, we're not going to like this one way or the other? Yeah, let me draw it out. Let's not draw it out. I just I learned that lesson very early on when I think my wife and I spent an hour and a half in the middle of the night trying to get my son to swallow a pill. You just like swallow the pill? Just take the please take the pill. I don't want to hold on. Wait a minute, wait a minute, wait a minute, you know, like it's the it was that I'm just aren't used to wait a minute. I was like, God, let's just do it fast and get it over with. Yep. And just get it done. I mean, you'll find what works for you. But I think dragging it out, just extends the panic because it goes away when it's over. It does. Yeah,

really. It's even like an argument. You know, with a five year old, essentially, you're having an argument. And you can tell that you're continuing to get more irritated, because they're just not listening to you. It's better as the adult to literally just be like, I'm stepping away. I've told you what needs to be told to you. We're not doing it for this reason. And I'm gonna go over here. And you can just sit because there's, you know, so just deal with it. Now, get it over with and move on. You also have a lot more time in your day.

This one person says I was 39 when I was diagnosed, and I kept thinking, What do I do wrong? And she said, or he said, Excuse me one or the other. I still, they said that their mental health is still not where it was before they were diagnosed. And they, they just don't know what to do about it. And speaking of not knowing what to do about it, this next person says, How do you deal with overwhelming emotions? I've never had them before. And now here they are, I don't know what to do. And I don't know where to get help and do the whole thing.

Yeah. I mean, the the mental health piece of diabetes management, both for caregivers, as well as the person living with diabetes, thankfully, has gotten more attention, if you will, in the past couple of years. But I think it's still well at the bottom of pile in terms of discussion and asking, how are you doing with all of this? You know, what kinds of things are you doing? To to have joy and to still feel good and to do as much as you can back to the normal, whatever normal is, right? I mean, there are, there are quite a number of mindfulness and meditative types of things that you can kind of do to get back to letting your brain at least work through things in a way that doesn't make you continue to feel stressed all the time. But you have to look for the resources, right? Nobody hands something to you like that at diagnosis.

Well, there's a question I asked a lot when I'm interviewing people, and they have really heavy stories, you know, people are like, five, six metal conditions, like a lot of stuff going on, whatever. And they get done. And I try to remember to say to them, Hey, are you okay? You know, like, because I also try to make my interviews fun, and like you're talking about these really serious things and to keep it light hearted. And then I'm like, are you alright? I'm frequently surprised by the number of people who don't know if they're okay or not, or not. They can't say they it's not that they don't want to tell you. They're not okay. It's that they don't even consider if they're okay. Like it's not a concern of theirs. They can I guess they compartmentalize everything to the degree where they don't ever consider Yeah, at all. Yeah, you know, I've had people I'm like, Just take your time. Think about it. Are you alright? They can't say, you know, and that's, that, to me seems like emotion. They're not okay. Yeah. And they're not dealt with emotions. They don't even know how to like, put words to them, you know, right. Right.

And I think some of that might come from trying to bring down emotion around diabetes management make right to be able to just see the numbers as numbers and information and be able to navigate through them and move on right. But a lot of that is taking A piece out, that is part of being a human. And, yeah, it's okay. It can go too far in terms of I don't really even know how to analyze whether I feel good or not.

Or I don't think I should think about this because I don't, I might fall apart if I think about it. Right. And so everybody's just trying to be I think you're right. Like, there's whatever your situation is. And I'm certainly not, I mean, some people situations are much more manageable than others. But that is your situation. It's not, it's not changing. So you have to accept it, and then put your head down and keep going. And I guess maybe for some people putting their head down and keep going is I can't think about this. Because, hey, because it's yeah, I'm 39 years old, and my pancreas stopped working. Are you okay? I think the answer is no, I'm not okay. This is terrible. You know, like, and there's no, the doctor said they can't fix it. And it's not going to go away. So how am I supposed to be okay. And the answer is, I think you have to change your perspective about what Okay, is. That makes sense? Yeah. I mean, because in the beginning of life, everything just feels free. You know, they mean, like, I'm going to do this and it's going to be fine. And if it doesn't, I'll go do something else. It doesn't matter to me, it doesn't really hit you the first time till school when you're if if the idea of getting good grades is important to you, because then suddenly you're like, Oh, I'm being measured. Right? Yeah. And then you become an adult, and you get measured again, because you want to stay safe and secure and fed. So you got to find a job. And then oh, everything's not so easy. But then you fall into that you're like, hey, all right. I'm an adult, I'm doing it. I got a place to live. Television works. You know what I mean? Like, my vitamins, I'm good. Here's the next problem. And it's medical. And then No, no, it's not okay. I didn't want this to happen to me. I mean, it's

well, and medical, I think is really, it's one that may or may not have a quick solution to it, or a fix to it at all. It's something that you learn to navigate with. But it's not like, I'm not okay, because my tire went flat on my car. Okay, well, this is a situational not okay. This isn't a long term. I need to learn how to accept and move forward and realize that this will be here. I know that some days are going to be great. Like I want them and other days are going to be karate. Yeah. And, yeah,

I think it's important to know that you are going to go through a lot of the stages of grief, which you know, you can look up online, there's different doctors who think of them differently, but you know, shock disbelief, denial, bargaining, guilt, anger, depression, acceptance, hope, like that stuff is, it's all going to hit you. And it should This one's interesting. Do you know why they call it diabetes? Do you have any idea I'm asking you if you know, like, where they

come from the light, I mean, diabetes in and of itself. There are several, obviously, kinds of diabetes in terms of the end like the diabetes we have is diabetes mellitus or mellitus or, you know, whatever how you say that, that last term. In terms of just diabetes. It there are Latin terms, essentially, that go along with it, which is the reason

this person statement makes me think that it's, we should call it live a VDS. Because she said her six year old said, why is it that I have babies, that's how the kid heard it. So she thought I'm gonna die, because I got diabetes. She's, she's six. And you know,

it is kind of cruddy me. And actually, it's something my husband said to me a long time ago. And we're like doing the diabetes anniversary of their diversity or whatever he's like, why are we not calling this livability? Like, you don't die right away, like, in fact, you, you move forward? Along with it. You're living so what's the, you know, worse than I'm like, Well, here's the Latin meters. Yes, exactly. So

it's, I guess, Isabel did a very good job grouping these questions together for me, because I just keep thinking, Wow, it's amazing. They all just relate to each other as I go down the list, but now I realize she did this for me. So that was nice, because this next one is not pleasant. But this list this person said, my baby was diagnosed, and everything felt like that to me. She's like, well, is sugar gonna kill her? Am I gonna kill her with insulin? Is this pump gonna kill her? Will this CGM kill her? She said death just rang through her head in the beginning. Yes, it's a it's a it's there's probably a good spot here for us to point out that Jenny's living very well. diabetes and so are a lot of other people.

Many, many other people absolutely are.

Yes,

but I we're doing Next as part of this series, because these are very likely the things that are going to run through your head when this all happens, and I think that should you not go find a therapist, or should you not go find an online group, that it would be very helpful to know that there was another person who thought, I'm gonna kill everybody. I thought I was gonna call Arden constantly. In the beginning, everything I did, I was like, this is definitely gonna kill her. Like, just, you know,

I'm gonna give this to her. And I don't know that it's right, and I'm gonna snack and well,

lunch wasn't lunch anymore. Lunch was just like, I wonder if I didn't screw this up is how it felt. You know? And then, you know, a couple of hours later, she was still looking at me. I was like, hey,

yay, was when I didn't. Yeah, it isn't. You know,

I haven't thought about it in quite a while though. The question about the word. diabetes, I really haven't. I mean, the the first part of it has nothing to do with death at all Daya. diabetes really just means a passing through or a siphoning right. And mellitus or mellitus means sweet. So it's they tested eons ago, when we had nothing. Doctors would literally dip their fingers in like a person's urine and taste it. And if it was sweet, they knew that they had this like sugar sweats, sugar sickness, or honey sickness.

You also knew your doctor really cared about you. Because taste in

my urine. Urine is pretty sterile. So unless there's like Aki, you know, whatever,

how about I don't care, Jimmy, I would not have been a good doctor. In that moment, I would have been like, listen, we could taste this to see if you have diabetes, but I gotta be honest, I'm not doing it. Go find a friend.

There's lots of stuff that could be in. Good Doctor was like, let's taste this and see what's going on. He signed up for

that. This person said to be very careful that they stopped taking care of themselves when they were diagnosed. She said I could start, I got to the point where I could count the times I was showering because I I was just not taking care of myself anymore. She's like, I was fighting with my insurance company, calling companies begging nurses to call me back. She said I was distraught and overwhelmed. And that's where the that's how the grief hit her. She kind of just started to let go of like everyday activities that you would do.

Right better now. And I think it brings it in, I mean, that that brings in a layer in terms of what she mentioned, things like calling insurance and fighting for things, right? It brings in a piece to that management, that is the addition of more, right more things to keep track of and do. It's not well, my you know, medication that I take for whatever it is, I pick it up once a month, and it's okay. And I don't really have to think about it. And I want to fight the insurance to cover it and whatever. But all these parts that ended up coming along with diabetes management in today's world, especially mean, you may have to have more interaction, at times, not necessarily every day, but more interaction at times, and especially in the very beginning. When you are asking your insurance to now Hey, cover this and cover this. And we've got this new diagnosis, and they've got all of these protocols and things that they have to follow within their organization. There's a lot of work upfront,

ya know, I've yelled the F word into a phone a lot of times the beginning Oh, yeah. I don't know that I've ever used no word. But I've heard Yeah, I used to find that it moves things along very nicely.

I probably said them after I was off the

2022. i I'm assuming that this customer service rep would say that they don't feel like they're in a safe space. Now I'd hang up the phone. But back then I was like, Hey, you don't know how hard this is? Let's go. You know, it's just interesting. Consequences are real. But I couldn't let that stop me from living my life, the balance. I think that not being a person with diabetes, I can't be sure. But I think that's got to be a bargain that everyone with diabetes makes every day of their life. Like Absolutely. Right.

Absolutely. With with everything. I mean, the consequences. And they're not necessarily saying the consequences are real in terms of, let's say bad versus good. I don't love those words. But there can always be a good consequence to your choice. There could also be what you really didn't plan on happening, because it just worked out the other way. Right. So

this person says, the fear of complications for my daughter was my biggest worry. And that's all I saw when I look things up online. I have to tell you, my brain works that way too. Like, you know, you have an autoimmune disease, there's a likelihood you might have another one at some point. At what point your brain

goes to the world what else could be wrong? Yeah, the worst What else could happen because of this? Yeah.

Which by the way, you have to guard against, because you, you have to make sure to look at all your possibilities as things are happening over your lifetime, but do not just see diabetes all the time, too. I see people that happens them all the time, like, hey, my kids got a headache. What's this got to do with diabetes? I was like, I mean, maybe, yeah, maybe the kids just got a headache. But listen, I don't know is your blood sugar bouncing around all over the place? They've been low for a while high for a while. If those things decide people get headaches, still people with diabetes, get headaches and have nothing to do with their headaches. And it's hard sometimes to separate them. You know,

and then in kids in terms of headaches, I think a big one is hydration. A lot of the time, quite honestly. And yes, you might see some blood sugars that look funny to hydration being a big piece of overall management. But headaches just alone. Oftentimes, it's drink some water,

I want to I want to offer some comfort to the person who wrote this, because they said that they remember thinking that their son would grow up to hate them. Because she saw what she was doing taking care of him as hurting him. I don't think that's how it gets remembered. You don't know? Yeah. I mean, I guess it could, but

it could I think in again, that's where some of the discussion goes along with what you're doing, using less of your own, like inner thought as you work through doing an injection or changing a pump site or putting, you know, a new sensor on or all those kinds of things that parents are doing. If you talk through it, like and verbalize it rather than just think it through. Kids absorb. And they start to make connections. And with that, I would expect that the child who's hearing their parents say, we have to do this, and I'm going to do this, and this is why I'm doing it this way. They see it more from a standpoint of caring, rather than the parent. Like being me and yeah,

no, I think that hopefully, over time, it shakes out that way. Yeah. This next one, I learned the most important thing I learned from the podcast is that non diabetic blood sugars are actually possible. And no one told me that at first and I did not believe it until I found the podcast. So I'm very glad that that happened for them. I guess they made it on to the Pro Tip series. But that's that's lovely that that for somebody because I do think that when expectations start getting set up and they start telling you like a seven a one C is fine. Don't worry about it, you might start thinking like, oh, I guess I guess what I used to have with my pancreas isn't gonna happen anymore. But it can. Just a quick one lady said, I was told that in the beginning, it will be hard. And I thought in my mind, that's probably means like, two, three weeks. And not a couple of years or do this for three weeks. I got that. It'll be okay. If it's only going to be three weeks. That'll be okay. Yeah, so there's one on here. There's not there's one that's not on here. And I know we're kind of getting up on your time. Am I right? We're okay. Because I'm gonna tell you right now, this list goes on. And on and on and on. Like, I think we've hit the big, the big, you know, ideas, ones, but here's one that just isn't here. And this is all this is perspective from me, because I'm not a I'm not a religious person. But I see people talking online all the time. Why did God do this to us? I see a lot, or this is going to be okay. Because God wouldn't give me something I can't handle. And so I don't have a lot of religious perspective. And I and I understand that. That's how some people might see these things, which is, you know, I have no qualms with, but what I can see from an outsider's perspective is that sometimes sometimes I've seen people not pay as close attention to their health, because they think God's got it. If that's the way to put it, I don't know exactly. And if you believe in God, and you think he's on your side, or she's on your side, or whatever you think I'm down with that. But just remember God is not going to Bolus when your kid is 330 You know, you need to take care of these things. There was just another story recently, I think it was from Australia where these people were put in jail because they let their kids die. Yeah, because they said that God was going to take care of him. And yeah, you know, I just, it's not a commentary about religion to me, it's just you have to realize you're in a, you know, a unique situation that is not going to be in any way taken care of without you facilitating it.

Correct. And I think the bigger thing in, in whatever type of faith that you may have. Most, most religions, most faiths have an underlying to God or logos or whatever you believe in kind of out there. It gives us movement forward and information. And the better we utilize that information for the, for the greater good, or for our own health or whatever, we have to know that that knowledge, you know, is coming from somewhere, right. And so I don't think if there is a God, there would be, and I believe in God. But I don't I don't think that God dictates this person gets cancer, this person gets diabetes, this person gets heart disease, that that type of being if there is, isn't so cute into person to person on a grander scale, we've been given free choice, right? We've been given the ability to use our brain to use what we know how to do, or I don't believe that there would be doctors and engineers and plumbers, and, you know, people who are truck drivers or bus drivers or whatever, you know, we've decided along a path. And we are using our brains to make decisions. And one of those things comes in to health management. If you if you have a child or someone you love, you have to do what is been put out there already. To be two years. Right. I mean, that's that's what I believe. I think I in particular, from my faith base, I truly believe there was a reason that I have type one. I believe it's because I had a, I guess, a destiny, if you will, to be able to use what I've been given to help other people. That's what I believe. And I don't know. So I hope I'm Hope I'm achieving that.

I appreciate your perspective very much, because I honestly don't have one. First of all, I just know that, from my, from my perspective, looking on to other people's lives. There are times that I want to respond and say, Please stop hoping and Bolus, right. Yeah, like, right, please. I hope. Can you pray for my son, not none of us need to pray right now push the button on the thing, make the blood sugar go down, like like, you know, like that, that kind of thing? Right? I just think sometimes that that can get in the way of you making a good decision. And so I'm going to there's a story, I'm going to get it wrong to some degree. I think it's it's something that's been repeated over and over again for years. But guys walking down the street falls in a hole. A doctor passes by the guy shouts up, hey, can I can I get some help here? The doctor writes prescription throws down in the hole. And the guy's like, well, what am I gonna do with this? And then, you know, a priest comes along, and he says, Hey, can I get some help? And the priest writes out a prayer and throws down the hole. And the guy's like, actually can't get out of this hole and a friend of his walks by, and he says, Hey, man, can I get some help? I'm stuck down in this hole. And the friend jumps in with him. And the guy goes, What are you doing? Like now? We're both stuck down here. And he goes, No, no, I've been down here before. And I know the way out. Let me help you. Right. Yeah. So you, you have to accept that help. Right, right. You can't just you can't then you can't just step back and keep saying like, what's the other story right guys lives on a floodplain. And somebody comes by and the news cameras come by and they say, Hey, aren't you gonna leave? Man, there's a flood, you gotta go. And the guy's like, no, he's like, you know, gotta get me. And the guys like, I really think you should go there saying you should leave here. And then a little while later, a guy comes by on a boat and says, Hey, man, get in. There's a flood common. Let me get you out of here. And a guy goes, no, no, no, no, you know, like, God's got right. And then eventually the guy's house gets knocked over. He's dead. He looks at God. When he opens his eyes. He goes, what happened, guys, like, like I said, the reporter with a whole bunch of hell, I sent the guy with the boat, you know, I mean, it's an old story, obviously. But you really have to. These are just parables because this is how people's minds work. Correct? Right. So take the help that's offered to you and wouldn't help go to somebody who knows what they're doing. Yeah, excuse me find people who have been through this before. Err how you feel, don't hold your emotions in. Understand you didn't do this guilt is I understand it. But I mean, try to have some long perspective, I find that what helps my guilt more than anything is sometimes when I'm talking to a person who's got autoimmune down their family line forever. The other day, this woman said to me, Oh, my grandmother has she's achy all the time. I don't know if she has Ra. She's like, I'm not sure. But her grandmother was in her 90s. And I thought, okay, that sucks. But she still lived her whole life. You know what I mean? Like she like a long, long life. I think sometimes just seeing that other people do, it takes away a lot of the other stuff. And I also think, Jenny, that understand understanding, I don't think anybody gets out of this thing unscathed. Like, you know, I'm a little, maybe we all are a little jaded, because we know so many people with autoimmune diseases that it feels like everyone has an autoimmune disease some days, right. And I'm sure there are some people walking around who are just free and clear. Nothing's ever happened to them. But I think for the most part, that's not most people. So I don't Jennifer Smith, CDE 1:01:19 think so either. I think most people have something that is not visible to others, similar enough to diabetes. And the only outward visual in terms of diabetes truly are the devices right? Now, the pumps and the CGM that are very visible to but even that doesn't disclose internally what the person has to go through and manage and take consideration of all day long. So yes, and I loved your little boat, and, you know, the news reporter and being like, hello, hello, something's come in, right? Because that is it. Oftentimes, we, if you really are hoping too much hope is a grand thing. It's wonderful. I, you know, we all have to hope for things. But along the way, we have to take action, in order to get to that point of what we hoped for. You can't just sit back in the launch your chair and be like, well, if it comes to me great, and I really hope that it does. That's Scott Benner 1:02:31 not really gonna work towards it also work. If you've heard people on this podcast before we have multiple issues. And I'll say to them, If I gave you a magic wand and could make one of these go away, which one would it be? They almost never say diabetes. It's fascinating. Like, I always think like, Hola, definitely gonna say diabetes, and always like, Oh, no, I would rather not have to deal with this or, and I think my point is that even if you have one thing going on in your life, and the guy across the street has one thing, and you think, Oh, his thinks easier than my thing. If you had his thing in five minutes, you'd be like, dammit, my thing, I'll get my thing back, or how do I get rid of this now? Like nothing? I don't know. You know, this sucks. Don't get me wrong. And diabetes is relentless. And it's 24 hours and etc. But there's a way to, there is a way to get through it and not right not have to live with all these feelings. And I think in the beginning, it's hard to imagine that's true. But it really is. Jennifer Smith, CDE 1:03:24 And I think something around it, too, is actually opening up to the feelings in the beginning and letting yourself feel all those things. You know, the stages of grief, really let yourself work through that. Don't turn it off. Let yourself work through. I feel really horrible. Could I have done something about it? No, I couldn't have changed this. Okay, let's move on. Right? There's there's only so much that you can or you're going to just feel bad forever. I don't want that for anybody was the person Scott Benner 1:03:58 here that I didn't get through that said every hospital should have a crying room. It's the soundproof room that you can go into the chair in a box of tissues that you just sit there and Jennifer Smith, CDE 1:04:08 let it out. And garage is a really nice place for Scott Benner 1:04:12 me. It's like ice cream in the garage in case you're one. Well, thank you very much for doing this course. Jennifer Smith, CDE 1:04:20 Absolutely. Good. Very good topic. I'll talk to you soon. Scott Benner 1:04:33 First, I'd like to thank Jenny Smith for coming on the show today and continuing to pour her great knowledge into this podcast. Don't forget you can find Jenny at integrated diabetes.com. And if this is the first bold beginnings episode, you've heard there's a whole series of it, you should go back and find them. Thanks so much to Ian pen from Medtronic. diabetes please go to in pen today.com To get started. And of course the Omni pod five is available at On the pod.com forward slash juice box I don't want to lie to you. I'm tired. This is my last editing job of the day this episode and so for that reason, I'm not going to say anything else. Just thanks so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. I gotta go to bed

Hello friends and welcome to episode 763 of the Juicebox Podcast. This episode is another in the bold beginnings series hopefully, you've been listening to the bold beginning series, and you're all caught up and ready to take on the latest episode, community. If you haven't heard the others, you should check them out. You can find them in your podcast player by typing in Juicebox Podcast bold beginnings. Or you can find them at juicebox podcast.com. They're in your podcast player you understand. But if you're looking for a list, I'm saying juicebox podcast.com. And you'll also be able to find a list in the private Facebook group for the podcast Juicebox Podcast type one diabetes. If you'd like to hire Jenny Smith, you can do that she works at integrated diabetes.com Head over there and you'll be able to figure it out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. Or becoming bold with insulin. No ads in this one, just gonna have a little announcement here after the music and then straight through me and Jenny chiton in chat I'm just here to ask you for your support. And there's not much you need to do to give it follow the podcast or subscribe to the podcast in an audio app, like Amazon music, Apple podcasts, Spotify, something like that. That's one thing you can do. You could tell someone else about the podcast, that's a big deal, actually. Like you're talking to a friend like I got diabetes like you, you should try Juicebox Podcast. Or maybe you tell your doctor about it. Your doctors like to be your doctor in this scenario. Oh my god, how did you get your agency this good? You say I'll be you know, I listen to the Juicebox Podcast, you should check it out Juicebox Podcast and you start telling them that like in your you plot your app, show them on your phone, or tell him about juicebox podcast.com. You know, I'm saying sure the show is pretty much it actually. So I want to say to you, there's no ads today. So enjoy the podcast. The only ad is for for the show, support it, download it, subscribe to it, tell a friend about it followed on Instagram, check out the private Facebook group. That's pretty much it. I appreciate your time. Enjoy the episode. So Jenny, we are doing well with our bull beginning series, a few more episodes left to record. I am beginning as I told you earlier, but more and more getting nice feedback from people newly diagnosed people who have found it and are joining it finding it to be helpful. Yay. It's it's really been a fulfilling thing. Which you know, if you all know me, like I don't say things like I feel. But I really do. And so interestingly enough, I got a note yesterday from a guy, a young man's probably 20 to 23 years old just graduated from college. And it it's going to fit in nicely with the the topic we're doing today. So today's topic is community. And I'm not the type of person who prior to diabetes would have said to you, you know how you handle problems in your life, you surround yourself with people who understand, like I did not grow up in it that would have seemed granola and crunchy to me prior to all this, if that makes sense. Now I am a firm believer in it. I am a firm believer in the idea that people who understand your situation are in a unique situation themselves, and they're able to offer you support. Even if it's not directly that you can't get anywhere else. I've never right, the experience of seeing a person feel supported with just the knowledge that someone else understands. And they don't even know each other is fascinating. I never thought I would see that. But there are the vast majority of people who listen to this podcast or go on my Facebook group or in another community never say a word. They don't type a message. They don't send me a note to tell me they enjoy the podcast. They're just there. Right? Yeah. And there's something really magical about it.

There is it's a feeling of, as you said, I mean, a lot of people I think, are for one example Facebook, they're lurkers, right? They sort of just are there. And what they get out of it is either information or against a sense of like belonging to a group that gets it as well in whatever realm of, you know, chronic condition or lifestyle or whatever you might have. I mean, there are lots and lots of Facebook groups for things. Sure. But diabetes, being such a it's, it's something always that there. And I think you can find posts all the time, something new, this is happening, I had this occur, and there's always somebody who's going to chime in and say, I've had that happen, too. I kind of feel it, I get it.

Well, the people who listen to the podcast teach me what the podcast is, which is a weird thing, because I'm the one that makes it, but they're the one who tells me, they're the ones who tell me what it is to them, which is okay. It's an interesting, it's an odd dichotomy, right? Because I think I'm doing one thing, like, if you would have asked me five years ago, and even maybe three years ago, I would have told you the podcast is about managing insulin. That's it. That's how I saw it. And then I, I one day had this, this young girl on in her mid 20s. And she's like, you know, I started listening to the podcast, and my A onesies came down. And I thought, probably a little like, smugly. I was like, oh, yeah, cuz you heard how I talked about insulin fixture wholesaling, right? She does now, I always knew that stuff. She said, I just never did it. Yeah. And I was like, Well, what made you do it? And she goes, I don't know. She's like, Just hearing that other people were doing it. And that, I just thought, well, I probably could, too, you know, and then she just, she just did it. So I knew I didn't know that, like her conversation. And other conversations and notes taught me that it's, it's almost strange, because I don't have it in my life the same way that other people do, because I'm the one making it. So like, I can't, I can't be involved in it the same way. I don't know how that it's a strange position to be in, like my facebook group has at this point. By the time this comes out, there'll be 28,000 people in there. And I see the background metrics between 70 and 110 new posts a day. 24 of the 28,000 people are active in it, which is crazy, because Facebook groups are always like, well, we have 100,000 followers, when you look there's two posts every week, you know, like, right, they that

by the same people all the time. Yes.

each other, we think they're talking 200,000 people. But what's really amazing about that is, is that people will ask a question, and then you get a wide variety of answers by rack but not screwball answers. There's something about people who listen to the podcast, and then go online and participate they have they have enough information, where they're not saying things that you're like, wow, that's doesn't make any sense it all

right. It's not like crackerjack information. And if Yeah, if they're

a little off, there's such a great vibe in there, that other people will come in and be like, Hey, I see what you said. But have you considered this and it's all taken well, and I'm, I'm stunned every time I see it, because Facebook is, you know, colloquially it's a place where people argue, but yes, does not happen in this space. Really, really?

Yeah, I have not I mean, with you know, all the lurking that I myself do. I don't I don't off in fact, I don't think I've ever seen in your group negativity in a way that's, you know, cutting to other people who've made comments or have offered up this is what's happening, you know, whatever. And I've seen that in other groups. Yeah, of course is unfortunate.

So the way I do it is probably it's probably opposite of how people think about it, but I don't over moderate the thing. Right there adults get any mean like if they can't figure it out? How am I going to figure it out? Little things you know, there's obviously there's the rules in the Facebook group are kind of funny, if you go read them. I think it's, you know, like the basically it's the it's the equivalent of like, don't be a dick bait, you know, basically, you know, don't don't talk about politics, you know, that kind of stuff, like just just talk about diabetes with people and and it works and it doesn't just, I at one point thought it was going to be like, in addition to the podcast, and then I started realizing that the Facebook group had such a good it had such good word of mouth online, that people were ending up in the Facebook group, have no idea what the podcast is, like, forget that they haven't heard it. They don't know what it is. They just they were told, like, click on this link, and these people will help you with your diabetes. And you see them come in and ask, they'll ask a question. And other person will say, oh, you should try episode, this podcast. And they'll say what podcast, right? And that's amazing, because now there's these, there's these two entities, and they somehow support each other, but can operate

separately independently. Really, really interesting.

So some feedback from people, if you know, other type ones, reach out to them, if you don't know them, find a community and build a support system. As an adult diagnosed with type one diabetes, I didn't know anything about diabetes, and I had a lot of misconceptions, I felt very alone, finding support groups like Facebook helped READING A reading helped a lot getting Dexcom helped. I found out about them through Facebook groups, I would have loved to have been assigned and experienced type one to talk things through. So this person is a great idea. Yes, right. Yeah,

that's I mean, it's there. I know that there are diabetes, like mentors, especially like I think JDRF used to have, they don't still have it, they used to have like a mentoring kind of program. I know that the college diabetes network has some nice mentors, especially within the college chapters, you know, but that is from a boil down, like, Hey, here's your diagnosis, you know, et cetera. But here's somebody to connect with. This is somebody in your area, this is somebody that, you know, would be really good in terms of age level or lifestyle or whatnot. Because, you know, I, I can imagine the, and I have to imagine, because I don't really remember feeling alone when I was diagnosed, but it was a very different time than we have today with technology. So I think in today's world, there's so much connection on so many levels, whether it's texting, or you know, a Facebook or a some type of online group or whatnot. I think it would be a nice idea, actually be like, Hey, here's somebody connect with them, and they can help you like, feel okay,

have conversations. Yeah, I think that's one of the places where the podcast fills a void, because I hear from people a lot. I don't know, another person with diabetes. And I come on here, and the few times a week you put these conversations up with people, and I get to meet an airplane pilot who has type one and a firefighter as type one, or just some person, you know, and where someone comes on and says, Oh, you know, I have Hashimotos, too. And I'm, and they think I have Hashimotos. And then you know, it's just it's, it's an opportunity that just doesn't exist in the real world, unless you're gonna go to a diabetes camp. Right? You know, which they have for adults, and they have for for kids. But that's another thing you have to it's a week or two weeks, and they're not all over the country. And, and camps are an interesting, I like watching people talk about camps, because they're an interesting conversation. People fall on one of two sides of camps. They're either like, Camp is the greatest thing. You know, adults will be like, I still my best friends I met in camp when I was 16. And then there are people like, Arden, who I we wants to do you want to go to diabetes camp, and she was like, oh, no, do not make me do that place. And you know, and she didn't want to go to camp forget that it was about diabetes. Right? Right. You know, I have to skip through these. A lot of these people statements, they're lovely. And I want to thank everybody for them. But a number of them are just like, hey, that's the podcast, I found the podcasts and I don't want to just read all those. This person said, I wish they would have given us more access to a community, but like not not deliver it to us. Just tell us that existed. Like tell me there are groups online that there are podcasts. I had so much fear and anxiety, self doubt and blame no matter how much they say otherwise. But this community of moms and dads and adults with type ones was amazing for me. I think. I think that it's a message for doctors really, you know, it is

and I think it shows it shows a degree of sort of a lack of information on the clinicians side. Not because they don't want it but because there's not one that's just a an approved Hey, these are the really quality places that you can go for more information. Here's your rip off card along with your rip off card about how to carb count. Here is your like resources from a community based law Have all and they're they're good places they're not, you know, Johnny's corner shop of information.

Here's my I mean, I think my focus is pretty clear. But to put it in this episode, I think good, easy to understand information early is important. Yes, there is an entire segment of people who believe the absolute opposite, keep you not understanding give you small bits of information very slowly. They say don't overwhelm people, we had a real I'm not a very dramatic person. And online, I'm very proud of kind of the pragmatic way that I've run a Facebook group. But there was another Facebook group, that if you mentioned the podcast in the group, your posts would just be deleted. And people would come back to me and say, Do you have any idea what happened here? As if I would know I'm like, I don't know. I don't know these people. But I said, you know, they asked what helps you with diabetes? And I said, Oh, I began to listen to the defining diabetes series of the Juicebox Podcast, and I moved on to the Pro Tip series. Now my son has this a one C. And that's what helped me. And then they deleted it. And I said, Well, it's two things. First of all, people fervently love the podcast. And when they talk about it, they mostly speak very well about it. Except for a person who left a review the other day, Jenny about our bold beginnings thing that said they would be better if I didn't talk as much. And

maybe they just like my voice better than yours and hurt

my feelings, sir. Sorry. But But, but so I said, so I think there's a little bit of that when people share the podcast over and over and over again, it could probably seem like I put you up to it. And also, it's a weird thing, Jenny, but these Facebook groups become territorial. If sure if you have Face Book Group, a Jenny Facebook group, and you say what helped you, and they say, Scott's Facebook group, well, then you go to Scotts Facebook group and never come back to Jenny's Facebook group. And, and that bothers people, they lose their numbers. And,

and I think the unfortunate thing there is that as a, let's call it, whatever you are a moderator of your group or whatnot, you're then limiting, you're limiting the quality that you're seeing that you're trying to put out there. Right, you know, you're limiting access to what might work for one person. Great. I'm happy to have somebody go elsewhere. If I'm not the right provider, or the right caregiver or whatever, for you. Go ahead, I would rather that you get good information and good care. And if you're getting it in a different way from a different place. Awesome. glad about

that. I agree. But that's exactly how I run it. Like if when that happens in my space, and somebody's like, what happened, you know, what helped you and they're like, this XYZ Facebook group, I think, okay, good. Like, I think it's a strange thing. From a content. On some level, Jenny, I'm a content creator, right. And I need people to continue to listen to my content and share it or the, it'll just stop, like, it'll just end. It's hard not to be overwhelmed by that feeling. It's difficult to keep up the whatever's best for people's best for people. But I believe that, and that's what I do. Like, I also think that the time you spend online in the community, once you find it and realize that it's very valuable, you will spend a fair amount of time there. But it's usually six months, on the outset, maybe a year, and then people fade away. And that's beautiful. They learn what they need to know. And they go back to their lives, right. It's, it's what you would if you care about people, this is what you would want for them, you know, it's what

and or when there's new information, people who feel like they've learned enough, may end up coming back now that there's something new available, something new that there might be information that's again, discussed in a different way, or a completely different technology or something. You know, they'll eventually come back. Yeah, honestly.

So I hear from people too, that that happens to them, they cycle, but then they'll watch their a one C start to drift up. And they say, I just went back to listen to the podcast, and it wasn't management stuff anymore, because I knew the management stuff. It was It keeps them engaged, I think, yeah.

It's motivating. And I think because there's enough, there's enough posting. I see which is really nice. of both. Like, let's call it the wonderful day, right? The no hitters where you're like, Oh, I'm clearly cured today. All right. All right. And then Next day or whatever, there are also posts of, I don't know what's going on, or, you know, this is what's happening. And people chime in, and they're like, ah, you know, we've had that before too, and whatever. So it's a sense of, when you're trying to get back to your management, sometimes it's a sense of seeing those motivators from other people, like other people have really bad days to or really bad times, or have had something occur in their life that got them off track. This is a way to get back on track to get those, those motivators even if you're just reading and you're not posting anything. It just helps us to stay connected and remind yourself I know, I know all the tools, I just, I just have to put them back in the right places in my life. And it's

on you a little bit to be in the right mindset, too. Because if you see someone's success, and you're in the right mindset, their success looks hopeful. Yeah. And if you're in the wrong mindset, their success is like, it makes you think I can bleep this out. It makes you think, Oh. Why don't you Bolus for your blood sugar to over 120 You mother. But you have to be able to you mean you have to be able to let that go. And to step back and say, this is possible. Like I think this podcast as it grows, in my mind, it's mostly about what's possible. At this point, right? It's possible to do this, if that person can do it, then I can do it. They might know something that I don't know right now. But, and I, I'm stopping myself from reading over and over again. By far, this has been the best community Juicebox Podcast on Facebook, starting your podcast, especially defining diabetes in the QuickStart Series. I wish they would have given me your Pro Tip series on day one. Like there are countless comments here about this. And I want to tell you this story. Well, let me finish the other side of this. So we say when people are doing well, you can kind of respond to it a couple of ways. And when people are doing poorly. It also is helpful. I know that sounds crazy. But it's the same idea. You look and you think well, they're having a bad day. I've had bad days. Right? So this is normal to you know, it's not going well. And it takes away a lot of the angst from the whole Right. Right. It really does. Yeah. So so this thing at the beginning that I mentioned, I had a message yesterday from this is a long message. I'm not going to read it to you. But I'll give you the I'll give you the breakdown. diagnosed in high school, I think a senior on his way to college, finds the podcast listens to a couple of episodes, doesn't keep listening, goes away to college, drinking weed smoking, spiraling not paying attention to diabetes whatsoever. Blood sugar because it's college, three hundreds blood sugar's higher, a one C going up crazy. doesn't just doesn't even worry about it. I think COVID hits kind of refocuses the person a little bit person goes to a doctor to their Endo, and says, Hey, I found this podcast and I'm gonna try some stuff. And you can already see my agency starting to come down, I'm seeing some stuff, it's positive, and he starts telling them he's going to try it, doctor, whatever, do whatever you want, because doctors not helping. And then the person has a big success moves the agency really far life is changing, goes back to the doctor tells them I want to tell you about the podcast tells them all about the podcast, the doctor gives them the one of two responses that people tell me about either the doctors are like, This is amazing. It's great. Whenever it's more, whatever you're doing. Yeah, going, or you're just going to spend your whole life staring at your diabetes. And I guarantee you that that guy on that podcast doesn't do anything except watch blood sugars and blood and really amazing. Think about that. Right? The person takes their a one C from double digits into the sevens and the advice the doctor gave them was stop doing that. Just essentially Fascinating, right? So the the kid essentially telling this person,

that they're putting too much time and effort into their own health management. Yeah, that's really the cut and dry of what this physician was saying what's

in rest of that sentence that doesn't get spoken. So go ahead and have major problems later in your life or sooner maybe, you know, right? Yeah, but hey, at least you'll be drunk as a sophomore. Like what the hell are you saying to the kid right? Because the kid has making a change and is excited about it and then the doctor steps on it fast as fast that happens a lot. You have no idea how many notes I get from people. I went to the doctor, I was super excited. I knew my A once he was going to be lower. I knew my lows were going to be less. And all the doctor told me was to put my one C higher. Right Right. And and this three months of hard work, and you're looking for the pat on the butt at the end. And instead you get, don't do that. And it's hard for people to push through sometimes.

Absolutely. I mean, you're not surprising to me, you get people all the time who are frustrated with the fact that not only are they usually being told that the highest can be expected, like high higher than you would want highs, right? And that if your insulin is working, you know, you're, you're to expect this and that's and or just the comment of, well, that's just diabetes i in today's day and age, that is still a common that's being you know, or a message that's being given to people. And that's really, really sad,

really sad, especially in a world where I can pick my phone up right now and see that Arden's blood sugar has been somewhere between 80 and 110 for the last 15 hours, right? How can you tell somebody that's just diabetes? Why don't you tell them? Hey, here's this stuff that exists or try that or good job? How about how about good job? How about how about good job? person moved there a one see multiple points and found stability? How about good job, that'd be great. By the way, there's another part of that story I can't tell on here. But I'll tell you afterwards. It's about the doctor. And it's fascinating. I apologize that I can't say it here. When I was diagnosed in 2020, you and Jenny, we're all I had this. This group has been my support and my family. I was kicked out of the ER in DKA with insulin to Use as directed, but had to wait five and a half months for my first endo appointment. Every episode I listened to save my life and my Saturday. Oh, and I'm wonderful.

That's wonderful. And it's also an I've said it before, but that's, that's why I love I just love being able to contribute, you know, to what you've put together because well, it makes it makes me just smile. That's super awesome.

I am happy when you're happy for certain Yeah, this isn't a

show you my I know people can't see this. But this was my day yesterday.

Wow. Jenny's Jenny's showing me a graph. That's 24 hours. Oh, yeah, it's 24 hours. Yeah, some of you might look at and be like

some of my data to kind of, I have an endo appointment coming up. And I like to take photos and whatnot of like, really busy days, like it included a run and included swimming in the afternoon with my boys and included, like all these things. And you know, not every day is 100% like that. But they're they're pretty days where you're like,

I know, I did it. That's exactly right. And you should, by the way, celebrate that stuff. You really should. And it, it just it's very important. So anyway, I put all that I put this in this series, because A, I didn't realize how important it was when I started. And I've learned and B I think it's hard for people to accept, especially in the beginning, like you didn't want to have diabetes. And now what now you're gonna surround yourself with more people with diabetes, right? You're probably like, I wasn't looking to be in this club. Thanks. But it's, it's just like, give into it. I don't care. I don't care if you're one of those people who learns and stays on the Facebook page for years helping other people. Or if you get what you need, and you leave, or if you never say a word and you just read it, it doesn't matter. There's something really valuable about it. And it's it's not completely possible to quantify. But I am 100% Short works. And there's this long, there's this long lesson here that I won't read the entire thing. But this person said they found the podcast, and it felt overwhelming. And I understand that. And that's why something like bold beginnings exists, and why defining diabetes exists and all these other series that are inside of the podcast. So I did something Jenny, the other day that I want to put right in here. Yeah, I used so there's juicebox podcast.com, which is just it's a website where you can go and see most recent episodes, and a few of the series like pro tips and stuff are broken out on the front page. Because there are now 741 episodes of the podcast as of this recording. And podcast apps while they're amazing. They're not. It's not the Dewey Decimal System. It's it's not super easy to find stuff, you have to know what you're searching for if you're going to search. So I've had for a long time, another URL diabetes pro tip.com. And it just used to be an online player of the Pro Tip series and the defining diabetes series. But the other night, let me get it up here so I can make sure I'm saying this correctly. diabetes pro tip.com I revamp our tips Tip Because to Hakan No, really leave off, leave off the list. As for savings Jenny, I at first I thought, oh, diabetes pro tips.com. And then it was taken. So I use diabetes pro tip.com. When you get there, you scroll a little bit, and there is a player, the player has the first one, you'll see defining diabetes 44 episodes of that. And you can scroll right through really do that many doors, there'll be more so like, you just scroll through, and there's a player right there, you can play them in order, you can play them one at a time, or you can see the episode names and numbers and go back into your podcast player and find them there if that's, you know, easier for you. But you scroll a little farther, the bowl beginning series is there, which as of this recording has 11 episodes, we'll have more by the time you get there. 22 episodes of the diabetes variable series 25 episodes of The Pro Tip series after dark is now up to 27 episodes. And the cool thing about this is that as I add new episodes, they automatically populate in these players. So it's great, I don't have to go back in and add them like I put up a protip or excuse me, I put up an after dark episode today. And it's already available there. And then there are the wellness series, which was mostly with Erica Forsythe, and Eric and I are planning on doing a lot more in the coming months and years are asking, you know, when we do ask Scott and Jenny episodes, yeah, that's how many you know how many there are? No,

I don't know.

18 As of this recording, so really, we'll send in questions and we record episodes answering their questions, there's 18 of them. Algorithm pumping series is up to 17 episodes, defining thyroid series we did is there. I'm about to add some pregnancy episodes. So basically any collection of management type stuff. If you can't find it in your podcast player will always be at diabetes protip.com. And you can get to it through juicebox podcast.com as well. Good organization.

That's I like that. Yes, I know. That's the kind of person I like organization.

I think we all know that. That's not my wheelhouse. And it's pretty crazy that I even did that. But it just seems it seems important. I mean, listen, from a podcaster standpoint, I just want you listening in a podcasting app. It's the best thing for the show. But at some point, I realized, like this podcast has become it's a compendium of information. And it should be accessible, you know, in multitudes of ways. So that's one of them. I hope it helps everybody. Oh, good job.

Awesome. Very nice. Thank

you. Once again, if you need help with your diabetes, Jenny works at integrated diabetes.com. And in my opinion, there's no one better go check her out. I'd like to thank you for listening remind you that there is an entire bold beginning series that I hope you check out. The podcast has experienced insane growth in 2022. And that is directly because of all of you. So we're just going to take this opportunity right here before the music stops to say thank you, when you support the show, you're supporting me and the work we're doing. And you're helping other people with type one diabetes to be able to find this material. So thank you very much. Hope you enjoyed this episode of The Juicebox Podcast. I'll be back very soon, with much much more

Hello friends and welcome to episode 772 of the Juicebox Podcast. On this episode of The Juicebox Podcast Jennifer Smith and I will be giving you another episode in the bold beginning series. Today we're talking about journaling, which, though I got confused a little bit isn't about writing down your feelings. 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. The ball beginning series begins at episode 698 and includes honeymooning adult diagnosis terminology part one into fear of insulin the 1515 rule, long acting insulin target range food choices Pre-Bolus carbs stalking, flexibility school exercise guilt, fears, hope and expectations, community and today's episode journaling. If you're looking for that list, it's available at juicebox podcast.com. Or on the private Facebook group in the feature tab. The list actually has like the episode numbers with it, which I guess I could have just said but I felt like I had to rush to get you know in before the music ended. Anyway this episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. If you want an insulin pen that has much of the functionality that you find with an insulin pump, you're looking for the in pen, Learn more at in pen today.com 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. Well, Jennifer, we are so close to being finished with the bold beginning series. Yay, we are going to record today. What we have left is journaling. And then we have supplies like technology technology, durable medical stuff, which I thought was a great idea talking about how to people actually get these things, a little bit about insurance. And then we're going to talk about carb guidelines and food impacts. So we only have four topics left. Yay. Yeah, I feel I feel like we've accomplished something we have how many months? Have we been at this? Do you think?

I don't even know. Honestly all have my month they run together? And I have no probably three. I feel like we started like summer ish, right?

I'm gonna look, because I'm actually interested. I'll figure it out while we're talking. Cool. Okay. So can I just admit something right here? Sure. The list has been in front of me for quite some time. And journaling has been at the bottom. And the entire time I thought, well, people want to talk about writing their feelings down. Then I thought, Okay, if that's what everybody said, we'll do it. And then of course, today looked at it and I thought, Oh, that's not what they're talking about.

That's what I was wondering is like, what and when you said the name of I was like journaling? What kind of journaling? I journal and it's doesn't really reflect on diabetes, but sometimes it does when I'm journaling about that. But that's not in my journal. No.

I was so disappointed with myself. When I started reading, I say, Oh, they're talking about tracking food and doing a food journal and a carb journal and a Bolus journal, journaling diabetes stuff, and I thought it never occurred to me because, you know, I don't do that. But I go, but I do see people's, you know, people's comments telling me that for I think certain, I guess certain brains, right? This is probably incredibly important. So the first comment I have here is I counted carbs and tracked it in a food journal like crazy for almost a year, I would record everything my son ate and what happened to his blood sugar afterwards. This was kind of helpful to distinguish patterns. It was very stressful when things were not working correctly. But oh, here we go. I would never food journal again if I knew better.

Huh. And that, and I see I don't see, as if like, Well, gosh, why not? It's just sort of like, I think everybody again, you said personality. I think there are some people who can collectively see something happening. They take it in and it gets filed in that place that they know they can pull it out and use it and they don't have to write it down. However there are people in terms of like kind of learner, along with personality, there are some people their learning style is they get it once they've written it down. If it's written a couple of times, it's then in that place in their brain that they can draw from, and they probably don't have to write it down anymore. Right?

Yeah, I wonder if the message after we get through this is going to be that if this is how your brain works, this is probably amazing. And if it's not, it might feel like torture.

And I think the other piece to it too, is people who have a little bit more consistency in what they do, and probably would benefit from this, regardless of personality or learning style. They're the they're the person or the family that could get a lot out of, we have soccer every Monday, Wednesday and Friday, we always eat this for breakfast, this for lunch, and then dinner is these different meals. But there are like five of them, great journalists figure it out, you will see patterns, I guarantee. But the person who has a very random schedule, and you know, I bring up nurses sometimes, because the nurses that I've worked with often have variable scheduling, they might work overnight, and then they might be off for two days. And then they might work three shifts in a row, different times of day, and then they might be off for another two or three days in a row. While you might get something out of food evaluation, you may not get much out of time of day evaluation, because there's so much that's variable day to day for them. So I think, you know, you kind of have to pick and choose, what are you also trying to figure out what is journaling? The 1000 things that might happen in your day, you're gonna get overwhelmed with that

you're not a computer, right? Like, you can't, no, I can't write down so much data that you can't compile it and make sense of it. But what you're saying makes a lot of sense to me, if you have a more repetitive life, you'll probably more quickly be able to see the patterns, right. And if you have an incredibly variable life, what you might end up with is a lot of numbers and lines and dashes that you can't make sense of

correct interest. And sometimes because it's your own data, you sort of get lost in it, right? Sometimes it it helps to have an unbiased look. Which means then that hopefully you have a good care team that you can go to and send data to for evaluation saying, I don't see anything here. Can you please try to pick this apart? And you know, when I'm looking at someone's data, sometimes I say, I don't know, it looks like there are a lot of variables in the picture. So let's try this. And this to start out with?

Well, that's it really important to bring up because, I mean, in full, full transparency, probably a half a dozen times a year, I send something to Jenny and say, I see this, am I right? Because I'm living it and watching it. You're You're too, right. It's micro macro, like sometimes you get too close to it, and you can't see the big picture anymore. And often, like, I wanted to make this switch a couple days ago, and I said to Arden Hold on a second, I'm gonna check with Jenny. And she was Do you not know if you're right or not? Which I don't think like, filled her with a ton of confidence. And I was like, No, this is the right thing to do. But let's just tell somebody else first who, who thinks about it the same way so that we don't start turning a bunch of knobs and get too far away from where we are because we're so close right now. And she's like, whatever. And it's like okay, by the way, just to digress for half a second. Did you hear the episode that she did recently?

I listened to I think I got through three quarters of it.

Did you get to the part where she wouldn't give you credit for the oat milk ice cream?

I didn't get to that part. Although I have seen many comments about what's this ice cream. Jenny recommended and I was like, it's tasty. I guess the biggest reason was when I recommended it for you guys was trying to find something that was comparable in taste that she wouldn't be like, Oh my God, this crazy lady recommended something that's it's horrid. It is totally not ice cream to me. Right?

How long is the hair on Jenny's legs? If she thought I was gonna eat this? Yes. But um, but she just ended up really liking it. So I was like, I was like, Hey, give her credit. She goes, I'm not involved in this thing you do? It was like what do you anyway you have to get to it is hilarious. Okay, so the next comment here is, is super interesting because it goes the other way. Getting a scale and a notebook was huge for our family as well as staying as organized as possible was we had a little makeup. Oh, we had a little makeup organizer set up on our counter in the kitchen with everything we needed. So it was very easy to reference. Then, with a notebook right in front of them. We would write down all of our carbs and in insulin doses times, etc. And that really helped to make sure we didn't both accidentally give her something Oh, that's interesting, a little redundancy too. And reference back to the book, if something weird with her blood sugar happened that we could figure out better after seeing, Oh, what was going on with the insulin versus the food that she ate, get a good scale to help with Clark County.

And that's their, you know, in terms of the whole idea of journaling, there in lies, I think this person brings up a good, a good fact that sometimes actual physical written journaling, you can flip back to easier than the databases upon databases that allow you to do the same thing in an app. Because sometimes the apps become cumbersome to try to track through and page back and forth between one day note and then trying to find another days of note, where if you haven't just written down, you can kind of easily page back and forth. I know a lot of people use like the sugar mate, because partners or caregivers or whatever, you can see what every person is logging. And then you can see in the day, and you don't really have to worry about that redundancy, or Oh, my goodness, did I give it did somebody else give it what was done? But yeah, I mean, there, there are multiple ways to journal or I guess, record diabetes, if you will, sort of like texting diabetes, but recording, if you will.

So when there are plenty of times throughout the weeks, where my kids look at me funny, because I'm like, well, if I'm going to do this, I have to go upstairs to my computer. And they're like, you can do it on your phone. And I don't want to, I don't want I don't like that. And they they're like you're old and I'm like II say whatever you want. Like I want it big. I want it in front of me. I want to be able to look at multiple things at the same time. I don't want to be flipping back and forth. I take that point. Oh, well, it's interesting. He I would I would be better with it. Interestingly enough, I'd be better with it where I could just reach back three pages and go okay, Monday. That was that would be easier for me.

Absolutely. I mean, I did that. And I'm very glad. And I recommend this to a lot of the women that I work with, through pregnancy is I journaled my entire first pregnancy, the whole thing, all the foods every day, day and time of change of insulin doses and everything that I noticed, it was enormously beneficial. When I was pregnant with my second, okay, enormously beneficial, because I could go back and say, Well, this time of the first trimester, this is about what started happening. And then it didn't feel as crazy. Right with what I was noticing. I'm like, No, this is normal. I did do this last time, or I did see this last time, or I did stop doing this type of thing last time about this point. So

when something that's so out of the ordinary happens, even though it's happened to you in the past, it still feels very out of the ordinary. And it was helpful to go back and say, Oh, no, this this happened the last time. Yeah, right. That's right. Especially

because there were a number of years before between my kids. And so, you know, memory lapses entirely.

So that's nature's way of allowing you to get pregnant again. I think.

There you go. I guess yes. You don't remember all of this stuff you do, right? Oh, let's do it again.

You remembered it, you'd be like No, thank you. That's okay. Once enough. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. GE voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Two words like current glucose dose calculator, active insulin remaining dose history, Activity Log reports and glucose history make you think about an insulin pump? They probably do. Because that's a lot of the functionality that you get with an insulin pump. But I just read those words from in pen today.com, which is a website where you can learn more about an even order the insulin pen known as the pen Pen. This pen is special because it connects to an app on your phone that gives you the functionality that I just spoke of. Now you may think oh well, something like that. Scott has to be incredibly expensive. But in fact, you may pay as little as $35 for the implant. That's because Medtronic diabetes doesn't want cost to be a roadblock to you getting the therapy you need. And so with the in Panax This program, you may pay as little as $35. This is something you can learn more about at in pen today.com. While you're there, check out the app, great breakdown of the pen that's there you can see all the parts and pieces, the whosits and whatsits, everything you need to know about in pen from Medtronic diabetes. When you're ready to try it, scroll to that part of the screen that says ready to try. And you'll be that much closer to getting your insulin through a pen that connects to an app on your phone and gives you the functionality you're looking for. In pen today.com links in the show notes, links at juicebox podcast.com. In Penn requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, where you could experience high or low glucose levels for more safety information visit in Penn today.com. Makes sense? Okay, here's the one from somebody that says, Oh, hold on a second, while I mute my phone. Like I've never made a podcast before. Sorry about that. With everything overwhelmingly journaling. Journaling saved my tired brain from remembering everything. Okay, so while everything was overwhelming, journaling saved my entire brain from remembering everything. I keep everything in there food, Bolus timing, dosing, carb counts, questions, to ask questions to ask it and appointment, they use this thing like a Bible, then. Okay.

And that is good in terms of connections with your care team. Because if you do on a day have, gosh, originally I should ask about this isn't a question that needs to be answered now. Then reach out now, if it's a question that you're going to bring this journal in, in a month or two months when you have your next visit, because they were just things you wanted to go over. But I really not as necessary to get an answer to right now. Then you don't have to remember all your questions. Yeah.

My, my mom just moved from the East Coast to actually to her Jenny has to live with not to live with Jenny, but to live with my brother. Not that my brother lives with Jenny, but they're in the same state anyway. And my brother has been a little overwhelmed. And we had a conversation yesterday, where I said, Listen, you've been lucky this far, you haven't dealt with a lot of health issues. And, and he's like, Well, there's phone calls, and I'm talking to doctors, and they don't do anything you want them. You know, you have to ask three times. It's like, yeah, that's like, that's how this is. So. So I said, look, make a list. And I said, because if you think you're just gonna walk in that doctor's office, and remember to say everything that you need to say, it's not going to work like that. I said, you have to have a list in front of you. It's interesting how, you know, the one thing I'm realizing, as I'm listening to people talking about how they're journaling and listening to us talk about it, is that I would have benefited from it. It's just that my brain doesn't excuse me, I don't know how to say this actually. But like my my printing, my penmanship is is horrendous. Like, I don't mean not, you know, worthy of being hung up somewhere. I mean, I write things down. And then I didn't know what they say. Yeah, I have things written in front of me from yesterday. I don't know what they say anymore. And

it's kind of like Dr. chicken scratch really,

it's like, it's like something I'll tell you. And, and I wonder how much of that thwarted me from ever trying it because I have I have written things down before I'm like, this is useless. I don't know what this says. I've tried slowing down and writing slower. It doesn't like I can't do it. Like the first three letters and then I get bored like come on, let's get this out. And I can't get back to it. So

um, had you had at you know, I mean, Arden was diagnosed long ago, long enough ago that there really weren't the tracking tools that we have now right? Where it takes your handwriting out of the picture it does allow you to keep it all in an app or again or someplace that you can actually read what you wrote down

that is why I like being at a computer because I can go back and actually see it also might make a good point that my my book back then might have said woke up screamed into pillow cried. Yeah. Yeah. Chased Arden around room with needle went another room screamed and pillow. I don't know how helpful that would have been. Exactly. I guess the tools and the data coming back really is more modern day.

It is definitely I mean, even the ability to download, you know, a pump or a simple glucose meter or have the CGM data drive right into a database that you can look at online or that you can get notifications. Hey, clarity tells me that I did this much better this week compared to last week, right? I mean, that kind of information. Just it wasn't there. Yeah.

So I use that that data like in clarity. For example, when I'm returning Arden's blood sugars for something, I move everything to one day, I want to see just what happened today. Where was our average? What was our range today? And then as those numbers come to where I want them to be, then I open it back up and see, am I keeping it for a week? I am I keeping it for a month? Good. And then I kind of build off of it that way.

Yeah, those overlays or comparison reports, especially just, you know, talking about like a CGM. From a one point of view, like you said, when you make a change, and you're wondering if it's made enough of a difference, I always start with just compare a seven day, you made a change on this day, look seven days out, do things look better compared to the previous seven days before you made the change? And see, so you can definitely tell whether or not more stuff needs to be adjusted,

I cheat a little bit to like, I'll look at seven days and just pick a number. We'll say like, I don't know, variability is at 28%. And I'm like, Okay, over the last seven days, that's great, then I expand it to 14 days. And I don't even go back and look, if the number goes up, then I go, Okay, well, the week before, it wasn't as good. And if the number stays still or goes down, I go. Okay. Now I have some consistency over two weeks. Right? Yeah. Oh, it's interesting. The last person just says, please get a good scale to help with carb counting. I don't know how to comment on that. Because, I mean, that's a burden more for me, but I see the value,

there is value. And I think, again, I still use a food scale, but more specific to foods that they never have a label. They're real foods like butternut squash, or acorn squash, or apples or M kind of, you know, those summer into fall kind of vegetables and fruits, or anything that you might get from the grocery store any time of the year, that just does not come with a label, you can get a lot from using a food scale, and you know, a carb factor. And many foods scales now, if you get a smart one actually come with the carb factor already in them. And all you do is put the piece of food on the scale, put the code in, and it gives you the amount of carbon that portion that you're going to eat.

Oh, so yeah, cut up apples as an example. I throw it on there. I tell the thing. This is apples, it already knows what the carb factor is for me personally. Tells me for that

food particular. Yeah, yeah. Yeah, like I, one in particular, is it eat smart products.com is the website. It's a great food scale, you want to look for the nutritional kitchen scale. It's like a square like clear glass shape. But it comes with a catalogue of about 1000 foods that each have a code. And when you look at the code, then you put that in put the let's say Apple is 205. I only know it because I really like apples this time of the year. And I use it because they're all different shapes and sizes this time of the year. So you put the apple on and it pops back. This is how much fiber it has this is how much carbohydrate in this portion that you're going to eat. And if you are the precision kind of person, then maybe that's what makes the big difference for you. And if it does, it could be a huge benefit for you. Again, I mean, I don't use it for things that might like beans that come in a container that I can look at. I know what a half cup looks like. And you know, I've been doing this long enough that if I don't know what a half cup looks like, I'm in trouble at this point.

Okay, so I think the takeaway here is that different people are going to respond well to different ideas. But that's keeping track of something somehow is is a good idea. You don't I mean, even look, as I joke, I don't keep track of anything. Arden left for college, the last thing I did was open up our loop app and screenshotted every page of our settings, and I AirDrop them to myself. And we got we got there and we made changes, and I did them again. And over the last couple of weeks that she's settling into school, I refer back to them a number of times. So

Right. And in the beginning, I think the good thing about some tracking, especially if you do have a honeymoon period, the good thing about tracking early is that you'll start to see those differences that cue you in to say, this wasn't just a bad day, right? This was two days or three days I have much more sensitivity or much less sensitivity. And so you know, then something needs to be adjusted in terms of your doses, probably. And you can go forward in a much more precise manner rather than the randomness that creates more of the roller coaster up and down.

Okay, well, I'm glad we talked about this then thank you very much. Thank you. Okay, let's see what is next. So that was journaling. I honestly can't read my own writing. It's embarrassing.

There was, there was a physician when I was doing my clinical internship, which I had actually done I had done at a hospital where I was already working. And so I knew the doctor, but he had, like, literally, I don't, I would call it chicken scratch, it looks like somebody put ink on chickens like feet, and they just danced around on the page. And we got to the point of realizing some words looked the same. And then you could end up figuring out that the chicken scratch was like the or it's catchy, because it looked the same note to note, so then you could figure out what he had actually written. But, man, yeah, almost

impossible. No, I, I looked down at my own writing. And I was like, it feels like someone else wrote it. I have something in front of me right now. Oh, I know what it is. I was speaking to someone from Australia yesterday. And she said, we are in a potty. And I wanted to remember to bring it up later. Because she had she was talking about peeing on sticks to get her blood sugar when she was younger, because she had had a long time, right. But as I looked down at it now, it looks like it says Lee

Lee and Patti maybe

on poult. Good. Like, I don't know what it's, I don't know what it could say Q. Like cu e, it could say, definitely not wait because the first loop of the w goes down comes up and it goes right into the E. And then there's another E, the two E's don't even look the same. You can't even tell the second eat and the first day are the same letter.

I hope you never wrote like nice letters to your wife when you guys were dating because she was finally I was talking about my hobby telling them that he likes me. But I really don't know,

a greeting card for Kelly. I sometimes print it out first and then go and I copy it. Because if I just start writing, I hand it to her. And later she goes, Hey, what does this say? And then I'll just I just read it to her or the or I can't read it. And I just go well, here's here's the intent. Like I started. I don't know if it's terrible. It's really I don't I it's my whole life. My printing has been absolutely horrible. And my cursive is not anybody writes that way anymore. But

it's it's horrendous. And they don't even they don't even teach it anymore.

There's a lot of things they don't teach anymore. Some of it. I'm confused by like typing.

I'm amazed at the the use of iPads in school for young kids. It's the hunt and peck method of finding letters to spell things. Yeah. And I told I told Nathan recently, I was like, We need to get it. We need to get a keyboard to hook up to our home iPad. And we need to teach them how to type. Yeah, because for the year, they're gonna hunt and pack their entire life.

That was years of their life. You know, watching a person text who's proficient at it is like I watch Arden and her thumbs are just like flying. It's and they don't make mistakes. It's fast. It's fascinating, you know, so I had to teach myself to type to write my book. I did, I did not know how to type. I took typing class. I did it for like a day. And I'm like, I'm dropping this. And I dropped it and I left. I couldn't do it. So when I had to write my book, I sat down. And first I typed looking, and then I would practice not looking. And then as the weeks went on before I knew what I could type.

Yeah, I mean, that's how they teach you. It was a mandatory we had to take it as freshmen in high school. It was a mandatory, I still remember Miss Adelman, that was her name. And we had word processors. No, I'm like aging myself. We had word processors A S S, like that's what we did for the whole class. By the end you're like, oh my gosh,

Kelly had one in college where there was this little matrix LED screen in front of her that may be held like 15 or 20 characters and you would type and they would come up in front of you. And then they would disappear off to the left. And when you got done you hit save and it was on like a floppy disk if I remember correctly, and then you had to put the floppy disk in and hit print. I mean you didn't even you couldn't even go back to see if you made a mistake or it was and that was like high quality back then. Think about that the next time you complain. 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're looking for an insulin pen that does more, check out the pen from Medtronic diabetes at in pen today.com. And don't forget to fill out that survey for me at T one D exchange.org. Forward slash juice box if you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. That really is the best way to help the show, grow, thrive and continue. Tell them to look in their audio app like Spotify, Apple podcasts or Amazon music. If they don't know what that is, send them over to juicebox podcast.com Or take their phone from them and show them yourself. 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 776 of the Juicebox Podcast. Jenny Smith and I are back with the bold beginning series. As a matter of fact, this is the next to last episode in bold beginnings. And today Jenny and I are going to be talking about technology and diabetes supplies. Don't forget if you're enjoying Jenny, she works at integrated diabetes.com And she is for hire. If you need help with your insulin management, I'd like you to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you're a US resident who has type one, or is the caregiver of someone with type one and you'd like to help out with diabetes research without actually having to do anything like not off your couch, you know what I mean? T one D exchange.org forward slash juicebox. When you complete their survey, you're helping people living with type one diabetes, T one D exchange.org. Forward slash juice box. At the very end of this episode, I'll list all of the bold beginnings episodes for you. So in case you haven't found them, you'll know where to look. This episode of The Juicebox Podcast is sponsored by the Omni pod five. It's time for you to try the only tubeless automated insulin delivery system that integrates with the Dexcom G six, try the Omni pod five. All you have to do to get started is head to my link Omni pod.com forward slash juice box. There you'll see a photo of me which I imagine you'll want to scroll past quickly. And then we'll get right to the information. On the pod five is here it says the first and only tubeless automated insulin delivery system. Everything you need to know about it, including how to get started is right here. All you have to do is click that little link says talk to an omni pod specialist when you're there, and you're on your way, get the process moving, get yourself going with the Omni pod five. It's not hard to get going. You could do it right now in just a few minutes on the pod.com forward slash juice box. And if you're not looking for the Omni pod five, but you want a tubeless insulin pump, check into the Omni pod dash because you may be eligible for a free 30 day trial of the Omni pod Dash. And again, you'll find that out at Omni pod.com forward slash juice box when you complete the process with my link, you are supporting the Juicebox Podcast and for that I want to say thank you. The podcast is also sponsored today by Dexcom, makers of the Dexcom G six continuous glucose monitor. My daughter wears the Dexcom G six continuous glucose monitor and it saves us every day. Dexcom allows remote monitoring that lets users choose to share glucose data with up to 10 followers. Of course you're getting that famous Dexcom accuracy and performance, seamless integration with Dex comms expanding connected CGM ecosystem. And real time glucose readings sent automatically to the users compatible device that can be an iPhone, that could be an Android, it could be your Dexcom receiver. See your blood sugar in real time including the direction and speed of the number without finger sticks calibration or having to scan anything dexcom.com forward slash juicebox. For full on the pod safety, risk information and free trial terms and conditions, please visit on the pod.com forward slash juice box. There are links the Omni pod Dexcom and all the sponsors in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. If you're going to check out on the potter Dexcom please use my links. Thank you so much. Here comes Jenny Jennifer, we are up to technology and diabetes supplies in the bowl in the bowl beginning series on this is voluminous is

a very broad topic.

Yes it is. But there's a lot of feedback here from people. So I'm just gonna go through it in order. All right. This first person says this is very specific get a Dexcom that was the entirety of their of their thoughts. The next person says I wished I could have left the hospital with a Dexcom. But we did get it 10 days later. All right. I think advocating for a pump and CGM right away if that's what you choose. It's interesting. We always I don't know that there's something about polite I don't know, gently this is the wrong place for this, if that's what you choose, I just assume that's inferred like that. But I guess everybody's worried that people feel like they're telling each other what to do anyway. Correct? Yeah, correct. Yeah, yeah. I'm not telling anyone what to do. And if your insurance doesn't cover it, if you can't afford it, I'm sorry. Like, I'm certainly not trying to make you feel bad about that as we go through this. advocating for yourself as important as what I got from this person. This person that goes on to say, luckily, our endo was amazing and did that for us. So we had a libre before leaving the hospital. Nice,

good, which I've actually heard. I would say more frequently, in the past two years. Interestingly, the more newly diagnosed that I've had a chance to work with a more than a handful of them have left the hospital either with a prescription for it, or knowledge that they had already gotten a message that it was approved and on its way, or they left the hospital with it.

Okay. Yeah, I hear the same stories. It's, I think it's fascinating. And I reject the old thinking that you need to live with diabetes and let it beat the crap out of you for a while before you get technology. I just don't. I don't think that's accurate. I know people like well, what do you do if you don't have it? And I say, well, then learn it, then. Then

learn it then. Right. Yeah. I think the first comment, but quite honestly, as I tell a lot of people, if you're going to choose technology, get a CGM. Yeah, I mean, literally, that's the bottom line of any technology. Sure, you're gonna have a glucometer? I mean, I have not heard of anybody who has left any office without a prescription for a glucometer. But for the ups and the downs and following, you know, and or any journaling, right that you might do. You You need a CGM of any technology out there yet. One. No, I

agree. The next statement here is I wish they would have given me a CGM right away and not made us wait for it. Yeah, I will bring up here that if your practice says saying things like, Oh, we don't give people pumps for six months or a year, you're not allowed to have a CGM till some arbitrary date in the future. Just please know, that's an arbitrary statement. Absolutely. There's not a rule of diabetes or rule of safety or anything like that, if you're ready for it, you can afford it, your insurance covers it, there's no reason you can't have it right away. And please don't let a doctor's office tell you otherwise. Right. I've, I've seen people, circumvent their doctor, go to the company and say, I want this and they send a request for a prescription back to the doctor's office, who often just signs or signs it and sends it back, you know, right. So they'll tell you to your face? No, six months? Why six months? That's how we do it not a good answer for anything, that's how we do it is a bad answer. And then they'll just sign it when it comes to the office.

And I think the unfortunate thing about that bad answer of that's just the way we do it, or we have to wait six months, there should be explanation behind that, it. To be clear, it's not just a random response, there protocol goes a little bit deeper, especially for newly diagnosed to make sure that there is a certain amount of insulin, that actually does work better, once you reach a specific amount of total daily insulin. Most often pumps of any kind, whether it's with an algorithm, or just conventional kind of pump will typically give you better results with a certain amount of insulin that you use. So if you are in that early phase of six months, using very, very little insulin, and the doctor is like, Nope, it has to be at six months, well, what if at nine months, you're using still a really tiny amount of insulin, then it's no more appropriate than it was at two months in. Right. So I think there needs to be better explanation to that, quote, unquote, six month rule if there is one. And also, to go into that, you shall also shouldn't have to prove yourself to be able to get a pump. If you are actually utilizing enough insulin. And you're trying as hard as you can. You shouldn't have to perfect what you're doing to get the use of a pump. The use of a pump should actually help you to perfect things more.

Because I said so not a good answer. And the idea of like six months, as an example, is probably just what the the average of what the doctor expects, in your example where they're probably just guarding against a honeymoon situation where you don't need very much insulin to begin with. And a pump won't work for you. But it would be nice to have that explanation. Correct. Not just be told. There's this arbitrary date come back on this day and it'll be and by the way, when you come back in six months, and they start the process then it sometimes can take months. After that to finish the process so correct. Why don't we get this going now and you know, be ready, I listened the next bunch, a friend told us not to leave without a CGM. The best advice I ever got, I didn't have a Dexcom for three months would have made a big difference. Advocate for yourself, advocate for yourself, the more you know, and show the Endo, the faster they approved devices. So this is you just said it shouldn't be this way. And I agree with you. But it doesn't make it not true. That you are a little in there. proving yourself, you don't even interact. And that's that's tough, because I get the doctors might not know you, and they might not understand your ability to understand things. And they're judging everybody. But I mean, listen, I treat it like a first date. That I mean, let's go in there. Keep my smile up. keep my back straight. I'm not a lunatic who will kill anybody with a CGM or insulin pump. Please give me one. Thank you.

Exactly, yeah. Well, and I think it also brings in, you know, a bit of treating somebody almost as if they're an idiot. Honestly, if you tell them well, you can't have it until this certain, like, arbitrary time, based on I'm so and so with the white coat on. And I just know about her, you're kind of making the person who's coming in and actually living this minute to minute 24/7. At home, you're making them feel dumb, when in fact, they're the ones with the amount of data that could prove that they could benefit from something if you just kind of listen to them.

Just that the listen and have an actual back and forth conversation. And you're done. This person here, begged their way into two months of Dexcom samples at the hospital. That's impressive, Madam or sir, whoever did that? Well, that's impressive. Yeah. Okay, let's skip past all the ones that say Don't leave without a Dexcom advocate for tech. It's interesting. I also wanted, I would have loved to know about the eye port so great is because that would have been so much easier on my boy versus sticking him so many times. So I port Medtronic owns that right? Yeah, trogons iport. It's this little, it's it. It's like this little disc, right? It adheres to your body. And then this will get Jenny's looking at me like Go ahead, buddy. See if you get this right. And then your your. So there's a cannula in it is my expectation. Yeah. And then the syringe goes into the port, and you inject without having to poke the skin over and over again. Correct. The

eye port is a really nice, I think for for a number of different reasons. One early on, can reduce, it can reduce the amount of injections all over the body, it can get somebody on a second note, a little bit more comfortable with actually a pump site, if that's the way that you eventually want to move, and many people do. And especially for little kids who can be more prone to picking and pulling things off. It's exactly as you described it, it's almost for those who are already pump users. It's like an infusion site for like Medtronic or tandem pumps. And it has a straight in 90 degree cannula that just pops under the skin. And that leaves a hole essentially, or a tunnel in which you put your syringe right in and you deliver your insulin dose basil, or rapid acting insulin into that site. And the nice thing is that you can leave it on for several days, just like a pump site. And so you can put your injected insulin right into that place over the course of a couple of days. So absolutely. It's a wonderful, I think, really really underused tool. Add an apt sort of initial diagnosis.

Okay, next person. This is long, I wish we would have gotten a pump sooner. Oh gosh, them three years. I wish someone had put in a script for a libre for us before they gave us a Dexcom Okay, here you go is the person who would prefer Libra in those first few weeks after diagnosis? Were some of the scariest of my life. And a libre. Oh, I'm getting this now a libre would have allowed me some sleep. So I think Libra is cheaper. I think so they're saying I could have been no disrespect to libre, but I think what they're saying is if I couldn't have got a Dexcom at least I could have gotten a libre. It's something that I could have scanned and looked at once in a while. I was so worried that something terrible would have happened during the night and I'd never know about it since our room was on the opposite side of the house. A reminder that people have done this for years was nice. With only a glucometer so please remind people that too, okay, I will hold on last second. And sometimes lack of tech can be crippling, even though things will likely be just fine. She makes some good points in there. And I do say that to people, especially when they talk about like the warmup time for their CGM or something. I was like, you know,

do a finger stick? Yeah,

you just, it's not that hard. What are we gonna do? And I was like, you could use your meter. And

that thing over there as for and I do I mean, we're not laughing to the point that I understand. You know, little kids or, or people who are, you know, worried or frightful of that type of I get it. I get all the worries. But honestly, if you can get over a five second screaming because you want information, at least you're calm now because you know where things are. Right, so just do the finger stick.

Yeah, I agree. I wasn't laughing at people. I was like, You're phrasing so far, you've made me laugh to myself twice once it came out that was there. And earlier when you change into your doctor's voice, it reminded me of one of the claymation Santa Claus shows. Like Rudolph kind of one. Yes, yes. When one of the characters pretends to be another character, and they go into a deeper voice. I was like Jenny definitely grew up watching those claymation shows. Oh,

absolutely. I did I make my kids watch them. I don't know if they enjoy them. But I make them watch them because I grew

up. I agree. So okay. That's funny. I

didn't know I had a doctor voice. Yeah, you,

you went into like you even like you like, you straight up your shoulders, and everything was fantastic. Okay,

I, this one's I don't have a white coat on, though.

No. But you could gently I'd give you a give you a degree before some of the people I've met that are dark. Ah, this one's going to be interesting because you see the mindset of this person. But I could make the exact opposite argument. So they said I advise people to push for CGM, but don't be too anxious for a pump. And they do say I'm sure opinions vary on this. But we're still MDI after 11 months, and it has taken us some time to learn how to Bolus how basil impacts and how to monitor the ups and downs. While a pump may take a lot of the workout, I feel like learning MDI in advance is valuable, sort of like learning math by hand before using a calculator because at some point, if you go off a pump, you'll need to know how to do MDI. Now, it's not I don't disagree. But I don't understand. I don't know if that feels conflicting. I don't disagree that it would be great to know how to manage to MDI. But if you know how to use a pump, you can reverse an MDI and two seconds, you can reverse engineer it, you can't reverse engineer MDI to pumping. Does that make sense? Or am I wrong about that?

I don't think you're wrong. But I think that you have you have a broader perspective on insulin than this person manipulation. I guess that's that's the best way to say it. Because I actually am more the I'm more agree with the person. I think oftentimes, there are many people who get a pump before they have figured out insulin use on MDI. And there's there is value to it, whether it takes you three weeks or six months to figure that out. It timeframe is based on what you have, I guess, done the homework to understand. So a pump could be beneficial at any point doesn't have to take this long or the short of time. But I think MDI makes a good point here that if you do have to go back to MDI, after being on a pump, and you have knowledge of what you did, for how at least your life was at the point of using MDI, then you have a base to start at. So I, you know, I think it's, again, person to person. I also think with technology and stuff today. We're using a conventional pump before starting out on an algorithm driven pump is very, very valuable. Because I mean, we all know technology will fail. At some point, your tech will not work the way that you want it to work. You have to have someplace to step back to. And if you don't know what to do outside of what the algorithm has been doing for you, you're at a loss. Yeah,

I just sent a text to Arden to help her understand her algorithm. She's looping and I texted her end up end of your Let me see how I put it. So this is me trying to teach her something I said old pump site algorithm needs some help from you. And I don't know what she'll take from that or not take from that. But what I see is that the loop is micro Bolus thing like crazy and, and not getting what it wants. And so she either needs to change the site now, or make a larger Bolus if she wants this to actually go her way. And I don't see how I'll see your point. And here's what I'm taking from all this. You should not just flat out listen to anything you hear from anybody, whether it's me or Jenny or anybody else, just because and you go online where people say things like, definitely do MDI first. And then you hear that and go, Okay, that's a rule. Or, or I say, you don't have to do MDI, firstly, go, oh, the guy on the podcast said, you don't have to do that. That's not how this goes, you have to figure out like, this is MDI, I'm going to shoot some insulin, I'm going to have to give more. This is what it is. Do I want to do that? Do I want to do this? Like, who am I in this situation? And that's hard to figure out? I guess. So. I guess listen.

And also, I mean, readiness there, too. You know, we're talking with a lot of people who have kids in the picture, right? There are there are many kids who aren't, they're just not ready for all of that stuff on their body. Yeah, they're just not. And you as a parent may be ready for it for some of the precision that you think it's going to bring into the picture. But if your child isn't there yet, it may bring in a ton more frustration,

right? It's not Harlan, it's just not time. Right. The first thing you said in this episode, I'm gonna say at the end of it, which is if you get one thing, get a CGM. Yes, that's where you start. Everything else is great. And, but it's not the first thing like a pumps not going to tell you your blood sugar's go in under 50. That's pretty that's pretty much it. So alright, I want to keep going here. This person says ask about newer products, like, for example, for us v ASP as an insulin, because they wanted something that moved quicker, but the doctor's office was talking about older stuff, especially with Basal insulin when you're MDI if somebody's handing you Lantus or levemir. At this point, there are more modern Basal insulins that work better. So you know, knowing that is helpful, especially when you you know, using that as an example when suddenly you think every, every 18 hours, your blood sugar goes up for no reason. That might be because love Amir doesn't really make it 1224 hours, you know, you don't know that there's a variable you're never going to know as a new person with diabetes. So if you can get what are they true Siba

to jail as a Glar. Yeah,

the more modern Basal insolence and other stuff like listen, I do an ad for Contour. Next One meter. And in every ad, I say, not all meters are the same. As far as accuracy goes. So when the doctor reaches out to you and goes here, from my drawer, just keep in mind, those are in the drawer, because the pretty girl from the company that came in with them, gave them to him and brought him bagels, I'm assuming, I don't know if that's still illegal or not. But at the very least, she was pretty and smiled a lot while she was doing it. And he was

he was a very handsome man, he could be a very handsome man as well. A very

handsome man could have come in I listen to any variation to the doctor could be gay, gay man came in straight man came in and we found attractive doesn't matter to me what I'm saying. We're sending pretty people into these doctor's offices with big veneer smiles and handed out stuff. You don't know if you got the best meter or you got the meter that was in the drawer. So ask, say, hey, is this accurate? Or they're more accurate meters? It told me about that. You know what I mean? And I think that goes for everything you just for me, it goes back to insulin. When Arden was diagnosed, I thought Novolog was insulin. At the beginning, it never occurred to me that there was another brand or right blends

are well, and I think one step further in that too. While the doctor may have written a script for something, doctor isn't necessarily looking at what's going to be covered for you either, right? So you might go home with X brand glucometer or x brand of insulin. And then when you get to your insurance like well, we prefer you use this one

because we've got a big pile of them. But no, but yeah, best you can afford. It is you know is what I'm saying but don't don't just assume that what you were handed was the best or the most accurate or the fastest or whatever because it might not be person says please just take the time to learn about technology on the pod five looping any control IQ like keep opening your mind up to new ideas. I put well this person just ran through everything. Oh, how to this person says make sure you understand how to suspect if a cannula is bent. Hmm very interesting. I just heard a story the other day from somebody who had a long day of high blood sugars ended up in DKA. Got home and found out their cat. Yeah,

yeah. Yeah, I mean, and that is part of you know, we, we consider technology, just the actual like, pump or CGM or even glucose meter, right. But the pieces that work with the technology also go into what it does for you. So absolutely cannulas, you know, if you're having problem after problem with your particular cannula, pump companies will if you mean Medtronic in tandem, which use you know, a different set or you have options within the infusion sets, call them and say, Hey, this isn't working, can I try a different kind? Can I try angled versus 90 degree? Can I try the steel cannula versus, you know, the more flexible kind of plasticky one, there are options. So that consider that part of technology too. And that one size doesn't fit, all

right. There's this really great story, this person told here about iport, I'm just going to boil it down to like two, yay, two ideas. But her son had anxiety about injections was crying all the time, started saying how he hated his life, and then started skipping meals to avoid shots. And the eye port. She said save them. Because it sounds to me like he was on his way to, you know, some sort of an eating disorder on top of everything else is a meltdown. You know, so simple little thing. And there, I mentioned it doesn't cost anything and iport get, you know, like the tiniest little things. I wish Okay, what does a normal graph look like? This is interesting, they found it interesting to see what a normal graph look like, or just a well, you know, manage type on graph, we got a Dexcom with no idea what our big data should look like. And it took me like, right, and so now they get all the data. And they're like, Well, what the hell does this mean? Look like this is this right? I had to find someone's random blog, I did a bunch of googling. I found graphs for people who are wearing them who don't have diabetes, I have found people who were the data without a control set doesn't help. CGM should come with sample data and give parents and users something to shoot for an idea of what should happen after meals, like the effects of Pre-Bolus Singh versus not Pre-Bolus ng versus high GI versus low carb, etc. Data more data, not just here's the CGM don't let her fall between 80 and try to stay in range 70% of the time, the endo recommendations still piss me off three years later. That's a good point, like it is yeah. How do you know what you're supposed to be doing?

Right? I mean, they give you a range. And that range does differ. Practice to practice based on a protocol that they are trying to follow much more of a, like, a true protocol versus what their, what they feel comfortable telling you to aim for. But it doesn't tell you what that graph should look like, in that target range. Right? Should it be okay, that it looks like you're on the craziest roller coaster that you've ever been on in your entire life? Should it be smoother? Should it have no lumps or jumps or bumps at all? You know, how often are lows? Okay to see, how often could you expect? Or what could possibly cause a higher blood sugar that you're not expecting? And how to analyze that? I mean, all those things? Definitely, I think a piece that's also missed, because it's very buried in the manual that nobody reads for any product at all. But I mean, it's it's highlighted, highlighted in terms of described in the Dexcom manual about what the end arrows mean, the rate of change? I think that I have talked to maybe two people in the many people I've talked to, who actually knew before I brought it up what the arrows meant,

right? Or that How about a steady arrow doesn't actually mean steady all the time. You might be vacillating. A little bit with a stable arrow. Diagonal down is one rate of change a single arrow down as another rate of change two hours down as another rate of change, same as going up. And it is spelled out. You know, it's so interesting. You say that, because I think that all the time, like for all the visual things that people share about diabetes. You never see that image anywhere. It's almost like it's almost like nobody knows maybe.

Right? Right like I should I think that it should be a page that has one of those tabs. On the outside that says, This is important. Turn to this page.

Sticky Note right on that. Well, you know what, I'm glad you brought that up. I'll do a post about that and try to remind people, that's a great I know, this person says get a great blood ketone meter. Interesting. We have the precision, extra extra. It's a blood. It's a blood ketone meter. Big Deal stops you from having to pee on things. You don't use it very often in our situation, but it's great to have I sent one to college with Arden. And I remember holding it up going, you remember what this is right? I was like, if you get sick, I'm going to ask you to find this. And she's like, she's like, okay. She's like, leave me alone. Urine ketone test strips can be messy with young kids. They can be messy with me too.

Well, and not precise. I mean, what is mild? Versus it looks like it's in between mild and moderate. Like, do I do something differently? Right, the color change is not purposeful. It'll give you a little bit of information. But again, keep blood ketones are right now information just like a blood glucose value is right now here. Whereas urine ketones, it's older data. It's a collective of ketones, but it's not truly what's right happening

now. And your doctor should give you sick day rules for how to how to Bolus for ketones. And it's nice to know that you have point five or you have one or whatever, because it's easier to make that Bolus this person said they paid out of pocket for their first X Games. He's like, I didn't know what diabetes was. But when somebody told me what that thing did, I was like, I'll take one now, please. So that's, you know if you can do that, that's amazing. Yeah, I wish they would have been able to give me a pen, not a syringe. I told them to train with a pen in the future. I didn't even know how it worked until we got home. And they showed me but I had to do it the first time alone. Oh, okay. So she trained on syringes. And then someone just said, here use this insulin pen instead. And

it's different. Yeah. And they did. There's a different strategy. And yeah, dosing could be wrong if you're not using it the right way. The needle caps. I mean, there's a whole slew of things about using an insulin pen. And I think in terms of this being, you know, about technology, I wouldn't want to not mention in pen.

Yeah, no, it's really something because you get, again, I'm gonna sound like an ad, but you get a lot of the functionality of pumping with the insulin pen. And yeah, I say it's like pumping without a pump. Yeah, no, it's really terrific. I do think people should check it out. I do think I'm, I think I'm contractually obligated to say from Medtronic diabetes every time I say we're not bad, so I'll get past this person. This person said we hesitated to move from finger sticks. But gotta libre and loved it. Excellent. No, I sent my son to school five days after being diagnosed and I was terrified. I called the nurse about eight times a day to check his blood sugar. We did not have a CGM was the hardest thing for me personally. You know, that's another good point. If you have a CGM that shares data. I don't know if libre does. But Dexcom does, right. You have followers, people can see that it's incredibly comforting. Oh, I the fact that a monitor can have a variable range, a glucose monitor can have a variable range blew my mind. And I did not see how we could trust it. Now. This is very common. Jenny, are you good on time? Do you have to go? I've got about 10 minutes. All right. We can get this done in 10 minutes. This happened to me. I recently told the story somewhere but the nurse came into the room she had this big expensive looking meter checked Arden's blood sugar with a meter. Then gave me the freestyle like little white. Yeah, whatever. Whatever they gave me like it looked like it was it was like I came out of a bubblegum machine. I always say they checked Arden's blood sugar with that. Arden's blood sugar on the meter, they were sending us home with an ordens blood sugar on the one from the hospital that looked like it costs $10,000 were significantly different. And it paralyzed me. I was like, You're telling me to make decisions about insulin based on this thing? isn't yours more accurate

is can I just have this one?

I try it I was like, give me that one. She's like, I think it cost like 10 grand. I was like, I'll steal it just like give it to me. You know? That's what this person is saying. That the minute I realized these things aren't perfect. I did not know what to do. All I can tell you about that is get the most accurate stuff you can afford. And never think about that again. I don't know what to say.

Well, and because even as As most people who've already been using a CGM know, if you do have to calibrate it, you are calibrating off of a finger stick, you want that finger stick to be as accurate as possible. So now that you're tuning something else, that's going to give you many more data points to be more accurate.

I listened. I say all the time. I don't know if people believe me or not, but the people who advertise on the show are very carefully curated by me. So I'm not just I'm not Hawking a Contour Next One blood glucose meter because they they knocked on my door and asked to buy an ad, somebody else knocked on my door and asked to buy an ad. And I said, I'd rather do one for contour. Thanks. So you know that just surrounding yourself with as good of data as possible, is the best thing but that part in there the part where you like, well, this might not be right. I guess the answer. There's a lot of people living with diabetes, and they're all okay. Might be the thing you say here. Okay. I wish I would have known about sugar meat. Okay, third party apps that also give you data. That's great. The different CGM options. That's interesting. So somebody told them either libre or Dexcom. They didn't know there was a different company. Getting the T slim help for my mental health because I started sleeping. algorithms can help you sleep. That's a good thing to know. What are the different glucagon options? That's a great, right. So right now there's, there's old school, are they? Oh, no, they're being discontinued.

As of the end of December 2022. The old school red Lily glucagon box will no longer be available. That's, that's it. And then there's, there's G voc which comes in multiple different like, options, as well as the back shimmy, which is the nasal glucagon.

Okay, so right now, G voc and back to me are the ones that are available. There's a third one coming, isn't there? I don't know.

Now. Of course, it's not in my brain. Can I tell you the talked about it not too long ago in our staff meet AI. It's escaped me. Sorry.

It's interesting. Here's a little back back room. The only reason I know about that is because the company approached me to buy ads. Oh, and I said, I'm sorry, I already take ads from a glucagon company. That's the one we use. I apologize. Can't do that. But that's the only reason I know there's another one coming from how to use a lancing device. Don't laugh at me. It says first time I tried it out. First time I tried without the top and kept stabbing my finger until it bled. Oh, so they weren't clicking it they were stabbing

stabbing which was the old you never had to use it. I we refer to it as the guillotine the one that snapped over it literally you pulled back this like post that had a spring you loaded in a Landsat to it. And then you put your finger Neith finger underneath the platform, you push the button and the thing literally jammed into

like pots. What I use is like pulling a long time pulling chopsticks apart and letting go one side right and it just snapped down.

Oh area go. Absolutely. They were not nice. I mean, the good ones. Now I there's the Genteel. I know a lot of people use that one because it's very adjustable in multiple different ways. It is not a small device to carry around and use. But it is very gentle. Honestly. The one that I really liked the best that I like, baby because I know it's still in the market because I can still get the lands and

I tell you what you're gonna say. Yeah, ask the multi clicks. Yes. Multi clicks from X. Yes. Ardens Ardens just died. We kept going for like so many years. And we went to the fast clicks but it's not the same accucheck if you're listening, what are you doing?

Right? Yes, the accucheck is it are the the melty clicks was it was the best and I still I have the fast clicks because I couldn't get any of the things anymore for the clicks. And the fast clicks is certainly the next best in my opinion. But yeah, the those are another thing to consider because the typical ones that come with your meter. Yeah, many of them don't feel the greatest.

Get a good one. I listen, I could go on, I get you. You're limited on time and I have to get a couple of things. I could do a dissertation on what accucheck did leaving the multiplex and go to the fast clicks. It was a huge mistake. This is my opinion. I wish this person says I knew about different ways to keep insulin cool, like from gadgets to packs and things like that because that's a big deal. Right? Like you're MDI and you're moving around with insulin. Arden's going through it now because her classes are very far from her dorm. And so on days, she's she's kind of stuck taking insulin with her and a pump just in case we can't, not how she's used to traveling. So we had to go over that with her.

Did you guys get it there is a really good device. It's called the Vivi cap. Vi VI, the Vivie cap,

if that was just for pens,

it is for pens, but at some point, I do know only having talked to them at the educator conference. They are working on one for the vials. Yeah. But right now the Vivi cap is just for pens of any kind. So if you carry your pens with you, it's it's an excellent

option. Well, I hope they make one for vials. Because Arden's in a hot weather climate right now. So she's using a tiny little, like, very hot. Yes, she's using this tiny little Yeti thing that she has to throw ice in and then throw the thing and to travel around with her insulin every day. And there's already been days where she's like, look, I didn't take it with me. Because what, what about the frill get wet? If I trust me, I know it works well. And if I asked her to do that, she'd be like, I'm not carrying a wet bag around with me. It's definitely what I would hear from her.

Yeah, it's not I mean, I use it for my travel. But again, she has to do what she can do.

Yeah, trust me what she's going to what she did was she set up with her counselor that if she needs to go back to her room, she's allowed to call Campus Security and they'll zipper back to change your pod real quick. So that's awesome. Talk about getting the combination. That was a pretty good. Last couple things here. bracelets. Okay, I just interviewed Jennifer stone the other day from Wizards of Waverly Place who has type one diabetes, and she's talking to me on camera, she lifted up her hands and I brought up that she was wearing an ID bracelet. She said nurse now as well as being an actress still, I think you just supposed to say actor but and she said yeah, it doesn't take too many people coming into the ER without one of these Alon to realize you should be wearing one. So mine never comes off. I know Jenny's always got hers on.

I don't I don't it doesn't it never comes off. Yeah, I made sure that I got waterproof, won't tarnish won't rust won't blah, blah, blah just sits there so well. So

that's it. I mean, that's everyone's list about technology and data, or technology for diabetes. Excuse me. I mean, from my perspective, I mean, we've been using Omni pod forever. I can stand behind it. I also talked to a ton of people who love control IQ. To me, I think it comes down to to Bolus versus tubed and what you want. But yeah, this is it. No one's going to explain it to you. You gotta get out there and figure it out. So hopefully this will help. Cool. All right. Thank you, Danny. I appreciate it.

Of course, you're welcome.

I hope you've been enjoying the bowl beginning series. I want to thank Jenny Smith for lending her time to it. And of course, I'd also like to thank Dexcom, makers of the Dexcom G six continuous glucose monitoring system and Omni pod makers of the Omni pod five, get yourself some automated insulin pumping with Omni pod Omni pod.com forward slash juice box or to find out if you're eligible for a free 30 day supply of the Omni pod dash use the same link. In just a moment, I'll go over all of the episodes that are available right now in the ball beginning series. And I was like in a sorry about that. But first, let me tell you if you're living in certain countries in Europe, the Dexcom g7 is available already. And you can still use my link for that dexcom.com forward slash juice box. Today is the 20th episode of the bowl beginning series and there's going to be 21 One more coming next week. So far, here's what we have. Episode 698 Defining bold beginnings. It's a toss up of what the series is going to be. Then 702 honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology Part Two episode 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 School 755 Exercise 759 Guilt fears hope and expectations 763 community 772 is all about journaling today's episode 776 technology and diabetes supplies and next week's episode which will be seven Adi think is going to be all about insurance. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Oh, and by the way, if you're wondering where you might be able to see this list, you can find it in the private Facebook group Juicebox Podcast, type one diabetes, right at the top, under the feature tab. You Oh, are you not in the Facebook group? You should be it's really cool. 30,000 people all using insulin, asking questions, answering questions, being supportive. It's the most unfaced book like experience you're ever gonna have. It's actually nice. And it's free, free, mean, Scott, you're not trying to nickel and dime people to get access to information. So the Juicebox Podcast is ad supported. I don't want your money. That's it, I want you to have information, I want you to have access to each other to community. That's all I care about. There are no classes, you don't have to sign up for any kind of, you know, $60 a month of call me on the phone. I'm not going to give you 10 seconds of information in a podcast and tell you to come find me for the rest of it. I'm not up for that. But understand. I don't care about that. I'll make a living. But it's not going to be off your ass. You understand what I'm saying? That's all, head over to the Facebook page. Check it out. It's amazing. Listen to the podcast. It's amazing. And it's free. Everything's free that Juicebox Podcast brings forth. Everything is free to you as it should be. Having decent blood sugars and understanding how insulin works shouldn't cost you money. It shouldn't cost you a membership. You shouldn't have to pay a fee. You don't have to take a class, this this podcast, set your speed. You want to listen to the diabetes pro tip episodes in three days. Go do it. You want to listen to it over three weeks. Cool. Whatever is good for you. If you don't like listening, I've got transcripts on the website juicebox podcast.com. Go read it if you want to. You want to read a podcast. I'm not judging you couldn't possibly care less how you learn as long as you learn. That's it. Again, I thank you for listening, and I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 780 of the Juicebox Podcast. Welcome back everyone to the bold beginning series today Jennifer Smith and I are going to be talking about treating low blood glucose levels. At some point, in this episode, you're going to hear me tell Jenny that oh, this is the last one we're recording, but I might have made a mistake, so there's more coming. Anyway, you'll see 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. Remember that while you're listening, please. If you have type one diabetes and are a US resident, or you're a US resident, who is the caregiver of someone with type one, can you please go to T one D exchange.org. Forward slash juicebox and complete the survey. Just join the registry complete the survey takes fewer than 10 minutes. Absolutely HIPAA compliant, completely anonymous. Super simple answers to type one diabetes questions you already know the answer to your feedback helps other people living with type one, t one D exchange.org, forward slash juicebox. Omnipod five is the first tubeless automated insulin delivery system to integrate with the Dexcom G six. And now it's available for people with type one diabetes ages six years and older. Wait till you see smart adjust technology in the Omni pod five. It adjusts insulin delivery based on your customized target glucose helping to protect against highs and lows both day and night. Anecdotally, I am seeing so many people in our private Facebook group using Omni pod five and loving it. If you're interested in automated insulin delivery, I'm talking about a system that adjusts with your blood sugar, blood sugar tries to go up, it adjusts tries to go down. It adjusts automatically. If that's something you're interested in, head to Omni pod.com forward slash juice box and learn more about the Omni pod five. If you're not looking for automation, right now, you're probably going to love the Omni pod dash and you may actually be eligible for a free 30 day trial of that dash. Again, head to Omni pod.com forward slash juicebox to find out if you are now if you'd love that, but you don't have a Dexcom this is easy to fix dexcom.com forward slash juice box head there now click the link get started with Dexcom G six today. What are you going to get with Dexcom? G six? How about glucose readings right on your smart device your Apple or Android phones don't want to use a smartphone no problem, use the Dexcom receiver along with those devices comes customizable alerts and alarms. So you can set your optimal range and then get notified when your glucose levels go too high or too low. You can even share that data with up to 10 followers. That's pretty crazy. Think about it like your, your mom could like you could be like 40 years old be like Mom, will you watch my blood sugar because at night I don't wake up. If you're planning on moving to an algorithm based system, you should really look at Dexcom or if you just want to be able to see your blood sugar, speed, direction and number again, Dexcom I can look right now. Boom, my daughter's blood sugar is 77. It's steady right now. I saw it that fast. Right on my iPhone, you could do that to Dex comm.com forward slash juice box, head to my link right now fill out a little bit of information and you're on your way. Thank you so much for listening to the ads. There are links in the show notes of your podcast player or links at juicebox podcast.com. If you're unable to remember Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box. Now we're gonna get you to Jenny and I talking about how to treat low blood sugars. And there's no ads the rest of the way I'm gonna hit record Jenny to tell you this little preamble bit that I normally would have said ahead of time, but what we're done, you and

this is the last one we not yay, I should say, Oh no, we're done.

We're done with the bold beginnings, then we will move on to the long list of things that I have to do with you for next year. So but I'm gonna throw a little curveball in here. So you and I were going to talk about insurance. And then we were finished but I'm going to bring somebody else in to talk about insurance. Cool. So because otherwise it would just be you and I you know talking about our experiences with insurance which might not have answer some of the people's questions.

No, I think that's great. Because I think there are quite a number of people that definitely know more about the navigation. And I think in terms of this topic, it's more how to really nudge yourself into insurance and get what you need and get to be able to talk to the right person about it. Yeah. So I think that's great.

Yeah. So you and I would have done, we would have had fun. And I would have told stories about yelling the F word into phones to get art and things. I can do that with someone else who can also hit the technical sides of it for us a little awesome. So instead, you and I are going to add our very last episode to the bowl beginnings series together about how to treat low blood sugars. Oh, right. Because you get diabetes. And nobody says to you, hey, you might get low. And the low might be slow. And it might be fast, and it might be harsh, and you might be dizzy. They just say if your blood sugar gets low, eat 15 carbs, wait 15 minutes. And then it

might respond really fast. Or it might not resolve for a couple of hours. And you're thinking, Where did the food go? So,

so I so I want to kind of talk through a number of scenarios. And I know, I know, I'm dropping this on you out of nowhere. And of course, is that is that anything new? No. But I don't have any notes whatsoever. Like we've been doing bold beginnings off of people's questions. So, you know, we might have gotten lazy because we're like, oh, we don't have to drive this conversation. I'll just wait and see what this person said.

Well, I'm sure there are probably lots of questions that have come in about low blood sugars.

There may have been but they were not. They were not called together for me for the situation. So we're just going to fly by the seat of our pants, which I think will be fine. Not like before. Alright, so let's think about this. Your newly diagnosed, and I guess the first thing we can consider is that you might be honeymooning, still true. All right. So if that's happening, if you're getting help from your pancreas that you don't expect, you might see protracted I saw somebody online the other day whose kids blood sugar was like low all day. And she's like, this has to be a honeymoon because like we're not doing anything different than we've done in the past. So I guess if you're MDI, and you start experiencing low blood sugars, that seem like they're being I guess, impacted by your pancreas, still, you can't cut off your your Basal insulin, because you've probably shot it already that day. Correct. But you could start limiting. I don't know, would you

limit your Bolus insulin? Right? Right, or you could look at for that day, making your insulin to carb ratio, more conservative, you know, if you're floating around at a ratio of an in honeymoon, when kids and even some teens might be a one to 30 ratio, right? You could suggest one to 45 or one to 50. Or right if you know that you're floating, pretty stable when there's not food introduced, but the stable is low and you're having to give it a little bit of carb to keep it from like dipping, then it would be the Bolus is that would be the easiest to adjust in that day. And in looking forward into the next day thinking, this might be what it is. You could downplay your basil that day. Whether it's morning or evening time dose, you could take it down a little bit, and see if then the next day floats just slightly higher, and leaves you without having to add so much extra carb

to treat. And on the day that you get surprised by it and your basil is already in. You can kind of feed the basil a little bit for the day. Yeah, right and bred out and spread out carbs to cover the timeline. But so this is where you need to understand the difference between like a faster acting car but a more sustainable impact, right. And so if you're being drugged down constantly over hours and hours and hours, a couple of skittles might stop it for a minute. But the minute you bounce back up again, and this extra Basil is there that you don't need you're gonna get drugged back down again. So you need foods that are slower to digest. Right? You start you start reverse engineering your problems from diabetes and using your problems as solutions right like, right if you ate pizza that might take that might sit in your system for hours and hours and hours impact you so what a great opportunity to have pizza a little bit of pizza or what are

pleading some proteins with some carbs. Right. You might want to treat if you're done hoping or lower already. If you do, then knowing what you just said, you want some sustaining power after that to not drop yet again, you could do something that incorporates some fat and protein in it to hold things level because again, the other consideration that if if it is a honeymoon based, like drop in blood sugar, it could be that anytime your blood sugar does nudge up from what you treated with simple sugar, it could be that your betas are also like, Oh, look at that. There's a rise in blood sugar. Let's give some help. And it doesn't really know that you've got Basal injected, that's also there.

That's C you know, isn't that interesting that you brought that up? It didn't occur to me that I've always just thought of it is like you're getting help from your pancreas, but your pancreas seeds the carbs and attacks them while the insulin you've learned the manmade insulin you've put in is also drawing your blood sugar there. Oh, wow. So you have dumb insulin and smart insulin working at the same time.

Correct. And common time for that in honeymoon is overnight for a lot of people actually, where they may have corrections that work pretty well in the daytime, despite them being really tiny, you know, miniscule amounts of correction. But I've got person after person that says I can't correct unless my blood sugar's 300 At night, because if I correct with just a minor half unit of insulin, I'm sitting at like a 60 blood sugar.

In this reason we're newly diagnosed people.

Correct. It's specifically more honeymooning. I mean, you can even see it on nights where blood sugar is going up. You don't correct the high blood sugar because you have the hindsight to know what's coming. Blood sugar could hit 202 20. And it downplays in your wake up in a beautiful number. That's, that's not injected Basal that did that. Your body helped you?

Yeah. Okay. So that's one kind of low, you could experience now another one might be activity, right? I'm trying to think of I'm trying to put myself in a newly diagnosed person's situation, right? Like, they go back to their life, like I have diabetes, diabetes isn't gonna stop me. And then they go play tennis, and then their blood sugar falls really quickly. There we need fast working sugar, correct something that's gonna hit you very quickly, and stop this freefall. So if you're in a freefall, for whatever reason, you can't eat. That's not the time to have a slice of pizza.

That's not the time to have peanut butter cups, the slice of pizza, the nacho meal breaks, not

because that's because you're going to keep crashing before it has an opportunity to start digesting and to stop you. You're looking for simple sugars. I mean, in emergency situations, I know, I know, people don't seem to talk about glucose tablets anymore. Like they've become persona non grata, right. Because they taste achy,

they're not the greatest. I mean, they are they are okay. I think the greatest thing about them for me personally, is that I am never going to over treat with glucose tablets. Right? I mean, they do their job. They're doing the job that I want them to do. But they're not like a bag of I don't know, licorice, like licorice. I like black licorice.

So you might be like,

easy to keep eating with a low blood sugar.

Well, that is one interesting thing that there's a plus for for glucose tablets, you will you won't eat them for fun, that's for sure. No. Gel. I mean, I don't even know Do people carry that still, they should write it,

we should and or it's easy, especially if somebody needs to help you. Because you can just get it into kind of the gum line and sort of massage it in it. It does work really quickly. So if you don't love the taste of glucose tablets, the glucose gels might work really great. There's a nice liquid glucose that I just heard about two that I really liked. Okay, so

but, but in general juice boxes, people are gonna use Skittles gummy bears stuff like that. Right? Correct.

Exactly. But the another good thing as you bring up glucose tablets, glucose, or dextrose is the simplest form of sugar, right? So your body doesn't have to go through this breakdown of the structure of of sugar if you will. And so it gets absorbed really fast. So if you're looking for candy specifically, you really want to look for candy that has glucose or dextrose as one of the first two or three ingredients because it's going to have the fastest impact on a low or a really quick drop that you want to stop.

Yeah, the timing so super important because I know a story about a person. I won't say their name, but they're an adult. And diabetes for a long time felt themselves getting low knew it. ate a bunch of carbs passed out And then just turned back on when the carbs hit them. They were just like, hey, I'm back. And so so there's an it's an example of having the timing wrong. Like you're falling at a certain degree of speed or rate of speed. And you need that sugar to come in, and to slow like a parachute almost to parachute that that number fall down and to stop it, you know, what a nice level sponsor don't go too low. So things need to work the way you need. I mean, that really is the message of this episode, right? Like if you're one if you're 120, and you're wearing a CGM, and you see this gradual fall, and you look back over at 90 minutes going down, oh, geez, like I Bolus for this meal, it clearly looks like it's too much insulin, I'm going to get low a half an hour from now. Well, there, you could just add some more carbs to your meal or have a couple more bites. Correct, you might stop that. But if that same 120 was falling quickly, you're in a different scenario, you need to use different carbs,

you need to use quicker, exactly the simple carbs on a quick drop. If you've got a gentle sort of glide down something that's a little more complex, like crack, you know, something like peanut butter crackers, I hear a lot kind of get used, because there's a little bit more to the cracker with the peanut butter added to it, right. So something like that could use it down. But if you're really, really dropping, then sugar,

yeah. And you have to, in the beginning, it'll be hard not to over treat a low. But that is a skill you need to learn. Because otherwise, the bounce comes and then you're like, I don't know what to do. I wish you have that fear from you've just been low. You don't want to Bolus like you get caught in that, that balancing rhythm. You don't want to be in that. So maybe you'll learn at some point to look at your situation and say, half a juice box here. Or, you know, take a couple of sips just have two Skittles, you know, I say to people all the time, just because you open the bag, doesn't mean you have to eat all of them. Right? Yeah, just eat what you need.

All right, which is also why those little tiny bags, I mean, this is a popular time of the year for a lot of people to end up stocking up on simple car, because we have Halloween coming up. Whether you celebrate it or not, it's a great time of the year to find really little packets of somewhere between eight and maybe 15 grams of carb, simple sugar, Candy really prepackaged. So the whole bag of Skittles versus the tiny little packet helps you to contain things a little more.

And if you're not lucky enough to have a CGM in the moment and you're just leaning on your, your finger sticks. How frequently do you tell people to after they think after they've identified a low or felt it and treated it? How often do you stick your finger and look, I find myself. You know what I mean? I use a lot more test strips in that moment than you do sometimes for the whole week

you do but you can expect that even simple sugars going to take a little bit of time for digestion, right? So you're really not going to see much shift. If you do a finger stick, confirm your low, treat the low and five minutes later you're doing another fingerstick you're probably not going to see much of a difference, right? So that's where old school was that 1515 rule. 15 grams, 15 minutes while you might not need or take 15 grams to treat this low that you have. Waiting about 15 minutes to retest will give you enough information to say well I treated it. It doesn't look like it's come up but it hasn't also fallen. So that should give you enough to say it's not dropping. Clearly, digestion is happening. Well, let's give it another 15 minutes and test again.

Yeah, you know, I have two thoughts. So one of them I'm going to make a note about and then the other one I'm going to say if you are wearing a CGM. Sometimes it will not register as quickly so you can see like a like, Oh my God, my blood sugar is 50 You know what I mean? And you take a bunch of carbs and and then there's this way to look at the arrow with the Dexcom at least I don't know how it works with libre, you'll you're stopping a low blood sugar, let's just say it's 60. And it's the arrows diagonal down and you take some carbs in and the next reading is 55 and the arrows still down. And then all of a sudden, the arrow will like sometimes disappear. Like almost like the algorithms like I don't know what's happening right now. But the number stays the same. Or sometimes the number or the number will get lower, but the arrow changes. And do you know what I mean by that? Yeah. And so your

whereas if you were testing in a look then it said 55 with an eight Build arrow down, you've treated it. And now you can see it has a horizontal arrow, but the number is reading like 51 or 50. And you're thinking, Well, what that really indicates is the system has found a stability, even though the number has slightly nudged down yet, it's not dropping, what you've done is actually making some impact overall. So it's not really time to treat with yet another like whole box of juice.

It's so weird. It's a weird moment because the CGM is a little behind. And what you did with the carbs is maybe more in the now, but you can't see it. And so there's like, there's like multiple things happening at once that the technology has, has difficulty showing you. But you can see that something's happening. And so that's when that's when I say to myself, Okay, now this thing looks stable. And we've gotten to, you know, readings in a row that say 50. But I want to know what's really going on, because either the CGM seems confused, and I didn't do well. And we're lower than we think. Or we're higher than we think. And I don't want to treat more, that's the perfect time to do a finger stick to me absolutely have to write

Absolutely, especially for those. Those numbers where you're treating I say at a number less than 60. Honestly, if you're varying at all and decision about whether I should do a finger stick or not. If you're less than 60, and you've treated it and the numbers on the CGM just don't necessarily add up. Or you're mentally not quite like with it enough with a low blood sugar like that. Just do a confirmatory finger stick, because at least that's going to show you real time right now. Where is your number? Yeah,

yeah. And I know we're trying not to over treat. But if you get caught and you don't know, like, this is the time you're going to hear me say I'd rather I'd rather just Hi. Yeah. Because Because what you're saving yourself from or saving another person from. We don't talk about very much like in diabetes in general, even on the podcast very much like it just doesn't get talked about very much. You're talking about becoming incapacitated. You're talking about having a seizure. You're talking about death, like you're talking about. There's a lot that happens between 40 and then I don't know how low anybody's ever been right. You know, but while they were still alive, I saw Arden's blood sugar. I saw Arden's blood sugar 22 once on a finger stick when she was really little, and she was okay still. And I was just like, keep eating, eat. Yeah, II keep going. And then all of a sudden, it was 30. And I was like, Oh, I might have tested moving, I might have tested her blood sugar 10 times in seven minutes. I was like, but But I mean, it's the truth, right? Like you, you have to learn to do this because you use manmade insulin and your blood sugar is going to get low. I just don't care who you are, it's gonna happen. So you need to know how to handle it or how to handle it for somebody else. And you need to know how to handle it without causing a problem in the future. Whether that problem is a high blood sugar, or calling an ambulance, like right, you're it's not. I guess we don't talk. It sounds scary. It's probably why people don't talk about it, huh? Yeah, yeah. So

it's absolutely it's it's more around how to treat. There's not even an emphasis on like the overtreatment. It's just treat it. But why, right? Why is it so important to recognize a low sooner than later or deal with it sooner than later? Or stop it from happening? sooner than later? Because there is that scary factor of? I don't know. I don't know why some people can have a blood sugar. I might the lowest I was ever was 26. Yeah, I don't, I was fine. My mom actually thought the number had to be bad. I mean, it was really old. I mean, this was like 1988. So clearly, the meters were not what they are today. But she's like, that's got to be wrong. You feel good, right? We were camping. Did it again, it was like it was pretty much the same. Just like you need to eat. Here's the juice. Where's it? Where's the regular soda? You know, why could I be there? And fine when somebody else could be passed out, have a seizure, need an ambulance need assistance? When their blood sugar is 61 and low. Right? Right.

Yeah, everybody's going to be different. And so so let me let me say a couple things here. I use a football analogy because it's football season, right? You can't like the reason the offensive linemen are these giant blobs of people is because they're trying to stop this insane force that's coming at them. Right? Correct. You can sometimes put carbs in and you I made such a mistake earlier in the day with insulin or, you know, there's just so much power on the side of the insulin. It's like the carbs aren't there, like you might as well not have anybody blocking because it runs right through them. Right? That's a panicky situation, the first time that happens to you, where you take in a juice box, and realize that it's, it's like you didn't drink it. If you're enjoying the Juicebox Podcast, and you would like it to remain free. Please support the sponsors. Today's sponsors are Dexcom G six dexcom.com, forward slash juice box, and Omni pod. Both the Omni pod five and the Omni pod dash are available at Omni pod.com. Forward slash juicebox. It's a hard moment, you know what I mean? Because this is what you know is going to work. And now suddenly, it's not working for some reason. And you're like, Oh, God, what do I do? You can't find yourself in those scenarios. Wondering what's in the cabinets? Or what's in my bag? Or what do we have in the car, like you have to be prepared? Correct all the time. Just, you know, anywhere you are. There are fast acting carbs. I don't give a crap. If you don't use them for six months. I don't care if they get stale, throw them out and replace them. If the juice, you know, in the juice box, get some spongy from being in the car in the heat. Throw it away, put another one in there. Like just don't. Don't ever find yourself in a situation where you're like, it'll be okay.

Right? Yeah, right. I mean, It's fall now. and I were just like rotating through. We don't really have summer jackets, but like into fall into the winter jackets, we're kind of rotating them into the mix, right? So I bring up my winter stuff. And absolutely in at least like one, if not two of my like fall into winter jackets. Their old, nasty bad glucose tablets, like they've gotten the like crystallized sugar like dots. And like, if I had to, I would still use this. So like that juice box that's like nasty and squishy. If that's all you got, you use the squishy juice that

spread them around your life, like your grandma's spreads around her reading glasses, do you know what I mean? There's just a pair in this room and over here, you need to be less ready, you can't be it's a weird scenario, you can't be scared, you can't live your life scared. You don't want to live your life with a 200 blood sugar because you don't want this to happen. Because also, that's not any safety from not being low. Right? As a matter of fact, that might put you in a situation where you're a little more frequently, but but I like to say about diabetes, that you don't learn these things. You don't prepare for these things so that you can stop a problem. The problem is always going to sneak through somewhere, it's never going to be where you think it's you know, because if it was where you think then you'd get ahead of it. Right. So you have to be ready for when it happens. And then the last bit of this is, if all else fails. I mean, please be carrying glucagon, you know, with you like not, it's in the cabinet in the kitchen. But we don't take it, you know, anywhere I left it in the car when I went pumpkin picking like it needs to be with you. Right. Yeah, exactly. So well, this is a fun conversation.

Yeah, it's a harder, I think it's a harder conversation than you think about before. Because there's a lot of there's a lot more on the back end of not taking care of a low well enough. That is actually scary. Yeah, and it doesn't get talked about. We always try to like smooth it out like not to worry about it so much and whatnot. But in order to not really worry about it. Preparation is needed to have to have things in your purse or your car or your backpack or, you know, at your friend's your friend's house that you go to all the time or whatever it is. I guess it's like being a girl scout or a Boy Scout. Be prepared how

to be prepared. Yeah. You know, when Artem was younger, she spent her whole day in one classroom, right where she went to art or something like that. So she had a bag and she took it with her when she hit middle school in high school, and she started having English in one room and math in another room and that started happening. We put supplies in each room. Like we didn't say to ourselves like she should be humping this stuff all over the place constantly. Let's put a little here there was a couple of juice boxes in every room. You know, it's interesting when you learn about your management to how come we're always restocking the English class. And never the math class. What's the time Yeah, it's the time of day we're doing something that's making a low around this time of day. It's actually an interesting way to learn a little bit about your management is where am I grabbing my supplies from? You know, do you think that do you think that every load is different? Because there's there are questions here from people that are like you know, after I stop a load with a fast acting, should I put a protein in every time time afterwards, but not necessarily.

Yeah, no, I mean, the idea. Again, it's kind of an older concept. It's sort of like the 1515 rule, it's 15 grams, 15 minutes, and then you essentially may need to follow that up with a snack. But again, there's lack of enough information about why the idea really was simple carb will typically help keep your blood sugar up for about 90 minutes, give or take. Now, again, a variable in the picture is why was the low there, if it's excess insulin, you may actually need to treat with more than what you thought you would need. But the other idea is that the simple carb to keep your blood sugar up is it's meant to sustain you for that time period, before you might eat again. So if you treat a low blood sugar at, let's call it three o'clock in the afternoon, but you don't typically eat dinner until seven or eight o'clock at night. Lows can bring on another low they can. So if you treat the low, but there's something in the picture that's keeping you lower, could be honeymoon, it could be excess insulin, it could be more movement in the day, whatever. You may actually for longer than two hours before your next meal, it may be beneficial to have a handful of nuts a spoonful of peanut butter a piece of string cheese boiled egg, whatever it may be. The the idea there is that that's a little bit more sustaining and or a snack that might have a little bit more complex carbs to it long with some protein to sustain things. So you're right every low is not the same right?

Art in tried art is a college right now. She tried to use a following blood sugar as a Pre-Bolus for her lunch. But it just didn't like she didn't time it well enough. So like at 60. But so listen, for anybody who's listening. Here's how I did it. Arden's in another state, she's 13 hours away. I'm able to look at her phone and see where it is. Right. So I use Find My Phone to see. Okay, she's in the cafeteria, so at least I know she's right. So now where she should be near food. I text her, Hey, what are we doing about this? Because she's got this like 70 that became 65 pretty quick. And then I looked at the arrow. And then I looked at the line and I thought this isn't stopping. Like this is not a low that's going to stop right like this is this is going to be negative 15 If we don't do something about it, right. What are you doing? I'm trying to like Miss like, you don't I mean, I don't want to be up harass Johnny. And at the same time, I don't need her dropping dead. It's College. Like I'm trying to find the middle. I'm like, Hey, what's up at nothing. Now I know she's with the food. So I'm like, you see this? Nothing. Art and I really need to know you're okay. I'm eating now. I'm like, okay, like the food's going in your mouth. Yes. But Jenny 6060 560-560-5550 5540. I'm like, Are you eating now? Yes, I'm eating. I told you. I was eating

what are you eating lettuce leaves?

What's happening? Like, you're eating like handfuls of sugar, right? Like, and so, but so I texted or test her. So then I sent a text to test her cognitive, like where she was cognitively. Right. And I'm just like, how do you feel? And she's like, I feel fine. And I'm like, Okay, have you been eating for a while? She said yes. So I said, Okay, I got it. There's food in there. It's working. The CGM hasn't caught up yet, but I had to stand there. for like three go rounds. That CGM watching that 42 Just sit there knowing she's not really 42. She's in the mid 60s already. I know. I know this. But I only know this from

you. Because you've lived with her. You've dealt with it long enough. You knew the questions to ask. You knew how to get her to respond and whether or not she was going to answer you the right way. And that it takes learning

Oh, it's yours. Because otherwise I would have been like drinking juice. I don't care if you don't drink the juice. I'm bringing you home. I'm not paying for college. Like I don't you know, like, you know, because the number because we've done everything's over come home and live in this room for the rest of your life. Because the because the number was so scary, right? But I was able to pick together enough information. I swear to God, that CGM. One more time went from 42 to 66. And I was like, Okay, I was right. But I'll tell you, you're like, oh my god, what if I'm wrong? You know what I mean? Like, I don't want to be wrong, but I might be the next thing I think we should bring up about Lowe's. Because we're in a we're in an algorithm world now right control like you on the pod five that thing that Medtronic makes i What is it? Which one is that? Let me learn the number Medtronic, don't they have an algorithm right now?

They do. They've I mean, they've had an algorithm for a long time I use as a their CGM. Right. And I don't know that their, to their algorithm have a name likes me pod five, six. So their new their new one in the ISC. The number is what you're looking for 770 G. And I know someplace I don't know if it's here. I don't think it's here yet. 780 G, I know is available in some places in Europe already. But seven, seven D 780. Yes,

I just I feel like they buy they buy ads for in pen. So I figure I, I owe it to them to learn the name. I just can't keep saying the thing that Medtronic has they're gonna be like, How about how about if you're not the podcast that we sell the embed on anymore? Like? Alright, so the 770 G, right. So yeah, so whether it's one of those algorithms, we all live in a new space now, where the algorithm sees a low coming, and it takes away and takes away and takes away your basil and takes it away. But it doesn't, it isn't always going to get it right. And so you might end up treating a low after a prolonged amount of time of not having any insulin. And then your blood sugar shoots back up very quickly, because there's nothing to stop it. And what does the algorithm do when it sees the higher number gives you more, it gives you more insulin, sometimes sometimes can happen. That's what I'm saying. It can happen that's a better way to and when that happens, here's what I know, for certain, yeah, gonna be low again later. Because because, you know, the, you know, when you're taking, you know, sugar in for a low, if you take in the right amount, you've been getting on a regular, you know, on a regular pump or on an MDI, you've still been getting your Basal the whole time. So you're, you're correcting that low more in real time. When you do it right algorithm, the algorithm thought it was going to stop you, it does not expect these carbs. And now you jump up and it Bolus is the number or it's pushing basil at the number that the other night. I guess I should have listed lupus one of those Arden had Jenny, I think it was around her period, and she was tired. She's rundown. And she's getting her period. At the same time, we had this whole day where she was a little too low. And it persisted into overnight. And so around eight or nine o'clock, we fixed the low and I said listen, take these carbs, go into the settings and shut off micro bolusing without carbs. I was like where this thing is gonna hit your your correction. And it's gonna push it back again. And she did that we went through the night really nicely. It was a nice learning experience for her because then she brought it up the next day. She's like, should I put the microbuses back on again? And I was like, Yeah, everything looks good now. So but anyway, you have to be aware of that. So I mean, I don't know what you do. Me.

I mean, there are other you know, for other systems, you can certainly also navigate something like that. If you've treated a low, you know that you've overtreated it, but the system is going to give back eventually, and you know that it's going to be too heavy, similar to your scenario there. The other systems do have, I guess, adjustable targets or different targets that would be higher. So then it would adjust less, if you adjust the target up and say, Hey, I'm aiming for this now. So as my blood sugar is going up, it's okay. You don't have to give me as much because I want to be higher

anyway. So like an example with Omnipod five, you might tell it to shoot for the higher range and that's correct. And yes, with I'll tell you what, in that exact scenario with Arden I said, I asked her what did you take for the low? And she's like, Oh, I had gummy bears. They hit her really hard. So I was like, Oh, crap, she's gonna jump straight up. But they don't hit her and hold her. They hit her and then they disappeared on her. So I was like, oh, no, no, don't let that thing Bolus again. Yeah, anyway, this probably all sounds much more confusing than it will be you have diabetes for a few months. It's all gonna make sense. Don't

maybe know they will. Yeah. There's still some things I throw my hands up. And I'm like, oh, clearly, like Venus is not in the right place in the orbit of something because I I just I don't know right now.

You're maybe just said Good. Luck is what I heard.

That is so not the case. Not the beginning of this is what you want to hear. Yes. Forget the maybe. I shouldn't say maybe should be like the point 1% of the time. You know, it doesn't take much to learn, especially with CGM is in the mix. These days. It doesn't take much to learn how much is needed. And as you were sort of, you know, talking into the effective algorithms, you'll see, well, gosh, I was used to using this much. I probably need to use a quarter to a third of what I used to use to treat it when I didn't have system that was helping me You know,

I saw a woman yesterday say, I don't know the exact numbers, but the gist of it was on control IQ I needed 14 or 15, carbs stop below and on Omnipod five, I don't need four or five carbs to stop below. So interesting that interesting. I found that incredibly interesting actually. So

especially system to system, given the fact that they're both doing a given take of insulin, but they are, they are very different algorithms. Yeah. So that it does make sense.

Alright, so check me on this. You need to know how to stop a low they're going to happen. You're not going to stop a low from ever happening. You need to understand the different impacts that these different carbs are going to have on your low blood sugars. After a while teaching yourself to stop a low without creating a high is a great tool to have. Yes,

if you it will happen. Yeah, yeah.

Oh no, you're gonna rebound high until you until you learn how to do it in a real panic situation. Screw everything else save your life. Correct. And that's it right? Have glucagon with you have snacks with you. Don't go anywhere without ways to treat Lowe's, the people who love you and are around you should understand how to help you if you're unconscious or unable to help yourself.

And I think another thing as you mentioned, caregivers or loved ones or you know, whoever. I think within that for Lowe's is recognizing the like what you mentioned about cognitive when you're doing kind of a check with Arden the people that are around you enough, should be able to tell whether you're responding or or talking or whatnot, the way that you normally would. And in the case that your CGM is off, or you aren't using a CGM or technology, somebody who knows you well should be able to kind of chime in and say, Hey, are you okay? You know, and don't be angry at them for that. It's just a, it's a checkpoint to be able to keep you safe. So

yeah, also for I guess, caregivers, low blood sugars could leave you with people who are difficult to YES to help, right? They could become combative, or and that's a real concern, especially as they become adults. And I There's one story that sticks out in my head all the time of this woman whose husband got low, and she just wasn't big enough to overwhelm him to do what he needed, you know. And she had to call 911 because of that. But yeah, I mean, the people around you just need to know. And people should be following you. If you have CGM. Like I don't know if liberi has follow like Dexcom does, but yeah, it does it. Okay. Arden is in a suite with girls. And the girl in the next room follows her on Dexcom Oh, wow, that's awesome. He only has a 55 alarm and nothing else. But we explained to her I'm like, if this thing's beeping, please go find Arden. And make sure she's okay. That's all. Yep. And it just, I don't know, especially for adults living by themselves or kids off at college, like somebody, you know, has your back because it also not everybody hears the alarms to like I had a low last night. It was only like 65. But I was sleeping. And in my sleep. I thought did I hear something? Like that was all I thought, right? And then I'm like, I woke up and I looked, and I was like, huh, yeah, I'm gonna watch that for a second. Because to be honest with you, it was a real slow drift. The loop had been taken basil away. I'm like, I think this is gonna bounce. Like, I think it's okay. I don't want to wake her if it's not going to be okay. And it waited and waited and waited. And then I was like, Oh, it is gonna be okay. It went back up again. But I talked to her this morning. And I was like, you know, you're a little last night. She has no idea. But since she had that seizure more recently, if you listen to her last episode, she will tell you about it. If she has a she experiences any kind of a quick fall while she's sleeping now. I don't know. I don't know how that rewired her brain but she's boom. I'm up. I drank juice. I'm good. Hey, Dad. I did this. Do you think this is enough? Like she never used to wake up. And now I know she's feeling the fall while she's sleeping right now. Which has only happened twice since she's been away. But anyway. Alright, Jenny. Did we know it? We did it? I think so. Yeah. Yeah. For us then. Yay for us.

Awesome. Thank you. Oh,

I guess we should say something like thank you for listening to the bold beginning series and I hope you found it like helpful.

Absolutely. Especially in the beginning when everything is so new. So

let us know if you want us to add to this series. If you go back and listen to it and find something that should have been in there that wasn't please send me a note. And Jenny and I will we'll add it if we think it needs to be added. Absolutely. Thank you. What are we doing? What are we best here so I

got nothing else to know right? But just hang around

Well, as I mentioned at the beginning, we've already found more stuff for bowl beginning. So this was not the last episode. Let me thank Omni pod and Dexcom. While I have your attention on the pod.com forward slash juice box, see if you're eligible for a free 30 day trial of the Omni pod dash, or if you're interested in the Omnipod, five, for full safety, risk information and free trial terms and conditions, you can also visit omnipod.com forward slash juicebox. And of course, thank you to Dexcom for being a longtime sponsor to the podcast dexcom.com forward slash juice box see blood sugar in real time, the speed direction and the number right there on your iPhone, Android, or on your Dexcom receiver. There's so much more I want to tell you but I'm on about day seven of this illness that I have and to be perfectly honest, editing the show together almost killed me. So I'm gonna go take nappy, and I'll see you next week with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 784 of the Juicebox Podcast. This is another episode in the bowl beginning series. And I'm so confused at this point not. It's not something good to admit to you. But I wanted this to be the last episode of Paul beginnings, but I think there's going to be some more so I'm not certain, I have to go back and look at my list and confer with Jenny and do a couple of other things. But for now, this episode of bold Beginnings is not with me and Jenny, it's with me and Sam. And Sam is here to talk to you about insurance. I know that is not exciting, but you need to understand all of the varied ways that your health insurance works is impacted how you can make it work for you. And Sam is going to walk you through a lot of it right now. While you're listening. Please remember 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. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn, find out more at G Vogue glucagon.com forward slash juicebox. today's podcast is also sponsored by the N pen from Medtronic diabetes, if you're looking for some of the functionality that you get with an insulin pump, but you don't want an insulin pump, you can get that with the in pen from Medtronic. diabetes. Learn more at in pen today.com. Okay, so let's start like this. Don't say anything yet. Okay. Got it. Now you said something. Anyway, this is Sam, Sam, you won't be called Sam or Samantha.

It doesn't matter. Okay, well, then

I'm gonna call you, Sam. why people might be wondering, have I been listening to this bold beginning series for umpteen episodes. And Scott comes on. And then that lovely woman from Wisconsin comes on. And they talk about diabetes. And now today, it's Sam, why is that? Well, it's an interesting question. And I have a specific answer. Today we're going to talk about insurance for newly diagnosed people, some of the hurdles that they're going to run into answer some questions that people have had and sent into me. But Jenny and I were talking privately, and I said, Jenny, I think I know a person who's better for this conversation than you. Are you offended? And she said, No, not at all. And I was like, Okay, so, Sam, what episode of the podcast? Were you on? A lot? Oh,

boy. Now be put on the spot. It was episode 6162. Somewhere in there. I believe it's 61.

Wow. Okay, it's been a while. Oh, wow. That's the first year.

Yes, it was 2016. I want to say,

the second year, but but probably within 12 months of me beginning. Let's give people the tiniest bit of background actually. And give you your credit. Because yeah, yeah. So do I wonder if there's no way no one's gonna everyone's gonna know this. But me. But you're the entire reason that I'm a well received diabetes speaker.

Well, that was kind of a mutual benefit. Because, you know, once you kind of hear what you have going on, it was kind of a no brainer for me to think about bringing you in as a speaker for the conference that we have down in Orlando, testify type one. So we were thrilled when you agreed to be part of our conference series. And luckily for you, I think it spread around and a lot of other people decided they wanted to do,

but it was but it seriously. So you're so you're the mom of a girl with type one, right?

Yes. So she's currently a lab and she was diagnosed at 22 months old. So we're rounding into our 10th year,

okay. And you donate your time to touch by type one.

That's correct. I'm actually a board member at this point, but I definitely do a lot of volunteer work for them as

well. Wow. What's the difference between like doing the work and being a board member?

It just comes with a fancy title and I have actual responsibilities.

So instead of we hope Sam might do this for you, we it's we've told Sam to do this and she's gonna get it done.

Yeah, so I have different chairs. I'm actually the AVID sea chair were touched by type one as well as the golf chair. We have a golf tournament now yearly, and I'm co chair for a casino fundraiser that we do.

Oh, okay. Well, I appreciate it. Because you should know that while you were going to bat for me, and being like, Hey, I think we should let this guy speak at the conference. I was taking that very seriously up here. And I was very touched by it. Because it had been a it was one of those things where I kept thinking, I wonder why nobody's asking me to speak at things pretty good at this, you know, and, and it just wasn't happening. So the big the big ones weren't weren't calling. And you guys did. I had such a wonderful time. I've been I've been at every touch by type one event, have I not? Yes, you have? Well,

every conference I should conference. Yeah,

no. Well, please. Yeah, I'm not at the golf thing. Don't look for me there. I can't be flying to Florida every five seconds. But but every conference that and they've gotten, well, I I can't say they've gotten better, because they've been well run. And lovely from the get go. But they have gotten bigger and bigger. Yes. Yeah. Really, really beautiful. So anyway, thank you for tapping me in. And I'm glad I didn't let you down. Because I think now that we've all known me longer is probably a bad decision on your part right? Now. Anyway, so So when this idea of insurance comes up, I think I don't know anyone more capable, like in a regular just a regular person. You don't mean like more capable of answering these questions in you. You just have a knack for it. You're a savant around this for? I don't even know why I'll let you I'll give, like give everybody just a little bit of detail about why you find yourself so tuned into this. Yes. So

in my previous life, as I like to call it, before I had kids, I was an office manager for a medical office that dealt with multiple forms of insurance. So, you know, we were pretty much trained on how to look at two sides of insurance and figure out where the benefit should go. So that kind of set it up perfectly for this whole pharmacy versus DME situation that everyone finds themselves in. And the other part of it was learning how to appeal properly. So once that started, and I started seeing the struggle in the community, from people who were going through the same thing, and I was experiencing it myself, you know, the whole, wait six months before you can get a pump, I really kind of jumped into this whole appeal process. And then throughout the years, just the different questions that people would come to me with, you know, it wasn't always something that was actually denied. A lot of times, it would just was them not understanding how their insurance works, or not being able to find the particular answer based on what they knew how to research for their insurance. So I would say like 50% of people coming to me for help actually didn't need an appeal, they were able to solve it through other means a lot quicker and a lot easier. So just throughout that experience, it's really become my, the way my brain works is I have a hard time for getting certain things. So it just kind of like adds on. But I will have the disclaimer and an insurance salesperson if there's something that is not true for your state. I am here in Florida. So what might be true for my state? You know, just don't don't hang me on the wall.

Don't worry, nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, this is the other ones right here. This is the other way. But But anyway, I would believe that anything you're going to say would at least be a good breadcrumb to get started. So is exactly is it accurate to say that none of us none of us understand our insurance that well, because it's it's set up so that we have a hard time understanding it.

It is definitely one of those things where they pretend they give you a lot of information without giving you information. They are going to be obviously covering a wider amount of items, you know, there, there's a ton of other health conditions out there a ton of other medicines out there. So they kind of give you like the here, here's exactly what we'll pay for. But there's all of these policy guidelines and stipulations, and that's going to be buried on a website that's really hard to get to but you think you've got the coverage for it. So yeah, they're they kind of like hide the fine print and especially with open enrollment, when it's a little bit even harder to get into all of those documents that you might need. It becomes really frustrating sometimes, but, you know, I think the best that we can do is, you know, do as much research as we can find and, you know, kind of make your assessment there. And

you know if it's, I'm sorry, yeah, I didn't think I is it sometimes just the is that the word asking the wrong questions. I used to man i for a minute. I hate to throw up my little brother right under the bus, but my youngest brother was quite the schemer. And one year, Sam, my mom bought a Carvel ice cream cake from my other brother's birthday. And in the center of it was a picture of a hockey player. And we came home one day, at my house, the rule is, you get a birthday cake. Everybody has some, and then whatever's left is yours. And you can eat it as you want, give it away, whatever, but it's yours to deal with. So my brother comes home one day to have a piece of his birthday cake. And the hockey player is hacked out of the center of the cake. In artfully man I say, and my brothers, of course, like, Hey, what the hell happened? So he turns to me, he's like, did you eat my my cake? And I said, it wasn't me. I'm sorry. So he goes to my younger brother, our younger brother. And he says, Did you eat my cake? And my brother says no. And that was it. So my brother asks, and he looks at me, are you sure and I'm older and sort of like, I'm almost there Dad, to be perfectly honest. He was no like, 15 at the time. And so he doesn't just trust me. He turns back to rob, and he goes, come on, man. Did you eat my cake? And my brother goes, No. And this goes on for quite some time. And finally I went way, way, way, way. Wait. And I go, Rob, do you know who ate the cake? And he goes, Oh, yeah. So my brother asked, Did you eat the cake? And my brother on my other brother honestly answered? No. And sometimes I think that's what this insurance game is. It's like asking the right question, you gotta ask the right question because it feels like they gave you a puzzle and said, if you put this puzzle together, you get an insulin pump. And then they take three pieces of the puzzle and stick it in their pocket. And then they go I don't listen, Fair's fair, you can have the pump just put the puzzle together. And so how do you but that's incredibly frustrating. Because unlike my brother in the in the ice cream cake. I don't know all the I don't know all the pieces. Do you know what I mean? Like, I know they exist, but I don't know where they are. And you have this, this kind of, you know, intuitive knowledge because of what you've been doing for so long. But how are you? Not? Let's answer, let's ask some of the people's questions. And we'll see how this goes. Okay. So everybody knows bold Beginnings is a series of input from the listeners when I said, What do you wish you would have known when you were first diagnosed? And this is what we got for insurance? Do you listen to this series by any chance, and

I don't tend to lean towards the ball beginning just because we've been going for so long.

This is going to be a surprise for you how this goes perfect. So the first person just makes a statement. Navigating insurance is huge that we know.

That's a whole that's you got a couple hours for me on that

one. The whole thing, right? It's just, it becomes a really well, in the beginning, it feels like it's a very big part of your life.

It is absolutely because that's usually the panic sets in of oh my gosh, you know, I'm newly diagnosed, or I have a child who's newly diagnosed. And then the second thing is always how are we going to afford this? So it's, you know, with With luck, they have insurance at the time that they were diagnosed. But if they don't, then you know, it's generally they're going to quickly get it or try to find better insurance.

So the first question here is how do you navigate insurance to find the best coverage for insulin and supplies? So we'll start with that. Let's put ourselves in, in open enrollment, or we just got a new job. And they're like, here are three insurance options. What are you looking for?

So generally with insulin and supply so the first thing I kind of like forewarn people with insulin is that people get very brand specific very quickly. You know, it's kind of a built in loyalty because that's what their doctors prescribing. But generally, you want to look at what's on the formulary. The formulary is kind of like your your go to and most people can use different insolence that are on the formulary versus what the doctor originally prescribed without complications. You know, some people have better reactions to certain insulins, or they might be allergic to one of the stabilizers in the insolence and that would be a necessitating reason to go to something off formulary. But for most people, you know, they're looking for insulin coverage in general, a long acting and short acting or a short acting. Same with supplies, you know, it's pretty, most most insurance companies are going to cover something. It's usually a law in their state that requires a base amount of coverage. Most states have that law, that insurances are required to cover certain things. They just don't specify what brand. So as far as best coverage, it really comes down to them. What's the Cost of things. And that's really where finding the formulary with the insurance that you're looking at is key because even though, you know, I was talking about how open enrollment can kind of take things and make it a little bit harder, because you don't have that as much access, generally, unless it's, you know, a self insured plan, which is where a large company basically pays for their own policy to be managed by an outside company, but at the end of the day, they're paying all of the, the costs of, of the patient's medications and their, you know, surgeries and everything. Unless it's a self insured plan. Most of the time, you can find those formularies either the current one so you get an idea of what they're covering, or, depending on what time of year it is, they'll release the 20 for us or in 2022. So you'll start seeing the 2023 formularies come out.

Okay, so Sam, do me a favor trying to touch that microphone on the cable. Okay, if your hair is brushing it, move it away. Okay, so, first step, we ask, can I see the formulary so I can see if the things excuse me, so I can see if the things that I need are on there. Exactly. But if I'm newly diagnosed, I don't know what the things are that I need. So this is a great time to say for people you're looking for. Like Sam said, insulin first, long acting short acting insulin, more modern insulins like recibo over Lantus, for example for your basil, you're also looking to see does the plan cover insulin pumps, continuous glucose monitors, test strips, those sorts of things are those

XCOM libre those things on the formulary are really big indicator of how later you'll proceed and getting those covered so when you're looking at your formulary does it lists the Dexcom G six or you know in the future the G seven doesn't list the libre two or the libre three. If you're seeing those items on the formulary before you even sign up for the plan, that's a good indicator that you will be able to get that through the pharmacy channel rather than having to go to the DMV.

When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pan is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk. I'm going to share just a bit of a note that I got from somebody with you. This person says this podcast gave me my life back and told me about in pen, my insurance covered it 100%. And it's amazing. Just the insulin on board feature alone is a game changer. But I'm going to tell you a little more about what in pen does so in pen is an insulin pen that pairs up with an app on your phone. This app shows you a dosing calculator active insulin remaining glucose history reports activity logs, dose history meal history and your current glucose level. This person I was just talking about ended up getting it for free through their insurance. But even if your insurance doesn't cover it, it's possible that in pen will cost you as low as $35. That's because Medtronic diabetes doesn't want costs to be a roadblock to you getting the therapy you need. So with the implant access program, you could pay as little as $35 offers available to people with commercial insurance terms and conditions apply. You'll learn more at in Penn today.com. While you're there, you also see pictures of the pen. See the app, you can learn about the 24 hour technical support, they offer hands on product training, and online educational resources. The in pen is a great way to get some of the functionality that you're missing by not having an insulin pump. So if you're MDI and you're using a pen, you might as well use the pen pen because it does all this check it out at Hidden pen today.com in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information. Once again you can visit in Penn today.com I'm going to get you back to Sam Now here we're going to use more words like durable medical and other fun things like that about insurance. I know this is boring, but you'd need to know this and Sam is delightful, so that helps Durable Medical Equipment DME and a lot of the stuff now people you know old timey people like you and I know that like insulin pumps and continuous glucose monitors used to be strictly durable medical equipment. And now, I guess you I get on the pod through a pharmacy channel, I get Dexcom through a pharmacy channel to die.

Yes, yeah. So definitely Omni pod is generally this day and age going to be through pharmacy, that's how they've decided to set up their distribution. There's the old style Omni pod, of course through DME, but the newer stuff is definitely through pharmacy, for the most part. Dexcom is about 5050 at this point on whether it's going to go through DME or pharmacy, and sometimes you have the option of either choice, you know, and that's really important as far as cost savings, because if you've been doing DME, and you're subject to a deductible, and you're paying, you know, hundreds of dollars out of pocket to get this product that's going towards your deductible, if it's added to your formulary, and I will, I will preface this formularies can change throughout the year. So things can get added and taken off during a year. So you, you know, I hate to discourage somebody but it's also a pro that when new things are added, you get that access to them. So if something suddenly becomes $40 copay, you're going to be saving a lot of money by switching the pharmacy side.

Okay, so But back to the initial idea of I'm trying to choose an insurance. So I call the just the 888 number on the back of my card and I say I need the formulary. I'm thinking I'm picking through but I guess if you haven't chosen yet, and you're stuck with,

like I said, generally online is going to be your friend. What what a lot of times I'll do is I'll type in the insurance and always put the state because it does vary by state. So I'll say for instance, Aetna, Florida policy guideline, and then I'll put CGM or insulin pump. So if I want to know what are the restrictions on getting an insulin pump, or a CGM, before I choose that, that will pop it up. Or I'll say, you know, Aetna formulary, Florida, Open Access Point of Service, and that will pop up at least this year, so I have an understanding of what they're covering currently.

So this is a situation that is seriously it's on you, right, like, no one's gonna come help you with

it is, you know, you, if you've got a really great HR, you know, or a really great insurance broker, then, you know, they can kind of do some of this field work for you. But, you know, keep in mind during open enrollment, you and everybody else attached to them is probably asking, you know, a million questions. So even then, you know, it's not always, you know, the most thorough thing or the most timely for whenever you're trying to make your decision. So, you know, really online, they've, they've produced a lot of information online, you just have to know how to get to it. Okay,

all right. So do you have, it sucks, because, think back, you, when your daughter was diagnosed, you've worked in that office,

I had actually just left about a year and a half prior

to that. So you still had the knowledge but I'm trying to put myself in the position of somebody who's like, I work in a ball bearing factory and now I get this diabetes and I have to go do this thing. Like you know, I mean, people with diabetes are lucky that you that you that you share your knowledge because it's it's not it's a it's a specific thing that you had this information in your head already when you when you came to need it. Okay, so So we're looking for coverage for things that you think you might need. We're looking for, I mean, I imagined to you have to see about your deductibles your out of pocket to see how much you're gonna have to pay in cash every year before you even get to your insurance.

Yes, and let's let's take a moment to kind of explain that because that is a question that comes up a lot is, you know, what is? What is the deductible? What is a coinsurance? What is, you know, the out of pocket? And how does this apply to our situation? So what you'll always look at is, when you're looking at the different policies, it'll it'll explain, is this a copay? Or is this subject to a deductible. So if it is, such as a deductible, say it's $3,000. That means for anything in that category, such as inpatient, outpatient, sometimes it's DME, you will be paying the first $3,000 of those costs. So that is before any other portion of your insurance kicks in. And then after that, if there's a coinsurance listed, say, 30% 20%, whatever that is, then whatever that charge is, after the $3,000, say, you know, you're up for your next order, or, you know, you're getting an insulin pump, and it's $5,000, you're paying your first 3000 And there's $2,000 left and it's a 20% coinsurance, then you're saying $22,000 times 20%, you know, that's an another $400 added to the first 3000. So you would owe $3,400 For that insulin pump. But after that for the rest of the year, you're only paying 20% of those supplies until you hit your out of pocket Max. So out of pocket Max is kind of like the all in cost, and not including the premiums, but the all in cost of your out of pocket expenses on using your health insurance.

Oh, yeah, I've just jumped out a window, Sam. Good luck, everybody, I gotta go.

I know, I'm like, Oh, it gets granular talking about it. But you know, it's important to understand what those things are. Because it does get complicated, you know, what is coinsurance versus a copay versus all of these different things, especially when you're trying to calculate so, you know, kind of going back into, it's not necessarily navigating through insurance to find the best coverage, but it lends to finding the best monetary value. And I always say, do a spreadsheet. So, you know, if you've got like three or four plans that you're trying to narrow it down, I look at okay, what is, what are those copays? What are those expenses? And if I were to go in the hospital this year, versus having a typical year without a hospitalization? You know, what's kind of like my worst case scenario? And how much does that premium cost versus a premium for, you know, just your regular maintenance year? With nothing happening? And what is your risk factor? What are you willing to risk, in order to have, you know, more money in your pocket on a monthly occasion, but but per chance, you know, risking that if you were to be hospitalized, it has a larger deductible. So, you know, some of this is very individual, and what you're willing to risk, as far as saving money and finding that insurance. You know, if you're not sure, you know, how your hospital risk is, in the first year, because you're just diagnosed and you're still getting handled, you know, you might want to go a less risk, you know, maybe a little bit more expensive plan that doesn't have as high of a deductible or no deductible. But then as you kind of get a grasp of how your child or yourself is reacting with all of these variables, you know, how did they react with, you know, sickness, or, you know, they broke their leg or whatever, you know, if they're very rough and tumble child, and you know, you're always in the ER, you don't want something with a high deductible plan. You know, because there's other things besides just diabetes

recourse that is there. I I know, it

kind of seems like, you know, this is all over focus, but

I don't know about the rest of you. But I always enjoy the phone call in February, where you're ordering something. And the person says, Well, if you've met your deductible, and I go, Oh, please, met my deductible on January 1. But thank you very much. I appreciate appreciate your concern about whether or not I've met my deductible. Right? Here's the question. When insurance is being difficult, this person says, skip the bullcrap of calling them and jump right to human resources, Department of Work, if you have one at work, it has saved me time and also gotten me answers that I wanted. Because the poor person on the other end of the phone at the insurance company is just doing what they're told and reading out of a manual. So do you find that every HR department knows what they're talking about? And will be helped? I would

say, No, we've definitely say, there's definitely been a lot of feedback across the board, that various companies and various sized companies that certain hrs are a lot more dependable than others. You know, it, you're relying on an HR person to actually know what they're talking about with their insurance. And, you know, if you have somebody who isn't as enthusiastic about finding those answers, or really understand anything about diabetes, to, you know, if they're getting pushback from the insurance company to really go into it, and, you know, hammer down those fine details, they might just be coming back with the same answers that you're getting. So, you know, the quality definitely varies, but it's not to say that it's a waste of time, because you won't know until you try Of course.

Yeah. So maybe you'll get lucky. And you'll have a great HR department, like the person who sent in this, this idea, and maybe you'll walk in there and find people who are just as confused as you are. So

yes, and of course, you know, HR is another thing, you know, if you're finding restrictions, sometimes if it's, especially if it's a self funded plan, the HR person can be really key and getting an override on those because if the, if it's the the employer is the one deciding those things, what's covered and what's not, you know, they're the ultimate decision maker. So going to HR is alerting them that this plan isn't working for all the members and getting them to do those overrides, it's really key. But if it's a plan, that's kind of a generalized plan that you know, like a Marketplace plan or something that is not self funded, then you're kind of a little bit more restricted in what HR can do for you.

Okay. All right. I will tell you just the quickest story I think I've told you here before but it fits here. When Arden was really little. She had a bunch of cavities on her baby teeth. And I'm gonna guess they were probably from juice or something like that from having diabetes and the A doctor, you know who we took her to, to fix them. He said, Look, she's got to be out for this. And this was before Dexcom. This was you know, before, I don't even think garden had a pump back then. And he was like, I'm not putting this kid asleep in my office and have a you stand next door testing or blood sugar the whole time, like it all, it just doesn't seem like something I want to be involved in. I want to do this in a hospital setting where we can have her we can put her out there be an anesthesiologist, and somebody can track her blood sugar kind of in real time. And we'll have her hooked up the dextrose this whole thing we're like, okay, like, I mean, we don't know, you know, Sam, like, whatever. So we, we find out that's gonna cost like $15,000. I was gonna say it's, it's a lot. And my wife's like, we'll just pay it. I'm like, Who is we? And where do you think we're getting $15,000? From? Like, I was like, wait, what, like, you know, so I really just kind of kept pouring into it. And then one day, I realized, I don't remember how I figured it out. But something you mentioned earlier, my wife worked for a big company. And so I contacted them. I explained the whole situation. And they said, Oh, we're, we're self insured. And I was like, What? What, you know, explain that? Yeah, explain that to me more. So let me let me tell you what, I think self insured means salmon if you tell me if I'm wrong, but basically, these really big companies use health insurance companies to facilitate the insurance. And then once a year, or once every six months, or how often they've agreed to it, they just write a big check to the insurance company to pay for what that has been covered. So they sit down in the beginning, and they create a formula they see here are the things we'll cover. And here are the things we won't cover. And if you need something that's on the will cover it list, then your insurance company says yes to it, you get to go do it. And then every few months, your company writes a big check to cover that for you and all of your other, you know, all the other people that work there. Is that about what self insuring means?

Is Exactly Okay. And you nailed that. Weiss

company just went, oh, we'll pay for that. Perfect. That was it. And then they call the insurance company and said, Hey, say OK to that, and then it was over?

It was that's what I mean about quality. Ah, don't discount either. Everybody is gonna do that.

Yeah. Also, don't discount the talking to me on the phone. It's not a big bunch of fun, Sam, just so you know.

I was I can only imagine it probably about like talking for them to talk to me. I've definitely had my share of heated conversations. Companies.

Yeah, I, you know, I believe this out, but back in the day, I was not above yelling during a phone call with an insurance company.

Well, you know, kind of a not a little warning. But you know, one thing that I do find frustrating is, you know, you've got also things like clearing houses or you know, those facilitators, for instance. So for instance, for us, we have a company called the care Centrex, who runs all of our DME through Florida Blue, which Blue Cross Blue Shield of Florida. And when I get on the phone, they're insisting that our DME is subject to the deductible. Well, the plan that we have on Florida Blue, is a $0, copay, coinsurance deductible. It's like the one excluded category that isn't applicable to deductible, which is why I love this plan. We've been on it for five years straight, I am very intimately familiar with how this plan works. And she was yelling at me telling me this will be subject to the deduction, deductible, and I just got so frustrated, because how many other people would hear this, and be on a new plan like this, and just take her word for it that oh, my gosh, I'm gonna have to come out of pocket 1000s of dollars for this product. Now, when I thought my plan covered it, but this lady is telling me, so you know, if you're in a disagreement with somebody, and they're giving you this information that just does not jive with what you thought the plan was doing, go back to your broker and have the broker take a look at it and explain everything. Because ultimately, you know, they're going to be the one who knows how to read that insurance plan the best versus like you said, there's somebody on the other line with a manual, three, three ring binder, or, you know, they're staring at a screen and they don't necessarily understand how that applies specifically to the product that you're requesting.

Yeah. Well, you first of all, you're going to be surprised a lot during this process, how the person you're talking to, you're gonna think they understand what you're talking about. And they don't like be even like the difference between a transmitter and a sensor for like, Dexcom G six as an example. They're like, they're like, Oh, we see we already sent you six of those. You only you're not supposed to get them. I'm like, No, those are the sensors. We are supposed to get them. I wouldn't get six transmitters transmitter Oh, and they go back and they're looking at codes. They don't even know. They don't know what an insulin pump is. They don't know why you need it. You can explain to them all you want how dire it is and everything. They're just people doing a job. They don't, they don't know. I think your, your best bet is to learn how to very politely say, I appreciate everything you've done for me. I don't think we're going to come to a resolution. I'd like to speak with your supervisor, please.

Yeah, yeah. So be afraid to ask for a supervisor because they're generally, you know, different levels. And, you know, they might accidentally Disconnect the call, you know, that's happened to me a couple of times, suddenly, the call drops, miraculously. But, you know, don't be afraid to call back. I know that, you know, it is not the funnest thing in the world. But, you know, you've got to remember, you're the advocate for yourself, where you're your child, and, you know, it's just, I wish I had a magic answer that, you know, got around all of this. When we were, we were, but

there's no magic answer. The answer is persevere. Yeah, keep your head, be well informed. Understand that what you're asking for, especially if it's covered is reasonable. And that you, there is a person who will answer in the affirmative, you have to get to them.

And I would also say just remember that everything is recorded. So you know, you don't want to give too much information of kind of the the sob story part of it, where it seems like you just want this as a, I would say, there's a term I'm looking for convenience device. So a lot of times insurance companies will put those in their notes that this person is just looking for a pump upgrade, or they're looking for just something that makes it seem like you are just asking for it, because it's fancy, or it's nice. And really, that's not true for most of us, but they'll use that for a little bit. And you have to appeal it and just becomes a process. So, you know, just kind of I always tell people stick with the medical reasons. Because if it is recorded, they can sometimes take those things and hold it against you.

Oh, so yeah, they're swatting flies, they they know you're eventually going to land on the countertop and make everything dirty, filthy. But they're just going to swing and swing and swing and swing as long as they can to keep you from getting what you want. So they don't have to pay for it. It's it's such a sad thing to think. But it's cheaper to pay a person to sit on the phone and bat you away than it is to pay for your insulin pump. And then the irony is, is once they pay for it, it's all good. It's never a problem again, it's just always like except, you know, at the end of the year when, when it's time to, you know, why does that happen? This this question is not on here. Sam, I'm gonna ask a question. Why is my daughter been using on the pod for a bazillion years, and every year when the calendar flips over? We all act like we don't know what we're talking about.

I think that's true. A because you never know what your insurance is going to do. You know, there's no and I say this, to save people money as well, you always want to look every single year at what your plan has changes for including the formulary, especially as Omni pod is moving to formulary, those Dexcom every year those can change. So you know, it's it's okay to have like a little bit of weird, weary, kind of, let me see what this is doing phase because it is potentially something that would cost you money, if you're not on top of it, and things were to change and you didn't pay attention and select something that was better for your situation, while it was still open enrollment. Because once that open enrollment closes, you're kind of you're better at all the curse words on here, but you know, your, your skirt. You know, you're you're waiting for a special reason to get off of that plan. And onto a different plan at that point. And so, you know, it's really important during open enrollment, which it is right now, you know, with this November 1, some states have open enrollment, it's starting early, or companies have it starting early to really like analyze all this stuff and realize this is my plan for the next year. This is my deductible for next year. If this is my deductible, and I end up in the hospital, am I putting away money every year for those reserves to be able to afford this? So, you know, I know you're saying every year you kind of like forget that you're on Omni pod and stuff, but it kind of is you know, like starting a brand new year.

It's one of the most adult things that I do is that conversation where my wife and I sit down and decide if we're on the right insurance plan for the next year. How much do we want to how much deductible do we want to have that health care spending account, which I hate? I hate it because I always forget to you said, and then pre tax dollars. God, Sam, do you think people know so if your company offers you a health care spending account, you may be able to pick an amount 1000 2000 $3,000 A year and have your money diverted into this account. So that when you buy things at the pharmacy, for example, that are covered, you can pay for them with pre tax money, money that has not been taxed yet, which is lovely. I mean, I don't know what it really saves you in the grand scheme of things. I mean, if you did $2,000, and your tax rate was at 25%, I guess it saved you 25% or $2,000, which is great, you know, but for me, I go to the damn store, I pick up the thing, I hand them the card, I paid for it. And then I think five seconds later, God damn it, I didn't use the healthcare spending. But now the pharmacies at least brick and mortar pharmacies, even online, I guess, it is easier because you can give them the card and say put this on file and pay for my stuff with this. Yeah, so that has

to save the receipt as well. And you can try to go back to them and say, you know, this was a qualified expenditure, yes. And see if you can get that applied as well,

Sam, now you're getting a look into my psyche, because I really didn't want to do. And also, we get into an interesting thing where I kind of have to handle the bills at my house, but the insurance comes through my wife. So when we got into a situation like that, I was suddenly dragging her into something she didn't really get involved in very much. So I'm like, hey, I need you to figure out how to like submit this. And you don't I mean, what's your online access for your health insurance portal? She's like, I'll take care of it. I don't want you to know my codes. And I was like, No, I understand. I'll trust you either. Now, just kidding. But no, but she would turn into like she she would then get involved, it was frustrating for her, what we learned to do, because I kept forgetting to use it $25 here and $20 here and everything is we would just wait for like one big expense, you know, just a dental cost or something like that. And then we would submit that cost to the health care spending to take the money out and kind of one big chunk. That makes sense or not.

Everybody does it differently.

I just I every year I say to my wife, like don't put money in that she's like, it saves us money. I'm like, I hate it. So, but it is a great idea. Honestly, it's just it. Again, it's something that seems to me. Like it's it can be made to be more difficult than necessary. And I think that really is why this part of it sucks so much. It's the intersection of health and sanity and money. And you just like why do I have to deal with this? Like why? Like, the kid already has diabetes, I already have diabetes, I gotta jump through these hoops now to get medication to get to get a device like it sucks. And you know, it's reflected here. And what people said, this, this person says navigating insurance could honestly be a whole podcast by itself. With that, but that was like, she doesn't just mean an episode of this podcast. She means a there could be a podcast somewhere that just talks about this with nothing else. She said it was so confusing to me at first. Everyone's insurance is different. We've had four different insurances in the four and a half years since my son was diagnosed, I still double and triple check, calling insurance, make sure you understand what's covered and how much I didn't even have any idea what DME was, and how it was processed differently than prescriptions. I thought it was ridiculous. This person says that we had to wait a month before getting a Dexcom. But then another person says to Hey, let people know, insurance won't pay for a CGM until somebody sees the endocrinologist. And I was like, Oh, that's interesting. And but that could be specific to their state as well. Right?

Yeah, I'm not sure exactly what they're alluding to. I mean, obviously, you do need a prescription for that item. And most of the time it is going to be the Endo. But you know, there's definitely plenty of family practitioners, you know, especially in the type two side who are able to prescribe that and insurance will cover it. So I'm not entirely sure what their meaning by that but I'm sorry. Okay, so, diagnosis might be the key. Maybe their insurance was saying, you know, you haven't had the seed peptide testing or whatever it is. But a lot of those restrictions I've kind of modified in recent years. So hopefully, whatever that person was dealing with it with their insurance, as you know, had some policy changes that may get a little easier access.

That's very worth mentioning too, is that this process has, I mean, Arden's had diabetes, and she was to choose 18 This process has gotten better every year incrementally. Yes, you know, like,

yours. Even just, you know, the last time I was on was, you know, kids under seven couldn't get a CGM without a fight so you know, that's definitely come a long way because you know, studies evolve and, you know, the manufacturers go after younger and younger target. It's to try to make sure that they're not having to go off label and you know, have those battles for those patients. So it's definitely come a long way. Obviously, it's not perfect because insurances don't want to pay if they don't have to. But

yeah, this person said it was really difficult, because we wanted a pump and a CGM. But we had to wait because insurance made us wait.

Yeah, so on that, so the Dexcom. For the first month, generally, what they're saying is, there's like a 30 day log, some insurances will want of blood sugars. Those, you know, if that's going on, I would just ask the doctor to advocate for, especially if it's a younger patient, who, you know, just does not understand that they have diabetes and what alo is and how to feel that and tell an adult, you know, there's definitely a lot of kids who leave the hospitals with CGM. Some doctors are very much alike. No, this is what the insurance says that's what we're going to abide by. So, you know, sometimes it's not even the insurance company necessarily blocking it. Sometimes it's also the doctors who aren't as gung ho about, you know, kind of getting somebody on index calm that quickly, because they want to make sure that somebody knows how to properly check their blood, or that they understand what the lows are feeling. Or they want you to go MDI for a while, in order to, you know, if your pump were to break down, know how to treat yourself, and they want you to go ahead and wait six months. So if it's a six month waiting period on a pump, that's a common one. And that's definitely something that is completely appealable, especially with younger children, it's, it's kind of a no brainer, you know, for for a young child to be on a pump and my, my opinion, because there's the users who are grazing their snacking, you know, you want to have that control over it. And your choices basically become no insulin, point five, one point out, you don't have those little tweaks or for that blood volume, like there are so you know, when you lay that out for an insurance company, you're talking about blood volume, and you know, the carbohydrates, and you know, how, how fast it spikes the blood or how quickly it impacts the blood sugar. Having those micro doses, it really kind of becomes a scientific equation for those insurance companies to say, Okay, why aren't we covering this? Because this is difficult for this user. So it, like I said, it goes back to what is the medical nature? And how do I get that past big insurance company to make it a no brainer for them, or to make it something where there's something called Bad Faith and insurance as well. So they have to, in good faith be given coverage for these things. And if they're denying things just to deny them, and there's no reason to deny them, then they're in bad faith, and they actually could be subject to problems with the State's Attorney General. So you know, they've got to kind of go for that line of fiscal responsibility versus not getting in trouble with your attorney general.

Interesting. Well, let me read what this person here said. Please, first, they said they were insurance like long like them, just because a doctor prescribes something. Please don't think that that means that it's preferred item on your formulary. And that a lot of times high pharmacy costs are from the wrong item being filled versus what you could have saved on. You talked. You talked about this earlier. You didn't say it that way, though. You know, your prescription is written for human blog. But it's not covered by your insurance. So no vlog would have been cheaper, but you're like, No, I want Humalog you might get or

my doctor prescribe this, this is what I need.

And that's tough. Because in the very beginning, you have no way of knowing, like, that's the other thing we're not talking about here is it the people listening to this are going to be newer diagnosed and are going to know what they're doing. And they're going to really think that like, I don't know, the guy said, Novolog like, now you're trying to give me a pager, which I don't think would happen because nobody covers a pager, but you know, vice versa. And so, it's um, it really is. There's a there's a settling in period. And you do need experience with this, just like with diabetes, you will actually get better at this. You'll notice that there, you'll look back one day and think, Oh, I was beating my head against that wall for absolutely no reason whatsoever.

And yeah, and and the other thing, too, is just, you know, for those who are newly diagnosed, just realize there are a lot of programs out there, especially insurance, or sorry, insulin based ones for copay cards, and a lot of people just, you know, kind of forget that they're available or they don't realize that it applies to their insulin, or they think that Oh, I make too much money. I'm not going to qualify for those, but they really have had kind of a kick in the butt recently with all of the investigations with the Senate committees in order to facilitate more Portable insulin. So you know, you've got the NoVo notice you've got the lily drug cards, there's, you know, the NoVo care, there's a $99 Insulin program, Lily has a $35 a month insulin value program. Sanofi also just recently came out with a $35 a month insulin program. So, you know, investigate those, especially if you're struggling to afford your insulin because obviously, that's a life saving medication that you absolutely need. And, you know, there's also a 340 b program, and I hate to bring it out, because it's government. And it's very political in nature. So sometimes it does better at helping that others. But if you are somebody who has an insurance, if you can't afford to even really see the doctor, there's community health centers that are on a sliding scale, and you can get a prescription from them and go fill your prescription out of 340, the pharmacy, and they will take into account how much you can afford. And you know, it can be relatively cheap. However, I will say depending on how many vials you need, it may or may not be cheaper than say one of these drug copay cards, but at least the Community Health Center doctor, you know, should have been less expensive than going to see an endo you know, your regular Endo, you know, as a self pay patient per $100. So,

I just Googled 340 V pharmacy and I didn't know anything about that. That's interesting.

Yes, it's kind of it's not just for insulin, it's for you know, a lot of different medications are included. It's just the insulin manufacturers. By doing these copay cards have kind of been pushing back a little bit. And that's why I say I hesitate to just say, Hey, this is a solution for everybody. Because, you know, sometimes they don't want to necessarily give those discounts out. And it's different per state. There's a lot of hidden information on exactly what the costs are for the pharmacy products. But you know, if you are just in need, definitely look at that for your state.

You also Walmart was on here last year, because they're selling Novolog. It's kind of its rebranded. It's just it's called it's called rely on Nova log, but it's just trust me, I went through the whole thing, it's Novolog. So the problem is that talking about it brings up memories for people of older, outdated insulins that that are available at Walmart as well. And sometimes people think you're, you're talking about that, but I'm not talking about that I'm talking about Novo LOGG is available at Walmart, as long as you know, I

have Have you seen the recent pricing on the Nova log at Walmart. And the reason I bring this up is it's not always the best deal because of these copay cards. So say, you know, it's $80 to go get a vial of this generic Nova log at Walmart through the rely on and the, you know, you need two vials for that month. Well, the NoVo program is $99 for up to three vials. So you know, I mean, you're getting that second vial for $19 rather than $80. So

we'd really want to look at the company's code. Yeah,

just do do do the math. You know, I always say like, what is your time worth? You know, when you're doing these spreadsheets to look up different plans, and, you know, the insulin costs, the affordability resources that are out there? You know, is it worth, you know, a couple of hours out of your year to figure this out and save hundreds or 1000s of dollars? You know, for me, I'm, I feel like I'm worth it. I'm way cheaper than that.

I would do things you have no idea for like 50 bucks. Yeah, no, I, you know, when it goes to this last comment I have from this person here is test as much as all this sucks, anticipate that expenses are coming. My budget totally changed. And I spend a lot more on medical costs now, even though I have insurance. And I think that's just important to remember that. I mean, I can't tell you, I don't know what your insurance plan is or what it covers or anything. But I mean, I think I said it recently on here to cover a family of four. So the amount of money that comes out of my wife's check every month to cover a family of four plus the amount of money that we spend on diabetes supplies and co pays and things like that. I mean, I guess earlier, we might spend $7,000 a year maybe, like you don't think of it that way because most of it comes out of your check. You just don't see it that way. But it's the truth. You know about that much of our income goes to covering this every year seven $8,000 And that's if nobody gets sick. Yeah, yeah,

that's what I'm bringing up Sunday when you when you talk about this and this is really important for those people who are especially just starting out on this insurance journey is when I say look at different things on Have insurances every single year. I also mean, look, if you're on an HR plan, you know, you've got a company health insurance plan and say your child has type one diabetes, it's okay to split off that child onto a different plan that say, on the marketplace or off marketplace that's not on your company plan. There are things called child only policies that you could get great coverage for them or a smaller deductible or you know, it has the items that you're looking for, or the network that you're looking for. That's not on necessarily your company insurance. My husband is on the his policy for work, and we absolutely have our own policies outside of him. Keep in mind you subsidies do not apply for this. So it is, you know, there's a difference in premiums, however, we're saving so much on the deductible side versus what his company plan is that it absolutely is a no brainer for us to go off of his company insurance and get our own policies. So look at those child only policies because there's actually plans like Cigna has a lot of states the thing called Cigna enhanced diabetes care plan that actually has $0 payments for preferred insulins equipment, pumps, CGM. So imagine, you know, even if you pay $100 more per month, you know, say $1,200 per year on that premium for that child, but you're it's not subject to a deductible. As a, you know, the company Plan is a $3,000 deductible, you're automatically saving $1,800 Right there, just by switching that person over? No, yeah, really look at those different things, or a lot of states have Medicare type expansion programs, CHIP programs where they'll be, you know, say about 230 $240, but it'll be $0 or $5 prescriptions. So you're just kind of like walked into the Medicaid network, but it's a self pay, like full pay program. And most states have some variation of that. And that can be a lot cheaper than, you know, paying that premium, but still being subjected on a company plan, or even a Marketplace plan to those deductibles. So there's a lot of different affordable insurances. So when I see somebody saying like, Oh, you know, my costs have like, drastically gone up, I'm saying there's ways to mitigate, you know, you just might have to play it differently and not have that four person insurance, it might be just a subscriber on their own company plan. And then other people are on different plans that make more sense for them.

And then Medicare, Medicaid, Medicare, Medicare, right.

Medicaid is generally going to be the majority of people under 65. And then over, you know, in the Medicare, those are the senior citizens, so to speak, are on Medicare, Medicare has its own. That's its own topic, Medicare. But that a keyed is generally for people who just do not make a lot of money, especially children. And they really want to make sure that children have some kind of insurance. So what they'll do is if you make X amount of money, say, you know, it's a percentage of the poverty level, if you make that amount, or within like, 200%, you know, you'll pay $0 to $80 a month for that kids insurance. And if you make more than that, then you'll be full pay, which is about 240. Depending on the state,

is there insurance for anyone? Like is, are there if you don't have a job, for example, you have no income whatsoever? Is there insurance you can get through the government,

you can try through Medicaid, if you're just making $0 Every day, that's where it gets a little tricky, because every state has different rules and what they expanded upon. So it's hard to give a blanket yes out it's definitely a blanket Look at, look up your state's requirements. But you know, sometimes people feel like, they just can't afford anything. And that's when I keep going back, you know, look at those 340 B programs, just make sure you're getting that at the very least insulin, because nobody should be going without insulin. And, you know, even if it's asking a friend for $20 to go get, you know, a month and a half's worth of insulin from 340 B program, then that's what you have to do but

not sucks. I mean, it's it's interesting because you you have this conversation about like what are people with insurance so it's so hard you have to be on the phone with people and bug them about stuff and then you realize that there are far far many people who, who just don't have insurance or cash or any way to get to their their supplies at all. So

exactly. And so, you know, that's it's it's heartbreaking, but you know, it just goes into what advocacy is really Something that is needed, you know, with these insulin caps. I'm very much for them. I know there's a whole conversation that could be had about politics with these days, but just know, even if something hasn't passed, you know, there's always ways to get insulin for cheaper. Scott Benner 1:00:19 Yeah, it's interesting, isn't it that everybody thought, Oh, we got our politicians to talk about insulin pricing, it's gonna get taken care of and it almost feels like instead it just turned into a fun thing for them to talk about around election time. Samantha Arceneaux 1:00:31 Yeah. It's it's definitely one of those mouthpieces where everybody wants to say the right things, and then it comes down to actually doing something about it, and then nothing gets done. So that's a little frustrating. But yeah, I would say this is a really good topic, I would say, not just for people with newly diagnosed situations, but for anybody, you know, who's looking to have more affordable health care? You know, I would say it's bold beginning, Scott. But I think, you know, try to to get other people listening, because I get this question from people who've been, you know, having diabetes for years, and they just are so fed up with how much it costs. And, you know, there's definitely ways to save money Scott Benner 1:01:15 and keep you from having to give up i Well, listen, Sam, I've said it before, I'll say it again, you should be doing this for a living, although I don't know how much anybody that was. The problem is that who's going to a person who's trying to save money, can't afford to pay a person to do something for them to save money. It's, but there's, there's something here, like, this is something that, like, even as you're explaining everything, and going over it, I think this is wonderful information for people to have, but I don't know how reasonable it is to expect that they're going to absorb it and understand that the way you do and then put it into practice, and it would be lovely if they could go somewhere and just say, hey, help me with this. You can have a percentage of what I save, you know what I mean? Like, there's got to be a way to like, make this a mass mass market appeal. Like, you know, I know there's not it seems like leave me alone. I have a job. Samantha Arceneaux 1:02:06 Yeah, I don't think my I'm actually my husband's assistance. I'm not sure he would love me, separately for him. But Scott Benner 1:02:14 well, I, you know, back when you first came on the podcast, like, I actually contacted one of the companies I had a relationship with. And I was like, why don't you hire Sam, and put her in charge of helping people get their coverage set up? I was like, you have a problem. Like you have this, you have this thing you're trying to sell to people. One of the impediments you have selling it to them is that their insurance is a blockade? What if you help them get through their insurance. And I don't know if anybody ever took me seriously or not. But I still Samantha Arceneaux 1:02:41 I actually, before I came on the podcast, I was actually in talks with top manufacturer about that very subject. But unfortunately, it was not a work from home, and I did not want to relocate across the country. Scott Benner 1:02:53 I'm saying it again, because I know they're listening, it would take you a small department of people. And it would not be a tough process, somebody could contact you would already know they're having trouble because they're working through your customer service people. Yeah, it can be rerouted to this department, which would look at their situation, assess it, and show them what to do to get it taken care of. Samantha Arceneaux 1:03:13 And honestly, Scott, you know, some of the manufacturer, there's, there's honestly, some really, really good reps out there. So I don't want to discount and say that, you know, the manufacturers don't have reps who are already doing this kind of stuff. You know, that I've seen some really strong appeal letters, some, you know, really unique ways of, of tackling these issues, from the reps and even, you know, taught me something. So, you know, it's not to say that, you know, there's me and me alone in this country doing anything like this, but Scott Benner 1:03:43 no, I realize that. But yeah, but if I get a bad rep, not a bad rep, what if I get what if I get a new rep, and they just don't know, like, so now it's luck of the draw. I'm paying $200 more because I live in this county. And if I lived in that county that I'd have this rep and they'd know how to file it. Like you don't mean like it just didn't be centralized in my in my in my imagination. But that is not a problem for me to fix. It's just a problem for me to point out. So I've done. Sam, I cannot thank you enough for doing this. You are the last episode of The Little beginning series. Oh, wow. Thank you. You're welcome. That was really a big deal for me to do this for me. And on on late notice, too, because Jenny and I sat down to do this the other day. And I was like, This is wrong. Like, Jenny and I shouldn't be doing this. Like Sam should be doing this. So Samantha Arceneaux 1:04:30 it's funny. We had talked about doing something like this next summer, and it's October just for reference on when we're recording. And so I got the notice I'm like, Oh, no. I mean, I get prepared. And then I realized, wait a second. I know all of this. Scott Benner 1:04:43 There's nothing to prepare for your. I apologize to you in public right now for all the times that I tagged you in other people's problems. Samantha Arceneaux 1:04:50 Oh, no. And it's fine, honestly. And if other people in the Facebook groups want to tag me if they notice something I'm not seeing, you know, feel free to tag I know Nico sometimes does as well. But that's not a problem always happy as long as I see the tag that's usually the only problem is sometimes it gets a little wonky on Facebook but Scott Benner 1:05:10 Facebook is now giving my giving me my tags a week after they are given like somebody tags me. About a week later I get it. So my notification Samantha Arceneaux 1:05:18 sometimes you know, it'll it'll come up way later or just I won't see it and I just happen to be scrolling and I'll see myself tag and I'm like, wait a sec. I didn't see this notification. Scott Benner 1:05:29 Alright, well, Sam, thank you so much for doing this. I really appreciate Samantha Arceneaux 1:05:32 it. Absolutely. Scott Benner 1:05:41 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 juice box, you spell that g VOKEGL. You see ag o n.com. Forward slash juicebox. I'd also like to thank Ian pen from Medtronic diabetes to remind you to go to in pen today.com To learn more about it and to get started. And of course, thanks so much to Sam, for coming on and pinch hitting for Jenny here in the bold beginning series. I'm pretty sure there's going to be more bold beginnings coming but yeah, it'd be you know, I'm not sure. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Okay, I'm sick. So I'm going to regret this but I may list all the bulb beginnings episodes for you. 698 Defining bulb beginnings. 702 honeymooning 706 adult diagnosis 711 terminology Part One 711 I just said that 712 terminology part to keep in mind that bold beginnings was a huge collection of statements and input from people who answered the question, what do you wish you knew at the beginning of your type one diabetes diagnosis. So we took all of this feedback, it was literally like 80 pages of feedback and put it into categories and that's what drove the bulk beginning series. So anyway, 711 and 712 is terminology Part One and Two 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 school, Episode 755 was exercise episode 759 was guilt fears hope and expectations. Episode 763 Community episode 772 journaling 776 technology and medical supplies Episode Seven at treating low blood glucose. This is episode 784. Insurance and there might be more but I mean, that's a lot. So if you can't find them in your podcast player, look for them on the private Facebook group and the feature tab or at juicebox podcast.com. But if you just search bold beginnings juicebox in any of your audio players, they should pop right out. Thank you so much again for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 788 of the Juicebox Podcast. Well, I know I said in one episode that we were done with the bold beginnings, but turns out I didn't see a page of the document. So we're back. Jenny and I are back today with a bold beginnings episode. Just for you. Today's topic is family. Jenny and I are going to have some kind of big conversations in the first 20 or so minutes. And then we get into the questions and statements from listeners just like you about what they wish they knew when they were first diagnosed with type one diabetes. While you're listening today, 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're a US resident who has type one diabetes, or is the caregiver of someone with type one, please take a moment to fill out the survey AT T one D exchange.org. Forward slash juice box it will take you fewer than 10 minutes. You can do it right from your phone. You know like it doesn't I mean, it would take two SEC you could probably do it through seven traffic lights at a stop sign or one. You know, reasonable bowel movement something like that T one D exchange.org forward slash juice box take the survey. 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 Podcast is also sponsored by Omni pod makers of the Omni pod five and the Omni pod dash to get started today with Omni pod go to Omni pod.com forward slash juice box. It will take you but a few minutes to get everything going. And the next thing you know tubeless insulin pumping Omni pod.com forward slash juice box. Yes. I've never I mean I've only twice. Twice. Yeah, probably twice since I've had the podcast. Have I recorded an episode and then when it was over not had the episode. Like had like, oh,

meaning you didn't post it? Or because it never recorded? Oh,

yeah. Oh, no. One. So yeah. Once with with was with Donnie,

oh, gosh, Danny, Hi, Danny told

he told such a personal story. And then I had to contact him and be like, Look, we got to do this or do it again. Or you know, I would understand if you didn't want to and I felt bad. The other time was with Victor Garber. Wow. Yeah. That was something I had my voice and not his recorded. Oh, gosh, yeah. So I had to call him back and say, I'm so sorry. But you know, I messed this up. And at that time, it had never happened before. And he was so nice. He said, Well, I vote day off next week, we can just do it again. And while I'm filming a TV show, he was like, I could just do it again. Very

well. I was gonna say gosh, with his schedule, although I don't know how active he is anymore. As an actor. I don't even know what he has done lately.

I know what I seen him and I've seen him in recently. Orville on Hulu. Okay, it's like a look, we don't

do a lot of, you know, oh, no, I mean, even new commercials, like, you know, friends will comment about this silly commercial for something or another. And I'll be like, I don't know. We don't really watch TV. We watch the amazing race. And if Lego masters we watch Lego masters. That's kind of the real TV that we watch. Because there's nothing real on anymore. That's like, like Seinfeld. Like that was a you have to dig around. Watch it.

Yeah, you have to dig around. We I watched on Hulu recently, reboot. Sounds like a Hulu ad. It's not. And I enjoyed that. And Arden told me to watch the bear on Hulu. And I'm okay, two episodes into that. And that's been good so far. So anyway, my point is I'm recording.

You can tell that we are being recorded.

The only weird thing that's ever happened to you and I is that we once recorded the same episode twice. And I didn't realize it so I put them up together so people could hear the difference. The difference? Yeah, which one? Was that? Do you remember? I have to dig it up. It's like a defining episode. Okay. And but and it's, I don't know, 1520 minutes of defining a topic. And then we just did it again weeks later because I didn't check it off the list. And when I realized that I put them together and I said here, here's both of them so you can see where

interesting Wonder what we added to one versus the other? Or what was the same? I'd have, that'd be interesting to figure

it out. Oh, anyway, despite the fact that I told you we were done with the bowl beginning series, that was a lie. Because there's always more to add more topics here. So today, I'm gonna go over the feedback that we got from listeners of the podcast. And they said that family was an important part of a new diagnosis. Yes, so I agree. Yeah, I we don't live near our family. My mother doesn't drive. And you know, Arden was diagnosed a long time ago, when she was everyone was younger, my mom didn't drive so she could never get to us. And our extended family, like no one lived near us. But when Arden was diagnosed, my mother in law did say just tell me what I could do to help when you come home. And the only thing I could think of in the moment was like the house, like, go clean the house, go wash every piece of clothing, like try to get me I don't know, a Head Start or something like that, as I write back, I don't, I don't remember having an impact or not.

It wasn't so much about helping in terms of actual diabetes, it was more the behind the scenes stuff that you know, was going to sort of fall to the sidelines, because you had something so new to focus on that there was a lot of learning involved, too. It's kind of something I actually tell to all of the women that I work with through pregnancy, is you may not want help with the baby. But you probably want your mom to maybe or dad or somebody else to come in and help you do some cooking, or plan or grocery shop or clean the toilets for you. It's like,

well, well, I as I look back on that that story, I realized, I wouldn't have known what to ask for. I didn't know anything about diabetes, I couldn't have asked. I mean, if you brought me the two guys that invented insulin, and said here, ask him whatever you want to do. Like, I don't know what to ask them. I have no idea here, you know, right. So it is an interesting Well, that's a great idea, though. Just have somebody cover whatever you can. Yes, yeah. And to try to get you moving. Let's see what people said, though.

I can I add something to that, too. I think what may go into that, especially if you have other kids in your home who don't have diabetes, if diabetes is entirely new to you, right? I think if you have somebody who can come in to help with some of those other things, making sure that the life of your other kids also doesn't get like scheduled differently. Yeah, right. Like, hey, you know, you're gonna be here for the next two weeks. That's awesome. These are the things that could be helpful. But I just want to make sure that Johnny is always still going to school at the same time that his lunch is always still getting packed that he's, you know, it's got game night on Friday night, right? While you're getting used to things that other person could be just contributing to keeping normal normal stuff there.

We Arden was diagnosed on a family vacation. And it was the extended family vacation. So there were three or four families in this house at the beach. And I remember that feeling of like, we have to take our son to the hospital. But what do we do with Cole? Are we just abandoning him here, you know, and everybody was great about picking him up and keeping him moving? Right. I have to say to that, as much as I tend to believe that Ardens diabetes hasn't impacted coal that greatly. I don't think that's true. I just think it's probably in ways that he doesn't share that we don't know.

Or he may not even realize know how, right he may not acknowledge or even consciously realize, because this is what was he four ish or five when he was diagnosed? When she was diagnosed?

She was six and okay. And she was too. So they're four years

apart, too. Okay. Yeah. But he was at that stage where he was young enough that his whole life has really been with a sister who has diabetes and this is just the way our family functions. Well, right.

I even think now, you know, you know that my whole family Arden's at school, but my whole family got COVID We got it together. We did it as a family. And, and I, a couple days into it, Kelly asked me if I was okay. And I think I must have been acting strangely. And I said, I get very upset when Cole was sick. And I never really looked into it any deeper than that. But here's the rest of it because I think, gotta hope he doesn't get Diabetes. Like, you know what I mean? Like, a virus is here. And yeah, I'm always off kilter When coal is sick. And my point is he, he mean, he must think that too, right? Like, he must get sick of me. You know what I mean? Like, it's just gonna happen to me. Anyway,

I wouldn't disagree with that. I mean, I have to say as, as often as it might seem to some people, when my kids are sick with a fever and some kind of virus, I do finger sticks. I mean, I just do, it's just my typical habit now. Because in the back of my head, that's always that's always the potential that's there as well. Yeah. And obviously, catching it sooner than later. And all those things that we know, is a good thing. But yeah, absolutely. When you've got autoimmune stuff in your family that you know about, it's probably something that just, that's where your brain goes, whether you want it to or not,

even though most of the extended autoimmune stuff is on Kelly's side of the family, like there's celiac and things like that. I wonder sometimes, if I'm gonna get diabetes, like I interview so many people that get it in their 50s and their 60s, and you know, like, there are I think, is this gonna happen to me? Is this like, is this like, the, this is the end of the story about the guy that started the podcast about you don't I mean, somehow, a guy who doesn't have diabetes started a podcast about diabetes, it became really popular, and at the end, he gets it like, is he gonna be like, like I said, commenting for me, you know, anyway, I just think that that has to be the case. I mean, siblings who understand how it works, and are educated must worry about it. Having said that, the amount of people that I've interviewed who, whose children get type one, and tell me that their sister and their brother had it growing up, and I'm like, You were never worried about that right now. I didn't realize that could happen. So, you know, I don't know what people know. Right? Okay. So here's a little bit of feedback, balancing family life with other kids and making sure they aren't feeling left out or overwhelmed. And I think that's what we've been talking about here. But more contextually, you know what happens, right? You're, you're freaked out about high blood sugars, low blood sugars that somebody's going to pass out, you know, and you start hyper focusing on it. I realized, gosh, Arden must have been in middle school, when I recognize that when she would come in the door. I never once asked her how her day was or how she was. Yeah, I asked what her blood sugar was, because we didn't have monitoring back then. Right, you know, so as soon as CGM came up, I would orient myself with how her blood sugar's where she came home, and then consciously did not ask her about diabetes. But you do wonder how many times do you ask, how many times does another kid hear you asking? And how many times they realize that you haven't asked them about anything.

And I think you bring in an important piece here is the technology that we have today. It's wonderful that we have the information that we have. And in a way for you, it kind of did almost what I would think is kind of like the opposite. Right? Now you've got the information C or S asking kind of less. But like when I was growing up, the information asked was only around a finger stick time. Yeah. And unless I complained that I was feeling weird or off or low or whatever. I mean, you never hear it's never right. I mean, that wasn't something who my dad was usually the first one home from from work, we got home, we were latchkey kids, if anybody even knows that term any longer. I don't even know if it's used. But I mean, my dad never asked like, oh, how are your blood sugar's today? It only got one finger stick a day at lunchtime, and that was like four hours ago.

Yeah, no wonder. We were I mean, back then we were kind of caught in flux between some information, but not enough information. And I knew enough to be worried. I didn't know how to stop anything from going wrong. You know, right. i If you if this podcast existed 15 years ago, all you would have heard is a guy going I don't know what I'm doing. Excuse me, now I have to go cry in the bathroom. It was terrible. But okay, so how to create an empowered, less burdened cooperative relationship with your kid around diabetes, to not have super issues in the future? God, God, what do you think is I think about this all the time.

So I think it differs According to the age of the child, I do you know the term like texting diabetes is very common with the middle school to high school, maybe some elementary school but more the like, older than about fifth grade kind of age. And I think in terms of strategy like that, that's great. As long as you're not becoming the helicoptering like, Do this, do this. I see this Why are you not react? You know what I mean? Make the interactions purposeful, the same thing I recommend if you're going to do a finger stick, make it a purposeful time to do the finger stick. Don't just like check 50 times a day because you think your CGM isn't accurate, right? But then for, for kids who are more the teen age where you want them to start learning more and more, to take on a little bit or understand a little bit more in terms of adjustment, I usually recommend families decide on a day, or like just a 30 minute time frame, just to sit down and that's your diabetes time. And in between that the management should be should be brought down a level that it's not the only thing that you're ever really discussing with them. Right.

So I'm learning well artists to college every day. And you know, I've been passing Arden's care off to her slowly for years. And if you would have asked me two years ago, Scott, are you that involved Norton's diabetes? I would say no, not really. She takes care of it. But I overseas like I, meaning I pay attention to it. I come to her when I think there's an issue. What I didn't realize was different between her living here and her not living here is that if I texted her when she was in the house, and I was like, Hey, I think you should Bolus for this. And she disagreed. I could walk into her room, knock on the door and say, Come on, we really have to Bolus here, right. And so I was not controlled. Like I wasn't pulling the strings. But I could always jump in and grab the strings if I wanted to. Sure. Now that she's not here. There are no strings are there? No, no, there's no, there's no strings. And so not only do I not know what she's doing, right, I can only see through Nightscout I can only see, hey, she Bolus for 55 carbs here. So okay, she must be eating. i That's it. I don't know what she's eating. I don't know if she Pre-Bolus. Or if she put push the button and sat down late. I can't tell any of that. So one day, I sent her a text and I said, Hey, I don't I don't remember what I said do something. And she didn't do it. And time passed and time passed. And I texted her again. She completely ignored me. And then her blood sugar started to go down. And I texted her back. And I said in case you didn't get this. Don't do the thing I said now. And then she responded back. She said, I've seen all your texts. I disagreed with what you wanted to do. So I just didn't do it.

See, she knew more because you probably didn't know the variables that she knew because she was right there in her own moment. Yes,

yes. And so that I was proud of I was pissed. Asbestos, she didn't answer me on purpose. And I was proud. But I was proud of her that she she knew what was going on. And you know, we've been kind of going back and forth and doing that. And I found myself just only really contact here in what I would call either an emergent situation, or with something that she's clearly struggling with. Like I'll say, hey, look, this, whatever you're doing, I see you're trying it's not working. Here are three options that will make your blood sugar move. And then I don't I don't even tell her which one to pick. I'm just like, Here, try this trick. This trick or this trick, right last night. Last night, she she she was like, she got really aggressive about a meal. It was terrific. Actually she's like a 65 blood sugar like an hour and a half after she ate it was super stable. But I could see the loop taking insulin away and it wasn't making a difference. So I said to her look, just take one gummy bear. Just one, it'll turn you into like an ad. I was like, I don't want you to get into a position where you have to take too much. Because you haven't had Basal on so long your blood sugar is gonna fly up, then the algorithms gonna see the big number hit you again and you're gonna, you're gonna get low again, right? And she said, I don't need that. I know what I'm doing. I was like, okay, and then we ended up talking like, half an hour later about something that was about school related. And I said sure about the gummy bear thing. And she was I just took it you were right about that. And that was it. I was like cool. Yeah, good. So it's But all that aside The problem is, you've spent years thinking about stability, and thinking about stopping spikes and stopping lows. And I mean, in my mind, I guess everybody's mind you think it's, it's not going to change, they're just gonna get older. And you'll just keep doing this. And they'll learn more as you go. But it's not what happened. I mean, I don't know if it's what happens for some people, it is not what happened for me. Like she laughed, and she's like, I know how to do this fairly well. Right? I don't need his help. And he doesn't even know what I'm doing. I've gotten so many texts from her that just say, you don't know what's happening on this end.

Right? Like, I'm okay. I'm taking care of it. If not, please tell me to do something else in an hour. Right. And I think while you probably feel like, you haven't really planned this point of transition, at least not the way that it's happening, right, you thought that you had done some things along the years. And a lot of that was probably, I'm sure, quite helpful. But I think as I work with people, I usually also say, to parents, even for kids who are at least five and older, as you are navigating an adjustment right now within like the diabetes strategy, if your child is their voice, your plan, even if you're not really just talking to them, in fact, if you're not talking, but they're close enough to hear you, you're verbalizing out loud what you're doing and how you're doing it, especially not in a very emotional way. Just a blood sugar is high. This is what we're gonna do. We're gonna watch it for this time. Eventually, they absorb that.

Yes, no, I agree. I've done that. And I agree. And it's actually what I did in that story. I just told you by sending her three options, I was just sending her my thought process, right? Well, I guess we could do this. Or we could try this. Or we could try that. And I thought, well, she knows the variables. One of these options will make more sense to her than the other. The part about not being emotional that I was really cognitive cognizant of right away. Like, there have been plenty of times since she's left that I've wanted to text her and be like, Oh, my God, will you please Bolus? What I realized is that she's trying. And she's, it's not like, Oh, Dad, I'm trying it. She really is trying. And I thought how long it took me to learn how to do this. Like, why would I expect her to do it? So quickly, you know, just because I basically know what to do right now, doesn't mean she does, but she's gonna have to now, me we talked about in the Pro Tip series, so much like she is now has to have experiences over and over again, that teach her what to do. It's my job, not to apply my reality and my understanding of diabetes on top of her while she's trying to learn it. And that took a while to I mean, it took a while for me to be comfortable with I didn't do it like I didn't pressure but I didn't feel comfortable about it in the beginning.

And I think as much as a caregiver, you know, yourself, or any of the other parents or, you know, people who are helping to navigate management for a kid or a teen or even a college student, I think there are things that you learn the way you do without having sort of a sense of it, the sense of, which is what it sounds like art is doing. And it's some thing that I also can't explain from my personal why I would do something versus just looking at data, I'm sure somebody else would tell me to do something completely different. It's a, it's a sixth sense, almost of navigating. You will learn it by how you how you feel in the moment, right? I feel this way. It looks like it's going this way. Like your brain spins quickly forward of I have this coming. I did this. I have to apply this strategy right now. And those are things that somebody could have been doing for you. But they were doing it without the internal sense of feeling and feelings. Not really the right word. But you do you develop this like, additional sense.

You have a shorthand with your own diabetes. Yeah, yeah. Well, I've been there was a time where she was she treated a low in a class. And it she did it, she grabbed it, but it was not coming up. It was still like in the 70s. And I sent her a text and I said do not walk home from class with your blood sugar like this. And she didn't answer me and I said I texted again and I said, you have to answer me. And she said, Okay. And that was it. Like just little like I've only jumped in where I'm like, I do not need something bad how Talking to her while she's walking through downtown. Where am I supposed to say that she goes to school? Chicago? And and Fargo, how about Fargo? She we were when we recorded together. I said where she was going to college because that don't tell these people where I'm going to college. I'm going to Chicago. Look for me there. So anyway, I've been I've been clear about that. But it's, it's your problem as a parent. Now, in this scenario, I have a kid who's actually trying, I don't know what I would do. Well, I guess I do know what I would do if she just wasn't paying attention to it. Because there were some times the first couple of weeks while she's trying to adapt to school, that she when she, when it was time for her to give something away out of her brain, she gave away diabetes. And she'd let her blood sugar sit like 180 200 for a few hours. And I was like, okay, like, she's got to go through all this, this is not going to kill her for a butcher to be 180 for a few hours. And then I would kind of at the end of the night. If we spoke like she'll show me something she was working on. I would just kind of say, Look, I know you're busy. And I know you're trying. But we can't stare at blood sugars like this for three hours, right? You know, so next time trying to do something about it. If you don't know what to do ask me. And that's it. But that I mean to this person's point about creating an empowered person. It's such a tight rope, right? Because if you push them too hard, they might not take care of themselves. If you don't push them hard enough, then the disease will get them. How the hell are you supposed to decide between bad and bad?

And within that you're also navigating, managing just a child. Right? And all the things that you may need to counter just because they're a kid, right? And I know a lot of parents say, Well, I, you know, I feel bad scolding them for goodness, if they like kick the cat, and it was totally unnecessary. That has nothing to do with diabetes, you need to punish that. Clearly don't feel bad just because they have diabetes. I mean, it's a but it is, as you said, it's like a tight line to walk to no kid treatment versus manage the diabetes piece.

Right? No, it's, you know, it's that feeling of I mean, I've raised two kids into, I mean, I guess they're adults now. And then there's moments when you're like, What do I have to do here to make sure that we're all together and happy and love each other for as long as we can? Versus versus I don't want them to? Like, what do I also do to make sure that they don't try heroin when they're ninth grade? You don't even like? Yeah, in your mind, I don't listen, this might just be me. But in my mind, there's straight ahead, which I don't think we're going to get to. And there's way off to the left and way off to the right. And, and I'm just trying to keep everybody moving forward as best as I can. Yes. I mean, I don't know what everyone else's goals are. But around diabetes. I don't want my kid dying before me. I can't handle that. That's my goal. Right? And around regular parenting. I don't want my kids to be at goals. That's a simple, I really don't, I don't want Yes. And I want them to be able to take care of themselves, and to have fulfilling lives. And you know, every time you say something, it's hard to imagine, but everything you do everything you say every time you walk through a room, it's cumulative. And with diabetes, it's all sped up. Because you could very easily push somebody away or maybe they want to be pushed away. Who knows. I don't know this is depressing. How to handle big events like birthdays, weddings, having a baby going to a sleepover so this is how do you get your family to help you with these things? Gee je Volk hypo pan has no visible needle, and is a premixed auto injector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above. Find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or phaeochromocytoma Visit G voc glucagon.com/risk. If you're looking for a tubeless insulin pump, you're looking for the Omni pod. Now you may be eligible for a free 30 day trial of the Omni pod dash and you can find that out at Omni pod.com forward slash juice box. But if you're looking for more if you're looking for some automation Well then, my friends, you're looking for the Omni pod five, automated insulin delivery system. The Omni pod five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM, and uses smart adjust technology to automatically adjust your insulin delivery every five minutes, helping to protect against highs and lows without multiple daily injections. With the Omni pod five, you have the option to control it from a compatible smartphone. And the Omni pod five is available through your pharmacy, which means you can get started today, without the four year Durable Medical Equipment contract that comes with most insulin pumps. Even if you're currently in warranty with another system. To get started with the Omni pod five, go to Omni pod.com Ford slash juice box. If you're not looking for automation, you're still going to love the Omni pod dash. So head over there now and get started. For full safety risk information, a list of compatible smartphones and free trial terms and conditions go to Omni pod.com Ford slash juice box My daughter has been using on the pod every day since she was four years old. And she is currently 18. Why? Because on the pod works, and we love it on the pod.com forward slash juice box, when you use the links, you're supporting the podcast. So type them into a browser just the way I said them, or get them from juicebox podcast.com, or in the show notes of the podcast player you're listening in right now. I'm gonna get you back to Jenny. We're gonna finish up this bold beginnings episode. That's not easy, isn't it?

It's not? And I think it's not because there still is. There are so many tunnels to go to here. I think one it's not because many family members still don't truly understand. Type one management. And they have a very naive understanding of diabetes management in general. Yeah, they do. So, you know, I I'm quite sure if I got together with my family more often, somebody would still knowing that I was coming plan some kind of sugar free dessert. Yeah. Thinking that they were being so kind and whatever or you know. And while that can be nice that you were thought of, in a way, it also doesn't make much sense knowing what you know. Right? Right. So I think in terms of family education, who are your four, you're really close people in a family that you would be doing the most with, for big celebrations, holiday events, birthdays, and those types of things. And, you know, just if they're willing to listen to, this is how we navigate again, a simplified kind of form. But don't worry about bringing sugar free cookies, or don't worry about doing this, this or this, if I want you to bring something different or special, or we're following a specific type of you know, eating plan, then great, you could do this. But otherwise, just bring whatever you're going to bring. And don't worry about it. Because we've got it.

It's tough too. Because if you tell somebody treat me normally, and you're talking about like, I don't know, your sexual, like, don't treat them differently, treat them normally. That's great. Except then later, if I dropped them off at your house, they're running around in circles in the backyard forever, I would like you to pay attention to their blood sugar, right? So

I think there are different, that's a very good like side point to make. Because if you if you were going to rely on family, for some type of babysitting, or watching or whatnot, you'd have a different set of guidelines or information that you would want to go over with them. Yeah. These are the things to pay attention to, obviously, you know, versus like a birthday where there 40 People there, you're there as well. So, you know, I think they're different

when when we would leave art in with somebody, we just basically set up. I don't no checkpoints, test your blood sugar here, tested here. You know, if you're going to do a meal, we're going to test first if you're unsure about how much insulin you could go ahead and call us. Like that kind of stuff. I mean, I have to admit diabetes did dig into my my adult life as you know, as we were growing up, we didn't go out as much as we I think we would have afforded didn't have one, stuff like that. We also ran into the point where the problem where there was a A person in our family that for years, I would imagine would right now bring Arden, if Arden was low, they'd bring them her bag, like for insulin, and if she was high, they'd bring them sugar, they always had it backwards. And never, never really never sunk in. So Right. I

mean, that's, you know, again, if you're going to choose, don't expect to educate your whole family, you know, all your secondary cousins and who whatnot, about how to navigate, especially if you would never leave your child with them for an overnight, right? Pick the people that you definitely have as your go to, because they have watched your children or your child already. And you would like them to continue to be able to do it from a comfort level on in two places, right? Your comfort in knowing they can do it, and their comfort and feeling like everything's gonna be okay, if I kind of a decision matrix of do this for this, do this for this, cover it this way. But again, don't feel like you have to educate all 200 people in your family. One of the people who are really going to be the go to people,

I think you could save yourself a lot of heartache that way too. Because the mean, the truth is, is that everybody can't understand everything about diabetes or everything, but you're just gonna be I mean, you see it online, a lot people get upset. A comedian made a joke. It's not funny, he doesn't understand my life. Like I get that, like, you know, you know, somebody asks me if I can eat this thing over and over again, like, I mean, just kind of get, listen, everybody can do whatever they want. In my mind, I just gave it away. I was like, I don't expect these people to understand. They have, by the way, those people have problems that I don't understand. Correct, you know, and they're not mad at me for not understanding their you know, I don't know their rubella.

I would hope not. There are good vaccination out there. That's part of the MMR vaccination. Maybe they've been I don't know, in the I don't know, some country. I don't know,

I reached back too far from my joke. I thought to myself, like, did I just go back to the Old West? What happened there? But you know, I just I don't expect them to understand everything about me. They don't expect me to understand everything about them the diabetes, like, omnipresent your life that it gets irritating, and I get it, but at the same time. There's something more because I have another thing, no, go ahead. This person said, Have everyone in your household participate from early on, gave peace of mind that they will be able to take care of the child? If you're ever this is like this is household This is brothers, sisters, husband, anybody lives life house? Yeah, yeah.

Yeah, it's, it's, I think it's a very good point to make. Especially considering that I know, a lot of families have one of the parents who really heads up the management, I would say that it's less of the families at least that I've had the opportunity to work with less of the families who have both parents really on with each other, and how they navigate. And some parents have a really good strategy of as long as the glucose numbers stay within this range, we share some strategies that we know will 99% of the time, they will always work regardless of whether they're with, you know, this person or this, this adult or this adult. And some parents have some strategies that they find work when the child is with them. And the other parent has other things that they have figured out. And it works with them. And I think that's okay, that's okay, that there isn't always 100% of this. If this then this. Because when one parent or caregiver is with the child, there may be variables that the one who's looking at the data like you and Arden Yeah, that they don't know is happening. So one is navigating this way. And the other ones like why are you doing that? You gotta have some give and take there while also having some definitive management strategies that you're both enacting.

We started off with trying to do it together, like literally and then one day we were like, This doesn't work for us. Like we're, my wife and I both have like, strong personalities. And we'd get into situations where we were like, it's milk and I'd be like, it's juice. And then we were just like, while Arden was plummeting, we'd be we'd be arguing about what was gonna save her life. You know what I mean? And, you know, a sidebar Jenny I, I, I impart as Kelly out because of how Brighton and I'm sure she was of herself. And I'll tell you 25 years later, I don't know if that's a thing I would look for anymore. One time in my life, I'd like someone to look up to me and go, Oh, is that what you think? Okay? It hasn't happened yet. I'm keep waiting. But but the spirit of back and forth just didn't belong in that scenario. So we just said, Look, you're at home, I'm at home with her during the day anyway, just keep it with you. Doesn't mean Kelly doesn't know how to do it. But to your point, when she is doing it when Kellyanne Arden are by themselves, especially when she was younger, I had to learn to stay out of it for the exact reason you said because I don't know what the hell they're doing. And they're clearly not doing what I would do. And then you just you fall right back into the argument again? Yeah,

exactly. But I think it also, I mean, for those who are listening, who may have divided families, you know, there might be divorce or something in the picture, I think the really important thing is, as much as you don't want to be together in life, you have to find a management strategy that you're both going to stick with, from one house to the other. Because it makes it really difficult as you're navigating all the teaching that you did with Arden. Kelly was doing some of that as well, when they were together in a different way. But it wasn't, it wasn't a negative to her overall management. Well, fortunately, right? Unfortunately, some parents really have the whole, like, we're aiming for this, like Target Range, and we're doing it this way. And there are all these strategies in the picture and the other parent may just be sort of flippant about

it. And I've seen a lot of we have a number of episodes about divorced families because of that, because of just what you said that I've seen people send their kids somewhere for a weekend and the kids blood sugar's 400. all weekend long, right? And then there's no one. It's not even that they're not trying, there's no understanding of it at all. Correct, you know, so yes, that's makes it

and that's again, even if you're not thinking about it from think about it from the child's need, right? Even if you don't agree with each other. You have this beautiful little person that's depending on you, or their health, right. So put all of your irritation. And just do it for the kid.

Important it is well speaking of marriage, this person said this person said our honest to goodness, healthy marriage was bent every which way as we juggled sleep deprivation, math on MDI, guilt concern while trying to also communicate with different levels of knowledge about diabetes, she says that me with me with loved experience and him with little to no knowledge or lived experience. Experience. Yeah. And so it sounds like it sounds like the the, the wife parent, yeah, understood diabetes, the husband didn't. Some days, we still disagree. But we've come to a point where we have a unified approach. I mean, that's I read that it's basically what we just talked about. But But there it is, it's honestly got feedback from somebody who's gone through it, it is going to happen, I don't care. I mean, I don't care how good your marriage is, like this, having a chronically ill child is it's immediate, and it's frightening. And nobody just drifts through it. Like, hey, this was easy, I get you're not gonna listen to diabetes feels that easy to you might not be paying attention to it. So like, it's, it's not that easy. This person said, we let our kids do everything. And so this is interesting, because they said it's their body and so much is out of their control. We've been careful to let them be involved and put their curiosity to use and helping them feel a sense of autonomy over diabetes, of course, in age appropriate ways, and being careful not to burden them, dad, and I do everything, but we give them choices along the way. And have them learn the names of their devices and the steps that we take. It's helped ease anxiety about site changes, and they honestly feel proud and accomplished when they can show people their stuff and talk about it. It normalize that for them. It's also been a great opportunity for us as parents to teach emotional mental health awareness about the consent an age appropriate way. So that's really terrific. That's

fabulous. Absolutely. I think, you know, another one in that when this person says we let the kids do everything. Absolutely. I mean, there are so little, there's such a little, I guess, number of things that you can do, despite having diabetes, that really anything out there as a potential possibility. And one of the big things that's always you know, the question, in terms of everything is is food, right? We just let them make their choices and You know, navigate around them. And I think because there's there's a lack of nutrition education anyway, growing up, I think that kind of ends up turning into when we let them do anything. But along the way, there are teaching moments within that to say, if we do this, this is what could be the picture, we could have much more focus and navigation that we have to do. Versus if we do something this way. It might be a little cleaner, it might be a little easier or whatever. So

yeah, I as hard as growing up. The only thing I ever was, I don't want to say insistent about because she didn't. She wasn't resistant to it. But when CGM showed up, I was like, we were doing this. This is, you know, you know, and Kelly's like, what if she doesn't like it? I was like, I don't

I don't care.

Yeah, that was one of my mom, like parenting moms. I, you know, I used to say it on the podcast more frequently. But I don't get letting four year olds make medical decisions. I'm the I mean, I understand autonomy and everything like that. But you know, like, if your kid got an illness, they had to take three pills for it. And they and they said, I don't want these would you go oh, they didn't want them. So yeah. No, you would not. Yeah, that's not how this works. Like. But that doesn't negate anything that this person said, you, you should be striving for everything that they said.

Absolutely. That's a great post. Absolutely. Your

last one, my son was diagnosed just before his 50th birthday, and wanted to do everything himself. I thought this was great. And that that and that that showed signs of like super independence. But now I think this was a mistake. It may work for some kids, but not for us. And so it looks like actually there might be two more things. But sticking to that one for a second. There's a difference between Arden saying that I've got it. And she's actually trying. And her saying that I've got it and then she's ignoring it. So, you know, it's, and that's tough, because you want to believe that from your kids, I would, I would point people into the podcasts on this one. You want to really understand this, listen to conversations over and over again with 2526 29 year old people who were diagnosed in their teens. Right? So the parents were involved for a little bit. And then it seemed like they were old enough. So they said, Oh, that's okay, now you take care of it. Every person looking back with hindsight says I told my mom I had it. And I did not have it. I didn't know ya know what I was doing right? And then I went off to college, and then really didn't pay attention to it for four years. Now. I'm standing here five years after my college educated degrees over telling you, I wish my mom and dad would have stayed involved. Because I was foolish, and I wasn't doing so well. You know,

I think today is easier. Again, technology here is a huge pro in the fact that as long as the teen. And I think under the age of 18. Still, as a parent, you're you're the decision maker. You just are. And the kid says Well, I don't want you to follow me anymore. Too bad. Yeah, you're gonna be followed.

I'm so sorry. Yeah,

I pay for this, I pay for that I, you know, so sorry. But I think some of that, again, leads into how you navigate the discussion of, if you're doing these things, I'll be off your back, which is what a teen wants. It's not that they don't want you to care. It's that they don't want the constant hovering, that diabetes can bring into the picture. From a parental standpoint, right? You want to be involved, you want to be able to tell them more about what to do and how to do it and whatever. Because you think you know more. I think it only is when you need to step in only when you can really tell that they're just they're just not doing yet. They're not following the steps that you put down. You must do this, you must do this, you must do this, and I'll be off your back.

This is not too bad. So Arden had a situation a couple weeks into college, Arden doesn't drink and her roommates get drunk, and they come home and she feels very parental towards them because they're not in control themselves. So she's like, trying to help them. They're vomiting. She's disgusted by the whole thing anyway, like, I wish you could see oh, yeah, chain back and forth where art is like, I do not understand why people drink like, you know, she's like, I'm really This isn't me, I don't get this. I don't want them to get hurt. And so, you know, again, what happened overnight while this was going on, she let her blood sugar go up. She stopped paying attention to herself. And not in that moment, but later and I let a lot of time pass. I got her on the phone one day I said hey, we have some things we have to talk about. There was some school stuff. There was some stuff about money and how other things and I said and here's the last thing, here's the order. It's you. You You were first and when I They say you, I mean your blood sugar. Okay? That comes first, then everything else comes after that we don't give away our health for somebody else. Never, ever, ever. And, and I said, None of this matters Arden, if you go off to college and learn how to do this thing and become really great at it, but along the way, start accepting that your blood sugar can be 225 in the afternoon or overnight. So it's not going to matter. Because that's it, your your health is going to be destroyed, you're going to know how to do something and then be fighting with poor health your whole life instead, this this is first. And that that is a place where I stepped in and made that point, she also knows. And I want to say you can't just start making these, like pronouncements out of nowhere. You've got a parent like this the whole way they know this is the expectation like she had absolutely, she had a roommate that kind of, I don't want to say alright, there was a person who kind of wasn't handling being away at college well, and Arden said to me, I know if I acted like this, you would drive down here and get me. And I'd be living in my room and going to the college up the street from the house. And I was like, Yeah, but that was sure he knew that because of expectations set up before. I didn't just send her off into the world acting like an idiot. And then one day tell her act, right. You don't I mean, like it's

right. Yeah, I mean, it's just as simple as like the setting of a curfew, you're not following through with, I come home at 11 o'clock, because my parents told me that the time I had to be home, I can guarantee that transitions over into your diabetes management. Yeah, you're probably also not following those 123 steps that are must dues in terms of your management that your parents have set out for you. In order for them to not text you 62

There's the last one, we'll do it quick. Because there's it's a long thing this person says this is one of the top things that comes out later from families that I meet when they're talking about issues. It generally is that one parent or caregiver does not learn anything to the point where they can alleviate the need to help the main caregiver. And for initial training and pump training. Emphasis really needs to be on all caregivers attending. So it sounds like I hate to say what it sounds like it sounds like boys don't pay as close attention as girls, when they act like oh, you're gonna take care of it. Listen, I don't care if it's 2022 or not. I know men, this is what she's saying. You don't have to say anything to me, there is a higher there is a higher rate of divorce with families with chronic conditions. And this is a huge this is one of the huge ways that leads to complete burnout for one person. So I'm going to tell you that after Arden was diagnosed, however, many years ago, the endocrinologist pulled us aside and said, Listen, rate of divorce goes up when you have a chronically ill child. And then she pointed at me and said he's not going to and started like he she didn't know me.

She was and you're like, hey, here's the stay at home dad,

wait a minute, my wife laughed, and she said, Listen, if one of us is gonna leave over this, it might be me, not him. You don't know him, you know. But listen, whoever you are, in the scenario, don't care what's your, you know, if you're male or female, or whatever, it doesn't matter, like, but there is going to be some person in your relationship. Who gives that like, I don't know, you do it thing. And that's this person saying, if you get caught in that over and over again, eventually, it's going to be a landslide, you're gonna get knocked over. And you're gonna look up and say, nobody's helping me, especially this person here who I expected to be helping me because we said that there was part rich or poor, you know what I mean? And now something happened. And you're, you're out, you know, so

which also makes it harder. As I said earlier, it makes it harder if it does end up in a break in the marriage, and one person has been the Navigator. And the other one, which potentially contributed to at least some of that break. Is doesn't know anything. So then where are you left in terms of now the child having time with both parents, which is necessary from a child standpoint, but not from a health standpoint? That other one still doesn't know enough to manage? Well, yeah. And that's unfortunate.

Do you see this? I mean, the idea of there's more divorce? I mean, do you meet with a lot of divorce people?

I have never met I have to say I've never met with any family that has separated or divorced while I've been working with them with relevance to not all but some inclusion of the diabetes piece of it. I have met with people who've already been divorced. And I know the definite difference in management. Some families they do have an astounding job. Despite being separated and child one week is one place one week is another place but they The data doesn't change enough to reflect one being more hyper vigilant than the other, like, you know, being out for the counter. But I have a couple of families that certainly that's the case where one parent is definitely on top of everything. And then when the kid goes to the other parent, it's almost the complete opposite. It's almost especially for the teens, where that other parent just feels like well, they're old enough clearly, they can get themselves dressed, they can make themselves food, they can shower, they can get on the bus, they can do their homework. Clearly they've got this. Why would I have to step in?

Well, yeah, because diabetes is difficult and their kids is the answer. So Correct. Well, Jenny, I really appreciate you doing this with me. Thank you so much. You know, if you like Jenny, she works at a place called Integrated diabetes, and you can find her at integrated diabetes.com. She is for hire, if you need help with your type one. I want to thank today's sponsors on the pod and remind you to get yourself in on the pod five or an omni pod dash at Omni pod.com forward slash Juicebox. Podcast huge thank you to one of today's sponsors, DJI voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUCAGO en n.com Ford slash juice box. Thank you so much for listening. If you're enjoying the podcast, please take the time to share it with someone who you think might also enjoy it. Show them how to find a podcast app, how to download it, how to subscribe and follow and where to get the episodes that you think will help them most. Thank you so much for listening. It means it means a lot to me. You have no idea actually. Let's IT support the sponsors. Come back next week. Download old episodes, find the Facebook group Juicebox Podcast type one diabetes. That's all for now. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 805 of the Juicebox Podcast. Well, you would think that I would have learned after saying that the Pro Tip series was only going to be 10 episodes, and now it's like 25, you would think I would have learned not to say we're all done, like I did at the end of the bulk beginning series, because here we are back with something that fits in the bowl beginning series. Jenny Smith and I are going to talk today about how to treat illness ketones. 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 healthcare plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, it would mean a lot to me. And it would mean a lot to people living with diabetes. If you took a short survey that's available at T one D exchange.org. Forward slash juicebox. This survey helps move type one diabetes research forward. And it's something that you can do from the comfort of your home. It's also something that may open up other possibilities to you if you want them. And if you don't, doesn't matter. T one D exchange.org forward slash juice box fill out that survey helped move research forward. This episode of The Juicebox Podcast is sponsored by touched by type one, a wonderful organization helping people with type one diabetes, that you can learn more about on Instagram, Facebook, or at touched by type one.org. The podcast is also sponsored today by Ian pen from Medtronic diabetes Learn more at in pen today.com. And last but not least today's show is being sponsored by U S med. Us bed.com forward slash juice box or call 888-721-1514 to get your diabetes supplies the way we do from us med. You may remember a time when I told you we were all done with the bulb beginning series. Yes, that was a lie. So here we are.

Okay, what did we lie? Or what did we not complete? I should say we might not lie. It

wasn't a purposeful it was a it was we didn't know. So for today, I'd like to do a bold beginnings episode about how to deal with ketones. Because as I'm standing here or sitting, and Arden has now had diabetes since she was four, and she's 18. I would admit, I don't 100% know what I'm doing, especially around illness. So I think we should probably try to help people out a little bit with that.

Yes. And I think for clarity there, too, I think you've had you've always been very bold with insulin, right. And so I, I have a sense that despite art and having higher blood sugars, you've attacked it with the knowledge of even if there are ketones there and you haven't tested for them, you're adding insulin, that is probably what we would recommend adding in excess of correction. That's helping to clear the ketones. So I think you've gotten away with it, for lack of a better way to explain, because you're just like, I'm not going to deal with the high. I'm just going to bring the high down and this much didn't work. So let's add more. You don't really have a science to how you're doing the more.

And I do want to talk about that a little bit so that people have here's my last recollection of it. Arden had the flu, but she was well we both had the flu when she was like my god, four years old, maybe, like really little. And she and I are in bed together just like I mean, we were a mess, you know? And we that's when I learned how to use a lollipop to keep her blood sugar up. Because I was I didn't know what to do. She wouldn't eat. I think sports drinks helped a little bit but it was a lollipop I kept I kept them around. I was like here suck on this. And that she could kind of get away with

it probably helped if she was nauseous too. If she had like stomach piece of the flu. Oh sweetness. Probably yeah, often sucking on things if you're nauseous can really help to calm

the nausea action of sucking the sucking. Yeah,

in fact, I mean, they have you know, in pregnancy, they've got all these fancy products, the preggie pops that they're called like these. They're literally just soccer by it. I mean, I got through actually the early part of my pregnancy is sucking on. They're made by the ginger people. They're just like they look like little All cough drops but they're a gram and a half of carb apiece. They taste like ginger. Ginger is really good for calming the stomach. So stuff like that. It's probably the reason along with supplying the sugar to keep her blood sugar up. It helped to calm some of the nausea. Maybe she might not have told you what she was feeling like as a four year old but

well, you just messed up my my internet searching now because I'm going to start getting ads for preggy pop because I didn't I almost believe you that they existed. There are preggie pops, which are lollipops are also preggy pop drops, I guess. That women how about that. All right. Well, there's my there's my the ads. I'm gonna get served now. Google thinks I'm pregnant. Alright, well, that got off the track pretty quick there. Yeah. So. So what I remember from that time was, is that back then Arden was peeing on a strip to to see if she had ketones we Yes. We saw that she had ketones called the the sick line for her for her endos office. And I mean, the rest of it. I can't remember. Was it one unit for like, if our ketones were two, we were supposed to like put in a unit to bring our ketones the one? And is that right? Or whatever?

It depends? Yeah, I mean, so you did, you did learn an adjustment strategy, based on like adjustment for insulin strategy to help to clear the ketones and if your blood sugars are high, and not only are you using the corrective insulin that either you're calculating, or your pump is helping to correctly, you know, calculate for you. But you also have to add on top of that based on mild or moderate or even large ketones, an amount of extra insulin to clear the ketones, and that's dependent on how much some some places recommend basing it on total daily insulin. Other places recommend looking at your Basal dose that you take or that your pump provides. And then dependent on whether you have mild or moderate ketones. It's either a 510, or 15% of that total daily Basal that you calculate, and then you add that on to your corrective dose. So let's say you know, let's say your blood sugar is high and your pump recommends two units for correcting that high. With ketones present, that correction is not going to bring the blood sugar down as effectively, but your ketones are not going to get cleared well. So we need to add on to that. And if we're saying mild ketones, let's say you need five to 10%. Let's say your total daily dose is of basil is 10 units a day 10% One extra unit. So you're gonna add on to the two units of corrective insulin, the one unit to bring your ketones down along with address the hi

a couple of things here. First of all, what I realize now is that all that time ago, I thought they were telling me one unit for this number, but it turns out they may have been looking at other things about Arden's insulin usage that I didn't even know about.

They could have been exactly. Okay. And

the other thing I remember from that time was the abject horror because Arden's blood sugar was lower. It was like 90, and, and she had ketones, and the woman is like, so give her insulin. I was like, listen, she can't eat. And her blood sugar's 90, and a unit bill like Crusher, because she was little. And she's like, No, it won't. And I'm like what she's like, it'll just clear the ketones. That's a leap of faith right there. Because yes, yeah, I was like, wait, what so so you just kind of

I have to say that your your clinical team then was a little bit more on the aggressive side of adjustment. Many people will go home with directions, if they do get anything for ketone clearance, they'll go home with directions that unless the blood sugar is above this value, you have to get the blood sugar high in order to give the correct IV dose and to clear the ketones with the adjusted ketone dose. Many clinics will not tell you to just take a unit even though your blood sugar's 90, and you're not eating anything. So it's a pretty progressive thinking clinic.

There's, listen, I, the the problem is the reason I don't have more information about this is even though Arden is sick at the moment, we don't generally get sick in our house, or neither. And we don't get the kinds of illnesses that come with, like nobody vomits in my house. Right? Like, you know, families are either vomit or they're not, you know, like we don't we don't throw up and so I'm putting that on my tombstone. You're alive, Scott. Never really act. But so we don't have the problem with what we can't keep something down. Like it's not fun to drink or eat when you're sick. But Arden can she can power through it, right? Sure. So I've never really been in that situation. And I do take a lot of, I do believe what you said that we're just very aggressive with insulin so that even if Arden has been in a situation where there are ketones, we might not even know about it, because we're, we'd be bringing them down. Correct. There's a connection in there that um, oh, I know what it is. You hear a lot of people online get told. It's a variation of what you just said. You just said like push the blood sugar up so that you can put in a bunch of insulin. And I've also heard people told like, you know, Bolus but then drink like sports drinks at the same time. Correct. And that's

actually I think, if your blood sugar is low, and you can take something in especially kiddos, often Pedialyte will sit, okay, sometimes just sucking on a popsicle, or like you did a sucker can be okay. Sometimes if kids aren't willing to take anything, put some honey, you know, in their mouth, it can get absorbed through the mouth tissue, essentially. But why would you leave ketones where they are and drive your blood sugar up just to take some insulin. So another strategy is to use some carbs that can be taken in and not cover those, okay? And then allow the ketone coverage alone without a Bolus for any of the carbs that you've intake, or you've taken in?

What's the reason for that?

The reason for that would be if your blood sugar was lower already, and you're worried, you know, Arden's blood sugar was 90, and you're like, No, we we can't give her a unit of insulin. This makes no sense to me, right? So had she been able to take something you would have essentially let the carbs go in without covering those at a lower blood sugar value? Because with ketones present, you need insulin to clear that.

So correct. The blood sugar with carbs Bolus? Are the ketones. Correct? Right. This is this whole dance here is why a lot of people who are people who vomit, people, I can't believe I've designated there are people who vomit and don't but anyway, you don't even more prone to it. They often have a prescription for like Zofran in the house, right? A lot of type ones do that. So yeah, when nausea comes, you can treat the blood sugars treat the ketones if they exist, and have the safety of knowing that you can keep something in your stomach and not that I guess. I mean, let's just go over it. If you Bolus for something, and you eat it, but then it comes back out before you've digested it, then you don't have the impact of the carbs. All you have is the act of insulin. And that is the quick way to seizure Vil. Yeah,

correct? Absolutely. I mean, it's the big reason that with stomach bugs, specifically where you are throwing up or potentially the opposite of that, right? Whether it's coming out one way or another, you're really not also absorbing everything that you're even able to put in. And because your digestive system is irritated. And with that we you say take in the carbs that you can and wait until you know it's going to stay down before you Bolus for it. And then reduce the Bolus for the carbs you ate by about 50 Maybe 60%.

So some insolence happening, but not super aggressive. Correct? Yeah. Okay. All right. So now we're talking about illness ketones? Yes, these do land people in the hospital all the time, because then they can put you on a drip to keep your blood sugar up and give you insulin at the same time. They can bypass your digestive system basically and get your ketones down. Right. Can you tell people a little bit about why you don't want your ketones to be high?

Yeah, absolutely. I mean ketones, ketones that are specific to illness and high blood sugar or ketones that are relative to lack of intake because you have a stomach bugs, we're talking about illness based ketones. We're not talking about nutritional ketosis are those on a ketogenic diet. Right. So ketones in general in an in a state where you're sick, it's like having waste in your body, right? You know, the ash that's kind of in a fireplace once you've burned the logs, right? That's kind of what ends up happening when you have the not desired ketones in your body. It's like waste product from having your body break down. Pieces of your body, right? And so your body tries very hard to flush that out. And which is The reason that we use to test ketones using urine ketone test strips, because your body will try to flush as much as possible out. Hydration thus is very important if you have ketones whether they're mild or moderate or absolutely high. Need hydration, I want to talk about like a water bottle an hour of hydration with ketones like flush, flush, flush, drink, drink, drink. But you so that's essentially the reason that ketones are present, your body doesn't have enough insulin to clear the high blood sugar. And that often blood sugar's over about 240 or 250. If they're left lingering high for hours on end, you're more likely, especially with an illness to have ketones show up.

Okay, and this is just from the CDC. But decay develops when your body doesn't have enough insulin to allow blood sugar into your cells for the use of for use as energy. Instead, your liver breaks down fat for fuel a process that produces acids called ketones, when too many ketones are produced too quickly, they can build up to dangerous levels in your body. And decay in an illness situation can come on fast. And it can be deadly like, Yeah, seriously. Yeah.

And that's another big one with that, you know, another testing piece that they often look at, if you do go in, and especially DKA, or electrolytes. And so with illnesses that are the vomiting kind of illness, so to speak, you may have a difficult time keeping in enough hydration, and electrolytes then get very off, which does not help in this scenario with ketones present. So I

believe that beyond her, her initial diagnosis, Arden's only been in decay one time, and I don't know if she was in it or not. All I can tell you is that there was this one time, we had a kinked cannula that we didn't know about in a changed pump in the evening. So she went to bed and didn't get insulin, and then woke up in the morning, and was like, she had a really high blood sugar. And as soon as I saw it, I was like, That's odd. It's a long time ago. And I tested it. Change the pump saw the kink. And I thought, Ooh, Oh, no, no, no, this is bad. And you know, so I said to her, she was old enough to have a decision. It turns off, I said, Listen, if you can drink a lot of water right now. Hold on a second place.

Yes. Are you defining a lot? Oh, much water is a lot.

Well, back then. I, I told her to bottles, that if you can get two bottles of water, and I think I can get your blood sugar down in the next couple of hours. And she did not feel well. I mean, she felt terrible. And she kind of was like, I can't do that. And I said, that's no problem. But if you can't, we have to go to the hospital. They're gonna give you an IV and everything. She just like, I wish you could have seen me the water bucket action movie, she like grabbed the water bottle. She was like, just pushed it in. And I remember saying to Kelly like I put a timer on it. I was like, Listen, if you know, in three hours from now, like I said, an hour from now we're not seeing movement. But if we see movement that will go to two hours. And then after we get under a number, but I was making it up on the fly. I didn't know what I was like, You know what I mean? So

you're actually at what you did was right in the timeframe. I mean, you're talking about not illness space, but but a pump failure really insulin, right? She didn't have any insulin. So in that case, right? You did the right thing, we recommend checking or looking at blood sugar after testing for ketones. And if you don't have a way to test ketones, assume with a consistent high blood sugar, that it's probably a pump site failure. Change it out, take insulin to get it down. Hydrate, check again, you know, I mean, now with continuous monitors, you have the ability to see where things are obviously going but if you don't really checking blood sugar is about every hour to two hours checking ketones somewhere between you know that timeframe, every about every two to four ish hours. Check ketones again, if they're coming down, great, continue with the water correct as your pump recommends, you can correct and continue to check your ketones until they're you know, down.

So one of the more interesting conversations that I see online every year is around this. Somebody pops up into the private Facebook group. They're like, hey, my kid is sick, and they have ketones. What do I do? You're getting your diabetes applies from somewhere. But is that a pleasant experience? Only, you know, here's what I can tell you. We've gotten gotten, we've received Ardens diabetes supplies from a number of places. None of them have ever been as good as us med. Us med.com forward slash juicebox or call 888-721-1514 To get your free benefits check. And you would do that to be part of a company that has an A plus rating with the Better Business Bureau who accepts Medicare nationwide over 800 insurances. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM, like the Dexcom G six and the FreeStyle Libre three EU. And us med always provides 90 days worth of supplies and fast and free shipping, better service and better care is what you're going to get from us med a company that has served over 1 million people with diabetes since 1996. number one rated distributor index com customer satisfaction surveys. Who is that? Oh, that's us. But how about number one fastest growing tandem distributor, we're the number one distributor from the pod dash, US meds where we get on the pod supplies from we also get Dexcom supplies from them. You can get your libre stuff, your tandem stuff, just head over now, US med.com forward slash juice box or call 888-721-1514. So you want the functionality or at least some of the functionality that is offered by an insulin pump. But you're not ready for an insulin pump where you just don't want one. In that case, you should really look into the in pen from Medtronic diabetes, head to N pen today.com. Right now you can kind of follow along with what I'm saying. The M pen is an insulin pen, but it's attached. Connected I should say to an app on your phone that helps you with things like seeing your current level of glucose After pairing your CGM to the in pen app. Ooh, how about that? What about meal history, dosing history and activity log, where you can see a list of recent actions including doses meals and glucose readings. You can make reports to share with yourself or your doctor, I guess you don't share things with yourself, you just look at them, but you get what I mean. And the app also has a dosing calculator, and much more should head over and take a look at it right now. And if you happen to be ready to buy when you get there, it's possible that you may pay as little as $35 for the implant. Isn't that crazy? You know, I should say that the offer is available to people with commercial insurance in terms of conditions apply. But as little as $35. Go check out their hands on product training, online educational resources, and 24 hour technical support. All of this is that in pen today.com. And there are links in the show notes of the podcast player you're listening in now. And links at juicebox podcast.com. To in pen to us med to touch by type one and all the sponsors that you click on. I just hit something while I was talking. I apologize. When I'm talking with my hands right now I don't usually do that. When you click on my links, you're supporting the production of the podcast and keeping it free for listeners. So if you want it in Penn, if you want to switch to us med do it, but use my links and if you don't want to, I don't really care. Do what you want to do. But if you're doing my stuff, use the links this all makes sense to you right? Don't forget there are also links to the other sponsors Dex comm on the pod. G vo Capo pen Contour Next One blood glucose meter. Wow, a lot of sponsors. Feel like I can't remember them all. If I haven't said your name yet don't get Don't Don't get mad at me. Now I set them. Yeah, I got it. I mean, you know, take the T one D exchange survey that links they're touched by type one we already talked about today. Just use my legs please. Thank you. Oh geez. I'm all over the place. I have to say in pen requires a prescription in settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you could experience high or low blood glucose levels. For more safety information visit in Penn today.com. I almost forgot to do that. But then I remembered at the end and they have ketones. What do I do? Somebody who has had a bad experience with it or is afraid right away says good hospital. They don't even ask any questions. I go to the hospital to last but then other people come in and say Well listen, like are they able to keep food down? You know, can they drink a sports drink? You can give them insulin like how high are the ketones? Are they really large? Are they moderate? Are they small? Like you know you might be able to manage this on your own. It's a very it's a very interesting conversation to watch happen because there is fear from people who have either been in decay because of this or have been in a situation where they can't keep down food. And then there's the other people on the other side who are Like, I guess not yakkers. And they're like, you know, they're like, oh, no, you can manage this, as long as it's not too out of hand, if it's too big, you should go. And I always think, like, what a horrible situation to be in, you really don't know what the right answer is, you know, call the sick line for your thing. Some people call the sick line, nobody gets back to them for a while and correct,

or they give them information that that's not specific to their individual need, because the sick line really isn't. I mean, if it's within your healthcare network, they could potentially look up your information and see what's there. But they really don't know the day to day, you know, nuances of your management and how sensitive you are and whatnot. It's really just a, an off the list of do this, then do this and then do this and adjust based on what your calculated insulin dose should be.

It also gets messy are messy is the wrong word. It's gonna be funny in a second, because a lot of people have urine, Keystone, urine ketone strips still so they're like, why Amelia, get this, like, it's a baby or like, you know, a kid or like, I don't want to be it. That's why I don't know what you have in your house. But we've had a blood ketone meter for a very

long time, we in fact, that's the only thing we recommend. Yeah,

I use the precision extra. I've used it forever. They're not. They're not sponsors. I've just had it forever. It works great.

And they're, they're nice, because the test strips come individually wrapped. So you don't have to open a whole bottle, which is only then good for 90 days after you've opened it. Unlike the ketone, the urine ketone strips, once that bottle is open, you might use 10 out of the bottle of 100 over a sick period of time or a day when you had a high blood sugar because of a pump sight issue or whatnot. But then, hopefully, you don't have to use the rest of them in the next 90 days. But really, then that that battle is like, done there. And you know, you're in ketones also. They're old information, right? It's a couple of hours old, comparative to real time being a blood value of ketones.

Well, as soon as Arden got sick this week, like we got her set up in a room and the first thing I said to Kelly was like, Well, I'm gonna check her ketones, get the meter out, make sure we have it, you know, have a baseline like right now she doesn't have any that's good. But I guess I want to talk a little bit about what we're really talking about here is meet the need, right? Like you. Generally speaking, you have a need for insulin, you have a different need for insulin during an illness. And by the way, not all illnesses hit people the same. So right, you know, you could like Arden had ketones with the flu. But now more recently, she has a sinus infection. She doesn't have ketones with a sinus infection. You know, the Hoos and whys of that are not important just that sometimes this might happen. And sometimes it might not correct in general, in whether it's this ketone situation or not, you have a you have an increased need for insulin, and you're not meeting it. That's all. That's all it is. It's, it's scary. And it's different. And there's the piece about, oh, what if I can't keep food down, which I think ratchets up ratchets up the fear about 1,000,000%, because I can still remember being scared giving her that insulin when she was like four.

Right? Absolutely. And I think there's a there's a definition, kind of to make between high blood sugar illness and ketones. And the main illness that really doesn't drive blood sugar up, in fact, you may run lower, and your insulin needs may look like they go down on the base level of what you need. But if you have a stomach bug, and you're running lower blood sugars, as we said before, you may check ketones and ketones may be present. And they may be more mild. They may even get up to moderate because what you're doing is you're now not taking in any food. Right? Your body has to derive energy from something so you get this low level of ketones more from a starvation base. This isn't driven because of high blood sugars, because your blood sugar's aren't high is driven because you're not really taking anything in and so then it's sort of like the question, well, I've had a lot lower Basal insulin needs, I'm not eating anything, but I have ketones, and now I'm supposed to take insulin.

You know, and the other side of this too, is that like you mentioned it earlier, just there are starvation ketones, which you could also see if you were doing an ultra low carb diet, these do not put you into decay.

So not not at all. In fact, many people if you've been tested just just so that you figured out how to use the machine, like in a baseline setting and you're not sick or anything. Check your ketones first thing in the morning. Many people actually have a really mild, low low level of ketones because overnight, your body's supposed to go into this sort of like fasting. It's not supposed to be digesting food until you eat at midnight, the steak and fries and cheese sauce and whatever it

is. We you and I talked about this is episode 287. It's a pro tip called illness injury and surgery and actually in Episode 288 is the defining diabetes about ketones. Oh, I actually think it comes up also in how we eat episode with a person who was on the show, but you should go listen to you should understand the difference, but you know, keeping it to just illness. Okay, so let's kind of like, let's go back over what we've talked about. So sure, kids sick with two options, two sets two scenarios, kids sick and keep food down kids sick or your adult sick doesn't matter. Can't keep food down. So if you can keep food down, and you have ketones present, is there I mean, you know, me I'm like just thinking like, just use more insulin. But I mean, what did they do, like call the doctor.

So obviously, calling your Health Care Protect practitioner is really it's an important first step. Based on what their recommendations I would even say, rather than a, you know, a PCP, you really should be calling your endocrine team, because they're the ones that could help to dictate well, how much more insulin to clear the ketones. The baseline is typically again, one of two formulas, if you want a more precise dosing rather than us take two extra units because you got you know, ketones present. And I know I need more, so this must be more, right. But you know, if you're using it, looking at your total daily dose of insulin, and then you may need about 10% more than what you average total daily, if you have mild ketones. If you have moderate ketones, then about 15% More of what your total daily dose is. Other Other practices go more based on just basil. And that then would say mild ketones, you would look at just what your Basal rate is, or what your Basal doses and you would take 5% of that and add it on to your corrective dose if you also need corrective insulin at that time. Okay. And again, how often I that's a question when we're, when I'm talking with the people I work with, you know about, well, how much and how often can I give it really it's about every two to four ish hours is the kind of watch point right, where you're checking ketones again, about two hours later, again, hydration, the extra insulin, you should be starting to see some difference. And this is where the benefit of using a blood ketone meter really does come in, because it gives you decimal values to ketones. So you're starting ketone levels, maybe it's moderate. And maybe it's come down by, you know, point four over the time period that you've been testing and adjusting. And every that's a difference. Absolutely. You're making a dent in your ketones. They look like they're falling. So continue to do hydration, watch your blood sugar's watch the ketone levels, with kind of a testing plan of about every two to four hours, you

can't stop paying attention to it, because it comes on quickly. Are there physical signs to look for? When you should? Like, is there anything physical that would make you think we're not winning this battle? Maybe the hospital is the right way to go?

Well, if blood sugars are high enough, in ketones are present, obviously, somebody's going to be more thirsty. Definitely there. Also, ketones often make people nauseous. Like that feeling that you said Arden had ketones feel horrible. Okay. So those symptoms now again, in kids that are old enough to tell you how they're feeling or teens or even you're the adult, you know, managing everything. There's a little bit more ability to tell how you're feeling. But little kids are, I think they're harder. And so they're the ones that a lot more watchful, honestly, I would say under the age of six, more testing more watching. Because they may be the ones that end up needing to go in,

right. So and you're in, you're clearing these ketones with water, if you're lucky enough to be able to drink it. And with insulin, those are the two ways you can clear it out of yours.

Yep. And I usually even say try to try to go off and on with water and then maybe an electrolyte beverage that does have carbs in it. Because remember getting in some carb and if your blood sugar is high and you're doing carbs, obviously you're doing correction insulin, you're doing the carb insulin base, electrolyte drink, and you're doing the ketone. So you're doing kind of a three level of insulin. there because just because your blood sugar is high, your body still needs some energy

in an illness situations where people are still eating, but they seem insulin resistant. That's, that can be fairly common during an illness. Yeah, so our didn't had it this week with this, with this sinus infection every night after dinner until like two o'clock in the morning, I gave her I mean enough insulin to put down a pony, you know, like, and it was, we were barely holding her blood sugar 200. And, you know, it just it takes a lot of time and experience to be able to say, I'm going to use a significant amount of insulin more than I then what would normally be needed here. And right, you know, I don't even know how to tell you to get into that headspace. It just it takes time, you have to do it over and over again. But there was a moment when I came in. I said, I was like, I'm gonna go get a syringe. And we're going to just shoot like five or six units. And, you know, because this 200 is creeping, it's going to go to 40 and five seconds like we're not ahead of it. insolence not touching you. Right? And I need to my thought there was, it's interesting, I'm almost not as aggressive as I sound there. I just don't want it to skyrocket because I know I'm putting all this insulin into her. And at some point, it might start working and put her in the wrong direction to correct. So I'm being super aggressive. If I told you I thought I might have used twice as much insulin. But I had her I had her basil doubled. Or basil was like at two units an hour. And we were bolusing. It felt like every 90 minutes, just to hold it where it was like every time it tried to go up. I was like no, no, no, no, like more, you know, and we were up watching what do we watch? on Hulu? Does Oh, only murders in the building. And we sat. We sat up all Arden was sick watching that for a couple of nights. And we just kept pushing. But the problem was is that she she hadn't lost her appetite. And on top of everything else was going for comfort food while she was sick. Right? So it wasn't just it was the illness. We were trying to hydrate her. But God knows how well that was going. She was drinking a lot. But then she's eating food that's more comfort food. And I mean it was a journey like it.

I think you bring actually, an important point here in a sense is that when you're talking about illness, most illnesses that are the chest cold, the sinus infection and ear infection, even like a bad like tooth infection or whatnot, those will drive your insulin needs up because of the stress of the illness. And if you're not staying on top of that need to add more and by how much more mild mild cold when you're still up and around just feel sniffy, you might need 10% More Basal insulin, whether it's injected insulin or in your pump, you may need to use Temp Basal increases or whatever, you know system you're using to accommodate more. Yeah, you've got a nasty bug that is driving your blood sugar's up, and you're not adjusting your Basal up 2030 and 50%. I remember my insulin needs I wasn't even on a pump in college, I had mono. And I, I could barely like drink like broth. And my blood sugars are high. And my endo was like you need to just increase the Basal amount. I was amazed at how much my insulin needs went up, just because I was so sick. So I think if you don't stay on top of that with an illness early on, you're more likely to get ketones. Because you because you haven't brought the blood sugars down based on the illness. Yes.

Right. So you could almost have because of the situation as such high blood sugars, you might have ketones that are just from high blood sugars that aren't specifically from illness. Charities. Yeah, and you know, there's always I'll let you go in a minute, but that's okay. Inevitably, I see someone online who's sick. And they have a CGM, and everyone who has a CGM has ever seen this knows how frightening it looks like. There's a ceiling to the CGM, like it only goes to like 400 or something. It's flat and that it just runs this dotted line across the top flat. And somebody posted recently, I've been sick for days. And my blood sugar has been like this for days. And I'm like, oh, no, no, no, no, no, no. And you know, and people are saying, like, do this do that I just popped into their head, I was like, use more insulin, use more Basal insulin, inject it to like bring it down. Like even if you can get it to 200. Like better I would be much better because also high blood sugars impede wellness in general and healing.

Absolutely. The longer you leave high blood sugars while you're sick, the more likely you're going to be sick longer, right? Yeah, really.

All right, well, I appreciate you doing this with me, because it just seems like something that people struggle with constantly. And it doesn't matter if you're newly diagnosed, or if you've had diabetes for a while, but I thought that it would fit into the beginning series. So

it does I think the only thing that I, I think, because we have those levels of mild, moderate, and large for ketones, I think the last question a lot of people end up having is, when do when do I go into the emergency department? Yeah, right. When should I go, I've done all this stuff, things aren't moving, things are getting worse. You know, if your ketone levels, I think, one. You're trying to drive blood sugar down, it's not working. Let's say you've even while you're sick, you've done a site change because you think, Well, besides being sick, maybe it's my pump, right? Your blood sugar's aren't really moving. Your ketones aren't moving or are going up, that's more of a time, you may be behind the curve in terms of hydration and other the electrolyte balance and all of that in your body, you may need to go to the emergency department, you may need their assistance. So I think, just to clear up like, when should you really go?

Well, Jenny, to be completely candid, this is a hard episode to do. Because there's a lot of nuance, and everyone listening is not going to be in the same situation, right? And really, honestly, I mean, there'll be a disclaimer at the beginning that says like, this is not medical advice, because I don't know your situation. And you might need to go to the hospital and like bringing up those Facebook posts where people run into like, go to the hospital. Those are people were like, I don't know what's happening there. And it sounds like you don't know, either. So go find somebody who understands

this. Go somewhere who else who has a medical degree and can at least maybe hook you up to an IV?

Right? Yeah, I mean, I think the way I think about it is the way I described it when Arden had the bent cannula, right, which by the way, I just want to say, only Ben cannula the entire time, she said diabetes, just one, which I think is Wow, not bad, right? Oh, but in my mind, when I saw that, I thought, if I can start bringing this down right away, if she can hold water, and I'm moving quickly, at a reduction, okay. But I am not going to mess around with this like so, you know, I you have to use your own personal intuition. And you know, it's don't genuine aren't telling you what to do. But, you know, I just thought maybe this would help guide people through it a little bit. It is a really weird thing. Like, I seriously in this space, sometimes you'll think Why does no one ever talk about this? Or that? And the answer is, because I don't know. Like, I don't want to tell you absolutely something and it not be right. And I'll give you an example. What's an episode that we have on our list that we never get to? How low of a blood sugar causes damage to a person? Everyone wants an episode about that? They bug me constantly, I get notes about it. I say to Jenny, how do we do this? And we're both like, I don't know, like, like, right? Yeah, you could difficult.

That's a difficult one, because it's kind of like it's like ketones. It's you've been given these tools, you've been given this guideline to utilize. And every person I mean, what is it? It's your diabetes may vary, right?

Yeah, me, right. Yeah. And by the way, some people are dizzy at 70. And some people are dizzy at 50. And some people never get dizzy and etc. And right. But the question people have over and over again is when does damage happen? Like, where can I let and listen, I can tell you that last night hardens, blood sugar dipped down to 55 for a couple minutes. It went up to 61. I looked at it. I said if this keeps rising, I'm okay. But it went back down again. So I gave her some juice. I didn't want her to sit there. Do I think that she's three IQ points dumber today because of that? No, no. But you know, but I also am not comfortable saying that out loud. Like as a certainty, you know, correct. And

Reese, I mean, references or research often focus a lot heavier on what are what are the problems that come from high blood sugars. There's minimal. There is information but there's minimal information about what value creates problems with long term like mental health, right? And most of the research identifies under 55. So if you're looking for value, I would even say, let's say under 60, just to be safe, right? But honestly, it's it's the duration of the low blood sugar. And that's a general that's a general statement, right? If you're having duration one day into the next into the next into the next, it's very likely that you're impacting your brain cells,

but if you're 60 for a half an hour It's a different situation.

It's a different situation. I think that's the, that's the best, simplest way to say too much is too much and will likely create issues. So let's aim for less lows and defining lows as under 60. Let's aim for less of those.

One one day, maybe we'll try to tackle it and see how it goes. But I just wanted to make the point that this is not this ketones thing. It's there's no real certainty in it. Like I don't know when to tell you to go to the hospital. So good luck. And try not to get sick. I'll tell you right now, Jenny. I don't miss COVID. But I miss everybody staying away from me and nobody gets sick. I love that time. But he's been so secure for so long, I would go back to being locked down. I have to feel like this.

Hopefully, you guys are all on the mend.

I hope so too. All right, I really appreciate it. Thank you. So welcome, of course. First, I want to thank my sponsors in pen from Medtronic diabetes and remind you to go to in pen today.com Also want to thank us med us med.com forward slash juice box or call 888-721-1514. And of course touched by type one is touched by type one.org. They also have a bustling Facebook and Instagram presence. Go find them. If you're looking for more bold beginnings, episodes, head to juicebox podcast.com. Go up to the top to the menu and it says it right there bold beginnings. Actually, a lot of the series are up there. Ask Scott and Jenny after dark algorithm pumping defining diabetes, diabetes, pro tip the variable series, mental wellness to finding thyroid. It's all there where you can just search your podcast app if you just said juicebox one word. And then like bold beginnings, I think you would get a list of all the episodes right your podcast player. I hope you enjoyed this episode. Thank you so much for listening. Let me remind you that Jenny works at integrated diabetes.com Who wants to hire her head over there. And I appreciate you listening and sharing the show. As the year comes to an end, I find myself very reminiscent of the past year I think back that's not the word reminiscent. What am I don't remember the word. I'm feeling good. So another long year of making the podcast for me. And I'm just thrilled with how it went. I'm thrilled with how you guys enjoy the show your feedback and how you share it. It grew exponentially this year. Doubling downloads over last year, maybe more than doubling downloads over Yes, sir. Anything. Yes, more than doubling the downloads from last year. It's just taking off because you guys are great listeners who not only download and subscribe and follow but you tell other people about the show. And that's why it's growing. And that's why we get content like this and I just can't thank you enough. I'll be back very soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 1117 of the Juicebox Podcast. It's been quite some time since we've made an addition to the bowl beginning series. But today's episode is in fact, an addition to that series. Today we're going to be talking about your medical team. And it might be a little different conversation than you're expecting. 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. 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. 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 cozy earth.com. 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. Hello, Jenny, how are you?

I'm awesome. How are you today?

I'm awesome, too. Together. We're awesome squared. Yay. Today for the bold beginnings episodes we're going to do your medical team.

That's a good topic because it? Yes, I feel I'm curious what and what people have said, Yeah, I am.

First one off the bat. First off, find a doctor who listens to you and your worries, not one who tells you it's all in your head and, and are totally not knowing what you're talking and you're totally not knowing what you're talking about. So it's all in your head. Interesting. Your concerns aren't important. Why does that happen? Jennifer? Why would a doctor hear my concern? And just tell me it's not real? I don't know.

I don't know. That's a good question. I mean, on all ends of the spectrum, regardless of whether you have a child or an adult, part of being a medical professional is that somebody is coming to you for assistance. Right? And if you can say to them, let's look at this in a logical way. Let's look at this and your concerns. And let's figure the ones out that actually are relative to something that we can change. And what are some of the other ones that we can address in terms of like another avenue of discussion, right? But nothing is nothing is not important. So

here's the problem is how do you know? How do you get past that white coat syndrome? Where you look at them? And you think well, they must know? Right? And and how long have you put up with being treated poorly before you make a change? And what if you can't change but if you live in a small town, and this is the endo That's true. That's it, you know,

that's true. There are many, you know, places and I'm only talking nationally, but I do know, you know, internationally, it can be an issue to having worked with a lot of people outside of the US. Depending on where you live and what you have access to and what your network providers may be or whatever what you have access to makes, it can make a really big difference. You may not love the person that you go in to talk to. But you may need them just even from a prescriptive standpoint, you may really have to utilize them from that and you may have to outsource in another in another way. And that's that's sad because many times if you outsource, it will be you're paying out of pocket for something else.

And keeping in mind that this series is for newer diagnosed people like this is a frightening idea of like you mean all this happened to me and the doctor might not be good. Oh, and how would I even know if they're good? This this person said What should I expect? Back in terms of my support staff, we found that there were many conflicting pieces of information when we were first diagnosed, and they were coming from different doctors and nurses within the same practice. Yeah, so, you know, so you're in a room with one person, they're telling you one thing, and then you come back three months later, and they're telling you something different. Also, no one explains to you that in a lot of practices, you don't see the endocrinologist.

Or at least not very often. You're right, because there's there is Amin, if you will, a shortage of endocrine prac, you know, practitioners. And what you may find is that you have a nurse practitioner or a PA, a physician's assistant that you meet with in between the endo visits, you may actually only see your endo every six months, but you may see the other person in between on like, you know, a rotating basis.

I used to think that if I used to think the endo had to physically touch Arden once a year so that the billing was legal, because she would kind of come in the room like Mary Poppins just kind of flowed in. She, oh, looked at the chart. Arden. How are you? And then she'd reached out and she would just touch her? And I'm like, Are we completing some legal liability right now? Like I've touched her? We can bill you. Weird. And then she just how are things? And then let me and she she'd lay down rub Arden sites a little bit, ask her a couple of questions. Look at the chart. You're looking terrific. Keep it up and then move up the chin load out the door.

Or away on her umbrella or

movies right now. I've never seen Mary Poppins.

Oh my god. Oh, you are missing out. It's such a good movie. Both of them actually. The new one and the really?

She cleaned the chimney or did she go up the chimney? Or was it the guy that cleaned the chimney?

That's the chimney sweep. Oh, Scott.

That was right.

That was Dick Van Dyke. Nobody

listening to this knows who Dick Van Dyck is. At least I got that right? Well, if they've seen

the newest Mary Poppins returns, Dick Van Dyke does show up in it at the end. And he is very well. He's very old. He still does his little jig dancing and everything. So yes, I actually looked at my husband. I was like, I am super Rami is that his dancing ability? Like,

you know, he was sitting in a corner and they were like, alright, in five minutes, hit deck with the adrenaline. Out here he's like, do the dance. Do the dance. Then he was done.

That's funny. Yes, I'm that makes me sad that you have not seen Mary Poppins. Come on Scott up a spoonful of sugar. And you're talking about diabetes? No, I'm

just kidding. I saw I saw I saw the first episode of She Hulk last night. This might not this.

Probably. I don't even know what that is.

I wish I had known how to advocate for myself. When you don't know everything. Especially in the beginning, I knew there was more. And I knew it could be done differently. But I didn't know the words to say to create the partnership with my Endo. Instead, we often felt like opponents looking back, I can see how a change in language and better questions would have helped in our relationship. I struggled in that place of knowing I didn't that I didn't know everything, but not sure if our endo was going in the direction that we wanted. She said spoiler alert, they are actually amazing to work with. But in the first six months, we were in constant battling. Right?

I think there it sort of defines to the the underlying lack of the right kind of explanation at diagnosis, right, all of the things that get sort of spilled out to you. And you only you only can absorb so much, especially with now this turned around in life, right? Something that's bringing something in you didn't plan to have to manage and take care of. So things like you know, all of the language around diabetes management, anything from going into a clinician, it's really just being very upfront and saying, You need to explain that better. I don't know what that word means. And you have to step back and just pretend that you are saying I just don't get it. You're not saying that you're not a smart person. It's just that this is new. I don't get that or I've bring in some of the things maybe you've done the online community kinds of investigating and you've seen some things talked about and you're like, that's what's happening for us, but I don't know, is this right? Should I try? You know what I've read about? Go to your clinician and bring it up and say I've seen this too. Scott started seeing this product or whatever. You can open doors in terms of discussion, too. Because you know that doctors aren't mind reader's either. They don't know what you don't know.

It's an absolutely interesting situation because you're 100%. Right, like, well, it's easy to blame the doctor for not saying everything they should have said, right. They don't know what they should also they don't like when you when you're a doctor, and you use the word Bolus 800,000 times a day. There's no world where you think this person doesn't understand Bolus you don't even think about that Bolus is the to them. It's a word that they just use, which is why and I will absolutely without embarrassment, pimp the the defining diabetes series in the podcast because

I was gonna mention it too. So I'm glad you brought to it.

There's simple terms that we explain simply so you can listen through them. They're short episodes. And when you leave the episode, you go, Okay, I know what Basal insulin is. Now, I know what a Bolus is. Now, I know what an algorithm is. Now, I know what you know, there's so many people that come on this podcast that will say things like, I didn't know, I was MDI until I heard defining diabetes. Like I knew I gave myself shots. I didn't know anybody called an MDI. So then when the doctors talking, and they say MDI very quickly, you're and you're sitting there going, I don't know what that means. But I don't want to say, I don't want to say anything, right. And then quickly, that feeling can turn into animosity. You're like, why are they talking to me in ways I don't understand. And so, you know, it helps if you help yourself too. And if we're being fair, the doctor shouldn't assume you know those words. Correct. Especially in the beginning, correct. I

mean, the random, you know, time, I might take a pause with a friend at a mealtime where I, you know, they don't have diabetes, they know that I do, obviously, I'm like, I just have to Bolus, you know, for my food. It's, it's kind of like the deer in the headlights sort of pick. Jenny's just doing her thing. Like, I don't know what she just said. But we're gonna go back to our conversation about whatever, when she's done with this thing.

She needs a bowl. So somebody got her up. This person says, I was constantly told not to adjust my own insulin, or my insulin to carb ratios, or my basil. And if I did, I got in trouble. And several times, I got in trouble for doing it without permission, which this is an adult who's now being told, you can't do things. I felt bad at first. And then I stopped asking for their help. So to this day, they are always surprised at how the settings look when they get the pump information. But it really is. Okay, so to adjust things for yourself, so there's this thing. I don't know the movies getting old now at this point, but you remember the Madagascar movie? The Yes, the animated movie. So there are times when I tell people, you just have to act like those penguins. You just smile and wave. And wave? Yeah, I won't touch it. Don't worry. Do you have any idea how many people send me notes that say the doctor took my pump for me changed my settings, I thank them walked out of the office, put them all back and kept going. Right and it but again, if you're newly diagnosed, and you hear that, that is not comforting. Like you mean, I know better than the doctor? Or what if I don't like then there's that indecision like should I go with what this is what I see from newly diagnosed people most often is the uncertainty. And it all stems. My best estimation, it all stems it's easy to say, like the, you know, the gaps in our healthcare system. But it's the gaps in what's reasonable. Like you can't see your doctor constantly. You can't see your doctor once a week, that's not going to work. Right? Right, every three months is too often they don't know you, you know more than they do. They're trying to go off of a static piece of information that you bring to them. They might not even be that good at it. You're bad at articulating what's going on. Because you get in there and you clam up a little bit because they're the doctor and you don't want to say anything and blah, blah, blah. And so it's it's bad communication. It's all it is. It's bad communication. The same reason you have trouble in your marriage, you have trouble with your kids, you have trouble with teachers, you have trouble everywhere, you are not communicating well. And it's a two way street. And so if one of you is doing a good job, and the other one isn't, it's still not gonna work. It's a tough position to be

in. Oh, and I think from a standpoint we're talking about, you know, medical team, right? You should have a team approach in which you are a team member. You're not the stand back, let the team do it for you. You are a piece of this team, which means that you may have an endo you might have an endo and maybe a nurse practitioner or PA. You need to have an understanding of what can our communication be like how often Can we kind of check in with each other everybody, for the most part has an electronic medical record with the ability to send a message and get a response. It may not be as quick as you would like it to be. But you may get a response. But also, that team should be made up of not only an endo, but also an education partner. Yeah, right. I endos are an over the many years that I have been working as an educator, I only just really like thought about the fact that endos are not educators know, you may you may find a really good Endo, who does talk you through things and does explain things and really does the work kind of collaboratively with you. But I think real education comes from an educator who you can sit down with in a more lengthy visit. Yeah.

I used to hate ordering my daughter's diabetes supplies, and 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 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 a 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. I think it would be valuable. If you thought of yourself as a high draft pick quarterback, you've been taken in the first round, you're the fifth pick, you're not ready to play yet. But when you're standing in that huddle, and you're standing at practice, and everyone else is talking about what's going on, it should be in the back of your head, I'm going to be the starter son, this this the old guy is gone. It's he's not going to be here anymore, it's going to be me, I have to run this team because that's the situation you're really in with diabetes, it's that at some point, it's going to be you, you're going to be the right, right. And so absorb everything you can ask as many questions as you can. And then if you can't get your questions answered there, then go somewhere else, go to another rack, right? Go listen to the podcast or find a Facebook page somewhere, ask other people and don't take the first thing somebody says to you as gospel wait till you see some consensus a little bit like, you know, people tell you there are I

think another piece within that is take take some of what the doctor or you know, clinician might be telling you newly diagnosed, a lot of it is a little bit more experimentation than it is with lengthy years with diabetes and some understanding behind that, right. So take some of those things. But the next time you check in, bring back and say we applied these things that you told us should be working. This is what happened, whether good or bad, or you know what you wanted to happen or not. You have proof to be able to say we did try this. We next tried this, this seems to work better for us. And somebody should work with you then. Yeah,

and I think there's a there's a technique and conversation where you don't you don't put somebody in like a power situation over you. But you do act a little referential towards them a tiny bit. You know what I mean? Like you don't want to come in overpowering the doctor, because they're gonna they have a personality too. They're either going to push back because they don't like the power structure or they're going to be a timid person. And now you're not going to get their thoughts anyway because you're just kind of going at them. There is a way to center yourself. Say what you need to say stick up for yourself without being aggressive. And there's a there's a middle ground in there. This this person said try to find a doctor that works with you and doesn't boss boss you around. The first doctor I saw after diagnosis, walked into a room this harsh and told me that I had to eliminate carbs or else I would risk In amputation, if my certified diabetes educator, mom hadn't been in the room, I might have actually believed that. So my mom yanked me out of there and told me that I needed a doctor who didn't use scare tactics. And who would teach me instead?

Yeah, absolutely. There's,

I think, I think it's possible that doctors can become jaded. I have a friend who has been a police officer for a very, very long time. And he has to battle against the idea that every person he sees, is trying to get over on him lied to him, or is breaking a law. Sure. And I wonder how many people you see ignore their diabetes before you just think I'm going to come in with a club and just beat this into their head? Right? It's just it's how it that's my expectation, like, how many people did that doctor gave good advice to before they just gave up? You know, right, right.

And I think you know, what's a little bit different, age wise, is that, for the most part, while there are kids with type two diabetes, as a child diagnosed, majority of the time, it's going to be type one. Right. And so within that is an endocrine practice that has a little bit more specialty and understanding specific to type one diabetes. Whereas those who are diagnosed as adults, even young adults, oftentimes need to do a little bit of homework about the endo that they're going to be seeing or working with. One of the big questions I always have asked, whenever we've moved, and I've had to change practices, is I call the office and I ask, how much of your practice or who in your practice, sees the majority of people with type one diabetes, you know, if you're going into an office space, where 10% of the people that they work with have type one, it may not, it may be a really, really awesome Endo, your first experience might be that this person is really willing to work with you. So don't certainly turn away from them. But they may not have the experience of an endocrine practice that more so specializes in type one, right? So doing a little bit of your homework, if you have the ability, early on, that can help to

add on to that this person said don't assume that your pediatrician or your primary care doctor even knows anything about diabetes management. And that's probably not as common nowadays. But there are still places more rural places where there's no endocrinologist or I. Because when I interview older people, they'll tell me all the time, like Oh, an internist took care of my diabetes for 20 years, I never saw an endo, you know, like, or my general practitioner writes me prescriptions for my insulin or stuff like that. And it's, it's some people just aren't in the position to see. And I don't, I also don't want to paint a picture that all doctors are going to be like scary or bad at their job or anything like that. I'm sure there are plenty that are absolutely terrific. But the terrific ones aren't going to lead you to this podcast, where you're like, What the hell is happening? You know, like, it's, it's, it's going to be in these situations. And these are this is real feedback from people. I had to figure out that my doctor was being super conservative with guidelines. And they weren't telling us information because they thought it was too complicated to tell us. So this is an interesting scenario. I've talked about this before it's hurtful to hear. But the doctor makes a snap decision about your intelligence. It just happens. They look at you, and they think what can this person handle? And it's they're not always going to be right, they're probably frequently going to be wrong. I don't think it's a medical thing. I think it's a human thing. And then they can find themselves in a position where they're doling out the information on a level where they think you can handle it. And sometimes you have to tell them, I need all like, some people want it all right now, like, if you're one of those people that tell me everything, I'll let me deal with it. Right? And if you're a person who's not put your hands up and say, Hey, can we go a little more slowly? I'm overwhelmed by this a little bit, right? Like you can tell them who you are, instead of letting them decide who you are. Because I think I've seen it happen in both directions. I've seen like very kind lovely people get overwhelmed by information and I've seen people who are voracious to have information who have held back from them. Right.

And I think that also goes with doing a little bit of homework on your end, honestly, to be aware of what it is that's important to discuss knowing time constraints of the visits that we have with clinicians these days, your visit will not be three hours long, despite the fact that you came in with a list of 100 questions and you're the person who wants them all answered right now, a guarantee as much as the doctor may want to, they don't have, they don't have time for that. And it's unfortunate. So come in with the top priority of I need to address this, this and this especially nice, newly diagnosed where it is a little bit up and down, you're learning you're navigating through things like insulin needs and changes and all that kind of stuff. So what are your priority, you know, needs right now that you want answered that you want clarification around or you know, those things that you just need to understand? Because that can help direct the course of that visit, as well.

Yeah, man. It's interesting. I'm reading through some of these and we've talked about some of this stuff. And I just sort of made a point that I just wish I would have waited to see this person's thing because she just says I wish people would have stopped telling me what I could handle. Yeah, that that was a big one. Because

they don't know you personally. Like you said, You Are you were Joe Schmo. Nobody knows anybody. Yeah,

this person makes the point when you have questions, you can call your end out, day or night leave messages, there's services they can get back to you. There's other support at the hospital like social workers, child life specialists. Jenny used to work at a hospital right? Doing nutritional stuff, like there's people there you can talk about nutrition with Yes, ask for the services, don't just assume they're going to give them to you. Correct. Let's see what else we have. I think a lot of people don't realize they actually do have a say in their care. It was difficult for us because my husband is an ortho. He was leaning towards doing everything by the books. And I was reading and listening to all the podcasts and all sorts of things. And I wanted to derail this train quickly. And he thought we were being told truths from the hospital, we came to a common ground after a little while. So I read this one, because this is a common thing that people with diabetes have said to me when my daughter was diagnosed. And then I say to other people, there is an amount of time and it is not a long amount of time, where you will know more about this than the people who are helping you. And maybe you'll get lucky, it's a weird thing to say and have a practitioner who has type one diabetes, and thinks about it the way you want to think about it. If that's the case, you're probably really going to have a nice smooth time of it. But if you're just talking to a lovely person who wanted to help people and found themselves in endocrinology and are reading from, you know, books and charts are supposed to follow, there'll be a moment where it's not because their knowledge is lacking. It's because you're in it all day long, and they're not. You're gonna know, right? And then what's the, then the hard part is to make that leap to actually trust yourself, like trust your gut, like this is wrong, I need more basil, or I you know, my carb ratios, not right, or this shouldn't be happening this way. Instead of just asking a disembodied voice on the phone a year into your diabetes, what do you think? Because I mean, Jenny, you do it for a living and I see a lot of people's stuff. You can make an educated guess when you see a couple of graphs, yes, but you are still guessing. Absolutely.

Without details, you're still guessing. And that's where, you know, when you say, at some point, you will know more than your clinician knows, I think it's you will know more about your navigation of diabetes, then your clinician knows because your clinician isn't living it for you. And you those are some again, from a communication standpoint, you have to communicate that to your doctor. Let's say the doctor is the one who said to just this way for soccer every single Saturday morning, and you tried that, and you tried it and you're like that didn't work. This is what's happening. So let's try this. Let's do something different. Then bring it in and proof again. Say we did we tried what you told us to try. It didn't work. But it's working this way for us. We figured it out. So in that case, yes. Do you know more? Absolutely. You know more, because you are living your diabetes?

Yeah, there's a moment where you know it's true. And you just have to believe it. And there's a moment where you have to remember the old adage it's easier to ask for forgiveness than permission. So because then you're going to get caught into situations where Are, you come back in and you're like, look, we made our basil point five. And it was point three, and the doctors gonna be like, well, who told you to do that? And you're gonna say, my kids blood sugar told me to do that when it was sitting at 150 all the time. And now, by the way, look, it's 95. So I figured this out, say thank you. I always, I always think that sometimes when people are giving me crap, I'm like, what you can just say thank you. And let's move on, like I did your job. Like, like, just right, be cool. Do you think there's, this is sort of an unfair question, because I don't know how comfortable you'd be answering this. But do you think there is that, that God Complex with doctors, that they don't want to be wrong? Or they don't want to appear to be wrong? Because then you lose faith in them? Like, what is that? What stops a person from going? Wow, I can't believe you brought your agency down three points without me great job. Like, you don't

right. And I think it in a way it's it's that god complex kind of term is, it's a harsher way to say what I think is a doctor has gone to school for an awful long time has really learned has applied in a clinical sense, all of this book information, right? And it's not that they're displeased. I think on a personal level, they're not displeased with success, at least a good physician is not in fact, they should be praising you and saying, Hey, how did you do this? You know, let me learn a little bit because it may help me to help others who have similar, you know, but I think they're disappointed that not that they don't have diabetes. They're like, geez, give me diabetes, that I can learn about this better. But I think they don't have the personal experience. So that there is a little bit of sense of feeling like, but I know, because I went to school for all of this. Right?

Yeah. You know, I used to tell people in the, in the past on the podcast, if you listen to older episodes, I'll tell you don't go into the doctor and tell them you learned this on a podcast. It'll make it easier for you, right? And you think about it, right? How do you become a doctor, you get an undergrad degree, you have to pass the MCAT apply to medical school, complete your training in medical school pass like, I think there's parts one and two of like this medical licensing exam, you have to get into a residency program, complete your residency program, and then you have to graduate from medical school, you've done all that. And I come into your office and I go, Hey, Scott, and Jenny said, Who the hell are Scott and Jenny?

What do you mean? Do you see my awards on the wall? Right? And for a specialty specialties go beyond right? I mean, an endocrine fellowship is at its two years typically. So that if they go into school to be a doctor, now they've gone to school to specialized in what you walked into their office to talk about. So I

do think that like that, on that very human level, sometimes like somebody must sit there and think, Oh, well, yeah, I'm a doctor. But I guess you could listen to a podcast if you wanted to, like I think a podcast is the new Dr. Google to people, you know what I mean? Which, by the way, back in the day, when the when the internet was first getting going, I get it. But at this point, no kidding, you can pretty much diagnose anything with Google. You can be you can be right about it. Like the old joke is that you know, you can find out anything you think is wrong with you. But if you're really thoughtful about it, I figured out some significantly difficult things about people in my family by just thoughtfully going through the the details I knew and Googling the things I didn't understand. Absolutely. Yeah. But I have I listened to those doctors, I'm sorry. I can't imagine. Like if someone walked in here and was like, You know what you should do? I'd be like, shut up. I have this I know how to do my job. And so I think there's that. I also always wonder about the fear the doctor must have, like, how did you do this? I don't understand what you did. And how do I help you moving forward? If I don't know what you did to get to this point, like I see both sides of it, you know, right muscle. And that's,

that's where the communication part really, if you want a team, if you want a team, that on the back end of everything that you navigate and have figured out, something's going to come up where you're going to need your team. Yeah. And you want that collaboration. Some of it may be educating them. Like I said, You figured out that their strategy didn't work, then explain what you did. Because that may, that may bolster what they're doing in terms of or they're learning to help somebody else and learn you better. There

are also countless people who come into the Facebook group and you answer these couple of questions and one of them is how did you find out about the podcast and more people than I ever imagined? and saved from my, from my doctor, my doctor. So it's great. There are plenty of people out there who are open to it. And you know, again, if you find those people just rejoice and move forward, you know what I mean people, because you might, you might get the exact opposite, it's I almost feel like this conversation is a lot like the one about putting your kids in school with diabetes. There are people who have terrible experiences with schools, and there are people who have amazing experiences with schools. Now, here's the last thing I want to say about this. You know, when you ask somebody about how's it going, how's your agency, and they go great, but then they don't tell you anything else. And then later, you learn the array, one sees like, 8.2, but it used to be 10. So it seems great. It is great, right? But you lack the context, when you ask the question. Sure. How is it at school? Oh, it's great. The nurse is terrific. Sometimes that just means I don't get pushed back, or we don't fight. It doesn't really mean they're doing great. And I think people do that with doctors a lot, too. I hear them say all the time. I love my doctor, you have no idea how many people I've interviewed whose health is tenuous at best. And when they speak about their physicians, they're fantastic. Oh, they're great. Sure. Oh, we love her. She's wonderful. You're a one sees nine and a half. Oh my god, she's salt of the earth, you have no idea. Big hug every time I hear you judge your doctor any way you want. I'm judging your doctor, by your health. Okay, so, you know, so if your health is not optimal. I know you're a good person, and the doctor is a good person. But it's okay to expect better, I guess is what I'm saying?

Absolutely. And if you're not getting, again, you've tried what you know how to try. And you're not really giving getting any additional feedback to improve what you know, isn't quite right. It's time to potentially look for something better. Yeah. And

I would suggest interviewing those new Doctor candidates, by phone or in person, if they will, before you switch? Yes. Because I've seen people switch from one to the other. And I also want to tell you, that there is a moment when you're going to have to look down deep in your soul and make sure that it's not you. So maybe you're I hate to say this, but maybe you're difficult and you don't know it, you know that crap? Right? It could

be absolutely. And it's actually a reason that I really and I love the fact that on your website, you've got some endocrine resources. And I look at it every once in a while. I'm like, Are there any new ones in here that I've like missed any new states that actually have somebody that somebody's commented, because from a new standpoint, while there, there are a lot in there, there are not as many as I think need to be there. Because people with diabetes are all over the place. And there is not always going to be an endo. Doctor who fits. Yeah, this person is great.

It's juicebox docs.com. And when you go there, you can click on a link, it'll generate a little email for you. And then you fill in the information it asks for. And if you think you have a great doctor, then we add them to the list so other people can find them.

Yes, that's it's a great, it's a great resource.

I wish more people would would make submissions, because it really is difficult to find a good doctor.

It is absolutely and there are some cities in there that are not the typical like New York City or like Chicago, you know, there's some some smaller places or some areas around bigger places that have some good recommendations. Jimmy,

I have to tell you at the end of this if you have a second the Yeah, going through and living with diabetes with my daughter, and then thyroid stuff. It's taught me stuff that has helped me in other parts of my life. It's helped me advocate for myself. It's helped me help my mom, I'm gonna tell you right now, my mom is alive today because of what I learned from Arden having type one diabetes, because

because you know how to dig for more information and to find the right resource. And

I know I know what's happening in front of me, a doctor told my mom that she would not live through a surgery she needed to remove cancer. And he was telling us, we're just going to manage your mom's pain until she dies. That is exactly what we were being told. And we kept looking and kept pushing and found another doctor who gave my mom the surgery she needed and that was it. Two months a year ago, my mom was given a clean bill of health, she is finished with chemotherapy, and she is back living her life again, she would have died about five months ago if I listened to the first doctor, right? That is exactly the truth. I needed an iron infusion. And nobody believed me. But I kept pushing, and I came with facts. And I was persistent without being a pain in the butt. And, and I got it, and it saved me, you know, over and over again, these things happen. My mom's blood pressure got wonky last week. And I called the doctor and I said, What are you doing? And he goes, Well, we're upping her blood pressure medication. And I was like, well, that hasn't helped, what else you're gonna do? And he's like, Why can't try giving her more I said, You know what else you could try? And he said, What's that? I said, you could try calling a cardiologist because you're a GP. And let's go. And he gets the cardiologist in with her. And my mom calls me two days later, she goes, Well, I'm dizzy today. And I'm nauseous. I'm like, why she was good reason. They got my BP down. And I'm adjusting to it. She's like, it's gonna take a couple of days, I think. But my mom was going from a top number of 180. And they got her down to like, 120. Why? Because the cardiologist knew a different medication than they knew about.

And you know what I, I hear as you explain that, as well. I don't know how old your mom is. But she could explain why she was having the symptoms she was having. She wasn't just thinking, Well, I just have to live through this. The cardiologist did a good job of explaining that to her and saying, these are some of the things that you're going to go through until the meds are adjusted. Right. And your body has kind of come to the level that's appropriate. Yeah, that is a really good doctor, my mom,

who said, yeah, she didn't know that in Iran that she definitely didn't somebody shared. Somebody explained it. Yeah. Well, anyway, so good luck. I hope you get a great doctor. If you don't pick up for yourself. If you stick up for yourself, do it nicely, because you're building a relationship with this person, trust your gut. Understand, you're going to know more than them at some point. And smile and wave when you have to be the penguin. Yeah, that's my advice, which is not advice, medical or otherwise. See you later. Bye bye. 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. 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. Did you know that Apple podcast users can become paid subscribers to the podcast? And what that gets you is the entire bold beginnings series ad free the entire diabetes Pro Tip series ad free and early access to the regular show. More management series ad free are being added all the time to the subscriber feature. Check it out in your apple podcast app.

Hello friends and welcome to episode 1222 of the Juicebox Podcast. Today, Jenny Smith and I are going to talk about one topic. That topic is What do I do if I inject the wrong insulin? Now basically what that means is you're about to inject your Basal insulin and you do it you know, what do you get like 2030 units of basil a day, whatever your number is, and you won't put it in and whoopsie daisies I put in my mealtime insulin. What do you do? 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. If you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective, the bowl beginning series from the Juicebox Podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CDC as 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. This episode of The Juicebox Podcast is sponsored by the Dexcom G seven dexcom.com/juice box. And by the way, Dexcom now pairs with your Apple Watch. Check it out dexcom.com/juice Box. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juice box. 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 I thought today we could talk about what to do. Like I want to have a nice, small, all in one episode about what do I do if I inject the wrong insulin? Oh, that's a good one. Yeah, it happens to people and the time to start thinking about it isn't when it's happening. So I'd like people to know ahead of time what to do. So good. I was gonna say

I think something else that goes along with it too. Although most, most pumps now have a protection feature to dosing too much even have the right insulin right one unit versus oh my gosh, I took 10 units because I didn't realize what buttons I was pushing. Right? Yeah, but I think it's part of the same,

it's still happening. Also, I have a story that I'll tell during this that will. I didn't know what I was gonna say there. I always think of every time I think of saying something that will shock somebody I think of the line from the Julia Roberts movie, where she's famous. And Hugh Grant owns a bookstore. What is that movie? Do you know what I mean? I know they fall in love. And there's a crazy roommate of Hugh Grant. Anyway, he says, I'm going to tell you a story that will shrink your balls to the size of raisins. And I think of that every time I think of this and I have a story like that about somebody getting too much insulin, which I will tell awesome later, let