#471 Bolusing Insulin for Fat

Learning to bolus insulin for the fat in your food with Michelle from Waltzing the Dragon.

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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 and welcome to Episode 471 of the Juicebox Podcast. Today,

we're gonna talk about bolusing for fat in your food, and it might be easier than you think, to figure out. Michelle is here, from the website waltzing the dragon to try to help us understand. If you're thinking right now Wait, that doesn't make any sense. There are no carbs and fat I only Bolus for carbs. Well, you ever eat pizza and in a weird high Three hours later, french fries, milkshake, anything like that, where you think it's gone, you've handled it But suddenly, two and three hours later, this persistent high. If that's happened to you, you're gonna love this episode. And let's be honest, if you're using insulin, this has happened to you.

We're gonna get started in just a moment. But first, I'd like to remind you 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 are becoming bold with insulin. I'd also like to say right up front, that I've put a link in the show notes and a link at Juicebox Podcast comm to Michelle's website. And that link will take you directly to everything that we've spoken about today. And the way Michelle talks about it on her space. But I think this conversation will be enlightening. And I hope you enjoy it. At the very end of this episode, I will actually read from Michelle site in case the conversational nature of today's show. didn't let you take notes or or kind of walk through things incrementally. So after you hear the whole thing at the very end, I'll walk you through it one more time. Alright, little more music and we'll get started.

This show is sponsored today by the glucagon that my daughter carries g vo cuyp open, Find out more at G Vogue glucagon.com forward slash Juicebox Podcast is also sponsored by the Contour Next One blood glucose meter. You can find out if you're eligible for a free meter, check into contours test trip program. Or while there's a lot more you can do so I can't just list it all but all the information you need about the Contour Next One meter. It's a Contour Next One comm forward slash juice box there's links in your show notes. Links at Juicebox Podcast Comm. Let's talk about bolusing for fat now with Michelle.

Michelle 2:57
My name is Michelle and I am the mom of two kids. Gemma who is 12 just turned 12 and Max who is 13. It's max who has type one diabetes. He was diagnosed at just over a year in 2007. Actually 14 months to the day.

Scott Benner 3:15
Well was how old he was. Wow, that's pretty damn young. Jeez, that was Yeah.

Michelle 3:24
It was tough. I think it's tough at any age. You know, I think they're just different challenges.

Scott Benner 3:29
I agree with that. Yeah, I agree that it's that it would it's not like, Oh, I got lucky. I was diagnosed at 46 perfect age to be like, it's that's not how it is. But but that 14 months thing with a low body weight not being able to communicate well, it's just an end back then. I mean, you didn't even have the ability to to break Bolus down into smaller bits. And

Michelle 3:52
now although he got his first pump at three years old. So that's when things really changed in terms of being able to break it down. But before that, for the first two years, we use diluted insulin to try and get smaller boluses. Like really half as much as you could drop in a syringe. Yeah, I don't know if you did that with Arden. I know she was quite young to where she's two years old.

Scott Benner 4:14
She was Yeah, she was just after her second birthday. What I did was I took expired insulin, squirted it into a dish, added food coloring to it, drew it up into a needle and I would practice pushing the plunger slightly to make a drop come out. I just used the food coloring so I could see the liquid and then kind of think about Okay, this much pressure made a drop come out. And that way when I used insulin for real and the needle was in Arden, I could put that same pressure on.

Unknown Speaker 4:46
Interesting. Yeah,

Scott Benner 4:47
yeah. So it was a it was a good motivator to put weight on her. That's for sure.

Michelle 4:54
We're still trying Max's skinny as a rail. And I'm like, Where can we put these infusion sets? We need some fat No

Scott Benner 4:59
kidding. Oh, Yeah. Well, do you know how you ended up on this podcast today? Um, do you listen enough that

Michelle 5:07
you messaged me? And I responded? Okay, so that's I'm guessing Jenny had something to do with it

Scott Benner 5:12
right? So Jenny and I sat down. So I not, I mean, I can pull the curtain back here a little bit like you people listening here, Jenny, like every couple of weeks on the show or something like that. She is awesome. She's my favorite person. But what, but what I do to make that for everybody is Jenny and I carve out some time. And we power through topics. And I do not tell her what we're going to talk about first.

Unknown Speaker 5:41
So did you say that?

Scott Benner 5:43
Yes. So I said, Okay, like we finished a topic. And I said, Hey, Jenny, Next, I want to talk about how to translate fat into carbs for bolusing. And she goes, I don't think I'm the right person for that. And I said, Oh, okay, that's no problem. And I just put it on my list, like, find somebody else. And she says, Do you know that blog, and then she told me about your blog, which of course, I know, because of the the unique name, but tell people your your, your blog title.

Michelle 6:12
So the website is while it's in the dragon. And it was started in 2011, with another diabetes mom, Danielle, and I started it. Because we realized that when we talk to other parents, we just got the most helpful tips. Like other parents knew how to put the theory into practice. Yeah, they knew what kind of infusion sets worked. They knew you know, how to get around things, like you're talking about, you know, food coloring and making some really small boluses. When you're still using syringes, that's the kind of stuff that we learned from other parents. And we just thought, wouldn't it be awesome if we had a place where the theory and those practical tips existed in one place where I could look up? I don't know, illness management strategies at 2am, or my kids throwing up, and they would be there. I wasn't like shuffling through that jumped or looking for that handout that I got. Yeah. So that's, that's where Walton dragon came from.

Scott Benner 7:11
It's interesting. I don't want to go too far into the weeds here. But it's interesting that you can't just devise one repository, and it exists everywhere. Because that's not how people find out about things don't mean like the, the best movie I've ever seen in my life you may never have seen or ever heard of. And so that other places keep popping up is a is a gift to people because the internet is sort of, it's sort of cyclical, and at the same time, it's bubbled like you're in a sphere, you don't realize it, you're not seeing the whole internet, you're seeing the part of it, you see. So if somebody you know, has a blog like yours, that's great. And it can be frustrating for people listening. I imagine Michelle has felt this before too known how valuable the information you have is, and there's just you can't figure out how to get it to more people. Because you're not in charge of that. It's and I figured that out a long time ago, if the if people don't know immediately to go to the ADA to get information about something right, then that means that the ADA is information isn't so amazing that everyone who's ever seen it runs around telling everybody else about it, right, which is not to denigrate their information. It's just that that's not how it works. It's why you see somebody who's incredibly popular on Instagram today, who 11 months from now, you'll never see again, because everything just keeps going. But I always felt badly about like all this great information that just, you know, just kind of its cycles away. And so the podcast for me is, is an idea of like, how do you bring it alive. So that it It keeps existing and it keeps drawing people in and they keep finding it. So as soon as Jenny said the name of your blog, I was like, I've heard that name a million times. Now I don't read diabetes blogs. And I never have. But that was always a creative decision. I didn't want to, I didn't want to read something you wrote and then find myself saying it not realize that I had heard it from somebody else, right? So I always stayed very kind of insulated around it. But immediately is like, because how can you not remember that name like waltzing the dragon is just so you know, unique. So anyway, I go there, don't please. And there's all that information. And I was like, Okay, I'm gonna send someone an email and ask. And I picked around I think I think I figured out how to get you through Facebook. So I really appreciate you doing this. Because I want to take what you know about this one specific subject and kind of blow it up and leave it here inside of the podcast for other people. So awesome. Yeah. So tell me how you first realized that fat made blood sugar go up.

Michelle 9:52
What would happen is we would go somewhere like McDonald's like we had good control. You know, I wouldn't say it was fantastic. But you know, our overnights for good. We knew how to handle this kind of foods that we made at home. Max was pretty little. So we weren't eating a whole lot of high fat food. And then when we started to, like I said, go to McDonald's or have a pizza, we would have these incredibly high persistent highs that I just kept correcting and correcting and correcting and he wasn't coming down. And it was changing. Like, it was frustrating for me. And it was changing our family's lifestyle. Like I felt like diabetes was winning. I felt like okay, we're No, we're not going to go to McDonald's to get fries today, because I don't want to deal with the highlighter. We're not going to have pizza tonight. Because I don't want to deal with being up all night and correcting and correcting and correcting. And that was incredibly frustrating to me. Because we've always lived like diabetes, we have to pay attention to it, but it's not going to control us. And it was definitely controlling our family. So So I went looking for ways that I could cope with that. And within a couple of weeks of each other two different people brought up this idea of bolusing for protein and fat. Shannon, who was one of the CDs, one of the nurses at the Alberta Children's Hospital diabetes clinic, which is where Max is seen. And also Lorraine Anderson, who is a registered dietitian here in Canada, she worked for at the time animus was my son's pump company. And so I had had contact with her over that. They both brought up this idea of both protein and fat, which we had never done. But it seemed perfect. And it seemed almost divine that they were both talking about at a time when I really needed to hear it. Yeah. So we started experimenting, as a family. And just to back up, I guess that's, you know, I remember talking at a conference and people said, Well, wait a sec, you know, I guess I should start bolusing for fat because we've never done that. And you through the conversation, it came to be that they didn't really have post meal highs due to fat or protein. So So I was like, well, then you don't if it ain't broke, don't fix it. I mean, you don't, you don't need to do this unless you're seeing this pattern. That is one aspect of of diabetes management that you would like to address. But many people I mean, if you eat the same amount of protein, and most meals, or the same amount of fat in most meals, then you don't need to do anything different. Your insulin to carb ratios and your Basal rates after that are probably covering it just fine. I think the problem for us as a family was that we tend to eat low fat, but we didn't binge very often on things like pizza or, you know, burgers and fries at McDonald's. And so when we did I could really see the difference. Yeah.

Scott Benner 12:54
Well, almost divinely. Yesterday, Arden had a five guys double cheeseburger with bacon, french fries, and a milkshake. So she took her SAP, and she came out of the SAP and she's like, I want some food. And I was like, okay, actually, she took a sap prep class and the guy said, when she's done, she's gonna want to eat and take a nap. And I was like, Oh, you don't know Arden right? Like she won't boom, she ate this food, walked upstairs and fell asleep.

Unknown Speaker 13:25
seen a few of these kids,

Scott Benner 13:26
he's aware of what was gonna happen, but what I knew for certain was much like you are not gonna have a cheeseburger every day. Right? It's not going to be a meal like that every day. So now we have these fries. That are potatoes, which we know are difficult to Bolus for soaked in peanut oil. There is the protein in the burger plus the fat in the burger. There's cheese, there's bacon, then there's bread. And then she has a it's a milkshake. A real milkshake like real ice cream, you know? No, she actually says

Michelle 13:55
not ice milk. But ice cream.

Scott Benner 13:57
Can I get an ice cream? Can I get a milkshake with Oreo pieces and Oreo cream? So they put the ice cream in and then they scoop in chunks of Oreos and extra cream. Right? So what that tells me in my head, the way I think about it is, is that the the range of time that this meal is going to impact her in my mind goes right up to about five or six hours. Like that's how I first think about it. And then and then I just dump in as much insulin upfront, as I think she can handle. And then any indication that there's going to be arise gets re attacked along the way. The problem is when people are saying, Well how do i Bolus for fat and protein? That's not a real, you know, that's more of a here's what I do. You can try to see if it works for you. Do you have more of a formula for something like that? Absolutely.

Michelle 14:50
It's not my formula. No, but let me back up because you know, I've heard you talk about how you do like a Temp Basal, to deal with those sort of rises that come from food and we tried that. Danielle, the other original co founder of waltzing the dragon. That's what she did with her son, right? If she would set a Temp Basal after the meal for, you know, whatever, and her gut said was the right amount, and she had done all this experimentation. But when I tried it, it was an abysmal failure. Okay, like, I tend to be very systematic Anyway, I'm not a, I'm not a kind of a, you know, let's see what this does. I want I want to have something concrete, you and I are probably the Yin to the other's Yang. But in any case, we tried it a couple of times, and it just didn't work. Either he bottomed out, or he was still super high later. And I thought I do not have the mental energy that it's going to take to experiment with these rates and ratios. And, and, you know, pull numbers out of the air for the next two years until we get it right. I just don't, right. And so what both Shannon and Lorraine had brought to me was what's called the Warsaw school program. in Eastern Europe, they Bolus for carbs just like we do here in North America. But there's also a more of a practice of bolusing for protein and fat. So they've spent some time figuring out Well, what does that look like? Yeah. And so that was the program that I did more research on. And so what they basically say is that protein is kind of complicated, it protein creates in your body create some insulin, but it also stimulates the release of glucagon, which we know rises, raises blood sugar. And so the effect of it is a, like, if you if all you ate was protein, the effect is a longer rise in blood sugar longer after you eat it. So it might be three to five hours, if all you ate was protein without carbs, it might be three to five hours, you'd give a maybe an extended Bolus or a Temp Basal. I don't know, maybe three hours, I think Jenny said something like 50%, I'm trying to remember she had a great way of looking at it. You do that after the meal, and then it covers that slow rise of protein. So that's part of what they talk about. Then they also talk about the effect of fat, which is not at all unpredictable, that raises blood sugar. And the reason is you get insulin resistance, you've got fat in your bloodstream, that makes your insulin less efficient. But you've also got that fat is harder to break down. So it takes longer to digest. So what we found with Max was that when he would eat a high protein slash high fat meal, he would go low first, and then he'd be sorted me high. And the reason was, if we gave all of that Bolus up front, so let's say he had cheeseburger and fries. And that would be think like, maybe at that age, it was like the McDonald's Happy Meal. So it might have been like, I don't know, 3640 grams of carbs for the fries. And then the burger might have been another 20. So we're talking about, let's say 60 grams of carbs. And with that would come maybe 3040 grams of fat, I'll say 30 at that age. So we would give the Bolus for the 60 grams of carbs, which you would think okay, that's great. If he just eaten the bun and potatoes that weren't, as you say, soaked in peanut oil, then that Bolus up front would have covered that. And everything would be great if we do the correct timing to the insulin and all that. But what's happening is because there's such a high fat content, it's digesting more slowly. So that initial Bolus is all getting in before all the food gets in. So he'd go low first, which of course we would correct. And then that correction would add to his high blood sugar later, right. So then we were fighting both

Scott Benner 19:02
because it's so incredibly difficult to say to yourself, oh, I've gotten the meal and so on ahead of the impact of the meal. Now I'm going to correct with food. I actually have to Bolus the correction right now that is the hard right leap to make in your mind. But

Michelle 19:15
I have to Bolus that correction with an extended Bolus. Or perhaps if you're still on injections with like a split Bolus because I need it because if I Bolus it now, he may go lower dam. And we've found that that depends on the amount of fat to like, we don't do this. We won't even consider the amount of fat if it's under about 10 to 15 grams. Okay, so under 10 I don't even think about it. 10 to 15 maybe depends what else has been going on in his day hasn't been you know, fighting some highs has been exercising hard. Whatever that I might consider but over 15 we will almost always Bolus for the fat. Yeah. Because that's where we see the impact. Right. So getting back to This Warsaw schools, what they do is they talk about fat protein units. And there's this process that they go through to calculate fat protein units. And I don't know Do you want me to? It's all on Walton, the dragon. I'm looking at it. Do you want me to go through it? Yeah. Okay, Joe, I'm gonna go through it basically.

Scott Benner 20:16
Yeah. I'll just tell people now Oh, geez. Alright, so it's your Canadian. So it's waltzing the dragon.ca. And I'm actually

Michelle 20:25
ta although the.com will get you there, too.

Scott Benner 20:28
okay.com will get me there too. But on this specific page, it's got kind of a long title. So is there a quick way that you can tell people to get through your website to get to what you're

Michelle 20:38
watching the dragon.ca slash fat,

Scott Benner 20:41
slash fat? Okay. I'm doing it to waltzing the dragon.ca forward slash fat. Okay, how fat and protein affect blood glucose? Okay.

Michelle 20:56
So there's two articles, the first one that how fat and protein affect blood glucose, just sort of the introduction, it just talks about the fact that what we just talked about, right protein will raise blood sugar, slowly, fat will make you insulin resistant and give you a resistant high later, okay. And then the second article is how to reduce those spikes. or avoid them might be a better word like, if you if you use the Warsaw formula, then you can you can have a pretty close to flatline, if you you know, sort of tweak it enough for your own personal needs.

Scott Benner 21:33
Yeah, if you actually go through and figure this out. So this, this episode really is for people who want to look at a nutrition label, and say, I want to apply this to that. And I do want to agree with you, before we start, that I don't Bolus for all the fat or needs. I do think, though, that it's an elusive idea to people because I'll take I'll take a very basic example, every once in a while, like once or twice a year, I make my own potato chips. That's how bored I get. Okay, so you start with an amount of I use peanut oil, because it holds a nice steady temperature, right. And however much peanut oil you start with, you make your potato chips, you put your potato chips aside, each one's thin and crispy and doesn't even have a hint of oil on it. But then you go back and look at how much oil has been absorbed by the potatoes. And it's a fascinating amount of oil, right? So if you eat handfuls of these potato chips, you might as well take a cup, fill it with peanut oil, and drink it because what you're doing eating those potato chips, right as an example, or cheeseburger, or you know, all kinds of things like that, that have grease in them have way more grease in them than you imagine. And so, you know, did I know, fat from ice cream plus fat from cheese and fat from beef and oil from French fries and potatoes and bread was gonna crush Arden. It did. And if I told you that based on the carb count of that meal, even though it was an insane car mount, I mean, gosh, by the time you go through the burger, the roll, the roll is the rolls like 25. And then I just throw in five for the burger, because why not and a couple of more for the cheese. And now I'm at 35 and then the fries are probably 50. And now I'm at 85 and the milkshakes probably like 80. And like, in my mind, I'm like it's like 180 carbs, right? And even though you give that insulin for that, it comes back to haunt you like a bad acts. Absolutely. You know, every couple of hours. It's and you're putting in another, you know, oh, it's gonna happen again, here's two or three more years before you know it. You've used by half more insulin than the actual carb count. Kind of would indeed

Michelle 23:51
Oh, absolutely right. And the amount I've found since we've started bolusing, for fat, I found that the amount of insulin we use up front as an extended Bolus is a fraction of what we will have to use to correct it. Right. It's absolutely insane. Like we might add a I don't know, like a three unit extended Bolus. If we you know, do it at the front, if we forget to or when we were learning this, we might have to use like eight or 10 units to get him back down to range. And so the difference is just striking. Right? There's doing it proactively is is a huge benefit.

Scott Benner 24:28
You will being ahead of it. You're using far less than you will if you chase it, and absolutely when you're ahead of it, you most likely won't cause a low later because it's almost like that food, it almost precludes a low from happening. You know, it's almost the it's sort of the antithesis the idea of when people are newly diagnosed, someone will tell you to like oh, give them like a little protein and a fat at bedtime. If you don't want their blood sugar to fall like that kind of note that'll just not but except you're doing it times. Like 30. So, yes, so you're very aggressive. You know, the way I think about it is balancing the impact of the in some, or the impact of the carbs with the action of the insulin, trying to keep everything working at the same time, so that when the foods finally digested and the insulin is finally gone, you don't crash later. But yeah, once you're chasing fat and protein like this, especially high fat, you're just it takes so much more insulin than you could imagine. And your basil rate is nowhere near up to the challenge that you've that you've given it. Absolutely. I'm sorry. I love our conversation, but I'm not letting you get to what you're trying to say. So,

Michelle 25:38
no, that's okay. I just want to back up for a minute because you mentioned a lot of things like if people are curious what sorts of things that we do this for. You've mentioned a lot of them, like we talked about pizza. We've talked about burgers, cheeseburgers, french fries, funny if we have french fries, if we have homemade frozen french fries made in the oven, they don't have enough fat and we don't need to worry about it. But any restaurant we go to those fries will need a fat Bolus. Mass loves nachos lately. So the tortilla chips have fat, which we don't really notice if he had say, tortilla chips and salsa or hummus. But if he has nachos, so he throws all that cheese on top of it, and sometimes even like ground beef on top of that. Absolutely. He'll need a fat Bolus for that. Yeah. Real ice cream.

Scott Benner 26:26
Yeah, go ahead, jump on your Nacho thing. Arden loves kaiso from Moe's which, which might not be all over the countries and everything but it's a it's a restaurant you go into they fried the you know, the tortilla is right there for you. She buys the case. So we throw the chips away. And she uses like a toast Tito's brand like instead. And it by half makes this an easier project for us.

Unknown Speaker 26:53
Absolutely. I

Scott Benner 26:53
don't know how, let me hear I'll say this and to people who really are probably believe in me listening to the podcast, I I can't figure out how to Bolus for most chips for Arden. Like I haven't had the nerve to put in enough insulin yet to those chips in the heat and pretty aggressive. You know, so I'm sorry. And you were gonna say ice cream in a second real ice cream. And and that that's where people's confusion comes in online. Somebody will say, hey, you have to do this for ice cream. And another person will say oh, no, you don't. We don't have to, except there's no context the one person might be actually eating ice cream. And the other person might be buying something out of the freezer section that's 17 chemicals and might actually have very little bridal ice cream in it to begin with. So

Michelle 27:36
right or what we do we have here in Canada a brand called Chapman's, which their frozen yogurt tastes just like ice cream. It's awesome stuff, but it's got a fraction of the fat. So when we're having it at home, I buy Chapman's frozen yogurt because then we don't have to stress about it. McDonald's for example, there softserve is ice milk. It's not ice cream. So if you had a huge one that maybe we might have to but like if we go to Dairy Queen there softserve is ice cream. Right? So it's got a much higher fat content. What peanuts if he has a great big bowl of peanuts, we might have to Bolus fat for that. compared to any other nut like not almonds, not even walnuts. I mean maybe it doesn't eat enough walnuts. But like eats it down with a bowl of peanuts. You know, like salted roasted peanuts. Those we would have to Bolus for sometimes chocolate bars. Again, it depends on how much fat is in them. Do they have things like cocoa butter or coconut oil in the ingredient list will make them kind of perk up? Um, oh, all the meats. pepperoni sticks. You know, if you have like a footlong pepperoni stick, they could have 1418 grams of fat in a single stick. Bacon. Yeah, big Tam. Like if we have ham for supper, probably that will have to be Bolus for and on the idea of pepperoni sticks to like if you can get turkey pepperoni. It's much lower fat. So sometimes we'll do that instead. sausages. Yep. sausages. Absolutely. Yeah, they have probably like the lighter turkey ones even have like three grams of fat per like regular breakfast sausage.

Scott Benner 29:14
Do you know what I do that? doesn't know. I keep Turkey and regular bacon in the house. And if she has pancakes or French toast, I put the turkey bacon with it. And if she has eggs, I put the regular bacon with it. And I don't I don't know that I tell her that I do that. And they're actually now Well, she she won't listen to us. Don't worry, we're good. Yeah, so there are times when she'll specifically say I want to have french toast with regular bacon and I'll go Okay, then Bolus now. And you know, and I don't she doesn't see the difference. And I'll tell she'll be on the show one day and I'll tell her little stuff like that. So she knows but yeah, that that's just the kind of stuff that I think is intuitive for you a person who paid so much attention to this or to me, somebody who talks about it so much that I hard for me to forget Got it even, you know, but for most people, most people are not going to think, oh, there's a higher carb value here with some more fat. I won't pair it with the same fat as I, you know, I just think that's, it's a bridge too far, especially when you're first diagnosed. And in your mind, you're thinking bacon, no carbs. Good. Right. You know, I'm sorry, I keep cutting you off. But you're doing terrific. No, no, that's, that's great. Good. Good. Yeah.

Unknown Speaker 30:26
So what were we talking about? Well, listen, I want to,

Unknown Speaker 30:29
I want to tell you to do about all that. Right, before we

Scott Benner 30:32
get back to the calculation, you're gonna have to thank Michelle in your own mind here, or at least by visiting your website cuz she's got lists in front of her. And I have never sat down and made this podcast without anything written down in front of me ever. She's trying very hard. And I am just over here going like,

Michelle 30:45
Scott, you got to be systematic. That's why this process works for me,

Scott Benner 30:51
I win. That's why I love you being here. Because there are, listen, I think there are a fair amount of people who pick up what I'm putting down, like they used to say, in the 80s. But I think there are also people who hear it, and whose brains work like yours. And they're like, you got to tell me a number or something, you know, and I just don't, I don't know how to do it. I am literally a person who looked at a plate two nights ago, it had chicken and carrots and rice on it. And I looked at it, and nothing was measured. And I just looked at it. And I was like chicken 10 carrots, I don't know, 10 rice looks like 40 do 65 carbs. I literally counted the 60 and then said 65, which even made me wonder why I counted? Like why did I just like, wasn't it just look at and go

Unknown Speaker 31:41
process to get there? Sure.

Scott Benner 31:42
A weird thing. And, and that that's a you know, I do believe that most people can, with most meals get to it. But there's some of these things that we're talking about today that are just, they're just too much, you know,

Michelle 31:56
and just on that idea of looking at a plate, like I think we've had to teach yourself systematically over the last 12 years how to do what you do intuitively. So what I would do is I would measure that whatever pile of strawberries or that, you know, mashed potatoes, or whatever it was French fries, I would I would guesstimate what I thought how many carbs were in it. And then I would measure it and see how far off I was. And then from there, if you do that enough times, now you can start looking at a handful of cantaloupe. You know, a handful of potato chips, you can start looking at that and going, Oh, this is what I think. But I had to get there through very systematic like teaching myself, this is how far off you are right? Next time, guess a little higher, gets a little lower. So I had to get there very systematically, and you do it very intuitively, which I admire. But I would never be able to do with that kind of pull a number out of your bum approach.

Scott Benner 32:54
I imagine that that's my skill. If I put that on my CV, I'd never get a job.

Unknown Speaker 32:59
skill.

Scott Benner 33:00
You were able to figure it out in a way that's quantifiable Trust me, I don't mean, quantify it is to tell people stories about potato chips. get something out of it. Alright, so this.

Michelle 33:12
So just to point out, I didn't figure out how to make it quantifiable. I took a program that already exists. And I applied it to our family. And it worked. Well

Scott Benner 33:20
see that was a huge, you're very, you're very kind to give attribution where it's deserved. And I didn't mean that you've made it up out of thin air. I know. But you still went and found it and put it into practice. Like you could have showed me that at a certain time and Arden's diabetes, and I would have been like I can't read that. That would have been like the end, I've

Michelle 33:37
been told I can complicate things a little bit. Yes, it's my nature to go into it in deep, deep detail. And this is an aside all of the information on the website. So it's it's less of a blog and more like collecting information repository and only because what you do very easily sharing your personal experience does not come as easily to me, I'm much more comfortable sharing the information than I am sharing my life, which is why I kind of have a love hate relationship with social media. But there's a whole other topic for a whole other day. But what we've done on watching the dragon is set things up as beginner, intermediate and advanced articles. And this one is solidly in the advanced. It's like not for the faint of heart because it does look intimidating. But if you follow it through, follow the example through it makes sense.

Scott Benner 34:29
Well, let me tell you that anybody who's made it 34 minutes into this wants it so go ahead and give it to them.

Michelle 34:36
No Holds Barred. Let me tell you what to do that.

Scott Benner 34:48
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Look, if you're the kind of person that's here learning about how to Bolus for fat in your food, then your data is important to you. And that data begins with your blood glucose meter. Are you using a good one? is it accurate? Is it reliable? How do you know you just take the one the doctor gave you or buy the cheapest one at the pharmacy, maybe you should check into the Contour. Next One blood glucose meter. This is the meter that my daughter Arden uses, it is absolutely the most accurate and fundamentally easy to use blood glucose meter that she has ever had. You can find out more about it at Contour Next One forward slash juice box. The Contour Next One blood glucose meter has Second Chance test strips meaning you can touch some blood not get quite enough, go back and get a little more without changing the accuracy of the test or wasting a test trip might not seem like a big deal. But till I get 3am it will be is the light on your meter nice and bright. The one on the Contour. Next One is now allow you to see in low light situations. And the screen is simple and easy to use. And if you'd like you can connect the meter to your phone, they have an app, it'll Connect by Bluetooth. And you can share your data back to your phone and make better sense of it later if you want. But if you don't want to use that app, you don't have to, you can just use the meter, it's absolutely up to you. Go to Contour Next one.com forward slash juicebox. To learn more about the meter, and all the products that you'll find on the site. You know it's possible you'll even be eligible for a free meter. It's possible that the meter and the test trips will be cheaper cash out of your pocket than through your insurance company for other meters. This stuff is mind boggling. My mind is boggled. Before I get you back to Michelle and she talks in depth about how she Bolus is for fat. I'd like to remind you to support the T one D exchange, please go to T one d exchange.org. forward slash juicebox. Take a few minutes to answer some simple questions and make the lives of people living with Type One Diabetes better. If you are a type one who lives in the United States, or the caregiver of a type one who lives in the United States, this is for you. It is super simple to do, you can do it right there and your phone or your laptop. Again, it only takes a few minutes. It's 100%. HIPAA compliant, is 1,000% anonymous. And the answers you give go a long way towards helping people live better with type one. That's all you need to do. When you do that. You're helping those people. And you're supporting the show. T one d exchange.org. forward slash juicebox. Please take a couple of minutes. Alright, you ready for Michelle, she's got a whole system here. She's gonna tell you all about it.

Michelle 38:20
Basically, you start with figuring out how many grams of fat and how many grams of protein are in whatever you were about to eat. So you know, for your, for your cheeseburger, and fries. example, you could go to the company website and see what do they say is the amount of protein and fat in that meal, you could put something at home on a nutrition scale, you could look at the nutritional panel of the packaged food. You could look in a food database, like calorie King has a book or there are all kinds of apps that do it fig we and calorie King and our ones escaping me track three. Anyway, any of these ways. It will tell you the grams of protein and the grams of fat. You add those together. And then you can convert that into units of energy, which is just kilocalories I don't fully understand this except that I know that they've given me a formula, which is to convert the grams of protein into kilocalories I multiply by four. Why I have no idea. Maybe Jenny, as a dietitian has a better idea. I don't know I just take it on faith. To convert the amount of fat into kilocalories you multiply by nine. So let's say the example that I've given on the website is for an ice cream bar covered in chocolate with nuts, real ice cream, as we talked about, it's a Klondike bar, you know, ice cream chocolate covered. So on the nutritional panel, it says there's three grams of protein and 14 grams of fat. So I multiply the three grams and 14 by four, the 14 grams of fat by nine and I Come up with the total kilocalories, which I've got here is 130 830 for

Scott Benner 40:10
the fat, so that's 14 times no

Michelle 40:12
138, for both. So it is 12 kilocalories of protein, and 126 kilo calories from fat. Again, those are just units of energy. Okay? Just think about how much energy your body can take from that. So then you add those two together, you come up with that 138. From there, you calculate the fat protein units, which is just dividing by 100. Again, why I don't know gotcha, the Warsaw school people, no dieticians? No, I just do what they tell me to do. This gives me fat protein units. The reason that this is relevant or why that number is important is because it tells you how long to extend your Bolus. Okay, so they have a handy little chart, that just tells you, if you come up with one fat team protein unit, you extend your Bolus over three hours. If you have four fat teen protein, you fat protein units, you extend your Bolus over eight hours. So they just got this chart that's got 123 and four fat to protein units. I just looked at the chart. And that's what my extended Bolus is. So then we go, we got fat protein units, but how do we figure out how much extra insulin we need? What is the size of this Bolus that we are going to extend. And what they say to do is to multiply by 10, and divide by your insulin to carb ratio for that time of the day. I often don't remember what it is. So for max, like his insulin carb ratios vary from 5.2 to like, 7.5, I just picked six. Because I mean, it's sort of like I'd like to be very precise, because there's so many variables of diabetes that I like to make as many of them a constant as I can, so that there's less variability overall and less, you know, mass in the system. But by just picking six, I sort of acknowledge that there is variability in this, that even if I'm absolutely precise, there's still a different day, it's a different food, it's a different, you know, he's eating different things with the meal, right? So I just picked six, because it can be complicated, and that works for him. But like, when I look back at this example, I was using 15. So when he was younger, his insulin to carb ratio was one to 50. That's a very different thing when he was six than it is now that he's 13. Sure. So that's where the insulin carb ratio does matter on an individual basis, but whether or not you call it six, or 6.5, or seven, probably doesn't change things,

Scott Benner 42:43
a heck of a lot closer than the way it was going to go down

Michelle 42:47
the gas. Right, right. Absolutely. So if you do that, you come up with a number of units. So in this case, if I took that 138, and I divided it, or multiplied it by 10, and divided it by his IC ratio, which for this example was 15, then I come up with point nine units of insulin. So I would have given him point nine units of insulin extended over three hours, 01 100, nothing up front, everything extended over those three hours for the Klondike candy bar when he was six years old.

Scott Benner 43:22
And that was that the entire Bolus or is the point nine, the extra on top, just the extra for fat, right. So

Michelle 43:30
whatever the carb amount was in the candy bar, I would have Bolus up front and Pre-Bolus. Again, depending on the amount of fat, you may not Pre-Bolus. But this doesn't have a huge amount of fat. This only had 14 grams of fat. Gotcha. So all the carbs up front with a Pre-Bolus as you normally would. And then after he's eaten, and sometimes a couple hours after he's eaten. That's when extendible is comes in. So now when it becomes a couple hours after is if there's a huge amount of fat, then even setting this extendible is right after he eats means he will go first.

Scott Benner 44:07
Yeah. So you have to understand then, when that second wave arrives MB just appropriately ahead of it with a Pre-Bolus. So your Pre-Bolus second wave, but using a number that you can rock solidly believe is going to handle the impact of it. Because you use the formula,

Michelle 44:27
because I use the formula, and I did some experimentation, right? So let me take this one step further and say and maybe I should have said this earlier, for anybody who's not listening to the whole thing. When they use the warsop program, they get a really high incidence of lows. So if you use it as I just described it, your chance of going low is what I think and what many people in Canada think is unacceptably high. This is not best practice according to the clinical practice guidelines. And that's one of the reasons why

Scott Benner 44:56
what's been known as it. Yeah, so I I'm sorry. I find that when I talk to people, one of the most fascinating things is the word low and high is not quantifiable between people. So we if you said, If you said to me, this will make you low.

Michelle 45:12
Yeah, I would be saying under 3.9 millimoles per liter, or I think for you guys, I've got my chart here somewhere. That's 70. Right? So under 3.9, or 70 milligrams per deciliter. Okay.

Scott Benner 45:26
And so for me, if you see if you were talking to me, you said, Oh, no, this is gonna make Arden low. I'd think oh, like under 60. You know, which would

Unknown Speaker 45:35
it could it absolutely can.

Scott Benner 45:36
And it could, it's just, it's, it's tough to just say, it's this, the one thing I've learned from doing the podcast is that people's idea of high and low are different, like when I say absolutely got art and got really high after a meal, I mean, 180 to 200. And when other people say it, they're like, my graph is just flat across the top. I don't know how far over 400 I am. So we can't

Unknown Speaker 45:57
tops out at 22.2. You

Scott Benner 46:00
can't have an equal conversation when you think high means 400. And I think high means 180. Sure, right. So I just always like to make sure that we're talking about that way. So I'm going to go back over this because I am not the target audience for this. And I think I understand what you just told me. So this kind of exciting for me as a person who could not be time. You don't realize how bad I was at school. So

Michelle 46:23
you see you take this hasn't hurt you one little bit. How's it I don't

Scott Benner 46:26
know, my wife mocks me openly about it sometimes. So I read in that, in that vein, perhaps. So you have this example here of a an ice cream bar that has three grams of protein and 14 grams of fat. It also has 27 carbs. So you would have taken this ice cream bar, you would have known from experience. I don't know it needs a 10 minute Pre-Bolus not too much for your son, whatever. 27 carbs was in his insulin to carb ratio, you put that insulin in, he eats the bar. But then you take this information three grams of protein, you multiply the protein by four you come up with 12k cows, which are our total k cow from fat and protein. What is k cow stands for? Why don't I remember?

Michelle 47:13
It's a unit of energy kilocalories kilocalories.

Scott Benner 47:15
Okay. So you come up with 12. Then you take the fat from the bar, which was 14, and you multiply that by nine 126. You combine these together, you get 138. You take that 138? You divide it by 100. Is that right?

Michelle 47:31
Yeah. Okay, that gives you fat protein units.

Scott Benner 47:33
So then you came up with 1.38 fat protein units, is that correct?

Unknown Speaker 47:38
Yep. Totally.

Scott Benner 47:40
You just rounded it to one. Because the chart only really works because

Michelle 47:44
the chart says 123 or four right?

Scott Benner 47:46
And one fatty one fat protein unit indicates a three hour extended Bolus two indicates a four hour three indicates a five hour four indicates an eight hour. Yeah, so So you came up with using his ratio. Now this is the part where I got a little behind. So you took the 1.38 times 10? Because that was his ratio. Is that right?

Michelle 48:09
Nope, because there are 10 fat protein units. So fat, protein, fat and protein get converted to a certain amount like glucose, okay, so one fat protein unit is converted in your body, about the same as 10 grams of carbs would be?

Unknown Speaker 48:30
Okay.

Michelle 48:31
So if you didn't eat any carbs, and you ate one fat protein unit, that would be like eating 10 grams of carbs.

Scott Benner 48:39
Okay? This is the moment where I'm going to say this out loud. And take advantage of the of how popular the podcast is. The person who made the conversion calculator for the website, if you're listening to this, and you think you can program this into an app for online, please comment. Yes, yes, yes. Okay. And that'd be awesome. Then you would you would get that code for your website if you wanted it.

Unknown Speaker 49:03
Oh, thank you.

Scott Benner 49:04
So, okay, so then you you do this, this last bit here. And you can you came up with, it's going to be point nine because you round it again, because you came up with point nine, two, you round it at the point nine because that's how the pump would do it pump

Michelle 49:18
1.929 you

Scott Benner 49:20
extended that over three hours. Now in this specific scenario. How long after the ice creams consumed? Did you end up putting this in

Michelle 49:29
one hour? Okay, we started the extend Bolus at one hour after he started eating.

Scott Benner 49:33
So is that an indication to you that that ice cream cone has about a four hour life in his body?

Unknown Speaker 49:39
Yeah, I guess so. Yeah. All right.

Unknown Speaker 49:41
Well, plus the

Michelle 49:42
longer because at the end of your extended Bolus, that insulin is going to last for another three hours. It's gonna

Scott Benner 49:49
hell as well.

Michelle 49:51
And I've heard Jenny talk about how fat can affect you for you know, she said eight or 10 hours. We have at times of found that Max is still resistant. The next morning, like we're talking 1215, even 18 hours later, they'll be there. Right? It depends on how much right not the content and other things like how activity how insulin sensitive is he right now? Or has he been, you know, as he had a long weekend and sitting around in video games all weekend? Yeah, in which case, all of this compounds,

Scott Benner 50:24
hey, let me tell you a fun story while we let this sink into people's heads before we move forward. All right, two hours ago,

Michelle 50:30
there is an easier way to do this to let me

Unknown Speaker 50:32
say, we're gonna get to that

Unknown Speaker 50:33
I take the whole thing and make it easier we're

Scott Benner 50:35
gonna do with your funny story. Michelle, listen, you get a tease it out. I want people listening through the whole thing. All right, my listen through rate is important to ad sales, just so you all know.

Unknown Speaker 50:46
So listen to the end, I go

Scott Benner 50:48
pick up artists contact lenses today, there they we placed an order and they had to be picked up. And they get there. And I'm in a in an office that. I mean, I've been taking my kids to for so many years. There's a lovely woman at the front, who's been there for forever. And we're standing around talking, and I said to the person that was helping me, Hey, I gotta go, I have to go record a podcast. And he said, What's it about? And I said, oh, we're going to talk about how fat and protein impact blood sugars kind of more long term than people that who use insulin, but you know, probably think they do. And the woman behind the counter goes, I have diabetes. I've literally known her for a decade. I had no idea she was I struggle with this all the time. She goes, What are you doing? And I started explaining to her, she's like, how do I find this podcast? And she's like writing it down and showing me her phone and asking where podcast apps are and stuff like that. And I walked out and I just thought like, how did I not know? But there she was she had a Medtronic pump on her belt. She keeps it covered with their shirts weren't a sensor, nobody can see it. And, and there, she was just like a while she said this topic vexes me. Just it just controls my life. And she's like, even if I just need a piece of chicken, I'm down to just trying to eat a piece of chicken. And two hours later, my blood sugar tries to go up 40 points. And I said, Well, yes, your body can take that protein from that chicken and it converts it and stores it as glucose and then impacts your blood sugar. And she's like, I have no idea. I've had diabetes for decades. And I was like, No, okay,

Unknown Speaker 52:24
I said so. Okay, common. Yeah, just

Scott Benner 52:26
it was crazy. I mean, very, like, if I told you, I just thought to myself, hey, I have a little extra time here. I can make it to the store and back again to pick up Arden's contacts, like I just tried to squeeze and

Michelle 52:36
you were supposed to be there because she's supposed to hear your podcast. So

Scott Benner 52:39
lovely. Like I had a very nice feeling about the whole thing. Okay, so we just went through something, which let's be honest, is not that convoluted. But it's more than it must be out. It's Yeah, yeah. Right. So you're telling me there's a simpler way I could have gone through this. What would that have been?

Michelle 52:55
Well, first of all, as I said, we don't Bolus for protein. And there's a couple of reasons for that. Number one, because we found when we first started using this formula, including protein max always went low. And one of the things about protein is that it really only affects your blood sugar in a significant way. If you're not eating carbs, and we're pretty karbi family, I mean, I don't I think there are very few times when Max, like he wouldn't sit down and have like a steak in a salad. He wouldn't eat a burger without the bun. I would do those things. I have celiac disease. So, you know, I tend to be I would eat more just protein alone, but he wouldn't. So in a way because carbs are the body's preferred fuel source. If he's got carbs in there, then it's just going to use the carbs for fuel, okay, and the protein isn't going to have the same effect as if he had protein without carbs. Okay. So like think, you know, steak and a baked potato. You probably don't have to Bolus for the steak, although it sounds like you do and it works. So maybe there's something I'm just missing there. But salad will be good. Yeah, I

Scott Benner 54:08
don't do a ton, like red meat. I did a little bit you know, and if it's if it's more lean, I do a little less. I just, I just throw five I'm always throwing five like because you know what kids will put like a little dip in a bowl like honey mustard or something like that. People like how much is it? I'm I don't know, five more. Everything's always five more because isn't it interesting? I think for everybody who's listening, think how specific you are with your insulin. Oh, this is 43 carbs. And it's gonna be 14.8 units or something like whatever you end up doing preaching to

Unknown Speaker 54:41
the choir.

Scott Benner 54:46
And you're more frequently never right to weak, then you are too heavy.

Unknown Speaker 54:53
Absolutely. I get

Michelle 54:54
because everybody, you're speaking my language. We laugh because if we go out to a restaurant, and there's No carbon permission, you're like at a mom and pop place. So there's no you know, Boston Pizza website to go to or whatever, you're just, you're there and the food's there and you have no choice but to pull a number out and just go blind, this many carbs. And it's funny when we do that, quite often his blood sugar is much better than when we systematically counted. Now, that being said, we still systematically counted because I think if I did that, all the time, it would miss necessarily work out in our favor. Yeah, there'd be

Scott Benner 55:35
where you'd be in the parking lot going, well, Max can't stand. No, I think I'll tell you a measurement I use very privately in my own head when you're out in a restaurant. If it's a chain, it's more, because I always think there's more just stuff in it. It's not food, and the better it tastes. There's more because the better it tastes always, to me means food and means fat and salt. Absolutely. Right. So the better it tastes, the you know, the more it hits your pleasure center and makes you go I don't care about anything else in the world, the more you feel like that, the more insulin it's gonna take

Michelle 56:13
five units of insulin. Yeah, exactly. So

Scott Benner 56:18
I just it, it became, like, evident as Arden got older. And now I'll tell you, you know, now that she's a full blown lady. That's a whole other aspect of it. There's a you know, there's some foods that hit her differently now that she's mature than they did when she was a kid. And I don't even know if that's if I'm right or wrong about that. It's just, it's what it is. And there's some foods lately, there's a simple one, she likes these little baked Ritz crackers, right, so, so not the regular round Ritz crackers that everybody thinks of in the in the sleeve, those those we Bolus pretty easily carb for carb. But these ones that come in a bag that are like rich chips or something like that, I just take whatever the carbs are and add half if it's 20. It's 30. If it's 30, it's, you know, it's it's 15. More on top of that. And these things, just hitter? I don't know what's in them, but it ain't good. You know, they mean,

Unknown Speaker 57:14
have you looked at the label? Well, no,

Unknown Speaker 57:16
that would take a lot more effort. I just figured out how much insulin

Michelle 57:19
I'm just curious about how much fat and maybe even protein is in there, I'm gonna look but or if it's a glycemic index thing, like if they you know, if they digest super slowly, then something

Scott Benner 57:30
hit her like a truck. And then the truck stays parked on top of her for a while. Yeah, it doesn't pull off and go, I'm sorry, it just stays there. And the reason I don't look too deeply into it. And this might be helpful for people to with younger children, is because she will cycle through these. Like, I don't know if other people's kids do that to

Unknown Speaker 57:49
be gone a month from now. So it would be a moment where she'll sound go, Hey,

Scott Benner 57:53
did you want some of these crackers that you love? And she's like, I hate those. I'm done with those and then she'll never eat them again the rest of her life.

Michelle 57:57
Yeah. And you go donate those six boxes that you just got on sale. Yeah, yeah,

Scott Benner 58:01
like here. So crush your blood sugar. Congratulations. They're free now. But yeah, but no, seriously, it's um, she doesn't do the same thing for like, She's on a grape kick. Right now. I have four pounds of grapes and four pounds of grapes in my refrigerator right now. Cuz she just two weeks ago said, Hey, everybody, I'm doing grapes now. Like, there are things so let's say stock then I was like, okay, so

Unknown Speaker 58:24
no worse things. Yeah.

Scott Benner 58:26
Right. So I'm like, okay, whatever, and then they'll be gone. Like, you know, I'll try to give her grapes three months from now. She's like, Oh, I don't need grapes. What am I gonna do? Anyway, I'm sorry. So, okay. There's an easier way to do this.

Michelle 58:41
Right? Okay. So what we do is we first of all, like I said, we don't include the protein. So what it comes down to for us is that we just take the grams of fat, we multiply at 5.09, which is the time sign and divided by 100, all in one step. And then I might multiply by nine or 10.

Unknown Speaker 59:07
So that's what's the multiplication for?

Michelle 59:09
That's the 110 grams of carbs, for one gram, one fat protein unit. Okay? So we, because he's still sometimes goes low, if we use this with the 10. If he's in a good place, and things are, you know, he's insulin sensitive, and all that's going well, then I will reduce that number. So when he was younger, I might reduce it all the way to eight. And so that's another way to make it more conservative, reduce that risk of bottoming out.

Scott Benner 59:40
Gotcha. Well, I like to ask you to go through it again in a second. But I like the way you just said if he's insulin sensitive, and you didn't mean that in a bad way you meant if the insolence working the way I expect it to work in this moment. So I'm going to get a reaction that I expect and by expect, I mean, ratios. Basal rates are all Doing what we expect them to do.

Michelle 1:00:02
Absolutely. Right. Okay. And as an aside on that, like, I'll notice that they have a long weekend. Like they just had a five day long weekend from schools, teachers convention and things by the fifth day, because he hasn't been walking back and forth to school. He hasn't had gym class. He's been spending more time on the computer or hanging around with us watching movies, that kind of stuff by the fifth day, but probably the third day, really. I know that we need to crank things up a bit. Yeah. And if I forget that, then it comes back to tell me we need to crank things up a bit.

Scott Benner 1:00:33
being sedentary to me hits exactly like an old and full set. You know what I mean? Yeah, you know, when you're the last part of your infusion set, and it's starting to get like, suddenly it's like, this should be a unit but it's two units. And and, you know, it almost feels like it almost can feel like a leaky sight. It's almost like everything I'm putting in there. It's not getting in there is it like but it's it's wrong. Yeah. But instead, it's everything I'm putting in there. It's not having the impact that it should because right sitting around for a week or etc. I right? I'm glad people cuz all of us, this is good.

Michelle 1:01:05
So on those days, I will absolutely lose us 10. So using 10 would be more aggressive because you're multiplying it by more. Okay, so going through eight would be more conservative.

Scott Benner 1:01:16
Do it. Do it with me one more time. So let's just put 10 grams of fat in this imaginary thing we're eating? Yep. How do you do it?

Michelle 1:01:24
10 grams times point oh nine.

Unknown Speaker 1:01:27
Okay. Should I

Michelle 1:01:29
times 10. Okay, divided by the IC ratio, which for him right now is six. We just use six across the board.

Scott Benner 1:01:39
So in 10 times point oh nine times 10 divided by the insulin to carb ratio. Yep, that's it. Okay.

Michelle 1:01:48
So you'd end up coming up with what nine divided by six?

Scott Benner 1:01:52
Did I miss something on the second? Let's just do this the easy way, shall we? 10 divided by 10 times point oh nine.

Unknown Speaker 1:02:02
Oh, hold on. It's zero.

Scott Benner 1:02:07
10 times point oh, nine times 10 divided by four. It's 2.25 2.25. That would be ardens. Because our insulin to carb ratio is like four, four. So if there were 10 grams of fat in this thing that Arden ate, I would take 2.25 units and extended over three hours.

Michelle 1:02:29
Um, what did we come up with the fat protein, we have to pause at the grams of carbs times point oh nine because that tells us our fat protein units.

Scott Benner 1:02:39
My stupid idea. So that's

Michelle 1:02:40
so that's point nine. So just under one. So yes, it would be three hours. Yeah.

Scott Benner 1:02:45
So now

Michelle 1:02:46
and I should point out that we never actually would do this for 10 grams of fat. That wouldn't be enough fat for us to bother. Right. But I think for for example, purposes, screenings, round numbers

Scott Benner 1:02:55
for round numbers and simplicity, which is clear. But so that's a good point, though, because and why is that a good point? Let me Google something for a second. When I say five guys, five guys fries, fat.

Michelle 1:03:12
While you're googling that, I just want to point out that they go to a local mall to do Pokemon GO TO Pokemon 90. And they always stop for lunch. This is my husband and Max. And n W is the usual meal on that day. And it has 64 grams of fat for a cheeseburger, fries, and a pop

Scott Benner 1:03:33
Listen to this. This is from the Food Network. A large french fry has an unbelievable 1300 calories, 57 grams of fat, 1300 milligrams of sodium. So you're gonna get crushed if you eat if you eat this, because not only all of this, but the sodium is going to dehydrate you which also slows the insulin we're

Michelle 1:03:53
never even take that into account. polling numbers that on my phone like she's got

Scott Benner 1:04:01
a taste good more. So so there's a good example 57 grams of fat in just those fries yesterday. So leave the milkshake out of it leave everything else out of it when I'm telling you she used you know, just multiple 10s of units of insulin more it really isn't that crazy because in this scenario here, if we just round this to 60 right, hold on a second. If we just round this to 60 grams of fat for Arden for the french fries yesterday and I do 60 times point oh nine

Unknown Speaker 1:04:36
I get five minutes right?

Scott Benner 1:04:38
times 1054 divided by her insulin to carb ratio is four. She needed 13 and a half units more insulin for the fat in those french fries than the carbs in those french fries indicated and think about how many carbs are in the french fries. So Hold on a second, and five guys, large fries, carbs. Okay, there are 72 carbs. So So we've just decided Arden needed 13 and a half units of insulin for the fat in five guys fries. Now let's look at it as carbs 72 divided by 418. So while everybody's wondering why their blood sugar gets high, and they don't understand why it takes so long to come down, Arden needed 31 and a half units of insulin just for the french fries. But it had to be stretched out over the impact of the carbs because of how the oil is holding it up, which we've talked about a million times this podcast and anybody's listened to the pro tip series knows, the food goes in, it starts digesting, you're leaching out carbs, the more fat is in your stomach, the slower the digestion goes, the longer it takes, the longer you're slowly just basically infiltrating your blood with cart with sugar. So that really is telling honestly.

Michelle 1:06:09
And with that amount of fat, like I said, for the Klondike ice cream bar, we would start the extended bowls one hour after and by the way, we just say, Alexa, she's gonna listen to me. Now, we would just say Alexa set a one hour fat Bolus timer, which usually results in hilarity because she often says by balls timer. But anyway, all that aside, we just set a reminder,

Unknown Speaker 1:06:33
right?

Michelle 1:06:34
So that we actually do that an hour later, if he had this much fat. If I did that, an hour later, he would bottom out first, okay, because the food would take that much longer to reach his bloodstream and the ease in the car beat.

Scott Benner 1:06:50
Yes. And the easiest explanation for that, for most people is pizza, who you know, you look at pizza and you go, this is 30 carbs a slice, you put it all in, and 45 minutes later, your blood sugar's 40. And you're like, I don't know what to do. And you drink a juice, and that doesn't work and you drink another one, and then all of a sudden, the fat and protein hits you and the juice hits your 400. And you don't know what to do.

Michelle 1:07:10
Right? Right. And that wasn't a problem with the amount of insulin you took. It was a timing issue, timing that the insulin got in before the food did.

Scott Benner 1:07:18
I was talking to somebody today. And I said to them, in the end, all the things that we just talked about here, all we really said was right amount of insulin at the right time. It's all timing and amount. It's always it's always timing and amount.

Michelle 1:07:30
And fat messes with that in a big way. Because it's not just that you get that high, it's that it takes so much longer for it to digest that you can go low in the first place. Okay, or like you've said, on other podcasts, you've got this beautiful number and you think I nailed that. And then four hours later, you know, you're through the roof. And that's why, because you might have nailed the first two hours of it, but not the next eight. All right, Michelle, there's one

Scott Benner 1:07:57
thing I was I'm still lightly confused by. So it's the idea of one fpu, two, three, when we did it in the short version, we just said 60 times point or nine times 10 divided by insulin to carb ratio. Yeah, how what what would? How would I know if it should be over four hours or five? What number would change in that

Michelle 1:08:21
we stopped, we stopped at the 60 times point or nine. So that's the fat protein units. And that was 5.4. So for five units. Now here's here's the other thing that we run up against with 60 grams of fat. The chart only goes up to four protein units. Okay. So beyond that, I take the Scott Benner approach, and I just guess more. So for five units, I might say 10 hours because for fat protein units would be eight hours. So for five fat teen protein units, I might go 10 hours or maybe 12.

Scott Benner 1:08:52
Okay. I okay. So my confusion was, is that our original number that we started with? cabasse in the three hour range?

Unknown Speaker 1:09:01
Right, right. Okay, right,

Scott Benner 1:09:02
because we were only at 60. If we would have gotten two. Is there. Is there a cheat in there? Is there a number of FP us that makes it to like in your mind? I know you don't think of it this way, but pretend you were me for a second. And

Unknown Speaker 1:09:15
sometimes I do.

Scott Benner 1:09:16
Yeah. Yeah. So like, How many? How many? How many k Cal's would tell you, okay, this is going to be four hours. Do you have that number in your head? Um,

Michelle 1:09:30
nobody can reverse engineer it, like four hours would be to fat protein units.

Scott Benner 1:09:38
Yep.

Michelle 1:09:40
So then to fat protein units would be 18 grams of fat. Okay. So if you were looking at somewhere around 2020 grams of fat, you might say, yeah, let's extend that four hours. Okay, you can totally just do that shortcut. The other thing is insulin is insulin. So once you know that, you're looking at a four hour x Bolus, you can do a Temp Basal, that will equate to the whole thing,

Unknown Speaker 1:10:04
do the same thing I would normally do that,

Michelle 1:10:06
you know, it's a pump doesn't care if you do an extended Bolus or Temp Basal, it's the same thing. It just draws it out. Yeah, it's whatever makes sense to you in your head and whatever you can,

Scott Benner 1:10:16
you know, work with. So with 64, the French fries, that actually puts us up into the more like the five, six hour range, right?

Michelle 1:10:23
Yeah, when Max has a n w, and he's 64 grams of fat, we extend it over 12

Scott Benner 1:10:29
hours, 12 hours,

Michelle 1:10:30
which I believe is the upper limit of his current.

Scott Benner 1:10:34
And when you're doing that with a small person, what you're really telling the pump is I need extra basil for the next 12 hours because it is a small, it's a smaller amount of insulin once you break it up over 12 hours. Yeah. Okay, well, that's when

Michelle 1:10:48
you could convert that into Temp Basal. I guess my problem with that is like, he's still growing. So when he goes to bed, he's got growth hormone, and his basil rates almost double. So for me to go, Okay, how much of this would it you know, to tell it a Temp Basal, I would have to sort of figure out okay, well, between the hours of 11pm and 2am, his Temp Basal would be double. Yeah, but earlier in the evening, it's not gonna be like, it's a lie. Just go extended Bolus, yeah, just give me give me whatever, an extra five units over 12 hours.

Scott Benner 1:11:20
Yeah, Michel, the way if you if I'm sorry, if you've heard me say this, you have to suffer through it for a second. But I just think of, I've found a number of different ways to think about it over the time, there's an impact range that the food has, you know, from the minute that goes in till it's done, and I try to cover that range. With a heavier blanket of insulin. Sometimes I think of it that way. Sometimes I just think, you know, just basically like, Oh, it's going to be cold overnight, I need an extra quill. And so you know, my blood sugar is going to try to go up between here and here. Because I've eaten something with fat in it, I'll just lay something heavier in the form of basil overtop of it to hold it down. I've described as carpet bombing, before, you know, just picking the picking the range where the food is, and just try to decimate it, you don't I mean, just stay on top of it. There's all different ways to it. I mean, however, people can picture it in their minds. The idea here is that this fat is going to force your blood sugar up over, over hours, and the amount of hours is going to depend on how much fat it is and all kinds of other stuff. And And still, what we're talking about. While this while this method doesn't work for the idea still existed for some of you, protein will cause a rise a number of hours later, too. And if you can learn that you can count on that that a chicken breast with my meal is going to mean the two hours after I eat my blood sugar is going to try to go up 60 points, well, then an hour after you eat the chicken breast, you could do a Temp Basal to stop that or an hour and a half after you eat the chicken breast you could Bolus for it even so

Michelle 1:12:59
my problem was always how heavy of a blanket do I need? And how long am I going to put it on? So do I need that? You know that light summer blanket? Do I need the really thick dubay? What do I need here? And and so for me using this formula told me how heavy should the blanket be? I know you can have it on all night or just through the beginning of the night or what. So for somebody like that, who is eating the chicken breast and a salad and no carbs, and therefore needs to Bolus for it, you can use the same formula. But just the same way that I leave protein out of the formula and only do fat. You can leave fat out of the protein out of the formula and only do protein.

Scott Benner 1:13:37
It's fascinating. And I do mean this in a very kind way. Like I I would imagine you could take this wrong, so don't but the people who I've seen asked me for this information, as near as I can tell through the internet, have a similar personality to yours.

Michelle 1:13:55
What a shocker. Yeah, and it's I don't take that the wrong way. Yeah,

Scott Benner 1:13:58
it's fascinating because we're, those are the people who hear me go, I don't know, put in mourn, just don't let it cause a problem. They're like,

Michelle 1:14:06
No, no, try that, Scott, because my brain doesn't work that way. When I tried that, it just failed. And I was discouraged. And I was like I cannot put in the energy that it's going to take to keep trying and experimenting and figuring it out and trying this in China. I just can't. And the other thing is you have this incredible memory. I have asked to be introduced to people that I have met before people I have had in my home at my dinner table I have asked to be introduced to and so I don't have that memory. So if I don't write it down systematically and come up with a process that works, then I'm starting over every time I sit down with that food. I'm like, I don't know what to say. We're gonna try so I

Scott Benner 1:14:51
can't take credit for memory. It just occurs to me. Like I just look at it and then the answers in my head. I don't have a process to come to it. And I can also Yeah,

Unknown Speaker 1:15:01
that's awesome,

Scott Benner 1:15:02
please, it is an odd gift to have. But I would much rather

Michelle 1:15:07
the kid you've got that's incredibly valuable show.

Scott Benner 1:15:09
What if I ran a sub for 60 and could catch him was six feet five, then I could pay someone to do this, you

Unknown Speaker 1:15:15
have a different gift.

Scott Benner 1:15:18
But but it isn't it this conversation has been in an extended way interesting for me, because I can see now that you don't think in pictures. And I think in pictures No,

Michelle 1:15:30
right? Yeah, numbers in language, right.

Scott Benner 1:15:32
And the people who I hear describe me as Oh, it's this guy. It's just really aggressive with insaan. I was like, Oh, they think in numbers. Not in pictures, right? I sound like a lunatic who's just yelling, like pour it on and see what happens. But I don't

Michelle 1:15:48
you do that based on your sense of what is appropriate? And I'm saying I don't have that sense. Yeah. So I can take this formula. And then once I know, then, I mean, you don't have to go through the formula every time. It's not like I spent all my time, you know, doing Warsaw calculations, right. Once you know, when you have that same food again, you just use the same thing. And, and I literally kept track. I said, So what was the result? Okay, he went low first. Okay, I'm gonna give maybe less upfront and extend it more on, you know, I could tweak from there. But once we've tweaked it, and we get success, well, then when we have McCain's frozen pizza, this is what we do. Yeah. Or when we go out to a and W on Pokemon GO day, this is what we do. And so I think it gets us both to the same place, but just a different path to get there. No, I

Scott Benner 1:16:39
think the last 30% of the process is the same for you. And I, I think it's the how we understood it, how we made the decision. And when we use it, that yours is more calculated. And mine's more like, that feels like five units to me. But you know,

Michelle 1:16:55
and it also puts me in a position then when I get one that I don't know, and I don't know how much fat is in that I don't know how much protein it is. I can look at and go well, it looks like an A NW meal or it looks a little closer to you know, nachos, or it looks like then I can be in the ballpark. I can say well, I have no idea on this one. But I'm gonna compare it to something I do know something we've done before. And I'm going to try this. And that gets me in the ballpark. And it makes Max's blood sugar's post meal. manageable. Yeah. So that now we can do the the bumping and nudging that you talk about rather than this, you know, runaway freight train, but

Scott Benner 1:17:32
everything is held there is nothing maybe more confusing than seeing a blood sugar that's to at putting what you think is a massive amount of insulin on it and watching it go to 260 and then bounce back to to a again. Oh, yeah. Then your brains just like fried, because you're only thinking correction factor, and not considering any of the other things that are happening. And then you're just

Michelle 1:17:54
before we started analyzing this had no idea like I might think oh yeah, it's fat. But then when you think 64 grams of fat. That is that puts my understanding on an entirely different level for me to go, Oh, that's why when one unit would normally work, and I gave him three units thinking, oh, let's watch for the low. That's why it didn't even touch his blood sugar, right? Because we're talking about this astronomical amount of fat,

Scott Benner 1:18:19
right? Because and obviously Arden's insulin, insulin to carb ratio is different than other people's but because a large french fry from five guys for Arden needs 28 or 30, like 32 units of insulin 32 units of insulin, her pump only holds 200 for three days. Right? So I can. And so anyway, this was really great. Did we not say anything that you wanted to say? Did I find a way through it all?

Michelle 1:18:51
Um, I think so. Let me just look and see. Yeah, look at

Scott Benner 1:18:54
your notes, please. Ah, usually people with notes. So check it out. Make sure we're

Michelle 1:18:59
systematic. One other thing to think about is there are times that we would have he'd say, make himself nachos for lunch. And then we have pizza for supper, or, you know, we'd go to McDonald's for separate. If this happens twice in a day. The The effect is compounded. So like if I sort of imagine that, you know, his first is nachos for lunch, there's some fat swimming around in his blood, and that's making things a little bit harder to deal with. But we covered it and things look great, but underneath the surface. Wow, he's still got that extra fat in his blood. Now we go and we pile on more fat that's going to need even more of a hit. So yeah, you're more insulin, more insulin really applies if you're eating fat more than once in a day, which doesn't happen incredibly often for us, but we've seen the effects Yeah, and I think already Oh, sorry, go.

Scott Benner 1:19:53
I was gonna say I see it with Arden during her period like when she gets like cravings, sometimes craving They match each other. So it goes, you know, I've had days that have gone from nachos to Chinese food, you know, and you're just like, well, this is gonna be like, it really does feel like, you know, like, like the greatest football team of all time. So showing up the play you and you're like, Okay, I guess we're gonna lose. Let's try not to lose by too much.

Michelle 1:20:24
And that's where you you know, when you if you'd normally do Chinese food, you go, Well, this is how many units it needs. And we need to extend it over this many hours. The day that you have Chinese food after nachos, you need to ramp that up, it'll change or at least we find that we do because the effect is is cumulative. I definitely see that too. Okay, I'm sorry, cut

Unknown Speaker 1:20:44
you off. You're gonna say something else?

Michelle 1:20:45
No, I think that that might be I think we've I think we've addressed everything that I've got here.

Scott Benner 1:20:51
Well, Jenny was right, you were the right person to talk to about this. So thank you, I have to say this

Unknown Speaker 1:20:56
pleasure. No, I

Scott Benner 1:20:57
had a good time. But let me say this because I want to mention again, it's waltzing the dragon comm or.ca. There'll be links in the show notes for you to go find it. I'm going to try to talk Michelle into the day that this goes up to like popping up in the Facebook group and chatting with people about it if she wants to. I would love to but I want to say this and I mean this genuinely. She would never say this out loud. But there are not that many places where Jenny directs people for diabetes advice.

Unknown Speaker 1:21:24
So you

Michelle 1:21:25
ruin my day because I really admire her she is a smart cookie and has great advice

Scott Benner 1:21:30
is a big deal. She's I've outed her now she's only ever told me that privately but there are very few sources that Jenny will tell somebody about so that she brought was a big deal. So I that's how I knew right away to reach out to you because if she was willing to say it out loud, then I knew it was going to be a good conversation. So thank you very, very much. This was amazing. Thank

Unknown Speaker 1:21:49
you for your time. Scott.

Scott Benner 1:21:51
Are you kidding me? You stop it this is this is all all the things go to you. A huge thank you to one of today's sponsors. Je Vogue glucagon, find out more about chivo hypo pen at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc ag o n.com. forward slash juice box. The episode was also sponsored by the Contour Next One blood glucose meter. Learn more at Contour Next one.com forward slash juicebox. There's links in the show notes and links at Juicebox Podcast comm for these and all of the sponsors.

You can support Type One Diabetes Research and the Juicebox Podcast. The T one D exchange is looking for type one adults and type one caregivers who are us residents to participate in a quick survey that can be completed in just a few minutes from your phone or your computer. After you're finished with the questions. And they're really simple questions. I did them in maybe seven or eight minutes. You'll be contacted annually just to see if there's any updates to your information and to be asked any further questions if further questions exist. This is 100% anonymous, completely HIPAA compliant and it does not require you to ever see a doctor or go to a remote site. Now every time someone completes the process using my link, T one d exchange.org. forward slash juicebox. You'll not only be benefiting people living with Type One Diabetes, but you'll be helping out the podcast. Just use my link in the bio, then click on join our registry now. And then just simply complete the survey. T one D exchange research has led to increased insurance coverage for blood glucose meter strips, changes in the American Diabetes Association's guidelines for pediatric a one c goals and even helped get Medicare coverage of CGM devices. So if you've ever wanted to help out people living with Type One Diabetes, or the podcast or maybe both, this would be a simple, quick and safe way to do all of that T one d exchange.org. forward slash juice box. Okay, now I'm on Michelle's website, waltzing the dragon, and she has examples here for you. This is very clear and easy to follow. She's got a lot of examples of what foods are high in saturated fat here. She talks specifically about the what the Warsaw approach is. And she walks you through an example number one identify how much fat and protein the food contains. And she has an example here that she used on the podcast. It's an item that has three grams of protein and 14 grams of fat. Number two, you convert into units of energy. It's k Cal from protein equals protein in grams times 4k cow grams. Now when you see that You're just like, Oh, my God, I don't know about you, my brain goes, Oh, I guess everybody's blood sugar is gonna be high because scouting and figuring this out. But if you've got the kind of brain who loves this, go look at it, because it is incredibly well I know, when I look at it, I think if my brain worked this way, I know I would appreciate how this is being shown to me. Number three, calculate the total calories. Number four, calculate the fat protein units. Number five, how long to extend the Bolus, it walks you through it very easily step by step instructions, gives you the amount of extra insulin that you need Step six. And then it talks about the end result. She says here to make a long story short, in this example, to cover fat and protein. Her son had this bar after supper, she would first give the usual Bolus for the carbs before he starts eating. Then later, she would deliver an extra 2.3 units of insulin in this example, in an extended Bolus that covered a duration of three hours. So you've heard her talk about it now for an hour we've been talking about in the podcast. If you want to see her step by step instructions, there's a link in the show notes for this episode. And there's a link at Juicebox Podcast comm for again for this episode 471. Now in the meantime, I'm going to be paying closer and closer attention to how I'm using this idea in our life. And I'm going to come up with a way to say it that doesn't involve adding, subtracting, multiplying or dividing. I'm going to come up with a way to talk to you about this. And I will be sharing it as soon as I absolutely can. You know me I'm just like there's a lot of fat in this and then I you know, I just got a lot more insulin and I stretch it out. You've heard me talk in the diabetes pro tip series. You know how I do it. If you've liked this and never heard of the diabetes pro tip series, I really think you should check it out because if you like this conversation, you'll love those conversations. The diabetes pro tip episodes begin at Episode 210. They're available at Juicebox Podcast comm in your podcast players, or if you just like to see a list of them diabetes pro tip calm. Hope you found this interesting. If you did, please share the show with someone else. And of course check out Michelle's website waltzing the dragon.ca or calm and there's of course links right there in the show notes and Juicebox Podcast comm to this exact article. I'll talk to you soon.

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#470 Diabetes Pro Tip: Weight Loss

Understanding how insulin works is the first step

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 Music - 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 friends and welcome to Episode 470 of the Juicebox Podcast. Today, we're adding to the diabetes pro tip series with an episode that has been asked for by listeners forever. And for that reason in many others, I'm very excited to give it to you today.

The diabetes pro tip series from the Juicebox Podcast began almost two years ago now, when I decided to take the tools that were being spoken about in the podcast, and condense each one into its own episode. That was my original thought anyway, the pro tip series has become so popular that it's just you know, it's like watching a baby grow up and you just kind of go like oh my God, look what they're doing it. It's become more than I expected, and it continues to grow. And today is another another link in that chain, diabetes protip weight loss with Type One Diabetes. Please remember why you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. In just a second, I'm going to tell you a little bit about Jenny, a little bit about the sponsors and where you can find those other diabetes pro tip episodes. Then we're gonna jump right in

this episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, and you may be eligible for a free 30 day trial of the Omni pod dash right now. And you can find out if that so at Omni pod.com Ford slash juice box Get started today with the Dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box. And if you're looking for those diabetes pro tip episodes, you'd like to start from the beginning, they started Episode 210 with an episode called diabetes pro tip newly diagnosed or starting over, he does a series it's made to be listened to in order. And it's of course available to you as a subscriber to the podcast. All you have to do is go back in that podcast player to Episode 210. And there it is. If you're having trouble finding the other episodes, you can look at Juicebox Podcast comm there's a tab at the top that says diabetes pro tip. If you don't want to go to all that trouble, go to diabetes pro tip.com, where you will find the pro tip episodes and the defining diabetes episodes, which I also am very fond of. In just a moment, Jenny and I are going to get started. But first I want you to know that Jenny Smith has been living with Type One Diabetes since she was a child. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitors. Jenny happens to be the bomb diggity. I love her. And in a couple of weeks, her 33rd diversity is coming up. So if you're in the private Facebook group for the podcast, please take a minute to go to the thread celebrating Jenny and leave her a little message. And I'll be passing those messages on to her on her diversity. Last thing I want to thank the listeners who sent in questions for this episode specifically, we get them about two thirds of the way into the episode. But first, Jenny and I are going to talk about ways to lose weight when you have type one diabetes. Every time I think there's nothing more to do for the protests, then somebody asks something and I think No, no, that that would work there too.

Jennifer Smith, CDE 4:01
Is the variables in life that I think will always bring in something to discuss in terms of what it could be in, in diabetes? Like management? Yeah,

Scott Benner 4:13
no, I'm really happy. I'm really happy to hear from people because I think that others perspectives can make me go Oh, yeah, wow. Just because that hasn't happened here. Doesn't mean that's not happening somewhere. And then if it gives you no good focus for what to do. So this is it. We're gonna talk about trying to lose weight, you have type one.

Jennifer Smith, CDE 4:32
As I mentioned, I think I texted back to you. I was like, this is a big topic. It's not just like five minutes of just go out and start running. I mean, it's it's kind of like a rabbit hole, honestly. I mean, there are many different like, little avenues to kind of talk about and you had a lot of really good questions that came in, or like comments about Gosh, I don't understand this or why isn't this quite right or whatever. So

Scott Benner 5:00
Yes, we actually knew three topics. So I'm gonna have very little to say here probably. And I apologize for that. I guess this is the time, the time we pretend like I just came on your zoom. And I'm like, hey, how do I help? And then you just talk. But what what's the I mean, where do you think we should start? Because to me, I think we should start at the idea that people correlate taking insulin with gaining weight. And then they don't think about calories and get that right. Go. Hi, Jenny. Oh,

Unknown Speaker 5:34
you help me please? Yes, well, maybe.

Jennifer Smith, CDE 5:39
I know, it's a good place to start in terms of like, one thing that everybody with diabetes specifically thinks about is that it's insulin. And I think a good place to even go with Why does that start is because it's often something that a practitioner will tell people, you know, using insulin, you may be likely to gain weight. I think that was one of one or a couple of like, the comments that came back about this topic, were specific to you know why I've been told that I'm going to gain weight or why, you know, why is this going to happen? or Why did I lose weight, and now I'm gaining all of this weight back like after diagnosis, right. So insulin itself, whether your body makes it or you take it with an injection or with a pump, it's a storage hormone, that's its job, it's supposed to move a certain quantity of carbs, sugar really out of your bloodstream and into places to either be used or stored, right. So in terms of management, insulin can make you gain weight. In terms of like initial diagnosis, a lot of people with type one specific have lost weight. Prior to diagnosis, maybe it was very rapid. Or maybe it was like a lingering loss that people were like, well, I could just keep eating the whole cake. And Gosh, I don't gain any weight, and I'm actually losing weight. And then they're like, wait, this is wrong, this is bad, that shouldn't be happening. So they go to the doctor, right, they get a diagnosis of diabetes, they've lost weight. And in terms of that loss, it's often relative, it's usually a relative to the fact that their blood sugars have been so high, that their body isn't storing those calories, right. So you're essentially paying them out, thus, decay, and all of those things that can come about, you know, around diagnosis time, but because you're losing all those calories, and your body's not packing them in, once you have back the piece of the puzzle that was supposed to help you use that food that you were taking in, your body's gonna start storing it.

Scott Benner 7:43
And so and so. And that is the one confusion you see from newly diagnosed people, like I don't understand, I lost all this weight, and they don't understand the function of it. So explaining the function of it, I think is great. I think boiling it down into one simple idea is that you were dying. And yeah, and your body is using itself up and not storing at the same time trying to stay alive. And then all of a sudden, everything's all right. Now, the more weight at Listen, if I'm if I'm talking about a school, here, you're stopped me. But if you've lost a lot of weight, before you get to this skinny, emaciated, those are my ribs, you probably had weight to lose to begin with, right? Because it was there to lose,

Jennifer Smith, CDE 8:22
likely and especially more as the adults who are diagnosed Yes. If you had weight to lose for whatever reason, you may have just thought, like I said, Oh, good, I'm actually able to take weight off. Now. I don't know why I'm still doing the same three mile walk every day. And now it seems to be working better. Great. But yeah, once you get to that, like, I shouldn't be able to see my lower ribs or Gosh, my face looks really sunken in when I look at old pictures. That's not what you want.

Scott Benner 8:52
And I think that, again, I this probably sounds I don't want it to sound like distasteful, but if you had weight to lose, you were probably it's likely that you were taking in calories that helps you stay at that weight. Meaning that when you start taking the insulin back in, there are calories there to be packed away to facilitate the weight gain again,

Jennifer Smith, CDE 9:14
and that's in any case, whether you could have lost weight, you know, and successfully hopefully helpful, you know, left it off. But the goal was starting insulin is in general to maintain a healthy weight then right to get Yes, you will come back from the weight loss, but you should also with the proper insulin dosing, you should be able to get back to a stable healthy weight. You know, if you lost 40 pounds when you were diagnosed and Hey 20 of that you could have definitely lost and the other 20 you really didn't need to great, we should gain back maybe 15 to 20 pounds and then we don't need the other

Scott Benner 9:56
what is the functionality of the proper insulin dosing It makes you gain too much or not enough

Jennifer Smith, CDE 10:03
in terms of insulin dosing, that's correct. The amount of food you put in to work with it, of course, is a piece of the puzzle there. But if your insulin is being balanced along with your use of the energy that it's working with, then you should be able to gain energy back to your body that gets stored, that keeps you at a healthy weight, and you shouldn't then continue to gain if the dosing is correct. And it's so it kind of goes back to, on a baseline initially, make sure your insulin doses are right for you. And a lot of people wonder, you know, they, I just leave it to my doctor. Yeah, it tells me how much more or less to take.

Scott Benner 10:43
And does that mean that if you're not using enough insulin that your blood sugars are left higher, so you're still having some of the action that you noticed before you were diagnosed? Right? Yes, you're a little You're too high, and your body's not storing the, the calories correctly, the glucose collect correctly, and so you're not gaining as much weight. So you could have unhealthy blood sugars, but feel like your weights good. And then you kind of come to that point, you're like, Oh, I'm good. And that really is the beginning idea of diabetes aimia to write, manipulating the insulin to keep your weight down, okay, so that's going the other way, if you're too low all the time, you'd have trouble putting on weight.

Jennifer Smith, CDE 11:26
If you're too low all the time. One, you've that's actually kind of an, it's an opposite of what you would think really, if you're low all the time. And that's a big reason, then when we start working with somebody, we analyze insulin to begin with, and the first thing we look for, even if there are highs, high highs, we first look for lows, because if weight management is another piece that they're really concerned about, then all of those lows that you're treating, you are feeding insulin, and you're feeding insulin, which ends up packing away the excess that you're taking in, and you maintain a weight that you don't want, or you keep gaining weight that you don't want.

Scott Benner 12:11
So this, this puts you in the position of having to look at carbohydrates as medicine, and being scared because you're low taking away more than you need. And then suddenly, you're back back up again. And maybe you've got enough insulin in there to handle the carbs for your blood sugar. But you've taken in way more calories than your breakfast once got it.

Jennifer Smith, CDE 12:31
Yeah. Yep. So that's, that's that insulin is, it's kind of the key place to start really. And you know, then a lot of people ask, Well, how much insulin? Should I really be on? How does this enough for me? Is that enough? For me? I know, we just talked about that kind of in depth in another episode, but really, you know, figuring out about how much insulin you need based on a wheat to begin with. That's kind of a starting place that you could go to, how much total daily insulin Are you using right now? What's your like current body weight, etc? Should you be using this much insulin? is it taking this much more insulin to counter things? Or are you using like a heck of a lot more like let's call it Bolus insulin, right? But you see that your Bolus insulin is for a lot of corrections. And when you're looking at your data, you can see that the corrections are following lows. There again, more insulin than you really need. And thus your body is going to pack away by allowing the insulin to use up the food.

Scott Benner 13:38
It's funny because I wasn't 100% sure what you were gonna say today. And yet I feel like we're into this situation, again, where the podcast should maybe be three minutes long. And it should say limit your variability use the right amount of insulin. And it kind of addresses so many things. I know this isn't weight loss specific. But let me just ask you one question. How many people you know what percentage of people do you think just a guess, are are getting to reasonable outcomes by mistake. Like their bolusing too much, but they're eating on time and their basil is too low and it works out or their basil is too high and they eat before they get low. And they don't have to Bolus too much in it like how many people are getting there the wrong way, but it seems like it's working and then have underlying issues that they don't recognize. Like I

Jennifer Smith, CDE 14:35
wouldn't say it's I wouldn't say it's anywhere near a majority of people. Honestly, I'd say it's a small percentage of people who have figured out insulin needs. Even though the dosing strategy that they're using might be wrong, like you said, maybe there's way too little basil, but they're offsetting it with boluses and maybe the little amount of basil they're using is right for their overnights and that's why it looks stable or, you know, Vice So whatever. But I don't think that's the majority of people, I think the majority of people who are having issues with blood sugar fluctuations that they don't want, and also likely are having some issues with weight management of some type. It's, it's a start of let's look at what the initial factor could be insulin. And then you move on further. And you know, lifestyle is a big part of it, obviously. So then we look at things like calorie intake. And I think some of the some of the questions that came in were kind of, you know, around that, well, you know, I've run a calorie deficit, and I've like, run myself ragged, going to the gym, or, you know, exercising 90 hours a week. And it's still not working. But I, you know, and then, you know, there's the fasting component, and all of these things that people try to put into the picture. But from the standpoint of calorie, your calorie needs should meet your baseline kind of need, in general. And then if you were working out on top of that, or you know, a training athlete or whatnot, then calorie needs go up. But at a minimum, there is kind of a minimum, on average, that needs to be there. It's about 1000 calories a day, give or take person to person. But when you start dipping below that oftentimes what ends up happening is your body conserves. Because you're not meeting a need. And then you wonder, Well, I'm at a deficit, why am I not losing? Because

Scott Benner 16:38
your mind thinks you're lost on a desert island, and it doesn't, it's trying to hold on to everything you put inside? Exactly. I had that problem where I've, by eating more food, I've lost weight and eating less. It didn't, it didn't impact me as a fact. In fact, it sort of made me go the wrong way. So okay, so if someone asks you, is it not as simple as Hey, I need to lose weight? Can you tell me where to start? Is it really person to person? Like, because what do you have to do first, like, think about if you were listening to this right now? And you could be any of the varied people who are listening? like where do people start?

Jennifer Smith, CDE 17:17
I would definitely say with Well, first might even be an analysis of Where are you? And where do you want to be? Or where have you been weight wise, right? What's your goal to get to? And how much more Are you above that, then you want to be and also in that timeframe, it goes back to insulin analysis. If you've gained weight, as many people have in this past year, if you have gained weight, but your insulin doses haven't really shifted, there in lies a piece of the puzzle to write usually, for about a 10% change to your baseline like Wait, you're probably going to expect a need to change your your basil and your Bolus ratio is by about 10% as well, to be more aggressive and to take, you know, take into consideration that gain now when people are looking for loss. They're like, Yeah, but I don't want to use more insulin, because that's not going to work

Scott Benner 18:20
anything. Insulin, put the weight on them. Correct. Okay, gotcha.

Jennifer Smith, CDE 18:25
But really, they need to first manage their blood sugars. And then they can start working on whittling away or wiggling back and some of that comes into, okay, let's look at the lifestyle things. Let's look at are you exercising? Are you active enough? Does your calorie intake meet what your actual need is? You know, where can we whittle away some things so that weight comes down and along with it, then as you do lose? The same thing happens with insulin, your insulin doses should be adjusted back based on loss.

Scott Benner 18:59
You're making me think so strongly about when somebody comes to me and says, Hey, I just got diabetes, and I play a sport or my kid, you know, is on the team and we're so worried about this and I very badly don't want to give them a band aid answer about how to get through the sport I want to tell them let's take the time now and get your insulin right so that during the activity there really isn't any issue and it's hard for people to believe that once they've seen it once they see cause and effect once they say I ran around and my blood sugar went down. They imagine that is going to happen no matter what all the time. And I Ardennes. I'm sure you're the same way. But Arden's insulin so well balanced at this point, like activity doesn't make her lower or higher. Really, it's not it doesn't really change too much.

Jennifer Smith, CDE 19:46
Yeah, it depends. I think that brings in, you know, the consistency of exercise or activity, right. The more attune your body is, let's say you go out for an hour every single single day to get some form of real exercise right Your body gets used to that. So initially, you might see that your insulin needs drop off within the hours of the active time, right, and maybe even stretching several hours later, depending on what you did. But over time, that impact is lessened, you will usually need to be less aggressive with insulin adjustment, or maybe not at all. I mean, I can typically take my kids to the park and not really worried too much about that, unless I know I'm really going to run around crazy with them, and I likely have insulin on board. Right. So then something needs to be you know, offset. But, um, so yeah, I mean, once you get to the point of like, lifestyle adjustments, and a base insulin that's working, your fluxes in insulin dose, then will be minimized. I think, oh, sorry, go ahead, we'll

Scott Benner 20:52
see I think people need to be certain to that, once they start exercising their body is going to use the insulin better. The answer then is not to feed the low, it's to adjust the insulin, you know, maybe the first time you have to feed it, but then you have to learn from there and make an adjustment so that you're not constantly battling yourself because that is what happens, right? They exercise they get low, they eat it out, though it out. It overpowers what they meant to accomplish, okay,

Jennifer Smith, CDE 21:18
and then they and then you end up getting frustrated too. Well, goodness, you know, I go to the gym, but I have to eat like a whole sandwich and a half a banana in order to go to the gym and not have a low blood sugar. What's the purpose of that when I'm trying to lose weight, and then

Scott Benner 21:30
I stopped doing it because

Jennifer Smith, CDE 21:31
and they stopped doing it right. Or on the other side of it, you know, someone who may actually, okay, I'm going to really focus in on my diet, I'm going to clean it up, I'm going to you know, cut my macros down and actually meet the caloric need that I'm at right now. And then what they end up with many times are lows, especially the cleaner the diet gets, and the more accurate intake of calorie value is for that person, your insulin needs will actually come down sooner. So to avoid lows and needing to treat in the time period where you're really trying to be Let's be good, let's say right, just take your insulin doses down by maybe even it's just your basil, take it down by maybe five to 10% across the board.

Scott Benner 22:17
Okay? So it's get your insulin, right. So it's understand diabetes first. And then it's the normal stuff, we all talk about it being active, getting your heart rate up. A sedentary lifestyle leads to more resistant blood sugars, which leads to more insulin, which probably leads to more lows, because you get out of balance, blood sugars, and what you just said, about clean eating. We don't really talk about it like we like if we were all out in a field, okay, let's say if it was 400 years ago, and somehow insulin existed, but we were still just farming and breakfast might be an apple you found on the ground, and maybe on Wednesday, if you're lucky. The guy up the street kills an elk. And we get a steak right? Like if we were still eating like that, and we had manmade insulin, people would not be using nearly as much as long as they use now, Jenny?

Jennifer Smith, CDE 23:14
Oh, no, not at all. I mean, if you were living on like, berries that you picked along the trail that you were tracking the elk on and then you stopped and you ate some of the watercress. Hey, get your vitamin C out of the like stream that floated by whatever. No, what No,

Unknown Speaker 23:33
you might not need as much insulin right?

Jennifer Smith, CDE 23:34
No, you wouldn't. You're also active level that I mean most like let's call them you know, cave dwellers or whatever at that point of life, right? activity was part of your day. They didn't have a gym that they went to. Their hunt for the bison man was like, act.

Scott Benner 23:53
I bet you're running from a mountain lion burns carbs. What do you think? What do you think? So I guess my point is, is that while I'm not telling anybody how to eat, and I'm not certainly telling you that my daughter's counting macros or anything like that. Processed foods, right? manmade foods, stuff that comes in bags, oils that don't belong in your body, all the stuff that we consume all the time that we're not aware of. It's making your variability greater and it's making it more difficult for you to use insulin

Jennifer Smith, CDE 24:24
true in fact, I've also kind of heard people and there's truth to it.

Scott Benner 24:39
Hey, let's not let's not waste any time shall we? just did it nice. How I said let's not waste any time it took me 10 seconds to say let's not waste any time then I went over it for 10 more seconds. I better jump in. Get yourself a Dexcom g six continuous glucose monitor why you'll be able to see trends, directions impacts of insulin on blood sugars, impacts of food on blood sugars, the impacts of life on type one diabetes, you'll see it all with your Dexcom g six continuous glucose monitor. And how does it do that? Well, it shows you your blood sugar in real time, not just the number, but the speed and direction of your blood sugar. Are you 184 and dropping or rising or stable? That's a big deal, isn't it? Because in each of those three situations, you might do something different. A rising blood sugar might get some insulin, falling blood sugar might warrant you paying attention to it, and say it's super stable, right where you want it, you know, you've done the right thing. The Dexcom g six gives that feedback in real time in ways that is so usable, you hear us talk about it all the time on the podcast. So check it out. dexcom.com, forward slash juicebox. Sure, there's alarms, you can set, those are a big deal, too. You can say, I'd like to know if I'm going below 80. Or if I'm going above 140. And it'll tell you don't want to know till you're 160, you can change that, that's up to you. The Dexcom g six is a vital tool. If you're using insulin, I'm talking about type one or type two, check it out, support the podcast when you do use the links in your show notes. Or type in dexcom.com forward slash juicebox. After that, you're gonna want an insulin pump. Right? Maybe you don't have one and you want one, I say check out the Omni pod, you have a different pump. And you're a little sick of the tubing. I say check out the Omni pod. You use an MDI giving yourself the shots and you're kind of sick of it. You know what I say? Check out the Omni pod, do that Omni pod.com forward slash juice box, you have two options when you get there. You can see if you're eligible for a free 30 day trial of the Omni pod dash system. And I mean 30 days is like a long time. And it's free. Or ask for a free no obligation demo pod where on the pod will just send you out one nonworking pod. So you can try it on and see what you think there's a lot of options when you get to that link. All of them are going to give you more information and help you make a good decision. On the pod.com forward slash juice box, use an insulin pump that doesn't have tubing that doesn't need to be taken off when you shower, or run or kick a ball. an insulin pump it doesn't have something on it along to from an infusion set back to a controller that can get caught on a doorknob or just kind of be a pain to carry around. When you like to carry nothing, just have that little pod on that talks wirelessly to a device where you give yourself insulin, not something that's tethered to you with tubing full of insulin. And they if you don't want it on the pod, whatever, do the trial, say you don't like it, don't like it. Nobody's holding you up, can do whatever you want, but at least then you'll have real data to make decisions with. As you know, I think data is very important. Okay, that's it on the pod.com forward slash juice box dexcom.com forward slash juice box links in the show notes links at Juicebox podcast.com. And again, if you're looking for these diabetes pro tip episodes, you can find them they started Episode 210 in your podcast player, where they're available at diabetes, pro tip calm and Juicebox Podcast comm

Jennifer Smith, CDE 28:38
many people have found that if they eat a true cart, let's say they eat an apple and they Bolus for it, they end up with the ratio that they're using for that simple, like very clean carb to go low. Okay, and then when they mix it up, and let's say they have potato chips or something along with the apple or they have something, you know, more processed along with it, their carb count ends up looking clean, like okay, it comes out I don't get low later. So what gives it really is that the body processes more natural food in a better way. There's there's less left over to kind of linger in impact. And a lot of people are basing their insulin to carb ratios, more specifically, around combination meals that are not quite as for lack of a better term clean,

Scott Benner 29:36
right. So your your heavier. Insulin ratios work better if you have the orange with the potato chips, but if you just eat the orange, the orange doesn't need as much insulin so the ratios you have or too heavy. Correct. I now Arden's ratios are heavier because she doesn't you know she eats a diet that has processed foods mixed into it, but she'll go on a kick around this time. If you're about oranges, where I have to buy like 10 pound bags of oranges to keep around the house, and she's like, I want an orange I want like now these are big like softball size oranges that I'm going to

Jennifer Smith, CDE 30:10
cara, Cara oranges. Those are my fav.

Scott Benner 30:12
Yeah, I think they are and they're really good, right? And but I bet you I've never looked, but I bet you that the carb count on them's got to be more like 25 or something like that, like he could be more, right. But I only give her enough insulin for like 11 carbs. And and she does a little 130 rise and comes back again. Because I you know, because I know her ratio is higher to handle other things, which is why you look at plates and go Okay, tonight, I don't need as much, you know, for right. But this is not this is not going to be a satisfying, you know, people just want to hear like, please just tell me what to do. And I'll do it right. So work, but nobody wants to hear. I guess this? I know, I don't like it. You know what I mean? I don't have diabetes, and I'm listening. I was like, Oh, this is how I would lose weight. So you know, it's, um, it's just, do you think that we've just spent so much time as a society looking for marketable sellable ideas about how to get around? The idea of being in shape? There's no, it's, it's exercise and calories. Right.

Jennifer Smith, CDE 31:21
And I think that's the reason that there are so many, I mean, if you look at around the first of the year, there, I can't remember which publication it is. But they come out with an analysis of I think, like the top most, or maybe it's the 25, top most like us call them diets, right, in the past year, and what's kind of proven true to what it promotes and what really isn't, it's kind of like flimsy, right? Um, and some of the top ones are things like the Mediterranean diet. And you know, by no means am I promoting that, or whatever. I'm just saying that that ends up being taught from a lot of different health parameters. And it's also a clean way of eating. Most people think Mediterranean and they think well, lots of breads and lots of starchy things. And that's actually not true. A lot of it is plants, especially the really good non starchy vegetable types of plants. And then if there are grains that are hardier grains, right? I mean, it doesn't tell you to eat your carbs as a bag of Doritos. It tells you to go and eat some keen Wah On your salad with, you know, an orange on the side. Right. But I think it brings in diets. Yeah, this idea that there is the perfect thing out there.

Scott Benner 32:43
Right, right, and that it's going to be doable for somebody because maybe, listen, maybe macro counting, maybe there's a biologist somewhere that could give you the perfect diet for your body. But where am I getting that from? And where are most people getting that I have to tell you that a couple of weeks ago, I started getting an ad, right. And then I looked in the mirror and I was like, My face looks puffy. And I went to the Costco and I bought two little roaster, chickens, and four steaks. I spoke them all, slice them up, put them in the refrigerator, and I've been eating those and salads and some of those oranges because they're around the house. for about the past eight or nine days, I'm easily 10 pounds lighter than I was. And I know that I know, I'm a fluctuating person. Like I know I jumped around like because what'll happen is at some point, someone's going to give me a piece of bread and I'm going to pick Oh my god, bread does everyone remember Fred? And then I'm going to eat a lot of bread for a week and I'm going to go Oh, now my back's deaf. And I feel like I gained five pounds and all that stuff. But just if I explained to you that most of my meals have been like a couple of eggs in the morning, and a couple of tiny slices off of that steak and then at lunch, some some of the chicken and some of the steak with a salad. And I've I feel great and I know it's true, because I've been through it enough now now to talk my stupid childish inside into like just continuing on that way that I don't know if I'm ever gonna get to do but I do know it's honest. And it works for me. And I've seen it work for other people too. Like you take out processed food and carbs. And your your you're better off like I don't know, it just seems obvious. But

Jennifer Smith, CDE 34:16
it's, it's you know, like you said you're not focusing on like macros. You're not focusing on how many do I need in a day? You're what we end up finding and I think this is the premise behind a lot of the like, the Palio kind of diet and the keto type of diet, right. It's, if you're following the rules of those plans pretty well. They can be very clean eating plan. They can. There can also just like being vegetarian can be or vegan can be very healthy way of eating, but they're also like the complete like backside of that where you're eating a lot of processed vegan or like the key You know, like kinds of things that are like the treats and whatnot, you're focusing your intake on a lot of that kind of stuff, you're lacking in quality. And then your macros may very well without you realizing it be completely out of order. And I think that's why a lot of like plans like this end up failing, you know, I followed keto. And it was supposed to be this magic, like weight loss, and I also have diabetes, and it was really supposed to help with my blood sugar management and whatnot, well, I haven't lost any weight, well, maybe there are some things then to evaluate within it, you know, the keto diet is a way to get your body to start utilizing fat instead of carbs. So if you haven't really analyzed how you've broken that down to make sure that you are one maintaining ketosis in the right way. And that the kinds of like carbs that you're eating are really not offsetting, then it may not work well for you,

Scott Benner 36:03
don't you find that you have to be in tune with what your what satisfies your body? Like Not, not what satisfies your brain, right? But what satisfies your body. And I've absolutely, I've seen myself go either way, like where you're just eating for taste and flavor and comfort. And that's never usually good for your body. And then there's a way where you're just sort of never hungry. It's it's that's where I am this week, I have not been hungry this week. And if I had any like inkling towards a sweet, I've been specifically careful to take just like dark chocolate, like just a little bit of dark chocolate like this will this will get me through, like, what I'm assuming is basically withdrawals from flour and sugar and stuff like that, you know? So I don't know, like, are you telling? He's telling me that all these questions aren't even worth looking at? Or should we ask them? No, I

Jennifer Smith, CDE 36:53
think they're very worth looking at, because I think some of them may relate to what we've kind of already gotten into. And then some of them, I think, are really good questions in terms of the why it wouldn't be working. Right what's or why it might actually work. So yeah, let's

Scott Benner 37:12
pick a favorite or should I just pick, you just pick right? Well, so Jennifer's asking about her son, she says any any advice on how to balance all this high carb gluten free food from my growing always hungry, 14 year old T one D with celiac. So she has a son who seems to need blending down and at the same time. She's giving him a lot of carb heavy stuff, because it's like it's some of this. For the celiac diet, it seems like right? The gluten stuff,

Jennifer Smith, CDE 37:43
right? And that's it. I mean, celiac is a hard addition. It definitely is because while we now have a plethora of gluten free, very tasty products on the market, most of them are made with very, very processed very high glycaemic, I mean higher glycaemic than even your wheat based bread, you know, type of pasta, whatever it might be. So when you start processing things, like rice into a flower, or, you know, potato into a flower, you have a quicker digestive component to that, and it raises the blood sugar faster, its glycemic index is just high comparatively. So when you have to do these types of things, especially if you have a teen who is growing, is active, but also could maybe use some slimming down, or maybe needs to gain a bit of weight. One, it's may be sitting down honestly, with a dietitian to see what are my child's growing nutrition needs right now? Are we you know, keeping kind of a log a couple of days of what are they really in taking? And then looking at what their nutrition needs should be for the point in life where they are, you know, are they moderately active? Are they heavily active? Are they kind of couch potato video gamers? What is it and what do they need? And then looking at the kind of food that you put into their caloric need, right, again, I mean, parents are typically the purchasers of the food in the house. Yeah,

Unknown Speaker 39:27
give or take. You don't think this 14 year olds got a credit card?

Jennifer Smith, CDE 39:30
Yeah, no, I mean, and my kids, gosh, I mean, if we walk down the aisles in a grocery store, and they see like, the pretty packages and you know, like, I never got we don't eat cereal, so I don't go down the cereal aisle, but they'll always have something on like an end cap, you know, at the grocery, especially my eight year old, like, boy, that looks really good mom. I'm like yeah, and not really good for your body.

Scott Benner 39:56
That's why they have to make the picture. So nice. Right? There's no fun here, stop it.

Jennifer Smith, CDE 40:04
Well, so I think, you know, from from that standpoint, you have to look at what is the child in need of? Are you meeting it? are you creating access? And then potentially from a gluten free standpoint? Yeah, finding substitutions that can be fit in to meet his tastes, because all kids and teens are different, you know, as much as you want them to eat asparagus, they might not. Yeah, so you know,

Scott Benner 40:29
right. So, so you have to be, it's Listen, I know, if you've been listening for a while, you know that I took me a while to diagnose my low iron thing years ago. And during that a doctor made me eat like, gluten free for a month, and I gained a lot of weight because I went out and bought all these gluten free items. And somehow in my mind, I was like gluten free equals health. That's how it felt to me. So I was like, oh, it felt like zero calorie stuff when I was going in. And man, it was just not. I think if this was me, if Jennifer was me, and I didn't know what I was doing, I think I'd introduce, like, lower carb, more meat friendly, like meals, like that's what would occur to me first, right? Make some chicken, make some steak, put it with a salad or a vegetable, and maybe cut down on carbs. But then you got to remember, like we spoke about earlier, not to dose it as harshly as you would some of this gluten free stuff, or you're just going to create a low and you're and then have what you did buy with them. Right?

Jennifer Smith, CDE 41:27
And I think you know, when we look at, you know, going back to just that, like clean eating idea, quite honestly, you can be gluten free. If you're choosing to not buy as much processed food pretty easily. Yeah, I mean, you know, things like qinhuai, or, like a wild rice, or even like a brown rice, or what, that's 100% gluten free.

Scott Benner 41:52
It's the fun stuff where it causes your problem,

Jennifer Smith, CDE 41:55
right, it's not taking it out of the diet, it's just that you know, and I know the struggle with kids, I work with plenty kids and teens to know that what they get at home, under mom and dad influence because this is what you're eating turns around, it changes considerably once they start to do things with their friends, you know, now gluten free in the picture. If the child is paying attention to that, and knows that they just can't have gluten, they may already then have limitations, even compared to what their friends are eating, because they know that they just can't do it, or they're not going to feel good, right? But in that circumstance, then it kind of takes sitting down and figuring out well what that what will possibly be there that you could have, um, knowing that it's still more of like a process Trini kind of thing, but also that, you know, we're not going to do this at home. But you could have it when you're out.

Scott Benner 42:54
Okay. Laura has a question. It says, Is it true that insulin on board prevents the body from breaking down fat? Meaning that in order to burn fat, you need to have stretches of time with only your Basal insulin and no insulin on board? That's interesting. I've never heard that.

Jennifer Smith, CDE 43:11
Yeah, it is, I guess it's an interesting way to frame it. I mean, we know that in the we know that in the overnight time period, without any food on board. And on basil, only. Our body does get into more of that, like fasting state, right, of actually transitioning to some fat burn, etc. Because you're on a low level of insulin.

Unknown Speaker 43:34
I see what you're saying. Okay.

Jennifer Smith, CDE 43:36
But when you have insulin on board, technically, there's a reason for the insulin on board. Right? Right. You're dosing for food, so that insulin on board should be covering food that is there. So yes, your body's processing carbohydrates. And your body is not at that point then going to be in fat burn mode. It's kind of correct in a way of stating it. Yes. I mean, the same thing for a high blood sugar that you've corrected. Now you've got iob. And the high blood sugar indicates that there's excessive sugar there, and your body needs to process it. And as such, it's using the insulin to process it and break it down and get it in the right places. So again, technically, as long as there's not an insulin deficit in that high blood sugar scenario, and insulin is working to get it down then your body isn't also breaking down fats either. Then is that a vote for intermittent fasting for type ones? It could be and can intermittent fasting work, right? It can. But again, a blanket statement is to stay that any plan that you choose. No longer term that you can continue this, right? The problem with the diets that are out there isn't the diet itself. In fact, there's a lot of research around a lot of the diets that proves long term, these people have had this success in weight management and cardiovascular benefit, etc, etc. But they've stuck with it. Yeah, it is the Oh, I'm going to do intermittent fasting, oh, I'm going to do the keto diet, oh, I'm going to do the, you know, cabbage soup diet for the next month. And once it starts kind of showing benefit, I'm like, I can do I can kind of step outside of the rules, parameters, which are often for diets very black and white. Yes, do this, this and this, but don't do this. And as soon as you do that, don't do this. You've broken the piece of that plan. That was getting you to your goal,

Scott Benner 45:52
right. I found intermittent fasting, the easiest to stick with, because to me what it was was as long as I don't eat, like don't eat after ate, and don't eat before noon. That is basically how I did it. And I have to admit, it's very effective. Now, I realized while I was doing it, that Arden basically does that already, without the late night thing. But she's so young, I don't think it matters, right. But she gets up in the morning and is not normally hungry in the morning. And so I've had to over time thoughtfully balance out how her insulin works in the morning, right? How do I come out of sleep into feet on the floor, off to school without a rise that needs a bunch of insulin so that I don't create a low because she really doesn't want to eat until she's done with school or till lunchtime, right? Sure. So basically, Arden does intermittent fast, except she doesn't do 16 is it 16 wait 1819 2016 eight, that was embarrassing. A lot of people would edit that out, but I'm not going to. She doesn't do 16 eight and as much as she probably does, like, maybe 1410 something like that. But also she's 16 so she can write you know, she can like we over Bolus her meal last night for dinner. We had stuffed peppers, like Turkey stuffed peppers, and, and a salad. And my wife, my wife, like swung at it really hard. And about a half hour after she ate I was like, Hey, your blood sugar is like stuck at seven. I was like I This doesn't look okay to me. Like I think this is gonna go the wrong way. You know. And so as it started to trend away, Arden got a little light in her eye and she goes cinnamon toast crunch, please. So she knew she had basically Pre-Bolus cereals. So she was like, let's do it. And she had some of that have my wife go on. I'm gonna guess 10 or 15 carbs less on the Bolus. She hit it right on she was so close. But But you know, that's a young kid. And Arden's also helped by other things that I think are worth mentioning here too. Because those of you listening have type one diabetes, or love somebody who does, you really have to get your thyroid levels checked. Like you could be fighting against a borderline thyroid problem that's making weight loss impossible. You know, and you if you're going to do that you really need to go back and listen to the thyroid episode with Dr. Benito because the range that your doctor is gonna say your thyroid your TSH levels, okay, and a real badass endocrinologist will not accept you know, they mean they will not like if you're over a two Doctor beanitos giving you thyroid hormone like and there are people right now we're listening. You're like oh, my TSH is a five my doctor said it's okay. I'm borderline. Yeah, yeah, right. But I but my hair does fall out a little bit or I'm having trouble losing weight or I'm a little nasty sometimes or whatever the other things come. But I'm just telling you if your thyroids moving the wrong way, deal with it, because it makes a lot of life easier.

Jennifer Smith, CDE 48:56
And it's a lot within this whole topic of weight management. Absolutely. If you've the Hashi moto is which is very common autoimmune. Once you've got you know, type one, it's good to get tested thyroid levels at least once a year if not every six months, especially if you've got other family who has a thyroid disorder known already. But that's huge in terms of metabolic

Scott Benner 49:20
Yeah, but you have to you have to advocate for yourself. You can't say oh my god, Scott, you're right. I am tired all the time and I can't lose weight and blah blah blah, and then go to the doctor and the doctor say Oh your TSH is four you're fine your TSH just for you are not fine. That's the equivalent That to me is the thyroid equivalent of in diabetes. When somebody says yeah, your blood sugar, your average blood sugar is 180 You're doing great. Right? Right. You might you know you're not dying, but you you're not living at a healthy level. And that has other impacts on your life. This thyroid thing is it is crazy. It is like the equivalent you trust me at this point. I've seen everyone in my family except for me deal with it. It's like taking a long metal like paper. clip and just touching it on a computer circuit board. It just messes with stuff, you know what I mean? Yeah, but,

Jennifer Smith, CDE 50:06
and with with Ardennes doses, have you noticed that when things get out of order, do you notice a shift in her insulin need, because that's very common right away that, you know, metabolically, she's feeling more sluggish, sluggish and fatigued. And insulin is just not working, like it was supposed to work. And if there's a timeframe in terms of adjustment, or even just starting on a thyroid medication, where you will then start to notice a shift back to normal insulin dosing. See, again, that insulin manipulation in terms of the weight management piece with thyroid in the picture, you have to be very kind of eyes on right to make sure that you're adjusting then where you had bumped everything up in terms of insulin need, you're going to need to start bumping down. And if there's weight loss in the picture at the same time, definite need to bump down or you're gonna just run lows. Yeah,

Scott Benner 51:01
I there's something I use, I think I should even have a flowchart for myself like If This Then That kind of chart because you're right. If the thyroid level starts to get away, then her insulin needs go up. And then we adjusted, it doesn't happen right away, and our insulin needs start coming back down again, the same thing with she had to start a birth control pill to regulate her periods. Hall. I lost three months of my life to figuring that out. Like it was just first they gave her a pill with not enough estrogen in it. So it was basically just two wasted months. She was exhausted all the time because she was bleeding constantly. So I had to get her through those pills. Those aren't the right pills put her on the right pill that started working the bleeding, regulated. Yay. Now she's lost so much blood, I had to go get her an iron infusion. Got her the iron infusion. Now we're waiting for that to come back up. When the iron infusion comes on board, her insulin needs are gonna change again. Yeah, vitamin D levels seem to impact insulin knee. Yes.

I just,

Jennifer Smith, CDE 52:05
in fact, many people for vitamin D that you bring it up. That's another like piece. And I think in terms of like, like, again, going down the rabbit hole of discussion and weight management, the we're kind of on the track of like medications, and medications in terms of thyroid, as well as things like iron. But vitamin D, you know, your lab will tell you optimal is between or standard is 30 to 100 optimal according to the female specific physician that I'd worked with years ago, before I had my first son, she was like, you know, optimal range is really 50 to 70. For vitamin D, she's like, and if it is not in there, you need to be being supplemented, because otherwise, especially with diabetes, vitamin D works on the cellular level. And it allows insulin to be seen correctly, it for lack of a better term by the cells. And so it lets insulin actually work the way that it's meant to have one of the many things that can so if your vitamin D level is off, supplement, I mean, in general, someone with type one, adult wise, should be supplementing at least 2000 I use a day. And if your levels are not optimized at least 4000 a day. And if they're really on the low end, you need to be doing like the hyper significant doses of vitamin D for a short period of time, if you

Scott Benner 53:30
like. And then for 50,000, I use and you take one once a week or something like

Jennifer Smith, CDE 53:34
once a week, or I've even seen some doctors do like 110 1000 iu a day for you know, a couple of weeks and then retest. But vitamin D is huge.

Scott Benner 53:43
And I'm not a doctor, but there's something about vitamin D deficiency and autoimmune that go hand in hand. So just look

Jennifer Smith, CDE 53:50
at the studies out of Finland,

Scott Benner 53:52
right? I listen, I take 5000 a day. And I take 5000 a day of vitamin D, I take a zinc tablet, I taken a sorbic acid with iron and a B 12. And that's that's what I do every day. And that's what you know, my kids do and and everyone here is doing because when the D levels drop again, problems with insulin, I'll tell you right now too, because Jenny mentioned ranges that you need to be in versus what lab values will tell you, Dr. Benito back on the thyroid things that if you were a woman of childbearing years, anything under 74, your ferritin is too low. And they're not going to tell you you're low till 20. So she's like if you are having a period, he gotta be above 70. And so there's a lot of things. And then all of these things also impact your body's ability to work correctly, which is in part and parcel of losing weight or

Jennifer Smith, CDE 54:50
losing weight, right. There was one in here that does go along with medications that I think is a really important question. This woman has a son on a medication that is more for like attention. And it's specific to using it versus not using it school year versus spring date break or summer time and what ends up happening in terms of insulin needs. And I think it's an important one, because I've seen a lot of kids who are using a DD ADHD kinds of meds. And a very, very common thing with those is that it decreases appetite. Okay. And if they're using it in their school day, and they're also the brain uses carbs. And so the more thinking that's going on, and the potential that they're really not hungry, they may not even finish the lunch that you packed for them, they may pick at the lunch that comes from the school lunch, because their brain is just saying, I'm not hungry enough to eat, you may end up having to have two types of basil profiles, maybe one for like a spring break, time off another one for school days. And again, as kids get more into the teen years, that becomes really beneficial in terms of growth and the potential for weight gain in the wrong direction. Because if you're constantly feeding loads again, or constantly adjusting insulin up and down, but it's kind of willy nilly and not quite right on with need. It's a medication adjustment kind of thing that goes along with adjusting insulin

Scott Benner 56:31
again. We're right up on it. But there's enough questions in here that all circle around menopause. Do you have any feelings about what happens at that time? And

Unknown Speaker 56:41
yeah,

Unknown Speaker 56:42
that's a fun one.

Jennifer Smith, CDE 56:45
I mean, in general menopause in and of itself. I mean, perimenopause really is the start of kind of that time period in a woman's life where your cycles might start to get less evenly spaced, right, let's say you were the typical, like, 29 days, and you was right on spot. And now like, Huh, now it's like 26 days and next month, and might be 32 days, and that may be 29 days. And, you know, periods can get a little bit more aggressive, or kind of look more spotty. But that perimenopause kind of leading into menopause, which is really, a woman has not had a cycle in a 12 month time period. Right. So insulin needs can look very jumpy, you might even find that, again, as we get older. And these things come into the picture from a female perspective, our metabolism does slow down, we oftentimes start to need a little bit more insulin, or it takes a little bit more activity to maintain or burn off what we were able to do when we were 30. That doesn't work anymore when you're 45 or 50. So a menopause, perimenopause, it brings in a whole circle of hormone impact, right, that may more aggressively change your insulin needs, especially around your cycle times.

Scott Benner 58:10
So not unlike, well, I guess, more aggressive but not unlike having your period and seeing right hormone fluctuations throughout the month,

Jennifer Smith, CDE 58:19
right. And then once you're in menopause, oftentimes, you know, outwards of a year or two post no longer having a cycle. Many times, then insulin levels should get more stable, because you don't have that hormone flux. And as we age men and women have less and less and less growth hormone cycling anyway. And so we end up especially women passed about the age of 65, or people passed about the age of 65. Oftentimes, their baseline Basal needs definitely go down. And the reason there is because their hormone cycling has kind of started dropping off. Okay.

Scott Benner 59:01
All right. Did we do this justice in an hour? Because I feel like we did, but I don't know much.

Jennifer Smith, CDE 59:06
I think that we did as much as we could get it in an hour. I mean, if we really wanted to focus in again, dig really deep into that information hole. There's a whole bunch about meds that are very specific to like weight loss, and you know, things like the GLP ones and things like the stlt tos and what despite them being type two meds, they are getting a lot more. They're kind of climbing on the ladder of benefit for those with type one and who are just insulin users. And they do have promise in terms of weight management, if use the correct way.

Unknown Speaker 59:51
Okay, so

Scott Benner 59:53
do you feel comfortable talking about that? Because maybe you say here that if you like this episode, look for that one coming in? Yeah. Okay. Great, thank you. Yeah, Jenny, you have to do all the talking. I was at some points. uncomfortable. Not for because he was like, Huh, there's not a lot for me to do here. I was just checking. I was just saving files and checking rates and looking at questions I

Jennifer Smith, CDE 1:00:18
was like, so like, I should have just gone and gotten an extra cup of tea.

Scott Benner 1:00:21
kind of nice. I should have just said, Jenny, tell me about weight loss. I'll be back.

Jennifer Smith, CDE 1:00:26
Really is I was looking at all the questions. I mean, there are a lot of really good questions, but I think a lot of them honestly. Go back to insulin. Yeah. dosing it the right way for what you're kind of taking in. And then also, secondly, looking at what are you taking in,

Scott Benner 1:00:45
right? And obviously, in my mind, these questions all are, they're similar, they're tied together, whether it's vitamins, or your thyroid level, or your calories or, or whatever it ends up being, there is a balance that optimizes your body, it's not going to be the same for everybody, some people's vitamin D level can be crashy load to the floor, and they'll never notice it, and it won't matter to them. But for some people it does. And when you get those things in the right balance, then you feel better and feeling better. To me, as you feel stronger, you're more rested, like all this stuff happens. You're clear in your mind. But how. But some of these things nobody would even know to look into. No, you know, even vitamin D like I can remember 10 years ago, my ardens nurse practitioner gone, we're gonna start checking vitamin D was almost like a mandate came down from a mountain, you know what I mean?

Jennifer Smith, CDE 1:01:35
Yeah, actually, I don't even know when that would have been. But if it wasn't, I remember when I was working in DC, and the endo practice I worked with within the, our director was very, like high up within the whole, like, diabetes management, like realm of information. And his he was like, we are testing vitamin D levels for every person with diabetes. And at that point, it was really just, if the thought was it was relevant more to type two. But as we started testing, then I went to my own end to when I was like, you know, I run I'm outside all the time. I have, like, you know, like brown skin from being outside. Like, I don't take my, I'm like, I'm sure it's fine. In fact, my vitamin D level came back and my doctor himself called me, not his nurse. He was like, this is really weird. But he's like, I want you to go and get it tested again. He's like, this can't be right. And my level was 18. Yeah. 18. And so when it got to test again, nope, it was 18. Again, he was like he did he that was the one time a week the 50,000 I use, I came back in eight weeks, it had moved to 21. And he was like, Huh, so I he sent me to see like a naturopath, who was also a physician who knew a little bit more in that realm. And she actually had me started, she started me on oral drops, okay, and the drops get absorbed through your oral mucosa rather than having to go through your gut. And because we know there's a lot in terms of gut and absorption in autoimmune disorders, she's like, I guarantee your body's not absorbing it. She said that's the problem. And is within about I think it was 10 weeks after that I got it retested and was already up in the high 40s. Yeah,

Scott Benner 1:03:25
you know, I have to, I thought I was gonna have to live getting iron infusions my whole life, because I couldn't absorb it through my gut. And I do probably have some like weird stuff going on down there. And instead, I mix it. So first of all, I use a really pure like supplement from a company that you know, you can do your own research and find one that you like for yourself, but I researched out found a really pure supplement. And I have to take the iron within a sorbic acid at the same time. I do that it absorbs great if I take just the iron tablet without the sorbic acid won't won't work. Yeah, that's it. There's a over the counter when called via Tron or by Tron D or something like that. It's it's iron that comes with it. C, Vitamin C. Okay, gather that helps that too. But yeah, these are the kinds of things no one's going to tell you about. Or they're just gonna blurt out. We're testing for vitamin D Now, then you come back, quote, unquote, in range, and they don't give you one anyway. And you're like, wow, this was a lot of fun. So anyway, everybody balanced your body, balance your insulin. things should get better. That makes sense. All right. Thank you, Jenny.

Jennifer Smith, CDE 1:04:30
Yeah, you're welcome. Absolutely.

Scott Benner 1:04:38
Let me thank Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. I'd also of course like to thank Jenny, you know, Jenny works for integrated diabetes. So if you want to learn more about what she does for a living, you could even hire her. You go to integrated diabetes comm I think there's even a link in the show notes to email Jenny, but I don't remember I haven't looked in a while. You'll find out, just go route around, see what you can say? Would you like to see if you're eligible for a free 30 day trial of the Omni pod dash, go to Omni pod.com forward slash juice box. And of course, to learn more about the Dexcom g six and to get started, it's dexcom.com forward slash juice box there are links in your show notes, links at Juicebox Podcast comm or you can just type those right into a browser. Since we're at the end, and you're still here, let me tell you a little more about the diabetes pro tip series. First, I'm going to read you a couple of reviews, all from Apple podcasts, this podcast that changed my life, I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible and practical management approach that is taken my agency from 8.3 to 6.3 in less than six months. And that's just right now, it's going to keep coming down. Thank you, Scott, I'll be quoting you forever. My son was diagnosed with type one about five months ago. And I've learned so much from just the pro tip shows and we'll be listening to all of the episodes. This podcast is amazing both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel. And more like you can find ways of keeping your loved ones happy and healthy. And finally, I saw I mentioned this podcast and one of the Dexcom g six groups on Facebook. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years. I wish I had been more proactive in finding the information sooner. I'm going to recommend this to my endocrinologist. So that's a little bit about the diabetes pro tip series and the podcast from other people. You can just subscribe right now in a podcast player just hit subscribe if you're there, and you can listen to the podcast every week, three new episodes every week. If you don't know how to find a podcast player, there's tons of links to free ones at Juicebox Podcast comm where if you want to start with those diabetes pro tip episodes, or in my opinion, I like seeing you start with the defining diabetes episodes which are much shorter, and give you a good basis for all the terminology means and how to use it. All that information is at diabetes pro tip comm you can get there just by typing that into a browser. Or if you go to Juicebox Podcast comm there are links to the top one of those links as diabetes pro tip. start listening. I mean, wouldn't you love to send a review and that says my agency went from eight three to six three in less than six months would be amazing. So I hope you keep listening. I hope you enjoy the podcast. Thank you so much for checking out this episode. Please share the podcast with a friend. And don't forget to subscribe. Thank you so much. I'll be back soon with more episodes of the Juicebox Podcast.

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#469 Week 19

Lisa discusses her son’s life with type 1 diabetes.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa 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 friends and welcome to Episode 469 of the Juicebox Podcast.

On today's show, Lisa is going to visit us all the way from Sweden and tell us a rather remarkable story about her son, who among other things, has type one diabetes.

While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If you're here looking for the diabetes pro tip episodes, they begin at Episode 210 and are also listed at Juicebox Podcast comm you just go to the top and click on diabetes pro tip or you can go to diabetes pro tip.com. But I wouldn't do that until after you hear this conversation with Lisa, because I think you're going to love it.

This episode of The Juicebox Podcast is sponsored today by the Omnipod tubeless insulin pump. By the Dexcom g six continuous glucose monitor and touched by type one you can find touched by type one on Facebook or Instagram were touched by type one.org. You can learn more about the possibility of a free 30 day trial of the Omni pod dash tubeless insulin pump at Omni pod comm forward slash juice box. And you can get started today with the Dexcom g six continuous glucose monitor@dexcom.com forward slash juicebox. There are links in the show notes of your podcast player and links at Juicebox podcast.com.

Lisa 2:16
My name is Lisa and I live in Sweden. And I probably don't sound so Swedish. And that's because I was raised in Northern California.

Scott Benner 2:25
I was gonna say your middle name, which I'm assuming is your maiden name. Is that is that your is?

Unknown Speaker 2:31
Oh, that's that's a long story.

Unknown Speaker 2:34
Like we don't have time for that, buddy.

Lisa 2:37
We don't have time for that one. But you're correct. My my. My second name is the name in Sweden, right? My Swedish married name correct. And I am I've lived in Sweden since 1988. I came here with a tech company and I have two boys and a husband and boy dogs. So maybe four boys and I am the mother to a 15 year old who was diagnosed with Type One Diabetes 11 months ago.

Scott Benner 3:09
Okay, so within this year, correct, gotcha. Okay, so within a calendar year, your 15 year old was diagnosed. Was that out of the blue? is there other? It was okay. You've I have some background here on you, which I you know, I'm just happy to tell people that I'm looking at and I think we should probably just pick slowly through everything I'm seeing here is your type one's life. Right? Correct. Okay, so did the issues begin? Before he was even born? How did that? Yes.

Lisa 3:44
So the second ultrasound week 19 showed a fluid filled cysts in the abdomen of the baby I was carrying. And so that's when it all started was week 19 of the pregnancy and it was some quite severe damage to the intestinal area, primarily the liver and the intestine. So they took him out early and did nine hours of surgery actually. The surgeons actually said they had to lay him on the table and call Japan to get some help so so he's kind of a miracle. And it's just kind of been a long story since then. I want to start off by saying he's a great joy and I call him my sunshine. He's very happy and great young, young person. But he has medical issues in his abdomen, so that would include liver intestines, and now even kidneys. He has we did some investigations. I didn't really know what was happening. And I did suspect maybe behavioral disorder autism spectrum, but it turned out to be a severe hearing loss and then also a mild to moderate cognitive disability, which the two together kind of mimic, he didn't hear what we were saying and didn't know what to do about it. And then some motors, motor impairment, and then 11 months ago with diabetes diagnosis from nowhere, do you. Okay,

Scott Benner 5:33
I have a couple of questions. Yeah. One of them's just gonna sound silly. And I don't mean to, but after the surgery, they don't put them back, right. You know, when you're making a cake, sometimes you need some work, and then you put it back in. But it wasn't like that, right? No, no. So he,

Lisa 5:52
they did they did this is arion, five weeks early. So we tried to manage it in utero. And I had really great medical care. Of course, again, I'm living in Sweden, and living near the capital of Stockholm, right outside, actually. And so really the highest quality medical universities and kind of in Northern Europe and maybe around the world, or 10 minutes from my house with both pediatric care and even like the diabetes care now and all the specialists and even when I was pregnant with him, so yeah, so I was really fortunate to live where I live, what's happening.

Scott Benner 6:35
So he, they perform this nine hour surgery, he's in an incubator for a while, I imagine.

Lisa 6:41
Um, yeah. He was in intensive care for a while. And then we that did the hospital for we came home to visit for the first time after about five weeks. And my father had come over from California to stay in our home with our older child who was turning four at the time.

Scott Benner 7:09
Gotcha. See, Lisa, if you're gonna know what I'm going to ask you before I asked you, then you can just get I get, I'm gonna go have breakfast.

Unknown Speaker 7:15
And you can tell me,

Scott Benner 7:16
I'm just getting ready to be like, How old were your other kids? And were they Yeah. But but so you lived in the hospital for weeks upon weeks? And then he came home eventually with you? Or you will when he's

Lisa 7:28
a kid? No, no, they never separate parents and children here, so and so we were put up there, they have parent apartments and in the Children's Hospital here, so we lived there. And we came home with him briefly for a visit just he was maybe five or six weeks after his birth, and then kind of back and forth. And then he got really sick at home. Another long story. Another long story, but he he got something called necrotizing enterocolitis. You guys call it neck NAC which is basically it can cause sepsis in the body. And so we had to go back in the hospital for quite a long time to try to see if he could repair that through not eating. So he was on IV foods for a while. So we were we were in and out with multiple surgeries and, and and attention for the first you know, year. And then he was Yeah, and then he was going blue at home. So I was given a mouth to mouth when we came home. So again, it's a lot of life and death early on. For us with him.

Scott Benner 8:43
Yeah, what is? Do you feel like you're a completely different person now than you were a year ago? Did you know so many things that you didn't know, prior? Like, how does it impact you? I guess.

Lisa 8:56
So I think that for me personally, you know, sometimes when you go through traumas, and you know heartbreaks and challenges in your life, or, you know, you you're impacted by them, and I had worked really hard to heal from some of those. I mean, I've had a lot of support through our medical system here with therapy. And I think when, when, when we get hit with the diabetes diagnosis, it sure didn't take much to crack the egg, if you know what I mean it I think I don't know whether I took it harder or easier than somebody who had never had a trauma before with a child. But we had gone through so much and we had worked so hard to you know, to get him healthy and to adjust our life and to give him all the tools and resources. I mean, even for the cognitive side and the hearing side and special schools and we really we're getting somewhere and then to have this hit us the last the last 11 has, I think in some ways tougher than the first time we went through the medical challenges? Well, you've listed a number of things, I think any of which, on their own would be

Scott Benner 10:14
a significant hill to climb, you know, and then there's just one on top of it. Other ones have another do each of these. And I'm assuming, like, each of these things, when they need attention from a physician, it's a, it's a separate visit somewhere, like is much of your time spent. Seeing doctors.

Lisa 10:35
Yeah, that's a really astute kind of understanding that you get that I don't think a lot of people do understand is that when you have so many very rare issues to deal with, and such a number of them, and there's no known profile, then yeah, they're there. Everything's pretty separate. I mean, and and what it does on top of it is that a lot it, it makes the responsibility for keeping it all together on me and on our family. So I'll give me an example. And I might be getting ahead of this. But we had for the first time ever, an infection at a pump site last week. And I, of course, who do you contact for an infection in the pump site, and I sort through all these Facebook groups and internet forums, and I think, okay, it's our primary doctor. So I contacted our primary family doctor, and and she said, Well, maybe you should contact the diabetes nursery or doctor, and then if they think it's okay, all right out the antibiotic. And then I remembered, oh, gosh, antibiotics deliver specialists, they don't want us to give them these three antibiotics. But this one's okay. And in the end, I had to take the responsibility to tell our doctor, I want you to write out the prescription and the weekends coming, it was actually just a few days ago. And if it gets worse, I'm going to give it to them. But if not, I'm not going to so a lot of the responsibility ends up being here at home with us. Yeah,

Scott Benner 12:12
I would imagine that each of these things is sort of like diabetes, in that they give you some information, and then you have to make on the fly adjustments with it. And I just was thinking about the, you know, I mean, we're trying to manage our way through things with Arden that are obviously not nearly as significant or severe as what you're talking about, in many cases here. But it's one doctor over here, you know, and one doctor over here, and then the third one in the middle, and they don't really talk to each other, they'll send like their notes to each other. But you know, I don't know what that means. Exactly. And then, you know, at some point, like they give you some kind of marching orders. And then the rest of it, it's inferred. It never gets said out loud. But it's always like, okay, you take care of this, figure out what you're seeing and report back to me. And then we'll take the next step, which which heartbreakingly is often not the step that gets you to where you want to be. It's, it's like, I don't know, it's like, you're absolutely in the dark, and someone throws a flashlight on the floor, and you're just feeling around one hand printed at a time trying to figure out where the flashlight is, and and then you find it, the batteries don't work is to

Lisa 13:26
figure out what's causing what's causing the symptom or what's causing this not to work the way it should work. And, and it's, it's like a medical mystery every day. And then, you know, you said something smart about, it might be like diabetes. And I would say that diabetes is today's management of diabetes and how we're managing diabetes with the CGM and the pump and the data and, and the knowledge. It's actually quite unique. I would say the other conditions that we deal with are maybe like how diabetes was managed. Before CGM. So we're kind of blind as to how is this medicine helping the health of his liver? Like I can't I can't track that every five minutes at home. So. So diabetes is somewhat unique with with what we have now.

Scott Benner 14:16
There's so many like user tools that don't exist with other issues. Yeah, right. Do you see a lot of ghosts meaning while you're trying to figure things out, you find yourself I find sometimes that I spend three, four or five weeks chasing down a thing and you get to the end, you're like, oh, that was nothing. And you're just like, Oh, my God. And then I do this. I here's something I end up doing, and I'll ask you about it. Sometimes I just reset for a minute. Me personally, I stopped thinking about it, even though we haven't found the answer. And then that makes me feel guilty.

Unknown Speaker 14:55
Yeah,

Lisa 14:56
yeah. I am so honored. On top of the diabetes management that I ended up in, in the cardiac intensive three weeks after his diagnosis, so I'm chasing, I thought I could control an uncontrollable disease because I was used to being able to control math. And I work in in medical technology products. And so I put myself in the hospital with no underlying cardiac conditions. So I, you know, at a pretty young age in pretty good shape and, and so now, what you say is, as I'm chasing what's going on, I am getting better right now is 11 months in, I am sometimes saying, screw it, I'm going to bed now. Like, I'm going to live with that value. For now, you know, I just like so I'm getting better kind of saying, you just also have to live through this.

Scott Benner 15:57
We say your special kind of type A, aren't you?

Lisa 16:01
When it comes to math? Yeah. I mean, when it comes when it comes to algorithms, and I mean, that's, that's my background. And so watching trends and seeing curves, and, you know, the sugar surfing protocols, and all those types of things. And that's really interesting to me if it wasn't my kid that's like, this is like my dream job is being an artificial pancreas.

Scott Benner 16:23
Yeah, until it's for your kids. And it's not my kid. Yeah. No, I You should hear me talk to people privately. I'm so loose. I'm just like, do that. Try this. Why don't you do that? Why just think that they're like, what I'm like, No, there's part of me, that's just trying to imply that you have to chill out a little bit, you know, because it just isn't going to come together as quickly as you want it to end when you get so tight. And I think to micro you know, with your vision, then you miss other things that are happening that are valuable, you're always kind of hitting yourself hard saying, Oh, I messed this up, or I didn't figure something out or something happened again, that went wrong. It's too much for a person to take. You really, you really can't do you can't sustain it. I mean, you didn't make it three months, it sounds like

Lisa 17:13
no three weeks, I ended up in the hospital three and a half weeks after the diagnosis. And it's called the takotsubo. It's a stress induced heart failure. So there's so many the adrenaline and the cortisone and they're called catecholamines. In the body, it was a surge of stress hormones, and it basically paralyzed my left ventricle. And it's a rare condition. And you know, typically it happens people that have been married for 60 years, and they're both on their deathbed holding each other hands and one passes away, and then the other passes away, like 10 minutes later, right? That's generally when a takotsubo happens. That's in general, when people get them,

Scott Benner 17:55
we start to tell people not to marry men from Sweden, is this.

Lisa 18:01
What I want to go back to you said about you telling people like, try this and try that. And I, I think that's really what made a difference for me, Scott, is I that that I want to go back to that because I want to tell you what your podcast and that attitude did for me. But before I do, so, do you think we start out like that, because the medical professionals scare us into not daring to take take testing. And to like, try out things? Do you? Have you thought about that? I mean,

Scott Benner 18:36
have I thought about it? I've thought about it a lot. I I find myself wondering if it isn't just the nature of people to want to follow a rule or to be on a team. You know, I'm team low carb I'm team you know, keto, I do vegan. I you know, we love the I pump pumping is very important. Oh, no. MDI, like, everyone's got it. They want to be on a team, right? Like having a jersey on makes you feel good, because then there's other people, and you're not alone, this whole thing. But then there's the rules. The rules are the rules. People want there to be rules. And if you really step back and really look at society in general, there aren't many rules beyond a couple, right? Like, you know, you don't treat people poorly, you don't kill people hurt people steal things. You know, that's pretty much it right? The rest of it's just common sense and calm. And when you think your life is moving the way that it's supposed to you stay calm. And you follow these couple of basic rules. And for the most part, things work out about the way you expect. And that's what people seem to be able to handle and you throw them into this. This medical situation where nothing they're seeing is making sense and they want the rules. so badly. So then the doctors give you the rules.

Lisa 20:02
And the doctor in this society is not to be questioned often by people or they feel that they don't have the knowledge necessary to question the doctor. Whereas we're the ones that know our children and ourselves the best. And that's what I learned through all the other challenges all the other medical challenges over the past 1516 years is, I have always questioned what the doctor says.

Scott Benner 20:29
And when people do find time to challenge like they, they kind of get the nerve to challenge something very frequently, at least in this space. As far as I can tell, they pick the wrong hills to die on, they challenge the wrong things, they, because they're seeing, they're seeing so many ghosts in their diabetes care, they can't make sense of everything.

Lisa 20:51
I want to give you an example.

Scott Benner 20:53
I had one, but I want to hear you.

Lisa 20:55
Because I so I learned to be aggressive and bold with insulin, you know, through the podcast tonight. And I and I back it up with math. And so I feel, you know, quite confident in what I'm trying to do. And I generally take like a concrete situation. And I'll like back it up, for example, in the evenings when our son falls asleep, we fight rises, and I've come to determine it's a combination of growth hormones, and also late digestion of dinner. He's a huge eater. I mean, he he eats massive amounts of food every day. And so I was trying to adjust, you know, that from 9pm to midnight type timeframe and am I don't ask for much help from the Diabetes Center. And but I really wanted to get aggressive and I thought, Oh, can I really do that? Like I wanted to almost like double his basil, you know, those three hours and, and I called the nurse. And I literally shocked her because I said, I think I want to double his basil rate for three hours. And she says, Oh, well, we we recommend only doing 10% changes at a time and then waiting three days. And I was like, Thank you Bye, click.

Scott Benner 22:05
So the thing that I most frequently say to people that that they just can't wrap their head around is here's the scenario right? There, Basil is too low, they don't know it. And they miss on their meal insulin, so their blood sugar shoot up. So they have a lot of spikes a lot of highs then later they crash low. And then they put in food and they spike and they're on this, you know, it's never ending. It's a roller coaster. And so I'll get ahold of somebody and say, there's like we haven't, we're having a lot of lows, what would you do here? And I say you need more basil. And so now I've said more insulin, right? And they're like, No, no, like, it can't possibly be more insulin because the blood sugar keeps getting low. And that would indicate too much insulin. I'm like, no, that indicates poorly timed insulin. And that now your three steps into this situation. And I haven't said this on the podcast a lot. But you get much more past three levels of thinking. And you begin to lose people. There's there's a lot of balls up in the air. And you have to remember how they're all impacting each other. And I'm not saying that you could put me into a different scenario. And I'd be some great thinker. I'm just telling you that around diabetes, I can see all the balls up in the air like diabetes, to me feels like the end of the matrix. When Kiana figures out how to slow the bullets down.

Lisa 23:33
Yeah, and your daughter is very fortunate to have someone who gets that and I feel the same way about our son. But what I often feel is I feel so bad for those kids who have parents that don't understand the all of these complex factors together and they're getting this very traditional direction from their diabetes, you know, resources on I just, I see these curves. I know I've heard you before Scott, you're like, oh, man, I just couldn't not say anything. Like when you see something and you're, you're like, I just couldn't not say anything. And I don't ever say anything to anybody because I don't have the energy to spare beyond brushing my teeth right now.

Scott Benner 24:21
Are you sure you would get the tacos to be again, or whatever it's called?

Unknown Speaker 24:25
Yeah.

Lisa 24:27
Do you know that's the Japanese name for a device they use in Japan for catching octopuses. It's the shape of this almost like a it's like a vase. It's like a it's an octopus catcher. It's called a takotsubo. And it's the shape that the heart gets when it has this left ventricle failure.

Scott Benner 24:46
Okay, so at some point, a doctor saw this on an image and thought that it looks like the thing that catches the octopus.

Lisa 24:52
I mean, whoever that was, must have been catching some octopus.

Scott Benner 24:57
So I don't want to get away from what you're saying. And I have something I want to get by as well, but first of all it a long time ago, I came, you know, to the conclusion, as we all probably should, that you cannot just go out into the world and fix everybody or help everybody and is really sad to see someone struggling and walk away. And I will tell you that for me, it feels like, it feels like I came up on a car accident. And I could get them out. But I just decide not to. And I leave. And so when I say you

Lisa 25:30
wait for the paramedics to get there, and then you leave

Scott Benner 25:32
well, but but the point is, is that I wouldn't leave a car accident, but at some point, with my life being intersected with social media, which by the way, I don't particularly enjoy. And and somebody new comes every five minutes, and I look and I think I could fix that. And I don't have time. And and

Lisa 25:53
around the corner last night and there was this old man in a wheelchair outside and he and he was like trying to push himself up a hill. And I said to my husband, oh, I want to get out and push him. And he looked at me like I was crazy. I said, I want to get out and push him and he said Lisa, you know, you can't get out and push every single person that goes by in a wheelchair.

Scott Benner 26:12
Yeah, your life, your life would literally become about constantly about other people. And, and so listen to me this podcast, if I'm wrong, I'm wrong. But I think if you listen to this podcast, you'll understand how to take care of diabetes when it's over.

Lisa 26:26
I totally agree with you, Scott. And if you can actually take it in, I mean, sure. But yeah, I agree. And it changed it for me too. You know, it did, I had I had read in the hospital, we were only in the hospital two days with the diagnosis and I had already read through the whole sugar surfing, you know, website and I had ordered things like a pancreas and pumping insulin. And then I just met, you know, just child through all of that ended up in the hospital and started listening to the podcast. And, and as I was afraid this, you know, around three, four or five months into it, when I had this horrible fear. You really changed it I you know, I you really made me feel bold. So thanks.

Scott Benner 27:20
If you're interested in the insulin pump that my daughter has been wearing for ever since she was four years old, or the glucose monitor that she's been wearing for ever, since she was six, maybe a long time, then you're gonna want to know about the Omnipod tubeless insulin pump, and the Dexcom g six continuous glucose monitor. Let's start with the Dexcom. The Dexcom g six is a glucose monitor that gives you readings and data in real time. You can get them on a receiver or right there on your iPhone or Android phone. This is beyond exciting. And if you're not excited by it, then you don't understand what it does. Try to imagine seeing your or a loved one's blood sugar in real time. And not just the number not just she's 89 or 53 or 120. But what direction is that blood sugar moving? Or is it stable? And if it's moving in a direction? How quickly is it moving? That's the kind of information that is next level. That's how you make ninja level decisions about using insulin and type one diabetes. At least that's how I do it. And I think you could check it out@dexcom.com forward slash juice box. You can get started right there or just getting more information but one way or the other. You need to start looking. I just opened my phone. My daughter's blood sugar is 104. There's a little boy named Dominic. I'm watching his blood sugar today. This is 106 both are stable. not crazy. You could do that too. You could do it for a husband and a wife, a friend, mother, a daughter, a son, anybody you care about. Think about the possibilities. A school nurse could watch if you want it or not. It's completely up to you. And how do we give my daughter the insulin that made that 104 blood sugar? Well, we do it through the Omni pod tubeless insulin pump. It is tube less. I know that might be like if you don't have a pump right now like does that matter? But it does. Other pumps have tubing. So there's an infusion set on other pumps that goes into your skin followed by a long tube that has to snake through your clothing or whatever and then goes to a controller where the insulin is and where the buttons are. With on the pod. Everything is in one small pot. You put it on and then you tell the pod what to do from a wireless tubeless controller. It is very small, sort of like a cell phone. The great news here is that some of you will be eligible for a free 30 day trial of the Omni pod dash and that is available at Omni pod dot COMM forward slash juice box, go and check it out free 30 days of using an insulin pump with no strings attached and no tubing attached, but you don't have to buy it. If you do the thing in I mean, you could do the 30 days and be like I don't want it. That's not a problem. There's other stuff at that site too. You could also get a free no obligation demo pod, which would just be one nonfunctioning pod for try on and where just see if you dig it or not. So maybe you'll start slow with a nonfunctioning demo, and then move up to the on the pod dash trial. Who knows, there's only one way to find out on the pod.com, forward slash juicebox. And please don't forget, touched by type one.org. and define touch by type one on Instagram and Facebook. They do amazing things for people living with Type One Diabetes, they're a great org. And I hope you check them out. There are links to these and all the sponsors in the show notes of your podcast player, or at Juicebox. Podcast calm, please remember, when you click on the links, you're supporting the show. So I'm not saying just click on them. But if you're looking for a pumper CGM, or to help an org or glucagon that comes in a hypo pen, or the most accurate blood glucose meter I've ever seen in my life, I'd appreciate it if you did it through my links. Thank you very much. Let's get back to Lisa.

You're very welcome. And I'm super happy about that. I have to tell you, you named a number of things that I know people really like. Think Like a pancreas, that book is incredibly popular. Pumping insulin. I know some people really love sugar surfing, I've had Dr. ponder on the show. Yeah, I know. I've listened to it. But I've never read any of those books. And if I read those books, not those books, forget those books for a second. If I read a book, I just know how my brain works. If you told me Hey, the answer to diabetes is in these books, I would think oh, well, I'm never gonna figure this out. I'm just not it doesn't work that way for me. And I don't think this podcast is for everyone. I think there are plenty of people who can and will read think like a pancreas. And they'll just be like, Oh, that's it. Great. You know, but I think that the thing about the podcast is that it's alive. You know? And so when people ask me, can you write a book about diabetes, which people ask me constantly about, I'm like, that's a waste of time. The podcast is the right way to do it. Like conversations with the right way to do it. hearing things, explained multiple ways by different people. Until the thing that gets to you gets to you. And you're like, Oh, that's it. I understand. Now, this to me is the way but once you write something down, it's static. And then something changes, you start wrote

Lisa 32:32
down, if you wrote down the things that are being said in this podcast, you probably get sued.

Scott Benner 32:39
Well, you know, hey, not for nothing, too. I'm not a doctor. All three of those books are written by people with degrees. Yeah. And so you know, and not even just that, I think, but if I wrote it all down, it would either be a million pages of text, or it would be too, because there's part of me is like, really believes when I tell you like this is all timing and amount. That's it, you just have to use the right amount of insulin at the right time. There's no nothing else to it. There's Don't get me wrong, there's a bazillion other variables. But as you start experiencing them, them, you eventually just figure out Oh, this is potato chips. I get this now. And this is when they're playing ice hockey, I understand now. And you just you grow into it. I would tell you that if it wasn't for this podcast, I don't think I would. I don't think the word diabetes would come into my head maybe once a day. Because it's just easy at this point.

Lisa 33:39
And I think you guys are looping still, right? You're still

Scott Benner 33:42
Yeah, it but I felt that way prior to that as well. And, and the loop just kind of tightened everything down a little more takes out some of the, you know, you know, when you're just looking at a 97 blood sugar, you're like, this is great. And then all of a sudden, it's 130. And you're like, Huh, what happened? Like those, those kind of moments go away. You know, I

Lisa 34:04
ordered I ordered them rightly links from the US that have arrived and I was gonna build and I decided to postpone it now because number one, our son who has you know, a learning disability and, and all the other issues and he's actually getting pretty good at like, using the PDM 80 style PDM you know, on the old on the old Omnipod. Now, the people around him during the day are also you know, understanding when I tell them I mean I'm managing diabetes by SMS to adults that that are around him and he is gaining some self I wouldn't say not self care, but but he's able to understand like, Oh, this is what I'm supposed to do when she says you know, put a tent Bissau lawn and so I decided to postpone it primarily because of that, but also because I I feel like I've got such tight control right now that I'm going to have to go through a period of relearning and re testing all of the factors. And so I haven't done it yet.

Scott Benner 35:09
Yeah, you don't seem like the kind of person who should pick up a hobby. You know, I'm gonna try woodworking, or you know, and I'm looking at our graph, and it's great, you obviously know what you're doing. And it Listen, honestly, had one person not badgered me so harshly to try this algorithm, I had no reason to do it, I was never going to do it. And it just was, she said, like, I really think that people in general would benefit if you understood how to use this. And I agree

Lisa 35:42
with that. And I and I had planned to do it. And then I chose to at least postpone for for different reasons. And, but I do manage his diabetes quite a bit like Luke does, I am using temp bisol, you know, a lot. And I use that a lot as a big tool, kind of as loop is adjusting the bisol a lot. So. So I do I,

Scott Benner 36:05
I was I was an algorithm for many years on my own. And it just helped me, it helped me understand like, it's now like, when I when people ask me, like, how do you excuse me, when you you see a high blood sugar with loop? Like, how do you get it back down? Because the the algorithm does not want to come down quickly. Right?

Unknown Speaker 36:27
I know you open it, don't you?

Scott Benner 36:28
Yeah. So I basically tell the loop. Okay, you go away now. And then I

Unknown Speaker 36:32
carb sign I

Scott Benner 36:32
do. I don't even fake carb. I just put in a bunch of insulin. And I and I know where in the drop to close the loop. So that levels off? Yep. And if you think that's something magical, it's not I just did it a bunch of times till I figured it out. And people are like, Well, you know, they would ask them, well let what number do you turn it back on? I think it would be different for every person. What I'm saying is, is that I did it. I watched the graph. Yep. And one day, I was like, Okay, here. And when I say here, again, I'm not saying a number. It's a visual. Like I look at the line.

Lisa 37:08
That is so interesting, because that's exactly what I'm looking at every, every moment with, with the diabetes management. It's not about the number for me, like I've never had, like, I don't like have a number goal. What I have is I want it to be as little variation is possible.

Scott Benner 37:26
Yeah, you're just flying an airplane, and you want it to be smooth. You want it to go up smoothly and level out smoothly and come down smoothly and level out smoothly. Excuse me, let me take a drink for a second. At one point, Dexcom sort of changed their graphics on the follow up. And I had them on one day and I was like, don't do that. Like don't make it look different. I know what this looks like. And I was in a panic for a second. But you know what? I see it the way it is now too. They could change as much as they want. I could keep figuring it out. It doesn't matter.

Lisa 38:00
I don't use follow a nearly at all.

Scott Benner 38:03
Are you using sugar mate? Sugar, mate? Okay, yeah, and I have that as well. And I don't look at that as I need. I like Dexcom follow for the line. I like sugar mate for kind of the information that's on the front page of it a lot. I'm actually getting ready to do something that I think I might be, I might be doing something with sugar mate coming up. Which will probably happen before they put this out. So I'll tell you, I'm going to wear a G six and broadcast my blood sugar's live on my blog. And then I'm going to tell people when I'm eating and what I'm eating so they can see how a pancreas handles the different situations. Because I think that information will help them understand their kids and themselves.

Lisa 38:51
Do you know we use we use candy called Mentos if if if we have to treat kind of an aggressive following blood glucose, we don't have lows, but but essentially physical activity and then you know, trending down and we don't use. We don't use glucose tablets. So Mentos has glucose in it. That's the Skittles, what have you and and so I decided we came home from summer vacation and there was a half a package of this Mentos candy left. And I was kind of I don't usually eat candy, but I just thought well, I like to have those and I so I ate half of a role. And then I was just I had this like epiphany. So I went and I got the band tested my blood sugar. And I mean, I was super high. I was like what's that in? 8.8 times eight.

Scott Benner 39:39
I have my finger right here. So you were 8.8 by 8.8. This is a team Xbox 160 Yep, I have it at 158 there's a beautiful I don't know if you saw it but a listener built this. This calculator that does a one C and blood glucose. So like I I'm on. How do you say it? Is it mimeo? How do you guys say MMO? l do millimole millimoles. Okay, so I just put in 8.8, it immediately told me that that's in America 158. And it tells me that if your average blood sugar is a point A, it will come to an A one C of 7.1. And that was

Lisa 40:22
after a half, half a package, like maybe about double what I would use to treat it, you know, drop with him,

Scott Benner 40:28
right. And your functioning pancreas is in there fighting off those Mentos. Right,

Lisa 40:33
I test 5.1 Exactly. All the time. Like, whenever I test, I'm just at 5.1, whenever I see, well, is 91.8.

Scott Benner 40:44
And that gives you in that situation, I'm assuming gave you a real idea of Oh, that's why Mentos stopped drops so well. Like they're really fighting

Unknown Speaker 40:55
rocket fuel, fuel.

Scott Benner 40:57
It's funny how everybody just thinks of it differently like, but in my mind, it's sort of just like these opposing forces. It feels like a cartoon to me like fire like a flame thrower on one side and a flame thrower on the other side, and they're just blasting at each other. And they kind of meet in the middle and dissolve and like, that's how I think of the sugar coming in to press against the insulin that's pushing down, and then it pushes back up until they kind of you know, they both go off. And hopefully you're left about where you mean to be. I don't know. I can't imagine. There's What do I want to say there are not many other places in my life where the way my weird brain works about things, or people are like, Oh, this is very interesting. And I should listen, I can't believe it worked out for diabetes, of all the bizarre things I honestly can tell you that that this is my podcast still confounds me. Like, it doesn't seem like I should be the person doing this to me even. But

Lisa 41:51
thank you revisit, you're a visual learner and are like a picture learner. And I am a person who I have to draw when I have to circle and move. I just recently went to law school, you know, it's free here to go to university. So I'm an engineer, but I just went to law school right before this, this diagnosis and all the young kids, you know, they're like typing in a computer. And I hand wrote on paper, because that's the way I learned and your way of learning and communicating works really well in this kind of visual interpretation of the blood glucose trends and levels on so I get it. I'm also very visual. And I think that's why it works well for me, too.

Scott Benner 42:30
Yeah, it's crazy. You know, every time you mentioned Sweden, I think of the chef from the Muppets. I'm like,

Unknown Speaker 42:34
Oh, that's funny.

Scott Benner 42:35
I'm like a seven year old, like, I can hear it in the back of my head doing like, I'm trying to keep up with our conversation and overwhelmed, doing be doing in that's going on. And

Unknown Speaker 42:46
I don't even love The Muppets.

Unknown Speaker 42:49
Anyway, back

Lisa 42:50
to Sweden, I was thinking, when I was preparing, just kind of where I'm at with diabetes management, I thought to myself, because I had to relive this a bit just kind of thinking about talking to you. And I thought, wow, I couldn't imagine going through what we've been going through the past 11 months and having on top of it the financial pressure of insurance questions and insulin costs and things like that. I I really thought hard about that today that I couldn't imagine feeling any worse than I felt going through this, this first, you know, adaptation to life with a child with diabetes and, and just the thought of people, you know, not taking insulin they need or not having access to the medical technology they need, or being afraid of losing your job. First, in the first hand, in the second hand, you lose your insurance on top of it during these times. And it's like it's inhuman. I mean, we it doesn't cost anything, nothing related to our son's medical care. And especially with diabetes. I mean, nothing is a cost for us straight out of the pocket. So I don't have to pull insulin out of a pump that goes bad or there's no insurance.

Scott Benner 44:14
You'd have to fight comm or anything like that.

Lisa 44:17
Oh, no. I have the G six on him two weeks after diagnosis in the Omni pod about seven weeks after diagnosis. Terrific.

Scott Benner 44:25
It really is. What kind of insulin does he use?

Lisa 44:29
He uses he uses what would you guys call it as it called Nova log. It's nobody there.

Scott Benner 44:38
So it's no is it? No volin there or novo novo? No, you call it something completely different? Yeah.

Lisa 44:44
He in the beginning he had you know the when he was on MDI, he had I think you call it a basketball or we call it a basketball. So we had basaglar and novolog. And now he just has of course no vlog.

Scott Benner 44:57
Yeah, that's amazing.

Well, how is I don't want to make you upset, I guess. Are you okay? Like, how did you? How did you get to okay?

Lisa 45:14
What's a lot of support? I so, you know, I think the first few weeks for the first month was I can control this, I can handle this, just like I've handled everything else that's come our way. And I was somewhat, you know, like magical about it about reading and I wanted to know everything there was about diabetes, everything there was to learn. And that was my, that was my mode, that put me into the hospital. And then I was forced to chill out and ask for help. And then I ended up referring myself to psychiatry care. over the phone, I call them said, I'm concerned about my mental health. And I got help. So I a combination of just having, you know, therapist contact me twice a week, and some medication and some help asleep. And then with time, so they tied mostly with something called adjustment disorder, like and I remember the doctor saying that the psychiatric doctor saying, Okay, well, Lisa, you're going to feel better in about nine months, you just like the body has a great ability to adjust again, and we're gonna do all these things to get you there. But you will feel better. And I, I could, I never thought I would. But I did, we did have summer vacation. And I think just going from diagnosis to putting him into an environment with other people that didn't understand what was happening, and then trying to manage his diabetes remotely. And he goes to a special school in another area of the city. He rides in a taxi three times a day to special schools and care programs. And so I was having to, like take care of him, but I couldn't see him and I couldn't touch him. And I couldn't see the food I had to. I had to like use the pictures they were sending me and the weights they were sending me. And so that was just like this intense demand on me both workload wise, emotionally brain capacity. And then once he was on summer vacation, and I kept saying, why don't you just stay home with us when school was out? No, I want to go to my after school program, he wants to go and be with, you know, friends and, and with these, these mentors that lead them and when he got home, and when I got six weeks with him 24 hours a day. I just think I just healed me. I just got to share with him some more. And when I sent him back to school, when school started the end of August, I just I felt calmer. And he understood a bit more from his time with me and with us. together and I just so far. So, so far, it's only been what, five or six weeks since school started in this kind of like, energy. I got refilled during the summer. I mean, it's still lasting. So I'm feeling better. But it was it was touching go there for a while. I was concerned about myself. I was shaking, most of the time.

Scott Benner 48:21
Yeah. I told my son recently that with us all kind of living on top of each other because of COVID. And him being here instead of being a college, I said, Look, I realize how much you're missing. And I'm sorry that this is your experience right now with college. He's now in his bedroom, taking classes. But I said I'm going to look back over this time and be so thrilled to have this extra time with you. And and I I feel better when he's here. Yeah, I don't really know another way to say it. Like I just eat seems right that he's here. Now I'm

Lisa 48:57
going to start crying our older son just left for the university, just

Unknown Speaker 49:03
trying to learn things.

Lisa 49:05
No, I mean, he he just left and moved to the other side of Sweden to a university. And so this is the first time our older son has ever really lived someplace else for a period of time. So so now that your son's home, our oldest son left no,

Scott Benner 49:21
he'll be going again soon. He'll be out of here pretty soon there. He was talking to his coach the other day and he's like, I think you guys will be back in the spring and you know, so I feel like after the holidays he'll he'll be out of here. But how far did your did your child go to?

Lisa 49:37
Let's see Sweden is the same size as California length and width. And so if you imagine we live on the very east, east side of Sweden, and he moved to the very west side so that distance from you know one edge of the California State to the other edge, it's it's about five hours by fast train, or car, I think Yeah.

Scott Benner 50:06
Do you feel like you'll be able to visit him at all? When he's there is that is there a reason to?

Lisa 50:11
Well, my husband, you know, helped move him and his, his girlfriend there. But with, with how life is right now here with our younger son, I haven't been there to visit yet I just basically got brave enough to start kind of being in other environments with our son that has diabetes that it took me this summer, it took me about a half a year for me to actually grab up all my diabetes supplies that I have pretty good control of at home, and take them to what we call our summer house, which is another home that we own. It took me about a half a year just to just to do that.

Scott Benner 50:59
So I want to dig into this if you could, yeah, so here's why. Because I couldn't get in my car and drive to the store for the first year. Because I was like, What if something happens while we're in the car? You know, and that's kind of where I'm at. But it's funny to hear you say it. Because for 14 years, you've been in charge of all of these special needs. Right. And and obviously your son's, you know, going to school and taking taxis and he has friends and all that's going as I would I don't want to say as well as can be expected. It sounds like it's going really, really great considering

Lisa 51:34
absolutely doing he's doing really well. But I did feel like that also in the beginning. Yeah. When things happened, and know when different things happen.

Scott Benner 51:43
So did your experience with all of the stuff that happened at birth, it wasn't able to inform you enough for you to ignore similar feelings around diabetes. Sorry, I

Lisa 51:57
think I think it's actually opposite of what you just said. I think it made it more catastrophic that when your body goes into like, like, with a post trauma diagnosis, what happens is like you're living kind of always the flight or fight mode is what you're trying to reason yourself through, right? And when the body just consistently is like, do I fight? Or do I take flight? Or how do I handle this, this emergency that's happening? You know, you're on standby, you're on high alert. And it takes a lot of work. And I had done a lot of work to try to not overreact to things that weren't life threatening. But when the diabetes happened, my body biologically just hopped really fast, right back into that, that's why I landed in the hospital.

Scott Benner 52:51
So instead of my hope or assertion that being through something terrible, makes you ready for it the next time, all I did was show you the path to terrible quick,

Lisa 53:03
logically, I think I think it's and I think logically, I was calmer than maybe a lot of people would have been that, that the doctors in the hospital when we had the diagnosis, like they saw me as someone who was really on it really competent, already reading everything totally at ease, like adjusting well. So on the outside, I was logically well suited to fight, but on the inside, I was weak. I was like weakened from all that I've

Scott Benner 53:32
already cuz you know what it feels like to be punched in the face. And so you're, you know, it's coming, that kind of a feeling.

Lisa 53:38
It's just the body's response mechanism. I mean, it's it's just, it's innate in us. So you're saying it's happened fast? You know,

Scott Benner 53:48
your statement? Is that it to me the definitive answer on this podcast about whether or not you should tell people Oh, you're the right person for this to happen. Right? Yeah. No one, no one's the right person for this to happen.

Lisa 54:00
And I used to always say, before this happened, you know, my people that know enough about us and that have seen some of my doctor, doctor friends. I mean, I'm surrounded by some brilliant, empathetic, lovely, especially women in my life here in Sweden, that and you know, really fabulous people, and some of them understand what we've gone through. And, you know, I'll say to them, they'll say, Wow, I'm so sorry to complain about this, because you guys have it so much worse. And I said, you know, we're all kind of dealing with a mean person that has a child with a fever and a cough and it can't get to see a doctor. I mean, they're stressing over it. It's not just because I've had more severe experiences doesn't mean that they feel any better than me when they're dealing with, you know, issues. But I think the thing with diabetes, I think, where I'm at right now, again, 11 months in I'm almost getting upset because I, I feel that people have this misperception really smart people have this misperception that they say, oh, but he has a pump now. Why? Why are you Why aren't you sleeping at night? Right?

Scott Benner 55:16
Yeah, the pump. But no,

Unknown Speaker 55:19
I mean,

Lisa 55:20
no one I literally I'm a person who was very rarely angry. I really don't feel anger on, you know, at all very much. But I really wanted like punch somebody in the face with a say that because they don't get it and I don't want them to have to get it. But it's like, diabetes is the most I'm thinking of the Swedish word for it. See, but what is that? It's the most unpredictable but it he knows all these factors and what what works today with that food and that time, tomorrow at the same time, and the same food is not going to work and be one day when he has physical education class. Maybe he doesn't drop the next day the same. Maybe he drops. It's just like it's so it's such a constant. constantly moving target.

Unknown Speaker 56:14
Yeah. What was the Swedish word? You were thinking?

Unknown Speaker 56:17
Oh, no, I don't need to.

Unknown Speaker 56:21
Do you don't want to say

Lisa 56:23
I don't want Swedes to hear me say no, I was speaking Swedish in my head.

Unknown Speaker 56:27
Don't say I hear you don't want people to hear you're terrible. Like, like,

Lisa 56:32
Swedish. Yeah, no, I'm still in Swedish. I just I just took a law degree in Swedish.

Scott Benner 56:37
I understood why you won't say it out loud. I don't care if you don't tell me why.

Lisa 56:41
Damn. And I said, all we're for rootsy bar. It was just a word that was non predictable. And it was just sometimes I think in different languages in my head and I don't know which

Scott Benner 56:53
I'm asking you to spell because I'm very possibly putting that in the title of the episode is

Unknown Speaker 57:00
unpredictable.

Unknown Speaker 57:03
What what? Can you spell it? Do you know it? Yeah. Oh,

Lisa 57:06
my gosh, I have to spell it with the sweet but the English pronunciation of the Swedish

Scott Benner 57:10
I'm googling just give it to me.

Lisa 57:12
Yeah. Oh, F. Oh, four. c? CFR. It's a it's a Swedish letter with two dots over it. I'll have to send it to you.

Scott Benner 57:25
Okay, perfect. Seriously, it's totally ending up in the title of this episode. So I just I heard you slip into your like, into like the back of your voice and you were like working through a word to another language. And I was like, This is amazing. Well, you know, I guess that as we're looking here, I'm looking in front of me. You know, your son's born he has all these different operations like right out of the womb, issues with his liver, his intestines, all this gastrointestinal stuff. hearing disability, I'm interested, does he wear something to help him? Yeah, he

Lisa 58:00
has a severe hearing loss. So he wears hearing aids.

Scott Benner 58:04
Do you sign with them at all? Or is that not? Yes,

Lisa 58:06
he went, he went to a sign language school up until fifth grade. Okay, so he's essentially Deaf when he when he doesn't have them on. So there's an issue like when he's sleeping? He can't hear a pump alarm? Sure. So I've had to go buy another baby monitor so I can hear pump alarms in the night from his bedroom. And so if he you know, showers or is in the hot tub or what have you and takes out his hearing aids, then we use sinus support. Yeah, so we had him in assigning school.

Scott Benner 58:34
So then I guess I, it's you told me he has an intellectual disability as well. But I'm, it's funny how my brain stops me from believing that because you understand sign language. But I know, it's just it's a you don't I mean, like, it's a weird, like,

Lisa 58:50
let me let me translate the disability, very concrete is that he'll never he can't, he'll never be able to rack the call. He drove to he'll never be able to calculate carbohydrates will never be able to, he doesn't really understand numbers. And if you ask him, you know, a basic question about x plus y he he's guessing. He doesn't know. So, but he's a super social. He's got great. You know, he's a super social open person who?

Unknown Speaker 59:27
Yeah, yeah,

Unknown Speaker 59:29
well, what and you also Yeah, good. No, no, no,

Scott Benner 59:31
don't be I'm wondering what's your what's your hope like, for his life? And does he think about that? Or is it just still with you? I mean, my 15 year old doesn't didn't think about what they're expecting for the life I'm not sure.

Lisa 59:46
Generally speaking, the lower the intelligence level kind of the more here and now you are so you don't worry as much and that's interesting with diabetes. You know, people talk about the dawn effect and the feet on the floor syndrome. I've heard you know, people talk About that, and his his ex, and that's because people wake up and they get stressed out about what's going to happen during the day, right? Like that's kind of like I woke up now all of a sudden my adrenaline's going, Correct, yeah. He's opposite. He doesn't worry. He wakes up and he starts moving around so his blood sugar actually drops. He doesn't have any feet on the floor effect at all.

Scott Benner 1:00:21
So what Lisa just told all of you, if you calmed down enough, your blood sugar will not go. How calm Do you think they need to get Lisa, do you think everybody needs to wake up stoned or what?

Unknown Speaker 1:00:34
Probably Yeah. Probably.

Unknown Speaker 1:00:37
Right now, I got a lot of cortisol going on over here in America. Just so you know.

Lisa 1:00:41
I do. I don't. It's not being American overseas. I can tell you is it is a it's a show. Sorry. I can't say that on this show. We can

Unknown Speaker 1:00:49
probably bout it's fine. You

Lisa 1:00:51
can see it now. So that's all I can say it to you and I just voted Oh, I just voted from here. So yeah, I'm not we're not going to go down that rabbit hole right now.

Scott Benner 1:01:01
No, there's nothing about diabetes in that. I'm just saying that I'm at a heightened sense.

Unknown Speaker 1:01:06
I know. I know. Me too. Me too.

Scott Benner 1:01:08
I'm not accustomed to talking about this stuff every day.

Lisa 1:01:11
Now. I don't I don't like to talk about all this stuff anymore.

Unknown Speaker 1:01:16
Unless I'm happy that your son doesn't think about it. I seriously.

Lisa 1:01:19
You know what you asked about what my hope is for his future? Yeah, if you forgot what you asked me. And I can tell you that that's probably been the number one one of probably the number one reason why I haven't felt well. It wasn't because I couldn't handle the diet, the management of diabetes, that the problem is what happens when I'm not managing it.

Scott Benner 1:01:45
What does happen?

Lisa 1:01:47
You know what happens, like who's going to who's going to keep his blood sugar healthy, like, Who's How is he's never, he doesn't have the motor skills to put on a pump himself. He doesn't have the motor skills to inject himself. And there's all sorts of help available here for home health. They, like elderly people who have diabetes here in Sweden, I mean, they don't move into facilities, they have home care that comes eight times every day. So someone comes to your home here, as part of you know, the community service and they make your food and they give you your medicines. And so there is that kind of base level of care here that you wouldn't maybe have access to in the US, but they're certainly not going to employ the methodologies that I do. And they're not going to be on hand. 24. Seven to, you know, I mean, I'm up at night and giving him a Korean What do you guys call it when you're correct? the correct direction? Not good. Not a court hearing you guys

Scott Benner 1:02:46
from California, Lisa? Good.

Lisa 1:02:48
I know. Like, like, I start my evening, I start giving him corrections. Once he hits about 7.5. That's once he hits about 135. After he's gone to bed, I start smashing it. And, you know, because I know, I know that once he starts rising, and it's just going to get harder to keep them there. So then they're not going to do that. There's nobody else is going to do that for him. When if I'm not around. So. So, you know, I, it's that's what that's what's hurting me.

Scott Benner 1:03:20
Actually, while I'm on, it sounds like you get to live forever. So that's perfect. Right? Yeah.

Lisa 1:03:25
Can you arrange that? Scott?

Scott Benner 1:03:26
I'll work on it. I'll call the podcast Council and put my powers before us here. Excuse me? Oh, sorry. I'm sorry. I just I don't know what happened. I was just talking. And suddenly, I didn't have a voice.

Lisa 1:03:42
live forever. You know, one of my, one of the other parents in some of the groups I'm with, I'm on the board of an association for people with intellectual disabilities. And she the parents are older, they're in their 70s. And she wrote this book, and she said, and the title of the book, which has been really hard for me is I hope I die first. I hope she dies. First was the name of the book. I was like, wow. Sorry, that was wrong. That they hoped that their child died before them because they weren't going to be around to take care of them. So it is it's hard. You know, it's hard. Like, I mean, your daughter's gonna be able to manage her diabetes on her own as she's an adult and our son won't. And so that's, that's what's hard.

Scott Benner 1:04:30
I can't tell you that. I understand that I understand it intellectually what you just said, but on a feeling level. I don't I don't know how to wrap my head around that other than I mean, either other than to say I can understand the sentiment and because I mean, I don't I'm not trying to make you upset, but there You're right. No one's gonna care the way you know. No, yeah.

Lisa 1:04:50
And maybe but now I'm trying to say well, maybe if I get him maybe if I take good care of myself and I get him to, you know, 15 if I get him to 50 or 60 with really Excellent, you know, diabetes management, maybe we've avoided you know, that the a lot of the damage that can happen and then six, you know, 5060 plus with just kind of like the old style static diabetes management, maybe he'll be okay. I mean, you know, people, you know people manage like that. So the other

Scott Benner 1:05:17
side of that thought is that 35 years from now, I would imagine, I would imagine things are much different than they are right now

Unknown Speaker 1:05:23
in 10 years. I

Unknown Speaker 1:05:24
agree with you,

Lisa 1:05:25
I agree with you. We'll have commercial systems that'll that'll loop. And that'll do good enough, right. It'll be good enough, even if the highs take longer to bring down on a on a loop system, and they're not as aggressive. It'll be good enough.

Scott Benner 1:05:39
Yeah, I think Well, listen, artists, we tried fasp different insulin.

Unknown Speaker 1:05:44
Yeah, I saw that I

Lisa 1:05:45
haven't, I haven't seen what you thought after just the initial,

Scott Benner 1:05:49
I don't imagine we're going to be able to keep up and keep using it not it's working terrific. But it burns every time she gets it. And so it's irritating to just to wear the pump because it's always in the same spot. And she's always getting basil. She's got this background irritation that she says is not pleasant. We're trying to get through to vials to see if it if our body somehow builds a, you know, a way to help it. But I'm afraid if the body builds a resistance to the burning, it's also going to build a resistance to how the insulin works. I'm not I'm not I'm not sure. But she's toughing it out to try it. But we had to give her like a 15 unit Bolus the other day. And the entire time the Bolus went and she just held her arm and she was like this is not good. And so she's really being a trooper to get through it. Having said that, it works more quickly. And she has fewer lows, and she wasn't having that many lows to begin with. So it works really well. And at the same time, I don't know that we're going to be able to keep doing it. Which is

Lisa 1:06:51
nice. It's nice. She lets you use her as her personal Guinea guinea pig.

Scott Benner 1:06:54
I told her I was like this is you know, it's the real reason we tried first was because she has these muscle aches and joint pain sometimes. Right? And I just we're down to like what we were talking about the beginning of the episode, we're down to like picking through the minutiae, trying to find something that helps her. And so I just said, Look, there's probably preservatives in a pizza that don't exist in fiasco. Why don't we try and see what happens. And it hasn't really helped her in that vein at all. Which is why we're trying to wait a little longer. I the blood sugar control aspect was a bonus. We weren't, I love a feature and how feature works. So I wasn't switching away from it because of the insulin. So we'll say, but I imagine she'll be switching back with our next pump, actually. But I don't I mean, you were really nice to come on and do this. And I didn't we didn't talk much about diabetes. Do you have a couple extra minutes?

Unknown Speaker 1:07:52
Yeah, of course. Cool.

Scott Benner 1:07:55
So what's your I mean, obviously, you're texting with adults. So you have this ability to, like I do, and a lot of other people who like I always think of it as like tech support for computer. Like I don't need to be in front of the computer to fix it. And, and so I can kind of see diabetes in my head, and the numbers and just my understanding of what she's been doing. And even now, to be honest with Dexcom follow, I don't even need to know what she's doing. I can infer from the, you know, from the what's happening get

Lisa 1:08:25
crazy when I when I when I write and I say Hey, are you guys out taking a walk or something? And they're like, yeah, and I'm like, okay, just wanted to make sure that was why it was dropping, you know, for sure. See everything they do freak out a little doesn't graph.

Scott Benner 1:08:38
We have a, I have a thermostat in my bedroom and has a motion sensor on it. But I never told anybody. So my wife and I went to a baseball game with my son one day, and we were gone for, you know, a while and I texted Arden and I was like, Are you awake? And she goes, Yeah, I just woke up. I said, Are you in my bedroom? And she was freaked out for like hours. She's like, No, I'm like, I just had a feeling. And I teased her for a while about it, you know, and she couldn't figure it out. But I imagined something similar. Yeah, I just saw I see it. And I infer and I know what's going on. So you're doing that when he's away from you. But the one thing

Lisa 1:09:18
and even with him a little bit even when he's in the same house as us I'm trying to practice with him so that I'm acting like I'm you know that I'm not in the same house with him. So when he gets home and I'm preparing dinner, and he's in his up in his room, instead of me doing all like text him and so I'm trying to teach him that way too.

Scott Benner 1:09:39
I'm a huge fan of that. I really think it what what better time to practice distance care than when if something goes wrong. You can just walk into another room and go Okay, well I mess that up. Yeah, essentially

Lisa 1:09:49
I did that all summer and it's made a big difference in me feeling like he he understands a little bit more than what he did before. So it's just Kind of that's really important for me to try to help him and that we also implemented for that. We always do a split Bolus. So this was before this a long story, but I wanted to implement a routine that would, that would work for him most of the time, because I wanted to Pre-Bolus the lunch at school. And we didn't know what he would be eating or how much and so we started at school with doing just a standard amount every time as a Pre-Bolus. And as I saw it working, we just did that for every meal. And so every time is going to eat, we do the same Pre-Bolus amount against 50 grams of carbohydrates. He eats like 400 grams of carbohydrates a day, healthy carbs, if there's such thing but and so we Pre-Bolus for 50 grams of carbohydrates before every meal, breakfast, lunch and dinner. And that's really helped us actually to avoid kind of like the spikes and the dips. And I don't even use the extended Bolus function on the pump because I love the split Bolus demand a manual split Bolus. So you're

Scott Benner 1:11:01
doing basically when you hear me say, just get some going get some insulin on your side. That's what you're doing.

Lisa 1:11:07
Yeah, every time before, it's, we always give him that and then, and then he can take what he wants. And we don't have to like measure everything out, given the incident before you can eat it. He takes the Pre-Bolus for 50 grams of carbohydrates and then under under the meal at some point, we'll you know, figure it all out. And then we'll give them what's left. And if he didn't eat 50, which isn't very often then we'll supplement it with the you know, something else.

Scott Benner 1:11:32
That's amazing. That's brilliant. actually good for you, I think works really well for us. Yeah, that's excellent. I listen, I think that, again, the way that you use insulin is the whole game, like I just pulled up Arden's blood sugar to look at it. And I'm following other people too. So right now it's 10am, where all these people are all these, these, there's an 18 year old in here and a 16 to 16 year olds, right. Two of them are girls, I happen to know they both have their periods. And I got blood sugars here. 9994 95 are Arden's at school, the other girls still asleep, this, the kids at work, and they all have the exact same three hour graph. And it's just because it's just because I have

Lisa 1:12:21
the right amount of insulin at the right

Unknown Speaker 1:12:23
time. That's it. That's it.

Lisa 1:12:24
That's all it is, you know, you know, his our son's graph, when you don't introduce food into the picture, it's just flat. It's just, you know, once my only issue in the evening is to is to smash that rise, and not smash it hard enough to where I you know, push them too low. And I get you know, I rage Bolus, like you've talked about I definitely rage Bolus. And I've you know, I've upped his insulin sensitivity factor from one to six to one to two for three hours, because I was just kind of like reverse in reality, so I'm just giving him like, like massive amounts of insulin, I just need to make sure I don't push them too low. But once I have them stable, then I know he's gonna ride there. And he can wait to eat until like, 10 in the morning. It doesn't matter what seven or 10 he just writes flat. Okay. The whole time.

Scott Benner 1:13:12
Yeah. Beautiful. All right, listen, you got it, you figured the whole thing out? You're doing I mean, with the amount of carbs you said, well, seriously with the amount of carbs that you said he uses? Yeah. And and where his range is and where you're keeping him and how you're doing it with you know, being aggressive and thoughtful at the same time with insulin. I'm sure you'll get things you know, honed over time, but you're doing incredibly well. Aside of all the other stuff for being 11 months into diabetes. Seriously, you you leapt forward very quickly.

Lisa 1:13:49
Yeah, no, I know. And I mean, I that's I thank you for you know, for saying that.

Scott Benner 1:13:54
Well, it's true if he wasn't sure I would have said something different there.

Unknown Speaker 1:13:57
No, no, no, no.

Lisa 1:13:57
I mean, I know that. I mean, and that's not really like I'm, that's like, that wasn't ever my concern. My you know, like I said, my concerns are other things. And I just, I wish I wish them every parent kind of like got it like this and was able to help their child you know, stay calm what their blood glucose and and it's, I feel good, because I don't want it you know, his other organs are already damaged. He is sorry, was that mine or something was mine. And, you know, his, his livers already damaged his kidneys already damaged is you know, I mean, there's other his heart I mean, there's his other organs are already impacted by other diseases. And so, um, you know, the least I can do is try not to get them more damaged. And, you know, he hasn't had I mean, and this other part, you know, I'm terrified of lows because he doesn't feel anything and so I'm, it's, it's my next challenge. As you know, I hold him between five and seven, four and six is Correct. So five and seven, five would be 90 and seven would be 126. So I don't let him get down to four. I don't let him get down to 70. And I start treating him like bump him up a touch already, when he starts going down there, and he hasn't had a single blood value under for under 70. Ever, ever. Yeah, well,

Scott Benner 1:15:28
he's got so many cards, he's got so many carbs in them too, that it's probably seriously it's probably a little easier to manage. you're managing up instead of managing down the insulin. Is that the way I mean that?

Lisa 1:15:40
Yeah. I think I've listened to you before and and I, you know, you've said something to the fact that if you can hold them steady at 120, you can hold them steady at 90. And then you've said something to that before. And I know, I know that I can if I can hold him study at 100 or 110. I can hold him study at 80. But I'm too afraid to do it because he's not near me. And I'm not. So I tend to err on the higher side I my favorite number. If somebody said to me now, you know when you're a kid, they say what's your favorite number? At least I'd have all these different numbers. My favorite number 6.3. When he's 6.3 6.3 and when he's 113. I can I just I relax. It doesn't matter. Like in sleep like that. To me. That's like nothing bad can happen because I can catch it. If he's low and I can catch it. If he starts going up.

Scott Benner 1:16:32
We say your math is really tight before I could type that into the calculator you have the answer. Like all find out for Well, listen, then do those. If you want to try to go lower, just do it when he's with you on weekends or days. We do we try it right?

Lisa 1:16:49
We do. I just also don't want to give him I think you asked me earlier just now on the podcast, you know, is he worried and I gave you this feed on the floor analogy. But it's interesting because he he looked very thoughtful at dinner two nights ago. And I asked him what was wrong. I said, you know, what are you thinking about and a lot of stuff happened about a year ago at this time, we had several losses in our family and then of course the diabetes happened and and he didn't tell me and and he's not allowed to have Facebook and stuff. But he does have an Instagram post with with seven female followers. He only likes women. He only likes girls. He likes women. More so than girls.

Unknown Speaker 1:17:28
He's right. Yeah, no that way. I'm

Lisa 1:17:31
funny. Like all of my girlfriends is our his like, anyway, he posted a picture of himself two nights ago and I'm gonna do this translation direct from Swedish picture of himself in the mirror and he writes your attic. Lord, I am happy. In my new life. I have had a young big, I've had a I've had a job big, hard. I've had a hard year, the last year. It's been very tough the last year, but now I'm very happy in my new life. I hope you understand that. And he put that on Instagram. Whereas he's never been able to really express to us that I'm worried about diabetes or that I feel bad. And I mean, when we discovered diabetes had a blood sugar of he was outside working in the yard for eight hours with my husband like raking leaves and outside in the rain. And he and I took a Jacuzzi outside and not we walked in I just had this epiphany and I said, Oh, crap. He has diabetes, because he had like, peed the bed and was really thirsty. And he had a blood glucose of let's see, it was 30 he had a blood glucose of 540. And literally I'd asked him all day long. Are you okay? Are you feeling sick? And he's like, Nope, I'm going back out to work again. So he never complains he never like tells you that he's unhappy. Yeah. But I think he does feel the stress and I don't want to add to it by panicking when I see him dip and under under 79

Unknown Speaker 1:19:05
smile. I

Lisa 1:19:06
just want him to feel like hey, we've got all the time in the world. Hey, you want to eat three Skittles? You know, I mean, you notice these micro micro adjustments. But I'll get there someday.

Scott Benner 1:19:18
I know if needed. I think there's pretty damn close now to be perfectly honest. So I don't see what you could be doing that that would be that much better. I understand that. There's always better I'm not saying that. I'm just you're doing so well. I think if you're not if you're not really proud of yourself and somewhat satisfied.

Unknown Speaker 1:19:39
I am Yeah. Yeah.

Lisa 1:19:42
I'm worried about I worry about him. I love him a lot. So I yeah, just trying to, you know, melted in with with, you know, with what, what else we're dealing with and I just, you know, I want to keep them safe and healthy. That's really all I want.

Scott Benner 1:20:01
It really sounds like you're going through? Well, let me let me tell you this. And I actually, I have to go in a minute. But I talked to a lot of people like this. And I talked to many people privately. And I can tell when they're going to be okay. And I kind of boiled it down to desire and concern. And when people have the desire, and they have a reason to want to get to a place, they most often do. Yeah, you know, I don't see why you would be any different, you're obviously bright enough. And you're, you're paying attention to it, you're seeing aspects of it 11 months in, that I spend hundreds of hours trying to artfully beat into people's heads. And so you're, you know, you're, you've got it, and I don't see how there's anywhere to go but up, honestly, you know, yep,

Lisa 1:20:56
I just need to moderate, you know, the attention to it as well. And like you, like you've said a few times, or more than a few times, you've said, I don't think that much about diabetes in the day. And I can tell you like that's kind of all I think about and that'll be my next goal is to think about other things.

Scott Benner 1:21:12
Yep, you set those alarms, and you just wait for them to beep. And if they're not beeping, you don't think about them, you just trust that what you know is going to happen is going to happen.

Unknown Speaker 1:21:21
That's it. Yep.

Unknown Speaker 1:21:23
I really appreciate you doing this. Thank you so much,

Lisa 1:21:25
Scott, no great talking to you. I feel you know, really enjoy just chatting with you. And you're doing a great service for for this community. And you know, I, it needs more of this. The community, the parents, and the people need to have access to more modern thinking on how you do this, and I, you know, advocate for that

Scott Benner 1:21:52
all the time. I appreciate that. And let me just have hardly say, and with a little bit of just in my voice. They don't really need more podcasts. They just need to hear this one. I don't want I don't need What are you trying to do? Give me a bunch of competition. Somebody's gonna hear this and think I should start a podcast. You people don't need a podcast.

Unknown Speaker 1:22:06
I have one. Only one pod. Yeah,

Scott Benner 1:22:09
go do something else. You're fine. Find a hobby.

Unknown Speaker 1:22:12
I was actually thinking more in the hospitals. I was thinking more newly diagnosed. No, listen, I, I

Scott Benner 1:22:20
I'm sorry, you faded away for saying I couldn't hear you. But

Lisa 1:22:22
it's a pity, it's a pity that people aren't getting access to more knowledge earlier on. And they have to go find this on their own.

Scott Benner 1:22:29
I don't know how I think about this quite a lot. And I don't know how you're gonna make me upset. Because the way you feel about your son getting older, I feel about myself getting older. Because I'm my, my last goal is to do something that persists beyond me, for people with type one. And I'm I, to this point, do not know how you can take all of this and squeeze it down and tell it to somebody while they or their child is being diagnosed in a hospital. I don't know if you can maybe maybe that's why they don't maybe it's just impossible. I'm not sure.

Lisa 1:23:11
I think you and I should talk offline about

Scott Benner 1:23:14
that idea. Yeah, well, listen, what we need here, Helmsley, we just need some people to throw some some, some support behind some things. Because I do think that there are a dozen 20 or so episodes of this podcast that could be handed to you on a thumb drive. And that would really would zoom you right along. So I agree. There's definitely ways but again, if you're looking, here's the conundrum before we go, right. People have had diabetes for a very, very long time. And there are people who are good at speaking about that aren't me, I'm not saying that. I'm the only one I'm certainly not saying that. But for whatever reason, the mix of my experiences, and my the way I talk to people resonates with a lot of people who hear it, but I don't have any medical degree. So it doesn't matter if this podcast was 100% going to help everyone who heard it, let's just say somehow that was true. They still wouldn't hand it to you. Because I'm not a doctor. liability. Yeah. So it just wouldn't happen. And that

Lisa 1:24:21
we just then we just need to spread your podcast crazily and trying

Scott Benner 1:24:25
to tell people this and it's by the way, it's spreading so

Lisa 1:24:30
modulations Yeah, great, great metrics, Scott,

Scott Benner 1:24:32
people doing this really everybody who helps by telling someone else is helping beyond and I didn't mean to sound all like, I don't know how that sounded just now. But I, I, I worry about the day I can't make the podcast anymore. Like I get too old or, you know, whatever happens. I don't want this information to disappear and I don't want you know, because, think about it. Your son's diagnosed, you find the podcast, you're okay. 11 months later, the podcast does They exist. I don't know where you are right now. And I don't know where all of those other people are either. And I don't want to be a band aid in the world. Do you know what I mean? Like, I don't just want there to be a swath of time where I was valuable, where this information was valuable. And then suddenly it's gone. Like it needs to persist. And, and that's what I'm trying to figure out. So I appreciate you coming on and helping me add to the add to the lore of the show, and somebody is going to hear stuff that you said today, it's going to help them so I appreciate

Lisa 1:25:30
that. Thanks for having me. And thanks for thanks for the podcast.

Scott Benner 1:25:33
Have a great, it's really it's my pleasure. What time is it there, as I'm saying

Lisa 1:25:37
is almost 430 in the afternoon.

Scott Benner 1:25:40
Very nice. I am going to go hit a baseball with my son for a while and try to have a nice day. I hope you do as well stay

Lisa 1:25:47
safe and stay sane.

Scott Benner 1:25:49
I wear a mask. wearing masks, although I have to tell you last night 8pm not tired. completely out of things to do. I actually thought maybe I should just restart the next workday now. like should I sit down and just edit a show? I was out of things to do. And that doesn't normally happen. But apparently if you lock me in my house long enough I run out of stuff to do Yeah,

Lisa 1:26:13
yeah, I was gonna say I don't really wear a mask cuz I don't meet anybody.

Unknown Speaker 1:26:19
Away from people

Scott Benner 1:26:20
be in the house here. No, I it really is an odd, odd time. Just like there's nothing to do I couldn't I in a normal situation I would. You know, I've got a list of things I'd like to do that not the least of which is you know, go visit my mother and other things like that. Yeah. But instead, I'm just standing here going. It'll be time to go to sleep soon. I guess. You know,

Lisa 1:26:44
I lost my father a lot of COVID this spring. Oh, I'm so sorry. Yeah, I know. It's sorry. It's strange times.

Scott Benner 1:26:55
First, I'd like to thank the Dexcom g six continuous glucose monitor the Omnipod tubeless insulin pump, and touched by type one for supporting the show today. Touched by type one.org for Facebook and Instagram. The Dexcom g six is dexcom.com forward slash juicebox. And you can learn more about those free trials that you may be eligible for. And the demo pod that you're definitely eligible for@omnipod.com forward slash juicebox. And of course, I want to thank Lisa, for the really fun, thoughtful, emotional, and entertaining conversation that we had. I'm working on a pretty cool giveaway for you and if everything works out, I'll be able to tell you about it very soon. Keep listening. Please subscribe in your podcast players. Tell somebody else about the show. If you love the show, leave an amazing review wherever you listen. And of course, thank you. Thank you very much for listening. I'll be back very soon with another episode.

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