Scott Benner 9/24/23 Scott Benner 9/24/23

#1021 Diabetes Pro Tip: Postpartum

Scott is joined by Jennifer Smith, a registered dietitian and certified diabetes educator, who shares her insights on Postpartum and type 1 diabetes.

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

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

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only the remaster diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one, see all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. At the end of this episode, which by the way, if you're a person who's like, Oh, I'm never gonna have a baby or I'm a boy, or whatever it is, you're thinking right now postpartum doesn't apply to me. These diabetes pro tip episodes are, I think terrific. And I think they all go together. There's a lot to learn from listening to this episode, because at its essence, it's dealing with huge variables, which is what you'll find after you've had a baby. So it doesn't apply. But it does. You'll see, at the end of this episode, I'll tell you where you can find Jenny, I'll tell you where the rest of the pro tip episodes are and what the topics are. And anyway, I think you should listen to this one, whether you're going to have a baby or not. Alright, well, that took three minutes, which is probably two minutes longer than it took mostly to get pregnant. So here's Jenny, but a bump. As time passes, I'm becoming more and more aware of a lot of pregnant women or women who want to get pregnant who have type one diabetes who are listening to the show, and who are enjoying like there's a series back in the show with Samantha where I interviewed her every three months, like during her pregnancy. Yeah, I remember you mentioned her and that apparently, is making the rounds on the on the internet and the way people listen to things. And I just get a number of emails and I'm sure you do as well that are either that start off with like, I can't, I'm never going to be able to get pregnant because I can't get myself together. And then they go I can't believe I did it or I'm doing it you know, like that kind of a thing. But then there's that. The rest of it that I guess we stopped thinking about because the baby's out. And I don't know that's that's weird. So a person in my mind, being a person who's never been pregnant and doesn't have type one. That journey seems painfully taxing to me from going from not thinking you'll be ever, ever be able to have a baby to figuring it out to then doing it having these insanely great a onesies while you're pregnant. And I don't know it just feels like it would be super simple to just not abandon it but lose sight of it after you have the baby because of all the things that happen after that.

Jennifer Smith, CDE 4:46
And I don't think it's that. I don't think it's that the good majority of women really think that they're just going to just give it all like all the work that I've put in over the past, you know nine to maybe 12 Once if they really did a lot of really good preconception management to kind of get there, and managed, it could have been a long haul of, you know, nine to 18 months, let's call it of trying to really strategically nail things down. But I don't think that if you've done that, or even if you've come into pregnancy, maybe not where you wanted, but you really did an awesome job of mastering things and getting things taken care of through the pregnancy. By the end of pregnancy, most women aren't like, Oh, I'm just gonna, like throw it all in the basket, everything I learned how to do. But there is a big piece postpartum that, especially as a first time Mother, is completely 100%. New. Yeah, it's I mean, it is it's like being thrown into like, a new job. In a country where you don't speak the language, they're like, here you go, it's all yours to like, figure it out.

Scott Benner 5:54
And by the way, that job will die. If you drop it or leave it,

Jennifer Smith, CDE 5:58
you're gonna kill a million people, if you don't do it exactly the right way.

Scott Benner 6:01
That's how it feels, isn't it?

Jennifer Smith, CDE 6:03
That's kind of what it is postpartum. I think a lot of the a lot of the up, down comes in, because you're trying to manage something 100% new, or the hormones that shift and change after you deliver can be a roller coaster of effect. And for me, I usually say in a general sense, the first three months post delivery, is going to be kind of a rollercoaster up and down. Mainly because especially if you're nursing or pumping to feed your child, the shift in hormones, and the shift in how much your nursing how much you're pumping, can drive things, the opposite way that you would think that they might, which makes it very difficult to establish, I would have usually like over Bolus for this, or I would have usually been really aggressive to nail down this now climbing blood sugar, but oh, I'm going to nurse in the next 15 minutes. So I really can't do this strategy, because otherwise I'm going to tank. So there's a lot that changes postpartum.

Scott Benner 7:23
Okay, so not only. So there are some people who enter a pregnancy and already have that a onesie that they need. But But despite that, whether you're a person who had to get there, or you were there already, once you're pregnant, your insulin needs, they drastically changed. I know it's not like trimester to trimester Exactly. Right. But there are times when you don't need as much as you think and times and you need so much more that it's hard to imagine how much more you need. Right? Right. So now you have that in your head, you've been pregnant, you're having breakfast that prior to pregnancy, took three units during pregnancy took 12 units, and now you've you're holding the baby, you're thinking is this 12 units? Is it three units? Why does the weight of the world feel like it's on my shoulders? Like, you know, am I nursing? All this stuff comes together? And how do you do that? So you started by saying the hormones, and I only want to spend a second on this, but you know, I'm older. And growing up, it doesn't happen much anymore, like society has really shifted, you know, in the way people are towards each other. And that might be harder for like somebody in their mid 20s to believe but when 30 years ago, you know, stuff that you think of as a joke now is actually how people would think about women sometimes like, oh, you know, she gets upset, or you know what time of the month it is, or that kind of thing, not giving any, like, credence to the idea that when your hormones are jumping around is really difficult to deal with. And you're right, and that women are in a particularly vulnerable situation because of that. So how you feel from a hormonal shift could be physically, it also could mean your your clarity. And I think what you said is just really important to remember, especially for first time mothers, when you have a baby and they give it to you, it does genuinely feel like someone just told you that the fate of the world rests in your hands, and you don't understand what to do. But if you mess it up for certain the universe won't exist anymore. It really feels like that.

Jennifer Smith, CDE 9:33
And some people have really awesome babies that are like the easiest. They just they sleep when you'd expect that they nursed beautifully. They sleep again, like they don't have any like major poop problems. You know, you just have this like, what you would call like, I have no trouble with my perfect baby. And then there are women who just don't like some kids are just one that type of an infant as a newborn, and I think when you have diabetes to then it brings in management again of something that's completely new. I don't know, should I do this? Should I try this is the doctor right? You know, am I going to do this wrong to my child, bla bla bla. And then there's diabetes in the picture, and the timing of insulin, and the timing of adjusting and remembering to change your pump site or to actually take your Basal insulin injection. I mean, there's a world of scheduling difference that comes into the picture postpartum.

Scott Benner 10:35
And I would imagine to and this is just me imagining but if you live for nine months with an A one C, and like, the low fives, there's got to be a part of you as a type one is just like, wow, I want this for the rest of my life to write. And now you feel like if it's going away, now, it's another failure on top of, I don't understand why this baby throws up all the time. Or, you know, like, I I'm sure people are like, oh, yeah, like I've everyone's heard the joke about like, the baby peed on me one time. Yeah, that's fine. My son couldn't hold down food for months, until we figured out what to give him. And, and the combination of it was, quite honestly, Kelly holding him at her grandfather's funeral. When basically it felt like somebody took a half a gallon of spoiled milk and dumped it on Kelly, because it just came out of him like that at a funeral. And she had only been a mom for a little time. And it's hard. And so it's fun to talk about like, oh, the baby peed on me. Right throws up all the time. But sometimes it throws up at a funeral and your hormonal and your grandfather's bed.

Jennifer Smith, CDE 11:41
Your CGM is going off because your blood sugar is skyrocketing. Because you're stressed out about said incident.

Scott Benner 11:47
Yep. And so I was gonna say my wife didn't have type one diabetes. So then all that other stuff that goes on top of it. So what do you so is it similar? Like, could you sit down and make a flowchart? Is it similar for people at at least at some core level? Or is it going to be different for every woman?

Jennifer Smith, CDE 12:06
There are similarities as you know, we talk about in our in my pregnancy book that I co wrote, it's, there's enough similarity, just like in pregnancy, I mean, everybody's going to have some shifts and changes that are a little bit different, very specific to just like diabetes is very specific person to person, but postpartum Yes, I mean, the transition typically, as soon as you have delivered and the placenta has been delivered, as well. It's, it's like the placenta, which is the major like functional hormonal unit. Once that's gone, and baby is out, the hormone shift. It's like a drop off a cliff. It's like, it's gone fast, which is the reason that we usually say, based on where you were, at this point in pregnancy, just before delivery in terms of insulin use, if you didn't know where you were pre pregnancy, so you could see how much things shifted up by the end of pregnancy, than we usually recommend adjusting Basal rates down by about 50%. Wow, okay, that's the that's expected, it could be a little less, it could be a little bit more person to person, again, may differ. But that's a baseline adjustment. So if you've never been told what to do, and nobody's directing very well expect that postpartum you should cut your bezels by 50%. Another really good idea is to most women know when their due date is. If you're using an insulin pump, especially set up a profile that's called postpartum, because as soon as you deliver, all you have to enable do is enable that.

Speaker 1 13:40
Wow, that's that was gonna be my question. Like you're saying, like, placenta comes out, you take a deep breath and go, I need my pump right now. And that's it. 50% Less 50% Less. Yeah, so that placenta is

Scott Benner 13:54
please forgive me if this is ham fisted, but it's the it's the equivalent of a giant sausage cheese pizza sitting in your stomach that somebody just reaches in and takes out all the sudden and now you don't have that impact anymore. Correct. Wow. Okay. Yeah, I don't know if anybody's ever seen a placenta but it is very close to a cheese pizza. When you look at it.

Jennifer Smith, CDE 14:13
They're very interesting. organs. I mean, they're and the cool thing is that your body creates it for one purpose. And then it's gone. It's not like your heart which is like you know, it's always there for your whole entire life. It's like your body makes this thing just like it makes the baby and then it's all done it's only got this like nine month life

Speaker 1 14:37
I was just thinking this i It's funny you said that because I was just thinking the same thing like why can't we just tell our body to make another heart? Yeah, like I mean if it can do that, it could at least you know, vacuum or something, you know,

Jennifer Smith, CDE 14:48
at least also make another pancreas man if

Scott Benner 14:52
I mean, why not? I'm not a doctor, but somebody should get on that.

Jennifer Smith, CDE 14:57
I entirely agree.

Scott Benner 15:01
Imagine if you just had a panel on your back and you flip the switch and that nine months later your body just spit out an organ. Had a little slot on your side. I don't know why this is impossible, probably because of science but never. Okay, so baby comes out. We're all like, who went and on taking those weird bloody pictures that people take in the beginning and everything and then I changed my Basal rate. What am I going to see next my budget does the body begin making milk at birth or does it even start prior to that? That remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well on your hand, and features Second Chance sampling, which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juicebox free meter go get yourself a free starter kit. while supplies last US residents only touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org. Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean, it's a lot type one, it's school, the D box program golfing for diabetes dancing for diabetes, which is a terrific program, you just click on that to check that out. Both for cause their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org or find them on Facebook and Instagram. links in the show notes links at juicebox podcast.com. To touch by type one and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk.

Jennifer Smith, CDE 18:50
The way that it should happen again, everybody's a little different in what happens. But what should happen is a first milk is created it's called colostrum. And essentially that's very short lived in production before milk comes in. It could be a short lived, you know, few days, it could be 24 hours before your milk comes in. But that milk is a very like it's very simple form of nutrition for the baby. It's kind of what the baby is in need of right here and now. And there's not much of it. So it's not like if you were to pump it you're gonna get like six ounces of it. That's just not what you would get right. So, but in that simple form and with the loss of the pregnancy hormones. Now you have this sensitized system that was resistant, leading up to this point. And so there and also why some mental shift the shift of you know, nearing the end of pregnancy coming you know, pre Bolus is in 15 minutes, it's sometimes 45 minutes by the end of pregnancy, in order to have good flat after meal blood sugar as well. Now you have to completely flip that switch, and it's back to maybe I need 10 minutes, maybe I need no Pre-Bolus in the early couple of weeks post delivery. So not only is it that your Basal shifts, but it's also that your ratios shift your insulin to carb, your correction factor your Pre-Bolus time. So there's, there's a major transition,

Scott Benner 20:32
right? You just become a completely different person with type one diabetes, just like that. And, and so is it similar to, but more drastic to have getting your period like being that, like, there's that, you know what I mean, I don't know if it works for everybody. But Arden's three sometime now that she's on birth control, she's more like two different people during the month. But and, and it can be it's drastic for us, you know, she can go from a unit an hour to two units an hour, basil, depending on what time of the month it is, and that he doesn't flip like a switch. It's not like, but I can see it happen, happens over hours and maybe a day, but it doesn't happen. It's not like at three o'clock. She's like, I just got my period and everything changes immediately. What is it that just blown up? Much more? Because I mean, what are you really talking about? So for people who don't know, like, I go into pregnancy, I just said, I go into print, let's just say I'm pregnant. Alright, I'm pregnant. I

Jennifer Smith, CDE 21:35
have type one diabetes, you're a lady with long curly hair. I'm

Scott Benner 21:38
a lady. I have type one diabetes, I get pregnant, my Basal rate is 1.5 an hour in the first trimester, is it? How much does it go up? A lot in the

Jennifer Smith, CDE 21:50
early weeks. Typically, we a good round estimate is if you know the percent of increase you've had in the days before your cycle starts. If you've taken enough notice, and you have a rise and you offset it by a percent of Temp Basal or an extra Basal dose or whatnot, you can expect those early weeks of pregnancy, typically up to about 678 weeks that you're going to have an increase in insulin need. That's pretty similar. It might be more dramatic than that it may be less, but you're going to have a ramp as your body is increasing. Its production of now pregnancy hormones to sustain the pregnancy in furthering along.

Scott Benner 22:32
Okay, so I should have said my my Bolus was ones that we could keep track, right? It say I'm one usually when I get my period, I'm too. So then we're gonna say in the first six to eight weeks of pregnancy, I'm probably going to be more like two more like I have my period, correct exam there. Right. And then from there it goes, it goes up again.

Jennifer Smith, CDE 22:52
So end of first trimester, most women notice either a plateau, okay? Or they notice a bit of a dip off in their insulin needs. For just that end of the first trimester, usually, we say on average, it's about it starts at about eight weeks, goes through about 12, maybe even 1414 weeks, which is that fertile, very early second trimester start time period of sensitivity, you may have needed to back off of your Pre-Bolus time again a little bit, you may have gone down slightly in your baseline basil needs just more sensitivity around meal boluses. And kind of almost feeling like things have sort of stabilized like you have a little bit more wiggle room like I can eat three chips in between and not actually Bolus for it because it doesn't seem to do anything to me, or right. And then second trimester again, a little bit of a nudge up potentially an early second trimester. But a little bit more stability up until about 18 weeks 18 to 20 weeks. We kind of refer to it as the the slow roller coaster climb. So if you imagine you're at the bottom of the roller coaster to begin with, and now around 18 to 20 weeks, you start that slow like click click click up the roller coaster Hill. And that kind of progresses you increase in resistance along the way all the way up until about 3536

Scott Benner 24:20
ish weeks the steady climb.

Jennifer Smith, CDE 24:23
It's a steady climb. And initially in the second trimester, it's on average expect to make some tweaks to things about every two weeks give or take in basil as well as insulin to carb ratio as well as the Pre-Bolus time continues to lengthen. Your correction factor may need to get more aggressive. But usually by the beginning of the third trimester, that's the most resistant time okay, and often through like 34 to 36 weeks

Scott Benner 24:52
as you're talking I'm literally I have a piece of paper in front of me and I'm just kind of moving a pen. As you're talking I tried to make a graph of what to understand Especially now it's gonna grow up every two weeks. So I know this isn't mathematical. And I'm not telling anybody that if you started with one unit the day before you got pregnant, but where can somebody end up who started at one unit an hour, where could they end up at 35 weeks.

Jennifer Smith, CDE 25:14
So insulin needs, on average, double or triple from pre pregnancy to the end of pregnancy, or what we would consider just pre delivery time, which is about by 36 weeks, by 36 weeks, we reach again, this sort of like plateau place, where again, some sensitivity can start to come back, some women's Basal needs start to dip off just slightly shouldn't be aggressive or heavy. In fact, it's a time period that if you are having aggressive changes in your insulin in terms of like drops in need, it's a time to check in with your provider. Some of it can be relevant to placental failure. And so it's a time again, if things change drastically that you would check in. But otherwise, it's expected a little bit of a nudge down a little bit of increase in sensitivity kind of creep back in before you actually deliver. But on average, you know, how much to adjust. Like I said, most women either double or triple their needs from pre to about that 36 week point. And so

Scott Benner 26:19
I now you have the baby. And you could be going from this mindset on three units an hour. Back to why Yeah, back to one all the sudden, exactly. And on top of that, all the sensitivity around meals has changed. And and you're telling me nursing is going to drop the blood sugar

Jennifer Smith, CDE 26:38
nursing for most women who have good milk supply, and are able to, you know, pump or nurse completely without you know, most women experience especially in the early weeks, usually about the first eight to 12 ish weeks posted delivery, notice some shifts down in glucose. After nursing, during or after, if your child nurses for a lengthy period of time, you could notice it during the nursing session itself. Some women notice it only at certain times of day, versus the whole day, you know, having to consistently pay attention every nursing session, they're eating, you know, like to glucose tablets, or having half a juice box or something like that. I mean, our recommendations are once you once you're a few weeks out from delivery, kind of baby by that point has some typical sleep wake poop kind of patterns, you're probably still nursing about every three ish hours, maybe a little lengthier overnight, as long as your baby's nursing Well, during the day, are feeding well during the day. But you know, most often if you're going to nurse in the aftermath of a meal, a good recommendation is to take the Bolus dose down or count carbs, but underdose by you know 25%.

Scott Benner 28:01
So it's dramatic enough that if I eat, I keep saying I if the lady eats before nursing, that meal won't need as much insulin because you're gonna need some of that meal. So that means if you're not planning on eating, and you're going to nurse, you need to eat something going into the nursing,

Jennifer Smith, CDE 28:17
typically going into nursing or during the nursing session to prevent a low. Yes, and it could be anywhere, it could be simple, it could be five grams of carb, it could be as much as 15 grams of carbs. It just depends. And that's where, you know, looking at things like insulin on board, yeah, you might not be bolusing in nursing directly after but if it's still like within two or three hours after you bolused You still have some active insulin from that Bolus,

Scott Benner 28:44
and we tell people I at least I say and I know I feel like you agree with having active insulin while you're exercising is a pretty sure way to make yourself low. But so I'd want to avoid active insulin during nursing as well or plan for it. And the other thing is there too. If you can go negative insulin and get through exercise without dropping you can't do that with nursing this a nursing is more taxing on your body than some forms of exercise. Is that fair? Like is there a correlation to think about it in there are no

Jennifer Smith, CDE 29:21
I guess there's some relation to think about it. I think like I was thinking of overnight, right? Where for the most part. Mom, moms dads, they're tired at night with a newborn many people are and if that's the case, you're likely going to bed at like nine o'clock like you nurse your child and you're like, Okay, go into sleep because I'm going to be up again at like midnight, one o'clock to do this all over again. You may have eaten dinner at like seven o'clock. You're going to bed well you're well into Basal insulin by let's call it 11pm Right. So any time you're going to nurse after that And you're only on basil. And I experienced this myself for both my kids, Basil overnight, if I even if I had it at all. And my basil is, while I was nursing kids overnight in those early months, it was like near nothing. My basil was like, point 2.25 overnight, it was already down to almost nothing. And if I nursed and didn't still have something minimal, like I actually made these, what are called like lactation cookies. They're made with like oats and flax and peanut butter and stuff that helps with lactation, blah, blah, blah, but I made them so they were each about five grams of carb. But they were nice, because I could eat it, it had some stability to it, it wasn't just pure glucose. So it had some stability. And so I've usually eat it as soon as I started nursing, or something like trail mix some nuts and seeds with a little bit of like dried fruit in it, something that was no more than about five or 10 grams of carb. And that helped with the stability component with rather than

Scott Benner 31:00
the backhoe was die well, and so this is another time you know, where the food choices you make are going to make things easier for you to get you care. And, you know, so there's gonna, you're gonna have a different scenario going into nursing, if you're like, Hey, I know what to do. I'll have a handful of this and a little bit of that, and that's gonna work out perfectly. But on Thursday, when you're like, you know what I'm gonna do, I'm gonna have ice cream before I nursed there's going to be all everything about ice cream still exist there and your diabetes. Okay, in fact,

Jennifer Smith, CDE 31:29
those kinds of things, you know, as we know, ice cream, typically should cause a bit of a rise possibly later fat, depending on how much have you ate, you know, to spoonfuls probably not, but like the whole kind of it, probably,

Scott Benner 31:43
you're telling me that there's a way that I can get I can have ice cream far enough out in the future ahead of my nursing where I could balance that fat rise against the nursing. You know, there are some lunatics that listen to this podcast are gonna try that I saw somebody online this morning, who's trying to stay 100% in range till they get to their endosome appointment and they're doing it. That's awesome. Oh, my God.

Unknown Speaker 32:06
A lot of

Scott Benner 32:08
Yeah, I don't know. I don't do that. So I for Arden, I think they just got a little like, I just wanted to see if that's what I want to tell people to I know it sounds difficult in the beginning to have a baby. But if you want to know how good you will get at it at some point. Here's a great example. About two minutes ago, there was a bang in Jenny's house that was so loud. I thought the world was coming to an end. She didn't flinch. She didn't stop talking. It was that's what happens. Eventually, you just become a steely eyed missile man. She just did not move. She's just because there

Jennifer Smith, CDE 32:48
are beings all day in my house. I mean, when you work, you know from your own home office, and you have children in your home. I'm sure there will be more beings. I don't know what they're doing upstairs. But they are having fun.

Scott Benner 32:58
It was so it was just a great example of how you do become really great at parenting after you've had kids for I swear to you, you resilience. I don't think it's almost like you didn't hear it.

Jennifer Smith, CDE 33:10
Don't pay attention. Sometimes. Oh, yep. Sometimes, like, felt like I have a big sign that my husband made for me. It's outside my office door. And one side says quiet zone mommy is working. And the other side is Mommy is done. You may enter and be loud is what it says. Well, you know, when I'm working, it's still always in the quiet zone. Well, you know, with an eight and a four year old. They know what the sign says. But that doesn't always still click into place. So yeah,

Scott Benner 33:43
it does not overwhelm what they want in their hearts at that moment. That's for sure. Now, listen, artists funny artists going to be 17 in a couple of months. Wow. Isn't that crazy? And I saw her go into where my wife was working the other day. She looked at me like she was six like Hey, watch this. slides into Kelly's chair sits on top of ringers. Mom, can you wrap my head? Kelly's like, you know, reaching around for the keyboard and everything. So we will it will you won't always feel overwhelmed. How many people do you? I don't I'm not gonna say how many people but I mean,

Speaker 1 34:16
do you see women generally able to stick to their diabetes goals after pregnancy? Or should they expect it's gonna get out of whack? And they're gonna have to do some work to get it back like how does that usually go?

Jennifer Smith, CDE 34:32
i I see that. You should expect that there's going to be fluctuation that you will have to learn to adjust to. I myself, I had to learn to adjust because, you know as much as I know clinically and professionally, the experience itself speaks volumes about what you need to transition through. And so I think every woman postpartum should expect that things are going to be a little bit wonky here for a bit of time. I mean, some things that I think, helped me transition where I prepped some meals and froze them prior to baby coming, you know, and whether we have diabetes or not, that can be really, really helpful. You know, some of those kinds of things I also had snacks planned I had. Meanwhile, you end up sometimes nursing your child wherever is comfortable, you know, planned places, you know, in the baby's room in your bedroom and a comfy chair in the living room, just some things that were like easily reachable, that I didn't have to like, Call to somebody to bring me and I just had glucose tablets, and some juice boxes, some like trail mix, and that kind of stuff sort of set multiple places around. So I mean, there's some planning that you can do ahead of time. But the diabetes management piece of it, it kind of learned as you go, I mean, I'd say that about the women that I worked with, through pregnancy, if I had to estimate, I'd say about 50% of them end up sort of sticking with me a little bit longer postpartum, just because especially than the new moms, you know, ones that already have one or two kids. They're like, Yeah, I think I got this, you know?

Scott Benner 36:23
So does being pregnant with type one, give you an advanced. So what do I want to say here? There are so many times when I'm making this podcast, that it occurs to me that success with diabetes hinges, a good deal on your desire to be successful, and your ability to feed that desire with effort. Does that make sense? Yeah, absolutely. And so you, you get pregnant. And then it becomes like this thing we were talking about in the beginning like this, this feeling that you are in charge of the universe all of a sudden, and I will tell you too, and I mentioned it sometimes, when I talked to adults who didn't have particularly well managed, like teen years or whatever, a lot of them have a through line, they started to care more about themselves, where they started caring more about another person, like they want it. And then they wanted to be healthier, because they wanted to be in this relationship or because they wanted to go to do something or, and the baby falls in that category to me, like I want to, I'm going to do this so that the baby can be healthy. And that the number of women that I've talked to who were living really unmanaged lives with type one diabetes, and then are all the sudden 4.8 A one sees, you know what I mean, an eating like a lot because they're growing a baby, it happens. I just see it a lot. And so I always kind of think personally, as a person who's never going to have a baby and hopefully never have type one diabetes. There's something about that motivation in there. That I guess the fight in postpartum is to not, I don't know if it's something you can stop, but for all these things that are going to happen to you postpartum to try to still wiggle out a little bit of your energy or effort to devote to your blood sugar.

Jennifer Smith, CDE 38:19
Absolutely. And I think a good reason there too, in terms of diabetes postpartum is glucose management still translates into that time period for the sake of the child even though they're no longer growing in you. And your blood sugars aren't as direct of an impact postpartum, if you are nursing and you are not managing your glucose as optimally as you know would be helpful. Those higher glucose levels are going to impair your ability to make enough milk okay, if left high, your ability will be decreased. You will also be more dehydrated as you nurse it takes fluid out of you if you're not putting it back and glucose levels are also trending high that in and of itself is also going to make your glucose management more difficult

Scott Benner 39:17
does it change the milk itself?

Jennifer Smith, CDE 39:19
To a degree I mean years ago we don't we don't talk about this really much anymore. Although I have heard some women who've asked me should I just you know pump when I'm really really high and then dump it because I've been told that that I sugar milk is really bad for my baby. I mean, overall increment of right now my blood sugar is high because I ate something and didn't really have the right carb count and I'm knocking it down Should I not feed my hungry child right now? Absolutely not. Go ahead and feed your child nurse your child pump, whatever. Don't get rid of the milk. Your body works really hard to make that milk don't get rid of. But the goal is To have more sustained levels that are still in target to so you're able to continue to make milk and that the amount of milk sugar that's in that, that breast milk is stable, right? That it's stable and at the level that it's supposed to be protein fact, carb content of milk changes as the milk as the baby's kind of needs change through the growth cycle. So you want that amount of natural carbon there to be appropriate. If you're sustaining blood sugars, you know, well above 180, you can guarantee that your milk is richer in carb, not by like loads and gallons. But overall, you're supplying your child with bits more carb, and in a tiny growing body, a little bit can be a

Scott Benner 40:49
lot, okay, that's it just occurred to me, like we talked about undiagnosed people can, their urine can smell sweet, or their breath can smell sweet. I was like, I wonder if it could happen to the milk too. That makes sense. So much like most of this about diabetes, sustaining low variability is always just very important. No bouncing around, you know, that kind of thing. But if you just threw, like, say you were a person who had the baby, just like, boom, I'm going back to my nine a one see that milk would be tainted in some way? Not Yes. Yeah. It's not perfect as what we're saying.

Jennifer Smith, CDE 41:25
Not perfect. Right. I mean, you know, is enabled perfect. I don't know. But I mean, if you're sustained if you're sustaining these really elevated glucose levels, that's not a benefit. And you're going to I mean, for the most part, you're going to have difficulty maintaining

Scott Benner 41:42
milk production. You are, it made me wonder when you were talking about long term? What about people who I know sometimes you see people like nursing a two year old? So it for people who do that? Should they expect that? That hit like your body never gets used to that, right? Like, you're gonna get that? Yeah, that blood sugar head is gonna come forever, if you? No, not really,

Jennifer Smith, CDE 42:01
no, actually, no. In fact, after about three to four months postpartum, there's a stable enough nature to the milk supply, and to what your body or your baby is demanding. And that for the most part, things stabilize a lot easier after about three to four months. In fact, I nursed my kids while after they were a year old. And in fact, I think they were both almost two. I mean, it wasn't all day, it was like for bedtime, and for naptime by the end. So it wasn't really that they were probably even getting very much, but usually post a year, you're typically not going to see that hit. And the big reason, especially after about six months to a year is because now your baby is starting to eat. While milk supply is still considered the main nutrient up to a year of age. Some kids start eating really, really well, after 678 months. And so you may see a decrease in the amount of nursing that goes on as the baby becomes more interested in food and takes in less, especially the overnight many women, you know, might have a really great child who just sleeps all night. And so they might only nurse once or twice maybe, or eat, you know, some women nurse on need during the day. But those, those sessions are not typically going to cause the drop in blood sugar that the early three months will cause

Scott Benner 43:29
I want to make sure I didn't misunderstand something. So there is it a balance between you might not be using as much and your body's becoming very good at making it or is the like at first I thought you were saying like the same lady's body that can make an Oregon knows that can figure out how to make milk without it being like a tax on the system. Like is there some of that and some of the not being?

Jennifer Smith, CDE 43:51
I think it's Yeah, honestly, because for the most part, like I said about that three to four month mark, I would say the women that I get to work with well past the immediate postpartum time period, they find a lot more stability in their glucose even though they continue to nurse beyond that point, then the lactation or the nursing sessions don't have the hit that they do initially.

Scott Benner 44:16
Okay, thank you. It's a quick little parable, why are Vali asked you to think of there's anything that we haven't talked about. Let me tell you that I was interviewing somebody recently who said that they were listening to I interview this person I was talking to them doesn't matter. I was conversing with the person who said that they're pregnant now. They're listening to episodes of the podcast about pregnancy with you in them while reading the book that you wrote, and did not connect that you were the person from the podcast. They didn't realize the person that wrote in the book was the person talking on the podcast and all of a sudden it hit them one day. And she was like, Oh my gosh, it's the same Jenny. That's awesome. It was really cute. I want to tell you about that, I almost just texted me and I'm like, I'm going to tell her that while we're recording the postpartum episodes, that, that's awesome. That was really cool. Anything we didn't say that we should have, oh, I'm

Jennifer Smith, CDE 45:10
trying to think, um, you know, the only other thing that we didn't really touch on, while it should be considered is, depending on how you're feeling postpartum. I mean, most women have like this, I give you restrictions up until about six weeks post delivery, when you're going to have your check in with your OB and blah, blah, blah, and make sure everything's healing well, and you're okay. And then they kind of like, check you off. And you can drive again, or, you know, if you've had a C section, or you can get out and start running again, or whatever. And I think that's a piece to consider in the mix with diabetes, because, you know, we know what exercise. So now you not only have exercise coming into the mix, but you've also got nursing coming into the mix, and all these insulin changes that you're trying to make. So one of the big things that sort of fits here is if you have maternity time, not all women do. But if you do have maternity time, use your maternity time to try to establish sort of a route, like a routine or a schedule. And some of that's going to be dictated by the baby, obviously. But even regular for you trying to get your nutrition in timely through the course of the day. You know, once nursing is a little bit more regular, the baby's waking nursing times are more you can fit it in or around the meals and exercise is a big one of that. If you're going to start exercising, try it at a similar time of the day to kind of get a feel for how does this work? You know, what can I get away with? What's too much? What's too little? Because I think that just brings in the whole, like, I feel good enough to go and you know, take a three mile run. But what's this going to do? Oh, no, let's try.

Scott Benner 46:57
I hear you. So it's not dissimilar to it is interesting, as you're talking about it, it really feels like postpartum is a lot like just being diagnosed but having way more information about diabetes, right? Like Like, what if, what if somehow magically, I knew the things I knew, but never had to put it into practice. And then all of a sudden, there was a newly diagnosed person here, I'd be able to roll with the variables much better because I have better tools. And so you're going to go from having diabetes, maybe not doing it as well, learning how to do it really well, or already knowing how to do it well, and then it's going to feel like you're diagnosed again, and you're taking care of a baby at the same time. And all your variables changed again, I'll tell you, I'll tell you this is giving me a different feeling for first episode of season seven 2021 was with a woman named Jill, who was diagnosed as she got pregnant. So she was pregnant for the first time and had type one diabetes the first time and I am now talking to you thinking I had a lot of empathy for I might not have had enough like, like hearing about all this.

Jennifer Smith, CDE 48:11
That's a whirlwind of change. Not only is she pregnant, but now she's pregnant with something she has no background to managing. And she's got to learn how to manage it through the variables of pregnancy as they shift and change. I would imagine that postpartum was probably a lot more difficult for her than pregnancy was.

Scott Benner 48:31
I wonder? She's She's active on the Facebook page. She looks like she's doing terrific. She actually also was misdiagnosed type two diagnosed type one. It's a fascinating story. If you have to go listen to it. If you haven't heard it. Let me know which episode is it. I'm actually going to look right now because I don't know. I've I think I'm at the point now where this I've done so many of these.

Jennifer Smith, CDE 48:56
I know you're like I don't know what else.

Scott Benner 48:59
Let me look real quick. It is called Wait a minute. That was January 2021. I'm looking Why do I not see it? It'd be helpful if I knew what year it was. Now that I know what year it is. I'm getting down. It's called wine beans, babies and cue. It's episode to come up with these names. It's episode 425. Well, she was misdiagnosed as type two. So you know, she still went on a wind vacation with their friends. Beans, I forget babies because she was pregnant. Because she was told she could go she could she was told she could get pregnant by a person who told her she had type two diabetes. And then she got pregnant as she found out she had type one diabetes and a doctor with the last initial of Q set her straight. That's where all that comes from. And you just I can't remember what the beans were Damn it is a good episode. She's really lovely. Yeah, but I know her because she reached out right in that moment. Like she found the podcast and she's like, I don't know what to do. I just found out I'm pregnant. I have a baby coming in. I have type one. So I was like, well, after you figure this all out and have that baby, you got to come on the podcast. Yes. Tell the story. Anyway, she's terrific. And, and so are you. We've covered this pretty well. I like this a lot. We did a little like personal chatting at the beginning. So we didn't get to do one of the things I wanted to do, but I'll just put that on my list. Okay. I thank you very much. I somehow find it delightful that your kids were much noisier than normal. While we were talking about having

Jennifer Smith, CDE 50:41
this was one child. Oh, really? That was just just the four year old the other ones at school?

Scott Benner 50:47
Oh,

Jennifer Smith, CDE 50:49
I can imagine he is. So my mom came my mom came this past weekend to visit for my birthday. And she bought them a ring toss game, which has, like it's like a wooden base. And then it's got you know, the things to like, throw the rings over. And I'm expecting that either the whole thing was lifted up and dropped on the floor, or the ring toss was being thrown from a larger distance and maybe all the rings at one time were being thrown? How much

Scott Benner 51:18
of this do you think is the part of the country you live in as your mother prepping them for beer pong later is Do you think that what this could be I swear to you, it felt like two adults lifted up your dining room table and dropped it from about eight inches.

Jennifer Smith, CDE 51:32
And the funny thing is, it was like, like you said I didn't flinch. Because it was like a background like I don't it's just a background noise.

Scott Benner 51:41
I thought off the bleep myself out because here was the thought in my head. I thought did she not hear that? Cuz you didn't blink. It was fascinating. Anyway, ladies, have a baby get through all this and one day you'll either be as good at this as Jenny or is not Miss Jenny as I'm not sure how to put it. Yes. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org A huge thank you to one of today's sponsors. Je Vogue glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG g o n.com. Forward slash juice box. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We talk about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny Presented everything, even the scary stuff that reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months, I've never met Scott. But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast show Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.

#1020 Diabetes Pro Tip: Glycemic Index and Load

Scott and Jenny discuss the importance of understanding the glycemic load and glycemic index of foods. They emphasize that different foods can impact blood sugar levels differently, even if they have the same amount of carbs.

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:03
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juice box free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox. Okay, Jenny, so I know how people's minds work. And the problem with this episode is it's going to be incredibly important. And they're going to see the title and not listen to it. Right? Nobody. I'm just going to curse and I'll bleep it out later. For some reason. Your mother during glycemic load and glycemic index foods you're making me crazy. Okay. So here's the here's the problem. The core of this cod podcast, the concept behind it is I don't think you should have to limit your diet. The unspoken part of that sentence is I also don't think you should have a bag of sugar every day. Right? So I want you to Yeah, listen, if you get crazy one day and you're like having a pop tart, or I want to eat a bowl of cereal, I want you to understand how to Bolus for that that's really the the reasoning for the podcast that it's at its beginning, like I said, but the amount of people who say hey, listen, I counted these carbs. And it didn't work. So I don't know what you want me to do about it? Well, what I want you to do about it is understand that there's a difference between 10 grams of potatoes and 10 grams of sugar and 10 grams of Pop Tarts. And Cheerios are the I'm fascinated by how many unhealthy foods people think are healthy. Which one jumps into your mind when you say that? Because I think of wheat bread right away. Like somehow it being wheat bread doesn't make it bread.

Jennifer Smith, CDE 4:09
Right, I think of especially in the past five years, I would say maybe even more than that. I know what you're gonna say go ahead. I think of meal bars. I don't know what else to call them.

Scott Benner 4:27
I was gonna say go ahead.

Jennifer Smith, CDE 4:28
It's kind of like the bread idea. Just because Wonder Bread now says that it's wheat bread versus white bread. That's like if you want real bread, like go back to granny. She made her bread right? And even you know breads today being there's a plethora of them on the market. Right? But just because it says wheat bread doesn't mean that it's healthy bread. I mean if you're talking about like healthy bread, if you're going to eat it, you're talking About the sprouted like low glycemic, we'll talk about the glycemic sunsets yes of this whole episode. But right I mean, those types of breads the unprocessed, you can actually physically see the grains in it or the seeds or whatnot. There's a big difference between wonder wheat bread and sprouted grain Ezekiel bread. major difference.

Scott Benner 5:23
Even when I make bread at the house, I'm only just making white bread, but it's at least sugar, flour, yeast, water, butter. That's it. That's what's in it. Like salt. Excuse me, that's, that's what's in it. It's of course, the the flour is processed and the sugars processed. But you can buy a loaf of wheat bread. And the first ingredient is high fructose corn syrup. Right. And people are like, I don't know what happened. Right? I do.

Jennifer Smith, CDE 5:53
I do too. Yeah. It's kind of like I said to though, with the bars, people, lives are busy today. Very busy. And I actually did a whole like, I think I did a blog post about this actually, or it was in part of our newsletter or something all about, like, sort of the false advertising of nutrition bars, right? You're eating your nutrition bar, because it's like, it's low carb, or it's low glycemic, or it's follows your keto plan, you know what they're, you're gonna follow a plan, follow a plan and eat real food. Most I say most of the time like these, like 9010 8020, kind of, most of the time you're doing real food, you know where it came from, your grandmother could identify it, I can guarantee that if I showed my grandmother who was no longer living something like, I'm not gonna name a brand, but a general like, a store bought processed meal bars to be like, What is this? What is this? What is this gonna make yourself a peanut butter sandwich or something, you know,

Scott Benner 7:04
those things are so dense, with calories and carbohydrates and all that stuff. My son uses them. So my son does not like to have a full stomach when he's playing baseball. But you can't go play college baseball in the heat without fuel, right? But he can take like a half of one of those bars and power him through a baseball game. There's so much jammed into it. So he likes them because they don't fill his stomach. But it goes to show how much fuel is in it and you know, things that impact your blood sugar. I thought, you know, when you said, you know, a bar, I thought you might say vegan food. And I thought your vegan diet and I thought you might say no gluten stuff. Because I had to remember one time, they were trying to figure out my iron issue. And a doctor said, Hey, don't eat gluten for a month. And in a month of eating not gluten. I gained like eight pounds. And I thought, but I'm eating healthier. And then I looked back and I went No I'm not. I'm just eating things that don't have gluten in them. Right? Right. I confused no gluten with health. And my daughter's friend is a vegan. But she's basically a human garbage can. You know, it's fascinating.

Jennifer Smith, CDE 8:23
It is in terms of I mean, just those two, vegan or even being vegetarian is kind of the first right. Okay, you don't want to eat meat. Great. I mean, for the most part, the only animal that I eat is fish, okay, than any of the other animals on the planet. I eat fish. It's occasional, not very often. So for the most part, we are mostly vegetarian. And but you could be a very unhealthy vegetarian, you could also be a very unhealthy vegan. I mean, if you're doing a heck of a lot of the processed, oh, but it doesn't have any animal based product in it. Great, but like, how long has it been sitting in the bag or the box on the shelf just because it doesn't have animal product in it? Or? Right I mean, there are healthy ways to be vegetarian or vegan. They're also healthy ways to be on a ketogenic diet. You know, a lot of the products that are on the market for that type of an eating fueling plan are very processed, you can be healthy and actually eat good real food on a ketogenic diet or on a vegetarian diet or on a paleo or a caveman diet. But much of the process stuff that's out there like you found with the the gluten free stuff. Yeah. Unfortunately a lot of the gluten free packaged processed stuff. It's made out of very this is brings in glycemic index. It's made out of very high glycemic quick impacting refined carbohydrate, rice flour, tapioca starch, potato flour, I mean, the lower glycemic ones would be things like if it's made out of like an almond flour, or like the nut flowers or like a coconut flour or something like that. Those tend to be lower impact, lower glycemic, still processed. But

Scott Benner 10:15
the reason I bring it up, and I'm sure this happens to you constantly, then to me far last, because I don't speak to nearly as many people one on one as you do. But I am just endlessly inundated with people who want to know like, I don't understand why this isn't working. I eat healthy. It's almost like when people say it's almost like when people say to me, Oh, my blood sugar got really low. I've learned not to infer what I think of his low into what they say in the beginning, when someone say to me, Oh, I got really low, I'd go right over it. Now I stop. And I go, what does that mean? What number is really low? Because sometimes the personal say, 85. And I'll go oh, well, that's not really well. And so it frames my conversation. So when people say I eat healthy, I do. I'm like, what does that mean? Right? Because I need to understand what you're eating to talk to you about the insulin you're using, because we did everything right here. Your blood sugar should not be 200 right now, why don't understand I had a really healthy meal. And then when you talk to them, you know, it's like, oh, I had avocado toast and you think oh, that does sound healthy. Except a they don't know there's carbs and avocados for some reason. They're completely disconcerted with the facts in the avocado and there's high fructose corn syrup and the toast they made and I'm like, yeah. Okay. So, so So I don't care how anyone eats I would think of myself as the only real diet I stick to is an intermittent schedule. I only eat in a certain hours. But other than that, in the past week, I've had Ben and Jerry's ice cream. I'm making ribs tonight for dinner, Texas style, in case anyone's wondering gonna smoke them. And you know, I think last night we had I had chicken parm that I made last night. But keeping with Jenny's point, I made the chicken parm I took a chicken breast, I hammered it flat. I put bread crumbs on it, and a little tomatoes and some mozzarella cheese you at least you could see what was on and

Jennifer Smith, CDE 12:15
you knew what you put in it.

Scott Benner 12:16
Yeah, and I didn't. And I didn't fry it in any of the I don't use processed oil either. And the and the the the olive oil I use is only cold pressed I don't I don't use the heat pressed. So those are pretty much the only things that I follow and besides taking, you know a reasonable amount of like, you know, vitamins. I don't really do anything differently. But I'm also not really interested. I'm not trying to impact my weight. I just want to be healthy and I want to eat something

Jennifer Smith, CDE 12:46
and you're not concerned with your own blood sugar overall. I mean, you're concerned with your daughters, but

Scott Benner 12:50
other than a glucose monitor a couple of times my body handles my diet. So that's and I'm not over taxing it. I didn't eat like three pints of Ben and Jerry's ice cream. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well in your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juicebox free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now through your insurance. Contour next one.com forward slash juice box for a meter go get yourself a free starter kit. while supplies last US residents only touched by type one has the back of people living with type one diabetes. Take for instance their D box program touched by type one knows firsthand the intricacies of living with type one diabetes. And so their team has created a D box, which is a starter kit that provides important resources and supportive materials to individuals with diabetes. They want you to thrive. The D box is completely free and available to newly diagnosed people. All you have to do is go to touched by type one.org. Go to the Programs tab and click on the box. While you're there, check out all the other resources and programs available at touched by type one.org. Speaking of support, touched by type one.org is available in English and Spanish. Don't forget to find them on Facebook and Instagram too. You do not want to miss what touched by type one is doing. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit je voc glucagon.com/risk. You know, I

Jennifer Smith, CDE 16:18
think it's also I think that actually brings up kind of a good a good visual of the difference between glycemic index and glycemic load when you were wearing that continuous monitor. I remember you either I think you texted and you texted like how much you physically had to eat. In order to get the CGM to register like a bump up in your blood sugar is showing that your body was actually being taxed. He was fascinating by the amount that you ate. And that actually speaks to the load impact. Right. So when we talk about glycemic index and glycemic load, glycemic index is really just it considers the amount of food that you've eaten carbohydrate that will turn into impacting sugar in the next two hours after you consume the food. But that's just the tip of the iceberg and understanding. And that's when when I talk to people, you know, who are trying to consider glycemic index and like, you have to take it a step farther, there are depths or there is depth to glycemic index and a step farther as glycemic load in terms of glycemic load talks about the amount of the food that you're eating at a particular time. And my favorite example to give is watermelon. Watermelon has a very high glycemic index. If you're not familiar with glycemic index, or not quite sure it's a scale of zero to 100, with 100 being pure glucose. So as foods are rated on that scale with a number, that higher the number or the closer to 100, the faster the impact should be on your glucose level. Okay, but again, this is in a simple lab generated testing, right? Where you're only eating my example watermelon, you're not eating watermelon on top of chicken parm on top of like a whole stick of butter. Right?

Scott Benner 18:20
I also wonder, are these things tested on people with diabetes when they come up with the index or people with a working pancreas when they come up with the index?

Jennifer Smith, CDE 18:30
I believe it was, I believe it's people with a working pancreas. Yeah, to give a true definition of what the impact could be when sort of outside insulin dosing isn't in the picture. But that is a really good thing it makes me think of maybe looking that up.

Scott Benner 18:47
Here's what it made me wonder about, you know, when somebody tries to catch a low by turning their basil off for an hour, and then they create, like, avoid in front of them a black hole where there's no and then they have the tiniest bit of carbs, like my blood sugar shot way up, I don't understand it, well, your pancreas doesn't work, and you took away all the insulin in your body and then added even the tiniest bit of carbs. So the glycemic index of anything away from insulin is probably 100, right? Like everything probably hits like 100 away from insulin. And so when you've got the right amount of basil in these foods are going to still hit on this chart. And before we go on, like I just I'm gonna run through it real quick and just pull a couple out to give people an idea. whitebread is a 75 Right? White rice is a 73 cornflakes are 81 but an apples 36. Right strawberry jam is 49 A potato boil to 78 but a potato mashed is at seven. So everything hits differently and when I stand on stage, I try to simplify it down by saying Foods punch at a different weight, some of them just hit harder than others. And that's and it's interesting to they have sugars listed out here. Sucrose is 65. Glucose is 103. Honey is 61. And fructose, if I'm saying that right is 15.

Jennifer Smith, CDE 20:18
Yeah, because toast is fruit sugar. And that kind of brings into the treatment for lows, then the reason that glucose tablets technically work the best or anything in which dextrose is one of the first three ingredients in like a candy kind of thing. That's the reason it's going to work the best because glucose is the simplest form of sugar that there is, there's no breakdown to it, it gets in and it gets distributed and use. Whereas something like fructose, or galactose, which is milk, sugar, sucrose, they are more calm, there are more combined chemical sugar structures, so your body has to break it apart, to get the glucose out to actually impact the blood sugar.

Scott Benner 20:59
So in a scenario where a person takes a glucose tab, and it takes forever for their blood sugar to go back up, but eventually it rockets up, that means they have a lot of active insulin that the tabs fighting with Is that Is that what you would infer from that,

Jennifer Smith, CDE 21:12
that would be the estimate, you know, if there's iob, and there's a load of it, and there's a low and you only take one glucose tablet, that's like a drop in like the ocean of impact the other. The other reason could possibly be whatever is in the stomach already might be hampering the true absorption of that if the glucose tablets kind of sitting on top of that digestion. And if that other food is really highly fibrous or very high in fat or a lot of protein, it may take longer for that little bit of glucose to definitely impact and get absorbed. Yeah.

Scott Benner 21:50
Okay. All right. So I'm sorry, we kind of got away from it for a second. But it all feels really important, you know, that, that you can't just I mean, all carbs aren't created equal. I guess that's how I've boiled it down for the podcast. But again, the the amount of you out there who I tried to say to people, like when they're really learning about the podcast, and they're going through the pro tip episodes, and they're getting the ideas down, but they're still spiking, and they're getting low later. I always say like, why don't you just simplify your food choices for a little while while you're practicing? You know what I mean? Like, I think I think I said to somebody recently, if you got it in your head that you wanted to learn how to box and you went to the gym a couple of times, you took some sparring, and you were starting to get confident. Once you had a little bit of confidence under your feet. Your next thought wouldn't be, you know, I had to go find iron Mike Tyson and see if he wants to go a couple rounds. And because you're not ready for that yet, right? But people make a couple of good boluses in a row and they're like, I'm gonna try Cheerios like, no, don't try Cheerios, it's day three. You're not good at this yet, you're getting better at it. And so if you're having trouble putting tools into practice, I always say, go for things that are you know, that don't punches hard. While you're practicing it, cut yourself a break, you know,

Jennifer Smith, CDE 23:07
and also learn and I think I've said this before to some other episodes, but learn the foods are the that are most common for you. Take a look at what you love to eat, write them down. Most people have about 20 foods that are over and over what they eat almost every single day, write, mark them down, look up their glycemic index and see how does it work when you try to cover these foods, even if it's like a meal, let's say you eat chicken and broccoli and rice three nights a week because it's like one of your favorite things in the whole, great, write it down, figure out what you did. What happened if it especially if it didn't work the way that you wanted it to work out, and then eat it again, you know, two nights from now and try it again. Maybe it was more insulin that you needed. Maybe the timing was a little bit different. Maybe it takes into consideration though. Well, gosh, tonight I ate a whole cup of rice with the chicken and the broccoli. And maybe Wednesday night I decided to eat only a half a cup of the rice with the same amount of chicken and broccoli. So there's the load impact, right? It's the portion of the rice, the rice itself in one cup versus half a cup versus four cups, still has the same glycemic index. That's not going to change. But the load takes into I guess what you have to pay attention to is you're eating now like a whole cup versus a half a cup. And that load impact is going to then be the big driver of blood sugar after In fact, you might need to play with timing of the insulin a little bit differently based on portion

Scott Benner 24:43
right now Jenny brought up earlier that I tried to drive my blood sugar up when I was wearing a glucose monitor and I obviously don't have diabetes. And I took a I think it was a big piece of cake with a lot of icing on it. And I ate it and waited and my blood sugar did not go up very much All right, so I forced myself for you people, I hope you're happy. I forced myself by the way I did not enjoy. I did not enjoy the last third of the first piece. And I really didn't enjoy the second piece. And I was just like, oh, we get this and, and what do I get to like 132? Something like that my blood sugar like something like that

Jennifer Smith, CDE 25:21
right state under the defined like 140 Mark. Yeah,

Scott Benner 25:26
I couldn't eat myself over 140 If I tried and, and, but still I got to 130 in a life where I wasn't getting to 130 a lot I was having to like, do what Jenny said to get the 1/3 he was having to stack multiple different tough foods on top of each other, like layer them on top of each other's having to have bread with potatoes, and then something else and more and more. I was I spent one night I don't know if you know those little spearmint leaf candies that are just like they're just sugar with like, they literally they take sugar and then they dip it in sugar. I sat with a glucose monitor in front of me just going like just popping one of those in like every three minutes. And my blood sugar would not move off of 89 like it just wouldn't move. And I was just like I'm not trying to make people jealous curious

Jennifer Smith, CDE 26:19
did you I was Thank you pancreas thank you so much. No,

Scott Benner 26:23
I I told you I had a deep feeling of guilt. Eating food and watching my blood sugar not go up like a significant it makes me sad thinking about it. I had a real deep feeling of guilt the first number of days I award. And I was just you know, I'm trying to do these things. So I can talk about them on the podcast. And at the same time I'm looking over at my daughter while we're like correcting a 130. So it doesn't turn into a 170 You know, and and I'm just but anyway, like, let's get back to the fun part. I am throwing these candies into the point where I was like, I hate these things now. I couldn't get my blood sugar to go up. That was it. It was it was pretty fascinating. Having said all that, again, I think that the podcast exists because I think people are going to have a candy once in a while. I think that when people look at the you know at Harvard's good you know what you can swap out for lower glycemic index things. And I think oh, I could have corn on the cob or a leafy green or peas. You know, I think most people are like I would like corn would you like corn flakes or bran flakes? I want corn flakes. You know, even white rice to brown rice is you know now there are ways like you'll learn how to like for us. We I've switched the house over just a basmati rice. It just hits Arden differently. It just does. And who cares why? Like I tried four different Rice's and I finally got to one and I was like this is the one that doesn't hit her as hard. This is the one we eat now.

Jennifer Smith, CDE 28:00
Does it differ based on how you cook it or prepare it?

Scott Benner 28:03
I only prepare one way Jenny. I have this aroma is it's a Roshi, people are making fun of rice steamer. I have the greatest rice steamer on the face of the planet. And let me tell you why I am able to afford this rice steamer. I was walking through a Macy's one day and they had this little rack of things that had clearly been returned to the store but bought online that they don't stock in the store. And so they just want to get rid of it because they have no place to put it. And my eye luckily for me, is it zeros? It's ZOJIRU Shi they make bom bom rice cookers right? Wow. And my eye catches this rice cooker that I know in my heart costs like $500 and right and obviously I'm not going to own a $500 rice cooker in my lifetime. And I looked over and that things had 75 bucks. And I moved across that store. like Usain Bolt in his prime. I was like out of the way people. I snatched this box up and I was holding it. I was like hugging it. Everybody just moved like I felt like everyone else knew as I looked around, I realized I was the only one aware that I was holding a very expensive rice cooker with a $75 price tag on it. And I actually it was so crazy. I went over to an employee I was like, This is $75. And she goes yeah, and I would I will buy this. Thank you. So I took it. It makes perfect rice. It is fascinating. You put the rice in, you fill the water up to the line that corresponds with the cups, the number of cups of rice you use. You push a button, it plays Twinkle, twinkle, little star and 55 minutes later, you're eating the best ratio ever had in your entire life. I don't know why it plays tickle. Take a little star when you start up but it does.

Unknown Speaker 29:56
My kids love that.

Scott Benner 29:58
Oh my god. Other than that I am The word I can't make rice. I screw rice up six ways from Sunday every time I try to make it so I

Jennifer Smith, CDE 30:05
barely have rice. I only have rice when we do sushi.

Scott Benner 30:09
When my son is trying to gain weight, he wants it in the house too. So I make it and I and it goes in the um, it goes in the refrigerator. He just adds it to everything he's eating.

Jennifer Smith, CDE 30:17
Yeah, my choices always. My kids love quinoa, thankfully. And then wild rice, which isn't technically even rice, it's it's the seed of a long grass. So education for you. Oh,

Scott Benner 30:31
I love I love a nice long rice because I like the the the sort of like, you know, spices that go on with it, too.

Jennifer Smith, CDE 30:38
Yeah. They work glycemic ly better. And I've just found long term that it been my family likes it. So it's not like I even have to cook it separate for me and something like brown rice. So yeah,

Scott Benner 30:50
I can't believe I spent so much time talking about my excitement about getting a cheap rice cooker and this podcast episode. I'm sorry for all that. For everyone who's listening. It was like, Yeah, buddy, this is not helping me. I'm not buying a $500 rice cooker. Well,

Jennifer Smith, CDE 31:01
well, you shared it because the way I asked you how you cooked it, right, that does bring in as you were talking about the glycemic index before about like a big potato versus a boiled potato versus you know, the glycemic index can change based on how something is prepared and or how ripe something is. So for example, like your apple that you mentioned before, I think it's in like the 30s or 40s or something right? Most apples are considered low glycemic, anything under 50. On the glycemic index scale of considered low glycemic slow impact. Apples are there a kiwi fruit is there most of the berries are there. But then you get into the fruit that you really eat at its peak sweetness. You're talking about the summer melon, you're talking about pineapple, papaya, mango, bananas, grapes being cherries, they're all high glycemic, because their sugars are so developed to get that flavor that you want. I mean, I guarantee you're not going to eat it. Well, some people do. My husband doesn't care. He's one of the people can eat like a green banana, put it in a smoothie, he doesn't care. He's like the bananas there. Because I liked the nutrition in it. I don't care how it tastes, right. I cannot eat a green but

Scott Benner 32:18
on the outside when you're biting Do you notice that like the FMD? Like, why is that doing that to my mouth, my mouth.

Jennifer Smith, CDE 32:23
I wish people could see us sometimes that we make when we're talking. But I mean, I bring that in because glycemic index is higher for a ripe or fruit and the impact is going to be faster. And I can tell you if I make a smoothie with a less than ripe banana because it's what we've got, and I want a smoothie. The impact is definitely different for me. And I strategize my Bolus timing, different based on that. Based on that,

Scott Benner 32:54
well, you hit one with Arden loves cherries, and they like I have to like swing it those with both hands get you know, when your Bolus saying they're really tough. That is see i i find all this fascinating. And I find it sad, because I don't think that many people think about it at all. They just count the carbs. And then they're like, well, this I counted the number and the number says 10. And so it's 10 I, I'm right, you know what I mean? Nobody thinks about the insulin, because I don't think about the carbs that much like I look at the food and I pick the insulin. I saw somebody the other day. They were, you know, they had this meal. And they're like, We use two units or three units. And I said, Well, what is this? Like a, like, I don't understand is this like a four year old kid and it wasn't it was a teen and I'm like, that's not gonna work. And you know, and then I asked them their ratio, and they're like, oh, it's one to 10. And I was like, You think this is 25 carbs, I was like, this is 60 carbs. You know, if it's one, it's 60. And I'd be scared to say 60. As I was looking at it, I was like, I don't know, I'd like to go 70 To be perfectly honest with you. And, and there are 2030 they're not sure. And then the kids blood sugar jumps up to 240 and they don't know what happened. And then they're correcting, correcting, correcting, then the food gets digested out the kids crashing down and then they're correcting and then they want and it goes by and it's just it's never ends.

Jennifer Smith, CDE 34:19
I think you know the topics of glycemic index and glycemic load are they really are such they're kind of the like further down the road when you're talking about like just correct carb counting. Get that squared away. That is step number one get get some carb counting, get some labels read even if you have to do portion estimation, that's your tool that you get good at portion estimation. Then for again, those foods that are on your these are the typical things that I eat. Great. Then we can move on further to things like glycemic index glycemic load a little bit better Bolus timing, and then you kind of that maybe another step is, how was it cooked? Right? Am I boiling? My potatoes? Are my baking my potatoes? Am I you know eating a green banana? Am I eating a completely black bun? So?

Scott Benner 35:14
Well, you're you're kidding on something that I know I want to talk about on the podcast more with you in the future, which is after speaking to so many people, like I realized that there's a, an order in which you should pay attention to things when you're starting, right? And like in an overly simplistic way, like I always say, if I was if I was on the Titanic, and I was thinking you, you, you somehow recognize me as a person who could help people with diabetes. And like, Scott, I have a tape recorder, you're 30 seconds, what do you want to tell people about type one diabetes, I'd say get your Basal insulin right? Learn how long your Pre-Bolus is, and then understand the glycemic load and index of food. And then I would go under and freeze to death and drown. But but those like if the if I could only say those things to you like three things to you, I'd say that. And then from there, I'd start talking about well, it's timing and amount. And you know, and you can't forget about overnight, this happens. And you know, protein and fat cause rises, like there's the variables, I just think of it is the seed of the idea. Like I always think of like management of diabetes is a tree, it's 100 year old tree with 1000 branches. And every point of that tree is important, but at its core at its seed, it's basil. And then it's you have to Pre-Bolus and then it's you have to understand the impact of the food. Like that's the start of it, you never, but I see so many people who are out on the tip of the 700th branch going, I really want to understand this part. And I was like, there's a lot more to understand before you dig into that, you know, back at the trunk. And here's the problem, right? No one tells you to Pre-Bolus No one ever tells you Basal insulin is important. And the words glycemic index and glycemic load are not sexy, and I don't like to pay attention to them. When I hear them. My brain goes. Boring. That's for people who eat good. Like that's how it made me feel when somebody said it to me in a doctor's office one day, I'm not trying to run a marathon. I don't care about glycemic load. They instead of saying, Hey, you over here, these are the three most important things you need to understand. They told me the most important things and then moved on to stuff that doesn't matter as much. So not that it none of it matters. It all matters, but there's a core of it. And if you do the core, you're okay. I'm telling you, Basal Pre-Bolus glycemic load glycemic index isn't a one seeing the sixes. That's my guess. You want it in the fives, start crawling out in the edges of the tree and figure out the rest of it. But this is an exercise. Yeah, get a pump and go for a walk. Like there's I could say stuff all day. But you know, stop eating pop tarts and telling me like it's not fair. I can't have it. Of course, it's not fair. But first your poison.

Jennifer Smith, CDE 38:05
I remember the last time I had a pop. They're not really college because there was like nothing left in the cafeteria or something. And I was like, oh my god, I have to eat something. But

Scott Benner 38:15
my insulin Chinni assign to that if you want to goddamn Pop Tart, eat it. I don't care. Just don't act like you don't understand what happened afterwards. Because that makes me sad. Like, I just, you're killing me online, okay, you're putting things up online, and you're making me sad because I want to come sell this stuff. The I don't have time. And you're breaking my heart. So and and when I when I help people privately. Some people get it more quickly. And some people get it slowly. And then some people give it away, like after they know it. And I've seen them do it. And then they stopped doing it. I'm just gonna tell you, like, I don't follow many people's tax comps. And when I do, I don't for long. But when I do, and I've seen you do it, and I've seen you understand it, and then you have a 300 blood sugar, I gotta stop following you. It just It breaks my heart like I just can't, like it eats me up inside. You know, I look at the graph. And I'm like, oh my god, like it didn't Pre-Bolus Or why

Jennifer Smith, CDE 39:12
are they bad pump site or Cutlass?

Scott Benner 39:15
It could have been anything. The problem is, it's just it's ripping my guts out. I can't look at it anymore. Like with my daughter, I can do something about it.

Jennifer Smith, CDE 39:23
It's hard to follow people I agree. I mean, with the with the many, many, many people. I see their data. Yeah, it is. It's hard because and I think, you know, there's, there's no, there's no stop to, like my job isn't like, I go to the office and do my job. I put everything away. I close the door and then I go home, right? Like the people that I work with become like, they're almost like family to me, right? They're people that I I care about the people that I get the privilege to work with and help and I want the best and I Tonight, I feel like I could just like go home with everybody

Scott Benner 40:05
just texted a person this morning. And I said, if you could just come here for, I think 18 hours, I could just do this for you and you could see, but they and they know what to do and they won't do it. And I'm just like, oh my god, it just really listen, I'm not trying to turn this. It's hard on me. Like I really does. Like it just rips me up. Like, I'm like, you keep making the same mistake over and over again. But it's not out of ignorance. You you quite honestly know not to do it. And you just I don't know if it's fear bits are hard to break. Yeah, or habits are hard to break. But you're just you're doing the wrong thing. Like it's and I've told you it's the wrong thing. 10 different ways. And each time I say it, you say I understand I now you don't have this. I now know what my wife feels like when she's talking to me. It must be Kelly. I'm so sorry. It must be incredibly frustrating to say the same thing to me a million times, amigo. No, no, I understand. I 100% understand it three days later. I'm just doing it again. But But and so it's like, I don't mean to come down on me. I'm not trying to come down with evil. I'm just saying that. Jenny's not wrong, like following someone's blood sugar is it's a lot. And it's tough to win. Like, I don't think I know everything. And I but it's tough. When you look at a graph and you go, hey, you know what, you need more basil? And they go, No, you know what I think? And I always think to myself, I actually started saying it out loud. I just started going like, why don't we stop worrying about what you think? Because what you think led to this graph I'm looking at? Try what I think for a second and see what happens.

Jennifer Smith, CDE 41:39
That's my way for a little bit, please. Yeah, here. And

Scott Benner 41:43
listen, I'm gonna cost Jenny some money and save all of you an hour paying her Friday. Stop explaining to Jenny what you think, let her tell you what's going on. Because you're just in therapy at that point. And that's like getting you to a better blood sugar thing. You know what I mean? Right? How many stories do people tell you where you're just like, stop talking, this doesn't matter.

Jennifer Smith, CDE 42:06
And sometimes, you know, sometimes it's a marriage of what I see. And sometimes it's adding in then what they've seen, but they're addressing a certain way, because they think something's happening, that isn't really the reason for it. So it's kind of a marriage of what I see and how to tell them about what to do differently. It's not that what you're seeing is wrong, it's that the adjustments are not quite the right adjustment. You're

Scott Benner 42:31
100% right. And I was being too flippant, like you do need to hear it from them. But it's fascinating how infrequently their interpretation of what they're seeing is right, right. You know, you need to you need to hear what's happening. You don't need their interpretation of what's happening is much it's interesting. Anyway, it's like it's like trying to do I don't know, it's the weirdest customer service in the world like it people. This is like that except times like a million. So anyway, Jenny has to go. She's show I do drop bombs of knowledge and truth all over this episode. So I really appreciate that. I will talk to you soon. Cool. Awesome. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com Ford slash juicebox. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. If you're living with diabetes, or are the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes there are over 41 1000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you, or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook. And it's not just for type ones, any kind of diabetes. Any way you're connected to it, you are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and present it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#1019 Diabetes Pro Tip: Explaining Type 1

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

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming fold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juice box free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. The Pro Tip series that exists inside of the Juicebox Podcast is mainly about management of type one diabetes. There's also some informative stuff like what can you do when you go to the emergency room to make your experience easier. And today, I'm going to be filling a need that's been presented to me by the listeners. So I don't know if this episode is for them to get ideas from or for them to share, or maybe both. But in this episode of The Juicebox Podcast, I along with Jenny Smith, Jenny, of course has had type one diabetes for 32 years, she's a certified diabetes educator and an all around amazing person. And me Scott, who's you know, just the host of the podcast and the parent of a child with type one diabetes. So this episode is for people who need to understand type one diabetes more, or for those of you with type one who struggled to talk to those people about what type one diabetes is. See, if you're like the school nurse or a teacher, maybe my boss, friend, a neighbor, somebody wants to have my kid over for a sleepover. This episode is for you to try to understand better what type one diabetes is and what your role in it can be. And if you're a person living with type one or the parent of someone living with type one, and you're struggling for how to talk to people about it, this will be beneficial for you as well. And a huge welcome to those of you who don't usually listen to a type one diabetes podcast, those of you who care enough to try to learn a little more about type one so that you can be a better support system for the people you know and love living with type one diabetes, it means a lot to them. I'm sure they're really, really excited that you that you took the time. So I hope we can make this informative and fun for you. I think we have let's get started. I want to jump right into this because this has been interesting since I brought this up to you the other day, I I sat down myself and I thought who in my time have I spent? Have I had to describe diabetes to you know, when I started kind of making a list. And then I just a lot of people, a lot of people and then I went online and I said you know into the private Facebook group for the podcast and I said hey guys, Jenny and I are gonna do this thing. Who do you wish? You know, we could talk to and here's how the list came back. Grandparents, teachers, parents, babysitters, somebody who might have My kid for a sleepover, my child's friend's parents, a coach of a team, spouses or significant others, co parents, roommates, extended family, school nurse, co workers, bosses, bus drivers, and, and and family of adults with type one. So people who are diagnosed as adults who then are around other adults who never end up getting it. And then very much at the end of the list, someone said, Oh, I wish you could explain it to chaperones. And I started thinking, everyone should have just answered with the same word, it should have said, people, because this is just, this is like everything else around diabetes like you like, oh, explain it specifically to a coach. So what I'm going to tell you is, I think we're going to have a conversation, that whether you're one of the people I listed, or just a person who knows somebody with type one diabetes, when you're done, I'd like you to understand the basics of type one better, maybe a little bit of terminology. So things are happening, and maybe more so the mind of the person with type one, what's happening to them, and how you can be supportive of them. I think that's the goal here like not to speak to like, like there was there in the beginning, I thought, oh, we'll do a couple of minutes talking to grandparents, and then a few minutes tall, and I'm like, No, it's all the same thing. Really. Right.

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

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

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

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

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

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

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

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

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

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

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

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

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

Scott Benner 19:31
This was Jenny's politely saying don't look at somebody go diabetes. Oh, where have I heard diabetes from my grandmother? Oh, you know what? Oh, my grandmother had diabetes. They cut her leg off. That's not a good thing to say to somebody. Yeah, right. And just yeah, don't don't do that. Okay. So keep keep those thoughts inside. Because that's not helpful. And it might have nothing to do with the person you're talking about your grandmother's situation. Very well could be a ton different than this person situation and that It's important to understand too is that in this day and age right now, I know this sounds kind of strange, but this is the best time in the in the history of the world to be diagnosed with type one diabetes. So people have a much greater chance of staving off, what could be long term complications, and they have a much better chance of managing day to day in the moment in a way that won't impact their lives too badly. Now, I feel strange saying this because on one hand, what I'm telling you is, these people need some leniency. They need some understanding they need a little space because they're making decisions about how their bodies are, you know, working. And at the same time, I want to tell you that they can do anything, and so don't limit them. You know, and that's hard to do too, because you might not feel like you're limiting them you may feel like you're protecting them. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing an easy to read screen, it fits well on your hand, and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juicebox free meter go get yourself a free starter kit. while supplies last US residents only touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org. Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean it's a lot type one it's school, the D box program golfing for diabetes dancing for diabetes, which is a terrific program just click on that to check that out. Both are caused their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org or find them on Facebook and Instagram. links in the show notes links at juicebox podcast.com. To touch by type one and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk. And correct they don't need that. And if they do need that, they'll know and they'll ask you for it. Yes,

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Scott Benner 1:15:37
I think in the last thing, I think I want to say is that, as my dog barks, that you don't want to separate yourself from a person's life because you're scared of their thing. Like that hurts like it might, because I talked about co parenting earlier and spouses who aren't as involved, I believe, sometimes they just don't want to mess up. So they step back, but you end up alienating the person with diabetes and stranding the person who's trying to help them. And and I know, it's a lot to figure out, but you could like trust me, I know, as you're listening, you don't know me, but I am. There's nothing special about me and I understand diabetes really well. And everything I know about it. And Jenny knows about it, we put into those pro tip episodes. So if you're just a dad or a mom, or you know who's like, I don't want to get involved, because I'll mess it up. You know, you're doing other things that I think you don't mean to be doing in your relationships. And if you understood it better, I think you could do better it would help. Yeah, it really would. Anyway, I could keep talking about this forever. So let's just stop. Jenny, thank you very much for doing this with me. Of course. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed you're starting over episode 1001 all about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and an episode 1025 We talk about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with this and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful info Emeishan presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so it is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months, I've never met Scott. But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're living with diabetes are the caregiver of someone who is and you're looking for an online community of supportive people who understand check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.