#1019 Diabetes Pro Tip: Explaining Type 1

In this episode of the Juice Box Podcast, Scott and Jenny Smith discuss the need for better understanding of type 1 diabetes. They provide valuable insights and tips for parents, educators, friends, and neighbors to navigate living with type 1 diabetes. This episode serves as a resource for both those who want to learn more about type 1 diabetes and those who struggle to effectively communicate what it entails.

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

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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 0:04
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 fold 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 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 Penn Find out more at G voc glucagon.com. Forward slash juicebox. The Pro Tip series that exists inside of the Juicebox Podcast is mainly about management of type one diabetes. There's also some informative stuff like what can you do when you go to the emergency room to make your experience easier. And today, I'm going to be filling a need that's been presented to me by the listeners. So I don't know if this episode is for them to get ideas from or for them to share, or maybe both. But in this episode of The Juicebox Podcast, I along with Jenny Smith, Jenny, of course has had type one diabetes for 32 years, she's a certified diabetes educator and an all around amazing person. And me Scott, who's you know, just the host of the podcast and the parent of a child with type one diabetes. So this episode is for people who need to understand type one diabetes more, or for those of you with type one who struggled to talk to those people about what type one diabetes is. See, if you're like the school nurse or a teacher, maybe my boss, friend, a neighbor, somebody wants to have my kid over for a sleepover. This episode is for you to try to understand better what type one diabetes is and what your role in it can be. And if you're a person living with type one or the parent of someone living with type one, and you're struggling for how to talk to people about it, this will be beneficial for you as well. And a huge welcome to those of you who don't usually listen to a type one diabetes podcast, those of you who care enough to try to learn a little more about type one so that you can be a better support system for the people you know and love living with type one diabetes, it means a lot to them. I'm sure they're really, really excited that you that you took the time. So I hope we can make this informative and fun for you. I think we have let's get started. I want to jump right into this because this has been interesting since I brought this up to you the other day, I I sat down myself and I thought who in my time have I spent? Have I had to describe diabetes to you know, when I started kind of making a list. And then I just a lot of people, a lot of people and then I went online and I said you know into the private Facebook group for the podcast and I said hey guys, Jenny and I are gonna do this thing. Who do you wish? You know, we could talk to and here's how the list came back. Grandparents, teachers, parents, babysitters, somebody who might have My kid for a sleepover, my child's friend's parents, a coach of a team, spouses or significant others, co parents, roommates, extended family, school nurse, co workers, bosses, bus drivers, and, and and family of adults with type one. So people who are diagnosed as adults who then are around other adults who never end up getting it. And then very much at the end of the list, someone said, Oh, I wish you could explain it to chaperones. And I started thinking, everyone should have just answered with the same word, it should have said, people, because this is just, this is like everything else around diabetes like you like, oh, explain it specifically to a coach. So what I'm going to tell you is, I think we're going to have a conversation, that whether you're one of the people I listed, or just a person who knows somebody with type one diabetes, when you're done, I'd like you to understand the basics of type one better, maybe a little bit of terminology. So things are happening, and maybe more so the mind of the person with type one, what's happening to them, and how you can be supportive of them. I think that's the goal here like not to speak to like, like there was there in the beginning, I thought, oh, we'll do a couple of minutes talking to grandparents, and then a few minutes tall, and I'm like, No, it's all the same thing. Really. Right.

Jennifer Smith, CDE 6:25
Yeah, it is. And it's, it's really funny, you bring this topic up, because it's actually we do a monthly newsletter, and my my article last month was sharing your diabetes. Okay. And it was it was kind of along this same line it was, how do you talk to other people about your diabetes and give them the baseline of what you need them to really know. Without like a textbook, that's like 4000 pages long, overwhelming. It's overwhelming. And I some of the big points were one set a time to discuss specifically diabetes, with these people, or this person, or this culture, whoever it is, I like your term, just people in general, right? Pick the person. You need them to know this, this and this, these are the important facts. Because it's a lot easier if you've set a time for it, than if you go to the coach at the end of practice. And you're like, Hey, can you just take five minutes with me, I really want to talk to you about you know, Billy's like type one diabetes, and the coaches got, like, you know, soccer balls over is trying to get home

Scott Benner 7:40
to go home and get yelled at. There's a lot going on in my life right now. Right, right. So

Jennifer Smith, CDE 7:45
setting up a time, again, the timeline of what are the important things you want these people to know? Like you said, the basics.

Scott Benner 7:53
Let me add this to that. The other things that people came back in their, in their responses, very overwhelmingly was, I want this episode to be something I can text to somebody like a link and say, Please, can you listen to this and understand diabetes? Because many of the people who came in to speak said, Look, I'm not very good at describing it. Like I can take care of myself. But when I start there was an overwhelming feeling of when I start to explain it to somebody else, I either get frazzled or too detailed. You and Jenny do it. And I'm like, alright, well, we'll do it. So Jenny's after you listen to this episode, and you decide you really want to help a person you love with type one diabetes, or someone who's in your class, or because there was one very specific woman who said, I'm a college professor, I wish I could explain it to my students. Better, right. And so whoever you are, in this scenario, here's what I can promise you, Jenny, and I will not make this boring. And we will not make it overly like taxing. It won't be so technical, you won't understand. And it should be a good runway up to you having that conversation that we just spoke about with this person in your life who has type one diabetes. So that's my overarching goal, Jenny, don't mess it up. Okay. I'm talking to myself. I don't want to mess it up. Do we start with? Well, we usually talk about diabetes in such a specific way. But why don't we start with just a really simple description of type one diabetes? You want to go?

Jennifer Smith, CDE 9:23
Yeah, absolutely. I mean, type one. diabetes is the body's inability to create insulin or to put it out into the body. And so without it, your blood sugar gets too high. So type one diabetes is a deficiency of insulin. It's specifically an autoimmune disorder, which means the person did nothing to cause type one diabetes. It's not because they sat and ate hohos for you know, three years or whatever. So and I think that's a that's an important one to put out there. And just the simple explanation because there is a lot of misunderstanding And around just the term diabetes. Sure.

Scott Benner 10:03
So yeah, and it is a listen, it's a genetic issue, right? It's an auto immune disease, you know, you can use an example, my daughter was two years old when she was diagnosed, she weighed 19 pounds. And I, you know, fed her the same stuff, all of us feed our kids. And, and her body just was like, you know, got confused one day. I mean, that's even that right? For these people listening. I don't know exactly what triggered my daughter's type one onset, what I can tell you is that testing can prove that you have markers, that that make you more likely to get diabetes. I don't know if my daughter had them, obviously, because no one ever checked her. But she got sick. And you know, it's always been my belief that her immune system got confused. And instead of killing her virus, Winton killed her pancreas for the lack of a better term. And I want people to understand, too, that the advent of insulin is still fairly new 1921 one, right. So, for context, if my daughter's pancreas would have crapped out in 1919, she would have died in a couple of weeks, right? That's correct. Okay. The insulin is the only thing keeping people with type one diabetes alive. Otherwise, the first time your blood sugar starts heading up, it will just keep going up and never stop. That's right, right. And you'll slip into a coma and die. Okay, I told you, this wasn't gonna be too technical. So so people are getting this insulin in, in a ton of different ways. And so I think that would be important, what are the different ways people get insulin,

Jennifer Smith, CDE 11:40
initially, and some people even long term after diagnosis continue to take injections. So the age old, you get a little like bottle or what we call a vial of insulin, they now come thankfully, and easily dispensing pens. And you dose it through the course of the day based on many factors. There's other ways such as an insulin pump, that you could take your insulin, kind of a fancy little pager size device that sort of drips it into the body through a tube, or if you're using a tubeless, one like Omni pod, then that would be another way to do it. So essentially, an injection or a pump, those are two ways to get in the body. Now there is one other way. I mean, if we wanted to be truthful about it, there's also an inhalable insulin called the Frezza. So that's another way to use it,

Scott Benner 12:30
most people inject insulin correct. And so inject like Jenny said, with a pen, which really is just a very fancy syringe, you might see someone do it with a syringe, you might see someone wearing a device on their body, or carrying a device that's connected to their body with a tube, there's different ways, but in the end, you need to get that insulin under your skin, right. And this could happen for a number of reasons it could happen because you're eating if you happen, because your blood sugar just went up on its own, and you need to bring it back down. When it needs to happen, it needs to happen. And I want people to understand that asking a person with type one diabetes, to go into the bathroom, and extensively hide while they're injecting is is not the right thing to do. So if please, there's, throughout this, I'm gonna tell you say things like, please don't ever say this, here's one of them, people around here might be uncomfortable with your diabetes, you can't do that to a person. If they're uncomfortable, they can leave, I need to give myself this insulin. So my blood sugar doesn't go up really high. And don't get me wrong, like not getting the insulin is not going to you know, it's not gonna kill you in the moment if your blood sugar is going higher, but here are a lot of things that could happen. They're thinking could become cloudy, right? Right, they could become agitated. So if you're a teacher, you don't want your kids blood sugar high, because they're gonna have trouble concentrating, thinking, they're not going to learn performing in all kinds of different ways. Same thing with sports, your blood sugar gets too high, you slow down your body has a difficult time, you know, I can see at my daughter's foot speed. If my daughter's blood sugar gets over a certain number high where it doesn't belong. I can literally see her slow down while she's running, she just can't go as fast.

Jennifer Smith, CDE 14:23
Right? It would be the same thing too. I think in like a corporate world type of setting where someone may leave, feel like it wouldn't be acceptable in order to use their insulin or to respond to their pump, telling them to take the insulin or whatnot. And the same thing if they're being asked to present or to discuss something that's very, very important. They may not have the ability to do that. And if their blood sugar is not in the right place. Yeah.

Scott Benner 14:51
So you need to give people the freedom to do what they need to do. If you want them to be themselves or be able to do that. thing you're asking them to do or hope that they can do. They need to be able to take their insulin and feel comfortable about it, it's difficult to have. This is a lifelong disease, like it's not going to, it's not going to get cured anytime soon, it's not going to, it's not going to go away, it's not going to one person said, make sure people understand it doesn't just transform it to type two diabetes, like it's a progression from one to two, right? Doesn't happen type two diabetes, completely different thing, right. And so this person, it's hard, it's really difficult. Like, I really want people to listen and think that every time you have a body function that puts pushes up your blood sugar. And so for people whose pancreas is work fine, could be adrenaline, stress, pain, so many different things can make your blood sugar try to go up, when that happens to you out there. With a working pancreas, your pancreas just stops it, you don't even see it happen. Like if you were monitoring your blood sugar in real time, and you got some adrenaline like it might blip for a second, but it would come right back. A person who doesn't have that their blood sugar is going to shoot up and keep going or get too high and stay there. And then they need to put that insulin in into their body to bring it back down again. It's just it's 24 hours a day and to have somebody make it more difficult for you is is kind of terrible.

Jennifer Smith, CDE 16:24
And I think in terms of even bringing up the technology that is available, such as an insulin pump in terms of delivery, I know that there's also the misconception even in our day and age right now. Oh, you've got a pump? That takes care of it all. Yeah, that's a, that's not true. 100% not true at all, there is so much that the person with diabetes has to interact with in order for that technology to do what it needs to do for them. So just because they're connected to these devices, can be helpful. But it's not doing anything without their interaction with

Scott Benner 17:03
it. Yeah. And it's, it's easy for people to understand to make an assumption, like, Oh, they got the machine, the machine fixes it. Right, right, or something like that. And I want to be really clear for everyone listening, like, I'm not coming down on you. There are plenty of disease states that I don't understand in any meaningful way. But what that does is it stops me from, you know, saying things about it that I don't understand. And like, there's a ton of different things. You might think, Oh, this is helpful. Like, if you find yourself with a parent of a child with type one, and they've just been diagnosed, and you think, Oh, this parents so smart, or look how well they're handling it. It's not right to say to them something to the effect of you know, Well, God gave the child with type one diabetes to the right person, because you can really handle it. Right. Really think about that sentence. But you know, when you're in it, because it happens to a lot of people. No one's lucky that their kids got diabetes. Nope, no adult feels lucky. And no one walks around going, thank God, I'm a head screwed on straight kind of person. And I'm the one who got type one, because Jimmy up the street hot mess. And if he would have gotten it, it would have been way worse for him. It's bad for everybody. Okay, it's just that's a, so be careful how you speak to people. Right? I think I think about a person who's been on this podcast before who had a child who passed away and I asked like, what's the right thing for someone to say to you? And she's like, there is no right thing for someone to say to you. And, you know, anything you do is just going to, it's not going to make anything better. Unless you offer like sincere, simple support. Hey, if there's anything you need, I don't know what to do. But if you tell me I'll do it for you that works with this as well. You know,

Jennifer Smith, CDE 18:44
I think it's I think it's along the same line as offering up information about your neighbors grandma, who is something Something happened because they had diabetes, I same thing. It's like, don't, don't offer up in terms of like a connecting point. You know, if sure if you've got a cousin who has type one or you know, an uncle who had type one, and you have a little bit of understanding that might even further your discussion in terms of what the person with type one talking to you could put back into the conversation. But unless you've really lived with it, or you have taken care of somebody with type one, please don't? Yes. Tell them about your neighbors, uncles friends.

Scott Benner 19:31
This was Jenny's politely saying don't look at somebody go diabetes. Oh, where have I heard diabetes from my grandmother? Oh, you know what? Oh, my grandmother had diabetes. They cut her leg off. That's not a good thing to say to somebody. Yeah, right. And just yeah, don't don't do that. Okay. So keep keep those thoughts inside. Because that's not helpful. And it might have nothing to do with the person you're talking about your grandmother's situation. Very well could be a ton different than this person situation and that It's important to understand too is that in this day and age right now, I know this sounds kind of strange, but this is the best time in the in the history of the world to be diagnosed with type one diabetes. So people have a much greater chance of staving off, what could be long term complications, and they have a much better chance of managing day to day in the moment in a way that won't impact their lives too badly. Now, I feel strange saying this because on one hand, what I'm telling you is, these people need some leniency. They need some understanding they need a little space because they're making decisions about how their bodies are, you know, working. And at the same time, I want to tell you that they can do anything, and so don't limit them. You know, and that's hard to do too, because you might not feel like you're limiting them you may feel like you're protecting them. 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.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 an 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 juicebox 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 just click on that to check that out. Both are caused 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. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo 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. And correct they don't need that. And if they do need that, they'll know and they'll ask you for it. Yes,

Jennifer Smith, CDE 24:12
right, exactly. Which is part of this. You know, the purpose of this is understanding if they're having a conversation with you about what you need to know. The reason is because a lot of times they want you to know what to do in case they need help. Right some understanding about this is diabetes, this is what you might see me carrying such as the devices this is I might make some noise my products might be bit tight, or whatever you know, but in case of this, this and this, these are the things that you could do to help me and this is how to help me right

Scott Benner 24:47
because they may at some point need that help. And it's so you understanding like say you're a teacher, you understanding like signs like visible signs of hypokalemia anemia Okay, so low blood sugar, blood sugar. And I'm gonna read your list which I'm not a big list reader on the podcast but this person could feel shaky, be nervous or anxious. They could be sweating, have chills feel clammy, irritable, impatient, confused, their heartbeat might pick up, they can feel lightheaded or dizzy, voraciously, hungry, nauseous. Their skin sometimes can get pale, they'll look tired or could feel tired, they could end up feeling weak. Their vision could get blurred or impaired. My daughter talks about her mouth gets tingly and numb if her blood sugar gets too low headaches, trouble coordinating themselves clumsiness. This is coming right from the ADA A's website, the American diabetes Association's Association's website, in their sleep, they can have nightmares or cry in their sleep. And if their blood sugar gets too low, they can and if it gets low enough, we'll have a seizure. And so they'd like to know if they're not making sense when they're talking so that they can take in some carbohydrates of some kind to bring their blood sugar back up. And so you being a person around them, like like a coach. And you have to figure out the line, right? Because these things while they can happen, may very well not happen. So think of the other side of it. You know, you've got a little girl on your soccer team, and she's running around and every three seconds you're jogging next to her. Becky, do you feel okay? Becky, Are you dizzy? You don't feel clammy? Do you? Hey, Becky, Becky, Becky, Becky, you're ruining Becky's life when you do that, okay? Don't Don't do that. But at the same time, you could look over once in a while and visually, just, you know,

Jennifer Smith, CDE 26:44
evaluate the performance, if you're the coach, you know, how your kids usually perform or do things, you know, how they interact with their other teammates and whatnot. So yeah,

Scott Benner 26:54
it may not be at all, a strange thing to say, like, look, we have a two hour practice. Everyone sits down, you know, halfway through and drinks water. I'd really like it. If Becky tested her blood sugar, then, you know, because I don't maybe you don't feel comfortable as the coach like you don't want to be on the hook for like, seeing if this kid is about to fall over or not. Right, I get that. So talk to the parents and say, Look, can we just coordinate a blood sugar check, you know, at some point, you know, for safety, and then make it normal, don't call attention to it don't like it's happening. And everyone doesn't have to stare and people are going to stare in the beginning. But you got to just give the kid the the space to let it happen because everyone will get used to it. And I guess that's what I want to bring up with. Um, when my daughter was very little the first day of school, I'd go in and it's and I would give a talk like to the kids like five minutes on the literally the first day. Hi, this is Arden. Arden has type one diabetes, her pancreas doesn't make insulin, once in a while you're gonna see art and pull out this thing and give herself insulin within her controller for her pump. Hey, you know what Arden is just like the rest of you. She doesn't need, you know, she doesn't need you to check on her constantly. But if she looks like she's dizzy, or she's not making sense, you know, it'd be nice to tell your teacher, right? But it still didn't stop this one little girl from mothering her. And so she came home one day and she's like, this kid will not leave me alone. Like, like, and she goes, it seems really sweet. But she won't stop, I need this kid to stop back off. Like leave me alone. So that there's, there's a balance in there somewhere where you can be supportive, and understanding without being a burden to them or making them feel different or looked at. And this is very important. Like it really goes across the

Jennifer Smith, CDE 28:54
board and what you're saying to not just the little kid component, but the teacher or the coach, like you said like bugging, bugging, bugging, are you okay? Do you feel okay, do you need some more juice, you know, that kind of thing, or maybe even goes cross crosses over into spouses, significant others. You know, especially and I would expect that later in marriage or later in partnership. You've had enough visualization to not be like bugging, bugging, bugging, but in newer relationships, I think an upfront important talk when you know that it's going a little bit further than just let's go out and get a drink or whatever, right? I mean, it's important to bring up this is how you could help me Don't bother me though. You know, don't don't tell me not to have the potatoes with my dinner when we go out for dinner because oh my goodness, they have carbohydrate in and

Scott Benner 29:45
the potato makes your blood sugar go up. Thank you. That's what I want you thinking about right now. Unless the person says look, I have trouble saying no to potatoes. So if you could like if they want it

Jennifer Smith, CDE 29:56
that's different, right? It's Could you remind me not to do exactly

Scott Benner 29:59
what I say? See the french fries, if you could just go, Hey, you told me last time, I shouldn't get french fries to bring it up. I don't think anything that we've said the last couple of minutes about kids and coaches and teachers doesn't specifically apply to adults in adult situations, either. It's correct. It's all exactly the same. It's why I didn't want to break these up into like, Okay, now, here's 10 minutes for your boss, if someone's working for you, and they have type one diabetes, they're going to have some needs. And the most important thing is to support them and not make them feel awkward or odd about it. And I'll tell you why. And as a person who I'm hoping cares about other people who have type one, you know, you could create a, an eating disorder by telling someone don't, don't use your insulin here, because what you're saying to them is don't eat right now. And then they start associating the awkwardness of giving themselves the insulin with eating, and then they'll stop eating. And I know that sounds like oh, that won't happen, that happens a lot,

Jennifer Smith, CDE 30:56
or hide their eating. Right, right, in an effort to not like show others. I mean, there there is, it's I mean, it's a whole another broad topic in terms of diabetes, the eating disorders that are associated with diabetes. It mean, food is a huge part of diabetes management it is. And so it's not odd, that it can become an issue. But it certainly is something that in terms of being supportive for another person who has diabetes, you don't want to push the envelope that way. And I

Scott Benner 31:27
know that people listening right now don't know us. And they are like, it's 2020. Like, everybody seems super sensitive and social justice II and everything. We're not like that. Like, I'm not saying that at all. Like, I you can hear my terrible accent, I'm from the northeast, I'm good with like, Hey, get up, you'll be fine. I'm good with that I really am. But what I'm saying is, there's a real opportunity to mold a person in a positive way, or a negative way. And that goes for everybody I understand. But around this specifically, it does not take long to make someone feel different in a bad way. You know, and it'll stick with them, especially you teachers, who, you know, hear an alarm and are annoyed because you're trying to teach and it's alarming. Try to keep in mind that when that's happening, the student whose blood sugar is falling, who's now scared that they're going to pass out or die or something like that. They don't want this to be happening either. Correct. And you can't say let me just finish this lesson. Or they need to address because we've talked about high blood sugars, but low blood sugars are more immediate, immediate, yes. Right. You can't just ignore because a blood sugar that's falling, could be falling quickly. And one of those issues could pop up out of nowhere. So if this kid's wearing a monitor that tells them live, Hey, your blood sugar is getting low, or they say I feel dizzy, I need to test or you know, like, you can't just say, Okay, well wait till after recess is over. Or as soon as I get done explaining this math problem, like they need to do it now. Which is another great reason to normalize it, let them take their meter out at their desk and check their blood sugar. It's not going to hurt anybody. And and they'll have an answer immediately about what to do next. But the five minutes you want them to wait could end up being much too long. A time for them? Yeah,

Jennifer Smith, CDE 33:18
yeah, absolutely. I mean, in terms of you know, even that also acknowledging what they're using to treat a low blood sugar is, is something that you also don't want to form any, like, wrong feelings about someone might use, you know, in terms of carbohydrate, it's just simple sugar that we really want to use to treat. So simple in terms of it could be juice, it could be Skittles, it could be something that we call glucose tablets, it could be honey in there multiple things. And everybody seems to have a preference for what is great for them and even flavor preferences. So just because the kid in your class is using like Skittles, and you're thinking, Oh, my goodness, Skittles, why are they so unhealthy?

Scott Benner 34:04
Right? Yeah, you don't understand what you're talking about, which is a good is a great example of keeping your mouth shut in that situation. Like, they're not eating Skittles. Because you're here's what's going to happen to you. You don't know what you're talking about. The kid takes Skittles and you think in your head, this is why they have diabetes, look how they eat now, they need sugar to go into their body so quickly that it can literally fight off this extra insulin and stop from making them too low. So know what you don't know I think is important. And if you want to know find out more, but don't say silly things to people that, you know, it's not there. It's not their preference to have diabetes. The kids not looking for Skittles, you know, like, an adult doesn't want to get up in the middle of a business meeting and bang a Gatorade back. They're not like, oh, you know what I want to do to lay in front of 30 people who I'm trying to get to take me seriously. And that's the other thing too, is that you have to understand that adults are often are hiding their diabetes at work because they don't want you to judge them and like and lose out on unprofessional opportunities,

Jennifer Smith, CDE 35:08
correct? Yeah, promotion and those types of things. And I think that's also, in terms of people with diabetes. As I mentioned, initially, you have to really know, who do you need to share your diabetes with who is really important as an adult, it might be your boss, it might be the co workers at the team members that you work with, as a child, it might be, you know, your teachers, and hopefully your parents will help with that. Even some of your really good friends. I mean, I remember as a kid, when I was diagnosed, it was really helpful to have some of my really good friends know, a lot, you know, in terms of like, their understanding language, teaching them things about why I was, you know, doing a finger stick and all of that, but I think it comes down to defining who do you need to share with and what applies to this situation? You know, you're probably not going to teach your soccer coach about carbohydrate counting. I mean, that's, that's not purposeful. But you're going to teach them things like hypo awareness and you know what to do in case who to call emergency contact to there are defined pieces, I think, to teach everybody

Scott Benner 36:21
Yeah. And so it's also important to understand that diabetes is mostly an invisible disease, meaning that the people around you unless you're having a struggle, aren't ever going to see it. As a matter of fact, I pulled this up here just so that people can have an idea. Former Chicago Bears quarterback Jay Cutler has type one diabetes. Bret Michaels has it Nick Jonas has it and rice the author has it. Mary Tyler Moore, my close friend of mine coaches for the Philadelphia Phillies Sam fold he has he used to play for the Oakland A's he was in centerfield had type one diabetes. There are plenty of people. The Justice Sonia Sotomayor, right. Right has type one. So you can do

Jennifer Smith, CDE 37:07
was a baseball player? Atlanta. Oh,

Scott Benner 37:13
yeah. There's a guy. Well, there's a guy pitching for the Cubs. He's been on the show before Brandon Morrow he has, I think the tight end of the Ravens has it. There's, there's nothing you can't do with type one diabetes. There's a there's a guy that I know really well, who's a four time Olympian who has it, right. So and, and the point is, is that you look at those people, and I don't tell you they have type one diabetes, and you're never going to know these people are. It doesn't mean it's easier for them. They don't have the easy diabetes, because you don't notice it. They work very, very hard. At their health. I know it's hard to imagine. But the best I can say is imagine that you had to think breathe in, breathe out, breathe in, breathe out, or you wouldn't breathe. Like that's what it feels like having type one, I'm going to eat something I need insulin, I'd has to be this much. Not that much. I don't want to get too high. I don't want to get too low. I can't have a bunch of insulin in me when I go for a run later, because I might get low then he just like constant kind of tapping on the back of your head. You know,

Jennifer Smith, CDE 38:15
I call it diabetes inner monologue. Okay, let's see Jenny and

Scott Benner 38:19
Jenny has had type one for 31 years now. 3232 graduations. And, and she can tell you that you Jenny's really, really good at managing her diabetes. But that doesn't make it so of course, but that doesn't make it not in her mind. And and so it's there. Right? And it's an everyday conscious effort. Yes, it's so if you're a and I said that, so that you'd hear that. And so that if you are the spouse of a person who has type one, or your child has type one, but your spouse takes care of most of the management, you may not understand what's going into it on an emotional and physical and maybe sometimes lack of sleep level. It's really hard. It's incredibly hard to do well, it's also incredibly hard to do poorly. So if you're really great at managing are terrible at managing that comes with different struggles, people who are great at it understand, you know, the timing and how to take care of things in a way that maybe some people don't get to understand. But the people who are struggling, are aware every moment of the day that they're probably on their way to complications that are serious because they can't figure it out or because no one will help them. It's constantly in their head. Now, if you're co parenting, I can't tell you how many people come to me and say can you please find a way to talk to people who are like a divorced spouse or you know a step parent or somebody who's not for the lack of a better term in the fight constantly. Right, they only see a look, he's fine. Yeah, this isn't that hard or is blood sugar just went up for seven hours, that was no big deal. It is a big deal. And and either, you know, I, I don't normally get preachy, but either figure it out and help or get out of the way. But don't let your ego stand in the way of someone managing their health, which happens a lot, it may not be happening to you person listening right now, but it happens a lot more than you might want to think. Right? You know? Anyway, I didn't mean to get like that. I just I know if you saw the notes from like, my ex, you know, my kids blood sugar is terrific for a week and then they go to my exes for the weekend and his blood sugar's 300, all weekend long. So incredibly unhealthy. And, and I

Jennifer Smith, CDE 40:49
see the same thing with you know, as good as family caregivers could be like, you do the best that you can as parents, and then you have a weekend away, and you're like, Yay, we've got a weekend away. But even in terms of those parents that weekend away, is not free of diabetes thought, right? You know, their thought has gone into prepping whoever the caregiver is prepping their child for they may not know this. So you know, text me if something comes up, or you know, the grandparents or caregivers or God parents or whoever they are, that's taking care of them thinking, well, can't they just have a little of this, or can't we just give this to them, and we don't have to really worry about it, everything, everything is considered in diabetes. And as you said, you know, that couple of days that they're running now at 300, because you didn't follow the set of directions that you were given. That's making a difference in that person or that child's life,

Scott Benner 41:47
ya know, and so that people can understand when your blood sugar is high, there's too much sugar in your blood and no way to release it, the insulin is what releases it, we're not going to get into super technical stuff. But when you hear later, you know, when you turn on the news, and some guy died of complications of type one diabetes, now, you know, what they really died from was a heart attack or a stroke or an aneurysm or something that comes from too much for the lack of a better term sugar scrubbing away, you know, in the inside of your body, is it going to happen today, if a kid's blood sugar goes up to 300 Watts, because you messed up the insulin? No. But if it keeps happening, it will happen very likely one day. And so you're making a decision today on Sunday to maybe save someone's life 30 years from now. But that's that's worth understanding, you know, and just because it's going to be later doesn't make it not super important. And don't forget to you're helping them be clear minded, you know, thoughtful, being able to learn or perform like a lot goes wrong inside of the functioning of your body when your blood sugar's high. It just, it's just very important. And the people who love you and are hoping you'll understand are, they don't know how to explain it to you. So they asked us to make this. I will tell you, Jenny brought something up a minute ago that I wanted to kind of like add on to if there was a super simple way to make it, okay. Everyone with diabetes would be doing it already. And you wouldn't have to worry about it. There's no shortcut to it. So if you're having a pool party, I think you really need to try to understand how terrible it is to not invite one kid, because you're scared or you don't understand, or you just don't want the hassle. Like, just find some time talk to the parent come up with a simple plan that everybody can deal with because that kid sitting at home, and they're thinking, I'm not at this pool party right now. I'm not asleep over right now. Because I'm a problem. That's how it feels to them. Right? I'm broken, and nobody wants me around. And you can't you can't be a part of making people feel that way.

Jennifer Smith, CDE 43:55
No. And if you don't know, like you said, it's ask, you know, a lot of the kids that I work with, that's one of the big things I bring up with the parents, you know, it's if there's going to be a sleepover or something they've been asked to, again, defining a time to sit down with those parents or even the good, the good friends, parents, and make sure that they have a basic baseline kind of understanding. But I think it also takes from the standpoint of not not being the parent with a kid with type one or not being you know, the employer who has type one or any experience with it. It takes asking, really just I mean, don't be afraid to ask any question is a really good question. As long as it's not, I guess derogatory or you know, it doesn't come out as what should you really be doing that? You know, I don't know very much about this. But should you be doing that? I

Scott Benner 44:47
know a lot of people have type one diabetes, don't ask them if they should be eating something that really doesn't sit well with them. You know, they'll they'll they can eat anything they want if they know how to use the insulin to manage it. And, and so in the end, it's just that idea of, of being supportive. And like Jenny said, If you don't understand, try to find out and understand that when you go to find out, it's very possible that the person you're going to ask the mother of a kid has had diabetes for six weeks. She might not understand yet either. You know, and so her her instructions might seem like a lot, or babbling like, or I've babbled a lot of people when my kid first had diabetes, I'm like, Listen, you don't understand, she can't get high, she can't get low and you start rambling. And before you know it, you're like, Oh, great. I'm the crazy person in the room.

Jennifer Smith, CDE 45:35
You get the glazed over eyes. And they're just like, I always

Scott Benner 45:39
imagined that they're somewhere in between, like, I'm so glad this didn't happen to me, and why won't they shut up, but they won't shut up because they're scared, right? Because this stuff as much as it seems like, you can make it seem mathematical. diabetes is not like I take a pill every morning. And I'm okay. It's very fluid, it changes pretty consistently, depending on a ton of factors. And the people who really understand it, or the people who are living with it, are just sort of struggling moment to moment, because they don't know what's going to happen next, it feels like you're running for your life in a disaster movie. And you know, you're like, a bridge collapses underneath of you, and you pull yourself up on the bank. And then as as that's happening, a zombie bite your leg and a building falls on your wife, you know, like, you're just like, Wait, when is this going to slow down? You know, and at the same time, I know, I just said that. And it's true. This is gonna sound crazy. Don't treat people like they're running through a disaster movie, because they're trying to find some normalcy. And you could be a big help in that.

Jennifer Smith, CDE 46:43
And I think sometimes, within that understanding, let's say you're the teacher, or you're the boss, or you're the coach, and you've, you've been schooled, right, somebody sat down with you, and they've given you information. They're like, this is the plan of action. And then next year, they come to you, and they're like, Okay, do you understand everything? And you're like, Yeah, I got it, you gave me this whole, like, you know, hour long, entire, you know, information session, you're like, okay, but this year, this is a little different, right? This is what we're experiencing now. So know that life with type one diabetes also kind of, it's a little bit more fluid, there's, there's change that ends up happening, you know, last year, to juice boxes at the middle session of a soccer match, might no longer need to be there. This year, the reaction is a little bit different. So, you know, also continue to ask questions along the way to say, well, has anybody anything changed for you? Or you know, is it is it still the same? Do we need to consider anything different? I think that's why in the beginning of the year for kids, especially, there's always a, there's a point at which you need to go in and you need to reestablish that care plan for this year, what's going what needs to be different, what needs to change? Because Because life changes,

Scott Benner 47:58
and seriously, because your grandmother or your aunt, or your uncle has type two diabetes, you don't understand type one at all. There's nothing about that, that translates over to this in any meaningful caregiving kind of a way. I remember just recently, we were having a conversation before a school year. And one of the teachers, you know, my daughter's information about her blood sugar is on her cell phone, right, which is really cool. And so the teachers like, well, we take the cell phones away at the beginning of the class, and I laughed, and I was like, that's fine. Arden's not going to be giving you her cell phone, she needs it to, you know, make life and death decisions. And she's very good with their cell phone. She's not going to abuse it and everything like that. She was well, what do I tell the other kids? And I said, I swear I said this in a roomful of about 10 teachers is that tell them if they want to get a lifelong incurable disease, then they can keep their cell phone on them too. Otherwise, they should shut up. And like, and you have to have the nerve to do that, like you shouldn't to turn to 20 other kids and go, Listen, her situation is different than yours. I don't even care if you but just stop, you know, like it's a it's a big deal. Imagine wanting to use someone's diabetes as an excuse to keep your cell phone or to be a malcontent for a second, and then you as an adult, don't just shut that down right away. Instead, you're like, Oh, well, you know, Kim does have a good point. It's not fair. Of course, it's not fair. It's also not fair that my daughter's carrying a juice box with her and like, something called glucagon in case she passes out to somebody could stick it in her leg. It's not fair either, you know. So just think I'll tell you a common sense is, is a huge help with diabetes. It really is, and especially about being around them. But let's look, I think everybody understands now hopefully, why don't we drill down a little bit more about how in a situation whether you're a teacher or grandparent who's babysitting or something like that, or a you know, a boss who's trying to, you know, keep somebody healthy, like Let's give him more nuts and bolts of what goes on in the day of a person with type one diabetes and how they may be able to be helpful in those situations. So, I mean, but before we do that, Jenny, I'm sorry. Can you explain to people what it feels like to be high and what it feels like to be low? For you personally, it's gonna be different for some people. But

Jennifer Smith, CDE 50:19
yeah, so lows. As I said just a bit ago, low symptoms for the person can change through the course of life with type one, two. So my lows now, I feel as though I have like these racing thoughts. I feel like things are going really like exponentially fast. But I feel like I'm moving through mud. Like, I feel like I just can't get there. Even though everything in my brain feels fast. I feel like I'm just moving at like a snail's pace. It feels horrible. I also, for a long time, it started in college, and I didn't have this symptom before, but kind of like you mentioned that like Nam. With Arden, I have like this numb, tingly tongue kind of feeling for low blood sugars. And I've never thankfully knock on wood, I've never gotten to the point of needing glucagon, I've never had to use it in my 32 years of life. Nobody's had to give it to me, I have had to have assistance for treating low. But um, you know, sometimes I've, I've, like started talking kind of weird, like, not really what the whole conversation was about, or like mumbling and sort of rambling. And my husband said, like, Thank you blood sugars kinda low. And this was before CGM, like we're married early on. You know, he knew some of the things to watch for. So I mean, those are my lows. Now, when I was younger, I definitely was shaky. I mean, it was very visibly, my blood sugar was low. And again, that was a time when there were no continuous monitors and pumps were not really beneficial. So but highs, highs, I get really, like tired, and really kind of, like more annoyed, I don't get annoyed, I don't get that like irritated angriness with lows like many people can get, I get that more when I'm high. And I feel like I just can't put a lot of really good, like thoughts together consistently, I feel slow,

Scott Benner 52:36
so hard to put the effort in for anything. And it's not something that you can just fight through. It's not like that. It's not, it's not like I didn't get enough sleep last night, but I need to be at work. It's an absolutely physiological issue that is limiting you. So for people listening, it's sugar, glucose is the is the energy your brain runs off of. And having the right amount of it is perfect. Having too little of it, you know, is goes the way we've discussed and having too much of it does something to your body with a working pancreas just keeps you in a great range all the time. So you don't experience all of these things. But a person who may be could do something so simple as let's see, let's say you have a kid in your class who says I have to give myself my insulin right now, because I'm eating in 10 minutes. And you say, no, no, no, we're gonna finish this first, don't do that. I don't want you giving yourself insulin in front of all these people. Well, you've now missed time, their insulin with the impact that the foods going to have on their body, which will very likely drive their blood sugar higher and cause what Jenny just described. Similarly, if they say I put my insulin in 10 minutes ago, and I know you want to talk for five more minutes, but I have to start eating now. You can't say no, because then their blood sugar could go the wrong way the the insulin will continue to pull the sugar out of their blood, it doesn't know how to stop like, like a healthy body does,

Jennifer Smith, CDE 53:58
it's expecting there to be food there to work with.

Scott Benner 54:00
Yes, and when that foods not there, they can get awfully low and all the way up to like I don't want to, like, you know, I don't want to make you feel like I'm trying to be dramatic, but you could kill them. And you know, anywhere from shaky to not making sense to angry to seizures to passing out to dying, like if you take too much of that sugar out of their blood. That's like taking electricity away from a light bulb and you can't turn it back on again by putting the sugar back in after it's off. So it's really important. And at the same time super important not to make people feel like pariah and and not to give them long term, serious psychological issues around this thing that they you know, I am going to say this, but I don't think it matters. They have nothing to do with getting it. But even if they did, why would you? Why would you want to make them feel that way? You know, and I think that's important and I don't think any of the people listening to this want that. I think it's just it don't know what they're talking about. And then you make assumptions you No, I don't know, a lot of the things that we think are is anecdotal. You know, we kind of went over like, oh, diabetes, that keys off. My grandmother had diabetes. I understand diabetes, I live with my grandmother for three years. No, that's different. That's probably type two diabetes. And your grandmother probably took a couple of medications and, you know, different thing. But the person who says that, I don't think they say that out of malice, I also don't think the person who tells you, you're so strong, thank God, this happened to you. And not me. I don't even think I don't think that person means that with malice. No, you know, they're in any

Jennifer Smith, CDE 55:35
conversation, we're always trying to find a connecting piece, you know, I mean, communication is that it's a give and take between two people or six people or whatever. But if you're in the, if you're the person that doesn't know, then ask more than talking. Yes. Right. It's, it's always, well, oh, goodness, I, you know, I didn't know that you had type one diabetes, tell me what that's like. I mean, that's a very easy, simple, you know, and if the person really doesn't want or need to share with you, maybe they would just say, Well, you know, I manage it, and it's okay. But if they're, if you're sharing with them for a reason, then continue to really be more of the ask the questions. But don't share too much. Unless you truly have some experience to share. I feel

Scott Benner 56:22
like before we go over nuts and bolts like management ideas that people will have to intersect with, I think what we should really be saying here is, in case you haven't been paying attention for the last 49 minutes, this is about communication. And most people are terrible communicators. And it's because they don't listen enough, and they interject their thoughts. And it's a very human thing to feel like, you know, but you don't like I could sit here for the rest of my life and make a list of things I don't understand. You know, but I'll tell you what, put me in a situation where one of those things, I probably puff up a little bit, start reaching into my common sense, or, you know, a little bit of my anecdotal information I have, and I start saying now, now I know what's up here. You know, it's, it's like talking about, I know, we're recording this during Corona, but like, it's that thing when people step up, they go, Oh, no, no, you know what you have to do you have to do this. How do you know that? Is it because you're a Harvard researcher? Or is it because you heard a guy say a thing, and now two people said it, you're like, oh, that must be true. And that's just how our brains operate. And it's very valuable day to day, it's not very valuable when you're trying to talk to somebody about something important like this, that you don't understand. And they very well may be struggling with as well. You know, so anyway, all right, I'll start you jump in. Okay, I'll do breakfast, you do lunch, and we'll, we'll go from there. My daughter gets up in the morning. And if we're lucky, her blood sugar has been stable overnight. But if she's been low, overnight, we may have had to take away some insulin, or give her food, she could wake up a little higher. Because of that, it could throw off the timing of her eating, she might end up being late for school. Because of that. She may end up being a little rundown, you can wake up if you have a bunch of low blood sugars overnight, you wake up with what people some people call a low blood sugar hangover. Yeah, right. And so that could be that. So you got to give these people a chance to get their lives moving. And then they've got to get to work. And what if I get myself insolent or on time and I have to get my car then and drive to work. And now I'm scared, I could get low while I'm driving like these poor people, or you're just eating, you got a pancreas, it works. You get up, you make some eggs, you throw them in your face and run out the door. And it's all good. People with diabetes are already 45 decisions into life. And it's 730. And they haven't been in the shower yet. So they so they get that together. My daughter, you know, heads off to school and, you know, half an hour, 45 minutes later, she needs to know what her blood sugar's doing. So she's gonna have to look. So you see, my daughter looked down at her phone in the first in first class, she's not ignoring you. She's making sure that her blood sugar doesn't get out of whack. And then she's got to start thinking about like, Oh, I'm getting low. And I have Jim two hours from now. And, and lunch is going to be in three hours. And, you know, I have to give myself insulin during social studies so that it's working for, you know, all that stuff, right. And they have to count their carbohydrates in their food. So I'm going to ask Jenny to explain like, what what they're doing, they're around their meals.

Jennifer Smith, CDE 59:24
Yeah. So I mean, carbohydrates are it's just a big word for sugar, right? I mean, all all carbohydrate foods, like starchy foods, fruit, even vegetables have some kind of carbohydrate or sugar in and when we take insulin, insulin is meant primarily to cover the impact of carbohydrates. So timing is really important around that in terms of like you said, she might need to take her insulin and social studies so that by the time she gets to lunch, the insulin is already there. The way that our insulin today works, it's meant to meet with her Food in the system. But our insulin has to actually do what we call peaking, kind of get in get working get circulating in order for food, carbohydrates was which digest really fast. Once they start, you know, getting into the stomach, that insulin has to meet it at the right time. And so when we count our carbohydrates, it's a certain amount that goes along with a certain amount of insulin, so that our blood sugar doesn't get too high after that might involve looking at a food label that might involve looking up information on your phone. So that maybe you're you know, visiting an app that's got a calorie or a carb counter in it, you might see somebody again on their phone or their device looking something up. And I guarantee that diabetes is fits around a mealtime. It's not that they're ignoring you or trying to be rude, it's likely that they're looking for information, or maybe that they're telling their pump to do something important. Coming into that mealtime.

Scott Benner 1:00:57
And if you stand in their way of doing that, than most people to feel like they fit in next time won't do it, then you'll make their insulin late and they're gone. And their blood sugar is going to be higher. Not everybody's me, like I don't care what people think I would just do whatever, you know, and I've raised my daughter that way. I'm like, Oh, don't worry about them just do what you need to do. But but you have to understand that many, many people can't overcome social pressure. And so you pressure him even on the way you don't understand, you may send them in another direction. So they count all these carbs that give themselves their insulin. Now they're not sure if it's going to work, their blood sugar might go up and might go down. Now they might have to have their meter out to check their you know, they might have to poke a hole in their finger, make some blood come out, check it with a test strip, some people might be wearing a glucose monitor that's feeding their their blood sugar live to them on their cell phone, there's a lot of gear they have. It's not, you can't restrict their access to their gear is is a big thing. Because I've seen people say like, oh, just leave your bag here. Like I need that bag. I can't just leave it here. And that might mean if you're a teacher, that at recess for this year, you're going to be wearing some kids bag over your shoulder at recess. And just I know it sucks, but just do it. And that's it. For for, for I was good, please.

Jennifer Smith, CDE 1:02:13
Oh, I was gonna say along with that, like in terms of like, what do you have to leave your bag here, whatnot, I've worked with quite a number of adults, especially who are government employees who aren't allowed to run their phones aren't allowed to have certain devices like a phone or whatnot within their government building. And I think the important thing, I mean, if you are certainly, you know, within the realm of being an employer, for people with type one i policies need to change, then that's the biggest thing that I can say, because while the device itself might have pieces that you don't want within the building, you're really restricting their ability to have a healthy life in terms of also what you're asking them to do performance wise on the job, things

Scott Benner 1:02:54
change. And that goes right to what I was gonna say with like school nurses, like, I know, You've been a school nurse for 25 years, and no kid here has ever died from type one diabetes, except the way that you took care of it 15 years ago, it's not the way people take care of it anymore. It's much more fluid, it's, it's better. It just it really is and saying to somebody, Oh, it's okay. Or I'd rather their blood sugar be high than low? No, you wouldn't rather their blood sugar be high than low, you'd rather the blood sugar be normal normal than either of those things. Stop finding either ores in your head, I don't want to go down the wrong road away from away from diabetes, but everything's not black or white. It's not this or that. There's all kinds of other options and gray areas. And just because your brain picks, I'd rather be high than why rather than behind the load that doesn't make you right, and that doesn't mean that's the only option. There are a ton of options. Kids having to leave class to go to the nurse to do diabetes related things. That's bad. Okay, I know you think it's Oh, they need to be around me. So they do it right. You need to everybody needs to teach them how to handle it on their own because losing five or 10 minutes of math when you're too you know in second grade is one thing, but losing 10 minutes of advanced trigonometry is another thing you know like or may miss a whole concept. Yes, and it's gone and and if you learned how to manage on your own in the moment, you can just kind of find a need meet the need keep going instead of wait till the needs a problem. Go to the nurse spend a half an hour getting out of the problem going back much better to be proactive than reactive. And the going to the nurse thing all the time is reactive. It's waiting for a problem. These things can can be done in classrooms. Technology is amazing. My daughter has been managing her blood sugar through text messages with me for a decade. Right and she does no lie. Since the last day of second grade. My daughter who is a junior in high school has not been into the nurse's office for anything diabetes related in all that time?

Jennifer Smith, CDE 1:05:04
Well, even in terms of like safety to, you know, I know that there are a number of schools and families that have worked with well, they have to send my child to treat the low blood sugar to the nurse's station, it's down three levels and across the building and whatnot, like, blood sugar is low, they need to treat it in class, there's no reason that you're you're sending a kid whose blood sugar is dropping, you know, for a five minute walk through the halls in order to go suck some juice down and a nurse so they can watch and make sure they drink the whole box. That's ridiculous. Like,

Scott Benner 1:05:34
they're like, well, we'll send a kid with him like, Oh, great. So there'll be another eight year old there, because I am always putting eight year olds in charge of important things, you know, hey, listen, you just go with Jenny. And if she passes out, you know what to do your age. Right? Exact my 20 year old wouldn't know what to do, we'd be like, Oh, what happened? Jenny fell over, we left her there. And she died. Like, you know, like, you just don't put kids in charge of stuff. It's weird. Like I get if it's a little like, Oh, she just wants to have somebody to go down with and it's all nice. But the nurse's office is for emergencies. And here's the crazy thing. Having type one diabetes is not an emergency. It's just, it's just an extra thing you do during the day. So stop treating them like they're sick, Trump's stop treating them like they're broken. They're, they're just they're not, you know, and so and so listen, that they're gonna have to get on the bus, or you have to drive home from work. And you're still thinking about your blood sugar. And so if someone comes to you and says, Look, I need you to watch my kid tonight for a couple of hours, or you're the babysitter, or a grandparent, it's very doable, someone's gonna say to you look, eight o'clock, test their blood sugar, you know, text me the number, I'll help you do what you do. If you know if the numbers in this range, that's cool, give him this much insulin, let him eat this snack, you know, and here's what the snack is. Just follow the instructions, the person giving you the instructions is fairly confident that they're that they're right. And questioning them all the time is bizarre, you have any idea how many school nurses fight with parents, like I've been taking care of this kid for 10 years. And you want to tell me how to do it now. Because that's how we've always done it here. Very strange way to come at something. I get that you don't want to get into a long conversation with a family who maybe doesn't understand and maybe, least common denominator, it might make it easy for people who don't know, but instead of doing that to them, like what if you said to them, Hey, I think there's a way we could do this that your kid could be healthier, or you know, that kind of thing. And, and I want to say too, I'd like to give Jenny a chance here to talk about what it would feel like if her spouse had those kind of like anecdotal thoughts and was leaning on her all the time. First of all, I'd be dead. She'd bury him somewhere. It's over. She wouldn't take it. But But like, what would it be like for another adult who you respect in all other things, to suddenly have thoughts about your health that that aren't warranted or founded?

Jennifer Smith, CDE 1:08:05
It would be it would, it would feel horrible. I mean, this fact that somebody that, like you said, you care so much about and that you have a lot of good rapport, and almost every other thing that you talk about and live with and decide about together? I mean, it would make you feel kind of countered, honestly, in terms of what you've been doing. And also like visually how you feel like they're now seeing you. Like, is it all about this? Is this all they see now? is are they really gosh, they're they're really worried about this, or they feel like they don't have any, there's no confidence there, in what I in what I'm able to do for myself, you know, I've been managing this for 30 some years. They feel like I can't do it anymore, that they're constantly asking, like, are you okay? Or did you just check your blood sugar before bed tonight? Because, you know, I heard your Dexcom last night or whatever, psychologically to

Scott Benner 1:08:57
feeling like feeling like someone looks at you and sees diabetes, not you. Is is is kind of crushing. You know, and that's another great little tip you're looking for a tip don't lead with how's your blood sugar every time you see somebody, something else first, how's the day? Isn't it sunny out, blah, blah, blah. Like, even if you're the school nurse, like just walking in there. It's a drudgery for kids right to do that.

Jennifer Smith, CDE 1:09:20
Like it's very rare for my husband to actually like, ask, even if he hears like my Dexcom making a noise or something. It's very rare for him to ask I he does have the follow app on his phone. And even with that, he never I think it was maybe a month ago that he texted me to ask, you know, I've gotten these like urgent, low alerts. He's like, you know, and I've gotten a couple of them like, are you okay? It's kind of all he asked or, you know, and I was like, Yep, it's a sensor. That's totally off. I was like, I just restarted it this morning. A little difficulty. Yeah, I actually texted him a picture of like my actual life. finger stick, I'm like, I'm like, 92 totally fine. It's like, okay, I just wanted to make sure that he's like, because I keep getting them. And I just wanted to make sure that everything was okay. But other than that, usually it's not, you know, it's not even something I

Scott Benner 1:10:15
brought up, but it wouldn't be pleasant if if he was constantly.

Jennifer Smith, CDE 1:10:18
No, in fact, usually my my late native work in which he doesn't work, he usually makes dinner. And he'll actually usually text me and ask, you know, hey, I was gonna make this this evening, you know? This is how much carbs in it, because you know, is that I need to Pre-Bolus Or he'll have measured something for me. And this is how much was in it? Or, you know, when do you think you're going to be done, because he knows that the Pre-Bolus component is really important. So those kinds of pieces are really helpful. They're not like, annoying

Scott Benner 1:10:51
to good example. It's a good example of him. Like, look, what are we saying, listen, talk, ask questions, be empathetic, do things that are actually helpful, not that you think are helpful. I learned that from being married, by the way, that the things that I think my wife wants aren't necessarily the things that she wants. And that you know, and then I wouldn't be much more helpful if I did the things that would actually be beneficial to her and not the things that I feel would be beneficial, right. So listen, talk, ask questions, let them talk, realize it's hard for them as well. And like Jenny said, at the beginning, set a time to sit down and talk about this. And if you don't understand, keep asking and understand that things could continue to kind of morph and grow and change and that what you know, today to be true, very well may not be true a year from now. Right? You know, you have no idea how things evolve and change hormones and kids are huge stress is, is can sometimes be hard on your on your diabetes, but I really do want to make sure that no one leaves this feeling like oh, well, people with type one diabetes, I shouldn't hire them. I shouldn't put them on my kids baseball team. It's not the case, with with good support and understanding. I mean, this, okay, you guys are listening. Because somebody sent you this episode, you don't know this podcast, you don't know me. I've met 1000s of people with type one diabetes in my life. And overall, some of the kindest, smartest tuned in people that I've ever met in my life. Like, imagine how tuned during you are when you have to understand the inner workings of your body constantly. You want these people on your side, like they're, they're great teammates, they're there, they're great coworkers, there's just a little bit that they need you to understand. And then you'll find a rhythm. That's the other thing is like, this isn't forever, you'll find a rhythm together, whether you're you know, a, you know, the parent of a friend of a kid or something like that, or whoever you are in the scenario, you deal with times, it won't be a thing anymore, you'll just you'll have it, you know, and it's worth doing because you're gonna get to know some great people who otherwise may be marginalized. And I don't know, just think about it, like you have an opportunity to put in a little bit of effort to figure something out. And keep a kid from being a kid who's not invited to a birthday party, or a person who loses a job that they're completely qualified for, because they got low at work, and nobody knew how to help them that made all of you nervous, you know, that that sort of thing. I want to say to that, if you really want to dig in more, there are episodes of the podcast called defining diabetes. And they're very short. And they, they define very specific things. So like, if we set a word here, like Bolus or Pre-Bolus, that you didn't understand, it will explain that to you very simply. And if you really want to dig down deep and understand what people are thinking about when they're managing their blood sugar's, there's an entire series of episodes called diabetes pro tip, right? So it's diabetes pro tip Pre-Bolus diabetes, pro tip, something, there's maybe 20 of them by now, if you really want to understand what people with type one diabetes are thinking about. Those episodes will take you well inside. And same thing for people listening who were like, I can't make anybody understand Pre-Bolus saying like, just you could send them one of those. So yeah,

Jennifer Smith, CDE 1:14:11
I was actually going to mention that too. So yay.

Scott Benner 1:14:14
Thank you very much. And this is the first episode that Jenny and I recorded with her new microphone. And I have held in my excitement about how good she sounds the entire time we were doing this. So for regular listeners to the podcast, you're there. All right now going like 20 sounds so much better. And for everybody else, they're like, Hmm, I didn't know that was a big deal.

Jennifer Smith, CDE 1:14:33
I asked Scott if it was actually going to get rid of my Wisconsin accent. And he's like, yeah, probably not. But no, it'd be so much clearer.

Scott Benner 1:14:39
You talked earlier about the night your husband, would you work late and your husband cooks and there were four words that if I hadn't spoken to you so much, I don't know that I would have known what you were saying. Oh, really? That's right. I've said water a couple of times in here. So everybody who's not from Philly is like what is wrong with this guy? They think and I'm having a stroke probably Anyway, I really hope this was valuable. I know it's not possible for us to cover everything. But the goal was for you to be the person who's in some way supporting someone with type one diabetes or wants to understand better. And I hope that by listening to this, you, you have a better understanding, I think you will.

Jennifer Smith, CDE 1:15:18
And also know that you are really important in terms of the person's like feelings about things and that background support piece, you're a really important part of that as long as you understand things in the way that you need in order to provide that support. So

Scott Benner 1:15:37
I think in the last thing, I think I want to say is that, as my dog barks, that you don't want to separate yourself from a person's life because you're scared of their thing. Like that hurts like it might, because I talked about co parenting earlier and spouses who aren't as involved, I believe, sometimes they just don't want to mess up. So they step back, but you end up alienating the person with diabetes and stranding the person who's trying to help them. And and I know, it's a lot to figure out, but you could like trust me, I know, as you're listening, you don't know me, but I am. There's nothing special about me and I understand diabetes really well. And everything I know about it. And Jenny knows about it, we put into those pro tip episodes. So if you're just a dad or a mom, or you know who's like, I don't want to get involved, because I'll mess it up. You know, you're doing other things that I think you don't mean to be doing in your relationships. And if you understood it better, I think you could do better it would help. Yeah, it really would. Anyway, I could keep talking about this forever. So let's just stop. Jenny, thank you very much for doing this with me. Of course. 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 G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. 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 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 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 this 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 info Emeishan presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so it 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. If you're living with diabetes are 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. 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.

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#1018 Diabetes Pro Tip: Pregnancy

Scott is joined by Jennifer Smith who shares her immense knowledge on the topic of type 1 diabetes and pregnancy.

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.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:04
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. 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 Penn Find out more at G Vogue glucagon.com forward slash juicebox good and fresh.

Jennifer Smith, CDE 2:25
Because I'm not gonna sing. I don't say

Scott Benner 2:28
oh no, no, because this episode is going to be basically me going uh huh. And you saying a lot of different things. So I want to if I can, yeah, do a pro tip episode about pregnancy. And I mean, like, pre planning leading up to it, what to expect out of prepare what to do, what's going to happen if this happens, what I do, and if we can, how do I do it without a glucose monitor? Is that all doable in the next hour?

Speaker 3 3:00
Without a glucose. Alright, well, let's do the winning without a continuous without physically without knowing anything.

Jennifer Smith, CDE 3:08
That's possible. But

Scott Benner 3:10
isn't it funny? I call them glucose monitors or blood glucose monitor. Why do I do that? I don't know. Anyway, without a CGM, gotcha, gotcha. Okay. Because I would like to, I want to do that as well. So anyway, I am, I'm going to be on the outside looking in here for this. But I do think that the place to start, if you agree, is understanding what the pre planning is like? Because you can't, or you shouldn't I'm guessing if you have type one diabetes, if you're the lady, you should not just if you can help it be in a situation where we got bored on Friday, and now we're going to have a kid. Right? Right. There should be some more planning to that. So how far out? Does the planning have to be in is that maybe person to person based on their situation?

Jennifer Smith, CDE 4:01
Yeah, and kind of like we always talk it is sort of person to person. Uh, you know, overall, if you've all along had pretty good management, you've put lots of play, and you know how your insulin works, you know, how food and activity and all of those things work for you. Maybe three months, maybe, you know, maybe you get married, and it's a quick turnaround. And you're like, Yeah, we're ready. And like you're, you have everything in place. And, you know, you're where it should be. And I mean, there are other parameters to check to, especially with diabetes, things like thyroid. All of those things should definitely be checked and analyzed and evaluated prior. But everything checks out. Great. If not, then yes, it could be three months, it could be six months. It could you know, if you're somebody who's starting out you, you know that you and your partner really want to have a child but you don't really have things in place to do that safely from a discussion maybe that you've had with your doctor or your OB team or whoever, then it might take a long time. I think it takes going back to really like the pro tips episodes, really, if you're trying to get things contain and that's, that's the starting place. Because while while you know where you need to maybe get, or maybe you don't glucose target range for pregnant should really be started prior to conception. Because then it's not such a big change over from saying, Okay, well, I've been aiming for a target of 80 to 180, let's say, right, while pregnancy target is, you know, fasting 65 to 95. That's when you wake up in the morning. Is

Scott Benner 5:49
that is that anyone see in the fours? Is that is that high fours to look

Jennifer Smith, CDE 5:54
for the E one C listing because what I think, Zack, they were that

Scott Benner 5:59
I think what we're talking about here is that you have to know how to manage your blood sugar's tightly and see some consistency through weeks and months. So it's not just a fluke, like one month, you're just like, Oh, I did it. And you have to be able to do it without low blood sugars that are going to be dangerous for you or the baby to write, you know. And so yeah, get it right, and then prove it over and over again, over and over again, through your period through different meals, because you also could, I just finished what I really enjoyed, I haven't, I did a four part series with a pregnant person who has type one. And we interviewed together after her first trimester after her second after a third and just yesterday, when her baby is three months old. And so I went through the whole process with her to try to understand it. And her agency was like 4.8, during her pregnancy, and she was describing needing insulin, more than double than what she normally needed. And that like swallowing that pill of like, oh my god, there's way more insulin needed here. I have to do it. And yeah, and I want to get to all that. But But yeah, to me, what you're saying is, you can't be a person who's got an A one C of nine and say I'm going to have a baby. I'll just get pregnant now. And I'll fix it. Because what could those things lead to, like what Ohio one sees in pregnancy lead to?

Jennifer Smith, CDE 7:29
So that's where the typical national standard is? A one c less than 7%. At conception, right? That's, that's the broad goal. We aim for a little tighter than that. Because as you're kind of getting to, it's easier to have things tighter to begin with. Oh, goodness, I've not really done anything, or I didn't plan it. And I also haven't done anything. And now I really have to tighten everything up. That's a lot of change all at one time, along with a load of hormones impacting things at the same time. Yeah, so it's a lot, right. So the standard center conception is really because what they've seen in research is the risks of things like early miscarriage, or many of the genetic problems that can come up from those early weeks of forming all of the different body. All of the different body organs and everything. That's what's happening in that first trimester. So the goal being under 7%, your risk is is about even with the general population who doesn't have diabetes, for those same types of problems to have, okay? Okay, the higher the agency, the more potential for early loss or or miscarriage, the more potential for the heart to not form the right way or any of the organ systems, you know, a lot of those genetic types of things. Then also a lot of things that are not specifically genetic, like they don't come from down the gene line, but they just happen because glucose levels aren't allowing the cells to divide and form into what they're supposed to do.

Scott Benner 9:23
So anywhere from a miscarriage to birth defects, correct. Okay. And is it a mortal lock that that's going to happen? I mean, you know, how you know how some people are like I smoked all through my pregnancy and he's fine like that, like it are they're dumb luck people. And I'm not that I'm saying roll the dice on that, but, but were you definitely going to see something or maybe not even know like, is it possible? You know, is it is it out of this world to think that you could have a high one C and your child could develop asthma and that even though you're never going to know it could have something to do with that? I guess that would be some speculative, but that's

Jennifer Smith, CDE 10:00
it is complete speculation, because there's really not. There's a lot of research done on later outcomes in kids who've, I guess, born from women who have had diabetes, right through pregnancy, but a lot of it is more assumption of putting information together, right? Really, no, you're never really going to know. And, you know, on the opposite of that, let's say you, you did plan to really take care, just and make changes, and, you know, things do happen, people get pregnant,

Scott Benner 10:35
and it happens. I've seen it happen personally.

Unknown Speaker 10:38
Yes.

Scott Benner 10:41
And no one's planning on it. And the next thing, you know, you're moving to a place to have more space.

Jennifer Smith, CDE 10:47
Because you're gonna need it. There's gonna be another person,

Speaker 4 10:50
someone by mistake got knocked up, because, you know, long day everybody missed each other. And the next thing you know, I gotta leave my condo. That's all.

Jennifer Smith, CDE 10:58
There you go. So you know that it happens, right. And I mean, and I've worked with a number of women through pregnancy, who that has been the case while they were planning events. Really right now, and a one C really was not where we would aim to have it be the highest I've had someone start a pregnancy, which was really not planned. It was a teen pregnancy was 11.3.

Scott Benner 11:28
Wow. And now they come to you right away. And no, it took too long. They didn't

Jennifer Smith, CDE 11:33
they, you know, they came in early second trimester it was you know, they had gotten through their first trimester, with OB TM, and some endocrine, I can't even remember how the family found integrated to, you know, get in contact and get. But I worked with her through her whole entire pregnancy. And we pretty quickly got her agency down. Yeah. And then, you know, by the end of pregnancy, her agency was 5.7. That's great. So I mean, and she has, she's a beautiful little kid now that there are no. So can things be okay? Yes, they can. But the risk increases dramatically as the a onesie. And the glucose levels are not managed

Scott Benner 12:21
it to me, for me personally, and given that you can get pregnant by you know, not on purpose. By breathing out someone, hey, that's what I was told. But I think what we're saying is, is that, you know, say you live in a nice, safe town, you don't really need to lock your door, but you do anyway, there are certain steps you take, just because why would we take the risk if we don't need to? Like if we know we're going to have a baby, why would we start with a seven a one seat and go, I bet I can get it down before something weird happens to the kid like, you know, like, let's, let's not do that if we don't need to. If we get caught in that situation, then, you know, figure it out, get it down? It's correct. It really is. It's such a it's I don't know, I just I'm thinking back now to the conversation I had, that the person who I mentioned from the, you know, the four different interviews through the pregnancy came to my attention because her first pregnancy ended in a mask a miscarriage. And so and I've been contacted by people who there's a person I'm still hoping to get on the podcast, she found out that she had diabetes, because she was pregnant. You know, like, she got pregnant, they ran a blood test. And they were like, Oh, you're not just pregnant. You have type one diabetes. And yeah, did not know prior to that. That person is doing terrific has a really cute kid. And, and I'm hoping to have her on one day. But anyway, it's just, you

Jennifer Smith, CDE 13:47
know, the other thing I wanted to mention here, too, is that all the things that you can do ahead of time, sometimes things do happen anyway. Right. I mean, I I'm I'm actually my personal is our my first pregnancy I had a miscarriage. So, you know, and I did everything ahead of time. I had been doing everything for several years. We're like, yes, we're like, finally ready to definitely have a child. Right. And I had done everything. And in fact, my my maternal fetal medicine, which is a high risk OB doctor that typically manages through high risk pregnancies. You know, she was like, this has nothing to do with she said many, many early pregnancies back she said many women, they kind of their visit late especially, they've been pretty regular. They're a little late in their in their, you know, period starting and then it starts like five, seven days late and they're kind of wondering, she said, oftentimes those are very strange where the body actually didn't even start up anything truly. Many miscarriages in terms of For a person without diabetes, and a person with diabetes who has managed well, there just because the body knows that there's not something quite right,

Scott Benner 15:08
just feels like a false start. And that's what happens. Oh, that's sad. No, of course.

Jennifer Smith, CDE 15:13
Yeah. And so, you know, I mean, it's sad in any regard. But I think if you can do the things ahead of time to prevent it, then you know that you've done everything possible,

Scott Benner 15:24
takes away from the idea of is this diabetes? Or is this something else that you can see yourself as more than having type one, you can see normal things that happen to people, I just saw someone recently who had a seizure, and thought it was because of their blood sugar, but then figured out, it wasn't, you know, but that was their first thought was, oh, I must have my blood sugar must have gotten very low. And it turned out not to be right, you need to see yourself aside of diabetes. And the best way to do that is to make diabetes a lesser impact on you so that you're not always worried about is this happening because of that, right.

Jennifer Smith, CDE 16:00
And I think that that's a good point, though, for the pre the pre conception, the pre planning stage, to know the impact of this versus, versus, you know, I do this activity, and this happens. There's a lot that goes into that, beyond just having well managed blood sugars. Yeah, there are a lot of other things to consider in that right. Nutrition is one of them. And then the other factors that are very rare autoimmune disorder is, are your other autoimmune conditions? If you do have them? Are they well controlled? Thyroid is another very big one that's really, really important to have tightly managed prior to conception. Because thyroid levels do change. They will manage and evaluate and do more blood tests and adjust your medication. But you also have chi, you have to have kind of a baseline right? To know coming in. Yes, things are good.

Scott Benner 17:02
You know, it's funny, you mentioned that because just an hour ago, I took art and to get her blood test, because we've been managing her thyroid through her endo forever. But it's always just like, well, she's in range, it's fine. It started with still having a lot of, you know, side effects of what you would consider hypothyroidism. And so I finally found an endocrinologist who doesn't care exactly what the number says they care about how you feel. And so she's doing all these other things with her and I hope to have that doctor on at some point when this process is done with Arden, but it's fascinating. She's taking so often uses terrorists and and the amount of tariffs that that her first doctor had her on is half of what the second doctor had her on. And she looked and she said, Yes, her numbers fine, but her symptoms are terrible. And she said, given her weight, I would think that this should be more medication like so she was just she's very tuned into it. I just think that I would like to do a lot more about thyroid. On the podcast, I just you have to find the right people to talk to and they're difficult to locate, you know. But yeah, so that as well. So what do I do? I've, and I don't want to skip over what Jamie just said about nutrition too, like, don't get so focused on your blood sugars, that you're like, wow, look at me, I've got a four, eight, I can eat all the Twinkies I want. I learned how to keep my blood, the kids gonna need like some greens and protein and stuff like that to grow it. But I don't want to tell you how to pray in your family. What I am wondering is I've decided, I've got some money, I found a space I can put the kid nice. The safe closet, if I want to go out maybe that break can't get hurt, you know, and moving forward. Do I make with the bangbang fun part? Or do I go find a doctor first? What's the first? Yeah.

Jennifer Smith, CDE 18:51
The other part of it is not only your management, having a team in place, prior to conception is really, really important. Because I've had a number of women that I've worked with who have thought that they would just go with who was preferred with their insurance, right plan. And a number of them have transitioned once or even twice through pregnancy because they were so unhappy with the care that they were receiving. A lot of it's specific to diabetes and the consideration of diabetes in the pregnancy. I mean, and definitely higher risk, maternal fetal medicine teams, they know pregnancy, but it really takes the right team to know pregnancy and diabetes together. And pregnancy and diabetes with type one diabetes is very different diabetes. And so if you've got a practitioner who you know says yes or there you call and you ask around to a couple of offices talk to their nurse Horses and get a bit of an idea about how the clinic runs and how appointments run and the doctor and experience and oh, we've got lots and lots of experience with diabetes. diabetes, is the question you should be asking, because they may have a good amount of gestational diabetes management experience. It's very different with type one,

Scott Benner 20:22
you don't want to get caught up in the medical equivalent of Oh, my aunt has that. Yeah, correct. Right. type one, your and as type two, it's different. Thanks for Yeah,

Jennifer Smith, CDE 20:31
so do your shopping is really, you know, the case. The other piece when you're doing your shopping essentially, for your care team is, if you've got a really great endo that you're working with already, that would be a first, like, stop to actually ask them. Are you going to be my diabetes Backup Manager through this pregnancy? Because I've had some endos who differ to the maternal fetal medicine team, which, that's okay. As long as the maternal fetal medicine team has got it, man, they understand the diabetes pieces, and they understand the diabetes pieces. Well, I've also, you know, games differ, you know, some OB is, once you get pregnant with high risk anything, they're hands off, they're like, you're going to high risk, high risk is going to manage the pregnancy for you. We won't see you. Right, we will see you until baby is born and you are post delivery time, right? Other teams, the OB sees you for the base visits just for the monitoring and that kind of stuff. You'll be shuttled away to maternal fetal medicine potentially then for the high risk types of things. Anatomy scans, fetal heart echoes all of the higher risk types of evaluations, especially in the third trimester. So it it around, it pays to even see if offices have a preconception consultation that they will do. So you can talk to the doctor and you can bring them this is how I manage I'm well managed. This is what I've done to get to the point of being ready. Because the more that any team like that what you know, and how well you're doing, the more comfortable they're going to be helping you to manage the right way. Yeah, so yeah, it takes it takes looking.

Scott Benner 22:25
Okay. So we have to do some shopping, find we find the doctor. We, we we decide to move forward. We start doing what we're doing. I ended up pregnant. Me. I don't know why I didn't see you in this scenario. Hopefully you don't pretend I'm a lady for a sec. And I'm pregnant now. And I have diabetes. So pretend everything about me is different. I'm a lady I have diabetes. I'm pregnant. Now. How soon do I start noticing like well, I noticed that my blood sugar's before I noticed in my pregnancy test.

Jennifer Smith, CDE 22:57
For the most part in the first several weeks post conception, blood sugars are going to start to look wonky. wonky and I think the easiest way to describe it is if has experienced a rise of any kind in blood sugar during their normal monthly cycle, whether it's the three to five days before the couple of days of once they get it or even around ovulation. Hormones from the start of pregnancy are significant. A big difference in blood sugar most women in about the first week to let's call it five to six weeks will experience a rise in their insulin need because of those hormones and the impact that they have. So you know if you have been trying that you've been trying as soon as you know you're done try get on the these are my diabetes pregnancy targets that I'm aiming for if you haven't been doing it you know so tightly prior to trying then definitely do it as soon as you're done try you could be pregnant.

Scott Benner 24:10
Alright, let's take a detour for a second and and let Jenny rant for a minute. Why it's might be something I know about her that she's never said here but why are there different ideas of health for pregnant people with type one diabetes and non pregnant people with type one diabetes if it's great for the baby, isn't it great for all of us.

Jennifer Smith, CDE 24:33
There you go. Yes, it opens up a whole can of worms Pandora's box, so to speak. We have

Scott Benner 24:39
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Jennifer Smith, CDE 28:00
It's a great question. And it's one that's always kind of been like in the back of my mind even before my husband and it's like, we definitely want to have a child within the next year. Right. But I had already prior to that readiness, I had already been focusing on much tighter targets than my endo ever told me to aim for. Knowing what I know the research that I've done about long term outcomes of blood sugar management and control, right. And it was several years ago actually that I worked with a woman through her pregnancy and postpartum she said to me, so my doctor wants me to loosen up my targets. And she's like, No, I'm through pregnancy, managing the way that I did. And knowing what people without diabetes, what their body manages for them. Yeah, she's like, why would I go back to loosened targets? Why would I do that? And it was, I mean, it really like brought it to the front of my head from like, love. That's what I always aim for. So I guess I didn't really think about it. But that's right. It's it's a it's a great question. Why are we not overall consistently aiming whether you're a man or a woman? Why are we not consistently aiming for blood sugars that are in the nondiabetic? Why why is that the case? Now, outside of this? There are some good reasons things like older adults, hypoglycemia unawareness. There are some medical types of conditions or certain scenarios, let's call it that could meet a range and or a higher range for safety kinds of reasons. But the general population it's a good thing to bring up because that's it's true. It why are we aiming for less than 180 after meals, and I really it should be lower.

Scott Benner 30:03
And I brought it up. Because in my sort of peripheral understanding of this, this whole time that I've been in the diabetes space, I've always thought of it as people would people with, I was gonna say people with pregnancy, people who are getting pregnant, are somehow asked to do some superhuman thing with their health. That's not even necessary. And it took me a while to realize that's not what we're really saying. What we're saying is that every Listen, there's a lot of people that have type one diabetes, and we all have different access to different technology insulins, all these different things. And so there's a, there's a blanket statement out there, like, if you're a one sees, you know, under this number, you're probably have a really great chance of being okay. As it gets lower your chances of problems get differently, you know, maybe they lesson, but then once in a while someone will put out a report, this is all there's no benefit in having a one C under this number for some reason. And I every and we've talked about on here before and I see that and I think I don't, I don't believe that that's true. And I think that that's going to be one of the things that 10 years from now someone's gonna say, oh, there was a report 10 years ago that said this was wrong. Yeah. But oops. You know, and I also think that it's a, it's an emotional idea. Like, if someone has a seven, you don't want to make them feel like a failure, because they're not five and a half. Right? Right. Because they're not, but it doesn't mean that they should stop trying for the other day not make themselves crazy, or you know, like anything, but write better goals. It's, I don't know, right? It just, you know, it's like if I went out and ran a 300 yard dash today, I think I'd finish it. And I don't know, probably an hour and a half. And so right. Now, that might be my personal best, but I saw on the Olympics, it can be done. You know, it about seconds, about 15 seconds. And so I can't just sit here and say, Oh, I did the best ever, because that's my best because it's not and it's your health or your child's health. And you can't just I mean, I think that one of the underlying concepts of this podcast is that you can't just say, oh, that's fine. It's good, or it's good enough. 300 after pizza usually go to 400. That was a huge win for that.

Jennifer Smith, CDE 32:21
Was that right? And maybe that was a win. Maybe that was a win, you know, but if it's,

Scott Benner 32:25
yeah, it's totally better. Again, try again, try it.

Jennifer Smith, CDE 32:27
Right. And that's it. So yeah, that's a very good point to bring, I think target targets in pregnancy are in a way they are tighter, because we do have certain parameters such as, in the post mealtime period, the targets are at one hour post meal, the goal is at two hours post meal, it's less than 120. Yep. And really, if meals aren't in the picture, you should be averaging somewhere around, you know, like the 65 to like, 100 ish range. That's, that's, that's what you should be aiming for. Now, the person who's not pregnant, if they're sitting at 21, great, they might feel really good at 121. In pregnancy, that's the high end of really where we would want to hover long term. So there are some parameter differences. And I think it has to do also with everything that the mother is doing to her body. Yeah, that's the impact on the developing baby then,

Scott Benner 33:30
right? And keep in mind why that is to 121 blood sugar. If if you're a person, like we've been able to see my wife's blood sugar in the past, my boys blood sugar sits at like, 75 Most of the time, right? Yeah. And so if, if, if that's what your normal is, and you're 121, I'm going to tell you some quick math tells me that's 46 points higher than what your body would have done without diabetes, which is a significant difference significant. It's a significant concentration of glucose in your blood, messing with the development of that baby. That's what I'm, or if you're not pregnant, messing with your life, you know, so

Jennifer Smith, CDE 34:11
as far as like messing with the baby, I think another piece to bring in is once the baby. I always find this concept really interesting that a pregnant woman who has diabetes type one diabetes specifically has a pancreas that's doing right, the betas are either almost completely dead or they're all gone. Right. What they have and are growing this little person that has a working pancreas inside of its body. Yeah, right. I mean, that's, it's amazing just to think of like a developing baby to begin with, but then to think of all the little parts and pieces growing and working the way that they're supposed to, in that like little being. It's amazing to me so when you consider blood sugar in pregnancy as well. Your baby has a functioning pancreas. is very early on, right? And it starts to make insulin in response to what? Telling it's blood sugar. Oh, right. So the flux of your blood sugar tells then how is it kind of it goes along with how much glucose or how much food gets funneled in to the baby, the higher your glucose levels are, the higher glucose levels will get Now, baby's glucose levels again, they're being controlled well within a normal non diabetic target, because that's what its body is doing. But the more the pancreas has to work to combat your high glucose levels, the more like swapped in glucose the to be continually. And that's why like, later on post delivery, if the baby's body has been so used to pumping out excess insulin all the time, as soon as the baby is born, and you've heard about babies have been born with really low blood sugar. Yeah, soon as that umbilical cord is cut the mother's food source to the baby, it is gone, right? And if the baby has come into delivery, with a pancreas that's spitting out excess insulin because the mother's glucose levels were so high, its blood sugars are going to plummet.

Scott Benner 36:26
Interesting. So that makes sense, obviously, but that's Yeah, interesting.

Jennifer Smith, CDE 36:31
So that's another piece of like, we talked about the tight control in pregnancy. Tight is it's, it's there for a different reason, really. And so the ranges and how long glucose should stay at that elevated like one, then be back down, really into the normal range. There. There's reason for that.

Scott Benner 36:52
Yeah. It's funny, we all talk about it. So academically, like you know, 140 in the first hour, or 120, in the second hour back down and stable until I work glucose monitor and watch my body do it. It really didn't mean as much to me as it did, saying it out loud, right? Because my understood my entire understanding of insulin is through Arden's perspective. Like I've never thought about it before about about somebody else's ever once, and there's no lie, your blood sugar just sits in the 80s, you know, and then all of a sudden, pops up a little and comes back down and comes back down and levels out. And maybe you see a protein rise or something from fat later, it comes back up a little bit, but boom, right back down again, I ate my face off and couldn't get my blood sugar to go above 145. One, you know, 130 by the cage or something, totally took in as much food as I could, and I couldn't get over 135. So, you know, so, but how do we? You know, it's interesting, right? Because this podcast works, because we talk to people honestly about stuff like this, but most people's perception of how to talk to people. So don't make anyone feel bad. And I don't want anyone to feel bad. Like, I don't want someone to hear this and think I can't do that. Because I think you can. I think that I think that it's very possible that Jenny and I could have cottoned on and said this is a diabetes pro tip episode about pregnancy, go back and listen to the other protests, and then have sex. Yeah. Right. We'll see you next time. Like it may be could have been that really. And so if you're in the scenario, right now, where you're listening to this, you're like, Oh, I can't do this, or I have a different kind of diabetes, you probably don't, you know, like, you know, a blood sugar, that's it's stable, it's 7075 80. That's Basal insulin, that's just getting your Basal right. And so it's real doable. So if you've made it this far, you must really want to have a baby. And, and it really is doable. I really do say go back to Episode 210, find the beginning of the protests, or go to diabetes pro tip.com, where they're all listed, and listen through them, I think you could change your management. Now. Here's the thing. You've been pregnant, like you said a number of times with type one, is it more difficult? And by difficult, I mean, intensive with your focus and paying attention to your diabetes while you're pregnant, or while you're not pregnant? And what's different about it, like what are people going to find once they're pregnant? So I've got my three months where I'm doing great, but now all of a sudden, there's a baby in there, what changes?

Jennifer Smith, CDE 39:35
It's more intense, I think, because of the impact of the hormones once you are pregnant, right? So you knew what you were doing? You knew let's say you had your list of 30 Awesome foods that you had figured out or three pills and you knew what to do for them and how to Bolus and you can knock out your 10 mile run, you know, twice a week and whatever you figured it out. hormones in the picture change that okay. And so and that sounds kind of scary, but it's, it's kind of a roll with it sort of. Okay, you and if you've learned things again, from the pro tips, you've learned that don't let it just sit there fix it, right? Don't wait six days to see is this really a trend? If you've got a high blood sugar in pregnancy, okay, one, it might be hormones great. Okay, but then let's get it down in the tested that you know how to get your blood sugar down, use those tools, you may need to use the tools in a in a more hyped up way, right, let's say you always knew that an angled arrow up or a straight arrow up required an extra half a unit of insulin, oh, with pregnancy hormones in the mix, maybe it requires to offset that, because those pregnancy hormones cause some insulin resistance. And in early pregnancy, it's a very quick, noticeable rise in insulin need. The end of the first trimester typically things dip off a little bit, they plateau as there's a transition, where the pregnancy hormones are made transitions from ovaries into your placenta, there's a little bit of a transition there. You see, you might run some lower blood sugar's in late first trimester, before second trimester starts. And this is where I kind of call it like, if you've ever been at a theme park, and you get on the roller coaster and you're right at the bottom just starts to get you going up and you're up and you're up. And you keep climbing and you keep climbing. That's from second trimester or about like 18 ish plus weeks, that slow steady climb and insulin resistance, thus requiring more insulin and more. And then over time, I mean, the heaviest resistance is definitely the third trimester, typically somewhere between about 30 to 32 weeks until about 36 weeks is the heaviest resistance. So you accommodate by making adjustments. And again, this is where that team to begin with should be a huge advantage to you. Because during pregnancy, pregnancy brain or mommy brain is not a myth. Yeah, it is something that is there, you might get lost in in data. And so having a team that's really, really good and willing, and frequently through pregnancy with adjustments, despite you making your own, you may need a second set or a third set of eyes looking at things and being able to say that was great, but I think we could bump this a little bit more, we could change it a little bit more here. Oh, this looks like it's happening now.

Scott Benner 42:48
That's well, I was just as you were speaking, I there's this conundrum around more insulin like, you know, my body needs more all of a sudden give it more and we call it insulin resistance. And I'm always resistant to call it insulin resistance. I'm always thinking of it as just more need. But how do you convey that to a person? Right? How does a person who believes that their Basil is one unit an hour? How can they make the leap to now believe it's two units an hour or that a meal that was three units is six units all of a sudden, like that's such a huge leap in your head? And I wonder if it wouldn't help people just to think of insulin resistance as magical carbs that just appeared inside of your body? Right? Like so, you know, like, instead of insulin resistance, pushing your fasting blood sugar from 85 to 150, think of, well, how many carbs would have moved me that far? Right? And how much insulin would I have used for those carbs? So that's in there, there's a math equation of how much insulin do I need. But what I realized most about the podcast is that people need a way to think about it, right? They need a way that it makes sense to them. Because otherwise, they want an equation that's going to tell them when I'm pregnant, I need this percentage more, or the food's gonna need this much more. And I don't know that anyone's gonna give you that answer the way you want it. So

Jennifer Smith, CDE 44:11
I think it is it's more but I think if you know when you're talking about like the math, as you said, if you know that your typical fasting now in pregnancy has been like 7881. And now all of a sudden, you're waking up when I was nine 110 That kind of range. How much of an insulin adjustment is needed in that overnight Basal then and where did it go up and what to adjust because again, if you've done your homework ahead of pregnancy, you have an idea of where things started. And as you changes, you're more attuned to them in pregnancy. You just you see things on a super highlighted level. Let's call it that You know, you're paying more and more and more attention you asked, you know, what's the difference between paying attention outside of pregnancy versus B? I think just the pregnancy itself drives a woman to think I'm now caring for another little being that's growing. And I have, I have the ability to let this baby develop really healthy from the get go. And I'm a big part of that, right? So you become really kind of like, hyper on evaluating what's happening to your blood sugar. I mean, I looked at my I looked at my Dexcom. More than Well, while I was pregnant, I was constantly like clicking to see, you know, what was going on? Where was it going? What was happening? Because, well, the see, is this normal, or have I gotten a new load of like pregnancy impact? And do I need to make a shift now? Oh, look, this is like, day two, that I've now had to correct my blood sugar with a little more after lunchtime. I need to obviously add more insulin to my Bolus, I need to change my

Scott Benner 46:07
did you have anxiety around that? Samantha mentioned in the episode that she sometimes felt like she was hurting the baby when her blood sugar would get high? Yeah, it was hard to deal with sometimes. And then I think

Jennifer Smith, CDE 46:18
that's a I would say, 95% of the women that I work with their pregnancy that's at at least once it's mentioned, well, my goodness, my blood sugar. Again, we we had like a baby shower, and I had like a bite of a cupcake and my blood sugar was 201. Or, you know, I got it down really Rino right away. I'm like, okay, that's that's okay. And they're, you know, they're very, I think the worry really is one they need to voice it because it was concerning to have worrying about that baby did that really high blood sugar for one hour? Cause my baby to now have three eyeballs now weigh 12 pounds? No, it's It's more understanding that the consistent lengthy, high blood sugars, that's problematic. Right off, I mean, was my blood sugar sitting at 83, the entire pregnancy dislike flat, beautiful, I actually go back to my Dexcom records from that time because I printed them out. But I have them in like my pregnancy file.

Scott Benner 47:21
Just let everybody take a second to say to themselves personally, whether they're doing chores, the House working out or your grocery shopping to go. I knew Jenny had her Dexcom grafts from her pregnancy.

Jennifer Smith, CDE 47:33
They're good. They're reference for me, as I work with people, and I was really glad having done that my first pregnancy, because we knew that we wanted more kids. Yeah. And I wanted to have a reference to be able to say, tested. So once you get through a first pregnancy, and you get an idea, yeah, I needed more around 20 weeks, I needed more, again, in Basal and in Bolus, and I needed to lengthen my Pre-Bolus. That's another big one that shifts through pregnancy, you might you know, pre pregnancy, you might do 1526, things are stable, that works really great. Once you're pregnant. As you get more pregnant, the time of Pre-Bolus gets longer and longer and longer. So by about mid pregnancy, you should be pretty minute Pre-Bolus For most meals,

Scott Benner 48:31
how much of what's happening to a pregnant person is in regards to their insulin use is that they're pregnant, that they're cooking a little person inside of them, they've got a bunch of hormones going on. And by the way, all of you have to be so impressed that I talk about this stuff so much. And I've never told that joke from the 80s. How do you make a hormone? I keep it inside every time I hear it, just so you know. And so how much of this has to do with that? And how much does it have to do with gaining weight too? Is that a part of it? So like a side of the diabetes piece or a side of the pregnancy piece you are gaining weight as well, right?

Jennifer Smith, CDE 49:08
Gaining weight and you shouldn't you should be gaining weight and that is a very big piece of it. Yes. And you know, Healthy Weight Gain if you've if you're at a really good target, happy healthy weight prior to pregnancy. You could gain somewhere between 20 to 3025 to 35. Okay, in pregnancy that would be considered normal. You have to expect or I guess you have to understand where does that wait to come from? Because in both of my pregnancies, my first pregnancy I think I gained I think it was 26 pounds. My second pregnancy I gained 21 pounds. And you have to you have an eight pound baby. That's like a third to maybe half of your week. Depending you know, that's a big chunk of that already. Now, like put on the floor plucked out at You're you delivered right? Hopefully that the floor but right, it's like not on you anymore, right? And then you have to expect development for lactation, you have a placenta, you have all the amniotic fluid, your fluid levels in your body doubles through pregnancy. That's why a lot of women experience swelling and whatnot in their legs by the end of the day at in late stages of pregnancy, your blood volume increases to pump all of that extra blood through you, pink tissue and the bat. So you've got a lot of gain that disappears, literally once you deliver the baby. So really, women end up you hear people complaining on this last five pounds, I can't seem to get rid of it after break. That's really it is that gain? Yeah, most women gain someone seven pounds of fat gain through pregnancy. And it's normal, your body should be doing that. Because if you plan to nurse or breastfeed your child, your body needs a reserve. So it's packing things away. So you can make plenty milk to supply this like never are empty baby

Scott Benner 51:11
hungry all the time, it was about to show off and say that that was for breastfeeding. But then you beat me to it. I was like, Oh, I know something. Finally that's yeah, prove it now. So it doesn't matter.

Jennifer Smith, CDE 51:22
And typically, as long as you nurse, you're usually most women are going to retain about that. Once nursing is done, depending on how long you plan to nurse, usually, as long as you return to your normal activity, and you haven't been eating bonbons crazy, just because you want to typically that weight does come off once you're through nursing.

Scott Benner 51:45
Alright, so we've gotten through the pregnancy things have gone well, the day the delivery comes, please talk to your doctors well ahead of hand and understand that just speaking to your doctors doesn't mean that the nurse that the hospital's going to know that you're taking care of your blood sugar during your during your delivery, right. And it's going to, if you've been doing such a good job thus far be really weird to hand it off to somebody, you know, in the last 50 yards, when you're like I can see the end, now you take care of my blood sugar. So you know, if you have a spouse or a family member, that you can, you know, teach how to help you or she'll be there with you right in case something gets funky and they end up putting you out or something like that, I guess obviously, if they go to a C section, you're gonna get handled like a surgery case then too. But if you're just having a regular vaginal birth, you should be able to manage your blood sugar through that time pretty well.

Jennifer Smith, CDE 52:42
potentially even a C section, you know, really? Yeah, really. And I think this is where protocol, like you said initially, it's, it's really important to have this talk with your team much sooner than delivery could possibly happen. I mean, there are always certain instances delivery at like 28 weeks, or 30 weeks or whatever. And those are really, it's not often. And that's a very feel of management, right. But for the most part with women that I work with your pregnancy, we establish and detail a labor and delivery plan, okay, and it goes through, these are the expectations of glucose management, this is where you should target through dip through every, this is how much insulin adjustment you could expect to need to make. And again, every woman responds to laboring and delivery a little bit differently. Some women's needs with the active nature of laboring, some women's needs go down by 50%, great use a Temp Basal decrease. Some woman's needs go up a little bit with the stress of all of the contractions and everything. Great. So you might need a little nudge kind of Bolus of insulin in order to get a little bit, right. A little bit extra. Whenever you're correcting in delivery, our recommendation is typically about 50% of what your pump is recommending to correct a blood sugar while you're laboring because, again, you're you're active. I mean, it's not like you're out running a marathon. But a pregnancy can take long, or a delivery can take a lot longer than marathon takes a person, right? So you can expect that that now is gonna get active pretty quick, and it's going to have a faster impact on your blood sugar. Right. So those are some of the things that we highlight. We also have a pattern established in the care plan so that the doctors know where your rates are, what your sensitivity is going in delivery. And then there's also a postpartum part of the delivery plan that notes now insulin needs are decreased considerably. This is what your postpartum pattern should look like a lot of the women I work with take it into their OB team, they get it signed off, it becomes part of their medical record. And once they go into the hospital, that's the plan of care. The nurses know the targets. They don't have to continue to explain it over and over and over and over to all of the nurses as they're rotating through their eight to 12 hour shift.

Scott Benner 55:22
Yeah, yeah, that's Samantha brought that up to that the first nursing staff was great after the pregnancy. And then when they switched over, the next group didn't know what the first group knew. And then now you're explaining about your blood sugar's and that all gets and you've just had a baby said she was wasted from having the baby, the whole thing. Okay, so I have a couple more questions. And I know we're running up on time a little bit. Oh, we're good. Okay. Make the baby baby comes out. Everybody comes to the hospital. They're like, Oh my god, the baby made a baby. It's great. You see your friends of yours who you're like, oh my god, they shouldn't even be near kids. Somehow you let them hold your baby. If you're younger, trust me that will happen. One of your 25 or 30 year old friends is going to be hold them in your like, that's probably a mistake letting Jimmy near the baby. And so that all happens. Your home now. Now, you've got to take care of a baby. Yeah, I see a lot of people say well, it's hard to take care of the baby and my blood sugar the way I was taking care of it before. But it did you find I'm using you as an example here because you're very good at handling your blood sugar. Did you have trouble after you had a baby keeping carry yourself?

Jennifer Smith, CDE 56:30
I think you know, this is where again, planning your care team kind of thing comes into play. And while your mom, your aunt, your best friend, you know your uncle's brother, who isn't really your uncle, but is a good friend that you whatever it is, whoever's going to be there anyone post delivery that you trust, not Jimmy, who

Scott Benner 56:55
like drop the delivery of the baby to get the

Jennifer Smith, CDE 56:59
baby to but somebody you're going to trust to be there once you come home from the hospital. Yeah, that is a really, and something for at least a week, maybe even two weeks for someone to really be there to help with things because one delivery in and of itself is it's a labor. Yeah, that's why they call it labor, right? It's work you you may with a vaginal delivery. Okay, you may not be in the hospital for very long. If you have a C section delivery, C sections typically are about a three to three to four nights stay. It it depends on healing and how things are going and all of that kind of stuff, right? But definitely when you get home. It's harder because you're now not taking care of just you and diabetes. Now, it's like you've got a second child, even though if this is your first real child, I always considered diabetes, kind of like a toddler that never really grows up, like constantly sort of like caring for it. So it's almost like this first child diabetes gets pushed off in the corner and you're like, Yeah, you're just gonna have to sit there for a bit, because mommy's gonna take care of

Scott Benner 58:15
it fine. He can do his homework by himself.

Jennifer Smith, CDE 58:18
That's right, right. So you know, some things to kind of along with that care person, they're beyond your spouse or your significant other, you know, somebody else that can be there. So you can focus a little bit because in that time period, especially the first month, things will change considerably with insulin sensitivity, especially if you're nursing. There are a lot of changes that will take place and blood sugars are going to look a little bit more rollercoaster we want how important

Scott Benner 58:49
our blood sugars to the breastfeeding process does that impact the milk at all?

Jennifer Smith, CDE 58:55
So there's a lot of like thoughts around it a lot of research that sort of like a 5051 of the big things is high blood sugars can actually good lactation. So if you leave your blood sugars sitting high one, as we've talked previous episodes about like hydration, your blood sugar's are sitting high, you are not well hydrated, you are in a and milk is liquid, not only more coming out as your nursing, blood sugars are drinking enough. Oh, I see. So Right. So hydration is really, really an important part of not only the blood sugar, but also continuing to be able to supply enough liquid that's going to get sucked out of your body. Your

Scott Benner 59:41
mind too. If you've never had a baby before. They don't sleep the way real people sleep. So there's a tired factor that is really hard to put into words. It's not easy. And so there's a lot going on. I mean, listen, we've gotten this far I should put I'll be telling you having kids is a huge mistake. I don't mean that having them is great. It's getting them and taking care of them and keeping them alive and being, you know, good to them and teaching them things. All that is a harsh show. But the kid itself is lovely. Like, when you walk through the room, you're like, oh, look, the kid. That's nice. Yeah, in that moment, you don't think about when they're yelling at you when they're eight, or that you paid a guy who was probably homeless to be spider man and a third birthday party or something like that, like, that's the thing she you know, they want you to have a dog. And then you get a dog because you like, oh, the kid should grow up with a dog. And then it's 630 in the morning, everyone's asleep, but you and you're outside with the damn dog. You know, I'm saying kids are great. A lot of what goes with it is hard. And hard. And especially right after a

Jennifer Smith, CDE 1:00:51
baby is hard. Especially if, again, it's your first pregnancy. Yeah, it's it's a harder time. And this is again, where help comes in the form of also, like, pre planning, for the post delivery, the time period, you know, we number of like soups, and things that I could put in the freezer, that were easy to pull out. I knew the content of them, because I knew what was in them, I either made them or my mom made them. And I froze them, it needed a heck of a lot easier. Also, some of those foods that are definite, no one foods and how are you react to them? Yeah, can be a huge help in the aftermath. So it's just not it's not more struggle, as you're already managing. Nursing a child putting a child to sleep, learning how to not like have poop all over the place as you change them.

Scott Benner 1:01:46
You could experience postpartum depression, which is incredibly common. There's a lot that could happen. And by the way, a lot of guys will eventually turn into good fathers, but it doesn't, they don't have a nature provided switch, like I'm telling you, you're going to have a baby and be like, This is the most important thing in the world I watched might happen to my wife, she almost didn't even care that I was alive. When the baby came out. She was like, the baby's here. And that guy, you know, like, it was you if you're, you know, lucky, you're gonna get a great connection, and you're gonna feel that desire to take very good care. It takes guys longer to figure out how to be fathers than it takes women to figure out how to be mothers, generally speaking, even if you've got an even if you're listening right now you're like, now my guy is a good guy. Listen, I'm a good guy. It took me like two years to figure out how to be a good dad, right? Like, you have to watch it and go, Okay, this is what I think they want. But this is what they actually need. There's a difference in there, I still struggle with to this day, I'll probably be struggling with it on my deathbed. I'll be 80 years old, just drifting off, and I'll hear someone in my family go. He did that wrong, you know, there's that there's a lot that's going to happen to you and you have a baby, and you're going to have diabetes too. And it would be very much my hope that you don't take all this wonderful stuff that you've learned pre planning for your pregnancy, through your pregnancy through your delivery, and just do that human thing of going that baby's more important than I am and so I'll let my stuff Wait.

Jennifer Smith, CDE 1:03:26
You know, I think it will also has type one, she had a son prior to our first son. And she gave me some really good advice and said, You know what? If inter we're talking about like, low blood sugar's around nursing, right, she was like, You know what? is low, and the baby is screaming, that the baby is safe. Not sitting like on the edge of the counter waiting to fall off. Right? But like, fine. I am important to take care of myself. It's important that I take care of myself. I'm important too. I have to manage. Yeah, I have to manage my high blood sugar and the baby screaming. It's okay. Yeah, maybe it's gonna be okay screaming really? I mean, you're not going to let them scream for like three hours. But yes, in the case of 510 minutes while you are taking care of you treating a low blood sugar or even just for your meal before you actually sit down to eat it. That's another piece that I we talk a lot about Pre-Bolus thing and the timing in this podcast and that's a piece that often goes out the window because depending on what your schedule is like what your significant other schedule is like, you may at times be whole your maternity leave with the baby

Scott Benner 1:04:50
yeah, I there's a part of me that believes that we should be making a sign and selling it through the podcast that just says that's a real homie. You know how like you see those beautiful signs and people's kids It's like The cook is blah, blah, blah, there should just be one that says Pre-Bolus. hung in people's homes so that it gets drilled into your head over and over again, because this is the easiest thing to mess up. Like, tip, forget, you know, I did it this morning, this morning, we got back from the blood draw. And art is like, I'm gonna have eggs and turkey bacon and toast. And I was like, does that mean I'm making it for you? And she's like, Yeah, so I'm thinking, Well, I have an hour till Jenny and I record. And I can get this done by then. And I started focusing on getting it finished. And then I turned to her and handed her a plate and thought, Oh, I didn't give her any insulin

Jennifer Smith, CDE 1:05:34
damage. And of course, she didn't think of it either.

Scott Benner 1:05:36
Nobody thought of it. No, we'd gotten up super early to go to this blood draw place. And you know, like all this stuff. So I said to her, we're going to Bolus now and please eat the toast last. That was like the best I could come up with, you know, in the moment, and we ended up having to use an extra unit to overcome that offset. Yeah. So okay. Did we miss anything? Is there something in the back of your head burning?

Jennifer Smith, CDE 1:06:00
I'm trying to think of, maybe, I guess the one last thing along with it is definitely stay connected to your care team. You know, because that's, as you mentioned, already, there is potential for postpartum there's a difference between just being a little bit like down in the aftermath of delivery. And true, like, you crawl in bed, and you're like, I don't to do anything else I, I will nurse the baby. But then the baby goes over here, it's almost like a, it's a disconnect that happens in true postpartum depression. Yeah. And so staying connected to your care team, is really, really important. Making sure you have those postpartum follow ups kind of scheduled. Leave the hospital, it's really, really important. Maybe staying connected with your diabetes educator or your endocrine doctor, whoever was also a really good advantage through pregnancy, stay connected with them so that, you know, they can even nudge you maybe to say, hey, you know, can you just pop in and upload it and I can take a peek and I can make some recommendations for you let somebody help you. Let somebody help you really? think, oh, go ahead.

Scott Benner 1:07:18
If you think it can't happen to you, my wife and I, we were just talking about this recently, she said for the first two weeks after our son was born, she had no feeling at all about having a baby. Like she just felt like we brought home a lamp. You know, like it really she's just like, I don't know, if I like this thing or not. Plug it in over there. Leave it Oh, we'll see how it goes. And she said that all of a sudden, one day, a couple of weeks in, I was at work. And she said she just was holding call and just started crying. She's like the baby is the most important thing. Like it all hit her at once. It was almost like you expect that to happen when you need it, but it didn't happen to her right away. And then she had that like, oh my god, I have a baby and I don't care. Like we're not even not care but like there hasn't been this ramping up connection connection immediately. Right? Yeah. So and that's a rabbit hole people could fall down especially if you've been depressed in the past or something like

Jennifer Smith, CDE 1:08:12
that, especially with another condition to manage like diabetes. Yeah, there's there's more to manage than just connecting with this new little person. Yeah, so

Scott Benner 1:08:22
So stay connected to somebody that can walk you through it and if you're feeling that way have to tell somebody like don't hide it. Just tell somebody just tell ya then I should say here as we finish up, if anybody wanted to buy a book about pregnancy with type one diabetes, should they buy one called pregnancy with type one diabetes your month to month guide to blood sugar management available on Amazon and written by ginger Vieira and Jennifer Smith CDE. Oh, okay. Yes,

Jennifer Smith, CDE 1:08:49
they should absolutely. I think the farthest I've heard that somebody's purchased. Our book is Bally Bali or Bali? Yeah. I'm in Bali. Yes. Bali

Scott Benner 1:09:03
place in Vegas where I can lose my money in the slot machine. Ali. Ali's Ali. Yeah, there's someone in Bali right now has a little baby a Bali baby. Yeah, she's pregnant. Oh, look at that. All right. Well, all I know is Ginger has been on the show before you obviously know, Jenny, the books only 12 bucks. It definitely is worth your while and it goes

Jennifer Smith, CDE 1:09:24
through everything kind of in a much more. What we've touched on kind of in each of the sections of print planning pregnancy, whatnot. It's, it's a good book. I'm glad that we did it.

Scott Benner 1:09:38
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 juice box free meter while supplies last US residents only if you're enjoying the remastered Two 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 g vokeglucagon.com. Forward slash juice box. 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 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 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 1009 teen explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talked 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 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. 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 You can learn more about her at that link

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#1017 Diabetes Pro Tip: Bump and Nudge II

Bump and Nudge II expands on episode 1017.

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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 0:04
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. 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 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 Penn Find out more at G voc glucagon.com. Forward slash juicebox. So let's start like this. I just put up like the 340/5 episode of the show, which is mind bending to me honestly,

Jennifer Smith, CDE 2:34
what was the first first year first, cuz you've been blogging for a long time before

Scott Benner 2:40
I blogged from 2007 consistently until 2015 When the podcast started. And now I have to admit the blog a little more of a way of me sharing, I don't sit down and write from my heart as much as I used to because, right, it's so much easier to do on the podcast, and you reach more people. But I blogged for that many years the blog was strong, it was a million million and a half clicks a year 111 block of maybe two or three years, I got to like 2 million clicks, which was really big. But then I saw it kind of like trending away. And so in 2015 I started the podcast. And I really thought it was going to be I guess this isn't maybe a neat place to say this. I thought I was going to go back and read my most popular blog posts like into this microphone. Because that was my expectation for us. Like, you know, some of these blog posts are really helpful to people. I'll read them and make them audio. I did that for 20 minutes one time, stopped, deleted the file and was like, This is stupid. Yeah, yeah, nobody cares about this.

Jennifer Smith, CDE 3:44
And well, I can say there are some people that would care about that. I've actually got a couple of clients who really, they love the podcast because their their audio. And when they read things, it doesn't stick. And so they have to reread and reread. And finally some of the adults that I've got are like, I just put the book down because they're like, I can't keep reading. I'm not retaining it. But if I hear it, it's there. It's in my brain. So

Scott Benner 4:12
no, I hear that I should just felt boring to me. Like I thought someone would like it. But I mean, if I'm being honest, I was trying to reach more people, not just, you know, people who literally be willing to listen to somebody read something dry, you know what I mean? I mean, at least put some music behind it. You can imagine how funny that would be if I was reading with music behind me and there's like this guy's talking about It'd be terrible. And then it picked up and picked up. And, and like, you know, but for people who are maybe coming in late to it. After a number of years of the podcast, I started thinking there's like a real system here. Like I knew that while I was blogging, but when I could hear it I thought Oh no, it's this piece and this piece and these these four or five ideas and when you bring them together, there are five five a one seat like you just do these things and that's what happens, you know. And I, and I had had you on the show, maybe twice. And I always wanted you to be back. And I thought she's the best guest I've ever had. Like, I mean, honestly, you, when you when it comes to diabetes, you and I think exactly alike about it from two completely different perspectives, which is weird and interest. Nice, right? Yeah. And it's nice. And so I was somewhere one day, and I thought I know what I'm going to do. I'm going to take the tenants of the podcast and break them down with Jenny, if she wants to do this, I'm going to get a hold of her and see if she wants to do it. And that was a weird leap for me, because until then, my real belief was that if you just listen to all the episodes, you'd hear things come up very kind of organically, and they would stick to your brain better, because you heard them conversationally, and I was a little scared to do. Specific, more bulleted specific topics. But then I realized I could do it with you. Because we have a rapport. Like, I've talked to other people in the podcast, and I tried to talk to him about stuff. And I find I'm stopping and starting and like, I'm like, Oh, they're talking over me. I'm talking over them. I can't find a vibe, you know, I knew I had that with you. So I contacted you. And you were like, I'll do it. And at the time, I was like, it'll be like six or seven, Jenny. And I sent you a little list. And you were really great. Like you took the list and you're like, I'd put them in this order. I think they make more sense in this order. And I was like, Okay, great. And now I'm going to look, I'm actually going to diabetes pro tip.com. Now, because that little idea now has its own website, which is even strange. It's great. 1-234-567-8910 1112 1360s, there are 17 pro tips. And this is going to be the 18th one, and then we're going to do pregnancy and we're going to keep going right? And it spawned like defining diabetes, which I never thought was a thing that was needed until this one person sent me a note that said, Hey, I wanted to thank you. Because until I listen to the podcast, I didn't realize I was on MDI. They took and you told me that right. And that made me think, wow, there's some people really not understand some of the terms we're using. Let's define the terms for them, but simply not an hour conversation. Right. Right, a little bit. Anyway.

Jennifer Smith, CDE 7:25
So not a not a dictionary definition. I think, as I said, you know, before some people get things because they hear it in a different way, or they read it in a different way. And I think the great thing about the podcast too, even with the pro tips, part of it is that it's broken down much more like layman's, applicable, it's, it's not what you get in a typical Doctor education clinic.

Scott Benner 7:49
And we did it a couple of times. And I was like, damn, this is good. It went so well that I was like, give me your address. Jennifer, I am sending you a microphone. So it sounds better now. Let's go. But one of the things that we did was bump and nudge, it gets talked about in the episodes, but it doesn't have its own episode. And I always kind of thought that was okay. Until in the last year. I looked at algorithm based pumping and saw how my bumping and nudging was too much. It had gotten out of hand and it didn't realize it because it was so easy for us to do that. We never looked back at the root cause of why we were bumping and nudging. And so this has been bothering me for like six months now. And I said that Jenny, I need a pro tip episode on this because not that bumping and nudging is a bad idea. It's a terrific idea. Right? But you need to understand it more. It's a bigger topic than I thought it was.

Jennifer Smith, CDE 8:53
And I think you really I think you really like realized it when you guys started using the do it yourself, right?

Scott Benner 9:02
As soon as day one came.

Jennifer Smith, CDE 9:05
We talked and I was like, how much are you using Temp Basal? Yes. How much? Are you adding little micro corrections or adjustments or whatnot through the day and you're like, oh,

Scott Benner 9:14
I don't know. I never thought about it before. So So Jenny's the one who said it to me because we were trying to find it was such an easy thing. Like you guys would hear me say before, like, I don't know Arden's insulin to carb ratio doesn't matter to me. I don't know what anything is. None of it matters, right? I know, we're Basal rate. And I know food. I look at food and I see food but

Jennifer Smith, CDE 9:35
you're like, Oh, that looks like five units up up. That looks like I got to split it off and give some now and a whole bunch later and right.

Scott Benner 9:42
Being flexible, which is terrific and important. What I didn't realize it was doing to me. You have to kind of like step back and look at a timeline of months. Maybe the developing two years is that at some point, you know, meal X took two units. At this Basal rate of whatever it was, and then it took two and a half and three, and three and a half and four, but it happens so slowly, I didn't notice, I didn't realize that I was now bolusing six units for something I used to Bolus four units for. I mean, I did. But I never stopped and thought, I wonder how much of this meal insulin is attacking the food and how much of it is staying in our system for hours afterwards and maybe acting as Basal. Right. And so I had bumped so much with insulin that I lost track of what Arden's baseline need was, it didn't matter because we were doing so well. But it did matter. And I learned that when I when I said I don't this algorithm won't work. This is ridiculous, her blood sugar's all over the place, right? It's just crazy. And it's because I had lost track of how much insulin we were actually using versus how much my setting said, we were using that did I say very clearly how much

Jennifer Smith, CDE 11:01
was actually needed, versus how much you were just intuitively correcting with right, adding a little bit extra because you needed it, but not really realizing. In general, I'm always adding extra here. And it probably is a setting issue. It's an I shouldn't be adding this much more all the time,

Scott Benner 11:21
right. And it becomes such a way of life. Right? I didn't think of it anymore. So now, I want to leave that thought here. And we're going to come back to it later. Because I do think that being fluid around diabetes is incredibly important. And that you can't just keep resetting your Basal rates every day for all the variables that are going to come up in your world. And I noticed a long time ago, that idea that concept is what causes people problems, right? The idea of like, well, I'll go to my doctor, and we'll find a Basal rate and Oh, my doctor was great. They saw between 2am and 4am, we had some highs. So we moved our basil up at 1am or 12:30am. And it worked. But then they started getting low, you know, a couple weeks later, but I just fed the lows for two and a half months and went back to the doctor, the doctor moved the basil again. And that's how people that was considered a successful use of your physician and your insulin right. It probably still is in many people's minds. I saw that and thought this doesn't work. I don't want to be involved in this and I've said it before and I'll say it again this podcast is a it's partly in place because I don't like the math around diabetes. I don't like the waiting. I don't like the we'll wait and see. I don't all that stuff makes me uncomfortable. Like all the things that you're supposed to do. I just was always like, Oh, that seems wrong. Like I don't I don't want to do that. That 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 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 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

Jennifer Smith, CDE 14:49
within it I think you also have to say that the technology that we have available today makes it more user friendly for people to learn how to make their own adjustments in the here. And now. That might work then for a while, and then they make more adjustments. But, you know, years ago without technology, going to the doctor every three months, every six months, like I used to do when I was younger, that that was the way to make adjustments now. Could we have taken and done more data, more data analysis in between the doctor visits we could have? And my mom actually did, she was like, this isn't working anymore. Let's just adjust here, let's Nope, you need some more insulin here. And I don't think she ever like to set it like that. But her explanation was always like, Well, this was just too high. And if it's going to be too high again, tomorrow, then you're just gonna use more insulin for the next meal. Right? Right. Okay, my whatever.

Scott Benner 15:49
I'm with you, you're cooking, right? So you seem to care. So I'm gonna go. And another issue in the space of people talking about diabetes in the past, it's kind of it's a number of folds, but one of them is that nobody ever wants to say too much, right? They're always like, worried that they'll say something, and it won't apply to the third person that hears it. And I so that was part of what the protests were for was to take information down to a point where, you know, this really does apply to everyone, like not saying things that only worked for you, or me, or noticing that my daughter needed something different after she started getting your period than she did before. And taking the time to talk through those differences were writing about it is hard, because you write something down, it's static, you know, I write a blog post around about my nine year old daughter, somebody reads it, it now feels like a rule. I don't spend time for my

Jennifer Smith, CDE 16:46
nine year old child, this is going to be the applicable method that I use.

Scott Benner 16:51
And you don't take time to philosophize out that I bet you this will be different when she's 15. And you just writing doesn't work that way. But you can conversate that way. And so a lot of people in the past who were impacting the diabetes space, were parents of younger children, who until your child gets older, you don't realize you think this is diabetes, but this is diabetes. In a kid that's not, I don't know, like, coursing with hormones or growing as much as you think. Or as active as you believe they are. Like, you know, like, when you're eight, you're like, Oh, my kid plays baseball, like Yeah, okay, well, you know, your kid really plays baseball, like, like, we know, they weigh 200 pounds, and they're flying around, and it's 110 degrees outside, and they're throwing things through walls, like it's an impact on your body weight, or your kids playing ice hockey, as a high schooler. Like, you know what I mean? Like, we got

Jennifer Smith, CDE 17:47
practice from six until eight in the morning, and they've got practice, again, from you know, four until eight, six o'clock at night. I mean, sometimes, those practices I'm amazed with the kids that I work with, their parents are like, Oh, she's got tennis for you know, from six o'clock until 730. And then she goes off to school, then she's got another practice from four to six and like, like, seriously, like, she's the tennis thrower.

Scott Benner 18:11
That's how you make a tennis pro. One in a million times. The other 990,000 times is how you make a kid who hates tennis eventually, right? So Right, exactly. But so these people were doing great stuff. And they were talking about these these ideas, but they didn't realize how specific they were to the age group they were talking about. And, and I think that that's why this longer conversation while I mentioned how long the podcast has been up has been important, because in my heart as crazy as it sounds, I think if you want to have great success with your type one diabetes, you go back to Episode One, and you'll listen through, because you'll take a journey through somebody who's talking about a kid with a nine or 10 year old body that you know, you actually can hear in this podcast art and get older art and grow art and have problems her start to get out period, changing devices meters, like all the way through. And I know it sounds crazy, but in your 347 hours as of today. I think when it's over, you'll go who Okay, and then your kids just gonna have an A one C and the fives it like if you want it to be or maybe you you'll make an adjustment and it'll be in the sixes. Right. It'll also works for adults. And that was that was really cool. I hadn't had that like greater expectation. I thought it would but it didn't have a lot of a lot of adults weren't reading me as a blogger. You know what he mean? There were some, but there weren't a lot. Anyway, at some point, I recognized that was really long winded, but I guess the people there I guess there are used to that at this point. But it's a very long way of saying that you can't just set your Basal rates up, set up your insulin to carb ratios and go with that's what the pump told me and that's what they've done. After told me to put in the pump, right? Because things are going to change, sometimes day to day, sometimes hour to hour activity to activity, there are going to be too many variables. And you can't stop every time. Like imagine if I had to get up tomorrow and go, today is going to be a sedentary day. I will now go fix all of my Basal rates for sedentary and change my insulin to carb ratio for sedentary by the way, do you realize that that could end up for some people meaning more for some people meaning less, it could end up meaning less for basil and more for insulin to carb or vice depending who you are and what you eat. And so when all that exists, what ends up happening to people is they just go Ah, today was a good day. Today was a bad day. Yeah, right, they leave the settings, and then they have good days and bad days. And what I thought was, if we stay fluid enough, you can almost be ahead of what's happening and make these adjustments. Okay, right. All right. That's a long, long explanation. But to me, that's what led me to bumping and nudging. Now, for context, while Jenny and I are talking about it, I think of bumping as using insulin bumping your blood sugar down. And I think of nudging as nudging your blood sugar up with carbs, Jenny thinks of it the exact opposite way. So don't get confused. If one of us says one thing and one of us says the other. But in the end, the idea is to keep yourself between these smaller parameters, a range, a smaller range, and the range is defined by you, right? Doesn't matter to me what range you choose, right? It's

Jennifer Smith, CDE 21:41
it's your chosen range. But the idea is to use food in an insulin in a good advantage in both directions, so that you can stay within that

Scott Benner 21:52
target, right. And so some of the things I learned is, I wish people could

Jennifer Smith, CDE 21:55
see us by the way, our hands

Scott Benner 21:59
around good and bad. Oh my god, you keep saying that out loud. Someone's gonna ask you to turn this into a YouTube thing. And then we're going to be on camera, and neither of us are going to be happy about that. Because you're gonna have to hang up that stuff behind you. And I'm gonna have to get a haircut.

Jennifer Smith, CDE 22:15
Which by the way, is just like bags. And you know, it's not random strangeness. It's like bags and like colas. That's it.

Scott Benner 22:21
Jenny is now apologizing for something you can see. That's very Midwest of you. By the way. You're like, oh, it's it's not unclutter. It's nice people. It's a very important thing where the children hang their bags.

Jennifer Smith, CDE 22:36
The easiest for them to get to

Scott Benner 22:39
Off topic now. So anyway, so I'm going to do a little thing here. And please jump in whenever you want. In my mind, I take the I guess I should first say that I understand this would be more difficult without a continuous glucose monitor. I really do. What I'm saying would be harder, you could do it. I still think you could do it, you'd have to do it a little less aggressively, probably. And you'd be testing more but But what in my mind, what I see is that graph that goes along my daughter's Dexcom has a high line and a low line. And I take those lines from running. Oh my god, which way is this? Is this parallel? To the ground? Yeah, it is. Right? Correct. Yeah, I was asleep a lot in high school. listening to this podcast, just so you know. So I take those two lines that are spaced apart evenly, that run parallel to the ground, and I flipped them up on their end. So they're vertical, they're running vertical in my mind. And now they are a video game. To me. They're like driving, right? There are it's a football field, I don't want to run out of bounds on the left, or on the right. That's all it is. To me, there's in play an out of play. So when I describe it, and like talks, I discussed that like driving is interesting because it's um, you make a lot of imperceivable moves when you're driving, but if you jerk the wheel around, you swerve and you don't want to do that. So as you notice yourself approaching a, you know, the shoulder, you just turn the wheel back a tiny little bit and you come back into tow again, right? Like you're, you're it comes back. Same thing with you know, if you're gonna cross into the other lane, you just come back a little bit, you don't jerk the wheel around because if you jerk the wheel around, you end up in the in the ditch or in the other lane, where you end up with much higher or lower blood sugars than you mean. Right? So I bumped myself back, I bump. You know, I nudge back. I use that insulin to help art and stay in range. The problem that comes with jerking the wheel is that once you're in the ditch, you have to overcorrect again. And then you're on the roller coaster right now I've said roller coaster which now takes the graph back to being you know By the way, it belongs in your mind for a second, not vertically, but you're up and you're down and you're just overcorrecting the whole way with food with insulin, and you get the timing of the insulin so far off that some people it doesn't stop. It goes, it goes into

Jennifer Smith, CDE 25:17
keep going that way. Yeah. Yeah. For

Speaker 1 25:21
for not just for a day, for weeks and months and lifetimes of just that's what my blood sugar does. It bounces up and down. And people say that, and it's heartbreaking me like no, just turn the wheel a little less like, right, like, it's okay. I understand how it happens.

Scott Benner 25:38
And I think there are ways out of it. So I want to talk about some functional ways out of it. I guess people should understand the difference between a following and a drifting blood sugar. So why don't you talk about that for a second?

Jennifer Smith, CDE 25:52
Yeah, drifting is slow. And dropping is fast. I think that's the easiest way, drifting down and or even drifting up, happens gradually over time. So again, if you're using a continuous monitor of any kind, you'll see this slow continual change in blood sugar, little little nudges, kind of happening over the course of time. And since on all CGM, each of those little dots on your graph represents about five minutes, each little drift up or down, could be a change in glucose over a five minute time period, right? Yeah. So drifting being slower, means you have more time to implement a change right now, that could also be a smaller change, than having to make drastic adjustments with food or insulin. When you're dropping or rapidly rising, kind of the opposite. That requires more whether it's more insulin or more food, it requires more because the change is happening very quickly now. And usually I see drifts happening either with a horizontal arrow on your CGM, or you might get that slight angled arrow either down or up. That's I consider those drifts, I consider drops or rapid rises, when you've got arrows pointing straight up or poor straight down. That's fast. So you need to do something now.

Scott Benner 27:36
So to start with lows, if you're 75, straight down on a Dexcom, that could mean two or three points per minute, is that right? So every five minute change, you could go, you could end up moving 50 up to 15 points or something like that. I don't hold me to that. But fast is the point. Correct. So you don't like you know, when you're, when you're 80, straight down, you don't say hey, you know what I'm gonna just going to, I'm going to do a Temp Basal off for a half an hour here, that's not going to work. And there's reasons prior in the diabetes pro tip episodes, seriously, listen to them in order that will make sense to as why. But if you're just drifting down one of those situations where it's noon, and you're 100, and then it's 1215, and you're 95, and you just got this little drift happening, you could possibly be at the end of a Bolus that ended up being a little too strong, right. And maybe there's, you know, an imperceivable amount of insulin left in there a quarter of a unit, a half a unit, depending on your size, maybe it's two units if you're an adult, right. And if you take away your Basal insulin right there, it's possible that you can trade that extra Bolus that's left and create what I sometimes talk about as like a black hole of Basal, right. So keeping in mind that everything you do with your insulin now is for later because insulin doesn't work immediately. Like, what if at noon, when you started to see that drift down, you took some basil away, and that created a level. So now, the end of that too strong Bolus was acting as your basil and your basil wasn't there. But keeping in mind if you shut your basil off at noon? It's not going to probably start impacting you for at least one o'clock. Yeah, right for a while. But at the same time, you were only drifting anyway, it was probably going to take you an hour to get from 100 to 60, where either you'd then be drinking a juice but instead, as you're hitting that 70 Mark, you're all the sudden into the timeframe where there's no Basal insulin, and you just level out that doesn't always work. I've done it and thought I'm a genius and I've done it and thought oh, I missed that like but trial and error will teach you because there are a lot of different

Jennifer Smith, CDE 29:57
and I think some some visuals into that, too, as you said, you know, sometimes it works. And sometimes it didn't quite hit the mark, but you weren't necessarily wrong to take the basil away. I think especially again, with the technology that we have today, not only can you see the drift, but if you are somebody who's using an insulin pump, you also have the visibility of insulin on board, right. So if you have an idea how much insulin is left, like you said, an earlier Bolus of maybe you were a little heavy handed in it, or it was just you know too much, because you haven't quite figured out your ratios, or maybe it was, you know, a guesstimate completely, or whatever it was, you still have some insulin on board, if you have an idea of where your basil is right now. And you know how much insulin is on board, taking basil away, could substitute for some of the iob that's left? Absolutely. And like you said, it could nicely smooth things out and you just drift into a stable blood sugar. That might work if you've got iob of one and your Basal rate at that point is like point eight or point nine or even one that could absolutely smooth out if you've got three units of iob and your Basal is at point five, not going to help you to have you in a way it's going to help a little but you're still going to ask him to

Scott Benner 31:13
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Jennifer Smith, CDE 36:14
I think you know in to have you want to do if you wanted to add some definition to like people always ask, well, how much? How much when I start to see this drift? How much should I add? Well, you know, one, again, everybody's ideology is a bit different your sensitivity to insulin. So a point one might be what works for you a point seven might be what needs to be in, you know, somebody else's case. But I think if you give definition to direction of blood sugar, again, using today's technology, beneficially. And you mentioned before, kind of the directional arrows, and what that indicates as far as a drift up or a drift down, and how much is happening. If you're wondering how much to add with insulin, when you do start to see a drift up, the angled arrow is really kind of a rate of change of about one to two points per minute. Right? So if you're aiming to see, okay, I'm at 90, I've not done anything. And now my blood sugar, it looks like it's starting to come up. I don't know why, but it's happening. If you excuse me, you know, experience that a 90 with a angled arrow up one to two points per minute in the next 30 minutes. If you do nothing, your blood sugar could be 30 to 60 points higher. Right? Right. So if you use that to your advantage, and you say, Okay, I could be on the low end 30 points higher, I could be one at 120, I kind of know what I would use to offset, you know, a 50 point rise in my blood sugar, maybe I need to just add a little bit like point two, or maybe I need to take a point five extra, you know, that's kind of a way that's a little bit more, if you're the math person right, may help you to get a little bit more precise and not worry about then ending up on the down drift later.

Scott Benner 38:08
And if you were me, what you do is you try something and then the next time you try something different if that didn't work, right, less or more, yes, just more or less whatever try. And it's important to remember that it's not, you're not going to get it right the first time. And even if you do get it right the first time, the variables may change the second time it becomes an art, like it really does like just knowing how much to push just a little bit like you know, you squeeze too tight, and it's too much not enough and you let go. And using Jenny's example right there and flipping it to getting lower. You don't always need the whole juice box, you don't always need every piece of candy in the package. Sometimes you can nudge with food, right. And I know that 15 carbs 15 minutes is the rule of thumb. But if you're using a CGM, you can see it better. You don't have to 15 carbs to 10 minutes is when people are blind to what their blood sugar is. And they're trying to stop themselves from having a seizure. That's important. I'm not saying no. Okay, and I'm not telling you not to do it. But I'm telling you that if you do it, and find yourself to be 300 Later, you didn't need all 15 carbs, right. And by the way, if you do get into a panicky situation, and you've got to just Horkan carbs, I'm not going to tell you to not do it. What I am going to tell you is that when you when the dust settles, you need to figure out how much insulin you've got to Bolus for that food you just took correct Right, right. Like maybe not for all of it, but some of its going to need insulin. You have to stop the bouncing. You gotta make sure you can't get on that roller coaster like don't get on it. It's maddening. And the only way off of that roller coaster, by the way, in my opinion, is you stop taking in carbs and you get back to level again and like, like, I can listen, I can knock Arden off that roller coaster while she's still eating. But that is a ninja level event, like, like you need to be really good at that to stop to stop a roller coaster in between food. And you'll get it

Jennifer Smith, CDE 40:16
takes understanding sensitivity, right? You very well know and I'm sure Arden does as well, you guys know her sensitivity, and you've paid enough attention to say, Okay, we need this much right now because of all of these other variables in the picture, or you need this much less right now or whatnot. And you do get to that level when you start to pay enough attention, you know, to your personal sensitivity and the precision that you need. I think you know, the 15 and 15 is age old. I mean, that's what I started with 32 years ago, is 15 and 15. And we didn't have the visibility of blood sugar changes at that point, we did it or even just a meter,

Scott Benner 40:55
by the way that only takes a tiny drop of blood right isn't and this beautiful lands that, you know, it doesn't hurt that badly while you're doing it, you were stabbing yourself with a sword and dumping or dumping your blood and

Jennifer Smith, CDE 41:11
called it the guillotine and it was like this big ol drum that like hammered down on your finger. And like I would like I would like inch my finger like slightly away from like the little underneath platform from where it like jabbed my finger I would like just hold it back. So it didn't quite jabot. That was my like, adjustment to the lancet depth. Right? That was the only adjustment I had at that point. But point being really that you have some tools now that allow you a lot more precision and how you bump and nudge you do. And with smart tools. Today, too, I think this is a good place to mention it is with our with our smart hybrid closed loop systems that are on the market today. That adjustment with carb, the 15 and 15 is 100% Too much 100% Too much with most of these systems on the market today. When you're adding a little bit of carbohydrate, we're talking like a little bit of carb, because the system has already been helping you coming into this drop in blood sugar. So 15 grams, 100% is going to be way too much. You might need two or three skills, which is like two or three grams of carb, you might need half of a glucose tablet, you might need a quarter of a juice juice box.

Scott Benner 42:34
So well, you know, I want to go a little deeper into this, like faster rises and falls. You see people online every once in a while it's very common, actually. They're injecting and they all put in the measurement for their slow acting insulin as fast acting by mistake like oh, I take like you'll see an adult like I take 20 units of Lantis every day. And I just gave myself 20 units of Novolog. And they're online. What do I do? What do I do what I do? And I'm just like, figure out how many carbs that takes and eat them. Like, that makes sense to me. Right and give that a try. So say you do that. Not that but say you have a meal that really needed five units. And for some reason you thought seven. And the next thing you know, 40 minutes later, there's an arrow down on your CGM, you're falling fast, you need to eat the carbs to stop that. So it's a much bigger nudge, right? It's more like a nudge with a sledgehammer now, and you need to eat the carbs to stop that. In the same thought process. If you miss greatly with that insulin, it should have been seven and you use five and 30 minutes later, your two arrows straight up. I don't mess around there. Like I am stopping those arrows. Right? And you think well, okay, see, I don't know say it was literally like a mistake you meant to do seven and you did five. So you think oh, okay, two units, that two units isn't going to do it anymore. Because you have all this momentum, right? Like there's this momentum, you have to stop the momentum, you've got a higher number than you thought about when you decided on the insulin the first time. There's a lot to think about. There's the number, the momentum and getting you back without making you Well, there are times that I'll take what I think the amount is that's going to stop the arrows plus the amount that's going to change the number back to where I want it to be. And I realize if I give her this insulin right now, she's going to end up low later, but I still give it to her. And then there's a moment where I take the basil away away, right to try to do what I mentioned earlier, eat up that extra so I needed all that force from that insulin upfront because of the situation we're in. But I don't need the tail of it later, but details going to be there. So what if I took her basil away so that it wasn't basil plus the tail, right? And so I get the benefit of the oath upfront without the kick in the pants again, what comes later? Right? Right. That's another way to think of bumping and nudging, in my opinion. So there's no

Jennifer Smith, CDE 45:21
learning the tools, it takes learning the tools to use, you know, things like people who are using MDI or multiple daily injections, it becomes harder because you can't take basil away, once it's injected, it's there. So if you are heavy handed with a correction, because you really want that double arrow to stop, you're gonna be have to be, you have to be ready on the back end with carbs to stop,

Scott Benner 45:47
you want to do you want to know what a pump does that multiple MDI doesn't do, it stops you from having to take a bunch of injections that allows you to do temporary Basal increases, decreases, extended boluses. That's it, then you don't have to carry pens with you and wonder if your insulins getting warm while you're at the waterpark. Like like that's, that's, that's it? I mean, I think to me, it sounds like a very little bit. But it's a lot. If you're going to be reactive like this and stay flexible and things like that. I'm not saying you can't do it with injections, I know plenty of people who do. Yeah, they very commonly are adults, or, you know, kids who just don't care about the injections, because there's going to be a moment when you're going to put in a little insulin and realize it's not enough and have to put in a little more. And now that's two needles, you know, instead of two pushes of a button, I think certain kinds

Jennifer Smith, CDE 46:42
of food, which we've talked about in other episodes, leading a pump to cover differently over a longer period of time. With a with an injection, you can't do that, unless you're willing to just take more injections with more insulin.

Scott Benner 46:55
So now here's the next thing about bumping and nudging, you get what you expect a little bit. And I want to just before I tell you about that, I wanted to tell you that what Jenny just said, shouldn't have been glossed over. There's other parts to this, I'm talking about bumping and nudging within a fairly perfect system, meaning I have my daughter's basil, well in hand, I'm not that far off with her meal. boluses if I miss, like, we're not just like running around with our hair on fire. And I'm like, Yeah, you know, like, and I just hear

Jennifer Smith, CDE 47:23
feed here, give more here.

Scott Benner 47:27
Insane. And I do mean this without sounding like I'm trying to pimp the the content, if you go back and start at the beginning of the pro tips. Or if you want to power listen to by the way, those of you who start at the beginning of the podcast and listen right through, you have my respect, I thank you very much. Because why the downloads are so good. And I really helps me. So thank you very much. But at least go back to the protests, and listen through, because then you'll get to a point where bumping and nudging really is a good tool. But it

Jennifer Smith, CDE 48:00
doesn't happen not 100% of the time. It's

Scott Benner 48:03
not always gonna work. Right, right. Like there are gonna be times where it doesn't work. And it happened to me last night with Chinese food. So we came out of a pump change and went right into Chinese food, which just shows my arrogance, really, because I was like, this won't be a problem. But what I didn't take into account is this for the past 72 hours, Arden has just needed more insulin, like there are foods that don't make Arden spike that are making your spike for the last three days. I don't know why it's not important, why it's just happening, you know, like, like soup. She's having like, a clam chowder out of a cannon. I can't get her under like 250, like 45 minutes later, like, like what's happening, you know, and it'll go away. Because the day before this started, her blood sugar was like 85 for 17 hours in a row. So, you know, it'll, it'll cycle through, we'll figure it out. Maybe it'll end up being a variable that needs adjusting. I don't think it will be but I'll see. But that's not the point. The point is we came from a pod change, right and do Chinese food. And boy luck with that. I did not do well with that. And so I want to first tell you that when I say oh my god, I did not do well with that. What I mean is her blood sugar was between like 175 and 210 for a number of hours afterwards. I know you're thinking Shut up. I would love that. Right? You're hungry? Yeah. Yeah. People People are like, really? That's your complaints? Not a complaint. It's just I missed Right. Right. And there was a time five hours honestly, where she needed. I Bolus a bunch of times and I never once got it right. I was never strong enough with it. And I have to admit, it was because I was tired and I didn't want to be up all night. So I just I erred a little on the side of caution not a lot and and I kept pushing. So but I did not cause her to get Low afterwards, which was, which is a winner. It felt like that to me. And I'll tell you why. And I want to put this in this episode too. So very recently, I wore the Dexcom pro continuous glucose monitor and I was very happy to find out that I am apparently not pre diabetic as I was texting Jenny's ice put it in, I'm like, you know, this, I'm gonna find out I have type two diabetes, right? Like I'm I was very happy that I didn't. Obviously, I was grateful. But I got to see what a pancreas does, what it's doing what it's supposed to do. And I have to tell you that there is nothing I ate no matter how low glycemic or high glycemic, they got my blood sugar over. I mean, I told you that I had eat two pieces of cake to get my blood sugar to like 135 141 time, right? But as I look back over the day, my standard deviation was like 11. You know, my, my average blood sugar was I don't know, like 90 or 80 or something 85 or 90, right. But I still went up a little gracefully 120 Most of the time back down again. You know, that happened when I ate. And I had already changed my mind about my expectations for Arden over the last couple of years, and you guys have heard me loosen up on the idea of like stopping every spike like I don't, I'm not a flatline person. I don't feel like my daughter is butchered it needs to be a flatline, I do believe that she has type one diabetes, and that letting a flatline get away from you turns into a disaster that takes way too long to fix, which is why all this is important. But I don't care if she eats and her blood sugar goes up to 121 30 and comes back down again. I think that's fine. As long as she's not low on the other side, I start getting a little hinky over 140 In my heart, I'm a little much, you know. And it's not to say I wouldn't try to stop a 120 If I thought I had the answer to it. But I don't know it just it seems important for me to tell you that if your pancreas is working your blood sugar is not always at five, it you know, it just isn't. So be a little easy on yourself, have good expectations, but understand that my daughter, you your kid, Jenny, you don't have the mechanism to just, it isn't just going to put the brakes on for you. So that's why you can't you know, I say you'll never get high if you don't get high. That's sort of what I mean by that, like stop the arrows stop before it starts, right?

Jennifer Smith, CDE 52:32
Well into this kind of experience that you had to I think one of the funny texts was relative to Pre-Bolus.

Scott Benner 52:42
Yeah, I was tested on you're like,

Jennifer Smith, CDE 52:46
I Pre-Bolus better than my own tank Kurious Pre-Bolus. This, I think is what your text was because you had seen a difference in what you had done for the same meal for Arden with her Pre-Bolus Yes versus what your own pancreas was doing. And I think you said something like, I wish I could get my pancreas to Pre-Bolus. And I was like well, your pancreas kind of does actually do that the working pancreas body kind of does do this like pre Bolus Bolus, right?

Scott Benner 53:16
So Jenny's tried to explain to me and I got if this is true, she said that sometimes when you smell food or you get hungry, your body anticipates that your blood sugar is gonna go up and it gets a little working on things prior. That's really cool. But what she's pointing out and I am a little embarrassed is that after a couple of days, I would look at, like I haven't be cooking. And I think to myself, like I think rubbing my stomach wherever I thought my pancreas was, you know, I don't even know. And so I was just like, man, now do it. Now brother. We're about to have pasta. Go, you know. But no, Jenny's not wrong. And I'm not bragging. I was better at stopping spikes with Arden that my body was for me. And I was really, like, comforted by that. You know, I was like, Wow, this this bolt on that podcast really works. And I was I was just really, I was really thrilled. You know, I was like, wow, I because it felt like it wasn't overkill. Do you know what I mean by that? Like, I thought oh, I'm not taking this too seriously. I'm taking this the right amount of serious, right and it just really was it was a it was a great experience. I want to thank Dexcom for letting me wear the Pro. And it was really nice. I was the only that was only worn by national media outlet people. And me and I was very grateful and I really appreciate the Dexcom appreciates the podcast and sees it as what it is. Yeah, not not just not a guy with a podcast like I was like wow, they really like oh, it made me feel good. Anyway, point is the last point I guess of all this is Is, is that bumping and nudging is terrific. It's great while you're learning things, while you're learning about how to Bolus for meals while you're learning about activities, you know, all that stuff's great, but it's not a long term, everyday solution. And I didn't recognize that people wouldn't translate out of it eventually, like, just go like, Oh, okay, um, didn't happen to me. You know, I said at the beginning, I didn't realize it wasn't happening to me. And then finally, and again, I have to thank the people listening, because we started the private Facebook group, which I'm not particularly active in. But see, every day, I started watching and this is when I said to Jenny, I need a pro tip on pumping and nudging. I was like, Oh, my God, these people are doing this all the time, like constantly and like it's not for constantly. And so here we are. So if you heard us do defining diabetes, bumping nudge, which literally just came out last week, I said in there, what I didn't realize about bumping and nudging when I started doing it was that it says much of a diagnostic tool as it is. Yeah, a tool for keeping your blood sugar's in order. Correct. So Jenny, when you start seeing yourself bumping and nudging too much, what should you be doing?

Jennifer Smith, CDE 56:22
Then you should be going back. Personally, what I do, and with the people that I work with, what I do in in data analysis is, I look at a cumulative and I say, over the course of this time, whether it's a week, or three days, or two months, or whatever we want to look at together, we can say, well, goodness, we've had a lot more use of Temp Basal, that are not specific to like activity reason, or a food based reason, like you always eat Friday night pizza, or whatever it is, and you need that kind of a tool for but goodness we're having, there's a lot of corrections happening after meals all the time, or there's a lot of you know, you're using Temp Basal is to cut off insulin all the time, if that's happening, and while it might be proving to give you the results that you want, there's a bigger picture, they're saying there's either not enough insulin for some reason now. So we need more in the Basal or we need to add a change to the year ratios so that you do get more robust type of Bolus for food. And then you shouldn't have to follow it so heavily after an adjust with extra insulin all the time. So that becomes looking at information and saying, for whatever reason, I just need more basil. Now, let's pop it into place for whatever reason, my ratios look like they're not covering Well, or they're covering too much. Let's take some away, let's add some in. And let's make sure that I'm not bumping and nudging now 100% of the day, because that shouldn't be the case. Right? You shouldn't have to work that hard, essentially. Yeah,

Scott Benner 57:57
one of the I think one of the benefits of the podcast is that it eventually should make the management of diabetes simpler and less impactful on your, your moment to moment, you shouldn't constantly be like, Okay, a little more, a little less, a little more like, that's, you know, algorithms do that. But you shouldn't have to do that. Right? If you find yourself doing it, looked back and just tried to separate a variable from constant and address the constants and keep bumping the variables. That's, that's all it gets that easy. I took me a while to figure it out. And that's why I'm here saying it to you because I thought, oh, gosh, what if people don't figure it out? Like I started having this heart in my head that people would just be like, bumping

Jennifer Smith, CDE 58:47
following my child until they're 50. And I'll be 89. And you know, what's happening to their

Scott Benner 58:53
picture, people in my head that haven't seen the sun in three years, have their hair all wired, like they've been electrocuted, and they're like, my kids, my kids at once he was 5.5. Her blood sugar hasn't gone over 110 and six years, I'm fine. Like, please don't be like, Oh, my God, it would break my heart if that's what's happening to you. And don't get me wrong, by the way, in the beginning, while you're starting to figure it out. You may be

Jennifer Smith, CDE 59:18
that is one field, you

Scott Benner 59:19
should be able to get past that. Right. And I hope this has been helpful. Did we miss anything, Jenny? Because you guys, don't you really everyone listening should should just take a second to realize that Jenny and I don't have any notes in front of us. Like we're not working off a list. And I still think we got in the timeframe through everything I wanted to say. Do you feel like Absolutely. We did a good job should ring a bell. I'm going to spike a football. That's right. I want to say this is something I was going to say later when I was editing it together. But I want to say it was Jenny here instead. I appreciate that the people listening care about this. Like I really do like I I think it's wonderful that you all want better or easier or simpler, and aren't just throwing up your hands and saying, I don't know, there's good days, and there's bad days. I think it's really wonderful. I think that we're creating a feeling throughout the diabetes world that's going to help people in the future, it might not help you as much as it's going to help someone else. But I got, you know, it's funny, it's not a note, but somebody posted this on social media the other day, and I'm not going to put their comments and their name into it. But I want to tell you like how amazing I thought this was. This person is relaying that their child, a 13 year old who's only been diagnosed for four weeks, listens to the podcast with their parents went into the doctor four weeks later, advocated for themselves for a pump explained, explained that she wanted to use extended boluses. She tried it with MDI showed her doctor how she tried it, explained that she wants to do Temp Basal adjustments in the anticipation of exercise and activity, and started rattling off everything she learned from the pro tip episodes. Wow. And even rolled in with her on the pod demo that she passed, and persuaded the endo to approve the pump at the next appointment. And that's awesome that endo normally makes you wait six months. And that's from these episodes. And so I imagine not just the happiness for that child that's coming. But that maybe now the doctors like Hmm, why am I waiting? You're not making people wait, couldn't I just do this with them? That's exciting for me. And it's so it's everyone's desire to do better. And then your willingness to say it when you get to the doctor's office, it's,

Jennifer Smith, CDE 1:01:55
well, then maybe even from that doctor's perspective, maybe you know, this person obviously went in and said, Hey, I've learned all of this from this one place, maybe the doctor now has a reference to say, hey, you know, if you want a little bit more, and you come back to me knowledgeable enough and can say, hey, this is what I know. Now, this is what I want to be able to use why I want to be able to use it. Again, I think a lot of clinicians are just conservative, because they're worried right there. They're conservative, for many reasons, but I think worry is a big one. And they want some outcomes showing. Yes, my patient is now ready for this. And unfortunately, I think again, with the technology we have today, I think people are more ready earlier than they may have been years ago. So

Scott Benner 1:02:48
I think that I don't think that people should make the mistake that this is some special girl. Do you know like she is seriously it's, it's it sounds self aggrandizing I really don't mean it to be she just listened to the 17 or 18 pro tip episodes. And in four weeks, look where she is. And and I don't know that everybody could be but I think my experiences are that a lot of people are and so that it's possible. I'm in my heart. I hope right now that doctors listening to this going well, that sounds like something that happened and like I hope he went in was like, I wonder what that kid listen to you. Right? You know, right? Like, that's what I want. I want everybody to be healthier, and easier and less encumbered and anxious and all the crap that comes with having diabetes. So, Jenny, I want you to hear that. Thank you.

Jennifer Smith, CDE 1:03:33
Yeah, no. And I think that's a good cumulative of kind of, I mean, my overall when I had set out, going to college, knowing what I wanted to go to school for and eventually what I wanted to become just it was a very, it was a very, like, General, I want to become a diabetes educator, because I had had really awesome educators as a kid myself. But I never like I didn't have a broad like idea of what I really wanted. I just wanted, I knew I wanted to be able to share what I knew, with people and I wanted it to make a difference. Like it made a difference for me when I was younger, you know, and didn't have the technology or anything that we have today. Right? So, you know, in what I get to do every day, that's, I love it. But what I like more is that I love this connection that I've that I've had because of you because of the podcasts and the end what you've put together. I feel like I've reached so many more people than just the individual people that I get to work with every day. You know, I feel like kind of especially these pro tips what we've put together it's just able to reach so many more people in a way that's it's free. Yeah, you know, it's great.

Scott Benner 1:04:51
Um, thank you. i You made me. I felt like little butterflies and I looked. I looked away from Jenny while she was tucked away embarrassed that I couldn't keep looking at her through a video screen while she was saying something nice. I need therapy. Thank you i It really is terrific. It would obviously not be the same without you. So I really appreciate it. Okay, cool. All right. Well, we did a good job here. I'm gonna go back to your life which is probably just talking to somebody else about diabetes in a second.

Jennifer Smith, CDE 1:05:20
Actually it will be my husband went off to work and my my kids are out there watching I think they're watching dyno Dan right now and I could hear my little man outside the joystick. Mommy, I want us now. Like, okay, well, I'll be there in a minute.

Scott Benner 1:05:37
Work. Go back to what you're doing. Go take care of him. And thank you very much.

Jennifer Smith, CDE 1:05:42
Yeah, absolutely. Have a great weekend. Thanks.

Scott Benner 1:05:46
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 G voc glucagon find out more about Chivo Capo pen at G voc glucagon.com. Forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. Chan 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. 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 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. 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 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.

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