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

#1024 Diabetes Pro Tip: Female Hormones

Scott and Jenny dive into the topic of hormones, specifically female hormones and how they affect those with diabetes. They discuss the challenges and changes that come with menstruation and provide insights on managing blood sugar levels throughout the month.

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 0:03
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 healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn. Find out more at G voc glucagon.com. Forward slash juicebox. Okay, give me a testing. Hello. All right. You're there? I'm there. Okay. Yeah. All right. So I've spent, not my whole life, you know, but the last number of days and weeks looking into all of this, trying to get ready to make a pro tip episode about female hormones. And it's a very scary proposition. There's a lot going on. I'm not scared, scared, but I'm overwhelmed. And then the last kind of piece of it was that I went on to the Facebook page and said to people look, you know, throw out your questions for this episode. I want to be clear, I almost didn't think I needed their questions so that we could talk. I wanted to see if there was repetitive need, like you don't even like what are people like same questions over and over. And my goodness, I mean, it's kind of obvious, right? Like so. The questions ranged from like, just God, is there any rhyme or reason to this to? What about menopause? What about perimenopause, what about the time where my kid isn't getting their period yet, but it's starting to exhibit, you know, symptoms and having hormone fluctuations, talking about puberty and then pregnancy and then and then. Oh, is your head spinning post pregnancy? It's it's listen nature. God, I don't care what you think this is, there's gotta be a better way to do this. Someone, someone, this was an afterthought. Like, like someone at the end was like, oh, you know, here's what we'll do. We'll throw some eggs in here. And then you'll have to throw in some estrogen to get the eggs really roll and then one egg will come out. And if they don't get pregnant, the whole thing will just bleed out of their vagina. Perfect. Like, I don't know who what. Oh, my goodness. PCOS keeps coming up. Is that polycystic ovarian syndrome? PCOS? Yes. Now I know those words. So already, Jenny, I want you to tell me what you just said before we started recording about the inequities of diabetes management from men to men to women,

Jennifer Smith, CDE 4:48
or from an education standpoint to begin with. I mean, it was not something that was ever discussed in my presence, at least and I don't think my mom had outside of this Did conversations with my peds? No at all about hormones? Right. So I learned all of this as I was having this like, typical cycle, you know, that should happen after a certain point in the sort of teen years. And education today. It's focused as on diabetes, in general, right? Not on, if you're a woman with diabetes, versus if you're a man with diabetes, these are the differences that you will definitely see. So you're a woman with diabetes, you've got all the female hormones pumping in your body. Let's discuss diabetes from the angle of being a woman. Right? I mean, especially for my like, I wouldn't even say, when I start working with somebody, if they're from about the age 1011, all the way into, well, even the women they work with, into the perimenopause and menopause age, that's something in an initial visit, I always ask about, because it, even if it isn't yet visible, it will be at some point. And people need an idea that they need to like, see out into, if I see this, and this and this, I'm clearly not a crazy person. This is body function.

Scott Benner 6:21
Well, I guess, especially given that, you know, because we talk about things in general terms, like the cycles, 28 days, that's in general, it's not, it's not for everybody, and it might not be for you from month to month as well. So if you can imagine when you hear people talk about like diabetes, like just when I thought I had it, it changed or you know, those memes, there's meat is it memes? Oh, my God, I'm old, you know, where it's like Monday, two plus two is for Tuesday, two plus two is seven, you know, Wednesday, two plus two is zebra, like that kind of stuff. If that's already how diabetes feels to people in general, and then you put this on top. I mean, you really are kind of creating two different spinning layers of confusion that can impact each other, or show up on their own. And I don't know how you're supposed to make sense that I actually after going through all this, I have an idea I'll share at the end about how to get a handle on this. But I just don't know. Well, I guess to give people some context aren't in 17. So this is the depth of my understanding of this. My understanding of this is I'm married, and I've lived with a lady for a couple of decades. And, and my daughter has diabetes, and she's been getting her period for a while.

Jennifer Smith, CDE 7:43
And I bet you never paid as much attention as when it really was in reference to diabetes management.

Scott Benner 7:49
Only thing I used to pay attention to was, there's this what I call the nice day, there's like this. There's this literally one day a month, where my wife is a 1950s. Like, I'm making quotes perfect mom, wife, lover, like it's that day on that day, I feel taller and more handsome. Like, you know, like she is so incredibly

Jennifer Smith, CDE 8:18
kind of like Leave It to Beaver mom, sort of, at that age have an idea of what a Mom was

Scott Benner 8:23
right? Yeah. 100%. And I, I bask in that day, because the day that comes after it. I can't even look her in the eye. Because if I do something wrong, she's the different like, and then I know that the the event is coming in about five to seven days. Like that's how it works for

Jennifer Smith, CDE 8:44
us paid enough attention to actually like, I can tell you many, many spouses or partners are,

Scott Benner 8:51
I thought I was gonna die. I was defending my own life, you know. And so for years, that's the only way I ever thought about it. And then Arden starts to get her, you know, and then we're kind of rocking along and taking care of Arden's blood sugar. Like it ain't nothing some days, you know, it's just like, I do really have this all figured out. And then one day, she started getting her period. And it was all fine at first. It actually almost got more difficult at some junctures. But it was it was very structured. So I didn't have any trouble with it really. Right. And then all of a sudden, her periods got heavy. And you know, people listening will know that, you know, Arden went through a year or two of like us not understanding what was going on. She got anemic a number of times she had to have iron infusions. This was all ended up being because of her period. Right? Yeah. So Arden would get her period for like 11 days, like she'd have like 11 day long cycle, and then only a couple of day break before she started to bleed again. It was just really Nicholas, which led us to put her on birth control, hoping, like, you know that she wouldn't bleed to death, because she was, I mean, the impact on our life was insane. Sure, you know. And so first go round with the birth control they gave her it wasn't strong enough didn't really do anything. But they still asked you to be on it for 90 days before they consider changing it. So you, you struggled all this time you think you have an answer, and then 90 more days is struggling. And then they moved her up to another, I guess strength and that has, you know, straightened out her. Excuse me. Also, the first indication of that problem was nosebleeds. Oh, really bad out of nowhere nosebleeds. That only happened once a month. And it took us a while to figure it out. It was literally happening on a cycle. I never was able to connect it to her periods. But the minute she went on the birth control and the second round of birth control, and it straightened out her periods, the nosebleeds never happened again.

Jennifer Smith, CDE 11:11
That's really interesting. Well, and I mean, again, a symptom that if you're paying enough attention to your body, there are lots of things that your body is trying to tell you. Right, if we just pay attention to.

Scott Benner 11:24
And that's why I bring it up, honestly, because part of what I figured out, Jenny, part of what I figured out being a man who doesn't get a period, and a person who doesn't have diabetes, as I consider talking about this with you today was was that you kind of have to, you gotta kind of have to Jane Goodall it a little bit, right, like, you got to take notes and step back and see things and keep wondering what's happening until you can build some, some idea of like, I keep seeing this thing over and over again. And where does that fit on the calendar? And how does it work in relationship to, you know, bleeding or pain or insulin resistance, and then you sort of start making sense of it, you have to track your period. Yes, maybe for six months before you'll be able to wrap your head around it a little bit,

Jennifer Smith, CDE 12:14
especially if your cycle is not regular. I would say for women who, especially women who are considering maybe you're starting to track things and pay attention because you are planning a pregnancy, or maybe you're really trying to prevent a pregnancy. So then tracking things becomes just as important, right. But then along with the lines of even planning a pregnancy, the goal in diabetes is to have pretty optimized management prior to conception. So yes, I mean, you really should be tracking things for a fair amount of time, if you don't have them already nailed down because you've paid attention, right. And there are a number of really good period apps out there. I mean, there are some that are free that do just as well as some of the ones that have all the 1000s of bells and whistles for tracking everything else. But I think the ones that are the best actually have a place where you can keep notes. Because the tracking app that I like to use, I actually track month to month, how my insulin changes have looked this month. So I can go back last month, the month before and actually see, has it been consistent enough? Is it going along with what is normal for me. And that helps.

Scott Benner 13:29
Well, even very recently, in the last couple of months, Apple added a period tracker to their health app, which sounds interesting, robust, and it's free, and a lot of people use Apple phones. So I wanted to throw that out there.

Jennifer Smith, CDE 13:43
I didn't even know that was an option. So thanks.

Scott Benner 13:45
Yeah, so because Arden uses one that's third party, I don't even know what it's called now. But as I looked at people's questions, and I thought about Hold on a second. The gods are coming after me for talking about periods when I'm not a leader. That's right. As I thought about how I been figured, like, like step back and looked at what we had to go through to try to figure this out for Arden. And then I looked at people's questions. The real fear when you see fear is around the unknown portion of it. And all I could think over and over again, when I saw their questions like how do I know if it's going to fluctuate? When do I turn up my Basal insulin if I can't be sure when it's going to start? I kept thinking you're gonna have to track it, you're gonna have to pay attention you're gonna have to put like work in and I know that sucks because it feels like diabetes has already worked. But it really made me think about like, kind of what we talked about another pro tips, which is, you know, some upfront effort can save a lot of heartache, right over and over again,

Jennifer Smith, CDE 14:50
are a lot more micromanagement than you really should need to be doing.

Scott Benner 14:54
Yeah, yeah, you get stuck in that situation where you're constantly constantly constantly adjusting your blood sugar in the moment, which I'm a listen, I'm a fan of if your last to stay flexible, but in this situation where what was the number I saw the average woman's gonna have how many periods like 400. And something or it was like, oh, like

Jennifer Smith, CDE 15:17
hold on in a lifetime? Well, I guess if you expect an average age of a period starting at the age of 12, and there are 12 months in a year, right? So you would have, let's say, one cycle a year. And then the average time period of a cycle, completing would be about, let's say, age 12, all the way to maybe 55, let's say maybe even 60. And that's a good amount of time that you would be having cycle.

Scott Benner 15:52
I'm using your math 55 minus 12, is 43 times 12 months, is 516. So you go. So I'm saying, that's a lot of tracking. I'm saying put in put some, like real, like, it's gonna be honest effort, because you're gonna have to track you know, your insulin use every day. And, you know, just giving yourself I think, what helped me was just simple words. Difficult, easy. You know what I mean? Like, referring to my management, you know, meals were, what I expected, easier than I expected, harder than I expected. Yes, you know, my Basal seemed to work well, not Well, today, like just kind of keep it keep it like that, you make a little note for yourself. And I'll tell you to tracking your period is going to help you get better at taking care of your blood sugar, too, because you're gonna see all all around. Yeah, yes, you're gonna see all kinds of things that you didn't, didn't see before. To begin with,

Jennifer Smith, CDE 16:50
you're gonna learn a lot of things too, in that time of tracking for all of those other variables that we have to adjust around, right? Because I for one, know that my sensitivity, once I've gotten to about day three of my period, after that point, and until about ovulation is a really sensitive time. But it's more sensitive from day three to about like day seven ish. And in exercise, I have to be more aggressive and adjusting my insulin for exercise. Or I will go low. Despite my other tools and tweaks working outside of that, I will go low, if I don't adjust more than I normally would, is

Scott Benner 17:39
that a progesterone period in there.

Jennifer Smith, CDE 17:42
So you're essentially when you're looking at progesterone, that is typically like, peaking at certain points, right. And then there's also the luteinizing hormone, there's follicle stimulating hormone and there's estrogen, and you got a lot of hormones that are coming into play. So progesterone kind of starts to really kind of like, fall off. Essentially, once your period is started, it has really climbed in the time of you coming into potentially having a period. And part of the reason for that is in the anticipation that you in sort of that Avi LaTorre time period, have actually conceived, right? progesterone levels will stay high and continue to climb in pregnancy. One, you don't have conception happen, and you start to have your period, that level falls because there's no reason to have that elevated. I mean, again, other hormones at play here as well progesterone being one of them, but it doesn't need to remain where it was because you're not pregnant. Okay. So then it flexes right.

Scott Benner 18:58
And do do we let's try to think about this. Do we count the the beginning of the cycle is considered when the period starts right?

Jennifer Smith, CDE 19:09
Day one of your period is day one of your sites.

Scott Benner 19:14
In that moment, estrogen at that point is lower. Is that right? And then it starts to

Jennifer Smith, CDE 19:23
and then estrogen starts decline. Coming in to ovulation. And then in that next day is around ovulation and potential like conception. Again, progesterone is sort of like climbing into that time period, right? So, you know, again, all these fun hormones doing different things. I mean, if you even looked up a simple like just Google have a graph of like, what your hormones should look like. You can tell why. One Basal for 30 days in a row if you're a woman who has As a monthly cycle

Scott Benner 20:01
couldn't doesn't work yeah, it does. 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 juicebox 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 to carry case but most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well on your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box for E meter go get yourself a free starter kit. 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 program's 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 G voc glucagon.com/risk. You know what else I learned by digging into all this? Is that not that I wouldn't expect this because it's a physiological thing. But it's incredibly complicated what's happening. It's not just like, you know your your eighth grade health understanding of it, which you know, in my mind was an egg gets released you use it or you don't use it if you don't use it, you know the uterine lining and the egg come out in a period which I know is high level what it is. But the idea of like the ramp up right like the gosh, like you start talking about like follicles and like there's this process that's happening in there where your body's trying to locate the strongest egg to be released. It's not just like the next one on the assembly line. It's like it literally anyway, it's mind boggling. Even the TED talks on it are confusing. Even when even when nice girl sit in front of cameras in front of YouTube and trying to talk to you right in your eyes. You're like, I don't understand there's so much happening. But I think for the case of but for type one for using insulin is it is it as easy as saying that there's a time when you're bleeding. There's a time when you're ovulating. And there's a time when your body is trying to make your body a hospitable place for sperm to live. So that the process of fertilization can happen well, is that basically like there's I mean, that's

Jennifer Smith, CDE 24:45
basically the simplified and I think sort of along the same line of what you're getting at is if you if you're having a cycle whether you're on birth control with a cycle or you're not on birth control with a cycle you can expect the times of your period to show similarities for you in insulin need, right? One person may experience during this phase of, you know, hormone release, or this phase of their cycle, that they always have higher blood sugars now that they've been tracking things, they can say, Yes, I'm always getting higher here, one of the first places that that commonly starts is the fasting blood sugar, or the overnight blood sugar. For whatever reason, in the hormone dance of the human body, that's the first place that commonly women see things are running higher. And if you start to pay attention to your calendar, it will most likely coincide with, that's going to be somewhere about like, three to maybe seven days prior to your period, starting. Some women experience really short lived higher insulin needs. And whether they may have missed a slight nudge up maybe a week sooner. Most of them notice cash, the first, you know, day and maybe the two days before my period, I'm just high, I can't take enough insulin, I dump it all in and I still sit high. Well, next month, you know, if that's the case, and you start seeing higher blood sugars, and you do and you are maybe somebody who doesn't have a regular enough cycle, I would probably expect that this is what's probably on its way, as long as your site isn't bad, you know, all the other variables that it could possibly be?

Scott Benner 26:34
Yeah, so it's going to be incredibly important for you not to throw your hands up to the diabetes ferry and go, Oh, it's just diabetes, it's happening to me again, like, after it happens a couple of times, you gotta say, like Jenny saying, like, this is what happens. Whether or not I can tell you that it absolutely happens on day, I don't know 13 of my cycle or not, it becomes unimportant, like you, you sort of see, you know, it's not any different than, like, as you're talking about all this and about when people see higher blood sugars, like Arden has this too. But because my mindset is like more insulin pushback, don't let it happen. I can't see it. Sometimes I can tell you that we're bolusing more or that I'm running a higher Basal like profile. But I'm so accustomed to just being in the fight and fighting the fight. I sometimes don't think about why it's happening. I just

Jennifer Smith, CDE 27:27
right, you just adjust to get it back to target. Yeah. And I think that's, that's okay, as long as you're okay, adjusting that way. And if that works for you, then great. I think that more women especially again, those who are planning a potential pregnancy, are really wanting to track well enough because they're also in ensuring that their blood sugar's are really optimally managed for possible conception, and that thereafter, you know, so if you really do want more consistency, rather than saying, Well, I know how to do more insulin, I do it all the time. I just, you know, adjusted here and take more, they're just back here or whatever. But if you have even those that have a regular enough cycle, it could take some of the like headache out of the salon. Hi again, I know I need more, I'll take more. But gosh, is this happening regularly enough that I could actually figure out how much more do I need on an average monthly change time? Well, yeah, well, that is less guesswork in the moment that

Scott Benner 28:30
and the reason I brought it up is because the process of getting ready to make this episode with you made me realize I'm going to set up three different profiles for art and because she's gonna go to college. Yeah, I know what I need to do. Her blood sugar is gonna go up and she's gonna be like, this never used to happen before. You know, and she's, you know, not going to realize the thing she's missing is me. Texting, texting, you're going yo Bolus, what are you doing? Cuz because for people who don't like really understand, I know, it sounds like micromanaging to some like newer people, but for people listening to podcasts, I don't imagine it does. Like, I don't like to see a blood sugar over 140. And I act like like, you know how some people might act when your blood sugar is 300 is about how I start feeling at 140. I'm like, yo, what are we doing here? Because in my mind, I'm targeting back to AD in my mind 140 60 points too high. Like get it get it, but the the amount of insulin that it takes to get it has climbed since Arden's been on a birth control pill. So while yes, the birth control pill has regulated artists period, and she's not bleeding to death anymore. Her diabetes has gotten more difficult. Yeah, because and now if you go look at graphs about how it's like, Listen, what I know about birth control is probably not enough. But you're getting you're getting a pretty regulated amount of these hormones. Every day, and that birth control is literally tricking your body into not releasing an egg. I didn't realize that, that the bleed

Jennifer Smith, CDE 30:09
is keeping you on a one cycle of hormone akin to not needing

Scott Benner 30:14
ovulation. Yeah. Right. And so you're not nothing's happening. And obviously like the whole process isn't happening actually, I think what confuses people? Is that the bleeding that happens when you're off the hormones and you're on the the placebo placebos is not your period. It's got it's actually got a name. It's, uh, hold on a second. I have so many browser windows open. It's called withdrawal bleeding. Yeah, it's not your it's not the same thing.

Jennifer Smith, CDE 30:44
Never heard. I've never heard it called that before. Okay. Well,

Scott Benner 30:47
I was schooled, I recorded an episode about this with a different podcast. I'm going to be on a vagina podcast pretty soon. And that's funny. Oh, it was hilarious. And as I was being asked, I was like, why is this happening to me? But but but people who really take birth control? I don't mean, seriously is the wrong word. But but see it as stuff that maybe, you know, there are people who think you shouldn't do it. There are people who think you shouldn't tell people how to live their lives, there's a lot of consternation around birth control in some circles. And it's important for those people for you to know you're not actually getting your period when you're on birth control. So and I have to be honest, I don't want Arden to be on birth control, not because it's birth control, but because I don't want her to take anything she doesn't have to take right when she was going down. You know what I mean? Like, we were looking at her like, I guess this is it, like, you know, the money, the money we saved for college, we could buy a house with now or something? Well, and

Jennifer Smith, CDE 31:48
that's I mean, those there are, I think, really, there are really good reasons to utilize birth control all around, there are. But in a case like this, it's almost a necessity in order to get containment of something. Now, the other thing is, you know, is this something that's just, it's just the way that her body is gonna continue to work even into like adulthood, where she continued to have to have this level of birth control, you know, management, so that she doesn't have this problem. That question, you know, I had

Scott Benner 32:22
constantly like, when do we just like, stop at once and see what happens? You know what I mean? Like, but I don't understand any cause and effect reasons why using birth control for a while, would you know, quote, unquote, regulate things and then you wouldn't need it anymore. Were was this just a cycle of her life, and it was going to pass on its own. And we're never going to know, as long as she's on the birth control pill. Right? I keep saying, I keep thinking maybe, you know, a few months before college, maybe we like, would try to bail on at one time and see what happens. Because when you've done

Jennifer Smith, CDE 32:58
enough work already to know, I mean, she's used several different types of it. So you also have an idea of what works, what really did nothing good. And what does actually work because there are so many kinds of birth control that are available. And so many mixes of hormones that you could use, or some are single, single hormone, some are a mix of hormones, at different levels. They're taken different ways. I mean, there are

Scott Benner 33:32
at one point, our our pharmacy benefits changed her over to a generic things were going great. And then they change the generic and it went right back to where it was again. Oh, and then we had to swap her back to another one.

Jennifer Smith, CDE 33:45
So funny, right? I mean, if it was the same thing, only a generic what's different about it? Right?

Scott Benner 33:53
I have no idea. This is the this. Jenny in one way or another vaginas are the bane of my existence. They're, they're torturing me from different angles and different perspectives all the time. And, and on the Ardennes period has been, I mean, a roller coaster, it has not been fun for her for the people trying to help her. Well, and I

Jennifer Smith, CDE 34:17
think you see it from a perspective of you want the best for her. You want her to be healthy and enjoy life and everything's you see it really as a it's problematic, not from a physiologic standpoint is problematic and what it brings into the picture of her management, you know, you may have a very different look on it. If she didn't have diabetes.

Scott Benner 34:42
Yeah. Yeah, I guess I there's so much about I wouldn't even understand or pay attention to her. Right, Senator. So I, I'm basically having this conversation to tell people that I'm going to start doing what I think you should do, like I'm going to I'm going to set up my own tracking app. And I'm gonna track Arden's like insulin in bushes, Jenny's making a face because I don't,

Jennifer Smith, CDE 35:05
I'm pretty AMI like, you don't do things like

Scott Benner 35:10
she's gonna leave for college and either bleed to death or having a onesie and the aids like one of the other. Like, it's just one of the others gonna happen.

Jennifer Smith, CDE 35:18
So and typically I mean that is it's also another piece in the mix too because you brought a lot of things in that could be happening in periods that are mismanaged, right? Someone who has excessive bleeding can bring in a lot of other health risk problems that can also make the diabetes management piece even harder to figure out and manage around. So it's really important. I mean, on average, don't quote me, but I think I read at one point, like the average woman with a normal healthy cycle length, and not excessive bleeding, really only loses about a quarter cup of blood through the whole period, which is it's a tiny amount, right? I mean, if you know what a quarter cup measuring cup looks like. So I mean, if you're saying gosh, excessive, clearly excessive is like lots and lots that shouldn't be happening.

Scott Benner 36:14
Here's the one measuring stick for you. Arden's ferritin gets down to like the teens, she gets an infusion. They tested again, it pushes it into like the 130s. It gets pretty high when you get the infusion. Yeah, within three months of not being on the period. She was back in the teens again, teens again, yeah. So and just I mean, for people who don't know, anemia, low blood, low iron, whatever, you know, however you get to it. I mean, just can't hardly pick your head up. Oh, freezing feels horrible. You feel like you're dying, the whole time, shortness of breath. You can have heart palpitations. Like, it's not good. You know, you get like pain and you're like muscles and joints and like, it's, it's terrible. So Arden's gonna stay on this as long as she needs to. But yeah, but it's funny, while she was home, aren't chill at home, like when she was going to school from home, she needed less insulin. As soon as she went back to in person I knew her needs, were gonna go up again. And I did the thing, where I was bolusing too much and didn't adjust settings for a little while to like, it happens to everybody, it's sure doesn't not happen to me, because it's my podcast, like, you know, like, you're so used to managing one way. And then this big piece of your life changes. And you don't even realize it for some reason. And that just made me sad, or when I realized that thinking about this, because basically, on your period, your life is changing. Like every couple of weeks, you know, like there's this impact and an end, it might not happen to everybody, there are some women who will listen to this the go, oh, that doesn't happen to me, or, you know, just like, Oh, my God, well, in fact,

Jennifer Smith, CDE 37:59
I've got, you know, some women that I've worked with, you know, even outside of like preconception planning, just in terms of diabetes management. And obviously, the cycle is a piece that we talk through and talk about, and some women who actually have the higher blood sugar levels during their period. Not before. It's more really an onset, while they're actually having their period, which is not the typical of what I've seen, but again, I've heard it enough that it's also not odd or rare,

Scott Benner 38:30
ya know, in the questions that I sent to you that that I found online, it was almost like people were like, hey, during these days here, my blood sugar is incredibly easy. And then somebody would come along and say, well, in those same exact days, my blood sugar is incredibly difficult. And yeah, I'm sure if we could, you know, Doctor House, every person in the world you might find, but I don't think that's gonna I used to love that show. I mean, right. sarcoidosis usually. Right? And I don't even know what that means. But, but so did you see anything in these questions that you definitely wanted to go over?

Jennifer Smith, CDE 39:08
I was just gonna go back to because

Scott Benner 39:14
because at some point, too, there were a number of questions about menopause, too. And some women are asking about what about when they take hormone replacement? Is it going to happen then, and I don't know, but it seems like the same as taking birth control to me, right your your address, you're adding hormones to your daily intake. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast, private Facebook group Juicebox Podcast, type one diabetes. There are over 41,000 active members and we add 300 new members every week. There is a conversation how 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.

Jennifer Smith, CDE 40:23
And hormone replacement therapy is usually for the most part centered around like the menopause kind of time perimenopause, menopause kind of time, it's supposed to help to ease much of the hormonal transition that's creating some of the symptoms, things like the hot flashes, and the energy swings and the insomnia and the, I guess, level of irritation, one woman may experience versus another. Right? So that's supposed to technically, even things out more. And it's a good question to actually ask, if you haven't, and you're considering or already taking the hormone replacement therapy, you know, asking your physician if they know anything, really about that piece in terms of what they should expect. My expectation would be that with the replacement therapy, if it's going well, and the dose is well managed, technically, you should have actually more stability than in how you're feeling, which should also bring more stability to your glucose management, right?

Scott Benner 41:35
Well, I guess while we're in this area, what about somebody who's had a hysterectomy? Did they lose all of those, that the cycle is just gone? Right? So that is, but it's all the hormones are all the hormones gone to?

Jennifer Smith, CDE 41:49
So although I mean, there's a good question, because quite honestly, you could have a partial or you could have a, like a total hysterectomy, right? I mean, so there are hormonal imbalances that can definitely happen with partial hysterectomy. It does, for the most part, from what I know cause less dramatic change in hormone levels than a full hysterectomy does. So in terms of that, you know, your hormones definitely shift because obviously, there's nothing there to cause that trend of hormones change, right, there's the period, right disappears. So, you know, overall, while there may be some initial management that needs to be done, I wouldn't expect that there would be as much I've worked with many women who've had hysterectomy. But I wouldn't expect that there to be as much fluctuation, as they probably usually had. I mean, when the menopause obviously is kind of similar in that when that happens, obviously, your ovaries stopped producing enough hormones to continue the menstrual cycle. Right? So if you had a hysterectomy, which includes removing the ovaries, you would then be essentially moved into sort of like a premature menopause kind of time. Right? So

Scott Benner 43:19
all right. Well, you know, if there's one person that asked such as a detailed question that I think Yeah, way they broke it down might be valuable for us. So her first question was, why does the body become more insulin resistant during different phases of the menstrual cycle? Just the laid out for people now that I think we haven't, but is the answer, just simply there's more hormones at different parts?

Jennifer Smith, CDE 43:43
Right. And so that's, you know, initially we're talking like what is the surge of the different hormones through the course of pregnancy or through the course of of a menstrual cycle? Right? So in terms of that rise up in insulin need, you know, there are a couple of points of time for different hormones, one of them progesterone, as its kind of rising, in terms of, are you going to find out you're pregnant? Or are you now you don't know if that you're pregnant, or you're not going to be pregnant, so you end up having a cycle. So then that climb in progesterone is again that typical time period before your cycle starts, that you would have insulin resistance creep into the picture. It may creep slowly, like seven days before you start to notice you've got that rise in blood sugar, okay, maybe you change up your overnight settings or, you know, whatever it might be. As you get closer to your expected first day of cycle, you're going to see a lot more resistance. I mean, many women find 20 to even 40% more insulin needed in that time period of climb in hormone, and then that most women experience the most significant and resistance the day before their cycle starts

Scott Benner 44:55
the day before the cycle starts which is the day yes leading

Jennifer Smith, CDE 44:59
day before there. Put yes there before their period starts, there's their bleeding happens, the event here, but in the event, there you go. So you know, that could be, you know, a visual point of saying, Well, I'm not crazy, I didn't need to change my pump site and change to new insulin or at nothing was really wrong, I see that this is the pattern and this is what's always happening. So how high did my blood sugars go? How much more insulin did it look like I continually used in the past two or even three months, so that you can expect it now. And you can make a, I guess, a wiser shift in your insulin rather than just sort of like completely guessing. Right? Oh, I'm gonna take three units today because clearly two and a half yesterday didn't work well. Okay. But if you have some back knowledge, you can say okay, this is definitely how much more I needed. And I can adjust better here. Now

Scott Benner 45:53
do you know there are months that Arden's period doesn't begin on the first day of the placebo, it happens sooner. Which doesn't make any sense at all. She's definitely kooky in her belly, like like, something's, something's going like when that happens. So two days ago, I saw as much resistance from her as I as I had in the month. And I said to her, like something, you're gonna get your period. Soon she goes, I have like four pills left. And I was like, okay, so then yesterday, dude all day, like we had to cut her insulin back. Crazy yesterday. So when she got home from school, I was like, did you get your period? Because No, I still have a couple of days left. But her body acted like her period started yesterday starting. And I'm like, I wonder if the bleeding is now adjusting back to where it's supposed to be. I also wonder, sometimes like Kelly's, you know, still still matched traits, my wife still fertile.

Jennifer Smith, CDE 46:52
That's a good thing. The longer you actually have your cycle, the healthier for you. It reduces a lot of the risk of female related cancers. Because the longer you have your cycle, and the length of the cycle matters, too. Not that this is diabetes specific, but it's a piece in the mix of if you've bad cycle, regular cycle, and the longer you have it in the life the better for you.

Scott Benner 47:16
Yeah, well, that's good news. But what I was wondering was is you know how you kind of sync up to people? Yeah, like I I've often wondered if Arden and Kelly even being near each other is messing with Arden.

Jennifer Smith, CDE 47:29
Very likely because in college, I had three other roommates. And at that point, we we all within a week had our periods at the same time. Yeah, like it was not a house

Scott Benner 47:48
or buying a bigger trash can. Okay, so this person's next question was, do insulin needs change? Only when premenstrual or does it happen around ovulation as well? I think yes. We've pretty much gone over that. Right.

Jennifer Smith, CDE 48:03
Yeah. And ovulation. For some, just in clarification, some women notice more significant insulin resistance around ovulation than they do in the pre cycle or like period start time. And it's often much shorter lived have a is a swing up, more noticeable rise. Post meals often tend to be impacted more if you're going to notice a change around ovulation. But it's only going to be like 24 to 72 ish hours around that ovulation that you're going to notice such significant resistance. So again, we've got this like roller coaster of hormones going on. Making people feel crazy.

Scott Benner 48:48
So I watched a video about how to know when you're ovulating getting ready for this. And there's a lot that you can watch. Oh, geez, I learned a lot about discharge and cervix ripening and feeling sexual and that it sometimes happens and sometimes, to some people doesn't happen to others. Some people get many of the symptoms, some people get fewer Nan. Yeah, you know, I love it when something spelled out to you like this. Here's what could happen unless it doesn't. Or maybe it won't, but K could and you're like this is not helpful, like, say something concrete or stop making videos. But it was really, I don't know, it was interesting. Anyway,

Jennifer Smith, CDE 49:32
there's a really good book I got actually years ago before we even plan to to start trying. It's called taking charge of your fertility. And it goes through it's really, I think, I think that it should be given to women in general. Because even if you never plan to have children, it gives you a really good idea of how the female body works. Yeah, and it Can, from just that standpoint make you feel less like? Like, I've always kind of hated when people are like, Ah, she's getting her period. Like, that's the reason for all of these mood swings and whatever. Well, it's I mean, that's, quite honestly, it could be true. I mean, it's somebody's meaning it in kind of like, not a very nice way. Yeah, but it is true that hormones change in flux a lot. But for you to know that as the person living with it, so you don't feel silly, about that's your body. It's supposed to be doing that.

Scott Benner 50:34
I'm 20% More a feminist than I was before I started paying attention to this. And I was already on the lady side. And so I mean, listen, I've never once been given medical direction that began with start with a clean finger. But I've heard those words a lot. Now, since I've been paying attention to this. And I just thought like poor girls. Like you don't even like Jesus and seeing it happen to my daughter, like firsthand. It really does. I mean, if you're, if you're not moved by it, I mean, I don't tease my daughter or my wife about like, Oh, your periods come and you're acting. But I tell you, when I was younger, I probably said it. But now that I've lived around it, I'm like, it's not. I mean, they should just say you should, you should be thanking them, not telling them. Yes, sir. You know,

Jennifer Smith, CDE 51:19
I know, to some degree, and I'm very happy that they have two boys. Because I'm like, You're gonna go to your dad. This is dad's department, go to your father,

Scott Benner 51:29
whatever he says it's not going to start with begin with a clean finger. I can tell you,

Jennifer Smith, CDE 51:33
nobody asked Bobby about that. And you

Scott Benner 51:35
You're lucky to because you're not going to ever be in this situation that Arden and Kelly are in where your periods are like, No, it just jerking you back and forth on timing. Right? You know what I mean? Right,

Jennifer Smith, CDE 51:45
right. Because I have, like I said, I have experienced that like in college. But I don't think at that point, I was even while I did a really good job of management as well as I could. That technology at that point was not, I mean, there was no CGM. I was still doing, you know, a lot of darn finger sticks a day to see where things were going. But I don't think I was as attuned to even wanting to pay attention to why something I was just like, I didn't even at that point. I was like, it looks like I just need a little bit more insight.

Scott Benner 52:22
I mean, maybe we're a decade into having the technology where you can break this stuff down a person's next question, I really want to thank them for this. And I don't have her name here, I apologize. Is you know, she brings up what are ways to track it, um, you can track it on a paper calendar, you can track it in an app, it's my intention to just like I said earlier to it a quick, easy way, maybe even colors would work, honestly, you know, green, yellow, red for insulin. I would track insulin needs I would track when the period starting, I would try to figure out as much about ovulation as I could. So you can kind of find that window in there about where it is. And I'll tell you to like it sucks, but you could track your mood. You could track your you know, your sexual desire. Like you can make all those little like clicks there. It's yeah, you don't I found thinking sucked for women the whole time, is that things that from an outsider's perspective seem like choice can be driven so harshly by hormones, which can make you feel like you're not doing things purposefully like it's your body doing it

Jennifer Smith, CDE 53:34
telling you to do you telling you to do Yeah,

Scott Benner 53:37
like, like, I would hate the idea of, I'm on a date. And I'm open to having sex tonight. Not because I want to have sex or because I like this person. But because my hormones are in a state where it's telling me

Jennifer Smith, CDE 53:50
they're kind of telling me to feel this way.

Scott Benner 53:53
Yeah, do this now. Because sperm will live in you for five days, and then we can get you fertilized and give you a good chance that, you know, of bringing this egg along. That's, I mean, it's kind of which brings

Jennifer Smith, CDE 54:07
in a lot of interesting fact, especially for the teenage. Right, yeah, where I mean, the majority of teenagers at this point are not considering conception. They're not they're beyond that, you know, for many reasons, but those are some of the things that your body is supposed to be telling you to do. Right? And you know, what's the reason? Well, eons ago. People were getting married when they were 1415 years ago old and having kids at that point, in fact, you know, if you weren't married by the time you were like 25 was like it was over.

Scott Benner 54:49
Window, right, because you were five years away from dying and probably it's um Well, I mean, I listen. It's beautiful, like you know, in a nature kind of natural ballistic weigh like, it's amazing. I just found myself feeling badly that you could be having feelings or thoughts that aren't the ones that you decided to have. But then I kind of brought it out larger. And I thought, when my iron was lower, I wasn't who I was. Right? I mean, we're all just, you know, some dialed up level of different chemicals and hormones and impacts and everything. And I, you know, I think that I hate to say that I think this episode could have been like, Hey, you should track your period, and then make better decisions about your insulin. Like, I really think that could have been the end of it.

Jennifer Smith, CDE 55:36
And then well, I think there's other I checked, there were a couple other questions in here that I think that do go. I mean, they they kind of go into, yes, that's the base, track your insulin, see what you need, and then make the decision on how to make your insulin delivery system. Do what you want it to do before you right, but there were a couple of questions. One of them was on MDI. Che change my diesel in a certain point of my cycle to deal with increased or decreased position resistance. And I should I also focus on adjusting my Bolus is I can say that, absolutely, you'll need to adjust at least your Basal insulin even on MDI. I mean, when I was MDI, and had caught on to the fact of needing more, based on what my blood sugar was doing, I knew that I needed a certain dose, that was three units, I still remember it was three units higher than my baseline dose for the time period of resistance that I needed. So you know, in terms of that, I could always adjust and unless something shifted and changed, you know, I would have maybe used a little bit more, or a little bit less. But overall, it was, it's funny that I still remember three units, where it was always what I use when I had my period. So yes, you could use more. And if your doctor isn't directing you to do that. Our doctors don't direct us to do many things that we end up doing. This is not advice or recommendation to do that, but discuss it with them. But it definitely bring in maybe some of the logs that you've kept and say, Hey, I'm noticing this, would you agree? I'm thinking I need this much more insulin, right? I mean, always check with somebody, obviously, if you feel that you need to boluses could they need to adjust? Absolutely, they could.

Scott Benner 57:32
Well, you know, I just did the math real quick, three units is only like point 125 an hour if you're on a on a Basal program for a pump. So right, it's but but, but it might have been significant for you. Do you remember what your basil was back then?

Jennifer Smith, CDE 57:48
Yeah, I do my basil. And overall was sitting at 12. And I needed 15.

Scott Benner 57:56
Okay, yes. Okay, so that makes a big jump. Even though it doesn't look like a big jump per hour. It is a big jump percentage wise, it was a

Jennifer Smith, CDE 58:03
big jump percentage wise, and it was a bit I mean, it looks like a big jump like Gosh, going from 12, all the way up to 15. Oh my gosh, like, that's a lot more insulin, right, especially when you talk about, like adjusting things. Okay, we're going to add one unit more of your Basal insulin. And we'll see how this manages things over the course of that whole 24 hour time period, right. The other one that I thought was good to focus on would be using algorithm driven pumping systems. As a female, the algorithm was not, it wasn't built for this to deal with hormones. It was not it wasn't built for hormones, it wasn't built for pregnancy, you can successfully use it. If you know how to manipulate settings, right? I I personally find that it's better for me to just adjust my baseline profile in my system. And then the months that I am more resistant on top of that, then a temporary adjustment up using a temporary Basal or an override or you know, whatever your adjustment is for the algorithm that you're using. I adjust up using that. Yeah.

Scott Benner 59:21
Is this whole conversation really similar to what you would have if you were talking about like, a teenage boy who's going through a lot of growth and hormone changes and stuff like that, like just it's just not on a cycle that you can see as well.

Jennifer Smith, CDE 59:38
Right? It's not on a cycle. That's as I mean, it doesn't seem to be from the team guys that I've worked with. It doesn't seem to be as cyclic. Yeah, predictable, right? It Right, right.

Scott Benner 59:50
This really is predictable, though, within reason,

Jennifer Smith, CDE 59:53
within reason. Yes. And I can even see if you're the person with the irregular sight Goal, let's say 25 days, one month, 29 days, another month back to 30 days and then back down to 25 days. Despite that, the things that you're seeing happen to your blood sugar in that time period will continue to happen for you. Yeah. Right. So even if your cycle length isn't about the same, if you start to see those in a time period that could be soon enough to be close enough to like an early cycle. Or maybe you're gone back beyond that, and you haven't seen changes yet. And up now I see changes.

Scott Benner 1:00:36
Okay, right. Yeah. Well, I was just thinking that you're talking about like variables and inside of variables inside of variables. You can, you know, you know, food, food cravings are not uncommon, right around hormone changes. So you could you could have forever thought, why is it sometimes I'm really good at nachos. And other times, I'm not really good at nachos. And maybe it's because once in a while you have nachos when you want them. And sometimes you want nachos? Because your hormones want them. And you're already in a situation, that's more difficult. And then you add in food, because what made me this was the question here is like, should I eat differently or exercise differently through different phases of my cycle? She's a great question. And it made me think, you know, I'm not into telling people how to eat. But there are definitely foods that are easier on you that take less insulin that you might want to try eating, while you are having an increased need for another reason, because now otherwise, you have to increase needs correct difficult food and your hormones at the same time. Right.

Jennifer Smith, CDE 1:01:39
And the hormones are driving a desire for things that otherwise you may have very, you may have very easy management around, right. You may love nachos, but your typical serving of nachos is appropriate and, and fine. And if it's a hormone driven time, you know, you might eat much more of your batch.

Scott Benner 1:02:00
You know, while we were adjusting Arden's birth control pills and getting it right, she couldn't stomach meat. She was not a vegetarian kind of person. And for a while she couldn't stomach meat. Like just get it away from me, she couldn't smell it, she definitely couldn't even think about eating it. And then as her as the pill, we found the right pill. And it got kind of like set in stone. Now that's come back a little bit.

Jennifer Smith, CDE 1:02:25
It must be something to do with the hormone levels in the birth control she's using because it's actually not uncommon for just thinking about hormones in general. Many women have some aversion to meet during pregnancy. Yeah, many women can't stomach red meat specifically. Okay. So I wonder if it's something hormonally similar. That was weird happening for her before it got regulated.

Scott Benner 1:02:52
I'm running around the house pointing to that my wife's like, that's crazy artists like you don't like Arden just thinks I pay too much attention to her. So she's like, stop paying, like caring. I tried to level up to the OB the OB is like, I don't know, I'm like, god dammit, I'm right about this. I was like, no one's watching these people more than me. You know what I mean? Like, um, they trust me, they'd all be dead without me, Jenny. Like, in one way or another? My wife, like, you know, like with the thyroid stuff, like, I'm the one who's kind of like, stepped back. Like you guys hear me talk about on the podcast, like being micro and macro. Like, on my family on macro. Like I step back, I look for big picture stuff. And I don't worry, but when I start seeing stuff over and over again, I don't know. It's just who I am. Like, I just, I don't know, I worry about people. So

Jennifer Smith, CDE 1:03:36
that's not a bad thing necessarily bad

Scott Benner 1:03:39
for me. It's great for them. You never noticed me worrying about myself. But

Jennifer Smith, CDE 1:03:46
was this I think this kind of me answers some of the question. I see and hear about age. Do you how old was Arden when she had her first cycle? Do you remember? Of course you remember?

Scott Benner 1:03:57
No? I don't know if I do. It was a little later than her friends. Okay, maybe,

Jennifer Smith, CDE 1:04:05
as was, as was I have a couple of questions here. And, you know, just relative to like, When should I expect this in my daughter? Honestly, could be as early as age 10. Wow. Honest, and it could be I mean, I was I was definitely late. I was definitely late in getting my cycle comparative to all of my friends. But I also think, in terms of that, my, my management wasn't then what it could have been if I were diagnosed in today's age, right. So I think that the management style that I had, at that point was not managing well enough to allow my body to actually be consistent enough to start my cycle at the time that it technically should have started. Yeah,

Scott Benner 1:04:57
this is Jenny's third attempt to let You all know to go back and listen to all of the pro tip episodes, you can do a really great job of getting your settings right understanding how to make changes for yourself how to Bolus for meals, how to keep high blood sugars from happening, like she is very artfully telling you, it's the ability and understanding is the is the firm foundation of living with diabetes. She's just, she's so nice about it when she says, Say what Jenny saying, y'all aren't doing a good enough job. You gotta get in there and try a little harder. You know, it's funny, I think Arden was 14 Having just turned 15. And I don't remember the date. I remember the situation we we, along with a number of her friends, were on our way to go swimming. And this was Arden's first time swimming with a period. And a bunch of little girls disappeared upstairs in my house, and came back 20 minutes later, disheveled, sweaty, rocked, and the end the one girl just we couldn't get it in. And apparently, this is apparently at one point like a mechanic

Jennifer Smith, CDE 1:06:08
and how funny that they actually like. I mean, they felt comfortable enough with you that they actually announced it to like a guy. I would have been like mortified, telling my dad something.

Scott Benner 1:06:19
No, he just described to me as Arden was a car on a lift, and the girls took turns trying to change oil and couldn't figure out how to do it. Oh, that's interesting. So that's about what happens around here usually. And well. Actually, I gotta say that's not usual. But but it didn't work out. And so I'm thinking it was the end of her 14 right around her 15th birthday. If I'm paying from guessing right? If I'm wrong about that, then it's no, it's not 1516. She's been at this for a while. I think it's 14 to 15. But yeah, like this could like you could have kids getting their periods, all kinds of crazy, just like what I used to hear like the hormones and cow's milk or making girls develop sooner or something like I don't know if any of that's true. But you know, there are girls walking around sometimes where you're like, are they 20 or 10? Or like what you can't tell?

Jennifer Smith, CDE 1:07:09
Yeah, I know. Yeah. The I mean, I think that that's like a rabbit hole of we could dive in there. But it would be a long, long discussion.

Scott Benner 1:07:18
We should make euphemisms about holes while we're talking about periods. So. So I mean, do you think I'd see it? Do you think there's anything else? Like? I mean, I feel like this is a good conversation. I mean, perimenopause, people are asking about different kinds of birth controls, like there are non hormonal birth control, like, ways, right. So, I mean, there's, I'll tell you, more than two people asked about Plan B. Whether it has an app, whether or not that would have an impact on blood sugar's and I wasn't able to find that out. You know, I

Jennifer Smith, CDE 1:07:55
that is a really good one. I can actually ask my my old mayor, may MFM, I can actually ask them if they have any reference to that having worked with enough women with type one? I don't know. I mean, the goal of that, obviously, is to not conceive. So it has some level of hormone shift to prevent pregnancy,

Scott Benner 1:08:22
you would think it's an overwhelming of hormones to kind of stop

Jennifer Smith, CDE 1:08:26
whether it has an impact on blood sugar? I don't know. It's a really good question. I

Scott Benner 1:08:32
don't know enough about how that works. How about IUDs? Do they impact blood sugars? That I'm sure you've seen in practice? Right?

Jennifer Smith, CDE 1:08:40
Right, those more they seem smoother than other birth control methods. From what I have seen. So do they have impact? They probably have an impact in terms of initially having one and then the outcome of what now your sort of monthly cycle, if there is still one remaining. What does that look like? Do you see any shifts? I've I've seen women who don't actually have any visible cycle whatsoever, right? Who have noticed a minor shift that appears to be cyclic, but most of them tell me that they don't even adjust around it. They just end up taking like a little more corrective at the next mealtime the correction seems to work well enough, kind of gets them, you know, back to where they want to be. And they never make any shifts in their insulin at all.

Scott Benner 1:09:37
I have to say that Ardens OB was pushing, pushing, she wasn't pushing. She was saying if we don't find some stability with blood with birth control pills, she wanted Arden to consider an IUD now Arden's like a little young, like we walked out to shoot, like the first thing she said to me was like, I'm not doing that. And I was like, gotcha, but it was, you know, she's like, you know, in the future, we might have to keep this in mind. Yeah, I don't I, you know, that is another thing I don't know much about. But you look like you have something you want to say, what did you find? No, I

Jennifer Smith, CDE 1:10:06
was actually just looking up a little bit about whether I could find anything on the plan B and blood sugar specific to type one, but I don't really see anything at all that documents that

Scott Benner 1:10:21
Okay, how about so is PCOS somehow related to diabetes? And or no? Like, why do you use it just because I only apparently at this point in my life, I only talk to people who have diabetes that I I start thinking things are more common or

Jennifer Smith, CDE 1:10:37
right PCOS is more common in those with other metabolic shifts that include insulin resistance and PCOS can bring more resistance into the picture, right? Other metabolic things being have more difficulty with weight management, they have higher cholesterol levels may already have higher blood pressure, despite potentially doing all of the healthy lifestyle things to manage those. But PCOS is more common with the type two. But interesting. In the past, I would say five years, I have had more women more normal, like healthy body weight and healthy lifestyle, who have actually been diagnosed with PCOS. And part of the part of the reasoning in terms of like sending them to their back to their doctor to say, hey, I don't understand I am doing everything in the picture of management. And I need so much insulin to keep things where they are. Something else has to be in the picture. So a mine is always Why don't we look for PCOS? Because if that is in the picture, one of the long term even in women without diabetes with PCOS medication that's very common and uses Metformin. Okay, it helps to dial down the resistance. And from the PCOS level, it helps with some of that cystic nature in the ovaries, and it helps with evening some of that out in terms of hormones and everything. So Metformin is definitely a heavily used additional medication that could be, you know, beneficial.

Scott Benner 1:12:35
Yeah, somebody mentioned Metformin. In in one of those, I forget where it was. I didn't bring that question over for some reason, because they were like, because they were talking about like, can I could I just use Metformin during certain times of resistance around like, you can't stop and start it right?

Jennifer Smith, CDE 1:12:56
That's no, that's not the way that Metformin is meant, you know, if you're gonna use it, we started a low dose, evaluate tolerance. I mean, it's one of the older oral medications it typically for most people is well tolerated after you get over some initial like first week or so of like, some stomach upset. And as long as you're tolerating it, it increases to like more of a therapeutic level. And then you continue use of it, you don't start stop it use

Scott Benner 1:13:23
the Advil during one section of your I only, I brought it up here, because if somebody was thinking maybe somebody else was thinking, I did not think that was a good idea. So, okay. I don't know like, there's this moment where I go, Are we good Johnny that I do we do it or?

Jennifer Smith, CDE 1:13:42
Yeah, I think, you know, I was looking at more of the questions just to make sure that P A mean in terms of talking specific like cycle, I think yes. I mean, I think discussion around things like menopause and that kind of stuff are it's such a transitory time in terms of

Scott Benner 1:14:10
that ever, right? Like menopause can go on for years. It can

Jennifer Smith, CDE 1:14:15
go on from very long time. Absolutely. I mean, and that's really perimenopause. Right. Once you're fully in menopause, you have no longer have to cycle for a year's time. Right. Then are you are menopausal. perimenopause starts with many women notice a shift in their cycle. Let's say you have had a regular 30 day cycle consistently, you kind of getting into the age of and what age in general about 50 ish, but women with diabetes have from research sort of proven to start earlier than the typical like age of 50? Let's say. So, any shifts in your cycle, without any lifestyle changes or anything like that, you know, now you're having 25 day, the next month, It's 30 day, this month, you have three days and a really light cycle next month. It's really, really heavy and painful and it's just not your typical. It could be very likely that perimenopause is kind of in the picture. And there aren't. I mean, many women would say, Well, can I, you know, get hormone testing levels done to see in this point of perimenopause, it's not typically recommended. It really isn't until menopause, that they would recommend doing testing of hormones to actually sort of prove the case that they have come to a level without a cycle, you're no longer ovulating. And some women actually haven't done the testing to make sure that they're actually not ovulating. From just like a sexual standpoint, they're just ensuring that they can't get pregnant any longer.

Scott Benner 1:15:53
Yeah. Okay. That's how you imagined having a baby when you're 50. I'd be so tough.

Jennifer Smith, CDE 1:15:58
I personally, I can't I,

Scott Benner 1:16:01
I would be so tired. That's all I can think of.

Jennifer Smith, CDE 1:16:04
Yes, I mean, from an age No, I can't.

Scott Benner 1:16:08
So no, my God. Last night, Kelly was like, can you imagine if we had had three kids? And one of them was just a couple years younger than Arden. Wouldn't that be nice? And I was like, No, I don't think so. It's it's 930. And I want to go to bed. How would that be a good thing? That child would end up being feral? I'd be like, just try not to die. I don't know if I'd have the energy to take care of it. I really don't. I don't. I mean, good for you. If you do. I don't think I could. That it were good. I think that's it. You should be good. All right. So thanks. On the whole that's everything.

Jennifer Smith, CDE 1:16:42
Probably not everything, but you know,

Scott Benner 1:16:44
is it. Alright, cool. All right. Awesome, Jenny. I really appreciate this. Thank you so much. Thank

Jennifer Smith, CDE 1:16:51
you. Yeah, you're very welcome.

Scott Benner 1:16:53
I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juice box for E 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 juice box. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years, and she works at integrated diabetes.com If you're interested in hiring Jenny, you can learn more about her at that link. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We 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 tips series when our son was diagnosed last summer, it really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#1023 Diabetes Pro Tip: Honeymoon

Scott Benner and Jenny Smith dive deep into the topic of honeymooning in diabetes management. They discuss the challenges faced by parents of children with type 1 diabetes as well as newly diagnosed adults. The episode serves as a valuable resource for navigating the difficulties of the honeymoon phase of diabetes.

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. 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 juicebox free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Okay, so we're recording I want to tell you that this lovely woman named Isabel has been helping me with the Facebook page. And she came to me recently and said, You need a pro tip for female hormones and you need a pro tip for the end of a honeymoon. She said these are things that people ask about constantly. And they must not feel like they're getting what they need out of the podcast on this. Now Jenny, you know, in my heart, the end of the honeymoon just means use more insulin. And when you get your period it means use more insulin but darn it. Let's dig in. Let's just dig into it and find out the details. Okay.

Jennifer Smith, CDE 3:05
Sure. Yes, they're both good. Good topics. Yeah,

Scott Benner 3:08
details are apparently what is needed, and I am happy to deliver what is needed. And by that, I mean dig it out of your head and record it so people can hear it. Sure. Okay. Because my only experience with honeymooning that my only experience that I'm aware of personally with honeymooning because Arden had diabetes was diagnosed so long ago, and we had a little meter and some needles. I mean, I didn't really know what was happening in her. So Right. One thing that I can tell you is that I called my friend who was my children's pediatrician one day, and I I told you this before, but it fits in this this episode. So let's put it here. And I told him I preface my conversation by saying I know what I'm about to say is ridiculous. But is there any chance Arden doesn't have diabetes? And he said he sounded sad. I think sad that I asked him and he's and he said why? And I said, but she hasn't needed insulin for about a day and a half now. Right? And that lasted maybe? I don't know, 72 hours, and then it was just going yeah, anyway, that's my entire personal experience with honeymooning but I know how difficult it can be for everybody. So

Jennifer Smith, CDE 4:28
well, another good question. And that I mean, as you sort of began with I just give more insulin right? Well, a good piece of honeymoon is or coming out of honeymoon, right? When you're you've kind of moved through that lack of insulin need or really really, some people can get by on just Basal insulin. They might not need anything for their meals or their blood sugar's don't go high enough to correct or anything right. But did you notice also Oh, that after that, like three ish days that her insulin needs were higher than they were before that. Here's

Scott Benner 5:06
the here's the honest answer. I don't know. I didn't know what you don't remember. I forget that. I don't remember. I didn't know what I was doing. Right. So like, I think that feeling maybe encapsulates more honeymooning and the and the leaving of honeymooning for people more than anything like, right so somebody you or your child gets type one. It's a whirlwind. A, it's, you know, and if you're honeymooning, insulin needs are changing kind of radically sometimes. So just when you maybe get the nerve to, I don't know, Bolus two units of a basil, you know, and then the next day Your fight is 60, blood sugar all day that won't go up. And then the next day you think, well, maybe I shouldn't use the two units of basil and then you don't and then your body doesn't help that day and your blood sugar's 300. All day, that uncertainty, I think, is the main characteristic of honeymooning, don't you

Jennifer Smith, CDE 6:00
true and honeymoon is it is really different person to person, as well as the like, movement out of honeymooning is different person to person like you didn't have Arden didn't have a very long honeymoon at all. And that's not uncommon from the studies that have been done. It's not uncommon with kids under the age of five who are diagnosed to have a much more rapid rapid onset of type one very quick, very aggressive, really high blood sugars, you know, unless they've been watching for it, or they know because of previous antibody testing that it could be coming, you know, DKA, all of those kinds of things. And what that results in is causing enough of the betas to be stressed enough, and the body kind of decreasing them enough in, you know, in amount that now diabetes presents itself. So but in older kids, and especially in adults, there is often a slower progression of type one, like, you know, here it is, and all those symptoms, and that often leaves more betas in the picture. Also, what's been found is that the sooner you get containment of blood sugars after diagnosis, you give some relief to those beta cells. And because now you know, you're either injecting or you're pumping insulin. And so that's something that's helping to take care of the blood sugar levels. And your betas that do remain can actually help out. And so honeymoon then often comes in, you know, were usually somewhere between about one to four months post diagnosis is the typical, like, honeymoon, time to expect that to come into the picture. And how long it can last again is person to person. It could be a couple months, it could be three days, it could be a year or two that you continue to have this like lack of more typical insulin need.

Scott Benner 8:13
It's the consistency that you're that you're missing and and then yes people's hearts I think I'll tell you after interviewing so many people, I've heard, I believe every variation of time and distance about honeymooning from adults and children and, and crazy stories where blood sugars are suddenly super normal super out of whack. One lady I'll never forget told me like she thinks her honeymoon lasted years. And then I'm wondering like, is that? Is that honeymoon? Or is it a slow onset? Like is that like, and I guess it doesn't really matter? Right? Like, what matters is that you're using insulin now. And there's going to be this variability to how much until things, I guess you could just say settle. But obviously it's not settle. It's until your beta cells give up. Right, right completely. Do do some people just not see a honeymoon at all? Where does that happen? I'm not aware of it. In

Jennifer Smith, CDE 9:11
talking with so many people that I have, and you know, it's always something I asked about is diagnosis. If somebody wants to talk about it, you know, or if it's been very, very soon after I get to talk or you know, before I get to talk to them, it's been very close to that time period. And it seems like again, everybody is a little bit different. A little people again, very little people tend to be the ones that I hear the most. We didn't notice very much anyone, okay. Or, you know, parents are concerned because they're like, I don't know, I feel like we never had a honeymoon. I feel like we never needed just like a little bit of insulin. We just went from not using any really using insulin you know,

Scott Benner 9:55
so functionally, how do people deal with it? So we And you know, let's say I came to you and I said, Hey, here's my seven year old kid. Yesterday, this basil and this meal ratio worked perfectly. Today, it's a hot mess. And I'm saving low blood sugars all over the place. I don't know what's going to happen tomorrow. But as I look back, this is bouncing around. It's two days of this one day of that. But how do you find reasonable stability until things get normalized?

Jennifer Smith, CDE 10:30
Well, some of it again, in that early time period is, it's a bit of estimation, you can base it on Well, yesterday was a really sensitive day, if it looks like we fought low blood sugars all night, and we're entering morning time again today, with lower blood sugars yet again, that's a good visual that maybe today needs to be covered similar to yesterday, or even less aggressively than yesterday, right. So some hindsight can help. But then, you know, tomorrow morning, you wake up, hi. You didn't do anything strange overnight, and you're all of a sudden, hi, today might be one of those days that you're going to need more insulin. And so it, it's hard, because it takes us out of the picture, a lot of the things that we've done. In other we've discussed in other episodes, like testing, right, and doing things like Basal testing, in this time period, it's kind of hard, because you don't really know exactly day to day, how things are going to move overall, the general idea that kids before puberty, once remission, has kind of gone away, right? Once that honeymoon period, you're expecting it's over. Insulin needs usually are about point seven to one unit per kilogram per day of insulin,

Speaker 3 11:52
say 2.7

Jennifer Smith, CDE 11:55
to one unit, per kilogram per day of insulin. So and if you don't know pound to kilogram conversion, just take your pound weight and divide it by 2.2, then you'll have your weight in kilograms. But that's a it's a baseline, you know, if you were really, really, really low to begin with, and now you're doing a really low carb diet as well. You may not really see that insulin dosing kind of go along with what we would expect in terms of overall insulin need, right? Usually, people are considered in remission, if they're at, you know, point five or less point five units per kilogram per day or less of insulin. And then, you know, once you get to puberty, gosh, I mean, you could use anywhere between a unit to two units of insulin a day during puberty, and that's completely normal. Absolutely, and completely normal. So, if you're not so sensitive anymore, you definitely see these swings in blood sugar, you know, especially in that growth period overnight, or in the aftermath of meals, and is lasting and lasting and lasting. guarantee you're probably not in honeymoon anymore.

Scott Benner 13:09
Well, you know, you I've said it to you, I've said to everybody listening, you have to meet the need. And I don't know if I'm right or enough about that. But if one day the need is greater than meet the greater need. And if one day the the need is lesser than meet the lesser need. And, and flexibilities just it's completely key. It's what you're saying. It's like you have to sort of I don't think that I don't think that during honeymoon, you want to look real macro. Not all the time, right? You want to kind of just deal with diabetes in segments of of half days or hours or something like that. Like, here's what's happening right now. If it starts trending one way than adjust with it, if it starts trending the other way, then adjust with it. But I don't think there's a lot of value. Unless you're matching an apples to apples day and going well last Thursday. You know, she was really low. So I don't want to be aggressive six days later. You don't I mean, like, today's got nothing to know. Yeah, correlation between now and six days ago when you're in this honeymoon fluctuation. And I know that people are gonna think I'm flipping but I think you could just retitle this episode, diabetes pro tip ministration. And I don't know that we're gonna say too many different things when we get to it, which is why maybe for some people, they gloss over it when we talk about these basic ideas of like, it's not always going to be the same all the time. You can't always ask for a cut and dry answer. I mean, if you want to get through a honeymoon period, and it's, it's particularly, you know, Rocky, I think that just staying flexible, meeting the need, you know, taking a little bit of historical knowledge off of days that were similar to the one year clearancing now, I think that's really the whole thing.

Jennifer Smith, CDE 15:03
I think that's the best that you can do oftentimes, especially in honeymoon and then even, you know, coming out of honeymoon, there's, I know some people use the word like it becomes more stable. Okay. Sure. I mean, more stable in the fact that you're not like giving only one unit and that whole talk takes care of your whole day. Yes, absolutely.

Scott Benner 15:32
One day, the units necessary then the next day. It's not necessary. But there's consistency. I think they mean,

Jennifer Smith, CDE 15:37
there's more consistency is is it exactly. And I mean, in honeymoon, again, there are ups their downs, yes, you can, you can choose to use insulin from some hindsight from again, I know on a really, really busy day like this. My child needs a lot less insulin, but is running high today. Yeah. Okay. Again, it's the then meet the need in terms of where the blood sugar is right now. And thankfully, these days, I mean, you didn't have an I certainly didn't, does a kid have any visible to where my blood sugar was going at all. It was a one number, it could be rising in 10 minutes, it could be dropping in 10 minutes. And that's what it

Scott Benner 16:21
will. I wonder sometimes when I'm like, speaking to this person, now who's got a very small child who I think still their needs are, well, they're not honeymooning, they were just, they had too much basil going. So it's, you know, by using too much basil, they were getting drops, that didn't seem to make sense, right. And so it took a day or two to figure out that the basil was too high, to bring it down a little bit. But in there, while we were trying to figure it out, this person was using pens. And so they were relegated to point five units at a time. And I just said you have syringes, and she did was like just eyeball less than a half. Next time we go for this meal, and did that and fixed a lot of their problems. And so while this kind of unseen force, obviously I'm talking about basil that we needed to fix though, but you know, let the unseen force be up, you know, your pancreas working all of a sudden, was dropping her down. The limiting factor was the was the measurement on this on the pen. And like, for some reason, your brain doesn't jump over that and go, Well, this might be too much what your brain says this is all I'm able to do. Do you know what I mean? Like and so but the minute we drop, like these quarter of units, then suddenly there was far fewer spikes in the meals and then far fewer lows afterwards. And I'm just wondering like during the honeymoon period, if you are that scared of these crazy drops, do you maybe just draw back your basil a little bit? And then on days when that basil is not enough, just increase your meal insulin a little or do you really mean like, because also these these poor people are probably MDI in this moment. That remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen. It fits well in your hand and features Second Chance sampling which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips you can use my link and save time and money buying your contour next products from the convenience of your home. It's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juicebox free meter go get yourself have 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 gonna see all of the terrific things that touch 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 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 touch 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.

Jennifer Smith, CDE 21:31
Correct most often and like you said, unless they have, you know, half half unit dosed or marked syringes in which yes, if you've got to get good eyes or you have a good magnifying glass, you can get kind of a quarter unit ish in there, whatever it might be, that I've got a good friend that does just that, and she's done it for a long time, and it works great for her. But again, you have to kind of use those microscopic doses. And on pens, it's a hard thing to definitely do, because all you can get is a half a unit. I mean, I think on pumps, honestly, in honeymoon and I know a lot of clinics often don't encourage people to start pumping until honeymoon is expected to be almost over. And I you know sometimes I agree with that sometimes I don't agree with that I think it kind of is individual in need, you have to look at what people are able to do and kind of a knowledge base of where are you already. But those doses they do, they do shift and change through honeymoon. And then you know, going out of honeymoon, you can expect the doses to definitely increase your child your teen your you know, adult that you're living with or your partner to or whatever, you're going to expect that their doses are going to increase. And while kids are growing at the same time as coming out of honeymoon, there are a lot of factors there. Another piece in the mix that often shifts things to higher insulin, and we've talked about it before we talked about illness and management is that if a child is also sick within honeymooning, and is now requiring more insulin, then by the end of the illness, they may actually either leave honeymoon sooner, or they may just be still at a higher insulin need as during the illness, the pancreatic beta cells were trying to assist, and there aren't very many of them left. So they were getting stressed out and can can leave less than

Scott Benner 23:41
that makes sense. So interesting. Yeah, I think that so I think that the next step here, I mean, besides telling people like look, it's gonna happen, you know, if it's happening, it's flexibility is key, it's going to be a little more stressful, but only if you I guess only if you're looking macro when you should be looking micro and then vice versa. Like you just talked about a lot a number of ideas where you do want to pull back and see the big picture, but not about the fluctuations day to day those you kind of got to get on like a bowl and ride them you can't step back and have an existential conversation about whether or not you should be bull riding, you know, so but but the other stuff are their illnesses is their growth, you know, activity, those things are, those are big picture items, but to now. Okay, so now you've figured out a way to ride through this honeymoon. The thing that I see from people over and over again, is that when it ends, you know, like when the honeymoons over, they can't believe it. They can't pull the trigger. They can't ramp up. Think about it any way you want to, but they get stuck in the game, and don't recognize that the game changed

Jennifer Smith, CDE 24:59
now Oh, yeah, I think the big thing there is that especially in honeymoon, the sensitivity to insulin makes people very wary. Yes, of using more, right, because you can get burned, right, by using more thinking you needed more, because yesterday, it clearly didn't work with this, you know, lunch that we provided we're giving the same lunch today. So I'm going to be more aggressive, you know, gave a quarter unit yesterday, today, I'm definitely giving a half a unit and then on the back end of the drop happens, right? The good thing to know is that in, you know, the coming out of honeymoon kind of moving out of that, that phase is that you will have again, more consistency in more need for insulin, you won't have as much potential for those drops, where you learned they typically happen even if it wasn't every day, you probably got a good idea of where things needed to be lower in dose, or, you know, that won't necessarily be the case. Once you're out of time. I

Scott Benner 26:12
feel like you I mean, when I tell people about it, I say you just kind of have to reset at that moment. That's when you go back to the setting Basal insulin pro tip, you start over again, you get the Basal straight, you reevaluate how long your Pre-Bolus time is, you reevaluate your meal insulin after you've reevaluated your Basal insulin. And you just kind of start over that. The truth is, is that I think that the transition from honeymoon to out of honeymoon is not actually much different sometimes than the transition from MDI, to pumping in that it's just the, it's the same game different players, like I don't know how to like how to think of it, it's like, you know, right church, wrong, pew, I don't know what the what the the thing is, like you're doing the same thing. But the pieces have all just sort of adjusted a little bit. And you have to just step back, take what you know about the thing you've been doing, and reapply it to the new situation. Right?

Jennifer Smith, CDE 27:08
Correct. And with pumping, you know that you've got a lot more precision that comes along with that. So if you've been doing things as precisely as possible with, let's say, Just half units, right? And basil that's given once or maybe twice a day. Now you can really address where insulin needs are heavier, and are lighter, through the course of a 24 hour day, you can meet the need more precisely, thus, the benefit of doing some Basal testing again, even if you're just doing it overnight, I mean, everybody wants to sleep. So if there's one time a day that you're gonna do it, do it overnight,

Scott Benner 27:51
part done, and you get that part time to a bunch of a one C and some just good feelings. In general, if you're if you're thinking all 24 hours or just a train wreck, like maybe you can at least get eight or nine of them straight, you know an answer. And it's a good jumping off point for figuring out the rest of the day. I think that when you were saying something a minute ago, this thought just jumped into my head, and I'm gonna put it here. And I think it fits. I think no matter the situation, maybe I'm talking about just diabetes or life in general. But do something is often the answer. People, there's a few people freeze, wondering what the something should be. But if you're watching the same thing happen over and over and over again, if you just change the variables, the stressors on the situation, you might see something new, that helps you understand a bigger picture something different. And so, you know, if blood sugars are, I mean, I don't think it's a joke, but like online, sometimes somebody will throw up a graph and be like, I don't know what's wrong with this. And I'll literally just type more insulin. Because put in some more and watch what happens and then go Oh, cause and effect. I've done this, but they

Jennifer Smith, CDE 29:05
want to know where right. Okay, they want not just more or they're like, but where should I put that more insulin?

Scott Benner 29:12
Like do something right, right. Like, if you haven't been on vacation in 15 years, take $5 a week and put it in an envelope, you know, do something, try to change the situation a little bit. And I get that it's frightening. And I used to think jetting, I used to think that all these things that I saw around diabetes, were so specific to diabetes, but I've been having some personal things going on with my mom's health recently, which Jenny knows. Probably not at all. Yeah, right away. But but the point is, is that I recognize that the confusion and the lack of knowing when to jump and feeling like you're overwhelmed and feeling like you don't understand what to do next. It's life, not diabetes, right. And maybe it's Feels a little more dire in some situations than others. You know what I mean? Like standing in the store, trying to decide between two waxes for your car might not be as crazy as I wonder if I want to add three more basil units to my kid or something like that. But the truth is, is that that inaction, that's what keeps you where you're at. So if you're somewhere you don't want to be, do something,

Jennifer Smith, CDE 30:24
right, an easier one to honestly do. Let's say you are running high, you know, all day long. And you're higher after meals, but you're still just stuck high in that scenario, and a safer thing is just add a little bit more basil. Yeah, add just a little bit more basil, right? If instead, in time periods where you're not actually eating, it doesn't look too bad. And then you've got these big excursions after you eat just about, you know, anything, even a microscopic eight grams of carb, maybe and it goes rocketing up, well, then you may be okay with basil, and maybe the next place to add more. And again, not three units more, but maybe add a half a unit or adjust your insulin to carb ratio by one gram to get a little bit more insulin around the times that you see the change that you don't want to see happening.

Scott Benner 31:22
Arden has been getting up in the morning going to school, and her blood sugar has been rising this this school year, like 30 points in the morning. And I tried to let the algorithm mess with it didn't work. I tried making just some simple basil adjustments wasn't enough. And then finally I just said, Doris, like when you leave the house from now on, we just Bolus three units, please. And she's like, what I was like, just throw in three units, get the car go to school, I was like, because whatever's happening is happening enough. I believe it's happening, I trust that what I know is going to happen is gonna happen. And she's using an algorithm. So if you make an uncovered Bolus, it removes her basil immediately. So her Basal is like 1.2 in the morning. So I figured it was about a unit and a half or so to fix the number or to get ahead of the number. And we got to cover the Basal that's gone. So I was like, just three. And then we adjusted off of that ended up being a little too much the next day, we did a little less than next day, we had a better outcome. The next day, she forgot to do it. You know, on the third day, I was like, see it happened again, like, you know, like, do this thing that made her trust that tried to do it, and it becomes a little more important to her. I just think it's another example of do something. Right, you know, I I've been saying online a lot to people lately. And you'll forgive me because I can't pronounce it. in its in its origin language. In Latin, but I've been telling people lately, Fortune favors the bold. Just try something, you know, they mean, stand up thump your chest and go, I'm gonna take a swing here. Let's see what happens. And then you get back to this stuff you hear in the earlier pro tips, you know, right, it's all well,

Jennifer Smith, CDE 33:13
and I think the bigger thing too, that you're you're bringing in is try something, right? But then analyze what that training did. Right? Don't just try it and be like, Wow, that clearly didn't work. Like, still focus on it. Well, it didn't work, your adjustment either left you too high, or like, you know, happened for you and caused it to be a little bit too low in the algorithm couldn't really save you from that extra insulin well, but now you know, so you use that for that information and you move forward and you say, Okay, tomorrow, we're going to do it this way. I mean, that goes into you know, a lot of things in terms of kind of the exiting of the honeymoon. It does it's try this it looks like consistently in the past week, he's needed more insulin. Okay, great. You're trying to add more insulin? Is it enough? Is it getting to you to the place that you want to be? Insulin needs may actually continue to climb a little bit? It's not like a night and day like yesterday, we needed one unit and tomorrow we're going to need 10 units. That's not typically the exit of honeymoon. But over time, that lack of beta cells that is that was helping you is going to show up very evidently in that you don't return to that minimal amount of insulin.

Scott Benner 34:33
Do you know what made me do this episode when Isabel told me that she thought it was necessary? It was that I had to get over that thing in my head that it's already in the podcast. Like I was like, No, it's in there already. You just have to listen to it. And then I thought, well, it's in there but it's in a different way because what we just talked about what about that? It really is the way when I'm when I was talking about God I don't even know what episode it was now. I guess maybe That's a good point. It's hard to find them all but but when I was talking about like sometimes you know, people's meal insulin meal ratio, sometimes their insulin to carb ratio can be like spot on for a number of meals, but not work for a certain meal. And I always use that silly example, if you have meatloaf and mashed potatoes and green beans, and you count the carbs and it says the carbs say, Oh, this is five units, you make your Pre-Bolus, you spike, you end up correcting later with two units, which brings you down and you don't get low. Well, the next time you have the meatloaf in the mashed potatoes or whatever, seven units, you seven units, right, like you see it happen. And then you take the leap, you stop looking back at the meal ration going no, that's not right, I counted the carbs, it's right, this is five units, very similarly to the idea of you're using a pen that only goes up to a half of unit, and you keep using it and then watching a low blood sugar happen. I go, I'm powerless, but you're not powerless. Like you just need to go get a syringe and do it a different way. And you're not at the mercy of your carb ratio just because it works five days a week, but not on Sunday when you have meatloaf like Right. So it's all kind of the same idea. Like, I know, it sounds trite. But it's all well, and that's

Jennifer Smith, CDE 36:14
I think it brings in a good a good piece too, in terms of, you know, multiple daily injections, and then we moved to pumping. And then we move to the fancy features of pumping. And then you might move to an algorithm driven pump, right? All of these things take. They take like evaluation. And a good example from somebody I worked with a while ago, who had started using one of the algorithm driven pumps. And she's like, this is fantastic. I love it. It's working so awesome. Like doesn't work on Friday night. And I was like, Okay, well, what were you doing on Friday night, that this doesn't work anymore for you. And she had this like, whole thing figured out for her dinner Friday nights that she would go out to with her husband. And on a conventional pump. She could use like, you know, a temporary basil. She could use an extended Bolus, and she had it down, Pat. I was like, just go to manual mode in your pump. And use it that way overnight and Saturday morning, turn your algorithm back on. And she's like,

Speaker 3 37:20
why didn't I think I was like, Oh, I don't know, either. But I hope that

Jennifer Smith, CDE 37:25
it helps. And it it seemed to be much better. Right. So

Scott Benner 37:31
yeah, because we went to a bar and art and got nachos with cheese steak on top of it and had French fries. And I crushed my first Bolus. I was like, I haven't been this excited about a Bolus. And while I was like I was on top of it. And then I started seeing the fat rise. And we hit it again. And I want and like I was over. And then I go upstairs to start working. And suddenly she jumps up her blood sugar jumps up and I go downstairs to my lab. And what happened? I had some gummy bears. She told me and I was like, no, no, we can't put simple sugar on top of fat and protein. I was like, are you all out of your minds? Without like significant I said art, if you were any gummy bears in this situation, the Pre-Bolus would have needed to be causing a fall before you put the bear the bears in, you know what I mean? Then that would have been okay, but she just did the like my blood sugar is great thing through and some insulin, wait a little while and ate it. And it was not nearly enough. We needed to be more drastic with it. And so I was like, so my text, my text said this, I'll bleep it out. It said that it said, open the loop Bolus for you.

Jennifer Smith, CDE 38:43
And let and let the Basal

Scott Benner 38:46
pumping for a minute and stop asking this algorithm to do something that it doesn't know how to do. You know,

Jennifer Smith, CDE 38:51
because it's not it's not a learning algorithm. Unfortunately, it doesn't, you know, it doesn't react the way that we have the experience to say, I know this is what's going to happen. Please don't fiddle with the insulin that I put in purpose

Scott Benner 39:08
is not the time to take the basil away algorithm. Cheese Steak nachos happening right now. Anyway, Jenny, you know, there was in the past, there was a moment when I, I used to worry. And I think like Well, we've already said these things. And people will find it. And now I realize that that's not how this is going to work that these continuing conversations are incredibly important. I think maybe the conversational part of this episode and many episodes is more important even than the technical aspects of what was said inside of it. Right. So like, if you listen to the Pro Tip series, and you had your brain or my brain or your experience in my experience you could derive from the Pro Tip series how to manage a honeymoon. But for people who are in that situation I think they need Get the information here. Yeah, I mean, in one spot. Yeah. And I just, I don't know if I was just like, super hopeful or lazy, I'm not sure. But I used to think like, just go listen to the protest episodes, it explains the whole thing, you know, and it really does. So I appreciate this, I think we're gonna have to, you know, like I said, I want to do one for you know, female hormones, menstruation, that kind of thing. So yeah, pick the next time we record. And then from there, I'm going to say this year, Jenny, because it'll put us both on the hook. In 2022, Jenny and I are gonna go back to certain pro tip episodes, were going to re listen to them on our time, and then incorporate questions that I'm collecting on Facebook, on how to supercharge those episodes. So they're going to kind of that's gonna get part two, kind of a situation. That's what cool that's how we will you and I will spend our time seeing each other through the winter of 2022 sequels to certain episodes, I'm thinking of them as director's cuts for oh, there you go. Older people who you remember the director's commentaries? Yes. You know, where do you mean you flip the movie on and the audio goes away, and you just hear the guy go? In this shot. What I was thinking was that if the sun came in from the left,

Jennifer Smith, CDE 41:18
we could could pan over here and listen to this music from this producer, you know, whatever.

Scott Benner 41:24
missoma Hi, X eyes are glistening. I did. I told the DP like, I don't know if you ever listen to them. They're pompous exchanges, Jenny and I will not do that. But we're gonna go back and listen to what we've said. Because I've done it a couple of times, like in Episode 500. I went back to Episode 11. That's bold with insulin. And I listened to it and like tucked over top of it like so people listening in episode, I think it's 100 Oh, my God. 105. Sorry. In Episode 100, I just basically did a director's cut of that, because I realized that when I said it, I was just saying it. Like there was and now I've lived all this time since then, and had these interactions with people that maybe there'd be more to add to that. And I think that exists for the protest series. Like and I'm excited. I'm sorry that you're going to start getting emails from me that say, please listen to this one before we talk again. But

Jennifer Smith, CDE 42:13
no, that's fine.

Unknown Speaker 42:16
You're a busy person well, and I can do it during

Jennifer Smith, CDE 42:18
my workouts. That's not usually I just, that's my mental like, my moving like mental sort of like strategizing time is my exercise time. I am not like a sit in one space and like meditate. I'm a moving meditator, but I can meditate on the episodes so we can make them better for everybody else.

Scott Benner 42:40
I have a question, then I'll let you go. How do you make out listening to your own voice? Does it freak you out?

Jennifer Smith, CDE 42:49
It's I don't know. It's I guess it's kind of weird to me, because I like I hear myself speak, you know, in your brain like, but when you hear yourself, it sounds different. I guess. I don't mind listening to myself. But yeah, I don't know. I don't think that I sound like what I sound like when I listen. No,

Scott Benner 43:12
no, no, I sound so right now we're recording, I can hear you and me and my headphones. I sound different in my headphones that I sound on the recording. And if I'm just speaking out into the world, I don't think I sound like the person on the podcast at all, but people think I do. But in my ear doesn't sound the same. Although And do you ever get on? Do you ever? Do you ever say anything and hear yourself? I go oh, Jenny, you should not have said it. You should have said it like this. You ever correct yourself?

Jennifer Smith, CDE 43:37
I do. Absolutely. And a lot of the ones that I listen to I'm like, Oh, this would have been a better explanation. Or I could have put this in as an example. And that would have been better. So maybe we Yes, I think it's great to sort of rethink them. Because then we can

Scott Benner 43:51
walk and I agree that there's there's just always going to be other stuff to say. And as we move forward into 2022 and beyond more people are going to be using algorithms. And there's going to be a whole new layer of understanding for diabetes, there's going to be things that you and I don't haven't experienced yet, that that through these experiences over and over again, abusing this technology, you're gonna come out I don't see an end to this podcast, I used to think it was finite. And now I think somebody is going to need to, you know, make up a cure for this podcast not to be necessary. So Well, that's

Jennifer Smith, CDE 44:25
what I was gonna say. I don't think until there's honestly a true like, you don't have to use any technology or anything. You just go in and get your bloodwork done and make sure your doctors like yep, you still look great. It's all perfect. I don't think you know the information that people need, especially with life changing and everything. I think it's purposeful.

Scott Benner 44:47
I appreciate you doing this with this. It's sort of the end of the year. So let me thank you for giving your time so greatly to the podcast. 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 GE Vogue glucagon.com forward slash juicebox you spell that GVOKEGLUC AG 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 or 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 talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jennie 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, where 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 If 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

#1022 Diabetes Pro Tip: Weight Loss

In this episode of the Juice Box Podcast, Scott introduces the highly requested Diabetes Pro Tip on weight loss with type 1 diabetes. He reflects on the success and growth of the Pro Tip series, which condenses tools discussed in the podcast into individual episodes.

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter, you can get an absolutely free contour next gen starter kit. That's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Every time I think there's nothing more to do for the protests, then somebody asks something and I think no. Oh, that that would work there too.

Jennifer Smith, CDE 2:33
Is the variables in life that I think will always bring in something to discuss in terms of what it could be in? In diabetes? Like management? Yeah,

Scott Benner 2:44
no, I'm really happy. I'm really happy to hear from people because I think that others perspectives can make me go Oh, yeah, wow. Just because that hasn't happened here. Doesn't mean that's not happening somewhere. And then it gave gives, you know, good focus for what to do. So this is it. We're gonna talk about trying to lose weight when you have type one.

Jennifer Smith, CDE 3:03
As I mentioned, I think I did to I texted back to you. I was like, this is a big topic. It's not just like five minutes of just go out and start running. I mean, it's it's kind of like a rabbit hole. Honestly. I mean, there are many different like, little avenues to kind of talk about, and you had a lot of really good questions that came in, or like comments about, Gosh, I don't understand this, or why isn't this quite right or whatever. So, yeah. Yes. Great topic.

Scott Benner 3:33
So I'm gonna have very little to say here, probably. And I apologize for that. I guess this is the time, the time we pretend like I just came on your resume. And I'm like, Hey, how do I help? And then you just talk. But what what's the, I mean, where do you think we should start? Because to me, I think we should start at the idea that people correlate taking insulin with gaining weight. And then they don't think about calories and right, go. Hi, Jenny. Can you help me please?

Jennifer Smith, CDE 4:06
Well, maybe. I know, it's a good place to start in terms of like, one thing that everybody with diabetes specifically thinks about is that it's insulin. And I think a good place to even go with why does that start is because it's often something that a practitioner will tell people, you know, using insulin, you may be likely to gain weight. They think that was one of one or a couple of like the comments that came back about this topic. were specific to you know, why have I been told that I'm going to gain weight or why, you know, why is this going to happen? Or why did I lose weight and now I'm gaining all of this weight back like after diagnosis, right? So insulin itself whether your body makes it or you take it with an injection or with a pump, it's a storage hormone. That's its job. It's supposed to Have a certain quantity of carbs, sugar really out of your bloodstream and into places to either be used or stored, right. So in terms of management, insulin can make you gain weight. In terms of like initial diagnosis, a lot of people with type one specific have lost weight. prior to diagnosis, maybe it was very rapid. Or maybe it was like a lingering loss that people were like, well, I could just keep eating the whole cake. And gosh, I don't gain any weight, and I'm actually losing weight. And then they're like, Wait, this is wrong, this is bad, that shouldn't be happening. So they go to the doctor, right, they get a diagnosis of diabetes, they've lost weight. And in terms of that loss, it's often relative, it's usually relative to the fact that their blood sugars have been so high, that their body isn't storing those calories, right. So you're essentially paying them out, thus, DKA, and all of those things that can come about, you know, around diagnosis time, but because you're losing all those calories, and your body's not packing them in, once you have back, the piece of the puzzle that was supposed to help you use that food that you were taking in, your body is going to start storing it.

Scott Benner 6:14
And so and so. And that is the one confusion you see from newly diagnosed people is like, I don't understand I lost all this weight, and they don't understand the function of it. So explaining the function of it, I think is great. I think boiling it down into one simple idea is that you were dying. And yeah, and your body is using itself up and not storing at the same time trying to stay alive. And then all of a sudden, everything's okay. Now, the more weight listen to if I'm, if I'm talking about a school here, you just taught me but if you've lost a lot of weight, before you get to this skinny, emaciated, those are my ribs, you probably had weight to lose to begin with, right? Because it was there to lose,

Jennifer Smith, CDE 6:54
likely and especially more as the adults who are diagnosed yes, if you had weight to lose for whatever reason, you may have just thought, like I said, Oh, good, I'm actually able to take weight off. Now, I don't know why I'm still doing the same three mile walk every day. And now it seems to be working better, great. But yeah, once you get to that, like, shouldn't be able to see my lower ribs, or Gosh, my face looks really sunken in when I look at old pictures. That's not what you want. And

Scott Benner 7:24
I think that, again, it's probably sound, I don't want it to sound like distasteful, but if you had weight to lose, you were probably it's likely that you are taking in calories, that helps you stay at that weight. Meaning that when you start taking the insulin back in, there are calories there to be packed away to facilitate the weight gain again,

Jennifer Smith, CDE 7:45
and that's in any case, whether you could have lost weight, you know, and successfully, hopefully helpful, you know, left it off. But the goal was starting insulin is, in general, to maintain a healthy weight then right to get Yes, you will come back from the weight loss. But you should also with the proper insulin dosing, you should be able to get back to a stable healthy weight, you know, if you lost 40 pounds when you were diagnosed, and hey 20 of that you could have definitely lost and the other 20, you really didn't need to great, we should gain back maybe 15 to 20 pounds. And then we don't need the other kind.

Scott Benner 8:27
What is the functionality of the proper insulin dosing that makes you gain too much or not enough

Jennifer Smith, CDE 8:34
in terms of insulin dosing, that's correct. The amount of food you put in to work with it, of course, is a piece of the puzzle there. But if your insulin is being balanced along with your use of the energy that it's working with, then you should be able to gain energy back to your body that gets stored that keeps you at a healthy weight. And you shouldn't then continue to gain if the dosing is correct. And it's so it kind of goes back to, on a baseline initially make sure your insulin doses are right for you. And a lot of people wonder, you know, they I just leave it to my doctor. Yeah, it tells me how much more or less to take.

Scott Benner 9:15
And does that mean that if you're not using enough insulin that your blood sugars are left higher, so you're still having some of the action that you noticed before you were diagnosed? Right, you're, you're a little you're too high and your body's not storing the the calories correctly, the glucose clerk correctly and so you're not gaining as much weight so you could have unhealthy blood sugars, but feel like your weights good. And then you kind of come to that point. You're like, Oh, I'm good. And that really is the beginning idea of diable anemia too, right? Manipulating the insulin to keep your weight down. Okay, so yes, going the other way. If you're too low all the time. You'd have trouble putting on weight.

Jennifer Smith, CDE 9:57
If you're too low all the time. I'm one, you've, that's actually kind of an, it's an opposite of what you would think really, if you're low all the time. And that's a big reason, then when we start working with somebody we analyze insulin to begin with. And the first thing we look for, even if there are highs, high highs, we first look for lows. Because if weight management is another piece that they're really concerned about, then all of those lows that you're treating, you are feeding insulin, and you're feeding insulin, which ends up packing away the excess that you're taking in, and you maintain a weight that you don't want, or you keep gaining weight that you don't want.

Scott Benner 10:42
So this, this puts you in the position of having to look at carbohydrates as medicine, and being scared because you're low, taking away more than you need. And then suddenly, your belts back up again. And maybe you've got enough insulin in there to handle the carbs for your blood sugar. But you've taken in way more calories than you once got it. Yeah.

Jennifer Smith, CDE 11:03
Yep. So that's, that's that insulin is, it's kind of the key place to start, really. And, you know, then a lot of people ask, well, how much insulin? Should I really be on? How does this enough for me? Is that enough? For me? I know, we just talked about that kind of in depth in another episode, but really, you know, figuring out about how much insulin you need based on a weight to begin with, that's kind of a starting place that you could go to, how much total daily insulin are you using right now? What's your like current body weight, etc? Should you be using this much insulin? Is it taking this much more insulin to counter things? Or are you using like a heck of a lot more like let's call it Bolus insulin, right? But you see that your Bolus insulin is for a lot of corrections. And when you're looking at your data, you can see that the corrections are following lows. There again, more insulin than you really need. And thus your body is going to pack away by allowing the insulin to use up the food.

Scott Benner 12:10
It's funny because I wasn't 100% sure what you were going to say today. And yet I feel like we're into this situation, again, where the podcast should maybe be three minutes long. And it should say limit your variability use the right amount of insulin. And it kind of addresses so many things. I know this isn't weight loss specific. But let me just ask you one question. How many people you know what percentage of people do you think just a guess, are, are getting to reasonable outcomes by mistake. Like their bolusing too much, but they're eating on time and their Basil is too low and it works out or their Basil is too high and they eat before they get low. And they don't have to Bolus too much and it like how many people are getting there the wrong way. But it seems like it's working and then have underlying issues that they don't recognize.

Jennifer Smith, CDE 13:07
Like I wouldn't say it's, I wouldn't say it's anywhere near a majority of people. Honestly, I'd say it's a small percentage of people who have figured out insulin needs. Even though the dosing strategy that they're using might be wrong, like you said, maybe there's way too little basil, but they're offsetting it with boluses. And maybe the little amount of basil they're using is right for their overnights. And that's why it looks stable or, you know, vice versa, whatever. But I don't think that's the majority of people, I think the majority of people who are having issues with blood sugar fluctuations that they don't want, and also likely are having some issues with weight management of some type. It's, it's a start of let's look at what the initial factor could be insulin, okay. And then you move on further. And, you know, lifestyle is a big part of it, obviously. So then we look at things like calorie intake. And I think some of the some of the questions that came in were kind of, you know, around that, well, you know, I've run a calorie deficit and I've like run myself ragged going to the gym or, you know, exercising 90 hours a week. And it's still not working. But I, you know, and then you know, there's the fasting component and all of these things that people try to put into the picture. But from the standpoint of calorie, your calorie needs should meet your baseline kind of need in general. And then if you are working out on top of that, or you know, a training athlete or whatnot, then calorie needs go up. But at a minimum, there is kind of a minimum, on average that needs to be there. It's about 1000 calories a day, give or take person to person. But when you start dipping below that oftentimes what ends up happening is your body conserves. Because you're not meeting a need. And then you wonder, well, I'm at a deficit, why am I not losing? Because your

Scott Benner 15:09
body thinks you're lost on a desert island and it doesn't. It's trying to hold on to everything you put inside. Exactly. I had that problem where I've been eating more food, I've lost weight and eating less. It didn't, it didn't impact me as a fact. In fact, it sort of made me go the wrong way. So okay, so if someone asks you, is it not as simple as hey, I need to lose weight? Can you tell me where to start? Is it really person to person? Like, because what do you have to do first, like, like, think about if you were listening to this right now? And you could be any of the very people who are listening, like where do people start?

Jennifer Smith, CDE 15:48
I would definitely say with Well, first might even be an analysis of where are you? And where do you want to be? Or where have you been weight wise? Right? What's your goal to get to? And how much more are you above that than you want to be. And also, in that timeframe, it goes back to insulin analysis. If you've gained weight, as many people have in this past year. If you have gained weight, but your insulin doses haven't really shifted, there in lies a piece of the puzzle to write usually, for about a 10% change to your baseline like weight, you're probably going to expect a need to change your, your Basal and your Bolus ratios by about 10% as well, to be more aggressive and to take, you know, take into consideration that gain now when people are looking for loss. They're like, Yeah, but I don't want to use more insulin, because that's not going to

Scott Benner 16:52
work. And they think, oh insulin, put the weight on them. Correct. Okay, gotcha.

Jennifer Smith, CDE 16:56
But really, they need to first manage their blood sugars, right? And then they can start working on whittling away or whittling back and some of that comes into. Okay, let's look at the lifestyle things. Let's look at Are you exercising? Are you active enough? Does your calorie intake meet what your actual need is? You know, where can we whittle away some things so that weight comes down and along with it, then as you do lose? The same thing happens with insulin, your insulin doses should be adjusted back based on loss.

Scott Benner 17:30
You are making me think strongly about when somebody comes to me and says, Hey, I just got diabetes, and I play a sport or my kid, you know, is on the team. And we're so worried about this. And I very badly don't want to give them a band aid answer about how to get through the sport. I want to tell them let's take the time now and get your insulin right so that during the activity there really isn't any issue. And it's hard for people to believe that once they've seen it once they see cause and effect once they see I ran around and my blood sugar went down. They imagined that is going to happen no matter what all the time. And I Ardennes. I'm sure you're the same way. But Arden's insulin, so well balanced at this point, like activity doesn't make her lower or higher. Really, it's not, it doesn't really change too much.

Jennifer Smith, CDE 18:18
Yeah, it depends. I think that brings in, you know, the consistency of exercise or activity, right, the more attune your body is, let's say you go out for an hour every single single day to get some form of real exercise, right, your body gets used to that. So initially, you might see that your insulin needs drop off within the hours of the active time, right, and maybe even stretching several hours later, depending on what you did. But over time, that impact is lessened, you will usually need to be less aggressive with insulin adjustment, or maybe not at all. I mean, I can typically take my kids to the park and not really worried too much about that unless I know I'm really going to run around crazy with them. And I likely have insulin on board. Right. So then something needs to be you know, offset. But so yeah, I mean, once you get to the point of like lifestyle adjustments and a base insulin that's working, your fluxes in insulin dose then will be minimized. I think oh, sorry. Go ahead.

Scott Benner 19:23
I think people need to be certain to that. Once they start exercising their body is going to use the insulin better. The answer then is not to feed the low it's to adjust the insulin. You know maybe the first time you have to feed it but then you have to learn from there and make an adjustment so that you're not constantly battling yourself because that is what happens right? They exercise they get low they eat it adult the adult it overpowers what they meant to accomplish. Okay,

Jennifer Smith, CDE 19:49
and then they and then you end up getting frustrated too. Well, goodness. You know, I go to the gym but I have to eat like a whole sandwich and a half a banana in order to go to the gym and not have a low blood sugar. What's the purpose? stuff that when I'm trying to lose weight, and then I stopped doing it because and they stopped doing it right, or on the other side of it, you know, someone who may actually, okay, I'm going to really focus in on my diet, I'm going to clean it up, I'm going to, you know, cut my macros down and actually meet the caloric need that I'm at right now. And then what they end up with many times are lows, especially the cleaner the diet gets, and the more accurate intake of calorie value is for that person, your insulin needs will actually come down sooner. So to avoid lows and needing to treat in the time period where you're really trying to be, let's be good. Let's say, just take your insulin doses down by maybe even, it's just your Basal take it down by maybe five to 10% across the board, okay?

Scott Benner 20:49
So it's get your insulin, right. So it's understand diabetes first. And then it's the normal stuff, we all talk about it being active, getting your heart rate up. A sedentary lifestyle leads to more resistant blood sugars, which leads to more insulin, which probably leads to more lows, because you get out of balance, blood sugars, and what you just said, about clean eating. We don't really talk about it. Like we like if we were all out in a field, okay, let's just say that if it was 400 years ago, and somehow insulin existed, but we were still just farming and breakfast might be an apple you found on the ground, and maybe on Wednesday, if you're lucky. The guy up the street kills an elk. And we get a steak Right? Like if we were still eating like that, and we had manmade insulin, people would not be using nearly as much insulin as they use now, Jenny's Oh, no,

Jennifer Smith, CDE 21:46
not at all. I mean, if you were living on like, Barry berries that you picked along the trail that you were tracking the elk on and then you stopped and you ate some of the watercress to get your Vitamin C out of the like stream that floated by whatever. No, what No,

Scott Benner 22:04
you might not need as much as right now

Jennifer Smith, CDE 22:06
you wouldn't. You're also active level that I mean most like let's call them, you know, cave dwellers or whatever at that point of life, right? activity was part of your day. They didn't have a gym that they went to. Their hunt for the bison man was like, active.

Scott Benner 22:24
I bet you're running from a mountain lion burns carbs. What do you what do you think? So I guess my point is, is that while I'm not telling anybody how to eat, and I'm not certainly telling you that my daughter's counting macros or anything like that. Processed foods, right? Manmade foods, stuff that comes in bags, oils that don't belong in your body, all the stuff that we consume all the time that we're not aware of. It's making your variability greater and it's making it more difficult for you to use insulin.

Jennifer Smith, CDE 22:56
True. In fact, I've also kind of heard people and there's truth to it.

Scott Benner 23:02
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Jennifer Smith, CDE 26:18
Many people have found that if they eat a true cart, let's say they eat an apple and they Bolus for it, they end up with the ratio that they're using for that simple like very clean carb to go low. Okay, and then when they mix it up, and let's say they have potato chips or something along with the Apple or they have something, you know, more processed along with it, their carb count ends up looking clean, like okay, it comes out I don't get low later. So what gives it really is that the body processes more natural food in a better way. There's there's less leftover to kind of linger in impact. And a lot of people are basing their insulin to carb ratios, more specifically, around combination meals that are not quite as for lack of a better term clean,

Scott Benner 27:16
right. So your heavier insulin ratios work better if you have the orange with the potato chips, but if you just eat the orange, the orange doesn't need as much insulin. So the ratios you have are too heavy. Correct. I now Arden's ratios are heavier, because she doesn't she eats a diet that has processed foods mixed into it. But she'll go on a kick around this time of year about oranges, where I have to buy like 10 pound bags of oranges to keep around the house. And she's like I want an orange I want lunch. Now these are big, like softball size oranges that I'm sure to Cara, Cara oranges. Those

Jennifer Smith, CDE 27:51
are my favorite. Yeah, I

Scott Benner 27:52
think they are and they're really good, right? And but I bet you and I've never looked, but I bet you that the card count on them has got to be more like 25 or something like that. Like he could be more right. But I only give her enough insulin for like 11 carbs. And and she does a little 130 Rise and comes back again. Because I you know because I know her ratio is higher to handle other things, which is why you look at plates and go okay, tonight, I don't need as much, you know, for that. But this is not this is not going to be a satisfying, you know, people just want to hear like, please just tell me what to do. And I'll do it will work. But nobody wants to hear. I guess this I know, I don't like you know what I mean? I don't have diabetes, and I saw I'm listening. I was like, Oh, this is how I would lose weight. So you know, it's it's just do you think that we've just spent so much time as the society looking for marketable sellable ideas about how to get around? The idea of being in shape? There's no, it's, it's exercise and calories. Right.

Jennifer Smith, CDE 29:01
And I think that's the reason that there are so many I mean, if you look at around the first of the year, there, I can't remember which publication it is. But they come out with an analysis of I think, like the top most, or maybe it's the 25 top most like used column diets, right, in the past year, and what's kind of proven true to what it promotes and what really isn't, it's kind of like flimsy right. And some of the top ones are things like the Mediterranean diet. And you know, by no means am I promoting that or whatever. I'm just saying that that ends up being taught from a lot of different health parameters. And it's also a clean way of eating. Most people think Mediterranean and they think well lots of breads and lots of starchy things and that's actually not true. A lot of it is plants, especially the really good non starchy vegetables. types of plants. And then if there are grains that are the heart of your grains, right? I mean, it doesn't tell you to eat your carbs as a bag of Doritos. It tells you to go and eat some quinoa on your salad with, you know, an orange on the side. Right. But I think it brings in diets. Yeah, it's idea that there is the perfect thing out there. Right.

Scott Benner 30:23
Right. And that it's going to be doable for somebody because maybe, listen, maybe macro accounting, maybe there's a biologist somewhere that could give you the perfect diet for your body. But where am I getting that from? And where are most people getting there, I have to tell you that a couple of weeks ago, I started getting achy, right. And then I looked in the mirror, and I was like, my face looks puffy. And I went to the Costco and I bought two little roaster, chickens. And for steaks, I smoked them all, slice them up, put them in the refrigerator, and I've been eating those and salads and some of those oranges because they're around the house. for about the past eight or nine days, I'm easily 10 pounds lighter than I was. And I know that I know I'm a fluctuating person, like I know I jump around like because what will happen is at some point, someone's going to give me a piece of bread and I'm going to pick oh my god, bread Does everyone remember bread, and then then I'm going to eat a lot of bread for a week. And then I'm gonna go now my back stuff. And I feel like I gained five pounds and all that stuff. But just if I explain to you that most of my meals have been like a couple of eggs in the morning, and a couple of tiny slices off of that steak, and then at lunch, some some of the chicken and some of the steak with a salad. And I've I feel great. And I know it's true, like because I've been through it enough now now to talk my stupid childish insight into like, just continuing on that way that I don't know if I'm ever gonna get to do but I do know, it's honest. And it works for me. And I've seen it work for other people to like you take out processed food and carbs. And you're you're better off like, I don't know, it just seems obvious. But

Jennifer Smith, CDE 31:56
it's it's, you know, like you said, you're not focusing on like macros, you're not focusing on how many do I need in a day, you're what we end up finding. And I think this is the premise behind a lot of the like, the Palio kind of diet and the Keto type of diet, right, it's, if you're following the rules of those plans pretty well, they can be very clean eating plans, they can, there can also just like being vegetarian can be or vegan can be very healthy way of eating. But there are also like the complete like backside of that where you're eating a lot of processed vegan or like the Keto like kinds of things that are like the treats and whatnot, if you're focusing your intake on a lot of that kind of stuff, you're lacking in quality, and then your macros may very well without you realizing it be completely out of order. And I think that's why a lot of like plans like this end up failing, you know, I followed keto. And it was supposed to be this magic, like weight loss, and I also have diabetes, and it was really supposed to help with my blood sugar management and whatnot, well, I haven't lost any weight, well, maybe there are some things then to evaluate within it, you know, the keto diet is a way to get your body to start utilizing fat instead of carbs. So if you haven't really analyzed how you've broken that down to make sure that you are one maintaining ketosis in the right way. And that the kinds of like carbs that you're eating are really not offsetting, then it may not work well for you

Scott Benner 33:42
don't you find that you have to be in tune with what your what satisfies your body? Like, not what satisfies your brain, right? But what satisfies your body. And I've absolutely I've seen myself go either way, like where you're just eating for taste and flavor and comfort. And that's never usually good for your body. And then there's a way where you're just sort of never hungry. It's that's where I am this week. I have not been hungry this week. And if I have had any like Inkling towards a sweet, I've been specifically careful to take just like dark chocolate, like just a little bit of dark chocolate like this will this will get me through like, what I'm assuming is basically withdrawals from flour and sugar and stuff like that, you know? So I don't know like, are you telling? Are you telling me that all these questions aren't even worth looking at? Or should we ask them? No,

Jennifer Smith, CDE 34:32
I think they're very worth looking at because I think some of them may relate to what we've kind of already gotten into. And then some of them, I think are really good questions in terms of the why it wouldn't be working right? Or why it might actually work. So yeah, let's pick a favorite

Scott Benner 34:53
or should I just pick, you just pick? Well, so Jennifer's asking about her son, she says any any advice on how to balance All this high carb gluten free food for my growing always hungry 14 year old T one D with celiac. So she has a son who seems to need blending down. And at the same time, she's giving him a lot of carb heavy stuff, because it's like it's some of this. For the celiac diet, it seems like right? The gluten stuff,

Jennifer Smith, CDE 35:22
right. And that's, I mean, celiac is a hard addition, it definitely is. Because while we now have a plethora of gluten free, very tasty products on the market, most of them are made with very, very processed, very high glycemic, I mean higher glycemic than even your wheat based bread, you know type of pasta, whatever it might be. So when you start processing things like rice into a flour, or you know, potato into a flour, you have a quicker digestive component to that, and it raises the blood sugar faster, its glycemic index is just high comparatively. So when you have to do these types of things, especially if you have a teen who is growing is active, but also could maybe use some slimming down or maybe needs to gain a bit of weight. One, it's maybe sitting down honestly, with a dietitian to see what are my child's growing nutrition needs right now? Are we you know, keeping kind of a log a couple of days of what are they really in taking? And then looking at what their nutrition needs should be for the point in life where they are, you know, are they moderately active? Are they heavily active? Are they kind of couch potato video gamers? What is it? And what do they need? And then looking at the kind of food that you put into their caloric need? Again, I mean, parents are typically the purchasers of the food in the house,

Scott Benner 37:06
give or take, you don't think this 14 year olds got a credit card? Yeah, I mean,

Jennifer Smith, CDE 37:11
and my kids, gosh, I mean, if we walk down the aisles in a grocery store, and they see like, the pretty packages, and you know, like, I never go, we don't eat cereal, so I don't go down the cereal aisle, but they'll always have something on like an end cap, you know, at the grocery, especially my eight year old, like, boy, that looks really good mom, I'm like, Yeah, and it's not really good for your body.

Scott Benner 37:35
That's why they have to make the picture. So nice. There's no fun here, stop it. Well, so I

Jennifer Smith, CDE 37:44
think, you know, from from that standpoint, you have to look at what is the child in need of? Are you meeting it? Are you creating access? And then potentially from a gluten free standpoint? Yeah, finding substitutions that can be fit in to meet his tastes, because all kids and teens are different, you know, as much as you want them to eat asparagus. They might not. Yeah, so you know, right?

Scott Benner 38:09
So, so you have to be it's Listen, I know if you've been listening for a while, you know that I took me a while to diagnose my low iron thing years ago. And during that a doctor made me eat like gluten free for a month. And I gained a lot of weight because I went out and bought all these gluten free items. And somehow in my mind, I was like gluten free equals health. That's how it felt to me. So I was like, Oh, it felt like zero calorie stuff when I was going in. And man, it was just not. I think if this was me, if Jennifer was me, and I didn't know what I was doing. I think I'd introduce like, lower carb more meat friendly, like meals, like that's what would occur to me first, right? Make some chicken, make some steak, put it with a salad or a vegetable and maybe cut down on carbs. But then you got to remember like we spoke about earlier, not to dose it as harshly as you would some of this gluten free stuff or you're just gonna create a low and you're gonna then have what you did by with

Jennifer Smith, CDE 39:05
them. Right? And I think you know, when we look at, you know, going back to just that like clean eating idea. Quite honestly, you can be gluten free if you're choosing to not buy as much processed food pretty easily. Yeah, I mean, you know, things like quinoa or like a wild rice or even like a brown rice or what? That's 100% gluten free.

Scott Benner 39:32
It's the fun stuff where it causes your problem. Right? It's

Jennifer Smith, CDE 39:35
not taking it out of the diet. It's just that you know, and I know the struggle with kids I work with plenty kids and teens to know that what they get at home under mom and dad influence because this is what you're eating turns around. It changes considerably once they start to do things with their friends, you know, now gluten free in the picture. If the child is is paying attention to that and knows that they just can't have gluten, they may already then have limitations even compared to what their friends are eating because they know that they just can't do it or they're not going to feel good, right? But in that circumstance, then it kind of takes sitting down and figuring out well, what that what will possibly be there that you could have, knowing that it's still more of like a process treaty kind of thing. But also that, you know, we're not going to do this at home. But you can have it when you're out.

Scott Benner 40:34
Okay. Laura has a question. It says, Is it true that insulin on board prevents the body from breaking down fat? Meaning that in order to burn fat, you need to have stretches of time with only your Basal insulin and no insulin onboard? That's interesting. I've never heard that.

Jennifer Smith, CDE 40:50
Yeah, it is, I guess it's an interesting way to frame it. I mean, we know that in the, we know that in the overnight time period, without any food on board. And on Basal only our body does get into more of that, like fasting state, right, of actually transitioning to some fat burn, etcetera. Because you're on a low level of insulin,

Scott Benner 41:13
I see what she's saying, okay.

Jennifer Smith, CDE 41:15
But when you have insulin on board, technically, there's a reason for the insulin on board. Right? Right. You're dosing for food, so that insulin on board should be covering food that is there. So yes, your body's processing carbohydrates. And your body is not at that point, then going to be in fat burn mode, it's kind of correct in a way of stating it. Yes. I mean, the same thing for a high blood sugar that you've corrected, now you've got iob. And the high blood sugar indicates that there's excessive sugar there, and your body needs to process it. And as such, it's using the insulin to process it and break it down and get it in the right places. So again, technically, as long as there's not an insulin deficit in that high blood sugar scenario, and the insulin is working to get it down, then your body isn't also breaking down fats, either,

Scott Benner 42:16
then is that a vote for intermittent fasting for type ones?

Jennifer Smith, CDE 42:24
It could be and can intermittent fasting work, right? It can. But again, a blanket statement is to stay that any plan that you choose no long term that you can continue this, right. The problem with the diets that are out there isn't the diet itself. In fact, there's a lot of research around a lot of the diets that proves long term, these people have had this success in weight management and cardiovascular benefit, et cetera, et cetera. But they've stuck with it. Yeah, it is the Oh, I'm gonna do intermittent fasting, oh, I'm going to do the keto diet, oh, I'm going to do the, you know, cabbage soup diet for the next month. And once it starts kind of showing benefit, I'm like, I can do, I can kind of step outside of the rules, the parameters, which are often for diets, very black and white. Yes, do this, this and this, but don't do this. And as soon as you do that, don't do this. You've broken the piece of that plan. That was getting you to your goal,

Scott Benner 43:32
right. I found intermittent fasting, the easiest to stick with, because to me what it was was as long as I don't eat, like don't eat after ate, and don't eat before noon. That is basically how I did it. And I have to admit, it's very effective. Now, I realized while I was doing it, that Arden basically does that already, without the late night thing, but she's so young, I don't think it matters, right. But she gets up in the morning and is not normally hungry in the morning. And so I've had to over time thoughtfully balance out how her insulin works in the morning, right? How do I come out of sleep into feet on the floor off to school without a rise that needs a bunch of insulin so that I don't create a low because she really doesn't want to eat until she's done with school or till lunchtime, right? Sure. So basically, Arden does intermittent fast, except she doesn't do 16 Is it 16 Wait 1819 2016 Eight that was embarrassing. Oh, lot of people would edit that out but I'm not going to. She doesn't do 16 Eight and as much as she probably does, like maybe 1410 Something like that. But also she's 16 So she can you know she can like we over Bolus her meal last night for dinner. We had stuffed peppers like turkey stuffed peppers, and and a salad. And my wife, my wife like swung at it really hard and about a half hour after she ate I was like her blood sugar is like stuck at 70 I was like, This doesn't look okay to me like I think this is gonna go the wrong way, you know. And so as it started to trend away, Arden got a little lighter I and she goes Cinnamon Toast Crunch please. So she knew she had basically Pre-Bolus cereals. So she was like, let's do it. And she had some of that had my wife going, I'm gonna guess 10 or 15 carbs less on the Bolus. She hit it right on she was so close. But you know, that's a young kid. And Arden's also helped by other things that I think are worth mentioning here too. Because those of you listening have type one diabetes or love somebody who does, you really have to get your thyroid levels checked. Like you'd could be fighting against a borderline thyroid problem that's making weight loss impossible you know and if you're going to do that you really need to go back and listen to the thyroid episode with Dr. BENITO because the range that your doctor is going to say your thyroid your TSH levels okay in a real badass endocrinologist will not accept you know what I mean? They will not like if you're over a two Dr. BENITO is giving you thyroid hormone. Like then there are people right now who are listening are like oh my TSH is a five My doctor said it's okay. I'm borderline. Yeah, yeah, right. But I but my hair does fall out a little bit or I'm having trouble losing weight or I'm a little nasty sometimes or whatever the other things come. I'm just telling you if your thyroids moving the wrong way, deal with it, because it makes a lot of life easier.

Jennifer Smith, CDE 46:36
And it's a lot within this whole topic of weight management. Absolutely. If you've the Hashi Moto is which is very common autoimmune. Once you've got you know, type one, it's good to get tested thyroid levels at least once a year if not every six months, especially if you've got other family who has a thyroid disorder known already. But that's huge in terms of metabolic

Scott Benner 46:59
Yeah, but you have to you have to advocate for yourself. You can't say oh my god, Scott, you're right. I am tired all the time and I can't lose weight and blah blah, blah, and then go to the doctor and the doctor say oh your TSH is for you're fine. Your TSH just for you are not fine. That's the equivalent that to me is the thyroid equivalent of in diabetes. When somebody says your blood sugar average blood sugar is 180 You're doing great. Right? Right. You might you know you're not dying, but you you're not living at a healthy level. And that has other impacts on your life. This thyroid thing is it is crazy. It is like the equivalent you trust me at this point. I've seen everyone in my family except for me deal with it. It's like taking a long metal like paperclip and just touching it on a computer circuit board to it just mess with stuff. You know what I mean? Yeah, but and with

Jennifer Smith, CDE 47:45
with Arden's doses, have you noticed that when things get out of order, do you notice a shift in her insulin need, because that's very common right away that, you know, metabolically, she's feeling more sluggish, sluggish and fatigued. And insulin is just not working, like it was supposed to work. And if there's a timeframe in terms of adjustment, or even just starting on a thyroid medication, where you will then start to notice a shift back to normal insulin dosing. See, again, that insulin manipulation in terms of the weight management piece with thyroid in the picture have to be very kind of eyes on right to make sure that you're adjusting than where you had bumped everything up in terms of insulin need, you're going to need to start bumping down. And if there's weight loss in the picture at the same time, definite need to bump down or you're going to just run lows Yeah,

Scott Benner 48:41
I there's some times I think I should even have a flowchart for myself like if this then that kind of chart because you're right, if the thyroid level starts to get away, then her insulin needs go up. And then we adjusted it doesn't happen right away and our insulin knees start coming back down again, the same thing with she had to start a birth control pill to regulate her periods. Hall. I lost three months of my life to figuring that out. Like it was just first they gave her a pill with not enough estrogen. And so it was basically just two wasted months. She was exhausted all the time because she was bleeding constantly. So I had to get her through those pills. Those aren't the right pills put her on the right pill that started working the bleeding regulated. Yay. Now she's lost so much blood I had to go get her an iron infusion. Got her the iron infusion. Now we're waiting for that to come back up when the iron infusion comes on board her insulin needs are going to change again. Yeah, vitamin D levels seem to impact insulin knee Yes. I just

Jennifer Smith, CDE 49:44
in fact many people for vitamin D that you bring it up that's another like peace and I think in terms of like, like, again going down the rabbit hole of discussion and weight management the we're kind of on the track of like medications and medications in terms of thyroid as well. less things like iron, but vitamin D, you know, your lab will tell you optimal is between or standard is 30 to 100. Optimal according to the female specific physician that I'd worked with years ago, before I had my first son, she was like, you know, optimal range is really 50 to 70. For vitamin D, she's like, and if it is not in there, you need to be being supplemented, because otherwise, especially with diabetes, vitamin D works on the cellular level. And it allows insulin to be seen correctly, it for lack of a better term, by the cells. And so it lets insulin actually work the way that it's meant to have one of the many things that can, so if your vitamin D level is off, supplement, I mean, in general, someone with type one, adult wise, should be supplementing at least 2000, I use a day. And if your levels are not optimized at least 4000 a day. And if they're really on the low end, you need to be doing like the hyper significant doses of vitamin D for a short period of time, if you like. And then

Scott Benner 51:10
for 50,000, I use and you take one once a week, or something like once a

Jennifer Smith, CDE 51:14
week, or I've even seen some doctors do like 110 1000 iu a day for you know, a couple of weeks and then retest. But vitamin D is huge. And

Scott Benner 51:23
I'm not a doctor, but there's something about vitamin D deficiency and autoimmune that go hand in hand. So just look at the studies out of Finland, right? I tell you, I listen, I take 5000 a day, and I take 5000 A day of vitamin D, I take a zinc tablet, I taken a sorbic acid with iron, and a B 12. And that's that's what I do every day. And that's what you know, my kids do and and everyone here is doing because when the D levels drop, again, problems with insulin, I'll tell you right now too, because Jenny mentioned ranges that you need to be in versus what lab values will tell you, Dr. BENITO back on the thyroid thing said, if you were a woman of childbearing years, anything under 70 for your ferritin is too low. And they're not going to tell you you're low till 20. So she's like, if you are having a period, you gotta be above 70. So there's a lot of things. And then all of these things also impact your body's ability to work correctly, which is in part and parcel of losing weight or

Jennifer Smith, CDE 52:29
losing weight, right. There was one in here that does go along with medications that I think is a really important question. This woman has a son on a medication that is more for like attention. And it's specific to using it versus not using it school year versus spring date break or summer time and what ends up happening in terms of insulin needs. And I think it's an important one, because I've seen a lot of kids who are using Add ADHD kinds of meds. And a very, very common thing with those is that it decreases appetite. Okay. And if they're using it in their school day, and they're also the brain uses carbs, and so the more thinking that's going on, and the potential that they're really not hungry, they may not even finish the lunch that you packed for them, they may pick at the lunch that comes from the school lunch, because their brain is just saying, I'm not hungry enough to eat, okay, you may end up having to have two types of Basal profiles, maybe one for like a spring break time off another one for school days. And again, as kids get more into the teen years, that becomes really beneficial in terms of growth and the potential for weight gain in the wrong direction. Because if you're constantly feeding loads again, or constantly adjusting insulin up and down, but it's kind of willy nilly and not quite right on with need. It's a medication adjustment kind of thing that goes along with adjusting insulin again.

Scott Benner 54:11
We're right up on it. But there's enough questions in here that all circle around menopause. Do you have any feelings about what happens at that time and Chinese? Yeah,

Jennifer Smith, CDE 54:20
that's a fun one. For myself. In general menopause in and of itself. I mean, perimenopause really is the start of kind of that time period in a woman's life where your cycles might start to get less evenly spaced. Right. Let's say you were the typical like 29 days and you was right on spot and now like, huh, now it's like 26 days and next month, it might be 32 days and then maybe 29 days and, you know, periods can get a little bit more aggressive, or kind of look more spotty, but that perimenopause kind of leading into menopause, which is really A woman has not had a cycle in a 12 month time period, right? So insulin needs can look very jumpy, you might even find that, again, as we get older. And these things come into the picture from a female perspective, our metabolism does slow down, we oftentimes start to need a little bit more insulin, or it takes a little bit more activity to maintain or burn off what we were able to do when we were 30. That doesn't work anymore when you're 45 or 50. So I mean, menopause, perimenopause, it brings in a whole circle of hormone impact, right, that may more aggressively change your insulin needs, especially around your cycle times.

Scott Benner 55:50
So not unlike, well, I guess, more aggressive but not unlike having your period and seeing right hormone fluctuations throughout the month,

Jennifer Smith, CDE 55:58
right. And then once you're in menopause, oftentimes, you know, outwards of a year or two post no longer having a cycle. Many times, then insulin levels should get more stable, because you don't have that hormone flux. And as we age men and women have less and less and less growth hormone cycling anyway. And so we end up especially women passed about the age of 65, or people passed about the age of 65. Oftentimes, their baseline Basal needs definitely go down. Okay. And the reason they are is because their hormone Cycling has kind of started dropping off.

Scott Benner 56:39
Okay. All right. Did we do this justice in an hour? Because I feel like we did, but I don't know much.

Jennifer Smith, CDE 56:45
I think that we did as much as we could get it in an hour. I mean, if we really wanted to focus in again, dig really deep into that information hole. There's a whole bunch of out meds that are very specific to like weight loss, and, you know, things like the GLP ones, and things like the SDLT twos, and what, despite them being type two meds, they are getting a lot more. They're kind of climbing on the ladder of benefit for those with type one and who are just insulin users. And they do have promise in terms of weight management, if use the correct way. Okay. So

Scott Benner 57:32
do you feel comfortable talking about that? Because maybe say here that if you liked this episode, look for that one coming in? Yeah. Okay. Great. Thank you. Yeah, Jenny, you got to do all the talking. I was at some points. Uncomfortable. Not for because you I was like, huh, there's not a lot for me to do here. I was just checking. I was just saving files and checking rates and looking at questions I was like,

Jennifer Smith, CDE 57:58
so like, I should have just gone and gotten an extra cup of tea. Kind of nice.

Scott Benner 58:01
I should have just said, Jenny, tell me about weight loss. I'll be back.

Jennifer Smith, CDE 58:05
It really is. I was looking at all the questions. I mean, there are a lot of really good questions, but I think a lot of them honestly. Go back to insulin. dosing it the right way for what you're kind of taking in. And then also, secondly, looking at what are you taking in,

Scott Benner 58:25
right? And obviously, in my mind, these questions all are, they're similar, they're tied together, whether it's vitamins, or your thyroid level, or your calories or, or whatever it ends up being is there is a balance that optimizes your body, it's not going to be the same for everybody. Some people's vitamin D level can be crashy load to the floor, and they'll never notice it, and it won't matter to them. But for some people it does. And when you get those things in the right balance, then you feel better and feeling better. To me. It's like you feel stronger, you're more rested, like all this stuff happens. You're clear in your mind. But how but some of these things nobody would even know to look into. No, you know, even vitamin D like I can remember 10 years ago, my Ardennes nurse practitioner gone. We're gonna start checking vitamin D was almost like a mandate came down from a mountain. You know what I mean?

Jennifer Smith, CDE 59:15
Yeah, actually, I don't even know when that would have been. But if it wasn't, I remember when I was working in DC, and the endo practice I worked with within the, our director was very, like high up within the whole, like diabetes management like realm of information. And his he was like, we're testing vitamin D levels for every person with diabetes. And at that point, it was really just, if the thought was it was relevant more to type two. But as we started testing, then I went to my own Endo. And I was like, you know, I run I'm outside all the time. I have like, you know, like brown skin from being outside. Like, I don't take my eye like I'm sure it's fine. In fact, I didn't mean the level came back and my doctor himself called me not as nurse. He was like, This is really weird. But he's like, I want you to go and get it tested again. He's like, This can't be right. And my level was 18. Yeah. 18. And so when I got it tested again, nope, it was 18. Again, he was like he did he that was the one time a week, the 50,000. I use, I came back in eight weeks, it had moved to 21. And he was like, huh, so I he sent me to see like a naturopath, who was also a physician who knew a little bit more in that realm. And she actually had me started, she started me on oral drops, okay. And the drops get absorbed through your oral mucosa rather than having to go through your gut. And because we know there's a lot in terms of gut and absorption in autoimmune disorders, she's like, I guarantee your body's not absorbing it. She said, that's the problem. And is it within about I think it was 10 weeks after that, I got it retested and was already up in the high 40s. Yeah,

Scott Benner 1:01:04
you know, I have to, I thought I was gonna have to live getting iron infusions my whole life, because I couldn't absorb it through my gut. And I do probably have some, like, weird stuff going on down there. And instead, I mix it. So first of all, I use a really pure, like, supplement from a company that, you know, you can do your own research and find one that you like for yourself. But I researched out found a really pure supplement, and I have to take the iron within his sorbic acid at the same time. I do that it absorbs great if I take just the iron tablet without the sorbic acid, we won't work. Yeah, that's it. There's a over the counter when called vite Tron or vitamin D or something like that. It's it's iron that comes with its C, vitamin C, together that helps that too. But yeah, these are the kinds of things no one's going to tell you about or they're just gonna blurt out. We're testing for vitamin D now, then you come back, quote, unquote, in range, and they don't give me one anyway. And you're like, Well, this was a lot of fun. So anyway, everybody balanced your body, balance your insulin. Things should get better. That makes sense. All right. Thank you, Jenny. Yeah, you're welcome. Absolutely. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juice box for E meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juice box, you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 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 talk 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, weightloss 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 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 information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insolence so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and 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.