Scott Benner 1/10/23 Scott Benner 1/10/23

#823 There are Bugs in Your Belly

Arisha has type 1 diabetes and this is how she eats.

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

Scott Benner 0:00
Hello friends and welcome to episode 823 of the Juicebox Podcast.

Today's guest is a young lady who has type one diabetes, she reached out to me by herself wanted to be on the show, and then just really brought it. This is an amazing episode that probably should be called how Orisha eats, but I just like this title too much. While you're listening today, 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 healthcare plan or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, you can make a big difference by taking the survey AT T one D exchange.org. Forward slash juice box. It's anonymous, HIPAA compliant, not difficult and won't take you more than like eight or 10 minutes. T one day exchange.org forward slash juice box. You can be responsible for moving type one diabetes research forward. And you can do that right from the comfort of your home.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. I don't know how you get your diabetes supplies, but we get ours from us Med and you could do U S med.com forward slash juice box or call 888-721-1514 Get your free benefits check right now and get started with us med.

Arisha 2:04
Hi, I'm Alicia and I'm 13 years old and I have had type one diabetes for nine years. So it's been almost a decade.

Scott Benner 2:13
Orisha so he's Yeah, okay. Yeah, you're 13 Nine years you were diagnosed when you were four? Yeah. Wow. Is there any other diabetes in your family? type one or type two?

Arisha 2:28
Yeah, my grandpa had type two.

Scott Benner 2:31
So no other type one that that you know about?

Arisha 2:35
Um, yeah, but like, my I think it's like my cousin my mom's cousins like daughter like a really distant relative. But I think she got diagnosed after I did so.

Scott Benner 2:47
Okay. How about other autoimmune diseases, but a Lago stuff like that celiac? Oh, my mom has thyroid. Your mom? Is it? Hashimotos? I don't know. Okay. That's okay. Have you ever heard her call it autoimmune? Thyroid?

Arisha 3:05
I think I think it's autoimmune.

Scott Benner 3:08
Okay. Any brothers or sisters?

Arisha 3:12
I have a brother but like nothing. He has no autoimmune. Yeah,

Scott Benner 3:15
we don't want to talk about him. Is he older or younger?

Arisha 3:18
He's younger. He's, he's gonna turn three soon. Oh,

Scott Benner 3:21
that must be very irritating. I mean, I mean, fun. So. Okay, well, because of your age. I'm just gonna ask you what? Well, let me say this infrequently, but it does happen. people your age reach out to be on the show. It's always a good experience. But I have somebody on who, at 13 years old. A understands that there's a podcast that exists. I assume you listen to it. Right? Yeah. Okay. And then has the thought like, I'd like to be on the podcast, and then goes through the effort of getting on because I don't particularly make it easy for you to get on the podcast. Right? I don't actually particularly make it easy for anybody to get on the podcast, it's part of my secret Orisha. So that's how I know you're gonna be here when it when it's time to do it, because you've worked so hard to get here. But tell me what made you want to do this?

Arisha 4:22
Well, I feel like since I've had type one diabetes for so long, like I've learned a lot of information throughout the years that I would like to like, kind of share that information. Okay. I said it's like helped me I guess

Scott Benner 4:36
firstly, you want to dethrone me, you want this? Right? This is your first try and then you're gonna be like people love me. They'll start my own podcast. I'm not that old guy out of this thing and right.

Arisha 4:48
Not really.

Scott Benner 4:50
What what social media do you use or do you not?

Arisha 4:54
I have Instagram,

Scott Benner 4:55
Instagram, okay. Okay, So you're here to share what you've learned. This will be fun. Yeah. Before before we go into that, how long have you been listening to the podcast?

Arisha 5:11
Um, I think when COVID started a couple of years, like, well, like late COVID. So like when I was in sixth grade, so like, get around two years,

Scott Benner 5:23
how old would you have been? 11?

Arisha 5:26
I'm 1112. Somewhere around there. All

Scott Benner 5:29
right, I find this. This hits me two ways. This news. One perfect mom perspective is I'm super excited that it somehow captured the attention of an 11 year old. And I am mortified that you've heard all the silly, stupid and reasonably inappropriate things that I may have said, your parents are aware that you listen to the podcast.

Arisha 5:48
Yeah, my mom is actually the one who introduced it to me.

Scott Benner 5:52
Now we're getting somewhere. Okay, so your mom's cool? Yeah, yeah. Excellent. All right. How about your dad? Is he? Oh, yeah. Yeah. Yeah. wasn't as exciting when you said about your dad. I mean, he's fine. Okay, so tell me about that moment. Your mom comes to you and says, Do you remember like there's a podcast I think you should listen to?

Arisha 6:15
Oh, yeah, it was like, so in sixth grade, I did like online school. So there wasn't really much to do because you couldn't go out with your friends. So I was like, it was kinda lonely, I guess. But so my mom was like, You should listen to this. Because I think at the time when you had no exercise, because I feel like going to school gives you like a lot of exercise and like, yeah, yeah. So basically, like, I would wake up in the morning, and then I would eat like breakfast and my blood sugar would hit to 250. And then it would go to 40. And like, I guess that blood sugar rollercoaster kinda like didn't help me. So my mom was like, Maybe you should listen to this. Maybe I'll help. And like, Hannah did.

Scott Benner 6:56
That's really interesting. Did you do the fake gym class online? Like I used to see my daughter, I don't know how to explain it to you. She put like the top of her head in the picture. And then she just around like she was doing something like laying on the floor and not actually doing it. Did you do that though?

Arisha 7:12
Well, we just had like, a couple classes like math, science, and like English, that were like that. And then our like, what we call it here are electives. And they kinda just, and you just had to take like, a picture of you doing like jump roping or something. So I would just like take a selfie of me riding with my bike and like, send it to my gym teacher.

Scott Benner 7:34
Can I ask you because I'm gonna have some questions about food as we move on. You're Indian.

Arisha 7:38
Yeah. Yeah.

Scott Benner 7:40
Okay, so do you eat traditionally? Not anymore. Okay, so your mom,

Arisha 7:48
we go. We go out sometimes we eat traditionally,

Scott Benner 7:51
but not that your mom's like cooking? Like

Arisha 7:56
she used to but like it didn't help. My blood sugar's

Scott Benner 7:59
Yeah, well, that's what I was gonna ask about, right, because Indian foods hard to Bolus for right?

Arisha 8:03
Yeah.

Scott Benner 8:05
Did you go the what? I'm, I'm thinking of my daughter's one of my daughter's best friends right now. She is. Her mom still cooks traditionally. But, I mean, I think her mom knows she's losing that fight overall, like trying to keep her kids eating that way. But But artists friend Assange and I, she's basically, I don't know what part of the country you're from, but she's basically like a Wawa subway kind of girl. And like, she just got home from college last week, and she goes to college in England. And she got off the plane. And they drove like directly to a to a Wawa. And she ate there. Like it was fine food. Do you know what a Walmart is? No. Are you not on the East Coast? No. Okay. So it's just, it's like a convenience store that has a deli in it and make some hot foods. Oh, she treats it like it's fine cuisine. It is. It is not, by the way. But anyway, so So you just need kind of what you would consider to be an average, like American diet or you

Arisha 9:11
know, like, not at all like not not that I don't eat not at all, like not at all of the American diet. We like I think after I got diagnosed, we learned a lot of things. Like cuz I remember right after I got diagnosed like my nose, it was like really bad. It was stuffy. And like, I think the doctor even recommended surgery. It was really bad and I couldn't sleep at night. It was like months. So then my mom just started to read some books, and it like and then she was like, Okay, let's try being gluten free. So we tried it and it like really helped. So then my mom would make like gluten free items. But now like you can get like now, I'm kind of vegan. Like I've, I've transformed from being like gluten free to dare I'm also dairy free I'm not like egg free but like I don't eat red meat and that's like helped my blood sugar's like a lot like by a woodsy is a lot lower. So like I realized that gluten wasn't exactly the problem it was mainly like dairy. Okay that like, bothered by blood sugar and and then we started focusing on like gut health and that's like helped my my performance in like physical sports and like academically as well that's interesting just like

Scott Benner 10:32
alright, I want to hear all about this. So you're not you're not vegan? Yeah. You are like, well you eat chicken or fish.

Arisha 10:42
Yeah, we chicken and sometimes fish and then eggs, but we don't eat eggs as much because my brother is allergic to eggs.

Scott Benner 10:51
Interesting. Alright, so your brother has some allergies too? Are they just food allergies? Or does he just egg? Oh, really? Nothing else.

Arisha 10:57
It's nothing else.

Scott Benner 10:58
So if he's only pretty so little.

Arisha 11:00
Yeah, it's not like that bad. Like, if you put an egg in front of him, he's not gonna have a reaction. It's like, I feel like if you give him like a whole egg or like, give him a little bit the next day he'll wake up with like a fever. So we'd like avoided as much good

Scott Benner 11:14
thing you won't be ending up celebrating Easter. I mean, what a horror show for that little kid. wherever he's running from, that's where the eggs are hidden now. Okay, so your little brother has an egg allergy. Your mom, your mom starts reading books. She figures out a lot. It sounds like so yeah. Tell me about the dairy. Like do you think that cleared up? You're breathing through your nose?

Arisha 11:41
No, the breathing through the dairy. I think what I started like, I'm 13 I think I started the dairy like 1112 but the gluten I like completely stopped up for.

Scott Benner 11:54
Okay, so when you stopped the gluten? Does that

Arisha 11:58
nose help? Yeah, I don't need to get surgery anymore. Okay,

Scott Benner 12:01
see, do you think it was just inflammation? Do you think your passageways were like inflamed and blocked?

Arisha 12:06
Yeah, something like that. But like, as soon as I stopped it, I don't know what it was. But like I like everything was just like magically better like a magic wand? For sure.

Scott Benner 12:17
Um, I'm interested for a second. Let's think about this. Gluten Free. My Google foo might fall apart here. Hold on a second. Now I did it. The relationship between the respiratory system and gluten? And you say you got better at sports? Was it because you were able to run more? Without getting out of breath?

Arisha 12:46
Yeah, something like that. Like as a four year old? I don't really remember. But

Scott Benner 12:50
yeah, you don't think you were like Pele out there?

Arisha 12:53
It was like it was a lot better because I remember like by Bob talking to like, my teachers and they were like, she's like so much better like because like I remember I would just like kind of just sit there what if I what I ate gluten but acid I was like we kind of like stopped it. It was a lot better also, but at the time we also stopped from dairy milk to like Albertville. So as a kid,

Scott Benner 13:16
this is what I'm looking at here. This woman is an RN say she was making a podcast years ago. I don't know if she does it anymore. But since I'm gonna quote from her blog, let me tell you it's called gluten free RN. And there's an episode here where her show notes are talking about body fluids separate and less tissues, leaky gluten alters. I'm gonna think I'm gonna have I'm gonna have to spell this one epi T H E ial tissue, including that of the lungs. There's some stuff here that's listed as anecdotal evidence. She said she has a fellow nurse that was had a lung removed as the child always needed an inhaler went gluten free, and the inflammation in the lungs cleared and didn't have asthma anymore. Didn't need the inhalers respiratory issues that may be corrected on a gluten free diet anemia. It's interesting that they're calling that a respiratory issues cystic fibrosis C, COPD, bleeding lungs, pulmonary edema, I mean these are just listen, it's a podcast. I don't know if I'm allowed to say something funny. It's a podcast. I don't know if you can trust it or not. I don't know what you can trust honestly. But it's interesting that they put the information out there so and it has it worked for you right?

Arisha 14:34
Yeah. Like it worked a lot. It's amazing.

Scott Benner 14:37
Is it hard not to eat gluten?

Arisha 14:41
No, I feel like after like a certain like if you go to a certain healthy lifestyle you kind of just like forget about all about that. You don't want to like go back. Do you

Scott Benner 14:51
find the gluten free foods are higher in carbs or no?

Arisha 14:56
Um, lunch like a usually at school. I district like I'll just eat a salad from home. So I don't really have to Bolus for that. That I like, for breakfast. I would just eat like, I don't really eat foods that are like replaced with like gluten free stuff. So

Scott Benner 15:12
you're not buying a lot of processed packaged foods. That's gluten. Okay, so tell me like, What did you have for dinner last night? Um, we went out this Okay, what did you eat?

Arisha 15:27
It's like an Indian food. It's called dosa.

Unknown Speaker 15:30
Not gonna, and it's

Arisha 15:32
it's like this rice kind of thing. Okay. It's like, it's like what you would consider, like a pancake but not but made out of rice. That's like crispy,

Scott Benner 15:47
crispy rice parents.

Arisha 15:48
But like, that's not what we usually eat. Right? It's like, oh,

Scott Benner 15:52
I picked the wrong day to ask about is that what you're saying? What did you have the night before for dinner?

Arisha 15:58
Um, soup and salad. What kind of soup? Mushroom.

Scott Benner 16:03
Okay, like a thin broth? clear broth? No, no. Oh, creamy,

Arisha 16:07
thick mushroom. Yeah, thick, creamy butter.

Scott Benner 16:09
Okay, all right. How about breakfast? What do you do for breakfast?

Arisha 16:13
Um, so I drink this power shake from Purium. And it like really helps. Like, I like their products a lot to like. And I just I drink their power shake. And sometimes an apple.

Scott Benner 16:29
Interesting. So do you consider your eating style like light? Like you don't eat a lot of bulk when you eat?

Arisha 16:36
Yeah, I pretty light I guess.

Scott Benner 16:39
Alright, so and this power shake every morning? Never. Not.

Arisha 16:43
Twice a day, sometimes. Usually twice a day, actually. Yeah. It like really helps though. Because it like if you drink what power shake? It's like six salads.

Scott Benner 16:52
Okay, as far as nutrients.

Arisha 16:55
Yeah. And everything's like organic and non GMO. And they have like these juices to that like a really? Like there's this juice called Aloe digest. It says it has 40 carbs. But I drink it with no Bolus egg. So

Scott Benner 17:08
interesting. I'm looking. I'm trying to look for the carbs on the power shake right now.

Arisha 17:13
I think that is more but like.

Scott Benner 17:18
Like, is that? Is that what's in your cup right now? Are you are you doing the power shake? No, no,

Arisha 17:23
it's just water. I drink power shake when I'm like, as soon as I wake up

Scott Benner 17:28
for hunger does it? Does it make you? Like, does that make the hungry feeling go away?

Arisha 17:34
I don't usually get hungry. So like, it's just like a schedule to how like if I drink like power shake, like my stomach's good. Because like, usually for school, like I would have to drink get my power shake at like seven. And then like, we would have lunch at like, I think 1220 So like, I don't eat anything from like, seven to 12

Scott Benner 17:57
Okay. I'm sorry, I'm just I'm reading about the power shake. It's I'm trying to figure out it's interesting. So, alright, so you don't so what what? What's the normal lunch then? I don't know why just stuttered. But what's the normal lunch then after the power shake?

Arisha 18:14
Um, it's sometimes like depends like, what's your like? It's huge. Um, I like soup a lot. Like probably like butter squash soup with like, like an orange and like maybe a salad.

Scott Benner 18:29
Have you pull that off at school?

Arisha 18:32
So you know, those containers that have like soup in them? Like, carry that? Like, I pack lunch? And then like, well, actually, my mom talks my lunch but like, and I pack it. It's like a buffet and my lunch box. It's a box of salad. Like,

Scott Benner 18:50
okay, so you'll take a soup and a salad for lunch? Yeah, have your shake. At breakfast. You have the shake again, when you get home from school sometimes.

Arisha 18:59
Um, if I do, it's probably when my brother gets home from daycare. So like, okay, or five? Because I have I have like a lot of after school activities.

Scott Benner 19:09
Oh, yeah. Like, what would you do? Slab so like, like, I don't really swim for fun or swim for competition. Swim for competition? Yeah. Do you beat people? Are you good? Kinda. What other activities do you do?

Arisha 19:27
Um, I played field hockey this season, but I bought that I did ice hockey last year. But yeah, I don't think I'm going to do field hockey again. And then I did taekwondo for the longest time until COVID. Like and I was actually really good. Like, I went to the World Championships and all that. But that that COVID happened. So I haven't done it since then.

Scott Benner 19:52
Because it got uncomfortable rolling around the floor with your face and other people's faces.

Arisha 19:56
Yeah, it was like at that dowel. If I go back like I don't want i'll probably forgot everything. So I don't want to like start at a white belt after like eight years of hard work.

Scott Benner 20:08
Did you stop playing field hockey because of this short stick? Did you hate this?

Arisha 20:13
Um, I only played for one season and it didn't seem very enjoyable.

Scott Benner 20:20
Every time I see field hockey, I think why don't they just make that stick longer? So everybody doesn't have to bend over like that. Right? Yeah,

Arisha 20:27
well, if you bend over then it's like harder for them to like, get your I don't know about great field hockey

Scott Benner 20:34
was your dad or your parents? First generation?

Arisha 20:38
Of what? Like, did

Scott Benner 20:39
they were they born in India? Oh, yeah. So did your dad like field hockey to remind him of cricket or no?

Arisha 20:47
My dad. Okay. So he plays he played a bunch of sports like as a kid, like, India, like they call like soccer football. So he didn't play like the traditional like American football, but like the soccer and like, like cricket. He did swim. He was really good at basketball. Yeah. Yeah, there's dad. He played field hockey, too. But

Scott Benner 21:11
oh, no kidding. There's a group of guys around here that in the certain times a year, there's this field where they play cricket. And I sit and watch them sometimes try. I try so hard to figure out what the hell is happening in cricket, but I can't figure it out. But But anyway, it's really interesting. I just I don't I don't know what they're doing. If I could get somebody to sit next to me and explain it to me while it's happening. I think then I would, I would probably get a little bit. Okay. So you're moving around a lot. And swimming is you know, for for, for people with diabetes, they can think Oh, swimming, your blood sugar must go up and down all the time. But how is your blood sugar doing swimming?

Arisha 21:47
Okay, so basically, for large, I don't really Bolus so it's like, it's right after school. So I just have one more class after lunch, and then I'm out. So my blood sugar's kinda like trending in the 90s. Before swim, which is, which isn't the best place to swim. So I'll eat like, a banana and apple, an apple sauce. And by the time and then I'll put my pub bot activity mode, because I have the Omnipod five. And then when I come back, it'll be like, 70 like, I've like confused. Why is it not going to like one flirty? Like, why is it 70? After I've done

Scott Benner 22:24
well, you must not how much do you know about your Omnipod? Five? Do you know how to tell me what your total daily insulin is?

Arisha 22:32
Up kinda, you just Oh yeah. So you go to this little biopic put up. And then you like put your password and all that. And then you click the three dots, the three lines, and then you go to history detail. Of that it will say total insulin, and it will tell you,

Scott Benner 22:50
yeah, so tell me like, What was yesterday's? The like, Just can you like go back? Like maybe two or three?

Arisha 22:57
I think it's like 3032. All right,

Scott Benner 23:01
in that range? Do you know what your when you first set up the Omnipod? Five? What was your Basal rate? Do you remember?

Arisha 23:09
Um, I think it was like, point 7.75. But it was like in a dash, it was actually point six, okay. But you have the pod five is like, I feel like if you don't learn how to use it, it's like really complicated. Because, like, no one, like we had to figure this out. But basically, like, if you Bolus, like if you're eating like an apple, and it has, like, I don't know, like, I don't know how many carbs apples have, but let's just say it as Ted, you like, I will have to put double in subtypes. Because like, it just works better. Because then cuz cuz it has the power to like, stop your insulin. So based on your iob it will like make your make the Basal like lower. Which is like kind of weird, because I don't think it should be doing that. Like, I think it should just let like, eat the food. Like let us eat the food. And if it goes like lower like, I don't know,

Scott Benner 24:09
do you remember on dash what your insulin to carb ratio was one unit covered how many carbs?

Arisha 24:15
Um, 20.

Scott Benner 24:17
Okay, well, we're gonna throw this out. So if you were one to 20 I'm gonna get a calculator. Don't make fun of me for wanting a calculator. It's the one to get it wrong while we're talking. Okay, so if you were one for 20 This makes sense if you were one for 20 and the apple is 10. So then you would basically need a half a unit for the apple but instead you get binstead You put in a full unit, which basically covers the apple and almost all of your Basal need for the next hour.

Arisha 24:53
Yeah, cuz like if so basically, if you have like point five, I would I just add I'd like basil for an hour.

Scott Benner 25:01
Right? So you're, what you're doing is you're covering the basil in case the system takes the basil away. Yeah. Okay. And then then if it takes it away, you that's how you keep your stability. Okay, and that works for you. Does it work for everything? Or is it only with like simple things? Because that's not exactly it

Arisha 25:21
works for everything. It works actually really well. Like in the night, it'll keep my blood sugar stable. Because like, also, I feel like if you have the Omnipod five, you need to like set like, I know some people who like set their high thing about 250, which in my opinion, is kind of like ridiculous. But like, my thing used to be at 200, I think three years ago, and now it's at 130 for like, high.

Scott Benner 25:48
So you're like, I'm sorry, your high alarm on your CGM is what they're right. Yeah. Yeah.

Arisha 25:55
Omnipod five understands.

Scott Benner 25:58
Oh, see you like that they're both kind of having similar targets in mind.

Arisha 26:02
Yeah, cuz, if it's like, because usually the Omnipod five, what it like Bolus is it. Like all the Bolus is what you're like, trending high. So like, I feel like 181 50 like gets kinda like late. Like, makes you go above 200. But if you put it like at 130, it can stop, but it won't go above like 160.

Scott Benner 26:25
Okay. And also, I think it's important to point out that you have a fairly simple eating style, meaning Yeah, meaning there's not a ton of different foods in your stomach that are being addressed by your system at the same time, so, but I like I like being like being able to tell your story so that people can hear that. Because just an apple, like you figure it out. Like this is how you Bolus for an apple. And I don't need it. You know, I don't need insulin for my salad. But you also might be eating. I mean, let's say this or it's just some people say they're eating salad, but by the time you look at it, there's like a pound of bacon on it. And I have a handful of cheese and like, you know, a creamy. Yeah, you're eating lettuce, right. Well, like sprout. Yeah, right. You're not putting a pork on it and cheese. Right, right. You're you're actually eating the greens. So you like listen to the journey?

Arisha 27:25
Oh, well, yes. Yeah.

Scott Benner 27:27
She eats like you a little bit. You actually you might you might eat cleaner than Jenny does. I'll make fun of her later. And does your whole family eat this way?

Arisha 27:40
Um, yeah. Well, my mom like I think she's like the healthiest out of all of us. By dad, I guess like, yes, like, same as me like, and my brother. Okay, I'm gonna just like be honest. He's the odd healthiest out of all of us

Scott Benner 27:56
a three year old. How is that possible? But does he ever see at the store buying food for himself? Or what's going on?

Arisha 28:03
No, he's like, like, we have to pack food for about daycare, because you have like, if you were like allergic to eggs, like you have to be like, kinda like sure about what they're eating. And since he like, follows the lifestyle that we follow, like, he obviously doesn't drink the power shake at all. But he'll drink like the little kid drinks. Like they have like the MVP chocolate. He'll drink all that. But he'll he'll he's the one who eats like the most packaged fruits. But like, they're like healthy packaged foods. Like, like, they have like, there's these simple, I forget what's called, but they're like organic and they're like, they have like really clean ingredients, I guess. Okay, so it's like,

Scott Benner 28:46
so his foods are just more they're easier because your mom's moving him around to different people and dropping in places and

Arisha 28:54
Yeah, cuz he's not going to eat a salad like he'll, he'll probably eat like, I think it's like quinoa. Okay, and like rice most of the time. Okay. But like he, but he is like healthy in some ways, because like he really likes seaweed.

Scott Benner 29:09
So there's no one. There's no one in your house. Like when you guys sit down to watch television together or you're just paying you're hanging out. No one's eating Doritos. Is that what you're saying?

Arisha 29:18
No, no, like it's we don't get chips.

Scott Benner 29:21
Okay. Have you ever had chips?

Arisha 29:25
Um, yeah, I think when I was younger, yes, for sure. Like below for and then before we started like to focus on like gut health. I think like before this like a like 10 I think occasionally I would get it but like, after a certain point, you're like, it's kind of not worth it because I don't want my blood sugar going to 300 Okay, like you kind of have to like kind of like, now I don't crave this stuff. But I remember a time where I did believe you have to like kind of control yourself because you don't want your blood sugar going to like 280 it's kind of not worth it. You

Scott Benner 30:01
Did you figure this out on your own? Or do you? No, no. Your mom moved you in this direction. Yeah, was it graceful? Do you remember time and it was zero. Or she did you ever? Did you ever fight against how she was talking to you about food?

Arisha 30:20
The only time like I didn't like is like, I think I was like, five and she forced me to drink almond milk. But I think that was the only time but like, I don't think I didn't It's because I didn't drink like regular milk either.

Scott Benner 30:37
Or you didn't like milk in general?

Arisha 30:39
I didn't like it in general. So like, yeah, like I don't think anybody in our family really likes regular.

Scott Benner 30:46
I'm gonna bleep this out. But your mom's GMO Capo pen has no visible needle, and is a pre mixed auto injector of glucagon for treatment of very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G vo glucagon.com forward slash juicebox G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit GFO glucagon.com/brisk. Just last week, Arden was about to run out of her Dexcom supplies. Now. I was like Oh no, what will I do? But just as that was happening, I got an email from us Med and says do you want to reorder your extra supplies? And I was like yes. Click Add then they came to the house? Huh? What do you think of that? Us med.com forward slash juice box or call 888-721-1514 Same goes for maybe like three weeks ago? The same thought I started having except I was thinking about Omni pod. I was like Where are Ardens Omni pods that am I running out of those? What do we need? Email came? Would you like to do your order again? I would collect there they were super easy. Guess what else us med has libre three, they're going to have Dexcom g7 Very soon. And us met also dispenses Novolog insulin as part and human log insulin lispro through their pharmacy benefits. They've served over 1 million diabetes customers since 1996. And you can get everything from insulin pumps, and diabetes testing supplies to all those latest and greatest CGM that I just spoke about. US med accepts Medicare nationwide, it over 800 private insurers, they have an A plus rating with the Better Business Bureau and you you want to get your stuff from them. Because it's easy, and they're good. So let's call that number 888-721-1514. Go right on the internet, the web, the Urals, go, U S med.com. Forward slash juicebox. You know, the Urals the URLs, that's the URL us med.com forward slash juicebox. You can do it, it's not hard. And then everything after that, if you get it set up, you know, nice and easy, like butter. There are links to us med G vo Capo pen and all the sponsors in the show notes of the podcast player you're listening now. Or at juicebox podcast.com. I'm telling you that because when you click on my links, you're supporting the show. You're letting the advertisers know, I heard about us med from Scott on the Juicebox Podcast. And then next year, us men will be like, yes, we'll buy more ads from Scott at the Juicebox Podcast. And then I get to keep making the podcast and you get to keep listening to it for free. Plus, my bills get paid. We all win. All right, well, this part's over. I'm gonna get back to a Russia now. But when you decide to get the hypo pan or something like that, click on my links, please. Please, please, please. I know you're thinking right now. I like you, Scott. But I went to my doctor's office and asked for an omni pod. Yeah, I didn't get credit for that. Okay. I'm sorry. Maybe I can get a part time job at the Piggly Wiggly or something. Make this podcast in the middle of the night when I was supposed to be sleeping. You just you'll be comfortable. Don't worry about me

Yeah, okay. All right. So I because I kind of know her from online a little bit. You do? I mean, she's in my group.

Arisha 34:35
Oh, yes. Oh, yeah. Like from

Scott Benner 34:38
that and? And the the podcast over? Actually, I think I know how this happened. There's an app called Ghana. I think that's what it's called. And it started carrying. It started carrying podcasts like a couple of years ago. It's I think it's like the it's a very popular audio app in India. And then once that happened, more Indian people started listening to the podcast. Um, but that's how

Arisha 35:14
my mom, she got introduced to this podcast by like one of her friends and like through the podcast app, so I don't think it's related to God. I've never heard of that. Yeah,

Scott Benner 35:24
no, probably not that one. I'm saying that, generally speaking. So I mean, first, the first influx of people, the first influx of Indian people came around, almost around type two, a little bit, because type two is kind of prevalent in Indians. Yeah, you're right. So that was the first time. And then I think people found the show, and then they just started talking about it with people. And you'd be it's interesting how information spreads through culture, as well. Like, if you've listened to the podcast, and like, you'll know that a lot of Mormon people listen to the podcast. And that's another cultural thing that somebody, you know, found it enjoyed it. And when they turn to tell somebody else about it, it's another person in their kind of cultural circle, and then it sort of spreads that way. It's interesting, actually. But, but Okay, so now I want to talk about what do you understand about your, your guts health? Is it all from your mom? Do you do reading as well? Is it just anecdotal? Like you've tried things and you notice what happens? I want to hear about all that.

Arisha 36:32
Okay, so basically, when we started in this, I think, like my mom's cousin, or like, one of her friends, she like, was like, You should go to a functional medicine doctor. So we went there, because I think, at the time, my blood sugars are kind of imbalanced, like I was really tired, and all that. So we went there. And he started giving us like these medications, like the like, supplements. And like, he explained to us that I had like something that was called a leaky gut. Which is basically when I not explained this, but it's basically when like, foods go through your like that, like the cell wall is like broken? Yes. And basically, so he made us do some tests. And one of the tests was like, testing my energy level. Because and when it came back, the functional doctor was actually really shocked. Because like, the my energy level at the time was equivalent to a 60 year old man's energy level was really bad. And so we kept doing it, I think, for six months, but I ended up getting like, really expensive. Because like, I think one bottle like this big, like the size of like, like my hand would be like was like I think over $200

Scott Benner 37:56
Did you start having a feeling that this man was making money off of you? Um,

Arisha 38:01
no, because it was working. It was working. It was working. But he wouldn't. He wasn't like teaching us stuff that like we've learned now. So then later, like my mom, she's became like, active on Instagram. And she found some people, like under period, and she learned about like, being organic got held. And so then we started using like, period stuff and all of this. Yeah. And then we suddenly and then like, I don't know, like, it like worked really well. Like I had greats like my, when I slept. It was like really good. I didn't wake up in the night. And my energy level like we didn't get the test again, because we like, you know,

Scott Benner 38:43
why would you? Why would you wake up at night? What was waking you up? Alarms? Oh, your blood sugar was bouncing around. So you were waking for that? Yeah. Okay. I didn't know if it was like distress like in your stomach. Or if you had to use the bathroom overnight or stuff like that.

Arisha 38:59
Like sometimes like but like not, not like it's usually alarms.

Scott Benner 39:03
Okay, so. Alright, so yeah. So I I've heard. So first of all, leaky gut is a term that I think you do have to go to a more integrative doctor to hear them talk about it. Like I don't think your regular like GP is going to be like you might have leaky gut. I don't think they think that what I've heard Jenny say she doesn't like I think it was Jenny. She doesn't like the term, but she understands where it comes from. So I'm going to read from the Cleveland Clinic for a second so people can keep up. Leaky Gut Syndrome is the theory that intestinal is a theory that intestinal permeability is not only a symptom of gastrointestinal disease, but an underlying cause that develops independently. If you're if your intestinal barrier is impaired, it may be letting toxins into your bloodstream. So I think you said it better than that. Like there's There's like pass throughs in the cells. And if they get too large then things that don't belong outside of your gut end up getting into your body, causing, you know, people think, stiffness, you know, joint pain, muscle weakness, tiredness in general, this sort of thing. And have you heard the episode where we talked about Arden going to the gastroenterologist, they looked down her throat and said her food wasn't digesting. Well, have you heard them? So? So Arden had stomach pain for years, and she wasn't eliminating well, you're 13 I'm trying to be so like, you're like, why is it not cursing and saying stupid stuff? It's because you're 13 and I'm looking at you. So So anyway, she eat their food wouldn't digest well. So then she had pain up here, like, you know, in her sternum. Right? Because everything was kind of, like full. And then she wasn't passing, you know, still properly. And, you know, we tried all sorts of anything you can think of like eat gluten free eat like this, the only that like, you know, everything, nothing fixed it. And then one day, we took her to a doctor who just looked down her stomach and like his, it was he was a regular just, you know, a regular old white coat doctor, and he's like, he's like, you know, she has gastroparesis and like, she's gonna need drugs for this and this and this. And I was like, none of this makes sense. Like Arden's blood sugars are not out of whack. Like her blood sugar's don't act like she has gastroparesis, like, none of this makes sense. And then we kind of realized that when you have diabetes, you think of gastroparesis as a slowing of digestion that happens from poor blood sugar control, and, but the rest of the world who doesn't have diabetes just thinks of gastroparesis is a word, that means you digest foods slowly. And so we started thinking like, okay, like, we'll help digest our food. So we gave her a supplement, which is just a digestive enzyme, an enzyme because you guys like your pancreas is funky, you know, and, and so as Ardennes, and you know that your pancreas has two jobs, you know what they are?

Arisha 42:13
Isn't that like, like to process?

Scott Benner 42:17
It's make it makes digestive enzymes, and it makes sense one. So sometimes people get type one diabetes, and their digestion changes. So we threw some digestive enzymes in Arden while she was eating right. And now, she's like, Okay, this is it's better. My stomach isn't hurting after I eat. But she still wasn't like, it wasn't coming out the other side, or she, you know, I'm saying, and so like, Okay, so we're like, Well, what the heck. So then we gave her magnesium oxide, which is just a and that made her start going to the bathroom. So now we had the food digesting, we had it coming out the other side. Hold on second. I had COVID A couple of months ago. This part is not going away. Sorry. So now we've got it. We've, I was gonna say flowing. But I think that word is just improper. And this things are working the way you expect. But now how do we get to the part where because my expectation was, and this was just guessing on my part, right? I thought if all this food was sitting in her stomach for so long, her stomach can't be a hospitable place right now. Right? Like, like the bacteria in her stomach can't be balanced correctly. Like, this isn't how your stuffs supposed to work. Because in the past, before the digestive enzymes, and before the magnesium oxide, we would try giving Arden like probiotics and things like that to help like balance our stomach. But the truth is that stuff I don't think had any chance because it was not a good situation in there. So once we got everything moving through, right, then we hit her with the probiotics. Amazing changed her life. Like really seriously. We're still clearing her acne up. But it's so much better than it was. And your stomach doesn't hurt any more like she and I went out to dinner last night. This will probably freak you out. We had chicken and waffles. So fried chicken and waffles at the same time. I well you eat chicken right?

Arisha 44:28
Yeah, chicken. Like just like a fried chicken.

Scott Benner 44:32
One time have chicken and waffles just once. And don't go back because I like the way you eat. I don't want to see I don't want you calling me five years from now being like, Well Scott, I've gained 50 pounds and my blood sugar's all over the place but I do love chicken and waffles. You're right. But anyway, like, like, you know, everything's doing better for her now. And then she comes home from school. You're not going to when you might know like you know how you have a rhythm to your life. And you're while you're in school And then When summer comes, everything gets messed up for a while. Yeah, right. So she came home, she was a college, she had a nice rhythm go and she's taken her of acid haul, which helps her hormonal imbalance. She's, you know, taken her, her, her digestive enzymes and she's eating, she's taking your supplements and I prefer she goes to bed, everything's going great. And then you come home from school and like, Oh, I just want to sleep. And then you get off schedule, and then you're not there. And then you know, the next thing, you know, like five or six days later, I'm like you all right? And she's like, Oh, my stomach hurts. I'm like, are you doing all the things she's supposed to be doing? And she's like now, and then now I've gotten her back to doing it again. And it's just, it's interesting, like, so I think for Artem, I don't think her body makes digestive enzymes properly. And I think that's the basis of her entire problem for years. Now, she still has, you know, there's still times where stuff gets funky on her and stuff like that. And I mean, you guys have autoimmune diseases. So it's tough, right? But this is a big deal. So I want you to tell me, go over it again, you see that you see the integrative? And what does he is he or she I'm sorry? What that integrative Doctor UFO, oh, he, what's the first thing he does work?

Arisha 46:15
Well, he, he wants to like talk about our past, I guess, in our history. And he gives us like these little papers, and he wants us to like, take notes. And so he first like, asked me, and he because if you're like a functional doctor, you believe all problems start from the stomach. Okay. So he starts talking, and then he asked, like any trauma or anything, I haven't, I've never really had any trauma, I guess. But as a four year old, I always got sick. Like, when I was like two and a four, like, I would always get sick. And I would always have to get like, like Tylenol or something to bring my fever down. And according to him, because I had so he wants to figure out how I got type one diabetes in the first place. So according to him all the like antibiotics that I took caused by type one diabetes, because they like, wall like, I don't know, something like that, like killing the bacteria, the good bacteria in my stomach,

Scott Benner 47:23
you think he thinks the lack of bacteria in your stomach? Oh, so now listen, what I know, from doctors that have been on here is that people are born or develop markers for type one diabetes, right? And it seems like it runs and family lines a little bit. You know, and stuff like that. Could you know could getting rid of all the bacteria in your stomach? I mean, lead to something like that. I can't say for sure. But I also don't think it's a crazy thought, You know what I mean? Like you're, there's a balance in your body. If you knock that balance off, other things can get out of balance, too. I mean, we just talked about it with Arden. Like, you know, it's uh, you know, her, her pancreas stops working right. And as we look back, and it is important to look back, I think Arden stomach hurt for a long time. And she was when she was younger and we didn't really know what to do about it, you know? So, okay, so he so I mean, obviously this is also I don't want to be cynical, but it is also it is this man's business model to tell you your stomach is unbalanced and to sell you things Yeah, it gets you going okay, but But it ends up working for you. So who cares, right? Yeah, right. So what do you get? Do you get probiotics are they in pill pill form or that kind of stuff?

Arisha 48:45
He doesn't give us probiotics because he says in order to have probiotics like the purpose of probiotics is to like fake your stomach is to turn like the bad bacteria into like good bacteria but apparently according to him I have no bacteria so he says I cannot have that like probiotics yet. So he gives me what does he give me so he basically gives me like this gut thing like a gut pill.

Unknown Speaker 49:13
Okay

Arisha 49:15
something that's called a dreaded all of these are all pills and they're like they don't have natural stuff so we don't really like question herb I guess

Scott Benner 49:25
whatever you weren't doing well. You're doing better now. And you know how to spell that

Arisha 49:31
a dreadful Yeah. A d R E Ed. And then dash that all

Scott Benner 49:41
I got it sorry. Looks like Arden except the letters are switched around. Okay, so he How long do you take this for? Like six months? No kidding. And then did you start to feel better?

Arisha 50:05
Oh, yeah, like I think we felt like really good for a while, but that like we kind of got used to it but like, I feel like we could have done more things. Because I feel like functional better functional medicine doctors are supposed to like teach you about like healing the gut not just by like taking pills but also by like changing your food. Because the problem like oh is usually starts with food. So he never like taught us I guess anything about like, eating organic and like all the food oils, because like, there was a time when we used to like, like, put canola oil into our food. And that was like, like a really bad time. Because like, canola oil is actually really bad for your gut. And you're supposed to like be having avocado oil.

Scott Benner 50:49
So two things I agree with you I want to go back to that adrenalin law provides targeted amounts of vitamin AC Panfilo, Nick acid and other B vitamins that are critical to adrenal gland function. The powerful formula helps support the body's resilience or resistance to fatigue and aids in maintaining balance. Cortisol doesn't say how it does that. Or how they're saying it does that, but I really agree with you about the oils, but I stopped eating. So the only oil I use now is a cold pressed olive oil. Like I won't even need like hot like do you do you think of it that way too?

Arisha 51:30
Well, we'd use avocado oil ever for like baking good stuff. We use coconut oil like but it's like organics

Scott Benner 51:37
Yeah. I don't know what I don't know where it was. I just saw this. I saw this doctor, this woman on TV One time. And she's like talking about it. She's like, it's the hatefully I was like, What is this lady saying? So I listened for a second and she said, canola, corn cottonseed. Soy sunflower safflower flower, grape seed. Rice. Bran. I think I got all those right. She's like, don't eat those. Like, just don't Yeah, they're really bad for Yeah. And so I'm like, All right, because I grew up thinking. I grew up thinking, I guess it's marketing. Right? I grew up thinking canola oil was the better oil. Right? And like, that was just, I don't know if that's what I thought. I don't know who told me that or why I you know, anyway. But they say like she says she says specifically, she actually has a website is Dr. kake.com. That seed oil weakens your immune system?

Arisha 52:41
Well, I don't think it's like the seeds in general. I just think it's based on how they've been like process.

Scott Benner 52:47
Yeah, right. And that's why I'm like, like, when you heat something up, it changes it. So these, this is not an apples to apples comparison, although it might be and I just might not be smart enough. But that's why, like, people will tell you like Don't, don't microwave plastic. Right? Because it does it because it changes it. And who knows. I mean, I'm sure there's somebody who could explain it. I'm not the right one. But don't microwave plastic. Don't put plastic in the microwave, even when like I make hot tea. Like I make iced tea for myself. And so I boil water and I put the water in with the tea bags and I make tea, but I will only use like a glass container to dump the hot water until because I don't know why but I'm just like, I look at myself and I go something obviously went wrong. You know what I'm saying? Or should you say I'm saying you know, you're like this guy should eat a salad so and so. Like I know something went wrong along the way and I figure if there's just some simple things to cut out like why not you know? Yeah, and so did that though.

Arisha 53:53
Yeah, because like if you like we do buy like some packaged foods, I guess. Like we buy the simple meals like like they have like garlic crackers and stuff. And like, if you look at like their ingredients compared to like Lay's like chips, you're gonna find like potatoes and like canola oil. And like Lay's, like you already know canola oil is bad for you, but then you're probably gonna find something like a sorbic acid or mallows sorbic acid and those two are like really bad for your gut as well. Because like it's it's not just like oils like oils is probably like one of the most important things but then I would go on to like acids and sugars, because that like has really helped like manage my type one diabetes, as well.

Scott Benner 54:35
You don't have much sugar.

Arisha 54:38
Well, if I do have sugar I put I only use coconut sugar.

Scott Benner 54:42
I didn't even know that was a thing.

Arisha 54:46
Yeah, I use coconut a lot like I use coconut oil as like moisturizer for my face to okay, like really helps

Scott Benner 54:54
coconut palm sugar. That's it. Yeah. And you so you bake with it.

Arisha 55:01
Um, usually, like if I make like cookies or

Scott Benner 55:04
something, but like, what kind of cookies do you make? Just

Arisha 55:08
like the regular like chocolate chip, but like it has like, instead of like wheat flour it will have like tapioca or root. Okay. And then I'll put like the sugar. Like most of the things I bake are based on nuts. So, gotcha. Not sure like, oh, so that I'll put like, some nut butter eggs. So like, I'll with butter. But like the thing with Alba butter is that you can't really grow Allods if to like make them organic, because it's like really hard. So they're really hard to find, like organic elements, like much harder to find like or like Alba butter. That's organic, too. So because if you think about it, if you're not eating like organic food, you're technically like eating all those harmful pesticides. Because there's also this pesticide called glyphosate. And it like goes like they spray it on everything the United States like it's banned everywhere else except the United States of Canada.

Scott Benner 56:05
Canada,

Arisha 56:06
that's Sorry. Yeah.

Scott Benner 56:09
Like those Canadians. Okay. Glyphosate is a broad spectrum, systematic herbicide and crop. Not sure that we're just, it is, well, there's a lot of words here, I don't know. It is an Oregon, oh, phosphorus compound, specifically phosphonate, which acts by inhibiting the plant enzyme, blah, blah, blah. It's used to kill weeds, especially annual broadleaf weeds and grasses that compete with crops. Okay. So I was listening to this guy recently talked about, like, he's, he's got a farm somewhere, and the that he doesn't want to spray for the weeds. So well. So he's going to the trouble I think of buying, like putting animals or bugs or something on the property that will eat the weeds instead, so that he doesn't have to spray which stuff like this.

Arisha 57:04
Because it's like really bad for you. Because I think like, I've read this book, and like, I've seen, like, their studies showed that like, people who have cancer, like it comes from this.

Scott Benner 57:15
It's interesting, though, the EPA says there is no risk or concern to human health from place for glyphosate. So, but who cares? Like if it's, like, say, but you're kind of young for this conversation, but like, there's a lot of people in the world, okay, and we got to make food for them. And I know that that's difficult, right? So we've, you know, we found ways to do things. And there's probably a side to this argument really, like, Look, if people make it to 75 years old, and they've lived a reasonably healthy life, but their stomachs hurt a little bit. That's not so bad. Because if we didn't farm like this, nobody would have food, and you'd all be killing each other for a french fry. And so like, you know, like, you know, maybe there's Yeah, right, common sense in there somewhere, but it doesn't make what you're saying. Not true. And so for some people, if they can, understand or afford, are able to make better decisions like this, you know, it's a weird thing to think, right? That, that you're trying to eat in a way that doesn't kill the little bugs in your stomach, which really help keep your body balanced. So how much of that do you think about? Do you? Like I was just having this conversation the other day? I don't know what it is. We talked about around here like when this microphones not on, but I said to Arden and Cole. I was like I heard somebody talking the other day about it was Neil deGrasse Tyson. You know who that is? No, no, he's like a physicist. Hold on a second. You don't know who Neil deGrasse Tyson is? I bet you do. I bet if you Googled him right now looked at this picture. You'd say I do know who that is. Neil and EI l de gras is the E G R A. SSC

Arisha 59:00
Oh, I know that guy told me that guy.

Scott Benner 59:04
So that guy said something. Like if you take a very tiny sliver of your I forget what he said like your intestine or something like that, that they're like more like living things in that little like section. Then I forget how he put it all the people who have ever lived on the earth combined. So your body is basically like your earth for other things. Like there's a whole ecosystem going on inside of you things that are alive inside of you that are not you. Right, like, you know, generally mean like it's a weird thing. Like the the, you know, the the probiotics that you know that you're trying to grow the right bacteria in your stomach. That bacteria, isn't you? It's another thing and yet you can't digest food without them in there. Yeah, it's so funky right? Isn't it weird?

Arisha 59:59
I know But like make sense in a weird way.

Scott Benner 1:00:02
Have you ever looked at like that there's, there's things that live on your skin that are eating your dead skin.

Arisha 1:00:09
No, but I've seen that for your scalp like not your Yeah, like your hair scalp is like they're like really tidy.

Scott Benner 1:00:16
Oh, hold on a second. Don't Google this, it'll freak you out. Okay. Don't Google bugs that live on your skin and then go to the images that Orisha doing now

they're like skin mites. They're all They're everywhere. They're on your face. They're on your fingers. Are you looking at the pictures? Yeah. Are you freaked out now?

Arisha 1:00:47
I mean, at least they help you.

Scott Benner 1:00:48
Yeah, I know. Look at though, do you see the one with the face that looks like it's in a monster movie? Yeah.

Arisha 1:00:56
Actually looks kind of cute, though. See,

Scott Benner 1:00:58
it's, it is helping you. But But there's another example. Like, if those things somehow didn't exist on you, then, you know, like, other stuff would happen. So yeah. So basically, you don't want to be the one spraying Glice of fate, or whatever it is on the little things that are like, it's alright, let's make a big idea. You eating so poorly, that it's killing the bacteria in your gut is it's like walking into a forest and spraying napalm. You're, you're just you're burning the place where it lives. And it and then when you're leftover, you don't have a forest anymore. So you want your stomach to be what your stomach supposed to be. And listen, you eat? You You have obviously. I mean, I'm amazed that how you eat at your age, like I think it's it's amazing. And it's cool. But I don't know that everybody could be like, Yo, I'm gonna have a shake for breakfast and a salad and some butternut squash soup for lunch. That's how I roll. Like, like, that's pretty kind of special that you can do that. I'm jealous of you as well, I'm saying. But still, there are simple things you could do everybody? Yeah, like avoiding those oils, right?

Arisha 1:02:13
Because I know, a family who, like they have two kids, like one had asthma and the other one has type one diabetes, but the like, they switched oil and the kid who had asthma, like doesn't have any more symptoms. And like, according to doctors, he's like, cured from that. Like,

Scott Benner 1:02:33
I really think the oil thing. I mean, you don't have to do much. Any of you can Google, it just isn't me. Right and pay attention listen to people while they're talking and try to like discern for yourself, right? Like, canola oil was developed. Okay. I'm reading sorry. I mean, it's a it's a, it's a man made thing. Right? Like, like, just look a little bit into it. I don't want to be the one to like, pick through it and say, right, but like, you know, there are you we are eating things. I'm not speaking about canola in general, but we are eating things that were developed by scientists to be like machine lubricant. And then, and then they were like, Hey, you could eat this? I don't know. It seems like a bad idea to me. And maybe look maybe, you know, in a million years of evolution, maybe our bodies will learn how to deal with canola oil and things like that. But for the moment right now. And people can say, well, I eat it. There's nothing wrong with me, but I don't know I'm looking at you. You're healthy looking person. Your your skin looks healthy. Your You look like you're the proper weight for your frame. Like didn't you mean like you have good energy, and you're smart. And you're thinking on? I mean, you and I are talking about some heavy things, and you're 13 and you're, you're retaining information and pulling from things you've learned before. And you know, I mean, I know a 13 year old kid, when you say their name, they're like what? It is. So I don't know, like, it's working for you. You must be excited that you figured it out this early in your life too. Because you could have gone yeah, could have gone a long time and not known right. Is it hard to go out with your friends?

Arisha 1:04:34
Well, not really. Because like, I don't know if you know that like in eighth grade, you have to go to Washington DC. Oh, do you? Yeah, so we went to Washington DC. And like, it was like, it was kind of hard to like adjust based off like the food like it's not that I wanted their food. It was just that they didn't really have as many options like at some restaurants they had like really good options. So Like it was, like helpful, but like sub restaurants, they didn't have so many good options. So I would just like eat like a fruit or something because like, I remember I ate this rice thing that they made and it was like gluten free, like dairy free, but like it made my blood sugar go to 320. So I didn't really I didn't really trust Washington, DC dude again. So,

Scott Benner 1:05:21
yeah, Washington. What are you doing? Now? Basically? Well, you went to a place where they drag a bunch of kids. So there's Give me what chicken fingers french fries, pizza, like stuff like that. Right?

Arisha 1:05:31
They give you like a tiny menu. And it has like, a couple things. But like, I'm still like, really grateful for the experience. Yeah,

Scott Benner 1:05:38
no, I understand. But, but it's, I mean, when the world's working the way it's working. It's hard to go out into it without being prepared. Yeah, yeah. I did an episode with Jenny recently about how she eats. And they said like, well, what if you go on like a long car ride? What do you do? And she's like, I packed food debris out with me. And I was like, you don't stop at a convenience store ever and get like a pack of Swedish Fish? And she's like, No. That's how I go on ACARA. But it, so it takes some pre planning, but not a ton of them. But sure it becomes part of your life at some point. All right, and it's not a big deal. Well, it's, it's been interesting. Okay. I don't even know how long we've been talking. Sorry. I was like an hour. Geez, what else? So what else did you want to talk about? Because you got out a lot about how you eat and how you Bolus and stuff like that. So what else?

Arisha 1:06:29
Um, I don't really know. I'm

Scott Benner 1:06:36
like, what would you want people to know about your diabetes? Um, you turned into a 13 year old for the first time while we were talking just now you're looking at me like, I don't know. Your cheeks are getting red. You're like, why are you put me on the spot like this man. It turned into like a regular old boring interview. I'm like, so tell me about yourself. But But what did you um, but seriously, like you said, you want to tell people about how you do things. Do you feel like you've done that?

Arisha 1:07:04
Um, yeah, like pretty much like for Dexcom. Like, for the g7. I'm, like, pretty excited about that. But like, the thing with Dexcom is that I feel like it like, if it doesn't have internet, like it doesn't share. But if you have your own, like, 5g or whatever, like it doesn't work either. Which was like kind of challenging. Some at some

Scott Benner 1:07:26
point. You're having trouble with sharing your stuff.

Arisha 1:07:30
Like it only works when I have Wi Fi but I feel like it should work when I have like a 5g you'd like or

Scott Benner 1:07:35
like yeah, one of those like, hippie don't eat oil phones over there. Is it like a regular phone? Oh, no. It's like a phone like, alright, yeah, no, I thought looks like you through the ground a couple of times. Maybe? It's a bus. Oh,

Arisha 1:07:48
yeah. I had to get a case because I was scared. I was gonna like, like, break

Scott Benner 1:07:53
it. So is the back of your phone broken? or No? Is it just the case?

Arisha 1:07:57
Oh, it's just it's just like the cover like it cracked once on the corner. And they got me scared. So I just got a better case.

Scott Benner 1:08:04
In the first couple of weeks that Arden was a college. She'll kill me for telling you this. I don't even care. She fell out of a bus. How does that happen? Her pant leg got under her her heel. And she just like while she was going down this this is actually it's not funny, because it's not like a it's a it's like a city bus like that the school uses to move kids around with and she just like, fell out of the bus. And her phone went like flying. And the whole back glass. Like broke. It was shattered. But none of the pieces fell out. So she I mean, she was she wasn't gonna know for like eight weeks, the phone was working fine. Also, she's looping. So, you know, at that point, she was using free APs. And now she's using loop Dev. But you know, I'm like, well, that phone can't stop working. You know what I mean? So I had her go home to back to her dorm room. And she just took tape and lit and put tape across the back of the phone to hold all the glass in place. Anyway, Arden fell out of a bus. I'm gonna get her on the podcast to talk about at some point. She's very embarrassed by it. I've teased her about it in front of people once or twice and she looks at me like do not tell people and I'm like, I'm gonna tell people you fell out of a bus. Anyway, she had like a run of very weird, like, like small accidents at school. She ran into a door jamb. Like, like, you know this, you know, like, you think of your dog. Yeah. And then there's the part around it. She just I don't know what happened. Like she expected the door to pull or push. I forget what it was like, whichever she thought her and she just like in her head and like she crushed she just crushed into it. And she she facetimes me she's like, de she's like I just walked into a metal door. Anyway, I know you're 13 and I know it a little sounds like you went to a guy who was trying to sell you some stuff at some point. But I, but I super believe in what you know about your stomach about your gut, like I am all in on this being a very reasonable thing for people to consider into. And it is so super simple to cut out those oils that I mentioned earlier. Use. I mean, I just I just go to Costco. Honestly, I go to go to Costco, and I buy their cold pressed olive oil. And it's good. It doesn't have any weird flavors. It burns clean. Like you know, like even if you put it in a pan you leave the pan on to heart like you don't notice any like weirdness going on you so I use that. We do use butter in the house when we're cooking. And, but that's it. There is a tiny bit of canola oil on the house for popping popcorn. Because you can't pop popcorn in. In the other oil. It tastes funky. With the microwave. Well, you could but we were popping it on the stove. Like making it ourselves. Oh, you don't I mean, she

Arisha 1:11:14
put like stuff on it. And that Oh, like help.

Scott Benner 1:11:17
Well, I'm trying I've tried. Trust me. I tried a number of different oils that are better. I just can't make it work so far coil. The only thing I can make it work with. You

Arisha 1:11:27
could try putting like, like subtypes I put like that a bit audit or like

Scott Benner 1:11:35
you but what do I use for an oil?

Arisha 1:11:38
Well, you're gonna just use like, Just you try like, like a good oil and then put like stuff on it like the cocoa powder

Scott Benner 1:11:46
to cover up the coconut oil based on the popcorn.

Arisha 1:11:48
Yeah, like that. Like could this I feel like it was if it would be coca that it would like give you like coconut flavors?

Scott Benner 1:11:55
Well, I'll tell you, um, I just Googled it. I would have never thought of coconut oil until you said it plays popcorn and oil three quart pot. Okay, so you can popcorn in coconut oil. I'm gonna try it. Yeah, I'm going to try.

Arisha 1:12:10
Yeah, we use that. Or coconut oil for that because it tastes weird it avocado oil.

Scott Benner 1:12:14
Yeah. Okay. All right. Well, thank you. I'm gonna try that. I just I don't know, like, do you so as a regular course now? Do you take probiotics now that you're healed? And everything's Oh, you don't really need them anymore? Right? Yeah. And your digestion works well and everything. Nice. Wow. Do you ever think you ever thank your mom?

Arisha 1:12:36
Yeah, I really grateful for like every word. Because like I have like, like, for the DC trip to when we went by Dexcom wasn't shared correctly. So by nurse she had day like every two hours, she had to come by robe. And she'd set alarms. So like, like, grateful for that to like, like all the people because I know like a lot of people don't have all of that.

Scott Benner 1:13:00
There was art and went on as a senior in high school. They went on a trip to Disney, which sounds like so much fun. Martin hated it. But she talked about on the podcast. She's a little like me. She's like, it's hot. But so. But there was a nurse that the school hired to be there. And she was right across the hall. And they were there for like five days, I think. And she followed our donor CGM and had conversations with us ahead of the trip. And there was one night that Arden got lower overnight. And my phone rang. And it was Arden. And she's like, Hey, the nurses here, it's like three in the morning. And she wants me to drink a juice. But I already took care of this and I don't want to drink a juice. I don't need it. And she's like, Well, you tell her and I'm like, okay, so but the nurse was great. Like she was a lady who didn't know a lot about it. And she she took the time to learn. And she took it seriously and I was really grateful as well. I thought it was very nice of her. So my my last question for you. scale of one to 10 one is super easy. 10 is really difficult. How hard is it to have diabetes for you? Three how much of that do you think is because of your diet?

Arisha 1:14:20
Like non you know, I think the diet like helped it from like a seven to a three in my opinion. Yeah, because the only thing that annoys me is like going low in class or like they are fight pub like has an error and class like all of that.

Scott Benner 1:14:36
But you don't use as much insulin because of the way you eat which probably limits yes and lows a little more right? Yeah, yeah. Okay, so you weren't having a lot of like how did you eat before all this? Were you like were you eating? Subway? Were you signs and every like Subway and french fries and chocolate? Oh, no.

Arisha 1:14:56
I think I've just felt like I think my my family has just been like pretty Be healthy from like, a young age. Like I think we did eat like sub chips at all of that. And like, I know we had like dairy ice cream and all that, but like we had traditional Indian food, so it was more like like, we had like, I don't know, roti is it's kind of like a bread. Like at a circle. I guess

we have a gluten free woods for that. Well add like, maybe like lentils a lot. Yeah.

Scott Benner 1:15:36
I think you've I mean, it sounds like you have it going really well for yourself. I'm broke. I'm happy for you very happy for you may have diabetes for a long time already. What's your Excellency? Do you know?

Arisha 1:15:49
I'm six? Six.

Scott Benner 1:15:50
Very nice. Is that what your goal is? Or does? It's about days? What's your goal?

Arisha 1:15:55
I want it to go to like 5.4 Yeah, like,

Scott Benner 1:15:59
the five why? Why is it not doing that?

Arisha 1:16:02
Um, because if you have an average of 120 So if it's like 120 the entire day, your agency is actually like 6.1. So like, even if you have like, some highs, like if you go to like 160 and you don't drop low, you're a onesies

Scott Benner 1:16:18
gonna be like sick. Yeah, right, it throws off the average a little bit. But like,

Arisha 1:16:22
it's kinda good.

Scott Benner 1:16:24
How's your stability, though? You're not up and down all the time, right?

Arisha 1:16:28
I'm not really like, I think for breakfast, it'll go to like, 160. And then it'll go to like, 120. And then, you know, just like, stay stable. Like if it goes low. The only thing with like lows is that once it goes low, it'll take like time to like, go up. But like, what's it up? What's up? It'll be like, 140 for an hour, which I don't like,

Scott Benner 1:16:52
right. Arden has been eating late at night lately. And she's gotten a couple of lows, like five o'clock in the morning. But this is like the last six hours. So see if you can see that.

Arisha 1:17:04
That's actually like pretty good. Yeah. Is that about like yours? Or? Yeah, pretty much. Okay. Well, that's like that's like that for the night. And then it'll go like to 140 after breakfast.

Scott Benner 1:17:17
Well, yeah, oh, she's trust me. We didn't like oh my god, we went to the chicken and waffle place. So here's what happened. Here's what happened yesterday. We went Christmas shopping. She wanted to get my son like, nice. We think my son's gonna move to take a job. And he's always wanted a little fish tank like so. We went out to buy him a fish tank. But then when we were there, there were puppies. So she has all the puppies that she got all like, Dad, we have to save all the puppies, which is weird, because there's the thing you wouldn't think about art and if you've heard her talk all the time, but she was just like, we have to buy them all and she wasn't kidding. And I was like no. And she got all excited. And our blood sugar started to go up. But it turns out her loop wasn't connected, right. So the loop wasn't working. So then she she started to rise up. And and because it wasn't connected, it wasn't bolusing. So while we're in the puppy store, the puppy store was the pet store. It went from like Shahar butcher went from like one around 100 to like 150. And by the time we got out of there, we didn't realize that it was like 170. And our plan was a fish tank, chicken and waffles. And so then we were making this big Bolus going to chicken and waffles were like, This is not going to work. You know what I mean? So we didn't, her blood sugar went up to like 200. And it took us a couple of hours to fix it. And it was just from the it was from not addressing the drunk the adrenaline rise from seeing the puppies. As crazy as that sounds.

Arisha 1:18:39
Does she have an AMI pod?

Scott Benner 1:18:42
She's wearing on the pod dash and using the loop dev version of loop right now. I think she's gonna go to loop three, when that becomes available. Like that's the next thing. We were using free free APS for a really long time. And that was that was great. Anyway, it's you know, it's an algorithm. It's a do it yourself algorithm. But it's she have Dexcom she's Dexcom G six. Yeah. So her system is very similar to yours. Honestly, the algorithm is running yours is different than the algorithm that's running hers. It's exciting for free to get the Omnipod five for you, like really excited about that when it happened.

Arisha 1:19:23
Um, I think well, I was waiting for it for like, a very, like long time because like, they told me like, three years ago, oh, you're gonna get sued and like, I got it like two months ago. So I mean, I guess I was excited. But the thing was, I was really upset when I got it because it ruined my disbalance a little bit like it was annoying how it wouldn't go below 220

Scott Benner 1:19:47
Oh, okay. Good, because it was a different way like it yeah. Did it take a while for it to get working properly? Yeah, yeah.

Arisha 1:19:55
But like after that one week of like bad blood sugar. It's it works really well and it

Scott Benner 1:19:59
worked well. for you, but it was hard for you to look at that half. It's hard for everybody. It was hard for you because you are accustomed to something better, right? Yeah. So it learns in that first time. It probably and you were a little more aggressive. It sounds like when your mom put in your Basal rates, it sounds like she moved them up a little did she listen to my episode about it? Do you know the setting? She should have if she didn't have a nice, I have a nice three part episode about setting up Omnipod. Five. That's neither here nor there. Okay. You were delightful. I'm super excited. You reached out on your own. This wasn't your mom's idea.

Arisha 1:20:32
It was my idea.

Scott Benner 1:20:33
I really appreciate you doing this. And I'm glad we snuck you in. This was a cancellation today. You know, if we didn't do this today, do you know when we would have done this

Arisha 1:20:42
in August? I know because So basically, I was looking for my appointment for like, I thought I would look at it by going to the link and I was like, Oh my gosh, there's one open like next week. I like clicked on it,

Scott Benner 1:20:57
I was out. Let me tell you the other side of it right, and then I'll let you go. I was out somewhere with my family doing something. And I'm trying to like not do so much before Christmas. But I have to I have to take Arden back to school in January. Now it looks like my son might have to move pretty far away. So there's gonna be a lot going. So I have to like, produce a lot of episodes and get them ready ahead of time. So I can leave for a week. And so I thought, well, it's great because at least I'm not recording for these days, because I took off before Christmas. And then like I get an email. And it's like, a Russia is on and I'm like December 21 I'm like that little like I thought I thought was like that little like she found that day, because I didn't go block it when somebody cancelled. But I was I said to myself, my wife said, Are you gonna make her change? And I'm like, now I'm like, she's like, she's like, 13 I was like, I'm not gonna make her change it. So anyway, I wasn't supposed to record today, but I'm happy that I did. This was really great. Did you have a good time? Yes, yeah. Okay. I'm going to shut off the recording and ask you if there's anything about what happened today that you didn't like or that you're uncomfortable with? And you can feel completely free to tell me okay. All right. Well, thank you very much for doing this. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juice box. You spell that? G v o KEGL. You see ag o n.com. Forward slash juicebox. I also want to thank us men and remind you that you can get started today with the place the US man that I'm talking about is where we get our diabetes supplies you can do right? Insulin pumps, diabetes testing supplies. Dexcom g7 FreeStyle Libre three. Anything you can think of. They probably have it at us med.com forward slash juice box where you can call them I know some you don't you don't want the internet 888-721-1514 And a huge thanks to a Russia. She was absolutely terrific. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#822 The Math Behind Setting Insulin Sensitivity Factor

Scott and Jenny break down the math behind setting your insulin sensitivity factor. I really wanted to call this the GOZINTAs of ISF.

+ Click for EPISODE TRANSCRIPT

00:02:36 Understanding insulin sensitivity factor.
00:10:43 Adjust insulin sensitivity for accuracy.
00:12:15 Managing diabetes requires adjusting for variables.
00:20:42 Adjust insulin needs as life changes.
00:26:01 Importance of insulin sensitivity factor.
00:28:31 Empowering, informative podcast for diabetics.

Scott Benner 0:00
Hello friends, and welcome to episode 822 of the Juicebox Podcast

Hey everybody, today's episode is Jenny and I helping you figure out your insulin sensitivity factor. There's a little bit of math involved. Don't worry, it's not really like super confusing or anything. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you like Jenny and you want to hire her, you can she works at integrated diabetes.com. Are you a US resident who has type one or is the caregiver of someone with type one? Oh, if you are, this is great news, because you can go to T one D exchange.org. Forward slash juice box and fill out the survey. Every completed survey benefits the podcast and type one diabetes research T one D exchange.org Ford slash juice box. At the end of this episode, I'll tell you about more Juicebox Podcast episodes and series that will help you with insulin sensitivity factor. So hang out to the end

this episode of The Juicebox Podcast is sponsored by touched by type one now you can find touch by type one. Now you can find touch by type one at their website touched by type one.org. You can find them on their Instagram page. And on Facebook. Touched by type one has great programs like their annual conference which I speak at sometimes their awareness campaign Bowling for a cause they're dancing program called dancing for diabetes, the D box they have a golf outing touched by type one is helping people living with type one diabetes. And they'd like you to just to check them out touch by type one that work. That's it for the ads today. So I just wanted to tell you that if you're enjoying the Juicebox Podcast are finding it helpful. The best way you can support the show besides clicking on the sponsor links, or typing them into a browser would be to share the show with someone else. A doctor, a friend, a stranger, somebody who you think may enjoy or benefit from the Juicebox Podcast. Hey, Jenny. Hey, Scott. We're going to talk about setting up insulin sensitivity and getting your numbers right where you start and and how you can figure out where to go from there. Fantastic. How do we set up insulin sensitivity?

Jennifer Smith, CDE 2:51
Yeah, and I like that you call it insulin sensitivity factor or what you might see written down as I S F insulin sensitivity factor. It's also called correction factor. So if you've heard any of those words, it's all representative of the same thing. This idea

Scott Benner 3:11
correction factor, insulin sensitivity and insulin sensitivity factors seem to be the three ones that get used most in the zeitgeist they all mean the same exact thing.

Jennifer Smith, CDE 3:21
Yes. And from an abbreviation most often you'll see I SF I igloos s Sam F. Frank, there you go.

Scott Benner 3:30
I think that you weren't being clear with your enunciation.

Jennifer Smith, CDE 3:33
I thought that Yes.

Scott Benner 3:38
I think more likely, you're just trying to cover for my bed.

Jennifer Smith, CDE 3:42
No, not at all. Not at all. i It's funny, because I say that mainly because just as a side note, I hear I get so many like codes for seeing people's data and whatnot. And if we're talking, I always make sure that I've heard them correctly so that I can input it the right way. Otherwise, the program's like, no, that's not right. And then, you know, so anyway,

Scott Benner 4:06
I just thought I had a weird accent. You're like, there's no way people understood what he just said.

Jennifer Smith, CDE 4:10
If anybody has the weird accent, it's me. So I think

Scott Benner 4:13
of it as insulin sensitivity, I have to admit, when Arden was first diagnosed, I thought of it I guess with the old terminology, older terminology, and then going to a pump brought me to insulin sensitivity factor. And then I think going into looping made me say just insulin sensitivity. And it's not it's more about how I think about it than it is about what you're calling it. If that makes sense. So correct. And

Jennifer Smith, CDE 4:38
that's that's kind of why I like I like I like both terms. Sensitivity, I think gives you more visual to response, right? How you're going to respond to insulin to take your blood sugar to the place you want to get it to. But now Don't get too low, right? correction factor I like because it really, it implies why you're taking that insulin, you're correcting the number that you don't want to be sitting at back to the place that you want it. So I think they're both relative, obviously.

Scott Benner 5:18
But there is no, I don't want to get bogged down in this, but there is value in the words you use, and how they make pictures in your mind. And for me, calling it insulin sensitivity. It just makes the most sense to me. So okay, so what is the insulin sensitivity?

Jennifer Smith, CDE 5:38
Yes, so insulin sensitivity is how many milligrams per deciliter or millimoles, your blood sugar will get dropped by one unit of insulin. Okay, so if your ISF is 51 unit of insulin should bring your blood sugar down 50 milligrams per deciliter, right? Or I say 50 points just to make it easy. From where you're starting? And is it instantaneous? No, it's not, that we've talked about is this, it's rapid insulin, but rapids a bad name, it's going to take some time for that to happen. So you're gonna have to give the correction a little bit of time to get working, see its action. And to fully evaluate, does it bring you back close enough to the target that you're aiming for? within a defined period of time, which may be the active time of rapid insulin,

Scott Benner 6:39
right? Is there an when you're figuring this out? What's that length of time that you consider? Like how long because I can remember, I'm just going to keep using this as an example because I used it in other episodes, but are done with the school. And her sensitivities changed at school, and we had to, we had to change them. So that I just went back to basics, I did what we talked about in the basil episode I got, I made sure I got her basil about where I thought it was gonna be, I set up her carb ratio about where I thought it was gonna be. And then I had to get her insulin sensitivity, right. And basically, what I did was I put her she was sitting very stable, like a, I forget where it was, she was sitting very stable, like 180, while we were figuring this out, and I just gave her a unit of insulin. And I said, Let's not do anything. And we'll wait a couple of hours and see where you end up. And then I that's where I started building from that and the math.

Jennifer Smith, CDE 7:37
Right? And from a fairness standpoint, for any of those people who are using algorithm driven pumps to really analyze correction factor on its own, you have to turn the algorithm off. And I did you write it? I know you did. But just from a, from a reference point, because otherwise you don't, you don't want something else helping you along the way. You just want a point of this as the insulin, everything else was left turned on, Basil was working like it should have. This is where it ended up getting me right. And it you know, an asking of time, not only in that example, were you looking at does the rate show that I used work? Did it get her to the point of where I wanted, you could also have kept it you could have kept it going for a little bit longer to see the point of stabilization, like where did it land at the target? How many hours after the correction was that? Yeah, that gives you a little bit more visual of, of your insulin on board time or your active insulin or duration of insulin action, right? Let's say by three and a half hours after that Bolus, she landed nicely where you wanted. And then she was like, Well, I'm just going to sit on the couch and watch a movie. I'm not eating anything. There was, you know, again, you left your algorithm off. If it settled there, lovely. One, your basil is right. But to the Bolus action time was more defined, you could see where it hit and stabilized. That should be about your active insulin type. Yeah.

Scott Benner 9:16
Yeah. And that's not easy to come up with either No, and especially because those are dummy settings in normal pumps. And in and if you're using an algorithm at this point, now, if you're using the loop, okay, you can figure it out that way. I don't know enough about how control IQ works. And Omnipod five is, you know, kind of does its own thing. So that's even hard to know. It's proprietary.

Enough. There you go. But for me, I Arden was looping at that moment, when we did that I shut the loop off. And I just ran it like a regular pump. I was confident in the base that we had set up. And so I think in the end that one unit moved or Like 45 points. And that's and now Arden's insulin sensitivity is set up somewhere between 41 and 45, depending on the time of day. And that gives the algorithm, the wiggle room, the wiggle room, it needs to do what it needs to do. Like, if I made Arden's insulin sensitivity, one to 40. And she was on a regular pump. And it was just like that constantly. That would be too aggressive. Sure, yeah. So she'd get low at night, if I did that. Right. Anyway. Okay, so what's the math on this one?

Jennifer Smith, CDE 10:36
So what's the math on this? This is where there's another rule that comes into play. Many people start by just saying it's the 1800 rule, right? So you're essentially going to take, again, what is your total daily dose, and you're going to divide that into 1800? To get a starting point for your correction or your sensitivity factor? So if we take 30 units of total daily insulin, and we divide that into 1800, what are you going to get?

Scott Benner 11:07
I'm doing it right now. Oh, really? 8,000,400? And? I have a 6060.

Jennifer Smith, CDE 11:18
Correct? Absolutely. That's easy math, right. 30 into? Yes. So you're gonna start with a 60. And let's say you're, you've looked enough at having corrected insulin, or corrected blood sugars, and you're like, but my factor is already at 55. And my corrections don't work, or my corrections at night, work really awesome at 55. But during the daytime, I'm getting low with this 55. So maybe 60 In the daytime is more what you need more what the math tells you. And maybe at night, you just need it to be more aggressive, the lower the correction factor value or sensitivity factor value, the more insulin you're going to get,

Scott Benner 12:01
right? Also, it's super important to say that if your blood sugar's 130, and you wished it was 90, and you've got your sensitivity factor set up, it was you know, one unit moves me 60 And you and your pumps target is at 90, you're 16 you're like, hey, Bolus, it's gonna take a fraction of that amount of insulin to get you to 90 Correct. But if your blood sugar's 250, and you want to be 90, that factor might not work. Because you're a good point, right? Because there's a lot of other variables that we're not thinking about. And they could be anything from undigested food to a bad, a miscalculated meal Bolus that you're still dealing with, you could have ketones, which would come into a point, you might be dehydrated, there are so many things. So so you're getting these settings set up in. I don't want to say perfect, but near perfect conditions. They work in my perfect conditions. But now when I'm out in the world fighting with it, it's almost like learning jujitsu, I imagine probably you're on them on the mat, it probably works because the other guy across from us doing the same thing. But when you get into a street fight, and you're Indiana Jones, and you know, and you start going, I'm going to do jujitsu, and then Indiana Jones pulls out a gun and shoots you. And then you go, Oh, well that he just didn't help as much. So, like So given the fact that I'm now imagining that a lot of these people have never seen Indiana Jones.

Jennifer Smith, CDE 13:24
But when so sad, go watch it. Yeah, exactly.

Scott Benner 13:28
But but the point is, is that you get these things, right. And then you have to take them out in the world and actually use them. And, you know, variables change.

Jennifer Smith, CDE 13:37
I like that. What you brought in there in terms of a variable, because it's one that I talk to people often about when we're looking at settings and adjustments. My questions often go to, well, this correction never seems to be working well. What are you eating at 10 o'clock at night, your corrections overnight don't work? Well, they may not work, because the data isn't clean, for lack of a better right. If you're sitting down and eating a whole pizza at 10 o'clock at night, and then your correction at one o'clock in the morning isn't working very well. I can guarantee that the reason it's not is because there's food in the picture that your correction factor doesn't know is there. Right? So you're you're unfairly judging this sensitivity in a window of time where you're going to be more resistant.

Scott Benner 14:33
And total daily insulin. We're just not we're not saying it for some reason, but total daily insulin you can get out of your pumps settings. Yeah, tell you how much and you can't just don't just look at yesterday. No, yeah. Because look at yesterday, look at the day. I mean, I don't know how far back do you go to come up with a real one for you? I usually like to look

Jennifer Smith, CDE 14:53
at an average of about seven days in general, especially if it's seven days worth of pretty Typical day, you know, somebody's just come back for vacation and their past seven days is all jacked up. Because, you know, it's been vacation, right? It is what it is. That's not valuable, true insulin amount information, I might need to go back further than that to more typical days and get an average there.

Scott Benner 15:21
Do you knock out the outliers? Like if, if you look at seven days and five of the days, you're right around 50 carbs, or and, and you look Oh, yeah, I used 50 carbs, and then ended up being this much insulin. Let's just say it was just keep using 50. It's I use 50 units of insulin on Friday. He's 50 units of insulin. On Thursday on Wednesday, I use 48. On Tuesday, I use 52. But on Monday, I use 12. Like, do you knock that one out? When you're doing the average? That person, right? Yeah, absolutely. And the same thing as if on Saturday, you were at a birthday party, you're like, Oh, my God, I used 90 units of insulin. So okay, so you take your kind of AV, you got to do an average of those days. Correct. All right. So much math. This is why the Pro Tip series.

Jennifer Smith, CDE 16:09
I know that there is a lot of it. But I think this is important to go along with that. Because I know we did the protests a while ago. Jimmy, holy cow, really? Wow.

Scott Benner 16:23
When we started, there was

Jennifer Smith, CDE 16:24
a while ago, and I'd have to go back to them and listen yet again to remember exactly, but I don't know that they're obviously we're doing this because that wasn't a big piece of

Scott Benner 16:34
well, people. People asked for the math, right? Like, I want to know the math of setting up my Basal my insulin to carb ratio, my insulin sensitivity. And I just keep telling people, I would just go listen to the Pro Tip series, because in my mind, it's mindset, like so much about managing diabetes as mindset. And the math is not not important. It's very important. And so here are the episodes. Right? There's the the five, what is it? How many rules are there? There's the rule of see, I already forget, we've been doing hundreds the rule of 500 for the insulin to carb ratio, right? Yes. Okay. And this one's the 1800 rule for the insulin sensitivity. Yes, and the Basal was.

Jennifer Smith, CDE 17:15
And the Basal was not really a rule, it was based on weight to get either a total daily dose of insulin and then break it down or based on weight. And just looking at what your Basal needs would be all of them factoring in, like age, as well as where you are in activity level.

Scott Benner 17:37
And you hear me say all the time that I think managing diabetes is about its timing and amount, it's about using the right amount of insulin at the right time. So yes, you need the math to know where to start. But then you have to look at what's happening to adjust your math to fit the honesty of like, you know, of the fight you're in, not just what you hope the fight was going to be. You have to you have to take account of the variables in your life, your level of activity, the way you eat, even if you're a hydrated person or not, like you know, we say things like be hydrated. Like, that means that everybody here is gonna go like Oh, okay, and then start hydrating, but I'm going to tell you that a week ago, I promised myself I was going to drink more water. And last night, I went to the bathroom at the end of the day. And I was like, did I drink any water today at all? So so it's nice that good. So it's nice to say you're going to do it. But the truth is, you might not be doing it. And if you're not hydrated, your insulin won't work as well as an example of something that could change, change the urine.

Jennifer Smith, CDE 18:39
And in terms of that activity level, I think it becomes really important. You know, we talk about these rules, 500 1800 whatever, but I think just we you had asked in the Bolus one about 500, could we make this more aggressive with another factor? Could we make it less aggressive? We could, I mean, that is the strategy to in terms of figuring out this 1800 rule. Like I myself actually know that I'm, I'm closer to the needs if I use like a 2000 rule, because of the activity level that I'm at because metabolically I know where my sensitivity lies. And so my insulin needs would, I would be very much too aggressive if I use the 1800 rule and it's a middle ground there's like 16 1700 makes your makes your insulin sensitivity factor more aggressive write a lower number, you get more insulin, whereas like 2000 it makes it more conservative.

Scott Benner 19:38
Do you remember the conversation we had about Arden because do ya cuz you were like you You told me to go with a lower number. And because that we started getting mixed in with the food that she was going to be eating it. But then the interesting thing was in the first handful of days at college, she needed a more aggressive insulin sensitivity factor but then once this the As the day started becoming repetitive, and she was getting a lot more activity, I had to back that off, right. So in the first four or five days before she was really moving around the campus, I had her all the way at 40. And then when she started getting more active, I had to move her more like 4344 45, depending on the day. And that's, that's her insulin sensitivity was 4344. Also, I don't want people to get caught in the idea of well, these are my settings, and then my life change. Now my a one C seven, but it doesn't matter, because these are my settings. So I guess diabetes, is this happening to me your life is changing. Your body is changing, something's changing, you have to meet that need. Correct? That's it. Yeah. And just don't sit sedentary and go, Okay, well, things have changed, but I'm not going to do anything about it. Like you have to do something about it. You know,

Jennifer Smith, CDE 20:53
right. It's so mean life is life is ever changing. It is yeah, you will continue to grow, you will continue to get older, we don't unfortunately, get younger. Your insulin needs will shift and change, you have been a really active college student. Now you've moved into taking your first job, and it's a desk job and, you know, you will have to shift and adjust. You really

Scott Benner 21:18
will, yeah, don't don't, please don't just look at your stuff and go Well, this is this is what's happening now like you can, you can affect those things. And, and I think you can also not to beat a dead horse, but the Pro Tip series will put you in a mindset about managing insulin. I mean, this stuff will be great for you. But it'll really, it'll take you to another level. I mean, those that is really a long, the Pro Tip series ends up being what is now over 25 episodes, I think, but it's just a very long conversation between you and I about what it means to take care of your diabetes, you know, right? Like, I know, you

Jennifer Smith, CDE 21:54
imagine if we had done all of that, that would have been a very long discussion.

Scott Benner 21:58
And insane. Well, no, I mean, it never would have worked. Like you need to like you have a conversation. And you know, people don't know how you and I do this, but like these three episodes were all recorded at the same time. And so you'll see a flow through between the three of them. But the prototype series was recorded over a number of weeks in the beginning, and then we added 15 More episodes over the years. And even the way you talk about diabetes is different than the way you used to. It's not like in, it's not in its tone, your tone is different. And you're more mature, you've had more experience talking to people, you have more like anecdotal like conversations you can reach for and things like that the same things happened to me. I mean, you know, you know, we joke about it all the time. But, you know, you think it's, you know, your eight year olds insulin needs and how to handle them or like, you think they're hard while you're doing it. But when your eight year old turns 14, you'll be like, Oh, I wish the kid was eight again, because that was really easy. And but you then you have those experiences. And then when you're having a larger conversation, the things you think to reach to to make your point become more mature as well. And so I think I think it's been terrific. And, and I think this will add to it. But absolutely, there's more,

Jennifer Smith, CDE 23:16
I think I think the other thing in each of our conversations, too, is that you are very good at knowing the episode number most often. I'm like, I know, we talked about that in another episode. But I think it's nice, because we can continue to refer back and say, Hey, if you want more about this, go listen to this, right? It's really in depth.

Scott Benner 23:38
Yeah. And you're going to need it too. I mean, can you do the math and set it up? And just do what you do? And every six months, look at the math again and change it? I mean, if that's what you want to do, I think that's probably viable. And you'll probably end up with I mean, if you did the math or kept the math up to date Pre-Bolus Your meals and took into account different foods. You probably have an A one C in the mid 60s, right? Yeah. And and as your life changes, you got more sedentary or your eating habits got worse, you might see your agency go up if you didn't adjust. Or if you started walking, you might see it go down a little bit. Right, you know, but but the rest of it the like what to do in the moment without having to think about it. Like I think that's where the podcast shines. Like I think that's where you hear these conversations over hours and weeks and months. And something happens and then you just sort of do the right thing. And you almost don't even know why you're doing it. It's just you heard it talked about so many times. It's just what occurred you to do in that situation. Right? Yeah, right. That's excellent. I can't thank you enough. It's actually as the end of the year comes generally I usually Thank you privately but here I mean, listen, the podcast is it's never going to be what it is without you. So Oh really? apprec No, thank

Jennifer Smith, CDE 25:00
you absolutely no, this is this is wonderful and I'm, I'm proud and really glad that I have the opportunity to help you. Thank you

Scott Benner 25:09
means a lot your friendship and your and your participation mean a lot to a lot of people, but it means a lot. So thank you. Thank you. Well, obviously, we're gonna thank Jenny and remind you that she works at integrated diabetes.com. If you'd like to hire Jenny, that's where you will find her. I'd also like to thank touched by type one, for sponsoring this episode of The Juicebox Podcast, please find them on Facebook, Instagram, and it touched by type one dotwork. I hope these three little episodes have been valuable for you. If you're thinking three episodes, what are you talking about? Well, this was part of episode 828 21 and 822 820, the math around Basal insulin 821 The math around insulin to carb ratio. And of course, this episode was the math around your insulin sensitivity factor. I'm gonna tell you a little more in a second. But thanks so much for listening, I really appreciate it. Now that you understand better how to get your settings close to where they need to be, you should probably learn the rest. If you're new to diabetes, check out the bold beginning series. And if you've been around for a while, and you're feeling comfortable, and you understand the basics, head over to the diabetes Pro Tip series. These are available in your audio app at juicebox podcast.com. And there are lists of them in the feature tab of the private Facebook group Juicebox Podcast type one diabetes, all of this information is absolutely free. It's accessible in your audio app online, or wherever you're comfortable listening. Check it out. You can do it, you really can't. There's a diabetes, we have a defining diabetes Episode Episode 408, called insulin sensitivity factor in case you want to learn more. There's an episode 295 Defining diabetes, insulin resistance, which might help you understand why this setting is important. And don't forget, if you're using an algorithm based pump, understanding your insulin sensitivity is incredibly important in in getting those settings correct as well as as well as Basal insulin to carb ratio, everything we've talked about in these three episodes. But if you want to build on what we've talked about, please go find the diabetes Pro Tip series and the other collections of information within the podcast. I'm going to just I'm going to read you something before you go because I understand that I'm I'm saying here's some information go check out other stuff. And I know a lot of people charge money like they they give a little bit of information and they want you to pay for the rest. I'm not doing that. The entire podcast is free. It always has been it always will be. There's there's no hidden costs anywhere. There's no pay walls, it's all on your time you can do it you know as quickly or as slowly as you want. As far as listening goes. I want you to go find these things because I know they work. So I've gone to a website that keeps track of the reviews for my show. A one C 5.6 Just like you promised from 7.2 Scott empowered me to trust my instincts when dosing and to be bold with insulin. I love listening to this podcast it makes me feel not so alone. I'm just gonna click on More here for you saving my soul never in a million years that I think I would be here but I guess who does this podcast and it's private Facebook group saved my soul in a time when I didn't think it was possible. The earthy, stripped down conversational aspects of Scott make you feel empowered. I'm a type two with a type one granddaughter learn so much from the podcast. This podcast has changed our lives. Just started listening, you're going to feel empowered, positive parent easy to understand management information with a side of laughter to reduce burnout. I'm telling you right now I could read these all day. I'm not reading them to you to boast. I'm reading them to you. So you'll go find the other series diabetes variables, mental wellness, diabetes pro tip F there's just they're there. Just go take please. I made them for you. Go listen to them. juicebox podcast.com. On top in the menu, you can see a list of a bunch of the series where like I said in the private Facebook group, which is a font of information and support of its own Juicebox Podcast type one diabetes. I hope you check them out. I hope these podcast episodes have been helpful for you. I'm going to be back very soon with another episode of The Juicebox Podcast. Thank you so much for listening

#821 The Math Behind Setting Insulin to Carb Ratio

Scott and Jenny break down the math behind setting your insulin to carb ratio. I really wanted to call this the GOZINTAs of ICR.

+ Click for EPISODE TRANSCRIPT

00:00:19 Insulin to carb ratio calculation.
00:11:22 Starting point for insulin-to-carb ratio.
00:15:11 Consider insulin sensitivity when calculating insulin dosages.
00:18:22 Defining diabetes and managing it.

Scott Benner 0:00
Hello friends, and welcome to episode 821 of the Juicebox Podcast

welcome back today Jenny and I are gonna be going over the mathematical equation that will help you come up with your insulin to carb ratio. Don't worry, it's not really like super confusing or anything. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you like Jenny and you want to hire her, you can she works at integrated diabetes.com. Are you a US resident who has type one or is the caregiver of someone with type one? Oh, if you are, this is great news, because you can go to T one D exchange.org. Forward slash juice box and fill out the survey. Every completed survey benefits the podcast and type one diabetes research. T one D exchange.org Ford slash juice box. At the end of this episode, I'll tell you about more Juicebox Podcast episodes and series that will help you with insulin to carb ratio. So hang out till the very end

this episode of The Juicebox Podcast is brought to you today by the Contour Next One blood glucose meter. Learn more at contour next one.com forward slash juicebox. This is my favorite meter. It's incredibly accurate, easy to carry. I'll tell you more about in a little bit. But contour next.com forward slash juice box get yourself a great meter. The podcast is also sponsored today, by ag one from athletic greens. Are you looking for a green drink that tastes good? You're looking for ag one. I'm using it every day. You could go to athletic greens.com forward slash juicebox to get a book by the way, why would you use my link? Because when you do you get a free year supply of vitamin D and five free travel packs on top of your order. Athletic greens.com forward slash juice box. Alright Jenny, we're gonna have this little three episode series about setting doing the math, the math, I want to say maths like funny, but I can't get that out right the math of of diabetes. So we've, we've recorded about setting up your Basal insulin, this episode is going to be setting up your insulin to carb ratio. So the total grams of carbs versus the total insulin you need. Basic is basic idea. If your insulin to carb ratio is one to 10, then you use one unit of insulin to cover 10 carbohydrates. Right? Okay, so how does someone who's insulin to carb ratio is one to 10? How do they know that? Who told them? And what if they want to change it?

Jennifer Smith, CDE 3:14
I think the first question is, usually it starts with some type of educator or physician endocrinologist that says you know we're going to use we're going to use the strategy of allowing you to choose the food that you eat and count up carbohydrates. That's, you know, we're very our job centered in diabetes education. And so we're going to use a ratio of every time you eat 15 grams, you need to take one unit of insulin, I think 15 is the most commonly used, there's insulin to carb ratio.

Scott Benner 3:53
Oh, no kidding. Okay,

Jennifer Smith, CDE 3:54
at least on an initial like, we're going to set you up your one to 15. I mean, when I was first set up, I know that I didn't need one to 50. But that's what I was set up with is a wonder 15. Which leads to why we are talking about this because you need to have an idea of how to adjust that. Right. Which brings in a rule. It's called the 500 rule. Do you know the 500 rule? Scott?

Scott Benner 4:22
I don't think I mean, do I know it off the top of my head? No?

Jennifer Smith, CDE 4:28
No. Okay. Well, the 500 rule essentially. I don't know I'm not gonna say I know who decided on the 500 rule. But essentially, it's assuming the on average consumption of the average person of their carbs, and what their liver is sort of like outputting naturally. And so we use this rule of 500 and you take your total daily insulin dose So total daily is both basil and Bolus together. So let's say you use 30 units of insulin a day total. Okay? You're going to divide 30 into 500. And that's going to give you an average insulin to carb ratio of about 16.

Scott Benner 5:25
Okay, okay. Yes, I did it wrong, but okay.

Jennifer Smith, CDE 5:32
500 divided by 30. I don't know. Okay, so it's actually 16.6. But you know, we don't do like half. So it wasn't

Scott Benner 5:43
15,000 Because I was like, I know I'm doing this

Jennifer Smith, CDE 5:47
for it's not 15,000 No, I promise I stopped paying attention

Scott Benner 5:50
to the school around seventh grade is what I just figured out.

Jennifer Smith, CDE 5:55
Okay, are math paying attention to?

Scott Benner 5:58
So it takes the 500 I have a 3030 units, my total daily insulin? Yeah. And I take the 500 I do this math, I come up with 16.6. So this is my starting insulin to carb ratio, why would be a

Jennifer Smith, CDE 6:11
general starting place, especially if you are trying to figure out where to make some adjustments? Let's say that you are, let's say, and I will say that the 500 rule is, as I said earlier, it's more to the conservative, right? I mean, I know that my insulin to carb ratios, I on average, somewhere between about 25 to 28 units a day, total insulin, that's my total my insulin to carb ratios are more aggressive.

Scott Benner 6:54
Listen, if you're using insulin, or you have diabetes, you need a blood glucose meter. And you would like that meter to be accurate and easy to use. Am I right? Of course I am. I mean, this is not any greater stretch of the imagination. Well, guess what? I know the meter for you. It's called the Contour Next One blood glucose meter. My daughter has been using it for many years now. It is incredibly accurate. And it has Second Chance test strips. These are pretty much the big parts of why I'm telling you about it today. Accuracy is key of course and not wasting test trips is nice because they're expensive right? Now why else may you want this little dream of a meter? Well, it's easy to carry easy to use, easy to read has a bright light for nighttime viewing. And I mean it's it's pretty Jimmy's nice. You know what I mean? Contour next.com forward slash juicebox. Head over there for more information about a blood glucose meter than you'll ever need. Actually, there are also links there in case you want to buy the meter now online, you can there's like six different places you can buy the meter from right now online at my link, you will see all of them contour next one.com forward slash juice box. Easy to use, easy to carry. Second Chance test strips may be cheaper in cash than the meter you have now is through your insurance. You should check it out. Contour next one.com forward slash juice box. Are you looking for a green drink that doesn't taste like a green drink? If you are, you're looking for a G one from athletic greens. I started taking ag one because I was never quite sure of the quality of my diet and wanted to make sure that I was getting the essential vitamins that I may be missing. And now I take it every day and you could too. I find that AG one eases my digestion and leaves me feeling energetic. Ag one is great for any lifestyle keto paleo vegan dairy free, you name it gluten free, and it only has one actually less than one gram of sugar per serving. There's no GMOs, no nasty chemicals or artificial anything. You should check it out. Athletic greens.com forward slash juice box actually athletic greens is trying to make this a good experience for you. They're gonna give you a free one year supply of immune supporting vitamin D and five free travel packs with your first purchase. All you have to do is visit my link athletic greens.com forward slash juice box. Did you know that Athletic Greens was created when the founder experienced a ton of gut health issues and ended up on a complicated and expensive supplement routine. That's right. And now here we have it. Ag 110 A powder you just scoop in the water shake up drink. You're done. I think I must spend my first 30 to 60 seconds every morning with ag one but that's it. It's not a big commitment of time but it is paying me back athletic greens.com forward slash juice box. There are links to AG one and the Contour Next One blog glucose meter, as well as all the sponsors in the show notes of the podcast player you're listening in now, and at juicebox podcast.com, where you can just type in the links, athletic greens.com, forward slash juice box, contour next one.com forward slash juice box, when you use my links, you're supporting the production of the show. And I very much appreciate it. Let me get back now to Jenny, and the math.

Jennifer Smith, CDE 10:24
My insulin to carb ratios are more aggressive than what that 500 Rule factors out to be okay. But it is a very good starting place until you are able to evaluate your trends and assess where you need to shift that a little bit. So again, if it's from a starting place, if you have absolutely no idea what you're doing, and you're just all you know, is that, gosh, I use about 50 units today. Fantastic. Then, let's and you're really wanting to get into better coverage of your mealtimes and everything. And right now you're just sort of willy nilly taking some doses. Right, I'll give you a very fair starting place.

Scott Benner 11:11
Okay, is this statement that I have found at the NIH, the 500 rule 500 divided by total daily insulin is often used to find a starting point for the insulin to carb ratio. That is how many grams of carbs one unit of insulin cover. So that's a that's a perfect statement for what we're talking about. Okay. Absolutely. Perfect statement. Yes. Okay. So. Okay, so we've been diagnosed, and somebody's you've heard the episode about setting your Basal insulin, you've got your Basal insulin set pretty well. And you're seeing nothing like what you want, you have stability, let's say your Basal insulins good so you have stability away from food and away from carbs. So like when you're sleeping overnight, or you know, when it's been three hours since a meal and you're just sitting around your blood sugar is sitting stable where you want it to be, and now, but you're seeing like wonkiness at your mealtimes first thing to think about is m. I mean, I know this doesn't belong here based on the title, but I still think you have to say, am I Pre-Bolus? thing? My meals? Correct? Yeah, right. Absolutely. Yeah. So this, yeah, this is math, four. This is how much insulin I need for this many carbs. If we're setting up a fair fight between the insulin and the carbs, not if I eat and then shoot the insulin and later or eat at the same time that I'm shooting or something like that.

Jennifer Smith, CDE 12:31
Correct? Do you have to have the the second piece for analysis to evaluate from a starting place? I'm going to try this ratio. But you have to give the insulin a fair fight.

Scott Benner 12:42
Right, right. So again, protip series, you're probably should listen to that about how to actually use insulin. I think there's a Pre-Bolus episode. But I would listen, in the end, this is all great. I would just tell you to listen to the prototype series if you want to understand how insulin works. But to get this actual rule, this piece of math, this is it right here. One more time, Jenny, let's just make up a different number. I look at my I look at my pump. I've had diabetes forever. And I look at my pump and I say I use I'm just gonna make crazy numbers. I use 48 units of insulin every day on an average between I don't know 50 and 46. I'm calling it 48. Okay, I take 500 and divide it by 48. Yes. Am I insulin to carb ratio is one per about 10.4. Correct? Yes, you have no idea how proud I am of myself.

Jennifer Smith, CDE 13:37
Your math teacher would be very, very proud. No,

Scott Benner 13:39
every math teacher I ever had, I think thought I had bumped my head right before I walked into the door. So I was like, Hi, I'm here to not learn math today. Very bad at it. But okay, that's it. All right. Super simple, right?

Jennifer Smith, CDE 13:54
For the final rule, the 500 rule that's for insulin for your food.

Scott Benner 14:00
Yes. Right. But how about the moment when Arden moves into college, and I'm calling you from a target while we're shopping for things? And you say don't use 500? What did you tell me to do? You gave me a different number, I think,

Jennifer Smith, CDE 14:13
right? You can, you can make that a little bit more conservative, or you can make it a little bit more aggressive by just notching it up or down. Right. And that, I mean, it brings in to the next next part of bolusing, our corrective insulin right, where you can make the factor to figure out a little bit more aggressive, a little bit more conservative. So you know, you could certainly say, the 400 rule instead of the 500 rule, but in general, that 500 rule is really going to give you a starting place, a good starting place. And I think it's easier to remember than cash. It could go up a little bit, go down a little bit where you're going to do that Anyway, in your tweaking, right. Now, in terms of a good place to start, you may also consider that sensitivity for every person in a general statement is often that heavier weight, less activity, you are going to require more insulin than somebody who is a lower weight and more active or potentially, maybe they're the same weight as you, but their weight is based on more muscle based mass. And they are much more active than you. That person even though they're the same weight, as you may have heightened sensitivity to insulin, right, their insulin needs may be very much reduced compared to where you are.

Scott Benner 15:51
Even though we don't talk about it very much. Although there are episodes about digestion, that person might also be more likely to be eating cleaner food that's going through their system not impacting their blood sugar is longer during the digestion process, a lot of things to think of So, okay, so are we good here on this? We'll move on to making an episode about insulin sensitivity. Yes, yeah. And will we be talking about something that has 1500 in it when we get there? No, no. Do something. Oh, that's okay. I'll see you in the next episode. Okay, bye. All right. A huge thanks to AG one from athletic greens, head over there right now, athletic greens.com forward slash juice box, get your first order five free travel bags and a year's worth of vitamin D, athletic greens.com forward slash juice box. I also want to thank the Contour Next One blood glucose meter and remind you to go to contour next one.com forward slash juice box, find out about the little meter that could like you know the little engine that could just a great meter, I just I count on it. And it comes through contour next one.com forward slash juice box. And of course Jenny who works at integrated diabetes.com You can find her there. Alright, I'm gonna thank you right now for listening, and then give you some more episodes to listen to about insulin to carb ratio. So this is interesting because I think the defining diabetes episode about carb absorption digestion would be helpful here episode 668. I think that the episode called the perfect Bolus in the Pro Tip series would help me to find out what that one is for you. Sorry, you might think I would have done this before. But episode 226. Again, the entire Pro Tip series would be incredibly valuable. If you're new to diabetes, check out the bold beginning series. Some of these terms are lost on you. You're looking for the defining diabetes series, all the terms are listed out there. There's part of me that also thinks you should find the pro tip about fat and protein. And a lot of the other episodes we have to about how to Bolus for fat and protein. And if you're thinking to yourself, why would I Bolus for fat and protein? Scott, they don't have carbs in them. Oh, well, then you're really going to love them. Episode 263 diabetes, pro tip fat and protein. Episode 471 bolusing insulin for fat. What else do we have here? If you need that explained to you episode 360 is a defining diabetes episode. That's called defining diabetes, fat and protein rise. There's a lot here that would help you. In general, your carb ratio is the beginning, right? But it doesn't. It doesn't cover everything because of the glycemic load and glycemic index of foods, which reminds me that you're looking for episode 391 diabetes pro tip glycemic index and load. Again, if you don't know why you're looking for that there's a defining diabetes episode about it. Listen. If you're new beginning series, it's available in your in your app. It's available at juicebox podcast.com. You can find a list of the episodes that are in the series at juicebox podcast.com, or in the private Facebook group in the feature tab. Really, if you're new, please start with that one. Then move on if you'd like to the defining diabetes episodes, all these terms and many more are defined in short episodes. And then there's the diabetes pro tip episodes which really digs into how to take care of yourself. So get the beginning series, get your feet wet. Learn about the different terms and what they mean. And then go listen to that Pro Tip series. Get the a one C that you want, and deserve. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.