Scott Benner 9/22/25 Scott Benner 9/22/25

#1633 Bolus 4 - Pancakes

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Jenny and Scott talk about bolusing for Pancakes.

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

Scott Benner 0:00
Hello friends and welcome back to another episode of The Juicebox podcast.

In every episode of Bolus four, Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a roadmap called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash, meal, dash, bolt. But for now, we'll find out how to Bolus for today's subject. Please don't forget 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.

A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox Jenny, we are going to do pancakes. Oh, pancakes. Now we have two different pancakes sitting here. We have the ones for those of you who are in the grocery store buying the Betty Crocker Bisquick, shake and pour pancakes. And don't put your heads down. Stay proud. I know you'd buy them out there. Jenny, do you even know what this is? It's a plastic bottle that you pour water in and then you shake, shake, shake, shake, shake it up, and you have pancake mix when it's over. You don't know this. They

Jennifer Smith, CDE 2:25
didn't know that they made them that way. I thought you still had the powdery stuff that you had to mix in a real bowl at home. I did not

Scott Benner 2:32
know you can buy it like that too. This is, like, this is next level, I'm not gonna say lazy, but this is next level, easy, okay. Like, it's a plastic jug. You pour cold water and you shake it up, you have mix. I have tried to Bolus for them, and it ain't easy. So, like, I could do it, but it's not easy. It takes pre bolusing. It takes extended boluses. It takes increased basal over top of like eating and Arden does not use syrup with sugar in it. As a matter of fact, she oddly eats pancakes dry. Sometimes she won't even put butter on them. Sometimes. Now I have those. We're going to look at those. But then I also have a very simple to make on your own pancake recipe that has been on my blog for years that does not cause any consternation the way these the mixes do. But let us start with the mix nonetheless, and that's

Jennifer Smith, CDE 3:26
interesting. I would expect what I'd expect from both of them in the extended nature of insulin need after has is not the upfront, but it's the long term. Would be the because of the way that you cook them.

Scott Benner 3:41
Okay? Yeah, I'm not sure. I don't know why, but, like, all I know is simple ingredients that are real seem to be I'm not, listen, they're still pancakes. It's not like bolusing for you know

Jennifer Smith, CDE 3:53
what I would expect? Your recipe is real flour, right? It doesn't have all of the added preservatives. It

Scott Benner 4:01
doesn't. And I do spend a little extra money when I buy flour in the house. It's a little better, but it's still it's got butter. You'll see. You'll hear it when you hear it. But let's start with, let's, let me turn to a new, clean page on my shaking bottle. Let's start with the Benner cake. This quick shake and pour buttermilk pancake mix, 10.6 ounces a serving size is a this is hilarious. A half a cup of mix is a serving size, and they're calling that three pancakes.

Jennifer Smith, CDE 4:29
And is that dry mix before you've mixed it with the liquid ingredients, that's the next question.

Scott Benner 4:36
I think if it's three, I don't know, I don't know what they're saying. So let's look on the it's 10.6 ounces.

Jennifer Smith, CDE 4:44
That would be my consideration. It's that you've got a half a cup of dry mix, and what you add to it, liquid wise, it sounds like it's just water. You don't have to add milk or other nutrient containing foods. So if it's just water. So the whole container, I would expect, takes a certain amount. So if you break it down to a half a cup of the dry mix, how much water goes in? That probably makes three. Does it give a diameter? To

Scott Benner 5:13
be honest, I think it might mean the mix with the liquid in it. Oh, yeah, because it's saying there's five. I'm trying to think of, I have used this before, so five servings of a half a cup? Yeah, I bet you there's about two and a half cups of liquid in there. Yeah, I'm gonna go ahead and say that this means a half a cup of the actual mixed is there some tiny pancakes? Man? Well, that was my point. Is that this is where they're three pancakes. It's got to be like three inches Exactly. They got to be the tiniest goddamn pancakes you've ever seen in your life, is my point. So again, this is where they're going to mess you up, because no one's making a pancake that's two and a half inches across. No, no. So anyway, a grain of salt on the on the serving size. But let's just say, why don't we just say that you eat half of the container? That makes sense. Okay, so, so let's call it servings in the container. Yeah, there's five servings in the canner you're gonna have. Let's just say you're gonna have two of them. You're gonna have two servings. So this is six grams of fat. It is. Where are the car? Oh, it's 9090, carbs. 45 for a serving. 45 for a serving. So 90 for two servings, you get 90 carbs. You're getting six grams of fat, a lot of a lot of sodium, by the way, you're gonna see we're eight, almost 1000 milligrams of sodium. Wow, 480 per serving. Five or a gram for a serving. So two grams sugars, including nine grams of added sugars. You're getting, you're getting 10 grams of sugar in a serving. So 20 grams of sugar in that because there is at, I mean, most of it's added. Actually, they are adding a lot of sugar to it. Protein six, so you're getting 12 protein total. Okay, don't worry, there's calcium and iron in them. You're gonna live forever. The ingredients are enriched flour, bleached wheat flour, malted barley flour, niacin, iron, thiamin, mono nitrate, riboflavin, folic acid, sugar, Defatted soy flour. I don't know what that means. Leavening agents like baking sodium, sodium, sodium aluminum phosphate and mono calcium phosphate. There's also palm oil, dextrose, buttermilk, salt, something that's called da temp, but it's all in caps. That scares me, for some reason. I'm gonna look that up later. Contains wheat, soy and milk ingredients. Okay, well, let us go to our breakdown list. We have measured our meal. Our meal is 90 grams of carbs. We are one unit for 10. So that's going to be nine units of insulin. We're going to evaluate ourself again, this is the morning, I would have to say another evaluation here is, I mean, how many people are making pancakes and not putting bacon or some sort of, like a breakfast meat with it, which is, I know that's not what we're talking about right now, but like, you know, like, that's going to hold up the whole, the whole thing well,

Jennifer Smith, CDE 8:24
and I think in the realm of, again, your listening body, a lot of people are all actually trying to do that. They may not have before, but they may be trying to do that to mitigate the impact of what they expect the pancakes to do?

Scott Benner 8:41
Yeah, I'm saying the only the issue there is, like, you're trying to add protein with it. So in the morning, protein might mean bacon, and then bacon is going to mean fat, and then you're going to have, you know, you're going to get the lift from the fat later too, right? Okay, calculate our food. Bolus, we've done that. We have nine units. What do you think? Jenny, you want to you wake up in the morning, it's Saturday morning, you are having the experience that Arden has been having lately. A hot shower is shooting her blood sugar up. Never used to happen. All of a sudden, hot showers, boom, like she's

Jennifer Smith, CDE 9:12
going and it's not just her CGM that's being weird. It's actual, by finger six, she's rising too.

Scott Benner 9:17
She's jumping up in hot showers lately. Okay, so you get out of the shower, you come downstairs, Mom, it's Saturday. What are we doing? Oh, you're lucky. I'm a great parent. I've bought you a bottle of pancakes, and again, I've made them so you know, if there's shade, it's for everybody. There you go. And my blood sugar is 150 Oh, now I need a half a unit to move the blood sugar, probably more. Your blood

Jennifer Smith, CDE 9:40
sugar still rising according to the CGM trend, or is it stable at 150 let's

Scott Benner 9:44
call it stable, just to make those okay. Okay, so I need a correction for my one unit moves us 10 carbs. One unit moves us 100 points. That's for our examples. So now I'm looking at a nine and a half unit meal, uh, meal, Bolus. Do you. And what I hear from people all the time is like, oh, big Bolus to scare me. So I think that they can, often people look at them go, that's a lot like, you know, I don't know if I'm gonna put all that in there. I would say, you know, I think your rule of thumb here for double whatever you find works for you. So if you found, like Jenny used in other examples, if 12 minutes is a good Pre-Bolus for you, for something like this, you're going to need 25 minutes. This episode is brought to you by Omnipod. Would you ever buy a car without test driving it first? That's a big risk to take on a pretty large investment. You wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period. Plus you can get started with a free 30 day trial to be sure it's the right choice for you or your family. My daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player, or at Juicebox podcast.com

Jennifer Smith, CDE 11:30
and the Bolus size really does scare you. A stepping stone to getting there, if you really love this product, would really be do that 25 minute Pre-Bolus with half of what the Bolus recommended is, if it's nine units, take four and a half. Take that with the Pre-Bolus, and then as soon as you start eating, take the other because we all know the insulin action time is not right here and now, as it's delivered, still takes a little build up time to get it working. So that's it's this strategy that, while it may not be beneficial for keeping your blood sugar under 180 at least you're getting the whole Bolus without as much fear. Is truly what's in the picture?

Scott Benner 12:13
Yeah, I'm gonna say, you know, just from a person who's, you know, raised a kid with type one diabetes, I like Carrie's sugar free syrup. Of all the ones that we've tried over the years, that one seems to taste the most like syrup carries, yeah, S, C, A, R, y, s, do you have one that you tell people about?

Jennifer Smith, CDE 12:31
You know, there are two that I think have quality flavor, which I've heard from a couple of people. They really don't like one of them, the LE conto brand. I don't have an issue with the flavor of it. The other one is the RX sugar. That one has a really nice maple sugar. It's all yellows, sort of non sugar alternative, kind of in it. So those tend to work well, I've never seen an issue with the RX sugar. I while there are, again, on all of these alternative sugars, carb counts on them, probably like the carries. I don't know if Arden has to count any of the carb grams on there, but I don't for the RX sugar. But I'm also not eating, like a half a cup of it.

Scott Benner 13:17
I don't see the carries doesn't add rocket fuel to pancakes for her. So okay, I take that as a way that she probably doesn't need to cover it. Now, listen, I happen to know because during covid, I went on an extensive research to find out why the waffles at a local diner were so good. I was really bored during covid, and I found out what syrup they were using. So I'm going to tell you that the one you get in a diner that you probably think of is tasting good has a serving size of two tablespoons, which no person in the history of the world has ever used on pancakes. But let's just say two tablespoons, not only are you going to get 100 calories from that, but you are going to get 26 grams of carbs from two tablespoons of this, if you're doing 90 grams worth of pancakes and a quarter of a cup of syrup, which I'm still being generous for people, but let's say that. Let's say it's, it's another 52 grams, yes, yes. It's another 52 grams of insulin of carbs, which is now putting your, I'm gonna have to do some math here. That's 142 but that is that 14 plus the correction, that's just about 15 units for that. Then if you're gonna put, yeah, Jenny's like, I haven't taken 15 years, and it's less than three days, that's not true, but not all at once. Oh, my God. My point is, is that you can't, you can't come online all the time and tell me I don't know how to Bolus for pancakes if you're not addressing them for what they really are, that's all like, you're gonna have to come at it for what it really is. You can't say, oh, that number seems too big, or I've never Bolus that much before, like this is what it is.

Jennifer Smith, CDE 14:53
And I think a valuable piece to point out too is, you know, you brought up a waffle house for. Waffle right? Let's say you have figured out your pancakes at home. You know the portion size. You know exactly what goes into them. When you go to your local pancake place, it will be different. Is it a little easier to swag the pancakes you're eating? Sure, because you have something that you've figured out to work, but also your pancakes at home might be four inches, and this pancake that comes out to you now is the whole, the whole plate, right? And so then you end up, let's say you swag it pretty good in terms of the grams of carb, but now in terms of worry about that amount of insulin, you put that in your pump and you're like, my gosh, 14 units of insulin. I usually take five for what I eat at home. Yeah, what you need is what you need, right? Based on how much you're eating and how much you're calculating. So as long as your insulin to carb ratio is the same, sure, you might use five units at home, but you may very well need the 14 units because of the difference in portion.

Scott Benner 16:04
I would say that, you know, when we talk about, you know, looking at your CGM down the line an hour, three hours, and evaluating what happened, so you can tweak it for next time. If that amount of insulin scares you to the point where you're like, I can't, I just can't do all that. Like, I don't, not understand. But then when you're doing your valuation, and you end up having to make a correction. Look at that insulin. Like, the amount that you use to correct with, is that the amount you skipped in the initial Bolus? Like, is it close? Like, that'll help you get to the idea of what you actually need. I'm not saying run out there and make some like, super aggressive Bolus. Like, you might be the person who doesn't need it. Like, you know, like, you're gonna have to work into this. But this is the thought process for going through this and and I'll just say here at the end, if you go to Juicebox podcast.com and type pancake into the search bar, you'll get a simple recipe that I use when I make pancakes home. It's a cup of flour. It's all purpose flour. It has two tablespoons of sugar in it, and it has two teaspoons of baking powder, a teaspoon of baking soda, a pinch of salt, a cup of milk, one large egg, two tablespoons of melted butter and some vanilla extract. And is it like drinking water and bolusing? It's not. It's still like pancakes, but it's not like the packaged pancakes, the box pancakes that were there. So

Jennifer Smith, CDE 17:21
what is your since you know and you have had both, what do you see is your difference in strategy, knowing that who you're feeding it that she's still going to eat the same amount of pancakes either way, right? She's

Scott Benner 17:37
tough, because she'll like, she'll grab them and then start eating. And they go, can I give me another one of those? And some days she's like, give me some syrup. Or someday she's like, I'm just gonna eat them dry. Like, see, it's a little bit the syrup sugar free. But what I like is I take a couple of different strategies and I throw them together nice long Pre-Bolus. It's gotta be 20 minutes at least, right? I like to see a falling blood sugar when the food hits. And then I put a basal over top of the first hour, at least, right? Like, because my goal is not to leave 90, right. Like, especially on stuff like this. Like, I'm more aggressive on the things that, like, could possibly lead you to an afternoon of 350 blood sugars, right? I don't mind missing on something that goes to 160 and we have to fix it, like, whatever, like, but I don't want to get I don't want it to ruin the day. So I would lay a basal, like an attempt basal, over top of the Bolus. And, you know, Arden's using trio right now the do it yourself. App, it's very simple to do. I'd put the Bolus in 20 minutes before, you know, if she had a lower, stable blood sugar going in, if she came downstairs out of that hot shower, and she was 170 and she said, I want pancakes. The next words that would come out of my mouth are Bolus, like, before I even go to look to see if we add an egg in the refrigerator now, like, just now, you know. And it's momentum, like Jenny, it's timing and amount. Like, I know this is fun to break down like this, but like, it's the right amount of insulin at the right time for the situation. So and then I like that you can bail on the temp basal if you start getting too low. And then to me the L or the look at the CGM in meal bolt. I keep watching. If I see a drift up, I'm right back on. I smack its hand like it's trying to shoplift. You know what I mean, like right back at it again.

Jennifer Smith, CDE 19:22
And with trio, you've probably like me, I've been using trio for a year now, and honestly, what I've found is it's less likely to need to do that back end slapping, mainly because it does a good job of that additive. Depending on how you have your dials turned in, it does a pretty good job of hitting for you before you have to step in, which is nice, because you can kind of step away for a bit right in

Scott Benner 19:50
the end. It's in the podcast somewhere. Jenny and I've talked about it. I've said it over and over again, but I leave a over heavy carb situations, I lay a blanket of insulin over top of it. Like a weighted blanket so it can't stand up and

Jennifer Smith, CDE 20:02
and in this case, I think that weighted blanket effect, so to speak, is relative to, as I pointed out initially, both types of pancakes require cooking them in oil

Scott Benner 20:15
or butter, or I do butter on the pan, and very little like, I actually butter the pan, and then I wipe it off like so I just don't want it to stick. That's all I care about. But I do see you're not wrong. I've seen people look like they're deep frying their pancakes. Yeah, that's a more southern thing, too. I've noticed when I'm traveling sometimes too. Is that maybe what could be?

Jennifer Smith, CDE 20:34
Yeah, could definitely be. I think it's also restaurant style is definitely heavily cooked in some type of oil or butter on the surface,

Scott Benner 20:45
they're trying to kill you, for sure. Yes, actually, I guess what they're trying to do is give you enough butter that you're like, I'm coming back there one day. Yes, yeah, okay, all right, this is good. That's, that's, that's

Jennifer Smith, CDE 20:57
that long term effect. You're not only thinking about carbs, but you're thinking about that lingering, yeah.

Scott Benner 21:02
So, I mean, I'm gonna tell you this all changes. You add bacon to this, or we're from the Northeast pork roll to this, and now, yeah, right. And now my checking, like, isn't just one, two hours later, because if I get pancakes right, two hours later, I'm done. It's good, but you add bacon or some fatty meat to it, now it's three, three and four hours later, like you still have to be looking Sure. So okay, all right, I appreciate it. Awesome. Thanks. Thank

you. A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox

Unknown Speaker 22:00
you in

Scott Benner 22:04
each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward, slash, meal, dash, bolt. But here's what it is. Step 1m. Measure the meal, E, evaluate yourself. A, add the base units, l, layer, a, correction, B, build the Bolus shape, O, offset the timing, l, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load. And then we evaluate yourself. What's your current blood sugar, how much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress hormones, illness, what's going on with you? Then a we add the base units, your carbs divided by insulin to carb ratio, just a simple Bolus l layer, a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape? Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes? Are we going to have to, again, consider combo square wave boluses and meals, figure out the timing of that meal and then l look at the CGM an hour later, was there a fast spike? Three hours later, was there a delayed rise? Five hours later, is there any lingering effect from fat and protein? Tweak, tweak for next time. T What did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus. For measure the meal, evaluate yourself, add the base units, layer a correction, build the Bolus shape, offset the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. I can't thank you enough for listening. Please make sure you're subscribed or following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. The episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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Scott Benner 9/19/25 Scott Benner 9/19/25

#1632 Bolus 4 - Cinnamon Toast Crunch

Jenny and Scott talk about bolusing for CTC.

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Scott Benner 0:00
Hello friends and welcome back to another episode of The Juicebox podcast.

In every episode of Bolus four, Jenny Smith and I are going to take a few minutes to talk through how to Bolus for a single item of food. Jenny and I are going to follow a little bit of a road map called meal bolt. Measure the meal, evaluate yourself. Add the base units, layer a correction. Build the Bolus shape, offset the timing. Look at the CGM tweak for next time. Having said that these episodes are going to be very conversational and not incredibly technical. We want you to hear how we think about it, but we also would like you to know that this is kind of the pathway we're considering while we're talking about it. So while you might not hear us say every letter of meal bolt in every episode, we will be thinking about it while we're talking. If you want to learn more, go to Juicebox podcast.com. Forward slash, meal, dash, bolt. But for now, we'll find out how to Bolus for today's subject. Please don't forget 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.

Summertime is right around the corner, and Omnipod five is the only tube free automated insulin delivery system in the United States, because it's tube free, it's also waterproof, and it goes wherever you go. Learn more at my link, omnipod.com/juicebox That's right. Omnipod is sponsoring this episode of the podcast, and at my link, you can get a free starter kit. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox Jenny, I have a list in front of me here that says this is the top 10 Best Selling cereals by boxes sold. Okay, be a lot of words here. You don't know Cheerios, Frosted Flakes, Honey Nut Cheerios, Honey Bunches of Oats, cinnamon toast, crunch, Fruit Loops, Lucky Charms, frosted Mini Wheats, life and my favorite from when I was a child, Fruity Pebbles. Now,

Unknown Speaker 2:29
you know a fruity pebble? I know what they look like. Yes,

Scott Benner 2:32
they're nothing like those bastardized Cocoa Pebbles, which are just garbage. I don't even know. I've never had them. Are they the same maker? One's chocolate and one's fruit. I bet you it's not chocolate or fruit, by the way. I just want to say

Jennifer Smith, CDE 2:47
that I'm quite sure not. So

Scott Benner 2:49
let's pick one of these, and Bolus for it. You want to go, Okay, how about Cinnamon Toast Crunch? Oh my gosh, sure. Sure. You think it has cinnamon in it. It might, hold on a second. It might toast. I'm

Jennifer Smith, CDE 3:02
sure that it has cinnamon, either that or the side of it says cinnamon flavoring. Well,

Scott Benner 3:08
you can get a mega box of it for $6.21 what a deal. Let's see here, Cinnamon Toast Crunch. I am looking at its label. All right, Jenny, let's see. What

Jennifer Smith, CDE 3:26
is this? Serving size, three quarters of a cup.

Scott Benner 3:28
Oh, interesting. The serving size is one cup. Oh, one cup. Actually, I got thrown off a little bit because this label is in English and Spanish, and I kept going like, this doesn't seem like a word, I know. Sorry. So it's one cup total carbohydrates, 33 what is 33 like the magic number, or something like that? 33 grams of carbs, dietary fiber. Three grams. People are gonna be like, are you subtracting the are you not subtracting fiber? Yeah, right. No, you don't subtract by total sugar 12. This is exactly the same as, like we did. How is that? That's crazy. But this isn't gonna hit like the oats. This is gonna hit like a truck. So also milk, right? So we have to, like, a cup of milk. We're gonna have to do a cup of milk on this, do a standard one cup of milk. Okay, hold on a second. And now, is there anybody that only eats a cup of cereal? That's the question. Just made Jenny,

Jennifer Smith, CDE 4:32
I'm just referring back to the big the big vats on the wall in a cafeteria at college that like it's got the poor nozzle that you just pull it down it cranks it all out into your bowl. And I remember watching people fill their bowls at school with, like, the Jethro bowl of cereal.

Scott Benner 4:55
What's the Jethro bowl? What did you just say? Gigantic, gigantic. Okay.

Speaker 1 4:59
Oh. Whole bowl. Really, it was probably half of a box of cereal

Jennifer Smith, CDE 5:03
in a bowl, as though they'd sit down

Scott Benner 5:05
to eat. Hold on a second, food. Label, milk, whole milk. What do you drink? Oh, we don't drink milk. Sorry, I'm just gonna

Jennifer Smith, CDE 5:18
the dairy industry is gonna be like, Damn, that girl, she doesn't drink

Scott Benner 5:21
milk, cup of whole milk. It was hilarious. 12 carbs and no fiber, 12 grams of sugar, sugar and milk. Why is everything 12? Oh,

Jennifer Smith, CDE 5:37
1212, grams. That's because the carbohydrate is the same as the sugars,

Scott Benner 5:41
right? Yeah, but it's not, like, added, right? They're not added, no. That's all just protect me. I was like, they're not adding sugar to milk. Are they?

Jennifer Smith, CDE 5:48
Nope, milk sugar, essentially, it's in there naturally, yep. All

Scott Benner 5:52
right, I'll accept that. So we have now we got to figure out what an actual serving size is. I mean, it's, I bet she's three cups. I would say the

Jennifer Smith, CDE 6:03
majority of people eat two cups, two okay, let's, I would say two cups. So it is. And I'm, I'm thinking, kiddos,

Scott Benner 6:11
okay, right? I think that's the biggest problem is that people just look on the back like, Oh, it's 33 carbs, and then they just fill the bowl up with it. And, right,

Jennifer Smith, CDE 6:19
yeah. So what's, Yep, exactly. So what's the first step? Measure?

Scott Benner 6:23
Yes. So first step M measure. So we're going to measure and say we're having two cups, which is now 66 carbs. And does that mean we end up with two cups of milk? Or you think it's still one cup? I would still say one cup of milk. All right, we'll be generous and say one cup of milk. 66 carbs from the Cinnamon Toast Crunch and 12 from the milk is 78 total carbs. Okay, now we're gonna evaluate ourselves, right again? Yes, it's morning time. Are you a person who has wait? I wonder how many people are gonna realize they do or don't have trouble bolusing in the morning. That it's more about the food and the lack of Pre-Bolus than their scenario. But you want to check your blood sugar. If you have a CGM. Take a look at it. If you don't, please check with the meter. Do you have any insulin on board? What kind of a day is this going to be? Is it going to be a stressful day? Is going to be an active day that might impact how you Bolus? Probably not for Cinnamon Toast Crunch, however. So we're going to calculate our food. Bolus, Jenny, we have 78 carbs. And you guys, I wish this is not. This should just be video so you can just see Jenny going like, you know, in a day? Is that a week? I don't understand, but 78 carbs. And so that's 7.8 units of insulin using our standardized one to 10 carb ratio, which we're doing for all of our examples. So now we have 7.8 units of insulin that we need. I mean, let's say the kids wakes up at 130 I think you'd a lot of you'd be thrilled if your kid woke up 130 right? But we're also one unit moves you 100 points. So let's add another unit, another point three to it. Let's just call it eight for fun. Now we got to take a look at what we're going to do. We're going to build this Bolus up like, what are we going to do with it? Pre-Bolus, four in the morning. Jenny, when do you put it? I'm sure I've written blogs about it. I'm sure I've talked about on the podcast that you know. Arden, actually, after it, we left an end to appointment one day, asked me back when we just didn't know what we were doing and everything was upside down, or a 1c was in, like, the mid eights. Is there anything I can do to help you with this? Like a little kid standing in a parking lot said to me, and I said, you could stop eating cereal for a little while till I can figure this out. Yeah, but I did get back to it, and you know, she doesn't eat cereal anymore, but I did figure out a Bolus for it, and I'm gonna tell you that the answer is an aggressive Pre-Bolus, an aggressive amount of insulin, and you need momentum on your side when that cereal kicks like there has to be such a pull from that insulin when that cereal kicks that you can keep your stability. I mean, I don't know, what do you think for you're gonna say a half an hour, right? Today's episode is brought to you by Omnipod. It might sound crazy to say, but Summertime is right around the corner. That means more swimming, sports activities, vacations. And you know what's a great feeling, being able to stay connected to automated in some delivery while doing it all. Omnipod five is the only tube free automated insulin delivery system in the US. And because it's tube free and waterproof, it goes everywhere you do in the pool, in the ocean or on the soccer field. Unlike traditional insulin pumps, you never have to disconnect from Omnipod five for daily activities, which means you never have to take a break from automated insulin delivery ready to go tube free. Request your free Omnipod five starter kit today@omnipod.com slash. Juicebox Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox type that link into your browser, or go to Juicebox podcast.com and click on the image of Omnipod right at the bottom. There's also a link right in the show notes of your podcast player.

Jennifer Smith, CDE 10:19
Well, one thing I would say is, if you have an idea of what you've mastered with another type of meal that isn't cereal, yeah, this is 12 minutes, yeah, let's say you've mastered something that you love to eat is 12 minutes. It has a different hit than cereal does for high glycemic like this, my strategy is double that as a starting place.

Scott Benner 10:47
Okay? So if right, 12 works for you, for most things, you're going to 24 minutes, yeah, or

Jennifer Smith, CDE 10:52
25 to round it out, just make it nice and even say, okay, 25 minutes. This is a hard hitting now we've doubled the the serving size on the package, right? It's not just one cup. We're eating two cups of it, and we're now eating 24 grams of added sugar. You know, how many teaspoons of sugar that is? Do you

Scott Benner 11:13
know 24 grams of sugar is, how many teaspoons of sugar?

Jennifer Smith, CDE 11:17
Yeah, how many grams of carb is in one teaspoon?

Scott Benner 11:22
Ah, did I stump? Scott, look, I know. Is it two? No, a teaspoon, like a level, a teaspoon, like a measuring teaspoon, four. Wait, there's four carbs in a measuring teaspoon of sugar. So not like the teaspoon that you use to put in your coffee, which is probably five teaspoons. So what does that mean? Put that contextualize that for

Jennifer Smith, CDE 11:43
Yeah. So now we have 12 grams in a cup. We're eating two cups of the cereal. That's 24 grams of sugar. 24 divided by four is how many teaspoons.

Scott Benner 11:53
Six. There you go. Wow, really? So I,

Jennifer Smith, CDE 11:59
and I bring this in not this is, again, this is not a judgment. This is a teaching piece, but it's teaching in the fact of we're considering the glycemic impact of this food. We're not just eating one serving now we're eating two, so you're increasing the load effect of a high glycemic food.

Scott Benner 12:16
Yeah. Also, let me read the ingredients for you from Cinnamon Toast Crunch, whole grain wheat, sugar. Also, I don't know if people know this, the order they're in is their amounts. So there's, it's mostly whole grain wheat. It is second, mostly sugar. Third, rice flour, canola and or sunflower oil. Can they not make up their minds? What does end or mean? So whatever they got laying around, it's whatever they it's a mix. There you go. What do we got today? Throw it in there. 1234, we are now five things deep. The next item that is most prevalent in Cinnamon Toast Crunch is fructose, then maltodextrin, dextrose, which I think sounds like another way to say sugar it is. We've just said sugar three times in a row, right? Sugar, fructose, dextrose, sugar, sugar, sugar, am I? Am I right about that 100% okay, all right. Salt, wow, cinnamon. We got the cinnamon pretty early. Oh, and it's not cinnamon flavor. It's real salt. It's real cinnamon. It's probably in there to mask whatever tri sodium phosphate is, soy, less is thin, less than, less than caramel color, Rosemary extract. Oh, a little the nature. BH, two added to preserve freshness. Vitamins and minerals, calcium carbonate, vitamin C, iron, zinc, they list them all here, A, B,

Jennifer Smith, CDE 13:37
what are? What are those? Therefore they're enriched or fortified, right? Enriched or fortified because all of that whole grain weed at the first ingredient that's been stripped, yeah, of all the beneficial vitamins,

Scott Benner 13:50
right? Oddly enough, like percentage of your daily value for the vitamins, it's between 10 and 20% for all those. So, yes, yeah, they've given you a vitamin in there. You could have took it on your own, though, we're gonna Pre-Bolus this meal. You know, double of what you find to be working with a food item that you're good at bolusing for. Again, I'll tell you, like on something this aggressively glycemic. I mean, there's a load here and an impact, right? The load from the processed food, the impact from the sugar. I think if you Bolus for this even super aggressively, and you're on an algorithm, and that algorithm is going to go, here's the insulin, if you I don't like this word, but if you mess up that Pre-Bolus and don't get the insulin ahead of the spike that's coming, that algorithm is going to sit for hours and not give you basal. There's no way you're not going to be 400 if you mess up the pre vault. Potentially, yeah, no way. There's a way. But like, yeah, potentially, and at least on a regular pump, your basal still churning, and might get in the way of it a little bit. So now, if this all works, I. Know this is going to sound crazy to people. Wait, somebody online is going to call me a insulin pusher. I can keep a steady line. Yes, with with cereal, it's a lot of insulin and a lot of timing, and you can do it. Would I do this every day? Even if I could? I would not. I'm just being honest with you. I've seen my daughter eat a bowl of cereal once in the last year and a half so, and I she was sick, and she's like, You know what I want? And I was like, What do you want? Just like, and she says, yeah. Like, I was like, all right, but could I do it? I could. I don't think it's the greatest decision you're ever gonna make in your life. But if this is your sitch, what am I 10? If this is your situation, I want you to Bolus, well for the cereal that's all like, I mean, you're gonna, I just don't want you having high blood sugars, which, by the way, are gonna, at some point, those big spikes are gonna turn to, like, a crashing low at some point in the future, too.

Jennifer Smith, CDE 15:51
So good if you don't figure out your strategy. And that's where the end of our acronym, your acronym, right? It comes in. It's evaluate. Watch that one hour, three hours, five hours. How did this meal filter out for you? What do you have to tweak for next time? And I, you know, I'd go back to a friend of mine, who I've known had for a long, long time. She also has type one almost as long as I do, and I don't know that she still does it. But years ago, before all of the aid assisted types of systems on the market. She wanted cereal once a year for her birthday. Yeah, that's what she wanted. And she did. She didn't have your acronym, but she figured it out. She tested it out, and what she found works. This is not medical advice, not encouraging you to do this.

Scott Benner 16:42
None of this is medical advice. I've been doing this for a long time.

Jennifer Smith, CDE 16:46
Was it was a timing thing. So she had to get the initial step of insulin added the right way. And what she found worked was doubling the dose of insulin that she would normally take for cereal, and on the back end, she suspended her pump. Okay, so at the Bolus time, she suspended her pump for hours after and over Bolus, the hell out of the cereal. Over Bolus up front to get ahead of getting too high. And on the back end, she balanced it out because she took away the basal, which is a slower drip, drip, drip, and she could take it away easily. So that

Scott Benner 17:26
might work on an A I D as well. It could potentially, yeah, what people have to understand about the algorithms, like at a basic level, is you tell it, these are your settings, and this is how much I ate. It believes you right? It is not going to adjust, because your blood sugar, like, shot up out of nowhere. It goes, no, no. They told us how much we did and we did the right amount, like, we're going to keep doing the thing we're doing now. Some of them will, you know, start pushing back as something rises and rises, but that pushback is not going to be aggressive enough to overcome a major Miss in the amount of insulin or the amount of timing that you choose. Okay, all right, like, I know it's not food you ate, but do you think you could sit down right now eat two cups of Cinnamon Toast Crunch and Bolus for it? Yes, yes. If I get you to do that on video one day,

Jennifer Smith, CDE 18:14
that'd be do it. I could do it. I probably wouldn't pick Cinnamon Toast Crunch, but something else that I'd

Scott Benner 18:20
prefer I take my hall pass on that one. All right, I appreciate it. We covered it, right? We're

Jennifer Smith, CDE 18:27
good. No, it's great, perfect. Thank you.

Scott Benner 18:37
Summertime is right around the corner, and Omnipod five is the only tube free automated insulin delivery system in the United States, because it's tube free, it's also waterproof, and it goes wherever you go. Learn more at my link, omnipod.com/juicebox, that's right. Omnipod is sponsoring this episode of the podcast, and at my link, you can get a free starter kit. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox, hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast in each episode of The Bolus four series, Jenny Smith and I are going to pick one food and talk through the bolusing for that food. We hope you find it valuable. Generally speaking, we're going to follow a bit of a formula, the meal bolt formula, M, E, A, l, B, O, L, T. You can learn more about it at Juicebox podcast.com, forward, slash, meal, dash, bolt. But here's what it is. Step 1m, measure the meal. E, evaluate yourself. A, add the base units, l, layer. A, correct. Direction, B, build the Bolus shape. O, offset the timing, l, look at the CGM and T, tweak for next time. In a nutshell, we measure our meal, total carbohydrates, protein, fat, consider the glycemic index and the glycemic load, and then we evaluate yourself. What's your current blood sugar, how much insulin is on board, and what kind of activity are you going to be involved in or not involved in? You have any stress hormones, illness, what's going on with you? Then a we add the base units, your carbs divided by insulin to carb ratio, just a simple Bolus l layer, a correction, right? Do you have to add or subtract insulin based on your current blood sugar? Build the Bolus shape. Are we going to give it all up front, 100% for a fast digesting meal, or is there going to be like a combo or a square wave Bolus? Does it have to be extended? I'll set the timing. This is about pre bolusing. Does it take a couple of minutes this meal, or maybe 20 minutes? Are we going to have to again, consider combo square wave boluses and meals, figure out the timing of that meal and then l look at the CGM an hour later, was there a fast spike? Three hours later? Was there a delayed rise? Five hours later, is there any lingering effect from fat and protein. Tweak, tweak for next time. T What did you eat? How much insulin and when? What did your blood sugar curve look like? What would you do next time? This is what we're going to talk about in every episode of Bolus. For measure the meal, evaluate yourself, add the base units, layer a correction, build the Bolus shape, offset the timing, look at the CGM tweak for next time. But it's not going to be that confusing, and we're not going to ask you to remember all of that stuff, but that's the pathway that Jenny and I are going to use to speak about each Bolus. The episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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Scott Benner 9/18/25 Scott Benner 9/18/25

#1631 Glucose Guardians

Jacob brings his background as a nutritionist, love of food, and family connection to T1D into his story.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox podcast.

Jacob 0:15
My name is Jacob ritzert, and I'm a type one diabetic. Happy to be on the type one diabetic Juicebox podcast. Thanks for having

Scott Benner 0:25
me. I am here to tell you about juice cruise. 2026 we will be departing from Miami on June 21 2026 for a seven night trip going to the Caribbean. That's right. We're going to leave Miami and then stop at Coco k in the Bahamas. After that, it's on to St Kitts, St Thomas and a beautiful cruise through the Virgin Islands. The first juice Cruise was awesome. The second one's going to be bigger, better and bolder. This is your opportunity to relax while making lifelong friends who have type one diabetes, expand your community and your knowledge on juice cruise 2026 learn more right now at Juicebox podcast.com/juice, cruise. At that link, you'll also find photographs from the first cruise. Please don't forget that nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. This episode of The Juicebox podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour next.com/juicebox this episode of The Juicebox podcast is sponsored by the twist a ID system powered by tide pool that features the twist loop algorithm, which you can target to a glucose level as low as 87 Learn more at twist.com/juicebox. That's twist with two eyes.com/juicebox. Get precision insulin delivery with a target range that you choose at twist.com/juicebox. That's t, w, i, i s, t.com/juicebox. This episode of The Juicebox podcast is sponsored by Medtronic diabetes and their mini med 780 G system designed to help ease the burden of diabetes management, imagine fewer worries about Miss boluses or miscalculated carbs thanks to meal detection technology and automatic correction doses. Learn more and get started today at Medtronic diabetes.com/juicebox

Jacob 2:39
My name is Jacob Richard, and I'm a type one diabetic. Happy to be on the type one diabetic Juicebox podcast.

Scott Benner 2:48
Awesome, man. Thank you for having me. Yeah, it's my pleasure, Jacob. How long have you had type one

Jacob 2:53
two years now, just over two years. How old are you 27 I'll be 28 tomorrow. So so. Oh, happy birthday. Coming early. Thank you. Yeah,

Scott Benner 3:02
happy birthday. That's awesome. Wow. 27 What was your life like before? Diabetes versus what is it like now? Oh,

Jacob 3:12
I mean, I felt completely invincible. For the most part, I've been able to kind of do whatever I wanted to do and be able to accomplish anything I can really put my mind to, for the most part, and then getting diagnosed has been a challenge. But you know, there's two ways to look at it in my mindset. One, you take the challenge and you run with it, and you accept that it's a challenge and the only way through it is to just embrace it, and the other one was just to kind of withdraw and let diabetes manage my life, rather than manage the diabetes. So I went with throughout one, and I took it as a challenge and something to really put my life studying towards. I studied nutrition, so I found that I already had a leg up on what the disease was, but it did catch me by surprise, to be honest. Yeah, I was

Scott Benner 4:05
gonna ask you, how did you find out that you had type one?

Jacob 4:08
Yeah, the main indicator was losing the 40 pounds, you know, going into DKA. So studying nutrition, I've always been conscious of what I eat. I've always worked out, been athletic my whole life, and around that 25 timeframe, when I was 25 I started to lose a lot of weight and a lot of muscle mass. And I know how to eat properly, and I know how to maintain muscle and I thought I contributed to just being like you hear it all the time. It gets harder to maintain muscle mass as you get older, and that was not the case. So I went from about 160 healthy pounds to 120 pounds when I ended up in the hospital. That was July 1 of 2023 How tall are you?

Scott Benner 4:57
Five? Eight. Wow. You know, it's funny. I have more con. Tax now, because I weigh like, 166 pounds this morning, and if you took 40 more pounds off of me, I'd be in real trouble, like, real significant trouble, you know, and I've got a couple inches, maybe an inch on you, like, height wise, so, but that's really something, man, like you're out on your own by then, you don't live at home.

Jacob 5:19
I was actually, I was living with my ex girlfriend at the time. So in Columbus, I studied at Ohio State, and then I stayed for three more years in Columbus, once I graduated,

Scott Benner 5:30
okay, Did she notice? Did she say something?

Jacob 5:34
That's a dynamic question. Yeah, she noticed. I think we both knew something was off, but me being the way that I am, the way that I eat, the way that I work out, the routine, I didn't really think it was something to consider, like, to be concerned with Exactly, yeah, I wasn't concerned with it. And then seeing my parents on the occasion, versus I was living with her at the time, so she saw me on a daily basis, and those changes happened. And she did bring it to my family's attention that, you know, I was, I was losing weight. I contributed the drinking a lot of water, going to the bathroom a lot. I work out. I drink water. I could use the restroom. That wasn't like anything out of my normal. It felt like, right? It was the strength, you know, I always have been in sports and activities, even recreational just outside of college, and I couldn't even shoot a basketball from the three point line to the bucket. I couldn't serve a volleyball over the net, and that was about a week prior to ending up in the hospital. And that was concerning 120

Scott Benner 6:38
pounds. You must look like a pre pubescent boy, right? You must have been that

Jacob 6:43
small. Yeah, I lost a lot of weight. Friends, family were coming up to all their friends and family, asking if I was sick, if I was okay, yeah, and that was the main indicator when my family was like, All right, maybe something's

Scott Benner 6:58
up. Okay. See, did you head to a doctor then? Or did you wait till you, like, almost passed out and died? Doctor, okay,

Jacob 7:05
so I 25 at the time, right? You get kicked off your parents insurance at 26 I thought it would be a good idea before my 26th birthday to test my blood and go through the whole routine checkup. And when I did my fasted blood test, it came back at around 390 Okay, so nothing terribly insane, but that diabetes, you know, right there, 390 and my PCP, God bless his soul, but he decided to prescribe me five units of Lantus. So that long acting insulin, and he said, See me in four days. Within that, within those four days

Scott Benner 7:50
I was in the hospital, he wanted to shoot five units of Atlantis a day. Yes, that was the entirety of it. And then we'll see you

Jacob 7:56
in four days. Yes, he this was right around that July 4 area. So, you know, July 1, or really, was June 30. He was like, Here you go. Here's some Lantus. And he was on vacation, and he was like, you should see me after vacation. And within that timeframe, I was in the hospital,

Scott Benner 8:13
he was trying to get you through I thought. I was like, he's trying to get you through the holiday. Exactly what he was trying to do, right? Did he tell you had type one diabetes when he gave you the Lantus.

Jacob 8:21
No, no, no, actually, that that was a whole ordeal. Even in the hospital, I had nurses saying I had diabetes. I had nurses coming in saying, We don't know yet. So I was just kind of confused the whole time. Yeah, just wanted the actual diagnosis, because it was trending that way. It seems that way we have my aunts on my dad's side is actually a type one diabetic, so I had a broad understanding of the disease through education and watching her go through it. So my father called her, and the morning of me going to the hospital, my blood sugar was actually 590 right around there, and I was in a waiting room for about six hours before they brought me back. Do you think you were in DKA? Yeah, I spent a couple nights in the ICU. Actually, I think it was about 30 to 36 hours in the ICU, and you know, they're waking you up every 30 minutes, pumping you with potassium. And my anion gap was, I don't know the exact number, but it was a DKA number.

Scott Benner 9:23
Yeah, like, yeah. Well, they're worried about your blood gasses and everything else at that point. And, yeah, well, okay, that's how that went. And so you said your aunt has type one,

Jacob 9:32
yes. So she's had type one, I believe, since she was about 15. She was one of the first Medtronic pump users that got insurance to cover it back in the day. Wow. How old is she now about she's a couple years younger than my father, so I would put her right around like 5354

Scott Benner 9:53
okay, but she's the first person in what her area to get a pump covered by insurance. Mm.

Jacob 10:00
Yes, that's the that's how the story goes. Right? They were fighting back and forth with the insurance, and eventually she got put onto a Medtronic pump. Don't think it's a trial at that point, but if insurance is covering it, but yeah, insurance was able to cover the Medtronic pump for her. I don't know what age it was that she got on to the Medtronic pump.

Scott Benner 10:19
Do you know how old she was when she was diagnosed?

Jacob 10:23
Yeah, like, around 15. I want to say,

Scott Benner 10:25
you know, nobody ever tells a story, Jacob, it's like I was the 15th person to do that. You always hear like I was the first person my family, the first family in this bubble. I'm like, Okay, I even my friend of mine, he used to tell people like we were the first family in our neighborhood to have a VCR. And I'm like, What did you go to everybody's house and check? How do you know that? Yeah, knocking on the doors. Yeah. Hey, we have a VCR. I got to check to make sure nobody else has one, because I've got some claims to make.

Jacob 10:49
Yeah, running around with the movie. Can you put this into your Oh, you can't. I can.

Scott Benner 10:54
You know, where we used to rent the movies out of the back of a pharmacy, really, a local pharmacy. They had a little room in the back. They had maybe 50 movies. They had one copy of each. And you went back there and and rented them. You had to leave 100 back then. Keep in mind, I'm talking about like 89 you had to leave $100 cash with them, in case you didn't return the tape. That's ridiculous. That's absurd to me. That's how much the tapes were valued at, and they couldn't replace them. Like, it wasn't as easy as just grabbing another one. They're like, look, we have one copy of Top Gun here. And it wasn't like, I know even this sounds crazy, like everybody didn't have credit cards, so you had to give them 100 cash they held it, and that was you were allowed to rent from them while they held your

Jacob 11:37
100. Yeah, it's, it's the complete reverse. Nowadays you can't even use cash in some places.

Scott Benner 11:43
I did have a situation the other day where I pulled money out of my pocket and the person looked at me like, What are you gonna do

Jacob 11:49
with that? Yeah, I live in Cleveland, just like West Side of Cleveland, and I have the standing room season pass to the Cleveland guardians game. Nice. And I have a quota for myself. I try to get to five a month. You get all the home games. You just stand. I like standing anyway. I sit for work. But it's cashless. Everything inside. So, you know, you have people handing you cash and, like, can you snag me a drink real quick? Like, Sure, man, I don't know. Cash works for me. Yeah, I

Scott Benner 12:16
just put it in my pocket. Yeah. But yeah, it's really interesting. So other autoimmune stuff for you, or for anybody else in the family,

Jacob 12:23
certainly. So my dad's side, again, both grandparents, type twos diabetes, right? Is pretty prevalent, and they just, they really don't want to change their eating habits, and they're at the age where they're going to do what they want to do. I can't get them on CGM. I've tried. That's what I like to do for a living, right? Yeah, and I grew up as an asthmatic, so I was on a nebulizer until probably, like five, six, I want to say, also terrible allergies. I was allergic to everything under the sun besides food, which is great. I'm a foodie. My mom's a chef, so food is a passion of mine, which drew me to my education with the nutrition, but out of my siblings, yeah, I was the one that had the autoimmune

Scott Benner 13:08
disorders, trees, nuts, grass, dust, everything. You're

Jacob 13:12
not nuts, not nuts, just trees, high grass. You know, doctors like, don't go outside if it's a lot of pollen out. August is actually the worst month for me, so I get it a little bit still, okay, but no climbing trees, no long grass, and I still did all of those things because I'm an outdoors kid, and what are you gonna do? I'll sneeze a couple 100 times for the day if I can get outside pet dander. Yes, yeah, pet dander, the whole thing Gotcha. Yeah, no cats. But I hear it's a seven year cycle. So I've gotten much better with animals, maybe because we got a dog when I was younger, and I just dealt with it. You know, I was getting allergy shots every other week in both arms. Yeah,

Scott Benner 13:52
I have to tell you, when I was young, I had the worst allergies, like seasonal, like outdoor, like the what you're describing, and we got lucky, like, our kids didn't, like, kind of get branded with all that, but mine went away, like, at some point, I don't know when, in my 20s, I just stopped sneezing. Like it used to be, like spring would come. I touched my eyes once, and it felt like somebody was rubbing my eyeballs with sandpaper for weeks, right? Like, but that just doesn't happen to me anymore, and I think it was Kohl's, my son's junior year of high school had to have been his junior year the summer of his junior year of high school. So going into his senior year, because he was out visiting with all these different baseball teams for college, and we went to this one day. Yeah, one, this one, he came in, I think he come in on Friday. You spend the night with the guys, you go to a practice on Saturday, and you hang out for the day. And then you, I forget, you went to, maybe you went to classes on Friday, and then you went to a game on Sunday, or something like that. Watch the game anyway, like everything was indoors until we got to the game. And then. The fourth, fifth inning, like, we're standing there, and he's like, I'm dying. His eyes were just watering, and he was sneezing and coughing. He could it was, it was to the point where, when we left, he said, I'm not going to be able to come here. Like, he's like, this is the time of year. I'll need to be outside. Like, you know, as we get back from the fall and everything, he's like, I can't, I can't come here. And he ended up turning them down just just because he had trouble breathing at their stadium. And now it's, I don't know, six years later, and he still has seasonal allergies, but they're not nearly as bad as they were at that point. It is really interesting, like, because I've heard some people say the seven year thing too. I have no idea if there's any like reality to that or not, the brand new twist. Insulin pump offers peace of mind with unmatched personalization and allows you to target a glucose level as low as 87 there are more reasons why you might be interested in checking out twist, but just in case that one got you twist.com/juicebox. That's twist with two eyes.com/juicebox. You can target glucose levels between 87 and 180 it's completely up to you. In addition to precision insulin delivery that's made possible by twist design. Twist also offers you the ability to edit your carb entries even after you've bolused. This gives the twist loop algorithm the best information to make its decisions with, and the twist loop algorithm lives on the pump, so you don't have to stay next to your phone for it to do its job. Twist is now available in select areas. So if you'd like to learn more or get on the wait list, go to twist.com/juicebox that's twist with two eyes.com/juicebox. Get on the twist, wait list and be notified as soon as it's available in your area. Links in the show notes. Links at Juicebox podcast.com Today's episode is sponsored by Medtronic diabetes, who is making life with diabetes easier with the mini med 780 G system. The mini med 780 G automated insulin delivery system anticipates, adjusts and corrects every five minutes. Real world results show people achieving up to 80% time and range with recommended settings, without increasing lows. But of course, Individual results may vary. The 780 G works around the clock, so you can focus on what matters. Have you heard about Medtronic, extended infusion set? It's the first and only infusion set labeled for up to a seven day wear. This feature is repeatedly asked for, and Medtronic has delivered. 97% of people using the 780 G reported that they could manage their diabetes without major disruptions of sleep. They felt more free to eat what they wanted, and they felt less stress with fewer alarms and alerts you can't beat that. Learn more about how you can spend less time and effort managing your diabetes by visiting Medtronic diabetes.com/juicebox

Jacob 17:55
Yeah, neither do I maybe just build up some type of immunity as you get older, but I was in the same spot as your son. I played almost my mom put me in almost every sport, and just to get us coordinated and get us interested in athletics, but soccer, indoor soccer, you know those little rubber pellets that they put on the Tur? Yeah, I was allergic to those for some reason. Yeah, I would just, I couldn't even play in soccer indoors, and then I wanted to do football, but football, you started up in August. It's the worst month for me when it comes to allergies, the heat in Ohio, asthma on top of it. So I wasn't able to play football either. And it's frustrating, and it kind of ties back into diabetes. There's certain things that you want to do, but you have limitations on the disease, yeah, that extend past maybe your own physical abilities, right? So you have to find that fair balance. You know, if you want to go out for a run, your body might tell you you can go another three, but your diabetes is saying you got to stop and chuck some juice.

Scott Benner 19:00
You know, this is not a story I have all the details on, but I can recall some soccer players, specifically goalies and some other people who spent a lot of time on artificial turf, like developing, like, certain kinds of cancer, and I think they ended up tracing it back to those rubber pellets. Maybe it was a blessing. In disgust, I was gonna say, you might have got away lucky. I'm gonna have to look into that later. Into that later. But also, I did just look it up. And it says the seven year cycle is not a strict pattern, but your seasonal allergies can change over time, improve, worsen, shift. You know, get easier. Your immune response in the environment can fluctuate. It says, so anyway, that's going on your family. You don't have anything else. You have thyroid or celiac or anything like that yourself. Contour, next.com/juicebox that's the link you'll use to find out more about the contour. Next Gen blood glucose meter. When you get there, there's a little bit at the top you can click right on blood glucose monitoring. I'll do it with you. Go to meters. Click on any of the meters, I'll click on the Next Gen, and you're going to get more information. It's easy to use and highly accurate. Smart light provides a simple understanding of your blood glucose levels, and of course, with Second Chance sampling technology, you can save money with fewer wasted test strips. As if all that wasn't enough, the contour next gen also has a compatible app for an easy way to share and see your blood glucose results. Contour, next.com/juicebox and if you scroll down at that link, you're going to see things like a Buy Now button. You could register your meter after you purchase it. Or what is this? Download a coupon, oh, receive a free contour next gen blood glucose meter. Do tell contour next.com/juicebox head over there. Now get the same accurate and reliable meter that we use.

Jacob 20:53
No, no, I had a little bit of, like, stomach issues. Growing up in college, I ate a lot of, honestly, a lot of yogurt and dairy. I was really into the whole you hit high school, you wanna I played baseball, but ultimately I dropped that come around junior year, and I got into weightlifting. So I would come home from the gym and I would eat. My mom had an entire shelf devoted to yogurts for me, those Dannon light and fit yogurts. I'd have four a day, and I was getting some type of stomach issues. I don't know if it was from the dairy or from wheat, because I would put cereal on top of that and all the fun stuff. But now, for a little bit there, I had a little bit of stomach issues, but nothing outside of that. Everything was fine and dandy. Moving into college, I could eat, drink, whatever I wanted. Did you play something in college? I did not. So going to Ohio State. Oh, not that. I'm not an elite athlete. I just enjoy the recreational activities. But I played softball in Columbus, right men's softball league, because baseball was always my passion, and then also sand volleyball

Scott Benner 22:03
was that tough to just stop, like high school stopped and and like organized sports just stopped.

Jacob 22:09
No, I think really the reason I got out of it, for the most part, was because I wanted that freedom and choice to do what I wanted to do. Yeah, I still extremely active, but if I wanted to not be in a formal workout setting where I could just build my own workouts, and I'm certified in personal training, I actually it just expired. So I was certified for about four years, and I really enjoyed learning how to build your own workouts and just the freedom to choose to go on a run if I wanted to, instead of be forced to take drills all day. What'd you get your undergrad in nutrition?

Scott Benner 22:49
Oh, okay. And I know you said it a couple times. I wasn't sure if that was the degree or not. Okay, so you're you're in the hospital, you're sitting in chairs for six seven hours. They finally get you back there, keeping the ICU for what you said, maybe like, 36 hours, two days, something like that. Now you're on your way back to your big apartment you live with your girlfriend in at that time. So

Jacob 23:09
actually it was another two days in the hospital. So they shifted me out of the ICU into the regular part of the hospital. I guess you would call it, yeah, and this is when they're still trying to figure out what is, what's going on. They're balancing out my electrolytes, balancing out the sugar, and it's dragging on. It's July 4, actually, when I got that official diagnosis and was able to get out of the hospital. So you can imagine it's almost out of a movie. I got out around 9pm on July 4, and there's fireworks going off, got a big smile across my face, because I'm finally free, yeah, and somebody who likes to move around, being stuck in a little hospital setting like that drove me insane, right? So I was doing anything I could to get out there, and then I actually moved back into my father's place. My parents are divorced. They divorced when I was six, and my father, I stayed at his apartment for about a year after the diagnosis, but my mom took care of me for the first few weeks coming out of the hospital, just because she had the ability to do so it was the summer, and she's the food service director at a school, so she was off for that summer. I

Scott Benner 24:19
have to ask you a question, just because I think it fills the context, then a little better. Yeah, you were on shaky ground with the girl already, or you just thought, like for health reasons, like, I need to go somewhere where somebody can look after me.

Jacob 24:34
So we lived together for two and a half years. At that time, she was my ex girlfriend and moved out of the apartment. Oh, and I was fortunate enough where I landed a position at a startup company in Columbus called prescribed fit, which was in the orthopedic space, helping patients with weight loss so that they could be under a certain BMI, so that they could have total. Hip or knee replacements I see, and I was making enough where I could cover both of our halves for the rent, which was great. So I decided I was going to keep the apartment and stay in Columbus during that time, actually about three weeks before, maybe about a month before, I got diagnosed, I lost that position there, and that's when I made the decision to move back towards

Scott Benner 25:25
Cleveland. Hey, I'm sorry. This is probably apropos of nothing, but she tells your parents you're losing weight, and then not long after that, like, did she break up with you while you were sick? Or did you break up with her while you you were sick? Is that the timing? This

Jacob 25:38
is where it's funny. I told myself I wasn't going to talk too much about my ex. Well, then don't hear me. This is it's great because it gives good context we thought after the diagnosis, maybe because your personality, your mood, everything changes when your blood sugars in the 567, 100. Who knows? You know, I've had multiple nights where I've drink. You know, during that time, I probably had five beers and a pizza, right? Yeah. So who knows where my sugar was at that time, and I was irritable all the time. I was stressed, though, with work so you can you

Scott Benner 26:11
guys weren't getting along great to begin with, and you were a bit of a because that was going on.

Jacob 26:17
Okay, how's it going? I think it was a little bit on both sides, though, right? Yeah. So we decided maybe that was the reason. And once I was treated and my diabetes was managed, that wasn't the reason. You go to

Scott Benner 26:30
the hospital, your blood sugar is nice and stable, and you're both like, no, no. This isn't why we don't like each

Jacob 26:35
other, yeah? I mean, she knew I was in the hospital and didn't reach out. So, oh, okay, you see my locations in the hospital for four days and you care, then you probably reach out.

Scott Benner 26:44
I guess you figured it out during that time. Yes, oh, my God, I'm sorry. We're laughing. I must have been painful at the time. Oh, the pain is subsided. Okay, all right. Well, okay, so you're at home with your dad, then for a while, where you're getting back on your feet and everything. Are you managing the diabetes on your own? I guess you're in a job hunt at the same

Jacob 27:03
time. Yeah. And so was fortunate enough, I was in the orthopedic space at that startup. A family friend, her daughter was graduating and going to college within that party, so to speak, for the graduation party, and this is I'm fresh out of the hospital, maybe a week out of the hospital, maybe two, and I'm still at that stage where you don't know how many snacks or what you need, so I'm walking around with this little cooler because I need to make sure I have all my snacks with me. Right? The girl who's graduating, mother, family friend, her, one of her friends, works within diabetes. So this is the connection that I made. And I turned in my resume to the HR, she advised me to gave me a little bit of research about the company, and I managed to get a position within, you know, a few weeks. Oh, that's awesome, yeah. And it was a lot all at once, just because newly diagnosed, so learning and navigating on how to manage diabetes, but also I have a tremendous amount of support from my company, because we're embedded in diabetic care. So within the home life, I had support, and then while I'm at work, I also had a lot of support and resources. So I do feel very fortunate, almost like it's a calling just to be within the diabetic space. Yeah, I was already in medical channel, yeah. So this is why not? Yeah, get a little closer to home, right?

Scott Benner 28:35
Exactly. So how do you manage? Is it MDI at first they I remember the first doctor tried to give you Lantus, but I don't think that got too far. So what too far. So what

Jacob 28:43
happened after that? Yeah, so after first doctor gave melantis, right? And then I ended up in DKA within four days, so not enough insulin, five, five units of Lantus, I got MDI. So out of the hospital. They want to make sure that you can survive without the technology, and I think that's pretty common for most areas of the country. So blood glucose meter, MDI, is monitoring that way. I actually had a family friend who had a libre so we slapped one of those on me without a prescription. I don't know if that's legal or not, but I'd rather have streamlined blood sugar readings directly to my phone and then still adhere to taking the blood glucose meter test strips and the lancet and all

Scott Benner 29:30
the fun stuff. Hey, your friend had diabetes. Why did they have a Libra?

Jacob 29:33
My mother's friend, he, I think, pancreatitis, or something along those lines, type two, okay, and he manages his diabetes, but he had spares and backups. Okay, okay, and he knew I was in the hospital, so actually, right, right when I was getting out of the hospital, we put one on instantly, just because I've done I was doing research with my laptop while I was in the hospital.

Scott Benner 29:56
You weren't busy writing poems or making dinner dates. So you were, you were. Get a lot of

Jacob 30:00
free time. Jacob, yeah, nowhere, nowhere to send those so you're doing

Scott Benner 30:05
your own research in the hospital. You know you want a CGM. Luckily, a friend of your mom's has one for you.

Jacob 30:10
Exactly. Okay, okay. And then MDI is lasted a certain amount of time. They they needed to ensure that I knew how to carb count, okay? And do the whole sliding scale. Studying nutrition as a background. I basically logged all of my macros through an app called My Fitness Pal. I think it's a pretty common app, yeah, pretty common app. You know, not everybody uses it, but is probably aware that it exists. So I was tracking everything prior. I knew how many carbs are in a serving of a lot of different complex carbs, or, you know, even simple carbs. So I was able to show my care team that I can count carbs and guesstimate carbs pretty accurate. So I got onto an Omnipod, and you're, you know, this podcast really helped push me towards an Omnipod, not push but I listened to a lot of the Omnipod podcasts and decided that's something that I wanted, as an athletic person myself, I think the tubeless was the way to go, and I was on an Omnipod and a Dexcom g6 system within about a month and a half.

Scott Benner 31:17
That's quick, and today you still using the same pump and CGM. Yes,

Jacob 31:21
yeah. Love my Omnipod. Love the Dexcom g6 I know the g7 exists, but, you know, I try to find balance in my thought process. It's not because I want to stick to the older technology, because I think I see my grandparents in this situation, they still use their blood glucose meters, and they're still doing MDI, even though they qualify for a CGM based on the criteria, right? I just can't get them to use that technology because they're so comfortable with the way that they've been managing their diabetes for 25 plus years. Yeah. So I'm staying on the g6 system until I feel comfortable with all of the Reddit threads and all of the potential problems and issues that I see and read on the g7

Scott Benner 32:01
Oh, you're waiting for the Internet to stop complaining before you move up, you might have to wait a while. There's going to be complaints everywhere, right? Yeah, I take your point though. It's working for you right now.

Jacob 32:10
It's, yeah, it's tried and true, right? So, awesome.

Scott Benner 32:14
Omnipod five or Omnipod Omnipod five, it's doing what you want it is. It is a big

Jacob 32:21
accomplishment for me. So my my aunt, as I mentioned, has type one, and she's her a 1c is absolutely fantastic. It's in the five somewhere, and it has been for I don't know how long, so I looked to her for a lot of advice, initially, off the diagnosis, and I wanted to be just like her. I wanted my a 1c just like her. So within a year, I managed to get my a 1c from an 11 and a half to five, five right on the dot. How'd you do that? A lot of lot of upset, not obsession, but fine critiques. To my day, it took a lot of mental capacity away from me to do other things, because I was so embedded in making sure my sugar levels were perfect. You know, a five, a, 1c, is it was a 97 average.

Scott Benner 33:07
Yeah, you gave away some other stuff in your life for a while to to spend some time learning about this. I

Jacob 33:13
did. I gave away a good portion of my life. Well, that year, yeah, and I wasn't in automated I was in manual mode 95% of the time. I think it said because I wanted to personally make all of these decisions, I didn't feel comfortable yet trusting a system to manage the diabetes. I thought I personally have a better capability of managing it on my own, based on certified and personal, I know how diet and exercise works, so I'm like, I'm going to make this perfect. I'm going to get it, and it's going to be perfect for my whole life. It came with a lot of lows being, you know, you're riding that line the whole time. You're avoiding spikes, but also have to make sure you're not dropping to a spot where you could have potential fatal outcomes, right? And that next visit with my Endo, after the five was there, she was like, hey, congrats, but you're having way too many lows, and I was having quite a bit of lows, yeah. What did that mean? Too many lows, just too many below 50 fives,

Scott Benner 34:16
frequently, like throughout the week, throughout the day, yeah, throughout

Jacob 34:19
weekday, or whatever. Some days, you know, some days are better than worse. Some weeks are great, some weeks are bad, probably daily. In an

Scott Benner 34:27
effort to keep your blood sugar under 100 you were being more aggressive, and it was ending in lows, even though you're and you were wearing a CGM at that point.

Jacob 34:35
Yeah. So on top of that intense exercising I was doing, you know, I'm going on longer runs, long bike rides, and it's just dropping your sugar, which is fair. You have to combat that with carbohydrates. And I was doing a decent job. And I think some of these lows were false lows. You know, the Dexcom system can show you at a 75 going down, and I got a banana in my system, and it. Still drop, and then it comes back up. So yeah, it's touching the 55 but you know, my sugars probably not actually 55 it's just playing catch up. But yeah, and she recommended I switched to automated mode at least half of the time. Yeah, since then, I've been in automated mode probably 95% of the time. So it kind of did a big flip, and I feel like diabetes isn't so much of a hassle anymore. And yeah, sure. My a, 1c, is not out of five. It's probably low. Six is, is an estimate, but it's given me a lot of my life back. I feel like good where I can focus on other things.

Scott Benner 35:37
You're also you're still being aggressive, I imagine. Yes, yeah, right. So you took a little bit of what you learned, and now you're letting the Omnipod five try to stop some of those lows. For

Jacob 35:45
you correct, yeah, and it's does a great job. Overall, I catch more highs than lows. So, you know, lows for me, because you're exercising right, lows are going to happen and you're gonna have to correct those you can't. I learned, actually, a pretty scary moment in my life about I can't stay out of the hospital. Scott on July, 4 or fifth. July, 5 of this year, I had a seizure in Boston because my blood sugar was so low. And that was a huge just my major slap in the face from diabetes, because I thought I could control this, and I'm gonna ride as close as possible to the 70 line as I can. But we were just on a walk on the Freedom Trail and felt shaky. I sat down, and I woke up in the back of an ambulance. So, oh, I'm sorry, yeah, that's it's scary, yeah. But I've never, I've never experienced anything like that. And you know, you hear people that have had it for a long time, probably not, probably, but may have had a seizure in their life. It's just nothing I expected to go through. I thought I have a pretty good control over this, and sometimes you just don't. That's just how it works. I guess.

Scott Benner 37:00
Do you think you were being more aggressive than your knowledge allowed

Jacob 37:03
for? Yes, 100%

Scott Benner 37:07
you had all the desire in the world. You had a little bit of knowledge, and you had an ethos like, I'm gonna, I'm gonna do what my aunt's doing. And I

Jacob 37:15
was over ambitious. Yeah, I think the knowledge, the knowledge, sure, I felt knowledgeable. I had papers on diabetes and, you know, college, and I'm not saying I know everything about diabetes, but like I had, if there was one person I feel like and my family says this too, you know, I didn't come from a background of, I'm just going to eat a cheeseburger. I don't know what's in it. Kind of thing I know what's in food and how many carbs are in most things I know, diet and exercise. So I felt confident in my ability to navigate this. I didn't have the experience I was too new to be trying so hard to keep an A, 1c where it's perfect, yeah, and I thought I could do it, because I've been able to do most things throughout my life. When I put my mind to it, I'm a learner, and I was like, I'm gonna learn this. I'm gonna perfect it. It's not gonna be a major part of my life once I figure out this perfect system that works, okay? And there's no perfect system.

Scott Benner 38:14
All this stuff that you were trying to do, where did you like, gather the information from doctors like,

Jacob 38:21
not really trial and error. I mean, honestly, this podcast. So when I got my Dexcom system from my diabetic educator, she suggested your podcast, okay? And I took that to heart. I went through the I want to say it's divining or defining diabetes, all of the kind of the initial things that you need to know. You know, what's the Bolus, what's basal, right? And I listened to the, I would just walk at night for for two hours and just listen to a podcast or two. And I did that for the first month I was diagnosed at least. So I consume probably 50 to 100 of these of your podcasts, and I felt good about all of the information I was taking in, and I still do feel great about all the information I took in, but I was taking it, and then I was like, I'm gonna run with this, and I'm gonna perfect

Scott Benner 39:19
it, and not just going a little slowly and adding some here and then waiting to see what happens. You were just, you threw it all up at once, and you're like, and it was too much,

Jacob 39:28
yeah, okay, because most people you talk to within diabetes, it feels to me as they're trying to keep their sugar down, and I felt more like trying to keep it up. And I thought maybe this is the way that you should do it. And it wasn't like an over aggressive amount of basal that I was taking a day, or an over aggressive Bolus. It was a combination of complex carbs mixed with vegetables, a lot of vegetables, because it's digesting slower. So. So I was keeping a pretty level straight line when it came to my sugars, so not a huge amount of fluctuation. And I thought that that's just the way to do it. So I don't, I didn't consume sugar. I consume more sugar now as a diabetic than I did before I was a diabetic, which is frustrating at a certain extent. But yeah, I was like, I'm qualified to do this. Out of anybody like, this is what I enjoy. I enjoy food and exercise. And managing diabetes comes down to a lot of food and exercise.

Scott Benner 40:31
Do you have those kinds of lows any longer? No, not

Jacob 40:36
as often, especially being an automated mode, because the manual mode, it can push you down without you, just throughout the day, without you needing to be

Scott Benner 40:45
pushed down. I mean, anybody who's on any kind of aid system that you can see your insulin, like when you see the times that it's taking basal completely away, sometimes for, you know, half an hour or more. And you think, like if I was just in a manual situation, or if I was MDI, that basal is just working constantly, you can't stop it. There's a big difference. So would you say that there's something that you've learned or gained since then, or was it literally just adding Omnipod five that balance things for you?

Jacob 41:17
Well, I so I had the Omnipod five when I was in the

Scott Benner 41:20
manual. I mean, using it in automation, I've

Jacob 41:23
learned that you're not going to perfect this as much as I like you want to be at a perfect level at all times, and you can, you can get closer to that, I think, in manual mode, if you're attentive, sure enough. But the automated or the automation behind it, gives you peace of mind for one at night, I wasn't having lows anymore, because the automation just can allow for me to sleep through the night, but just letting it taking back some of my own control, and letting trusting the technology to do the work. And I wasn't comfortable with that at first. Okay, you are now, yeah, yeah, I'm a lot more comfortable with it. And my a 1c i think is still an appropriate a 1c but I'm not going to determine my life around having a perfect a 1c I'm not going to not go out and have a drink with my friends or eat a slice of pizza, because my sugar is going to spike a little bit, and a spike, to me is like touching 200 Yeah, because I'm so locked in on it. But prior to that, it was, I can't do this. I can't do that because I have a perfect blood sugar

Scott Benner 42:28
level. Gotcha, you mentioned in your note a little bit about some mental health stuff. Did it? Can you talk about what you were going through?

Jacob 42:35
Yeah, it's, I mean, it's a little debilitating, knowing like, I've wanted to do certain activities and things, and it's prevented me in a certain extent, to give it my full everything, because I was just, I enjoy snowboarding. Let's say I was in Colorado. And I don't know if it was the adrenaline, but every time we went up to the top of the mountain, my sugar was like, 222 30. And I'm like, I haven't even eaten. My friends are eating sandwiches on the ski lift. And I'm like, I haven't even touched a bite of food today, and I want to eat so badly, and now I'm like, in a bad mood. But

Scott Benner 43:13
could be the elevation, by the way, that's a good point. Yeah. People talk about it both ways. Some people like, when I get up higher, I get lower. When I go up higher, I get higher. I've heard people say it both ways. I've heard people talk about it about, like, pressure in the tubing on some pumps that maybe forces more insulin through almost like going on an airplane. I don't know. There's a lot of like, you know, personal stories that people tell, but there's a lot of confusion around elevation. So, or, like you said, or you're just about to throw yourself down a mountain, and maybe it's adrenaline

Jacob 43:45
Exactly. Yeah, it could be either one, but yeah, there's certain things that I would love to be able to do, and I'm learning how to do those things. I've done half marathons and before my seizure about a month and a half ago, when I would go out on a three mile walk, I would throw a they're called RX bars. They probably have 25 carbs. I throw one of those in my pocket and be like, All right, I'm probably good to go. And now I'm carrying around more things, juice, my blood glucose meter sometimes, yeah, just because that kind of scared the out of me, to be honest, if I didn't wake up, I don't think I would have even known,

Scott Benner 44:24
but so it's meant to be just, like, on one second and shut off the next second, yeah, just you're not there, and then you wake back up. And would you have like, a come to Jesus moment? Like, okay, well, I guess I don't leave without juice anymore

Jacob 44:39
or correct my sister, I'm blessed to have I was, we were in Boston for July 4 vacation, which is just funny. You should

Scott Benner 44:48
probably stay inside on the Fourth of July. I'm just saying, yeah, the

Jacob 44:51
joke of the family. And this is why it's crazy, because it's three years in a row. So you got type one diagnosis two years ago, last. Year, and this is part of the mental thing. I finally fell back to my strength, right? I put the 40 pounds back on through hard work, exercise and eating, and with the help of, you know, insulin, but we join my buddies in a wooden bat recreational league men's in Cleveland, I'm throwing pitches. I played baseball throughout my life. I could throw about 8085 I'm feeling good. He's like, Dude, you got to get out here. Coach. What really wants to come out and meet you. I go to my first game. I'm all dressed up in my got my pants, my cleats, and I'm playing left field. Naturally, we're getting rocked, and it's a close game, but the pitcher's given up way too many runs, and I get pointed at. I do my bullpen. 15 minute rain delay, sitting down in the dugout. Rain stops. I come in, my buddy's catching I'm about to throw my first warm up pitch. I throw that warm up pitch, and it's called a thrower's fracture. I shattered my arm in four places from throwing a baseball, really? First pitch? Yeah. Oh, surgery. July 5 last year,

Scott Benner 46:06
18 screws, two plates. I like you sitting in your house watching a movie on the Fourth of July from now on,

Jacob 46:11
yeah, that's why the joke of the family, I'm gonna be bubble wrapped in the closet. Did

Scott Benner 46:15
they give you any indication about how that happens, that that fracture?

Jacob 46:18
Yeah, yeah. I mean, no, there's no specific correlation, but my thought process, my sister, she's a physician assistant at the Cleveland Clinic, and you know, bless her, she's been through everything with me, and she's really helped. She actually was the one that put together the idea that I was probably in DKA. We believe maybe I put on the muscle, not quickly, but my body wasn't up to speed from being in DKA and, you know, kind of eating itself for a while, that that type of aggressive movement, my bone wasn't ready for. It hasn't been disproved. It hasn't been proved, but it's just my thought process. It could have been poor mechanics somehow, like, you know, a 15 minute rain delay after I threw my last pitch. And I probably threw way too many pitches that day. We don't know, but what we do know I was in the hospital again. How many pitches Did you throw? Do you think? Well, we did the warm up, my buddy and I threw in the backyard. So actually, I'm living with him now. He bought a house in Cleveland, and we were freshman year Ohio State roommates, right? So after I stayed with my father felt comfortable enough, moved in with him, and we were thrown in the backyard. And then get to the game, do our warm ups, and then we're in. I'm in left field. I probably got 10 balls hit to me. I'm doing the crow hop, throwing all the way in, and then I do my bullpen, and then sit for 15 minutes with a cold arm, and then I threw my first warm up, and it broke. So I would say, I don't know, 8090, yeah, a lot of balls, probably too many

Scott Benner 47:48
a guy who had previously been sitting around at his job and not playing baseball since high school,

Jacob 47:53
right? Yeah, since high school, but I played softball for multiple years, so I'm still throwing things. It's not like a It's not emotion. And my buddy and I, we were throwing in the backyard twice a week, you know, as quick as I can. So I'm like, Finally, like, I'm back, I'm about to play recreational sports, and then my arm shatters. And that was a whole nother ordeal. You know, when your your arms and pieces managing diabetes, trying to fill up an insulin vial when your arm can't even move. It's a lot of support for my family. How long was the recovery on that? I mean, the official recovery at least six months. Oh, wow. Were you in a cast? At points, I was in a sling for the first two weeks. They have to let the blood and the swelling go down, and then they cut you open bicep, and they screw you together, 18 screws, two plates, wow, 52 staples to seal

Scott Benner 48:52
it all up. How'd you manage your blood sugar during

Jacob 48:55
that? Yeah, that's that's a tricky one, because you can't do a lot. I like meal prepping. You know? It just makes it easier when you you're eating the same things. You know how it affects your blood sugar, you can't do a lot of that when you can't even work a knife or your lefty now, right? My favorite question is, was it your dominant arm? And yeah, I was throwing a fastball, so I'm eating left handed. It's is difficult because the timing is different. Your Pre-Bolus could be off because you can't get your meal ready in time, and now you're eating something else. Yeah, it was more there's a lot more highs and lows throughout that a lot more swings

Scott Benner 49:31
they have you on any kind of antibiotics or steroids or anything like that,

Jacob 49:36
pain medication. It was that I didn't know that level of pain existed. No kidding, yeah, so they had me on, like Percocet or whatever it was, for a couple months, and that was tough, especially, you know, with work, right? I'm not going into the office. Everything was from home. I could, kind of couldn't drive a car, because you're on medication. In, and I don't even know, like, how my arm would have worked at that time, but from a diabetic, yeah, it did. It did affect it quite a bit, because everything had to be reached with my left arm. So wherever my sights were, it was going to be my left arm. Oh, but I wasn't putting it on my right so don't put them on my left arm, because how do you reach or how do you put an omnipot or a Dexcom with one arm on the same arm? Pretty impossible. You and the roommate aren't that close? Oh, we were close enough I couldn't take a shower for three weeks. So God bless him. He he helped you what? He was wiping me down. Oh, my God, I had some boxers on. But, you know, no no showers. Brother was helping me out. Father was helping me out. Step father helping me out. So I am very fortunate and blessed to have a lot of support around me.

Scott Benner 50:46
Yeah, of course, are you able to play baseball again? Or is that a thing you're not gonna do ever

Jacob 50:50
again? Yeah, we'll see about that one. Scott, I probably got I've thrown a bit, but I'd probably maybe touch 60 miles an hour now, not nowhere near 80. It's

Scott Benner 51:00
not going to be like that. My son doesn't throw a baseball in a couple of years now,

Jacob 51:04
yeah, and it's that's a shape, yeah, got to get out

Scott Benner 51:09
there. Makes me a little sad that he just and he plays a lot of basketball now, that's where he gets his you know, that thing that get that activity out, like, use that energy up, stay in shape and stuff like that. He plays a ton of basketball.

Jacob 51:19
Yeah, I like basketball. That helped with some of my therapy on my arm, because you think about you need extension, so a lot of physical therapy when your arms locked in one spot. Yeah, throwing darts helped me quite a bit, just bouncing a lacrosse ball or a tennis ball on the ground. Through that,

Scott Benner 51:37
say that again, bouncing a lacrosse ball, how? Just

Jacob 51:42
on the ground. The ground, just any, anything that extends your arm. Yeah. Just made it work, because my arm was locked at a 45 degree angle, if you can kind of picture that. And then it took about two and a half months of therapy for them to get it all the way extended out.

Scott Benner 51:57
Geez. That's it, man, you've been through a fair amount in a short time.

Jacob 52:01
Yeah, yeah, certainly. And part of the reason I believe, and I'm sure there's some kind of research to support this, I know I've looked into it at one point that I got the type one, you know, it's a trigger. It's a stress trigger. So covid, I had about eight months prior diagnosis, are up since covid, and then girlfriend, ex girlfriend, you know that whole let's deal, yeah. Well, there's just a lot of mental, emotional and physical stress. All that happened pretty quickly. And

Scott Benner 52:31
you have a family, you know, a background with the autoimmune and type one, specifically, you have brothers and sisters I'm gathering from this,

Jacob 52:41
yep. So older brother about three years older than me, and he's fantastic. He's married, no kids, dog. They have a house. Kind of both work from home, almost picture perfect, right? I'm the middle child here, and then a younger sister. We're very close. She's about 16 months younger than me, and she's about to get married. We have her bachelor bachelorette party in a week from now, so I'm all excited for her. And she's a she's a PA so a physician assistant over at Cleveland Clinic in Cleveland, Ohio,

Scott Benner 53:15
do those two talk about ever getting like screened to see if they have type one markers,

Jacob 53:21
not screened with type one markers, but they do their routine blood

Scott Benner 53:25
work. Do I have an A, 1c that's moving that kind of stuff?

Jacob 53:29
I wouldn't say they keep a log of that, but they do their their annual checkups and

Scott Benner 53:34
such. Okay, yeah. I was just wondering, like, some people want to know, you know, like, is this a thing that maybe I have a predisposition for and some people don't want to know. So yeah, I was just wondering. I

Jacob 53:44
run into those people all the time. I've had friends and family go get their blood checked after I got diagnosed, and I have friends and family and they're like, I really should do that. I'm like, Yeah, you really should. And they're like, Nah, I'm too

Scott Benner 53:54
scared. They just don't want to, yeah. What made you want to come on the podcast? I

Jacob 53:59
have wanted to be on this podcast, I got back into listening to some of just the stories, you know, the personal stories, and I felt like I had a story that I might be able to share and resonate with some people out there. Yeah, I'm glad. So I just figured I'd go ahead and shoot you an email.

Scott Benner 54:17
I'm glad you felt that way. I'll tell you what, though, how close are you to the I was gonna say, I tell you what, like, this idea that you get to go to, like, five guardians games a month, like, Are you, like, walking distance to the stadium? Like, that's the thing that slows me down from going to games, more than anything, because Philly has that standing room stuff too, where, you know, it's not a ton of money to go, like, stand, and I would stand and watch the game for sure, but it's an hour in a car, and then you park, and they charge them so much money to park your car, you think that that was the ticket. And then, you know, then you get a fight with, I mean, listen, you're lucky. You're in Cleveland. I don't know how many people show up to a game here, but every night in Philly, there's 40,000 people at that baseball stadium, you know, like, it turns into, like, your day to go to a game. So I don't go as much. As I want to, but it sounds awesome that you get to go that much. Are you close by to the stadium? Not as close as I'd like to be, but we're about 15. Will you take a train in? Or you drive? Or what do you do?

Jacob 55:13
Yeah, I'll drive. I got my secret parking garage. I know it's $10 to park, and then you go to five a month, and it's $50 a month. That shakes out to be about a $20 adventure. If you don't buy anything inside the ballpark, I'll go to about two or three weekday games throughout the month, and my company were embedded in Cleveland, so if I decide to go to the game, they'll let me out about 30 minutes early. I can beat the traffic, go straight there, and it's mostly on the way home. So I take that as just a commute back home from

Scott Benner 55:45
work. I feel like I was there one time. Is the stadium right? Me? Is there? Like you go out one side of the stadium and go down like this long, kind of flat concrete thing, and then there's a waterway? Is that the Guardian stadium? Am I remembering that right or no, there's no water near the stadium. There's

Jacob 56:00
water. There's water near the state. We're right on Lake Erie. So I can say yes to you. I can't picture exactly like what road you're Yeah, Carnegie,

Scott Benner 56:10
I felt like I saw the stadium. And then we we made a turn, walk through some what felt like. I don't know

Jacob 56:20
dark alleys. I

Scott Benner 56:21
don't know what it felt like Exactly. Then there was water there, but I'm wondering if I was at an older stadium, like, was I at the like, are the Browns

Jacob 56:30
place? Browns are right on the water, so that that would more resonate with the browns.

Scott Benner 56:34
This might be what I'm thinking about. Then, okay, then maybe I've never, I've never seen the Guardian stadium. Then Gotcha.

Jacob 56:39
Well, with the name, my name is Jacob, right? It's still Jacob's field to me. Yeah, I'm blessed enough I'm going on Saturday to the pre season game against the Rams. Are you? I try to go to, I don't go to very many Browns games. It kind of hurts my soul.

Scott Benner 56:54
So No, Jacob, this is the fun time of the year to be a Browns fan, when everybody thinks something's going to

Jacob 56:59
go well, I totally agree, and that's why I'm going on Saturday. I I grew up going to pre season games right around my birthday, yeah, and it's something that I'm fortunate enough to do. So my my buddy and I will be going on Saturday.

Scott Benner 57:13
Now, the Browns PR is magical, the way that every year, everyone acts like, Oh, this is it. We got it all figured out. And then by like, game five, you're like, Oh no, no, this is the

Jacob 57:24
browns. It's ridiculous. Somehow, I was hanging out, you know, got a friend. We grew up together. She's great. She was like, we should just buy the ticket to the first game. And I'm like, All right, let's do it. I spend the money. And this is before the game time app had to disclose all their fees. And it was like, 200 something dollar ticket, which is already absurd to already absurd to me, yeah. And it ended up being like $300 which, mind you, I pay $50 a month for the Guardians. And that is the entire season of 25 baseball games I just watched and more in one ticket. And we got stomped on. I don't even think we we scored a touchdown. I actively try to meal prep or do something while the TV's on. And I'll walk back and forth, and I'll look at the TV and be like, and then I just walk back into the kitchen.

Scott Benner 58:09
I might be on the outside on this one, but I think football is a better television sport than it is

Jacob 58:13
an in person sport. I Yeah, but I, like my father there, I prefer to be at a baseball game, though. Yeah, the weather is better, yeah. And when you're a buck guy, I mean, I can rest my my case with football on you can go watch college football. Yeah, let's go watch some college football, right, right? And then my Sundays, I'll glance here and there. And I've had years where I've, oh, I still follow it, don't get me wrong, yeah, it's just it's so tough being a Browns fan sometimes. And you guys, you got a football team. I

Scott Benner 58:43
don't know what happened, man, we figured it out in the last handful of years. They've got a front office that seems to understand the game better than anything. I mean, every time we lose somebody, just somebody better just shows up. I still think it's crazy that AJ brown plays for the Eagles. I still don't know how they accomplish that, right? Doesn't make any sense at all. So Nick bold is your Savior. Exactly. That was weird, but nevertheless, like you're around your apartment, like, I mean, I'll disclose something here during baseball season, I would tell you that there's maybe 30 games a year where the game's not on TV while it's happening, like the television is on in our house with a baseball game constantly, like while the Phillies are playing. Do you do that with the Guardians? Is it? Are you aware of every game? Yeah,

Jacob 59:29
yeah, and especially as it gets closer down the line. But it's on. If I'm not at the game, I'm getting notifications on my watch. I have, I think, three different group chats with friends that are all tribe fans. So

Scott Benner 59:41
your phone lights up with somebody says, like, Oh, what is he doing? And you actually know what that means, because you're all, yeah, you're all watching the game Exactly. My son attacks like that when we're not together, too, where I'm just like, you say something that out of context, somebody would look at and go, I have no idea what this means. If you've got your head in that baseball game, you know.

Jacob 1:00:00
Yeah, but it's and baseball's our team specifically. You know, we have such a small budget, and we, we don't, we don't spend a lot, but our guys are mighty and true to Cleveland for the most part. So there's always that underdog feeling where we're like, we gotta, we gotta take out the Yankees, you know, we gotta take out Texas. Like, it's just such a great feeling when you win those type of games, sure, or the Dodgers, and we've come close, it's just, you know, we we lost two pitchers because of a gambling scheme. So, like, you can't really control that one. Oh, they got caught gambling. Yeah, they were throwing games. Bosse,

Scott Benner 1:00:38
Oh, that's awesome. That's not a thing you're supposed to do.

Jacob 1:00:42
Yeah? I mean, you're not supposed to throw balls into the dirt because you got money on it. Oopsie. That's crazy. First pitch ball. Okay, hey

Scott Benner 1:00:53
everybody. I know what the bet in top of the seventh inning. I know it's gonna happen. Yeah? Exactly. That sucks for you guys, especially when you're just trying to be a fan and watch it. You know, it's funny, like, I grew up hating the Yankees for having all that money and, you know, buying teams and buying players, and now the Phillies do it. I don't mind it at all. I have to be

Jacob 1:01:12
honest, enjoying the dark side. Yeah.

Scott Benner 1:01:14
I'm like, No, this is fine. This is fine. This is how this should be. After watching a lifetime of like baseball, it's just coin flip. Are there going to be any good or not? You know, do they have a chance in any of these games? There's something nice about knowing, like, you you might show up and just, you know, like, something awesome could happen. And then it does, you know, like Kyle Schwarber is a great example of that. Like, man, just, you just sit and watch a game, and when he catches one, it doesn't even look like he moves, really, and the ball is just gone. It's so much fun. Like Bryce Harper was like, the beginning of all but that that seemed like when it feels like, when our our ownership, was like, I'm gonna spend a bunch of money now, and like, and it started there with Harper. So

Jacob 1:01:58
I remember my brother showing me videos of him hitting bombs inside of a football stadium when he was a kid. Yeah, and it's just like, yeah, he turned out to be the real thing. But, and this is what's great about these $50 all home games, standing room passes. I've always played baseball. I've been passionate about baseball, but it's becoming less and less popular with the younger generation, and it brings in the younger generation, right? You're a little bit older, they're going to buy tickets. They're going to sit down. We don't care. We're just there for the environment for the most part, and hopefully you catch a good game, yeah, and you're on your feet the whole time. So, right? That's the trade off. And my dad's like, we should go to a game together. I'll buy his tickets. And I'm like, it's kind of weird to think I'll be sitting and not standing, and most people are thinking the opposite. Yeah, well, Jake, go to a game with your dad. What are you doing? Oh, yeah, I will be okay. All right. Is there anything that we haven't talked about that we should have? I don't know. I'm sure if I listened through some of your more recent podcasts, and I've been trying to, like, I just heard Arden's name so many times as I was navigating my diabetes. So it's like, and at that time, I don't know how many episodes have come out, but she was in college a lot of the time, or going to college. I just don't know much about her. I've heard her name more than Cole.

Scott Benner 1:03:12
Yeah, go because, I mean, Cole has Hashimotos, but he doesn't have type one, okay, so it's not a ton to talk about with him. He's 25 and he has a good job. He's working away. He worked for Sony for a little while, doing the Statcast stuff. I know when people who watch baseball, they're like, Statcast, that's Google, right? I think Google is just the one that buys the ads on it. Like, I think they call it Google Statcast, because Google pays for it, but it's actually run by a subsidiary of Sony, and he did that for like, a year, which was pretty cool. Like he actually would sit at a desk and monitor like, three or four professional games at once to make sure all the measurements were happening correctly, like how fast the ball was moving, interesting trajectory, all that stuff. But in the end, he said that he's, like, this job is making me hate baseball. Like, I gotta get

Jacob 1:04:00
out of this. I've probably seen some of his work that, yeah, I'm sure

Scott Benner 1:04:03
you have. And then so he's now he does something else. Now he's coding, and

Jacob 1:04:07
I heard that he's got the Flipped screen. He's got all that going on.

Scott Benner 1:04:11
He's in there working. And, you know, I don't know if I think today he was learning something about snowflake and something about AI or, I don't know exactly. And Arden's in college. She's getting a degree in psychology and some other stuff. Awesome. Yeah, she's getting ready to start back up again in a couple days. Actually, she just had her tonsils out, and it completely changed her voice, really, yeah, it's ridiculous, coming back a little bit that that could happen, yeah, but we don't know how far back, so her tonsils were huge, and Arden had a really deep voice. And the first time she went to speak, she was like, hey, and we were like, oh my god, what happened, you know? And hopefully it's and now, like the couple days after the surgery, she was talking, I looked away from her, and she's like, what's wrong? I'm like, I cannot look at you like you don't like while you're talking, like you do not sound like anything like anything like yourself. And it's freaking me out. And they keep saying, like your your voice is going to come back. I'm like, I'm just not going to look directly at you while you're speaking till it comes back, because it's an absolutely like out of body experience to watch it happen. I'm sure. Yeah,

Jacob 1:05:20
very strange. That's great. Yeah, I just as a listener. I appreciate that update. Nice,

Scott Benner 1:05:25
nice. Well, listen, I hope you find a girl who shows up at the hospital if you're sick, even if you guys are arguing a little bit, that would be a nice thing for you guys. How do you guys meet girls?

Jacob 1:05:34
I go out. I'm I don't use the apps. I'm an organic guy. So I enjoy going out, shooting pool, throwing darts, having a drink here and there, and talking. You know, I'm in sales, so you gotta kind of have a personality and be personable with people. And I think that's awesome. Best way to go out and meet somebody good for you.

Scott Benner 1:05:51
Well, I hope you meet somebody nice that, like I said, even if they're mad at you, we'll show up at the hospital while you're in DKA,

Jacob 1:05:55
thank you. Yeah, hopefully she doesn't, maybe she'll listen. Maybe she won't. Well,

Scott Benner 1:05:59
if she listens. She you know, shame on you, like you know, you should have called him and something. If it was okay, you would have called her in the same situation. No, yes, I would have exactly we know what the problem here is, Jacob, don't you? Mom's gonna kill me. Your mom. Your mom knows too. She probably told you to get away from that girl long before you did. Am I right? You're right. I knew it okay. All right. Hold on one second. You thanks for tuning in today, and thanks to Medtronic diabetes for sponsoring this episode. We've been talking about Medtronic mini med 780 G system today, an automated insulin delivery system that helps make diabetes management easier day and night, whether it's their meal detection technology for the Medtronic extended infusion set. It all comes together to simplify life with diabetes. Go find out more at my link, Medtronic diabetes.com/juicebox the episode you just enjoyed was sponsored by the twist a ID system powered by tide pool if you want a commercially available insulin pump with twist loop that offers unmatched personalization and precision or peace of mind, you want twist, twist.com/juicebox, I'd like to thank the blood glucose meter that my daughter carries, the contour next Gen blood glucose meter, learn more and get started today at contour next.com/juicebox and don't forget, you may be paying more through your insurance right now for the meter you have then you would pay for the contour next gen in cash. There are links in the show notes of the audio app you're listening in right now, and links at Juicebox podcast.com, to contour and all of the sponsors. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox podcast. You so

when I created the defining diabetes series, I pictured a dictionary in my mind to help you understand key terms that shape type one diabetes management. Along with Jenny Smith, who, of course, is an experienced diabetes educator, we break down concepts like basal, time and range, insulin on board and much more. This series must have 70 short episodes in it. We have to take the jargon out of the jargon so that you can focus on what really matters, living confidently and staying healthy. You can't do these things if you don't know what they mean. Go get your diabetes defined. Juicebox.com go up in the menu and click on series. If you're looking for community around type one diabetes, check out the Juicebox podcast. Private Facebook group Juicebox podcast, type one diabetes. But everybody is welcome. Type one type two, gestational loved ones. It doesn't matter to me, if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox podcast, type one diabetes on Facebook, the episode you just heard was professionally edited by wrong way recording, wrong wayrecording.com.

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