#312 Fox in the Loop House - Part 1

Kenny Fox talks Loop Management

Kenny and Scott talk about DIY Loop and type 1 diabetes.

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

Scott Benner 0:00
Hello, everybody, welcome to Episode 312 of the Juicebox Podcast. Today's show is part one of a two parter with Kenny Fox. Now Kenny's name might not ring in your head like, oh, Kenny Fox says that like Brad Pitt, but for diabetes? Well, no. But what Kenny is, is the data of a little girl who has type one diabetes, who really dug in to the DIY loop. And he understands it in a way that I find it inspirational. Now, Kenny and I are going to walk step by step through every setting in the loop, talk about it and kind of a big picture way. If you're not into a do it yourself algorithm for insulin pumping, I get that you don't need to be I'm not telling you to be. What I am saying is listen to the episode anyway. Because it's just another way of thinking about how insulin works. This episode of The Juicebox Podcast is sponsored by Dexcom. The Contour Next One blood glucose meter, and touched by type one, you can always go to touch by type one.org Contour Next one.com or dexcom.com, forward slash juicebox. To find out more about the advertisers. There'll be a little more about them later in the show. But for now, I think we should get to it. We're going to start right at the top by saying nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please consult a physician before making any changes to your health care plan, or becoming bold with insulin. And today. Also remember that what we're talking about is an algorithm that Kenny and I downloaded from the internet. It doesn't belong to a company, you just completely do it yourself. It has not passed through the FDA. So understand that while we're talking. Now that aside, using the algorithm. And watching the data come back from it and seeing how it reacts will absolutely supercharge your understanding of how insulin is working in your body. I'm telling you to watch a an app a computer algorithm decide about insulin. It just elevates your understanding. At least it did for me. It's taken me a while to figure looping out and I'm probably not all the way there. But I'm getting closer. And I'm going to keep having these conversations with people who are ahead of me until we're all at the same level together. Luckily, I found Kenny and Kenny understands looping. And that's why this episode is called Fox in the loop house. Part One.

Kenny Fox 2:50
My name is Kenny and I am into computers and technology and helping people. My daughter Tessa was diagnosed with Type One Diabetes last year, about a year ago. I have four kids ages 865 and two and Tessa is the number two child she is six years old. Okay,

Scott Benner 3:11
that's a six. She's had type one for a year when she's diagnosed, how soon until you discover there's a do it yourself algorithm that helps insulin pumps talk to glucose monitors.

Kenny Fox 3:27
Well, it was kind of in the emergency room. So is when we went in for diagnosis. I spent a couple hours here there about four hours I spent the first part of it just googling and trying to figure out what diabetes was if there's any kind of cure what would work. Then I quickly realized there was no option there. So then started searching for diabetes technology and kind of found Dexcom found your podcast has mentioned somewhere in there I vaguely remember. And then I found looping and Katie's post about fine tuning settings. And that sort of oriented me to what the mechanics kind of involved might be with insulin and the body and Bazell testing and all that kind of stuff. How long after

Scott Benner 4:15
test this diagnosis? Did you end up with a CGM and a pump?

Kenny Fox 4:21
We got one, about three weeks into diagnosis probably would have been another week earlier if I had just said Yes, right away. But instead I was like, Well, how much does it cost? And you can never find out those answers until you just say well give me the prescription and we'll see how much the bill is. So yeah, I've only just just just put it on there. And then I'll, when they call me and tell him how much it is we'll figure it out. But by the time I got the call back to tell me how much it was and all that I started listening to your podcast and it was like, Well, obviously I'm doing this so just send it to me. So yeah, so we got that about three weeks in. We started pumping about six months. in I think it was like June ish to the month of June pumping with an omni pod. I think we were probably only the first few people to ask for an omni pod with our particular Kaiser, Southern California. Group and then I was just waiting for the right link because only reason we didn't start looping right away. So I got it later on July 3, I think I started and we started looping.

Scott Benner 5:22
So tell me, you said you think you're one of the only ones you mean, like in the practice, a lot of people didn't use on the pods.

Kenny Fox 5:27
Yeah, it wasn't typically approved pump get this extra exception process to go through and actually talk to Syrah and she she's the one that I think really pushed it to finally make it like they had a known process for how to get an omni pod very easily. I just asked for rather than having to fill out a bunch of extra paperwork or something.

Scott Benner 5:45
So it was an insurance thing more than

Kenny Fox 5:47
Yeah, yeah. And then our endo are. We see the nurse practitioner most of the time, she's like, wide just haven't really helped a lot of people with the Omni pod. So it's kind of up to you. Okay.

Scott Benner 5:58
We're not gonna help you. Little did you know, back then they weren't gonna help you anyway, you were just

Kenny Fox 6:01
Yeah, right.

Scott Benner 6:04
So, okay, so you're pumping chest for a month, and then you get your Reilly link, and you're off to the races with loop. How long ago was that?

Kenny Fox 6:15
Um, yeah, so it was July and it's March now.

Scott Benner 6:20
So hold on August, September, October, November, December, January, February, March, that you're saying?

Kenny Fox 6:26
Yeah, the infamous got math.

Scott Benner 6:28
All right. Gosh, it's so easy. If you have enough fingers. It's very simple. So So eight months, so you've been doing it less time than I have? Is that right? Yeah, yeah. Ah, but you're way better at it than I am, aren't you?

Kenny Fox 6:40
I don't know. Probably. Yeah.

Scott Benner 6:42
Oh, look at you. Right. That's nice. I'm so accustomed to discussing things with women. And they're, they're much more demure. Kenny like you were really like, Yeah, probably am, buddy. But, but but ladies are always sort of like, I don't know, like, it's, um, there's a whole research on that, that we're not going to get into now. But anyway, women, they say you should stick up for yourselves at your jobs more because men will stick up for themselves, even if they don't believe in themselves, even if we're wrong, right. Whereas women who do believe in themselves sometimes won't. So stick up for yourself, just like Kenny did. Now let's find out if he can back it up. To Kenny, you and I have messaged a number of times, which I feel like is a bit of an understatement. More than more than a number of times. Have we actually spoken voice to voice once?

Kenny Fox 7:27
We did once when you were heading out to a conference, I want to make sure our didn't.

Scott Benner 7:31
Yes,

Kenny Fox 7:32
leave setup was all solid. Alright, so Okay.

Scott Benner 7:35
So here's what so has your path gone through the same iterations of this software that mine has pretty much right?

Kenny Fox 7:42
Yeah, yeah. Okay. All right. So,

Scott Benner 7:45
up until now, you've heard on the podcast, Katie came on, she described what looping was, I think I had a conversation with Jenny, somewhere along the way, I've had a meltdown conversation with somebody where I was like, I don't know what I'm doing. Now, please keep in mind for everyone listening, that I just can't record every day as I'm learning something. And I really, I do want to say this here. Because sometimes these episodes get listened to, you know, not in the order, I hope they get listened to. But when you began listening to this podcast five years ago, if you did, I already had a plan in place. Like I started, you know, the podcast, when I already solidly knew what I was doing. When we decided to try any kind of, you know, an algorithm based loop. I didn't know what I was doing. And so I've been learning it. And you guys have been really cool about it. Because in the beginning, when I said, we're gonna try this loop thing, people just inundated me with, like, explained to me how to do it. I was like, I don't know how to do it. I can't explain to you, I, what I found was they were accustomed to me knowing the answer. And I was accustomed to knowing the answer sometimes, or most of the times as well. And so I've been purposefully spreading out these episodes, to give me time to learn in between them so that I'm not saying I don't know, for two years, you know what I mean? And then suddenly, no, one day, so it's a weird thing. It's not exactly a documentary of us figuring out Luke that you're listening to but so I'm a little further along. Now. I'd actually say I'm a lot more further along now than I was in the last episode, which, while you would have heard it a few weeks ago, if you're listening now, in you know, March, it was recorded six months before that. So I'm a little ahead of last time any of you heard me talk about it? I'm going to start by saying that when the Omni pod horizon comes out, we're going to try it. If I don't like the on the hot, the on the pot horizon algorithm, I'm going to try the tide pool algorithm when it comes out. And I'm going to, I'm going to devour all of it. Because this Do It Yourself experience has cemented in my mind that an algorithm based pump matched with a Dexcom transmitter and glucose monitor sensor is it's better at enough than I was with less work and the things it's not good at. I'm learning how to stop it from not being good at that. Do you feel more comfortable than that? If you describe how you use it, how do you how do you feel about it?

Kenny Fox 10:25
I think I think I would try some of the newer ones too. But I'm, I'm pretty comfortable with it as it is, it's probably has some pros beyond what we were doing. Before that we had actually better numbers, I guess, on shots, and maybe even a little bit on the PDM. Then when we started doing loop, but what kind of the goal was to make this a little bit less mentally taxing, but also allow me to let her go to school and be with grandma and grandpa or whoever, without worrying as much. So that's helped a lot to you. But then what I didn't expect the reason why I would stick with some kind of system. But why I really like loop other than the obvious like I can see everything that's happening in real time, which no other system at the moment has through nightscout. That's a big deal and watching how school goes, especially because she's only six. It's also like the overrides the things that allow us to manage and make Sick Day management easier when you really have sick days that we'd like with higher beegees until after we started loop. And our settings are fairly dialed in by the time sickness showed up this winter fall and just using the overrides intelligently, as made our sick days look a lot like our regular days, probably like 90% of the time. So to me just a lot easier. So I wouldn't, I would want a system that would do that. But I could, knowing what I know now I could probably use any system and kind of mess with profiles and things of that nature to get a similar effect. Yeah,

Scott Benner 11:57
I'm starting to feel that way through. Let's let me clear up a couple things just to be sure. Is your daughter still honeymooning?

Kenny Fox 12:03
No. So we had honeymooning on and off for probably after the three or four months, and I and I kind of found a little pattern with that, too. Like whenever honeymooning was happening, it would sort of pull her blood sugar down, but you'd mostly notice it. When she was eating, she'd just fall immediately. And he like another hundred grams of carbs just to bring her up very slowly. And I think I read an article somewhere that was talking about how the body's like neutral state is 72, sort of like where you wouldn't see any insulin or glucagon in the bloodstream. And so after I read that the next time she had a big honeymoon spell lasted almost a week, where she was just on her basal insulin, but no, nothing no Bolus thing unless something out of control was, she would just fall rapidly and then level out right around those 17 depending on how accurate the sensor was at the time. And if I just didn't treat it and just waited, she would like level out and hang out down there. She'd do it at night, you know, my alarms would be going off because she'd be showing 6869 like a blood test. And she's in the 70s I just finally had to turn my alarm down to like 65 or something after I knew the sensor was accurate. And she just cruise down there all night. And if I tried to give her honey or something to treat, she just come right back down within 1520 minutes. So we had a few honeymoon periods. And I haven't seen any for a good six months or so. It's interesting. So you saw stability to lower number during the honeymoon. And if you tried to put in carbs, you think her body was pushing it back down again? Yeah, because we had we had bazel locked in probably a week after we had probably less than a week after we had the Dexcom. We were close. So we had to back off just a hair on the lantis. But and we're having pretty stable nights. But yeah, the what I so I just trusted that the bezel was right. And if I just like waited, as after I read this article, it just Yeah, she just cruised kind of flat around the 70s it was pretty amazing to watch because you could see like a minus 15 or 10 point drops, and all of a sudden she just stopped and stay there. So it was it was pretty, a little scary at first but but once I saw it, we just wrote that whole week out like that I'd let her come down and didn't panic until she hit 60 or something like that.

Scott Benner 14:11
Nice. Arden had an illness recently that was one of those that you couldn't really see on her. You know what I mean? Like there was no huge change in how she was or how she felt or anything like that. But her blood sugar's were lower constantly for like two weeks like she didn't need the we went through about four or five days where bolusing for food was like a crapshoot, like do Is she gonna need this, how much of it like that kind of thing. And then she, you know, whatever was going on, it stopped and we're back in it. But more importantly to our conversation here. An experience just yesterday that I'm going to start by telling you about and then if it's up if it's okay with you, I'd like to walk through the settings of the loop loop algorithm and talk about each one of the settings with you and how you think about them. Sure. Cool. So the thing that happened yeah. Yesterday right? So Arden poor Arden Arden had her period. This whole this whole podcast. She's gonna listen back. Like, are you kidding me? Arden has her period right? And it got a little heavy. And so I over the weekend. Now I flew Friday morning to Atlanta to give a talk. Which by the way went great and thank you Atlanta. That was really wonderful. I got to meet Jenny in person for the very first time. And got down there Friday. Went to bed, got up, get my talk came home. Get up Sunday morning. My wife and I are going to drive two and a half hours to see my son play in his second start as a college baseball player. Now, excuse me his third start that we were going that that we were going to see it for the second time because Saturday I didn't go I was obviously in Atlanta and he was playing in Washington. So while I was speaking to a large group of people, my son got his first ever collegiate hit playing baseball, which was really interesting because my wife texted me something. I think it had a curse in it too. So I can't read it to you. But he got a double for his first hit. I read it and then got a little like weepy in front of people. for a split second, I had to pull myself down, which is very interesting. Anyway, I, you know, I finished my talk up, I got on a train, I get to the airport, I come home, I walk into my house at 10 o'clock at night, and my wife and I are going to get up at seven in the morning to drive two and a half hours to a different baseball field to see him play. But Arden's not feeling well, because of her period, she's tired, and she doesn't want to come. So luckily, there was no weirdness going on with her blood sugar's like there had been prior weeks, it's been incredibly steady. And I set an override and a temporary target. And I set that out, like for forever thinking that way she could sleep as long as she wanted. And you know, least nothing there would shut off or go back to the you know, normal settings. And I figured she'll get up later in the morning and she'll know, she'll text me and I'll tell her what to shut off and she'll be fine. And she'll go about her day and she's gonna do homework and hang out around the house. So this is damn near embarrassing, and hopefully she'll hear this years later and actually be a little embarrassed by it. But at 430 in the afternoon yesterday, Arden sent me a text and said, I'm up. Like what? So turns out she was sick to her stomach the night before and didn't go to bed till like three in the morning. And still she slept over 12 hours, which is insane. But, you know, at least it's a little better than had she gone to bed at 11 and slept till four. But No kidding. I am going to pull this up. I scraped because I had been watching the entire time I was going I want everyone to keep in mind. There were telephones in Arden's room that I could have bled to wake her up. I could have sent you know, Find My iPhone to wake her up. My neighbor knew Arden was by herself here, you know, like we didn't just like abandon her in her bed, like kind of a thing. You know, both sides of my house are being watched by my different neighbors. But I am going to admit I didn't think she'd sleep till 430. But I am looking at this graph. 24 hours I left the house and her blood sugar was

Unknown Speaker 18:17
at

Scott Benner 18:18
and it never went over 110 it never went under at the entire time. She slept from 8am till 430. And I'm going to tell you right now, Kenny, I used to be really good. And I still am really good at using insulin with a pump and a CGM. But I could not have done that.

Kenny Fox 18:37
That's pretty, it's pretty unreal. I wish my kids would sleep 12 hours and keep their blood sugar in range

Scott Benner 18:41
just to leave you alone. Right. But I could not have accomplished that. Without that algorithm. There's no way she would have had to gotten up. I mean, not that that would have been the biggest thing in the world. But my point is, is that that she could not have slept, but ended up honestly being eight hours with us not in the house without any intervention whatsoever. And that's the loop. That's what me understanding the loop is what made that happen.

Kenny Fox 19:05
What kind of override Did you set a higher or lower one?

Scott Benner 19:08
Lower, I took insulin away. So her so Arden's daytime settings are more aggressive than her overnight settings, mainly her basal rate, and her insulin sensitivities are stronger during the day than they are overnight.

Kenny Fox 19:25
School and weekends are just

Scott Benner 19:27
Well, this weekend. It's just for school. And excuse me school and weekends while she's awake. The problem is during the weekend if she sleeps in her daytime settings that begin at like 7am are viciously too aggressive for her to be asleep with. Gotcha. Alright, so inside of the settings of the loop, and for clarity, we're using the Omni pod with the Dexcom gs six you are as well. Yes. Okay. There are there's a setting for correction range, suspend threshold bazel rates, delivery limits. Insulin model dosing strategy carb ratios, insulin sensitivity. And Kenny and I are going to go through all of them now. Exciting. Yeah, I it is actually kind of exciting because I think you know way more about this than I do because your brain works more technically than mine does. But I'm hoping I'm hoping for today you're going to be the technical side. And I'm going to be the, the blue collar side, you're basically Jenny for this looping episode. Okay. Okay. So let's just start at the top correction range. When I got loop initially, what was told to me was, you know, this is the bottom and the top of, you know, like it, it was, it was explained to me as target. So, you know, I'm shooting for between 80 and 100, for example, or from between 90 and three, I don't care if it was a target range. But as time passed, and as people came onto the podcast and spoke with me and I met people privately, I began to think of correction range as when the when I want the insulin to turn on and turn off, its its aggressiveness, its corrections. Somehow, that tiny difference in language was a big deal for me, because I wanted Arden's blood sugar to be no lower than 70. And no higher than 95. Like That was my you know, like, that was my pie in the sky hope, right? But it didn't work that way. And I'm going to tell you what I ended up changing it to, but tell me what yours is and how you think about it.

Kenny Fox 21:37
It's, it's still like a target, but it's where it's where the blood sugar should land after the time insulins all done. So when it expires, when the insulin action time is over. So that's the unfortunate part about that is it's doesn't, doesn't try to keep you in a range at the moment, it's more concerned about where you're going to end up. And that's a little frustrating, I think, for, you know, probably juicebox folks, like when we were on shots, we would her carb ratio, I use Tesla's carb ratio stronger than probably what it needed to be because a carb ratio, strictly speaking, is you start at one number you eat, and then you end up at the same number eventually, which would be when insulins done, you know, a long time in the future. But I'm not happy with the spiked comes with that even with a proper Pre-Bolus. So we always dosed a little bit heavy, knowing that she'd probably be eating in three, three and a half hours, no big deal. And so that's, we were always thinking in blocks of more like, three or four hours, not five or six hours, which is how long loop says, at the instant. And the last. So having a target way out there six hours is, can be a little tricky. So I still use the target country correction range as where I want her to end up because that's, like, overnight, that's really applies. But you have to get used to reading the prediction line, and then figuring out how to tell loop everything that you know, so that where you end up even in the middle of that is sort of where you want to be and still try to shoot for a landing. That makes sense.

Scott Benner 23:09
So this is super interesting, because I'm gonna learn something here from you for sure. Because I've come to ignore, ignore the prediction line completely. I act like it's not there. And it's telling me nothing, but you're getting a lot out of it. So this is this is gonna be terrific.

Kenny Fox 23:23
Yeah, I had to get a lot out of it. But eventually, I figured I couldn't have the same experience that you and I were both dealing with when we started which is sort of yelling at loop and fighting with it. So I did figure out how I could tell loop what I knew. So that prediction on looked reasonable that I mostly agreed with it. And if I didn't agree with it, then I needed to figure out why. Either I didn't agree with it, and why loop thought otherwise. And eventually, some of those things, you know, mostly if it's around food, once you get most of settings close. It sort of helps me figure out how do I change things in the moment when things aren't working the way I want to, to get that line to look right and not not be too wrong.

Scott Benner 24:02
While I was in Atlanta, I was talking through something with with Kelly Arden just came through a she's a lower number. She was like 65 as they were going to food. And so putting in, you know, the the carbs, the accurate carbs. This thing didn't want to give her insulin right away. Oh, yeah. Right. So I told Kelly, like, just you know, we're gonna, you're just gonna manually bolus enough insulin now. And you know, so there's at least a Pre-Bolus going on, then come back around and check the pending insulin in a little while she starts going up and then you can put the rest in. But I used the sentence. The Loop thinks, and that's where Kelly was. Wait, what? Yeah, I said so. So I said, there's what you know is going to happen from your history with insulin. But at the moment, the loop doesn't know that. It's not, you know, it's not a it's not a living, breathing thing. It's an algorithm. And it's taking these settings, and it's taking what you've told it. And it's saying, based on what my settings aren't what you said, you just took in as carbs. This is what's going to happen. You don't need this insulin right now. But, you know, differently, you know, you know, something it doesn't know. But this is what loop thinks. And I was like, now here's how to tell it something to make it think what's true, instead of what it thinks.

Kenny Fox 25:26
Yeah, exactly. Meant to think like that.

Scott Benner 25:29
It's so funny, because you said, Yeah, exactly. And my wife was like, this thing is bullshit. What? So we two different conversations. And I said, No, no, I swear to you, I'm being as clear as I can be about this right now. This is as clearly as I know how to speak about it right now. So so. So for clarity, where do you have your correction set for your daughter,

Kenny Fox 25:53
usually around 85 to 100, during the day, overnight, 80 to 90, I think right now, I just changed it to 8585. Since we're on the United spoken about this route using the feature testing branch for call automatic bolusing. And that helps keeps us I can give her like a single number target and sort of try to shoot for 85 overnight, for example. And it does a pretty good job. But she has such low basal rates we can get into later. But with a traditional loop, but the bazel modulation, it just doesn't, it's too slow to act, because her basal rates are so slow, so low that it would take you know, 2030 minutes to give her a little tick of insulin from the Omni pod over over 20 or 30 minutes that it's I prefer the auto bullets like Oh, she needs it. She needs it now. So I couldn't give it to her. So I can, I've now changed it from a range of, you know, 1520 points to five points or so

Scott Benner 26:49
yeah, so Arden's right now is set it at seven to 95 during the day. And that started with me just like going alright, I, when I have it at 85, she gets a little low, sometimes I make it at six, she's getting a little low last time, let me make it at seven, then I'm starting to like feel like I'm fine tuning it. But I believe that after this conversation with you, I'm going to decide that there's a different setting I should be looking at instead of this correction range, but but we'll get to that. So. So for clarity, if you set your range at whatever, you set it at 90 and 150, you think I want to live between 90 and 150. That's not how this thing is thinking this thing is thinking that often the future based on everything that's going on right now, eventually, I want to keep you from going under 90. And it could be talking about hours from now is that right?

Kenny Fox 27:43
It might even be not even under 90, but it might usually what happens after you've done your initial bowl. So usually when you set up carbs, it initially tries to say, okay, you want to end up at the bottom to the middle or the bottom of that range you've set when it's choosing how much insulin to give you. But once you're past that, it's mostly shooting for either the middle or the top of that range. So if he's at 90 to 150, and you end up at like 180, it's really only a target to bring you down by the time the insulins done kind of around 151 3140, probably in that range. So if you prefer to be more like a 100, but you use 150 as your top range, you're more likely going to be sitting especially overnight, let's say around that upper line. So if you were to enter, it's a prediction or to enter into that range, it's not going to take any action, it's like it's fine, as long as you're going to land somewhere in here. Now you don't 150 it's cool with that, if you're going to under 90, and it tries to back off, if you're going to get over 150, it thinks then it's going to add some more. But if you're gonna land anywhere in that range, it's not going to take a whole lot of action. So if you want help to get lower into the 110 100, somewhere in there, instead of 150 you should probably have your target market where you'd ideally like to be but balancing like you mentioned, the risk of kind of going low if you shoot too low.

Scott Benner 29:02
Well tell me why you wouldn't just make the correction range 85 and 85. My top and bottom goals are 85 and 85.

Kenny Fox 29:10
Why would Yeah. So normally, it's just the amount of like, back and forth the amount of work I guess Luke puts into it. So if it's if the correction if the prediction kind of moves up or down a couple points away from that line, it's going to try to do something so it's going to change the basal rate temporary basal rates using and what the Omni pod. This is the issue we both struggle with early on was every time that bazel rate changes every time Luke makes a change the timer that the Omnipod uses to start delivering on that rate sort of resets. So if you need a couple of you know, deliveries point 05 within a certain hour, let's say then that amount, how fast that's going to tick. That counter starts over every time it changes. So it's like hey, if you need five in an hour I'm going to spread it out

every 12 minutes, and then the loop changes

Scott Benner 30:05
the Yeah, easily again, and then it starts all over again. So you're never really getting as much of it through that model is through the Basal model,

Kenny Fox 30:13
not as quickly Yeah, so what will happen is if it changes again, so if you need like five in an hour, it'll do every 12 minutes or so, let me just start over as is okay, and 12 more minutes, I'm going to give you something more than in five minutes sleep makes a change again, then it's the counter starts over. And once that calculation for how often that happens was fixed, at least what would happen is in five more minutes, it'll probably pick an even higher rate. And if five more minutes, they'll pick an even higher rate. But for someone with a lower insulin need, whether your basal rates are higher or low, but you don't need very much, it may take three, four or five cycles before that first delivery is fast enough that it actually gets in there, if it keeps changing every five minutes. So if you pick a range, it's more like it's less likely to have to change, if you're going to land somewhere in the range you picked. It's like, Okay, I'm good, I'm just gonna stick with this one, for a little while, that's kind of most of the reason otherwise, it's more, I just don't care if I'm 100. Or if I'm at five, I'm fine with either, so then you would just leave it there.

Scott Benner 31:12
So we're gonna jump around in the settings a little bit like the next setting in the, you know, when you look at it would be suspend threshold. But yeah, I'm gonna skip over that for now. Because I think that what we're talking about leads into insulin model. And if you disagree, then obviously, I don't know what the hell I'm talking about,

Kenny Fox 31:28
well suspend, suspend is easy enough suspend is in that situation you gave with Kelly loop is really concerned with you not going low. So if 60 whatever it was below, your suspend, that's why it wasn't giving insulin, it doesn't care that if she doesn't have a Pre-Bolus, the prediction, you might even show she's gonna go to 200 loops, not worried about that, I just worried about the fact that she's currently low, so I shouldn't be giving more insulin, which is a little frustrating. So that's, that's really where suspend is, if any part of that prediction line is going to go below suspend, then you should probably, it's going to stop giving insulin so you want to make sure you're not seeing lines dropping that you don't agree with you don't think she's gonna this year she was gonna go low, then you probably need to fix some settings. Otherwise, that suspend threshold is gonna like banging your head against the wall. Why is it cutting insulin when it shouldn't be?

Scott Benner 32:19
Quick hitting ads today, the dexcom g six continuous glucose monitor, you want to check it out. It's at dexcom.com forward slash juice box. type that into your browser right now. If you're not good at typing, click on the link in your show notes. It's right there in your podcast player. There's notes in your podcast player, just find them and click last thing you could do is go to Juicebox podcast.com. And click from there. All of these options are viable ways to get to the sponsors. While you're there, check out the Contour Next One blood glucose meter, go to Contour Next one.com there's a little button at the top, you can find out if you're eligible for an absolutely free meter. This meter is by far the most accurate one that my daughter has ever used in her entire time with Type One Diabetes. Lastly, if you'd like to see some lovely people doing wonderful things for people living with Type One Diabetes, check out touched by type one.org. I'm doing you a favor. I'm shortening up all the ads today. You can do me a favor and click on the links dexcom.com forward slash juicebox. Contour Next one.com touched by type one.org. That's all I'm asking today. No big sell. Just go check them out. book I'm done before the music. It's like you owe me almost how there's so much time left. It's kind of weird, right? touched by type one.org helps people living with Type One Diabetes, amazing organization. Contour. Next One best blood glucose meter I've ever seen Dexcom g six continuous glucose monitor game changing technology for type one diabetes. There I said I wasn't gonna tell you more about there's just weird. What I was gonna jump to next is insulin model. So yeah, so that's, I guess for conventional pumpers. That's insulin on board measurement. The idea that insulin lasts in your body for X number of hours. It's it's based in that idea, but not really like good. So this is more about the pump. I've come to think of it as the window of time that the pump considers the insulin for like, like if you Bolus and your model said it six hours, which I think is the default, right in the, in the in the algorithm. You know if that's a scenario, it's thinking, Oh, you definitely won't be high six hours now because we put in enough insulin right now. But if your settings are wrong or the foods you know, whatever, you're dehydrated, all the other things variables that the the algorithm can consider. That's not going to work for you. And so that's why you see some people with the loop. They're like, Well, my blood sugar went up to 180. And it sat there for like, five hours. And then it but it did finally come back down. And you hear them say that, like, that's some sort of a win, which I think for a lot of people, quite honestly, is a win. But for you, and I'm probably most of the people listening to this podcast, like, I don't want my budget to be 174 or five hours. And Kenny was the first person to say this to me, because steadfastly, everyone I spoke to said, don't touch the insulin model. Six hours, leave it at six hours, leave it at six hours. And Kenny was first starting to say to me, like, yo, mine's not at six hours. And this works a lot better for me. So mine is set. ardens is set at five hours and 15 minutes, I think. And yours is five, is that right?

Kenny Fox 35:52
Yeah, so hopefully I don't get in trouble.

Scott Benner 35:57
First of all, this Kenny's not in any way related to the to the the looping, like the people writing these algorithms. You're just the person using it.

Kenny Fox 36:05
Right? I am. And I would love to meet the people that are Katie and Kate and others. So um, yeah. So mindset at four and a half hours. And I'll tell you how I got there. So before? Really?

Scott Benner 36:17
Good. Tell me.

Kenny Fox 36:18
Yeah. So when we were on shots, I found apps like extra up and some others that would let me track insulin on board, I just found this cool app. And honestly, I was too cheap to buy a phone that would be useful with the approved dex comm app for my daughter. So I just grabbed my old android phone down next trip and said, Okay, well, that means I have to build a nightscout site. So I've built a nightscout site. So we put extra bond extra put all these like cool knobs and levers I had to Google about every time I was trying to figure out what these different pieces mean, and one of them was insulin duration. So what I did is I just once we got the bazel locked in, on my daughter, I would just watch, obsessively every day, when the insulin onboard time when the heard line would stop moving even just one point, like just nice and flat. And so it was between four hours, and like 15 minutes and four and a half hours somewhere in there. You know, we had to give some sensor lag and other variables, some sway there. But I ended up just dialing up from four to about four and a half on extra nightscout. And so I could with confidence know, when she would level out. So like, you know, if she didn't have a snack between lunch and dinner, she would level out right around five or six, and I could watch the iob number go down down down to zero. And sure enough, she'd be flat, I wouldn't treat no matter how fast she was falling zero would be, she was fine. It was fine. Basal was fine. Everything's happy, she's nice and level. The other benefit to that was I was always tracking how long it would last. But then it also allowed us to do things like treat and I know how much to treat for so I'd look at how much insulin was on board. If she was starting to go lower than I wanted to, you know, at that kind of three, four hour mark, knowing that I give him too much insulin most likely for that meal. And then I would just turn that insulin on board number into a carb ratio, and say here have this many carbs, and then she would level out. And you know, once the insulin board time was done, when it was zero, she would turn off level out. So that kind of predictability was important and comforting. And also, let me have the confidence to change the duration of insulin action in a loop. But I didn't do it initially, I really wanted to give lupus as a chance to kind of prove itself and say, Well, maybe six is right. And I read Katie's post about why messing with the insulin reaction time is could be bad. But frame that conversation she's having around the fact that pretty much every endo will have you set your pump insulin action time to something like two and a half, three, three and a half hours, which is obviously not right. So when they when you get into the loop group and you read the docs and people are really hard about Hey, you got to stick with six hours. It's because people are convinced over you know, years of time that insulin only last two or three hours and that's not the case. So and six is definitely safer than say five or four and a half it would safer to over represent how much insulin is in your body while annoying and possibly keeping you high. If it's not actually how long it lasts. It's still safer than under representing the insulin so and for some people I've helped out five and a half, six hours is about right so we don't really mess with it. But there's still a chunk of people that five is probably like a really good number that gets it pretty close. So I was just watching all that's all I could watch on shots and so I knew that number going in or most people don't really have a sense for that. What that number should be so you can test for it. But yeah, I changed mine to four and a half.

Scott Benner 39:44
So I think that it's it's pretty obvious. If you listen to the podcast that my concept is I try very hard to break the wall between the the time I don't know how to put this, let me get up to give me a second Kenny. So obviously, everything about insulin you do now is for later insulin doesn't always work exactly the way you want it to in the moment you put it in your body, right, it always takes time to build momentum or power, it peaks sometimes, you know, it's always, it's always about later about later. But I feel like this is gonna be a ham fisted explanation, because it's still something I've been mulling over my head for a while, I don't think I've ever said it out loud. But I think of the management of insulin, like the momentum of a car climbing a really steep mountain, you need to get to a pace and stay at that pace. And it's going to become more and more difficult as you go. But if you just keep this pace up, you'll make it to the top. And so I like the idea of there being active insulin all the time when it's needed. And it's so that so that the food or your body function can never really overpower the insulin that's active. And that so that the insulin is not overpowering the body function, I don't want anybody low all the time. Not saying that. I'm just saying that when you accelerate, and then take your foot off the gas, you drift back, and then it takes more effort to get going again. And so you know, instead just put your foot at one spot on the accelerator and head up the mountain. And I know that's not 100% clear. But that's the background way I think about using insulin, it's the closest thing to creating constant insulin action so that what's happening now with food is being in real time impacted by insulin because there's always insulin coming from the past to help you now. So instead of putting in insulin now for later, I think of it as putting in insulin later before for now.

Kenny Fox 41:52
Constantly, that makes sense. Yeah, it's way I have a really old big RV. And so driving up a hill, yeah, if you back off just a little bit, someone cuts you off or something you're, you're now Don't slow the whole time up the hill just to make it up. So you get to keep your momentum going to stay ahead of it. Wait, I found with diabetes, you always have to be kind of looking ahead a little bit always planning ahead and looking ahead, like if you know you're going to eat, you might as well give some insulin, but getting looped to kind of agree with you on that. Or, or to know when to how to use loop to be bold, so that you can keep the insulin moving when you need it just takes a little bit of practice.

Scott Benner 42:27
Yeah, it's just sort of this. It's tough because I try to say things a lot of different ways so that it eventually hits everyone. But I'm always talking about insulin for now is for later. And I know this is gonna sound like the same thing. But it's not if you just kind of like, you know, just microdose a mushroom right now and listen to what I'm saying for a second, okay? insulin for now is for later, but insulin before is for now. And that's probably more how I think about it than how I teach it. I teach now for later, but I think before for now. And so the minute you start taking away insulin now, you're just gonna be getting, you're just gonna get high later. And and I hope that makes sense.

Kenny Fox 43:19
It did to you, which is in the same way, in the same way, if driving my big vehicle, you take away the speed at the bottom of the hill, it's gonna affect how easily I can make it up to the Hill, right? I just don't have the power of momentum to push me up an hour.

Scott Benner 43:33
Or if you don't have that momentum going. The minute you come up on a speed bump or a branch to drive around, yeah, you're gonna lose your, your momentum. And now all of a sudden, the detour wins. Like, right, like, all of a sudden the meal wins or the you know, the spike in your adrenaline wins, that thing wins. Because you're it's the same reason why at the end of the story that I just, you know, I told you the beginning Arden's blood sugar, no lie 8am till 4:30pm while she slept right in that tight range, but when she woke up, she says to me, Hey, I'm gonna get a bowl of cereal. And all I told her was this, that's fine, your blood sugar is going to get high. Here's our goal. I'd like to try to keep it under 180 get it back down without you getting low. Now keep in mind, I'm not there. My daughter's about to have Froot Loops. She's not going to measure them. I'm not asking her to okay. And so I told her, you're going to get high. And she said on Pre-Bolus. And I said, Yeah, not gonna matter. Because you've been living on a deficit of basal insulin for the last eight hours, right? The before is not strong enough to handle the now and you were going to Pre-Bolus and we're gonna smash most of it. But unless you're willing, but you're at so I can't have you wait 30 minutes. I can't tell her to put in you know, 11 units of insulin and wait a half an hour because if she doesn't eat that cereal the exact right time, and God knows what that is that insulin is going to crush her. And I'm going to come home to a puddle of a kid on the ground, right? Or at the very least my neighbor is going to be handling something I'm pretty sure he didn't think he was going to be doing on Sunday. So I said, Look, we're gonna deal with it, there's gonna be a spike, right? So we're going to, you're going to go downstairs. The first thing I asked you to do, Kenny, I don't know what other people think of in this situation, like you would think Pre-Bolus thing. I said, Go make sure the cereal is not stale, because you don't need it all the time. And make sure the milk is fresh. Because the last thing we need is 10 units of insulin going in you and then you saying this milk doesn't smell right. Because I don't know how to eat that fast. You know what I mean? So, um, so she checks all the food, all the foods, right? I'm like, I cool. You know, go ahead and put in, you know, this, I think we use a massive amount of carbs, like 80 carbs or something like that. And it wanted to give her 10 units ish, like, right in that space. And I was like, Yeah, go ahead and do it. And I said, try to wait 1015 minutes if you can, and but I don't want you to wait much longer because we're there. And she did. She ate and it held on for a while. Right that Bolus thought for a little while but all of a sudden 15 I think no fifth is longer that 3530 ish minutes later, we got the dreaded 126 diagonal up now I know everybody's different. But 126 diagonal off means to me they penciled in their

Kenny Fox 46:37
index column showing a diagonal year you're having a problem Next comes arrow changes after two readings that are equivalent to like a diagonal so like if more than five like six to 10 points every reading it needs to have those in a row before it changes the reading hundred percent to a Yeah, which is way too slow. I like using extra power I get to see the plus and minus that. Reading the reading and I don't have to worry about the stupid next Camaro so while

Scott Benner 47:03
that super stiff line is still there, right on a second Arden's talking to me here. While that's super stiff line is there at 105 or 95, or whatever. I'm like, That's not right. There's no way that that cereal This Pre-Bolus has not been alive in here long enough to to hold back Froot Loops and milk, even for 15 minutes. So I'm like it's gonna go up. Oh, wait, I'm gonna go to lunch right now. Excuse me for a second Kenny. You guys is interesting artists coming out of gym. Then how are we gonna do this? With the carbs and like this. I'll talk you guys through this Hold on one second. I can finally talk about a loop thing about a lunch. Arden's leaving gym right now. And she was away from her CGM. So her blood sugar went from like 75 to 60. While she was in gym, she feels fine. She's going to eat that's not an issue. I'm not worried about that. So we're going to tell the loop that she's going to have 35 carbs. We're going to tell the loop to consider those carbs as a two hour impact. And then we're going to tell it 40 carbs and consider that as a three hour impact. So Arden has Zell's and a chocolate chip cookie, a half of a bagel, a pretty big bag of grapes. A Clementine a bag of popcorn? I can try to guess those carbs for everybody if you want. I'm gonna guess the actual test hitting carbs. Yes, I'm guessing the bagel at 25 I'm putting the putting the grapes at 15 to 18 now we're at 35 or 40 the cookies are gonna be another five for the chocolate chip. I'm at 45 the puzzles are probably 10 more I'm at 55 the tangerines like 12 or 15 I'm at 6570 I don't know popcorns 10 at ardens. Carberry shows 7.42 to one now as soon as it tells her that it says Of course not to give her insulin because their blood sugar 60 Yep. So I'm gonna say when are you going to eat? Do when do you begin eating?

Kenny Fox 49:32
So have you tried not giving Pre-Bolus in the situation since you're on the automatic Bolus will give a fair amount pretty quickly and then just text her and say hey, give the rest later.

Scott Benner 49:41
So I think of it just like that. But opposite. So if she tells me she's going to start eating right now. Like right now right now we're going to Bolus

Kenny Fox 49:51
Oh, yeah, that

Scott Benner 49:52
would just give it Yeah, sure. We're gonna put in probably like, I'm gonna guess like five or six units right now. And then I'll let the auto Bolus do its thing a little bit or will check for pending insulin and just do the whole thing,

Kenny Fox 50:05
if that makes sense. Well, the wonderful thing about the auto bolus is that since it loop doesn't use increased Temp Basal at all, there's not going to be a whole lot of pending unless, I mean for three hour, I guess there technically might be some pending, but there's almost never any pending, it's always recommended Bolus. So she can always just tap her watch her her phone and just hit the bullet screen, it should just have a recommendation. So if an even more insulin, there's always a recommendation with the auto Bolus branch, which I really love, because my six year old, I can just say, Hey, Bolus, and she just turns the watch over tops to Bolus green. If there's something there, she takes it. And then nightscout I can see if there is a recommendation before it would, you know, increase the Temp Basal rates? And it would it would loops like I got it, don't worry about it, I'll, I'll take care of it. I'm like, yeah, you'll take care of it eventually. But I don't, it's not fast enough. But I can't tell my daughter to pull it put this much in and trust that she'll hit the right number, using the watch or her phone. So now there's always a recommendation if she needs more. So I can say hey, I think you need all of it right now. So just just hit your watch. And she handles it just fine.

Scott Benner 51:10
So what I ended up saying is she said, I meeting like right now I'll be putting food in my mouth in three minutes. So I said seven units. Eat as soon as possible. Let's talk again in 15 minutes. But you just said you can see you can see recommended insulin on nightscout. I need to let you I need to let you dig around in my nightscout apparently I don't think I see that.

Kenny Fox 51:32
Well you have that loop pill right underneath the time underneath the clock.

Scott Benner 51:37
Right. Okay, let me

Kenny Fox 51:38
think. So if you hover over that loot pill with your mouse or if you use it on your phone, you just kind of tap on it. You should get like a list of information in that hover area. And one of the things you should see at the very end of it. It only shows up when there's a recommendation below you'll see the last things are listed in that list of all kinds of crazy information. So is a recommended Bolus

Scott Benner 51:58
I see the loot pill so right now I have four minutes ago squiggly squiggly line 103 what is squiggly line 123 mean?

Kenny Fox 52:06
The I forget that icon squiggly line I think means everything's Oh squiggly line 103 got it. Sorry, five minutes ago or four minutes ago, a squiggly line means eventually. 103. So the the end of the prediction line is 103 at the moment.

Scott Benner 52:20
It is I'll be

Kenny Fox 52:21
Yeah. All right. And but that will only update you know she's updating it on her phone so you won't see the next update until you know the next sleep cycle till next time it uploads night to night scout. So even though her prediction line probably doesn't look like that because she's put in, you know, seven units. You'll get the update eventually and you'll see the the eventual number will update.

Scott Benner 52:42
Okay, so Arden's all squared away. Let's go back a little bit here. So insulin model, when you have yours, even lower than mine is what's the intention of making the insulin model a shorter time period. And that's where we're going to pick up in part two, which will be out in just a couple of days, it's going to give you enough time to absorb this, maybe go back and listen to it again. And then we're gonna get through the rest of the settings list on loop. Hope you found this interesting. I just think Kenny speaks so wonderfully about loop. He's very clear. He understands exactly what he's saying. And he's helping me a lot to bring things into focus. If you agree, definitely check out part two. Coming up, I think Thursday night. Thank you very much to the sponsors. dexcom. Contour Next One blood glucose meter and touched by type one. Check them at a touch by type one.org dexcom.com forward slash juicebox. Contour Next one.com. Of course, there's always going to be links in the show notes of your podcast player. And at Juicebox podcast.com. I appreciate you supporting the sponsors.

If you're looking for more episodes about loop, check out Episode 227 diabetes concierge. Episode 252. A loopy few months Episode 304. loop de loop.

It bears repeating that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. A huge thanks to all of the people. Most of whose names I'm sure I don't know, who have put their blood sweat, tears time, effort, heart and soul into this algorithm. It's hugely, hugely, hugely appreciated by me and I'm sure by everyone else

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#311 Diabetes Pro Tip: Long-Term Health

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

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

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello, everyone, welcome to Episode 311 of the Juicebox Podcast. Today's episode is a pro tip. So you know what that means. It's not just me today and a guest, it's me and Jenny Smith. Today Jenny and I are going to talk about long term health as it relates to type one diabetes. This one's a little less pro tip and a little more conversational. The information rises to the level of pro tip. But the style of conversation is more like Jenny and I got together as friends and I said, Hey, tell me your thoughts about this. And then we chatted about it a little more laid back a little more conversational. But the information is definitely something you want to have in your tool belt. And that's why this episode is part of the diabetes pro tip series that begins back on episode 210. This episode of The Juicebox Podcast is sponsored proudly by dexcom, makers of the G six continuous glucose monitor. And of course, on the pod, the tubeless insulin pump that my daughter has been using for 1112 years, a long time. It's been an honor every day for that time, must be good. I'll never forget the day I was sitting in a hotel lobby when a person asked me what's next for your podcast? What are you going to do to innovate and keep it moving. And I said, I'm gonna do a pro tip series, I think I have all these ideas, and how to bring them all together and really talk through them with somebody equally knowledgeable, but who will come from a different perspective. And I had that person in mind already. That person was Jennifer Smith. Because Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Plus, she's had Type One Diabetes for over three decades. And bonus, I like Jenny. I like the way she talks about type one. It just, there's a goodness about her. She seemed like the right person. And she certainly has been. It's been over a year since the first pro tip episode came out at Episode 210. And today is the 17th. In the series, I believe you got to go check them out. They're all listed as diabetes pro tip is a colon and then the titles afterwards. One last thing you know what it is? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin.

Jennifer Smith, CDE 2:47
What are we doing today?

Scott Benner 2:48
We are going to do a pro tip episode that you suggested and prevention of long term complications you said and you said What does optimizing glucose long term do for keeping things healthy? So I feel like what you meant by that is below less variability not low but in you know, lower than what a lot of people go for less variability, lower standard deviation, how is that going to help you throughout a lifetime? And so I feel like between that, and some other safety ideas that I'd like to bring into the conversation. I think we're gonna have a good a good talk here. So I guess first, why don't we talk about a little bit through time, right? Where does everybody and by everybody, I mean, doctors, where do they get the information that they put on their patients? You know, I'd like to see you have an A one C of x. Does that come from the American Diabetes Association? Do they set the tone who sets the tone for what we should be shooting for? Because somebody does it?

Jennifer Smith, CDE 3:51
As far as targets? You mean? Yeah. Yeah. So I mean, well, targets calm. It's funny. I just had a conversation with somebody who listened to the podcast, and I had a first visit with her just before this. And she asked the same exact thing. She's like, I'm getting all of these different targets from different people. And she's like, I don't even know what to believe anymore for a target. She's like, I know where I feel good. I know where I kind of want to be, but what am i aiming for? And I said, Well, there are a couple so the American Diabetes Association aims for your post meal target under 180. Okay, it comes from the American Diabetes Association, through research and gathering of all of this information and, you know, whatnot and looking at complications down the road. cumulatively. They aim for what less than 180. Now, the American Association of clinical endocrinologists recommends less than one six.

Scott Benner 4:48
So less than 160

Jennifer Smith, CDE 4:50
less than 160. Okay, so there are two high in the ranks of diabetes management. Yep. That are different. Already, right. And then we bring into the mix. Well, what are recommendations even further than that, like pregnancy? pregnancy recommendations, you know, are for the most part under 120, fasting under 100.

And post meal no higher than 140.

Scott Benner 5:20
So M is what I'm hearing good good for the shift. Oh, fusion.

Jennifer Smith, CDE 5:24
Yeah, confusion entirely. And then I had a woman in a couple of years ago postpartum, I had her visit with her. And she's like, so I was aiming for all of these targets in pregnancy to keep my baby growing healthy, and myself. And she's like, and then my doctor tells me to loosen up my target in my palm, and tells me I don't have to be so you know, quote, unquote, tightly managed, and she's like, sick, I want to ask your opinion, Jenny's? Like, why wouldn't I want to stay this tightly controlled if it was good for me and pregnancy? And these are targets that people without diabetes? maintain? Because their body does what it's supposed to do? Like, why wouldn't I want to maintain this? Whether I'm pregnant or

Scott Benner 6:03
not? Yeah, yeah. So here's right here. Exactly. And here's what it's making me feel like, so much like, with everything about diabetes, when you try to give someone like this just, I don't know, this is how things are right? Like it 181 6120 whatever anybody ends up saying, that's not personal. And and personal, between should be consideration should be you, your intent, your involvement, your intellect, your understanding, then it should be, am I injecting? Am I using a long acting insulin that's been I was made 20 years ago, or my using one of them that's, you know, been made more recently that people find more stable a lot of the times, am I using a pump? Do I have a glucose monitor? Is that you know, is it a Libra? Or is it a dexcom? Is that the G six? Or is it the G four like, it would seem to me that all of those variables would would make it more or less likely for me to be able to maintain targets that are lower or higher? Right? And so then you get the doctor, like what you just said about the pregnant person? I feel like that doctor was like, Look, you must have had to have killed yourself to keep your blood sugar that low. Right? Like, obviously, it ate up nine, you know, nine months of your life, you did nothing but keep your blood sugar in check, have to pay and watch television, that must have been your whole line months, right? Like, like, you're talking to a guy in 1920. It's like, you know, you didn't even have time to make me my pot roast. Like, like, like that, like Reagan old time idea, right?

Jennifer Smith, CDE 7:41
And now you come into the office and You look like you've got baby spitting your ear, you look like you haven't slept or combed your hair. So let's loot some things. Sure. Right.

Scott Benner 7:50
Right. I think that what would make your day easier is if you were less healthy. But it's not it becomes about and I get that right? Like, I think that out away from the ideas that we talked about on the podcast. Maybe that's real. Do you know what I mean? But when you start telling people, we, when I started asking people, you've been at this for a while now six months, eight months? Is it that hard? They say no. Like most of the people, I don't want to say most of them everyone I've ever spoken to who's picked up the ideas of the podcast, put them in practice, and gotten to the point where it's just second nature. They don't think about diabetes, very much these these targets are meaningless because you get to a spot you stay at that spot. If you leave that spot, you know how to get back to that spot? Right? That seems like it to me, honestly.

Jennifer Smith, CDE 8:40
Right. And from the standpoint of, you know, prevention, I mean, that's the that's one of the biggest things that brought out beyond Well, here's your insulin, here's how to inject it. And oh, by the way, insulin can cause your blood sugar to go too low. complications are always within the first like, new onset diagnosis, discussion. Always something about complication, right. Always, like you have to control things. I love that word control because like, like a moving target and control.

Scott Benner 9:11
Not only that, by the way, it gives you the impression that you're going to be out of control and it's your job to control the chaos.

Jennifer Smith, CDE 9:17
Correct. Right. Exactly. It's like your job to hurt all of the million cats in your yard with no fences. Yeah, right.

Scott Benner 9:23
What if I just didn't let the cats in? How would that be?

Unknown Speaker 9:26
How would that

Jennifer Smith, CDE 9:28
play? Yes, exactly. So you know, the prevention of complications that I mean, there's no, there's no set solution, really, on how to 100% prevent complications. In research. We've seen people with many years of diabetes, some of them poorly, you know, managed, some of them tightly managed, and complications can start for people at different points of time. And that makes it seem like well, gosh, I'm just gonna throw my hands up in the air if I can't 100% prevent anything. But what we do along the way makes you feel good. on a day to day basis with tighter containment of things overall, yes, we are likely 99% likely avoiding the complications down the road, right at 1% that something could happen. Sure, it could be there. But I don't think there are many things in this world that are 100%.

Scott Benner 10:29
Right? perfection. And so to your point, it's, it's presented incorrectly to people. It is like right away, like, you know, it's not your goal not to die. Right. It's your goal to live really well. until you die. Right. Right. And and if you can extend those years, wonderful. But you know, it's just and you just said to about how people feel? I've been talking about that a lot lately. I don't know why people don't think about that. Like just how they feel every day. Like, you know, are they tired? Are they sluggish? All the stuff that we've spoken about over and over again? Why is that not important to them? And I don't think it's not, I think they find it to be something they can't impact, which isn't true. It just isn't like there are times there are times genuine, I'm afraid people will realize that when I keep saying over and over again, it's about timing and amount and common sense. They're gonna go, Hmm, I don't think I need to listen to that podcast. That guy might be right about that. Like, why don't I just tie my insulin better? And when I see something happening, go, Hmm, that makes sense. I should do this now. Yeah. Right. Because, I mean, honestly, there's no pot, if you guys all figure it out, the podcast is over. Basically, I, you know, obviously there'll always be newly diagnosed people who are going to get this terrible information and start down the wrong path. I just I want I want people to think more about how they feel. And I spoke about this in my talk this weekend. And I've said it here before, too, but you have to, you have to believe that if your blood sugar is constantly high, you're altered. You just are like there is a person

Jennifer Smith, CDE 12:09
without short term and long term.

Scott Benner 12:11
Yeah, there's a person you would be intellectually articulately that you don't get to be when your blood sugar's high, or crazy low or bouncing around, right? Because your brains always just, it's, it's, it's just, it's not where it needs to be.

Jennifer Smith, CDE 12:27
I don't know. And within that, even within that day to day feeling, are those behind the scenes. Unfortunate what's happening in the body that you aren't feeling? Like, we know how high blood sugars make us feel. And if you're paying attention, you know, the containment of them, you get out of that you can think better, you can act better you can do the things you enjoy doing. But behind the scenes, internally, what's happening with better management is you're not causing damage to cells. You know, I mean, especially heart disease, I mean, heart disease is a huge component that we have to take into consideration. But it's not like it has to be there in your brain every single day. If you are managing the blood sugars, you're also managing a healthy heart. You're also managing healthy kidneys, healthy nerve cells, healthy eyes, you're managing those internal pieces that until they are damaged enough and give you indication that there's a problem. you're managing that along the way so that you don't get to the end of the road and have heart disease or kidney problems or whatnot, right? Yes.

Scott Benner 13:37
Oh, and where do you stand? Have you ever heard me explain how I think of it with the sandblasting? Have I ever said that? Because here's the place to say if I've ever said it to you, okay, so the way I think about high blood pressure, high blood sugars, and back when my kid was little, and I was looking for motivation, like seriously, like, what, what's gonna get me up at two o'clock in the morning to correct a 150 blood sugar. But when my doctor is telling me That's okay, like, what's the motivation. And whether I'm right or wrong, technically, in my mind, it feels like this. My body is built to withstand a certain amount of certain content of sugar, glucose in my bloodstream. And when there's more there, on a cellular level, glucose is still sharp, right? It's like, it's like if you take a sugar and you spill it on the table, you look at it, its course and you know, it's sharp, and even on a molecular level, like smaller, smaller, it's still sharp. So when you pack too much of it into your veins and your arteries that run through your heart and your eyes and your legs and your fingertips and everything else that's sharp. This is scratching at the inside of that soft tissue and those veins and those arteries, and one day, it'll wear through a little hole. And if it were through a hole in your heart, you have a heart attack. If it wears through a hole in your eye, you have vision trouble if it starts wearing through in your feet, you might not be able to feel your feet and honestly And again, so all of the diabetes complications that are on a list somewhere in your doctor's office to scare the hell out of you. What it really means is, if your blood sugar is too high, you know, what inside of your body, is it going to rub through first and create a breach? And you know, and will that breach, you know, and that breach will hurt. You might, you know, we talked recently about my friend Mike who passed away, he was on dialysis. So the first thing that it rubbed through worse his kidneys. And then as he was on dialysis, the second thing it rubbed through was his heart. And then he had a heart attack and he died. And that's it. And he'll he'll his death certificate says he died from complications of type one diabetes, though. That's it,

Jennifer Smith, CDE 15:43
right? And that's a great, it's a very layman's way to understand it. Because I think that the textbook explanation is, it's too clinical, it's to medical. And I think that's why, for the most part, people are aware of complications. But when you explain it, such as that damage piece, and I used to explain it in the class, the type two classes that I used to teach is that my sugars, cause damage to the inside of your vessels cause damage to the outsides of the nerves and everything and almost like eat it away. So like a sandblast. Yes, it's like cutting and cutting and cutting and calling causing small abrasions, right, scratches, scrapes, that the body actually tries in your body is a it's a, it's a self healing.

Like organism, right, which

Scott Benner 16:36
is why it doesn't happen to you right away it wrapped fixing little making little patches, it's like your road crew in town filling potholes, when you think you just repave the whole road, they're like, nope, best we can do is pop in a little patch in this hole.

Jennifer Smith, CDE 16:49
And it's more inflammation, I mean, long term, those little holes are really from inflammation in the lining, and along with cells and whatnot. And over time, I mean, if that inflammation causes a tear, the body tries to patch the tear. Well, if more and more tears happen, and more and more patches get placed into the vessels, you know, and I know visually, this isn't a podcast, people can see. But as you can see, my hands get closer and closer together to indicate the constriction and the narrowing of vessels. So then we have heart disease and potential for stroke and problems with blood flow, getting to the kidneys to do what they're supposed to do, and circulation to your fingers and your toes and never anything see. And Jenny, the way I think of it is I was just there one day in my house trying to talk myself into not giving up before I understood what was going on, right? So what do I need to do to not give up and this is how I put it, it's really no different than a football coach who just has a player has three brain cells in his head, and he goes, look, see this line right here. Don't let that ball go past that line. And that really is how I dumped it down for myself. I was like, I can't let that ball go past that line. Like I have to try to figure out how to stop that.

Scott Benner 18:05
And I think everything that everyone's listened to since then, is born from that idea. Like, how do I stop this from happening? Right. And I've had that moment where I realized I may not be stopping it from happening to like, maybe my kid genetically is just the one who can't withstand having type one diabetes. I don't know, you know what I mean, but she certainly has a better chance, the way the way she lives right now than she would if I just listened to, you know, just keep her under 200. You know, don't let her spike over 180 or 160, or whatever, after a meal if you right, you know if you can. To me that was just that just made sense. In the moment when I was scared and alone, and it didn't know what I was doing. I just thought like, I need a I need a I need a goal. You know, right? Why? blood sugar? Oh, sorry. Sorry. Go ahead. No, good blood sugar is gonna say blood sugar is a big piece of it. But you know, the other components to those complications, too, are the other factors that also contribute to blood sugar management, right? So the kind of nutrition you take in that interior sedentary versus more active lifestyle, all of those are also huge benefit for long term health, outside of just rolling or managing your blood sugar. And all of those things become exponentially more important. When you have type one diabetes, they're important to a person who doesn't have it. It becomes even more important when you do like sometimes you just feel like, you know, like how many, how many gunfighters are gonna be on the other side before I just I don't have time to get to the mall, you know, you'd be like, I'm gonna get overwhelmed because there's just so much over there. So you have to give yourself a chance. You know, and aside from the idea that exercise helps you keep lower blood sugars like that aside, exercise does all the other things that exercise you know, it's funny, it's worth mention Hear that I realized the other day that some people refer to me behind my back is like, somebody who pushes carbs on people. And I thought, That's odd. I've never considered that before. Excuse me, but I guess more low carb people kind of can feel that way a little bit. But I listened to it. And I thought it through and I don't feel like I do that. I feel like this podcast teaches, talks about preaches maybe how to use your insulin, like how insulin works. And I say all the time, once you know how your insulin works, I don't care what you you know, you do whatever you want. But I think you need to know whether you're low carb, or whether you're a person who's like, wow, I think I could eat that whole box of hohos. Like, like whether whoever you are in that scenario, you know, one side or the other. If you understand how to use the insulin, you can accomplish it. I'm not saying because I know how to bolster Chinese food. You should do it every day,

Jennifer Smith, CDE 20:54
every day. Every day. I know how to Bolus the chocolate chip muffin and the chocolate milk and the Hershey syrup on top doesn't mean it should comprise every meal. Because is that better than an apple with peanut butter? Right? And nutrition wise? Probably not. But

Scott Benner 21:11
is there a danger I found myself wondering of people focusing on themselves so much as diabetes that they forget to think of themselves as person. Like, you know what I mean, like Does, does a piece of this a big cupcake not seem unhealthy anymore, because you know how to stop a spike from happening when you eat it. And that's important to remember that it's still it's still a cupcake. It's still something that's, you know, a once in a while thing, not an everyday thing, because I can Bolus for it. And I think that's so I think Jenny's point is important too, is that there's just a lot more that impacts your health than just your blood sugar. And we sometimes we talk too much, not too much. But we're so focused on trying to understand it because there's so many components that people don't understand that you stop thinking about like, Hey, you know, what else is easy to Bolus for broccoli.

Jennifer Smith, CDE 22:05
It's learning to manage the insulin around what you eat, you decide what you're going to eat, and you figure out how to manage it, like not encouraging people to eat a high carb diet.

Scott Benner 22:17
Not at all. I don't see it that way at all. I see it as understanding insulin. It's it's just how it is I I was speaking somewhere recently, and I looked down and saw a person in the crowd who this has happened to me about three times since I've been doing public speaking around diabetes. But I've looked down to see what I would call like an old school person in the diabetes community. And when I'm talking I can see on their face, they're just there somewhere between angry and horrified that I that I would even deign to talk about insulin, and how to use it. You know, like, you can't tell people. When I'm on when I'm up on stage, I tell people, no different than, you know what I say here, right? I'm like Basil's first beat, we have to have your bazel, right, because we can't just start Pre-Bolus saying and doing other stuff. Because if your Basal is wrong, it could end up being dangerous. So first, we get your Basal right. Now after that, step two, you have to Pre-Bolus your meals. And that's usually when I look down and see like somewhere like a 60 year old mom whose kids had diabetes for 30 years. Like, you know, like their arms are moving around and like, Oh, you can't say that to people, you're gonna kill them. You know what I'm like. And so I'm like, you're thinking about this in a different way. Before that, you're not considering the technology, you're not considering that these are not the same last lambs that you talked to 30 years ago, right? Like these people are here to find this out. They want to know this.

Jennifer Smith, CDE 23:52
And long ago to bring in long ago, timing was an insulin issue. Long ago, I've had diabetes 31 and a half years, okay, I started on our insulin, and the cloudy, but most people started on something called nphr. And I was on L, which was Lily's brand. Okay. Um, I did no carb counting. I use the exchange diet. I took exactly this amount of searches and fruit portion and vegetable and protein and fat at every meal and my mom or dad gave me my insulin mixed in a syringe at breakfast and at dinnertime and I eat it strategic times in exactly the same amount of food there was no other than measuring the food for the right portion. There was no carb counting, there was no insulin based on carb. It was you take your insulin and from the dosing standpoint, my insulin regular insulin you know, it's slow. I mean, we call it short acting balls forever. I mean, it may man would dose me 45 minutes an hour before I even started to eat in order to curb that post meal,

Scott Benner 25:06
right? Yeah. And so everything you just said, is about using the right amount at the right time. Yeah, it's timing. It's all timing. Like I, again, I that I figured it out. I mean, we should all be able to figure it. Really I know myself, trust me, it's there's not a lot like I'm not, you know, I'm not over here. Figuring out the Pythagorean theory after or a theorem, whatever it's called. I see. I don't know, after I get off the podcast. Yeah, I just don't think i think there's so much fear in now that we forget later. And, you know, what we're talking about right now is long term health. And so let me jump to I can't quote it, I don't have it in front of me. I don't know where it came from. But I think everyone's fairly aware of this article that came out in the last six months that tried to say that lower a one C's aren't necessarily an indicator of health. And that, did you see that one they started talking about, like, you can have an A one see it like this here? It'll be fine. It tried to give the impression to me, that the way I saw it was someone trying to say, Look, I know a lot of you are using this technology to do better, but you really shouldn't do that. Like it's not necessary. And I thought, Well, how do you know? You don't mean like, like, I thought the same thing? I thought when I saw vaping The first time I was like, I have no interest in that. But if I did, I wouldn't do it. Because I don't want to be the one to find out 10 years from now what happens? Because no one knows, you know, right? So is there any in your mind, if you're safely at, if you're in the fives, and you're a one, say and look, you know what I'm going to do here, I'm going to actually pull up an email. To make my point, hold on one second, it's going to take me a second to find it. I apologize for that. But I got this email this morning from a person I know who listens a lot. And when she emailed I thought, wow, this is gonna work right into what Jenny and I are talking about. It's crazy. And it's from Laura. And this note from Laura mimics many, many, many, many notes that I get. Scott, I achieved a 5.4 a one C, first time I've ever been under 6.4. But my doctor freaked out at the number of lows. And she's asking, what's an acceptable amount of time under 70? Like, how many times can I dip under 70? And you know, and so I there's First of all, it's it's a two step thing, right? Everybody who goes to any kind of a doctor who's more like the lady in the crowd, who's thrown her arms around yelling, don't talk about it like this. When they get their blood sugar down, and they find a way to keep it stable, and it starts impacting their variability and it starts impacting their agency, the doctors flip out, they make this assumption that they have all these crazy lows and it's throwing them off. So I know what I'm okay with. But what Where do you stand in your personal life? I guess like how often do you find yourself under 70 DFA.

Jennifer Smith, CDE 28:19
So personal versus professional, I kinda, I really aim for the same thing, quite honestly, overall, and this is where I think that that data is very helpful from a CGM standpoint. Because especially and I speak for clarity. The other reports are the other CGM do give you something similar as far as data. But from a clarity standpoint, clarity always gives you that overview gives you your glucose management indicator, their quote unquote a one see right from CGM, not from your blood glucose, right? It gives you your average glucose, it gives you your standard deviation, and also gives you this little like chart that shows you time in range, right? And it is based on what you have your time in range numbers set for 70 to 180 60 to 140 90 to 200. So you have to adjust those parameters, but clarity has it set 70 to 180, for the most part, right? We aim for the lows specific to be less than 5% of the time. So from all of the gathered data, whether it's two months or two weeks, or one week or whatever you're looking at that percentage of time, we're aiming for less than 5% to the low and low being less than 70

Scott Benner 29:43
less than 70.

Jennifer Smith, CDE 29:44
That's that's the goal is to be low less than 70 or less than 70 less than 5% of the time. So from the standpoint of overall a one see though, you know if if a clinician is coming in saying hey, you know why? That's way too low. And they're looking at data, which proves that, well, gosh, you're hanging out in the 50s. consistently. And that's why you're achieving a five point for sure. And if you're low, let's say 12% of the time, okay, there's some work to do to bring that back up into range. So that that 5.4 is actually better for lack of a better word. better, right? It's, it's more real 5.4 in a target range, that's healthy, safe. And good for you overall. Yeah, you're

Scott Benner 30:33
reaching that number with quality decisions, not with not with, you know, being low. Correct. And that's

Jennifer Smith, CDE 30:40
coming out and saying 5.4% is it Oh, my goodness, that them that's way too low and not even looking at what other stuff 5.4 the person could have very low standard deviation, maybe their variability is 20. And they're ranging somewhere between 70 and like, 120 pretty consistent or 70 and 100. Great, fabulous. You're, you're knocking it out, have at it, and you what you're doing.

Scott Benner 31:09
So when I gave the explanation of a Pre-Bolus this week, this weekend, I used something that had happened an hour before because my wife was at home with Arden and I said actually my wife did a great job this morning with breakfast. About an hour ago Arden's blood sugar was 70 and it was time for lunch. Now Arden's at school, and I think 70 is a great blood sugar right before a meal. Arden's blood sugar was able to stay at that level for a number of reasons. But those reasons are evident to us as they play out, because we can see her blood sugar in real time with the dexcom g six continuous glucose monitor. Not only can ardency her blood sugar right there on her iPhone, but I can see it here at home on my phone as well. Because of that knowledge and seeing the stability that had existed within Arden's blood sugar for the hours prior to lunch, we were able to make a good Pre-Bolus and give her a nice launch into her meal time. Now that hour later, Arden's blood sugar is 132. The data that comes back from the Dexcom g six continuous glucose monitor is life altering with Type One Diabetes, but being able to see it remotely, that takes life altering to another level. So if you'd like to know what your blood sugar is, the speed and direction it's moving, and find those things out without a finger stick. The dexcom g six is something you should check out. I have a link you can use dexcom.com forward slash juice box. There are links also right here in your podcast player notes at Juicebox podcast.com. But I think you should check out the Dexcom Arden's results are hers and yours may vary. But I'm telling you right now Dexcom is a game changer. Now moving from continuous glucose monitoring to insulin pumping. I'd like to talk about the Omni pod until you first I have just as much affinity and love for the Omni pod as I do for next time. Arden has been wearing the Omni pod tubeless insulin pumps and she was four years old, she'll be turning 16 in just a couple of months. The Omni pod brings so much freedom along with the ability to pump your insulin right no injections all day long. No slow acting insulin and fast acting insulin let the army pod take care of your background basal insulin for you. It does that put your insulin pump you get your basal insulin from the pump. And when it's time to Bolus for a meal or to crack the high, same insulin, same pump, no tubing, right so not an infusion site on your body somewhere that's attached to this plastic tubing that runs through your clothing out to a controller that has to clip to your belt. You know whether you're an adult or a little kid, you're not looking to have something clipped to you. Here's what you can do. Go to my on the pod.com Ford slash juice box there, you can ask on the pod to send you an absolutely free, no obligation demo of the new pod. It'll come directly to your house. You can try it on and see what you think for yourself. You can see the difference between wearing a shirt and not having tubing running down your sleeve. Every time I've worn a demo pod. What I thought first was it's amazing how quickly I forget that it's there. This is super important. This is something you have to do every day. You don't want it to be constantly bugging you. Check it out my Omni pod.com forward slash juice box with the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And absolutely free no obligation demo can be in your mailbox before you know it.

Actually, my wife did a great job this morning. With breakfast. She made a Pre-Bolus at like 83 right and it was a big kind of bread First, and Arden drifted down drifted down and she actually hit like 63 for like a split second and came back up. So imagine this 63 probably happened 30 minutes after my wife pushed the button, right? And probably 10 minutes after she had already started eating. So if you want to say she missed, I guess you can, but it's funny. Had she been at 68 everyone would have been like, That's amazing. But 63 is a number that somehow gotten to somebody said, so I'm like, so she hits 63 one revolution of the CGM and right back again, and I said, if she didn't have a CGM, you never even would have known that that happened, right? She's She's wasn't dizzy. Nothing happened like that. I can see it cuz I'm looking at it that this same person in the crowd, this person who's you know, you know, from a property from a different era with diabetes, you know, fell just shy of, you know, back of the hand on the forehead. Oh, Scarlet, what happened? I've got the vapors, you know, I mean, like, that kind of thing. And I was just like, I looked over second, I was like, You got us. I was thinking to myself, like, just stop, like, don't like, look at the rest of these people. These people are in Thrall. They're excited. These are people who a half an hour after they put their insulin in, or running around with their blood sugar's 250. And are you really telling me that that's what you want to say is okay for them. Because when I speak to them privately, when they come up to me, as I'm trying to walk around you guys, we're all delightful. But people would come up and be like, hey, look, this is my, you know, my 23 year old son's CGM, kids like 400 and 300 all the time. Like you tell me, it's not worth trying to do better for this kid. And so I think sometimes, both in the community, in people's minds, in doctors minds, in some older doctors minds, there's just more of that idea. And we talked about all the time, like, it's better not to like, like, I don't want you to have a seizure. Like that's it, like when I say don't die advice, like, that's what they're trying to say that I don't want you to have a seizure. I don't want anyone to have a seizure, either. But I don't want your blood sugar to be 300 all day. You know, it just it's, it's not okay. Because we say these nice things out loud, and other people who are maybe well meaning but don't have good information. They're like, Oh, you know, I want you to be safe, blah, blah, blah. But those people you're talking to online, or whatever your whatever that person's ability to get to people is, you don't get to see those people 20 years later, you don't know what's happening to them. And so I'd rather take a bet on what I'm saying being good for them 20 years later, than what I hear some of those other people saying, I think that if you're going to if you're going to roll the dice one way, you ought to roll the dice and try to be healthy, not hope, hope that your body's the one impenetrable thing that diabetes can't find its way through? Yeah, you know,

Jennifer Smith, CDE 37:47
right. Right. Well, and there's also the safety of bringing those high numbers down to, right. I mean, it's like, you don't want to end up going from an average of 280, which means you're drifting well above 300, and not quite into the low to hundreds to average a to 80, right? Yes, you're not gonna say, Okay, today, we're at, you know, an average of 280. And tomorrow, you're gonna be averaging 100,

Scott Benner 38:11
right, that goes on?

Jennifer Smith, CDE 38:13
Well, that would be a pie in the sky one, it's, it's not actually healthy, drops that fast, drop that fast. I mean, you will have efficient changes in your body. And you know, I remember when I came home from the hospital for two to three weeks after I was released from the hospital. And I think I started with an A one C in the 12, when I was first diagnosed, and my blood sugar was coming down and coming down. My vision changed so much, that my mom had to read me my homework in order for me to answer and she had to write things down. Because my vision was so blurred, I couldn't actually see well enough to read what I needed to get my homework done. Right. So and that was gradually. So again, you can imagine bringing a really high blood sugar down that's been consistently stable high. Yeah, it will be problematic.

Scott Benner 39:11
What I said to this group of people was luck. Like, don't go home, I'll shot out of a cannon, you know, and be like, I usually give a unit for this, but now I'm gonna do five I'm like, No, no, a unit in half, maybe, you know, and I was like, the next time go, ha, that could have been more I said, you know, over days, bring it down over weeks, bring it down, not like don't go home and just be like that. Because that's probably not going to go so well. You know. And, and again, bazel first, and it's funny, no matter how many times I say it, and how many times I preach how important it is. The look on people's faces. When you say to them, I need you to get your basal insulin right is like up then I give up. Like it's quick. It's they're so quick to be like, that's not possible. I can't do that. And I'm like, No, of course she can. And that's why I've got it down to like, they're like, well, how and I was like, Look, there's a great app. pisode on it that you could go listen to them like, but if you're looking for how I think of it, I think of it like volume, like I turn it up until it's too loud, and then I start bringing it back down. So you turn it up a little, not loud enough, turn it up a little not loud enough. And what I mean by that is turn it up a little, my blood sugar is not sitting stable, where I want it to, you know, blah, blah, blah, and then all of a sudden, you get to a spot and you go, alright, that looks like it. Or maybe it's Oh, I went a little too far. I'll turn it back down a little bit. I'm like, but don't you know, one woman's like, by basals? point nine. You know, should but my blood sugar's are 250. Should I try one? And I'm like, I mean, okay, and I'm like, but an hour later when that doesn't work. But could you push it up a little more for me? Like, I was like thinking about what you're saying? You your blood, your bazel is holding you at 250. But, you know, point nine, like, but you want it to come down 150 points, but you only want to move it up. point one. I was like, that doesn't make sense, right? Like, don't you feel like it might need more than that. She's like, yeah, I guess you're right. But that but that's a doctor that scared her not to touch her basal insulin. And so she's, it's just it's, I don't know, I'm a little heartbroken. Like, it's a little it's, it's very exciting and uplifting to talk to people and see them have some ideas they're going to take and at the same time, when they come up to you, and they show you how bad things are. You know, after the fifth, sixth 10th one, you start feeling like oh, gosh, like I'm never gonna reach enough people to make a difference in the world like it starts feeling

Jennifer Smith, CDE 41:28
might even like from the adjustment standpoint, sometimes comes from the people who had diabetes, a long enough time to have actually had a long enough experience with bazel injected insulin, and how long it did a week to really see the difference in an adjustment up and or down in the actual dose and the imprecision in which that basal insulin works on a 24 hour scale. Right. And I noticed immense different, going from lantis to using an insulin pump. Right, an immense difference. It was

Scott Benner 42:10
amazing. Is that where that kind of that that adage is like making adjustments here bazel wait three days and see what happens is that what that's from,

Jennifer Smith, CDE 42:19
for the most part because the well, you know, the basal insulin clears technically within like a 20 to 24 hour time period, right from let's say, for the example of Atlantis is supposed to work 24 hours, most people somewhere between like 20 to 24 hours. And so you adjust, you need kind of at least a 48 hour period, at least after that adjustment of incremental change by let's say two units, to see if that was enough to now hold things level and steady. And then it also depends on where you taking your basal insulin in the morning, or were you taking it in the evening, you know, the evening time was a little bit easier to see. Because you could notice an overnight with only true basal insulin there. No boluses no food, no activity component, you're sleeping on that right? And then through the course of the rest of the next day. How did things look in between meals or after the meal bolus was gone? Did you kind of get into the next meal on a nice stable level? Were you where you want it to be? Were you still too high? Or are you drifting way too low? And then we adjust again, you know, so I that it is probably where that like, adjust wait three days to see if the adjustment held things where you wanted them and then adjust again. It's kind of where that would have started. I like Spock because

Scott Benner 43:39
someone from the crowd asked me, How long is it going to take me to get my bazel? Right. And I was like, well, I said if I think if you listen to that episode, and you really understand it. So maybe a few days, you know, she says how long would it take you? And I was like What time is it now? She goes it's like It's one o'clock. I'm like I could have it done by dinner, you know, like so. And then we would adjust off the the rest of the clock moving forward, like but there's a there's somewhere there's a good number. And it's funny because I just I realized, um, I could just keep looking at the CGM and the side I said, Now, if you didn't have a CGM, it take me a couple days to write, right? Because now we're kind of blind. And we're testing and seeing things and, you know, making sense and seeing if we can see repeating that and stuff like that. It was like but, but looking at it. That's like, That's cheating, almost like that. That's pretty easy. But I also infer things from pitches and lines and and there's no and then people all the time, like can you do an episode about how you see that? I don't even know how to talk about it. Like I wish I did like I just look and I'm like, okay, that's not enough insulin. That's too much. This is here. You know what I mean? Like, it's just, I don't know what pops into my head, but I don't know. I really don't know how to quantify it. If I'm being right. Come on. I'm not joking.

Jennifer Smith, CDE 44:55
Well, you've you've looked at things enough and you understand, you understand insulin. Action, I think better because of the way that you've looked at things and the way that you've taught about things. But sometimes it is hard to just nail it down and explain, hey, if this is happening here, this is why and this is how we would adjust for. And that's kind of, that's kind of what we do. Get people's graphs and information and their insulin here. And like bazel testing for a pump, especially, you know, we'll do a bazel test within a time segment, I get the data The next day, I look at it, adjust here, test again tonight. They do great, that looks awesome, we're perfect. We've got it like checked off, move on to the next. So it shouldn't be like six days in a row that you have to test that to make sure that each single one of them exactly was nailed. Because we adjusted it four days ago, nope. If you adjusted, it looks beautiful with the adjustment. Great, we're moving on. We got it. I've learned

Scott Benner 45:53
from talking to people face to face to that. The stuff they want to tell you that they think is going to help you help them is never the stuff I need to know. Do you know what I mean by that? They start giving me like and it's it's not I don't even mean to be funny about it. Like, they're they've been paying close attention. And they're like, okay, like, here's a piece you absolutely have to understand. I'm like, I don't care about that doesn't matter. You know, like, like, I'm like, how much do they weigh? How old are they? What kind of insulin are you using? What's your basal rate right now? You know, where do you sit steady, when you don't have insulin, you blah, blah, blah. And then from there, I'm just like, okay, turn this up, turn that down, make this this. And then let's wait and see what happens. But it's interesting, because the information they've been given so far has led them to ask almost all the wrong questions. Right? That's the part that I find fascinating, right, is that somebody has been directing them along the way. And now I talked to them. And then I talked to them again, two weeks later. And now they want to make a small adjustment. And they're asking the right questions. It's very interesting. Like, it's just where you, it's who talks to you first. Like it really is, it's like, whoever talks to you first, you win, or you lose, like right then and there. You don't even realize it when it's happening. There's somebody being diagnosed right now, in the world, who's talking to an endo, who understands, and they're going to go on one beautiful path, they'll never find this podcast, because they don't need it. And then there's somebody else being diagnosed right now who's being told all that stuff that we, you know, have to debunk, and then reteach. It's just, it's bizarre. I mean, you don't like, get cancer and get two wildly different ideas like this one, cancer, doctors say to you, hey, listen, we're gonna try a little radiation. And then if that doesn't work, we'll try to cut it out. Is there another doctor that says you should go home, blow up balloons and eat birthday cake, and I'll fix the whole thing? Because it feels like it's that far apart. You know, like, one ideas, right? And one ideas? I mean, I'm sure there's variations in between?

Jennifer Smith, CDE 47:54
Well, I think the extremes truly are the people who still to this day, for whatever reason, will go into their clinical diabetes team, and they get the hand me your pump. It's like handing over like, you know, your foot. I think I said that before. And so it did nothing. And you're like, Hey, thank you. Your pump is like, like your butt. Like, no, not really my foot, just a body part over, they like, take it away from you. You're like, oh, my goodness, you've taken like my body part from me, you know, and then they bring it back to you. If they've dumped this data in, they look at the data. They don't ask you anything. The doctor might actually sit there and actually might push your buttons on your pump. Yeah, physically make all the adjustments for you. And your left, then handed back reconnected with your pump. The doctors like, Oh, we adjusted some of the bezels or we did this and this because I thought I saw this happening here. what's lacking there the education do? You adjust? What were the explanations that person could go home and say, Okay, I understood the doctor adjusted here because he was seeing this. I'm going to Now watch this. I'm gonna see did it help? Does it make it better? Did it make it worse? Do I need to readjust this? How should I readjusted? that's missing chunk. Yeah. And, you know, I think that that ease of not educating people nor even letting them push their own pump buttons to make the changes or add in Hey, b d is in a row this past week. I was at gramma Joe's eating like sloppy joes and birthday cake, and is please don't pay attention to that data. It's not my true trend, but the doctor is basing adjustments off of it.

Scott Benner 49:45
It messing up everything else that may have been working better than that. I brought a poor kid up on stage from the college diabetes network this past weekend. And I just we stood arm's length apart. We put our palms together you know standing side to side I said, you know, I'm going to be insulin, and he's going to be body function and carbs. And I was like right now, he and I are pushing, you know, an equal amount into each other. And we could stand here forever like this. I was like, but as soon as I don't push quite as hard, and he started, like overpowering me, I was like now the carbs and the body function or winning, which means my blood sugar is going up. And it should I push too hard. I start driving that down and your blood sugar gets too low. But as long as we stay balanced, and we're pushing equally on each other, this could go on like this forever. While I'm saying it, audibly I can hear people going, Oh, like out in the audience like, Oh, wow. Okay. And I just as I was saying it, I thought a doctor couldn't think of that. Like, like, you know what I mean? Like, cuz dumb me figured it out. And and, you know, put it into words, like, like, that was it and just them watching that. And it's something I'd done before with my own hands like palm the palm. I've explained, I've gotten people on the phone, and I've made them put their palms together and like, and, like done it. And I just think like, it's, it's just, it was so simple. You could see like nodding going on. And people were like, Oh, Okay, I get it, I found a million ways to talk about it. Since then I talked about like, bringing in more blockers to like, you know, stop by Blitz, like in football, like, I've talked about it a million different ways. And every time you kind of paint a picture around it, you get somebody else to understand it. I just don't know. It just doesn't make sense to me. So these doctors are telling you, I want you to be healthy forever. But then they kind of some of them don't tell you how. And so. So optimizing your glucose, right for long term is going to keep you as healthy as hopefully possible. Right?

Unknown Speaker 51:41
Yes, absolutely.

Scott Benner 51:42
What about gaps of fall off? Right? I don't like the word burnout so much. But what if they just stopped paying attention for a week that turns into a month, it turns into six months, is that if I if I come back from it, now, I'm not trying to give people like, like, I feel like I'm saying, you know, you can go off and, you know, go off and do heroin for six months and come back, and it's not gonna hurt you, right? Like, not me. But I'm saying like, if you have one of those moments that a slip up or your life gets, you know, busy, and all of a sudden you start leaving your blood sugar at 140 instead of 120 or 180, instead of 150. Is there any way to quantify what that means to you long term? Or there isn't really right?

Jennifer Smith, CDE 52:27
It really isn't? Because again, there's nobody has kind of quantified exactly what amount of mismanagement equates to this amount of complication down the road? Yeah, if you don't do this for three years, you will have this amount of heart damage 10 years from now, right? There's no, you can't quantify it. But I think you can also not bank

control that was optimal, yes.

Or the next month and saying, okay, I was really, really awesome for six months. And now I'm going to go on like an eidl convention, blow out in Italy, and just that care or pay attention, detrimental stuff could be happening. I don't know what's happening in your body, but you don't either. It's not great for you. But it's, you know, but you, you're not, you can't bank on the six months previous being like a code over for smoothing that out and being like, Okay, this whole month of like, mismanagement doesn't really count because I was so good before

Scott Benner 53:35
it's like sleep, you could get great rest six days in a row, and then stay up 24 hours, you're still going to be exhausted, you can't run, you can't bank sleep, you can't bank health, you can't like that. That kind of stuff is really super important to understand. But you know, it's funny because at the same time when I'm teaching people how to get going, like with a one season I started trying to impress upon them that overnight is easier than you think you know, and like once your Basil's right, you're not bolusing too much or too little, you're not going to get these wild swings. Now you've got this third of the day, you know, and it's like so if you see a 160 in the middle of the week, in the middle of the day, you can feel a little better about it because you had like, you know, your 85 or eight hours last night, right? It doesn't make whatever impact the 180 spike has. And like you said, I don't know what it does or isn't is or isn't doing your body. But if it is doing something being at all night long, doesn't stop that. But you know, like being safe right now doesn't mean that if I burn my finger five minutes from now it you know, it doesn't make it go away. It's still happening. I think that's really that's good information. So what are we in your own personal life? Is that how you think about it? Like just I'm gonna do my best and hope this works out?

Jennifer Smith, CDE 54:51
I do because like, you know, I

I try really hard not to like I go to all my checkups, right? I mean, I Get like, my heart checked, I make sure that I go to the podiatrist, I make sure that I get my feet checked, I've never had any problems, thank goodness. But I still go for all my checkups. I go on, I see my ophthalmologist to make sure they check all the vessels and you know, do the test for the puff of the air in the eyeball, right? is like

Scott Benner 55:23
an idiot when it hits your

Jennifer Smith, CDE 55:26
anticipation of that puff of a puff of air is worse than the actual puff is. But you know, I do all of those things, because I know that they are a check in the long term. And you know, what, if something does come up, then the checking is also prevention for furthering problem, then maybe you say it, check on something and up now something is happening. Okay? One, I might beat myself up a little bit of I could have done this better, I could have done that. But that doesn't help that's asked, you can't go back and fix it, what you can do is continue to go forward and say, Okay, I can try to do better here. Or maybe I need to add this or now I just need to see the doctor every three months instead of every six months or once a year, or they've got this treatment that could help me and it could make it better. And if I continue to do what I need to do, then I can prevent further complications down the road. So

Scott Benner 56:26
yeah, I also want to say that, I think I've never met anybody so far, I should say, that has told me, I decided I don't care, I'm going to run full force straight ahead, I'm not going to pay that much attention to my diabetes. And however long I make it, it's how long I make it. Whenever one of those people runs into a complication, they have always said the same thing to me, I wish I wouldn't have done this, like you don't mean like, I wish I would have bla bla bla or tried something else. Or it wasn't my fault. Even I didn't know. But I wish I would have kept searching. And and I think that that's the truth like it, whether you make it, you know, till you're 40, when all of a sudden, you're finding out at UT dialysis, or you make it to 70. And you're like I made it to 70. And then all of a sudden you're having a heart attack, a 70 year old type one is having a heart attack doesn't go at least I made it this far, you start thinking oh, I would like to stay alive a little longer. You know, like I get it, I don't think many people get to the point of no return whatever it is, and go, you know, I did my best. And I'm happy with this. I think I think that people such really do feel like that, like, Oh, I wish I would have whatever that means, you know, whatever they wish they would have done. I mean, if you're a person who can make it the whole way and just be like, you know, 35 years old, jumping your car over a canyon and realizing you're not making it the other end to go, Oh, well, I did my best. Like, you guys, like that's a special like, that's a special gear you have. But what I'm saying is that caring now will keep you from that feeling of I don't know what that feeling would be what how to describe it. When people talk about their they are disappointed in themselves. And then they can't shake that feeling for the rest of their life. Right? Like every day, they wake up with a problem. And they have this feeling like, oh, maybe I could have done something about this. And then you have to live with the problem and the guilt. And it's hard, you know, so I say all the time. I think with what we talked about on the podcast, diabetes becomes pretty. You know, I don't like to say easy, but I think it becomes like second nature thing for you. I would rather put that effort into understanding Pre-Bolus or, you know, something like that, then I would spending six, eight hours a day fighting with high blood sugars that cause a low that have me eating, that make my life feel like turmoil that I'm not living, I'm just existing through rock. So that's how I feel

Jennifer Smith, CDE 58:56
having and that I agree. And it's kind of the way that I feel about my own management is I do the things that I do every day to make it less of a visible upfront in my face, to let it be more of a Yes, I have to manage it. I still have to look at my blood sugar, I still have to take my insulin, I still have to count my carbs and Bolus the right way and whatnot. But those are like more second nature things that I just do now. And until I have like a bad site or something that I really have to completely put my focus into and you know, take care of

Scott Benner 59:37
the normal things that I do every day are just part of my day. Exactly. And those bad sight moments, because I recognize what you're saying is how Arden's life is and mine with helping are is that most of the time we are just sort of cruising along. And when something really goes funky, and you're all the sudden you have to stop thinking about life and you're now you're focused on this diabetes thing in my heart. I know that some People live like that all day long every day. Right? And that's just because that's an explanation to me like your bad sites a great explanation because you're but all that means is you're not getting insulin the way you need to. Mm hmm. And if if your bagels off if you're not Pre-Bolus if you're not doing all those things in every moment, you're not getting insulin the way you should. And, and so your life's always gonna be, you know, I like that.

Jennifer Smith, CDE 1:00:22
And in the instance, then of

blood sugar's being all over, you never really know unless the pump tells you if you are on a pump, that you have an occlusion and that there is a real problem. You never really know. If there's a problem you should be addressing. Yeah, I mean, I know when I know even ahead of clusion alert coming, that something's not right. Yeah, I can tell. Yep. Um, because things are contained. And if I see something odd happening, and I know that nobody is like, injected me with like the sugar to

Scott Benner 1:01:03
go,

Jennifer Smith, CDE 1:01:04
right, then clearly, I'm not getting in. For

Scott Benner 1:01:08
whatever reason, I don't know, change it out. I don't care what I'm going to address it, I'm going to take care of it. I'll just change my pot out and move on. Let's see you and Arden have a scenario, a life where your expectation is a lower, more stable number that reacts the way you expect it to. We said this the other day, when we were talking like I, I talked about how I think of the site as doing what I expect it to do. So the minute I don't see it, doing what I expect, or I see a blood sugar, that's all the sudden 150 my my I start thinking like, I can look back if I didn't mess this up somewhere. This is this is I'm not getting enough insulin. So I don't mess with that either. Like there's a moment. Like I think some people end up looking at a bad site for days. And then and then they they'll change their property. Oh, it turned out to be the pump 48 hours later. Right? Yeah, I'm not into that. You know what, the second or third time I bolus and what I want to happen doesn't happen. And I'm getting out of it. Yeah, I actually had

Jennifer Smith, CDE 1:02:08
it this morning. I mean, I wasn't, I wasn't actually supposed to change. My pod out until this evening is when it was supposed to expire. And I woke up this morning. Not at my normal like, he ish blood sugar. I was like 130 something I was like, kind of odd, right? And like, that's not where I should be. And I could see all this, like, positive temping that been kind of happening. And so I look at my site. And it's bloody in the window, or my pod site, right? And I'm like, had I not checked, I just gone I've got about three, though I'm higher than I normally am this morning. And I'll just correct some insulin, I'll eat for my or I'll take for my breakfast. And hope all goes well. Well, I just I know that that's not the norm for me. So what did I do? I changed out my pod. And that's it.

Scott Benner 1:02:58
Yeah. Because you're you would have been fighting with that all day.

Jennifer Smith, CDE 1:03:01
Otherwise, right? Oh, correct. In my post breakfast would have been for it. I'm sure. I'm sure. I bet she gets

Scott Benner 1:03:06
to 20. That in that situation? Right. Right.

Jennifer Smith, CDE 1:03:09
Yeah. Right. At least. Exactly.

Scott Benner 1:03:12
So, Jenny, if you and I were one person, we'd be a super diabetes brain.

Jennifer Smith, CDE 1:03:17
Oh, my goodness.

Scott Benner 1:03:22
place? Oh, my gosh, all right. I know you got to get going. I'm not sure if we talked about what we said we were going to talk about, but I found this to be a really great conversation about, about long term health and, and ideas of how to get to it and why it's important. So thank you very much.

Jennifer Smith, CDE 1:03:37
Yeah, absolutely. It was, it was good. I think sometimes, you know, the stuff about complications and whatnot gets, it gets to clinical. And I think people just need a return to all that. That's why I'm aiming for just keeping things tighter, or why I'm keeping things more in this range, or whatever. I mean, they know that the complications are out there. But this is the reason I'm doing that

Scott Benner 1:04:04
instead of talking about a thing that seems like it's so far away or so impossible, that there's no real reason to try to plan for it not to happen. Because it's so far I will always use this example. My father smoked cigarettes all day long, two and three packs of cigarettes a day and not like not some like Marlboro light thing like Chesterfield kings, no filter, you know what I mean? Like it was left over on the floor of the place that they just roll up and sold the people you know, and in his 30s in his 40s, in his 50s, smoke, smoke, smoke, smoke so 60s, he'd come back from doctor's appointments doctor says, I can't even tell you're a smoker and he would wear that with a badge of honor right up until smoking killed him. right up until he had COPD, and then and then he died. So you know, can only you can only you You only stay ahead of a charging bowl for so long right and right you don't want to be you just you don't want to give yourself

Jennifer Smith, CDE 1:05:07
up off the path and be like, let it run by. run by.

Scott Benner 1:05:12
My dogs are barking like crazy. I think someone's breaking into the house. I might be killed soon we'll find out. For me, Kelly, probably Yeah. Oh my god finally dating. Oh, I hope not. All right, I will talk to you soon.

Jennifer Smith, CDE 1:05:29
Okay, awesome. Bye. Bye.

Scott Benner 1:05:33
I bet you didn't know that you can hire Jenny. She works at integrated diabetes, just go to integrated diabetes comm or there's a link right there in your show notes that you can email Jenny directly. Jenny is not a sponsor of the show. She's a friend of the show. But that doesn't change the fact that she's got a mortgage to pay. huge thank you to Dexcom and Omni pod for sponsoring this and so many other episodes of the Juicebox Podcast, my Omni pod.com forward slash juice box go there today. Get the demo pod get a pod experience kit sent to you and get your Dexcom g six continuous glucose monitor right now stop waiting dexcom.com forward slash juice box. This episode is the 17th of the diabetes pro tip series. It began back on February 25 2019. With an episode called newly diagnosed you're starting over and there was 211 to 12. That's all about MDI and all about insulin to 17 to 18 and to 19 Pre-Bolus in Temp Basal and insulin pumping to 24 to 25 and 26. mastering a CGM bumping and nudging and the perfect Bolus, Episode 231 about the variables that come with Type One Diabetes, Episode 237 setting basal insulin 256 exercise in Episode 263. We talked about how fat and protein impact your blood sugar's and they do. Episode 287 illness, injury and having a surgery with type one diabetes in Episode 301, glucagon and low blood sugar emergencies and Episode 307 emergency room protocols different than illness injury and surgery. This is what happens when you're thrust into an emergency room. Not something you were planning for. And of course today's episode 311 diabetes pro tip long term health. Thank you so much for listening to the podcast. Please leave a rating and review in Apple podcasts if you're enjoying the show. But moreover, if you like what you've heard, find someone else who could use it the only way a podcast grows by word of mouth. So I appreciate it when you tell somebody else about the show.

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#310 She Is Having a Baby! Third Trimester

Part Three of a Four Part Series

Samantha is 24 years old, newly diagnosed with type 1 and pregnant. I'll be talking with Samantha after each trimester and after the baby arrives.

+ 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
This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. It's the best blood glucose meter My daughter has ever used. And when I say best, I mean, it's the most accurate one that we've ever used. It's the handiest blood glucose meter that we've ever used. It's got the greatest test trips that even allow a second chance sampling, and it has an app to help you make sense of all the data. All of you may not have a continuous glucose monitor, but you are testing and that data is important. Let Contour Next One help you with their app. Check them out Contour Next one.com, where you can click on the links in the show notes. Were the ones you'll find for this episode. At Juicebox podcast.com. After you get yourself a new meter, you're going to want to head over to touched by type one.org. Touched by type ones mission is to elevate awareness of Type One Diabetes to raise funds to find a cure and to inspire those with diabetes to thrive. I'll tell you more about the Contour Next One blood glucose meter and touched by type one a little later in the show Samantha's back. Samantha is really pregnant at this point. This is her third time on the show. She came on after her first trimester after her second trimester. And now as she's getting ready to deliver, find out how the pregnancy has been going. It turns out Samantha has one big fear. You'll find out what that is. programming note for those of you who listen with your children. We're going to speak about parent Neil massage at some point. We're going to read the steps for it. So it's clinical. But you know, we use all the words. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Hey, if you haven't heard it, Samantha's first two episodes. The first one is she is having a baby. first trimester. That's Episode 259. second trimester is at 285. And this of course, is Episode 310. of the Juicebox Podcast. Thank you for listening. Hey, I just got back from Atlanta. Thanks to everyone who came out. I love seeing that big full room. You guys were terrific.

Samantha 2:32
Morning.

Scott Benner 2:34
Hey, how are you?

Samantha 2:35
I'm good. How are you? I'm

yeah, I'm alright. Yeah.

Scott Benner 2:42
I perhaps overcommitted a little bit on the public speaking but I'm

Samantha 2:45
really tired.

Scott Benner 2:48
I got sick on the last flight. Oh, no. And I um, I had this situation where I was in Dallas. And it was a it was a quick turnaround on a long flight. And so I left my house at 9am Saturday morning, and returned home at 1am. Sunday night. So Monday morning. Yeah. And then I had to get up in the morning and go to like a long dentist appointment at 10am. And while I was sitting in the dentist's chair, I thought, My throat feels weird. Oh, gosh, I remembering the coughing kid on the plane. And I was like, huh, yeah, so I was like, I'll be okay. Because Sam, here's the thing you don't know about me. I don't get sick.

Samantha 3:36
My dad says that too, until he gets sick. No,

Scott Benner 3:39
no, it really like I will get sick. You know, don't get me wrong. Like it'll be 10 o'clock at night. And I'll be like, wow, I have a fever. I don't feel well. And I'll go to bed and wake up in the morning. I'm like, Oh, don't miss over like that quickly. So you know, I'm like, Okay, my throats a little scratchy. This won't get me the next day and the next day. And then like, the third day afterwards, I raised my voice. And then I lost my voice. Oh, and I was like, seven days away from sorry, the music's playing. I was like seven days away from having to go to Atlanta, which is now I leave for Atlanta in like three days. And I couldn't speak it.

Samantha 4:20
Oh, gosh. Well, you sound like you don't sound like Yeah.

Scott Benner 4:24
My body wasn't putting up with that. Yeah,

Unknown Speaker 4:27
I'm by job to do.

Scott Benner 4:29
My jeans are a mess otherwise, but I don't get sick for very long. But I was in a bit of a panic. Because I felt Yeah, I thought oh my gosh, this whole Atlanta thing is it's built around my being there. Like there's four. There's four sessions that I'm in. There's not that many sessions. Yes, I was. Yeah. Oh my gosh, I'm in trouble. So I was real quiet for a couple of days. I didn't talk much. My wife was like, This is amazing. Alright. But he's funny, you know? Anyway, you're super preggers now. How's it going?

Samantha 5:01
I am I'm, I'm good. I it's three weeks from today that he will be here if he doesn't decide to come earlier.

Scott Benner 5:10
So are you being induced?

Samantha 5:11
Yeah, they're inducing me on the 17th of March. Wow,

Scott Benner 5:15
is that a day isn't the 17th of March something?

Samantha 5:18
Yeah, but it's also the only day my doctor is working the entire day. So I have to St. Patrick's Day, but

Scott Benner 5:27
I was just thinking all the Catholics listening are like, yes, idiot. It's Saturday. That numbers ringing true in my head for some reason. Um, are you excited to have the baby on St. Patrick's Day if it happens? Or do you just don't care, it's just the day they had.

Samantha 5:41
Um, I mean, I'd rather not be on a holiday but. But as long as I mean, it's fine. I because it was really important that my doctor was the one that was there to be the one to deliver. And so like, they're having me come in right after midnight, on the 17th. And then, because she's like on call, and then she's gonna be in the office all day on the 17th. So that was the best chance to make sure she was there.

Scott Benner 6:13
Here's my thoughts. My brother was born a few days before Christmas. And he got screwed over every year because my parents would just go Christmas shopping. And they? No, no, they would just go to his Christmas pile and pull out like two or three things and a birthday present. So the kid was getting less stuff. He was totally getting hosed. And now I'm thinking, What if your child your son grows up to be a bit of a drinker? I don't think I don't think we want his birthday on St. Patrick's Day.

Samantha 6:39
Everyone says that he'll like it when he's older. Yeah.

Scott Benner 6:42
How much? And how much were you like it? Yeah.

Samantha 6:46
So it's fine. It's

Scott Benner 6:48
so I'm super interested in how, because I realized when we started doing this, like, the first time we spoke, it was gonna be you know, there was a lot there, like you were getting, you're getting over a personal tragedy. You were pregnant again. You know, it was a lot of excitement. And like, and, you know, little consternation, maybe a little wary. And then the second one's always like, that's the cruise control part of the pregnancy, usually like that three to six month range, but I'm gonna curse and then bleep it out. It's real in the last three months, right? Yeah, what's going on?

Samantha 7:21
I mean, huge. That's definitely. And people keep saying how big I am. And I'm tired all the time. It's really hard to sleep, because especially in the last couple weeks, when he is like, big enough, in my stomach, where he's like running out of room. At night, he likes to stretch. So it's like his butt is pushing on one part of my stomach and his feet are pushing on the other part of my stomach. So it's very hard to sleep because his feet are on my right side. I usually try to sleep on my right side. But then it's like, he's poking me. And then I try to turn over. And he doesn't like that. Because like his whole body shifts, and it's a lot.

Scott Benner 8:13
It's hard to sleep with other people, whether they're outside of you, or inside of you, apparently,

Samantha 8:17
yeah.

Scott Benner 8:18
Are you able to move him? Or do you have to move yourself? Have you figured anything out? Or is there it's just kind of fruitless?

Samantha 8:25
At night, I think I'm just too tired to deal with it. During the day, if he's doing the same thing. I will like push on him until he moves. Gotcha. And

Scott Benner 8:35
go ahead. I'm sorry, I just I started to talk in my brain was like, You have nothing to say. So.

Samantha 8:41
Yeah, my husband gets worried when I push on my stomach a lot. But I mean, he's fine. Because sometimes you like you can't feel him at all. Like right now. He's not awake. So I can't feel him at all. But like, in a couple hours is when he usually wakes up. And he'll be like, poking insides and my stomach will look deformed because he's poking at two different sides of it.

Scott Benner 9:06
How do you find the commentary? Because I was thinking about it from my perspective. Sometimes you see a pregnant woman who's clearly like towards the end and yeah, it's nice like it's like oh my god you're so big kind of means like the baby's coming or you know, like something like that but that's if you hear at once what happens when every person who passes you is like oh my god, like a big year. Like, how does it end up feeling?

Samantha 9:29
I don't mind much the only thing that runs through my mind is like he has to get out of me. So Stop saying that. I'm like, so big, because that means he's so big.

Unknown Speaker 9:40
The exits not so big. Yeah.

Samantha 9:43
Like I'd rather him be like, Oh, yeah, you look like a normal size. So yeah, he'll be normal, but he's already he was measuring like, perfect normal size. Up until like two weeks ago. We had our final ultrasound where they measure him. And his, his. His like body is measuring a little bit bigger. So

Scott Benner 10:09
have you ever been behind a tractor trailer on the highway and you're coming up on an overpass? You think oh my god, it's not gonna make it's not gonna mean that it goes right under it. It's not a problem.

Samantha 10:17
Yeah, that's what everyone keeps telling me. He told me not to worry, but

Scott Benner 10:21
oh no, I would worry about it. I'm just saying that you won't see that you won't be behind the tractor trailer on the 17th. But your husband's gonna have that feeling he's gonna be like, this isn't gonna work. There's no look the baby came out that's really feel like it actually tell him unless he's got a strong feeling about it. He should really probably stamp on your half of the of the game. It's just,

Samantha 10:45
it's easier. Yeah, I don't know what he plans to do. Actually, we haven't talked about that. I always just assumed he was going to be next to me because I'll need him to be there for me. But I don't know. I wonder

Scott Benner 10:56
how that always goes. Because I felt like I was well, with my first son, with my first son, like, I have 17 sons with my first my son when my son was born, my wife was in labor for quite a time. And at one point, I was trying to do all the things that I thought I was supposed to doing, like comforting stuff. And it's she's like, why don't you go get something which I look back on now. And I feel like she was like, What if he just got out of here for a little while? realizing right? So back then I was younger, and a Dorito was nothing. So I had a sandwich and a couple Doritos or something come back up. She goes into labor later and I have diritto breath. My wife will retell this story with the same anger that she had. On the day of my son's birth. She'll tell that story right now. It just I must. I was like, it's gonna be okay. And she was like, Oh, my God, like, get back if he's going to screw something up. Or perhaps he won't. Excuse me. I'm excited to find out what happens like? Or if you get irritated with even the support at some point, if you find it necessary. Like it's a really interesting what happens in the moment? Are you thinking about epidural or what are you planning for? touched by type one has programs and services for those living with a daily reality of type one diabetes, they offer a supportive community with many interactive programs, and creative resources designed to empower one to thrive with type one. program programs like their annual conference, their awareness campaign bowl for a cure their dance program, dancing for diabetes, the big show every year. And they even have something they call a DI box that they send out to newly diagnosed people. That conference, by the way, touched by type one. It's on May 30. in Orlando, Florida, and I'm pretty certain I'm going to be speaking at it. I hope to see you there. Check that out. And everything else they do at touched by type one.org.

Samantha 12:55
As soon as they can give it to me or as soon as it starts hurting my eye yesterday, I was talking with the nurse. And she was saying like, if you don't feel anything and you're fine with the pain, then you can always put it off. And I was like No, I want it written on something that you give me the epidural right away. Like I don't want to feel.

Scott Benner 13:14
I don't know if you understand how pain relief works. But once you feel the pain, it's too late.

Samantha 13:19
Yeah. And I was like, I don't want to feel any pain. So I want it right away and keep it coming. It's 2020 lady.

Scott Benner 13:28
Yeah. No reason for mama to be like, Oh my gosh, why someone stabbing me?

Samantha 13:33
Yeah,

Scott Benner 13:34
I hear you. Oh my gosh, well, I'm okay. So so the people talking to you really just makes you think about the delivery more than anything. Like you're not like, don't feel like a body image problem. When they're saying like, you're pregnant, you're supposed to look like that.

Samantha 13:48
Well, I have a double chin now, which I'm not used to. And that's the only thing that I have an issue with. That's fair. But other I mean, other than that, that's a small thing. It's not like I dwell on it all the time. It's just like, it's there. And I know, I know, it's there.

Scott Benner 14:05
Not that I'm pregnant. But I have a double chin. And I daydream about having it altered. Oh, yeah, monthly, monthly. I look in the mirror. And I think How hard would it really be to make a small incision here, just whatever this is here. Just take it out and pull the skin the tiniest bit. I owe that to myself. afford it? But yeah, I feel like I'd be happier.

Samantha 14:26
Is that strange? No, no, I mean, I think I think it's something that everybody goes through your normal.

Scott Benner 14:33
I avoid taking photos sometimes because of it, which I don't have any other feeling about having myself photographed. Except for that.

Samantha 14:40
Yeah. See, that's when I noticed that the most in photos. And I'm like, Oh, wait, no more photo. me.

Scott Benner 14:48
Sure. Everyone's like this. I look in the mirror and I think I'm having I'm having a good day. And then I'll let someone take a picture. I look at the picture. I'm like, how is the person in the picture now? in the mirror like that's not I mean, and not that. It's like It's so far off.

Samantha 15:02
One of these things is lying. I don't know which one it is

Scott Benner 15:05
hundred percent. And I think it's I think it's anytime I look and think I don't look so bad today. Yeah, the light must be right or something. Oh my god. Okay, so we've got it, we've got a delivery date, but you're hoping that maybe he comes sooner.

Samantha 15:19
Um, I kind of well, not too much sooner. Because I mean, I'm working up until like, the 17th is a Tuesday, and I'm working until that Friday before

Scott Benner 15:30
so interesting. So it's a little bit of a money thing to like you. You need him to stay in.

Samantha 15:34
It's, um, it's a money thing. And it's like I otherwise I'd be sitting at home and what am I going to do at home? kind of thing.

Scott Benner 15:42
You're about to find out because you're having a baby.

Samantha 15:45
Yeah. And then the baby will be here. And I'll have things to do. But

Scott Benner 15:49
you certainly will. Oh, my gosh, I there was like a three year span where we'd watch the Academy Awards and just think I heard about this movie. Yeah. Yeah. I so okay. So you don't like staying a little bit hoping maybe? Do you prefer natural over being induced?

Samantha 16:12
No, I don't care. It doesn't. Yeah, as long as I don't, I don't want a C section. I really hope it doesn't turn into me having to get a C section just because I don't want my stomach to get cut open and have to deal with the longer recovery. But other than that, then, yeah, induced or natural whatever. Whatever happens.

Scott Benner 16:34
My son came out two weeks late.

Samantha 16:37
Yeah, usually what the first he they at least stay in their full term. So I'm thinking that he'll probably make it unless something happens where they're gonna like where they decide he needs to come early. Yeah,

Scott Benner 16:49
Arda needed a parachute on her on her due date. Like she was just like, coming out. Yes, we were we were our Kelly was going to be induced on Arden's due date. And the night before we're like packing up and getting ready. It's like 1230 and she's like, I think my water just broke. Oh, so we just made it that long, though. Should we made it to the hospital and Arden came out? A few five, six hours later, we actually were just at lunch the other day, where am I was chest I was chastised again by my wife for not knowing the times my kids are born. Oh, gosh. So my son's born in the early evening and Arden's born in the early morning, but I mean, the exact number. You would think I was really taken, taken to the woodshed at this restaurant for not knowing and then I start then I start guessing I'm like, I don't know. 716 then my brain doesn't remember. So they'll ask me 20 minutes later, and I'm like, I don't know.

Unknown Speaker 17:45
Doesn't matter now.

Scott Benner 17:46
They're here. I'm taking a great jet. Look at how good she's doing.

Samantha 17:50
Like me, like if it really matters what time they're born, then we're only selling they're celebrating their birthday at that time. For a minute.

Scott Benner 17:58
I'll say this yesterday was my son's birthday. Yeah, I turned 20. And it was the first day his first birthday. We weren't with him on his birthday. Oh, more impactful than I thought it was going to be. Yeah, but we saw him the day before. He played baseball the day before we went to see him but it just kind of didn't feel the same, like not being there for some reason. So anyway, all that sadness, you have to look forward to

Samantha 18:22
awesome, yay.

Scott Benner 18:25
Turns out when you love somebody, it hurts almost as much as it is. It feels good. All right, so how how's your diabetes been? How's that been going?

Samantha 18:37
Right now, in the last couple of weeks, it's been a lot nicer to me than it has before I went through like maybe a month plan where I wanted to scream because my my insulin resistance kicked in. I was hoping that it wasn't I thought I was gonna get like, it's gonna be a miracle. And I wasn't going to deal with that. Because everyone had said that it kicked in earlier for them. And it wasn't happening for me. So I was like, maybe I skipped that part. But I didn't. I hit that and I was needing a lot more insulin and I was changing my Omni pod, like every day and a half. Because I was going through so much insulin. And I mean, I probably could have eaten less carbee things and made it last longer. But I didn't really change the way I was eating. So I was going through my Omni pods. Like every day

Scott Benner 19:29
we had that chin defeat.

Samantha 19:31
Yeah, exactly.

There now so you guys will take care of it.

Scott Benner 19:38
What are you gonna do? What are you gonna do give birth of that chin and then ignore it. That's not okay. I'd have to call Beifuss on you for that.

Samantha 19:48
So that was really I felt like I was changing it like every second which was crazy. And then like once that's I think the most frustrating part is that it doesn't like change, like, your settings don't change, and then they're good. It's like my settings were changing every day to something different than the day before. So it was really hard to like, like, I would figure it out. And then the next day, it would just be completely different. And then I'd have to figure it out again. And that that's the most frustrating part to me.

Scott Benner 20:23
So that's probably off the F Jenny at some point. But that's probably hormones, because you're describing Yeah, you're describing like, like doing like, like, I don't know, like a period situation or something like that, where like, one day, it's, it's going this way. And then you know, a couple hours later, like, Oh, I got it, and then all of a sudden, it heads in a completely different direction. And it's really tiring to keep up with,

Samantha 20:44
it is tiring, and it's totally the pregnancy hormones it has, like it probably has to do with something like he's growing or something, I don't know. But definitely, it's happening. And that was the most frustrating part. Not that I was using so much insulin just that like, I like it when, like if it changed at one day, and it was like that for even like, even the next day, I would have been happy. But it was changing every single day, every hour, like the morning of Wednesday was going to be different than the morning of Thursday. And it's just really exhausting.

Scott Benner 21:20
I feel that. So you're using 200 units of insulin about in 36 hours for that amount of carbs. How much insulin Do you think you should have been using? In that 36 hour time period?

Samantha 21:32
will usually my pod while I'll be able to make the the for what? Three days?

Scott Benner 21:41
Yeah, doubling your insulin? Almost?

Samantha 21:43
Yeah. And like, right, my carb ratio is already pretty like I've ever since I was diagnosed, my carb ratio has been kind of crazy. So I use a lot of insulin in general. So when I hit when I need more insulin, it's just like,

Scott Benner 22:01
a ton more. Did you say you did it? Or did was it hard to do sometimes, like what is your current ratio? Now? 12124

Samantha 22:06
is my current ratio when like pre pregnancy

Scott Benner 22:12
artists is aggressive at like one, one to like seven and a half or something like that.

Samantha 22:16
Yeah, I've always been one to four. It's never it wasn't. It's not like a pregnancy thing. It's like since I've been diagnosed, it's been wonderful. And it works for me. So obviously, it's right. It's just when I'm needing more insulin on some days, it's like, my half I, I use a lot of insulin.

Scott Benner 22:37
Is it Mom? I'm thinking for you. But is it scary to use that much?

Samantha 22:42
It was in the beginning. I especially during the pregnancy, I've gotten a lot more used to using more. And I don't. So I break up the Bolus in the pod just because I worry about like, I have problems with the pod leaking. Sometimes if I do too big of a bolus, and I don't know if it's because of where I have it on me, or it's probably something that I'm doing wrong. So I'll break it up. And that kind of fools my mind also into thinking that I'm not taking so much.

Scott Benner 23:16
Because you're looking at like 445 carbs. You're looking at like 11 units or more. Yeah, one for four. So you mean you could have had a 45 carb meal and been doing 25 units like Yeah,

Samantha 23:28
yeah.

Scott Benner 23:30
Jesus, that must have been that does. There are people right now have kids that are just like, Wait, what?

Samantha 23:36
Yeah, cuz Yeah, it's crazy. And that's why I always find it so interesting to hear other people's carb ratios and settings because mine are so aggressive that it's just like, it's so interesting.

Scott Benner 23:50
Arden's I would say that, to get 11 units into Arden would be for something pretty carb tastic in the 80. To 90, maybe it might be the 70 to 80 carb ratio. Oh, yeah. And, and that's, you know, she does not very frequently eat more than 6070 carbs at a setting. Unless, unless it ends up being something like crazy, like a waffle and it has, you know, syrup. Yeah. But but every now and so what I wanted to kind of talk to you about a little bit is that from all of the other people I've spoken to adult women who have had babies, as hard as this part is right here. As far as your management goes, the real time to be vigilant. And for somebody looking in from the outside to like maybe be a little more concerned is going to be the after part.

Samantha 24:43
Yeah. And that's and that's what my the nurse was talking to me about yesterday to she was just because everyone says like, she was saying that my my needs are going to go back to pre pregnancy pretty quick after he's out of me. Which right now in the last two weeks, I have been doing my pre pregnancy settings. So I haven't needed as much insulin as the month before, like previous, which has been nice because everything's been more steady. And I've been able to keep things in my range easier. But I hear breastfeeding drops you fast.

Scott Benner 25:22
Okay? I didn't, that's interesting that I didn't, that I didn't hear what I was thinking about more is you're going to be tired. And the baby is going to suddenly seem more important than anything else. And that there's a concern, people stop paying close enough attention to their blood sugars and stuff like that.

Samantha 25:41
Yeah. And I met, the nurse was telling me because she knows me, because she is a nurse that went through our previous pregnancy. And then I see her all the time now. So she knows that I'm a little bit crazy with my management. And so she was telling me like that I need to kind of relax a little bit, because she's worried about, I think she's more worried. I had a whole kind of argument with her, like a month ago, because she thought my agency was too low. And I was trying to explain to her that I didn't go low. So it's okay, that my agency was on the lower side, because I wasn't having any hypose. And she was very adamant that that like that it was just too low, because I think she's used to dealing with different kinds of people. And so I think she's just worried about me going low and being with a baby, and not fixing it, and then something bad happening, which I understand. But

Scott Benner 26:45
so I have to say something from a more theoretical standpoint, let's keep in mind a I don't have type one diabetes. MB, I'm not a lady. C, I could not give birth but D I did take care of two newborn children. Like my, you know, joking, joking, and no joking aside, like, somewhere in the mix in the middle of my wife's job is to go to work, make babies and hand me the babies. You don't I mean, so it's not that she's not involved. But, you know, the overnight stuff, you know, that kind of stuff is I know what it's like to raise a newborn is what I'm saying. Yeah. And so from everything I've seen doing this podcast and everything I've heard from hearing from people who've do well or struggle vice versa. I sort of think that in the in the vein of bumping and nudging, the bigger concern would be letting it get away from you. Yeah, right. Because like management, obviously takes a little focus. Mm hmm. But not managing takes way more time. It's going to make your blood sugar higher a person like us not going to feel well with their blood sugar higher. Yeah, that's gonna just create different problems. Like I don't understand the idea of trading a possible problem for definite problems.

Samantha 27:59
Yeah, and that's what my husband said yesterday, when I was telling her telling, sorry, telling him what she said when she was a hurt, because then you wouldn't have this baby inside of you, but go ahead. Yeah, because I told him, I told him like, she was like, telling me if I go over 200 then it's okay. Like, we'll correct and, and they'll come down. Oh, I'm sorry. I lost I lost the earphone. And that my husband, my husband's reaction was, well, if you go anywhere near 200 you're gonna feel like, like, you're not gonna Yeah, you're gonna feel terrible. So that's not gonna help you any. So we'll see. It's gonna be an adjustment. And I'll probably

I'll probably mess up somewhere along the way.

Scott Benner 28:44
But all I'm saying is that it's not that you're gonna mess up it's that you're adding a layer of responsibility concern and like love and affection that you at this moment and I don't mean this pejoratively. But I also try not to use too many big words that I know while I'm doing the podcast, but I don't mean I don't mean this poorly. But people are like, is this guy smarter than he says he is maybe me. Okay, and, but the concept here would be you don't know what it's like to have a baby. I know you, won't you do you right now. You know what it's like to be pregnant. That kid's gonna come out. It's gonna hit you so deep in your heart. It's going to change everything you care about in a split second. Yeah, you're going to value your own health less. Yeah, soon as it feels like valuing his health comes first. I sat in a doctor's office yesterday, because my back has been a bit of an issue and I have plantar fasciitis in one of my feet, right? And so it sucks because my ankle gets stiff. I can't run when I can't run. I can't work out when I can't work out my back gets that from you know this cycle. So I go to a place where they offer physical therapy and chiropractic stuff. Like this whole kind of like Wellness Center, and I'm in there going, like, just let me go to the chiropractor guy. And they're like, no, if you do two weeks of physical therapy to like, we'll get you back to where you need to be, and you keep going. And I'm like, I don't have time for that. And the guy's like, What do you mean, I'm like, I just, I don't have time. And he's a younger guy. You know, he's a married man, but he doesn't have kids. And I'm explaining to him like, you mean, you don't understand. Like, I have a job like this. This podcast is a job, it takes up a lot of time. It doesn't make a ton of money, but it makes enough money to help me send my son to college. And this is how much college costs every weekend. And this is what my mortgages, my bills, and you know, and I have to support my wife who's making the lion's share of the money that's taking care of all these things. And I have a daughter who has type one diabetes, she has hypothyroidism, she's been struggling with muscle stiffness and other problems. She just had a surgery to have this thing taken out. I'm like, you don't get it, man. I'm like, I'm not a person. Yeah, I'm a facilitator. And then at the end, if there's anything left, that's when I'm a person. And the guy's like, that's wrong. And I was like, No, I know. And I completely agreed with you on that, right? Until I had a kid. And, and so like, you know, theoretically, for all single people listening, you're right, I need to value myself and make more time and all that stuff. But when you're in the fight, you know, when people are shooting, that's not how it goes anymore. So I just want to caution you against that, because you have a different layer with diabetes.

Samantha 31:27
Yeah, I feel like

Scott Benner 31:28
if Arjun was about to have a baby, this is what I'd be saying to her, that I you should learn from me, and value yourself enough that you can find strike a better balance than what our monkey minds do once we have kids. Which is just like, like, Oh, I'm gonna just die sooner as long as he's okay. Doesn't matter.

Samantha 31:49
I know. And that's probably something I'll struggle with. Because I already see myself like when we babysit my, my nephew more than my niece, because my niece is older, but my nephew was four, like, I, I noticed that when I'm taking care of him, I kind of don't, because I'm caught, like the person that constantly checks my decks calm. And every five minutes, I know what my blood sugar is. Because I like, if it changed, for whatever reason, I need to know so I can stay on top of it. Because that's just who I am. Probably not the most healthy, but

Scott Benner 32:24
you're probably insane. But, um, yeah.

Samantha 32:26
And but I, but I understand that I'm insane. So it's okay. But when I'm watching him, I don't really pay attention to it as much, and then my alarm will go off. And I'm like, Okay, I need to do something

Scott Benner 32:42
where your alarm set.

Samantha 32:44
Right now I have my alarm set at 80 and 120. So it's, it's the alarm when I have time to do things. But also, if I'm at and running around with a four year old, then I couldn't be 60 in the next five minutes. Right? Right. So it's something that I'm going to have to figure out,

Scott Benner 33:05
yeah, it's gonna be different, right? You're, you're gonna have to, you've now known what it's like to be, have type one, and not be apparent. And now you're gonna find out what it's like to have type one and be a parent. And maybe, you know, maybe stability at a slightly higher number than you're accustomed to, maybe will be the way to get through the first number of months. And I'm not also saying, like, for the rest of your life, because that's the other thing is that if you think your diabetes has changed a lot over the last number of months, day to day, like, Wait, do you see what happens? Like, you know, there's a stretch of time, where the baby is just like, you know, a drinking pooping mission with that. But once that stops, it's just like, I don't know, it just feels like you're on a roller coaster constantly going down a hill, and then one day it flattens out, and they leave for college. You know, so the rest of it is going to change frequently. And yeah, and it's going to happen so quickly, you're not going to notice it happening sometimes. So, you know, if you can't be fluid and be a parent, you're going to be in trouble. Yeah, of course. Yeah. So I I'm saying I think your management, like if you chose a slightly higher number to stay stable at and that benefited you not saying that even that's your answer. But if that's what you choose, it's not going to need to stay like that for long

Samantha 34:22
before. Yeah,

Scott Benner 34:23
life's gonna shift and you could probably shift along with it.

Samantha 34:26
Yeah, which is I'm sure. I mean, I'm thinking that because I've heard that your hormones are still wacky and will mess with your settings and your insulin needs. Like in the entire time you're breastfeeding up to just and then after you're done breastfeeding because your body still needs to adjust to being normal again. So I assume it's gonna be crazy for a while. A wild ride to say the very least, and I'll just have to do my best.

Scott Benner 34:57
And they remind us again with the with the Little Man is going to be called when he gets a name. Harrison. That's 100%. Correct? Yeah. After Harrison Ford in case any of you missed? Mm hmm. And by the way, if you missed the second episode, what are you doing the Sam's given her time Sam's came on? Right when you found out you're pregnant. Mm hmm. And then at the end of the trimesters, and now we're right, ready for the birth, you're going to come on once more. When I after the baby. And here's what I expect the last episode of viewers to go like Sam ready, I just, I don't know, I just say, Please, help me we eat the cat. We didn't mean to. We didn't even have a cat before the baby. We got a cat. I don't know where it came. A toxic shock. So we eat the cat and I don't know what to do. We're thinking of having another baby. Yeah, watch all this stupid stuff that happens to you now. Really, really excellent. Listen, having children, to me is is one of those things that you could put me on a deus and say, Scott, I want you to spend the next hour arguing against having children. And I could do it fervently and mean every word I'm saying and then move me to the other side of the stage and say, Scott, I don't want you to argue for having children. And I could rebut everything I was saying and I'd be right on both sides of the stage. So good luck.

Samantha 36:26
Yay.

Scott Benner 36:27
Really start looking back at what kind of a child you are. And your husband was because trust me there in is gonna lie. what's about to happen to you

Samantha 36:35
somewhere? Well, from all the stories, my husband was a little perfect Angel. So

Scott Benner 36:41
did his did his mom tell those stories? Yeah, you need someone else to tell those stories?

Samantha 36:46
Well, I believe it. He's very good now. So yeah, this whole thing it continues on through the generations.

Scott Benner 36:53
So if you told stories about your husband, they'd all be like, super positive about what a great guy is?

Samantha 36:57
Well, yeah, mostly, he's a great guy.

Scott Benner 37:01
Maybe you're gonna get lucky here. Some people's kids are nice. But

Samantha 37:06
I mean, I'm sure I'll think my kid is wonderful. So Oh, isn't that old? Man.

Scott Benner 37:12
I don't know if you'll think that or not like. So I'm wondering now, I'm super intrigued now to all the mothers that are listening. Like, I wish I could hear all their thoughts at the same time, because right now they're like, you know, the first one's nice, but the second one's kind of the very first thing you're going to notice when you go to Contour Next one.com is a yellow button at the top that says get a free Contour Next One meter, just give it a little click. When you do that, you're one step closer to the most accurate, Handy blood glucose meter, my daughter has ever had. To get started today with the Contour Next One smart meter and their contour diabetes app, you're going to discover that smart blood glucose testing with the Contour Next One meter. And the contour diabetes app is just what you've been looking for. get to that link, scroll down, fill out a little bit of information, find out if you're eligible for that free meter. And get started today. If you don't want to do that, you can just ask your endocrinologist at your next appointment say, Hey, come on. I've been using this meter right here forever. I think things been on the market for you know, a million years. I don't know how accurate This is. Is this the latest greatest technology and blood glucose metering? I don't believe so. But I'm hearing that the Contour Next One might be worth a looky loo. Your endocrinologist will probably say, I don't know why you're saying looky loo, it's not 1924 then they'll write you a prescription and get the thing yourself. That's it, get some test trips, a new meter, you're on your way. whole new life with accurate tests. Don't forget to be hit that blood drop once and you don't get a you know the beep with the Contour. Next One, you can go back in and go again without affecting the accuracy. So you don't have to waste that test trip if you don't get it right the first time. It's got a great little light for doing it in the dark. And this little neat system with like colors and arrows that shows you if your blood sugars in the range that you've preset, you got to check it out. Contour Next one.com I'm super intrigued now to all the mothers that are listening. Like I wish I could hear all their thoughts at the same time because right now they're like, you know, the first one's nice, but the second one's kind of then like it just it really does. It's interesting, like my wife and I were talking last night my son had a uh, his very first start at college. And they his team was getting like, they they were really putting it like getting it put to them. They had maybe two hits the whole game, but my son was putting the ball in play like hitting the ball hard. He just kept hitting it at people and even just hitting the ball seemed like an accomplishment in that moment but it was certainly not the excite exciting debut. I think he was hoping for in his second season you know, like nobody plays in there. freshman season if you get on the field in the first game in the sophomore year, that's pretty exciting for you. Yeah. And and so there's a doubleheader. And after the first game, he comes over, we brought some food for him. And he comes over. And as he's walking towards us, my wife and I, like, how's this gonna go? Like, is he happy that he's like, like, that he reached this goal, is he going to be upset at how the last, you know, hour and a half didn't go is probably the way he diagrammed in his head, like, where's this going to be? And we knew for certain that the year before he would have walked up to us, and been disappointed and probably aggravated to some degree. But instead, a completely different person walked up to us. And we had to admit, when he walked away that as good of a kid as he was prior, he had been short a lot in the last year, in some ways that we had not seen because he's been away at school, sometimes. His reactions were just measured and thoughtful. And we were like, Oh, my gosh, and he walks away. My wife's like, wow, that one really worked out. And sitting right there, and she's like, yo, you're doing fine, too, just like, we only time will tell with you. We're just like, he's starting to look like he's not gonna ever rob a bank. Like, maybe we can sit back a little bit pretty good about what's happened here, you know. But, you know, but last night, going to bed, I still felt like, I can't believe we didn't, you know, we didn't see him on his birthday, more than just like a FaceTime, you know, for a few minutes. And yeah, a couple of text messages. So I definitely don't want to be trite. But I have not found any better way to say it really does go fast. You know, just to try to enjoy it. And if you can, big picture once in a while, it helps on the really slow days that are mind numbing. There are going to be a lot of days, where you just start questioning your existence like why am I here? Even one of my kids no bigger doesn't look any different than yesterday.

Samantha 41:59
All he's doing is sitting there crying.

Scott Benner 42:01
If he was an egg, at least I could just turn a lamp on him and go out. But you know, it's illegal to leave them by themselves. In the 50s, you could put a kid in a crib and go outside. No one cared. Nowadays that'll get you locked right up. So I just I'm so what do you expect? You have expectations now? Are you clear minded about what you think is about to happen?

Samantha 42:30
Uh, like when he actually here for I think

Scott Benner 42:34
it's gonna be like to be a mom. Like, I want to match this up against what he's

Samantha 42:38
saying? Um,

I don't know. I guess I don't really have. I'm just more worried about him like getting out. Get like escaping getting getting out of me, like no sleep

Scott Benner 42:57
and have that kid wander off someday?

Samantha 42:59
No, I'm like, I haven't got farther than that. I'm like, I worry. I worry that he's not going to be able to fit into his clothes, because he's going to be I think I'm making him a lot bigger in my head than he's going to be at least I hope so.

Scott Benner 43:13
Did they give you an estimate of how big they think he's gonna be?

Samantha 43:15
Well, last, and was that it was either two weeks ago or it was last Monday. Whenever the holiday was. It was last Monday. He was measuring at six pounds 10 ounces, which is bigger, or than he should have been measuring. For my comfort.

Scott Benner 43:38
zone. Okay, so. So how tall are you? I'm five nine. I see you're taller person. Yeah. How are your hips? Are they narrow?

Samantha 43:47
I see my my ob told me that I'm tall and I have wide hips. So I should be okay. But that doesn't assure me any.

Scott Benner 43:56
Absolutely shouldn't listen. But my wife is five nine. And my son was 711 when he was born 710 maybe. So is your kid gonna pack on another pound in the next three weeks?

Samantha 44:08
Oh, that's what I'm worried about. If he's if he's not if he's eight is like the maximum okay with but I'm worried he's gonna be over.

Scott Benner 44:17
Did you let me do some math here? three more weeks. Baba. I bet she's seven, four maybe? Yeah, it'd be like that. Yeah. We'll see. I mean, I have Keep in mind, no medical training whatsoever. Go with it. But I'm just trying to make you feel better. I don't think I don't think that's not doable.

Samantha 44:40
Of course, it's not doable. But

Scott Benner 44:44
can I ask a delicate question, and there's gonna be a lot of bleeps in this. So feel free to answer but prior to this. It wasn't like super tiny or something, was it? Yeah.

Samantha 44:55
No, but I have to push and pull baby out of me. Basically.

Scott Benner 44:59
comes out on its own. It really your body just rejects it at the end. It's just like, Yeah, get out.

Samantha 45:05
And I'm afraid of like the leg ripping. Oh, you might be worried about that. Yeah, I'm worried about I think I'm more worried because I'm hoping I'm not going to feel anything during the delivery. I think I'm more worried about how much pain I'm going to be in afterwards.

Scott Benner 45:24
Yeah, I listen, if you have a nice natural birth, that should be you should have too much trouble. Are you doing any prep stuff? Let's talk like adults for a second. any of that, like oil massaging around your exit?

Samantha 45:37
Are you know, I've never heard of that.

Scott Benner 45:40
A whole bunch trying to keep things like loose. No, here's

Samantha 45:43
everything is uncomfortable. Listen, you want your cake and

Unknown Speaker 45:47
eat it too. Like

Scott Benner 45:50
have to have some uncomfortable sex with your husband to get this together? I think or by the way, you don't actually have to do it with him. You know what I'm saying? But if he's become a problem, but But no, I mean, are those things wives tales?

Samantha 46:06
I will I've never heard that that help. I've never heard the oil thing ever, ever. And then I've never heard I've heard that. Having sex couldn't do like couldn't make you have the baby. But I haven't heard that it loosens you up to get ready for the baby to come out. Hold on.

Scott Benner 46:27
I've googled. Okay, there are six things you can do now for a better delivery on your labor day. Find the right caregiver when this isn't eat well, okay. This is

Unknown Speaker 46:38
we're talking about how do we take breathe

Scott Benner 46:43
and make it more accepting of what's about to happen. Right? This is not let me be. Let me be more clear about my googling make childbirth

Unknown Speaker 46:55
easier.

Scott Benner 46:57
On my vagina. There we go. vaginal stretching, how to stretch your vagina before giving birth? You got to Google more

Samantha 47:06
like cables or whatever they're called. Is that isn't it? Oh, oh. Learn To Play shouldn't do that.

Scott Benner 47:16
Lengthen pelvic muscles and soft tissue practice getting into labor positions, practice relaxation techniques, prevent or treat urinary incontinence. Oh my god. You're not incontinent, or you

Samantha 47:25
know?

Scott Benner 47:26
Yeah. How's your back pain? Anything?

Samantha 47:29
Yeah.

Scott Benner 47:31
The sex hurt or did you just give up on trying? Don't say your husband's lovely. Let's not say that he hasn't gotten laid in six months. Okay. for him. Oh, here's my thing. perinatal massage perineal. Massage lengthens and softens the tissue of the peronism. You can start this at 35 weeks, how far you and 36 weeks. Thank God I'm here. This massage technique for 10 minutes once a day, take a warm bath or hold a warm compress on the its premium right? I thought yeah, premium per diem? I don't know I don't have one. Or do I? Just the taint? What are we talking about here for 10 minutes to help you relax. I'm gonna send you this link. Sit or lean back in a comfortable position. Put a water soluble lubricant on your thumb. And apparently, um, place your thumbs one to one and a half inches inside your vagina. Press downward toward the rectum and to the sides until you feel a slight burning, stinging or tingling sensation. Hold the pressure for two minutes until the area becomes numb. Oh, this sounds fun. pretty painful. Breathe deeply. Listen,

Samantha 48:42
I want to put myself in more pain that I'm just gonna still feel pain later on. This baby's

Scott Benner 48:47
gonna fire out if you just loosen these muscles up deeply and concentrate on relaxing the muscles as you continue to press down with your thumb slowly and gently massage back and forth over the sides of your vagina. If you would have done this, you wouldn't have gotten it would have been like, you know what Never mind. And massage thing was enough. Thanks. Relax, repeat this process once after you give birth, you may experience new physical problems that prevent you from fully enjoying life with Wait. Hold on a second. skip that.

Samantha 49:16
Don't send me this link.

Scott Benner 49:19
But just talks about getting your body back into shape afterwards that did a physical therapist might help but this massage thing I'm telling you this is all you have. You gotta gotta like you know, when you get like a new baseball

Samantha 49:33
well, then my husband will be good at it. I'll have him do it.

Scott Benner 49:36
Tell him to get some oil out and beat that thing into shape. So you can play with it on the 17th I think that's worth talking about.

Unknown Speaker 49:43
Oh my god, I'm so happy. I don't have

Unknown Speaker 49:47
realized that as I was reading.

Samantha 49:48
I keep telling myself that people have like another child after the first so it can't be that bad. Because why would they do it again. I

Scott Benner 49:57
think some women are trying to keep wealthy husbands I think that's

Samantha 50:04
because women that are having babies because they want, because

Scott Benner 50:07
they love their babies. Oh, I do. I mean, I think it probably just feeds that dopamine part of your brain,

Samantha 50:14
right? If it was so terrible, then there would just be only children everywhere. Yeah, right is what I keep telling myself hundred percent

Scott Benner 50:24
and don't listen, we're joking around a lot here. Of course people have babies all the time and it goes all the time. But yeah, I listen, I think if you don't need what is that word when there's when they when they cut to make the space?

Samantha 50:42
Oh, I don't know what you're talking about. I don't know what the

Scott Benner 50:45
word is such a silly word to I'll think of it in a second. It starts with the P. program note, I realized it was a PC Atomy as soon as I said starts with the P but then when I remembered what it was it felt mean to say in front of Samantha, I'll figure it out. That doesn't happen. And if you don't prove yourself when you're pushing, I think you're doing really well.

Samantha 51:04
Yeah, I'm fine with that. That's not gonna matter to me.

Scott Benner 51:07
I like your line. You're like, Listen, if someone's got to clean that up. that's their problem, not mine. I'm paying to get in.

Samantha 51:15
Yeah, I'm paying plenty they can clean up my poop.

Unknown Speaker 51:25
Yeah, exactly. All right, Jesus. I think

Unknown Speaker 51:35
we'll end on

Scott Benner 51:36
early today, but I feel like we've covered a lot. I didn't realize we'd be reading about the massage technique. I just came up like, because I remember hearing it somewhere. I don't know if my wife did it or not. I don't think she did. If she did, she was like, I don't need him for this. But I mean, I just it makes sense, right? Like, if you were gonna go for a run, you'd stretch your legs.

Samantha 51:56
Right? I mean, yeah, I logical.

Scott Benner 52:00
I will tell you this. I don't think that your concerns are unfounded, or unreasonable. My daughter is 15. She has like, zero. You know, besides thinking some boys are cute and something like that. She's not thinking about having a baby. But anytime the subject comes up, she immediately says, I'm adopting kids, because I don't want anything to have to come out of my vagina. Like, you might change your mind. She goes, I really don't think I'm going to just like okay, yeah, so um, yeah, that's it, you're gonna be great.

Samantha 52:35
Yeah, I can do it.

Scott Benner 52:37
Hey, listen, you're gonna do it.

Samantha 52:40
I have to do it. Now. It's way too late.

Scott Benner 52:43
backing out now would be unprecedented in the history of the world. I think you're having a baby. Let's talk a little bit before we go about. I mean, I feel like I don't feel like we can Jinx the last three weeks of your pregnancy? Do you spend much time thinking about your first pregnancy? Um, or does it just make you feel like I'm

Samantha 53:05
me? Um,

I don't think I spend time thinking, well, it's, it's a little bit. This is like I was pregnant in January, February, March, April, May last time. So it's kind of that time zone. And it's getting to April's when my diagnosis anniversary is. So it kind of brings up the thoughts. But I don't think we're really thinking about the actual pregnancy rather than just like her. The fact that like, we were supposed to have another baby before this. And she's not here. And like, like, we just kind of think, I don't know, it's hard. It's hard to not like, compare that technically, this could have been like our second child, you know?

Scott Benner 54:01
Yeah, no, I think I mean, I don't understand from Kant, you know, from context. I obviously, it hasn't happened to us, but I feel like I understand what you're saying. Like, even though your daughter was never born. It doesn't feel like she didn't exist.

Samantha 54:16
Yeah, yeah. She she's still very much like a person to us. And we say that she's up watching over us and like, she'll be watching over Harrison, and she's very, she's very much a part of our family, even though she never like took a breath.

Scott Benner 54:36
Does she have a name in your mind?

Samantha 54:38
Yeah, her name was gonna be Elena.

And then I mean, we even have, like, I don't know if I had said it in the first episode, but the doctors made her footprints for us. So we have her footprints, like framed in our bedroom, and we have her ashes. So like, she Is the person to us?

Scott Benner 55:02
No, I agree with you. I, I don't think that's Um, I don't think that's something anybody could argue with, you know, just the idea that that you were going to have a baby. And just because she didn't make it all the way to the world doesn't make any of that less. Anything, you know?

Unknown Speaker 55:17
Wow.

Scott Benner 55:18
You guys are doing great. You really are you you've rebounded from, you know, a tragedy and turned it right around. It must have been incredibly scary to try to have a baby again. And then to have diabetes on top of all that is a stressful a lot. Yeah, but you're doing it.

Samantha 55:36
Yeah. Yeah, that is, I am doing

Scott Benner 55:41
the truth. Right. Like, yeah, you hear people say things like, you know, just try it. You'll say, you know, that kind of stuff like anything's accomplishable. And I have found that my life just,

Samantha 55:52
yeah, completely doable. I want people to know that just because you have Type One Diabetes doesn't mean you can't get pregnant. I've had people tell me that their doctors have told them because you have type one, like that sole reason alone, you cannot get pregnant. And I think that's terrible have a doctor to even say, because if my doctors had said that to me, then we wouldn't be here. And both my doctors were very supportive. And they told me as long as I manage it, too.

The point like where I need to do management.

pregnancy is completely doable without complications.

Scott Benner 56:40
Yeah, I no lie. I get a lot of emails from people who say that though, they can now have kids because they listen to the podcast, they got their agency down and their blood sugar's are more stable and stuff like that. But almost every one of their notes includes some statement about they didn't think they could ever have a baby or or a doctor told them they couldn't. Listen, I don't know when this will come out in the timeline. But since I pretty comfortable yours will be out soon. I've been helping my daughter's friend, Jani. So Arda met a girl online years ago, and they've been friends, you know, for a while. They've never met in person. But Jani and Arden are the same age and Johnny's had diabetes for six years. And so there was times where Arden would come to me and say, I think Jani needs help. Like her blood sugars are high a lot and Arden was concerned for but it didn't feel like anybody's business. Do you know what I mean? Yeah, so one time I just said to her, like, Look, if you want to, because they were comparing their blood sugars. And so you know, I said, if you want to tell her, I can help her just, you know, have her ask, but I wasn't going to push it on her. I wanted somebody to ask me. I don't know why that seemed to make a difference to me. But eventually, it came up and we start talking about it right before Christmas. And about four weeks ago, she and I spoke for the first time and I've been recording with her like 10 or 15 minutes at a time a couple of times. Oh, yeah. So she went yesterday. Yesterday. Yeah, she went to her. She got her a one c done yesterday. Now this is not a full a one c after she and I've spoken it's four weeks after she and I spoke and her a one c went down two points. Oh wow. From the last time and so to tell somebody you know your you know your blood sugar's don't support having a baby. That might be true in the moment. But yeah, the rest of the statement, you know, like, here's what we could do to get your blood sugar into a place where you could have a baby, and by the way, enjoy your life more and be healthier.

Samantha 58:38
I think that's the most important thing from like, hopefully people are getting from listening to at least at the very least, like my episodes, like it's completely doable without any complications. And to have I mean, despite having to deal with the diabetes to have a completely normal pregnancy.

Scott Benner 58:58
I'm super excited for you. This is really great. I feel like I'm having a baby a little bit.

Samantha 59:03
I'll send you a big shirt in three weeks.

Yeah, hundred percent. That's what my endo, I'm not going to see my endo again until the end of April. He said that I just need to make sure I text him a picture of a baby.

Scott Benner 59:16
That's so nice. It's cool to have so many different people like thinking of you and supporting you and everything that must be helpful as well.

Samantha 59:22
Yes, definitely. Yeah.

Scott Benner 59:24
The only difference between you having this baby and me being involved is that on the 18th, I'm not going to be tired.

Samantha 59:31
Well, hopefully, the 18th all already have the child by them.

Scott Benner 59:34
Well, let me give your husband a tiny bit of advice here. That night you have the baby and they get you up to move around the room and there's not a lot of space so he sits down on your bed for a little while. Don't fall asleep. Oh, yeah. Because I might have done that after hours after hours. Like I got in the bed notice like, and she's the other day she's like, I can't believe you fell asleep again. 15 years ago. And I said I was tired. I just had a baby. And I said, Kelly, I know I've said this a million times, right? But just because you're tired doesn't mean I'm not

Samantha 1:00:16
feeling so you understand we were talking heard your struggle doesn't

Unknown Speaker 1:00:19
negate mine.

Scott Benner 1:00:23
I don't think she accepted that, by the way as a viable excuse. But anyway, I was sleepy. And it turns out, I used to have really low iron, so this isn't my fault at all. Oh, there you go. Hey, I'm good. I've valuable medical reasoning. I can get a doctor's note for that. I should. Each time I go in for an iron infusion. I'm gonna get the doctor to write a note. Back on the date Arden was born excusing me for fall asleep.

Samantha 1:00:48
It's gonna matter much but

Scott Benner 1:00:52
trying to when we're in a point system here. We've been married a long time. I'm way behind. Okay. All right. So, I hope the I hope everything goes great. I'm sure that baby's gonna be fine. There's no gonna be any problems. Fingers crossed. Yeah, yeah. Hundred percent. I am sending you this stuff for the massage. I'll take. I'm sending out I'll send you the text. So okay. And if you do it, you have to tell me.

Samantha 1:01:18
Yeah, it'll be it hurt a lot. And it's still frickin hurt when I gave birth.

Unknown Speaker 1:01:24
All right, that seems fair.

Scott Benner 1:01:27
Alright, happy birthday. I will talk to you soon.

Samantha 1:01:30
Okay, thank you. Bye.

Scott Benner 1:01:34
A huge thank you to Samantha for coming on again to describe her journey through pregnancy. She's going to be back one more time. A few months after she has Harrison to tell us what it's like to be a new parent with Type One Diabetes. huge thank you to the Contour Next One blood glucose meter, please go to Contour Next one.com to find out more. And of course, touched by type one. When you go to touched by type one.org, you're going to see an organization helping children and people living with Type One Diabetes, you're going to find an organization that's helping to raise money for a cure, and so much more touched by type one.org. Give them a look. Once again, I want to thank the Georgia chapter of the jdrf for having me down to Atlanta this past weekend. I had a terrific time. I met a ton of wonderful people. Want to wish you all success if you're listening for the first time here. Hello. Coming over the next couple of episodes. a two part conversation about looping coming soon. Maybe it'll be Friday. Maybe it'll be next week. I haven't decided yet, but I'm getting close to deciding. Anyway, it's gonna be really soon. Dan, don't

do you think I have a future in this ASMR thing? I could just make like relaxing sounds into a microphone. That would be so much easier than interviewing people. I don't even know how to begin to do that. What would I do? What I was I don't think I can whisper Oh, you're listening to the Juicebox Podcast. Today, I definitely can't whisper it makes me like shorter breath whispering I need to like fill my lungs and go you don't mean like that? Yeah, I don't know. I couldn't do that. Alright, I fallen down a rabbit hole here. A s m R stands for Autonomous Sensory Meridian Response. The Autonomous Sensory Meridian Response sometimes auto Sensory Meridian Response is a tingling sensation. That typically be excuse me that typically begins on the scalp and moves down the back of the neck and upper spine. A pleasant form of para thesis paraesthesia paraesthesia. I think it has been compared with auditory tactile synesthesia, and may overlap with Phrygian well, hell now I don't know what Phrygian means. Give me a second Phrygian is that a made up word? A sudden strong feeling of excitement or fear a thrill that just comes from like what what's an example of ASMR then? Alright, people give me a second set of video here. Listening to a video from Mashable. Get to it, man. What does it mean? Common triggers. Here we go. whispering crisp sounds like tapping and crinkling Hold on.

Wait, you have to roleplay and pretend you're doing it like I'm not doing that. Just like a whole business. Not everybody gets the sensations from the trigger sounds, the video says, well, it's definitely not doing anything for me. So I thought I could make a little extra money on the side here.

By the way, if you're still listening, examine your life. I don't even mean because the SMR I just mean like, I mean, the the part about the diabetes has been over for a while now. Alright, let's keep going.

Here's an idea. We try this.

Now it's not working. It's not as easy as it looks.

Okay, I'm done.

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.

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