#672 Defining Diabetes: Antibody

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Defining Diabetes: Antibody.

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

Scott Benner 0:00
Hello friends, and welcome to episode 672 of the Juicebox Podcast.

On today's episode of The Juicebox Podcast, Jenny Smith and I are going to define antibodies, auto antibodies, antibodies, auto antibodies, antibodies antibodies WHAT THE HELL ARE antibodies antecedent here we go please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise Always consult a physician before making any changes to your health care plan. We're becoming bold with insulin Are you a US resident who has type one diabetes or is the caregiver of someone with type one because if you are, you can support the T one D exchange and research for type one diabetes by going to T one D exchange.org. Forward slash juicebox. When you get there, join the registry fill out the survey the whole thing takes fewer than 10 minutes and you are going to help people with type one. You're also going to support the Juicebox Podcast. I don't even want to stop talking now. My voice sounds amazing in my ears. T one D exchange.org forward slash juicebox this episode of The Juicebox Podcast is sponsored by us med us med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor from the pod dash, the number one fastest growing tandem distributor and the number one rated distributor index. com customer satisfaction surveys. US med is a place where you get your diabetes supplies from most of us use them right? Most of us are using some sort of an online Wait a minute, are you not getting your supplies online? Okay, hold on. First of all, it's super easy to get your supplies online. You just are you're not doing this. Alright, hold on a second. Let me get a sip of water I gotta explain this whole thing to you. So we used to use another company, we've actually used a couple of them. And in the past they've been you know, spotty, let's say spotty in their customer service. But us med prides themselves on their white glove treatment of their customers. US med has an A plus rating with the Better Business Bureau and they want you to get better service and better care than you're accustomed to getting now. US med always provides 90 days worth of supplies and fast free shipping. You can get a free benefits check right now at us med.com forward slash juicebox or by calling 888721151. For us Medicare is everything from insulin pumps and diabetes testing supplies to the latest CGM including libre two and Dexcom G six. They accept Medicare nationwide, and over 800 private insurers. This 888 Number is dedicated for Juicebox Podcast listeners. Call now 888-721-1514 Get the service you deserve. Get your supplies without a big hassle. US met us med.com forward slash juicebox. Look, everybody these supplies are going to be common forever and ever. I'd love it if you had it set up so that it just happened and you didn't have to think about it. That's how we have it here. And it is a real it's a weight lifted. It's another thing you don't have to think about. Let us med think about that. You go live your life we've talked about antibodies in thyroid episodes. Yeah, and other places. I am told by Isabel who helps me run the Facebook page that people are confused about antibodies. And she said to me, please do a defining episode about them put it in one place where they can find it. It's easy to understand. And I said okay, as well. I will absolutely do that. Now here comes the problem. I'm still I still get a little confused as well. And I know it's just because I haven't looked at it closely enough. If you said to me right now, what's up? I'm not gonna look at anything. I'm not just gonna go off of what I remember right? Then you're gonna you're gonna tell me if you said to me antibodies in conjunction with type one diabetes

I would say something like, your body has antibodies that are meant to do stuff, fight illness or disease or whatever. And if you have type one diabetes, or if you are predisposed to type one diabetes, there are antibodies in your system that are likely to go get the beta cells in your pancreas at some point, and they don't belong in your body. And I don't know if that's right, that's literally the best I can conjure up out of my mind. Just told

Jennifer Smith, CDE 5:40
me, No, not, I mean, not really wrong, I think it's the way that you think about it or see it, it's, I mean, an antibody in general, whether it's for diabetes, or thyroid or other, you know, issues. an antibody essentially, is just a protein that your immune system uses to essentially take care of a foreign object via a virus or, you know, bacteria or something that's potentially harmful, right? I mean, that's, that's the gist of an antibody. But in someone specifically with type one diabetes, and something in the body triggered an immune response. And so your body, unfortunately, has identified beta cells as the foreign object. So your body produces antibodies to take care of this foreign object, which technically isn't foreign, but for some reason, the body now thinks that it is. So the antibodies are I mean, they're there, they would be identifiable in the bloodstream in a in a blood draw, if you had antibodies that were specifically attacking the beta cells, right. So we can do blood draws to test for antibodies, we can do blood draws to test for insulin antibodies. I mean, one of the very well known ones that most people definitely have done at diagnosis is the GAD antibody. And then, you know, if you've done any testing, or had any family members who have done testing through like TrialNet, or any of those types of places, there are, I think, at least two other antibodies that they're kind of looking for as well, to identify, so in general, an antibody is just it's really supposed to be there. That's something that your body uses. Unfortunately, it becomes something not great, because of the way that your body is identifying the beta cells, which is now seeing as like a foreign invader,

Scott Benner 7:49
okay. So for auto antibodies are markers of beta cell autoimmunity and type one diabetes isolette cell antibodies ICAA against cytoplasmic proteins in the beta cell, antibodies to glutamic acid, well, the carbo laisse which that's the GAD 65, right? Insulin insulin auto antibodies, which are IAEA, and I A to A to protein tyrosine, phosphatase. FOSS. Wow, okay. All right. So not everybody has these, the these like, like, like, let's just take gad as an example, right? Like, if I tested the population, most people would not have that antibody.

Jennifer Smith, CDE 8:36
They shouldn't. I mean, honestly, if you're testing positive for the GAD antibody, it indicates an immune attack, which is really points to type one diabetes specifically. Okay, so general person should not have gad antibody.

Scott Benner 8:50
So if you have it, where do you work? I don't understand where you get it from? Like, how does how does one body Jenny that are we outside of your depth?

Jennifer Smith, CDE 9:01
I don't know. I think if that could be, I don't know if it's out of my depth. It's certainly out of the realm of

Scott Benner 9:09
understanding at this point.

Jennifer Smith, CDE 9:11
I think it's to my like, limited explanation. It would be the reason that there's no

Scott Benner 9:18
cure is because we don't know how that happens. We don't

Jennifer Smith, CDE 9:21
Okay, right. I mean, some other really, really intelligent scientist and because sure could say hey, we're pointing things in this direction or whatever. And I'd be like, Okay, well, that's really fancy.

Scott Benner 9:35
So for reasons that may be at this moment, beyond understanding as a person can develop one or all of these antibodies, and then what you're waiting for next, it's the other shoe to drop it's for you to get ill sick, stressed something, your immune system to be like alright boys, go attack those invaders and they run right past your Your virus and go right into the pancreas and go after your beta cells. And that's

Jennifer Smith, CDE 10:04
why there are and for the GAD, I think I was actually wrong. I think that there are I think there are other autoimmune conditions if I'm not incorrect, I think thyroid, you may have gad antibodies present. Okay. And I am I think there's another autoimmune disorder if I'm correct, that that may be something that would show positive, I would have to again, look that up. But I'm, I'm quite sure gad is also present for thyroid. So anyway, um, you know, in terms of a virus, that's why many people believe that people with type one may have had a virus, which was like a switch. It's like a light switch. i That's kind of how I think about it. My brother probably had the same virus that I had, if the reason that I have type one is from a virus, I don't know why I have type one, I'm quite sure that my brother and I living in the same house probably had the same viruses, why my body decided to interact with that virus and the switch turned on and decided to flip and say, Okay, we've taken care of this. But now we're also seeing these body parts or these pieces of the body of the beta cells as foreign objects to. So why one person versus another? I don't know.

Scott Benner 11:31
Yeah. I would again, I think I've said in other episodes, I don't know for certain, but I would bet money that Arden had Coxsackie virus, and then she got type one. I've heard a lot of people specifically say Coxsackie. And then type one. As a matter of fact, we had the CEO on a prevention bio. Hey, it's Scott, I know I put the ad at the beginning of the episode today. I tricked you a little bit. But I still need to pop in and tell you that US med offers a free benefits check and you can get it at us med.com forward slash juice box, or by calling a special number just for Juicebox Podcast listeners 888-721-1514 us med carries everything from your insulin pumps, to your diabetes testing supplies, go check them out, who was on to talk about Tomislav, which I always mispronounce. And later I will get a message after this goes off where they say you've pronounced it wrong again. But I know that he was talking about how one of the ways that he thought you could significantly cut down on type one diabetes is to inoculate people against coxsackievirus. Yeah. And he said so that to me, I mean, if someone's saying that, then they've seen enough impact that way, but they're saying like, don't get me wrong, like Coxsackie doesn't make type one diabetes. Right. But if you have these auto antibodies, which I'm assuming Arden had, then you get Coxsackie. I'm, I'm thinking what he was saying was that there's more frequency to go from a person who has auto antibodies, who gets Coxsackie to type one, then there is a person who has auto antibodies, and they get the flu, and then they go to type one, etcetera, like something like that. Right. So yeah, there's probably a mechanism in there that I mean, we don't understand. Maybe somebody else does, but and the Coxsackie

Jennifer Smith, CDE 13:31
is certainly one that's well identified. I mean, as you said, you can look for it, you can easily find multiple noted references to Coxsackie and type one. Yeah. But it is also a more of a childhood disease illness. Right? Which then also leads to the questions of, well, if an adult didn't have Coxsackie, then why all of a sudden, is this random adult who has no family history of type one at all? Right? Why is it all of a sudden there?

Scott Benner 14:06
Right? Well, so is it. So let's keep talking about that for a second. It's possible you could have these I mean, it's possible that there are people who live their entire life with these auto antibodies and never get type one diabetes, right. And so, I hear from, I mean, this podcast has allowed me to talk to so many people, that there's no longer an age that I think you can't get type one diabetes after, you know, like, I know that people used to think, you know, it was kind of like that weird slippery slope of, you know, the JDRF was the Juvenile diabetes Research Foundation. So people know that it's juvenile diabetes, you can only get it if you're a kid, obviously wasn't true. But even in my like, you know, uninitiated understanding, if you would have found me before Arden had type one I would have told you like if you can get it like 30 years old, you're not going to get diabetes like type one. Right? And that's how people would think about it in the past.

Jennifer Smith, CDE 15:05
Yeah, I mean, I've worked with people who've been in their 60s, upper 60s, I have one woman who was 71 when she was diagnosed with type one. So, you know, there's still certainly no age that it is not possible.

Scott Benner 15:21
Right now, I think it's point, I want to say 73 is now the oldest person that I've interviewed. Really? Yeah. But I mean, what the hell, you know, right. And talk about, you know, thinking you made it mean, really,

Jennifer Smith, CDE 15:37
this far in life. And this is what I get handed now, like, what

Scott Benner 15:42
the heck is done? You know, I thought I was all good. So I think that, if I go back to what Isabel saying to me, about that people asked about this all the time about the antibodies and not understanding them. That is what I want them to leave this episode understanding is that, you know, first of all, you didn't do anything wrong. Right? That and I think that's, I mean, if we could kind of shift gears away from a more medical to maybe a more psychological for a second. You didn't give your kid type one diabetes? Like, No, you didn't give it to yourself? It's not possible, you know, like, you either have these, these antibodies within your system, or you don't. And like Jenny said earlier, modern medicine can't tell why at this point. And if it was just that you watch the prices write too much, or you you know, you know, or you had too much ice cream or like something like that the things that people knee jerk worry about when it first happens, like, Oh, my God, you know, I mean, you know what I'm saying? Like, people come up to you. Not always, but there are people, a lot of people who have personal experiences where an uninformed person will come up to them and just say, like, What, did you feed that kid? You know, how did you do? Absolutely. Right. And that's a big problem. And then it's a bigger problem if it just happened to you. And you and you don't know that, that that couldn't be the case. Correct. I

Jennifer Smith, CDE 17:08
mean, when I was first diagnosed, my mom's coworker, my mother was a grade school teacher. And one of her co workers said, Well, I and I only her overheard the conversation between my mom and my dad, my mom did not tell this to me directly. But she was telling him that her co worker had said, well, thank goodness, it's just juvenile diabetes, she'll grow out of it. Right. I mean, and again, this was, you know, in the 80s. So clearly, a lot of I mean, this information is still out there. I'm not saying it's not but I mean, that's the misnomer of juvenile diabetes to, it'll be, it'll be over soon. You know, as soon as like, you turn 80. And magically, like, I'm not a juvenile anymore must be gone.

Scott Benner 17:55
Arden diagnosed in 2006. And I've lost count of the amount of people have asked me what age children outgrow it. Right. As if, by the way, have you ever outgrown anything? Like, if you ever heard of like, oh, you know? I don't know. He can't keep he can't process protein. Oh, he'll outgrow that. You don't outgrow? There's in the history of the world. I've never heard anybody say, oh, cancer, don't worry. You'll Yeah, like no one's ever said that. But for some reason, it is a really interesting example of how, how the wording is impactful just by calling it juvenile, you make it feel like once you're an adult, it doesn't exist anymore. Exactly. But I just one, listen, I want people to know that you didn't do anything to cause you're type one. Type one. And and I,

Jennifer Smith, CDE 18:44
you know, the question that I also get kind of along the same line is from a lot of the adults that I work with, who have children, they themselves as an adult have type one. And the question always comes up, either should I get my kids tested? Or how likely is it for my child to get type one? You know, quite honestly, there are statistics, if you really wanted to look things up. You certainly could look up some statistics, but it doesn't necessarily say your child because you have type one is 100% going to have type one too. So in a causative. If you have type one and your child ends up developing type one, likely there's a genetic link there, but you didn't necessarily cause that piece to turn on.

Scott Benner 19:29
Right? Like if you have brown eyes, and you don't like them, and your kid has brown eyes. It's not your fault. Your kid has brown eyes. So it's a genetics work. Yeah. And I understand how people feel like I mean, if I'm being honest with you, I wondered for a really long time what I could have done differently, you know, and so I was a stay at home dad. So I was with art and 24/7 I was the I mean you guys all they'll be fairly well from the podcasts like, I'm the kind of person who would wake up in the morning and be like, Wow, it's warm out getting the car, we're going to the zoo, screw the dishes, you know, like we went every which way. And before I understood these antibodies, I used to think, did I not wash something? Well, did I take her to the wrong place? What if I just wouldn't have gone here? Was it a ball pit that gave her diabetes? Like, before I understood that, in all likelihood, Arden was getting diabetes, you know, whether it was going to be when she was two, or three or four or whatever. It was definitely happening. You know, I don't think that we could have locked Arden in a bubble. And you know what I mean? Like, I don't understand the point of that, right? Like, at some point, let's say that would be true. Let's say that if I, by the way, you're gonna have to be really old for this one. But John Travolta was in a movie called The Boy in the bubble. And

Jennifer Smith, CDE 20:52
I was gonna mention that, like, nobody's gonna know what we're talking about some

Scott Benner 20:55
matter, I'm saying it, okay. It was a TV movie of the week in the 70s. I know, you don't know what a TV movie of the week is, if you're under a certain age, I don't care. John Travolta lived in a bubble. The only way he wasn't gonna die, because the outside world was just gonna, like his body couldn't handle it. You know, eventually he left that bubble, he didn't care. So if my point is that if you've got these auto antibodies, and you're gonna end up with type one diabetes, you're gonna end up with type one diabetes, and you're gonna live with diabetes, because that's, that's the straw you drew, you know, so you can't feel bad about it. I know, it's gonna happen and people are gonna feel guilty, but it's these antibodies fault, not yours.

Jennifer Smith, CDE 21:35
Right. And it's how your body interacts with them, right? Whether your body uses them the way that they're supposed to, to identify truly foreign pieces, objects, you know, viruses in the body. That's their job. That's you want them to be there. That's a really important thing. But sometimes they don't do the right thing.

Scott Benner 21:57
Friendly fire, Jenny. Yeah, right. There you go. Yeah. So oh, this was depressing.

Jennifer Smith, CDE 22:06
Nah, was informative. And I hope it's, I hope it was more, you know, I guess informative in a way. That's more, I guess, understandable.

Scott Benner 22:17
Yeah. No, I appreciate breaking it down. Because it's just like the other defining episodes really, you just make these assumptions that people know what Bolus means. And if they don't, they start forming other thoughts. And if you don't understand what these antibodies are, you could run around your whole life thinking you did something, or I could still think, why didn't I wash? Arden's hands one time, and she was a year old before I did something or I don't know what the hell?

Jennifer Smith, CDE 22:41
So I mean, I've gotten off of the whole, I've had people, I've had friends who who've asked me, Well, why do you think I'm like, I don't think anymore. I, I manage this. And I don't have time to go back and think because it's not going to make a difference. Right? Right. I mean, if it made a difference, in fact, of like proving what happened, and then I could actually move into like solving and having a cure. Awesome. But no,

Scott Benner 23:12
well think of it like this, really. I'll keep this vague, but my son is having a problem with another person. Okay, a person who holds sway over him. And he has, he's a bright kid and a thoughtful kid, and he's a thinker. And he will look at what's happening and break the problem down and say, maybe if I try this, this will allow me to you No, change this, to let this other person see that this isn't the case. Or maybe I can, maybe I can end around them and get around. And I've watched him for years, go over it and over and over and at times, make himself crazy about it. And just the other day, he said to me, there's no path. He's like, I'm not the only one impacting this situation. And no matter what I do, it's not right. It won't work. I have to just accept that this is the reality. And I'm going to go do something else now. And I when he was talking about that, I thought that is how I used to feel about diabetes. I used to think like, maybe I could think my way around it or, you know, at least to give myself comfort. And what I realized is that eventually is that the comfort is knowing that not everybody gets out of this unscathed. And people get things and my kids got an autoimmune problem. And she ended up with type one diabetes. And now we just we choose another path and go live happily on that one. So move on. Yeah, for sure. All right. Well, thank you very much. Yeah, absolutely. Have a good day.

Unknown Speaker 24:50
You too.

Scott Benner 25:00
I want to thank Jenny for being here. Don't forget that Jenny works at integrated diabetes.com. If you'd like to hire her, you can. I like to thank our sponsor today us Med, get your diabetes supplies easily, it doesn't need to be a big hassle. And with us med it won't be check them out and get your free benefits check at us med.com forward slash juice box or by calling 888-721-1514. There are links to us, Matt and all the sponsors in the show notes of your podcast player and at juicebox podcast.com. And don't forget to go take that survey AT T one D exchange.org. Forward slash juicebox. When you support the sponsors, you're supporting the show. At this point, I don't even remember how many defined diabetes episodes there are. But there's got to be more than 40. If you're enjoying them, you can find them at juicebox podcast.com diabetes pro tip.com, or by joining the private Facebook group Juicebox Podcast type one diabetes, and then heading up to the top I want to call it the I always want to use the wrong word. And then I hold on a second I'll tell you what it's called when you get the sort of the Facebook page is a private group. It's really terrific. I think it's got like 24 25,000 members in it right now. And at the top. Not here this there's a feature tab. So you have to answer a couple of questions to get in. But once you're in there, go to that feature tab. And there's a list of all the defining diabetes episodes, all the variables, all the how we eats the Quickstart guides. If you're just starting with the show, the Pro Tip series is a list of popular requested episodes popularly requested episodes if I'm going to use English special episodes, Scott and Jenny's where they're called ask Scott and Jenny people send in questions and Jenny and I answer them a whole bunch of stuff on how to Bolus for fat and protein. I mean, there's a ton here anyway, it's all in that private Facebook group up under the featured tab. This is the part where I say thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Please subscribe and your apps Subscribe and follow follow and subscribe.

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#668 Defining Diabetes: Carb Absorption and Digestion

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Carb Absorption and Digestion.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

---

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

Scott Benner 0:00
Hello friends, and welcome to episode 668 of the Juicebox Podcast.

On today's episode of The Juicebox Podcast, Jenny Smith and I are going to define carb absorption and digestion. There's no more to it than that. That's what we're gonna do. I mean, there's way more to it than that. But as far as the explanation prior to the conversation, that's all I've got for you. Please remember while you're listening, that my voice sounds terrific today, and that you should always look and that you should always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Are you a US resident who has type one diabetes, or is the caregiver of someone with type one, because if you are, you can support the T one D exchange and research for type one diabetes by going to T one D exchange.org. Forward slash juicebox. When you get there, join the registry fill out the survey the whole thing takes fewer than 10 minutes and you are going to help people with type one, you're also going to support the Juicebox Podcast. I don't even want to stop talking now. My voice sounds amazing in my ears. T one D exchange.org forward slash juicebox. This episode of The Juicebox Podcast is sponsored by us med. US med is the number one distributor for FreeStyle Libre systems nationwide. They are the number one specialty distributor from the pod dash, the number one fastest growing tandem distributor and the number one rated distributor index. com customer satisfaction surveys. US med is a place where you get your diabetes supplies from most of us use them right? Most of us are using some sort of an online Wait a minute, are you not getting your supplies online? Okay, hold on. First of all, it's super easy to get your supplies online. You just are you're not doing this. Alright, hold on a second. Let me get a sip of water I gotta explain this whole thing to you. So we used to use another company, we've actually used a couple of them. And in the past they've been you know, spotty, let's say spotty in their customer service. But us med prides themselves on their white glove treatment of their customers. US med has an A plus rating with the Better Business Bureau and they want you to get better service and better care than you're accustomed to getting now. US med always provides 90 days worth of supplies and fast free shipping. You can get a free benefits check right now at us med.com forward slash juicebox or by calling 888721151. For us Medicare is everything from insulin pumps and diabetes testing supplies to the latest CGM including libre two and Dexcom G six. They accept Medicare nationwide and over 800 private insurers. This 888 Number is dedicated for Juicebox Podcast listeners. Call now 888-721-1514 Get the service you deserve. Get your supplies without a big hassle. US met us med.com forward slash juicebox look everybody these supplies are going to be common forever and ever. I'd love it if you had it set up so that it just happened and you didn't have to think about it. That's how we have it here. And it is a real it's a weight lifted. It's another thing you don't have to think about. Let us med think about that. You go live your life

okay, so we fixed your computer.

Jennifer Smith, CDE 4:08
We did thankfully Yeah. Good for us.

Scott Benner 4:12
Do you want to start with carb absorption and digestion as the defining or antibodies? I let it be ladies choice as I'm going to have very little to add on one of them for sure.

Jennifer Smith, CDE 4:28
How about we do carb absorption.

Scott Benner 4:31
Okay. Well then, in fact, Jenny, we are going to define carb absorption and digestion talked about that. Okay, can I tell you that the first time I want to be honest. The first time you said to me that the body digests things in an order. I had never heard anybody say that before. I knew

Jennifer Smith, CDE 4:57
I remember telling you that. You told Utah in order.

Scott Benner 5:02
So I'll tell you what I remember,

Jennifer Smith, CDE 5:04
I might have to clarify, because I don't even remember

Scott Benner 5:07
what it is like, please don't put that on me I never said. So what I recall is that we were talking about pizza as an example. And right, and we were talking about how, in people's minds, pizza is an example could be a is a food. But if you really stop and deconstructed pizzas cheese, it's sauce, it's salt, it's oregano, it's flour, right? It's all these things, if you put sausage on its protein, if you put, you know pepperoni on it, it's protein, that's sort of an idea. If you put pineapple on it, it's a simple sugar, like getting these things, right. And you were describing why people get low blood sugars from pizza, because they look at the slice. And they, Oh, it's 35 carbs, they Bolus these 35 carbs, they hooked down this pizza, the, because that's how I eat it. If the rest of the first slice goes fast, and and then of course, the the insulin is working, working, working. But because of how digestion works, the pizza, the impactful parts of the pizza aren't being absorbed by your body right away. And you I if I'm wrong, stop me. But you said that the cheese is the most difficult part. For the body to break down, it starts with that it takes a long time, it's not pulling out carbs do I remember all this correctly,

Jennifer Smith, CDE 6:30
kind of it's sort of yes, in a way. Because, right, the fat in the cheese, and the protein and the cheese and whatever else you might have also put on top of it. I mean, it could be, you know, the Italian sausage and whatever. And the multiple cheeses that might actually be on top of it, right. But the body sort of breaks things down in a general sense to completely like process, right, almost like a blender, if you will. But if you have like the pineapple, if you only put the pineapple in your stomach, simple carb or simple sugar, so it's going to break that down really fast. Whereas when you start mixing that with the other macronutrients, like fat and protein, such as in cheese, you're really going to get a slowdown of the carbs, that you really only see the pizza as being or anything really that you've identified as a carbohydrate, you're gonna see it, you're gonna count the carbs, you're gonna say, Okay, I'm just gonna go ahead and give my insulin right now. And that insulin, it's meant to work. The way that you know, rapid insulin specifically is sort of designed is to work with carbohydrate digestion, it's got this in out sort of bell curve of action, which is kind of how carbs get digested and carb decarb. Even those are a little bit different, depending on the kind of carpet is right. But pizza, for example, being Yes, it might have carbs in it, but those carbs really get slowed down when everything gets blended together. And the body is trying to also work on, I guess, simple way to say it is a harder to process,

Scott Benner 8:13
right? The macronutrient. So if so, if we took the slice of pizza as an example, and it just had, I don't know sausage and cheese on it, and we eat, we eat it, our body processes it in one bell curve that we could see. But if we rip the cheese off it and eat it, the bell curve completely changes.

Jennifer Smith, CDE 8:33
Right? That's a great way to describe it. Absolutely. In fact, something like the pizza crust with just the sauce, which pretty much that's just all carb unless you've added fat and whatnot to the crust, then yes, that's going to be a faster digesting type of food or meal because you really have added nothing to slow down. So you have a typical carbohydrate bell curve and in kind of out within, let's say about three ish hours, right? Whereas when you start adding those other macronutrients, they take proteins and fats take longer for the body to process you might actually have sort of a double humped kind of felt curve maybe, right, it might go up a little bit, or it might actually remain pretty smooth and steady. Especially if you've dosed your insulin in a split type of fashion, or extended your Bolus out. You might actually see something that's pretty stable for a while before it slowly starts to go up later, where things like fat and protein, those may be the end result of all of a rise up later. Not necessarily truly just carbohydrate,

Scott Benner 9:43
right? I just not that. I mean, I just think we should so bell curve. If you think about a spike that you see on your CGM where you're going along, you know, okay at 90 and then all of a sudden you go up to 140. It hangs there for a little while and it curves and it comes back down to 90 Again, if you can picture that in your head, it sort of looks like the outline of a bell. Yes. So the carbs, it's an impact of the carbs, the carbs start the impact, they impact heavier and heavier and hit harder and harder and harder. The bell at the top of the bell gets formed, the carbs start to be digested, so less impact. And at the same time, if you're lucky, there's another bell curve going on, which is the insulin. Yep. All right. But the insulin and the insulin is not working as hard at first, it starts to work harder and harder and harder, which is why you always hear me say something like, you know, you got to, it's all about timing and amount, you have to put in the right amount at the right time, you have to line up the impact of the carbs with the action of the insulin. However, I don't know I've said it, like 1000 different ways at this point. But those impacts have to be fighting the fight at the same time. Correct, right. But aside of that, just just sort of keep in mind that if you Hey, it's Scott, I know I put the ad at the beginning of the episode today, I trick you a little bit. But I still need to pop in and tell you that US med offers a free benefits check. And you can get it at us med.com forward slash juice box, or by calling a special number just for Juicebox Podcast listeners 888-721-1514 us med carries everything from your insulin pumps, to your diabetes testing supplies, go check them out. All right, sorry, I have ordered a new computer.

Jennifer Smith, CDE 11:30
Oh, that wasn't my fault. I did nothing.

Scott Benner 11:37
So but but what we're saying is, is that if you so if you eat the pizza, and it doesn't have cheese on it, your body can get right to breaking down the dough. And so you're gonna start seeing an impact sooner. But if you mix the cheese in with it, fat and protein slow down the digestion process, and your body sort of focuses on the things that are more difficult to break down first. So it's breaking down stuff that doesn't have carbs in it necessarily. So is there's less than

Jennifer Smith, CDE 12:07
breaking it down all at one time. But because the carbs get mixed in with these foods that are harder, and it's breaking everything down, the whole slow the whole process down really

Scott Benner 12:19
significantly slow it down. And significantly

Jennifer Smith, CDE 12:21
slow it down exactly which again, as your example when you then take a Bolus all up front for something like like pizza, or the other foods that would fit into that, you know, same category, you're really going to most likely get a low blood sugar, and up needing to treat the low blood sugar, that treatment might even be a little bit slower. Because you have this food that's a heavier type of food already in your stomach. And then you end up going up later, not only from treating the low, which you needed to do, but also now the food is actually hitting, and you got impact of insulin more upfront where you actually needed it stretched out over the course of how long that was taking to digest.

Scott Benner 13:10
And that's why Chinese food can be difficult, right? Because it can be a mixture of a slow and a fast impact. Yes, you can almost have what you do have, you'll have two bell curves, you'll have quicker faster ones and slower, more drawn out ones. And you have to hit both of those differently with insulin differently. Yep, yeah. So. So now that we've kind of like walked through it, pizza is a great example. Because it makes the point but so if you have anything now, like, just think about all the different foods you're eating, if you eat them singularly, they have an impact, you know, across this curve, when you start mixing them together on a plate, you're now we were talking about this in another episode, you have different lines of I don't know reality happening, you have the bell pepper reality and the mashed potato reality and the meatloaf reality all kind of happening at the same time. Now, it's not. I mean, I have to say, like anecdotally from managing art, and it's not like there are these three different crazy, I don't know, things happening, they kind of blend together a little bit, you kind of almost can't see it with the naked eye. But it is true that it's working that way. It's different foods differently.

Jennifer Smith, CDE 14:21
And if you have paid enough attention, I've said it before, if you've paid enough attention to the 80% of time food that you eat, right what you've eaten over and over and over. If you've paid enough attention to that, you can get your timing down. Yeah, pretty pretty well, right? And in most mixed meals setting something like a you know, brown rice and I don't know broccoli and grilled chicken, right? I mean, that's still unless your portions are exorbitant or you've had them slathered in butter or some type of other fatty kind of, you know, dressing You are going to have the pretty typical bell curve of action. It's just when things get heavier in fact, especially and or heavier in protein and maybe lower in carbohydrate at the same time or lower glycemic. I mean, it brings in a whole carbohydrate to carbohydrate. Not all carbs are sort of digested by the body the same way, right? A good example being plain old white bread versus something like a sprouted grain like in Ezekiel bread, for example, right? Very unprocessed, versus really, really broken down. There's nothing left in that white bread. It's kind of like eating sugar. Really, right.

Scott Benner 15:50
It's funny, because I find it if you choose a whitebread that doesn't have high fructose corn syrup in it. I find it easier to Bolus for because I know what it doesn't right away and it takes a lot of insulin, but it doesn't it's not like these real kind of like, like the grains don't take more time. It doesn't stretch out the process like No, not at all. It's but it's a ton of it's a ton of insulin like you're making me think about, like I just I Googled, this is one of my favorite things and I'm not sure it's real in the world or not, but that there's that there's silicone in McDonald's french fries. So I Oh, is there silicone in McDonald's fries, the chemical sharing a link between finding a cure for baldness and fast food french fries is di meth low poly Ciloxan, which is a is reportedly found in the silicone that is added to the oil McDonald's cooks is famous French fries, and it's from 2018. So not not really my bigger point. My bigger point is that when you start looking at processed foods versus natural foods, this is a big deal. Because these foods are generally speaking going to be higher carbs. And there are things in them that your body is not really supposed to be dealing with. You know, you wouldn't, you don't I'm saying like deep frying is a great example to me. Because if anybody's ever like deep fried something on their own, you fill the you know, you fill the pot up or whatever, and you fry it. And when you're done, the pot has much less oil on it, but you don't think about it that you're the one eating the oil. Right? It's over.

Jennifer Smith, CDE 17:27
It's like it magically just just went someplace. It's like when you boil water and the water like sort of evaporates, right? You kind of think, well, they must have just like evaporated educated

Scott Benner 17:37
did by the way, it's up in the air now, right? Like it's still there, this oil is still it still exists on the world in the world, it's been absorbed into your food. And so if you go back to the pizza explanation, where fat slows down digestion, then fried foods are going to slow down digestion too, because you're gonna be taking in oil. And in a in most settings, it's not going to be like real expensive, cold pressed olive oil that they're making your french fries. And it's going to be whatever, like, you know, Jack's easy to buy, you know, stuff that these companies can use for their oil. So you're getting that in there, you're getting whatever is in French fries, you know, and I'm using this as an example because it's here's this from a 20 2015 article. Let's see if it shows you how McDonald's fries are made. There are real potatoes in it. That's nice.

Jennifer Smith, CDE 18:32
hatefully Oh my goodness.

Scott Benner 18:35
Do you add any type of flavor guests so they put in flavors and oil blends be flavoring? Like there's all kinds of stuff? What kind of oil do you use, we use an oil blend made from four different kinds of oil, canola, corn, soybean, hydrogenated soybean, those are four oils, I wouldn't eat. And I am not nearly the healthiest person in the world. And so I'm assuming there's salt. You know, a lot in

Jennifer Smith, CDE 19:02
thankfully, salt is like one of the least dangerous things on the whole list. Fries,

Scott Benner 19:08
Chinese, like maybe you'll get some iodine. Exactly knock your thyroid down. They use the right kind of salt. But I just think that when I watch people online speaking and talking about the problems, they have bolusing for their meals, they only ever think of it as the number on the carb count. Like the the rest of it just usually doesn't come into play for them. And I mean, I just think I don't think you should eat any certain way and I'm not telling anybody how to eat. I enjoy McDonald's french fry. But you have to understand it. You can't just blindly look at this meal and go McDonald's says that this is the 86 carbs and dial it up and think that's going to work out for you because it very likely is not going to

Jennifer Smith, CDE 19:53
right i mean it brings in a bigger a definite bigger piece of it. The lack of detail in education that's provided, because majority of people diagnosed are sent home and told, count your carbs, take your insulin, maybe they're told to Pre-Bolus by 10 minutes. And it's sort of left at that. Most places unfortunately, don't even go into use of potential split Bolus ideas, or whether you're on multiple daily injections or have the use of a pump with extended Bolus and those types of things. There is there's no definition to these type, this type of carbohydrate, or these types of carbohydrate are these groups here, you can expect quick impact, sort of moderate impact, really slow impact that gets into glycemic index. And from the get go, if we're not giving this information. That's where the confusion starts to come in. But if I was just told the count carbohydrate and that every single apple out there was 12 grams of carbohydrate, well, great, fabulous. So then I go and get my big old honey, crisp apple, and it's 12 grams of carbon.

Scott Benner 21:11
Not really. And I say good luck using a 12 gram count for a big apple because you're gonna be in trouble. All right, where you send your kid to a pizza party, and the kid has three slices of pizza and you're like, well, that's 90 carbs, you give your kid 90 carbs worth of insulin, that insulin is going to crush them long before the pizza catches up. Some other stuff, we know that

Jennifer Smith, CDE 21:31
most kids are not sitting at a birthday party, right? I mean, it's a trampoline park or something. Right? Yeah,

Scott Benner 21:38
the balance of the timing and the amount is just it's more important in different situations. It's also Alright, hold on. So from online, how are carbohydrates digested absorbed? During digestion, starches and sugars are broken down both mechanically through chewing, and chemically by enzymes into the single units glucose, fructose, and or galactose. That sounds like a transformer, which are absorbed into the bloodstream and transported for use as energy throughout the body. Which, if you listen closely to that sentence, what it means is, is sugar gets put into your blood. So yes, and so this happens at a different time. The end here, very quick googling How soon after eating our carbs absorbed, the denser the food, meaning the more protein or fat it has, the longer it takes to digest notes, Dr. Li simple carbohydrates such as plain rice pasta, or simple sugars, average between 30 and 60 minutes in the stomach. So you put your insulin in at noon, it starts working really well. 20 minutes, it starts working 20 minutes later starts working really well at 45 minutes, this pasta, except this stuff might not even be impacting you yet, or not impacting you enough to combat this.

Jennifer Smith, CDE 22:51
And it's, you know, these are the pieces of science education, I guess, that? No, I mean, unless you really Google something yourself. Most people wouldn't know, unless they've gone for some type of a, you know, nutritional biology degree or something that they get the understanding. I mean, most people don't even know that starches essentially start to get digested in your mouth, right? I mean, one of the enzymes is amylase, it's like a salivary based thing that starts to kind of break things down. Thus, a really good reason, then even if you don't remember any of that, it's a really good reason to Pre-Bolus Most things that are simple carbers, right, baseline carbohydrates, and then, you know, other other types of carbohydrates actually, kind of get moved further down. And in your small intestine, you actually have a whole bunch of other enzymes, which, at this point, I would have to look them up, I would have to go back to my nutrition physiology books to look exactly which one they are up, but majority of their those kind of come in through the small intestine. And so we have, we have to wait out this process, right? Your stomach is like a big turning place, and absorption gets done in your digestive tract. Right, so the more things that you put in with carbohydrate, that are longer in terms of the body breaking them down, such as fats, the more drawn out that whole process gets,

Scott Benner 24:26
I wonder, and this is just me wondering if you're constipated. Does your body slow down digestion? Does it say it didn't come out? So we're not going to worry about it right now. We're just digestion just keep happening and the constipation just keeps being forced from what's in your stomach. Right?

Jennifer Smith, CDE 24:44
I mean, constipation is usually there are many reasons for obviously too many to kind of get into and discuss but your body is still breaking down and it's still absorbing. But I've had quite a number of people who've definitely said As soon as I go to the bathroom my blood sugar's seem to even out a lot better who have who have said that, you know, I have trouble with constipation or a lot of the people that I work with through pregnancy, essentially, that's a typical thing in pregnancy is constipation.

Scott Benner 25:18
I remember saying it once, too. And you looked at me a little weird, but I swear to God, I knew what I was looking at. Like, if Arden gets constipated, then she disappears in the bathroom and comes back. You're like her blood sugar is gonna, sticky blood sugar is gonna start going down. Yeah, I mean, that's one of those things I can't prove.

Jennifer Smith, CDE 25:35
But I bet you have hindsight. Yeah,

Scott Benner 25:37
I would, if you made me bet. I'd bet in that direction for certain. Yes. So have we done justice to this idea?

Jennifer Smith, CDE 25:45
I think so. I mean, in a general sense, it's yes, I think so. Yeah,

Scott Benner 25:50
I just want people to understand that the time it takes for food to go through your body impacts where you're going to need your insulin. I mean, I think in very simple terms, I think that's important to understand, you can't just have this blind idea that, you know, it's gone out of sight, out of mind with the food, it must be doing exactly what it's going to do right now. And because, you know, on the flip side of that, you have to understand how insulin works to an insulin, really, you're in the same problem as it just doesn't start happening immediately at full speed, you know, the foods not impacting you right away at full speed. And, either is the and so on. And so you just have to, I mean, you said it earlier, but it bears repeating, you have to eat these things, you have to watch it happen. And then next time believe this is about how it's gonna go. You know,

Jennifer Smith, CDE 26:44
that's exactly right. And again, sometimes those normal things that you eat over and over can then give a little bit of insight to something that you may choose at a restaurant or a friend's house that you haven't necessarily had before. But if you're looking at them, you can gain a little bit of perspective from what you've done and say, Ah, this looks kind of like something I've had at home. And I would have probably done this type of a Bolus strategy for it. So I mean, the best that you can do is give it a try, which is kind of what we all do.

Scott Benner 27:13
Right? Exactly. I always tell people, somebody asked recently, can you do a pro tip on eating in a restaurant? And I said, it doesn't eat a pro tip, the better it tastes, the more insulin it needs.

Jennifer Smith, CDE 27:26
Possibly a drawn out

Scott Benner 27:27
fashion. Yeah. Yeah, cuz that's probably going to be butter that's making you happy. Yeah. All right. Well, I appreciate you doing this with me. Thanks. Yeah, absolutely. Want to thank Jenny for being here. Don't forget that Jenny works at integrated diabetes.com. If you'd like to hire her, you can. I like to thank our sponsor today us med get your diabetes supplies, easily. It doesn't need to be a big hassle. And with us med it won't be check them out and get your free benefits check at us med.com forward slash juice box or by calling 888-721-1514. There are links to us Med and all the sponsors in the shownotes of your podcast player and at juicebox podcast.com. And don't forget to go take that survey AT T one D exchange.org. Forward slash juice box. When you support the sponsors, you're supporting the show. At this point, I don't even remember how many defined diabetes episodes there are. But there's got to be more than 40. If you're enjoying them, you can find them at juicebox podcast.com diabetes pro tip.com, or by joining the private Facebook group Juicebox Podcast type one diabetes, and then heading up to the top I want to call it the I always want to use the wrong word. And then I hold on a second, I'll tell you what it's called when you get the the Facebook page is a private group. It's really terrific. I think it's got like 24 25,000 members in it right now. And at the top. Not here this, there's a feature tab. So you have to answer a couple of questions to get in. But once you're in there, go to that feature tab. And there's a list of all the defining diabetes episodes, all the variables, all the how we eats the Quickstart guides. If you're just starting with the show, the Pro Tip series is a list of popular requested episodes popularly requested episodes if I'm going to use English, special episodes, Scott and Jenny's where they're called ask Scott and Jenny, people send in questions and Jenny and I answer them a whole bunch of stuff on how to Bolus for fat and protein. I mean, there's a ton here anyway, it's all in that private Facebook group up under the feature tab. This is the part where I say thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Please subscribe and your apps Subscribe and follow follow and subscribe.

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#664 Defining Diabetes: Dictate the Pace

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Dictate the Pace.

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

Scott Benner 0:00
Hello friends, and welcome to episode 664 of the Juicebox Podcast.

On today's episode of defining diabetes, Jenny Smith and I are going to define a phrase that I use every day managing type one diabetes, many of you may think of it as a sports thing. But for me, it applies to type one and insulin management in general very, very well. So today, Jenny and I will define dictate the pace.

You know, if you'd like to hire Jenny, she works at integrated diabetes.com, head on over there and check her out. Before you do that, please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you have type one diabetes, and are a US resident, or are the caregiver of a type one, and R US resident, please head over to t one D exchange.org. Forward slash juicebox. Take the survey, you'll be helping people with type one diabetes, and supporting the show.

This episode of The Juicebox Podcast is sponsored by us med. US med is the online diabetes supplier that you've been looking for. They have a dedicated 800 number for Juicebox Podcast listeners. And you can call today to get your free benefits check 888-721-1514 Or go to us med.com forward slash juicebox. US med wants to bring you better service and better care than you're accustomed to. All right, Jenny, I would like to talk about an idea that I keep in my head around diabetes that I don't think you're gonna see on any in any diabetes textbooks. But I like to dictate the pace. And I think of that as a sports metaphor. In my mind is usually a boxing metaphor more than anything else.

Jennifer Smith, CDE 2:24
I was thinking running, but Okay, okay.

Scott Benner 2:27
Well, yeah, that's a good idea that, you know, you could jump out ahead. And once you have the lead, you're in control of maintaining the lead. Right. Okay. It is a simple idea. Normally what I say it's funny, I'll retell this very quickly. I was in front of like, 500 people one time. And I said, you try to imagine that you invite somebody out to speak at something and they get up on the stage in front of all your people. And he goes, has anybody ever been in a fistfight? You know, the people who are running the event go, what is the guy on stage talking about? And he's here to talk about this. Better this guy? So you hear somebody in the corner, go, he's got a podcast, people seem to like it. I don't, it's not my fault. But I say they said this one time, like, who's ever been in a fistfight? And this little kid I swear to you is like six years old, just jumps up out of his seat and puts up his hand and I'm like, I'm like, You should not be hitting people. It's like, Is anyone else any grown people been in the fight? So this man finally like, kind of put his hand up, but he was embarrassed. He's an older guy, time he goes, I've been in a couple fist fights. And I said, Would you rather hit the person first, or get hit first? And he did not hesitate? He's like, I want to hit first. And I said, Yes. And I was like, that's how I use insulin. I'm like, you've got to hit first. Because then everything that happens after that is dictated by the pace that you've set. Yes. And more importantly, what I hear people talking about all the time with insulin is they act like it's happening to them, you know, they just diabetes is happening to them all the time. I don't know, I get high, I get low. I don't know why, like, right. In that scenario, diabetes has dictated the pace. Yes. And now you're the person frantically trying to catch back up again. In my opinion, you hit first. And that way, at the very least, even if what happens next isn't exactly what you want it to happen. At least you know, you made it happen. And you can kind of step back and make sense of that I Bolus five units for this meal. And, you know, a half an hour afterwards. I'm 65. And it's not coming up. Right, right. I didn't get a spike. So I think my Pre-Bolus was okay, but I'm a little low. And what that tells me next time is well, maybe I'm gonna try four and a half units for that meal next time. But at least you know what's going to happen next. Because you know, if you if you let diabetes go First, if you don't Pre-Bolus your meal, as an example, even if you've got the right amount of insulin, now you're shooting up. And you've added variables, mathematical variables that your brain cannot find or figure out anymore, right? You could kind of get ahead of the idea of I think this meal is 45 carbs. And I think my insulin to carb ratio is this. So it's five units. But once you don't Pre-Bolus, once you give those carbs the opportunity to get out in front. Now, it's dictating the pace, and it's changing the rules as it's going, because no longer you just trying to cover these carbs, you could have started at a beautiful blood sugar. But if you didn't, Pre-Bolus Now, you're not just trying to cover these carbs with this insulin, but you're trying to stop this rise, you're trying to take this momentum out of this rise, and you've got to correct a number and keep the food covered. All without creating a low later. Right. But if you just go first, if you punch first, what happens next? You made happen? Right?

Jennifer Smith, CDE 6:00
And then you can figure it out from there, like you said, yeah, if it's, you know, if it's your first sort of adjustment to a ratio, or you've really decided to get more precise about your carb counting, and you're trying to figure out your insulin dosing now that you are being more precise, or whatever it is, you're putting in effort, and whatever outcome is because you made a decision to do something this way. And it like you said, it makes it a lot easier than to say, okay, you know, I got low after this meal where I know, everything I put in should have been right, maybe now that I'm counting more appropriately, maybe my Bolus ratio is actually too aggressive. Maybe it doesn't need to be as much insulin, or maybe I Pre-Bolus. Really, really long. And that's the reason now I'm actually too low. Yeah. So you know, it gives you points to sort of reference and go back to, to make a better call the next time. If you give enough time, it's kind of like your example, I know, you always use the tug of war game, right? Between insulin and food and insulin and carbs. So you want insulin pulling a little bit bigger. And, and, and sooner, and then you have more control of the out of why things are turning out the way that they did, right?

Scott Benner 7:24
Yeah, I mean, people are gonna put it into whatever perspective they can, that's what I want. I mean, you might not be interested in the same things I'm interested in. But you know, another way to think about it is if you like baseball, and you're pitching, you need to strike the first time, right like is nothing worse than starting with a ball. Now, let's want to know, and you're already behind. And now you're just like, Oh, now everything gets finer, it gets tighter, you have to be perfect, because you're running out of chances. And but if you start with a strike, you're ahead. Now if the guy should hit the ball, and he gets a hit, that's good, good on him. Tough luck for you. But at least you're not fighting with this guy down to balls, no strikes, like like you're dictating the pace you're like are if you beat me, you beat me. But if you don't beat me, we're playing this game on my terms, I'm getting ahead of you, you're the one who's at, at a disadvantage, not me. And once you get that advantage, the worst thing you can do is give up the high ground. Like you always make the opponent fight from down low, right. And that's what you have to do with the diabetes, it's what you have to do with the blood, I think of it as the blood sugar, probably, but you come at it hard. And then you're now dictating the pace, and then it might try to do something else. And maybe it'll even do something that you don't like, but you don't switch places with it. When that happens. This is such a weird idea. But, you know, you strike first, you're ahead, it strikes back, you don't go into defensive mode, you push back again, right, you keep the high ground, always keep yourself in that position. This may be more of a an intellectual exercise than it is an actual physical exercise, when you're not managing insulin, but whether you think of it as a mindset or as an actual action that you're going to take in my mind, the minute you start, you know, I'm I'm joking my sports metaphors all over the place, but the minute you start covering up your face, I mean, think of every fight you've ever seen when I cover up, um, skirt, you know, like you gotta keep moving forward.

Jennifer Smith, CDE 9:39
Right? I kind of think about it in a little bit. I guess in I think about it in terms of how insulin works, right? As we talk time and again about rapid insulin and really dictating the pace means you understand how long it actually takes insulin to start I'm working. And so I kind of think of it being a runner, I think of it like, a warm up, like a Pre-Bolus, to me is kind of like a warm up. I don't leave my house at, you know, huge, like, I don't sprint out of my driveway, right? And my muscles are gonna be like, Okay, we're done now, thank you so much. I need to get things going. And that's why I think about my Pre-Bolus is kind of like that warmup time, until like, insulin is really now like, it's ready. And this is this is the time to put my foot in. Because it's gotten enough time to get its momentum, right and get moving. So that's kind of how I think that's beautiful.

Scott Benner 10:46
Really, because that's like, that's like thinking about it like starting a Have you ever seen a locomotive start moving? Or have you ever been on a cruise ship? Like a job? Okay, if you hire Alright, well, listen, I'm sad to tell you I've been on a cruise ship. And it's, you're up against the dock, and the things not moving, right. And they unmoored it, and then it starts to move. And it's many minutes before you recognize that the ship is moving. Right. So like, it's the old adage, it's like turning the turning a turning a ship takes forever, that kind of thing. But when you just talked about it as warming up to run, I've seen a a freight train, pull pull out of a station, and it starts to move, like it's trying to go and it doesn't move right away. And then it starts very, very, very, very slowly. I mean, almost imperceivable to your eye at first, and then it's moving at a snail's pace. And then it almost looks like it's walking away. But I'll tell you what, 15 minutes from now, that thing's got it moving like a rocket, you know, and you can't stop it. That's a perfect way to think about the insulin. It really is. You can't just you can't just push the button on your pump, and start eating. By the way, especially with some pumps, I'll use Omni pod as an example on the pod puts insulin in on the slower side. Like if you're making a big Bolus, it isn't magically, it isn't magically in 30 seconds from now you might look up a couple of minutes from now you've only got five of the 10 units in

Jennifer Smith, CDE 12:28
and as a good example, how many pods each click is point 05.

Scott Benner 12:33
Really, as its Bolus, click

Jennifer Smith, CDE 12:35
05.

Scott Benner 12:36
If you isolate

Jennifer Smith, CDE 12:39
zero 5.0 5.0. I mean, it takes a while I've I've counted them. I did it. When I first started years and years ago on Omnipod. I asked my trainer, I was like all these little cliques. She said, Yeah, if you wanted to, you could count them up and see how many go into like a one unit Bolus because they're all point zero five,

Scott Benner 13:00
you were the exact right kind of dork for this podcast.

Jennifer Smith, CDE 13:05
I like it. That's okay. I'll be a door. No, I

Scott Benner 13:07
mean that. I mean that in a wonderful way. Yeah. So in my mind, when if you hear me say, like, dictate the pace, this is what I'm talking about. I'm talking about, you can you can picture it any way in your heart, you want to if you're a UFC fan, once they're down on the mat, jump on top of them and keep punching them in the face until they give up like do not stand up, turn your back and get kicked in the back of the head. You know. And I do think that in practical terms, when you're making a Bolus, it's, it's easy to push the button and just think it's going to be okay. But if you're using the CGM, my goodness, 30 minutes afterwards, take a look at it. You know what I mean? 45 minutes, take a look, you know, if you have your setting set to alarm on your Dexcom, for example, like Ardens is 70 and 139 7121. I'm following her. If 30 minutes later, she's 115 Diagonal up. And I'm starting to look at a real harsh up. This might not be going the way I think it's going to go. But if you don't look or if you have your high alarm set at 180 You know, then by the time you want to know soon enough, it's too late now. And now you're and you're immediately chasing at that point when you find out too late. Now you're chasing now you're from a previous episode now you're showing up 15 minutes after the bank has been robbed. Right? So we want to the information is your friend. You know people talk about like data in court, whatever you want. But this thing is telling you what's about to happen or what is happening. And if there's a moment where if you react correctly, you maintain control. And there's a time that you wait too long for that. control changes hands. And now you've given up the high ground. And what that means practically speaking with diabetes, is you're about to spend the next three to four hours, beating your head against the wall, drinking juice, or bolusing, or whatever's going on. Because you let this thing get the better of you. And in my mind, a couple of well placed glances. A little bit of effort upfront, saves three and four hours of what actually feels like a tragedy when it's happened in the middle of your day. Like it really, you hear people and especially overnight.

Oh, it's terrible.

Jennifer Smith, CDE 15:34
I think the overnight is the biggest complaint.

Scott Benner 15:36
Yeah, yeah. Because when you going to sleep now, it because in your mind, you're like, Okay, well, I Bolus this one ad. It's not going to be low in an hour. But if I fall asleep, am I going to wake back up, and then you start doing that thing where you're like, I'll just sit up till 230. And then at 230, it's 150. And you're like, Oh, I guess it needs a little more. And all of a sudden, it's four in the morning. And, you know, it just it paying attention upfront, doing the little things, keeping the timing of the insulin on your side, dictating the pace, however you want to think about it. A little bit of effort upfront saves a ton of problems on the back end. Right? That's all and some of it

Jennifer Smith, CDE 16:15
is also you know, some experience obviously goes into it too. I mean, I would certainly say that it takes a little bit of time to know how to manipulate things, right. I mean, I had a horrible pods like the other night like horrible. Obviously slept through high alarms. I mean, in my heart Hi, alarms are not like terribly high. I slept through a lot of alarms woke up in the morning. I think it was like 250 to 50 am. And I knew before even looking at my CGM I knew that I was high. I knew I was high. And I look at it and like, Okay, this is always lovely at this time of the night right and I Bolus took an injection to Bolus because my news sites I knew at a blood sugar like that we're just not going to get over this Hi, I Bolus are navigated up my low alarm just a little bit in case of need to kind of catch what was falling. And it woke up in the morning at 84. Nice and flat. I felt like I jumped up. Like nobody was there to see me. But that's okay. I did my own little happy dance.

Scott Benner 17:31
Well, I'll do it with you. Because knowing that that's what needs to be and at 230 in the morning, getting your ass out of bed and changing that pop up. Give me your shot. That's not easy to do. But what it did was it saved your next day. It did really poorly. You If you ignore that you wake up you're 300 Yeah, spend five hours fixing that easily. And you feel oh, it was 301

Jennifer Smith, CDE 17:53
I was 301 that I can't remember the last time I saw a number that hi i so it was I mean, very clear to me where my pump had actually like pooped out. Yeah. And in terms of knowing you're talking about before, kind of like that black hole. Kind of there was clearly a black hole that started because I could tell where the black hole ended up causing the rise up to happen. And it just kept going from there wasn't

Scott Benner 18:25
gonna stop No kidding. Yeah, I mean, and you said something earlier to like, you really do need to. Like if this is for somehow this is your first episode of the podcast. Oh my God, please don't start here. You know, like, go back to 210. Listen through the pro tips. Try the defining diabetes series. Like you don't want to jump in at ninja level and try to start rolling. You really will mess it up. There's a lot to understand on top of that, but once you're caught up, listen, I think of the podcast is a compendium like my assumption is if you're listening to this episode, I mean, I don't even know this is probably in the late six hundreds. You know, my thought is that you've heard the stuff before this. So yeah, okay. Well, I really appreciate you taking the time to do this with me. Thank you so much. Always fun, thank you I cannot be the only one of us who is incredibly frustrated with the company that sends the diabetes supplies to our house. I just can't be I mean, if the experience that I've had so far and all these years is even a little reminiscent of what you're going through, then you may be looking for something better. You may be looking for us Med, a company who prides themselves on white glove service. They want you to get better service and better care than you're accustomed to. US med is the number one distributor for freestyle Lee Bright systems nationwide. They are the number one specialty distributor for Omni pod dash, the fastest growing tandem distributor nationwide and the number one rated distributor index com customer service surveys. With over 1 million diabetes customers served since 1996. US bed carries everything from insulin pumps, and diabetes testing supplies, the latest CGM, they always provide 90 days worth of supplies and fast free shipping. US med accepts Medicare nationwide and over 800 private insurers. Come on, give them a call 888-721-1514 Get your free benefits check. Find out why they have an A plus rating with the Better Business Bureau Wouldn't you like some white glove service? I know I would. The phone number again is 888-721-1514 and that number is just for Juicebox Podcast listeners or you can go directly to us med.com forward slash juice box and get that free benefits check there. At that link. You can also see reviews for us met better service better care. There are links in the show notes of your podcast player and links at juicebox podcast.com to us Med and all the sponsors

if he enjoyed this episode of the podcast, there are many more defining diabetes episodes. There's a list of them a complete and full list of them at Juicebox Podcast type one diabetes on Facebook, that's the private group that you might want to join. I am now going to try to list all of the defining diabetes episodes in one take without misspeaking. I'm not going to do the episode numbers you're gonna have to get those from the Facebook group Okay. All right give me a second here on me. Let me center myself

you're ready you're I go. Start started episode 236 With Bolus then Basal honeymoon a one C time and range standard deviation extended Bolus algorithm non compliant glycemic index and load Pre-Bolus Trust will happen low before high Bertel diabetes stop the arrows ketones insulin resistance and over Bolus feeding insulin bumping nudge rage Bolus compression lows and interstitial fluid. fat and protein rise Dawn phenomenon smudgy effect feet on the floor instant sense damn instant sense damp insulin sensitivity why can I say sense of insulin low insulin sensitivity factor adrenaline highs insulin deficit growth hormone stacking insulin hydration Lata diabetes moody diabetes crutch crutch crush it and catch it see peptide and beta cell insulin onboard pump break barriers and today's episode dictate the pace. Once again. There are lists available on my social media. Check it out. Tell you what I'm gonna put it up on Instagram today then you'll be able to find it there in the Instagram wall or still I don't know what you kids call that story. Now that story. Now I don't know wherever you put the pictures. And it'll be on both my Facebook pages the private one Juicebox Podcast type one diabetes and the public page bold with insulin. Actually the defining diabetes series as well as the diabetes Pro Tip series is available at diabetes protip.com and juicebox podcast.com as well as those other places aforementioned. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, if you're listening in a podcast app follow and subscribe follow and subscribe follow in subscribe.

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