#237 Diabetes Pro Tip: Setting Basal Insulin

Diabetes Pro Tip: Setting Basal Insulin

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

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

Scott Benner 0:00
Hello everyone and welcome to Episode 237 of the Juicebox Podcast. Today's episode you know by the title is with your favorite guest, Jenny Smith, Jenny and I are here today to add an 11th entry into my diabetes pro tip series. Please don't let the fact that this is the 11th episode in this series make you think phased array testing probably not that important. If it was they would have moved it up sooner. Not even close. Having your basal insulin correct is the core of everything you're doing with insulin. You can't trust that your Bolus was right or wrong. You can't understand why you got low or why you got high. When your basal insulin isn't correct. Everything you see coming back to you from your blood sugar experiences from your glucose monitors from your meter testing. None of it is actionable. None of it is valuable. If your bazel isn't right. Every time I speak with someone privately we start with basal insulin doesn't matter if you're pumping or injecting, and most people's basal insulin is significantly incorrect. If you're seeing blood sugars that you don't understand, it's easy to see a low blood sugar and think that means less bazel. But that's not always the case. At the end of this episode, I believe you're going to have a firmer grasp of what basal insulin is, how to make adjustments to it and why it's so important. You really need to listen to this one. This is where it all starts. This episode of The Juicebox Podcast is made possible by Dexcom ami pod and dancing for diabetes Dexcom. Of course the makers of the G six continuous glucose monitor on the pod makes the only tubeless insulin pump in the world. And dancing for diabetes is the organization bringing joy to children in Florida and touching people all over the world. With their generosity, you can find out more dancing for diabetes.com dexcom.com forward slash juicebox in my on the pod.com forward slash juice box. My friend Jennifer Smith is not just the CDE. She's a person who has been living with Type One Diabetes for a very long time. 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 I'm most makes and models of insulin pumps and continuous glucose monitors. Not only that, but she's my guest in every episode of the diabetes pro tip series. If this is your first one, you have to go back started episode number 210. From there, it goes to 11 and 212 then jumps to 217 1819 diabetes pro tips picks back up at Episode 224. With mastering of CGM to 25 to 26 to 31. And of course, you are listening to Episode 237. This is the 11th in this diabetes pro tip series. And in my humble opinion, it just wouldn't be the same without Jenny. Last thing, actually last two things. First one's easy. You know, I'm gonna say nothing you here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. Becoming bold with insulin. And the second thing is that Jenny does this for a living. You can check her out at integrated diabetes calm, or her email address is right in the show notes of your podcast player.

A funny thing happened the other day, I felt like we did such a great job of outlining everything that everyone would need to know. And I was so comfortable with it that I started supporting the podcast episodes with like social media posts like Hey, don't forget how important your basal insulin is. And the right the amount of notes that I got that were like, Hey, you didn't do an episode specifically about setting up your basal rates. And I was like I didn't, I felt like we covered it all with what we talked about. But okay, if you want it like so let's add one that's about setting up your bazel testing and getting it right. And I was like, Alright, well, we'll definitely do that if the people are asking for a journey, then we have to deliver.

Unknown Speaker 4:02
That's right. That's what I'm thinking. That's what we're thinking.

Scott Benner 4:06
So, so I wanted I would like to do that. Now, here's how I imagined this. And I'm recording already. So this will probably all end up in episode. I'm assuming there's a super like specific way, because I remember being taught it like, you know, in the doctor's office, like very specific don't eat food for this much time, like make sure to like this whole thing, and this is what your basal rates gonna be. Now, there are times when I think that's antiquated and as much as if you have a CGM, you may be able to figure out your base more quickly. But I'll cover that when we get to my less technical way of doing it. But I really do want to start with what is the accepted medical process for figuring out what your basal insulin should be? Check out dancing for diabetes at dancing for diabetes.com that's dancing the number for diabetes.com you can also find them on Facebook and Instagram. Fantastic organization, you should check them out at the very least get involved if you like what you say. What is the accepted medical process for figuring out what your baseline slash obey? Go crazy, Jenny, because I feel like you're gonna get to talk a lot.

Jennifer Smith, CDE 5:21
The I mean, the accepted, ethical way to do it can also vary. You know, I've heard, I've heard a lot of different but I've also heard enough similarities for you, I guess, our best ethical way to do it within integrated when we start working with somebody brand new. As a first and foremost question, have you verified that your bagels are working well, and bazel evaluation can also be done using injected basal insulin as well. Not in the same way or as extensively as a pumped Faisal rates, right. But you can evaluate the whether or not your basal injected insulin is working pretty solidly to Okay, so both of them can be looked at. As far as pumping, we always start with an overnight evaluation. And the reason for doing overnight testing first is one majority of people, unless you're a shift worker, or overnight truck driver or something, most people are sleeping in that overnight time period, there's no eating, no exercising, there's no food going in anyway, it's like one of the easiest times of day to actually get a bazel test in. Okay, the biggest thing heading into any bazel test is that there isn't any food that's going to be impacting in that bazel time period. And there's no lingering impact of your bullet. So for an overnight test, we aim to say, have your dinner and bolus by 6pm. Because by 10pm, when most people are going to bed, give or take depending on if you're a little kid or an adult or whatever, by 10pm that bolus itself and 99% of that food impact should be gone by 10pm in out kind of the bell curve of effect, right? So from 10pm overnight and into your normal waking time, then we get a true look at what is bazel doing to hold things steady. Now, the other variables in episode about variables too, right? Dude that comes into play with testing. You know, if you are in those couple of days before your period is starting, if you have a nasty cold if you have a lot of exercise because of training or practice or something you don't want to be able to tap on an overnight when any of those pieces are.

Scott Benner 7:54
Right, you know what I wonder, too, is I'm starting to believe that there's a different bazel rate that my daughter needs depending on our site. So I think there's a leg bazel rate for her and I think there's a belly basal rate for

Jennifer Smith, CDE 8:07
that's actually funny I use when I use my upper bulat for my knee pads prior to looping with a Medtronic pump. Okay, I noticed that on my bus, I need about 10% more basal insulin. And so I set up a bazel profile that I call but

Scott Benner 8:32
I could definitely say But

Jennifer Smith, CDE 8:34
yeah, I called it but and I had it 10% higher than my standard tested Faisal rate, right that ran on my other normal sites, which seemed to work the same, you're not crazy and thinking that it could be the case. And it's something I bring up with people too, especially those use Omni pod, which can you can wear it in a lot of different places compared to conventional tube pumps, right. So overnight, the goal of diesel testing then is to have fair stability, and not like this entirely flatline. But the goal is to not have more variants than about 20 to 30 points up or down from where your finger stick value at 10pm is. And the goal at 10pm. One set bolus from dinner and the dinner food is pretty much gone. 10pm your blood sugar you're aiming for it to be somewhere between 80 and 250. I know that looks like a broad range, right? And you're thinking well, gosh, if it was like 150 i'd totally correct that at that time because I don't want to sit at night All night at bedtime, you know, 150 you let it lie. You don't touch it. You don't take corrective. Just let it sit. So if you go to bed at 188 you leave it alone, because the bazel job is to not correct that. The bazel job is to hold you pretty steady. If you're not going to have more than a 20 to 30% variance up or down from that. That means all night long. shouldn't really go more than like, a little bit above 200? Or maybe down to like the 150s? If you started at like 188.

Scott Benner 10:09
Push that then you imagine that the bazel is pretty steady, correct?

Jennifer Smith, CDE 10:13
Correct. If you accomplish that with little variants, but not a lot, and you wake up, let's say at 169, awesome, your bazel, we would hold it, check marked off in our box of records as stable tested, it's good. Let's move on to the next testing period. Now, let's say your bazel does show that it's not right. Let's say that 10pm, one at blood sugar, but by 1am, you're starting to see a drift up. That's significant. And by two or three o'clock, you're like 50, or 60 points higher than you went to bed at? Absolutely, there's something wrong. Now, where do you adjust? That's the next big question. People are like, Well, I was high at two o'clock. So I changed my bazel at two o'clock, so that it wouldn't be high anymore. It's actually it's kind of missing the boat, right? Because where you really want to adjust the bazel is about one to two hours prior to the drift being too high or too low start. Okay, so if you're too high by 2am, you probably need a basal adjustment, at least by 1am. Or maybe midnight, that's higher, so that you don't have the drift up in the next two hours. Yeah.

Scott Benner 11:27
And that's the end for people listening to get confused by that. If you think about Pre-Bolus, and you put insulin and it doesn't begin working for a certain amount of time, either does basal insulin, and you're using much less of it. So to get a real impact from it could take some time for it to build up its efficacy, I guess, right? And then not be able to hold you stable.

Jennifer Smith, CDE 11:48
Okay, correct. Yep. So that circulating insulin level at the great description, it needs some time to bump up or bump down right to the rate that's going to be then effective an hour to two hours from now at that rate.

Scott Benner 12:01
It's the same reason, same reason why when we tell somebody if your blood sugar is super stable at 70, and it's been like that for hours, and you haven't had any food or you know, insulin, and you want to try to bring it up by doing attempt down, you can but if your blood sugar's falling at 70, shutting off your bazel is not going to do anything to affect what's happening right now. Wow. You'll make your blood sugar high, two hours later, right after your seizure.

Jennifer Smith, CDE 12:24
Right. Exactly. Right. Yeah. Or after you had, you know, a 30 grams of a juice box or whatever. Yes, exactly. Yeah. So it's Same, same thing, you know, if you're drifting down, you adjust the bazel down a little bit, fill in the same timeframe, one to two hours prior to that drift, starting, so that you don't get too low, later. Now by how much? I mean, again, this is where it does vary a bit. But usually, you know, if the drift up is somewhere between like, if the like 30 to maybe 60 points higher or lower than you want to be within that time period, and adjustment by point 05 to the basal rate could be enough to make a change so that you're not drifting up or down. If it's more significant drift, and you're really rising like 100 points, you started at 188 by two as you're at 280. That's, that's a pretty big change. Yes. And again, we would probably adjust the bazel at least by point one, maybe even point one, five. Depending,

Scott Benner 13:32
you know, what's interesting is that I know this isn't like any kind of hard and fast rule, or it is, and I've found that by mistake, but I talked to a lot of people with kids, you know, younger children. And it seems to me that the rule of thumb is point one per 10 pounds of body weight with kids. I don't know, I don't know if that ends up working for adults or not. But the more people I talk to, the more I see, like that's what makes sense. And I don't know if it's an anomaly for me. But when you have somebody on a phone call with you, which you know, telling telling you something about themselves. And it's like, you know, I'm doing this and it's not working and blah, blah, blah, and you need somewhere to start like it doesn't you don't even you need somewhere to start. And I always ask like, well, how much do they weigh? And most the time it bears out but then recently I spoke to somebody, it wasn't even close. It didn't matter. The weight was unimportant that that child just did not use the insole in the same way. Right.

I think of bazel in a completely odd way. I think of it like volume. Right, like on a on a stereo. And I just think if you can't hear it, or if the base is not working, turn it off. And if it's too loud, turn it down. And because Arden's using, you know, a dexcom, g six, I, I just turned it up until she gets where I want to be, and then I dial it back a little bit. Is that a bad thing? Am I doing that wrong? Is that is that irresponsible? Which by the way, in the last 10 years has become a word again, I don't know if you know that. You're irresponsible. There was time grammar people would be like, that's not a word. You can't say that. And all the sudden, it's been come acceptable in like the last half a decade or so. So now I feel comfortable to speak improperly again. So you're responsible? Is it irresponsible?

Jennifer Smith, CDE 15:47
irresponsible? Well, I actually use that word with my six and a half year old all the time. So I guess I've been using it more appropriately now. And I thought, yeah, that is irresponsible to do that. Do not do that, you know. So,

Scott Benner 16:03
anyway, I

Jennifer Smith, CDE 16:04
don't think I don't think that that's irresponsible. I mean, you're doing again, and again, in the topic of bazel, specific adjustment, we talking about temporary bazel adjustment, we do that a lot, to dial it up to dial it back to kind of you know, and that's also the concept of looping, right, is that the system works according to what it sees happening to the blood sugar and the insulin that's active in the food that's active, and it may dial things up, and it may dial things back. So that's, I mean, definitely not irresponsible. When you're talking about setting through bazel, though, we really want to make sure that we set the the bazel rate itself in the profile the right way, and you can dial it up, you know, if you want to be truly bold with insulin, you may want to dial it up a little bit more than you think you may need do another bazel test, and then it doesn't work quite well, because now you're ending up lower than you want. And great, just dial it back a little bit in the adjustment that you made. But at least it'll be a better picture. Um, you know, overall, and you can always test over and over again. Most people hate vehicle testing, myself included.

Scott Benner 17:17
Listen, that's I remember getting the sheet of paper handed to me when Arden was two, and they're like, the first thing we're gonna want to do is bazel test. And I looked at the sheet like, Well, I'm not doing any of this, but okay, and you know, looking back, it really should have done it, you know, especially back then when there was no CGM, and you know, none of that stuff, and I really shouldn't have done it. But, you know, no food being digested, you know, no active insulin, like, how am I going to get like a little kid not to eat for five or six hours? And I did eventually figure out that overnight was the place to begin. And you can, to some degree, infer the daytime from the nighttime meaning meaning, you know, if it takes a unit an hour overnight, you're probably not five units an hour during the day, you're probably somewhere near that unit. Right. Right. Right. And it could be I mean, it could be significant i right now Arden is more like a unit overnight and more like two units during the day. Right. So in, but that also will go back and forth. The just, just I will say this, because you you alluded to it earlier, and you were just talking about the idea of bazel testing, like I know a lot of you don't want your blood sugar to be 180 or 200 overnight. But for this test, maybe that's what has to be, I'm really coming to realize that an incredibly flat line one that's 85 for 24 hours a day, is really not reasonable. It's doable, right? And sometimes you'll get it and maybe you'll get it for days in a row if you're really dialed in. But you can't be upset if a blood sugar goes to 160 for 45 minutes and comes back again. It just my blood sugar goes to 160. Like if I sit down to play two pancakes today, my blood sugar is going to be 160 probably for a couple of hours now. different situation, right? And I don't have the other impacts of Type One Diabetes like people with type one, two, and I get wanting to limit it. But everything we've talked about on this podcast for the last number of years, I've seen it intersect with Arden becoming an adult. And so do I think you can keep a 90 blood sugar forever if your kid hasn't hit puberty yet? I bet you can. Right? I think it's super easy. I think that when you get to puberty, I don't think you should beat yourself up if that doesn't happen. And and I can still do it most times you don't I mean, like don't get me wrong. But I don't know. Like it's it doesn't seem as important to me. It almost seems like a video game. Now when I step back, and I watch people online, do it, for instance. And they're like, look at this graph, and I'm like, That's amazing. And then there's part of me that wants to say show it to me 10 days in a row and then I'll get excited right like don't Just show me one in the middle of May and go, Hey, look what I did here. And that's why, you know, on my blog, I tried to put things up that are like, Look wrong, everything went today, Arden say onesies still under sick? You know, I don't know, I just I want you guys to realize that we don't want spikes when we get them, we want to bring them back down again. But if they happen, you cannot run around like you've lost some, you know, game that that's attached to your mortality somehow, you know if your blood sugar is always 200 Yes, but you know if it jumps twice, come on, like ease up a little bit. Okay, right. So how reasonable is it that once I bazel test, I'm actually going to know what my basal rates are. Normally, I tell you about the dexcom g six continuous glucose monitor about the share feature, you know, you can see your kids blood sugar when they're not home. Or you know, if you're an adult, and you'd like your parents still or a friend to be able to see it, you know, sharing files amazing. It's available for Android and Apple and blah, blah, blah. And you should do that. Wouldn't you be great if you could see the direction of your blood sugar and the trend lines and how fast your blood sugar's moving up, down all that stuff that you hear me talk about all the time, hundred percent true, but with the time that's left in this Dexcom ad, I'm gonna say this year, you are listening to the bazel adjustment episode. By now if you're still listening, you must believe how important it is to have your basal insulin correct. And while you can do it without a dexcom It is so much easier with one I mean, oh my god, it's so much easier. Go to dexcom.com Ford slash juice box to find out more about the Dexcom g six continuous glucose monitor. Let me sweeten the deal by telling you this story. It's summertime now Arden's home from school. Last night, she was up facetiming with friends from all over the country. And they were up way too late. So Arden needed to sleep in today. She slept till 130 in the afternoon. And I was able to keep her blood sugar from going below were high. While she slept all of that time away. All that think about that

6am 789 10 1112 one, no food, no intervention, just the information from the Dexcom to help me make decisions about her basal insulin. And those decisions kept her blood sugar between 70. And you know, 120 is where we get I alarm. But honestly, I never saw over about 95 dexcom.com forward slash juice boxes, links in your show notes at Juicebox podcast.com. Get started today. But before you do, let's talk about on the pod, the only tubeless insulin pump in the world, the insulin pump that my daughter Arden has been wearing since she was four years old to 11 years ago. And it has been nothing but the best friend we've ever had in diabetes. last day of school, Arden went to a friend's house to go swimming, had around the pot on last night, need to make an adjustment to her blood sugar picked up her PDM button button button. Just like that No tubing, she's laying in bed facetiming she's not wrapped in tubing, she doesn't have to bounce her controller on her head or stick it in her pants that doesn't exist on the pod was over on the dresser right there. just just just there, just reach over and grab it, push a couple of buttons, give yourself some insulin, take some insulin away, maybe a Temp Basal decrease. I don't know what you're doing. But trust me, whatever you're doing, you want it to be easy, and you want it to be good. And you want it to be wholesome and fulfilling and make your life better. And that's exactly what on the pod does. The best part is on the pod wants to send you a free, no obligation demo, they call it a pack a pod experience kit, they'll send it right to you right to your house. So you can try one on the pod for yourself before you make any decisions. My omnipod.com forward slash juice box or the links in your show notes or Juicebox podcast.com. No more ads, talking about basal insulin the rest of the way.

Other times I bazel test and then I don't have any better of an answer.

Jennifer Smith, CDE 24:05
There might be especially if like I said before, if you're doing some bazel testing, and there are variables at play that you didn't really think to pay attention to in that time period, then absolutely though that bazel test could be not very purposeful. It could be kind of null and void. And this is something I encountered a lot with women. And something I bring up when I work with them to begin with. And in a first visit is one you said you've done beta testing, but to see you know your cycle impact if you have one and two Did you bazel test in that sweet spot of like two to maybe three weeks whether women are on birth control or not. They're sort of like this two to three weeks of sweet kind of plays of management without significant hormone impact. And that's where beta testing used to happen. It needs to happen without the impact of Pre cycle or oscillation hormones kind of coming into play. So if you haven't been tested in those sweet spots, and you're completely wrong, what's happening and what your basic needs are. And once you do have that sweet spot to put into play, and other, this is an important piece that a lot of people ask about too, is great. So then I need to test in these other times, well, that really, you know, what we find is that women mostly need like a 25 to maybe 40% increase in a hormone specific time period of the month. If you know that what you can do is use the Temp Basal, ie How well does this work? And what you can do because the time periods during the day that your Basal goes up or down, physiologically, those times will remain pretty stable. Those shouldn't need to change, it may be that you just need 25% more between 6am and 10pm. Right. So you can plug that into a bazel profile, set it and turn it on or enable it when you need to. But those time periods of the day, they stay pretty stable. Once you've designated Oh, my basal needs go up at 2am. Up, they shift down again at ADM, they're pretty stable until four or 5pm, they might go up or down again. Another piece for bazel testing is that most most people, again, your diabetes may vary. But most people will have about Orwell, most people have one Valley and one peak to their bazel during the day. So let's say they start midnight at point six, it might go up to point eight by two or 3am. Maybe it goes down around 8am 9am to like point six again. And then through the day, it's phase kind of lower, and then it may shift back up into the evening time. Okay, so you kind of had one dip, but one rise through the course of a 24 hour time period. Again, that's most people, not everyone. Most people also have about three to five basal rates through the course of the day or bazel time periods. So, you know, midnight until 6am 6am until 4pm 4pm to 9pm 9pm to midnight, those time blocks. Most people have about three to five different segments of rate need. Through the course of a day,

Scott Benner 27:25
you have to stay flexible too. You can't just say to yourself, look, I've set this basal rate, it starts at 3pm, it ends at 7pm. It always works. And then Thursday comes in at five o'clock your blood sugar starts to drift up, and it won't stop drifting up. You can't lock yourself into that doesn't make sense because my bazel always works. It's not working now. And the reasons you know, I'll be talking about this throughout the years of the podcast, but the reasons are almost unimportant in the moment. The truth is your blood sugar Yeah, yeah, right. You need more insulin, use more insulin. And and I've come to start, I've begun to start saying privately that that the diabetes, your blood sugar, it's requiring more of you. So give it to it. You know, he's telling you something your blood sugar going up is is your body's saying hey, I don't have enough insulin. Don't like wonder why just believe it. You know, like, there's no reason to, I don't know, if you came up to an intersection. And there was a cop standing there with his hand up it says don't go around the corner. There's a guy with a gun there. Just believe the cop and don't go around the corner. There's no reason for you to peek your head around the building. Oh my god, there is a guy shooting there. Like just take his word for it and walk around the block. And so. So when your diabetes is telling you, Hey, I don't have enough insulin, just believe it and give it more insulin. I got this beautiful note this morning from someone who said they were listening to the last episode. And she said, I think she called it like a bat in the head moment where she was just like, oh my god, I'm an idiot. Why am I not using more insulin like like, you know, running around all day looking at her blood sugar going, what's wrong? What's wrong? What's wrong? What's wrong? And she said, We must have said something on the podcast. And she just was like, oh, but sometimes that that happens like because you get so narrow, focused on the things that are supposed to be happening, that you can't break away from them for a second and look at actually what's going on. You know, listen, this is good life advice, too. If you're fighting with a spouse or a girlfriend, and you're saying to yourself, I have the best intentions here. Why is she upset? It doesn't matter. She is you know, so you're doing something wrong. Forget figuring out what it is. You're wrong. Stop or you're wrong. Right. That's it? Yeah, I've given you a number of ways to think about this. Now, when your blood sugar is going up. Give yourself more insulin. As a matter of fact, Jenny my next t shirt is going to say more insulin. That's the next t shirt. I'm going to print if I can ever figure out how to have one absolutely deserves a T shirt. All right. Everybody's always like telling me it's so easy to print t shirts. How can you not figure it out? It's like I'm very busy. Leave me alone. But I'm trying. Anyway.

Jennifer Smith, CDE 29:59
Yeah, I do. That's also a really good point. Because if this is where you could also say, is it a trend now? It Like you said, 5pm, my blood sugar is going up. I don't know why I don't have any active food. I don't have any active insulin shouldn't be going up. I felt like things were pretty good up until today. Great. Well, you know what, tomorrow if it's happening again, the next day, if it's happening again, something shifted. Why? Again, don't play with the why I mean, you can go back and evaluate and look at some things and whatever. But in the moment, you say, you know what, it looks like my blood sugar starting to go up by 435 o'clock every day, and I'm high by six o'clock and I keep adjusting and correcting. Don't do that. Right? adjust it, make an adjustment and go forward. And then you know, what if it shifts back down, right? If a couple of days, you're ending up low, then you shift it back down again?

Scott Benner 30:50
Yes. See, you're you're highlighting something that I've never understood when people say to me how many days till I think it's a trend, and I should change. And I'm always like, Who, what, like by the time you by the time you suss it out three days later, it might go back again, now you've given away three days of your blood sugar at that level, get just learn. Don't ask your wife Are you really gonna wear those pants, like she doesn't like it when you say that to her right leg, Sue, so stop and don't don't do it again, like, my blood sugar went up at five o'clock, I did something about it. Tomorrow, it went up at five o'clock, I did something about it. The next day, I'm not even letting us get to five o'clock, right? I'm just gonna decide, I'm going to expect that what I know is going to happen is gonna happen. And I'm gonna deal with it ahead of time. And if it happens to not go that way, well, then I can dial it back again. But it's so much easier to ramp up your insulin and bring it back than it is to sooner than later.

Jennifer Smith, CDE 31:46
Many times doctors will say, Hey, you know, follow a trend over the course of a week, well, that's five to seven days, then that you have chunked out higher or potentially lower than you want blood sugars, because you're trying to find a trend. I mean, in pregnancy with the women that I work with, we say two days of a trend, we're making an adjustment. And you know what if we need to dial it back again, for whatever reason, we will, but we're not leaving things travel higher or lower. For more than that time period, we will adjust and then we'll adjust again,

Scott Benner 32:18
and for all of you who have ever said to me, yeah, I'm going to handle that the next time I go to my doctor three months from now, you make my brain hurt when you say things like that. Okay, just please do not wait three months to address something even. I just yesterday, had a person who won a giveaway that I did with dancing for diabetes, and they you know, we had a phone call together. And this person, this is great. A person in their 60s who decided to get a CGM and a pump and you know, very excited for themselves. And then she said, You know, I have a doctor's appointment July, I said, No, no, don't wait till July. I said, write an email right now. Hey, Doc, guess what, I'm getting a dexcom g six, and I'm getting an omni pod. Go ahead and send those prescriptions in for me, I want to do that right now. And when we get I'm excited to come to you in July, and I'm going to bring my new stuff with me, you can show me how to do all of it. And I said if you never make it there to show or maybe you figure it out on YouTube or somewhere, whatever. And you know, and and, you know, but or maybe they'll send a trainer to your house. I think that is the appropriate thing to say right? And and but but I was like don't wait till July. So because July is six weeks from now, six weeks from now you're going to tell the doctor what you want. They're going to wait a week because people don't do things right away for you. They're going to send in their prescriptions for you, then you're not going to get this pump for six months. If you get that like start today. Go right now. Be proactive.

Jennifer Smith, CDE 33:38
Yes, with technology the way that it is and electronic medical records and things like my chart and things that you can send back and forth. There is no to not communicate between with a doctor and you know what if you don't get a response from them within 24 hours, you call that office and you ask to talk to their nurse and you say this needs to get to the doctor needs to be saw and it needs to be taken care of.

Scott Benner 34:01
Arden's endocrinologist and I have been adjusting her Synthroid are just taking Synthroid and site ml now and we've we've been making adjustments by email. But what's taking and it's still taking a long time to get it straight. Imagine if I only made the adjustment every three months when I saw her art, it would be like a puddle on the ground. When Arden doesn't have enough Synthroid. She can't pick her head up off of the ground. She just slumped over and she's like, her blood pressure, her blood pressure gets incredibly low. And she looks like she's dying the whole time. And and so once she has more Synthroid, she sits right back up again. It's it's literally like grabbing a marionette bytestrings when she has an Synthroid. But if I had to only make adjustments to her medication quarterly, it might take us two years to get it right. And we might never because she's growing and gaining weight throughout that time.

Jennifer Smith, CDE 34:53
And think of her education in this time period to what would she be getting out of her classes and the ability to perform And any athletics that she likes to do and enjoyment of fun with friends and everything. I mean, that puts a major cramp in any age, whether you're a child or an adult trying to perform in work or whatever. I mean, any adjustment, it needs to be addressed in the here and now not waiting three months to say, Oh, well, Doctor, you can see my is such a child. I've been having a lot higher blood sugar's I didn't know what to do. But I knew I had an appointment. So I waited until I came at that.

Scott Benner 35:30
Yeah. All right, Jenny. We're standing in front of your house. And you had your garden hose in your hand, and your porch caught on fire. Would you stand there with the hose thing? Or the fire coming? You'll be here soon. I don't need to squirt the hose at this porch. Why would I do that? The fireman is coming. He's a professional. I'll let him handle just hold the hose. Get started

Jennifer Smith, CDE 35:49
with my hose.

Scott Benner 35:50
Yeah, why don't I just see what I can get accomplished here. All right. So bringing this all back to your baseline slim, because no one thinks about their basal insulin with nearly the importance that it is I spent the first 10 minutes of a conversation the other day explaining to a person what it was. And after I explained it, I had to explain it again. And and so and you can still hear people go so that's the level here like people on empty out there like so. And I get it like they're newly diagnosed maybe sometimes, or they never got a firm explanation. But we treat basil insulin. Like it's not important. And it's everything. It's it's so much more important like it. Can we say it all the time. Everything starts at bazel phaselis not right, nothing else works coming off of it.

Jennifer Smith, CDE 36:35
Well, and so many people think that bazel job is to bring blood sugar down. Right? Oh, many people I mean, people I've worked with who've had diabetes long term who've come in and you know, I look at their records to begin with and they are confused and annoyed that their basal insulin isn't letting them wake up at a target blood sugar. I just stay high all night long. Well, you're starting the night high. So something I mean, time chunks of the day. Usually where you are now it's because the hours ahead of that. Something isn't right. Yeah, it's not the here and now. It's the what happened before this that got you here. So let's look I wanted my diesel should is here, here and here. And it should be bringing me down. No, that's not fatal job Faisal. dabit. The whole just it if you didn't eat all day long, you shouldn't have much.

Scott Benner 37:24
Diabetes is like a time travel movie. I've come to think of it this way. Right? Like it whatever is happening to you in the moment when the cameras pointed at you has nothing to do with what's in the frame with you. It's not a it's not a murder mystery. It's not somebody stabbing you and going, Oh, this is what's happening right now. It's the guy in Act One, set something down on a table and enact 325 years later that thing is how come you blah, blah, blah, blah, blah. There are things in the past. And there's decisions you're making right now with your diabetes that are going to affect you in three hours, or six hours. And and it's not now so much like it's interesting to how people overreact to the idea of Pre-Bolus Singh originally, because when their blood sugars are out of whack when they're really first starting to get things together, and they're jumping up and down. They're so reactive to everything they see I did something and then this happened. And I always tell people, if you Pre-Bolus and two minutes later, your blood sugar starts dropping that has nothing to do with the Pre-Bolus nothing. That's why when you know when you guys hear me say Arden's blood sugar was at five and I Pre-Bolus there. Because she was stable at five for three hours, the Pre-Bolus isn't going to start working right away. I only needed her to get to lunch 10 minutes later.

Jennifer Smith, CDE 38:38
The only reason it would start working right away is if you physically had that canula in a vessel. Right on it was literally going right into the van tapping into her bloodstream. Right?

Scott Benner 38:48
So in normal situations, which Jenny's bringing up, probably because she knows we actually had a pump. Probably Nick a vein in Arden one and for two days. I couldn't we couldn't get her blood sugar to go above like 50 most of the time, until we finally just changed her sight and everything went back to normal. But that was anyway that had never happened before. That was crazy. For the I'm texting Jenny, like you should have seen that texted Jenny, I sounded like you guys sound but you email me I was like, I don't know what's happening. I wasn't with her. I was in Florida doing dancing for diabetes. My wife's at home going? Seriously. This is what's happening when you leave. And I was like, I don't know how to explain any of this. I said I've looped in Jenny, we're gonna figure it out, you know, but, but anyway, yes. The point is, is that timing of your bazel just as important as the amount of your bazel. And to Jenny's point, for those of you who are thinking that bazel is in charge, you're bringing your blood sugar down. It's not it's in charge of keeping your blood sugar stable. And I say all the time, it's a stupid thing. But do it with me here. Unless you're driving. Hold your hands together in front of you like you know in like the classic, you know, prayer prayer motion, right. Imagine yourself Body function and, you know, sugar on one side and your and your and your bazel on the other side, and they're both pushing each other towards the center. And when nobody wins, right, when your hands don't move to the left or your right, that's a good basal rate, when you start moving towards body function, then your basal is too high, and when your body function starts pushing you away, then your basal is too low, you're trying to just give the bazel enough strength to fight off the background things that are happening in your body. If, right, and when you eat, you know, a reasonably normal meal, that bazel should also, you know, help with your Bolus. But don't expect that if you're going to eat like an entire pizza that your point six bazel rate is going to be okay. Because it's not. And then so that's, that's another thing. So once you get done bazel testing and figuring out your bazel for all your normal times when you're just standing around being you amazing you. That's one thing, what about your basal insulin while you're eating? And those tests have to happen in real life, while you're eating? You have to say to yourself, when I eat a salad with a burger, my blood sugar tries to go up. I wonder what would happen if I did increase my basal rate during that? And you know, I mean, for those you've been listening for a long time

Jennifer Smith, CDE 41:15
or after that

Scott Benner 41:16
we're right, right, maybe it's pizza, it doesn't hit me for 90 minutes after I've eaten it, you know, or any other thing like French fries, or had french fries the other night, it must have made her high like four hours after she you know. So

Jennifer Smith, CDE 41:29
it's not the nothingness is understanding again, that's why we also start with the overnight test it because if you can wake up in target, you are not fighting being too low from excessive insulin dropping you and you're not fighting being too high and having to correct and add insulin in a time that you're most people are insulin insensitive in the morning, right. So we talked about things like adding fat in Yes, your background bazel. If you know it's solid and set to begin with, then you know how to play with that temporary bazel feature to accommodate for long term impact like that, that causes essentially a stress factor, it releases triglycerides into the bloodstream, which causes insulin resistance in the aftermath, it can last as long as 10 hours after eating high fat. So most people need a bazel increase. It's like fat almost causes your basal insulin dose to be reduced by 50%. So if you're running at a rate of 1.0, overnight, and you have this big ol awesome like cheese, meat lovers pizza night, you go to bed thinking man, I nailed that Bolus, I'm going to bed beautiful. I'm like a 103. I'm going to sit here all night, it's going to look awesome. At two o'clock in the morning, you're at 300. And you're like, what the heck, you know, where did this cut, its fat, usually fast starts to impact by about three hours, you get this like drift, and then you get stuck by and you nail it with insulin and you nail it with insulin and you nail it again. And then finally you might start drift down. By the time you wake up the next morning, you could have fought it ahead of time by using a temporary rate adjustment. If you know your bazel to begin with is set Well, you can increase using temporary bazel and offset the impact of that

Scott Benner 43:12
fat. I wonder if I can explain what's in my head correctly. Because when your blood sugar gets elevated, imagine it's 250 coming off of the pizza and you think oh, a unit brings me from 250 to 100. So I'll put it in a unit. That's great. But what Jenny just told you was you're at 150% need for your Basal. So the unit really just keeps replacing the bazel you don't have. So you put the unit in, replaces the bazel keeps you stable at 250. But you still haven't addressed the number. And so then you wait an hour and you go I can't believe that didn't do anything and you put it in another unit. It doesn't do it again, because you're still just replacing the bazel you need a yak up your basal rate and Bolus for the number. And remember, the turning up the Basal at midnight doesn't make doesn't mean it's going to start working really maybe until one or two o'clock in the morning. So what So in the end, let me get very close to the microphone. What you need. And I don't want to oversimplify diabetes is more insulin. That's what you need. You do not have enough insulin. It's your union that T shirt. I'm talking right now. I can't do this podcast forever people more insulin if your blood sugar is high. Hey, if your blood sugar is low, guess what? Let me just go at it right now. Less insulin. There you go. It's not difficult, right? It's difficult to imagine the whole thing, which is what this podcast episode is about. Like we're talking through a number of different scenarios where your basal rate means something. But I think that i think that's it at the beginning here. Jenny explained a more clinical way to do basal testing. I think if you have a CGM. I tell people when we're speaking privately, and they're like, how do I figure out you know, how much more bazel to use? I just go well, you know, if it's a kid and they're like, at point three, I'm like, well turn 2.4 and see what happens. You know, and as they start getting low, Put it 2.35 you know, and it has because your kids blood sugar's sitting at 200. You know, like, with point, you know, point three going in every hour, point four is not going to make them nothing, it just doesn't stand to any reason. Common Sense and diabetes is, you know, just like I tell people all the time, one of the best pieces of technology for managing someone with diabetes is text messaging. It is a absolutely, like pivotal way in how art and I deal with our blood sugar if you don't, if text messaging is a is a diabetes tool, and it the same way, right? Just trying things is a diabetes tool, like give it a shot and see what happens. You know, point four, Okay, now let's see what happens. Not enough. So

Jennifer Smith, CDE 45:46
even for little kids, you know, even the incremental of the smaller rate, you know, the point 05, or the point 025. You know, all of that is an option. It's not an omni pod, but it is an option on the tandem in the Medtronic pump. So that is an option to get smaller, incremental adjustments, depending also on what your sensitivity kind of seems to be. I think the only thing that we didn't really is like the daytime testing, honestly, you know, daytime means that if you really want to know what's happening behind the meal, to make sure that the bazel is doing its job, the meal can't be there, right. So if you wanted to look at morning time, you really have to, for adults, you can skip a meal, because you can deal with that. You can just you can slug it out until lunchtime, and go ahead and eat your lunch and just see what happens in the morning when you wake up. You know fasting blood sugar, you let it sit you don't bolus you don't take caffeine, you don't eat anything. You can have water, herbal tea, or whatever. Don't go for a 10 mile run either. Look at what happened. Oh, kids, I usually say you know what, if you can get them to sleep in a little bit longer, maybe on a weekend, at least you're going to get an idea behind what their normal breakfast time is in that morning time to see did the bazel carry them pretty well, or what I had one mother I worked with, not too long ago. She's like, he woke up and he just started playing with his Legos right away. And he played with his Legos for a long period didn't even care about eating breakfast. I'm like, awesome. Yeah, that was a bazel test. I was like, there was nothing there. no food, no balls, he was sitting and playing with Legos. Fabulous. We've got information.

Scott Benner 47:28
That's cool. That's excellent. Yeah, whatever you can do, just just but do it. Because you need to know. In the end, if you've ever spoken to me privately, what I'll tell you is, in a perfect world, if your Basal is right, your blood sugar is gonna be 90, it's gonna be 85 or 90. Now, I don't expect it to always be that. But that's your goal. And if that's your goal, then it's when you're at 150. It's not correct. And also, when you're bouncing all over the place. If you're one of those people who right now is struggling and your blood sugar flies all over. You may turn your bazel up and get a low blood sugar and think oh my gosh, that's because I turned my Basal up. But it again, it might be about the Bolus you use before. So you know, there's one thing I say all the time. That I think is how you start your Basal rates. First thing you have to do is find a level, just find a stability point hasn't really almost matter where it is just get your blood sugar to sit still. And if you have to nudge with food, to do it, or nudge with insulin to do it, it's fine. Get stable somewhere and start over even when things go crazy here. I'll say that the Kelly I'll be like, Listen, I said we're out like everything's out of whack. Like we got to find a stable points where we can start over again. And you know, you just can't I don't know. It's like It's like trying to catch up. It's like trying to catch up on you know what I mean? Like he you gotta wait till it lands. Anyway. All right, um, do you feel like we've covered it?

Jennifer Smith, CDE 48:53
For the most part, I don't think

Scott Benner 48:55
we have to. I appreciate everyone who reached out and asked about a more specific episode about bazel testing. This was it. I hope you liked it. Goodbye, Jenny. Ah, thank you for listening to the 11th installment in my diabetes pro tip series with Jenny Smith CD. Don't forget that there are links in your show notes to email Jenny or you can go to integrated diabetes.com if you'd like to hire her personally, and have these conversations private like with her. Thank you also to Omni pod Dexcom and dancing for diabetes for being such wonderful advertisers. And sticking with the show weekend and week out really makes it possible for you guys to get the show. And I appreciate honestly how easy they are to work with. You wouldn't see that behind the scenes but they're good peeps. If you just found this diabetes pro tip episode, go back and listen to the rest they start around Episode 210. Also something new you may not have noticed last Friday, I began to post a second episode of The Week called defining diabetes. In the short episodes, Jenny Smith and I will define a phrase from your daily life with type one diabetes. If you're a subscriber, this extra episode will just show up like you're used to seeing everything else, it will just populate your podcast player, you can listen to it whenever you want. Thanks so much for listening. I hope you have a great day and a better week. And a special shout out to all of you on Instagram who share the podcast so much there. It's amazing. Thank you so much. You're helping the podcast grow in ways that you can't even imagine. Before I go, I'd like to share something that I imagine that most of you who have been listening for a while understand. It took so much restraint not to call this episode Jenny's but but I did it. I'm an adult. And I use the diabetes pro tip series because that's what this is. But when Jenny said she made a bazel rate called but I was like oh my god. This episode should be called Jenny's but, or but bazel or Jenny's but bazel I don't know. But I just so hard not to do that.

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#236 Defining Diabetes: Bolus

Defining Diabetes: Bolus

Scott and Jenny Smith, CDE define the terms at the center of your type 1 diabetes care

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

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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
I always like to give consideration to the things that we take for granted. For instance, some of the words that we use on the podcast, I get notes from you guys all the time. My favorite one very recently was I didn't know until I was listening to the podcast for months that I was doing MDI. I mean, I knew I was injecting insulin, but I didn't know it was called multiple daily injections, and that people shortened that to MDI. So I thought, you know what, that probably happens to more people than I realized. And so today is the first of our new mini episodes, they're just going to be a few minutes long. They'll happen on Fridays, and they're going to be with me and Jenny Smith as we define diabetes. I think I want to call this defining diabetes with Scott and Jenny. That data that then there'll be like music and there's no music. I have no money for music. Anyway, just imagine like game show music in your head. And then I'll say the thing so I'll give you a second. You get the game show music running. Right? Like card sharks or something like that. You got to go and ready. Hi, everybody. Its defining diabetes with Scott and Jenny. I'm gonna use this weird I'm not talking like that. Anyway, this one's Bolus, okay, that's where we're gonna start Bolus. That seems like a good reasonable place to start to believe it or not. There are people listen to this podcast and send me notes and say, I don't know what Bolus means. So you will in a second, hey, by the way, it means more than you think. Defining diabetes is made possible by Dexcom on the pod and dancing for diabetes. After Jenny and I define Bolus today there'll be a little information about those companies. Stick around for 30 seconds and check it out. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise the Always consult a physician before becoming bold with insulin or making any changes to your medical plan. Jenny let's define Bolus you go for

Jennifer Smith, CDE 1:47
I go first of Bolus is the easy way to define it. Bolus is a one time right now dose of insulin that's given for two reasons. One, either to cover food or to correct and bring a high blood sugar down, though it's a whether you inject it or you do it with your pump. It is an amount of insulin that you give right now it's not something that lingers like a basal insulin would.

Scott Benner 2:24
And it's also outside of diabetes, a real medical word that would be used that's nothing to do with insulin. And it just means to infuse liquid right and or something like that. Isn't that the the actual Hold on a second lunch this Jenny? mission, I'm gonna look it up on the internet. A small rounded mass of a substance especially of chewed food. That's weird at the moment of swallowing a type of large pill use in a veterinarian medicine. I think Here we go. Here's the one for us a single dose of a drug or other medicinal preparation given all at once,

Jennifer Smith, CDE 2:58
all at once. And part of the reason that Bolus came in to use with diabetes is because of the initial known definition is that it's that small mass of like food that you chew up and that goes down your throat. It's called a bolus. Really so when you when you take insulin for food, it's almost like your Bolus Bolus thing because your bowl of thing a single dose of a drug insulin, they cover an amount of food a bolus of food.

Scott Benner 3:28
You're so smart.

You don't want to miss the diabetes pro tip series that Jenny and I did recently. It begins back in Episode 210. with diabetes pro tip newly diagnosed starting over after that it's Episode 211 all about MDI Episode 212. All About insulin. In Episode 217. We talked about Pre-Bolus going into 18 Temp Basal in 219 insulin pumping into 24. Or mastering your CGM into 25 bumping and nudging into 26 the perfect Bolus and into 31. We talked about variables. That series is ongoing. Do not miss it and it's designed to be listened to in order even if you're not doing MDI. Check out the MDI episode started newly diagnosed and starting over listen through. I guarantee you're gonna love them. Defining diabetes on the Juicebox Podcast is brought to you by Dexcom on the pod and dancing for diabetes. There are links in the show notes at Juicebox podcast.com to all the wonderful sponsors. But if you want to find out more about getting a free no obligation demo valmy pod you can go to my on the pod.com forward slash juice box to get started on the Dexcom g six continuous glucose monitor dexcom.com forward slash juice box and to learn about the good that's being done at dancing for diabetes good at dancing the number for diabetes.com Thanks for checking out defining diabetes come back every Friday. And I break down a new word or phrase that is impacting your life with type one diabetes.

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#235 Tommy

A type 1 diabetes conversation in transit…

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Tommy and Scott chat while Tommy drives home from his endocrinologist appointment. Type 1 diabetes meta.

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 235 of the Juicebox Podcast. Today's episode is sponsored by Omni pod dancing for diabetes and Dexcom. You can go to my Omni pod comm forward slash juicebox dancing the number four diabetes.com or dexcom.com forward slash shoes box to find out more. There are also links in your show notes, and at Juicebox podcast.com.

In this episode of the Juicebox Podcast, I'll be speaking with Tommy, Tommy's had Type One Diabetes for a year, maybe a little longer. And I got to record this with him while he was on his way home from his endocrinologist appointment with his mom. Tommy is 11 years old. And I think you're going to be pretty amazed when you listen to this conversation. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise and always consult a physician before making any changes to your medical plan. or becoming bold with insulin.

Tommy 1:36
We're driving right now.

Scott Benner 1:38
Oh, you're in the car. Okay, I didn't realize that. Okay.

Tommy 1:51
My name is Tommy and I've, I've been diagnosed for a year and a half right now. And I've, um, I've stayed steady and strong. I recently very recently just got an A one fee of about 6.0 6.0 M. And I feel pretty confident with that. But it wasn't as good as my last day once the my last day once he was 5.7.

Scott Benner 2:19
How is your variability though? Are you You know, sometimes a lower a one c isn't better if your blood sugar's bouncing up and down. So are you how are you doing with staying stable?

Tommy 2:29
I'm staying stable. Um, but in the mornings in the mornings, I kind of spike up a little bit because I'm I eat cereal, but we figured out a way to kind of make that work. That's excellent. Cute. Would you like to hear that?

Scott Benner 2:43
Hold on a second. Let me let I see. You're excited. Tommy. I like that. Hold on a second. Let me ask you a couple questions. Okay, so you said you were diagnosed about a year ago? But you're 11 years old?

Tommy 2:52
Yes. All 11 right now about to turn. Well, in April.

Scott Benner 2:59
No kidding. All right. Well, happy birthday a little early. Okay, so let's think anybody else in your family have type one diabetes?

Tommy 3:07
Um, oh, no one actually had type one diabetes in my family. And we don't know how I got it. But I think we might run a test.

Scott Benner 3:17
or other people thinking of like doing testing on them? Is it gonna do trial net? Maybe?

Tommy 3:25
Um, I, we might try, but I don't think

Scott Benner 3:30
it's that big. I was just wondering, so Okay, so nobody else had type one. You're the first one in the family to to get it before gotcha. Okay. And you say that now I got an email from you. Let me see if I can find it. And you said that your mom listens to the podcast, and then tells you things that she's heard for you to try? Or do you listen as well. Um,

Tommy 3:51
I listened sometimes. But my mom really listened to the most. Gotcha. And

Scott Benner 3:55
how does that go? When she comes to you and says, Hey, I have this new thing I want you to try. Do you? Do you want to try?

Tommy 4:02
So, um, we listened to one and it was it was you talking to another boy. And he said that you ate cereal and other things by waking up covering then going in the shower. And that really helped him with his insulin. So we tried that. And, um, and we couldn't really tell the difference, but it worked just a little bit. But it was true. And we really liked it. So we wanted to give it a try. Gotcha.

Scott Benner 4:34
Yeah, I mean, I think things work differently for everybody, you know, so something that worked for him might not work for you. And you know, Vice vice versa. So that's no big deal. So you said you're eating cereal now and you're keeping your spikes down and you wanted to tell me about how that's happening. So tell me a little bit about Yeah.

Tommy 4:51
So um, I wake up and I give myself some I give myself insulin like so my ratios are One to 30. And so I give myself three units, which is 90 carbs. And my base is also very high. And if if I was pretty high overnight, I might hop in the shower. But then after that I could change and change, and get my shoes and socks on, get ready for the day or school or school, whatever I'm about to do. Um, and then after that I eat and, and then we go to school, but I eat, eat and sometimes I go up a little, but then it works. It works. It goes, it goes up to like maybe one one, like top 180. But it it's, it's the best system that we've tried so far. And it's pretty, it helps us a lot.

Scott Benner 5:51
It's excellent. So tell me something when you put that those three units in? How long between when you put the three units in, and when you start eating the cereal is it it would take like,

Tommy 6:02
maybe 15 minutes. But right now I feel my body. It feels like it's kind of it's, it's getting faster, like I'm

Scott Benner 6:15
thinking is starting to work more quickly than it has in the past.

Tommy 6:19
Uh, yeah.

Scott Benner 6:21
Yeah. Is that so let me ask you this. How long have you been using insulin pump?

Unknown Speaker 6:28
How long?

Scott Benner 6:29
Yeah, no insulin pump.

Tommy 6:32
Oh, um, for about? Maybe like, a year.

Scott Benner 6:35
Okay, so pretty much the whole time. You've had diabetes. You've had a pump?

Tommy 6:39
Um, yeah, pretty. Pretty much the whole time. Okay, we haven't really changed or anything like that.

Scott Benner 6:45
Gotcha. Okay, are you getting? Are you getting out the car going somewhere else now?

Tommy 6:50
No, I'm low right now. So I'm trying to find a new job. Take

Scott Benner 6:52
your time. What's your blood sugar?

Unknown Speaker 6:54
I'm like 71.

Scott Benner 6:56
Okay, and When's the last time you had insulin?

Unknown Speaker 6:59
I gave myself insulin because I was going a little high. So are you?

Scott Benner 7:03
Are you 71? And like, is your blood sugar falling right now? Is it stable?

Unknown Speaker 7:08
So I just want to give myself just a little bit.

Scott Benner 7:11
How do you feel at 70?

Tommy 7:14
I feel a little weird. A little hot, like getting hot. But I don't feel I don't feel really weird. But when it gets really low, I feel it.

Scott Benner 7:23
Yeah, no kidding. So now will you drink the whole juice box? Or just half of it? or What will you try here? Oh, yeah. So what's your goal to get your blood sugar back to where?

Tommy 7:35
Maybe like, one to five?

Unknown Speaker 7:37
Cool.

Scott Benner 7:40
Take your time Drink up. But what flavor is the juice?

Tommy 7:43
Oh, I'm cooler. But cherries. My favorite

Scott Benner 7:51
artist has one that she doesn't like. But I switch it back and forth just so she doesn't get sick of the one she does like and sleeping if she's if she has to drink it while she's sleeping. She makes a face even in our sleep. For the for the flavor. She doesn't like as much.

Tommy 8:05
Or sometimes my mom wakes me up to um, so maybe give myself a Duke juice all like, I'll talk I'll be like

Scott Benner 8:16
Alright, so you take the juice box to Rm while she's sleeping and touch the straw to her lip. And she knows it's there. And then she just opens her mouth and drinks. She never wakes up.

Unknown Speaker 8:27
My mom tells me

Scott Benner 8:31
Are you ready to keep going or do you want to take a minute?

Tommy 8:33
Oh, yeah, no, we can go right now. I already had

Scott Benner 8:36
no clue. So why are you in the car? Where are you going are coming from?

Tommy 8:40
So I just came from the Indra and an endocrinologist. Sorry, I can't say it.

Scott Benner 8:48
I'll say it with you. Ready? It's endo. chromo chronologist. See you got it. All right. Okay, so you went in the to do your this is your like quarterly checkup? Like you're like every few months?

Tommy 8:59
Yeah, we're gonna get blood drawn. But um, we had we had it.

Scott Benner 9:05
Listen to you. We're probably thrilled about that. Right?

Unknown Speaker 9:07
cancer so happy.

Scott Benner 9:10
Nobody wants to give blood for any reason. I hear you. So what did you find out at the at the appointment?

Tommy 9:18
Um, we found out we found an agency. We just, we we got stuff rescheduled. Um, and prescriptions?

Scott Benner 9:31
Yeah, new prescriptions. Yeah, you went to visit the prescription and a once a lady. Yeah, I

Tommy 9:35
think I think we're gonna get touch a new touch on the pilot touchscreen.

Unknown Speaker 9:41
Are you gonna get the dash?

Unknown Speaker 9:42
Yeah, I'm really happy about that. That's

Scott Benner 9:44
so cool. I used one a couple weeks ago and they're really neat. All right, yeah, you're gonna like it I have to wait just like everybody else. I have to wait to my insurances. More book cover, but that's really cool. You're gonna like it. It's it's a it's a different experience and using that other one. So Okay, so you got a six a one C, which is probably thrilling. I would be amazingly happy to see

Unknown Speaker 10:06
a six my mom, my mom, my mom kind of likes it. Oh, yeah.

Scott Benner 10:11
What do you want it to be lower war. Okay, all right. Oh, but you know, there's not a real big difference between like five, seven and six. Right? Well, I think that whether you're 576, you know, or in any tight kind of space like that, you have to realize that it's not about the number as much as it is about knowing that what you're doing is working. So the idea is that you're following and you know, the steps you're taking are keeping your blood sugar in a place where your a one c stays under six, and you're not going over 180 very frequently. Do you get low very often, like under 60?

Tommy 10:48
I'm not not that frequently, but this morning, I was pretty low. I like had two arrows going down. And I got in the O Ws, but um, we got back up. The funny thing was, is that I put the milk in the pantry.

Scott Benner 11:04
so low that you tried to put the milk in the refrigerator and you just put it the pantry instead. Do you remember what being that low felt? Like?

Tommy 11:11
Um, I know it feels. I mean, I I, um, I was all I feel. Um, I feel like shaky and a little like, lightheaded. Confusion, of course. Yeah. And I'm just like, you, you just kind of just like, you don't really know where you are. I mean, you feel like your head's in a different position in like a different place. But you you just can't really tell it's it's really hard to tell like, people ask me Hey, what is low feel like? I tell them. I tell them, I tell them that. It's not the best feeling and you can't you can't control you can't really control yourself. But you, you feel you feel you feel you feel normal, but like you feel like you're in a different you feel like you're in a different universe. Like you feel like you're floating in space. I felt like your organs and organisms are in different places of your body.

Scott Benner 12:18
I understand. I mean, I don't understand this never happened to me. But I understand your your explanation. That's a pretty clear explanation. So you don't get low like that very often. What do you think happened this morning? That got you low like that?

Tommy 12:29
Yeah, we I waited a lot.

Scott Benner 12:33
She you waited too long on your Pre-Bolus. And then the cereal couldn't catch up with the insulin. Gotcha. How long did you end up waiting? That was too long.

Tommy 12:43
I ended up I think I might have ended up like 30 minutes, something like

Scott Benner 12:47
that. That's a long time because there's that moment, Tommy where it starts to fall, like and you have to realize that that that CGM is not showing you exactly what's happening in the moments a little behind, right. So when you start feeling it when you start seeing that like drifting down and even if you don't get a diagonal arrow down, even if the numbers moving down, then you're insulins active and it's working. And that's probably a pretty safe place to start eating that. Wow. Well now you know, right 30 minutes is cool. Okay, well, you won't make that mistake again. What kind of cereal by the way? Oh,

Tommy 13:26
my brother likes lucky charms. Um, I kind of like rice krispies, but I'm pretty sure if it was curious

Scott Benner 13:34
Cheerios that see then those those hit you hard right? They if you don't do all right, they'll really send your blood sugar up. Let me tell you about cereal for a second time. Nowadays, it's not like it was when I was a young man your age. They used to have real sugar in it like it was just like, you know, it wasn't like all chemically and weird. stuff was so sugary. My Favorites included back then. Apple junks. Froot Loops. Right. Have you ever had a fruit loop? Oh yeah, they don't taste anything. Now like they used to end my absolute favorite fruity pebbles.

Tommy 14:06
Oh, 30 cable is amazing.

Scott Benner 14:09
I'm gonna tell you if I can put you in a time machine. take you back. 20 years. Wait a minute, let me do the math again. That would make me 27 I don't mean 20 Oh my god. Tommy I think what I mean is if I could put you in a time machine and take you back 40 years. Oh my god. I'm so old Tommy. Your Fruity Pebbles would have been a different experience. They were just magical. Magical. I'm telling you. Okay, so now they're just not the same foods different now. GMOs. We're killing the farmers. That's all Tommy let's get past that. Now. What what are you using for a pump?

Unknown Speaker 14:42
I'm using for my pump?

Scott Benner 14:44
Yeah. Which which pump? Yeah.

Tommy 14:46
Oh, I have the Omni pod the M

Unknown Speaker 14:50
I'm confused. No,

Scott Benner 14:51
no, don't be confused. You're confused because you're lower because of my question wasn't ordered. Well,

Unknown Speaker 14:56
I think your question was,

Scott Benner 14:58
I think so to me, because I I already knew you had an omni pod because you said you were thinking of getting a dash. Oh, yeah, so my question should have been what made you pick the on the pod when you chose?

Tommy 15:09
Oh, I didn't like giving myself shots that often. I didn't like I'm just like, I just kind of like I cannot like giving much like, I saw that the Omni pod would just like give you insulin, which was like, Wow, that's cool. So it's just like a shot and then you're ready for three days. But um, instead of shot shot, shot shot shot shot shot shot over constantly. Um, I like I just thought it just seemed weird to me. So I wanted to try it out for you.

Scott Benner 15:43
And did you get to CGM at a similar time? Dexcom?

Tommy 15:46
Um, yes, I think I got it maybe before the pump. No, I got I got the I got the CGM before before the pump.

Scott Benner 15:59
Okay. And so did you have the G six always? Or do you have the G five? g five.

Tommy 16:05
And now I have the G six.

Scott Benner 16:06
Nice. Do you like it?

Unknown Speaker 16:07
Yeah, it's amazing.

Scott Benner 16:09
I think so. Alright, let's think about this. 11 years old puts you in? Let me do the math real quick. Are you in? seventh grade?

Tommy 16:19
Um, I got held back. So right now I'm in fifth grade. So I would be a sixth. So

Scott Benner 16:23
I should have guessed sixth, but you're in fifth. Okay, so you're in fifth grade? How do you find school and diabetes theater? Like how do you manage to go to the nurse's office to do stuff with your mom? Like how do you handle it?

Unknown Speaker 16:38
My name is Elizabeth. And at 10 years old, I was diagnosed with Type One Diabetes. Shortly after inspired by my middle school dance class, I came up with the idea to host a show to raise funds and spread awareness about diabetes. And dancing for diabetes started and has grown ever since.

Scott Benner 16:57
When you're done here today, please visit dancing for diabetes.com that's dancing the number for diabetes.com.

Unknown Speaker 17:05
My hope for all the kids and teens in our dance program is that their Type One Diabetes will never get in their way, it will never stop them from achieving any goals or dreams that they have. And that they will feel empowered by their Type One Diabetes to do more to do better. And to do well for everyone, including themselves.

Tommy 17:27
On the night of the show, I want people to know that diabetes doesn't define you.

Unknown Speaker 17:35
I want people to be inspired. And if they even have type one, that they're not alone, and that we can do anything we put our hearts to.

Scott Benner 17:56
Like how do you manage to go to the nurse's office to do stuff with your mom? Like how do you handle it?

Unknown Speaker 18:01
At my school, I'm

Tommy 18:03
surprised where we live, we live way out in the country. So we live pretty far out and I go to a private school. Like there's no nurse's office. So when I get low, I would tell my teacher and have a juice box. But if I get like really low, I'd tell my T shirt I'd sit down or something like that. But there's no nurse's office. So that means like I can't I just do it on my own. I don't have pretty I mean, except for my teacher. She's just there to make sure I don't pass out and start having seizures. You have a phone? Yes, yes, sir. I

Scott Benner 18:33
do have a phone. Do you ever communicate with your mom during these times?

Tommy 18:37
Yeah. So it's, it seems weird to take out your phone during class and just start texting your mom. So I got a we got recently just got an Apple Watch. So um, I would just go on my Apple Watch and text my mom. I'm like, Hey, I'm low. Um, I took a juice box and blah, blah, blah. So she didn't get scared or nervous. Cool.

Scott Benner 19:00
That's really good. Yeah. And by the way, I mean, I know you don't want to take your phone out in class a lot. And you probably you know, you shouldn't always have it out. But if you need it for your diabetes stuff, don't feel worried about that. That's just that's what it's for. You know, so now listen, you said you live out in the country? How far out in the country? Like if you needed an ambulance with a cow come get you or would it be a car? How would it be like where are you?

Tommy 19:21
Um, so we recently just moved, we lived we lived like on a farm kind of we live we lived on 30 acres and then like 100 acres was private land. So I just ride my dirt bike, like the round. So we had chickens and stuff like that. Um, and then now we now we move to a place it's like 15 acres in like 158 acres private land. Um, so it's not a lot of land but it's like they live like so if you pull up a map of Charl South Carolina, Charleston You would see Charleston, and then you'd see James Island. And then there's this tiny island across, it's called the wall and blah, blah, blah is a hard word to say. But it sounds like it sounds like a watermelon. Um, so we live kind of far out on watermark. And so, um, we like, it would be a 30 minute drive or a 25 minute drive to school. Um, and then to the nearest hospital, it'd be maybe an hour.

Scott Benner 20:32
Okay. How do you spell the island's name?

Tommy 20:37
Who AWA de ma LAW.

Scott Benner 20:44
I found it. I'm looking on a map right now. Because I want to see what you're talking about. Yeah.

Tommy 20:50
That's cool. Yeah, so it's, it's just this tiny island.

Scott Benner 20:55
It would take me 11 hours and 15 minutes to drive to

Unknown Speaker 21:00
just LA.

Scott Benner 21:01
And so you're really close to the water to do you go to the beach a lot.

Tommy 21:05
Yeah, well, there's not really a beach. But um, we live on the water. So um, we live in a place that

Scott Benner 21:14
like, like, it's an inlet, like, like, what are the leads to the ocean?

Tommy 21:18
Yeah, so we had our front yard and then there's just big draw. There's kind of not a big drop, but like, maybe a five, five foot drop on down to the water. And then there's just trees hanging over the water, which is pretty cool.

Scott Benner 21:33
There's a lot of green around where you just told me. That's really cool. That's cool. So you today. So I have to ask you something, Tommy. Because this sounds crazy. And you don't have to tell me if you don't want to. But you're 11 years old. And you sound incredibly smart. And you're doing such a good job with your with your diabetes and talking to me that I can't imagine that you got held back in school. Did you? Oh,

Tommy 21:59
sorry. Um, I, I have dyslexia I have um, so I just don't have it. So dyslexia is like something with Word. So I um, so say you guys hear we're like people without diabetes. I mean, not hold on to the word.

Scott Benner 22:20
Don't worry. That was good.

Tommy 22:21
dyslexia. I'm there. So you'd, you'd be like, Oh, my teacher just taught me how to spell. Cow. I'd be like, okay, EAWCBO W.

Scott Benner 22:38
I gotcha. So it just so you just need to you just need to like a little more time. Like you didn't get held back like you couldn't. You couldn't add or subtract or figure out who Magellan was you were just you need a little more time to do what you needed to do. That's understandable, man. It really isn't. How are things going with that?

Tommy 22:57
Oh, it's honestly really difficult. It's not really difficult, but it's like difficult because I sometimes I forget how to spell. I'm, like, where or when I yeah, when I took someone I always say, I'm like, I'm, like, been bn? I don't spell b e and

Scott Benner 23:19
gotcha. Listen, I'm 47. And I'm misspell about 20 words like that all the time. So I won't even embarrass myself with the amount of words I can't spell. I think you're doing great. Can I ask you a question? And if it's a weird question, and you don't like it, you don't have to answer it. Okay. But if I if you were walking out on that beach, right, you follow the water down to the ocean, you went to the beach, you found a bottle on the beach, you rub it in a genie popped out of it. And he said, Tommy, I can take away your diabetes or your dyslexia. Which one would you pick?

Unknown Speaker 23:54
I'd pick my diabetes.

Scott Benner 23:55
Okay. Can you tell me why?

Tommy 23:58
Um, diabetes is a whole nother thing from dyslexia. Diabetes, you have a risk of like dying. dyslexia, it's just like, I mean, it's like, you can't spell a word. No biggie. But like,

Scott Benner 24:13
I hear what you're saying. He'd like to be alive and not be able to spell BB for being dead and be able to smell I got I think that's a quality answer. Very nice. I just was very interested in in what you might find. That's that's really cool. All right. So seriously, you're so you're on your way back from the endocrinologist right now recording a podcast about having diabetes. Yep. Just making a day of it, aren't you?

Unknown Speaker 24:39
Yeah, I got to skip school. So I'm happy.

Scott Benner 24:41
Hey, I'm with you. I won't even share with you how many days my senior year of high school I missed because it's embarrassing. And I think people would stop listening to the podcast if they knew. But I like having a day off to how's the weather there. I'm just gonna open up ardens Dexcom. Follow up here to see what our blood Pull up the six hour view last six hours. Arden's blood sugar is 93 right now it's stable. She got home a little early from school today. It's the end of the year they have half days, but she's still been studying for tests and doing homework, around four o'clock or blood sugar tried to get over 120 and we pushed it back down. And just prior to dinner at 6pm was 85. Now Arden's blood sugar is not been over 120 or under about 90 in the two hours since dinner, what do we have for dinner tonight, turkey breast, carrots, broccoli, mashed potatoes. Somewhere this afternoon, Arden had some snacks. I honestly don't remember what they were. But the information coming back from the Dexcom allowed us to make timely Pre-Bolus 's and adjustments to our dis blood sugar when necessary. So that heading into mealtimes, her blood sugar was where we expect it to be. And it made it easy to give her insulin for those meals. Now as the evening progresses, her blood sugar settling in nicely and getting ready for bed. Now with the dexcom g six, if her blood sugar tries to you know, get away from us here as bedtime comes, we'll be able to make some nice adjustments to get her back into range for needing food or something like that. Let's say she's drifting down a little bit, you know, we might trim back or basal insulin a little bit and get it to come back up again. I don't like Arden to have to eat things that she doesn't want to just because your blood sugar is going well. And with Dexcom, we can make decisions that'll stop that from happening, you can use the Dexcom link at Juicebox podcast.com. Or, of course right there in your podcast player, where you can just go to dexcom.com forward slash juice box, no matter how you get there, get there. These are our results. And yours may vary. But I believe that this six hour window is reflective of something that everyone can achieve. Especially when you have the dexcom g six continuous glucose monitor.

Tommy 27:02
Oh, it's actually really rainy today. But normally, it's always sunny. Like I, um, my, my great. My grandparents live in Minnesota. So it's like, it's like, um, it's rainy and sunny. But in the summertime, it's, it's pretty pretty. I really like it because of all the lakes. Um, I kind of like the cold, which is weird, say, um, but um, I just like how it snows there. And I'd like to move to Minnesota, honestly. But here, it's just like really, really a hot every single day. Like, even in the winter, like, the coldest it gets is like 40.

Scott Benner 27:45
I would like like, do the bugs bother you after a while the bugs would bother

Tommy 27:50
a living here for almost 12 years. It's like, not you like the bugs don't really bother you. Gotcha. Here you stood. But if you come here, like straightaway, yeah, you'd hate the bugs. It gets like I'm a big animal person. So I wouldn't kill a bug single bug.

Scott Benner 28:10
You sound like my wife describing being married to me. She's got used to it after a while so it doesn't bother as much anymore. I understand what you're saying. I'm looking right now. There are a lot of people listening to this podcast in Minnesota. And I know a few of them. So if you want to move live. No, no, no, no, no. We're recording it. Not as many listeners in South Carolina as Minnesota. So if you move there, you'll find more podcasts friends, I think. Yeah, yeah. But do you think so? Hey, are you said your grandparents so if your grandparents are in a Minnesota and you're in South Carolina, who moved Where did you guys move?

Tommy 28:46
So, um, this is gonna sound really boring. But my family my whole family. Like is really interesting. So my, my debt like, way back. I'm from my dad's parents. Um, I forgot his name, but it's like Thomas or some. He came from Czech Republic, okay. To hear. And he he I'm pretty sure he can't he got from. He came from Maryland. And then he moved up to Minnesota. And he started this thing called the tracks loose. And the tracks lawyers is a huge hunting company. Huge hunting company. I love hunting, but my dad asked me to go hunting. I wouldn't. I'd say it right away. So so then from there, I'm one of the girls married a guy and his name was Taka. And that's my last name. So that then that was my great grandma. Great Great Grandma. Great, grandma. I mean, well, they came from my dad that I'm what my dad My great grandfather, great grandfather, great grandfather, all those other things. And then my parents ended up moving there. And they came up with a banking company and a bunch of other companies. Um, and so then my grandfather, his name is Thomas taco, like my name. Um, and he, he is an investor. And he invest because other things like thing companies like a real estate investor, yeah. And then he passed that on to my dad, which my dad is now a real estate investor. And he invests in houses, like companies and buildings and stuff like that. That's pretty cool, Tom. So

Scott Benner 30:45
this was gonna be boring. But then you said it was gonna be interesting. I think you were right. When you said it was interesting. So your family immigrated up north, from the Czech from the Czech Republic, I guess is the right way to say. All right.

Unknown Speaker 30:57
Well, you know,

Scott Benner 30:57
did you hear like at the end of last year, we had an episode with a Lenin. She's from the Czech Republic.

Unknown Speaker 31:04
Oh, cool. Yeah, she

Scott Benner 31:05
was on she has type 120. So, so you're okay, so your Do you guys move down there? I get this. Let me ask some other more like child friendly questions. What's the last movie you saw? What movie? Are you excited to say?

Tommy 31:19
Ah, last movie I saw was maybe the Spider Man movie.

Unknown Speaker 31:25
Spider verse. Wow,

Tommy 31:27
that's really changed it up.

Scott Benner 31:30
Tommy, I love that movie. You and I now have something we can definitely talk about here. Hold on a second. So they, so they kind of followed the, like different. My comic book thing. So my son didn't like some of the things that I thought were really great. So really weird. And you found it strange.

Tommy 31:49
Yeah, they had Spider Man having electrical shooting webs and also invisible powers, which the original spider man just had a just had, like, able to shoot webs. And that's that, like, I was totally fine with that. But a spider that can shoot electrical webs and going visible.

Unknown Speaker 32:10
But why was too much

Unknown Speaker 32:11
for that?

Unknown Speaker 32:13
Yeah,

Scott Benner 32:13
yeah. How about when they like? Did you notice the colors in the movie sometimes separated from each other? Do you know why they did that?

Tommy 32:21
No, I don't really Did you notice? Oh, yeah. Okay, but I didn't really

Scott Benner 32:27
do you want to know, I'll tell you why. Yeah, I want to know. So back when they used to make comic books a long time ago, the printing presses weren't really as good as they are. Now the idea of printing wasn't good. So sometimes you know how they print. Like, they lay colors overtop of colors, how our printing press works till you get to the color at once. So sometimes you write to like old inkjet printers still do that. Like they lay down the yellow and the black and like all these colors, and then you're like, well, it's purple. So what would happen was while they were doing that printing process on the comic books, the books would move. So you'd see like, the bands of other colors, like bleeding out from the actual color. So they so they reproduce that in the movie on purpose to give it like a comic book feeling sometimes. Oh, cool. And then need there's Yeah, there's a lot of cool stuff in that in that movie, actually.

Tommy 33:16
Right now I'm taking a huge animation class. Um, and well, not right now. I just finished it. And I I became white. I was I was pretty good in it. And my teacher, like, I was not not to like brag or anything, but I was like a straight A student in that class.

Scott Benner 33:34
And what kind of anime or do you Is that something you might be interested in doing when you get older?

Unknown Speaker 33:38
Yeah, maybe?

Scott Benner 33:39
How do you Are you good? Can you draw or like, my Arden likes design clothes, but she can't draw.

Tommy 33:46
So there is there's, um, there's traditional animation, which is like the flip books and stuff like that. And then there's computer animation, which is like the ones that they're doing right now. Um, with, um, like, with, like, on computers, like explains itself. And then there's, um, claymation, which I study down a lot. And you make you make these fingers of the clay and you take a picture, then you move them then you take a picture. So long process, but when it ends up when it ends up, it looks really cool. And then you can also add green screens and music and stuff like that to the videos, which was really interesting to me.

Scott Benner 34:28
Okay, so do you. What do you have a favorite claymation movie?

Tommy 34:35
Chicken one is claymation which is pretty good. It's one of the most recent. Um, I bet I bet your kids I've seen that.

Scott Benner 34:46
Trust me, so if I

Tommy 34:50
Yeah, um, but there's not claymation I don't know it's, I wouldn't like to say it's fine, but there's just not a lot happening. anymore, but the most popular one is computer animation, obviously.

Scott Benner 35:04
Yeah, well, there's a company that's still making movies like the ones you're talking about. Maybe you've seen some of them. So have you seen kubu and the Two Strings?

Tommy 35:14
Yeah, that one's really good. That's

Scott Benner 35:17
right. I really enjoyed that one. Mm hmm. And but else that comes about paranorman.

Tommy 35:23
I've never known and also, um, this is Halloween. Like I for Halloween is one.

Scott Benner 35:30
Are you talking about?

Unknown Speaker 35:32
Yeah. Christmas. Yeah,

Scott Benner 35:34
that one is great. I just want I just saw the Nightmare Before Christmas back at the holidays. In a theater, and instead of the music to the, to the dialogue from the movie came from the projector. But all of the music was done by a live orchestra.

Tommy 35:54
Yeah, I heard that. And then, yeah, that's, that's what they used to do. In the olden days. They used to, um, it was always it was always a they'd make their claim nations and then they'd do a live orchestra and add it to the background of the movie.

Scott Benner 36:12
And live like so it was really cool. So there's a new one coming out soon. But paranorman is Kelly's favorite my wife loves loves paranorman. From that, that production company, what is it called La? I'm trying to think of the name of the production company. I'll think of it in a second. But they have just, they they really it's Laika like la ik A. So they have a new they have a new movie coming out soon. With Hugh Jackman. called missing link. But my wife loves paranorman and Coraline. JVC Coraline. Oh,

Tommy 36:50
yeah, Coraline, I was just about to say that

Scott Benner 36:52
right in that cool now you know which one I I saw in the theater, but didn't like but I want to go back and try it again. Because I'm not sure if I was in a bad mood that day. But have you seen the boxtrolls?

Tommy 37:01
Oh, yeah, that one that one. Did you like it was a good movie, but it was just like, it was weird to come up with that theme of them making little kids that have boxtrolls and stuff like that.

Scott Benner 37:15
Yeah, I wasn't sure where I stood on that one. I'm gonna watch it one more time to know. But I'm gonna tell you right now that I think that spider man into the spider verse is one of the best movies I saw last year. Yeah, that's what I was really good. So I've already seen it a couple of times. Like I watch it up in the corner of my computer when I'm editing the podcast and stuff like that. So I really do. Okay, so we've covered movies. That's pretty cool. And you you like animation? Are you thinking about doing this? I mean, I know you're young. It's weird to ask you when you're 11 what you want to do when you grow up? But is that something you really think about?

Tommy 37:46
Oh, maybe? Oh, by now, I don't really know. You can

Scott Benner 37:51
always invest in real estate sounds like that. Working out for Paul. Is that, I think? Um, yeah,

Unknown Speaker 37:57
I think it's

Scott Benner 38:00
Let's pay in the bills, though. Right? You've got like shoes and a car and stuff. So it must be working out pretty well. You fix up? Yeah, yeah. Who? So? I guess your dad does that. But who has more involvement with your diabetes with you? Is

Tommy 38:14
it your mom? It's my mom. Definitely my mom.

Scott Benner 38:18
How does that work out? Like, how many times in a day? Do you actually go up to her and say, Hey, I need help with this?

Tommy 38:27
Most likely, probably once but I don't really I always her, it's always her. Tommy, do you have this? Oh, okay, Tommy, you okay?

Scott Benner 38:40
Miami pod.com, forward slash juicebox. That's where you're gonna go to find out about the insulin pump that Arden has been wearing for over a decade, the Omni pod. When you get to the link, you're gonna ask for a pod experience kit, you're gonna get a pack, you fill out a little bit of information, they're gonna send you an absolutely free demonstration pod that you can wear at home. And really, that's the best way you're going to be able to tell what you think of the Omni pod, you're gonna be able to see it. Hold it your hands, and where you'll be able to put it on your child. Take a moment to step back and say you know what? This isn't bad. I was scared to put something on the maybe with you know, tubes and all this stuff attached to them, but the only pods not like that. It's tubeless it's worth the try. Take a look. Miami pod.com forward slash juicebox. I cannot. I just can't I don't know how to say it enough. The Omni pod is a staple in our life every day for over a decade Arden's been wearing it on the pod. This pump offers freedom in so many different ways. The freedom to adjust your basal rates up and down to extend out your boluses to bathe without disconnecting. These things are possibly something that if you don't have the Omni pod You can't imagine, but they're wonderful. They're life changing. They allow a adjustments that just make all the difference. And if you're skeptical because you're thinking, yeah, I mean, Scott, you're being paid to say this. Okay, fair enough. But you can still get the demo for free and decide for yourself. Miami pod.com forward slash juicebox. Give it a try today. There is nothing to lose. There's 100% no obligation.

Tommy 40:25
It's always her. Tommy, do you have this? Oh, okay, Tommy, you okay?

Scott Benner 40:30
She's worried about you. And Sheila, it said, you said earlier, right? It's something you probably should worry about a little bit. So that's nice. Listen, trust me on this topic. You would rather have your mom be involved with this, then not be involved with it. So you do tell her sometimes like, Hey, I don't want I got it here. I'm okay. Or, oh,

Tommy 40:51
I usually I don't, I don't really want to say that. Because I'm, I know that if I if I say that I might hurt her feelings or something like that. But I always need your help. There's nothing I can do without her help. So she's always out. She's always looking up to me. And it will she's not looking up to me. But I'm always looking up to her. And she's always very helpful and kind of got my diabetes. And she doesn't give me any things that stressed me out. Which is, that's what I love about her.

Scott Benner 41:19
Yeah, that's beautiful, man. That's exactly what she should be doing. She's letting you figure it out and helping you when you need help. I think that's really cool. It really is. And she gives you a lot of trust, which I bet is nice. Right?

Unknown Speaker 41:32
She does. Good for you.

Scott Benner 41:34
That's very cool. I, I can't tell you that I hear stories about other people. And some of their stories aren't as good as yours. So there's plenty of people listening who are older now. And they'll think by wish my mom was more involved when I was younger, or gave me space when I needed space and everything. And I think it's really amazing that you're so involved in it. Can I ask you Do you ever get sad about having diabetes?

Tommy 41:58
Sometimes I there's always ups and downs to having diabetes, there's always something that will pull you down, there's always something that will just let you up a little bit. There's always someone out there that will be like, Hey, you got this. You You can get through this. But diabetes can be tough for some people and diabetes can just die. I mean, the thing I try to do is just I you have to always remember about diabetes, because it's life or death situation. But diabetes, I just if I could I just feel like, hey, just leave me alone just by. But right now, right now there is some there's some things that I don't like about diabetes, which is like, you have to give yourself shots you have to worry about. It's just sometimes it's not the best but diabetes. Diabetes,

Scott Benner 42:55
yeah. Push that. I hear what you're saying. So it kind of is what it is. There's not a lot you can do about it. Sometimes stuff happens, they, you know, kind of lifts you up. And sometimes there's stuff that knocks you down, but you know, you can do it. You just sort of keep going right? Yeah, that's excellent. Man. That really is that is an absolutely great attitude to have, because it isn't going to be wonderful every day. And there are going to be days that are harder than others. But that's your situation and you need to make the best of it. Because it's not going to change right? Like it's not like you can't wish it away right there is no real Genie on the beach. It's going to come by and ask if you want to get rid of it. You know, so you just you just do the best you can it sounds like you're doing really fantastic I mean I'm completely impressed with your a one season your variability it's it's stunning. I mean, you're 11 you've only had it for a year you're really doing a great job What if I'm, if I asked you to give other people advice about how to keep their blood sugar's you know, where they want them to be. What do you think the the most? The most best? I almost said, say, Tommy, I'm trying. What do you think the best advice would be?

Tommy 44:02
So I hear what you're saying. But first of all, I I I always I always, always, always. I'm trying to get the word out there and I'm trying I'm trying so hard to um, help people with newly diagnosed diabetes, just like just giving them advice and stuff like that. So this is a perfect question asked me Okay. Um, like, like, so if you newly just got diagnosed with diabetes, there's, there's no, there's no wrong answer to diabetes. Like, if diabetes. If, if you think diabetes, the worst thing that could ever happen to you. It's, it's really not theirs. Diabetes is just another one of those things that it's just like, it's bad. It's not that bad, but you can push through it and you can always stay active with your diabetes and give yourself Give yourself the ups and downs. Like what I said, like what I said, like, you can always you can always just be the happiest about diabetes, but then there's some times that you can be diabetes, the worst, I hate diabetes, nothing else is gonna happen better to me. But you know what? That could be true. And but then the other thing you just said, diabetes, the best could be true too. There's no wrong answer to diabetes.

Scott Benner 45:29
So what's one good thing that's happened to you because of it,

Tommy 45:33
I mean, a lot you get, you get a lot of attention, you get a lot of attention. And then you also some things like you get, like, right now I'm skipping school because I kid to do diabetes. And then you get juice boxes, like sugar when you're low, like. And then I recently decided my diversity, um, diversity is your, like, when you got when you just got born, like, it's like a happy birthday, but for diabetes. Um, and then. So like, I recently just had it and it's like a second birthday. So you get two birthdays in one year. Congratulations.

Scott Benner 46:16
So Tommy, you're telling me that I get if I have diabetes, the way I can be thinking about it is I get an extra birthday every year, I get to skip days of work or school to go to the doctor. Right? People like around me and care. I can tell people care for me. And I see the love that other people have for me that I might not get to see in other situations. And I get snacks. Yeah, yeah, you've made it sound pretty good. You really have and, and tell people that it's not as bad as it seems. And you know, you just have to, you just have to keep going. I hear that. Okay, well, so where do you try to help people you said, it's important for you to try to help people in that you're trying really hard. What do you do that?

Tommy 46:55
I recently just started a social media page on Instagram. And I'm almost 200 followers in like, less than a week, which is amazing. I didn't, I didn't realize that I get this much. Um, and so I reached out to people with type one diabetes, saying, I haven't actually right here. So I say, um, I said, Hey, I'm a diabetic with the dream, blah, blah, barely pull it over here. I say, um, hey, so I'm a diabetic with a dream. And I, I dream, that one day, one day, diabetes will be no more. So I, I reach out to people saying, saying I asked them for a photo with their, and also with their glucose monitor and pumps, and stuff like that. And then what's what's you're able to see? And like, when did you get diagnosed? How long have you had diabetes for and then if you hear, I'll tell you what my Instagram pages, it's p, e, one D, all lowercase underscore power. Um, right now we're in at 797 followers, and I post things. My most recent post is of this boy of this boy named Dalton. And he is he's age seven. He was diagnosed of at 20 months old on on, on the 20 22nd of April. It will be six years now. And he he has a pump in GMC. I mean to CGM and he's been very confident with this type one diabetes. So I make people without Type One Diabetes more, like have more aware awareness what type one diabetes is. So um, so we can get the word out there that type B Type One Diabetes isn't just a disease. It's like a cool thing that other people have that. That's amazing. And you should you should like you should tell people about it. Tommy I'm

Scott Benner 49:05
looking at your page now. So you so I see what you're doing. You're having you're having other people with type one kind of share their pictures on your page and you're telling their story and everything and just trying to raise awareness for all these people. Is this you in the picture? At the waterfall?

Tommy 49:22
up the waterfall? Yes. That is me like a year ago?

Scott Benner 49:25
Yeah, go see. Yeah, I gotcha. All right. So listen, I want everyone listening who's on Instagram. Please go check out Tommy on Instagram. He's T one D underscore power. And give him a give him a follow. Say hello. All

Tommy 49:39
right. 98 followers right now. So

Scott Benner 49:40
good for you, man. That's really cool. I gotta tell you that stuff takes a long time to build up if you do it the right way. And it means more. If you if you do it the right way you don't like just try to get like clicks and likes out of you know, anything you can but but you're really trying to do something thing and I think that will, that will end up working out for you it really well. And I'm going to I'll share your, I'll share your stuff on my, on mine as well. I'm not the greatest at social media, I'm a little better at this podcast and I am a social media,

Unknown Speaker 50:13
now you're doing great.

Scott Benner 50:19
I have no idea why it's coming through my phone. And in my headphones, that sucks. I appreciate that. I, I appreciate that very much. I'm trying really hard to do just like what you're talking about. Like, I feel like I've found some ideas that would help people keep their blood sugar in the range that they're hoping for, give them some freedom that they might feel like they don't have, and I'm doing my best to spread the word about it. So I really appreciate what you're doing. I know how hard it is.

Tommy 50:48
Yeah. And I I really appreciate what you're doing to on with the, with the podcast and social media. It's just it. It's from my hopes up, like 100% like I feel great with diabetes a lot because because of what you did, and I really appreciate how how you've handled like with your podcasts and social media.

Scott Benner 51:13
Thank you. That is really kind of you. I think that's a it was very sweet of you to say thank you so much. I I am hoping that it continues to grow. It really is. And, and I'm hoping to reach more and more people. And you know, I say sometimes I get nice notes from people about how well they're doing. And they'll tell me that, you know, it has something to do with the podcast. And I just think that's amazing. I wish I could reach more people. And I just keep trying. So I can tell you that this past month, just ended. March just ended. It was the most downloaded month in the history of the podcast, just like the month before and the month before the month before. I think I'm up to like 18 months in a row where each month does better than the last one. And this in March, I had, I think 71% more downloads than I had in December and the ones I had in December. We're pretty amazing. So it's it's really going well. Yeah, I bet your your Instagram page will take off like that as well.

Unknown Speaker 52:15
Yeah, absolutely, man.

Scott Benner 52:16
All right, Tommy, I'm gonna let you go because you've got to get the rest of your day going here. He took off this whole day you need to do something cool. Please thank your mom for letting you Come on. And I will I will let you know as soon as this is gonna be on the podcast. Okay.

Tommy 52:32
Okay, you can you can either DM me or

Scott Benner 52:36
Thank you or not? I will I absolutely well might it might take it might take a couple months, but I absolutely will have it on Okay. Okay. All right. Keep in touch Tommy. All right.

Unknown Speaker 52:45
Okay, bye bye.

Unknown Speaker 52:50
What a nice kid.

Scott Benner 52:53
That's a first for us Tommy having a conversation while riding in the car coming home from his endo appointment. It's about the most diabetes meta thing you could imagine right? On a diabetes podcast on your way home from your endo. Thank you so much Tommy for being interested in being on the podcast and to his family for allowing him to come on please don't forget to check out his Instagram. Thank you also have Dexcom on the pod and dancing for diabetes, you're good at dancing the number four diabetes.com my omnipod.com forward slash juice box or dexcom.com forward slash juice box. If you can't remember any of that. Those links are actually in your show notes right there in your podcast player or at Juicebox podcast.com. Keep your eyes open later this week, we're going to start a little bonus episode. We'll just be a few minutes long. It'll be Jenny Smith and I defining simple diabetes terms. You'd be surprised how many times I get notes from people who asked me What does Basal mean? What's an extended bolus. I don't understand what ketones are. Somewhere here I have a absolutely delightful note from someone who said I was doing MDI for six months before I knew it was called MDI. So some diabetes definitions coming your way. You'll see them start appearing your podcast feed this Friday, and they should go on every Friday, you know, till I run out of definitions. If you have a definition suggestion, send it to me. Anyway. You can I don't care, Facebook, Instagram messaging, email, through the blog, whatever you want to do. If you have a phrase or word or diabetes idea that you'd like to find, send it in Jenny and I'll see what we can do.

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