#780 Bold Beginnings: Treating Low Blood Glucose

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 780 of the Juicebox Podcast.

Welcome back everyone to the bold beginning series today Jennifer Smith and I are going to be talking about treating low blood glucose levels. At some point, in this episode, you're going to hear me tell Jenny that oh, this is the last one we're recording, but I might have made a mistake, so there's more coming. Anyway, you'll see 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. Remember that while you're listening, please. If you have type one diabetes and are a US resident, or you're a US resident, who is the caregiver of someone with type one, can you please go to T one D exchange.org. Forward slash juicebox and complete the survey. Just join the registry complete the survey takes fewer than 10 minutes. Absolutely HIPAA compliant, completely anonymous. Super simple answers to type one diabetes questions you already know the answer to your feedback helps other people living with type one, t one D exchange.org, forward slash juicebox.

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I'm gonna hit record Jenny to tell you this little preamble bit that I normally would have said ahead of time, but what we're done, you and

Jennifer Smith, CDE 4:28
this is the last one we not yay, I should say, Oh no, we're done.

Scott Benner 4:32
We're done with the bold beginnings, then we will move on to the long list of things that I have to do with you for next year. So but I'm gonna throw a little curveball in here. So you and I were going to talk about insurance. And then we were finished but I'm going to bring somebody else in to talk about insurance. Cool. So because otherwise it would just be you and I you know talking about our experiences with insurance which might not have answer some of the people's questions.

Jennifer Smith, CDE 5:01
No, I think that's great. Because I think there are quite a number of people that definitely know more about the navigation. And I think in terms of this topic, it's more how to really nudge yourself into insurance and get what you need and get to be able to talk to the right person about it. Yeah. So I think that's great.

Scott Benner 5:24
Yeah. So you and I would have done, we would have had fun. And I would have told stories about yelling the F word into phones to get art and things. I can do that with someone else who can also hit the technical sides of it for us a little awesome. So instead, you and I are going to add our very last episode to the bowl beginnings series together about how to treat low blood sugars. Oh, right. Because you get diabetes. And nobody says to you, hey, you might get low. And the low might be slow. And it might be fast, and it might be harsh, and you might be dizzy. They just say if your blood sugar gets low, eat 15 carbs, wait 15 minutes. And then it

Jennifer Smith, CDE 6:07
might respond really fast. Or it might not resolve for a couple of hours. And you're thinking, Where did the food go? So,

Scott Benner 6:17
so I so I want to kind of talk through a number of scenarios. And I know, I know, I'm dropping this on you out of nowhere. And of course, is that is that anything new? No. But I don't have any notes whatsoever. Like we've been doing bold beginnings off of people's questions. So, you know, we might have gotten lazy because we're like, oh, we don't have to drive this conversation. I'll just wait and see what this person said.

Jennifer Smith, CDE 6:37
Well, I'm sure there are probably lots of questions that have come in about low blood sugars.

Scott Benner 6:42
There may have been but they were not. They were not called together for me for the situation. So we're just going to fly by the seat of our pants, which I think will be fine. Not like before. Alright, so let's think about this. Your newly diagnosed, and I guess the first thing we can consider is that you might be honeymooning, still true. All right. So if that's happening, if you're getting help from your pancreas that you don't expect, you might see protracted I saw somebody online the other day whose kids blood sugar was like low all day. And she's like, this has to be a honeymoon because like we're not doing anything different than we've done in the past. So I guess if you're MDI, and you start experiencing low blood sugars, that seem like they're being I guess, impacted by your pancreas, still, you can't cut off your your Basal insulin, because you've probably shot it already that day. Correct. But you could start limiting. I don't know, would you

Jennifer Smith, CDE 7:47
limit your Bolus insulin? Right? Right, or you could look at for that day, making your insulin to carb ratio, more conservative, you know, if you're floating around at a ratio of an in honeymoon, when kids and even some teens might be a one to 30 ratio, right? You could suggest one to 45 or one to 50. Or right if you know that you're floating, pretty stable when there's not food introduced, but the stable is low and you're having to give it a little bit of carb to keep it from like dipping, then it would be the Bolus is that would be the easiest to adjust in that day. And in looking forward into the next day thinking, this might be what it is. You could downplay your basil that day. Whether it's morning or evening time dose, you could take it down a little bit, and see if then the next day floats just slightly higher, and leaves you without having to add so much extra carb

Scott Benner 8:55
to treat. And on the day that you get surprised by it and your basil is already in. You can kind of feed the basil a little bit for the day. Yeah, right and bred out and spread out carbs to cover the timeline. But so this is where you need to understand the difference between like a faster acting car but a more sustainable impact, right. And so if you're being drugged down constantly over hours and hours and hours, a couple of skittles might stop it for a minute. But the minute you bounce back up again, and this extra Basil is there that you don't need you're gonna get drugged back down again. So you need foods that are slower to digest. Right? You start you start reverse engineering your problems from diabetes and using your problems as solutions right like, right if you ate pizza that might take that might sit in your system for hours and hours and hours impact you so what a great opportunity to have pizza a little bit of pizza or what are

Jennifer Smith, CDE 9:54
pleading some proteins with some carbs. Right. You might want to treat if you're done hoping or lower already. If you do, then knowing what you just said, you want some sustaining power after that to not drop yet again, you could do something that incorporates some fat and protein in it to hold things level because again, the other consideration that if if it is a honeymoon based, like drop in blood sugar, it could be that anytime your blood sugar does nudge up from what you treated with simple sugar, it could be that your betas are also like, Oh, look at that. There's a rise in blood sugar. Let's give some help. And it doesn't really know that you've got Basal injected, that's also there.

Scott Benner 10:39
That's C you know, isn't that interesting that you brought that up? It didn't occur to me that I've always just thought of it is like you're getting help from your pancreas, but your pancreas seeds the carbs and attacks them while the insulin you've learned the manmade insulin you've put in is also drawing your blood sugar there. Oh, wow. So you have dumb insulin and smart insulin working at the same time.

Jennifer Smith, CDE 11:01
Correct. And common time for that in honeymoon is overnight for a lot of people actually, where they may have corrections that work pretty well in the daytime, despite them being really tiny, you know, miniscule amounts of correction. But I've got person after person that says I can't correct unless my blood sugar's 300 At night, because if I correct with just a minor half unit of insulin, I'm sitting at like a 60 blood sugar.

Scott Benner 11:30
In this reason we're newly diagnosed people.

Jennifer Smith, CDE 11:33
Correct. It's specifically more honeymooning. I mean, you can even see it on nights where blood sugar is going up. You don't correct the high blood sugar because you have the hindsight to know what's coming. Blood sugar could hit 202 20. And it downplays in your wake up in a beautiful number. That's, that's not injected Basal that did that. Your body helped you?

Scott Benner 11:57
Yeah. Okay. So that's one kind of low, you could experience now another one might be activity, right? I'm trying to think of I'm trying to put myself in a newly diagnosed person's situation, right? Like, they go back to their life, like I have diabetes, diabetes isn't gonna stop me. And then they go play tennis, and then their blood sugar falls really quickly. There we need fast working sugar, correct something that's gonna hit you very quickly, and stop this freefall. So if you're in a freefall, for whatever reason, you can't eat. That's not the time to have a slice of pizza.

Jennifer Smith, CDE 12:36
That's not the time to have peanut butter cups, the slice of pizza, the nacho meal breaks, not

Scott Benner 12:41
because that's because you're going to keep crashing before it has an opportunity to start digesting and to stop you. You're looking for simple sugars. I mean, in emergency situations, I know, I know, people don't seem to talk about glucose tablets anymore. Like they've become persona non grata, right. Because they taste achy,

Jennifer Smith, CDE 13:01
they're not the greatest. I mean, they are they are okay. I think the greatest thing about them for me personally, is that I am never going to over treat with glucose tablets. Right? I mean, they do their job. They're doing the job that I want them to do. But they're not like a bag of I don't know, licorice, like licorice. I like black licorice.

Scott Benner 13:23
So you might be like,

Jennifer Smith, CDE 13:25
easy to keep eating with a low blood sugar.

Scott Benner 13:27
Well, that is one interesting thing that there's a plus for for glucose tablets, you will you won't eat them for fun, that's for sure. No. Gel. I mean, I don't even know Do people carry that still, they should write it,

Jennifer Smith, CDE 13:40
we should and or it's easy, especially if somebody needs to help you. Because you can just get it into kind of the gum line and sort of massage it in it. It does work really quickly. So if you don't love the taste of glucose tablets, the glucose gels might work really great. There's a nice liquid glucose that I just heard about two that I really liked. Okay, so

Scott Benner 14:04
but, but in general juice boxes, people are gonna use Skittles gummy bears stuff like that. Right? Correct.

Jennifer Smith, CDE 14:11
Exactly. But the another good thing as you bring up glucose tablets, glucose, or dextrose is the simplest form of sugar, right? So your body doesn't have to go through this breakdown of the structure of of sugar if you will. And so it gets absorbed really fast. So if you're looking for candy specifically, you really want to look for candy that has glucose or dextrose as one of the first two or three ingredients because it's going to have the fastest impact on a low or a really quick drop that you want to stop.

Scott Benner 14:45
Yeah, the timing so super important because I know a story about a person. I won't say their name, but they're an adult. And diabetes for a long time felt themselves getting low knew it. ate a bunch of carbs passed out And then just turned back on when the carbs hit them. They were just like, hey, I'm back. And so so there's an it's an example of having the timing wrong. Like you're falling at a certain degree of speed or rate of speed. And you need that sugar to come in, and to slow like a parachute almost to parachute that that number fall down and to stop it, you know, what a nice level sponsor don't go too low. So things need to work the way you need. I mean, that really is the message of this episode, right? Like if you're one if you're 120, and you're wearing a CGM, and you see this gradual fall, and you look back over at 90 minutes going down, oh, geez, like I Bolus for this meal, it clearly looks like it's too much insulin, I'm going to get low a half an hour from now. Well, there, you could just add some more carbs to your meal or have a couple more bites. Correct, you might stop that. But if that same 120 was falling quickly, you're in a different scenario, you need to use different carbs,

Jennifer Smith, CDE 16:02
you need to use quicker, exactly the simple carbs on a quick drop. If you've got a gentle sort of glide down something that's a little more complex, like crack, you know, something like peanut butter crackers, I hear a lot kind of get used, because there's a little bit more to the cracker with the peanut butter added to it, right. So something like that could use it down. But if you're really, really dropping, then sugar,

Scott Benner 16:30
yeah. And you have to, in the beginning, it'll be hard not to over treat a low. But that is a skill you need to learn. Because otherwise, the bounce comes and then you're like, I don't know what to do. I wish you have that fear from you've just been low. You don't want to Bolus like you get caught in that, that balancing rhythm. You don't want to be in that. So maybe you'll learn at some point to look at your situation and say, half a juice box here. Or, you know, take a couple of sips just have two Skittles, you know, I say to people all the time, just because you open the bag, doesn't mean you have to eat all of them. Right? Yeah, just eat what you need.

Jennifer Smith, CDE 17:07
All right, which is also why those little tiny bags, I mean, this is a popular time of the year for a lot of people to end up stocking up on simple car, because we have Halloween coming up. Whether you celebrate it or not, it's a great time of the year to find really little packets of somewhere between eight and maybe 15 grams of carb, simple sugar, Candy really prepackaged. So the whole bag of Skittles versus the tiny little packet helps you to contain things a little more.

Scott Benner 17:40
And if you're not lucky enough to have a CGM in the moment and you're just leaning on your, your finger sticks. How frequently do you tell people to after they think after they've identified a low or felt it and treated it? How often do you stick your finger and look, I find myself. You know what I mean? I use a lot more test strips in that moment than you do sometimes for the whole week

Jennifer Smith, CDE 18:05
you do but you can expect that even simple sugars going to take a little bit of time for digestion, right? So you're really not going to see much shift. If you do a finger stick, confirm your low, treat the low and five minutes later you're doing another fingerstick you're probably not going to see much of a difference, right? So that's where old school was that 1515 rule. 15 grams, 15 minutes while you might not need or take 15 grams to treat this low that you have. Waiting about 15 minutes to retest will give you enough information to say well I treated it. It doesn't look like it's come up but it hasn't also fallen. So that should give you enough to say it's not dropping. Clearly, digestion is happening. Well, let's give it another 15 minutes and test again.

Scott Benner 18:56
Yeah, you know, I have two thoughts. So one of them I'm going to make a note about and then the other one I'm going to say if you are wearing a CGM. Sometimes it will not register as quickly so you can see like a like, Oh my God, my blood sugar is 50 You know what I mean? And you take a bunch of carbs and and then there's this way to look at the arrow with the Dexcom at least I don't know how it works with libre, you'll you're stopping a low blood sugar, let's just say it's 60. And it's the arrows diagonal down and you take some carbs in and the next reading is 55 and the arrows still down. And then all of a sudden, the arrow will like sometimes disappear. Like almost like the algorithms like I don't know what's happening right now. But the number stays the same. Or sometimes the number or the number will get lower, but the arrow changes. And do you know what I mean by that? Yeah. And so your

Jennifer Smith, CDE 19:56
whereas if you were testing in a look then it said 55 with an eight Build arrow down, you've treated it. And now you can see it has a horizontal arrow, but the number is reading like 51 or 50. And you're thinking, Well, what that really indicates is the system has found a stability, even though the number has slightly nudged down yet, it's not dropping, what you've done is actually making some impact overall. So it's not really time to treat with yet another like whole box of juice.

Scott Benner 20:30
It's so weird. It's a weird moment because the CGM is a little behind. And what you did with the carbs is maybe more in the now, but you can't see it. And so there's like, there's like multiple things happening at once that the technology has, has difficulty showing you. But you can see that something's happening. And so that's when that's when I say to myself, Okay, now this thing looks stable. And we've gotten to, you know, readings in a row that say 50. But I want to know what's really going on, because either the CGM seems confused, and I didn't do well. And we're lower than we think. Or we're higher than we think. And I don't want to treat more, that's the perfect time to do a finger stick to me absolutely have to write

Jennifer Smith, CDE 21:14
Absolutely, especially for those. Those numbers where you're treating I say at a number less than 60. Honestly, if you're varying at all and decision about whether I should do a finger stick or not. If you're less than 60, and you've treated it and the numbers on the CGM just don't necessarily add up. Or you're mentally not quite like with it enough with a low blood sugar like that. Just do a confirmatory finger stick, because at least that's going to show you real time right now. Where is your number? Yeah,

Scott Benner 21:53
yeah. And I know we're trying not to over treat. But if you get caught and you don't know, like, this is the time you're going to hear me say I'd rather I'd rather just Hi. Yeah. Because Because what you're saving yourself from or saving another person from. We don't talk about very much like in diabetes in general, even on the podcast very much like it just doesn't get talked about very much. You're talking about becoming incapacitated. You're talking about having a seizure. You're talking about death, like you're talking about. There's a lot that happens between 40 and then I don't know how low anybody's ever been right. You know, but while they were still alive, I saw Arden's blood sugar. I saw Arden's blood sugar 22 once on a finger stick when she was really little, and she was okay still. And I was just like, keep eating, eat. Yeah, II keep going. And then all of a sudden, it was 30. And I was like, Oh, I might have tested moving, I might have tested her blood sugar 10 times in seven minutes. I was like, but But I mean, it's the truth, right? Like you, you have to learn to do this because you use manmade insulin and your blood sugar is going to get low. I just don't care who you are, it's gonna happen. So you need to know how to handle it or how to handle it for somebody else. And you need to know how to handle it without causing a problem in the future. Whether that problem is a high blood sugar, or calling an ambulance, like right, you're it's not. I guess we don't talk. It sounds scary. It's probably why people don't talk about it, huh? Yeah, yeah. So

Jennifer Smith, CDE 23:27
it's absolutely it's it's more around how to treat. There's not even an emphasis on like the overtreatment. It's just treat it. But why, right? Why is it so important to recognize a low sooner than later or deal with it sooner than later? Or stop it from happening? sooner than later? Because there is that scary factor of? I don't know. I don't know why some people can have a blood sugar. I might the lowest I was ever was 26. Yeah, I don't, I was fine. My mom actually thought the number had to be bad. I mean, it was really old. I mean, this was like 1988. So clearly, the meters were not what they are today. But she's like, that's got to be wrong. You feel good, right? We were camping. Did it again, it was like it was pretty much the same. Just like you need to eat. Here's the juice. Where's it? Where's the regular soda? You know, why could I be there? And fine when somebody else could be passed out, have a seizure, need an ambulance need assistance? When their blood sugar is 61 and low. Right? Right.

Scott Benner 24:36
Yeah, everybody's going to be different. And so so let me let me say a couple things here. I use a football analogy because it's football season, right? You can't like the reason the offensive linemen are these giant blobs of people is because they're trying to stop this insane force that's coming at them. Right? Correct. You can sometimes put carbs in and you I made such a mistake earlier in the day with insulin or, you know, there's just so much power on the side of the insulin. It's like the carbs aren't there, like you might as well not have anybody blocking because it runs right through them. Right? That's a panicky situation, the first time that happens to you, where you take in a juice box, and realize that it's, it's like you didn't drink it. If you're enjoying the Juicebox Podcast, and you would like it to remain free. Please support the sponsors. Today's sponsors are Dexcom G six dexcom.com, forward slash juice box, and Omni pod. Both the Omni pod five and the Omni pod dash are available at Omni pod.com. Forward slash juicebox. It's a hard moment, you know what I mean? Because this is what you know is going to work. And now suddenly, it's not working for some reason. And you're like, Oh, God, what do I do? You can't find yourself in those scenarios. Wondering what's in the cabinets? Or what's in my bag? Or what do we have in the car, like you have to be prepared? Correct all the time. Just, you know, anywhere you are. There are fast acting carbs. I don't give a crap. If you don't use them for six months. I don't care if they get stale, throw them out and replace them. If the juice, you know, in the juice box, get some spongy from being in the car in the heat. Throw it away, put another one in there. Like just don't. Don't ever find yourself in a situation where you're like, it'll be okay.

Jennifer Smith, CDE 26:30
Right? Yeah, right. I mean, It's fall now. and I were just like rotating through. We don't really have summer jackets, but like into fall into the winter jackets, we're kind of rotating them into the mix, right? So I bring up my winter stuff. And absolutely in at least like one, if not two of my like fall into winter jackets. Their old, nasty bad glucose tablets, like they've gotten the like crystallized sugar like dots. And like, if I had to, I would still use this. So like that juice box that's like nasty and squishy. If that's all you got, you use the squishy juice that

Scott Benner 27:09
spread them around your life, like your grandma's spreads around her reading glasses, do you know what I mean? There's just a pair in this room and over here, you need to be less ready, you can't be it's a weird scenario, you can't be scared, you can't live your life scared. You don't want to live your life with a 200 blood sugar because you don't want this to happen. Because also, that's not any safety from not being low. Right? As a matter of fact, that might put you in a situation where you're a little more frequently, but but I like to say about diabetes, that you don't learn these things. You don't prepare for these things so that you can stop a problem. The problem is always going to sneak through somewhere, it's never going to be where you think it's you know, because if it was where you think then you'd get ahead of it. Right. So you have to be ready for when it happens. And then the last bit of this is, if all else fails. I mean, please be carrying glucagon, you know, with you like not, it's in the cabinet in the kitchen. But we don't take it, you know, anywhere I left it in the car when I went pumpkin picking like it needs to be with you. Right. Yeah, exactly. So well, this is a fun conversation.

Jennifer Smith, CDE 28:14
Yeah, it's a harder, I think it's a harder conversation than you think about before. Because there's a lot of there's a lot more on the back end of not taking care of a low well enough. That is actually scary. Yeah, and it doesn't get talked about. We always try to like smooth it out like not to worry about it so much and whatnot. But in order to not really worry about it. Preparation is needed to have to have things in your purse or your car or your backpack or, you know, at your friend's your friend's house that you go to all the time or whatever it is. I guess it's like being a girl scout or a Boy Scout. Be prepared how

Scott Benner 28:57
to be prepared. Yeah. You know, when Artem was younger, she spent her whole day in one classroom, right where she went to art or something like that. So she had a bag and she took it with her when she hit middle school in high school, and she started having English in one room and math in another room and that started happening. We put supplies in each room. Like we didn't say to ourselves like she should be humping this stuff all over the place constantly. Let's put a little here there was a couple of juice boxes in every room. You know, it's interesting when you learn about your management to how come we're always restocking the English class. And never the math class. What's the time Yeah, it's the time of day we're doing something that's making a low around this time of day. It's actually an interesting way to learn a little bit about your management is where am I grabbing my supplies from? You know, do you think that do you think that every load is different? Because there's there are questions here from people that are like you know, after I stop a load with a fast acting, should I put a protein in every time time afterwards, but not necessarily.

Jennifer Smith, CDE 30:02
Yeah, no, I mean, the idea. Again, it's kind of an older concept. It's sort of like the 1515 rule, it's 15 grams, 15 minutes, and then you essentially may need to follow that up with a snack. But again, there's lack of enough information about why the idea really was simple carb will typically help keep your blood sugar up for about 90 minutes, give or take. Now, again, a variable in the picture is why was the low there, if it's excess insulin, you may actually need to treat with more than what you thought you would need. But the other idea is that the simple carb to keep your blood sugar up is it's meant to sustain you for that time period, before you might eat again. So if you treat a low blood sugar at, let's call it three o'clock in the afternoon, but you don't typically eat dinner until seven or eight o'clock at night. Lows can bring on another low they can. So if you treat the low, but there's something in the picture that's keeping you lower, could be honeymoon, it could be excess insulin, it could be more movement in the day, whatever. You may actually for longer than two hours before your next meal, it may be beneficial to have a handful of nuts a spoonful of peanut butter a piece of string cheese boiled egg, whatever it may be. The the idea there is that that's a little bit more sustaining and or a snack that might have a little bit more complex carbs to it long with some protein to sustain things. So you're right every low is not the same right?

Scott Benner 31:44
Art in tried art is a college right now. She tried to use a following blood sugar as a Pre-Bolus for her lunch. But it just didn't like she didn't time it well enough. So like at 60. But so listen, for anybody who's listening. Here's how I did it. Arden's in another state, she's 13 hours away. I'm able to look at her phone and see where it is. Right. So I use Find My Phone to see. Okay, she's in the cafeteria, so at least I know she's right. So now where she should be near food. I text her, Hey, what are we doing about this? Because she's got this like 70 that became 65 pretty quick. And then I looked at the arrow. And then I looked at the line and I thought this isn't stopping. Like this is not a low that's going to stop right like this is this is going to be negative 15 If we don't do something about it, right. What are you doing? I'm trying to like Miss like, you don't I mean, I don't want to be up harass Johnny. And at the same time, I don't need her dropping dead. It's College. Like I'm trying to find the middle. I'm like, Hey, what's up at nothing. Now I know she's with the food. So I'm like, you see this? Nothing. Art and I really need to know you're okay. I'm eating now. I'm like, okay, like the food's going in your mouth. Yes. But Jenny 6060 560-560-5550 5540. I'm like, Are you eating now? Yes, I'm eating. I told you. I was eating

Jennifer Smith, CDE 33:12
what are you eating lettuce leaves?

Scott Benner 33:17
What's happening? Like, you're eating like handfuls of sugar, right? Like, and so, but so I texted or test her. So then I sent a text to test her cognitive, like where she was cognitively. Right. And I'm just like, how do you feel? And she's like, I feel fine. And I'm like, Okay, have you been eating for a while? She said yes. So I said, Okay, I got it. There's food in there. It's working. The CGM hasn't caught up yet, but I had to stand there. for like three go rounds. That CGM watching that 42 Just sit there knowing she's not really 42. She's in the mid 60s already. I know. I know this. But I only know this from

Jennifer Smith, CDE 33:59
you. Because you've lived with her. You've dealt with it long enough. You knew the questions to ask. You knew how to get her to respond and whether or not she was going to answer you the right way. And that it takes learning

Scott Benner 34:12
Oh, it's yours. Because otherwise I would have been like drinking juice. I don't care if you don't drink the juice. I'm bringing you home. I'm not paying for college. Like I don't you know, like, you know, because the number because we've done everything's over come home and live in this room for the rest of your life. Because the because the number was so scary, right? But I was able to pick together enough information. I swear to God, that CGM. One more time went from 42 to 66. And I was like, Okay, I was right. But I'll tell you, you're like, oh my god, what if I'm wrong? You know what I mean? Like, I don't want to be wrong, but I might be the next thing I think we should bring up about Lowe's. Because we're in a we're in an algorithm world now right control like you on the pod five that thing that Medtronic makes i What is it? Which one is that? Let me learn the number Medtronic, don't they have an algorithm right now?

Jennifer Smith, CDE 35:03
They do. They've I mean, they've had an algorithm for a long time I use as a their CGM. Right. And I don't know that their, to their algorithm have a name likes me pod five, six. So their new their new one in the ISC. The number is what you're looking for 770 G. And I know someplace I don't know if it's here. I don't think it's here yet. 780 G, I know is available in some places in Europe already. But seven, seven D 780. Yes,

Scott Benner 35:34
I just I feel like they buy they buy ads for in pen. So I figure I, I owe it to them to learn the name. I just can't keep saying the thing that Medtronic has they're gonna be like, How about how about if you're not the podcast that we sell the embed on anymore? Like? Alright, so the 770 G, right. So yeah, so whether it's one of those algorithms, we all live in a new space now, where the algorithm sees a low coming, and it takes away and takes away and takes away your basil and takes it away. But it doesn't, it isn't always going to get it right. And so you might end up treating a low after a prolonged amount of time of not having any insulin. And then your blood sugar shoots back up very quickly, because there's nothing to stop it. And what does the algorithm do when it sees the higher number gives you more, it gives you more insulin, sometimes sometimes can happen. That's what I'm saying. It can happen that's a better way to and when that happens, here's what I know, for certain, yeah, gonna be low again later. Because because, you know, the, you know, when you're taking, you know, sugar in for a low, if you take in the right amount, you've been getting on a regular, you know, on a regular pump or on an MDI, you've still been getting your Basal the whole time. So you're, you're correcting that low more in real time. When you do it right algorithm, the algorithm thought it was going to stop you, it does not expect these carbs. And now you jump up and it Bolus is the number or it's pushing basil at the number that the other night. I guess I should have listed lupus one of those Arden had Jenny, I think it was around her period, and she was tired. She's rundown. And she's getting her period. At the same time, we had this whole day where she was a little too low. And it persisted into overnight. And so around eight or nine o'clock, we fixed the low and I said listen, take these carbs, go into the settings and shut off micro bolusing without carbs. I was like where this thing is gonna hit your your correction. And it's gonna push it back again. And she did that we went through the night really nicely. It was a nice learning experience for her because then she brought it up the next day. She's like, should I put the microbuses back on again? And I was like, Yeah, everything looks good now. So but anyway, you have to be aware of that. So I mean, I don't know what you do. Me.

Jennifer Smith, CDE 37:53
I mean, there are other you know, for other systems, you can certainly also navigate something like that. If you've treated a low, you know that you've overtreated it, but the system is going to give back eventually, and you know that it's going to be too heavy, similar to your scenario there. The other systems do have, I guess, adjustable targets or different targets that would be higher. So then it would adjust less, if you adjust the target up and say, Hey, I'm aiming for this now. So as my blood sugar is going up, it's okay. You don't have to give me as much because I want to be higher

Scott Benner 38:30
anyway. So like an example with Omnipod five, you might tell it to shoot for the higher range and that's correct. And yes, with I'll tell you what, in that exact scenario with Arden I said, I asked her what did you take for the low? And she's like, Oh, I had gummy bears. They hit her really hard. So I was like, Oh, crap, she's gonna jump straight up. But they don't hit her and hold her. They hit her and then they disappeared on her. So I was like, oh, no, no, don't let that thing Bolus again. Yeah, anyway, this probably all sounds much more confusing than it will be you have diabetes for a few months. It's all gonna make sense. Don't

Jennifer Smith, CDE 39:05
maybe know they will. Yeah. There's still some things I throw my hands up. And I'm like, oh, clearly, like Venus is not in the right place in the orbit of something because I I just I don't know right now.

Scott Benner 39:21
You're maybe just said Good. Luck is what I heard.

Jennifer Smith, CDE 39:25
That is so not the case. Not the beginning of this is what you want to hear. Yes. Forget the maybe. I shouldn't say maybe should be like the point 1% of the time. You know, it doesn't take much to learn, especially with CGM is in the mix. These days. It doesn't take much to learn how much is needed. And as you were sort of, you know, talking into the effective algorithms, you'll see, well, gosh, I was used to using this much. I probably need to use a quarter to a third of what I used to use to treat it when I didn't have system that was helping me You know,

Scott Benner 40:01
I saw a woman yesterday say, I don't know the exact numbers, but the gist of it was on control IQ I needed 14 or 15, carbs stop below and on Omnipod five, I don't need four or five carbs to stop below. So interesting that interesting. I found that incredibly interesting actually. So

Jennifer Smith, CDE 40:16
especially system to system, given the fact that they're both doing a given take of insulin, but they are, they are very different algorithms. Yeah. So that it does make sense.

Scott Benner 40:27
Alright, so check me on this. You need to know how to stop a low they're going to happen. You're not going to stop a low from ever happening. You need to understand the different impacts that these different carbs are going to have on your low blood sugars. After a while teaching yourself to stop a low without creating a high is a great tool to have. Yes,

Jennifer Smith, CDE 40:46
if you it will happen. Yeah, yeah.

Scott Benner 40:49
Oh no, you're gonna rebound high until you until you learn how to do it in a real panic situation. Screw everything else save your life. Correct. And that's it right? Have glucagon with you have snacks with you. Don't go anywhere without ways to treat Lowe's, the people who love you and are around you should understand how to help you if you're unconscious or unable to help yourself.

Jennifer Smith, CDE 41:13
And I think another thing as you mentioned, caregivers or loved ones or you know, whoever. I think within that for Lowe's is recognizing the like what you mentioned about cognitive when you're doing kind of a check with Arden the people that are around you enough, should be able to tell whether you're responding or or talking or whatnot, the way that you normally would. And in the case that your CGM is off, or you aren't using a CGM or technology, somebody who knows you well should be able to kind of chime in and say, Hey, are you okay? You know, and don't be angry at them for that. It's just a, it's a checkpoint to be able to keep you safe. So

Scott Benner 42:02
yeah, also for I guess, caregivers, low blood sugars could leave you with people who are difficult to YES to help, right? They could become combative, or and that's a real concern, especially as they become adults. And I There's one story that sticks out in my head all the time of this woman whose husband got low, and she just wasn't big enough to overwhelm him to do what he needed, you know. And she had to call 911 because of that. But yeah, I mean, the people around you just need to know. And people should be following you. If you have CGM. Like I don't know if liberi has follow like Dexcom does, but yeah, it does it. Okay. Arden is in a suite with girls. And the girl in the next room follows her on Dexcom Oh, wow, that's awesome. He only has a 55 alarm and nothing else. But we explained to her I'm like, if this thing's beeping, please go find Arden. And make sure she's okay. That's all. Yep. And it just, I don't know, especially for adults living by themselves or kids off at college, like somebody, you know, has your back because it also not everybody hears the alarms to like I had a low last night. It was only like 65. But I was sleeping. And in my sleep. I thought did I hear something? Like that was all I thought, right? And then I'm like, I woke up and I looked, and I was like, huh, yeah, I'm gonna watch that for a second. Because to be honest with you, it was a real slow drift. The loop had been taken basil away. I'm like, I think this is gonna bounce. Like, I think it's okay. I don't want to wake her if it's not going to be okay. And it waited and waited and waited. And then I was like, Oh, it is gonna be okay. It went back up again. But I talked to her this morning. And I was like, you know, you're a little last night. She has no idea. But since she had that seizure more recently, if you listen to her last episode, she will tell you about it. If she has a she experiences any kind of a quick fall while she's sleeping now. I don't know. I don't know how that rewired her brain but she's boom. I'm up. I drank juice. I'm good. Hey, Dad. I did this. Do you think this is enough? Like she never used to wake up. And now I know she's feeling the fall while she's sleeping right now. Which has only happened twice since she's been away. But anyway. Alright, Jenny. Did we know it? We did it? I think so. Yeah. Yeah. For us then. Yay for us.

Unknown Speaker 44:24
Awesome. Thank you. Oh,

Scott Benner 44:25
I guess we should say something like thank you for listening to the bold beginning series and I hope you found it like helpful.

Jennifer Smith, CDE 44:31
Absolutely. Especially in the beginning when everything is so new. So

Scott Benner 44:35
let us know if you want us to add to this series. If you go back and listen to it and find something that should have been in there that wasn't please send me a note. And Jenny and I will we'll add it if we think it needs to be added. Absolutely. Thank you. What are we doing? What are we best here so I

Jennifer Smith, CDE 44:53
got nothing else to know right? But just hang around

Scott Benner 45:02
Well, as I mentioned at the beginning, we've already found more stuff for bowl beginning. So this was not the last episode. Let me thank Omni pod and Dexcom. While I have your attention on the pod.com forward slash juice box, see if you're eligible for a free 30 day trial of the Omni pod dash, or if you're interested in the Omnipod, five, for full safety, risk information and free trial terms and conditions, you can also visit omnipod.com forward slash juicebox. And of course, thank you to Dexcom for being a longtime sponsor to the podcast dexcom.com forward slash juice box see blood sugar in real time, the speed direction and the number right there on your iPhone, Android, or on your Dexcom receiver. There's so much more I want to tell you but I'm on about day seven of this illness that I have and to be perfectly honest, editing the show together almost killed me. So I'm gonna go take nappy, and I'll see you next week with another episode of The Juicebox Podcast.

Test your knowledge of episode 780

1. What is the significance of blood sugar monitoring before exercise?

• It helps in preventing hypo- and hyperglycemia
• It has no impact
• It should be avoided
• It is only relevant for type 2 diabetes

2. How does physical activity affect insulin sensitivity?

• It decreases insulin sensitivity
• It has no effect
• It increases insulin sensitivity
• It should be avoided

3. What should be done if blood sugar levels drop during exercise?

• Stop exercising and consume fast-acting carbs
• Ignore it and continue exercising
• Increase insulin dosage
• Drink water

4. Why is it important to adjust insulin doses based on the type and duration of exercise?

• To maintain stable blood sugar levels
• To avoid taking insulin
• To increase blood sugar levels
• It is not important

5. What types of exercise are beneficial for people with diabetes?

• Only aerobic exercises
• Only anaerobic exercises
• Both aerobic and anaerobic exercises
• No exercises are beneficial

6. How often should a person with diabetes exercise to see benefits?

• Once a month
• Once a week
• Regularly, several times a week
• Every day, without rest

7. What should be considered when planning an exercise routine for a person with diabetes?

• The type and intensity of exercise
• The duration of exercise
• Blood sugar levels before, during, and after exercise
• All of the above

8. How does regular exercise contribute to diabetes management?

• It helps maintain stable blood sugar levels
• It has no impact
• It should be avoided
• It complicates diabetes management

Submit

Change Answers

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#776 Bold Beginnings: Technology and Medical Supplies

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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+ Click for EPISODE TRANSCRIPT

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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 776 of the Juicebox Podcast.

Jenny Smith and I are back with the bold beginning series. As a matter of fact, this is the next to last episode in bold beginnings. And today Jenny and I are going to be talking about technology and diabetes supplies. Don't forget if you're enjoying Jenny, she works at integrated diabetes.com And she is for hire. If you need help with your insulin management, I'd like you to 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 or becoming bold with insulin. If you're a US resident who has type one, or is the caregiver of someone with type one and you'd like to help out with diabetes research without actually having to do anything like not off your couch, you know what I mean? T one D exchange.org forward slash juicebox. When you complete their survey, you're helping people living with type one diabetes, T one D exchange.org. Forward slash juice box. At the very end of this episode, I'll list all of the bold beginnings episodes for you. So in case you haven't found them, you'll know where to look.

This episode of The Juicebox Podcast is sponsored by the Omni pod five. It's time for you to try the only tubeless automated insulin delivery system that integrates with the Dexcom G six, try the Omni pod five. All you have to do to get started is head to my link Omni pod.com forward slash juice box. There you'll see a photo of me which I imagine you'll want to scroll past quickly. And then we'll get right to the information. On the pod five is here it says the first and only tubeless automated insulin delivery system. Everything you need to know about it, including how to get started is right here. All you have to do is click that little link says talk to an omni pod specialist when you're there, and you're on your way, get the process moving, get yourself going with the Omni pod five. It's not hard to get going. You could do it right now in just a few minutes on the pod.com forward slash juice box. And if you're not looking for the Omni pod five, but you want a tubeless insulin pump, check into the Omni pod dash because you may be eligible for a free 30 day trial of the Omni pod Dash. And again, you'll find that out at Omni pod.com forward slash juice box when you complete the process with my link, you are supporting the Juicebox Podcast and for that I want to say thank you. The podcast is also sponsored today by Dexcom, makers of the Dexcom G six continuous glucose monitor. My daughter wears the Dexcom G six continuous glucose monitor and it saves us every day. Dexcom allows remote monitoring that lets users choose to share glucose data with up to 10 followers. Of course you're getting that famous Dexcom accuracy and performance, seamless integration with Dex comms expanding connected CGM ecosystem. And real time glucose readings sent automatically to the users compatible device that can be an iPhone, that could be an Android, it could be your Dexcom receiver. See your blood sugar in real time including the direction and speed of the number without finger sticks calibration or having to scan anything dexcom.com forward slash juicebox. For full on the pod safety, risk information and free trial terms and conditions, please visit on the pod.com forward slash juice box. There are links the Omni pod Dexcom and all the sponsors in the show notes of the audio player you're listening in right now. And at juicebox podcast.com. If you're going to check out on the potter Dexcom please use my links. Thank you so much. Here comes Jenny

Jennifer, we are up to technology and diabetes supplies in the bowl in the bowl beginning series on this is voluminous is

Jennifer Smith, CDE 4:23
a very broad topic.

Scott Benner 4:25
Yes it is. But there's a lot of feedback here from people. So I'm just gonna go through it in order. All right. This first person says this is very specific get a Dexcom that was the entirety of their of their thoughts. The next person says I wished I could have left the hospital with a Dexcom. But we did get it 10 days later. All right. I think advocating for a pump and CGM right away if that's what you choose. It's interesting. We always I don't know that there's something about polite I don't know, gently this is the wrong place for this, if that's what you choose, I just assume that's inferred like that. But I guess everybody's worried that people feel like they're telling each other what to do anyway. Correct? Yeah, correct. Yeah, yeah. I'm not telling anyone what to do. And if your insurance doesn't cover it, if you can't afford it, I'm sorry. Like, I'm certainly not trying to make you feel bad about that as we go through this. advocating for yourself as important as what I got from this person. This person that goes on to say, luckily, our endo was amazing and did that for us. So we had a libre before leaving the hospital. Nice,

Jennifer Smith, CDE 5:35
good, which I've actually heard. I would say more frequently, in the past two years. Interestingly, the more newly diagnosed that I've had a chance to work with a more than a handful of them have left the hospital either with a prescription for it, or knowledge that they had already gotten a message that it was approved and on its way, or they left the hospital with it.

Scott Benner 5:58
Okay. Yeah, I hear the same stories. It's, I think it's fascinating. And I reject the old thinking that you need to live with diabetes and let it beat the crap out of you for a while before you get technology. I just don't. I don't think that's accurate. I know people like well, what do you do if you don't have it? And I say, well, then learn it, then. Then

Jennifer Smith, CDE 6:18
learn it then. Right. Yeah. I think the first comment, but quite honestly, as I tell a lot of people, if you're going to choose technology, get a CGM. Yeah, I mean, literally, that's the bottom line of any technology. Sure, you're gonna have a glucometer? I mean, I have not heard of anybody who has left any office without a prescription for a glucometer. But for the ups and the downs and following, you know, and or any journaling, right that you might do. You You need a CGM of any technology out there yet. One. No, I

Scott Benner 6:57
agree. The next statement here is I wish they would have given me a CGM right away and not made us wait for it. Yeah, I will bring up here that if your practice says saying things like, Oh, we don't give people pumps for six months or a year, you're not allowed to have a CGM till some arbitrary date in the future. Just please know, that's an arbitrary statement. Absolutely. There's not a rule of diabetes or rule of safety or anything like that, if you're ready for it, you can afford it, your insurance covers it, there's no reason you can't have it right away. And please don't let a doctor's office tell you otherwise. Right. I've, I've seen people, circumvent their doctor, go to the company and say, I want this and they send a request for a prescription back to the doctor's office, who often just signs or signs it and sends it back, you know, right. So they'll tell you to your face? No, six months? Why six months? That's how we do it not a good answer for anything, that's how we do it is a bad answer. And then they'll just sign it when it comes to the office.

Jennifer Smith, CDE 7:58
And I think the unfortunate thing about that bad answer of that's just the way we do it, or we have to wait six months, there should be explanation behind that, it. To be clear, it's not just a random response, there protocol goes a little bit deeper, especially for newly diagnosed to make sure that there is a certain amount of insulin, that actually does work better, once you reach a specific amount of total daily insulin. Most often pumps of any kind, whether it's with an algorithm, or just conventional kind of pump will typically give you better results with a certain amount of insulin that you use. So if you are in that early phase of six months, using very, very little insulin, and the doctor is like, Nope, it has to be at six months, well, what if at nine months, you're using still a really tiny amount of insulin, then it's no more appropriate than it was at two months in. Right. So I think there needs to be better explanation to that, quote, unquote, six month rule if there is one. And also, to go into that, you shall also shouldn't have to prove yourself to be able to get a pump. If you are actually utilizing enough insulin. And you're trying as hard as you can. You shouldn't have to perfect what you're doing to get the use of a pump. The use of a pump should actually help you to perfect things more.

Scott Benner 9:28
Because I said so not a good answer. And the idea of like six months, as an example, is probably just what the the average of what the doctor expects, in your example where they're probably just guarding against a honeymoon situation where you don't need very much insulin to begin with. And a pump won't work for you. But it would be nice to have that explanation. Correct. Not just be told. There's this arbitrary date come back on this day and it'll be and by the way, when you come back in six months, and they start the process then it sometimes can take months. After that to finish the process so correct. Why don't we get this going now and you know, be ready, I listened the next bunch, a friend told us not to leave without a CGM. The best advice I ever got, I didn't have a Dexcom for three months would have made a big difference. Advocate for yourself, advocate for yourself, the more you know, and show the Endo, the faster they approved devices. So this is you just said it shouldn't be this way. And I agree with you. But it doesn't make it not true. That you are a little in there. proving yourself, you don't even interact. And that's that's tough, because I get the doctors might not know you, and they might not understand your ability to understand things. And they're judging everybody. But I mean, listen, I treat it like a first date. That I mean, let's go in there. Keep my smile up. keep my back straight. I'm not a lunatic who will kill anybody with a CGM or insulin pump. Please give me one. Thank you.

Jennifer Smith, CDE 11:00
Exactly, yeah. Well, and I think it also brings in, you know, a bit of treating somebody almost as if they're an idiot. Honestly, if you tell them well, you can't have it until this certain, like, arbitrary time, based on I'm so and so with the white coat on. And I just know about her, you're kind of making the person who's coming in and actually living this minute to minute 24/7. At home, you're making them feel dumb, when in fact, they're the ones with the amount of data that could prove that they could benefit from something if you just kind of listen to them.

Scott Benner 11:39
Just that the listen and have an actual back and forth conversation. And you're done. This person here, begged their way into two months of Dexcom samples at the hospital. That's impressive, Madam or sir, whoever did that? Well, that's impressive. Yeah. Okay, let's skip past all the ones that say Don't leave without a Dexcom advocate for tech. It's interesting. I also wanted, I would have loved to know about the eye port so great is because that would have been so much easier on my boy versus sticking him so many times. So I port Medtronic owns that right? Yeah, trogons iport. It's this little, it's it. It's like this little disc, right? It adheres to your body. And then this will get Jenny's looking at me like Go ahead, buddy. See if you get this right. And then your your. So there's a cannula in it is my expectation. Yeah. And then the syringe goes into the port, and you inject without having to poke the skin over and over again. Correct. The

Jennifer Smith, CDE 12:39
eye port is a really nice, I think for for a number of different reasons. One early on, can reduce, it can reduce the amount of injections all over the body, it can get somebody on a second note, a little bit more comfortable with actually a pump site, if that's the way that you eventually want to move, and many people do. And especially for little kids who can be more prone to picking and pulling things off. It's exactly as you described it, it's almost for those who are already pump users. It's like an infusion site for like Medtronic or tandem pumps. And it has a straight in 90 degree cannula that just pops under the skin. And that leaves a hole essentially, or a tunnel in which you put your syringe right in and you deliver your insulin dose basil, or rapid acting insulin into that site. And the nice thing is that you can leave it on for several days, just like a pump site. And so you can put your injected insulin right into that place over the course of a couple of days. So absolutely. It's a wonderful, I think, really really underused tool. Add an apt sort of initial diagnosis.

Scott Benner 14:01
Okay, next person. This is long, I wish we would have gotten a pump sooner. Oh gosh, them three years. I wish someone had put in a script for a libre for us before they gave us a Dexcom Okay, here you go is the person who would prefer Libra in those first few weeks after diagnosis? Were some of the scariest of my life. And a libre. Oh, I'm getting this now a libre would have allowed me some sleep. So I think Libra is cheaper. I think so they're saying I could have been no disrespect to libre, but I think what they're saying is if I couldn't have got a Dexcom at least I could have gotten a libre. It's something that I could have scanned and looked at once in a while. I was so worried that something terrible would have happened during the night and I'd never know about it since our room was on the opposite side of the house. A reminder that people have done this for years was nice. With only a glucometer so please remind people that too, okay, I will hold on last second. And sometimes lack of tech can be crippling, even though things will likely be just fine. She makes some good points in there. And I do say that to people, especially when they talk about like the warmup time for their CGM or something. I was like, you know,

Jennifer Smith, CDE 15:15
do a finger stick? Yeah,

Scott Benner 15:16
you just, it's not that hard. What are we gonna do? And I was like, you could use your meter. And

Jennifer Smith, CDE 15:23
that thing over there as for and I do I mean, we're not laughing to the point that I understand. You know, little kids or, or people who are, you know, worried or frightful of that type of I get it. I get all the worries. But honestly, if you can get over a five second screaming because you want information, at least you're calm now because you know where things are. Right, so just do the finger stick.

Scott Benner 15:55
Yeah, I agree. I wasn't laughing at people. I was like, You're phrasing so far, you've made me laugh to myself twice once it came out that was there. And earlier when you change into your doctor's voice, it reminded me of one of the claymation Santa Claus shows. Like Rudolph kind of one. Yes, yes. When one of the characters pretends to be another character, and they go into a deeper voice. I was like Jenny definitely grew up watching those claymation shows. Oh,

Jennifer Smith, CDE 16:24
absolutely. I did I make my kids watch them. I don't know if they enjoy them. But I make them watch them because I grew

Scott Benner 16:29
up. I agree. So okay. That's funny. I

Jennifer Smith, CDE 16:33
didn't know I had a doctor voice. Yeah, you,

Scott Benner 16:35
you went into like you even like you like, you straight up your shoulders, and everything was fantastic. Okay,

Jennifer Smith, CDE 16:42
I, this one's I don't have a white coat on, though.

Scott Benner 16:45
No. But you could gently I'd give you a give you a degree before some of the people I've met that are dark. Ah, this one's going to be interesting because you see the mindset of this person. But I could make the exact opposite argument. So they said I advise people to push for CGM, but don't be too anxious for a pump. And they do say I'm sure opinions vary on this. But we're still MDI after 11 months, and it has taken us some time to learn how to Bolus how basil impacts and how to monitor the ups and downs. While a pump may take a lot of the workout, I feel like learning MDI in advance is valuable, sort of like learning math by hand before using a calculator because at some point, if you go off a pump, you'll need to know how to do MDI. Now, it's not I don't disagree. But I don't understand. I don't know if that feels conflicting. I don't disagree that it would be great to know how to manage to MDI. But if you know how to use a pump, you can reverse an MDI and two seconds, you can reverse engineer it, you can't reverse engineer MDI to pumping. Does that make sense? Or am I wrong about that?

Jennifer Smith, CDE 17:57
I don't think you're wrong. But I think that you have you have a broader perspective on insulin than this person manipulation. I guess that's that's the best way to say it. Because I actually am more the I'm more agree with the person. I think oftentimes, there are many people who get a pump before they have figured out insulin use on MDI. And there's there is value to it, whether it takes you three weeks or six months to figure that out. It timeframe is based on what you have, I guess, done the homework to understand. So a pump could be beneficial at any point doesn't have to take this long or the short of time. But I think MDI makes a good point here that if you do have to go back to MDI, after being on a pump, and you have knowledge of what you did, for how at least your life was at the point of using MDI, then you have a base to start at. So I, you know, I think it's, again, person to person. I also think with technology and stuff today. We're using a conventional pump before starting out on an algorithm driven pump is very, very valuable. Because I mean, we all know technology will fail. At some point, your tech will not work the way that you want it to work. You have to have someplace to step back to. And if you don't know what to do outside of what the algorithm has been doing for you, you're at a loss. Yeah,

Scott Benner 19:40
I just sent a text to Arden to help her understand her algorithm. She's looping and I texted her end up end of your Let me see how I put it. So this is me trying to teach her something I said old pump site algorithm needs some help from you. And I don't know what she'll take from that or not take from that. But what I see is that the loop is micro Bolus thing like crazy and, and not getting what it wants. And so she either needs to change the site now, or make a larger Bolus if she wants this to actually go her way. And I don't see how I'll see your point. And here's what I'm taking from all this. You should not just flat out listen to anything you hear from anybody, whether it's me or Jenny or anybody else, just because and you go online where people say things like, definitely do MDI first. And then you hear that and go, Okay, that's a rule. Or, or I say, you don't have to do MDI, firstly, go, oh, the guy on the podcast said, you don't have to do that. That's not how this goes, you have to figure out like, this is MDI, I'm going to shoot some insulin, I'm going to have to give more. This is what it is. Do I want to do that? Do I want to do this? Like, who am I in this situation? And that's hard to figure out? I guess. So. I guess listen.

Jennifer Smith, CDE 21:01
And also, I mean, readiness there, too. You know, we're talking with a lot of people who have kids in the picture, right? There are there are many kids who aren't, they're just not ready for all of that stuff on their body. Yeah, they're just not. And you as a parent may be ready for it for some of the precision that you think it's going to bring into the picture. But if your child isn't there yet, it may bring in a ton more frustration,

Scott Benner 21:31
right? It's not Harlan, it's just not time. Right. The first thing you said in this episode, I'm gonna say at the end of it, which is if you get one thing, get a CGM. Yes, that's where you start. Everything else is great. And, but it's not the first thing like a pumps not going to tell you your blood sugar's go in under 50. That's pretty that's pretty much it. So alright, I want to keep going here. This person says ask about newer products, like, for example, for us v ASP as an insulin, because they wanted something that moved quicker, but the doctor's office was talking about older stuff, especially with Basal insulin when you're MDI if somebody's handing you Lantus or levemir. At this point, there are more modern Basal insulins that work better. So you know, knowing that is helpful, especially when you you know, using that as an example when suddenly you think every, every 18 hours, your blood sugar goes up for no reason. That might be because love Amir doesn't really make it 1224 hours, you know, you don't know that there's a variable you're never going to know as a new person with diabetes. So if you can get what are they true Siba

Jennifer Smith, CDE 22:37
to jail as a Glar. Yeah,

Scott Benner 22:39
the more modern Basal insolence and other stuff like listen, I do an ad for Contour. Next One meter. And in every ad, I say, not all meters are the same. As far as accuracy goes. So when the doctor reaches out to you and goes here, from my drawer, just keep in mind, those are in the drawer, because the pretty girl from the company that came in with them, gave them to him and brought him bagels, I'm assuming, I don't know if that's still illegal or not. But at the very least, she was pretty and smiled a lot while she was doing it. And he was

Jennifer Smith, CDE 23:11
he was a very handsome man, he could be a very handsome man as well. A very

Scott Benner 23:15
handsome man could have come in I listen to any variation to the doctor could be gay, gay man came in straight man came in and we found attractive doesn't matter to me what I'm saying. We're sending pretty people into these doctor's offices with big veneer smiles and handed out stuff. You don't know if you got the best meter or you got the meter that was in the drawer. So ask, say, hey, is this accurate? Or they're more accurate meters? It told me about that. You know what I mean? And I think that goes for everything you just for me, it goes back to insulin. When Arden was diagnosed, I thought Novolog was insulin. At the beginning, it never occurred to me that there was another brand or right blends

Jennifer Smith, CDE 23:55
are well, and I think one step further in that too. While the doctor may have written a script for something, doctor isn't necessarily looking at what's going to be covered for you either, right? So you might go home with X brand glucometer or x brand of insulin. And then when you get to your insurance like well, we prefer you use this one

Scott Benner 24:18
because we've got a big pile of them. But no, but yeah, best you can afford. It is you know is what I'm saying but don't don't just assume that what you were handed was the best or the most accurate or the fastest or whatever because it might not be person says please just take the time to learn about technology on the pod five looping any control IQ like keep opening your mind up to new ideas. I put well this person just ran through everything. Oh, how to this person says make sure you understand how to suspect if a cannula is bent. Hmm very interesting. I just heard a story the other day from somebody who had a long day of high blood sugars ended up in DKA. Got home and found out their cat. Yeah,

Jennifer Smith, CDE 25:09
yeah. Yeah, I mean, and that is part of you know, we, we consider technology, just the actual like, pump or CGM or even glucose meter, right. But the pieces that work with the technology also go into what it does for you. So absolutely cannulas, you know, if you're having problem after problem with your particular cannula, pump companies will if you mean Medtronic in tandem, which use you know, a different set or you have options within the infusion sets, call them and say, Hey, this isn't working, can I try a different kind? Can I try angled versus 90 degree? Can I try the steel cannula versus, you know, the more flexible kind of plasticky one, there are options. So that consider that part of technology too. And that one size doesn't fit, all

Scott Benner 26:05
right. There's this really great story, this person told here about iport, I'm just going to boil it down to like two, yay, two ideas. But her son had anxiety about injections was crying all the time, started saying how he hated his life, and then started skipping meals to avoid shots. And the eye port. She said save them. Because it sounds to me like he was on his way to, you know, some sort of an eating disorder on top of everything else is a meltdown. You know, so simple little thing. And there, I mentioned it doesn't cost anything and iport get, you know, like the tiniest little things. I wish Okay, what does a normal graph look like? This is interesting, they found it interesting to see what a normal graph look like, or just a well, you know, manage type on graph, we got a Dexcom with no idea what our big data should look like. And it took me like, right, and so now they get all the data. And they're like, Well, what the hell does this mean? Look like this is this right? I had to find someone's random blog, I did a bunch of googling. I found graphs for people who are wearing them who don't have diabetes, I have found people who were the data without a control set doesn't help. CGM should come with sample data and give parents and users something to shoot for an idea of what should happen after meals, like the effects of Pre-Bolus Singh versus not Pre-Bolus ng versus high GI versus low carb, etc. Data more data, not just here's the CGM don't let her fall between 80 and try to stay in range 70% of the time, the endo recommendations still piss me off three years later. That's a good point, like it is yeah. How do you know what you're supposed to be doing?

Jennifer Smith, CDE 27:58
Right? I mean, they give you a range. And that range does differ. Practice to practice based on a protocol that they are trying to follow much more of a, like, a true protocol versus what their, what they feel comfortable telling you to aim for. But it doesn't tell you what that graph should look like, in that target range. Right? Should it be okay, that it looks like you're on the craziest roller coaster that you've ever been on in your entire life? Should it be smoother? Should it have no lumps or jumps or bumps at all? You know, how often are lows? Okay to see, how often could you expect? Or what could possibly cause a higher blood sugar that you're not expecting? And how to analyze that? I mean, all those things? Definitely, I think a piece that's also missed, because it's very buried in the manual that nobody reads for any product at all. But I mean, it's it's highlighted, highlighted in terms of described in the Dexcom manual about what the end arrows mean, the rate of change? I think that I have talked to maybe two people in the many people I've talked to, who actually knew before I brought it up what the arrows meant,

Scott Benner 29:22
right? Or that How about a steady arrow doesn't actually mean steady all the time. You might be vacillating. A little bit with a stable arrow. Diagonal down is one rate of change a single arrow down as another rate of change two hours down as another rate of change, same as going up. And it is spelled out. You know, it's so interesting. You say that, because I think that all the time, like for all the visual things that people share about diabetes. You never see that image anywhere. It's almost like it's almost like nobody knows maybe.

Jennifer Smith, CDE 29:55
Right? Right like I should I think that it should be a page that has one of those tabs. On the outside that says, This is important. Turn to this page.

Scott Benner 30:06
Sticky Note right on that. Well, you know what, I'm glad you brought that up. I'll do a post about that and try to remind people, that's a great I know, this person says get a great blood ketone meter. Interesting. We have the precision, extra extra. It's a blood. It's a blood ketone meter. Big Deal stops you from having to pee on things. You don't use it very often in our situation, but it's great to have I sent one to college with Arden. And I remember holding it up going, you remember what this is right? I was like, if you get sick, I'm going to ask you to find this. And she's like, she's like, okay. She's like, leave me alone. Urine ketone test strips can be messy with young kids. They can be messy with me too.

Jennifer Smith, CDE 30:55
Well, and not precise. I mean, what is mild? Versus it looks like it's in between mild and moderate. Like, do I do something differently? Right, the color change is not purposeful. It'll give you a little bit of information. But again, keep blood ketones are right now information just like a blood glucose value is right now here. Whereas urine ketones, it's older data. It's a collective of ketones, but it's not truly what's right happening

Scott Benner 31:30
now. And your doctor should give you sick day rules for how to how to Bolus for ketones. And it's nice to know that you have point five or you have one or whatever, because it's easier to make that Bolus this person said they paid out of pocket for their first X Games. He's like, I didn't know what diabetes was. But when somebody told me what that thing did, I was like, I'll take one now, please. So that's, you know if you can do that, that's amazing. Yeah, I wish they would have been able to give me a pen, not a syringe. I told them to train with a pen in the future. I didn't even know how it worked until we got home. And they showed me but I had to do it the first time alone. Oh, okay. So she trained on syringes. And then someone just said, here use this insulin pen instead. And

Jennifer Smith, CDE 32:17
it's different. Yeah. And they did. There's a different strategy. And yeah, dosing could be wrong if you're not using it the right way. The needle caps. I mean, there's a whole slew of things about using an insulin pen. And I think in terms of this being, you know, about technology, I wouldn't want to not mention in pen.

Scott Benner 32:38
Yeah, no, it's really something because you get, again, I'm gonna sound like an ad, but you get a lot of the functionality of pumping with the insulin pen. And yeah, I say it's like pumping without a pump. Yeah, no, it's really terrific. I do think people should check it out. I do think I'm, I think I'm contractually obligated to say from Medtronic diabetes every time I say we're not bad, so I'll get past this person. This person said we hesitated to move from finger sticks. But gotta libre and loved it. Excellent. No, I sent my son to school five days after being diagnosed and I was terrified. I called the nurse about eight times a day to check his blood sugar. We did not have a CGM was the hardest thing for me personally. You know, that's another good point. If you have a CGM that shares data. I don't know if libre does. But Dexcom does, right. You have followers, people can see that it's incredibly comforting. Oh, I the fact that a monitor can have a variable range, a glucose monitor can have a variable range blew my mind. And I did not see how we could trust it. Now. This is very common. Jenny, are you good on time? Do you have to go? I've got about 10 minutes. All right. We can get this done in 10 minutes. This happened to me. I recently told the story somewhere but the nurse came into the room she had this big expensive looking meter checked Arden's blood sugar with a meter. Then gave me the freestyle like little white. Yeah, whatever. Whatever they gave me like it looked like it was it was like I came out of a bubblegum machine. I always say they checked Arden's blood sugar with that. Arden's blood sugar on the meter, they were sending us home with an ordens blood sugar on the one from the hospital that looked like it costs $10,000 were significantly different. And it paralyzed me. I was like, You're telling me to make decisions about insulin based on this thing? isn't yours more accurate

Jennifer Smith, CDE 34:31
is can I just have this one?

Scott Benner 34:34
I try it I was like, give me that one. She's like, I think it cost like 10 grand. I was like, I'll steal it just like give it to me. You know? That's what this person is saying. That the minute I realized these things aren't perfect. I did not know what to do. All I can tell you about that is get the most accurate stuff you can afford. And never think about that again. I don't know what to say.

Jennifer Smith, CDE 34:57
Well, and because even as As most people who've already been using a CGM know, if you do have to calibrate it, you are calibrating off of a finger stick, you want that finger stick to be as accurate as possible. So now that you're tuning something else, that's going to give you many more data points to be more accurate.

Scott Benner 35:20
I listened. I say all the time. I don't know if people believe me or not, but the people who advertise on the show are very carefully curated by me. So I'm not just I'm not Hawking a Contour Next One blood glucose meter because they they knocked on my door and asked to buy an ad, somebody else knocked on my door and asked to buy an ad. And I said, I'd rather do one for contour. Thanks. So you know that just surrounding yourself with as good of data as possible, is the best thing but that part in there the part where you like, well, this might not be right. I guess the answer. There's a lot of people living with diabetes, and they're all okay. Might be the thing you say here. Okay. I wish I would have known about sugar meat. Okay, third party apps that also give you data. That's great. The different CGM options. That's interesting. So somebody told them either libre or Dexcom. They didn't know there was a different company. Getting the T slim help for my mental health because I started sleeping. algorithms can help you sleep. That's a good thing to know. What are the different glucagon options? That's a great, right. So right now there's, there's old school, are they? Oh, no, they're being discontinued.

Jennifer Smith, CDE 36:38
As of the end of December 2022. The old school red Lily glucagon box will no longer be available. That's, that's it. And then there's, there's G voc which comes in multiple different like, options, as well as the back shimmy, which is the nasal glucagon.

Scott Benner 36:58
Okay, so right now, G voc and back to me are the ones that are available. There's a third one coming, isn't there? I don't know.

Jennifer Smith, CDE 37:07
Now. Of course, it's not in my brain. Can I tell you the talked about it not too long ago in our staff meet AI. It's escaped me. Sorry.

Scott Benner 37:16
It's interesting. Here's a little back back room. The only reason I know about that is because the company approached me to buy ads. Oh, and I said, I'm sorry, I already take ads from a glucagon company. That's the one we use. I apologize. Can't do that. But that's the only reason I know there's another one coming from how to use a lancing device. Don't laugh at me. It says first time I tried it out. First time I tried without the top and kept stabbing my finger until it bled. Oh, so they weren't clicking it they were stabbing

Jennifer Smith, CDE 37:47
stabbing which was the old you never had to use it. I we refer to it as the guillotine the one that snapped over it literally you pulled back this like post that had a spring you loaded in a Landsat to it. And then you put your finger Neith finger underneath the platform, you push the button and the thing literally jammed into

Scott Benner 38:12
like pots. What I use is like pulling a long time pulling chopsticks apart and letting go one side right and it just snapped down.

Jennifer Smith, CDE 38:20
Oh area go. Absolutely. They were not nice. I mean, the good ones. Now I there's the Genteel. I know a lot of people use that one because it's very adjustable in multiple different ways. It is not a small device to carry around and use. But it is very gentle. Honestly. The one that I really liked the best that I like, baby because I know it's still in the market because I can still get the lands and

Scott Benner 38:48
I tell you what you're gonna say. Yeah, ask the multi clicks. Yes. Multi clicks from X. Yes. Ardens Ardens just died. We kept going for like so many years. And we went to the fast clicks but it's not the same accucheck if you're listening, what are you doing?

Jennifer Smith, CDE 39:06
Right? Yes, the accucheck is it are the the melty clicks was it was the best and I still I have the fast clicks because I couldn't get any of the things anymore for the clicks. And the fast clicks is certainly the next best in my opinion. But yeah, the those are another thing to consider because the typical ones that come with your meter. Yeah, many of them don't feel the greatest.

Scott Benner 39:35
Get a good one. I listen, I could go on, I get you. You're limited on time and I have to get a couple of things. I could do a dissertation on what accucheck did leaving the multiplex and go to the fast clicks. It was a huge mistake. This is my opinion. I wish this person says I knew about different ways to keep insulin cool, like from gadgets to packs and things like that because that's a big deal. Right? Like you're MDI and you're moving around with insulin. Arden's going through it now because her classes are very far from her dorm. And so on days, she's she's kind of stuck taking insulin with her and a pump just in case we can't, not how she's used to traveling. So we had to go over that with her.

Jennifer Smith, CDE 40:13
Did you guys get it there is a really good device. It's called the Vivi cap. Vi VI, the Vivie cap,

Scott Benner 40:19
if that was just for pens,

Jennifer Smith, CDE 40:21
it is for pens, but at some point, I do know only having talked to them at the educator conference. They are working on one for the vials. Yeah. But right now the Vivi cap is just for pens of any kind. So if you carry your pens with you, it's it's an excellent

Scott Benner 40:42
option. Well, I hope they make one for vials. Because Arden's in a hot weather climate right now. So she's using a tiny little, like, very hot. Yes, she's using this tiny little Yeti thing that she has to throw ice in and then throw the thing and to travel around with her insulin every day. And there's already been days where she's like, look, I didn't take it with me. Because what, what about the frill get wet? If I trust me, I know it works well. And if I asked her to do that, she'd be like, I'm not carrying a wet bag around with me. It's definitely what I would hear from her.

Jennifer Smith, CDE 41:13
Yeah, it's not I mean, I use it for my travel. But again, she has to do what she can do.

Scott Benner 41:18
Yeah, trust me what she's going to what she did was she set up with her counselor that if she needs to go back to her room, she's allowed to call Campus Security and they'll zipper back to change your pod real quick. So that's awesome. Talk about getting the combination. That was a pretty good. Last couple things here. bracelets. Okay, I just interviewed Jennifer stone the other day from Wizards of Waverly Place who has type one diabetes, and she's talking to me on camera, she lifted up her hands and I brought up that she was wearing an ID bracelet. She said nurse now as well as being an actress still, I think you just supposed to say actor but and she said yeah, it doesn't take too many people coming into the ER without one of these Alon to realize you should be wearing one. So mine never comes off. I know Jenny's always got hers on.

Jennifer Smith, CDE 42:10
I don't I don't it doesn't it never comes off. Yeah, I made sure that I got waterproof, won't tarnish won't rust won't blah, blah, blah just sits there so well. So

Scott Benner 42:21
that's it. I mean, that's everyone's list about technology and data, or technology for diabetes. Excuse me. I mean, from my perspective, I mean, we've been using Omni pod forever. I can stand behind it. I also talked to a ton of people who love control IQ. To me, I think it comes down to to Bolus versus tubed and what you want. But yeah, this is it. No one's going to explain it to you. You gotta get out there and figure it out. So hopefully this will help. Cool. All right. Thank you, Danny. I appreciate it.

Jennifer Smith, CDE 42:52
Of course, you're welcome.

Scott Benner 43:00
I hope you've been enjoying the bowl beginning series. I want to thank Jenny Smith for lending her time to it. And of course, I'd also like to thank Dexcom, makers of the Dexcom G six continuous glucose monitoring system and Omni pod makers of the Omni pod five, get yourself some automated insulin pumping with Omni pod Omni pod.com forward slash juice box or to find out if you're eligible for a free 30 day supply of the Omni pod dash use the same link. In just a moment, I'll go over all of the episodes that are available right now in the ball beginning series. And I was like in a sorry about that. But first, let me tell you if you're living in certain countries in Europe, the Dexcom g7 is available already. And you can still use my link for that dexcom.com forward slash juice box. Today is the 20th episode of the bowl beginning series and there's going to be 21 One more coming next week. So far, here's what we have. Episode 698 Defining bold beginnings. It's a toss up of what the series is going to be. Then 702 honeymooning 706 adult diagnosis 711 terminology Part One 712 terminology Part Two episode 715 Fear of insulin 719 The 1515 rule 723 long acting insulin 727 target range 731 food choices 735 Pre-Bolus 739 carbs 743 stacking 747 flexibility 751 School 755 Exercise 759 Guilt fears hope and expectations 763 community 772 is all about journaling today's episode 776 technology and diabetes supplies and next week's episode which will be seven Adi think is going to be all about insurance. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Oh, and by the way, if you're wondering where you might be able to see this list, you can find it in the private Facebook group Juicebox Podcast, type one diabetes, right at the top, under the feature tab. You Oh, are you not in the Facebook group? You should be it's really cool. 30,000 people all using insulin, asking questions, answering questions, being supportive. It's the most unfaced book like experience you're ever gonna have. It's actually nice. And it's free, free, mean, Scott, you're not trying to nickel and dime people to get access to information. So the Juicebox Podcast is ad supported. I don't want your money. That's it, I want you to have information, I want you to have access to each other to community. That's all I care about. There are no classes, you don't have to sign up for any kind of, you know, $60 a month of call me on the phone. I'm not going to give you 10 seconds of information in a podcast and tell you to come find me for the rest of it. I'm not up for that. But understand. I don't care about that. I'll make a living. But it's not going to be off your ass. You understand what I'm saying? That's all, head over to the Facebook page. Check it out. It's amazing. Listen to the podcast. It's amazing. And it's free. Everything's free that Juicebox Podcast brings forth. Everything is free to you as it should be. Having decent blood sugars and understanding how insulin works shouldn't cost you money. It shouldn't cost you a membership. You shouldn't have to pay a fee. You don't have to take a class, this this podcast, set your speed. You want to listen to the diabetes pro tip episodes in three days. Go do it. You want to listen to it over three weeks. Cool. Whatever is good for you. If you don't like listening, I've got transcripts on the website juicebox podcast.com. Go read it if you want to. You want to read a podcast. I'm not judging you couldn't possibly care less how you learn as long as you learn. That's it. Again, I thank you for listening, and I'll be back very soon with another episode of The Juicebox Podcast.

Test your knowledge of episode 776

1. What is the significance of regular blood sugar monitoring?

• It helps in managing blood sugar levels effectively
• It eliminates the need for insulin
• It has no impact
• It is only relevant for type 2 diabetes

2. How can stress affect blood sugar levels?

• It lowers blood sugar levels
• It has no impact
• It raises blood sugar levels
• It depends on the individual

3. Why is carbohydrate counting significant in diabetes management?

• It helps in accurate insulin dosing
• It has no impact on blood sugar levels
• It is only relevant for type 2 diabetes
• It should be avoided

4. What is the primary function of basal insulin?

• To cover meal-time glucose spikes
• To manage blood sugar levels between meals and overnight
• To correct high blood sugar levels immediately
• To eliminate the need for monitoring

5. How often should blood sugar levels be checked in a newly diagnosed patient?

• Once a week
• Before and after each meal and at bedtime
• Only when feeling unwell
• Once a month

6. What role does physical activity play in managing diabetes?

• It should be avoided
• It helps in managing blood sugar levels
• It complicates diabetes management
• It has no role

7. How should insulin doses be adjusted during physical activity?

• By ignoring blood sugar levels
• By increasing the insulin dose
• According to the intensity and duration of physical activity
• By avoiding physical activity altogether

8. What is the best way to handle a low blood sugar episode?

• By ignoring it
• By consuming fast-acting carbohydrates
• By stopping all activities
• By drinking water

Submit

Change Answers

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#772 Bold Beginnings: Journaling

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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+ Click for EPISODE TRANSCRIPT

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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 772 of the Juicebox Podcast.

On this episode of The Juicebox Podcast Jennifer Smith and I will be giving you another episode in the bold beginning series. Today we're talking about journaling, which, though I got confused a little bit isn't about writing down your feelings. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. The ball beginning series begins at episode 698 and includes honeymooning adult diagnosis terminology part one into fear of insulin the 1515 rule, long acting insulin target range food choices Pre-Bolus carbs stalking, flexibility school exercise guilt, fears, hope and expectations, community and today's episode journaling. If you're looking for that list, it's available at juicebox podcast.com. Or on the private Facebook group in the feature tab. The list actually has like the episode numbers with it, which I guess I could have just said but I felt like I had to rush to get you know in before the music ended. Anyway

this episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. If you want an insulin pen that has much of the functionality that you find with an insulin pump, you're looking for the in pen, Learn more at in pen today.com This show is sponsored today by the glucagon that my daughter carries G voc hypo penne, find out more at G voc glucagon.com. Forward slash juicebox. Well, Jennifer, we are so close to being finished with the bold beginning series. Yay, we are going to record today. What we have left is journaling. And then we have supplies like technology technology, durable medical stuff, which I thought was a great idea talking about how to people actually get these things, a little bit about insurance. And then we're going to talk about carb guidelines and food impacts. So we only have four topics left. Yay. Yeah, I feel I feel like we've accomplished something we have how many months? Have we been at this? Do you think?

Jennifer Smith, CDE 2:40
I don't even know. Honestly all have my month they run together? And I have no probably three. I feel like we started like summer ish, right?

Scott Benner 2:52
I'm gonna look, because I'm actually interested. I'll figure it out while we're talking. Cool. Okay. So can I just admit something right here? Sure. The list has been in front of me for quite some time. And journaling has been at the bottom. And the entire time I thought, well, people want to talk about writing their feelings down. Then I thought, Okay, if that's what everybody said, we'll do it. And then of course, today looked at it and I thought, Oh, that's not what they're talking about.

Jennifer Smith, CDE 3:24
That's what I was wondering is like, what and when you said the name of I was like journaling? What kind of journaling? I journal and it's doesn't really reflect on diabetes, but sometimes it does when I'm journaling about that. But that's not in my journal. No.

Scott Benner 3:40
I was so disappointed with myself. When I started reading, I say, Oh, they're talking about tracking food and doing a food journal and a carb journal and a Bolus journal, journaling diabetes stuff, and I thought it never occurred to me because, you know, I don't do that. But I go, but I do see people's, you know, people's comments telling me that for I think certain, I guess certain brains, right? This is probably incredibly important. So the first comment I have here is I counted carbs and tracked it in a food journal like crazy for almost a year, I would record everything my son ate and what happened to his blood sugar afterwards. This was kind of helpful to distinguish patterns. It was very stressful when things were not working correctly. But oh, here we go. I would never food journal again if I knew better.

Jennifer Smith, CDE 4:31
Huh. And that, and I see I don't see, as if like, Well, gosh, why not? It's just sort of like, I think everybody again, you said personality. I think there are some people who can collectively see something happening. They take it in and it gets filed in that place that they know they can pull it out and use it and they don't have to write it down. However there are people in terms of like kind of learner, along with personality, there are some people their learning style is they get it once they've written it down. If it's written a couple of times, it's then in that place in their brain that they can draw from, and they probably don't have to write it down anymore. Right?

Scott Benner 5:17
Yeah, I wonder if the message after we get through this is going to be that if this is how your brain works, this is probably amazing. And if it's not, it might feel like torture.

Jennifer Smith, CDE 5:27
And I think the other piece to it too, is people who have a little bit more consistency in what they do, and probably would benefit from this, regardless of personality or learning style. They're the they're the person or the family that could get a lot out of, we have soccer every Monday, Wednesday and Friday, we always eat this for breakfast, this for lunch, and then dinner is these different meals. But there are like five of them, great journalists figure it out, you will see patterns, I guarantee. But the person who has a very random schedule, and you know, I bring up nurses sometimes, because the nurses that I've worked with often have variable scheduling, they might work overnight, and then they might be off for two days. And then they might work three shifts in a row, different times of day, and then they might be off for another two or three days in a row. While you might get something out of food evaluation, you may not get much out of time of day evaluation, because there's so much that's variable day to day for them. So I think, you know, you kind of have to pick and choose, what are you also trying to figure out what is journaling? The 1000 things that might happen in your day, you're gonna get overwhelmed with that

Scott Benner 6:56
you're not a computer, right? Like, you can't, no, I can't write down so much data that you can't compile it and make sense of it. But what you're saying makes a lot of sense to me, if you have a more repetitive life, you'll probably more quickly be able to see the patterns, right. And if you have an incredibly variable life, what you might end up with is a lot of numbers and lines and dashes that you can't make sense of

Jennifer Smith, CDE 7:18
correct interest. And sometimes because it's your own data, you sort of get lost in it, right? Sometimes it it helps to have an unbiased look. Which means then that hopefully you have a good care team that you can go to and send data to for evaluation saying, I don't see anything here. Can you please try to pick this apart? And you know, when I'm looking at someone's data, sometimes I say, I don't know, it looks like there are a lot of variables in the picture. So let's try this. And this to start out with?

Scott Benner 7:49
Well, that's it really important to bring up because, I mean, in full, full transparency, probably a half a dozen times a year, I send something to Jenny and say, I see this, am I right? Because I'm living it and watching it. You're You're too, right. It's micro macro, like sometimes you get too close to it, and you can't see the big picture anymore. And often, like, I wanted to make this switch a couple days ago, and I said to Arden Hold on a second, I'm gonna check with Jenny. And she was Do you not know if you're right or not? Which I don't think like, filled her with a ton of confidence. And I was like, No, this is the right thing to do. But let's just tell somebody else first who, who thinks about it the same way so that we don't start turning a bunch of knobs and get too far away from where we are because we're so close right now. And she's like, whatever. And it's like okay, by the way, just to digress for half a second. Did you hear the episode that she did recently?

Jennifer Smith, CDE 8:46
I listened to I think I got through three quarters of it.

Scott Benner 8:49
Did you get to the part where she wouldn't give you credit for the oat milk ice cream?

Jennifer Smith, CDE 8:55
I didn't get to that part. Although I have seen many comments about what's this ice cream. Jenny recommended and I was like, it's tasty. I guess the biggest reason was when I recommended it for you guys was trying to find something that was comparable in taste that she wouldn't be like, Oh my God, this crazy lady recommended something that's it's horrid. It is totally not ice cream to me. Right?

Scott Benner 9:17
How long is the hair on Jenny's legs? If she thought I was gonna eat this? Yes. But um, but she just ended up really liking it. So I was like, I was like, Hey, give her credit. She goes, I'm not involved in this thing you do? It was like what do you anyway you have to get to it is hilarious. Okay, so the next comment here is, is super interesting because it goes the other way. Getting a scale and a notebook was huge for our family as well as staying as organized as possible was we had a little makeup. Oh, we had a little makeup organizer set up on our counter in the kitchen with everything we needed. So it was very easy to reference. Then, with a notebook right in front of them. We would write down all of our carbs and in insulin doses times, etc. And that really helped to make sure we didn't both accidentally give her something Oh, that's interesting, a little redundancy too. And reference back to the book, if something weird with her blood sugar happened that we could figure out better after seeing, Oh, what was going on with the insulin versus the food that she ate, get a good scale to help with Clark County.

Jennifer Smith, CDE 10:21
And that's their, you know, in terms of the whole idea of journaling, there in lies, I think this person brings up a good, a good fact that sometimes actual physical written journaling, you can flip back to easier than the databases upon databases that allow you to do the same thing in an app. Because sometimes the apps become cumbersome to try to track through and page back and forth between one day note and then trying to find another days of note, where if you haven't just written down, you can kind of easily page back and forth. I know a lot of people use like the sugar mate, because partners or caregivers or whatever, you can see what every person is logging. And then you can see in the day, and you don't really have to worry about that redundancy, or Oh, my goodness, did I give it did somebody else give it what was done? But yeah, I mean, there, there are multiple ways to journal or I guess, record diabetes, if you will, sort of like texting diabetes, but recording, if you will.

Scott Benner 11:29
So when there are plenty of times throughout the weeks, where my kids look at me funny, because I'm like, well, if I'm going to do this, I have to go upstairs to my computer. And they're like, you can do it on your phone. And I don't want to, I don't want I don't like that. And they they're like you're old and I'm like II say whatever you want. Like I want it big. I want it in front of me. I want to be able to look at multiple things at the same time. I don't want to be flipping back and forth. I take that point. Oh, well, it's interesting. He I would I would be better with it. Interestingly enough, I'd be better with it where I could just reach back three pages and go okay, Monday. That was that would be easier for me.

Jennifer Smith, CDE 12:07
Absolutely. I mean, I did that. And I'm very glad. And I recommend this to a lot of the women that I work with, through pregnancy is I journaled my entire first pregnancy, the whole thing, all the foods every day, day and time of change of insulin doses and everything that I noticed, it was enormously beneficial. When I was pregnant with my second, okay, enormously beneficial, because I could go back and say, Well, this time of the first trimester, this is about what started happening. And then it didn't feel as crazy. Right with what I was noticing. I'm like, No, this is normal. I did do this last time, or I did see this last time, or I did stop doing this type of thing last time about this point. So

Scott Benner 12:54
when something that's so out of the ordinary happens, even though it's happened to you in the past, it still feels very out of the ordinary. And it was helpful to go back and say, Oh, no, this this happened the last time. Yeah, right. That's right. Especially

Jennifer Smith, CDE 13:06
because there were a number of years before between my kids. And so, you know, memory lapses entirely.

Scott Benner 13:17
So that's nature's way of allowing you to get pregnant again. I think.

Jennifer Smith, CDE 13:20
There you go. I guess yes. You don't remember all of this stuff you do, right? Oh, let's do it again.

Scott Benner 13:26
You remembered it, you'd be like No, thank you. That's okay. Once enough.

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Makes sense? Okay, here's the one from somebody that says, Oh, hold on a second, while I mute my phone. Like I've never made a podcast before. Sorry about that. With everything overwhelmingly journaling. Journaling saved my tired brain from remembering everything. Okay, so while everything was overwhelming, journaling saved my entire brain from remembering everything. I keep everything in there food, Bolus timing, dosing, carb counts, questions, to ask questions to ask it and appointment, they use this thing like a Bible, then. Okay.

Jennifer Smith, CDE 16:27
And that is good in terms of connections with your care team. Because if you do on a day have, gosh, originally I should ask about this isn't a question that needs to be answered now. Then reach out now, if it's a question that you're going to bring this journal in, in a month or two months when you have your next visit, because they were just things you wanted to go over. But I really not as necessary to get an answer to right now. Then you don't have to remember all your questions. Yeah.

Scott Benner 16:54
My, my mom just moved from the East Coast to actually to her Jenny has to live with not to live with Jenny, but to live with my brother. Not that my brother lives with Jenny, but they're in the same state anyway. And my brother has been a little overwhelmed. And we had a conversation yesterday, where I said, Listen, you've been lucky this far, you haven't dealt with a lot of health issues. And, and he's like, Well, there's phone calls, and I'm talking to doctors, and they don't do anything you want them. You know, you have to ask three times. It's like, yeah, that's like, that's how this is. So. So I said, look, make a list. And I said, because if you think you're just gonna walk in that doctor's office, and remember to say everything that you need to say, it's not going to work like that. I said, you have to have a list in front of you. It's interesting how, you know, the one thing I'm realizing, as I'm listening to people talking about how they're journaling and listening to us talk about it, is that I would have benefited from it. It's just that my brain doesn't excuse me, I don't know how to say this actually. But like my my printing, my penmanship is is horrendous. Like, I don't mean not, you know, worthy of being hung up somewhere. I mean, I write things down. And then I didn't know what they say. Yeah, I have things written in front of me from yesterday. I don't know what they say anymore. And

Jennifer Smith, CDE 18:16
it's kind of like Dr. chicken scratch really,

Scott Benner 18:19
it's like, it's like something I'll tell you. And, and I wonder how much of that thwarted me from ever trying it because I have I have written things down before I'm like, this is useless. I don't know what this says. I've tried slowing down and writing slower. It doesn't like I can't do it. Like the first three letters and then I get bored like come on, let's get this out. And I can't get back to it. So

Jennifer Smith, CDE 18:45
um, had you had at you know, I mean, Arden was diagnosed long ago, long enough ago that there really weren't the tracking tools that we have now right? Where it takes your handwriting out of the picture it does allow you to keep it all in an app or again or someplace that you can actually read what you wrote down

Scott Benner 19:06
that is why I like being at a computer because I can go back and actually see it also might make a good point that my my book back then might have said woke up screamed into pillow cried. Yeah. Yeah. Chased Arden around room with needle went another room screamed and pillow. I don't know how helpful that would have been. Exactly. I guess the tools and the data coming back really is more modern day.

Jennifer Smith, CDE 19:32
It is definitely I mean, even the ability to download, you know, a pump or a simple glucose meter or have the CGM data drive right into a database that you can look at online or that you can get notifications. Hey, clarity tells me that I did this much better this week compared to last week, right? I mean, that kind of information. Just it wasn't there. Yeah.

Scott Benner 19:58
So I use that that data like in clarity. For example, when I'm returning Arden's blood sugars for something, I move everything to one day, I want to see just what happened today. Where was our average? What was our range today? And then as those numbers come to where I want them to be, then I open it back up and see, am I keeping it for a week? I am I keeping it for a month? Good. And then I kind of build off of it that way.

Jennifer Smith, CDE 20:22
Yeah, those overlays or comparison reports, especially just, you know, talking about like a CGM. From a one point of view, like you said, when you make a change, and you're wondering if it's made enough of a difference, I always start with just compare a seven day, you made a change on this day, look seven days out, do things look better compared to the previous seven days before you made the change? And see, so you can definitely tell whether or not more stuff needs to be adjusted,

Scott Benner 20:52
I cheat a little bit to like, I'll look at seven days and just pick a number. We'll say like, I don't know, variability is at 28%. And I'm like, Okay, over the last seven days, that's great, then I expand it to 14 days. And I don't even go back and look, if the number goes up, then I go, Okay, well, the week before, it wasn't as good. And if the number stays still or goes down, I go. Okay. Now I have some consistency over two weeks. Right? Yeah. Oh, it's interesting. The last person just says, please get a good scale to help with carb counting. I don't know how to comment on that. Because, I mean, that's a burden more for me, but I see the value,

Jennifer Smith, CDE 21:28
there is value. And I think, again, I still use a food scale, but more specific to foods that they never have a label. They're real foods like butternut squash, or acorn squash, or apples or M kind of, you know, those summer into fall kind of vegetables and fruits, or anything that you might get from the grocery store any time of the year, that just does not come with a label, you can get a lot from using a food scale, and you know, a carb factor. And many foods scales now, if you get a smart one actually come with the carb factor already in them. And all you do is put the piece of food on the scale, put the code in, and it gives you the amount of carbon that portion that you're going to eat.

Scott Benner 22:18
Oh, so yeah, cut up apples as an example. I throw it on there. I tell the thing. This is apples, it already knows what the carb factor is for me personally. Tells me for that

Jennifer Smith, CDE 22:29
food particular. Yeah, yeah. Yeah, like I, one in particular, is it eat smart products.com is the website. It's a great food scale, you want to look for the nutritional kitchen scale. It's like a square like clear glass shape. But it comes with a catalogue of about 1000 foods that each have a code. And when you look at the code, then you put that in put the let's say Apple is 205. I only know it because I really like apples this time of the year. And I use it because they're all different shapes and sizes this time of the year. So you put the apple on and it pops back. This is how much fiber it has this is how much carbohydrate in this portion that you're going to eat. And if you are the precision kind of person, then maybe that's what makes the big difference for you. And if it does, it could be a huge benefit for you. Again, I mean, I don't use it for things that might like beans that come in a container that I can look at. I know what a half cup looks like. And you know, I've been doing this long enough that if I don't know what a half cup looks like, I'm in trouble at this point.

Scott Benner 23:37
Okay, so I think the takeaway here is that different people are going to respond well to different ideas. But that's keeping track of something somehow is is a good idea. You don't I mean, even look, as I joke, I don't keep track of anything. Arden left for college, the last thing I did was open up our loop app and screenshotted every page of our settings, and I AirDrop them to myself. And we got we got there and we made changes, and I did them again. And over the last couple of weeks that she's settling into school, I refer back to them a number of times. So

Jennifer Smith, CDE 24:07
Right. And in the beginning, I think the good thing about some tracking, especially if you do have a honeymoon period, the good thing about tracking early is that you'll start to see those differences that cue you in to say, this wasn't just a bad day, right? This was two days or three days I have much more sensitivity or much less sensitivity. And so you know, then something needs to be adjusted in terms of your doses, probably. And you can go forward in a much more precise manner rather than the randomness that creates more of the roller coaster up and down.

Scott Benner 24:44
Okay, well, I'm glad we talked about this then thank you very much. Thank you. Okay, let's see what is next. So that was journaling. I honestly can't read my own writing. It's embarrassing.

Jennifer Smith, CDE 25:00
There was, there was a physician when I was doing my clinical internship, which I had actually done I had done at a hospital where I was already working. And so I knew the doctor, but he had, like, literally, I don't, I would call it chicken scratch, it looks like somebody put ink on chickens like feet, and they just danced around on the page. And we got to the point of realizing some words looked the same. And then you could end up figuring out that the chicken scratch was like the or it's catchy, because it looked the same note to note, so then you could figure out what he had actually written. But, man, yeah, almost

Scott Benner 25:46
impossible. No, I, I looked down at my own writing. And I was like, it feels like someone else wrote it. I have something in front of me right now. Oh, I know what it is. I was speaking to someone from Australia yesterday. And she said, we are in a potty. And I wanted to remember to bring it up later. Because she had she was talking about peeing on sticks to get her blood sugar when she was younger, because she had had a long time, right. But as I looked down at it now, it looks like it says Lee

Jennifer Smith, CDE 26:19
Lee and Patti maybe

Scott Benner 26:20
on poult. Good. Like, I don't know what it's, I don't know what it could say Q. Like cu e, it could say, definitely not wait because the first loop of the w goes down comes up and it goes right into the E. And then there's another E, the two E's don't even look the same. You can't even tell the second eat and the first day are the same letter.

Jennifer Smith, CDE 26:52
I hope you never wrote like nice letters to your wife when you guys were dating because she was finally I was talking about my hobby telling them that he likes me. But I really don't know,

Scott Benner 27:04
a greeting card for Kelly. I sometimes print it out first and then go and I copy it. Because if I just start writing, I hand it to her. And later she goes, Hey, what does this say? And then I'll just I just read it to her or the or I can't read it. And I just go well, here's here's the intent. Like I started. I don't know if it's terrible. It's really I don't I it's my whole life. My printing has been absolutely horrible. And my cursive is not anybody writes that way anymore. But

Jennifer Smith, CDE 27:32
it's it's horrendous. And they don't even they don't even teach it anymore.

Scott Benner 27:35
There's a lot of things they don't teach anymore. Some of it. I'm confused by like typing.

Jennifer Smith, CDE 27:40
I'm amazed at the the use of iPads in school for young kids. It's the hunt and peck method of finding letters to spell things. Yeah. And I told I told Nathan recently, I was like, We need to get it. We need to get a keyboard to hook up to our home iPad. And we need to teach them how to type. Yeah, because for the year, they're gonna hunt and pack their entire life.

Scott Benner 28:10
That was years of their life. You know, watching a person text who's proficient at it is like I watch Arden and her thumbs are just like flying. It's and they don't make mistakes. It's fast. It's fascinating, you know, so I had to teach myself to type to write my book. I did, I did not know how to type. I took typing class. I did it for like a day. And I'm like, I'm dropping this. And I dropped it and I left. I couldn't do it. So when I had to write my book, I sat down. And first I typed looking, and then I would practice not looking. And then as the weeks went on before I knew what I could type.

Jennifer Smith, CDE 28:49
Yeah, I mean, that's how they teach you. It was a mandatory we had to take it as freshmen in high school. It was a mandatory, I still remember Miss Adelman, that was her name. And we had word processors. No, I'm like aging myself. We had word processors A S S, like that's what we did for the whole class. By the end you're like, oh my gosh,

Scott Benner 29:13
Kelly had one in college where there was this little matrix LED screen in front of her that may be held like 15 or 20 characters and you would type and they would come up in front of you. And then they would disappear off to the left. And when you got done you hit save and it was on like a floppy disk if I remember correctly, and then you had to put the floppy disk in and hit print. I mean you didn't even you couldn't even go back to see if you made a mistake or it was and that was like high quality back then. Think about that the next time you complain.

Huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com forward slash juicebox. If you're looking for an insulin pen that does more, check out the pen from Medtronic diabetes at in pen today.com. And don't forget to fill out that survey for me at T one D exchange.org. Forward slash juice box

if you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. That really is the best way to help the show, grow, thrive and continue. Tell them to look in their audio app like Spotify, Apple podcasts or Amazon music. If they don't know what that is, send them over to juicebox podcast.com Or take their phone from them and show them yourself. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

Test your knowledge of episode 772

1. What is the primary function of basal insulin?

• To cover meal-time glucose spikes
• To manage blood sugar levels between meals and overnight
• To correct high blood sugar levels immediately
• To eliminate the need for monitoring

2. How often should blood sugar levels be checked in a newly diagnosed patient?

• Once a week
• Before and after each meal and at bedtime
• Only when feeling unwell
• Once a month

3. What is the significance of carbohydrate counting in diabetes management?

• It helps in accurate insulin dosing
• It has no impact on blood sugar levels
• It is only relevant for type 2 diabetes
• It should be avoided

4. How can stress affect blood sugar levels in diabetic patients?

• It lowers blood sugar levels
• It has no impact
• It raises blood sugar levels
• It depends on the individual

5. Why is it important to stay informed about new diabetes research and treatments?

• It can improve management strategies and outcomes
• It is only relevant for healthcare providers
• It has no impact
• It is unnecessary for most patients

6. What role does physical activity play in managing diabetes?

• It should be avoided
• It helps in managing blood sugar levels
• It complicates diabetes management
• It has no role

7. How should insulin doses be adjusted during physical activity?

• By ignoring blood sugar levels
• By increasing the insulin dose
• According to the intensity and duration of physical activity
• By avoiding physical activity altogether

8. What is the best way to handle a low blood sugar episode?

• By ignoring it
• By consuming fast-acting carbohydrates
• By stopping all activities
• By drinking water

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