#253 Defining Diabetes: Non Compliant
Defining Diabetes: Non Compliant
Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care
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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
Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes, please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise the Always consult a physician before becoming bold with insulin, or making any changes to your medical plan. Today, Jenny Smith and I will define and then break down in a little more detail, the term non compliant. We did a bunch of definitions. And they've been running Friday's just these little short episodes and people seem to be enjoying them. So far, we've we've done a lengthy time and range, Bolus bazel. Pre I think we've done Pre-Bolus honeymooning, a one C. And I was wondering, there's, there's one I want to kind of slip in here. Because I want to understand it from a clinicians point of view, this is going to be something that it's funny, I don't really think of this as a real thing. I guess I'll say what I think about that in a second. But when your doctor or a nurse or a clinician or someone they call you non compliant, from a medical perspective, what are they saying?
Jennifer Smith, CDE 1:10
Oh, that's a can of worms there,
Scott Benner 1:13
right? It's a beehive, right? But we're gonna, we're gonna pick through this, there's a tiny bit of noise behind me for the first minute or so maybe it's the beehive.
Jennifer Smith, CDE 1:23
Unfortunately, it's commonly still a term that's used as used in regard to a person who does not take a prescribed medication or follow a prescribed course of treatment that the clinician has told them to follow. That's kind of in a nutshell, that's non compliance. Now, if that's the case, as I say that every he died, he presented people with diet type one diabetes, especially, are probably non compliant. Quite honestly. And and I'm not saying that I mean, I am technically, if I were to be considered by my endo as following every rule that he told me to do, and free adjustment, I am not in compliance then. Right. Because I fortunately have I've got a good endo, who is very, you know, happy and willing to work and talk with me on an educated level, and we discuss back and forth. But non compliance comes in when the doctors like set these bezels, or they grab your pump, and they set the bezels for you, and you walk out the door and in your car, you're like, Nope, I'm gonna turn on.
Scott Benner 2:33
Because I know more than the doctor knows. Right. And so technically, you would be called non compliant, right? I it's a very bad term. It's a bad term. It's horrible. It gets hurt is trying, right? Like you're not trying, you're not wrestling. So I think there's a way to get through this. Okay, so best intentions for this just being a definitions episode, it sort of turned into a tiny conversation goes on in about five more minutes, I'm going to cut the music out of the background and let you keep listening. I think that it gets used a few different ways. I think that, that when you hear it as the patient or the parent, it sounds like it sounds like you're you're being jumped on it. And you might be because a bad endo will call you non compliant. If you're not having the results that they want you to have. They never stopped. They think that their direction may not have been very good, right? Like, you know, you told me to do this. And because you're sitting across from the gun, look, I did what you said. But it didn't work. That doesn't make me non compliant that makes what you said, non valuable. Right? Right. Like you gave me You gave me invaluable information, I followed it, I didn't get anywhere you don't know what to say next. So you call me non compliant, there is a medical term for it. For Non compliance. It just means like you said, like, you know, if a doctor tells you to take this pill, you know, every six hours and you don't do it, you're non compliant. You're not you're non compliant for the purposes of their reporting and your notes you were non compliant with with what needed to be done.
Jennifer Smith, CDE 4:08
And I think in terms of diabetes, unfortunately, the fact is that they have a set of goals that they need to check off and want to check off as far as what they've gone over. Many times I feel like they use the term non compliant because they've not physically asked what are your goals? What do you want to work on? What are you trying to achieve and manage and take care of? And if that's not addressed, then of course, you're going to look non compliant because they didn't help you with what you actually needed help with to begin with. So why should you pay attention to what they told you to do?
Scott Benner 4:43
Right percent. I've had somebody tell me they were called non compliant because their blood sugar their agency was six and a half and the doctor told him they didn't want to under seven, they call them non compliant. I think it's just something people throw around. It's a horrible it's a stick to hit people with, you know what I mean? So I think I think that when it Doctor calls you noncompliant because you're not having the outcomes that they want you to have. That's a false narrative. That just means you don't I mean, my experience now for this podcast, if you have the right tools, you can do it. If you have the wrong tools, it doesn't work out, you know, like, you can want me to do what you want. All you you have any idea how many you do, Jenny, Jenny does, I'm talking to all the rest of you, you have any idea how many people I talked to whose basal rates are so wrong, they couldn't possibly get good blood sugars, there's just no way for it to happen. And then they go back to the doctor and say, Look, you know, I'm 200 all the time, but I had this bad low, and sometimes the doctors back there bazel off more like, Oh, my God, it's going the wrong way. And then that same doctor will call them non compliant at some point,
Jennifer Smith, CDE 5:46
right? I think to help with it is,
even if you have no idea where to start and what you need help with, that's important to tell the doctor then I know something is wrong, I need help, or I know something's wrong, every time I go and take a run something is wrong. So you're giving them a focus area, you're giving the doctor something to say, Well, I can educate you about this. So I can give you strategic, you know, I guess guidelines to help with this. And we'll take a look at how it helps the next time. Unfortunately, a lot of times people come into their endo, and they expect the doctor to just say, well make an adjustment here make an adjustment here, oh, I'll see you in three to six months again, well, you're not giving the doctor any direction either then to be able to help you and your goals. And you
Scott Benner 6:33
by the way you could be there are people who are non compliant, by the way that that would be a way to address. And then there's going to be people to who psychologically for reasons of anxiety or stress or depression can't follow through to call that person non compliant. That's criminal, you don't mean so doctors really need to hear that there. There are other ways and better ways to address people and that no one wants to be called non compliant. That's a nice little technical word you use in your reports that shouldn't be said out loud to somebody. If that those weren't words meant for the patient. Those were words meant for your notes.
Jennifer Smith, CDE 7:11
And I don't even think they should be used in the notes. because quite honestly, then another clinician may come in later and think well noncompliant. Gosh, this person is not doing anything that we said. And that may not be the case. Instead, documentation needs to be more specific. It means to say, Well, you know, I talked to the person today because it appears in the records that they're they're missing boluses based on their CGM data, why are they missing boluses this, this topic was discussed, oh, I found out that they're really worried about low blood sugars, they have a high risk job, they've got something else going on. We discussed this, this is more of a psychological we need to overcome this isn't they don't want to take their medication the right way. This is they're trying to figure out a way around it or avoid something else happening.
Scott Benner 8:01
Right? details need to be added? 100% correct. It's just something that gets bandied about. And as if it covers all these different things. And really, it only speaks to one specific situation like like, and then it gets it gets. It gets attached to all these other people and their scenarios, and it just doesn't fit and it's hurtful. It's hurtful to have somebody tell you when you're trying so hard at something for someone while you're not trying. You're like man, you didn't give me any tools. I'm still I'm beating my head against this wall. I'm getting nowhere and you're gonna yell at me afterwards. Why am I coming here? You know, so that's all. I'm only gonna make you do that one today, Jenny, because that one was hard. Oh,
Jennifer Smith, CDE 8:41
that's a good one. No, very, very, very good one, I think.
Scott Benner 8:45
You know, I was looking online for medical definitions of non compliance and everything matches up with what Jenny said. But this one is interesting, it goes on cancer the initial definition to say, the cause or causes may be difficult to ascertain. The patient or client may have values and beliefs about health that are different from those of the healthcare provider or there may be other conflicts in the relationship that work against following the advice offered. In some cases, the patient or client may not have the financial resources, family support, physical ability or emotional stability to perform the prescribed tasks, poor self esteem, negative side effects of drugs and other forms of treatment and lack of progress, after adhering to their prescribed regimen can also lead to non compliance. Since it is assumed that the individual has sufficient knowledge to make the informed decision, lack of knowledge is not considered a likely cause of failure to comply. But that doesn't kind of count for diabetes, right? Because you can tell somebody something it doesn't mean they understood it. The nurse also should be aware that the patient or client may have the necessary knowledge and resources but have made an autonomous decision not to imply that someone Complete idea. I hope you enjoyed this episode of defining diabetes. Remember that it was brought to you by Dexcom on the pod and dancing for diabetes, there are links in your show notes if you'd like to find out more about them. As always, I appreciate you downloading the show, sharing it with others, leaving reviews and all the good things that you guys. I'll see you next week for the next episode.
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# 251 Defining Diabetes: Algorithm
Defining Diabetes: Algorithm
Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
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
No Jenny in this episode of defining diabetes, but that's okay, I can handle it. In today's episode, I'll define the algorithm. Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, the Always consult a physician before becoming bold with insulin, or making any changes to your medical plan. The word algorithm isn't really thought of as diabetes specific, but in the coming months and years, it's going to be the general definition for algorithm is a process are set of rules to be followed in calculations or other problem solving operations, especially by a computer. In Webster's definition, it expands this a little bit, a procedure for solving a mathematical problem in a finite number of steps that frequently involves repetition of an operation, more broadly, a step by step procedure for solving a problem or accomplishing some end. Now, why am I choosing in the middle of all these diabetes definitions to tell you about algorithm? Well, that's simple. In closed loop systems, algorithms are the brain, for example, on the pod is working on their horizon system that they expect to have out in the year 2020. It's a hybrid closed loop system that uses an omni pod, a Dexcom, G six, and an algorithm. This algorithm is designed specifically to take the information from your Dexcom G six be information about your blood sugar, what it is how fast it's moving, what direction it's going, this algorithm takes that information, goes through a bunch of settings, and decides this is how much more or less insulin you need to maintain a steady, stable time and range to avoid a low blood sugar to stop a pending Hi, this algorithm is going to make all of those decisions. So I think it's incredibly important that you know what an algorithm is, because you're gonna be hearing the word a lot. Now be clear about what an algorithm isn't. It's not a fortune teller, it can't see the future. It doesn't know something's going to happen before it does. It can only make decisions based on the settings that you tell it. What do I mean by that, if you're setting say that your insulin to carb ratio is, you know, one unit covers six carbs. And your Basal rate is definitely two and a half an hour. And you count your carbs up and you say, Okay, this is 50 carbs, algorithm. Here it comes but your way wrong, it's 100 carbs. But the algorithm believes you that it's 50 carbs, and it believes that it knows what your insulin to carb ratio is what your Basal rates supposed to be. And so it is possible that it won't be able to stop that high blood sugar, not right away, but eventually it will see that it's happening. And we'll get on it. But it's not a mind reader. It's not a catch all. It's not going to fix everything. These algorithms, however, are in their infancy right now within the diabetes community. And from what I've seen already from a number of them, they're spectacular. So I think it's worth you understanding what an algorithm is, as I believe they're going to have a large part in the way you live your life with type one diabetes in the future, the not so distant future
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#249 Defining Diabetes: Extended Bolus
Defining Diabetes: Extended Bolus
Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
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
In this episode of defining diabetes Jenny Smith and I are going to define extended Bolus. Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise the Always consult a physician before becoming bold with insulin or making any changes to your medical plan.
Extended bolus
Jennifer Smith, CDE 0:30
extended bolus that's a very good one because
first of all, a lot of people don't realize how this ended Bolus works. So extended Bolus refers specifically to pumping right in an insulin pump you have the option old if your son animist pump you had something called the combo bolus. If you have a Medtronic pump you have dual bolus and square as if you have Omnipod. Extended Bolus. If you have a tandem pump, it's extended Bolus as well. They all call it something different. They all essentially works the same exact way. Extended Bolus allows you to take a bolus and extend all or a portion of it out over a designated time period. So let's say for example, like the terms that the tronic came up with, honestly, the duel in the square wave Bolus, because you can do them on all the pumps even though they're not called that in all the pumps. A duel with Bolus means that you're going to give let's say your pump recommends two units right now for what you said you were going to eat. If you choose a dual way of Bolus. The pump will ask you how much of this Bolus do you want to give right now as an upfront amount, like a normal bolus that you get, let's say you say 50%. Okay, your pump is going to give you one unit right now, the other The next screen that comes up How long do you want to deliver the other 50%? Over in this case, one unit? Do you want it over half hour? Do you want it over three hours? Do you want it over four hours, eight hours, what do you want? At that point, the pump will start a drip, drip, drip, drip drip of that one unit bolus out over the course of time you told it to deliver it out over it doesn't wait until the end. Let's say you said two hours. It doesn't wait until you get to two hours and then it delivers the one unit Bolus. That is not how extended works in any of the pumps. It is a drip drip almost like a secondary bazel kind of if you think about it, drip drip drip drip drip out over the time period you said and again the other bolus is the square wave in Medtronic. You can do it the same way and the other pumps square wave means you give no normal bolus right now and say you say zero percent. Right now the next screen will say well how long do you want to deliver this two units over you say two hours it will drip drip drip, drip drip the whole bowl is in over a two hour time period. That's extended Bolus.
Scott Benner 2:55
I will sometimes cheat on a Pre-Bolus if Arden's blood sugar is not stable enough to hold it. So like say Arden's 20 minutes away from eating lunch and this is when we get a chance to Pre-Bolus while she's at school, but her blood sugar's you know 75 then we'll do a zero percent now and the rest over a half an hour so that it starts dripping rain right away but by the time she sits down and eats about two thirds of it is in probably none of its active. It just starts becoming active as she starts to eat and the rest of its in by then too and coming online. It's just it's it's a brilliant way to manipulate insulin. And in the end, a lot of what we talked about here is ways to make the insulin do what you want it to do, but more importantly when you want it to do it. So extending the wave square. These are all ways of stretching out your your insulin boluses.
Defining diabetes on the Juicebox Podcast is brought to you by Dexcom on the pod and dancing for diabetes. There are links in the show notes and Juicebox Podcast comm to all the wonderful sponsors, but if you want to find out more about getting a free no obligation demo of the Omni pod, you can go to my omnipod.com forward slash juice box to get started on the Dexcom g six continuous glucose monitor dexcom.com forward slash juice box and to learn about the good that's being done at dancing for diabetes, go to dancing the number four diabetes.com Thanks for checking out defining diabetes. Come back every Friday is Jenny and I break down a new word or phrase that is impacting your life with Type One Diabetes. Those of you on social media can follow me on Facebook, Instagram, Twitter, and of course the podcast is available in every podcast player you can imagine and at Juicebox podcast.com. please consider sharing the show with a friend. Okay guys, I finally did it. It took me a while to find a company that had merchandise that I thought Was quality. And it took me a while to find the design that I really liked. But we have redesigned the Juicebox Podcast logo. There's new fonts. I've got your favorite sayings like be bold, bold with insulin, stop the arrows and there's more coming. Head over to Juicebox podcast.com to check it all out.
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