#291 Ask Scott and Jenny: Chapter Eight
Scott Benner
Answers to Your Diabetes Questions…
Ask Scott and Jenny, Answers to Your Diabetes Questions
How do you teach kids to feel their lows?
How do you help a type 1 who has an addiction or eating disorder?
What are good practices about addressing lows when you're sick and how do you administer a micro-dose of glucagon?
How do you bolus for pizza?
Bonus! Listen to Scott reading and singing How the Grinch Stole Christmas!
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
friends, neighbors, countrymen, lend me your ear. This is Episode 291 of the Juicebox. Podcast, a super sized ask Scott and Jenny with how many ads? Zero? That's right, baby, we reached the end of the year. So instead of ads at the end of the podcast, a little Christmas cheer.
Here's what we're gonna do today and ask Scott and Jenny, we are going to talk about, I'm looking well, you would think I could read my own writing, especially notes that I've taken in the last hour. Well, this is a letdown.
Unknown Speaker 0:44
Okay,
Scott Benner 0:46
we're going to talk about micro bolusing, glucagon, like around the flow. So there's going to be a tiny bit of conversation around being sick. Similar to what you just got in the episode about illness, but it's more about many glucagon boluses. So we're gonna deal with sick lows, like how to deal with sick time lows. We're going to talk about how Jenny speaks to people about addiction, and
Unknown Speaker 1:13
you eating disorders.
Scott Benner 1:16
We're going to talk about how you can discuss with young children what feeling low, feels like. So maybe if they don't understand that they can learn and Jenny's gonna describe her pizza bolus. Plus just regular Scott and Jenny goodness.
Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Okay, so here's a question from Trina that I don't know if there's an answer to but I'm incredibly interested. Maybe you're just going to say there's no answer to this. But she's not Trina says she has a fairly newly diagnosed seven year old. That can't recognize being low. Uh huh. And somebody else comes in and says, You know, I, you know, I have a daughter who doesn't feel low to ardens always felt her lows at, you know, I could tell by what she would say to me, I could I could probably tell you what her blood sugar is by her response, you know, from 65, to 60, to 55, to under 50. I know. But is there a way to teach people to feel low? Like that? Doesn't? I don't feel like you could? And if not, then what are the reasons why some people feel it and some people don't? Or is there not even a reason for that.
Jennifer Smith, CDE 2:57
It's not uncommon for younger kids, to not really be quite aware of what their body is signaling and telling them, I mean, outside of like, like a big gash cut that they get in the backyard or something or like, Oh, my God, I'm bleeding, you know, or it hurts, you know, pain sensations are typically felt by all people, right. But from the low sensations, kids are usually not very good with how their body is doing, you know, unless they're like, Oh, my God, I've got a toothache or my ear really hurts, you know, and even little, little kids, like, you know, under the age of, I would say, three, an earache is typically like their rubbing their ear or their like, they don't want to lay down on that side. So as a parent, you can kind of tell, as far as I mean, a seven year old, technically should be coming into some body awareness. Being able to send some things, but as a, as a parent, you might need to discuss some of what the common symptoms are, you know, maybe they don't know how they're supposed to be feeling if their blood sugar is low. And maybe when it is low, saying, Hey, you know, do you? Do you feel kind of shaky? Or do you feel sort of, you know, like, you can't really, you can't really do math, I mean, by the age of seven kids or kids know how to add and subtract at least the basic numbers like, you know, 20 and last, right. So in that sense, maybe it's not a symptom, but maybe something you teach them is, hey, do you know what two plus two is? Yeah. And most kids of the age of seven, should be able to sit out for pretty quickly, right? If they can't, maybe that's something you teach them to think okay.
Unknown Speaker 4:49
to press to?
Jennifer Smith, CDE 4:51
I don't know what it is. And I mean, since we've got sensors, kids nowadays can actually visually see And they can start to associate a value with something in their body. That's not quite right. You know, asking them, does your tongue feel kind of funny? Do your lips feel kind of tingly? You know, when you put your hand out? Does it kind of shake a little bit? Or do you feel sort of like, you know, topsy turvy on your feet? Sometimes it takes talking to kids about what they could be feeling to get them to start paying attention.
Scott Benner 5:30
Yeah, that makes sense symptoms. I think that I think that makes a ton of sense. Actually, please, you said something in there that just made me think we're expecting them to say I'm dizzy. But they may have no, they may have no context for dizzy. So maybe you take them at a time when they are absolutely at a good blood sugar and spin them in a circle a couple times, then go, Hey, if this ever happens, if this feeling ever happens, let me know.
Jennifer Smith, CDE 5:55
And we haven't spun you around like a twist the
Unknown Speaker 5:57
right? Yeah,
Scott Benner 5:58
you know what I mean? Like, if we haven't spun you and you feel like this, let me know. Or I think that's a great idea like, and I would caution when you try to teach them these sensations. Maybe don't tie them to diabetes, because then it's possible. They could make them up at some point to like, teach them the sensations. Don't mention the diabetes, and then just tell them hey, if you ever feel like this, we want to know, right? You don't want to do the I always used to say to my wife, like when we were first billing, we first had Cole, if he fell over, she would like go at him and say, you know, like, you know is your leg hurt? And I'm like, don't put thoughts in his head. You don't mean like, you know, you hit your head? Are you hurt? Well, then you're like, well, I guess I am yet. You know, like, so you can put that thought into someone's head. But that's a great, I did not think we were going to have an answer for that this podcast is excellent. All right, let's go. As the end of season five comes to a close, I want to take a couple of moments throughout this episode, the Thank you. There are 508 ratings for the podcast on iTunes today. And I took some time to jump around iTunes all over the world. And in maybe six to eight other versions of iTunes, like Australia, Canada, there are amazing reviews for the podcast. I'm so touched by all of them. And I appreciate all the time and effort that it takes to put them up. They're really thoughtful, and heartwarming. And I definitely think they go a long way towards helping other people find the podcast. So every time I say to you guys, please help someone else find the podcast. Just know that I appreciate it, that you're doing it. And it's work.
You know, I saw somebody talking about something online the other day, let me see if I can figure it out. I might have a question for you, Jenny on the second. Awesome. Well, I am going to hit this first though, because then how do you? How do you help people who have type one, and also have an addiction? So let's see. And let's keep it to a drug addiction, you know, is there? Are there things that those people can be doing when they make the decision? Like, I have to do better with my diabetes? Like how it seems like such a crazy thing. But at the same time, any kind of addiction could mess up diabetes, obviously, I think, you know, drugs, and alcohol would probably be worse. But even if you had like a food addiction that would throw off managing your type one a lot like how much do you end up having to talk about that with people?
Jennifer Smith, CDE 8:51
I would say that it's more the anger that you brought in food as a piece of it. While it's not I mean, addiction isn't there's a lot of disordered eating. That comes in with diabetes, because our management is from the get go very centered around food, intake food and you do food and you become food becomes almost a control piece. For many people with diabetes. As I think it's good, it's right to kind of categorize it in with drugs and or even alcohol. Those are pieces that we end up talking to people about but not really managing that piece for them. And so far as our explanation about things like for example, alcohol, right as an addiction. Alcohol can have major impact on blood sugar control, and what happens within being drunk right Your ability to mentally decide things and make appropriate choices and what to do. And even, you know, if you were high or drunk or whatever, and you were even changing your pump site, you could totally inaccurately do that. And you could have a major problem. Right. So I mean, those are pieces that we, we do bring in as far as discussion. We encourage people to continue with their, you know, their therapy, if they are in most of the people, I would say 98% of the people that we work with, who have either had an addiction, or a managing an addiction of some kind, already have a therapist that they're working with. Yeah, I have not personally work with anybody that has a known issue, and hasn't had somebody that they're getting help with from it or for it. But I think that's a big piece of it, it's also from the standpoint of their therapist, or who they might be working with, that person also needs to understand the diabetes component to it, because it needs to be brought in to the overall picture of discussion. You know, the diabetes is a stressor, and that's going to be part of how they manage the raw.
Scott Benner 11:22
Yeah, I so I don't know if you saw recently, I did a, something I called after dark drinking addiction edition, excuse me. And it was a piggyback off of a conversation you and I had and we talked about how to Bolus for alcohol. And then I said, You know what, Jenny, I'm gonna get like a professional drunk on here to talk about this, right? And actually, the funny thing is, is that, uh, the person, Maya, who ended up being on the episode, two different people in her life, who listened to the podcast, separately of her, contacted her and said, Oh, my God, it's your turn to be on the juice box. He's like, she's looking for somebody. Scott's looking for somebody who knows how to really drink and take care of their diabetes. It's your turn. And she sent me a message. And she's like, I don't know how to feel about this. But apparently, I'm the professional drunk you're looking for. And I was like, gotcha. So she came on, and we had a really honest conversation about how she manages. She's a person who drinks she's not a she's not a blackout drunk. Do you know me much, but she drinks a lot more than probably most people do. Like, you know, she's at least having a couple of glasses of wine a day at her meal. And she is a person who finds a lot of pleasure going is she described going to like, out to a lake and tubing around and drinking a case of beer and that kind of thing. And she talked about all how she did it. super interesting. When I asked her what she thought the most dangerous part about drinking with diabetes was, she said, it was about making a bad decision with insulin when she was too drunk correctly. And she was like, that's my biggest fear. She's like, I figured out the rest of it. Like, I'm not super afraid of falling asleep. And getting too low. Especially because she has, you know, she's got good technology too. But already, but she said I would think the biggest concern and it's funny, it's exactly what you said, like, what if I make like a grave mistake and give myself too much insulin? That's really that there's a lot of consistency in that.
Jennifer Smith, CDE 13:17
As you listen to that episode, actually, because that sounds It sounds very good. And I'm always I love to, I love to learn it, you know, more even. Yeah, no different insight Exactly. Because it helps me to help people better. Well,
Scott Benner 13:34
the next one we're booking right now is with a legit waken Baker, I found a 26 year old kid who smokes every day and has diabetes, I'm gonna have him come on and talk about that. And as we're sitting here talking, I think I know somebody I'm going to reach out to about addiction, see, if I can't do one with them to maybe they could add some more context than you and I are going to be able to be free. Because even as you're talking about it, I realized that everything I thought to say, was conjecture. I have no real life experience whatsoever. Like I can imagine what the problems might be, but I don't really understand what it's like to be addicted. So. So the answer to that one here for Ana is that I think we're going to try to do an after dark episode about this and get you more answers. Awesome. Cool. We've done some of you are asking questions that are already listened to listen to more of the podcasts are already out there.
Unknown Speaker 14:30
Go search. There's more on there.
Scott Benner 14:33
to them. I don't really label them that well. I want to wish everyone a Merry Christmas. Happy Hanukkah. Happy New Year, wonderful holiday season. Hope all of your dreams come true. Hope you find some time to relax. May you find time to be with your friends and family. And just reboot, you know, let your brain go limp for a couple of days. So you can reach out And I hope during all this eating and celebrating that's going to happen over the next couple of weeks, you keep in mind the things that we've talked about so far on the podcast, because I think they're going to help you. It's flu season. And this person's asking about something I have absolutely no experience with. How do they micro dose glucagon? In scenarios where they have blood sugars that are so low that they can't, they can't get them to come back up and the person's may be too sick or can't keep down food? Like what a good I guess not just around glucagon, but what are good practices about addressing lows when you're sick? Oh,
Jennifer Smith, CDE 15:41
sorry, you cut out a little bit. They're addressing
Scott Benner 15:45
low low blood sugars when you're sick, you know, when you're stuck. Yeah.
Jennifer Smith, CDE 15:50
So I mean, low blood sugars in illness are much more typical for stomach or digestive bugs. not as common for like, the cold or, you know, like a bronco infection, those usually spike your blood sugar. So those aren't as common. If the flu includes some digestive issues, then we usually say a temporary bazel decreased to begin with, can help to cut the risk, especially if you're not eating very often, or can't eat more than like a chicken or vegetable broth, you know, or eat a popsicle every, you know, couple of hours or whatnot. So taking your bazel down temporarily, anywhere between 10 to maybe 25%, less is a good place to start. If you have a blood sugar that you notice is starting to trend down and you literally You're so nauseous that you can't take anything in turning bazel down by 80%. So you really only running about 20% Normal bazel for about one to two hours, really cuts off insulin significant enough that it should help that glucose to stabilize, and not get too low in a time where you can't take anything in at all. So those are, you know, some, some adjustments that can be done. Other ones certainly, if you find something that you can sip on even a little bit of like, honey in the cheek, or, you know, cake frosting, I know is another one that's commonly you know, mentioned, maple syrup is a very curvy. So those kinds of things, even in a cheek and sort of massaging can help to get it to absorb through the the like oil area
Scott Benner 17:42
without you having to maybe swallow it and affect iraq feels Okay,
Jennifer Smith, CDE 17:46
correct. I mean, you're certainly not going to get 100% of carb absorption, but you're definitely going to get some carb into the system by just putting it in the cheek and massaging it. So that's another good option. electrolyte beverages, especially for stomach bugs are also a good place that you can get a little bit of carbohydrate. There's one that's got a minimal amount of carb. It's called drip drop, okay, it's an electrolyte replacer you put it in water, I think per serving, it's got like eight to 10 grams of carb. So again, not a lot, but enough that it could help to stabilize blood sugar some. And then, you know, in a scenario where you really may need to use glucagon. If you don't have if you don't have the current and newest back semi, you know the the nasal sort of glucagon that be many dose unless somebody figured out how to do that already. I don't know. But I mean, it's a one, pop it in and it's there. You can't like micro dose it. But there are some rules of thumb for micro dosing the injectable glucagon. Essentially you would mix up the glucagon. The mixed glucagon is good for I believe up to 48 hours after mixing. So if you had to use more of it over the time period of and stomach bugs usually don't last very long, somewhere between 24 to 72 hours at the at the longest. You would mix it up but you're not going to inject it with a glucagon injector syringe, you're essentially going to use an insulin syringe. So for those people who are using insulin pens with needle caps, get a one time prescription from your doctor for insulin syringes. Keep a box around so that you could go ahead and micro dose your glucagon
Scott Benner 19:47
I would say ardent hasn't has been pumping for like ever. And we still have syringes in the house. I always make sure we have some just in case. Yeah, that's all it just needs to be there just in case I need it. So So
Jennifer Smith, CDE 20:00
don't really go bad. I mean, your syringes. I mean, they do have expiration dates on and I always think it's funny. I'm like, is this it's not like cheese
Unknown Speaker 20:10
with a piece of metal on it. I haven't got
Scott Benner 20:14
I have some that are so I had so many at the end of MDI that I gave a number of them away to somebody because I thought in a lifetime, Arden won't use all these, you know, so we held on to a few and they've lasted for a decade, it's you know, but been incredibly helpful when they were needed. So when I so when someone goes to micro bolus glucagon, is it just? Is it a testing thing? Are you just trying it and seeing are you so there's a rule of thumb or
Jennifer Smith, CDE 20:43
there is a rule of thumb, and I'm actually off the top of my head, I don't know, I'm actually looking in my education materials right now. Because it's something that I actually send to people.
Unknown Speaker 20:56
Core ability to squat,
Scott Benner 21:02
you're looking at that, let me say this, the idea of sipping tiny, tiny little sips, while you're sick of you know, something that has a little bit of carbs in it with the electrolytes, first of all, it's going to help you being sick anyway. But it's really no different than when I was talking to someone, a month or so ago, somebody I know, personally, whose child has type one playing ice hockey, ice hockey, and was getting low. And I said, look, I think he should have some sort of a Gatorade and water on the bench. And then when he sees himself dipping a little low, that's the time you take a couple sips of the Gatorade. And then the next time if the arrow levels out, you go back to the water. And maybe you have to go back and forth a little bit to to, you know, kind of bump and nudge with the glucose from that drink, you know, right. And it worked out really well. For him, I think you're basically saying the same thing. If you're sick and your budget is just trying to get low all the time and cutting your basal back's not helping, then you just have to kind of it doesn't have to be a big drink, don't get into a situation we need a big glass of liquid just write a little bits, little bits and little steps.
Jennifer Smith, CDE 22:08
And with nausea, and everything those little sips can sometimes still be tolerated enough that you can, like you said, you can get in just a little bit incrementally, I mean, stomach bug to really help to get in some power that you are bolusing even a micro amount for because it really helps to prevent starvation ketones, and anytime you're ill, you really want to prevent ketones of any kind, because they could even at lower blood sugars. I know we talked about this before, as far as ketones, even with lower blood sugars in a time period of illness, it can lead to decay, even at numbers that look more normal. So if along the line of a stomach bug, you're micro dosing for, you know, a popsicle, that was 12 grams and you only Bolus for three grams of it, it's getting enough little bit of insulin in that you decrease significantly the risk of ketones
Scott Benner 23:09
you do not want to go into DK and if you go into DK or you lose control of it, you got to get to the emergency room. So correct yet don't correct. Especially going into like overnight, like like don't don't you don't mean like it make a decision. My wife wasn't feeling well the other day and I was like, don't wait till Saturday to decide you need to go to the doctor. It's so don't wait till midnight to decide, you know, I don't think I'm doing well then fall asleep and find out you aren't decay overnight. Like, you know, you have to make it sucks being sick. Hopefully everybody and it
Jennifer Smith, CDE 23:41
kind of, you know, blood sugar wise, it kind of also in an illness goes along with Where? Where should you look at the potential for needing something to help prevent a further dip, right? So if you're starting with somebody who's Ill really nauseous, unable to keep things in, or things are coming out kind of like both ends. Not to be gross, but you know, they really can't keep anything in. You mean need to utilize something more than just taking bazel down temporarily. Right? That might not cut it completely. So Then where should blood sugar safely be? We usually say especially for kids, not letting blood sugar get less than like 85 to 90. Only because less than that you're really risking a quicker drop to being a time or a glucose value that you can't really recover from when somebody can't take anything in right, so many glucagon. And there are a lot of really good resources online. I mean, there's one at diabetes in control. There are some from the NIH. Typically for kids, we would recommend if your child can't take anything in literally at all. And glucose looks like it's dropping. It's not like that nice stable, but it looks like it's trending down, we'd recommend that the mini dose mixing it up that vial, push the liquid and mix it up, get your insulin syringe. And using an insulin syringe, it's kind of based on age. So the mini dose of glucagon. Each unit on an insulin syringe is 10 micrograms of glucagon. So that's the conversion. If your child is under the age of two, you would need to units on the insulin syringe, which is 20 micrograms of glucagon. If your child is between the ages of three to 15, you would need one unit per year of age. So one unit of an insulin syringe or 10 micrograms of glucagon per year of age. And then over the age of 16, it's 15 units, or 150 micrograms. And you'd inject it essentially the same way you're going to give insulin. Pinch up injected in AI, we typically still recommend similar to low glucose, you know, we still recommend checking blood sugar every 15 minutes and definitely doing it with a finger stick. Don't just rely on your CGM value, do a finger stick, get an accurate value. And if it's still lower than that 90 or if you're someone listening from outside the states, and you're in millimoles, that's five millimoles or less, then you can give your child a second injection of glucagon and you would actually double the dose from what you gave the first time.
Scott Benner 26:49
Now, are they going to experience any of the kind of bad side effects that sometimes come from glucagon when you're mini dosing?
Jennifer Smith, CDE 26:55
typically not in fact, those symptoms which common symptoms would be nausea and vomiting, which is pretty significant to give that whole entire syringe full of glue good on, which to my understanding is at least what I initially learned was that syringes meant to treat somebody up to 250 pounds. Cheese. So if you've got a little, you know, four year old who is like 30 pounds or 40 pounds, no wonder they're getting such a significant, like, nauseous. With Yeah, we have a micro dosing of it. You shouldn't
Scott Benner 27:33
Arden's emergency one at school up until I think she was over 80 pounds, just that just give half of it if you can, you know, just eyeball it. I mean, if if Wallah seven year olds having a seizure, and you as a teacher who really never wanted to be a part of this can stop the thing. I just want to put it in half of this. Well, you know, good luck and everything. Right. I think you're in an emergency situation that and maybe the nausea afterwards is is the price of doing business, you know, but I just wondered if it came with a micro dosing to Okay, so I had one more question. I don't know if we can get through it in 10 minutes. Sure. But um, what are we okay, well, we're gonna do one more by the way, Arden's blood sugar 77 and stable. Nice job. Thank you so much. Banana bagel, three molano cookies. Oh, my gosh, big bag of grapes have no, I have no idea how many. And a yogurt. I've even come to the idea of I can now put in more food to give her choice knowing she won't eat at all and still hit the but the Bolus, right? So seriously. Alright, so now we're gonna test this right? We are going to answer someone's question here. Gosh, why can't I just see it? I've been looking at it for 10 minutes while we're talking about moving on. And now all of a sudden I've lost track of it. But this person says, I don't know how to Bolus for pizza. So given that everyone's going to be different. Still. I would like to ask you, you're a grown person. I'm assuming you eat pizza sometimes. How do you Bolus for pizza?
Unknown Speaker 29:12
Oh,
Jennifer Smith, CDE 29:14
assuming this person is using conventional insulin pump.
Unknown Speaker 29:19
And we don't know.
Jennifer Smith, CDE 29:21
I don't really see Tam on injections or I'm pumping or I'm you know, using a frezza nasal nasal insulin or whatever you're doing right? I don't know. So let's assume a conventional pump. Yep.
Unknown Speaker 29:35
In that case,
Jennifer Smith, CDE 29:38
the pizza bolus sort of became the term for an extended bolus, right? It was the first reason that we started to use extended boluses or have that feature on a pump. And the reason being pizza is high carb, very, very high carb unless there's somebody making a cauliflower pizza. across, then whatever your pizza is high carb from the grain nature, but it's also really high in fat. I mean, unless you're doing a vegan pizza that has no cheese and sausage and whatever on top of it, your pizza is high fat. And if it's a pizza from a source outside, the crust probably has fat in it, as well as the toppings that you're adding on top of it.
Unknown Speaker 30:19
So
Jennifer Smith, CDE 30:20
the high fat nature along with the high carb component to it really mean that if you Bolus 100%, right now, for pizza, with a Pre-Bolus, as we've talked about before, the benefit of that
Unknown Speaker 30:36
you're going to get low,
Jennifer Smith, CDE 30:39
and then your blood sugar is going to get high. And then it's probably going to stay high for a while. Right. So there are a couple pieces to pizza food management. And let's kind of tie in nachos and you know, fish and chips and like a cheeseburger and fries or a real Italian pasta meal with all the good cheese, sausage and cheese and oil and whatever. Right. So high fat, essentially an extended bolus. And again, it takes a little experimentation to see what type of extension you need. For the most part for pizza type of food, you would use about a 60 or 70%, upfront possibly, and the rest over at least a two hour time period.
Unknown Speaker 31:27
So
Jennifer Smith, CDE 31:28
what you're doing is you're giving insulin up front, but then that extension over about a two hour time period and the back end is grabbing on and hitting the food that's more slowly getting into the system because the fat isn't letting all hundred and 20 grams of that pizza. Get in right now. Right? Some people do a 5050 50% now 50% over two hours that works very well. Um, I think the upfront amount from my experience really is specific to how much is on top of the pizza. You know, if it's your Margarita pizza that has a couple of blobs of real mozzarella on top, but it's not slathered in cheese, and sausage and Canadian bacon or whatever, it's probably a lot lower fat pizza, right then something like the meat lovers, right? So that breakdown of percent now percent over time, kind of goes along with the nature of what you've got on your pizza. But that's that's the gist of pizza. And again, it takes a little experimentation. Sometimes you got to take a hit
Scott Benner 32:49
and learn and then move on from it. Right? I would say so Arden just had a slice of pizza going out the door to a party last weekend. And it was more the way you describe in some ways. So it was a thinner crust, but it had less cheese. Like it's not completely covered with cheese, you know, and I, you know, I come to realize too. I live in a portion of the country where, you know, I'm eating pizza that somebody in the middle of the country might have never seen before to me I'm not it's not Domino's, or you know, some restaurant chain pizza. This is you know, this is a Sunday night real pizza 90 year old Italian man who has, you know, the, the, the recipe for his pizza chained in a box around the killing to get it from him. So, and I happen to live in that part of the country where a pizza like that exists. And so she has this thing, but it does have sausage on it. So I looked at it and I thought okay, Arden's blood sugar's like 105 I believe back then, because she was she was a little on the lower side, because she was spent a lot of time getting ready with a costume party and everything. She's moved around the house a lot. blood sugar's nice and stable. I'm going to have a slice of pizza. I didn't worry about Pre-Bolus. And partly because I thought she might be trending down to begin with wasn't but because it's pizza too. And my idea about these carby things that hit hard. And then last is I kind of just think about it as getting my insulin up front to stop a rise or a spike. So I have so much, I have so much up front, that there's no way for your blood sugar to spike. And then as time goes away, I can take insulin away and let what's left over from the big push at the beginning act as the bazel going through it. And that is one way I do that. The way you just described I do as well. I don't need to read describe it because you did such a perfect job of talking about it. But But another way is, is that like it's just I bring in so many blockers up front. You can't sacked my quarterback. And then later later in the game when you stop blitzing, I send them away, you know, so and so I sometimes get in so much upfront that the it can not only handle the food, but it can be part of the bazel rate going away. And then I take the bazel way I trade I trade Bolus earlier for bazel later to leave the Bolus tail end acting as bazel later, yes, yes. Yeah. Yeah, that's, that's one of the ways I think about manipulating insulin. So
Unknown Speaker 35:31
but then the other component
Jennifer Smith, CDE 35:32
to pizza too, is again, the fat content, right? Like I said, before the Margarita pizza with a couple blobs of buffalo mozzarella on top, probably not high enough in fat that you're going to have that long duration extended high blood sugar for six, eight hours after, however, bringing the neat lovers and you not only probably need the extended bolus, but you probably need a temporary increase to your bazel for hours after right to avoid the sustained high. So again, scenario to scenario you may have to decide what your strategy is going to be. But those are the typical ways to manage pizza would have grabbed another slice,
Scott Benner 36:11
then I would no longer have been thinking about a bunch up front and no more back now I would have been as soon as she had the second slice, I probably would have bolused thin thin crust pizza, my guesses like 25 carbs, like I probably would have, I probably would have Bolus 25 carbs and probably done zero upfront and the rest out over like an hour and a half. I will as soon as she grabbed another one, I would have started thinking about the future. Yeah, right. But it looked like one and then she was going somewhere. She actually did have to Bolus once while she was at that party. We did not end up taking it away. I did a pretty good job of balancing it. And so while she was there, we had a nudge like a 134. Diagonal up at one point. She did not eat anything at the party, though. Oh, yeah, I think at a certain age kids just stand around and look at each other. So. So you're here I'm here to and then they that's pretty much the end of it. And I did not see Luke doing any gyrations during that time. Like there was no technical way away or way up, you know. So I was in a fairly traditional situation there too, because we'd hit the ball. So well, in the beginning. It just didn't. Luke didn't really have to do anything. It just sat with her base. Alright. Nice. That is really kind of fun when you can see that when you're on an algorithm. But you're like, wow, we did such a good job with the Bolus, like the algorithms not doing anything, you know. Yeah. Wow. That's really like, that's right.
Jennifer Smith, CDE 37:38
You don't see the down or the off the you know, cityscapes kind of thing. You just riding along your leg is looping. Is it working? is it doing anything? No, it's just got me hovering. Nice.
Scott Benner 37:47
We really hit this one. That's crazy. All right. Okay, so hopefully that was helpful. My Eternal grateful thanks to Jenny Smith from integrated diabetes. Don't forget, if you would like to hire Jenny, go to integrated diabetes.com to contact her. Also in the show notes of your podcast app. Jenny's email addresses right there. It also exists on Juicebox podcast.com for this episode. And I know this was ad free, but I'm feeling very festive. On the pod Dexcom dancing for diabetes. companion medical makers of the in pen. All the sponsors that supported the show this year. Happy New Year. Merry Christmas. Thank you so much. And now I'm going to try something that may or may not go well for the holiday season. We're about to find out.
This is for all of you who listened with your children. And for those of you who may still be children. Somewhere inside the Grinch by Dr. Seuss. Every who down in Whoville liked Christmas a lot. But the Grinch who lived just north of Whoville did not. The Grinch hated Christmas the whole Christmas season. Now please don't ask why no one quite knows the reason. It could be perhaps that his shoes were too tight. It could be his head wasn't screwed on just right. But I think that the most likely reason of all may have been that his heart was two sizes too small. But whatever the reason, his heart or his shoes, he stood there on Christmas Eve hating the who's staring down from his cave with a sour grinchy frown at the warm lighted windows below in their town. For he knew every who down in Whoville beneath was busy now hanging a Holly who reef and they're hanging their stockings he snarled with a snare. Tomorrow is Christmas. It's practically here. That he growled with his Grinch fingers. nervously drumming. I must find some way to keep Christmas from coming. For tomorrow I know all the who girls and boys will wake brighten early. They'll rush for their toys. And then oh the noise. Oh the noise noise noise noise there's one thing I hate. All the noise noise noise noise they'll stand close together with Christmas bells ringing they'll stand hand in hand and those whose will start singing far who for $1 who don't? Ray welcome Christmas Come this way. Bar who for a DA who don't raise well gum Christmas Christmas Day. Welcome Welcome, fall Who? ramas welcome welcome Doctor Who does Miss Christmas Day is in our grasp. So long as we have hands to clasp foul Who's Who? For who? And they'll sing and they'll sing and they'll sing, sing, sing sing. And the more the Grinch thought of this who Christmas sing, the more their Grinch thought I must stop this whole thing. Why for 53 years I've put up with it now. I must stop Christmas from coming. But how? Then he got an idea. An awful idea. The Grinch got a wonderful, awful idea. I know just what to do. The Grinch laughed in his throat. I'll make a quick Santa Claus hat and the coat. This is stopped number one, the Grinch claws hissed as he climbed to the roof. Empty bags in his fist. Then he slid down the chimney. A rather tight pinch. But if Santa could do it, then so could a Grinch. He got stuck only once for a minute or two. Then he stuck his head out of the fireplace flew where the little who stockings hung all in a row. The stockings he crunched are the first things to go. And he slithered and slunk with a smile most unpleasant around the whole room. And he took every present. It was quarter of dawn all the who's still a bed. All the who's still a snooze. When he packed up his sled, packed it up with their presence, their ribbons, their wrappings, their sniff and they're fuzzles their tree anglers and trappings. 10,000 feet up. up the side of Mount crumpet. He rode with his load to the tip top to dump it. Poo Poo to the whose he was Grinch Lee humming, they're finding out now that no Christmas is coming. They're just waking up. I know just what they'll do. Their mouths will hang open a minute or two. Then those who's down in Whoville will all cry boo hoo.
That's a noise grin The Grinch that I simply must hear. He paused and the Grinch put his hand to his ear. And he did hear a sound rising over the snow. It started in low then it started to grow. But this sound wasn't sad. By the sound sounded glad. Every who down in Whoville the tall and the small was singing without any presence at all. He hadn't stopped Christmas from coming it came. Somehow or other it came just the same. And the Grinch with his Grinch feet. Ice cold in the snow stood puzzling and puzzling. How could this be so? It came without ribbons it came without tags. It came without packages boxes or bags. He puzzled and puzzled till his puzzler was sore. Then the Grinch thought of something he hadn't before. Maybe Christmas he thought doesn't come from a store. Maybe Christmas perhaps means a little bit more. And what happened then? Well, in Whoville they say that the Grinch is small heart grew three sizes that day. And then the true meaning of Christmas came through and the Grinch found the strength of 10 Grinches plus two. And now that his heart didn't feel quite so tight. He whizzed with his load through the bright morning light. With a smile to his soul. He descended mount crumpet surely blowing hoo hoo on his trumpet. He wrote into Whoville, he brought back their toys. He brought back their floof to the who girls and boys. He brought back their sniff and their trailers and fuzzles brought back their petard cuz they're daflores and muzzles. He brought everything back all the food for the feast and he himself, the Grinch. carved the roast beast. Welcome Christmas, bring your cheer. Cheer to all who's far and near. Christmas Day is in our grass, so long as we have hands to grass. Christmas Day will always be just as long as we have we welcome Christmas while we stand, heart to heart and hand in hand
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About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!