#293 Jenny

Certified Diabetes Educator

In our season six opener a long-form conversation with your favorite CDE, Jenny Smith.

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

Scott Benner 0:00
I have this sort of pet peeve around the way television shows and podcasts mark their seasons. For example, survivor, the television shows been out for 20 years, but somehow they're on season 40. I don't like that. Alright, even that makes sense, right? But don't don't launch a podcast have eight episodes and tell me that was season one. And then come back two months later, do eight more episodes say season two. I saw one the other day. It's not even two years old. They're like we're in season six. No, you're not. I mean, okay. But, you know, I don't know. It bothers me. Not a lot. I'm not, you know, not making picket signs about or anything like that. It's just one of those things that when I see it, rubs the wrong way, chase me a bit. That is why I'm very proud to tell you that today you are listening to the first episode of season six of the Juicebox Podcast. This is episode 293. And I wanted to start out the 60 year of this podcast, with a little bit of a mishmash. So I think the podcast is basically, you know, conversations with people, or conversations between me and Jenny, about management ideas. But what if we treated Jenny like a person and talk to her. So today, just start season six, I interviewed Jenny Smith. And in a real crazy, Mom, I just got a little rude Heather, in a real crazy twist, you are hearing this episode on the day it was recorded, which is never going to happen again this year, just so you know, probably. But for this one it is. Before I get to thanking the sponsors. I want to thank you, because of your support, because of all the downloads and streams and listens that this podcast gets, and the T shirts and sweatshirts that you've purchased all the stuff, all the ways that you support the podcast, I was able to upgrade some equipment. So I'm gonna sound a little better, I hope I was able to replace an old computer that was on its last legs that actually crashed a couple of times this year while I was recording podcasts. So there's new computer, same microphone, love my microphone, and some new equipment for getting my voice from the microphone into the computer. So technical stuff you don't care about. But nice new stuff, I was using five year old equipment. And now I'm not. So you will hear a little bit of that. Over the next couple of months you'll hear like this sound, which will be all new equipment. And then you'll hear me have a conversation with somebody with some older stuff, it should not be that big of a deal. I don't think you're going to be taken out of the moment by it or anything like that. But hopefully by about mid year, all of my pre recorded stuff will be published and produced and out the door to you. And then the new stuff will all sound like Jenny and I today where I have my dulcet tones. Coming to you right through the microphone. This episode of The Juicebox Podcast is sponsored by Dexcom and Omnipod. Please go to dexcom.com/juice box, or my Omni pod.com/juice box to find out more. Of course, as you all know, there are links in your show notes of your podcast player. And they can also be found at juicebox podcast.com. You're supportive the sponsors means a great deal to me. And I'm going to just come out and say it. It's how you get the podcast so much and why it's free. So if you're thinking of getting an insulin pump, check out on the pod. And if you want a glucose monitor at trial XCOM but if you do use the links.

Jenny Smith came on the podcast the first time in November of 2015, episode 37. She came on because a friend of hers that is who was also a friend of mine, Ginger said I think you should have Jenny on she's really interesting. And she thinks about diabetes the way you do. So she came on and we talked about management stuff. And call that episode Jenny Smith diabetes guru. Kenny came back on the show again, I think in an episode about a one C. And then for a long time you've guys probably heard me say this before I thought I really want to have her on more to talk about the podcast, like the stuff we talked about in the podcast. I'd love to break it down with her. I loved the way Jenny talked about management. So in 2019, she started coming on and we did the diabetes Pro Tip series, which starts at Episode 210, I think and goes on for a while. I saw how much you guys enjoyed it. And let's be honest, how much I enjoyed it. So it's like Jenny Kwan, just some more stuff. So we started doing ask Scott and Jenny and defining diabetes, all these little things you got on Fridays with Jenny, that is going to continue in 2020 and we're gonna do another Pro Tip series in 2020. I'm not going to tell you what that is yet, but I think we hint at it in this one. And it's going to be very cool. Anyway, I love it. Jenny Smith, she works at Integrated diabetes. And you can love her too. For money like that you don't I mean, you're not falling out. But you can go to integrated diabetes.com and hire Jenny and Jenny can help you with your blood sugar management. But anyway, she's a delightful person. And she will be horrified that I just said that. But seriously, for a moment, before I get to my conversation with Jennifer, she is just really wonderful, and honest and true. And every time I record with her, I don't even tell her what we're talking about. And I talked about that a little bit in this episode, but she is just such an incredibly good sport, and a fond of diabetes knowledge. I am thrilled that she comes on the show, I am genuinely happy to be able to call her a friend. And if you're in the Atlanta, Georgia area, I think in February, you can see Jenny and I on stage together, which I'm super excited to meet her in person for the very first time, even though she and I talk quite a lot

those of you who don't like it when I talk too much, you're gonna be thrilled because Jenny super chatty today, which I love. What else last thing I guess nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. Hey, how are you? I'm fine. How are you? Good. Happy New Year.

Jennifer Smith, CDE 6:51
Happy New Year to you, too.

Scott Benner 6:53
You're gonna be so surprised about what we're talking about today. Oh,

Unknown Speaker 6:57
I hope I'm ready. Oh, you will

Scott Benner 6:59
be I think you know the answers to these questions. Oh, good. Can you hear me? Okay, I have a new setup.

Jennifer Smith, CDE 7:06
I can you just beautifully.

Scott Benner 7:09
Excellent. So we are recording just so you know. Okay. So everything you're saying is being recorded? You know that. But I just want to double check that, you know, because I was thinking about that we're doing this even today, because while you're setting up times, I said to me, I'm like, Oh, that's right. After New Years, you know, let's not do that. And she's like, Oh, but then it'll be so long since we spoke. And I thought, Oh, that's nice. That's true. And I started thinking back about how you came to be on the podcast, and then to be on it more frequently. And I thought, You know what, we haven't done some dying to see what Jenny's gonna say, I don't know, I've never interviewed you, like a person with diabetes. I've always talked to you, like a C, D, or somebody who came on to talk about a thing or something like that. So are you interested in talking about you the person around your diabetes a little bit? Sure. Sure. See, this is exciting. Cool. All right. Well, now you all know listening that I just literally dropped that in Jenny's lap.

Jennifer Smith, CDE 8:17
It's kind of it was kind of funny, because you know, working with people, a lot of people like will ask, I guess, you know, like, how do you do things? Or like, what do you eat? Or like, you know, but I think it's more. It's more, usually, the parents that kind of ask, you know, things like, Well, what did your parents do and whatnot. And I mean, I was diagnosed so long ago that it's not really relevant.

Scott Benner 8:46
Yes, is what I want to talk about. So. Okay, good. Yeah. So you know what I'm getting at here. All right. Well, I'll tell you, what, Jenny, why don't we do what I do with every part. So you know, the podcast is pretty much broken up into arms, right. And there's the interviews, which are always just people randomly, like, they're not really talked about this in a while, but I have stayed pretty far away from talking to people who talk about diabetes as a matter of course, whether it's for money, you know, it's their job, if it's because they have a blog or something like that, only because, and not because they're they don't have great information, some of them, but because they're very practiced. And I don't mean that in a bad way. I just mean that they know the questions. They know the answers, and when you're speaking to them, it's sometimes sounds like that. Like, they're just they're reading respond, yeah. Oh, like, like, they're talking to someone who just was like, Oh, look, they just asked question. 17 I will use answer 43 For this, you know, and, and I just thought, the community's been around for a long time. We sort of heard what those people have to say now, you know, and I think the proofs in the pudding where some of them are not doing it anymore? Sure, you know, like, they're, they're moving away, they're getting different jobs, I have to move a little bit here for my microphone. They, you know, maybe blogging isn't what it used to be, or whatever it ends up being. Maybe they've just said everything they want to say, and they want to do something else now. So I've just always had on people have reached out into, you know, social media places, you know, originally, does anybody want to come on, people came on, then listeners start asking to come on, which is terrific. It's how I get some of the best interviews, just people who are ready to talk about something. Cool. Yeah. So I think that's always very, it's great. But then the other side of the podcast is sort of you and I talking about, like management stuff, you know, whether it's the Pro Tip series that ran through 2019. Or if it's maybe another Pro Tip series about, I don't know, something else that maybe will happen in 2020. Writer, there's the ask Scott and Jenny stuff that happens on Fridays. And it's interesting, because while you and I really only record together, what do you think maybe like, a dozen times a year or something like that, right? Like, it's not that often, you are a constant on the show, because of how it's spread out. Right? So I thought, let's let people get to know you a little better. So I usually start these interviews. And if you listen, you don't hear me say this, because I cut it out. I always say, introduce yourself anyway, you want to be known. And then we'll start talking. So go ahead, Jenny. Introduce myself. Well, as easy as it sounds, is it No, it's

Jennifer Smith, CDE 11:34
not as easy as Introduce yourself can take a lot of different courses, I guess, depending on who you want to be known as, right? I mean, right. I mean, so I'm Jennifer Smith, or Jenny, most people just call me Jenny. Rare people call me Jennifer, my father in law, one of them. And let's see, I have two little boys. I live in Madison, Wisconsin, I've had type one diabetes for 31 and a half years. I'm a certified diabetes educator and a Registered Dietitian. And I don't know. And that's, I guess that's, that's me in a very like little tiny nutshell.

Scott Benner 12:23
What people listening don't know is that when I interview people, I never see them. I always do audio. But when Jenny and I talk, we see each other. It's a little, you know, because we're talking about stuff overlapping where we're, we both have ideas, we're gonna get them out. It's easier visually, right? And so Jenny, when we do the podcast normally sits pretty upright. And she's in an authoritative position, right? Like she's about to talk about diabetes. She knows about this. And you could see it in her inner in her shoulders and her face. She's like, God asked me the stupid question, Scott that I know the answers to at the drop of a hat. And just now I asked her, she was her shoulder shrug forward, she leaned forward a little bit, she looks like she's 15 All of a sudden, which is fantastic. Giggling Your face is all like lit up and tight. It was very interesting to see you do that. No one else would get to see it. But I really enjoyed. Awesome. Just, you just meant like, Who me? Jennifer Smith. I don't know.

Jennifer Smith, CDE 13:18
I mean, because you know, and like I said before, it's like, there are so many aspects to somebody's life. And I mean, since this is always all about diabetes. I mean, it's relevant to say, hey, you know, I've got diabetes or whatever. But then, outside of that, I'm a lot of other things, too, I

Scott Benner 13:36
guess. Well, we might find out about some of them while we're talking. So let's just start with this because it's simple, and it'll be a little comforting. You were diagnosed 31 years ago, you said 31. And I've never really asked you do you tell people how old you are? I'm 44. Okay, so that you were 13? Yeah. Wow. So good at the math stuff. Now I'm getting really good at this level subtraction and additional things like that. So okay, so hold on a second. So 31 years ago, I'm just going to write down 2000. Today is, is today. The second is the second is going to be another interesting thing, we are going to record this and it's going to go up almost on the same day. So 2020 minus 31. Now, one minus zero, you can't take one out of zero, you have to borrow. So you make the two a one and then you move one over 10. So that's a nine. And now I have one you can't now you can't subtract three from one. So if the bar from this that makes that 19 This is 11. And then that's a you were diagnosed at nine years ago. No, no, in 1989.

Jennifer Smith, CDE 14:37
I was diagnosed actually in 1988. And we just changed we just changed years. So yes, actually my diagnosis my di aversary diabetes anniversary, whatever you want to call it. Is may 15 1988.

Scott Benner 14:53
All right. I was so well Jenny, this is weird. You were 13 Then Haha, and I was getting ready to I was going to graduate from high school the following year. Ah, I'm old. Okay. You're not all I mean, you have to say that because you're not that much younger than me. But

Jennifer Smith, CDE 15:14
well, it's kind of funny. It's always like, number relevancy. I think it's interesting. Once you certainly once you kind of get to a certain age, like, number wise, I feel like the number doesn't really reflect how you feel. Or maybe it does for some people, I don't know, like, I see my age number as totally not where I view myself in terms of how I feel or how I act about things or whatnot. I mean, I can remember as a teenager thinking, oh my god, like 40s really old like, right, you'd have a cane and like, crippled and and like, I just I don't, I don't feel that way, like a lot.

Scott Benner 16:00
I have a similar feeling. Like I got up off the sofa. So New Year's Eve, super exciting around here. Our children abandoned us pretty quickly. Cole went to a friend's house, and he's just like, I'm going to the beach. And I was like, Why didn't turns out one of the kids on the baseball team has a beach house. So they all just went there. And then Arden's like, I'm gonna go to lives house for New Years, and I'm killing it like, okay, like, you know, like you spent all those years like making like, kind of like a family friendly. New Year, same thing wasn't ever a really big deal. But all of a sudden, they were gone. I was like, What do you want to do? And she's like, we could watch the last half of the marvelous Mrs Maisel finish that off, and I was like, Yeah, okay. And so, here we are. Great shows. By the way, I love the Marvel. I'd said, Here's what I said to Kelly, you're sitting on the sofa. If someone were to buy me a marvelous Mrs. Maisel t shirt, I'd wear it. So. But we're here we are in the very last episode of this current third season. And it's there's like 10 minutes left. And Kelly says, oh, it's like two minutes before midnight. And I said, Do you want me to switch over to like the balls wrap or something? And she just No, I don't care. I was like, I don't either. Sort of it. But then I get up to go to the restroom A little while later. And I know I like I wasn't limping. But, you know, I had been sitting down for a couple of like, hours, and I was like, oh, and I and she called me old as I walked away, and I got in. And I was walking through the hallway. And I thought, I don't feel old. Like, like, I'm a little more achy than I used to be. But like, if I when I can't see myself, I don't feel that way. Right? Minute. I wander past the mirror. I'm like, oh, yeah, yeah, it's going away. Anyway, so that's a long time ago, right? 31 years. Do you remember management back then? Like, what did you do?

Jennifer Smith, CDE 17:51
100%? Well, I wouldn't say 100%. But yes, a good a good majority of what we did. I have good memory of because I also, when I was diagnosed, I stayed in the hospital for an entire week. Now that's almost unheard of. I mean, you may be in the hospital a couple of days. And then you're released with, you know, this line of information about what to do and what not. I mean, I've even worked with people who've gotten information about pumps and CGM and everything right away in the hospital, and they're on things within a month or two after diagnosis, which, you know, great. I mean, that's today's technology and where things move. But yeah, I mean, I was in the hospital for an entire week, I had a room at the hospital that was full, it was so awful, that they had to start putting my balloons outside of my door from all my friends and every everything that they brought balloons, and like all of the inflated balloons and cards and flowers and everything. I mean, I had, I had a really great group of friends at that age, too. And they came their parents brought them almost every night, even though it was a school week. It was in May. So we hadn't finished the school year yet, but they brought them almost every night to visit me and hang out with me and whatever. And but from I mean, from the beginning, you know, I, I learned how to give an injection in an orange. I did. I learned how to check my own blood sugar. And while my mom and dad were there, and would obviously help me do that. I mean, I went home from the hospital, giving my own injections and doing my own finger sticks and all of that. I mean, the glucometers then were nothing like days, like 10 seconds and you've got a value. I mean, I had to like physically have this hanging drop a blood that I put on the test strip, I had to click a button. It counted a timer down and I had to wipe the blood off the test strip and then I had to push another button and then I had to stick it into the machine And then it was like another two minute countdown before I actually got a value. It was like it. I mean, it seems like caveman age kind of stuff, right. But that's, that's where technology was. And in I believe I might be wrong about this. But I believe the first glucometer came to market in either like the home blood glucometers, where you actually physically didn't have to pee on a strip to just see a color of where your blood sugar might be within a range. I think the first monitor for home use was either 1983 or 1985. So it wasn't very many years. And that was standard that was huge. And I mean, so the monitor that I got in 1988 was actually an upgrade from that original, you know, so yeah, I mean it and use syringes. I mean, I used the old school stuff, have an MPH or end the cloudy insulin that you physically had to like, roll in your hand in order to mix everything up and make sure that you are getting an even concentration, you know, as you're sort of, I mean, it's an intermediate only lasts about 12 to 16 hours, right? Today,

Scott Benner 21:14
it would settle like oil and vinegar, like, kind of failing or

Jennifer Smith, CDE 21:18
kind of Yeah, so if you imagine like, the clear insulin that we have today, and then if the bottle had been sitting in the fridge, and all of the white content would settle it almost look like milk was settled at the bottom with white liquid at the top and you physically had to roll it in order to distribute and kind of reconstitute everything within them, you know? So and that had to be mixed. I mean, you had to mix the regular our insulin the short acting along with the intermediate longer acting in full and I only took shots twice a day,

Scott Benner 21:52
you would draw them both in the same syringe. Same syringe. Yeah. And what was Do you remember what was success? Then? Like, what were you aiming for?

Unknown Speaker 22:05
Um, well, and it

Scott Benner 22:08
I don't even mean a number, you know what I mean? Like, overall, like, what was your goal? You know, year to year from appointment to appointment, like a glucose wise kind of goal or what your health like, Were you just trying not to pass out? Like, were you like, you don't even mean like, were they doing anyone see at that? They were

Jennifer Smith, CDE 22:25
absolutely In fact, I, I saw my pediatric and every year, it must have been every three or four months. I would, I would guess because I felt like having not been a very like sick kid. Before I was diagnosed. I feel like I don't recall going to the doctor as much as after I was diagnosed. And so and it wasn't because I was ill and needed to go it was because you know, you do the annual light or the checkups and so they were doing them pretty frequently for me. And so yeah, a one see, I mean, I started high, remember correctly, my alien. See, when I was first diagnosed was like 12 something. And then after that he once he had it drifted down. I mean, I'd really have to guess. But I would say that it was probably somewhere in the sevens for a fair amount of time. And the doctors felt like that was really great. I mean, considering what we had available for tools to use. That was considered really, really good. In fact, I don't think that I had under a seven until I went to college and had when I when I went to college human log came out. And Lantus was just around if I remember correctly, trying to remember when Lantus came out, but I switched over, because I actually have heard about human log insulin. I was like, wow, I don't have to wait 45 minutes before I can actually start to eat. So I asked my doctor and my doctor prescribed Do you know some of the the humor blog to be able to take an eye? I know that I mixed humor blog for a while with the cloudy insulin and I didn't use enter NPH I actually used one my by Lily it was called lenti or L

Scott Benner 24:29
that I've heard the L

Jennifer Smith, CDE 24:31
Yeah. So I remember mixing homolog with the lenti. And then when Lantus came out, I started on that very soon after it was to mark it or after I could get it, you know, with my insurance or whatever. So I mean, you know, just moving through so many different changes. But you know, with the, with the plan of the way that insulin was essentially dosed for me when I was first diagnosed, a meal times were very specific times. Again, if even in the summer when I was not needing to get up early, my mom got me up at six o'clock every single day because I had to take my insulin and I had to eat. Because that was the plan. There was, there was no sleeping in. I mean, my my insulin got dosed at six o'clock in the morning and about like 530 in the evening. So about like that 12 hour span of time that they have between. I didn't take insulin with my lunch because the peak action of the cloudy insulin was supposed to technically cover my lunchtime, blood, lunchtime intake. I can remember going to and I went to, for for school for grade school and middle school, I went to a Catholic school. So we didn't have a school nurse, like at all that was not available. In fact, when I was diagnosed, I had to go into the secretary's office and check my blood sugar and she just she just watched what I did. She didn't have two clues about like, what was right or what was wrong. There was no texting my mom or calling her being like oh my gosh, your blood sugar's you know, 258 What should we do about it? No, I just, I checked my blood sugar because that was what I was supposed to do. And then I went to lunch.

Scott Benner 26:23
She was just there so that there was some adult supervision, but she didn't really add anything to it.

Jennifer Smith, CDE 26:30
She did nothing about it. No. And I went to lunch and I ate my lunch and I went to the playground and i i played on the playground, I had gym class, I was a cheerleader. I was on the volleyball team. I mean, I, I did a million things. And I think about all those things that I do now like and even just thinking about it right now. And like, I had no visual on what my blood sugar was doing. Right? I had no visual. In fact, I do remember. Originally, the doctors only really wanted me checking my blood sugar at mealtime. So I'd get up in the morning. I'd then check it again at lunchtime before dinner and always at bedtime. So it was like, check it four times a day. And my mom at some point, pretty soon after I was diagnosed. She said to the doctor, she's like, we need more test strips than this. She's like I because I was active. And my dad was really active with my brother and I She's like, you tell me that she needs to take insulin. Well, you also told me that my that this insulin can cause her to have a low blood sugar. So she's like, I need to know what her blood sugar is before she goes and rides her bike 10 Miles downtown with her father, right, you know. So I do remember testing more often. But again, that was as much extra visual, as we had

Scott Benner 27:51
enough still to make. Like it was just it made you feel more comfortable, I guess like

Jennifer Smith, CDE 27:55
it right. Yeah, right. Right. More information. But other than that, I mean, the thing was, I realized and I was 13. So from the perspective of that, versus a really small kid who doesn't really have bodily awareness yet about what symptoms might mean. I mean, I, I really, I guess took to heart what the doctor told me about the these are symptoms, this is what you'll feel like if this is happening, or that was happening. And thankfully, I I could acknowledge those changes in my body. I could tell if my blood sugar was getting too low and stuff. I remember my dad always bringing gummy bears along to go biking. Nice. It was it was nice. It was you know, it's a good memory just with my dad. But yeah, I mean, all of those things that we now have a visual to, there was there was no perspective of that. In fact, I'm really proud of my parents, I two and a half months after I was diagnosed I had originally I had previous to diagnosis then signed up to go on. I was a Girl Scout. So I was signed up to go on a an away camping trip. And it was supposed to be primitive, which we would camp, we would dig our own. We dug our own refrigerators, we lined it with straw and ice to put our cold or our put our food in to keep it like cold and wool. I mean, we had to start our own fires. I mean, it was everything to learn how to like camp in the wilderness really. And my mom was like, that's not gonna suffice. My daughter needs more than this. She's like, you need to allow her to take a cooler along with this food that she knows how to you know how to use

Scott Benner 29:41
medicine,

Jennifer Smith, CDE 29:42
medicine, essentially right? And my insulin had to be kept cool. My mom's like, you're not putting her insulin in the ground. I'm sorry. This is going. Exactly. So I mean, they, she certainly had to make a whole bunch of different like extra considerations with the camp. That year, because there was somebody for that two weeks of camping that actually had to bring ice in every other day to fill my cooler with so that it would stay cold.

Scott Benner 30:13
It was two weeks. It was two weeks. Oh my gosh. Okay. Yeah. All right.

Jennifer Smith, CDE 30:17
And the the kicker of all of this is at the end thankfully didn't happen earlier. But near into the into the second week, the the dug holes for like, putting in the food for the other campers were starting to like, fail. And so some of the stuff that they were going to put in the hole, they asked me, Can we just put some of this in your cooler? Because there was space? Then since I had been eating stuff? And I was like, Sure. I mean, I was 13 I was like, Alright, whatever. Put it in the cooler. I don't care, right. Well, I came home from camp with food poisoning.

Scott Benner 31:00
Because the food came out of the ground here. I thought you're gonna say that was the day Jenny Smith entrepreneur was was born and he's charged the kids the user.

Jennifer Smith, CDE 31:11
Yeah, no, no, no, I came home from from camp with food poisoning. My mom was like, so upset. She's got this child with like diabetes, they've never had a major illness like this before. I mean, it was. It's it stunk. But he survived.

Scott Benner 31:28
And he was sick for 10 days recently, right before Christmas. And I could feel it in my heart. Like, I was like, okay, she's getting sick. I will start now mentally preparing myself for not sleeping for the next week. And like everything being messed up, there were days where she didn't need like hardly any insulin. And you know, you're just going along, you find the pattern. I have to admit now, like, it doesn't take me long. Like I just had to tell myself like she's sick, like, switch to sick, you know? And then, but there is it is always in the back your head like, when's it gonna stop? Like, when's it gonna, like, when is it all of a sudden, but this time, she kind of gracefully went back into needing insulin, it was kind of nice. There's like a ramp back up, took a couple of days. That went right in to her cyst removal surgery. Oh, like three days before her sister removal surgery. She's looking at Kelly and I and she's like, I am getting this thing removed. And she's I'm like, Okay, and here's why she had planned it. I can't believe that, me a person who missed over 50 days of his senior year of high school, just to go to work or sleep or whatever. My daughter was like, no, let's plan this surgery that has basically a one to two week recovery period over my Christmas break. Because I don't want to miss any class. I was, wow, when she said that I was like, Get out of here. We've done way better job than I thought with you. Because my brain would have immediately been like, oh my god, are you saying I'm going to miss two weeks of school? This is fantastic. We can remove something once a year if you want to get on do you need a rib, you know, like, but she was just the complete opposite. So she, she's like, I think she willed herself to feel better. And when we got to the hospital, you know, at five o'clock in the morning for this procedure. She's like, I feel okay, I'm breathing clearly. Do not tell these doctors I was sick last week. I was like, okay, okay, um, and we used her weak mate. And we maintained control of her insulin throughout the procedure. And afterwards, and before, it was really cool, I'll talk about on the podcast at some point, but it all worked out really well. But she was, I feel bad for your parents, because I have all this visual data, you know, and your mom was just like, gonna wake up a sick kid at six in the morning and give her eggs like what if she's not hard, and it did not occur to your mom ever on a Saturday night? We could do this at eight instead. And then at eight at night, like she was just like, this is the rule. This is what we do. Right? And it worked for you. And it

Jennifer Smith, CDE 33:56
worked. It worked it was what it was in fact it's it's kind of funny you know, I mean, I guess once I got to college to you know, there were pumps on the market. I just was not I gotten so I guess a tuned to doing things the way that I had always been doing them with injections and checking my blood sugar and everything that I just didn't even want to consider a pump. I didn't start considering a pump until after I was married. I because it worked and I used injections for a long time I you know kind of like you know ginger mean, Ginger has used injections having come off of a pump that just wasn't for her. She's like injections work, I can make it work for me and I I was I was actually kind of, kind of I hesitated a lot when we were talking about like starting on a pump and what that would mean and whatever. And by that point pumps were actually much, much better, smaller, easier to use you No, you can put ratios in and everything that it would appropriately dose and figure out what you needed, etc. So yeah, it's interesting, just the difference in

Scott Benner 35:11
before we move out of that part of your life. I have a question. Yeah, you described a pretty solid seven a one C, you didn't have a lot of you know, you weren't low, right? You weren't, you weren't. Jenny wasn't the Dizzy girl or anything like that at school? So right? Better than better now?

Jennifer Smith, CDE 35:31
Hmm. I think that it's, I think that it's better now. I really do. I mean, the, you can look at it a couple of ways. I was also pretty young, and had a very watchful parental piece to my management. I mean, I, my parents were really especially my mom who did all of the cooking and all of that kind of stuff. She was really like, this is what the doctor says that we will do. I mean, which we've talked about before in the podcast, she stuck to it, but things were also not what they are now, by any means. And she stuck to it. And I think the biggest thing of why I had some good stability, while of course, we didn't see the variance in what was happening between the only had finger sticks to look at. And the average glucose, you know, as as an A one C, of course, we know the, the missing pieces in only seeing an A one C, right. But on average, if I kept a seven ish, a onesie, and it was in the low sevens, it really meant that because my mom was so regimented in, you'll take your insulin, now, you always get this much, you know, and I was on the exchange diet, too. There was no counting carbs for probably at least a year and a half before. I met with my CDE. And she taught me about carb counting, like and dosing insulin, you know, kind of based on that sort of concept. But other than that, I mean, I got, you know, two starches of fruit, a milk, two proteins of fat with like, all of my meal times, and my mom was on it. She was like, This is what you're getting right? And she didn't vary from it. And my snacks. I mean, I don't know if you remember, I don't even know who they were made by. But do you remember things called snack packs, they were like four little crackers, and a little packet of cheese, quote unquote, cheese, which really is like cheese food. It's really nothing. It's like Velveeta really is.

Scott Benner 37:33
At the end of the day. Yeah. But that

Jennifer Smith, CDE 37:35
was my afternoon snack for years. End of the night, it was peanut butter and graham crackers. Because that's what worked. And like so variants, you know, there wasn't a lot of variants just because we found things that made things stable. And do you feel like

Scott Benner 37:57
that? informed how you eat as an adult? Like, are you do you still eat like that? Are you like, because what you're describing really is? It's not a lot of variability like in food. Like, here's the Kevin graham crackers every night with a thing. Are you one of those people who kind of doesn't care about food? Are you just like, hey, yeah, that's fuel to keep me going? Or have you found a love of food? Now that you can you use your insulin differently.

Jennifer Smith, CDE 38:20
Um, I guess it's kind of a combination. I mean, I still, Food is fuel. I mean, you're supposed to eat in order to be able to live, right. It's a basic necessity of life, but also from the standpoint of my education and my collegiate schooling and everything. I understand the benefit of different kinds of foods and the importance of variety in those foods. And also really, really love I love cooking. And I love baking. So I've, I've loved the fact that with what we have now, technology wise, I can use that to have the variety and enjoyment of food while still acknowledging that food is really just a purpose. I mean, there's a purpose for it, right?

Scott Benner 39:08
I have such a weird feeling about food. I don't particularly enjoy eating. And I never sort of have, but if you get me too close, like this Christmas time, like, I swear, I was just like, I probably for four days lived off of like a chocolate chip cookie every three hours. So it's like, that's enough. You know, like, I'll just eat that cookie and then have another cookie and another cookie. And then at the end of the day, I was like, what Jeath it has like, six chocolate cookies spread out over like 18 hours. That's fine, isn't it? And as it was going I looked in the mirror three days ago and I was like I've gained five pounds. Like since the Christmas break started I absolutely know I have and so I just woke up the other day and made some eggs and I was like I'll just low carb it for a few days and drop this water weight and I don't have like a you know what I mean? Like Like, I don't think you could didn't mention a meal right now, right? Be like, oh my gosh, that. Let's do that right now. But I'm not thin. And I'm not. I'm not obese. I'm just like, I'm like, my weight fluctuates around. And if you get me too close to sugar, and I get going with it. If I wasn't smart enough to recognize what was happening, I could probably eat myself to death and like a month, I'm thinking, but I don't have any real like excitement around food. I just I don't

Jennifer Smith, CDE 40:30
have addictive No, definitely. Yeah, I mean, once you start eating it, it's the reason that you continue to finish a dessert even though from the standpoint of taste perception, you don't get any more delightful response from continuing to eat the dessert after that first initial, like, Oh, my God, this is so yummy, so yummy. And you just continue to eat it because that first initial response was the yumminess factor. But you really don't get any yummier. Like all the bites, keep tasting the same. You could just

Scott Benner 41:05
take one bite and have Did you see the? I don't want to get too far off the subject. But did you see the research of they got rats addicted to cocaine and sugar. And then once they were, like, you know, knew what both of them were and they both were affecting their brains. When they gave them a choice. They chose the sugar over the cocaine. Interest and that's something

Jennifer Smith, CDE 41:28
so meaning more highly addictive, just

Scott Benner 41:32
meaning when you give an addicted rat the chance to choose between cocaine and sugar, it took sugar. I don't know why. Maybe it tasted better, maybe? I don't know. Yeah,

Jennifer Smith, CDE 41:40
I wonder too. From a physiologic standpoint. I wonder if the body though, recognize that sugar was actually quote unquote, nutritive, right? It was energy, whereas the cocaine was sort of a false. It's kind of similar to those people who decide that coffee is their like food for the morning, right? They don't eat a breakfast, they just eat caffeine, right? Have coffee, and it gives them this energy level. But unfortunately, that energy level isn't like a sustained energy because there's really nothing backing up. There's nothing. There's no fiber, there's no extra protein, there's no extra fat or anything with it just goes in bumps them up. And then you get that like crash down.

Scott Benner 42:21
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So you make it through school in high school, okay, you're very active, which I wanted to point out because you you were an active person, which I think in those variable times where you couldn't see your blood sugar. That was probably a big help to you, even though you maybe weren't thinking about it that way at the time. You go off to college. Did you go to college nearby? How did that work out?

Jennifer Smith, CDE 47:11
I did go off to college. I mean, it was not it was not far away. But I but I didn't live at home. I went off my freshman year I lived in the dorms I lived with. I actually was fortunate in having a dorm my freshman year with a high school friend who was actually a grade school friend as well. So had not known me a long time. But yeah, I mean, I went off to college and you know, did my thing in college? And

Scott Benner 47:43
did you go find foods in the cafeteria that matched your

Jennifer Smith, CDE 47:48
I was I was on the college campus, swipe your badge and pay for your food kind of plan. Yep, I mean, whatever was there, we did thankfully have some outside of just the cafeteria, we did have some like sub shops and pizza shops and other like options on campus as well. And our dorm room was actually quite it was quite nice. We actually had a big refrigerator down in the common area. And you could put food in it there was a freezer down there, there was a stove and everything to kind of cook in. We were allowed to have microwaves in our in our rooms. And my mom at that at the time, you had to get like a specific written to be able to have an extra refrigerator in your room. And we did that. So I had like a mini like a like a camping refrigerator and I counting carbs by then. But by then I was counting carbs,

Scott Benner 48:47
you're using Humalog. So it was a little more like that no problems getting through college like medically, did you stay the same did it go up or down?

Jennifer Smith, CDE 48:56
My a Wednesday again, it stayed it never got into above the sevens I don't think until I was it was probably like my senior year in college if I remember correctly that I was in the sixes. And that was just from a knowledge of I mean, I'd been going to school I knew that I wanted to be a diabetes educator, eventually. I had kind of a whole course of this is where your career is kind of going to go. And so I I had made a fair amount of changes by just starting to also do some research about things and how you know how this works versus how that works, etc. So, on my own I ended up you know, kind of moving things down further by the end of my college career. So yeah,

Scott Benner 49:49
I'm gonna do Arden's lunch real quick. So while we've been talking, Arden was in a lockdown for like a half an hour. So she texted me and said, Is there something going on in town? We're locked down. And I said, I have no idea. I'm recording the journey. That's where I was like, Look, I'm not gonna stop podcasting to find this out, it's, you know, it's gonna be nothing. And then she gets a note. Then she sent me a cop came in and said, we can get up but we can't leave the room. But this was during her lunch. So we attempt her Basal is back when it's first happened just in case she got caught in there for a while. So now she's off to lunch, and I'm gonna put her Basal back. Try to figure out how much so I guess we're gonna do this. I don't know. Like, now everything's messed up. But no big deal. He'll figure it out. And I don't have to remember what's in there. Half a bagel puzzle cookies. All the Italians are mad at me now because I said puzzle and it gets picked sell.

Unknown Speaker 50:56
I wouldn't have even known that. Heaps

Scott Benner 50:57
yogurt. Something else down in there. Oh, okay. There's one of those like, like kind kind of like Nutty Bars alright. Anyway. Okay, so it's do you meet your husband in college?

Jennifer Smith, CDE 51:21
My husband in high school high school.

Scott Benner 51:23
I don't know why I didn't. I didn't guess that. Well, I don't know why. You guys really don't. But you do know Jenny by now. Like by now. Like I should have just said to Jenny, did you meet your husband in kindergarten, you guys bump into each other on the first day and to the soldier and and

Jennifer Smith, CDE 51:42
so you met with me when we met in high school. We got you know, freshman year. But we started dating. We went to junior prom together. And then we started dating that summer.

Scott Benner 51:53
So did he go to a different college?

Jennifer Smith, CDE 51:55
Did he actually went to Marine Corps? Oh, look at

Scott Benner 51:59
you. So he went right into the Marines out of high school. Yeah, you went off to college.

Jennifer Smith, CDE 52:03
I went to college. And then he went to he moved once. He could get a different order. He moved to Milwaukee and he went to university. And there. So we were close enough, then we could drive. And then we got married about a year after he graduated from college

Scott Benner 52:26
doing the math on that. And the best of my world history in my head. He didn't have to serve overseas at that time. Right. He didn't know. Okay. And how long did he still in? Or how long did you know?

Jennifer Smith, CDE 52:36
No. He when He was he finished? He was done after eight years. He was he didn't decide to make a lifelong career of it. Although, at this point, he says that he he wishes to some degree that he would have just for different, you know, reasons. But yeah, so he did not stay in long term. It was just eight years. So

Scott Benner 52:58
he said no, just eight years. I was like, wow, that seems like a really long time. But not a lifetime.

Jennifer Smith, CDE 53:03
Not a lifetime. No. And we I mean, we've been we've been married a long time. I we've been married for 20 years.

Scott Benner 53:10
Wow. What so you got married in? Oh, in 2000.

Jennifer Smith, CDE 53:15
We got married in 9999.

Scott Benner 53:16
Okay, well, I think I got married 99 No. 9660s upside down. Nine. That's what confused me. I got married. It was like 12 When I got married. So yeah. 96 I think I'm married 24 years this year. Wow. What do you like? 2120? Ish, like right on there. Right?

Jennifer Smith, CDE 53:36
We'll be Yeah, it was 20 this past June. So it'll be 21. In this coming June. Yeah,

Scott Benner 53:41
we, my wife. And I joke all the time. Like the great thing about getting married earlier and having kids earlier is that you have plenty of energy to get divorced at the end. So we'll be able to be able to work out the energy to be like, I might get an apartment.

Jennifer Smith, CDE 53:55
Kind of did things different. We actually didn't have kids early. You know, we actually did a lot of things we moved. We lived in a lot of different states. We you know, we lived in DC for a really long time. And so we we traveled a lot before kids. So we did a lot of things just as a like a couple prior to actually having kids.

Scott Benner 54:20
That sounds very nice. I don't think there's a right or wrong way to do it at all. Yeah, our life just pushed us in one direction and you might not have had the same things pushing you and see you like, ooh, we can do this. Everybody thing is great. You end up in DC. Is that the first place? You're a nurse in a hospital?

Jennifer Smith, CDE 54:36
Um, no, actually, after I finished my clinical internship in Colorado, then I took a job down in Orlando. So I moved down to Orlando. And I took a job there as a clinical dietitian inpatient. And I did do some outpatient education is Well, at which time I started logging my hours, to be able to sit to take the, the CDE, or the diabetes educator exam. And after we weren't in Florida for long, we are there for about a year. And then we moved up. My husband took a job up in DC. So we moved up to the DC area. And we lived up there for almost eight years,

Scott Benner 55:23
he worked in a hospital there as well. I did, I

Jennifer Smith, CDE 55:25
worked right in DC at Washington Hospital Center, with the endocrine team. And so we did inpatient, outpatient, we did emergency room, education, and I did two diabetes clinics with the endo team. So,

Scott Benner 55:43
yeah, do you think that moving around and having to get new jobs? I'm assuming you ended up in different positions at different jobs? Do you think that's all how you built this up? Or, like, like, your knowledge? Because, yeah, yeah,

Jennifer Smith, CDE 55:56
yeah.

Scott Benner 55:56
Are you a person who doesn't want to be somewhere forever? Are you just like, Oh, I've learned everything I can about this, I should go learn something else. Now. were you back then, um, did you follow the jobs with your husband, or how to go,

Jennifer Smith, CDE 56:07
I think we were more so um, I was a little bit of kind of everything. I mean, I knew that I needed experience in order to be able to move toward what I wanted to eventually be able to do. And so while I'm, I'm really happy in one place. Whereas my husband is sort of the the Wanderlust T likes to see an experience. And that's great. Because otherwise, I may not have ever experienced a lot of other things, right, it was great. But with the moving, I was also able to move my career. And, you know, I learned a lot of different things in the different places that I worked in starting out just as a clinical dietitian, teaches you a lot of things about all of the different health conditions, and how to manage them, and the nutrition that goes into them and everything. And then also seeing diabetes in respect to other conditions, and how it responds. And so I learned a lot, you know, along the way, and eventually got to my job in DC at the second hospital at hospital center with the endocrine team, I think was prior to working for integrated was probably my favorite. Besides what I do now, only because it was with a was with a really good team of endocrine doctors who, who were very like, foot forward and moving to what would be good to do in diabetes management. And they were very willing to accept us, there were four CDs on the team, including myself, and they viewed us as an extension of themselves. So you know, we would include with the outpatients that we worked with, we could make adjustments to their pump settings, we could help them for our type two patients who were using pills, we could help adjust, all the doctors did was sign in and sign off on our recommendations. That was it. So I learned a lot, you know, from that, and have been able to kind of bring that forward and in what I do now, so I watched

Scott Benner 58:24
my wife, like, my wife has an incredibly complicated job. And by that, I mean, there's a ton of complicated information that she has to understand before she can make her complicated rulings on things. And I don't just mean like a page of information. I mean, like, hundreds of pages of, you know, what's come before legally, sometimes medical stuff to understand, like, it's it's really fascinating. But there's a moment when I see her at a job, and I can see it now like, Oh, she learned the job. Now she's just doing it. Yeah. And then I wonder like, How long before she gets like antsy, like, Well, I'm not learning anything new. And I don't think everyone feels that way. And I think we're lucky when people do like, when a person like you feels that way. That's great. Because, I mean, honestly, if I would have said to you, when you were in Florida, you know, one day Jenny, you're gonna sit in front of a computer, and help people manage their diabetes, you would have been like, that's not a thing. Stop it. You know, like you, you made that up, where one day you'll meet a person who will introduce you to another person, then you're going to talk to somebody, they're going to record your voice. And this is going to end up being like a fulfilling thing for you. You would have been like, no, no, I'm a nurse. Like I help you know, like that kind of thing. It's it's you never know where you're gonna go. We need some people to bounce through, grab up ideas and keep moving like collect, you know, collect ideas like a like, I don't know, like a piece of gum on the floor, picking up dirt like did it just like constantly grabbing more and more until it's so full. You can't do anything with it. And I think it's obvious how important it is. When you and I speak, because I know I say this and I don't know how how well people take it. I really did start this episode today not telling you what we were going to do on purpose to make the point later that if you love those pro tips or the asks gotten generally stuff, Jenny does not know what we're going to talk about when I see her face pop in front of me. I'm, I'm really just like, Okay, here's what we're doing now we're recording boom, because I want her to just access her brain and say what she's going to say like I think, right, right. I don't want you to prep, which and you're really cool about it. Because there are some people who are come on the show, and I get like dissertations from them. Tell me what you're going to ask. I'm like, I don't think this shows right for you. Yeah, because I don't know what I'm going to ask you. Yeah, you know, that I don't want it to feel stilted. I don't want to feel like we're reading to each other. Right. But you couldn't do that. If you didn't have all those experiences. It's not like you went to college, and you came out like this, like, you know, boom, I know. So, let me ask you this. Not that this would minimize somebody who isn't. But how valuable is it being a diabetes educator who has diabetes? Does it take it to another level?

Jennifer Smith, CDE 1:01:03
Absolutely. 100% I more than that, because I think that's the piece that's missing, unfortunately, with most endocr, in practice, and with many edit educators, it there are very few who get it from the perspective of life with it, there are very few, and the the ability to take the relevant clinical information and the book information, and to be able to translate it into, like living it and applying it in life. You can't do that unless you live with something, you you cannot, you can't there is no ability to do it. I mean, I, I can't, I can give somebody let's say, who has had an amputation. Right. And let's say they have diabetes, and I can give them a whole bunch of different ideas for how they could get exercise and activity and whatnot, despite having, let's say, a lower limb, you know, amputation or whatnot. I, however, I don't physically know what it takes to move my body without limbs. I don't. And I would never, and I've got a very dear friend of mine who's married to a wonderful guy who was overseas and lost both of his lower legs. And he's a phenomenal athlete now and whatever is, but seeing him in action, and and everything. I know from the perspective of diabetes, I would I would never assume.

Scott Benner 1:02:45
Yeah, his product manager, right, his perspective is much more relevant, I would think, right, then just somebody who's like I've, yeah, I will, I'll say that, you know, when I started the blog, all those years ago, I always just thought like, well, this blog will be for people who have kids who have diabetes, and therefore, you know, it's not, it's not questionable for me to be writing about it, right. And I always did keep it that way, for a really long time that it was always just my perspective of being the parent of a kid with type one, I tried really hard not to put myself in my daughter shoes. And then when I moved to the, you know, when, when the ideas that we talked about now kind of started to form for me, it was not lost on me that now I was talking about how to use insulin as a person who doesn't have diabetes, but not just talking about it in a real light, kind of like, this is what's written down in the package insert, this is what you're supposed to do kind of way, right. I was worried, like, when the podcast started, like people might like, not like this, like that. It's me, you know, or a person like me, or maybe the podcast is just going to be for other parents still. But it has grown beyond that, like there are as many adults listening as parents of kids, I still think that one of the nicest things anyone said to me, is that I was talking to a person who had type one diabetes, and they said, I forget you don't have diabetes, what we're talking about, right? And I was like, Oh, that's so nice. Like, you know what I mean, but I think that I think that much like you going from job to job, the job, that blog, put me in different scenarios, and then being the parent of somebody and actually caring and then being the caregiver, not just like a dad, like not the dads aren't involved, but like, I'm like, the 24 hour parent, you know, all these little pieces. You can't like help, but you can't help but to pick things up at some point and write you know, and then the podcast allows me to sort of step back and make sense of it all and, and kind of like, take the parts, take them apart, put them back together and make a bigger idea out of them. But I was worried like I thought people would be like, and it happens sometimes. Like I'll get a note every once in a while from somebody who says like you said, My endocrinologist and I'm like, yeah, it's just the like I'm just misspeaking, but from a person who has type one they don't like that as much like they don't me like they're like animal Miko and I get that like I do I really get it all. So tell me when you from meeting people in a hospital setting to now meeting people one on one. What do you find? To be? Like I asked this question of my daughter's endo a long time ago, and it led to this podcast really? I said, What would you change for people? If you could? And I'm going to ask you a slightly different question. What do you find that people are lacking? That once they have things change for them? What do you give them that ends up being a big deal? And you boil it down to a thought? Or a couple of thoughts? Do you think?

Jennifer Smith, CDE 1:05:39
I, I feel like the easiest way to describe the difference between one type of like, present education and another, like what we provide is like a helping hand, like a holding something that's, that's there, like the people I work with, they know that they can reach out. And we really try hard to get back to people within about like a 24 to 48 hour time period with a response. In fact, most of our clients, you know, if they've got something significant mean, they text us, you can't there's no, there's no helping hand in a physical endos office or another CDs office, they're not going to give you their line to text them. They just if they are, that's a really special person that you're working with. It really is. So I think from that perspective, the difference being like I always hated when I first started in my career with initial jobs, I really did not love inpatient work, from a perspective of education, teaching somebody something when they are in a state of illness. And there are 6 million other people trying to help them in. That's not a that's not a time to teach them something. It's not. And I mean, from the standpoint of let's say, you know, many people come in the hospital with one thing and they find out by blood tests, oh, my goodness, now you have, you know, type two diabetes or whatever, look at your blood sugar's blah, blah. Sure, they need to be taught some basics. Absolutely. I mean, you have to teach them how to take insulin, or how to dose their pills or how to check their blood sugar. They need to be taught that absolutely, you're not going to send them away, you know, without, but from a real perspective of true in depth education, in inpatient setting is not the place to do

Scott Benner 1:07:36
it. Crazy that you say that, because last week, you know, like I said, Arden had a had a cyst removed, and they did it. God, what is it called was the process where they just make little holes and go in with like, a machine like, oh, like a laparoscopic. Yeah. And so she had these three small incisions. And she's, you know, coming out of there. It's an outpatient procedure. So she's out of the, you know, the anesthesia, and she's pulled herself together. And when we left, I said to Kellyanne, like, the nurse that talked to us at the end, she really just kept hammering these, like three points over and over again, she must have said them, like four times. And while like, by the time she gets to like, the third time, like, Yeah, I hear you like, I got it. Thanks. Right. But then you come to realize it's a it's a, it's a frantic time in people's like, lives. And these are the like, don't die advice, right? Like, like, let me make sure you do these things right now, this is what's important, and then call the doctor if you have a bigger problem, right? It's not a time to start talking, theoretically about, you know, what's next, or, you know, the next slide. And so I always do try to say on the podcast a lot, like I think your your, your windows are all doing an amazing job, you know what I mean? They just don't have access to you the way you just described. And I have noticed when I've spoken to people, privately, some of them really just do need you to say, Yeah, that makes sense. You're doing a good job, I'd keep going like that. Trust yourself a little bit. You know, it's, um, it's fast. I

Jennifer Smith, CDE 1:09:03
think. I think within that, too, I think some people have the sense that they could be adjusting, right, they have the sense, but they've gotten it drilled in from an endo perhaps, or whoever else who takes their pump from them when they get in the office and makes all the adjustments. They get the sense that they're not supposed to be that they're like doing something illegal by actually touching their pump and making a change that will help their life right now. Well, right.

Scott Benner 1:09:32
So look at 31 years ago, little Jennifer Smith getting yanked out of bed on a Saturday morning to have breakfast, right? Your mom, your mom probably could have like fudge that around a little bit, but she's just like, No, this is what someone told me. I find that to be incredibly true. And so you get the don't die advice. And it seems like the only advice and it feels like the most important thing and then and then I think that it gets lost and I know I've said it before but you just said it people start seeing I could be making a change here that I think would be beneficial to me. But the doctor didn't say to. And so then they end up with a, it's a more of a psychological conflict, then, you know, like, I want to do this thing. But I, I'm afraid I'm not allowed to, but if I don't know, I'm afraid I'm hurting myself. So they get caught in complete inaction, then they're frozen, you know,

Jennifer Smith, CDE 1:10:20
and they're afraid to get them, you know, they're afraid to get this, like, complete, like, you're a five year old child, and why did you, you know, throw that toy across the room, I didn't tell you what your Basal until you could touch that. And I think that with the people that we work with, I think that's the piece, too, that helps them kind of come to terms with gosh, I can be this is how to make an adjustment because Jenny taught me how to make this adjustment, I see this change now. And I can adjust it, I don't have to check with her. You know, when she when I upload the next time, she's gonna see the change that I made. And we'll talk about it and whatever. But I think initially, many people feel like very stock.

Scott Benner 1:11:02
No, no, no, I completely agree. I have actually wrote a couple of questions now for you. It might be hard to believe, right? Hold on a second, but I don't remember them. I have to look now. So well, this is we just hit this like I was gonna ask you the importance of people having confidence in their decisions? And I think that's, that's important. How much do you see? Maybe you don't maybe you're seeing more forward thinking people in your practice now. But I feel like so I feel like when when I came into like the blogging world, it was fairly early on in it. And then you can see people, they take the, what ends up happening is, is whatever part of you you feel strongest about, or, you know, a thought that you feel strongest about, when you start talking to other people, this is the now the angle you come from. And some people come from scared angle, they might write a blog for ever, that's about like this, this scary, diabetes is scary. And it's a really valid, you know, perspective. And then some people are, you know, I just, you know, whatever they do, I went from the management standpoint, where I started thinking about, like, I don't want this to be my daughter's story, like, you know, 15 carbs, 15 minutes, this is as good as we can do. Like, I just thought there must be something better here. I bet you there is. But then that becomes commonplace. Like, you can see I'm more of a management oriented, you know, content provider. But what happens when you're a fear oriented content provider, then you've been doing this now for 20 some years. And, you know, we went from two, you know, two tests a day and not really knowing what was going on to glucose monitoring, or the ability to check your blood sugar with tiny little drops of, you know, blood more frequently. Like, what, at what point? Do you have to look back and say, That's old timey thinking that's not valuable anymore. Like it's actually harmful to people at this point. Like we're teaching, you can't teach 1975 and 2020. But those people have had great success with it, you know, or, or it's all they've known where, you know, and I feel weird, but there's got to be a moment where like, I wish there was an arbiter of like, of patient sharing, who could come in once in a while ago, hey, you know what your thing was great in in 96. But you got to stop telling people that now like, because that's not relevant anymore. I've always talked about the idea of I don't want my daughter to ever look up and think, oh, wow, no one's doing it like this anymore. You know, what I mean? Because not not to change for the sake of changing but when there's real leaps made to leap along with it. Right? Do you see a lot of people who have old ideas, and to those old ideas come from like, you know, from Dr. Still, because, you know, we talked about online, but the truth is, the online community about diabetes is amazing. But it's a tiny fraction of the people who have type one diabetes, no wrong. And and like, so when those ideas come from somewhere. They they come from doctors, do they come from personal fears? Like, you know, do you see it a lot anymore? Do you see people who are a little more emboldened?

Jennifer Smith, CDE 1:14:13
I would say the latter, I would say definitely people who are much more. They're more in search of making a change and making it a beneficial change and what's available, and how can I use this? And hey, did you see this? I mean, I am from the perspective of like, a career that there's not a boring piece to it, at least not at this point. For me, I am certainly in a place career wise, and in a job for what I can do that things keep evolving and changing even in what I need to teach. Because technology is changing so much and because we're learning so much more. So, you know, from the standpoint of The people that we typically work with, it's those who are really reaching for more, that really do want. It's not, it's not common that we have somebody called Office and they're coming to us specifically on like, just injections. And not necessarily that it's bad to be on injections, but those that who are still using that as, as their management strategy, they're being bold about it, they're, they're using it to their advantage, they're not afraid to use it, you know, in the way that they need to take 12 injections a day, if it means that they're keeping things nice and stable that way, great. It's, it's really odd that we would have somebody come to us, and they're still doing what I was doing in 1980,

Scott Benner 1:15:50
there are people doing that still, right, they're just not visible to us,

Jennifer Smith, CDE 1:15:55
I would say they are probably more so in a I would say more of maybe like a rural type of community, that maybe access to things

Scott Benner 1:16:08
disconnected in any way really,

Jennifer Smith, CDE 1:16:10
you're disconnected, right, they're already disconnected, they haven't had, you know, their endo might be an old school type of Endo, they're not reaching out to like the online type of community that's either not for them to do, or they don't know that is an option to do. Or they're kind of lost in how to use the information that they see there. And there's nobody to guide them in using it. So they just they don't make a change. Or, again, you know, people who've been doing something for such a long time, and they feel like it's working for them. So just don't want to change. Yeah, I should I make a change. You know,

Scott Benner 1:16:45
I know, next weekend, not this coming. But next weekend, I'm going to Oklahoma to give my talk in in Oklahoma. And to give you a feeling for how true what Jenny just said is, is that when I was initially contacted with Oklahoma, from Oklahoma, the message was, hey, you wouldn't come here. Would you like that feeling like you won't come here, right? And I thought,

Jennifer Smith, CDE 1:17:10
like you're from like the law. I'm like, I'm like,

Scott Benner 1:17:13
no, yes. I would never go to Oklahoma. Like no, I said, no, why? And she's like, well, it's more rural. We don't get as many people. I've seen pictures of some of your talks, talking to 600 people, we're only going to get 200 250 People here. And I to that I responded, No, no, I think it's more important, or you know, just as important to go where you are. And then I laid out my idea. And I told her I'm like, my goal with these talks, is to just go around the country kind of selectively, and start little bonfires of people being bold, you know, teach it to 200 people, and maybe it'll stick to 50 of them, you know, and maybe 10 of them will tell somebody else. And maybe 10 years from now, there'll be a community in Oklahoma that spreads out with with that kind of thinking, like I was like, that's how I see this because we can't reach the people we can't reach not everyone's gonna listen to a podcast, not everyone's on Facebook or Instagram. Honestly, most people aren't. Right, you know? And so how do you go find those other people who are thinking? No, this is okay. And how do you? Man, it's funny, I'm now talking about one specific person who will hear this and understand that it's them. Someone who found the pot. So there's a person who listens to this podcast, who listens to it, because they were in a diner when someone else saw their pump, and basically went up to them and started talking about this podcast with them. And now and now another one of those people is talking to their friends about it. But they've had they had this experience where one of their friends was like, hey, right on, I would love to do better. Show me how, and the other one just isn't interested. Yeah. And then I had to tell that person like, you can't, you can't internalize that, like, it's up to them. And you can't, I know, you'd realize if they would just make these tiny little changes that you know, the improvements they'd see. But you can't do that. I've had to get away from that. And I wondering about it for you to like, how because I know it hurts. For me, it always comes from like reach. I always feel like every person I don't find as another person doesn't have the opportunity to understand something they didn't understand before. But I wonder what it's like to talk to somebody. Is there ever people who just don't ever get it? And like you've done everything you can do and you just can't figure out how to explain it to him or do most people see an improvement. It's just the that level of improvement varies from person to person.

Jennifer Smith, CDE 1:19:49
I think the level of improvement does vary person to person. Most people however, at least that we work with. tend to see sort of elite Send improvement beyond where they had started, even if they were trying to be more, you know, more aggressive, more bold more this is I'm trying to do this, it's not working teach me what I'm not quite doing right about this. And they move forward, you know, and make huge improvements. And then there are, I think there's a, a piece there for some people that might be fear based as well. Right, because I, I have not many, but a couple of like, early college age kids, teens, I guess, that I work with, who are doing all of their own management and have been for years, but they are, there aren't very many things that we can continue to tweak, in order to get their averages down. Because they, they still have that ground level fear of lows from either like one incident of a very significant severe low blood sugar in which they needed to be helped or whatever, or from whatever was instilled from, you know, a doctor growing up or wherever it came from. But you know, stable looking values just running, you know, at like 170 or 180, instead of being down in a healthier target range, right. So I think, you know, and, you know, an example to have, like, ability to have information, sometimes it's a it's community based, like your Oklahoma kind of setting, you know, we're only gonna have 200 people. Yeah, but those 200, like you said, they may reach more and more and more, or they might outsource, and they might say, you know, what, we're not getting what we need in this community, we need more, we need to ask for, you know, additional practitioners to come in who do get it or whatnot. A years ago, it was probably about six years ago, I went and I did a talk at a kid's camp in Sioux Falls, South Dakota, very small community. They had this beautiful small kids camp, you know, for kids and family members with diabetes, and I did a presentation for them, and encouraged kind of similar to what you get at it's like, being more aggressive. It's being more bold. It's not having the fear to address things and adjust things. And one of the mothers, you know, in the question part of it, she asked, she's like, But who do we go to then to check up on what we're doing differently? She's like, in our small community here, she said, we we drive far to get to our one paediatric Endo? Who, and she said, if we don't agree with what he's telling us to do, and she said, many of us don't. She said, then we have to drive as far as Colorado.

Scott Benner 1:22:58
Well, actually see back there pump or something like that? Or, you know,

Jennifer Smith, CDE 1:23:01
right. I mean, so there are, there are some of those settings where you have to judge and say, Okay, well, this is what we can do in the setting that you're in. Yeah. This is how I can teach you to do things a little better. And if you can bring information to your doctors, and I think that's the big piece, too, is bringing in information that says, This is what I did differently. I know you told me not to adjust, but I did. And look at what it's done now that we have the tools today that we didn't have, you know, 30 years ago, when I was first diagnosed, we can bring in tools and we can say, hey, I adjusted and look what happened, I'm no more in Target or I'm not having these peaks after my meals or I'm in target all night long. I mean, have a mom had just a CGM. I'm sure that she probably would have said, Gosh, Jenny doesn't have to get up at six o'clock and push it until eight o'clock or whatever, she decides to get up, you know, and if she starts to travel down, I will wake her up earlier, you know. So

Scott Benner 1:24:00
I hear you, I think that as maybe overly simplistic as it sounds, the, our inability to communicate is is the rate limiting factor. It always says it's either the doctor's inability to communicate or like you just said, I've done something at work. But how do I get that across the doctor without them being mad at me? Like how do we talk to people without things escalating? And and a lot of us don't have that skill. Like Mike you know what I mean? Like we like some and some people get very emotional, they just come in and they right away feel like like little kids like you said or whatever and and you just don't say something in the right way. I mean, how many times have you had a great intention in your mind and then opened your mouth and 10 minutes later you're fighting with somebody and all you can think in the back of your head is this isn't I don't mean to be fighting with you. Like I didn't come here for this like you don't mean like I had I haven't I get so far away from my message. Right, let's just because a lot of us don't communicate well. And I think that is the basic issue, you know, like, if you have something that works, you should be able to say to a doctor, and you know, if you have a good doctor, they'll hear you. But what if, what if they're not a great doctor? What if they're full of ego? Or what if you know, blah, blah, blah, blah, blah. And that's where you have to be able then to just turn to those penguins from Madagascar and just be like, just smile and wave boys, just smile and wave. I tell myself all the time somebody tries to change your swing, just go Oh, yeah, sure. I'll try it as soon as you walk away. Thank you, I appreciate your concern, and then just go right back to what you're doing. So you know, and I do think sometimes that has to be you have to know who you have, and and know who you're talking to. And then, you know, adjust what you're saying. I hate to say it like this, but to get the outcome that you need. Right, you know what I mean?

Jennifer Smith, CDE 1:25:57
Right? Right. I mean, I've been very, once we, when we first moved to the DC area, I met with a doctor with a new insurance plan and whatnot. And I, oh, I just needed a prescription. So I needed primary care. And I also needed a referral to an endo, right. This primary care, didn't even know how to write a prescription for insulin, which in a major metro area, really was kind of scary to me. And I left her office. And you know, those little surveys you get about your doctor visits, like after you've been there. I filled it out, I don't know, whatever came of my survey review of her, but I was like, and she had given me, you know, some referral to NGOs and whatnot in the area, which I was very happy for. Because I was like, I am never ever going back to this person ever again, even for a simple cold. My gosh, I was so worried like what she was doing for other people. But in terms of it taught me something about like, asking ahead, how they wanted a primary care doctor who was more knowledgeable about just diabetes in general, I could have done some looking around, I could have done some asking. So even essentially, when I call the office, I learned after that, calling endo offices for new endos. How many of your clients are type one? How many of them use a continuous monitor? How many of them use an insulin pump? How much? You know? How often do you see them? Those are just questions that I've learned over the years to ask to actually find a caregiver who's going to be most appropriate for me to start to work with. I mean, I overall, for the majority that I've worked with, I've sort of just gone into the appointment very boldly being like, this is what I do, unless I have some major trauma or whatever. I really need prescriptions from you. And I really need lab work from you. And if you see anything in my data, please say something. Please say something about it. But also let's discuss it and not just say, well, I You could change here, you could do this. But why?

Scott Benner 1:28:04
Even that? Just think of my visits as 10 minutes of bathroom break for you. Just take my $40 copay, and we'll shake hands and not get out of your hair.

Jennifer Smith, CDE 1:28:15
Exactly. Yeah, it's interesting. So you need

Scott Benner 1:28:19
a Jiffy Lube is what you're saying for doc right? You just want to you don't ever want the car to get cold. Just drive in the front right off the back and keep going again. Okay, yeah, I'll tell you what some healthcare might go that way eventually, with you know, talking to people online and I maintenance stuff like that, it really could end up being like that.

Jennifer Smith, CDE 1:28:37
Well, we've just got a card in the mail the other day from our insurance for like Tella doc. Like if you've got a cold or the flu, or you know, whatever and you want to talk with them, you can literally like FaceTime with them for like 10 minutes for like five bucks. You can get your visit taken care of without ever leaving the comfort of your nice comfy slippers at home.

Scott Benner 1:29:00
We did something with one of our instructors recently that was on FaceTime, because and we're going to talk about it in 2020 Arden's been going through a lot for the last year and a half and it looks like it's coming to a close now. But the one doctor was just like, Look, don't drag her all the way over here. Just let's just video chat real quick, and we'll get this out of the way. Cuz she she'd been there enough. So I don't think it's not viable. I really don't. And listen, doctors, doctors and their family members have been doing it for years over the phone, right? They don't let you know they do.

Jennifer Smith, CDE 1:29:34
It's kind of almost like returning to old school, like Laura Ingalls Wilder home visits from the doctor. It is, I mean, it's more technologically advanced than that, obviously and you're not going to pay them with like a chicken or a pie. But

Scott Benner 1:29:50
listen, there. It's just not everything is not feasible. There's no doubt that people will reach out to me as I'm sure with you. And I think to myself, if I just was were you Are, we could have this straight in about 18 hours, but I can't do that. And so the best I've been able to come up with so far is you should probably listen to these episodes and then these and then go back to the other ones. And I think that in three or six months, if you put the effort into listening, I think you'll get to that point somewhere, right, but I can't, you know, I just I can't I mean, obviously, no one can. There's millions of people with diabetes. And I don't think there's many people who understand how to walk into a scenario right away and go turn that off, turn that down, do this do that this is happening because of that. It's just it and it's sad. Like, it makes me feel sad sometimes. So I guess that I have two last questions for you. Yeah. The first one is, do you really prefer Jenny or Jennifer? Like, if you could make people call you something? It's Jennifer. Right?

Jennifer Smith, CDE 1:30:48
Honestly, I don't care. I don't I don't really mind. I don't. I don't really like Jen at all. It's not Jen. Just that, Jen. I don't. But Jennifer, you know, my husband calls me Jennifer. My father in law calls me, Jennifer. But majority of other people just have always called me Jenny. I've got one aunt who calls me Jenny Claire, because my middle name is Claire. And she's always lifelong called me, Jenny Claire. Um, but other than that, yeah, I mean, I've always been okay, Danny,

Scott Benner 1:31:20
I'm glad because I've, over the years, felt like I just strong armed you into being called Jenny at some point, because I didn't understand what you wanted. And then my very last question, I guess is, do you ever have that feeling that I just described like you ever think, like, you just feel bad? You ever just think, Oh, I could help this person. If I could just take them out of the mix for a second. Like, it's a really weird thing to think. But if you just took them out of control for a second, you could just like, put this right. It's almost like watching someone do a puzzle who doesn't see the pieces? And you're like, oh, my god, get out of the way. You know? Yeah. But but do you have that sad feeling? Or do you feel more hopeful about it? Or like, where do you think my best? I guess my better question is? Where do you think this is all going for people with diabetes? Like, do you think it's going to keep getting better? Or do you think there's always going to be this level of I just need to? Do people just want set it and forget it that badly? That they don't want to understand it that much? Do you think or does it vary?

Jennifer Smith, CDE 1:32:18
I think it varies, honestly. I mean, from my perspective, I'm, I've always been like very science, like math kind of oriented thinking even as a kid even prior to diabetes. And I always wanted to know, like, the why, why is this happening? How do you fix it? What's the, you know, my brother kind of took it to the other side. He's very mechanical, he was he just took everything apart. He wanted to know why it worked the way it did. And then he could put it back together. And mine was like, what is the body doing? Why is it doing it that way? Why is this happening, you know, and then they're 100%, just different personalities, some people truly just want and quite honestly, for long term health, I think really need a set it and forget it, they need a system that is going to just work for them. And it's going to dose insulin, and hopefully someday the insulin, you know, glucagon kind of component altogether, they're going to be able to set it. And unless something changes, like they need to re enter their weight, or whatever, they need a system that they don't have to do very much with. And I think, from the perspective to have many people with diabetes, who also might be living with some type of mental disability, I think set it and forget, it could be very, it's very important. It's very advantageous, but then there are people, I think, parents, to my mind, sort of come into the picture here, they very much want the tiny, microscopic, in and out of this management, because they've gotten so used to doing it with so many things change, things that change for little kids through the growth time periods. They know things change, they know how to eventually react to it. And you know, they're kind of attuned to it. So to take that away, I know from my perspective, when I transitioned into using the system, the pump system that I'm using, it was very hard to take a bit of a step back and let it do its job, right. Without my thought, which had been there for like 20, whatever. 28 years, I guess, before I'd started using this, so yeah, it's it's hard.

Scott Benner 1:34:36
I think you and I have a Yeah, a Pro Tip series in us in 2020. That's going to talk about that so we'll get to that pretty soon. Cool. All right. Well, I really appreciate you doing this and being so open and just talking about yourself I thought was really great. Yeah, happy New Year. Happy New Year to you. I'm gonna I'm gonna hang up here and and say one thing to you that I don't want all these people to hear. So hold on. For now, that's how you start off season six of the Juicebox Podcast Am I right? Thank you so much, Jenny for coming on and talking to me differently than you usually do. Also want to thank Dexcom and Omnipod, for sponsoring this episode of The Juicebox Podcast, please go to dexcom.com forward slash juice box and check out the Dexcom G six continuous glucose monitor. And then my omnipod.com forward slash juice box where in a couple of clicks and keystrokes, you will have an omni pod demo sent right to your house free, absolutely free and zero obligation. Just try it. Bring it home, try it on, see what you think. And if you'd like to work with Jenny, one on one, you can go to Integrated diabetes comm and find her there. There's also a link in the show notes with Jenny's email address, you just send an email like Hey, Jenny, my name is Bill. And I would like to have you help me with my blood sugar. Thank you, Bill, you probably will be more thoughtful in your email. Hey, you know what, if you want to see me and Jenny together, we are going to be together in Georgia on February 29. You can actually go to the bolt with insulin Facebook page, go to the events tab there you'll see let me see what I got coming up January 5 St. Peter's hospital I think that one might be sold out. January 11. Type One Nation Summit, Oklahoma City, Oklahoma. And on February 16. I'll be at the Greater Dallas type one nation event that's in Irving, Texas. That's a Sunday. And here Jenny and I will be in Georgia the type one nation event on February 29. I'm doing a Juicebox Podcast live with the JDRF in Appleton, Wisconsin on March 26. That's a Thursday evening. I think it's like a three hour event. And then on May 30 touched by type one that's with a touch by type one is dancing for diabetes. They're going to be a sponsor again this year. So excited. But you'll be able to see me in Orlando, Florida on May 30. And then I have something set up on August 22 2020. The type one nation event in Richmond, Virginia. I do not have any details about that yet. And there might be something coming in Indiana, not certain. Anyway, if you want to see me that's the schedule for now bold with insulin on Facebook, go to the events tab. I actually think you can also go to Juicebox Podcast comm go to the bottom click on Events, you can get that same information. All right, season six of the Juicebox Podcast is here. I have a lot to say about this. But I won't say it here. This episode's been very long. I'll do it a standalone episode soon for myself, where I'll talk about what's coming up sort of a state of the podcast address, we'll do something like that. Here's what I need from you in 2020. I want you to be bolder, I want you to have a better time of it an easier time of it. A healthier time of it. I hope the podcast helps you that I hope it helps you find community a sense of calm motivation that all is goes without saying and then I need you to tell other people about the podcast. That's your job, right? My job is make the podcast and put it up on the internet, do the editing all that stuff, get the gas I'm doing all that right. And then you tell other people about it. Honestly, the division of labor here seems kind of unequal. But, you know, Fair's fair. I get the money from the ads and you don't so I mean, I guess giving you a job at all is probably a little weird, but not really. You know what? It's not weird. This is free. All I need you to do is tell someone else about it. Grow the podcast. Alright, you have your job. I have mine. Let's get to work.

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#292 Have Yourself a Merry Little Christmas

Happy holidays from the Juicebox Podcast!

In 2015, then nine year old Sydney Muller created the theme music for the Juicebox Podcast. Today she shares her versions of 'Have Yourself a Merry Little Christmas' and Elton Johns, 'Goodbye Yellow Brick Road'.

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

+ Click for EPISODE TRANSCRIPT

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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
Welcome to a very special and surprise episode of the Juicebox Podcast. I've got a little something for you for Christmas. So bear with me for one second, to tell you a little bit of a story, then I'll get you your gift. I'd begun to imagine the podcast back at the end of 2014. I started by trying to teach myself about recording equipment and producing audio microphones and feel like I did an okay job back then, but I'm definitely still getting better at it. As time goes on. One thing I got 100% right back then, in 2014 is I reached out to a friend named Rob Miller. And I asked Rob, if his nine year old daughter Sydney would consider making me a theme song for my podcast.

A few weeks later, Sydney began to write and perform. And eventually she came up with this terrific theme that we use every week on the podcast. After we had the theme in place, I needed music for ads. And Sydney came through again.

Since the podcast is now five years old, you know what that means? Right? Sidney is 14, and she's still making music. As a matter of fact, the other day, I heard Sydney singing Have yourself a merry little Christmas. And it made me reach out to her and her father to see if they'd be willing to share it here with you guys. For Christmas. very kindly. they've agreed to let me play it right now for you. And as a little bonus to this bonus, after Have yourself a merry little Christmas, you'll get to hear Sydney from a year or two ago. Perform Elton John's goodbye yellow brick road. Sydney, I want to thank you so much for lending your talent to the show. I think your theme music brings warmth and compassion. It makes the show feel friendly. And I love that people here at first thing every time a new episode comes out. So Merry Christmas to everyone. This is Sydney Mahler performing Have yourself a merry little Christmas and goodbye yellow brick road

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Gavin

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gonna come down when I

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sign up with you

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and your friends to

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be senior.

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So goodbye

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dogs aside how

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to kill manual

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I'm going back to my

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bat

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finally decide my future

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What do you think you do then bet this shoe down it'll take you a cup of vodka hands on it's to get you on your feet again.

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mongrels

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were the dogs of society.

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so goodbye yellow brick road, where the dogs aside how

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go

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finally the sign in my future

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Finally, decide

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The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

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#291 Ask Scott and Jenny: Chapter Eight

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

• How do you teach kids to feel their lows?

• How do you help a type 1 who has an addiction or eating disorder?

• What are good practices about addressing lows when you're sick and how do you administer a micro-dose of glucagon?

• How do you bolus for pizza?

• Bonus! Listen to Scott reading and singing How the Grinch Stole Christmas!

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

+ Click for EPISODE TRANSCRIPT

---

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

Scott Benner 0:00
friends, neighbors, countrymen, lend me your ear. This is Episode 291 of the Juicebox. Podcast, a super sized ask Scott and Jenny with how many ads? Zero? That's right, baby, we reached the end of the year. So instead of ads at the end of the podcast, a little Christmas cheer.

Here's what we're gonna do today and ask Scott and Jenny, we are going to talk about, I'm looking well, you would think I could read my own writing, especially notes that I've taken in the last hour. Well, this is a letdown.

Unknown Speaker 0:44
Okay,

Scott Benner 0:46
we're going to talk about micro bolusing, glucagon, like around the flow. So there's going to be a tiny bit of conversation around being sick. Similar to what you just got in the episode about illness, but it's more about many glucagon boluses. So we're gonna deal with sick lows, like how to deal with sick time lows. We're going to talk about how Jenny speaks to people about addiction, and

Unknown Speaker 1:13
you eating disorders.

Scott Benner 1:16
We're going to talk about how you can discuss with young children what feeling low, feels like. So maybe if they don't understand that they can learn and Jenny's gonna describe her pizza bolus. Plus just regular Scott and Jenny goodness.

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 health care plan, or becoming bold with insulin. Okay, so here's a question from Trina that I don't know if there's an answer to but I'm incredibly interested. Maybe you're just going to say there's no answer to this. But she's not Trina says she has a fairly newly diagnosed seven year old. That can't recognize being low. Uh huh. And somebody else comes in and says, You know, I, you know, I have a daughter who doesn't feel low to ardens always felt her lows at, you know, I could tell by what she would say to me, I could I could probably tell you what her blood sugar is by her response, you know, from 65, to 60, to 55, to under 50. I know. But is there a way to teach people to feel low? Like that? Doesn't? I don't feel like you could? And if not, then what are the reasons why some people feel it and some people don't? Or is there not even a reason for that.

Jennifer Smith, CDE 2:57
It's not uncommon for younger kids, to not really be quite aware of what their body is signaling and telling them, I mean, outside of like, like a big gash cut that they get in the backyard or something or like, Oh, my God, I'm bleeding, you know, or it hurts, you know, pain sensations are typically felt by all people, right. But from the low sensations, kids are usually not very good with how their body is doing, you know, unless they're like, Oh, my God, I've got a toothache or my ear really hurts, you know, and even little, little kids, like, you know, under the age of, I would say, three, an earache is typically like their rubbing their ear or their like, they don't want to lay down on that side. So as a parent, you can kind of tell, as far as I mean, a seven year old, technically should be coming into some body awareness. Being able to send some things, but as a, as a parent, you might need to discuss some of what the common symptoms are, you know, maybe they don't know how they're supposed to be feeling if their blood sugar is low. And maybe when it is low, saying, Hey, you know, do you? Do you feel kind of shaky? Or do you feel sort of, you know, like, you can't really, you can't really do math, I mean, by the age of seven kids or kids know how to add and subtract at least the basic numbers like, you know, 20 and last, right. So in that sense, maybe it's not a symptom, but maybe something you teach them is, hey, do you know what two plus two is? Yeah. And most kids of the age of seven, should be able to sit out for pretty quickly, right? If they can't, maybe that's something you teach them to think okay.

Unknown Speaker 4:49
to press to?

Jennifer Smith, CDE 4:51
I don't know what it is. And I mean, since we've got sensors, kids nowadays can actually visually see And they can start to associate a value with something in their body. That's not quite right. You know, asking them, does your tongue feel kind of funny? Do your lips feel kind of tingly? You know, when you put your hand out? Does it kind of shake a little bit? Or do you feel sort of like, you know, topsy turvy on your feet? Sometimes it takes talking to kids about what they could be feeling to get them to start paying attention.

Scott Benner 5:30
Yeah, that makes sense symptoms. I think that I think that makes a ton of sense. Actually, please, you said something in there that just made me think we're expecting them to say I'm dizzy. But they may have no, they may have no context for dizzy. So maybe you take them at a time when they are absolutely at a good blood sugar and spin them in a circle a couple times, then go, Hey, if this ever happens, if this feeling ever happens, let me know.

Jennifer Smith, CDE 5:55
And we haven't spun you around like a twist the

Unknown Speaker 5:57
right? Yeah,

Scott Benner 5:58
you know what I mean? Like, if we haven't spun you and you feel like this, let me know. Or I think that's a great idea like, and I would caution when you try to teach them these sensations. Maybe don't tie them to diabetes, because then it's possible. They could make them up at some point to like, teach them the sensations. Don't mention the diabetes, and then just tell them hey, if you ever feel like this, we want to know, right? You don't want to do the I always used to say to my wife, like when we were first billing, we first had Cole, if he fell over, she would like go at him and say, you know, like, you know is your leg hurt? And I'm like, don't put thoughts in his head. You don't mean like, you know, you hit your head? Are you hurt? Well, then you're like, well, I guess I am yet. You know, like, so you can put that thought into someone's head. But that's a great, I did not think we were going to have an answer for that this podcast is excellent. All right, let's go. As the end of season five comes to a close, I want to take a couple of moments throughout this episode, the Thank you. There are 508 ratings for the podcast on iTunes today. And I took some time to jump around iTunes all over the world. And in maybe six to eight other versions of iTunes, like Australia, Canada, there are amazing reviews for the podcast. I'm so touched by all of them. And I appreciate all the time and effort that it takes to put them up. They're really thoughtful, and heartwarming. And I definitely think they go a long way towards helping other people find the podcast. So every time I say to you guys, please help someone else find the podcast. Just know that I appreciate it, that you're doing it. And it's work.

You know, I saw somebody talking about something online the other day, let me see if I can figure it out. I might have a question for you, Jenny on the second. Awesome. Well, I am going to hit this first though, because then how do you? How do you help people who have type one, and also have an addiction? So let's see. And let's keep it to a drug addiction, you know, is there? Are there things that those people can be doing when they make the decision? Like, I have to do better with my diabetes? Like how it seems like such a crazy thing. But at the same time, any kind of addiction could mess up diabetes, obviously, I think, you know, drugs, and alcohol would probably be worse. But even if you had like a food addiction that would throw off managing your type one a lot like how much do you end up having to talk about that with people?

Jennifer Smith, CDE 8:51
I would say that it's more the anger that you brought in food as a piece of it. While it's not I mean, addiction isn't there's a lot of disordered eating. That comes in with diabetes, because our management is from the get go very centered around food, intake food and you do food and you become food becomes almost a control piece. For many people with diabetes. As I think it's good, it's right to kind of categorize it in with drugs and or even alcohol. Those are pieces that we end up talking to people about but not really managing that piece for them. And so far as our explanation about things like for example, alcohol, right as an addiction. Alcohol can have major impact on blood sugar control, and what happens within being drunk right Your ability to mentally decide things and make appropriate choices and what to do. And even, you know, if you were high or drunk or whatever, and you were even changing your pump site, you could totally inaccurately do that. And you could have a major problem. Right. So I mean, those are pieces that we, we do bring in as far as discussion. We encourage people to continue with their, you know, their therapy, if they are in most of the people, I would say 98% of the people that we work with, who have either had an addiction, or a managing an addiction of some kind, already have a therapist that they're working with. Yeah, I have not personally work with anybody that has a known issue, and hasn't had somebody that they're getting help with from it or for it. But I think that's a big piece of it, it's also from the standpoint of their therapist, or who they might be working with, that person also needs to understand the diabetes component to it, because it needs to be brought in to the overall picture of discussion. You know, the diabetes is a stressor, and that's going to be part of how they manage the raw.

Scott Benner 11:22
Yeah, I so I don't know if you saw recently, I did a, something I called after dark drinking addiction edition, excuse me. And it was a piggyback off of a conversation you and I had and we talked about how to Bolus for alcohol. And then I said, You know what, Jenny, I'm gonna get like a professional drunk on here to talk about this, right? And actually, the funny thing is, is that, uh, the person, Maya, who ended up being on the episode, two different people in her life, who listened to the podcast, separately of her, contacted her and said, Oh, my God, it's your turn to be on the juice box. He's like, she's looking for somebody. Scott's looking for somebody who knows how to really drink and take care of their diabetes. It's your turn. And she sent me a message. And she's like, I don't know how to feel about this. But apparently, I'm the professional drunk you're looking for. And I was like, gotcha. So she came on, and we had a really honest conversation about how she manages. She's a person who drinks she's not a she's not a blackout drunk. Do you know me much, but she drinks a lot more than probably most people do. Like, you know, she's at least having a couple of glasses of wine a day at her meal. And she is a person who finds a lot of pleasure going is she described going to like, out to a lake and tubing around and drinking a case of beer and that kind of thing. And she talked about all how she did it. super interesting. When I asked her what she thought the most dangerous part about drinking with diabetes was, she said, it was about making a bad decision with insulin when she was too drunk correctly. And she was like, that's my biggest fear. She's like, I figured out the rest of it. Like, I'm not super afraid of falling asleep. And getting too low. Especially because she has, you know, she's got good technology too. But already, but she said I would think the biggest concern and it's funny, it's exactly what you said, like, what if I make like a grave mistake and give myself too much insulin? That's really that there's a lot of consistency in that.

Jennifer Smith, CDE 13:17
As you listen to that episode, actually, because that sounds It sounds very good. And I'm always I love to, I love to learn it, you know, more even. Yeah, no different insight Exactly. Because it helps me to help people better. Well,

Scott Benner 13:34
the next one we're booking right now is with a legit waken Baker, I found a 26 year old kid who smokes every day and has diabetes, I'm gonna have him come on and talk about that. And as we're sitting here talking, I think I know somebody I'm going to reach out to about addiction, see, if I can't do one with them to maybe they could add some more context than you and I are going to be able to be free. Because even as you're talking about it, I realized that everything I thought to say, was conjecture. I have no real life experience whatsoever. Like I can imagine what the problems might be, but I don't really understand what it's like to be addicted. So. So the answer to that one here for Ana is that I think we're going to try to do an after dark episode about this and get you more answers. Awesome. Cool. We've done some of you are asking questions that are already listened to listen to more of the podcasts are already out there.

Unknown Speaker 14:30
Go search. There's more on there.

Scott Benner 14:33
to them. I don't really label them that well. I want to wish everyone a Merry Christmas. Happy Hanukkah. Happy New Year, wonderful holiday season. Hope all of your dreams come true. Hope you find some time to relax. May you find time to be with your friends and family. And just reboot, you know, let your brain go limp for a couple of days. So you can reach out And I hope during all this eating and celebrating that's going to happen over the next couple of weeks, you keep in mind the things that we've talked about so far on the podcast, because I think they're going to help you. It's flu season. And this person's asking about something I have absolutely no experience with. How do they micro dose glucagon? In scenarios where they have blood sugars that are so low that they can't, they can't get them to come back up and the person's may be too sick or can't keep down food? Like what a good I guess not just around glucagon, but what are good practices about addressing lows when you're sick? Oh,

Jennifer Smith, CDE 15:41
sorry, you cut out a little bit. They're addressing

Scott Benner 15:45
low low blood sugars when you're sick, you know, when you're stuck. Yeah.

Jennifer Smith, CDE 15:50
So I mean, low blood sugars in illness are much more typical for stomach or digestive bugs. not as common for like, the cold or, you know, like a bronco infection, those usually spike your blood sugar. So those aren't as common. If the flu includes some digestive issues, then we usually say a temporary bazel decreased to begin with, can help to cut the risk, especially if you're not eating very often, or can't eat more than like a chicken or vegetable broth, you know, or eat a popsicle every, you know, couple of hours or whatnot. So taking your bazel down temporarily, anywhere between 10 to maybe 25%, less is a good place to start. If you have a blood sugar that you notice is starting to trend down and you literally You're so nauseous that you can't take anything in turning bazel down by 80%. So you really only running about 20% Normal bazel for about one to two hours, really cuts off insulin significant enough that it should help that glucose to stabilize, and not get too low in a time where you can't take anything in at all. So those are, you know, some, some adjustments that can be done. Other ones certainly, if you find something that you can sip on even a little bit of like, honey in the cheek, or, you know, cake frosting, I know is another one that's commonly you know, mentioned, maple syrup is a very curvy. So those kinds of things, even in a cheek and sort of massaging can help to get it to absorb through the the like oil area

Scott Benner 17:42
without you having to maybe swallow it and affect iraq feels Okay,

Jennifer Smith, CDE 17:46
correct. I mean, you're certainly not going to get 100% of carb absorption, but you're definitely going to get some carb into the system by just putting it in the cheek and massaging it. So that's another good option. electrolyte beverages, especially for stomach bugs are also a good place that you can get a little bit of carbohydrate. There's one that's got a minimal amount of carb. It's called drip drop, okay, it's an electrolyte replacer you put it in water, I think per serving, it's got like eight to 10 grams of carb. So again, not a lot, but enough that it could help to stabilize blood sugar some. And then, you know, in a scenario where you really may need to use glucagon. If you don't have if you don't have the current and newest back semi, you know the the nasal sort of glucagon that be many dose unless somebody figured out how to do that already. I don't know. But I mean, it's a one, pop it in and it's there. You can't like micro dose it. But there are some rules of thumb for micro dosing the injectable glucagon. Essentially you would mix up the glucagon. The mixed glucagon is good for I believe up to 48 hours after mixing. So if you had to use more of it over the time period of and stomach bugs usually don't last very long, somewhere between 24 to 72 hours at the at the longest. You would mix it up but you're not going to inject it with a glucagon injector syringe, you're essentially going to use an insulin syringe. So for those people who are using insulin pens with needle caps, get a one time prescription from your doctor for insulin syringes. Keep a box around so that you could go ahead and micro dose your glucagon

Scott Benner 19:47
I would say ardent hasn't has been pumping for like ever. And we still have syringes in the house. I always make sure we have some just in case. Yeah, that's all it just needs to be there just in case I need it. So So

Jennifer Smith, CDE 20:00
don't really go bad. I mean, your syringes. I mean, they do have expiration dates on and I always think it's funny. I'm like, is this it's not like cheese

Unknown Speaker 20:10
with a piece of metal on it. I haven't got

Scott Benner 20:14
I have some that are so I had so many at the end of MDI that I gave a number of them away to somebody because I thought in a lifetime, Arden won't use all these, you know, so we held on to a few and they've lasted for a decade, it's you know, but been incredibly helpful when they were needed. So when I so when someone goes to micro bolus glucagon, is it just? Is it a testing thing? Are you just trying it and seeing are you so there's a rule of thumb or

Jennifer Smith, CDE 20:43
there is a rule of thumb, and I'm actually off the top of my head, I don't know, I'm actually looking in my education materials right now. Because it's something that I actually send to people.

Unknown Speaker 20:56
Core ability to squat,

Scott Benner 21:02
you're looking at that, let me say this, the idea of sipping tiny, tiny little sips, while you're sick of you know, something that has a little bit of carbs in it with the electrolytes, first of all, it's going to help you being sick anyway. But it's really no different than when I was talking to someone, a month or so ago, somebody I know, personally, whose child has type one playing ice hockey, ice hockey, and was getting low. And I said, look, I think he should have some sort of a Gatorade and water on the bench. And then when he sees himself dipping a little low, that's the time you take a couple sips of the Gatorade. And then the next time if the arrow levels out, you go back to the water. And maybe you have to go back and forth a little bit to to, you know, kind of bump and nudge with the glucose from that drink, you know, right. And it worked out really well. For him, I think you're basically saying the same thing. If you're sick and your budget is just trying to get low all the time and cutting your basal back's not helping, then you just have to kind of it doesn't have to be a big drink, don't get into a situation we need a big glass of liquid just write a little bits, little bits and little steps.

Jennifer Smith, CDE 22:08
And with nausea, and everything those little sips can sometimes still be tolerated enough that you can, like you said, you can get in just a little bit incrementally, I mean, stomach bug to really help to get in some power that you are bolusing even a micro amount for because it really helps to prevent starvation ketones, and anytime you're ill, you really want to prevent ketones of any kind, because they could even at lower blood sugars. I know we talked about this before, as far as ketones, even with lower blood sugars in a time period of illness, it can lead to decay, even at numbers that look more normal. So if along the line of a stomach bug, you're micro dosing for, you know, a popsicle, that was 12 grams and you only Bolus for three grams of it, it's getting enough little bit of insulin in that you decrease significantly the risk of ketones

Scott Benner 23:09
you do not want to go into DK and if you go into DK or you lose control of it, you got to get to the emergency room. So correct yet don't correct. Especially going into like overnight, like like don't don't you don't mean like it make a decision. My wife wasn't feeling well the other day and I was like, don't wait till Saturday to decide you need to go to the doctor. It's so don't wait till midnight to decide, you know, I don't think I'm doing well then fall asleep and find out you aren't decay overnight. Like, you know, you have to make it sucks being sick. Hopefully everybody and it

Jennifer Smith, CDE 23:41
kind of, you know, blood sugar wise, it kind of also in an illness goes along with Where? Where should you look at the potential for needing something to help prevent a further dip, right? So if you're starting with somebody who's Ill really nauseous, unable to keep things in, or things are coming out kind of like both ends. Not to be gross, but you know, they really can't keep anything in. You mean need to utilize something more than just taking bazel down temporarily. Right? That might not cut it completely. So Then where should blood sugar safely be? We usually say especially for kids, not letting blood sugar get less than like 85 to 90. Only because less than that you're really risking a quicker drop to being a time or a glucose value that you can't really recover from when somebody can't take anything in right, so many glucagon. And there are a lot of really good resources online. I mean, there's one at diabetes in control. There are some from the NIH. Typically for kids, we would recommend if your child can't take anything in literally at all. And glucose looks like it's dropping. It's not like that nice stable, but it looks like it's trending down, we'd recommend that the mini dose mixing it up that vial, push the liquid and mix it up, get your insulin syringe. And using an insulin syringe, it's kind of based on age. So the mini dose of glucagon. Each unit on an insulin syringe is 10 micrograms of glucagon. So that's the conversion. If your child is under the age of two, you would need to units on the insulin syringe, which is 20 micrograms of glucagon. If your child is between the ages of three to 15, you would need one unit per year of age. So one unit of an insulin syringe or 10 micrograms of glucagon per year of age. And then over the age of 16, it's 15 units, or 150 micrograms. And you'd inject it essentially the same way you're going to give insulin. Pinch up injected in AI, we typically still recommend similar to low glucose, you know, we still recommend checking blood sugar every 15 minutes and definitely doing it with a finger stick. Don't just rely on your CGM value, do a finger stick, get an accurate value. And if it's still lower than that 90 or if you're someone listening from outside the states, and you're in millimoles, that's five millimoles or less, then you can give your child a second injection of glucagon and you would actually double the dose from what you gave the first time.

Scott Benner 26:49
Now, are they going to experience any of the kind of bad side effects that sometimes come from glucagon when you're mini dosing?

Jennifer Smith, CDE 26:55
typically not in fact, those symptoms which common symptoms would be nausea and vomiting, which is pretty significant to give that whole entire syringe full of glue good on, which to my understanding is at least what I initially learned was that syringes meant to treat somebody up to 250 pounds. Cheese. So if you've got a little, you know, four year old who is like 30 pounds or 40 pounds, no wonder they're getting such a significant, like, nauseous. With Yeah, we have a micro dosing of it. You shouldn't

Scott Benner 27:33
Arden's emergency one at school up until I think she was over 80 pounds, just that just give half of it if you can, you know, just eyeball it. I mean, if if Wallah seven year olds having a seizure, and you as a teacher who really never wanted to be a part of this can stop the thing. I just want to put it in half of this. Well, you know, good luck and everything. Right. I think you're in an emergency situation that and maybe the nausea afterwards is is the price of doing business, you know, but I just wondered if it came with a micro dosing to Okay, so I had one more question. I don't know if we can get through it in 10 minutes. Sure. But um, what are we okay, well, we're gonna do one more by the way, Arden's blood sugar 77 and stable. Nice job. Thank you so much. Banana bagel, three molano cookies. Oh, my gosh, big bag of grapes have no, I have no idea how many. And a yogurt. I've even come to the idea of I can now put in more food to give her choice knowing she won't eat at all and still hit the but the Bolus, right? So seriously. Alright, so now we're gonna test this right? We are going to answer someone's question here. Gosh, why can't I just see it? I've been looking at it for 10 minutes while we're talking about moving on. And now all of a sudden I've lost track of it. But this person says, I don't know how to Bolus for pizza. So given that everyone's going to be different. Still. I would like to ask you, you're a grown person. I'm assuming you eat pizza sometimes. How do you Bolus for pizza?

Unknown Speaker 29:12
Oh,

Jennifer Smith, CDE 29:14
assuming this person is using conventional insulin pump.

Unknown Speaker 29:19
And we don't know.

Jennifer Smith, CDE 29:21
I don't really see Tam on injections or I'm pumping or I'm you know, using a frezza nasal nasal insulin or whatever you're doing right? I don't know. So let's assume a conventional pump. Yep.

Unknown Speaker 29:35
In that case,

Jennifer Smith, CDE 29:38
the pizza bolus sort of became the term for an extended bolus, right? It was the first reason that we started to use extended boluses or have that feature on a pump. And the reason being pizza is high carb, very, very high carb unless there's somebody making a cauliflower pizza. across, then whatever your pizza is high carb from the grain nature, but it's also really high in fat. I mean, unless you're doing a vegan pizza that has no cheese and sausage and whatever on top of it, your pizza is high fat. And if it's a pizza from a source outside, the crust probably has fat in it, as well as the toppings that you're adding on top of it.

Unknown Speaker 30:19
So

Jennifer Smith, CDE 30:20
the high fat nature along with the high carb component to it really mean that if you Bolus 100%, right now, for pizza, with a Pre-Bolus, as we've talked about before, the benefit of that

Unknown Speaker 30:36
you're going to get low,

Jennifer Smith, CDE 30:39
and then your blood sugar is going to get high. And then it's probably going to stay high for a while. Right. So there are a couple pieces to pizza food management. And let's kind of tie in nachos and you know, fish and chips and like a cheeseburger and fries or a real Italian pasta meal with all the good cheese, sausage and cheese and oil and whatever. Right. So high fat, essentially an extended bolus. And again, it takes a little experimentation to see what type of extension you need. For the most part for pizza type of food, you would use about a 60 or 70%, upfront possibly, and the rest over at least a two hour time period.

Unknown Speaker 31:27
So

Jennifer Smith, CDE 31:28
what you're doing is you're giving insulin up front, but then that extension over about a two hour time period and the back end is grabbing on and hitting the food that's more slowly getting into the system because the fat isn't letting all hundred and 20 grams of that pizza. Get in right now. Right? Some people do a 5050 50% now 50% over two hours that works very well. Um, I think the upfront amount from my experience really is specific to how much is on top of the pizza. You know, if it's your Margarita pizza that has a couple of blobs of real mozzarella on top, but it's not slathered in cheese, and sausage and Canadian bacon or whatever, it's probably a lot lower fat pizza, right then something like the meat lovers, right? So that breakdown of percent now percent over time, kind of goes along with the nature of what you've got on your pizza. But that's that's the gist of pizza. And again, it takes a little experimentation. Sometimes you got to take a hit

Scott Benner 32:49
and learn and then move on from it. Right? I would say so Arden just had a slice of pizza going out the door to a party last weekend. And it was more the way you describe in some ways. So it was a thinner crust, but it had less cheese. Like it's not completely covered with cheese, you know, and I, you know, I come to realize too. I live in a portion of the country where, you know, I'm eating pizza that somebody in the middle of the country might have never seen before to me I'm not it's not Domino's, or you know, some restaurant chain pizza. This is you know, this is a Sunday night real pizza 90 year old Italian man who has, you know, the, the, the recipe for his pizza chained in a box around the killing to get it from him. So, and I happen to live in that part of the country where a pizza like that exists. And so she has this thing, but it does have sausage on it. So I looked at it and I thought okay, Arden's blood sugar's like 105 I believe back then, because she was she was a little on the lower side, because she was spent a lot of time getting ready with a costume party and everything. She's moved around the house a lot. blood sugar's nice and stable. I'm going to have a slice of pizza. I didn't worry about Pre-Bolus. And partly because I thought she might be trending down to begin with wasn't but because it's pizza too. And my idea about these carby things that hit hard. And then last is I kind of just think about it as getting my insulin up front to stop a rise or a spike. So I have so much, I have so much up front, that there's no way for your blood sugar to spike. And then as time goes away, I can take insulin away and let what's left over from the big push at the beginning act as the bazel going through it. And that is one way I do that. The way you just described I do as well. I don't need to read describe it because you did such a perfect job of talking about it. But But another way is, is that like it's just I bring in so many blockers up front. You can't sacked my quarterback. And then later later in the game when you stop blitzing, I send them away, you know, so and so I sometimes get in so much upfront that the it can not only handle the food, but it can be part of the bazel rate going away. And then I take the bazel way I trade I trade Bolus earlier for bazel later to leave the Bolus tail end acting as bazel later, yes, yes. Yeah. Yeah, that's, that's one of the ways I think about manipulating insulin. So

Unknown Speaker 35:31
but then the other component

Jennifer Smith, CDE 35:32
to pizza too, is again, the fat content, right? Like I said, before the Margarita pizza with a couple blobs of buffalo mozzarella on top, probably not high enough in fat that you're going to have that long duration extended high blood sugar for six, eight hours after, however, bringing the neat lovers and you not only probably need the extended bolus, but you probably need a temporary increase to your bazel for hours after right to avoid the sustained high. So again, scenario to scenario you may have to decide what your strategy is going to be. But those are the typical ways to manage pizza would have grabbed another slice,

Scott Benner 36:11
then I would no longer have been thinking about a bunch up front and no more back now I would have been as soon as she had the second slice, I probably would have bolused thin thin crust pizza, my guesses like 25 carbs, like I probably would have, I probably would have Bolus 25 carbs and probably done zero upfront and the rest out over like an hour and a half. I will as soon as she grabbed another one, I would have started thinking about the future. Yeah, right. But it looked like one and then she was going somewhere. She actually did have to Bolus once while she was at that party. We did not end up taking it away. I did a pretty good job of balancing it. And so while she was there, we had a nudge like a 134. Diagonal up at one point. She did not eat anything at the party, though. Oh, yeah, I think at a certain age kids just stand around and look at each other. So. So you're here I'm here to and then they that's pretty much the end of it. And I did not see Luke doing any gyrations during that time. Like there was no technical way away or way up, you know. So I was in a fairly traditional situation there too, because we'd hit the ball. So well, in the beginning. It just didn't. Luke didn't really have to do anything. It just sat with her base. Alright. Nice. That is really kind of fun when you can see that when you're on an algorithm. But you're like, wow, we did such a good job with the Bolus, like the algorithms not doing anything, you know. Yeah. Wow. That's really like, that's right.

Jennifer Smith, CDE 37:38
You don't see the down or the off the you know, cityscapes kind of thing. You just riding along your leg is looping. Is it working? is it doing anything? No, it's just got me hovering. Nice.

Scott Benner 37:47
We really hit this one. That's crazy. All right. Okay, so hopefully that was helpful. My Eternal grateful thanks to Jenny Smith from integrated diabetes. Don't forget, if you would like to hire Jenny, go to integrated diabetes.com to contact her. Also in the show notes of your podcast app. Jenny's email addresses right there. It also exists on Juicebox podcast.com for this episode. And I know this was ad free, but I'm feeling very festive. On the pod Dexcom dancing for diabetes. companion medical makers of the in pen. All the sponsors that supported the show this year. Happy New Year. Merry Christmas. Thank you so much. And now I'm going to try something that may or may not go well for the holiday season. We're about to find out.

This is for all of you who listened with your children. And for those of you who may still be children. Somewhere inside the Grinch by Dr. Seuss. Every who down in Whoville liked Christmas a lot. But the Grinch who lived just north of Whoville did not. The Grinch hated Christmas the whole Christmas season. Now please don't ask why no one quite knows the reason. It could be perhaps that his shoes were too tight. It could be his head wasn't screwed on just right. But I think that the most likely reason of all may have been that his heart was two sizes too small. But whatever the reason, his heart or his shoes, he stood there on Christmas Eve hating the who's staring down from his cave with a sour grinchy frown at the warm lighted windows below in their town. For he knew every who down in Whoville beneath was busy now hanging a Holly who reef and they're hanging their stockings he snarled with a snare. Tomorrow is Christmas. It's practically here. That he growled with his Grinch fingers. nervously drumming. I must find some way to keep Christmas from coming. For tomorrow I know all the who girls and boys will wake brighten early. They'll rush for their toys. And then oh the noise. Oh the noise noise noise noise there's one thing I hate. All the noise noise noise noise they'll stand close together with Christmas bells ringing they'll stand hand in hand and those whose will start singing far who for $1 who don't? Ray welcome Christmas Come this way. Bar who for a DA who don't raise well gum Christmas Christmas Day. Welcome Welcome, fall Who? ramas welcome welcome Doctor Who does Miss Christmas Day is in our grasp. So long as we have hands to clasp foul Who's Who? For who? And they'll sing and they'll sing and they'll sing, sing, sing sing. And the more the Grinch thought of this who Christmas sing, the more their Grinch thought I must stop this whole thing. Why for 53 years I've put up with it now. I must stop Christmas from coming. But how? Then he got an idea. An awful idea. The Grinch got a wonderful, awful idea. I know just what to do. The Grinch laughed in his throat. I'll make a quick Santa Claus hat and the coat. This is stopped number one, the Grinch claws hissed as he climbed to the roof. Empty bags in his fist. Then he slid down the chimney. A rather tight pinch. But if Santa could do it, then so could a Grinch. He got stuck only once for a minute or two. Then he stuck his head out of the fireplace flew where the little who stockings hung all in a row. The stockings he crunched are the first things to go. And he slithered and slunk with a smile most unpleasant around the whole room. And he took every present. It was quarter of dawn all the who's still a bed. All the who's still a snooze. When he packed up his sled, packed it up with their presence, their ribbons, their wrappings, their sniff and they're fuzzles their tree anglers and trappings. 10,000 feet up. up the side of Mount crumpet. He rode with his load to the tip top to dump it. Poo Poo to the whose he was Grinch Lee humming, they're finding out now that no Christmas is coming. They're just waking up. I know just what they'll do. Their mouths will hang open a minute or two. Then those who's down in Whoville will all cry boo hoo.

That's a noise grin The Grinch that I simply must hear. He paused and the Grinch put his hand to his ear. And he did hear a sound rising over the snow. It started in low then it started to grow. But this sound wasn't sad. By the sound sounded glad. Every who down in Whoville the tall and the small was singing without any presence at all. He hadn't stopped Christmas from coming it came. Somehow or other it came just the same. And the Grinch with his Grinch feet. Ice cold in the snow stood puzzling and puzzling. How could this be so? It came without ribbons it came without tags. It came without packages boxes or bags. He puzzled and puzzled till his puzzler was sore. Then the Grinch thought of something he hadn't before. Maybe Christmas he thought doesn't come from a store. Maybe Christmas perhaps means a little bit more. And what happened then? Well, in Whoville they say that the Grinch is small heart grew three sizes that day. And then the true meaning of Christmas came through and the Grinch found the strength of 10 Grinches plus two. And now that his heart didn't feel quite so tight. He whizzed with his load through the bright morning light. With a smile to his soul. He descended mount crumpet surely blowing hoo hoo on his trumpet. He wrote into Whoville, he brought back their toys. He brought back their floof to the who girls and boys. He brought back their sniff and their trailers and fuzzles brought back their petard cuz they're daflores and muzzles. He brought everything back all the food for the feast and he himself, the Grinch. carved the roast beast. Welcome Christmas, bring your cheer. Cheer to all who's far and near. Christmas Day is in our grass, so long as we have hands to grass. Christmas Day will always be just as long as we have we welcome Christmas while we stand, heart to heart and hand in hand

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About Jenny Smith

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

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