Scott Benner 9/20/23 Scott Benner 9/20/23

#1004 Diabetes Pro Tip: Temp Basal

In this episode of Diabetes Pro Tip, host and diabetes educator Jenny Smith discusses the topic of manipulating basal insulin with her guest, Jennifer Smith. They cover the importance of understanding basal rates and how they can be adjusted to better manage diabetes.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - Radio Public, Amazon Alexa or wherever they get audio.

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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 0:03
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening 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. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juicebox free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Temporary Basal rates do a number of different amazing things,

Jennifer Smith, CDE 2:30
lots and lots compared to what your doctor told you.

Scott Benner 2:33
Yes. And so here's how I always think about it about Basal rates in general, it is bizarre for us to think that we can set up a static Basal rate that will always work at 2pm for the rest of this week, or this month or our lives, right. It's just an odd statement. I don't have diabetes, my blood sugar varies based on what's happening in my body or what I eat. And I bet you even though I have no medical training whatsoever that my body is more aggressive with the amount of background insulin that I get the amount of force it pushes on my blood sugar at different times,

Jennifer Smith, CDE 3:08
because it's got natural compensation. Yes. And I think that that that piece about about Bezos is also really, really, really important for women. Right?

Scott Benner 3:17
Okay. Yes, because of their periods. Or, by the way now I've been told not to say, Lady time by people that I should say period, so that I went back to period to make that person happy. Then I got a beautiful note from somebody the other day, who said, I think Lady time is delightful. And I'm like, I can't win, but that's not the point. So the so so here's a couple of ideas. We get Chinese food coming into the house, right? Or pizza or something that's high carb that breaks down slowly in your system. Okay. My Pre-Bolus For Chinese food is this Temp Basal increase 95% for two hours, boom, I start right there. Then I get a healthy Pre-Bolus in you know, and I start the I went to a decline when when Arden starts eating her food. Chinese is a good example because it's not it's simple sugars and complex carbs at the same time, right. So the coating on the meat might have a lot of sugar in it like the sauces will hit you quickly. But that rice could sit in your system forever and take hours and hours and hours to break down and to go away. So I think of it as carpet bombing insulin. I went to I went to cover the entirety of the timeline that this food is going to have impact on Arden with an increased Basal insulin. It I would also use an increased Basal insulin. When Arden's hormones are affecting her. Yeah, we just got done doing that this week. There was a day and a half or Arden ran a Temp Basal increase of 80% for two days straight. Yep, get a straight. Yep. If your Basal is not right, your Bolus is aren't going to work. Right because you're just replay acing Basil with your Bolus. So even again, you count your carbs. 100%, right. But if your Basal insulin is set at, let's say a unit, but it should be at two units, then when you make a Bolus for a three unit snack, the first unit of it is only covering the basil you don't have. Plus, you haven't had enough basil leading up to that. So you're probably so insulin resistant and having a higher blood sugar to begin with. None of this works without basil. When people come to me and say, Oh, my God, look at my roller coaster. I'm 60. I'm 400. And the first thing I say is okay, let's get your basil is right. If your basil is aren't right, the rest of it doesn't work, right,

Jennifer Smith, CDE 5:39
and temporary bases that are not going to work either because they're working off of a setting. That's not That's not right to begin with. Yep.

Scott Benner 5:45
Inevitably, while I'm talking about bases with people, they say, Well, what about my insulin to carb ratio, and I went, That's not even worth thinking about until we have your basis, right. So now you can think about Basal insulin as Basal insulin used, you know, in the normal course of your day to keep your body function low when you don't have any food. And if you really start to think about them around food, that's when they become incredibly powerful. Yeah. And so there's also a time where, like I alluded to before, you can bump in nudge with basil, right? So not only can you create a hard basil that helps you with carb, heavy meals, but you can look at a blood sugar that's at, you haven't had insulin for hours, and then suddenly, it drops to 75. And it sits there for a little bit. And instead of feeding that 75, you can Temp Basal back. So Temp Basal is unlike the, you know, when I think about the tug of war with with Pre-Bolus Singh, Bezos, I think of this way. I imagine if you and I put our hands out, stood up and put our hands together our palm the palm, and we pushed equal amounts on each other. That's you don't fall back, I don't fall back. That's a perfect Basal rate. Right now there might be a situation where my my blood sugar is starting to fall. So I need the body function to push a little more. So I, I take a little power away from the Basal which allows me to push up. Same thing if I'm at a 90 that's going into a 95. And it's creeping up. But a Bolus is definitely even a tiny Bolus is going to make me a little later I might just do a Temp Basal increase to stop that kind of creeping. Yep. This all occurred to me when I interviewed someone about artificial pancreas and they told me that most of the adjustments that an artificial pancreas makes is through Basal insulin. Yes, not through Bolus

Jennifer Smith, CDE 7:41
100%. If you're doing anything within the looping community, the do it yourself insulin pumps, either open APS or looper, Android APS or whatever that is, that's the gist of the algorithm. It is most of most of the incremental adjustments based on the trend in glucose are being done by positive and negative what's called tamping you get a bit of a bump up, you get a bunch of a bump down, you had a bit of bump bump up, and it's all being based on your current Basal setting. Right? Right. But the incremental ups and downs are what keep you stable

Scott Benner 8:18
that remaster diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well on your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter. You deserve an accurate one contour next.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips. You can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. contour next one.com forward slash juice box for E meter go get yourself a free starter kit. while supplies last US residents only touched by type one has the back of people living with type one diabetes. Take for instance, their D box program touched by type one knows firsthand the intricacies of living with type one diabetes. And so their team has created a D box which is a starter kit that provides important resources and supportive materials to individuals with diabetes. They want you to thrive. The D box is completely free and available to newly diagnosed people. All you have to do is go to touched by type one.org. Go to the Programs tab and click on the box. While you're there, check out all the other resources and programs available at touched by type one.org. Speaking of support, touched by type one.org is available in English and Spanish. Don't forget to find them on Facebook and Instagram too. You do not want to miss what touched by type one is doing. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pan is a ready to use glucagon options that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit GE voc glucagon.com/risk. So when I talked about bumping and nudging, which is going to come up in the future a little more, it's the idea that if you don't use too much insulin, it can't cause a wide swing. Correct, right. So bumping a 120 Diagonal up back to 90 takes a smaller amount of insulin than ignoring your blood sugar till it gets the 180. Now you're putting in a bunch of insulin, it becomes miss time and you get low later. So using these little bumps, just make sense that you can accomplish that with Temp Basal. Again, remember, Temp Basal is going to start working right away. You can't save yourself a va 65 one arrow down with a Temp Basal. No, that's, that's juice time. Right, right. But, but but a 70 that's drifting low and has no impact from insulin really could be saved with it, it could be saved it maybe it won't be but you try and figure it out for yourself, maybe that'll end up being a 90 that's drifting low that you'll eventually use Temp Basal for. But they are, they are such an important tool. And if you're not using them, you're missing out. I will say it here I'll say it again. an insulin pump is not just the way to get less injections. It's also a way to be able to give yourself micro Bolus is to be able to manipulate your Basal insulin to be able to manipulate your Bolus is to spread them out. These tools are are vital. So please tell me and I know you and I are short on time here. But tell me how you talk about Temp Basal with people like where do you where do you really focus in on on education about it.

Jennifer Smith, CDE 13:06
So i we i and i usually really, really focus in on all of the scenarios that are likely to come up where temporary Basil is really an important piece of management, that that bumping and nudging that you talk about, you know, unfortunately, most people are only taught about exercise and the benefit of temporary basil. And they're usually told, well just, you know, just set it for 0% or turn your basil off during that time. Well, that's 100% incorrect to begin with. But exercise is one of many reasons that you may want to change your Basal for a, you know, a duration of time, illness, a woman's menstrual cycle, or that woman's time of the month or whatever you're going to call it. That time you're going to definitely need temporary basil, you're going to need it for sedentary days, I can go to a conference where I'm literally sitting for eight hours. And while I might be walking between conference rooms, the sitting and sedentary I need a 25% increase in my basil. In order to not run high that whole day. I've figured that out right? I figured out what I need to do to take a five mile run versus a 12 mile run temporary basil changes. I figured out what to do for different kinds of illnesses stomach bug may require a decrease. An illness like a sinus infection or a bronchial infection may require an increase. Even even temporary basil around food like you mentioned before with the Chinese high fat food

Scott Benner 14:43
Yes

Jennifer Smith, CDE 14:44
100% requires knowledge of using temporary basil because I know we'll talk about extended boluses and things a little bit too but temporary basil for high fat man. Fat can affect you eight to 12 hours after you're done eating it and it keeps you high. And you may go to bed with an awesome looking blood sugar thinking that man, I nailed that I really got it. What do you get an alarm at two o'clock in the morning? Where are your 300? And you're like, what happen?

Scott Benner 15:11
And those are the examples, by the way, when you can't say to yourself, oh, well, that's just diabetes. It's not just diabetes, if you didn't use the insulin, right, and so every time you think diabetes is just this, this, you know, magic fairy that runs around messing with you, it's something happened, like, you might not know what it is in that moment. But something happened, and you can figure out what those somethings are and stop them. And there's a great example high fat, you might need a Temp Basal increase that goes on for hours and hours later, and maybe

Jennifer Smith, CDE 15:45
maybe fat 50%, at least 50% increase for at least six to eight hours after the meal. Right?

Scott Benner 15:52
Right. It's just it's, I know, it's a little mind numbing to think that, but that's a lot to think about. But I want to, I think now's a great place to say this. As much as we're breaking things down and really stretching them out. So you can see the tiniest little aspects of these ideas. For people who understand them, I will speak for myself. I do not think about diabetes that frequently during the day, this stuff just kind of happens. I know that sounds crazy. But I look at a plate and I go, Okay, here's what this needs. And if and if I miss I readjust. But But I don't spend a lot of time, of course aside of this podcast, but I don't we don't say the word diabetes in our house very frequently, I guess is what I'm saying. We're not always fighting and, and you know, scary lows, and oh my gosh, she's been high for three hours. Like that doesn't happen around here. And you can live that life too. By understanding how insulin works. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast, private Facebook group Juicebox Podcast, type one diabetes, there are over 41,000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you, or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org A huge thank you to one of today's sponsors je Vogue glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGL You see a ag o n.com forward slash toolbox. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1000 21 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talk about transitioning from MDI to pumping. Before I go, I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult, and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now in my learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.

#1003 Diabetes Pro Tip: Pre Bolus

Scott talks about the importance of pre-bolusing for people with diabetes. He is joined by Jennifer Smith, a registered dietitian and certified diabetes educator, who shares her insights on the topic. They discuss how pre-bolusing can help ensure that insulin is well-timed with meals.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith, Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening, 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 healthcare plan or becoming bold with insulin. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There's a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it, you are invited to join this absolutely free and welcoming community. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juice box free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen, find out more at G voc glucagon.com forward slash juicebox. In the episode about insulin, I told you that that my nurse practitioner CD told us that fear of insulin was the biggest sticking point for people making good decisions with their diabetes, right. And after I got past my fear of insulin, the next hurdle I had to get past was Pre-Bolus. And I am now years and years later at a time where I will tell you that if you do not Pre-Bolus a meal, the likelihood of success is near zero. And if you have success without Pre-Bolus saying all that means is that you gave yourself too much insulin prior to that. And it's just catching up now. And so this is it. We're going to talk about Pre-Bolus and we're going to talk about how about insulin action right the action of the insulin and how to balance it against the impact of the carbs or your body function. So tell me let's go over the part that people aren't going to find comforting at first right which is the amount of time it takes insulin to begin working in a person varies person to person and insulin to insulin is that pretty fair to say?

Jennifer Smith, CDE 4:25
It's pretty fair to say yes and insulin to insulin. I would definitely say most of the the rapids on the market should be fairly similar okay? The rapid acting insulins on the market and their time of action should be fairly similar now. Person to Person yes, that may vary situation to situation as well as situation it may vary but again, that's the learning part of it.

Scott Benner 4:54
Okay, so person the person could end up meaning just your body chemistry could mean where your infusion set is right, you know, your your injection site,

Jennifer Smith, CDE 5:03
absolutely. Say

Scott Benner 5:04
you're a person who gets stuck on, I always injected my belly in the same place, that spot might not be as reactive to the insulin as if you would just try a new spot. If you went to a new spot, it might work quicker than it has been in your old spot. Right? If you're wearing an infusion set it could we alluded to it before you could get better action from your insulin on day one than you do on day three or better on day two, then, you know, two hours after you've put it on, there's a lot of different variables. But we're speaking generally here to you'll apply them to your variables later. Now, if you've heard this podcast before, you'll know that I have alluded to how insulin works in a number of different ways. So I'm gonna give my kind of cartoony description of it, and then we're gonna let Jenny talk about it for real

Jennifer Smith, CDE 5:50
cartoony, might be better, actually, we'll see.

Scott Benner 5:52
So here's how I pictured in my head a couple of different ways. The first way is I think of a tug of war. And I imagine a rope with a with a flag hanging in the middle of it. And on one side of this tug of war rope is insulin. And on the other side is your carbs and your body function. It could be adrenaline, it could be fear, it could be anxiety, whatever it helps to drive your blood sugar up. That stuff's on one side of the rope. The insolence on the other side, unlike a tug of war in a schoolyard, our goal is not for one side to win, our goal is for them both to pull and pull and pull until they get exhausted, they both go, I can't do this anymore, and they dropped the rope and our flags still in the center. That flag represents the blood sugar. You start at when the impact of the carbs begins in my mind, so I'll explain a little more. If you let them both start pulling at the same time, the carbs are generally speaking, going to gain power and momentum before the insulin begins to work. So now your rope is going towards a high blood sugar and you're you're starting to head up. Now suddenly, you're 50 points higher. And what if you started with 150 blood sugar, now you're at 200. And now these carbs have momentum. They have speed, they're pulling your blood sugar up. Now all the sudden, 1520 30 minutes later, the insolence like, oh, no, no, wait, I have a job to do. I remember and it kind of comes online. But now it's pulling, it can overpower the the momentum that the carbs have created. Plus, you now have another 100 points of blood sugar to contend with. And all you have is the insulin that you counted your carbs for. So even if you counted your carbs perfectly, and realize that this meal is five units, once the momentum of the carbs is rocketing your blood sugar up, once you have a number that is higher than you started with those five units are not even going to begin to cover what's happening, let alone the food that you've put in. But if you put the insulin in first, and let the insulin come online slowly and begin to pull down and create the momentum in the other way, then you flip the script. And now the carbs are fighting. So instead of having a fight at 180, blood sugar, you're having a fight at an 80 blood sugar. And instead of your blood sugar falling at 80 It's being the attempt is that it's now trying to be pulled up by the carbs. And that's how when you see people with a stable graph, that's how they're doing it. And so for me, in a perfect situation for me, my daughter's blood sugar is diagonal down when I give her most foods. There's differences you know, food to food, situation to situation but in a perfect world. To me, that's it, you want your insulin working, your blood sugar trending down, creating some momentum down, when you allow the carbs to begin to pull up. Correct. Now, you to explain that in a technical way that sounds

Jennifer Smith, CDE 8:54
and in most in most settings, yes, that's 100% I mean, insulin, our rapid I've always thought that rapid is such a misnomer. Honestly, rapid indicates like now rapid is like you know, click, click click light switch. It's on, it's working. And it's you know, still education is take your insulin and start to eat. I mean, even from most endo offices, it's take your insulin and start to eat, it's going to be working very, very quickly. That's not the case and anybody who's been taking insulin long enough, and you've seen the spikes, and you've seen the issues, despite counting your carbs as precisely and weighing them and everything and you're still seeing these issues. It's the mismatch of insulin timing. It is so our rapids take anywhere between about 15 to 30 minutes to really get that active peak, not peak but that active phase where then when you start putting your carbs in there They will match. As you said, the carb digestion will start to match with the insulin, you'll get a nice gentle curve up. And it should then start to curve back down. And there is a lot of, there's a lot of education that also focuses on, as you mentioned, watching for that curve down, watching for the curve down to start so that you know, the insulin is already moving things.

Scott Benner 10:30
Yeah. And to give you some context that a person I spoke about in a previous episode, who was having trouble, told me, but what am I gonna do, I'm going to be scared. I said, well try it a little bit, this time, and then a little more next time and a little more next time and go forward. And, and so I always tell this story somewhere. And I think here's the right place to tell it. Prior to glucose sensing technology being a thing that anyone knew about prior to Dexcom, I was again in the office and the CD says to me, Hey, you're gonna get one of those Dexcom things. And I thought, I don't know what that is, you know, and she starts telling me, it's a continuous glucose monitor. And I'm like, Yeah, I again, don't know. And then she tells me this simple story. There's a 17 year old boy in her practice, who loves candy, certain kinds of candy, and he can't figure out how to Bolus it. So he gets a Dexcom, whatever the first one was, I don't even remember anymore. His whole goal was to eat this candy without a spike. So he goes out to the store. And he buys like little grab bags of these candies, and a number of them enough for a week and every day starts on this experiment first day, just like you said, eats, gives himself as his insulin, just like he'd been told his whole life, blood sugar goes up to 20, something like that sits there forever. Eventually, he has to give himself more insulin to bring it back down again. Next day, he tries a little sooner, give himself a few minutes, 510 minutes gets a little less of a rise. So the next day, he goes even sooner. And then before you know it, it's a little sooner, a little more, and he starts adjusting it back and forth a little more a little sooner, a little later, until one day, he eats the candy. And his blood sugar never moves. And she tells me that story. And I thought immediately Wow, that means it's possible. Yeah, that was the first time I thought I was like, if that kid can do it with candy. I can do it with anything. Like anything, right? And so yes, give me that CGM place. And I got it. And I started dispense with my fear. And I started learning about it. There were hiccups along the way, right? I've given her insulin, and she's gotten lower than I meant to for two when she's eating. But you know, once twice, I'll go back to this over and over again, when something goes wrong. It's not a mistake. It's a learning experience. It's data for next time. Right? Right. So I put the insulin in, and she goes down to 70 and sits at 70. While she's eating. It's beautiful. You know, like, there she goes. And then and then then a spike. Even if I really messed up on the amount of insulin, I used a spike takes you to 120. Right? Right, right. It's not right. It's just, it's all about that timing and amount. And I repeated over and over again, that you all the things you and I are going to speak about all the things that people hear about on this podcast, if you want to know how to use your insulin, at its core, the very first step is timing and amount. If you get used the right amount at the wrong time, you can use the wrong amount at the right time, that it's too much, you have to have the right amount of insulin at the right time, you have to balance the action of the insulin against the impact of the carbs. If you do that, I don't want to say it's easy, because that's insulting to people. But let me just say I don't think about diabetes that much anymore.

Jennifer Smith, CDE 13:44
It's easier, it's much easier if you do that. It is easier. Absolutely. And it's a lot more. It gives you a lot more visual than to understand. Because it's not so much of an unknown Well, gosh, I counted the carbs and it took the right amount of insulin and this is always happening to me. Why. And if you can start to put those pieces together, it's not a wi anymore. It's like turning the light bulb on.

Scott Benner 14:16
Here's how I explain what Johnny just said, touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org Go up to the top of the page where it says programs there you're gonna see all of the terrific things that touched by type one is doing and I mean, it's a lot type one it's school, the D box program, golfing for diabetes, dancing for diabetes, which is a terrific program you just click on that to check that out. Bowl for a cause their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org or find them on Facebook and Instagram. links in the show notes Lynx at juicebox podcast.com To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series, touched by type one.org. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter will you use my link you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing an easy to read screen, it fits well in your hand, and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips, then you're paying now through your insurance. Contour next one.com forward slash juice box free meter go get yourself a free starter kit. while supplies last US residents only. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Here's how I explain what Johnny just said. I think of it as this equation that it's a mathematical equation that doesn't have any math in it. I did this that happen. So next time I'll do more less sooner, you know, little less little more, that kind of thing. And I always just I always just keep looking at it like that. I did this and that happen. It's the idea of being in a fistfight and you want to hit first because now you have cause and effect. Right? And if you and so now you know I've done something. And that's what happened next. Now I can make a good decision about what what I do next, instead of waiting for diabetes to do something to you. And then you're just covering up your face hoping not to get knocked out. Right? Like because you don't know what's happening. You don't know why it's happening, you have no context for what's going on. But when you make the first move, you can be sure that what happens next was impacted by what you did. I put insulin in 10 minutes before you ate 10 minutes before I ate. And my blood sugar went to 150. So the next time I'm going to try 15 minutes. And if it goes to 130 I might try 20 minutes. And you know if I get low than later, I might say okay, I might need a little more a little less. Now here's where people always say, Well, how much Scott How long? You know, give me the time give me the amount? That answer for me. It's always going to be I don't know, figure it out for yourself. Okay, you have to

Jennifer Smith, CDE 19:04
this is the starting place. Yes. This is where to start. This is how to start. You have to do your own. I mean, diabetes is a science experiment. It's a daily, I feel like every day you're almost given like this new petri dish. And you're told, keep the dots growing purple today. Okay, let's work on keeping the dots growing problem is that something green pops in and then these like little horny pink things pop on? You're like, oh, no, but it is it's like it's a science experiment that for the most part, when you figure out what does work, the timing around the most typical foods that you eat and whatnot. It takes a lot less thinking out of the equation.

Scott Benner 19:46
Yeah. And while this isn't about Pre-Bolus and it will come up later, but it's important for me to say because I think this is impactful. When you really stop and think about your your habits around food. They're pretty similar Right, right. So, you know, you're not I always say like this, like, if you're a person who gets a pizza on a Friday night and has two slices, you don't suddenly next Friday have seven slices. You don't go from being a two slice person to a seven slice person, right? Like, yeah. And so, so you can start making these decisions about how much insulin and when, and you can make them based on Yes, historical knowledge about what's going on. Yes,

Jennifer Smith, CDE 20:24
I usually tell people as the Pre-Bolus piece, you've got, most people have about 20 to 25 foods that are the most common for you to eat regularly. Yeah, that's at least 80% of your control there, at least. So if you can nail the Bolus timing around those and figure it out, for the most part, you know, variations in setting will happen, whatever, yeah, but for the most part, if you've figured that out, you're also much more likely to be able to figure out food that isn't your norm, because of the similarities to what you've chosen. And what you're usually eating, because you

Scott Benner 21:09
can stay flexible, I call it saying stay fluid, right? So here's, here's where I'll tell people this, don't get mad. I don't count carbs. I actually think about it a little backwards from maybe how most of you think about it. I don't look at the food and say, you know, weigh it or measured and say okay, well that's 25 carbs. And my pump says that I get one unit for every 10. So that's two and a half units. In honesty, there is no accurate insulin to carb ratio set up in Arden's pump. We don't even I don't even pay attention to that. I look at a plate and I say to myself, that's seven units. I think that if she's going to sit down and gorge herself on nachos and cheese, the last time that happened, it took 10 units. But I think of it as insulin, not as carbs. And of course that takes a little practice, right? It does, it does. And it is a little contingent on you having a CGM. I'm not going to lie about that, right, because I start with a healthy Pre-Bolus. And healthy would mean in amount and time. And then I watch her CGM, and I don't really watch it, I have her tolerances set tightly enough that if she leaves that range, I find out about it. So as an example, if I were to give art in something incredibly carb heavy, I might use a Temp Basal increase, and a Pre-Bolus to try to spread out the action of the insulin across this timeline where there's going to be these carbs, right? If I make a Bolus, and 30 minutes after I do it, she's 121 30 Diagonal up. I look at that line. And it tells me something based on my previous knowledge, it's I say to myself, ooh, this I missed, like, this isn't enough insulin, and I will give her more I will bump it and nudge it back. It's not a ton more, it's enough to stop the arrows,

Jennifer Smith, CDE 23:06
right. And the arrows are very important to bring up in this in this as well. Because if you are using a CGM, those arrows do indicate a rate of change. And again, that's not something that most people realize. They don't understand that and not understand and people won't tell us but it's that they've not been told they've not been told, Hey, these arrows tell you that you're increasing by 30 to 60 points in the next 30 minutes. Okay, if that's the case, and I know what my kind of correction factor is, or whatever, I can say, Okay, I'm going to need this much more insulin, because if I don't correct my rising 130 blood sugar in the next 30 minutes, I could be 30 to 60 points higher. I could be as high as 190. I don't want to be 190 I've obviously miscalculated someplace, I can throw in a bit more insulin to counter that expected and stabilize it. Yes. Yeah.

Scott Benner 24:02
It very much. It very much is remembering to like I guess the way I usually say it is that you have to trust that what you know is going to happen is going to happen. Right? Yeah, you see. And I think that the least important aspect of what the Dexcom does is the number. It's the direction and the speed, direction and 100%.

Jennifer Smith, CDE 24:29
I wish more please say that again. It is the direction it's the trend. It is not just the number.

Scott Benner 24:38
The number is nice, like don't get me wrong. It's a starting point. But, you know, if you're 60 and stable, and you haven't had insulin for three hours, you haven't had food for three hours when maybe you could get away with like a Temp Basal decrease of 100% for half an hour, maybe you'll rise to 90 Right? But if you're 60 and you're falling well Then you don't have enough time because as we've now discussed over and over again, insulin doesn't begin working right away. Also, Temp Basal is our insulin. It's funny how people think of bolusing. And Basil is different. But once you're on a pump, it's the same thing. You can't just turn your basil off, and it starts happening right away,

Jennifer Smith, CDE 25:16
takes about 60 minutes for circulating insulin level to be different.

Scott Benner 25:20
And I always write and I always try to think of it a little bit as like Ardens Pre-Bolus. Time Like if Ardens Pre-Bolus time is 20 minutes, well, then setting a Temp Basal is not really going to start working for at least 20 minutes plus, it's a fraction of the Basal rate, if, if you're getting a unit an hour, and I say to it, okay, let's double it, let's double it to two units an hour, that impact of that doesn't begin for 20 minutes or so plus, it's not the whole unit extra. It's the it's the fraction of it. So when we talked about basil, we'll get to that. But so Pre-Bolus thing is really just the idea of balancing, again, the action of the insulin against the impact of the carbs, giving yourself a chance, not letting the carbs wash you away, because here's what happens when the carbs wash you away. Count your carbs exactly right, you put your insulin in, you spike up the 200. When that happens, that insulin was only for the food. It wasn't for the 200 blood sugar, and it wasn't for the momentum of the rise. And so when I see that, like, I guess an easier way to say this when when I don't have time for a Pre-Bolus. And Pre-Bolus thing to me is never about the number, you can Pre-Bolus a 65 blood sugar, you know, you can Pre-Bolus a 90 blood sugar because still no matter what, if you're stable at 65, the insulin you put in, it's not going to start working until it starts working. So you have and so don't get me wrong if I see a 65 blood sugar and an artist needs 10 units for what she's eating. I don't put all 10 units in at a 65. I might do an extended Bolus which we'll talk about and extended Bolus but I get some insulin moving, I make sure the insulin is on the winning side of this tug of war to start. But in a situation where I can't Pre-Bolus Let's say I know the meal is five units. 100% certain it's five units. But for whatever reason life, let's call it I can't Pre-Bolus and Ardens. You know, I'm going to start eating right now. I'll give her seven units. Because I Pre-Bolus for the food, the five units for the food I knew. And I pray. And I'm Pre-Bolus seeing the rise I know is coming and the end, the number I know is coming. So I'm already treating a high blood sugar that hasn't happened yet. Because I know it's going to happen. Because I didn't Pre-Bolus Right.

Jennifer Smith, CDE 27:45
John Walsh goes into detail about what you're doing in a little bit of a different way. He calls it super Bolus I call for bolusing. Yeah, and he calls it super Bolus in the way that you take that five units, let's say in your example. And let's say your basil behind that meal for the next two hours is one unit an hour, you actually take your basil running for the next two hours, and you add it into the Bolus for the meal and you take it all upfront. And then to decrease the chance of being too low leader. Because of so much upfront action and the blood sugar staying normal, you actually set a temporary Basal decrease, he recommends starting with 100% Because you've loaded that onto the front to avoid a low but on the back end. Some people find though that attempt Basil 100% off is too much. They only need a 50% they still call the spike and prevent it. But in the back end, they're not having a low then. So similar kind of concept. Yeah,

Scott Benner 28:49
I consider that trading Bolus for basil. So So you know, say 120 Diagonal up 3040 minutes after a meal and I go oh, geez, I got to stop that arrow. How much do I Bolus to stop there? I usually Bolus an hour's worth of a base of Basal insulin. That way if the arrow stops and I stay steady, and she doesn't go down, I say okay, well obviously I was just wrong on the initial amount. But in those situations where you push the button, you know the unit and a half goes in, and five seconds later the arrow goes from 122 Diagonal up the flat you go oh, I didn't need that. Right Temp Basal off off half hour. All I've done is trade the basil for the Bolus. Absolutely. Here's a good place to say this. And we'll say this in each of these little vignettes. Never suspend your basil. It's always temporary Basil is when you suspend your shutting your pump off when you shut your pump off.

Jennifer Smith, CDE 29:41
It does not turn back around. You have to remember to turn it back on. Yes, yep.

Scott Benner 29:45
It's always temporary because you can set a Temp Basal for a half an hour or an hour, two hours but at the end of that time, it goes back it'll go back on to start delivering your basil it's always temporary Basil is not not don't suspend your pump. Oh Okay, so I think Do you think we covered Pre-Bolus there?

Jennifer Smith, CDE 30:02
I think that's pretty good. Good. Yeah, that's awesome.

Scott Benner 30:08
I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free Contour Next One starter kit at contour next one.com forward slash juicebox free meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She has also had type one diabetes for over 35 years and she works at integrated diabetes.com If you're interested in hiring Jenny, you can learn more about her at that link. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed you're starting over episode 1001 all about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and an episode 1025 We talk about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#1002 Diabetes Pro Tip: All About Insulin

In this episode Scott continues his series with CDE Jenny Smith. They delve into the topic of insulin and its importance in managing diabetes. Scott shares a personal anecdote about his visit to a nurse practitioner's office, highlighting the need to understand insulin at its core. Jenny emphasizes the importance of continuous learning and gaining a deeper understanding of diabetes. Tune in to gain valuable insights into the world of insulin and its role in diabetes management.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

+ Click for EPISODE TRANSCRIPT

Jennifer Smith, CDE 2:44
Right. It's always a nurse practitioner who is Yeah, yeah. And most often they've got more time anyway. So that's good. Yeah.

Scott Benner 2:52
When people say who's your I know, I sometimes I have to pause. I'm like, huh, I don't really know. So this was a number of years ago back before I think I would quote unquote, say that I started to understand. And I would say that I've understood diabetes on a different plane for about the last five years or so. Okay, but the run up to understanding it was reaching out into the world and picking these little ideas and really wrapping my mind around them. And as much as I tried to understand bolusing, or understand, you know, the, the peaks and valleys my daughter was seeing and all the problems we were having. It wasn't until the certified diabetes educator in my daughter's practice, answered a really simple question for me. I asked her if you had a magic wand, and you could change the way people do one thing around diabetes, what would it be? And without hesitation, she said, I teach them not to be afraid of insulin. She said that would be the core step one. Nothing else matters if you're afraid of the insulin. And I took that to heart. So I guess let's start with why are people afraid of insulin? What do you think it is?

Jennifer Smith, CDE 4:10
I think the main reason is because the initial education includes so much about hypoglycemia, insulin, I mean insulin is one of the very very few medications on the market that doesn't have a tremendous amount but really doesn't have any effect on anything else. You know, it's not going to cause your eyeballs to turn green or you know, your toenails to grow extra inches or anything funny, right? It's its side effect, let's call it is hypoglycemia, low blood sugar. If you don't understand how to use insulin, right so that I mean it is drilled into you if you be careful of low blood sugar. This is how to treat low blood sugar. These are symptoms have low blood sugar, I mean, low blood sugar, low blood sugar, low blood sugar is drilled in. And so what are you going to get from that? I mean, if you're told every time you come to the stop sign that some car is going to come and swipe you, you're not going to like go into a stop sign either, are you?

Scott Benner 5:15
It's funny, I think of when you say that I thought of driving in my mind right away and a little differently I thought of when you first teach someone to drive, you teach them about the brakes. Right? Right. Right. So it's the it's the first thing you think, right? Like, even if they steer wrong, or anything, they're doing wrong, if they can stop, maybe they won't get hurt too badly. Right. And so it is really the same idea. I guess for doctors, they look at the giant picture that is type one diabetes. And they say what's, what's the thing where these people could run into a wall, they could use their insulin incorrectly cause a scary low a scary low might mean if you're an adult, loss of your own function, inability to stop that fall from continuing. Right, right. And then so let's talk about granularity for a second because I don't think we do this enough about diabetes, insulin extracts sugar from your blood. That right? Yes, yeah. And unlike my body, which knock on wood has a pancreas it's working in my body knows when to stop, it gets me to a nice level on it, and it stops, manmade, insulin is going to work until it's not there anymore,

Jennifer Smith, CDE 6:25
gonna work and work and work and work. And it's going to work in an interaction setting with the food that it's meant to work with, or the glucose that's in the in the bloodstream for it to work with. Now, there's too much insulin there, and there's not enough glucose for it to continue to work with. And it's still gotten whole hour of action, right? Absolutely low blood sugar.

Scott Benner 6:45
Yep. And it's not going to cause low blood sugar. Like you said, if there's impact of carbs impact of body function, then that's what the insulin is working against. The minute that carbs are going from your system or the adrenaline you had is gone. This insulin, if it is still there, if you've Miss timed, it is going to continue to work so that we know what we are scared about. Let's be more more honest about it. I'm going to test myself and you'll tell me if I'm wrong. Sugar is the energy that our brain works off of. It's the get the gas for our brain, right? It is yes. And if there's not enough sugar in our blood, our brain shuts off like a light switch. Is that correct?

Jennifer Smith, CDE 7:30
In an easy way of saying it? Yes. If our brain is not getting the that sugar? Yes, we That's why all of those strange symptoms come about with low blood sugar, your your brain is being deprived of the food it needs to function to think the right way. Yes,

Scott Benner 7:49
let's just throw it out on the table, what everyone's really afraid of right. Nobody wants to die when they're sleeping. That's what everybody's concerned about. I don't want to say that that's not an issue. Because if it happens to one person, that's an issue, I would say that I do think of it again, like driving like I think driving is incredibly dangerous. But I do it every day. If I happen to have an accident one day where I'm killed, I will not be thrilled about that, as I see the telephone pole coming for me, right. But I think that's maybe the cost of doing business for being alive. I have to get around, I have to travel. Right? I think the same thing about diabetes, you need to use the insulin in an effective way to make your life healthy, longer, happier, you know, all that stuff. So you have to learn how to do this. And then the rest of it just like driving, you throw it away, you're like, Okay, going out there and I'm going to do my best. The first thing that's happens is people get dizzy, confused, they're easily agitated. But then as your blood sugar continues to drop, you lose the ability to what, like what happens as you continue to get lower.

Jennifer Smith, CDE 8:51
And again, this is where symptoms are different for everybody. But truly what can what really continues to happen is the the loss of the right way of thinking you it just continues to decline. And if it gets far enough, you could lose consciousness, you know, you could certainly no longer be awake. It doesn't mean doesn't mean death. But it does mean that you could certainly pass out from a low blood sugar, which

Scott Benner 9:21
is why you'll hear it adults sometimes say they knew it was coming, they consumed a ton of food, then wake up on the floor because then the food gets in and it turns things around for them. Yes. So I'm gonna I've said this before, but, you know, for context in this episode, prior to technology, I mean, honestly, back when we were needles and little tiny like I've said before, like a diabetes bubblegum eater, right. I have caused Arden to have two seizures. One right after she was diagnosed, she was only maybe a few months into it. And I had this grand idea that I had figured the whole thing out which probably meant she was honeymooning Right, right and we go to the mall One day to pick up some stuff real quickly. My wife's going on a trip and we need I think, another bag or something. Everybody gets hungry while we're running through the mall. And here's this like, mall Chinese food. And I thought, this doesn't, no big deal, right? I'll just count the carbs and I'll shoot the insulin and she'll eat the food and she ate and it was good. And she was little two years old. She had a little bit of food. I gave her no, not a lot of insulin for of for 20 pound person, right, bought the bag went home, she fell asleep in the car later in her crib. My wife and I are helping her. I'm getting her packed up for what she's doing. And then I hear what sounds like a wild animal in my house. grunting and snorting and like like that. And I go into the room, and there's my daughter, she is having a seizure in her crib. And so I pick her up and I don't know what to do. I mean, I know the doctor told us about glucagon. But for the life of me in that moment, I couldn't, I couldn't hold my hands still, I couldn't reconstituted It was a disaster. While she's on the floor, and my then seven year old son is dialing 911. For us, my wife is rubbing glucose gel in her cheeks. And as I'm fumbling with the glucagon and really messing it up, Arden is blind. If you touch her, she overreacts in a way like she thinks she's being shot like, right, like it scared her. She is grunting, and incoherent. And then it just ended. Like, the glucose gel worked. And she came back and the police came into the house and the rescue squad and we went to the hospital. And now I look back, we didn't even have to go to the hospital. Like the hospital was nothing. By the time we got there, her blood sugar was back up and she was fine. And this whole thing, but it's scary.

Jennifer Smith, CDE 11:45
I mean, just one of the worst moments of my life. Yeah, you know, I mean, and I talk with and work with so many parents with little, little little, you know, and it is it's, it's scary when it's when it's your child, and it's not even you, you know

Scott Benner 12:04
the worst thing. Now I tell the scary story to tell what I think is the funny story. Yeah, so a year and a half later, we're at Disney for the first time. It's our first time outside in the heat. On a big day with diabetes like diabetes. A whole day's going great. Again, no CGM still using needles. End of the night we're walking back to the hotel and coming at us is a vendor holding these giant popsicles. And I remember looking up and seeing them and thinking we're like 200 yards from the hotel, like make a left turn, what are you doing, you know, but it's hot out and it's late. And my kids see those and they're like, can we have them? And I thought, sure, I'm going to do what the doctor told me to do. I counted the carbs, I gave her the insulin. And of course, it turns out and I know now, you know, I could have just let her eaten that popsicle it would have been it was a fast acting carb, it might have hit or spiked her a little bit and gone away. She didn't need any of it. But there we are back in the hotel room. Packing again, always packing with seizures in my house. And so we're packing because we're leaving the next day. She's laying in a bed off in another room sound asleep and I hear that noise again. And this time instead of being confused and thrown off. I say to my wife Arden's having a seizure. Now remember, it had been a year and a half since it happened before. And my wife runs and grabs art and brings her back she's holding her and I have the glucose gel in this Squeezy tube. Now the gel we owned, you had to screw the top off of them pull the foil thing off it, I guess keeps it fresh, and then you can use it

Jennifer Smith, CDE 13:40
as your gel spoil. She is

Scott Benner 13:43
because you never because you know because honestly now in the of course the ensuing 12 years later, we've never gotten to never had a seizure since then, but so I unscrew the cap, and I go to squirt out the gel, and I don't pull off the foil cover. And I squeeze it so hard with so much enthusiasm that a pinhole breaks on the opposite side of the thing. And I'm squeezing it. I'm like what's going on and then I look up and on the ceiling of the hotel room is a kaleidoscope of jello. I'm shooting all over the ceiling. So I don't even pause I flip the thing upside down. And now I just scored it from the pinhole in the Ardennes mouth, we rubbed around, she wakes up, we put you know get everything straight, put her back to bed. We were traveling with my brother, when it was all over and to say that it might have been a four minute experience right? When it was all over. I look in the corner and my brother is cowering in the corner, just with a look on his face. Like he can't believe what he just saw. And my wife and I look up and see the gel on the ceiling. We crack up laughing wipe off the ceiling clean it up and go back to packing.

Jennifer Smith, CDE 14:44
His experience is a good example of of the fear.

Scott Benner 14:49
That's exactly right. Because no matter how much I explained it to him, and I said look, you know I don't want to call this the cost of doing business but we've never been in this situation before we're completely blind. We don't know what her blood sugar stowing, I think the point is this. And my point is this, I don't think my point is this. I know my point is this, I don't want Arden to have a seizure. But in GS two to 15, in 13 years of having type one diabetes, it's happened twice, it was both when she was tiny, it was both when I didn't know what I was doing. And it was well before the technology that exists now

Jennifer Smith, CDE 15:22
than before experience of walking around. I mean, in this example of walking around a park all day, and not really knowing, hey, she can probably get away with having this little bit of extra sugar, she'll climb, she'll come back down, and the exercise is going to hit all night long. She doesn't need insulin, you didn't know that I

Scott Benner 15:40
had no idea. And now I do. And now Arden can go play softball for nine hours on 105 degree day, and she doesn't get low at the end of the day. And because now I know what I'm doing. But that fear that exists exists for that reason. And so I don't know how comfortable you are talking about this, because I haven't asked you ahead of time. But how real this is, then we'll get off the fear. And we'll move on to other stuff about insulin. But how real is the concern that I'm going to go to bed one night and not wake up the next day?

Jennifer Smith, CDE 16:12
I would say that the concern? It's a real concern. 100? Absolutely. It is. Is it a concern that it could happen? wildly out of the blue with? And I bring this up with the technology we have today? I would say that piece is it's not going to be as common. Okay. And it's not because we have alarms and things that set now is technology always perfect. No mean, we can get alarms and alerts for blood sugars that are ultra low or look like they've dropped off the map and you do a finger stick. And it's that the sensor was not right, you know, it was a, you know, kind of a compression low. Or you could have a low alert and you could actually be lower than the low alert already. Right. However, the fear of going to bed and not waking up. While I would believe that it's there. For 90% of people with diabetes, the other percent, maybe don't even think about it or know that it's a potential again, education piece there. But I think that there is the knowing about insulin and action going into that time of the night. I think that's a piece that can really help to prevent that from happening.

Scott Benner 17:40
As we move forward, you'll hear me say a number of times that I think that highs cause lows, because highs create situations where you have unbalanced insulin. And and eventually, like we talked about earlier, body function, blood sugar will will be pushed away by the insulin, it's there leaving more insulin behind. And there are a lot of times that people will say to me, you know, I get low at 2am. Or, you know, it always happens. And I think well, I don't know that you get low at 2am. It's very possible that something's happening hours before or you're using insulin hours before. And it's and this is what the residual of that. Right. And so when you use insulin more thoughtfully, I guess is the word I want, right? Yeah, that's

Unknown Speaker 18:24
a great word.

Scott Benner 18:25
You don't have as much of it laying around later in your body that has nothing to do except for to make you low. And I'm hoping that we get to that as we speak. You've addressed fear and insulin, it's a real thing. It exists for most people. There's good reasons why you shouldn't be afraid. But how do we stop people from being afraid?

Jennifer Smith, CDE 18:46
But I think the fear to it just to kind of clarify there, it's okay to be afraid. But it's also really important that you do something to understand and be able to get rid of the fear. It will be there it is certainly but it's important to learn how to not worry so much with the fear.

Scott Benner 19:11
Right? let it overtake you. I think of it let it overtake you. Just like they tell you with fire when you're three years old. You're you have to respect fire. But you can't be afraid

Jennifer Smith, CDE 19:19
of it. Right? Yeah, be afraid of it. Exactly. Yes.

Scott Benner 19:22
And that's what I do. I it was the first delete that I made that brought me to the place where I am now. And I think that I think that no matter what tools you give people, if they're afraid to use them to kind of it's never going to work out quite right. And it's always going to become unbalanced. They're always going to end up in a situation where they go see look, this is diabetes is unpredictable. And and this is always going to happen and then yes, you know, and that that's that So okay, so All right. So what's the first step to not being afraid? It's got to be understanding how to use the insult, right? Absolutely. Okay, all right, so we're gonna get

Jennifer Smith, CDE 20:02
100% 100%. Yes.

Scott Benner 20:04
So let's understand a couple of things first that the insulin can do that cause issues for people and one, right people say, I started using insulin and I started gaining weight. Okay. Now, very recently, I had an interview with Chris Rutan, where Chris said, That's not as really nearly as much about the insulin is, as it is about calories. And that was his take on it. Like if you eat extra calories, you're going to gain weight. And that a lot of times we have low blood sugars that we treat with food, but we don't think of that food as food and access where we think of it as as necessary because it is the moment because you're allowed, but what is the act what is the what is the technical reason why people see weight gain with insulin. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well on your hand, and features Second Chance sampling, which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box free meter go get yourself a free starter kit. while supplies last US residents only touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org. Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean, it's a lot type one, it's school, the D box program golfing for diabetes, dancing for diabetes, which is a terrific program, you just click on that to check that out. Both for cause their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org. Or find them on Facebook and Instagram links in the show notes links at juicebox podcast.com. To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org. Why do some people see weight gain with insulin?

Jennifer Smith, CDE 23:41
The easy answer there is that the insulin is being it's being mismanaged the dosing of it is being mismanaged and mismanaged why? That takes in depth analysis of what's going on in the person's individual setting. Right? The and I work with a lot of people weight management wise type one who I you know, I just I've gained weight or I've done this my blood sugar's are now better, but I've gained weight. Now, if to start with, if you're running really consistently high blood sugars, you're actually peeing out calories, okay emptying out glucose because that's how your body is trying to get rid of the excess because there's not enough insulin there to bring it into your body and utilize it. So you may be maintaining a weight that you love. Your blood sugars are high, that's it's not healthy. On the second side, once you do rein in control, and you're now taking insulin to contain blood sugars, you may be gaining weight because your body is now retaining some of those calories that were being lost before that you didn't realize right. So that comes then to the point of understanding lifestyle and the Management of insulin. And I bring up a really important piece that people don't, people don't realize insulins job is a storage hormone, insulin job is to pack the food into different places in the body, right? It either packs it and moves it into your muscle cells or at PacSun, and moves it into fat. Right? It's usable, or it's going to be hopefully used later. If there's too much of it, your body has to pack it away and utilize it later. So that's a that's a lifestyle piece. That's something to look at and say, Okay, where's my activity level where it is my nutrition intake needs to be is my insulin matching that, am I driving my glucose values too low, and like you said, Am I taking in too much because of low blood sugars that are consistently happening, and then you're adding more insulin to correct the high that follows, and then you're dropping, and you're adding food and you're correcting and add. So it becomes this vicious cycle of management, if you don't understand how insulin works. And in a body, I think a good point is that in a body without diabetes, insulin plays a very big role in weight management. And people without diabetes aren't injecting it, their pancreas is making it. So if they're themselves not managing lifestyle, they're having to produce a heck of a lot more insulin, to bring food out of their bloodstream for their body to maintain that normal blood sugar, the way that it's meant to do, they will likely gain weight too.

Scott Benner 26:35
So do me a favor and go over that cycle for a second, I take something in through my mouth that has carbohydrates in it, it goes into my stomach, my bug, my body begins to break it down. It basically those carbs are leached out, that's sugar, which is the sugar is carbs, the sugar comes out. And the insulin actually helps it go into my blood. Right it or how does

Jennifer Smith, CDE 27:02
it insulin takes insulin, you know, we take it, we inject it or we pump it into our sub q tissue, it gets absorbed and dissipates that into our bloodstream is I guess the easiest way to say how it works. Insulin in the bloodstream then matches with the glucose from the food that we've eaten in whatever form you know, it could be rice, it could be celery, it could be an apple, whatever it is, sugar in the bloodstream. The insulin kind of combines with the glucose they latch on together. And insulin is then the key to the door on the cells. With insulin, the doors open, the key unlocks the door on the cell, the glucose is allowed to enter the cell muscle cells then use it for energy. Fat cells, pack it away, right? So that's how

Scott Benner 27:53
it works. And so with, so without insulin, we go into DKA. Right? And so MDK is what is it technically, but what what is it that's happening.

Jennifer Smith, CDE 28:06
So technically, with DKA, it's it's a significant deficit of insulin with high blood sugars. Right now, there are cases of DKA at more normal blood sugars. The DKA, however, really is it's a deficit of insulin, meaning that your body it has no way to clear the glucose out of the bloodstream and move it into the places it needs to go. Now your body tries to compensate. Like I mentioned before, with the weight management piece, if it tries to compensate, you get really, really thirsty with higher blood sugars, you take in more fluids your body up because you're drinking more, and your body is trying to flush a lot of that extra glucose out. And the only way it can if it can't do that forever, though, at a deficit of insulin. And so your body at the point of not having energy from glucose, it starts to break down fats and proteins. So ketones are produced with the breakdown of fat.

Scott Benner 29:10
Is that why when I think back on Ardens diagnosis prior to which she was ravenously, hungry at the end, because she her body was starving, and it's telling her eat, we're starving, except the food went in. And then there was no insulin to move it into the cells where it was needed.

Jennifer Smith, CDE 29:26
Correct? Correct. I mean, I could have I remember, I mean, I was older than your daughter and I very, I very much remember the two weeks leading up, especially the week leading up to my diagnosis. I very much remember it. I mean, I at the lunch table at school with my friends. I was asking them for their milk. I was so thirsty and so hungry. And so they would they would get two milks, and they would bring one for me. I mean, I was consuming probably six of those little curtain Have milk at every lunch and between classes in the hallway I needed to get to the water fountain. I mean, it was. It was unbelievable. The unquenchable thirst and hunger.

Scott Benner 30:11
No, that's crazy. It really is. threw me off for a second thinking. No, I was thinking back on Arden's diagnosis. And it, it just, it always just makes me think like, how do I not see her dying? Because she was, you know, like, like, no insulin in her body. And she was withering away and you look back at it.

Jennifer Smith, CDE 30:29
I think for kids, it's hard to because kids are hungry all the time. I mean, I've got a two year old and a six year old and man, like every hour, they're like, I'm hungry. Grab this. I am hungry. Can I have that kids are hungry? Yeah. But it's a different. It's a very different ravenous in that setting.

Scott Benner 30:46
Oh my god. Yeah. And so let me ask you something when a blood sugar starts to get low with a person who's being managed, but maybe they have theirs, their insulin is on balance, and they're getting lower. Arden will say she's hungry, prior to a low blood sugar. And I always tell her, Hey, if you feel hungry, first thing we should think about is are you hungry, hungry? Or is your blood sugar getting lower about the same function right there?

Jennifer Smith, CDE 31:11
In a in a similar way, just in an opposite, you know, high blood sugars, you're hungry because your body is starving for the energy. Right? And it's not getting it. low blood sugars. You're hungry because again, as we talked about, initially, your brain is being deprived. Okay? Your brain is saying, Hey, you're hungry. There's not

Scott Benner 31:37
enough. There's

Jennifer Smith, CDE 31:38
not enough food here. i There's there's too much of this insulin, it's calling. And sometimes even that precipitous drop in blood sugar that can happen.

Scott Benner 31:47
That's why manifests as hunger. Yeah, is there

Jennifer Smith, CDE 31:50
with Lowe's. I mean, you could literally go to the refrigerator and eat the whole roof. I mean, there, there are people who have done that, or just the whole box of cereal. And they're like, Okay, where's the next box? You know?

Scott Benner 32:01
It's yeah, and it's commonly referred to as eat the kitchen. Right? So yeah. And then and so. But when Arden was younger, and before sensor technology, and I was staring at her trying to figure out ways to understand where her blood sugar was. One of them was if she said she was hungry at what I thought were odd times of day. I thought, Ooh, she might be low. And yeah, yeah, because the looking for the bags under their eyes was not working. I'll never forget, she's diagnosed and the nurse practitioner goes, you know, dark circles under the eyes could be signs of low blood sugar. And then she paused and she goes are high blood sugar. And I was like, Wait, what was that gotta help me. And by the way, it never came to fruition. I spent, I spent the first year of her diagnosis, staring at her face looking for a sign of something wrong with her blood sugar, and it doesn't exist.

Jennifer Smith, CDE 32:51
I have never heard that before Scott in that, right. Yeah. Never heard that as a symptom of high oil.

Scott Benner 32:59
And it makes me think of the insanity of like when Arden will say to me like you know, you'll be in the middle of a CGM changeover. And I'll say, hey, look, it's been an hour since we reset the CGM, or since we put it on whatever, why don't you go ahead and test let's just make sure we are where he thinks you're at. And she'll say, I feel fine. And I always go, ironically, how you feel is not the best indication of what your blood sugar is. So and so she still won't wrap it, she still doesn't wrap her head around that right away. If she feels okay. Then she thinks I'm okay. You know, well,

Jennifer Smith, CDE 33:32
and there's some children that have not quite even gotten to the point of realizing what the difference of body feeling is. Yeah. Right. And if they've lived with diabetes long enough, they may not necessarily know what, quote unquote, normal should feel like, right? Yeah, they may not know that at your diagnosis at two or three. They're not even realizing outside of like, an ear ache, that they're like screaming in pain, or they're pointing at their mouth because their tooth hurts or whatever it might be. Kids that young are not in tune with

Scott Benner 34:11
how their body's supposed to feel, and and

Jennifer Smith, CDE 34:14
associating it with oh, I'm low mommy, or I have high blood sugar. And so then moving on through life, because they've had diabetes, from such an early age when you do start to make those connections. It's very difficult to translate that then into you know, older age.

Scott Benner 34:33
So I was it's funny you brought that up, because this was gonna be my next question for you. So I just was interacting with somebody on Instagram. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk, who, you know, found the podcast is bringing their blood sugar down. And now they have a beautiful stable 85 blood sugar where they feel dizzy. And, okay now, so I'm talking to this woman, and she says, I'm going to ignore it, I know it's not real, like, I know I'm not in trouble. So I'm just going to power through on my maybe I'll give myself a little bit of carbs to, you know, kind of help it a little bit, but I'm gonna power through it. Because I know my body's going to adjust to this. And I spoke to a different person who said that they got to that that nice, stable, good number, and they stopped themselves from eating too much. But it's still they had trouble doing it. So my question is, when you've spent such a long time with an elevated blood sugar, you know, thinking 180 was a great day, you know, your 250 for six of the hours of the day, and you finally get this all under control. You keep listening to these podcast episodes, and you get to a place where you're at five and stable. When that first happens. You feel like you're low? What's the function of that first of all, and tell people that it's going to get better, please?

Jennifer Smith, CDE 36:18
Yeah, the I mean, the function of that is because your body is having to adjust to values that it hasn't seen as the norm, you know, an average of one at an average of 200, an average of 250. While it's high, you're you may feel normal at that, because you don't know what a normal value or a target value feels like. So as you start to notch things down, your body has to readjust to that new normal value, and it does take some time. So hovering, you know, now at even 110. For somebody who is averaging 200. They may feel low. Okay, that may very well feel low, it doesn't mean it needs treatment, is it's truly not a low value, but it does feel low. And so it's hard. It's hard to work through that.

Scott Benner 37:17
I don't know. But I can imagine. Yeah,

Jennifer Smith, CDE 37:19
yeah. So I you know, I think as far as CGM, especially I think that's that's good technology now that at least they can also see where things are going. I mean, if they're at 110, feeling low, and they're all were all red, they're consistently still dropping very much, especially, you know, fingerstick wise, they might be lower than that. If they're on a trend, if they're hovering nice and stable, nice horizontal line at 110. No need to treat that.

Scott Benner 37:46
Yeah, fight through it. How long is it, I realized it'll be different for everybody. But what's the average amount of time before stable in range, blood sugar starts feeling normal,

Jennifer Smith, CDE 37:55
usually, at least a couple of weeks. I mean, from starting, you know, at the end, depending on timeframe of how long things were higher, it may take a couple of weeks for that to feel normal at those lower in target values. And again, stability there, and lacking this big jump up and down and whatnot, that makes a difference for resetting those symptoms in your body. Okay.

Scott Benner 38:25
I have one last question. And then we're gonna move on to something else.

Jennifer Smith, CDE 38:28
Can I show you my line right now?

Scott Benner 38:29
Yeah, sure. But look at you. Okay, I'm looking at at Jenny six, our Dexcom line that looks like it's been right at 100. It might have dipped to was that where's your low at 60? Or 70? Was at 770. It hit 70 for a little while, maybe for about an hour, and then it banged up at 85. This is very, pretty good for you. Are we? Are we are we are we gonna? Okay, let me compare. So Arden has one compression low in the last 12 hours. That isn't real. But other than that, let's see if you can see that.

Jennifer Smith, CDE 39:06
Very nice. Thank you. She's even averaging lower than me right now.

Scott Benner 39:10
And we it's a new it's a new pump to get the best day. Yeah.

Jennifer Smith, CDE 39:17
Those pod change days are like, it's almost like magic. Well, can be almost like magic.

Scott Benner 39:24
I actually just walked through walk somebody through how to pod change without a high and we'll talk about that when we talk about pumping. But yeah, so here's my last question about insulin. It's gonna I'm gonna go back to something scary for a second, but I think it's, well I know how impactful it was for me. So back when I had to dispense with my fear of insulin, like we talked about at the beginning. How do you do that? Right? Like how do you make a leap like that for me and it will probably be different for a lot of people. I started thinking more about long term health. I realized that the doctor was telling me to leave Arden's blood sugar high so that she wouldn't get low. We We were trading today's Health for tomorrow's Right? Like, we won't die today. But we might not live a long healthy life either, right? And I thought that can't be okay. But I still couldn't make the leap. And finally, I thought about it in as technical and scientific away as my brain would allow. And what I, what I came to, to think about was, I actually spilled some sugar out on the table, and I looked at how kind of coarse and granular and sharp it was on its edges. And I thought, well, at its at its microscopic, like existence, it's probably still course and sharp like this. And our bodies are built to handle a certain amount of it flowing through our blood. But if you pack that blood with too much, that must be and this was me thinking my way through when people say, I, he died of a heart attack, you know, because of his diabetes, or he went blind because of his diabetes, or he couldn't feel his foot anymore. What that really means is that the sugar has basically sandblasted you from the inside, damaging, right, making damage to the inside of your veins, capillaries, all the places where bloods covered, right, if you have a heart attack, and they say it was because of diabetes, it's because the flesh in your heart got rubbed thin, and it burst. And

Jennifer Smith, CDE 41:18
and you know, and beyond that, beyond that are the other the other pieces of those complications, such as heart disease, right? That come about, and most actors don't teach this. And I think you know, it may be a time thing it may be that they don't want to get the in depth piece of it,

Scott Benner 41:42
I think might be a good thing to bring up on day three of your exactly your sandblasting yourself,

Jennifer Smith, CDE 41:48
you know, I have a good and I wish that I could show this to everybody. But this is a tube full of a glucose solution. Do you see how slowly those little they're supposed to be particles of sugar are flowing through the bloodstream? Yeah, sugar or nutrients, right, I like to refer to them as nutrients because this is the other piece to overall long, long health with diabetes is as you mentioned, glucose I love your rough part of that example, because it is high glucose levels cause your cause your blood to get thick, almost like molasses in winter, okay, which means that all of the nutrients your bloodstream are also flowing very slowly to all the places in your body that need to get those wonderful, micro macronutrients. So healing and everything gets slowed. If your glucose level stays high, the the roughness of that sugar that you're talking about or the high glucose values it is it's very damaging to vessels almost creates like rust on a car, it creates damage on the inside of the vessels, your body tries to heal itself and self heal healing machine, your body actually makes cholesterol. It's like a band aid. So even if you never ate cholesterol, again, your liver is meant to make cholesterol and cholesterol is like it does a lot of other things. But it is also a patch. The more damage the more patch Do you see how narrow my vessel is now getting the more and more patches, those vessels that narrow that leads to high blood pressure, high blood pressure damages your kidneys High Blood Pressure puts a lot of pressure on the vessels in your eyes. So it's a it's a snowball effect right? With consistently maintained high blood sugars now have a 200 blood sugar because you decided to eat the whole you know Disney princess cake or whatever and then you bring that blood sugar down that's that's a different story than this consistent maintenance of high glucose that's different

Scott Benner 44:01
Yeah, I think that when people when I say that Ardens a once has been between five two and six two for five years I think people imagine a steady 85 blood sugar forever which is not the case no right she spikes up just like everyone else you know if you're gonna if you're gonna eat with diabetes and not have you know, you know not not have boiled it down to low carb or no carb or somebody that you're gonna miss sometimes I miss on boluses you know, insulin pump sets aren't as effective on day three is they aren't day one. There's reasons why right? Yeah. So it really is. It's not a perfection. You're looking for it. It's it's a fluidly it fluidly. It's a consistency to how you manage that's what keeps your Awan cielo. Right as you were describing cholesterol coming in and making patches on you know, arteries or veins. And it it thinning. You know, that's what people would commonly think of as needing a stent in their heart, right like eventually it has to open up that space again. All right. So for me back to what I started to say, I got past the fear by saying to myself, I can't let my fear of something happening to Arden today affect her entire life. Like, I just can't do that. And, and if that means she's gonna have something bad happened to her, or my life's gonna be a little more hectic managing insulin, then that's got to be what it's got to be. Because the alternative is, I put all this effort and heart and love into my daughter, and at the end of my life when I'm 65 7080 years old, and I'm looking back at my 40 year old daughter, and she's in incredibly poor health. I'm gonna think, like, what was this all for? Like, you know what I mean? Like what I spend my whole life doing? So I'd rather get in the game now, and do the best I can let the chips fall where they may a little bit, then just to ignore it, I can't I am not across that bridge when it comes to IT person. I find I find when you think about life like that, people have heard me talk about it on the show before you get a bill in the mail. You can't afford it. And you know, you can't before you open up the envelope, just open it anyway. Be an adult and go I owe the electric company 400 ollars. Like, no, they're

Jennifer Smith, CDE 46:17
not gonna be better tomorrow, it's gonna be the same bill. Absolutely.

Scott Benner 46:20
It's the same idea with your blood sugar. Like, don't ignore it. Don't say to yourself, it's okay. I'll deal with it later, because later is going to be worse. Now Sox laters worse. So, get in the game, do it. Now.

Jennifer Smith, CDE 46:34
I've always thought about myself, personally, I've always thought about all the things that I am able to do. Because I choose to manage because I have chosen to understand how to manage. I mean, I, I've done a lot of awesome things. I've had two kids, I, you know, I want to see those kids grow up. I want to be around with them. And that that is the biggest thing to look out to future wise. And remember every day Yeah. And that's

Scott Benner 47:09
why you and I are doing this like series inside of a, it's a series of podcast episodes inside of a podcast. Right? Right. It's because somebody's going to hear that and think, yeah, that's nice, buddy. But I don't know how to keep my kids blood sugar at 70 and blah, blah. But I'm telling you, we're going to talk about how to do that in a way where you don't have to when you hear the idea of keeping your blood sugar stable to lower number, it doesn't make you think, well, that's impossible. We're, we're going to talk about the tools that make it possible. And I'll leave this episode with this thought. Three nights ago, a man in his 40s I saw him on Facebook, and he was basically begging people, he was at the end of his rope. And he had had diabetes for a long time. And it was just not going well. And people were all jumping in given them, giving him their best piece of advice. And I always think the same thing. When I see people on social media. I'm like, wow, that's valuable. But how do you make sense of it, you know, then somebody will say something else, like, oh, well, that's not really that valuable at all in this situation. But I see why it's well meaning. And so then the person's frazzled, to the point where they thought to reach out into the world to strangers, right. And now these strangers are throwing 20 ideas at them. None of them are cohesive, even if they're good. And so I just couldn't take it. And I, I stepped in and I said, if you want to message me, I'll see if I can help you with us. And they were very kind people who all jumped on and said I would mesh with Scott if I have a show. So we got on, we got on the phone. And 45 minutes later, we got off of the phone. And the next morning, he sent me his steady overnight graph. And then at the end of that day, he sent me his 30 Day graph, and then next day, and the next day. And my point is, I can't talk to all of you on the phone and Jenny can't speak to every one of you personally, but I think we can give you enough tools to get you to that spot. So so keep going with the with this series and I think you're going to be happy that you did. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter. while supplies last US residents only. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that g VOKEGL. You see it ag o n.com forward slash choose box if you're enjoying the remastered episodes thirds of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. If you're living with diabetes, or the caregiver of someone who is, and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast, private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You may not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin popping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We talk about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She has also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.

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