#434 Splitting Long Acting Insulin

January 29, 2021Scott Benner

Jenny Smith in the house!

Jenny and Scott talk about the possibility of splitting basal insulin for type 1 diabetics using multiple daily injections.

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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
Hello friends, and welcome to Episode 434 of the Juicebox Podcast. Today's show is with Jenny Smith, Jenny and I are going to talk about long acting insulin for those of you who are on MDI. So insulins like love Amir lantis, tresiba, stuff like that long acting, which Jenny corrects me about because I want to call it slow acting. But Jenny is older, and she's had diabetes for a long time, so she remembers insulin, it was slow acting. Anyway, let's get started.

My friend Jennifer Smith 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 monitoring system. systems. I didn't say the Ask the first time and most just pretend like but and continuous glucose monitoring systems. She's on the show today, to help me talk about long acting insulin for people were using multiple daily injections. Now if you're pumping, we still, we talk a little bit about the ideas of how basal insulin works and how to create coverage for different things. So I don't think the conversation wouldn't be valuable for you. But this one was definitely done with people who are injecting in mind. 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 healthcare plan, or becoming bold with insulin. Now after all this, if you'd like to contact Jenny, you can find her at her real job at integrated diabetes.com.

I'd like it if you could consider supporting the good work that's being done by the T one D exchange, your participation will take just a few minutes. But the impact of your kindness will last forever. Because the T one D exchange is looking for type one adults and caregivers who are us residents to participate in a quick survey that can be completed in just a few moments right from your home, on your phone or your computer. And after you finish the questions which are very simple, I think it took me maybe six or seven minutes to do them. You'll be contacted annually after that just to see if there's any updates to your information. But other than that, there's nothing left for you to do. And this is 100% anonymous, completely HIPAA compliant. And it never requires you to have to see a doctor or go to a remote site. But it does allow you to help with the research being done around type one diabetes. The T one D exchange is building the most robust Type One Diabetes data platform in the United States. And it's using it to drive meaningful research and innovation in treatment prevention and hopefully one day a cure. With their partners, they work to increase patient access for care resources, to promote education, and advocacy for policies that help the Type One Diabetes community, these things lead to better, longer lives. For everyone living with Type One Diabetes. If you can take the time to do it, please visit them at T one d exchange.org. forward slash juice box. Thank you very much. Jenny, I want to talk about slow acting insulins for people using MDI. Because I always tell people that the difference, the main difference between pumping and not pumping is well, if you're pumping, you don't have to inject yourself a bunch. And if you're pumping, you have access to extended Bolus features and manipulating your basal insulin from turning it off to temporarily putting it up or down. And to me, those are the real differences between pumping and MDI. I don't see a bunch of others,

Jennifer Smith, CDE 3:56
the dose two from the standpoint right? I mean, in terms of especially a little little are really sensitive, if all you can do on MDI is half a unit. Or if you've got really good eyeballs, and on those half unit syringes, you can get a quarter of a unit which I can can be done if you but it's again, it's not exactly right. But I mean, if you're somebody that can take point 05 or point one, and it turns things around for you, then MDI is not going to ever allow that

Scott Benner 4:30
right. And then thinking specifically about being an MDI patient and your slow acting insulin. So let's list them because I'm not I can do the old ones Lantus. levemir. I know tresiba because people seem to love that but there's another one right?

Jennifer Smith, CDE 4:46
Oh, so not so. You mean long acting?

Scott Benner 4:49
Yes. I call it slow acting. You call it long acting?

Jennifer Smith, CDE 4:52
Yeah, it's long acting. And yeah, there. You're right. There's Lantus is old left Amir to jail

Unknown Speaker 5:03
to jail was the one I couldn't see. But

Jennifer Smith, CDE 5:06
then there's also you know, Basil glar, essentially, which is like Lantus.

Scott Benner 5:11
Okay. They changed that they changed. Okay.

Jennifer Smith, CDE 5:14
Yeah. So those are the those are the main, long acting sort of 24, what they call 24 hour acting.

Scott Benner 5:22
And if I put you in charge of the world, and you had to give people long acting insulin, which brand would you give them?

Unknown Speaker 5:29
Oh,

Scott Benner 5:31
you should have saw the pressure on your face when you were given free rein over the world just now. You're like,

Jennifer Smith, CDE 5:36
Yes, it was. Like being told that I get to be like, controller of everything. Yeah. Just insulin. That's that's not as fun. But I think that there are there are two, I wouldn't really only just pick one. I had to only pick one. I'd probably picked receba. Okay, honestly, second line, I would still go with the age old lantis. Okay, I really would. And I think that lantis to Jao probably would be kind of like, right with each other. And this is from both like this, his professional opinion in terms of what I've seen with all the people that I've worked with. And then really, fourth in line would really be more like 11 year. Okay. So I mean, by no means am I saying if you're on the level of your and it's working for you, that's bad or whatever, again, you're a diabetes. Is that what works? Well, it

Scott Benner 6:33
works works. That's no trouble at all. Yeah, what I started to run into this is going back a long time, this is this is Time Machine going back. Arden's using. They started on Lantus. It burned her we moved her to 11 year lever mirror didn't burn, we were all good. A little while in dardennes diabetes, I started seeing what I thought it's funny now because people have glucose monitors. They're like, yeah, it's so obvious, but it wasn't obvious back then, when I had a freestyle meter, it looked like it came out of a bubblegum machine and a bunch of needles, you know. And, and so I started thinking, I'm seeing Arden back then I thought of it as being insulin resistant. But her blood sugar's going up about 18 hours after I would inject her level mirror, right. And so I start, I'm online trying to figure it out. And again, for people nowadays, online back then was not the same thing online now is, and I come across Jenny, I don't I've never told you this. I know I haven't cuz I've never said this on podcast, I came across a web forum that should have been password protected. That wasn't where a where pharmaceutical sales people talk to each other. Okay, so there's a bunch of farmers A long time ago, this was a long time ago, I found this web board where pharmaceutical sales people talk to each other. And I found a thread where they were lamenting that the slow acting insulin that they were selling doesn't always last 24 hours, the way the label says it does.

Jennifer Smith, CDE 8:03
Say that, for that particular long acting. It's probably at least 90 if not more percent of people cannot use it once a day,

Scott Benner 8:15
once a day. And so that was a light bulb for me. And I was like, Okay, well, then what do you mean like so now I'm sitting there by myself. I don't have a podcast, I listened to her anything like that. I'm not reading anybody's blog. And I'm like, What do I do if it doesn't last 18 hours. And then I was like, What if I give her some of it? Every 12 hours. And that's the first time I split. Arden's love a mirror. I couldn't get a doctor to tell me to do it. I couldn't get anybody to tell me to do it. And, you know, so I started off with 5050, if she was getting four units a day, excuse me. If she was getting four units a day, I put two in in the morning, and 12 hours later, I put two more in. And then I started being like, Huh, like at night, she's staying stable. But during the day, she's a little high. So it's like, let me try two and a half in the morning, and then two at night, and I just kept messing with it until I got it right. And it messes with your head a little bit when you first started because your picture this 24 hour clock in your head, you're like where do I stop? And what's that going to do to success? You worry so much about it when you go to do it. But splitting that insulin absolutely was a game changer for Arden. And do you and I want you to tell me how you talk to people about splitting so and you would you wouldn't split receiver right because receiver actually seems like it makes it like 18 hours or a day and a

Jennifer Smith, CDE 9:40
hacker actually trusts eba from I mean if you pull out like the pamphlet details and all that kind of stuff. I mean it's a 24 hour acting insulin but the action profile is a true 24 hours at a minimum meaning many people know that it does last longer than that 30 hours, 36 hours, which also in terms of like dosing allows a little bit of leeway. Let's say, You were always really strategic about making sure you took whatever basil it's with, let's say it was love Amir once a day or lantis once a day at like 10pm. And it had to be 10pm every night or you notice like you did that after that it was just all out of luck because it was gone, or it was dissipating. Right? Not so much with Chris Eva, you could have leeway on erring on the side of later. If 10pm was your dose, but you didn't get to it until midnight. For the most part, you could be pretty okay or you would be pretty okay being sort of delayed in getting to taking it. But that's not really the case with like your lattices and your love Amir's. So for splitting like 11 year in terms of what we usually do, when it's really evident in data, kind of like you were following, even with the sort of rudimentary stuff,

Scott Benner 11:05
paper a pen and a little, I wish you could all see the meter. It was just like, it felt like it was gonna fall in half sometimes.

Jennifer Smith, CDE 11:13
Plastic carry, I mean, they're all plastic, but like, this was really like, not like that. Yeah, yeah. But you know, you we look at data and we say, Okay, this is clearly not serving you well. In fact, a good like basil sort of evaluation on like 11 year would be when you dose it, and you think you've got the timezone where it's dissipating in use, just don't Bolus and eat after that and see what happens to your blood sugar. Right? That's a really good way to analyze about the stoppage point, which then would give you more detail to splitting it, we do still try to do about a 12 and 12, in terms of hours in, you know, break. So morning, 6am, evening, 6pm, or whatever you want to do like that. We start with a 5050. Unless there's very definitive data, again, that shows a time period of the day with a lot more sensitivity and a time period where there's a lot more resistance. So let's say once we start splitting with 5050, the overnights are like, God, you're dropping, you're dropping, there's I gotta feed and feed and feed and we're in the daytime, you need more like you saw, right? So then we would really probably do more like a 7525 kind of thing more in the daytime, less in the evening or opposite, maybe less in the daytime and more in the overnight, especially if growth is a potential issue or there's stuff that's causing rises overnight. So the breakdown, we start with 5050. And then we go ahead with looking at records to see how to adjust it. Yeah.

Scott Benner 12:46
And in this again, to be clear, this isn't something you would do with anything other than Lantus or levemir.

Jennifer Smith, CDE 12:53
Correct. And for the most part, even Lantus, most, maybe not even lentils don't really need to split lantis, like that.

Unknown Speaker 12:59
It had

Jennifer Smith, CDE 13:03
in little doses, sometimes it becomes necessary, because the smaller the dose, the less lengthy the extension of use to a two to a true 24 hour gotcha. And same thing with a baseline basal insulin, that's a very large dose, we see large being more than about 40 units at an injection point. While you might take it once a day, you know, 8pm at night, anything more than about that 40 units in one pop, we split into two injections, gotcha. If you're taking 60 units, 30 units in one hip 30 units in the other hip or butter leg or wherever they're kind of putting it because that big depot under the skin. It's a lot. But

Scott Benner 13:51
is it true that those two those those insulins go under the skin they crystallized and they kind of melt away? Is that the functionality of it? Or am I

Jennifer Smith, CDE 14:01
wrong? I guess in terms of chemistry, that's kind of a way to look at how it doesn't get all absorbed, like our rapid acting insulins do like, you know quite right away or so to speak. Um, it forms more of like a solid like crystal, I guess.

Unknown Speaker 14:15
Yeah. And then and then it just sort of gets used slowly.

Unknown Speaker 14:18
That's not a bad way to describe it.

Scott Benner 14:20
I made that up years ago for the podcast or for the blog. And I just couldn't I was trying to explain it to somebody one day I'm like, just imagine it goes inside it kind of isn't liquid anymore. And then it just slowly kind of melts away and gets used up over time. It's time like throwing water

Jennifer Smith, CDE 14:34
hot water into the air on a really freezing cold day it crystallizes and then I probably

Scott Benner 14:38
could have just had time released now that I'm thinking of it, but then we will visual is more fun. It is more fun that way. So the reason I bring all this up is because watching people manage with MDI and getting this in their head that hey, I put that in now that's gone. I don't have to think about that anymore. Like that. It's it's, it's it's another avenue for me to watch people under represent how important their basal insulin is. And I guess then if I'm telling you what the real difference between pumping and not pumping is, is the ability to change your basil on the fly, day after day or segment after segment is kind of huge now I'm not a big proponent of having like 1000 basil programs, I'm I try to keep them pretty close, and manage everything else with with boluses. But there just can be no doubt, especially if you're a hormonal person, a woman who gets her period a little kids who are growing. I'm watching at times, like, like, I'm something it's a little exasperated right now and kind of blown up to make the point. But Arden is trying birth control pills to regulate her period. So poor Arden's period is not great. It comes, it literally doesn't stop, like in the last 60 days, Arden, you know, she hasn't had four periods, but she's had four episodes of bleeding that have lasted at least 11 days. So she gets 11 days, a five day break, and it comes right back again, right? So we're trying to regulate it with the birth control,

Jennifer Smith, CDE 16:15
not like a lot of women do that,

Scott Benner 16:17
please, whatever works, whatever makes her feel better, I'm good with. But the point is, is that we introduced more hormones into her body. And I watch her Basal needs change significantly. And I think, what would another person do? Like what do people do when they're on MDI and their I don't know, they're shooting five units in the morning. And that works for them, right? And then all of a sudden, something happens that puts their need up, it's kind of the last thing they would think to do is give themselves more basil. If they run empty, I think I think they'd be like injecting and injecting trying to stop highs and everything and just think, oh, why am I getting high diabetes? You know, instead of that?

Jennifer Smith, CDE 16:57
You're just the dose? Yeah, totally an MDI, which is what I had to do in terms of the same scenario as Arden when I was on MDI. And I had my period, I had to take about 20 to 25% more insulin in the days before it started, right, in order to calm down the impact of those hormones.

Scott Benner 17:22
100%. Like, it's well, but here's what I see the fear from people, which I don't not understand. How do they know how much? Because once they put it in there, it's in there, right? When I do it with a pump, I just go, I don't know, turn it up to this. If that didn't work, little more, was that too much? Take it away. But once you make the decision, I usually get five, I'm gonna put in seven, you can't take it out again, you know, it's in there. And that's got to be the piece that stops people from making the adjustments, don't you think? Like, that's the fear part that gets to them?

Unknown Speaker 17:57
Yeah, I mean, in general,

Jennifer Smith, CDE 17:58
depending on why you think the increase is coming. There's a general idea of about how much you might need more. So for a woman again, in that time of the month, typically somewhere between about 20 to 40%, more baseline insulin is needed to calm the impact of those normal monthly hormones that are cycling. For things like an illness, you know, like a nasty cold or whatnot. Most people need at least 25% more insulin on a basil level for an illness. So having some parameters to start with, for known situations, can help give you I guess, a math equation to figure out how much more to add in this scenario. If it's just like, oh, today, I'm running higher. I wonder if it's going to happen tomorrow. I need a little bit more data than just today. Don't be like, Oh, I'm running, you know, 70 points higher. I'm going to add four more units to my Lantus dose tonight. See if that helps, it is not what I would recommend doing.

Scott Benner 19:08
Yeah. But you have to you have to incrementally move. And it's just I feel for people who have that. Well, once it's in there, it's in their fear. Because I remember the first time somebody showed me an insulin pump, the first thing I thought was I can manipulate basal insulin. That was my most excited idea about pumping. I'm sure Arden did like not getting shots, but that's what I was thinking about. And it just so Okay, so you might need to split lava mirror, you don't think you'd need to split lantis tresiba can last much much longer. So it's on a different cycle. Here's a really out of left field question that maybe you're gonna tell me I'm an idiot on. But now that we have this conversation, I started thinking instead of splitting the lever mirror, should I have just shot less every 18 hours? Would that have worked in that scenario?

Jennifer Smith, CDE 20:01
If you were, I mean, if you gave less in an 18 hour time period,

Scott Benner 20:08
would it have made it this far? Maybe not, maybe I would have to shoot the same amount every 18 hours. Right? Let's see, back then I didn't think about and this is kind of the next little bit I want to talk about here. And I'm gonna keep it all in one episode. Back then I wasn't thinking about timeline. So we've talked about it before. But I kind of segment Arden's management in my mind into timelines. So there's a 24 hour timeline that I step back and look at that, to me is how I figure out basil. And where I see whether or not I've Pre-Bolus Well, or chosen the amount of insulin for food while But then I also think of timelines of meals. So in terms of how long is food going to be in our system? And where is it impacting or along the way. And so there are times that I change the impact of the insulin through the timeline of the meal. That's just sort of how I think about it. So there's a bigger timeline, that's 24 hours, then there's a smaller timeline that to me begins with a Pre-Bolus. And then any kind of fat or protein rise that I'm going to see. And then when the insolence out of her, those are sort of the two kind of ways that I think about it. And just now while we were talking, I thought I wonder if I couldn't have manipulated that basil insulin. Instead of thinking of Arden as a 24 hour timeline, what would have happened if I thought I was like, sure, whatever

Jennifer Smith, CDE 21:27
you did, and I think in hindsight, and that's the reason I wouldn't have, I didn't kind of comment on doing that. Because it, it becomes a little bit harder than because that 18 hours is always changing the time of 18 hours. Right, right. I mean, if you're going from taking it at six o'clock in the morning, 18 hours from there,

Scott Benner 21:50
what I really even think to do it, then

Jennifer Smith, CDE 21:51
would you even think I mean, you'd have to if you really did think it was definitely 18 hours and the dose was right, because the time in that 18 hours was spent in target along with the boluses. And everything was jiving the way that it was supposed to. It was after 18 hours that everything went sort of kakui. Yeah, then sure you could dose every 18 hours, but then you really have to be on top of setting a reminder that says this is 18 hours, this is time to dose.

Scott Benner 22:19
Yeah, it doesn't lend to what I'm saying doesn't lend to the idea that time is kind of artificial. Like you don't realize that till you really think about it. Like you're just running your life by a clock because we've all agreed to do it. Yeah. And so. And I'm thinking of it as a person who pumps insulin into his daughter, not as a person who shoots it anymore. Like what I really think too, like you said, 7am would turn it into what, like one in the morning or something like that, like what I'd be like, Hey, you know, well, probably not. But it still was an interesting kind of like exercise to consider just now like, like, I'm not saying you should do it. I've never done it. I can't stand behind this idea at all. It just kind of popped into my head as we were talking about it. Yeah. So okay. So when you're using tresiba, as example, your timeline, your macro timeline isn't even 24 hours. It's longer than that, but you still shoot it every 24 hours still

Jennifer Smith, CDE 23:16
give it every 24 hours. Exactly. Which again, in terms of use, I don't have a good amount of people who are using it because the majority of people just don't want to stay on MDI so long anymore. They just don't. I have I've had to in the past year women that I've worked with through pregnancy, who are MDI, and did it through pregnancy, and they were actually 11 mirror users, okay? Because it seemed to actually work better in terms of that dosing adjustment strategy gave you more

Scott Benner 23:57
flexibility to give

Jennifer Smith, CDE 23:58
more flexibility.

Scott Benner 24:00
Gotcha. How often do those people's levels change? Like how often are they their level are going up or down frequently?

Jennifer Smith, CDE 24:10
Specifically in pregnancy Yeah,

Unknown Speaker 24:12
those two Oh yeah, a

Jennifer Smith, CDE 24:13
lot. A lot. A whole pregnancy.

Scott Benner 24:16
All right. Now this is the eye you're losing me I've lost the ability to make eye contact with me while I'm talking now Jays The only person I look at long interview well while I'm talking but I'm so far in my own head thinking about like different timelines and overlays of influence everything like I'm just but and I know that sounds like probably nerdy and too deep. But I didn't know you could be nerdy about using insulin but I now learning it's possible that I am. So but there's a way to layer it on there that creates all that and and even thinking about that receive a piece like really think about that for a second. You shoot it every 24 hours, but it lasts longer than 24 hours meaning that somehow when you initially shoot it, it's got some sort of A ramp up period. That's because the beginning of the new shoot and the end of the old shoot are working together, kind of overlapping. And then there's a middle section where the new shoot is the only thing happening. And then the new shoot leaves a tail that you overlap with. Oh, that's good. I love that. I don't know why I like

Jennifer Smith, CDE 25:19
it from the couple of people I've worked with with tresiba. One of the times of day that most people have trouble with, of course, is the morning, right fasting time, breakfast time. So if you're taking your trusty bus in the morning, you have a potential for actually improvement in the aftermath of like a breakfast because you have that if there is for you, that like window of time where you've got the new one going in and ramping up, and the old ones still potentially dissipating out. So a bit of a layering effect there.

Scott Benner 25:56
I was talking to someone recently, and I said, Look, you don't have to do this. And I was like, I'm not saying you should. But I'm wondering if I was you? Would it be interesting to get up every night just for a week at 3am and shoot your your long acting insulin then to see if that quells the feet on the floor and the rise in the morning? Because you're getting up. All this is hitting you that insulin goes in. It's not working yet. But what if you just and I was like, obviously, it's not a long term fix. But if but if you were on a pump, I would say to you, four or five o'clock in the morning, I think you should ramp your basil up to get get ahead of this thing. I was like, I wonder what would happen. I wonder if that person ever did that.

Jennifer Smith, CDE 26:39
And they were inject they were? Yeah,

Scott Benner 26:41
yeah, they were empty house like just tried for a week to see what happens like set the set the dejection up, put it off the side of the bed, set an alarm. And then shut your eyes and go back to sleep and see what happens. I was like, just for an experiment. But you know,

Jennifer Smith, CDE 26:54
I think that's actually kind of one of the reasons that I'm so it's really hard for me to sleep in. Because from whence I was diagnosed. I mean, I had really, really old insulin. I mean, I had what was el insulin, the cloudy mix it up, you know, regular insulin. And that was even more than our current long acting insulin. That was very much you were on a time schedule. It was take it at this time, eat at this time have snacks at this time, because this is the action profile of the insulin. You have to meet it with food, correct?

Scott Benner 27:32
Yeah, there's no there's no other option. So you think to this day you can't sleep in because you're used to getting up to give yourself

Jennifer Smith, CDE 27:37
I really think that's it. I mean, in high school. And then in college, I mean, I kind of offset it in a way I never, I never didn't take my insulin on time. But I would set the alarm, get up, take my basal insulin, and then just go back. Once I was on like Atlantis, you know, I couldn't I didn't necessarily do that with my L or my lenti was what it was called. And my regular because I mix those in a syringe. So I didn't ever do that. But I did do that with lambdas because I was like I want to sleep in so I just I would take it and then go back

Scott Benner 28:20
to this pandemic lockdown stuff. I have lost all semblance of understanding of what time means. Nothing matters anymore. It doesn't matter. The other night. I was it was last night. I was putting the podcast together and I got done. Put it online. I was like I'm gonna watch TV. I looked up on like, it's midnight. Like, what am I doing? It didn't even matter. We're eating it odd times a day. No one cares. No one knows what day it is. It's like it's I know,

Jennifer Smith, CDE 28:49
if I didn't have a calendar to go by every single day. I wouldn't remember what day of the week it was either.

Unknown Speaker 28:56
Who would even know? Like,

Scott Benner 28:59
even it's almost been in the house for like the rest of us. I think we're on 10 months now. Like more than 10 months. I I don't know somebody asked me like what would you do if this was over right now? And I was like go to an island. Yeah, like just get on a plane and fly somewhere warm and sit down for a minute just you know, to see something different. I don't even know like but that was what it reminded me of when you said that. Like I sometimes the kids get up they do something for a couple hours. They go back to sleep again. They get up again they're Arden's done school at 1230 in the afternoon. Like why are we getting the kids out of bed at 630? If like, if nothing matters. I don't understand anything. It's just I if I sat here and told you the number of television shows I've watched to completion in the last 10 months. It's embarrassing. It's embarrassing. I off the top of my head Friday Night Lights. I've rewatched mash. Mash it was like 11 seasons the whole thing like the whole damn thing. Friday Night Lights on Halfway through new girl now, I just watched a reality show where glassblowers competed in a competition. I loved it. These are not things I would normally watch on television. Now,

Unknown Speaker 30:13
if you watch the Have you watched the tattoo one?

Scott Benner 30:17
No, but I will know that you said

Jennifer Smith, CDE 30:19
it's interesting. I can't remember. I think it's on Netflix. But yeah, it's a whole. I've only watched a couple of them with my husband. But yeah, it's a competition between like the top rated tattoo artists being judged by one of the judges is some big like, movie, not movie music. I can't remember which band he's in Tommy Lee.

Scott Benner 30:43
I'm guessing

Jennifer Smith, CDE 30:44
anyways, these tattoos are like amazing. Phenomenal, like, amazing.

Unknown Speaker 30:49
But there you go. There's

Scott Benner 30:50
a new one that was last blowing. I was like, this is fascinating. Like, I'm just I watched the watchman. I swear, I should sit down and make a list. And I'm always doing something else like I am. Like, I watch while I'm cooking. Or even while I'm working. It's on a different monitor or something like that. I don't

Jennifer Smith, CDE 31:07
really sit idle and like, I don't

Scott Benner 31:09
remember the last time I did that. But even that bothers me. Like, it's not that I'm all for like laying around watching television, but nothing. And then I never feel like I'm getting anything accomplished. Which is another horrible feeling. And I know this is bad. Like we need to, I want to take my vaccine and I want to go back and go somewhere. Yeah, I'm gonna get a vaccine. I want to go outside. You know, here. In this time, I've taught myself to smoke BBQ. make pizza dough, so that I can actually make a pizza like better than the one you would get at a pizza place. I bought an oven to make the pizza dough. And because I couldn't get my oven to get hot enough jet. What else am I gonna do? And somebody just bought me like a little beginner drone for Christmas. I'm teaching myself to fly a drone. Why? I have nothing else to do. So I'm trying to do something

Jennifer Smith, CDE 31:57
with sourdough to

Scott Benner 31:59
No, I. But I think about it.

Unknown Speaker 32:05
conversation about thinking about it.

Scott Benner 32:07
I think about it. But there's so much going on that I don't understand about starters and like live yeast and everything. I but trust me, this goes on six more months. I'm gonna teach myself how to build a brick wall next. Like I wonder how how do you do this? Like, I don't know what's up. And and to top it off before you go. A deer dropped dead next to my house the other day. Like went up into my land

Unknown Speaker 32:31
had a heart attack?

Scott Benner 32:33
I don't know. It went up in my landscaping laid down under a bush and died. Like you watched it happen. No, I walked outside. And I was taking down Christmas lights on the patio. And I'm like looking forward rolling lights up. And I look away and then I can hear the voice in my head Go was that a deer? Like, like, Look again, and I looked back and there was a deer laying under a bush. Now I'm staring at it. That doesn't seem like something I've ever seen before. Hmm, that thing's dead. So I go over and I'm like it's dead. Now what

Jennifer Smith, CDE 33:05
it was, was it still warm when you prodded?

Scott Benner 33:08
I don't think it was warm, then. So luckily, it's been cold outside or probably we would have noticed it was dead sooner. So I call the township and I'm like, Hey, what do I do? And they're like, well, we'll come get it. But we can't come on your property. And I went, but

Jennifer Smith, CDE 33:24
you had to drag it to the curb. I almost said

Scott Benner 33:25
to her, I make podcasts like I don't know if you understand who you're talking to right now. So yeah, I had to get a piece of rope, tie it up around its legs and drag a deer across my front yard out to the side. I don't know what else is gonna happen in this pandemic. But I would like it all to end because

Jennifer Smith, CDE 33:42
you don't live any wooded places like they would have gotten. I mean, this isn't deer hunting season. Shot just

Scott Benner 33:49
died under the bush somehow there's a pathway that goes behind all of my neighbor's backyards, where they make it from one piece of like woods to the next and they just walk through. And this one just I said to my neighbor sees me, you know, humping a deer across my front yard. And he goes, Hey, what's up and I was like, Hi. And and I said, you know, if this thing would have given up 50 feet sooner, this would be your problem. Like cuz he just made it over the property line. I was like, anyway, I feel bad for the deer. Then I had that problem. I was like, Oh, this poor thing, you know, but then there was another part of me going I think they carry ticks. Like get along. So I'm like, Who am I? I don't belong in this conversation. You know,

Jennifer Smith, CDE 34:33
typically do but not this time of the year.

Scott Benner 34:38
How would I even know that? That's ridiculous. All right. You have to go right.

Unknown Speaker 34:43
I do.

Jennifer Smith, CDE 34:44
realize we were like out of time.

Scott Benner 34:46
That's fine.

All right. I hope you enjoyed that. And if you're still here, I want to be completely honest with you, the next couple of minutes are going to be me talking about the advertisers. If you've been wanting to check one of them out, stick around, and I'll tell you how to do that. And if you don't, okay, you can go now. But first, let me thank the T one D exchange, and ask you again, to consider adding your voice to the work that they're doing. Remember, you want to be a T one adult, or caregiver who's a US resident, who has a couple of minutes to answer some simple questions that will go a long way towards helping everyone living with Type One Diabetes, check them out at T one d exchange.org. forward slash juicebox. There's links right there in the show notes of your podcast player. And of course, there's links at Juicebox podcast.com, if you forget how to get there. I also want to thank the rest of the advertisers, even though they don't have any ads on this episode. That's how much I feel good about them. And I'd like you to be able to get to them. So if you're looking for that Dexcom g six continuous glucose monitor, if you are using insulin of any kind, if you're a type one, you're a type two, go check it out. dexcom.com forward slash juicebox. And don't forget, if you get your health insurance through the Veterans Administration, the United States Veterans Administration, if you're a vet, I guess that's what I should have said if you're a US vet, go check them out. For sure. I think you might like the coverage that you find, but everyone has an opportunity to get a Dexcom g six by going to dexcom.com forward slash juicebox. There's a little bit of information you fill out and Dexcom is going to get back to you. If you want an absolutely terrific blood glucose meter, I suggest looking at the Contour Next One, and you can do that at Contour Next One comm forward slash juicebox contour makes an easy to use incredibly accurate meter that does not take up a lot of space in your pocket or your bag. Arden's been using it for quite some time. Now it is easily the most accurate, and handy meter she has ever had. What's next, let's see, Oh, I know. The Omni pod tubeless insulin pump, it is an insulin pump, it doesn't have any tubing to get caught on doorknobs. And also, because it doesn't have tubing, you don't have to take it off. It's self contained. You can swim with it, get involved in all of your favorite activities, take a shower, all the things where to pumpers would have to disconnect and you know likely have their blood sugar's go up because of it with Omnipod you won't have to on the pod would be thrilled to send you a free no obligation demo of the on the pod that you could actually try on and where to give it a little test drive of your own. It's nonfunctioning so don't worry, it's just for to get the feel, you know, my omnipod.com forward slash juice box, fill out the information, watch the Omnipod demo show up in your mailbox. I'd also like to remind you about touched by type one. It's a diabetes. org that does amazing things for people with type one. And all they want the whole world is for you to know that they exist. So check them out at touched by type one.org. They're also on Facebook, and Instagram. And of course my daughter carries the G Vogue hypo pen with her wherever she goes. Check it out at G vote glucagon comm Ford slash juice box. Okay, that's it. I have a little bit of time left, I want to thank you for listening for sharing the show with others. If you're an endocrinologist that recommends this podcast to your patients. Hit me up. I'd love to have you on the show. You could even be anonymous if you wanted to. What else? Thank you for the great ratings and reviews that you leave on Apple podcasts. And wherever you listen. And if you're listening online, please find yourself a podcast app. They're free. They're handy. Get in there and Subscribe, subscribe to the Juicebox Podcast. Oh, last thing. It's like the end of January. There's two more days left in January. And if it's not January 2021 anymore, you can stop listening now. But if it's still January 2021. And there's like a day or an hour or something left, download a couple of episodes for me, please. I'm right at the edge of milestone for this month. And I would just just try to push a little bit new meaning like go back and find a couple that you were like Oh, I didn't mean to listen that one downloaded. Or now's a great time to start with the diabetes pro tip series if you haven't, or the defining diabetes series. These are strewn throughout the podcast. I know the diabetes pro tip episodes begin at Episode 210. I gotta be honest, I don't know where the defining diabetes starts. But you can just search it right there in your podcast app, just defining diabetes and they'll all pop up and you can see them all I'm just blathering on now. I should hit stop but I don't even know what I'm gonna do with the rest of them. I think I might watch one division tonight.

That is the extent of my Friday evening. There you go. Now you know the excitement. I don't want to get off because I don't have anything left to do. I like talking to you guys. Thanks so much for listening. be back next week with more episodes of the Juicebox Podcast.