#264 Bolusing Keto
Fat and Protein needs Insulin…
Vickie has type 1 diabetes and eats Keto. She's on the show to talk us through her Keto bolus practices. That's right, fat and protein need insulin too. This episode should be listened to in conjunction with episode 263, Diabetes Pro Tip: Fat and Protein.
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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 264 of the Juicebox Podcast. Today's show is sponsored by Omni pod Dexcom. And dancing for diabetes, you can go to dexcom.com forward slash juice box, my omnipod.com forward slash juice box or dancing the number four diabetes.com. Vicki is a returning guest and she's here today for one specific reason to talk about how she boluses for a keto diet. Oh, what's that? Mm hmm. You have to Bolus for protein and fat? Uh huh. Consider this one, a beautiful standalone. It's just a short conversation about how to Bolus for a specific meal timing and a little bit of the details around it, or, and this is how I think of it. It's an extension of the diabetes pro tip episode, Episode 263. Just the one before this. So if you haven't heard to 63 my opinion, you listen to that one first, then this one. But listen, I'm not your mom. I'm not here to tell you what to do. You handle it any way you want. Just know in my mind, they're sort of the same episode, they could have been together, but the other one was a pro tip. And I want to keep that series just me and Jenny. 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.
You know what episodes you were on before? Do you know the number of it by any chance?
Vickie McWatters 1:50
I want to say 191 one something like that? I don't know is my second we should finish the sentence or something like that. I don't know why you need it that way. Excellent. Yeah, cuz that
Scott Benner 2:01
Yeah, no one knows why any 191 is shame cycle so that I know that wasn't you. So hold on a second, all second.
Vickie McWatters 2:12
171
Scott Benner 2:13
we should finish the sentence Episode 171. And it says it says no, not platypus platitudes. Look at that Vicki and Scott, discuss everything you can think of. And two things that you can't about type one diabetes, no more platitudes finished the sentence. All right. Well, I don't remember either, but I bet you people should go listen to it. But But I'm having you back today. And let's give people a tiny bit of context, Vicki, since you've been on the show, I have visited your home state and spoken at your jdrf conference because you are actually an employee of that chapter. That's right. Which I was really grateful for. It was very thrilling. And second biggest crowd I've ever spoken to in my life. Very cool. I didn't mean to judge you by not just saying the biggest crowd. But the truth is that it was the second biggest, had a wonderful time met a lot of great people that I see online today, almost every day, listen to the podcast, and everything was really a wonderful experience. But while I was out there, you had to pick me up from the airport. So for all you people who think like, you know, you roll up at the airport, jump off the private plane, the jdrf sends a stretch limo. It's not what happens, Vicki rolls up and she's like, get in buddy, you know, like I get sort of like that. So on the way back to drop me off at my hotel, we stopped and got food. And he ate that day, what I would consider to be almost no carb or very, very low carb. And we sat down and she ate her food. We talked and I don't know how long we were there. I imagine it felt like it was a half an hour maybe. And we got back in the car. And we're driving. And then we're stopped at a traffic light and Vicki whips out our PDM from her Omni pod and starts giving herself insulin and I was mesmerized like wow, what is happening here. And she said I have the Bolus for the protein rise, which I was gobsmacked. I was like that's brilliant. And she put in insulin. And I never heard or CGM after that and, and it was pretty crazy. So while I don't subscribe to a low carb diet and Arden doesn't a lot of people who listen to podcasts do and the other day someone said to me, I don't know how to Bolus for these. You know, for the situations I'm trying to eat lower carb or I forget what they said if it was keto, I don't know like all those words don't mean a lot to me, but I the idea of not having a lot of carbs. Right. And I thought I am going to have Vicki come on and explain how she boluses her meals. And now here you are.
Vickie McWatters 4:48
Here I am. Thank you, Scott. Thank you. exciting to be back.
Scott Benner 4:52
I can only imagine how excited you must be. It's got to be overwhelming. Really the just the joy you're probably vibrating. Vicki and I now know each other, so please do not cast could go way off the rails. Let's go through it first, what do you how do you characterize the way you eat?
Vickie McWatters 5:10
Well, I think it's been a learning experience over the last two and a half years. So I was doing low carb off and on prior to that, and within the last two and a half years, I would say I'm more keto. But I don't really subscribe to the fact that I label myself keto. I love this new craze. I love the new food options that are out there. But I do it because I love the blood sugar control that it gives me.
Scott Benner 5:36
You're saying keto not Cato, not Green Hornet sidekick from the 50s or 60s television show right
Vickie McWatters 5:42
now. I don't even know what you're talking about. Are you serious?
Scott Benner 5:43
Oh, unbelievable. You know you very closely just gonna make this episode called keto. Or keto not keto or something like that. I hope you know that. Just by not you don't know the Green Hornet. And now, Vicki, that's a different thing. Now I guess we have to get past that and keep moving. So sorry. All right. So explain to me what keto means because I definitely don't know.
Vickie McWatters 6:06
The idea of keto is to switch your body from burning glucose for energy to burning ketones for energy. And that's where the keto diet came from. So you don't do sugar, you don't do complex carbohydrates, you really cut back on even the fruit that you eat. So the idea is to eliminate the glucose so that your body burns ketones,
Scott Benner 6:33
okay? And so ketones aren't something that I have in this fat on my stomach, right? It's, it's an I wasn't, I didn't have like a reserve of it I wasn't using and now I've gotten rid of all my glucose. So it's like, hey, this, but it really does. I don't know another way to say it, but it just cuts the fat off of a person like you are incredibly lean. If you're doing a keto diet, and it's really working for you. Is that right?
Vickie McWatters 6:58
Yes, I mean, there are exceptions, for sure. But I think that for the most part, what happens is if your body stops burning glucose, it starts using the fat in your body as energy. And that's where the fat starts to just kind of dissolve on a keto diet.
Scott Benner 7:13
Gotcha. Now, we're getting off track here, but I have to understand something and maybe you don't know. And we should be clear that Vicki's not a doctor. She's a person who picks up people like me at the airport, and other things, right. But, but what if I, what if I go keto, and all the fat, my body disappears? What do I do the next day? Like now you're saying my energy comes from ketones, so my body, so it's funny, because people who have Type One Diabetes here, ketones, they think, oh, ketones bad, because when you don't have enough insulin, your body also produces ketones in it. So what's the difference between ketones that I get if I don't use my insulin correctly, and ketones I get if I eat with this diet, because they can't be the same thing, obviously.
Vickie McWatters 7:56
Right. So like you said, Scott, I'm not a doctor. So I'm going to explain it the way I understand it. ketones, your body burns ketones, even when you're in a fasted state, when you may be sleeping for eight hours, if you ran out of glucose in your body needs a little bit more energy, it can start burning ketones, so you could theoretically be passing ketones when you wake up in the morning. ketoacidosis is lack of insulin. So when your body doesn't have enough insulin, and it starts spilling ketones, that's where it becomes dangerous for a diabetic. And there's a lot of further explanation that I don't quite understand either. But that's kind of how I separate in my head. All I'm trying to do is is just help you understand my experience. And what I found because again, I've been doing this for two and a half years. And again, like you said, there are so many opinions out there. I personally am not necessarily wanting to say every diabetic has to eat this way, I would actually go as far to say I think every person should be eating this way. Because the way it makes you feel it's just so much better. You have so much more energy, you don't have the bloating that you do when you eat a big meal. Even if I eat a big meal because I don't eat all the carbohydrates. I feel better. So I would go as far as to say, I think everybody should be eating this way.
Scott Benner 9:21
Okay, so that that is I think that's incredibly valid. I have done a low carb diet in the past. And I can't argue with anything you just said. I lost weight. I wasn't as bloated. I felt better. I had more energy. I didn't get oddly tired at weird times the day for no reason. Just there's you know, there's no way around it. That is exactly what happened to me. I also, you know, I don't know, I don't know, like, I don't know if I could do it forever. There was a moment six months into it where I just thought to myself, I can't eat this food anymore. You know, like it just felt like I needed more variety. Now I understand it's a different world. I'm probably talking about my Uh, gosh, I'm probably talking about 20 years ago. Right? You know, and now there are like, you know, there are companies making great foods that, you know, mimic what you're accustomed to and, and do a really good job of it. So
Vickie McWatters 10:12
yeah and great ingredients now like almond flour instead of regular flour so I can make desserts, you know. So there's there's a lot of options out there right now
Scott Benner 10:20
I hear people say almond flour a lot. I don't know what they're talking about. I just like look at the almond. And I think how they get into the flour. But then again, when I look at them, and I hear about almond milk, I think there are no nipples on almonds. I maybe just don't understand. Anyway. Okay, so let's put us in a real world situation. Why don't we take us back to that moment that you and I were together? You had a mixture of food? I feel I feel like you had greens, I think you ate a burger outside of a role. Like some other stuff? I don't know exactly. I don't remember anymore. If you remember, that'd be great. But if not, just tell him walk me through a meal. Like how do you do this?
Vickie McWatters 10:55
I do remember, I remember I had just hamburger, I think it had bacon on it. And I think you're right, it had maybe some lettuce and tomato, and I did not eat the bun. Um, that meal for me, is obviously a lot of protein, very little vegetable. So that's something that I need to plan for the protein spike, and the protein spike for me is, is longer, it takes a while for that protein to actually break down into glucose. So it takes a while longer for it to start acting. So I want to put the insulin in. I don't Pre-Bolus for that meal. So I want to put the insulin in after I've already eaten. And when I know that that protein, maybe start turning into glucose.
Scott Benner 11:50
Okay, do you know? Can you put into words the idea of protein turning into glucose? Like what do you like? What's your understanding of what happens?
Vickie McWatters 12:02
I think the lack of glucose in my body means that my body still needs glucose to function. That's my understanding. And when it doesn't have it from the food that you take in, it will turn the protein into the glucose that you need. So that's my understanding of how it works. gluco Genesis I believe something like that, and your body really does take care of itself as far as making what it needs from the foods that you eat.
Scott Benner 12:34
Okay, so yeah, I mean, what you just described is sort of amazing. It's not as amazing as making a baby or something like that. But it's so pretty amazing that your body can do things like that, like just say, hey, I need glucose. Here are the ingredients I have. Right? Maybe I was watching a cooking show the other day on Netflix, by the way, in case anybody likes, it's from john fabro. If you ever saw the movie chef, which is a great, just little underserve movie, that's fantastic. And so he's doing this Netflix special with the cook, who taught him how to cook for to be in the movie. And they're going to do all these wonderful things. And they got to this place the other day, and they just made lunch out of what was there. And it made me think of what you just said, like, your body's like, Alright, here are the ingredients I have, I need to get glucose and and I'll turn this protein into glucose. It's kind of fascinating, you know? And so is it the same every time like, like, can you set a clock to it? Like, do you eat and go, Hey, in 40 minutes, I have to Bolus or does it not that simple.
Vickie McWatters 13:35
So I would say I would even maybe even back up a second. Because I think what's important for everyone to understand is and why I reached out to you in the first place because one of the questions that you asked me was, I don't, I don't know, low carb Arden doesn't eat low carb, why are you Why are you contacting me? Why do you listen to the Juicebox Podcast. And I still use all the methodology that you talk about on the podcast. And I still use all the tips and all the tricks. The only one that I've modified is really timing. When I Bolus and when I give myself insulin, and it truly is a learning experience with the help of the dexcom. So if I didn't have the dexcom, I wouldn't be able to see that I need that insulin 30 minutes later than I actually do. And it is an experiment. You do have to figure out what works for you. But it's I don't feel like it's that much different than figuring out how to eat pancakes. Right? It's your job. It's sort of the same thing as figuring out your Pre-Bolus time you ate exactly to see when how when your blood sugar starts going up and instead of putting in insulin and waiting to see when your blood sugar starts going down. You just have to figure out that timing
Scott Benner 14:49
do anyone else? I mean, you must know other people and like I'm assuming of like a witch's coven of keto eaters or something like that friends or something but but Are there lead times different than yours? Or do you know?
Vickie McWatters 15:03
Yeah, absolutely. Actually, one of my little tips for everyone that I would like to leave with them is I follow a friend of mine who eats very similar as I do, Julie, Julie's a big fan of yours, too.
Scott Benner 15:17
I think a second. Thanks for listening, Julie, tell a friend, appreciate it, maybe leave a rating and a review on iTunes, and I'm sorry. Okay. Joy, joy, appreciate you listening. Thank you.
Vickie McWatters 15:28
So we follow each other's Dexcom. And it's been really valuable to me, I've never followed anyone before. So it's been really valuable to me to see, like some of the trends that she has, and will share with one another up, I just ate this meal. And I just missed it. And here's what I've done. And we are both very different in how we how we manage things, even though we go about kind of the same eating habits, we have the same goals set for our blood sugar. And yet, we still manage it differently my lead times different than hers, if she does have a meal where she decides to eat carbs, because Yes, we do. I'm sorry. I do occasionally. I just this is a lifestyle. For me, I do it because I want amazing blood sugar control. And it's easier for me to eat this way. So if I decide I want to have chips and salsa, which is kind of my weakness, and tacos, I plan for it, I do Pre-Bolus. But I do in depth, hours later, having to really monitor and watch out for my blood sugar because I can spike even like four to five hours later. So I really have to keep an eye on that. And my Dexcom allows me to do that.
Scott Benner 16:54
Imagine if you were in the market for a new television or car, piece of furniture. And the company that you were thinking of buying from said do you don't even bother worrying about all this? Let us just send the car to your house. drive it for a few days. Let us know what you think. If you want to keep it, that's great. And if you don't, don't worry, just you know, no harm no foul. We don't mind. We're just happy to let you try it. Well, that's what Omni pod does with their insulin pump. Did you know that? Did you know that if you go to my Omni pod.com forward slash juice box, you can get a free, no obligation demo of the AMI pod sent directly to your house right now for doing nothing just filling in like the information they need to get it to you. On the pod calls that a pod experience kit. They'd be thrilled to send you one right now. This way you can try on the AMI pod and wearing or a loved one can try it. You can have the absolute experience of wearing it on the pod so that you can see how it would work in your life. And if you'd like to keep going with it on the pods happy to help you and if you don't, that's okay too. It's up to you. It's your choice. This is how it should be now you're not going to catch other in some punk companies sending out a free demo of their insulin pump. I mean how good they are. But ami Popkin Why? Because the Omni pod is a small, self contained device, right? There's no big gobs of tubing like spaghetti everywhere, just plastic tubing, up your nose and around your shirt and under your belt that doesn't exist with Omni pod on the pods, just this little cool thing. Try it out. Go to Miami pod.com forward slash juice box and try the free no obligation demo today. ardent has been using an omni pod for over 11 years, and I counted as one of the best decisions that we've ever made.
Vickie McWatters 18:44
Julia is not necessarily the same way. So it has been so insightful and so fun and just informative to be able to follow one another and help each other out. So if you guys know anyone that you could follow, it's it's been extremely beneficial. And
Scott Benner 19:03
I learned a lot from following other people's Dexcom. So I really do so. Um, I want my daughters texting me. I'm trying. Does that mean? Now Okay, I know what that means. Sorry. I didn't mean to jump out there. I saw attack sounds like Is there a problem? But there's not a problem. Your blood sugar's like 130 it's after lunch. We're doing great. Nice. So okay. Tips and Tricks, anything you would tell people who are trying to figure out how to so now most people listening to this or listening to the podcast. I've never done like a Gallup poll, but I'm assuming most people are eating carbs, but still see protein rises. So they sort of have two different things going on. They have the impact of those carbs and that glucose like right away, and then they have the rise they can get from protein later some people get some people don't it's more or you know, sometimes it can be more impactful, less etc. But what are if It's a person just doing keto, low carb, like you're talking about. Is is, is it that different? First of all low carb keto, like if I had if I eat a keto meal, or I had a carb meal with a carb meal with, like 20 carbs in it, do you see that big of a deal? You just talked about what you can see later. But what about in the moment?
Vickie McWatters 20:20
No, I think the difference between low carb and keto is your end result. So if your keto Your goal is to truly pass ketones, you burn ketones, so that you can potentially lose weight, use it for energy, use it for mind clarity. So if that's your goal, you'd usually stick to 20 grams of carb or less per day. And some people can fluctuate on that. But that's kind of a good rule of thumb. And to me, if you're low carb, you're just you're you may be eating under 100 grams of carbs a day, maybe less. But your end goal maybe isn't to be in ketosis. So that's where I see the difference, I just really go from meal to meal, I try to stay under 20 grams of carbs a day. But if I don't, I don't know myself over it. And I manage things with my Dexcom. If I'm eating a meal that has moderate protein, and maybe some vegetables, like a salad with chicken on it, I can sometimes get away with not bolusing at all. But depending on what that protein spike might do, I've got my alarm on my Dexcom set at 120. So if I get to 120, I can start paying attention to it and my rising have I just kind of peaked and my floating there at 120. If I am that's okay. But if I'm starting to really peak, then I'll go ahead and Bolus
Scott Benner 21:47
are those and I, I'm sorry, good.
Vickie McWatters 21:49
No. And I think the other thing that's important too, that I've learned from listening to the Juicebox Podcast and from you. And this was something that I really struggled with. Once I allowed myself not to count carbs anymore. It was like a whole new world opened up to me, it was like freedom. It was like I can just kind of guess. And then I'll guess. And if I don't get it right, then I'll make sure the next time I'll do it a little bit differently. And so if I was sitting here trying to calculate, I've seen some people online say, Okay, I'm having this many grams of protein. And I need about half the amount that I would for carbs. And so I'm going to give myself that that bolus and that may work really well for some people. I would have failed by now. If I had to do that, because I don't I don't want to have to do math. I love the way I do it. I have great results. And you given me permission. I know Don't let this go to your head. But you've given me permission not to count carbs has been like freedom.
Scott Benner 22:50
That sounds delightful.
Vickie McWatters 22:53
Julie will love that. Thank you.
Scott Benner 22:54
I said delightful just for Julie to see. I How did that go? Did I meet her and say that I was delightful to her face? Or where did that? No, she just asked and I
Unknown Speaker 23:07
yeah.
Scott Benner 23:08
All I'm trying to do if I'm being honest, is I'm really trying to bring back the word delightful. I just
Vickie McWatters 23:15
I think you're doing a good job.
Scott Benner 23:16
I want people to say the world but I don't know why I just it's one of the words I'm trying to get back into the everyday lexicon. And I'm and I think it's incredibly funny for me to call myself delightful. I really wish I could be in the car or in someone's kitchen while they're listening who is taking me seriously what I'm calling myself delightful, and they're like, what an egomaniac. I love that. I love those. I love those people. I really wish I could meet you because I think you just need to be around more sarcasm so that you understand it better. But it's really, I mean, the key let's not lie i i do think I'm pretty terrific. But
Unknown Speaker 23:55
yeah, let's face it.
Scott Benner 23:57
Do you think that just now when I said I do think I'm pretty terrific that people understood like the second level sarcasm there. I never know I really can't tell. And it's not your fault if you don't understand it. I'm I'm related to people who can't pick up my sarcasm at all. And there are times when I'm just like I should stop like I think they hate me. But it just delights me so much that I don't care.
Vickie McWatters 24:24
Well, I know you have some fans out there that really enjoy it when you say delightful stuff.
Scott Benner 24:29
I'm doing my best here. You know, I mean like I am trying to make diabetes entertaining. You ever try that? It's not that easy. No, it's not. I you know what? I'm gonna yell at everybody. That's second Vicki. You're making me upset. I am over here killing myself trying to make this this education. This is basically school I'm giving you here and I'm making it fun.
Unknown Speaker 24:50
You are making it funny. You
Scott Benner 24:51
gotta jump up on the line and call me names. It's not polite. Just don't listen, if you don't like it, like don't. By the way, if you stop listening still stay subscribed. So I get credit for this. Alright, which I knew this would go wrong. How? How is there anything I'm missing because I really don't know anything about this part of life, I really do want to make sure that we talk about everything that you find to be important around this. So that you can, so that we can, you know, kind of open it up and expand it for people who are interested. But it's but let me go for a second, just say, what I just heard you say, really made me happy. And I wish I wouldn't have just spent all that time saying delightful, because I would have said delighted me. But it's it's that because as I'm doing this podcast, I think in the back of my mind all the time, are people hearing this. It's timing and amount. The whole thing's about using the right amount of insulin at the right time. There's really no more to it than that. And it's an oversimplification at the same time, it's actually a very focused statement. And then you came on, I didn't know what you were going to say. And I feel like that's pretty much what you just said. So yeah, I was really right.
Vickie McWatters 26:05
Well, you know, I still use like, I'm still bold with insulin, there are times that if my blood sugar is a stubborn high, and I, I'm just piecemealing it, and I'm trying to be nice, and I'm just giving myself a little bit, a dose here and there fine. I just have to like rage bullets and give myself enough insulin to I can bring it back down. I can always correct. So bold with insulin is huge. I've been following that ever since I've been listening to you trust what you know to happen will happen. I mean, even with low carb, if you've been eating the same meal, and you know that you're going to go high in three hours time because that protein is going to spike you then then do the bolus later or extend the bolus or you know, do none up front and do all of it later. If you have to Bolus now, because you may forget, in 30 minutes, I do that strategy a lot, where I'll go ahead and put a Bolus in that I won't have it start until 30 minutes or an hour later. And then the one that's huge is using your Dexcom. And setting your parameters. If I were to be at, you know, 80 and 200, it would be too late, I wouldn't be able to catch it. So I've got it set at 70 to 120. And if my alarm goes off at 120, then I know I've got to pay attention. And do I need a little bit more influence? Do I need to Bolus or am I just gonna kind of coast and trend back down? So everything that you've been talking about applies to low carb too. It's just the timing is different.
Scott Benner 27:39
Yeah, in many ways, if not almost all of them. It's exactly the same. And like you're saying, besides the timing, and I would probably ask one more question. Is it also impact? Like because you're not eating things with the same glycemic load? Probably do spikes not happen as quickly when they happen? Or do they still?
Vickie McWatters 27:59
No, they don't happen as quickly. And and if I'm eating, like I said, if I'm eating fiber, if I'm eating a big salad if I'm eating more fat, the time that you and I had lunch together, I was basically protein and fat. That was it. Yeah. And I knew that would spike much much later. So I was able to into and I should have just Bolus when I ate and said none up front because, you know, life gets busy and you get talking to me in the car and I lose track of time. But it's it usually is about I usually don't Bolus if I eat that kind of meal for a half hour to 45 minutes after I've eaten it.
Scott Benner 28:37
Okay. All right. That's perfect. I appreciate you doing this. Hey, real quickly. For anybody out there listening and other jdrf events. would you suggest that they bring me out?
Vickie McWatters 28:46
I definitely would. We had such a great reaction. And, you know, I'm sure I'm adding to the ego here but that's okay. Hold it up for a second. We had such a great reaction from Scott coming out. So many people crowded into listen to his breakout even after he did his keynote session. And we've got several people that want to have you back. So you may be coming back to Arizona.
Scott Benner 29:11
I like it there. By the way. Could it be warmer next time I come because it was cold and rainy. And I didn't think it rained in Arizona and you flew me into Arizona it was raining.
Vickie McWatters 29:20
Well, if you came this month, it would definitely be warmer but no guarantee.
Scott Benner 29:24
Can we talk Can I tell you how sad it made me that you put me in this very lovely hotel across the street from where the California angels were doing their spring training. And it was raining so they weren't playing? And I had no I had like this. Well here's the funny story is I thought I had three hours till I had to be at this dinner after I landed it turns out I was completely wrong about that. So I was and this is not to be pictured no one picture this but I was like naked in the hotel room. Like getting ready to get in the shower when I recognize that the car was picking me up in 20 minutes and I'm just like Look, I'm rolling around the room. I'm thinking, you know, I'll shave, get a shower. And maybe hopefully they'll start playing baseball across the street. And I wonder what I'll do with this time? It turns out because you know, the time of change, I didn't really pay attention to that fact. Yeah, that was probably late. Anyway, I still showed up. I came through.
Vickie McWatters 30:18
Yeah, we did. It was great. We loved having you.
Scott Benner 30:22
Yeah. So just Vicki one more time, say how great I was. And I'm just kidding. No, I seriously, I love coming out to those events. I love meeting people who are not thinking this way. And it's so interesting to talk to them. And watch the gears turn in their head. Like that. That's my favorite part. Like I love watching someone think, Oh, my gosh, I've been struggling all this time. And you're telling me there might be a different way. And then this person is explaining this different way to me. And it's making sense. I love watching the the dots start getting connected. It's really a it's a lot of fun. And I really do enjoy it.
Vickie McWatters 30:56
I love seeing people in our community saying, Oh my gosh, my agency came down two points since Scott came to the, to the type one nation and that does, that just thrills me it's it's just great. I love hearing stories like that. It really is cool.
Scott Benner 31:12
I genuinely appreciate you, uh, you know, you took a, you had me out early on before a lot of people had me to those events. And it's, it's no stretch of the imagination to, to imagine that the jdrf doesn't always have people like me out to their events. And so when your chapter does have me out there, they're a pretty progressive chapter. And you should thank them. Because they really are looking out for you. They're trying to find ways for you to to live better. So it's very cool. All right, Vicki, I genuinely appreciate this. Thank you so much. Yeah, I hope I was helpful. I think you are, but I don't know anything about it. So you could have been making the whole thing up, but I would never No. Huge thanks to Vicki for coming back on the show a second time and sharing how she handles her keto diet. Thanks also to Dexcom on the pod and dancing for diabetes, I want you to remember that you could go to dancing the number for diabetes.com right now, and just have your heart filled with goodness. How could you do better than that, you can follow them on Instagram or Facebook. And if you want one of those fancy Dexcom g six is go to dexcom.com forward slash juice box. And of course to get the free no obligation pod experience good for monopod Miami pod.com. forward slash juice box. Let me take a second to thank you guys for the newest ratings and reviews on iTunes, which I guess Apple wants us to call Apple podcasts. bunch of new ones came in this week, very much appreciated. Thank you love the five star reviews. Also. My Facebook page bold with insulin you may have heard has a little private group going and I say a little private group and I'm looking because Ooh. Once I approve this person who's asking to be in the private group, it has 801 members. And when you go in there, it's really amazing. It's people like you listeners to the podcast, we're helping each other using like phrasing and terms and ideas they learned on the podcast. It's very meta, and amazing. And you should check it out if you're interested. And if you're not interested, please don't check it out. No pressure here. Last thing, right. Go to Juicebox Podcast calm and yes scroll and you scroll and you scroll right there's a you can sign up to the mailing list. And then up here to merge t shirts just added a bump and nudge shirt there's more that the converse stickers with all your favorite sayings on there. There's a very cool Be bold tote bag. Stop the arrows shirts, be bold shirts Juicebox Podcast logo and there's mugs and I didn't imagine these would be so popular but they are coffee mugs with all your favorite sayings. Stop the arrows pumping nudge Pre-Bolus wake up in the morning Get yourself a cup of coffee remind yourself to stop the arrows or whichever saying really resonates with you. These items are not a huge moneymaker for me. They were asked for by a lot of listeners, I found a way to give you guys quality items that were the shippings handled and everything and I don't really need to make make stuff at my house and send it to you. It's cool if you want it if you don't, you know it's cool too. I'm not gonna lie to you, I'm keeping whatever money I do make off of them and make a couple bucks off of each thing. I put it back into the podcast mostly or pay my bills. So if there's something there that you like, That's amazing. If there's not just keep listening, share the podcast. That's what you can do more than anything. If you're enjoying the podcast, and you'll want a mug but you can't afford a mug, but you'll want to help tell someone else about the podcast that helps as much if not more than anything else. I can't spend that but it is really helpful.
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#263 Diabetes Pro Tip: Fat and Protein
Diabetes Pro Tip: Fat and Protein
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 friends and welcome to Episode 263 of the Juicebox Podcast. Today's episode is sponsored by dancing for diabetes Dexcom and Omni pod, you can go to dancing number four diabetes.com my omnipod.com forward slash juice box or dexcom.com forward slash juice box to find out more. I hope you're ready for another diabetes pro tip because this episode with Jenny Smith is all about fat and protein. That's right. How do you Bolus for the thing that they tell you? It doesn't need insulin, but really does. We're gonna tell you right here. And after you're done with this episode, Episode 263 special bonus episode number 264 is available right now. That episode is with Vicki. Vicki is eating keto. She's going to talk us through how she boluses for her keto diet. Because guess what, you need insulin for protein. In fact, if you don't know that, you're gonna love this episode. Now, even if you're not eating keto Vicky's episode is going to give you a ton of insight into the timing of fat and protein. It's actually sort of interesting to look at. If you're not a keto Well, it's interesting if you aren't keto, but if you're not, it's still really insightful. Because you get to strip away the carbs and just see where the protein comes into effect. It's almost like that, you know, do Row row row your boat, you start singing and then the other side of the room starts singing like when does the second tier of row row rowers come in? When does the fat and protein start working? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your medical plan or becoming bold with insulin. You however, do not have to talk to your doctor about going to Juicebox podcast.com, picking up a T shirt or a mug or something like that, you know, to help support the show a half an hour before you and I started recording this someone sent me a message on Instagram and said, How do I deal with fat and protein overnight because I was bawling all night with my kids. So I texted them back and I said hey, great timing. Can you see my recording calendar from where you're at? And hold tight? Because the answers coming? This is another one that Jenny proposed that I'm really interested in. And I don't know how much help I'm gonna make. Why don't we start with what I know? Because it's so little. So forever seriously. So for everyone who listens to the podcast and knows that I'm just sort of fluid with insulin, right? Like more, more need equals more insulin. And so because of that, I don't usually stop and think about whether that means it's protein or fat or what it is just if Arden's blood sugar seems to require insulin, I give it more. I'm assuming I'm been handling fat and protein rises for ever.
Jennifer Smith, CDE 2:58
You're not dissecting her meals, you're just saying I see the need. I'm giving more insulin. That's kind of what you do.
Scott Benner 3:05
Yeah, I see diabetes is a forest fire and I fly over it with a giant plane full of water and just drop all the water on top of it. And I go, oh, I've got most of it. And, and
Jennifer Smith, CDE 3:16
Oh and look at that's where the fire started where the fire man comes in and looks at and Scott's like, I didn't really care where it started. I just want to take care of anything
Scott Benner 3:24
was to me, I'll go get another plane full of insulin and drop it back on again. So. So I never really think about stuff like that I do a little more obviously, as you and I have been speaking as the years go past, but I find it to be it's another level. Like sometimes I joke about things being like like ninja level, like, I think that you don't really need to know about fat and protein if you're doing what I do. But you do need to know if you want to start understanding things in a bigger way. So I'm really excited to do this. Now, the only thing I know about protein is that I do indiscriminately bolus for protein. I don't know why I do it. But I do it. So where some people might look at a plate and go, Oh, there's potatoes. Well, that's, you know, this many carbs. But then there's a, you know, a cheeseburger. Well, that's me, I don't do that. And here's a roll that rolls 25 carbs, and you know, and we're gonna have broccoli, and I don't know, broccoli probably has five or six cards or like, so I look at my job I look at I look at a plate, I go broccoli, and six, the roll. Let's call it 30 then I look at the potatoes and they go I don't know 35 and then they look at the burger and I go, yeah, let's call it 10 and we'll extend it for a little bit. And and so that's me looking at a cheeseburger with mashed potatoes and broccoli, right. I don't know why I do that with the. I've heard that. I know. People who eat incredibly low carb, who tell me that they bolus for their protein but farther out from when they actually ingest it. Huh, is any of that right? If visiting dancing for diabetes is wrong, I don't want to be right. Not about this, I want to be right about the fat and protein thing. But I would not want to be right about visiting dancing for diabetes being wrong. If it was wrong, which it's not, I think you should definitely do it. Dancing, the number four diabetes.com. You know, studies show that if ads are incredibly confusing, they work so much better. Check out dancing for diabetes on Instagram and Facebook, throw them all like to really great organization, dancing, the number four diabetes.com. Even if you're not interested, could you go like their pages? Because they paid for this. And now I'm listening back to it. And I didn't do a very good job. So let's at least give them their money's worth. Is any of that right?
Jennifer Smith, CDE 5:47
Because, yeah, so I and again, I from the standpoint of looking, you're not doing this in a blind way, you have, you have the method that you've developed for analyzing looking at Arden's control and her management and what happens here and what happened there. And you remember it, you've got like this, like library of like, times have this has happened, you can like pick from them, Scott, and you're like, I know this happened last time. So let's time this time for the burger and broccoli, we're gonna give 10 for the burger, because I know what happened last time and something was off, and the carb count for everything else was right. in context, though, for everybody who's listening, and why would you need to Bolus for protein. It's really typically two points that you'd need to Bolus for protein one, you brought up the low carb eaters, or those who are eating lower carb at times, if you've got a meal that's typically less than about 15 to 20 grams of carb, and a normal amount of protein, not like this big 16 ounce steak, but a typical, you know, five ounce chicken four or five ounce chicken breast, let's say, You're usually going to need about 4050, sometimes even 60% of the amount of protein in the aftermath of that meal in order to accommodate for your body's own digestion of protein in a low carb environment. Because remember, carb is the body's natural first fuel, right? If there's not enough of that first fuel there, your body looks to another source, like protein digest sit down, and you get a usable amount of glucose out of protein. Even if it's not a huge amount of protein eaten in a lower carb environment. The opposite of that would be let's say, she has a high carb meal, or anybody has a high carb meal that's like the meat lovers pizza, okay, and which is not only a huge amount of carb, as well as a huge amount of fat, but you've got this large amount of protein, let's say instead of your standard, like 25 gram portion of protein, which is like about the size of the palm of a woman's hand, that's about 20 to 25 grams of protein, that's pretty normal amount, okay, if you've got this huge amount of protein that you're taking in, even in a normal amount of carbs, or a high amount of carbs, you're still gonna need an Bolus for about, let's say, 50% of that protein, but it's going to be a drawn out type of insulin need. So both of those scenarios would require you to take, you're doing like a dual bolus, you're extending some of it assuming you're meeting that protein kind of need for a while. Protein bolus typically is a good idea is at the end of the meal to set an extended bolus with zero percent delivered up front and 100% extended out over about a three hour time period. And that's just for aware proteins impact usually starts impacting about two ish hours after a meal. And then by about three hours, you're too high and you might sit high and correct to try to get it back down. When in effect had you used what you use to correct to actually Bolus for the protein you wouldn't have had the rise to correct to begin with.
Scott Benner 9:17
Yeah, I got it. It's parallel to the idea of over Bolus and like when you can't Pre-Bolus and you throw in a ton of extra to handle the rise before the right yeah. Okay. So yeah, exactly. I Bolus the meal normally. Then I finished eating and I put in this amount for the protein in an extended bolus, zero right up front, the rest of it out over maybe three hours.
Jennifer Smith, CDE 9:39
Correct.
Scott Benner 9:40
Correct. So basically, I'm creating a heavier blanket of insulin over the timeframe where the food is going to have
Jennifer Smith, CDE 9:47
where the protein is going to have the impact or where you're assuming from previous experience with meals like that. That impact is going to kind of fall in and fat is even longer. As we've kind of talked about before fat can have impact on To 10 to 12 hours after eating high fat.
Scott Benner 10:02
How does that technically happen? So these are where my questions exist. And by the way, I just everyone listening, I just stared at Jenny while she said that and thought, Oh, I'm in a Master's class about diabetes. And so, so fat as an example, when How does fat does it slow down digestion? Like, why does fat hold up blood sugar? I don't understand, I guess.
Jennifer Smith, CDE 10:26
Yeah, so one, it's also usually the reason as you just said, fat does slow digestion a bit, it's a it's a tough nutrient for your body to break down and make use of. So even if there's a ton of carb with it, it's often the reason that somebody eats a pizza. And they're like, wow, I must have nailed that carb count, because my blood sugar is like, beautiful rock, steady, flat, no rise at all. And then all of a sudden, later, they get this like creep, and the creep happens, and it happens. And then you ride high, and you're like throwing insulin at it and dumping the plane worth of insulin. Here, you know, it's, it's and it's annoying, right, especially for people who may not realize where it's coming from, because they've never been told what it potentially could be. So it's not a missed missed amount of car. But it is the reason that you had that nice flat look, in the aftermath of eating that, let's call it pizza. Otherwise, if you just ate the pizza crust, I guarantee that pizza crust is going to give you a rise without the fat being there, right? Even if you did Bolus,
Scott Benner 11:32
right, right, right,
Jennifer Smith, CDE 11:32
right bread or potatoes or whatever it is. Now fat The other reason it impacts blood sugar is because as it gets to the system, a creates a rise in triglycerides in the bloodstream, which is a stress on the system. So we know what stress does to blood sugar, right. But as a stressor, if it impacts insulin use as if, as if it's reducing it by about 50%. So let's say your bazel overnight is running at 1.0 units an hour, and it works beautiful, you've tested it, you know that it does what it's supposed to do. But in the effect of pizza or anything high fat, nachos and cheese or whatever it you know, the whole bucket of chocolate, whatever, you essentially have a bazel now that's functioning almost at like point five instead of one. And so you are not getting the impact of all the bazel you need your blood sugar climbs because of the fat and it stays high because of the fat and it can be long duration. So I mean, you know, we typically recommend people accommodate for a high fat meal or something, you know, high fat in nature, like the whole hog and does sundae bar or whatever. 50% increase in bazel at the end of the meal. And you extend it out over eight hours.
Scott Benner 12:52
Wow. 50% bazel increase over eight hours for a ton. Yep,
Jennifer Smith, CDE 12:56
see a ton of fat.
Scott Benner 12:59
That's where it's a Jenny. So there's a couple of things in there. But the one thing she just said was how the the impact of the food sort of gives the appearance that your bazel is only at half power. Because Because now your body needs so much more insulin. It's funny, because that stuff we say I've been saying for years, but I never thought it that way. Right? I never considered Wait, you just said it. I always say right, the by like, you know, in high carb situations, you need more bazel. That just makes sense. If you know if one unit keeps you stable when you're not, you know, when you're not putting the body through through the paces, then when you're out then when you're attacking it with ice cream or pizza or something like that, it stands to reason that you would need more in that situation, right to meet the need. But it's interesting the way you put it, I hope that maybe that'll find a strike other people maybe at the core of their thinking, because that's a neat idea. Like when when you're using that kind of food, it's as if you don't have enough bazel by half rats, they have something to like measure with even the idea of eight hours. I think the genius behind the extended, you know, the Temp Basal increase over that much time is if you do start to trend down at some point, you can just make a the foods out of my system. Now I can shut it off. Maybe I'll have to re correct this a tiny bit, too, you know, but that's it.
Jennifer Smith, CDE 14:15
Right? Right. And or maybe you got enough temping increase for quite a while. And now it's going to navigate down as you turn it off, and you may not necessarily get 100% back to target, but you're certainly going to navigate down to a much lower number than you would have been had you not done that at all.
Scott Benner 14:32
Yeah, yeah. I mean, and you have to know by now, if you've been listening this long, that you would rather stop a lower falling blood sugar than a fight with a high one. That's it. It's simple. How much truth is in the way my brain thinks about, like, more dense carby stuff like a soft pretzel or pizza or something like that, in that it sits in my stomach and it breaks down slower so that it has more opportunity to run. So my blood sugar being impacted by over a longer period of time sometimes passed when the impact of my Bolus is there. Mm hmm. Do I think about that correctly? Or is that just the cart? Yeah, that
Jennifer Smith, CDE 15:10
works. No, it's, it's a great way to kind of think about it and also plan to Bolus for it. And some of that also takes experience, right? It takes experience seeing, well, gosh, whenever I eat this soft pretzel, it's all carb. And unless you're like dipping into the cheese sauce, or something high fat that kind of comes along with it, the vat of butter, if you're just eating the soft pretzel, it's all carb. But the dense nature of it, maybe what requires a little bit more drawn out, because you don't necessarily need that quick impact all up front, you may need some, but then you're going to need it for a little bit longer in the aftermath. And the same is true for some of those, like more wholegrain hardy types of starchy foods, things like wild rice, or qinhuai, or you know, those kinds of things, they've got better fiber complex to them, they've not been processed, they're going to break down slower, and they're going to have a lower glycemic impact. So you may need to draw out the Bolus a little bit in order to prevent having a low before it kind of impacts or hits you later.
Scott Benner 16:19
Right, you have to stop thinking about the food goes in, and my blood sugar tries to go up right away. So I'll get that's not that's why your timings messed up. Like you have to understand a little bit how the food makes its way through your system. Mm hmm. high carb, low carb, high fat, low fat, you know, an in between there, the, the, you know, I used to tell people, like try to imagine an overlay machine like but then that got like an old idea, you know, like, you're in school and they do the, you know, the somebody would write on a piece of plastic and it would they'd shine up on the board. Say take two pieces of plastic instead and make one like a line of the impact of where your insolence pitting and one a line of where the food's hitting the goal is you have to slide those like those pieces of plastic left and right and make a me Italy match up? Yeah, you absolutely can't. You can't just throw in all the insulin now and just hope it hits because you hear people all the time, like, Oh, I bolus and I got low. And then I got high later. Now this makes sense, diabetes. And I'm like, No, you're so close to you. It's interesting. Jenny, earlier you said that I look at a plate. And I just know from experience and everything. I also think I just know, I don't know why I know. It's important to understand, like, I can't quantify it for you. Sometimes I can just look at a plate and go that's this much insulin, I know it. And it is obviously from something but at the same time, I have privately for the one person who called me an egomaniac in a recent review. This is not me being egotistical. I'm just telling a story. But I I fixed two kids bazel rates this week, mm remotely. And they sent me a graph. And as soon as I looked at the graph, I thought, Oh, I know what's wrong with this. But I couldn't explain it to you. Like, do you know what I mean? Like I couldn't write a manual about why this graph right points to what it points to. But I knew as soon as I saw it, I think everybody can get to that. Because I know who I am. I know what I got in school is for grades I can't possibly be smart. Right? So, you so seriously, like I think time just teaches but and please, guys, this is not an invitation for everybody to send me their thing. But But I am By the way, it did make me think, Jenny, I think there's got to be a way to start a service where you take people's graphs and make bazel recommendations back from the graphs. Because once you get people moving in the right direction with their bazel, they start to see it. And then they can then they can dial it in on there. And then they don't need you this this person this lovely person's texted me. You have to let me send you something cuz I'm going to be bugging you for the rest of my life. And I laughed and I said, Hey, you can't send me anything. And I don't, I don't want anything. And and but but be you're not going to need me for like, ever, like three days right? Now, this is gonna just make all the kind of sense in the world to you. It just starts to you start to see it, you know, right? Right? Which the matrix movie because it's such a great reference. But things start to slow down.
Jennifer Smith, CDE 19:26
You know, they do and they start to they start to come together in a way like like Neo sort of all of a sudden, all of those images that are flooding the screen in the matrix. Like he said, that's a great movie to bring up in context here. Because it just it comes together and his brain is like, I can see it all. It's clear. And I mean, diabetes, life with diabetes changes, variables come up, and there are always going to be new avenues to explore and figure out but the intuition of the day to day management, the intuition gets easier, and I think that That's what you kind of you manage off of a lot of really good built in intuition of, it's this, this feeling and you can't, you can't often I think other people would agree, you can't often put that down in writing, you can't say, I know how I know how this is wrong, I can't tell you why. But I know this is how to fix it. I know this needs to be adjusted here, you need something else here or whatever. Now, some of it can be, you know, some of that intuition can be simplified. If you do do some, you know, we're talking all about like food and the impact carbs, and fats and proteins and some of that, if you know, I've gotten a little bit into the science of why there's impact there from these foods that we don't really ever talk about fats and proteins are kind of like, swept under the table, when Diabetes Education comes, you know, comes up, it's usually all carbs, right? We focus on carbs, we learn how to carb count. And I mean, the basics of carb counting are pretty easy with a label, you look at the label for the serving size, you look down the label for the total carb amount. Next down, you might look at fiber, if there's enough of it, you might need, you know, deduct a little bit of it. But that's what we're taught. And then you're given this little ratio that's like, oh, for every 10 grams that you count from a label, you need this much insulin to take with it, right. So it's, it's a very mathematical figure. But if we take it sort of one step farther than that very simple carb counting, as you mentioned before, not all carbs are created equal, you know, you could have 10 grams of counted, you know, celery, versus 10 grams of counted watermelon, there's going to be a different impact blood sugar wise from those carbs, even though the carb count is exactly the same. And so that it kind of brings in, can you be precise in carb counting to a degree, you can look at labels, you can measure, you can use weighted scales and all of that kind of thing, you can get precise, but from the standpoint of then understanding why blood sugar did this versus did this, you know, upswing stable flat drop down, that actually it takes it a step further into glycemic index, and the nature of that food and glycemic index also in it encompasses the components of a meal to not just the carb at the meal. But like I said before, with the pizza, you could have just the flat old pizza crust and Bolus for that with just all the carb that's there. Your Aftermath blood sugar is going to look very different than when you eat it as like a meat lover or an all over cheese pizza. There are different components. They're impacting how those carbs are going to change your blood sugar.
Scott Benner 22:54
In case you missed it Episode 255 is a defining diabetes episode with Jenny, where we go over a glycemic index and load. Kelly and I went to the movies this weekend with Arden and her friend, we went to the snack stand and Arden chose a box of cookie dough bites day slushie I don't know if that's something that translates all over the country, but just imagine pulverized ice with sugar water through it. Now, I'm not scared, right? I've got all the rules in this podcast and I've got Dexcom I feel comfortable. Flip over the box with a cookie dough bites. 76 carbs for the whole box. I say Darden Are you gonna eat the whole box. She says, I don't know, the Slurpee, you're gonna drink the whole thing. She says I don't know. I look at the lady at the stand. I went any chance you got a carb count for this slushy thing. She looks at me and says carb What? I say Don't worry everybody because we have a dexcom g six continuous glucose monitor. I know what I'm going to do. So I just ballpark the carbs. Right? I use the 76 carbs for the candy thinking there's no way she's gonna eat all the candy. But, you know, the slushy obviously has a ton of carbs in it that I can't even begin to guess we're just going to start with 76 carbs, boom, insulin goes in. Now we wait for the dexcom to tell us that Arden starts trending above you know 120 as soon as she does Janga more insulin. Throughout the hour and a half of the movie we put on a number of different smaller boluses which kept Arden's blood sugar around 170 and then we got her back down as soon as the slushy cookie dough concoction stop going in. You know what I call that success? Arden Sala movie she had a snack, there was an unknowable amount of carbs that impacted her in all different crazy ways. She did not get terribly high and she never got low later, we accomplished that the dexcom g six continuous glucose monitor, head over to dexcom.com forward slash juice box to find out more. Results are mine and yours may vary. And when those variables are invisible to you, it causes you to say oh, that's Diabetes, I can't do anything about that. That's just nice. But there is like I've, I've been saying forever Jenny's just put it into specific words, which is beautiful. But I've been saying forever. If your blood sugar is getting really high or really low, you're not using the insulin correctly. I know that doesn't help you figure out how to use insulin, but it should help you to know that there's still an answer. And right, because you don't see it in the moment doesn't mean it doesn't exist. It would be no different than if I sat down and looked at multivariable calculus. And then, and then I said, you there's no answer to this. Well, a person who understands multivariable calculus would say, of course there is, you just, you just don't understand calculus. And so the trick is with diabetes, how do you find the ideas that help you get through this stuff without everything turning into a calculus problem? Right? Like, how does it just become day to day super simple and easy. And the reason you need to listen to Jenny is not only because she, you know, teaches this stuff and integrated diabetes, not just because she's been living with Type One Diabetes for a very long time, not just because she's a CD, or a nutritionist, all that stuff, but she lives in a part of the country where food literally tries to kill people. So that wow, I my brother and Jenny live reasonably near each other and the things my brother describes his food. When he got there, I was like, Brian, that's not food, don't eat that. And it's like,
Jennifer Smith, CDE 26:27
man, I would have to say Madison is sort of a little bit of an island in the state of Wisconsin. So Madison is a little bit a little we're a little beyond what the typical wisconsinite but yes,
Scott Benner 26:39
I'm just saying if you're rolling into a moment with a you know, bratwurst on a roll with a beer with some popcorn,
Unknown Speaker 26:45
curd,
Scott Benner 26:47
cheese curds, deep fried like you, boy, you you need to know what you're doing, you know?
Jennifer Smith, CDE 26:51
Right? Absolutely. And that's, you know, that's where understanding and learning things like, hey, fat, and protein and all of these factors, they can have an impact for you. It's not all cut and dry. Count the carbs, take the insulin and you've got it made it it's not and i i hate saying that because it sounds like well, gosh, I'm never gonna get a handle on this if I have to start being a mathematician and you know, figuring it all
Scott Benner 27:17
out. But you will if you just, if you think beyond what you were told. So somebody like Jenny said, they'll flip the box over a half a cup of this is 10 carbs, you know, you get sick, you know, you get a unit for every 10 carbs. So that's a unit like that. But then once that doesn't work, you know, you guys have heard me say it a million times. It's insane to go back the next day recount the same 10 carbs and go Okay, unit, because that's what the math The doctor told me. No, no, I used the unit, my blood sugar went up. It took me three quarters Veena to correct it next time. Let's try a unit and a half. Or, you know, yeah, let's try more because more it took more, you know, correct. You just have to, like, do some evaluation is that Yeah, you have to I'm following you for the people that I speak to over and over and over again, there's a moment where you just have to trust your gut. Like, you have to trust that what you're seeing is actually happening, which is why I made one of the tenants of the podcast, you know, trust that what you know is going to happen is going to happen, you know, and that's just that's simple. Like, it's not, I say all the time, like it's not stalking if you need it. And somebody I got a private message of the day it said that sentence unlocked my world, just, you know, change my life. And I thought, I'm glad I randomly said it because I didn't think of it ahead of time. I you guys have been listening for a long time you realize there's no notes in front of me. I've planned none of this is a matter of fact, Jenny and I start recording I go hey, we're gonna do like the fat and protein today. Okay, and she goes, Okay. It's, it's about unlocking your mind from what, you know, the confines that you are giving at diagnosis. And it's really it's, it's energizing to see it happen to people early in their diagnosis, because then you know, they're not going to live their whole life like this, but it's rewarding to see someone who's lived with diabetes for a long time. Have like the light turned back on for them. Yeah, I mean, the messages you guys send Are you guys owe me tissues? You know what I mean? No. It's really something. Okay, so I did we do we did carb counting basic site, like flip the box over, take a look,
Jennifer Smith, CDE 29:22
you'll buy box over? Yeah, I mean, if you wanted to go beyond the carb counting basics and get more into a little bit, I mean, taking it beyond would really be looking at the glycemic index, but then one beyond would be glycemic load. You know what that is Scott.
Scott Benner 29:38
Those are gonna be defining diabetes things we're going to do after we stop recording this journey.
Unknown Speaker 29:42
Okay, awesome.
Scott Benner 29:44
All right. Okay. We did well with this, I think.
Jennifer Smith, CDE 29:46
Yeah, I think so.
Scott Benner 29:49
Okay, don't forget that defining diabetes episode about glycemic index and load is back in Episode 255. Let your podcast player keep running because Episode 264 is the next episode. And it's with Vicki who will tell us how she handles a meal on a ketogenic diet. keto, right, here's the great thing. Even if you're not on a keto diet, even if you're not doing low carb, the information is amazing because it shows you the timing of when proteins and fats hit a person. Try to imagine that Vicki's gonna explain a meal to you, that includes no carbs. And she's going to show you where the fat and protein comes into play. So you can kind of in your head separate out when the carbs head to where the protein hits. Trust me, this is the capper for the episode with Jenny, I promise you go right from this one into 264. Thank you so much to the sponsors Dexcom on the pod and dancing for diabetes, you can go to my omnipod.com forward slash juicebox dancing the number four diabetes.com or dexcom.com forward slash juice box to get started today, we're gonna find out about the answer for diabetes. Don't worry if all that confuses you. You can find links in the show notes of your podcast player or at Juicebox podcast.com.
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The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#262 Ask Scott and Jenny: Chapter One
Answers to Your Diabetes Questions…
Scott and Jenny Smith, CDE answer listener submitted type 1 diabetes related questions.
How do you combat that morning rise?
How does carb absorption work?
How does it feel being low?
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
This episode of The Juicebox Podcast is sponsored by in pen from companion medical. 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 healthcare plan or becoming bold with insulin. Welcome to ask Scott and Jenny. In today's episode, I, Scott and Jenny Jenny Smith from the diabetes Pro Tip series and defining diabetes. You know, Jenny, Jenny works at Integrated diabetes. She's a CDE, or registered pump trainer CGM trainer dietitian. She has type one, Jenny is the she's the full pack Jenny's the goat, I think that's what we're saying. Right greatest of all time. That's why she's here on the Juicebox Podcast. So we're doing something new on Fridays, they're still going to be some defining diabetes. But we're going to go back and forth a little bit between ask Scott and Jenny and defining. Anyway, in these segments, Jenny and I will be answering your questions. This all began as Jenny and I were talking about new episodes for diabetes pro tip. And I said, Let's do an Ask Jenny thing. She's like, I'm up for that. I said, you know, I'll ask people on the Facebook page if they have any questions for you. And they did. But the questions were sort of never ending and really good. It's interesting how listening to the podcast is making people think about deeper questions. The day after Jenny and I recorded, I woke up thinking, well, that really went well. I love that we should do more of that, you know. And I got an email from Jenny, you know what it said? Jenny told me we should do that. Again, that's a guy was thinking that too. So we were like, You know what, instead of making this a protip thing that happens once in a while, and we can't just make it one episode. Because there's so many questions in an hour, I think it would just get overwhelming. You'd forget what you heard. I said, Jenny, let's break these up into smaller episodes, so they're a little more digestible, and keep doing them. You know, I'll put up a thread every once in a while and we'll get new questions from people. Jenny was like, that's a good idea. I said, Jenny, why are you talking like that? And then I realized I was texting with her. And she wasn't really talking. I was just making up that voice in my head. Anyway, welcome to ask Scott and Jenny, answers to your diabetes questions. For those of you who think that Jenny and I have practice this ahead, you'll know for certain in a second that that's not true. I did send any of the questions so she could look at them. There's no I don't
Jennifer Smith, CDE 2:31
think I did not. I think I looked at like a couple and I was like, Okay, we'll just attack these as we get to that, because I can't, and it was like, 945 at night, and I was like, my brain has no bandwidth, or reading or Okay.
Scott Benner 2:48
All right. Well, I'm just gonna start what I see is the top right, so I think I can get first names. Lionni asks, she says, I just started listening to the series with Jenny and you in the last month and love it. My question, how do you combat that morning glucose rise, no matter what time of the morning, I wake up, as soon as my feet hit the floor, my sugar spikes, Basal increase causes lows, and doesn't fight the rise quickly enough. I know hormones get released when you get up, but still haven't figured out how to stop it from happening. So I'm not fighting highs all morning and delaying food. Good question. Good question. I have very little to add to this. But I think I should go first because I think it will lead you please. I have Arden's you know Basal program set up for a normal day being alive, getting up at a certain time going and doing something summertime comes along or Saturday comes along and she sleeps in. Now all the sudden her Basal insulin that kicks in at like 630 in the morning, so she can get up for school demands too much at some point. So I wake up a little earlier. And I dial her Basal back for a very long time, usually by 30% Does it most days, if she's trying to get low, there might even be moments in there for half an hour right to shut it off completely, to create, like, like there's so I have to mess up on the loss so that she can. So that's the sleeping in idea. But the reason I bring it up is because what it taught me is that opening your eyes, makes your blood sugar go up. And I know technically that's not true. But I think there's something about being awake and alive and aware and anxious and in a hurry and all the other things that come with being alive and having your eyes open, make you need more insulin. So now you can tell her like the technical reason for all
Jennifer Smith, CDE 4:36
that. Yeah. I mean, you alluded to some of it really, it's like, you know, what we kind of commonly referred to as the dawn phenomenon, right? And while most will say oh, it happened somewhere, you know, starting around maybe three or 4am and continues through, let's say maybe 8am. Most people really see it heaviest. Once they do wake up, it's almost Like the feet on the floor, and my blood sugar is rising, and I haven't even like said hello to my dog yet. And my blood sugar is like skyrocketing, right? And this listener reader poster,
Scott Benner 5:12
essentially, is a listener, but she follows okay for Facebook.
Jennifer Smith, CDE 5:16
Awesome. So both fabulous. So essentially, it has kind of the right idea, we would typically say, go ahead. And if you are, in fact getting up at about the same time, every day, like Arden's example, her normal school day, she's getting up six o'clock in the morning, if that's your typical, and you start to see a rise by 615, the accommodation in Basal is appropriate. But in this setting, perhaps the Basal hasn't been adjusted high, soon enough to accommodate for when the rise is going to start. So you know, if the rise is starting at 615 in the morning, and you have your Basal set to increase at 6am 15 minutes of more Basal isn't going to offset arise in 15 minutes, it's not going to do it, like we talked about in the Basal, you know, setting episodes, you really have to get about an hour lead way before you expect to see a rise or a fall happening in your blood sugar. And so in this instance, again, you'd probably need to do a, an increase in your Basal around 5am. If you want an offset arise that you know is going to happen by six 615 To get started, because then by then the Basal be high enough, it'll stop it from happening, you won't have the spikes.
Scott Benner 6:37
This is an example of like what I'd say about like anything you're doing with Vincent currently isn't for now it's for later,
Jennifer Smith, CDE 6:43
it's for later, right. And if you are getting low, you know, she mentions, well, I've tried the Basal thing and it's causing you to go low, it may be again, the timing, it may be that the Basal isn't adjusted high enough, soon enough. And if you're adjusting it six o'clock to accommodate for a rise 15 minutes later, but then it doesn't need to be high anymore by 8am. By that's why you're low is because it's high hitting you at a point when you now no longer need it to be too high. So it's kind of a mismatch of timing. The kind of the other compensation like you bring up, you know, for Arden's sleeping days for adults who are on their own. And I, I did this, you know, with my pump early on, I figured out the same thing. My work days were very different than my weekend days. Not by much. I mean, I'm not I wasn't a teen, it's not like I was sleeping until 11 o'clock versus getting up at six o'clock. But even if I slept in by an hour or an hour and a half, that Basal accommodation that I had set, it was it was too much. So I actually created weekend or day off profiles. And on Friday night, I would set my weekend profile to start running. And it accommodated for that time of day that was just longer in asleep,
Scott Benner 8:04
I would say to for any pump companies that may be listening, you have to be able to they need to be automated. I agree. Or you can't make me remember Friday night to turn on my Saturday Pro. I had
Jennifer Smith, CDE 8:14
reminders on my phone. Yeah. And then my reminders specifically said it wasn't just alarm going off. It was turn on weekend Basal. On Sunday night, I had an alarm that said turn on weekday Basal. Otherwise, I would forget,
Scott Benner 8:29
of course, people for people who are thinking about it on this level, there's no safety concern with allowing them to change their Basal programs automatically. So my last few thoughts about this are basically Liana, what what, what Jenny's saying is, is that you're throwing a punch an hour after the fights over, you know what I mean? You're putting your insulin now, the extra Basal, but it isn't working right now, all of a sudden, an hour later, when you kind of don't need any more. Now all of a sudden, it's there. She's thinking maybe and by the way, right? You know, this is our guests off of four sentences. The other thing I want to say, right? It's interesting to me like Leanna, she says, I know hormones get released. This is what I always talk about. Don't spend so much time trying to figure out why it's happening. Just stop it. You know what I mean? Like, when the bank robbers coming in the door, we don't try to figure out the psychology of why he thinks it's okay to steal from the bank, someone just really needs to stop, right from stealing. So I get it fixed, then if you want to, you know retcon it and think you know, analyze it, then do it. But don't worry. In the moment you need more insulin when you need more insulin. Okay.
Jennifer Smith, CDE 9:37
And another I guess another accommodation just to finish it to is for people who do have more shift kind of work and let's say as you brought up it's hard to remember to change a Basal pattern and to remember you needed on Tuesday for this shift in this, you know, Friday for this shift in a weekend and a day off and whatever. The other potential accommodation that does work for some people is it You know, by evaluating what the rise is that you get, as soon as you wake up, let's say you always know that you get a 5070 30 point rise in blood sugar, you can actually use your correction factor in an opposite way, then you can say, Okay, if one unit drops my blood sugar by 50 points, and in the morning, I have this consistent 40 To 60 point rise in my blood sugar. But when I wake up, if I take a unit of insulin right now, I should be able to offset that rise, because we know it's going to take about 15 to 20 minutes to get a Bolus working. Usually that rise is going to be seen, if it's going to start it's going to be within about 15 to 30 minutes of waking up in the morning. So if you can take that Bolus to offset with a figured amount of insulin, it's another way to accommodate if your days are very different in when you wake up. So you're over bolusing the morning. So you're over Bolus in the morning without ever playing with Basal. You're just accommodating for the rise that you know is going to be there
Scott Benner 11:04
like that. Okay. Do you need a breath? Yeah. All right. I'm good. Here we go. Jennifer asks what I think is a really interesting question. She says so garden, did she, this must be a brilliant question, right? She says so carbohydrates begin digestion in the mouth and absorption can start in the mouth. But the amount of time that the food actually stays in the mouth before you swallow it isn't that great? Then it goes to your stomach. There's about three hours before it moves on to the small intestines for digestion finishes, and then the majority of absorption happens. So my question is, why do we Bolus for the insulin upfront? Why don't we Bolus heavier on the end so that three hours afterwards to catch it when it's being absorbed by the small intestines? Now? I think there's a this is an interesting question, because I think it's possible Jennifer asks, and answers her entire question. What she needs is someone to come along and tell her she's right. Or maybe right so there's a lot in here. So for food does not spend very much time in your mouth by now. The quickest way to stop a low blood sugar is your chipmunk. You just run around with your nuts. He pocketed your key. Yes. Run around with your nuts in your mouth and looking for a hole. That's what a chipmunks right, saving for a rainy day. Anyway, jeez, this is gonna go off the rails, we need to be more structured than this. But so she's you know, I just the other night, a person who's been on this podcast, you guys haven't heard her yet, but contacted me privately. And she said, I just Bolus eight units. And I meant to do point eight, and I'm alone. And I don't know what to do. And I've drank juice, but my blood sugar is like I think it was in the under 40. And so I started like rattling off like, get some of this, get that get this well the person's like, like keto or low carb or something like that. Like I don't have any of that stuff in this house. I was like, okay, so I was like now I'm like, Oh God, now I'm on the hook. Like I'm really thinking right? I said, Oh, sugar bowl. And she goes, Yeah, I said take a teaspoon of sugar. Just melt it in the saliva in your mouth and keep it in your mouth. Like don't smile, it just keep it there because your cheeks super absorb really quickly. Right? So I guess this is an interesting question. And we'll get to Jennifer's overall question, but how is it when my blood sugar is 50 and it's not falling? And I drink, you know, 1015 carbs of juice? How does it pop up so quickly after that? Where does the majority of that absorption happen? Because I'd imagine that just doesn't even make it to your stomach because you start seeing it hit pretty quickly. Do you know?
Jennifer Smith, CDE 13:44
And well in that in her question, and this kind of bring up component of a meal, right? If you're drinking something like juice, the reason for juice being recommended, or any very simple carb source being recommended as a true treatment for a low blood sugar. Or, you know, the reason that you want to Pre-Bolus if you just decide you're going to drink juice and you're not low is because you do need time, because that is going to work fast. That sugar gets absorbed. In the absence of fats and proteins and fibers and other things. Sugar itself gets absorbed pretty quickly. And it gets it gets absorbed essentially, you know through the whole passage and a liquid sugar source things like a gel or a goo or the juice or even like you said liquefying like in fact, something I learned years ago was if I choo choo choo choo choo, the glucose tablet up and needed almost like liquidity in my mouth and then swallowed it. It was a lot faster and why I came to this probably in those strange moments of low blood sugar where you're like, oh, let's try this and your brain is like floating through mud and like, whatever. But I figured, you know, I figured out what works a little better. So that liquid component to it, it gets absorbed a lot faster. And in a very simple sugar form, it's going to get absorbed through the digestive system much, much faster. Now with a meal, she brings up a good point with a meal. Why am I taking this big upfront Bolus? For food, that probably is going to hit me at least some of it is going to hit me a fair amount of time later, right. Thus, you know, a lot of the reason that they truly built in especially for pumpers, that feature of a combo or an extended or a duel or a square wave Bolus, two pumps, that's why it's there. The problem is that you've been taught how to use your pump, but you haven't really been taught how to use your pump, the insulin works, you've not been taught, this is how the insulin works. This is the component of a meal. This is why the insulin needs to be matched to this kind of a meal. This type of food, you know, together. This is the type of Bolus you might need. I mean, the science behind it is more in depth than the education that's being provided it is. So again, this brings up a very good question and potentially, you know if that's if that's what this person is seeing, then yes, an extended Bolus, if you're using a pump is probably in your best advantage to try to figure out writing down some of your common meals. Seeing what is your CGM trend look like trying to match accordingly. You know, maybe I need 30% of my meal Bolus right now. And maybe I need 70% of it drawn out over two hours to accommodate that kind of digestion.
Scott Benner 16:53
I think I think this this question from Jennifer made me think she's never heard an episode where I do Arden's lunchtime, insulin and Arden's blood sugar's already like 80 Because that's the exact situation where I go, Okay, we're gonna use 13 units now. But it's 0% up front and the rest over a half an hour an hour. Because I need I needed to start happening. But I needed to, I need the impulse out longer shot longer, right? Yep. All right. Yep. For now. I think that answers Jennifer's question. I also wrote down that if this wasn't a regular episode, I would call it floating through mud, because that's the most interesting like analogy I've heard for being low ever, like the idea that you're floating, but very slowly.
Jennifer Smith, CDE 17:33
That's how I feel. When I it's one of the best descriptions that I've like been able to come up with for how I have felt long term because symptoms change for low blood sugar for many people. But I've always had this feeling that I'm sort of like, floating or slogging through mud. Like, I feel like I'm moving exceptionally throw the very slow, but my thoughts at the same time are running extremely fast. They're like they're spinning and spinning and spinning and spinning. But I feel like I'm just the slow like, I'm like the slowest, slowest slot on the planet.
Scott Benner 18:13
For your life, but you're changing your chair.
Jennifer Smith, CDE 18:15
Yeah, yeah, it's just, it's, it's a weird sensation.
Scott Benner 18:20
The way you said that.
Jennifer Smith, CDE 18:22
floating through IDs like that.
Scott Benner 18:25
At the beginning of the podcast, I told you that this episode was sponsored by in pen by companion medical. And I want to tell you a story about how that came to pass. So things don't happen as quickly as you might think. About a year and a half ago, companion medical came to me and said, we'd love to come on the podcast and talk about this new smart pen we have it works with Dexcom. It's really terrific. And it's called in pen. I said, Yeah, that's nice. But I can't have you on the show. Because my daughter doesn't use it. I don't know anything about it. And that means a lot to me. I can't take an ad from somebody that I don't really know. You know what I mean? You guys don't even realize it. But there are people who try to come on the show all the time to push what they do in the world. You know, I'm a physical something, I do this for people. And if I don't have direct knowledge of what they're doing, I don't let them come on here. I don't let people just come here and sell to you. So anyway, I kept talking to in pen. And the more I heard from them I liked but I still didn't have any like real world data to back up having them on the podcast. So I told them if you want to come on, that's great. You'll have to sponsor the whole episode. I want people to know for certain that this is an ad. No mistakes, right? I'm not saying I use him pen or I stand behind it. But if you want to come on and talk about it in pen, do it. Just make sure people know this is like a paid for episode and way back like a year ago. They did just that in episode 174. In the year since then. I can't tell you how many of you I've heard from her like Scott, I heard about impact on the podcast. It's amazing and everyone's telling me about how well what's working for them? And what a great thing it is for them. And not only that, but I'm going to talk past the music here for a second. But not only that, but major props to Omnipod for never saying to me, Look, you're taking ads from us. So you can't do like a pen to. Nobody does that this is a very open community. We're building here on the podcast, and it's very collaborative. It's fantastic. So anyway, you know, Omni pod doesn't stop me from taking other ads, you hear people come on here all the time and say I wear a T slim or, you know, I use a libre CGM. Nobody ever gives me trouble about it. When I set these things up with the sponsors, I was clear upfront, you know, I can't stop somebody from saying they use a product that's not yours. If someone starts saying something about your product that you don't like, I'm not going to stop them. I can't do that. And everyone agreed, which, you know, is great in theory, but it's actually happening in real life, like in real life, none of the sponsors have ever called me sent me a note or anything and said, Hey, we didn't like what that person said there, please, you know, could just stop that. That is never happened on this show. I would never let that happen, which I liked. Because I like this information to be, you know, unfiltered for you. Anyway, in pen came back a couple of months ago, and there said, you know, we really would like to buy ads on the show. Is it possible that you'd be open to that now? I said, I gotta tell you, I've heard from so many of your users such great experiences, I think I would. But let's not just lay an ad in the middle of the episode and clog the whole episode up with these ads, right? Let's do something interesting for my listeners. So what I decided was, I'd like to talk to an in pen user, and then break up their story kind of a mini episode, over a number of weeks. And that's what I'm going to do on these Friday shows these episodes on Friday for a little while, are going to be sponsored by in pen, and you're going to hear from one of their users. Now, I think we found a really cool user with a really amazing job. And I don't think we have the person exactly nailed down yet. So if the wait a second longer to make sure that she's on board, should I even say she I'm not sure. Anyway, I'm pretty sure it's gonna happen. So this episode of The Juicebox Podcast is sponsored by in Penn by companion medical, and for now, there's nothing for you to do, unless you'd like to learn more. And you can go back to Episode 174. And listen to the conversation I had within Penn last year. Coming soon, of course, the story of an impending user and some links, you can click on To find out more. Thanks so much for listening to ask Scott and Jenny. Be sure to go follow the Facebook page bold with insulin so that you can ask a question next time the opportunity arises. And please don't forget that Jimmy Smith works at Integrated diabetes. Not only has Jenny lived with type one diabetes since she was a child, but she holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. All of that is nice. But here's what you really need to know.
I like the way Jenny thinks about type one diabetes management. I love it. Actually, she fits right in with how I vibe. If you'd like to hire, check her out at integrated diabetes.com There are links in your show notes. And at juicebox podcast.com. Thank you to everyone who sent in their question. We look forward to doing this again and again. This is going to go on for a while guys. I have a feeling this is going to be pretty popular. I'm tempted here to sing along with the music until the end of the show. Because I hear from a lot of people that you like that. But privately I want you to know that I believe you're mentally unstable for thinking that and I will not be encouraging this with anything today.
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About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!