#11 Bold with Insulin
Bold with Insulin
Erring high feels safe — until you see the A1C math. Scott makes the case for being bold with insulin, and how a Dexcom finally made lower blood sugars feel manageable.
- Erring high has a math cost. An average blood sugar of 150 is about a 6.8% A1C; an average of 100 is about 5.1%. “The side of caution” quietly turns into comfort, and comfort turns into habit.
- Bold means aggressive and cautious. Scott stops a rising arrow early — but only doses what a juice box could rescue if the fall came too fast.
- Overnights are leverage. Nine steady hours around 90–100 buy room for the daytime blips you can’t control — because A1C is an average.
- Squeeze the lines. Tightening the Dexcom high and low alarms reset Scott’s expectations, and Arden kept landing inside the tighter range.
- Technology makes “low” feel safe. A CGM turns a falling 90 from a panic into a text message — the reason Scott could get bold in the first place.
- Arden's Day — Scott's diabetes parenting blog — including the Froot Loops post mentioned on-air.
- Accu-Chek A1C Calculator — The A1C-to-average-blood-sugar calculator Scott clicks through during the episode.
- ADA A1C / eAG Converter — The American Diabetes Association tool that put a 5.9% A1C at an average of 123.
- Dexcom — The CGM and Dexcom Share setup that made bold overnight numbers possible.
- Omnipod — The tubeless pump used for the extended (dual-wave) lunchtime bolus.
Every word of the conversation
Welcome Back & Why Insulin0:00
Before we begin a brief disclaimer, the medical information on this podcast and on Arden's Day is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment. You can find the full version of this disclaimer by going to Arden's Day or juiceboxpodcast.com, scrolling to the bottom and clicking on disclaimer. For those of you who have been listening to the podcast since it started, welcome back. And if you are a new listener, thank you for joining us.
Let me introduce myself real quickly. My name is Scott Benner. I am the father of a little girl named Arden who has type one diabetes. Arden was diagnosed when she was two years old and is just about ready to turn 11. I write the diabetes parenting blog called Arden's Day, which you can find at Arden's Day. Also on Facebook, Twitter, Instagram, what else? Pinterest — if it's social media, and it's Arden's Day, I think it's probably me. Okay, welcome to Episode 11 of the Juicebox Podcast. I appreciate you coming by.
Today we are going to talk about insulin. So there's not going to be any guests on this episode, although you may hear Basil snoring in the background. Basil is Arden's little eight month old puppy. She named him after her basal rate, and he is sound asleep and snoring away. If you hear him, I apologize. Okay, so I want to talk about insulin because it's the main component to a lower A1C, and lower blood sugars in general, and going to speak just from my personal experience. Again, nothing here is advice. And you certainly should talk to your doctor before trying anything that you may hear on the podcast. Okay.
The Diagnosis & The Fear of Insulin2:08
So let's go back to when Arden was diagnosed. She's two years old. We're in the hospital. It's of course incredibly stressful and frightening, and not something you were expecting. Certainly wasn't something we were expecting. And it's bad news, good news, bad news, good news back and forth all day long, right? Here's the bad news. Your child's just been diagnosed with an incurable autoimmune disease, their pancreas doesn't work anymore. It's no longer making insulin. But hey, here's the good news. There's man made insulin. So unlike prior to the finding of insulin, your child's not just going to die in a couple of days. You're going to be able to manage diabetes with insulin. Well, yay. That's fantastic. Small pause from the doctor. Insulin, however, is very dangerous. If you use too much of it, it could cause dizziness, seizure and even death. Well, okay, great. So let me get it straight. Disease incurable. Pancreas doesn't make insulin, but don't worry, here's some insulin, but be really careful because the insulin could kill you. Okay, I'm clear. Everything's good. Let's go home. Now I've got it.
That's pretty much how I felt, right? You know, I'm sure a lot of you felt the same way as well. Here's this great medication. It's clearly a lifesaver, but used incorrectly it's dangerous. That's okay, they'll tell me what to do. There's probably instructions, right? Except that, you know, the instructions they give you are very general and don't work day to day, let alone person to person. It's their guidelines to get you started. It doesn't take you long to figure out that living with type one diabetes is probably just as much about kind of the vibe of it as it is about the science. It's probably — I mean, honestly, it's probably three times as much. You know, the vibe is such a huge part of how I manage Arden's type one. Just my feeling about, like, I think our blood sugar is gonna go high here, I think it's gonna go low. You know, yesterday, in a similar situation, this happened. I was trying to calculate, you know, not just how many carbs, but what kind of carbs. How long are they going to stay in our system? You know, how much exercise did she get? Is that going to affect it? It's a little bit more about the magic than it is about the science and the numbers. But when you're first diagnosed, here's the numbers. If this happens, do this. Inject this much insulin. If this happens, if you get low, you want to take in this many carbs. Those directions from your doctor are starting points. They're jumping in spots.
A1C Math: The Cost of Erring on the Side of Caution5:10
I think the problem is that — and very rightfully so — you're told to err a little on the side of caution with the blood sugar, right? Stay a little higher so you don't experience a seizure or a low blood sugar incident. It's insulting that they call them low blood sugar incidences. I've seen two of them, they're seizures. But the idea, right, is, you know, stay a little high to avoid that. Well, I know for me, you know, back then 2006, no glucose monitor technology, not even an insulin pump, just injecting insulin with syringes, I was probably erring more on the side of caution than I probably should have been. And the more you did it — excuse me — the more you let a high blood sugar be because it felt safe, the more normal it got. And you start thinking, well, you know, what's wrong with 150? 150 is fine. 150 is not fine. I mean, it is, but it isn't. My blood sugar right now — I don't have diabetes — my blood sugar right now is probably 96. Maybe it's 100, who knows? Maybe it's — the point is that there's a vast difference between 90 or 100 and 150, or 200, or wherever it is you're comfortable. So I'm actually going to click over to a website here for a second to talk about this next little bit.
So at the moment, I'm on accu-chek.com, which is A-C-C-U-dash-C-H-E-K dot com. I'll put a link in the show notes. But I'm here because they've got this little A1C calculator. So what did we just say? What is my blood sugar probably right now? Let's just say 100. Well, actually I have to say 100, because Accu-Chek's calculator only goes down to 100. So if your average blood sugar is 100, your average A1C for a three month period should be about 5.1. But what if, like me, you were thinking, well, I'll just stay at 150, because that seems safer. Well, now your A1C goes from 5.1 to 6.5, you're almost in the sevens now, because you're erring on the side of caution. But you know, it's impossible to keep a blood sugar stable, you know, without vacillating up and down for very long. So what happens when your 150 becomes, I don't know, 170? Well, then the A1C is obviously going to take a leap, and you hear me click around on the webpage — now it's 7.5.
So when I'm online, and I see people who have newer diagnosed children, and they say, well, I put my kid to bed at 180 because I'm scared of what's going to happen overnight — and I've seen that that's a number that people seem to like, right? It's high enough over where they think they're going to have a problem, but under 200, just enough that it doesn't really kick your guilt in. An average blood sugar of 180 is an average A1C of 7.8. So we've gone from 100, 5.1 for your A1C, up to 180, 7.8. That is a huge, huge difference. So you can see that cutting out just 10 points from a blood sugar — right, seven — let's do 180 at 7.8, I'll change it to 170, and you'll see it's 7.5. Well, that's not bad. Well, that makes you think, well, if I could do 170, I could probably do 150. What's 150? 6.8. Things are getting better. I think the problem is that you're told err on the side of caution, and before you know it that becomes comfortable, and before you know it that comfort turns into habit, and then it becomes difficult to break because of the fear that you feel.
Managing Overnight Blood Sugars9:22
So I will tell you that I'm comfortable with Arden sleeping overnight with a blood sugar of 80. I don't have a problem with 80. And I can't even, on this website, tell you what 80 is, because the website will only go down to 100, I'm assuming for legal reasons. So let's just talk about Arden's last A1C. Arden's last A1C was after Christmas, so end of 2014, it was 5.9. A different calculator on diabetes.org, which is the ADA website, tells me that that A1C percentage of 5.9 is an average blood sugar of 123. So you can see that even though overnight I'm happy with 80 — and trust me, Arden will sleep overnight most nights at 90, you know, down there, why, our Dexcom alarm doesn't sound until she's under 80 — you can still see that her average blood sugar is still 123. And why is that? I sit and I think that's because — I think when people think about blood sugars, and I know that we have a Dexcom CGM, and not everyone does, not everyone has the benefit of that really great technology —
but when you think about blood sugars, you think about this rolling graph line, you know, and if you have a great A1C, I think people imagine that your graph must be very steady and very low constantly. And I just want to tell you that that's not the case. Arden's graph is not steady, not nearly as steady as I'd like it to be. And it's not always low. But what I do is I take advantage of the overnight hours, because if she goes to bed — and Arden's not a — she doesn't go to bed early, she's gonna be 11 — but Arden goes to bed between about 9:30 and 10 o'clock on a school night, and she gets up in the morning around seven. So let's say she goes to bed at 10 and wakes up at seven. So I'm going to just do some quick math here. That sounds to me like nine hours. I've done the math in my head. So for nine hours, if I can keep Arden's blood sugar at, I don't know, let's say 100, because the calculator says 100, that gives me some leeway for the rest of the day to not be able to get a pre-bolus on for lunch in time, or to miscalculate some carbs at dinner, or to have some sort of a, you know, a hormone induced rise, that ends up taking up, you know, two hours of a day where the blood sugar is up at 150 and you can't do anything about it, or it's a 200 and you're pouring on insulin trying to get it down. That's why it's an average. So when we average those 24 hours back together, I will tell you that Arden's graph usually gets two blips a day where her blood sugar goes up, and it takes us a little while to get it back down. But then we have nine hours at night where it's, you know, most nights — without, you know, listen, growth hormones, things that go wrong could definitely be higher — but on the average, every month, most nights at 90, 100, I try to keep her down there.
I know that sounds scary to some people. But that's a fear that at some point I think you have to get past, because you can't protect constantly for today and never think about tomorrow. You just can't do that, because the long term effects — and I know this is something that we don't really talk about a lot because it's sad and uncomfortable, but we all know what the long term effects of type one diabetes can be if you have high blood sugars, and they are significant and life altering and life changing and life ending, they can be. So you have to find yourself a balance. You have to find a number that you think, I can live with this, this won't make me neurotic, or I'll still be able to sleep. Now, you know, if your insurance can cover it, the Dexcom Share really does change how overnights happen, because now you're getting an alarm back in your room if your blood sugars are going down or get below or above a certain level. It is a game changer, I'm not going to pretend otherwise. And prior to having a Dexcom CGM, I was not as bold with these blood sugars as I am now.
Aggressive But Cautious: Real-World Scenarios14:30
And you do have to be aggressive but cautious. You have to be respectful without being afraid. And the technology helps a lot. So it's a good example of being aggressive — you know, I'll just use today at lunchtime. Arden's blood sugar 101 diagonal down, a half an hour before we're going to pre-bolus for lunch. So there's a lot of stuff here to think about. But 10:30 we pre-bolus for lunch when Arden's at school, but she doesn't actually start eating till about 10:55.
So if she's 100 diagonal down at 10 o'clock, it was fair to say that by 10:30 she was going to be a little lower and wasn't going to give me a lot of latitude to do a big pre-bolus like I would like to do. So I had her eat like 10 carbs of a piece of candy, just stick a piece of candy in her mouth while she was at school. And when 10:30 came along, Dexcom had her blood sugar at 85 and steady. Now I knew the sugar from the candy was in there, we were gonna get a bounce at some point, but it wasn't there yet, so I couldn't — you know, I made my calculations like it wasn't there. So I gave her her insulin for lunch, 10:30, and we did an extended bolus, gave her 50% of it right away at 10:30 and told the pod — the Pod, the Omnipod — give the other 50% as an extended bolus over the next 30 minutes, so that basically she's getting a pre-bolus of half of the insulin, and at 10:55, when she goes and sits down with her food, the rest of the insulin is in — not active yet probably, but it's in.
And it's not five minutes after 11, I get a warning on my phone from her Dexcom Share. Her blood sugar has hit her high, her high watermark, when we — we try not to go above 160 — and it's straight up now. Okay, so some of that insulin hasn't been in for very long, and bolusing more right now is probably not what a doctor would tell you to do. It's probably not what a doctor would tell you to do. It's definitely not what a doctor would tell you to do. They would tell you that insulin's not even live yet, it hasn't even started working, some of it you extended it, don't do anything. Don't do anything would be the call today. But at 169 straight up, which means her blood sugar's rising at two points per minute or greater, I texted Arden, I said, I want to increase your basal by 95% for half an hour, and I want to bolus a half a unit. My half a unit is just my blanket, I don't like the way the arrow's going up, bolus. Arrow's going up when I don't think it should, half a unit. And why half a unit? Half a unit because, you know, a juice box is for Arden 15 carbs, about 0.85 insulin, maybe one unit of insulin. So let's bolus the equivalent of a juice box, because I think I'm right, history is telling me that she shouldn't be going up this quickly after we've bolused for lunch. But if she does, if it is for, you know, just a blip and it's going to come back down, then we'll cover it with a juice box. So I don't want to give so much insulin that a juice box wouldn't fix things if her blood sugar went down quickly, but I want to give enough to stop that arrow. I want to stop that up arrow. I am aggressive about stopping up arrows.
And, you know, in the — oh, what's this one — Jim's — one of my dogs will be texting in a second, if you hear that in the background. But her blood sugar is now — it's an hour and a half, excuse me, two hours since that pre-bolus — and her blood sugar's 150. And I know that probably sounds pretty good, 150 two hours after her lunchtime bolus at school, but I really wish it was 130 right now. Now, with gym coming up, I'm going to admit to you, probably not going to do much about it. I don't think I would bolus while there was still active insulin on the way to gym. That doesn't sound — not at 150. If my blood sugar was 200 right now I would absolutely bolus, but not at 150.
So does that sound aggressive to you? Does it sound scary? It did to me at one point, and I'm sure it does to you now. Again, the technology helps. Having a CGM will make it easier for you, because you'll see a fall before it happens, with any luck, and it's not as scary. So the doctor tells you to err on the side of caution. It's good advice. But then it becomes comfortable, and you probably live inside of those higher blood sugars much longer than you could. You know, you have to change, you need to be more aggressive. You know, the A1C's up because you're not using enough insulin, or because you're erring on the side of caution too much. But you have to find — I think there's a big difference between when you're ready to make that decision and when you're comfortable making that decision. And I don't know that you're ever going to be comfortable making the decision. Ready is when, in your mind, you say to yourself, I understand that my child's blood sugars are higher because I'm not using enough insulin, I understand that the A1C's are higher than I want them to be because I'm not using enough insulin. I don't think you're going to be comfortable using more, but I think I can give you a couple of tricks to get yourself there, because the comfort comes later. Obviously, after you do it a number of times and nothing goes wrong, you become more comfortable, you'd be a little more bold, you're pushing, you're pushing, you push an overnight blood sugar of 80 — I want to be really clear — that would have scared the crap out of me before a CGM. I never would have done that. But having the ability to see a blood sugar falling or rising is a game changer.
So once you're ready, once you understand that you need to be doing this, do it incrementally. You know, whatever that means. If you're seeing that a dinnertime bolus is a certain number, just randomly put a number on it, let's say you're using four units of insulin at five, six, doesn't matter, whatever it is, and you're seeing high blood sugars two hours later, an hour and a half later, we'll just use another half a unit or something like that, and see what that does. You know, just try it, keep an eye on it. You know, if you don't have a CGM, test. But give it a shot, because I bet what you would find is that after a couple of dinner times, maybe that half a unit was good, maybe it was what we needed, maybe I'll try a little more. Maybe you're on a pump and you can go very incrementally, 0.5 at a time, and the next day you try 0.6 over and you get a slightly better result again, and just keep trying it. Show yourself that it's not the end of the world. Show yourself it's not going to cause some great problem. It's not like your blood sugars are at 90 and you're trying to get them to 85. Those are tight tolerances. I'm talking about people who are happy to see a blood sugar of 200 two hours after lunch, two hours after a meal. People who are looking at a 180 overnight and going, hey, it was steady at 180, that's great. Well, what's the difference between steady at 180 and steady at 130? Go for steady at 130, right? But what are you gonna do — I mean, what are you afraid, you're afraid it's gonna fall, you're not gonna have time to figure it out? But I mean, everyone's different, but I don't think Arden starts to feel dizzy until she's under 70. So even if you went from 130 to 80, you know, in Arden's situation, if she goes from 130 to 80 overnight, I'm still in a good space for her. And that's 50 points. 50 points. And we did it before, and let's do it again. 6.8 is your average A1C if your blood sugar's 150. If it's 100, it's 5.1. Now, some quick math for me, that's a 1.7 difference in A1C between 150 and 100. So 50 points, which means that if you can be comfortable at 130 instead of 180, that's how far your A1C's gonna go down, 1.7. So think about that, right? Now, if your child's A1C is eight, would you be much happier if it was 6.7? What if it was nine, would you be more happy if it was 7.7? 50 points, we'll do that, 50 points will take you down that far.
Squeezing the Lines: Changing Expectations24:56
Now that, to me — that's when it hit me. You know, when I started really understanding that, I felt, well, then I want to shoot for lower. Now this next bit comes from having a Dexcom receiver. I noticed something. You set a high line and a low line, right? I don't want my blood sugar to go below this, I don't want it to go over that, and if it does, I want it to alarm. I think when I first got the receiver it was 250 for the high, and the low was like 130. Like I was like, oh my god, under 130 she's low. And one day I realized I do a pretty good job of keeping Arden's blood sugar between 130 and 250. I wonder how much is expectation? That was my question for myself. I accept these lines — these are my expectations for myself, and I'm able to meet these expectations. What if I closed the tolerances on the expectations? So I did, I pushed the high number from 250 to 200. And I don't think you're going to need to guess what happened. I was still staying between the lines most of the time. I set a new expectation for myself, and I was staying with it. So I pushed it again. I said to myself 190, just a little bit, what's 190, I could stay there. Well, forget 130 is the low, let's go to 120. So do you think I could keep her between 190 and 120? Turns out I could. It turns out if you stop and really think about it, the only difference between a blood sugar of 90 and a blood sugar of 190 in your mind is that if 190 starts falling, you have time to do something about it. If 90 starts falling, it's more of a panic situation. Do you want to send your child with a blood sugar of 90 in a car with somebody who doesn't know anything about diabetes? No, you probably don't want to. But if you add education and the ability to speak, communication, and Dexcom that you can see the blood sugar as it's happening, in case it's beeping away in your kid's bag and they don't notice it, then all of a sudden 90 is not scary. 90 is completely reasonable.
Oh, it's 90 diagonal down, I'll text the parent, hey, you know what, her blood sugar's falling, can you have her drink half of a juice box, can you have her take a glucose tablet, can you do this, you know, whatever your adjustment's gonna be. So think about what I said there, because it's a leap. The only difference between a blood sugar of 190 and 90 in your mind is padding, it's time, it's the ability to react without a low. But after years go by, you won't need that much time to react anymore. If you're newly diagnosed, I completely, 100% in my heart understand that a 90 blood sugar could be scary for you, and that you might need that time to make better decisions. But trust me, as time goes on, you'll get better and better at this. It's not going to get easier, but you'll get better and better at it. You won't need as much time. It won't seem like a panic situation when a 90 is going down. I don't feel like that anymore. I don't. I cannot remember the last time I panicked about a low blood sugar or even a falling blood sugar, because I've got so much information, right, so much time in the simulator, that I know what to do to make it stop. I take the information I have from what we've been doing that day, what food we've had, how much insulin we've got going, and I look at historically what it takes to stop a 90 diagonal down, what it takes to stop a 72 hours down, and I just make that decision almost without having to think about it. And I get it, if you're not in that spot, you need to be a little higher. But if you just continue to close the tolerances on what you're willing to accept as a blood sugar, then I believe, at least in my experience, if you can hit inside of those lines, then just squeeze the lines a little bit, and I bet you'll keep hitting. I really — I believe you will. One second, I have to pause.
Podcast Housekeeping29:59
Before we get back to talking about insulin, I just want to let you know that there are a number of ways to listen to the Juicebox Podcast and any podcast, and I want to tell you what some of them are. You can listen through iTunes. That's a simple, easy way to do it. Apple has an app called Podcasts that you can download for free from the App Store, and you just search for the podcast and hit subscribe, and you're listening there. You can use Stitcher's app or go to stitcher.com, the podcast is also posted on Stitcher. You can listen at juiceboxpodcast.com, inside of each blog post for the episodes is an online player where you can listen right there. And I'm posting the episodes in Facebook with an inline player that you don't even have to leave Facebook to listen. So between your web browser and podcast apps, of which there are many, if you have a favorite podcast app, just search us up. There are limitless ways, almost, to listen to podcasts like the Juicebox Podcast. If you're enjoying the show, I implore you, please go to iTunes and leave a review or rating. It really does help the program be found in searches.
The Results of Being Bold with Insulin31:23
Okay, let's get back to talking about insulin, shall we. Talking about this today because a lot of people on the blog asked me — after I write about different things about A1Cs and things like that, I always hear about — you know, I always talk about being bold with insulin, being bold in general with diabetes, and I get a lot of emails, correspondence privately back from people who say things like, you know, I took your advice about being more aggressive, my son's A1C fell, you know, I'm being bolder, it's hard, it's scary, but I'm doing it, I want to thank you. And these are some of the most heartwarming notes that I've received. When I stop and think about kids who are walking around with in-range blood sugars that aren't causing them to feel foggy because their blood sugar's not high, and I think about their A1Cs being more in range — I want them in that, what that means for them health wise, and what that means for their parents stress wise — I mean, it's just information that you want out there to be in the world for people like you to hear.
It's more difficult to write about these things, because you feel like everything in writing sort of seems very official, and I don't want people to think that I'm saying, do this and do this and do this and everything will be fine, because that's certainly not true. Your diabetes will absolutely vary from person to person, and it is something that takes time for you to kind of figure out the flow of, you know, to get the vibe of your child's diabetes and the things that affect it and don't affect it. But I really felt like the podcast was the place to talk about this, because you can hear my voice when I'm telling you, like, look, this isn't advice, this is just what I do, this is how I feel about it. And I believe that if you could try to feel a little bit about this too, in a similar way, that you might have some similar luck, with a little bit of luck. But what pushed me over the edge to the podcast, besides the emails, was Arden's last A1C, 5.9, right around Christmas time. And we go in and our nurse practitioner comes in the room with the test result, and she says, my god, you decreased — not a lot, I think we went from 6.2 to 5.9, but any decrease is amazing.
And she says, I can't tell you how many people at the holiday time of year I tell them, oh, it only went up a point, it's okay, you did good. She's like, you don't see decreases at the holidays because of all the extra meals and food. How did you do that? And I thought about it for a second, because I didn't do anything differently than I did the quarter before. All I did was act aggressively — not wildly, and appropriately, but aggressively. Arrow up, I want to stop that arrow. High blood sugar, I want to get it back down as soon as possible. I would much rather get a blood sugar down quickly than to watch it exist for three hours and bring it down slowly. I mean, the less time with the high blood sugar, in my opinion, the better. So that's how we got 5.9. We were just bold. We were aggressive. We weren't scared. And when the times came where we did use a little too much insulin, we combated the insulin with, you know, something that worked quickly for Arden, juice a lot of the time. Just to kind of go over everything one last time. Aggressive but cautious. Respectful, but not afraid.
Definitely have to lean on the technology. I genuinely don't know how to give you advice about doing this without a Dexcom CGM. I feel like it would be impossible for me to do. Overnights, find a way to be comfortable with a steady lower than what you're used to now, because there's so much A1C that can get cut out. Like we talked about earlier, the difference between 180 and 130 is huge. The difference between 130 and 80, same difference. Stop and think about that for a minute. At some point Arden's blood sugar overnight was 180, and now I'm comfortable with it at 80. It's obviously not always 180, obviously isn't always 80, but those are our goals, right? That's what we're shooting for, 100 points, 100 point difference. And that's the story of how Arden's A1C went from 9, 8, 2, 7, 2, 5.9. And don't get me wrong, not just insulin — there were a couple of meals, things we cut out of eating. Arden used to eat cereal for breakfast, she doesn't eat anymore. There's a great blog about Froot Loops on Arden's Day where Arden came out of an endo appointment and just asked me one day, how can I get my A1C to come down? And I said, well, you could probably stop eating cereal in the morning, that would help, and we got a big reduction out of that. So it's not just insulin and being aggressive.
There's Basil, up from his nap. It's not just insulin and being aggressive, it's also diet and exercise and a lot of other things. But anyway, while my — Basil's scratching — and I talk like she's — my nurse practitioner — while Arden's nurse practitioner's asking me, how did we get a reduction at the holidays, and I explained it to her, she paused, and she looked so serious and thoughtful and sad all at the same time, and she said, getting people to not be afraid of insulin is probably the hardest thing I do. So then I decided to make a podcast about it. And it looks like we're gonna take a little break here while Basil finishes barking, and I'm going to come back in a second and just talk about Apple Watch for a second and a couple little news things. I'm gonna let you out of here and get back to your life.
Real-Time Blood Sugar Update38:22
Okay, I'm back, and Basil's calm again. You know, I just thought this would be interesting, because I recorded this, you know, basically while Arden was at lunch at school. And you remember earlier in the episode I told you we pre-bolused at 10:30 in the morning, and 11 she was 160 something straight up, and I actually gave her more insulin. Then it is now — 110, my larger dog is now moving around — it's now 110, her blood sugar. I'm looking at my follow app for her Dexcom Share, her blood sugar is 97 diagonal down, and I expect that to level off in the next few minutes. You know, hopefully by the time she's 85, that's my goal. But just so you can really see it in real time, you know, she was, what did I say, 100 and something, 103 or so, diagonal down at 10, we took in some carbs, by the time it was ready to pre-bolus at 10:30 she was at 85 and steady, I figured that the sugar from the candy hadn't kicked in yet, I did an extended bolus, 50% of the insulin at 10:30, the other 50% went in over a half an hour, at 11 o'clock she was eating, her blood sugar was 160 something straight up, I gave another half of a unit, just a blind half of a unit, and now, you know, 11:30, 12, almost three hours since the beginning of the extended bolus, she's at 97 diagonal down. And I do believe that that diagonal down will level out, and if it doesn't, then we'll just take a few carbs in here and her blood sugar will probably stay around 110 for the rest of the school day, for the two hours before she comes home. So it made sense, good look at what aggressive means. You know, the difference between the 97 after lunch, and what probably, without that extra half of, you know, it would have been more like 150, and we've talked about that, 50 points is 50 points, is a lot.
Apple Watch & Dexcom Share40:43
Okay, so hey, I hope you enjoyed talking about insulin, we can do it again in the future. If you liked it, you send me an email or comment on the blog and let me know what you thought. If you want to talk more about it or about different topics, I'd love to know your thoughts. We are — we, me — it's on by myself, it's a blog I write by myself, and I said we — I have two more interviews coming up for some upcoming shows. I'm gonna be talking to a mom from Canada whose child lives with type one diabetes and celiac disease, and I'm going to be talking to Karen who runs Diabetes Blog Week about Diabetes Blog Week. So that's coming up. I ordered an Apple Watch, yay, yay. This — it was expensive. Here's what happened. I'm up with a high blood sugar at night, high, I think she was like 180, and I couldn't get it to move, it was one of those, like I felt like I could have poured the insulin over Arden's head, blood sugar wouldn't have gone down. So I'm struggling with this one at trying to get it down, and I'm running out of ways to keep myself amused, I end up on Twitter, and I see on Twitter — and there's not a lot of people tweeting, by the way, at 3:30 in the morning — but I see on Twitter that there's some Mac rumor websites are saying that the Apple Watches are about — like the stock's about to run out, they're going to push the ship date. And I feel like, get out of here, like I did not expect that. So I went on Apple's website through my iPad, through my Apple Store app, which works too well, because you can pay by putting your thumbprint on the Home button. And I had never really looked at the watches and thought, oh, I wonder which one I would buy. But there I am laying in bed trying to stay awake, 3:30, 3:40 in the morning, and I'm swiping through watches, and I see one that I think, hmm, that one looks attractive, I think I would actually wear that watch. And then I go back to Twitter, and they're talking about some watches aren't shipping till June now, you know, it's April 24th with the ship date, then they were saying four to six weeks after that, now all of a sudden they were saying June, and I thought, I'm just gonna buy one, because if I don't want it, like I'll just sell it, like I'll probably be able to sell it on eBay and make money, so it didn't scare me off, the vibe. Anyway, I picked one that I liked, and I stuck my thumbprint on the Home button, and just like that, I'm going to be getting one. They say four to six weeks, I think I'm supposed to get it around May 13th. So I will be back by the end of May talking about Dexcom Share too, and Apple Watch, and how they integrate together. And so I just thought that might be something you might be interested in.
My phone is ringing. Hello?
Hello. Hello. My name is Robert, calling you from Green Energy Solar.
You are Robert, but I do not have any interest in solar energy for my house. But thank you for calling. And could you, while I've got you, put me on your Do Not Call list, please?
That sounds like a no. He just hung up. Sorry about that. I'm not against solar energy, I just don't think it's a perfected thing yet, and I'm really scared about putting like panels all over the roof of my house, because I feel like, what happens when like the roof underneath gets weaker. Anyway, I have too many questions about — I like the idea of solar, I don't like the idea of putting panels on my house, I don't feel like I have to explain this to you. Okay, so I'm going to be talking about Apple Watch and the integration with Dexcom Share too, probably by the end of May. Hopefully I'll get it a little sooner and I can do it sooner. But I have to admit, it does look pretty tasty.
Softball Success with Dexcom Share45:37
So, I want to mention too that this past weekend Arden had a softball tournament, she played three softball games in one day. She got up in the morning at 6am, we drove to the field, she had to be there at 7:45, it was an hour away, they practiced and worked out until — what do you know — when the first game started, she played a game at 8:45, then they went to the playground, then we went to lunch, then we came back, they played another game around noon, 12:30, and they played another game at five o'clock, and then we didn't get home until eight that night. I think we were out of the house for, you know, almost 13 hours. And I can't say enough — and I am not being paid to say this — but that Dexcom Share too, I don't think Arden and I spoke face to face about her diabetes more than about three times the entire day. And honestly, one of those times was me throwing a juice box into the dugout and saying to her, drink half of it. I saw her rip the straw off, she punched it in, drank half of it, she stuck the other half underneath of the bench, and she went right back out on the field again. I think that was for a blood sugar that looked very steady at 90, which I knew wasn't going to last in the middle of all that.
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