#1566 Five Ways to Boost Insulin Sensitivity
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Jordan Wagner shares five practical strategies—stress management, movement, sleep, nutrition, sunshine—to sharpen insulin sensitivity in diabetes.
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Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox Podcast.
Jordan Wagner is back. He is, of course, a nurse, a certified diabetes educator and a person living with type one diabetes, and today, Jordan is going to go over his top five tips for improving your insulin sensitivity. If you're looking for community around type one diabetes, check out the Juicebox Podcast. Private, Facebook group, Juicebox Podcast, type one diabetes, but everybody is welcome type one, type two gestational loved ones. It doesn't matter to me if you're impacted by diabetes and you're looking for support, comfort or community, check out Juicebox Podcast. Type one diabetes on Facebook. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.
The show you're about to listen to is sponsored by the Eversense 365 the Eversense 365 has exceptional accuracy over one year, and is the most accurate CGM in the low range that you can get ever since cgm.com/juicebox this episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox You can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com the episode you're about to listen to was sponsored by touched by type one. Go check them out right now on Facebook, Instagram, and, of course, at touched by type one.org check out that Programs tab when you get to the website to see all the great things that they're doing for people living with type one diabetes touched by type one.org
Jordan Wagner 2:26
Hey, Scott, good to be back with you here. So I'm excited for this, you know, third episode here, but in case you guys missed the first two episodes, I want to go check those out. In the first episode, we had a pretty detailed discussion on diabetes and management in the hospital setting, so more of the inpatient setting, what to do, what not to do, how to be successful with that. And then we looked at pump Training Success and CGM success. So you've been diagnosed with diabetes and you want to get an insulin pump. There's definitely some things you should know before you get the pump, so that when you do get to that training, you're prepared and ready to go with all that. And I'm really excited about this third episode here. This is a topic that probably doesn't get as much attention as it should with especially the type one diabetes community, and that is insulin sensitivity. And I think part of that is because, you know, we're all insulin dependent with type one, so thinking about insulin sensitivity is not necessarily something we often do. It's just, I have to get the insulin. It doesn't matter. I have to have it. But there are certainly things that will improve your insulin sensitivity with all types of diabetes, but even with type one diabetes, improving that insulin sensitivity could mean that you're using less insulin, which overall could be a good thing for you, perhaps. So I want to go ahead and dive into that here
Scott Benner 3:43
today. Tell people before you start. Why might it be a good thing to use less insulin? Yeah,
Jordan Wagner 3:49
so that's a good question. So there's, there's multiple multitude of reasons here, but one of them could just be that I often see a lot of people scared of low blood sugars, and so naturally, if you're using less insulin, there's going to be a lower risk of hypoglycemia. So low blood sugars, there two would be insulin, in and of itself, doesn't make you gain weight, but if you have a bunch of insulin floating around in your system, and you have excess calories in your system, that will make you gain weight, you know, using less insulin, having a little lower calorie intake, that could also help with weight loss goals, not, you know, having a lot of excess of weight gain, things like that. You know, I've heard from some people that there's a stigma behind it as well, too. So let's, let's say that you're taking a shot, right? Maybe you're able to reduce your needs down to, let's say, 10 units at this meal, right? Versus, like, 20 units. You know, maybe you're out with friends, and people look at the syringe and go, Oh, wow, look how much you're taking. And so I've heard that from some people, even in the hospital setting, that by getting a little bit more sensitive to insulin, they could take less and they felt less stigma about to. Making insulin Interesting? Yeah, so there's, there's different, different things that could pop up for for different people. I mean, not everyone's gonna share the same sentiment, but it's something that, no, it should be considered.
Scott Benner 5:11
Yeah, it's funny, because I, as you're going over those things, I'm, I'm almost playing devil's advocate in my head on some things, like, I spend a fair amount of time telling people you need the amount of insulin you need, correct? Yeah, and I don't want people running around with high blood sugars because they think, Oh, that's a big number, or I'm definitely going to gain weight if I do that. Because there's, there's a cascading effect that comes off of all of that, right? Like, you know, if you can't figure out a way to use less insulin, and you don't want the big number, it could be an eating disorder. At some point you could stop eating correctly, or you could stop bolusing correctly. Some people do that. Some people under Bolus for their food because they think the Bolus like sounds better at a number, or, you know, somehow impacts the thing you're talking about, right? And I don't
Jordan Wagner 5:56
want that, and I don't want that either. That's right. Hear me when I say I'm not. I'm not telling you to take less insulin so that your sugars run higher. Like, what I want good control blood sugars for everybody. But the point I'm making is like, you can get to a spot where your body is more sensitive to insulin and doesn't require the same amount Exactly. So let's talk about the five things you have listed here that can do. So I'll go ahead and just Yeah, list off what we have, and we have, and then we can go ahead and dive in, jump in. One of the biggest things I see that kills insulin sensitivity is stress. Stress is gonna just the stress hormones. There's a lot that goes into that there. I see also that people are not active enough. Doesn't mean you need to be out running a marathon or doing crazy workouts, but just having activity in your life improving your sleep quality. So sleep is a huge time where where we repair and build back up, and if you're not sleeping well, that's going to definitely impact your sensitivity, your nutrition. That's a huge thing that's going to impact sensitivity. Depending on what types of foods you're eating, you could definitely be hurting your insulin sensitivity in today's world, a lot of us have, you know, maybe a corporate job or a desk job, and we're not getting outside. Getting natural sunlight on your skin is really beneficial, and it does help with your insulin sensitivity. There's many studies to back that. So those are the five topics, just to kind of dive into
Scott Benner 7:17
there. So everybody gets super excited, Jordan's your mom now. She's like, get outside, move around a little bit, yeah. But there's a reason people have been saying stuff like that forever and ever. But let's talk about how it actually impacts your insulin sensitivity. So we'll just start at the top, like you. The first thing you mentioned was stress, right? So hey, everybody, be less stressed there. Next thing, No, exactly,
Jordan Wagner 7:41
yeah. Explain to them how the stress is actually impacting them. For sure, the first thing I like to tell people is, when it comes to stress, it's stress hormones. Those are the big things we talk about. So cortisol, epinephrine, that's adrenaline, norepinephrine, things like that. Glucagon can play a role in that as well, but those same hormones will be high in your blood if you are getting chased by a bear in the woods, or if you're chronically stressed out driving home from work, those are two different situations, but your body is going to respond in a similar response with stress hormones. Why do we want those stress hormones? Well, we do want some stress hormones because it's promoting glycogen breakdown and gluconeogenesis, which basically means creating glucose from a non glucose source that is important in times that you need energy. So again, with that bear example, if you're in the woods trying to run away, you need extra energy to either run away or to fight that thing off. That's that fight or flight response. But if you have type one diabetes, or you have type two diabetes, or some form of diabetes where there's some sort of dysregulation going on through insulin, you're not going to be able to respond to that, those excess stress hormones and to increase the glucose there,
Scott Benner 8:56
you won't actually use the glucose either, right? Like in the you won't in the example of the bear, you're gonna burn it off really quickly, running away from the bear, but Correct? Yeah, sitting around worrying about something, it raises all of this up. But then your body doesn't use it,
Jordan Wagner 9:11
correct? And then you have a high blood sugar, okay, right? And so, you know, insulin is like the key. It's the key that unlocks the cells, gets the glucose inside, lets you use it for energy. But if you're you know, chronically, you chronically having these high stress hormones, here it like desensitizes the cells, the insulin. So if you, if you take example of someone with like type two diabetes, that's primarily insulin resistance, the response to that situation, of that chronic stress is that the pancreas is going to make more insulin. So oftentimes with type two diabetes, we see people have very high insulin levels, very high C peptide levels, because it's trying everything it can to get those glucose levels to come down. But again, over time, your cells just keep getting more and more desensitized.
Scott Benner 9:56
Yeah, in all of these things, like in each of these five examples. Temples, the problems build on themselves big time. Like, yeah, like, you start off, like, healthy, and then you have, like, one moment where you're in the car and you're like, everything sucks, and then all the things that are happening behind the scenes are happening. It's not like you then eventually it's gonna happen again tomorrow and the next day, so your body doesn't even have time to go backwards. And, like, repair what's happened. And then it becomes incrementally more concerning. And then I'm guessing here too. It also, like, if you're stressed, maybe you're also not sleeping well, so you start getting compounding right? It compounds
Jordan Wagner 10:35
right. So like, if you just take a look at improving your sleep quality there, it's interesting, because oftentimes we don't sleep well at night, and what do we all do in the morning? We go and get a big cup of coffee or an energy drink or something like that. But it's interesting because caffeine will bind to those adenosine receptors in your brain, and adenosine basically is building up during the daytime, and by nighttime, it's almost aiding you to feel tired and helping you fall asleep. And so like, I'm guilty of it big time, but you drink coffee too late in the day because you're not sleeping well, or you're stressed, and you feel like it helps well, then you get the bedtime and you're not super tired or you're tossing and turning. And so just improving the sleep quality, that's the time where your body's healing itself, it's repairing itself naturally, you're going to see cortisol levels decrease during sleep and getting good rest. Okay? You know, there's other hormones like ghrelin and leptin, right? So ghrelin is going to be one of the hunger signaling hormones you often see, say you are up late at night, right? And you get really hungry all of a sudden? Well, it's, that's ghrelin, right there. That's telling you go get a snack, right? Leptin, is that satiety or I'm full? Hormone. Now, if you're getting poor sleep quality, ghrelin tends to increase because you're so tired your body needs energy. So it's, it's prompting you to want food, prompting you to want, perhaps even junk food, because that's a quick energy source. It's gonna decrease that leptin level, the I'm full hormone, and so you can see how you know the stress and the poor sleep quality, it starts to dysregulate your hormones. And as we know, like with type one diabetes, right? It's a big thing with insulin and glucagon, right? Those are two big things there, but our bodies aren't. It's not just that, right? Our bodies, it's got so many mechanisms happening all the time in the background. When all of your hormones start getting dysregulated, that's when we start seeing this cascade effect of problems showing up.
Scott Benner 12:36
Yeah, okay, all right, I'm sorry. I think I cut you off before you were done with stress, though, did I Oh, yeah, we can definitely talk about a few things there. But I wanted to lay into people's minds that this stuff's going to start stacking up and that these things impact each other as well. You know, you might be more stressed out because you can flip it around. You could be stressed out because you're not sleeping big time. Yeah, absolutely, yeah. And you could be not sleeping because you're stressed out and etc and so on. And maybe you're not dealing with stress as well because your nutrition is wonky, or, you know, you're not exhausted at the end of the night and sleeping when you should because you're not getting enough activity and getting your body moving like this. All stuff this all fits together. Honestly, it does
Jordan Wagner 13:14
everything here is compounding, like you said, there and there's, there's so many angles to look at and talk about, you know, so like, I'll try to stay focused right now.
Scott Benner 13:26
It's my fault. Go back, go back and finish up on your ideas about stress. Today's episode is brought to you by Omnipod. Did you know that the majority of Omnipod five users pay less than $30 per month at the pharmacy? That's less than $1 a day for tube free automated insulin delivery, and a third of Omnipod five users pay $0 per month. You heard that right? Zero. That's less than your daily coffee for all of the benefits of tubeless, waterproof, automated insulin delivery. My daughter has been wearing an Omnipod every day since she was four years old, and she's about to be 21 my family relies on Omnipod, and I think you'll love it, and you can try it for free right now by requesting your free Starter Kit today at my link, omnipod.com/juicebox Omnipod has been an advertiser for a decade, but even if they weren't, I would tell you proudly, my daughter wears an Omnipod. Omnipod.com/juicebox Terms and Conditions apply. Eligibility may vary. Why don't you get yourself that free starter kit, full terms and conditions can be found at omnipod.com/juicebox when you think of a CGM and all the good that it brings in your life, is the first thing you think about. I love that. I have to change it all the time. I love the warm up period every time I have to change it. I love that when I bump into a door frame, sometimes it gets ripped off. I love that the adhesive kind of gets mushy sometimes when I sweat and falls off. No, these are not the things that you love about a CGM. Today's episode of The Juicebox Podcast is sponsored by. The Eversense 365 the only CGM that you only have to put on once a year, and the only CGM that won't give you any of those problems, the Eversense 365 is the only one year CGM designed to minimize device frustration. It has exceptional accuracy for one year with almost no false alarms from compression lows while you're sleeping, you can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox, one year, one CGM,
Jordan Wagner 15:37
for sure. For sure, really. So one thing to think about with stress. Here's the deal. Picture your body as a bucket. Okay, inside that bucket is going to be water. Water is like the mineral balance inside your body. Every time you're stressed out, it's like poking a small hole in that bucket. So if you're chronically stressed, you've got a bunch of little holes. And as you can imagine, that water starts to pour out the sides of the bucket there well, as your mineral balance gets out of whack, your insulin sensitivity also majorly gets out of whack. So not only do we have hormones raising your glucose levels, the minerals in your body that would naturally be there to kind of help with that insulin sensitivity, making those cells receptive to insulin, are now out of whack, so now these cells are not as receptive. So think of that almost like rust building up on a lock, and if insulin is that key, that key is going to have a harder time fitting in a rusty lock compared to a lock that's completely cleaned and and nice looking, right? Yeah. So there's, there's big things there that that stress can really impact.
Scott Benner 16:43
You know, in your professional life, when you talk to somebody about this, do you find that explaining it to them, like, because saying to somebody be less stressed is, yeah, you know, I'm married, that's not a thing I would say out loud. The reason is because it's not a feeling of like, Oh, you're right. I'll just be less stressed. Thanks. Do you get to talk to people about ways to do that, or do you find that your idea is like, let me just give them this idea and hopefully they'll go back into the world and figure out how to accomplish this on their own?
Jordan Wagner 17:13
Yeah. So it depends on the console and depends on the patient I'm talking with, and the reality of being working on the inpatient side of medicine, you're often seeing someone, and you have 30 minutes to an hour basically unload as much information as you can without overwhelming them and hoping that they take some of what you have as the as they're leaving the hospital, essentially, yeah, some people are open, right? They'll, they'll talk about things in their life, like stress and for example, maybe they have no community, right? So then I'll say, okay, maybe you need to find a church community. Maybe you need to go out to a place to where you can go dancing and make some friends, right? Get some community in your life. You know, maybe it's they're struggling with their bills, right? And maybe we can talk briefly about like, Hey, this is how a financial planner could help you with your bills, and, in turn, start lowering your stress. So there are definitely times where, like, I'm able to dive into it a little bit, but this is definitely something that needs to be ongoing. And so I think if your only conversation you're having is with me in the hospital, it's going to be unlikely that you actually start lowering your stress levels. Yeah,
Scott Benner 18:18
it's funny. I find that people like you and Jenny and Erica who like coming on the podcast, I feel like it's because you always, you guys always feel like it's just so difficult to get your message out, and you're just always looking for a way to reach other people, which I love. I think it's
Jordan Wagner 18:33
awesome. Yeah, without a doubt. I mean, because I tell people all the time like I probably get 60 70% of my consults of people who actually don't want to talk to me.
Scott Benner 18:45
They don't, like, come on man. Like, just, let's guy need the insulin,
Jordan Wagner 18:50
yeah? Or, like, I've had diabetes for 40 years. I'm not going to learn anything from you. Just give me your spiels I can get out of here.
Scott Benner 18:56
Jordan told me to go dancing, yeah? But what you're really saying is identify your stresses and ways to try to alleviate them, and without a doubt, because this has look, the truth is, these five things have impacts on people who don't have diabetes,
Jordan Wagner 19:12
without a doubt, I mean, and that's it, like we get so fixated on a number, right, whether it's an insulin dose or our glucose level, but I've always said my whole life, like I am more than a number, and that goes for everyone else with that. With diabetes, you are more than a number, right? Your health is not just a glucose number. You have to look at it holistically and look at everything else going on in your life. If you want to have a healthy, long life.
Scott Benner 19:38
I try really hard to think about it this way, I wish my daughter didn't have diabetes, right? But as long as she does, and I'm being made aware of things, things that maybe I would not otherwise be made aware of because the aging process, you know, in a healthy person, you know a person who doesn't have a chronic illness, or like, you know, other things. Going on. You age slowly, and you, you know, you deteriorate slowly, and you don't see it coming. It's that idea of like, I think the jumping in part is, I've always said this, like type one diabetes. It's because you can get, like, in trouble so quickly, it forces you to pay attention to it. It does, and maybe that's valuable for the rest of your life. There's nobody else sitting around talking about, like, you know, parents, like, go to sleep, you know, like, calm down. Like, you should get out and move around. But they're not talking about the why, right? And they're not going to see the impacts of it. If they're lucky for so long that they'll think, Oh, I just got older,
Jordan Wagner 20:38
for sure. And like, there's a benefit too. Like to even my family and friends knowing that I have diabetes, because it's taught me to care for my body, and I'm very open about that, and right. So then they start thinking about their own lives, of, Wow, I need to look at this, or maybe I do need to get a little more exercise, and so you can have this compounding effect of impacting a lot of different people as you take care of yourself.
Scott Benner 21:02
Yeah, no, 100% okay, activity. Go ahead. Talk people into being more active. I dare you, for sure, for sure.
Jordan Wagner 21:09
Okay, so activity is huge. Not only is that gonna make you feel better in the long term, I know, like, if I go out and take a jog, sometimes it doesn't feel the most fun during the jog, but you finish and you go, Wow, I feel great. You got that, that rush of endorphins there? But ultimately, what's going on is when you are using glucose for energy with exercise, some of that is able to happen with limited insulin use, like your muscles are able to use it without a lot of insulin, okay, and so you're naturally going to lower your blood sugars without having to take a lot of insulin, right? So let's say your blood sugar is 200 and you might be a little afraid of taking a dose to bring that down. Well, it's completely reasonable to say, why don't I go take a little walk, you know, walk around the block, right? I guarantee you that if you're doing that, you will likely see that blood sugar starts to drop a little bit, of course, like if you just ate a candy bar or something, and it's 200 that's different. But that exercise there, that little activity, is going to help there. But one of the ways I like to think about it is through analogies, right? And I already have shared a few analogies, but there are these things called glute, right? So, G, l, U, T, those are all capital letters, and stands for glucose transporters. And there's a bunch of different type of ones there. Think of those as like a taxi cab or like a bus, and they're dropping people off the building. The people in the bus is the glucose, right? And as you're moving around, you're getting more of those glute proteins bringing glucose to the muscles. It's dropping more off there, right? The different types of glute proteins get to the other destinations. You have the insulin as the key opening the door. So the point being here is that the exercise is making your body work the way it should, and we are supposed to work, right? That is using the glucose the way it should, and it's making you more sensitive to your natural insulin without having to take excessive amount more now, there are studies out there that will show that the effects of exercise can last for up to 72 plus hours. So let's say you did do some exercise today, you could be benefiting this for for days, but if benefiting this for days,
Scott Benner 23:24
I have to tell you that I've been exercising more recently, and in this past few days, I've been on a medication. I've been a little sick, I guess, for the past couple of days. And because I had not yet, I don't know how to put this, I had not yet built up a real habit of doing the exercise, but I was doing it like I was a month strong every day doing exactly what I was supposed to be doing. And then I got up one I slept in a little bit because I didn't feel good. And then I got up, and I actually think I thought to myself, I should go do that. And I was like, oh, but the day got messed up. And I was like, I'll do it tomorrow. But then I woke up the next day, I didn't feel well, and four or five days later, end of the day, nine o'clock at night, I was standing in my kitchen. I'm like, why am I so tired? Yeah, no. Lie that during the, like, the month of intent, you know, intensively, making sure that I was doing the exercise every day, not even that it was intensive exercise, because it really wasn't. I would get at the end of the day. And I my thought was, like, I have so much energy, like, I hope I can go to sleep, like it turned on in a week, like it just felt different. And I don't think that's even a thing I would have believed had I not experienced it, I guess,
Jordan Wagner 24:34
for sure. Yeah, and you know, another huge benefit of consistent exercise, and I like that you brought that up the consistency part there, if you're consistently exercising, having increased activity in your life, it will start to get rid of some of that visceral fat around your organs. That is basically the fat that just lines the organs in the body. And when, when you can start getting rid of some of that fat there, your insulin. Sensitivity is going to go up a way to perhaps think of that. And this is not a perfect analogy, but it kind of paints a picture here, a little bit. Picture a snow storm blowing through, like the Midwest, or something like that, and you're trying to get into your house now, before you can even get to your door to unlock it with the key, you're going to have to get rid of that snow, and so if you're shoveling that snow away, you get to the door, you can unlock it. That's that's an analogy to kind of picture that that visceral fat there, right? So the insulin is going to have to work harder to get to that lock, to unlock it there. There's just so many benefits exercise. You're going to feel better. You'll have a better outlook on life. Your glucose levels will be better controlled. It's just a win, win. Truly, to exercise other parts of your health are gonna thank you for that as well.
Scott Benner 25:48
Yeah, yeah. I can't agree more, and I also can absolutely throw in with all the people who hear that and say, like, I don't like exercising. I don't have time for it, or whatever you're gonna say, I said it all. I've thought it all. I've believed it all. And now, like, it's on me, you know, talking about like, ways to, like, reduce your stress, it's on me to find a way to actually bring this to bear every day for the rest of my life. Yeah, this is the part where, like, it's easy to say I'm stressed and there's nothing I can do about it, or I would like to exercise, but I don't have time. Or whatever it is, you're going to tell yourself, like, at some point, you know, you just either you have to do it or you have to live with you,
Jordan Wagner 26:29
and a lot of these things, you do have to take some self responsibility. I understand like it is not ideal that any of us have diabetes, but the reality is, we have diabetes, and so you either come to terms with that and do what you can, or you're going to be constantly blaming people and not doing well. And so when it comes to exercise, you have to take some self responsibility. I firmly believe that anyone can get increased activity into in their life in a pretty easy way. Yeah. I mean, that might even just simply be, you know, every hour you sit down and stand up 1015, times in your office, right? That's something you could do right there. Maybe it's when you're watching TV at night. You grab some exercise bands and just stretch them back and forth a bit. Use those muscles. You know, I was listening to a podcast with Andrew Huberman while back, and he mentioned that just taking, like, 30 Seconds to just run up and down the stairs at your office building, like once or twice a day would be a big deal. Makes a huge deal for, like, your cardiovascular health in the long term, it's not just like you feel good, then it's making long term impact. Yeah, how about when you're
Scott Benner 27:34
sitting at your desk for a while and you feel tired and just getting up and walking around is valuable, without a
Jordan Wagner 27:39
doubt. Yeah, right, or even sitting at your desk. I mean, there's honestly, like, you can't make an excuse, because there you could literally be doing those. They're called soleus push ups, where you basically just sit with your legs at a 90 degree angle and raise your ankles up and down. That soleus muscle is just right there by the calf muscle in the back. It's like a sponge for glucose. So you, I
Scott Benner 28:02
gotta tell you, you're gonna make me admit to something I don't wanna say out loud. All right, go ahead. Hold on a second. How many times am I gonna say this? But, like, don't have a podcast if you don't wanna say stuff like this, listen, it's not the healthiest thing in the world. I'm not gonna lie to you, one way or the other. But throughout the winter this year, art and I have been, like, once a month going to, like, a tanning salon, like, just the like, I don't, well, there's reasons why she wanted to do it that are not frivolous, but never. Nevertheless, she wanted to do it to try something. She wanted to see if it would help her acne. Okay? And I was like, she felt weird about doing I was like, I'll go with you. We're signing up. And the woman's like, are you gonna do it too? And I'm like, Okay, I'm in like, I mean, I'm already getting my eyebrows threaded with Arden. I might as well do this as well, right? So I'm using a stand my god, I'm using a stand up tanning thing. Okay, now keep in mind, you're in there and you're not very dressed, but I'm like, standing there for six minutes and I'm like, What am I doing? I'm like, I'm just standing here. So I instead, I do body weight squats while I'm doing exactly yes, yeah, okay, sorry. I didn't want to say that. I really didn't want to say that. I'm telling you, Scott, like, you you can do whatever you can in life. Like, I've told patients. They're like, I don't have time to do this. I'm like, Well, do you do you cook dinner for people in your house? Like, Well, yeah. I'm like, well, then dance while you're cooking dinner, you know, do some squats, turn some music on, turn it into a little time, like I, I've done that with my boys before. It's like we're cooking dinner, but we're having a blast. We're listening to music, we're moving around. It's, it's just what you're gonna have to I mean, it's easy to say, well, this is the world, the way the world works. Now there's no time for that, but this is the way the world works. Now it's not gonna work differently. You have to find a way to incorporate the things that a human body wants while you're living in the modern world. Absolutely. And listen to me, I don't want to be like, you know, I'm not an alarmist or anything like that, but at the rate AI is picking up, y'all might be on universal income soon. Anyway, you'd be like, Oh, I got I got much better. Or this, and much better that I have nothing to do. No, seriously, Jordan, are you not worried about that? Like, what would you call Yeah, when you when you hear somebody say, jobs might be eliminated, we might have to start paying people right like, and I don't know that that's crazy, that that could end up happening one day, and in your mind, like, I don't know about you, but for me, I think, Oh, it's wonderful to give people an opportunity to express themselves, or paint or do the things they've always wanted to do. But I'm afraid that for some people, they're gonna what they're gonna do is nothing, and then and then this is gonna get worse. You know what? I mean? Like for for some people? I mean, maybe this is an extreme example, but you know that movie wall e Yeah, no, yeah, exactly. I mean, dude riding around in chairs and robots do everything for you, yeah? And then that, and that little robot goes Wally, yeah? And you're like, Oh, I love this movie, yeah. I just, I'm saying is, my real point is that, you know, technology is changing quickly. Life is changing quickly. We are not running from bears, most of us anymore, true, but you're still going to get this stress. You have to find a way to manage it in the world that we actually live in, and you have to find a way to get activity in the world we actually live in. Now, if you're out there listening to this right now, and you know you're you're cutting a sewer pipe, well then you're probably okay, yes, yeah, absolutely right. So also, that's another thing, I guess you could, you could try to get more work that does things for you that I don't know. Like, I'm saying there's a lot of ways to,
Jordan Wagner 31:26
there's a lot of ways it doesn't have to be something. It's that's impossible. I mean, accountability is really big. Like, you know you had mentioned earlier, like, oh, I want to exercise, but I'm gonna, I'm not gonna do it right now, like having accountability is really important too. So like, in the past, I've done, like, through social media, like, you know, challenges, right? I did one where it's, like a push up challenge, and it was like, Okay, I'm gonna do X amount of push ups every day, and then at the end of the month, I gotta post my calendar so everyone can see that I did or did not do it, right? And so there's almost, like, a little bit of a motivation when you have some accountability, or people like, Hey, are you doing this? Are you not
Scott Benner 32:06
a lot of the things that happen on this podcast happen because I'll say them out loud so that I have to do them. That happens to that a lot like a lot of the series you that you might love, that's me going online, going, here's what we're gonna do. Because if I don't say it, then I might not do it right? Jenny and I just recorded earlier today the last episode of a short nutrition series that we did together, awesome. And at the very Yeah, and she's so passionate about it, because it's, it's her background, and it's just something she's actually really passionate about. She related a story at the end where she just said, like, look, my father died in his mid 60s, yeah, and, you know, like, basically what she was saying was, like, I'm taking care of myself, because I don't want my kids to grow up as adults without I miss my dad. I don't want my kids to miss me, right? Like, you know, like, whatever you can find to get yourself going, like, find something that means enough to you that you're willing to put forth the effort and and be consistent with it. Absolutely, yeah, absolutely, right. Where are we at on this? I'm sorry,
Jordan Wagner 33:04
no, we'll jump into some of the the sleep again here. So I know before I mentioned a little bit about, like, the the ghrelin and the leptin and things like that there. But just let's touch on how to promote sleep before going to bed. Because that, again, is going to the insult sensitivity, right? But I would say one of the biggest things is a routine, right? If you're going to bed all different times, like maybe at Monday night, it's 10 o'clock, Tuesday, it's midnight. Wednesday, it's eight o'clock. Thursday, you're at 1am if you're doing stuff like that, you're naturally going to have dysregulated sleep patterns. So you got to have a routine. Try to go to bed as much as you possible at the same time and wake up at similar times every day. I know that's not always possible, but if that is becoming a habit in your life, that will, I think, make some impact eventually there. I'm about to say something that's not gonna be feasible for everybody, but if you're able to getting like a bio sensing ring or like a watch, can really help with the sleep, right? I myself personally wear an aura ring, okay? And it tracks your sleep very well. It tells you when you're hitting all the points of your sleep, if you're aligned with your your your sleep type.
Scott Benner 34:14
What do you do with that information once you have it?
Jordan Wagner 34:16
So right now, not a whole lot, because I'm up with a newborn and a two year old almost every night. So you can't really do a whole lot with that, but in the past, if I could see like I'm having these issues here, I would try things like not drinking the caffeine closer to bedtime, I would say like, Okay, I clearly am having a hard time unwinding at night, so maybe I read a book instead of watching TV. I drink some chamomile tea before bed, something like that to relax me. Jordan, you
Scott Benner 34:44
have four kids. I think I know how you relax before you go to bed.
Jordan Wagner 34:49
Yeah, I just honestly hit the sheet sometimes and I'm like, holy cow, yeah.
Scott Benner 34:53
I meant two things there you. Laughed about one of them. I know what you mean. We got a. Lovely you are. You tried to pivot to like, I'm very busy chasing those four kids around. I was like, Hey, you're very busy making those four kids. That's what I'm saying. That's funny. No, no, listen. I don't want to put it on you, but if you listen to you know some of the data that's floating around now as a society, apparently we have sex less now, yeah, and I don't know nothing puts me to sleep better than that, so, but I think we're in a situation where the speed of life, I think it just sped up before we could adapt to it. Yeah. Does that make sense? Like, I don't think we're adapting as well as we used to, because things are changing so quickly. And
Jordan Wagner 35:38
so, yeah, and then, or I think everyone's, I mean, not to touch on these things too, too much. But like, I believe in, like, gender roles, right? And so, like, I think we're getting away from that kind of stuff a lot, right? And so everyone's chasing the bigger, better next thing, right? So it's a hookup culture, and I think that's promoting people not having good marriages. And there's a cascade effect, like we talked about from the very beginning, right? And so like my wife and I have tried really hard to have have a good marriage, you know, have a good intimate life and things like that, and that's paid dividends to the way our family is, and even things like improving sleep quality,
Scott Benner 36:17
yeah, in so you found a way to make a cohesive life together, and it's impacting other things in positive ways, stuff that you didn't plan at the time. Like, you probably listen, you probably just started off, like, with some, you know, like, either, like, cultural, religious or family values that said to you, like, this is how we're going to shape our family, right? And you didn't do that, and say, Hey, we're going to get married, and then, you know, we'll have some kids. You'll stay with the kids, I'll go work, and that'll definitely make it so that we sleep better one day. You weren't thinking that, right? Absolutely not just in the same way I believe that someone's not sitting at home thinking like, you know, I work really long, and I still want to play Call of Duty, so I'm gonna do it at 1130 like they're not thinking. And then I'll ruin my sleep with that, and then my visceral fat will go up and my insulin sensitivity will get worse. Like, no one's thinking, right? Yeah, they're just like, I just want to play this game, or I just want to do this. People, most of the time, are just trying to find a way to unwind at night, get ready for bed. And so, you know, even with that example, there of Call of Duty, or, like, watching a TV show, there are certainly things you can do to make sure you're not destroying your sleep, right? Have some maturity, right? Maybe you play Call of Duty, and you, you know, you stop yourself, you play it for an hour or so, and then you're like, that's it. I'm done for tonight. I know when I was gaming back in like, high school and stuff, I had zero self control a couple games, and then it's like, oh my gosh, it's 4am yeah. And if I just win five more of these games of Madden, I'll be able to draft better next year, and then I'll be like, yeah. Like, no, listen, it's another like, you know, look, I I'm not gonna, like, beat a drum, but, you know, there are a lot of things in your life that are driving up that dopamine for you, and especially in a modern digital world, and I feel very strongly about good sleep, like I harp on it in my family. It's a losing battle. I'm not going to tell you otherwise, you know, I'm not going to tell you that last night, I didn't wake up in the middle of the night and see a light on, and I thought like, Oh, let me go shut this light off. But it was hard. And she was still awake, and she was talking to her. You know, they're in a spring break at college. They're talking to her boyfriend, and I'm like, I'm like, I walked in. I was like, everyone go to sleep. Like, talk, during the talk, when the sun is up, right? Like, right? I try hard to, like, just follow that simple idea of, like, follow the sun. Like, get up with the sun, try to start shutting down when the sun goes down. I'm not all the way. Yeah, I'm not Amish. Like, I don't go to sleep when the sun goes down, like, you know, but like, I'm not trying to, like, stay up super late anymore, like I used to when I was young, and then, like, I was forced to, before algorithms existed and my kid had diabetes. Like, I value sleep. And at the same time, I'll say this, like, because I just shared this with my wife recently, we got in bed, and I was like, I'm so tired. Like, I want, you know, I'm excited to go to sleep. But at the same time, I said to her, like, I'm starting, as I get older, to get mad at have about having to sleep, like, and she's like, What do you first of all, she doesn't want to talk to me when she's tired, like, but because she's like, Oh, good, now he's gonna have like, some existential conversation with me. He just said he was tired. I'm tired. Blah blah. I said, like, I don't know. I just, I feel like my life is winding down, and there are things I want to do, and some days it pisses me off. I have to go to sleep, you know? And I I wonder if that's like, a real feeling I'm having, or if it's a feeling I'm getting from like, some unnatural acceleration that I feel from the work.
Jordan Wagner 39:44
No, that like my wife's grandfather, and he ended up passing away a few years ago, but he always said to white my wife, if he could have a superpower, it would be that he didn't have to sleep like if you I like dream. And stuff like that, right? So if you could sleep, but you didn't have to, that would be kind of cool. Yeah,
Scott Benner 40:06
no, I hear you, I really do. But my point is this is that if you sleep well when the sun's down, then you can pack more in to your life while the sun is up, and you're going to improve your overall health and everything else. Let's move on to do nutrition, because I gonna start sounding like a hippie in a second. I don't like that vibe. Well, Scott, I am a bit of a hippie, so that's okay. Oh no, I imagine you living in a yurt, just in case you're wondering.
Jordan Wagner 40:30
Oh, that's exactly right. But yeah. Anyways, yeah, nutrition. And I'll preface this to saying like, I'm not like a nutrition expert, but these are things that I have seen that have have impacted patients. I'm sure Jenny might be able to speak better to some of these things here, but the idea that I want to get across is that somebody can eat literally terribly and still have good blood sugars. But that doesn't mean that like you're in a good spot with your health, and that that gets back to what we touched on earlier. Of you could look at just the blood sugars and think you're doing great, but health is a lot more than just your blood glucose there. So we'll just start with that there. But I think one of the big things to think about with nutrition and insulin sensitivity is as much as possible avoiding Ultra processed foods, right? So that's going to be things like fast food, or that's going to be things like frozen meals at the grocery store, or, like a lot of packaged goods, things like that. The reason you want to avoid a lot of those, aside from the fact that a lot of them are really, really high in carbohydrate, there's there's trans fats, and a lot of those, and those are, those are known to cause insulin resistance,
Scott Benner 41:42
yeah. I always tell people, if you're looking for a reason not to have some of those oils that are available in so much of our food. Yeah, one of them was developed as a lubricant, exactly, right, yeah. And then they realized, like, Yo, you could eat this. They changed it a little bit, and they took machine grease and turned it into food, and now you make cake with it. So
Jordan Wagner 42:03
Correct, correct. And then that. Those are some of the seed oils that you're referencing there. And this is a hot topic, so we don't need to dive in this one too, too extensively, but the idea just think about this. Okay, if you were to eat, let's say, a peanut, you chew it in your mouth, and a little bit of oil comes out of it because you're naturally just chewing it. That is so much different than having, like, a refined peanut oil coming in out of a plastic bottle, right? So like, for example, those oils there, a lot of them are called PUFA, is polyunsaturated fatty acids. They're often touted as the healthier oil choice, which, again, without getting too, too much into it, I think there's some problems there. But what you often see is that the the Omega six to Omega three ratio is, like, completely unbalanced. It should be somewhere along the lines of like four to one of omega six to Omega three. And these unrefined ones, I'm sorry, these refined ones are closer to, like, 20 to one. Yeah, additionally, they're, they're also, like, stripping these things, not like, intentionally, but you go through this processing, it's getting stripped of all that's natural vitamin E. And vitamin E is, it's a really powerful antioxidant, and so that's why I think it's healthier to just eat, like the nut or the seed, right? Compared to having some of these oils. So not to sound like a hippie again, but like my wife and I will sometimes carry around little vitamin E capsules. And so if we go eat, like at In and Out Burger or something like that, you you pop a few vitamin E's before you eat it, just to help with the antioxidant and all that stuff. I'm
Scott Benner 43:40
going to tell you something like, If you I say this all the time, if you guys knew me, like, 35 years ago, you'd be like, I can't believe that's the guy that's talking to me right now. But I went through a whole renaissance of understanding oils a few years ago, and Jenny and I, by the way, Jenny and I, like I mentioned, we made a series on nutrition. It's out now. It's called Smart bites. I think it's maybe six episodes long, you'll you'll find it. But Jenny is a nutritionist, like by trade, like by by her education, who is also a CDE, and she's incredibly passionate about this. I told her years ago I was like, I think I'm gonna stop eating like oil, like I had like canola oil, which I grew up being told, was like, a healthier oil. But like, now I think of it as, like, healthier a healthier oil is like saying, like, let me find a better way to punch myself in the face. I'm still not doing a good thing for myself. Like, is it as bad as had I hit myself with two hands? No, but it's still not something I'm looking for. We cut all those out. The only oil that's in the house right now is coconut, and we only use it to make popcorn, okay. And other than that, there's a olive oil, but it's used really sparingly, and only cold pressed olive oil, because, like, Good, yeah, because the way Jordan talked about the way they process it sometimes either strip. Sort of the only nutrients you were gonna get out of it, or, believe it or not, heating up olive oil to process it is actually making it processed food, and processing it cold without heat takes longer, so you have to pay more money for it, correct? Yeah. And not to mention, even with olive oil, it has a lower smoke point, right? So using olive oil as a primary cooking oil, you could actually make that olive oil go rancid from over cooking it. And so, yeah, it's, I love what you said, the cold press. That's a very, that's a very important thing with, you know, oils, but especially with olive oil, I have to tell you, cold pressed olive oil might be the only reason I have a Costco card. So that's hilarious, yeah, because they make really great cold pressed olive oil. Yeah, yeah. So that kind of stuff, like, you know, taking vitamins, like this, the thing I've added to my life, like they're right here, like I'm not lying, like they're on my desk, so that I don't forget to take them every day. Yep, yep. I found that if I put them in the kitchen or somewhere near food, eventually somebody puts them away and takes that out of my mind. And so instead, it's just, it's in front of me on my desk, and every day I and by the way, it's not one of them. You have to read the label. You're supposed to take more than that of the one I have like, so I make sure to take more, you know, right, right? Oh yeah, that's funny. If you really want somebody who understands nutrition, who isn't going to talk down to you, but is going to be honest with you. I say go check out the smart Bites series with Jenny. That's awesome. She did such a great job of putting together these different modules to speak about, and we just literally, just literally finished recording it today. So that's so cool. And like, I truly believe that if people want to eat Twinkies and hot dogs and hamburgers all day long, they should be able to but they should also have the information to kind of know what potential consequences could be coming their way. Well, that's where I'm at, Jordan. Let me, let me. I'll finish nutrition, and we can move on to getting outside and get out of here. But, like, everything's a process, right? Like, everything starts one place with one idea, and if you get to keep it going long enough, you watch it grow and it morph. When I started making this podcast, I was in a place where I said, I know how to use insulin, which was revolutionary to me at that time, because I spent so many years with my daughter not understanding how to use it, right? I said to my wife, I'm going to start a podcast and tell people about how we do things, because I think they might find it valuable, and that's come to pass, like the Pro Tip series and the bull beginnings and those things are, I think they're seminal in this space, and people know about them far and wide, and they've helped a lot of people understand how to use their insulin. So when I start talking about that, I am immediately met with the idea that some people are going to eat really poorly, and I can't stop them from doing that right. And if I say, here's the ideas I have about how to use insulin, by the way, eat right and like and start scolding them, because that's how it's going to feel to them, this information is not going to get anywhere. So I started with a very basic idea of you need as much insulin as you need, and you need it where you need it and you should use it, yep. And it took a long time and a lot of years to build up a following that can be disseminated and people share it, and to the point where, like, you know, I mean, you see the Facebook group is huge, right? And people come in, and most of what they say is, my doctor told me about this. Yep, exactly. Mostly how people get into the group. So now, like, we've, you know, we've got this reach. We've taught people how to use their insulin, and there's a resource there for new people to learn how to use it. And I'm saying, in all of it, Bolus, what you need. But at some point. I'm not saying go live unhealthily, right? My concern was, if people don't use the amount of insulin they're supposed to use, it's either going to, like I said earlier, lead to some sort of an eating disorder, or it's going to lead to elevated blood sugars. Exactly. I thought, let's eliminate those two things first, right? Teach them how to use insulin so that they feel free to eat, so that they don't get involved in an eating disorder. Teach them how to use insulin so they're not running around with nine and 10 and 11. A, one, Season Eight, a, one, season seven, that they can put their a, 1c, where they want it to be, that they can have a variability that they choose, right? Like, let's give them those tools Exactly. But the next thing to say after that has to be, this would all be easier if you didn't eat some of these things, or if you limited the amount of times you eat those things. But if I start with that, then I'm just everybody else online telling you what to do, and you're not going to listen. And then you never know how to use your insulin. And you run around with a, 10, a, 1c, and it just, it seemed to me to do it in this order. Was,
Jordan Wagner 49:41
yeah, and I agree that that is the appropriate order to do it. And that's, that's how I approach it too. Like I have some of these conversations a little bit deeper with some of the patients, but a lot of the patients that I am doing this with, they had to come back to the hospital for another reason. So we've already established rapport in the past. Yes, of. How to get them going. And now it's like, all right, you know how to use insulin for the most part. Let's start adding on top of that. Yep, yes,
Scott Benner 50:08
it's super duper important, and it's not me. It's not a bait and switch for me. I still think like I would rather you be in a world where you have two choices about your health, your blood sugars and your variability and your nutrition, I would rather one of them be good than neither of them be good. Yeah, without a doubt, at least. Let's give you that like, if you're gonna eat a ding dong, then, by the way, that sounds so wrong. I'm gonna pick something else. If you're gonna eat a ho ho, then eat a ho ho and don't have a blood sugar spike from it. But for the other people who eat differently. You know how to use your insulin for an avocado and toast, exactly right? Like it works for everybody. It does anyway. I'm and I'm not talking down to anybody. I am totally going to have a Dorito this weekend. I just want everyone to know it. And Dorito is the food I use in the nutrition episode where I'm telling people like, you know what sucks for you? Doritos. But if I see one, I just want to be clear, Jordan, I'm gonna eat it. I mean, like, and that's the thing too. There's, there's a balance to in all of this, like, we've been talking about the whole time. Like, I think, personally, my quality of life would be a little lower if I was like, Yeah, I'm never gonna eat pizza again. I eat pizza every Friday night. Yeah, you know, and I've learned how to dose for it. I know that eating that pizza and the quantity that I eat is probably not the healthiest thing in the world, but I enjoy eating it. I enjoy spending time with my family and doing that. And so to me, that's worth it, right? So there's, there's that balance there. And in fairness, the next series that Jenny and I do is going to be called, What am I calling it? Bolus for? Probably the number four. I don't know why the number we're going to go out to the community and say, Tell us all the food you can't Bolus for. And Jenny and I are going to do short episodes where we talk through making a Bolus for each one of those items. And I guarantee you, most of them are going to be lucky charms and stuff like that. Yeah, you know. And fair enough, no one's perfect. Life's not perfect. We can all sit here and say, don't eat a seed oil, or don't do this, or don't do that, but we also just said it's hard to sleep because of technology and the way life is. It's also hard to eat because of, you know, how populated the planet is, and the way that we have to make food so that everybody can eat like it's not, it's not just you're out there making a bad decision, you're out there trying to live in the you know, you're swimming in the pool. Somebody threw you in basically. So, yeah,
Jordan Wagner 52:25
it's, I mean, just an interesting thing I learned in nursing school, and you see, if you just look around, is especially in the United States. It's like, one of the few countries in the world where a lot of, like, lower income people have access to food, but it's, like, very low quality food, yeah, whereas, like the rest of the world, they might not have access to any food at all,
Scott Benner 52:46
right, no, there's a lot of problems in the world. Like they're really, I mean, I'm not trying to say they don't exist. Also, my income is not challenged, but I grew up that way, and so did my wife, yeah, and we fight the things that were, like, bred into us as far as the way to eat. Like my, I know my wife wouldn't like me to say this, but my wife will eat like a garbage person sometime. I'm like, you know, we have money. I'm like, we're not poor anymore. Like, we're not like, you know what I mean? Like, I'm, I can't have a cook come in and slaughter the cow in front of me or anything like that. But, like, but we can afford it a reasonable meal, but she just grew up a different way and like and the things that occur to her, like, I watch her have to, like, say to herself, like, and my wife's she eats well, and she No, but her first thought is always the thing from when she was a kid, you know. And then in she stops herself most of the times, but there's also times she doesn't, you know, so holidays are a great example. Like, my wife equates holidays and certain like candy, or she almost can't stop herself from going to a movie and not buying popcorn. Yeah. It's not that tradition that built in tradition, almost, yeah. But then once she buys it, I see her take a couple bites of it, and she's like, I don't want this. Like, I actually said to her the last movie we saw, it was thunder bolts, in case you're all wondering. Like, she took two handfuls of popcorn, and she's like, I don't want this. And I said, Hey, next time. I was really like, I think it was very sweet. I said, Next time, let's buy a smaller one, because you don't want this. And she goes, No, you're right. And I was like, Okay, so like, let's see what happens. Like, when I go see hopefully, Mission Impossible part two, which I'm very excited to see. Yeah, those are great movies. Oh, my God. The last one was awesome. Like, hopefully she'll say, like, give me a small popcorn because, like, the, you know, help the little girl on her feel like she's at the movies. And, you know, cover for the fact that the adult owner doesn't want this popcorn at all. Super interesting. Anyway, I'm sorry, and by the way, go outside. Well, tell them about the sun, yes.
Jordan Wagner 54:46
Well, yeah, just get outside. I mean, if you're getting outside consistently, there's a high likelihood you're also increasing your activity. So that's a huge part of it there. But one of the big things is you. With, you know, vitamin D, right? So vitamin D in low levels, has been associated with insulin resistance. And there's even some some theories of diabetes diagnosis for type ones that point to the fact that vitamin D is low in a lot of type one diabetes, getting outside the sun, hitting your skin, helps our body to be able to make its own vitamin D, and so you don't need to go outside all day long. But like again, speaking to the person who you know works in the office, maybe you take your your lunch break and you go outside. And I know that's not always possible, but to the best of your abilities, just getting outside at some point during the day is going to be it's going to be really helpful for you, right? The other thing tying it all into sleep here is that when you're getting that full spectrum light coming from the Sun that helps balance your circadian rhythm, so your natural sleeping patterns, things like blue lights, so that's going to be lights coming from screens, or like the overhead lights in the office or perhaps at home, those things can actually really mess up your your circadian rhythm there, and the sun is a natural way to be able to balance that there. Just just as a side note, like they do have those blue blocking glasses that you that you can wear and block out some of the lights. You know, there's different colors. Yellow is going to be approximately 50% or so, the orange is going to block out closer to 100% so depending on what when you're wanting to do it, those are good options, too, if you're stuck inside. But it is just truly best just to get outside, get get a little sun. If you're not in a sunny state, that's okay, but like just getting outside, you're still going to get the benefits. To an extent, it might not be as much as, like, where I'm at in Arizona, you're going to get some benefit, for sure, so you're probably avoiding the sun and still getting it. Yeah. I mean, I am in the sun all the time. If you'd ever drove past my house, you bet go there's Jordan. He's not wearing a shirt again, because I just, I always have my shirt off, doing yard work and things like that.
Scott Benner 56:58
Yeah, awesome, Jordan. I can't, I can't. Thank you enough for for coming on and putting together these few episodes for me. If you have more you want to talk about, you, let me know you could always come back.
Jordan Wagner 57:07
Absolutely. Sounds good. Scott, awesome. Thank you. Yeah, of course.
Scott Benner 57:19
Thanks so much to Jordan for spending his time with us. If you're enjoying Jordan on the podcast and you'd like him to come back, go find him on Instagram, the diabetic murse, and let him know how much you enjoyed him on the show. This episode was sponsored by touched by type one. I want you to go find them on Facebook, Instagram and give them a follow, and then head to touched by type one.org where you're going to learn all about their programs and resources for people with type one diabetes. Are you tired of getting a rash from your CGM adhesive? Give the ever since 365 a try, ever since cgm.com/juicebox beautiful silicon that they use. It changes every day, keeps it fresh. Not only that, you only have to change the sensor once a year. So I mean, that's better. This episode of The Juicebox Podcast is sponsored by the Omnipod five, and at my link, omnipod.com/juicebox you can get yourself a free, what I just say, a free Omnipod five starter kit, free. Get out of here. Go click on that link, omnipod.com/juicebox, check it out. Terms and Conditions apply. Eligibility may vary. Full terms and conditions can be found at omnipod.com/juicebox links in the show notes, links at Juicebox podcast.com. Hey, thanks for listening all the way to the end. I really appreciate your loyalty and listenership. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. When I created the defining diabetes series, I pictured a dictionary in my mind to help you understand key terms that shape type one diabetes management. Along with Jenny Smith, who, of course, is an experienced diabetes educator, we break down concepts like basal, time and range, insulin on board and much more. This series must have 70 short episodes in it. We have to take the jargon out of the jargon so that you can focus on what really matters, living confidently and staying healthy. You can't do these things if you don't know what they mean. Go get your diabetes to find Juicebox podcast.com, go up in the menu and click on series, Hey, what's up, everybody? If you've noticed that the podcast sounds better. And you're thinking like, how does that happen? What you're hearing is Rob at wrong way, recording doing his magic to these files. So if you want him to do his magic to you, wrong way, recording.com, you got a podcast. You want somebody to edit it. You want rob.

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#1565 The Great Taboo
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Noor’s sudden DKA diagnosis sparks battle to survive, learn carb counting, and embrace tech while raising two young kids.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Welcome back friends to another episode of The Juicebox Podcast.
Noor 0:14
So hi, my name is Noor, and I have been a type one diabetic for a year and four months. Now, if
Scott Benner 0:23
this is your first time listening to the Juicebox Podcast and you'd like to hear more, download Apple podcasts or Spotify, really, any audio app at all, look for the Juicebox Podcast and follow or subscribe. We put out new content every day that you'll enjoy. Want to learn more about your diabetes management, go to Juicebox podcast.com up in the menu and look for bold Beginnings The Diabetes Pro Tip series and much more. This podcast is full of collections and series of information that will help you to live better with insulin. 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.
Today's episode is sponsored by the tandem mobi system with control iq plus technology, if you're looking for the only system with auto Bolus, multiple wear options and full control from your personal iPhone, you're looking for tandems, newest pump and algorithm. Use my link to support the podcast, tandem diabetes.com/juicebox, check it out. This episode of The Juicebox Podcast is sponsored by us. Med, US med.com/juicebox, or call 888-721-1514, get your supplies the same way we do from us. Med,
Noor 1:52
so hi, my name is Noor, and I have been type one diabetic for a year and four months now.
Scott Benner 1:59
Wow. Very recently, how old are you? I'm 34 Oh, so you were just diagnosed. What like end of your 32nd year? Yeah,
Noor 2:10
like January 15 of last
Scott Benner 2:14
year. No kidding. Oh, wow, yeah. How did you make it to me so quickly? I
Noor 2:18
was just searching on YouTube about like, tandem Moby and OmniPods, when I was just, like, diagnosed, checking, like, all the pumps out there, and I found your podcast on YouTube, and I found out, like, there is a Facebook group, so I'm like, I'm on it right away, so learning and giving like advices for people when they need, like, adhesive, or like over patch or Things like that.
Scott Benner 2:41
Just most of the things that come up in the beginning that you're just like, I would have no way to know about any of
Noor 2:46
this. Yeah, yeah, true. Oh my goodness. If, if I tell you what, I hate the ideas I had about, like, T, 1d, when I first was getting diagnosed, you will laugh.
Scott Benner 2:55
Well, let's laugh. So first, let's figure out how you found out you had type one. And then we'll, we'll figure out some of the things. She
Noor 3:01
thought, Okay, so my sister was preparing her wedding, and my parents came over. We were just like, happy to prepare for the wedding and everything. And it happened on November. After November, I started feeling like, really tired. I go drive my kid to school, and I can't remember that I drove her, and I would sleep. And then my mom, after my sister's wedding, she went, and she was sleeping over my sister's house for 88 days before Christmas of last year. So I'm like, I called my mom and I told her, like, I'm not feeling good, and I wish you didn't leave to my sister's house. And I'm I'm just like, not myself, and I want to sleep for a year. So my mom was like, No, don't worry. You're good. Maybe you're just, like, really tired, or you got used that I'm there, like, helping you with the kids, and now you're sitting with the kids by yourself. I'm like, okay, whatever. So one of the days I was getting, like, really sick. I don't like sweets, and I would want to eat sweets, and after I eat sweets, I throw up. And I was just, basically just sleeping in. No one can wake me up. And my mom would every time come and just check on me if I'm breathing or not. I would just, like, forget things if I'm awake. I can't take my shower by myself. I can't even, like, use my legs properly to walk. I would go and pick up my daughter from school with my pajama in my school slipper, sorry, my house slippers, just because I can't, like, lift my legs to put it on the like, winter boots. To that point, how
Scott Benner 4:32
long did this go on for? One month and a half now, looking back, if you were in the mind you're in now, how long would you have let it go on for?
Noor 4:41
Oh, no, right away I would know, like there's something wrong with me. So there's part
Scott Benner 4:45
of what's happening to you that stops you from assessing what's happening to you. Yeah,
Noor 4:49
and I had a problem too. I was losing a lot of weight, and this is indicate that you have T 1d but the problem is, before I was diagnosed with T 1d I had. And sleeve surgery, which means I was not that fat, but I didn't like the way I look, and I was not feeling happy about the way I look after having like, two kids and going to the gym, I'm not losing weight or whatever. So I told my husband, like, see, I'm I'm not in the mood to go buy like, X large clothes or large clothes, and I'm not happy with the way I look. So don't tell me to go out. Because every time he tells me, let's take the kids and go out somewhere, I would cry. So he's like, Okay, let's do the sleeve surgery and check how much is it, and we can do it if this is what will make you feel happy about yourself. Okay,
Scott Benner 5:33
so you got that gastric sleeve? Yes, how long before this whole time of being diagnosed with type one? Did you seven months? And had you been losing weight from the surgery?
Noor 5:43
Yeah, I was losing weight, and I reached target goal of my weight, and after that, I was just going down very fast. I'm from the Middle East, so we do it with kilos. I'm not like good in calculating it with like pounds, but I reached from 60 kilos, which is around like 160 pounds, I think, to 46 kilos in that seven month period. No, in the one month and a half, oh, oh my gosh.
Scott Benner 6:13
Oh, so you had lost some already and been happy with your weight loss exactly then this larger piece happens in just those four weeks. Yeah, did you think, oh gosh, the surgery is still working too well now? Or what did you think when you were thinking about your weight?
Noor 6:28
My mom was accusing me that I'm not eating at all, just to because some people, when they do the sleeve surgery, they think like, I'm gonna starve myself. I'm not gonna eat so they are scared to gain weight. And all what they did and went through was for nothing I see. So basically, this is my was not my point. I tell my mom, like, I have been eating like a cow and drinking water like a cow since I'm just like, feeling like, you know the like, the dka in the beginning, yeah, I'm like, I'm eating and I'm drinking more than I did just like, few weeks ago. And I don't know where the food is going. Why I'm not gaining weight. I'm losing weight,
Scott Benner 7:03
eating and drinking more, losing more weight than when previous Yeah, your mom is older or
Noor 7:09
no. She was born in the 6519 65
Scott Benner 7:13
Oh, okay. Well, she's what, yeah, she's in her late 50s. Then, yeah, okay, so she's not that. I was kind of wondering if maybe you were a late in life baby, and she was just kind of gotten past the point where she could work through this problem, and just was, yeah, but that doesn't seem like that's the case
Noor 7:28
either. No, I'm the oldest, actually, and we are only two, my sister and I, and my sister is younger than me, with only like, three and a half or four years so I'm the oldest, actually. And she got me when she was really young, which is around like, 2122 years old, something like something like that.
Scott Benner 7:43
Is there any illness in your family, generally speaking, like reasons why people would be paying attention and know what to look for in these situations?
Noor 7:50
No. What I know of growing up that my grandmother had type two diabetes, and she was doing good with the medication, but she came to a point in life that she had dementia, and she started forgetting so many things, and she drinks a lot of coke and a lot of chips and all these carbohydrates, and it turned with her to be type one.
Scott Benner 8:12
Oh, eventually her type she had type two for a while, but then they gave her a type one diagnosis.
Noor 8:16
Yes. They gave her type one diagnosis when she started like to lose her Pinker, yes, and she forgets to take her medication. And it was like, at the end of her, of her living years, you know, I remember my mom and her sisters were just like, taking care of my my grandmother. She was not talking. She can't remember who are they. They were trying to figure out, like, how to give her insulin, where to buy insulin. And it was just like, hard to
Scott Benner 8:39
deal with it before she died. Yeah, gosh. How old was she when she passed? You know,
Noor 8:43
around, I think 70s or 75 I can't remember so and she was diagnosed when she was around 60s. So she stayed type two for a long time, and then it started to be type one when she was just like out of the world. She can't remember who is she, or who are they, or whatever.
Scott Benner 9:00
How about other autoimmune issues like thyroid or celiac? Nothing, nothing,
Noor 9:06
nothing, nothing in my family. And surprisingly, I'm the only one also who has a kid with Down Syndrome and no genetic
Scott Benner 9:13
problems in the entire families. You have? How many children do you have? I
Noor 9:17
have two. I have Milia. She's turning eight in September, and I have Adam, my sweet angel, who's turning four next month,
Scott Benner 9:25
okay? And Adam has Down syndrome, Down syndrome, okay, all right, how about on your husband's side? Is there anything going on over there? Nothing
Noor 9:33
at all, just his dad in the past years, because of he was like a heavy smoker, he had the problem with her heart, and that's it.
Scott Benner 9:42
Okay, all right. So how did they get you to the hospital going back to your diagnosis?
Noor 9:46
So my insurance was very bad at that time, so I had to go back to the doctor who did the surgery for me, and I told him, like, what's wrong with me? He's like, I don't know. Like, the surgery is fine. I'm like, I'm eating and. Drinking. I drink like half of the bottle of the water, and when you are having the sleeve, you can just eat, like, you can drink like two sips, and you have to wait because your stomach can't take more sips of water. And he's like, are you serious? I'm like, yeah. He's like, show me. So I hold the bottle of water. And I'm like, he didn't believe it. So he's like, come with me to the X ray room. And he did, like, an x ray on my ultrasound, or X ray, I don't know how they call it, but just to see my stomach and all the stitches and all the rings he put, like around, like the things that he closed my stomach with, he's like, everything in its place, no leakage. So what's going on? I'm like, I don't know. So I used to go to him every Thursday he puts for me, like, banana drip in other like drips and stuff, I would feel good, but I feel so dizzy after that. So after doing that for three weeks, I think or two weeks, he told me, let's do blood work. He did for me some blood blood work. And he accused all the nurses there that I was taking the drips, the IVs, and they took from me the blood so all my numbers are just, like, very confusing to him. It's like the person who did 17 months ago the blood work is not the same person that's standing in front of me. So I'm like, What's going on with it? Why you're screaming at that? It's okay, be kinder. He's like, no, no, no, they did something wrong. Your blood sugar is very high, your sodium chloride, and all these things are really low. There's like, no, they messed it up. So come next week, let's do it again.
Scott Benner 11:25
Oh, so he saw the type one, but he didn't know what to think of it, so he thought it was a mistake. On on the staffs part, diabetes comes with a lot of things to remember, so it's nice when someone takes something off of your plate. US, med has done that for us. When it's time for Arden supplies to be refreshed, we get an email rolls up and in your inbox says, Hi, Arden, this is your friendly reorder email from us. Med. You open up the email. It's a big button that says, Click here to reorder, and you're done. Finally, somebody taking away a responsibility instead of adding one. Us. Med has done that for us. An email arrives, we click on a link, and the next thing you know, your products are at the front door. That simple, US med.com/juicebox, or call 888-721-1514, I never have to wonder if Arden has enough supplies. I click on one link, I open up a box, I put the stuff in the drawer, and we're done. Us. Med carries everything from insulin pumps and diabetes testing supplies to the latest CGM like the libre three and the Dexcom g7 they accept Medicare nationwide, over 800 private insurers, and all you have to do to get started is call 888-721-1514, or go to my link, usmed.com/juicebox, using that number or my link helps to support the production of the Juicebox Podcast. This episode is sponsored by tandem Diabetes Care, and today I'm going to tell you about tandems, newest pump and algorithm, the tandem mobi system with control iq plus technology features auto Bolus which can cover missed meal boluses and help prevent hyperglycemia. It has a dedicated sleep activity setting and is controlled from your personal iPhone. Tandem will help you to check your benefits today through my link, tandem diabetes.com/juicebox this is going to help you to get started with tandem, smallest pump yet that's powered by its best algorithm ever control IQ. Plus technology helps to keep blood sugars in range by predicting glucose levels 30 minutes ahead, and it adjusts insulin accordingly. You can wear the tandem Moby in a number of ways. Wear it on body with a patch like adhesive sleeve that is sold separately. Clip it discreetly to your clothing, or slip it into your pocket head. Now to my link, tandem diabetes.com/juicebox, to check out your benefits and get started today.
Noor 13:59
Yeah, because I nothing is indicated that I am team. Like he didn't believe it. Like, until now, when I go see him, he still can't be, like, he's not digesting the idea that I'm T 1d until now, wow. So I went home and my mom said, like, what were the numbers that he was screaming about? And he doesn't didn't like it, and he accused the nurses and stuff. So I told her my blood sugar was he's saying my blood sugar was very high, like around 500 in my chloride, in my sodium, and everything was just like messed up, like he said, like you're not the same person that I did the tests for seven months ago. My mom looked at me with a look in her face, like her face turned white. She started sweating around, like, her mouth and her like, front head. And she's like, Noor, I want you to buy the blood meter. I'm like, what's that like, the one that he used to use for my grandmother to know her blood numbers. He's like, Yeah. I said, okay, it was a weekend. So I order it from Amazon. She didn't make it. Like, it's a very big. Deal that I need to go and buy it, like now from CVS or something. I order it and it came on the Monday that was, like a link clean birthday or like it was, it was like a vacation in the US. I can't remember. What was it, January 15, 2004 14. Sorry, 2024 so I got it, and she's like, let me do it for you. I was not knowing. What is that? I didn't know the terms for, like, a strip, the needles, the length, like, what are these? I have no idea. So she did it for me, and she's like, but you just ate, so it's okay if the number is a little bit high. I'm like, I don't know. It's okay. So she did it for me, and I was like, 580 and she looked like she looked with a very scary face again, and she's like, she's just looking, you know, and she's not talking or anything. I'm like, whatever I was saying is, am I gonna die? Am I gonna die? Just let me know, am I gonna die? Because the past one month and a half, I was feeling I'm dying slowly, like life is torturing me. They are taking my soul out of me, like, very slowly. So she's like, No, but you're diabetic. My mom even didn't know, like, if it's type one or type two, you know, she's like, You have to go right now to the to the emergency room. So I called also my doctor, again, the sleeve surgery doctor, because he's the only doctor figure in my life at that point. And I told him this and this happened, he was not believing. He's like, how did you know I'm like, from the mirror that you put strips and blood in? He's like, You sure? Okay, meet me at this hospital. So I went, and my mom told me, when you go there, if they tell you they want to give you insulin, no, take pills, because this will mess up with with your pancreas. I'm like, okay, mom, okay. Called my husband. I'm like, I'm diabetic. Take me to the hospital. He's like, what? I'm like, diabetic. Take me to the hospital. He's like, no, no, no, there is nothing wrong about you. Let's go to the hospital and we check. This is how my story started. I was a 1c
Scott Benner 16:49
12, right? Now I'm interested. So your husband doesn't want this to be true, and your mom thinks that if you take insulin, it'll make things worse. Yeah, yeah, okay. He took you to the hospital. What did you find out? Yeah,
Noor 17:01
my aunt also was here from we are originally from Egypt, so she was here visiting to attend the wedding as well. So she went with me, went to the ER, and I told them, like, just letting you know, I'm not gonna take insulin. I just want you to run for me a 1c and stuff. And the doctor of the ER was smirking at me. I'm like, he's like, um, what did you say you're diabetic? I'm like, Yeah, how did you know is any doctor told you so? I'm like, No, my mom told me. The meter at home told me, you know, like, I was still not I didn't even know what a type one diabetic person is. In English, I had to google it before I go to
Scott Benner 17:36
the hospital. Okay, just to see you could say something when
Noor 17:39
you got a 1c I didn't know what's a 1c we have another term for it in Arabic. So I had to call one of our friends who works in hospitals, in in blood work and stuff, and he told me it's a 1c so I had to know my terms before I go and just like, talk to the ER, you know, so the doctor said, like, oh, so your mom told you. And he was smirking at me, and I was standing and I'm telling him like I have been dying, and he's not believing that I'm still standing on my legs. And I'm talking to him that way, and I just telling him, you have to do to me. 1234, yeah, as if I'm giving him orders. Yes, exactly. I'm giving him orders.
Scott Benner 18:13
Your mom, by the way, who did what? Professionally,
Noor 18:16
no, nothing. She was yeah, like, nothing. Medically, actually, she we lived in Kuwait for around, like 20 years before she moved back Egypt, and I moved to the US, and she was sales manager at Kia Motors, and she was like a sales person as
Scott Benner 18:33
well, so everything she knew about diabetes was from the last 10 years of her mother's life.
Noor 18:38
Yeah, actually not 10 years. It's the last like, three years or something with my grandmother. Yeah. Okay, so I went the doctor was smirking at me. He's like, You know what? Sit down. We are gonna do some blood work and we are gonna take care of you, don't worry. And he's just laughing and being very chill. And I'm very, like, being very mad at him. They did and everything they said. He said, like, go outside, go talk to the person on the reception. He she's gonna take some intake and stuff. I'm like, okay, so I went, I told her I'm not gonna take insulin, please. I'm not gonna sign any paper that says I'm gonna take insulin. I'm gonna take only pills. And I'm not gonna do this. I'm not gonna do that. And she's like, but if you are in a late stage in your diabetes, you will take you you will have take insulin. I'm like, no. My mom said, No, I'm not gonna take so my husband was like, let them do whatever they are doing. And just like, shut your mouth.
Scott Benner 19:26
Yeah. Your mom's like, Listen. Your husband's like, I don't listen to your mom at all. I don't think we should be listening to her right
Noor 19:33
now. And my mom just like, when my mom say something or my sister to me, like, you know, go right. I go right, go left, I go left, because they are like, I believe them. I trust them, you know. So. So anyways, they took me back, and the doctor was like, we did your blood work in your blood sugar level is over 700 let me go back a bit sure I was telling him, they kept me on the whole and the whole way of the hospital, and they put for me the IV. And I was very hungry. He was dying. So I told the doctor, Ken, my husband, buy for me. Like, Uber Eats and just like, deliver it for me. Here, he's, like, he bent down on his knees on the floor, as if, like, he's gonna say, Would you marry me? And he said, Ma'am, your levels are 700 and plus your a 1c we can't do here, because you have to be in the fancy ICU. So they are gonna take you in a very private, nice room with private toilets upstairs. And they can, they are gonna run for you. The A 1c, is there. You are not gonna be eating for the first three days, and you're gonna stay here with us for for few days, right? So no no eating. You can't eat. So you're
Scott Benner 20:39
definitely not getting Uber Eats. Just put that out of your head.
Noor 20:43
So what I told my husband is, he's not allowing me to eat. And he said, You're not gonna eat for two days or three days. He's like, why? He said, I told him, like, they're taking me to the ICU. I didn't know what I see. I was not there. I had, seriously, I had black holes over this, like, this period. This is only what I remember from the one month and a half, you know,
Scott Benner 21:01
no, I believe, especially with your, I mean, your blood sugar had been very high for like, a significant amount of time, yeah, that's true. Yeah, that's true. I don't imagine that you're gonna make a lot of good decisions during that time.
Noor 21:14
Yeah, yeah, that's interesting. I just felt so sad that I was not gonna buy, like, Uber Eats and eat because I was so hungry. So my husband is like, are you gonna sleep over the hospital? I'm like, yeah, he said that he's gonna take me to a private room with a private bathroom. He's like, nor can I come in like, my husband was so worried that I'm taking decisions in not knowing what they are saying, you know? So anyways, they took me to the ER waiting list of the ICU, and they started doing like, a lot of blood work and a lot of information they needed from me, and they couldn't find any like, good veins in me just to take like blood work. It was just a disaster in the beginning, until they took me to the ICU. I was in the ICU for five days, I think, and all the doctors came in the next day and they said you're type one diabetic. So I was standing there with my husband, and husband was like, what? My gosh, yeah, so I'm like, how he's they are, like, they also didn't have the full information of, like, how an adult in this age would have type one diabetes, and they don't have anyone in their family except the example of my grandmother. So they're like, We are running a lot of tests, and we have one of the doctors said, like, you are one of the few patients, or maybe the first patients to put a lot of resources and a lot of exams on her, like blood work that's traveling like this estate or this here, or that, or whatever, and just trying to figure out why you have type one diabetes. Am I gonna take, like, medication or take insulin? Insulin like injection? They're like, No. Definitely are gonna live on injections. Okay. I'm like, okay, so I just, like, had it as if, like, someone slapped me on the face. I was okay. I was not crying, nothing. My husband was the one who was crying. Because, of course, like, you know when, when a person just feeling vulnerable at that time? He was like, sure, like, God sent us Adam and and we didn't know how to do it, and you're the only one who knows how to do it, and doing it all by yourself, and now you have diabetes in like, I don't know why, why God is doing that to us. I'm like, the problem is not why. The problem is how. Now it's how. And I didn't know anything about T 1d at that time, so yeah, your
Scott Benner 23:27
husband was more focused on, how did this happen to us? Yeah, and you were more focused on, how are we going to manage all this? And what the hell does this even mean, any of it? Yeah, because it's not a thing you understand at that point like you're literally calling people and saying, Hey, what's the translation for this? I have to go to the hospital. Yeah, true, right, right. Wow. Did he come around, or did he stay in that space?
Noor 23:51
No, my husband would act like he came around, but it's gonna come out eventually that he's not feeling okay with it. So he was okay with it, until I would be like, really sick, or my blood sugar is really down, and I can't, like, reach to the to anywhere, because, especially in the beginning, I came out of the hospital on a walker because I couldn't walk. And I didn't know that when I was there until I left the ICU bed, and when I came on a walker, he was feeling sad that me, the strong person, the mountain of the house, that nothing would blow it away, is not knowing how to walk, and she's learning how to walk again, and she can take showers by herself. She's waiting for for me to come home, or her sister to come like from one hour and a half drive just to take to give her a shower, so he felt sorry for me, and he doesn't want to show that I'm he's feeling pity on me, you know.
Scott Benner 24:47
Okay, no, I understand. Yeah, I do. I mean, how long were you in the hospital for a week? Yeah, like five, six days, as I remember, and then you get home, you're pretty out of it for a while. Yeah, I was
Noor 24:58
still can't walk my leg. Were not strong enough diabetes eventually, like, ate a lot of muscles around my house, my around my body.
Scott Benner 25:06
What did they tell you about the the extent of your diagnosis? Like, were you obviously, you were in DKA, but did they tell you things like, wow, you're you were close to being in a coma. This was close to death. Like, what was the feeling for how far along this all was
Noor 25:21
no, they told me, We The a, 1c, can't indicate if you were, like, having these numbers for three months or not, but we are so sure it's for the past month. And they said, Thank God, you came on the right time, because I was on the last bit of symptoms before. And actually they told me, like, when I was sleeping and I couldn't wake up at all, I was going into high comas, and thank God, I was waking up from it. Oh my gosh, yeah, because I remember one of the times that my mom was sleeping over at my sister's house. They called me from my daughter's schools that my school that I am late to pick her up one hour, and they have been trying to reach me, and they couldn't reach me, and I woke up, went to pick her up, and I came back home, and actually, my my son was home in his crib sleeping, and I forgot all about him. Yeah, you
Scott Benner 26:10
were just out. You were completely just Yeah, wasted, yeah.
Noor 26:12
So this is what scared me, bad, of course, like, I don't know what's happening. Maybe the surgery was a bad idea. Or, like, I'm dying because of the surgery. Or, you know, like, I all, we all blame it on the surgery. Yeah, there's so many
Scott Benner 26:23
possibilities happening in time. You have no idea what's going on. You're just trying to sleep and just and try. You feel like, Oh, I'll sleep and I'll feel better. Yeah, exactly. And your husband, he's having that thought. I mean, I heard earlier your mom was, you know, saying like, Oh, you just need to get rested, and things like that. So, wow. Well, it's lucky you, you know, I guess it's lucky your mom knew exactly, yeah, it really is, what, where is the hospital? Like, what state
Noor 26:48
we are in, California, Orange County,
Scott Benner 26:51
okay, all right. And okay. And they were still confused by it like that too.
Noor 26:55
Actually, what happened is, when they were trying to dismiss me, they got this nutritionist to tell me how to eat, you know, like, this is your plate. Half is this? Quarter is this? The other quarter is that? I'm like, I have this leaf surgery, so I can't eat that much. I have to eat only, like, two, three bites, and I have to survive with diabetes. So how to do that? Yeah, they would look at me confused, and that's why they all told me my case is complicated, even the first endo I saw, Wow. So I was all by myself, yeah,
Scott Benner 27:27
no, no. I was gonna say, like, you know you're in DKA and you're on your way dying because you have type one that's undiagnosed, and they're busy telling you about the food pyramid. Oh yeah, you're in trouble.
Noor 27:37
Exactly, exactly. Wow. And they made me starve, actually. And of course, you will have like, other complications during the process, because they put me a lot of insulin. And then I remember one of the amazing nurses I dealt with, he came in and he's like, wake up, wake up. Your blood pressure is going down. Everything else is going down. I want to make sure that you're alive. So I had one of my best friends died many years ago because her blood sugar went down, they were trying to put it up, up high, her potassium, magnesium, all that went down. Both of them went down, and then she died. I lost her. Jeez. So of course, I asked him, am I dying? Am I dying? He's like, if you were not here in the ICU, probably you would. So I'm like, Okay, are you gonna take care of me? I'm so sorry. I can't remember his name, but he was the best person that he sat with me at night and he would talk to me, of course, I couldn't move, so I would ask him to help me, like, sorry to mention that, but to pee while I'm sleeping there, and it was so embarrassing. But you know, you have to do what you have to do.
Scott Benner 28:34
Yeah, you just couldn't. You couldn't. You were really, I mean, we got to figure out how much weight you lost. So hold on one second. I'll okay. So you were at 160 kilo. What were you at? No, 6060, kilos. 60 kilos. To how many? 4046, how tall are you? I am five five. Okay, so you lost your five five. You lost like 30 pounds in a month? Yes, jeez, they're a little more than a little more than 30 pounds in a month. On on a five, five frame, and you didn't have, what were you before the surgery? I was like
Noor 29:11
85 kilos. I think, okay,
Scott Benner 29:17
so in seven months, you went from 187 pounds down to 130 pounds. So you lost, like, you lost like 55 pounds, just a pretty significant amount of weight, and then especially on your frame. And then, yeah, even 30 more. So you were down 85 pounds. Yeah. I know. Excuse me, 85 kilos. Yeah. Basically, yeah, yeah. Well, that's insane, yeah. I mean, you lost 80, I'm not wrong, like 8586 pounds in in seven or eight months, yeah, oh, geez. And the doctor's trying to, I'm right, right. He's giving you IVs to try to bring your nutrition up. That was his concern.
Noor 29:59
Yeah. Yeah, like they are giving me IVs because they kept me with no food for three days. So they were trying to, I can't really remember what they were trying, but I remember that this point I was gonna die. And the nurse himself came in just to make sure that I'm awake, because my my blood pressure and my heartbeats were like fading away, something like that. He says I would what I would remember in and I was feeling so lonely, of course, just like doing nothing, sleeping and waking up. So he would sit with me and talk and stuff. And for them to I had, like, around four IVs in my two hands, and one of them are getting blocked in blood out or whatever. So they were trying to figure out, like a spot in my body to give me IVs from and they take, like, blood work every, like, two hours, and, oh my goodness, my hands were abused to the point like they were taking blood from my, like, between my knuckles.
Scott Benner 30:50
Oh my gosh. Oh yeah. Listen, and I know you're out of it. Like, I know you're beat up, and you've this crazy weight loss. Nutrition is a problem. You're in. DK, the whole thing, like, I understand why you don't, but like, Does no one else stand up? Like, I don't mean this is an attack on your family. I'm trying to understand big picture. Like, for all of us, not just you, you're in the middle like you're dying, you're dying, and no one's noticing beyond, well, we'll ask the doctor, and then the doctor says something, and it doesn't stop you from dying. But nobody throws up a hand and says, Well, we have to do something else, because whatever the doctor's saying is not helpful. Like, I'm very fascinated by that part of all of our stories, of the point where something egregious is happening, it's obvious, and yet we don't push past whatever advice we end up getting from a doctor. Like, you don't. I mean, by that, like, it's yeah, I get you, yeah. It's like you're drowning, and I'm telling you you're not,
Noor 31:47
yeah. Basically they, like, was just pushing me to go to the hospital. But at that time, my insurance was only covering to go to an, er, okay, nothing
Scott Benner 31:58
else. So money and insurance is a part of it, yeah?
Noor 32:01
Like it was part of it in my head. Like I told him I would go to the hospital in the ER and sit there for like six, seven hours. At the end, they tell me, take these pills and go home and you'll be fine as usual. So no, I'm not gonna go sit my ass down like for for six hours, just because they tell me you have nothing as usual. Yeah. You know,
Scott Benner 32:21
to go back to my analogy, it feels like you're in a pool, and you could stand up and your head would come out of the water, but instead, I have you with your knees bent. Your knees are on the bottom, your head's underwater. You're drowning. You say to me, Scott, I'm drowning. I go, No, you're not. And you go, Okay, should I stand up? Because, no, like, don't stand up. Just keep drowning. Like that. Part of it really throws me in a lot of people's stories, yeah, when we get to the part where what's happening is clearly not what's being said, and yet we just, like, as people, have just a lot of trouble, I don't know, turning to a doctor or saying, like, Look, you, this isn't helping. Now, again, I get you were in a bad way, but the people around you and the other stories that I hear, I'm always fascinated by by that. And you know, people oversimplify it by saying, like, Oh, you have to advocate for yourself. Like, I hear what you're saying, but like, I think it's more than that. And I don't know how to put into words,
Noor 33:13
yeah, no, I understand. And everyone around me blame it on me that I'm not eating enough. And it was a bad decision to take that, to do the surgery, and I did that. I brought that over myself. Even after I was diagnosed with T 1d some people in my family, they were like, Yeah, of course, you know, like, I don't know if you have the same thing here around the US families or not. By the Middle East, they like to talk about the taboo in a bad way, and they make it like other people's problem, like, they like to blame other things. So yeah, of course, when he was cutting your stomach, he hit the pinker. Yes. I'm like, if you want to see it that way, and it's gonna make you feel happy about it. Okay,
Scott Benner 33:51
a lot of that, like, oh, I told you, or even quietly behind your back, like I knew she shouldn't have done that.
Noor 33:56
Oh, yeah, yeah, yeah. They kept on going and back and forth. And until now, I would still like hear this, these comments, of course, the doctor hits your pinker. Yes, I'm like, if he hit my pancreas, yes, it's not gonna stop working. It's gonna bleed, like, if you don't know what you're talking about. So shut it.
Scott Benner 34:11
Yeah, no. But at the same time, those are the people who you have around you to listen to. In a situation where you're not able to really think straight for yourself, you have to count on the people around you, and that's the way those people are thinking. So, yeah, like,
Noor 34:25
this is the extended family, but my family themselves, like my mom would like, I hear her from the kitchen when I was just awake or something. Like, I'm like, Yeah, I know what she's saying, you know? Like, I know that she's blaming her life for making me do the surgery.
Scott Benner 34:40
I know I, I think all the time. I'm like, you know the I just, I don't want anything to ever happen to me, where I look up and I look around me and I'm like, Oh, these idiots aren't going to be able to help me. Like, like, I'm finally incapacitated, and it happened to me at the Pet Smart, like I'm in trouble and and,
Noor 34:58
to be honest, I don't. Know, I keep saying the Middle East, the Middle East. I don't want to offend anyone who's listening, but I'm talking about, like, the Middle East my family, they don't like to talk about a taboo. This is a taboo, like having T 1d or looking at me taking my injections. This is a taboo. Oh
Scott Benner 35:14
no, no, I listen. I don't think that's just the Middle East, but I have heard, I mean, you, if you're listening to the podcast, you know, I have a fair amount of people on from that part of the world, actually. And actually, yeah, yeah. I know, yeah. I know. I do. I do get it, like, I see that. But I mean, if you think that that's not going on in Missouri or New Jersey, I think you're, you're not, you're crazy too. Like, people just find the strangest things to I have a story that is, I'll leave out all the details of who the person is, but a tangentially related to me. I know a person who got cancer, and they, you know, there's a pool party, and the person with cancer got in the pool, and everybody got out of the pool.
Noor 35:53
Oh, my goodness. Oh, my goodness. These were
Scott Benner 35:55
all family members, wow. And I was like, what lack of understanding about the world, you know what I mean, or how cancer works, or anything. Do you have that? That was what happened that poor person just like, stepped into the pool and everybody just was like, woo, and got away. And I think that's what you're talking about, is that level of misunderstanding?
Noor 36:14
Yeah, yeah. And it happened also with my son. Like, don't talk to her about her son. Don't ask questions. Don't look at him. I'm like, Why is his nose with six openings instead
Scott Benner 36:23
of two? And then you're telling me that now you're alone, right? Yeah, yeah, yeah, yeah, because nobody's willing to talk to you about it, nobody's willing to help you.
Noor 36:35
Because my my parents don't live here, my sister lives like one hour and a half away from me. So when I say, like, I'm alone. I'm just taking care of my kids alone because my husband is working too much so we can afford the Cali life, you know. So this is what I meant by doing it alone. And of course, even the doctors after I was diagnosed, they didn't know what to do with me, and they were all saying, like, Oh, your case is complicated. Go figure it out. Yeah. I mean, listen,
Scott Benner 36:59
if you're living in California, and he's the only one working, he's working 24 hours a day, I would imagine exactly
Noor 37:05
true, true. And man, my son needs a lot of care because he's self severe harm, and he's turning four, but he still can do this and can do that. You know, he's very smart, though, but still, like, I don't want to see it, but he is having a lot of bit of differences between him and a normal kid, sure, even though I am just saying like he is as smart as anyone else, of course he is, but still, I am helping him to do every single thing else. Yeah,
Scott Benner 37:32
you know. And now you're there's a lot more to keeping you alive, too. Exactly,
Noor 37:37
so taking care of my kids by myself and do whatever I used to do by myself as just like so limiting. Now, even though we say like, we are different, but we are not less, no, sometimes it hits me like, No, I am less. And every time I say I can do it, I end up dying, so I'm not gonna do it. You know, I'm and because I felt even the doctors that I was trying to let them help me after I was diagnosed and went to see my first Endo, she said, Oh, I can't help you. I can't give you a sliding scale. Your case is complicated because you don't eat like a normal person, so I don't know how to help you with that. So go figure it out, and then come cry to me to have a pump. Yeah,
Scott Benner 38:22
yeah. Boy. I so they So, because of this, they used your sleeve as an excuse to even help you get your insulin set up.
Noor 38:29
Yeah? Like, they couldn't. They couldn't, like, the sliding scale. Oh, my goodness, I would, I would take the sliding scale they are giving me, and I would end up, like, having a lot of severe lows, to the point I'm like, I'm drowning in lows, and I'm drowning in this more than when I was not diagnosed.
Scott Benner 38:44
Yeah, so what did you end up doing? What helped you?
Noor 38:47
So I end up searching online why I'm having five lows in more in less than, like, two or three hours at night, and I will be sweating. And after after diagnosis, I have been sleeping and not waking up at all. And I was like a light sleeper before. So my phone is ringing, everything is so I felt like it's very overwhelm, overwhelming, and I don't have anyone to turn to to ask. So of course, in this era, you would feel like, Oh, I'm the only one who's diabetic. This is happening only to me. Every other person who has diabetes, they, of course, they are now like professionals in their like, I thought, like other people with diabetes for like, few years, more than me, their numbers are flat because they are taking, this is what I thought. You take insulin, your number stays flat in as if, like, it's a working pinker gas. Just, yeah, yeah. I have this myth. You know, I thought, like, pumps. You just eat the pump. See that you ate. So it's gonna work by itself, and nothing else happens, like, as if you have a working printer. Yes, I'm like, Okay, I want a pump.
Scott Benner 39:51
I'll take the magic pump in the flat line. Let's, let's make that happen. So
Noor 39:56
I That's why I tell you. Like, when I think all the men. I had about diabetes in the beginning, and I didn't have anyone to correct me. I was like, Oh my goodness. And when I went to the first support group that I went to, I thought, oh my goodness, this person had diabetes for like, 50 years. He's he took masters. He's a master in this he's very professional. I wish I learned from them. And I was so surprised that I added him on my social media, and I found that he has highs and lows. I'm like, I'm not the only one. It makes you
Scott Benner 40:25
feel better just to see somebody else had the experience, yeah? Like,
Noor 40:30
I was so surprised that other diabetics go up and high. It's not because me still new to it and I can't control it, right, right?
Scott Benner 40:37
Yeah, no, you just think that. And when you have that feeling too, that the technology is just, it's perfect,
Noor 40:43
oh yeah, I had you just put it and wear it and you eat, in a sense, even my husband, he's like, it doesn't do that. I'm like, No, it doesn't. He's like, are you serious? So why would you put it, like, take injections? I'm like, at least I'm not gonna take injections for three years, for three days. It's gonna only work. Like, I change it every, like, three days. He's like, Oh, and it doesn't stay for you, like, forever. So we had all these imagination like, you know, dreams, yeah,
Scott Benner 41:09
what it all was gonna be, yeah? Well, now that you know what it is, though, are you happy? Like, do you have? Like, what pump do you have now I'm on tandem Moby, and how do you feel about it? I love it. Yeah, it's working for it. That's awesome. Yeah, yeah, I love it. But what did you figure out between the time when you thought it was a magic thing and what you know now? Like, what did you learn, and especially with your sleeve and your eating style? Yeah,
Noor 41:31
so I was on Omnipod before I was freshly diagnosed. They said Omnipod is no tubes and stuff. And I was so scared to have a tube wand, because my son would pull me from it, and he will not get like, don't touch this. Because when you tell him, don't, it's like, yes. So I was on OmniPods, and I went on the honeymoon phase really fast, like I was going still gradually down very fast. So when this started to happen, I started having a lot of highs with my pump and a lot of like, skin abuse and all these that like all these things. And until one of the clinic nurses, he has diabetes too, and he told me, You must count carbs. I'm like, but my case is complicated. I don't eat well. He's like, even though put this application on your phone, and he was on the phone with me for two hours, and have Scott just teaching me how to count carbs. So he taught me how to count carbs. So after I changed from Omnipod to tandem Moby, I was already a professional knowing myself, like if I ate this, this is 30 grams of carbs. If I ate this, this is, let's say, 50. I'm gonna only eat 20 grams of carbs. So I have been mastering it. Now, of course, sometimes I would, I don't like, trying to Bolus, like, really high, because I know I'm not gonna eat that much, so sometimes I under Bolus, but it's okay, like, the pump works, it gives me corrections. And sometimes I let it be I'm just, like, happy with the tandem movie, because it helps. Like, I don't have to go in every time and correct it myself. It corrects itself. You
Scott Benner 42:59
were using Omnipod, but not Omnipod five, not Omnipod five. Yeah, you were using Omnipod five, but on the sliding scale, it wasn't helping. No,
Noor 43:06
of course, not like the doctor said, Go teach yourself how to give insulin and then come back to me. I will then write for you a pump. When
Scott Benner 43:15
you first explained that, I thought that's backwards, because if you're not eating very much, then counting carbs would have been the way to go. From the beginning, like the sliding scale didn't make any sense to me. When you can't possibly eat all the carbs that they're asking you to take to begin with. Yeah, that's it's backwards. It's so interesting that somebody heard your problem and then came up, and there were two options, and they picked the one that was completely wrong. Yeah, yeah. And how long did you stay in that situation before you figured out to count the carbs? That was
Noor 43:44
just like after I went out of the ICU, immediately, I went to this and do she told me that. So I went home trying to figure it out with my mom. So at the hospital, they gave me these like pens, and said, Go home, eat and then give injections. I told my mom this. My mom said, No, we were doing that with your grandmother? I said, like, No, I'm not gonna start like, I'm not gonna believe sorry. I'm not gonna trust your decisions with my grandmother, because after I got diagnosed, she was going through hell, and you and my aunts didn't know that, yeah, and I started explaining for them how my grandmother was feeling, and they all started crying because they were doing their best, not knowing what's going on, sure, and she doesn't talk. So I told my mom, like, I'm not gonna trust your decisions. I'm gonna listen to the hospital
Scott Benner 44:26
well. So what ends up really happening is you have to go online and figure out what to do for yourself.
Noor 44:30
Exactly, yeah, exactly. Until I met, like, the support group, I started going to right? They started helping me. They made me know, like, they gave me this all information about like, Oh, you have to make sure that the DMV knows that you have diabetes. You have to put this in your car that on you, and you have to do this, do that. Of course, no one could help me with the food, because still, when you say this to anyone, they don't understand that my stomach is smaller than my four year old. But I figured this part out. But they were there, like, my support group was there to just, like, help me through it, and they were the best thing that ever happened to me until now. Well, I'm
Scott Benner 45:08
glad, I'm glad you found people to help you, yeah. So it's wonderful. It really, I mean, especially in a world where the doctors were on, they weren't getting you very far, and they weren't going to help you anymore, like you were told, go figure it out for yourself exactly, yeah, no, that's awesome. And you would say Today things are going smoothly. Oh
Noor 45:27
yeah, oh yeah, no, no, I'm seeing myself as a master in T, 1d just like how the other people that I used to see them when I was diagnosed, yeah,
Scott Benner 45:36
oh, that's awesome. It's and it's awesome that it happened so quickly for you too, because it really is. It really isn't that long. You haven't had type one for a while. I mean, as messed up as your story is, you got through it really quickly. Yeah, sure, yeah, awesome, but good for you. So what made you want to come on the podcast?
Noor 45:53
Because I I'm not, like, having a different story than others or anything, but your podcast was one of the things that helped me trying to figure out and search about like things of for like T 1d people or T 1d things or whatever. So I wish someone somewhere would hear it out. Maybe I will give them a laugh. Maybe they will say, Oh, I didn't know this. I didn't know that, just like how I was so surprised and learned from you so many things about T 1d in the pumps, and especially the one for OmniPods, before I was going on it, on it. So I just want people out there just to hear my story, know that you are not alone. Because I thought I was alone, if you still say that you can't do it, part of it is somehow okay you can't, but you still can, because we are different, but we are not less. Just to be with you and hear your voice like in my ears, not like just watching you. Oh, that's
Scott Benner 46:47
nice. Well, I'm glad. Is there something about I don't know, the way the information is delivered, or the information itself, or me, or the people you listen to, like, can you give me, like, some insight on why it was helpful to you? Because it's a thing that I know it sounds strange, because I'm the one that makes it, but I don't really always understand why it
Noor 47:06
helps. Yeah, no, it helps, because you would see other parts of the world, and other people from this world. You are not like alone. You take people from Bahrain, you take people I don't know the other woman that I she was explaining so many things about her son. She wasn't from the Gulf area, but I can't remember which country. So I'm like, also Scott, like, have also people, like different people, not only like here in the US. So that was one of the things I loved about I love it, about it the way you're so friendly to the person in front of you, and you made me feel like I'm talking to my therapist right now. Like, it's not like, oh, I have to be like, oh, like, formal. And I'm like, you know how to laugh, so your prestige doesn't, like, get affected. So no, you made me feel like I'm just talking with my best friend on the phone. You know.
Scott Benner 47:56
Well, I'm glad. I'm glad. Yeah, so, so a mix of information, yes, and community and a and a personal feeling, yeah. And
Noor 48:04
one of the best things ever to be part of your Facebook group, because they were, they will answer right away. It was the only group that I was on after diagnosis. And most of the people, when they tell you, like, most of the information there is right. It's not like just people saying whatever they want to say, even if it's false or true. You know so. And you are on the group all the time, and when someone like tag you, you are there your posts. You have a lot of like fans in this group that they share. Once anyone ask anything, they share your podcast. This is what made me know podcast. And I have a podcast on my iPhone. I can listen to you through my iPhone. I'm like, I was so surprised with the technology I learned
Scott Benner 48:46
how much you figured out. Yeah, I think it's possible I've brought more people into pot to listening to podcasts that would never and were never going to listen to a podcast before. Exactly. Yeah, I think that's that's pretty and I have to tell you that I agree about the group, like, it's always gonna be the internet, and you certainly can't expect that everybody's gonna say something that's completely 100% right every time, right. Like, I get that, but, man, this group of people, I don't know how it worked out so well, but you're right. 24/7, someone's there first of all, and I think that's the podcast helps that, like, you know, because there's people from different countries. So while the time zones are switching, it doesn't matter, someone's always awake, people are motivated to help. And very kind, like, you know, especially for the internet, you know what I mean? Like, very, very kind, yeah, oh, I'm glad, I'm glad it's all working out for you? Yeah, thinking about like, where you're from. Are there a lot of people looking for this information that don't speak or read
Noor 49:49
English? I don't know anyone there that is diabetic, except a person who does also like interviews for people by just like, look, I added him on. My Instagram, and he's very good, actually. So this is the only person I know that has diabetes in my life from the country I live at like I used to live like I'm from, you know. So the unfortunate, you know, like information is I don't know anything about, like, other diabetics there in Egypt,
Scott Benner 50:17
yeah, I just, I always wonder if there's a way for me to make not all the content, like, you know, not not like long form conversations with people, like all the time, but if maybe just the bold beginning series, or like the pro tips, for example, could be translated into other languages. Like, I wonder if that would be valuable, or if it's,
Noor 50:35
of course, it was. Someone is doing a research like how I did, just because trying to figure out, like, What the hell is going on? Maybe it will, because, to be honest, I heard, like, bad, negative things about what's going on there with diabetes, and I thank God that I'm here and I have good insurance. I can pay my co pay for my, like, insulin. I can get whatever insulin I choose to get the case there is very different. And even the sensors that we say OG seven is bad, og six is bad. Oh, my goodness. Replacement there, they have to pay, to pay fortune of money just to get the very old version of like Abbot, like the libre, yeah. And for tons of money, that stays only on for 14 days. So when I saw that, I'm like, I'm now taking care of every drop of insulin in my cartilage, because I don't want to, like, waste any drop of insulin just because people there are just, like, die or go search for insulin all over the pharmacies. You know?
Scott Benner 51:38
Yeah. I mean, obviously you can't fix everything for everybody, right? Like, and it's, it sucks, but I wish I understood maybe more clearly. Like, what do they have at their disposal? And, like, you know, you know I'm saying, like, so maybe you could tailor what they need and look at what they have and try to find a plan for them that works, that's more valuable than what they're getting, like, because it almost seems mean to like, lay out, like, well, here's what you need to do, except that, like, you know, yeah, they can't find that device, or they don't have this thing. Like, I'd love to know, like, this is what we have, and then talk through how to help them with that.
Noor 52:19
Yeah, yeah, I would say this, like, the information I'm going to tell you right now, this is what I heard from people there. May I don't want to offend anyone in my country, because I don't know, like, Sure, back home, like, I don't know what's going on with the situation of everyone. But what I heard is the insulin is so hard to find, and you can find, like, a local insulin, but you have to go and search for so that my friend that I met on Instagram, he told me, like, I have to drive to several pharmacies just to find insulin. And when I find insulin, I don't take like all the insulin that this like pharmacy has. I just take like some because I'm leaving for others. And I would tell others, like, hey, look, I found insulin that where, like, this place, the insulin is expensive. Not everyone can get hands on, even the needles that we use one time and throw away. My mom said, like, we didn't know that you have to use it one time and throw away, like the needles of the pens. My mom said, like, we would use it for so long until it bent. I'm like, why? She's like, we don't know that we can do it like every time to change like, you have to change it every time. And the needles itself are very, very, very expensive, and the sensors and stuff, these things are not like, laying there for everyone to get, only people with money and only people who can get hands on, like, with Egyptian pounds, it's around, I think, I think, if I can remember, well, it's like, 7000 Egyptian pounds just to get the Abbot, old virgin, and you can't find it every 14 days. It's not like, like, here, you take the supplies for 90 days or 30 days. No, it's you get it today, maybe tomorrow, you can't find it,
Scott Benner 54:01
right? And then 14 days. Now, if you're lucky, it lasts 14 days, it doesn't work, and then you have you can't find it again anyway, yeah, my
Noor 54:08
friend that I'm talking to you about, he said, like, this is the only sensor I have, and I can't find any. I'm like, I wish I can send you whatever I have at home, yeah, or buy for you at least, and send it to you. Like I was feeling so sad that he can find a sensor and he has to go the old school.
Scott Benner 54:25
Is this indicative of all healthcare there, or is this a little bit of the taboo part, where nobody's really looking at diabetes? No,
Noor 54:32
it's not like that. It's just like because resources of the country itself is is not good in like, I'm not living there. I can't really see but some of the people, they even don't know if they have type one or type two. When I ask, let's say, like, half type one or type two, I don't know. I'm like, I asked, Do you take pills or pens? Like needles? They Oh, no, no, no. We take, uh, pills, yeah,
Scott Benner 54:56
just yeah. Maybe that's all they can find. Even. I have
Noor 55:01
no idea, Scott, to be honest, but I heard like it was so hard, so because I can't help so many diabetes there, like back back home, what I do is, if anyone here that needs any help, I can afford help, and I can help any person here. I told my husband, I'm not gonna die on, like, I'm not going to sleep sorry, on my pillow, knowing that other diabetic person needs insulin and they can't get because of insurance or, like, money problem, or whatever, I would spare, whatever I can, just to help people here because I can't help my friend back in back home, you know? So at least I'm going to do it here, because people are suffering. No one can know anything about diabetes, except when you have it. Yeah, I'm gonna help people here when I can.
Scott Benner 55:44
That's lovely. I don't know it's such a problem. And not, I mean, not that it's not a problem in America, but like, when you juxtapose it against other countries, you think, like, Wow, it's so much it seems so much worse there, then, then here. But doesn't, it doesn't make anybody's you know, it doesn't make anybody struggle less, you know, but it just really, I don't know how to handle it, like I wouldn't, you know, in a million years. I don't think, I don't think a pile of money fixes it. I don't think, you know, it's, it's obviously the governments of all these different places need to prioritize these medications for the people who need them. And if they're not willing to do that, then there's always going to be deserts where you can't get it. There's going to be gaps where you can get it for some time and not in others, or times when your employment is going to change or something, and something is going to get in the way for most people at some point. Yeah, and
Noor 56:36
people there, so many people are really poor just to afford even strips for each other meter. So, so you can, you can do anything about it. Like, you know, you want to take all the answer in the US and send it there, and it's not gonna still work, because it's gonna be very expensive for the people
Scott Benner 56:53
there. Also, you have people testing, but they don't even know what to do with the numbers when they get the test back, right? Like, yeah, you know what I mean? I
Noor 57:00
have no idea. Like, oh, he, my friend, told me, like he's trying to do all the interviews that he's doing to advocate for everyone else with diabetes and just to teach the diabetic person what you're supposed to do, yeah? So I'm like, Oh, they are way back there.
Scott Benner 57:17
Well, that's, that's kind of what I was talking about, too. Like you could drop, you could drop this podcast onto somebody, but it might go so far over their head that if they're not able to dig through it, like, really spend the time, listen, understand what they're hearing, then look at their situation and think, like, how can I apply what I have at my disposal to this idea? I mean, it's a lot. Yeah, right, yeah, true. I don't know what to say. I really don't. Oh my gosh. I appreciate you coming on and sharing your story. That was very kind of you. And thank you for spending this time with me. Do you think we talked about everything that you wanted to talk about?
Noor 57:51
Yeah, yeah. And thank you for having me and let me talk about it in with someone who speaks the same language, like as I, and the people who are gonna hear they speak also the same language, so they would understand no so thank you so much. If you have like, any more ideas or any more like questions for me, you want me to answer just, I'm here for it.
Scott Benner 58:14
Awesome, awesome. I appreciate this so much. Thank you. Can you hold on for one second for me? Yeah, sure. Thank you. Hold on one second.
Speaker 1 58:22
You the conversation
Scott Benner 58:29
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#1564 Smart Bites: Carb Counting & Insulin Timing
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Module 5 unpacks carb counting, insulin timing, fat-protein effects and meal-planning essentials for practical, balanced T1D nutrition.
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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Welcome back, friends. You are listening to the Juicebox Podcast.
Welcome to my nutrition series with Jenny Smith. Jenny and I are going to in very clear and easy to understand ways, walk you from basic through intermediate and into advanced. Nutritional ideas. We're going to tie it all together with type one diabetes, talk about processed foods and how you can share these simple concepts with the people in your life, whether it's your children, other adults or even seniors, besides being the person you've heard on the bold beginnings and Pro Tip series and so much more, Jennifer Smith is a person living with type one diabetes for over 35 years. She actually holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator. She's a trainer on all kinds of pumps and CGM. She's my friend, and I think you're going to enjoy her thoughts on better eating. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin.
A huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out, omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox this episode of The Juicebox Podcast is sponsored by us med. US med.com/juicebox or call 888-721-1514, US med is where my daughter gets her diabetes supplies from, and you could too use the link or number to get your free benefits check and get started today with us. Med, I'm having an on body vibe alert. This episode of The Juicebox Podcast is sponsored by ever since 365 the only one year where CGM, that's one insertion and one CGM a year, one CGM one year, not every 10 or 14 days, ever since cgm.com/juicebox, all right, Jenny, we are up to Module Five. Look at we're rolling right
Jennifer Smith, CDE 2:51
along. I don't even know how many modules there are. What do we have? Eight? I don't
Scott Benner 2:55
know. I thought it was six. It's a list. Don't worry for the people listening. It's written down. I was thinking today that I genuinely like doing these things with you, because, yes, it's a module, right, but and it there. We have stuff here that we want to talk about, but the conversation, it's very organic still, and I think that's hopefully leading to value for the people listening, that they can just kind of hear us talking through it, and not just be, I don't know, like saying, like, here's the bullet points, and these are the things you have to do and and the reason I even bring that up is I was listening to an episode of the podcast today, and kind of listening back. It's something I recorded months ago. And this is mom, and she's got six kids, wow, and she's an engaged person, you know, like, good mom, all that stuff, but she talked about how difficult it is to cook for eight people, yeah. And she's like, I know that I I work out of some packages and I do stuff, but, like, even financially, like, I can't do a piece of meat and two vegetables, and financially or the time every day. And I thought, I you know, so many people have to be in the situations like that of some level or another. So my hope is that the conversation just allows people to pull out whatever bit of value they can find to add to how they actually live and what their lives are actually like. You know,
Jennifer Smith, CDE 4:18
yeah, no, it's a very valid point to bring up. Again, I've worked with all all populations and people of all different, I guess, economic kind of levels, right? And we have to take the information that is valuable or most valuable, and we have to find a way to work it in and down the line then, especially if you live with a chronic condition like diabetes, it does eventually make a big difference in long term expenditure. Yeah, things that you get away from paying for because you've done the here and now, whether it's with you know better food choices. Disease or moving your body by taking a walk, and you don't have to join a gym, or, you know, those kinds of things.
Scott Benner 5:05
But I started to relate it back into my head the way I think about, like, diabetes management. Like, here's all the information. I know your goal is not perfection. Like, some of you will do that. Like, every once in a while somebody listens, they're like, Mia, one sees five, and I just do the stuff you said. I'm like, awesome. Like, that worked out for you. That's great, right? But there are other people are like, Well, I'm five and a half, I'm six, I'm six and a half, I'm seven. They take the parts that either made sense to them or the parts that they were actually able to incorporate, and they improved Right. Like, right? They did better for themselves. And I just hope that this kind of works out the same way anyway. So module five key areas to address in nutritional education for type one diabetes. First step here, blood glucose management, basics. So take it away.
Jennifer Smith, CDE 5:49
Yeah. So we started these modules about nutrition and health from a base to finally move into what every listener, I think every listener has some tie to type one diabetes, right? Or diabetes in general, let's say, and those basics, most people realize we talked about the macro ingredients, or the macronutrients, right? The carbs, the proteins, the fats, building that into diabetes. It starts with understanding those because they impact our blood sugar, and in what way do they impact our blood sugar, carbs, sugars impact most and most immediately when we're working it all together, it's kind of like health in general. We sort of compartmentalize a lot of the health things or health conditions, when truly they all do impact each other, right? So if you are taking the bases from the nutrition pieces that we've talked through, and you're applying them now at the level of diabetes management, hopefully the puzzle is starting to make a picture that's understandable,
Scott Benner 6:59
yeah, but there are pieces that are diabetes, really, just like we talked about micros and macros. There's also this stuff that we're going to talk about now, and I guess it's stuff that people probably imagine they understand, but I don't know if they've ever had to explain to them. The way you're going to is that how you feel about
Jennifer Smith, CDE 7:14
it, kind of, yeah, I mean, and when we talk about, you know, blood sugar basics, what are some of the basics? We've got three big things in managing blood sugar. We've got food. You get the big one that has been discussed and over and over talked about is that kind of the really top of the pyramid is understanding your insulin and how it works. But then when we have the foods we talked about, again, the big nutrients that impact blood sugar, major being carbohydrates, but then the pieces of those carbohydrates that we have to understand timing for, and it all works itself together. So anytime we're considering blood sugar in relative, I guess, in relation to the food that we're eating, we also have to have a defined range. What's the target that you're aiming for? Are you the standard Ada, which is 70 to 180 Do you have a tighter range for that? Do you have a target that's specific to certain variables in your life, such as exercise times or sick day management, or if you are you know more of an aged person or a really, really young person, your targets need to be clearly defined, because then, as you work in foods, to try to figure out which ones work the best in terms of what I'm aiming for, you have to have the range defined? Yeah.
Scott Benner 8:42
Well, what range I mean, I'm happy to share Arden's, but like, what range do you think of? Yeah,
Jennifer Smith, CDE 8:47
so I always really consider fastings, fasting blood sugar, which we often defined as an overnight time, right? We could be fasting sometime else during the day, but overnight is typically what we call fasting. And in that time period, if we're aiming for the range that is for people without diabetes, it's under 100 so if you define something that would be safe, let's call it 80 to 100 or 75 to 100 for that overnight time period. And then in the aftermath of meals, this is again, where some definition that's individualized may become beneficial again, as you're trying to contain things in the target and in relation to the foods you're trying to figure out. So you know, 180 could be 160 which is more, more along the lines of what the Clinical Endocrinology kind of aims for. And then if you're pregnant, it might be under 140 in the aftermath of a meal. So again, defining that as your goal helps you to see whether or not you're meeting it, and your timing and your insulin dosing and this food versus that food are all kind of working out
Scott Benner 9:56
for somebody who's had type one for you know for many years, who. Who might and probably does, remember the ADA telling them, like, oh, 200 is good for a spike or two. You don't want to go over to fit. Like, those numbers have been coming down. They come down with technology, right? Like, I want people to understand that if you were told a number 20 years ago and today, that number is 100 points less, and you're like, well, it's okay. They told me before it was okay, like they told you, what they thought the mass public could accomplish with the technology that existed at that time. That's the way I think of it. I don't actually know if that's what's happening, but, but as technology gets better, and there's better measuring and CGM get better, I see them tightening those tolerances. Is that, do you think I'm right about
Jennifer Smith, CDE 10:38
that? I think you are, but the underlying there is what safety, okay, right? When we didn't have technology, unless, unless, like my mom, I mean, my mom asked for more test strips. There were no CGM. She asked for more test strips because of the things that I did, and we wanted to have more visible what was going on before I went to play, you know, volleyball, or whatever it was. And there was, again, a defined range, but we had less. We weren't finger sticking every five minutes like a CGM can give you at this point. Yeah. So I think it boils down to safety. The targets, as you said, can be they can be tighter, they can be lower targets, and the value there is we can catch things because of continuous glucose monitors, especially, and now with aid systems or automated insulin delivery systems, with algorithms, there's also a safety catch feature there. Not only do you have the visibility of the direction the glucose is going the value that it's sort of within, but also, what has the system been doing to take care of that for
Scott Benner 11:43
us? Yeah, yeah. I guess the establishments aren't going to say even if they knew back then, like, Look, you want to be between 80 and 100 overnight. If they didn't think you could do that without getting low, having a seizure, that kind of stuff, no one was going to say that. I have always disliked ordering diabetes supplies. I'm guessing you have as well. It hasn't been a problem for us for the last few years, though, because we began using us Med, you can too us med.com/juicebox, or call 888-721-1514, to get your free benefits, check us med has served over 1 million people living with diabetes since 1996 they carry everything you need, from CGM to insulin pumps and diabetes testing supplies and more. I'm talking about all the good ones, all your favorites, libre three, Dexcom, g7 and pumps like Omnipod five, Omnipod dash tandem and most recently, the eyelet pump from beta bionics, the stuff you're looking for, they have it at us. Med 888-721-1514, or go to us. Med comm slash juice box to get started now use my link to support the podcast. That's us. Med comm slash juice box. Or call 888-721-1514, you four. This episode of The Juicebox Podcast is sponsored by ever since 365 and just as the name says, it lasts for a full year, imagine for a second a CGM with just one sensor placement and one warm up period every year. Imagine a sensor that has exceptional accuracy over that year and is actually the most accurate CGM in the low range that you can get. What if I told you that this sensor had no risk of falling off or being knocked off? That may seem too good to be true, but I'm not even done telling you about it. Yet. The Eversense 365 has essentially no compression lows. It features incredibly gentle adhesive for its transmitter. You can take the transmitter off when you don't want to wear your CGM and put it right back on without having to waste the sensor or go through another warm up period. The app works with iOS and Android, even Apple Watch. You can manage your diabetes instead of your CGM with the ever since 365 learn more and get started today at ever since cgm.com/juicebox one year, one CGM
Jennifer Smith, CDE 14:10
Correct, right? And we had old insulin. You know, when I was diagnosed, I used a cloudy insulin called L or lente, and I used our insulin, which is that longer, as close to rapid as we had at that point, right? Mixed them together, you're really only taken twice a day, like it was. It was a very defined, structured daily life compared to today's flexibility because of the technology we have and the safety that that brings along with it.
Scott Benner 14:43
I just think it's good to recognize that while we're talking about it, because, you know, I mean to your point, I used to say, like, hey, I need more test strips. And at one point they'd say, Why do you need so many? And I was like, well, because I'm testing her blood sugar, they didn't even expect that. Like, you know. I mean, you get like, a little bottle with 50 strips in it, and I'd say, well, there's, that's five days maybe. And they were like, five days that should last you two months. Aren't you just testing three times a day? And I was like, how's that gonna help us? When I think back on, like, early ads that I used to do for Dexcom, like, how, like, much we were saying, like, you can actually see the direction and speed your blood sugar is falling like that was a it was a completely different idea at that point. You know,
Jennifer Smith, CDE 15:25
absolutely and it again, that safety piece is that it's the kind of bottom line. I just did a breakthrough T 1d summit presentation, and the keynote speaker was a phenomenal guy who was diagnosed as a kid. He was a competitive swimmer had no CGM when he was diagnosed, either he had, I think he said that their their prescription for test strips was like 25 test strips a day, my max, I believe, if I remember, was like 18 or something like that, frequently for testing and getting enough information. But God, like 25 tests a day to be able to have swim for four hours and be able to do it the right way with safety and everything in the picture. And there we had no technology to help.
Scott Benner 16:09
So I'm just going to leave this for people listening. Please don't just test at the times of day that you know your blood sugar is going to be good, right, so that you can go, I don't know what happened. I got 85 I got 120 and I got 113 It was awesome, because you do listen, I have a lot of conversations with people, and they'll say things like, I don't test my blood sugar every day or and I don't have a CGM, or I have a CGM, but I turned off the alarms like that kind of thing. Like, well, then, okay, the same as nutrition, you can be doing something today that is not valuable for your health, that isn't going to make you fall over dead. That doesn't mean it's not worth not doing, I guess. Right? Yeah, changing anyway. Well,
Jennifer Smith, CDE 16:48
and with this technology, what does it roll into? It rolls into understanding not only the food that we eat, but the timing of the insulin for that food, right? What's the Tell me, what's the role of insulin in the body?
Scott Benner 17:01
Scott, oh, well, hold on a second. There's something about a key and some blood and like, Jenny, I forget how you explain it to me that one time, but it's helping the regulation of the glucose in and out of your bloodstream, in and out of the cells, the cells. Thank you.
Jennifer Smith, CDE 17:16
Yep, absolutely. You get sugar your body digest. Does a whole bunch of fancy things, which I wouldn't, you know describe here, but essentially, glucose ended up in your bloodstream. The that has to move out and it has to get to the right places your cells to provide fueling.
Scott Benner 17:30
So the insulin lets it go from your blood into the cells where it belongs. Yeah, your body can use it
Jennifer Smith, CDE 17:36
again. It's the lock and key concept right. The doors on the cells are essentially lacked without insulin. Glucose floats around your blood sugar gets higher and higher in your bloodstream because it has no real ability to get into the cells. So understanding insulin is valuable then, because it moves the food that we eat into the cells for proper fueling, and a big piece that we've already talked a bit about in terms of, like more processed types of foods and quality types of foods, etc, is it leads to the potential for there to be a disruption already in how your body gets energy. But if we have disruptions, and then how insulin works, it disrupts the food moving into the right places in our body for us to use that. I mean, I'm essentially talking about resistance, right? Okay, so those pieces when we're talking about the influence of nutrition on diabetes or blood sugar management. Again, it all ties together.
Scott Benner 18:48
It's almost like you could trick yourself in a number of ways. You could eat very healthy, but not use insulin well, and you still not get the nutrition, the energy that you need. You could also eat poorly and be so great with insulin that you feel like, Oh, look how good my blood sugar is. I'm doing great, but now you're just getting the impact of poor nutrition. So correct,
Jennifer Smith, CDE 19:06
and maybe I would change it there, and maybe not over nutrition, but over the caloric amount that your body needs. There are a lot of people who have way more caloric intake than they need, but they don't have very quality nutrient intake. Okay, so that's kind of a fine line to
Scott Benner 19:24
discuss. What I'm thinking of right now is understanding how important using insulin well is. I see a lot of people think of insulin as it's a cultural it can be like old age, you know, older ideas, maybe. But I hear a fair amount of people say that if you're using insulin, you failed. That's kind of like from the Type Two world, and then that idea is moved into the type one world, which is like, well, if you're using too much insulin, you're doing it wrong. It's so hard to talk about I find for me personally, because I do want people to use the amount of insulin they need. I don't want them. I say this a lot, right? I don't. You having high blood sugars, but I also, once we figured out how to use insulin, I would love it if you ate in a way that wouldn't require a ton of insulin that wouldn't be needed if you were eating in a healthier way. This episode is brought to you by Omnipod. Would you ever buy a car without test driving? It first, that's a big risk to take on a pretty large investment. You wouldn't do that, right? So why would you do it? When it comes to choosing an insulin pump, most pumps come with a four year lock in period through the DME channel, and you don't even get to try it first. But not Omnipod five. Omnipod five is available exclusively through the pharmacy, which means it doesn't come with a typical four year DME lock in period, plus you can get started with a free 30 day trial to be sure it's the right choice for you or your family, my daughter has been wearing an Omnipod every day for 17 years. Are you ready to give Omnipod five a try? Request your free Starter Kit today at my link, omnipod.com/juicebox terms, and conditions apply. Eligibility may vary. Both terms and conditions can be found at omnipod.com/juicebox find my link in the show notes of this podcast player or at Juicebox podcast.com
Jennifer Smith, CDE 21:16
and there's the define, no. That's 100% correct. It's a I see a common thread online about, you know, my child is nine years old, and they're this they're using this much insulin. How much do your nine year olds use? And that should be like a stop right there. While there might be a weight based idea for insulin dosing and approximation within an age range, no similar nine year old is going to be that alike in dosing needs, and you defined it well in saying that eat what you need to eat, for nutrient value, for caloric, for fueling, for all the activities you Want to do. But we can easily these days, have more caloric value, and thus now we're using more insulin, right than we should be using only because we're putting more food in than we
Scott Benner 22:13
need. So using more insulin is not the problem. Using more insulin if you're eating so poorly that you need more insulin, that's the problem, and it's not a thing we say out loud, because we try very hard not to tell people how to eat. Listen, it's an edict of mine. It's one of my rules in my Facebook group, like, don't tell people how to eat, right? But at the same time, we're talking about nutrition right now. So I'm not telling you how to eat, but I am telling you that if you do this, it'll be better for you, and you can do whatever you want. Like, I'm not saying, you know, I think there's a difference. Like, if you want my personal opinion, I think there's a difference between having a bowl of cereal on a Saturday and eating cereal every day, all week long, right? Like that. There's just a difference there. And if you want to know, like, my nine year old uses this much, how much does yours use? Well, you got to ask the rest of the question, what does your nine year old eat? How active are they? You know what I mean? Like, those kinds of things you can't just, it's not apples to apples, unless you have all the apples,
Jennifer Smith, CDE 23:05
right? Yeah, right, yeah. And, you know, in in moving all of the nutrient nutrition, kind of micro macronutrient stuff that we've talked about into this now realm of diabetes, it's like the macros do require coverage. And here we're talking about insulin, insulin from carbohydrates. We typically start with an insulin to carb ratio and figuring that out, defining it really for those who maybe haven't listened or don't realize we tend to have about one unit of insulin that covers a certain number of grams of carb at a particular meal. So if you're a one unit for every 10 gram and you have 30 grams of carb, you'll have around three units of insulin that you need just for the carbohydrate part of the meal. And then it becomes deeper, right? The discussions we've had are about what kinds of foods that are carbohydrate. Are you eating? What's the glycemic nature of those foods? What are the components of the meal? Is it all simple sugar stuff? Or are you eating a really big green salad with two cups of chopped up, non starchy vegetables on it? Right? Yeah,
Scott Benner 24:17
which, by the way, still have carbs in it. You just have to, you have to know how to count those carbs. Like, there's, yes, there are carbs and things that I bet you people don't imagine, you know, and so it's important to count your carbs accurately, like, right, your your insulin to carb ratio obviously needs to be right. But then once you're counting, you know, you can't make a cheeseburger and say, Oh, that's meat, because the roll might have high fructose corn syrup and it might not. You might put ketchup on it, and then just ignore the fact that that might be 10 carbs of ketchup, or, like, right, that kind of stuff, or that you put a bunch of cheese on your burger and there's fat in the burger, like I'm telling you, you got a Bolus differently for a burger made out of 80% lean meat than you do for 90% lean. Me, because there's more fat, the fat slows down your digestion. These are the things that I think we do a good job in the Pro Tip series and other places of explaining to people, but your carb count has to be right. Like, if you're eating and you're spiking and you think, I don't understand what happened. It's not a big secret. There's only a couple of things that may have happened. Your settings are wrong, your carb counts wrong, or you don't understand the impact of your food. You know, maybe there's, if you're a girl, certain week of the month, you might have different resistance, but, like, I mean, sure, other than that, and
Jennifer Smith, CDE 25:30
or different activity levels, or, you know, factors there too, or illness. I mean, there are variables that are in the picture, or that could be but in general, if you have these basics of understanding, okay, as much quality kind of food that we put in, what food category do they fit into? Okay, carbs. I'm gonna count those as well as I can. There's no 100% perfect on it, right? But what's the nature of them? Are they quality, low glycemic, going to be slower in hitting my blood sugar. Do I have an idea of how to cover them with insulin? And then, what are the other parts of the meal? As you said, a burger with cheese. Now we're getting into proteins and fats, and at some point, while protein has minimal effect in this goes to what we were talking about, portion, right? Portion, controlled, well well managed amounts. You should be able to get away with covering carbohydrate at your meal time and not having to factor in fats and proteins. It's when we end up having a meal that is much more complex in fats and proteins, or much higher, I should say you haven't miscounted your carbohydrates, but now you've got this problem happening, happening in the aftermath of the meal, and with fats and proteins, it could lead to hours worth of issues that you're seeing and then it leaves you wondering, well, I thought I counted the package said, you Know, 28 grams of carbohydrate, and that's what I did, and, well, I got low, and now I'm sitting high, and the high won't come down. So there's a deeper
Scott Benner 27:09
level. I think it's important to realize that if you just randomly think of five different foods in your head, rice, bread, you know, like, I don't know, a fruit, like, just picture five in your head, and imagine all of them have been measured perfectly, and they're all 10 grams of carbs. Each of your five things, each of those five things, need a different amount of insulin, very likely because of the way they impact your body. So if you just ate the fruit, and it was, it was 15 carbs of a banana, well that might be a lot of simple sugar, and you might have to Bolus differently for that. If it was bread, it might go and, you know, it might go in your stomach and sit there for a little bit before it goes. So, five different foods, five different impacts, and then you put them all together and stick them in your belly at once, right? Five different impacts and five different foods and five different timelines that they're going to impact on, and etc. And I know that sounds, I mean, it can if you're new, frustrated, oh my God, you're like, What am I supposed to do? Right? But there is a way to like, just to kind of simplify it down to like, well, there's, you know, there's 50 carbs here, but there's some fat, there's some this, so I know I'm gonna have to, you know, but there's also simple sugar, so I'll hit it hard at front, but I know an hour from now, it's gonna start going up again, so I'll make sure that we cover that rise before it happens, and it should be okay. I know that sounds crazy if you don't understand it, but it's not that hard, really
Jennifer Smith, CDE 28:27
well. And when you simplify meals, again, I like to use what eons ago was called the plate method, right? It's the idea of taking a standard size plate, and about 50% of that should be as low glycemic types of vegetables, right? Steamed, grilled, sauteed, salad form, whatever you can kind of fit in. And then the other part of the plate is your your proteins, a healthy, nice portion of protein. And then some type of lower glycemic, if possible. Carbohydrate could be just fruits. It could be, you know, a grain of some kind, or whatever you're choosing to put on your plate there. But in that balance, you're also getting the concept of portion, and then you're also getting a mixed meal that doesn't have such an overload. And you should be able to, in a meal like that have the insulin to carb ratio truly cover the carbohydrates the way that you would expect them to and not having this lingering
Scott Benner 29:24
right kind of later effect, like a fat rise later, or something like that, right? I mean, if you give
Jennifer Smith, CDE 29:30
fat being that other one, that it really leads to a lot more insulin resistance. I like to think of high fat at a meal time, and high fat could be still healthy fat. Like you eat two avocados, that's a lot of fat. Man, it might be good fat for you, right, right? So what are you going to find? You find in the hours after you're not going to spike from an avocado, but you're going to require extra insulin. I think of fat kind of like it sits on. The insulin in your bloodstream, or it slashes its effect by like 50% which is the reason eons ago, we used to set a Temp Basal increase on conventional pumps in the aftermath of high fat, a 50% increase for four to six, maybe even eight hours to compensate for that sensitivity reduction we get from high fat. So again, it's not so much the quality of the fat here, although that can have other effects, but it is really the portion of it and the potential, then, that it could require you to do something different in your insulin, use
Scott Benner 30:37
good food, good portions, good coverage with your insulin should lead to stability. Let me say this Juicebox podcast.com, up at the top, go to guides, fat and protein insulin
Jennifer Smith, CDE 30:50
calculator. Oh, that's a great one. I recommend that one to people all the time. Thank you.
Scott Benner 30:54
This will take you to a pretty technical overview of how fat and protein can impact your blood sugars, but it also takes you to four episodes that discuss it. And I want to just say this, the calculator is not medical advice and nothing is always consult your physician. But I do have a calculator on there that will help you turn grams of fat, grams of protein, into a Bolus amount to help you. And it discusses there how to do it. If you don't understand how to do it, talk to your doctor about it. But I hope that would help you. Awesome. Yeah, yeah, awesome. Okay. Oh, what we got anything else on here? Meal
Jennifer Smith, CDE 31:32
planning, I think we kind of talked a little bit about within all of this, really. It's just, I know with again, as we go back to that talk about technology that we had early on and the benefit of technology, I think what that has also brought in is flexibility, which can have a positive, but flexibility could also lead to not as much regularity in what you're doing, and that could be detrimental, right? It could be that, oh, I know all of my settings are right, so I can consistently do this, but sometimes maybe this is skipping a lunch every once in a while, right? And then what ends up happening is you end up being very, very, very ravenous later on, and then you get an overage. When had you had more regular meal intake, a breakfast, a lunch, a dinner, or, you know, something similar. Your appetite gets, I guess, better regulated, right, right? You have intake your body works through the fuel that you've put in. Oh, now it's four or five hours later. Yep, I'm hungry again. That hunger signal, too is often very disrupted in diabetes, because of how we have to navigate food, and also because there is not the same regulation of insulin use as if your pancreatic, you know, if your beta cells were producing there's a very fine tuned machine in there that we try to mimic as best we can as humans, but we're not doing it the same way.
Scott Benner 33:13
Yeah, there's a lot in there. And I think that, I think the idea of just meal planning is important, because here I'm gonna we did not plan this. But
Speaker 1 33:20
have you eaten already this morning? I have eaten this morning. Yes, I
Scott Benner 33:24
haven't. Who do you think eats better me or you? You? Okay, I'm not gonna make you sit right. No debate. Do you know what you're having for dinner
Jennifer Smith, CDE 33:30
tonight? We have as much of a plan usually in the week as we can, mainly because that's how I shop is for knowing what's in the house and having an idea of what's going to be prepared. So
Scott Benner 33:43
I don't is what my point is, okay? So I think that the a little bit of planning goes a long way. I just really do, like, even, like, back to that. I love that story about, like, what the time I asked you about like, road tripping, and I was like, well, don't you stop at gas stations and get candy bars? You're like, no. And I was like, Well, what the hell do you eat on a long road trip? You're like, I bring food. And I was like, Oh my God, what an awesome idea. I think that a little bit of planning can go a long, long way. I tried to do it more. I'm not as good at it as as other people are. You know, I run a business completely by myself. There are days. The other day was one of them, I just, I don't think I ate. I got up, I started working. I recorded twice. I got hungry. I went downstairs. I actually took food out, put it on the counter. Somebody called me. I ran back upstairs, and two hours later, my wife texted me and said, there's an egg on the counter. And I was like, Oh, I didn't eat. That literally happened to me. So yeah, yeah, you got to put some effort into it, like I'm as guilty as everybody else. But
Jennifer Smith, CDE 34:38
no, and I that effort, it does go a long way. And from the standpoint of being a caregiver for kiddos, I try to keep that planning in place, because I think a big piece of why I do it, not only because I have diabetes, maybe I would have learned it, but my parents just planned that way as well, right? So there was a piece. Piece of influence in the caregiving, or the, I guess the caretaking my parents had for myself and my brother, but I hope to provide that to my kids as well, that if we are out someplace, I try really hard to have things along, because then the idea of, Mom, can't we just stop there, or can't we just go there? Or can't we just grab something from here? So easy, you know, I hope to instill that in them, that they can have some preparation and keep what I've been feeding them in their life.
Scott Benner 35:34
I watch it like my son is a pretty healthy eater, honestly. And yet, if there's no food, like there, what they go to is, it's such a drop off so quickly. Like, no kidding again, it goes right to, we could DoorDash something. We can go here. We can do it's too easy to get credit. I mean, let's just be honest, right? Like, some food is great and some food is just, you know, yeah, it's not great. And then not great food is super easy to get. So it is yeah, entirely, yeah, yeah, absolutely, do your best. I'll talk to you guys later. Okay,
the podcast episode that you just enjoyed was sponsored by ever since CGM. They make the ever since 365 that thing lasts a whole year. One insertion every year. Come on. You probably feel like I'm messing with you, but I'm not. Ever since cgm.com/juicebox a huge thanks to my longest sponsor, Omnipod. Check out the Omnipod five now with my link, omnipod.com/juicebox you may be eligible for a free starter kit, a free Omnipod five starter kit at my link, go check it out. Omnipod.com/juicebox Terms and Conditions apply. Full terms and conditions can be found at omnipod.com/juicebox you Arden has been getting her diabetes supplies from us med for three years. You can as well us Med, Comm, slash Juicebox, or call, 888-721-1514, my thanks to us med for sponsoring this episode and for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links@juiceboxpodcast.com to us, med and all of the sponsors. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show. If you go a little further in Apple podcasts and set it up so that it downloads all new episodes, I'll be your best friend, and if you leave a five star review, ooh, I'll probably send you a Christmas card. My diabetes Pro Tip series is about cutting through the clutter of diabetes management to give you the straightforward, practical insights that truly make a difference. This series is all about mastering the fundamentals, whether it's the basics of insulin dosing adjustments or everyday management strategies that will empower you to take control. I'm joined by Jenny Smith, who is a diabetes educator with over 35 years of personal experience, and we break down complex concepts into simple, actionable tips. The Diabetes Pro Tip series runs between Episode 1001 1025, in your podcast player, or you can listen to it at Juicebox podcast.com by going up into the menu. Hey, what's up, everybody? If you've noticed that the podcast sounds better. And you're thinking like, how does that happen? What you're hearing is Rob at wrong way. Recording doing his magic to these files. So if you want him to do his magic to you, wrong way. Recording.com, you got a podcast. You want somebody to edit it. You want rob you.
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