#739 Bold Beginnings: Carbs
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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Scott Benner 0:00
Hello friends and welcome to episode 739 of the Juicebox Podcast
Welcome back to the bold beginning series, today's episode with Jenny Smith and I is all about carbs. I think I'm just gonna call it carbs, carbs. Anyway, while you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry take the survey that survey taking part less than 10 minutes easy questions about type one diabetes, your answers help people with type one diabetes and they might help you as well go find out T one D exchange.org. Forward slash juicebox. And if you're looking for Jenny Smith, she works at integrated diabetes.com You can find her there
this episode of The Juicebox Podcast is sponsored by the Dexcom G six continuous glucose monitor. Get started today@dexcom.com forward slash Juicebox Podcast is also sponsored by Omni pod makers of the Omni pod five, learn more ami pod.com forward slash juice box the show is also sponsored by the Contour Next One blood glucose meter contour next one.com forward slash juice box and by us med get your medical supplies at us med.com forward slash juice box or by calling 888-721-1514. The podcast is also sponsored today by Ian pen from Medtronic diabetes. You can find out more about the in pen and ink pen today.com. Last but not least, the episode is sponsored by je voc hypo pen, je voc glucagon.com forward slash juicebox. Now don't worry, I'm not going to start piling up 17 ads on every episode I just had a thing this week. So instead of two longer ads, you're gonna get more shorter ads. Just this one time on this episode right here. I hope you understand I hope you'll listen it's going to be fun. I'm going to try to do them without stopping the recording. It should be crazy. I'm gonna need a stopwatch to Anyway, I'll see if the ads we'll see how I can do with this. And to the advertisers. I'm sorry, I didn't clear this with you. But things come up. You know what I mean? Pico? Hello, Jennifer, how are you?
Jennifer Smith, CDE 3:05
I'm great. How are you?
Scott Benner 3:06
I am I'm doing okay, I am looking through our bowl beginnings list. We are little more than halfway through recording. And we are upon carb guidelines and impact of food. But just how the statements, questions and concerns sent in by people were categorized by our dear Isabel. So it's a bit of a long list. But I think we can get through it. Cool if we try. So there's two. There's no There's two thoughts here. Right carb guidelines like what does that mean impact of food? What does that mean? I think we're gonna see by listening to people's statements first first one out of the box. All carbs are not created equal. That comes directly from the podcast. So somebody is speaking from a perspective of having been diagnosed, listen to the podcast and looking back now thoughtfully and saying what do I wish people would have told me the beginning that all carbs aren't the same? Correct. Okay, now, you and I talked about this. It feels like constantly to the point where sometimes I'm embarrassed that I don't have other examples. When I pull up like two foods, there's two foods that pop into my head every time and I I'm always like, I should come up with different foods. That's a conversation. I'm having these. There's consistency there then, right? Yes, my brain is pulling from the same place over and over again. But you know, the basic idea here is that you're going to be told to either count your carbs and Bolus for you might be told to eat on a schedule or eat a certain amount of carbs. But no one ever explains to you that all carbs don't impact blood sugar's the same way. You're taught the number. Right right. And that is come forgetting in the beginning to people like, Oh, you just count, you know, and that's why you'll hear some people go like real, like, heavy into, like, I bought a scale, it goes down to the like, the gram, you know, like, if I if I measure this correctly, you know, that works mostly. But it's not a perfect system, right? Correct. From a different person counting carbs was a huge stressor for us. We needed easy ways to count carbs. And we needed to understand how different things would hit differently. So let's talk about that a little bit. What do you think, is the benefit of telling people that and what do you think the problem is with telling people that
Jennifer Smith, CDE 5:43
I think initially the benefit goes along with the first line of information, which is counting carbs, because you have to learn, many people don't read labels before they're diagnosed, right? They may look at certain things on it, but they're not really looking specifically at carbohydrates, and learning how to count the grams of carb. But I do think that along with that conversation, if you're going to show somebody and tell them how important it is to count carbohydrates, and give this medicine, that's, that could be really heavy and action based on what the what they know now about food and how the food works with their insulin, you essentially should be telling them or giving a baseline list of these foods are slower, these foods act a little faster, these foods act really, really fast. They may all have the same carb amount, based on portion. But they may have a very different onset of action in terms of what you see happen to your blood sugar. So I think, a simplified chart, not only for carb counting, which is a really basic easy concept, for the most part. Moving into that though, the bigger discussion should be about how those carbs could show up differently in terms of your CGM trend, especially or even fingerstick values if you're doing enough of them, because you don't have a CGM yet. And I think, you know, taking that one step further, if, if you do have a really good educator, they should really sit down with you. And they should ask you what, what are you eating, not give you a random list, and you maybe eat three foods out of the 50 that are on it. And you say, well, this wasn't very helpful. Sitting down and giving them what you eat or what your child eats and getting feedback on. What should I expect of these foods? Do
Scott Benner 7:42
you think that sometimes when clinicians give lists of foods, they see it as an opportunity to change your eating habits to better things? So they write stuff so the list consists of like broccoli, and you know, things that they're like, I'm pretty sure people don't eat enough broccoli. So we'll put there's one that you say all the time that I stopped myself from laughing constantly. Quinoa. No one eats Kean rocket Jenny, just you and four other people. Right? My kids like, Alright, listen, but you know what I'm saying? Like they think sometimes they give you the list they wish you ate not the list you actually ate. Right, right. And
Jennifer Smith, CDE 8:21
which is, it is unfortunate, I would say, I don't know, I would have to ask honestly, like how many people were really given this random list of stuff that looked like it was supposed to be healthier, but they never really ate versus just the typical list of carb counts for foods. That's like a general list, right? The 15 gram per portion kind of list. And I can tell you those lists from when I was a kid are there there. Many of them are not like great foods, many of them are
Scott Benner 8:54
processed. I just find myself wondering how many nurse practitioners who on a set on a on a Saturday morning hungover eaten honey smacks would never tell you how to Bolus for honey snacks. So because it seems like you'd be saying, hey, it's fine to eat a Twinkie. You know what he mean? Instead of saying, Look at Twinkies not great for you. There's here I could sit for 20 minutes and tell you why not eat this thing. But I think it's possible you're going to eat it. And it would be nice for you to know how to Bolus for it. And I don't think that conversation happens. But I want to know want to go back a little bit to something you were saying a minute ago about how nice it would be to explain to people, here's a list of foods that will kind of impact at this level. And here's a list that might hit a little harder. Here's a list that might hit a little quicker. Whatever it is. It made me feel like the problem with doing that. If I'm thinking about how to explain things to people, is that you're in this short doctor's visit. And now you're going to start telling them that foods not food. This food is Mike Tyson and this food is Sugar Ray Leonard and this food is You know, 150 pound guy who's only been boxing for three days? And or I don't know how so I'm trying to think like, what would you say to somebody would just say, Look, when you think about speed, there's the kind of speed that a Camry creates, there's a kind of speed that a Mustang creates, there's the kind of speed that a Tesla creates. These are all cars. But the way they generate speed is differently, I don't know how you could save to someone and explain to them, you're going to eat a baked potato. And it is going to make your blood sugar higher in the future. Right, it might make it really high, because it because of the impact that's going to have for the lasting effect it's going to have in your system, but it won't jump up in the air. Like if you took out a ring pop and just started sucking on it.
Jennifer Smith, CDE 10:46
Correct. In fact, one of the ones that I explained that way. It's grapes. I call them Sugar Bombs. I mean, they really are they are you eat them. It's why raisins are also one of the like, treatments for low blood sugar, because they impact so quickly, that they will cause a quick spike. So I that's a, it's a good way to think about kind of reaching somebody at a level that they can say, Oh, I understand that. That totally makes sense.
Scott Benner 11:16
Around this time of year, cherries come into season. Yeah. And Arden will just take a bowl of cherries. And I swear to you, I think sometimes she might take 10 or 11 units of insulin to eat a small bowl of cherries, right? It just, it's like she's having a popsicle over and over and over again. Like as she's sitting there, right? It's funny, because before diabetes, I would have thought cherries, that sounds healthy grapes, that sounds good for you. You know, like I didn't pay much attention to nutrition. Prior to diabetes. I was not raised well, in many different ways. But around food was just really broke. You know, like it was like meatloaf night you got potatoes. But that night was chicken with chicken came green beans, like we were just my mom was trying to make $70 Last week, you know what I mean? Like she didn't, she just didn't want us to die. And she didn't want us to be broke. So you know, like, so? It is, um, I don't know, like I said, kind of like circling back to it. There has to be a way right now to explain to people that more than all carbs are not created equal. Although, after doing this podcast forever, I don't know that that's not the best thing to say is that you have to be aware that these foods are going to impact differently. And you start to talk about it a second ago, that processed food is going to be more difficult to Bolus for than
Jennifer Smith, CDE 12:45
simple simple style real food. I mean, to be quite honest, it food that is real, is not broken down. It hasn't been processed through a factory someplace transformed into this dinosaur shape. You know, I mean, I use the phrase which has been well overused in on online and describing food. But if my grandma didn't know what it was, then it's probably not real food or it's probably processed and started out as food.
Scott Benner 13:24
Well, so the way the way my brain does it because it's funny you said dinosaur shaped, which it's really funny because when Cole was little, one of the first nutritional decisions I made as an adult, was if I'm gonna give the kid chicken nuggets, I'm gonna buy chicken and a bread at myself, and I'll bake it in the oven, and I'll give him nuggets. And when we first did it, you might have thought I don't know if you saw this. This video lately. Apparently, there's an aquarium overseas because of budget cuts. They had to go to a cheaper grade of mackerel for the penguins. And they hold them out and the penguins turn their heads away and won't they like won't eat them, like, like, and so that was cold when I first gave him fresh real chicken nuggets. He ate them and he was like, What is this garbage? Gold this is just a I overspent I bought chicken breast i cubed it up nicely. I even I don't know if you know this, but when you slice meat, there's a direction you can slice that makes it easier to chew right? Even I went that far Jenny breaded it nicely. I put seasoning on a nice daddy mother Jennifer, you know and then then the kid then he acted like I was trying to give him one of these cut rate macros. And but after a long time, it just switched and just noticed how his palate just changed. He doesn't want a frozen dinosaur that somebody said has chicken in it because I'm not certain it was chicken. You know what I mean? And so we did that. And then we did it in as many places as we could but but my thought here You're for people. And you were just saying that a second ago, when you look at something, you look at a piece of chicken and somebody says you what's in that? Your answer is? Chicken, Chicken. Yeah. When someone says, that's a grape, what's in that? Your answer is, it's a grape. When somebody says, hey, what's in that Oreo? You don't go Oreo.
Jennifer Smith, CDE 15:20
Let's look at the ingredients on the package. How many are there? Can you read them? Do you know what they are?
Scott Benner 15:26
Right? If you there are, I don't know how many things and I don't even mean to just pick Oreos, but anything like that. There's 2030 things in there. And you don't know what any of the more and this is this oversimplified thing I've been hearing people say for decades. And it just becomes more important when you're the one that has to figure out the insulin, not your pancreas, because you can your body can hammer through a lot of crap. Like I'm pretty sure we could eat stones and get away with it for a little while. Don't need stones. But you don't need mean like like, we're not birds. Birds eat stones,
Jennifer Smith, CDE 15:59
birds, some birds, it helps their digestion if you see birds on the side of the road. Totally random thought. But yes, they're like picking stones you'd like why is that bird picking through the stones? It's because the stones in the digestive system help to? Oh, I don't know that it's all birds. So if you are a bird expert, I am certainly not stepping on toes. I I know that birds eat stones, not all of them
Scott Benner 16:24
do. I thought you just said birds because I said penguins earlier. But no. But my point is, first of all, I can't believe I have to say this, please don't eat stones, your body cannot process. But my point was is you can put a lot of crap in yourself, especially when you're younger, and your system can fight through it. It doesn't mean it's good for you. And it doesn't mean you're not going to have short term or long term, like health effects from it. But I think that thing tricks us a little bit. You know what I mean? Like, you go out on a Friday night, and you have nachos and this and you have pizza and you're drinking beer, and the next day, you know, someone says Are you okay? And the answer is no, I'm not okay. And then more of the answers, you probably shouldn't go in the upstairs bathroom, you know, like, like, five or six hours later, you feel okay again. And that somehow, I don't know how humans think Jenny, but somehow we don't think about the time spent in the bathroom, clutching the wall. Talking to Jesus.
Jennifer Smith, CDE 17:22
It's almost like our taste buds when out, right? The memory of the of the taste, and maybe even the social experience that went along with the taste and the enjoyable like eating experience. All of that is more of the forefront of the brain. And Out goes the experience of the bathroom that you spent four hours in. Yeah, you know, it's it is I humans are. We are interesting, right? And really interesting.
Scott Benner 17:50
And what I see anecdotally is when people are diagnosed with diabetes, their first thought is generally I don't want to lose my freedom, about how I eat. And I don't want you to either. I mean, if you listen to this podcast long enough, you'll know I think you should eat whatever you want. I just want you to know how to bowl a sport. So that's what we're talking about here. Whether you're going to eat the Twinkie or have a pile of nachos, or eat rice, quinoa, you know, or somewhere in between, right?
Jennifer Smith, CDE 18:18
And I think what it boils down to honestly is given like the more newly diagnosed and this information coming to them, carb counting, know that the carb count is like, it's like the base step right? Now you know how to count how much you're eating. But the next step of that and very close to it really is, what kind of food is it? Is it a slow action kind of like a turtle? Or is it fast? Like the hair, right? I mean, if you imagine those two, just simply, it'll help you make more sense. And then look at what you're already eating. Regardless of what somebody told you should be eating or shouldn't be eating anymore. The easiest thing to not change yet another piece of your life. Take what you're eating, and see how things look after you eat those foods, and you can say, Okay, I think this is enough insulin, but it looks like my blood sugar rose up too quickly. Gosh, Scott was right. Maybe I need a little bit more Pre-Bolus Right. So let's try that and be this is more of a high glycemic food. It's not really so slower medium like I thought it might be.
Scott Benner 19:33
So yeah, you know, I'm funny. I'm looking at two different statements here from two different people. And if you want to know why it's easy for people to get confused. These are two statements that are I think, pretty consistently told to everyone and they completely they they clash with each other right? The one person says the hospital made it seem very black and white. You eat X amount of carbs and you take x amount of insulin and just go on then live your life. And the next person says, it would have been nice to understand that all the free carbs they were telling me I could eat weren't really free. And it's it you know, so what? Which is it? Are there free carbs? Or are there not free carbs? And every card gets covered? The real answer is in between? It is
Jennifer Smith, CDE 20:18
yeah, it is. Absolutely, I think the first statement is take this amount of insulin for this amount of, of black and white carbs, regardless of what it is, and it should cover that amount of food. But now we're digging deeper into insulin action and food digestion. So it's it's a, it's a road kind of that veers off of take the insulin to cover this amount that you counted. It may be a timing thing, you know, something like a big bowl of cherries, for example, you definitely need that insulin. Now, the same amount of carbs though in a grilled chicken caesar salad. You may need that same amount of insulin, but I can guarantee you don't need it all up front.
Scott Benner 21:06
Do you think that they talk about free carbs more with kids, because they've they've already given the kids a wide target range to begin with. So if your kids at and drifting down, you can give him this, I don't know a certain number of these things. And it's free. Don't bother giving insulin for it because they know you need it to fix the blood sugar. And the bigger idea about insulin you don't have yet. All right, ready, this is off the top of my head. I don't have anything in front of me. 30 seconds. For each one, I have a stopwatch in front of me and go the Dexcom G six is a continuous glucose monitor. You wear it to see your blood sugar's speed, direction and number. For example, my daughter's blood sugar is 104 right now, and it's steady. I just saw that on my iPhone. You could actually do that on your iPhone or your Android device. dexcom.com forward slash juice box. Check it out. It is absolutely one of the greatest things I've ever seen managing insulin dexcom.com forward slash juice box 30 seconds. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. Go to contour next one.com forward slash juice box when you get there, you're gonna know everything you need to know about the greatest blood glucose meter I've ever seen, held or touched fits in your hand wonderfully. It's an amazing size. It has a great light, it's easy to read and it's incredibly accurate Contour Next One, go to contour next one.com forward slash juicebox that was 30 seconds. So okay, now oh my gosh. US med go to us med.com Ford slash juice box or call 888-721-1514 To get your free benefits check. US med is where I get Arden's diabetes supplies. They're the number one distributor for Omnipod dash, they have over 1 million diabetes customers worldwide. And they always give you 90 days worth of supplies and fast and free shipping with that one over 30 seconds. Sorry, they carry everything from CGM to all of your diabetes needs us met.com forward slash juice box links in the show notes links at juicebox podcast.com. This one's not going to be easy. I have to say certain things. Okay. There's no way I'm gonna get this done. You want it? Oh, I'm scrolling up. Do you want an insulin pen you're not quite ready for an insulin pump, but you'd like to get some of the functionality that insulin pumps offer. If that's you, you're looking for the in pen from Medtronic diabetes. You can learn more and get started today in pen today.com in pen pairs with an app on your phone to give you much of the functionality that you see with type one diabetes and insulin pumps but you get it with a pen. In pen requires prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in pen today.com The Omni pod five baby it's here automated insulin delivery system it is available on the pod five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM and it uses smart ingest technology to automatically adjust your insulin delivery every five minutes helping to protect against highs and lows without multiple daily injections. The Omnipod five is currently cleared for people with type one diabetes ages six and older and if you have the option, and you have the option, dammit to control it from a compatible smartphone, Ali pot five is also available through your pharmacy which means you can get started today. Damn, which means you can get started without the four year Durable Medical Equipment contract that comes with most insulin pumps. Even if you're currently in one RT with another system. So to get started today with the Omni pod five, go to omnipod.com forward slash juice box for full safety and risk information, a list of compatible phones as well as clinical trial claims data, go to omnipod.com/juice box. Alright, I don't think I'm going to get this last one in. But it might go a little past the music already. G voc hypo pan has no visible needle, and is a premixed auto injector of glucagon for treatment of very low blood sugar. In adults and kids with diabetes ages two and above, find out more go to Jeeva glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. And the bigger idea about insulin, you don't have yet
Jennifer Smith, CDE 25:51
it could very well be and remember a lot of kids initially diagnosed are very sensitive to insulin, and may have a ratio that's something like one unit for every 50 grams of carb, well, then really, if you're starting out, you don't have a pump yet. And you're using multiple daily injections, and your child wants to eat five grams of cucumbers. That that's free. There's there is no way to dose for that. Right. You know, well, I shouldn't say that. You can dose you can dilute insulin, you can get micro doses of rapid insulin, but that's another that's another regular.
Scott Benner 26:27
Yeah, it's funny, as we're talking, I think, here are the words that are missing when people are talking to clinicians, right now. These foods are going to be free. But that probably won't be like that forever. It's the it's the those things are the things that no one tells you. Because as I'm reading the I mean, we're going through these bold beginnings things. And the thing that sticks out to me most is that what you get told in the beginning really, really sticks in your head. Yes, you know, and then when things morph and change your honeymoon ends, or your kid gains 20 pounds, and all of a sudden, a half a unit, it's not enough to you know, just tank them completely. Once things change. People hold on to the rules they were given at the beginning, and then the rules and reality don't match any longer. And no one ever comes by and tells them Oh, that's fine. This stuff changes, you know, be flux.
Jennifer Smith, CDE 27:25
Excuse me, I think also that goes right along with that is it is the concept of change. And people rightly so they take the information they have been given as if it's written in stone. And this is not going to shift. Again, some explanation needs to go along with it in terms of especially kids who have very fluxing needs for many, many reasons. Not that a newly diagnosed adult doesn't initially to, but I think more so for kids, especially since their insulin doses may be microscopic. To begin with. You have fried foods for a child who's really residing on just a couple units of Basal insulin, and really doesn't seem to need coverage at all for meals yet. Yeah. Eventually, those foods that look like they're free, will need to get covered. Eventually, as their insulin needs creep up that five gram treat or snack in the afternoon, as their insulin to carb ratio becomes more aggressive, they're going to need some insulin to cover what you didn't really need to give insulin for before
Scott Benner 28:33
this other thing that happens to people where they get told to eat a certain amount of carbs at a meal. Even when they're using a fast acting meal insulin, that again, I think of his lazy, the description that was given to them because I think what's really happening is the clinician saying to them, Look your kids so small, I don't know how to break this down beyond a half a unit of insulin. So you're gonna have to eat 20 carbs. So you can give this kid a half a unit of insulin correct. But instead the takeaway from the family is he has to eat 20 carbs every time he sits down. And then they start getting into the like, Well, how do I eat 25 carbs, no one tells me that. So now if I want more than 20, I have to eat 40. And then and then kids can't do that. And because it's too much food for them. And again, if someone would have told you the reason we're doing this right now is because we just can't get the amount of insulin low enough to tell you how to Bolus for eight carbs. But don't worry, kids gonna gain weight, this is all going to change, honeymoon is going to end etc, etc. Again, I think it's the rest of the words that nobody speaks that are always what causes the problem.
Jennifer Smith, CDE 29:40
No, yeah, that's absolutely correct. Especially, you know, again, for a kiddo who's like a one unit might cover a warming meal, but they're three years old and they're not going to eat that large amount of food. Then you have to break it down a different way for them and it takes It takes individualizing the care from the start. It does.
Scott Benner 30:05
What do you think about the idea that most people newly diagnosed are going to be MDI. And that the way I heard somebody told me the other day that the podcast is about, it's for pumpers. And I thought, I don't think that's true. Like, I think that what we talked about works fine. If you're doesn't matter how your insulins getting in, like, you lose, right, can't do an extended Bolus, you know, without a pump, you can't shut your Bayes law for Jack it up without a pump, okay. But the rest of the stuff is just about putting in insulin at the right time using the right amount the right time.
Jennifer Smith, CDE 30:39
I, I wonder if some of that timing though, I can say I mean, we do refer to things like extended Bolus and Temp Basal are using, you know, the fancy features of all the other algorithm driven kind of systems that are out there. But from a timing perspective, it covers both bases, it covers MDI, and it also covers pumping. But in a sense, you have to be okay with potentially giving more injections, on MDI, in order to cover the food the way that you want, and get the sort of out, you know, the aftermath covered the way that you need it to be. So you can do that. And from the beginning, again, we've talked about this in stacking right, from the beginning, people get scared of stalking their insulin, and they need to learn from the get go that if you're going to eat little bits, as many little kids do a little here a little here a little here, you may have to figure out how to get the insulin in in the right amount to cover that little bits of nibbles along the way. Yeah.
Scott Benner 31:52
I have this thought from this person here that I don't I kind of don't see how it fits into this conversation completely. But it is really interesting to me. So I'm gonna mark it and come back to it at the end. There. Oh, yeah. Okay, hold on. We were told snacking under 15. Carbs was free, just so this person was just told anything under 15 carbs was free, not just certain foods, like you can have a cheese stick, or you can have chicken or something like,
Jennifer Smith, CDE 32:18
I wonder what their initial dose of insulin was like to his I mean, 50. And as we've the 1515, right, anything under 15 is free, but I can use 15 to treat a low blood sugar. Right? I that's confusing.
Scott Benner 32:34
Yeah. I and then you wonder if this is what they were actually told, or if this is how they remember it. And or if this is exactly what they were told. And the person telling them was, was conflicting ideas. Yeah. Not all carbs are the same. This person says, I had anxiety about food and insulin, it took weeks to really get an idea of what a balance look like for me. So I, I can't tell you, I mean, I don't have diabetes, right. But I can't imagine what it feels like to be given this medication being told, Look, you have to use it. If you don't use it, you're gonna die. And if you use too much of it, you're gonna die. And it's connected to everything you put in your mouth. I don't know how that that must freeze people. The idea that that eating disorders come out of type one diabetes frequently is very easy to see. It's not at all shocking, right? Because of that feeling, like this paralysis of analysis that you must get I hate using terms like that. But But that idea of just like, What do I do? And then everything you've been told, is scattershot. It seems, I mean, some people come away with great, you know, with great information up front, but for the most part, I don't get to talk to those people very frequently.
Jennifer Smith, CDE 33:53
Right. And I think it also speaks to the very individual nature of how you first teach somebody about their diet, you know, their diagnosis with diabetes, you can't, from my perspective, you can't approach somebody the same way as you did the person three hours ago, there is no way to do that from a newly diagnosed standpoint as well. You still have to ask enough questions that help you to individualize the care so that their lifestyle while it's going to be impacted, is a little bit more. It's a little easier to get them to understand how to do these things within what they had been doing before diagnosis from a from a comfort level and there are some personalities that certainly require some additional assistance sooner than later.
Scott Benner 34:50
Yeah, no, I mean, obviously, there are some people who just get like, I'll do it tell me what to do. I'll do it right and there's some people are like you're not changing my life. And again, Anywhere in between a we just tell them all the same thing and sent them home? Right? Is this accurate? This person says, the kids are hungry for a few weeks after diagnosis, like overly hungry.
Jennifer Smith, CDE 35:14
That's in a general sense, especially if they have lost a fair amount of weight. Because their body was essentially eating itself. That's the easiest way to explain it. You know, when the blood sugars are running so high, obviously, they are losing a lot of calories through urine excretion. And so after diagnosis now, when their body actually is able to, gosh, I can grab this food and I can pack it away, I can store it, absolutely. Kids can get very, very hungry. They're also in a stage not to say that adults or you know, those over the age of growth couldn't also be hungry again, especially if they've experienced that extreme weight loss before diagnosis. They may also their body is just telling them, Hey, we need to put this back on. You lost a lot. We have to sort of recoup what what was kind of given away, but kids are growing already. So you could expect them to be hungry,
Scott Benner 36:12
right? Even if they're just more feeling healthier, because they have insulin, and they're getting back to where they were. But I mean, Artem was down, excuse me, Arden was down a fair amount of weight, she was small, and she was ravenous for a little while as well. Somebody just says here, it would have been nice if somebody gave us the rundown about the glycemic index and glycemic load. If you go to the Pro Tip series, there's an entire episode about that. Earlier in the podcast. Jenny touched on a little bit about giving you lists of foods that impact differently. But if you I was going to say if you want to understand but you really have to understand it. So go find that episode. Understand you know how how words that seem a little weird and confusing and stuff you haven't heard before are really important glycemic index and glycemic load. While we were in the hospital, we were told not to do more than 45 carbs a meal. So she says this was clearly BS. We felt the need to go to the store and buy a ton of diabetic food. Of course, we haven't bought any of that sense. So it's just a it's just an insight Jenny into how saying something to someone incorrectly or not conversating with them to make sure they understand your intent can send people down these crazy rabbit holes. I don't know that people can afford to go to the grocery store and spend hundreds and hundreds of dollars re fitting their home only to find out later that magic spoon cereal tastes like not good. I'm sorry for those of you who like it.
Jennifer Smith, CDE 37:46
I like magic. Cereal is the one process thing and I will say it is processed I mean it there is no doubt about it. If and when I have it we do it for like a road trip or like to go camping or something because it's it's a little bit easier. And it certainly doesn't have bad impact on my blood sugar. I have tried some of the other brands out there, which I will not name. But the magic spoon is definitely one that I can I can say works like it says it's going to work glycemic ly. And many of the flavors. I won't say all of them, many of the flavors are palatable.
Scott Benner 38:24
Art we tried one said, I'm gonna have to bleep this out. Arden said where are they trying to approximate Hold on a second. I'm making myself laugh unintentionally, or were they trying to approximate what a unicorn say, almost tastes like he did not like it at all. He didn't like the garbage. But that's fine. There are a lot of people who love it. And I think that's terrific. But but the point is, is that if you say something specific to somebody, you can never have a meal again, that goes over 45 carbs. They think well, how are we going to accomplish that? Right? You know, now they're in that one aisle at the grocery store that nobody goes into?
Jennifer Smith, CDE 39:07
is unfortunate. If you go back, you know, I don't know, 15 minutes ago when we're talking about real food versus processed food, all of the all of the food that is labeled diabetes friendly or whatever they're calling it now. It is processed Yeah, there is nothing. There is nothing in it. That is there are a few pieces, I guess a few ingredients but most of it is artificial sweeteners of some kind added fibers of some kind or some nature added protein powders of some nature, right? I mean, so you're better to go home and at least just keep eating what you've been eating and maybe then asked for help cleaning it up or figuring it out or whatever. Or just go to the produce
Scott Benner 40:02
weighed real food. Yeah, what is that they put in the diabetic. I wish people could see me making the finger quotes, but diabetic case sort of a tall, right. And if you get too much of it right,
Jennifer Smith, CDE 40:14
the bathroom will again be your friend. Yeah.
Scott Benner 40:17
Because things will be flying in all directions. Don't eat too much candy. Just eat regular candy, learn how to pull it sport for God's sakes. Right? Yeah. This is interesting. This person says that they were told that anything was free under 15 carbs. On top of that they were told not to Pre-Bolus their meals. And they said that these two things together made any kind of stability in their blood sugar impossible. Absolutely. Yeah. Right. I mean, and I wish someone would have given me a comprehensive list of actual zero carb snack. So this is the I
Jennifer Smith, CDE 40:56
don't know, I don't know who would have said, I really don't that. It makes me really, really sad that there are that there are education teams out there that are giving this kind of information. Really, I am like, I have nothing. I don't really even know what to say about that. I really don't. Jennifer's mortified. Yeah, I am. I'm mortified. Honestly, from a professional level, I am mortified that somebody would have given that information.
Scott Benner 41:25
Yeah. So here's the next thing that's gonna happen. Pizza's gonna get ruined for you. You've been diagnosed with diabetes. And, and there's this thing that through 35 minutes of talking here, we have not gone over which is yes, food. One broccoli hits your blood sugar in a certain way. And yes, mashed potatoes hit in a certain way. And yes, mashed potatoes will hit differently if you put butter on it. And if your meatloaf is just meatloaf, that's one thing, if you put gravy on it, it's another thing. What happens when you eat them all at the same time, right? They're all in a mixed meal where they all live. The way I like to think about it, when I'm thinking about insulin is where they all live on their own kind of timeline of existence in your body. Like an impact timeline, the broccoli impacts with a certain amount of force over a certain amount of time, as does the butter, and the potatoes, and the beef, and the flour and the gravy and all these different things. And you just thought it was gravy and mashed potatoes. And now you're realizing, oh geez.
Jennifer Smith, CDE 42:30
I think one concept there is the the typical, the typical mixed meal of proteins, carbs, and fats, right? All the macronutrients in a portion that should be eaten. Should should have a typical absorption or digestion that goes along with the Action Timeline of our rapid acting insolence. Okay? The, the larger the portions get, or the higher in one macronutrient versus another, like, really, really large amount of the meatloaf and like a spoon of the mashed potatoes and maybe one stalk of broccoli, right? Do you see there's a there's a definite difference there. And that goes back to impact on blood sugar and what you may end up seeing happen. So portion comes into play, to not only just carb counting, but a portion of a combined mixed healthy meal. And the impact that you're going to expect to kind of see Yeah, so
Scott Benner 43:47
the idea being, we'd all be okay, if we took a handful of potato chips once in a while. Eating the entire bag of potato chips has a different impact on your body. Yeah. So alright, so back to pizza. And Pizza gets described throughout the podcast a number of different ways. But pizza is not just pizza, it's flour, and it's cheese. And it could be meat, right? Or it could be vegetables, it gets the sauce. There are all these different things on this one delivery system. When you understand how to Bolus for pizza, that will actually open your mind up about bolusing for a mixed meal too, right? Because why? Because you look at a slice of pizza and you say, well, the box tells me or the pizza place told me this is 35 carbs, you Bolus for it. The food goes in your body doesn't start breaking it down right away. So your Bolus makes you low. Then you end up drinking a juice because you get so low and then all of a sudden 45 Yeah, the pizza hits you and now you're you're just you're lost because the insulin you put in was for the pizza. You didn't cover the juice because you were alone, etc, etc. And then you learn when to Bolus for pizza, right? Like when does the insulin go in versus When's the food going to hit? How do I balance these things up? This is what you're going to learn in the Pro Tip series for certain, if you go listen. And you'll also be able to see bigger picture about other meals, you'll be able to look at a plate at a mixed meal and say, Okay, this turkeys not going to hit very hard. It's five or six carbs, maybe. But here's the stuff that is going to hit me. And you just I don't know, at some point you just learn, right, Jenny, it's not a
Jennifer Smith, CDE 45:26
you do and that it kind of in. In that example, it kind of also goes back to figure out the foods that are pretty normal for you because that that base knowledge rolls over into other meals that may not be your typical, but appear to have similar enough content that you could expect to try to use your insulin the same way around this newer meal, right. Pizza as an example. On Nacho dinner, right nachos and meat, cheese and guacamole and whatever else comes on that they are all similar monsters, if you will. A burger and fries or a cheeseburger and fries, for example. They all have a lot of mixed nutrients that are going to be similar to pizza. So if you have the most experience with pizza, and your friends are like, Well, hey, let's go out for Burger night on Friday. You know, like okay, well, it's definitely high fat, just like my pizza. Let me try the pizza strategy. Right? Let's see, right?
Scott Benner 46:35
Yeah, even even you find yourself in a place where you get a burger. And then you grab a milkshake. And you probably think ice cream sugary fast, right? More, really, it's the fat in the ice cream that's gonna kill you right later later. Yeah, a whole bunch of episodes about how to Bolus for fat and protein. And that's the next part of this really, is that this whole conversation is based around carbs, because that's people's understanding that they're given. Except protein breaks down in your system and turns into glucose. And fat slows down digestion, which changes Bolus timing. There are other things to think about not just carbs, I'm gonna roll through some people statements here just so you can hear them right. I cried about never being able to eat cake again. I know it's ridiculous. But that's what got me. And now I learned how to eat up because of the pocket. Oh, I wish people would have told me about the glycemic index again. I wish people would have told me that my kids will be starving because of the way they set this up. And that's how it's going to feel. So now the kids are running around asking for food asking for food. And the parents like I'm sorry. You can't eat for three hours or we already Bolus for something you should have told me before. And all the stuff that they get messed up when these are some of these are really sad. Oh, my first couple of weeks, I thought I needed to have three hours after dinner before giving my Lantis like Ha he. So he's eating dinner right now. And at 9pm. I was leaving for work early. And this was stressing me out. So isn't that interesting, just a misunderstanding about when somebody told them to shoot this Lantus at a certain time, they get stuck in their head as a rule. And it creates all this anxiety for this person down to like they're now making meals when they don't want to have them to. To right.
Jennifer Smith, CDE 48:23
And again, there's lack of proper information given Yeah, it's your Basal insulin might be a very defined time of the day. But dosing that at that time of day doesn't go along with your whatever rule you've been giving about the dosing of the rapid insulin Yeah, at all, that they are independent.
Scott Benner 48:44
Right? This person says I wish someone would have just told me a little bit about how to visualize portions. Ah, see what to what you just said. Because apparently prior to that they were eating, what occurred to them and not, you know, they know people don't really think about it, right? Like, we don't talk about that, like a scoop of mashed potatoes is probably Oh, no. See you.
Jennifer Smith, CDE 49:08
I mean, you do you do or did a lot of assistance for Arden. She's been growing up, you could sit down at a dinner out, and you're focused on what's coming on to her plate. But when it comes to your own plate, are you also like, oh gosh, my burger? And is it about the same? No, you just start eating.
Scott Benner 49:27
I'm saving. I'm making her live forever. And I'm killing myself with this.
Jennifer Smith, CDE 49:32
There is no care for what's on your plate in portion.
Scott Benner 49:35
Right. And so that really is the I mean, listen, that's a bigger conversation, obviously. And I don't want to just say like Americans or anybody you know, like, is that we don't think about stuff like that food is plentiful in this country. Right? You don't think about like, well, I'll just have a little bit because I want to have some more for tomorrow, right? I mean, how many times you eat something you don't finish it again. You throw it the trash, you don't think twice about it there. You feel like there's always going to be more Food. So that feeling there's something about finances and food that go together, I haven't had I don't have this all worked out yet in my head. But when you can afford it, you stop thinking about it as nutrition and you start thinking about it as a thing you need. And because you can afford it, you can eat it, if that makes sense or not
Jennifer Smith, CDE 50:24
possibly and, or if you can afford it, you can do a little bit more specialty, or you can choose to do a little bit more quality, let's call it from specialty items. Whereas if you can't necessarily afford it, or you have just a budget that you really stick with, right, then what comes into the house may be very different.
Scott Benner 50:51
And I think that thought works in two different directions. Maybe if I can afford it, I can buy better food. And I can show it right? I should because I can afford it. But also the other side of it, I can afford it, so it doesn't matter. And the personal, like, the thing I can say is that I have found myself sometimes he's like a little candy dish. And I'll sometimes take candy out of it. And I don't want it. And at first I thought like, okay, like that's a snacking function. But I also realized back when I was broke, I wouldn't have touched it. Because the candy would have been so special. It wouldn't it was, it's almost like a favorite. It's almost like, I never missed the Charlie Brown Halloween special because it only came on once. And if I missed it, it was gone. But now I could stream it anywhere I want. And so I can just grab it whenever and the food almost falls into that category. Sometimes I can afford it. And it's here. And I stopped thinking about it as nutrition. And I just sort of I think about it as a possession almost right. That makes it
Jennifer Smith, CDE 51:54
does Yeah. You know, the other day I was I was chatting with somebody and they're like, Well, what would you have done if you wouldn't have gone this route of like, nutrition and diabetes education and whatever. And I said, you know, I, I have a very big health connection. And I said, I think I probably would have gone into the realm of educating on school information, that's health specific, to start with educating from kindergarten forward, each year builds on itself with what the kids learn in terms of their health and what they put in their body and exercise and how that builds into an adult healthy level of living, right. I mean, my, my little guy the other day, we've made a stoplight thing for our pantry. It's got a red, yellow and green light on it. He made it and we put it in there. And he knows the green foods, he can have those. As long as he's hungry. He doesn't really have to ask much about them. The yellow foods he needs to ask about and the red foods are absolutely I mean, they're not even typically in there, or they're very much on the top shelf. But it's a good way to start educating on a very early level of these foods we can go to because they're really good. They serve our body these foods, they don't need as much of them. They're still good. Or we don't really need them as often. And then, you know, but if we did more of that,
Scott Benner 53:26
right? And then it would work like the chicken nuggets with my son. Yeah, eventually his palate would just desire something that was better for him. Right? Yeah. Jane, do you have a minute or do you have to go? Yeah, I've got a minute, just unroll through a couple of things here. It would have been nice if somebody would have told me the difference between a correction Bolus and an insulin to carb ratio. They didn't understand that. That one person said that they gave me a Basal Bolus doses just excuse me, they set up Basal and Bolus dosages for my kid, but never asked about their physiological activity. And the kid was a super aggressive like active person. And so the kids always falling always falling. And of course, the mom is so new to it. She never puts two and two together. Just thinks this is what diabetes is. My kids got a thing now where his blood sugar's low all the time, right? Because
Jennifer Smith, CDE 54:19
there's no explanation to why it's happening. Right? You know it Yeah,
Scott Benner 54:23
yeah. So then she comes online and learn stuff and and then puts two to two, two and two together on her own and figures it out. The last thing was, I said I was gonna go back to something.
Jennifer Smith, CDE 54:37
Oh, yes. I don't know what it was because you
Scott Benner 54:40
didn't know I haven't. wrapping my head back around that again. She was just talking about that prior to insulin. Her whole understanding of medications was in pill form. And somehow that that predominantly made her believe that every thing was super regimented, because you take the pill in the morning with food, and then you take it again at lunch with food and everything she'd ever learned about about medications was based on timing. And then she couldn't make the insulin work the same way. And it was frustrating. I don't know why I wanted to bring that up other than,
Jennifer Smith, CDE 55:23
well, I wonder if the person is an adult who was diagnosed initially with type two diabetes?
Scott Benner 55:31
No, it's for a kid, I said, the kid, the beginning of the statement is my kid was starving, because I was trying to keep a schedule.
Jennifer Smith, CDE 55:40
So they're in again, should have been better explanation in terms of timing of insulin, it really is, because it oral oral medications, or even some other injectable medications. They all have a timeline of action, from time of giving to expected time to give the next dose, right. But they are, they are not as precise in terms of what we can then control versus insulin being much more in our realm of controlling. Because we can put it in when we know that we're going to need it based on what we're putting it in for. Even if it's for food, we do it this way. If it's for correction, we do it this way. And we might even do something else along with it. Right. So I think insulin is definitely very different than pills. Yeah. And that is that's unfortunate, too. And I don't think the doctors maybe, obviously, maybe they didn't ask enough questions in terms of understanding of medication use.
Scott Benner 56:50
It made me think about people with thyroid issues. Because when you get a thyroid issue, a doctor is going to explain to you very clearly, you have to take this medication at a certain time of day, you have to take it with, you know, an empty stomach, you have to take it not with other pills, like and or you can take it with some pills, but not all of them. And here they are. Because if you don't, your body will not take up that medication correctly. And you're going to have a deficit that will come on you slowly. And you'll just sort of your your functionality falls apart. And you don't see it happening because it happens so slowly. And still, if you go through the forums and look at people who have thyroid issues, most of their problems are because they don't take their medication correctly. correctly. Yeah, right. It's all about like, you know, I don't know, like, I just take it when I think to take it no, take it at the same time every day, because it only lasts for 24 hours. That doesn't seem to matter to them. I don't understand, I take it every day, I never forget with my vitamins, and then you look at their vitamin list. And they're taking vitamins that are blocking their absorption, the absorption of the thyroid medication. If you can think about that pill correctly, you can think about insulin correctly. And because insulin is not going to work the same in every situation. And in the beginning, that seems incredibly overwhelming. But if you I can't believe I don't I just I mean this the way I mean this, if you listen to the podcast, you'll understand those different situations eventually. And not because the podcast is magical. But because you'll hear conversations and scenarios and experiences that will eventually teach your brain like the stop and go like that your son made that. Yeah, I'm gonna do this thing, because this thing is what works for me. It's not because you've beat it into your head, or you wrote it down or you, you know, you remembered it's because it happens. You just do the thing, because it's the right way to do it. And you've heard it enough times where that's how it happens.
Jennifer Smith, CDE 59:00
Well, I think the biggest thing to within many of the episodes. Actually, I'd say all of them is something to do with a variable. Right? Yeah, it is. So if you if you pay attention and learn whether it's learning from somebody else's experience and saying, Well, I have this same sort of lifestyle, maybe I could give that a try, or that sounds like it would work better. Maybe this is why it's not working for me. Right?
Scott Benner 59:29
Well, you know that you said that. I skipped over a statement from a person here who said I wish someone would have just told me that breakfast will have a different impact every day. Even if I eat exactly the same thing, and I thought I don't want to go through that because that's not really true. It feels like that. Because that's what you see. You see the I put the insulin and at this time they ate the same food and then something different happened. But you don't see how much insulin did they have over Night. Is this a moment where there is a growth spurt or there's not a growth spurt? Is my period happening? Is my period not happening have less I very active yesterday or very sedentary? All of those variables. People who ask questions like that in the beginning, they don't see that the truth is, is that the meal and the food that didn't change something else change and you don't realize it, maybe you're on a prop and you're at the end of a pump site and it's going bad. Or,
Jennifer Smith, CDE 1:00:27
or maybe you're on an algorithm driven pump. And because settings aren't quite navigated appropriately, the system is doing one thing, some mornings giving you a load of insulin getting you ready. And so your aftermath of breakfast looks a lot better, right versus taking away. And now you're left with, you know, this deficit of insulin and then things look the opposite of what you really wanted.
Scott Benner 1:00:47
Yes, there are so many variables, yes. And the only way to learn them is to live through them. And to not put yourself in that exact mind set of that question, which is why I didn't ask that question out loud. Because I don't want people to think that I don't want them to think that diabetes just magically happens to them. Because,
Jennifer Smith, CDE 1:01:08
yes, there's nothing magical about right.
Scott Benner 1:01:12
It's all pretty, it all happens for a reason. The reasons are hard to see. And again, you keep listening to people's conversations and they say something and finally, like it pops in your head, you go oh my god, and then you relate it to something in your own life. And before you know it. That's another thing you've got in your tool belt that you don't have to wonder about ever again because it's just there when you reach for it. So anyway, I thought this is a great conversation. I appreciate you. Absolutely. Thank you. A huge thanks to you all for listening and to Jenny for coming on the show. I'd also like to thank in pen from Medtronic diabetes and remind you to go to ink pen today.com Us med.com forward slash juice box or 888-721-1514 Get your free benefits check today. Don't forget the Contour Next One blood glucose meter is available at contour next one.com forward slash juice box to get the glucagon that my daughter carries go to G vote glucagon.com forward slash juice box Omni pod five. Are you interested where the Omni pod dash doesn't matter which one you want? You get them@omnipod.com forward slash juice box and get the Dexcom G six continuous glucose monitor@dexcom.com forward slash juice box. I appreciate you guys putting up with all that today. I want to remind you that there are more bold beginnings episodes in your audio app. And they're also available at juicebox podcast.com diabetes pro tip.com. And at the private Facebook group Juicebox Podcast type one diabetes. The bold beginnings episodes begin at episode 698 Defining bold beginnings. Then at 702. honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus And today's episode, carbs. There are more coming, check them out. There'll be there in your audio apps on Friday for subscribers. They just pop up if you're a subscriber, a subscriber or a follower, by the way, in whatever app you're listening in. It'll just magically be there. So subscribe and follow, follow and subscribe. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 739
1. Why is continuous glucose monitoring (CGM) important for diabetes management?
2. What is the purpose of different types of insulin?
3. How should insulin doses be adjusted?
4. What impact does physical activity have on blood sugar levels?
5. How can stress and illness affect blood sugar levels?
6. What role does diet and nutrition play in diabetes management?
7. Why is having a supportive network important for diabetes management?
8. How can staying updated on the latest advancements in diabetes care help?
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#735 Bold Beginnings: Pre Bolus
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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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 735 of the Juicebox Podcast.
On today's episode of bold beginnings, Jenny Smith and I are going to be talking about Pre-Bolus simple concept that not many people learn about. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app.
This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, take the right insulin dose at the right time. The right pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously, in pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed. Or you could experience higher low glucose levels for more safety information visit in Penn today.com. And just like that, I've gotten the ads out of the way for you. So you can listen straight through to Jenny and I talk about Pre-Bolus. Jenny, our bowl beginning series is going along well. We are making our way through so far we have recorded and put up honeymoon being diagnosed as an adult terminology which came out in two parts. Fear of insulin, the 1515 rule, long acting insulin, time and range like what range is shooting for and food choices. today. We're going to talk about Pre-Bolus Oh, yes. So I hope you're ready. I'm gonna scroll down to people's,
Jennifer Smith, CDE 3:43
I'm always ready. I never know what we're topic going to kind of address here like here, this is today.
Scott Benner 3:50
Like you're like You're like a member of my gang. You're like we can do it. Let's just go out right now. Always ready.
Unknown Speaker 3:56
What's the plan?
Scott Benner 3:58
Nevermind. We'll figure it out as we go. So the first person just says, I wish we had been told about Pre-Bolus Ng and I'll have to tell you, I'm reasonably astonished when I see people who for days, weeks, months, and sometimes years of their lives using insulin, run into the idea of Pre-Bolus in one day, and they just go I've never heard of this before.
Jennifer Smith, CDE 4:21
Correct. I've gotten multiple comments like that. And the assessments that come in for the people that I get to work with. That's one of the big things there like I had somebody just told me about this, or the emails that I get, you know, asking about, like working together. Nobody had told me about Pre-Bolus thing I've been you know, I've had type one for 40 years and nobody told me
Scott Benner 4:44
like, I talked to somebody recently diabetes for 50 years. And I said how do you handle your meals? You're like, you know, I just sit down and I Bolus the night. And I was like it was like like a Pre-Bolus No, I mean, just you know, just do it at the same time. Why do you not do it earlier? Why would I do that? Right? Well, what about this? And they're like, Oh, that makes sense.
Jennifer Smith, CDE 5:06
Well, and usually, I think the first piece of that comes with the rapid acting that we have had around for a number of years already has the idea that rapid means rapid. So when it's prescribed to them in terms of what the doctor or educator has given them an information it's take the insulin, start to eat your food, this is a rapid acting insulin. But we've talked about for rapid is not rapid, I think still needs time,
Scott Benner 5:39
especially for people who've never used to CGM or worn one, that you can't really see how food impacts blood sugar, and how long it takes for it to start moving. And you can't see the differences between different types of carbs. And so if like, you're saying, if somebody says, well, it's rapid, I couldn't take my rapid insulin 15 minutes before I eat, because sounds like I would be in trouble. I don't want to get low, and they've probably seen themselves get low at some point. And then it then some, you know, probably not for the same reason. But then anecdotally, they believe I couldn't possibly ever do that. So the next person says, it would have been nice, if someone would just would have explained the importance of Pre-Bolus thing. So I think we should. So if you're newly diagnosed, someone's giving you insulin, and they're telling you probably count your carbs, you know, this formula will tell you how many you know how much insulin for this for this amount of carbs. The thing you need to understand different, I think, big picture is that the impact of the carbs happens over its own timeline, just as the impact of the insulin kind of happens over its own timeline. So if you just sort of like picture in your head, you know, a flat line going along your blood sugar at any number, it doesn't matter where 8590 110 200 Wherever you start eating at, you have like some stability, and then all the sudden the food starts to push your blood sugar up. There's sort of a bell curve that happens, they're going up yep, at the same time, the insulin tries to push your blood sugar down. So there's a bell curve going down, you need to line up the the impact of the carbs and the action of the insulin so that they're fighting with each other instead of just working unencumbered, I guess it's correct way to say, All right,
Jennifer Smith, CDE 7:22
yeah, you want to time them appropriately. And I think they're in brings, I think, brings in another piece, potentially, to timing, from initial diagnosis. Most people are told, you don't have to change a thing that you're eating, you don't have to change a thing that you're going to feed your child or your teenager, just remember, you have to take insulin for whatever is eaten. Yeah, well, if if that's the case, then in they're not really transitioning at all from what they had been eating, which may be very high carb or very high glycemic types of foods. But you're also told rapid insulin, just take it before you start eating. As you just said, the timeline there of action is going to be very displaced. And you want to, you want to line those up or overlap them, almost overlay them so that the insulin and the foods start to work better together.
Scott Benner 8:20
I also think that it's possible that the statement from a doctor, you're not gonna have to change how you eat is true. But if they don't give you more context about how insulin works, that's not going to be very helpful, because it will seem like you have to change how you eat. My point is that I believe, I believe that if a doctor says you don't have to change how you eat, and here's how you use insulin to make that true. That's one statement. But you are also going to run into doctors who are trying to soothe your soul with with that, right, you know, they're, they're just trying to they're trying to say, Look, I know that you've just found out that you or your kid has diabetes, this is all very shocking. We're talking about insulin for food. But don't worry, you don't have to change how you eat like, you know what I mean? Like that's more it makes
Jennifer Smith, CDE 9:06
it it makes it easier, right? Like, there's one easy piece it's a comfort to know, well, I can keep eating, you know, Froot Loops for breakfast.
Scott Benner 9:15
Well, and that's the other thing is they don't ask you how you eat, you know, they just like don't worry, you won't have to change your over and they're like, Wow, this is great, because I eat Popeyes for lunch. And I have this and I love it crispy chicken sandwich. Oh, it's gonna be like, and so it's a lovely thing to say to somebody and I happen to believe it. You know, I think you can manage insulin for different eating styles. But you can't just tell somebody, oh, don't worry. You don't have to you don't have to change how you eat, but not give them any more context than that so correct that Pre-Bolus thing. I mean, I guess the last thing I'm going to say before I move on to my next thought is that we did the these episodes are in an order for a reason honeymooning happened first because Pre-Bolus thing if you're honeymooning This is gonna look different than if you had diabetes for a while to, you know, so you have to be careful about that. Because you might have, I mean, you see people worrying about it all the time, go back to the honeymoon episode if you don't know what we're talking about. But if your pancreas is still making some insulin, you don't want to like, be out ahead of the charge, don't like, Don't worry, I'll take care of it too. Now we got everybody trying to get your blood sugar
Jennifer Smith, CDE 10:21
down. And the reason that concept of Pre-Bolus in comes after we've talked about the impact of food becomes even more beneficial than it sort of adds a layer to understanding, oh, I guess this discussion around like nutrition intake or food intake. Looks like I really do have to pay attention to insulin, and oh, look, Pre-Bolus is the next thing to really bring into the picture along with what I choose to eat. So
Scott Benner 10:47
yeah, I mean, there's, listen, there's a level of of proficiency, you need to Bolus for more difficult foods, right. And yours. And Pre-Bolus thing is a big part of it. This person says here, I was really confused on whether I should Bolus before or after a meal. It's interesting. She says, they made this sound like a preference and not what would work best. It took me five years into diagnosis to learn about Pre-Bolus Singh. And I only learned because of the podcast. So no one, no one really told me about told me that insulin doesn't work immediately that it has a lag time, whether I'm injecting it or pumping it,
Jennifer Smith, CDE 11:28
which is really interesting, because it Pre-Bolus thing is not it's not a new concept, by any means. When I was initially diagnosed, and I was using our insulin, regular insulin, which is short acting, takes a longer time to get moving in your system that was told to my parents and explained very well from the beginning. If you're going to eat at noon, Jenny needs to have her insulin by 1130. At the latest in order to make sure that it's moving along with the food. So this concept of Pre-Bolus is certainly not. It's not just because we have rapid acting insulin. And we it's it's been around for a long time. But it seems like there's a disconnect in terms of who teaches about it, or who doesn't.
Scott Benner 12:21
I think you're you've I mean, for all of time, you're you've been trying to balance the action of the insulin against the impact of the food, it's just that the amount of time that it takes for insulin to begin working has changed over the years change. Right. Right. And so it's the same game. It's just different parameters. Right? Yeah. It's just It's fascinating that I mean, it's somebody could get five years into this and have to find a podcast to learn about it. Because guess what they fall into is that, well, this is just diabetes. This is what diabetes is I eat my blood sugar goes to 250. It stays there for a couple of hours. I mean, it comes down rap, and it comes back down again. Yeah. And that must be what this is, because it happens every day. And so that's that. Here's a great, but yeah,
Jennifer Smith, CDE 13:06
and those are also the people that ended up getting sort of hand slapped at visits with the doctor, for why are your blood sugars not like more contained, let's add more insulin probably in the wrong place? Because of the mismanagement of insulin specific to food. That's unfortunate. Yeah,
Scott Benner 13:27
it's that concept of Listen, I'm not trying to be funny here. But if you're married, you know the concept of moving the goalposts, right. Yeah, yeah. You're told that the goal is here. And then you start working towards that goal, and someone comes in and goes, none of the goals over here now. So no, no information about Pre-Bolus thing. And then it's your fault. Your blood sugar's high. Well, what are you doing? What are you eating? This, you know, and when you start getting questions like that, my opinion is you're either with an under skilled clinician, or a lazy one, one or the other, who's putting it back on you. They either don't know or they don't want to try. It's one or the other. Because if you knew how to use insulin, your blood sugar would knock up to 50. FDA correct. Just wouldn't tip here from this person Pre-Bolus thing ahead of time, like when I'm finishing cooking, so that it doesn't feel like I'm waiting forever to eat. So this is a big part about Pre-Bolus thing that we never talked about. There's a little beautiful post this cute little like cherub face girl on my Facebook page the other day, she's like four years old. And the moms video is showing us a video of her and this girl is just like, I don't want to wait.
Jennifer Smith, CDE 14:44
That's so cute. It's cute, but it's sad.
Scott Benner 14:48
It's both things. And so it kind of sucks because yes, you do sort of have to Pre-Bolus ahead of time and think about it like when you're driving to the restaurant is That time, or is it when I get out with a car at the restaurant? Or is it when I order you know, because I don't know how long it's going to take for the food to come. And that's one problem. And when you're cooking at home, it's one busy cooking. And so I don't I didn't remember to do this. Now what am I gonna sit and watch the food get cold? I'm not going to you do have to think ahead. I'll tell you. There's all kinds of strategies if, if we're on our way to a restaurant, and Arden's blood sugar's terrific. Then I don't nothing right heart, right. But when we pull up, I know the restaurant a little bit. I know we're going to be eating 20 minutes from now, or 30 minutes from now, and about what she's going to eat. What are we gonna have? I might be like, Hey, why don't you Bolus like five carbs 10 carbs now then after she eats, we check again, put in a little more, I'll tell you with that strategy. We went to a place the other day, Arden had her period. I haven't said Arden had her period in the podcast for a while. So I think it was about time. We're going into this diner kind of place where she is going to get something not good. Like, like, quality wise, this is going to be a French toast and real syrup. And or a macaroni and cheese situation. She's just juggling the possibilities in her head on the way to the place. Right. And on top of that she had a little ice cream while we were waiting to leave. And so she missed on her ice. I said did you Pre-Bolus This ice cream? She goes look at my graph. Does it look like I did? I said no, it doesn't. So heading up 141 50 We're trying to Bolus it. And we roll into the place where already bolusing in the in the parking lot because this one, it's 170. Now like she totally just booted the the ice cream, and her blood sugar leveled out at 200. But still, with all that Pre-Bolus thing, we she ate a massive, I'm just gonna call it a pile of macaroni and cheese like all kinds of cheese. And within a two hour window, she went from not Pre-Bolus and ice cream to eating macaroni and cheese to back to 95. Right. And it's because of where we thought to put the insulin correct nothing else. It's I mean, well, and
Jennifer Smith, CDE 17:10
where to put the insulin with a little bit of good information or attention to the information you have. Right? Had you only had finger sticks, that would have been harder to do? Oh, of course. Right? We we have access to where our levels are trending now because thankfully, a lot of people have access to using a continuous monitor. Right. So that's a teaching piece in terms of Pre-Bolus. And the idea behind it and a comfort level around starting to do it if you've never had that, you know, in your habit before for food is where's your blood sugar, like you said, if it's level coming in or on the way to a place you're going to eat. Maybe you don't Pre-Bolus until you get to the parking lot or until you actually get seated especially you know, if it's more of a sit down kind of place, you have this waiting time. Whereas, you know, if your blood sugar is already heading up, you're going to do something about it, even if it's just the corrective insulin that you take right now. So that you can get some things leveled off before you actually sit down and Bolus for the food. So there's a lot that you can use your CGM in a high level way to learn how to put insulin in in the right place.
Scott Benner 18:26
That story is a collection of my I mean, 14 years of knowledge having a CGM, knowing how to Bolus for foods not the first time she had macaroni and cheese. You know, like there's all kinds of stuff that I knew about that it is not the story about the time we Pre-Bolus in the parking lot of a restaurant and then walked in and found that no one brought their wallet with them. Oh, that's fine. Yeah. So we were like, just back in the car, just hammering home, trying to get some food before the Pre-Bolus word still worked out. It was just a little more stressful.
Jennifer Smith, CDE 19:00
My strategy would have been like, somebody goes home to get food, get the wallet, the rest of us go into the restaurant and order. And that would have been my strategy
Scott Benner 19:09
with me and kids at that happened a long time ago, I would have been abandoning small children in a restaurant, but which by the way, they probably would have been fine. I mean, look where they ended up with my help. So this person says, Oh, this is about timing of a Pre-Bolus. And I'll tell you, you know, this is the next step. When somebody wraps their head around, I'm going to Pre-Bolus They want to know how long, five minutes, 10 minutes, 15 minutes. And to me, I mean, it that has a lot to do with where your blood sugar is at the moment. What it is you're going to eat next. And then you got to practice. I mean, right. You know, if you have more to add to that, go ahead, but I haven't been able to figure out any more than that in all these years.
Jennifer Smith, CDE 19:50
No, I mean there is there's an assumed strategy to get going with again, a lot of it is relative to the content of the meal and You know, if you're sitting down to a chicken caesar salad, you're probably not going to have a really long Pre-Bolus Again, depending on where your blood sugar is sitting. But even then a meal like that being lower on the scale of glycemic index comparative to a big bowl of rice and grilled chicken. There's a difference there, you know.
Scott Benner 20:22
So well, Jenny, somebody said something I want to pick your brain about, they said, there's a rule of 10 that they were taught. It said, take the blood sugar you have now and divide it by 10 for your Pre-Bolus time. Have you ever heard that?
Jennifer Smith, CDE 20:41
I have not. That's an interesting concept. So if your blood sugar is 180, you should have an 18 minute Pre-Bolus
Scott Benner 20:49
s3 Pre-Bolus a half an hour before? So I
Jennifer Smith, CDE 20:53
guess. I mean, to a degree on the lower end of blood sugar, it still tells you, you still need some whatever. Pre-Bolus you know if your blood sugar's 70. That's still a seven minute Pre-Bolus time.
Scott Benner 21:05
Yeah, I that's the one thing I still can't hammer through Arden's head, like without me there. Going back to the ice cream store. I said, Why didn't you Pre-Bolus The ice cream? She said, Well, my blood sugar was 90. And I said, that don't matter. You still need to Pre-Bolus
Jennifer Smith, CDE 21:21
good blood sugar,
Scott Benner 21:23
good blood sugar. We're trying to keep it here. And right. And she just was like, okay, and then that was it. But she's 18. And, you know, yeah. But anyway, Pre-Bolus your meals? Like, I'll tell you right now with no, I have nothing scientific to back this up. You start Pre-Bolus In your meals, I think you're a once he goes down a point. I just think it does. You know, I think if you wonder why you can't get into the sixes, and you're not Pre-Bolus eating meals, that's probably a large reason why
Jennifer Smith, CDE 21:54
this, especially if you're a one C is if it's under eight, but not quite where you want it yet, let's say in some range of five and a half to six and a half. If that's your pie in the sky kind of place to get to. If you're higher than that. Pre-Bolus I would agree with you. It's a lot of the reason that that a one C tends to be higher is the post meal time period that's left higher than you want it to be. Especially if your overnights are really solid value that's in target and right where you want it to be. If you're having post meal excursions, getting those contained with just the concept of a Pre-Bolus If you hadn't been doing any at all will likely bring your agency down.
Scott Benner 22:38
I like that you've been saying excursions lately?
Jennifer Smith, CDE 22:41
Oh, yes. I like that word.
Scott Benner 22:44
My new favorite. It's my new favorite thing. I don't know why exactly. We left anything out here. Are we good?
Jennifer Smith, CDE 22:53
Um, I don't think so I think from a base level, it gives a good idea of the Pre-Bolus concept. I mean, there's certainly a deeper dive into it. But other than that we've given a good,
Scott Benner 23:05
right click go head over to the, to the protests to learn more, but I'm just going to tell you right now you got to Pre-Bolus your meals, like there's situations where you can't if you're eating when you're 60 I get it if you'd be scared. But generally speaking, please Pre-Bolus Your Meals
thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in Penn today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app and helps the show and honestly it's easier for you. The episodes come right to your phone and the Phone is right with you constantly. Mine's right here. See, I just picked it up. Everyone always has their phone or just blood sugar's 126 In case you're wondering. So let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there of course, right in your podcast player, just go to all episodes and you scroll around and you can find them or search and find them by searching for something like diabetes, pro tip or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're going to find a Facebook group with 27,000 members in it, people just like you who are sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series but all of the series It exists within the podcast and there are many. There's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are, even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes protip series you don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 735
1. Why is it important to have individualized diabetes management plans?
2. How should blood sugar trends be interpreted and responded to?
3. What are the benefits of incorporating physical activity into a diabetes management plan?
4. What are the different types of insulin and their uses?
5. How should high and low blood sugar episodes be handled?
6. What role does a balanced diet play in managing diabetes?
7. Why are regular check-ups with healthcare providers significant?
8. How can staying informed about advancements in diabetes care help?
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#731 Bold Beginnings: Food Choices
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
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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 731 of the Juicebox Podcast.
Today we have another edition of the bull beginning series, a series that began back on episode 702 With honeymooning, and then it went to 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 bold beginnings fear of insulin, Episode 719, the 1515 rule episode 723 long acting insulin episode 727 target range, and on today's episode, Jenny Smith and I will discuss food choices. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. We're becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash use Box join the registry take the survey when you complete the survey which will take fewer than 10 minutes, you'll be helping people with type one T one D exchange.org Ford slash juice box
this episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash and the Omni pod five, you may be eligible for a free 30 day trial of the Omni pod Dash. And here's how you can find out on the pod.com Ford slash Juicebox Podcast is also sponsored today by Dexcom. And the Dexcom G six continuous glucose monitor, head over to dexcom.com Ford slash juice box to find out if you're eligible for a free 10 day trial of the Dexcom G six. When you use my links, you're supporting the show. Hi, Jenny. And welcome back to the bold beginnings. I can't pretend that we didn't just record another episode. I'm sorry. Nevermind. Scott, it's very lovely to see you again. And I just finished one we're moving into food choices. So there's a ton of feedback here from people, I really enough that I'm not certain we're gonna get through it, but we'll give it a shot. And I'm going to start the conversation based on based on the conversation that I had, just recently with a young person in their 20s with type one diabetes, and just we're talking about all kinds of stuff. And in the middle of it. She said having diabetes, diabetes really messes up food for you. She's like it just you start looking at it, like what is that going to do? And you know, is this or you know, maybe I won't eat that because of what it's going to do or it doesn't feel worth it to me to fight with this for three hours. She said she never thought about food like that prior to diabetes and right, it's a fair statement. So let's dive right in. Because there's a ton here. This person says that grocery shopping seemed incredibly difficult at the beginning. And it was also emotional. She said they were trying to eliminate some of the kind of quote unquote, not good for you foods that my daughter was getting. But then she saw me crying as we went down the aisles. Wow, that sounds like really in the beginning. Because you're feeling I'm gonna guess not a therapist, Jenny. But that's a sense of loss. Right?
Jennifer Smith, CDE 3:41
It is. And there's a sense of loss. I think in many things that because food is food is a major part of diabetes management. It is because food is also a basic necessity of life. We have to eat, we can't just say well, I've got affects this. So I'm just going to just not do that anymore, right. But we have to eat food. So what you've been used to doing may need to change. Now, you know, one step into that is was what you were doing? Not the greatest, or was it not as healthy anyway? And could you start to see some of these changes once you mentally get over all of the hard stuff that it takes to navigate through all these thoughts. It can you start to see this as a well gosh, as a family, we could clean this up. We could be doing this versus that and it would be better for all of us. Right? But it is it's it's hard.
Scott Benner 4:51
And not everyone's going to take that path either. You know, and I will tell you that some people see it as a challenge to like I'll just because we have died videos now doesn't mean I'm gonna You can't change me. I'm gonna figure this out, right? It's funny because I'm somewhere mixed into that idea, I'll probably figure it out as we're talking. This first and biggest worry I had was limitations of food. What in the world was I going to feed my kid? Because she only really ate a few things to begin with. Yeah. And those things all had carbs.
Jennifer Smith, CDE 5:27
And that's where then you work with that, because so much has changed with the child's life to begin with. That that's not a starting place for being like, well, you're just gonna eat broccoli today? Because that's so much better for you than whatever it was the child. No, no, that ain't that's not appropriate. But it's then learning Well, the 10 things that your kid does eat. figure those out, yeah, eventually move
Scott Benner 5:54
on. The same person said that they then had an appointment with a dietician a number of days later, where the dietitian lifted the fear by just saying, Hey, listen, you can eat what you want, but you have to cover it with insulin. But then they didn't give them the rest of the information, which is, you know, what this whole thing is about, right? Like is, you know, 10 carbs, this and 10 carbs that might not hit the same, right? So they went from, oh, my God, there's nothing my kid can eat to Oh, doesn't matter, they can eat anything to then realizing we don't seem to be very good at Bolus thing for them. Right? Then Then they ran into that idea of like, well, well, this must be what it is. Now, this next person says I was confused about the different views between low carb and like a regular diet. And I didn't, I didn't realize that you could use insulin skillfully. And still, and still have a great day one, see. And we do that now. But there still are times that we might not want a bunch of insulin on board. So we eat appropriately around that. Correct. So that's, that's a really thoughtful, that's the, that's somebody who's been through it already, and figured it out, you know, or has
Jennifer Smith, CDE 7:06
kept enough, even in a shorter period of time, has kept enough notes, or has done some trend analysis, or looked enough at what is going in and has seen. But when we do this, this works out pretty well. We've got it figured out whether it you know, is an apple or fruit snacks. They've figured it out, right? But then comes in, you know, the other types of things. And they say, well, these are the variables, I think it would be easier if we just have less overall insulin, maybe we could go this route for this type of setting. And it works better for us. Great. That's it's probably adding a good amount of variety anyway, which is healthy in your nutrition intake overall to begin with
Scott Benner 7:52
this next person's point I agree with completely. So, you know, they talked about, you know, I'd never thought about glycemic index and foods before this obviously said the podcast helped her think about it. But that she did make some pretty what she thought were obvious decisions on some things. And she puts a little list here, but I'll tell you for certain little things, like if you have pancake syrup in the house, get a sugar free one. Like that's me just like Why are you punishing yourself for right? You know, like, like, first of all, I don't know if you've ever really thought about it, but you start squirting that syrup on everything. By the time you're done. You have a half a cup of it in there, you're basically drinking 40 carbs of sugar, you know, at a know so
Unknown Speaker 8:35
much more. Much more. But yes,
Scott Benner 8:39
so so if you're gonna have pain, so Okay, fair enough. I still want to have pancakes, have pancakes, use the sugar free syrup. It makes it easier on you. Do you have to know? I mean, there are people listening this podcast who think this podcast is about the idea that you can eat whatever you want. I mean, I think the podcast is about understanding how insulin works, but fair enough. So but yeah, that kind of thing. Or, here's a super easy one. No one's ever going to tell you make sure you're buying bread that has no high fructose corn syrup. Super easy decision to make makes things much, much simpler.
Jennifer Smith, CDE 9:14
And if you go a step further, get sprouted grain bread. So much easier glycemic li than even the typical white breads that might say they're organic with no added corn syrup or whatever. But the more the more unprocessed something is, the better you're going to find your glycemic kind of, you know, outcome
Scott Benner 9:37
if you're a person who absolutely has to have soda and I have to admit, I don't understand that. I don't ever drink soda really. But aren't that I went out to lunch the other day and we're like, can we have two unsweetened iced teas and she goes we're out of unsweetened iced tea and I was like supply chain issues. And we were both like we'll have a Diet Coke and at a meal where I I probably would have drank a couple of iced teas. I did not get through the Diet Coke. It just it's not for me. But if you have to have soda, God bless, drink diet soda, and then you don't have to worry about that thing. Like, there are simple places where just for health in general for that if you don't have diabetes, you could be cutting out sugar. And, and at the same time, it just makes this whole thing easier, especially in the beginning. There's still times when people send me graphs and I'm like, Look, do yourself a favor, eat a simpler diet for a couple of days while you're figuring this out. Like you don't know what you're doing. And on top of that, you're trying to Bolus for Lucky Charms, like you know. Yeah, that's like, that's, that's an angel level decision you're trying to make here. And you just started yesterday, you know, right. Yeah, that kind of an idea. You okay with that you? Like I'm not saying to restrict your diet, I'm saying.
Okay, let's head together to Omni pod.com forward slash juice box. The first thing we'll do is brace ourselves because there's a photo of me there. And it's not. I mean, it's not pleasant. It's the best picture I could take. I don't know what to tell you. Anyway, I apologize. On the pod. They're makers of the AMI pod five. It's the first tubeless automated insulin delivery system. It's an algorithm based system. It's probably what you've been waiting for on the pod five is the first and only tubeless automated insulin delivery system to integrate with the Dexcom G six. It is now available for people with type one diabetes ages six years and older. Featuring smart adjust technology. The pod adjusts insulin delivery based on your customized targeted glucose helping to protect against high and lows, day and night. Where do you find out about this Omni pod.com forward slash juice box. Now if you're not in the market, for an algorithm based system, you might want to take a look at the Omni pod dash and you may be eligible for a test drive a free 30 day trial of the Omni pod dash, you can also learn this add on the pod.com forward slash Juicebox Podcast scroll down to the big purple box and start reading. After that you fill in a tiniest bit of information, and you're on your way. So whether you're looking for the Omni pod five, or the Omni pod dash, you want to go to my link Omni pod.com forward slash juice box. there everything is well explained and easy to understand. A tubeless insulin pump is within your grasp, head over there. Now. When you're done, I'd keep going right to dexcom.com Ford slash juice box. Now here's the good news about this next calm.com forward slash I'm typing I'm sorry, Ford slash juice box. Here's what you're gonna get there are Moreover, not get a photo of me. So it's a nice relaxing and calm experience. No pictures of Scott. Instead what you're gonna get is the breakdown about the Dexcom GS six, you're going to learn about zero finger sticks, glucose readings that are right on your smart device, customizable alerts and alarms and how to get started right now with the Dexcom G six. You can make better diabetes treatment and diabetes management decisions with zero finger sticks and no calibrations. The Dexcom G six lets you see your glucose numbers with just a quick glance at your smart device and receiver get alerted when your glucose levels are headed high or low and share your data with up to 10 followers. And the Dexcom G six is covered by most insurance plans. There's details surrounding all of what I've just said. But those details are@dexcom.com forward slash juicebox you don't want to I mean listen. You don't have to listen to me, right you can do whatever you want. My daughter has been wearing an omni pod since she was four and she's 18. She's been wearing a Dexcom since I don't know she was six or seven. And she's 18. These items are at the core of our decision making process, moment to moment, hour to hour day to day with type one diabetes. And you know what, they could probably help you a lot with type two diabetes as well. dexcom.com forward slash juice box on the pod.com forward slash juice box links in the show notes links at juicebox podcast.com. I am contractually obligated to say that for full safety and risk information about the Omni pod Plus Free Trial terms and conditions you can visit omnipod.com forward slash juicebox. I'm going to get you back to Jenny now who by the way works at integrated diabetes.com In case you're interested in working with her like I'm not saying to restrict your diet I'm saying
Jennifer Smith, CDE 14:52
make make potentially wiser decisions and Dorsey what you're doing Are you constantly having problems No matter what you're trying, maybe you're at the level of getting the majority of stuff. But there are a few things where like the maple syrup, or the regular sodas or you can't get over drinking juice. Okay, we know what I mean juice is recommended for a low blood sugar treatment. Don't drink juice. Just drink juice, eat the fruit don't drink the juice.
Scott Benner 15:23
I grew up in a house where nobody understood nutrition and orange juice was seen as healthy as hell. Yeah, yeah.
Jennifer Smith, CDE 15:30
I'm sure it was yeah, you know, better than soda from an from a from, I guess nutrient quality, especially if you're getting the not from concentrate, whatever. Okay.
Scott Benner 15:43
That is not a good marketing line. It's better than soda that does not breed. But in all of your foods. I mean, I'm telling you right now, no high fructose corn syrup. If you just cut that out of the things you're buying huge deal, if you can. I know. Listen, it's time consuming. But it's try to stay away from things in bags or boxes. These things have preservatives in them that make them more difficult to Bolus for. I made my own potato chips last weekend, which took hours but I found relaxing people made fun of me, but that's okay. And you should see how much less impact that had on Arden's blood sugar versus any kind of potato chip that would come out of a bag.
Unknown Speaker 16:28
And you would because you know what you did to them. It was a rough
Scott Benner 16:31
was soft on it. That's what it was like that. There's nothing else in it. I mean, except for whatever they sprayed on those potatoes before we bought them.
Jennifer Smith, CDE 16:39
Oh, you didn't buy organic potatoes.
Scott Benner 16:42
I don't know if I did or not. I was just for the situation teasing.
Jennifer Smith, CDE 16:46
Well, you know, who knows the organic versus non organic? Who knows what floats through the air? And
Scott Benner 16:52
I'm sure there's a way to get around that distinction already here. Yes. A lot of statements here about my first food shopping was completely overwhelming. We weren't carb counting. And we had to work in 15 grams of carb portions, oh, poor person was not carb counting. So they were eating either 1530 4560 That's a lot.
Jennifer Smith, CDE 17:15
And that would be more of like a sliding scale kind of concept of this many carbs. Take this much insulin. And that's all then use this correction if your blood sugar's in this range.
Scott Benner 17:27
And then the end of her statement, I've seen online a million times and heard from people in general, which was That was way too much food for my kid. My kid wasn't eating 30 carbs at a sitting they were a little but they wanted more than 15. And now they're forced feeding. They're telling the kid you got to finish this because we Bolus for it, which is not a good start to your life. That's for sure.
Jennifer Smith, CDE 17:48
Not at all. I mean, uh, you know that that's really old. I mean, that's, that's really what I learned. And that was really old, old school education. I mean, I could remember when I was taught, I was so excited when I was taught to read a food label. And I could cover carbs with insulin better. I was so excited about that, because it just, I don't know, it widened up things. I still wasn't the grocery shopper. I mean, it was still my mom. But I don't know, it just made a difference.
Scott Benner 18:20
This person said that they ran home from the hospital throughout everything with sugar in it based on no no information at all from anyone just thought that was the right thing to do. And then it took them months to realize that this stuff still had carbs in it. And it probably didn't matter one way or the other. People said I wish someone would have told me the best cards to carry with me. That's a good Yeah, yeah. Because I do. Do you ever see, like, here's one that floors me right? Chocolates not good. A good treatment to stop a low with right? Not at all. It's still a fat, but people do that all the time. Right? Like so you want simple sugar that's absorbed easily through your body. Think about like if you ever had that emergency gel, they tell you to rub it in the cheeks, inside of your cheeks. So juice works really well. A lot of people
Jennifer Smith, CDE 19:09
another really good one are the honey sticks. Okay, especially if you're someone who really doesn't want to do all of the processed Color Fill candies and that kind of thing. The long skinny honey sticks work really well. I've seen a lot of people comment about and I've done it myself when I've had like lack of something in a purse is just the sugar packets at a restaurant. Yeah, they work. Awesome. Dump it under your tongue. It dissolves right away and it is quick. It works.
Scott Benner 19:39
I remember having to do that with Arden one time. And she was like, you know and I said well just pour it on your tongue and I was like melted in your spit. Hold it in your mouth for a little while before you swish it around. You know, get it make sure you get on all your teeth so we can end up with it. But that's also a great Good example, if you're giving people sugar overnight, you might start seeing you might start surveys. Yeah, dental problems. And I've had a dentist on actually, his episode will be out pretty soon. So by the time this is out, it'll probably have been out where he said, you know, look, I'm not telling you to jump up in the moonlight and brush your teeth. He's like, but have water by the bedside. And when you're done, just swish it around your mouth and clear your mouth. That would be a big deal to do that. Yep. Okay, so best cards to carry around simple sugars that were quickly.
Jennifer Smith, CDE 20:31
I wanted to say simple sugar too, if people are looking at labels, the simplest, like most most easily digested carbohydrate is is is glucose, right? Which is why we have glucose tablets. But glucose is dextrose. So on candy labels, if you're looking for a candy, look for glucose, or dextrose, within the first three ingredients, and then you've got something that's going to work really quick,
Scott Benner 20:58
okay. And then after that, I think find what works for you, too. Right. And and let me say this, just don't think that because you open the package, you have to eat them all. You know, if you have a little single serving, like, I don't know, gummy package, and there's 10 pieces in there, five of them might fix your low blood sugar, you know, don't feel weird about throwing the other five away or twisting it up for later or something like that. You don't have to eat them all because you opened it up, which is the thing that people fall into all the time. All right, now's the time. Let's say hold on a second. This person actually made your point earlier that this might be a good time to make a sweeping change in how you eat. If you if you looked up and saw that your diets not a healthy one, it's a good, it's a good excuse to do something about it. So that was yours.
Jennifer Smith, CDE 21:48
And as you said earlier to you know, the least processed or the less processing of food most often means the food is is clean, if you will, right. There's not a lot that's been added to it, whether it's corn syrup, or all of the additives that they keep to preserve it on the store shelves mean the best places to shop and the grocery store. It's around the perimeter. You've got your fresh produce lots and lots of non starchy great vegetables, healthy fruits, you've got your protein sources, it's it's the aisles that are the danger zone.
Scott Benner 22:27
I know. I've seen it. I've seen it before they're there. The grocery store is actually set up. Just the way Jenny said like, look at it one day, they you know, they concentrate kind of the crappy food internally. Yeah, it's interesting. Here's one, what were the free snacks, I wish somebody would have given me a list of free snacks. And that's a funny statement to me. Because, because it's not always free. Right? Like, you know, I understand the concept like a like a cheese stick might be considered or a Slim Jim or something like that, you know if you're but if your blood sugar's I don't know, 120 and having a cheese stick, you know, doesn't have carbs in it. Okay, I get your point, maybe you don't need insulin for it right away. But if you really listen to the podcast, and if you've lived with diabetes for a while, you start realizing that, you know, the fat and the cheese could slow down your digestion, which could push up your blood sugar, or you could eat meat that later would be broken down and stored as glucose that there's nothing that's like legitimately free. I don't think
Jennifer Smith, CDE 23:36
Iceberg lettuce. There you go. Okay. I mean, unless you literally eat the entire head of iceberg lettuce. And I'm not saying that that doesn't have carbs in it. It does. But I mean, Iceberg lettuce, and many of the greens will have very limited if any impact blood sugar wise, right? I mean, on a whole big dinner size plate size spinach salad. I might add to what I'm kind of swag calculating on that. Maybe five extra grams for all of the greens that are there. Really, the rest of the stuff that you add on top of that is what needs counting all of those other nonstarchy you know, bell peppers and onions and mushrooms and cucumbers. They have carbs in them. They were I mean the concept of free again is kind of an old concept. It kind of is like that 1530 45 grams per meal and you take this amount of insulin. I got to know free foods as as a newly diagnosed as my aunt and uncle would bring to family gatherings big vegetable trees, because Jedi could eat those foods for free. And man did I eat them? I'm quite sure if I had a CGM. My mom would have been like man we got a dose for cucumber.
Scott Benner 25:03
Garden goes on kicks for sheets, tons of carrots. And we believe we Bolus for the carrots like
Jennifer Smith, CDE 25:08
oh yeah, Carrots are one of the curvier, non starchy type of vegetables. Definitely,
Scott Benner 25:13
the point is this is that in the beginning, you might not know what you're doing, you might have your Basal too high. And so you don't notice things like this. But as you start to get your settings, right, understand diabetes more, you're going to start seeing the impacts of those so called free foods. Now, don't get me wrong, if you've got a four year old and they want a snack six times a day, I take your point, and you should definitely find those ideas. You know, a little piece of cheese is definitely going to be less of a hassle for you blood sugar wise than given them an orange slice.
Jennifer Smith, CDE 25:47
And for a four year old from a standpoint of portion, the cheese stick or the Slim Jim or you piece of you know, grilled chicken or a boiled egg or whatever it may be, it's probably couldn't have pretty little to no impact whatsoever in the portion that that child is eating, versus the adult who's like, Well, I'm just going to eat a big ol six ounce chicken breast because there aren't any carbs in it. Wow, that's not going to work out so well.
Scott Benner 26:14
And that makes me think too, if you do have a toddler or a kid who's running around all the time, there may be an amount of, of carbs they can take in throughout the day that will look free. Because they were going to go low, and you're just kind of counterbalancing it before you see it.
Jennifer Smith, CDE 26:33
Yeah, you kind of bolstering with little snips in between. And that's often the way that toddlers eat too. Right? Little bit here a little bit there. They may eat two strawberries, they might eat, you know, a bite of cheese, they might that's just what they do,
Scott Benner 26:48
right? So if you're in a situation where you think, Oh, my God, my kid eats throughout the day, and they never eat insulin, try thinking about like this, instead, it's not a free food, you're pre carving a low before the low happens, right? You're treating before it happens, and you don't even realize it. Yeah, could be the situation. I wish somebody would have given me a list of foods. That's interesting, because then that's, you know, we get into eating styles. And I don't know that doctors would want to be pushing an eating style on you one way or the other. But, I mean, you should definitely see a dietitian who could help you with that. You know, and I
Jennifer Smith, CDE 27:25
would, I would request a dietician, who specifically is a diabetes educator, if possible, if where you live, that is a possibility. I will say that being a dietitian, myself. I know diabetes, for many reasons, obviously. But had I gone into the realm of cancer management. As a dietitian, even my life with diabetes would have taught me something. But I may not be quite so good at education outside of that, because that wasn't my realm of professional work. I've learned a lot by working with so many people with so many different needs and interests and requests and whatnot, to kind of draw on, so definitely do your homework, as we've said before, with any clinical team, do your homework and find somebody that can work with you,
Scott Benner 28:21
this person said, you know, there are just days when I need a break. And so I eat very low carb, or, and I think that's completely reasonable, first of all, and said, there should be options that people know how to do that without being scared. Because if you if your settings are set up for a lifestyle, and then you suddenly swap that lifestyle to something else, your settings are going to be too heavy, then, and you're going to have trouble. But she's like, it would have been nice if someone would have explained to me that, hey, if you just don't want to eat a bunch of carbs today, switch to this basil program and do this. And I take your point, I think that's a really good point, actually,
Jennifer Smith, CDE 28:59
indoor cover your meals, you know, learn how that learn what that means in terms of meal coverage, because it really should be a swap out of okay, my Basal does this because I've tested it, that should be worked pretty well. I mean, I've got a lot of people I work with who for religious reasons, do all day fasts, right? And so we've been fine with that having tested basil, that sometimes on a fasting day, they may even need a 10% reduction in their base basil, these there really is no food impact whatsoever through the course of the whole entire day. But the meal times themselves. If you're doing a type of fasting, that's more vegetables and protein or just a little bit through the course of the day or if you're doing any intermittent fasting where you're really only eating for six hours of the day, or eight hours of the day. You may see different impacts than you do with all day food intake of more, you know, mixed meal
Scott Benner 29:56
Yeah. Do you give time or do you have to go No, I've
Unknown Speaker 30:00
got let me check me. Let me check my schedule. I have five minutes. All right,
Scott Benner 30:08
so we'll do one more. And then we'll kind of come back to this one. This person says, I wish someone would have told me that it's okay. Right to eat one way to eat another way. But instead, I got a very restrictive care team that shamed us. And it was it was really tough. You know? That's the I'll tell you though, of all the things like I'm really freewheeling on my Facebook page, meaning like, I let people talk like adults, you know, there are very few rules, but shaming people about their food choices. I am not okay with ever, no, especially around diabetes, you can you can cause eating disorders with very easily. You know, eating disorders with people with type one is, is you know, more common. If someone wants to eat Kentucky Fried Chicken every day and learn how to Bolus for that's their life, you let them do that. If someone never wants to take a carb and once their blood sugar to be, you know, at 24 hours a day, that's their decision is their decision. Yeah. And then I see then everybody's tries, you know, everybody tries to make their point. And the one thing I wanted to ask you before we go on this one is do you I mean, you're listening, you're a trained dietician, right? So you have type one diabetes, do growing children need carbs to grow correctly? Freaking word?
Jennifer Smith, CDE 31:32
Yeah, that's a very good question. I think the bigger the bigger piece to it that I always look to analyze, when I get the questions from parents is calorically, what's necessary. And within that then also becomes food preferences and what they currently look like, and what you're considering transitioning into for your child, let's say, you think that it would be easier to just be carb free, or to be low carb, let's say, I mean, most people who are not entirely carbon free, children do need a very set amount of nutrition, intake through the day, carbs, proteins and fats, proteins and fats are really the very essential. I mean, they are protein is the building block of your body, you need fat for a lot of different functions, hormone, and all that kind of stuff in the body. And carbs are the preferred energy source of the body. They are, they're fast, they get in, they give you this energy boost, and then they kind of digest and they come out. And that's sort of the reason that we eat every several hours, if we are eating more normal carb types of meals. So our carbs necessary, carbs are necessary, I think in a certain amount, what that amount is boils down to, what are you looking at doing? And how can we meet the overall nutrition need of your child where they are? Are they heavily into sports? Are they more sedentary? What is their growth percentile? Are they growing on par with where they started out prior to diagnosis? Do we need to make any adjustments and then we can look at you want to aim to try lower carb because it might be a little bit easier in terms of glycemic control. Okay, but then we need to navigate those other pieces to make sure that they're meeting their growth needs.
Scott Benner 33:28
Okay, the fat and protein stuff fatten, right, it's funny, you're making me think of Arden's friend who is a she's like I'm a vegetarian are, you know, and but then she basically just eats like, potato chips and stuff like that. Yes, that's not I think you're missing the point.
Unknown Speaker 33:45
I don't be a vegetarian, but
Scott Benner 33:49
it's, um, I think that's what you just said just resonated with me so much. It made me feel like if everyone had you with them, I don't even mean diabetes, or a person like you to stand behind you and go, Okay, look, here's your lifestyle. Here's your need. If we eat these things in the course of the day, that's going to put your body in the best position possible. Right, right. And then the problem is that people don't get caught up in what you need carbs to grow, like, okay. Okay. Maybe you do and maybe you don't maybe let's just say you want to have carbs in your diet. And then there's a person over here is eating like a pretty keto diet and they don't want that. Just let live and let live like just let it be your name and their
Jennifer Smith, CDE 34:33
their parameters. Most often the people that I've seen who are keto or more paleo, or more just considering low carb. They've done enough homework or they've come in with I'm trying to do this. This is what I really want to stick with. I'm missing something. Something isn't quite right. I don't feel quite right or whatever. So then we have some things to look at to make sure we're meeting glycemic goals as well as for kids, especially again, bro. Schools. I mean, protein is it's a big piece of piece of growth and change. And kids are growing rapidly. They they need a good quality, you know, nutrition intake. I think the bigger thing if you're looking at carbs, are you looking at going low carb and getting an answer to whether carbs are necessary carbs, like celery and cucumbers and kale and spinach, and berries, if you're going to add carbs in small amounts, those are the ones you want. You don't want the processed, like keto carbee foods that are just like tricking the body.
Scott Benner 35:43
The only time eliminating carbs from someone's diet makes me sad, is when I see them do it because they can't figure out insulin. Correct. That's all like if you want to do it as a choice, I understand. And if you figure out insulin and then decide I still want to be low carb, I understand. But I feel badly when someone just didn't you know, all the things we've talked about in this podcast forever didn't learn how to Bolus didn't learn how to Pre-Bolus Didn't understand glycemic load all that stuff, you don't understand any of it. And you're just stuck in a space where you like when I eat carbs my blood sugar goes way up. I eventually give myself insulin I get super low and I'm bouncing all over the place in the dam and I'm not eating carbs anymore because I don't want to be on unwell. That That to me? I don't know. I wish they knew if they knew when they decided to do it. I understand. But if they don't know and they just are being pushed into it because they're scared. Well, I would rack you know, I would hope that somehow they could learn before they made
Jennifer Smith, CDE 36:40
that decision. No, I 100% agree. They're 100%.
Scott Benner 36:44
Alright, so Jenny, the next time we do this, we'll come back and make sure we're done with this list. Before we move to the next one, you can go back to your thing. Sounds good. Have a great weekend. Thank you, you too. Thank you.
First, I'd like to thank Jennifer Smith for helping me again on the podcast today and remind you that she works at integrated diabetes.com. I also want to thank Omni pod and Dexcom for sponsoring this episode of The Juicebox Podcast. Go check out all the trials and offers at Omni pod.com, forward slash juicebox and dexcom.com forward slash juicebox. Those links, of course are available in the show notes of your podcast player, and at juicebox podcast.com. I hope you're enjoying the bold beginning series. There's way more coming so keep downloading them every Friday. If you've been enjoying the podcast, here's a couple of things you can do. That will help me you can leave a great rating and review wherever you listen. You can follow or subscribe in the podcast player or audio app that you listen in. You can tell a friend about the show. If you see a question online where people are like, I don't understand this. You could say oh, you should try episode bla bla bla of the Juicebox Podcast. That would be lovely as well. What else? Hi, listen, subscribe. Tell a friend. Oh, here's another one. You could join the Facebook group Juicebox Podcast type one diabetes now with over 27,000 1000 members, over 110 new posts a day. What am I trying to say? It's jumping over there, full of great information. And great community members go meet somebody just like you. I'm going to share a little something here at the end, I assume you're a real big fan. If you're still listening once you know the podcast is over, but we're at the halfway point of 2022. The podcast is now as popular by download or stream you understand you can download an episode or stream it while you're listening a download or stream count the same for me. And in 2022 The show has as many downloads or streams already at the halfway point of the year as it did in the entire year of 2021. Now, not only is that true and amazing, and I thank you very much. But the best day in 2021 like the day with the most downloads, it was the day of the year I was like I cannot believe this many people downloaded the show today. That kind of thing. Right? That amount. The best amount from 2021 is now about I'm not great with percentages. Give me a second. Hold on a second. I'll be right back. I'm back I use the calculator. Okay, sorry. So the that that show that one show that had the most downloads in 2021. It has As about 21% fewer downloads than an average day in 2022. Does. That is bananas? As a matter of fact, what I would consider a slow day on the podcast is now only 14% lower than what the best day of 2021 was. That is crazy growth. It is because of you. It's because you're sharing, you're listening, you're subscribing. I can't thank you enough. It's really astonishing. And really, you could knock me over with a feather when I see stuff like this. Absolutely wonderful. I really appreciate you supporting the show. I hope you're enjoying the bowl beginning series. Don't forget, there's a ton of other series within the podcast. If you go to that private Facebook group, scroll to the top click on the feature tab. There's lists of all of them. I'm not going to bother you here with all of them. But there's so many about how people eat and the Pro Tip series defining diabetes stuff. Stuff about thyroid and pregnancy, mental health, on and online. Go check it out. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 731
1. Why is regular blood sugar monitoring important?
2. How should insulin doses be adjusted?
3. What role does diet and nutrition play in managing diabetes?
4. What are the benefits of using insulin pumps and CGMs?
5. How should diabetes be managed during travel and unusual circumstances?
6. How can the psychological impact of living with diabetes be managed?
7. Why is having a diabetes care team important?
8. How can staying informed about the latest diabetes treatments and technologies help?
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