Scott Benner 3/25/20 Scott Benner 3/25/20

#317 Ask Scott and Jenny: Chapter Eleven

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

When do you change basal rates? Basal versus temp basal adjustments.
What are the most meaningful measures of successful diabetes management?
What is a good standard deviation?

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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 and welcome to Episode 317 of the Juicebox Podcast. I'm your host Scott Benner. Today, Jenny Smith and I will be answering questions that you the listeners have sent it. Three questions today. The questions three. As you can tell, I've been locked in my house for a number of weeks now, I'm getting a little weird. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. And by touched by type one, you can go to touched by type one.org or Contour Next one.com to find out about these wonderful sponsors. My friend Jenny Smith has had Type One Diabetes for over 30 years. She's also a certified diabetes educator. She has a bachelor's degree in human nutrition and biology from the University of Wisconsin. Jenny's a registered and licensed dietitian, a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. And as you'll find out later, very well may be a person who can talk to wildlife. But one thing Jenny definitely is, is a person who would want to to know that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, she'd want you to always consult a physician before making any changes to your health care plan. We're becoming bold with insulin, and he's just good like that. She's rock solid, you know what I mean? She wants what's best for you. In today's show, Jenny and I are going to talk about when to change bazel rates you know when to do with Temp Basal, and when to put, you know, a firm change into place. We're going to talk about the measurement for success in diabetes management. And what a good standard deviation might be not just for you. But for everybody. Bum Bum, bum bum bum, bum, bum, bum, bum, bum, bum, bum, bum bum bum. The highlight of my entire week has been that the Costco near me had paper towels.

Hey, sorry, I was moving my microphone stand a little.

Unknown Speaker 2:18
That's okay.

Jennifer Smith, CDE 2:21
I think I have a like, I think I have like a problem with like, I did a finger stick. Okay. And my finger really hurts. really hurts. Like, like, and it's kind of like, puffy. Like, can you see that? It's like puffy and red again.

Scott Benner 2:42
We're on the top. It's puffy, but you didn't stick yourself?

Jennifer Smith, CDE 2:46
No, I stuck it on the side where I always does do and yeah, like I can't see anything from it. I also need like bifocals, because I have to go like this every time I have to like see something up close. My son brings me like the directions for a game. And I'm like, like, seriously, who wrote these directions? Like, come on.

Scott Benner 3:09
You have no idea how many times because Arden's a side stick like she sticks on the sides of her fingers, too. Yeah, you have no idea how many times like in the middle of the night when I do it. I'm so close to a cuticle. I'm like, how did I miss that? Yeah, and I looked down at her and she's not awake, and I go ooh, she's never gonna know about this.

Jennifer Smith, CDE 3:30
never happened before like, and it's it like it hurts it physically. Yeah. I'm like, I can't there's like no hole. I can't tell if there's like gross underneath or anything. But who knows? I don't know. Maybe there's like an alien growing underneath

Scott Benner 3:45
there. Listen, if it's too fast for you to get an infection, obviously. So it's not that I did you maybe just hit a nerve. I just

Jennifer Smith, CDE 3:54
responding must have just hit something that was just a much more sensitive spot. Or maybe I hit a spot that I had already hit. It's wrong. It's time it's kind of a favorite thing. Like

Scott Benner 4:07
Yeah, her sleep. Right. This is fascinating. In in Arden sleep, I will try I will go to fingers that she doesn't use figuring she's asleep. She won't know in her sleep. She'll pull the finger back and give me a different finger. That I'm always impressed by because sometimes I'll be like Arden and she's not awake. Right? she just she feels you in her sleep. Take the wrong finger. She's like, No, no, no, this one. Or she'll do two of them. She'll like either one of these is fine, but not like I try to use her thumbs when she's asleep. Yanks him right back holds him up in a fist. I'm like, That's hilarious.

Jennifer Smith, CDE 4:44
That's super funny. So So how are you? How are your older older kids? I hate calling them kids because they're really not kids anymore, but like, how are they doing with everything? I've got 17 nieces in Milwaukee, and they are just like, they're like climbing the wall really learning to up brother in law says they're just like, I cannot be inside anymore. I need to be not near my parents.

Scott Benner 5:13
I'm bored. Well, we're gonna turn your question. You're very kind. How are you question into part of this episode. And here's here's why Arden's insulin needs have gone way down since she stopped going to school.

Jennifer Smith, CDE 5:27
Do they go down in the summer too?

Scott Benner 5:30
Yes, she doesn't like being at school. That's just what it is. So now this whole the the, the incarceration is actually freedom to her. She can go to bed when she wants get up when she wants handle her work when she wants to. She's much happier. I'm seeing more smiling. I don't think I should ever send her back to school.

Jennifer Smith, CDE 5:55
The reason a lot of a lot, I've got several people that I work with who homeschool their kids. One who I started working with. I was telling about her she's the pilot. Yeah. And her parents school homeschooled her. She's now like, out of college, she's actually doing an internship with one of the airlines doing wonderful, but she was homeschooled. And they didn't see the fluctuations. Like comparatively with the other kids her age that is working with who were in school. clear difference from a weekend or a holiday away to actually being physically in

Scott Benner 6:33
school. Right now. There's there's been, even the summer takes time for her to like ramp down. Sure. But this was one day, the first day, which she was unsure of how this was all gonna work, her blood sugar didn't change. And then after she got her work in on time, she was just like free and easy and really happy. So it's interesting. Now my son. He doesn't like the lack of activity. Like we were outside in the driveway throwing a baseball yesterday for half an hour. He brought us. He said, He's the my kids are both very good with money. They don't ask for a lot of stuff. And he's like, I need a squat rack. For the basement. He's like, I need to be able to like exercise. And I was like, okay, and the other end, he walked outside just sat on the front step for a while, you know, just the hate, I need to get outside, because he's also a boy. So like, he'll start playing a video game and lose a day to it if he if you let him, you know what I mean? And last night, he told me around midnight, I'm going to get a shower. And then I'm going to read for my economics class. And I was like, Oh, that's great. And he's like, it's not. I was like, why is it not? He goes, because I'm going to read for an hour to get what I could get out of a five minute explanation for my professor. And I tried to do like I did the dad thing. I was like, oh, there's nuance to the reading. You'll appreciate it later. He was looking at me like, I don't care what you're saying. And I was like, I was like, I tried not to be, you know, I just was like, you know, this is it. It's good. And, but he wants that he's also concerned about how much we pay for school. And that now he's basically learning through, you know, yeah, really fancy YouTube videos. So he's like, why are we paying for this? And I said, coal, this time is going to turn. It's one of the strange things about about the United States at least, that I've never understood. Like, why has quality distance learning not become more? I don't know, like acceptable, especially in college. Right.

Jennifer Smith, CDE 8:40
Right. Right. Yeah. I mean, I think it's getting better now. How people viewed the distance learning like the University of Phoenix or whatever it is, yeah, all the commercials for but there, there are quality programs, and my sister in law actually did an online master's degree in business management. And she she does a great job. She's a wonderful job because she did that. So there's nothing wrong with

Scott Benner 9:07
no, no, no, but why is it not more popular? Why? Why not? Yeah, it is. It just is like, his level of embarrassment. Like I went to school, like through the mail. Does it feel like that or something like that? You know what I mean? Like 1960 took a writing course from Hollywood.

Jennifer Smith, CDE 9:22
Yeah, I don't know. I think I think in today's technology world, it's getting better. Um, in fact, some colleges as I'm sure you've seen with even Cole, I'm sure he probably has some things he needs to submit online and do that way already. But I think it's such a big change from the quality of as you know, in high school and even in college. There's a lot of social networking that goes on that you you don't get that when you have it at

Scott Benner 9:53
school. You just don't and we talked about that. There's, you know, you sometimes meet guys You know, he's playing baseball with or he's met through school. He talked to them a little bit, you know, that's an impressive kid for 20. It's going to be an impressive adult. And you don't know when 10 years from now that kid or your son's going to wake up one day and go, you know, I have a position to fill, you know, who would be great for this? Yeah, yeah, that guy played baseball with 10 years ago. And so there's that piece and there's the social part of it. Like, I'm not, I'm not discounting that. But for some people, they just want their degree. They're not looking for you know,

Jennifer Smith, CDE 10:28
they could care less about sitting in class next to the guy who doodles pictures of his dog.

Scott Benner 10:32
Right? Yeah, I met the most interesting guy in college yet. No one cares. But anyway, it's just it's it's interesting that they both are, they're not happy. We spent a number of hours playing poker the other day. You know, there's, we keep talking about having a movie night, but it hasn't happened yet. Everybody said we're, I think we're kind of quietly keeping things. Activities aside for when everyone loses their mind. And we really, like need the activity. So far. Everybody's been okay. And Kelly's under the weather, but Oh, it's not um, you know, it's nothing related to all of us. Yes. Yeah. It doesn't feel well,

Jennifer Smith, CDE 11:14
just a normal thing. I know. And that's every time you hear somebody like,

Scott Benner 11:19
like, Oh, my God, get back 30 person get away.

Jennifer Smith, CDE 11:24
The cough. Maybe they were eating a granola bar that didn't go down the right way.

Scott Benner 11:28
We're doing it on purpose for comedy reasons. Oh, yeah. Yeah,

Jennifer Smith, CDE 11:31
that would be my husband.

Scott Benner 11:32
Yeah, just everybody runs out of the room. Mom's like, Don't touch her. She's like, I just I got a dry piece of wood. Like that bringing us down with you. So, and she cut caffeine out. But she did it too fast. So now she has a caffeine headache, you know, and I gave her a little tea. I'm like, here have a little that's not from soda. And this, she might

Jennifer Smith, CDE 11:55
even do better if she if she's willing to do tea. She could even do something like a matcha which has a little bit of caffeine in it and could kind of ease down

Scott Benner 12:03
help her the caffeine.

Jennifer Smith, CDE 12:05
Because it's also much smoother caffeine than coffee coffees. Like you get this big like, Whoa,

Scott Benner 12:11
yeah, we don't drink coffee. Nobody here drinks coffee. Actually, I think the truth is that I don't believe Kelly ever has, but I've never had a cup of coffee in my life. So I wouldn't even know what it is. Jenny takes a large as well.

Jennifer Smith, CDE 12:26
I drink tea every morning. Usually a couple of hops, but

Scott Benner 12:30
I'm drinking Earl Grey with a little bit of honey.

Jennifer Smith, CDE 12:32
Oh, I have a very good friend in Colorado who Earl Grey. And lady grey are like her favorite.

Scott Benner 12:38
My favorite thing? It really is. Alright, so Jenny, we have a ton of ask Scott and Jenny questions. And we are going to do like three recordings in a row over the next two weeks so that we have them all set up. Yes. Before we start, let me tell you that and there's no pressure here. But tomorrow at 3pm I'm doing a like it's just a social meetup online. And if you're free and you jumped in for a couple of minutes, I bet you these people would be very excited to catch

Jennifer Smith, CDE 13:07
up on were zooms on zoom.

Scott Benner 13:10
Yeah, you could sit like this, click on a link pop up.

Jennifer Smith, CDE 13:13
What? Yeah, we zoom for our staff meetings on Wednesdays. But

Scott Benner 13:18
what at what time, three o'clock tomorrow? Three to 430 it's gonna run. It's gonna be like a free thing. Like people can come it's your

Jennifer Smith, CDE 13:24
time. So like, two to 330 my time. I should be around. Usually I'm working on emails at that time. So send me the link. I will

Unknown Speaker 13:33
even if you just popped in and you were like, yo,

Jennifer Smith, CDE 13:35
and send me a quick text while you're doing it so that I remember you

Scott Benner 13:39
will. You're gonna find out what it was like to be Elvis in the 60s.

Unknown Speaker 13:43
Ah.

Jennifer Smith, CDE 13:46
Interestingly, um, are you recording right now? Of course. Okay.

Scott Benner 13:51
I just wanted to read you want to say something private? Hold on a second. Bye, everybody. Well, Jenny, I hope nobody finds the body. I think you're gonna be okay with where you hit it. I mean, it's Wisconsin. There's so much snow on top of it. No one's ever gonna find it.

Jennifer Smith, CDE 14:10
We've got lots of bogs, too, you know?

Scott Benner 14:11
Yeah. Should we just start at the top of this list? Or do you have a favorite in here?

Jennifer Smith, CDE 14:16
No, I the one that I think we had commented briefly the last time we talked was it last week already? Um, was about there was somebody who asked about artificial sweeteners. And that one was curious to me. But there's a good list of questions. So wherever you want to start, it's totally fine to me.

Scott Benner 14:33
Okay, well

Unknown Speaker 14:38
can you like

Scott Benner 14:41
there's so many guys first of all, Rudy was so nice to send in so many questions. Yeah, let's just roll through the top. Okay. Okay. Sarah asks, please address puberty specifically. I think Sarah wants eight question answered for her specifically, but 12 year old, pre period girl spikes and drops are insane. They're on Omnipod Dexcom. So I think the question here is when to change bazel? And just Temp Basal. Okay, so she's seeing drops and spikes. And she's looking for when is this a change I make forever? And when is this just something that's happening? Well, that's interesting.

Jennifer Smith, CDE 15:22
It is. And it's a great, I mean, given the age of the preteen and and you know, her being a female, obviously, there are going to be, as I've talked with a lot of the people I work with who have girls about this age, who have not started a cycle yet. There are often about like a six to maybe 12 month time period before a cycle actually shows up. Okay, that if you start to track these resistant and sensitive times on a month to month basis, you may find anything to answer her question, you may find that it actually flows around the same time every month. And if you can catch that, then yes, you may be able to put a pattern in, you know, Omnipod, all the pumps out there allow you to actually set up different Basal profiles to turn on at certain points. So if you can track enough to say, Okay, this cyclic nature of resistance is always coming around the 15th of the month, or whatever it is, right? If you track a couple of months, and you see that, and you say, Okay, last month, we used 50% more this month, we're using 40% more, you should be able to set up a bazel profile, then that essentially is that much more at least in bazel delivery. And then just enable it for that time of the month and the duration of days that you see it typically lasts. That's you know, that's kind of then going forward into once a cycle does start, you'll be able to utilize that same kind of pattern. And once the cycle becomes regular, which is usually it takes about a year, yeah, give or take for most girls once they start their period to have kind of a consistency to it. So you should be able to use a pattern then, rather than just always employing a temporary bazel. It does take using the temporary bazel up front though, to figure out which amount extra you need to actually create a profile from

Scott Benner 17:28
okay. So last night, I learned that Arden has a name for her period and she won't tell any of us what it is. It has a human name, apparently human

Jennifer Smith, CDE 17:35
name. Yes. Awesome.

Scott Benner 17:36
I think she likes to feel like there's a person who's inflicting this on her so that she can be focused on the person doing the problem that's on the side. Yesterday I showed Arden's friend Jani, who has not been on the show yet, but will eventually she's somebody whose blood sugar on tracking. I showed her how to see that her pod site went bad. So she's rolling along great in the 90s just kind of bouncing, you know, at 996. Like all day long, three o'clock in the morning, it shoots up and levels off at like 220. And just stays that way all night till she wakes up at like four in the morning realizes that Bolus says the Bolus takes her down a little. And then she levels off and kind of rises back up again. And so I just pulled up a 12 hour graph. I showed it to her and I said just look at this. This is a bad site. And she's like, why? And I'm like, doesn't matter. It just is like look at it. Look at it. This is what a bad site looks like all the sudden, your insulin pump is not doing what you expect of it. Mm hmm. Common sense here says bad sighs it is this the last day of your set. And she goes it is and I was like, okay, change your pump. Get yourself down and start over again. The reason I bring that up where it doesn't feel like it maybe fits here is that the way I would handle Sarah's question is I would just do it over and over again until I had that feeling of like, Oh, I know what this is. And I really believe that it's not just me. I mean, I think the podcast has proven that out right? That eventually after you do something enough, you just see it. And then all the thinking goes away Jenny's what Jenny said is all perfect do that. But I think that one day, it'll just be a situation where you go Oh, this is a Temp Basal increase or Wow, this is not giving up. This is more. Right. Sorry. Exactly. long game.

Jennifer Smith, CDE 19:33
It is a lot. It's a marathon, not a sprint. Yes. entirely. And you know, in the beginning, though, when you're really trying to figure out the difference between a temporary or a true solid adjustment. Yeah. I think you know, when you make let's say you make you decide you're going to make a profile change. Oh, sorry. Ringing it shouldn't arraign I had it turned off.

Scott Benner 19:57
I didn't hear it on the sensor. You're good.

Jennifer Smith, CDE 19:59
Oh, good. Good. Good, good. So, you know, overall, you might make a bazel change. And then you're like, well, what, what gives Three days later, you're like, that's not working anymore. And now I'm way back down that might overtime again, prove, I need to maybe make a temporary adjustment, rather than a permanent kind of an adjustment, kind of similar to growth patterns and kids, you know, where you see a temporary need, because you're now fluxing up and Okay, all of a sudden, this is gone now. And I'm staying a little higher, but I wasn't at the rate of need. Like I was for three days. Yeah, it's come back down a little bit. But now it looks more stable. It's a little higher, but not quite. So. Yeah,

Scott Benner 20:41
yeah, I think that somewhere in between, stay flexible, be and reactive, not in a negative way. But in that sort of, don't wait around way, you know, like, and there's drifts Sarah that you'll start seeing on the Dexcom line. And just by the angle of it, I don't know how to explain it to you. But you'll start to look and go, this isn't going to stop, like this shouldn't be happening here. I'm going to try a Temp Basal increase right here. With Arden's period yesterday, I used a lot of temporary increases yesterday, because she was sitting stable at 190 boluses weren't moving or, and so to me, that meant, you know, bazel jacked it up, it worked a little but not enough, it was the end of her pump. So we swapped her pump, you know, we just went through the steps of you know, what it could be and, but we didn't wait around, like once you saw it, we moved on it. Well, we all have one thing for certain. And that's an abundance of Time, time that can be used in many different ways. You could perhaps spend your time at touched by type one.org. Or maybe you'd go to Contour Next one.com to find out if you can get a free Contour Next One meter by just clicking on a link and filling out some information. So here's what we're gonna do. Touch by type one.org has a mission of elevating awareness of type one diabetes, they also want to raise funds to find a cure. But mostly they're looking to inspire people to diabetes to thrive. They have these beautiful programs and services. They're helping kids all over the world with their D box program. And they put on one heck of a dance program every year in Florida. Go check them out, touched by type one.org. And once you've done that, you know what you need. You need the best blood glucose meter My daughter has ever used. And by best I mean, the most portable the handys fits well in your palm lights up nicely at night super duper accurate. And blood sugar test strips, the little strip things you get a second chance with if you mess up, you know when you go into the blood, sometimes you're like I got it, I got it, and then it doesn't beep and you're gonna throw away the test strip, not with the Contour. Next One, he does dive back in again, beep beep looking at your blood sugar. I absolutely adore this meter as much as anyone could adore a blood glucose meter. But Contour Next One is it. So head over to Contour Next one.com and see if you're eligible today for an absolutely free no obligation meter. And if you know you need a prescription, contact your doctor. They're just sitting in their living room to no one's doing a damn thing. Just throw them an email be like Yo, what's up? Let's try this new meter. send out a prescription. I've got nothing but time. Contour Next one.com touched by type one.org. Those links are in your show notes right there in the app, right that you're listening in now. And it's Juicebox Podcast comm check them out support the sponsors.

Okay, well, it's so funny. It's another Sarah but a different Sarah.

Jennifer Smith, CDE 24:17
There are lots of stairs just like Jenny. Yeah, it was a popular name. So

Scott Benner 24:24
they're even spelled the same way. It's not even helpful. What would you consider the most meaningful metric or measure of successful diabetes management?

Jennifer Smith, CDE 24:33
Oh, that's a good one. I think we've actually got we went over that a really long time ago. Any of the of the pro tips or any of those kinds of things? I think if you're looking at measurement from a site like clarity or one of your pump upload sites that gives you all of the metrics of this is your you know your average or standard deviation. This is what your glucose management indicator showing you what not what's the best indicator is time in range. That's it, I and second to that really would be that standard deviation, right? Because the lower the standard deviation, the more smooth management is rather than the jig up and down kind of Rocky Mountain. But definitely, I would say time in range. Our goal when we work with people is always new, at least 75% time in range less than 5% of the time low. pregnancies a little bit different. But

Scott Benner 25:35
yeah, so ranges, what are the ranges you give people? But is that range?

Jennifer Smith, CDE 25:40
I work with people on their target range, because everybody is individual. Mm hmm.

Scott Benner 25:45
So okay, so if Do you feel like most people are being told at 180? Something like that? 7180 Yeah,

Jennifer Smith, CDE 25:54
70 to 180. Like, if we look just at tide pool, tide pool has automatically set up as a timing range target, as 70 to 180. You can in your settings, go in and adjust that to get it tighter or make it broader or whatever. But yeah, most most practitioners, I would say, are aiming for about an 80 to 180. That's the most common that I hear. Um, so again, if you just aiming for what the standard is. That's it? Well,

Scott Benner 26:24
I think that these companies should expand this a little bit. I've been thinking about this, I need a time in range. And a time in Nirvana, like kind of mess, right? Like, I want to know,

Jennifer Smith, CDE 26:39
I want to know, the end range, but I really wanted this sweet spot. Like I'm not I'm

Scott Benner 26:43
not, I'm not upset that Arden's blood sugar's 180 for an hour, right? I'm going to get it back down again. But I want to know when I'm 70 to one to one, or, you know, at 130, once we're in there, I want to know when I'm, I even want to know, like 65 really like because if I'm because if she's 65, for a couple of minutes after Pre-Bolus? Yeah, I'm already with that, right. And so I think that everyone needs to remember that when we talk about this stuff, there's context that you need to give it. And you see all the time there's people online, or Look, I was in range 100% of the time today, and somebody will come in and say, you know, what's your range? And then suddenly, they don't come back again? Because you know, they never went over 350. And we're never under 50. I'm in range all day. And even you know, what, if that's for them a success? I'm not taking that from them. I'm just saying that when you're trying to share it out loud in public, you need to tell people what that range is, right? It lacks, you know,

Jennifer Smith, CDE 27:45
weight. And I've even seen something that goes along with it. I've even seen people then question, well, what are you eating? Because when we're looking at sharing our own information, and kind of patting ourselves on the back, what's good for us? Absolutely, it takes work. So go ahead and pat away. But you also have to, when you're putting it out there to the public, you have to give all the information that went along with that. You can't just say look at this nice flat line. Well, people then ask, Well, what are you eating? How did you get that? Because there are so many different variables that go into meeting that.

Scott Benner 28:21
So my blood sugar has been between 82 and 86. All day, I've had four hard boiled eggs yet like, like tell somebody the whole story.

Jennifer Smith, CDE 28:28
Right? Exactly, yeah, because it feels

Scott Benner 28:30
bad. Otherwise, like, otherwise you're looking at it, you're like, Oh, my gosh, you know, this person's blood sugars like this, I try to remember as much as I can to say, you know, ardency, one sees been between five, two and six, two, by the way, coming up now on six years. And she doesn't have any diet restrictions. But I always think the important thing to add is, for all of you that are imagining that her blood sugar is just at three constantly. That is not the case. You know, we just don't look at high blood sugar's very long and she's not low. So, you know, I would say that ardens deviations never where anyone would want it. Hers is usually like 40. You know, and

Jennifer Smith, CDE 29:11
but within range,

Scott Benner 29:13
it's being measured between, it's being measured between 70 and 120. Right. So, you know, and, you know, and I know, I still don't want her to spike up, but she sort of doesn't, right, you know, so. And not that she doesn't ever she does a couple of times a month or you know, a couple times a week or whatever it ends up being, but she just doesn't jump the 300 and stare at it. So I think that while the measurements are really important, the way we talk about them are is possibly even more important. So I don't see anything wrong with a one see if it's being done correctly, meaning no protracted lows that are giving you a false sense that you're a one C is lower. But what Jenny's saying is you do not want your blood sugar bouncing up and down. That is just It's not good for you, it would probably be better for you to be steady at 150 than to go from 70 to 300.

Jennifer Smith, CDE 30:07
Correct. Exactly.

Scott Benner 30:09
Right. So there you go. Actually, the funny thing here is the next question from Nicole, is, what are your thoughts on a reasonable standard deviation for a growing five and a half year old? Hmm.

Jennifer Smith, CDE 30:22
Yeah, that's an, I think you have to have a little bit of expectation that there is going to be more variability in certain periods of life, there will be I mean, kids, I mean, she's is growing five year old kids are growing considerably from birth, I would say, honestly, until about the age of like, 10 ish, things are kind of similar and patterns of growth, they really speed up, I mean, you can see the difference. You know, we've got one of those, like tree growth charts for our boys. And I usually turn every couple of months to see where are you because I know, you look like you've grown or your pants look way too short again. And I swear, I just bought new one last month, you know, but at some point that growth slows down. And certainly the teen years are a different amount of growth, not the same as far as like height or anything, although it could be for boys differently than for girls. But hormones are a bigger impact there in the teen years. for little kids like that five year old age, you can expect that eating for a standard deviation of something like 20 might not be in the cards, because you may have a lot more variability. Even if your timing range is kept very good, you still might have a little bit more variability in there. Because if your five year old is like my who is now seven, when he was five, I mean, he could be like I want to eat, I want to eat, I want to play I want to eat Nope, I'm not going to eat all of that. So when you mix diabetes in there, and you have to bolus and strategize and Okay, now I have taken a little way. And now I have to plan for this and whatever, there's going to be a lot more variability perhaps. But aiming, that's why I said that metric of time and range would be really more what to look at. Yeah, we don't want your standard deviation to be 80. But if it is going up a little bit more, you know, up and down. That's kind of par for the course with littler kids.

Scott Benner 32:30
I think that common sense is incredibly important here too. Because as you're listening to Jenny, explain this, from a clinical standpoint, you're thinking about what is or isn't said to you by the American Diabetes Association, or by your endocrinologist, all that stuff, you have to remember that they're just trying to give, they're not with you, they're not always whispering in everybody's here, right. So they're just giving a baseline like, you know, your standard deviation should be less than blah, your agency should be here, your variability shouldn't go but like, they're just giving you a place to start. I think that it's a, it's kind of incumbent upon all of us to take what looks like the rules, I'm making little quotes with my my fingers, and realizing that that's probably not the best you should be shooting for. It's not It's not the top, they're just trying to keep people. I don't know how to say this. There's a there's a way that if your own? Well, I'm struggling here, anyone, anyone who's been in a position of power in an organization knows that you're giving common denominator advice to your employees to you know, the subjects of your kingdom to like to whom ever you're talking to. And and to hear that advice and take it as gospel, I think is a mistake. Do you know what I mean? Like, you know, yeah, you ever go around a corner and the speed limits 25. But you're in a sports car, and you're like, I could go around this corner of 45. And it would be you know, that's you you're in a different car. They put the 25 there for the guy coming through in the 1975 Datsun like do you mean like his car can't handle this curve at 25?

Jennifer Smith, CDE 34:17
He will roll the car and right yeah,

Scott Benner 34:20
so for us, for instance, my standard deviation doesn't look good on Arden compared to what people say, except those people have a range between, you know, 80 and 180. While I'm shooting for a range between 70 and 120. And so, my I, I know where our standard deviation sets when I'm happy with our blood sugar, right, and I don't care what anybody else says that works well for us, right? And then people are like, oh, but then or health or health or health is going to be great. Like if you tell me that a person growing up with diabetes, who's got an eight one C and the fives constantly eat whatever they want, doesn't spike Hi, you know, maybe sees one ad twice a day for 45 minutes. If you're telling me that's a problem, I don't believe you, you're I mean, like I were, here's this, that's the best we can do. So, you know, we keep trying to tighten it down and make it better. But at some point, that's when you get to the life versus management trade off, like I got to be alive to

Jennifer Smith, CDE 35:24
weed. Right? Exactly. Right. Yeah.

Scott Benner 35:26
And so the problem with asking these questions are and getting the answers is that no one's going to give you a real answer. They're just gonna say what feels safe. Right. And so that's the most part common topic,

Jennifer Smith, CDE 35:39
what I can kind of say about standard deviation, though, even in, let's say, your timing range of whatever range you have set. Even for a five year old, for example, you know, if you're constantly having these big old climbs, and then constantly attacking then and then having a drop that you're getting into the red zone, and then you've climbing again, because of the red zone, and then you're dropping again, even if you're in range in doing that, that standard deviation, still, it requires improvement, right? You don't want this mountain peak, you know, up, down, up, down, up down all day, because even in range, it doesn't feel good for any age person. So the smoother that is, the better the person, the child to whoever feels.

Scott Benner 36:29
And if you're looking it up and down and up and down like that and worried about time and range or standard deviation, you're missing your Miss focusing your concern, your right turn should be Pre-Bolus thing and carb ratio and understanding glycemic index and stuff like that.

Jennifer Smith, CDE 36:43
And also effective insulin right duration of insulin. Yeah, understanding how long is my insulin actually working? You know, we're under I mean, that kind of takes it a step further in that variance that you see that standard deviation, because we're kind of in the understanding that our rapid insulin is rapid. And we've talked about this before, and that it also clears very rapidly. That's not actually the case, if you follow it out, right, there's actually a lingering dribble of impact. So if you are getting that up, down, up, down, up, down, it's very likely that even with using a pump, you might unknowingly be stacking insulin because your duration of insulin has been too short. And with modern day conventional pumps, what you set it at is what it uses, it doesn't know anything else beyond that, right? So it can't say okay, there's still insulin left here, make sure you take some of this off. But yeah,

Scott Benner 37:42
Chinese talking with her hands while I can hear birds outside of her window, and she looks like Snow White. I talk with my hands a lot. I don't mind the hand talking. I'm just telling you like Snow White for a second. Listen, here's what I think. Don't worry about your algebra grade worry about understanding algebra, right? You know, the grade will come if you understand the math. And with this, if you know how insulin works, the standard deviation of calm, the time and range are commonly a one seal come like you can't, don't focus on the grading focus on the work. And, you know, I don't know how many more times I can say this, I keep thinking I'm going to sync the podcast, it's timing and amount. It's understanding how insource use the right amount of insulin at the right time. And the rest of this becomes unimportant, you know, its background all of a sudden.

Jennifer Smith, CDE 38:30
And the important thing about that timing and understanding is that it is individualized right for you not to cut and dry up here. The doctor told me that this should last three hours. So that's what it should last. That might be the case for Johnny. But for Susie over here in the corner, maybe she's figured out that three hours the doctor told me Ah, it looks like it's four hours for me. So it does have to be individualized,

Scott Benner 38:52
right? I don't know where I was where I rolled up into a talk and I told people look, here's the truth. I could have flown in here, got up in the morning, got showered, jumped up on the stage, grabbed this microphone and said, Hey, everybody, it's all about timing and amount. Just understand how insulin works and you and you're going to be fine. Thank you. Good night. I could have left. You know. Well, you know what I left out some of the details about how to get to that but that's still the truth. Correct. Jennifer Smith is available to work with you. Check her out at integrated diabetes.com Thank you very much to the sponsors. Contour Next One and touched by type one. A lot of ones in there. Two ones you know you get when you add up to ones. One on One is equals to.

Unknown Speaker 39:45
I'm completely alone in this room.

Scott Benner 39:48
I just want to go outside, touch a handrail. Don't walk past somebody who sneezes and not have a stroke. Soon, probably a couple more weeks, couple months at the most, it'll be fine. I'm still wearing pants or you don't judge me. Listen, I put this up a little early. Right? Because on March 26, at 3pm going to do a big zoom meetup. And I have an idea for that I think you guys are gonna like, so if you're hearing this in the moment, check it out. And if not, the video will be running on the Facebook page, you can go back to it. But here's what my thought is, when you get a bunch of people together. And we're all going to, you know, just chit chat, see how things are going make sure nobody's like, you know, go and do it because they've been locked in their house too long. And after we all do a little Chitty, chatty like that. We're gonna talk about getting people's bays on its own right. So like a big group thing on everyone's basal insulin. And then we're gonna come back the next week, see how people are doing and then add another step. And maybe during this whole Coronavirus thing, we can bring everyone's variability and standard deviation and a one seat down, when that'd be cool. If we just all got together in a group and did something like that. I hope you think it's cool, because I'm pretty excited about it. March 26, Thursday, 3pm Eastern time. There's links right now on Facebook, I think the links on Instagram, send me a message if you don't know how to get to it, get there gonna go through people's bays or it's just like it's a private phone call. We're all gonna be there, kind of kicking in our two cents, helping everybody out. You know, if the listeners of the Juicebox Podcast can't count on each other during a time like this, then I don't know who we can count on. So while we're all busy being stressed out watching bad Netflix shows, I figured we could spend a little bit of time doing something for everybody's health. I hope to see you there. Hey, last thing if you're not a subscriber to the show, like if you just count on remembering the shows on it would help me out a lot if you hit subscribe in your podcast app would help even more if you share the show with a friend. And if you're not up to like sharing the show, maybe just share the zoom with them get together and maybe they'll see something they like and they'll check it out on their own. The podcast is growing so quickly because of you guys. It isn't even letting down during this Coronavirus thing. I'm super impressed. I thought for sure. Like oh, downloads will slow down but they haven't. And that's really very touching. Oh, by the way, last thing next week. So the next show that comes on. Let me take a look. On the 30th of March, it's going to be an after dark episode. Sexuality from a female perspective. So if your kids usually listen, don't let them listen to that one. Because there's not a lot of bad words in it. But there's a lot of clear talk. So unless you want your kids to know exactly where the round peg in the square hole are, I think you should. I think you should make sure they skip that one. I didn't believe a lot of kids listen to until recently but apparently they do. Which I think is great, but not for this one on Monday. So there's an afterdark coming up on Monday. Make sure you kids. don't hear it.

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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Scott Benner 3/25/20 Scott Benner 3/25/20

#316 Julia

Dr. Julia Blanchette, PhD, Registered Nurse, Certified Diabetes Care, Education Specialist and Type 1 Diabetic.

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Scott Benner 0:00
Hello, and welcome to Episode 316 of the Juicebox Podcast. I'm your host, Scott Benner. And this is the type one diabetes podcast that you've been searching for. Today's episode is with Dr. Julia Blanchett, PhD. She's a registered nurse, a certified diabetes care and educational specialist and a person living with Type One Diabetes. Not only that, she may become a regular on the podcast, you'll find out why soon. Today's episode of The Juicebox Podcast is sponsored by Omni pod, the world's greatest insulin pump. It's tubeless, you know, no tubing. What does that mean to you? Well, it's easy to find out. Because you can get an absolutely free no obligation demo of the on the pod sent right to you by going to my Omni pod.com forward slash juice box. Today's show is also sponsored by the dexcom g six continuous glucose monitor, you want to be able to track your blood sugar in real time without a finger stick. Get the dexcom g six, head over to dexcom.com Ford slash juicebox. To find out more. As I said in the cold open, Julia has type one diabetes, she's also a CD even though you know they're starting not to call them CDs anymore. Julia has a PhD as well and her focuses for her dissertation are of great interest to me. And I think to you as well. To check out Julia today, I think you're gonna like her. And I think she's gonna be back. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. Becoming bold with insulin, or you know, walking outside during this Coronavirus thing. While we're all locked up in our houses, I'm going to be holding some zoom meetings for people just to check in and chat with others. The first one's going to be March 26 at let's say 3pm. Eastern time. Okay, March 26 3pm, eastern time, you'll be able to find links, where you're gonna be able to find links on my Facebook page, and on Instagram, and Twitter 3pm you can come by and chat, just listen, you can show your face, you don't have to just going to be like a little support group for people to type one. You know, while we're all locked up in our house. First of all, you know, we're recording. And I'm gonna apologize to you for you know, you and I had a full and complete conversation that I made you wait months and months and months to actually hear. And then it turned out I had recorded my voice and not yours. The third time I've done that in five years. So not feeling too bad about it. But I did enjoy speaking with you. So I thought let's do it again.

Julia Blanchette, PhD 3:02
I mean, it was pretty fun. So

Scott Benner 3:04
fun dad will be able. And plus there's other stuff to talk about now. So we're gonna, we'll do a little a shorter thing about you. And then we're gonna talk more about what's going on in the world. Perfect. Makes sense. All right, perfect. So how old are you right now? And what is your name?

Julia Blanchette, PhD 3:23
I am almost 28 and a week, I'm 28. So I guess I'm 27 and almost 28. And my name is Julia. And oh, I was gonna say more. And she didn't ask me to say more.

Scott Benner 3:36
So, look, you don't have to follow the instructions that closely. Why? Why are you so accomplished at 28? What happened to you as a small child did someone impress upon you, you need to work really hard or something like that.

Julia Blanchette, PhD 3:49
So I was diagnosed with Type One Diabetes when I was shopping. And I had a really amazing support system. Mostly my mom who always advocated for me and helped me learn how to advocate for myself and show me that I wasn't going to let anything stop me. And I think that really has led me to become who I am. And

Scott Benner 4:12
you just got a degree right? Like, what what did you just accomplish?

Julia Blanchette, PhD 4:17
So I just finished my PhD. So I have my PhD in nursing science and my area of expertise is financial stress and psychological symptoms in young adults with type one diabetes.

Scott Benner 4:33
So hold on a second. Wait, that seems like a lot. Explain that to me. What was that?

Julia Blanchette, PhD 4:39
So it's, it's I have a PhD. So if you actually look at my degree, it just says doctor philosophy, okay. But but then people are always like, well, what's your PhD in? So then I say, well, it's nursing science that was technically my major, but then people are like, but then what is it really in in nursing? So I gave the full answer

Scott Benner 4:58
and give it to me. One more. I'm slowly.

Julia Blanchette, PhD 5:01
So I have a Doctor of Philosophy or a PhD in nursing science, and my area of expertise is in financial stress factors, psychological symptoms, and self management outcomes. And young adults with type one diabetes, the

Scott Benner 5:18
only person who has this degree in the whole world are the other people in the room with you.

Julia Blanchette, PhD 5:23
Um, so I'm the only person who's defended this dissertation and the whole world. But there's other people who have PhDs in nursing science.

Scott Benner 5:32
So when you are tasked with your dissertation, what, what led you to choose those focuses?

Julia Blanchette, PhD 5:40
Yeah, so that's an amazing question. So I'm very

Scott Benner 5:43
good at this podcasting. That's why it's

Julia Blanchette, PhD 5:46
so good at the podcasting. I'm

so I'm so when I graduated with my Bachelors of Science in Nursing, my BSN. That's what would have allowed me to take the RN exam. I worked at diabetes camp for that summer, and I was the counselor and training nurse. So I spent the whole summer with 16 year old, young girls, or young women. And it really opened my eyes. So I worked really closely with some amazing now young adults who have overcome a lot and but at the time, they I just saw all of the psychological stressors they were facing. And it really was eye opening to me to realize that I had an amazing support system. And I really haven't had a lot of barriers psychologically with managing type one diabetes, but it's not like that for everyone. So that was the first really important thing that I noticed as a clinician for the first time that I wanted to then bring research in to figure out how to solve problems. So I went into my PhD, saying, I want to figure out better support systems for adolescents and young adults with type one diabetes. And then at the same time, I was going through the transition from pediatric to adult diabetes care. And I was kind of just thrown, for lack of a better word, onto the adult side, um, I went to see my pediatric endocrinologist in a different state. And so when I was seeing my adult endocrinologist, like 500 miles away, my pediatric endocrinologist who was amazing just didn't really know who to connect me with. So I had, I was nervous to make it my first adult appointment. And when I made it, it was really discouraging. So then, I was like, Wow, so there's all of these adolescents that don't have a lot of psychosocial resources and have a lot of psychological barriers, and then they have to go into this transition. That is awful. So that was the next piece of what I wanted to look at. And so first half of my coursework during my PhD, so it was like a year and a half, I was set on trying to find better ways to smooth the transition from pediatric to adult diabetes care, by making sure that these adolescents and young adults had better psychological support. Okay. And then January 1 2017, happened.

Unknown Speaker 8:28
And

Scott Benner 8:29
that's my I painted my bedroom.

Julia Blanchette, PhD 8:32
Well, well, that's amazing. That's that that's not what happened to me. something a little different happened. So um, so January 1, that year, I was switched from a non high deductible private insurance plan paid by my father's and player, or covered by my father's employer to a high deductible plan. And young Julia had no idea. Like, I had no idea about health insurance, right. My parents were paying for it. I was, at this point, I was going to pick up all of my medications by myself. And I was paying for some of my medications and supplies by myself. But I was I was a graduate student. So I was on my parent's insurance. I was not 26 yet. So then, I'm the first week of January. So it wasn't January 1, but that was the day the insurance changed. So it was probably like the fifth or sixth. I go to Walgreens to pick up my three vials of insulin. And the farm tech looks at me and she's like, I don't know what's wrong, I can't dispense this. And I said, What's going on? And she said, your insulin is like astronomically expensive. I don't know what's wrong. I don't know why your insurance isn't covering it. And so she even applied the pharmaceutical coop on which at the time only deducted like a $100 savings for the high deductible and then, of course, I had to I called my parents crying and we figured out a way to pay the high deductible to get my insulin. But it was a shocker like I was my eyes were open again, to just another problem that a lot of people, especially young people with diabetes were likely experiencing. So,

Scott Benner 10:20
Julie, I just did something that I don't normally do. I wrote down things. Yeah. And here's what happened. Please don't feel any pressure to say yes. Okay. But what I think we've just done is outline the first three episodes of a new diabetes pro tip series, with you as the guest. Oh, that just happened? Do you feel like that just happened?

Julia Blanchette, PhD 10:41
Well, well, Jenny, get upset. I love Jenny. No,

Scott Benner 10:43
Jenny, and I have already had a conversation. I've been looking for someone to handle the psychological stuff. The questions that come up that I can talk through, but don't understand enough to be definitive about. And I just as you're speaking, I started writing down questions that I had around these ideas. And if you're up for it, we should talk about that later. If you're not just disappoint all the people who just heard me ask you that. And then you said, No,

Julia Blanchette, PhD 11:11
no, I'm down for anything. So you know,

Scott Benner 11:14
I'm sure your parents don't want to hear that. Okay, so there's, so I'm first I'm gonna say something to you, that's gonna make you laugh, and I'm gonna bleep it out. No one's ever gonna hear it. When you said on january first 19 data 2017 this amazing thing happened. I thought you're gonna say I found my

Unknown Speaker 11:35
Oh, my God.

Scott Benner 11:38
I see you understand where my brains running in 19 different directions while I'm doing this podcast, there will be one long beep through everything I just said. just wonder forever when I said to Julia,

Julia Blanchette, PhD 11:50
but and this is this is the difference between me and Scott. I'm a researcher who finds these aha moments. And Scott thinks about other things. My

Scott Benner 11:59
brain just bounce around. Okay, so write your first thing you talked about. Um, I was wondering, what are you seeing so far? Like, let's tease us this idea a little bit. When you talk about the stressors, right? Do they lessen when people have good tools? We're living in Strange Times. It seems we're all sort of in our homes now waiting out the Coronavirus are still some people of course it has to get out to work. But many people around the world are in their houses right now. And it feels strange. It might feel like life's on hold that there's a pause here, but I choose to see it as an opportunity. It's an opportunity for you to better your own health, you have this block of time now. There's less to do. So that means there's more time to focus on your health. more time to figure out a new device for instance, like beyond the pod tubeless insulin pump. There is no better time to go to my Omni pod.com forward slash juice box. Then right now, let Omni pod send you out a pod experience kit. And absolutely free, no obligation demo of the Omni pod can wear it around your house to your new dystopian life and see how you like it. And when you decide that it's for you contact on the pod and they'll get you going. Then you can use this free time, you know to get your basal rate set up and learn how your new insulin pump works. It's really kind of perfect. I mean, you know, with the exception of the Coronavirus, otherwise the free time is what I mean is perfect. My Omni pod.com Ford slash juice box. It's the world's best pop. It's an amazing device. It's tubeless nothing to be clipped to your belt or stuffed in your bra or hidden in your shirt. Right just this little self contained, beautiful pump that will deliver your insulin sleeping and awake, active inactive sitting on your sofa rewatching your favorite show for the 30th time. After you do that, reset the music. And check out the Dexcom g six continuous glucose monitor. You may not be surprised to know that that's at dexcom.com Ford slash juice box. When you get there. It's a simple trip to a better life. Get started with the dexcom g six it's a green button right on that page. You can make knowledge your superpower with the dexcom g six. It's covered by most insurance plans and it is absolutely at the center of how we make decisions about my daughter Arden's type one diabetes. It's how I can look over my shoulder right now and see that her blood sugar is 78 after today having a bowl of cereal and Apple I saw her with something else and Between think she's been snacking on chocolates, it could possibly be that time, you know, I'm saying her blood sugar has never been under 70. We're over 120. Not today. Imagine that Frosted Flakes, and a 120 blood sugar. I get to that courtesy of the information that comes back from the dexcom, continuous glucose monitor, you absolutely owe it to yourself to check it out. Zero finger sticks, customizable alerts and alarms, smart device compatibility for Android, and iPhone, you can share your data with followers, right? Your mom, your dad, your sister, your brother, your best friend, they could see what your blood sugar is. It's indicated for children two years and up. Come on dexcom.com forward slash juicebox. Get in there, get in the fight. Look at this text I'm getting right now. I swear this just happened. Hey, Dad, I'm gonna have some sherbert Look at that. No worries, just sherbert Dexcom. When you talk about the stressors, do they lessen when people have good tools?

Julia Blanchette, PhD 16:08
So that's a really good question. I'm gonna preface this by telling you so I can only talk about what I have published from my dissertation. But I can also tell you what I've seen clinically and what I know just from other researchers, so I'm with the young adult population, even young adults that have access to technology. So that's a, you know, it's a high percentage of a lot of people with diabetes. But we think that potentially a young, lower percentage of young adults than the general population are using these technologies. They're still having stressors.

Scott Benner 16:46
Okay, so so people to so if, say, I'm a person, let's make me a person with diabetes in this scenario, and I know all the stuff that you know that I know, because you listen to the podcast, I'm still going to feel stressors, even though I'm that on top of the idea of my management.

Unknown Speaker 17:05
Yeah. Okay.

Scott Benner 17:06
All right. I imagine that to be true. Are they greater when I don't understand the management?

Julia Blanchette, PhD 17:12
So from what I've seen clinically, I think when you don't understand the management, it definitely can contribute more quickly to burnout because you feel more helpless.

Scott Benner 17:24
Okay, so is in your mind? Because it's such a it's a word, right? burnout, like we throw it out? Yeah, it really does it really mean just an inability to care at some point or to or to be motivated or something along those lines?

Julia Blanchette, PhD 17:40
Yeah, so it does, I mean, it means that you've gotten to a point where you, you've physically and emotionally cannot do the tasks. And then there's other components as well, like with diabetes, distress, and other psychological factors to like depression and anxiety. But burnout itself means you do not have the ability to actually get yourself to do what you need, what you don't want to do what you need to do, because I'm trying to steer away from making people feel bad when they're unable to do what they would otherwise do.

Scott Benner 18:22
descriptive word in, in an intellectual conversation, it's the things that have to happen, you have to get your insulin in a timely way, you have to know how many carbs you're taking in for the most part, like the things that have to happen around diabetes, you just literally cannot bring yourself to, to do them to care or do them or to, to feel the and it, but it doesn't stop you from feeling the impact of not doing it.

Julia Blanchette, PhD 18:44
Correct. And I think there's a lot of guilt that I see.

Scott Benner 18:47
Okay, all right. Yeah, you're the right one. We're doing this. This is the least five episodes that could turn into more. See, it's good thing that my recording thing didn't work, because I never would have had this idea. Otherwise, it was it was the different way that you described your PhD this time than the last time that made me think oh, this is the right person

Julia Blanchette, PhD 19:08
will remember last time I didn't defend my PhD yet. Yeah. So I am I am a different person now. So when we recorded last time, I was a few weeks away from defending it.

So imagine how different of a state I was in.

Scott Benner 19:22
You were just back then you're like, I hope I get this damn thing done.

Julia Blanchette, PhD 19:25
Yeah. Yeah. And I hope I hope that they passed me like that's how I was feeling

Scott Benner 19:30
I can wonder to out about the just the pressure of like, what if I defend this thing, and I get my PhD and that's all great, but I get to the end and think to myself, Oh, this whole thing was bull. I don't even believe this. Like, Is there ever that feeling like what if I get through all this and I get to the end and I don't even agree with myself when it's over.

Julia Blanchette, PhD 19:48
So I think I'm doing a PhD in itself is a really emotionally challenging process. And I think for most of the PhD students that I've talked to And then there's quite a large support network on social media like on Twitter. Um, I think all of us just feel so burnt out by the end of it that it's like, you just want to get it done. And like, that's the main thing you're thinking about. But I was so lucky in the fact that I had this, and I'm going to be honest, like, most PhDs, you just try to get your dissertation done. But I mean, I really crafted something from what I had seen clinically what I had experienced personally, as a young adult with diabetes, and where I saw the gaps in the research. And I actually did, I will tell you, I had significant findings, which isn't always common for a dissertation. So not everyone actually finds that their hypotheses and their research design actually conclude with relevant Well, all results are relevant, sorry, so I take the relevant word back, but they're not always significant results. So I did have significant results,

Scott Benner 21:02
I have to tell you that I don't have the ability to, I would not have the ability to claim a PhD out of the world. But I do believe that this podcast has given me back significant results about the stress that you take away from people by just allowing them to make decisions that they can kind of count on. And yeah, and have repetitive occurrences and outcomes and things like that stuff that they can lay back and go I know, if I do this, this is gonna work. And that if it doesn't, there's a reason aside from the steps I've taken. And I think that's amazing. But I'm, you know, again, the dirty secret of the podcast, right? It's, it's for me, if it helps you, that's a benefit. That's awesome. Um, I'm thinking that what you and I are going to talk about, is, is going to help me and I'm already I'm already feeling more comfortable with my thought that as life progresses, there are going to be times where Arden is going to have to kind of you know, come home for the lack of a better term, to reset herself around diabetes. And that could that could happen, as a young adult in college, it could happen as a married person, it could marriage, it could be as an older single person, like whatever she ends up being, I think there's going to need to be a home base, where you can go back to people who just like are like, Oh, I know how to do this. It's okay, let me take it off here for five seconds. So you can reset. So sort of the way we talk about, yeah, when you roller coaster, right, with diabetes, or when you get high and you get stuck high. Sometimes you just got to get low, stable and start over again. I think that that the truth about life, if you're if you're really listening to the show my concept about diabetes, it's just my concept about living, well applied to insulin. So I don't want to I don't want to give the whole secret away, you know, before I'm done paying for my kids college, but Oh, God, but that's what the podcast is like, to me. Like, it's just my basic idea of being alive applied to other things, and in this case, diabetes.

Julia Blanchette, PhD 23:04
Well, and I want to take a step back and go back to what you were saying. So, you know, what we're finding is that even if parents aren't actively involved, parents or other types of caregiver support, aren't 100% actively involved in self management for young adults, just having someone who is supportive and who's there for you for your diabetes, like you just described, is that in itself helps helps prevent some of the psychological distress,

Scott Benner 23:32
right? Oh, no, I I find myself saying just as a matter of, you know, a baseline, I say, into your mid 20s. I think they need support, at the very least, and I don't know why. I mean, there have been times in my life in my 20s and 30s and 40s, where I've had the thought like, I gotta go find my mom, you know, they mean like,

Julia Blanchette, PhD 23:53
Yeah, well, and it's the same thing. So it's, it's this whole, like developmental stage of emerging adulthood. So it's not only when one's taking on diabetes, self management and experiencing how that is, but it's, you know, the typical developmental process when you do need to lay on others, especially people who you've depended on your whole life for support in certain situations.

Scott Benner 24:17
I know excuse me, the whole concept of the excuse me one second.

Julia Blanchette, PhD 24:24
Give Coronavirus Coronavirus in my throat. Yeah. Oh, no. Good thing. We're, we're not talking to each other in person right now.

Scott Benner 24:33
I'm not even six feet from this microphone. This microphone screwed to? Oh, no, but no, no, um, I think that as much as I understand the statement, how old you know, people ask me very frequently, you know, what's a good age where they can take over their own care? And I think some people ask because they don't want to infantilize the kids around diabetes. That's their fear. But I think there are some people who ask us like, you know, when can I stop? You know, being burdened with this diabetes thing, like I like kind of put it on the kid a little bit, you know. And in my mind, I don't think there's an age. You're,

Julia Blanchette, PhD 25:07
you're on it, you're on it. There's not an age, it's different for everyone in every situation, you get it. Of course,

Scott Benner 25:13
William was on the show years ago with 15, listening to the podcast, and then figuring things out as mom came on and was talking about, you know, how well, you know, she and I spoke privately and she's like you, my son, listen to your podcast, and like, put a whole plan together for himself. That's a certain person. All you know, Arden is, you know, sometimes I'll be like, Hey, what's your blood sugar? And she'll be like, isn't it on your phone?

Julia Blanchette, PhD 25:38
Well, that's what teenagers do. But I mean, I think to like, so the type of person I am, I always wanted to manage my diabetes by myself. So I was diagnosed when I was seven. And for the first year, my mom and dad gave me most of my shots. But then I can say, I think by the time I was eight, when I was on a pump, I was calculating my carb doses, I remember. So I was, my carb ratio was point seven for 15, which is actually a one to 20 to carb ratio. But the reason it was so weird is because in 2000, we were still using carb exchanges. So you did everything in 15. So that's why it was point seven units to 15 carbs. But I remember my neighbor, who's amazing, she was, she's a teacher. And she kind of did like, um, I don't know if she did special ed support or what she did, but she actually helped a lot of kids like with math and like smaller settings. That was her job. And she actually showed me how to do my carb calculations, because the pump didn't calculate it. For me at that time, we it there was no carb calculator, or calculator on the pump. So my neighbor actually showed me how to calculate my carbs. And I would I, at eight years old, I was figuring out how much insulin I needed for carbs. So but that takes a special person like not to call myself special, but what you just did. But like, I think not, it's just the person I am like, I am very motivated to do things and self motivated. And, and, you know, so with the transition and doing the independent self management, it really just depends on who the kid is, but also their situation.

Scott Benner 27:18
It just, it's who you are, right? Like, yeah, it would, it would be ridiculous. We couldn't randomly just take 10 children and tell them all, you know, you're going to be calculus majors, right? It's right for some people and not right for other people. And you do need to listen, there are some, in my opinion, some basic ideas that everyone, you know, kind of has to adhere to, and there are things you should expect from your children a baseline, but then you don't start expecting calculus from all of them. Some of them, you know, probably should be drawing a picture or write telling a story, you know, or or talking to other people. I mean, honestly, this thing I'm doing right now, this if this idea of having a microphone, and being able to speak to a person remotely about something, if that was a thing that existed in the 70s, I would have known that was right for me that,

Unknown Speaker 28:05
right, you know,

Scott Benner 28:06
and but it just didn't, it didn't exist. But imagine if someone, I was lucky enough to not get pushed into a direction that wasn't me. Right? You know, I had this, um, I don't think I've ever told this here. But I said it to somebody the other day that made me remember, as I was leaving middle school and going into high school, I was walking down the hall in the waning days of my last year, and my guidance counselor came out of a door saw me and grabbed me pulled me in, and don't worry, this doesn't end poorly. And, and, and he said to me, I'll never forget him. His name was Mr. Wiley land I but I didn't have that much, you know, interaction with him. But he said, I'm glad I found you. I wanted to let you know, I think you're going to do great. And I always thought you should be an attorney. Well, I don't know how old I was. Maybe I was in ninth grade, eighth grade, you know what I mean? Like, whatever how old you are then. And even at that age, I stopped and said, Oh, that's really nice. Thank you, but then I'd be an attorney for the rest of my life. Right. I was like, that sounds bad. Yeah. You know, like being anything for the rest of my life. sounds bad, but I don't want to. And then he asked me why. And I said, I have to be honest with you. I think I could be a good attorney. But I don't know if I have the self restraint. Not to be a bad attorney.

Julia Blanchette, PhD 29:29
And I knew that in eighth grade.

Scott Benner 29:32
I know, I know that I see the other side of I know that there's a there's a good person who I am. But I also see the other side. Like if I decided to start an online ministry and steal from people, I think I think I could do it you hundred percent wouldn't. But I also always wonder, you know how much of what we wouldn't do is because we don't have the necessity like you know, when people used to tell me like You're such a great dad, it was easy. My kids were good, easy kids. Like, I wonder if my kids were like, terrible how good of a dad I would have been, you know? Yeah.

Unknown Speaker 30:07
And I wonder

Scott Benner 30:07
if you made me an attorney, if I wouldn't end up being like the mankind? Or you don't I mean, like, so yeah. So I had those two thoughts. Like, I don't know if I can trust myself even then. And I definitely don't want to do the same thing for the rest of my life. Now, as an adult, I know I can trust myself to do the right thing. I do it over and over again, when I have the opportunity to do the wrong thing. Yeah, but but I still cringe at the idea of doing the same thing forever.

Julia Blanchette, PhD 30:36
Well, sounds like you're doing what you enjoy. And it's different all the time. So I wish to see you got that

Scott Benner 30:41
I'm at the point where I wish I could make this podcast every day. Yeah, like, I would enjoy that you and I are having a completely different conversation than we had the first time. And I think I could bring you back on every day and have a different conversation with you. Oh, don't take that. Personally, I can do it. Anybody. I'm saying it's me. I'm the skill not usually you

Unknown Speaker 31:00
stop trying. Hey,

Julia Blanchette, PhD 31:02
my spot? No, but I mean, I think like, I do think you're right about that. I think you're you have very good, real conversations with people. And you're not just interviewing them with the same types of questions and getting the same types of answers. And I think, yeah, you could you could find someone different every day. Thank you. And

Scott Benner 31:21
yes, I'm very proud of it like really am and I'm proud of how it gets better. Because Yeah, even I there are times I'm in the middle of a conversation, I think this is better than I would have done last year. like wow, while I'm talking to somebody. But But nevertheless. So. Alright, so you've had type one for quite some time. And now how do you take all of your fancy learning Julia and apply it in the real world? And by the way, did you find out your PhD made you another $5? a day? How much? How much? Is that helping?

Julia Blanchette, PhD 31:49
You want to know the real answer?

Nothing more right now. So yeah, thank you. But I can tell you know, the jobs I'm qualified for, it'll, it'll pay more. I'm just right now, since I graduated in the middle of the year, I am working not full time, but I'm working like 70% of the time as a Diabetes Care and Education Specialist formerly known as a certified diabetes educator. And I love that job. So I do have a couple of future opportunities that are potential that would Yes, they would pay me quite a bit more with the PhD. Um, but for now, I am happy on where I am. So I'm not I'm just going to things will fall into place.

Scott Benner 32:34
And I see I see that we're not saying where you work, and that's fine. But I, I want to say that Julia works in a very impressive place.

Julia Blanchette, PhD 32:42
Oh, thank you. Well, and I have a I have an awesome team. So I think I've grown a lot even since I started working with them. I've grown so much as a clinician, it's excellent. To answer your question about how do I take what I learned and apply it to myself. So I'm a very hands on learner. So what that means for me is that in order for me to fully understand things, I actually have to try them myself. So a lot of times, I find myself doing these self diabetes, self management experience experiments, before fully taking the knowledge I know about it into practice. So I think I kind of do the opposite of what you were asking, I kind of try it on myself first, and then I apply it in practice. But when I'm trying it on myself, I definitely take a lot of time to stop and look at my patterns and figure out kind of what's going on as it's happening. So I do take a lot of time to understand all the different factors that are impacting me and what changes I can make, and that I learned from working with patients, right? So I'm telling them to look at their data, and think about everything they're doing and think about all the factors and I have applied that to myself. So

Scott Benner 34:00
how many people do you meet? What's the ratio? I guess, is my question of people who you look at and think this is gonna work out for them versus people who you look at and think this isn't going to work out for them.

Julia Blanchette, PhD 34:15
So you asked me this question last time, and I have the same answer. I never look at someone and say this isn't going to work out.

Scott Benner 34:22
Okay, a more difficult road. Is that a more fair way to say it?

Julia Blanchette, PhD 34:26
So, and this is good, this is really weird timing. So I have to tell you, I've met one person in my years as a diabetes current education specialist, who really didn't want to be in my office and really didn't want to be talking to me. So that is the only example of a person where I'm like, this person is going to have a difficult time because they don't even want to learn. Um, so you know, adult learning since I work with adults is a lot. It's um, it's a lot of the person wanting to learn themselves. and applying it to what's relevant for them. So I try to shape all of my education sessions to the person and to what their needs are and to what's relevant to them. So I kind of go in with, what can we make work for them, as opposed to what what worked for them? And that's just my frame of thinking.

Scott Benner 35:20
That's the same thing we were just talking about really, with, like parenting or diabetes, or any of that stuff, just like, yeah, molding it to people. So that so then that's a, that's a great answer, and makes me realize is my question incorrectly? That's okay. How many people? Let's start here? How many people have type one diabetes in America?

Julia Blanchette, PhD 35:41
Um, you know, Dr. Julia should really know the answer to that. But it changes so frequently. It's it, I believe, isn't it one point something million 1.8 million, something like

Scott Benner 35:54
that one and a half coming up on 2 million people. So my question then is, how many of those people are significantly underserved with information and support? Like, maybe our you may be seeing the ones who have insurance who come You know what I mean? Like, like, I only try to imagine who it is we're not finding.

Julia Blanchette, PhD 36:15
So I yes, that's okay. So that's a really good question. So in my current practice, we, we do take people who are on public insurance, but we don't offer like free services to those who do not have insurance. But even that being said, I mean, I get people every day that are like, I'm so happy I met with you. No one's ever told me this before. No one's ever told me why I need to count carbs before No one's ever taken the time to explain what a carb is to me before. No one's ever taken the time to explain that. It's not necessarily my fault. My insulin might not be what's right for my body's needs, right. Now, how does that happen to them?

Scott Benner 37:02
Because they know they have no tools in their hands. Somebody saw Oh, no,

Julia Blanchette, PhD 37:07
it's an it's like, I have to say, it's, I would say with 80% of my patients, they feel like they're doing something wrong. And in the end, then I always, you know, I take the time to provide them the education they deserve. And, and it's just, it's really shot. I mean, yeah, I think now that I'm talking about it and thinking about it, it is really shocking that so many of them just don't ever get the education that they need. But I think a lot of it has to do with our healthcare system. So if you know, if you're diagnosed in the hospital, you're kind of they kind of this is nothing against inpatient diabetes management, or educators, it's very different. And they have to kind of put out the fires, and just explain to you, okay, you need insulin, you need to prevent lows, like, that's all you can, that's all a person can have the capacity to learn when they're in patients, and we're

Scott Benner 38:01
handling it wrong, then. Because the truth is, this podcast shouldn't need to be popular. Right? You know what I mean? Like, there, there is a very easy way to put it out of business, it's just have died, have people educate better at the at the at the point of contact?

Julia Blanchette, PhD 38:18
Well, so I think so just from, you know, I, I obviously didn't get my like I my whole family education at our point of contact. And I think my mom would have a lot more to say about how she felt overwhelmed opposed to me, who is running around the hospital, in hospital socks, dancing with my friends, not not feeling very sick. But I think now that I've had friends my age that have been diagnosed with diabetes, and have been in the intensive care unit in DK, like, it's really, you can't provide even if you try to provide the education needed at that point in time, people don't have the capacity because they're so overwhelmed with their diagnosis, or they're so sick. So I think the key is getting them to diabetes education when they're out of the hospital, but that doesn't happen. Because, you know, it can say that on the discharge orders. Or they might, they might be at a smaller community hospital that doesn't even have diabetes education, right. Or they might be at a hospital and live far away. And they might not have access to an educator. So I think there's still a lot of barriers. And then if you're overwhelmed, and you just went through all of this have, you know, of this new diagnosis and this hospitalization? I don't know I would show up for diabetes education, but maybe other people still feel too overwhelmed too. So there's just a lot of factors. Um, it's a really complicated,

Scott Benner 39:47
I'm gonna say something that's gonna sound pompous for a second. Okay,

Julia Blanchette, PhD 39:50
okay. Okay. Now,

Scott Benner 39:52
I think that if you could, obviously there's a lot of pie in the sky here. But yeah, if you could Bring me to your institution. And okay, and let me talk to 10 people, okay, the first three days of their diabetes diagnosis, and I would need a half an hour with them, and then a 20 minute follow up. I think I could do it.

Julia Blanchette, PhD 40:16
I think there's something about connecting with someone else who has diabetes in a light that's not medical, medical, medical, and a light that's like, I'm a real person. But I also find that that's why patients appreciate me, because part of my strategy is showing them like I do understand, or sometimes I don't understand, but if I do understand, I let them know, like, hey, like, here's what, here's what I found helps me. I'm a real person. And you know, it's interesting, a lot of my patients will come in, and they'll be like, you're gonna be so mad at me. Because I haven't been Pre-Bolus thing, or I've been, what they'll say is I've been eating bad. And I'm like, I'm not mad at you. You're a real person, like, this is how we live our lives. And we just have to find a smaller goal, and figure out how to meet it for you.

Scott Benner 41:07
I don't change what people say when they're on the podcast. Like, I don't correct them if they use terminology I don't agree with because I think it's good for people to hear how people feel. But I'm always like, shocked when someone tells me they're a bad diabetic. Like I

Julia Blanchette, PhD 41:20
know, and it's just showing how guilty people feel. Yeah,

Scott Benner 41:23
I know.

Julia Blanchette, PhD 41:24
It's a problem.

Scott Benner 41:25
It is. Okay. All right, let's do. I'm gonna hit two things, right. And because I've messed you over so badly with your episode, yours is going up very soon, so I can

Julia Blanchette, PhD 41:37
Oh, can I trust you or no, I don't know.

Scott Benner 41:44
So I want to talk to you about and you're gonna have to help me be. You're gonna have to help me with your phrasing. Okay. Okay. And I want to finish up talking with you about algorithm based pumping. Okay, and what you're talking about at your practice around Coronavirus, as it's March 17. Right now. So okay, let's start with the corona thing. So have you been in Corona meetings? Like are you got what is happening, but like, what I expect is happening in our endocrinologists offices, this is all kind of ramping up and happening.

Julia Blanchette, PhD 42:21
So I'm gonna be totally transparent. And let you know, I think it really differs based on what state you're in. And because you know, different state governments are suggesting different or implying different restrictions right now. And then I think it also depends if you're at a big practice or at a really small private practice. So I can tell you at my big practice, as of March 17, we are not closed, we are trying to limit in person contact, though. Okay, so and that's another thing. So like, if your practice doesn't have virtual visit capability, or you have state law restrictions on that, that might be a barrier. That being said, I'm saying this on the morning of March 17. Later today, there could be some sort of law passed that waives those restrictions. So it's very, it's a very fluid situation. But I think you don't expect that you can't contact your endocrinology or your diabetes practice, because we're all making arrangements, as of March 17, that you can contact us and that we can somehow get you what you need. So I've seen some practices doing just telephone console, that don't have the virtual capability. I've seen other practices that are just waiving fees for the time being, and then figuring it out later. So don't feel like we're not available. As of March 17. We are. We're just a lot of us are trying to limit the in person contact.

Scott Benner 43:53
You're further in off of the coasts, not a lot, but yeah, you still are. And it's very funny as, as I saw, like speaking engagements getting canceled. Yeah, I had one in Wisconsin. And they were like, everything's fine. I'm like, are you sure cuz I don't think my son's going to college anymore.

Unknown Speaker 44:13
Yeah, no

Scott Benner 44:15
one's talking about here. And I said to Julia in Wisconsin, I said, give it two days. Yeah, and sure enough, two days later, yeah, had bled, you know, the virus had spread towards the center of the country a little more. And so it's happening. It is interesting, how we, how we like to, like wish for what we want to happen, you know, when you start seeing what's happening in Seattle, and New York, and these other things to think it's not going to continue on is just like, that's just hopeful, in a way so it's coming towards, towards everybody what and it's so are you looking at tele med, is that an idea where you're going to be able to video, chat with people and have real life Thanks, do you have any idea which way they're gonna go?

Julia Blanchette, PhD 45:02
So I can tell you my practice. Um, we have virtual visit capabilities for my practice in my state. Not all insurance covers virtual visits, though. So there's an out of pocket costs for some situations as of March 17, that may be waived by my hospital at some point, I don't know what's going to happen. But yeah, so we're going with virtual, but then like, yesterday, I actually had a patient who doesn't have a smart device, or a computer. So like, in that situation, we would do telephone, instead of virtual. So like, we're making it work, like know that we're not trying to push you guys, at least my practice, and I would hope everyone's like this. We're not, we're not trying to limit your resources, like, we know, you need your resources. So so so don't freak out, I would always call your practice or your provider to see what they're offering at this moment.

Scott Benner 45:57
Because it's gonna change pretty readily is this it's gonna change. Yeah, and this is, my best guess is this is going to go on for a number of months, probably. So

Julia Blanchette, PhD 46:07
yeah, as a as a health care provider and a researcher. I would say, it's not we don't really know when this when it'll stop at this point. But expect, at least for the next month to two months.

Scott Benner 46:21
No, I think I think eight weeks is the is the bare minimum? We're gonna

Julia Blanchette, PhD 46:26
Yeah, that's what that's what it seems like the experts are kind of directing towards, so it's not going to be over quickly. And, you know, I think this probably is, unfortunately, I don't think this is the first time we're going to be hit by a pandemic, either. So I think we're learning a lot from this experience, especially as healthcare providers, and I think we'll be much better equipped for next time, because right now, we're just doing what we can we're just adjusting as needed.

Scott Benner 46:52
I completely agree. Yeah. So have you met or heard of anyone with type one who has Corona yet?

Julia Blanchette, PhD 47:00
I have not. I'm waiting for it to happen, since I feel like I have a million friends that all have diabetes. care. I don't know anyone who's been diagnosed with it yet. That being said, I'm sure I'm sure. Yeah, it's coming. And I'm sure someone's had it. But you know, as someone with diabetes, it is really important to know that if you have any type of complications, you and or your blood sugar's are running higher, not blaming anyone for either of those things. I know a lot of people have circumstances where that's just how you have to live. But if you're in one of those situations, know that you could be at higher risk of contracting it, if you have well managed diabetes, for lack of a better term right now. And you don't have complications, you're not necessarily at a higher risk of contracting it. But with either situation. Like with any type of illness, you are at higher risk of going into decay, or getting ketones or having dehydration, or hyperglycemia, from contracting an illness. So we all just have to be careful,

Scott Benner 48:05
right? And I just recorded an episode that I put up today, I just recorded it last night with Dr. Adam Edelman, he said the same thing, just in general, the better you the better health you are in, aside from diabetes, just in any way you can consider, you know, the more capable your body's going to be fighting off a virus or right, you know, or maybe you know, I'm not saying keeping you from getting it, but it might make it more difficult for you to get it might make it more difficult for it to thrive. And you just in general, your quality of your health has a lot to do with your quality of your ability to stay healthy.

Unknown Speaker 48:39
For sure. Yeah,

Scott Benner 48:40
I agree. Yeah, it's just it. I mean, that's, this is common sense, right? We haven't really said anything too deep there. It doesn't mean that, you know, some, you know, Olympic pole vaulter with you know, point 14% body fat isn't gonna get the Coronavirus

Julia Blanchette, PhD 48:56
will. Right. That's the other thing too is it seems that there's gonna be situations that are exceptions to the overall situation. Like there's going to be exceptions where someone randomly gets a really bad case today, and there's no logical explanation. It just happened. Like I feel like that's also something we need to be aware of. So social distancing, guys.

Scott Benner 49:19
Yeah, stay away. Stop. Yeah, stop kissing people. Yeah, that's hot. You just wait a little bit. Relax.

Julia Blanchette, PhD 49:29
Oh, that's hard right now. Well, listen, the

Scott Benner 49:31
last thing I'm gonna roll into because of just because of your, your PhD, if else is what about people who are already sort of naturally anxious or, you know, depressed or worrisome like I have. I don't want to say who it is, but there's someone that I know who you know, sort of suffers from some, you know, mental health issues and you can already see that person bubbling over trying To think their way through this in, you know,

Julia Blanchette, PhD 50:04
yeah, so I think at this time, I mean, social isolation and itself can contribute to even greater feelings of depression and anxiety and isolation, right. And then just the angst that the rest of the world has right now can also contribute. So anyone that has already has a mental health diagnosis, they're already at higher risk of being they're being put in an environment right now, that's going to exacerbate their symptoms. So keep that in mind. And I think just like with diabetes, don't assume that your mental health care provider is closing, or not available. Like I'm telling you Everyone is making resources available. I also know in general, telemedicine. And I'm like, so tell it and then virtual medicine for psychological resources are both increasing in popularity in general before this happened. So if you don't already have a mental health care provider, look and see what you can get connected with online to see what services are available to you, because it's really important to take care of your mental health during this time. It's I mean, it's just going to exacerbate things.

Scott Benner 51:13
I'm thinking of just doing like a Facebook chat just for everybody to kind of come together and chill out. And you know,

Julia Blanchette, PhD 51:19
yeah, and I think community support during this time is really vital to

Scott Benner 51:23
know. Cool. All right. So now, Julie, I want you to be really thoughtful about my ads. Okay.

Unknown Speaker 51:31
Okay. Okay.

Unknown Speaker 51:35
Oh, boy, okay. He's good

Scott Benner 51:36
at this. This is a test for you. Okay. Are you using an algorithm based pump?

Unknown Speaker 51:44
I am, how is it working for you?

Julia Blanchette, PhD 51:47
It's fantastic. So I was using a different algorithm based pump before, which was also great. But yourself? Yes, it was a little more. Yes. Um, and I now using a different algorithm based pump. And I mean, honestly, like I was achieving greater than 80% time and range on both. But with this one, I'm actually having even less variability. So my standard deviation, which shows the variability, that's one of the measures for it is very low. On this one in comparison to the last one, even though I was achieving greater than 80%, time and range on both. And on this one, my 90 day average for timing ranges over 90%,

Scott Benner 52:34
what is your time and range set out? Your range?

Julia Blanchette, PhD 52:37
So I am I am a Diabetes Care and Education Specialist. So when I read reports, I use the same time and range that we use as clinicians, because that's how my brain works when I'm assessing. So and also in the, in the clinical trials, this would also be the way they've set time and range. So it's 70 to 180 is the way that providers look at time and range and the way that we look at like ambulatory glucose profile outcomes and metrics, and then it's also how the studies for all of these devices, look at time and range seems very

Scott Benner 53:08
reasonable. Yes, excellent. I have Arden's obviously set at my goal. Not Yeah, yeah. From 70 to 120.

Julia Blanchette, PhD 53:15
Well, no, that makes sense for you guys, for me, so I actually have my highlighter on my pump. Oh, sorry, on my device. I'm so pumped. That's the pump. Okay. Okay. So sorry. So my Hyler on my pump and on my CGM of choice, um, of choice and that is integrated with the system. Um, it's actually set lower than 180. But just for my reports, I put it up one at every once in a while for my

Scott Benner 53:40
for the reports on for art and stuff, I just switch it down, I switch it back up to 182. Yeah, I'm like, Oh, my God, we're doing great. And they push it back down. It's funny how pressure serves different people differently. Like, I like to set it at 7171 20. And when I when it says I'm out of range, even if she's 130, or 140. I like to know that 40% of the time, she's not under 120. So that I can write, it helps me think about how that happened. But I'm not. I'm not impacted by it. Like, for instance, last night. So Arden was home. This was her first day yesterday, distance learning for high school because her high school got shut down. Right. So I think she was maybe a little stressed out all day, and we had her we had her bazel cranked to like 150% all day just to keep her like more stable and down around. Yeah, one focus.

Julia Blanchette, PhD 54:36
She wasn't like running around school either. Like in the

Scott Benner 54:39
hallways a lot changing and I'm trying to figure it out. Right, but I did think all day. She's gonna get lower overnight because of this. And around 1130 her blood sugar started like trending down and we turned off all the you know, the extra insulin that we have going. Yeah, but I'm like this isn't gonna stop like I just know it isn't and she ate an uncovered Banana. And I kept, I turned everything down a little more. And then right when I know I needed the insulin to go back on, I fell asleep. Oh no. And so from about 3am till 6am artists blood sugar was like 270. It showed up out of nowhere and leveled off. Yeah. And when I got up in the morning, I just looked at I went, I fell asleep. That sucks. I fix it. And I didn't think about it again. But that's a long time with diabetes, practicing not feeling guilty. Not not going down that path of like beating yourself up and everything like that.

Julia Blanchette, PhD 55:36
You can't I mean, you're a person. You have to fall asleep. You fell asleep. That's how it happened, right?

Scott Benner 55:41
Yeah, this is not going to, you know, this is not going to negatively impact Arden's existence. No, and so and so I'm like, you know, cool. But there would have been a time years ago, where I would have beaten mice, I would have got up and like, what do I do you know what I mean? Like it would have felt, but, but I like that range set where I can feel I want the feedback. It doesn't Yeah, it doesn't make me feel bad. But But it took me some time to train myself to that. So okay, so you're so your timing ranges? is really excellent. Yeah. Are you still Pre-Bolus thing with this?

Julia Blanchette, PhD 56:17
I am right. Pre-Bolus thing is key. And I will keep saying that. So until the devices do not require you to Pre-Bolus which is coming. Um, the current devices Pre-Bolus thing is still key.

Scott Benner 56:30
Yeah. 100% do you think, from what you've seen, I know what I think. But do you think from what you've seen, this is the way the future? Or do you think this is the thing that five years now? We'll all look back? No, no. Do you remember that time we thought algorithms were going to help us with our insulin?

Julia Blanchette, PhD 56:48
No, I think they're gonna keep getting more complex. So I think I mean, I know, from some research presentations, I've been to, that they're integrating even more machine based learning into these algorithms for the future ones that are in development. So, you know, soon the pumps will be able to predict like, you're moving in this way you're about to eat, and then they'll be able to change insulin based on that. So I think the algorithms are going to be great. I think we're going to look back and say, Wow, we needed, like different types of insulin to work a little more efficiently in order for these algorithms to be even better.

Scott Benner 57:27
Yeah, no, I think improving insulin canula technology like little Yeah, that's what I think about right, like, those are the those are the, the points that should be focused on right now. But I'm just gonna say that I, I am looking very forward to the on the pot horizon coming out, when it comes out. And I'm thrilled that there are other options for people in this is it to me, this is, this is it, you're, you're right there,

Julia Blanchette, PhD 57:58
you know, and I think they're just gonna keep getting better. So I think, you know, the first couple that have been out here, like, maybe we'll look back and be like, wow, that really wasn't as much of an algorithm as what's currently available in five years, you know, but I think they're helping people so much. I'm not focus so much on the little decisions that we have to make constantly. I mean, there's still, obviously some psychological involvement with diabetes, but they're really reducing it. And I think they really are helping people achieve much better time and range. I do something Pre-Bolus thing is key with the commercial ones, though. Yeah. Listen, and I think that's what's helped me so

Scott Benner 58:37
2021 and 20. And 20, the end of 2020. Here in the beginning of 2021. This is the jumping in period. Like, yeah, I'm telling you, if you if you met me on the street and asked me I'd say do it, let's go. Yeah, yeah. Right. So

Julia Blanchette, PhD 58:51
yeah, there's a saying, stop. Yeah.

Scott Benner 58:52
And and then the next step, of course, is access and affordability and getting these things to a point where they're less expensive, easier for other people to get because then maybe one day, there'll be a world where the person who is not going to understand what was told to them in the hospital or doesn't get a hold of them. Maybe they really just will get a thing. You know, here, slap this on here. Put this on here. I'm going to put an app on your phone.

Julia Blanchette, PhD 59:17
Well, that's Yeah, that's what it's coming to. I can tell you that's, it's getting there. So it's really exciting.

Scott Benner 59:23
I'm excited to know that you agree. I really am. Yeah, because you've been using it for a while, haven't you?

Julia Blanchette, PhD 59:31
Are you allowed to say that? automated? Yeah, I am. Um, so I've been using this device for over three months now.

Scott Benner 59:39
Right. Okay. Cool. Yeah. Yeah. I just been doing this for a long time at this point now, too. Yeah, yeah. We just put some episodes out about it that I think you even came up online said you learned something on one of the episodes with Kenny, didn't you? Was that you?

Julia Blanchette, PhD 59:55
I don't know if it was me. I think I'm the one that will. No offense to the listeners. I'll send you messages. I was like, I thought about this a different way.

Scott Benner 1:00:01
Yeah, no, I like that. Yeah.

Julia Blanchette, PhD 1:00:05
I don't, I can't remember if it was I don't think it was Kenny. So I think it was a different episode. Gotcha.

Scott Benner 1:00:11
I hear, I just think it's a, it's so worth having these conversations, because you're laying a blanket of understanding across the community that hopefully we'll, you know, will one day be big enough to warm everybody? Yeah. Because you're not just gonna reach every single person. Like, you know, and this is not how it's gonna work. It's there's gonna be a trickle down. There are gonna be people who, you know what, not unlike how you spread the Coronavirus. There are going to be people who use an algorithm based pump, because it's something I said on this podcast, and they're never going to have heard of this podcast. Yeah. And I think that's important for us all to be doing spreading good information out to

Julia Blanchette, PhD 1:00:50
people. No, I agree. Good. And like accurate information is really important. Yeah.

Scott Benner 1:00:54
Trust me. That's a that's not as easy to get people to do. I know, but it's getting better. And you know, what is helping? This is gonna sound crazy. Facebook pages are less and less popular now.

Unknown Speaker 1:01:07
Yeah.

Scott Benner 1:01:08
Have you seen? Have you noticed that?

Julia Blanchette, PhD 1:01:10
Yeah, I think we're moving towards Instagram. But I don't know if that's more accurate.

Scott Benner 1:01:17
What I'm saying is what you're losing is a place where let's pretend you were diagnosed a day ago, and I was diagnosed a month ago. And I found this place online, me with my one month worth of information and pontificating about what I've learned. And you come rolling in thinking, Oh, Scott knows, listen, look at how he's talking. He must know he typed a lot. Yeah, you know, and you don't realize that you're listening to a person who's three and a half weeks ahead of you. Right? And then it just blends confusion. And the information still in there, because there's also people in there who are giving you good information. But when it's all blended together, like how do you figure out what which is, which like, what do you know, is a trusted source in that situation? Right. And so, you know, and that's blurring away. It's so interesting to have watched this for as long as I have, you know, I came into it during blogging, and Oh, yeah. And there were blogs that were rock solid. Do you know what I mean? Like, wow, you could you could you could bank on what was being said there, then blogging became popular, and then all of a sudden, there were a lot of opinions. Right, which are fine, except now how do I decide which opinion blog is good? Yeah. And then they kind of drifted away, blogs drifted away. And Facebook killed blogging. Yeah, right. Because it used in the beginning, you'd write a blog piece. And you'd post it on Facebook, and someone would read it and share it on Facebook and social sharing, like that used to be really popular. And so then the Facebook was good for the blogs. But then as soon as people opened up Facebook groups, and made them private, that killed the blocks, because the guac

Unknown Speaker 1:02:57
don't want

Scott Benner 1:02:58
you to leave the group. They want you to stay in the group. And so they don't direct you out to other stuff that killed blogging. And then now, I think that being able to get information in other ways, you know, is now is now hurting Facebook. And so those groups are dwindling down. And it's so interesting to watch how it just rolls through and changes and changes and changes. Super.

Julia Blanchette, PhD 1:03:22
Yeah, you've seen all of it. So I'm very old as well. You're not old. You've just seen the internet grow. Yeah,

Scott Benner 1:03:28
it's a very weird thing to go from dial up to this. Yeah, seriously. It's like I said last night. How is it possible that my kids are bored? Like at no other time in the history of mankind? Have you had more ways to keep yourself busy or fill your mind or anything that you do right now? My son was home from college for three hours to just wander around the house go What am I gonna do? I'm like,

Unknown Speaker 1:03:52
Oh, no.

Unknown Speaker 1:03:54
Poor guy.

Scott Benner 1:03:56
Oh, man. Yeah. are just like artigos school. Thanks for gonna read for 30 minutes a day. Haha.

Unknown Speaker 1:04:03
Man.

Scott Benner 1:04:05
Oh, man, I getting Julius PhD one day, that's for sure. Oh, God, anyway. Okay, so I'm gonna say goodbye here. And we're gonna spend 30 seconds, but me asking you about setting up some other stuff. So hold on one second. Thank you so much for doing this.

Julia Blanchette, PhD 1:04:22
Yeah, thanks for having me.

Scott Benner 1:04:24
Huge thanks to Julia for coming on the show and for considering being on some diabetes pro tips about more emotional and psychological issues regarding type one diabetes, look for those in the future. Thank you also to Dexcom, makers of the G six continuous glucose monitor. I appreciate that you sponsor the show. And of course, my longest advertiser, my dearest advertising friend, the Omni pod tubeless insulin pump. You can find out more about Dexcom dexcom.com forward slash juice box, have yourself an absolutely free no obligation demo of valmy pod sent to you at my Omni pod.com forward slash juice box. And the links to all of the sponsors are in those show notes of the podcast player you're listening to right now right in that app. They're also available at Juicebox podcast.com. Now, if you're listening in an app, and you haven't already, go ahead and hit subscribe, so you don't miss the next episode of the Juicebox Podcast, and then go look back, because there's about 314 other ones that you haven't heard yet if this is your first one. Okay, don't forget on March 26, at 3pm eastern time, we're gonna have a meeting, it's just a meet up, right, it'll be through something called zoom, you'll just click on a link to get into it. You don't need any special software, you'll be able to interact with, see if you want or just listen to other people just like you who are listening to the show. I'm thinking we're going to use it as sort of a support group, while we're all kind of you know, holed up in our homes. So that's Thursday, March 26, at 3pm. Eastern Time, there'll be a link on my Facebook page, my Instagram, and my Twitter, you'll find it or if you don't send me an email, I'll hook you up. absolutely free by the way, no charge No, nothing like that. No special software needed. Just bang and look around. Don't look around. You can turn your camera on or not turn your camera on. Right. And we'll just sort of like you know, shoot this

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Scott Benner 3/20/20 Scott Benner 3/20/20

#315 Jenny Smith, CDE discusses Coronavirus

Coronavirus disease (COVID-19): Juicebox Podcast conversation with Jenny Smith, CDE

Recorded March 20, 2020

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:07
Hello, everyone, welcome to Episode 315 of the Juicebox Podcast. Today's show was recorded on March 20. It is a conversation about Coronavirus with Jenny Smith. At the end of the episode, I've listed some important talking points from the CDC website. Make sure you get to those.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, becoming bold with insulin, or anything else that might come up. You know what I mean? Jenny Smith is a registered and licensed dietitian, a certified diabetes educator, and a person who's been living with Type One Diabetes for over three decades. Jenny has the exact same person you hear on the diabetes pro tip series during the defining diabetes episodes. And of course, ask Scott and Jenny. Jenny works at integrated diabetes. And if you want to check her out, or even higher, you can do that. Jenny's email addresses right in the link of the show notes.

This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. The Contour Next One is without a doubt the finest most accurate blood glucose meter My daughter has ever used in the entire time she's had type one diabetes, go to Contour Next one.com to find out if you're eligible for an absolutely free meter today. The podcast is also sponsored by touched by type one. When you go to touch by type one.org, you're going to see an organization that is working towards a cure, supporting people with type one diabetes, and putting on maybe one of the greatest dance shows I've ever witnessed. Go find out more about them. They're supporting people with type one diabetes all over the world. You might be one of them, go check them out. And if you don't need that support, and you want to help support someone else, this is a great way. Touch by type one.org is a great way to do that. Get yourself an absolutely free no obligation demo of the Omni pod sent to your house today. Go to my Omni pod.com forward slash juice box. When you get there fill out a little bit of information. And on the pod is going to send you an absolutely free no obligation demo of the Omni pod. You'll be able to try it on wear and see what you think. And of course, find out more about the Dexcom g six continuous glucose monitor the exact same CGM that my daughter wears today. Go to dexcom.com Ford slash juice box. Let's get to the show.

Jennifer Smith, CDE 3:01
Hello. Hey, good morning.

How are you today? I'm

Scott Benner 3:06
we're hanging in there. How about you?

Jennifer Smith, CDE 3:09
Yeah, I'd call it the same. Oh, I would assume calls home from school.

Scott Benner 3:14
Yeah, we didn't even make it through. My gosh, we didn't even make it through is I'm

Jennifer Smith, CDE 3:23
sorry. I didn't realize I was all covered. A little post it notes.

Scott Benner 3:27
I don't want to know what you're doing with your computer in your private time. It's fine. So Cole was in Florida for his college tournament. He got there Friday. We got there Friday. On Sunday. He asked us for Azhar tech thinking that his allergies were coming on the runny nose. On Monday, he asked for another one. Kelly and Arden left on Monday to go home. I stayed behind Tuesday was his day off. And when I picked him up Tuesday, late Tuesday morning to take him to lunch. I was like, are you okay? And he's like now I don't feel right. And I was like, okay, so I took him out to eat. And he didn't look good. So I said hey, go back to my hotel and lay down for a while. So three hours later, he woke up. And he woke up to an email from his coach and said we're having an emergency meeting to talk about the season. So I had to hump him back like a half an hour to his hotel. He was feeling better from sleeping, but, you know, he didn't look magically better than me. Right. You know, and they announced that the season was going to be suspended. That's what they do at the time. And he definitely didn't feel well still. So now he's like ask me kind of like trying to be like, slides like I couldn't have the Coronavirus, right. And I was like, I mean you could you know I said you know what, what are your symptoms at that point he had a sore throat, a runny nose, you know Now you don't have a fever, you know. So, right. So the next day comes Wednesday, he ends up pitching his face off against the number one ranked team in the country. In Division Three, just pitches, these two amazing innings comes out of the game. The game ends, he gets on a bus and goes back to the hotel. I'm supposed to pick him up for dinner, he texts me, he goes, Hey, I'm not gonna go to dinner. But come over here. He's like, I felt like I was gonna throw up on the bus. And so I think he used every ounce of energy, everything he had, and realized that he was sick. So on the way over there, I just stopped at a like a Walgreens. I'm like, let me just get a thermometer. You know? Yeah, stuck the thermometer in his mouth. He must

Jennifer Smith, CDE 5:45
be a dad. Yeah.

Scott Benner 5:46
100.4. I took him right to urgent care. Oh, my God. Now he's an urgent care with a mask on. And they swap him for flu. He doesn't have the flu. And the guy looks at his throat and says, Listen, you have strap? I can see it. You know, he's like, I'm gonna give you a antibiotic. And I said, Are you gonna swap him for it? He goes, man, this is strep throat. And I was like, okay, you know, fingers crossed and all. But I took him out of the hotel where the kids were where the poor kid had to leave his team. Wow, I just basically like shudder, like, just yeah. And the he didn't play the rest of the week, obviously. But the antibiotics did it. That's right. He had strap. Yeah. So but you know, in the moment, it was weird. And when he went back to watch the games, like from outside of the dugout, and the last two days, people were, you know, they're like, hey, how's he doing? Like, you know, we just want to make sure it's all right. It really what they meant. No, they really meant was Hey, got strapped we took given authority has exactly what I was saying. Just like just like, oh my god, are you allowed out of your house? What's the Wisconsin thing so far?

Jennifer Smith, CDE 7:03
So the Wisconsin thing is beyond the like, multiple levels of weather we have happening, like it was raining before and now it's like, fuzzy snowing, sorry, I'm looking out my window. But being trapped in the house. No, I mean, we can go outside. Our kids are out of school. The governor originally had a timeline of like, on April 6, but just two days ago, no, two days ago, we got another email from our school district specifically stating that according to the new guidelines, school is delayed or cancelled indefinitely. We don't know which my husband and I are like, okay, that means that Oscar is just not going back to school this year. That's what I think we will be homeschooling and I mean, the The good thing is that, you know, working from home, I'm here right? But the bad thing is that working from home, I don't have a clinic to go to so I have work that continues which is very good. It's good that people can utilize this type of telemedicine to stay up especially as things change and things happen and there are more questions that come in. But it also makes navigating my day a little bit more interesting.

Scott Benner 8:22
Okay, we're talking about the Coronavirus today. So here is on the pods website if you want to know more about how they're handling Coronavirus. It's it my omnipod.com forward slash Coronavirus. So if you want to get a free no obligation demo, go to my Omni pod comm forward slash juice box but if you want to find out about the Coronavirus and how Omni pod is handling it, my omnipod.com forward slash Coronavirus there they will tell you how insulin is responding to the coronavirus outbreak. They're going to tell you if Coronavirus is impacting insolence ability to produce its products, what sterilization processes are in place to ensure the pods are safe. may talk about reordering. I'm gonna jump through it really quickly. insolate continues to be vigilant monitoring and managing the global impact of the coronavirus outbreak. So that's how they start to talk about their response. They say they also have a comprehensive plan in place to ensure the safety and well being of their employees and they are going to continue to deliver on the pods to those who depend on the product manager type one. At this time. insolate does not anticipate any product supply issues. Pretty cool here. They talk about the sterilization process. Why don't you go check it out if you're interested my omnipod.com Ford slash Coronavirus. Next thing I have to share with you is a lovely email that I got from Rick Doubleday. Rick is the chief Commercial Officer at Dexcom. rick sent me a note and said at this moment, there are not any interruptions to Dexcom his ability to produce and supply product. However, we do anticipate near term delays in both customer service and tech support as we transition more employees to a remote work environment. wait times on the phone will be much longer than usual. We ask that customers Please only contact Dexcom support for urgent requests at this time. Dexcom is committed to communicating with their customers as the situation evolves, and customers should visit dexcom.com forward slash Coronavirus for latest updates. So that's directly from Rick. Now, if you want to get an Dexcom system going go to dexcom.com, forward slash juicebox. If you're already using it, you want to know how Dexcom is reacting to the outbreak, check that out right there. Now, when you start looking around the internet for a little break from all this, go to touch by type one.org. There, you're going to find an organization with the mission to elevate awareness of type one diabetes, raise funds to find a cure and to inspire those with diabetes to thrive. They've got great programs and services, all kinds of stuff. And hopefully, I'll be there and may speaking, if you know, we're allowed to travel again and get together with people. But you know, that's a long way off, I have good feeling about that. Anyway, touched by type one.org. Check them out today. Last but not least Contour Next one.com. That's where you can check out the Contour. Next One blood glucose meter, there's a little yellow tab at the top it says get a free Contour Next One meter today, check that out, see if you're eligible. This meter also has a wonderful app that works both with Apple and Android really helps take your data to a new level. Contour Next one.com. All of these links can be found in your show notes at Juicebox. podcast.com. Alright, let's get back to Jenny.

Jennifer Smith, CDE 11:57
My husband is on medical family medical leave right now from his company. They allowed employees who have family members in home or whatnot that could be at increased risk to take their family medical leave. So he chose to do that. I mean, he sees thousands of people a day at work. And he was like, yeah, I'm

Unknown Speaker 12:16
just gonna be at home with you guys. So I'm sure companies looking for some people not

Scott Benner 12:19
to come in anyway. They're correct.

Jennifer Smith, CDE 12:21
Yeah, yeah, exactly. So you know, that kind of works out for whatever limited time he can use that for? I mean, he'll have to go back to work at some point. You know,

Scott Benner 12:34
we'll figure it out. We're gonna become a socialist nation pretty soon.

Unknown Speaker 12:37
Right? Well, yeah.

Jennifer Smith, CDE 12:39
But I mean, I'm, it's interesting, because, you know, grocery stores and everything, those things are still open. I expect for like limited time. I haven't really looked at the websites to see Are you still 24 hours? I would expect? Probably not. But yesterday, I thought, I got the brilliant idea from actually somebody I was working with. And she's like, Oh, I just, I just go online. And I just ordered all my food. And I just pick it up at the door. And I was like, why did I not think about? Oh, so I went online. And I did that, oh, the next time I could pick up groceries at the grocery store that we most often go to is Monday, March 30. Like, at 6pm. I'm like, I'm out of all of the fresh stuff that I eat every single day. I'm like, I'm not living just on like frozen broccoli. So we picked

Scott Benner 13:27
one person. So one of us goes to the grocery store. Nobody the other person's not going. Yeah, tomorrow, we're supposed to go move cold stuff out of the dorm. I don't even know if they're gonna let us do that. But wait and see. But no, I think this is going to go on for months. I don't think the kids are going back to school this year. And everybody is now seeing, you know, for all the things we talked about that are important. If you can't walk outside without getting sick, nothing else matters. You know, it's really, really something else there. I there's that one model out of England that says between 600,002 point 2 million Americans could die in the next year and a half or something like that, which is it's funny. It's a staggering number, right? And at the same time, my son said to me, because he's, you know, he's younger, and he doesn't feel like he's gonna get sick. Right? He goes, how many people die anyway. And I was like, what, just like before this and I said, about 150,000 people a day worldwide die every day. And he's like, so was 2 million a lot. And I said, it is if it's you. Yeah, you know, there's a way to look at the world personally. And there's a way to look at the world,

Jennifer Smith, CDE 14:40
you know, globally, globally. And yeah,

Scott Benner 14:42
there's two things are they're very different. So

Jennifer Smith, CDE 14:45
we are exactly I see no,

Scott Benner 14:47
I stopped my 20 year old son from going to play basketball. He's like, we're gonna go play basketball like you're not. Yeah, no, you're not PlayStation, that's your dream come true. You can play it as much as you want. So, um,

Jennifer Smith, CDE 15:01
we have everything closed. I mean, other than pharmacies and that kind of stuff. So yeah.

Scott Benner 15:06
Okay, so let me let me first talk with you about this. I think it's just important right now with the timing to put out an episode for as long as it needs to be if it's 10 minutes or half an hour or whatever it has to be talking about how to manage through a respiratory illness. Because, you know, it's gonna happen and we can at least have a baseline idea. We don't know what this you know, what do you call it? By the way, do you call it COVID-19? Or the Coronavirus when you're just chatting about it at home?

Jennifer Smith, CDE 15:35
I've just been calling it the Coronavirus because I just I feel like all of these extra like, names to things just it's confusing in my brain. So I'm like it's the Coronavirus whatever they want to call it beyond that. Fine. Right?

Scott Benner 15:48
We definitely go with Corona here. Because in the you know, in the monsters incorporated movie when the sock touches the thing, and they yell 2319 2319. So when people say COVID-19 Kelly, here's 2319. And it starts the whole comedy routine in the house. So we don't say that like that.

Jennifer Smith, CDE 16:06
That's funny.

Scott Benner 16:08
We go Coronavirus, though. So okay, so we don't see, I've seen I think two people with type one on social media who have had it so far, but haven't really heard much from them. We're starting, you know, you're you're not really hearing from people yet who have recovered from it. Because those recoveries have happened overseas, we're right, you know, we're, we're still in the spot where you're gonna see, I mean, today is the 20th of March, we had a big increase yesterday in diagnosis, and I'm gonna guess it's gonna double today, because we're now starting to see numbers from, you know, people who were tested five, 810 days ago, right. So there was

Jennifer Smith, CDE 16:50
a really good post done, and you might have read it, The Washington Post did a really good article that had graphical of dots interacting with each other, and how, like, you know, no social isolation versus minimal versus extreme socializing, isolation, and how much difference that makes, but you still get a blowout of people, it's just slower, and it decreases that, you know, that you graph essentially, of how many people will potentially get it, I think the problem will be until we have hopefully a vaccination for it at a small level, and I think this is why it draws out how many months we're going to see things closed, and social interaction minimized and things. Because until we have a vaccination, it's just going to keep floating around, just like somebody is always going to bump into somebody that bumps into somebody that bumps into somebody that hasn't had it yet. And you know, they don't, but that being new from everything that I've read, the human body doesn't know what to do with it really yet, or how to form like the antibodies and things that it would normally form for the typical cold and the typical flu and, oh, I see this again, I had this, you know, two years ago. Now I can handle it better again. Yeah. I think

Scott Benner 18:11
a lot of people mistakenly believe that it's gonna have a season like the flu. And it'll just we'll get to a date, and you just won't hear about it anymore. And that I think, listen, I don't know anything other than what I'm paying attention to. But I just had Dr. Adam Edelman on the show the other day, in this episode with us going to go up right after that. He talked, I brought up the Washington Post article, and before I could tell him, it was out of the Washington Post he was was that in the Washington Post? And I was like, yeah, we've all seen that. Right? Yeah. Because it's such a wonderful visual visualization of how you know, spread happens. But I would say, this is gonna last two full Corona seasons, whatever this time is going to be, and then I think there's going to be a break, and then I think it's gonna come around again. And then it'll probably be a normal part of life, like the flu, and, you know, write SARS and MERS, and all that other stuff. But it just spreads so much more quickly. And easily then things in the past have. And so you're just seeing it, overwhelm everything.

Jennifer Smith, CDE 19:13
Right. I think that in terms of, you know, diabetes, I think people with diabetes, or even people with other, like chronic health conditions, where they've become, it's become a habit to be more careful about things like, you know, you change your pump site, or you take an injection, you clean the site, you wash your hands, or, you know, maybe you wash your hands before you do a finger stick or you put your, your continuous monitor site on or those kinds of things. So we we already are a little bit ahead of the curve of just paying attention to hygiene is in it cautiously in that sense, you know, but then, in terms of just management, I mean, the only the only one that I read about online with type one specific was, as you mentioned a guy over In the UK, I believe he was from he had gone on a ski trip in like, December, December, early January or something with a group of friends. And a good majority of the group got have Corona or had Coronavirus. He himself got tested because others in his group, he was positive. And his symptoms actually didn't show up for several days after he was tested positive, and he has type one. And he actually, in his article, he mentioned the fact that it wasn't so much the diabetes management. That was the hard part about it. It was he described it as like uncontrollable respiratory coughing. He said it was just so unbelievable that the only thing that helped was some type of medication, his doctor prescribed him and he went and he picked up steps to stop the actual coughing, but he said otherwise. And of course, this is an end of one experience, right? Everybody's experience with an illness is a little bit different. But I think it gives, it gives good information that if you were fairly healthy outside of just your diabetes, and you have fairly good blood sugar control, which is a huge key in a lot of this, then your management strategy for the illness piece of it shouldn't be that much different. If anything, you're you're gonna likely need I mean, most people with a respiratory illness who have a fever, or an infection, you're going to increase your insulin use. So

Scott Benner 21:35
I Well, it's interesting, because obviously, we this is a new virus, you know, for us and no one's really seen it before, but I've been managing Arden's blood sugar in one way or another for I mean, over 13 years, it's probably coming up on 14 years pretty soon. Viruses don't really change her insulin needs greatly. Now, I've seen it differently for other people, you know, but I just don't see a mass difference. I have to share this somewhere. So I'm going to do it here. So Vicki's been on the show before she talked about eating. What's the thing when you don't have any carbs?

Unknown Speaker 22:15
I can't believe that we're just Oh, like ketogenic ketogenic she was she Yeah.

Scott Benner 22:18
Vicki was on to talk about that. She and I were speaking this past weekend about something different. And she said something just hilarious. She's like, I'm not afraid of this fires. She goes, my immune system has already killed my pancreas and my thyroid. It could take this, it could take this Coronavirus. No problem. I was like, oh, but I think a lot of people with type one feel that way too a little bit. Right. Like, I mean, it's not everybody, but you talked to a lot of people are like, I don't get sick that often. You know, like my immune system is really great. I'm incredibly healthy with the exception of the fact that my pancreas doesn't work,

Jennifer Smith, CDE 22:54
right. I mean, honestly, I was until I had kids who started going that well, one child who started going to school, I rarely had even the common winter cold rarely. But, you know, so and even from that standpoint, I would say when you talk about you know, Arden's insulin needs don't really change so significantly, everybody is a little bit different. And I think the other thing to consider is the severity of the illness. And what At what point you are in illness, right, because I know myself with just a typical cold like the sniffles I might feel a little under the weather. But other than that, I'm going about my normal daily I'm not laying in bed like blowing my nose like minute after minute after minute. That typical cold, I maybe need a little bit more insulin like maybe five or 10% more it's not even as significantly noticeable and if I can remain at least moderately active, I actually don't even notice a difference in my insulin needs. Whereas if I have a really nasty cold my insulin needs will go up 40% from a basal level to start with and then if my post meals still aren't I'll adjust my ratios too.

Scott Benner 24:09
And there are there are illnesses that Arden needs more insulin for sure. It's those ones that are just sort of like she's got a little cough or her throat a little sore or has a little stuffy those don't seem to hit her but when she if she gets like, you know, knocked over by an illness when the body aches stuff happens and when the right rundown thing happens then and then you start getting like you said you start moving around as much you're more dehydrated, like there's a lot of stuff that goes into that

Jennifer Smith, CDE 24:39
well and I think you bring up a good he said hydrated right? It's we've talked about hydration piece just in general before but we talked about a respiratory illness specifically. I'm sure we've all seen the mucin x commercials right it's a little like blob of like mucus like you know haha I'm like in Getting your logs in your nose, and I'm not gonna let you sleep kind of thing. One of the biggest things to do is stay hydrated more. So if you're the person who's like, I drink eight cups of water a day, or I have five water bottles or jugs of water a day, you know what double that, because that fluid will help to move things faster through the system and keep that stickiness down. From the mucus standpoint. Listen, in

Scott Benner 25:27
plain words, if you have fixed not, and you hydrate yourself more thiess not will get thinner.

Unknown Speaker 25:32
That's right.

Scott Benner 25:35
It's just, you know, it's not something that's it's hard to, it's not hard to follow, it's hard to drink the water when you don't feel well. Right. That's the whole thing. It's difficult to maintain these good practices, when you feel like a truck ran you over and then backed up to see what it hit. You know that that really is the problem.

Jennifer Smith, CDE 25:54
There are some other things that are even not like, pharmaceutical, but things. I think that the Tea Company traditional medicinals makes a tea it's called throat coat. There's another one that they make, it's called breathe easy. All of them, they work very well. I've used them in, you know, a respiratory kind of bugs. So beyond going to your local pharmacy and grabbing everything off of the shelf, some of those things to kind of have stocked in your cupboard as a backup, um, peppermint and ginger can help to ease if you've got some stomach discomfort from like, post nasal drip and that kind of stuff. So there are a lot of things that we can do chicken broth, vegetable broth, all of those. I mean, there are there's actually really good research even just into chicken noodle soup when you've got a respiratory illness and the benefit of what that actually does for the immune system. Yeah.

Scott Benner 26:46
Well, you know, it's interesting as this is also new, and I think that it's going to continue to feel new even when we get deeper into it. Just the other day. You know, there's a wash of an article about you can't take ibuprofen if you have the coronavirus, it makes it worse. And I was like Now hold on a second. What just happened here? Like Did you know I started thinking about the podcast a little bit. I was like somebody stuck a pencil in their pocket and robbed the bank and was like, I know what this pencil just made me do. You know? And so and then it didn't take long for I think who to come out and say that ibuprofen is not a problem to take with the Coronavirus, right. It is really one of the problems with with social media, is it just anybody really could say whatever they want it and you know, if a person sees it, and they're scared, you know, they go back. So it's funny, we talked I you know, I talked about having you on for this to talk about management during a respiratory illness. But I mean, what really changes in management? Not a whole lot, right?

Jennifer Smith, CDE 27:47
Not a whole lot, honestly, I mean, you it's an illness. And unless you have another background illness, such as, you know, lung diseases or you know, there are some people with type one who actually have type one because of something called cystic fibrosis, right, which is already a lung disorder. So someone like that would have much more different management needs, even outside of the blood sugar component to it. So but when we're talking just about diabetes management with a respiratory illness, there shouldn't be much that you don't know in your normal Sick Day. packet of no checkoff, I got this. I got this. I got this.

Scott Benner 28:30
So when this all started happening, I thought, I'll put let me put some information out there'll be helpful people, and it was great to talk to Adam because he really did go over what the Coronavirus is and what it is and all that stuff. But as we were talking, and as I've been thinking over the last number of days, I think the most important thing you can do about the Coronavirus whether you have type one diabetes or not is be healthy, right like just be as healthy as you can be because a healthy body does a better job of fighting off viruses, colds and all kinds of things. Rock so much like well, you know, we're all locked up inside. Go back to Episode 210 and start the pro tips over again. It means like like get your blood sugar lower, stable, take out the variability. you'll move around a little bit even though it's probably gonna be in your living room for a while. We're here

Jennifer Smith, CDE 29:24
by the way, we've got lots and lots of online videos now that are free workout options, even my gym my gym like stopped all of our memberships so that we would not like have to keep paying for something and not being able to go but they also sent out a connection link for 150 workouts online that are free for us to use, which I thought that was a really nice thing just from a gym standpoint to do for its members. Um, but their 10 minute workout their 30 minute workouts, there are a lot You've got some equipment at home, you could even use your peloton or whatever it is, you know. So

Scott Benner 30:05
I think it's it's stay moving, stay healthy don't fall into like really poor diet habits because you know, it's going to be easier. And I don't know how easy that's gonna be to maintain over time, I don't know how easy getting food is going to be weeks from now I'm sure it's gonna get a little dicey at some point. Maybe just because you're gonna be scared to go outside, I don't know. But I don't think if you're really paying attention to the day to day numbers, and not listening to political conversations around it, but actually seeing what, you know, the CDC is saying those kinds of things. We are, we are following the bend of that, that Italy was falling, like we're gonna get a really big spike. There are a lot more people here we are spread out further, we have population centers, not just one or two, like smaller countries, too. We have, you know, countless dozens of population centers. This is not ending anytime soon. You know, if I had to bet money, I'd bet my kids aren't going back to school this year. I bet that things are gonna change moving forward, even. Yeah, you might start seeing work from home days for school in the future. And, you know, I think the other thing that's gonna happen here is we're gonna learn a lot about things that we've been afraid to look at. So far, like telemedicine is such a god example, right? You guys, you guys have been, you know, who else is talking to people about their diabetes through, you know, through video interaction, except for you. And now suddenly, every doctor's office in the world is like, this is how you go to the doctor now. Right? Right. Okay, so I think you have type one. Are you doing anything differently? No,

Jennifer Smith, CDE 31:51
I really not. I mean, other than, I mean, in my diabetes management itself. No, I'm not. I mean, we have, you know, all of the Sick Day things in the cupboard that we could possibly need. I mean, we actually went about was like, two weeks ago, before any of these school cancellation and anything of that nature. I was in the aisle just picking up some band aids. And I was like, you know, let's just get some extra things. Just like I could see what was sort of like, coming down the line, right? So I got some extra, you know, like cough medicine and that kind of stuff, just to have got popsicles in the freezer. All that kind of stuff. But other than that, my normal management is it. I'm managing the same way. I'm trying to get exercise every day in my house, or going outside and taking a run with my dog or, you know, whatever. I know some communities even have some restrictions on that, but we don't right now. There are plenty of you. In fact, more people I think I've seen like, I have to get Brashear like, let me out of my house. Right. Fair.

Scott Benner 32:58
Two days ago, Colin, I went to an outdoor cage so he could hit Hmm. And afterwards, no lie. His personality was brighter. He had more energy. He was smiling. Like he just he's not a person who wants to be trapped and sitting around and you have to almost the same as you sometimes can get lulled into being like Oh, 150 is a good blood sugar. 180 is not bad. You know, 200 is not far from 150 you can start getting to the like, Well, you know, Doritos for lunch is fine. Today, three days a week with the Reno's isn't bad, you don't I mean, like I haven't moved around a month, but I've only gained six pounds like you can like

Jennifer Smith, CDE 33:35
you can write, you can sort

Scott Benner 33:37
of just know that and slide into it and not know that it's happening to you. And then by the time that happens, you know, you're having that conversation with yourself like ooh, I've let things get out of hand. And then it's harder to get back from.

Jennifer Smith, CDE 33:50
I do think too, within that. from a management standpoint, we do have to consider some some things that if and when you can get to the grocery store, right? Because you're probably not going every other day or every three days Oh, I just need to pick up the milk today or I just need to do is you're like okay, everything on my list I can get it and I hopefully this will be stockpiled for like two weeks before I have to go back you know running in and out again. So from the standpoint of diabetes management and then making sure your list is full of all those things that you know keep you in line and it might even come down to making some more soups or making some more things that do last a little bit longer. I mean I know fresh fruits and vegetables and we certainly we have to go shopping either today or tomorrow someone in our house you know myself or my husband has to go because we're out of those we've got some frozen stuff but other than that our fresh is gone and I I like living on my frat

Scott Benner 34:50
Yeah, well listen, I am so the the I'm one of those people who usually goes grocery shopping like every few days. I'd much rather like bang in and Because that's how I like to keep the food fresh in the house, you know, I don't want to grab, you know, a ton of vegetables I grab enough to get me through a couple days. That's obviously a little upside down right now and might not be going as well. The other day, we ate leftovers, that I think in a regular situation, I would have been like, you know what, let's toss these out and start over again. But I was like, No, eat this. You know, like, What's another? What's another meal? Like? Let's get another meal. And prior to all of this? I guess not really prior to it. Maybe I just paid attention to it a little sooner. I ordered everything that Arden had a refill for I refilled. I'm starting to think I should have gotten to see but to just in case. She you know, I don't know. I don't know what, just in case three months from now, you know, other stuff starts happening me Meanwhile, pump companies Dexcom they all say like, we don't see this affecting our supply. But what if it? What if it's not them? What if it's delivery? Or, you know, what if it's, what if it's FedEx or, you know, whatever it ends up being. So I got all of our supplies, restocked. And I buy these juice boxes online that come in a big flat, and I was like, I'm gonna get to them, like garden could get low, like, I don't know, 150 times that I'd be okay. Yeah, right. Right, which I don't think she'll get low because you

Jennifer Smith, CDE 36:24
also have a goose box that works very well for her. Yeah, others don't. So you know, what works. And, you know, you kind of stockpile put it away, I know, my my glucose tablets that I really like to use have been out of stock online for quite a while. And so when I went to pick up my last insulin fill at the pharmacy, I grabbed two bottles of the only kind of that pharmacy brand glucose tablet that doesn't have artificial colors or anything in it. I grabbed two of them. And I actually, if I don't hide them, my kids will eat them. Like lip height these way away. So nobody else knows where Jenny's supply. I think,

Scott Benner 37:05
you know, I am not an alarmist person at all. But and I think this is going to be fine. Like I think this is gonna be a natural, it's gonna run a natural course. People are going to die. It's not going to be pleasant. I think we're all going to know somebody who died from the coronavirus next year. But at the same time, I did say to Kelly last night, I was like, let's start thinking more long term around Arden. Like that was the only thing I've said about diabetes so far. Like, I don't know what that means. Exactly. But let's always be thinking months in advance, not days in advance about Arden. And she's like, okay, and I'm like, I'm not worried. I'm just thinking we should change our focus a little bit. Right. You know, I did my best the week or so ago, I put up on my social media. I was like, Listen, if you have refills, filled, do it now.

Jennifer Smith, CDE 37:51
Yeah, absolutely. I know. That's actually one of the things that I also went through even my husband who pretty much leaves my diabetes management to me, I mean, unless I'm like, I need help with this or, you know, can you pinch my skin back here to put the Dexcom in or whatever, for the most part, it's all my management but even came to me is like, sure you're okay, on all of your supplies. You got enough insulin, you got enough of your pods. You got enough, you know everything and I was like yeah, I'm, I'm really good for you know, he's like, how many months? Like, hi, at least four months? I'm pretty good before I'd have like even maybe more than that, quite honestly. The biggest one is sensors, because I can't get more sensors other than what my insurance will cover. Yeah, I can't. The one the one thing to my pump right now is that I'm I'm kind of training on the control like you with hand up. So right now my pads are not being used a little extra,

extra.

Scott Benner 38:58
He's like, I gotta figure this other pump out for my job. So my my pumps are sitting in a pile I'm not gonna use.

Unknown Speaker 39:03
That's right.

Jennifer Smith, CDE 39:04
My Riley link gets a little break. And

Scott Benner 39:06
it's funny. Yeah, yeah, little extra stuff here and there. You know, little stuff off to the side, if you can afford to grab it. It really does make you think about the people who can afford it who are paying cash, or just, you know, that horrible. It's got to be in the back of all of our heads somewhere, right that, you know, if I don't want to be like, I'm not a doom and gloom person. But I do think this and I thought this before Coronavirus society is a paper tiger. It really is just holding together because we all agree to let it hold together. Right? That, you know, I don't walk across the street with a bat, kick my neighbor's front door down and steal his television just because we've agreed basically not to do that. Right. Right. Right. And but you know, it's it's assumed that if you get sick you go to a doctor a doctor helps you even if you don't have insurance. Someone will help you right? Yeah. Now all of a sudden your doctors are like, Look, call us on the phone. Don't come here. You know, the grocery stores always got food right? Now, Wow, well again, but it doesn't right now. And it makes you think, like bigger picture, like would it make you realize is that 10 pretty smart people who were writers sat in a room one day and said, what would it be like if zombies came? And then they wrote what they thought would happen. And, you know, that's probably pretty close to what's gonna happen. You know, it's, it's just where human nature takes us in these situations. The toilet paper is a great example, right? People are afraid, what makes them feel better control. having enough toilet paper feels like control. It seems silly right now. But it's true, like, right, it gives you some feeling of control. I filled Arden's prescriptions and got more juice boxes, and I bought, you know, I got the G vote the kids, you know, like stuff like that, but, and that makes me feel like it's okay. And it is okay. Unless, you know, people just decide to be lunatics. And then I don't know what happens next, you know, and none of us do. And, and that's the real, that's scary for every living person. But more so for a person who has type one or has something else who is who is your ally is reliant on these things working on the on the traffic lights going on, when they say they're going to, you know that that stuff that we just take for granted. So the best thing you can do is be be prepared. And and do your best and not lose your mind. Right, you know, don't go Don't go barging through people's doors with the you know, the bat, right?

Jennifer Smith, CDE 41:45
Give me that. It's so funny.

Scott Benner 41:47
This must have been in the consciousness a month or so ago. Because Because Arden came up to me six weeks ago. And just out of the blue, she goes, Hey, the zombies come? What happens to me. And I was like, so

Jennifer Smith, CDE 42:06
just a random teenager kind of idea.

Scott Benner 42:08
And she wasn't really talking about zombies. She was like, Hey, you know, this stuff gets upside down. You know, with the diabetes, what happens? It's like the first time she ever asked, and I said, I said, well, in truth. I said, If things really got sideways, I guess I would throw my morals away, go down to the corner and overpower as many people as I could and take as much insulin as I could for you. If we're if we're into the apocalypse situation, if that's what you're talking about. I said we'd lower your carb intake, which I don't think would be trouble because I don't think we'd have food. Eventually you I tried to keep the insulin cold. you'd run out of it eventually. And she goes, how long? I'm like, you'd be dead a couple weeks, a month later, probably. And she goes, Okay, that's what I thought. And I was like, I right on. And then we just sort of like, walk around the room. Yeah, it just she she wanted to know. I don't think she'd ever said it out loud. I think she knew, but she never said out loud. Like, what happens if these mechanisms go away? For me? I was like, that's pretty much it. It's like some of the Egyptians stayed alive a really long time. I was like, Oh, yeah, I mean, if you How long do you think you could eat kale before you just gave up?

Jennifer Smith, CDE 43:23
There are lots of ways to cook kale. I like

Unknown Speaker 43:27
that, you know,

Jennifer Smith, CDE 43:28
the other. The other thing to possibly do is maybe you know, get your own pig farm started. And then directions about how to make your own insulin and your you know, pig farm out of the pigs that you're growing in your backyard. Or

Scott Benner 43:41
I'll tell you what, if that kids, if that kids hanging her hat on that on me figure that out, she's in trouble. I could maybe do a podcast about it, but I don't think anybody would care. Right? But anyway, like, I don't think of that as, like, I didn't think of that as a sad thing. She just wanted to understand her reality. She got to an age where she was like, hey, just real quick, like, you know, right? What, what is this about? And it's not something I was talking about. Maybe she was hearing something at school, or like, I don't know where it came from, honestly, but I wasn't gonna lie to her, you know, and I wasn't gonna just be like, that'll never happen. I mean,

Jennifer Smith, CDE 44:16
who knows? We don't know what the future is. in any circumstance. Even without this. We don't know what the future necessarily.

Scott Benner 44:23
And if it if it happens, you're not going to stop it. If it's happening. You know what I mean? Like, it's, you know, and I just I told her, I was like, Look, I said, She goes, do you think it'll happen? And I said, No. And she said, why I said, greed. She goes, what I'm like, we live in a capitalist society. Everybody wants things. The only way they get things is to go to work. They want to go to work, they want to make money, they want to have things. I was like, it's what keeps people chugging along. It's what keeps insulin being made. And insulin pumps being you know, people like they think there was a guy one day who was like, I could make a better insulin pump. I bet you I could do this without tubing and he made it and turn into a business. And it was like, that's what keeps society moving people's desire to do things have things be alive. You don't I mean, I was like everyone's desire to be alive is going to be why you're going to have insulin and pumps and needles and whatever else you need. And, and I said, so while I can, you know, I can think about your little scenario here that you've made up in your head. I don't believe that's gonna happen, you know? No. So we'll say even with this, it's gonna it's going to pass. There'll be a day in the future where you'll say to somebody, do you remember that Coronavirus thing? Wasn't that crazy?

Jennifer Smith, CDE 45:37
Right. Right, exactly. It's, you're right. You're right. But I you know, in terms of even like, your daughter's question, I think you also, you know, you kind of bring we've already talked about like the supply component. But the going back to like, the age old management strategy, like maybe your technology dies, and you can't get a replacement for it. Do you know what to do? To go back to an injection? Do you have pens? Do you have syringes? Do you have you know, your vials? Do you know how to use them? Do you know what your doses are? All of those things are, they should be in your marked down list of I would know how to do this. If this happened, or if this failed, I could go to this parameter. If this fail, I could go down to this like 1940s way of management.

Scott Benner 46:33
I thought about it last night, and we don't have slow acting insulin in the house. And I thought she'd get stuck a lot. But I could do it with just her pager. Like I know I could you know what I mean? Like it wouldn't be perfect. But it would be she'd be alive, he would be alive. Yeah, and in enough time to go get some slow insulin somewhere. Right. But I think I could do it, you know, it's just, you know, there's a certain I'm thinking, I would probably create layers with boluses, like rock, like like just, you know, put in a bolus. Think about where it peaks, probably right at the peak time, put in more and just keep those like dolphins like

Jennifer Smith, CDE 47:15
flying through the muck have to do your own little like graphical chart, I don't sit here it should be done here. I dusted here, it should be done here. We kind of have to keep track that way, mentally, to not drive yourself like insane with a charged brain. But in

Scott Benner 47:31
my mind, if I know when it goes in, I know when it peaks and I know when it crashes, then I can put the next one in and create them

Jennifer Smith, CDE 47:37
for next week at

Scott Benner 47:38
the crash and just keep the peaks covering the crashes. And that should make a reasonably level amount of insulin the whole time. So

Jennifer Smith, CDE 47:46
and that that would work for somebody who has looked at and truly understands the total action time of their rapid insulin. This podcast for a while you're right, you do and I would say you know Scott definitely could do that. If you've not really ever figured that out. probably

Scott Benner 48:05
thinking a lot of people might kill themselves doing it. Yeah, oh, this is definitely one of those episodes where nothing you hear on the Juicebox Podcast should be conservative. But But I was really that's what I was thinking. Right? Like, would there be a way to bump insulin and over and over again, so that she didn't find herself without insulin? Or didn't find herself with too much? Right then? I don't know. I think I could figure it out. But, you know, again, it's because I, I can be like, I can be dispassionate about it. It's not me if I had diabetes, this is what the sound sounds like, Jenny, I don't know what I would do. If I didn't have so I can answer I probably just run around the house, I hit a wall and just passed out, you know, like, so it's, it's an interesting thing when it's for someone else,

Jennifer Smith, CDE 48:48
because you can step back and you can look at it for a second.

Scott Benner 48:51
Wow. And you don't have that Panic of like that your health is on the line.

Jennifer Smith, CDE 48:55
But overall, you should run to the pharmacy. And you should get well Jenny,

Scott Benner 48:58
I'm gonna tell you what I'm gonna. I'm gonna send an email when we're done to Ardennes. And oh, and I'm going to ask for some slow acting insulin. There we go. And I guess maybe two, I don't have a backup. Yeah, that's exactly what I'm going to do. And that's what we should all be doing. Right. It's just preparing.

Jennifer Smith, CDE 49:15
Just prepare.

Scott Benner 49:17
So did we learn today that at the moment with the information that we have, that a person with type one diabetes in the Coronavirus is going to get some level of sick and they're going to manage their type on the way they would if they got any other virus and

Jennifer Smith, CDE 49:32
in a normal illness? Yes, exactly. And I would think, you know, unless you're really newly diagnosed, and you've been a fairly healthy person outside of the diabetes, and you've never really managed an illness with diabetes yet, then sure it will be very new for you, and it's going to be kind of scary, you know, but the biggest thing really is looking at the glucose levels looking where they're going and seeing Gosh, I'm you know, so 7500 points higher than I normally run. Clearly I need more insulin. So

Scott Benner 50:10
Jerry, what's your what's your level of commitment to the podcast? Are you willing to get the Coronavirus? So we can talk about what it's like to have it now.

Unknown Speaker 50:19
Can't get you to go look a couple of handrails or something like that.

Jennifer Smith, CDE 50:23
No, and I can go hang out at UW hospital. Sorry.

Scott Benner 50:28
Gosh, do you think health care workers who are in situations where they may be more susceptible? Do you think they should step back from their jobs? Like, what would you do if you are in a hospital right now working?

Jennifer Smith, CDE 50:43
So, you know, given my profession, I know that my position would have been not necessarily cut, but I would have probably been sent home because I would have been outpatient, I wouldn't have been necessary to be there. Right? If I were a nurse, or a doctor or any other profession that's absolutely needed. And you We need people I mean, what, what would happen with all the sick people, if all the doctors were like, all the nurses were like, nope, okay, I just gonna go hang out at home, I can't get sick. I can't do this, you know. I would have to say that I would, I would do my job. It's even if I had, you know, people at home as I do little kids, a husband, or if I had, you know, an elderly parent, or grandparent or something living, I guess I would just live at the hospital then. Yeah, I wouldn't come home with it.

Scott Benner 51:37
You know, yeah, we're in a situation now where everybody's got a row, the boat, whatever, where they have in their hand they need to use and it's very similar. You know, when you think about police officers, right, or emfs or firemen? What do they just gonna be like how your house gonna fire? I don't know if you have the Coronavirus or not. So we're just gonna have to burn your life. At some point, there are some a lot actually of professions that just you don't get to think about yourself first. Well, that's, you know, what ends up? Kind of,

Jennifer Smith, CDE 52:08
you're doing social good. By continuing to do what you professionally chose to do. It is. I mean,

Scott Benner 52:17
well, when I was speaking to Adam, the one thing I said that was interesting that I've kind of noticed from afar is that we have set up a society that, for the most part for most people, goes the way you want it to go. Do you know what I mean? Like there's not a lot of, like, I remember my parents, you know, talking about getting a car, and it taken them seven years to get money for a car. Do you mean like, we're gonna get a new car one day, they never got a new car, they would always get a newer car, right? But no one ever woke up and was like, I will just take out a loan, and then I will buy this car. And then I don't need the money today, I'll give it to them. Like, like, we've set up a situation where if you have any kind of income and need something, you probably can get it. And that goes for entertainment, as well. Right? Our entertainment are amazing now. Like, we're all at the point now where we're like Disney plus nothing on here. I want to watch it. Like we're a little spoiled. Right? Right. This is the first time in my generation, and definitely my children's where someone said that you're being limited and there's no alternative. Right? You just have to do this. Right? It's very interesting. And people are so far, I think doing a really good job with it. Yeah, I don't see people freaking out or anything like that.

Jennifer Smith, CDE 53:34
I think it's hard. Even from a from the from the child standpoint, though, you know, our kids have gotten so used to social interaction. Right? I mean, very minimal numbers of kids are homeschool. These days. I've got a couple of clients who have I work with Who are they do homeschool their children. And I've actually email I'm like, I bet you're glad that you've been doing the homeschooling you'll know exactly how to do this. I however, do not. So we've been after school or after I'm done with work in the afternoons. Now we've actually just been getting in the car, and going and taking a drive around the city. Just to like physically, like,

Unknown Speaker 54:16
get out, change,

Jennifer Smith, CDE 54:18
and change the visual and change and see that, you know, the world is still there. Everything is still in place. It's just that we've got limited interaction.

Scott Benner 54:28
It really is we're all just trying to stay away from each other so that we don't overwhelm the healthcare system. Right.

Jennifer Smith, CDE 54:34
And for explaining to kids it's also something for explaining to I mean, you know, with a seven and a three year old, they don't really quite understand, you know, why can't we go to the coffee shop and get a flowerless cookie? Why can't we you know, well, they're closed so we drive past the coffee shop. You have to kind of visually explain to many younger kids and well it's closed you know, we can't go and see all the chairs are up. But why Mommy, can't we get a morning muffin. Let's go home and let's make morning muffins. So now we have morning muffins sitting on the counter in the kitchen. Yesterday,

Scott Benner 55:06
I had that conversation with my 20 year old son. I was like, Listen, you can't play basketball. And here's why. Because Do you want to wonder for the rest of your life if your buddy's grandmother dropped dead because you had to go play basketball, you know, like, just go outside, you have a net play by yourself. And that's what this is gonna be for a little while. It's tough because you because it isn't. It isn't hard to look at what you're missing. Like, I watched kids on my son's baseball team and every baseball team who were seniors, who were eight, eight games into their season, be told That's it, you're never gonna play college baseball again, say goodbye to everybody and get back on the plane to go home. Wow, it was hard. It was really interesting. All these kids weren't going to graduate from high school at a ceremony maybe or from their college. You know, that's all total. But like I said, I think at one day, it will just be it'll just be a story to tell people. You know, like, remember the time I'll tell you this. And I mean, this, I said this to Kelly last night, I was like we are parenting through. Our parents never had anything like this, that I can remember that they had to be parents. And my wife's like, my parents just sent us outside anyway, we'd be dead. They'd be like, go outside and play, you know. So I really feel a feel like we're gonna be professional parents when this is over, like really good at it. Because this is just another level Jenny.

Jennifer Smith, CDE 56:22
It's really funny. I said that to Nathan, the other day, I said, this is really kind of a it's a social experiment in teaching people who've been so used to and nothing against it. This is the way that society work. Because moms and dads all have jobs now and you send your child to daycare or you send your child to school. It's teaching parents what it actually means to like spend majority of your time interacting with your child. I wonder if somebody else isn't raising your child? Yeah, somebody is else isn't teaching them. It's on you now. 100%? That's,

Unknown Speaker 57:00
that's hard. Yeah.

Scott Benner 57:01
Yeah, I listen, I've raised two kids, as a stay at home parent, right? That means you get up in the morning, and you're with them 24 hours a day. And it gets long after a while. And you really have to have the fortitude to just push through and find the good and what you're doing and not make it feel like oh my god, this is my whole life like that, that whole thing. But I'm wondering how many people will maybe I wonder how many people will try to go back to a single, like income, like how many people are gonna like this and think, Oh, this is nice, you know, right. I never thought it was possible.

Jennifer Smith, CDE 57:33
I didn't know my kid could do this. Or I didn't know I liked doing this type of thing with my child. Or look how good my child is that like reading and we can read together and we can learn all these things. I mean, I think of all the like, books that hopefully people are reading and the games that they're getting out of the closet that have cobwebs on them and like, Yeah, because especially with kids, you know, specifically, as you know, you have to entertain them up to a certain age, you kind of have to do the entertainment. Yeah, yeah.

Scott Benner 58:06
I've got my pile of books right here. I'm hoping. Yeah, really only five fingers crossed. So okay, so stay healthy. Keep your blood sugar stable. I think the other thing we didn't say that I think is really important is get sleep. And as

Jennifer Smith, CDE 58:19
bunk water.

Scott Benner 58:20
Yeah. And try not to make yourself nuts. Like stress, people don't sleep well. People don't sleep, well don't fight off colds. Well, like the really the things you can really do is, you know, take care of your health, get some sleep, keep your stress down. And you know,

Jennifer Smith, CDE 58:36
and some of that keeping your stress down ultimately is just keeping as much normal in your day as possible. Yeah, you know, you get up every day at seven o'clock, keep getting up at seven o'clock. If you always have tea at nine o'clock. Keep having your tea at nine o'clock. You know, it's just keeping some of those normal scheduled things, helps to keep the stress level down to I think, too, if you're working from home, I know everyone's interested, but don't leave like cable news on 24 hours a day in the background, because they're repeating the same thing over and over again. And it's getting into your brain. So right.

Scott Benner 59:07
Yeah, right, Jenny, I appreciate you doing this. And I hope you guys all stay healthy there. And I hope you do too. Thank you. I hope hopefully this will help some other people do the same. So I'm going to read to you from the CDC website for a second. Older adults and people who have severe underlying chronic medical conditions like heart or lung disease or diabetes seem to be at a higher risk for developing more serious complications from covid 19 illness, please consult with your health care provider about additional steps you may be able to take to protect yourself. The site goes on to remind us to stay home if you're sick. But I think at this point travel bans are starting to go into place as I'm recording this on March 20. So you know that may be that may just be a given at this point. Cover your coughs and your sneezes cover your mouth and nose with a tissue when you cough sneeze or use the inside of your elbow. Throw used tissues into the trash. Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with sanitizer that contains at least a 60% alcohol. If you're sick, you should wear a face mask when you're around other people, even if you're sharing a room or a vehicle with them or before entering a health care providers office. If you are not able to wear a facemask or a sample because it causes trouble with breathing, then you should do your best to cover your coughs and sneezes and people who are caring for you should wear a face mask when they enter the room with you. If you're not sick, you do not need to wear a face mask unless you are caring for someone who is sick and they are not able to wear a face mask. face masks may be in short supply and should be safe for caregivers around the home clean and disinfect. This includes tables doorknobs, light switches, countertops, handles, desks, phones, keyboards, toilets, faucets and sinks. If surfaces are dirty, clean them use detergent or soap and water prior to disinfecting. The CDC goes on to tell you about disinfecting most common EPA registered household disinfectants will work. Use disinfectants appropriate for the surface. options can include diluting your household bleach. To make a bleach solution. Mix five tablespoons or a third of a cup of bleach per gallon of water, four teaspoons of bleach to a quart of water. Don't forget the manufacturer's instructions about proper ventilation when you're using bleach. And if you're going to use an alcohol solution to kill bacteria or the virus, ensure that it has at least a 70% alcohol content. This is all available@cdc.gov there's guidance from the CDC around the 15 days to slow the spread. Listen to and follow all directions for your state and local authorities. If you feel sick, stay home Do not go to work, contact your medical provider. If your children are sick, keep them at home Do not send them to school well. Think that cats out of the bag to around most of the country contact your medical provider if someone in your household has tested positive for the coronavirus. Keep the entire household at home Do not go to work, do not go to school, contact your medical provider if you're an older person stay home and away from other people. And if you are a person with a serious underlying health condition that can put you at an increased risk, for example, a condition that impairs your lung or heart function or weakens your immune system stay home and away from other people. Okay, so here are my plans for the podcast. Next week. There'll be two episodes that are just stories from people with type one diabetes stuff that's more entertaining. We're going to do some after dark stuff, you know stuff to keep your mind off things keep you entertained. I will come back with Coronavirus information whenever it's necessary. Dr. Needleman we'll come back on Jenny and I'll talk again. But the podcast is going to be here for you. I'm trying to figure out how to do a live chat for us all. So if people just need to feel a little less alone, they can get together and talk. that'll probably happen through the Facebook page. So keep an eye there. Perhaps even Instagram and I'm looking for a way to bring everybody in. Maybe in a third party platform. I'm doing my best on that. The Juicebox Podcast will run as scheduled. It's not going to go away. And I appreciate that you guys are such supportive listeners. I hope this information has been valuable for you. Please just use your common sense. Stay well stay away from people. Don't touch things. Wash your hands. be cognizant of your surroundings. Do your best to stay safe. Do your best to stay healthy. If you feel sick in any way, please contact your physician immediately. I'm going to read you one last thing the symptoms of coronavirus. People may be sick with the virus for one to 14 days before developing symptoms. The most common symptoms of coronavirus disease, the COVID-19 virus are fever, tiredness and a dry cough. Most people about 80% recover from the disease without needing special treatment. More rarely, the disease can be serious and even fatal. Older people and people with other medical conditions such as asthma, diabetes, or heart disease may be more vulnerable to becoming severely ill. People may experience cough, fever, tiredness, difficulty breathing in severe cases. Now having that in your head. Don't forget what Jenny and I talked about today. If you're a healthy person, if your blood sugars are well maintained, you don't fall into that category just because you have type one diabetes. Be healthy, keep your routine going. Keep your mind fresh, get some fresh air. Try not to go crazy in your house a little bit. You're going to be okay. The Juicebox Podcast is sponsored by Omnipod Dexcom touched by type one and the Contour Next One blood glucose meter. You can go to Contour Next one.com touched by type one.org My Omni pod.com forward slash juice box or dexcom.com forward slash juice box to learn more about the sponsors. There are links in your show notes at Juicebox podcast.com. If you can't remember those links, now might be the perfect time to check into some new gear, the stuff you've been thinking about getting, I mean, you got a lot of time to read up, right? I genuinely meant what I said to Jenny earlier, I'm not just trying to get you to listen to the podcast more. If you want to work on your variability if you want to work on keeping your blood sugar's more stable. Go back to Episode 210 of the podcast and listen to the diabetes pro tips again, you can figure it out if you're struggling. And if you knew what you were doing in the past, but you've sort of burned out a little bit. This podcast episodes can help bring you back around again. I want to wish you all a ton of success. I'm gonna see you soon. You guys are going to be okay. I'm gonna be okay. We're all going to be okay.

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