Full Transcripts

Hello, everybody, and welcome to Episode 491 of the Juicebox Podcast. On today's show, we're gonna try something a little different. Jenny's here to start a new series with me called variables. When the episode begins, ah explain to you how we kind of came up with this and where we got the variables from. But today's variable, the very first one in the series is trampolines. 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. We're becoming bold with insulin. If you're looking for ways to support the podcast, it's simple, easy and free to do. Just subscribe in the podcast app that you're listening in right now, if you're listening online, check it out in the podcast app and hit subscribe or follow. And of course, tell someone else about the show. Subscribe and Share. That's all I need you to do. While there are no ads on this episode, I do want to remind you of the sponsors that support the podcast, the Dexcom g six continuous glucose monitor, please learn more@dexcom.com forward slash juicebox the Contour Next One blood glucose meter Contour Next one.com forward slash juicebox the Omni pod tubeless insulin pump on the pod comm forward slash juice box find out about g vo glucagon at G folk glucagon.com forward slash juice box learn more about touched by type one at touched by type one.org. And please consider supporting the T one D exchange T one d exchange.org Ford slash juice box. You added a variable pro tip episode I didn't like there's a there's a pro tip episode about variables talking to people about how things that you might not expect can impact your blood sugar. And I was not on my radar when I made the first pro tip list. That was all Jenny putting that in. But more recently, I went to the Facebook page and I just asked people tell me everything that impacts your blood sugar. Right? Just everything. And I am looking at a list here, Jenny that is 159 things long. Some of them might be duplicates, and we'll find out as we go. But I thought it would be important for people and I know you agree for them to understand these. These impact things. Yes, yeah. Because they're like, you know, say again, what you just said before we started talking about this, like you were talking about doctors give directions, but don't take stuff into consideration.

Yeah, many doctors have their sort of cut and dry very black and white. If this than that, right? It's sort of if you're going to go and exercise just stop your pump, take the insulin away and it will work right. Well, that's, that's given everybody's exercises that they're going to go out and walk their dog for 35 minutes. That's not in any means, especially with exercise that we have today. You could be doing anything for God's sake I two weeks ago I took what do you know what a pound classes like you have these like drumsticks? And you like

right sounded dirty to me. So no, I guess I don't know.

weighted drumsticks and it's actually it's a good cardio workout actually made my kids do it with me because a friend was doing it. But anyway, I I had no I knew it was going to be a variable. Right? But what kind of variable? Was it going to be more aerobic? Was it going to be aerobic and anaerobic? Was it going to be like sitting and pounding Fiddlesticks have any idea? So how do you plan for a variable like that I you know, planned for it to be like cardio. So from the sense of what a doctor would tell me to do as a cut and dry black and white each time I go and exercise do do this. That's not true. It isn't. And so there are many variables to consider,

right? Well, since you went that way with your description, here's number 157 on trampolines. So I said test people tell me some things that make managing blood sugar's difficult and so many people said trampolines that it wasn't funny. So there is something about that specific exercise that crashes blood triggers, right?

It's it? Well, if you think about, it's kind of an all over body workout, right? You're using your arms, you're using your legs, you're using your core muscles to stabilize your body. Depending on how much flipping and acrobatic, maybe you've got a basketball hoop inside of your trampoline, like I've seen seen many kids have. So maybe you're doing that along. I mean, it is. And for the most part, it is an aerobic exercise, it will drop blood sugar. In fact, a lot of the kids that I work with who have them, their parents send them out when they've got a high blood sugar to get it to come down. Quick. And it works. Yeah. And it works. So you know, in the case of that, typically, it's insulin adjustment, if you know what's coming. And with kids, oftentimes, in you know, exercise is so sporadic that you can't so then you just have to use extra carbs or sort of ahead of time coverage carbs, as they're heading out to accommodate for the expected drop.

Yeah, I guess, even like knowing ahead of time it is. So it's such a violent drop that you see for a lot of people that even taking basil away and doing a really proper job of having that basil create a deficit over top of the trampoline. I don't even know if it would work, right?

No, no. And I think a lot of times too, for kiddos because they're eating so frequently, you know, a meal, maybe a snack, maybe another meal, maybe a snack, and then another snack. And then oh, my friends want me to go over to the trampoline and play with them. And parents are like, Oh my gosh, there's three units, then

you learn eventually how to handle it. I've seen people say that their kids take like spoonfuls of like peanut butter, like, you know, there's they'll drink a juice before they get on like stuff like that. But that's just one of those examples of the it just it's way more impactful than even somebody who's willing, who understands that activity impacts blood sugars, like it's just out of magnitude that is crazy.

It is it really and I think in all the variables, I think the other really big thing that's kind of a consistent across the board is now that we have trending on glucose monitors. It's where are you? Where are you sitting? Right? Because coming into any variable city setting, whether it's exercise or whatnot, you have to know where you are or where it looks like you're heading, because that's also going to impact how much or how little you adjust right

here. Like if you just messed up a meal spot and it's starting to spike, you might be able to bounce in there for free because you don't have enough insulin to begin with. But if you're super stable at 140, and you haven't eaten in a couple of hours, even if you don't have insulin on board, you are going to drop from this exercise. Yes,

Basal. Yep,

this is why gymnast looks so strong. Because that whole and for some reason, the adrenaline doesn't even help it.

For the most part, I don't think there's enough adrenaline unless it was like you just said like maybe accom a competition, you know, that like adrenaline competitive kind of component. And then it's not really an all it's like a performance. It might be a two minute four minute sort of like routine. And then they go sit on the bench. Yeah. And so there was like this buildup of adrenaline to perform to do their best. And then they sit there until their next event be one hour later. Maybe I realized

from your answer that I'm just a big baby because I just met the adrenaline bouncing up and

well, there could be two. I mean, if you're really the kind of person who's like, I don't know, where my feet actually gonna hit the net, or am I gonna crash through the ground? I could there could be adrenaline.

I was genuinely embarrassed. When you answer that way. I thought, Oh, that's what that's a good answer. But that's not what I was worried about. I'm such a baby. I would never get on skis or do anything like that. So

Oh, that's funny. Yeah, I'm

not up for that. Okay. Thank you. Cool. First, I'd like to thank Jenny, as always. And I'd like to thank everyone in the private Facebook group for compiling the list of variables that impact diabetes, that you're going to hear moving forward. Was that English? the variables that you're going to hear moving forward were given to me by the peep. Yeah, I think I said that, right. Anyway, oh, you should check out the Facebook page. It's really cool. I think 12,000 people in there now really active people helping each other with their type one. It's called Juicebox Podcast type one diabetes. It's a private group. So nothing you say in there gets outside of it. It's very cool. Anyway, well, now I use the polka music dammit. I want to tell you more about Jenny. But before I do, I want to tell you that this is the first in the variable series. There are going to be as You heard it a lot more Jenny and I do in short descriptions of the variables that were brought up by listeners. And of course, if you're interested in learning more about what Jenny does for a living, you can check her out at integrated diabetes Comm. I am incredibly excited about this series. In my mind, it's sort of like the defining diabetes episodes, but instead of terms, these are going to be the pitfalls that kind of impact diabetes that you might not know to look for. trampolines was just an obvious place to start. There's so much more coming. I'll talk to you soon.

Hello friends, and welcome to Episode 505 of the Juicebox Podcast. Today I'm bringing you the second in our diabetes variable series. Today's topic is temperature. Don't forget while you're listening 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. Obviously today Jenny Smith will be with me Don't forget that Jenny Smith has had Type One Diabetes for 33 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Besides that, she's Jenny. So if you don't know what that means, you got to go check out the pro tip series, the defining diabetes episodes and get yourself a good dose of Jenny Smith. This episode of The Juicebox Podcast is brought to you by touched by type one. To learn more about them go to touched by type one.org or find them on Facebook and Instagram. Touched by type one started as a community fundraiser organized by a middle school student in a small group of her trusted advisors. It has blossomed into an impactful and well respected nonprofit organization, spreading awareness about type one diabetes. Seriously, they do amazing work. Check them out at touched by type one.org. It's the number one touched by type one.org. Their founder Elizabeth is featured in Episode 454 of the Juicebox Podcast. If you haven't heard it, check it out. Okay, here comes Jenny, and our second diabetes variable. Jenny, we've been just started with the variables. And like I said, we've got this list of like 150 different variables that listeners brought up that impact their blood sugar. So today, I was hoping to talk about the temperature meaning like your body temperature, the outside temperature, I guess times of year fits in there. I have to admit, I don't know that I see it that often. I can remember Arden playing softball in like high heat situations. But she was so active that her blood sugar's were always pretty stable. But I do have to admit, I guess after those softball games, she was more her blood sugar tended to rise afterwards. But I never associated that with temperature. I always associated that with shoes playing playing was holding her pretty stable, almost acting as extra basil and she was eating throughout the day too. So I always thought that that eventually that that drift up might have been from the food that happened in betray games and stuff like that. But what do people I mean, I guess we should just start with you Like, you live in a pretty interesting part of the country where the temperature fluctuates, do you see differences with your blood sugar's cold, the hot

not for short durations of time? No. And I think this kind of crosses over into the majority of people, if you're going to see something, it's more the length of time you spend in a particular temperature that's kind of out of the normal like comfort level zone, right? Of what I would just say is like room temperature, let's say, you know, the extremes in winter, winter can get cold where I live,

but and

if I'm outside in the cold, I've got loads of clothes on, I'm usually moving, I might be pulling a sled or shoveling or something like that. And so the cold in and of itself isn't my concern. And it doesn't seem to be what the impact on my blood sugar is. It's more the movement in that extreme right. And the fact that I've probably got many more layers on than I would in spring or summer, even fall. And I think with that if there is a temperature consideration, maybe it's just that I'm warmer and moving, and I've kind of metabolically kicked up, then you know what I need? I see lower blood sugars, essentially.

Let me break this down for a second. So let's start with something unnatural. What if I just lowered your blood your whole body type What if I just made you 50 degrees? Would your blood sugar move? Like, I know that that's not what like natural life is. But so because I want to work off of that idea, because what I'm feeling like is that people probably think, oh, cold weather makes me low. But they're really going outside in the cold and then being more active and not recognizing it, like so. So at its core, does just the temperature lowering change?

Well, it could a could for me, I've not noticed that in particular, I mean, my, my temperature overall, runs lower Anyway, my normal core body temperature is not 98.6. I mean, that's just an average standard that's been given out, I run in the 97. That's my normal kind of temperature. So I would say just knowing physiology, that if your temperature core temperature had dropped, then metabolically, your body is actually working harder to keep you warm, which I would expect then that metabolically burning heavier, you're going to use insulin better, you are going to have a drop in your blood sugar.

Okay, so whether you see that happening to you or not, it's still a variable that could impact you. That's a good so like, you could start shivering and your body starts trying to keep you warm, and that uses up resources. And some of those resources are glucose in your blood. Right? Interesting. But isn't it funny how, like one thing we talked about this a lot, but you see one thing? You think, oh, the cold weather makes me low? And I guess it could but then you're like, well, what if I put on a big heavy coat and I'm not really cold? And I'm still getting low? Maybe that's because I'm outside frolicking about fairness. You live in United States, Canada, so?

Not really. But

it's pretty normal. Yeah. And there's there's a north. Yeah. But being serious the place where you live? Like you you involve yourself in outdoor activities in the cold. Correct, right. So if so I could go skiing and some and somehow misinterpret the skiing impact for the coat legs, it could get confusing, but still, on a metabolic level, there is a possibility there that that would happen there

is and I think you bring in another variable that we'll talk about, which is altitude when you talk about skiing. Yeah, that's another piece. A different episode. We'll get there. Yes. But on the opposite of cold, though, is hot.

Okay, so what happens when I get hot my blood vessels.

So you you're like your blood vessels are the little capillaries, they kind of get closer to the surface of the skin to allow cooling of the body to again, keep your core temperature kind of around that 98.6 where it's meant to be right. So the more cooling effect that you get. And also Where is your insulin being infused and or even injected, it's being infused or injected into that like sub q layer, right. And as the vessels get closer to the surface of the skin, the body works harder to cool itself off. Potentially, you could have more circulation around that area of insulin infusion or absorption. And so that could increase the rate of the insulin working. I know myself for hours outside in the warmer temperature. We lived for a short time after we got married in Orlando. And it was for about a year. And there's no real weather change down there. I mean, people think that it gets cold in the winter, and they bring out their like fur lined parkas, and I was outside and a T shirt and like shorts, and I was like you people are kind of funny. But it is just what you know, it's the extremes. I mean, it is what it is. It's just the norm. But Florida is pretty like it's just warm. I think of it as warm, right? And so the year that we were there, the time period outside, when it was really hot in the summer. I know that I needed less insulin, if I was going to spend time out. I mean, we had passes for Disney. So I would take less basil on the days that we would go walk around at the parks. Some of it I know was the heat and some of it I know was the heat and the movement that was consistent in that type of day.

Okay. Did humidity make a difference?

humidity seemed to make a difference. Yes. The more humid it was, again, the more your body is trying to cool off and so that like the stickier you're going to be, and along with that temperature and humidity then comes hydration. Okay, are you taking in enough fluid, you know, if you're dehydrated, you may actually see blood sugars that go up, which would be kind of counter to what you would think would be happening if you're well hydrated, then likely you're responding more appropriately to blood sugars, your CGM works better, etc.

So if it's hot out, I might see an advanced use of the insulin. And so might work more efficiently. Correct more so than I normally say. But if it's hot out and I get dehydrated, those two things could conflict with each other. Yes. And the dehydration might went out over the. That's enough. Yeah, right. So again, it's what we're saying is that there are things hat variables that happen, that are hard to see in the moment, because you see the big stuff go, it's hot outside, my blood sugar went down, and then somebody else will come along and say, oh, when it's hot outside, my blood sugar goes up. But they also don't say I only drink 16 ounces of water every day. They're missing that piece when they that's what's interesting about online, it's funny not to get too far into this. But you and I were just talking about this privately about something else that the ability to explain the entire scenario. Not everyone has that. So sometimes they just come in with a piece of the puzzle, which then makes it more anecdotal. But then right, you hear four or five people say something like that, and it feels like a rule all of a sudden, right? Yeah. So there are, and by the way, 150 other variables on this list, it could be hot out, you could be dehydrated, while you're going for a walk or on an airplane, or like, you know, like, there's

no, that's the variables overlap each other, right? You're not just going to experience one variable in a setting of a day and be like, yep, it was that it was the temperature, right? Totally know.

That, and that's why people make the I know this is gonna, cause colloquially, this makes sense. But when people say something like I can do the I can eat the same thing one day, and then the same thing the next day and something completely different happens. Diabetes is so unknowable, except there are other things happening that I guarantee you're not thinking over. See. Okay, did we cover that?

I think so. Yes.

Nice. We're getting very good at this. Thank you so much, to touched by type one, for sponsoring this episode. Of course, check them out on Facebook, Instagram, and it touched by type one.org. And Jenny Smith, Jenny is I mean, she's the best, it's obvious, right? But she also works for a place called integrated diabetes Comm. So if you ever wanted her input, what she does for a living, go find Jennifer Smith at integrated diabetes.com. Thank you so much for listening. I hope you're enjoying the new variable series. We're going to put a couple of them out in a row here. So look up for another one. There might actually be an episode every day this week. I got to catch up a little bit. If you're not subscribed in a podcast app, this is a terrific reason to be

Hello friends and welcome to Episode 507 of the Juicebox Podcast. Back again with another diabetes variables episode means Jenny's here, and today we're going to talk about traveling. That is a variable. You know, I asked the Facebook community Juicebox Podcast type one diabetes, for a list of things that impacted their blood sugar, they came up with over 150 of them. Today, Jenny and I are discussing number three, travel and travel time, the world's open back up, it's warm outside. Many of you may be heading off in your car or an airplane or other ways that you travel. We thought this would be helpful for you. 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. For those of you who are right now thinking can long car rides my kids blood sugar goes up. Wait a minute. Yeah, that's traveling. Now you're interested. It comes Jenny. This episode of The Juicebox Podcast is brought to you by me kind of and I want to tell you about my thing. That back in Episode 210 of the Juicebox Podcast. I started making episodes called diabetes pro tip with Jenny Smith. These are ideas from the podcast that you hear, you know sprinkled about in different episodes condensed down in one place. These are management conversations. So I'm going to tell you about them very quickly. Episode 210 diabetes pro tip newly diagnosed are starting over. You may have just heard Dr. maltz talk about it in Episode 506. I think after that to 11. All About MDI to 12 all about insulin to 17 Pre-Bolus ng to 18 Temp Basal to 19 insulin pumping to 24 mastering a CGM to 25 bump and nudge to 26. The perfect Bolus to 31 variables to 37. Setting basil insulin to 56 exercise to 63 fat protein to 87 illness injury and surgery 301 glucagon and low beegees 307 emergency room protocols 311 long term health 350 bumping nudge Part Two 364 pregnancy 371 explaning type one two others 391 the glycemic index and load 449 postpartum for 70 weight loss. I am incredibly proud of this series, it is completely free. You can go back and listen to it in your podcast player right now. Or you can find it at diabetes pro tip.com. You can also get to it through Juicebox Podcast calm. And now I'm going to read your review. I saw a mention of the podcast and one of my Facebook groups. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years, I wish I had been more proactive in finding this information sooner. I'm going to recommend this to my endo. That's a podcast review from Apple podcasts, diabetes pro tip calm. My son was diagnosed with type one about five months ago, I've learned so much from just the pro tips. And I will be listening to all of the other episodes. This podcast is amazing both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel as Scott correctly describes the feeling of type one diabetes and more like you can find ways of keeping your loved ones happy and healthy. Also from Apple podcasts. They're real reviews. You can read them at diabetes pro tip.com. I am not a doctor. This is not advice. But I think if you listen to those episodes, your life will get better. It'll get healthier, it'll get happier, it'll get easier. At least you've got a great shot of that happening. If you don't believe that. Go back and listen to Episode 506 with Dr. Meltzer because she believes it and I do to travel elevation or exercise you pick.

Oh, what about travel? That's big right now.

Okay. Well, I I just flew on a plane. You did. It felt a little weird. I'm finally breaking a rule. But it wasn't a it was it was fine. I mean, I'm vaccinated. I didn't think I have to admit I didn't think much about it. But my son had to go cross country to work out for baseball. And he was staying for five weeks. He's still actually there right now. And I just was like, Look, I'll come with you. It was all very nebulous. The place is great, where he's working out, but all the pieces around it, like, Where do you stay? How do you run a car when you're 21? Like, I just felt like, if I sent him out there by himself, he would have called four days later crying from the airport and being like, I don't know what happened. Yeah, so I'm like, I'll go out with you. I'll get you set up, and then I'll come back. So the first thing that I think about, I mean, we're gonna do air and like ground travel, right, like, we'll talk about cars and flying. So start with flying. The first thing, the only thing I think about about flying is that people talk about the air pressure, pushing insulin through their tubing and giving them insulin that they don't mean to get. That's the thing I feel like I used to hear about all the time, but we've flown with Arden a million times. And I've never once thought of flying as any different than any other sedentary situation. So I might be the wrong person to ask, but what do you say?

So it's a it's a known while, it's a known issue. While there's no real at least, I haven't found any as of yet, there might be something out there that I haven't seen. But from a tube pump standpoint. We advise people based on people's anecdotal information about what they've tried. I mean, they're even photos online, if you look at people have used tube pumps have flown and done their own experiment in flight or before, during or after kind of thing, what they've done is they've taken pictures of their tubing. From a pressurization standpoint, on ascent and descent, there's a pressure shift. And that can either push insulin out, meaning the reservoir actually pressurizes enough to push insulin through the tubing and give an infusion of an extra almost like a Bolus. Or the pressure can pull insulin, sort of the reservoir in making the insulin from the tube sort of retract into the reservoir inside creating a bubble in the tubing, which means then you would miss insulin, as it's being pumped out if you didn't realize what could be going on. So we typically advise on ascent and descent essentially just disconnect from your tube site. Once you get to cruising altitude, or once you land essentially reconnect to or take a peek at your tubing to begin with. If there's any bubbles there, purge them out. People with two pumps know how to do that, purge it out, pop it back in and go ahead about your business. In both regards, then you're not only going to not miss a dose of insulin from a bubble, but you're also not going to get a push of extra insulin, that the pump doesn't register as a Bolus. You don't visually see that in your pump, insulin dosing history, right. So those are tube pumps. Omnipod is it seems different. There's no tubing obviously. That's the reason a lot of people use it, which is great. And I, I have had only I'd say less than a handful. From what I can remember in counting to people that I've worked with, who've noticed because they fly often enough that they've noticed a definitive difference in their blood sugar during flight as well as after flight. Where and these are more lows. They're not highs, but they are lows. One woman who religiously flies first thing in the morning, she doesn't eat any food. She's got her settings, well in place. And mid flight depending on the length of the of the flight, it seems like mid flight she ends up having a low blood sugar. Now is it because she walked a lot at the airport while she was there and didn't realize it. I mean, we've looked at all of those pieces in terms of travel for this individual. But what she actually chooses to just do Is she has a snack as soon as she gets on the plane and she doesn't cover it.

So for whatever reason, she just thinks there's something happening a variable that is basically Pre-Bolus thing me, I'll just I'll

just take care of it. Exactly. Now after flights, people of all pump you know types can sometimes have like baggage claim lows. That's kind of what I refer to them. You know, if you haven't disconnected your tube pump, you could have gotten a kind of a pulse out of insulin. And now you're traveling through the airport who knows how long depending on the size of the airport, you're kind of walking around a little bit more after flying and moving your legs. You could technically have a low walk into a taxi, you know, stand to pick something up. All of those could be variables in the mix of travel. They may have nothing or something to do with potential extra insulin. Yeah,

you're lifting things and you're right tussling around, there's a lot of pressure. By the way, did you get a parakeet or is that a bird outside of your window here?

Oh, those are birds outside? Yeah. Oh my god, I would never I don't I don't do birds.

No birds in Jenny's house. over to my house. No, I've got cats fish dogs. As crazy as it sounds. Maybe I see diabetes everywhere. But I when I flew with my son out west, we were waiting. It was an It was a nighttime flight was my first experience of flying with the sun. Which was very strange, because we took off here around 630. And it never got dark outside of the plane. And so you know, you're tired. But your brains like No, dude, it's seven o'clock still. And you're like, ah, and so we get there, we're standing at baggage claim. And there's a girl there. She's a mom of a little kid less, maybe two years old or so. But the the woman's I call her a woman. But she felt she felt young to me. She was like in her 20s. And she had a pump on with tubing. And the entire time we stood there waiting for the bags. I felt so parental towards her. Like I never talked to her spoke to her. But I just thought of the whole time because the kid was fussing, we'd all been on a long flight. She's kind of wrestling holding on to the kid. I just kept thinking like,

Is there something I could do to help you I could help you. If you

want to check your blood sugar just like I just, it's all I could think I started talking to my son. So I stopped paying attention to her. But she was fine. So okay, so the air pressure thing aside from flying is the next idea of travel is being sedentary, right? Correct. not moving around, can make your blood sugar go up.

It can and are typical is a recommendation for if you're using a pump to increase using a temporary basil, somewhere between 10 and maybe 30% extra for the duration of time of sedentary travel. So in this kind of goes for both air travel, train travel, you know if you're taking a boss, if you're taking a car, whatever it might be, but sedentary more than about two hours, typically needs more basil at least insulin,

right? Yeah, well, so So now so you have steps here. Then if you're using a two pump and you're going to fly, you disconnect, you take off you get up to cruising altitude, you purge the the line of air hooked back up again and then start with some sort of an extended basil and increased Temp Basal, to address the sedentary nature of you just sitting about. That's it. Alright, typically,

that's about right. I mean, usually for me, I've found that where I need extra, because we know how long it takes that temporary rate to kind of get circulating. I tended to find a need to increase it while I was sitting and waiting for the flight to kind of come in so that we could get on

a flyer. You're not a nervous flier or you know, I like flying. Yeah, it's so relaxing. I love the idea of like not there's nothing I can do about my situation. There's something very freeing about it.

Yeah, but I like sitting in the airport watching people that's the like, I do I was I always bring a book along. I never get to reading my book until I actually get on the plane. Because I'm I like watching people and people are interesting.

I have I'm going to tell a story at the end of this but so So interestingly enough, now you disconnected to pump get up to fly altitude, purge, reconnect, do your Temp Basal increase so that you don't get high during the flight. But then do you do a Temp Basal decrease like right before the flight stops? So you don't have the baggage check thing? Or do you just throw some food in your mouth as the plane hits the ground? Do you think?

No, usually I recommend setting that Temp Basal increase for like three quarters of that travel duration kind of so that by the time you get to the descent, which can take some time, once the you know the pilots like we are going to start descending into wherever it may be, right? I mean, it could be a little bit of time. So I usually say that's a good cue if you didn't set your Temp Basal to run a certain period to just stop that Temp Basal increase, right.

So I do and I disconnect my two pump for the descent as well. Okay, yes. All right. So

I'm shaking my head and then realizing that nobody can see me. Yeah, do

Jenny please, please respond with words. Okay, so here's my quick airport story. I went to Dallas to speak at a thing. It was a Very quick in and out, I don't want anybody to feel bad for me but I'm basically I'm cargo get any mean like they shipped me down I get stuffed in a car I show up, I clean myself off put on clothes that I look better and stand on a stage talk like a lunatic for four hours. And then somebody goes your cars here and they take you back to the airport and jam. And so I'm sitting at the Dallas airport, I'm wrecked, right? It's only been 36 hours since I left my house and I'm already going home. And talking takes I know it's maybe it's think it comes naturally but talking and thinking like it takes a lot out of you. So I'm sitting at the airport still on the clothes that I presented in thinking, just rest up enough to go into the bathroom, and change it to something comfortable for the for the flight home. That's I've got my headphones in, I'm trying to relax. And this woman if she's listening, she was lovely. I can see her from across the terminal. She is coming at me. Like and she's walking with a lot of purpose. And the closer she got, the more I thought wow, I think she's really coming over to me there are a lot of people there. So I started taking out like my my earbuds. And I was I've made eye contact with them like Hi, how are you? Can I help you? Like, but what I'm really thinking is don't murder me in the airport. Like cuz I don't know, like, I don't know what's happening right now. And she goes and

you're tired. Your brain isn't working.

I'm like, What is she goes, are you Scott? And I was like I am. And she goes, I love your podcast. And so and so my brain just goes through? Well, she was just that the thing. I said, Did you just hear me speak? And she goes speak Where? And I'm like, Wait, you're not here for the thing. And she goes, No, I'm here. I think she said her daughter was an attract meet in college, they flew into sere. And I was like, so it's coincidental that we're sitting in the airport together. And you know who I am? And she was like, Yeah, and I was like, Oh, I was so freaked out, you know, like really, really, really freaked out. And she said a lot of nice things. And it was lovely. And she walked away and I and etc. But I never like you don't start a podcast thinking one day across the country, somebody will recognize you and identify you. But there I was back in New Jersey, in the little bus going back to where my car was parked and talking. And this woman turns to me and she goes, are you Scott? And I was like, wait, what's happening? Why is this happening again? She was I recognize your voice. I love your podcasts. I was like, Ah, so it's very, very, very strange. But generally speaking, I'm a heads down flier usually,

are you you

don't really I just put my earphones on. And I kind of keep my I do look at people, because it's fun. But you know, then I'm sure they're also looking at me going like picking this guy's stupid headphones on not paying

I found I've found that, especially with the amount of people that I work with and talk to and like the different personalities in travel. I've, I've got kind of a good personality filter. I've found, like interaction wise, you kind of you learn how to talk to certain people and interact and whatnot. And that's kind of the traveler that I am you. You get this like almost Sixth Sense feeling about people that really could be a good interactive like discussion. And other people who are like, nope, they sit down, they get their book out, they put their headphones on, you're like, yeah, I'm just gonna leave you alone.

I was sitting next to a woman in the terminal. And then we took a five hour flight. And then an hour and a half later, I'm standing at a train station. And she and I are the only ones there. And I just looked up at her I went it's weird that seven hours ago, we were sitting next to each other across the country. And now we're standing here and she goes, I was just thinking the same thing. And we had a nice little conversation. Listen, the truth is if I'm not tired, I will talk that I love talking. I will talk to anybody my son's like, Why do you talk to people you don't know? And I was like, I don't know, man. Like we're not alive that long. Like, let's write what's the point? And he does it. But he doesn't think he does it. Oh, never pointed out to him. But that's funny. Yes. I don't say anything. Okay, so what do you hear all the time from people? I put my kid in the car and their blood sugar shoots up. It's not the car though, right? It's that you have this little thing that moves around like a ball of kinetic energy. You've got it and now you're making it sit in one spot and it stopped and now suddenly the basil that works while the kids super active is not enough for while the basil for while the child is is steady. But does that happen to adult? I guess that would happen? It does. Yeah.

Yeah, absolutely. I mean, we used to live down the east coast, we would drive up from DC up to New York or whatever, which is a long enough drive, especially depending on traffic that I always found I needed a Temp Basal increase to accommodate for that. I also found as I do with a lot of the people that I work with that food, if I mean if you're used to a Pre-Bolus that's 15 minutes. I found I needed longer. Yeah, it was just that sedentary nature that really like, was horrible. So yeah, and with the shoot up for kids, I think sometimes it might be anticipation of what they're going to do, right? I mean, if you're living someplace that you're going to take this awesome vacation, once you kind of get there, and the child knows about it, they get in the car that's like, that's like adrenaline. They're like, excited, or they're going to go and spend a week with their favorite grandfather or grandmother or whoever it might be. They know what they're gonna do. It's like, all of this energy that's now like, sitting. Yeah, and they can just run it out. So it goes up.

Now it's the same thing. You know, Arden's insulin needs can go up or down, depending on if she's like in school, or virtual, just like she's even just the walking around the hallways. My mom's in her mid 70s. And she told me the other day, that she hasn't been able to sleep during the pandemic. And then she got vaccinated. So she's out again, moving around. She's like, I sleep so much better now. And I'm like, Yeah, well, you're exercising more. And she's just like, I had to talk her into believing that that was true. Like you're moving around more you've expelling your energy at the right times a day, when it's time to sleep. You don't have extra energy. And she's like, no, we're just sitting right here. We're just sitting there. It's, I mean, listen, movement of some kind, everyday is super important. And children do it so naturally, that you don't notice it as being part of there. Unless you have a boy who's just like constantly throwing trucks against the walls, then maybe you're aware of it. But But um, he kids are like little mini tornadoes. And then yes, I'm still listening is a car ride across town, like 15 minutes. That's not if you're talking about a long travel situation. Yeah, seated in a car,

which is why we usually say, like, defining time, which is what most people want, how long should I expect? You know, a need to change something for is it 15 minutes? Is it an hour, we usually say two hours or more, you're gonna need extra insulin.

So all of this really, you know, my mind, in my mind, it's just being flexible. It's noticing something happen. noticing it before it's a problem. And just, I don't even care why it's happening. Like that's almost why some of these conversations are so interesting to me, because I was like, I didn't realize that, if because if I put Arden in a car for a long time, their blood sugar started going up. I wouldn't even care what the variable was. I just be like, she needs more insulin. I don't and I don't argue about it. I just give it to her.

Right. But the prep for them for the next time gives you some hindsight to say, this is what happened last time. Yeah, I can do it. Let's do better job this time by attacking it before it happens. Yep.

Okay, so I'm excellent. I want to thank Jenny Smith, so much for lending her Sage like wisdom to the Juicebox Podcast. Don't forget Jenny does this for a living and you can find her at integrated diabetes calm. You know, I also want to thank today's sponsor me. Actually, I just want to remind you that the diabetes pro tip series is available right now in your podcast player, just hit subscribe and go to Episode 210. I listed them all for you at the front of the episode. But they're also available at diabetes pro tip calm, which is also accessible through Juicebox Podcast calm. Please try the diabetes pro tip series. As always, is completely 100% free. It's not like I give you some of the information and the good stuff is locked up somewhere behind a paywall. That does not happen on this podcast. Everything is free for you. The show is always free, it is ad supported. And so it is free. Understand I don't have to charge you for content. The content is yours. Share it, use it. It's for you.

Hello friends, and welcome to Episode 511 of the Juicebox Podcast. Back again with another diabetes variables episode means Jenny's here, and today we're going to talk about exercise. That is a variable. You know, I asked the Facebook community Juicebox Podcast type one diabetes, for a list of things that impacted their blood sugar, they came up with over 150 of them. I don't get to exercise because I'm sitting here making this podcast but I hear from a lot of you that you do the running about Nah, I also hear kids play sports, etc, etc. Anyway, exercise is very important as we know. So let's talk about it. 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 love Jenny and want to check out what she's doing in her professional life, she works at integrated diabetes comm or check her out. This episode of The Juicebox Podcast is brought to you by the Dexcom g six continuous glucose monitor. You can learn more about Dexcom and get started with the G six today@dexcom.com Ford slash juice box. The episode is also sponsored by touched by type one end. And there's another one I know the Contour Next One blood glucose meter. Find out more at Contour Next one.com forward slash juicebox and touched by type one is it touched by type one.org. And they're on Facebook and Instagram. Do please check them out. So the variable of exercise will now bring out that I can't remember the difference between two words because they sound similar. I can kind of remember but

arrow aerobic versus anaerobic

aerobic versus anaerobic I always pause my I always go aerobic versus anaerobic. Here's how I do it. This is gonna I'm so embarrassed. I start thinking about Jane Fonda in her 40s and a leotard and I think that's aerobics that's moving quickly. And that's the thing that brings your blood sugar down. I can't believe that's how I make the connection in my head.

That's funny. Is that the let's get physical? Is that the Joe that would be

that would be the girlfriend grease. Oh my god. Oh yeah. My wife's favorite movie is Greece. And now I feel really stupid for not being able to think of she's Australian. Now. I'm gonna know everything about her but her name. Hold on a second. I'm Slavia Newton. JOHN, is that Yeah, Olivia. JOHN would be let's get physical. The thing I think of is, like I said that that leotard from which by the way, is doing the Jane Fonda Workout. And she comes out and she goes, that thing kicks my ass. She's like, I and she's like, how is she doing? It covered head to toe in that like bed stretching. I was like, I don't know, harden. I was like, that was a really long time ago. I'm like, you know, that woman's a famous actress and she's like she is it just became like Internet popular. You know what I mean? Anyway, so So there's two different kinds of exercise. Yeah, something that's aerobics or would playing soccer be aerobic. Yes. basketball. Yes. Okay. Hockey. Yes. Running, obviously, exercise. But now if I lift weights, no.

If you're doing lifting in and of itself. I'm not like circuit training or while circuit training could be circuit of weights to some circuit training is cardio and lifting or cardio and resistance kind of combined. But in general, aerobic means that you are breathing in oxygen kind of at that higher rate, you're increasing your heart rate. That's aerobic exercise. Yes. I mean, you could be taking a dance class or doing a Jane Fonda Workout that is all aerobic. Yes, anaerobic is typically like lifting or resistance training. Some yoga can be an interesting combination of both. If you're doing something like a vinyasa flow where you actually have the resistance of your own body weight, but you're flowing through the moves enough to actually get a cardio increase.

I feel like you're showing off a little bit by saying that. I've never heard those words together before. I was like, really? Like Jenny's flexing. She knows something that I don't know. But I know you're not doing that. I know you don't have that thought in your body. Everyone know? What, what about yard work? What about yard work where I'm lifting things, but I'm hustling around at the same time. That's both do they cancel each other out?

Kind of Bolus? No, I Well, perhaps for some people. But for the majority of people that I work with who do a lot of yard work, myself included at certain times of the year. It tends to be because of the lifting component and the consistent low level movement. I mean, you're not like running between shovelfuls of like mulch or extra dirt for your garden. But you are moving and you're moving enough that the low level aerobic nature tends to create enough sensitivity to insulin to drop your insulin needs.

The robot can will went out most likely. Yes. I guess unless you're literally stopping in between bolts to do dumbbell presses or something. Right. Right. Okay. Yes. Excellent. So, if I'm going to do something a robotic, I mean, what I tell Arden is to set a Temp Basal, like an hour before she does it. That's usually what we try. She's not excellent at doing that. She She likes to just test the limits of her algorithm. She's like, it'll catch it. I'm like, it's not magic. You know that thing. And so if she doesn't set one, she will reach that like that 60 range. But you also have to be able to remember that Arden's using an algorithm. So it's taking her basil away, just taking it away too late. It's enough time to stop around 60. But had she done it a little sooner? I think she she's in the 80s no problem,

right.

But if you're working out on purpose, we're heading out the yard to work. Tell me if I'm wrong, I would avoid active insulin that wasn't countered with carbs. So I wouldn't mind her going out in the yard to work if she had a meal that I knew was really well Bolus, you know, great, Pre-Bolus great carb ratio, then I would think it was okay. I don't mind the food and the insulin fighting while she's outside. But if I were to miss on that Bolus, or if I made too big of a Bolus, active insulin while you're exercising is almost a certainty for dropping, right?

Yes, is cardio exercise specifically or the aerobic exercise? Yes. I even have a lot of people who definitely find that that yard work or whatever the aerobic kind of thing is, that like peak in action of that Bolus is typically going to have it sort of height of action during the exercise time. So oftentimes have you can't adjust Basal ahead of time, or there's really not enough time of activity that it's purposeful to adjust the basil for, then adjusting the Bolus down and allowing the food to work to cover what you're doing. aerobics Lee with less insulin in the picture to cover the food, lower insulin with activity paired together, they tend to balance that food out,

okay. All right, so But now, if you're going to go do serious lifting, those people have to Bolus before they do that, right.

Some do. Some there are multiple ways that people go about anaerobic true anaerobic like lifting sessions or resistance sessions. Some of the lifters that I've worked with have to Bolus after doing some experimentation for seeing how much of a rise they're getting. And when the rise is actually happening. They may Bolus as soon as they start their session, they might do a temporary Basal increase that started about 30 minutes before their session starts so that they're ramped up enough that the rise doesn't get going once they start their lifting. And some find that they actually need to Bolus more in the middle or by the end, because they find the rise in blood sugar is more in the aftermath of the lifting session.

Is there something physiologic physiologically that you're aware of that makes that happen? Like is it like, Is it the lifting version of like a fat rise? Like do you mean like, Is there something that actually happens inside of the body that you know of, or just you just know this as a role that the lifting does? I think Jenny's googling she has a very or she's on her notes or something

I know I was thinking because some is Some is a adrenaline, obviously. And it depends on what type of I mean, if you're really working with like your power lifters, you've got a huge amount of like adrenaline that kind of gets driven out in order to do these lifts. And usually, if you're like, a strong power lifter with lots of weight, you're not doing loads of reps, you're tending to lift, heavy kind of, to exhaustion of heavy amounts, and then you kind of move on. So, you know, there, that's a component is adrenalin, obviously, it's glycogen also kind of gets released, it's a stored, it's stored in your muscles, it's stored in your liver. So that release of glycogen releases the stored glucose into your muscles to kind of get moving. And that can also cause a spike during sometimes, like I said, some lifters find that it happens after the lifting session. And if it does, again, it's the timing of when to take extra insulin and also how much because despite it causing a rise now and maybe directly after, because of what you've done to your muscles, lifting weights, it essentially tears the muscle fibers apart, right? That's why you lift more and you do more, right, you know, and you give breaks between because those muscle fibers repair themselves in between lifting sessions. And that metabolically increases your body's use of food. Right. So you can end up hours after lifting sessions actually needing that Temp Basal decrease now, or needing to Bolus less, because your body is more sensitized to insulin now, even though it wasn't later,

almost like shivering to keep yourself warm, your body's doing something to and it's using up energy to do that. Right. I I'm gonna ask you one last question on this one. Yeah. And you might not have any experience with it. But some people use, you know, steroids to build themselves up, does that change in that and they use them? In part because it shortens the need for recovery time? I wonder if that. I know, that's a weird thing to bring up. But like, I wonder if that impacts that I guess we'd have to find somebody using illegal steroids and has type one diabetes to ask. But I just anyway, I guess there's no,

no, it's well, it's it's a question. I mean, in terms of discussing like exercise and potential for blood sugar shifts, because you're using steroids. I mean, steroids in and of themselves, cause a rise in blood sugar. So along with the lifting, which could be causing the rise in blood sugar, you may need to counter kind of both for that. That's interesting. for that.

I just yeah, I'll tell you from the after dark episodes, what I've learned is, everybody has needs and they're not always the ones we talked about. So I just wanted to bring it up for a second. All right, yeah. Thank you very much. Yeah, absolutely. Hey, if you're looking for an absolutely rock solid, dependable, accurate, easy to carry, easy to use, easy to see at night, blood glucose meter, look no farther than the Contour. Next One blood glucose meter. Find out more at Contour Next one.com. forward slash juice box. This thing is terrific. The test strips have second chance testing. So if you get some blood but not enough, you can go back get more without making a mess of your accuracy or ruining the strip. How nice is that? Right? It's got a super bright light for nighttime viewing the screens incredibly easy to look at and to read. And the thing is designed in a way that it's just super simple to hold and to use. It's a well thought out. But simple design. Contour Next One comm forward slash juice box. And lastly, the Dexcom g six continuous glucose monitor, see the rate and number of your blood sugar in real time on your iPhone or Android or on your Dexcom receiver dexcom.com forward slash juicebox being able to see your blood sugars in real time is a game changer. It will allow you to make changes to insulin changes the carbs that are meaningful and not just guesses you'll actually be able to see where things impact your blood sugars or your loved ones blood sugars. And the share and follow features allow up to 10 followers. So your child could be followed by you, your spouse and eight other people. Or if you're an adult, and you're looking for some friends or some family members to have your back. You can do that as well. dexcom.com Ford slash juicebox. Thank you so much for listening to this episode of the Juicebox Podcast. Let me just thank Jenny and we'll get out of here. Jenny Smith is a CD. She's a type one for over 33 years. And she's just an amazing font of knowledge about diabetes and using insulin, and she works at integrated diabetes. You can find out about hiring Jenny at integrated diabetes that calm thank you so much to the sponsors to you guys. I hope you're enjoying the variable series. And I Oh, and let me say this real quick, touched by type one, find them on Facebook, Instagram, and it touched by type one.org quick episode today but I'll be back tomorrow with another

Hello friends, and welcome to the next episode of the diabetes variable series with me and Jenny Smith. This is Episode 524 of the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Volk glucagon.com forward slash juice box. On today's episode, Jenny and I will be talking about hydration, and how that is a variable in your use of insulin. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always, always, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. Don't forget, if you're interested in Jenny, professionally, she works at integrated diabetes.com. And you can hire her last little bit here, if you're looking for the diabetes pro tip series, which by the way also includes Jenny Smith, they begin at Episode 210 were are available at Juicebox. Podcast calm and at diabetes pro tip calm. There, you'll also find the defining diabetes series, The how we eat series, the variable series, and all of the other episodes of the Juicebox Podcast, including ones about algorithm pumping, and some of my favorite, the afterdark series. So Jenny, we are getting into another diabetes variable. And I was thinking today, since it's summertime here in the US, we could talk about hydration and its impact on blood sugars. Yes, that's a great topic. So is it as simple as Watch, watch, watch me make a three minute long episode of this. Which maybe is fine, right? So I guess let's start at the basis of hydration like are most people probably don't understand what really being well hydrated means.

I would say that that's probably correct. And I think that most people don't think that they're dehydrated until they're actually like physically oh my gosh, I have to get a glass of water or I need something to drink. Like you're beyond like that. Now you're definitely dehydrated, you should be getting something. This point.

Yeah, kidneys hurt, you're thinking of the hospital. You're right, right. So So I guess that is how maybe most people think of hydration is the idea that like, like there's something significantly wrong, not just that there's not quite enough water in your body. And because of that, specifically with type one, and anybody who's using insulin, the insulin can't work. So can you give them a brief overview of why the insulin won't work if you're dehydrated?

Well, one thing to start with is, you know, when you don't drink enough water, the glucose itself in your bloodstream becomes more concentrated. So it's thicker, it's almost like if you imagine the old saying of like molasses in winter, it's kind of like that, when you don't have enough water or liquid to let your blood and fluids flow through your body and your vessels like it's supposed to, it gets kind of sticky. And that leading to higher blood sugar levels means a lot of things including the fact that insulin which we're expecting to get absorbed out of our subcutaneous or underlying tissue, whether you inject it or you pump it however it gets in your body. Unless you inhale it, that's different. If you're putting it into your body via injection or pump, you're expecting your body to absorb it out of that underlying tissue absorption means that you need enough fluid to then sort of transport it into your circulating system. And if your circulating system is slow, because you're dehydrated, right, then the insulin is going to take a bit more to kind of get working if if you will, okay, along with potentially also having some higher blood sugars too. So

is there I mean, bit poor hydration can also lead to body temperature rise, right? Yes. Which I guess could have an impact on blood sugars as well. I don't I just

it would be a stress to the body. Right. Yes. So the

correlation but still important,

but still important. Absolutely. I mean, if you think about it, all of the things in your body Rely on hydration right? In terms of like lubricating your skin and your joints and making digestion go the right way. Even just removing things out of your body, the reason that we go to the bathroom is to rid our, our body of some of the toxins and the things that it is sort of disposing of either you know, one way or another of bodily elimination. So if there's not enough fluid there to kind of move digestion. Now you've got other things that could be enough impact and stress on the body that could be raising your blood sugar

chivo hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Volk glucagon.com forward slash juicebox g vo shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Symptoms of dehydration feeling thirsty dark yellow or strong smelling urine dizziness lightheadedness, feeling tired dry mouth, lips eyes or ping fewer than four times a day are things to look for. for hydration. I think maybe the other important thing to say here is that if you're dehydrated, a can of coke isn't the answer. Right? Like so. Right? So no, it's I feel like there are so many people right now just waiting for me to say water. But you should be drinking water. Right? And and how much do you know? How much do you drink a day?

Um, a lot of water. We go through a lot of water. And I mean, it's the main thing that we all drink. We don't drink milk or any of those other things. We don't drink juice as a beverage. So, gosh, my water bottle is 32 ounces. And I probably go through at least two of those a day. And that's just water. I mean, I drink probably two or three glasses of tea in a day. I drink one cup of coffee in the morning. You know everybody knows what I do.

Pleasure drinks like because that's how I think of that. Like I had a die ginger Lv I sound so boring. I had a diet ginger ale The other day I was like, Well, I haven't had this in such a long time. It's

my, my pleasure drink. Like if I did this when I was pregnant to start because I wanted something that was like a treat in the evening. But I didn't want something that was going to like ruin everything for overnight. So there's a brand of quote unquote, sugar free cereal, or not cereal, soda. zevia. Okay, and it's sweetened with stevia. Some of them are sweetened with stevia and monk fruit, etc. But it's zero sugar. And my favorite is their ginger root beer. Okay. So if I was going to have a treat, I mean, we usually even only buy it like if we're going camping now. But that was my thing to do, like in the evening. A really big glass with lots of ice and zevia. Okay,

well, the so I'm seeing here online that it could take up to 36 hours to rehydrate yourself. If you're dehydrated, like like I guess clinically dehydrated, right is there. So I guess there's also a world where you're just sort of on the bubble and you hear all the time I do it with harden. Like there are times where if our blood sugar's kind of stuck, I'm like drink a big glass of water. See what happens. And you do sometimes see like, it is almost like flipping a switch sometimes. Yeah, so that's not that's a case where you're not as hydrated as you could be. But you're not clinically dehydrated. Correct? That makes sense?

Correct. I mean, clinical dehydration is definitely much more of a there's a visual as some of the symptoms, the signs and things that you mentioned already are kind of in place. It takes a lot to be really dehydrated enough to need to go and get assistance. I mean, in general, you know, how much water do I drink? the age old? Oh, you should be drinking, you know, eight glasses of water a day essentially, or what adds up to like two liters of water. Right. So doing that, a lot of people also don't think that that intake is just considering actual drinking. There is fluid in a lot of the food that we eat naturally, you know, our fruits or vegetables. So it's another reason that they should just eat better food because we also hydrate our body. The less processed foods are

Yeah, okay, and so on. I think the last thing I want to say, and I know this is difficult but it's you know, diet Snapple is not really good for you. You know, it might taste good to you it might not have sugar in it. So you're excited about it. I am not judging. I am definitely a person who, in my heart of hearts wants my drinks to taste like something. But, I mean, I there exists just no doubt in the world that just drinking water is more valuable, I

suppose more valuable. Yeah, I mean, if you do want a little bit of something like flavor wise, you can always add some lemon juice or some lime juice or something like that to the water to get it to have a little bit more flavor. If your reason for not drinking water as much as just because water doesn't taste like anything. Even like some of the sparkling waters, like spindrift and the Waterloo, they get an awful lot of really good like natural essence sort of like flavored it's a sparkling water but sometimes that even is enough for people to drink a little bit more than just plain water.

Right. Well, I think that's a an excellent place to leave this so awesome. Thank you very much.

Yes.

First, I want to thank Jenny for being such an important part of the show. Don't forget you can find her at integrated diabetes comm I'd also like to give a huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pan at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGL Uc ag o n.com. forward slash juicebox. Thank you so much for listening, and for sharing the show with others. I'll be back very soon with another episode of the Juicebox Podcast.

Hello friends, and welcome to the next episode of the diabetes variable series with me and Jenny Smith. This is Episode 526 of the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Volk glucagon.com forward slash juice box. On today's episode of the podcast, Jenny and I will be talking about the quality of the food you eat, and how that is a variable in your use 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. We're becoming bold with insulin. Don't forget if you're interested in Jenny, professionally, she works at integrated diabetes.com. And you can hire her last little bit here if you're looking for the diabetes pro tip series, which by the way also includes Jenny Smith. They begin at Episode 210 were are available at Juicebox. Podcast calm and at diabetes pro tip calm. There, you'll also find the defining diabetes series, The how we eat series, the variable series, and all of the other episodes of the Juicebox Podcast, including ones about algorithm pumping, and some of my favorite, the afterdark series. Before we get started, I just want to briefly remind you that if you're a US resident with Type One Diabetes, or a US resident, who is the caregiver of someone with type one, I would love it if you would check out T one d exchange.org. forward slash juicebox. Consider answering the short survey there. Your answers may help Diabetes Research grow. It's super simple to do completely HIPAA compliant. 100% anonymous, it only took me a few minutes, you can do it from a laptop, phone, anywhere you get on the internet, your answers to those simple questions will support research that may help you or someone you love. He won the exchange.org forward slash juicebox Hey, Jenny, how are you? I'm great. How are you? Oh, I'm so excited to talk about something that I think people are gonna get upset about. So, no, we're gonna do a variable today about Type One Diabetes using insulin. And I'm picking the topic of the quality of the food you eat. So I feel like it's incumbent upon me to start with, I know I am the person who tells you you can eat whatever you want, as long as you understand how to use the insulin. You know, I do want to tell you that I believe that wholeheartedly. And at the same time, it doesn't mean that certain foods don't make things more difficult. It doesn't mean that you know, you're having a meal that you're using 15 units of insulin for when you could have had a different meal that might have used four units of insulin like that's not that's not in dispute. And I'm also not, I'm not judging anyone about how they eat. I think that's fairly obvious if you listen to the entire podcast, but it is a variable of using insulin. It's a diabetes variable. And the truth is that it is easier to Bolus for something natural than it is the Bolus for something that isn't. What do you I think that's a good

I think that's a that's a really good statement. I think the word easy. I use it lightly in terms of like diabetes management easier, easier. But in terms of more natural or simple food, versus more processed or like complex nature of something that's been put together in a processing or a process type of way. A food that's simple, like an apple is just an apple, right? It's mostly carbohydrate in terms of like macronutrient content, right? We've got carbs, proteins and fats, and Apple is mostly carbohydrate. And because of that simple nature of one nutrient you have, what we use and the human body makes insulin that works. cleaner isn't the right word, but it works in a more simple way around a simple food. Has this effect, it should go this way your blood sugar should do this. And it should return down here. If your insulin dosing strategy is Right, right. Whereas if you do something like my father in law loves Apple dumplings, like they're in? Is it still a lot of carbohydrate? Absolutely more than the apple. But there's also other stuff in that, that adds a complex nature to your strategy of management after you eat it.

Right? So I have zero education on this. But I think if we attack this from a common sense approach, the world's bigger, right, you know, there, there used to be a time where everybody in the village you lived grew the food that everybody in the state, right, so you'd, you'd grow food, you'd pick food, you'd eat food, that's it, people, people started noticing that if you left food laying around, it would rot and be gone. They started finding ways to keep it better. lutzer. Right. Right. Eventually refrigeration happens. salting meats to slow down, etc, etc. Point is, is that we now do it chemically. So if anybody, everybody has to try that thing, where you buy a McDonald's cheeseburger, and then stick it on your, I don't know, countertop, and leave it there for a year, it doesn't mold, notice that it still looks like a McDonald's cheeseburger, right?

Only really dry. I don't

think we usually curse in these episodes. But that's it's kind of scary. So, you know, like, that's fascinating is what it is. It's so there are so many preservatives in some foods. And the idea is to keep it from degrading. But again, if you apply common sense that that would mean that it makes it incredibly difficult for your body to break down as well. Yeah, that's the idea, right? And simply speaking, talking about type one diabetes, that keeps the food in your stomach longer, which allows the leaching into your blood longer, right, the carbs are leaving it, it's coming out of sugar, the sugar is going into your blood, it's more difficult to Bolus process food than it is unprocessed food. I mean, it's just kind of it's, it's, it's my It is my finding over the last 15 years of, of watching our need food, better anything

quantity, and what you add up in a day two on one on top of another on top of another on top of another, you know, I see it the most in like vacation days versus eating at home. Right? People go on vacation, and they're like, Yeah, but I had pizza and I know how to Bolus for it at home. Well, what's the difference? Your whole make your pizza, you know what went into it, it's just you know, flour and baking powder and whatever else or baking soda and you make a crust and you put the stuff on top of it now you go out and who knows what they made it with and how they put it together and what they grilled their fries in and

what the company they bought it from put in it so that they could ship it across the country etc, etc. Also, Jenny I don't want to be a stickler, but pizza dough is water, salt, flour, and yeast. Nothing

and yes, there you go. See I don't I don't usually make real pizza dough. I usually make like a cauliflower crust or like an almond flour. So my ingredients are a little different.

definitely understand that. I just don't i don't want people to think I don't know how to make pizza though. I know you've got a pizza oven. It's quite nice. And the truth is, is that the pizza dough I make by hand my body processes better than when I would buy premade at a store or anything I would buy even from a local place. So and then we run into pizza such a great example because the difference between some some guy that owns a shop in New York who's making the dough by hand using salt water, flour, yeast, and you going to any number of Little Caesars Pizza Hut, like those kinds of places that are spread across the country. I mean, that's not really pizza. that's a that's a baker and a chemist getting together and trying to approximate pizza for you. Right and

a lot of the reason like you said it's because of a preservative nature that's needed, right? I mean, in general, there may be some corner shop, Mom and Pop pizza place that whole makes everything like you're gonna get it on the street in somewhere in Italy, right? But typically, much of the pizza shop stuff is been pre made, shipped frozen, they might do the rolling out and that kind of still has to have preservative in it. And again, it leaves into the like, how much of that is where are we kind of over and over and over daily putting into our body? There's a lot of processing. If people were looking at labels, there are a lot of ingredients you can't read.

Right? Right. And you sound like, Listen, I'm not unaware, you start talking like this. Most people are like, Oh, great, hippie. I'm glad you. I'm glad you have a ton of time to grow cabbage in your backyard. I don't like and and I'm not saying that. I don't understand that. But you can't not understand it. You can't sit there staring at a blood sugar going. I don't, I don't know what happened. This doesn't make any sense. You don't I mean, like this, this, you know, 10 carbs, one unit. That's the ratio always works. But now suddenly, you're like you said, You're, you're out in a restaurant. I mean, there's a reason restaurant food tastes good. It's like so much other stuff in it. You know? Like, it just is really, there's no doubt, I guess I should say that the days I'm most proud of how good I am of using insulin are usually reflective of the days that aren't eating the poorest. Because it really tests my, my skills. Yeah, yeah, like when you when you get up on a summer day, and somebody's like, oh, we're gonna go to the I don't know, we're going to the pool. And which we, which we do four times a year, which is so funny that I picked that as an example. But you know, you stop, and you grab all this food, you have a big lunch, and four or five hours later after baking in the sun and sitting around people like oh, we shorter wings, you know, right, like any and these things start piling on top of each other. Right? So

even my husband says the same thing. We actually, we've been in the pool, all but like, five days this summer. So we've been in the pool a lot. But the days that are like a weekend day where we're actually spending like a couple of hours there or whatever. My husband always says the same thing. He's like, now I'm hungry for something that's like, salty, crunchy,

right?

He's like, I don't know what it is the haften the whatever. So no, I

i've i've looked up on days. And Kelly's like, we're getting Chinese for dinner. And I think to myself, like Didn't they have nachos for lunch? Like, you know, I'm like, Alright, then I feel myself like focusing in on like, I need a I need like a diabetes, Adderall. Like I got to really focus here for a second, like, how am I going to leave nachos and go into Chinese and then get her to bed. Like there's a lot that goes into that. And, and so again, there's no judgement for me. But you have to understand if you're listening, that the quality of the food you're eating is going to impact how it how it works. And, you know, super simple like, you know, your carb ratios that work well for natural foods might not work well for other foods. And that's why in the pro tip series, we talked about being flexible and understanding the different impacts of different foods, etc. But the but this is, I mean, it's a serious thing. It's worldwide mostly, everyone has access to food that's been treated with something or has ingredients in it that's meant to keep it shelf stable longer. And while it makes it harder for your body to deal with. GMO hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about, all you have to do is go to G Volk glucagon.com, forward slash juicebox g vo shouldn't be used in patients with insulin, Noma or phaeochromocytoma visit je Vogue glucagon.com slash risk. Everyone has access to food that's been treated with something or has ingredients in it that's meant to keep it shelf stable longer. And while it makes it harder for your body to deal with,

well, I think you know, in terms of like going the distance in this conversation to I even like I try out like different like diets, right? I hate calling them diets just because they come out and I'm like, ah, let's see what that does do something different. And I mean, overall, I consider the food that I eat and I feed to my family and whatnot. pretty clean food. I mean, we don't have a lot of processed kinds of stuff. I mean, we've got like canned beans, because they're a lot more convenient than soaking the beans, right. But overall, I did is a couple years ago I did the whole 30 diet. And you've heard of that it's like a it's like a 30 days of like a reset. It's essentially completely grain free. And it's it's non processed at all. I think one of the most process things is probably like coconut oil or something like that on it right? But doing that for a 30 day time period, even compared To what I typically do, dropped my insulin needs and made it very clearly visible insulin action and insulin need based on literally no processed anything.

Really? Yes. So even you who listen, for people wondering, Jenny and I see each other while we're doing this, and there are times I think the camera goes on and she's just like, oh, hideous monster. Like when she's because she's super healthy. That looks so natural. Oh, no, no, but but I still like, Listen, my birthday was this week. And they bought me like a little ice cream cake, which is a holdover from my childhood, right. And so everybody, everybody gets like a piece of ice cream cake. And then there's this like, little voice in my head. That's like, the rest of this is mine. people stay away from it. Birthday. I live this long, not you. And so. And I know in my head, like I'm gonna revert to a small child and have a piece of ice cream cake every day for three days until it's gone. You know, and I don't know what is an ice cream cake. But part of me believes it's not ice cream.

But it's darn tasty. In fact, by the funny thing about that is that when my husband and I got married, he for our my first birthday, like married, he really wanted to make me a cake. He's not a baker. He can cook. He's just he's not a baker. So he bought me an ice cream like a mini like it was just us. Right? It was one of those tiny little ice cream cakes. That probably was like four servings. And I think we ate it over like two weeks because it was like, my favorite part of the ice cream cake. Is that crispy? crunchy? Like,

I don't know what's in the middle. And it's not food. Yeah.

I don't know where it was made. But it's good.

I have one more thing to bring up. But let's finish this thought we had an entire conversation where we sat around and said rate the parts of the ice cream cake. And it's so funny. It's not even it's just so is it the like the decorative icing around the corner, which is is it the vanilla? Is it the cookie I'm making air quotes the cookie in the middle are the chocolate and everyone rated the parts of the ice cream cake differently as ever part was my son throws it up on I Snapchat I think through his friends. And he's like, I've got nine responses. None of them are the same yet, for people's favorite parts of the thing I want to add here. I'm not the healthiest person in the world. But I have made a change in my life that I have found to be impactful. And I think it fits in here. So I saw a woman on a television show once which is the best way to make health decisions next to listening to a podcast. And she said don't eat canola, corn cottonseed, soy sunflower, safflower Grapeseed, or rice bran oils, just don't use those oils. And I thought, well, I use canola oil and corn oil. Like sometimes I use sunflower oil. Okay, so I just cut them out of my diet. I just thought like, like you said, with the 30 days, I was like, let me see what happens. So I cut them completely out of my diet. If I cook with it, I need oil, I only use cold pressed, non fermented olive oil, or butter. Like those are the only two things I'll cook with in a pan. And I can't tell you that my life magically changed, right? Like I didn't like suddenly I wasn't a foot taller or anything like that I but but here's the biggest thing that I noticed. If I got kind of like, ooh, she didn't say peanut oil, I'll have some like, like, I'll pull out a deep fryer and make some chicken nuggets or something like that. Or we'll go to a bar and I'll get wings or something. The minute I add in one of those other processed oils, you might as well just wherever I am to the bathroom decide that I'm on my way to that situation because while I haven't had some great impact by removing them, what I realized has happened is I've stopped taxing my body in a way that it wasn't prepared for. So like I'm giving my body a job with this oil that it's barely keeping up with. And and so I don't know that that's quantifiable for people. But I think of that as when you're thinking of foods to cut out of your life. Like just because your body processes processes that doesn't make it good. Like I could eat a rock and like come out the other end. But right I shouldn't do that. And it's not good for you. Yeah, yeah, at some point, you're gonna attach yourself to the point where your body's gonna be like, Yo, man, listen, that's the last Brock I can get out of here. And and I just think that, you know, that's what I saw with the oil. So you can Yeah, heat oils or don't i don't care. But I'm saying that when I stopped taxing my body with them, I noticed that my body was happier. And my body showed me that it was unhappy when I tried to give it back.

Well, and you know, the other thing, too, that you probably would bring into that, given this conversation is that a lot of our processed foods contain those types of fats, because they're processed, they're processed and broken down from these plants that would not naturally like it wouldn't be visible that they would be an oil that we would use, right? In fact, it's only like, these haven't been available. They weren't available until like the 20th century, right? Where we finally had enough technology or different types of machines that we could take these oils out of these products and use them. And we found that they had a very good preservative nature, we could add them to things, they had shelf stability. But are they things that we should be eating? A lot of? No, in fact, most In fact, if you're looking just at canola oil alone, most of the resources kind of show that if you are going to eat it, don't cook with it, use it more in like a salad dressing that remains cold, rather than in actually like cooking with it.

Because when you heat it up, you change it again,

you can't change the chemical structure of it again. So

I oddly enough, I'm gonna equate this to I will not microwave plastic, I don't care if it's plastic, if it's microwave safe or not. microwave safe means it won't melt in there doesn't mean it's good for you.

Right, it gives I mean, there again, another like rabbit hole of everything that it gives off chemically at Yeah, I mean, I've always done glass,

right. So. So that's my point about that is just that, and Jenny ties it in a nice bow. These oils are processed, where this one oil that I've chosen. Extra Virgin Olive Oil cold fermented. So it's not it's not changed by heat. Right? That that seems to be fine. Like, I don't have any issue processing that whatsoever.

Right. Right. And I mean, if you broke it down further, a lot of it has to do with why do we? Why do we need some of these? Well, we're looking at the Omega, the Omega fatty acids kind of coming from some of these products. And there are different types of omega fatty acids, their omega threes and their omega sixes. And you're supposed to have a certain like ratio of these coming in one versus the other. And unfortunately, these oils actually have a very high percentage of omega six. Yeah, which we don't really need a high percentage of omega sixes, I have

to tell you again, I have no no education to speak of. But in my mind, at least butter is like it's it's from a cow. I mean, like I at least feel that way about it. You know what I mean? And I don't know, I feel weird talking about this. Because again, I'm like, if you saw me, you'd be like, well, there's a guy who's not out of shape and not in shape. You know, like I don't I don't I'm not a I'm not a bodybuilder. I don't I don't think that way about myself. I don't think I'm interested in it. But I can tell you that I've seen it with Arden. I've seen her eat stuff that's processed, and it makes things more difficult. And I've seen it my own body. I think it's just worth it's just worth thinking about while you're doing this. Like I'm not saying you're going to be able to talk to your four year old into not eating Cheetos, but Cheetos or not food,

like you have and if they're everyday versus Yeah, right. Gosh, I want Cheetos because we're on vacation and we're gonna have like sandwiches on the side of the road, you know, when a wayside snacking on okay. But yeah, I mean, kids don't nobody needs Cheetos, or Doritos, or, I mean, like calling out big brands here. But truly, if you read any of the books that are really about, like mindless eating, and they all prove points of research that companies make, quote, unquote, food, which isn't real food taste better than it would actually taste without salt and sugar, and flavorings added to it. And that what, it's what hooks you

Yeah, it makes you want more? Yeah, I mean, what more we could talk about if you cut sugar out of your diet, you'd go crazy in the first couple of days until it was out of your system. You have crap, you'd have incredible cravings and, you know, all all that stuff. So I mean, to try to keep it in the into the diabetes realm, I guess and keep it around that. It just you just need to be aware of it. Like again, if you want to eat Cheetos all day long. I'm sure there's a way to Bolus for now I'm pretty sure that way exists in this podcast. It'll explain it to you. Right, right. But you can't. I guess we're this episode comes from for me or where my perspective comes from is that I hear from so Many people I'm sure Jenny does too. And at some point, it's frustrating to hear somebody say, I need you to help me My stomach hurts. So what did you eat? I ate a rock. And you're like, well, well don't eat rock, don't eat rocks. You know, what, can't you They told me you could get the rock out like, Okay, well, I guess we can but like, let's not do it again. You know, I'm not gonna tell you that I was at a picnic the other weekend. And I brought my own food cuz I like there's problems like, I'll do it so that I knew there's something there I could eat, right?

That's my trick. Like, I know what I could do. Because I know what I added to,

I'd be happy to make something which means I want to eat while I'm there. And I don't want to be sick, like five hours after I leave. So. But I rode past the ball once and I looked because you brought it up. I was like, God, Doritos, when's the last time I had to read those? Say, I don't think it's been in forever. I took about four or five Doritos, and I ate them. And I was like, Huh, okay. And then that was it. But I saw a person living next to those Doritos. And their arm, like just kept going back and forth. You know, and because that stuff is like, like you said, some of these foods you have to understand I'm going to go off course for a second. I once tried to explain to my younger brother, that I wouldn't smoke a cigarette, if for no other reason. Because I could imagine 12 really rich people sitting in a conference room laughing at me for buying their cigarettes. And and so there's sort of that process food thing makes me feel the same way. Like I know for sure they make that food so that your body is just exploding at every pleasure center when you have it. Right. And they don't care if you can't get your blood sugar down later or, and you know, I've want to CGM and everything we talked about on the show everything around insulin I saw impact me with a working pancreas. I saw what happens if I ate late at night. And I chose poor food. My blood sugar would sit at 110 all night long. Right? You know, I saw what happens is where it would naturally

sit. I mean, some people be like, Oh my god, 110 how horrible right

and my works. So here's right, yeah, I 110 for nine hours, because at 10 o'clock. I mean, I did it as a test. But at 10 o'clock, I said to myself, well, I'm gonna eat this thing and see what it does to me. And just like we talked about, I went to sleep, my body slowed down digestion, slowed down, the food stayed in my stomach forever. And it kept driving up my blood sugar. So yeah, that's it. Alright, just got out of hand? I don't think so. Actually, but yeah, for anybody who wants to read about the doctor that I saw, called the oils, The Hateful Eight. And so I think if you google Hateful Eight oils, you'll find it. It's not made that

whatever the doctor was referring to also included things that are very relevant to diabetes, including things like chronic inflammation.

She was talking a lot about the metabolic impact of Yeah, well,

yeah. Yeah. And that has a huge component to diabetes management and insulin and what you see happen and everything. So yeah, absolutely.

A huge thank you to one of today's sponsors, je Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc AG, o n.com. forward slash juicebox. And don't forget to head over to the T one D exchange and fill out that brief survey your us resident who has type one or a US resident, who is the caregiver of someone with type one, they need your help T one d exchange.org. forward slash juice box only takes a few moments. If you're looking for a great online community around diabetes and using insulin, look no farther than the Juicebox Podcast Type One Diabetes private Facebook group, it is completely free to join and has over 13,000 members, people just like you talking about type one, strategies, and so much more. Go find it now on Facebook Juicebox Podcast type one diabetes. Thank you so much for listening, for sharing the show for being wonderful listeners. And for whatever else you're doing out there to support the show that I don't know about. Thank you. Thank you. Thank you. I'll be back very soon with another episode of the Juicebox Podcast.

Friends Hello, and welcome to Episode 530 of the Juicebox Podcast. Jenny and I are going to talk about another diabetes variable today. And today's topic is called tunneling. But you may think of it as a leaky site. So I'm still deciding at the last minute what to call the episode. But once you get in here, you know, then you'll see the whole thing. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you want to hire Jenny Smith, she works at integrated diabetes.com Check her out. And while I'm talking about stuff, let me remind you that I really appreciate when you share the show with other people. That's it, the show is growing incredibly fast. It is getting silly, silly amounts of downloads. And that is because of you. And I want to say thank you. So thank you very much for listening, for subscribing, and for sharing. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. In fact, the most accurate and easy to use blood glucose meter that I have ever used. Contour Next one.com forward slash Juicebox. Podcast is also sponsored today. By Dexcom, makers of the Dexcom g six continuous glucose monitor, you can find out more or get started today@dexcom.com forward slash juice box.

Is the sound better? By the way? I guess you probably wouldn't be able to tell until you listened. But I I got a really long cord.

Okay, and you're back in the other

100 foot cord. And it's like out of my office down through our house down into the basement where the thing is. And so I'm back in my office small space. Right. So hopefully it won't echo is my show sound nice.

Thank you. That was very nice. I would record you didn't have to buy Oh,

god it was 20 bucks. Okay. All right. Deal. So yes, no, that's very nice. You're very kind to do that.

Okay, so you brought up a topic, you sent me a note and you're like, you know, we should talk about tunneling. And I have to admit, I thought to myself, tunneling sounds like with those characters on Hogan's Heroes we're doing all the time when I was a little kid watching that show. And then I thought, well, Jenny knows I wrote it right on the list. And no lie. Four days later, I get a note, like an email, like something someone had to like, sit down and compose from a woman who said, Hey, could you and Jenny talk about tunneling? I thought, get out of here. Like, it's

really funny. What works isn't like quite

a coincidence. That's fine. So I don't know what it is. I'm just gonna be honest and say it.

Really? Yeah. I

mean, I, when you said the word, I started imagining what I think it is. I'm probably not far off. But I had never heard the phrase.

So yeah, I mean, you're, you're probably not far off. I mean, you're a smart guy. So I'm quite sure that you can probably guess honestly, but it's most common with straight inserted Teflon infusions that's most common. It's really when the insulin that goes in through that infusion set or through the canula. And it's supposed to be get kind of dispersed under the sub q tissue absorbed, blah, blah, blah. It doesn't it sort of pools at that infusion site, and then because of that, it leaks back up. If you imagine the sides of the canula, right, it leaks back up the sides and it leaks out the top, so you're essentially losing insulin. So the most common are kind of the straight in infusion sets, especially the ones that are not very long, the shorter as well as it happens in larger doses. Typically, you're not going to see it in a dose that's like a unit. But if you've got pretty hefty donut boluses donuts, maybe I'm hungry. I don't know I ate breakfast this morning. If you've got pretty hefty boluses eight units, plus, you could potentially see more of That tunneling happening tends to be reduced in sets that are more the angled sets. Or especially for those who use the 90 degree set, if you can choose the steel canula, that goes straight in kind of like a foam tack, it doesn't tend to be as common to happen with that.

So where would we see that? So I know on the pod goes in on an angle. And that's not the case. And I do know that people use like 90 degree sets that are plastic, and I've heard people say, Oh, if that one doesn't work, if the if the plastic handle doesn't work, try to steal one. Yep. Right. And well, so what you're making me feel like is, I don't know, has anyone ever, like, taken the garden hose and like, jammed it down into the mud, and then hold it there for a second, and then the water starts pouring back up like that. That's it. That's what's happening.

That's exactly right. Yes. And, you know, it does also happen in more common, I guess, lifestyle types of activities that can be prone to like pulling, or yanking on the site, things like golfing, things like tennis, where you've got those swift movements, especially with tube pumps, that you can get that because anytime there is a yank on that tube, it Yanks the infusion set sitting under the skin. And another reason for tunneling is inflammation of that tissue underneath the skin. So as it gets inflamed, anything that gets inflamed gets puffy or swollen, right? And that creates more space. You would think if it gets swollen, it would create less space like it would squeeze the canula. It doesn't it actually creates more space expands. Yeah, right, it expands. And so the tube itself, the canula has more space to move, and insulin can leak that way as well. So

we are counting on on some level. Anytime you put in an infusion set you're counting on so tenuous. Now that I'm thinking about it, you're counting on your body just sort of healing around that tube just a little bit to create a seal. Correct. And you start and so if you have a tube pump, the tubing gets pulled, that seal gets broken, if you're twisting or turning, it could get broken. And then you get what I would just call leaking. I didn't realize people called it tunneling, but like the site leaks is how I Right, right. Yeah, but that's specifically what's happening.

It is exactly and you can tell, honestly, I mean Omnipod you can often tell because they do because there's insulin that kind of leaks around that edge. Or oftentimes you'll see liquid in that viewing window area. I mean, there should be some degree of condensation over the wear of a pod, not from me,

do you know why? What do you do? What's your magic. So after I pop the little plastic, like safety tab off the Omni pod, we take a clean tissue and twist it like and we we dab the liquid now people listening just heard of very weird diabetes like nerd that moment. Because if I take the liquid out that I can trust, if I see liquid in the window, that sounds coming from the site,

right? Because you can usually tell liquid versus again, condensation, I mean a really hot sticky day or if you're sitting in a sauna or something like that, you may get some visible like clouding condensation in that viewing window. But it shouldn't be liquid to the degree that you can physically like see it almost if you've ever had like a bloody sight, you can see the blood sort of pooling in that area. It's the same thing with tunneling of insulin. And on the pods, I've, I've noticed more than with tube pod to tube pumps, that that adhesive that's right around that curved area. If you've got a leaking problem, it's going to be wet there too. Let's face it, it's Yeah. Um, so I mean, some ways around it are for those who are more active or have more movement to their day, or just kids who are just more prone to pulling on a tube pump, potentially. I mean, there are some tricks things like using the product called iv 3000. It's like a really thin, clear sort of bandaid, almost hypoallergenic, you put it down on the skin, you essentially put the site over that and let the canula go in and through. And then you put another one on top of it almost sandwiching the infusion site, so that what happens is you minimize like the movement, okay,

so like there's no tectonic shift, sort of like that. That's correct.

Yeah, the other one is and this is actually with and maybe Part of the reason that it's better with steel camulos is that the steel Canyon has a site. And then it has a short amount of tubing that connects to another, not a site, but almost like another little adhesive area. So you've got the site tubing, a site that holds that secure, and then the tubing that goes on from there. So another recommendation with non steel cannulas is to just take about a two to three inch section after the canula and adhere it to the skin using some type of you know skin.

Okay, so if you're if you're using tubing, you go a couple inches away from your site and here the tubing to your skin. And that way pulling on the tubing pulls on the fixed site, not on the

not so much on the actual infused area.

Yes. Is this more common in certain body styles or types or older or newer sites or anything like that. I'm going to make the ads super duper quick today. As you can tell, they're going to be fast by the long intro, and my use of super duper, because nothing says brevity, like the use of made up words and long introductions. But if you trust me, just trust me, I'll be done in a minute, you'll be better for knowing that the Dexcom gs six continuous glucose monitor is something that I think you should take a look at. You go to dexcom.com forward slash juice box. And when you're there, you're going to learn a multitude of things about the Dexcom. But not the least of which are these very core and important facts. When someone using insulin is wearing a Dexcom, they can see what their blood sugar is in real time. So if your blood sugar is 150, you can see what it is art is actually not even with me right now she's out shopping for school supplies with Kelly, and her blood sugar is 92. I just pulled that up on my phone. It's not just 92 it's 92 and stable, meaning that it is not falling or rising at any perceivable rate. But if it was, the Dexcom would tell you that it would say it's rising, and it would give you a little arrow to tell you how quickly it was rising. Think about what just happened here I picked up my iPhone. Now this could have been an Android phone, but I picked up my iPhone. And in a split second saw my daughter's blood sugar. She's using her phone where she can also see her blood sugar. You can set alarms to let you know when your blood sugar is crushed thresholds that are important to you. Arden's alarms are set at 70 and 130. Mine at 7120. Yours could be wherever you want dexcom.com forward slash juicebox. Your kids could be off shopping away at school or anywhere. And you can see their blood sugar. And for adults, hello. If you don't want someone to see your blood sugar, that's cool. You can see it the speed, direction and number. This information is at the core, how we make good decisions about insulin and carbohydrates. And I think you would find it very, very helpful as well. Arden just got her latest day once he recently and it has been between five, two and six two, for over seven years, I give a lot of that credit to the Dexcom. Everyone using insulin needs a great blood glucose meter. But not everybody thinks about that. Sometimes we just take the one the doctor gives us or you know whatever the doctor has lying around the office. But you could put a tiny bit of effort into making sure you have a fantastic blood glucose meter. That's not just super accurate, but gives you other things to crow about, like Second Chance test trips as super bright, light and easy to read screen. And it fits well in your hand. But it's also super simple to carry around. That blood glucose meter in my opinion, is the Contour Next One blood glucose meter. And you can find out more about it at Contour Next one.com forward slash juicebox It seems so simple, doesn't it? Just never really think about our meter. Think about your second. Is it a good one? Do you have any idea at all? Contour Next One forward slash juicebox. Get yourself a great meter. They also have a fantastic website, head over there right now. They got all kinds of plans. And I mean, you might even be eligible for a free meter. You just gotta go check it out.

Definitely, I mean, you bring up a good thing about, you know, just the rotation of sites, obviously, because if that is going to be a reason for tunneling, older sites, sites that have more scar tissue, again, scar tissue is going to be less mobile or less, you know, flexible, I guess is the better word. So you're going to have the tissue that's hard, and has more ability for that canula to kind of have wiggle room.

Alright. But not like I'm thinner, I'm heavier, I'm older, I'm young, none of that stuff happens.

That doesn't seem to be it's much more the insulin amount, and then the movement itself of that particular person's lifestyle.

So if I just sit perfectly still, I'll be okay. And don't eat a lot of food don't eat the Bolus. So you're saying if I could just basically get rid of diabetes, and this tunneling thing wouldn't be much of an issue at all.

Right? I mean, in terms of in terms of the insulin doses themselves, knowing that we obviously have to use insulin. Sometimes using the fancy features on a pump can be more beneficial to dispersing insulin slower. So using things like an extended Bolus with a portion of a large Bolus, now a portion extended out a little bit more slowly. I know some of the insulin pumps. I know tandem does it. I can't remember I don't think that Medtronic allows you to change but tandem allows you to change the rate at which your insulin gets dripped and on boluses. And so slowing that process down even in a small amount can sometimes help that Bolus get absorbed. I've

often used a 30 minute extended Bolus to bridge a gap like while Arden's leaving a class going to lunch like if like if her blood sugar 78. And I still want to Pre-Bolus but I'm like, Well, I don't know how we're gonna do this. Like I can't put it as much as I want, because she's going to be low before she eats, right? I would do like a 0%, upfront, and all over 3030 minutes. So you kind of get it in on time ish. But it's not all in there that seems like that might help that, hey, this is making me wonder do people with higher basil rates, Basil? How do I just miss pronounce basil to people with higher basil rates? Go through this more often. Do you think

like we would expect? So I mean, I would say yes. In general terms, yes, mainly, because if you've got a higher basil rate to begin with, you also have much larger boluses. I mean, think about a Basal rate that's like 1.75, you're not going to have an insulin to carb ratio of one to 30. And if you do there, something's not set. Something's wrong. start over again. But you would expect that with larger basil, overall, your sensitivity to insulin is lower. So you're going to need larger Bolus as well. So another thing that kind of goes along with decreased chance of tunneling, especially with larger insulin dose, is making sure that you're changing the site more frequently, okay, you might need to change the sight, despite your pump holding 300 units of insulin, you might need to change it once you get to two full days, and nothing beyond that, regardless of the amount of insulin, you know, in that large amount, you might make it to two days. And that might be it.

Could you cheat a little and split your Bolus, and inject some of it, if this was an issue,

you're kind of getting into all the realm of what I do in pregnancy with women who've got really high resistance before they get pregnant. And we know that their insulin needs are going to be just exorbitant by that third trimester, we pull a lot of tricks out of a hat, I mean, we sometimes cover 50 or 60% of the basil with a basil injected insulin and take the basil that's pumped in way down, then we may even use you 200 insulin, which gives you two units of action per one unit of an actual dose volume. So then instead of a Basal of two, you get down to a Basal of one, but you're getting the impact of a Basal of two. What is that called?

I can't think of the word all of a sudden when people only Bolus with their pumps, but they use an injected Basal insulin. They call it something

really, I don't know the name for that. But it's

right out of my How could two people who twist up a tissue and dad out the couple of drops of insulin on the pod not be able to remember that word?

I don't know what that's called.

I'm never gonna figure it out sitting here, that's for sure. But But people have a name for it.

They do and even at smaller doses, some people find that for whatever reason, a Bolus with an injection works a lot better they get more very precise. Like dosing action. Yeah. And impact of action by just Taking a Bolus versus they love the precision of the basil coming from their pump. Okay, so I mean, there are lots of ways to attack things. Definitely. I've got someone in college right now that I work with and she knows that any Bolus that she needs to take over seven units, she will have tunnelling, if she doesn't Bolus with an injection,

okay, would change into an omni pod for her make a difference? She's on Omnipod. It's still happening to her even with the FC that so some people it's funny because you hear people sometimes say, oh, if you're having trouble with that with the, the Omni pod can yell at go to a pump with a 90 degree candle. And I've heard people say, Oh, if this 90 degree candle is not working for you, you should try the army. Right? Exactly. Right. You shouldn't just sit around struggling with something that doesn't work for you.

No, you shouldn't. And that's a that is one benefit, I think to tube pumps is that if you think it's one canula that you're using, there are multiple to choose to try. Call the company and let them know hey, I think that this set this type of set is a problem. Do you have some I'd like to try this one. This one, they'll usually send you a couple of samples to try before you order a whole big box.

years ago, I interviewed Todd Hobbs, who I think at the time was the CEO of Novo Nordisk, but I don't, I don't believe he is anymore. And in his talking about what he thought people with type one diabetes needed, he was adamant that what they needed was better canula technology. Oh, yeah, that at the top of his list, you know,

well, and there, I'm sure that you've seen, the study is about the candle that has, it's almost like a sprinkler effect, right? It's a candle, that's a tube that's got multiple holes through the tubing rather than just coming out the end. And what they find is that with more more surface area that they're covering with like a spray of insulin, rather than an injection, at one point, you get a lot better absorption, you get more precise and even absorption. And tunneling almost disappears.

I wonder how hard that is then to inject the cannula because now maybe some of the rigidness of it is gone? Because you've got little holes in the side. Right? Good question. Yeah. All right. What made you want to do this? Like why you were very like, like, we talk frequently, but not that frequently. And you were like, Hey, we're doing this.

Yeah, because I think in and I, you know, I texted you about it as like one of the variables, because we've got so many variables to talk about. And I think a lot of people call it leaking. Right? Without, and I think it helps to understand what's actually happening. And some of the reasons and the frequency if you're one person versus another, you know, one kid who's like, a swimmer maybe has no issues ever with tunneling, and they're the same body size and type of their, their little buddy next door, who is an avid golfer? Well, there might be the issue to consider, you know. So I think I think I thought it was important, because I don't see a lot of people but I see enough people that have had this issue. And just think that they've done something wrong, or their doctor isn't offering any solution. I don't know it's a leaky site, change it?

Well, yes. But

it'd be nice if I understood this a little better. It's funny, because he's, you said that, I thought, well, I'm gonna have to call the I'm gonna have to call the episode leaky site so that people even understand like, how to go, like, figure out what it is right. But that's great. I'm glad you did this.

Awesome. Yay.

Jenny and I are starting to get quite a little list of diabetes variables, episodes. You can find them right there in your podcast player. There's a lot more just search Juicebox Podcast, diabetes variables, or search diabetes variables at Juicebox. Podcast calm. When I get a couple more together, I'm going to build a list. But Ilana put it on the website. Not quite yet, though. Come come into it. All things in time, my friends. Are you looking for Jenny? She's an integrated diabetes.com. Oh, and let me thank the advertisers. Thank you Dexcom, makers of the G six continuous glucose monitor. And of course, the Contour Next One blood glucose meter. Why I almost forgot the links. I think they pay me to say the links dexcom.com forward slash juicebox. Contour Next one.com forward slash juice box. Check out that amazing Dexcom g six, and the most accurate meter I've ever held. The Contour Next One. Thank you so much for listening. Thank you for sharing the show. Thank you for downloading it your podcast app. Oh, Thank you for subscribing in your podcast app. Thank you. Thank you. Thank you. Thank you. Thank you for making the Juicebox Podcast what it is, I really appreciate it every time you listen every time you share, every time, everything. If you're really looking for some help with all this stuff, you should check out the private Facebook group for the podcast. It's called Juicebox Podcast, type one diabetes, and there are over 14,000 members. I do my best to look in on it every day. And so should you it's an incredibly helpful Facebook group. I know that sounds kind of weird, like people like Facebook doesn't Facebook suck. Maybe it does, but not this group Juicebox Podcast, type one diabetes, go find your brethren. They're very, very kind, very helpful and excited to say hello to you.

Hello friends and welcome to Episode 535 of the Juicebox Podcast. Jenny's here today to do another diabetes variable with me. And today's topic is video games. This is the eighth in the diabetes variable series. So far we've covered trampolines, temperature travel, exercise, hydration, food quality, leaky sites, or tunneling. And of course today, those good old video games, there's also a diabetes protest episode about variables that is Episode 231. If you haven't heard the diabetes protests, I wish you would give them a try. They begin at Episode 210 where you can find them at diabetes pro tip.com. Please remember while you're listening today 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. Today is a pretty short episode there's only one ad and I think the episodes about 15 minutes long. I hope you enjoy it. This show is sponsored today by the glucagon that my daughter carries g vo hypo pen Find out more at G Vogue glucagon.com forward slash juicebox g vo hypo pan has no visible needle and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com forward slash juicebox G voke shouldn't be used in patients with insulinoma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Well, here's one that I hear from a lot of moms. I don't want to be too specific, but a lot of moms of boys usually my kids blood sugar shoots up and they don't just mean 40 or 50 points. They're talking about 202 50 when they play video games is that adrenaline? That's adrenaline. That's people should know that.

It's and I think you're right in terms of video games and maybe the type of person who might be playing one video game versus another. I mean, I like age old like Mario Brothers I can guarantee you my blood sugar was never going up when I was playing Mario Brothers with my brother as a child okay, but I can probably say that if I could go back if I was doing some of the the Olympic ones where you were like competing against the other person like you were doing jumping and even though it wasn't an activity my brother and I were very competitive in that in terms of who did better so I would guess without knowing I didn't have achieved CGM at that point but I would guess that my blood sugar probably went up a bit

I'm picturing you trash talking to your brother playing we bowling right now.

Oh it wasn't we bowling It was like Do you remember the old like you had to do like the lock you had to like run run run and then do like the long job kind of thing like the old school Nintendo right Yeah, no

kidding like can you get moved in? So that's interest but

today's games

the first person shooters and that's stuff that feels like you're really doing specially

the virtual ones the ones where you have the visual the goggles on you are almost immersed in that setting. And many times there will be a rise especially if it's any of the what I call more violent ones. You know the games where you're really like shooting and killing or you're battling the zombies are these like demon looking creatures?

I've been scared I've sorted for my son shoulder and watched it been like this is kind of Loki frightening. Yes, and I know I'm okay I'm so I wonder too. I would love to hear from somebody I wonder if it is that competition piece. coupled together with the frightening like intense nature of it like all that together just drives out of nowhere. So do you Bolus for it?

I usually recommend paying attention too What ends up happening, because a first visual is often what parents see in activities or competitions, sport, not obviously the practices. But typically the sport on the weekend where you're doing a tournament or a game against your ATM, you know, rival or whatever it is, this spike in blood sugar, we can either see, blood sugar sits high, and you do have to take care of it, or it's just high the whole game, or it spikes. But then as the kid keeps moving things even out and they end up coming down without correcting the adrenaline rush at all. So the piece in the picture of these games is, is it a seated adrenaline rush type of game? Or is it one in which you are also moving along with the game? That may be the difference of correcting? or letting the rise happen and letting it even out?

Is there an impact about what happens after the game? So if I kill the zombies, jack, my blood sugar up and then sit down? That would be different than if I did that and began to move around afterwards? Because the movement might have a blood sugar down. But if you go from a jacked up adrenaline to sedentary or into bed or into a meal, right, then you're not Yeah, then those other variables are going to keep the adrenaline from because I've seen I think there's a fairly common story that I have told on the podcast a number of times about noticing that Arden was competitive at sports, and learning to Bolus for it. But the other you know, the end of that story is, yes, it kept it down. But then she needed food later, I was basically Pre-Bolus Singh food, and the Pre-Bolus was handling the spike of adrenaline. And then afterwards, it needed to be fed.

Or it was like the end of that insulin action had to be taken care of.

Yeah, the adrenaline bump in blood sugar was not enough. How do I mean this, the the insulin, the amount of insulin I used was necessary to keep her blood sugar stable through the adrenaline. But as soon as the adrenaline was gone, there was still insulin leftover and it needed carbs.

Right especially considering it's on the back end of exercise, which enhances insulin absorption for a couple of hours after in most cases,

which is why aren't always got waffles after basketball. So it was like a nice little pre planning thing. Like I still would listen, I used to do the same trick afternoon at high school, she'd get higher 1231 3230. But she was always hungry after school. So I was aggressive through that afternoon, knowing that there was going to be food right at three o'clock. Right, you know, and then that's, that was one of the ways I was able to stay on top of that kind of blood sugar problem without causing a low later. Right. So video games, and that's just, it's confounding to people when it happens then once they see it, they're like video games make my kids blood sugar go up. I wonder. I wonder if it says frequent with girls as it is with boys.

I would expect it's it depends on what their interest is. Yeah, you know, a lot of the girls that I work with who are sort of in that like eight to 12 range where they're sort of getting into like the dance dance type of game or whatever it is. They're excited about doing it. But that's that's like exercise they're moving and so their insulin needs actually obviously go down. I wear a lot of girls games girls specific I guess if we're terming them boy girl games, which they're not really anything. Yeah.

No, I mean, like, I wonder how many people who are, you know, who are girls are into like, thrashing zombies in video games. It seems like a I mean, I don't know I'm using my

I would guess that if there was a group of friends that was very interested in doing it all together, regardless whether they were boys and girls, they just wanted to hang out and they were all doing that. And

I just wonder if like internally in their brain they have that same like, kill it, stomp it I'm amazing. Let me win feeling like I want to hear from somebody who's got a little killer for a daughter. Outside just running through things constantly.

The warrior ninja child.

A huge thank you to one of today's sponsors. g Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juice box. you spell that GVOKEGL Uc ag o n.com forward slash choose ba If you'd like to hire Jenny, she works at integrated diabetes comm go check her out. Thank you so much for listening. I'm gonna put a little bit of information after the music about the pro tip series and the defining diabetes series. But if you already know about that stuff, pace, you're done. Alright guys, there's some series within the podcasts that are about management. I mean, you're listening to one now variables. There's also the defining diabetes series, which goes over jargon, tools, ideas, but there's also the diabetes pro tip series. And I want to read you just one piece of feedback that I got from a Facebook user just a couple of weeks ago. It said, I've been listening to the podcast since May of 2019, when my son was diagnosed, without all of your help, advice, tips, education, we wouldn't be where we are now, a one C in the fives this last year, brought it down from 11.3 diagnosis, no food restrictions. And I swear my child doesn't even know he has diabetes half of the time. That's from Christine, I could read you hundreds and hundreds more. But instead, I would just like it, if you check out the diabetes pro tip episodes, I've tried to make them easy for you to get to because I realized there's so many episodes in the podcast. So you can go to Juicebox Podcast COMM And at the top, just click on diabetes pro tip. actually gonna make sure I'm telling you the right way Juicebox Podcast calm diabetes pro tip will take you right to it. Or there's a direct link, diabetes, pro tip.com. At diabetes pro tip calm, you'll have access to all of the pro tip episodes. So you can write down the numbers and go find them in your podcast player or just listen to the mirror online doesn't matter. You'll also have access to the defining diabetes series, please just check them out. They're very worth your time. I saw a mention of the podcast and one of the Dexcom groups I follow on Facebook, the pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years, I wish I had been more proactive in finding this information sooner. I'm going to recommend this to my endo. I'd love it if you could be the next person to leave a review like that. And I think you could, if you just check out the pro tip series. I don't know how many episodes there are at this point, maybe 20 could listen to them at your leisure. They're absolutely free. The whole podcast is always free. I don't think it would take you that long. But I do think they'd really be valuable for you. So I hope you check them out. Thank you so much for listening, for sharing the show with others. And for downloading it in your podcast apps that I'm positive you're subscribed in. Please tell me you're subscribing to your podcast apps, please. Thank you. If you don't know what a podcast app is and you want one, go to Juicebox Podcast comm or diabetes pro tip calm there's links to the most popular ones. They're all free. You should not have to pay for a podcast app, Google podcasts, Spotify, Apple podcast, Pandora, Apple Music, Android, just there's it's an endless list of ways you can listen you can basically listen anywhere that you get audio

Hello friends, and welcome to Episode 540 of the Juicebox Podcast. Jenny's here today to do another diabetes variable with me. And today's topic is stress. While you're listening today, 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 for becoming bold with insulin, know this as well. Jenny does this for a living. If you want to check her out. Go to integrated diabetes comm you can hire her. Hey guys, please don't forget to go to T one d exchange.org. forward slash juice box and fill out the survey you'll be helping people with type one diabetes and supporting the show. If you do that, it really does just take a few minutes. It's HIPAA compliant. Absolutely anonymous, you do need to be a US resident who has type one, or is the caregiver of someone with type one. But otherwise, if you haven't done it already, please go fill out the survey just takes a few moments. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Head over to Contour Next one.com Ford slash juicebox. To find out more links to Contour Next One comm forward slash juicebox as well as all the sponsors are right there in the show notes of your podcast player. We're at Juicebox podcast.com. When you support the sponsors, you're supporting the show, so allow me to thank you right now if you've used any of those links, or if you're considering using any of them. Alright, let's get to Jenni. How does stress impact blood sugar's?

Do you want to talk or should I?

Well, I mean, it seems it seems obvious, but it's not because I've spoken to people who get stressed out and their blood sugar's go down. So I'm wondering what you've seen from people on both sides of this.

I've seen more people who have an impact of stress with a rise in blood sugar or an increase in their insulin need. It isn't to say though, and a good friend of mine, her level of stress, just like her level of like adrenaline rush causes her to need less insulin. Okay, like race morning, she is cutting her insulin down while the rest of us are like rage bolusing

blood sugar.

She's like, what do you guys all doing? Like you're sitting at like 82 like going down? down this high. Right? But yeah, I mean stress the same thing. For the most part stress will cause a rise in blood sugar relative to that like mental strain. It's kind of putting I mean, and then you have to determine the type of stress right? Is it a mental stress? Is it something that you're really working through? Is it a lengthy stress like several days worth of something happening? I mean, one stress I can say personally really increased my insulin needs was when my dad passed away, okay. I mean that week with going to family helping my mom out with a week and a funeral and everything in the process. I was using like a 75% temporary increase in my basil. Okay,

well, it was a lot I'm looking here and long term stress can increase depression caused headaches heartburn, insomnia, weakened your immune system. Make your breathing rapid puts you at a risk for a heart attack. It can bring up your blood sugar, your blood pressure, pounding heart fertility problems, stomach aches, low sex drive, erectile dysfunction, miss your periods, tense muscles and high blood sugar. Yes. So when you're under stress, it is not healthy for you know, that's obvious, but it actually can impact your blood sugar. And I don't know if people would consider that or not.

Yeah, and you know, in terms of that effect, you also then have to look at the length of time that the stress is going to happen for and if it's already impacted these other health pieces. If you've ever been under significant like work related stress in the past year, then you may have caused injury really too many other pieces. Have your body which until they get healed is likely causing inflammation and inflammation in and of itself also increases blood sugar increases your insulin D input increases resistance to insulin. So stress is bad.

And well, I guess what I'm thinking is, like we talked in other variable episodes about, like, you know, I said, My daughter gets into the shower and her blood sugar goes down where a lot of people, you know, would say that might be heat, I kind of think that she's relaxing. Sometimes I think of it that way, like, and can you just chill out? And is that possible in our society, the way the way our days are set up, right? Like this is way more about, you know, your general health than it is about maybe blood sugar health, like sure. stressful moments can make your blood sugar rise, you should be aware of that. I've seen notes from people who have car accidents fender benders, right? And boom, you know, their blood sugar goes up, you think, well, that might be adrenaline, but then it stays like that for hours and hours. And if that's

more that fight or flight, that's, that's

okay. But yeah, I mean, I realized that this is somebody telling you be generally healthier, and you'll be generally healthier, which is obvious. But it's, um, stress can cause your liver to release extra sugar into your bloodstream, which over time puts you at risk for type two by diabetes. This is telling me here, meaning that if you're a long term stress, you're hurting yourself long term. Right? Wow. So is I have to say I use a breathing app on my phone. It's really helpful. I mean, just got one on my watch. Yeah, yeah, a couple times a day, it, it pings me, and I spend 60 or 90 seconds doing some sort of in and out breathing. It's kind of nice. I mean, I'm sure it would be better if I moved to Wyoming and lived on a hill and a cabin, I'm sure I'd be less stressed. Although I gotta be honest with you. I'd the entire time I'd be like a bear is about to kill me. I'd be incredibly stressed out by that. But you have to find a way to overall lower your stress. But in the moment, so in the moment when it happens. Do we Bolus weren't

in the moment for stress is kind of like the adrenaline Bolus consideration, right? Do I Bolus for the stress in terms of like the car accident example. And my blood sugar's now shooting through the moon, you could Bolus at least minor amount. Because obviously, the incident as well as the skyrocketing blood sugar is not going to create anything that's more even flow. It's just gonna keep increasing your anxiety.

Let me ask you a question. A personal question before we wrap this one up?

Yeah. Do you?

Are you so in tuned with yourself? That you always know because it's unfair, like you're here, like this front facing image of you is Jenny, who knows about diabetes, but you're a person to like I actually want to do and I want to interview completely about burnout just one day, like, like, away from all this, like the baby stuff. And but if you're stressed out, if your kids are struggling with something, and your husband's being a jerk, and somebody else is doing a thing, like Do you notice that? And how quickly Are you able to say to yourself, my life is more stressful right? Now I need more basil? Like does that in a real world situation? Does it work?

in a real world situation, if you have enough awareness of everything that's happening, it can work to use a temporary increase to basil. I mean, many people I know who are using a pump, you know of whatever kind of pump you're using, have either a basil profile that may be termed stress, or they have a temporary basil kind of setting that's specific to stress increased need. I've got an override that's already programmed for stress. Thankfully, I don't use it very often right now. It has happened. I mean, in terms of like life, things happen, you know, somebody might need some additional help in the family. And beyond that you don't have time to take off of work. So now you're juggling and juggling and sleep, you might get three hours a night instead of your eight hours a night and that can definitely increase you know, but personally, yes, I've, I feel like at this point, I know myself well enough to be able to say my kids spilled the milk all over the table. That's not going to cause my blood sugar to go to 250 I'm just gonna tell him to get a cloth and clean it.

I asked because I've become much more in tune with the idea that people have anxiety since I've been doing the podcast because I am a person I get up in the morning. You know what I'm thinking about nothing. I go do the thing I'm supposed to do, I do it as well as I can, if it works out great. If it doesn't, whatever, you know, and I move on, right? But I see my wife get out of bed. And she, you can like, look her in the face. And she's going through a checklist already. She knows what's happening today. And if what's happening today is something she feels like she can't keep up with. It stresses her out. And I've just talked to too many people at this point, who live in that reality. And I just wonder. I mean, it's, it's too simplifying to say to them lower your stress, because they're like, yeah, da, thanks. I can't, you know, so. I don't know. Just

I know myself, you know, in terms of like, as you asked me, personally, I know myself enough to also say that I'm kind of like your wife in terms of like the morning time. I'm German. I'm a little bit like, like strategy, figure it out, apply it kind of you know, so in the morning, especially on the weekdays, I know my checklist of things, I have to do this, I've got this many people to talk to, I've got to attack emails, I've got a project, I've got a podcast with you. I've got, I've got this checklist of things. And I keep moving through it through the course of the day. But a stress to me, that would increase like my need for insulin overall would be something major happened to like a family member, and it's blowing all those things on my checklist, like they're now off the list. And like this is an immediate and I'm like, okay, must assess and redo and plan differently. And I

only worry about my kids and my wife like that. I don't worry about anybody else. Like when I get in bed at night, I can see Kelly going through that like wind down thing she does. Like I feel terrible. Because all I'm really concerned about what is like are the blankets where I wanted to be and do I have my pillow flip the right way and is my phone on its charger. And once it is on like goodbye. And then I'm just asleep. where she's, you know, trying to decompress and trying not to think about tomorrow. And I feel terrible for anyone who's caught in that because it really is, it really seems like a place he can't get out of

you. In terms of like overall stress that's I use that that breathing app like you talked about, I use that because especially in the evening time I really tried to stay away from like, technology itself, right within about 30 minutes of actually like getting in bed and trying to like fall asleep. Because that I found is a big impact for me. I have like one of those mindful adult coloring books.

adult coloring book, it's just kids,

let me clarify for Jenny. They're there. Because my wife actually has these two. They're very intricate, pretty pictures, not naked people having sex. I got your

intricate pretty flowers and deer and fish. And yes, there was funny to watch you catch yourself. Anyway, but things like that to kind of do that decompress. And while my brain has an idea of what's coming in the next day, I'm really not too like focused on it until the next day, because I've found that I don't sleep.

Here's an interesting question. And I will let this go after that. But say I'm pre diabetic, right? I'm like, type two diabetes is coming for me. And I'm also an incredibly anxious, stressful person. Is there a world where and I'm not pushing medication. But if a doctor prescribed like, like an SSRI or something like that, to take care of the anxiety that as the anxiety went away, and the stress went away, the blood sugar impact would go away as well, to some degree, I mean, could you get some win out of that?

You could get some win out of that. I mean, we always try to encourage people in terms of like lifestyle change to actually make a lifestyle change rather than a medication addition. But yes, in all, whatever type of stress reduction you put into play, could have enough impact that that person on the path that they're on whatever stress management strategy they're putting into place could make them turn the road down the path that's going to prevent that now they're going to have to continue whether it's now I start taking a mile walk every morning, because it decompresses me, I think through what's coming for the day, and I'm ready, maybe they choose to start eating broccoli now rather than a handful of potato chips at lunchtime. So there might be other little things that they could do along the way that impact the stress that's on their body helps them to feel better or decreases the chance of type two or any other health condition itself, which in and of itself is a decrease for anxiety as well. Right? If you know you're doing something good to prevent something,

even if it bolsters you, I have to say it would be criminal Not to mention in a even in a short conversation about stress, that activity, you know, of any kind is, is really good for your mental health, it just really is. So, okay, well, thank you very much. Friends, if you're enjoying the variable series, I'm going to list all of the available variable episodes in just a moment. But first, I need to tell you actually, I want to tell you about the Contour Next One, blood glucose meter, you know, bare bones, simple cell, it's really, really accurate. And that's incredibly important, especially in a world where sometimes we just get the meter that someone gives us, you can actually make a choice, you can choose an accurate, reliable meter. And the Contour Next One, in my opinion is exactly that. Not only is it easy to carry, easy to read, easy to see at night, but it has Second Chance test strips. So you can go in for some blood, get some but not enough and head back for the rest without impacting the accuracy. We're ruining the test trip. I don't know what else you want in a blood glucose meter. I mean, if you want it to be Bluetooth enabled so that you can launch an app on your phone and see your records. It does that. And it works fine if you don't want to use the app. So there's a lot of flexibility in there for you lets you choose. I mean, really, it's just a great meter. So why don't you check it out, it's super simple to look into Contour Next one.com, forward slash juicebox. He may be eligible for a free meter, there's a test trip savings program that you might find eligibility in. And it's possible that all of this could cost you less in cash than you're paying right now for your current meter through your insurance, I think I'm not sure. But it could work out that way. And if not let your insurance pay for Contour Next one.com forward slash juicebox. If you have to have a blood glucose meter, you might as well get a good one. First, I want to thank Jenny for lending her expertise to the shell. Don't forget, you can find her an integrated diabetes calm. I want to thank you for listening. And I'd like to remind you that there are others in this variable series. trampolines, temperature travel, exercise, hydration, food quality, leaky sites, or tunneling video games and today's stress. There's one coming every week, this variables list is compiled by listeners just like you, we did it over on the Juicebox Podcast Type One Diabetes private Facebook page, if you're not a member, you should go check it out. We do stuff like this all the time over there. Listeners just like you made a list that is so long that there'll be variables episodes coming for ever I feel like but for now, just once a week, I'm gonna let you go in just a second. But if you're not part of that Facebook group, I wish you are. It's private. And it's full of people just like you. It's a matter of fact, I think this month, September 2021, I'll be celebrating 4 million downloads of the Juicebox Podcast. And I think I'm gonna do it with a like a q&a, I'll probably just jump on Facebook Live, or do it through zoom or something like that. And if you want to know about that, I'll be announcing it there. So I hope you'll become a member. There's you know, it's absolutely free, obviously. I mean, I hope that's obvious Juicebox Podcast, Type One Diabetes to private group, you'll have to answer a couple of questions to prove to the algorithm that you're a human being. And then after that you'll be in and talking to other listeners, just like you. Hey, thanks so much for listening, and for supporting the show. I really appreciate it. I'll be back soon with another episode of the Juicebox Podcast. Please continue to share. Subscribe in a podcast app, tell a friend. Leave great reviews wherever you listen, that kind of stuff is all very supportive and super, I mean helped it. Take the T one D exchange survey. Support the sponsors. All right, that was choppy at the end, but you get the point. I appreciate you. Thank you so much for supporting the show. I'll be back soon.

Hello friends, and welcome to Episode 544 of the Juicebox Podcast. Hey everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE, a nutritionist, she says a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life, that very well may impact blood sugars. The variable that we'll be talking about today is masturbation. I know you probably saw that in your podcast player, but I'll just give you a second to let it sink in. Right. So you know, that's what we're going to talk about. And it's gonna be serious and it's gonna be silly. So try to expect both serious and silly here. 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. I looked up some euphemisms for masturbating, because I thought I would put a couple in here, but if I'm being honest, a number of them are disturbing, so we're just gonna skip it. Instead, I'd like you to say your favorite euphemism out loud right now, no matter where you are. This show is sponsored today by the glucagon that my daughter carries, Gvoke HypoPen. Find out more at Gvokeglucagon.com/juicebox. Okay, all right. I'm just I'm just gonna ask you before we start, are you Oh, are you up for something here?

Sure. It's not like technically research, like, Oh my gosh, I have to delve into like studies for this question

the exact opposite of that. Okay, you're ready? I feel so weird. I'm not gonna look directly at you, Jenny. Okay, I want to talk about a variable today that I'm hoping I mean, honestly, if you can't help me with this is going to be such a sad conversation but orgasm. Oh, interesting. Good question. It's a honestly, do you want to know where I got it

from? From your questions online besides

the list? The The reason I moved it up on my list was, there was a massive conversation in the private Facebook group amongst parents. I just it's so weird to say, who all had an aha moment at the same time. And a lot of their statements sounded like this. Oh, I just thought that at a certain time of night, my kids blood sugar went up, or I thought a shower made my kid's blood sugar go up, or I thought and I was like, Oh my god, I never thought of this. So

that's in the population in which that will occur. Yes, because I've got little kids who are like five and their bath makes their blood sugar go up, I guarantee it's

gonna be a different thing. So the the, so the conversation started very boy centric, like people are very much like, Oh, this is why my son showers make his blood sugar up. This is why when my son's like, door is locked, his blood sugar goes up like this stuff, right? But then very lovely. adult women who have type one in the group jumped in and said, I gotta be honest with you. My blood sugar goes up to when I'm doing that. And I was like, Okay, now some people said it doesn't. And some people says it does. But I want to, I guess I'm separating orgasm, during intercourse from orgasm while you're by yourself, because I guess it's probably if you're doing it right. It's probably more vigorous when you're doing it with somebody else. Right. So then there's other things to think about, like I

would guess so. Yeah, two children stop.

Oh, yeah. Yes, I would guess so. I mean, experience wise. And actually, because I get into those conversations with my female clients. I don't think it's honestly ever been something that I've worked with, that a gentleman has brought up to me, but the women that I work with, especially like in preconception time, and all of that kind of stuff. It's it's a topic that that's brought up. I've actually found I think, it seems to be about like a 5050. And in women, so to speak, not the teens but women who seem to have more of a drop in their blood sugar. After but, you know, I'd have To have data with markers so when and whatever to actually see was there actually arise before like the drop off almost like you drop in blood sugar after exercise, but not maybe during it. So that could be but I would expect in the teen population, I'd expect if I, if there's a little bit of maybe like, maybe there's like a behind the scenes like anxiety, especially for teens who live with their parents and are in their shower or lacking their bedroom door. And there are other people in the house, right? So they're kind of at a point of like,

So are you saying that while in my

mind, maybe a little anxious doing this because they might be discovered maybe I don't know. I thought

I enjoy thinking mister with you. This is fun. So the plotting, you're saying could bring your like an anxiety or something? While I'm walking around the house, making sure I got door locks tissue. Whenever I need, I might be getting like, like, Hey, I'm about to do this thing. Maybe somewhat. Maybe it's exciting. Maybe I'm excited. I'm about to do it. Maybe I'm worried somebody is going to catch me. Right? Okay,

I would I would put it kind of in the class of like, practice running, usually will keep your blood sugar steady or drop it right. You get to your a race and the adrenaline of the race day performance expectations and everything. Many of the athletes I work with on their race or their you know, team kind of competition, they their blood sugar's go up, I see what you're saying. Maybe it's I mean, again, studies would have to be done to the

point. I guess we can just talk these are all thought yeah. So

that's a great question. That's a great question. Really, it is,

listen, it is something that I would guess impacts most people. I might be giving something away here. But I would say many days of the week. Yeah. frequently with enough frequency that it should be talked about. There's no way anyone's going to talk about you said earlier. This has never come up with any gentlemen, I'm going to tell you Jenny, a guy who brings up the Bleep this up. But a guy who gets on with you to talk about diabetes and starts talking about their health habits probably not going to come across like gentlemen. This is true. That's why they're not asking. They're probably just figuring out on their own. That's why the podcasts here so we can talk about stuff like this. This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash Juicebox.

Podcast Funny thing is about it that from a parent's standpoint, it's not something I've heard in terms of a question from parents either. Yeah. And the topic of alcohol comes up very frequently for my teen population. I mean, I've had questions as young as kids who are like 13 and 14, parents questioning, you know, well, we don't encourage this. And we've been, you know, we've discouraged until this certain age or whatever. It is a point that I want you to bring up to reference the dangers of it. But this other topic,

people don't want to think about it. I'm here, don't bring up by going through the the Facebook, the thread, it was forever long. And most people found it incredibly valuable. Because you realize that especially for a mom, I think, like I would imagine it dad's just like I get that happening. And I don't say anything, but moms are probably like they look at their sons. And they don't think of them that way when they're young. And then you hit that moment where you're going to figure this part out. That's not nearly the first thing that's going to pop into your head when you're like, I wonder why his blood sugar is going up. Because you're going to be thinking like, oh, maybe this is happening. Maybe it's a Grossberg maybe it's this, maybe it's that

or maybe he's sitting and eating the bag of Pringles in his bedroom and forgot to Bolus or whatever you're thinking other things.

But more more accurately what happened is somebody they found attractive, he probably scrolled by on Instagram. And now there you go, now we're gonna see what we can do. So is there a physical like suit? But to start over again, you're saying women, when they're by themselves as often as not finish? And then their blood sugar's drop? Or what do you see there?

Yeah, I mean, I would say again, in the women that I'm working with, mostly that the topic comes up, it's like in the preconception stage, right? Where they're actually trying to have a child and have to do things in order to have the child we you know, into terms of that many are very willing and want to actually make notes about things that they can figure out what to do. And so most often, I would say, like I said before about 50, at least 50% of women find that it's more the after is a drop in blood sugar. Versus the during. Okay, so. And I would expect maybe it has to do with movement and length of time together and all of the other things that could propel more of a drop in blood sugar, or it could be, you know, like the end of a run. Many people have a lower blood sugar in the aftermath of a run for hours because of the lasting effect of those like, feel good hormones and the exercise, so

Okay, but if we're, if we're talking about Have you had any experience with like, women talking about masturbating, or no smoking, mostly, yeah. So no, nobody's ever come to you and said, like me when I flick my been like stuff, nothing like that. By the way, what's your favorite? What's your favorite? Well, I'm gonna bleep this out. So no one ever tell me your favorite euphemism for masturbating that a woman can use?

Oh, my God, I don't even know. I know. There was I guess I never think about that. I mean, in terms of like, what you would call it? I don't? Yeah,

I don't know. Fine. All right. I just thought totally funny. Alright, so. Alright, so

I think it's a great question, though. Especially considering all of the like, tuning commentary that was kind of being discussed online about it.

Yeah, it was super interesting how interested people are I also listen, as I think through what I know about masturbation, and what I know about diabetes, I would say for an older person who doesn't feel a guy who doesn't feel like oh, someone's going to catch me doesn't have any of that build up stuff. I would say that, you know, you'd be surprised how it pops into men's heads, like, in the course of a day, you know, like the way you might the way you might think like, I'm gonna get a glass of water now, like a guy might be like, Oh, you know, I'm gonna do and so that might be very blunt, say leading into it. And then so I'm a guessing there's vigor and excitement. dooring.

And then it could be like an adrenaline rush could

be a bit of an adrenaline rush, although sometimes it's medical journey. You know what I'm saying? Sure. No, you don't even know you're such an awesome person. I such a white person, you're such a nice person. Like, here's my sometimes it just needs to be accomplished. Okay. It's like a chore and not not a fun thing. But I would think that to

get it done, it's like mowing the lawn, check it off.

See, there's your euphemism. It's, it's next time your husband like disappears for 15 minutes, and he comes back go, Hey, were you mowing the lawn? Never know what you were talking about. And, and so I would, I would guess, too, for a lot of women it might feel more intimate than then for guys who might see it more as utilitarian sometimes. I guess. Yeah. So there's a lot to be considered here. But if you're the parent of a adolescent child, and you can't figure out why every time the door's locked, there's a blood sugar change. I mean, I don't know where to go from there with that I never had to have that conversation with my kids so far. Although in the course of the conversation online, an adult woman talked about her mother could see her orgasms on this CGM and knew it over like, because her mother was like, inspect your clue. So so the girl would go out sometimes on a date she see this thing happen, the girl comes home. And then no mom started putting two and two together and then the girl grows up and becomes an adult and the moms and now though girl's mom knows when she's having sex by your CGM data.

I feel like my you got to get rid of Yeah, that would be time to go then. You can't follow me anymore. I'm

so sorry. But anyway, that's a variable. It's really interesting. I guarantee you no one else is going to bring up on their diabetes blogger podcast except for me.

No. So that might be more of an after dark.

I think I can do it. After Dark berry diabetes variable after dark, and then I'm just gonna call it I don't even know what I would call it. I'll use my I can't use my favorite euphemism. But anyway, I will share something personal with you or not about me about a euphemism that I think is funny. All right. We're done with this. Now it's over. A huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pen at G Vogue glucagon.com forward slash juice box. you spell that g VOKEGL Uc ag o n.com forward slash juicebox. And if you enjoy Jenny she actually does this for a living so you can find her at integrated diabetes comm Let me help you with your diabetes needs. Before I go, I'll remind you that the diabetes pro tip series begins at Episode 210 and goes on for quite some time. Episode 211 is called all about MDI while 212 is all about insulin to 17 Pre-Bolus to 18 Temp Basal to 19 insulin pumping to 24 mastering a CGM to 25 bump and nudge to 26 the perfect Bolus 220 excuse me 231 variables, that's a pro tip that just talks about variables. And then this is a episode about a specific value anyway. Let's not get confused, you're probably writing 237 diabetes pro tip setting Basal insulin 256 exercise 263 fat and protein 287 illness injury and surgery 301 glucagon and low VGS 307 emergency room protocols 311 long term health 350 bump a nudge Part Two 364 pregnancy 371 explaining type one glycemic index and glycemic load 449 postpartum 470 weight loss they are available right here in your podcast player at Juicebox Podcast calm and at diabetes pro tip comm check them out. Please, please, please. Thank you so much for listening. I'll be back soon with another episode of the Juicebox Podcast.

Hello friends, and welcome to Episode 548 of the Juicebox Podcast. Hey everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE, a nutritionist, she says a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that we'll be talking about is school. 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 are becoming bold with insulin. On the front page of Juicebox Podcast comm a lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes, and today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling. You'll find it after this brief advertisement. We'll get started. This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash juicebox. Can we do school as a variable? Because not only is it that time of year right now. But a lot of children are going back to school for the first time after COVID right now. And the internet is full of new parents who are astonished that their children's blood sugar's don't look the same when they go to school as they do when they're at home. Yes. So I can start by saying that for Arden even though she's a fairly chill person, the first couple of days going back to school in person every year forget COVID are not Arden's insulin needs go up. There's some sort of either underlying adrenaline anxiety, maybe, I don't know, maybe she's, I don't know, I don't know what it is the hydrated, like maybe she's rushing, I couldn't even begin to tell you, I can just tell you that for the first few days. I find myself fighting to use more insulin, and then suddenly, it's just okay. And I don't know, when

does it even out to her typical normal nun school needs then or do other things change?

know, if you're coming back from the summer vacation, then? Well, it can go to it can go two different ways like so if she's sedentary during summer vacation, she might need a little more insulin to begin with. But if she's going back to this, like now she's walking more, right? Like there's so much to change is first of all, you're up earlier. So you run into more feet on the floor, like the life thing, which you may have been controlling with basil while they were sleeping in during the summer. Right? Like there's there's that. But I always just at at its face. To me, it seemed like anxiety, adrenalin, stress, excitement, and then it kind of goes away. But in fairness, Arden's bales are typically a little stronger during the school year than they are. Otherwise, yeah. So but I'm, I'm assuming that everybody's could be different, like, you know, you might be maybe somebody's suddenly going to be more active because schools there are suddenly getting exercise on days where they didn't have or, or I guess, if you're super active at home, maybe you end up getting less exercise because you're going to school.

Right? That's true and or more, you know, especially I see this as a difference. Kids have gone through high school, understanding kind of what their insulin needs do with school days and that kind of thing. And then they go off to college, in which they may have a huge campus that they're now walking across from class to class or back and forth, which brings in a very different structure than to their insulin needs, comparative to the last four years in a very, very structured day to day schedule, not walking all over the place, etc. I find that when kids go back to school, more often than not, I see issues with it's funny like the foot on the floor, I call it the foot in the school. I guess soon as they are either like On their way to school for some kids, or as soon as they put set foot on the school property, and they're heading in, up goes the blood sugar. Yeah. 900 less common for the drop. It's more common for a rise.

I when the world was normal, I would drive Arden to school every day. And as we would pull out of the house, I'd make us I'd ever make a small Bolus. Yeah, it was for nothing other than I could see your blood sugar one day of 20 or 30 points as we were approaching the school and she was getting in there. But it's, it's um, it's just kind of fascinating to think about all the different implications that could happen, just changing. You know, your physical spot. This is my life here at home. This is my life at school. And it changes but I'm talking about like, for the moment, I'm talking about that first couple of days, like you can call it whatever you want, you know, I would assume, listen to me, I don't know about you. The day before school started every year, I cried. Like I would like I was like, I don't want to do this. I don't want to go there. I want to go back to school. Oh my god, no, I hated school. Like with a burning passion. I hated going to school. And a lot of your kids might feel that way and not be telling you, you don't mean like I just I could not have

that's totally not my kids. My boys already have their backpacks already for the first day. And they're very, very excited.

thing made me nauseous. Kids are buying stuff. They're excited. I got new pens, not me. I looked I was like, Oh, this now I gotta go over there. Listen to these people. Well, I hate this. Like I just I there was nothing about school that I found attractive, except for the social stuff. Sure, I just I mean, I'll talk to anybody. So like, I'm good with that, like super smart people, girls were cuter. You know, like Rick, you don't need like the nowadays like I'm I'm think you're allowed to look at each other anymore. But in the 80s, we were pretty touchy feely, like going both ways. Like everyone was exploring, you know what I mean? And so there were a lot of friendly boys and a lot of friendly girls. And nobody said anything about it. And it was that part of it was fun. But the rest of it was

more anxiety inducing just the class component and all that kind of stuff.

I wish I could put myself back in my own head to tell you if I was anxious or not, I just didn't like it. Like, I don't know that if I was I don't think I don't know, if I was anxious like this several times. Like I felt like, I don't do well with this. And maybe Sure, maybe we would call that anxiety today. But I just I think

that brings in another one in terms of school is the impact of one class versus another. And how the child sort of feels about that class or that type. or that type of learning, right? You know, the people who really love their math or really love their science or really don't, they'd rather be in English class or writing or doing more, you know, self kind of guided stuff then. So those are pieces. I was when I talking when I'm talking to parents, I talked a lot about knowing what your child's schedule is going to look like right? Where is there going to be PE Where is there going to be recess? Where are the classes that you know as a parent know that they kind of struggle in again math, English, writing whatever it is. Because those may be the times that you have to do something to offset what you see is happening.

Yeah, I'm excited you brought that up because during COVID I learned de veau hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com forward slash juicebox g Vogue shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. I learned that during biology Arden's blood sugar went up she hated that teacher. She really dislike teacher, like on a visceral level did not like being with her. And because of that, I would I would see that the climb and it was it was that real steady, slow like 8595 103 110 120 and it was just go and go and go and go and like what is happening right now. It took me a while to figure out that she just did not enjoy that hour and a half. Like you know, yeah, she and she was I irritated the minute she thought about it, and then I think aggravated the entire time when she was there. Sure, she might have had like a low level of like, anger or I don't know, like, but some emotion that's pushing her up. You know, to me, that's what this variable is about. Like it's it's more about the impacts of school like I don't want to talk about, you know how things change when you have to go to the nurse's office and your Pre-Bolus your Pre-Bolus Singh is different, like I don't know, that fits here. That's not a variable. That's, that's just, you know, circumstance, I will drop in here for anybody listening, that episode number four of this podcast is called texting diabetes. And it is me telling you how I got our out of the nurse's office. So Arden is a senior this year, and has not been to the nurse for something diabetes related since her last day of second grade. And I accomplished all that with just texting. So I just managed her remotely, even when she was little. And you know, there

and you have had a benefit of being a dad who has the time to follow as close as you do.

Yeah, yeah. I mean, it's not like in the middle of a business meeting. I'm like, hold on everyone. My daughter's 120 diagnol. Up, we have to manage this right now. I, I had the I tell people all the time. Like, if you enjoy the podcast, part of the, you know, part of the thanks goes to Kelly, because I've been a stay at home dad, and I've been able to focus on this stuff for so long. But yeah, I mean, but there are a number of people who have the opportunity. And if you do, it's, I'll tell you to you don't have to go to the nurse's office, suddenly, you can Bolus on better schedules, you can fix Lowe's more quickly, with less, less of an impact and causing, you know, maybe avoid causing a high later, there's a lot about managing at school, that is difficult because of the time gaps. The I have to realize this is happening, then I have to ask somebody, if I can leave, then I gotta walk down to the nurse's office, then I have to wait in line till the nurse can get to me. And by the time all that happens, your your you know, wherever your alarm is, you're 30 points higher, or maybe 20 points lower, you know.

And the thing you learned early on, though, given that it was you know, second third grade that she no longer had to go to the nurse was you learned early on to navigate that like school health treatment plan, right? To be able to say, this is what we will be doing. This is how we will be navigating her blood sugar management at school. And unfortunately, a lot of people don't, they don't have that type of very specific plan. Or sometimes the school systems just they don't support it

really resistant, and they're tough to get past some of them can be really difficult to get past I'm a little more forceful. And Arden's 504 plan is like rock solid. We have good doctors who will write things in like I've had a sentence and I Arden's 504 plan forever that just says, parents make the last decision. Like I don't care what this this document says if the parent says do something differently, that's what you're doing. That was very helpful. Having ardan cell phone designated as a medical device was very helpful. There's there's a number of different things that you can do.

Those are all really helpful little I just that sentence that you have in your 504 because there are a lot of parents who are frustrated in terms of management, because their 504 says things like only only able to treat and or adjust, you know, for blood sugar changes. If blood sugar is here, and or like the whole iob thing. If there's no iob then you can take care of this 300 level blood sugar. Well, you know, to get past that parents will make the final decision period like bold highlight and yellow.

Yeah, then then what we're doing is we're satisfying the legal requirements of the document, but putting ourselves in a common sense, ability to make decisions, right? Because in the end, those those ranges are set up, so no one gets in trouble. And, and, you know, some school nurses are like, Look, I don't want to get in trouble. The paper says this, I'm doing this. And they might even know it's the wrong thing. But they're not going to go against the document. So suddenly you put yourself in control. And that's it. Yeah, schools different. Maybe one day I'll have to do a 504 episode. I bet that would go over very well. I don't know. I remember writing that thing. Initially. And it's morphed since then and grown and changed, but I don't know. I remember the day I did it the first time I was still like I don't want to tell like going to school is like I don't want to do yes and no and there was no help back then either. You would just go online and look for like the ADA had this forever document you're like this. This is too much, you know, so I read it and I highlighted things that I thought might be important. And then every year we'd given take a little in horse trade and get rid of some stuff, add some stuff and that was it, but Okay, well, I really appreciate you doing this. Thank you.

Yeah, absolutely. Awesome. Hope you have a very nice weekend. You too. Thanks.

This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juice box. My friend Jennifer Smith has been living with Type One Diabetes since she was a child she was diagnosed over 30 years ago. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She also works at integrated diabetes Comm. Guys, I really appreciate you listening to the show. If you are a US resident who has type one diabetes or a US resident, who is the caregiver of a child with Type One Diabetes, please consider going to T one d exchange.org. forward slash juicebox and completing their survey. When you do, you'll be adding important information, important information to the lives of people with type one diabetes and you'll be supporting the podcast. It's literally easy to do. There are no big questions nothing will be asked that you don't know the answer to it's completely HIPAA compliant. 100% anonymous and takes less than 10 minutes you can do it right there on your phone. Your tablet, your computer really is easy. I hope you try it. T one d exchange.org forward slash juicebox. Thanks so much for listening. I'll be back soon with another episode of the Juicebox Podcast.

Hello friends, and welcome to Episode 452 of the Juicebox Podcast. Hey everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE, a nutritionist, she says a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that Jenny and I will be talking about is bad sites. 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 are becoming bold with insulin. On the front page of Juicebox Podcast comm a lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes. Today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling, you'll find it. I'll get started right after this brief message from our sponsor. This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash juice box. Alright, Jenny, so I have four of them set aside to try for today. One of them. I can't wait to see how you respond. But the other ones are our I want to start with a couple that are shorter I think and and then see see what we're going to get to so Okay, this one I think is going to be a really short variable. But I want to talk about bad sites. So just you're using an insulin pump. And the site stops being as effective as you expect, or as you've I guess, experienced already with the site. But people have the hardest time baling changing, it's like, yeah, it's that they the hope that sticks with them is sometimes fascinating. I can't tell if it's the if it's this thing supposed to last this long, dammit. Like I'm not given up or I mean, I even get if it's money. But right. You know, like if you're saying, I don't want to take this thing off. But if you have insurance. So I guess the first thing to say to people is if you have insurance, and you experience bad sites, your provider can write you a prescription for more stuff, if that becomes necessary

to change more frequently, not at all. No. In fact, with all the pumps, I think there are people who definitely find I get today to I can maybe make it today, two and a half. If it looks like it's really, really still working well. But I don't push it anymore to day three. So yes, I mean, if you're one of those people then just don't push it. Know what you know, and ask your doctor to write for changes every 48 hours instead of every 72.

Yeah, it's so an example is you know what the funniest thing about diabetes is whenever I go to talk about I always have a fresh example because that's never stops. But Arne and I are going to go shopping this afternoon together, we're going to find little baskets to put on her shelves that she put up. She put up shelves and she wants to put baskets on the shelves. I've been a stay at home dad for a long time. So that seems like a reasonable way for me to spend my afternoon to me,

but for bunny eggs or something or what is she putting?

I don't know what she's putting out there. Hopefully she's not hiding, you know, paraphernalia which I don't believe she is. But not the point. The point is that I woke up this morning to find that Arden's blood sugar had been fairly sticky at like 140 overnight. And I thought, Oh, we must have missed on the last thing that she ate and you know, the basil is holding her nice and steady. I'll Bolus this I Bolus it and it doesn't move. And as soon as that happened, I thought this site is shot. Like it just it hits me like immediately. Now do I yank the pump off or right away? No, I turned to all of our settings up a little bit and made all of her insulin stronger. And it worked. And then when the settings reverted back, it drifted back up again. So in my mind, she's not getting insulin correctly anymore, because I'm not getting what I expect. Right? And so I told her just before you and I did this, I said Listen, do one more Bolus because that's going to bridge this time. I'm going to be talking to Jenny and then I said and then we're going to pull your pump before we go before we go. Cuz, I mean to get eight more hours out of this thing. I mean, I guess we could just jack it up, it's probably leaking, right or something get or what? So what are all the things that could go wrong with a site?

Yeah, it's like a rabbit hole of information about site, right? It really is. So what could it be, it could be that the site is in a place that just got bumped or nudged or something. And so now, it's not really working as well under the site, maybe you develop like a little tiny, like, I don't know, like a clap, let's say it, but it's not absorbing quite as well. Thus, when you bump everything up, and now you're jacking in a little bit more insulin, it's kind of pushing out enough to overcome whatever the reason for the resistance is at the site, it just could be that this area, especially if you've documented enough to know the, you know, the right hip and the left hip don't absorb as well after day two, so let's just change it when it's in those locations sooner than later. So it could be the site, right? You know, variables of site, it could be infection at the site, especially in infections, I usually, usually you know that you have something starting, even if it's a mild infection, I'm not talking something major, but usually the site hurts. It's sore. You might even notice a little bit of bruising, like outside the canula kind of area, but definitely it's sore in sites should not be sore. I mean, they should be with the little flexible canula under the skin, and or even the ones who use the steel infusion sets. It shouldn't hurt.

Okay. So if I'm going to make an admission here are not an admission and admission. I'm going to admit something. omission is when you leave something out. Yeah, admit

Okay, when you you have to admit something. What are you going to admit,

I Arden's had diabetes since she was two. And I hear people say my pumps occluded all the time, I've never figured out what they mean when they say I mean, I understand the word. But mean physically, like the word makes me feel like somebody stuck bubblegum in your tubing, you know, like, but that's obviously not it. So, when people say, I got an occlusion, what are they talking about?

Well, a true occlusion is different than a site, that's technically gone bad, okay. In a site that is occluded, occluded, means like, you know, like the tubing is straight underneath the skin. And typically, tubing will be bent visually, to some degree when you remove it. And most pumps I know, at least Omni pads. If you have an occlusion and your pad errors, it will tell you that it's either a pod error, or it will tell you that a pod occlusion is detected. And to change the pod at that point. So and all of the pumps will register an occlusion based on a certain amount of insulin that gets backed up into the pump. And it triggers the alarm to say this insulin hasn't gone in up to this certain amount. And each pump has kind of a designated amount that triggers that occlusion alarm. So an occlusion is definitely different than a sight problem. Now an occlusion could be it could be something that starts to make the site not feel good to because obviously, if you've got like a bent canula under the site, that might be more irritating than something that's just supposed to be sitting straight, right? Most often though, what I've found is that an occlusion will happen soon after a site change.

Okay? But a bad not always

but a bad site could be two, three days in, etc. But an occlusion usually is sooner than later in the life of a site, mainly because it usually happens on the sight being put under the skin. Okay? Something has triggered it to bend, etc. could it happen while you're wearing it? Yes, it could, if

we're likely from the injury,

more likely from the actual puncture under the skin,

I should knock on some wood but in 13 years or more of using Omnipod arms had one bent candle ever. And I've never seen the occlusion thing. I actually think it's kind of cool that on the pod. If Omnipod thinks you're not getting insulin correctly, the thing just errors and shuts off. Yes. Like it's just like, Look, this is bad for you. I'm going to force you to put on a new insulin pump now. Yeah,

I've always thought to it has more checks and balances to alerting sooner than later that something isn't right internally. Then the other pump So

I also don't see them as much since they took the manufacturing in house. Oh, you know, interesting. Yes. Since they moved from China to I just did an interview with them not too long ago. But since they moved that they have a, if you've never seen it, it's astounding, like the man in mass in Boston. Yeah. So maybe that's it, too. Okay, so so here's the bigger question, I guess and how to wrap this up. You learn what a bad site and bad sites just a colloquial phrase, it's not a technical term, it's a phrase that stops working the way you want it to, excuse me a site that stops working the way you want it to work, you start to notice them, after experiences, like and then kind of like figure out when you can be like, This is bad. I'm jumping on this. So there's no real. I don't think there's any way in this conversation to say just look for this, this and this other than to say, if the site's not acting like you expect, if it's towards the end of the site, life, maybe switching now's a good idea. Do you have anything to add to that? Or is that kind of it?

It's kind of true. I mean, if you have enough hindsight from your life with diabetes, right, from experiences, you can say, Well, my lunch usually does this my breakfast usually does this, my run in the afternoon usually does this kind of thing. And if it's not, and considering other variables that could be impacting towards a higher blood sugar. If none of those are really in the picture. I usually our recommendations, take take a correction. Like you kind of did you drove a correction in and you're like, Huh, I didn't do anything. Don't, don't play, just change it out. Just change it out, get some insulin going again, who knows what the reason was when you could play with thinking about what the reason is forever. Just change it out deal with the high blood sugar and move on.

Okay. All right. So cool. Thank you. I know that the short episodes I'm gonna have a little more for you right after this. g vo hypo pen has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Volk glucagon.com forward slash juicebox. g voke shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. So the diabetes variable series is coming along pretty well. So far. There's trampolines, temperature, travel, exercise, hydration, food quality, tunneling, video games, stress masturbation school and today's episode bad sites. I think it's working out well putting them out on Fridays. So expect that to keep happening. And that's pretty much it, I guess, on the variables front. Now, if you're new to the podcast, don't miss out on other series like the diabetes pro tip episodes, defining diabetes, after dark algorithm pumping how we eat, there are so many to choose from. I'd also like to let you know about the private Facebook group that's dedicated to this podcast. It's called Juicebox Podcast type one diabetes, it is a private group, as I just mentioned, meaning you're going to have to answer a couple of questions to prove you're a real person to get in. But once you're in there, you're going to be with at least I mean, at this point, it'll probably be 16,000 by the time you hear this, but at least 15,000 people just like you talking about type one diabetes, it really is a kind and valuable space. So don't go there expecting like, Oh, it's Facebook, I'm gonna fight with people. It's not like that. It's actually pretty great. There's a link in the show notes if you need it. Anyway, if you don't want to, I mean, you know, cool, but I just want to let you know it was there. I hope you're very much enjoying the podcast. I hope you're just enjoying the podcast actually very much seems excessive. If you are, please share it with someone else who you think might also enjoy it. And if you're a practitioner, and you're listening Hi. And if you're a practitioner and you're listening, and you're suggesting this podcast other people hi and thank you really appreciate it. Alright guys, I'll be back really soon. plenty more to come. We're going to finish the year up super strong with a ton of great episodes. By now, the podcast has crested easily 4 million downloads. There were more downloads in 2020 One by August. Then there were in all of 2020 and 2021 might reach a real milestone at the end. So keep your eyes out for that. We'll do a little celebration when it happens at the end of the year.

Hello friends and welcome to Episode 556 of the Juicebox Podcast. Something kind of weird happened, and I'm going to share it with you. So this is a diabetes variables episode. It's about growth spurts. But it may or may not surprise you to know that Jenny and I record a number of variables in a sitting. So I have a little list. I say, hey, Jenny, next up, I'd like to talk about growth spurts, then we talk about it, we don't pre plan we just have a free flowing conversation. Now to prove that, I'm going to share something a little embarrassing with you, Jenny, and I only record about once a month. There's pretty big gaps of time in between when we see each other normally. So we did growth spurts, and I forgot to cross it off my list. So they ended up on my list again for the following month. Neither of us remembered that. And we ended up doing and we ended up doing this variable twice. And I'm going to leave both versions in here for you. So you can see the differences right in between the conversations and they did go differently. It's very, very interesting. I mean for me, and I hope for you as well. This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juice box. Let's not forget to Jenny is just a person who comes on the show, but she has a real job she works at integrated diabetes comm if you want Jenny can help you with your diabetes. That's not an ad. It's just me saying I love Jenny and I want to help her. Okay, get ready, you're going to hear the same variable twice. Alright, I record I hit record. Hey, Jenny, I want to talk about a variable today. growth spurts. And I think that I think that probably is going to lead into hormones too. And puberty. So I feel like they may go together. Am I right about that? Or no?

You say because they all have to do with growth hormone and changes in the body? And yes,

okay. So the reason it comes up as a variable in my mind, and this is from me, being able to watch people interact online, is that, you know, children get diabetes at all ages, obviously. But the younger ones, eventually their parents kind of get into a rhythm and things are just like, working right? And then all of a sudden they see on their graph at a certain time of the night. This just never ending upward trend of blood sugars. And, and that's why I think it merits its own variables episode. Yeah, absolutely. Because it comes out of nowhere and they don't know what to make of it. Is there an age? There's not right, like it could happen to you. I mean, I'm sure there's an age range, but when to like let's start with boys, when the boys start hitting puberty.

Honestly, I mean, the range I would honestly say is probably somewhere between 10 on the very early age range, 12 ish, 13 ish most likely, all the way through potentially like that 18 to 20 because boys can grow longer, give or take boys can grow for a longer period of time than girls. Girls typically grow visibly like in height especially girls typically grow up until about the age of 1617 ish. Boys grow a little bit longer than that. So I would say anywhere between 10 to 20 as a very wide range and probably more like 12 to 18 out of on a shorter range

for boys the Google magic here tells me that people don't know either because they're people Google you know can a 12 year old can an 11 year old can a 10 year old boy hit puberty and so I thought well why don't I just like go over some signs of puberty. That way you don't have to worry about the age so much but then what came up is hilarious so laughing instead of first signs of puberty and boys. This is a great this is such a strange sentence the first sign of puberty in boys is usually that their testicles get bigger and the scrotum begins to thin and red. So I don't know how you're gonna check on that.

Right exactly unless you've got you know a very like comfortable like you know family I don't know and or you take Do the doctor and you say I'm not comfortable looking at this, could you please check this out for my child?

Right? Because I was hoping for like, you know, shoulders brought in or just look at that you could just kind of look at you know,

yeah. And I don't know I mean for boys, another sign is often times that voice change starts right? Like some crappy voice, some deepening of the voice from the, from the kid to sounding voice which, you know, my little guys still obviously have they're only four and a half an eight and a half. So they still obviously have that like little kid. But that's another typical for boys. I mean, some that occur in both boys and girls are obviously like, some underarm hair and like hairier legs and that kind of thing.

I will say for moms, I think you can, the way your son smells starts to change you like that's it. That's a good one to look for

when they start to need deodorant. Right? You're exactly right. When they start to need deodorant. They have a definitive funk after they're done playing an hour of soccer, you know?

Yes, yeah, yeah, I don't I want to be clear, I don't think you should like tell your kid Hey, if you're when your testicles start getting bigger, and you're screwed them, what does it say? begins to thin and red. Yeah, I don't think that's a good way to go. But so but when you see that the indication to you around diabetes should be there are going to be more growth hormone now. And so we're going to probably have to meet that with insulin. But does the Why does that impact? Why is that impact so obvious overnight to so many people? Is it because that's when growth really happens? What do you think it can be that some people's overnight basil rates or a week or two, like that just popped into my head?

Well, I know that you know, we actually have, Gary actually has in his thinkbook a really nice chart that actually defines sort of insulin needs through the life cycle. And it goes from like infants, kids teens, into like adulthood, and then older age people. And what we actually find is that kids and teens have the highest insulin needs overall, you know, if you're completely opposite, it doesn't opposite of this, it doesn't necessarily mean anything's wrong with you, it's just the majority of kids and teens will have a much heavier base basil need overnight. And it often then sort of dips down a bit kind of comes through the course of the day, whereas adults, and definitely older adults, often have a lower bass diesel overnight. And then it kind of nudges up a little bit more at certain times of the day, especially that morning time period, right? hormones in the teen years, I think are they're heavier in terms of visible insulin need. Because once you get to the point of being 10 plus years old, you're most likely if you've been living with type one for a number of years already, you're most likely already at a point of more insulin than you were as a little kid. And so then the hormone impact on top of a rate that's let's say, already, like one unit in our teens might go up to 1.4 or 1.8 2.1. I mean, the amount of extra insulin needed from a hormone standpoint, during that whole team growth cycle looks really heavy, because your base often starts heavier already. Whereas where your little kid, you might have a basil of point one, five, and it goes up to like point three. And yeah, that's, I mean, that's a big shift. But it's not as dramatic as like, the bigger doses, right?

Yeah, it's why that I know, I've said a couple of times, and I hope it doesn't seem pejorative, but you know, when you're managing a seven year old really well, that gets almost like diabetes training wheels, a little bit like yours, there's still a lot more coming in, you need to know that, that it's on its way but I think more importantly, when you see it, you need to be able to react to it and just understand it, you know, what happens that people see and they're like, oh, something magical is happening, and I don't know what to do and you know, like, and they get all flustered, instead of just saying, well, there's a need here for more insulin, let's just meet it. Yes, and I do understand that. The can the concern can be it's the first time you've seen it. If I come at this very aggressively, what happens if I'm wrong and I'm too aggressive then on the other end, we see some sort of a drop. But I mean, after you notice these things over and over, and again, you have to you have to get ahead of them. Right? You know, and

they will happen or and it to say over and over again is really important because they will happen over and over again. And again. If you've had a child who's had or a teen who's had diabetes since they were younger, you've already seen As a more sick, let's call it nature to hormone shifts, growth cycles and this you get to a point of insulin need and then it shifts again. And then it shifts again and then it shifts again. Well, kids grow and they keep growing.

It's waves to its waves. And it doesn't necessarily have to happen when you think like there was a time for a long time that Arden was the smallest girl around like she's five one she weighed 70 pounds, like, you know, that kind of thing. And our I mean, I think Arden's done growing now but aren't five seven, you know, she's one of the tallest girls in the town we live in. I mean, so much so that if she meets people like guys that used to coach her softball team when she was little she can they don't even know it's her. You know, like she's

okay she is taller compared to her little petite. Yes, pretty self.

And when I go back and look, sometimes it was weight. Sometimes it was height sometimes she started maturing at one point she was rather curvy. She is not anymore like it. It went through a lot of different shifts. Yeah, seasons. By the way, Jenny, signs of puberty for girls. Why do they use words that make me want to giggle breast buds? buds, okay, right? pubic hair, which they listed for the boys. But after I said, fitting and reading, I didn't. armpit armpit hair for girls again, acne could be an indicator. And then a higher growth rate. I guess when girls start growing tall, they they keep going. Right? And then what I mentioned earlier, I said kind of curvy, but hips thighs, you start getting Yep, you start getting fat and all the lady places. Yeah, like not fat, like,

well, you just I guess another term is like you fill out really, you know, you go from really a kid based, very, like, I call them like square bodies, kids have like, really no hippie, kind of there's they just started like, straight down from like armpit all the way down their legs, they're just this like rectangular box. And I've got like good visibility of it. Like, with my third grader, he and his friends have like, grown considerably over the course of the summer. Like just seeing them now in these first couple of weeks of school, the differences in the heights of kids and whatnot, but they all have boys and girls, they all have this straight, like rectangular box shaped like part of their body. And then once puberty hits, that changes and it's especially visible for girls as you know, breast development kind of comes into the picture. And hips kind of change and shift and wait, especially for girls who may not have the best like nutrition plans or the you know, maybe activity and the best types of foods, they can tend to during that puberty time game more than they may actually need to because the hormone shift is causing a lot of shifts in hunger and you know, the appetite and the way that their body is sort of maneuvering change.

Let's I want to add a couple things here and we'll stop but my son's like 21 and a half now and he texted me the other night. Hey, I just I just squatted 375 pounds. I'm like really? Please don't hurt. Wow. Yeah. And and now I realize that even just a handful of years ago, even though he was a strong athletic kid, I still could have manhandled him if I needed to do you know, like, not that that was our situation. But if if it went down to me, I think I could have taken care of it. And, and now, I'm pretty sure that if that happened, he would just grab me by my face, and he could just like throw me out of the way if you wanted to. Yes. And so point is don't be worried. Yeah, well, he's still maturing. Like I know that's a weird thought. But he looks it was this spring we went out on the baseball field for the first time and I said this is the first time I feel like I'm having a catch with a man I actually told this was the very first time I've had that feeling. And he was a college athlete prior to that, right you know, and so but that was the first time he looked at me and his shoulders were bigger and his chest was broader. And you know, I thought oh, this is I'm out here with another guy get on it. It's not a kid anymore.

Well, that's why I said you know, guys can tend to grow and some of that growth is more like I said about like, the early teen girl like filling out. Guys, especially if they're really paying attention or they're into a specific sport or something. They tend to plus 18 years, they get that fill out, their shoulders brought in a little bit more their body actually kind of gets more to the point of like, like visible structured

He talks about weird ways that I think my he goes, I think my frame can handle about 205 pounds. Like he's like 190. Now when he was trying to gain weight, but it's interesting the way he, like, you're right, like athletes think about it in a different way I do. I'm always like, I wonder how much thinner I can get. I would like to not look like you know, I don't want to have like fill out and but my fill out is different because I'm 50. And let's, let's just add at the end that a birth control pills. Yep, can can mimic all of this right?

They can I mean, and again, most most girls are not really started on birth control until there's a visible issue in terms of their normal menstrual cycle during the teen years. Right. And or you think that there's definitely a purposeful reason for birth control, right. But most often in the teen years, it's because the cycles are very irregular, or very heavy, or very, very painful, almost kind of like a debilitating type of you know, pain. So then birth controls bring in another level of like hormone, but many times with birth control for the women who things have not been as regular, the regularity that's brought in because of them can actually make blood sugar control a little bit easier in terms of the cycle. Some birth controls can contribute to some weight gain, and some of the newer ones on the market and or the adjustments to the doses and whatnot for for what women need. The can be just kind of stabilizing, they won't necessarily cause gain or loss. Yeah.

So Arden had to do it for reasons that you just mentioned, irregularity having, like etc. and took us a couple times I'm still not sure we found the right one to be honest. So yeah, like I mentioned to you before we recorded like she has like a she's not she's hungry, but she can't like imagine what food tastes sounds good to her. She also is having trouble stomaching meat. And there's part of me that wonders if it is maybe a birth control pill? That's because does it mimic you being pregnant in some way to and doesn't sometimes like that happened with foods? I mean, I could be

wrong during pregnancy? Yes, during use of birth control, it essentially continues to cycle you through without oscillation. So there is no potential for pregnancy because it just shuts off the ability to obviouly right. I mean, that's a general statement.

But my question was that does. Is there anything about taking the hormones that gives you similar situations to like, when you have cravings when you're pregnant? Or maybe I'm just maybe that's not right. I

don't believe so. I mean, not from anything that I've seen with the women that I work with, nor that I've necessarily read about in terms of cravings, if anything, because it's stabilizing hormones, or should be more to keep a regularity to the cycle. Usually, most women have the same types of cravings the couple days before their period that they would have even if they weren't on birth control, like the salty sweet kind of like could eat anything and then maybe the rest of the time, their appetite is just kind of back to normal.

Yeah, so it's interesting. I've experienced it now twice in my life once dating and once father and the child. It's a different feeling like in both situations, but it's really interesting you ladies are very, very interesting people. Okay, yes, we are like I could, I could spend the rest of a couple of lifetimes probably not understand what it is I'm looking at still. chivo hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar and adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Volk, glucagon.com Ford slash juice box. g Vogue shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Alright, you guys ready? I'd be a little weird. It's gonna feel like deja vu for a second, but then you're gonna see the differences. I want to talk about growth spurts as a variable. Oh, so fun one. So here, I just I I know it's something that people generally see as my child falls asleep and their blood sugar magically goes up. I know. That's one way to think of it, when I talk to people who have young kids, and those and they start off by saying, this Basal rate has worked forever, I don't understand, you know, what could possibly have changed? The first thing I say is, you know, are you coming out of a honeymoon? And if the answer's no, then I go to, has the child gained weight or grown recently, right? Because there's two different things going on here. When you're talking about growth spurts, there's really hormones in the moment. Like if you're seeing a spike overnight, or if you've grown in, don't notice it, you have a bigger insulin need. And it's the last thing in the world do you think of for some reason? Right, you know, so let's talk first about the hormonal thing that happens that causes you to get bigger. So that normally happens overnight? Is that correct?

I mean, for the most part, yeah, a lot of children's growth in the hormones that impact growth happen into the after bedtime time period. And while kids overall insulin needs are higher overnight, in general, that's pretty typical. So even on the nights that kids aren't in a growth phase, you know, with increase in hormones, most kids still have a rise in blood sugar after they go to bed. But it's not as profound of an increase as during a growth phase. And there are other like, cues, you know, you said, well, has your child gained weight, are they a little bit taller, a cue to me of just my own kids who don't have diabetes, but I know when they're going through growth, because it's visible in what they eat. And their sleep or their like fatigue level. So both of my kids will eat and eat and eat. I mean, kids eat right, but they will eat more, like they will get asked for like to burn breakfasts, they're kind of like habits when they're growing. It's like at first breakfast, second breakfast. First one, you know. And other times, like my little guy, right now, he's definitely in like, a stable time period. Because his breakfast I have to, like, urge him finishable finish your breakfast, you know, whereas usually it's down in like, four minutes, it's gone. You know, so that's something visually to pay attention to, too, because if you're going through that, you can say, Okay, I'm going to expect an increase in need.

My son, when he was going through his real growth, time, you know, 12 years old, 13, like through there actually, boys are usually a little later, but his calves would get bigger, and then he would get taller. That's what happened every time. So it was just the craziest thing you'd watch his calves get bigger. And then we'd say a coal is gonna get taller soon. And then he would. And I funny that you noticed this cow. is a baseball players always insurance. He never Okay, he's never wearing pants. So it was just one of those things aren't in sleeps more. You know, when when her body is going through changes? I mean, but but I guess the it to bring it back to diabetes for a second. Its growth spurts is a weird thing. Because yes, yes, I just my tongue just came out of my mouth didn't go back in at the right time. Yes, I was like, Am I having a stroke is this but but yes, growth spurts cause your insulin needs to change. But it's a throwaway answer online when people don't know what to say. Like, what is this? Oh, it must be a growth spurt. Do you mean like, it's one of it's one of the diabetes. You know, I'm saying buddy. Like, I get that vibe. And I think at least if people can see it, maybe then they won't write off other things as being a Grossberg if that makes right. You know what I mean? Yes.

Well, and it also goes along with, as we know, experience, right? If you are newer in a diagnosis of diabetes with a child, there are things that you'll have to experience to be able to see what to do and what the impact for your child or teen is gonna look like. Right? And then you then you use that as you move forward. You use those experiences to kind of build on, but if you've been doing it a while, and it's always a throw your hands up in the air.

Yeah. Yeah. So I'm probably gonna talk myself out of downloads here. But the truth is, if you came to me and said, Scott, I want to do a variables, episodes about diabetes. And you came on and you said, Hey, Scott, today's topic is puberty and hormones. What do you think? I'd say? Yeah, insulin needs changed. You should just Be flexible and change with it. But then I would say that in every episode that was sort of, like the, in my heart, and I think at the core of what makes the podcast valuable for people is, I don't really care why your blood sugars are doing what they're doing. Just meet the need with insulin and move on is But still, when you're in the moment, it is. Listen, it's not only necessary, it would be difficult to try not to diagnose things. And so I love these valuable episodes. I'm being a little facetious. I love them because it gives people something to go Oh, like, maybe they're growing. Like, I don't know, a ton of technical stuff here, like, your kid might grow and need more insulin. Give them more insulin, don't stare at 220s overnight for a week and go I don't know what's going on. Because, you know, because maybe it's a Grossberg give them more insulin but right maybe an aliens flying in their room and giving them sugar to if that's give them more insulin, like care why

it's happening. Probably bigger problems there then just

better window locks at the very least. So that's the kind of overnight like, while your body's making it, blah, blah, blah, like, right, like you're, it's giving you things you're building. But don't overlook the idea that as the body gets bigger, if you're being medicated with something, you're going to need more there's a reason your doctor asks you how much you weigh. When you when you go, I remember having a surgery one time. And Jenny, this is uh, not exactly a humble brag, but I don't look my weight to most people. And so I go into get a surgery. And you know, they get they give me the medication, and they come back in the room, the pre op room, and they're like, are you okay? And I'm like, yeah, I'm great. What's up, like, you should be half asleep by now already. And I was like, feel good. And then nurse picks up the chart looks, looks, looks, looks looks, how much do you weigh? And I told her, and she goes, Oh, oh, the doctor thought you weighed much less. And then

they didn't check your weight before you show

her Am I is this gonna go Okay, you know, but the part I took from it was that because of my body weight, I needed more medication. And then the same thing happens here. If your body weight goes up, you're probably going to need more insulin and, or right maybe, but it's worth looking into it because I've talked about here before, but it beat us in the butt before when Arden we finally got Arden's thyroid medication straightened out. And then she got bigger. And suddenly she's having these terrible symptoms. And our brain didn't say thyroid, because we thought we fixed thyroid already, right? So then we're taking her to heart specialists, when it turns out what she needed was like 15 more micrograms of terrorists, or something, you know what I mean? Like, so please look at that. Growth and growth spurts.

Well, and I think the big thing too, that you kind of touched on. But more specifically, when kids grow, they don't, they always up grow, they don't down grow. If your child is growing, you will need more insulin and likely more insulin in that time period of growth, be it two or three days be at five days. Usually growth phases are not extensive, right in terms of like a month long amount of increase. But you will also find because of the growth, your baseline insulin is not where you're going to land back to, after the larger need for growth, you'll usually find like a middle ground between the low need the high need for growth, and now you're settled in after the growth. That's kind of where you're gonna aim to get to.

So there's a spot where your basil is at where even your meal needs your correction factors. And then during the growth, they're going to increase. Yes, but they may drift back down. Lower from where the growth is happening, but not all the way back down to where you began. Correct. Excellent. Cool. Thank you.

Yes.

A huge thank you to one of today's sponsors. g Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGL Uc ag o n.com. forward slash juice box. Let me do a little round up here at the end of the week. dexcom.com forward slash juice box omnipod.com forward slash juice box Contour Next one.com forward slash juice box touched by type one.org. Trial net.org. forward slash juice box. Those are the sponsors hit the link support the show I hope you enjoyed that kind of little look behind the curtain. It's never happened to me before. And when I realized that it happened, I thought, wow, this is super interesting. And I first I thought, I'll just delete one of them. And I'll give them the other one. And then I listened through both. And I thought, these are fundamentally different conversations. And such a good indication that Jenny and I really do sit down and have off the top of our head conversations about stuff like this. And I think it's interesting to see how the conversation can be drawn in different directions, just by somebody asking a question, or having a thought one day that they didn't have the next. That was really cool. And it gave me an idea. So in 2022, Jenny and I are going to go back privately, separate of each other, and listen to a diabetes pro tip episode. And then we're going to come together the next day. And we're going to record an update to the diabetes pro tip. And we'll do that all through the year in 2022. How cool is that? Right? I think that's gonna be really interesting and fun. And I think valuable. I really think we might look back at ourselves from a couple of years ago and say, Oh, I would have I should have said this here or since then I've learned this And now I'd like to expound a little bit. Anyway, that's a little teaser. That's gonna be a long while from now, but it's something to look forward to. Alright guys, seriously, thanks so much for listening. I love making this podcast. I'll be back soon.

This is Episode 560 of the Juicebox Podcast. I am. I'm impressed with myself if you all knew me personally, you would be amazed that I've done this, honestly, that I didn't like, you know, get like five minutes into it was like it was a lot of work. Oddly not like me, but maybe it is now. Who knows, live learn, right? Grow change, etc. Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is sleep, Jenny and I will talk all about sleep and how that is a variable for your type one diabetes management. While we're doing that, you'll remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And further, you'll remember to consult a physician before making any changes to your health care plan, or becoming bold with insulin. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com ask for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean you could ask offer a sofa, see if she'll help you with your Basal insulin. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org forward slash juicebox take the quick survey help the podcast help people living with Type One Diabetes. I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen. And I'll do this so that you get an interrupt an inner, inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means if it's in your pocket, if it's in your purse, anywhere you need to keep your gear, the Contour Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. room it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test strip by doing that, or ruin the accuracy of the test. Second Chance test strips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me got text matches the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well you know i want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh this thing must need so much blood but it doesn't it needs a very little bit it's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay last part go to contour next comm forward slash juicebox there's like zero sincerely, I'm not just trying to drive you to a link What am I really want you to go to the link but that's not the point. There's a lot of information at the link. So if you really want understand all this Contour Next one.com forward slash juicebox and I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juice box. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Jenny Campbell Do sleep as a variable for managing insulin. I don't know, I don't have a lot of feeling about this, honestly, it's not one of the things that I've noticed. But maybe I'm not looking hard enough. And when people sent in variables for the list, sleep, sleep deprivation, getting good sleep versus getting bad sleep, like broken and unbroken. Everybody sent that in as a variable. So I don't understand why that would impact anything.

Well, you know, overall, sleep provides a lot in terms of recovery, and build of like cellular sort of restructuring and whatnot in the overnight time period, right? That's, we're supposed to get these waves of light sleep, deep sleep, etc, that help our body to actually then recoup and be ready for another day. When it comes in terms of type one management, that's one of the biggest things that most people say is, I just want better sleep, the daytime, I can struggle through manage through if I've had good sleep overnight, I can deal with the daytime management. So from one, sleep deprivation can lead to poor overall management, because you don't have as much with all that we have to manage in today's world beyond our diabetes, that's another layer that we have to consider. And if you haven't slept well, you're not going to be thinking as clearly, right. on another level, though. There are a lot of different hormones that are regulated through the sleep cycle that have relation to appetite, and the turn on the turn off of appetite during the daytime. And so for someone, again, managing diabetes, if you are not sleeping well, it is very likely that some of those hormones that are supposed to be being managed for then transitioning into what you're craving, unable to manage in terms of your intake through the course of the day, those are not going to be regulated the right way either. So there's a lot to sleep, that does translate into diabetes management, right.

So the one, the one thing that popped into my head, when I saw this as a variable was that I thought I for sure had heard that shift work could be bad for people in a way that I never expected that he could make you more, the way I looked it up it's a shift work can have an adverse effect on type two diabetes, it can also put a person at higher risk of developing type two type two in the first place shift work, particularly that involving overnight and varying shifts can make it more difficult to manage glucose levels. It doesn't it doesn't really go on but I really I just remembered hearing that that there's something about the is that this circadian rhythms, the

circadian rhythm really. And I it's interesting, because I just attended the ADA scientific sessions with our virtual conference. But some of the sessions that I did attend were specific to the circadian rhythm, and sleep and appetite and weight management, which does relate to much more into type two. But it's also a realm of something that many people with type one try to manage really well to write. So in terms of what they found is those who had a much more stable daytime structured schedule, and they slept overnight, even if the sleep was not as good but they had their normal sleep time in the overnight time where typical circadian rhythm kind of is meant to be. They found that people had better weight management and had better glucose control. The other piece to it was that with shift work in the picture, schedules are often very disrupted with shift work. It's not often that people have consistent enough schedule with a shift like I think of many of the nurses that I've worked with, who have some shifts and some weeks that are an overnight shift, and then they've got several days off and then they go to a daytime shift, then they've got several days off and then they go back to like the evening or the overnight shift, right? That's a complete disruption to what your body is even trying to set as a some type of stables schedule. It just it doesn't happen. So in terms of like all management It's really hard to then get a grasp on insulin doses and or even use of medication. And food intake gets disrupted, now you're eating at two o'clock in the morning because that's technically your lunch hour went in four days from now, your lunch is going to be back at 12 or one o'clock. And I know

I remember we've talked about that before, too, that that actually still impacts things like feet on the floor and stuff like that, too. Like if you wake up at three o'clock in the morning, suddenly that feet on the floor impact is happening at that time of the day. Absolutely. all that other stuff that's really fascinating.

I mean, I in terms of that, I even remember noticing that myself if I would get up overnight for more than just a tuck a kid back in bed and then go back to bed myself five minutes, I didn't get that impact. But if I was up with a foster child or for nursing overnight or something like that, and I was up for enough of a period of time, I definitely saw that happen when otherwise overnights were flat.

You know, I was just thinking about you ever been like gotten sick or exhausted and you fall asleep in the middle of the day? And the sun's up? And you're in a deep sleep? Lee, when does that happen? Back to had to have happened to at one point, and you wake up at seven o'clock at night. And it's dark. And it's the kind of dark where you're like, it could be midnight, it could be 2am I don't know what time it is. And you can't it gives you that really horrible strange feeling of like you don't know where you are. It feels very disorienting, right? Yes. And the only time the only way to fix it is to go back to sleep and wake up with the sun again. Yeah, yeah, it's a I have it here just us is it circadian circadian circadian rhythm or circadian cycles, a natural internal process that regulates the sleep wake cycle and repeats roughly every 24 hours, it can refer to any process that originates with an organism, okay, we don't care about that part. But the other thing there. And the only way I can relate to this, and I've had someone on recently to talk about it, is that I am very steadfastly eating within a an intermittent fasting schedule, is really made a vast improvement on how I feel. You know, when I spoke to Jen Stevens about it on the podcast, she was talking about, you know, just pick a she talked about is in the eating window, not as like, she didn't think of it as fasting as much. And so I'm just pretty much sticking to an eight hour window. Yep. She told me if I take my window down to fewer hours, I'll start losing weight. And I haven't gotten to that part yet. I was waiting for the kids to go back to school. So we're getting up to that. Now I'm going to shorten the window up a little bit. But basically, basically, I'm not eating after the sun goes down. I'm 11 to seven ish. I'm trying to eat around in that situation. And one of the things she talked about is how, why does that work for people for weight loss, and she said it. it lessens your need for insulin. So your body goes through big portions of the day where you're not your body's not calling for insulin, like it's the opposite of the idea of like, eat small snacks all day long. She's like, I don't like that idea because your body is always using insulin. Now she was talking about, you know, people who don't have diabetes or type twos, how that could affect them. But then I realized Arden's a person who doesn't eat breakfast. So overall, like most of the time, like on a regular school day, so overall, Arden's eating in an intermittent fasting window. And she can fast with a stable blood sugar, like no one I've ever seen in my life. Like, you know, now that you're on the algorithm, and you can see it Arden, if Arden doesn't eat for 12 hours Arden's blood sugar is just he just is. And so I don't know that all those things fit together. But I think all the ideas fit in here somehow, you know, the idea of being on that cycle, and that your body works better in cycles, and that it needs time off and time to do things. I mean, I'm obviously no expert, but all that makes sense to me somehow.

Yeah, absolutely. I mean, the they're sick, their circadian rhythm, the hormone component and the overnight time period. I mean, they are all kind of tied in along with the intermittent fasting idea. In fact, one of the other ones that I listened into was all about, like those who did the best weight management wise, kind of from short term analysis to long term like a year out from having lost weight, and then what's the maintenance of that in terms of their ability to maintain and some of them were doing intermittent fasting, but they did it. I also don't really like the fasting component because you're fasting in a given time period, but you're not Really just not eating, right? I mean, people think of fasting as like 24 hours, you're just not eating anything really you just containing the time period. And they found that people that did intermittent fasting with breakfast being the bigger of the meal, lunch being a bit lighter and the last meal of that time period, especially when it's eaten, I think it was before, like 7pm did the best with overall loss, and then maintaining that loss, compared to people who just shifted that eating timeframe by about, I think it was a three hour chunk of time forward and eat later into the evening. But still within a time block. That was an intermittent fasting, like I only eat within the six hour eight hour time period. So the later eating tended to increase the risk of gaining weight back and or just not losing as much weight, which was interesting to

the reason I brought it all up is because if you're if you're sleeping on a pretty consistent schedule, then it makes sense that you'll be able to eat on a pretty consistent scale. Yes, right.

Exactly.

I and I mirror what you said in what I'm seeing that. First of all, it's easier to eat bigger in the beginning of the day, because you've come out of a window where you haven't eaten for a while. That is the time I am the hungry. It's like I don't I want to know, you know, I don't I don't wake up like I haven't eaten yet. It's 1151. And I'm not hungry. So but I will go eat now when you and I are finished. Sure. And I will eat probably my larger meal of the day.

Yeah, and it's in the day. Yeah, you're not putting it in the evening, when you're less likely to be up and moving and going about your business, you're not going to bed on a really full stomach that your body then has to do something, digestion specifically, in a time period that is not meant to be doing that, which

I was gonna say can affect your sleep, which Yes, talking about and we've talked about it in a number of other episodes, leaves your body with a task of having to work on food and digest food at a time when it's trying to take away that process to do other things. So yeah, you're basically asking your body to do something when it was getting ready to shut down that function and do other things. Right so don't go to bed on a full stomach.

Yes, yeah. That's it easy, easy statement to say harbor.

Pizza much better and even. It's just obvious. First, I'm gonna thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com forward slash juice box. There are also links to the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate you listening and supporting the Juicebox Podcast. Tell a friend. That is my least favorite part of making the podcast asking you to like tell somebody else. Don't forget to subscribe in your app. Like it's, I feel like I feel like an idiot having to say that. It's like I see a YouTube video, you know, and they're like, hit the bell do the thing. And I'm like, Oh, this is so sad. And then I come here and I have to do it here and it just it's hard to get people to listen to things and and subscribe and you know, it takes so much for them to learn that the contents there and it really might be valuable for them. So then I end up saying like, just please tell someone who else you know and just, I don't it makes me feel weird. I don't like it but I do it because it is important. So thank you so much for listening for supporting the show. If you know somebody else who you think might enjoy the show, also please share it with them, show them how to start listening. podcasts are not intuitive for everyone. Subscribe in your apps people. I just did it. I was like hit the bell thing. You know what I haven't mentioned this in a little bit. The Facebook page is really great. No joking. Juicebox Podcast Type One Diabetes on Facebook. It's a private group with I think it's got like 16,000 people and now everyone's talking about diabetes to really on Facebook like experience. So that is to say it's a good experience with a lot of great people. Check it out.

Hello friends, and welcome to Episode 564 of the Juicebox Podcast. Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is pump site placement. 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. We're becoming bold with insulin. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com asked for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean, you could ask try to trade a lamp for a better Pre-Bolus time. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org. forward slash juicebox. Take the quick survey, help the podcast help people living with Type One Diabetes. I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen, and I'll do this so that you get an inner, an inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means it fits in your pocket, it fits in your purse, anywhere you need to keep your gear, the Contour. Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. Room, it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance, click click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test strip by doing that, or ruin the accuracy of the test. Second Chance test strips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me text messages the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well, you know, I want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh, this thing must need so much blood but it doesn't it needs a very little bit. It's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay, last part go to contour next comm forward slash juicebox. There's like zero sincerely, I'm not just trying to drive you to a link, what am I really want you to go to the link. But that's not the point. There's a lot of information at the link. So if you really want to understand all this contour next.com forward slash juicebox. And I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juicebox. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Can we do pump site placement? Sure, all right. So it's always feels weird to start over when we do the string stuff. Back to them and add It, I hear myself go hey Jenny today, can we talk about pumps? I

know we've really been talking for like, 45 minutes.

We've been talking forever. We've done like a bunch of these like, and I feel silly. But anyway, hey, Jenny, can we talk about pump site placement today?

Absolutely. Excellent. Yeah,

we just leave all that in so people know why I'm laughing. So it doesn't matter, right? If it's injected, or pumps, there are just going to be places on a person's body that I don't know what to say, does it absorb the insulin better? Does it use the insulin more efficiently? Like how do we think about it?

I think they're both kind of the right way to say it. Because honestly, underneath the skin, I mean, the goal is to have insulin absorb, right, and to get used in an efficient like, pattern of in, gets used goes out, it's finished working. I mean, many people, on pops, I think more than people using injections will start to notice places on their body that definitely absorb the best. And other places that they get good use out of, but they might actually have to have a secondary Basal profile that's notched up a little bit more, because they just don't quite meet the same glucose targets, with the same diesel from let's say, a stomach site versus a butt site, or, you know, whatever it is. And then there are some people who can't use certain sites at all. I mean, I personally cannot use my leg. It just, it just doesn't work for me. I either get occlusion alarms, or the sight hurts. And I've also noticed with that then it's just not getting absorbed accurately enough, I guess is the easiest way to kind of explain it. It's it's much less consistent absorption there. So I just I just don't use my legs.

Do you think that's because do you think there's a reason to point to do you have like a stronger leg? Is that muscular? For

me? I truly believe it's because I just have pretty much just muscular legs. I mean, I've done biking and dance, and lots and lots of things over the years and I continue to run and do yoga and bike and yeah, I think it's that now the interesting thing is that I can wear a sensor on my leg. I just can't put a pump site with insulin there.

Okay, is there anything about like I've heard people say over the years and I've never understood if it was true or not like I can't put my pump near like the you know, muscle in my thigh or towards a larger muscle because the muscles they feel like the you know, the way they say it is that the muscles burning up the insulin, but I don't I don't imagine that that. Isn't it just that there's not enough like fatty tissue there to move it around? Or no?

Well, you know, muscles are, they've got a basketball nature to them, right? So they've got lots and lots of vessels that contribute to keeping the muscles doing what they're supposed to be doing and supplying nutrients and everything into the tissue, right? Whereas fat is just I mean, you've probably seen pictures of like fat blobs, right? Fat balls, right? Imagine Yes, imagine a styrofoam ball, that's a good idea. So when you have insulin infusing pretty close to a muscle, let's say and this is kind of general, you would expect potentially that you are going to get if you haven't gotten occlusion from nicking a vessel and getting kind of a clot at the end of the canula. And then the muscle because of the nature of vessels, you may actually get faster absorption in an area. Like I've in particular, noticed if I've ever had a site that has bled after I've taken the site out, but it wasn't really like it wasn't painful. There was no reason to change it prior but it just was one of those like gushers that you like pull out and then I look back at the couple last days and I'll be like, yeah, my blood sugar look pretty perfect. Like it was almost like I didn't have diabetes. Like it was just all working like so beautifully that I felt like this is just it. I'm just at like this beautiful like point, right? And then I see Oh, there's the reason right next to my blood supply.

That's what you think you said that it's almost like you're in a very tiny way. mainlining the insulin a little bit.

And that's what I guess yeah. And it's actually just closer to the absorption line. You know, because when We put up Pump site or even in jacked insulin, you're supposed to be sub sub Q, right? underlying tissue, which is mostly your like, it's like your thermal layer of protection for your body, right? That's where we're supposed to be absorbing insulin through. And thus the timeline and the absorption for the trend in rapid insulin, regular insulin, long term insulin. It's all based on how it's supposed to get absorbed in us through that timeframe, through that tissue.

And so I think it's important here to mention that, when you buy a pump, any pump, it's going to give you some instructions and tell you hear the places you can wear your pump. All that means is that those are the places that the company who made the pump had the time and money test to test so that they can prove to the FDA that these places worked. And I assure that Omnipod probably isn't thrilled if I'm saying this, but you can put your pump somewhere else. Yes, yes, you could try other places I've seen from Chris Freeman, where it on his chest, you know, when he's in the middle of, you know, in the Olympics, and I mean, I've said it before the guys like, I don't know what his real body fat is, but he doesn't appear to have any. And you know, and it's on us, it's on his pack. I've seen ladies wear them in their, on their breast. I've seen people wear them on their hips, their thighs, their calves. I watched somebody do it on their forearm once it's like a test, you know, there's no place. I don't think there's any place where it isn't reasonable for you to try based on what I've seen from the community and from people in general. But you are going to find places that work better. But then I think that leads us into talking about, you can't have too much of a favorite place because you'll ruin it.

You have to rotate Yes. Very important to rotate

have to have to look at your sites and see for Arden they get a little like if she's using them too much I can start to see in them little vascular, maybe like a little red on top. Like that's the first like sign for me. And then you can start rubbing your your you can rub your hand over top of it. If it gets bad. You can feel like it'll get lumpy or hard. Yes, right. That kind of thing. So yeah, you have to have a place to go. And it is going to change them. Like Jenny said it could possibly change how much Inslee Arden just went off the side of her thigh to the top of her thigh. And I had to increase everything by about 20% for that just from the social side at the top of the thigh. So and I think too, for little kids. As long as we're talking about sites for a second. Here's probably a good place to talk about when you start doing things with little kids or you know, sometimes adults. They build rules in their head. So that's where my pump goes. It can't go there because it goes there. I always wear it here kind of becomes a psychological thing at some points to you know, and then you'll see kids will fight against it. Like I can't put it on my arm. It goes on my leg. Yeah, right. I aren't in 17. And I think she has it. I think she believes her, her CGM goes on her hips. Because that's because that's where she likes it where she likes it. And it works fine and everything. And if I ever say to her, Hey, why don't you try putting your pot on the back of your arm. It's a flat No. And it's only because in my opinion, she remembers it being there in a softball game one day, and we didn't think about it. And she threw and then the pod like yanked on her arm as she was as she came across, she had a bad memory of it. And now even years later that she's not throwing us off ball anymore. years later she's has an aversion to putting it on arm. You know, so sure, if

there's like an associated kind of experience there.

Yeah, and then it comes out as this is where it goes. And I will fight to the death to keep it here. And then you run into a problem where you don't have ways to to rotate sites. Yes, and then you're gonna run into a problem and the way I've always put it the Arden is look you keep putting it there and one day you're not going to be able to use that spot at all. And that's that's the thing that helps her move around. Now, I think the other good thing to talk about about that is, you know, I really have experienced with the Omni pod but sometimes it's just as simple as turning it 180 degrees like you really like it on your abdomen. Great. Have it point towards your belly button this time and have it point towards your side the next time. Yes, you know, those are still

when I do the same thing you know, especially for backs of the arms, which for many little kids, because especially for tiny little kids who really don't have a lot of tissue or are very, very averse to having it on their abdomen for some reason, you know, then that back of the arm like you said it's it's essentially just turning the pod with that viewing window facing up versus the next time turning it with the viewing window facing down to technically that and even have two sites on the back of each little arm that you could potentially use Which makes for places between two arms. And at assumably? Three days per site. It's a fair amount of these before you get back to site number one on the first star,

do you think specifically on Omni pod? Use it vertically? On limbs? right?

Correct. Yeah, perpendicular up and down with the viewing window, either facing the sky or facing the floor on limbs. Exactly. And then on, like, your torso region or your upper but you would use it in sort of a horizontal fashion.

Is that because of just the nature of the shape of the pod?

Yeah, that's from what I know. It's nice. It's based on the wear comfort wear of the pod itself? Yes.

Do you know a second ago because I didn't want to look stupid. I just checked it vertical, up and down? Like I googled it right before I said it, and then it made me feel so much better, because the rest of the world doesn't know either. It's it's a very popularly Google thing is horizontal, left and right, is vertical up and down. What is vertical? What does the vertical line look?

Pretty funny? Is that

closer attention in school? Anything about this that we didn't cover?

Um, I don't think so I think in terms of site you covered, you know, all the places that are approved versus the ones that people are trying, not necessarily approved. So yes, but

it's a variable, because you are going to get it in your head that these are my settings, and then you're going to move the site somewhere else. And then you start, I love it, people immediately go, this pump doesn't work. That's always my favorite reaction to everything,

right. And I've got a number, I mean, as a secondary to that site to site going to number of people, myself included before using, you know, the system that I actually use. I actually just had separate basil profiles that I would use from one site to the next, more specifically, all the body sites on me work pretty much the same, except for my upper but my upper back just seemed to need more insulin whenever I used it. So I had a profile that was specific to that.

So do you think that and I'll let you go. But do you think that the advent of g7 Dexcom. Like when it changes form factor? I keep thinking people are gonna start trying like, a lot of different places, because it's going to be easier to put in different places all this probably,

I would expect. Yes. I mean, as it is, a lot of people are wearing their CGM is on places that I would honestly like there. I've seen it on their forearms. I've seen it like, places I would never think of popping it in. But I think getting accurate results. I

guess I have to admit, there are times I see those pictures, and this is exactly what I think and I'm just gonna have to bleep this out. I think, man, skateboard, huh? I wonder if we can make it work here. I'm gonna

I know I don't even have like, I don't it's all muscle there. I don't know where it would sit under my skin. I would hit something and it would be immediate pain or blood.

I I just think of those people as they're they're explorers. They're just like, I wonder what will happen if I walk across Antarctica? You know?

Exactly. Go find out exactly. I'm

not doing it but whatever. Okay, thank you very much. First I'm going to thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com. forward slash juicebox are also links in the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate you listening and supporting the Juicebox Podcast. Tell a friend

Hello and welcome to Episode 568 of the Juicebox Podcast. Hey guys, welcome back to another diabetes variables episode with me. I'm Scott and Jenny Smith. Jenny, of course works at integrated diabetes, and you can hire if you'd like at integrated diabetes calm. The diabetes variable series has been going over listener submitted variables for type one diabetes, today's variable is a full moon. And I don't mean when you pull your pants down, I mean the thing up in the sky that's made out of cheese. Now that I've said the moon is made out of cheese, I probably don't need to tell you this. But just in case 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 are becoming bold with insulin. My friend Jenny Smith has had Type One Diabetes for over 30 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. If that's not enough, she's pretty freakin awesome. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juicebox. Jenny, is there any chance that a full moon is a diabetes variable

in the grand scheme of considering everything, I mean, my mom was a school teacher, like elementary middle school teacher. She didn't have any kids who had diabetes. But she saw enough children. She she could put a finger on the date of the calendar when the full moon happened. Because of the way that kids acted. She knew it was a full moon time she just she knew it. I actually saw an article the other day is something about mercury being in retrograde until like October 18 or something this month. And so it was from school teachers. And they had noticed that their kids were much more irritable, anxious fatigue, not paying attention. Even the the highest rate graded kids in the classes were having like issues. So I mean, that has I don't think that has anything to do with the moon. But it's something in terms of like whole, like astrologically whatever.

I don't know about that. I can tell you that a friend, a lifelong friend of mine is a police officer. I mean, lifelong, he's getting ready to retire is how long. And for as long as I've known him, there's a time where he'll just be like, hey, like, you know, sometimes people know cops, sometimes they stop at your house, he's standing outside your talk, but right. And as consistent as could be every month, he'd be like, I gotta go. He's like, tonight's gonna be crazy. And I'm like, why? And he's like full moon. He's like, he's like, there'll be more car accidents. There'll be more assaults. He's like, I just it's I don't know, man, he goes, it just happens, you know, so.

So as a variable? Could it have some impact on blood sugar? I think not directly. But indirectly, as we've talked about all of the variables in diabetes already. Things like anxiety, things like appetite, or attitude, or fatigue, or I mean, all of these things, if they're being if they're being impacted because of the placement of the moon and the phase of the moon and whatnot. That could then impact the blood sugar, right?

So there's no direct line. It's not like the moon and your blood sugar starts coming up for real physiological but what if a full moon makes you anxious or weight? Or something like what is it I mean, the moon for not

sleep as well. I mean, we had a whole episode, we talked all about sleep and impact on blood sugar, so you're not sleeping as well or you're more tired or whatnot. All of that. Are there stress factor variables on the body? that could impact your blood sugar? So yes, there's not a direct like line from the moon to your blood sugar that's like, this is what's going to happen now. But indirectly, I think

so. Maybe there are other ways that it impacts you. Okay, yeah. And so that's a funny one. Well, yeah, I mean, but it got set enough that it made it on the list. So I like you know, listen, in fairness, breathing is also on this list. That's people's people trying to be funny. You know, but I really just thought like okay obviously a full moon doesn't have anything to do with your blood sugar but if it is impacting people like you said like maybe there's other things that come from that that then in turn impact your blood sugar so they indirectly it does then right you know, right

that's all I'm gonna What a perfect time of the year for talking about a film.

I'm gonna put this up around Halloween and it gets Yes. All right, well thank you very much for doing that little care fairy welcome. Hey, don't go anywhere. I'm going to be talking more about the moon in just a second. g evoke hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com forward slash juicebox. g Volk shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Alright, let's talk about the moon for a second. How often do you think a full moon occurs on Halloween on October 31? The answer is only once every 18 to 19 years. The first full moon after Halloween is November's moon, which is traditionally called the full beaver moon. Say Aren't you glad you waited? The full moon after Halloween is thought to be the time when the deer rut where mating season for the year is in full force. You know what I mean? Like they're out there just like Thumper and away. Thumper was the bunny and Bambi. I mean, for those of you who are not 1000 years old, okay, a little more about the moon. So as you may know, there is a lot of superstition around full moons. I've gone online and tried to find some fun things tell you about them. First of all, I can tell you with a fair amount of confidence that werewolves don't happen in full moons, but people think they do. werewolves are not real people. My God if you think they are, I'm so sorry. This here says oh, this is interesting. menstrual cycles are affected by the full moon 2011 study showed evidence that a full moon affects the periods of women 16 to 25 years old. They have no reason for this. It has not been fully explored. But the findings do point to a full moon influencing a woman's menstrual cycle, which I guess then technically would impact your blood sugar. So Ah, seems that sea turtles lay their eggs during a full moon. Because of the know the higher tide takes them further into shore and makes a better place for their nests. This is a little sketchy, but a recent study says that the gravitational pull of the moon may have something to do with the amount of births. Statistics have shown a high rate of babies being born on around the supermoon. They call it unexplained. And I can also find a number of articles that will say that that's absolute bs so you know greatest all. This is interesting one study monitor brain activity on sleeping participants and it showed that it took longer to fall asleep during a full moon than during other phases of the moon. It also found less brain activity related to deep sleep and shortened sleep times all around. There have not been many studies on it. But if you're having trouble sleeping during a full moon Hmm. I alluded to this earlier, emergency rooms get busy many er doctors think that a full moon really does have an effect on the number of patients admitted as well as the strangeness of the injuries that they see. Interesting little website. The crime rate goes up. I said that too. Oh, moods change. Research has shown that the moon's gravitational pull may very well be responsible for messing with our emotions. Those with unstable personalities or personality disorders may be extra sensitive to the moon's poll. So on average, the moon is 238,855 miles from Earth, and it seems it can impact things. One of those things might be your blood sugar, dum dum dum. That was supposed to be scary music I can't afford like sound effects and stuff. Although I did pay for this music. A huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pan at GE Vogue glucagon.com Ford slash juice box, you spell that GVOKEGL you see ag o n.com. forward slash juicebox. I just want you to know that there are so many stories about the moon and weird sex stuff. I did not get involved in it while I was looking But turns out that might be something to, at least people think it is. Hey, make sure to check out those other diabetes variables. They're right there in your podcast player, and at Juicebox Podcast comm you also don't want to miss the diabetes pro tip series, the defining diabetes series, how we eat after dark. There are so many to choose from. Check them out at Juicebox podcast.com and diabetes pro tip.com. And if you're a US resident, go to T one d exchange.org. forward slash juice box. Fill out the brief survey that helps people living with Type One Diabetes, super simple questions. Completely HIPAA compliant, completely anonymous takes less than 10 minutes, you can do it right on your phone, right on yourself. You're going to help people living with type one, you're going to support the podcast. I'm trying to get to 2000 completed surveys by the end of diabetes Awareness Month. So one month from now. Go go go. If you all stopped and did it right now. Just based on how many people I know are listening to this episode. Not only would there be way more than 2000 but you might you might hear a pop like an audible out in the world that would be the minds of the people at the tail end exchange just blowing they just be like Oh, I can't believe that happened. That'd be one day exchange.org forward slash juice box.

Hello, everyone, and welcome to episode 571 of the Juicebox Podcast Hey guys, welcome back to another diabetes variables episode with me. I'm Scott and Jenny Smith. Jenny, of course, works at Integrated diabetes. And you can hire if you'd like at Integrated diabetes calm. The diabetes variable series has been going over listener submitted variables for type one diabetes. Today's topic is diabetes technology. Sometimes stuff doesn't work. Sometimes it doesn't work as you expect it to sometimes you don't know how to use it. And in a moment, Jenny and I are going to talk about all of that. But for now, 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 are becoming bold with insulin. My friend Jenny Smith has had type one diabetes for over 30 years. She holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. If that wasn't enough, she just told me she ran a marathon. I mean, who does that running on purpose? This episode of The Juicebox Podcast is sponsored by trial net. Are you wondering what trial it is? I will tell you trial on it is a risk screening for type one diabetes. It is available at no cost to the relatives of people who have type one diabetes. Here's who's eligible are you between the ages of two and a half and 45. And have a parent brother sister or child with type one you are eligible? Are you between the ages of two and a half and 20 and have an aunt, uncle cousin grandfather, niece, nephew, half brother half sister with type one, then you're eligible. Have you tested positive for auto antibodies outside of trial net? Now then you're eligible trial net.org forward slash juicebox. Now once you get the you go to the website there, right you do a little typing you do everything. You have options about how to get screened, you can do an in home test kit. This free kit provides everything you need to collect a fingerstick blood sample from the safety of your home. And then you could just ship it back in a free FedEx envelope. Contactless pickup, ooh. You can use contactless pick up with FedEx contact less means no talking to anybody. Okay, sorry. So enough tests get I've got a little away from I saw, I was like fancy, I could just leave it outside, I'll come get it. In home test kit, you could also use a lab test kit, which would mean you would take the free screening kit, that trial that sends you to a Quest Diagnostics or LabCorp lab, and they'll handle the blood draw and take care of everything. Or if there's a trial in that location near you, you could just go there. And no matter which of those processes you choose, this is what happens next, you get your results, you will receive your screening results in four to six weeks. If your results show that you are an early stages of type one diabetes, trial net, we'll schedule a follow up visit to see if you're eligible for a prevention study. And remember what all this cost you nothing. It's free. It's really free. I swear to whatever you swear to put up your hand, hold your hand on something else. I swear to tell the truth, the whole truth about trauma, it's free trial net.org forward slash juicebox. Here's the thing, if you want them to know that you came from me, there's a checkbox while you're going through the process. You have to tell them I heard about this through the Juicebox Podcast, it's I think it's just a drop down box, you choose Juicebox Podcast, then you have to follow through and send in your test. So don't just get the kit from them and sit on it and think Oh, I hope the podcast you didn't they need to get your test back before I get credit for you, as a participant trial net.org forward slash juicebox. My family use trial net many years ago for my son and we've always been grateful for the information that is sent back to us. If you're not sure if you want to do it or not, I understand. But I would check it out trial net.org forward slash juicebox. Alright, I appreciate you listening to all that I'm really trying to help try and like get the word out about what they do. And of course that they're free. So I appreciate you listening. And now we'll get to the episode with Jenny and I know ads rest of the way. Do you think driving is a good variable? Or do you think that's just stress and anxiety?

And really do I mean? I mean, does that mean it's a variable? Sure. I you know, like driving to me, is 100% not a variable, but to somebody who has anxiety around driving Anxiety, fuel long distance travel, or you know, anything like that, could it? I mean, is it a variable? Yes, we can a short definition.

It's not an episode. It's not like that. Thanks. So I didn't think so either. I was just looking so then I want to jump to bad equipment. So we all have bad equipment. So the way it was presented to me by a listener was I think unprimed pen needles where you inject insulin or air excuse me instead of insulin. And just bad equipment, in general, is a variable for diabetes. And I have to tell you, inconsistencies in technology is definitely a variable. Oh, yes, 100%.

And I think the other picture too, is inconsistencies with technology. Because of initial training, on said, technology, I really do think that's a piece in the mix. Because from just a simple standpoint of many people who've come to work with me, or our practice, the amount of information that is left out when somebody is new to a product, or has transitioned from one product to another, and they didn't realize that this new product does this, or doesn't do this the same way anymore. I think that's another piece in the same bucket of variable.

Yeah. So where I think of it, it jumps to my mind is when you start pumping, after, after MDI, and how frequently do you see somebody say, Well, we started pumping on Wednesday, and I've already gone through three infusion sets, I've changed them three times, this thing doesn't work. I don't, and that is so common, that I think it should just be it should be the first sentence of anybody's conversation when they say, so you're going to get a pump? Well, here's what's going to happen. Next, you're going to see things happen, you don't understand, we're not going to have your settings right, you're immediately going to blame the pump. That's probably not what's going on. That fear will snowball on you. And within a week, you're going to be yelling, I shouldn't have done this, this was a huge mistake, and you're going to panic yourself, it happens to people so much. Right? And you're right, is that bad equipment? Or is that a bad understanding of equipment? And really, what's the difference?

Right? I mean, it's not that it's not that technically bad equipment, you'd think failure of the equipment itself, right? Something is clearly wrong. It's got an error message, there's, the tubing is bent or has something cracked or whatever. But quite honestly, in this circumstance, it's like, it's, it's bad information to the person who was going from one type of therapy to another, it's they didn't get enough of the right information, to tell them, these are the pieces to look for once you're starting again, MDI example to going to pumping, the first couple days to a week to a couple of weeks, maybe is going to look at, we're going to have to change things and check things and evaluate things because settings will need to shift. So what do you have

the panic comes from? Let's go down a little bit of a side street for a second. Is it the idea of like, I thought I had this figured out, and now it's different? And I don't want to go back to not understanding or do you mean, like, it's so interesting, how quickly I mean, what's the most common thing, right? You move to a pump, your your educator, plays the safe card and takes away some of your Basal insulin doesn't give you all the Basal you've been having, because they don't want you to have too much or whatever, which is a fairly common way for people to attack it. And then you see high blood sugars, and some how your brain just jumps to this pump doesn't work. It's it's that simple. It's yeah, yeah. You don't mean like, it's not a, they don't get they a lot of people don't get real thoughtful about it. Like, Oh, I wonder how much insulin I was using before versus how much I'm using now. It's right to this thing you handed me is what I remember last. And it's not working and it's not working. It's just gonna be panicky, right?

Well, and I think it is absolutely an it's kind of, as you said, you go from one quickly, you crawl the ladder of all the problems that it could actually be to, it's just the product, the product is bad. Clearly I shouldn't have done this. And I'm going to just go back to injections or to my previous management, you know, plan. But I think that brings in to you said something about when people are started on a pump, usually their insulin doses are kind of cut and to a point they are some of the reason for the cut is that infusion of one type of insulin now, instead of dosing with today Types of insulin as an injection under the skin, the body does. For most people, not everybody, but most people absorb from that one site better as a base Basal. And so we usually from a safety standpoint, you're right, we take the base dose down from what they were using as their Basal injected to their pumped Basal dose, we take it down by about 10%. On average, some doctors are definitely more conservative, they take it down by like 20%, which most often is kind of too much of a cut.

That's where it causes people's panic because they're like, well, this used to work. I also think to specifically tell me if you've seen this too, Omni pod can sometimes use a little more insulin than injecting Does that make sense to you? Or do you think that's just Do you think that's just not real? Do you think if you weren't using enough before, and then they go to a pump, and they think, Oh, I'm using more now on a pump?

It could be especially if you consider no may not be specific to Omnipod? It might you know, it, I think it definitely includes the other pumps on the market as well. But I also think if you consider the precision of an insulin pump, and that the dose can be as small as point 05 In Bolus doses, right. So if that's the case, and you were previously under dosing via injection, because you couldn't get the micro dosing between unit to unit, then what you may be seeing are more lows, or maybe more highs, if again, the doses were also adjusted to be more conservative to you. So that could be some of what they're seeing.

So it's a lot it's more ghosts like diabetes, ghosts, like you think something's happening, but it's not it has nothing to do with that. And your brain jumps to this thing. Now there are real bad equipment issues, you said, Yes, you can get a kinked cannula, air air in your tubing, right? If you don't prime your tubing and certain pumps. This this example that the person use an unprimed pen needle, I guess in a small child could be a lot of insulin, right?

It could be absolutely I mean, that's the purpose for every time you put a new pen needle on your insulin pen of whatever kind that you do that air shot, you know, a couple units that you dial up, you dose it into the air, and then you dial up your dose and inject. I mean, another common pen as an equipment kind of failure is that people are not waiting once they dose or completely inject the dose of insulin from a pen, you have to wait with that syringe under the skin. For account of I mean, I've heard anywhere between some people do five seconds, some people do whole 60 seconds. I mean, on average, I think it's recommended about 10 to 20 seconds, you count, leave that there so that all of the insulin actually gets under the skin and you don't have that leakage from the pen needle cap. When you pull it out. Again, there is a potential like error in the dose them that you're getting, if you're pushing it all in and pulling it right out and some leaks out and some is still dripping out of the needle cap and you're like, Well, how much did I actually get? How much is here anymore? How much is here?

I would say two in this episode. CGM. I think we all recognize if we use a CGM, that the first number of hours are not a spot on as they are as they kind of settle in and they start working around I think that's, that's um, libre and Dexcom. I would put them both in the same bucket. I would. Yeah, absolutely. So they're, I mean, you could call that I know, it's not bad equipment. It works the way they expect it to work. But if you are a person who puts on a CGM, and for the first 12 hours, get numbers that are higher than they really are, or they bounce around for Arden, when when Arden's waiting for her Dexcom to settle in, it gets a little bouncy.

Yes, right. So it's the data doesn't look smooth. It looks jagged.

Yeah. It's like she's 62 Oh, no, really. She's 120. And then I test and she's 130. And I'm like, okay, and then suddenly, it's like, she's 130. She's 63. And I'm like, wait, and then an hour or two later, it just doesn't happen anymore. Right. And it's over. Right. But the one time that I do see with CGM, and it doesn't happen frequently does but I've seen it a couple of times do you foresee it gets stuck at a stability that doesn't exist? Like you ever look back at 12 hours in because there's no way that I was 92 for 12 hours? Yeah, and then and I learned to see that just

laid on the couch and looked at the ceiling and I didn't

move possibly be what happened, right. And I I have learned that when I see stability, like super stability over a long period of time, somebody just asked me the other day, like when do you test still, that's one of the times if I see something that's too good to be true, I checked to make sure to see Jim's telling me the right thing. Right? You know, that's just one of those spots.

Well, and I think in terms of like this as a technology, failure kind of piece, it's you bring in a good point in that really early time after a sensor is put on. If you're the if you are one who is not doing finger sticks in that time period, and you are dosing, whether injection or pump or algorithm driven pump off of what the CGM is telling you, there could be significant error in the dose that the pump or your you know, injected math calculator, you know app is giving you because you're using a number that's actually not accurate from a CGM. That's not quite accurate.

Yeah. Now you're making you're making insulin decisions often and writing attention to it because you have a ton of comfort around it at that point. I guess it'll be fine. What else is bad equipment? Like? You know, I almost want to throw in here because I don't think I don't think it's worth its own episode, but people want it to be when insulin goes bad. Arden's had diabetes, since she was two, she 17 I've never seen her insulin go bad ones. So like, I know, it happens to people, but it doesn't it can't possibly happen with the frequency in which you see people online use it as a reason why something could have gone wrong. If you don't mean that, like, every time someone sees a high blood sugar, someone comes into this, oh, your insulin might be bad. Right?

And it is, I think it's a good it's, it is a variable, it's one to definitely consider and in terms of like, technology or device failure. Yes, I mean, insulin is kind of a piece of technology, not like equipment, but it's part of what you put into your equipment, right. So, um, but there are definite times that it could be, what is the driving nature of the high blood sugar, days where you have sat, you know, outside for hours on end, you know, 100 degree weather super humid, is your insulin in the vial going to be bad? Probably not, unless you had it sitting out in the heat with you, is the insulin in your pump or your pen going to be bad? That could possibly happen? I mean, insulin degrades pretty quickly in more extreme high temperatures, comparative to almost from what a couple of studies have kind of shown not as much detriment to like, cold or really cold temperatures. So you know, again, consider high blood sugars, hours after you've been outside really hot, change the insulin in your pump and see if it takes care of the issue. But unless it's really, a vial or a pen that sat out for a long enough time in heat

doesn't magically go bad. Right. Okay. If we did a survey, would we find that people in Florida and Nevada have higher a onesies? I don't know. I don't

know. I mean, if anything, I would think that maybe people in more consistently hot temperatures. Maybe they are also those who change their sights more frequently, or change their you know what I mean? Or change their reservoirs more frequently, especially depending on what type of job or outside time they spend. I would probably say that, more than maybe a difference in a one. See, I don't know,

I'll throw I'll throw this in for equipment failure. I guess I'm making quotes around that. Now. There are some test strips that once you touch it to blood, if it doesn't register, and you go back and get more blood, it actually hurts the value of the of the test. Like there's some like, like the Contour Next One has Second Chance test strips. They don't they don't all have, you know, Oh, yeah. So there are times where you touch the blood to it, it doesn't work, you need to throw the strip away. And unless you're unless your strips handle like seconds, correct. I guess that's one place right?

That would be definitely a tech that. I mean, again, it's not technology, it's more error. It's more user error of not knowing how their technology works

almost all of this is really what that is, you know, I mean, how many times online you're like Oh, I see the problem here you are the problem let me try to gently explain to you what you've done wrong see, because there's no way for you to know you know what I mean? There's no reason to feel badly about it. But right

I mean, have they know and they wouldn't have done it that way.

Yeah, do figure it out. But I think that's the thing is you don't always figure it out and sometimes it's just you think you get into that like mindset of like oh, I guess this is how this is and then you just suffer with it. I would say to to throw in here not all the meters are created equally as far as accuracy goes. So no, do you

not I mean, the last time I actually, the last time we did a visual of all of the accuracy ratings within those little pamphlets that nobody reads inside of their test strip container, right? Or their meter, you know, information. The Contour Next One was top in terms of accuracy. The other ones on the list are the accucheck guide, or the accucheck. Guide me. The Freestyle light was also within that context of accuracy. So in terms of like top level monitors, those are ones that had really, really good accuracy.

Yeah. Hey, I know you didn't say this for this reason. But let me just say here, Contour. Next One, comm forward slash juicebox. That's all.

I didn't even know that. So

they're, well, they're a sponsor because of that, because of the, because it's the I got to the point where I felt like I kind of had my choice of advertisers around a meter. And I was like, Well, I'm going with the best one. Like, why would I? You know, why would I not do that?

Yeah. And then as kind of a, you know, a second to it, I, I would love to be able to use the contour I can't my insurance does not prefer it doesn't cover it at all. In fact, even if I wanted to use it, but they do, they do prefer the accucheck brand. So I use the guide me. And I did have some test strips for my contour as a comparison when I first started using it. And I can say that, from from how the tests looked taken from the same drop of blood. They were very comparable. So from a standpoint of accuracy, that's

yeah, I'm not saying you have to get the Contour. Next One. I'm saying you can. It's great. If you want to support the show, you can, by the way, Jenny, did you know that it's possible that your Contour Next One meter may cost less in cash than your other meters costs through your insurance? You should check out the link to find out more. Did you did you know that I

did not know that. I do

that sentence at any time if I need.

That's pretty funny. I just said a lot. That's

all. Alright, I think this was great. Thank you very much. Cool.

Yeah, you're welcome.

First, let me thank Jenny for coming on the show yet again and being delightful. And don't forget she works at integrated diabetes.com If you'd like to hire her. I also want to thank trial net for their sponsorship of the Juicebox Podcast and remind you that trial net offers free type one diabetes risk screening that you can do right from your home. Trial net.org. Forward slash juicebox. If you skip through the ad, the beginning, you should have done that go back it explains trial net completely who's eligible? How to sign up? How to get screened, how to get your results, what happens next? Go back and listen if he did, but if he did listen, remember this information is power. Couple things and I'll let you out of here. Don't forget, if you're looking for a community, try the Juicebox Podcast private Facebook group with over 17,000 members. It is a private and supportive community that you should check out Juicebox Podcast type one diabetes. Also wanna remind you that the diabetes pro tip episodes begin at episode 210 and are available at diabetes pro tip.com, and Juicebox. Podcast calm. If you're a part of the Facebook group, I think there's actually Spotify playlists in the Announcements section. But if you're not listening through Spotify, you can see an entire list that will help you understand the Pro Tip series diabetes pro tip.com. While you're there, you should check out the defining diabetes episodes as well. If you're a US resident, go to T one D exchange.org. Forward slash juice box. Fill out the brief survey that helps people living with type one diabetes, super simple questions. Completely HIPAA compliant, completely anonymous takes less than 10 minutes, you can do it right on your phone, right on your sofa. You're going to help people living with type one, you're going to support the podcast. I'm trying to get to 2000 completed surveys by the end of diabetes Awareness Month. So one month from now. Go go go. If you all stopped and did it right now. Just based on how many people I know are listening to this episode. Not only would there be way more than 2000 but you might you might hear a pop like an audible out in the world. That would be the minds of the people at the T one D exchange just blowing they just be like oh, I can't believe that happen. That'd be it. T one D exchange.org. Forward slash juicebox. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast.

Hello, everyone, and welcome to episode 580 of the Juicebox Podcast. Hey guys, welcome back to another diabetes variables episode with me. I'm Scott and Jenny Smith. Jenny, of course, works at Integrated diabetes. And you can hire if you'd like at Integrated diabetes calm. The diabetes variable series has been going over listener submitted variables for type one diabetes, and today's topic is weight change. Maybe put on a little tick off a little gain muscle lose muscle, that's a variable for diabetes. And in a moment Jenny and I are going to talk about all of that. But for now, 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 are becoming bold with insulin. My friend Jenny Smith has had type one diabetes for over 30 years. She holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. And if that's not enough, she's one of the kindest people I've ever met. This episode of The Juicebox Podcast is sponsored by trial net. Are you wondering what trial it is? I will tell you trial on it is a risk screening for type one diabetes. It is available at no cost to the relatives of people who have type one diabetes. Here's who's eligible are you between the ages of two and a half and 45. And have a parent brother sister or child with type one you are eligible? Are you between the ages of two and a half and 20 and have an aunt, uncle cousin grandfather, niece, nephew, half brother half sister with type one, then you're eligible? Have you tested positive for auto antibodies outside of trial net? Now then you're eligible trial net.org forward slash juicebox. Now once you get the you go to the website there, right you do a little typing you do everything. You have options about how to get screened, you can do an in home test kit. This free kit provides everything you need to collect a fingerstick blood sample from the safety of your home. And then you can just ship it back in a free FedEx envelope. Contactless pickup, ooh. You can use contactless pick up with FedEx contact less means no talking to anybody. Okay, sorry. So no test get I've got a little away from I saw, I was like fancy, I could just leave it outside, I'll come get it. In home test kit, you could also use a lab test kit, which would mean you would take the free screening kit that trial that sends you to a Quest Diagnostics or LabCorp lab, and they'll handle the blood draw and take care of everything. Or if there's a trial in that location near you, you could just go there. And no matter which of those processes you choose, this is what happens next, you get your results, you will receive your screening results in four to six weeks. If your results show that you are an early stages of type one diabetes. Trial net, we'll schedule a follow up visit to see if you're eligible for a prevention study. And remember what all this cost you nothing. It's free. It's really free. I swear to whatever you swear to put up your hand, hold your hand on something else. I swear to tell the truth the whole truth about Tron it's free trial net.org forward slash juicebox. Here's the thing. If you want them to know that you came from me, there's a checkbox while you're going through the process. You have to tell them I heard about this through the Juicebox Podcast it's I think it's just a drop down box, you choose Juicebox Podcast, then you have to follow through and send in your test. So don't just get the kit from them and sit on it and think Oh, I hope the podcast you didn't they need to get your test back before I get credit for you as a participant trial net.org forward slash juicebox. My family use trial net many years ago for my son and we've always been grateful for the information that is sent back to us. If you're not sure if you want to do it or not, I understand. But I would check it out trial net.org forward slash juicebox. Alright, I appreciate you listening to all that I'm really trying to help try and like get the word out about what they do and of course that they're free. So I appreciate your listening. And now we'll get to the episode with Jenny and I no ads rest of the way. I'm gonna start with weight change as everyone knows by now, you know listen to the podcasts and in like 150 different variables that they find that impact their blood sugar's weight change was one that was brought up by a number of different people. And I think it's something that gets lost that people don't don't see. I see it mostly when people are talking about Children, because their kids gain weight. And they don't notice it. But doesn't everybody gain weight? not notice it? Really? You don't I mean, like, you know, I'm saying like, colloquially like we don't, most of us don't know when we put on five pounds at

first. True, yeah, unless you're really the person who is very much on top of like, I weigh myself every single Friday morning when I get out of bed with no clothes on.

Like, I have to have this weekly, weekly weight sort of check in.

So yeah, I would say even five pounds is kind of hard to feel a difference on your body. I think the biggest shift in terms of noticing is like how your clothes are fitting. And that also then means that it's kind of where did the weight goal to go more around your waist? Your pants are harder to button now? Did it kind of get distributed evenly through the course of your whole, like all the fat cells in your body? And maybe you're really not visually seeing the five column weight gain. But we changes affect diabetes? As a general statement? Yes.

So where do you think it affects first Basal is that

from a if we're talking true weight change in terms of fat weight gain, right? Not muscle fat, not muscle weight gain, but fat weight gain, then metabolically, you would think you would see the change in Basal first. Now if you're somebody that hasn't really had much precision around like mealtime, dosing or whatnot, you might also start to see more excursions around meal time than you did before. But also that could be that there's not enough Basal behind it too. And so your Bolus is just are covering as well as they were before too. So Basal first,

I was just delighted that you use the word excursions for oh, I don't know why. I just she means when things get upside down at mealtime. Why is my blood sugar 240 All of a sudden? Yes. I love the use of that word, it really took me by surprise. Are you saying that if I like yoked up and put 20 pounds of muscle on it, the impact would be different or different

how because remember, the more muscle that you have on your body, typically speaking, the more muscle you have. Muscle needs to be maintained by the body. And as such, muscle gain means a higher metabolic turnaround. It means that you use energy more efficiently that somebody who weighs the same amount, but is more fat weight than muscle weight. So typically, we would expect that the more muscle gain you have, you would have more sensitivity to insulin. To maintain that weight, you also probably have a pretty regimented exercise plan, both some cardio, some resistance, some, you know, weightlifting, whatever is in the mix. So all around heavier weight increase in the body, whether it's toning and definition and muscle build or like body building muscle, you would expect that your insulin needs may metabolic Basal wise go down because you're burning things and using insulin better.

Okay. So just being healthier, in general, can require less insulin, because of what it infers not only the way your muscles work in your body, but you're probably eating differently or working out differently than even a person at your same weight. Who's more sedentary? Correct, got it. Okay.

And I think along with that, you can kind of, you can actually see a pretty quick turnaround in difference. Let's say that you're a person who exercises pretty much every day, like at least 30 to 45 minutes of some type of movement that is designated in a time period, right. And let's say you have a week where you are not sick, but just things have gotten so busy that you literally just can't even get out the door and go do what your normal thing is mid to end of that week, you may definitely notice the difference in no exercise compared to the sensitivity you were seeing when you were regularly day after day or every other day, moving your body

and that'll you'll notice that by your blood sugar's rising in general,

right and less response to insulin in the way that you had been experiencing comparative to in a more sedentary, okay, setting.

So, so more I guess let's look at kids for a second is the similar idea with kids gain weight. Then as their growing parents kind of don't notice. And then they suddenly nothing's working. So there's nothing really different here. Right? If your child gaining weight or or an adult, I mean, is it that the similar?

Well, I guess not so much. But in a kid, remember, if it's healthy weight gain because of normal growth pattern, it's what would be expected in terms of where they are, in age or in life, their gain is for a, for a real reason, they're growing. So they may be growing right, gaining weight, and then they may grow in height as well. Kids usually grow out, grow up, grow out, grow up. And so with growth, usually, you'll see those typical things which we've talked about in terms of like, increase in insulin during those growth periods and whatnot. But then usually with growth, that has been a weight gain, and the increase in insulin need will be sustained. Because they've gained some weight. I mean, kids usually don't go from one week weighing 42 pounds to the next week weighing 52 pounds. I mean, that's, that's excessive gain, right? There's something wrong.

What about, let's, let's say we have an adult who's, generally speaking, is that a weight that they they wish wasn't so and there, they go about losing weight, but they do it? Let's just for an example, let's say they do it in an unhealthy way. It's not, it's not about exercise, they just stopped eating or something crazy, okay, and then they're losing weight, will they see it? Will they see a decrease in their insulin needs, because you're not adding exercise, you're not adding good food, you just just the dwindling of body mass?

Absolutely, they'll see a difference. I mean, their mass their body mass has gone down, they will metabolically require less insulin, unless the weight loss is such a stress on the body. Enough of a stress kind of like an illness, they stress that the body is really like, bothered by this loss and struggling through it, especially in I mean, you brought up like just stopping eating or dwindling, the amount that comes in to a considerable amount. Again, that could be a significant enough stress that while insulin needs will go down, because of the weight based shift, they the stress on the body may make it look less significant. Again, these are like assumptions around a scenario,

right? No, I just wanted to paint a picture because I because I'm a little afraid that this episode really should be, hey, when your weight shifts, your insulin needs are going to shift shift. Yeah, yes. And then the music plays at the end. And we say goodbye, like so. Yes. Yeah. I just wanted to

I mean, that's in a nutshell. Absolutely. That's it? Yes.

I just wanted to give some contextual ways that people might see it in their real life. So that it's not just so simple as hey, if your weight shifts, because I think it's possible people don't notice that as much even great stunning when you don't notice it on your own kid or yourself. I mean, especially on yourself, if you're a person living with type one. I mean, or if you're, you know, you don't notice people you live with people you live with are the last people to ever notice that you've gained because they see you every day, there's no way for him to tell whatsoever. I will like walk down stairs, sometimes I'll be like, Yo, anybody want to notice like, but I look better? If you notice how, like, flatter my chin is or like anything and like, No. So then you think, well, what's the point? They just seem to be the same

point should be for your own self benefit should have nothing to do with others. Right. But I think you know, as a variable, which is what this really is right? weight change as a variable. I think you bring up a good point in terms of excuse me, if you've looked at so many other things, as Why are my insulin needs so much higher? Why does it look like I'm so much more sensitive? Maybe is it? Have you stepped on the scale lately?

Yeah, maybe you just don't know what happened. What's happening, right. Okay. All right. Great. Thank you. Yeah. Let me thank Jenny. And I'd also like to thank trial net for sponsoring this episode of The Juicebox Podcast. go to trial net.org, forward slash juicebox. To get started right now, don't forget to tell them that the Juicebox Podcast sent you when they ask on the forum online, they'll be like, Where'd you hear about this, you say Juicebox Podcast, and then you get the kit and then send it back. And don't forget trial net is 100% free for you. Trial net.org forward slash juicebox. Couple things I'll let you out of here. Don't forget, if you're looking for a community, try the Juicebox Podcast private Facebook group with over 17,000 members. It is a private Have it in supportive community that you should check out Juicebox Podcast type one diabetes. I also want to remind you that the diabetes pro tip episodes begin at episode 210 and are available at diabetes pro tip.com, and juicebox podcast.com. If you're a part of the Facebook group, I think there's actually Spotify playlists in the announcement section. But if you're not listening through Spotify, you can see an entire list that will help you understand the Pro Tip series at diabetes pro tip.com. While you're there, you should check out the defining diabetes episodes as well. If you're a US resident, go to T one D exchange.org. Forward slash juice box. Fill out the brief survey that helps people living with type one diabetes, super simple questions. Completely HIPAA compliant, completely anonymous takes less than 10 minutes, you can do it right on your phone, right on your sofa. You're going to help people living with type one, you're going to support the podcast. I'm trying to get to 2000 completed surveys by the end of diabetes Awareness Month. So one month from now. Go go go. If you all stopped and did it right now. Just based on how many people I know are listening to this episode. Not only would there be way more than 2000 but you might you might hear a pop like an audible out in the world. That would be the minds of the people at the tea when the exchange just blowing. They just be like oh, I can't believe that happen. Maybe he won the exchange.org forward slash juice box. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast.

Hello friends, and welcome to episode 584 of the Juicebox Podcast. Today, I have a brief diabetes variables episode for you with me and Jenny Smith. I'll be getting to it in just a few moments. Before I start, please let me remind you that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. if I'm remembering correctly, there's three more variables episodes left, and then they're done. Took all year but I thought it was a really good idea. And I hope you enjoyed it. For today, I have one for you that is very real, and yet may be misunderstood by some people. My friend Jenny Smith has had type one diabetes since she was a child for over 30 years. Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. I don't usually put so much effort into timing the episodes, but this one's for Black Friday. This episode of The Juicebox Podcast is sponsored by trial net. And trial net offers type one diabetes risk screening at no cost to relatives of people with type one diabetes, you can sign up right now at trial net.org. Forward slash juicebox. I don't know if this is just a thing from online. But how many times have you heard someone with type one diabetes say that Walmart makes their blood sugar? Go low? Yeah.

Or any really I mean, it doesn't have to be that brand name place. But yes, but absolutely. But

online. It's it's a moniker right? I went to Walmart, my blood sugar, I'm on my way to Walmart, I know my blood sugar is going to get low. Okay, so is it as simple as people are maybe sedentary in their day to day life. And now all of a sudden they're up, they're moving around, they're driving, they're getting out of their car, they're walking through the parking lot. They're walking through Walmart, they've added activity, probably with an insulin on board that's meant for sitting around.

That's the simplest explanation of anything. Yes. I mean, that's it's not rocket science, quite honestly. And it's, it's longer term lingering. It's not that you for the most part, people aren't running in and getting batteries at Target. And then they end up back in the car. And then they're low. That's this is like, Okay, I'm planning you know, the trip to Walmart or wherever it is. And it's a trip, it's you're doing your errands, you're getting things done, it may not just be there, you may also be going to the grocery store, you may love be lugging bags and think of I mean most big places like a target or a Walmart these days, or not just go in for like underwear, right? They are like the super targets. They are the stores, you can buy your water jugs there. You can buy gigantic things of totally lit paper, or whatever it is. So you might be doing a little bit more activity than just walking around popping things into your car

doing a bit of an excursion. You're lifting things. You're right. Yeah, maybe you're doing the like, Oh, let me look at the shower curtains before I go buy milk because it's all in place. And you're humping around. And then you get low at Walmart. All right, correct.

Yes. And, you know, quite honestly, if you're a parent of a child, and you're the person with diabetes, and your children are young enough that they won't sit in the cart anymore. And then they're running around and they're in between all the aisles. You're not only putting things in your cart, you're now chasing around a lot more in terms of, you know, activity.

It's it's interesting that anecdotally, I mean, I understand that it's joking for the most part, but then you do see a couple of people say very earnestly, like Walmart makes me low. Like they like they don't see it as well WalMart where I shop, it's not Walmart, it's this is where I'm going shopping, and they don't make the connection between the exercise. And the thing like it's such a weird A B that the people's minds have some time

right it's just it's the store right? It's the stores fault that I went low. I mean, it's it's funny because quite honestly, I mean everybody in terms of like, nobody's perfect with diabetes. And myself. I have had to like grab a bag Have like gummy bears the middle of target shopping because I was like, I started out fine. I planned that, you know, like all the things that you would plan knowing what was coming. And it still didn't work out the way that you did. And now with, you know, like wearing masks everywhere. Now it's like popping them under the mascot. It looks like you're chewing on something. But she doing like, you know, the fun stuff.

I mean, Arden was younger. And I didn't have quite a grasp on this. This would happen to us and I never get back then I didn't have to and to to even put the I didn't even know what to into was let alone right. I couldn't add them up, you know. But it would be interesting that if she got low in a public place where they sold food, and you grab something off the shelf, she was too low to be okay with. She felt like she was shoplifting the food. Right? I wonder too. If that happens if people's mind start going down weird paths, like I can't eat this. I haven't paid for it. I'll go pay for it first. Like you ain't got time to pay for it. Like explain it to the security guy. Yeah, you know, when he catches you down in the Gatorade, and I'll 16

Yes, I mean, those are all my internal monologue. I could care less if you're gonna ask me why I'm eating gummy bears right now. Have at it. I got a whole load of stuff to talk to you about. So don't bug me.

I'll pay for it. Calm down. Yeah. But But it happened to her more than a couple times where she's like, I can't eat this. I haven't paid for it. Oh, Arden. That's sweet, honey, you're just gonna eat it. And we're gonna pay for it afterwards. It's fine. You know, I think because if we wait, and now I'm explaining it like now and you have to remember to back then probably no CGM. I just got this little I'm looking at this number on this little freestyle meter, you know, and I'm like, Oh, honey, we'll pay for it later. Eat the food. Eat the food. Eat it, just eat it. Right, right. Because there's that other thing that happens to her too when she if she gets too low. She goes, I don't want juice. And I'm like, But juices the thing that works the best right now liquids, the thing that works the best right now. And then she starts turning into a food connoisseur. She's like I would prefer to have and I was like, yeah, no, not right. Now. If you eat that, you know, you're gonna pass out before you wake up. So can we get to it, please?

Right. That's the point at which she's like, I'd rather have a boiled egg Daddy, you're like, No. Yeah. Oh, my gosh.

She once said to me, can I get avocado toast? And I was like, as soon as we're done fixing this low blood sugar, you can now write avocado says great.

But as a variable. I mean, you're right. And in terms of like, it just takes planning. Like if it's if it's commented on often enough, clearly people know that when they're going to go out whether it's grocery shopping, or Walmart or wherever. You're going for it. Yeah.

Well, let me let me ask you a question as a person with type one your whole life basically. What is that mechanism there that makes the idea of Pre-Bolus thing so difficult or setting a Temp Basal to go grocery shopping? Or, you know, like, I mean, I mean, how many people stand up randomly at 1115 and go I'm going grocery shopping right now. Like you don't think you're you at least know you're going grocery shopping today. Right? Like, set a Temp Basal if you get low at the grocery store,

right? Or if you don't, if you can't think that far ahead. Again, if it wasn't really a plan, you're driving and you pick up your kids, you're like, Oh, I really needed this at the store. So and then you stop off. Okay, fine, unplanned but at that point, then you know, what's going to happen? Yeah, so take a snack. Right?

Like have some sort of like stabilizing snack before you leave or something. Right. Yeah, I actually it's funny you said like that, because what I was thinking was that somebody recently I asked what episodes of the podcast are really helpful and she's like, she said, trust the trust episode. It's called trust what you know is gonna happen it's gonna happen. And that's what I wrote about like, I mean, how many times you have to get low at Walmart before you go. I got to do something about this. I'm going to Walmart can't possibly be Walmart's fault.

Hey, or maybe you plan your Walmart trips around the around the fact that when you're high, I have to go out the door. to Walmart,

you see your blood sugar 180 Diagonal up. You know what, it's time to go grocery shopping. That's right. There you go. Hey, what's up everybody? I'm going to explain TrialNet to you in some detail. As I mentioned before, trial net does type one diabetes risk screening at no cost to relatives of people who have type one diabetes. Here's who's eligible, immediate family members under the age of 45. And second degree, family members under the age of 20. I'm going to break that down for you. If you're between two and a half and 45 years old, and you have a parent brothers Sister or child with type one, you are eligible for trial. If you're two and a half to 20 years old and have an aunt, uncle, cousin, grandparent, niece, nephew or half brother or sister with type one, you're eligible. If you've tested positive for auto antibodies outside of trial net, you are eligible for trauma. Okay, now that's who's eligible. Now I'm going to tell you how to sign up. You go to trial net.org forward slash juicebox, you'll answer a couple of quick questions, make sure that you're eligible for testing. And then you can join 1000s of t one D families on the pathway to prevention. Here's how you get screened three ways. They're all simple trial that can send you an in home test kit. And this kit will provide you with everything that you need to collect a finger stick blood sample from the safety of your own home, and return it using FedEx contactless pickup, the second way you could do it is to get a lab test kit, then you could take this free screening kit to any Quest Diagnostics lab, or lab core lab for a blood drop. And the third way is if you live near a trial net location, you can go there to have the blood trial done. After that, you just need your results. And they'll take between four to six weeks to get to you. If your results show that you are in the early stages of type one diabetes trial net, we'll schedule a follow up visit to see if you're eligible for a prevention study. You may be asking yourself, why would I want to know if I or a loved one have these antibodies? Well, type one family members are at a 15 times greater risk to develop T one D than the general population. T one D risk training will detect if you are in the early stages of type one diabetes. If you are identified as at risk trauma will be there to help you. They have prevention trials. If your screening results show that you're in the early stages and type one, you may be eligible to join Prevention Study. It's testing the ways to slow or stop the disease progression. There's also ongoing monitoring by top type one diabetes researchers in the world. And if you develop type one, being monitored in a clinical research study like trial that decreases your chances of DKA from 30% down to three. So there you go. All of that absolutely free to you. A future without type one starts with you. Research can only advance with participants, the more participants who are involved in clinical research, the faster we'll get our answers. So you're in a unique position to identify treatments that will slow or stop type one from happening for you or a loved one and helping clinical research that could help everybody. In the last 20 years trauma has been the leading network and type one diabetes prevention research. In addition to being able to accurately predict who is going to develop type one trial that has now found a way to delay it by leading it to Ms. apoB prevention trial to miss aplomb is the first drug to delay type one diabetes for a median of two years. Trial net.org forward slash juicebox when they ask you where you heard about them, say the Juicebox Podcast and when you get your kit, you have to complete it and send it back in order for the podcast to get credit for you. Trial net.org forward slash juicebox Alright guys, so like I said there's a couple of more variables episodes coming up. But they began back on episode 491 With trampolines after that there was temperature, travel, exercise hydration, food quality, leaky sites or tunneling video games stress masturbation school, bad sites, growth hormones, sleep pump site placement, a full moon weight change this one today, Walmart and there's a couple more coming before this series wraps up for 2021 I hope you've enjoyed it. Go back and check out the ones that you might have missed. They're all available at Juicebox Podcast comm we're right there in your podcast player. I'm putting this one out specifically on Black Friday in case you're out there in the thick of it trying to get yourself a cheap TV or something like that. Just wanted to have this one for that. There's also a diabetes pro tip episode of episode 231 all about variables. If you don't know what the diabetes pro tips are, you should check them out at juicebox podcast.com or diabetes pro tip.com A pro tip series begins at episode 210. Hey, thanks so much for everything. You guys are absolutely terrific the way you listen download, subscribe, share the show with other people. The support is amazing. To be very clear with you the week of Thanksgiving is normally one of the slowest downloaded weeks, all year and yet this year, I didn't even notice a slowdown. I was really touched Honestly, I know there are a lot of things you do with your time. You're busy. You could be doing anything and listening to anything. And the fact that there was no downturn this week. I mean, it really blew my mind. I really appreciate it. Seriously, this is the end of the seventh season of this podcast. And to think that it's on the uptick is, it's just mind bending to me. I really love you guys. I appreciate your support. I'll be back very soon with another episode of The Juicebox Podcast. Happy Thanksgiving. To those of you who celebrate. And to the rest of you. I hope you enjoy your Thursday. Oh, that reminds me, the private Facebook group Juicebox Podcast type one diabetes right now it's really late on Thanksgiving night. While I'm doing this. Don't ask why I didn't do this sooner. I messed up. It's just full of people celebrating and sharing their graphs about how they handled Thanksgiving. Some people had some tough times. If you want to see great examples of how people Bolus for a big day full of food. You should check it out. Juicebox Podcast type one diabetes. It's a private Facebook group with now I think over 17,000 members. It's absolutely an amazing place to either watch other people talk about type one management and living with type one, where to get involved yourself and have one of those conversations that you need to have

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

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

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

I would expect that that's what it is. Honestly, yes, we'll

drop that into something at some point. Ooh, constipation. That doesn't strike you that way.

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

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

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

I have to tell you, we have a half an hour here and our little chatting just now made me realize how to handle the rest of this list, okay. On today's episode, Jenny Smith and I will go over the rest of your diabetes variables list. We first talked about variables in Episode 231 In a protip called diabetes proto variables. And then wow, two years later, I started the variables series. It began with trampolines went to temperature travel, exercise, hydration, food quality, leaky sites, video games, stress masturbation school, bad sites, growth hormone, sleep pump, site placement, full moon diabetes, tack weight change Walmart today is and the rest I'm not sure what the call it yet. And then by the way, there's going to be two more after this, but you'll hear about that later. While I'm talking to Jenny Smith, who by the way, has had type one diabetes for over 30 years. My friend Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. She is also simply the best, the bestest. You want to hire Jenny. She works at Integrated diabetes. This show is sponsored today by the glucagon that my daughter carries, G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. And as season seven winds down and the end of the year approaches. I'd like to mention all of the sponsors this year we were sponsored by Dexcom they make the Dexcom G six continuous glucose monitor by Omni pod makers of the Omni pod dash tubeless insulin pump touched by type one my favorite diabetes organization, the Contour Next One blood glucose meter, G voc hypo pen that's glucagon. And towards the end of the year TrialNet did a little sample ad with us for about seven weeks. Hopefully they're happy and maybe they'll come back in 2022. I did just add another advertiser for 2022. I'm not allowed to say who it is yet, I don't think. But it's somebody who's been around before. And I'm glad they're back, we'll say that. On top of the advertisers, there's the T one D exchange, who, while they are not an advertiser, every time you hear me talk about them, they don't pay me to talk about them. But they do give me a couple of dollars. Every time you take their survey AT T one D exchange.org. Forward slash juicebox. I've thanked everybody this year, over and over again. Who has bought me a cup of coffee at buy me a coffee.com Ford slash Juicebox Podcast. What else? Have you heard me talking about these bumpers and ads? No, I tell you to go to the private Facebook group for the podcast right Juicebox Podcast type one diabetes that now has like 17,000 or more members in it. So bustling type one diabetes page full of really good people. It's very unlike Facebook, but happens to be on Facebook. I tell you about Juicebox Podcast calm, the diabetes pro tips, the defining diabetes series, the variable series how we eat algorithm pumping, after dark, you guys are just over and over again. Terrific. So much so that November, I'll tell you that today's the 29th when I'm recording this November just became the most popular month in the history of the podcast. As a matter of fact, every month since May of 2021, has been the most popular month of the podcast, this podcast will do over 2 million downloads just in 2021. And it's all because of you guys. It's how you share the show and talk about it. It's when you put great ratings for it wherever you listen, it's word of mouth, there's nothing else to it, if you enjoy the show, tell somebody else it helps the show to grow. When the show grows, more people hear it. When more people hear it, we have a greater chance of somebody needing one of the advertisers. When that happens, and you click on one of my links, the advertisers come back. And I get to keep making the podcast. And then you get to keep listening to it. It's a circle of life kind of thing. So thank you very much to everybody listening to everybody who's ever shared or told their doctor or a friend or to the lady this year who told me she bumped into somebody at a Costco wearing a Juicebox Podcast t shirt. Like my favorite story of 2021. Two people who listened to this podcast met strangers, right out in public. That's pretty cool. Anyway, I appreciate you guys so much. And I appreciate the sponsors. It's a terrific lineup of quality products, organizations and services for people with diabetes. I'm super proud of it. I really am. I've never once ever thought, Oh, I can't say this ad. You know, I'm lucky to have advertisers like this. And I'm lucky to have you guys listening to the show. So that's it. Here's Jenny and my conversation about the end of the variables list where we basically just go over a bunch of variables. We've gotten to the point on the list of variables that were sent in by listeners where there are multiple ideas that sort of they fit together. You know, they're the, you know, somebody says emotions, but then somebody says getting angry and stewing and being angry, Jenny and I can't do a variable for each and every one of them. So what were tantrums? Yes, right. That's right. So instead, what we're gonna do is run through what's left on the list, and just hit each thing very quickly will tell you if we think it's a variable or not, but probably doesn't deserve its own episode or need need its own episode. And then that'll be it. We'll move on, we're gonna start adding more stuff back to the Pro Tip series after that. So, alright, Jamie, here's what we haven't done yet on the list. And to be clear, the list is 150 things long. We've already done the things that are clear variables that, you know, translate to a lot of people, right. We can't do the, you know, the one thing that somebody is like, you know, pointing to for themselves specifically, we're not going to start doing personal variables. But here's some stuff that we didn't get to, but probably mentioned in other episodes, so showers and baths we talked about in the temperature episode for sure. Right? Yeah. So if you want that head back to their illness we did talk about and obviously being sick blood sugars, was one week could have probably made its own episode, but then you would have seen how it leaned into other ones is somebody just said Life, they're trying to be funny, I get it, right. Life is all variables, high blood sugar moves around because things happen. But that's what the whole variables episodes are about is that there are these little things that happen in your life that you don't, you don't think of as being impactful. And I think what happens sometimes, and Jenny and I were just talking about it kind of privately a second ago, is that we don't see the forest for the trees, sometimes, you know, Walmart makes me low, not usually I sit around and my, my blood sugars are at one level, and I have an insulin use at one level, and then suddenly I get up and running around, I'm grabbing things in the store. And then my blood sugar goes down, Walmart doesn't make yellow activity. When you have a bunch of active insulin, make sure though, but that's the life thing. Right? Like, there are things that happen. I think, I think that the thing to remember here is that you have your settings put together in a way that works best, during the largest swath of your 24 hour period, as you have, you've been able to figure out during your

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

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

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

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

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

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

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

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

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

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

I would think so. Yeah, I think that's a good discussion.

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

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

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

I would say menopause could be its own definitely.

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

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

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

I'm sure. Alright.

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

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

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

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

Interesting. And then ironically, on the list the next one's emotions. So

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

So the adrenaline overwhelms the emotion. Right? Yeah. Is caffeine its own or no,

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

Okay. The next two we've literally talked about in the last couple of moments in a different way infections and excitement so we're good there. I will say this. If this one's an episode, I don't know because I've never understood when people talk about this daylight savings. How the heck does that change things that much it's an hour right. Je voc hypo penne has no visible needle, and it's the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about, all you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit je Vogue glucagon.com/risk I love the G vocab because it runs perfectly into this little music swell. How the heck does that change things that much? It's an hour right? It is.

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

So then that goes right along with this one here. schedule change, same thing. Yes.

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

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

it'd be like, 911 Yeah, I'm calling for this location, not where I live.

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

an irritability, more temper tantrums, probably less sleep. I mean, all a collection of variables in one.

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

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

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

maybe they're a hockey player.

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

go back and listen.

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

And I think we talked a lot about that in hormone based episode. Yes.

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

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

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

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

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

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

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

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

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

are her ISF is different based on the system that she's on or her ISF different through the day then that may make a difference?

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

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

It's got to be like barometric pressure doesn't move your blood sugar, right?

I've never looked that one up. That'd be an interesting thing to look up. I've never, I've never checked.

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

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

Okay, so alcohol is does that need its own?

I think we set Yeah, I think calls definitely. We're gonna make

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

Everybody should go to the bathroom every day.

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

My boys love that book. It's I think, actually, it's called everybody poops. They love that. They think it's hilarious.

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

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

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

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

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

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

Oh, wow. Do you think you could pick it up and like knock something out with it?

I could I actually I really right now I need a new bowl for my violin because the strings on my on my bowl are done. So but other than that I could

your violin is good. You just need a bow.

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

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

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

sorry. I really do. Okay, so the next time we get together, we'll do a couple of them that we've that we've set on and then we might do another run through the rest. And I thought this was good. So awesome. Cool. All right. Yay, one second. Yeah, I like it when things work. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G folk glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. That's it for this one. Thanks so much for listening. And for sharing the show. I'll be back soon with another episode of The Juicebox Podcast. If you want to wait till after the music, I'll run through the links for every one of the advertisers just in case you need them. So on the pod is a tubeless insulin pump, my daughter's been wearing it forever. And you can find out more get started and see if you're eligible for a free 30 day supply of yummy pod dash at Omni pod.com forward slash juice box. The Dexcom G six continuous glucose monitor is a mainstay at this house dexcom.com forward slash juice box. The Contour Next One blood glucose meter is in fact the meter that my daughter uses. It is literally the favorite one that I've ever held or used. I am not kidding. Contour next one.com forward slash juice box. If you want to see people doing wonderful things for people with type one diabetes, go to touched by type one.org Or visit them on Facebook, or Instagram. And of course the GMO hypo Pan was today's sponsor, so we don't need to do that one. You can find out if you have auto antibodies that lead to type one diabetes at trial net.org forward slash juicebox. Tell them I sent you touched by type one mentioned oh and the T one D exchange. Take the survey. If you're from the United States and you have type one, or you're from the United States, or you're from me, I came to say the words. I'll try again. Or you're from the United States and you're the caregiver of someone with type one. You can take the survey probably in less time than it told me to. Then it took me to tell you all this because I see him a little gobbly goo in my mouth. He won the exchange.org forward slash juice box check out the Facebook page. There's a public page called bold with insulin, a private page Juicebox Podcast type one diabetes, I'm on Twitter and Instagram and tick tock just look for Juicebox Podcast. diabetes pro tip comm is where the diabetes pro tips and the defining diabetes stuff is. It's also at juicebox podcast.com. It's also in your podcast player. There's great lists of them in the Facebook page. I think that's pretty much it. I really appreciate you listening. I'll be back really soon. Take care

Hello friends, and welcome to episode 592 of the Juicebox Podcast well today we have another episode of the variable series. There's actually two more left counting this one. Today's episode is diabetes variables. Menopause. If you experience a hot flash during 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. Today I'll be speaking with Jenny Smith. Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer and most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast. So show some respect. Now there's like 15 seconds of music left here. Go with it. Just sway your hips. bob your head? I don't know. Pretend you're making your own personal tic tock video this episode of The Juicebox Podcast is not sponsored. I haven't run out of sponsors. I've just fulfilled my requirements for this year. Huh? This is weird, isn't it? Um, what do I want to do here? You should check out the Yeah, I don't want to say hold on a second. Just stick with me. Are you looking for those diabetes pro tip episodes, the ones that begin at episode 210? Well, they're available right here in your podcast player, or at Juicebox Podcast comm they're also available at diabetes protip.com. And if that wasn't enough, at those same links, you'll find the defining diabetes series how we eat algorithm pumping afterdark there's so many to choose from. Let me also throw a little shout out here to the private Facebook group Juicebox Podcast type one diabetes as it crests, 18,000 members. The only thing that's missing is you go home, I'm recording now. Let me let me take a look and make sure that they're what I think they are. Because we did that. I'm recording. So we did that. Bubba we did that variable episode, the width was just kind of going through the rest of the list that didn't seem like they needed their own episodes. And while we were pulling through that we found just a couple that needed their own. So I'm gonna pull those

up a little more discussion we did. Yeah, we are

gonna finish up the variables, which took us all of 2020 long. weird to think of

it. Yes. That's that's really weird to think. Yeah.

Yeah, it is. It's an incredibly strange thought that you and I started this at the beginning of 2021. In here at the end, we're going to finish it up. So, ladies choice you want to do alcohol or menopause. First.

Let's do menopause. Okay.

Well, I don't know how much help I'm going to be with this. Really out of my wheelhouse. Now I don't have diabetes, and I don't have any lady parts. So

and you have well and you have no experience helping a lady with menopause. Right?

So I don't put Well listen, you're right. I don't. But my but I have a little bit of I mean, maybe I'm starting to but I don't see what it has to do with diabetes. But we'll see because there's a fan in my house now. A year ago,

a fan like a ceiling fan, or a fan or we're talking about

a year or two ago at Christmas time. I bought my wife a ceiling fan for our bedroom. But no lie has got to have a wingspan of maybe six feet. I like my two of them, I could get something off the ground. And it creates such a downdraft in my bedroom that if she turns it up too high, and I get in bed, my eyes begin to water and my lips chat. And I'm freezing like you can't leave your extremities outside of the blankets because they start to get numb. And I look over at her and she's barely got a sheet on it. She's like it's hot in here, right? So yeah, maybe I have some tiny bit of experience with this. I'm not sure. But how does this impact people with type on?

Well, for what I mean they're multiple stages right to what we're kind of What we've typically classify as menopause, right. And I think another important thing to consider is, research has proven that women with diabetes tend to enter menopause earlier than women without diabetes. So it's a piece in the mix, not, you know, 100% of women, but many people, many women experience it starting sooner than later. So in terms of adjustments, we tend to start to see changes in monthly cycles, they either get longer, or they might get heavier, the, I guess, pain that may be associated with it cramping, and that kind of stuff can become more intense. And cycles can also become less regular. If you were the typical, like 32 days between my cycles, you might be 26 days and 35 the next month, so things kind of get a little bit wonky. And in terms of what's impacting blood sugar, then, if you had a pretty typical turnaround in insulin need, and you figured it out with a normal cycle, then this change in how your cycle is, you know, occurring now may get disrupted as well, your insulin needs may change, you may not need more insulin for a whole seven days before your cycle starts. You might need it for two days before and then you might need it during versus your insulin needs falling like a typical cycle.

Okay, question. Let me Yeah, so you said it might start earlier, but age wise? Yes. Is there an amount of like, like, 10% earlier two years earlier? Like, is there any way to track it? Or? And how do you even know what earlier is right?

Yeah, I mean, most, most menopause kind of perimenopause. And then once you're completely through, and you've no longer had a cycle you consider yourself sort of, into menopause is when you've had a cycle. We've not had a cycle for a year, 12 month time period without any normal cycle. So perimenopause can start and usually does over about the age of 45 to 50, for most women without diabetes could even be later. And some of that may have to do with like just genetics. You know, my mom started menopause at 55. If I didn't have diabetes, maybe I'd probably be in about that same bucket of time to consider it starting right. But some of the research that I've looked at actually shows that menopause or perimenopause, the beginning of changes to the cycle can actually be in like the mid to late 30s.

Oh, wow. How long does perimenopause last? There's no way to know either.

No, it's a big cycle of shift and change, like I said, So you, a good way to know is some of the symptoms, as you mentioned, you know, buying a big ceiling fan for your wife. Some of those are common symptoms in terms of like the hot flash, that's one that most people think about in terms of menopause is I get hot, or I get cold really easily or whatever. So you may have some symptoms that are also cueing you in but a big one, again, as you've been probably tracking and following based on just insulin adjustments that you typically need, if your cycle starts to become irregular, for no reason. And you're in the age group where you could be of an age that IP menopause starting, you know, then tracking even more and paying attention because insulin needs will shift and they really shift mainly because one of the big hormones in a woman's cycle is estrogen. Right. So as estrogen estrogen levels kind of fall as you move through perimenopause, menopause, you can see your insulin sensitivity shift as well.

Okay. And shift in likely in the in the way of needing more. Okay, yes. Does any of this stop after menopause? Like once the

there's more from the women that I've worked with who are definitely through menopause or I've been working with them? Well, after you know, they've no longer had a cycle. There is more. There's more stability in their numbers because hormones aren't fluxing like they would have been before Right? So there's not this ebb and flow tonight I need more I need less now etc. There's more stability unless something else variable wise changes like weight or their exercise level or you know their eating habits or Those kinds of things. So in terms of during, there's a lot of shift and adjustment. And from what I honestly see, for women working through it, there's a lot of navigating insulin changes that just look weird.

Monthly, like, yes. Okay, so, you know, one, one month, it could be seven days before your period starts, you need a lot more than next month, it could be four days, or not quite as much, there's gonna be a lot of you being flexible through this,

right. And it might even be, you know, if you knew ahead of time, you know, prior to this expected change happening, if you were needing, I need to adjust my insulin up by seven days before and I needed to adjust it for the whole seven days before my period started. In that perimenopause kind of stage, you might find a flux up where seven days before you need a little bit more. But as you get closer to your period, starting maybe the day before or two days before is when you're really needed the excess, you know, amount of insulin comparative to it just being a steady increased need for those days as it was previously.

Okay, so is this because I'm going to ask you, at some point next year to do a pro tip about, about periods, and okay, male hormones in general, the whole thing's just like, I mean, the best I've been able to figure out around Arden is that, you know, like you said, coming up on her period, she needs a little more, it does seem to get, you know, a little more gradual towards the period. It used to be once she had her period, it just like it, it almost got easy during the period. But now she now she's on a birth control pill. That doesn't seem to happen as much anymore. So she's a little more consistent through the month now. And then when she gets through a period, it's not this like, like her period was almost like time off from paying attention to to, to insulin, it was just really easy. And yeah, now it's not as easy that and I realize she's not even getting the hormones, right. Hold on. Let me think about this. Yeah, usually she gets her period, right as you get to the placebo. Right? It's about how it's supposed to work. So then through the period, she's on the placebo. And, and she's not getting the hormone at that point

outside of her normal cycle of hormones her normal body doing what it's supposed to do, right. Yeah.

And she's taking them because she had no. I mean, like, Arden almost didn't have any quality of life without birth control. Like she was getting her period on this constantly. Too frequently. Yeah. And for like 11 days at a time. And they get like a two or three day break, and it would come back again. Yeah, so it completely depleted her of iron, made to get her a couple of infusions because of that. And just in general, it's it's, you know, it's, I mean, I don't know, but I live with a couple of women who don't look fun. So. Right. So doing it constantly looks a little, a little less fun. Let me ask you, is there any impact on menopause, if you also have a thyroid thing? Where are those things not connected? Well,

I would expect that they would be connected in terms of thyroid having just relation to overall metabolism, right. And as your body cycling through a change in hormone production, with menopause, then you're going to have changes. I mean, many women experience weight gain during menopause, even who don't have thyroid issues. So I would expect them to impact each other. So obviously, just as you would normally do continue to have your thyroid levels checked, continue to adjust your medication kind of as needed. One time period of the day. That's interestingly, a time that many women going through like perimenopause into menopause often find more consistent lows is in the overnight time period. Oh, wonderful. Where insulin needs may need to go down overnight to decrease the chance of lows. I mean, thankfully, today, we've got a lot of technology and devices that obviously you know, you can watch things you can set alerts, you can adjust things much more precisely for that. But it is something to definitely know is you're not crazy if you think your insulin needs overnight are much lower than they are during the daytime as we age, we tend to need less insulin. If you look kind of at charts of insulin dosing. Insulin needs overnight are typically highest for like the young and like the teens. And then as you move into adulthood and then later adulthood into kind of like that menopause age. The overnight insulin needs are lower than the younger population, let's say

okay, so alright. Yeah, because there's not as much growth hormone. A lot of other Hey, yeah, yeah, I want to say this real quickly before we say goodbye. If you haven't if you have a thyroid issue and you haven't heard episode 413 thyroid disease explained with Dr. Addy, Benito, you should listen. And if your doctors telling you that your four TSH or your six TSH or eight TSH is in range, you probably should find a different doctor who wants your TSH to be more like two or lower. So, but there are plenty of people Jenny's got a horrified look on her face. But there are plenty of doctors who are like you're fine. You're in range and in range they think of as up to like 10. Yeah, yeah, that's not okay.

Yeah, no, that's not okay. No.

All right. Okay, so the wrap up on menopause is it's going to be variable could change month to month, May last years. And I'm going to add probably going to be easier if you have a pump, and a CGM.

I would agree it would be easier from a dose adjustment standpoint, yes, also allows you to track kind of shifts in in your, your needs a little bit more, especially if you have any of the sort of automated kind of or augmented insulin delivery systems that you can actually see your data. And you can see where insulin is being adjusted up or down based on your glucose shifts, that can make it a little bit easier to follow and see what your changes look like.

Yeah, I'm saying that because if you have an increased need an insulin that goes 24 or 48 hours before you even realize it before, you don't think oh, maybe my you know, maybe I'm just you know, people are like I'm gonna maybe it'll go away. And then now you're right now you're significantly behind and this curve is going up and up. By the time you put in more Basal injected and figure out how to be more aggressive with it. You could be five days into your into this portion almost through the need. Yeah, by the time you by the time you see it, it might be too late. And that could really put you in a position where you start ignoring it, which I don't think you should do at all. So Okay. All right. I appreciate you doing this. Thank you very much. Yes, sure. If you're interested in learning more about Jenny Smith, she works at Integrated diabetes, and you can hire her to help you with your type one. After Jenny, there's no one really to thank because there's no sponsors here today. Let me just remind you again, private Facebook group Juicebox Podcast type one diabetes, diabetes, pro tip episodes, defining diabetes stuff. I mean, the podcast is chock full of great information. If you're using insulin. I hope you check it out. Follow us on a podcast app, subscribe, tell a friend leave a great review somewhere. Have a nice holiday. I'll talk to you soon. When I'm back with another episode of The Juicebox Podcast

Hello friends, and welcome to episode 596 of the Juicebox Podcast so this is it. This is the last episode of the diabetes variable series with me and Jenny Smith. And today's topic is alcohol. You see how I've timed that to coincide with New Year's? Huh? That's right, I'm thinking. 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. Today I'll be speaking with Jenny Smith, Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast. So come proper. I really hope you've enjoyed the variable series, if in the future, Jenny, and I think other ones will add them. But if not, they're always there for your needs and enjoyment. 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, this is the last variable we're going to record. It's very exciting.

That is very exciting. A whole year of recordings of variables. That's that's a lot of variables.

I'm not kidding about it. At one point, I looked at the list and I was like, Why do I like this is not a good idea. But it ended up being great. And I really did enjoy it, you obviously brought a ton to it. So last one alcohol. How was alcohol a variable for for using insulin?

Well, alcohol is a variable because alcohol can lower your body's ability to respond to the typical turnaround hormones that would raise blood sugar, you know, if you have a low, and so alcohol in and of itself, and we're talking like several drinks, or even just wondering, depending on how your body tolerates alcohol. And many people I think are kind of confused what to do about alcohol because they feel like well, if they're drinking like hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it. And should you know not not necessarily unless it's mixed with like cranberry juice or orange juice or something like that, right. But other types of alcohol such as beer, have a fair amount of alcohol to them. carbs, or sorry, yes, alcohol, carbs. Yes, thank you. I was thinking Alcohol Alcohol. Yes. So there's, you know, I mean, anywhere between 12 to maybe like 22 grams, depending on the size of the bottle or the can or whatever you're drinking, really. So do you cover the carbs? And then what happens later, right? Do you take insulin to cover the bottle of beer that you're drinking? Do you not what happens most people who don't cover the carbs initially will have a higher blood sugar.

So is the concern around bolusing for carbs that are an alcohol that at some point, you become a knee braided and are not the best shepherd of your blood sugar if it gets low?

Those are the good questions to always be thinking about. Yes. Because in terms of low from alcohol, low from alcohol is a delayed low. It will tend to happen later on. So our typical recommendation on a normal conventional pump. It's a little more a little more, I guess difficult if you're doing injections, but on a pump, it would usually say at the end of the night, let's say you've had several drinks over the course of the evening. It's midnight you get home at that point, you want to really decrease your Basal insulin delivery, because that's when alcohol is likely to come into the picture in terms of hitting you and causing you to go low.

And is it the actual alcohol that's bringing you down or is it your or is it the Bolus that you used or know if even if you didn't Bolus you would get low afterwards.

It shouldn't really be the Bolus I mean again bolusing has a definite like end point of action right let's call it four hours, just give or take three to five hours, four hours. So if you left Bolus at 10 o'clock, you're low at 2am. Sure, it could have something to do with some of that Bolus still being left in the system. But it could also have to do with the way that the liver turns around and deals with, let's call alcohol a toxin, right. So as the liver is dealing with turning that alcohol around and getting rid of it in the body, your liver is also not putting out the typical turnaround for drop in blood sugar, right? You don't have that counter regulatory hormone production, so that your body has some glucose drip coming out of it saved stores to help you. So in that, we usually say for every alcoholic beverage consumed, we really want to take the Basal rate down by a certain percent for about two hours per beverage consumed. Okay, so if you had three beverages at the end of the night, the percent that we would take it down would be by 40% of a decrease. And then the timeframe to decrease would be about two hours per beverage.

Okay, so So you're basically people might not recognize that your liver is making glucose in, you know, and giving it is giving it off, like glucose, is it glucagon or glucogenic? Or I forget the word,

right? I mean, your body's counter regulatory hormones essentially coming from the liver or helping your body to essentially put out in the TR in terms of a low or a drop like that, it's helping your body to put out the glucose, right? I mean, that's why we have glucagon kits, right glucagon kit is a really quick turnaround of telling your body to spit out the glycogen and to turn it around into glucose to sort of bring you up from the low.

But if you're, if you're taxing your body with enough alcohol, the liver gets focused on that. And then as your blood sugar gets low, it doesn't go through that process. In the same

way, it doesn't go through that big process of counterregulatory. But also remember, the reason that we're taking Basal insulin is to counter the production and natural drip drip of glucose into our system to begin with. So if the liver is busy taking care of alcohol, it's no longer going to help with that normal drip, drip drip of glucose, and thus, your Basal is going to be too heavy for you. Okay, in layman's terms, right. I mean,

listen, it's not a it's not a deep dive into how the liver works. But it is something I don't think people think about for certain, you know,

and I think it's something that often isn't even brought up like I, I try really hard with a lot of the teens and those heading off to college that I work with, I try to bring up alcohol at some point, because it will come into the picture. Yeah, I mean, unless you're unless your kid has really sworn off, because they just don't have any interest in that. At some point, alcohol will be something they need to think about. And it's really important that they know better how to adjust if needed, than just say, Well, I'm never going to do it.

Right. Okay. Does this? Does this need a bigger episode? Or? What do you think?

Come on. What do you have more? More questions?

No, I just I don't know if it's, I don't know. I mean, it's like, you know, it's if you're, if it's beer, beer has carbs. If you're drinking, you know, some harder liquor, there's no carbs in them. But you have to look and see if you're going to add fruit juice just seems like maybe I could understand that when I start. But what happens when I'm like three drinks into it? Like, where do I? You know, what do I do when the when the room starts spinning? You know what I mean?

Right? I mean, the big things with alcohol, too, that we always recommend is definitely have something to eat with it. Right? So it's not just alcohol. I mean, you you probably know that. Or maybe you don't, I don't know, whether you drink or not. But if you don't, if you drink something on a pretty empty stomach, the impact of the alcohol is faster, right? You will feel the impact. Versus if you have it with a meal or at the end of the meal. Are you drinking along with the meal? It's much of a dumbed down impact. Yeah. Which may also then if you were expecting the impact of alcohol may lead you to drink more, because I'm

also that there might be people who are wanting to get to that spot too. It's a really difficult thing to talk about, because you're talking about it from the perspective of how do I do this responsibly? And I don't know that everybody starts an evening of drinking with that in mind to begin with, right?

Correct. And you also have to consider like, i i much feel like if I and I've only been drunk a handful of times, I'm not a drinker. I I'm, in fact, I came I think the last time I was drunk was probably at my brother's wedding in Aruba. And that was a long time. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar.

Okay, those tip sees

types of maybe that's not a symptom of yours, but I very much have a similar feeling with alcohol as well as with a low blood sugar. Yeah. So then comes into the equation, you're also already not really thinking very well, because you have alcohol on board. Is your symptom of being drunk? Also a symptom of a low that you're not paying attention to?

Yeah. And how are you going to be able to handle that I'm so I'm just thinking of a person I met recently, whose son was away at college and was not a drinker, not a drinker. And then all of a sudden, one night just dove headfirst into it. And then this person had to, like, driving to a place to like, rescue the kid and take them to a hospital. Yes, you know, because then the next problem is, is that you're now around a bunch of drunk people, no one's gonna be able to help you. Like, you know, the, it's not like you have a designated, what if my blood sugar gets low person here? You know,

right? I mean, it's the reason in college that I 98% of the time, I offered to be the driver, when we would go out. And I might have knowing that we are going to be out for a fair number of hours, I might have like, half a beer when we got there. And then I had nothing else the rest of the night giving it a good like four hours of clearance time to be able to be like the driver hole.

I can say with confidence that in my life, I haven't had the equivalent of a case of beer. Like I just don't drink for no reason that I can particularly point out to you other than it's not interesting to me. It's just not a preference. Yeah, it's not for me, I I just I don't know, like, I don't even know how you like consume that much. Like, I have a bottle of like, flavored like peppy water here. Uh huh. And if I tried to drink this whole bottle, I'm like, Oh,

I can't really be too much. Yeah,

happens when you start putting, like hops and barley. And don't I be like, Oh, I'm so full. But yeah, but anyway, alright, I appreciate this. I know, it's, it's not an easy, it's not an easy conversation, because there's a lot of perspectives that didn't need to be taken to account. But I think in general, I mean, at least you could try to follow what Jenny was saying about decreasing your Basal. And, and, you know, I would add, you know, you gotta have I would want to have somebody there that understood my diabetes a little bit who wasn't drinking,

but correct. Absolutely. And I mean, even people ask even about wine, you know, a glass of wine, typical table wine is somewhere between three to five grams of carb, per, you know, glass, should you cover that? I think a lot of it is also experience, right? What do you know about what has happened, and along with what you said, make sure somebody is there who knows, you knows you have diabetes knows how to help you if you don't seem to be acting, the way that you normally would be acting? Because all of those things very much like all of the things with diabetes in general, take a little bit of experimentation. And you have to figure out what works the best for you.

Let me let you I know you have to go. But let me ask you this, because I think I remember that this is true. When I'm drinking. My glucagon won't work as well, right? That is, right. Yeah. Okay. So if you're thinking doesn't matter, if I pass out, I'll just use my glucagon, it might not help.

It will. I mean, will it turn things around versus nothing at all? Yeah, but it's not going to be the same impact from what I recall. And I would, I mean, it certainly would look it back up, but I'm quite certain nothing has changed about the recommendations and what we know about your glucagon kit and alcohol in the mix

together. Yes. So read the label on your glucagon if you're expecting it to save you when you're, you're drunk, because it might not be as impactful as you're hoping. Okay, Jenny, that somehow we made drinking sad, and I'm sure everybody oh

well, people don't see us so they can't tell whether we're smiling or not.

Having a great time talking. I'm like I just started thinking like we're taking the thing where people like oh my by Saturday night happy place. These guys are bumming me out. All right, well, thank you so much. G voc hypo pan has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G Vogue glucagon.com slash risk, and the diabetes variable series began, I guess technically at episode 231 with the pro tip called diabetes pro tip variables, but then the variables proper began at 491 with trampoline followed by temperature travel, exercise hydration, food quality leaky sites and tunneling video games, stress masturbation school bad sites growth hormone sleep pumps like placement of full moon, diabetes, tech weight change, Walmart, the final episode, sort of the last episode menopause and today's episode, alcohol. Check them out. They're all available in your podcast player. We're at Juicebox Podcast calm. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.