#562 Katie and Scott Talk about Type 1

Katie is the mother of a child with type 1 diabetes.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

---

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

Scott Benner 0:00
Hello friends, and welcome to Episode 562 of the Juicebox Podcast.

I'm certain that you've heard me say that I talked to people all the time outside of the podcast about type one diabetes. Well, I can't anymore. This podcast has become so popular. I just don't have the time. But I didn't want to stop having the conversations. So now if somebody asks me, I just say, Okay, can we record it? And Katie is the first person to say yes, Katie was willing to have a vulnerable conversation, where she did not know what she was talking about, and was asking for help. And so we had this conversation together, and I recorded it. And now it's a podcast episode. definitely important to remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. or becoming bold with insulin. That's very important because Katie, and my conversation is, is pretty full of me. You know, telling Katie what I think so just remember, I'm not a doctor. And this is not advice. It's just the Juicebox Podcast.

This episode of The Juicebox Podcast is sponsored by Omni pod, makers of the Omni pod dash and the Omni pod promise, which I'll tell you about later in the show. But for now, find out if you're eligible for a free 30 day trial the Omni pod dash at Omni pod.com forward slash juice box. Today's program is also sponsored by Dexcom. makers, the Dexcom g six continuous glucose monitor, you'll learn more about that@dexcom.com forward slash juice box. Get started today. I almost scared myself with my own deep voice just as like today's episode. I can't even do it again. I just haven't by mistake. Hold on. I'll try one time for you. I'm ready, rock calm. Today's episode of the Juicebox Podcast. Whoo, you feel that room rattled me right to my core. You are the inaugural one of these. In all of the years that I've been doing this, and one could argue that these phone calls lead to the podcast in some way. I've never recorded one of these. So thank you. And hello.

Katie 2:41
Well, hello. Yeah, well, I have like, a really old, like came with my phone. headset thing. You sound great. And so if you can't hear me, well, it's probably that it's kind of old. Like

Scott Benner 2:55
don't talk about it cuz you look you sound terrific. And I I was a little low on my end, I had to turn it up a little. So that's the only reason I couldn't hear you for a second. So okay, do we want to keep your name out of this? Or do you not mind using your first name or what's up?

Katie 3:10
I don't care. Okay. I don't think there's many people that will know me. So are you

Scott Benner 3:15
afraid you're gonna say, I don't want you to feel empty? Because this is gonna be like a real loose conversation about management where I ask a lot of questions. You answer. I talk for a while. I ask you if you have questions, like it's gonna go back and forth like that. It might take like, 45 minutes. Is that okay?

Katie 3:32
Yeah, no, I, I'm fine with that. I you know, I've been listening to your podcast for a little bit. And I, you know, I've been struggling. And my husband's was juggling with gauges, care gauges, my son. And, you know, your podcast really, honestly changed the game for us. And it's so sad to say, kind of, you know, a podcast changed for us more than our doctors said, you know, so I'm glad to help. I'm cool. With all that, you know, alright.

Scott Benner 4:08
Okay. So just because of the guest, because we're recording it. Just Introduce yourself very quickly and tell me a little bit about your son.

Katie 4:17
So my name is Katie. And gage is my three year old autistic son that also was diagnosed with type one. He was just diagnosed like six months ago. So we're kind of new to everything. Okay.

Scott Benner 4:35
All right. So if I have to stop myself, because I get questions right away, like stuff starts popping into my head to ask you and that's not what we're doing today. This is not a regular episode of the podcast. He started saying that I was like, oh, question here about this and then this, but no, so if if this was a regular phone call if you were so I guess first I should say this. There are three main types of people who reached out to me privately, I'm gonna say they're the type a people who have figured it almost completely out but still get like a weird rise somewhere and they want it to be perfect. And they can't figure out how to make it perfect. And they think I can help them. That one's always an interesting conversation because not that it's hard to take seriously, but when someone's like, Hey, I have a six, one a one C, but I get a little bit of a rise at lunchtime. You know, they're like, oh, you're doing great, like, No, I'm not. So there's that person type a really wants things to be perfect. There is the person who is generally lost, and just doesn't know what to do, and has gotten so desperate that they're willing to reach out to a stranger on the phone. And then there's the third person who I think of as having common sense, seeing that what's going on, doesn't make sense. They feel like they know what they want to do. But it's so flies in the face of what their doctor told them that they're frozen, and they can't act. Do you fall in any of those three categories?

Katie 6:18
Um, I would say probably the last one. Okay. The, you know, definitely not the first. But more like, the second and the last for sure.

Scott Benner 6:31
I have to tell you, no disrespect, but I don't, you wouldn't want to be in the first group. Those people seem to know what I'm talking.

Katie 6:40
There's no, that kind of makes me angry. It's funny, like, shut up. You got to figure it out.

Scott Benner 6:45
But, you know, it's sort of like, you know, once you furnished your house, but you still have one old table in the corner. You could live with it. But you're like, I don't want to fix that up too. So yeah, Everyone, listen, everyone's in a different spot. I would hope that you will be some someday at a point where you actually have that thought, like, oh is a once he's five, nine, but I wonder if I could make it five five. by that. I mean, I don't see why you couldn't. Okay, so they're gonna call would start. I feel like I'm narrating the call, which I'm gonna have to stop doing and just just talk with you. But you would jump on the phone, you'd be like, Hey, I'm Katie. And I'd say hey, Katie, how are you? I hope you don't mind if I clean a toilet or pick up leaves in my backyard while we do this? And you'd say, No, because I mean, what are you gonna say? And then I go, listen, Katie, it's really important for you to know that I'm not a doctor. That nothing we're going to talk about on this call is advice. If I misspeak, or you misunderstand me, and that kid of yours ends up dead, it's not my fault. I'm gonna need you. I'm gonna, I'm gonna need you to respond audibly that you understand. And

Katie 7:50
I totally understand. And all I'm

Scott Benner 7:53
really going to talk about with you is, what I do, and how I see it. Being applicable to what's happening to you, that really is like all this is going to be but I think it's gonna be really helpful for you. So then I started asking questions, and I say, How old? How long? What? insulin? What tech? So he's four. Is that right?

Katie 8:15
He's three three. Excuse

Scott Benner 8:16
me. And look at me already.

Katie 8:21
He's almost four. Really? born July one July.

Scott Benner 8:23
How much does he weigh?

Katie 8:28
I don't know. I would say probably like 40 pounds. It's pretty solid

Scott Benner 8:33
pounds. almost four years old. You say at all? He has autism? Yes. I don't know why that's important to this, but I'm already down just in case I forget. And he's had diabetes for about six months. Yep. Which insulin do you use?

Katie 8:47
So he is he does the shots. The pens so he's on human blog. Okay. During the day, like for his meals and stuff, and then he gets Basal Gar at night. So which is likely Santos Yep.

Scott Benner 9:06
And you have a CGM?

Katie 9:09
Yes, he has the Dexcom g six.

Scott Benner 9:11
Okay. Can you take your phone for me pull out his Dexcom turn it landscape. Go to 24 hours? Take a screenshot of it and text it to me.

Katie 9:21
Cool. You're not gonna be very

Scott Benner 9:24
happy. No, no, no, no, you misunderstand. Don't feel judged. I need to see it. So I know how we can fix it. Don't Don't worry about what it looks like. Now think about what it's going to look like. My next question would be is somebody home with him all the time, or is he in daycare or with another person?

Katie 9:41
So he was on he was in school, a special education school. And he had to leave because they don't have a nurse or anyone felt comfortable giving him insulin. So which is complete bs but Anyway, that's a whole nother story. So he, no, he's no longer in school or daycare. My husband actually left his job to stay home with them.

Scott Benner 10:10
Tell him that worked out well for me. I don't know. How will

Katie 10:13
I know. I was like I told him I was like you'd love this podcast and it's a stay at home Dad. Yes. And?

Scott Benner 10:20
Yeah, really? That's if you're looking for the biggest high side of being a stay at home dad. It's not having to shave every day. And I didn't. I'm sorry. Do you know how to text that to me? You maybe don't right?

Katie 10:33
Um, so is it like you're like a cell phone number? I'll

Scott Benner 10:36
give it to you. Just let me know when you're ready for it.

Katie 10:39
I'm ready.

Scott Benner 10:40
690 and that's totally getting bleeped out. And so zero. Yes.

Katie 10:52
All right. Let's see if that works.

Scott Benner 10:54
It did I have it. Okay. Except you didn't turn it landscape.

Katie 11:00
Oh, whoops. I have very good. Sorry,

Scott Benner 11:03
Katie. This phone calls over. You break one rule and could you do it again?

Katie 11:10
Alright, let's try again.

Scott Benner 11:13
You're in luck. This is going to be easy.

Katie 11:16
Oh, well, that makes me feel better. All right. I have to turn rotate back on on my phone because I always turn it off.

Scott Benner 11:29
Right now the people listening which are people from the future are like, come on, Katie.

Katie 11:35
Seriously, like how old are you?

Scott Benner 11:38
I got things to do. But they're getting this as a bonus episode. So you people stop complaining. Okay.

Katie 11:44
Can you give me a break here? with Katie.

Scott Benner 11:47
I don't know if you heard she had a three year old with autism and type one diabetes. You're lucky she's still in the house. I mean, honestly, you ever go to the grocery store and just think maybe I'll just keep driving.

Katie 12:00
Just gonna stay here for an extra hour.

Scott Benner 12:02
I talked to a woman yesterday who had four children. And while I was I was having what the conversation you and I are about to have with her. And her kids were screaming nonstop in the background. And I said, I said to her Do you ever think you just maybe are going to go and she is it occurs to me so. Alright, here we are. I got it. Thank you. Right. Now I got the graph. And normally I don't have to explain the graph while I'm talking because you're looking at it too. But let me just say out loud for people who are listening. It looks like you have your high alarm set at 250 your low alarm set at 70 that makes sense.

Katie 12:41
Yeah, probably. It sounds bad but he goes high so much that we're like, you know, we might as well set it a little higher because we're gonna Yeah, I mean we get alarms on it, we're gonna

Scott Benner 12:57
fix that we're gonna make it so that that doesn't happen. So I am looking at a graph that runs from about 10am to 10am right about there. Back at 10am the other the day before I see blood sugar's around 250 that came down to about 220 stayed stable for a couple of hours at 220 then it looks like there's food that pops it back to 250 Is that right? That makes sense to you. That first spike up that happens on the left of that graph does that look like a meal Can you still there Katie Oh what happened oh whoa oh wait she's muted That's hilarious. Oh, what happened Katie? Yeah, what happened?

Katie 13:58
Well, my phone I don't know what happened my phone just shut off and now it's like turning on and off and on and on. But you can hear me okay. No. phones. I had to use my husband's phone okay. And they're not headphones aren't working on it.

Scott Benner 14:15
Okay, yeah, go ahead just kind of try to keep it still you just have it up to your head. Yeah, yeah, just keep it from rubbing your face or your hairbrush and by the microphone we'll be okay. Okay, so I went through a ton of ideas what may have happened you struck by lightning in your home. I thought possibly you left your family and I use that perhaps you know, sometimes frozen urine gets dropped from airplanes and goes through people's homes. When that have been crazy. I thought maybe a car crash to your front window.

Katie 14:48
Go with all of that.

Scott Benner 14:49
Then when I texted you didn't answer. I was like, Huh, this is curious. I think our phone just thought

Katie 14:55
yeah, I don't know. It's still turning on and off. So I don't know

Scott Benner 15:00
If like, like it worked yesterday, right? What do you use it for yesterday? Give it a mean. Yeah, no, it's it has done it done that before. But well, let's let that go now. Okay. So where are we? Where was I was looking at the graph, which can you see? Or not anymore?

Katie 15:18
Hold on? Let me see. Are you still there? Of course. Oh my god, I feel so old right now. How old are you 31. Okay, see, I can still see his graph for you. I'm on my husband's phone, though. So if you need something else, that'll be from a different number.

Scott Benner 15:37
Don't worry about it, I'm just, I just want you to, I want to talk through the graph, and you'd be able to see it. That's all to my mind. So I was starting to describe it when you disappeared. What I'm seeing is about 10am to 10am 24 hours. At the very beginning of the graph, I have about a 250 blood sugar coming down, and then it levels off around 220 ish, and it stays there for an hour or so. And then it pops back up again, is that quick pop up some sort of food I'm imagining, probably, okay, and then a Bolus, which did drive the blood sugar down over the next hour or so probably like 130. But then it pops again, wants to go back up, then it drops back down, then it goes back up to 180. And now we're at 4pm is 180. It looks like somebody puts an insulin, he drops down, but then he spikes. Then he drops harshly to 65 ish. It looks like somebody intervenes with some fast acting sugar, which drives or food and drives them super up almost the 300 over the next seven o'clock, eight o'clock, nine o'clock, 10 o'clock time. It looks like it gets it drops down again, it hits 200, around 1011 o'clock. And say stoop stays reasonably stable between 180 and 220. From 10pm until seven or so when I'm assuming he ate, right. Okay, and then comes back up. And now in most recently around 930 took a sharp turn, which looks like food that wasn't covered well with insulin. So. Okay, so there's a lot of stability in your graph. And by that, I mean there are long stretches of time, where the blood sugar's not vacillating up and down wildly. I take that as good news. And you so you don't know how to Bolus meals and your basil is probably a little weak. And we're going to figure out how to tell you how to do that right now. So what is how much basil is he using that basil garden? And when do you inject it?

Katie 17:47
So we don't give it to him till nighttime. Okay, so like right before bed, like nine, nine anywhere between nine and 10 and six units of that

Scott Benner 18:01
basil guy around nine or 10pm? What do you think his correction ratio is? And what's his meal ratio?

Katie 18:09
Correct. is

Scott Benner 18:14
Katie, I lost you. Katie, I lost you. Oh, can you not hear me? I got you two right now. correction is what?

Katie 18:22
I'm 115 115

Scott Benner 18:25
for a unit and meal ratio.

Katie 18:28
So breakfast is 18. Lunch and dinner are 14.

Scott Benner 18:35
All right. This is mostly been set up by your doctor I imagine.

Katie 18:39
Yeah, I mean, the whole we don't really deviate at all from what they say which I know we could but that's okay.

Scott Benner 18:47
I just wanted to make sure it wasn't something you had done. Hold on a second. Seven. You said seven units. Excuse me. How many units are past the guard night? Six, six. Okay. six divided by 24 is point two five an hour. I'm gonna guess he could handle more than that. So, point four times 24 is 9.6. That would be point four. If we did point three five times 24 we get eight or eight. Okay. All right. Now I have to ask you some questions. The lows that I see and or I know they're not all they're not actually low. Actually. Let's go through that really quickly. What do you consider low?

Hey, this is a good place to drop in the ads because we're going to really get rolling after this and I don't want to break up the flow Dexcom g six continuous glucose monitor. Yeah. insulin. Are you using it for your diabetes? Yeah, probably want to Dexcom dexcom.com forward slash juicebox. See your blood sugar in real time right there on your cell phone if you like or on the Dexcom receiver, I'm picking my phone up right now. My daughter is at school, her blood sugar is 115 and extremely stable. Although if I'm being honest, it started to rise up about 35 minutes ago, from where it was sitting at 85. Yes, it doesn't look like food though. Although it could be. But Arden would have had to make a really rock solid Bolus for this to be a food rise. You know what, just for you guys, give me a second. I'm gonna text there. I'll be right back. through the magic of editing I am right back. It turns out Arden did make a Bolus for food. How crazy is this? I can see right on the CGM. I'm looking she's got this nice stability. 910 11 o'clock in the mid 80s. Everything looks good. And then I see a bit of a rise. But it's not drastic, you know. So it either looks to me like Arden's insulin needs changed all the sudden, or she's impacted her blood sugar somehow with carbs. And I just texted her and turns out she did. As a matter of fact, Arden Bolus for 65 grams of carbs, about 11am Oh, look at that. Isn't that cool? 10:55am art and boluses. And I see the rise beginning in the in a few minutes after that. The rise is controlled over the next 20 minutes and is leveling off now in the 115 range. So I'm thinking Arden did a really good job bolusing for whatever she had. But I can see that on my phone. So imagine what else I could see an unexpected drop. I don't expect that rise. Dexcom doesn't just show you that Arden's blood sugar's 115. It shows me that she's stable. If she was rising or falling, it would show me that too. And tell me at what rate that was happening. She could also be sharing this information with up to 10 followers. Right now it's just my wife and I looking at it but could be her school nurse or a friend or a loved one of any kind. dexcom.com forward slash juicebox see the speed and direction of your blood sugar in real time. Let's talk about Omni pod for a moment. Before we get back to Katy. You may be eligible for a free 30 day trial of the Omni pod dash. Go to Omni pod.com forward slash juice box to find out. That's it. A free 30 day trial. Are you kidding me? What do you still I can't believe you're still listening. You should be on the pod.com forward slash juicebox finding out if you're eligible right now. If you are, give it a shot. And if you're not, you could always get them to send you a free, no obligation demo pod just to try on and see what you think. That way you can at least get a feel for what it's like to wear the Omni pod. A lot of options. Head over to alibaba.com forward slash juicebox to find out about them. Now, maybe you're thinking right now Yes, God, I would but I'm waiting for the next big thing from Omni pod. I'm hearing it's coming soon. I don't want to get this thing and get stuck with it. Well, you won't. Because with the Omni pod promise you can upgrade to Omni pods latest technologies for no additional cost as soon as they are available to you and covered by insurance terms and conditions apply. But you'll get those details at my link. You're not locked into anything. There's no reason to wait. Get started today on the pod.com forward slash juice box dexcom.com forward slash juice box links in the show notes links to Juicebox Podcast comm when you use my links, you're supporting the show. Alright, let's get back to Katie. Thanks for listening to this.

Katie 23:55
m I'm so I get worried when it's at like 65 and it's like an arrow down.

Scott Benner 24:02
Cool. Katie, you're my kind of girl. Alright, so lowest 65 just for our conversation. What are you calling hi in your head to 50? Because that's where you set the alarm?

Katie 24:13
No, I mean, I know that Hi. I mean Hi. To me. It's like 180 and above, but

Scott Benner 24:22
that's great. I just want to make sure we're using the same definitions of things while we're talking. So you don't Pre-Bolus meals right?

Katie 24:31
We just started Pre-Bolus Singh. Um, but I don't think that we're timing it right.

Scott Benner 24:40
How long out are you doing that? It looks like I

Katie 24:44
don't know. Maybe it looks maybe like maybe 10 minutes.

Scott Benner 24:48
It looks like five to 10 minutes. So yeah, yeah, that's not Pre-Bolus thing. Enough, that would be like if if you started with a condom and then took it off halfway through and I practice safe sex, he kind of. So um, look at me feeling pressure to be funny because I know it's being recorded. That's interesting. That's a look into my brain. Okay, so here's what we need to do. We need to get your basil right, we need to teach you how to Pre-Bolus better. And we have to talk about the glycemic load and glycemic index the foods he's eating, so what kinds of food is he eating?

Katie 25:24
So he's eating really horrible food.

Scott Benner 25:27
That's a girl, be honest, let's

Katie 25:28
go. I'm just gonna be honest. I'm not going to beat around the bush he he has that the typical autistic diet where he pretty much eats the same exact things every day, which is kind of good in our case, but it's all high carb, like processed crap.

Scott Benner 25:49
Give me some some selections.

Katie 25:53
So like chicken nuggets. We try to get him like we buy him the organic veggie breaded ones that Walmart sells. So there, we pretend that they're healthy. And he eats those premade peanut butter and jelly sandwiches. So I can't work they're called uncrustables. So those are two huge things for him. So that's either lunch or dinner everyday for him with like snack so like a fruit strip. He eats those gogo squeezes. Trying to think like, you know, like Cheez Its anything chippy like he likes so basically carbs.

Scott Benner 26:45
tell you after hearing that list of foods, you're doing really well. Okay, don't I mean, you did not list one thing that is easy to Bolus for.

Katie 26:59
No and and that's the thing is he like he really likes oatmeal. But we kind of had to

Scott Benner 27:06
pretend it doesn't exist anymore. Yeah, cuz

Katie 27:09
we get we give them oatmeal, and he would be like, 300 all day.

Scott Benner 27:12
If brandy is listening, the person I spoke to yesterday, she told her child that because of COVID that you can't get Fruity Pebbles right now. I thought that was brilliant.

Unknown Speaker 27:22
That's a good idea.

Scott Benner 27:25
Anyway, okay. I don't normally have to ask this question. But how well does he understand you? How well are you comfortable that he's going to eat when you give him food, stuff like that.

Katie 27:35
So he's not, he's pretty much completely nonverbal, like communication wise, but he, he pretty much eats everything that we give him. And that's why like, in the beginning of this whole thing, they were like, do not Pre-Bolus you know, because he's so young, you don't know if he's going to eat. But we pretty much know he's going to eat everything. So there's been a couple times where he didn't, and he plummeted, and we had to give him juice. But other than that, I mean, he, he doesn't know that he has to eat everything. Or he's, you know, his sugar is going to

Scott Benner 28:16
drink something if there's an emergency or something like that,

Katie 28:19
right? So if we did Pre-Bolus for something, and he's not eating it, I would just give him something I know he's going to eat, like a fruit strip or something else.

Scott Benner 28:30
Right? Well, so there's, there's a couple of different things here. And I just want to walk you through some ideas before I tell you what I'm thinking. So, you know, to start over again, if the basil is not right, even a well timed Bolus isn't going to work, even if it's right. So say for say somehow, you know, Jesus comes to you and says, Hey, this one unit per 18 carbs is the exact right meal Bolus for gauge. Even if that's true, like, just undeniably true. If your basil is wrong, it won't matter. So imagine that, you know, you're, you're having a meal here and it's 40 carbs and gage is probably getting about two and a half units of insulin for that, right. And his basil is six units a day, but maybe it should really be eight units a day. And if that's the case, some of the Bolus that you're putting in when you're injecting for meals is really just making up for the job of the basil insulin. There's not enough there. So you know, if he needed 10 guys to I don't know, cut your lawn and only five of them showed up. When two more show up. You're still not going to get the job done the way you're supposed to be a hell of a lawn, wouldn't it? But you know, the point is, is that you if you don't have enough basil, then your bonuses are going towards basil job and then they're not able to go towards their job of handling the meals. Additionally, you're by not Pre-Bolus thing, you're letting the food get way out ahead of the, of the of the, the insulin, so there's just no way for the insulin to catch up. So again, if you don't have enough basil, and you're putting in your insulin in a way where it doesn't have a chance, even if you use the right amount of insulin, you're bolusing for the food not that are you correcting when you're boasting for meals? So if he's 220, before meal, are you correcting those who 20 and bolusing? The food? Yeah, okay, and that's still not working. Alright, good. And I say good, because then it makes me more comfortable talking about the Basal insulin.

Katie 30:44
So the Basal insulin that we give him at night, the Lantus or the Basal Gar, um, that is supposed to be holding him over for 24 hours, not just at night.

Scott Benner 30:58
Yes. So okay, your Basal insulin has one job. When you're on MDI, you shoot it in, it goes in, it kind of crystallizes under the skin, and slowly melts away. And its entire job is to over 24 hours until you put it in again, to hold your blood sugar stable at a number. So meaning away from food, and away from Bolus insulin, you know, meal insulin. Your blood sugar should be super stable at a number, and if you're using enough insulin, that number can be as low as you want it to be. So see how super stable he is overnight? Yeah, I mean, if he had more basil, insulin, he'd be super stable, lower. That's it.

Katie 31:53
So when he if he gets on, because we're trying to get him on the Omnipod if he gets on that, I think I've heard you say before that it kind of it like does a whole day not just that, like once

Scott Benner 32:06
what Okay, let's say that let's say we've Can you shoot half units of basil Gar are just full units.

Katie 32:12
It's a it's a half, you can do a half. Okay, good. So let's say no, no, the basil Gar is one unit at a

Scott Benner 32:20
time when you're done. So let's say we figure out that his basil hours eight units a day instead of sex. And when we're done here, I'm going to tell you to try seven like how long I'm going to tell you to try seven tonight and then look at your graph again and decide if it could be more right and I don't know if it's going to be or not but with such a carb heavy diet that's so consistent and I'm imagining Am I right is he active or not particularly active during the day

Katie 32:49
he's pretty active I mean, it's kind of hard right now with it being cold Yeah, um, but yeah, he's he's always moving around, he doesn't sit down for much.

Scott Benner 32:58
So we'll just make up that we come up with seven being the right amount, okay. And then you get an on the pod So what we'll do is we'll take the seven we'll divide it by 20 for the hours in the day and you'll start you're on the pot at point three units an hour of basil. So every hour the pod will give you point three units of basil and it will spread it out over the hour. So it just kind of like spurts little bits throughout the hour, just constantly putting it in until you get point three every hour and it just keeps going 24 hours a day. And the great part about that is is that you can increase it if you're having a particularly stuck day or you can decrease it if you're having a lower day or you're going to like say he's more active so you're going to a trampoline park or something like that. You might then say well I really don't he's not gonna be point three today today is going to be like point one. Like imagine you could reach inside of his body right now and turn up the bathtub or turn it down. You're actually going to be able to do that with a pump. But for now I'm what I'm guessing is at 40 pounds, he could probably handle more like point three. And he's not getting that he's getting six divided by 24 he's getting point two five, and that could be a big difference for him. So another point oh five times 24 is 1.2 more units of basil a day. And it might be four but it might be point four it might end up being eight units. I have no idea but if I was you the first thing I would do is tonight I'd give him seven units of basil var instead of instead of sex. Because this because even when he's down near 100 it's only because you're driving him down with a lot of like injections. It looks like does that make that right?

Katie 34:46
Yeah, I mean we still think that like there's a couple days during the week that we're convinced that he's still honeymooning because we like have to give him juice all day long. But then, there's some Is that it does seem like it, that is what is going on. Okay.

Scott Benner 35:05
So on those days where it seems like he's honeymooning, instead of just giving him juice, I guess you get caught in the loop like, Oh, hello, here's some juice, and then he goes back up, and then he comes back. Oh, cool, here's more juice, just give him something more substantial. Give him a half of one of those peanut butter things or a bite of one of those peanut butter things, put something in his stomach, it's going to stay in his stomach for a while on days like that. Because on days like that, when his body's doing the work, or some of the work, the Basal insulin you gave him is still doing what it's doing. So since you can't shut it off, when you're injecting it, you need to put, you need to then think of the Basal insulin like a Bolus. I know that's like a weird leap to make. But you can give him uncovered carbs. And if you give them enough of them that will sit in the stomach and digest more slowly, then that will hold his blood sugar up longer than June than juice which will go in and try to fight with that extra basil that he doesn't need because his pancreas is making some insulin today. And that it's just the juice gets overwhelmed and basically burned off too quickly to help you. So you have to put something more substantial and in those situations.

Katie 36:15
Okay, okay.

Scott Benner 36:16
So the graph I'm looking at here, is this a pretty a pretty common graph for most days?

Katie 36:25
Yeah, I mean, if you looked at it, like a few days ago, you'd be like, what the heck because that was when he we think he was still honeymooning. And he was like, dropping down quick. Okay, every hour, but I would say probably we've been trying to do it. Like, there's some days I that I'll look at it while I'm at work, and I'm like, wow, he's, he's doing really good today. And, you know, he's in like, the 119 area for most of the day. But he does jump up pretty high. So I'd say Yeah, probably, you know, that's pretty accurate.

Scott Benner 37:00
Okay, so the next thing here is, is the meal and so on. So I want you to try to imagine, tug of war. So we got a rope. And on one side, there's one team on the other side, there's another team, let's call one team insulin and call the other team carbs. All right. And in a normal tug of war, the goal is for one team to win, right, there's a flag hanging in the middle of the rope, and you're trying to pull the flag to your side. Mostly what's happening is your carbs are winning that tug of war. But you're playing a slightly different game, you don't want anyone to win the tug of war, you want the flag to stay in the middle. You want the carbs to pull as hard as they can, while the insulin is pulling as hard as it can, and no one, neither side be able to overwhelm the other. So when you see a really flat line, that's what's happening. What's happening is, you know, you see somebody on line, they're like, look at me, I Bolus for Chinese food, and I'm at and stable and you're over there cursing at them. And and the point is, is that they've balanced the impact of the carbs against the action of the insulin perfectly. You're not doing that. So what you're doing is you're setting up the rope, giving everybody the rope and you're telling the carbs, hey, you go ahead and pull now. But insulin, you're not going to get the pull for 10 minutes. Right? So even if you were to start at a great blood sugar, say he was 85. And he's super stable, say we figured out his basil. He's 85. He's super stable when he's away from food. And you're just like, we're so good at this. And then you go to feed him food, and he eats his crosstable but you put in the insulin five minutes before so the insulin goes in. In five minutes. It's doing nothing. He starts eating that crosstable it starts hitting him almost immediately. And now the rope starts getting pulled towards the carbs. He goes 85 he goes 90 he goes 95 He's 110 He's 125. Now you're diagnol up 131 arrow go straight up. The sound familiar? Yep, yep. Okay, and now he's flying up 151 80 boom, and then all of a sudden it starts to dip a little bit 180 200 it's catching, it's catching? Oh, I think it's gonna work. It's gonna work. No, it's not to 2250 right, that right there is when the insulin started working. Because without the insulin at all, his blood sugar would have went for forever up because he has diabetes. So right when you start seeing it to slow down, and then it starts to level off that time. That's how long it took for the insulin to have him like sway over the food. Right. So now imagine if you put the insulin in 15 minutes before then you'd be telling the insulin go ahead and pull sooner. And you'll keep messing with that a little sooner, right a little later. Sometimes it's a little more, it's a little less, and you figure out timing and amount. gotta use the right amount of insulin at the right time. If you do that, you can eat anything. Anything and your blood sugar won't go up. It has to be the right amount at the right time. Now Some foods are going to take an insane amount of insulin over other foods, you know bolusing well for broccoli is not as hard as bolting well for chex mix, or oatmeal or something like that, but it can be done if you can figure it out. So the first thing you have to do is Pre-Bolus longer. So you actually have to do it what happens, you guys put it in, and then you lose your nerve and give him the food.

Katie 40:23
No, so like in the morning, it's hard because he wakes up and he's like, ready to eat, like, give me all the food. And, you know, with his autism, he gets, he gets really aggressive and upset and it's almost like, Okay, are we gonna, what are we going to deal with? Are we going to deal with them beating us up until the insulin kicks in? Or,

Scott Benner 40:47
you know, up in the morning? Or does he wake himself up?

Katie 40:51
He pretty much wakes himself up. There's some mornings where we were. My husband has to because he has like therapies and stuff. Um, but he, he pretty much is about about Yeah,

Scott Benner 41:06
similar time. Yeah, okay. This is blood sugar start going up before he eats ever.

Katie 41:13
This when he wakes up, it starts to go up. Yeah.

Scott Benner 41:16
Okay. I'm gonna say good, because that means he wakes up. I'd give him insulin. Like, right away. And how was he with the shots? Does he mind them?

Katie 41:28
He doesn't like he doesn't like him. And that's why we want to get them on the pump. Because we literally have to, like, told him like, it's pretty. It's pretty aggressive. You know, like, my husband has to hold him down pretty hard for certain places.

Scott Benner 41:43
I used to have to hold I used to have to run after she giggled and ran away from me. So and then I'd have to grab her and hold her and I'd be like, come on, I had the needle in my teeth. And it was you know, I'm sure it was very hygienic. But my The reason I asked the question was because I was wondering if he just didn't mind the insulin injections could we do to in the morning, like, wake him up, pop in the unit just to get it going and then Bolus for the food? You know, I'm trying to think of ways for you to do that. But you're right. If you get to a pump, then either, you know I what I would do is I would say to myself, how much insulin does a meal this breakfast usually take? Can you tell me about how much?

Katie 42:23
Um, yeah, I've got I've actually got his chart right in front of me. And so he averages usually like, three, like anywhere between two and three in the morning for breakfast.

Scott Benner 42:34
Okay, and you think that when he wakes up how soon is it before he eats?

Katie 42:39
Pretty quick after he wakes up? After he wakes up?

Scott Benner 42:41
When's he eating? timewise

Katie 42:45
Um, so my husband says like, within 20 minutes to half hour,

Scott Benner 42:49
20 minutes to a half hour, but it would be sooner if it could be. Like, like, if you just if you gave him the if you if you like whip the peanut butter and jelly Adam in the bed, he'd start eating it. Oh, yeah. Okay, so you you, I just want to make sure so you have control of when he can start eating. So I have to say if that's the exact scenario you're describing, he wakes up, I inject the insulin as soon as he wakes up

Katie 43:17
with you, at the end he would do for the blood sugar. That is when he wakes up and what you're going to feed them on a Purdue bowl.

Scott Benner 43:25
Yeah. But we're also going to try to get him to wake up at a better blood sugar. But yes, I would. That means to be perfectly honest, at any point overnight last night, I would have tried to move his blood sugar with an objection while he was sleeping.

Katie 43:38
Okay, yeah, we have done that once. He was pretty high one night, and we went in and gave him some but it ended. I don't even think that it did a ton. Well, it's

Scott Benner 43:48
probably because he doesn't have enough basil too. But so that's so understand if the basil is only in there enough to hold him at 200 overnight, and you put in a little bit of insulin, he'll dip down but then his body function will push them back up again. So even though he doesn't have food, his body's still making glucose in different ways. And so I'm waiting, trust me in a couple more years when he starts growing, it's gonna get worse. So it's good. You're figuring it out now. So yeah, I mean, how much like how much insulin would have moved in from 200 to 100. Last night, do you think? Like, forget the chart for a minute, what do you think it would have taken?

Katie 44:29
Well, we did last night before he went to bed. We had to give them a unit.

Scott Benner 44:35
Then that's what it was like 300, like around 930 or so.

Katie 44:39
He was that's probably what Yeah, so we wrote it down it at 910. He was 242. And we gave them a unit

Scott Benner 44:46
and then he popped to 300 and then came back down. Can I ask you Did he jump up from the anxiety of the injection do you think? Do you know because if he doesn't like the shots, anxiety and adrenaline can push your blood sugar up.

Katie 45:01
So he actually was asleep woman gave him his head up anyway, last night. Yeah. So he doesn't mind them money sleeping.

Scott Benner 45:10
I see. Okay, I see what you did here. He's low around six, seven ish. He does this fire up and around 250 you're like, Oh, hell, and you gave him insulin, and it's still powered through that insulin up to almost 300 before it started to come back down. So I know you don't see that. But if you're looking at the graph, that's what I say. Yeah, pretty much. Yeah. So I'm gonna tell you that see the two dots that are the, the harsh shop and then there's two dots that are closer one that's farther away, and then they get tight again, around like maybe eight or nine right in there. Yeah, he's sharply going up there, that's when I would have given him the insulin for that, like you waited like, you really, you You let you let the momentum get on the side of, of the blood sugar. So even though you put a unit in, he only he went 250 to 300, then back down to 180. And then see how he starts rising again once the units out of him. That's because he doesn't have enough basil. That's exactly what that is. And even though the basil was in him all night, and it did try to get him down and only ever got him as low as like 170, maybe 175. So yeah, I think I think another unit of basil is a great start. I honestly think if you do another unit of basil, and try to do a longer Pre-Bolus let's just call it 15 minutes for now. Okay? I think tomorrow's graph looks substantially better. I wouldn't even want to mess with your ratios. Until we could get the basil right? And then get your beginning get your Pre-Bolus is right because I can't I can't tell if your ratios are they might be way too heavy and you don't realize it and and you're just making up for the Basal all the time. Do you does anything that I've said so far not made sense or been confusing?

Katie 47:03
No, I, I mean, it's, it's all making sense. It's all me It all makes sense. When you kind of explain it a little bit better than the doctors that I'm getting to. I didn't even know that the basil guard stays in his system that long. I thought it was just to keep him study at night. No, it's

Scott Benner 47:23
it's all day. It's supposed to be doing that same thing all day. You know, in a perfect world. I know you can't imagine this. But if he didn't eat in a perfect world, that basil Gar should hold him at like 8524 24 hours. It's hard to get right. Don't get me wrong, but that is the that is the overarching goal of that medication. That's what it's for. Okay, I'm gonna ask you to listen to the defining diabetes episodes. Okay, they're short. And so you'll get through them quickly. They're in your they're in your podcast app, but you can find them at diabetes pro tip calm to if you need them in a list. Because there are some pretty basic terms that you don't know yet. And you're so these these shorter episodes like you'll scroll all the way to the bottom there's a list of them there's I think it starts around 236 number 236. It's Bolus basil honeymoon, a one see some of these are, you know, just a few minutes long to 20 minutes long there, me and us and my friend Jenny. She's a CDE and she's had diabetes for almost 33 years now. As a matter of fact, for everybody listening we're gonna do like a big like online card for Jenny for her 33rd diversity. But we'll talk about that later. Standard Deviation extended Bolus algorithms non compliant like there's just a ton of there's a ton of just terms that if you understand not just what they mean but how they work there, they become tools in a toolbox so do that get through those and then once you get through those or at the same time, I mean, you should start the diabetes pro tip episodes. So it's going to be like this phone call except much more focused topic to topic and they started Episode 210 and you'll find them on that page as well. I think you're I think this is usually something I end up saying to a lot of people you are seeing it right like you're seeing the problems and you just don't have enough tools to do something about it. And it doesn't sound like your doctor is doing much more than saying things like let's change his carb ratio to one to 18 at breakfast and see what that does is that about it

Katie 49:42
is exactly what it is. That ain't gonna work.

Scott Benner 49:47
Because one to 18 might be too much. Like if we get his basil right, you might find his breakfast is one to 14 you might find as lunch as 110 maybe not, I don't know, but we're never going to know for sure while his basil is This far off. So and you need to understand what the Basal insulin does, you need to understand what all this stuff does or you can't, like imagine you're going 1000 miles an hour in a car and you're in control of it, you don't know which one's the brake. Like that's where you're at right now. So let's teach you what the brake is. And then you'll do better job when you need it. But I'm saying, just based on this graph, and what we've talked about so far, we're going to try another unit a basil at night tonight. And starting at his very next meal, you're going to Bolus him sooner Can I ask is what's the last time he's eaten today? It's 1047 right now, or is it 1047? Or your? Yeah, okay, what time has eaten last today?

Katie 50:47
Um, he had breakfast around eight. But he's, we gave him eggs first, and then gave him regular food, carb food. So probably, like 830, he was done maybe 30.

Scott Benner 51:06
By 30 1032 hours to the medical What's his blood sugar right now?

Katie 51:11
Um, might be too far away from him. It says 242.

Scott Benner 51:19
All right. I don't like this any more than you do. But go tackle him and give me an answer. Because I want you I want you to make a Bolus here with an intention of getting his blood sugar to 120. If that's a unit, if he really is one for 115, then that's perfect. Give him a unit. And let's see what happens because you either didn't Pre-Bolus his meal, which I don't think you did. Or you didn't use enough insulin for his meal, or a combination of those two things. And so he's now 240, he does not have enough basil. So he's gonna, he's gonna drift up till the food's out of him till it's been digested. And then his basil is just gonna hold them steady, wherever he's at. He's just gonna sit there. So drive him down and see if it'll sit there. Now, if you drive him down to 110, like say you give him this unit. And 90 minutes from now he's 110. And two hours from now, he's still right in that area, and he's sitting stable, well, then, hey, guess what? Your six units of basil is good. We don't have to give him seven tonight. But you need to do a better job at meals. And that might mean that these ratios are off, and you're not Pre-Bolus thing. So let's take a shot at it today. And I'm going to keep in touch with you. Okay, so take a shot out to take a shot at it right now try to drive them down to 110. And then I want to see what happens. Does he go down at all? Does he go down and stay stable? Does he go down and bounce back up. And now if he goes down, and it looks like it's going to be too far, like say he gets to like, you know he's at and he's one arrow down like an hour from now, well, then that was too much. But don't give him an entire juice box. Like give him a couple of steps try to stop the arrow. Because if you just throw in 15 carbs, then it's very likely that his blood sugar is going to stop going down like it did yesterday at six o'clock and then shoot back up again. Because you've got all these carbs in them that are uncovered because you didn't Bolus for them and your basis might be wrong. Does that make sense?

Katie 53:23
Yeah, cool. All right.

Scott Benner 53:28
Is it reasonable to ask you to jump back on and do this again? for like a post mortem for like, 15 minutes tomorrow? Yeah, that's fine. Even though it's Easter.

Katie 53:38
Oh, right. Yeah. Like I don't Yeah, I guess it depends on what time

Scott Benner 53:42
right. Well, whatever time is good for you. I just I don't want to just leave you and in the lurch. I want to I want to figure out what what happens.

Katie 53:51
I'll tell you what, Can I Can I ask a question ask a lot of questions. God. So if we do the unit now, so we've pretty much stuck to and I know it I know it's not right? But we're kind of like we have no idea how to do like a unit without giving them food and stuff. You know what I mean? Like he he's gonna be eating lunch probably in the next hour and a half. I would definitely if we gave him a unit now. I guess our thing is that we don't we've never really done that we've never like corrected for his blood sugar alone.

Scott Benner 54:31
Yeah, so here's how I would think of it for you. If you think he's gonna eat in the next hour, an hour and a half, then most assuredly give him the unit now. And maybe give him a unit and a half and then consider this a correction and a Pre-Bolus. You could do that or you could just give them a unit now and let's see how far we get down. Like say you give me a unit now. And an hour from now he's acting a little hungry, but his blood sugar's 150. Then in that case, What I would do is then Bolus his meal, right, and then wait for a little bit of a downturn like say the one they put the insulin in. And when you start seeing that insulin working is 150 turns into like 130 have a diagonal Down Arrow, that kind of thing, because it's your first time, then go ahead and feed him. And now you've got insulin on your side. Now Now you're holding that rope and you told the insulin Hey, go ahead and pull. So now, the interesting thing about when the insulin poles is it, it doesn't pull it full speed immediately. So it's not like a light switch. It's a slow burn, it's like it's like getting a tractor trailer up to speed, you know how you have this going to shift to like 20 years just to get into like 40 miles an hour, right. So that's how insulin works. It's like, it starts the pole, but the rope doesn't move. And then five minutes later, you're standing back on, I think the rope is moving, I'm not sure. And then 10 minutes later, maybe it did just move a half an inch, 15 minutes later, oh, it is moving 20 now it's moving a little more. Now you've got this, this starting blood sugar, let's say you started 100. Now you're 2025 minutes later in whatever that space is, you're at diagonal down. Now you put that food in, right, he starts eating at 85 diagonal down. And as the food starts to hit him, boom, the insulin kicks in. So now the insolence pulling as hard at it as it Canada 85. Now the food's pulling as hard as it Kennedy five, neither of them can win, and your blood sugar stays at 85. That's how people make a straight line on a graph. It's that easy. You know, it's not incredibly difficult, but it's that easy. It's that it's that simple, but it's difficult. But you have to have your settings right before any of that can work because if you're running in with that plan, with a deficit of basil, and carb ratio that you don't know is working while you're trying to fight with frozen chicken nuggets of fruit strip Go Go whatever the hell that is. And and across the board, you're in trouble. They think that's not those foods are of the most difficult ones. Like the only way you can make that worse is if you gave him oatmeal and put fruity pebbles on top of it, then I think maybe you could make it worse. And he would definitely Thank you Are you kidding me? As I'm saying it I'm like, Oh my God, why is no one ever put Fruity Pebbles? It can

Katie 57:13
sound seems okay, yeah, cuz we vote. You know, when they were in the hospital, they kind of scared us into our train of thought being okay, this kid's only gonna eat three meals a day. Yeah. snacks are gonna be pork rinds and eggs. Like, that's it. Like we

Scott Benner 57:34
were the country issue you live in.

Katie 57:38
upstate New York.

Scott Benner 57:39
Interesting. Okay. Yeah, well, listen, this ain't working. So you should try something different. And his blood sugar is higher. So I think the thing you need to try is more insulin in targeted areas. And I think you need to kind of, you know, like I said, like, do a little studying, we get some of those other episodes and kind of fill your toolbox up, tell your husband I said, Shut up and listen, like, Who cares what he thinks, just do it. By the way, when you're listening, and this is a personal favorite of me. Please don't listen on the same phone. So that I get credit for two downloads. I'd like you to listen. Thank you very much.

Katie 58:16
Hi, listen at work when I'm at work all day. Yeah. So

Scott Benner 58:18
he if he I don't know if he would hate me or like me, but the information is good. And you know, neither here nor there. What do you think something. So I do think that you guys, ironically, are only a couple of days away from a graph that you're like, holy crap, look at this, but you just don't know it. Like, aside from having to tackle him and not knowing anything about autism, if you sent your son here, I could get his blood sugar down and stable in the next four hours. Like I could do that, but I know how to do it. And it'll take a little longer because he's MDI and we have to wait till tonight to get in some basil. And it sucks because he doesn't want a bunch of injections, but I would use humor log to get his blood sugar down today. And then I would get the basil right and have it held there. That makes sense. I also I also definitely wouldn't try to get a pump.

Katie 59:12
I just think Yeah, we're we're trying we're I don't know if you I mean, you obviously know, but they're coming out with a new Omnipod and or an updated version and we're trying to figure out if we get it now. It will qualify for an update updated version 10 that comes out

Scott Benner 59:32
to the algorithm. You want to get the VM on the pod five.

Katie 59:35
Yeah, yeah. Like that.

Scott Benner 59:37
I bet you would give other kids Yes. Oh my gosh. Wow. How many Tommy?

Katie 59:45
Well, we have one that is 11. And we have one on the way so you're preggers?

Scott Benner 59:50
brave and or stupid people. Good for you. Congratulations. Which which Are you brave or stupid? But Tommy.

Katie 1:00:01
Well, we found out we were pregnant. Before gauge, we found out about his diabetes. So

Scott Benner 1:00:07
no, I say, gotcha. I also like found out you were pregnant. Did you have any inkling you might be? Yes. Back then, like you're telling you don't know how it happens if you found out you were pregnant when you got the invitation to the wedding, that's all. Alright, so any other questions?

Katie 1:00:31
I don't think so. I think we'll try that. And, you know, we really, I really don't like, I mean, even in the hospital, they I was so surprised that they let us leave the hospital and his sugar was like, 300. Yeah. And so when we left the hospital, like, okay, they let us leave, and it was 300. So we could probably get away with him being free. You know, we have that mindset. And so when I'm listening to your podcasts, and people are talking about, you know, a high, you know, a high for you is over 120 it's like, holy crap. It is like high all the time.

Scott Benner 1:01:12
I asked. I have a question I prior to the diabetes. I mean, he's always been on test deck, right? I mean, you've known he's had his autism for ever ish, I would imagine six months. Yeah. Yeah. But you have a feeling for who he was before the diabetes. Is he different now? More aggravated, easier to set off moodier?

Katie 1:01:35
Um, I mean, his his lifestyle changed a little. So I think that he's, you know, he's home all the time now, which he wasn't before. So that is different for him. But no, I you're not sure. But I don't I don't think I don't really think so.

Scott Benner 1:01:54
Because a lot of people don't recognize when their blood sugars are high constantly. That it's it's impactful on your brain. And it makes people short tempered and cloudy and confused sometimes. And so you may see a change in him after a couple of weeks of his blood sugar being lower and more stable. Does he know when he's dizzy?

Katie 1:02:17
No, I mean when he's been low before, like very low and he just, you know, acting totally fine.

Scott Benner 1:02:23
Okay, I just didn't want to like bring him down too quickly and have him because he could get because people can get dizzy at higher numbers than dizziness really exists, but it's still real. So you know, when your body becomes accustomed to higher blood sugars, and then even like, I helped a girl one time and she was like, like fallen over dizzy it like 150 but her blood sugar's were constantly 250 so it took her took her a number of days to get accustomed to it. And then she was fine eventually. Yeah, yeah. So that I just wasn't sure about that. So your your overall goals are if we're just talking about blood sugars, our stability spikes that don't go over 160 you I want you to get into a world where 160 is like a mess and 180 is a complete okay. And when you're away from food, or Bolus insulin stability that exists more between 85 and 110 Okay, so that's the ability that we saw last night that was basically between 180 and 220 we want that stability to exist more 85 to 110 overnight and you do that and you start Pre-Bolus the meals and you dial in these settings a little bit and his a one sees next day one to be 6.5 probably and I'm guessing now it's more like Hold on one second. For some reason a guest did not pop right into my head. So let me do a little checking his his a one C in the nines right now.

Katie 1:04:05
So the last time we had it done was actually when he was diagnosed and it was 9.6 I think

Scott Benner 1:04:12
average blood sugar of 230 is 9.6 so it would be interesting for you to know that I just pulled up a little glucose calculator that by the way is available at Juicebox podcast.com. And I typed in 230 because I think that's about your average blood sugar and it popped up a one see 9.6 so I when do you when's he gonna get it done next? I guess he hasn't had it done in a while because the COVID

Katie 1:04:35
Yeah, and it's mean he is like the most difficult person to get blood drawn.

Scott Benner 1:04:43
Gotcha. So you're gonna miss like for people to hold him down. Well, here's the good news. Right? If you if you aren't in by the way, want for years, no trouble ever, never any trouble and one year I forget how old she was. She just decided she didn't like needles anymore. In the windows office like she was backpedaling into a corner up the table into like, if she was Spider Man, she'd have been on the ceiling. And the nurse looked at me like what is happening? I was like, Oh no, and it lasted for a couple years. Like she she was able to do it finally, but in a panic the whole time and then one day it just went away. Now she gets blood draws, she's like, Here you go, she just throws her arms and she watches while the needle goes in. I don't know what happened, but she freaked out for a little while. Not to say that it's gonna get any better for gage. I'm not sure but what I am gonna say is that if you have a CGM, you can be reasonably assured of his blood of his a one sees using like their clarity app. Right? And so maybe that's the thing you can save him from is having to get those blood draws that are just for a onesies.

Katie 1:05:49
Yeah, I think they want to test him for other stuff like celiac, and I can't remember what

Scott Benner 1:05:54
Yeah, they're gonna they're gonna want to test them for celiac, it's very common with type ones. They'll probably want to test this thyroid function as well. Yeah. And the thyroid things uphill, if he has that. That shouldn't be difficult for him. But my God, if that poor kid has celiac,

Katie 1:06:11
I know how the healthy. I have no clue what the cavity? No. I don't think he does. I mean, I think we would know I

Scott Benner 1:06:24
think he would just be walking around holding his stomach constantly going. I think there's something wrong. Yeah. So Alright, so let's do this. Is he still 240? ish?

Katie 1:06:35
Yeah.

Scott Benner 1:06:38
All right. If you want, you can send me his next comment. I'll watch it overnight for you. So we can talk about it. You want to do that?

Katie 1:06:46
Yeah, that was the Dexcom share thing.

Scott Benner 1:06:49
Yeah, I'll follow him for like the next day or so. And we'll get back together tomorrow and talk for maybe a 20 minutes? Sure. Okay. I'm gonna say. So I'm going to push stop on the recording, and I'm gonna give you an email address to send me as Dexcom. Most podcasts would split this into two episodes to try to double their downloads. But I'm not a scumbag like that. So just listen to one more ad, and then we'll get back to it. It's not really an ad Actually, it's um, I don't know how I've explained that before T one D exchange is not an advertiser, I get compensated when you complete the survey. So it's not technically an advertiser, it's me using up my space on my podcast to let you know about it. It's splitting hairs, but neither here nor there. That's how it works. And I think it's important that you know, now that we're past that, that D one D exchange is looking for type one adults and type one caregivers who are us residents to participate in a quick survey that can be completed in just a few minutes from your phone, or your computer. After you finish the questions. And they are simple, I actually did it about seven or eight minutes, you will be contacted annually to update your information. And to be asked further questions. This is not an intrusive process, it's just an email. This is 100% anonymous, completely HIPAA compliant and does not require you to ever see a doctor or go to a remote site. So this is your opportunity to impact Type One Diabetes Research right from your home. Now every time someone completes the process using my link, T one d exchange.org. forward slash Juicebox. Podcast benefits. So if you've been looking for a way to help people with type one, research, or the podcast, nothing could be easier or more beneficial. So one more time, go to T one D exchange by using my link. It's right there in the show notes of your podcast player, or you can type it into a browser T one d exchange.org. forward slash juicebox. When you get there, click on join our registering now, and after that just simply complete the survey. It's super easy to do. And it'll help a lot past participants like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and have made changes to the ADA guideline for pediatric a one c goals, which is a really big deal. People filled out that survey and they took that data and impacted how the ADA talks about a one c guidelines. That's important because that's how endocrinologist hear about goals. So the reason that your endo right now isn't trying to keep you at an eight a one C is in part due to the T one D exchange, and the data that they collect from people who take the surveys. It's a big, big deal. It seems like it might not be, but it's huge. I'm excited to imagine what your participation might lead to. And I'm personally trying to add 2000 people to the registry by the end of diabetes Awareness Month. I hope you can help me one d exchange.org. forward slash juicebox. Thanks for listening to that. Let me catch up here. Katie and I spoke I started following her child on Dexcom. We texted back and forth For a number of days, then we got back together and recorded this follow up. You ready? Here we go. Okay, you are being recorded. So I appreciate you coming back and spending a couple more minutes with me. I expect you're going to talk a lot more this time and ask a lot more this time. So I'm just going to ask you, it's been five days since we spoke, how are things going?

Katie 1:10:27
Um, oh, they're kind of went the opposite direction. Okay. So instead of being I mean, he still has highs, but instead of being really high all the time, he's kind of now we're dealing with a lot of lows. And we're thinking that maybe that has to do with maybe the insula homologue, the the insulin that he gets when he eats, maybe that needs to be cut back.

Scott Benner 1:10:56
Okay. All right, let's figure it out for you, because your graph over the last number of days is exponentially better. Overall. You know what I mean? Well, I agree. Yeah, everything that's happening is happening, lower now, not hire, which is, which is amazing. When you do find, well, this last day, this last 24 hours. If I'm looking at it, and I am then I go back to last night. And I'm looking overnight, so you're correcting high blood sugars. Luckily, your blood the high blood sugars are cracking are now under 200. Which is really exciting. Yeah, and you even when you're high and stable all the way overnight, you're higher and stable between like 140 and 160. ish. And there's just big Bolus at 9am. Drops really fast. And then Okay, so all we did so far was move the base lop one unit, right? from six to seven. Yeah. Okay. And I actually thought for the first couple of days, that looked incredibly stable to me, like, like, I didn't see a lot of lows that were from, I didn't see any lows that were from basil. As a matter of fact, now even looking at the last 24 hours, I don't see any lows that are from basil, I see them from corrected high blood sugars. And you're getting like, like today, as an example, around 130 there's a little bit of like a 6065 blood sugar, and then it pops over the next 20 minutes up to like 75 or 80 levels. And then two hours later, he's 250 so what do you know what happened there so we can talk it through?

Katie 1:12:56
Um, so Zach was actually home with him today. And he went low. And I believe he corrected for he's he saw the low that you're seeing was like, okay, we need to do something because it's going to go lower, you know? Yeah. He gave him like a 15, gram, carb, gram, whatever. Fruit strip. And then it seemed like he was gonna be alright, and then it gradually just started going up.

Scott Benner 1:13:29
Yeah, 1515 carbs of something that sugary without insulin is never going to be okay. I would imagine I mean, unless unless his blood sugar was 65 and two hours down which the graph doesn't make it feel like it that was the case to me. But you have a tea? So are you looking at it? You see it? Yeah, I have a Okay, so just in general we're we're still looking at like timing issues, like you're either bolusing the meal and it's getting away from you and then you're correcting the meal. And it's either dropping super fast, straight down or fat not fast at all, but still falling over hours and hours and hours and ending up lower. So when that happens to me, that's a good indication that your meals are mis timed. Or you're not using an offense and like you're saying or too much insulin You know, one or the other at your meal time so what do you think is happening at the meals?

Katie 1:14:30
I really think that it's the excuse me that it's the actual amount of insulin we're giving him I feel like maybe now it's too much

Scott Benner 1:14:40
because you're on Pre-Bolus thing now. Yeah, cuz he's

Katie 1:14:43
definitely Pre-Bolus thing and i and i know that he's, you know, he's pretty much talking to me all day, like okay, I waited 1015 minutes and and then he eats and then it's like, holy crap. He's like dropping super fast and then you know, we just give them something else. But it seems like since we changed the basil, that he's been having a lot more of these lows after he eats, and the only thing I can think of is that his humalog is just there's too much being given for that now.

Scott Benner 1:15:17
Yeah, because we really did two things on day one on day one, we gave him another unit of basil. And you started to Pre-Bolus the meals. So I think of that as two distinctly different steps. And like I said, the basil, I think is, I know you had to correct a 65 today. But the truth is, is that he was on the lower side from 930 till one, but he was still between like 65 and 75. In that time, so there's still stability there. But what you really need to look at from that is that it came out of a, this nine a 177, blood sugar that somebody hit very hard, because it dropped like a stone in like 35 minutes, down to 60. So everything that's happening after that big drop is, I think, precipitated by the big Bolus that brought you from the 170 ish down to the 60. So that Bolus was see how fast it worked. Like to me, that means you put in a lot of insulin that didn't have a lot of resistance, and then it gets down. And I'm assuming he ate in there as well. Yeah, I think a lot of that, I would be hard pressed to say that the basil is the issue is what I'm saying. I think you're definitely right. And let's talk about why for a second. Because before when you weren't using enough basil, and you weren't Pre-Bolus Singh, you needed more insulin to stop the spike. Because the blood sugar just didn't have any resistance coming from anywhere. It didn't have any resistance coming from a timing aspect because you were Pre-Bolus thing. And it didn't have enough resistance from a basil aspect. So you fix the basil or make the basil a little more aggressive. And then you start putting the insulin in sooner that gets it working sooner. So that just makes sense to me that then you're right. You're probably using you're probably using too much meal insulin back then. And you need to probably take some of it out now. I think that's probably your next step. So what's his insulin to carb ratio?

Katie 1:17:28
I'm trying to remember I had it in front of me. So he gets he gets I'm trying to think because they're all different. 16 I think for breakfast, although we noticed with the with it going down, Zack had changed everything back to to an older number that we had before. Yeah, so he was getting he changed it to like 20 but then that still he's still dropped pretty low. Yeah, it's so I think we're just gonna, like tweak it a little bit. If that if that helps.

Scott Benner 1:18:13
Yeah, no 100% I would say that, that you're gonna have to, like play experiment in here a little bit and keep changing the ratio for the food until you're getting a Pre-Bolus that doesn't result in a spike. Or if there's a spike it comes back down and gets level it doesn't come back down and and fall or you know, you don't have to put in insulin to make it come back down. You just wanted to sort of happen. We don't care if it goes up a little bit as long as it's gentle and not spiky. Right? Yeah. And does it make this the reasoning? Why makes sense to you after I said what I said. Yeah, okay. Yeah, definitely. Cool.

Katie 1:18:51
Do you guys I was already kind of thinking that good.

Scott Benner 1:18:54
Yeah, no, no, you're you. You I felt like you got a lot out of our other conversation. Because cuz you guys really like that the two days afterwards, were just exceptionally good. And you were just still figuring stuff out. It's and listen to say that you're not going to figure out Pre-Bolus in four days is an understatement. Like you're gonna have to, you know, you're gonna need some more time to figure it out. But you're not creating. You're not creating scary panicky lows. And so, you know, and his blood sugar right now is 109 which is just amazing. You know? Do you have any questions?

Katie 1:19:35
No, I mean, the only thing is that we we just got approved like, fully approved for the Omnipod dash cool. And so we're setting up setting up going to his hospital and having them train freenas on it and having them you know, put put it on them for us and all all that fun stuff

Scott Benner 1:20:01
yeah

Katie 1:20:03
and at that time we'll be able to control his basil like hourly right so we can you know if we notice a low at a certain time a day we can just change it

Scott Benner 1:20:18
you should win it'll

Katie 1:20:20
be easier

Scott Benner 1:20:21
oh my god it's so much fun the first time somebody explained to me what an insulin pump was it felt like they gave me like an on off switch for basil which was always my biggest like concern was once you injected it, it was in there and you couldn't do anything about it you know your Basal rate per hour should start in my estimation are around point three an hour watch that the hospital doesn't try to like make it point one or something like that and then tell you like oh we just want to make sure like it's not too much because if they make it point one his blood sugar is going to be 250 constantly and so you know point three it might end up being point two five you know what I mean? At some point maybe overnight it'll be point two like I don't know but it isn't going to be like point one or point one five in my in my estimation so just kind of pay attention to that when you make the switch when you're doing it you know

Katie 1:21:16
um, so we asked to do it in person because they asked if we want to do it virtually or in person but we're not comfortable doing it on our own so the first time at least and so we just have to wait for them to tell us when we can come in person so hopefully because we should be getting getting all the materials tomorrow and in the mail so we should probably next week or the week after at least

Scott Benner 1:21:44
excellent very cool that's that's amazing I think and he's gonna be okay with it right cuz he leaves the Dexcom alone so he should be for the

Katie 1:21:52
pump right every once in a while he touches it but

Scott Benner 1:21:55
it's not really an often thrown across the room or something like that.

Katie 1:21:57
Yeah, actually the day that I was talking to you we got our so I went on to touch by type one and he got the box that they give to people who are newly diagnosed and it came was the demo

Scott Benner 1:22:14
Oh the power demo was in there cool.

Katie 1:22:16
Yeah, so it was cool so I just stuck it on him and to see you know how he does with it on like his back area because we're trying to figure out where to stick all the stuff Yeah. And he he was fine with it so we're thinking yeah, he's gonna do okay I'm excited

Scott Benner 1:22:32
because you to you and your husband? I thought I thought made like a quick adjustment like it all seemed to make sense and you're you're you're doing a great job like I it's I know that his graphs not super like like smooth and straight and everything and you're probably thinking like oh, you know, but it's so much better. Like it really is like it's just do you feel better about it in general?

Katie 1:22:56
Yeah, I mean, I feel way better about it because I was just so glad that Zack actually was on board with it and you know, he felt comfortable with it because he's the one that's with him you know all day long so I was really happy to that you know, you kind of convinced him about all this stuff.

Scott Benner 1:23:18
I ended up texting with him by mistake I think because your phone died like the the day or something after we talked and so I ended up texting with him he asked me a couple questions and I just answered them and you know it's funny because guys text so much differently than women though. It's, it's like yes, no, thank you good. But now I felt like he understood everything I'm seeing. You know, as I look at this CGM tells me that you're doing a good job. And it's and it's making sense to you and you're going to, you're going to figure it out. You know, like it's coming around. I have to tell you right now, of the four people I'm following right now Your son has absolutely the best blood sugar of the four of them, including my kids. So he's doing really good. I got a 109 a 134 or 146 and a 67 on there so Wow, you're you're winning in mind. 67 is pretty stable, though. Alright, let's let's we will have to, we'll have to, we'll have to have a little race at the end. I'm going to I'm going to unfollow him if that's okay with you unless you want me to follow them a little longer. And if you do tell me if like if you're gonna try something and you want me to look back at it, that's fine. I don't have a problem one way or the other. Just tell me if you need me again or if you want me to be gone.

Katie 1:24:41
Okay, I mean, at this point, you know, I think it's fine if you unfollow him. If I feel like I need your opinion on something I can just, you know, we can just read them that okay. Yeah, cuz I think when I know what our next steps are, but, I mean, we're gonna be getting on the pump. Anyways, so not like we're gonna be able to do too much in that timeframe. Yeah,

Scott Benner 1:25:05
I think just keep working on your Pre-Bolus is keep adjusting the amount of insulin you're using it meals, and you know just try to react mean you're doing a really great job like listen when when you and I got on the other day and we started talking I had no idea your son had autism. And that must add like a level to this that I just can't possibly fathom you guys are doing a really, really good job and you're so new at it like this is April, I've only been at this like five months or so right? And so you guys are killing it like you really are. Yeah, definitely don't feel bad about anything, if you even have the inclination to feel badly work on the Pre-Bolus thing. Keep in mind, and then, you know, tell your husband to keep paying attention, like you know, I put a strip of this, this stuff in to correct and it was too much next time, let me try giving him a quarter of a strip of it. You know what I mean? Like that kind of stuff doesn't have to be the whole thing just because he opened it. And, and he'll learn how to kind of bump those blood sugars around a little bit. And you'll be on your way is that listening to the pro tip episodes?

Katie 1:26:15
I think that he maybe has started listening to some because he, you know, was using all these new terms I didn't think he knew. But I don't know for sure. I really don't know. Well, I did though I listened to podcasts all day at work. So I listened to pretty much all of them. And now they were great. really informative.

Scott Benner 1:26:37
I'm glad I'm glad just Hey, look, let him know that I think it would be a great idea if he listened because he's he's super close. He's just got to think about it a certain way, and it'll start working out. Right. I appreciate you jumping back on. Anything else. Any questions? Anything?

Katie 1:26:52
I don't think so.

Scott Benner 1:26:53
I'm calling you. Well, you're very welcome. I'm calling you a win. And I am unfollowing your son done. I am no longer seeing your private life. You absolutely sent me a note if you need anything, okay? Okay. All right, Katie, hold on one second. Gone, because I'm sorry, I'm turning the recording back on because I should have said this to you. There's two possibilities in here. We fixed this basil. And now you have to fix the meal ratios. Or now that your Pre-Bolus thing. Maybe the basil could go back to six. I don't know which is which that's the thing you're going to pay attention to over the next couple of days. So if you start getting better and better at the Pre-Bolus thing, and you start finding stability at like 90, then you say to yourself, okay, great, we're looking good. But if you start getting better at the Pre-Bolus thing, but the stability you have is still too low in the 60s or the 70s. And maybe you have to take the Basal back to where it was. Does that make sense that maybe because you weren't Pre-Bolus Singh before. The basil wasn't the problem. And we kind of fix the problem a little bit like CGM. I'm saying like, as crazy. I was almost cursed. But as crazy as that sounds, it could end up being one of those things.

Katie 1:28:07
Yeah, I mean, I, I can understand that. Um, my thought my only thought is that. So like, at some point today, I'm not looking at as graph right now. But he was studied for a while. And it was read before, I believe is right before lunch. And so I said, Zack, I was like, you know, you're going to Pre-Bolus and then watch him because if he goes, whoa, then you know that it's the human log, and it's not the basil,

Scott Benner 1:28:39
right? I don't, I don't think I want it. For clarity. I don't think the basil is a problem, I just want you to remember that it's an option, that there are two different insulins working here and then by the, you know, by the way, you're gonna get on a pump, and then it's, you know, and then you're gonna have more control over the basil, then you could then you could start doing like point two, five an hour, you know, and see how that goes. And you could get kind of granular with it. Because you know, either six or seven might not be the right thing, maybe it's six and a half a day really needs. You don't. So you'll have that kind of fine tuning when you when you get the pump to write plus, if it you know, like I said, Maybe he needs point three during the day. And he'll need point two, five or point two overnight, like I'm making up numbers. But if that happens, you can you can make that change. And now you're not just counting on this insulin to go in one time a day and magically take care of 24 hours basically. Anyway, I just want to say that to you so that people can hear it too. I don't want to keep you I know it's late in the evening. probably have to go feed your family and avoid things and hide watch TV and stuff. isn't about what you're gonna do. I'm gonna push the button shut this off again. Huge thanks to Dexcom for sponsoring this episode of the Juicebox Podcast. Find out more about the day Dexcom G six@dexcom.com forward slash juicebox. There's links in the show notes and links to Juicebox Podcast comm Also don't forget about that Omnipod promise. And don't forget that it's possible you're eligible for a free 30 day trial the Omni pod dash Omni pod.com forward slash juice box. And lastly, but not leastly. That's not a word, Katie for coming on the show and having this rather private conversation in front of everybody. Thanks so much, Katie. I hope you and your family are doing well. I'll be back soon with another episode of the Juicebox Podcast.

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#561 Double Whammy

Devon and her child were diagnosed with type 1 diabetes around the same time.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

---

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

Scott Benner 0:00
Hello friends, and welcome to Episode 561 of the Juicebox Podcast.

Today's guest is Devin Devin has type one diabetes. She also has a child with type one diabetes, and they were both diagnosed around the similar time. That's not English, but I'm going to leave it in around the same time. You know what I mean? Devon's actually a nurse, that Oh, she'll tell you about it for you. What am I going to explain the whole podcast in the first two minutes? It's ridiculous. Just listen to it, you'll have a great time. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin. I'm hoping to personally with this podcast put 2000 new surveys in the pocket of the T one D exchange and you can help you have to be a US citizen who has type one diabetes, or is the caregiver of someone with type one, and then you go to T one day exchange.org forward slash juice box fill out the survey which takes less than 10 minutes is completely HIPAA compliant and a bazillion percent anonymous. You'll help yourself you'll help other people living with type one, you'll help the show

this episode of The Juicebox Podcast is sponsored by touched by type one head there right now to get your tickets for dancing for diabetes. Are you in the Orlando area and would like to see an amazing dancing extravaganza? The extravaganza doesn't dance there's a lot of dancing that makes an extravaganza but I think you understood touched by type one.org had there right now. The event happens at Let me see where I'll tell you why in a second. You know what, I'm just gonna read it to you. The 21st annual dancing for diabetes showcase features award winning dancers raising funds to support those touched by type one diabetes. It happens on November 13 at 7pm in the Dr. Phillips Center for the Performing Arts. Tickets begin at $15 and are on sale now. Head to touched by type one.org to get them go go go What are you doing? I mean not now listen to the podcast first. Oh geez. I almost forgot to say that. This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juicebox.

Devin Clark 2:39
I am Devin Clark, and have type one diabetes. I am the mother of a diabetic two year old as well. He was diagnosed when he was 10 months old. Okay.

Scott Benner 2:53
So like I said a second ago before we were you know, recording this. You just sent a very concise, interesting email. And that got you right on the podcast. Good job. Some people's emails are long, and voluminous and volume in this volume vault helped me Devin filemon it voluminous Thank you. I know the word and it just fell in my head. And still very interesting. You're just got right to the point. So why don't we just find out a little bit about your first pick through and we'll see where the conversation leads. Okay, I want to start with how old you are when you were diagnosed.

Devin Clark 3:34
I was 26 years old and I'm currently 28

Scott Benner 3:38
a couple years ago, were you pregnant or not.

Devin Clark 3:42
I was pregnant. I found out on a Friday that I was pregnant. And then two days later, I was very symptomatic of diabetes. drinking a lot being a lot decided to check my blood sugar at home. And it was not reading on my home meter. So I knew what I had to do. had to go to the ER and it was just about 600 when I got there,

Scott Benner 4:13
why did you Why did you have a meter at home?

Devin Clark 4:16
So with my first pregnancy, I had gestational diabetes. And it was just leftover from that.

Scott Benner 4:23
So when you see that number, do you think I have gestational diabetes again?

Devin Clark 4:28
I did. And the ER doctor thought the same thing. So he told me since I already had some medication leftover from my first pregnancy. I was just on pills at that point to go ahead and take those whenever I got up in the morning because I went in at night. And he said get in with an OB like first thing in the morning and so I took some of the medication I was checking my blood sugar about every 30 minutes, it was not going down. So by about 10am, I was well over 300. And just really eager to get in with an OB at this point. The first one I called was close to our house. And I told them what was going on and how much of an emergency it was going to become. If I did not get in within that day. Yeah.

Scott Benner 5:29
Well, tell people I guess why you know more about medical stuff than other people.

Devin Clark 5:35
So I have a background in ICU nursing. Being an ICU nurse for several years, taking care of patients that are in DK a, some newly diagnosed and some not. That's where my certification lies is in critical care nursing.

Scott Benner 5:56
Yeah. So I didn't know we were going to do this. But would you mind Can we go back to your first pregnancy? How old were you then?

Devin Clark 6:02
Sure. I was. See 25 had to think about

Scott Benner 6:13
it. I gotcha. You're not Irish. Are you? That was a quick turnaround on that second one.

Devin Clark 6:17
No, no. No, they're 14 months apart. Gotcha.

Scott Benner 6:20
The 20 the first pregnancy, you've had up until that time, no medical issues with you. You're just cruising along, Mary decide to get pregnant. And how soon until you figure out you have gestational diabetes, and how do you find out?

Devin Clark 6:38
So just you know, routinely with the glucose tolerance test through the doctor's office? failed the first one the one hour, had to go back and do the three hour one and failed that one really bad?

Scott Benner 6:52
How far into the pregnancy? Did they begin to do that?

Devin Clark 6:56
I believe it was around 28 weeks.

Scott Benner 7:00
Sorry for the pause. I was counting on my fingers. around so embarrassed around seven months ish. Yeah, okay. I really was. I was like, oh, it took too long. It's gonna be obvious, I'm gonna have to say something. So until then, I know you would never you had never been pregnant prior to that. Right? Right. So you didn't know what feeling pregnant felt like, but was there a big difference? After they found the glucose tolerance test as a failure and put you on medication? Did you feel differently after that?

Devin Clark 7:37
Not so much. Um, in the beginning, he had put me on too much of the medication. So it had induced hypoglycemia that I felt I was down into the 50s. And so I cut my dose in half and called them and told them what I did, and said, okay,

Scott Benner 7:58
isn't it great? How often you call a doctor and just say, Hey, I did this, they go, okay.

Devin Clark 8:02
I guess that's just the nurse and me, Oh,

Scott Benner 8:06
I see it with other people, too. Like, a doctor made a recommendation for my son recently. And I said, Well, can we try this instead? And the doctor goes, Yeah, sure. I was like, Well, why did you say the first thing is that if if I mean, if you're so easy to move off that idea, like, it feels like it's not a firmly held idea, and I think it takes a while to understand that. Sometimes doctors are just, it's their best guess to, you know, like, here it is. So, seven months, gestational not knowing it. Did that have any, like, what are the impacts on the baby that we're supposed to be concerned with about stuff like that.

Devin Clark 8:42
So with gestational diabetes, most of the time with the, we'll see the need for insulin during pregnancy, it starts to go up around the 28 mar 28 week mark, to a much, much higher level. And so that's why they do it at that point, and not sooner. Because if you will end up with it. It that's where it really shows gotcha. And, and not before, so they don't want to miss it too soon.

Scott Benner 9:21
What is the management for it after it's found? It's just a medication, or is there more to it?

Devin Clark 9:27
So it's different with every pregnancy that I've found. For me, I had to take an oral medication glimepiride some women have to take insulin, but I never had to with my first pregnancy.

Scott Benner 9:44
Gotcha. All right. You know, it's incredibly interesting the way things kind of ebb and flow around here because it has been less than five days and somebody said to me, You never had anybody on who's had gestational diabetes, and I was like, really? And then, you know, you said it was Go well I took care of that. But I would like to have someone on who had to use injections throughout their pregnancy and so if you're hearing this and that's you and you want to be on reach out, but Okay, so you got through that pregnancy fine with the oral You know, it sounds like you cut the dose and then it worked. Okay. It did. Yeah,

Devin Clark 10:17
I had no issues after that point. What happens

Scott Benner 10:18
after you give birth? Do you still need that medication? Or does that need go away? If you're just gestational?

Devin Clark 10:24
So the doctors supposed to tell you to check your blood sugar daily for a certain amount of time? Which I did, and then if I felt weird off, you know, anything like that, I would check it again. And I went back to pre diabetic state. Some women end up developing type two diabetes, with having a history of gestational diabetes you have you're predisposed for developing type two.

Scott Benner 11:01
I wonder I'm gonna you know what I just made a note for myself. I have a list that just says Jenny and I just wrote gestational diabetes on it. So get her on him and pick her brain about that. Okay, so that all goes well. You have a baby baby's healthy. little while later you're like cool, make another baby. And in between those two babies, you You seem okay are looking back. Did you have any indication for type one?

Devin Clark 11:27
No, I was perfectly okay. Like I said, you know, anytime I would feel off I would check my blood sugar first thing and I never got a reading that was over 90. And so the first indication of me having diabetes was feeling symptomatic two days after I had a positive pregnancy test.

Scott Benner 11:54
Hey, so you're proactive then you I guess from your background? You were like okay, well, I've had gestational diabetes. Now I'm more likely to have an issue with insulin, and you've started paying attention to it on your own. Yes. Wow. You're very that's smart and brave, too Don't you think most people would just be like I'm gonna cross my fingers and hope that doesn't happen to me. But you didn't so do you know it? Like do you know what drove you to pay attention and just test once in a while I imagine you like testing a couple hours after pizza and stuff like that. Like you were doing those sorts of things.

Devin Clark 12:32
I can remember one time my husband and I went to go see a movie I had some popcorn and coke maybe and I started feeling kind of dizzy and when I got home I was 81 and that was one of the times where I felt off and just decided to check myself just you know knowing that I am at a higher risk of developing type two at that point.

Scott Benner 12:59
What the does he make you think it didn't make you think you were low right it made you think something else?

Devin Clark 13:05
It made me think that I might have had like possibly a rebound hypoglycemia

Scott Benner 13:12
from like, what do they call it hyper insulin? hyperinsulinemia Yeah, okay. Oh, no kidding. All right, like you're really on top of this. Did you always want to be a nurse?

Devin Clark 13:25
No, at first I wanted to be a doctor and you know whenever I started and pre med at college, I did not like the coursework so I switched to nursing and fell in love with it.

Scott Benner 13:37
Cool. That's really cool. Any autoimmune in your family line? Yours personally than your husband's? No, nothing. celiac? No thyroid, hyper hypo graves.

Devin Clark 13:55
Now no autoimmune thyroid. Just right I did have several family members with just general hypothyroidism but not hashimotos non hashimotos I have hashimotos I ended up Yes, I ended up with it the same time I was

Scott Benner 14:15
diagnosed with type one. Wow, you got a two for one deal?

Devin Clark 14:19
Yes. So I started taking Synthroid and insulin at the same time

Scott Benner 14:23
overwhelming especially being pregnant a bit I would cry Did you cry?

Devin Clark 14:30
I think I did. You know whenever I realized the especially when I realized the medication wasn't working the glimepiride I think I was in tears calling an obese office telling them that I needed insulin and I thought I was developing type one diabetes

Scott Benner 14:46
was gonna say cuz you were diagnosing yourself with that phone call.

Devin Clark 14:50
My endo told me at my first appointment that she thinks I was the only person to self diagnose at home.

Scott Benner 14:58
Wow, no problem. You're up. On top of it since the first kid well so with the with the second baby day two because you're checking good for you by the way you know really interesting had you not done everything you did I wonder how long it would have taken you like if you were just the cross your fingers I'll just gonna hope this doesn't happen to me I wonder how far you would have gotten into that second pregnancy before you recognized it I wonder if it would have made it to seven months or if you would have been in decay sooner and if it wouldn't have hurt the pregnancy to

Devin Clark 15:30
um so I thought about it in depth and talked about it with my endo and we came to the agreement that it probably would have ended my pregnancy being so close to the beginning of pregnancy whenever this happened especially at that point when the baby is forming all the nervous system portion that is it can be very devastating to the development of the fetus such

Scott Benner 16:03
a critical moment Did you write Did you hear Jill at the beginning of the year beginning of 2021 my first episode I did she was diagnosed right as she was pregnant and and didn't wasn't you wasn't like hey I'm checking my blood sugar because I know about all this stuff like she just it just came out of the blue for it's fascinating but okay so you you call the doctor do their job for them and and how does like what's that next step you don't go to the hospital you're right to the end oh

Devin Clark 16:35
so I got in with my ob who was older he had been practicing for a while he had a lot of experience with type ones in pregnancy. Thank goodness so he immediately got me on the gold standard for him which was regular an MPH which I hated.

Scott Benner 16:58
This is two years ago right?

Devin Clark 16:59
Yes. And so I didn't stay on that for very long. Being a nurse you have to it's it's difficult because you have to be on an eating schedule. If you're taking regular an MPH and I told him that I said I can't just you know jog what I'm doing at work and say hey y'all I gotta go eat. So I was

Scott Benner 17:25
having a heart attack but it's time for me to nosh so I have to go somebody impressions over I got a roll up out of here now you're not you're not able to do that. Also Isn't that great? I so thought you were going to tell me this was a guy who'd been through it so many times he really knew what to do blah blah blah and you were like he seen so much and then gave me insulin from 1963 like that was super interesting. So did you say you push the doctor to go to a faster acting insulin?

Devin Clark 17:57
I did. I told him that I would be comfortable with switching at that point. So I believe he had left me on the regular but gave me lantis at that point. But I was able to get in with an indo about a month later. So he wasn't doing my diabetes care for very long. And whenever I got in with an endo, they ordered me a pump immediately.

Scott Benner 18:26
Can we divert for a second here? Can you help people? What am I want to say? Can you help people understand how you advocate for yourself in that situation and how you don't need to be concerned with the doctor's feelings because you really basically are saying to that first doctor Hey, thanks for your help. I don't agree with what you're doing. I'm going to go somewhere else now but how do you say that politely or do you not have to what you're finding

Devin Clark 18:55
it really just depends on you. You know you're paying the doctor to do a job and so if you don't feel like they're doing the job to your specifications or standards and you let them know you can also look up scholarly articles for current evidence based practice about what needs to be used as far as medications or what needs to be done like procedure wise to treat whatever you have going on.

Scott Benner 19:27
It's funny I never until Not that I haven't thought of it. The way you just said it but it just popped into my head it's like you're hiring a contractor to put a floor in your bathroom and you walk in and go whoa. I don't want you to do it like this. And and they say no, this is how we doing you learn we'll get out. Something else though with that. That's really cool. But you did it with a lot of confidence where I think most people don't have the confidence that you're instilled with because of your because of you know your experience. You see so many people just they take it and they put the head down and go on to the doctor said to do. So it's just it's really cool that you did that. So you go over. I'm thinking you had a pump before the pregnancy was over, but I'm gonna ask how did the rest of this go?

Devin Clark 20:12
So I got in with an endo, my plater, who ordered me a pump, and it took about a month for that to come in. So at this point, I'm about let's see, at the end of April, getting my pump and so about two and a half months pregnant. So not too bad. But the pump was like a lifesaver. So, so much,

Scott Benner 20:41
Which one did you end up with?

Devin Clark 20:43
I ended up with the Medtronic 670 G, which I ended up not liking. But you know, whenever I first started, I didn't know that I just ordered it for me right now. And you know, I hadn't researched insulin pumps or anything at that point. So I didn't know to ask for something different. But yeah, I wasn't. I wasn't a fan of it. In the long run, ended up switching after my pregnancy.

Scott Benner 21:15
Did you have a CGM during the pregnancy or just the pump? It was

Devin Clark 21:18
the Guardian CGM that goes with it.

Scott Benner 21:23
That's the 670 g that does all the Yeah, together. Okay. So do you have a Dexcom now or libri?

Devin Clark 21:31
I have a Dexcom g six.

Scott Benner 21:33
And you sound very happy about it. It feels like you just said I bought a Tesla.

Devin Clark 21:38
I was so happy. Like, you know, in online forums, I will advocate for people switching off of the Guardian, because I found that to be highly inaccurate, whereas the Dexcom has been very accurate for me and my son.

Scott Benner 21:55
Devin, here's the part where I usually say this, Hey, sorry, Medtronic, I don't pre screen these people. I don't know what pump she's used before she got here, do a better job. And people won't say stuff like this. Okay. So I mean, no, I think one person, there was this. I wish I can't remember his name. He was so great to talk to, I think we, Jenny and I did an episode about kind of breaking down the 670 G and, and it was from Jenny's perspective, and she just did not enjoy using it. And a listener who has it and really loves it sent me this just like this email is so mad as I was like, it was like we said something bad about his wife. And he was defending her. And I was like, Well don't, you know, say, come on the show and tell me, you know, like, I don't care what pump you use. I was just her opinion, you know? And he loved it. So I was like, great. Come on. Come on, tell people you love it. You know, it's fine with me. But you Okay, so now? I mean, really? it? I didn't want to bury the lead at the beginning because it seems wrong to us. Well, it doesn't seem wrong. Let me be clear, Devin, it is wrong to use your child's diagnosis as a cliffhanger in a story. So that's why you know, I wanted to just say up front, kind of all the facts. So you you, you have type one diabetes. And then oh my god, I forgot. And you were How did you? How'd they catch the hashimotos? They just do a full blood workup on you.

Devin Clark 23:17
Yeah, especially with a family history of it. My mom and both grandmother's have hypothyroidism. So they just wanted to go ahead and make sure and my levels were way

Scott Benner 23:31
off. They image your thyroid. They did they

Devin Clark 23:35
measured my thyroid and also thyroid antibodies, which were very elevated. So that's how I got diagnosed with hashimotos. At that point,

Scott Benner 23:44
do you have any symptoms from hashimotos now or just the Synthroid handle it for you?

Devin Clark 23:51
I'm actually off the Synthroid. I only took it during pregnancy I get lab work done every four months because it is it's imminent that I will have to start taking it again okay um but for now my my levels are fine

Scott Benner 24:04
oh no kidding in range so I don't think of I don't think of hashimotos is in range I think of it is symptomatic or not symptomatic. I'm assuming you feel the same way. Yes, yeah. Okay, so you just don't have anything going on right now. It's tough because it Devin I will say this, it sneaks up on you. So be careful not that it seems like you would definitely know but you know it'll it'll start like with you know, something like you're losing more hair in the shower and you'll you won't think of it as that or you're a little tired or you get kind of snappy with people and you want no you don't I mean, like it just, it sneaks up on you. So be careful. But every four months Geez, you must have like an open vein. Do you just have like a tap?

Devin Clark 24:43
I feel like I need one. I

Scott Benner 24:45
just need like a little a little screwed open up or something like that. Okay, so used to Synthroid through the pregnancy. Stopped afterwards. Yes. Okay. Baby comes out. Yay, baby. And then why How long until your second child is diagnosed with type one?

Devin Clark 25:04
So he was diagnosed during my pregnancy with my daughter. I was diagnosed in March of 2019. And he was diagnosed in July of 2019.

Scott Benner 25:19
Wait hold on a second. I'm either confused or you had a third baby. No we only we have two Okay, so let me start let me make sure I understand So your first child has type one night Your second All right, sorry. Okay, got it. I was like if she got pregnant a third time so that second kid could die. I was like then I don't know how you're have time to be a nurse if that's what nursing sounds art, you know. But okay, so first child, so how old he she I'm sorry he.

Devin Clark 25:49
He is two and a half now. He was 10 months old when he was starting.

Scott Benner 26:04
g vo hypo pan has no visible needle, and it's the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Vogue glucagon.com forward slash juicebox g Vogue shouldn't be used in patients with insulin Noma or FIA, Chroma, pheochromocytoma, visit je Vogue glucagon.com slash risk.

Don't forget to go to touched by type one.org to find out everything that they're doing over there. And if you're in the Orlando area, and interested in some dancing extravaganza, get yourself some tickets and head over to the show. That's right. It's time for dancing for diabetes. Again, everything you need to know is it touched by type one.org. There are links in the show notes of your podcast player. And at Juicebox podcast.com. To the G vo Kibo pen touched by type one and all of the sponsors, please click the links and support the show.

Devin Clark 27:18
He was 10 months old when he was diagnosed.

Scott Benner 27:20
And how long had you had type one when he was diagnosed? formats. Okay. So for clarity, you're pregnant for four months have had type one diabetes and hashimotos for four months, and then your first child is diagnosed with Type One Diabetes. Right? Then you cry for sure. Yes. By then the pregnancy hormones are on top of you, you would have cried if like I offered you like a tissue had been like you're so kind to me. So I'm so sorry. First of all, that does not seem like a fair collection of circumstances. Very certainly. Is your husband around? Like how do you manage childcare to begin with? And then what happens when he's diagnosed?

Devin Clark 28:03
So he is he's here he helps a lot. But my son was staying with my in laws. Whenever he went into DK, my husband and I were away on an anniversary trip.

Scott Benner 28:20
Happy anniversary. Yeah. Wow. That sucks. How long had you been married?

Devin Clark 28:28
a year. Oh, my

Scott Benner 28:30
goodness, I Devin there. First of all, let's just pause here. And I'll tell a stupid story about myself so that we can stop thinking about you for a second because I'm sure some of you out there. There are times I've been married for a very, very long time. And there are times that my wife and I just look at each other. And we're like, I just didn't realize all this would happen. You know, like I mean, I thought stuff would happen. I thought some stuff would go right? Some stuff would go wrong, we make a little money, we lose a little money, we try to buy a house, maybe we get a better car at some point. We'd fight we wouldn't fight. You know what I mean? Like I thought all that would happen. I didn't think that my wife would get thyroid problem that would go undiagnosed for seven years and really Ravager and then my daughter would be diagnosed with Type One Diabetes. And then my daughter would be diagnosed with hypothyroidism. And then later my son was diagnosed with hashimotos. And I for some reason lived for like a decade with an iron level that was so low and had no like, I didn't think all of that was going to happen. And it's hard. It I mean, when it's all spread out, like you can kind of fight it and then rest and fight it again. It's almost like a boxing match, you know, but you don't usually get in the ring and have a baby in your belly and then two boxers come at you at the same time. Like that's just, I almost curse that's really crazy. And you're young to did that. Do you ever feel like holy crap like maybe 10 years from now I could have had This but like, I'm in my mid 20s.

Devin Clark 30:03
Yeah. But at the same time, you know, I'm just very thankful for my knowledge. Without it, I don't know how I would have done any of this.

Scott Benner 30:14
Yeah, that that is occurring to me that if you didn't have the training and the education that you did, that this really would have probably steamrolled you, I imagine. Yes, yeah. Well, well, yeah. Then Let's be happy for that. Okay. Okay, you're on a bureau. Oh, my God, I keep thinking, like, it's hard to I'm sorry, I'm sidetrack now, because it's hard for me to think of you as four months pregnant when you get the news about your, your, your baby, but what is that? Like? How did you so he's with your parents in laws, their parents, and you're away. And then what happens?

Devin Clark 30:51
So um, I get a phone call from my mother in law, she says, Hey, we're going to take him to urgent care. And I'll call you and let you know what's going on. Because at this point, he's just not acting right? He's lethargic. And he doesn't look good. Like, he looks dehydrated, like his eyes are kind of sunken in, they facetimed with me. And but she said, Oh, he's got like, a little low grade tip. And I said, Well, maybe he's got like an infection or something. So bring him in. The PA, who had previously worked with he, he called me and said, We don't know what's wrong with your son, but we just tried to stick in for an IV and he didn't even flinch. So we're going to send him to the emergency room. And at that point, I got really nervous. And so I sent him to the hospital where I used to work. And I had one of my friends send me a text message said, she said, Hey, I have Jack's, and we're going to take care of him. And so you know, made me feel a lot better. The next phone call I got was from the ER doctor. He said, Do you have your husband by you? I'm going to go over the test results we got since we had some blood drawn. And I said he's standing right here. He said, jack says glucose level was 1432. And I just hit the floor screaming. Like, I knew what it was at that point. Wow. So we had an sent to a different hospital with a pediatric endocrinologist because they didn't feel comfortable handling his care because he was so young. But the the other hospital was close to our house instead of two hours. So why were my in laws were? So you know, worked out?

Scott Benner 33:04
Well. Devin, I've heard a lot of people told me the stories about how they are their children were diagnosed with Type One Diabetes. And this was more jarring to me, because I knew that you understood what was being said to you through the steps. Like I found myself wondering, like, what does it mean when you try to take blood from a baby and it doesn't flinch? Like what would that be an indication of I'm sorry to ask you a because now I feel like I'm asking you a medical question. And you're relating it in your head to your son that makes me feel badly for asking. But from a medical perspective, like what does that say to you as a nurse.

Devin Clark 33:42
It says to me that he is close to being in a comatose state. That's what I thought, that's the body shutting down.

Scott Benner 33:49
That's when I started getting upset when you were telling the story of me, I get the chills, and I felt like it was gonna cry. You did a really good job. You were trying to make me cry. You really did it. But that's all I can think of is that every step along the way. You were going to you were going to know the the underlying inference of the statements. Can I ask that after the shock of the glucose went by? Was it more relieving than some of the other things you were thinking?

Devin Clark 34:17
He also went over the results of his blood gas. That was really, really bad. So he was in severe decay. And I just kept growing as he was telling me the numbers because I knew what they all meant.

Scott Benner 34:31
Well, that part seems unfair to I've used the word unfair twice now. But it does, like there's something about but there's something in there. I think most people will never get to appreciate what the doctor is trying to do for you in that moment, like get you to the care without making you understand what they understand because of the emotional aspect of it. But there's no avoiding it for you. Yeah, they don't tell you the worst stuff in Till the worst stuff is, is you know there and they have a way of kind of like good doctors have a way of gliding you through it a little bit, but you couldn't you couldn't take that ride. So how far were you from where your son was? At that moment?

Devin Clark 35:16
Six and a half hours away?

Scott Benner 35:18
by car? Yeah. Oh my gosh. So you guys pack up and head?

Devin Clark 35:24
Yeah. So we actually went to a baseball game right after that we were actually waiting for an Uber to come to our hotel and pick us up when I got the phone call. And we had friends of my husband meeting us there and so we ended up going to the game, but we ended up driving home right afterwards. And then to the hospital The next morning,

Scott Benner 35:50
Devin this guy you're married to he got a nurse. A good mom and a girl that will go to a baseball game for their anniversary.

Devin Clark 35:59
Oh, the baseball game is it that's all me. I got him into baseball.

Scott Benner 36:05
Does he? Like you get extra gifts that like gift giving occasion?

Devin Clark 36:08
Yeah, I should I'm gonna pass that along to him. I

Scott Benner 36:12
mean, really? He's not paying attention if he's not what I'm What? So did you travel somewhere to see like your favorite baseball team play?

Devin Clark 36:18
I did. So we live in Louisiana. And an Astros fan, the Houston Astros. We went to Dallas to see them play the Rangers

Scott Benner 36:28
Look at you. This is perfect. I would like to, if anything happens to this guy. And you know, and my wife at the same time, I'm going to, I'm going to ring you up. But you're a little young. But I but I would like to go to baseball games. I want somebody who's like, hey, let's go to a baseball game as a celebration. That is very cool. So So timing wise, you couldn't get out of there. So you're like, we're just gonna go to this game anyway? Or was this year like, we might as well stay and do one decent thing before we leave like situation?

Devin Clark 36:58
Well, that was my husband's idea. I wanted to come home immediately. And he said, Well, what are we gonna do like, there's nothing that we can do at this point, other than just sit there in the hospital. Might as well just go to the game that we've already paid for, and go in the morning. So he wanted to stay overnight in Dallas and then drive all the way back and I said, No, we're gonna leave and go home, which home would be about four hours from Dallas, and then another two to my in laws. The next day,

Scott Benner 37:30
husband's never going to live that down. You can be polite on here if you want. But I once had, we were on the way to a flyers game when my wife and I were dating, and she got really kind of like sick to her stomach. And I was like, oh, we're so close to this day. And what I was really thinking was these tickets are really expensive, and I'm not sick. And I know that 25 or six years later, if you were to bring that up right now she'd be like, you were such an idiot for making me go to that game. So I feel bad. I feel badly now as an older person. And one day your husband will tell. But I get his idea. Like I really do like, big What are we going to do? But at the same time I get you want to just go right away?

Devin Clark 38:10
Yeah, I can tell you, you know, as much of a fan as I am. I can't tell you a single thing that happened during that game,

Scott Benner 38:18
I would imagine. Yeah, I would imagine that you're just in a blur, right? Yeah, yeah. Geez. All right, um, son's diagnosed, you already have type one, although you're pregnant, you're just you know, the pump thing. How long till somebody suggests the pump for your son.

Devin Clark 38:36
Um, it was suggested immediately in the hospital by his endo, to go ahead and get an on one. And I was like, Well, let me let me think about it. So we ended up doing MDI for three months before we got him on apart. Okay, I just I wanted to feel comfortable with his management in that way before we moved into something different.

Scott Benner 39:03
So while you're learning about his management, in honesty, you're learning about your own at the same time.

Devin Clark 39:08
Oh, yeah, I'm freshly diagnosed you know, trying to figure out diabetes and pregnancy and that's just a whirlwind and its own and then diabetes and infancy is just another you know, headache on top of it.

Scott Benner 39:25
Well, you're being polite. Those are two sides of a tornado. You know what I mean? Like it's the the infancy thing is tough, because I mean, what could he have weighed?

Devin Clark 39:35
Oh, I think at that point, he was about 15 pounds,

Scott Benner 39:41
so using barely any insulin to get his blood sugar to move. And you're getting ready for an insulin resistance in a couple of months. Right? Yeah. How hard did that hit you? When that time came.

Devin Clark 39:57
Um, it honestly wasn't terrible. I stayed on top of it. I, for the most part, did my own adjustments at that point. Now I still did get with the suggestions that my endo made. If they didn't work out, I'd tweak it a little bit, and let them know.

Scott Benner 40:22
Stay on top of it. That means as your needs increased, you increase the insulin. Right? Yeah, I think that's the, the disconnect for people. So often is they they just get settings and they're like, well, these are the settings and then like, my blood sugar's high all the time, I understand what's wrong. So maybe you need more insulin? Well, no, these are my settings. It's not how it works. But I know that in the beginning, managing I mean, we're half units, like too much for your son.

Devin Clark 40:54
Sometimes we actually had him on a u 25. Insulin homologue, to be exact. So sometimes, we would just end up giving him a half unit of u 25. And that was enough for his bottle, or whatever he was eating.

Scott Benner 41:16
Yeah, I didn't know how to ask if you can. I didn't I find with sound silly or not where you breastfeeding was going to be my question, but I'm assuming your body had done about enough by that.

Devin Clark 41:29
I was not breastfeeding. But I see people online that struggle doing that

Scott Benner 41:36
with with type one. And without but yeah, but with type one specifically. So so you have to how often? Is he getting a bottle?

Devin Clark 41:47
He was getting a bottle every four hours at that point, I believe.

Scott Benner 41:51
Okay, so you how do you do that? Do you inject and start the bottle right away? Or do you get feed the bottle and then put the insulin? How are you handling it?

Devin Clark 42:01
Um, so they had him on, I think in pa h in the background with the diluted homologue. So we had to be on a schedule. And sometimes it didn't work out because you know, the predictability of mph with a rapid acting is kind of easy sometimes. So in general, it was normally sometimes between three and four hours. And then we would oftentimes have to wake up in the middle of the night and give him an extra one.

Scott Benner 42:47
So you were testing? Were you testing him while he was sleeping?

Devin Clark 42:51
Yes. In the beginning, it took us two or three weeks after he was out of the hospital to get him on. A CGM.

Scott Benner 43:02
What did you find was happening overnight. Like what was what was happening that you couldn't see prior to the CGM.

Devin Clark 43:11
He had a hormonal search right after he would go to sleep and it would sustain and then drop off about 4am.

Scott Benner 43:20
What did that do to his blood sugar's?

Devin Clark 43:23
So whenever he got asleep and had the growth hormone surge, it would elevate it a good bit. So he would shoot up to, you know, like, 300 or so. But then since he was also in the honeymoon stage, he'd start working his way back down, and oftentimes find himself flow. Somewhere around four to five ish.

Scott Benner 43:47
I'm incredibly comfortable talking to you, Devin. I'm trying to figure out why. So when you first popped on and you had a more southern drawl, I thought I gave a to let you inside of my head. I was like, I said to myself, talk slower Scott, like, like, just don't like try to dial yourself back a little bit. But you speak more quickly than I expected you to. And at the same time, you have the there's the comforting part of the of the accent. So I've come to realize that the southern accents lo me to like, they make me calm, I guess. But I still have to Anyway, I'm enjoying talking to you. I hope you are too. And you're such You're so good about the knowledge piece of it. Like I I've not asked you a question yet that you were like, Oh, I don't know. But you said you were nervous when we started. Are you nervous now? I'm a little more comfortable. Only a little more. A bit more. I'm doing my best here that would feel better. gone all the great roads. I've made fun of your husband, women love. I can't believe you're a great baseball fan. That's amazing. You're doing a terrific job. like managing your well yourself and your son and you know, through an infant diagnosis is it's just that much more difficult. Really, it's, it's, it's fantastic as as time has passed Now, is there much overlap with your management and your sons? Where are you just like literally two separate people.

Devin Clark 45:28
We are two separate people. But we are also using the same system just for you know, ease of use for myself and my husband. You know, just in case, you know if something bad were to happen. So, we are on the DIY loop.

Scott Benner 45:50
Oh, you're looping, okay? Yes. All right. So you're both looping. So you're using Omni pod or the Medtronic pump to loop?

Devin Clark 45:59
We're both on Omni pod. Got it?

Scott Benner 46:02
So you're looping. And you're both in the same thing. But you have? Well, that's what I'm wondering like you have you have hormones throughout the month. But isn't he growing? Doesn't he too?

Devin Clark 46:13
Yes. So his needs will dramatically go up during a growth spurt. And then they'll kind of taper back off for a little while, and then they'll go back up quickly again, and then it's, you know, just kind of like an

Scott Benner 46:32
ebb and flow. His aren't as predictable as yours. Oh, no. Yeah,

Devin Clark 46:36
my my settings pretty much never change. But his change frequently.

Scott Benner 46:43
That's, that's interesting. Okay, so you're not too much more difficult to manage during different parts of menstruation? You're, you're pretty stable. What does that mean for you? What are your goals?

Devin Clark 46:56
So I've maintained a good time and range. I'm not like, you know, super hardcore, I'm okay. In the 80s. My a one C's been in the fives. consistently. And, you know, I also eat my fair share of junk food. I'm pretty proud of that.

Scott Benner 47:22
You should be what would make you feel hardcore. I mean, that seems pretty hardcore to me. But

Devin Clark 47:29
well, you know, I know a lot of people try to maintain a flat line. And I, you know, I know that's not possible. You know, without a lot of hard work, which I'm not really willing to put in, because I have two people to manage. And I also have, my daughter has katatak hypoglycemia. So I have three blood sugars I have to manage.

Scott Benner 48:01
I'm glad you brought that up, because I want to find out about that in a second. But I just want to tell you, I think what you're doing is really bad ass. And if your blood sugar is not constantly at five, I don't think that's a big deal. I think that's kind of amazing. Are you able to achieve the similar for your son?

Devin Clark 48:17
Um, so his is gonna run a little higher. His endo has already told me you know, two years old is a very hard age to manage. So we just had our first Well, no, our first but first in a while, what I would say hire a one C for him, which was seven. Whereas he's been in the sixes. And I've been okay with that. And so when she told me it was seven, I was like, beating myself up. And she was like, Oh, no, no, this is great.

Scott Benner 48:52
Are you are you would you say, I guess I should say, Would you say I should say which I've made that very confusing. Let me start over. Would you say that stability within a range is your main goal for him? Yes. So you're just trying to avoid bouncing more than anything, right? Is the higher number in your head because does he drop out of nowhere pretty easily?

Devin Clark 49:20
He can. Sometimes he can be a little unpredictable. And just depending on where he is, in his stages of growing, yeah. And then we've also found that sometimes his pancreas is still putting out just a hair of insulin that'll cause him to get really bad. You're getting

Scott Benner 49:41
help so that you don't want anymore, right? Yeah. And I'm assuming to his diet is more commensurate with a younger person's

Devin Clark 49:51
chicken nuggets.

Scott Benner 49:54
entire industry made out of chicken nuggets for little kids. Yeah, and that's tough. I actually was talking talking to somebody the other day with a two year old. And they're like, I don't understand. It's just chicken nuggets. They're the good ones. I was like, Huh, they're frozen. They're not that great. Yeah, I know you think they are, but they aren't like, the only way you're going to get away with chicken nuggets is if you buy ground chicken yourself, or make them out of, you know, chicken breast and like, then you'll get a more stable thing. But the breading on the frozen ones and whatever they put in them so that when they unfreeze, you don't have botulism. Makes it makes it harder, you know, just yeah, I hear you. Well, I mean, that's amazing. Does anyone ever tell you you're doing a great job? Yeah, sometimes good. Because if they don't, I will tell you. You're doing a great job. Thank you. Yeah, you're welcome. It's astonishing. You're still at the age where if you told me, I have type one diabetes, and I mainly go to concerts, and I don't have kids yet? I would that's still your age. You don't I mean, like you're getting a lot accomplished. Do you feel like an old soul? Or? sometimes sometimes, sometimes you feel like, I should have kept that guy away from me?

Devin Clark 51:08
Well, I'm also an only child. So I, I've kind of heard that my whole life.

Scott Benner 51:14
Yeah. Oh, no kidding. It's kind of a little more stoic way of being and, and you're a protector, too. I would imagine. If you love nursing so much. You must really like the caretaking aspect of it. Yeah. Yeah. Cuz that's especially you couldn't not? I mean, I don't know how to be a nurse. If you didn't feel like that. I guess it would just seem like a would feel like a nine to five punch in job than if if that was if that was the case. Okay, so I have to ask, you mentioned your daughter's blood sugar. She has one.

Devin Clark 51:41
She has katatak hypoglycemia. That just

Scott Benner 51:45
sent me to Google. Hold on a second. Okay. All right. A medical term, used in two ways broadly to refer to any circumstance in which low blood glucose is accompanied by ketosis were to in a much more restrictive way to refer to recurrent episodes of hypoglycemia, excuse me, hypoglycemic symptoms with ketosis, and often vomiting in young children. Which one, are you? Number one, number one, good, anything that doesn't involve vomiting is better than anything that doesn't go right. So how does this Well, I guess, how does this show up first?

Devin Clark 52:31
So you know, I'm already hypervigilant, having a second child after having one with type one. So I made it to about a year without checking her blood sugar. Yeah, Amy. And one morning, I go to get her out of her crib. And I've noticed that the crib is soaking wet. And I said, Oh, no. So she's also a little more fussy than normal. So I checked her blood sugar, and it's 50. And I'm like, okay, that's not what I was expecting. So I called the pediatrician, got an appointment. She had had, like, a few episodes of diarrhea about a week prior, and I said it was probably linked to that, but to also keep checking her blood sugar given the family history. So we did, and about a week after that happened, I go to get her out of her crib, and I smell ketones. And I get my blood meter out and it was 3.6. And I call my son's info and I'm like, I need to get my daughter an appointment with y'all.

Scott Benner 53:50
Give a plan or a punch card where I get like a free sandwich at the end of these visits or something like that.

Devin Clark 54:00
So long story short, we couldn't get her an appointment in time. We had to get her to go in patient about two weeks after that. When I woke up, she woke up she was kind of out of it. Her blood sugar was 41. So we brought her to that hospital that evening, and I did fast with her to try and get her blood sugar to go down to take labs, which is when they had diagnosed her with it. At that point,

Scott Benner 54:36
what's the diagnosis mean?

Devin Clark 54:40
So her, this is normally a diagnosis that amount nurse child would get and if you could see my daughter, she is anything but she she's very well fed and plump and So that's why they were kind of scratching their heads. You know why she had this, but she develops ketones in a starvation period. Where you know, her body is so low on glucose, it's trying to get energy somehow. So it starts developing ketones for energy in a state of low glucose.

Scott Benner 55:30
How do you? Is it manageable some way like is there any way to impact it, you have to eat on a different schedule, you have to eat

Devin Clark 55:37
on a schedule, she cannot go any more than three hours during the waking hours, without having at least a snack. And at night, we have to put cornstarch in her milk, which we also had to deal with my son when he was first diagnosed with type one. So so for him it about

Scott Benner 55:59
that for him, you did it to keep his blood sugar up. And for her, you're doing it to keep the milk in her stomach longer. Yes, similar reason, similar thing, but different reasons.

Devin Clark 56:09
And also to keep her blood sugar up because it takes longer for your body to process a starch.

Scott Benner 56:15
And then if, okay, so if your body's still seeing it, and has blood sugar, it won't do the ketose the ketone thing? Right, okay. Forever. Is this a forever thing?

Devin Clark 56:30
It normally goes away. Later in childhood, sometimes it doesn't.

Scott Benner 56:37
But that's a short answer. Yeah, no. I'd have been like, Great, thanks. But you were probably just like, Whatever. I'm doing well, now I can do this now. Yeah, wow. I'm assuming no more kids. No more kids. I'm sure they're delightful and everything, but you get one more thing to do. And you're going to, you're going to be losing your mind, I would imagine. How is it managing all three of these things? Like what? How do you? I mean, you seem unless you're pretending for the podcast, you seem relatively normal and together. So Howard, how did you find a balance? Um, where have you not?

Devin Clark 57:19
I don't know if I have I just kind of get up and do it every day. That's why um, now I you know, mental health very important. I do see a therapist. Yeah. I don't know what I would do if I didn't.

Scott Benner 57:38
I was you I'd shrink it down and just put it on my shoulder. The therapist. Just come along for the ride. Yeah, I don't see how you wouldn't want to do that. I mean, perfectly honest. That's a it's just a lot. It would be a lot if you had diabetes, it would be a lot of your kid did. I think it would be a lot of with this. You know, ketotic hypoglycemia thing too. But all three of them togethers it with a young family is something else. I'm assuming your husband does everything else in the world, right? Like you don't have to, like take out the garbage or move something. You just stare at him? Right? play with the kids and come on. You gotta be kidding me. Now, he can't do there's nothing you shouldn't even know what a garbage day is. Like, if I said you a devil, what day is trash? Come? You should have to go. Um, I think Tuesday. That's that would be the answer I would want from you. Yeah, tell him he's got to get moving here. Yeah, there's, there's a lot going on. Holy crap. So see a therapist weekly.

Devin Clark 58:38
I see your once a month now.

Scott Benner 58:39
Is it just sort of maintenance? How does that go? I mean, do you mind telling me? No, no, it's fine.

Devin Clark 58:45
Yeah, it's it's just, you know, a check in make sure everything is going okay. Um, but I just, you know, find it very important to have somebody to talk it out with and my therapist also is diabetic, so she understands where I'm coming from. And a lot of aspects, was that on purpose? No, it was not. It was definitely a God thing. That we were both diabetic,

Scott Benner 59:20
you're like, so here's the story, you start telling a story about diabetes. Do I know exactly what you're talking about? Yes. Nice. That's a little bonus there. They should put that right on the sign. Honestly. I would I'd be like I have diabetes. Just cater to a diabetes crowd. Because I think it needs a level of understanding that you probably can't have without diabetes. Right? You know, or otherwise, it just sounds like you take insulin, your son takes insulin and your daughter has to drink milk with corn starch in it. Like you don't I mean, like not really understanding the gravity of what's happening and hearing it clinically. I would imagine might not be pack some people the same way. So good. That's amazing. We are coming up on an hour. I want to make sure that we've talked about everything you thought we were going to talk about.

Devin Clark 1:00:11
I believe so. In my mind, I thought we might talk about labor a little bit more, but that's totally fine if we don't.

Scott Benner 1:00:21
Yeah, it's not that we can't. That's why I asked here at the end. So you are using the Do It Yourself loop that you just download from the internet. Which sounds crazy every time I say it out loud, even though I know it's not. I personally think that the algorithm is amazing. And does really great work. Do you use auto Bolus,

Devin Clark 1:00:44
or I I do I use auto Bolus? I had my son on it for a little while. I found it to be a little aggressive for him. So I switched him back to Temp Basal

Scott Benner 1:00:56
gotcha. I think if Kenny was here he would say that you could adjust the percentage that the audible is works at in the programming somehow but to ask me how to do it would be a mistake. But I think it's at 40% Does that sound right? So if it thinks you need a unit it gives you point four it waits five more minutes, I think then it gives you 40% of the next indication. I think that's how it works.

Devin Clark 1:01:24
It does until it finds a level of status or it starts to go down. It'll start it'll keep giving you insulin Yeah, but

Scott Benner 1:01:33
I think there is somewhere in the programming of it where you could just say to look if you think I need a unit give me a unit. I think you can make that 40% 100% not that I'm saying to do it. I'm just saying I think it's possible to adjust them.

Devin Clark 1:01:44
Um, I think that is an open APS not 100% sure, but the the one that I have, I don't have that option.

Scott Benner 1:01:59
Gotcha. So you're not using Ivan's branch you're using a different one? Yes. That's a lot of words that most people didn't understand just now. But it's uh, I mean, I can tell you from my perspective Arden's using Ivan's open APS and it's amazing. It just it really is absolutely spectacular to watch. You make a mistake on a meal. And for it to go, Oh, you're gonna need more insulin and just put it in. It's crazy. Like, you know, you can miss on a meal reasonably. And the auto Bolus, I don't know what your findings are, but I think the auto Bolus will stop Arden from being more like you know 200 at least if we've you know what I mean if we've missed on the amount of insulin she needs it can it can get her stopped usually by 200 Yes, if you just ignore you know, if we were in a situation where we just ignored it and let the auto Bolus kick in Do you have a similar finding?

Devin Clark 1:02:57
I do personally know for my son we had to make a lot of settings adjustments trying to go from Temp Basal to to the audit Bolus with him and we found where we landed was still a little off but in talking with his endo about it we found that we probably weren't going to get to the level we needed to be without using diluted insulin because he was using such small amounts is basil right sometimes your point oh five oh

Scott Benner 1:03:37
my gosh. upsample What's the way now? Present day 33 pounds because he was 10 months old when he was diagnosed he's still only like two right? Yeah. Wow. Yeah, that's that makes total sense. Are you interested in on the pod five trying that for him when it comes out?

Devin Clark 1:03:55
I am very interested in that

Scott Benner 1:03:58
to get rid of the Reilly link alone would be amazing, right? Yes, I agree. I'm it's April now when you and I are recording you know, people will hear this probably will have, you know, Halloween decorations up but I'm like, I'm trying my hardest through all the channels I have, like I'm pushing. I'm like, Can I just like can I see the only about five plays nicely. So I'm excited too. I think that carrying a link between something and the pod is Arden's least favorite part of it. So So yeah, I agree with you. Do you think you would change yourself too, if you found it working?

Devin Clark 1:04:35
Ah, it really just depends on what the hard settings are. That, you know, things that I couldn't change, like, target and such. I know. Whenever I was on Medtronic, they had a certain level I couldn't go below. Yeah, and I know it's the same for tandem and I'm sure shirts. For FDA approval, it's going to be the same for the Lv pod five,

Scott Benner 1:05:04
you would imagine I'm hopeful that you can make your setting so that they do more what you want, as far as outcomes go like that's I don't know, but that's why I'd like to get my hands on it to find out because I'd love to try. Yeah, I'm excited. Um, how long have you been doing it?

Devin Clark 1:05:23
I actually got my son doing it first. I started with him in January of last year, so he was 15 or 16 months old. And then I started in August of last year,

Scott Benner 1:05:45
in about every way I can measure from this conversation, Devin, you are a badass. Seriously, like, Oh my god, are you kidding me? I saw that thing. And I was like, No, I need help make somebody help me. I scared No, no, thank you computer don't want to do it. You sound like you just do whatever's best and jump in. That's very cool. I had a question for you just put that in my head. Oh, do you listen to the podcast at all? How did you find me?

Devin Clark 1:06:12
online on Facebook, actually. And then my son's endo had suggested you to me at some point, I think last year, and I was like, Oh, yeah, I heard about that. So yeah, I started listening. I actually started with when you interviewed Kenny Fox, cuz I was trying to get my loop settings, right?

Scott Benner 1:06:38
Oh, I found so I got you through the loop stuff. Very nice. I like that. And you're and by the way, your endo limits. Just take a second here to say hi, how are you? Thanks so much. Really appreciate it. You're the best endo in the area there. I'm CL willing I am to pimp somebody out if I'm just happy to say Yes, you did a great I don't even know if he's a good endo. Or she I don't know anything about I just happy that they like the show. That's really cool. Like, I mean, being serious that it's, it's very cool that a doctor would say hey, you should try a podcast. And it's interesting that you found the podcast through Facebook, because I I know this shouldn't be surprising, but I'm always like stunned by that a little bit. You know, the the podcast has a Facebook page that's public and you know, basically it just tells you when new stuffs coming out and stuff like that. But then there's a private one where people talk constantly and I think the Facebook page must have gotten a good reputation because now people come into it. Thinking I heard that if you're in this Facebook group, you're a one see goes down and you get better, you know, variability and they get in there and eventually they're just like hey, I'm all this stuff you guys are doing Where did you learn this? And people are like the podcast and they go what podcast and I'm like oh my god that's so crazy. You know you mean like they're there and they don't even understand that the podcast exists or why what how the Facebook page got there it's pretty cool how the I don't know if the snake is eating its own tail now or I don't I don't know what the the euphemism is there. But it's it's pretty, pretty great. Is Do you find that to be a good Facebook group? Yeah, definitely. Yeah, I like I think it's a it's got a good vibe. So I'm always happy about that. Well, I'm glad you found it. And if any of it's helped you It sounds like you didn't need much help you seem like you know what the hell you're doing. So just very cool that you're here. Thank you. Thank you. A huge thank you to one of today's sponsors. g Vogue glucagon. Find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juicebox you spell that? g VOKEGL Uc ag o n.com. forward slash juicebox. And I don't want to forget to thank Devin for coming on the show and sharing her very unique story. Thank you so much, Devin. And if you love watching dancing, well Well, well, we've got a surprise for you touched by type one is dancing for diabetes. Find out why, where and how. At touched by type one.org.

Are you enjoying the Juicebox Podcast? Please share it with someone else who you think might also enjoy it. Are you really loving it? Like is it hitting you right in the soft, gooey spot in the middle and you're like, Oh my gosh, I love this podcast. I have so many wonderful things to say about it. If you are, leave a five star rating and a beautiful review wherever you listen, like if you listen to a podcast app, go into the app and see if you're allowed to rate the show. And if you are rate rate rate, rate, how many five rate great, great, great, great, great rate and then say something really meaningful about the show that might help a new listener to want to listen. Thank you so much for listening, the show is doing terrific. It is because of you it is because of your sharing. I really couldn't say thank you enough or, or even find the words I think to express how grateful I am. Thank you so much for being here. I'll be back very soon with another episode. Oh, I'm sorry, I meant to also say T one d exchange.org. forward slash juicebox. us resident with type one us resident who is the caregiver of someone with type one, take the survey, you can do it on your sofa from your phone, it takes less than 10 minutes. I'm being serious. They're not difficult questions. They're not probing or deep or super personal. You're going to be helping people living with Type One Diabetes, when you complete the survey, you're going to be helping the show. If you can do that. I would really appreciate it. I'm trying to personally with the power of this podcast, push 2000 new surveys to the T one D exchange before the end of November before the end of diabetes Awareness Month. If you could just give me 10 minutes on this. It would mean a lot

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#560 Diabetes Variables: Sleep

Diabetes Variables: Sleep

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

---

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
This is Episode 560 of the Juicebox Podcast. I am. I'm impressed with myself if you all knew me personally, you would be amazed that I've done this, honestly, that I didn't like, you know, get like five minutes into it was like it was a lot of work. Oddly not like me, but maybe it is now. Who knows, live learn, right? Grow change, etc.

Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is sleep, Jenny and I will talk all about sleep and how that is a variable for your type one diabetes management. While we're doing that, you'll remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And further, you'll remember to consult a physician before making any changes to your health care plan, or becoming bold with insulin. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com ask for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean you could ask offer a sofa, see if she'll help you with your Basal insulin. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org forward slash juicebox take the quick survey help the podcast help people living with Type One Diabetes. I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen. And I'll do this so that you get an interrupt an inner, inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means if it's in your pocket, if it's in your purse, anywhere you need to keep your gear, the Contour Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. room it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test trip by doing that. Or ruin the accuracy of the test. Second Chance test trips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me got text matches the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well you know i want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh this thing must need so much blood but it doesn't it needs a very little bit it's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay last part go to contour next comm forward slash juicebox there's like zero sincerely, I'm not just trying to drive you to a link What am I really want you to go to the link but that's not the point. There's a lot of information at the link. So if you really want understand all this Contour Next one.com forward slash juicebox and I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juice box. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Jenny Campbell Do sleep as a variable for managing insulin. I don't know, I don't have a lot of feeling about this, honestly, it's not one of the things that I've noticed. But maybe I'm not looking hard enough. And when people sent in variables for the list, sleep, sleep deprivation, getting good sleep versus getting bad sleep, like broken and unbroken. Everybody sent that in as a variable. So I don't understand why that would impact anything.

Jennifer Smith, CDE 5:35
Well, you know, overall, sleep provides a lot in terms of recovery, and build of like cellular sort of restructuring and whatnot in the overnight time period, right? That's, we're supposed to get these waves of light sleep, deep sleep, etc, that help our body to actually then recoup and be ready for another day. When it comes in terms of type one management, that's one of the biggest things that most people say is, I just want better sleep, the daytime, I can struggle through manage through if I've had good sleep overnight, I can deal with the daytime management. So from one, sleep deprivation can lead to poor overall management, because you don't have as much with all that we have to manage in today's world beyond our diabetes, that's another layer that we have to consider. And if you haven't slept well, you're not going to be thinking as clearly, right. on another level, though. There are a lot of different hormones that are regulated through the sleep cycle that have relation to appetite, and the turn on the turn off of appetite during the daytime. And so for someone, again, managing diabetes, if you are not sleeping well, it is very likely that some of those hormones that are supposed to be being managed for then transitioning into what you're craving, unable to manage in terms of your intake through the course of the day, those are not going to be regulated the right way either. So there's a lot to sleep, that does translate into diabetes management, right.

Scott Benner 7:31
So the one, the one thing that popped into my head, when I saw this as a variable was that I thought I for sure had heard that shift work could be bad for people in a way that I never expected that he could make you more, the way I looked it up it's a shift work can have an adverse effect on type two diabetes, it can also put a person at higher risk of developing type two type two in the first place shift work, particularly that involving overnight and varying shifts can make it more difficult to manage glucose levels. It doesn't it doesn't really go on but I really I just remembered hearing that that there's something about the is that this circadian rhythms, the

Jennifer Smith, CDE 8:12
circadian rhythm really. And I it's interesting, because I just attended the ADA scientific sessions with our virtual conference. But some of the sessions that I did attend were specific to the circadian rhythm, and sleep and appetite and weight management, which does relate to much more into type two. But it's also a realm of something that many people with type one try to manage really well to write. So in terms of what they found is those who had a much more stable daytime structured schedule, and they slept overnight, even if the sleep was not as good but they had their normal sleep time in the overnight time where typical circadian rhythm kind of is meant to be. They found that people had better weight management and had better glucose control. The other piece to it was that with shift work in the picture, schedules are often very disrupted with shift work. It's not often that people have consistent enough schedule with a shift like I think of many of the nurses that I've worked with, who have some shifts and some weeks that are an overnight shift, and then they've got several days off and then they go to a daytime shift, then they've got several days off and then they go back to like the evening or the overnight shift, right? That's a complete disruption to what your body is even trying to set as a some type of stables schedule. It just it doesn't happen. So in terms of like all management It's really hard to then get a grasp on insulin doses and or even use of medication. And food intake gets disrupted, now you're eating at two o'clock in the morning because that's technically your lunch hour went in four days from now, your lunch is going to be back at 12 or one o'clock. And I know

Scott Benner 10:19
I remember we've talked about that before, too, that that actually still impacts things like feet on the floor and stuff like that, too. Like if you wake up at three o'clock in the morning, suddenly that feet on the floor impact is happening at that time of the day. Absolutely all that other stuff that's really fascinating.

Jennifer Smith, CDE 10:34
I mean, I in terms of that, I even remember noticing that myself if I would get up overnight for more than just a tuck a kid back in bed and then go back to bed myself five minutes, I didn't get that impact. But if I was up with a foster child or for nursing overnight or something like that, and I was up for enough of a period of time, I definitely saw that happen when otherwise overnights were flat.

Scott Benner 11:00
You know, I was just thinking about you ever been like gotten sick or exhausted and you fall asleep in the middle of the day? And the sun's up? And you're in a deep sleep Lee, when does that happen? Back to had to have happened to at one point, and you wake up at seven o'clock at night. And it's dark. And it's the kind of dark where you're like, it could be midnight it could be 2am I don't know what time it is. And you can't it gives you that really horrible strange feeling of like you don't know where you are. It feels very disorienting, right? Yes. And the only time the only way to fix it is to go back to sleep and wake up with the sun again. Yeah, yeah, it's a I have it here just us is it circadian circadian circadian rhythm or circadian cycle is a natural internal process that regulates the sleep wake cycle and repeats roughly every 24 hours. It can refer to any process that originates with an organism, okay, we don't care about that part. But the other thing there. And the only way I can relate to this, and I've had someone on recently to talk about it, is that I am very steadfastly eating within a an intermittent fasting schedule, is really made a vast improvement on how I feel. You know, when I spoke to Jen Stevens about it on the podcast, she was talking about, you know, just pick a she talked about is in the eating window, not as like, she didn't think of it as fasting as much. And so I'm just pretty much sticking to an eight hour window. Yep. She told me if I take my window down to fewer hours, I'll start losing weight. And I haven't gotten to that part yet. I was waiting for the kids to go back to school. So we're getting up to that. Now I'm going to shorten the window up a little bit. But basically, basically, I'm not eating after the sun goes down. I'm 11 to seven ish. I'm trying to eat around in that situation. And one of the things she talked about is how, why does that work for people for weight loss, and she said it. it lessens your need for insulin. So your body goes through big portions of the day where you're not your body's not calling for insulin, like it's the opposite of the idea of like, eat small snacks all day long. She's like, I don't like that idea because your body is always using insulin. Now she was talking about, you know, people who don't have diabetes or type twos, how that could affect them. But then I realized Arden's a person who doesn't eat breakfast. So over like most of the time, like on a regular school day, so overall, Arden's eating in an intermittent fasting window. And she can fast with a stable blood sugar, like no one I've ever seen in my life. Like, you know, now that you're on the algorithm, and you can see it Arden, if Arden doesn't eat for 12 hours Arden's blood sugar is just he just is. And so I don't know that all those things fit together. But I think all the ideas fit in here somehow, you know, the idea of being on that cycle, and that your body works better in cycles, and that it needs time off and time to do things. I mean, I'm obviously no expert, but all that makes sense to me somehow.

Jennifer Smith, CDE 14:15
Yeah, absolutely. I mean, the, they're seeing their circadian rhythm, the hormone component and the overnight time period. I mean, they are all kind of tied in along with the intermittent fasting idea. In fact, one of the other ones that I listened into was all about, like those who did the best weight management wise, kind of from short term analysis to long term like a year out from having lost weight, and then what's the maintenance of that in terms of their ability to maintain and some of them were doing intermittent fasting, but they did it. I also don't really like the fasting component because you're fasting in a given time period, but you're not Really just not eating, right? I mean, people think of fasting as like 24 hours, you're just not eating anything really you just containing the time period. And they found that people that did intermittent fasting with breakfast being the bigger of the meal, lunch being a bit lighter and the last meal of that time period, especially when it's eaten, I think it was before, like 7pm did the best with overall loss, and then maintaining that loss, compared to people who just shifted that eating timeframe by about, I think it was a three hour chunk of time forward, and eight later into the evening, but still within a time block. That was an intermittent fasting, like I only eat within the six hour eight hour time period. So the later eating tended to increase the risk of gaining weight back and or just not losing as much weight, which was interesting to

Scott Benner 16:00
the reason I brought it all up is because if you're if you're sleeping on a pretty consistent schedule, then it makes sense that you'll be able to eat on a pretty consistent scale. Yes, right.

Jennifer Smith, CDE 16:10
Exactly.

Scott Benner 16:11
I and I mirror what you said in what I'm seeing that. First of all, it's easier to eat bigger in the beginning of the day, because you've come out of a window where you haven't eaten for a while. That is the time I am the hungry. It's like I don't want to you know, I don't I don't wake up like I haven't eaten yet. It's 1151. And I'm not hungry. So but I will go eat now when you and I are finished. Sure. And I will eat probably my larger meal of the day. Yeah,

Jennifer Smith, CDE 16:41
and it's in the day. Yeah, you're not putting it in the evening, when you're less likely to be up and moving and going about your business, you're not going to bed on a really full stomach that your body then has to do something, digestion specifically, in a time period that is not meant to be doing that, which

Scott Benner 16:58
I was gonna say can affect your sleep, which Yes, talking about and we've talked about it in a number of other episodes, leaves your body with a task of having to work on food, and digest food at a time when it's trying to take away that process to do other things. So yeah, you're basically asking your body to do something when it was getting ready to shut down that function and do other things. Right? So don't go to bed on a full stomach.

Jennifer Smith, CDE 17:24
Yes, yeah. That's it. Easy, easy statement to say harbor?

Scott Benner 17:32
Pizza much better and even. It's just obvious. Okay, um, can we do pump site placement? Sure. Alright. So it's always feels weird to start over when we do these strings. Because I come back to them and edit it. I hear myself go, Hey, Jenny, today, can we talk about pumps?

Jennifer Smith, CDE 18:02
We've really been talking for like, 45 minutes. We've been talking forever.

Scott Benner 18:05
We've done like a bunch of these like, and I feel silly. But anyway, hey, Jenny, can we talk about pump side placement today? Absolutely. Excellent. Yeah, we just leave all that in so people know why I'm laughing. So it doesn't matter, right? If it's injected, or pumps, there are just going to be places on a person's body that I don't know what to say, does it absorb the insulin better? Does it use the insulin more efficiently? Like how do we think about it?

Jennifer Smith, CDE 18:36
I think they're both kind of the right way to say it. Because honestly, underneath the skin, I mean, the goal is to have insulin absorb right and to get used in an efficient like, pattern of in, gets used goes out is finished working. I mean, many people on pumps, I think more than people using injections will start to notice places on their body that definitely absorb the best. And other places that they get good use out of, but they might actually have to have a secondary Basal profile that's notched up a little bit more, because they just don't quite meet the same glucose targets with the same basil from let's say, a stomach site versus a butt site or, you know, whatever it is. And then there are some people who can't use certain sites at all. I mean, I personally cannot use my leg. It just it just doesn't work for me. I either get occlusion alarms, or the sight hurts. And I've also noticed with that then it's just not getting absorbed. Back early enough, I guess is the easiest way to kind of explain it. It's it's much less consistent absorption there. So I just I just don't use my legs.

Scott Benner 20:09
Do you think that's because do you think there's a reason to point to do you have like a stronger leg? Is that muscular?

Jennifer Smith, CDE 20:15
For me? I truly believe it's because I just have pretty much just muscular legs. I mean, I've done biking and dance, and lots and lots of things over the years. And I continue to run and do yoga and bike and yeah, I think it's that now the interesting thing is that I can wear a sensor on my leg. No, I just can't put a pump site with insulin there.

Scott Benner 20:42
Okay, is there anything about like, I've heard people say over the years, and I've never understood if it was true, or not, like, I can't put my pump near like the, you know, muscle in my thigh or towards a larger muscle because the muscles, they feel like, you know, the way they say it is that the muscles burning up the insulin, but I don't know, I don't know, imagine that that. Isn't it just that there's not enough like fatty tissue there to move it around? Or no? Well,

Jennifer Smith, CDE 21:06
you know, muscles are, they've got a basketball nature to them, right? So they've got lots and lots of vessels that contribute to keeping the muscles doing what they're supposed to be doing and supplying nutrients and everything into the tissue, right? Whereas fat is just I mean, you've probably seen pictures of like fat blobs, right? Fat balls, right? Imagine Yes, imagine a styrofoam ball, that's a good idea. So when you have insulin infusing pretty close to a muscle, let's say and this is kind of general, you would expect potentially, that you are going to get if you haven't gotten occlusion from nicking a vessel and getting kind of a clot at the end of the canula. And then the muscle because of the nature of vessels, you may actually get faster absorption in an area. Like I've in particular, noticed if I've ever had a site that has bled after I've taken the site out. But it wasn't really, like it wasn't painful. There was no reason to change it prior, but it just was one of those like, gushers that you like, pull out. And then I look back at the couple last days, and I'll be like, yeah, my blood sugar look pretty perfect. Like, it was almost like, I didn't have diabetes, like it was just all working like so beautifully that I felt like, this is just it. I'm just at like this beautiful like point, right? And then I see Oh, well, there's the reason right next to my bud spy,

Scott Benner 22:44
you think he said that it's almost like you're in a very tiny way mainlining the insulin a little bit.

Jennifer Smith, CDE 22:51
And that's what I guess yeah. And it's actually just closer to the absorption line. You know, because when we put a pump site or even inject insulin, you're supposed to be sub sub cute, right? underlying tissue, which is mostly your like, it's like your thermal layer of protection for your body, right, that's where we're supposed to be absorbing insulin through and thus the timeline and the absorption for the trend in rapid insulin, regular insulin, long term insulin. It's all based on how it's supposed to get absorbed in us through that timeframe. Okay, through that tissue.

Scott Benner 23:27
And so I think it's important here to mention that when you buy a pump, any pump, it's going to give you some instructions and tell you here the places you can where your pump all that means is that those are the places that the company who made the pump had the time and money test to test so that they could prove to the FDA that these places worked it and I assure that on the pod probably isn't thrilled if I'm saying this but I you can put your pump somewhere else. Yes, yes, you could try other places I've seen from Chris Freeman where it on his chest, you know when he's in the middle of you know, in the Olympics and that I mean, I've said it before the guys like I don't know what his real body fat is, but he doesn't appear to have any. And you know, and it's on us, it's on his pack. I've seen ladies wear them in their on their breast I've seen people wear them on their hips, their thighs, their calves. I watched somebody do it on their forearm once is like a test, you know, there's no place. I don't think there's any place where it isn't reasonable for you to try based on what I've seen from the community and from people in general. But you are going to find places that work better but then I think that leads us into talking about you can't have too much of our favorite place because you'll ruin it.

Jennifer Smith, CDE 24:44
You have to rotate Yes, very important to rotate

Scott Benner 24:48
have to have to look at your sights and see for Arden they get a little like if she's using them too much I can start seeing them a little vascular maybe like a little red on top like that's the first like sign for And then you can start rubbing your, your you can rub your hand over top of it, if it gets bad, you can feel like it'll get lumpy or hard. Yes, right, that kind of a thing. So yeah, you have to have a place to go. And it is going to change them. Like Jenny said it could possibly change how much insulating Arden just went off the side of her thigh to the top of her thigh. And I had to increase everything by about 20% for that just from the social side of the top of her thigh. So and I think too, for little kids. As long as we're talking about sites for a second, here's probably a good place to talk about when you start doing things with little kids or you know, sometimes adults. They build rules in their head. So that's where my pump goes. It can't go there because it goes there. I always wear it here kind of becomes a psychological thing at some points too. You know, and then you'll see kids will fight against it. Like I can't put it on my arm. It goes on my leg. Yeah, right I Arden 17. And I think she has it. I think she believes her her CGM goes on her hips. Because that's because that's where she likes it where she likes it and it works fine and everything. And if I ever say to her, Hey, why don't you try putting your pot on the back of your arm. It's a flat No. And it's only because in my opinion, she remembers it being there in a softball game one day and we didn't think about it and she threw and then the pod like yanked on her arm as she was as she came across, she had a bad memory of it and now even years later that she's not throwing a softball anymore years later she's has an aversion to putting it on arm you know so sure if there's like

Jennifer Smith, CDE 26:41
an associated kind of experience there

Scott Benner 26:45
Yeah, and then it comes out as this is where it goes and I will fight to the death to keep it here and then you run into a problem where you don't have ways to to rotate sites yes and then you're going to run into a problem and the way I've always put it the Arden is look you keep putting it there and one day you're not going to be able to use that spot at all. And that's that's the thing that helps her move around now I think the other good thing to talk about about that is you know I really have experienced with the Omni pod but sometimes it's just as simple as turning it 180 degrees like you really like it on your abdomen great, have it point towards your belly button this time and have a point towards your side the next time Yes, you know, those are still

Jennifer Smith, CDE 27:23
when I do the same thing you know, especially for backs of the arms which for many little kids because especially for tiny little kids who really don't have a lot of tissue or are very very averse to having it on their abdomen for some reason you know, then that back of the arm like you said it's essentially just turning the pod with that viewing window facing up versus the next time turning it with the viewing window facing down to technically then even have two sights on the back of each little arm that you could potentially use which makes for places between two arms at assumably three days per site. It's a fair amount of these before you get back to site number one on the first or

Scott Benner 28:10
do you think specifically on on the pod? You use it vertically? On limbs right?

Jennifer Smith, CDE 28:17
Correct yeah perpendicular up and down with the viewing window either facing the sky or facing the floor on limbs exactly and then on like your torso region or your upper but you would use it in sort of a horizontal fashion

Scott Benner 28:33
is that because of just the nature of the shape of the pod?

Jennifer Smith, CDE 28:37
Yeah that's from what I know it's nice it's based on the wear comfort wear of the pod itself Yes

Scott Benner 28:45
Do you know a second ago because I didn't want to look stupid I just checked it vertical up and down. Like I googled it right before I said it and then it made me feel so much better because the rest of the world doesn't know either. It's it's a very popularly Google thing is horizontal left and right is vertical up and down. What is vertical? What does a vertical line look?

Jennifer Smith, CDE 29:08
Pretty funny is that paid closer

Scott Benner 29:09
attention in school. Anything about this that we didn't cover?

Jennifer Smith, CDE 29:14
Um, I don't think so. I think in terms of site you covered you know, all the places that are approved versus the ones that people are trying that necessarily approved. So

Scott Benner 29:28
yes, but it's a variable because you are going to get it in your head that these are my settings, and then you're going to move the site somewhere else. And then you start I love it, people immediately go this pump doesn't work. That's always my favorite reaction to everything.

Jennifer Smith, CDE 29:41
Right? And I've got a number I mean as a secondary to that site to site going to number of people, myself included before using, you know the system that I actually use. I actually just had separate basil profiles that I would use from one site to the next more specifically, all Body sights on me work pretty much the same except for my upper but my upper but just seem to need more insulin whenever I used it. So I had a profile that was specific to that. So do you

Scott Benner 30:12
think that and then I'll let you go. But do you think that the advent of g7 Dexcom. Like when it changes form factor? I keep thinking people are going to start trying like a lot of different places because it's going to be easier to put in different places all

Jennifer Smith, CDE 30:27
this probably, I would expect. Yes. I mean, as it is, a lot of people are wearing their CGM is on places that I would honestly like they're, I've seen it on their forearms. I've seen it like, places I would never think of popping it in. But I think getting accurate results. I

Scott Benner 30:46
guess I have to admit, there are times I see those pictures, and this is exactly what I think and I'm just gonna have to bleep this out. I think, man, skateboard, huh? I wonder if we can make it work here. I'm gonna

Jennifer Smith, CDE 30:59
I know I don't even have like, I don't it's all muscle there. I don't know where it would sit under my skin. I would hit something and it would be immediate pain or blood. I

Scott Benner 31:10
I just think of those people as they're they're explorers. They just like I wonder what will happen if I walk across Antarctica? You know?

Unknown Speaker 31:18
Right, exactly. Go find out exactly. I'm

Scott Benner 31:20
not doing it but whatever. Okay, thank you very much. First, I'm gonna thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com forward slash juicebox. There are also links in the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks, also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables, go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate your listening and supporting the Juicebox Podcast. Tell a friend. That is my least favorite part of making the podcast asking you to like tell somebody else. Don't forget to subscribe and your app like it's, I feel like oh, I feel like an idiot having to say that. It's like I see a YouTube video, you know, and they're like, hit the bell do the thing. And I'm like, Oh, this is so sad. And then I come here and I have to do it here and it just it's hard to get people to listen to things and and subscribe and you know, it takes so much for them to learn that the contents there and that it really might be valuable for them. So then I end up saying like, just please tell someone who else you know and just, I don't it makes me feel weird. I don't like it, but I do it because it is important. So thank you so much for listening for supporting the show. If you know somebody else who you think might enjoy the show, also please share it with them, show them how to start listening. podcasts are not intuitive for everyone. Subscribe in your apps people. I just did it. I was like hit the bell thing. You know what I haven't mentioned this in a little bit. The Facebook page is really great. No joking. Juicebox Podcast Type One Diabetes on Facebook. It's a private group with I think it's got like 16,000 people and now everyone's talking about diabetes to really on Facebook like experience. So that is to say it's a good experience with a lot of great people. Check it out.

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate