Full Transcripts

I am in the position very frequently where newly diagnosed people are looking to me for help or answers or direction, and while they are speaking, it becomes obvious to you that they need encouragement. And I have said before that I think a lot of my job is like, I feel like I'm like a coach that just like, whacks you on the ass as you're running out of the field, and goes, you can do it, go get them right? That kind of like an idea, but you actually physically have to say something to them at the end of your conversation, and that was hard for me. Like, what do you say? What are your parting words to somebody who's like, Hey, I just got diagnosed with type one diabetes. I'm freaking out. I don't think I'm gonna be able to eat the same anymore. They told me I can't run. I'm a huge runner. I don't understand. And my mom is telling me it's my fault, like you're having that conversation with somebody, and then at the end there's a pause, and it's the time for Scott to speak, right? Like

you're supposed to solve it all and give them rainbows and unicorns, right? You

can't just go. I wouldn't worry about it. I think it'll be fine, right? What I've learned to tell people, which I believe is that diabetes is hard. And I don't want to lie to you, I don't think it ever gets easier, but you can get so good at it that it could feel easy some days, and sometimes more than that, like true this hard thing is hard, right? Think of yourself as Bryce Harper. Baseball is incredibly difficult. But when I watch him do it, I go, huh? I bet you I could do that, because he makes it look so easy right now, I'm not saying you have to be an all star to do this. I'm saying that after some time and experience and getting your feet under you, listening to bold beginnings, listening to pro tips, figuring out how insulin works, learning how about timing and amount, and learning how fat and protein impact your food, it could actually feel the way it feels for me now. And I'm not bragging to tell you that, like, I don't think about diabetes like that anymore, and that I am not burdened by it, right? Like, big picture stuff. I wish my daughter didn't have autoimmune issues. And there's stuff that comes along with it, I probably sell my leg to make go away for like, Do you know what I mean? But like, I'm not burdened by it, and most of the time, and I say this with a lot of deference, and I realize I don't have type one and I'm just a caregiver. It does feel easy to me most days, but it's because I know what to do when something happened, right?

Yeah, your example of like a baseball player or a basketball player, just because they look good on the TV. When you're watching these professional right, they have practiced That's right, their sport so much that 99% of the time they're going to catch the catch. They're going to make the shot. They're going to do the thing that they expect to happen because they've practiced and they know how it works. And eventually, with diabetes, you will get to that point. Is it going to happen a week from diagnosis? No, and I feel horrible saying that too. Yeah, right. Easy is not a word that belongs in discussion with diabetes. Diabetes is not easy. Yeah, it's not. But as you figure out your variables, and they are your variables, as you figure them out and grow into you know, from five to 20 or however, whenever you were diagnosed, you're gonna find the things that do work most of the time. It is going to be easier, despite still having to put thought into the picture that you'd otherwise be like, I really wish I didn't have to think about it. I do too. 36 years, I'm still like, man, if the man in the corner was like, I'll just take that all from you, I'd be like, sure.

Years ago, I've done some pretty heavy joking. If you just said to me, like, just kill one person you've never met before, I'd be like, Oh, I could probably do that. It's terrible. I would do anything to get rid of it. I wouldn't hurt another person, but I would do almost anything else to get rid of it. Your example is so spot on. While you were talking, you know, my son's older now. He's going to be 25 Gosh, next month. Oh, but in college, and his entire life, he played baseball, and I have a video on my I always tell people, don't tell him this if you ever meet him, but like, I have his last college home run video on my desktop, and every once in a while, I pop it up and I watch it, and it's in a bat where he takes a ball and he doesn't swing, and he gets a high, fast ball, and he cuts at it, and he misses it, and then the guy tries to throw him a breaking pitch off the plate, and he just hits it. And they were in a stadium that day, so they were in a professional baseball stadium, and my son hit the ball out of the stadium, like on in right field, right out over the wall, over the grandstand, out of the stadium. It's a minor league park, but it's a full size stadium. If you watch that video, you just think like, wow, that look how good that kid is at that but as you're talking, what I recalled, moreover, was three days a week, all summer long, with an instructor by himself on a baseball field hitting three. 300 baseballs, 100% 95 degrees outside, humidity. It's not even baseball season anymore, like right now. It's cold and he's doing it now. He's inside, and he's doing it, hundreds and hundreds of baseballs and so much. And I'm not kidding you, so much failure and despair and wanting to give up and cursing and screaming and crying and throwing things for years and years and years and years and years to hit one fcking home run in college. Yeah, and I guarantee he wouldn't trade it in so

he wouldn't know. And what, what stuck there is, I got this sense once I started really running, is the concept of, in the moment, he knew internally that he was going to hit that ball. That was the home run. He knew it was going to happen, the connection. He could feel it. He was like, that was it like, it's this feeling of, I know I'm doing I've put all the pieces together in the right way. This run is 100% the pace, the way the breathing, everything is fitting together, but it's only because you've done it

for so long, and if, for some reason, it doesn't work out, you just do it again. You do it right? Yeah, right. Because success isn't going to come quickly, and it might come more difficultly to some people than others. You know, in the end, I you know, the goal is not to always hit a home run. My son became a very good hitter, and it took him years, like, years and years and years to do it during COVID, when we were all hiding in our houses, my son, like, flew across the country and, like, worked in a place that was still up and running and just to hit a baseball, like, because everybody else stopped playing baseball, he's like, I'm not going to stop playing that's what makes that home run magical. Like, it's not about the home run. Like, I see him four years old and 10 years old and 12 and 15 when he hits it, like, in all the effort and the work he put into it, and the good news is, around diabetes, you're not gonna have to put nearly as much work into diabetes as you are into learning how to hit a fastball, like, because that's that's hard too. It's not going to take you 15 years to learn your diabetes, no, right? And so to me, like, That's it, like diabetes is hard. I wouldn't take that from anybody. I don't know what it's like to have it. I do know what it's like to help somebody with it. It's hard for me. I can see how hard it is for her, even though I don't imagine I completely understand it. But most days it's not that hard, and that it comes from doing that work and not just blindly trying, but purposefully trying. I can't tell you how many bad hitting coaches my son had, and what a moment it was when he met a good one. You know what I mean, when he got good tools to practice repetition on anyway,

right? And or a good connection, I think that actually brings in a good point of maybe the other ones were good, but they weren't personality matches for how he was going to receive the information and the instruction from that the same in diabetes, right? You may find the educator, the clinician that you click with, and that might be after going through 246, of them, yeah, but keep looking, right?

Well, Jenny, there's a reason. Now, listen, you're Midwestern. Everybody loves you, but like, it's just, it's just the way I say, Oh, listen, I could probably line up a couple of 50,000 people to, like, show up for me. You know what I mean, who would tell you, like great things. I could probably find exactly as many people who hate my guts and don't like the way I talk or the way I say things. I know people who like me who don't like me. I'm actually thinking of a person right now who I think genuinely likes me and hates me at the same exact time and around diabetes, right? And I know being your wife, no, no, no, she's we've been married for 30 years. She just doesn't like me most of the time. My point is, is that my message, my tone, my the way I do things like the way I just said what I said is gonna vibe with some people, and I've seen it recently online. Someone said, You know what I love about Scott? No bullshit with Scott. Just says it in another episode recently, I just thank the ADA for finding their balls on something. That's not a thing most people say out loud, right? But at the same time, I could come off course or abrasive, or I gotta. I got a review the other day. The woman's like, I love this podcast. I wish she'd stop saying Jesus Christ and God damn so much. I'm not even saying it on purpose, but I grew up in the 70s, and there was a lot of cursing. It's how it comes out of my mouth. Like, I don't even know what to tell you, right? So that's a good point. If you're not vibing with the person you're doing the thing with, stop beating your head against the wall and go find somebody else, right? Yeah, same with this podcast, yeah, because

you're gonna absorb the same information in a way that actually meets your need, and you're gonna use it then go

find what works for you. Pumps, CGM people you're getting information from doctors. Do not stand and beat your head against the wall like, don't. No, listen. I want you to listen to the podcast, but if I'm not. Right for you, then go find something else that will help you. I mean, stay subscribed and keep downloading the episodes to help and stuff like that. But you don't

have to listen. You know, you could read the transcripts. I mean, they're not always perfect. No,

listen, AI is doing a pretty good job making those transcripts. All right? Thank you very much. Sure you.

Jenny, insulin used now is for later. What's happening to you now is from insulin you used previously. Correct. So this is in a number of different episodes. I talked about it in 506, listening to the doctor. It's in a bumping and nudging episode. It's in an episode of The Pro Tip series called The perfect Bolus. But in general, it just struck me one day, while I've been talking to people for so long that a lot of people look at their graph, or they look at their finger stick, and they try to assess this thing that's happening to me right now, and they only see the other things happening right now? Like, didn't I mean, like, it's almost like, if someone tapped you on the shoulder, you wouldn't think to go back three hours to see who you let into the house. Like, right? You didn't mean, like, it just you're like, Oh, who's here? What's happening, right? Right? And so there

are lots of different points in your day where if you start to use your data and evaluate your data, you'll be able to see this spelled out pretty easily. I see it a lot again, in Bolus strategizing, where you haven't been Pre Bolus in great we've gotten to the idea of starting to Pre Bolus, and then why can't Pre Bolus, because I'm going low within five minutes. So this brings in the perfect picture of it's not that Bolus, that Bolus did not drive your blood sugar low in five minutes. I promise. I'd bet a million dollars that I don't have that it was not this Bolus. Instead, I again looking at graphs and everything we talked about those trend lines and the arrows in CGM, if you're already dipping coming into a meal Bolus time, right? You have insulin pulling that blood sugar in that downward direction already. So the fact of getting low in five minutes after taking that Bolus, it was not the Bolus fault. Instead, we should look for a trend. And if this is always happening coming into a meal, then first we have to stop that trend down so you can adequately Pre Bolus and get some confidence around Pre Bolus saying, because you're not going low anymore.

Yeah, I'm gonna get back to insulin now, is for later in a second. But yeah, the amount of times that I've heard people say I can't Pre Bolus because I Pre Bolus yesterday, and like you said, it's five minutes later, time to eat, and my blood sugar dropped out the floor. But these are the same people who are telling me, like insulin takes forever to work, and I don't know, like it's never does what I want it to do. And so my point, I guess, is that you have to time shift in your head a little bit. And I guess the way the sayings ended up being insulin now is for later. Was my way of saying that what's happening to you right now is not because of what you did with insulin just now and then to like, adjust it out further. I started finding that it was easier for people to think about like, Well, what I did in the past is impacting what's happening right now, correct? Yeah, there's 1000 different examples of this. If your blood sugar is getting high at, you know, midnight, it's probably from dinner. Could be, could be, might not be, I don't know, but you need to assess it that way first, like, maybe you, you know, maybe your doctor turns your basal down at 10pm and that's why you're getting high at at midnight that but that's still the same idea. It is. Yes, the thing that happened at 10 is what's impacting you at midnight. So when you once, you understand that you have a good like feel for it, then you can start understanding greater that what I'm doing right now is for later, and so I can make decisions in the moment that will make 23456, hours from now, better, more stable. Yeah, yeah. You just kind of have to wrap your head around it's not like stepping on the brake of a car. It's not like I need to stop now I'll push on this

pedal. And that's the whole idea around understanding insulin to begin with, is that we have something that I really wish we could change the name the way that we think about it. We call it rapid insulin. It is not rapid. It may be more rapid than I lived with yan's ago, which took a really long time to get moving, but it still is not instantaneous. And I think those two words people think of as being the same thing. And it takes movement for that insulin. And one of the first places I bring in the concept of that insulin, you know now, is for something you're going to impact later, is in the basal testing time period, where we're really looking at segments of the day without any Bolus or anything in them, and we can say, Okay, well, blood sugar rising, like you said, at midnight. We don't change the basal rate at midnight, right? It's a backed up, because that's going to take at least an hour or two of circulating change in a basal amount to impact by. Midnight to stop the rise or fall. But

do you know how many people just heard you say that and thought, Wait, you don't I know, right? Yeah, why not? Like I'm getting low at midnight. I'll change my setting at midnight. It's because insulin takes time to begin working. And Jenny's point is so good that you know, when they came up with faster insulins and called it like rapid acting insulin compared to what they were replacing. It was rapid. Was insanely rapid. They were like, Oh my God, look at it. It's like an hour. It's working, right? Yeah, it is one of those things that, like, you know, we named something because of, you know, what made sense in the moment. And now that's not people's expectation of rapid anymore, especially in this. I mean, in a, I hate to say, I sound old, I think, but like in a social media, like, everything now, yeah, rapid doesn't mean that. So anyway, insulin used now is for later. What's happening to you now is from insulin you used in the past. Here's an example. Just because you're 75 like, people are like, Why can't Pre Bolus my meal, I was 80 before I ate. And I always tell them like the number, like being 80 doesn't make the insulin magically work faster, like you know. I know you have a shorter distance to go to being low and being, you know, concerned, but you can still with a stable 80 blood sugar that is not being impacted by anything that happened before you can still Pre Bolus, just like you would Pre Bolus. Anything else, correct? Yeah, that's all right, excellent. All.

So it says here that in episode 1050 this was with you as well. 105 all about a 1c with Jenny Smith CDE, that's you and mastering continuous glucose monitors in the Pro Tip series. And actually comes up in Episode 11, bold, with insulin. I talk about the the idea of like, if you can be steady at 150 you can be steady at 80. Yes, like so this might sound weird read back. I'm just gonna start talking about anything in a second, but the difference, I've said this a million times, but it's very worth repeating in this episode, the difference between steady at 150 and steady at 180 The only difference between those lines is your fear. So this came to me through Arden's journey, when I realized, and almost another saying came out of it, like, you get what you expect. Like I realized that Arden's top line on her CGM was set at 200 that's where her alert went off. And generally speaking, when I went back and looked Arden was never over 200 so one day, I was like, this sounds crazy, but what if I just set the line to 180 like, what would happen then? And then I learned, like, Arden's blood sugar didn't go over 180 Now, if you're listening to this and thinking, that's not how it works, Scott, obviously it's not how it works. But it made me react sooner, correct, right? And it taught me that if I Bolus at this point, or if I did this thing, or if the setting was like this, that I got an A 180 blood sugar, because it's not like I just heard the beeping. It was like, Oh, this sucks. I was doing things to stop from getting to that line right. So I kept moving the line down and down and down. And now Arden's high alarm is set on her phone. It's 130 on my phone, it's 120 and I know people would hear that and think, Oh, if I set my high alarm at 130 my thing would be beeping constantly all the time. But it wouldn't be, because eventually you'd learn how to use the insulin. And so people heard that and then started saying, like, oh my god, this is great. Like, my blood sugars are 150 all the time. They were super excited, because it was way better than what they were getting, sure. And then I expanded it, and I said, Why don't you shoot for lower? And they'd say, Well, no, because I'm gonna get I'll get low if that happens.

But if there's stability in this, probably what you're gonna say, if there's stability already, then just bringing it down slightly isn't going to introduce lows, right? It's just going to bring your average

down. And so what I ended up saying to that person that day is the only difference between steady at 150 and steady at 80 is your fear. So if you make the settings changes and you make the lifestyle choices, meaning like paying attention at the right times and using your insulin when necessary and etc, you can be steady at 180 8051, 50, like, you know, pick a number. I don't want you steady at 50, but I guarantee you there's a setting we could do that would put your blood sugar stable, you know, like, you know what I mean, like, so let's not aim for that. No, no, no, we're not aiming for that at all. The point is, is that there are settings that create stability. And if you found 150 it could be a little insulin sensitivity. Turn, it could be a little basal. Turn, it could be, I don't know, maybe you got to pre bullish your meals five minutes sooner. Like, I don't know, but like in that, in that stew somewhere, is the answer to stability at the number you choose. That's all, yeah. I'm not trying to tell people that one number is right or wrong for them. I'm saying you could, by understanding how insulin works, choose that number and create stability of that number. You

could, and it takes time to adjust that right. You had a 200 and then you gradually brought that value down, 180 maybe 160 maybe 150 over time, you can adjust that, finding a comfort level again, with stability, meaning that you're not having major swings, that your standard deviation, your variance, is not roller coaster up and down like the Rocky Mountains. Maybe your average looks lower now, but if you don't have stability in that, then you're achieving that average, not the way that we want to.

That 32nd story I told took a year. You know what I mean? Like, yeah, I mean, I didn't know what I was doing. I was figuring it out. I didn't have a podcast to listen to. I didn't know you. You know what I mean? Like, I didn't live any of that myself. I was just like, what's happening? How do I make it stop? That was pretty much my whole life, for many years. Why is this happening? How can I make it stop? But you know this idea, it's been born out over and over again in conversations. And you know, once you I just want to say one more time, like, once you have settings that are creating stability, you can make adjustments to those settings that create that stability where you want it to be correct, and you might turn the wrong dial the first time. I don't know, right? You know? I mean, like, you might be like, I know what the problem is. It's basal. And you might make the basal more aggressive and go, Oh, that wasn't the problem. Like, right? Like, maybe it's like, you know, we've talked about in other episodes, but you make a. Meal Bolus, and you're you're shooting for that bell curve, but sometimes you kind of rise up to the top of the bell and just never come back down again, right? That could have been your insulin to carb ratio. It could have been your understanding of the impact of that certain food, like, maybe your insulin to car ratio is awesome, but it doesn't work on this

meal, particular component of your food, right? Right? What I'm

trying to say to people, and I probably should say this more frequently, is that I know this sounds like 1000 different variables, and like you're like, Well, how the hell am I supposed to figure any of this out? But it's just trial and error. It's you're a little bit of your own science experiment that going on and learning slowly, and then you just pop your head up one day. And if it's a year or two, or I know you guys listen to this podcast, you're like, you know, Jenny's like, great at this, and Scott seems like he understands it, and blah blah. But, I mean, Arden was diagnosed when she was two. By the time she was four, I was still crying. That was two years later, and I was like, now we had a meter. We didn't have CGM, but we added in a CGM. We learned how insulin works differently. I'm trying to say that it might have taken me six, eight years to figure this out, but I hear back from enough people. I'm telling you, go listen to the Pro Tip series. You might six months from now be like, Oh, I figured this out. Stand on the shoulders of other people who went through it already. There's no reason to reinvent the wheel, like there's no person that needs to do what I did ever again,

not with the technology that we have today. Thankfully. Yeah, and I would definitely say, if you you said just before, that's all well and good, but like all these variables and how do I start, and where do I pull the information apart. And for those of you who do have really good clinicians or clinical teams that are willing to sit down with you, really take the time within the data that you're collecting to pull the pieces apart, please do so, because they're they're very wanting. If you have, again, a team that's willing to take the time use them, because that's a huge value to your being able to not do it all on your own, right,

also. And to give us a plug, by the time I came to you, when I was in like, episode 200 and said, Jenny, I I think I have a system. Like, I know if I do these things that Arden say a 1c, just ends up at six. Jenny was so kind and came on. That's how she's here today, like, and we made that Pro Tip series together. And what it ends up being is this blend of, we don't probably talk about this enough, but it's this blend of me, like, bootstrapping those ideas, and then you coming in and being like, Oh yeah, Scott. Well, the thing you figured out is called this, and they already had a name buddy. We could have told you about it, but there's something about and I hear from people all the time, Jenny, there's something about your experience and my experience blended together that allows people to listen and just go, Oh, I understand what they're saying now, because there are plenty of people who go to a great clinician and walk out and they're like, I don't know what the hell is happening. I don't understand

anything more. I think it's the reason that when I have the opportunity, I'm so thankful for to work with the people I can it really is a blending of it's a conversational education, right? And I think that's why, when we put these episodes together, especially the pro tips, right? It's that you can bring in experience. I can bring in experience along with a simpler educational explanation that makes it understandable again, in a clinical setting, a lot of times the time, factor is, is the hard piece. There's so much that has to go into it and it it makes it difficult to completely give everything that I think most clinicians really want to be able to do, but no, I'm glad to be able to put it together in an understandable way with you.

I appreciate it very much. I'll talk to you later.

Okay, bye. You.

Awesome Jennifer, we are going to do for our small sips series, the last page, which says extra topics. So they were things that we heard back from people that really had a nice impact on them from the podcast, but they didn't have any deeper meaning or more explanation. So I figured we would try to parse through them here. Okay, so the first one is it was very helpful to me when Scott said to get stable and then increase your expectations. So now we have to figure out what I meant by that.

Well, I would expect the comfort level with stability means that you're not having problems with significant drops. You're not having really dramatic rises. Stability offers you a comfort. It does. But if you get stable, and you're stable at 150 and we've talked about this before, but you really would rather be stable at 110 Yeah, it's a step wise approach to getting there, you've achieved healthy, safe stable, and now that stable is leaving you higher than you want. So then it just little inch by inch. I mean, you could do it in increments, add a little bit more, add a little bit more. Look at your data and see where could I add a little more to get me closer to my desired next lower target. So

who is the person who's helped by this? So like, one of the problems I have, like, you'll hear me say all the time, like, I don't know what the podcast is. I'm not going to go down a long road on this, but when you do this thing that I do, and you just say, like, here's what I think, I don't know, good luck. And then somebody reports back, though, this really helped me. It took me a couple of years to realize that they weren't always being helped the way that I thought they were going to be helped. Sure, you know what I mean, because they're not me, but they still took something from it, the way I would think about it, like this. To me, seems like common sense, like, if you don't know what you're doing, starting out on day one, looking for an 85 blood sugar all day long is like a weird first hope you don't even like that's not going to happen. Oh, I guess that's what it is. So then find stability somewhere, anywhere, and then work from that by increasing your expectations. You can do that, I think, probably just psychologically increase your expectations. But I would also think, with your alarms on CGM true, adjust them

if you've been comfortable now that you've come down from an average 200 blood sugar, you're wanting to be lower than that. You have stability in the picture. You can adjust again, that expectation of, okay, know the tricks that I do to hold me here? Yeah, again, it's all about insulin entirely. If I'm stable here, I clearly need more insulin in the picture to get me to a stable place still, but lower my expectation is if I add just a little bit and nudge it slowly, I'm still comfortable and I'm reaching the goals that now I've moved on to.

I guess what I'm thinking is, is that if people have found stability at 180 for example, is it that they don't know that more insulin in targeted places would make that stability happen somewhere else? Like, why do you mean, like, yeah. Or do you think it's even maybe it's burnout? Like, maybe they're like, they spent so much time getting to it that once they're there, they're like, oh, I don't want to think about this again right now, like I finally got it stable. You know, I don't know I'm interested, and

I think that's where the personality and the individual nature of this kind of comes into the picture, right? You know, when I was like, planning pregnancies, I already had had a pretty tight target, so it wasn't hard to adjust my goal range a little bit tighter, and knowing what I knew about insulin, to expect to make adjustments, to get lower in a safe way.

Yeah, the pregnancy is such a great example for this, right? Yeah, because if you're running a six and it's a nice, tight ship, and the doctor says we'd love to see at five and a half. You're like, oh, okay, right. If you're running around at an eight and a half, and they're like, we'd like to see in the fives, you go, I don't know if I knew how to do that. I would have done it already, correct? Yeah, I see, okay, so get stable and then increase your expectations. I hope that helps somebody from my money. That means learn how to find stability at one number, then bring down your CGM high alarm so that you don't get above that or see that you act prior to that number. And then, I guess the thing that I would say, that I have said in the past is it seems so childish, but often you get what you expect. And so true.

I mean, it's kind of like taking a test, right? You're taking a math test. You don't study really in the back of your head unless you really, really know the subject, and it's not terribly new. You're not really expecting to do the greatest whereas, if you've put the effort in, you've done the work, you know all the equations and everything, and now you just need to move it up a notch you're expecting to really have. At a on the test, yeah.

And the work is tools. It is with diabetes, understanding basal insulin to carb ratio. Your insulin sensitive. If you have those tools and you found stability and you want it to be lower, expect it to be better, like, right? Sometimes your expectations set your self confidence, a lot of other things. Okay, all right. Awesome. Thank you. Yay. You.

Oh, it's time, Jennifer, it's time, in our little series to talk about the tug of war. Oh, oh, that's fun, okay, but we got to keep it short, because it's small.

Yes, the tug of war and, well, this is just, it's easy. Yeah, you think so? Well, I

think I hate the word easy in diabetes, because I think when you're starting out, it doesn't seem easy, and then as you move further along with things, easy is a word for some pieces of it, but other parts of it change, and it isn't quite easy until you figure it out. So anyway, tug of war,

I always tell people, diabetes is never going to be easy, but one day you might be so good at it, it could fool you into feeling like it's easy. So this has come up in episode 156, 214, and 1220, but, and I know we're trying to do this quickly, I'll do it as fast as I can. I was once on a phone call helping a young mother of a small child with the kids diabetes, and I realized that the mom was not in any meaningful way, pre bolusing meals, and I tried to explain it to her, and then she asked why, and then I tried to explain to her why, and I thought I had done a pretty good job. And she said, I'm sorry I don't understand. You'll don't get it, yeah, and I was left with a moment of like, this person, like, I'm, first of all, I'm not a doctor. Like, somebody put me on the phone with this girl, you know, but she was, like, 2021, years old, and she had already had, like, a three year old baby. The baby had type one, and I just felt like, I can't, like, if I hang this phone up and don't find a way to help her, it's gonna be horrible for her. It's gonna be horrible for the kids. Like, I felt very responsible, sure. So I just reached down into my wherever and started talking, and I said, Have you ever, like, been in a tug of war, like at school? And she was like, Yes. And I go, okay, so, like, instead of there being people on both sides, and I'm freestyling this whole thing, I'm like, instead of there being people on both sides of the of the rope. Why don't you imagine on one side is insulin and on the other side is carbs or anything else that tries to make your blood sugar go up. And she goes, okay. And I said, now there's that flag in the middle of the rope, right? And at school, you're trying to get the flag on your side to win. And she said, Yes. I said, Well, this game is different. We want the flag to stay in the center. And she's like, okay, so I'm like, just, you know, I don't know what I'm saying.

Well, you're trying to find the right way, the simple way to explain that will make sense given you had tried a couple of different ways of explaining how insulin and food work against or with each other, right?

I was just, as they say, grabbing its draws, and I had, I launched on this idea, and so I just stuck with it. And so I'm making it up as I go. And I said to her, I'm like, so here's the problem. I said, if we just blow the whistle, and everyone starts pulling, the insulin starts pulling one way, and the food starts pulling the other way. The problem with insulin is it's not really super powerful at first, right? Like, it's not at its full power when you inject it, but that food, you know, like you eat, and you see maybe 510, minutes later, you start seeing your your CGM go up, right? And she goes, Yeah, I said, so the food's going to end up pulling before the insulin. So if we blow the whistle and everybody starts pulling as hard as they can, the food is going to overwhelm the insulin and win. And then instead of thinking about this, like east to west, like, you know, pulling the rope, kind of flip it so that the insulin is pulling down and that the food's pulling up, right. And she goes, okay. And I said, so if you let the food pull first, you're going to get higher and higher and higher, and then suddenly, who knows how long into it, the insulin kind of comes online for real at full power, and it just starts pulling. But the problem is, you Bolus for the number and the carbs. Say your blood sugar was 90 when you Bolus. And you know it was two units for whatever you ate. Those two units were meant to have a fight at a 90 blood sugar with carbs that were not overwhelming them, that didn't have momentum, that weren't already winning, I said. But the problem is, when you don't pre bullish your meals, the food is not just winning, but it's creating a higher number. The higher number needs more insulin. You suddenly don't have that amount of insulin, the food has momentum, meaning that number is flying up, and now you're trying to stop it with amount of insulin that was really only meant to keep a 90 blood sugar stable during this eating excursion, right? And then I went through the rest of it about how to, like, you know, put the insulin in first, let it get working, so that that rope is moving in. You know, we have momentum going towards the insulin, not enough to make a low but just enough so that when the food starts pulling, that flag comes back to center, and then you've got the food at full power, you've got the insulin at pull power. They're both pulling as hard as they can, but neither of them can make that flag go left or right and flip that in your head north. South, and imagine that flag rolling along that 90 number for two hours. That's a straight line on your CGM. That's when you see people who like Bolus and have a straight line in their CGM. That's what's happening. And she just goes, Oh, I understand that. Was like the end of it. I was like, Okay, great. So it works so well for her that I said it in the podcast, and then I said it again, and then one day, and I mean this sincerely, Jenny might not remember this, but one day, Jenny complimented me about it, and it was like one of my nicer moments around diabetes. Oh, you remember that? By any chance, I

think so. Yes, you think so, we talk about so many things. I know quite sure that I did, because it is, it's a really easy it's an easy way to understand. Because if you were the person who is very interested in looking at all the documentation of every device and every medication, and you pull out the little insert that is inside of your vial of insulin package, you will see a graph of how insulin is supposed to act, how it's supposed to work, what its timing of action is. Nobody, nobody reads that. I don't read it. I think in my 36 plus years of having diabetes, I've maybe opened that little packet two or three times just out of like, I don't know, curiosity at the moment, whatever, but majority of people are not going to read that. They're not going to put it together with the reason that they take insulin, which is primarily for food coverage, right? And you do, you have to understand it in a way that that marries the two and gets them to work in unison. It is. It's a great description of keeping that flag once the insulin is working where it's supposed to, in a timeline, in its action profile of creation. You're getting a stable flag in the middle, which is holding your blood sugar in a good place.

If that flag is a stable blood sugar at 90, then the insulin can pull as much as it wants, and the food can try as hard as it wants. You know, if you want to think, I think of the food as pulling the number up, and the insulin is trying to pull the number down. And the balance of the timing and amount of that insulin against the food done correctly, just doesn't allow either side to win their stated goal of making the number higher or making the number lower. But you and I'm going to sound weird saying it myself, but you said to me one day, you said, this is the best explanation of Pre Bolus thing I've ever heard. I really was touched by that. So thank you. Oh, you're welcome. And yes, as you can tell now, I can tell the tug of war thing with my eyes closed, because I've done it a couple of times, but I appreciate very much you doing this with me today. Thank you, of course, yes. Thank you. Bye.

Okay, Jenny, I'm at the office talking to the endocrinologist. Kids just been diagnosed. I've just been diagnosed, and I ask the question, if I ate dinner at 7pm and at 7:45pm someone brought out ice cream. Should I Bolus for that too? And my doctor, for some reason, says to me, no, don't do that. You don't want to stack your insulin. Stack

your insulin. Okay?

So not right. So whether they get told incorrectly, where people develop the idea on their own, somebody is going to say to you after being newly diagnosed, don't stack insulin. What do you think of when you because there is a world where you can stack insulin. So what? What is 100% what is that stacking

insulin is taking insulin that isn't meeting the need for another lovely, I guess, little saying, right? It is insulin that really is kind of being almost given willy nilly, right? You may not think that you're doing it that way, but it is a okay, I've given insulin. My blood sugar is still high, or, goodness, the air was going up. Now I'm going to give more insulin. I think of it as not really having a thoughtful delivery reason, purposeless,

except for the fact that you have a high number and you're trying to squash it right, correct,

exactly. I mean not stacking insulin or taking insulin for what you need it for is not stacking, even if you're adding insulin within the defined time period of a three to four hour action window, which is what we call iob, or insulin, on board is essentially the time frame that we're given to watch for this concept of stacking, right? And if you need the insulin, though, such as, somebody brings brownies over an hour after you finish your lunch and you really want to eat the brownie, do you need insulin for the brownie? 100% you need insulin for the brownie. And

here's where the saying that helps people came out of the podcast. It's not stacking, if you need it, that's bolusing, right? That's it. That's the thing that apparently helps people more than anything. Is that phrase, yes. So I don't want you to stack your insulin. That would be bad and wrong, and you're going to end up low, or like panicky low later if you do that, but you have to cover the carbs that you take in. That's that you just do

sometimes. Other pieces this consideration comes up a lot when I start talking to people about why blood sugars might not seem to be responding to that initial amount of insulin, and then they bring in the idea, but if I add more, I'm stacking right? No, you're not. Let's look at the meal content. Is your meal high fat? Is it high protein? Because now you've Bolus for carbohydrates here, and in the end, hours later, you might have an impact from other pieces that they're macronutrients in that meal that are going to require more insulin. Are you adding insulin within the original Bolus time frame of action? 100% you are. But if you don't, your blood sugar is going to sit high,

right? If you misunderstand the impact of a food item, like you said, it's got more fat and it's going to extend its time whatever. Like you You misunderstand. You count the carbs, or you just count the carbs wrong. You count the carbs. You say, Oh, it's 10, but it was really 20. If you Bolus 7pm eat 10 carbs, you think, Bolus for 10 carbs. 20 minutes later, realize, oh gosh, that was twice as many carbs as I thought it was. If you put in the rest of the insulin, you're just covering the carbs. You're not stacking insulin, right? It becomes one of those. It's like a boogey man, I think, for diabetes, like, right? Like somebody's going to tell you very early on after you're diagnosed, do not stack insulin. And then that phrase is going to override all your common sense in the future, when you're like, I think I don't have enough insulin here, because

what does it bring in? It brings in fear. Yes, teaching somebody to be afraid of putting in extra of something that might cause, again, a place of fear is brought in with talking about low blood sugar or hypoglycemia, right? So, oh my goodness, if I take more insulin right now, it's going to cause a low blood sugar, and I don't want to do that. And again, with today's technology, thankfully, you've got more information to actually be able to stop any detrimental outcome from taking more when you need more, you would

think that the new technology would have squashed the better high than low theory, but it hasn't for every clinician, and I'm always interested by what we choose to say, like, better high than low means like, well, I'd rather you have a higher blood sugar than be you know, like fighting with a low or passing out or something that well, like, okay, I guess I can agree with that. But like, what? If we would have just said, like, better stable and in range than low, right? Come that wasn't the thing. But probably because of no CGM, like, it's easier for me to say that because glucose monitors exist now,

I would expect absolutely and I I also think within that realm, there are some people who take it to another place, of saying, Okay, I only have these time frames of available eat and Bolus within this time frame. I can't do that. I was told I can't take extra insulin. It could be dangerous to take extra so I'm going to eat a breakfast, I'm going to eat a lunch, which is well outside of that action time, and I'm going to eat a dinner, and that's it. Well, goodness, if you're hungry, if you're metabolically up or down, if you're a training athlete, that is not going to be a strategy that's going to work for you.

I don't know, like I just, I just want to say this one again, right? So just put it here at the end. You can stack insulin. I don't want you to do that, but it's not stacking if you need it, that's bolusing, correct. Okay, and that is one of those phrases that the feedback comes over and over again, like there's a lot of people's light bulb moments. Yeah, so awesome. I appreciate you talking about with me. Of course, I.

Uh, Jenny, broccoli, mashed potatoes, white bread, rice,

lollipop. I like broccoli in there.

They're all food, right? They're things people put in their mouth. They are

all food. I like the fact that they are technically all food, yeah.

Now, if we took 10 carbs of broccoli, 10 carbs of mashed potatoes, 10 carbs of brown rice, 10 carbs of basmati rice, 10 carbs of all giant lollip, how much? How big would a lollipop have to be to be 10 carbs? Probably not that big, right? Yeah. No.

Your typical lollipops, like the little round, circular ones that are like a quarter size, are usually five to eight grams a piece depending. So, you

know, I'm old enough to think of that as a doctor's office lollipop. It is. Yeah, I don't think they give this away.

Lollipops that had the curved bottom, they had the two sticks that were a curve. Do you remember those

so excited? She's so excited. She's like, I love that lollipop. I have to tell you. I went into a place the other day to order something, some food. It wasn't gonna be ready for a half an hour, and I said, I'm gonna go wait in my car. You know, it's that time of year, and I'm like, these people are sick. I know they are. I gotta get out of here. And they had a, like, a bowl of lollipops. And I was like, I'm just gonna take one of those. I just, I rolled outside, sat in my car with my lollipop. But I bring these things up because if we took 10 carbs, 30 carbs, and made equal piles, carb wise, of all these different foods, it doesn't mean that those carbs are all going to impact your blood sugar the same way. It doesn't mean that they're going to require and I think this is the part that throws people off the same amount of insulin. So 10, you know what I mean? I want to talk about that. Yeah,

no, I think it's valuable to bring up, because I think in the world we live in now, with the technology we have, we can actually see more of what you're saying. We can see that 10 grams of broccoli versus 10 grams of mashed potatoes, let's say are all worth they're all worth the same amount of insulin, but because we have the quality of technology in delivering that insulin, we have a better way to push that insulin out to cover the food. And we also know a lot of people, thankfully now know a lot more about Pre Bolus thing for certain things versus not other things. So that the understanding of how insulin works and then how food digests, they're really they're the two factors that are so very important, and a carb is a carb as a carb is not true when you're trying to deliver insulin to match the effect that that CARB is going to have once it hits your bloodstream,

right? I have to tell you that we did a defining diabetes episode called carb absorption and digestion. It's 668 was a long time. It was a very long time ago, and I understood by then, through my experience with Arden, that all carbs weren't created equally. Like, that's how I thought about it, and it's how it comes out in the podcast. It wasn't until one day, I think, in one of the pro tip episodes, where you started talking about the digestion. And I have to admit, like, I don't know if I ever told you this at the time, but I was like, oh, that's why. Like, you know what I mean? Like, I was like, I knew it was happening. I saw it happening. I knew how to combat it, like the whole thing, I didn't know why it was happening. And I found that's been such a almost set a delightful path, because I think it's really opened up the podcast a lot, because it's led to so many other things, like, right? Like, you know, initially, just the conversation of, like, Look, if you put those potatoes in there, the makeup of those is going to, you know, kind of dictate how it gets digested, how long it stays in your system, how long it's impacting but if you like, go flop a little sour cream, you know, or some butter on top of it. Butter is a great example, because snow carbs and butter. So you know, if your mashed potatoes are really just a butter delivery system, and it slows down your digestion. Well, then those potatoes, they sit in your stomach longer, they impact longer. And that's what I mean by it. Like, yes, it's 10 carbs of potatoes, but the impact over the timeline of digestion, the life of the insulin, all the things that are going on at the same time are not going to all be equal. You can't just push the button, put in the insulin, wait however long you're going to wait, eat the mashed potatoes, have the experience, and then do that again with broccoli and have the experience. I think that's why people with diabetes so often say things like, I did the same thing today that I did yesterday, and it didn't work out the same, except you didn't do the same thing. You just aren't seeing the variables that make yesterday different from today, correct. Sometimes Absolutely.

And when we talk about there are, you know, working with as many little kids as I have the opportunity to there are a lot of little kids. And even adults, but who have likes, and they stick with those likes for an amount of time before they decide, well, I just don't like that anymore. I'm not going to eat it. But that makes it a little bit easier to determine the impact, and then you have to take into consideration the variables around that so you may have figured out your grilled chicken with steamed broccoli, and you have it every single day for dinner because that's your favorite thing to eat, but the variable surrounding entry into that meal time, or even after that meal time, can then make a shift in how the insulin gets in in a timely manner versus a more lengthy manner, versus, you know what I mean, like exercise, you're doing volleyball for three hours ahead of that meal, versus the next day. You've had three tests, and you come into dinner time and you've had no activity, because if you've just been sitting, there are those variables that are going to impact this meal needs two units in a given scenario, but the variables surrounding that are going to change day to day.

I have probably 1000 times said to people, if you're really struggling to figure out how your insulin works, get boring for a few days and eat the same thing for breakfast, the same thing for lunch, the same thing for dinner. You'll get better at it, like, because right then, at least you can see like, oh, I tried a 10 minute Pre Bolus. This didn't work. You know, like, there's nothing worse than somebody being so bum fuzzled that they start saying things like, I saw someone lying the other day. Said, This is what's making me think of it. She said, I don't understand. I'm up to a one hour Pre Bolus. And I was like, Oh, well, that's not your problem. Then, right? Like, your basal is wrong, or you're, you know, the meal before isn't being addressed correctly, or any number of problems. But like, if you're up to, like, trying to pre bullish your meal for an hour, you're looking at the wrong problem correct, you know? And I just think that if you simplify, you can see how like this food works, and then you can see, well, now I can figure out like this food mixed with this food on a plate might work differently again, and that's a little easier for me. I'm a very boring person. You and I are going to get done here. I'm going to go downstairs, I'm going to take two eggs, I'm going to take a little bit of protein, I'm going to put it in a pan with like a half a tablespoon of butter, I'm going to fry it up on a throat and a wrap and I'm going to eat it like I do every morning. I don't care. Doesn't bother me. But do that for a few days, you'll start seeing consistencies. Start realizing, hey, my Pre Bolus was a little short. It was a little long. This carb ratio doesn't work for this meal, but it does work for lunch for some reason, like, who cares? Why? Learn that you know right? Expect that what's going to happen is going to happen, and do it again the next day. Have some success. And then, like you said, now you've got actionable tools that you know how to use. Start applying them to different scenarios, right? And then you

can take that even further. Let's say you love your protein wrap that you're eating, and you decide, well, goodness, you know, I'd really like to get some good antioxidant quality into this meal as well. I'm going to start throwing some blueberries or some raspberries into this right? Well, that's an addition to what you had figured out. So now, if things go sideways and you didn't expect them, it's okay. I added this extra How do I need to compensate for this? It's an do I add a secondary Bolus at a different time? Do I Bolus a little bit longer Pre Bolus? Do? What do I do? Right? So you can take your again foundation of things that you do most of the time, and most people have about 80% of the same foods over and over and over again in a week's time, you can figure those out. You can start throwing in the oddities and figure it out in an easier way.

Yeah, I mean, listen, I don't have diabetes, but that wrap can sometimes have I'll tell you what I'll do. Sometimes I smoke sausage and I put it in the refrigerator and I put it with my wrap. Sometimes I do chicken, sometimes I do shrimp, sometimes I do beef. Sometimes I'll get crazy and put bacon in there. I'm crazy. Just losing weight for the last two years has been a lot of fun, but the bacon, if I was using insulin, would slow down digestion differently than the chicken, or the chicken would digest 45 minutes later, an hour later, versus maybe the beef would do it a different time. Or the shrimp might not really impact me very much. It's all there. But like you said, you throw, not that you're putting a berry in with shrimp, but all of a sudden you, like, throw some berries into it. You could, I guess, but now, all of a sudden, you might get hit with some fast acting carbs, because that wrap prior to that is eggs. It's a protein in the wrap. I try to use a fairly low carb rep. That's probably a slow, consistent impact. All of a sudden, I have a little bowl of blueberries on the side. Now I'm going to get a zing of, you know, fast acting sugar. It changes Pre Bolus time. It changes the amount of insulin, you know, yeah, all of a sudden. Now, if I was getting. 50 point rise out of the wrap that I was getting rid of in two hours that fast acting sugar could throw that 50 point rise another 50, 100 points higher if I don't hit it correctly one way or the other. What I can tell you is that people report back that the phrase not all carbs are created equal, really help them understand diabetes episode 668, 739, and 1068, are some places you can hear that discussed. Awesome. Thank you.

Thank you. Applause.

So another thing Jenny, that I will just, I'll bang a drum about for as long as I have this podcast or a way to talk to people with diabetes, is that I used to say that if I only had 30 seconds to explain diabetes to you, I would tell you that everything is timing and amount the amount of insulin, using the right amount of insulin at the right time. If you do that. Obviously, it's not as easy as it sounds, but if you use the right amount of insulin at the right time, diabetes works out much better, right

80% of the time it's gonna work better. Yes,

yeah, it's not a listen. Nothing's a perfect system. I've had people come after me before because they're like, you can't say something so definitively, because somebody will get confused. And like, I understand that idea, but at its core, managing insulin is timing an amount. It just is, like, you have to use the right amount of insulin at the right time. You can use the right amount of insulin at the wrong time, and that won't matter, right? You could make a perfect Bolus and not Pre Bolus a meal and still get high. I think

that's valuable in all walks of nutrient intake or fueling plans that people are choosing, the real low carb eaters, the all fruit eaters, whatever. It's 100% about timing, even the people who are eating a ketogenic diet are timing that insulin that they're using in the right way to hit and smooth the blood sugar for the nutrients that they are eating. Yeah, same for carbohydrates. If you're going to be a all fruit eater, you know 800 grams of carp in a day, you still really have to know it boils down to insulin action. When do you need to take the insulin? When does it finish working? When does it hit? Where it want it to hit?

I sat at lunches with type ones who are eating no carbs at all, like just taking in protein, but they know they're going to get a bump from the protein later. I'm thinking of an example now where I sat with a person who was just eating the patties out of a cheeseburger, right? Sure. And 45 minutes later, she's like, I have to Bolus now. Yep, that's timing and amount, right? Like, if you're like, I don't know keto the right word, like, if you're super keto, or you're ultra low carb or something, and you're using, I don't know, you're using old time insulin still, right? Maybe using our our

insulin, but many people are using our because it hits in a slower pattern, much like the fats and the proteins in the diet, more more fat in the ketogenic diet, truly. But even for those eating more of a high protein diet, you're going to get better impact from our or regular insulin, slower onset, much longer than our today's quote, unquote, rapid insulin.

But that gets timing. Still it is that's just you're matching up. They go back and take an older insulin because of the way it works, because of the way the timing of the insulin works. Yes, going back to the idea that you could use the right amount at the wrong time, you could Pre Bolus too long and get low. That's the right amount of insulin at the wrong time. But you know, just like in that Eminem story, if you put the right amount of insulin in at the right time, you might not see a blip on your graph ever. I was looking at Arden's graph last night, and I can pull it up now to look at it again. Like Arden's over, like this is overnight, right? So here's her overnight graph, you can probably see it enough. Yes. Okay, so Arden has been, this is like the last six hours. Arden has not been under 70 or over 120 for the last sleeping six hours of her life, and she's 76 right now. That stability in that graph is being controlled by, I mean, Arden's using trio, so she's on an algorithm. She has a GLP going, so, like, she's got a lot of things helping her, but in the end, right? That insulin is being put in, taken away by the algorithm. Little here, a little here. Hey, the Bolus is there. The basal is usually point eight, five overnight, but you'll see it go to point five. Sometimes you'll see it go up to point nine, five to one, like, all you're seeing happen is the right amount of insulin being used at the right time, and when it's done perfectly, that's a stable line that you get. You can do that with a meal. Like you just can't it might take you a long time to figure it out. I'm not saying on the first try it's gonna go awesome. Like, I'm not saying that if you have like, a Twinkie sandwich with a cupcake chaser that it's gonna, like, you know, be as easy, but the truth is, you could eat a Twinkie sandwich with a cupcake chaser and use all I don't know how the hell you'd figure it out. You could put that insulin in the right places, and it would, generally speaking, work for you Sure. And I think that once a person learns how to manage, like, something, you know, with a crazy glycemic impact regular meals are, you're like, Oh, this is pretty easy. You know what? I mean? Like, easier? Yeah,

right. And it's the, it's the meals that you regularly eat over and over that then give you a confidence level of trying something maybe a little bit. More aggressive for something like, I can't believe you made up a Twinkie sandwich. I know somebody has probably done that, but anyway, that's what you're going to try to do. I want

to just tell you, if I'm going there, it's not a Twinkie. I don't I think the cake is weird. I don't like the cream. It's not for me. Yeah.

Anyway, go ahead. It's all good. It's all about timing. That's

it. You can hear more about this in episode 255. Comes up in 223. Something called Johnny's mom took notes. Sounds like Johnny's mom was listening to the podcast and listened and understood and in understanding glycemic index and load in, I think the pro tip episode so great timing and amount. Again, if I was falling off a cliff and you're like, Scott, help me with my diabetes, I'd yell, it's all timing and amount. Ah.

Jenny, let's talk about using your CGM graphs for more than just the number. Oh, you up for this, of course. Okay, apparently we talked about this in a number of episodes. Episode 37 with you, Jenny Smith. It's called Jenny Smith, type one diabetes guru. That's crazy is that, like the first year of the podcast.

It wasn't number 37 you said 37 really early, yes.

And we also spoke about it in episode 1006 called Mastering A CGM, and in the bowl beginning series, episode 1271, but the person that sent this idea in is saying, Look, I came to realize that I could infer things from the graph and not just count on the number. Now, yeah, I will say this. Do you think that that changes from system to system? Or do you think it's pretty consistent throughout them,

meaning brand to brand of CGM, yeah, and

maybe even like, g6 to g7 for example. Like, does the pitch of the line mean something different to you in g6 than it does on g7 that kind of an idea. Or, do you think, generally speaking, this conversation could cover all these ideas? I think

it could cover all of the ideas, because the systems all have some type of an arrow directive along or associated with the number that is your considered current glucose value, right? They all have a graph that indicates rising, falling or stability. I think it could be used across the board. Okay?

Because I used to say to people, Dexcom, g6 and prior, I used to say, set your graph to three hours, and then look at the last three dots on the right side, and if they would bend one way or the other, it was a good indication that you were about to get an arrow that way. And I have to admit, I don't find that to be the same in g7 anymore. Well, it's interesting. I don't know why exactly. Maybe some people still use it that way. But whether I think it is or not. These, to me, are the little things you're looking for. Like, what does the graph tell me is happening? You know, for instance, we all know about compression lows with CGM, right? You roll over, you lay on the CGM, all of a sudden, your blood sugar looks significantly lower than it was five minutes before after. That's happened to you a number of times. I don't know about you, but I can look at the graph and say to myself, being fairly confident, oh, this is a compression low, yes, because I can see it on the graph

well. And there's a very on the graph again. And in terms of talking about those, the graphical view, the compression, those are very evident, because they look like a pretty stable looking line of trending dots, and one dot veers off in a very different, abrupt manner. It's almost, I kind of describe it, akin to a cliff dive. Yeah, you're on the cliff, and all of a sudden you're like, at the bottom of the gully, or

whatever. Sometimes you'll lose connection for a second. It'll almost look like a couple of dots weren't there, and then all like, Listen, I'm not saying this couldn't happen, but it's fairly unlikely without insulin that would, you know, make this happen, for your blood sugar to go from 100 to 40 correct in a couple of minutes. Like, you know what? When you look and you go, Oh my God, it just went down 40 points. And then that panic hits you. I'm not saying you shouldn't check on it immediately, but what I am saying is you might think I'm just going to test my blood sugar, because this could be a compression low, correct, right? And then after that happens a number of times, I still think you're going to check. I would still like you to check, I guess is what I'm saying. I'd like you to whip out your meter and make sure, but at the very least, maybe it could keep you from having that heart dropping into your stomach feeling correct

and or treating when you really don't need two grams, four grams, eight grams, whatever. You've gotten used to treating something like that with. You're likely to not really need it if that value is not truly

that low. So instead of the panic putting a juice box into your hand, let the panic put a meter into your hand and go. No, look, you know what? I am 100 maybe I'll just wait a second to see what happens here. Now, similarly, using the graph after a meal, for example, I think of that line sometimes, like on a protractor. I don't know if people have ever used a protractor before, like when you're like, put in a little, I don't know, Pre Bolus for a meal, and you've got a nice little drift happening, and then all of the sudden it looks like a bent arm, like shot up into the air. All of a sudden, I say to myself, well, I don't think my Pre Bolus was long enough, long enough. And okay, so let's next time to take a little look at that. Now, if it jumps up very quickly, and then, you know, levels off, and then comes back down to me that says, Oh, I'm close, like, I almost have this, right, you know. But if it goes from if you Bolus at 100 and you're at 80, and then all of a sudden it's jumping up like a rocket, and you're 121, 4160, and it goes up over 200 you might. Missed on your pre balls. You might have missed on the amount of insulin you needed. Like this, to me, is an example of I have to look at the amount and timing of the insulin that I'm using, but I'm pulling out art and CGM just so I can look at it and think about it. I think often you can look at your CGM and say, Oh, I see the mistakes I made, but I don't feel that way about it. Like I feel like you should look at it and say, Oh, this is what happened. Here's what I did. I know what I should do next time to stop this from happening. Like those lines tell you a lot

well, and that's a good differentiation of passing judgment on yourself, or your decisions for yourself or for the child or the person that you're caring for, trying to take the emotional piece out of it. Don't judge your decision. Instead, I always recommend once a week, not every day, maybe, but once a week. Take a look at your data. Look historically back and see, okay, I can see where I might need to make an adjustment. I can see where some things aren't falling into the target ranges where I really would like them to be. Again, don't judge. Just say. I can take a look at breakfast. It looks like there's not enough Pre Bolus. I could take a look at lunch, knowing I have enough Pre Bolus. I'm still getting higher or lower than I want. I need to make an adjustment in something. So, yeah,

I should have it with me, but I don't. But there's this great little graph that people made from the podcast. Apparently, you and I said things over the years, and people like, put them out, like, if this happens, it was too short of a Pre Bolus. If this happens, it was like, like, so probably, yeah, I'll find that, and maybe I'll put it into the end of this episode. Again, your blood sugar doesn't jump up right away, but drifts up slowly over, you know, the last 45 minutes, maybe this was just not quite enough insulin, like, if it didn't jump up initially good, Pre Bolus, but if it does, then continue to rise, not enough insulin, right? If it just jumps up out of nowhere, but then levels off and stays super steady after that might have been the right amount of insulin with not enough of a pre ball. It's like correct those are the things that you can and I hope you do infer from the graph and teach yourself with because in the end, this whole game is timing an amount. It's using the right amount of insulin at the right time, and that graph can teach you a lot about it. Yes, sure you can get used to like, what is a compression low look like as a more valuable tool, it's that. It's going back and saying, I put the insulin in here, then this happened. What would happen if I put the insulin in five minutes? Sooner or five minutes later, there was a little more, a little less. And really learning from it. I

know I was going to say, go along with that. That really is that's assessment of your information. I think a lot of people value whatever continuous monitor they're using these days for the alerts the here and now, I'm getting an alert here, or I'm getting an alert here. It gives you something to react to but if you get into looking at your information, like I said, even every seven days, just taking 15 minutes to look at your trend in the last week, you can then learn to be proactive and make the right adjustments so that your alarms and alerts don't become a nuisance and they aren't going off as regularly.

I think the two things I hope people take away from this one that you shouldn't just look at and go, look what it's doing, because it's not doing anything like you're eating and putting in insulin, and it's showing you what's happening. So, you know, just don't look at it when you see the peaks and the valleys and go, Oh man, diabetes, just, I don't know. You know. Trust me, you could know. And the other thing I would say, this will sound crazy to people who are not at a place yet to feel like they can keep their blood sugars in a range that they're shooting for, but having a lower high alarm and not treating your CGM just like a don't die. Advice is, like a device is a big deal. Like, please don't just treat it as a low alarm right, and then push your high alarm up to 400 and ignore it like you'd be surprised. The way I usually think about it is often after you have good ideas about your settings, and you know how to Bolus insulin, and you get better at that, you start to get what you expect. So if you expect your high blood sugar to be high at 150 you'd be surprised how often you stay under 150 so if you've got a 400 you know, and listen, I'll go over very quickly if your highest set at 202 5300, 400 wherever it is, the amount of insulin it's going to take to bring you down from one of those big numbers is much more. It's much more. It's harder to know. It's more likely to cause a low later. And I think it puts you in a three hour fight with this high blood sugar, instead of getting an alarm at 140 or 150 and going, oh, what would fix this? A quarter of a unit, you know, and then putting it in, and now all that other stuff doesn't come with it. There's so much you can do with that CGM that will make your life easier. I think. To

a lot of people are with the tightening of people's ranges, the goals getting tighter than what the ADA recommends that 70 to 180 right. People want maybe 80 to 150 or 70 to 160 they're tightening their range that they want to see their overall averages in which is a healthy thing, but you have data now to be able to do that much more precisely. And so with the concern about high blood sugars, many times if we're reactive to just the CGM alert, but we end up doing is creating more roller coaster. We're creating more variability. And so like you said, if you have your high alert set really high, rather than a bit lower, to be able to see what's happening, sooner, you may end up giving more insulin, creating a low. The low most often creates another rise up. And so you start this up, down, up, down, up, down. It's very difficult to get off of that roller coaster. So if you instead of focusing so much on highs, look first at your reports for where are the lows, and if you can filter out a good majority of the lows, you're often going to decrease the height of the highs, and that may take some adjustment to, you know, insulin doses, strategies, all of those types of things, yeah, but yeah, often lows are really the the end result is, is a high that you didn't want, and then it just keeps going. Well,

there's no doubt that most of the people listening, who are like in need of this information, probably see some sort of stability overnight, right? And then they get up in the morning, they miss time or miscalculate their first meal. Whoop up. They crush it with insulin. Whoop down. You panic about the low food in too much. Back up. And I know it sounds crazy, but I've seen people get on that roller coaster and not get off it for years, right? I'm not even kidding. Like it's not like, oh, Monday got messed up. Sometimes, if you're doing the same thing over and over again, expecting a different result, I guess that's the definition of insanity. In the end, it really is just, I promise you, it's, it's about timing and amount. Like, go listen to the Pro Tip series. I don't know how many episodes it is now it starts at Episode 1000 in your player. It's Jenny and I talking about big ideas, more, you know, long form conversations. I genuinely think if you listen to it, you'll understand by the time it's over, and you can make this stop happening for yourself. Yes, thank you. Awesome. Thank you. You.

All right, Jenny, I appreciate you doing this with me again. We are going to talk about stopping the arrows today. Oh, fun. So this came up originally in defining diabetes that we did in 286 where I think we were just talking about visual cues that we were using in Dexcom or any CGM, really to make decisions about diabetes. So I'd like to hear from you first, how do you utilize arrows on CGM? Do you pay attention to them? Is the number more important to you? How do you think about it?

I think the arrows can actually be more beneficial than the number value itself, because we know that CGM is going to be a little bit off of a finger stick in general, and when your number is changing, or you've got that arrow or the directional line of the dots on your on your system, showing you that things are shifting and changing, whether it's a rise or a fall In your glucose value, but the number isn't exactly a finger stick value. It is giving you information about what's happening right now, though. And so when I look at, you know, my arrows, for example, I expect a little bit of a trend up in the aftermath of eating something, but I also know enough about the types of things that I eat that I could expect based on timing, knowledge and everything else, that arrows shouldn't be dramatic, like I should not get. In fact, I don't know the last time I actually got, like a double arrow up, kind of or even a single arrow up, but in general, a nice, stable sort of course, up in the after math of eating something. You might get a little bit of that angled arrow trend up in the aftermath of a meal. But you also have to think in that scenario, again, not based on the number, but based on the trend that's happening. Okay, I just ate. I expect a little bit of a shift in my blood sugar. It's not going to stay flat in most cases. Some eating styles, sure. But in general, it's going to coast up a bit at a certain point. However, after the meal and the Bolus, it should plateau. It should stabilize. You shouldn't any longer have that trend Up Arrow or that angled arrow up, it should plateau and then eventually, over not a terribly long period of time, maybe 30 minutes, it should actually start to kind of come back down. So we're looking for a bell curve when we're looking at data around meal times in times that aren't around meals, though, those arrows can give you more information about what you might need to do, too, because if you're in a fasting time like overnight, and you just so happened to wake to an alarm that you've got set for a high or a low blood sugar, and you have a trend arrow happening there, it might actually cue you into doing a finger stick to evaluate whether that's true or not, and to take a course of action, because now, assuming there's not any food or anything else happening, the trend up might actually need some assistance. You might need to do something about it. Or the trend down, you may need to do something about it, to stop it, because clearly you have nothing else impacting the change right now.

So I think when I said originally, like, I think about stopping the arrows, it was when I was trying to figure out how to use the insulin, right, like, so to your point, I like that. You said after math, after after a meal. Like, it was like a car accident, and everybody's just like, dazed out the

streets. People talk about it, it seems like, kind of like it is, like a whole, like a Trojan situation that sounds like you ate, you know,

just wandering around and there's smoke in the air, like, what happened you ate? Yeah, it's, I just love that when you said aftermath. That was so what I was trying to get at back then in these episodes, but, by the way, comes up again in episode 327, episode 125, like, it's a thing I've talked about a lot. But before algorithms, and before really understanding firmly how insulin was working, I was teaching myself about the value of my Bolus by what the arrow was doing afterwards, right? Like, and, to your point, like nowadays. I mean, if I saw a double arrow in either direction nowadays, I don't even think I'd, I'd be like, what just I don't understand. But back then, they were happening constantly, right, sure, but back then I didn't understand Pre Bolus thing. If you listen back, you can hear that as Arden was growing, because Arden was diagnosed when she was so small, as she was growing, her office never changed her insulin to carb ratio. Oh, her endo office, really, they did, and her also the insulin sensitivity. Like I looked one day, and it was like, one unit moves her 300 points. And I was like, that's not true at all, you know. Like, and then I. Realized like these settings are being ignored by people, and they're important. She's grown, she's gotten bigger. Her basal doesn't change. She's grown, she's gotten bigger. Nobody changed her insulin sensitivity, I'm like, which is one

that drives me crazy, that sensitivity factor, correction factor, it is the least adjusted of all the three knobs, so to speak, that you can kind of turn right. We've got basal insulin to carb correction factor. It's the one that gets left in the corner by itself. It nobody fixes it. Yeah,

I was stunned. I mean, once I figured everything out, I was stunned what was happening. I didn't even think twice about it. I wasn't pre bolusing. Her settings were way off. She'd eat something. Her blood sugar would definitely two hours were happening all the time. I even think back then I was blaming the insulin at one point, like, probably, I actually think that I love a Pedro. Arden's been using it forever. I find it very smooth for her. But I think I made the switch because I thought it was Nova logs. Fault that we were seeing these double arrows because I was out of ideas about, like, what to do, what to do. But anyway, like, what I this, this kind of fundamental idea I had back before the settings were right and I knew what I was doing is I would think I have to stop the arrows right so, like before, I understood that I wasn't using enough insulin. I at least knew I should not be seeing this arrow up and I kind of set these lines in my head, like, if you know, in the first 30 minutes after she ate, she was rising quickly, or she got over 140 and it looked like she was gonna go to 160 I assumed. I didn't use enough insulin. I put more insulin in. Nowadays. I still use that, but it just doesn't come up as much. But what really ended up happening was the people listening to the podcast who also were in a situation where they didn't understand that there were three settings they needed to be looking at, that they were probably all wrong, that they were timing their insulin incorrectly, etc, they found that phrase stop the arrows to be really helpful in the beginning, while they're learning, you know, while

you were saying that, learning about how to stop the arrow, as I imagined you're like, in my head, this scenario of like, packing your backpack full of whatever you're going to leave the house with to take care of whatever force was invading your home at that point. Oh, it felt like, imagine, it's like you're in this war against, oh, something against

the arrows. Like, like, really, because that's what it's because the number, to your point, listen, CGM are fantastic, but the speed direction, that information is super, super helpful, maybe more so than the number, right? But, yeah, that's exactly what it felt like. I was like, oh, it's everything. Felt like it's coming for you all the time, like you don't I mean, like, here comes the arrows coming. I don't know how it got here. I don't know how to kill it. I don't know how to stop it without it turning into a different arrow that I don't want to see. Right? Anyway, as a general management idea, I think when you see straight arrows in either direction, they need intervention. So it's obvious when you're dropping fast that you need intervention, but I don't think it's so obvious, at least in the beginning, to people that those straight arrows up mean I've significantly mistimed and miscalculated my insulin. Right? Yeah, right.

And those, I think those straight arrows are definitely, I mean, angled arrows you're likely to see more often, especially angled arrows that are coasting up slightly again in the I was going to say it again, the aftermath of a meal.

It is, I mean, if it's going like this, and

to not be too again, this is where the understanding of insulin and how insulin works, along with food, becomes really valuable. Because if you're just trying to stop the arrow and it's 20 minutes after you've eaten a meal, you haven't really given that insulin enough time to do justice, right? I think there is a timing or an evaluation time to look for that arrow and say, Okay, I know I still have insulin working here. I'm going to wait 30 minutes and hope for that plateau, hope for the turning point that it's not going up anymore. The insulin really is taking action. And they're kind of that tug of war idea that you, that you created. They're working together, the insulin, the carbs, they're working together. And now it's going to coast back down the up and down arrows, like you said, those straight arrows, those are the ones that usually indicate either something is a miss with the insulin site, that the pump site right? Is it leaking? Has it been pulled loose? Is it disconnected? Because if this is a normal meal for you, that shouldn't be happening. But the other piece would be, if you got a straight arrow up or a straight arrow down, it's probably timing that was the best. Yeah,

right. If you're using the right amount of insulin and you're still seeing a straight up arrow, you may have just let the food get ahead of the the insulin by not Pre Bolus. Thing. Enough. I kind of think there's two different ways to think about. This. Like, there's the way to think about it, once you're in my position and your position where you know your settings are good, right? Like, once you know your settings are good, if you see those drastic arrows, you're like, Oh, this is timing, or I didn't use enough insulin, or I've miscalculated the impact this food's going to have something like that back when you don't know what you're doing and it's just starting out, like, to your point, you don't want to Bolus for a meal. 15 minutes later, see an up arrow and just start pouring in more insulin, because correct, you don't know what's going on. Like that might be a time to sit back and evaluate and say to yourself, you know, for next time, I'm going to try to get the insulin in in enough time that this doesn't happen, that this food doesn't come in and just crush and overtake the insulin. Because it's not working yet. If this makes sense to you and you want to learn more, go to the Pro Tip series to try to learn more about how to get your insulin settings set up. Thank you, perfect. That's awesome. Yes, you.

There's more behind it too, which is a fun discussion then, yeah. Well, what she sent me? You wanna just do it now?

Sure we can do it now. All right, so

she sent me a list of all of the different meanings that she's seen people attribute to swag. Oh, but I've been aware of the acronym forever, since Arden had diabetes. So, I mean, it existed at least then in 2006 do you know about it prior to that?

Gosh, I don't even know. I because I think, I think the internet was not as there's a defining point to when the online sharing of terminology and the sharing of stuff within the diabetes realm just became much more there, right? And so swag being one of them, I don't even know that it was something people talked about despite having, I think before the acronym was there, people knew that they were totally just pulling it out of their butt, right? Like, Oh, this looks like 40 grand a car, right? So

I heard it in an elevator, probably for the first time, at a diabetes event. People were going up, and somebody said it, and I might have made a quizzical face, and somebody looked at me and said, scientific, wild ass. Guess?

Yeah. Is that scientific? Wide ass? Guess? Same thing? Yes. So

I have here a list of a real list of ways people say it so, okay, so we comb through the Facebook group we've seen it as wild ass, guess, wise arse guess, scientific, wildly amazing. Guess, oh, sophisticated, wild ass guess, seriously, wild ass guess, super wild stuff we all guess, see what end guess, somewhat accurate. Guess that one's kind of good, yeah? Someone called it freestyling. It's like jazz. Someone said, Yeah, shot in the dark. And hope for the best. To me that should go along, like, listen to it this way, shot in the dark, and hope for the best, scientific, wild ass, gas, see, yeah. I think you put them together. It's very lyrical. Now there's more here, but I went to the internet. It says that in the diabetes community, swag stands for scientific wild ass guess, referring to an estimate of carbohydrate content when precise information isn't available. This term has been used in various fields, including the US military, where it denotes a rough estimate based on experience and intuition. So this is what's going on here. Ah, it's been adapted from something else interesting.

Yeah. And if, as you ask, kind of where and when I think that I went to diabetes training camp in 2008 and I'm quite sure that's probably the first place that I heard it used like all around. People were definitely guessing at, it's a it's a training camp exercise wise. So we were totally guessing at, well, how do we adjust? How do you adjust for this planned workout, and we are doing it for the meals and everything as well. So if I had to think back, I think that's about where I heard it, which is quite a long time ago now.

The terms broader use dates back to the 1960s in the United States. Wow. So somebody used it back then, probably, it says, probably in the military. The origin makes sense, yeah. The Origins trace back to the US military in the 1960s and it was employed to describe a rough estimate. So after I Googled it, I then went to chat GPT and asked, and it said that, based on just there's not enough documentation to try to figure out when it was used in the diabetes community, first community, yeah. I mean, I'm sure some of you could dig up some of those old blogs that people wrote and see how far back? But I don't think that's going to give you a real answer, no. So when you think of someone saying, swag, do you think, please don't do that. Please count the cars. Or do you do you do it?

Oh, absolutely. I do it. Okay, absolutely. And I think, I think there is a bit of a back to that as well, because I think all estimates in this respect, especially if you are seasoned with diabetes, you're guessing based on historical information, right? Not until I would say that my truest swag is when I have traveled someplace and the food is absolutely foreign to me. I have nothing to go back to guessing from right when we went to Peru years ago, I would 100% i say that i. I swagged everything that we ate while we hiked the Inca Trail, because

the food that was being prepared for us, like, I don't know what this is, I was like, This

is great. I'll eat it. It seems to taste fine. I'm not gonna real, really ask. This looks kind of carby. This looks like protein. We're gonna go with it. Yeah. Did that work for you. It did. But I also think the benefit was the active time, right? I mean, just walking and walking and walking and sleeping and walking some more. So I I think that smoothed out whatever was not the best guess

for me. Which way did you guess like, Did you guess light, or did you try to go for it? I

did, I guess lighter only because, and I also judged it based on, were we done for the day, or did we have more moving to do, right first thing in the morning? I guess lighter, more towards the end of the day getting done, kind of camping in or whatever it was, sort of a I might not need quite as much now. I also didn't, I mean, this was just a baseline pump that I was using. There was no algorithm. Thankfully, I had a CGM. Thankfully it kept working for me. But I did the best that I could. I realized

while you were talking that I've always just attributed swag to carbs the way you just described. But as you're sitting here talking, and I'm thinking about diabetes in a broader sense, I think the entirety of diabetes is a swag perhaps, where should I put my pump? This might work. You know, how does this work? I don't know. Try this. I think that really is, oddly enough, that's leveling up with diabetes. When you're willing to say, I think I have enough information here to make a decision that I don't have all of the information for correct you know what? I mean? Yeah,

absolutely. And some of the stuff, you might have some information, you know, like when I talk to people, especially newer pump users, I go through the you should be rotating. You should have a schedule of rotation, or a direction of rotation, right, so that that doesn't become a complete guess. But then when you have a site that didn't work well, or was a bleeder or a gusher or whatever, and then you're like, Well, I supposed to rotate over here, but maybe it won't work now, and then it is completely let's just try this site. I have not used it for a while, you know, so it's

kind of awesome when you stop and think about it that way, that everything like to really level up again. With diabetes, you have to be willing to take your intuition and mix it together with your knowledge and then continue to build and that's probably why so many people's opinions are varied around diabetes because their experiences built up their knowledge and now their intuition draws on that. Okay, so the whole thing's of scientific. Which one do you prefer? By the way,

I've always said scientific. Why to Ask? Ask. That's what I have always used. But again, I use the word or the acronym swag so my brain says wide as gas.

You know, on this list here, of like, 1-234-567-8910, 116, that that we called together, just from like one post about swagging, why it's not on it? So I wonder what else is out there that people use that isn't on this list. Other people said. I'm amused by people who did not stick with the acronym. I think of it as accurate guess based on experience with similar foods, nutritional content, knowledge guessing for a dose, if you don't know the exact carbs, a massive guess to figure out how much insulin to give for food item. Pretty much meaning educated guesstimate. So anyway, and

I like to go back to the one that said guessing on an amount of insulin based on so I've also done that almost as a swag, because sometimes the amount of food on a plate correlates with something that you know inherently takes a certain amount of insulin, right? Yeah, there's not really a carb count to it. So you might put something into your pump. You might see what the suggested is, according to how many carbs you're now estimating only to generate a Bolus, and then off of that, say, no, no, I know. I need one unit more. Or No, no, I need a unit less,

or whatever it is. Actually, I was thinking I swag juice. I mean, in the past, like I'm being like, here, and then you feel the juice going down in the in the juice box, and stop, right? How do you know that stuff? It feels like it's enough. We don't use Skittles, but that would be the idea of, like, having a handful of Skittles and just pulling out seven of them. That's a swag you're like here, I think these so, all right, yeah, cool. Well, I appreciate you doing this with me. I can't believe we're still finding things to add to this one. This was

a great one. Yeah, excellent. Cool. Yeah.

Jenny, we're going to talk about meet the need. You'll hear it discussed in episode 476, called Common Sense versus fear. Episode 482, too much insulin. Episode 826, defining diabetes, meet the need. Where does this come from? Out of my mind. I think it comes from me watching people online, want to compare the amount of insulin they use with other people's amount of insulin. 100%

I see it so much and in the questions that I just get in interaction, you know, individually with people, well, how much I'm concerned. You know, Billy's Billy's insulin needs have gone up. Is this normal for this age of of you know, Billy's like place Billy's going to need the amount of insulin that Billy's going to need. And it might vary up and down. Billy might be a five day a week, two hour practice every single day. And Billy's little friend John may not, yes,

or maybe John plays soccer and Billy plays baseball, right, right? And so they're, I don't know, aerobic versus anaerobic impacts on their day or different. Maybe Billy's like, you know, a gamer, and sits around and plays video, right? It would break my heart, because that statement, like, especially written out. You know, my daughter is nine years old, and she weighs this much, and this is her daily insulin. Does this sound right to anybody like you know, then the way that cascades in my experience watching people online is that there's also this feeling among some people using insulin, that there's an amount of insulin that's too much, and are you using a lot of insulin? Do you use too much insulin? Like those are those phrases I hear people say, and what I think that leads to, I mean, we could dissect where this probably comes from. I think it's probably comes out of the type two world, where people somehow see that if them using insulin, I've had a failure, so, like, insulin bad, because I could have dieted my way out of it, or whatever thing they were told that they now believe they've reached this, like the bad part. And then I think that got translated over to some people with type one, because they're diagnosed, or their kids are diagnosed, they've heard, oh, my grand mom's diabetes got bad. She had to start using insulin, sure, and now it's, am I using too much insulin? And where I think that leads? And where it scares me the most is I think it leads to like, possible eating disorders, possible high blood sugars, right? Like, so people start restricting their insulin to keep their number lower, and then they ride around with higher blood sugars, or they stop eating because they don't want to use enough insulin. I've had a lot of time to watch people with diabetes. Jenny, oh yeah, this is the path. You know what I mean,

it is, and I think it does, to some degree, also boil down to maybe, maybe not even an online search of what is quote, unquote, normal amount of insulin. But sometimes it, unfortunately starts in a clinician's office. Sometimes it's and it's not a an all out goodness, you're using too much insulin. It's not a statement like that, but it is a statement of, look at your insulin needs. They're going up. Well, okay, are you a growing child? Are you a teenager? Are you, you know, at a certain point in your life where we would expect a shift in your overall insulin need, and then again, it needs to be individualized. I mean, on average, you'd have to really look up. I think yens ago, I had looked what the average person without diabetes, what is their pancreatic kind of output of insulin look like it's in a range of somewhere between about 20 to 40 ish, something units per day. But again, that's a body that's working as it's supposed to. It's not a broken system. It's responding the way that it should, in microscopic doses of insulin that are made and released and absorbed exactly like the body was designed to do. So we have a mismatch when we start to either inject or pump insulin in or, I guess, inhale insulin. Now, since we've had that for quite a while too there is a mismatch, and it's not going to be as precise as our own pancreatic kind of output, but our need is our need. Now, I do think it begs to discuss, or at least touch on the fact that could you be using more insulin than you technically should need. You could, especially if your intake of food is going beyond what you should be taking in. Yeah. So

this is the part of the story where, if I think meet the need is probably my kids first, diabetes second to very low carb people who have type one like so when they hear kids first, what they hear is let them eat whatever they want. And when, when I say, I. Think you need to meet the need. I think they think the same thing that I'm saying, just yo, just unhinge your jaw and just load it in there, and you just put insulin in for it. I'm not coming from that perspective. No, I'm coming from the perspective of, there's people running around with eight, 910, 11, A, one, CS, and they eat. How they eat, I just make a podcast, right? Like, so I can't go to each one of your homes and go like, I, you know, please don't eat 1000 carbs at every meal, right? Right? If that's your situation, what I don't want is, I don't want you to be eating unhealthily and having high blood sugars. Like, let's at least just have one of the things in check, right? Also, I think it teaches people how to use insulin, and then, you know, like, and then they can apply it to how they eat. I also don't think that everybody's out there eating Crazy, right? Maybe, like, the bro podcast world acts like everybody's just being irresponsible. I don't think that's what's happening. No. I just want people to know how to use insulin. That's all after that. You know, God bless you. Do whatever you want to do, right? Not knowing how to use it is, I think, just dangerous in too many different ways. Like I said, some people freeze up and stop eating. I saw a post today about that, what foods do I have to cut out? I just got diabetes. My blood sugar's moving. It's making me scared. They don't want their blood sugars to be high, and they don't want to use insulin, but they've got type one now, and they don't know what to do. So I also think meet the need works, management wise, on both sides, not necessarily also more insulin, like your need might be less. Meet that need as well. You know, right? Whatever. I don't know whatever timing and amount. And

I think in the in the, you know, the holiday ish season that we are in right now, it also brings in the idea of, there is excess, there is, oh, for certain, going to parties you're enjoying, you're having festivals and whatever else you know you're enjoying at this time of the year, your the idea of meeting the need is absolutely you are going to need more insulin. Use the insulin to keep your blood sugars at the target that you're aiming for to remain healthy in this time period, get back to your normal, regular life after all of this kind of passes, right? But in all those instances, you still have to meet the need to meet a target in terms of blood sugar. And today you might use 50 units, where yesterday you only use 20, because you didn't have six parties to go to. Yeah,

I'm not here to, like, Judge anybody's eating style. I don't. I don't have that in me. I just want people to understand that there is an amount of insulin they can use that will keep their a 1c in the fives. And I honestly don't care what they eat, they can do that. Please don't take that as like a hall pass from me. You know what I mean? To bake a nine tier cake and eat it yourself. I'm not saying that, but, and I don't think it would be good for you, I want to say that as well. But, like I do, think you could do it. I think that if I was there, I could Bolus for it, and that's the skill I'd like you to have. And then, you know, with any luck, you'll apply it to a moderate, reasonable lifestyle. That's all So, yeah,

no. And I think that's, I like the way that you just said, that it's really taking care of yourself in all situations, the majority of them, being your normal day to day, also knowing how to meet the need, so to speak, in any other given situation, which does take a learning curve along the way. But no, that's it's valuable. I hear it okay. I.

I like blanket of insulin. You want to go blanket of insulin? Yeah, I like that one that. I think that's a good one.

Do you remember what I said? I

don't remember what you said, honestly. But just looking at the title of it, I'm assuming that it has something to do with almost like an extended Bolus or a Temp Basal use, or expecting that the food that you're eating, which we kind of alluded to already in a lot of these that we've just done, is that it's not just carb that you're eating most often and that you might need a stretch out of insulin. And

that ends up being the answer to the question. But my but the reason I once said I remember saying it to you, by the way, because I use the weird phrase, and you laughed. So I Oh, I remember saying to you in a carby situation, and then you laughed at carby in an overly carby situation. I tried to think of it like this. So first things first, your basal is set where your basal set right, and if you most days, eat a certain way, and then all of the sudden, on Saturday are like, I'm going out for pizza. I'm not even gonna get good pizza. I'm gonna go to Pizza Hut. No disrespect to those you who like Pizza Hut and like, so I'm gonna get, you know, frozen crust, you know. Like, because, you know, they meat lovers, probably cheese, you know, like if I'm gonna go eat all of that, what happens is people say, Well, I expect my blood sugar to go up. What I say is, I expect your need to rise. So I used to tell people, This is before automated systems in situations like that. For my daughter, I would lay what I thought of as a heavy blanket of insulin over the timeline of the impact of the food. So generally speaking, I would use a Temp Basal increase,

right, right, most effective for high fat, and again, conventional pumps eons ago, before any of the A I D systems and the compensations and all that kind of stuff. But yeah, it was either Temp Basal, usually was for really high fat, or the potential of even knowing that again, with experience your pizza example being, well, gosh, I Bolus the whole thing. I go low, and then it sits high for hours and hours and hours later. So it might even be two smart feature uses, like an extended Bolus, as well as a Temp Basal for hours later.

Yeah, my thought here is just that. I mean, it's obvious, like you're going to hear your doctor talk about, do they call them square waves anymore? Does that? Is that saying? Go on, is it just it's

interesting, because the square wave and dual wave, I think they were coined by Medtronic, if I'm correct, like eons ago, because their pump offered the ability to choose between the two. One the dual wave being dual two, part 1% of insulin, now, of the total Bolus, the other percent delivered over a time period, yeah. And then the square wave was the whole amount delivered over a time frame that you designate. Oh, okay, so yes, yeah.

And so like Omnipod dash still does extend it like some now, the rest over a time frame. So like, for those of you who don't use this feature, if you you know, as an example, pizza is a good example, right? Like, it might not hit you right away, but you need something at the beginning, but it's going to hit you harder, like 45 minutes in. So you might, do, you know, you might say, Okay, I think this is, I don't know, 50 carbs. And your pump might say, that's five units. You might say, Okay, well, then I'd like two units to go in now, and the other three units to go in over the next 40 minutes, or whatever. Right, right, extended Bolus. I would do that, and on top of that, do a Temp Basal increase, like, sometimes, so like, what I ended up doing, Jenny, is I would look back over a failed experiment and say, you know, I used their carb ratio, and it said she needed five units. But by the time this fight was over, we ended up using more, like seven and a half. Yeah, so I'm like, let me get those other two and a half units in there. Somehow, I used to think put it in as basal, because you could always take the basal away, right? And it wouldn't be as impactful as just jamming in the two and a half units like maybe I'll just do, I mean, just say your basal is, I don't know, you know, a unit an hour. I might just make it 100% increase for two hours to get in two extra units of of basal, you could always bail on it later, and it shouldn't have as big of an impact is just throwing it in the whole two units at once and realizing you didn't need it. But I think that overall, I think the takeaway I would like people to have is that, you know, food, or, you know, stress, anything that's trying to push your blood sugar up is being met, in my mind, by a force above it trying to push it back down again. And there's an amount of basal I usually use, there's an amount of Bolus I usually use. And when we get into carbier situations, those settings I have might not work. I need more resistance on the top half, pushing down on that number. And I would try to find ways to spread it out. That was. Is most effective while still being something I could get away from without causing a low. So in my I know it's weird, but in my mind's eye, there's a blanket of insulin over the timeline of the impact of the carbs. That's how it seems to me.

Yeah, it's a great way to think about it. I always, I always describe fat to people like the fat is sitting on your insulin, kind of like you'd sit on a bean bag chair, right? It's nice and puffed up in a circle. You sit on it. What do you get? Like, a 50% reduction in its normal puffed up feature, right? Right? So you sit on it. You are the fat. You are decreasing your basal now in its effectiveness from one unit an hour 2.5 units an hour, because fat creates a resistant environment. Now, like you said, I love that example. Because you're using a Temp Basal, you can easily cancel it. And now, when you stand up from sitting on the bean bag, if you've got a good vegan bag chair, it starts to puff back up pretty quickly, right? And so then you can take that away without effectively having a long lingering impact. Yeah,

I remember when Arden moved to an automated system. The first one she ever used was loop, and I had an app where I could watch it, giving and taking away basal. And I remember having this moment where I was like, oh, it's doing what I've been doing, yeah. And I thought, maybe I could stop doing it now.

Maybe I can sleep finally, actually, that's,

that's what happened, is I got to sleep because the things I'm talking about, they don't end because you go to sleep, or, you know, because it's Christmas Day or anything like that. And while I did get a ton of experience and knowledge from doing it, which I guess is helping now with the podcast, I was tired, yeah. And now I take what I know and I can apply it to the automated system if I need to. Though Arden's older and, you know, not as involved with me as she has been, I can apply what I know there, and I do sometimes. I sent her a text the other day that says, aren't using trio now, I sent her a text that said, Set attempt basal, like, just for a half an hour. Like, like, it's taking basal away right now, but we don't want that. And I know we don't want that because you were just home for a break eating good, wholesome foods, and now you're back at school eating whatever the hell you just ate. And those settings that we had working real nice for your one week break, they're not working anymore. And yes, trio will get a little more aggressive in the next couple of days, but for today, it isn't and it needs help. So it's cut your basal away, but you need the basal, so put it back. And then I usually get a text back that says something like, stop. And

at least, even though she's responding that way, she's probably applying what you're telling her to do, despite being like, why are Why are you telling me these things, like, I'm done, please stop,

right? She does. She does. We're at that. We're at this interesting moment now where she doesn't want to tell me she's done it. It just happens with it just happens without her saying it. But stop, is our diabetes love language? Yeah? So, hey, is this a real low stop? I'm like, well, at least she knows she's low. Yes,

yeah, triosa. I mean, trio and the other algorithms are really they add another level of this blanket of insulin that requires attention when you first start using them, because conventional pumping to aid pumping is a jump. Yeah, you have to re learn, not necessarily, how insulin works, but how the system is working with insulin as it works

for you right in one of these episodes, I'll do the tug of war thing, which I think makes, makes the point about how I think about the blank events on slightly differently, but in a way that might help somebody awesome. Anyway, I appreciate this very much. Thank you. Of course, you.

Dollars, let's go over more insulin. Yay. So these are topics picked by listeners that they found to be extremely helpful, and we're going to do a tiny little dive on each one of them so that we have some short form content around it. So cool. Apparently, in episode 121 is the first time I talked about just the concept of more insulin. Since then, it's come up in a diabetes variables episode and in a pro tip episode. But this is a takeaway from that episode. It says, apparently, this is me talking. It's gonna be odd to like, say my own words out loud on a second insulin, because it's restricted by little pieces of tubing, though. That's you hold on a second. So you need to make it work. And then the end of them, then the reason is the moment meal is as

I'm reading it. I think what the person is making sense of, or what whoever one of us said, this is the fact of in the moment, if you're trying to decide whether or not you need more insulin. You don't necessarily need a historical look at is there a trend to it in the moment? It's more like right now, I know I need more. This is happening. So give more, and then if you feel like in your brain, this could be a trend that you've kind of seen happening time of day, time of the month, whatever it is. Then go back and historically, look at the information, because it may suggest that there's a setting change that actually needs to be made. But right now, don't put her around trying to figure out the reason just give more insulin if you really think that that's the right thing to do now

100% so this comment came from a listener named Monica, and what she said was, what helped me most was the idea of meeting the need and figuring out why later. So what ends up happening to people, more often than not, right is they get a little, I guess, what you call paralysis by analysis. And, you know, blood sugars have done a thing. Usually gotten high. They don't understand why, and instead of addressing it, they very often stare at it, worried about a couple of different ideas. They don't want to stack their insulin. They've been told not to stack they've been told that they can't Bolus often, you know, until three hours after the previous Bolus is finished, right? And from my perspective, if you've given yourself some insulin for food and your blood sugar is shot way up and it's sitting there, my expectation is that something went wrong with either the carb counting, the insulin to carb ratio. Maybe you didn't understand the fat content. If you're hearing that now and thinking, I don't know what fat's got to do with it, don't worry. We have an episode for that too. But something happened, and the need for insulin is greater than what you calculated. That happens probably every day to people all day long. I think it's important what you do next. I think if you sit and stare at it and wait for it to come down, often it doesn't, and then you end up making a large Bolus, everything crashes low later. That happens because the food's finally digested out of your system. It's not impacting your blood sugar anymore. Now you've put on, put in all this, this insulin for the number, you come crashing down. People might say, Well, then why would I not come crashing down if I put the insulin in sooner? Well, while the food's still in there, impacting you, you're gonna have more of a balance between the insulin and the need for the insulin. So when you talk about this with people, when when they see high blood sugars, what is it that that you find yourself saying to them

most often, if you're seeing high blood sugars, my first consideration is, is it a normal right? Is this a normal thing that suggests a change to a setting? If it's abnormal then, and I can see where the question here, really is, in the moment, address the issue and then move forward and figure out kind of why. But in the moment, sometimes there are considerations as to, Why could it be that the site is bad? Is it leaking? Does it smell like insulin? So there are still things outside of willy nilly, just saying, I need going to take more insulin. There are some things to assess right here and now. Is it a problem? Is it a disconnected site? Did your cat chew through the tube? Blah, blah, blah, right? But outside of that, it's really address the high blood sugar, and I guess in a time frame of the previous dose having been taken. You know, if you like, you just said, if there is mis timed insulin, it might be that you had enough insulin there, you just didn't give enough time for the insulin to start working. So now adding more insulin could lead to a drop later, because you really don't technically need more insulin. You just needed to time it better and more insulin right now is still going to have its action profile to get going. And. Things, whereas, if it's in the aftermath of a meal, miscounted because you were less than precise, you didn't have the information you needed, very likely you need more insulin. So give some more insulin in a safe manner. You know, if your insulin needs around a meal are usually a unit for a fairly good sized meal and your blood sugar is high and you're like, Well, I'm gonna knock it down with another two units. That's really not the greatest idea. Be conservative, but more aggressive in your range of what you know about insulin and how it works for you, right? Yeah.

I mean, I don't want people to ignore the idea that there could be something wrong, but the amount of times that you see somebody say, Well, I don't know. Like, is the cannula Ben is my is, did my insulin go bad? Like that stuff doesn't really happen that frequently. You want to rule them out. It shouldn't. Yeah, right. It shouldn't happen that free. But you know, if that stuff's happening very frequently, you have a larger issue. But my problem with that, it's not a problem, but, but what I've seen from people is that they'll get so frozen on the things that are probably not happening that they don't do the obvious thing, which is just say, well, maybe I count these carbs wrong or the right, you know, like, I mean, we talk in all kinds of episodes about glycemic load and glycemic index, the idea that 10 carbs worth of one thing will require more or less insulin than 10 carbs of something else. So if you've eaten something and thought, Oh, well, this said 40 carbs. And you know, my insulin to carb ratio is good. It works all the time for me, but this thing has more fat in it, more protein, and it's something that's going to push your blood sugar up. I just think that once people start using the insulin, not more aggressively, but where it's necessary and how it's needed, they start having experiences that show them, I did this, then this happened, and then it empowers them moving forward, it's almost like kind of the same thing as not sitting on the same settings for a year and waiting for a doctor to tell you, you know, do something about it. I think that once people with type one diabetes have a firm idea of how insulin works and how to manipulate it, I think that leads to a leveling up of your understanding and lower a one CS and less variability in all the good things that you're looking for,

and more comfort level with using again more insulin when you need it, you have a comfort level from understanding insulin usually works this way. For me right now, it doesn't seem to be that way. So I'll give more insulin again in a safe manner. But also, as we go back to considering, is it a site issue at this point, if you've given more insulin and it doesn't move your blood sugar, and it was a good enough of more insulin, absolutely. I mean, my go to is one correction on a high that looks weird, and if it doesn't work, I am changing my site. Take care of it, bring the blood sugar under control.

I'm in favor of injecting, if you're wearing a pump to check to see if the site's bad. But also, I think important to bring up here, if you're on an automated system and you just willy nilly put in more insulin, like you, you know, say, you said, Oh, this is 40 carbs, and then 45 minutes later, you're 250 and you think, Oh, I'm going to put in another unit and a half. If you put that in the automatic system that you're using now believes that you have way too much insulin. It doesn't look at the number and have the same conscious thought you're having. It says you told me 4040, was this much insulin? I don't care about what your blood sugar is, right now, I believe I've got enough insulin in here. You put in more, it's going to take away your basal, and then you're just going to end up trading your like little mini rage Bolus is for the basal that it takes away, and you will stay high forever, like that, for

a much longer time. That's right. I mean, the aid systems are wonderful, all of them, FDA or non FDA approved. They're all really fantastic in many ways. But you're right, and that's why an injection, it's a way to quietly, sort of unknown to the system, give insulin and evaluate is the insulin working from the injection well, clearly, then the site is the problem, because that didn't bring it down.

So I'll leave a couple ideas here for people to check out. If you think, Oh, I don't want to stack insulin. We have episodes about stacking. I'll tell you that in a one sentence. Takeaway, I don't think it's stacking if you need it, I think that's bolusing, but I do think you can stack insulin, and I do think it could be dangerous, so, but those are two different thoughts if you want to learn more about glycemic load and index and why some carbs might hit you differently than others. Again, in the Pro Tip series, there's a great, longer conversation about that, but for now, I would like your takeaway from this to be if my blood sugar is high, I shouldn't just stare at it. I should do something about it. That, to me, is the takeaway from this idea. Yes, awesome. Thank you. Of course, you.

Jenny, we're doing what I think I'm going to be calling small sips in the titles, not sure yet. It's a kind of a fun way to think of it. I don't know what else to do. Honestly, sometimes I run out of ideas, but we're taking concepts from the podcast and talking about them in really, like small chunks. So this next one is low before high. It's easier to impact a low or falling blood sugar than it is to bring down a high blood sugar. Apparently, that was said in WoW episode 44 getting off the diabetes roller coaster. And then we did a defining diabetes at 269 called Low before high. But oh, now we've got some separation of about eight years between the first time it was said. And now it can't be that long ago, can it anyway? Long time? Yeah, let's just try not to think it was that long.

I think it has been about eight years. Because I think we started this when my youngest was first born, really, and he will be eight in January. No kidding,

I'm sorry I've drugged you through this for so long.

I'm glad you have

Jenny and I both drank at the same time. We've been doing this together way too long. But so to me, I know I said it's easier to impact a lower falling blood sugar than to bring down a high. That's how I remember saying it. It's how I think about it. And I've said to people in the past, I'll say it here happily. Like, if I'm in charge of your diabetes, I'm going to come from that perspective, like, that's a daily and I want to be clear, like, even though that's a daily mantra for me, I'm not saying I want you running around with your blood sugar under 70. I'm not saying like, Oh, we'd shoot for 60 and then we'll fix it. Like, I'm not saying that. I'm saying play down in the numbers 7080, 90, before erring on the side of caution. I guess is kind of how I think of it. Does that make sense to you?

It does, and I don't think, as you just said, You're not encouraging a roller coaster at all. What the goal is kind of a rule of small numbers, if you will, right? If your blood sugar is rising, and you know that there might not be enough there, you know is add a little bit extra so that it doesn't get as high, which is harder to bring down and then on the back end, oh, if it was a little bit too much, especially with our A I D systems that we have now, it's likely that it's going to catch it for you, or that you could easily catch it with a jelly bean or two. Yeah, right. Again, not the goal long term, because you don't want to constantly be catching lows or you're adding in calorie value that your body doesn't need.

So given over proper respect to the idea that once your blood sugar gets elevated, it needs more insulin to bring down a number, just meaning that if there's an amount that brings you from 200 to 100 that same amount doubled isn't necessarily going to bring you from 300 to 100 right? I mean, people talk about in all different ways, but you experience some sort of insulin resistance when your blood sugar is higher, and so I just think better low than high, not meaning Low. Low meaning lower, better lower than high. It's also a term, like people are not confused by it. It's obviously a well understood idea in the podcast, but for somebody who's just tripping across this in like a clip somewhere, what I'm saying is, if you stay in the lower numbers, things are easier. Now my expectation is that people hear that and think, oh, yeah, sure. Well, if I could do that, I would just do that. But you know, like, you know what I mean? Like, that doesn't sound so easy. I'm not saying it's easy to keep your blood sugars 7080, 90, 100 110 in there, but there are tools within the podcast that will help you understand how to do that, about Pre Bolus thing, getting your settings right, how to impact certain foods that you may not recognize are requiring more insulin than your insulin to carb ratio might indicate things like that, right adjustment for variables all the things, yeah. And the other thing is, is that when you're higher and you make a big Bolus to bring it down, you are much more likely to experience a low later, which you very well may over treat, end up going back up again. And I think that's how this idea popped up in an episode called Getting off the diabetes roller coaster, because you know, over and over again, you're gonna see people who are just living a life of up and down. And it is, and I'd like Jenny to speak about this for a minute, but stability is a much healthier place to live in than the roller coaster. Can you tell people why

it is so long term. I always give the idea of an A 1c right. I see in the diabetes community online, especially the aim for these much, much lower a 1c is, right? And I think the best explanation is you could have an A 1c that 6.5 Five and have what we call standard deviation, which is the variance up and down from what that average a 1c suggests. And if your standard deviation is a low number, that means that that a 1c of 6.5 has stability. It means that you not having the roller coaster up down, like the Rocky Mountains, your more gentle rolling hills, kind of up and down through the course of the day. That long term is better in terms of prevention for micro vascular, those small vessel, nerve eyes, you know, the vessels in the eyes, preventing complications down the road, stability is what we're aiming for. So the wider the variants, the more up and down again, that roller coaster, which means that your body has to constantly move through a wide range of glucose values. And I see it very common in kids, and what their parents or their teachers suggest, it's not working, right? It's not working because their blood sugar might be 200 to start the day, and then they might Coast Way down into lunchtime. They can't Pre Bolus, because their blood sugar is already at 60 at lunch time, and then without the Pre Bolus, then they're at 200 again an hour after lunch, and then they have recess, and it comes coasting back down that kid or that adult. You feel horrible when your blood sugar is coasting through such a wide range of blood sugar numbers, the more stability, the better you're going to mentally feel. The more I guess, the better the learning capacity of a child or a teenager, even a college student, is going to be, the more attentive at work you're going to be as an adult. So

I just think that as you're trying to figure that out, if you're shooting for a lower a 1c by having, you know, lows half the time and highs half the time. And, like you said, then the standard deviation says, Okay, well, you have a lower a 1c I'd prefer you had a a 140 blood sugar that was super stable all day. Had a six and a half a 1c and learned how to make that 140 a 130 then learn how to make that 130 or 120 until you figured out the right the amount of insulin and the timing required to keep you as much as possible there. I think

that's really valuable to say, because I think a lot of people come in with really variable blood sugars, or just consistently running high, but have stability, and it's it's hard to get them to see that. Okay, your blood sugar is higher than we want it to be, but at least you have stability. You're not having this roller up and down. Great. We have an easier time actually adding a little bit extra insulin and keeping the stability there. As your body adjusts to the lowering of blood sugar values, you're also going to feel a lot better, rather than just going from an average of 180 down to an average of 100 that doesn't necessarily feel good within two days either.

Yeah, you're so close, if you have stability at like 140 for example, you're just a couple of turns of a couple of knobs of getting where you want to be very likely. Okay, cool. I appreciate this one. Thank you,

of course. Yeah.

Jenny, let's talk about apparently in, oh, look at this, apparently in Episode 37 again, with you and I brought up in Episode 11, bold with insulin that, oh, I think I, the way I put it was, I steal a 1c overnight. So, like, take advantage of overnight hours. And the way I used to think of it back then with Arden, like, for full clarity, like, Arden's a 1c wasn't terrific when she was little. They were in the eights and and when I was first trying to imagine, like, how can I impact this, right? Like, how can I create, at least, maybe stretches of time with less glucose in our system? The first thing that occurred to me was like, well, when she's asleep, there's no food in there. Like, maybe that'll help. You know, now, eventually she got big enough where there was growth hormone overnight, and that's a different headache. But if you're of the mind, like, I want to be stable overnight at 180 because I want to be safe, or I want to sleep, you hear people say that all the time, like, I leave my blood sugar 200 because I want to sleep, and I think, Gosh, what if you could keep it at 100 all night? Now, again, probably everything I say here in these smaller clips. People are going like, Yeah, great. Well, but if I know to do that, buddy, I would right. But the idea is that when you're you're overnight, you're at rest. I'm assuming the food should be I mean, unless you're eating late at night, there should be no food in your system by the time midnight comes around. It's just a great time to steal a 1c so if you're a six and a half during the day, but a six at night, you're going to be more like a six two, maybe, or something like that. So

yeah, it actually gives, you know, we break a 24 hour day into segments. You break it in easily. Most people should be sleeping, let's say should be sleeping about eight hours, right? Kids might even be sleeping longer than that, because they go to bed earlier than most adults do, so stealing the overnight hours in terms of affecting that long term average, if you've got eight to 10 hours, even eight hours, that's a third of the weight of your overall a 1c right? Yeah. And if you've got 30 some percent of your overnight sitting at a blood sugar of 100 you are absolutely going to be able to wait a little heavier to a lower overall average, or a 1c so 100% take advantage of the overnight, and if you don't know how to do it, I think it's a good idea to start understanding the hours before the overnight impact the overnight. So if your blood sugar after your dinner or after your evening snack are consistently leaving you higher, but your basal is allowing you to then stay stable and flat at 161 4180, overnight, then it's not the basal fault, right? It's the problem before the hours of the overnight. And so I think it should teach you to look at time before where you're having the problem.

Everything that is happening to you right now with that number is from something that occurred before, correct? And it could be hours and hours before, like, you used something. I think people all understand, I had a slice of pizza at eight o'clock and my blood sugar got high at 1030 you know, like that kind of thing. Like, there's food in your system. It's digesting once it's cleared out the amount of insulin it takes to keep your blood sugar stable should be pretty consistent. And also, I think that what you learn from overnight not to shift gears too hard, but once you learn how to keep overnight stable where you need it to be, where you want it to be, that information or way of thinking can go a long way into helping you in the waking hours as well, absolutely. Yeah. So I tell people all the time when they're like, I don't know how to get my basal right. I'm like, well, it's easier to get it right because people don't want a basal test, you know, yeah. I'm like, Well, if you're not going to basal test, use overnight as a test, you know, clear system basal test, and then use that as a jumping end point for the morning and the rest of the day. Okay, awesome. Look at us being all like good one. Yeah.

So Jenny, this one's weird because it's more of a thing I said one time, and then we can kind of like, pick it apart a little bit. Okay. So I think the point I was trying to make to people back then was that you just shouldn't take what someone tells you and just blindly do it, especially if it's not working. And I think the way I illuminated that idea back then was I said, if you were being taught to drive a car, and for some reason, the person the instructor said to you, just push halfway down on the brake when you come up on a curve, and you came up on your first curve, and you pressed halfway down on the brake, and your car skid off and went into the bushes, and you got your car out of the bushes, and you got back in your car the next day, and you approached that curve, would you press the brake halfway and go? Well, this is what the instructor told me to do. Or would you say, I wonder what happens if I push on this thing a little harder? Right? So, right. So in that driving situation, everyone learns how to drive and doesn't know what the hell they're doing at first, right? And you make these quick adjustments, Trial by Fire adjustments often while you're learning to drive,

which is why my father took me to a parking lot exactly

like so he could yell

stuff. We're not gonna go on the real street, we're gonna go around the parking lot.

We could yell stop 1000 times and still have trouble, right, or have time. But my point is that a lot of this, my expectation from making the podcast from so long, is that people just have different personalities. Like, of course, somebody goes to the doctor, and the doctor says halfway down that the brake pedal, they will not change. And there are plenty of people who hear that and go, Hey, look, I drove into the bushes. I'm going to push harder. And I don't care what you say, if you're in that first camp related to diabetes, you could end up for the rest of your life making small decisions that could go much better and never will. And so to me, I think you have to take control. And by control, I mean a little bit of responsibility and a little bit of understanding how insulin works. You're gonna hear me say this over and over again in all these episodes, but diabetes type one using insulin, it's a lot about timing and amount. Relate that to my little story, if it helps you or not, but what I'm saying is you got to learn how to set your settings. You got to learn how to change your settings. You got to learn when to Bolus a little more at a meal, when to Bolus little less at a meal that you don't always need 15 carbs to stop below like these little things will change your life if you take control of them, right?

And it goes along with also the concept of using if you are using a continuous monitor, using that to your advantage, because then you can see, well, goodness, when I pushed on the brakes a little bit didn't work fast enough, or it didn't work the way that I expected. When I gave a little bit more and I got a little bit more comfortable, look at the difference. Look at the change in the graph, right? And that's how you can evaluate. Thankfully, you know, we have that information now where finger sticks only gave you a blip in time right now, and you missed all of the information in between, so you couldn't make as much, I guess, true adjustment. That made sense

if you're an old head and you've been around forever, and you're resisting, you know, technology apply the brakes idea to that, you know, like, push harder. Get a CGM if you can afford it, your insurance covers it, and you don't have one, please get one. Like, even, just try it. Don't put it on once I got the thing. Like, just wear it for a little while. Like, try to really live with it for a bit, because I promise you, it's going to change your health, and it'll change your psychological health, it'll it'll change your physical health, it'll make diabetes easier. So, I mean, that's one idea. Like, if you're out there managing like a baller with MDI, I'm not saying go get a pump, right? But if you're struggling all the time, maybe give it a shot. You know what I mean? And I didn't mean for this to be about technology, really, but what you said really, kind of like, lit me up inside, like, you've got to be willing to try things. Maybe that really is the message, right? Like you have to try things to see what happens. You can't just say, Well, the doctor told me, and this is what happened. So I did what I was supposed to do, and it didn't work. That's just diabetes. Because, I promise you, it's not just diabetes. And I don't mean this in a boastful way, but if Jenny came to your house and bullish you, it wouldn't go that way, right? And if I did it, no, can you imagine, if you, like, showed up all proud, you're like, I'll take care of this. Nothing. Nothing changed. Just because someone didn't give you good information doesn't mean that's your lot in life, like you can go get that information for yourself, correct, you

can and again, where the technology piece of that comes in, I think what it offers is the person who is more the personality that would take what. Suggested. This is the black and white rule. This is what I was told to do. But without any new technology, even as much as just a CGM, you're in the dark about what that recommendation is or is not doing well for you, and you have nothing else to go on. So if you want to gain some confidence and be able to step outside of just a baseline recommendation, not that you're not going to take it from the doctor or the clinician, you're going to try it, but then with more information, you can actually make adjustments, or you can go back and say, You know what? I tried this. This is what I saw. Don't you think I could do it this way? Right? If you feel the need to really get the recommendation back from your doctor or your clinician, then do your own homework and bring them back some information so that they can help you further, because it's not that they don't want to, right?

And if your clinician ends up being not as good of an instructor as Jenny's father was. And I'll sound like I'm pushing people towards the thing, but it doesn't need to be my thing. Go find a friend who knows how to drive and ask them for some advice. Go to the Juicebox Podcast Facebook group and ask there, like, go find another person with type one. And you can't find a person with type one. I got over 55,000 of them. You can go talk to in the Facebook group. Facebook group is free. It's very kind, gentle place. Head over there. Ask your question out loud, mate. Hey, listen, I've been seeing this happening. I told I told my doctor. My doctor says, Don't worry about it. I'm listening to this podcast now. I'm worried about it, right? What do you guys think? Because the tiniest bit you don't know which tiny bit of information is going to just light a candle in your mind and make you go, Oh, I understand. Now, at some place on this list of shorts that we're doing, someone said the thing that changed my life was when Scott told the story about the M, M's like, that simple, when I just said, like, and we'll do it another episode, but it's a parable, like, it's a it's a 62nd story about a thing that happened to me and my daughter in an endos office, and 18 years later, some lady in Kalamazoo is like, Oh my God, my blood sugars are better now, because she heard that was the one thing that made her mind click, and she went, Oh, I know what to do now, right? Yeah.

Well, I will actually to just put a plus towards the Facebook group. I think the quality sort of experts, I guess they're called now, I don't do much social media ing, yes,

so I have a handful of lovely people who volunteer their time as group experts. When you ask a question, they will answer your question with links from the podcast that should help you, which

I love, because again, while it's valuable, the whole diabetes online community is valuable in many, many different arenas, CGM, pump, use blah, blah, blah, whatever it is, but I think you can, especially as a person asking a baseline Question, you can get overwhelmed with the responses, and because each and every response is the lived person, the lived experience of that person, this, I see your issue is such and such. Give this a try, and the next person is like, Well, that didn't work for me. This is what worked for me. The original question is, I don't know what to do. I got 50 responses. Yeah, right. But I love that the experts step in and they say, Hey, you want this whole concept described to you, go here, right?

It's great. It's definitely the internet. Like, it's never gonna not be the internet, right? But no, I've definitely seen people like, I have a stomach ache, and five minutes later they have celiac I'm like, I was a pretty big leap. But Jenny's point is, is valid, and it's what makes it so valuable, which is everyone comes in with their experience. And the truth is, that's a real post I saw recently. Hey, my kid's stomach hurts. Someone said that happened to my kid and it ended up being celiac. Somebody said that happened to my kid, and it ended up being stress that happened to my kid ended up being constipation. And I said, Hey, that happened to my kid, and it ended up being this. And we all, and you know, what in there somewhere is your answer, right? Like, right, very likely of all the responses that came in. Now, I know it gets scary, because one person's like, Oh, my stomach hurt once is because I was shot at the bus station and, you know, like, and you're like, and you're like, Oh, well, that's probably not it. I would just take what everybody says, write it down, and go, I'm going to try to figure out if in here lies the answer, right, and that, and it normally does. But you know, between me and you and everybody listening, please don't just accept that's just diabetes. It's the way it is. There's nothing I can do about it. And as much as I think there are tons and tons and tons of wonderful clinicians, I also believe there's probably an equal amount of them who are winging in a prayer in it, and don't know what the hell they're telling you. And. And they've told you something you think is a rule, and it's not even right, and you're going to go live your whole life that way. So check and do it for yourself. Push down on the break if you're running into the weeds, is what I would say, good idea. You.

Okay, so this next one says, respond to the information you're seeing, not what you thought. And I know that's not quite English, right, so, oh, I think I shared at some point that I've spoken to so many people, and you have too, so you'll be able to speak to this. I've spoken to so many people who come to me saying, like, I have trouble, like I need help. And before the podcast was this big, I mean, I took a lot of private phone calls from a lot of people and tried to help them, right? Sure. And what I started to learn and notice over and over again is that these people were so lost that the things that they would think to tell you, or the explanations they would give about what was happening was so off the mark. They were so lost. They didn't even know what their story was. And then they would, they would say, like, I know this is because of my I don't know carb ratio, like they were so certain. And and I'd be like, I don't even know how you could make that leap your basal so far off. Like, I don't even know how it could possibly be that. And so that, what I realized was they're chasing ghosts, is the way I used to put it. Like there's things that they think they're seeing, and they chase after them, and they make all their decisions based on this, but that thing's not really there, or it's not what it appears to be to them, right? That makes sense, and I think

it does. And I think it also leads to, again, the piece with our technology we have today is we do have information overload with it. As great as it is, it's a load of information. I think it can be very easy if you have not had enough good education, or listened to some of the pro tips, or, you know, even just the beginning kind of concepts of things, if you're really all over the place and so scattered, you may be throwing out a an adjustment and kind of pulling it out of a box. Yeah, let's try this this time, right? But it leads to eventual burnout, because you get to the point then where, well, I've thrown everything at this that I think I should and really, it boils down to something is probably off in your setting or in your timing, based on your knowledge of how insulin works. There are two pieces there that really you should go back to if, in fact, it's so all over the place that you are just lost and just fatigued from battling

it. Yeah, yeah. And if you're making well intended actions, if you're performing well intended actions that are emanating from bad information, then you're putting in all the effort and the hope and getting probably not just the opposite of what you're hoping for, but it's probably making it worse a lot of times. And then, I don't know if I am good at explaining this in words, but you're trying to balance something in your in your hand, and you know the wind starts blowing and but you don't know it's the wind. And so then you lean, because you're like, Oh no, it's me, and it's Nope, it's not you. It's the wind. And now you're leaning, and it's the wind. And now you didn't realize, but when you lean, now the sun's in your eyes. And these things keep, like, piling up on top of each other, and these snowballs, it really does. And then before you know it, if I said, you take one of these problems away now to fix it, you think I don't know we're so far down this path at this point, like, I don't know which way is up, right, right? Yeah, that's what I mean. Like, respond to what's happening, not what you think is happening. Like, because people, I mean, look, we all have, like, a relative or a friend or something, and every time something comes up, they react. And the reactions always wrong. It's like, always wrong. You're just like, how do they get it wrong? Every time right? You're in that situation now you don't realize it, yeah, because you know tons of variables, etc.

I think again, it boils down to really understanding your own kind of day to day, and also how insulin works, because otherwise, in all of those variables, the wind, the sun, the leaning, the oh my gosh, now the rock is rolling down the hill. At me exactly

things right? What's that noise? What's the noise

right? You know, should I put my sunglasses on? Is that the right fix? It's like all the things you throw in when really, if you just sometimes you have to step back and you have to instead of being reactive. I think that's one of the hardest things to see within diabetes, is we tend to be too reactive, instead of looking over time at your data and finding a way to be proactive, to address, gosh, this is a trend. Or, you know what today is just, I call them bad diabetes heritage, where you're like, I don't know. I don't know.

You know what it is. I just realized how to say this. Don't have hot takes about your diabetes. Yeah, right, yeah. Just step back. Take some time absorb what's happening. Maybe it's gonna go wrong for a little while, or something like that. But you need enough data that when you're making a decision, it's reasonable. And then make one decision and then see what happens. Don't make five because if you you turn five knobs and something works, like, I mean, I don't even know which was right here, like, and it's and I

I think that this is valuable, especially for the newly diagnosed everybody, yes, but I think especially for the newly diagnosed who may be in that, what we call the honeymoon kind of time period, you are going to have weird looking things happen. Because one, you're in a learning stage, you're trying to be as safe as possible, but also to maintain blood sugars that you know are healthy, whether it's for you or your child or the person you're caring for or whatever, right? But there are going to be things that you may do one day and three days later, it doesn't exactly work quite there's

1000 things you got all the plates up in the air, and you're like, I think I've got, I think I've got, it's all balanced, and then suddenly the kid or your your pancreas is like, no, I'll help today. No. Like, please, no, don't do that. And you don't know that's what's happening when it's happening. And so, oh, the living through the honeymoon thing, when I look back on it now, I so didn't understand what was happening. And nobody talked about it with me. It was maddening, yeah, like, genuinely maddening, you know. So anyway, I don't

even remember that. And I was old enough, you know, to potentially have memory. I have no recollection of that time period whatsoever

at this point. Jenny, it's been a while now, and it has, it has.

And I don't even think my mom would remember, though, quite honestly, and she has no like, memory loss or anything, you know, but I don't think she would even remember that, nor I don't even think that she'd remember it was called honeymoon. Oh, nobody

called it that, no. And I only, I only have a memory of it because I am personally friendly with my child's pediatrician, and I called him, and I it was, it was a memorable phone call. So, like, I started it off by saying, I know I'm wrong, just tell me to shut up and get off the phone. But is it possible, or doesn't have diabetes because I haven't given her insulin in two days? And it was so upsetting, you know, by then, anyway, thank you. This was good. I appreciate this. Of course, you.

Jenny, apparently in episode 366, 260, and 693, I have said the message is, trust will happen. The problem is, is that the first time I said it, I remember this as clear as day, because as I was speaking it into the microphone, I thought, oh, that's an incredibly awkward way to say something, but I just kept going with it. And I think the way I say it is trust that what you know is going to happen is going to happen. And again, I could probably just go to chatgpt Put that sentence in and say, Please tell me 10 better ways to say this. But I think you have to trust that things that you have seen in certain situations, and they repeat, if you trust that they're going to happen, then suddenly you can have just a half a juice box to stop below, or you can Bolus three extra units. Then this thing says, because you know that this food needs more insulin, like that kind of example. And

if this wasn't the case, we wouldn't have smart features in especially our pumping systems that allow us to set something like a temporary basal or an adjusted, you know, override, or something like that. I mean, if this wasn't the case, I wouldn't have an override that I set when I take my long runs on the weekends, it wouldn't work. It would be wrong every time, and I'd be frustrated. But I know what's going to happen, because I've done it before enough, and so I trust that my setting adjustment is going to

make the difference. So I'm digging around here. Nico, who is a group expert in the Facebook group, has been on Nico. She's awesome, really wonderful. She's been on one of the episodes of the podcast too, but she actually did screenshots for me of where I said these things in the podcast, which is awesome, and I'm looking at it. And it turns out that when I said this, I was talking about stopping a low blood sugar. Oh, because it was part of a bigger episode where Arden had experienced a pretty significant low as a young kid, and I gave her, you know, a bunch of carbs to fix it, and once it was fixed, and she was stable, and these couple of minutes passed by, and I saw the arrow on her CGM swing up, and even though she was like, 55 and Rising, this was not a situation where anybody would intuitively say it's probably time for insulin. But right, I knew how many carbs I had given her, and I knew she was going to end up being 300 if I didn't do something. And so I didn't Bolus carb for carb, but I just kind of randomly in the middle that I was like, I think I'm going to polish for like two thirds of the carbs, and I Bolus, and I remember feeling that feeling when I pushed the button, like I have to trust that this is going to happen. It always happens like this. She gets low. I give her too much, she gets high. It ruins the rest of the day. I know this is going to happen. I know it is, I know it is, I know it is. But the problem is, is the pushing the button like, you know what I mean? Because what if this is the one time that it's not needed? It doesn't happen, right? And so it turns out that that was in that conversation about that topic, but over the years of the podcast, I think the reason people go back to it isn't about correcting a low. I think it's about everything. I think it's about pre bolusing a meal, or that the fat from a french fry is going to come get you an hour from now, like or all the other things that seem unknowable about diabetes until you see them happen a couple of times, and then right The truth is, if you can remove your fear, then they are knowable. And so I think you should trust that what you know is going to happen is going to happen. And

also it takes, as you've been saying, it takes a little bit of history of doing things. Yeah, right. This is not necessarily for the one week newbie who is still having fluctuations and adjusting doses and in honeymoon stage and whatever you can still learn in that phase. Yeah, what seems to work, but understand that a lot of things will need adjustment, especially for kids, will need adjustment. And once you learn what is working again, you have to trust that it's going to keep working until, oh, it's not enough anymore. So now I need to change something diabetes.

It surprises me in a lot of ways, and one of them here is that I was putting myself back in that situation so I could talk about it, and I'm crying now. Oh, so, but, yeah, it's not like, Arden didn't get low on her first day, and I gave her like 60 carbs, and I was like, I'm Bolus thing. This was right, whoo. It wasn't like that, it was gonna try, you know, she was eight, nine years old. She'd had diabetes for seven years, and I stopped the low. I've got all that adrenaline from the low, you know, and like, it was one of them, like, test, test a minute later, test a minute later. Like, you know, like you're not gonna die. Right? Like, like, you know, like, that kind of, like, horror. And then it was over, and I knew she was okay, and then I was just hit, like, with the the other side of it. I'm like, oh my god, her blood sugar is gonna go up to 300 like, it's gonna be, like, I gave her too much, like, and I didn't give her too much in the moment she needed it all, because she was, she was falling like a stone. I did not know why, right? And Arden hasn't had maybe five of those lows in her whole life. But if you have diabetes and you think they're not going to happen, you're out of your mind, because Jenny will tell you a story about her sitting on the floor in a store. So then it happened, and I had to, like, like, this thing that we now talk about in the podcast, like it's an idea that people use, and it is. It really reflects on a moment in my life where I had to force myself to believe that in a dark room at like, two o'clock in the morning. And the problem is, is that when I put myself back in that spot, so I could explain it to you, I continued on into when I got out in the hallway and, like, fell apart afterwards. How you feel? Yeah, I cried in the hallway a lot. Anyway, it's not that easy, but once you have the information, and it really happens over and over again, if you can learn to trust it, I think it changes a lot about diabetes, maybe life too, but definitely diabetes. Yeah, thank you. Now I'm all upset. Thanks for sharing. You're welcome. You.

I wasn't sure if I ever spoke about this with you, but I did in bold beginnings, medical team. Episode 1117

Okay, you'll have to tell me what I clearly don't know. The numbers.

It's also come up in episode 357, and 679, 357, was actually called just smile and wave. So I would see people online have these, like, great achievements with their diabetes. They, you know, had a seven and a half a 1c they listened to the podcast. All of a sudden, they had a six and a half a 1c they'd go to the doctor, and the doctor would immediately try to turn like, take away insulin, they're like, Oh, you're getting low. Because the doctor could not imagine that they did something purposefully, right, right? Achieved

it without lows, right? It was just, I'm aiming too low now. And so, of course, my a, 1c reflects that, because it is just an average, yes, so you must be having a whole bunch of blood sugars that are way too low, rather than goodness. Let's look at your data to actually evaluate how you did that. Yeah. And, wow, look, you're more stable. There aren't really any lows in the picture. But yeah,

and it's not uncommon for people to stand in their doctor's office and then be forced to say something that I fully admit, and I think anybody would admit, probably sounds crazy in a doctor's office, which is, no, I found a podcast, and I listened to it, and now my a one sees better and look like, look at my graph. I'm not like, you know, I'm not coming by this, you know, by having a bunch of lows and then a bunch of highs and a balancing out. Like, I'm actually like, I learned how to keep my blood sugar stable at a lower number and everything. Now some doctors will take your pump from you and change your settings. Some people get told their settings are going to get changed. They don't want them changed, but they don't have, they have that little bit of that white coat, right? Like they're scared of the doctor. So they just, they just go along with it. What were you going to say?

I was going to say, you saw me like cringing with the take the pump and touch it. I think I've said before when we've talked, I feel very much when somebody in the past, eons ago, because I don't let them do that anymore, eons ago, they would take it, and I felt like they were touching me. Yeah, because the pump is a it's a piece of me. It's almost like a body part, right? And in taking it, it's like removing it from the room. It's like, it's like taking your baby, your newborn baby, and taking it out to do tests, and you're the the new parent in in the room, thinking, what are they doing to my poor child when I'm not there? You know? Yeah, that's how I felt about it. And I just, I learned to put on my big girl pants, and I was like, I'm so sorry. I printed my reports for you. Here they are. You don't need to download my pump. I

have learned and and still have to remember sometimes, but I ask permission to take Arden's phone. I used to like because it occurred to me. It's funny you say it like this, because at first it occurred to me like she didn't want to be told what to do. But I wonder how much of it might be like, No, this is me, like you're changing my body. If you touch this phone, you know, right beyond that, beyond just like, you know, hey, I want to change your settings. There's other things. People come in and say, like, you know, I'm bolusing now for fat and protein. And some doctors have never heard that before, and they'll go, you can't do that. Like, so any situation where you're with somebody medical, or otherwise, even maybe your mother in law, who's trying to tell you that if you just put ashwagandha up your nose, that kid's diabetes will go away or whatever, you know, whatever, there's more cinnamon, you know, you just haven't washed his hair enough with Berberine. Any situation you find yourself in, what I tell people to do is smile and wave, and it's getting to be a very old reference at this point, but there's that animated movie Madagascar, and the penguins are very mischievous, but when people look at them, they just put this big, dumb smile on and wave. And their leader, when they're get they got caught doing something, their leader goes, just smile and wave. Boys, just smile and wave. And that's how I think of all of these situations we want to make your basal lower. Okay, that's fine. Yeah, you know, have you tried having her tap dance on a piano? My grandmother's cat's diabetes went away after it danced on a piano one time. Oh, thank you. Thank you. That's lovely. Thank you. And then you leave the room and either talk about that person behind their back, or you put your settings back. The amount of people who have sent me a note that said I listened to this podcast, I made changes. I went to the doctor. The doctor changed them back. I stopped in the parking lot and put those settings back. And anyway, just smile and wave. That's my advice in situations like this.

No, it's a great and I usually say if they are wanting to touch your pump because they think you don't know how to use it, have them tell you what to adjust and you push the buttons. Therefore prove. You actually know what you're doing with your device, right? You are visually showing them. I'm not a dummy. Just because you have a white coat doesn't mean that I don't know what I'm doing. I wear this product, 24/7, it never leaves my side. At two o'clock in the morning, I know what to do when it alarms me. You're not there, right? And if they really want to give you the settings, then have them write them down, print them out on your you know, end of appointment summary you can change. Say, I will change these when I get home, or whatever. But if it's me, I'm like, you're not touching.

Well, my takeaway from smile and wave is this, if you truly know better on any subject, and you're not looking to have an argument with somebody. You can just placate them. Yeah, and that's it. Now, for those of you who have a genuine inability to go against something, a physician has told you, I think that the reason that this is on the list from people who have listened to the podcast and said, Here's a thing that's really helped me. I think this has really helped that type of person, very likely to say, I know what I'm doing. You're not going to push me off what I know. So, right anyway, just smile and wave. Boys, just smile and I like it. Smile and wave. You.

Jenny, I'm like, a fruit fly. I have a very small memory, a very short Oh, I

was gonna say, well, at least you went to memory, because I was like, Fruit flies are really annoying. You are not annoying. Okay,

hold on a second, then what has a really look, by the way, now I can hear everyone who thinks I'm annoying. Oh no, no, he's annoying. He was right. Say, fruit fly. But I have a short memory. I find it to be the way to get through life, like it's a purposeful, short memory on some things. And the way I would tell you is that I wake up every morning hopeful. It doesn't matter what's happening in my life. It doesn't matter how bad things were the day before, how bad things have been for the last month, how sick people might be, you know how long we've been fighting at something? I swear to you, I don't know why I'm grateful for it. I wake up every morning and I'm like, let's get this. This. Today's the day we get this. You know,

I am 100% the same way. Yeah, whether it's sunny outside or not, I wake up with a hope for what's coming in the day, and that it is. It's all gonna turn around like,

today is going to be the day you have no idea like my wife is. She'd be thrilled to for me to share this, but she's going through menopause right now. And on top of that, yeah, perimenopause. She has perimenopause. Yeah, those are the words I keep hearing. And she also has significantly low iron at the moment, ferritin, iron saturation, iron binding, everything is very low, right? And so she needs an iron infusion. I believe she called out of work yesterday and slept till 430 in the afternoon. Oh, no, yeah, she's really stuck. And on top of that, she's having these per menopause little problems too. So she's having all the problems of two different issues, and yesterday afternoon, I couldn't get her an appointment with a hematologist to get the iron infusion. And they told me, like, don't worry. Like, we're gonna, like, we'll call you. But I'm like, No, you won't, like, it's Thursday. You're not gonna call me on Friday. You're gonna call me on Monday, and then on Monday, you're gonna give her an appointment on Thursday, and then you're gonna get her in there on Thursday, and then you're gonna say, Oh, now the insurance, it's gonna be three weeks from now when this happens, right? And I'm like, I'm gonna make this happen today. And so I got up this morning, and now my wife has an appointment at three o'clock at a different place. Yay, because I just don't quit, like, I don't have that in me. I don't even know what it is. I don't take credit for it. It was not given to me by a parent, as far as I can tell. Like, it's just lucky wiring, right? But when it comes to diabetes, I think you have to get up in the morning and not give up. And I start every day with diabetes thinking I have a mantra around type one, and it's it's very quiet. I've said it on the podcast, but I don't say it out loud during the day. I'd rather stop a lower falling blood sugar than fight with a high blood sugar. That's how I managed diabetes, like at its core, that's what I do. It starts with getting up in the morning and not being I don't know, like not carrying the last day over, but I want to give a lot of like attention to the idea that if you have feet on the floor or your basal week overnight, you wake up in the morning and you've been 300 overnight or 60 overnight, or you open your eyes and your blood sugar goes from 85 to 185 like, it's gotta be a lot harder to be like, hey, everything's gonna be all right. It is. I want you guys to be able to find that hope and that joy in the morning. But I think it comes from the same thing we talk about over and over again. It comes from tools, and it comes from understanding how insulin works and timing and amount and mitigating as much as possible, being in that situation in the morning like that's what I think is important. Because I think that most people wake up and it must be like opening your I don't have diabetes, right? But it must be like opening your eyes in a box hole. Somehow you fell asleep. It's Normandy, and you fell asleep somehow. And when you open your eyes for a half a second, you don't remember that Jerry's shooting a mortar at you. And then all of a sudden, bang, bang, bang, bang, bang. Here it comes. Here it comes. Your adrenaline pops up, and your day is ruined before you dries all the way open. That's got to be what it's like, right? I don't know.

I think in the realm of sleep, I can't say that I remember ever having a dream in which I know that I have diabetes? That's interesting, right? So, and it's kind of the same concept of what you're talking about, that wake up in the morning like my alarm goes off. I don't think to just look at my CGM first eight morning. I know that that sounds very bizarre, like coming from me, but it is, I kind of wake up in that same realm of the alarm goes off, my brain kind of cycles through, what do I have coming for the day? Is it a weekend day? Is a day that, you know, get the boys up for school and kind of get rolling for the day? But unless I have alarms, alerts or some craziness going off, that reminds me that diabetes is in the picture, and it kind of goes along with what you said. You know, if you've been 300 overnight, you're probably going to feel like trash in the morning. So that's going to remind you almost right away about diabetes versus stability, good quality sleep, and kind of get rolling from the start of the day in a place that a. Allows you to move into your day with that hopeful kind of perspective.

I don't want to ignore the fact that if you were low overnight or high overnight, that you're gonna feel horrible. Like, I'm not saying just like, Get up and push through it. That's I'm saying. Let's figure out how that happens, so that you have stability overnight, so that you can wake up with the best possible, you know, start of the day and

that you're not rolling over like you said from yesterday's

Oh, like, yeah, it's not even over yet, right? Like, yeah, over yet. Yeah.

I mean, in that, it happens a lot with evening meals, whether they're really heavy, heavy meals and your body is still processing them, or it's a really late, heavy meal, or any of that, absolutely. That's a first thing on your brain. Then, is this done? Yeah, no, did I finally nail it? You're

getting your ass kicked in an alley. You pass out for a second when you open your eyes, like, Oh, good. They're still hitting me, right? Awesome. This isn't over. I genuinely think that these are all little things, their sayings, like write their T shirt slogans that are meant to like, from my perspective, I try to sprinkle in things that I think will help you in moments when you need help but you don't have the bandwidth to remember an entire episode of a podcast, or everything you Jenny said, or something like that. Like, you know, trust that what you know is going to happen is going to happen. Like people say that that saves them sometimes. Yeah, I'll just Bolus for a juice box. I don't know what they even call them. I'm sure there's a word for like, that kind of stuff, but I'm just a cliche machine over here about diabetes, like I'm just churning out and it ends up helping people. So I'm not saying ignore things aren't going well and just Buck up. Like that is certainly not what I'm saying. But what I'm telling you is, if you can put yourself in that position to wake up in the morning and just be hopeful, it really is going to help a lot. I mean, it genuinely is going to bring a lot to your life. So go listen to the Pro Tip series and figure out how to make it so that you can sleep and wake up like a like a regular person who doesn't have diabetes a lot of the time, agreed.

I think a big piece that goes into that, too is, thankfully, again, our new technology, and I don't know if you've read them, maybe not. But the 2025, Ada, sort of standards of care this year, they have some very specific things that they've they've really addressed things like type twos. Should have access to a CGM, awesome. They should have right in terms of like type one screening should be there for type one. And from the technology standpoint, they absolutely have statements. Now, within these guidelines of healthcare providers should learn how to use these systems accurately and assist their kind of patients in in using them, should be recommending them, whether they're FDA approved or the do it yourself, systems which are part of the recommendation, which is fantastic.

What happened over at the ADA, somebody fall in their head and decide to do a good job? I don't,

I don't know, but, I mean, they're, they're really fantastic, yeah, adjustments to the standards they're, I think they're coming to realize, as you're saying, this hopeful nature. It goes along with tools that are working well, right? And we have to put the tools in the hands of the people that need them sooner than later.

Yeah, I'm a proponent of that idea. Like, I've been through all the conversations and the ideas around, you know, like, oh, well, sometimes you know that idea of, like, oh, you should get a get a needle and a meter and figure it out that way first. Like, I don't know. Like, I think you need to have as much information as possible. Some people are going to be overwhelmed by it. That's fine, but we'll help them get through that. Everyone's progress shouldn't be, you know, held back because some people will be overwhelmed by it, because a lot of people won't be, won't be, yeah, and so it's, it has to stop being like a zero sum, you know.

And I would say it's amazing, from what you just said about some people will be overwhelmed and some people won't. It will surprise you, the people who you would expect it to overwhelm, and that it doesn't. And it doesn't, it absolutely is the best thing you could have done for them, and you didn't think again. This is a judgment piece. Unfortunately, judgment is there. And do you think that they're quote, unquote smart enough? You think that they can do it. I mean, all the things that you have no right to really pass over in telling somebody that this is an available piece, let's see if it can work

for you. You can't prepare for failure. No, it's the wrong way to come at this. You have to if the prep people for success, and for those people who don't have that success, then you pull them out and help them, but you don't just set everybody up to fail and then hope some of them figure it out on their own, which is basically been how this has been going since, you know, for 30 years, before my daughter had diabetes, you're all gonna die. Oh, look, some of them didn't. What a plan, Jesus. Like, you know, like, what a plan. Great job. Well, listen, whoever at the ADA, whoever found their balls and decided to do this, I think it's awesome. So good for you. Thank you. Yeah, that's enough, Jenny, we're done. You.