Scott Benner 9/19/23 Scott Benner 9/19/23

#1002 Diabetes Pro Tip: All About Insulin

In this episode Scott continues his series with CDE Jenny Smith. They delve into the topic of insulin and its importance in managing diabetes. Scott shares a personal anecdote about his visit to a nurse practitioner's office, highlighting the need to understand insulin at its core. Jenny emphasizes the importance of continuous learning and gaining a deeper understanding of diabetes. Tune in to gain valuable insights into the world of insulin and its role in diabetes management.

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

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen, find out more at G voc glucagon.com. Forward slash juicebox. What is it about insulin that people need to understand at its core? And I'll start by telling you that it just a very simple story that that I was in my nurse practitioners office one day, you know I like to say we are at the Endo, but honestly I never see the Endo.

Jennifer Smith, CDE 2:44
Right. It's always a nurse practitioner who is Yeah, yeah. And most often they've got more time anyway. So that's good. Yeah.

Scott Benner 2:52
When people say who's your I know, I sometimes I have to pause. I'm like, huh, I don't really know. So this was a number of years ago back before I think I would quote unquote, say that I started to understand. And I would say that I've understood diabetes on a different plane for about the last five years or so. Okay, but the run up to understanding it was reaching out into the world and picking these little ideas and really wrapping my mind around them. And as much as I tried to understand bolusing, or understand, you know, the, the peaks and valleys my daughter was seeing and all the problems we were having. It wasn't until the certified diabetes educator in my daughter's practice, answered a really simple question for me. I asked her if you had a magic wand, and you could change the way people do one thing around diabetes, what would it be? And without hesitation, she said, I teach them not to be afraid of insulin. She said that would be the core step one. Nothing else matters if you're afraid of the insulin. And I took that to heart. So I guess let's start with why are people afraid of insulin? What do you think it is?

Jennifer Smith, CDE 4:10
I think the main reason is because the initial education includes so much about hypoglycemia, insulin, I mean insulin is one of the very very few medications on the market that doesn't have a tremendous amount but really doesn't have any effect on anything else. You know, it's not going to cause your eyeballs to turn green or you know, your toenails to grow extra inches or anything funny, right? It's its side effect, let's call it is hypoglycemia, low blood sugar. If you don't understand how to use insulin, right so that I mean it is drilled into you if you be careful of low blood sugar. This is how to treat low blood sugar. These are symptoms have low blood sugar, I mean, low blood sugar, low blood sugar, low blood sugar is drilled in. And so what are you going to get from that? I mean, if you're told every time you come to the stop sign that some car is going to come and swipe you, you're not going to like go into a stop sign either, are you?

Scott Benner 5:15
It's funny, I think of when you say that I thought of driving in my mind right away and a little differently I thought of when you first teach someone to drive, you teach them about the brakes. Right? Right. Right. So it's the it's the first thing you think, right? Like, even if they steer wrong, or anything, they're doing wrong, if they can stop, maybe they won't get hurt too badly. Right. And so it is really the same idea. I guess for doctors, they look at the giant picture that is type one diabetes. And they say what's, what's the thing where these people could run into a wall, they could use their insulin incorrectly cause a scary low a scary low might mean if you're an adult, loss of your own function, inability to stop that fall from continuing. Right, right. And then so let's talk about granularity for a second because I don't think we do this enough about diabetes, insulin extracts sugar from your blood. That right? Yes, yeah. And unlike my body, which knock on wood has a pancreas it's working in my body knows when to stop, it gets me to a nice level on it, and it stops, manmade, insulin is going to work until it's not there anymore,

Jennifer Smith, CDE 6:25
gonna work and work and work and work. And it's going to work in an interaction setting with the food that it's meant to work with, or the glucose that's in the in the bloodstream for it to work with. Now, there's too much insulin there, and there's not enough glucose for it to continue to work with. And it's still gotten whole hour of action, right? Absolutely low blood sugar.

Scott Benner 6:45
Yep. And it's not going to cause low blood sugar. Like you said, if there's impact of carbs impact of body function, then that's what the insulin is working against. The minute that carbs are going from your system or the adrenaline you had is gone. This insulin, if it is still there, if you've Miss timed, it is going to continue to work so that we know what we are scared about. Let's be more more honest about it. I'm going to test myself and you'll tell me if I'm wrong. Sugar is the energy that our brain works off of. It's the get the gas for our brain, right? It is yes. And if there's not enough sugar in our blood, our brain shuts off like a light switch. Is that correct?

Jennifer Smith, CDE 7:30
In an easy way of saying it? Yes. If our brain is not getting the that sugar? Yes, we That's why all of those strange symptoms come about with low blood sugar, your your brain is being deprived of the food it needs to function to think the right way. Yes,

Scott Benner 7:49
let's just throw it out on the table, what everyone's really afraid of right. Nobody wants to die when they're sleeping. That's what everybody's concerned about. I don't want to say that that's not an issue. Because if it happens to one person, that's an issue, I would say that I do think of it again, like driving like I think driving is incredibly dangerous. But I do it every day. If I happen to have an accident one day where I'm killed, I will not be thrilled about that, as I see the telephone pole coming for me, right. But I think that's maybe the cost of doing business for being alive. I have to get around, I have to travel. Right? I think the same thing about diabetes, you need to use the insulin in an effective way to make your life healthy, longer, happier, you know, all that stuff. So you have to learn how to do this. And then the rest of it just like driving, you throw it away, you're like, Okay, going out there and I'm going to do my best. The first thing that's happens is people get dizzy, confused, they're easily agitated. But then as your blood sugar continues to drop, you lose the ability to what, like what happens as you continue to get lower.

Jennifer Smith, CDE 8:51
And again, this is where symptoms are different for everybody. But truly what can what really continues to happen is the the loss of the right way of thinking you it just continues to decline. And if it gets far enough, you could lose consciousness, you know, you could certainly no longer be awake. It doesn't mean doesn't mean death. But it does mean that you could certainly pass out from a low blood sugar, which

Scott Benner 9:21
is why you'll hear it adults sometimes say they knew it was coming, they consumed a ton of food, then wake up on the floor because then the food gets in and it turns things around for them. Yes. So I'm gonna I've said this before, but, you know, for context in this episode, prior to technology, I mean, honestly, back when we were needles and little tiny like I've said before, like a diabetes bubblegum eater, right. I have caused Arden to have two seizures. One right after she was diagnosed, she was only maybe a few months into it. And I had this grand idea that I had figured the whole thing out which probably meant she was honeymooning Right, right and we go to the mall One day to pick up some stuff real quickly. My wife's going on a trip and we need I think, another bag or something. Everybody gets hungry while we're running through the mall. And here's this like, mall Chinese food. And I thought, this doesn't, no big deal, right? I'll just count the carbs and I'll shoot the insulin and she'll eat the food and she ate and it was good. And she was little two years old. She had a little bit of food. I gave her no, not a lot of insulin for of for 20 pound person, right, bought the bag went home, she fell asleep in the car later in her crib. My wife and I are helping her. I'm getting her packed up for what she's doing. And then I hear what sounds like a wild animal in my house. grunting and snorting and like like that. And I go into the room, and there's my daughter, she is having a seizure in her crib. And so I pick her up and I don't know what to do. I mean, I know the doctor told us about glucagon. But for the life of me in that moment, I couldn't, I couldn't hold my hands still, I couldn't reconstituted It was a disaster. While she's on the floor, and my then seven year old son is dialing 911. For us, my wife is rubbing glucose gel in her cheeks. And as I'm fumbling with the glucagon and really messing it up, Arden is blind. If you touch her, she overreacts in a way like she thinks she's being shot like, right, like it scared her. She is grunting, and incoherent. And then it just ended. Like, the glucose gel worked. And she came back and the police came into the house and the rescue squad and we went to the hospital. And now I look back, we didn't even have to go to the hospital. Like the hospital was nothing. By the time we got there, her blood sugar was back up and she was fine. And this whole thing, but it's scary.

Jennifer Smith, CDE 11:45
I mean, just one of the worst moments of my life. Yeah, you know, I mean, and I talk with and work with so many parents with little, little little, you know, and it is it's, it's scary when it's when it's your child, and it's not even you, you know

Scott Benner 12:04
the worst thing. Now I tell the scary story to tell what I think is the funny story. Yeah, so a year and a half later, we're at Disney for the first time. It's our first time outside in the heat. On a big day with diabetes like diabetes. A whole day's going great. Again, no CGM still using needles. End of the night we're walking back to the hotel and coming at us is a vendor holding these giant popsicles. And I remember looking up and seeing them and thinking we're like 200 yards from the hotel, like make a left turn, what are you doing, you know, but it's hot out and it's late. And my kids see those and they're like, can we have them? And I thought, sure, I'm going to do what the doctor told me to do. I counted the carbs, I gave her the insulin. And of course, it turns out and I know now, you know, I could have just let her eaten that popsicle it would have been it was a fast acting carb, it might have hit or spiked her a little bit and gone away. She didn't need any of it. But there we are back in the hotel room. Packing again, always packing with seizures in my house. And so we're packing because we're leaving the next day. She's laying in a bed off in another room sound asleep and I hear that noise again. And this time instead of being confused and thrown off. I say to my wife Arden's having a seizure. Now remember, it had been a year and a half since it happened before. And my wife runs and grabs art and brings her back she's holding her and I have the glucose gel in this Squeezy tube. Now the gel we owned, you had to screw the top off of them pull the foil thing off it, I guess keeps it fresh, and then you can use it

Jennifer Smith, CDE 13:40
as your gel spoil. She is

Scott Benner 13:43
because you never because you know because honestly now in the of course the ensuing 12 years later, we've never gotten to never had a seizure since then, but so I unscrew the cap, and I go to squirt out the gel, and I don't pull off the foil cover. And I squeeze it so hard with so much enthusiasm that a pinhole breaks on the opposite side of the thing. And I'm squeezing it. I'm like what's going on and then I look up and on the ceiling of the hotel room is a kaleidoscope of jello. I'm shooting all over the ceiling. So I don't even pause I flip the thing upside down. And now I just scored it from the pinhole in the Ardennes mouth, we rubbed around, she wakes up, we put you know get everything straight, put her back to bed. We were traveling with my brother, when it was all over and to say that it might have been a four minute experience right? When it was all over. I look in the corner and my brother is cowering in the corner, just with a look on his face. Like he can't believe what he just saw. And my wife and I look up and see the gel on the ceiling. We crack up laughing wipe off the ceiling clean it up and go back to packing.

Jennifer Smith, CDE 14:44
His experience is a good example of of the fear.

Scott Benner 14:49
That's exactly right. Because no matter how much I explained it to him, and I said look, you know I don't want to call this the cost of doing business but we've never been in this situation before we're completely blind. We don't know what her blood sugar stowing, I think the point is this. And my point is this, I don't think my point is this. I know my point is this, I don't want Arden to have a seizure. But in GS two to 15, in 13 years of having type one diabetes, it's happened twice, it was both when she was tiny, it was both when I didn't know what I was doing. And it was well before the technology that exists now

Jennifer Smith, CDE 15:22
than before experience of walking around. I mean, in this example of walking around a park all day, and not really knowing, hey, she can probably get away with having this little bit of extra sugar, she'll climb, she'll come back down, and the exercise is going to hit all night long. She doesn't need insulin, you didn't know that I

Scott Benner 15:40
had no idea. And now I do. And now Arden can go play softball for nine hours on 105 degree day, and she doesn't get low at the end of the day. And because now I know what I'm doing. But that fear that exists exists for that reason. And so I don't know how comfortable you are talking about this, because I haven't asked you ahead of time. But how real this is, then we'll get off the fear. And we'll move on to other stuff about insulin. But how real is the concern that I'm going to go to bed one night and not wake up the next day?

Jennifer Smith, CDE 16:12
I would say that the concern? It's a real concern. 100? Absolutely. It is. Is it a concern that it could happen? wildly out of the blue with? And I bring this up with the technology we have today? I would say that piece is it's not going to be as common. Okay. And it's not because we have alarms and things that set now is technology always perfect. No mean, we can get alarms and alerts for blood sugars that are ultra low or look like they've dropped off the map and you do a finger stick. And it's that the sensor was not right, you know, it was a, you know, kind of a compression low. Or you could have a low alert and you could actually be lower than the low alert already. Right. However, the fear of going to bed and not waking up. While I would believe that it's there. For 90% of people with diabetes, the other percent, maybe don't even think about it or know that it's a potential again, education piece there. But I think that there is the knowing about insulin and action going into that time of the night. I think that's a piece that can really help to prevent that from happening.

Scott Benner 17:40
As we move forward, you'll hear me say a number of times that I think that highs cause lows, because highs create situations where you have unbalanced insulin. And and eventually, like we talked about earlier, body function, blood sugar will will be pushed away by the insulin, it's there leaving more insulin behind. And there are a lot of times that people will say to me, you know, I get low at 2am. Or, you know, it always happens. And I think well, I don't know that you get low at 2am. It's very possible that something's happening hours before or you're using insulin hours before. And it's and this is what the residual of that. Right. And so when you use insulin more thoughtfully, I guess is the word I want, right? Yeah, that's

Unknown Speaker 18:24
a great word.

Scott Benner 18:25
You don't have as much of it laying around later in your body that has nothing to do except for to make you low. And I'm hoping that we get to that as we speak. You've addressed fear and insulin, it's a real thing. It exists for most people. There's good reasons why you shouldn't be afraid. But how do we stop people from being afraid?

Jennifer Smith, CDE 18:46
But I think the fear to it just to kind of clarify there, it's okay to be afraid. But it's also really important that you do something to understand and be able to get rid of the fear. It will be there it is certainly but it's important to learn how to not worry so much with the fear.

Scott Benner 19:11
Right? let it overtake you. I think of it let it overtake you. Just like they tell you with fire when you're three years old. You're you have to respect fire. But you can't be afraid

Jennifer Smith, CDE 19:19
of it. Right? Yeah, be afraid of it. Exactly. Yes.

Scott Benner 19:22
And that's what I do. I it was the first delete that I made that brought me to the place where I am now. And I think that I think that no matter what tools you give people, if they're afraid to use them to kind of it's never going to work out quite right. And it's always going to become unbalanced. They're always going to end up in a situation where they go see look, this is diabetes is unpredictable. And and this is always going to happen and then yes, you know, and that that's that So okay, so All right. So what's the first step to not being afraid? It's got to be understanding how to use the insult, right? Absolutely. Okay, all right, so we're gonna get

Jennifer Smith, CDE 20:02
100% 100%. Yes.

Scott Benner 20:04
So let's understand a couple of things first that the insulin can do that cause issues for people and one, right people say, I started using insulin and I started gaining weight. Okay. Now, very recently, I had an interview with Chris Rutan, where Chris said, That's not as really nearly as much about the insulin is, as it is about calories. And that was his take on it. Like if you eat extra calories, you're going to gain weight. And that a lot of times we have low blood sugars that we treat with food, but we don't think of that food as food and access where we think of it as as necessary because it is the moment because you're allowed, but what is the act what is the what is the technical reason why people see weight gain with insulin. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well on your hand, and features Second Chance sampling, which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box free meter go get yourself a free starter kit. while supplies last US residents only touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org. Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean, it's a lot type one, it's school, the D box program golfing for diabetes, dancing for diabetes, which is a terrific program, you just click on that to check that out. Both for cause their awareness campaigns and the annual conference that I've spoken at a number of years in a row. It's just amazing, just like touched by type one touched by type one.org. Or find them on Facebook and Instagram links in the show notes links at juicebox podcast.com. To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org. Why do some people see weight gain with insulin?

Jennifer Smith, CDE 23:41
The easy answer there is that the insulin is being it's being mismanaged the dosing of it is being mismanaged and mismanaged why? That takes in depth analysis of what's going on in the person's individual setting. Right? The and I work with a lot of people weight management wise type one who I you know, I just I've gained weight or I've done this my blood sugar's are now better, but I've gained weight. Now, if to start with, if you're running really consistently high blood sugars, you're actually peeing out calories, okay emptying out glucose because that's how your body is trying to get rid of the excess because there's not enough insulin there to bring it into your body and utilize it. So you may be maintaining a weight that you love. Your blood sugars are high, that's it's not healthy. On the second side, once you do rein in control, and you're now taking insulin to contain blood sugars, you may be gaining weight because your body is now retaining some of those calories that were being lost before that you didn't realize right. So that comes then to the point of understanding lifestyle and the Management of insulin. And I bring up a really important piece that people don't, people don't realize insulins job is a storage hormone, insulin job is to pack the food into different places in the body, right? It either packs it and moves it into your muscle cells or at PacSun, and moves it into fat. Right? It's usable, or it's going to be hopefully used later. If there's too much of it, your body has to pack it away and utilize it later. So that's a that's a lifestyle piece. That's something to look at and say, Okay, where's my activity level where it is my nutrition intake needs to be is my insulin matching that, am I driving my glucose values too low, and like you said, Am I taking in too much because of low blood sugars that are consistently happening, and then you're adding more insulin to correct the high that follows, and then you're dropping, and you're adding food and you're correcting and add. So it becomes this vicious cycle of management, if you don't understand how insulin works. And in a body, I think a good point is that in a body without diabetes, insulin plays a very big role in weight management. And people without diabetes aren't injecting it, their pancreas is making it. So if they're themselves not managing lifestyle, they're having to produce a heck of a lot more insulin, to bring food out of their bloodstream for their body to maintain that normal blood sugar, the way that it's meant to do, they will likely gain weight too.

Scott Benner 26:35
So do me a favor and go over that cycle for a second, I take something in through my mouth that has carbohydrates in it, it goes into my stomach, my bug, my body begins to break it down. It basically those carbs are leached out, that's sugar, which is the sugar is carbs, the sugar comes out. And the insulin actually helps it go into my blood. Right it or how does

Jennifer Smith, CDE 27:02
it insulin takes insulin, you know, we take it, we inject it or we pump it into our sub q tissue, it gets absorbed and dissipates that into our bloodstream is I guess the easiest way to say how it works. Insulin in the bloodstream then matches with the glucose from the food that we've eaten in whatever form you know, it could be rice, it could be celery, it could be an apple, whatever it is, sugar in the bloodstream. The insulin kind of combines with the glucose they latch on together. And insulin is then the key to the door on the cells. With insulin, the doors open, the key unlocks the door on the cell, the glucose is allowed to enter the cell muscle cells then use it for energy. Fat cells, pack it away, right? So that's how

Scott Benner 27:53
it works. And so with, so without insulin, we go into DKA. Right? And so MDK is what is it technically, but what what is it that's happening.

Jennifer Smith, CDE 28:06
So technically, with DKA, it's it's a significant deficit of insulin with high blood sugars. Right now, there are cases of DKA at more normal blood sugars. The DKA, however, really is it's a deficit of insulin, meaning that your body it has no way to clear the glucose out of the bloodstream and move it into the places it needs to go. Now your body tries to compensate. Like I mentioned before, with the weight management piece, if it tries to compensate, you get really, really thirsty with higher blood sugars, you take in more fluids your body up because you're drinking more, and your body is trying to flush a lot of that extra glucose out. And the only way it can if it can't do that forever, though, at a deficit of insulin. And so your body at the point of not having energy from glucose, it starts to break down fats and proteins. So ketones are produced with the breakdown of fat.

Scott Benner 29:10
Is that why when I think back on Ardens diagnosis prior to which she was ravenously, hungry at the end, because she her body was starving, and it's telling her eat, we're starving, except the food went in. And then there was no insulin to move it into the cells where it was needed.

Jennifer Smith, CDE 29:26
Correct? Correct. I mean, I could have I remember, I mean, I was older than your daughter and I very, I very much remember the two weeks leading up, especially the week leading up to my diagnosis. I very much remember it. I mean, I at the lunch table at school with my friends. I was asking them for their milk. I was so thirsty and so hungry. And so they would they would get two milks, and they would bring one for me. I mean, I was consuming probably six of those little curtain Have milk at every lunch and between classes in the hallway I needed to get to the water fountain. I mean, it was. It was unbelievable. The unquenchable thirst and hunger.

Scott Benner 30:11
No, that's crazy. It really is. threw me off for a second thinking. No, I was thinking back on Arden's diagnosis. And it, it just, it always just makes me think like, how do I not see her dying? Because she was, you know, like, like, no insulin in her body. And she was withering away and you look back at it.

Jennifer Smith, CDE 30:29
I think for kids, it's hard to because kids are hungry all the time. I mean, I've got a two year old and a six year old and man, like every hour, they're like, I'm hungry. Grab this. I am hungry. Can I have that kids are hungry? Yeah. But it's a different. It's a very different ravenous in that setting.

Scott Benner 30:46
Oh my god. Yeah. And so let me ask you something when a blood sugar starts to get low with a person who's being managed, but maybe they have theirs, their insulin is on balance, and they're getting lower. Arden will say she's hungry, prior to a low blood sugar. And I always tell her, Hey, if you feel hungry, first thing we should think about is are you hungry, hungry? Or is your blood sugar getting lower about the same function right there?

Jennifer Smith, CDE 31:11
In a in a similar way, just in an opposite, you know, high blood sugars, you're hungry because your body is starving for the energy. Right? And it's not getting it. low blood sugars. You're hungry because again, as we talked about, initially, your brain is being deprived. Okay? Your brain is saying, Hey, you're hungry. There's not

Scott Benner 31:37
enough. There's

Jennifer Smith, CDE 31:38
not enough food here. i There's there's too much of this insulin, it's calling. And sometimes even that precipitous drop in blood sugar that can happen.

Scott Benner 31:47
That's why manifests as hunger. Yeah, is there

Jennifer Smith, CDE 31:50
with Lowe's. I mean, you could literally go to the refrigerator and eat the whole roof. I mean, there, there are people who have done that, or just the whole box of cereal. And they're like, Okay, where's the next box? You know?

Scott Benner 32:01
It's yeah, and it's commonly referred to as eat the kitchen. Right? So yeah. And then and so. But when Arden was younger, and before sensor technology, and I was staring at her trying to figure out ways to understand where her blood sugar was. One of them was if she said she was hungry at what I thought were odd times of day. I thought, Ooh, she might be low. And yeah, yeah, because the looking for the bags under their eyes was not working. I'll never forget, she's diagnosed and the nurse practitioner goes, you know, dark circles under the eyes could be signs of low blood sugar. And then she paused and she goes are high blood sugar. And I was like, Wait, what was that gotta help me. And by the way, it never came to fruition. I spent, I spent the first year of her diagnosis, staring at her face looking for a sign of something wrong with her blood sugar, and it doesn't exist.

Jennifer Smith, CDE 32:51
I have never heard that before Scott in that, right. Yeah. Never heard that as a symptom of high oil.

Scott Benner 32:59
And it makes me think of the insanity of like when Arden will say to me like you know, you'll be in the middle of a CGM changeover. And I'll say, hey, look, it's been an hour since we reset the CGM, or since we put it on whatever, why don't you go ahead and test let's just make sure we are where he thinks you're at. And she'll say, I feel fine. And I always go, ironically, how you feel is not the best indication of what your blood sugar is. So and so she still won't wrap it, she still doesn't wrap her head around that right away. If she feels okay. Then she thinks I'm okay. You know, well,

Jennifer Smith, CDE 33:32
and there's some children that have not quite even gotten to the point of realizing what the difference of body feeling is. Yeah. Right. And if they've lived with diabetes long enough, they may not necessarily know what, quote unquote, normal should feel like, right? Yeah, they may not know that at your diagnosis at two or three. They're not even realizing outside of like, an ear ache, that they're like screaming in pain, or they're pointing at their mouth because their tooth hurts or whatever it might be. Kids that young are not in tune with

Scott Benner 34:11
how their body's supposed to feel, and and

Jennifer Smith, CDE 34:14
associating it with oh, I'm low mommy, or I have high blood sugar. And so then moving on through life, because they've had diabetes, from such an early age when you do start to make those connections. It's very difficult to translate that then into you know, older age.

Scott Benner 34:33
So I was it's funny you brought that up, because this was gonna be my next question for you. So I just was interacting with somebody on Instagram. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G Bo Capo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma visit G voc glucagon.com/risk, who, you know, found the podcast is bringing their blood sugar down. And now they have a beautiful stable 85 blood sugar where they feel dizzy. And, okay now, so I'm talking to this woman, and she says, I'm going to ignore it, I know it's not real, like, I know I'm not in trouble. So I'm just going to power through on my maybe I'll give myself a little bit of carbs to, you know, kind of help it a little bit, but I'm gonna power through it. Because I know my body's going to adjust to this. And I spoke to a different person who said that they got to that that nice, stable, good number, and they stopped themselves from eating too much. But it's still they had trouble doing it. So my question is, when you've spent such a long time with an elevated blood sugar, you know, thinking 180 was a great day, you know, your 250 for six of the hours of the day, and you finally get this all under control. You keep listening to these podcast episodes, and you get to a place where you're at five and stable. When that first happens. You feel like you're low? What's the function of that first of all, and tell people that it's going to get better, please?

Jennifer Smith, CDE 36:18
Yeah, the I mean, the function of that is because your body is having to adjust to values that it hasn't seen as the norm, you know, an average of one at an average of 200, an average of 250. While it's high, you're you may feel normal at that, because you don't know what a normal value or a target value feels like. So as you start to notch things down, your body has to readjust to that new normal value, and it does take some time. So hovering, you know, now at even 110. For somebody who is averaging 200. They may feel low. Okay, that may very well feel low, it doesn't mean it needs treatment, is it's truly not a low value, but it does feel low. And so it's hard. It's hard to work through that.

Scott Benner 37:17
I don't know. But I can imagine. Yeah,

Jennifer Smith, CDE 37:19
yeah. So I you know, I think as far as CGM, especially I think that's that's good technology now that at least they can also see where things are going. I mean, if they're at 110, feeling low, and they're all were all red, they're consistently still dropping very much, especially, you know, fingerstick wise, they might be lower than that. If they're on a trend, if they're hovering nice and stable, nice horizontal line at 110. No need to treat that.

Scott Benner 37:46
Yeah, fight through it. How long is it, I realized it'll be different for everybody. But what's the average amount of time before stable in range, blood sugar starts feeling normal,

Jennifer Smith, CDE 37:55
usually, at least a couple of weeks. I mean, from starting, you know, at the end, depending on timeframe of how long things were higher, it may take a couple of weeks for that to feel normal at those lower in target values. And again, stability there, and lacking this big jump up and down and whatnot, that makes a difference for resetting those symptoms in your body. Okay.

Scott Benner 38:25
I have one last question. And then we're gonna move on to something else.

Jennifer Smith, CDE 38:28
Can I show you my line right now?

Scott Benner 38:29
Yeah, sure. But look at you. Okay, I'm looking at at Jenny six, our Dexcom line that looks like it's been right at 100. It might have dipped to was that where's your low at 60? Or 70? Was at 770. It hit 70 for a little while, maybe for about an hour, and then it banged up at 85. This is very, pretty good for you. Are we? Are we are we are we gonna? Okay, let me compare. So Arden has one compression low in the last 12 hours. That isn't real. But other than that, let's see if you can see that.

Jennifer Smith, CDE 39:06
Very nice. Thank you. She's even averaging lower than me right now.

Scott Benner 39:10
And we it's a new it's a new pump to get the best day. Yeah.

Jennifer Smith, CDE 39:17
Those pod change days are like, it's almost like magic. Well, can be almost like magic.

Scott Benner 39:24
I actually just walked through walk somebody through how to pod change without a high and we'll talk about that when we talk about pumping. But yeah, so here's my last question about insulin. It's gonna I'm gonna go back to something scary for a second, but I think it's, well I know how impactful it was for me. So back when I had to dispense with my fear of insulin, like we talked about at the beginning. How do you do that? Right? Like how do you make a leap like that for me and it will probably be different for a lot of people. I started thinking more about long term health. I realized that the doctor was telling me to leave Arden's blood sugar high so that she wouldn't get low. We We were trading today's Health for tomorrow's Right? Like, we won't die today. But we might not live a long healthy life either, right? And I thought that can't be okay. But I still couldn't make the leap. And finally, I thought about it in as technical and scientific away as my brain would allow. And what I, what I came to, to think about was, I actually spilled some sugar out on the table, and I looked at how kind of coarse and granular and sharp it was on its edges. And I thought, well, at its at its microscopic, like existence, it's probably still course and sharp like this. And our bodies are built to handle a certain amount of it flowing through our blood. But if you pack that blood with too much, that must be and this was me thinking my way through when people say, I, he died of a heart attack, you know, because of his diabetes, or he went blind because of his diabetes, or he couldn't feel his foot anymore. What that really means is that the sugar has basically sandblasted you from the inside, damaging, right, making damage to the inside of your veins, capillaries, all the places where bloods covered, right, if you have a heart attack, and they say it was because of diabetes, it's because the flesh in your heart got rubbed thin, and it burst. And

Jennifer Smith, CDE 41:18
and you know, and beyond that, beyond that are the other the other pieces of those complications, such as heart disease, right? That come about, and most actors don't teach this. And I think you know, it may be a time thing it may be that they don't want to get the in depth piece of it,

Scott Benner 41:42
I think might be a good thing to bring up on day three of your exactly your sandblasting yourself,

Jennifer Smith, CDE 41:48
you know, I have a good and I wish that I could show this to everybody. But this is a tube full of a glucose solution. Do you see how slowly those little they're supposed to be particles of sugar are flowing through the bloodstream? Yeah, sugar or nutrients, right, I like to refer to them as nutrients because this is the other piece to overall long, long health with diabetes is as you mentioned, glucose I love your rough part of that example, because it is high glucose levels cause your cause your blood to get thick, almost like molasses in winter, okay, which means that all of the nutrients your bloodstream are also flowing very slowly to all the places in your body that need to get those wonderful, micro macronutrients. So healing and everything gets slowed. If your glucose level stays high, the the roughness of that sugar that you're talking about or the high glucose values it is it's very damaging to vessels almost creates like rust on a car, it creates damage on the inside of the vessels, your body tries to heal itself and self heal healing machine, your body actually makes cholesterol. It's like a band aid. So even if you never ate cholesterol, again, your liver is meant to make cholesterol and cholesterol is like it does a lot of other things. But it is also a patch. The more damage the more patch Do you see how narrow my vessel is now getting the more and more patches, those vessels that narrow that leads to high blood pressure, high blood pressure damages your kidneys High Blood Pressure puts a lot of pressure on the vessels in your eyes. So it's a it's a snowball effect right? With consistently maintained high blood sugars now have a 200 blood sugar because you decided to eat the whole you know Disney princess cake or whatever and then you bring that blood sugar down that's that's a different story than this consistent maintenance of high glucose that's different

Scott Benner 44:01
Yeah, I think that when people when I say that Ardens a once has been between five two and six two for five years I think people imagine a steady 85 blood sugar forever which is not the case no right she spikes up just like everyone else you know if you're gonna if you're gonna eat with diabetes and not have you know, you know not not have boiled it down to low carb or no carb or somebody that you're gonna miss sometimes I miss on boluses you know, insulin pump sets aren't as effective on day three is they aren't day one. There's reasons why right? Yeah. So it really is. It's not a perfection. You're looking for it. It's it's a fluidly it fluidly. It's a consistency to how you manage that's what keeps your Awan cielo. Right as you were describing cholesterol coming in and making patches on you know, arteries or veins. And it it thinning. You know, that's what people would commonly think of as needing a stent in their heart, right like eventually it has to open up that space again. All right. So for me back to what I started to say, I got past the fear by saying to myself, I can't let my fear of something happening to Arden today affect her entire life. Like, I just can't do that. And, and if that means she's gonna have something bad happened to her, or my life's gonna be a little more hectic managing insulin, then that's got to be what it's got to be. Because the alternative is, I put all this effort and heart and love into my daughter, and at the end of my life when I'm 65 7080 years old, and I'm looking back at my 40 year old daughter, and she's in incredibly poor health. I'm gonna think, like, what was this all for? Like, you know what I mean? Like what I spend my whole life doing? So I'd rather get in the game now, and do the best I can let the chips fall where they may a little bit, then just to ignore it, I can't I am not across that bridge when it comes to IT person. I find I find when you think about life like that, people have heard me talk about it on the show before you get a bill in the mail. You can't afford it. And you know, you can't before you open up the envelope, just open it anyway. Be an adult and go I owe the electric company 400 ollars. Like, no, they're

Jennifer Smith, CDE 46:17
not gonna be better tomorrow, it's gonna be the same bill. Absolutely.

Scott Benner 46:20
It's the same idea with your blood sugar. Like, don't ignore it. Don't say to yourself, it's okay. I'll deal with it later, because later is going to be worse. Now Sox laters worse. So, get in the game, do it. Now.

Jennifer Smith, CDE 46:34
I've always thought about myself, personally, I've always thought about all the things that I am able to do. Because I choose to manage because I have chosen to understand how to manage. I mean, I, I've done a lot of awesome things. I've had two kids, I, you know, I want to see those kids grow up. I want to be around with them. And that that is the biggest thing to look out to future wise. And remember every day Yeah. And that's

Scott Benner 47:09
why you and I are doing this like series inside of a, it's a series of podcast episodes inside of a podcast. Right? Right. It's because somebody's going to hear that and think, yeah, that's nice, buddy. But I don't know how to keep my kids blood sugar at 70 and blah, blah. But I'm telling you, we're going to talk about how to do that in a way where you don't have to when you hear the idea of keeping your blood sugar stable to lower number, it doesn't make you think, well, that's impossible. We're, we're going to talk about the tools that make it possible. And I'll leave this episode with this thought. Three nights ago, a man in his 40s I saw him on Facebook, and he was basically begging people, he was at the end of his rope. And he had had diabetes for a long time. And it was just not going well. And people were all jumping in given them, giving him their best piece of advice. And I always think the same thing. When I see people on social media. I'm like, wow, that's valuable. But how do you make sense of it, you know, then somebody will say something else, like, oh, well, that's not really that valuable at all in this situation. But I see why it's well meaning. And so then the person's frazzled, to the point where they thought to reach out into the world to strangers, right. And now these strangers are throwing 20 ideas at them. None of them are cohesive, even if they're good. And so I just couldn't take it. And I, I stepped in and I said, if you want to message me, I'll see if I can help you with us. And they were very kind people who all jumped on and said I would mesh with Scott if I have a show. So we got on, we got on the phone. And 45 minutes later, we got off of the phone. And the next morning, he sent me his steady overnight graph. And then at the end of that day, he sent me his 30 Day graph, and then next day, and the next day. And my point is, I can't talk to all of you on the phone and Jenny can't speak to every one of you personally, but I think we can give you enough tools to get you to that spot. So so keep going with the with this series and I think you're going to be happy that you did. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter. while supplies last US residents only. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox you spell that g VOKEGL. You see it ag o n.com forward slash choose box if you're enjoying the remastered episodes thirds of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. If you're living with diabetes, or the caregiver of someone who is, and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast, private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members, and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You may not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin popping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We talk about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She has also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.

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#1001 Diabetes Pro Tip: All About MDI

Remastered Diabetes Pro Tip: All About MDI
Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:05
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. How frequently does someone leave a diagnosis with an insulin pump?

Jennifer Smith, CDE 2:31
I would say never part of the reason for that not leaving a hospitalization or a doctor's office with a pump is because of all of the red tape that you have to sort of go through for ordering and you know that kind of stuff. I would say the rare case, this is probably 10% of the time, maybe even less, somebody's pretty quick to get the order written by their prescriber. And in fact, I worked with somebody maybe a month ago that her little boy was diagnosed and had a pump within about six weeks. Okay, but that's pretty quick. It's not typically that fast.

Scott Benner 3:10
Most people are going to get diagnosed with type one diabetes and leave with either pens or syringes or syringes, right? Yes. And so whether you're a person who thinks right away, I have to have a pump and you hammer through insurance and get it six weeks later. Or if you're a person who gets told, we don't give pumps to people until you've had diabetes for six months, or any of those arbitrary times that doctors throw out one year or until you're in perfect control, then you can have a pump as soon as you know how to do this so well that you'll never want to pump we'd be happy to give you one which will never come and so so people are going to need to know what managing with just MDI looks like so multiple daily injections. These people are going to get some sort of a fast acting insulin that they can use at mealtimes and to try to adjust highs and they're going to get a slow acting insulin that's going to be their Basal insulin. Right? Well, so let's start slow with the Basal insulin. There's a lot of them on the market at this point back when Arden did MDI we were using love Amir, and we found that we had to split it half a dose every 12 hours. How how much of that is really good advice about slow acting Basal insulin, specifically,

Jennifer Smith, CDE 4:25
that what you found with the love Amir as a specific brand or type is very common. Okay. While while the you know the makers of love, Amir will say that it is a 24 hour acting insulin. What we find, especially with the smaller doses, is that dosing twice a day or two injections of it works much more optimally because it doesn't carry a full 24 hours.

Scott Benner 4:54
That was absolutely my finding. I think a lot of people find that so that's the first thing to understand. If you Save yourself every day a certain time my blood sugar goes up. And I can't understand why I bet you it's about 18 to 20 hours after you've injected your slow acting insulin. And so the important thing to remember when you if when you make the decision to split your Basal insulin is that it might not be a 5050 split. So say you have your five units or a one unit, it doesn't matter, it doesn't mean you're going to put in a half a unit and then a half unit again, 12 hours later, it might end up being three quarters of a unit or one and then a half later, there's your because your body has different needs at different times.

Jennifer Smith, CDE 5:37
And that kind of goes into understanding the needs of the different age groups, kids and teens tend to have a much more profound increase insulin need in the overnight like literally like as soon as their head hits the pillow kind of thing and through and into the overnight. So splitting doses for you know, multiple daily injections with the Basal insulin, you may have a heavier dose in the evening than you do with that morning time, the heavy dose in the evening carries you through the increase in need overnight, as well as the morning which is a little bit higher resistance as well. And then your dose in the morning kind of carries you through the day when you're more active, right? And you likely will need a lower Basal amount. And so

Scott Benner 6:23
all we've really said here, and I repeat this a lot to people is that setting up your slow acting Basal insulin when you're on MDI is about amount and timing, right? Yes. We're gonna say this in the next episode, but so make sure you get to that next episode, but you have to balance the impact of the insulin against the action of carbs or body function, right. So it's just, it's about a tug of war between those things. And that again, I'll talk about a little later. And that's where

Jennifer Smith, CDE 6:56
watching you know, glucose values, especially if you are privy to getting a CGM early on, which I do encourage over I've said it a million times to people that I work with, if I had, if I had to decide on a technology piece between CGM and a pump. If somebody was going to take one away, I would 100% Keep my CGM, right 100%. Take my pump, I'll figure out my multiple daily injections. As long as I've got the data and the trend of what's happening, I can figure it out.

Scott Benner 7:25
If you are going to I would 100% agree with you. If you're going to say that one thing is more important than the other, which I think is a bit of a you know, yeah, right. I I'm not looking to give one of them away. But am I by any means when you when you lose your pump when you're using MDI, what what that means is that if you want that kind of like, tighter control, I guess you're going to be injecting more. If that doesn't bother you, then right on, you know, like, that's absolutely fine. You also

Jennifer Smith, CDE 7:53
see what my friend ginger does. Ginger Vieira, who I wrote the book with the pregnancy book, which you know, she long term has been multiple daily injections. She uses CGM. She is not scared to give 1216 20 Micro dosing adjustments through the course of the day to keep things tightly managed.

Scott Benner 8:15
So and I think so I always say the same thing. Here's what you gain with a pump. You don't have to inject all the time. And you now have the ability to manipulate your Basal insulin. Yeah. But other than that, there's no more precisely

Jennifer Smith, CDE 8:27
right, right can manipulate Basil with injected basil, we don't, we don't recommend it. Like we would on a POM it's difficult to difficult, it's difficult to manipulate. But you can use your precision to do that on punk. Yeah,

Scott Benner 8:44
the first time I thought about getting on a pump, and I didn't know anything about them, and I went to a pump class at our children's hospital. You know, even back then I didn't realize that, that my Basal insulin would just be fast acting insulin given by the pump, but in smaller doses, like, like, spread out over minutes and hours, right. And I didn't I didn't think about that. It was explained to me in that room. And then I thought I could shut it off. Like because how many times I thought, Oh, I wish this level mir had an off switch right now. Because it turned it off. She's so stable and she's at but I know she's gonna go down because this, this level here, she's gonna keep working in the background. I

Jennifer Smith, CDE 9:22
don't want to feed her three juice boxes just to prevent it right. Yeah, looking for

Scott Benner 9:25
that. I have become adept at manipulating artisans, blood sugar, with Basal insulin through her pump. But that's not what we're talking about right now. But we'll get to it in a different episode

Jennifer Smith, CDE 9:35
leads in it goes very well with MDI, because you can manipulate differently even if you are on MDI.

Scott Benner 9:44
And so, so I guess the first thing, just very basic ideas you're injecting, you need to pick multiple sites, keep rotating your site you can put in so on and over and over in the same spots. It's incredibly important because you you're Your spa your spots will become saturated you can actually what do they call that when that when you can actually see like bumps under this under your skin from Yeah, it's

Jennifer Smith, CDE 10:08
it's really a either a scar tissue development or potentially fatty tissue under the skin that that light lipo hypertrophy, other big, you know, fancy words for it. But really, it's just when you inject in the same place over and over and over and over again, you're damaging the underlying skin tissue. And it can lead to, like I said, either scar tissue or fatty deposits. And unfortunately, then the absorption in those areas is quite variable, variable, if anything at all,

Scott Benner 10:42
and you could lose your favorite place and never be able to use it again. Exactly. So when your doctor or your nurse practitioner tries to scare you with whatever, Jen, whatever Jenny just said they're like or something like that. Just think to myself, just think to yourself, Well, that sounds scary. What she meant was rotate your sights,

Jennifer Smith, CDE 10:58
rotate your sights, and there you know, there's so many places on the body to use mean the backs of the arms, the lower back the upper, but the legs, the tongue, the tummy, the sides of your tummy. I mean, you've got a lot of places to use. So I think with little kids. That's always a it's a question with parents, you know, mainly because little kids are, there's so little, I mean, Arden was too, right. So it's, it's like it's finding the place on such a little body.

Scott Benner 11:30
That remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next one.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and a carry case. But most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well in your hand, and features Second Chance sampling, which can help you to avoid wasting strips. Every one of you has a blood glucose meter, you deserve an accurate one. Contour next one.com forward slash juice box free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box free meter go get yourself a free starter kit. while supplies last US residents only. And let me veer off for a second to say something that I think people will find valuable, especially parents. I did some quick math and in the time between art and being diagnosed just after her second birthday. And when we got her on an on the pod when she was about four and a half. I think we injected or you know or stuck her fingers a combination of 10 to 15,000 times those years, right? A lot. And every time broke my heart in a way that I find difficult to put into words. And years and years later, we had been on the on the pod for years before we ever ran into a situation where I thought I should inject here just to see if my site is bad, right? So we had had we were on just a really great run with with insulin pump sites. But one day, a number of years after we switched from from MDI. I said to Arden, hey, I'm not sure if this site's bad. And I don't want to change the pump if I don't have to. So I'm going to inject some insulin. If it starts going down right away. I'm going to say the pumps, sites bad. And if it doesn't, then you're just resisted for some reason. We're going to give you more insulin. So I put her up on the counter. There she is, you know, she's like six, seven years old. And I pull out the insulin and she's just going along. And I bring out the syringe and she says, what is that? And I was like it's a syringe. It's a needle, I'm going to put the insulin in and then she goes and then what? And I was like, Well, I was thinking of injected and she was like whoa, wait a minute, like really? Like, what are you doing? I'm not getting a needle. That's not something I do. And I was like Do you not read Remember these? No idea, no recollection of ever getting a shot ever. So I know it breaks your heart as a parent. But I don't want to say kids are resilient, but time has a way of, you know, blurring the past. So yes,

Jennifer Smith, CDE 15:15
absolutely. Absolutely. And that's, you know, even pump sites, then, you know, same thing with rotation. Yeah, yeah, they all need to be rotated. And that becomes the, I think it as an as an omni pod. Plus, there are so many more places that you can put that pod. And easier, especially from the kid standpoint, or anybody who has dexterity issues or whatnot. You know, because there's no tubing, there's no tubing, and you can pop it on. And that's even easier than an injection.

Scott Benner 15:47
I've seen people put them backs of arms. Arden, where's hers, you know, the left of the right of her navel on her stomach, and you can even and she wears them on her thighs. You can even rotate within a rotation. So you could put it on your stomach cannula facing your belly button. And then the next day turn it and you know, put it the other way like you can. If you have four spots, you have 20 You know what I mean? Because you can just kind of start moving around a little bit of grown grown women who wear them on their breasts like that one, like I show that every once in a while somebody will kind of like pull their shirt down online. I said it's the art and art like I've never doing that.

Jennifer Smith, CDE 16:26
Yeah, I've not tried that myself. Although, you know, this year, Chris Freeman.

Scott Benner 16:32
I was gonna bring Chris off. He wears, he

Jennifer Smith, CDE 16:34
wears it on his chest. Yeah. And I know, he also wears it on like his upper back. And I've seen people on many of the like the Facebook, diabetes groups and whatnot. The places that I mean, people wear them on their calf, I've seen people wearing them on their forearm. Now, although not approved sites. Again, this is where your diabetes will vary. And you've figured out what works for you. But you know, yeah,

Scott Benner 17:02
and for people who don't know, Chris is a four time Olympian and a cross country skier. And there is a picture that he shared years ago that is to this date, the most popular thing I've ever put on my website. So ladies, you might want to look at why you're clicking on things. But it's a Chris without his shirt on. And he has no body fat to speak.

Jennifer Smith, CDE 17:23
And just wear the reason he wears it there he does. And my

Scott Benner 17:27
point is he's still pumping and using a Dexcom. And so if someone tells you, you're too skinny for this, or I've heard it both ways, it's so funny. Oh, you're too your kids, too chubby for that pump. Your kids too skinny for that pump. i There have been I've heard a million different excuses. But okay, so MDI, so rotate our sites, what are other good practices around MDI.

Jennifer Smith, CDE 17:50
Other really good practices, make sure you are changing the syringe, if you're using a pen, really, really important is syringe itself, as well as the pen needle caps. In fact, one of a very, a very common practice for people to do is reuse the pen cap. And by reusing, they actually store the insulin pen with the needle cap, screwed on to the pen. Really not a good idea, it can introduce air into the pen. And it can change the way that the pen dialing can actually dose the insulin. So if you are going to reuse the needle cap, I don't recommend doing it. But if you are going to do it, take the needle cap off in between those uses. Always make sure that you're wiping the top of the needle or the insulin pen itself, you know, with an alcohol swab, just cleanliness. Those are kind of the basics.

Scott Benner 18:49
Okay, well, what about and I realized to go back for a second you were starting by saying Don't reuse a syringe, which never in my wildest dreams even occurred to me, but you're telling me people do that, too.

Jennifer Smith, CDE 18:59
People do that. Absolutely. And, you know, having worked with people across the spectrum of economic setting, just like insulin is expensive. I mean, even though a box of syringes is not expensive, even off of the shelf, it's not expensive without a prescription. Again, it may be something that people are reusing because it's an expense that they could decrease

Scott Benner 19:27
somewhere, right? You know, so if you can avoid that, please do. So I have a question and here's a good place to put it. I'm probably gonna bring it up again when we talk about pumping. So the quickest story would be that one day I took off Arden's pump and I saw little redness under where the adhesive was. And I was quite literally standing in my house, rubbing my hands together thinking because I was scared oh my god, is she allergic to this adhesive and we can't pump anymore and like my brain was racing, and I'm rubbing my hands together and rubbing my hands together and as I was doing and I thought, Why are my hands so dry? And then I realized I'm constantly touching alcohol. Yeah. And so I do a little research and I find out that in Europe, it is not common practice to clean anything, a site with alcohol. And I was like, huh, so I stopped doing that. And Ardennes never had that problem again, and my hands don't crack as much in the wintertime. And so is that a lawsuit? Decision? Like do you say to somebody clean this with alcohol first? Because every once in a while someone's gonna get an infection? Or why do we teach it and some other places don't?

Jennifer Smith, CDE 20:42
Alcohol itself is not a I guess the best thing that that I can call in layman's terms, it's a degreaser. It literally wipes clean, that area of any grease, any any skin, moisture, any lotions, anything that could be on there. It's it's not antibacterial, okay, it's wiping the area clean. Sure, right. But the real reason for cleaning the site is just to make sure that you've, you've taken care of anything that could be there. And as far as adhesive component, it's very likely, of course, that the adhesive isn't gonna stick as well as if you've got body lotion on it. Or if you haven't taken a bath in two days, and you're putting it on your skin and your skin has done its normal thing, and you've got oily skin. So the adhesive isn't really going to stick as well. What do I tell people, I also do not use alcohol. Oh my gosh, a CDE. That doesn't use alcohol swabs. But I do, of course, have a clean site. And by clean sight, I make sure that I wash the area. Soap and water, make sure that it's clean, dry it and that's what I you know, apply on top of then you're entirely 100%. Right? Alcohol is it will dehydrate the skin and used over and over and over, especially for kiddos little kiddos who have very sensitive skin to begin with. You're just asking for more. I mean, there are skin barriers, if you do truly have, you know, a slight problem. But yeah, even for injections though, making sure that the injection site is just clean. I mean, obviously, if your kids been outside rolling in the mud or in the sandbox or doing whatever they've been doing in the rain puddle, clean the site.

Scott Benner 22:37
We do the same thing, I use warm water, a clean towel, a clean towel to dry it, let it air dry, something like that. It goes on, you know, schedule your pod change around your shower, you know, get out of your shower, pod change. Sometimes, you know, I see some people like they call them naked showers where they change all their gear, they take it off before they jump in, they're free. They're free for a couple of minutes and they jump out and they do it then there's a bunch of different ways to do it. But I think the important thing here is to use your common sense, right like to and that's all I did that day, I thought I'm drying her skin out and then throwing this adhesive on top of her No wonder there's a reaction here. Absolutely. There is a wonderful post on my blog about how to treat real severe at ease of allergies it is is one of the most popular posts over the last five years. And I'll link it in this so that people can find it was written by a mom who devised a infallible plan. And when you see the pictures of the reaction that her poor kid was having, it was an all over body reaction. And she figured out a way for it not to happen and him to keep using this stuff. So that was really good. I remember the first time Arden was in like a thin pair of like yoga pants as like a four year old and or a three year old or four year old and I wanted to give her a shot in her leg. But we were out and I just was like, I'm just going to jab the needle right through the pants. And that's what I was like, Okay, maybe all these rules aren't that important. And you know, and so she was like, Oh my God, what are you doing? And I said, No, it's fine. I brought it up in you know, now I say I've done that in the past and she was mortified. She's like, why would you I was like, listen, we were in the mall, you know, like, like, what do you want me to because I and here's something I really believe. And I think this is a great place to bring it up. I don't think you should hide when you give yourself injections. I think I agree. I think that not just not hiding. But why in a public place? Would you go to what is arguably the dirtiest, the bathroom to open up a hole into your body?

Jennifer Smith, CDE 24:45
Absolutely. kind of goes along with nursing for women. Why should you have to go to the bathroom to nurse when it's the same thing? It's the comfort level of other people. It's not your comfort level that you're worried about? got

Scott Benner 25:00
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Jennifer Smith, CDE 26:25
Level of other people. It's not your comfort level that you're worried about

Scott Benner 26:28
exactly. And so let me tell you the briefest story. I'm in a restaurant one day with my kids. And we're leaving that day and there's this little girl seriously a little girl injecting at her table. And I stopped at the table none of my business I said excuse me. I just wanted to May I say something and they looked up at me in horror I realize now and I said my daughter has type one diabetes too. And I want to say good for you for injecting here at the table. There is no reason for you to hide. You're doing a great job, little girl like last year. I had to do the math. Last year, seven years later, I had to make a phone call about jury duty. And I said look, I would like to skip jury duty because I'm the sole caregiver for my daughter, I help her make her insulin decisions. And if you listen, if you'll let me be on my phone while I'm there, I don't care. But if you don't want me on my phone, I need to ask the skip. And the woman says oh, I completely understand. My daughter has type one diabetes too. And I gave her my name. And she says is your daughter's name Arden and I was freaked out and I thought Yeah, why? And she goes, I read your blog. And I said great. She goes actually you're going to find this strange. You've been a real help to my daughter through her life. And I said why? And she said, Because you bumped into us in a restaurant. The week she was dying. The week she was diagnosed, and you told her she was doing a good job and she shouldn't hide. And she's like, and it's been such a big deal in her life. And I was like, wow, that is so touching. I'm gonna get out of jury duty. Right? And but, but absolutely 100% on a story. Like don't, don't hide, you know, and because Jenny's right it is for other people. It's not for you, and it quietly you'll you feel shame, like it quietly will make you feel shameful about what you're doing. And you should not be ashamed of having type one.

Jennifer Smith, CDE 28:28
Not at all. It's just like, you know, I mean, everybody wears it. I mean it kind of goes along with everybody wears their pump differently. And there are a lot of people especially Omni pod wearers who wear them you know, only in like, unseen locations, man I like I wouldn't buy pods they're get decorated with stickers and I used to like color them with markers and now that I know that you know we have the 3d printer kind of thing. We don't but I ordered a Wonder Woman 3d print pop snaps it snaps over the top. It's awesome. I actually let my six year old pick it out because he was like wow, all those are cool. You have to get wonderful mom You're wonderful. I was like great.

Scott Benner 29:16
But Mommy was gonna get flowers but okay.

Jennifer Smith, CDE 29:19
Exactly one of my favorite places to wear it is on the back of my arm because honestly because it isn't visible. Yeah, not like the other places on my body aren't good. It's just I like to wear it good spot visibly, you know,

Scott Benner 29:32
I would tell you that Arden has in the past seen other people using insulin pumps on the pod and CGM and it she's not the kind of person who runs around excited about it but it has quietly given her a lot of comfort.

Jennifer Smith, CDE 29:45
Yeah, yeah. It's always fun to when you run into die I call it diabetes in the wild. Like you run into somebody at the grocery store who's like, you know, boldly got their pump like hanging off their pants or you know, clipped to their jacket or you know, something like because I've, I always reach out, I'm always like, hey, you know, look, you know, pumps, we've all got pumps, and it kind of starts up a conversation. And it's, I don't know it just because diabetes is so like, it's such a silent unseen. For the most part, it's just a nice way to bring it to have visible

Scott Benner 30:19
and make it make it normal because and here's why that's important. I interviewed a singer a long time ago, a Broadway singer named Kelly. And if you go back and listen to Kelly's episode, which I'll link in the show notes, she hid for a long, long time, and it was not good for her. And when she finally decided not to do that it was freeing. So I'm saying don't put yourself in that position to begin with, you know, just be yourself. And, and this is who you are. And look, I'm not judging you, if you can't bring yourself to do it in public. I'm not saying you're a bad person. Yeah. But I'm saying if you can do it, do it. You know, I think you'll be happy with what happens. So, okay, so what are we not? I haven't, I haven't injected insulin in a really long time. So let me tell you one thing that happens to me all the time, every once in a while when I have to give a needle, I'm not good at it. rd tells me I'm not good at it. And so what what is, like, what should I be doing? Is there a pinch? Is it quick? Is it slow? Like, what's the right way to stick that needle in there?

Jennifer Smith, CDE 31:27
Do it? Yeah, I mean, you know, obviously, the age old recommendation is to pinch up. To put the needle in, when I was initially diagnosed 30 years ago, we were told to inject at an angle almost at like a 45 degree angle. Quite honestly, now the the recommendation is just like most 90 degree pump sets, just straight up, putting it straight in, no angle is needed. A lot of people have question too, about the needle length, and all of the research and studies that have been done. Regardless of body type, and body stop body size. Even those really, really, really micro looking needle lengths, they give you the same, the same ability to put the insulin under the skin in the place that it needs to be, which is the sub q tissue, like the that kind of fatty layer for absorption. So pinching up the skin, putting the syringe or the the needle that's on the the pen straight in 90 degree angle, and then just push the insulin in,

Scott Benner 32:37
that I have to keep the needle in for a second or is that a pen thing?

Jennifer Smith, CDE 32:40
That's for the pens, really, the recommendation is it does vary. I've heard people being told that they're supposed to count to 20. I've heard people say that they're supposed to count to five. When I was initially educated, we were told that to tell people count to 10. So that is what I educate with. And it's interesting because if you have ever given a syringe injection versus a pen injection, you will notice a difference if you pull that pen needle out right after and you don't give that count to 10 the insulin can leak out. Okay. So that's the reason for that count. And whether it's a Basal insulin or your rapid acting insulin or a regular insulin. If it's a pen, you do need to do that count.

Scott Benner 33:27
Okay. All right. Let's see what you think of anything that I'm going to ask you about because I'm at a disadvantage when talking about MDI.

Jennifer Smith, CDE 33:35
Um, I mean, the only kind of, you know, Basal insulin, of course, rapid acting insulin, you know, there are multiple of them on the market. There also is still some use of regular insulin which we called short acting insulin, it had a longer profile of of working in the body, then our rapid acting insulins have, it also didn't work as fast. So again, this is where figuring out what your needs might be, for the most part, the rapid insulins on the market, the three age old ones, you know, human log Novolog, a Piedra, technically, they're all supposed to work pretty much the same way. I can tell you my personal n of one is that human log and Nova log work pretty much the same for me, a pager does not I've tried it, it doesn't work the same for me. Then there's also of course, the ASP, which is faster acting insulin aspart, which is just faster acting Novolog insulin, it does have a faster onset of action, and has, in my experience, having used it for a bit of time, it seemed to have almost a more clean finish to working. It was done and that was kind of the end of its actual Elon by Basal was kind of kicking in and doing what it was supposed to do. But you know, determining what again, works for You insurance wise, many insurance plans have a preferred or a tiered kind of both basil and rapid acting insulin for you to choose. monetarily, if you can go outside of you know, tier one or tier two, most insulins are tier two. If you can go outside of that, they'll usually be a tier three and your copay is just going to be more. But if you prefer one over the other, that might be the course of action you have to do. If you can't, then you're kind of stuck using what the preferred is.

Scott Benner 35:30
Okay? And I'm going to ask you one question, and then we're going to switch to another episode and talk about insulin. So the one thing I've found is that when I talk about Pre-Bolus, sing with people, and you know, Pre-Bolus thing is a pumping word, it just means putting your insulin in before your food, right. So you can you can pre inject you call it whatever you want. But but some, but a lot of times, what you'll hear from especially parents is I don't want to inject them twice at a mealtime. And I say, Look, I understand that, but but if you can't be sure of how much insulin or how much food the child is going to eat, you still need to get some moving first. So if you're on MDI, and you're seeing crazy spikes at your meals, it's because you're not Pre-Bolus thing, I'm guessing, or a lot of other reasons that you'll hear through the next bunch of episodes. But you're gonna have to make that leap in your head like I'm going to if I can't trust he's going to eat all this or she's going to eat all this then I need to put some in now, and some and later, right. Please remember that the Juicebox Podcast wouldn't be possible without its sponsors for today's episode on the pod, and Dexcom Dexcom, the makers of the G six continuous glucose monitor, and of course on the pod is the tubeless insulin pump that Arden has been wearing for over a decade. You can go to my on the pod.com forward slash juice box get a free no obligation demo of the pump sent right to your house. Or you can go to dexcom.com forward slash juice box to find out more about art and CGM. Heck, you could do both. The next episode of my series with Jenny Smith is called all about insulin. And it's available now at juicebox podcast.com. are right there in your podcast app. If you're enjoying the podcast, please leave a rating and review on iTunes and take a moment to share the show with someone who you think it can help. Thank you for listening for being bold with insulin, and for remembering that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, and to Always consult a physician before making any changes to your health care plan. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juicebox free meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon find out more about Chivo Capo pen at GE Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com Ford slash juicebox. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years, and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are I'm going to tell you now, Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus. Episode 1004 Temp Basal 1005 Insulin popping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees. In Episode 1015, Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two, in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022, weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talk about transitioning from MDI to pumping. Before I go, I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer, he'd really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you eat but means timing your insulin so that is active as the carbs become active. Took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#1000 Diabetes Pro Tip: Newly Diagnosed or Starting Over

This is the first episode in a 26-part series called "Diabetes Pro Tip”. Scott and Jenny emphasize the importance of understanding what insulin does and how it works, especially for newly diagnosed individuals or parents of newly diagnosed children with Type 1 diabetes.

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

Key takeaways from this episode are available below in English, Spanish and Hindi. Los puntos clave de este episodio están disponibles a continuación en inglés, español y hindi. इस एपिसोड के मुख्य बिंदु नीचे अंग्रेजी, स्पेनिश और हिंदी में उपलब्ध हैं।.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. While you're listening please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter and they have an amazing offer for you right now at my link only contour next one.com forward slash juicebox free meter you can get an absolutely free contour next gen starter kit that's contour next.com forward slash juice box free meter while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org and on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com forward slash juicebox. And now I'm proud to present the episode that started the diabetes Pro Tip series. What was originally episode 210 diabetes pro tip newly diagnosed we're starting over Welcome to the Juicebox Podcast. I'm your host Scott Benner. I first interview Jenny Smith, the CDE from Integrated diabetes back in season one on episode 37. At that point, Jenny and I were just talking about different management ideas. But it was then that I realized how much we agreed about type one diabetes, and the management of the disease. I brought Jenny back on and episode 105. And we really drilled down about a onesies what they were and what they weren't. After that second interview with Jenny, I decided that one day I would have her back on to discuss all of the diabetes management ideas that come up on the show, I wanted to break them down into small categories, something that was easily digestible, where we'd stay focused on just one idea. I wanted to create something that you could come back to hopefully learn from and if you found useful share with others simply. And so with that in mind, I give you the first in this 10 part series, diabetes pro tip for the newly diagnosed or for those wanting to start over with Jenny Smith CDE.

Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to Always consult a physician before becoming bold with insulin or making any changes to your medical plan. If you're a newly diagnosed person with type one diabetes, or the parent of someone who has been newly diagnosed, what do you think the first things to understand are?

Jennifer Smith, CDE 4:20
The first things to understand beyond the glucose values are what does insulin do? How does it work? I think that's it's a huge one that is it's under, it's under emphasized, I guess is the best way to put it. Many people, especially adults who are diagnosed are kind of given a this is your insulin. This is the dose to take and kind of go experiment at home. I feel like that's kind of the way that it is and I think insulin is a first most important thing to really understand. How does it work? What's What's the purpose of it? How is it supposed to kind of finish working? And what is the effect for you?

Scott Benner 5:08
Okay, and so what are some, like bare bones ways to come up with those understanding. So I think, obviously, if you have a CGM, it becomes different, right? If you have a CGM, you can get yourself at a stable spot where you haven't had insulin or food for a while. And just give yourself an amount of insulin and see how it moves you. Let's talk for a second about like old school, do you still teach people that they need to do Basal testing?

Jennifer Smith, CDE 5:33
In a general way? Yes, I think especially for pumping is helpful in the beginning, because it does in that basil only time period, it does give you a general idea of how things are being kept with the rate that's at play. I do think that basil testing needs to be more explained, let's say, when we are talking about pumping insulin, though, because there are as you know, a lot of variables that could be at play in that Barrett basil testing time period, especially like from, from a woman's standpoint, it could very much be that it's not the right time of the month to be Basal testing. Right? Right, right. So all of these various are a kid or a teen who is a kid or a teen who is really athletic. Right, and there is consistent effect of activity level. And it may be different on different days, but there could be overlap from a day ago that you had for our practice or a tournament. So Basal testing. As a general idea, yeah, it can be a really good place to start, especially if you think things are really off in a certain place of the day. But is it the end all be all of knowing where your insulin should be? Not 100% of the time

Scott Benner 6:58
and so, so what I ended up telling people when I speak with them, is that, you know, if you're having an issue, and that issue could be anything like you're spiking at a meal, or you're drifting high all the time, or you're incredibly high all the time, you know, any of those things, you have to first look at your Basal insulin. It's it's absolutely far and away the first thing and I have to apologize to your audience texting me and I believe she's trying to tell me, it's lunch. That's okay. Hold on. So lunch question mark. So Arden has been sick the last couple of days and pretty, pretty kind of resistant like this to her insulin a little bit. But we are ahead of it now. So she's 106 and stable now. But to give you an idea, she woke up at 110. By the time she was getting dressed, she was 120. Then there was this diagonal up, I Bolus a unit and doubled her Basal for an hour. And 30 minutes later had to Bolus two more units to get her back to this 106. And what she never got over about 150. But she sees that rise every morning like that, that little bit of a rise. But this morning, I used I'm going to save three units more than I would normally use. Yeah. And it's just because she's not feeling quite well.

Jennifer Smith, CDE 8:11
Again, another reason that basil testing. This is not it's not purposeful. In fact, I think, you know, a lot of people try to overcome that morning time rise with a Basal adjustment. But what happens then when you wake up at a different time of the day, right? Or you have a variable schedule, so a lot of times I actually tell people, you know what, let's look at what the rise is. Don't correct it. Let's let's watch the rise. Let's figure out how much of a rise Are you consistently having, you know what, we can offset it with it with a dose of it of Bolus. Sometimes that actually hits the mark better than trying to incrementally adjust a basil behind the scene that could actually change day to day.

Scott Benner 8:57
Right, right. Okay, so now this is um, this is really interesting. To the way like, tell you what just happened. So this is kind of hilarious, but my wife is here I'm gonna have to walk away for a second and back. Arden's pump only has 10 units left at it, and her and just add her lunchtime Bolus is going to be 12 units. So I just had her do a smaller Bolus as a Pre-Bolus still, and I'm going to send my wife over to like swap. I'll be back. Let me go explain this to my wife. I'll be touched by type one has a wide array of resources and programs for people living with type one diabetes. When you visit touched by type one.org Go up to the top of the page where it says programs there you're going to see all of the terrific things that touched by type one is doing and I mean, it's a lot type one it's school, the D box program, golfing for diabetes, dancing for diabetes, which is a terrific program. Just click on that to check that out. Both are caused their awareness campaigns and The annual conference that I've spoken at a number of years in a row. It's just amazing, just like touch by type one touched by type one.org, or find them on Facebook and Instagram, links in the show notes, links at juicebox podcast.com. To touch by type one, and the other great sponsors that are supporting the remastering of the diabetes Pro Tip series touched by type one.org.

Jennifer Smith, CDE 10:26
So all is okay. Yeah,

Scott Benner 10:28
my wife's it's across the street. Yeah, my wife's gonna run over. She's working from home today. And it really does just go to show, I guess, the fluidly that you have to keep around diabetes because, okay, I'm lucky my wife's here today. If she wasn't, I would have to tell you, Hey, I gotta go. But in the end, there's no panic here. Arden's blood sugar's 107. I wanted, I wanted to do a Temp Basal increase of 50% for an hour and a half. And an extended 12 unit Bolus for lunch. But she only has 10 units. So instead, I had her set the Temp Basal still and do an eight unit extended Bolus. So she's still going to have four units going when my wife gets there, they're going to swap that pump real quick. And then she's going to head off to lunch and be okay. Right? She'll be fine. She's got early lunch. Yeah, on every other day to 1030. And then on the 30, like,

Jennifer Smith, CDE 11:20
what does she get up at five o'clock, the breakfast? Really that

Scott Benner 11:24
she eats? 1030 every other day and the opposite day? She eats at 1130? And she's out of school by two. Oh, wow. Okay, it's all kind of very quick. I don't know if she's learning anything. But so so I Yeah. So anyway, what I wanted to say about Basal is that, I'm sure just like you, I meet people who are having trouble, right, they're either on the roller coaster, and they're going to 400. And they're going to 60 and up and down or, you know, somewhere in that problem. They're high constantly, they're always 180, you know, they can't really seem to do anything about it. And when they get to you, they have all of these theories about why their blood sugar is too high. Right? And I tell them, your blood sugar is too high, because you don't have enough insulin, and it's not timed correctly. And we're going to start with your basil. And they'll inevitably say, Well, what about my insulin department, that doesn't matter? I'm like, you can have a perfect insulin to carb ratio. If your Basal insulin is not right, none of this matters, right?

Jennifer Smith, CDE 12:22
That's right. That's why we call Basal insulin, the foundation of your management, it really is we, we actually tell people, it's like the foundation of a house. If you have a sound structure that you're building on top of everything you put on top of it will work. Even if the insulin, the carbon, the correction factor, and things are a little bit off. If the basil is off, those are going to also look like they're not working well.

Scott Benner 12:49
And it becomes impossible to diagnose what's happening, right. And so what I ended up saying is that you try to imagine we use round numbers for examples, but try to imagine your basil is a unit an hour. That's what that's what it should be. But you have it at point five. And then you have you look at some food and you say, Oh, well that food is two units. So you and let's say you're right about that. Let's say you're 100%, right, that the food takes two units, you put your two units in, all you've done is now replaced the basil that you needed, right? You're so you're resistant, you're high, now you're replacing your basil, it's possible those two units will only go towards impacting the problems your Basal insulin has, right. And then your blood sugar shoots up and you go, I don't understand, I put in the right amount of insulin, I counted

Jennifer Smith, CDE 13:38
my carbs, right, I counted my carbs. I looked at the label and I did everything

Scott Benner 13:42
the doctor told me why didn't this work. And in the end, and you know, through this series that you and I are going to do together I'm going to repeat a couple of things over and over that I've found to be incredibly helpful. But in the end, if your blood sugar is high or low, you've mis timed miscalculated, or a combination of those ideas. And that's pretty much it, you know that I find that to be the core of it. It's not the first step to me. Not being afraid of insulin is the first step. But we're going to talk about that in a different episode. But I think that it's it's timing and amount. And I think there's a million other things that can impact your life with diabetes. But that's the seed of the tree, right? And you could throw away all the leaves and all the branches and everything that comes off of that seed if you'd have that seed timing and amount you're well ahead of the game. Right?

Jennifer Smith, CDE 14:31
Right. Absolutely. And I I would say the that those two pieces actually go very well together as far as not fearing insulin, you know, not being afraid of using it because i i certainly work with many people who that is a major problem it is I just want to eat 200 Because I'm afraid to give the amount my pump is telling me to give or the amount that the doctor told me to give you You know, and I think understanding Insulin is the base of that, understanding it and understanding the timing. And the action of the insulin and how it also individually works for you, helps to dissipate that fear, right?

Scott Benner 15:16
I think that I think that if you can keep your blood sugar stable at 200, then you can keep it stable at 180. And if you can do it at 180, you can do it at 140. And believe it or not, if you can do it at 120, then you can do it at 75. And, you know, and so, because the, the tools that you use to, to achieve that stability aren't different depending on what level your blood sugar is at. It's all the same. It's all the same stuff. Okay, so that's, that is that's excellent. So we'll talk about fear in an upcoming episode as well. I'm newly diagnosed, I go into my doctor's office. Now you are uniquely qualified to tell me this. What do people get told a diagnosis and why do they only get told what is shared with them. The remastered diabetes Pro Tip series is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have a unique offer just for listeners of the Juicebox Podcast. If you're new to contour, you can get a free contour next gen starter kit by visiting this special link contour next.com forward slash juice box free meter. When you use my link, you're going to get the same accurate meter that my daughter carries contour next one.com forward slash juice box free meter head there right now and get yourself the starter kit. This free kit includes the contour next gen meter 10 test strips, 10 lancets, a lancing device control solution and to carry case, but most importantly, it includes an incredibly accurate and easy to use blood glucose meter. This contour meter has a bright light for nighttime viewing and easy to read screen, it fits well on your hand, and features Second Chance sampling, which can help you to avoid wasting strips, every one of you has a blood glucose meter, you deserve an accurate one contour next one.com forward slash juicebox free meter to get your absolutely free contour next gen starter kit sent right to your door. When it's time to get more strips, you can use my link and save time and money buying your contour next products from the convenience of your home, it's completely possible that you will pay less out of pocket in cash for your contour strips than you're paying now, through your insurance. Contour next one.com forward slash juice box for a meter go get yourself a free starter kit. while supplies last US residents only.

Jennifer Smith, CDE 17:53
I think it there's a wide range of what people are told, I certainly think that the younger the diagnosis, especially for type one, the younger the diagnosis, the more education there is, the more information is provided. adults that are diagnosed I think, unfortunately, get the least amount of education again, and it differs system to system and provider to provider. But in the beginning, you know they're taught how to use a glucometer. They're taught how to give an injection they're taught or you're going to be taught essentially the basics of that insulin action. And you're going to be taught carb counting, right. I mean, that is pretty much the gist of what you're going to be taught.

Scott Benner 18:40
Anyone who's been listening to this podcast for any amount of time will know that I call that do not die advice. That's the that's the advice you get so that you don't die. It doesn't keep you healthy. It doesn't help you understand anything. It just keeps you from going home and falling over.

Jennifer Smith, CDE 18:54
Well, and I think another piece of that too is it's very, very soon in that beginning is how to avoid hypoglycemia, how to avoid a low blood sugar because insulin causes low blood sugar. And unfortunately, that's where the fear starts.

Scott Benner 19:12
Exactly. And so that's where it starts where the fear starts, but try to understand it from the clinicians point of view. You are frazzled I say this all the time being diagnosed with a disease that you cannot cure. It feels like someone just walked up to you with a shovel and smacked you square in the face with it and then started yelling, Basal insulin Bolus glucometer. This is a test trip and you're like, wait, wait, why? And so the doctor sees that on your face and can't in I guess in their minds, they don't want to overload you. But the unintended problem is just what you said that you start with fear then everything starts with fear. It would be a simple sentence. It would be it would be Listen, we're going to teach this to you slowly. I know that seems counterproductive but it's not But there's no reason to be afraid. And that's what we're going to learn. Now the question is, do doctors not teach that because they don't have the time, or they don't have the knowledge? Like what like, because there are everyone's going to walk into a different endos office, you're gonna get an 80 year old guy who's been doing this, since people have been boiling their urine. And he and he's just gonna think that if you count your carbs, and inject and go to 300, and come back to 100, that's amazing. And that's that, right, right. And then you're gonna get a guy who's in his 50s, who's just starting to hear about like, this CGM stuff, and you're gonna get different advice from them, you're gonna get different advice from, you know, a woman who's been out of medical school for three years and has diabetes. How do you as the patient know what advice you're getting? When you don't know anything about diabetes?

Jennifer Smith, CDE 20:52
That's a very good question. Absolutely. And I think, you know, with today's technology, honestly, I personally, as people have come to, to work with me, or to work with us that integrated, you know, it's people come because very soon, they realize they're not getting what they need. That's not quite, they're not sure what they're missing. But they know from researching and looking and Googling it, that the information that they've gotten is so just literally the tip of the iceberg, that they're missing so much more beyond and that, you know, that the doctor is saying, Well, you have to be in good control for a year to be able to start on a pump. And most parents or even adults are saying, that's not the case. Right? Does that make sense? That's that's not doesn't make sense. I want to know what I should be doing. I want to know, what is the best for my child or for myself? I want to know, and I think those are some of the things that as a as a newly diagnosed, asking more questions of your provider, even though you may not know exactly what you're asking, when you've Googled it, and you've researched and done some of your home's searching, and even asked, you know, some people I think more and more people are, they're kind of they have acquaintances or whatnot, who might have diabetes. And so they, they will ask them, they'll say, Well, they're doing this, you know, maybe I should ask about this. And I tell all the people that I work with, you know, what, if your providers not able to meet you or can't answer, even those basic questions in the beginning, it's, it's time unfortunately, to find a new provider. It really is.

Scott Benner 22:34
And based off of that idea, I want to say, I want to say the same thing to two different segments. So if you're a clinician, and you're listening to this, or if you're a person who has diabetes, or is trying to care for someone who does, there's a space that a lot of people get into, they're not given enough information up front. And they're, they're paying attention, right, they want to do well, they're paying attention, and they see inconsistencies with what's been taught to them in the doctor's office. But because you're the doctor, or because you're looking at a doctrine, you were raised to listen to a police officer, your teachers and a doctor, you're raised to believe that a person in a white coat is infinitely more intelligent than you are, there's no reason to question them. And so when they give you these concrete laws of diabetes, you go home, put these laws into practice, and they don't give you decent results. This is for the doctors, it puts people into such a psychological bad place. It just wrenches their gut, they feel like they're killing themselves or their children. And they don't understand why. And even when common sense things about their diabetes show up. They can't bring themselves to make the leap, because you've told them or not told them anything about that idea. And I will give you a great example. And it's a very simple example.

Jennifer Smith, CDE 23:52
Or kind of before your example. You know, it's kind of a cut and dry too. As you know, kind of going with what the doctor said, the doctor said to do this, the doctor said I should take my my insulin and eat right away. Well, if that's not working, and you don't, if you don't know that and clinically, clinicians, I think, really do need more information about what really is the real life of diabetes. What's the real life use of insulin and mastering its action and all of that because clinical book does not mean it meets what happens at home. And when your clients come to you and your patients with or people with diabetes come to you and they say, This isn't working. I'm following all of your rules. It's not working. Instead of saying well, you must be doing something wrong because that that happens often whether as a clinician you want that expression to come out or not. It does you make them feel like they're not doing something right. Right. And you don't give him a way to to help you don't explore with them. Say, Okay, I hear what you're saying, I hear that you've tried everything I thought would, excuse me would work. And it's not let's, let's see why it's not working, maybe something is variable for you.

Scott Benner 25:12
And let's have more of a conversation and explain what's happening. So that so that the doctor can glean more from what's going on. I'm at the point now, and I'm sure you're there, too. I can look at a 24 hour graph, and make changes in five minutes that improve somebody's life. immeasurably in 24 hours. I don't know why a doctor can't do that. So I mean, I figured some can

Jennifer Smith, CDE 25:34
Yeah, some are, some are awesome, but some are not gonna know me

Scott Benner 25:37
well enough. Now to know that, you know, I'm not the greatest person in the world. And I can look at it and go, Okay, this is this like this. My example of, of how powerful the doctor suggestion or non suggestion can be to people is that I was speaking with a woman in her 40s, who had diabetes for 25 years. I looked at her graph, she was distraught. And I said, you just need more insulin? And she said, Well, no, no, because in the oceans, like I said, all these reasons why it that wasn't the case. And I said, No, that doesn't make sense. And in a brief 32nd, Explanation, over a telephone call, I could literally hear the light bulb turned on in her head, and she went, Oh, my God, I just need more insulin. And I was like, right? That's it? I mean, can we go now or, you know, but but think about, think about that. A well intended, intelligent, educated person who goes to her doctor's visits, and in 20 years, can't figure out why their blood sugars are the way they are, and no one's ever helped her. Right. So what I'm saying to people who are newly diagnosed, or people who have gotten to that point and want to start over, you have to sort of think different, you have to, you know, if you're, if you're in a situation where you're newly diagnosed, and you've gotten some real, like what I call like old timey information, you need to think differently. And if you've had diabetes for a long time, or have been caring for someone forever, and it's not going the way you want, that's the first thing you have to do. You have to say to yourself, I must not be thinking like flip it upside down, look at it all the time, I have a friend who every decision they make is wrong. And I once said to them, How come when you have a reaction to something, you just don't wonder what's completely opposite of that, and then just do that. I was like, I was like, You're right, you're always wrong, you know, so like, and, and that's what happens every day, you get up and you do this thing with this insulin and this pump and all this stuff, and it always goes wrong, but yet, there you are the next day,

Jennifer Smith, CDE 27:35
doing it over and over and over again, which is a another reason that I you know, working especially with the women through pregnancy that I work with, that's a piece of the variability that I try to encourage them to sort of work on prior to pregnancy. Okay, you know, because if you can figure out, it's why many people with diabetes, eat some of the same things over and over and over again, they have a standard breakfast, I know that it works, I know that I need this much insulin, I knew they need to use a temporary basil for this much or for you know, whatever extended Bolus, and it works for me, it's, that's the reason because once you figure it out, you're like, great, I like little magic, this magic piece right here and I'm not gonna screw it up. Now

Scott Benner 28:21
I'm just gonna have this half a piece of wheat toast two eggs over easy and two tablespoons of avocado for the rest of my life.

Jennifer Smith, CDE 28:28
Right? Exactly. Every morning, if that's

Scott Benner 28:31
happening to you, if you're listening, and that's happening to you, I say this proudly, the there are some low carb people who will get upset and I want to tell them right now you can eat low carb your whole life. I don't care. I'm just saying that if you ended up there because you couldn't figure out insulin. You know, if you're if you're eating something you don't want to be eating, there might be a way to manage this. But I tell people very proudly, that at this point, my daughter is 14 years old when I'm recording this. She has had type one diabetes since she was two. And for the last five years, her agency has been between five two and six two, with absolutely no diet restrictions whatsoever. Anything you can think of Arden eats and eat frequently.

Jennifer Smith, CDE 29:14
And I bet her more important within that I think we talked about this in the A one C discussion and podcast. But more important than even the a one C is per standard deviation the variability which I would estimate without even seeing her information, I would estimate that her standard deviation is very nice meaning she's got these juicy little gentle rolls through the course of the day rather than this major roller coaster because you can have anyone see a 5.4 Yes, but you can have wrong major, you know, standard deviation,

Scott Benner 29:45
and we will talk about that in coming episodes. You can't run around with your six a one C but be at 300 Half the day and 50 the other half of the day. That's you've just tricked the a one C test, right,

Jennifer Smith, CDE 29:56
Doctor? Yeah, because again, that goes back to clinic shins. A onesie is is certainly it's a starting place. It is not the end all be all there is more in depth that needs to be looked at with that a onesie. Yeah,

Scott Benner 30:08
we try very hard. Well, you know, as you go on and listen to these episodes, you'll realize I'm not trying that hard anymore. I figured it out to the point where it doesn't really take that much involvement from us. But Arden's low alarm on her Dexcom is set at 70. On my follow app, it's 120. For the high alarm on hers, it's 130. And so we'll talk about like bumping and nudging later on, but that's my concept is that smaller amounts of insulin as you try to leave a tight range, get you back into that range more quickly. And cause far fewer lows later. Yes. Give me one second here, we'll take a pause. Okay. I'm gonna text art and she's now wearing a new pump. I need to know how much insulin delivered from the last Bolus. And then because it's a new pump, and she's literally going to walk right into lunch. Excuse me, I'm going to double her basil for I was only gonna do 50%. Now I'm just going to double it for an hour and a half. And that way, if there's any slow start with that site absorbing and having action I'm just going to do, I'm going to do something that at some point during these you'll hear me talk about where I call it over bolusing like I just I imagined not just what her needs are now, but the momentum and higher number that I know is coming. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com forward slash juicebox G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Yep, so

Jennifer Smith, CDE 32:10
that's hard change was one thing that I was always in in. In the beginning, I was very thankful that I had noticed a difference with my animus pump change that I needed that site to just be like, just saturated with insulin to get absorption sooner. So and I was glad because when I started Omnipod in 2006, I started doing the same thing that I did with my other pump sites, you know, just Temp Basal going up by almost 100%. For about it was usually about an hour to two hours depending on kind of where I was at that point. And if it was if I was having to change that pod, especially if it was before a meal, and I was going to need insulin for that meal with the new pod. I actually instead of doing it through the pod, I gave an injection, because I just found that a Bolus with that new pod site. It never went well. Whereas if I did a Temp Basal increase, I took a Bolus via injection for that food that I was going to eat and let the pod get settled in. I didn't have any blood sugar issues. Okay.

Scott Benner 33:26
Yeah, it's everybody's strategy is different, right? But I'll tell you what it what it what that tells me is, again, this is going to be another sentence you hear over and over again, you have to trust that what you know is going to happen is going to happen. Yeah, so if you make a pod change and your blood sugar's 90, you still need to do that. Right? Right. It's okay, hold on, since you got 5.6 units, so I'm gonna do a Temp Basal increase 95% for an hour, and Bolus seven units. All now go eat as soon as possible. So she's got 5.6 units in from 20 minutes ago or so she's still 102. And so I'm not scared of those seven units. She's going to be eating in five minutes. And look, the 5.6 units didn't do anything over the last 20 minutes. So I'm good. My goal here on this Bolus is 75. Diagonal down while she's about halfway through her meal. Anyway, that's again stuff we'll talk about later. Yes. Okay. So

Jennifer Smith, CDE 34:32
and comfort level with you know, will happen.

Scott Benner 34:36
Yeah. And because, and by the way, and this, these, you have to you have to have these experiences like I'm going to leave this in this episode so that you know, that things have to happen that you don't expect, because it's data, right it's, it's, I did this and this happen next time I'd like this to happen, so I'm gonna do sooner or later. More or less, whatever it is I'm going to do. But you can't know that unless something goes wrong. Right, right. And so and so here's a great tip for somebody starting over or who is newly diagnosed. There are no mistakes. There are only experiences that build on for next time. That's it, I see something happen. Instead, you can't get dramatic. You can't get upset. You can't cry. You can't go, Oh, my God, I'm killing her. You can't do it. Right. You say to yourself, Okay, bare bones, what just happened here, I put insulin in here. It went up to there. And then it came down and crashed. I bet you if I would have put that much insulin in sooner and spread it out a little bit like I could have created the resistance that that blood sugar needed. Right and right. But if you're busy running around, wringing your hands, and just you gave away an amazing opportunity, and, and I will use this as an example. This past weekend, I was helping a mother with a five year old four or five year old boy. And while I was talking to her, this kid's blood sugar went to 300 off of some Cheerios. And we talked for 20 years, that breakfast cereal. Oh my gosh, we're talking about 20 minutes or so. This poor kids blood sugar's at 300 It's not moving. And we're getting ready to get off the phone. She's like, he's hungry. I don't know what to do. And I was like, Are you? Would you like to do something that's gonna sound insane. I'll help you. And she goes, I think I'm desperate enough to try something insane. I was like, great. How much insulin Do you think it'll take to bring a 300 to 90? And she says a unit? And I said, How much do you think lunch is going to take and she said a unit and a half. I was like cool. Bolus two and a half units right now. And she said, she's like, what's going to happen? We're going to put his blood sugar into a freefall. And then we're going to add the lunch at exactly the right time. And then with a little bit of fast acting carbs, if we need to, we'll bring it in for a landing. I said, I'll never leave you. We'll we'll text the whole time. We'll talk again and we have to, so she does it. We get diagonal down to 90 to 75 to 52 hours down to 50. She's texting. Oh my god. I'm like, no, no, perfect. Like, a whole lot. I actually texted her a picture of the guys from Star Wars who are trying to blow up the Death Star. Stay on target like just don't don't flinch. Like don't flinch to 52 down to 42 3200. I said, Okay, now's the time to start getting the lunch together. And she laughed. She goes, Oh, it's already it's just here on a plate. And I was like I said when we get the one ad given the food. So one ad to down kid gets the food 10 minutes later. Now isn't this interesting? We're dropping 10 points every five minutes on the CGM. Then he eats. Then all of a sudden the dropping stops. The arrows are still there. But now it takes longer to get to 170 took even longer to get the 160 and she gets the watch this happen 150 Still to down 140 Still to down. I said okay. It's not going to catch the arrows. Do me a favor, give them a few ounces of juice. She says we don't have juice in the house. And I thought to myself, Oh, I just killed a kid over the phone. Give it wrong number. So she said she says we treat Lowe's with jelly beans because they hit him so hard. I said that's great. But do you have any liquid in the house that has carbs in it? That's not soda. And she said oh, we have lemonade. I said that's great. I want you to give them four ounces. Eliminate. So she gives them I said and don't go crazy measuring it. Just give them a little bit of lemonade, right? So she gives them the lemonade boom. goes to one arrow goes to diagonal down. The kid comes in I swear to you 75 Nice and stable. Yeah, it's foods been in for a half an hour. And when it was over, she's like, wow, that was nerve racking. I said, Okay, I know that. Clear your head, and then go back and look at the boluses. Look at the time you put the food in and look at the CGM and figure out how that insulin works in him. Because you just had a Master's class how insulin impacts blood sugar and how food impacts insulin.

Jennifer Smith, CDE 39:14
Absolutely, absolutely. And that's, that's the place that as you know, clinicians, they don't have the time to do that. And it's unfortunate is it's unfortunate in the stance that with somebody something like diabetes, type one diabetes, specifically, you need that hand holding in an instance like that. You need the ability to be with somebody who can say, you're okay, write it out. You're okay. He's going to be fine. You've got jelly beans, you've got juice, you've got honey, you've got something in the house. You've got a mini glucagon that you could use if you need to. You're going to he's going to be okay. She's going to be you're going to be okay. It's it'll be fine. But you do you have to use those learning pieces. I think it kind of goes Along with a really good friend of mine, who has had diabetes a bit longer than me, which is 30 plus years, her, her doctor actually gave her kind of a good little hint for numbers, you know, we we start to view numbers in diabetes as good and bad, right? And that comes with that feeling of frustration then, and oh my gosh, I'm like killing myself, I'm doing something bad or whatever. And he said, you know, the numbers are information. So just like you said, it is okay, I'm here. Why am I here? You know, what can I learn from this? What can I do better next time. And maybe you analyze it, you know, three hours from now, maybe not in the instant, but it's information. So he told her, you know, when the number is going to come up on the glucometer, you put this test strip in, you put your blood on the strip, and you tell yourself, I am awesome. And here comes a number,

Scott Benner 40:59
right? Yeah. Because I just need to be it'll tell me what to do next. And it can't be a judgment, you can't feel judged by it. You can't let you can't, you know, you can't look at it and say bad luck, you can say not what I wanted, not what I was shooting for. But what makes me what gets me to what I'm shooting for. And you know, it's funny as, as you and I are pretty much wrapping up this first thought, right? I have so many people asked me when they're first diagnosed, what are the things I need to know? And I find around diabetes in general, everyone's looking for an amount or a number from you. Just please tell me how many minutes I should Pre-Bolus? Please tell me how many units I should do if his budget is like this. And I tell them all the time, I don't know figure it out for yourself. And you will write like you have to but I can't give you no one can tell you that a 10 minute Pre-Bolus is going to be what's right for you. In any given situation, let alone all the time. I think it's insane that we think that just because we've set a Basal rate of you know, one and a half units at 2am, that we think that that's what our body's going to need every day at 2am. It's, it's insanity to think that it's just the best we have with the technology we have at the moment. Exactly. And so if you listen to this thinking, someone's going to tell me the rules about what I need to do. And I'm starting with diabetes, we did, we told you what to do. It just isn't what you expected. Right? Right. And so I get that, I understand that it's, it's not a pill disease, it's not take three of these a day, and you have to have food with them. Like it's not that easy.

Jennifer Smith, CDE 42:33
And I think as a general too, in the beginning of of learning that comfort level and learning, you're learning what works for you by watching, you also have to take into that the variables, that can mean what you did figure out needs to change because of such and such variable, right. So you know, my breakfast in the morning, if I don't get to go to the gym before or after my normal breakfast, which I just I like it, which is why I eat almost the same thing every single day. And it works nicely blood sugar wise, but I like it. So it's easy. So but I the variables that I had to figure out were pre eating it, exercise, post eating it, exercise there, those are the variables, you know. And so what works in a morning, where I'm not exercising at all, is completely different than the mornings when I have exercise at such or such time.

Scott Benner 43:36
The variables are forever changing, which is why you have to, interestingly, know what they are, and at the same time completely ignore them. And what I mean by that is that you're not a machine, right? So there's certain things that are going to make sense. Like you just said, I know if I exercise prior or post that this changes how this Bolus needs to be. But if you're walking around trying to decide constantly, am I anxious? Did I just bang my knee? Like, like, you know, like, am I going to get a client the thing I see people saying online all the time, like his blood sugar is going up, he's gonna get sick three days from now I'm like, Oh my God, just give him more insulin. Like, who cares if he gets sick three days from now, I and so that's what I think of. When I say be fluid. I just that it's going to keep changing at such a rate that for you to try to apply static rules to it is insane.

Jennifer Smith, CDE 44:30
You've got that piece of of life with diabetes that you can then bring into education, which is why people usually come to us because we understand it from the Living standpoint, not from the this is what the clinical book says should be happening. So do this.

Scott Benner 44:49
I'm incredibly proud to say that I've gotten to the point where if I can talk to somebody for about 45 minutes or an hour they can have a major change in just a couple of days. And that's that's commuter Keishon that's what that is right? Well, that's what I have in mind Jenny for this series. Today we talked about being newly diagnosed or starting over. The next episode will be about multiple daily injections or MDI. We'll do an episode about insulin bolusing pumping CGM EMS and on and on until you and I finish covering every aspect of the things that we talked about on the show. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juice box for E meter while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G voc glucagon.com. Forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. Jenny Smith holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com If you're interested in hiring Jenny, you can learn more about her at that link. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bump and nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talked about emergency room protocols in 1016 long term health 1017 Bumping nudge part two in Episode 1008 teen pregnancy 1009 teen explaining type one 1020 glycemic index and load 1021 postpartum 1022 weight loss 1023 Honeymoon 1024 female hormones and in Episode 1025 We talked about transitioning from MDI to pumping. Before I go I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with us and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics. Scott brings useful information and presents it in digestible ways. Learning that Pre-Bolus doesn't just mean Bolus before you Eat but means timing your insulin so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months, I've never met Scott. But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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Key takeaways from episode 1000 of the Diabetes Pro Tip Series from the Juicebox Podcast

Episode 1000, “Newly Diagnosed or Starting Over

Key Takeaways:

English:

Understanding how insulin works is crucial for diabetes management.
Basal testing can help determine the correct basal insulin rates.
Basal insulin is the foundation of diabetes management.
Timing and amount of insulin are key factors in blood sugar control.
Don't be afraid to adjust insulin doses and experiment to find what works best for you.
Doctors may not provide comprehensive education, so it's important to seek additional resources and support.
There are no mistakes, only experiences to learn from.
Trust your own observations and make adjustments based on your individual needs.
Numbers are information, not judgments. Use them to guide your decisions.
Be flexible and adapt to the ever-changing variables of diabetes management.

These takeaways are sourced from the audio above. It is currently only available in English but when technology allows; more languages will be added. Translations are A.I. generated. Additions, corrects or suggestions can be sent to me by email. Translations are not guaranteed. Please read the full disclaimer here.

Spanish: español

Comprender cómo funciona la insulina es crucial para el manejo de la diabetes.
Las pruebas basales pueden ayudar a determinar las tasas de insulina basal correctas.
La insulina basal es la base del manejo de la diabetes.
El momento y la cantidad de insulina son factores clave en el control del azúcar en la sangre.
No tengas miedo de ajustar las dosis de insulina y experimentar para encontrar lo que funciona mejor para ti.
Los médicos pueden no proporcionar una educación completa, por lo que es importante buscar recursos y apoyo adicionales.
No hay errores, solo experiencias de las que aprender.
Confía en tus propias observaciones y realiza ajustes según tus necesidades individuales.
Los números son información, no juicios. Úsalos para guiar tus decisiones.
Sé flexible y adáptate a las variables en constante cambio del manejo de la diabetes.

Estos resúmenes son obtenidos del audio arriba. Actualmente, solo está disponible en inglés pero cuando la tecnología lo permita; se agregarán más idiomas. Las traducciones son generadas por inteligencia artificial. Adiciones, correcciones o sugerencias pueden ser enviadas por correo electrónico. No se garantizan las traducciones. Por favor, lea el descargo de responsabilidad completo aquí. Disclaimer descargo de responsabilidad

Hindi: हिन्दी

इंसुलिन काम करने का तरीका समझना मधुमेह प्रबंधन के लिए महत्वपूर्ण है।
बेसल परीक्षण सही बेसल इंसुलिन दरें निर्धारित करने में मदद कर सकता है।
बेसल इंसुलिन मधुमेह प्रबंधन का आधार है।
इंसुलिन की समय और मात्रा रक्षा के नियंत्रण में महत्वपूर्ण हैं।
इंसुलिन खुराकों को समायोजित करने और अपनी जरूरतों के अनुसार परिवर्तन करने में डर नहीं होना चाहिए।
डॉक्टर व्यापक शिक्षा प्रदान नहीं कर सकते हैं, इसलिए अतिरिक्त संसाधनों और समर्थन की तलाश करना महत्वपूर्ण है।
गलतियों की बजाय, अनुभवों से सीखने की आवश्यकता होती है।
अपनी अवलोकन करने पर भरोसा करें और अपनी व्यक्तिगत आवश्यकताओं के आधार पर समायोजन करें।
नंबर जानकारी हैं, निर्णयों के लिए नहीं। उन्हें अपने निर्णयों के मार्गदर्शन के लिए उपयोग करें।
लचीलापन बनाए रखें और मधुमेह प्रबंधन के स्थायी बदलते परिवर्तनों को स्वीकार करें।

ये संक्षेप ऊपर के ऑडियो से लिए गए हैं। वर्तमान में, यह केवल अंग्रेजी में ही उपलब्ध है, लेकिन जब प्रौद्योगिकी अनुमति देती है; अधिक भाषाएँ जोड़ी जाएंगी। अनुवाद कृत्रिम बनाए गए हैं। संशोधन, सुधार या सुझाव मुझे ईमेल द्वारा भेजे जा सकते हैं। अनुवादों की गारंटी नहीं है। कृपया यहां पूरी अस्वीकृति पढ़ें। Disclaimer अस्वीकृति