Scott Benner 9/15/20 Scott Benner 9/15/20

#381 Brent has a Story

Husband and father of three

Brent shares his 20-year journey as a person with Type 1 diabetes, a husband and father to three young children. After 15 years of manual daily injections and multiple daily finger sticks, Brent switched to a T1D physician in 2015 which has made all the difference in his daily management and overall health. He now uses a continuous glucose monitor and insulin pump and talks about the success he's had using technology for the past five years. Brent offers a laid-back personal perspective on why it's so important to take care of yourself and practice patience when living with T1D.

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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 0:09
Hello, everyone, welcome to Episode 381 of the Juicebox Podcast. On today's show, we're gonna be speaking with Brent. Brent has had Type One Diabetes for 20 years. He's been married for a long time and he's got three kids. Brent's progression with Type One Diabetes has been steady but slow. And it's really coming together for him. So he's here to tell you his story. In fact, this is brandstory.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. We're becoming bold with insulin. If you're looking for a terrific endocrinologist, or have one that you'd like to share with people, please go to juicebox docs.com. And if you're enjoying the pro tip series of the podcast and like to share that with someone, or if you're looking to see the episodes all in one place, without using your podcast app, you're looking for diabetes pro tip.com.

This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter, please visit Contour Next one.com Ford slash juice box to learn more about the Contour Next One. There's so much information at this link. I don't even know where you'll begin. But where I'm going to start by telling you about Arden's blood glucose meter, the Contour Next One blood glucose meter is incredibly accurate and cheaply priced. It's actually possible that the test trips purchased directly with cash could be cheaper than what you're paying through your copay with your insurance company, when that'd be interesting. Check it out. While you're there, you're gonna see all of the contour products listed right at the top. There's resources, such as downloadable log books, and the contour diabetes app that works in conjunction with the meter that's available for Apple or Android, it's even possible that you could be eligible for a free Contour Next One meter seriously, you got to go click around on those links. There's a test trip savings card there, it's worth picking around and learning about everything, not just about ardens meter. But if you're in the market for a new meter, I can't say enough good things about the Contour. Next One. It's absolutely been the most accurate meter My daughter has ever used. I'd also like to direct your attention to touched by type one.org. It's a great diabetes organization doing wonderful things with people living with type one diabetes, and they'd love it if you check them out on Facebook, Instagram. We're at touched by type one.org.

Brent 3:30
My name is Brent. I live in Payson, Utah. It's a town about an hour south of Salt Lake. I have had Type One Diabetes for just a tad over 20 years. I've been married for a little over 10 years. As three kids, two boys and a girl. My oldest son is eight. My daughter is four and my youngest son is one almost too

Scott Benner 3:59
bright. Do me a favor that cord with the with the microphone. I try not to brush spider, let it touch your clothes. Okay. Okay, that's all otherwise sounds terrific. And I appreciate you telling us about yourself. How old were you when you were diagnosed?

Brent 4:15
So I was 17 happened over Christmas break of all times. And I believe that was the Christmas break of 1999 to 2000. So I always just go off of 2000 since that's kind of an easy time to remember how long I've had it.

Scott Benner 4:39
Brent, you know what? It's funny. We all put so much effort into being worried about y2k and what would happen to computers and we should have been worried about what was going to happen to your pancreas.

Brent 4:49
Yeah, I had no worries about y2k either, didn't bother me at all.

Scott Benner 4:55
I do remember being in a number of meetings at my job and I just kept thinking I feel like we're making a big deal out of this. And the computers just gonna say it's January 1 2000. Here we go. But such an odd thing. Anyway, tell me about your diagnosis a little bit.

Brent 5:12
Yeah. So, um, you know, my memory is kind of fade a little bit, you know, the other. Yeah. I remember it being a Sunday morning. pretty typical Sunday morning, I'm a, I'm a member of the Church of Jesus Christ of Latter Day Saints growing up here in Utah. But anyways, you know, did my regular thing and getting ready for church and going to church, and I was over there at church, I remember a couple people saying, it looks like you a little thin, and I, I just brushed that comment kind of off, I didn't really think anything of it. And after coming home from church that day, I was not feeling good at all, I just want to lay down and do nothing. Yeah. I was the kind of kid that, you know, wanted to be playing video games all the time, or watching TV or something. But for some reason, I just wanted to lay down and do nothing. I was using the bathroom a ton during the night, I think I got up at least once an hour. But anyways, after church, my parents had noticed that I was just doing nothing. And we had a friend that lived pretty close by who was a doctor. So he came over and kind of checked me out. And he had told my parents that I need go to the hospital. So we went to the hospital. I don't remember other much than checking into the hospital. And, you know, they ran some more tests. And, you know, told me I had diabetes, I had really no idea what that meant. I think I spent the course of the next couple days or three days in the hospital, learning about all I could and how to kind of manage it from there.

Scott Benner 7:20
They won't ever tell you what your blood sugar was, at your time of diagnosis.

Brent 7:24
I don't remember the exact number. But I remember it was over 600. So it was pretty high.

Scott Benner 7:30
That's why you weren't playing video games. Whenever.

Brent 7:33
Yeah, take it right out. I was

Scott Benner 7:36
our bread. Listen, we got it. We've got to dig down on something for a second here. Because since you listened through the entire show, you said in like a month and a half. So you're aware. And I've never been able to put my finger on this yet. But I asked every time to try to get closer to the answer. Why is the show so popular with Mormons? And why do they come on all the time? And like you have to be the sixth? or seventh perhaps? Like you do? Have you heard them as they're as they're talking? Sometimes people don't identify themselves right away. Sometimes I out them for having like, 43 kids or something like that. And I'm like, hey, so, but um, is there anything about the community? That's is diabetes? more prevalent? That doesn't make any sense? But is that possible?

Brent 8:27
I don't think it's any more prevalent around here anyways, I mean, I just I found the podcast, and it seemed really interesting, you know, listening to you and how you talked about your daughter, you know, finding out she had diabetes, and it was just really interesting in it. It hit me because you know, I've had it for at the time, it was only 19 and a half years when I had started listening, but you know, I've had it for 20 years ago. I've really not connected with a lot of other type one diabetics,

Scott Benner 9:01
so maybe it's the opposite maybe. Maybe there's just nobody in Utah. So everybody there needs to find Am I might be the Mitt Romney of type one. Diabetes, podcasting. It's possible. Is this not true? If you were to say that maybe.

Brent 9:14
And I really haven't listened to any other.

Scott Benner 9:19
Just found this one.

Brent 9:20
Yeah, I found this one. And you know, it just

clicked right off and I listened. I really liked it.

Scott Benner 9:26
I would like people of all religions to listen, I'm just telling you that, you know, it just comes up. So frequently. I'm not wondering how many people I've interviewed. Who, who did not tell me? It's possible. I've interviewed 306 people from the church. I don't know. Anyway,

Brent 9:45
I suppose.

Scott Benner 9:47
So how did you find how did you find growing up? And 20 years ago, what kind of technology they started with?

Brent 9:55
Um, so I remember, just syringes and vials. Well, what it was. I've used human log for most of my diabetes life. That's what I used. And I think it was humulin was what the other was called the long acting one.

Scott Benner 10:19
Yeah. What's your most dear? I'm sorry to cut you off? Did your parents jump in and help? Because that's a weird age, it's 17? Or did they do the like, he's a man, he'll handle it. Like, where? Where did that fall? And how did that impact you how, however it went.

Brent 10:34
So I do remember me handling most of it. I mean, my parents, you know, were they were there in the hospital learning about it just as much as I was. But, you know, I'm, I was practically an adult. So, you know, I just pretty much handled everything on my own, you know, short of, you know, setting up doctor's appointments and insurance and that kind of thing. But, you know, managing the diabetes, I pretty much handled it on my own, from what I remember,

Scott Benner 11:07
where you're out where your outcomes, what you were looking for, like, I'm interested how a 17 year old, you know, 20 years ago with some syringes, and some, you know, insulin we don't use anymore. Like, was your health where you wanted it to be? Or was that constant struggle? Or did was it not thought of that way at the time?

Brent 11:27
I honestly don't remember too much about how I did. Way back then I will tell you this. So later that summer later

2000

I got an early graduation gift and my sister also, there's this, I think it's kind of a high school program national throughout the country. It's called people to people, student ambassadors. Have you heard of that?

Scott Benner 11:56
I have not. No. But it was, um, so what it is.

Brent 12:01
Yeah. So what that is, it's a program that's available to youth, basically. And they go on a big trip somewhere around the world and experience

other cultures, okay.

And anyways, so that summer, my parents had bought my sister and I, well, we actually, you know, helped pay for it ourselves to we went into this program, I think our particular group, there was about 30 or 40 youth and, you know, five or six adult leaders. And we went to Scandinavia for three weeks. So here I am, I'm only six months newly diagnosed, I don't remember having any, or not very many worries about my diabetes and taking, you know, all the supplies that needed to go with me. Yeah. They had us keep a journal as part of the kind of the program. And I don't remember writing anything about my diabetes, rather than just everything I was experiencing. Right?

Scott Benner 13:19
Well, is that because the insulin back back then what you were doing is you were shooting insulin a couple times a day at certain times, then making sure to eat at certain times. Is that about it?

Brent 13:29
Yeah. So you know, I was doing my normal meal time. boluses, if you will, you know, take the insulin for meals. And then I was doing the human, I believe, a shot in the morning and then shot at night.

Scott Benner 13:42
And how do you find, like, how you manage now, compared to that. So how do you manage now?

Brent 13:49
I have been using a pub since 2015, a tandem pump. And I'm actually just got started on my second tandem pump. Just this past November,

Scott Benner 14:01
so you were 1616 years on in on MDI.

Brent 14:05
Yes, yes, that is. That is correct. I did. Okay. I won't say I did gray. And this might have been around maybe 2005. My blood sugar's were or my Avon See, I would say was probably between 10 and 13. So I mean, it wasn't the greatest right. And I wonder, I mean, I was also the doctor I was seeing was just a family physician. So it wasn't anybody specialized in diabetes. But it eventually turned to a point where he recommended me to diabetes doctor and I was able to reduce my agency a bit with I think I got it down between nine and 10%. So I mean, that was a pretty significant increase.

Scott Benner 15:00
Yeah, I mean, you moved it from what? Like more like, and was it swinging around like 10 1112? Like, or did you not? Check? How often were you checking it? I guess it's my question.

Brent 15:12
I was probably the only checking three times a day, I would guess

Scott Benner 15:15
your blood sugar three times a day. And did you go to an endo appointment quarterly? Or was it not that frequent?

Unknown Speaker 15:21
Um,

Brent 15:23
I mean, with the family physician, I think it might have been

maybe every three to six months. So maybe quarterly

Scott Benner 15:31
sees now you've listened to the podcast straight through, as you're listening. Do you think wow, the way people are doing it now is no, it's just not close to what I was doing growing up. Did you have that thought ever while you were listening?

Brent 15:43
I've had it a few times. I mean, it's understandable to me. No, that was 20 years ago. So I mean, things were a lot different back 20 years ago.

Scott Benner 15:54
Yeah. million percent.

Brent 15:56
Definitely blood sugar machines. I, when I was first started, I used a lot of one touch machines. And the first one I had thing was huge. And test trip was huge. And it required tons of blood compared to blood sugar machines today.

Scott Benner 16:17
Do you think that was that part of the impediment around testing more? Or was there just not an onus on testing more? Nobody was like you were testing enough for your doctor?

Brent 16:26
I think I was testing enough for my doctor.

Scott Benner 16:28
Friend. What about for you though? Like, were you? Like, how did you feel with a onesies that were that high? Was it an impediment? Did your body adjust to it? Is it something you look back on now and worry about?

Brent 16:43
I mean, yeah, I do worry about it. I mean, obviously, that's not a great a one C and, and whatnot. But I mean,

I'm still alive today,

Scott Benner 16:54
I really appreciate you being on because I mean, the podcast is five years old. So you're talking to people who are mostly brought up around faster acting insulin, you know, their carb counting, covering meals, you know, testing more frequently, we're in glucose monitors. That's the kind of stuff. And I think that people sometimes make the mistake of believing that that's just how it's how it is how it's always been. And, you know, like, that's it. And even today, there are more people in the world with diabetes, who have a story, it's like yours, then a story like theirs. But then those people who are listening going, Oh my gosh, like, you know, my one sees in the sevens and I'm always wanting to get it down. And, you know, like, I know what my blood sugar is all the time, etc. I think we all need to really remember that most people don't have access to good information, tools, and sometimes, you know, even, you know, the meters and the glucose monitors and the pumps and etc. Even smartphones, you know, it's easy to like, get caught in a bubble and think that this is how it is. But I think it's more the way you're describing honestly.

Brent 18:05
Yeah, most certainly as I mean.

Yeah, sorry. I lost my train of thought.

Scott Benner 18:15
up early in the morning. What time is it there?

Brent 18:17
It's a

it's just after seven. I get up at 530 here because I actually start work normally at

Scott Benner 18:25
seven o'clock. Oh, no kidding. You work from home or you.

Brent 18:28
I actually work I commute. I've got about a half an hour

Scott Benner 18:32
ish commute. I appreciate you making time for this. I really do.

Brent 18:36
Yeah. I felt this was pretty important. So I

Scott Benner 18:40
Well, what did you ask? You asked you asked for time off for this.

Brent 18:45
I just told him I was gonna come in later. Oh,

Unknown Speaker 18:47
thank you very much.

Brent 18:48
Look at this, this and I still work my normal time is the level of

Scott Benner 18:52
dedication. Brian, I expect from everyone listening to the show, just you know, Brent, listen to all of the episodes. He didn't say, Oh, I didn't think that one would be interesting. I don't want to hear that from you. People listen all the way through. And if I need you to get up early to be on the podcast, that's just what you have to do. Just kidding, from what what made it feel important to be on the podcast.

Brent 19:13
I just, you know, I just wanted to share my story, you know, hear, you know, let the listeners hear kind of another. Another story. I mean, that's what got me into this podcast, was hearing your daughter's story. And you know, to change in yours, your life, her life, your whole family's life. Just you know, having another point of view, basically. Yeah.

Scott Benner 19:40
So did it help you more like spiritually, like psychologically or was it helpful management wise or what did you what what's happened after hearing all those experiences,

Brent 19:51
I would say all the above. I mean, it's, you know, I think I've tried to get myself more involved with Other type one diabetics, and it's kind of even listening to this podcast. And you know, it's just kind of helped me even reflect on myself and how I manage my own diabetes.

Scott Benner 20:14
Were you meeting people? Is it online? or in person?

Brent 20:18
Yeah, it's mainly through Facebook groups and stuff.

Yeah, that's kind of the the main part.

I have some family that's got type one diabetes, and some pretty close friends that has it. But you know, aside from that, it's mainly been just online.

Scott Benner 20:40
Yeah. Do you find yourself talking about it more since you've listened? Or have you always been kind of open and conversational about it?

Brent 20:49
I've been pretty open about talking about it. But I think I, I do feel like I have been more open to talking about my diabetes to people since I have been listening to the podcast.

Scott Benner 21:01
Okay. That's excellent. Well, one second, Arden is asking me a question.

Unknown Speaker 21:08
Let's see,

Scott Benner 21:10
the blood sugar got a little low. And she's in class. She's trying to treat it already. But her blood sugar hasn't popped back up yet. And she's just like, my phone won't shut up. So she's had this very interesting, this is ridiculous. Solar people, you know, what, most likely? And then all the everything I gave her as you know, hey, try this or this. She is not right now. So why are you telling me about the phone? If you're not willing to Alright, listen, let's not try to make sense of children, I guess. So, her blood sugars have just required less insulin for the last over a week now. And at first, I know everybody's gonna laugh at me. But our What is this? What is this?

Unknown Speaker 22:05
What? Oh,

Scott Benner 22:08
I don't have a January electric statement. That's not why they're calling they're lying to me. Sorry about that. So her blood sugar's have been lower. And everyone's gonna laugh, because, you know, I always say like, don't just say they're sick. I think they're getting a cold. But when Arden has certain kinds of illnesses, her blood sugar just is easier to control. She needs less insulin. It's always been that way. So when this happened, we just assumed that's what was happening. We started cutting insulin back, you know, the way we normally do, but it still wasn't helping. And she was, you know, still just lower, lower, lower, lower, but she'd also kind of lost her appetite. So we thought, all right, we've made it even worse, you know, you couldn't, you know, she doesn't want to eat a whole lot. You know, you're trying to Bolus you don't really know how much to do. So her blood sugar's been a little up and down for the last few days. And finally, last night, I thought, what if so Arden just recently got an infusion of iron. And her her ferritin level was very low, which happens to me too, and it happened to her. So she'd been tired and rundown and is going on for a long time. And through the process of trying to diagnose this. We went through a lot of different things, one of them being thinking it was her hypothyroid medication, because the symptoms of low iron and hypothyroidism, so perfectly match each other that that made sense. So, yes, you know what I mean? So we lost a lot of time and art and spent a lot of time feeling rundown. And now she's had the iron for a month or so. And you can see her changing, like, she's got more energy, she's not as tired, she looks better, you know, like all the stuffs happening. Right? But she doesn't feel perfect yet, which we didn't expect and even the doctor that she saw, who was the hematologist told her Listen, it's going to take two to three months for you to feel the complete effects of this iron transfusion. Or infusion, excuse me. And you know, so in you know, he told her like two more months from now, however good you feel, then that's how good you're gonna feel from this. But I started wondering out loud yesterday with Kelly. Is it possible that as her cells are dying off and regenerating, but regenerating now being built from building blocks that have the correct amount of iron and ferritin in them? That's how she's feeling better, but could that be why her insulin needs have been higher? Because Arden's bazel rate is significantly higher than I would expect it to be. And it's not just like around food, like you're a grown man. What's your base rate?

Brent 24:46
Um, varies.

I mean, I have a schedule but I think it's anywhere between point nine an hour to 1.3 an hour

Scott Benner 24:57
right? So my hundred and 40 pounds daughter who's 15 her basal rate during the day has been 2.6. Wow. Right. And so that's just a lot.

Unknown Speaker 25:09
And now that is Yeah.

Scott Benner 25:10
So all of a sudden, yesterday, I was like, Oh my gosh, this isn't a thing, maybe that's going to go away. Like, we're gonna have to adjust to this. Maybe forever. And let's try. So I paired all of her settings down pretty significantly, had a lot of success overnight. But of course, this was my first day time with it. And she got the school and it's just, you know, it was doing great, doing great. And then all of a sudden, it dropped down. And now it just does not seem to want to move again. So that is, yeah, that's

Brent 25:44
interesting. Hold on a second.

Scott Benner 25:55
So I'm gonna get her to test and we're gonna check it out. not know, who knows, I could end up being wrong about this. And three days from now, her blood sugar's might go right back to the way they were, I don't know. But it's a significant difference in the amount of insulin she needs, like significant.

Brent 26:14
Yeah, well, hopefully she gets her numbers back to where they should be. And hopefully to get that figured out.

Scott Benner 26:20
Yeah, I appreciate that. I do. So first, so how do you find pumping versus how you were doing it for so long, because I'm it's very, it's very much interesting to talk to somebody who basically lived a lifetime not using an insulin pump, and now uses one.

Brent 26:36
I love it. I will say that right off, it's great. I don't know how I lived without it.

Unknown Speaker 26:42
Um,

Brent 26:43
so back in 2015, that's when my daughter was born. Okay. And she had some complications with being born that year, and she ended up being in the Nikki for 18 or 19 days, which, you know, that's traumatic in itself. But, you know, towards the end of the year, I had started researching pumps, what pumps I want to use, which one I think is going to be the best for me. I should say, a few years before that. I ended up switching doctors to a another one up in Salt Lake who has type one diabetes himself. And I actually still see him to this day. He's the best. I think it's, you know, if you can find a doctor that has type one diabetes themselves, I don't know if you're gonna get any better than that. Because they have. They understand everything. They have a different perspective than somebody who doesn't, if that makes sense. Oh, of course.

But anyways, so 2015.

I had researched a few different pumps, I didn't even considered Omni pod. And I think I was considering another Medtronic one. But I finally emailed my doctor and saying, here's what I'm looking at. I'm looking at this Medtronic pump. I think I will really like it because it talked with my glucose meter. I think it was the Contour. Next One link or something. had talked Bluetooth with it anyways, anyways, I emailed him, he actually recommended that I also look into CGM. And I actually hadn't even heard of it, which was

quite interesting, I guess.

Scott Benner 28:49
Well, you had no contact with people with diabetes. Right. So yeah, I wouldn't have heard.

Brent 28:54
I mean, I didn't really know anything. I mean, I knew what an insulin pump was. But he recommended two pumps for me. He had first mentioned the Animas five, which I don't think is even available anymore. Because it integrated with dexcom CGM. Oh, and the first thing he had told me is, he wouldn't recommend me doing the Medtronic team because they're CGM, he says wasn't very good. He outright said the dexcom is the best. And, you know, his opinion kind of kind of changed my mind pretty quickly, just because I trusted him and I knew him pretty well. Um, the other pump he recommended was the tandem t slim g4 at the time is what it was, and it was going to be integrating with Dexcom soon and that's the font that I chose. ended up using So I've been with Dexcom since g4.

Scott Benner 30:03
Yeah, cuz that animus vibe, how did that work with the g4 back then? Did they act? They didn't actually speak to each other? Did they? Or they did it. Oh, you know what it was, you could see your CGM data on your pump. Is that right? Yes.

Brent 30:15
But it was

Scott Benner 30:16
That's correct. It wasn't telling it what to do like a closed loop or like, no algorithm or anything like that right now.

Brent 30:21
Nothing like that. Um, I believe you were required to calibrate every

Scott Benner 30:28
12 hours, I believe how I remember it. So.

Brent 30:31
Um, yeah, the pump didn't do anything based off any other readings other than just showing you constantly what your blood sugar was, which was huge. I mean, poking my fingers for 15 years, 16 years, or whatever it was got a little. Yeah, I mean, my fingers. Were pretty callous. So you were

Scott Benner 30:56
you're like, you probably had those fingers, like you saw like people see sometimes online, which, you know, more newly diagnosed, people don't know from but those hard bumps all like everywhere, because you're constantly looking for space on your fingers. And eventually, after years, years, years, they just don't heal as quickly. And it's, it's Stark, right, like you can see it when you're looking.

Brent 31:17
Yeah.

Scott Benner 31:18
Can I ask how that? How did that affect tactilely? like touching things and lifting things? Did it have an

Brent 31:23
impact on that? I didn't seem to notice too much.

I don't know if this was the right thing to do. But I would sometimes take fingernail clippers and try and kind of cut away the callus a little bit. Take

Scott Benner 31:40
them away. You're doing your own landscaping there on your on your

Brent 31:45
Yeah, I did that every once in a while? I don't know.

Scott Benner 31:48
Don't worry, Brent, we will cover that with nothing on the Juicebox Podcast is considered advice. So that's funny, it worked, right? Hey, I guess whatever works, right? diabetes is a lot about, you know, making adjustments on the go and sort of, you know, being your own MacGyver and figuring things out, you know, for you. Yeah.

Unknown Speaker 32:08
Yeah, and

Scott Benner 32:09
I mean, two more things that you made up during this episode, you're gonna be the Mormon MacGyver Just so you know, on the

Unknown Speaker 32:15
on the episode.

Scott Benner 32:18
So, hey, listen, tell me a little bit about having kids when you have type one,

Brent 32:21
it didn't really bother me at all. I mean, I didn't really think of it much. I mean, I know the symptoms, I know what to do with, you know, we we find out things. Luckily, all three of my kids are, are not type one diabetics. But you know, what, if they were, I'm not going to love them any less, and I'm going to know how to help them. And you know, I'm going to be able to basically coach them through it. That kind of thing. If they were,

Scott Benner 32:56
you'd have a leg up, you're kind of if your children ended up with diabetes, it would sort of be like what you were saying about seeing a doctor who has type one, it's just an extra level of understanding.

Brent 33:06
Yeah, it's an extra level of care.

Scott Benner 33:09
Yeah. That's excellent. That's wonderful. Well, what are your goals? Now that you're pumping? And you have a glucose monitor? What do you like? Do you have goals with your agency? Or how do you think of it? Because you are coming from an old school idea of this? So I'm interested in, in what you're doing now?

Brent 33:26
Absolutely. I mean, I see my endocrinologist every quarter, still every three months. And we have a goal of keeping it well below 7%. I usually do that pretty good. My last day when see. I was 6.7. I have been as low as 6.3. before. But you know, just basically under 7% is kind of the the goal with that.

Scott Benner 34:03
Does it fluctuate greatly? quarter to quarter?

Brent 34:07
Ah, not usually. It's usually pretty close between I'd say it's usually between six five and six, eight. Okay. You know, that's that's pretty good. And definitely a huge improvement over when I first started,

Scott Benner 34:23
right? Oh, no.

Brent 34:26
Yeah, I stay pretty consistently. Pretty close to that. The only exception was last year when I was in between jobs. I didn't have a month of Dexcom Okay. And it was just interesting to see how much it affected my pay one see and bloods here without having that for a month. I think my name once he got to 7.5 not horrible. But I mean, I haven't hadn't been over seven for

years.

Scott Benner 34:59
So you You moved anywhere from a half to a full point just from losing your glucose monitor for one month. Yeah, the CGM, the Dexcom. What did that change for you not having it? Like, do you remember that feeling of like, what what's gonna happen to me? I'm losing my CGM. How do I go back to what I was doing before?

Brent 35:19
Yeah, I was part of some groups on Facebook and an app called help around which, you know, it's type one diabetics, you know, trying to help each other giving them supplies and that kind of thing. I was almost in a panic to try and find some supplies that somebody can give me. Yeah, just because, you know, I hadn't been without a CGM for years. Right. And, you know, I didn't end up finding anything, unfortunately. I mean, I got some supplies, but they didn't end up working. I even went back as far as trying to find some GE for supplies, just so I could see my graph you were just gonna see right, it's going on.

Scott Benner 36:04
Listen, your your, your unemployment story is much better than most people's, you're only out of work for a month.

Brent 36:11
Um, so I wasn't out of work. So what happened was, I had switched jobs. February last year, and insurance would kick in until I had been there 90 days, I think. And I had enough of my leftover CGM supply to last for for two months. But then I had that third month where I wasn't gonna go pay out of pocket for the supplies, either. I had plenty of pump supplies. So I didn't have to get off of that. Luckily,

Scott Benner 36:44
can I ask you a question now that you've been through it and not asking, you know, for your your financial situation, but now having done it? Do you wish you would have paid cash for the month?

Brent 36:59
I wish I would have had the cash to pay for

Scott Benner 37:01
it. Right. Right.

Brent 37:04
But I mean, you know, what? Living a month without it. I, you know, came down to I lived 15 years without it. What's a bond can make it 30 days, right?

Scott Benner 37:17
So, can you tell me a little bit about like your health and your your how you physically feel? Do you? Do you have a comparison how you are living now versus how you were living then? And the impact that has on you? Um,

Brent 37:34
I'm not sure that I really notice a whole lot of difference. I mean, I'm not very active than the first

place, which, you know, it's

just something I never get around to running a

Scott Benner 37:48
marathon. But no, so you so it's likely that you began at a higher a one C and kept it steady. So you then your body adapts, and you don't feel the higher blood sugar. Did you feel it when it was coming down when you made the changes?

Brent 38:04
Yeah, I mean, I've I definitely feel my highs and I mean, I, I think I started feeling groggy, you know, 200 and above. And I can tell when I'm high without even having to look at my CGM. I do because that's what I do. Because I look at it pretty often. And I can, yeah, there's a big difference between high and low. I can definitely feel feel that.

Scott Benner 38:38
You just said something I want to ask you about you said you look at your CGM. Often, I was just speaking somewhere this weekend. And someone said to me, how do I stop myself from looking at this data? And I said, I said lower your high alarm? Because then you won't have to wonder if your blood sugar is getting high. It will tell you and then when you're not getting high, you won't think the look. So it made me wonder what your high alarm setup.

Brent 39:05
I have my high alarm set at 180. So anything above 180

Unknown Speaker 39:11
you get a good alarm.

Scott Benner 39:12
But prior to the alarms you find yourself checking.

Brent 39:15
I mean, I look at it fairly often. So I looked at it a few different ways. I have it I have the app on my phone. I have an iPhone. I also use sugar mate. I don't know if you've heard of that. I know

Scott Benner 39:28
sugar mate.

Brent 39:30
I use a Mac app on my work computer computers at home so I can up in the top I can see what my blood sugar is what it's doing

Scott Benner 39:41
Luca gram Is that what it's called? Yeah,

Brent 39:43
yep. I think it's a

sugar may glance or something.

Scott Benner 39:49
Okay. Okay. Oh, I know that one too. All right.

Brent 39:53
But I mean, I just have it everywhere. I have it on my palms. I just see Ever I mean, I'm not sitting there staring at it.

Scott Benner 40:04
No, I understand you're not No, I get that. But what do you see my point, though, that if you, if you know, the alarms going to sound prior to it becoming a problem than it, then you just realize I'll hear the alarm, I don't need to look at it, it'll tell me when it gets there. And that, I think that takes away a level of involvement. And there's also terrific research that says that the lower you bring down your high Dexcom alarm, the lower your a one C will go, because I'm gonna say it here just so other people can hear. But I know you've listened to the podcast already. But the sooner you react to a high or an impending high, the less insulin you need to stop it, most of the time, when you use less insulin, you're less likely to have a low later, and you can bring a 120 for instance, back to a 90 quicker with less insulin, then you can affect the 180. And so it's sort of like a little effort up front to lose all that other stuff. And it just it's a it's a matter of putting your effort in what I think of is a better place, but I'm not telling you how to live your life. But just that's how I do it. I don't know if you see any sense in that or not?

Brent 41:18
Yeah, no, no, I definitely do. It does make sense and whatnot. I know, one eight is just kind of weird. My doctor and I have figured is a good spot to know to have the alerts or not. I keep my phone on silent at work. So it's not

Unknown Speaker 41:39
blaring off vibrates for you.

Brent 41:41
And that kind of thing. And even at home sometimes. But I with my pump, I also get vibrates on my bump when it you know, tire blow as well. So I mean, I have another alert for you? Well,

Scott Benner 41:57
well, let me add one more thought to it is that if you if you as you bring the alert down, you sort of will start using insulin differently in a way that you don't recognize. Exactly. Right. And so eventually you don't find one at anymore, I would tell you for certain that what most people consider a 302 B. That's what I consider 180. Like that feeling you have when you see 300 is what I see. That's how I feel at one ad because we so infrequently see one ad? Oh, yeah, like a high blood sugar here would be like 160. And it's not because we're more involved. I actually think in a weird way, it's because we're less involved. But when we're involved, we're using more of the what you might consider to be the correct amount of insulin for the situation. And you only learn that through experience after experience. So I'm just here's what I'm telling you. Right. I think if you move your low alarm to 150 for a month, and then move it to 130. After that the next time you get your a one c check, there'll be a point lower. Right, I would definitely think that and I would think you wouldn't look at your CGM as much a month or two after that. But that's just that. That's my guess out loud.

Brent 43:14
Yeah, so. So I got my new tendon pump this last November. Okay. And it had it came with the bass like you I'm sure you hadn't

Scott Benner 43:26
heard that shut the bezel off yet. Well,

Brent 43:29
yep. And so actually, I just upgraded or updated my software to control IQ just last week, actually,

Scott Benner 43:38
five days ago. And this is a closed loop system. Not Not really. It doesn't have glucagon in it, but it's it's an algorithm.

Brent 43:45
Yes, yeah. So you know, if my blood sugar gets too high, it increases basal and can even deliver an automatic correction automatic correction bolus.

Scott Benner 43:55
Yeah. How are you finding? Um,

Brent 43:58
it's going pretty well. I mean, is it perfect? Of course not. Nothing's perfect. I mean, my blood sugar still gets high a little bit sometimes. And I'm still still learning it. You know, I'm only five days into it

Scott Benner 44:12
is a big adjustment. So yeah, yeah, you're not gonna have it in five days? That's for certain.

Brent 44:16
Yeah, you know, I, I would say, you know, give it at least a month to Ghana. Start, you know, to learn

Scott Benner 44:23
on Friday this, it's funny, because you and I are recording this and what February. And in all honesty, this might be out in August. But tomorrow, I'm interviewing somebody who's going to talk about control IQ to, and he's actually been using it longer. I think she was part of a study. So she might have a little more insight about it. But I think that, you know, I can tell you that from the algorithm stuff that we've done is that it's you know, so much about the settings being correct, so that the algorithm can can make good decisions, right? Yeah, I'm sure you'll find your way with it. Do you Do you have an expectation that it will bring your a one seat down? Is that your hope? Or are you just looking to be less involved?

Brent 45:06
Um, I'm hoping that's going to help with my agency. I'm kind of hoping that down, I mean, not that I've been in a horrible a one seat position. But you know, I've also looked forward to not having to manage it as well. And it's kind of nice that it's got a little bit of automatic

kind of control with it.

I believe it states on their website, you know, that control IQ is helping to lessen the burden on man engine diabetes. Yeah, but it does not replace an active role in taking care of it.

Scott Benner 45:52
It's 100% true, but it's my experience. And from everyone I've spoken to so far. If you're, if anyone is expecting an algorithm pump to just make diabetes disappear out of your life, I'm afraid that's not what's gonna happen. But it should, for people with higher like, imagine, you know, past, you know, Brent, from five years ago, having this thing slapped on him with a 12, a one C. And all the sudden, without really understanding anything else about diabetes, or a one c dropping, you know, five points into the sevens, that would be a absolute, you know, miracle for you. And yeah, and so it's going to be for so many of those people that we talked about, you know, at the beginning, people who just not as involved with management, and understanding, you know, the kind of the tools that that help your blood sugar be lower and stable. And the other thing is, and I'm wondering, even in five days, if you've seen this, is it helping your variability? Are you staying more stable?

Brent 46:45
I yes, I have been seeing more stability and less spiking and that kind of stuff. The last 24 hours within the exception of the last tool, any 30 minutes.

My blood sugar

has been pretty flat.

Scott Benner 47:08
Lovely, flat, where where's it flat? At? What number?

Brent 47:11
Um, so just in range, basically. So I have two ranges during the day. I'm 70 to 180. And then at night, I'm 80 to 150.

Scott Benner 47:24
Okay. Yeah. overnights. easier because you're not eating I guess. Yeah.

Brent 47:30
You mean, boosted shouldn't be

Scott Benner 47:33
erratically, right?

Brent 47:35
Yes, theoretically. But yeah, it. I mean, the last 24 hours on my pump here looks really good. I mean, there was only one time where it went high for about 10 minutes, and then it came right back down.

Scott Benner 47:54
So went over went over 184 unit got it back under again.

Brent 47:58
Yeah, yeah. And I think that was also some help with Bolus to that I did on my part, to say

Scott Benner 48:04
this thing's only manipulating your basal insulin right? It's not sending boluses through.

Brent 48:09
It can send an automatic correction bolus

of what it calculates it only I think it can remember from the training video, I think it says it does up to a 60% of the calculated needed bolus. Okay, but it can only do that once every hour.

Scott Benner 48:28
Okay, that doesn't sound bad at all to me.

Brent 48:32
No, no, it's actually really great. But it does mainly adjust the basal rate. Yeah, increase it or decrease it or completely stop it. Have you

Scott Benner 48:43
had any lows in the last five days?

Brent 48:46
I have had some lows. They haven't been horrible.

I think I've only gotten down to

55 the lowest right?

Scott Benner 48:58
So did you in the beginning think oh control? Like he was never gonna let me get low. I'll let me see what it does. And then you got low. Are you gonna intervene in the future, I guess is what I'm asking.

Brent 49:09
I mean, I know it won't prevent everything. And you know, he can only do so much. For instance, if I take way too much of a bolus of my blood sugar is dropping fast. It can only prevent so much. I mean, if there's way too much insulin on board, it's not going to be able to stop it all the way. The hard thing for me and this has actually been true with basal IQ two is not eating well. It's not true. Just basal IQ it's just been most of my life actually not eating one too many glucose tablets or, or that kind of thing to, you know, shoot you up higher than what you were hoping for. Yeah, kind of thing. But I mean the biggest adjustment with control IQ and basal IQ as well is you know that it It's also working to bring to help your blood sugar get up to that to the area that you need to be, and it's hard to not want to just chomp chomp chomp down on stuff, or,

you know, juice box or whatever.

So you don't go get too low.

Scott Benner 50:23
Is that feeling? Or is that a physical feeling when you when you can't stop?

Brent 50:29
It's been both. I mean, you know, when you start getting below 50, you start kind of getting that panic almost that it's like, I just need to eat sugar and sugar and sugar and sugar. And so I can get that right up in that pan thing. And then you know, it goes the other way. And then you kind of start taking more insulin to bring it back down into range.

Scott Benner 50:52
Yeah, but you feel like a physical need to eat. Is that correct?

Brent 50:57
Yes. I mean,

when I go low, you know, I feel First of all, I feel just different. I don't know how to explain it to somebody that's not a diabetic. Um,

Scott Benner 51:15
I had, let me ask you a question I had, I put up an episode just today with a girl named Aggie, and she's from hungry. And she said, she said that, when she gets low, her thoughts make sense in her head. But when she speaks them, they don't make sense to other people. It's like she like she's not saying what she thinks she's saying. But, but in her mind. She's right. So she can't get her thoughts that come out of her mouth. Has that ever happened to you?

Brent 51:44
Um, I don't think it's ever happened to me. I mean, I'm not saying that it won't ever happen.

But I mean, it's just I kind of

I know and I, I keep glucose tablets on me in my pocket all the time. So I always just

had popcorn out, put some in my mouth. And

it's, it's hard waiting for your blood sugar to go up to and not to continue just chomping down on the glucose tablets or whatever.

Scott Benner 52:16
Yeah, it's hard to wait. It's hard to wait I, I actually said in a in my talk this weekend. I was like, sometimes you just have to have the balls to wait. Like, you just have to be able to just wait a little bit. Because if you do, and you're you know, working off of you're like, don't get me wrong, not the first time you're, you're low. But once you've got a historical knowledge of how this works, and you've done the right things, and you're looking at your data, and your data is suggesting to you that this is going the way you expect it to that's the moment when you have to be able to say okay, let me just stop for a second. Let this Let this be and see what happens for a moment. Yeah, you know, it's a tough it's a tough decision to make, but it keeps you off the roller coaster. And there's nothing more true than you know, the thing that causes lows more than anything are highs. So if you you know, if you don't get high, it's sometimes it's it keeps you from getting low later. I don't think people think of it that way. Sometimes. I hear your kids are milling around. Are they all up? Or just yeah,

Brent 53:17
I'm

on my boys. My eight year olds come down a couple of times.

Scott Benner 53:22
He wasn't gonna make it much longer.

Brent 53:26
Yeah, he's got schooling a little while too. So I hope he's got enough.

Scott Benner 53:31
Listen, it's not your fault. You're busy. Hey, listen, any more plans for more kids?

Unknown Speaker 53:37
Um,

Brent 53:39
I think we're kind of hoping to still have one more. One more. Sure.

Unknown Speaker 53:41
Yeah.

Scott Benner 53:44
Four Sounds Sounds like a lot of work.

Brent 53:47
threes a lot of work.

Scott Benner 53:50
would better be worth it? Cuz if it's not worth it? What are you gonna Imagine if you said to me, Scott, I have three. It's a lot of work. And to be honest with you. I don't think it's worth it. I mean, that would be sad. Now, I think

Brent 54:03
yes, it would be sad. Yeah. No,

Scott Benner 54:05
I I agree with you. I there are definitely days where I wish I had more kids. Last night, I went into Arden's room where she was collecting her clothing she's grown out of and she's got a plan to sell it online. Mostly because I don't think she worked very often. And you know, she's she's telling me about her plan to make money. I said, so you're gonna take the clothes I bought and sell them for less money than I paid for him. I said, Why don't you just not buy clothes and steal out of my wallet? Wouldn't that go quicker? But But uh, but but she's I was looking at her and I thought that is, Oh, that's a woman standing in front of me a young woman, right, like, and I said, Come here, give me a hug. And I hugged her and she's like, why are you hugging me? I said, you look older. And I just want to hug you for a second before you look older again. So you're in a really sweet spot with your kids. eight, four and one. I hope you I hope you enjoy all that because There's no no no bullshit, man, it goes fast.

Brent 55:04
I tried to enjoy it. I'm not, you know,

I have ups and downs.

Scott Benner 55:09
Yeah, please. I had little kids, I know the downs. That's amazing. I They're so adorable in the background, you're gonna make people get pregnant. Right? If you if you keep hearing that they can't see what a pain your kids are they just think they're adorable because they're listening. Well, did we not? Did we? Is there anything we didn't say that you were hoping we were talking about?

Brent 55:31
Um, it's funny, I actually, like wrote out my whole story and tried to kind of figure out what I should talk about. Um,

let me just look over some things real quick.

Scott Benner 55:46
I can't wait to hear what you wrote down that we missed. Um, but Brent, honestly, I'm not bad at this, we probably got the most of it. Right.

Brent 55:55
Yeah, no, we definitely have.

I do want to say, you know,

taking care of yourself is very important. You know, especially if you have a family and kids, you know, you want to be around as long as possible. It's important to kind of, you know, take care of yourself, you know, do your best don't beat yourself up for not being perfect, because nobody's perfect. Even with the technology that's out there. Yeah, that's a

Scott Benner 56:29
damn good life lesson. And then it's, I think, 100% true. I mean, I can't speak to it from personal experience, obviously. But from talking to so many people, it feels like that. It wouldn't be difficult for diabetes to overwhelm you, and get the better of you and start feeling like, this is just my life. I can't do any better than this. And it's what's going to be is going to be but I, I really do think you can affect it. So and being positive about it is a is a good first step.

Brent 56:59
Yes, definitely. And and another thing is Be patient. things take time to learn. And that kind of thing I see on Facebook groups all the time, people complaining about everything that goes wrong and whatnot. Both with you know, Dexcom and tandem stuff. Things happen. But a lot of the time they don't happen as much as

Scott Benner 57:23
it looks like it does on Facebook. Yeah, no, Facebook is not to complain. It's not. People don't pop on to go, Oh, my God, everything's going so great. Let me tell you about it.

Brent 57:31
Yeah, yeah, I can tell you was quite an interesting time on Facebook. When Dexcom had their outage a month or two ago, whenever

Scott Benner 57:40
I spoke about it, too. It was interesting.

Brent 57:42
It was just so sad to see all the negativity

out there.

Scott Benner 57:50
Right away, you're thinking, yeah, this thing that's doing this amazing thing for me, you know, and not that you don't want it to do better, and not that the company doesn't want to, you know, fill in gaps when it has them. But yeah, it's it's interesting to see how quickly someone can turn on you. Yes. It really does give you that feeling like, wow, you know, watch my back. Because five seconds ago, I saw this little avatar with this name next to it saying, Next comes the greatest thing that ever happened to me. And three hours into the share not working correctly, which by the way, didn't mean the Dexcom wasn't working. The Dexcom was working fine. It was just, it was the sheer function. And you might have thought that Well, you know what, I heard less people upset when Australia was on fire. So seriously, you would think that would make people upset? No.

Unknown Speaker 58:36
Yeah.

Scott Benner 58:38
Now that's this is where this is where everybody gets upset. But now I hear you. So to just really do your best. Now you're not gonna think about having four kids. And so, but yeah, do your best, right. And it takes time yet sometimes you have to experience things going wrong. So you know what it looks like when they go right. You know how to make them go that way? It just takes time. Like it really does. Yes, it does. Yeah. Not being dramatic and getting frustrated. If you can help. It is a big hump. All right. Listen, you go make those kids smarter by sending them to school. I will you be very happy. I didn't have time to ask you about your magic underwear because I still want to understand it better than I do. And is that an insulting phrase magic underwear. I'm assuming you call it something different.

Brent 59:25
Yes, we do tell something different, but I'm not insulted.

Scott Benner 59:30
Listen, apparently it's not insulting because Mormons continue to come on this podcast. So I feel like I'm doing the right thing here. I really appreciate you doing this. Brent. Thank you.

Brent 59:41
Yeah, no, I really appreciate you taking the time to let me talk to you and share my story.

Scott Benner 59:47
Hundred percent is my pleasure. I hope you have a great day and I'll let you know as soon as this is going to come out. All right

Brent 59:54
now I hope you have a good day as well and I will look forward to when this comes out. I appreciate that.

Scott Benner 59:59
Thank you. family for me, thank you very much.

Unknown Speaker 1:00:01
I will.

Scott Benner 1:00:03
Huge thanks to Brent for coming on and sharing his story. And of course the the Contour Next One blood glucose meter and touched by type one.org. for their support of the Juicebox Podcast, there's a list of all of the advertisers in the show notes of your podcast app, and at Juicebox podcast.com. But you can go to Contour Next one.com Ford slash juice box to find out more about this meter or touched by type one.org. To learn about that great organization. Last thing, if you go to T one d exchange.org. forward slash juice box, you can add your voice to some wonderful Type One Diabetes Research and it's super simple to do. Right there on your phone, your tablet, your PC from your home, you never have to visit a doctor. You never have to visit a site. It's completely HIPAA compliant. You can back out at any time if you change your mind and it is 1,000,000% anonymous. The answers you provide help people make good decisions about how to help people with type one diabetes. That's what your answers can do. Super simple. The ADA has made adjustments to their a one c recommendations for children because of T one D exchange. Test trips are covered by more insurance companies because of D one D exchange. The list goes on and on. This research does great stuff. You can support T one D exchange support people with type one diabetes and support the podcast T one d exchange.org. forward slash juicebox. The survey didn't take me more than 10 minutes to complete. Thanks to everyone for listening to the podcast and for sharing it with someone else. Two days ago, the show had its most popular day in the history of the show. It was it was a day that I will not soon forget the downloads were astonishing. And I very much thank you all for being ardent listeners and for sharing the show so freely means a lot and you're helping the show to grow. So thank you very much. I'll see you soon with another episode of the Juicebox Podcast.

#380 Defining Diabetes: Feet on the Floor

Scott and Jenny Smith define diabetes terms

The third in a three-part series describing what naturally occurs to blood sugars when we first wake up and prepare to start the day. Scott and Jenny tackle basic T1D terminology in this easy guide for newly diagnosed T1D and/or caregivers of someone with T1D.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.

I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about feet on the floor. But there are two others that go with it. The other one's called defining diabetes, smokey effect. And the third one defining diabetes dawn phenomenon.

Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm gonna have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One you go to Contour Next one.com forward slash juice box and of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that type one diabetes for over 30 years. Jennifer 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 is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She's my favorite person. feet on the floor is something that I didn't know people called a thing until I heard somebody say, Oh, that's that's feet on the floor. And I've always thought yeah, I didn't know that. I just found it. I figured it out. And then I attacked it, then I stopped thinking about it again. You know, so I've in in Arden's life, I've attacked feet on the floor a couple of different ways. So but first, like, I guess we'll, we'll define it. I think of it as if anyone's ever played on a football team. There's this thing you do right before the game, they get everybody together and whip them into a murderous frenzy, and then they send you out on the field. They're literally like saying just shy of go rip everyone's head off. Go do it now. And I feel like that's what your body does. When you stand up. It's like, we got to go, this is it. We're gonna go take a shower. We're gonna make lunch. I got to be on time I got to get to school, and it just Jacks you up so that you can accomplish those things. I know that's not technical. That's how I think of it. Is that about what's happening? Like, what is your body doing when you wake up? I'm assuming cortisol and

Jennifer Smith, CDE 4:14
Yeah, well, bunches of different hormones that are supposed to be there. And again, they're, I mean, if you think of them in terms of the flight or fight hormones, right. They're kind of the same thing. It's not like you're trying to run away from a saber toothed Tiger first thing in the morning, but at least not in today's world. But there are all the things as you just mentioned, in today's world, especially as an adult, there are a lot of things that are on your plate. As soon as you get out of bed in the morning. Yes, I have to get myself ready. If you have children or a spouse or anybody that you're a caretaker for that. You have to get ready. You might have breakfasts that you have to make things that you have to pack calls that you have to make, I mean the list just it goes on and on with the chores in the morning time and even kids Think well, why does it happen with my 12 year old child then? Well, kids have a lot of things that they're not really verbalizing. But their brains are thinking through, especially once they get out of bed. And in a life with diabetes, there are things that they're thinking about, again, they might not be talking about them right away. But, you know, what am I gonna have for breakfast this morning is mom and our mom and dad going to be really worried because my blood sugar is gonna go high. If I choose to eat pancakes today. I mean, there are lots and lots of things that are reasons for the rise. But the base reasons really are those like the cortisol kind of the get go, your body wants to ramp you up, and kind of move you give you energy.

Scott Benner 5:40
So what people call feet on the floor, I think of his bolusing for life. I don't know another way to put it really. So you know, if Arden were to wake up at a, an 85 blood sugar, and lay in bed for two hours looking at Tick Tock and Instagram, her blood sugar would not go up. It's got nothing to do with the timing. It's it's quite honestly, she gets out of bed. And then 1520 minutes later, her blood sugar can go from 85 to 120 and catch a diagonal up arrow and keep going if you don't stop it, right, so I always just have her wake up and bolus. And I don't know how much you know me. I don't know, let's throw some insulin in there. Get on the right side of this game, you know, unit today. One little eye care insulin, get it going. And, and that works terrifically. It really does. But I mean, honestly, this is gonna seem like a strange story to put in here, I guess. But when I was 16, for about three or four years, while I was 16. In my hometown, I volunteered as a fireman was a common thing for people to do. And I trained, you know, I got trained, I think we had to do like 100 hours of training, and then you know, you become a fireman. And when there was a fire at night, like in the middle of the night when you were sleeping. We used to have this old technology was so bad back then it was just this box that sat in your house. And they would send out this radio frequency and the box would pick it up, and then make this horrible, harsh, shrill scream that would wake you up, right? I want to say the company was realistic that made it I'm not gonna remember. But this thing I can't even like, I wouldn't even want to tell you that you'd have to cover your ears, it just would go. But so high pitched and loud. And you'd be standing up, I'd be standing on the floor in my underwear. unaware of how I stood up, it was so loud, right. And a few moments later, you're at the Firehouse, you're getting dressed, you're now in a truck, and you are flying down the road as wide awake in this alert as you have ever been in your entire life. I am crystal clear at that moment. Like that's when I should be taking my SAP. You know what I mean? And that has got to be this. Like just your body just going like holy Hannah. We got to go, you know, and this happening. And now I guess in a modern world. People talk all the time about like, Oh, I don't like to get upset because my cortisol levels go up and I get fluttery or nervous or, you know, anxiety hits me for some people. I think it's it like I think a feet on the floor is his life and you have to give yourself insulin for it because it doesn't go away once it's not like adrenaline. Right? adrenaline pushes you up. And then when the adrenaline's gone, your blood sugar drops back down again.

Jennifer Smith, CDE 8:39
Mm hmm. It's definitely different thing first thing in the morning. And I think that's it's a compounding factor when people are trying to figure out that morning breakfast, right? Because if you haven't realized that the rise is already starting, before you go ahead and even if your Pre-Bolus thing for breakfast, and you're thinking, well, gosh, I've waited 15 minutes. Let's try 20 minutes. Let's try 30 minutes. Let's try 45 minutes. And like finally you're at the hour point and your budget or you're still rising and you're like, Yeah, but I Bolus for my food. You're missing possibly a quarter a half maybe a whole unit and a half of insulin for this feed on the floor. impact. Yeah. And so that's it kind of like I said, it sort of covers up what might be going on behind a breakfast and the food kind of Bolus. Yeah. And so it's making you feel like well, gosh, I just I obviously need more insulin. So I'm going to dump more insulin in then and then you end up like you said, it sticks around for a long time if you don't get ahead of it and by getting ahead of it. I think most people that I talked to in teaching about it, it's you wake up, look at your CGM or do your finger stick and give your give your Bolus for that feet on the floor in me Utley. And sometimes it takes like I said before, a little bit of analysis, let's say, your feet on the floor doesn't really start, maybe it's an hour between waking up. And then it actually starts to rise with again, no food or anything else in the picture. But maybe you're the person who sees it within 20 minutes. That's me. I can wait at a blood sugar of 68. And I can have it start within 15 to 20 minutes,

Scott Benner 10:25
but you also don't strike me

Jennifer Smith, CDE 10:26
Oh, that I don't need to treat that low. Yeah, because

Scott Benner 10:30
it's gonna go up. You also strike me as a person who is active in your mind as well as your like your body. Like you're not you don't get up in the morning and think like, well hang around for a couple of hours. And then like you're moving right? Yeah,

Jennifer Smith, CDE 10:44
I don't have hang around. Yeah. And

Scott Benner 10:46
what's that? I said something that is literally say to you on an episode recently, and you're like, you have all kinds of free time. And I was like, I don't what do you Oh, when I said I fixed my carpet. When I got to pull it out. You're like, Where do you get time for that? I was like, Well, wait, lady, there's a big hole in my car. But I can't just leave it there. You know, Jenny couldn't even imagine. She's like, cut the carpet off. start over again. It's, it's done.

Jennifer Smith, CDE 11:09
Go Why just put like, you know, like, I don't know, I'll play it over it and be like, don't stop here. Mom will take care of it later. And then like three months later, I'd be like, my set plates. Do I

Scott Benner 11:20
really like that? But No, but seriously, like, you have that, like, you have that attitude. And I have to tell you, that I'm not good. I'm a busybody, I'm not good with free time either. As soon as I have too much free time, like I could make another podcast episode. Like I think that right away. I'm like, maybe we could move people along a little sooner I could be working is what I feel like. I this weekend, I talked my wife into relaxing, which she's terrible at. And so everyone's sort of outside, we have a little little patio out back. Everybody's sitting around. We drugged like a television outside. People are watching sports and just hanging around. And I realized the other day, I don't think I ever sat on that patio. And I was mad at myself when by the time it was over, you know, but I just couldn't. I kept thinking of things I had to do, which I know is bad. Don't write me. I know, it's bad. I know it's killing me. But um, but your feet on the floor is what I think of his life like bolusing for life. And really, when you stop and think about these three little episodes, which I'm gonna put up all at the same time, so people can find them all at the same time. You're thinking about, you don't realize you're thinking about what if? What if smokey happens, right? What if you What if you that happens? What if while that's happening, you start experiencing dawn phenomenon. And then you jump up and you're a more high strung person. And you've got this going and you're back here trying to Bolus for toasts with two years. Right, you're a lot already

Jennifer Smith, CDE 12:45
out of three things that you didn't realize could be impacting and the toast had nothing to do with the 290 blood sugar. Yeah.

Scott Benner 12:53
And it makes me think about how many people like to say, Oh, my, my blood sugar goes up every time I take a shower in the morning. But what if it's got nothing to do with the shower and everything to do with the feet on the floor? Correct. We've done it Jenny, this is that if people just listen these podcasts there, he wants to be in the fives. Some of them will make themselves crazy, but I mean, a lot of them will end up in the

Jennifer Smith, CDE 13:19
hopefully you don't need extra meds along the way.

Scott Benner 13:23
Just find yourself in the corner mumbling about oh gee and feet on the floor, and I gotta move my basal insulin so that it combats the dawn phenomenon. And then I'll just go to work and take these four kids.

Jennifer Smith, CDE 13:39
makes me kind of think of what's his name Gollum from Yeah,

Scott Benner 13:42
yeah, just shrink up and start talking to precious and rubbing your head. Yeah, yeah. So anyway, that's why honestly, is we kind of finished this one up. Without joking about it. That's why my theory is always just like, more get ahead. Don't let this stuff like make all of this stuff. Absolutely not even something you think about by being just being first by acting first. I am such a big fan of punching first with diabetes, so that you can at least say I did this and what happened next, I had some impact on instead of covering up defensively and waiting for all this stuff that happened to you and then trying to react on the go You just can't react the diabetes you have to be you know, you have to be first you have to be active I think

Jennifer Smith, CDE 14:31
and in some of that, too, like you said, you know, needing more is the idea of more is important knowing Okay, clearly I didn't do this well, so I just needed more. But I think also looking at, as I said before, you know a couple of trends in the morning time to be able to define Why do you need more? Is it just today or huh? Look at this. I see the trend of lows overnight and now then when I'm high in the morning, then I need more or Every morning I get out of bed at this time, and I've made a note of it. And no matter what I do, I don't even eat for three hours and my blood sugar's already going up before I eat well, clearly, this is the problem. So then it gives you more definition to maybe even quantity of the more, you know, how much more could I possibly need? You know, more three units versus more half unit to two different ideas.

Scott Benner 15:24
I don't know more, just more, did you get higher than more than that? Did it happen the next day, then more than that? What if it's too much, it hasn't been too much. So far, you know, if it gets to be too much, not for nothing, then do less. Every month, just I don't know another way to think about it. Because when I see people try to think about it logically, like like, I guess logically is the wrong word. But mathematically, maybe I see people making themselves crazy, because there are so many of these variables that you can't quantify. And even if you could, you can't quantify them in real time, while living a life, you know. So I just like putting a nice layer of insulin on everything and trying to keep the blood sugar down. And that way, if you don't get high, you don't get high. And that's it. I'd rather stop a lower falling blood sugar, and fight with a high one high. That's all it's so simple. All right. This is this was it feet on the floor, which, again, I would like to call bolusing for life, but then no one's gonna know what I'm talking about. If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com Thanks so much to the Omni pod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my Omni pod.com forward slash juice box. Learn more about the dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show. The pentameter of that reminds me of save the cheerleader save the world. From heroes, you remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them going to your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app, all episodes, scroll down, you'll see them you can go to Juicebox podcast.com. and scroll down a little bit. Right. And you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books you look up, Oh, hold on. Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right, it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginia and I explained that to you ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes but you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on. On and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes.

Two new ones that are out right now around this, like I mentioned the beginning, I think go together with this one. The other two are feet on the floor. And this Moji effect, the sum Mogi effect, I don't know how to say that word, but you'll see it. It'll be the only word that sounds like some Oh, gee, when you read it, looking for a great doctor, or other type of diabetes practitioner, check out check out Whoo, there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add. Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.

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Scott Benner 9/12/20 Scott Benner 9/12/20

#379 Defining Diabetes: Somogyi Effect

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Somogyi Effect

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.

I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about the smokey effect. But there are two others that go with it. The other one's called defining diabetes, feet on the floor. And the third one defining diabetes dawn phenomenon.

Jennifer Smith, CDE 3:18
Absolutely.

Scott Benner 3:19
You know what I realized that for the last number of years now, as the new year rolls over, I have this horrible pit in my stomach. And I think I'm never going to come up with stuff for Jenny to do. And I'm gonna run out of it. And now it's September already. And unlike we don't have enough time to record all the stuff that I'd like to record. I just I think back to the person who told me like, no, you're starting a diabetes podcast that won't last long, you'll run out of things to say and I think more now that that person just didn't realize all the things their work to say, you know,

Jennifer Smith, CDE 3:55
right. Well, and I think so many things engine with being with having your, like online kind of groups and whatnot, I think there are a lot of topics and things that end up coming up that you're like, Oh, good one to talk about for certain

Scott Benner 4:12
for certain of all the trepidation I had about starting a private Facebook group. watching all of those people speak to each other. Like sometimes like really lights me up. I'm like, Ooh, that's such a good thought right there or, or somebody has a half a thought, and they can't get to the rest of it. And you can see the rest of it. And you're like, Oh, I wouldn't have thought of the first part. But I understand how to finish this idea. Right. So anyway, it has been it's been incredibly valuable. At this point. I don't see why this podcast would have to end. And in the beginning, I thought like oh, it could probably only go for a certain amount of time. But I think that might have just been bad advice from somebody. All right. So three defining diabetes episodes today that I think of, I'm going to put them up separately, but I think they could probably all go together. I want to do Dawn phenomenon feet on floor and the one I can't pronounce somehow G. A fellow he's Mogi. Is that what it is? Yeah. All right. Let's start with the one I don't know anything about so you can get warmed up. What is the smoky effect?

Jennifer Smith, CDE 5:18
Do you want to actually spell it for people? Sure.

Scott Benner 5:22
I have it here is so mo gyi and then effect in the classic way, with an E, for all of you who always use an A when you mean a.

Jennifer Smith, CDE 5:35
What the interesting thing

is that this topic is kind of one that's sort of like it's like this 5050. I don't know that that's the exact like percentile breakdown of people who believe versus don't really believe that it's kind of the issue, but it's essentially relative to why you might have elevated blood sugars in the morning. Okay, what ends up happening after you have a low blood sugar is it's a rebound, high blood sugar that you end up with in response to having had the lower blood sugar value, some from what we call kind of counter regulatory hormones that are released in terms of a low blood sugar. Yeah, why sometimes it happens, versus not all the time, I think is probably the reason that people question whether it's a real thing. I guess that's the easiest way to because it

Scott Benner 6:38
doesn't consistently happen every time.

Jennifer Smith, CDE 6:41
Correct. Okay. Exactly. I mean, there is in relevance, it seems to be low blood sugars that are usually less than about 55. And that are more sustained in length that seemed to have this counter regulatory hormone output, and can then result in the higher blood sugar later. Now some of it also is we have a low blood sugar, especially with today's technology, you get an alert right from your CGM. And so then you may treat that low blood sugar. And because those counter regulatory hormones are not like, hey, right now, she or he needs this right now. Yeah, they could have lingering impacts, you end up treating this low blood sugar with what would normally work for you, right? 10 grams, it always works, it brings you up, you never go too high from it. But now with the counter regulatory hormones in the picture along with your normal 10 gram treatment, you end up at like 290. When you wake up in the morning, you're like,

Scott Benner 7:45
yeah, so Okay, so I have, I feel like I have some experience with this, not knowing that it was a thing or had a name, or at least a name that is hard to pronounce. And oddly spelled, but it is, but you know

Jennifer Smith, CDE 7:59
that it's actually named after a person gets up. It is it's named after it's the last name of things, the professor or the doctor who saw it happen, and thus named after him. All right, if I remember correctly,

Scott Benner 8:14
I'll try to figure out who he is. While I'm telling you that before Arden had a CGM. I've said this a ton of times on the podcast, right? I would get her blood sugar up to like 190 put her to bed. She'd wake up at 100. And I was like, look how good I am at this. Right. And then one day, we put a dexcom honor and I realized I was pushing her up to 190. In the early part of overnight, she was dropping to like 55 sitting there for an hour or two. And then she'd rise back up and level off at 90.

Jennifer Smith, CDE 8:50
And you never treated the low because you didn't really without a CGM. You didn't really know that it was happening.

Scott Benner 8:56
Never knew it. I took all that anecdotal data about her waking up at 90 and starting at 190. And I never considered she could have gone below 90 and come back up again. I always just thought she was drifting 100 points down overnight. Yeah, right.

Jennifer Smith, CDE 9:09
And that's she had to be hired to go to bed at night. Because otherwise, if she went to bed at 100, she'd be in the toilet by the time she woke up, even though it was happening sooner. Yeah. And then just naturally rising back up from the counter regulatory release.

Scott Benner 9:24
And I want to keep everyone focused on the idea that the reason Arden drifted down overnight was because I did not have any meaningful idea about how to use insulin like so. She She was just like, you know, because I've been helping this person recently. Who hears me, but can accept it. You know what I mean? They just think oh, no, the low happens at night. I'm like, No, you are messing up your meal bolus, then your overcorrecting afterwards and then she is experiencing a low blood sugar later and no matter how many times I say You know, what's happening now is not about now it's about before, you know, it's it's like this a fee for this person specifically. And I would imagine for a lot of people, it's this fear that's been built into them day after day, week after week, month after month, year after year of thinking like this is just random, and there's no reason for anything that's happening here. Because they can't see the causation. Right? They, they just they see the pencil go in the pocket and they think, Oh, it's the pencil. It's not the pencil. You're you're looking here. What's going on over here is what's happening. And when you talk about a hormonal release, is that from the liver? Mm hmm. Okay. And it's just glucagon, right? Or no, it is. Yes. Yeah. But you can't count on it.

Jennifer Smith, CDE 10:50
You can't count on. You can't count it always happening. From my base understanding of it. Yes. And secondly, you can't count on how much is don't.

Scott Benner 11:03
Plus, I would assume you can't count on an overpowering a certain amount of insulin active insulin, like maybe it could catch a drift where the insulin is almost gone. But if you were to put in a large bolus, it would take you right past that it would power right through any glucagon dump and just tank you. Right. Alright. Okay. Apparently it's Stephen. smudgy. And he's a jersey guy. Sup, Steven? Oh, is somebody who's gonna tell you that they heard this on here and come back and let you know about it. This is the guy it's I don't know. He's an internist. Apparently. All right. Well, no, no, wait. Now there's another smokey. There's a guy and he's an orthopedic. How many Smokies Could you be in the world? Yeah, what I

Jennifer Smith, CDE 11:47
found is it says it's a theater at theoretical phenomenon was named after Michael smudgy, a Hungarian born professor of biochemistry at Washington University and Jewish Hospital of St. Louis. I have it here. Who prepared the first insulin treatment given to a child with diabetes in the US in October of 1922. Smokey showed that excessive insulin makes diabetes unstable, and first published his findings in 1938. That's what I found. And

Scott Benner 12:15
he will not take offense to what I just said. Because he died the year I was born. So he has I don't care for quite a long time. Although you got to give this guy props. Born in 1883 he lived till 1971. Wow, that's amazing. 101 a math? What's math? Yeah, that's almost 100. What? 1883 17 years? 1771? Hold on seven, carry the one. It's eight. He was like, 88.

Jennifer Smith, CDE 12:50
Yeah, he was, wow.

Scott Benner 12:52
Go to public school. So

Jennifer Smith, CDE 12:54
I did not know cap Catholic school from first grade through 12th grade.

Scott Benner 12:59
We've just let down the Catholic and public school systems in one fell swoop. Really good. All right. So is there anything else to say about the smokey effect? It causes? It causes high blood sugar high blood sugar in the morning due to low blood sugars overnight because of a glucagon dump. That happens from a low if in fact, any of this is happening. Wow. All right, then. That's a rock solid. It's a rock solid description. It's a rock solid description of something that may or may not exist.

Jennifer Smith, CDE 13:33
Well, and I think the interesting thing about it too, in terms of like pushing it a little further is that it's really something that's considered or named after just that morning, high blood sugar and the potential reason for that morning, high blood sugar beyond another thing that we're going to define which we'll talk about high blood sugars in the morning, too. Yeah. But during the daytime, it's not like you don't have this counterregulatory potential impact either. So you could, again, have a low blood sugar during the day. And you could also have counterregulatory hormone impact in the aftermath. Again, treating it as you normally treat it, let's say 10 grams of carb is your staple treatment, it always works. And now all of a sudden, today for some reason, you're at, you know, a high 200. And you're thinking well, why, you know, so again, it could be the relative nature of the number or the low that you were at, and possibly how long the low was sustained, in terms of those counter regulatory hormones.

Scott Benner 14:45
If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com Thanks so much to the Omni pod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my office. The pod.com forward slash juice box, learn more about the dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply, in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org. forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show. The pentameter of that reminds me of save the cheerleader save the world. From heroes, you remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them. Go into your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app all episodes, scroll down, you'll see them you can go to Juicebox Podcast comm and scroll down a little bit. Right, and you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books you look up. Oh, hold on. Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right, it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginie I explained that to you. ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes. But you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes. Two new ones that are out right now around this, like I mentioned the beginning, I think go together with this one. The other two are feet on the floor. And this Moji effect, there's some Mogi effect. I don't know how to say that word, but you'll see it it'll be the only word that sounds like some Oh gee, when you read it, looking for a great doctor or other type of diabetes practitioner, check out check out Whoo, there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add. Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.

Please support the sponsors

Donate