#225 Diabetes Pro Tip: Bump and Nudge

Scott and Jenny Smith, CDE share insights on type 1 diabetes care.….

I am thrilled to welcome Jenny Smith, CDE back to the show. Jenny will be joining us for an extended series of conversations that focus solely on the management ideas that we discuss on the podcast.

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.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello everyone and welcome to Episode 225 of the Juicebox Podcast. Today's show is a continuation of the diabetes pro tip series with Jenny Smith. This installment is the eighth in the series and it's called bumping nudge. You'll find out why in just a second. I briefly want to thank our sponsors on the pod dex calm and dancing for diabetes for always being there, you can go to dexcom.com slash juicebox dancing for diabetes.com that dancing the number four diabetes.com or my omnipod.com slash juice box to find out more. There are also links in the show notes of your podcast player and that Juicebox Podcast comm

pumping nudge is the eighth in my diabetes pro tip series with CDE Jenny Smith, don't forget that you can hire Jenny. She works for integrated diabetes calm and she would love to help you do better with your type one. There are links in the show notes to Jenny's email address where you can go to integrated diabetes comm let's please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise and to always consult a physician before becoming bold with insulin or making any changes to your health care plan. This is a short but really powerful and important episode. Please remember that the diabetes pro tip series is designed to be listened to an order don't just jump in here. Go back to the beginning. This is installment eight of the series. The first one was called newly diagnosed. We're starting over

Jenny Hello How are you?

Jennifer Smith, CDE 1:47
I'm good. How are you got so good. Yay.

Scott Benner 2:08
short episode going over the idea of bumping and nudging blood sugars, which is something we talked about on the podcast all the time. I'm a huge believer in the in the infuriating statement that you won't get high if you never get high. Sure, that's not as easy as it sounds, but that's how I think about it in my head. Right? So I want to fight with the high blood sugar if I don't experience high blood sugar. Of course, that's not always gonna work. I'm not saying that. But I am saying that it's avoidable a lot of the time. I think of it as bumping and nudging just bumping and nudging it could be bumping. I love that

Jennifer Smith, CDE 2:48
term. I love that. I love it.

Scott Benner 2:50
Right? Yeah, you can do it with insulin can also do it with food. You can also do it with a deficit of insulin, which you can create with Temp Basal. We're going to talk about it all right now.

Jennifer Smith, CDE 3:02
We also do it with exercise.

Scott Benner 3:04
Do you know i just i just interviewed somebody who you won't hear for six months. But a girl who has had Type One Diabetes since she was a little kid and she's like she was so compliant like with whatever her mom asked. So she'd eat like celery all there for blood sugar was high. But if she but if she wanted a cookie, she would go exercise and then come back and say to her mother, I just ran around the house this many times and went up and down the steps this many times I would like my cookie now. And this is this was back when she was doing Oh gosh, the words just slipped out of my head. What what's the old timey insulin regular insulin regular an MPH that's what she was mph. Back then she would do a little exercise to get her cookie. But I you know this by the way, this girl is delightful. You have to find the episode with her.

Jennifer Smith, CDE 3:54
My, my mom would do the same thing with me. We're at my grandparents house, usually in the summertime for a couple of weeks. Usually at that time of the year, it was rainy, at least several days out of that time and I couldn't do anything outside. She would have me run around my grandmother's kitchen table and they had a pretty big dining room because it was a farmhouse. And I would literally my mom would be you need to run around. You need to move you need to move. And I was like, Okay, I mean at that point.

Unknown Speaker 4:23
That's all movie. You know, there'd be a snack

Scott Benner 4:25
after this. I guess it's all right. So yeah, yes. Okay, so. So basically, we'll start with this if you have a glucose monitor. You can't think about the alarms. The way you're thinking about them right now you have to your low alarm, you should put wherever you think you need to know like whatever gives you enough time to react. I don't care what that is. That's up to you completely. Ours is at 70 Some people put theirs at 60. You know, 80 whatever, I don't care. It's the high alarm that I care about. Because you need to be able to react to a rising blood sugar quickly. If you react to it quickly, you're able often to react to it with less insulin, you're present, right? It takes less insulin to stop a 120 diagonal up than it does to stop a 150 or a 180. Straight up or 202 arrows up, you could have avoided the problem that you're having now 45 minutes ago, if you knew it was coming, right, right, right now people will say, but Scott, I don't want this thing to alarm all the time. And it's gonna bother me and my kids at school, and I hear all your complaints, put them away. And here's why. Eventually, if you listen to these podcasts long enough, these concepts will lead to a world where you don't really ever leave your 120 blood sugar. So you won't get a ton of alarms. And on the days when that happens, I don't know mute your phone, but don't make a bad decision to avoid a problem that I think is avoidable. And so I know I've said this a billion times, but it belongs in this episode. And I know I talked about driving a lot. But when you're driving, and you find yourself just kind of drifting off of the road, you don't turn the wheel 90 degrees to the left to avoid the curb. It's this almost imperceivable turn of the wheel, you're just nudging it back the tiniest bit. Yeah, that's how you avoid swerving into the oncoming traffic, because you've only turned it a little bit. This is how you stay off the diabetes roller coaster, it is that simple, right? So you stop arise before it can happen. And you use such a small amount of insulin that the likelihood of being low after you've done that is mostly imperceivable. Right? How much does that make sense? Jenny? Where should this be on the Mount Rushmore of diabetes thoughts?

Jennifer Smith, CDE 6:48
I think it should be right, they're taught along with the early the early information of insulin use, it really should be, it should be it should be right there with when you're prescribed insulin. This is our target for high blood sugar should really in my professional opinion, it should be ratcheted down, we should not be being told that post meal blood sugars of 200 or 224 kids

is appropriate only because it's safe.

Scott Benner 7:25
Right and safe in as much as you're not going to have a seizure. correct? That's

Jennifer Smith, CDE 7:30
correct. I mean, am I saying that you're aiming for, you know, a no rise at all? No, am I saying that you're aiming to stay, you know, if you've been consistently rising to 250, and your alarm isn't set to 250, or 300, maybe you bring it down to 200 for a little bit, and then maybe you bring your high alarm down to 180, or you bring it down to 160. But as you do that, like you said, you're gonna see, it takes a lot less to address a rise than it does to correct a blood sugar that's already too high.

Scott Benner 8:02
And in the beginning, this will take more of your effort. But as time goes on, it takes nothing. It really does. I know sometimes I'll explode a bolus out on screen when I'm doing a talk, right? And when you blow it up like that, and show all the decisions that were made you think, Wow, this does look like a ton of effort. Right? I always have to start by telling people what you're viewing up here, encompass about three seconds of my thoughts spread out over five minutes. Right, right. You'll spend more time in initially then, than you will one day. And so it's the same with this idea. I know it feels like if you set it at 120. It's always going to be beeping, but one day it won't be and And wouldn't you rather be bothered even on a on a bad day and a quote unquote bad day? Wouldn't you be bothered? Wouldn't you like to be bothered five times to bump a 120 back down? That might take up 20 minutes of your overall day, then to be stuck in a 300 blood sugar and comes with it all day long, right? All right, little bits of effort. little bits of insulin, way better way, way, way, way better to avoid the highest because you can't get high if you never get high. You can stop it from happening. Does it always work? It doesn't always work. But mainly, I will say this, Arden spikes about twice a day. And it's timing stuff where we don't have the ability to do what we're doing. But when I tell you Arden spikes, I'm talking about 151 70 you know and we get it right back again. So imagine if you had to 180s or to 160s in a day and the rest was between 120 and 70. That's where you get an A one see it's in the fives.

Jennifer Smith, CDE 9:52
Right. for clarification to even about Arden spikes. It's not that you've waited until she's 172 Dress it, you've gotten the alert, the rise is happening, you've addressed it, you've probably taken a correction at like 120 or 130. Because you see the trend happening, she may still get to 151 70 before that insulin starts to working, but the curve down is probably more like an up down almost like a roller coaster. Right? But you're addressing it so that that ride down then is nice and smooth into the end versus being way too high. And crashing from Bolus, Bolus, Bolus, Bolus, oh, now I'm like 50. And because

Scott Benner 10:33
I reacted sooner, I still am keeping mainly the balance of the insulin action carbon pack. I'm still keeping them pretty well balanced. I obviously missed a little bit in the carbs. Got ahead. But I got back in the game soon enough that I'm not going to create a crazy low later, right, you come in for like a nice landing afterwards, which somebody just texted me the other day and says, Can you please tell me what that means. And I always like I think just put your hand up high, and then dip it down and then bring it flat again. And like that's sort of like this. That's what you're trying to make happen. Right? You're trying to come to

Jennifer Smith, CDE 11:04
the end of a roller coasters, what I explained is kind of where you're the rush of that ride down and then you like roll into the station. That's it. It's a flat and smooth, perfectly

Scott Benner 11:15
bringing in for a nice landing. Right? Okay, so, so sure you can bump and nudge that way, right. But what if I'm at the tail end, for example of a meal bolus, and I'm noticing I'm 110 151 hundred, I'm starting to drift down. But I'm so far past this Bolus that I'm now in that space where people do the thing, they can just go, I hope this stops. Right, right? Like, wouldn't it be nice if this stuff, what I like in that situation is a Temp Basal decrease, right, take away some of the basal rate. So now Jenny can see me which is a little unfair, but I'm holding both of my hands together palm, the palm, and I'm pushing a thumb bazel is so important to think about like this on one side is the impact of your body and carbs. And on the other side is the impact of the insulin. And when you push at the same rate, no side wins, like I'm not going wildly one way or the other. Right. But all of a sudden, we get to a situation like I just described where Okay, the insulins winning a little bit, right, the carbs that were there can't hold up the insulin that's left behind. So we start drifting towards a lower blood sugar, we'll just use your pump to tell it to use less insulin, take away a little bit of the force that that insulin has now maybe you'll catch it with Temp Basal, maybe you won't. But in certain situations, it's the best way to start. You know, he I forever see people were like, Oh, I'm heartbroken. I had to give my kid juice overnight. And you look and you see this 90 blood sugar that was just drifting down, that later, by the way, turned into a 180 because they put all this juice in. So you could have in that situation, if you really felt like you needed the juice bump with the juice, you don't have to drink the whole thing, drink enough to bring it back in for a nice landing. Or if you're far enough ahead of insulin impact, try dialing back your your bazel and see if that doesn't catch it and your natural body functions don't come back up again.

Jennifer Smith, CDE 13:16
And if you're an evaluation time period as just a kind of an aside in the overnight, if you give that little nudge with juice comes up a little bit and address down and you give a nudge again and it comes up and it drifts back down. That's bazel you're in bazel only unless you have a correction from earlier that brought you down so much. That's still working. Visa only that's a good you've got too much bazel there's too much they're up down up, down, up down and it never stays stable. You got too much.

Scott Benner 13:49
Alright guys, you know how I do it short episodes, short ads. Ready rapid fire succession. Check out the new Dexcom g six continuous glucose monitors today go to dexcom.com slash juice box to find out more. You're going to be able to see what direction your blood sugar is moving and how fast it's moving in that direction. And with their share and follow feature, you'll be able to find out what the blood sugar is of a loved one who is away from you that's compatible with Android and iPhone. Like I can see Arden's blood sugar right now, but she's not in the house 109 and that cool. You want that to dexcom.com slash juice box with links in your show notes or Juicebox Podcast comm now on the Omni pod on the pod is the only tubeless insulin pump in the world. It's the insulin pump that art has been using for over a decade. And trust me, you want to check it out. But you don't have to trust me too much. Because Omnipod will offer you for free a pod experience kit. That's right, they'll send that demo right to your house. Just go to Miami pod.com forward slash juice box, put in your name and your address. Click in enter there, whatever. It's called the button I don't know, click like like, and they'll send it right to your house. You can hold it, feel it, try it on wear it, see what you think and decide for yourself, you don't need to trust me, you can trust your eyes. Last thing I need you to support dancing for diabetes, I want you to go to dancing number four diabetes.com. And check them out on Facebook and Instagram, great organization doing wonderful things for children with diabetes, through dance. I say a lot that if you find yourself when you find yourself bolusing too often, your bazel is probably too low. If you find yourself out and doing to address in that situation too often with food, your base is likely to high. Right?

Jennifer Smith, CDE 15:38
Right. And you want to stop nudging as much as you can.

Scott Benner 15:42
We all want to go to sleep and nobody wants to eat juice in the middle of the night. That's all the things we're trying to avoid right here. And I know a lot of it still sounds like oh, yeah, buddy, that. That sounds nice. But how do I accomplish this? I think that by now you're getting towards the end of this series. I think Jenny and I have laid it out pretty well, a couple of different ways here. So and important to remember. Because if you've ever spoken to me privately, if you listen long enough, I will beat into your head over and over again. It's about timing and amount. It's about timing about even with Basal, even though you don't think of it the same way. Because Basal doesn't all go in at the same time. If your basal rate is too high, you have too much insulin and at the wrong time. So with I've simplified diabetes down to like a handful of ideas that are sometimes so distilled, that even when I say them out loud, I go, does it just sound ridiculous to people when they hear it. But please trust me. At the end of this series, I'm going to go over all these ideas in simple sentences. It'll be a very short episode, you remember those sentences, apply what you've heard here. You're going to be on your way I you know, I can't promise but I swear I've seen it happen.

Jennifer Smith, CDE 16:54
And I believe a little print off sheets got,

Scott Benner 16:57
oh, I don't want to get away.

Jennifer Smith, CDE 17:00
I know. I know. Well, the full full ideas are really behind all of those little simple statements. So if you had just a little simple fit, and you're like, I don't even know what that means. And those reminders,

Scott Benner 17:11
I actually, I use them too. Yeah, I've had times where I'm like, What is happening? Because it's life, right? Like stuffs going on. You don't know like, why am I bolusing all the time. And I actually stopped myself one time. And I remember standing in my kitchen thinking, what would I tell someone? If they asked me this? And oh, that's ridiculous. But I was like, Oh, my God, or bazel needs to be increased. Boom. And there I was, I was like, Oh, that was I should have listened to me. But like for days, I was like, what's the problem here? So you're gonna get those like simple ideas broken down into sentences that you can kind of repeat and keep in your head, you know, that that'll should reignite the ideas that you heard in the podcast. Okay. So, to go over this again, because it's in a different episode. You need to think about how food affects your blood sugar. Sure, you need to think about how in some affects your blood sugar, sure, but always to remember that you need to understand how the food affects the insulin so you can reverse engineer ideas. You're so used to thinking, I have this high blood sugar and I'm trying to force it down with insulin. Well, what if you have a low blood sugar you're trying to force it up with food and I don't want to use too much. That starts us off on that rollercoaster, right we forget to believe that what we know is going to happen is going to happen we put in this food for low blood sugar, we shoot up now our insolence Miss time, we eventually put in enough insulin it gets Miss time with the food, the food now digest to your system. All the insolence left, you fly back down again, oh my god, what do I do, I throw in more food than I wait and I get high and you start looking at the garage and thinking I just gonna pull the door down Start the car put on my favorite. But we don't need to do that. What we need to do is to bump in nudge with the food as well. And so this is crafting

Jennifer Smith, CDE 19:00
and nudging with the food might actually be a little different. If you know and pay attention to in those, let's say the drops where you're going to nudge with some food. Why is it declining? Is it truly bazel? like we talked about overnight, right? Where you meet need a lot less nudge, little incremental nudge versus you've got three units of iob. And you're dropping, and the drop is actually happening a lot more precipitously, right? You're really like coming down? Well, that little nudge of three sips of juice. If that's not the time to like nudge us, you need a little bit more aggressive nudge than that.

Scott Benner 19:42
Yeah, I tell people all the time if you see a 65 and it's really stable and you want to try to shut your Bayes law for half an hour to see if it comes back up right on but if it's a 65 and dropping like a stone for the love of god drink a juice eat a banana shut off like like, you know, you've really messed up somewhere so

Jennifer Smith, CDE 19:58
right but Right, but

Scott Benner 20:00
the opposite idea of that is not I'm gonna quote a mom that I spoke to. She said, Why did I always give the whole package of gummy bears? Why did I just automatically think because I opened the package he had eat all of the gummy bears. Why not? You know why are three because 15 carbs, 15 minutes 15 carbs 15 minutes. Right bad advice you got from a doctor one time.

Jennifer Smith, CDE 20:25
And it was again it comes to the safety. Right? It comes to the safety piece of this is an easy rip off. None in the moment. This is just please do this because it will at least

alleviate the wall, right? You'll be safe.

Scott Benner 20:40
It's jamming on the brakes 100 yards before you have to stop because you can't be 100% certain you're gonna be able to stop but before you get the hundred yards away because a doctor is not with you because they don't know the situation. Because they don't want you calling them on the phone every five minutes. Now I bolused because I'm going to tell you when some people start explaining to me their bosses. I'm like, Look, I'm good at this. But that is hard to get straight in your head when somebody and you know they're keeping something. They're forgetting something. And so you're like, I can't make sense of this. Like show me a graph. Like when did you eat and sometimes they don't even though, right?

Jennifer Smith, CDE 21:15
I like that's the reason I like little tiny like the Jelly Belly jelly beans. They're a gram of carb apiece. doodles are a gram of carb apiece. They're an easy way to nudge with food in a counted way. Rather than like sips of juice really guy I don't know, I might have had a bigger sip or a little or sip, right? Whatever my sip might be the whole container. I don't know.

Scott Benner 21:39
I'm telling you again, Ninja like level of understanding, I can sometimes stick a straw in Arden's mouth from a juice box as she's drinking it, I just go and that's enough. That's just something that comes with time, right? Like, you're not gonna figure that on day one. But the idea that it might not be all of it. And this and I alluded to earlier, it's gonna sound a little crass. But there are times when you just have to have the balls to wait. Like, you can't just, you can't just over treat an 85 you know what I mean? Like I said it before, I've saw a woman online who told who once said that, that's a mom, and I'm sure she was scared out of her mind. I don't mean to make light of her. But she's like, I saved my kid's life last night. With a juice box. A kid was like 110 diagonal down. I was like, wait a minute, you may very well have been on your way to the greatest night's sleep ever. You're never gonna know. Right? And because this wasn't like what you were talking about. It wasn't like a big bolus that was gone wrong. This was just like a drifting blood sugar. And I was like, Oh, you gotta wait, the you know, you have to. And so let's talk about here, like, because we're gonna try to bump a nudge and in and out of an area. What is that area? And so I mean, you have to define your target. Yes. What is it you're going for? Right? I don't need Arden's bunch are gonna be at five constantly. I don't feel that way. But I and I don't like her blood sugar to be under 70. But I got to tell you that if she drifts under 70 for a couple of minutes, I'm not running around looking for the glucagon. You know, like, let me see how I can just get this to kind of gradually come back up again. Same thing if she gets the 140. And it sits in a guy. I really missed this. But you know what, now I'm only an hour and a half past this Bolus, I really do have to wait a second to see what's going on here. Or I have to decide I'm not gonna look at this 140. And I may need to redress with food later. Right. Right,

Jennifer Smith, CDE 23:33
right. Absolutely. And, you know, that also speaks then to the benefit of now we've got the CGM, right, because with the CGM, you can see more often what's happening that 140 hour and a half after eating, it might be a stable 140 you don't know whether the next three blips are going to start a downtrend or they're going to start an uptrend or they're just going to kind of stay stable. So you have to really have that same thing with your 70 before if she's laying on the couch watching a TV program at 70. Okay, yes, she's not out running a marathon. She's not going to go to the amusement park and walk around for four hours. sitting on the couch.

Scott Benner 24:11
Yeah. Yeah. Even when Arden is like incredibly active on a hot day playing softball, I still like a blood sugar right around 90 and so if I see 90 trying to get away from me it's it could be just you know, you have a Gatorade with you take two splashes of Gatorade, then go back to the water, or, you know, have half of this juice box or are you hungry? You know, sometimes people are hungry. You'll think about it like that. Because you have diabetes. You always think about food as being this like surgical strike. But if you're playing you know a sport, maybe it would be nice to take a bite of a banana every time you sat on the bench or something like that, right? performance energy is different than blood sugar strategy energy. for athletes, there's about 1000 different ways to think about bumping and nudging your blood sugar around so I want you to open your mind to it think differently. Try to really make sense of it. Jenny's Gotta go she's got a life. Okay? work. So I'm gonna let her go and say thank you.

Jennifer Smith, CDE 25:07
Absolutely always, always nice Jenny,

Scott Benner 25:09
I'll talk to you soon. Everything I'm about to say can be found in the show notes of your podcast player at Juicebox Podcast calm but if you'd like to hire Jenny, go to integrated diabetes.com or email her right through your podcast player. Thank you Dexcom Omni pod and dancing for diabetes for supporting the show. You can go to dancing for diabetes.com my omnipod.com slash juice box or dexcom.com slash juice box to find out more. Don't forget on the pod we'll send you a free no obligation demonstration of the pod just for filling out a little bit information and saying you want it even though they're not on this episode. Don't forget real good foods calm you'll save 20% of your order by using the offer code juice box. That's a lot of money you can save. This was installment number eight of my diabetes pro tip series. installment nine is available now and it is called the perfect Bolus. I hope you're enjoying the podcast. I hope you're enjoying the series. If you are please go to iTunes and leave a wonderful rating and review for the show. It helps it to be found by more people

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#224 Diabetes Pro Tip: Mastering a CGM

Scott and Jenny Smith, CDE share insights on type 1 diabetes care.….

I am thrilled to welcome Jenny Smith, CDE back to the show. Jenny will be joining us for an extended series of conversations that focus solely on the management ideas that we discuss on the podcast.

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.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

---

DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello everyone and welcome to Episode 224 of the Juicebox Podcast. Today's episode is the seventh installment of my diabetes pro tip series with the CDE Jenny Smith. Jenny has been living with Type One Diabetes since she was a child. So she has first hand knowledge of the day to day events that affect life with type one. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. Besides helping me here on the podcast, sometimes Jenny works for integrated diabetes services. And if you like the way Jenny thinks about diabetes, and you'd like to hire her yourself, you can do that. Go to integrated diabetes comm there's also a link in the show notes where you can email Jenny directly. As always, this episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and dancing for diabetes. There are links in your show notes and at Juicebox podcast.com for all the sponsors. But if you'd like to go directly to them, you can go to my omnipod.com forward slash juicebox dexcom.com forward slash juicebox or dancing the number for diabetes.com.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise and to always consult a physician before making any changes to your medical plan or becoming bold with insulin.

This is the seventh installment in my series called diabetes pro tips. And if you have not heard episodes, one through six, please stop this one. Now go back and start at the beginning. These pro tip episodes are designed to work in Congress with each other, you should listen to them in order. However, if you're all caught up, sit back and relax and get ready to listen to Jenny Smith and I talk all about continuous glucose monitors. And as you've become accustomed the pro tip series come out in blocks of three. Right now there are two other installments available. eight and nine. They're called bumping nudge and the perfect bolus.

Jennifer Smith, CDE 2:24
What's on our agenda today

Scott Benner 2:26
we are going to talk about continuous glucose monitors.

Jennifer Smith, CDE 2:30
It's a big topic

Scott Benner 2:31
it is right.

So I tell a story that I think is going to fit here in this episode. We were in my daughter's endocrinologist visit a long, long time ago, probably a decade ago. And the nurse practitioner asked me Are you going to get one of these CGM Xers. And that's how new the whole idea was. And I said, I don't know what you're talking about, you know. And so she begins to tell me a story about this 17 year old kid in the practice, who loves m&ms but can't seem to eat them without a spike. So he gets the dexcom, which I think back then would have been the seven plus maybe 10 years ago is that the first one with a

Jennifer Smith, CDE 3:14
seven seven. I know that in 2006 is when I got my first CGM and the seven was on the market, along with whatever came with Medtronic and then Abbott's navigator had come out. And that's actually the first PBM that I had, and I loved it. It was unbelievably accurate.

Scott Benner 3:33
Yeah, I remember that one too.

Jennifer Smith, CDE 3:34
Yeah. So it probably was a seven when you are.

Scott Benner 3:37
There it is. So she's telling us about this thing called Dexcom. I don't know what it is. I don't know what she's talking about the the letter CGM mean nothing to me. Right? Chinese, right. I just I was like, it could have been any language except English. I didn't know what she was talking about. But then she tells me this story. And she says that the boy gets the glucose monitor. And he goes home to the grocery store and buys this little single serving packs of m&ms. But he grabs seven of them. And the first day he goes home and he eats the m&ms as he always would. He puts in his insulin as he always would. And he watches his blood sugar go up. And it kind of stays up after that. So the next day, he thought, oh, okay, I must need more insulin. So it gives himself more insulin in his blood sugar goes up less. So the third day he thought he had it fixed. He's like, this is it. I just need more but give himself more. He barely goes up at all, but then he crashes low later. So the kids like Okay, so the next day a little sooner, a little less, a little more. he messes around back and forth, back and forth with us. And then she looks at me, I'll never forget the look on her face. Because she was astonished, right? And she goes, I saw his graph. He put his insulin in, ate the candy and his blood sugar never moved. And she's telling me a story about that. And all I can think in my mind was well if that's possible with that, then that's possible with anything. Like that's what I left with that feeling of like there's information coming back to me They can do that. That's amazing. Because I used to be one of those people. We'd go into the, I don't really show them the pump anymore. But we used to go in and they download your data. They look at, you know, your boluses and all this stuff and where your blood sugar's were and she'd say to me, Hey, you tested she, you know, RNA at lunch at noon, you test at 1230. She's like, why would you do that? And I said, Well, don't you want to know what's happening? Like, I want to know what's happening. So it was a number of years later that she she said back to me, she was I realized, now prior to you having a glucose monitor, she's like you were doing it yourself. Like you were trying to act as a glucose monitor. You were figuring out what was happening, which made sense to me back then,

Jennifer Smith, CDE 5:39
my finger sticks prior to CGM, and on average, were about 14 a day,

Scott Benner 5:45
I'd have to say that's where we were to,

Jennifer Smith, CDE 5:46
because I literally similar as you, I wanted to know where things were not only before, but especially after because it's a learning piece. Yeah, just like the m&m, it's how did this work or not work? And what do I need to do to make sure that it works the next time because I like this right? Or like to do this kind of exercise or whatever it is.

Scott Benner 6:07
I was so amazed. Just doing that just you know, it Fried my mind back then like to test and go, but but she went to 300. And then 45 minutes later, she was 340. But then she fell and like all that stuff. It was it was interesting information. It was valuable, but it wasn't enough. Right. Right. Like it was it wasn't enough to make sense, at least for me, I couldn't make sense of it still. Could

Jennifer Smith, CDE 6:28
you literally when you do finger six, then you have to do the connection of the dots yourself. Yeah. And I couldn't do nothing in between.

Scott Benner 6:35
I couldn't make that leap. I just couldn't figure out what like, like, what you're like those gaps. Like I couldn't figure out what it was. And it's not Jurassic Park, I couldn't just use frog DNA to fill in the gaps. Right? Because you see the gap. You see what happens? And they're they're, you know, they're making babies by themselves. And it's just it's not good. But you don't want to fill the data in with something unknown is what I'm getting at. So I did as best I could. I heard her story. Oh, my goodness, I ran to get a CGM. You know, we got the Dexcom right away. I can still remember sitting in that we have the endos office, right. And the nurse practitioner put it on for the first time and Arden didn't like it. And I remember breaking my heart. Like I remember thinking like, oh, god Did that hurt. You know, and and now, you know, with the G six Arden Arden honestly says like, I can't even I don't feel it at all right? Yeah, it just it's but back then, you know, there she was, gosh, I don't know, four or five years old, right? So I tell you every week go to dancing for diabetes calm and you really should support them and check them out on Facebook and Instagram and everything. And a lot of you do, which I appreciate. But I just wanted to do more for them. So in May, I'm actually going down to speak at one of their events, but we were trying to figure out a way that I could help them, you know, fundraise. Here's what we decided dancy for diabetes and I have teamed up to give away to not only the people attending the conference, but to you the listeners to the Juicebox Podcast, an opportunity to speak with me. So if you would like a chance to chat with me one on one I'll be conducting 245 minute phone calls or Skype, you know FaceTime, whatever you got, as well as one big one hour call. That includes a 30 minute follow up. So there's three calls in there to 45 minute calls. One one hour call that includes a 30 minute follow up. That's three opportunities to ask me anything you want. Talk about whatever's on your mind. So while I'm at the dancing for diabetes event on May 18, I'm actually going to choose the winners at random before I leave the conference. To have your name included in this opportunity go to dancing for diabetes.com and click on the donate today button between now and may 17. There's a suggested donation of $10. But I don't think dancing for diabetes is going to get upset if you donate more. And all you have to do is be sure to mention juicebox in the notes of your donation. Those of you who do not have internet access, although I don't know how you would get this podcast without it. Or if you have an inability to make a donation you can mail your name to dancing for diabetes go to their website for their contact information. I hope to see everyone at the conference in Orlando but if you can't make it this really is a wonderful way to pick my brain. We can talk about the Avengers movie or Brexit, whatever you want. Even you know diabetes. There she was four or five years old, this little dress and she's so like sitting up on the table and trying to be tough and everything and oh, and it wasn't good. But we stuck with it because of what I was getting back from it. I just found it to be amazing. And now today, today I think that if you're listening to this podcast and is of any value to you, I have to give half the credit to the Dexcom and the other half of it on the pod like I I took those two tools and figured out how to use them on with them

Jennifer Smith, CDE 9:59
but you also I'd have to give myself a big part of that credit because you took tools. It's like any kind of tool, you could have a hammer as one of the simplest tools that there is. And if you don't put it to use, it's a great tool, but it doesn't do anything else for you. Except that they're,

Scott Benner 10:17
you're very kind. I was avoiding saying something nice about myself. But let's do that for a second. But let's, let's translate it out to the people listening. My goal with this podcast is just to be your MLM story, right? Like, I want you, I want to hand you off tools that you then take home and learn how to be professional with right, I'm not, I'm not gonna stand with you forever, Jenny can't come to your house, right? But we're gonna, we're gonna throw this.

Jennifer Smith, CDE 10:41
Anytime

Scott Benner 10:42
that somebody said to me once, can you come live with me? I started thinking there might be a number or I'd say yes to that. But I don't know what it is exactly. How much would it cost for me to abandon my family? Guys, I'm leaving. But but but seriously, I genuinely mean that, like you, you're going to get these tools. You learn how to use them in situations. And before you know it, they work in more and more, what you would have called complex or difficult situations is exactly the same thing. When people come to me and say, Sure, this is great. But how does this work during hormonal time, or during a growth period during illness or during You know, when your daughter's playing softball, I always say the same thing exactly the same way.

Jennifer Smith, CDE 11:21
This tool makes me more comfortable, of course, right? Especially when I mean, we talked already about insulin. And it's actually I mean, this tool shows you not only effective food, but more. So how to be more comfortable with insulin use.

Scott Benner 11:38
Yeah. So not unlike the first time I thought about an insulin pump. And while everyone else was yelling, oh, you won't have to inject so much. I was thinking, Oh, I could manipulate the basal insulin. Like that seemed like the exciting part to me. And we've CGM and you probably have heard people say this before if you have considered a glucose monitor. But the most exciting thing about a CGM isn't the number that it shows you. I'm sitting here now Arden's blood sugar 75. She got insulin for lunch, I'm going to find out when 47 minutes ago, she was 9547 minutes ago when we put the insulin in. She's 75 now. So that's comforting to see that she 75. But what you don't hear me talking about when I tell you that is that there was a moment when she was 89 diagonal down and she was drifting down. But she wasn't falling that fast. I could see how quickly she was falling. That's the information from the CGM. That's just mind blowing. Sure, she's going down. But she's going down at a speed I'm comfortable with based on the food that I know is going in, because that battle is about to start really happening that's really going to kick in and the second. I love that she's drifting down at that moment, because you know, when lunch hits her, I like like, you know, we've talked about before, like the insulin to have momentum. Right? If you think it's about the number you're misunderstanding the CGM. If you think about the m&m story, you have to know it's about timing and amount. It's about speed and direction. Right? Like, which way is my blood sugar moving? And how fast is it going? When you know that it's everything? It's the difference between treating a 75 blood sugar and leaving it alone. So I can see right now Arden's blood sugar is steady, which means I want you because the trendline is horizontal, and her arrow is probably horizontal. And that arrow is still telling you something, right? Like even being horizontal, it's telling you we're steady and Dexcom gives you the breakdown. What that means steady could still mean plus or minus a point every five minutes. But great. You don't I mean,

Jennifer Smith, CDE 13:56
but it's happening so. So slowly at that horizontal arrow, they usually say that it's less than a point a minute. Right? And so and that's where to bring in that that angle there. Oh, that you saw with the 80 something blood sugar. I mean, had it been angled up or angled down. It's still the same rate of change, right? It's about one to two points per minute. Yeah,

Scott Benner 14:17
yeah, it's it right. And so when people talk about, Scott, I don't know I don't understand how you don't count carbs. So here's a here's a way I don't count carbs. Sure. I go historical. I look at a plate and I say I think this is 10 units, right? But Arden had pancakes this weekend. Big homemade not measured pancakes. And I have a feeling that pancakes are going to be 12 units. ish. So I double her bazel rate for an hour and a half. 15 minutes before she gets the pancakes. Her blood sugar is already 78 then she's coming out of bed 10 minutes ish before the food starts. I do the 12 unit Bolus but I take one unit that I've added from the bazel. Right, so now it's an 11 unit bolus, I extended out 80% right away 20% over an hour. Now I'm creating kind of like that blanket of insulin like we talked about. Now, if I get it wrong, I adjust. The most times I expect by getting it wrong means I won't even be aggressive enough. And I'll have to come back and bump it down again. When I see a diagonal up arrow, 30 minutes after pancakes, I say to myself, ooh, I messed this up. Maybe I shouldn't have extended the bolus, or maybe I should have put more up front. But anyway, I'm going to bump that arrow back down again, in this situation last weekend. I was so aggressive that I had to bail on the Temp Basal rate. And so about 45 minutes after Arden ate, she was 70, which was fantastic. But I was like, I still have insulin going. I don't need any more clearly. So we cancelled the Temp Basal. Right. And she rode low for ever. I mean, it was great. 85 like right in there.

Jennifer Smith, CDE 16:01
Right. healthy. That's not low. That's right. healthy. She wrote health lower

Scott Benner 16:06
than you. Yeah, of course. I definitely misspoke. They're lower than you would expect after pancakes. Yep. But but at a great blood sugar. Because I was able to use what the CGM was telling me and what the CGM was telling me Was she was starting to drift lower from like 90 and I and I read that drift as these pancakes are through her now to enough of a degree that we shouldn't be going down anymore. Right. All right. So I bail on the Temp Basal. I don't shut her Basal off, I just go back to the regular base. All right. So we're going along like that for hours. I mean, hours and hours. Now there's nothing. There's nothing now I know the insulins gone from the pancakes. Now I know the pancakes are definitely out of our body. And at some point, that arrow kind of diagonals down a little bit. And we were getting ready to go out to the mall, her and her friend. So I said to her, Hey, take your vitamins, the little gummy vitamins, they must have like six carbs and she pops her vitamins in, we get in the car, the arrow kind of bangs back up a little bit again, right in that 75 area. So we get to the mall. And I'm like, Okay, I'm gonna ride this out to see what happens. Like, I'm not panicking here. But we were there for about 20 minutes or so. And I wasn't sure if like the excitement of the shopping was gonna make her go up or not. And it didn't she was walking around. And my wife and I left her alone. Went did something else and I text her at some point. Hey, I think you should shut your Basal off for a half an hour. And she did. And we stayed right at like, at the whole time she was shopping without the CGM. There's just in my opinion, I don't know how to make any of that happen. Like maybe there's a way. But if there is a way you're listening to the wrong podcast, because I can't quite figure it out. Right, right. So right. I think those CGM are absolutely stunning. I want to know how you talk about using a glucose monitor with with your patients.

I want to know how you talk about using a glucose monitor with with your patients.

Jennifer Smith, CDE 18:08
One of the big things I usually say when people are really either considering one or they've been using one for a long time, but they've may not really be using it to their benefit. Let's say they're looking like you kind of alluded to just the number, right? What's the number? What's the number? They're not learning from it, because there certainly is some optimization when you start using a continuous monitor. But of any form of technology. I might have said this before. I mean, if I were to have to choose between a pump or a CGM, I would say please let me keep my CGM. Right, right. Because even then, if I had to go back to multiple daily injections, I can micromanage that as long as I know the direction of where things are headed. I can you know, and with a pump, then it just brings in more precision. So using a CGM, along with a pump is a another huge beneficial tool, you know, to management. So I guess as far as that it's really helping people to learn what is what's the benefit of that trend that they're seeing? And I think, in the end, many people I find, tend to overreact to the trend too. And you know, oh, my goodness, I you know, things are going up or going down. Well, you do have to make you have to make some considerations within that trend then too, because Have you just eaten? Is there a load of insulin here? Have you just exercised all of those variables that could be there? there a reason for some of that Trent? that trend just like the guy with the m&ms, right. He knew something was going on with his m&ms. He didn't want to be high, but he's like, awesome. I'm going to use this and fiddle with it and figure it out. So you know, CGM can give you that figuring piece that you don't have with finger sticks alone. I mean, you know, again, doing a million finger sticks before I actually had a seat. GM per day, I was still missing all of the pieces in between I missed I was missing. When did it start to rise? Or when did it start to fall? Yeah, I know that I'm like 40 points higher now than I was after I ate my meal. But why and where did the rise actually start? Right. So those are some of the biggest pieces. And I think getting people over the over the overreaction to the trending is something, it's hard for many people to be able to try to say, okay, things are rising. You ate Now, let's do some self experimentation. Let's see. You know, is this happening today, around 80% of your most common foods, which most people have about 20 to 25 foods that are pretty common for them to eat over and over. Use your CGM to your advantage that's 85% of your management then is figuring out and that's the reason that you have outside of not, let's say carb counting in the real sense of doing it. You have a sense just based on the meal because you've done it so much. You can see. This should probably be about 12 units, or that's more about five units. I mean, Ginger actually does the same thing. She doesn't really carb count. Truly she's like this green apple that I eat every morning with peanut butter takes two units. Yeah, you know. And using a CGM, then I think that's the biggest thing for management is the figuring that it allows

Scott Benner 21:38
Yeah, so I think that you hear a lot of people in the beginning talk about like that anxiety right? There was a huge concern in the beginning of CGM, a lot of old school people in the in the diabetes space for like, this is gonna make people crazy. They're just going to stare at that thing all the time. And that probably did happen to some people. But again, it's it's like I say all the time, like if you're looking at what's happening to your blood sugar and think of it as a mistake. That's your mistake, right? It should be like let me experience this. Let me see what this is. Let me see what happens when I put the phone in here versus in there. And that quickly died down I you quickly heard even some of the more ardent I don't know what to call them. But naysayers calm down after a while, you know, saw the value in it. I thought the most important thing was to explain to people that it's not just an alarm for when you're allowed. And I use that phrase in anytime I speak somewhere on this podcast. I say, look, if you're looking at your CGM as a don't die alarm, you're making a huge mistake. It is it is the it is the very least of what it does. And so I mean, it's cool that it tells you Oh my god, oh my god, your blood sugar is getting really low really fast. That's amazing. Don't get me wrong. It's gonna it's gonna

Jennifer Smith, CDE 22:48
turn one of those alarms off that it's always there, no matter how much you hate that, that noise. It's,

Scott Benner 22:53
it's there. The FDA tells them look under 55 we're gonna bang and we're gonna bang an alarm in people's ears. There's nothing they can do about it. And fair, fair, right? But if that's what you're looking at it as it's incredibly short sighted when people say to me all the time like Arden's tolerances are. Her low alarm is set at 70. And on my phone, her high alarm is 120 on her phone, it's 130. So I like to have a if she's raising up, I like to be able to think about it for a couple of minutes before I involve her in the conversation. I don't want her beeping at 120, right. But people say oh, it must be all the time. It must be beeping constantly. And I'm like, no, it never beeps. And that's actually how I don't worry, I'll get back to my thought about moving down the high Dexcom alarm after these messages from the pod and Dexcom. Let's start first with on the pod. The tubeless insulin pump that Arden has been using since she was four years old over a decade now. Choosing Omni pod all of those years ago was and remains to this day one of the best diabetes decisions that my family has ever made. And I'd like to tell you why. With Omni pod, you do not have to disconnect for activity. With a tube pump, you'll have to take your pump off to play soccer or to go swimming to take a shower, you know, and if you're an adult, you're having adult time. You might want to take it off for that too, but not on the pot on the pot is always with you. And why is that important? Because you're always getting your basal insulin. It's a completely under appreciated idea. But when you take your pump off for a half an hour, an hour, two hours to go play a sport, you're not getting insulin. And sure while you're running around, it might seem like oh, this is fine. But eventually you're going to experience a high blood sugar from that. Getting a constant flow of background insulin is incredibly important. And only on the pod allows you to wear their device throughout your life without having to take it off for any of the you know, activities that you enjoy so much. Want you to go to Miami pod.com Ford slash juicebox. Or to the links in your show notes or at Juicebox podcast.com. You can do that today. And absolutely for free. And with zero obligation on the pod, we'll send you out a pod experience, get a free demo of the pod that you can actually hold field touch, keep it in your hand, see what it is, and then wear it, you get the test drive it before you buy, it's a non working pot, don't worry, it doesn't have insulin in it or you know, a candle or anything like that. But it's an exact replica of what you'll be wearing. So you can feel the weight and the size and decide for yourself, if you'd like to try it, my omnipod.com forward slash juicebox. Now on to Dexcom. The Dexcom g six continuous glucose monitor is without a doubt, the Cadillac of continuous glucose monitors. Everything you hear me talk about on this podcast is predicated on the data and information that comes back from ardens Dexcom g sex, we don't need a big long ad for this dexcom.com forward slash juice box get started right now. You need to see what direction your blood sugar is going and how fast it's getting there. And you want to be able to see your loved ones remotely with an Android or iPhone. Come on dexcom.com forward slash juicebox get going today. If you've been hesitant, please trust me when I tell you there's absolutely no reason to not move forward with Dexcom. There are links for all of the advertisers at Juicebox Podcast comm or in the show notes of the podcast app that you're listening to right now. I implore you don't wait another second. Go to Bolus with Omni pod. Get the information you need from Dexcom and support dancing for diabetes.

It must be beeping constantly. And I'm like no, it never beeps. And that's actually how the kind of this way that we talked about doing this here. This being fluid. It makes diabetes a very much a very much a smaller part of your day because you're not thinking about it. Because when it does be, you know, oh, it's trying to leave this tight range. I'll just bump it back down again. Right when you put that threshold up at 400, because you're like, I don't want to hear this thing beep. Well, that means that by the time you think to look at it two hours later in your blood sugar's 280 right now. Yeah, and now you've all this mistimed insulin. Now you're putting in a bunch of insulin to bring it down your insulin resistance so it doesn't work as well. Suddenly, you're going to be a little later. Later, you'll feed the low, you won't have the bolus you get on the roller coaster. I'd rather know now I talked about it in a million different ways I open bills. I don't think I can pay you on day one, because I want to know what they are right? I want to know when her blood sugar's trying to go over 120. And if you do that, there's a great episode way back in the podcast with a scientist from Dexcom. There was a study done, the lower you lower your high alarm on your CGM, the lower your agency goes because you react sooner with less insulin stopping arise and staving off a future low because you're only using a tiny bit events and we've talked about it before you're going to listen through these things. Again, they're going to make total sense to you. I want to address when people say well, I don't want to wear a bunch of stuff. You know some it's some adults just don't want to wear things. That's fine, but I hear a lot of parents. I don't want to look at her. I don't want to look at him and see him attached to something I don't he's not a robot. He's not like that kind of stuff. Arden hated that CGM. The first day she put it on right. And I wouldn't think she thinks twice about it anymore. Not even a little bit. She rolled out that she rolled out the door this morning for school in a pair of leggings. You can see her CGM on her hip and she doesn't care she's wearing a top that doesn't go all the way down to her to her belt or her on the potty sticking out like in that gap of space on her belly. She doesn't think twice about it. You can make those things normal and and they will be you know at some point so I don't know for me CGM is about reacting. And and instead of,

Jennifer Smith, CDE 29:23
you know, appropriately reacting rather than, rather than being you're being proactive really. If you have a CGM, you can be proactive, rather than having to always be reactive at the like you said, Have you CGM set at 400. And you're finally seeing it at 280. Because you're not feeling the greatest. You could have been proactive well above or well ahead of that right.

Scott Benner 29:46
And that proactiveness By the way, takes less time and less involvement than it does to be to 80 and fighting with it for hours. That it seems. It seems counterintuitive because people say to me all the time, you must be so intense. volved all the time and I'm like, man, I don't think about diabetes for more than about 10 minutes a day. You know, like on the really bad days, 20 minutes, but but I'm not mired down in it. Like, there's no hand wringing in my house all day long, like staring at big numbers wondering when they're gonna come down? Are they gonna make lows? We just don't have that. I mean, don't get everyone should. I'm generalizing to make my point. It happens sometimes, right? But, but as a day to day idea, it is not something that occurs here. And I if you've heard me speak somewhere, in my slide presentation, there's a picture of Muhammad Ali standing over top of someone he's just knocked out. And I always start that part by going Has anyone ever been in a fistfight? And inevitably, it's always a little kid who's like, I have, like a golf. And I was like, well, you shouldn't hit people. But but but you know, I tell people all the time, like you, you want to act, like, like we talked about, you want to react, but really, you want to be able to act B first, right? You want to make a decision first, because besides stopping an arrow, there's the concept of cause and effect. Correct, right. And there's this idea that, you know, people always run around yelling, well, that's just diabetes every time something happens, they don't understand that was just diabetes. And I always say that when you're saying, well, that's just diabetes, what you really mean is, I don't know how to use insulin correctly. Right? Right. Right. And so your blood sugar doesn't go up to 400. Because the diabetes very tapped you on the head? Like, there's a reason I don't know what it is. Maybe you might not know what it is. But there's a reason. So at the very least, if you act first, then with some some confidence, you can say that what happened next was a result of your action. Right? least you're not always covering your face in defense, like, like a boxer who just can't, can't get upon it anymore, right? diabetes is not pummeling you in the face. You you maybe you hit it too hard. Maybe you end up with a 65. You didn't mean to, but at least you know, wow, I put that insulin in here and I got the 65. Next time, I'll use less. Next time, I'll do my Pre-Bolus, five minutes shorter, whatever it ends up being I don't know. Right? Right. But I'm a big fan of acting first, and then taking that feedback and making a better decision next time with it.

Jennifer Smith, CDE 32:13
Absolutely. And that's why I think it's it's, it's when you're especially if you're new to CGM, or starting out, sort of over with the CGM, or you haven't used it consistently on a day to day basis, because you have felt more frustrated about it, I think, if you get it down to some basics of use to begin with, and like you said, kind of tighten up those targets. Even if it's just a short time period, you can designate and say, okay, for the next seven days, I'm going to have my targets that the high alert for 130 in the low alert set for maybe 70, or even 80. If you're hypo, you know, hyper unaware, or you just really worried or whatever about the lower end, because tightening it up helps but also then fitting in more of your more more of your regular habits. In that testing time period, your typical foods, the things that you like to eat for breakfast, or lunch or for dinner, or for snacks. Because if you're committing to using something by applying it to your body, and you know being a robot

Scott Benner 33:21
in for a pound.

Jennifer Smith, CDE 33:22
That's right, exactly. If you're committing to using it, then get everything that you should be getting out of using it.

Scott Benner 33:28
And there's a there's a way to start, in my opinion, I'm interested in what you think. But I think that when you first have a CGM on it, you're accustomed to wearing it. Finally, you know what this information means. The first thing you do is you get your bazel, right. Like, like, to me it's bazel. First, make sure your bazel is right. And I tell people all the time, if you haven't had insulin or food for three or so hours, and your blood sugar is not 85, your bazel is not right. And so and so if you're 180 or 200, shoot lower, I don't like don't shoot for 85 right away, shoot for lower and keep kind of just cranking it down and cranking it down. After you've got your bazel. In a situation where you're staying pretty stable most of the time without getting low. That's then you can start thinking about Pre-Bolus. And then and then the CGM can really help you with that too. If I'm 120 and I haven't had food or insulin for hours, when I put in some insulin here, how soon before I start seeing a diagonal arrow is it 10 minutes 1520. Some people say a half an hour, everybody's numbers different. So once your bazel is right, and you can trust the cause and effect that I've Bolus now and it took 15 minutes, let's say for my blood sugar to start going down. Within reason trust that that's probably your Pre-Bolus 15 minutes right when your blood sugar is in range. Now keep in mind if your blood sugar's higher, you'll be more insulin resistant that Pre-Bolus time won't be the same but but for the for the sake of the conversation. Now you have your bazel right now you know your Pre-Bolus time. Now you can start using insulin and being a little more aggressive with it. I've put about Pre-Bolus in I'm 90 diagonal down, I've started to eat my blood sugar shot up. Now here's where the CGM becomes incredibly helpful. So you've you've got your insulin and you've eaten but you're going up. Are you going up? Like a short sharp incline right or is it what I call the prices? right you know the prices might the the what which which is it the minor the the climber the gates like Yoda, he really getting it right. And he's got the pic in his hand he's going back. And it's it's this very gentle gray that goes on forever and you watch it the whole time. God he's gonna stop he's gonna stop he's gonna stop Oh, he'll definitely stop is nobody's gonna fall off the edge. It's not gonna happen through the whole thing and it just keeps going. That's that CGM line that it tricks you. Because you keep thinking it's not on a crazy incline. I'm not shooting up. I'm just climbing. It's going to stop in a minute. But no, it's not. So not most of the time. Most of the time I find a gentle grade up means not You almost got the amount, right. And you're pretty happy with it. Right? Right. And your Pre-Bolus might have been not quite long enough, right? The sharp up is a complete. I just thought the curse but it's a complete cluster, you're like you have not you didn't have nearly enough Pre-Bolus and you did not use nearly enough food. So there is nothing about your Bolus that even gave resistance to that carb impact at all.

Jennifer Smith, CDE 36:30
Right, you can even more often with that arrow up more often at the Pre-Bolus. Especially if you are using a ratio for your carbs and counting your carbs and whatnot. Most often, if you have a pretty significant quick, straight up or double up arrow, within 30 minutes, 45 minutes of a meal, there's a deficit there and or the deficit is more because you did not Pre-Bolus there wasn't times like that tug of war between the insulin that you said, you know, in a podcast before, there was not enough time to let insulin get the upper hand,

Scott Benner 37:06
right. And I'll tell you that that exact situation, that scenario you're describing, that taught me how to overhaul us. So what the first time I put in insulin and her blood sugar started to shoot up, I just made the leap, I was like I missed big time. And I didn't just put in like another half unit, like I crush it, I was like I'm gonna stop these hours. If I have to feed them later, I will. But I'm not going to let this blood sugar go up like this. And so I realized a meal that I thought was going to take five units with no Pre-Bolus needed eight units. And so that taught me in the future, when I don't have time to Pre-Bolus I'll just give eight units for the five unit meal because I can create that action of insulin and overpower this even without a Pre-Bolus. If I use too much, it's a little more. I call it like that's definitely more of a pro level tip kind of a situation. I'm like you're you're more of a diabetes ninja. Once you're doing stuff like that i i hold that up with the same ideas after you've had a 30 too low. And you start coming back up again. And you Bolus like when you're 50 diagonal up like you're a ninja at that point. You're just

Jennifer Smith, CDE 38:11
like, yeah, I need a lot more because I know I eat 60 grams of carbon I really only needed like 50 and

Scott Benner 38:19
start knowing how much insulin the bolus to overcome, not Pre-Bolus Singh again, you've been at this a while but I learned that from the Dexcom. Like I never would have liked so you know, when you see those arrows flying up? Not it's not what was me time, right. It's what is happening. Like what what could I do next time over blessing is an incredible tool

Jennifer Smith, CDE 38:42
so and over bolusing in the way that you're doing it is very I think we talked about this before probably is it's actually what john Walsh from pumping insulin, he calls it a super bolus, right, right. And he does it in a little bit more of a calculated way. He says, you know, you take the Bolus, as suggested by your pump for the food that you're going to eat or the calculated, let's say you said okay, she needs five units for this all the time. Well, today, there's no time to Pre-Bolus usually, you would have done a 20 minute Pre-Bolus for that five units. Okay, he says, You're then going to take the insulin and bazel that's running behind that meal for two hours. And you're going to actually add it on to that five units or whatever your pump is suggesting. So maybe if your bazel is running at a unit an hour, that's two units of extra insulin, you're gonna pop that on top of the suggested bolus, but then behind the scenes, and you probably do this a lot too with that heavier bullets up front, you're like, I'm probably going to need to watch and do a Temp Basal decrease for a little bit after because I know that this is too much in the end results, right? We don't want to cause a low he says to start by just taking the Basal down to zero for about two hours. Yeah. And then evaluating I've got people use it and say, you know, I tried it. The Superbowl is part of it works but I don't need to turn my bazel completely off led to a 50% bazel instead of 100%. Yes.

Scott Benner 40:00
And that's where the Dexcom again comes in incredibly handy. You need it when you need it. You don't when you don't, right. And then I consider that idea trading Basal for Bolus, like there. There are times where I think, Oh, ardens you know, Basal rates 1.4 an hour, I just bought a unit and a half. Listen, there's going to be a moment, right? There's a moment for everybody. There's gonna be a moment where you see the arrow up, put in the insulin, five seconds later, the arrow flattens out, and you go, Oh, my God, I didn't need that insulin, right? Oh, that's when I'll trade the bazel for the balls. Now

Jennifer Smith, CDE 40:31
you can only say cut it out to be the law. Yeah, but do you know that? Do you know that if you don't have a CGM? You don't know. You don't know when that transition was happening? Right? If you had none, and you were very aggressive about just finger sticking, you're like, Oh, my gosh, you know, 20 minutes ago, it was here. And now it's like 50 points higher. I have to slam this with more influence. Yeah, awesome. But if you're not willing to do finger sticks, then like every 20 minutes after that, to see where things are go. You never know when that horizontal is coming, or when a downtrend is coming, either. Yep,

Scott Benner 41:03
I am wrong now texting art. And while you and I are talking, so what I say it is now been an hour and 12 minutes since she got her bolus for her food. I got a little I didn't panic. But because you and I were talking and I could see what was happening. I shut off or at the very tail end of our Expendables and her Temp Basal. Yep. And now she's 105 diagonal up. I'm bolusing that, because I'm putting in the insulin that I bailed on from the extended bolus and the base, I should have trusted myself, right. And so instead, I'm putting it back again, when I will stop this diagonal up arrow around 115 120, she'll float there for a while, we'll come back down. I expect you to be at five by like an hour and 45 minutes from now.

Jennifer Smith, CDE 41:50
And the interesting thing about that, too, is what you're saying in in terms of her management. And I know her agency has been like in the 5% for, you know, for a long time. But the bigger beyond that, and we had a whole we had a whole we did a whole long podcast about a Wednesday and kind of what that all means right? But I think bringing in to the fact here CGM translates into that CGM, because what we're really hoping for is more gentle rolling hills within our target, rather than these major rises and falls of a roller coaster. And if you start to analyze your data in CGM, you can actually start then to be able to say, Okay, I need to tighten things up here. I've got an awesome looking at one See, but I have a huge what's called standard deviation, which speaks to the variability between highs and lows, right? You may have this awesome looking at one C, but if you're going up and down and you look like a big Jagan, you know, roller coaster or mountain range, that's not helpful, your standard D deviation value should actually be low, which means the variance between the highs and lows are also more gentle, rolling, rolling, rolling,

Scott Benner 43:03
right. And the way I found to say that to people is that if you were 350, and then 60, and then 350, and 60, all you're doing is tricking the a one c test. And he comes back and tells you Hey, you have an average a one C of seven, which you do when you average 60 and 50. Again, but you also have a, you're also not living in a healthy way, in any specific way. So don't let that number for you. Right. And Jenny's right there is an episode called all about a one see that she and I did probably more than a year or so ago. Yeah. And I'll link it in the show notes so you can find it, but I have Arden's last five days. And her hurt, let's see, her average blood sugar over the last five days has been 114 she's been in range 56% of the time, which probably seems low, except that her ranges from 70 to 100 that's another thing you need to be careful of when you look at these reports. If you have your high set at 300 and your low set at 60. And you tell me I'm in range 100% of the time Well,

Jennifer Smith, CDE 44:06
sure sure you are Yeah,

Scott Benner 44:07
I mean, good

Jennifer Smith, CDE 44:08
standard deviation within that time and range,

Scott Benner 44:11
right what what is that and standard deviation is just a simple mathematical idea that I didn't understand in school and still don't understand now but it's a basic right it's a it's an average is it an average of maybe it's a mean I don't know see I didn't pay attention to math. You know it's funny you were talking about Walsh earlier talking about like all these ideas about like over bowl his Super Bowl is and I call it over bolusing and when I think about it all I think about is more like the word more just pops into my head more insult and he's over there like with his college degree being like what you want to do is for two hours and this is I'm like more

Jennifer Smith, CDE 44:49
right but you've also figured it out. You're more is not a dangerous more random more now. It's not a random you've figured it out in your you know, this is your diabetes. may vary, you figured it out in in art and diabetes, but you know how much more to give. It's not like you're slamming in five more units you're like, she needs based on experience about a unit more, or she needs based on experience to units more based on what went in what has transpired up to this point.

Scott Benner 45:18
So people who listen to the podcast know that if this wasn't a special episode called diabetes, pro tip, continuous glucose monitor, I would just call it Roger Moore. Because you have no idea how many times I hear from people they're like, could you just make the title something about what's in it? I'm like, No, I can't. That's not fun at all. I want to talk for a second about what happens when you're brand new, shiny decks Come on. And it tells you your blood sugar's 90, but then you test with your meter and your meter says your blood sugar's 140. niggle I don't know which one of these things to believe. So I think it's important to note that CGM is measuring interstitial fluid around your meter is measuring your blood. Thank you for bringing that up. Yeah, both of them have an FDA requirement of only being within 20% of range. So if if a meter says your blood sugar is 100, it could very easily be 80, or 120, or somewhere between 80 and 120. As people living with type one diabetes in the 2000s ease, you're gonna have to accept this is pretty much the best we have right now. And not to make yourself mental. So imagine that your CGM tells you you're 100. But it's off by 20%. High. So you're really 120. And your meter says you're 140. But it's really off by 20%. Low. So you're really 120. They both agree the numbers you're seeing don't agree. You cannot spend a ton of time being upset about that. You have to pick something and believe in it. And I know that's crazy. But I tell people all the time, there's somebody online, there's like look at my meter says this, and my Dexcom says this, and I'm like you're holding a brand new Dexcom g7 your hand and a meter that was made 12 years ago. And you're telling me I believe the meter and I always ask them the same thing. Why did you decide to believe the meter over the CGM? Is it because you had it longer? Because it's testing blood? And that seems like something that's more accurate to you like what is the random thought your brain has had that's made you decide that one of these is more accurate than the other one? Which do you I test sometimes when I don't,

Jennifer Smith, CDE 47:26
but I'm not. So really I mean, blood glucose is the first line of glucose change it is interstitial glucose follows blood glucose. And so with those random, you know, differences most often I would say people on G five and G six, for the most part have pretty good accuracy finger stick to actual CGM, we're, I think a lot of discrepancy can honestly come in is from a finger stick value of let's say it's telling you 140. Right, and you're looking at your CGM, and it's 100. Well, as we kind of started out saying, it's not about the number on the CGM, it's about the trend. And like you do very often you're saying, Okay, now there's a trend going up, you know, you just bolused what you misgiving before because you started to see a trend up. Well, her fingerstick might actually be reflecting a higher glucose than what the CGM is showing right now, because again, glucose changes first in your bloodstream. And so CGM is going to lag especially in those time periods of more significant glucose change such as after food, or after or during exercise, that that can be a varying time. So finger stick 140, your CGM is trending up, or you've got an angled arrow heading up and it's telling you your one or two and you're like, hmm, so what do I do about this? The CGM just hasn't met yet the glucose value in the bloodstream, it will catch up right? It will, it's just that it hasn't gotten there yet. Because really, if you think about the way that glucose sort of moves in a simplified form, it moves out of the bloodstream sort of has to move through insert interstitial fluid before it gets to the cells to get absorbed, essentially, I mean, that's simplified, but and so your, your, your interstitial fluid is also always for the most part gonna lag, especially in special times, like food and movement.

Scott Benner 49:26
And I'll tell you to and to circle back around with the idea of the quality of your meter. Arden's had an omni pod forever, like since she was four, so she's gonna be 15 soon. Point is, that thing's been around a long time. It's got an old freestyle meter in it. They've always been kind of wonky. And now we're using the Contour. Next One, it's the little tiny meter that's going to start calling

Jennifer Smith, CDE 49:53
accurate on the market. Yep.

Scott Benner 49:54
So when Omni pod decided to switch over to dash which should you know, you might be listening to this and that Might be a thing already, but it's about to happen. They're going to offer you a free Contour Next One meter to come with it. So I've been using it for a few months to get my head around it. It's spectacular. Like what a great accurate meter. It's absolutely insane. Like I just compared to what was in that PDM. It was nuts how much better it was?

Jennifer Smith, CDE 50:19
Well, and this brings up for the people to who might still be using a G five, or a CGM. That requires calibration. What you calibrate with? Yeah, really mix accuracy on the CGM hold better, right,

Scott Benner 50:34
right. And if you're calibrating with a band meter, so you have a G five that still asks for calibration, and the G five says it's 90, but you've tested with a 10 year old meter, it's like it's not it's 150. What if you really are 90 and now you're telling the two five, everything you think is wrong? You're 150. But the algorithms like that's not right, we're nine. And did you confuse it? And then it it blows

Jennifer Smith, CDE 50:54
up? Again? Three, three question marks for three hours.

Scott Benner 50:59
And then you go this something wrong with the CGM? Actually, no, it was you, you know, you put the wrong information. And so none of this technology is obviously perfect. But again, I always like to say you're not boiling your urine to find out what your blood sugar is. So you're doing right, yeah, right, you're doing great. I all I can say for sure, as we as we kind of come up on the end here. And I might ask you to kind of sum up in a second. But what I can tell you is that, as I've said before, ardens a once has been between five, two and six to four or five solid years. And it's going to be a lot to do with the tools that you hear us talking about here on the podcast and how I've learned to implement them. But how I learned to implement them was the information coming back to me from Arden's glucose monitor. So if you have an opportunity to get one, and I know they're not covered by everybody's insurance, and they can be expensive, but if you can get one, you absolutely In my opinion, should the absolute will just change your life. So

Jennifer Smith, CDE 51:52
yeah, I 100% agree. Yeah.

Scott Benner 51:55
Did we forget anything? Because at this point, people who listen, probably aren't surprised. But I don't pre plan these with Jeremy, I should put on her headphones. She goes, what are we talking about? I'm like CGM. And she goes great. And then we just started talking. But again, I like the way these conversations flow. So did I forget anything? That is like wildly wrong?

Jennifer Smith, CDE 52:16
I don't think so. I, I do think that if, I mean, this is just from an education standpoint, your own education with your CGM. If you really need some pointers, I mean, it's helpful to look or ask more of your care team. You know, if you do need some pointers, some some endos. And CDs are really awesome. Some don't know much more than just telling you how to slap it on. But look beyond I mean, because there is there's a wealth of of benefit to knowing. And some of it is self experiment, experimentation. In fact, I think a lot of it self experimentation. But if you need some help with looking at things, I think searching out somebody can be helpful.

Scott Benner 53:00
Yes, somebody who can look at the graph and just make sense of it in a second. Yeah, we've talked about before I can at this point, I can look at someone's three hour graph and go, is this where you're putting the insulin? And they're like, how did you know I'm like, yeah, cuz it should have been here. And it wasn't enough. And this would have stopped that and like, it's pretty easy to see after you can see it, right. It's like those, you know what it's like? It's like those posters that you look at it. You're like, there's somebody tells you it's a tree and it's a sailboat, you stare long enough, it turns into a tree. I think that's what happens after you look at it long enough. I know people can get scared of the idea of data. I don't like the word because I think it I think it scares people off. Like, you need to understand the data. Well, that sounds scary to me. Right? Right. There's a little line on your thing, okay, that line tries to go in a direction you look and see where you put the lights on. And you see how harshly the line tried to go in that direction, you make a better decision next time.

Jennifer Smith, CDE 53:53
You know, I think that actually brings in one point that we may have missed is that especially dex comm does allow you to use event markers. So if you are really wanting more, you know optimization, and you're the only one who can really look at your your lines and your info. Using the event markers. I know in G six at the at the bottom of your at least your screen on your on your phone app, you just choose events. You can log things like food or exercise or illness or even alcohol and like your your cycle or monthly and all that kind of stuff. It'll put little marks on your actual trend graph. And that way you can make more sense of the if you're again, the one that's really trying to look back for what what happened, why did it happen? You

Scott Benner 54:41
don't have to remember that I ate lunch at 1130 you can just say food and the amount of carbs and then make a note about what the food was. Right? And that helps you when you look back. See again, that's well more way better thought out than I can ever be. But that makes a lot of sense. That's why you're here. You're the you're the smart part of this conversation. part of the conversation.

Jennifer Smith, CDE 55:03
Were both important for me then.

Scott Benner 55:06
I'm pretty sure that's true. Okay, I think you have to go in a couple of minutes, right? I'm gonna let you go now and say goodbye. Don't forget, you can hire Jenny Smith to help you with your type one diabetes at integrated diabetes.com. There's a link in your show notes that will allow you to generate an email right to Jenny. It's magic. Thank you Dexcom on the pod and dancing for diabetes for sponsoring the Juicebox Podcast. I cannot tell you how much your support means. Don't forget that when this episode went up to other diabetes pro tip episodes went up along with it. You're looking for bumping nudge and the perfect Bolus. There will be more episodes with Jenny coming up next month. And the programming note. Next week. I'll be talking with Katie. You might not know who Katie is Katie is one of the people who is key right there in the middle of the DIY looping world. Katie and I are going to talk about the new looping option with Omni pod. Which by the way, I think I'm gonna try

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#223 Johnny's Mom Took Notes

From Phone to Podcast…

Allison and I spoke privately last year about her son's type 1 diabetes. In today's episode you'll hear me realize that fact way too late into the episode.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello, and welcome to Episode 223 of the Juicebox Podcast. Today's episode is sponsored by dancing for diabetes Omni pod Dexcom. And real good foods. There are links to all of the advertisers in the show notes of your podcast app at Juicebox podcast.com. And by now I'm hoping stuck in your head because I've done this a bunch of times. For more information about on the pod, go to my Omni pod.com forward slash juice box. And to find out about Dexcom, you can go to dexcom.com forward slash juice box dancing for diabetes is at dancing the number for diabetes.com. And it real good foods calm you can save 20% on your entire order by using the offer code juice box at checkout. I have a lot of have to say during the music. So let me get right to it. Nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before making any changes to your medical plan or becoming bold with insulin. And later in this episode during the dancing for diabetes ad, you don't want to miss it because they are announcing a giveaway. And what are they giving away a phone call with me where you can talk about whatever you want. So stay tuned for that. Today I'm going to be speaking with Alison Johnny's mom. She's a person who I spoke to on the phone a long time ago and sort of did the podcast for her privately it seems like and this is going to be a little follow up, find out about their lives and see how they're doing since she and I spoke.

Alison 1:38
My name is Alison, I have a almost nine year old boy who has type one. He has had type one for just about four and a half years. So you're kind of at this point where he has had it at half of his life and half not because he's just about to turn nine. And he has an amazing boy named Johnny.

Scott Benner 2:03
Was Johnny in kindergarten when it happened?

Alison 2:05
No. So Johnny was finishing up preschool. And he was registered for pre kindergarten because here in California, you have to have a September birthday. And he's November. So it was so easy. His whole time in elementary school. He's had it.

Scott Benner 2:19
That's actually I would think better. So did you? Did you sort of you leave him in preschool? Did you bring him back home? What did you do during the diagnosis time for that?

Alison 2:28
You know, it happened Mother's Day weekend. So he had about a month of school left for preschool. And we weren't quite sure what to do. Because,

Unknown Speaker 2:36
um,

Alison 2:37
I called the preschool director. And I said, you know, here's what's happened. And they said, you know, like, they had to meet with their board, because they're part of a church to see if they were willing to take on the risk. But they, you know, they Johnny had been there since we were doing baby and me. So they just adored him. They wanted to do what they could I am I also had a little one at the time. He wasn't even I think he just turned two. So the director like, you know, we met and she learned to finger pricks, and we're like, Alright, let's just wing this. I mean, I kind of remember your stories where you said, You sat in the parking lot with Arden and I kind of did the same thing with Johnny, I would just, I go and be like, Alright, let's you know, let's see what happens. And I'd get called from the director, you know, he's crying, we think he's like, low, and I'd go over there. And he's like, 400. And I was like, no.

Unknown Speaker 3:27
But we got through it.

Scott Benner 3:28
Did their fear outweigh their understanding? Do

Unknown Speaker 3:30
you think? You know, it

Alison 3:32
was interesting. I know, several of the people here, when we had the meeting with the faculty were like, Oh, we have our, you know, my parents of type two. And so I know all about this. And it was like, you know, we were still no one in our family has type one. And so for us, we were like, We don't know,

Unknown Speaker 3:47
you know, at the time,

Alison 3:48
we didn't even know much of the difference between type one and type two, we were like, great, you know, something? You know, I think they loved my son, and they wanted to do what they could. Yeah, um, and I appreciate that. And I think he had like, he was only going three days a week, right? So and he didn't have a dexcom he wasn't on a pump. And so we, you know, we made for the whole world and our whole world change, like everyone's does, and we just, we made the best of it for that month. Um, and then we brought them home for the summer.

Scott Benner 4:18
We didn't have any real context. So anybody who who offered up I know, don't worry, you were like, Oh, thank god, there's someone around me that understands this. It is an interesting position to be in. Why do you think you had such a limited understanding in the beginning? Was it just like, did your doctors not explain things in a certain way? Because it's an interesting thing to say that I wasn't even I was still confused between type one and type two.

Alison 4:43
Well, it was weird. So I mean, you know, the whole the whole day when he was diagnosed was so weird and even leading up to it because both my children about three months before had strep throat, and my little one bounced back immediately. But Johnny, he was four at the time. He went like through two rounds of antibody biotics. And it was weird as the night he was diagnosed with a strep, he started having potty accents, which was like nothing, you know, and, and for the whole month and like he started having the thirst and like going to the bathroom all the time. And I actually his pediatrician tested his blood sugar during that time, and it was like 70. Okay, so, you know, going into like, when, and after three months of just this continuous behavior, when I took it back to the pediatrician, I'm like, Look, there's something wrong here. And when they finger picked him, he was 330.

Unknown Speaker 5:31
And that goes Johnny's meter.

Alison 5:35
And, you know, but the pediatrician was like, Oh, you know, they gave me the devastating news, he had typed type one, and you know, I'm crying, and they have to take my kids out of the room, and they're like, you know, we're gonna send you to an endocrinologist who can tell you about food, they're gonna give you some insulin and send you home. I was like, you know, okay, I call my husband yet my mother's an RN, nurse. So she came, my best friend is a pediatrician. So, like, everyone met us at the pediatric endocrinologist. And suddenly, he's throwing, you must go to the ER, your life is changing. Like he was so serious and scary, that we couldn't comprehend anything anyone was saying.

Scott Benner 6:11
So I tell you, every week go to dancing for diabetes calm, and you really should support them, and check them out on Facebook and Instagram and everything, and a lot of you do, which I appreciate, but I just wanted to do more for them. So in May, I'm actually going down to speak at one of their events, and we were trying to figure out a way that I could help them, you know, fundraise, here's what we decided, dancing for diabetes. And I have teamed up to give away to not only the people attending the conference, but to you, the listeners to the Juicebox Podcast, an opportunity to speak with me. So if you would like a chance to chat with me one on one, I'll be conducting 245 minute phone calls or Skype, you know, FaceTime, whatever you got, as well as one big one hour call, that includes a 30 minute follow up. So there's three calls in there to 45 minute calls. One one hour call that includes a 30 minute follow up. That's three opportunities to ask me anything you want, talk about whatever's on your mind. So while I'm at the dancing for diabetes event on May 30, I'm actually going to choose the winners at random. Before I leave the conference, to have your name included in this opportunity, go to dancing for diabetes.com and click on the donate today button between now and may 17. There's a suggested donation of $10. But I don't think dancing for diabetes is gonna get upset if you donate more. And all you have to do is be sure to mention juicebox in the notes of your donation. Those of you who do not have internet access, although I don't know how you would get this podcast without it. Or if you have an inability to make a donation, you can mail your name to dancing for diabetes, go to their website for their contact information. I hope to see everyone at the conference in Orlando. But if you can't make it, this really is a wonderful way to pick my brain. We can talk about the Avengers movie or Brexit, whatever you want, even, you know, diabetes.

Alison 7:58
He was so serious and scary, that we can comprehend anything anyone was saying,

Scott Benner 8:04
you got you got flipped out. And you were just like, yeah, I hear that. Like, I feel like it happened to me. My wife was just retelling a story the other day about when my daughter was diagnosed, and they came into the room to teach me how to teach us how to carb count. And there was like some fairly simple mathematical equation that had to do with fractions and everything. And five minutes into it. My wife's like, he just started to cry. And I was like, I was like, I don't understand. I'm like, Oh, my God, I don't understand seventh grade math all of a sudden, you know, like, it really just shut my

Alison 8:33
my background, I work in finance, but I couldn't get the math like I my brain was on shutdown of my poor son like I, you know, like my husband, he's, you know, he's got a physics degree. And so he had to kind of take over at that point, because I remember just crying when we brought Johnny home. And I was like, I can't do two plus two, like,

Unknown Speaker 8:52
I just got lost. I

Alison 8:54
you know, but the hospital was so scary because they were like, you know, the nurses, he's in the PICU. And the nurses are like, okay, you have to fit me, they brought a tray of food. They're like, you have to count these cards. They were like, What are you talking about? And then they're also like, your son cannot leave the hospital until you and every single person who comes in contact with him can count cards and gift shots.

Scott Benner 9:13
Yeah, we'll just take a tiny bit of I know, they don't have the time probably but it would take the tiniest bit of compassion during during those conversations to really make a huge difference, you know?

Alison 9:24
Yeah. And it's weird as well. He was I mean, he was one of the first to come to pick you while he was in the PICU two kids came in to UK. And they're like the nurses are like yeah, lucky he wasn't like them.

Scott Benner 9:36
When you look back, we look back now Don't you wish she were like you now so you could be like, Hey, why don't you go to hell? Why are you talking to me like that? Like I don't I did you feel Do you in hindsight feel like, like that was not valuable. Imagine?

Alison 9:51
Oh, absolutely. Because at one point my husband he had called we called in. All of our parents are divorced and remarried. So we called in every grandparents we had people from all over This tape Come on my sister came our nanny came everyone came to the hospital and spent two days learning how to take care of Johnny. And at one point, I guess the doctor had come into the PICU. And because we weren't there, he got all upset. And when we finally went back, he was like, yeah, you weren't here for me. So I'm not here for you when he left. The doctor did that. Yeah. We don't see him anymore.

Scott Benner 10:22
Where are you aware? Are you are you like seven miles off the shore in California?

Alison 10:27
You know, it was, it was a very rough start. Fortunately, I learned as we were learning all this, that's a dear friend from high school is an endocrinologist, and he sees kids. So dad has changed everything for us. Like we ditched the other doctor, we moved to him. And it's been an amazing experience since then, because we get the comforting support we need.

Scott Benner 10:48
I'm always interested when I look at, I was just looking today at the map of where everyone listens that like all of you guys listen from. And it's so global. It's incredible. Right? There are very few there are very few countries that don't download this podcast, which is is really something I was contacted two days ago by a woman in Australia who's like, can you come here and speak to my group? And I was like, Yeah, I guess it's sure you help me work it out. I've never been to Australia before, but I would love to ride on a plane for 19 hours. And but but but my point is, is that there's places you know, the listeners come from everywhere. But a disproportionate amount of Californians listen to the show. Really. So I know the state is obviously much larger. But if the numbers still don't bear out, it's there's more people listen, I guess, per capita in California than almost every other state in the US. It's really it's really interesting. I never I'm never gonna figure out why.

Alison 11:47
I Well, you know, it's weird when Johnny was diagnosed. The endocrinologist said that where we are living there had been in the last year a 30% increase in children develop developing type one. And a lot of them were not hereditary.

Scott Benner 12:00
Maybe that's my answer. Yeah. Not hereditary in a way that you can see when you look back. So what is your history?

Unknown Speaker 12:08
No one.

Scott Benner 12:09
How about other endocrine issues? hypothyroidism? Nope. silly thing.

Alison 12:13
This is like our No, this is our first I mean, we have you know, our parents are like, possibly type two, you know, but nothing. Yeah,

Scott Benner 12:20
no. Interesting. Well, you're just you and your husband are just the lucky combination.

Alison 12:25
Yes, he got super lucky with this brand new at least I'll tell you this. At least Johnny's amazing. He handles it. And I could not have asked better. I mean, I have parents who come up to me and are like, shots of just how mature he handles it. And I think it's he doesn't remember life before it.

Scott Benner 12:42
Yeah, I do wonder sometimes I don't think Arden has a perspective at all prior to diabetes.

Alison 12:48
I know it makes me a little sad. But it's I he takes it with just he just does it. He's a normal kid. And diabetes comes along with it be

Scott Benner 12:57
sad if you want to be but I can remember not being married. And that just makes me sadder.

Alison 13:04
I remember getting sleep vaguely.

Scott Benner 13:06
Exactly. There's things I remember a little too well. How's that? like five minutes by myself? Yeah. Okay, so so Johnny is diagnosed. You said in the very beginning, obviously, there was no how soon until someone mentioned to you Do you guys want to do pens or a pumper? Like when did it start becoming less people yelling at you and more kind of common decisions being made?

Unknown Speaker 13:28
It's hard to you know, it's

Alison 13:29
hard to remember the craziness in the hospital. I mean, I remember, you know, my husband, I think my husband and my mom went but then to get them all stuff. And then nurses are like, okay, you have to call the insurance and your insurance, you have to figure out what meter they cover which pen they cover, like, what's a pen like I? So they had us, you know, and it likes everyone else's story. They had us leave the hospital with one bottle, Atlanta's one bottle of homologue a bag of syringes. And they're like, go to your pharmacy on your way home, pick up a pen pick up, you know, if we're like, Okay, um, is that, you know, it was trying out that summer. It was like trying to figure out how to get all this together. How to, you know, I had to sit on him. At four years old, I had to chase him around the house and sit on him to give him a shot. Because I can't blame him. He didn't want them. Yeah, um, and it was just it was a rough training out getting the car counting. And you're and then also like, I had to cancel all of his summer camps, because he I work from home at the time I work part time. But they're all of them were like, We're sorry. We don't have a medical team who can watch him. Yeah.

Scott Benner 14:33
Yeah, they don't know what to do. And listen, in fairness, you didn't know what to do either. So it was Yeah, right. So it's, yeah, it's, it's very difficult to be upset at somebody for not understanding your disease.

Unknown Speaker 14:44
I mean, no,

Scott Benner 14:45
I even I sit here now and I realize I understand this. But you know, I'm sure there's any number of things that other people are living with, I would have no frame of reference whatsoever. So it's just it's just it's with a four year old. Going to be a five Like, Hey, can I drop my kid off with this insulin that might kill him if you do it wrong? And by the way, I'm not 100% sure how to use it and good luck, you know, like, and you wouldn't put him in that situation to begin with?

Alison 15:10
No, in the end, you know, and we were hearing terms like an insulin pod, but we didn't know one was we had not heard of a dexcom yet.

Scott Benner 15:18
Today, we had a little bit of a waffle catastrophe. Arden chose waffles for breakfast, and my wife Pre-Bolus for them. She wasn't sure how much exactly to do. And she was about to ask me, but she got some units moving. You know, at the right time, just get some momentum going on the insulin side like you hear us talk about her on the podcast. Anyway, a second or two later, she texts me She says, Hey, Arden chose waffles. This is what I did. What else should we do? And I said, Oh gosh, the pumps about to run out of insulin. I was gonna change it this morning, I would have changed it before the waffles Had I known. But no matter. I'll come down and do it now. came downstairs, change the pump. waffles are already in the you know, being warmed up with her on the new pump put in more insulin, you know, change some bazel rates kind of ramp them up a little bit. But now the question is right, this is a new pump. It's a new site. Is it going to work? Well, I don't know. But you know, we already promised the waffles and how do we keep on top of this? Well, the answer is simple Dexcom. All I did was watch the data coming back from the Dexcom. And adjusted appropriately. We got through this lawful catastrophe, if you want to call it that. How about with a blood sugar that never went over? 170 I'm looking at it right now to make sure I give you the right number. That included me leaving the house and going somewhere and continuing to manage this remotely. How do I do that? Because Dexcom has Sharon follow. And I have an iPhone. Actually, if I had an Android it would work as well. So I was able to see Arden's blood sugar while I wasn't in the house continue to make adjustments to her insulin based on the information coming back from the Dexcom we got waffles got through a whole pump change a pump change in the middle of a waffle meal. I want you to let that soak in. Never over 170 got it right back down hour and a half later with Dexcom. Let me see you do that without Dexcom. Go to dexcom.com Ford slash juice box are the links to show notes at Juicebox podcast.com. To get started today, these are my results. Yours may vary.

Alison 17:14
We were talking about like you know the old endocrinologists were like okay, what should we be doing next? You got to get this right first. And we were like, okay, you know, thank goodness, two things happened. Um, my husband's cousin had a friend who had a daughter who was type one. So she allowed me to call her and email her all hours of the night, when I had questions like the night we gave him way too much insulin when he was going to have some s'mores. And we were afraid he was going to crash in goes to low super low. I was nervous to call the school he was going to go to the elementary school because this you know, everything had changed for when I registered him. And we got the most amazing health clerk who was like, You know what, hey, we haven't we have two type ones here. And one of the moms has said if another mom ever calls give the number. So over that summer, I met this mom who had a son who was I think in second grade, and she had a son who was going to be in my son's pre k class. So I got to connect with another family. And that helped the transition. I had two sources of people I could go to when I was super overwhelmed. Not

Scott Benner 18:12
great. You had your own little personal, like, three person community. Exactly, yeah, it's excellent. It's so needed. It's, as I sit here and think about what I'm going to do tomorrow, I had to I'm given a talk tomorrow. So I had to, I had to pare my thoughts down, because we're gonna do, we're gonna do the podcast live for the first time. So it's gonna be, you know, a half an hour of the podcast and a conversation, and then it's going to transition into more talking about management stuff. So I had to really pare it down. And I got it down to like five, like, you know, simple thoughts. And one of them that I couldn't remove as I was looking through what I thought was important was was the sense of community, somebody to reach to. Yeah, you know, it just I don't see how I mean, it's just so much easier when, when that exists, because look at you, you were willing to listen to a person working at a preschool Who said I have I know somebody with type two diabetes, there was a moment in your life where you were like, you are the source of all knowledge.

Alison 19:10
Well, you know, at least I had, you know, I had also with my mom being here was a nurse, she had at least a little experience, not too much of diabetes. And at least I also had a friend My friends, a pediatric cardiologist, so again, it was like they had snippets, but they didn't want to, to advise because they're like, this is not our expertise. Yeah.

Scott Benner 19:28
And what that and that's a very polite doctor way of saying I really don't know what you're talking about. Yeah, much. I I went through medical school and we read about this. That's pretty much what they what they get. And so you know, it is what it is. Exactly, it gets a little more confusing when it's your endocrinologist who doesn't seem to understand or or says what they said to you. Like we like think about it you I heard you say there was a moment where you thought we're ready to find out what else there is. And they told you no. Yeah, like, just stop. And that's what's that four years ago, right?

Alison 19:59
It was Four years ago, yeah, just a little four and a half. And my husband, we're talking today like I even remember going in at one point to his office, you know, he was the lead endocrinologist in this area. And you know, first of all, super too many patients too little time. He was so busy, he sent some sub doctor who like changed all of my son's numbers. And we were already weren't understanding he was in the honeymoon phase. We weren't understanding what to do. And this new doctor comes in is like, you're doing everything wrong. Do it this way. And his numbers were atrocious. And based on that,

Scott Benner 20:31
he fixed it real good. Did he? Oh, yeah. So where this is interesting, where were you when he said, this is not you're not doing well? Like what do you what what did that mean? But you know, average blood sugar and stuff like that.

Alison 20:44
I felt for years, like I was failing and all this. And I felt like you know, every eight one c test I dreaded with a pit in my stomach because it was a report card. And there's my big fat f when my son's a one C was not where I wanted it to be. He was on. I mean, one first pocket I think I listened to you of yours was the roller coaster. And it just made me cry. Because I just it was it. We just we thought we would get this, my husband and I and then we would just lose the control.

Scott Benner 21:12
So let me tell you what I told Rosa on the phone last night, Rosa, if you're listening Hello, I was speaking to Rosa and her 22 year old daughter, because I just happened to be online yesterday. And I saw somebody put a graph online that looked like jagged teeth from a pumpkin. It just went from 60 to 460 to form up and down up and down all day long. And it made me sad. I didn't know them. And I just I had some extra time here saying I reached out. I was like, if you have any interest, reach out and Rosa actually called. And I joked with her I said, um, I said, Well, this is how desperate you are. You've called a stranger on the phone about a situation. But but the I guess my point is, is that I ended up saying to her the same thing I'm going to say to you which isn't it amazing that somebody is willing to give you no tools, no understanding, no instructions? And then have the nerve to tell you, hey, you're doing this wrong?

Alison 22:07
Oh, yes. It's like, because there was no he had no CD. So there was no one they had no nutritionist he I mean, it was we were just trying, you know, suddenly it was like, well, do we ban all foods? Yeah. And some of us even I mean, the transition also into when we saw we switched to seeing my friend, my old high school friend for as an endocrinologist, you know, as we still couldn't get the control. And he kept trying to talk to me, oh, Johnny was on Johnny's been on shots only, he's only gone on an ami pot about a year and a half ago. So we so for the first two and a half years, we were doing shots. And we kept asking, we're like, what are we doing wrong? He's like, well, you need to Pre-Bolus. But you got to figure it out. And we were like, you know, should we do low carb, he's like, at least a one piece of ice that goes with the low carb, he

Unknown Speaker 22:47
said is look,

Alison 22:48
you could do that. But I'll tell you right now, when your kids a teenager, he's going to rebel ate everything under the sun. And then you're going to have a real problem on your hands,

Scott Benner 22:58
I just think then you you're going to lack the understanding of how to in the end, it's all just understanding how the insulin works. It's such a, as I was explaining it last night, on the phone to a person who I'd never spoken to before. And I was sort of with an eye on thinking about this conversation, I'm gonna have to speak to him enough to give on Sunday, I was just thinking, I was like, Wow, it really is. As long as I've been doing this podcast, the absolute core of the truth is that this whole thing is about the timing and amount of your insulin and understanding how it works. Like it really everything else grows from that seed. If you if you don't understand that the rest of it is just, you know, the person on the phone was like, Well, what about Temp Basal? And what about extended bonuses, like yeah, that stuff's all incredibly valuable, like, but you're so lost at this point, you just have to start over, you have to just scrub it down to nothing and and start with, let's figure out how long it takes your insulin to work in your body. And then we'll work on Pre-Bolus. And then you can start working on adjusting amounts and Pre-Bolus times and until you can kind of kill the spikes completely. I was like, and from there, these other ideas will grow. But you can't, you can't turn to page 84 when you don't understand the first you know, 83 pages and just go I'd like to get to the advanced stuff now. But the problem is, is that somebody said to them, You know, I think you could use an extended bolus there. And then they don't know they're stuck in the same spot you're at, they're talking to the lady at the preschool who's like, I know, somebody would type to me like Alright, well, you know, more than me, you're in charge now. And so,

Alison 24:26
you know, and that's what's funny is even when, you know, we let Johnny decide when he wanted to go on a pump. He fought us for the first couple years and I'm like, that's fine. I'm not gonna stick something on you. If you're not willing, you know, you need to be a part of this conversation.

Scott Benner 24:38
You are so California. You bring that kid out here. I'd be like, Hey, this is a Pompey like I don't want I back doesn't matter stuff the rd you're good. And here's $100 make it go away.

Alison 24:51
He felt like he got he got this. He got a bum rap. And so he he for the first few years didn't have much say he didn't have say when we had to stick him All that kind of stuff. And he came to us about because it was a year and a half ago and was like, Okay, I'm ready. And we're like, okay, so I was at least, you know, I was on the forums, and I was on Facebook, I just don't like so I knew all this terminology. And when we went with the Omni pod people, I was like, Alright, how about Temp Basal and extended? They're like, well, we're gonna teach you the basics. I'm like, Well, no, I don't want the basics I need if we're gonna do this, I'm jumping all in, right? And even they were like it, congratulations, you know, the words, not gonna teach you it.

Scott Benner 25:26
So here's what I think it is. And if I'm gonna say two things, first of all, I was mainly joking, I think what you did with letting him come into it on his own, I think that's an incredibly smart idea. I'm probably not a very good parent. But I grew up on the east coast. So nobody really ever took my thoughts into account as a child. So I have a limited understanding of my kids thoughts. Although, you know, one mistake not to get sidetracked too long. But this is a absolute generality, that will be true for everybody never let your kids decide the restaurant. It just a horrible thing you don't like, Where do you want to go? And the next thing you know, you're like, I would just let's not eat. Anyway, going back to what I was saying. So sorry, I just had that happen the other night where we're all sitting in the car looking at each other. And my thought was, why don't I just go back in the house? We're never leaving this. Oh, see. Now

Alison 26:10
if you had a conversation, my little one, it's always Taco Bell, and he refused to go anyplace else.

Scott Benner 26:14
I liked it. He's got to go to. Anyway, um, so seriously, I think you you know, I think the way you handled it is amazing. I think that the the larger problem with when you ask people, can you tell me about this? Can you tell me about that? I think everyone that's why I always tell people, when somebody says no, ask them why? Because I think you'll find most of the time, they don't have an answer to why well, your doctor when you say, hey, I'd like it. And sometimes they go No. How come? Well, you don't know enough yet? Why? Then there's never an answer. You just have to figure this out. Those are very vague. In specific statements. You have to figure this out, you have to figure out Pre-Bolus. And you that's somebody that's code for I don't know what to tell you. And or, or everyone's different. And I don't want to tell you something I know works for me, that doesn't work for you. That's just another variation of, you know, oh, that's just diabetes. And I think that the one thing this podcast has done for me and for anybody listening is proven that that that initial statement of timing and amount that's true for everybody.

Alison 27:19
Well, and I agree with that, because I only learned about your podcast, probably in March, I was I was on I finally saw someone post one of your episodes and one of the diabetes groups. And I was like, Okay, let me listen to this. And I remember going for a walk a couple walks, listening and just coming home in tears, because I was like, wow, we are just messing things up. And over Easter and never having my husband I'm like, okay, we're gonna listen to a couple of the first ones we listened to were a date with someone from Dexcom about the G six that was coming out. And so what about Omni pod that was about the dash. And that those convinced my husband, he turned around, he was like, Okay,

Unknown Speaker 27:52
what are we going to do?

Alison 27:53
So then I reached out to you, and you called me. And we talked in from, I think it was like, early April. From that point on my husband. We're like, okay, we're throwing everything we're doing out the window. And we're gonna start over and we're gonna really figure this out. And it has been now an amazing seven months.

Scott Benner 28:08
Oh, my God, this is so embarrassing. I remember the conversation with you just now that you said it, but not prior to us starting to talk. I'm sorry. I just I just had a whole wash. I completely remember talking to you back then. And I and it was the time of year because I was outside talking was so nice out and like, oh my god. Yeah. And you and you were super enthusiastic at the time. And I talked, I must have had a ton of free time because I went on at length. You're delightful. Thank you. And I know I did. And I remember when you hung up the phone thinking these people are going to do okay, so I had a drumroll here. I would do it. But I don't have one. So how did it go?

Alison 28:50
It was okay. So April was rough. Like I was in tears a lot because I just I feel like, you know, I've worked in this place where like, why can't we just get this and we would try things and he would go super high or super low and the school was really fighting us because he was only on g4. So they were like okay, I'm sorry, he's not FDA approved to do it himself. So every time you want to do something, you either have to go to the school or we're going to have to go get him and he was still missing school. And we were like this is what we're trying to avoid. Like we're fighting to avoid this and I remember it That was one thing you even I even talked about was like how did the administration and what to do and so we struggled through April and we and even It was interesting like even his first day one seemed like after like even a month you're like wow, okay, there's a difference.

Scott Benner 29:39
And then you could see the difference in the first month even though it felt like a struggle.

Alison 29:43
Yeah, because it's a one see went from like 6.4 and January down 5.9

Scott Benner 29:48
Okay, so what I would say to anybody By the way, those are great numbers to begin with but but I what I would say to anybody is that just the same thing again, I said to rose last night I was like when you first start this this is starting over like things aren't Make sense, unlike you just have to stick these basic tenants until they start making sense to you. And, and I do get worried sometimes that people might bail a little early on it. But for the most part, I think that you see Enough, enough improvement in that early going that it makes the rough part rough and it is my assumption I hope people believe me, when when, when they when I say this is that I have no idea how it went for you after you and I talked and we're gonna find out over this next 30 minutes. You know, most old people will think that the first cliffhanger in television was on Dallas with the who shot jr thing but was actually the year before on soap. But this is my own little cliffhanger right here. I'm gonna make it simple for you. Go to my Omni pod.com Ford slash juice box to get started today. With the world's only tubeless insulin pump. It's the insulin pump that Arden has been using since she was four years old. Every day, she's gonna be 15 this summer, Arden's agency has been between five two and six two for five years on the on the bottom, two percents on top of these things alone. Plus, my heartfelt endorsement should really be enough for you to try at least the free demo of the Omni pod. I mean, there's nothing for you to do. No money changes hands, you have not made a promise to continue. When you do this, you just go to the link, which you can find, of course at Juicebox podcast.com. Or in the links of the podcast player that you're listening to right now in the show notes there. That's going to take you to my omnipod.com forward slash juice box. And you're going to get yourself a pod experience kit, a peck on the pod is going to be thrilled to send you an absolutely free, no obligation demo of their product that you can actually try on and wear. And here's what's gonna happen when you do, you're gonna put it on, you're gonna forget it's on, because it's freaking amazing. And then you're gonna call on the five back up and say, Yo, I really would like to try using the omnify Can you help me get started. And they're gonna say, of course, that's gonna be that. I mean, no cliffhanger here. You're gonna enjoy it. And the rest of this ad is the fault of the person that emailed me and said, You should sing more. Get yourself and I'm the pod it's a tube was insulin pump. The god I love it by omnipod.com forward slash the juice bar. Don't just blame the person that email. I didn't want to do it. My assumption is that first time is rough, you start seeing a little bit of improvement gives you a little bit of hope you keep then you start honing things. And it gets easier and easier to the point where I hate I hate to say it like so like it's trite, but diabetes takes up a very small part of my day. And and I don't spend a lot of time with it. You know, Arden has been in a really weird place in the last few months where she's growing and and it's you know, it's been as difficult I told our endo the other day, it This has been as difficult a three month period, as I've ever experienced since I figured out all this stuff. And still hurry once it was five sec.

Unknown Speaker 32:57
That's amazing.

Scott Benner 33:00
All I did was diabetes just got more aggressive with us and I just got more aggressive back with it. There were days where she had 50% increases in her basal rate all day. Last week, Arden had pancakes. So even in the middle of me knowing that she has been using more insulin than you know than normal. I don't relent. She said, Can I have pancakes got a head cold? She wants pancakes. Her blood sugar's really rough. And I was like, Yeah, go ahead. I'll tell you what those pancakes which I think should have taken about 12 or 13 units of insulin took 23 units. Oh my goodness, it was insane. And I just kept going and kept going and pushing and pushing and pushing. I stayed to what I knew would work even though it seemed insane while I was doing it. So anyway, I'm sorry. So after that first one, you saw that a one C and how to go.

Alison 33:49
And you know it like I said it was it was okay. But I mean we were so frustrated with her and my husband's like call handle pain fly him out here because it was like, definitely like, where do we say wrong? If we show you our numbers, you'll get it. And we're like, No, okay, we

Unknown Speaker 34:01
want to get this. Yeah,

Alison 34:04
yeah, yeah, we need to get this you know, it was it was a little hard with some resistance from the school. Our endo. We also started around that time when we were telling him like we're redoing everything and he was cautiously optimistic. He's like, let's he goes on. He goes just you've got to get the timing down. You've got to get because he Johnny was hyper aware for a very long time and he's like, you got to get those lows out of there.

Unknown Speaker 34:25
He just

Alison 34:28
he kick it down to the 40s or 50s that's low. Yeah, yeah. And there's too much insulin and he has you know you in oftentimes he will be functioning just fine at 40.

Unknown Speaker 34:39
Um,

Alison 34:40
so we're like okay, but may start to be the turnaround. And he no longer because we were keeping things stable. He didn't feel gross. He didn't have headaches, he didn't have stomach aches. I didn't have to pick him up early from school. Um, we and it was it was actually it was good timing that we had done all this because as we got through the middle of May something was kind of Went on changing with him. And we were starting to see the effects of adrenaline, okay, but we didn't understand it because suddenly, he was getting like his blood sugar was going up with baseball playoffs, and his blood sugar was going off with presentations at school. And, you know, we learned like we thought they were, we thought we were doing something wrong, and we would give a whole bunch of insulin. And then as soon as the nerves were gone, he crashed. So but we were like, okay, since we had stability, more stability going into that, we then better understood things. So at least now, we had, you know, we had better trend lines, he was feeling better. Um, you know, we I pushed as soon as I knew that the G six was coming out, I was pushing for it, because the school was like, You can't eat because we wanted him to treat take care of himself come third grade, and they're like, unless he's on the G six and your doctor signs off. We're not going to let him

Scott Benner 35:47
really have what so you were on the floor at that point? Yeah. And what was the what was their basis for that? Was that your how your 504 plan was worded? You said earlier, so

Alison 35:59
the G the G four was not FDA approved for dosing off of

Unknown Speaker 36:03
O and B and your school knew that?

Unknown Speaker 36:05
Yeah. Oh, yeah. Really? Yes.

Scott Benner 36:09
I don't know too much. that's a that's a something of, I have to ring Arden's phone and try to get her she's killing me by not answering her text messages right now. I texted, I was like, Hello, hello. Now it's a what now now all of a sudden she hears it. Bolus, excuse me. Point. Six. So funny. So when I talked about kind of just bumping and nudging and the timing of it, right? So Arden's blood sugar's 140 right now. But when I started trying to text her a half an hour ago, and she didn't answer me, she was 122. And I've never gotten a diagonal arrow. The arrow is not up. It's just it's this drift up. Yeah. And so I just needed a little more bumped to get rid of it. And the timing, it's messed up. Now, if she listened, it's not her fault. I'm not angry. But had she had she said, Hey, what's up half an hour ago, I would have used point four instead of point six, so slightly less insulin. And this 140 never would have happened. And she shows how much the timing means, you know,

Alison 37:11
oh, yeah. Well, I'm dealing with you. We had a Johnny had a presentation this morning. And he was in like the 80s. And so I had him have a little sugar. And then as soon as it was done, and when we started our call just now, he was like 160. And I've been fighting 160 for over an hour. And he's down to 147. But it's like,

Scott Benner 37:28
should you have left the ad alone? Do you think?

Unknown Speaker 37:30
Probably?

Scott Benner 37:31
What What made you do it? You just didn't want him to get low while I was doing something at school in front of kids?

Alison 37:35
Yes. Yes. I also I actually didn't anticipate him growing up because of adrenaline because he had been nervous at breakfast. I also, they don't have snack until 10. And he would not have stayed at 80 for two hours. You don't think I just was experienced with him?

Scott Benner 37:52
Yeah, yeah. Even with even with giving the presentation, you don't think that might have helped a little bit?

Alison 37:57
No, because the presentation was over by 815. It was like he was so. So in we've been having this is one of the things like we've been having some challenge with this pod. And it's hard to know, is it the pod? Is it the site,

Scott Benner 38:08
it's always it's just it's the one thing and I think I've been saying this a lot lately again, but where are all of our technology lacks is still the tubing, the canula. And in every pop, not just one of the other i'm not i wouldn't point to one of them that technology that that material is it's just not perfected yet. And your body sees it as a foreign object and it begins to attack it the minute it goes and it sends white blood cells to that site, there's infection, there's like, you know, like, not infection, like oh my god, pus oozing and dying, but like, you know, your body sees that as Hey, something stuck in my skin, and all the things that come with that, when they can design a material that that I mean, I don't know if they ever will be able to but the problem is that no one puts any effort into and Aaron Kowalski was on a year ago from the jdrf. And he said, he really thinks that's one of the very underserved parts of technologies that we're not studying the calcula material enough

Unknown Speaker 39:03
interesting. So

Alison 39:05
well, it's always like we have that we sought to beat is that, you know, we've also been having, you know, cuz all over the diabetes reforms are about you know, the problems we were having with the G sixes. And it's like, we either have an amazing g six, or we have a bad g six. Is it the site or is it the sensor?

Scott Benner 39:19
That's so funny. So we've been using it for a good long while now. Right from the the limited marker, at least rollout which I think was in June 2018. Okay, and now I'm June, July, August. I mean, we're six months later. And I think I haven't had one issue that that I've heard anybody say, and I always try to think of it like this, like I know, it's the forums and it's a concentrated place where people with diabetes are but people don't generally get online to say great stuff. You know, like like so they're there they have so once you see a couple people say, Oh my god, this is the problem even think about on the pot for a second. I don't know how many users they have, but like, you know, it's hundreds of thousands Dozens of people using the Omni pod. If you see five people online saying I'm having a real problem, you think to yourself, oh my god, there's a real problem. I saw five people talking about it. But the truth of the matter is, is statistically, if 10,000 people were having a problem, it wouldn't be a lot of people it would be to them. But it wouldn't be overall, it's such a weird thing to try to figure out. Well, you

Alison 40:19
and I were kind of restarted in like mid to late June, we're about four months into the G six and I mean, we had we had a they had to replace this first transmitter, they had it they replace it within 10 days, it was just a bad transmitter. Okay. Um, but you know, we've had in for the over the summer was crazy, because I would expect the summer were so much going on in heat we would have had problems with with sensors. And it's only been since he's been back in school that we've had some quirks, like, I think one I think the way it must have just been swaying in his body. Like, I don't think it stayed in a good spot. Because it was like, we had to pull it after four days. And the readings were just so inaccurate.

Scott Benner 40:55
So it's interesting, because you just said something that I'm fairly certain is, is impossible, that it was like swaying in his body. Like I think sometimes we all just, I'm a big fan of something doesn't work. Just keep going, like, take it off, put another one on and keep going. Like I don't, I guess I don't spend a lot of time wondering what happened because I think the variables are so incredibly many that it would just it's silly, like I finally figured out one problem with Arden right? Like there was this time I kept thinking, while Arden does her homework, her blood sugar gets low. And I was like, that doesn't make any sense. And so I finally realized that Arden was doing her homework on this bench where she would curl up in a ball. And so she kind of pulled her knees up, and or where her scent where her sensor was for her g six, it kind of mimicked a compression low even though she wasn't sitting on it. And so one day, I was just like, Can you put your knees down for a second? And that was interesting. And so so it wasn't in that situation. The sensor was fine. Everything was fine. It was reporting correctly. It just was displacing her interstitial fluid. And and I just like that's what I when you said it's been since he's at school, I'm like, I wonder if he's like, like, and that's as insane as that sounds. I wonder if something's changed about that. Like is he sitting up against something as a body position? Does his his his bookbag blocking his trans like, I never know. The people that real good foods have been real busy adding more options for you. their newest addition the breakfast sandwich comes in bacon or sausage. Of course, you can always get the five inch chicken crust pizzas that come in personal supreme pepperoni and three cheese. There's the seven inch chicken crust pizzas, three cheese supreme and pepperoni again. enchiladas cheese, pork, chicken and beef. Would you like a mixed case of enchiladas? You can do that too. Now what about the poppers? Bacon and cheddar, jalapeno and white cheddar. artichoke and cheese pepperoni and mozzarella. Would you like it mixed case a poppers you can get that to real good poppers mixed case for pepperoni and for jalapeno that's eight poppers. Eight pops. Now of course the cauliflower crust pizza is everyone's favorite. Comes in cauliflower, vegetable, pepperoni, Margarita, and cheese. And you guessed it a mixed case. Looks like there's some pepperoni snack bites here I haven't seen before that must be new. So if you're looking for so if you're looking for high protein, low carbohydrate, so if you're looking for high protein, low carb options, real good foods is a really good place to start. All you got to do is go to real good foods calm. All you have to do is go to real good foods calm and at checkout, use the offer code juice box to save 20% That's amazing. If you ordered a million dollars worth of real good foods. Watch this. Okay, Siri, what's 20% of a million? It's 200,000 Oh, my God, you could save $200,000 on your next order real good foods calm by using the offer code juice box. For a more normal perspective, you'd save $20 off of 100

Unknown Speaker 44:09
Yeah, no, I

Alison 44:10
will text him like we at least now that you know he does. He's um, we had spent the summer using summer camps to have a lot of data to show his endocrinologist that he could self care. And, and since third grade, like he's only seen the nurse once and it was because I had to replace this pod. So he does everything in the classroom. So also, you'll see that like I'll see like a real funky like, drop and I'll be like, I'll text him and he has an Apple Watch and I'll be like, Okay,

Unknown Speaker 44:32
what did you just do?

Alison 44:34
Did you move Are you laying on the beanbag chairs? Because exactly that kind of thing. I'm like is typically it this G sucks. It's like you know like right now, if I was still on the g4 I would be like a she fours broken. It's too steady. But I know the G six. This number is accurate. We're just having he's either got scar tissue. Something's going on. I know I have to do a pod change tonight. I really want to try and get this one to last until tonight.

Unknown Speaker 45:00
We'll make it work.

Scott Benner 45:00
Yeah, no, I listen. I think that I think the technology is stunning. I think it gets better and better every time. But I think you still have to remember you're taking something made of plastic and metal and taping it to yourself. And then and then it sticks under your skin. And it's not the movies. You know what I mean? Like, it's just this, this stuff works incredibly well, as well as it can work with the technology that they have right now.

Unknown Speaker 45:25
I'm grateful for Oh, I

Scott Benner 45:26
don't think you I don't think you aren't. I just it's, it's tough because I do like having honest conversation like this at the same time. What I would want somebody to believe when this is over is that nothing you have said would ever have stopped me from using the stuff that I use, like it's such right over and above such an amazing accomplishment in you know, in people's lives. It's just me, you've you go back and listen to these other episodes with older people. You know, there are people boiling their own urine to test their blood sugar. There's people you know, getting a drop of blood on their finger the size of their finger to test their blood sugar. There's, you know, the people who used to use meters that probably didn't really even work that well.

Alison 46:10
Yeah, my husband stepmother has type one. And she was diagnosed in 11. And she's in her 60s now. And she has said, Now she's talking to get a dexcom because she's she's always done everything with injections. She mostly takes Lantus. She's like, but she goes, I see the what is done for Johnny. And I want that for me.

Scott Benner 46:26
It's amazing. Yeah, no, it's it's really amazing. So anyway, I just think there's a there's a line between understanding the limitations of the technology and understanding those limitations don't mean that it's not absolutely the most amazing thing in the world.

Alison 46:42
I mean, don't run with these, these are such little quirks. And when their quirks we just kind of go like I agree with you, like we just kind of we pull it and go let's get on to a new one, because we want to get back to keeping him healthy. And like I said, I mean, the last seven months have just been a whole change for us. It's a nice,

Scott Benner 46:58
it's very, it's who you are. It's funny when because when you're talking, you know about things not going well and everything if you will give me if you'll help me before the before the pump, in the CGM, anything when you said things weren't going well, you already kind of know what you were doing. What was your agency? And what was the range of agency back then

Alison 47:15
we were typically keeping around. It was about 6.8. But I think the problem was is that the high highs and the low lows were offsetting each other.

Scott Benner 47:22
Okay. Okay. So that's what I want to understand because your numbers not awkwardly high. And yet you were so so what was happening is he was riding high a lot and then riding low a lot. And then that average was getting thrown off in the air one. Yeah, I'd

Alison 47:35
like to be the waitress and we would throw we would throw you know, we would throw stuff you know, high would get going and our high alarm. I mean, I my high alarm at night wasn't we set it to 20. Which, and because I was like, oh, as long as he's 180 or heal at night. That's perfect. It was interesting that a year ago, he was out of 6.8. And I changed. I decided on my own I was like, yeah, let me change my high alarm at night to 180 and be in the three months after that he dropped down to 6.4.

Unknown Speaker 48:01
Yeah, so so

Alison 48:02
I think like it was kind of like we It was one of our first signs of like, maybe that was it. But we couldn't, it was hard to catch. We just you know, we would you know we would do our we were very devoutly to the to the carb county and we weren't too much into like we knew french fries had a kick later. Other feuds hard to say. But I think we would overcorrect. So then he'd get low. And then you'd give the pilot give a little too much to counter the low just bounced up

Scott Benner 48:29
and down from there. Yeah, that's why the roller coaster episode made you upset. Because you realize, Oh, that's what we're doing.

Unknown Speaker 48:35
Yeah, exactly. But it also made me realize I had to get off it. Right.

Scott Benner 48:39
Right. No, I it's I think listening to you is really interesting because it just because it it's hard to put into words really, but I'm really enjoying listening to you explain how you were feeling and what was going on? Because you were so close. Like we know when you create a low by over bolusing you weren't you probably weren't off by that much. You know, like when I talk about Pre-Bolus thing, you know, usually talk about like tug of war, right? Like trying to maintain this like tug of war that nobody wins. And I somebody asked me the other day about, I don't understand. I was explaining to them like I like to see Arden's blood sugar, lower and and coming down as the food starts working. Like I really like the insulin to be sort of in the power position when when the struggle starts. And I found myself explaining like a timeline. I'm like, imagine this long timeline, and I stood up, and I was like, so I'm gonna walk along the timeline, and I'm time moving. And I took one hand and I was like, This is the insulin that took the other hand, this is the carbs. And I just started pulling down with the insulin. And I was like, Nah, see, now see right here now. Now the carbs are going to pull up and I'm like kind of doing that struggle with my hands. But as I'm struggling and they're going back and forth, fighting with each other, I'm walking down the timeline I was like, and then you get to the end and it just stops foods out of your system, the insolence out of your system. And the struggle has been happening. Hopefully it whatever blood sugar you started at, you know, when that struggle started at 70, then you might stay around there for start around 90, you might stay around there. If the insulin doesn't have enough power and the food gets out of hand, that's a spike. And if the insulin gets too far ahead of the food, that's a low and like, and I was doing all this stuff, and I was like, God, this is visual, I didn't realize how visual this could be. You know, like, it really is. And I'm picturing it as you're describing it. It's just, it's crazy that you were so you would see a spike, and how long would that spike last?

Alison 50:32
Oh, you know, at least we had learned going into this that it would take two hours, even a one ad takes two hours to come down. And it was like you and speaking to you about the tug of war is where I could visually see it. That's how you say I would send him to school with a knot in my stomach, because I had no idea where he would be that day. Okay, just a horrible and even that first month when we had thrown everything out and started over every day, he went to school, just a knot in my stomach, and I would just sit there and I would so so watch his numbers, and be like, Okay, can we just get to snack today where you don't get a low? Um, because again, he would have to miss class to go to the health office to deal with anything. Um, and you know, we were Pre-Bolus it by that point, at least at breakfast, but the the school was not set up to have an Pre-Bolus for lunch.

Scott Benner 51:27
Okay. Okay, and was the Pre-Bolus at breakfast working.

Alison 51:31
So we, we learned the hard way, you know, when we got the dex comm we had it. We had an issue when he was finishing pre k before he had the dexcom he had he ate breakfast at that time he burnt out people assumed he went to class. The school calls me because a substitute came in and seen as medical orders and insisted he got fingerprinted before PE and they call me they're like in a panic cuz they're like he's 450. So I raced over to the school, give him some insulin, not knowing this whole tug of war thing. And an hour and 20 minutes later, his teacher carried him into the health office almost passed out. And his blood sugar was 38. Yeah, yeah, that's so we got the Dexcom and we learned every day after breakfast he was going up to 450 so we started

Unknown Speaker 52:15
with shots.

Alison 52:16
Pre-Bolus early, breaking up his breakfast shot, some before the breakfast and some after what was he eating at breakfast? We stay away from cereal. So but he loves I love to bake. So muffins and pancakes and waffles and bagels.

Scott Benner 52:35
You kind of thought back then prior to having a CGM you thought okay, I've put in, I've counted the carbs. I've put in the insulin, I Pre-Bolus that a little bit that means that I have to pre balls or I'll never, you know, do anything. And you were like, Okay, this must be okay. And then finally someone says, hey, look, isn't funny. Like a sub just says, Look, I'm not gonna let this kid go to gym unless he does a finger prick. Because that's in the orders. You find out he's 450 did it just were you shocked by that? Yeah, I

Alison 53:04
mean, I'm fortunate I work from home and I am five, like five seconds from the school. So I you know, I've raced over there in a complete panic. I'm like, 450 Oh, my God. You know, let me give you insulin, we got to get you down. And then you know, I'm an hour, two minutes later, I'm at the gym, and I get a call from like the district nurse who says, Okay, I get attacked, and she's like, he's really low. And that's all the tech says, yeah. And I call and I'm like, What do you mean? And she's like, well, he's 30. I'm like,

Unknown Speaker 53:30
What do you mean? He's

Alison 53:31
38? Like, how did that happen? So that was like our final point. We're like, Alright, let's get this deck calm.

Unknown Speaker 53:37
We can you know, we've

Alison 53:37
gone a year without it. We don't know how often this is happening.

Scott Benner 53:41
Let me jump in and say that I think a lot of people might be inclined to think Well, yeah, he went to gym and that's why his blood sugar went down. His blood sugar didn't go down that far. Because the gym, his blood sugar went down because you gave him more insulin again.

Alison 53:52
Exactly. Well, and the problem was that he probably was on his way down, but we can see it. And then what I gave him just plummeted more. Okay,

Scott Benner 54:00
now fast forward to today. You have you have different technology have a different mindset. How does that how does that breakfast go now?

Alison 54:08
So now we do a Pre-Bolus 20 minutes ahead, we give him 85% at 20 minutes, and then he gets the rest over an hour. Okay. And he can eat, we still have to try to stay away from cereals and, and just in general and he eats. Otherwise, whatever else he wants. And he peaks at 130 maybe 140. We'll change the meal. He has PE at 830 in the morning, two days a week. So those days we'll do more of a eggs bacon kind of thing. Okay, to give them the extra fat because they play hard at PE

Scott Benner 54:41
Yeah. Yeah. That's amazing. I mean, that's in such a short amount of time you went from someone's carrying your half lifeless kid to the office to being able to you know properly bolus for a waffle or a pancake or something like that and send your kid off to school and not see a bunch of over 130. That's wrong. I'm not,

Alison 55:00
I don't have the pit in my stomach anymore. And I don't check his numbers. And last, like I have my range now set like at 95 to 130, just so I can catch anything that's about to get out of control. Right. But otherwise, like, I think the other day I didn't hadn't checked my phone for like an hour. And I was surprised.

Scott Benner 55:17
Yeah, I really don't look often at all, I actually look more while I'm recording the podcast because it's on my, I have it on my computer screen so I can kind of see it. And I think sometimes it helps the conversation. So but for most of the day, if Arden's and rate in the range that we choose, I don't spend any time checking on it like that, just that doesn't exist for me.

Alison 55:39
Yeah, and like, and I have mine up right now, because I'm like, he's finally 131. And I want him down more, and I just can't he something's just going on want today. Right?

Scott Benner 55:49
Right. That's really cool. Like, I mean, it was just such a it's such a change, you know, I mean, like you described like confusion and and a loss for what to do. down to like, I can do pancakes now. Like, that's really that's really cool. What What was the what, what do you think the main? Do you think it's the technology? Do you think if you got the technology before you met me, you would have figured it out on your own?

Unknown Speaker 56:17
I feel like

Alison 56:20
I think you helped give us the push. And I think you helped give us bringing the whole thing full circle. The equipment helped. But even you know, by the time I have spoken to you, you're keeping on the pump, eight months, and we still weren't getting it quite right. Yeah, we were still we were doing 10 days old. And you know, we were, I hadn't even read, you know, sugar surfing, I had started to read it. I bought it like two years before what sometime before, but

Unknown Speaker 56:47
it sat on my Kindle.

Alison 56:48
So I was like, whatever this is, I don't know what this is. Um, and we were just, I think all of us, Johnny, myself, my husband, we were just at a point where we're like, okay, we knew we also had to be able to prove to the school that he had to do it on his own. And so something significant had to change to get there.

Scott Benner 57:07
Right, right. It's I find the highs, the highs that you had prior to kind of pulling together and understanding better I find your scarier than a stable. Yeah, like I would like if Arden's a one see for a very long time was in the 80s. But what it just meant was her budget was, you know, around 200 or so all the time. But we didn't have like scary lows, but you were having 450s and, and, and 50s and three hundreds and fit like that. He must have felt like and I don't want to make you upset, obviously. But well, but he felt crappy, like mostly. Yeah,

Alison 57:42
I get I get the calls that it was really bad. It was a first grade because PE was right before, um, they get out early on on Wednesdays here at like 1240. And he had pe 1130. And I'd get a call from the nurse at 12 o'clock. They're like, he has a raging headache. And he feels like he's gonna throw up. Come get it. Yeah, we had to finally pull him from PE on those days and have him sit

Scott Benner 58:02
was bouncing around, right?

Alison 58:03
It was bouncing all over the place. He would you know, and now just I mean, he, he just he lights up. He's like, Mom, I don't miss school. I might, you know, because it also used to be the nurse would call over the intercom the whole class would get interrupted with the phone call that he had to go do something. He doesn't like the attention on it.

Scott Benner 58:22
Yeah. Well, Johnny report to the office. That's exactly sucks. And by the way, the name of this episode, in case you're wondering, I love and so, but But no, I mean, just so many little things that add up to one big thing have changed for you know, it's really I'm just very happy for you.

Alison 58:43
And so and so, you know, for us that like I'm the near tears because I'm so I'm so proud of him. But I mean, you know, he had 5.981 C and APR and he was 5.5 a week ago. That's his doctor called up and he's like, you kind of got it. Like, he's like, I don't know what else to say. You guys, you've just figured it out.

Scott Benner 59:02
You should have said it was when you guys yelled at us. We really that really helped Thanks a lot. Well, you know what isn't an interesting situation. And when you're with them a little longer you maybe we could say to them at some point. I'm happy that you see that we got it. But you realize we got it with literally no help from you whatsoever. And here's what actually helped us. Maybe you could tell other people this

Alison 59:23
well, so and I have until lately like I told him I told him about your podcast, we've started to get a little more involved with jdrf. Around here. We're doing the big walk on Sunday. We told we went to a Dodger game event we told them they hadn't heard about it. Like Um, there's a new family in our community who just got diagnosed last week. I told that family cuz I'm like, go here. Just listen to these, like, just listen to him and listen to the people he's speaking to. You're gonna get something from it. It's cool, man. I

Scott Benner 59:49
appreciate that. And I think it just it's it goes back to the idea of community from the beginning. You just need to find somebody I you know, there's nobody really in our life. You know? I'm not kidding. Personally to anybody who has type one, like nobody that lives near me, you know, or anything like that. So my connection to type one is, is through this podcast, the blog and stuff like that as well. And, and it just, it's incredibly helpful. It helps me. You know, there are times I'm going when I'm gonna go to a jdrf event in Cincinnati this weekend, and I'm bringing a ton of these bold with insulin magnets for people's refrigerators. Now I'm bringing them because people are gonna ask me, How do I get the podcast and I don't want to tell everybody, I'm gonna be like, Here, take this stick of you. But the truth is, I have one stuck to my refrigerator. And it's not there because I need a magnet. It's there because I need to look up and remember to, I have to keep being aggressive. I have to keep doing the things that I know work. You know, I can't get thrown off by you something just being out of the ordinary. Like, I'm telling you that three months ago and Arden's insulin needs just skyrocketed. And I thought I was tempted to question what I was doing for a second. And I just stopped and I was like, No, like, it's not I didn't do something wrong, nothing change. For whatever reason, she needs more insulin, who cares? Why doesn't matter why, let me make sure I give her more insulin. So we upped her basal rates, we upped her, you know, you know how much we give at a meal, I was gonna say insulin to carb ratio, I don't even know our insulin to carb ratio. I'm just that I would, I would, you know, evaluate a meal. And instead of saying eight, I'd go over 11. You know, and people might listen to think well, where did that number come from? And what I'm going to tell you is I tried eight the week before, and then it took three more to bring it down. So 11 Next time, you know, and and I just kept pushing, kept pushing. That was pancakes that I mentioned earlier in the podcast that took 23 units. If she eats those pancakes again next week, it's going to be back to the needs from before. Something she was sick. She's growing there was there was a confluence of things going on at the same time that created this need. But we were still actually able to do it. And

Alison 1:02:01
yeah, good and not like, well, like we're seeing like, that's what we did this week. Like for the last three days. Like Monday through Wednesday. This week. Johnny was just for lunch. He started going up for lunch, he would stay Hi, I was like okay, that's it. I just going to increase his Temp Basal two hours before I'm changing his lunch carbs. And not did it yesterday.

Unknown Speaker 1:02:19
Yeah, that just broke the cycle. I'm just

Scott Benner 1:02:20
gonna tell you that. During this period of time, I saw high blood sugars I haven't seen in years. And I still just kept being aggressive with them and still got a 5681 c without lows. So and I'm talking about like, now all of a sudden, you know, usually when I tell you Arden's blood sugar's high in my mind Arden's blood sugar's high, it's 150 to 170. That, to me is high. And I'm usually like, what did I do there? You know, and I like, let me figure out how to fix it for next time. Over 180 maybe I'll see a spike to 200 once in a while, but I can get it back right away. But I'm talking about blood sugars that went to 202 20 and sat for a while, and, and I was pouring insulin on her and nothing was happening. And so still without Lowe's by being aggressive, a one center sex and no and still no, no restrictions on what shade. So in a moment, when she was growing, and needed that food, I was able to give it to her. When you know, you might think that what might happen is you start going out Well, why don't we just do less carby stuff for during this time and everything that she needed that food she was, she went from what she normally eats to eating more. And I think she needed I think she's growing Arden is at the moment, 14 years old. And five, five and a lot by the time someone hears this, by the way, it'll be six months from now. But But and she weighs I think like 120 pounds 18 months ago, Arden was five one and a half and weighed like 90 pounds.

Alison 1:03:50
Yeah, that's like a meat. That's what we're dealing with Johnny. It's like it was one of the things it was a kind of a good thing he got diagnosed because we had realized that before that he'd only gained about like, gosh, like a pound and a half in between for 18 months. Since then he is now I think they told me he's like, just nice, like four foot 10 and he's like 69 pounds like he's the tallest kid in third grade. He knows it's so scary growth spurts tumor were like stamping it like my husband always say keep people with the insulin. Like, let's just tackle this. Yeah, you can't figure it out. You just got to figure out how to go forward.

Scott Benner 1:04:23
Arden went from the 10th percentile for height to the 75th in a year and a half. Yeah, that's just and she needed that she needed that food. She needed to be able to eat unfettered when she was hungry. Yeah. And and it's just I'm just really grateful to be able to do it for

Alison 1:04:38
you. I feel chilly because we don't have restrictions that so he gets to eat what he wants. Like we went to Walt Disney World this summer and he got to have whatever he wanted because we had more confidence that we were going to prevent the spike.

Scott Benner 1:04:52
I'm glad for you. I really am I listen to harden left, um, Halloween was the other night and a couple of her friends came over and they threw to you know, they put their house Seems on. And they went out like 730. And at 730. She's like, I'm gonna go. And that was the first time I thought, well, what's your blood sugar? And she looked and she's like, it's 80. And I said, Okay, I was like, well do like a Temp Basal decrease for like, 50% for an hour. And she's like, okay, and she laughed, and I remember she was walking out thinking, I should have done that, like a half an hour ago, this isn't going to work, you know, and maybe a half an hour later, I got a little beeping and Arden's like drifting under 70. And I was like, hey, reach into that bag and eat some candy. So and I'm not with her, she's off wandering around with friends. And a couple minutes later, the blood sugar's 260. And I texted her back, I was like, what you eat. And she, I forget what it was, but it was something with chocolate on my Hey, less chocolate, more sugar. And, you know, like, like more straight sugar. I'm like, look for something shiny that looks like you know, plastic like that kind of that kind of sugar. And so she had something else. And her blood sugar kind of like leveled up, but then it hung. And I said, and she texted me and she was I'm thirsty as like, if you're thirsty, just drink the juice shack with you. So she drank or juice or blood sugar when like back up to like, 85. And he she got home and she was 90. And when she got home, she's like, I'm really hungry. And I was like, okay, maybe she's really hungry. But my in my gut, what I think is her blood sugar is gonna try to go back down again, like her hunger is a lot of times a precursor for her for a blood sugar fall. Like she's, you know, and so I was like, Yeah, great. So she like had a salad. She took a whole bunch of stuff together. And she's eating it and eating and eating. I'm like, she's not really taking that many cars. But look how much she's eating. I didn't give her any insulin for what she had. Even though there were some carbs in it. She didn't just have a salad. She had some other stuff too. And was good. It was a great pleasure. It was like 100 by the time she went to bed. And I was impressed. I was like, great, but it was all just timing. Again, at the end here. I want to say that. I haven't said it enough over the episodes. But when I talked about you have to time the insulin, if you there's a way to do the food that way too. You can time the food too. Like there's you know, people used to call it free food. It's like, hey, what can I eat for free, we can't really eat anything for free. But there are moments where you're, you're almost Pre-Bolus the meal, by mistake, like her walk and her trick or treating was a Pre-Bolus to eat. And as long as she didn't take in too many carbs. Had I given her pasta at that moment. Obviously she would have needed, you know, insulin, but she was having a salad with some crotons a little bit of their stuff. And I'm like this stuff is been Pre-Bolus tardy, not that it's free. You know, but the walking and you know, we use some simple sugars to kind of artificially hold her blood sugar up while she was out. I was like, I think she could do this. That is not something I thought I ever would have been able to have before this podcast.

Alison 1:07:44
Oh, Walt Disney World this summer would have made me so nervous if we weren't like this, because I was thinking with all the walkie and the heat. Like he just made it easier and less nervous

Unknown Speaker 1:07:55
to let him eat what he wanted.

Scott Benner 1:07:59
Hey, you got him down. Finally.

Unknown Speaker 1:08:01
Finally, he said that under 95. It is 95. He just did a 27 point drop. So he must have played hard at recess today.

Scott Benner 1:08:09
It's really cool. I just I can't tell you how happy I am for you when or how much I appreciate you coming on the podcast. And speaking about all this. I really do. Appreciate your time. And please thank your husband too, for helping set up with the headphones and stuff earlier.

Alison 1:08:25
Again, but yeah, just thank you for what you're doing. Because like I said, and thank you for taking the time that day to talk to me because I don't think we'd be where we weren't. If I had not been able to actually talk to you.

Scott Benner 1:08:34
I am just sorry that I didn't realize that you were you until halfway into this apology. As you said it, I was like don't bring it up. It makes you sound like an idiot. And and I thought no, let me be honest with you. First of all, thank you very, very much. I genuinely think that people just need help. Like they, it's, it's too difficult to be put into a situation like this with no tools, no ideas, not even a roadmap and to be told by somebody, hey, here's a bag and needles you figure this out. And then we'll let you do better after that. I don't even understand what that means. Like why would you be like putting a four year old four year old in a car and be like drive down the street. And when they crash 10 feet into it opening the door and yelling, you're a terrible driver, you know, like, like, it just can't put me in a situation where I have no ability to succeed. And give me the pressure of the health of my child or myself on top of all that and and just expect anything. So yeah, I don't think I did anything except put things into context for you.

Alison 1:09:36
I think you just you opened her eyes. You got us thinking down the right path. We had to do the work. We had to figure it out. We had to figure out what worked for him. But you just gave us the direction. Sure. Well,

Scott Benner 1:09:49
I was glad to have it to give to you. That's that's really absolutely I thank you so much and thank California for me while you're out there.

Unknown Speaker 1:09:55
I will

Scott Benner 1:09:56
really bump up my download numbers. I appreciate that. Don't forget dance. For diabetes.com for your chance to have a private conversation with me, of course on the pod comm forward slash juice box to get a pod experience kit absolutely free with no obligation sent to your home dexcom.com forward slash juice box so you can tackle waffles and to save 20% on your entire order real good foods comm use the offer code juice box. And please accept my thanks for your support of the sponsors because obviously, they allow the show to stay free and available to you every week. So I thank you for checking them out. And guess what I have come in next week, the next installment of diabetes pro tips with CDE Jenny Smith, get excited. And if you haven't listened to the first six, now is the time to go back. It's a series they connect. You're gonna want to hear them. Sure. You'll see one of them's like, Oh, it's about MDI, I'm not MDI, but they all connect, you need to see them you wouldn't have skipped two episodes a lot back in the 2000s. He would you know, then you wouldn't have known anything, like a monster full of smoke would have come through and you would have been like, What in God's name is that thing? And you know why he didn't know because you skip the MDI episode. Thanks again for listening, guys. Hey, and thanks for the great reviews on iTunes. I'll talk to you soon.

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