Scott Benner 9/26/19 Scott Benner 9/26/19

#265 Ask Scott and Jenny: Chapter Two

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

Does bathing affect blood glucose levels?
How do you handle alcohol?
How do you crush a high?

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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
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 to Always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. MDI users, this one's for you. How would you like to live your life less complicated? You can do that within pen in pen is a reusable injector pen that has its own smartphone app. They talk to each other through the Bluetooth. that Bluetooth is magic, isn't it? You know what the app does? I'm going to tell you a lot of battle over the next few weeks on these Friday shows. But for right now, dose calculator dose reminders reporting actually tells you if the temperature of your insulin has gone out of range. Not only that, it connects to your CGM. Ooh, I got you there tonight, an app on your phone that connects to your continuous glucose monitor that connects to your insulin pen. Now you want to know more about indepen don't you? Check out companion medical.com 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, a registered pump trainer CGM trainer, dietician, she has type one. As a matter of fact, if it was the mid 70s, Jenny would be the Bionic Woman of diabetes care. She'd be Jamie summers. And for all of you who don't get that reference, I hate you for being young.

In today's episode of the show, Jenny and I are going to be taking questions from you the listeners. In this episode, we answer questions about bathing and whether or not that affects insulin drinking and how to handle it. And the third thing not lying to you, I cannot make out my handwriting. Oh, you'll have to figure that one out. I mean, it's only like 20 minutes long. You can do it. I wish I was kidding. That is what just happened. Right? You're ready.

EDAA EDA is editor right EDA at its at a let's call it says this is interesting because I think we kind of gone through this in our exercise episode recently. But she said okay, another doctor rule. When we got diagnosed, we were told not to take a shower and our past post insulin intake is I read this one is that is that true or false? My son's eight years old needs a shower every night. But sometimes we have to alter our night routine because he was given insulin. This is interesting because I think this is a great example of doctors trying to give you boilerplate answers to life's questions. And now doesn't consider that for the rest of time in memoriam Ed his kid is sitting around dirty not go into because he had a snack you know, I get the overall. So I've never really seen it Arden showers in her blood sugar doesn't get low is that because our Basal is right. And she doesn't have too much insulin in her body when she gets in the shower. What is that about it? Because I've seen it happen to where she jumped in the shower and her blood sugar falls?

Jennifer Smith, CDE 3:26
Yeah, it's it's really I mean, it has to do with the fact that in a shower unless you're literally taking like a Polar Bear Plunge which you're in the Midwest, you do in the middle of winter, right, that I guarantee is not going to cause your blood sugar to fall.

Scott Benner 3:42
You guys now have a great image of what Jenny looks like going from her shower to her towel to her bed.

Jennifer Smith, CDE 3:50
So, overall warmth to a site that's infusing insulin warmth creates, you know, it causes the blood vessels to move closer to the surface of the skin. And since that's where we're kind of infusing insulin, you get more vasculature, you get more circulation, I guess is the easier term so that your insulin actions speeds up. So you can get drops in blood sugar now, does it happen for everybody? No, it doesn't happen for everybody. The warmer the water, the longer the time that you spend in the water, etc. I know myself, you know, I mostly take showers now i with two little kids, they really don't have time to lounge in the bathtub for like three hours and read a book so

Scott Benner 4:39
Calgon commercials a lie, Jenny. It's a

Jennifer Smith, CDE 4:41
lie. It's totally a lie. Sometimes. In fact, I've said I need a Calgon moment my husband like sort of laugh in the background like I seriously

Scott Benner 4:50
fight. You know, now that he knows he could be replaced by dark chocolate peanut butter cups.

Jennifer Smith, CDE 4:57
Actually, yeah. Forgot I told you about

Scott Benner 4:59
that. Yeah, get in line and just laugh when Jamie says lamb.

Jennifer Smith, CDE 5:05
So yeah, you know, if I spend five minutes in the shower, I definitely don't see a change in my blood sugar now is my and I were Omni pod. So my pod is not like soaking in warm fits, you know I'm moving around in the shower, not just letting the shower water hit specifically that place. But for a kid who might be taking a bath, whether the if maybe the pump site is completely submerged in the water, if they're like my six and two year old who loves to like, play in the bathtub until it's literally like frigid, Ice Cube cold. And then they scream when they have to get out of, you know, if that's the case, it may be a reason that doctor is being I've never heard that a doctor actually even bring that up. So I think it's interesting that their doctor mentioned that

Scott Benner 5:51
at all a lot. I've seen this a lot. So,

Jennifer Smith, CDE 5:55
but really, yeah, I think it's interesting. But you know, it's, I think it's a preventative for hey, let's, let's not have you have low blood sugars just because you're taking a bath, but quite honestly, you know, if he's taking a bath, and you're doing an injection and his upper arm, technically, the bath unless he's laying down in it shouldn't cause a drop in blood sugar. Again, timeframe is also a difference there. I have noticed the difference. If I've been sitting in like a hot tub. I'm usually on vacation. If we do that I try to have my pat on the back of my arm so I can kind of hang my arm out of the hot tub and not like boil my insulin or anything. But even so just the warmth of sitting in that much, much warmer environment. I have definitely seen my blood sugar come down. So that's it's not odd. Your doctor was certainly not, you know, just blowing smoke. Yeah.

Scott Benner 6:52
For clarity to you're not saying that we don't want to heat the insulin up because it works better. When the insulins warm. You're saying that when your cells are warm, just like we talked about the exercise.

Jennifer Smith, CDE 7:01
So absorption is faster and Yeah, exactly.

Scott Benner 7:06
Okay. I like that one. This one's interesting, because I said to someone recently, I have to find a real like professional like drinker to come on the show and talk about how to Bolus for booze, right? Because I don't know but you live where it's called. You must have to get liquored up to get through the winter.

Jennifer Smith, CDE 7:27
So much. So people probably do.

Scott Benner 7:30
So Jim says what's general best practice considered for bolusing? For booze? I generally don't Bolus with my adult beverages. But what but I'd like your take on this. And then and then Emily came in and said, Yes, I gave up beer for more than a decade because it was so difficult to manage my blood sugar. Lately, I've been allowing myself one beer, but I tend to nurse it. So should I do a Bolus and extended Bolus or Temp Basal? So what are you? I am not a drinker at all, and I don't have diabetes. So I'm out on this one.

Jennifer Smith, CDE 7:59
Yeah, it's very, it's a good question. So in in general, have an alcoholic beverage that has carbohydrates in it, you will require insulin to cover the carbs in it. That's we're not talking about alcohol part of it yet just the carb part of it. So a beer. Most beers in fact, the lighter the beer, like the pale ales and those kinds, they tend to in 12 ounces have somewhere between like 15 and 20 grams per 12 rounds. The darker the beers like the stouts. And the Guinness kinds of things, they tend to actually have less carb, usually only about like 10 to 12 ish grams per 12 ounce. So there's a little card for you, beyond what you'd have to Bolus for. But if you are not a college, beer slam drinker in two seconds to see how long you know how quick you can actually get it down in competition with somebody else. If you're nursing it and it's a social drink. My assumption is that you're probably drinking a beer over let's say 30 Or maybe even 60 minutes. Let's It depends. She brings up a good point. Yes, extended Bolus is absolutely very beneficial there, especially if you're drinking the beverage on an empty stomach with no food with it was that mainly because food would help with the overall just it helps with the absorption that your body is also working on digesting the food and the beer or the alcoholic beverages sort of being absorbed and digested kind of along with the food. So you have less impact of like the alcohol component up front. So you have less tendency to have that drop first, even with a beverage that has carbs in it. But again, in a in a no food environment, just drinking a mug of beer. Essentially an extended Bolus would be a good idea, let's say over 30 minutes even over 60 minutes just depending the other types of alcohol let's say you're just doing something like gin or vodka, or something that really doesn't have a carb component to it. There's no reason to Bolus for it since there's not a carb piece to Bolus for. But does that mean that you shouldn't consider the impact of alcohol at all? No, in fact, conventional pumpers, the typical recommendation that we give is, when you've finished drinking, let's say you've consumed three beers or three, you know, drinks with vodka, that are carb free, or whatever it is, at the end of drinking, the goal is to take your Basal down a decrease of 40% for two hours per drink consumed. So at the end of the night, if you've consumed three alcoholic beverages, three times two hours would be six hours, you would decrease your overall Basal by 40% for six hours. And that helps to decrease the chance of lows, which are the end result of alcohol being processed in the body as a first response of the liver, the livers, that's one of the livers many, many, many, many, many jobs is to process the alcohol out because it's seen as kind of like a toxin, right? So in that same form, then the liver output of what your Basal insulin is supposed to be covering, if not outputting, that drip drip of glucose, that your body is supposed to be being covered by the Basal rate. So if you have lower output, you're not going to need quite as much of that Basal and the alcohol content to then cause low blood sugars.

Scott Benner 11:44
I had no idea. Yeah, and I here's one thing I do know that I can add, even though it wasn't asked, glucagon doesn't help you. When you've been drinking, is that right? Or is it not? It's,

Jennifer Smith, CDE 11:55
it's, it's not as effective, it can be less effective. Yes, because again, the liver is first word, especially if there's a fair amount of alcohol in the system, being one glass of wine. It's very wise if God would be fine, but you know, you've had several drinks and whatever, and you're kind of like tipsy and the glucagon would definitely have an impaired detail.

Scott Benner 12:18
And that's because your your liver is busy with other things, and it's depleted in the glucose. So if people understand or not, glucagon releases glucose from your liver, it's not a magic thing that brings your blood sugar up. It's not it's not Yeah, I don't know if everybody understands how it works. So if you're a power drinker, looking at your friends right before you pass out and saying hey, if I have a seizure, mix this up and stick it in my butt not going to be the only guy and I don't mean in the button

Jennifer Smith, CDE 12:45
all up right, right. It's better to call the better to call the EMTs and you know even in that case, you know, like you brought up earlier with the glucose you know, kind of in the cheek even at that point, something like honey or like a glucose gel if the person is actually carrying something along with them squeezing it in their cheek and actually getting it you just massage their cheek is gonna get absorbed and it'll help the blood sugar you know, faster so those are good options but yes, you know, overall, sure carb needs to be accommodated for in beverages especially if you're drinking the fancy you know, my ties and whatever they are Bahama sunflower, whatever Bahama breeze or whatever. Exactly. A there's a fair amount of carbon those.

Scott Benner 13:33
I think that's from Bahama breeze. I'm such I have probably not Jenny No kidding. I have probably not had the total of a case of beer in my entire life. I just does not occur to me to drink. I don't know why just it's never struck me. Let's talk about the in pen from companion medical, first of all companion medical comm. That's where you go to find out when you get there, there's a little blue thing up in the top right corner says get in pen. If you want to just jump right to the good part, you just click on that. First, I should tell you why you should be excited. If you're an MDI user. This thing is the bomb diggity, you understand. It's gonna help you track your insulin. You know, all that fancy stuff that people with insulin pumps get, you could get that with your pen. Not only that, it talks to your continuous glucose monitor if you have one, and if you don't have one. It's all right. The app still works great. The app, of course is for iPhone or Android. It is completely free. And available right now on the Google Play Store. And on the Apple App Store is it they don't call the App Store, right. They called the iOS App Store. They called the App Store. I think it was called the App Store. It's on the App Store. Let me tell you a little bit about what comes in this app. First of all temperature alerts. It can tell you right it's amazing temperature alerts limit the chance of extreme heat or cold impacting your insulin. And if it happens, the app will let you know Reporting is amazing. The summary of your therapy is spelled out right in front of you. You can share this with care providers or use it as a big picture look to help you make decisions. Do you have trouble remembering to dose your insulin in Penn provides you with an optional dose reminder. Right so you can decide to set up a dose reminder can also remind you to check your blood sugar in pen will not remind you to make dinner. The app has a dose calculator. Now listen, I know a lot of you who are on injections wish you had this because they're on pumps and they're really helpful in pen has it right on the app dose calculator to help you take the guesswork out of dosing. You enter your blood glucose and what you intend to eat. And the correct dose is recommended. It takes an account recent doses to avoid insulin stacking impact it's currently available in the US you can head over to companion medical calm right now to find out if your insurance covers the impact. But even before you get your answer, head to the app store and get the app the apps free. The pen, you know, depends on free, I'm not gonna lie to you. Insurance coverage varies by plan, please visit the get Impend link at companion medical calm to submit your information and find out with a no obligation verification of your insurance benefits if you're eligible for the in pen. Here's a funny one. Because Jenny and I know what we did last week. Jessica, who's another top fan? Jessica, thank you for being a top fan on Facebook says how do we concur? Or how do we handle a fat protein rise? When we know the blood sugar will rise again due to like Chinese food or mac and cheese steaks, burgers, etc? How do we learn how much to give at that second rise? And this one's an easy one for me to answer. I get to say, Go back a month to the pro tip episode about fat and protein. So you probably have heard of an easy answer. Just like yay, we finally got one. We don't have to do anything for Jenny and I just recorded an hour about fat and protein. So we're not going to rehash it here. But you can go find that episode. Jessica will absolutely answer your questions. Let's pull this one might be more like for me. Finally, ask Scott. Oh, yay. Actually, let me say this before I move on. One of the nicest replies in this one that made me feel really good about you know what the podcast does is Jessica said, goodness, you all do such a good job of answering questions that I didn't even realize I had. So oh really great. Like I was like that's that's wonderful. Yeah, that made me feel good. That is awesome. Yeah. So okay, here we go. Scrolling. Megan. Megan says, when you talk about crushing a Hi, can you please give an example in a little more detail. For example, if my eight year old daughter finishes eating 45 minutes ago, had finished eating 45 minutes ago, and she's 220 double arrows up. I either miscalculated the Pre-Bolus, the insulin or both? I love hearing people like they're mimicking the like the words in the pockets really makes me feel like we're getting through to people. How would you determine how much to give? This is Jenny's gonna laugh? Because my answers gonna be so just basic. And if and in how much time? If she's still going up? Would you? How would you When would you determine to give another Bolus, same amount this time, etc. So she's talking about like, how to stop this like a blood sugar flying up? My daughter's let's hear Scott's response. Responses just give her more insulin? How much more? I don't know. But more than you used the first time, that's for sure.

Okay, so this, to me is one of those trial and error things. It's where you have to use the information that you have from the past to make a decision today. And oftentimes, it's information you don't see as valuable. That's why I always tell people, anything that happens. Anything that happens with diabetes is never a mistake. I know things don't go the way you want all the time. But if you you can't step back and go, Oh, I screwed that up, or that really didn't work. You have to break it down and say, Okay, here's what I did. Here's where I put the insulin. And this is how much I did. This is what happened later. That's the information that will tell you next time when my blood sugar's to 22 up how much insulin will stop this. And you know, like and so there is a bit of that Megan, I think that you have to do it's sort of pre work for you know, really kind of breaking down what you've seen in the past now. I can tell you how I do it. But the numbers are there meaningless to other people, right? Like how much insulin I would give Arden to stop a 222 hour show up first of all, Meghan and I don't mean to brag but I don't see a lot of two arrows. But but that I mean might be what you really need to look into like how are you seeing two arrows like how far off were you in amount or timing it could have it should be to arrow should say to you significant miss? Like I really missed somewhere. You know what I mean? Now

Jennifer Smith, CDE 19:59
I can bring in what due to what does two arrows mean? We have a CGM. And you're seeing two arrows. What does that mean? That's a rate of change of at least three points. Plus, per minute. Yeah,

Scott Benner 20:09
it's flying. So

Jennifer Smith, CDE 20:10
it's a quick rise, just to define that.

Scott Benner 20:14
It's at least three. By the way, I know we've all done the thing. We're Dexcom says 215. And then five minutes later, it's like, 227. You're like, whoa,

Jennifer Smith, CDE 20:25
right. Right.

Scott Benner 20:28
Right. So Right. There's two thoughts in here. Megan, first of all, the one is sometimes you know, sometimes the arrows can, you know, throw you off a little bit and I like to look at the pitch of the line. I know that sounds may be strange to people but a a more gentle rising more of like a slope. I describe it as for people have seen the prices, right. It's the it's the, the unity, who the guy goes up the thing and like you're guessing things, and then you know, the fall is little pickup, right? And the whole time you're watching it, you're like, Oh, the little like, is it Switzerland? Is that what I'm thinking of? I almost said Swedish, but that's the Muppets. So it's Switzerland, and he's going up the Swiss Alps, they're in this real steady climb, and you spend the whole game thinking he's gonna stop, he's gonna stop and he never stops, he falls off the edge and you lose. That's what happens when you watch that line to me like that slow growing, but steady upward line that went to me says Pre-Bolus was probably pretty good. Not enough insulin, right? And so because if your Pre-Bolus wasn't really good, you'd be shooting straight up, like, like, and so to me that the line is, the answer is helpful. Yeah. Is it? Is it going up? Quickly, but still on more of a diagonal? Or is it like shooting straight up shooting straight up? You missed on everything? How much more do you put in the back? Like, I don't know how to answer that question. But I would I I've always said on the podcast I start with, when I need more insulin, back in the day, I would Bolus, like what what you would consider to be like life saving foods, like they were going to be eaten. So if I had a juice box that had 15 carbs in it, I'd say to myself, how much would I Bolus for this juice box? If I wanted her Arden to drink it as an enjoyable thing and not drink it as a way to stop a low blood sugar? Whatever that answer is for insulin. I know I can put at least that much in, right because I can cover it real quickly with a juice box. But you're looking at a 220. So in my mind, you're stopping the momentum, you're stopping you're covering a number, you have to account for the amount that's still going to rise before the insulin kicks in, like so you can kind of do that calculation through your head and go Alright, well listen, I think like say 220, a unit of insulin would bring it to 20 back to 90. So I go, Okay, I need a unit for the number. Now. I got to stop the arrows too, right? So I'll stop the arrows that probably going to take a unit. And she's gonna go another 50 points before this thing even slows down because I'm two hours up. That's how I sort of do the math, math math for me. Right. So Megan, I can't tell anybody how much that is? I can tell you the answers more. And I can tell you that you can do it in a way where your safety is how do I catch it on the way back down again. And I think that this is scary for people in the beginning, especially probably with kids or adults who are by themselves. But there's so much to figure out about this. And when you do figure out how to stop one of these things, the information you've learned that leads you to stopping this and bring it back level without a low. It will help you for years. And all other aspects of diabetes. Like when you really understand how to manipulate the insulin and smack that that high blood sugar down. It's It's It's the stuff you'll use forever. I think a gentleman might have a technical answer for this.

Jennifer Smith, CDE 23:58
Oh, well, let me and maybe a little bit more technical, because I you know, from what we all figure out by by experimenting on ourselves, we do. I mean, that's you've figured out many of the things that work for Arden, because of like you said, you do something you see the impact. And next time you're like, Oh, it worked but not quite enough or it worked way too heavy. So let's dial it back or let's dial it up. And while there's not really math there, there is an intuitive math that you're kind of using, right? If you really are trying to use a math to work this issue out. One she's right in considering Well, what was the problem to begin with? Okay, if you're getting a pretty quick rise up, as you said, it's probably the timing of the insulin in the Bolus. My my assessment would also be it's likely that the insulin to carb ratio is probably not quite right either. I mean, if it's still 45 minutes later When the insulin really should be getting active if there wasn't much of a Pre-Bolus To begin with, if it's still shooting up with a double arrow, there was missed insulin there as well. Right? How much one good and very, I guess, conservative way, if you wanted a conservative, you know, look of how to address how much is plugged into the pump. And see what is the pump recommending for this 220 blood sugar. Now, the pump doesn't know that there's a rise still happening, it just sees a solid, like written in rock number, right? And so you can utilize that and see, well, the pump is recommending you know, for a kid, it might be recommending something like point to your thinking will point to God, it's like a drop in the bucket, that's totally not going to touch a double arrow up with a 220 blood sugar. Okay, so intuitively, you know, something isn't quite right there with what the pump is recommending, nor does the pump know that it's still ascending. It's such a crazy climb. So there's where you can learn by saying, Okay, I know what the double arrows mean, the double arrows mean at least a climb of three, possibly more points per minute. So in the next 30 minutes, if you have a double arrow, and you do nothing about it right now, in the next 30 minutes, your blood sugar could be 90 points higher if you did nothing, right. So if you plug that number in as again, a way to use the math that's already programmed in with all of the ratios into your pump to 20 plus 90 Gets you What 310? Yeah, right, if you plug in a 310 blood sugar, and you ask the pump now to say, okay, what are you going to recommend for a Bolus? Now to correct this, you were going to get a more robust recommendation. Right. So that's a conservative way, it's not quite as bold as you would attack it with. But if you're trying to learn, it's a more conservative math way of figuring it out. And learning from it. Okay, you took the extra that the pump now recommended. And now I'm watching and the arrows have kind of angled and oh, it's now plateaued. But this is like that. It's another like 60 minutes that it took, because you took this conservative amount, right? So next time, be more bold, right?

Scott Benner 27:19
Because that can very easily lead to actual stacking. Yeah, so the difference between No, and let's add stacking to our defined diabetes list to that's a good idea.

Jennifer Smith, CDE 27:29
That's a good one.

Scott Benner 27:30
So I, I got some feedback about the podcast once where this gentleman said to me, we the day I said, it's not stacking, if you need it, he said changed his life. But it's not stalking if you need it. So but if you put in, in this scenario that we've built here, if you put in a half a unit, and then wait 20 minutes and put in another half, and then get frustrated, and wait a half an hour and put it in a unit, and now it's fit five, or you know, and next thing you know, you've put in three, four or five units over this hour and a half period, that is that you are going to get low later. But if you actually needed, say you actually needed three of those units. If you took it all up front, right, it wouldn't you wouldn't be stalking you. Because now because the impact of the insulin would be lined up with the with the carbs and what the carbs are doing right now. So the action of the carbs, the impact of the insulin are going to be lined up against each other, they'll get to that fight we talked about, then they'll all kind of dissipated the same time. But But thinking about the idea that insulin you use right now is for later, you keep adding later and later and later it keeps layering over top of itself. Eventually those layers are all going to be on top of themselves at the end of this timeline. And that's where you get low. So I like crashing up front because it also stops stacking it stops slows later. And if you are drifting low after crashing a high blood sugar, they are much easier to catch without loads or rebound highs if you haven't stacked Yeah, if you haven't checked if you stack Absolutely. Now you're stuck guessing how do I feed this insulin and not? Which one

Jennifer Smith, CDE 29:04
is actually which dose was actually causing the drop? So how much do I use to treat

Scott Benner 29:09
yourself a problem is what you've done. Yeah. A huge thank you to in pen for sponsoring this episode of The Juicebox Podcast. I hope you've enjoyed to ask Scott and Jenny as Jenny and I have enjoyed bringing it to you. Don't forget to find out more about in pen go to companion medical.com There are also links in your show notes and at Juicebox Podcast comm I'm going to take the rest of this time to remind you that I have a Facebook page. It's called bold with insulin. It's on you know Facebook, because that's where you keep the Facebook pages. Now there's a public page you can go to bold with insulin but once you're there is also a discussion group right? You got to kind of answer a couple quick questions that get in there so we know who's in there. And there you're going to find listeners from the show just like you talking about ideas about management supporting each other. It's very cool. You should check it out. I'm also on Instagram at Juicebox Podcast the Twitter if any of you are still doing that. Where else I don't know. Pinterest. I'm really I mean, I'm gonna be honest we I don't put anything on Pinterest last thing thanks so much for your wonderful ratings and reviews on Apple podcasts or wherever you listen means a lot I really do like them I say it means a lot a lot. A lot a lot. A lot. I say I say it a lot so I don't want you to think I don't mean it because I really do I say it a lot because I really mean it. I want you to know I also now wondering how many times I can say a lot before the music ends. Oh Joe, jeez, almost forgot. Check out Jenny at integrated diabetes.com Or there's a link in the show notes to her email address but integrated diabetes.com is where you can find Jenny Smith. Let her do the Voodoo that she do on you do a lot

About Jenny Smith

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

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Scott Benner 9/23/19 Scott Benner 9/23/19

#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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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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Scott Benner 9/23/19 Scott Benner 9/23/19

#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

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

+ Click for EPISODE TRANSCRIPT

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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