Podcast Episodes

The Juicebox Podcast is from the writer of the popular diabetes parenting blog Arden's Day and the award winning parenting memoir, 'Life Is Short, Laundry Is Eternal: Confessions of a Stay-At-Home Dad'. Hosted by Scott Benner, the show features intimate conversations of living and parenting with type I diabetes.

Filtering by Category: Ask Scott & Jenny

#369 Ask Scott And Jenny: Chapter Fourteen

August 19, 2020Scott Benner

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

Any helpful tips on sleepovers?

What to do and consider when relocating? Tips on finding a new doctor.
What other specialists do diabetics need to visit?

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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 0:02
Hello, everyone, welcome to Episode 369 of the Juicebox Podcast today on Ask Scott and Jenny. And these are questions that Jenny and I did our best to answer that came directly from you. Today we'll be talking about sleep overs, relocating, finding new doctors, blind management, which is the idea of being able to manage Type One Diabetes without being with the person that you're helping. And what are those other doctors that people with type one diabetes need to visit? Now you guys know Jenny, by now, Jenny has had Type One Diabetes for over 30 years. She's a certified diabetes educator and a lot of other cool things. But mostly, she's the first you know, from the pro tip series from ask Scott and Jenny, of course, and defining diabetes. Jenny really is just the cat's pajamas when it comes to type one and a couple of other things. 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 for becoming bold with insulin. If you hold on for just one second, after the music, I have something for you.

So today's show doesn't have a sponsor in the classic sense, meaning that no one has you know, paid a fee to put an ad on the podcast today. What I do have, however, is an opportunity, one for you. And one for me. One for everybody living with Type One Diabetes, actually, but let me explain a little bit to you. If you remember back a number of weeks ago, maybe it's months now, the CEO of T one D exchange came on. It's a nonprofit that does data driven stuff to help people with type one diabetes. Anyway, after that episode, I maintained a relationship with T Wendy exchange, we're talking back and forth about a couple of things. And they asked me if I'd be interested in helping them gain participants for the T one D exchange registry. So see the T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters for like the parents of somebody with type one as well. The participants are volunteers that provide their data for research by just answering these questions in an annual survey. Once you're enrolled, registry, participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one diabetes, help accelerate the discovery and development of new treatments, or to generate evidence that supports policy and insurance coverage changes that help people living with type one. So if you're not just paying for me to tell you this, how does this work? This is important for me to tell you, I want you to understand this.

Every one of you that goes to the link, T one d exchange.org. forward slash juicebox enters the registry, answers a couple of questions to see if you're eligible. And it's really just about having diabetes, couple other things. And then complete the questionnaire, which I've done already took me about seven minutes, I actually did it live. And I recorded it. So it's at the end of this episode. So you can hear took me about seven minutes. The questions are very basic and completely anonymous, your information will never be attached to the answers, they will never know that you. Let's say your name, for instance, is john. And john, your information, the answers to your questions will never be attached to your name. It's taken very, very, very seriously. HIPAA regulations are followed to, you know, the nth degree. Anyway, this information impacts all kinds of things. For instance, you know how Medicare started covering cgms. They used the data that the T one D exchange was able to pull together to show how important that was. And it helped move that legislation forward. It's helped coverage for test trips, it's helped to show that Dexcom can work without finger sticks, all of this different stuff. But but here ends up being the real problem. The more data that they have, the better. They can do their job. And the T one D exchange is having trouble getting enough people to do it. That's why they came to me they thought that this podcast could reach more people. It's not a situation where people don't want to do it. It's that they don't know it exists. So they don't know how to do it. So they don't just need 25 of you to do this. They don't just need 100 of you to do this. They need thousands of you to do this and it's super simple. Again, you'll see at the end, but you go online, the website is really clean. It's very intuitive. It's easy to get through a couple quick questions. Am I okay to do this? Yes, comes back immediately through your email, you keep going, right there on the web page, answer the questions, I go over every question. So you know them. And then that's it. And then annually, so yearly, you'll be asked to kind of update your answers to some things and maybe ask different questions. I put a lot more information at the end of the episode, so you can understand this. But that's it. It's super simple, and incredibly valuable for people living with type one. So if you've been looking for a way to support people with type one diabetes, and if you'd like to support the podcast, this is going to do that, you know, with one one effort two birds, one stone, think of it any way you want to, you're going to help people with type one, you're going to help yourself, you're going to help your child, you're going to help the future with type one diabetes, and you're going to help support the podcast. T one D exchange wants you to know that the purpose of the study is to collect the information from individuals with type one diabetes, and parents of children with T one D to learn more about the management of type one diabetes, how it may change over time, and how different management approaches relate to glycaemic outcomes, acute complications and the use of health services at this time, there is no end date in sight for the registry. T Wendy exchanged hopes to follow a large group of people with type one diabetes over many years, so they can get a very firm grasp of what all this data means. Anyway, I think the people listening to this podcast fit perfectly into this idea. And I know we can reach a lot of people. So if that sounds good to you, and you can spare a few minutes, T one d exchange.org. forward slash juicebox. Links near show notes and links at Juicebox podcast.com. us residents only. Oh my god. Hi.

Unknown Speaker 7:00
Hi.

Scott Benner 7:02
When you texted I was like leisurely. Just you know,

Jennifer Smith, CDE 7:05
like getting a cup of coffee or no tea. Don't drink coffee. Tea. Yeah, I was.

Scott Benner 7:10
I had a Arden's blood sugar got low on me at 4am Oh, no, just two seconds. I got up and I fixed it. But I I stayed awake to make sure. And then the dogs barked. And then before I knew it, it was 630 to get out. I hadn't been up yet. And Kelly let me sleep. So I just like 10 minutes ago, my eyes was like, Huh, it's morning. Funny, I don't sleep in ever. I never get to sleep in. So I was like,

Jennifer Smith, CDE 7:43
well, that's a long sleep. And it was.

Scott Benner 7:45
And so I was like, Okay, cool. Like, I'm gonna go set up and get ready. I'll take a shower. And then you're like, I'm ready. Lady, what's going on? All right, Jenny, let's actually get to the questions here, shall we? Get Megan Megan goes, I've heard Jenny talk about when she was little. This is about little tiny Jenny Oh, and did sleep overs. I've never let my daughter go to someone else's house overnight. She's nine years old. Any helpful hints? She doesn't wake up to her phone alarms. So it would have to be me calling in other parents when she needs something. Well, I know what I do. So you're in a different position. You're, you're not little Jenny anymore. But like, let's talk about that for a second back in the day. Like why was it easier when people knew less about diabetes? Like and I mean about the data and what was actually happening? Because

Jennifer Smith, CDE 8:37
Yeah, I mean, did you because nobody could follow anything. I mean, there was there was literally no continuous glucose monitor. And while there were pumps, they were they were nothing. So I didn't I didn't have one. I was only on daily injections. I mean, this lipo was first that I had, it wasn't like some random person down the block that was like, Hey, I met Jenny at the playground. Let's have her come sleep over. You know, I mean, these sleep overs were with good friends that knew that I had diabetes. I mean, they didn't know much about the management of it. But you know, what my parents essentially my mom really did. And she was like, the order keeper in our house. Was she just kind of hyped up a plan, right, she was, she called the parent ahead of time. She knew kind of like what kind of snacks and things what we were going to be doing, whether it be like playing outside or whatnot before or if it was just an evening kind of thing where we'd be watching movies and then talking all night or whatever it was, you know, and she essentially just gave a guideline for Jenny needs to check her blood sugar at these times. Again, we had no continuous monitor just so I had to do a finger stick right and you know, has to have a snack at this time because actually at the time of doing sleep overs, and even In through high school, the insulin that I was on required very regular meals and snacks, I didn't have the option of using a human log because it wasn't available or a nova log because it wasn't available. There was no rapid there was our right, which was longer acting. So I had very time two types of things. So I always had an evening snack plan. And it was just that my mom had to make a consideration for what that was going to be at the friend's house. Now compared to what I usually had at home,

Scott Benner 10:31
did you deal with the lows, the way people deal with lows now on that insulin.

Jennifer Smith, CDE 10:37
Um, only if you didn't eat only if you didn't eat correct, because on regular insulin, you usually mixed it in a syringe with an intermediate acting insulin, which was cloudy, right? And that had about a 12 to maybe 16 ish hour impacts, you took that kind of insulin with the our insulin every 12 hours morning, you didn't take any insulin at lunchtime, because the cloudy insulin was supposed to peak in action. And so the lunchtime met the peak of that insulin, so you didn't take insulin to cover lunch. But again, meals were also very structured, like I had a certain amount of fruit and vegetable and protein and fat. And, you know, everything at the meal was very sort of sketchy, you know, a schedule that was regimented. So I think that might have actually made it a little bit. A little simpler. I would say

Scott Benner 11:28
I'm honestly, I'm thinking your mom's real concern was eating at certain times, right testing to make sure we're not way crazy off one way or the other, and, and maybe having to adjust the insulin a little more aggressively for party foods that you didn't eat every day.

Jennifer Smith, CDE 11:47
Right? Right. And potentially knowing that, you know, the next morning, I mean, the call was always this Jenny's blood sugar. It wasn't that the parent of the house figured out what to do. It was that they called my mom and they were like, this is Jenny's blood sugar, and that we did the math, and we figured it out. You know, we knew how much to take them in. Because we did have a correction. Yeah, you know, to be able to add in. But as far as overnight, I believe I remember the parents at night, waking me up in some cases, but I can definitely say not all the time to test. I mean, that was a, that was a thing that my parents did do at home. But I'm quite sure that my mom didn't have them doing that all the time with,

Scott Benner 12:33
it'll be okay. It's usually Okay, that kind of thing.

Jennifer Smith, CDE 12:35
And she went with that, because she knew the kinds of things I was going to be snacking on at a party in the evening, were likely actually just going to drive my blood sugar higher than we would want them anyway. Yeah. And we just left him sit there. So you know, we didn't know really,

Scott Benner 12:48
so. So I think the two things here that make your experience different than Megan's question is the type of insulin right that we use now versus back then. Right? And that your mom had things pretty well structured, right? Yeah. She wasn't like, things weren't a mess at your house for your diabetes. Your mom was like, well, we'll just roll the dice and let her go. You're like, shoot, right? She had a plan? I think it sounds to me, How old is your mom?

Jennifer Smith, CDE 13:21
Um, my mom is

Scott Benner 13:22

How would she do on one of these interviews? Do you think I just thought it might be. might be interesting to talk to your mom one day. But, but you'll decide if that's a good idea or not. I don't I don't need to know. But But my thought was, is that she was she was more like us, the people listening to this podcast, probably. But back then. She really, like dug through it. It wasn't just as easy as you know, like, blah, blah. Like, I know, I had friends who had diabetes, you know, that long ago. And it was just sort of like, Hey, this is what they told me to do. And this is what I do. Right? They weren't looking at it any farther than that. Right? And so

Jennifer Smith, CDE 13:59
today's technology has brought in the ability to see so much more. I mean, I mean, even my mom says, today, gosh, I wish that I had had this type of visual information. When you were little right. The things that we could have done differently is kind of, and I'm like, you know what, Mom, I'm alive. I am complication free. You did a really good job with what you had. And that is what it is, you know. But in today's world with the technology we have, you kind of have to take it and say, What do you know about the people where you're sending your child's sleep over?

Scott Benner 14:34
Right really going to do this thing that you're asking to do? Or will they not see it as being important? But I also think that if Megan has a CGM, if she has a dexcom and she has shared I mean, which I think at this point, they all share like there's not one that I don't think anybody's using one that they can't see on a phone or, or something like that remotely. So is the idea for me. I mean, here's how I did it. I think I thought, okay, I can't not let Arden spend the night at someone's house, right. And I've had two different experiences. I've had parents who lets you know what, I've had three different experiences. That's interesting. I've had parents who just listened to what I said, and didn't over or under think it. And that always went well. I had a guy who had struck him so hard. The Father, not the mother. He just stayed up all night long. He couldn't bring himself and go to sleep. When I got there in the morning to pick him up. He hugged me, and we did not know each other. And it was a I'm sorry, Your daughter has this hug. Oh, like it was like that.

Jennifer Smith, CDE 15:39
Like, I'm sorry that you stay up all night? Yes.

Scott Benner 15:41
He just assumed I think that I probably know, he probably looked at me. Like, that's why that guy looks so bad. But, yeah, I mean, I wouldn't be I wouldn't be okay either if I never slept, but no, he just, he cared so much. And he and he took it so seriously, that he couldn't bring himself to have a moment he slept through. And he just sat up. Sure. And I've had people this one woman comes to mind. Who, if something would go wrong, it was fine if it went right. But if something went wrong, if Arden's blood sugar got out of toe a little bit, she'd call me and say you have to come get her. And she made me pick it up at three o'clock in the morning, once. So I've had all the different experiences. So the people you're sending them to, are a big part of this AR because you don't know how they're going to react to being able to see the data. Right?

Jennifer Smith, CDE 16:37
And I think you may want to in that, in that sense, you may want to even start with the people who really, you've come to know them, well, you don't only know their child, but you've come to know the parents of the child, right? You've gotten comfortable with them, they see your strategy of management because you've interacted socially, hopefully again, at some point.

Unknown Speaker 16:59
What right.

Jennifer Smith, CDE 17:02
video now. Right, right. So, you know, I think once you get to know people, they have a comfort level, because they can see how you strategize. And they can see your comfort level with it. It's throwing a child into a setting where again, it's like, the parent of a kid who's kind of newer, to the group of kids your child hangs out with, and you're like, they're trying to get to know people. So they're going to have a party and whatever. Well, you know, what, maybe call the parent talk, see what their comfort level really is with everything. Because people I've learned people get a sense of comfort from what you exude. Right? They, they, they feel eventually what you're feeling about it. So if you're like, oh my goodness, wow. I mean, they're gonna be all like, anxious and like, ramped up

Scott Benner 17:53
to, every time I talked about school, I tell people do not come off as crazy, because they're just gonna think you're crazy. And that's going to be the end of it. Now, the person who made me come get Arden at three o'clock in the morning, let me say this. I was not surprised that she was the one that that happened with. She was a me person. And when it got hard for me, being her she didn't want to have anything to do with anymore, but her kid was popular and art and was trying to, you know, get along. Yeah. Interestingly enough, now I think Arden's popularity has changed a better way. Yeah. So I don't see Arden trying to, you know, make friends anymore. It's she's just comfortable with the people she's comfortable with now, which is really nice. But But this bigger idea. And Megan, you're lucky you answer the SS question here. Do you know, years ago before all this fun technology, I actually sat in Manhattan for 12 hours in a television studio in a chair, and a light would come on. And someone would say you're live in Indianapolis on CBS three news in 54321. And then I would talk about sleep overs. And I did it for Lilly. And then you'd sit back and say this one's a radio, you don't have to be on camera and you sit back and then you do a radio interview. I forget what they call them. But I did one one time for Lilly diabetes, when they were putting out this little book, it was like kids books or something like yeah, like the CoCo bucks. Yeah. And it was interesting, because I got to talk about sleep overs over and over again, it was a little more like, Listen, you really need to let your kids do this, because it's a weird thing to restrict. Now, having said that, I know people who think that sleep overs are weird, and would never let their children sleep in someone else's house. And I don't know that I can argue with that. Like, I mean, if that's your feeling then right on, but what I think is, is that if this is something your kid wants to do, and something you want them to do, having to restrict them because of diabetes is gonna have some sort of psychological impact. It might be a little But it's not a good thing moving forward, I was never allowed to go anywhere, which will later build into I shouldn't go places I'm scared like it could, it could pet right it could build, some people might not care. So I think if you've got the technology, the way I ended up eventually being good at letting art and go anywhere, was I would practice managing when she wasn't with me through Texas Rangers, right, and then we got so good at it, I don't need to be with Arden to help her with their blood sugar, right, then it becomes the overnight spot, then you have to have a person who's willing to take a phone call, and knows it's possible the phone's gonna ring overnight and will wake up and can take direction from you over the phone. Correct me though.

Jennifer Smith, CDE 20:44
And all kids too hard, a very different level of their own ability to manage, right? Some kids from early on, can wake up to their alarms, and they may not know how to treat it, but they wake up to it, they go shake their parent, they're like I'm low, or their parent is already in the kitchen getting themselves think or whatever. Some kids sleep through everything. And it's a good majority of kids who actually sleep through everything, you know, because they just kids have a very deep sleep, which is a good thing. But from the standpoint of alarms, especially when you're trying to communicate with your child at three o'clock in the morning, and they're, you know, six miles away. That's it's hard. So again, you have to have that communication piece with the parent, not necessarily saying hey, if to sit up all night and watch my child's blood sugar, but if I call you, I would hope that you're going to answer you know,

Scott Benner 21:38
two other things with technology that helped with that. One Find My iPhone for people with iPhones, if you don't know what find iPhone is it sends a piercing signal through another phone. So you know, you could send that. The other thing is to I would you know, after dexcom share was was you know, a thing. I put the the follow app on the parents phone, right? But only give them alarms for low extreme

Jennifer Smith, CDE 22:08
high or really

Scott Benner 22:10
percent right, I would put an extreme high or at 55. I said, Alright, listen, if this thing beeps you know, kind of deep and twice. Her blood sugar's too high. And if it beeps, like faster, I can't I said dumb and you'll see like, it actually sounds more panic the low beat Yeah, it feels like it's killing you, oh my god, you're low do something. Or my brain is, you know, you know, attributed that to the sound at this point. But and I said, you know, it'll be beep, beep, beep beep for really fast that's low. Low means do something right now don't wait, hi means we really should be getting her blood sugar down. And those were simple, like directions that I think they were able to understand. Yeah, maybe my

Jennifer Smith, CDE 22:55
mom, my mom went as far as all the sleepovers that I went to I always had my glue gun kit with me. I did. I mean, the parents again, were knowledgeable, good friend, parents. And they, they knew how to use it. They knew the purpose of it. So I just I brought it along. But again, never had to use it in those circumstances. Thankfully, the parents never had to try to read the directions at two o'clock in the morning. And

Scott Benner 23:22
it's a tough thing to look at another human being in the face, pull the thing out and go, if she has a seizure, what I need you to do, like, wait, what a second now. Yeah, and you're like, Oh, don't worry, that's not gonna happen. I used to say aren't had diabetes for five years, six years, eight years, that's never happened. We've never used one of these, I buy these and throw these away all the time, blah, blah, blah. Right. Having said that, if she should have a seizure, it's not a not a reassuring thing to say to another person. But it's a good thing. And so my point is, maybe have that this is how the glucagon works conversation, not at the drop off. But prior to that, so that you don't put them into shock. You know,

Jennifer Smith, CDE 24:02
and I think you'd actually just said something very appropriate. It's the prior to, it's the planning. Yeah, right. Most people don't have any plan for dropping their child off at a sleep over. Other than just saying, yes, you can go get everything ready, and they drop them off. Yeah, as a parent with diabetes, you already know that you have to have a plan for a plan and plan B for Plan C and whatever else. Yeah. So it's the plan ahead, the talk ahead, don't expect to spit everything out at the parent as you're dropping your child off at the curb and then be like, bye, bye.

Scott Benner 24:40
This is not something you should be yelling out the car window. I'm actually thinking we should add a couple other things to this. So parties, picnics, things that you don't go to because you don't you know, you don't like the parents. So you just I can't spend the afternoon over there with those drunks, you know, like gigs or whatever. Whenever you know, something you Won't be at. I think a lot of these ideas fit right along. And they're actually simpler because people are always going to be awake during them. The one thing that I know causes a hiccup is a pool party when you go in the pool, now you're not, you don't have a signal for your CGM anymore, right. And so I think still, one of my, one of my most valuable diabetes skills, is being able to blind manage diabetes, like not to have to be with the person or see exactly what's happening, to infer, from what I know about the situation or what I can see in the data. I think that's why I'm good at looking at someone's graph and being like, hey, blah, blah, blah, you know, do this and this and the way I think of it, the way I thought of it originally, when I realized I need to be better at this when I'm not with it, is I was always impressed by customer service people for computers. Like they're not looking at your computer, but they're walking you through the computer, right? Like they're like, you know, see that thing over there. Click on that,

Jennifer Smith, CDE 26:06
you know, the parts, they know where they are, they know where to poke it, they know exactly on a list of a drop down which one to write,

Scott Benner 26:12
right, like, in my mind, make yourself a marine that can take apart and put his gun back together, blindfolded. Like, like that sort of a thing with diabetes. Like I feel like I'm there now, which will help you in your own life too. But it definitely helps you when you lose the signal. And you can calmly say to yourself, okay, the signals last Arden's in the pool now, yeah, she's not gonna swim that long, she doesn't usually swim this long. So in about a half an hour, you know, she was 105 and a half an hour, if I haven't heard from her, I'm gonna send her a text and ask her to get back near the transmitter for a minute. And be okay with that. And not be sitting around your house, you know, scrolling on the walls in your own excrement because you've lost your mind. Billy's a nice boy. Like, you know what I mean? Like, like, try to hold it together is what I'm saying. And if you can't hold it together a nice phone call to the host parent who's willing to take that phone call or text just say, hey, I need you to have Arden test your blood sugar. Right? That's all

Jennifer Smith, CDE 27:12
and tell her to get out of the pool for five

Scott Benner 27:15
minutes, text me afterwards. That's, it's all very reasonable. In the end, as we're talking to Megan and talking to each other, and I'm recollecting all these things I've done throughout time with diabetes. In my mind, I feel like I'm like, I almost feel like I'm getting away with something or having a podcast, because is anything we've just said not common sense. Like, right? It's just that what happens to us around diabetes, is the fear literally knocks that common sense right out to you. Correct? Yeah. And then and you cling to I need rules, give me rules to follow, if I have rules, then nothing will happen to my kids not gonna have something happened to him, I don't want to happen. I don't think that's it. Like I don't, I think those rules are just there to make people give them like a, almost a false sense of calm, where what you really need to do is understand it, and is different than anything else in the world really. You know, also making keep in mind is your kids nine, now she's going to get a little older skin and want to go to a dance at the school, this is going to be the same, the same muscle you're going to use there, you're going to start sending her to parties, I hate to say this in the 1314 range, some little malcontent and your town is going to start drinking and think it's really super cool to bring alcohol to a party. And hopefully your kid won't be the one at 14 years old and artist that wants to try it right. But you know, by then I'd like to see you have a firm grasp on this. Because, you know, right, everything gets a little harder when they hit that, that age in there.

Jennifer Smith, CDE 28:50
And I think you brought up a point to before about, you know, it's your decision that you just don't agree with sleepovers at all has nothing to do with diabetes, then for the child who has siblings, those siblings also follow the same rules. So it's a little easier for that child to feel like has nothing to do with diabetes, it's just because mom and dad don't really agree with going to sleepovers. Whereas if your siblings are going to parties, and they're eight years old, and you're 12 years old, that's really that's not fair. It's not your call, and you're causing a problem that could be a problem later on for how that child continues to grow and feel about sharing about diabetes and being open about it and even managing it a little bit more on their own in an open way.

Scott Benner 29:36
Diabetes is already an already has the possibility of being an issue in your kid's life. You don't want to turn it into that cousin that you talk about behind their back. Where you know, I mean, where you're like, oh, yo, Patty's great. And then at home, everybody's like, Patti. So where am I? Right? You know, maybe like you, you know how it goes with family, right? Like because that's, you don't want your kid you don't want to be telling your kid. It's fun. This is manageable, you can have a normal life. And then, you know, three times a year be like, but you can't go because of this diabetes. It's not my fault. I'm not the one keeping you out of it. Because now you now know Nobody. Nobody likes Patti, and not therapy, and right, not gonna help you throughout your life.

Jennifer Smith, CDE 30:18
No, no, I mean, I can, I can remember only one. And as an adult now, well beyond my teen years, I still remember this one time that I was not allowed to go to do something. And it was in high school. And I know it had to do with diabetes. I do. Yeah. And I know, because my brother who's four years younger, so we were never in high school together, right. I finished I went to college, he started his freshman year, so we were never together. My senior year, our basketball team went to stay. And that meant that we wanted to travel with our team. And we wanted to go to state and watch them play a weekend tournament. Right? My mom wouldn't let me go. All my friends were going my known friends, good parents that my parents knew were going to be there. My mom wouldn't let me go. Yeah. And I knew the reason, despite her letting me go to a million other things, sleep away Girl Scout camp, sleep overs, all those things. But I was in high school. And she didn't want me to go out of town to sleep in a hotel, along with this like, and again, I think from a visual had she had some information technology wise, she would have been okay with it. But yeah, that was the one instance and I know it was diabetes, because my brother when he was in high school, they also at some point went to state, the varsity team, and my brother got to go

Scott Benner 31:46
could this has been a gender thing, as I'm asking was, was was your mom trying to keep Jenny pure another week? I don't know. Why, why did you really want to go to the basketball tournament?

Jennifer Smith, CDE 31:58
And that's the funny thing that was a really like, I was I still am pretty much like a follow the rules. There are many things that I don't, you know, follow strictly everything kind of go my, but I'm pretty much like the rule follower. And I was I growing up my brother was the one that pushed the buttons. He pushed the limits. He did not me. I was the firstborn and I did it. Like I was told I'd be home by 1130. I am home at 1120. I was told to be home at 1130. I I don't know if it was the gender component. Perhaps it was. I maybe don't

Scott Benner 32:33
I don't know, either. I'm just wondering. That's all

Jennifer Smith, CDE 32:35
anyway, that's the only one situation that I

Scott Benner 32:37
can remember if your mom was like, I'm just gonna pull this diabetes card out one time here to keep Jenny a virgin.

Jennifer Smith, CDE 32:47
Boyfriend at the point.

Scott Benner 32:49
Don't need one of those at a basketball tournament. Anyway, that's nice. Do we want to talk about relocating when you have type one, like literally moving somewhere else? Or do we want to talk about it or

Unknown Speaker 33:05
have you? Oh, I've done.

Scott Benner 33:07
Alright, here we go. MC pres what to do or what to consider when relocating, especially if you're the caregiver of a younger kid with type one, what should I do before leaving? And when I get to my new location? All right, Jenny, you married somebody in the military. All right.

Jennifer Smith, CDE 33:26
I did. My husband is a retired Marines.

Scott Benner 33:29
So he actually probably does know how to take a gun apart with his eyes closed. And what else can your husband do in the dark? And? And

Unknown Speaker 33:42
we'll go with guns.

Unknown Speaker 33:42
Yeah.

Scott Benner 33:45
We're just gonna talk about Jenny's husband's pistol for a couple more seconds. And then we're going to talk about reload. I'm just kidding. Go ahead. What do you do to read now that I've got her?

Jennifer Smith, CDE 33:52
Yeah, we've, we've relocated a lot. I mean, since we got married. We have moved many numerous times, within cities as well as out I mean, we grew, we moved. When I did my internship out to Colorado, that I took my first job and we moved down to Florida. Now we, that husband took a different job. So we moved up to Washington, DC. And then the area was very busy, and we wanted to be closer to family. So we moved back to Madison, Wisconsin to be closer to family when we wanted to have kids. So we've moved a lot. And in each instance I can say that prep ahead of time and so that this is a great question. I somebody is thinking ahead here, they're thinking I know I should be planning something, but what should it be right? I mean, as as the person myself with diabetes, I always very quickly established, who to go to write with whoever my insurance was. Once we got there who I could see I called a bunch Have people I called around to see, you know, as an endocrine practice for adults? Do you see a lot of type ones? Or are you mostly type twos and you just dabble in type ones, or, you know, you're only like, this friendly to this particular pump, and you don't want to help anybody with anybody, anything else? I. So I guess, in that it's asking questions, right? In within, again, kind of your network of provider availability, yeah. As the caregiver, those are some things that you can do ahead of time, that, you know, if you're, if you know that you're moving someplace, obviously, you've got a location that you're moving to, you're not just going to like live in your car on the street corner until you find a place. So you've either got an apartment, or a home that you're renting or a home that you're buying and your new location. You know, consider distance in a city, if the best provider is 20 miles across the city, but they're the best. And you've heard the, the greatest things and they've got openings, you have to kind of fit that into your I can do that. And in the moment to see the person every three months or every six months. So I can do that? Or do you want to be closer? Do you have a lot more issues that you need to discuss, but calling around as well, like I said, if you know, especially because insurance dictates a lot of what you can do. So if you know what your provider is going to allow in the new location, look at the network of providers on that plan. Yeah, start to pick out some even even you know, with so much social networking online and the diabetes online community, there's so many Facebook groups, especially available that can give you you know, parents of kids with type one, ask a guarantee, at least in some of the big major cities, and in most of the states, you're gonna find somebody who answers you back and says, Hey, I live in this city, and I see this person and they're really, really awesome.

Scott Benner 36:59
You know, mine when you do that, though, everybody, everybody grades differently, like they do. What is awesome mean? Like, you know, in the back of someone's head, awesome could mean you know, I come in there with an 8.1. And they don't give me a hassle. I like that. It's awesome, which probably isn't is a good thing. I'm just saying that people's expectations are varying. But I do think it's a valuable way I just used my breach to try to find a an endo, for a girl in New York City. Yeah, you know, and I'm wondering as we're talking, if you don't, I wonder if you couldn't set up a short conversation, not an interview, you wouldn't call it an interview to the doctor, because they wouldn't like that. Right there. God complex would definitely not like that. But um, but you know, I conversation where you say, look, this is how I manage? Would that be okay with you? You know, like, would you be open to helping me on this path, because I don't want to take all the effort of coming to the PAC practice sitting down explaining to you what I do, and having you say, you can't do it like this, or, you know, I just don't waste your time or my time. I wonder if that's not valuable?

Jennifer Smith, CDE 38:04
I think that's kind of the it's sort of a more in depth. thing to do, I think more the tip of the iceberg for for filtering. Yeah, which is kind of what you're doing is calling the providers that you can see, you know, on your plan or whatever, and assessing, most likely you're going to get in contact with their nurse that helps them rather than the actual practitioner and ask ask them Yeah, right, you know, have a line of questions that are essentially, I use this kind of product, I use this kind of continuous monitor this kind of, you know, I use this software. Does your offer, is your office, you know, kind of allowable for these types of things. Do you use these? Would you allow me to bring in reports, if you can't physically see them? How much time will you spend with me? I've got a lot of questions. I've got other things besides diabetes, maybe they've got celiac as well. Or maybe they've right can you work with them?

Scott Benner 39:03
how flexible would you be if I said, you look, I you know, I don't wait three hours to correct the high. You know, because there's a there's some places who'd know, I'm starting to believe they know so little about it. In regard in terms of like, looking at the data and making a decision, they need to know when things happen, because that's how they think about it. I'm starting to think now that's what it's about. It's not about I don't want you correcting a high probably in the back of their mind. They're like, geez, get this blood sugar down. But if you did, then they don't know how to look at your graphs and make sense of them anymore. Right. And and so, you know, if I did that, yeah, right. I need these notes to say what I need them to say so that I can help you. Otherwise, if you bring me different data, I'm, I'm useless to you. You know, I'm starting to think it's a little less about them wanting you to do something a specific way just to control you or because they think you're wrong. And it's more about them, about you getting them out of their element. By doing things differently than they're accustomed to, right, right. But But and

Jennifer Smith, CDE 40:04
that's, that's the notes component that I always talk to the people that I work with about. Your doctor isn't necessarily like a bad doctor. Yeah, it's just that one, they have a time constraint. First. Secondly, if you only give them your pump to download, there are no notes. There's no history, and there's no information about it. They can only take the information there and make suggestions based on data, right, but they don't know the variables of your day. If you come into the office, and you've been in Aruba for the last three weeks drinking my ties on the beach. They didn't know that when they looked at your data and said, well,

Unknown Speaker 40:43
gosh, right,

Jennifer Smith, CDE 40:44
what was going on here?

Scott Benner 40:46
Sometimes people don't know, I have to say, That's weird. What's happening right there. You know, I, you know, what made me think of this. And I've never considered this before. But I think it's a good idea. Like you're saying call head talk to a nurse or practitioner or something, get a feel before you lock yourself in, and then then have to go through that trauma. It made me think of, when my son was recruiting for baseball, we went to a meeting. And I think he wanted to go to this place. And the guy started saying weird stuff. And it was like any any we walked out, he goes not here, not this guy. And I went, Okay, why he goes, I don't know, man, not here. And I'm like, all right, you know. So he just, he got some feedback back from this man that made him feel like this is not where I want to spend four years playing bass. Right?

Jennifer Smith, CDE 41:31
Well, and you bring in a good point there too, from you know, this, this person is asking specifically for their child, they don't know how old this child might be a young or might be a teen or whatnot. But I think especially for all ages, finding this would be a pediatric and no practice, right? But finding one that the doctor really has interaction with the child and expects the child to be a part of the conversation too. Even if it's you, right? It's it's not just I'm talking to your parent, and you're off in the corner playing on your iPad, because I don't give two hoots about talking to you. I'm just going to look at your data. In my opinion, if it was my child, that's not the kind of practitioner I want. My child needs to be engaged in that visit, even if they're three years old. And the doctor just asks, Where do you like to put your pump? Or which finger Do you like to stick or write? I mean, there needs to be and that those are questions again, that you can ask ahead of time. How do you work with kids? Yeah,

Scott Benner 42:35
and that's good, because it might not be so important in the moment, but it's important for when your kids 25 and feels comfortable talking to their doctor about their diabetes, right? Yeah, I our endo is very good about that with Arden. Because, you know, in honesty, Jenny's right, they're just they're honestly those kids are really there. So they can check their sites to make sure their sites aren't going bad. And like, you know, right, ask them, you know, the rest of the questions or to make them comfortable. And now you're making a point, though, about being an adult. I think about this all the time for Arden. I wouldn't know this if I wasn't so involved in community. But adult endos are a bit of a grab bag. Right? It there's not a ton of really good ones. And so, unfortunately, I want Yeah, I wonder how long I have to start prior to art and getting booted from a children's hospital. How old? Do they let you be at a children's hospital? You're done college 18. Is it not? If you go to college, you can keep going there because PD pediatric? That's a good question. Yeah. also find out about that.

Jennifer Smith, CDE 43:40
Yeah, I would definitely ask about that. Because I know it used to be like, when I was kicked out of my pedes it I was 18 Yeah, it didn't matter. That was in college. I was 18. And I had to switch over to a an adult and oh,

Scott Benner 43:53
yeah, I'll tell you, I might very well lead with Listen, here's Arden's records for all these years. I just need you to write some prescriptions. Can you do that for me? You got an A one c machine back there somewhere, you know what I mean? Like, like, that sort of thing. Without being cocky in a way that will make them be like not like you to like there's that's the other part of it is like you have to realize you're building a real personal relationship even though it only happens 20 minutes at a time every three months. You don't want the doctor to walk in and look you in the face again. This one? Yeah. I remember him. He didn't need me, like didn't mean like you're you need to avoid that kind of stuff. So. Alright. That makes sense to be cover that,

Unknown Speaker 44:40
I think All right, cool.

Scott Benner 44:46
So here's a pretty simple one. And now you got you go.

Jennifer Smith, CDE 44:48
Oh, I was gonna say the one. The only other thing that I would add to the end of that would also be from a prep standpoint, which is the quote, you know the question make sure that priority tubing, you have enough supplies that you're not in a rat race of establishing with a practitioner to actually get new prescriptions for things. Yeah. Because that a new new provider will usually not do, right. If they don't know you from the corner, man. They are not going to write a prescription for you just because you're in urgent need of one, but

Scott Benner 45:22
the person you're currently with would probably be happy to load you up before you moved. Yeah, right. I know. Um, one time, Kelly switched jobs, unexpectedly. Nice way of saying that, isn't it? One time? Oh, and don't worry, we're fine. But but but you know, she switched jobs unexpectedly one time. And I was right on the phone, nurse practitioner, I was like, Hey, we might have a gap in medical insurance. And she's she, I didn't even have to like, finish my sentence. She's like, Oh, okay. I'll just send all the scripts here because we bought online pharmacies. Like I'll send everything in right now. for it. I was like, thank you. There was it. So what I'm saying is that while my wife was transitioning, there was a stack of insulin in my refrigerator big enough that like, we couldn't buy hotdogs get on me. Yeah, so we're a little low on space. And, and, and that's because we had a great relationship with her. But you know, she's the one we know. So if you're going to relocate, stopped up with the person who knows you beforehand. All right. We I think we can do this one before you go. Brittany said, all of the other. By the way, there's a before I start, there's there's a question here that I don't know if we can ever, I'm going to read your question, and we're not going to do it. But it says I feel like so many of us struggle with finding the right balance of explaining diabetes, like fitting in the right amount of details. So they understand it's more than a couple of shots, but not too many details where you give, but they give you the glazed over last

Jennifer Smith, CDE 46:54
is like explaining to somebody else about

Scott Benner 46:58
just like not necessarily the how or the why or the scientific medical part. But like a, hey, if you're listening to this, someone you know, love has type one diabetes feel they need insulin for food they eat but not all carbs are equal, you know, and she goes, this is really interesting. She goes, basically, you know, could you roll all of the episodes of the podcast into a quick 30 minutes that I can hand off to another person? I don't know. I don't know if we could and at the same time, I'm I'm invigorated by the idea of trying.

Jennifer Smith, CDE 47:31
Well, actually, that strikes of funny because I had a thought the other day, like as I was, I usually try to like read or like do a little bit of journaling before bed. Just like my down mental shift. And I was thinking, we've done a lot of like informative, I was like, I wonder if somebody would take all of these and like write them into a book. I make a book for

Scott Benner 47:56
waiting for somebody to ask me to make the podcast the book. And to be perfectly honest with you. I started having that conversation with someone last year, and then it died somewhere along the way. But interestingly enough, for you know, I've written a book, I have this podcast, there's a couple of things I've done throughout my life. If you knew how many things how many irons went into the fire and never came back out of the fire again, you gotta throw a lot against the wall to make something work, you know? Yeah. Yes, you do. I'll tell you what I you know, hold on. Let's do one more quick question about that. Okay. So Brittany says all of the other type one diabetes related appointments we need to make diagnosed for nine months and just heard last week, we need to make eye appointments for my four year old what else Don't I know about? So I appointments are the, you know, the big one, right? They dilate your eyes, and they look all the way back there and they get a baseline for the health of your eye? And then you go back every year and do it again and again. Yep. Right? And what do they just tell people what they're looking forward to that.

Jennifer Smith, CDE 48:56
They're really looking at the vessels in the back of the eye? Anytime you go to an ophthalmologist, not just an optoma optometry, you know, Dr. omala, just actually has studied enough and knows, like, kind of the diseases of the eyes. And also can really focus in and do that where they dilate the eye. They look at the back of the eye. They're essentially looking at the vessels and they're looking for what are called micro like hemorrhages, or big hemorrhages, potentially, but they're looking for those vessels to have kind of opened, right. And when that happens, the eye tries to heal itself and it makes these tinier little vessels. But unfortunately, in that healing and making of little vessels, those little vessels are not as stable so they have more potential to break and or hemorrhage yet again, creating more problem in the eye so that you just we really want to establish and when I was first diagnosed, my doctor told my parents Not to have me visit the eye doctor until my blood sugar's had actually stabilized after diagnosis. Because those high blood sugars can affect so much early on, it makes

Scott Benner 50:09
it look wonky right there,

Jennifer Smith, CDE 50:11
it makes it looks wonky. So you, you really want some stability after initial diagnosis to go in and get an eye exam, right. So, you know, nine months post diagnosis certainly get been established, where is the eye health right now, whether the child has to or 80, or 96, you want to have kind of an established, this is where your eyes are, because then every year at least, you should be having new checks. And if there are problems that do end up coming up, they'll have you come in more frequently then, and there are therapies and things that they can do if there is a problem down the road. But that early on, gives you baseline, right. And for little kids, it's it's really mostly the eye doctor, really, I think of one two that many people don't really consider relevant to diabetes, but it's the dentist. Yeah, if you don't have a regular dental routine for your children with diabetes, get on board with that right now. They should be having a cleaning evaluation checkup every six months at least. Right?

Scott Benner 51:16
Yeah, it's a for a couple of reasons a diabetes, but by your kid is, you know, we always talk about it, like, you don't think of juice is a bad thing. Cuz it's medicine. You know? Oh, my kid takes Smarties by do. You know, like, there's a lot of simple sugars, especially in the beginning, when you're really learning how to keep things, they are a lot of sugar that is not followed up by much teeth brushing. So you really have to be ahead of it. And I've talked about it on here before we just one time switch juice boxes, because Arden just was sick of hers. But I had the right one meaning I could track it, it did what I wanted, it didn't have too much sugar in it. In the six months, she used the other box. And thank God she had baby teeth, teeth still, she developed 10 cavities from this different juice box. So you know, yeah. T says, Is there anything else you should be doing that she can't think of right now.

Unknown Speaker 52:13
I mean,

Jennifer Smith, CDE 52:15
you know, we always talk about like, foot health as well with diabetes, right, just from the standpoint of like nerve health and everything. podiatry. I mean,

Scott Benner 52:25
you know, taking your No, no, your four year old to the house. Yeah, this

Jennifer Smith, CDE 52:29
unless for some reason they already have been established with flat feet, or something else, or they've got shoe inserts or whatnot, obviously, you want to talk to your podiatrist and inform them. Well, now we have a diagnosis of diabetes in the picture here, as well, just to you know, I obviously chart should show them that, but you just want to bring it up.

Scott Benner 52:48
Yeah, if you don't understand the reason, foot health is so important for diabetics, if you should develop neuropathy, and you can't feel your feet now suddenly a small wound that you'd be aware of you might not be aware of any more wrapping that could be your fat goes on long enough, that can be a really terrible problem.

Jennifer Smith, CDE 53:06
Correct. And in the same vein, you know, kids are kids. I mean, sometimes my kids run around in the backyard in the nice grass without shoes on. Yeah, I mean, technically, as somebody with diabetes, and technically, you know, we're told Don't, don't not wear shoes, you know, walk in the backyard without shoes, and walk out to get the mail in the morning or whatever, you know, without my flip flops on, and, but I have feeling in my feet, no

Unknown Speaker 53:33
buttons, nobody dresses.

Jennifer Smith, CDE 53:35
But even for kids, you know, kids, sometimes they're not very like a tune to their body, right? So check your kid's feed every time you give them a bath or at night when you're taking their socks off to put them in bed. Just check their feet. And that's better than anything but don't have

Scott Benner 53:51
a paranoia around it puts don't happen. Right, right. I mean, the only thing, the only other thing I would say to Brittany is that through the years, you know, I pay a little closer attention to blood tests. I think I don't just take it's in range as an answer. So, you know, what does that mean? Am I at the low end of the range of she thought, like were in that range? Is she and you know, I'll go into it in another episode. But, you know, Arden has hypothyroidism but her labs were quote unquote, in range, but we were watching her like, shut off like a, you know, like a light. That battery was dying. Yeah. And and the doctor is like, no, she's fine. We don't treat in this range. And I was like, ooh, you treat my kid in this range. So make make with the Synthroid, you know, right, but right. I'll talk about that at some point.

Unknown Speaker 54:39
Yeah,

Jennifer Smith, CDE 54:40
I think the the only other thing I was gonna say would be um, this is a, I feel like this is a missed point entirely. And I know I've talked about it, we talked about nutrition, and kind of impact of foods and whatnot. But for kids who have diabetes, working with A good dietitian, who's a diabetes educator. Yeah. It's a great way to establish what are your child's needs? Not because they have diabetes, but as a child, what should your child be eating? How much and it's not, you know, work with somebody who really understands that it's not all about, I'm not here to talk about carbohydrates, I get it, I know how to count my carbs don't teach me how to read a label. I want to know what my kid needs, how much extra protein do they need, they're in gymnastics for hours, three times a week, or they're playing soccer, you know, two hours, four times, whatever it is, those are really important, because then the diabetes management works in to what you're

Scott Benner 55:43
feeding them. We really don't talk about, like, food as fuel. No, in America at all the way we should. And sometimes you're pushing through activities. And your body is, you know, it's it's lacking. It's eating itself to get through what it wants to do. And you're like, Look, they're fine. They're kids, kids are resilient, you know? Right, whatever stupid thing people say.

Hey, huge thanks to everybody out there for sending in their questions. And of course, the Jenny from integrated diabetes.com for coming on and checking it out. If you want to hire Jenny, you can do that at integrated diabetes.com. Okay, if you want to join the T one D exchange registry, just go to T one d exchange.org. forward slash juicebox. And you can do everything that I explained at the beginning of the podcast episode. But if you'd like to actually hear me go through the questions first, that's going to happen right now. So settle in and keep listening or jump over there to T one d exchange.org. forward slash juice box right now. And get started. Okay, guys, I'm gonna sign up for the T one D registry right here. My name is Scott, enter. My email address is Scott Juicebox podcast.com. password, phone number for added security for a one time identification code to your mobile phone. All right, do that. Who am I completing these questions for my child who is under 18. The other option is myself over 18 because I picked my child I put in hardens name. Sign up. Well, that was easy. confirmation code. That quick submit success. Your account has been created. Let's get started. Okay, now I'm going to answer the questions. Start the study. Are you and your child able to read understand English? Yes. What's your child's date of birth? was easy. I knew that. What is your child currently live which state? Okay, was easy. And the code you can also answer my child does not live in the US or US territory. Let's say. Has your child been diagnosed with Type One Diabetes? Why she has been easier child currently using insulin? Yes, I'm finished. You are all finished the screen questions? That was easy. Once you're ready, you can submit your answers. I have submitted my answers. But this is going to tell me if I'm if Arden's eligible for success your child is eligible to take part in the registry, you will now move on to the informed consent and decide to go to consent. There's some legal stuff here I say continue what is good for my son? Can I stop being the study? You or your child can stop participating at any time you will be told about new information or is there a cost related to being the study no cost? Is there a payment for taking part in the study? There is no payment for taking part in the study at this time. How will my child's or my information be kept confidential? Very, very, very. There's a lot of stuff here confidential. Okay. Now consent, I agree to take part and then type your name like a signature and agree received an email says, Oh, it's a copy of the consent form. That's lovely. That was easy. And you do a cent you're being asked to be in a research study. The purpose of this asset form is to help you decide if you want to be in the research study then you should not join this study until you've answered all the questions are answered. Okay. Who's doing the study done by the T one D Exchange and is being funded by the Helmsley charitable trust. He went to exchange we use the funding to organize the study. purpose of the study is to collect information from individuals with one D and parents of children went to India to learn more about the management of T one D, how it may change over time and how different management approaches relate to glycaemic outcomes, acute complications and use of health services So at this time, we do not have an end date for the registry, but we hope to enroll and follow a large group of people with T one D for multiple years. That's cool. And I hope that a large amount of those people come from this podcast. Alright, so we say yes to assent we have your consent you have completed the informed consent process, you are signed and dated consent form has been sent to your email. Oh, there it is. Okay, now there's a questionnaire. Before you start, you will be reading and answering the following questions on behalf of a minor. Okay. What's your child's biological sex at birth? They identify race and ethnicity. What percentage of the time does your child reside in your home? When was your child diagnosed with Type One Diabetes? You know, I don't remember the exact day. What's interesting, just put month in year how was your child diagnosed? Or it was in DK? What was your child's last day one see this one? I know

5.8 How did you or your child find out about the registry I found out from the Juicebox Podcast that's other juice box make sure you put that in their podcast Cool. Thanks. What's the highest level of education that you the parent of the parent or caregiver completed Please select only one answer. What is your the parent or caregivers current household income from all sources? How would you best describe your the parent caregivers current employment status? I think I'm employed right here on the podcast. Call that part time. What kind of health coverage does your child currently have? Who does your child see for diabetes care? And you can choose more than one like she has an endocrinologist but also a nurse practitioner he which of course we go by Be specific match practitioner got it in a certified diabetes educator. How tall is your job? I know this to Arden is five seven feet seven inches.

Unknown Speaker 1:02:21
wants to see why. I know that as well.

Scott Benner 1:02:26
Just any of her immediate biological family members have diabetes. Does your child have any other immune diseases? Seems so hypothyroidism? I look at this psoriasis is listed there. It's interesting.

Unknown Speaker 1:02:44
Is your child currently pregnant?

Scott Benner 1:02:46
No. How many biological children does your child have? Zero? Has your child ever been treated for and or diagnosed with any of the following frozen shoulder? anxiety Alzheimer's substance abuse I'm not gonna read all these let me just roll through here real quick cardiovascular disease

Unknown Speaker 1:03:07
No, no, no, no.

Scott Benner 1:03:11
It feels pretty good to be able to say no to these things. That's cool. No I should child had an ice slit transplant. No. pancreas transplant No. Types of insulin does your child take a pee next How does your child usually take insulin? insulin pump tubeless Omni pod it's very specific was also on here for if you loop you can put on here open APS Android. Oh, there's very uh, insulin, pens, oranges and helbling. Everything's here. addition to insulin. Is your child currently using medications to lower blood sugar? No. Child ever used a real time continuous glucose monitor? Yes. The dexcom g six. How many times per day? Does your child check their blood sugar with a glucose meter? Doing a little averaging here? Which glucose monitors your child use? Oh, that's easy. Contour. Next One blood glucose meter. Where's that? From a sensia Contour. Next One. Got it. Next, describe your child's experience starting in January of 2020 with Coronavirus.

No, my child has not had symptoms. And then okay. And my child did not get tested. Okay. I finished it was it I submit my answers. I've done it. I have successfully joined the T one D exchange and completed the questions. Now what's gonna happen is once a year they're going to reach out to me and ask me to update some questions. And that's it. That's all this is completely complete. pletely blinded meaning no one knows who you are. Nobody knows who your kid is. These are just questions that you're answering to help other people with type one diabetes. The T one D exchange registry is a research study conducted over time for individuals with Type One Diabetes and their supporters. Participants volunteer to provide their data for research, for example, by answering questions in an annual survey. Once enrolled, registry participants have the opportunity to sign up for other studies on various topics related to type one diabetes. The goal here is to improve knowledge of type one, help accelerate the discovery and development of new treatments, and to generate evidence to support policy or insurance coverage changes that help people with type one diabetes, all participant information is kept confidential participation is completely voluntary, your information will be kept in an encrypted database in an anonymous way, this means in place of your name, you will be issued a randomly generated identification number, opting out at any point will not affect your care. By sharing your opinions, experiences and data, you will help create the most comprehensive data set of those diagnosed with Type One Diabetes in the United States. This will advance meaningful treatment care and policy, all participation information is kept confidential. And participation is completely voluntary. This questionnaire can be done from your mobile device on the go or in the comfort of your own home. It is fast as you just heard, easy as you just heard, and confidential. As I've promised you now three times, and the T one t exchange has promised me over and over again, I asked them a million times before I did this, the online platform is very easy to use. I just did it in front of you. But I'm telling you super simple and clear. The screens are clear what to do next is clear, there's no you know what I mean? Like it's not a messy setup online, you can really see what it is you're supposed to be doing. It is not difficult to get through this. The T one D exchange, of course takes your data very seriously. That's why they are HIPAA compliant. When you register, you're assigned a unique identifier. So none of your personal identifiable information will ever be linked to the data, you provide your what I'm saying, you and the data, even though I mean, you heard what they just asked me it's not like it's a big deal or anything but you and the data are never associated to each other within the database. Nobody could. I'm so nervous talking about this, because I'm going to keep saying data and data because I jump between data and data just like it's super easy. Oh, by the way, everything you do with T when the exchange is online, you'll never be asked to go to a doctor or an in person study or anything like that. But if they have something like that in the future, that's going to be completely optional. So if you've ever wanted to support the Type One Diabetes community, and didn't know how this is a really super simple way for you to do it. And full disclosure, it supports the podcast. But I want to be absolutely clear. This is an ad. Now it doesn't mean that the T one D exchange just said Look, I'll pay you some money to be on this episode, you'll tell people about the exchange. It's not an ad like that you just hearing this is not is not making money to understand I'm saying I'm going to get some money every time one of you completes the survey. So if you're looking for a super simple way to support the T one D community research development, things like that, and the podcast without having to buy anything, right. So here's a way for you to support the podcast without $1 leave in your pocket. You don't have to get yourself an omni pod tubeless insulin pump, you don't have to get yourself a dexcom g six continuous glucose monitor. You don't have to get yourself a Contour. Next One blood glucose meter. You don't have to buy Lily's chocolates. You don't have to get some GMO glucagon through a link. Like none of that just do this thing. You'll support the podcast. Obviously, supporting goals of people with type one diabetes comes first. But if you can help the podcast at the same time, I mean, double bonus. Right? Like Bingo.

I just want to add that as you know you hear me say all the time I'm very careful about the advertisers that come on the podcast. I think you know that I believe on the pod Dexcom Contour Next One to be gold standard in their spaces and the T one D exchange gives me that same feeling. I don't know if you remember back a little while ago but the CEO of the T one D exchange, Dave Walton came on the show and I had a really interesting conversation with him. That led to more conversations that led to this opportunity. So being superduper honest, the T one D exchange has thousands of spots open and they need this data from the from thousands of people and they're not getting it. So they came to me and said we were hoping you could reach a broader audience with more people and fill these slots. So Everybody, please go. They don't just need 50 people, they don't just need 500 people, they need thousands. And I know you're all out there, I can see, I can see who's listening. So if you guys could just jump in and do this, you'd be helping them, helping me helping the podcast, helping yourself helping other people with type one diabetes, it is a win, win, win, win, win, win, win. Okay, guys, T one d exchange.org, forward slash juicebox. I put that link right there in the show notes to the podcast app. And there'll be a page at Juicebox podcast.com. But all you need to do is go to T one d exchange.org. Ford slash juice box and do the things you just heard me do. It's that simple. Thanks so much for listening to this episode of the Juicebox Podcast. We'll be back very soon. With more interviews, information, and fun. Oh, hey, I'm glad you're still here. Listen, I bought any new microphone and we had a time set up this to get it all set up for and it happened to be as I was finishing up this episode, the editing of this episode, so I recorded it. I don't know if you want to hear Jenny and I set up a microphone. But if you do keep listening,

Jennifer Smith, CDE 1:11:17
stay in place. And then I hooked on the microphone and just see where it was supposed to be. So I was

Scott Benner 1:11:22
like, clearly that's all I had to do. By the way a second ago. I decided I'm recording this because I'm going to put it at the end of the episode. I was trying to hook your microphone and microphone. So if you want to curse I'll BPL Okay, so you already hooked up your one mic, it shouldn't be that hard. This is just a USB cable just like the other one, right?

Jennifer Smith, CDE 1:11:41
Um, yes, it's got a USB cable. Again, I didn't like connected or plug it in yet. And it looks like it's got a place for like, it just got a headphone jack to

Scott Benner 1:11:51
Yes, that is not something you'll need.

Jennifer Smith, CDE 1:11:54
So just keep doing my headphones through the computer like I do. 100%

Scott Benner 1:11:57
that's for if you were doing recording and you wanted to do something where you could hear yourself before you got processed through the computer, you'd listen to that. And that's actually those dials are for that as well. So you won't need those dials either. Okay.

Jennifer Smith, CDE 1:12:13
So I don't really have to play with either of these, which I don't really know what they mean nothing

Scott Benner 1:12:17
for you to do there.

Jennifer Smith, CDE 1:12:19
Okay, so just plug this into the computer and then hopefully the microphone goes through this. I

Scott Benner 1:12:25
think it's gonna magically begin to work. Let's see. I'm just finishing an episode that's gonna go up now, but with you and I, oh, yeah, I can ask Scott and Jenny episode.

Jennifer Smith, CDE 1:12:38
Oh, nice. Yay. Okay, I've got like a little blue light on this thing in the jigger. Okay. It's all fancy. Like I walked into my office, I set it up, like, at night, it was like 10 o'clock, because then everybody's asleep, right? And nobody bugs me. And little boys aren't like, Can I play with the buttons and like, dial everything and like, see how the arm works and whatever. Yeah. And so then I walked into my office the other day, and I was like, outside my office being completely deranged right now because we'll be doing the floor and everything in it. So everything works for it. This is art and stuff from

Scott Benner 1:13:11
her room or painting her room. Everything of hers is behind me right now. So I hear you.

Jennifer Smith, CDE 1:13:16
Yes, if you could see the floor, it looks it's like a disaster. for it. They walked in and I was like, outside of the horrid stuff. I was like, my desk actually looks like it looks like like a studio.

Scott Benner 1:13:30
Kind of is. So um, alright, so I think what you need to do is go you're Are you in zoom the application? Are you on zoom online, you have the application zoom on your, on your computer, right?

Jennifer Smith, CDE 1:13:43
I do have the zoom app on my computer, and that I clicked the link that you sent me in the the message and I just pulled up my messenger messages on my computer. And I just clicked the link through the messages. So I'm assuming it's coming through the app on my computer.

Scott Benner 1:13:59
So top left of your so when you click on the zoom window and activate it, you should see on the top left of your screen and your Apple it should say zoom.us next Yeah. Okay, good. So go up to that and then go down to preferences. Yep. And microphone. What's the show?

Jennifer Smith, CDE 1:14:18
I have? Oh, yeah. So it's on audio already. And then

Scott Benner 1:14:22
this is a microphone microphone on turn. All right now,

Jennifer Smith, CDE 1:14:26
it looks like it says built in microphone. internal microphone. Yes.

Scott Benner 1:14:31
Click on that. And then the new microphone should be there as well.

Jennifer Smith, CDE 1:14:34
Yes. And click on there.

Scott Benner 1:14:36
Yeah. Okay. Oh is the volume all the way up the volume slider underneath of it.

Jennifer Smith, CDE 1:14:41
The volume slide is like a little bit down lower than half. We should

Scott Benner 1:14:46
all the way to the top. Let's see what happens at the top.

Jennifer Smith, CDE 1:14:51
Hello, move, move, move, move, move. almost to the top. Wow.

Scott Benner 1:14:58
Okay, let's try halfway.

Jennifer Smith, CDE 1:15:02
Alright, let's see here. Oh, I don't know what it's, it's not sliding down. Now, let's just

Scott Benner 1:15:11
click on it. You can click on the dot and then drag it.

Jennifer Smith, CDE 1:15:16
It's not dragging for me. It's not doing anything. It's kind of weird. Did you click on automatically adjust microphone volume by mistake? Oh, let's take that off. There. So now it's in the now it's in the middle.

Scott Benner 1:15:28
Okay. So, now you can see, I my microphone is different than yours, but I'm up on my mic, right? Yes, I'm like, about next to it like next to him. I don't want you to have to be that much. So let's try bringing it How far are we from your face right now, I guess. Jenny's measuring with their fingers, probably about 434 inches. Okay, three inches, so try bringing it a little closer. But there are that,

Unknown Speaker 1:16:00
hey, that's like, two inches right

Scott Benner 1:16:03
there. Whoo. It sounds really good.

Jennifer Smith, CDE 1:16:05
Okay, I'll have to just mark this little like, space. Well, like, I feel like I like cfcu. Because the microphones like covering. I know,

Scott Benner 1:16:14
I feel the same way. Sometimes. Actually, there are times when people say you go away from the mic. It's because I'm looking at a person and I kind of turn my face to try to feel more like something which is not the there's not good, better, better, they can hear us. Cool. So I'm with you at that desk. Here's why I like you at that distance. Because when that slider was higher, we were getting a little noise but but slide that slider up just a little bit more. And let me see where the noise comes in.

Unknown Speaker 1:16:43
See.

Jennifer Smith, CDE 1:16:47
So now it's at like three quarters.

Scott Benner 1:16:50
And there's a little bit of noise. So slide it down. Go back a little bit. I'm trying to get it so that's louder, and you can take the mic a little farther away from your mouth, if that makes sense.

Jennifer Smith, CDE 1:16:59
So now it's probably at like 60% of the way towards full volume. I love this.

Scott Benner 1:17:04
This sounds terrific. It really really does sound good. Yay. Oh, I'm so excited. I'm glad it's because this good.

Jennifer Smith, CDE 1:17:13
I don't I don't hear anything like different but I also don't do this, like, you know, I don't record and do all of the listening and the editing. So I don't hear the differences. Yeah,

Scott Benner 1:17:23
it is literally not going to sound any different here, but it's just gonna be way better for the people listening. So this actually ended up being Oh, I lost my ears for a second. But I know why give me a second. Um, hold on one second.

Jennifer Smith, CDE 1:17:38
Yeah, thank my my tea and like slosh around the ice cubes anymore. While we're actually

Scott Benner 1:17:44
because the irony here everything The irony is, is that microphone is going to hear less of the background in your room than they did. So that one is more just right here around your mouth. Because interest. It's so odd the way this worked out. Because you and I set up this microphone test randomly. And I spent the morning editing an episode, the episode that made me think I am buying Jenny a new microphone. Because there was something I don't know if you remember we must have recorded How would you remember this was like April right? As Corona was starting. We did an ask Scott and Jenny, which is this episode right here. Okay, um, because I'm just going to leave this conversation at the end of it so people can hear it. And there was a noise behind you. And we couldn't get rid of it. And we were like, Is it the fan from your computer? You remember? So there's some small noise in the background? That that microphone was just picking it up? Right?

Jennifer Smith, CDE 1:18:38
Yeah, I remember picking up the mic that I had, which is a much better mic than I had ever had before. And I was like moving it around. You're like Yep, nope, I can still hear it. I can still hear I don't know what else

Scott Benner 1:18:50
was picking something up in the room, right like a background noise in the room. And so I'm getting a text that Arden is hungry. One second. Apparently I'm the short order cook. today. I would never say this in front of my wife. But when we're both working for home, I think to her Her work is more important than mine. So when something like this comes up, I tend to be the verse that takes a break and goes and handles it. But I'm not complaining. It's fine. No. But anyway, yeah, like so we're recording and there's this background noise and you're talking I'm really interested. And then I'm just annoyed by the noise and I thought yeah, I have to get any better microphones so you have a much better microphone now. And you sound super clear. As a matter of fact, in an hour or two when this is on the internet, you should go listen to some of it from the beginning and then and then listen to this you'll be totally different in the difference in it. I am jacked up excited about this. This is a really great thank you and you don't have anything else to do so. Is it okay like you'll be able to keep it out of your way when you don't need it like or Yeah,

Jennifer Smith, CDE 1:19:52
absolutely the arm is really actually quite nice because I it did come the microphone itself came with like a stand to pop it up.

Scott Benner 1:19:59
I saw that. I didn't like that though, for you

Jennifer Smith, CDE 1:20:02
that Yeah, the nice thing is that this I can just slide off to the side and pot often over. Um, so yeah,

Scott Benner 1:20:10
plus Thank you very much. No, please, thank you. Here's some stuff you don't know about yourself when you're being when you're making a point. You bang the table. Do I really you get excited? You're like, you bang the table. So I couldn't give you the mic stand on the table because it would like go think when you were doing that that was and so I'm like, I she can't have that. That's why when I didn't by the way for anyone listening I did not force Jenny. I said Do you want a boom arm? Or do you want a table? She got the pic. And but when you said you under the boom arm? I was quietly like, yes. Okay, that's gonna be better. But you're gonna use this now for your calls. Now? I would imagine, right?

Jennifer Smith, CDE 1:20:45
I guess I certainly could try it and see if the call like, if the noise and everything is certainly better, especially since you said that it deletes much of the noise in the background. I mean, I do work from home. So especially with everything the way that it is now and the fact that my upcoming second grader will be virtually school from home.

Unknown Speaker 1:21:06
I'm ever feeling it was gonna be on the podcast sometime this year.

Unknown Speaker 1:21:10
Or noise? background.

Jennifer Smith, CDE 1:21:12
But that'll be kind of nice. Because if I do use this, I would expect that then maybe some of that background noise will be less Yeah, I'm can't guarantee that my 85 pound chocolate lab barking will be completely gone. But

Scott Benner 1:21:26
no, no, this is a way to you just hear those a clarity in your voice now. And like a like a, I think you would call it a timber. Like there's a depth to it that didn't exist before. So isn't there's perfect? Listen, we never do this. But when we're going to record on Friday, let's see. Can we do an episode of you and I talking to significant others in people's lives, teachers, co workers, family members and explain diabetes to them. Like this is the first time they're hearing about it.

Jennifer Smith, CDE 1:21:57
Like layman's term? Well,

Scott Benner 1:21:59
well, so like imagine you get diagnosed or you have type one and you have people around you who want to know more, but it's overwhelming to explain it to them. I want them to be able to say here's an episode of this podcast. It will explain diabetes too. Can we do though? That sounds fun. I think we can. Okay, absolutely. All right. You go back to your life. This is super exciting. I will send you a text when this is available so you can hear it. Thanks Scott. CJ, you want to say goodbye to the people are gonna hear

Jennifer Smith, CDE 1:22:23
Bye bye. Bye

Scott Benner 1:22:27
bye. See you

About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

As Scott & Jenny

#369 Ask Scott And Jenny: Chapter Fourteen

#355 Ask Scott And Jenny: Chapter Thirteen

#328 Ask Scott and Jenny: Facebook LIVE Edition

#321 Ask Scott and Jenny: Chapter Twelve

#317 Ask Scott and Jenny: Chapter Eleven

#299 Ask Scott and Jenny: Chapter Ten

#297 Ask Scott and Jenny: Chapter Nine

#291 Ask Scott and Jenny: Chapter Eight

#282 Ask Scott and Jenny: Chapter Seven

#277 Ask Scott and Jenny: Chapter Six

#273 Ask Scott and Jenny: Chapter Five

#271 Ask Scott and Jenny: Chapter Four

#267 Ask Scott and Jenny: Chapter Three

#265 Ask Scott and Jenny: Chapter Two

#262 Ask Scott and Jenny: Chapter One

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

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categories Omnipod, Juicebox Podcast, Dexcom, Interview, Type 1 Diabetes, Pre Bolus, Ask Scott & Jenny
tags Juicebox Podcast, Omnipod

#355 Ask Scott And Jenny: Chapter Thirteen

July 11, 2020Scott Benner

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

How do you estimate how long an increased temp basal will be necessary based on the amount of fat, carbs or protein in a meal?

Is there a strategy for eating food in a certain order?
Let’s talk about artificial sweeteners, sugar alcohols and the impact on blood sugar.
What happens when you fly with an insulin pump?
Let’s talk about the first years of diagnosis and the impact on long-term health.
Is it true that younger children are harder to control? Tips on pre bolusing kids, not comparing your graphs and asking the right questions.
How do you calculate your bump and nudge ratio?

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, welcome to Episode 355 of the Juicebox Podcast. Today's show is an hour of ask Scott and Jenny. I'll tell you about Jenny in a second. But let's look at my notes here about what's involved in this. Out.

Unknown Speaker 0:18
Increase babies.

Scott Benner 0:21
I can't read my own writing, but this is a thing. Well, alright, hold on. Let me count the scribbles. 1234567. Jenny and I are going to talk apparently about seven different things about type one diabetes today. And all those questions were sent in by listeners just like you. I'm sorry, I cannot be more direct than that. I tried to make a list. I wrote them down. I just hold on. Air travel with a pump. Alright, that one I got figured out our kids easier when they get older. Maybe that's what that means. My writing is terrible. Is there a method to bazel increases Temp Basal increases? That might be what that is. Order. ordered. Cathy, that can't be right. Um, figure out bumps. I guess that's about how do you know how to bump and nudge. Bad. Turn COVID. Court Li issues Wait, what? Between Okay, not bad turn between old something issues. Health beegees that health? halt all halls.

Unknown Speaker 1:52
Okay.

Scott Benner 1:55
Um, anyway, it's gonna be a surprise. It's a great episode. I just edited it. I really loved it. I just edited it. The other day is edited a word or do I say it wrong? It's hard to know, I guess. All right, hold on a second. Let me tell you a little bit about Jenny Smith. You know, Jenny, of course, from the diabetes pro tip episodes from ask Scott and Jenny, and defining diabetes. Jenny has type one diabetes now for over 30 years. I wonder if I could do this off the top of my head. I'm gonna go to where I have the information. Give me a second. I'm gonna go to where I have the information about Jenny. But I'm going to try to say it off of the top of my head first. So I'm near Jenny's thing, but I'm not looking at it. Alright, ready? Off the top of my head. Jenny Smith has had Type One Diabetes for over 30 years. She's a certified diabetes educator. Something nutritionist, a certified trainer on most makes and models of pumps and continuous glucose monitors. She's a terrific person. Alright, hold on. Ready? Now let me go to the thing. Jenny Smith has lived with Type One Diabetes for 30 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. But of course, most importantly, she is the best Juicebox Podcast Guest ever unless you've been on the show. And then in that case, you're the best one and Jenny's the second best one. I wonder how well I got that from the first thing. We are four minutes into this now are you guys listening to this? I'm so sorry. This episode of The Juicebox Podcast is sponsored today by Dexcom. On the pod the Contour Next One blood glucose meter and touched by type one, there are no ads in the show today. I'm just here to remind you that these are the advertisers and that they're lovely. And if you're interested in them, using my links helps the podcast and I appreciate it. Usually I tell you dexcom.com forward slash juice box, my omnipod.com forward slash juice box touched by type one.org. And I usually say something about Contour Next One but I've got my own link now. So you got to remember this one now. Contour Next one.com forward slash juice box. And now I'm just gonna make sure that that's actually correct because that feels wrong. Nope, it's right. Contour Next one.com forward slash juice box. Check out the Contour Next One blood glucose meter and all of the meters that contour cells. Also do you know it's possible that you're paying more to your insurance than it would cost to buy test strips in cash. You should check that out at the link as well. Do you want a free no obligation demo of the Omni pod sent directly to your home? do that at my link to my omnipod.com forward slash juice box. Dexcom is Guess where all the great information about the G sexist, but that's a lot. So go check that out too. And when you're done, you're gonna need some energy because you've been on the internet now and you're getting sleepy. Touched by type one.org. It'll lift you're right back up again. Let's get to Jenny and the Ask Scott and Jenny questions. Thank you everyone for sending in the questions that you sent. I am sorry that at the moment, I don't remember what any of them were. But I do remember that they were wonderful. Jenny was fantastic. I of course, was delightful. Hey, now please remember, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. One last thing juice box. docs.com is an ever growing list of doctors and other helpful people in the medical industry that you found you the listeners have found and shared with me. We're making a beautiful list. You can add to it if you want or go take from it. It's like that Penny thing at the convenience store. Give a penny take a penny. Give a good doctor. Take a good doctor. When Jenny and I record we usually catch up for a few minutes first, and I don't record it normally. But this time I did. It's just us talking about weird stuff going on around Coronavirus in our lives and I left it in for you. You can eavesdrop on the silly things we say to each other when no one's listening.

Jennifer Smith, CDE 6:31
Because their haircut had been delayed twice. We had had haircuts set up right including my own. You got a friend who has her own shop. And so she was going to do the boys it's in with the boys watching a movie with their little girl who is just a little older than Oscar is. And she was going to do my hair all set up. Now we rescheduled it because things had been like postponed. Now we've rescheduled it again for like mid May. Who knows whether that my boys look like shaggy dogs. Like I was like, even my husband was like their hair needs to be cut like it was getting to the point of like they'd sleep. And that bed head was like just not culpable. How did you no matter how much I just I caught it. Have you ever cut anyone's hair before? Um, I've trimmed their hair before in a pinch like this, okay, but like this was really like it was a haircut. And I it's fine.

Scott Benner 7:27
Kelly, Kelly sent me the other day, time to go to the heavier hair product. And I was like, Yes, I'm gonna need something with a little more control. I had my hair kind of short recently. And so I was just using like a little paste or rod or whatever, just like just a little bit. And now I use it, my hair is just like weak back, we can overpower that. And you know that I'm gonna have to go to a baseball hat pretty soon. And I don't think I have the head to shave my head just to start over again. So I'm not doing that.

Jennifer Smith, CDE 7:57
It's kind of funny. I actually I refer to like those days with diabetes, where you're just like, I don't know what's going on today. And it's just weird and bizarre. I called them I call them bad diabetes hair days where there's no amount of like mousse or gel or whatever that you can throw at it. That makes it like flap down the right way. That's how I count for that.

Unknown Speaker 8:20
How long have you been in your house by now?

Scott Benner 8:23
This is in three days. I'm on to three solid weeks.

Jennifer Smith, CDE 8:29
Yeah, by the end of this week, it'll be three solid weeks. Yeah.

Scott Benner 8:32
Can I make them? admission? Yeah. I know a lot of people say this. But I haven't really noticed that much of a difference in my life, which I'm assuming is bad for me. But, but also, I find it incredibly relaxing

Jennifer Smith, CDE 8:50
that you don't actually have to physically go anywhere.

Scott Benner 8:53
what the expectations are gone now

Jennifer Smith, CDE 8:55
are gone. Right? Yeah. Like, you're not expected to attend the ball down the street or go to some fees like hoopla right?

Scott Benner 9:03
My kids keep my house clean. Talk to my wife the way we always do. There's nothing there that would change and put this podcast out in the schedule. Nothing else in the world matters right now.

Jennifer Smith, CDE 9:16
Yeah, that's the only the biggest things I mean, that are changes for us. Like I love. I love grocery shopping. I love grocery shopping. And at this point, my husband is the one that's actually going now to the grocery store, pick

Scott Benner 9:31
the person

Jennifer Smith, CDE 9:32
because we pick the person and I'm the person that doesn't have you know, so. So yeah, so he's the one going to the grocery store and doing all that I like, I feel kind of a sense of loss.

Scott Benner 9:45
Oh, wow. Now I hear you. I'm the one having to go to the store. So yeah, and I've been twice now. And I'm like a ninja. I just have a little schmutz in my pocket. You know, I'm sure there's a real word for it but the stuff that kills the germs. And I hadn't, you know, I don't touch anything, bang, bang, bang and grab my stuff. Get out of there gela hands, move to the car, get the stuff into the car gel the hands again, get back in the car. You know, get it home, I strip away the packaging and do all the things you're supposed to do then clean the place where I stripped away the packaging, clean my hands again, and I'm done. I'm just like, hmm, probably should be doing this all the time. Not this intensely. But.

Jennifer Smith, CDE 10:28
But something similar. Yeah, actually sounds very much like ginger. You know, she actually posted something the other day about this is, this is what I do my one trip out of the house like and we also in, we've been really trying to like, we get the load of what we need. And then we really like our refrigerator right now is on the minimum. I think the only fresh vegetable we have left in our fridge right now is celery. Like we got to get to the refrigerator or the grocery because I need more than celery and hummus.

Scott Benner 11:03
That's a Facebook post for us. Anyway, we're down to celery, it's time for the celery. It's time,

Jennifer Smith, CDE 11:07
right? But so ginger actually takes she has gloves. She wears them, she actually takes in paper bags to the grocery store so she can get her groceries into the paper bags. Rather than having to push a cart that somebody else pushed, she takes them to the self checkout. So nobody else has to touch her groceries. She puts them into her bags. And then she actually doesn't even take those bags into the house. She like, takes the stuff out, puts them in a new bag to go into the house. And she's like, and I wash and scrub and I sanitize and I she's like, that's what I do.

Scott Benner 11:40
So my friend washing a brand new bag of potatoes in their sink yesterday. And I had two simultaneous thoughts. I thought that's a great idea. And I laughed a little bit. So but I when I put the hand sanitizer on I hand sanitize me and the cart. But But again, I got lucky because when we moved my son out of college, he had a 40 ounce jug of hand sanitizer that he hadn't touched. Oh, it was like finding a gold brick and the top of his like I was up in the top of the shelf. I was like, Oh my god, I'm so glad you're coming home. You're saving all of our lives Look at this. And and and then it made me think like, why does he buy stuff like this and then not touch it and use it for anything? Because he we didn't give it to him. He needed it for something. He got into his head at some point, you know,

Jennifer Smith, CDE 12:28
yeah, he put it in the back of his closet.

Scott Benner 12:29
Yes. There's a 20 year old boy for you. He heard about what was going on. I do remember sending him a text. And I said, Look, I know I bug you sometimes at school about sanitizing your hands, please be a little more mindful about it. Like I was trying to get him moving before this all exploded without worrying him. And so I guess he went to the trouble of buying it, which was not using it away rather.

Jennifer Smith, CDE 12:51
I'll use it when it really gets. Alright.

Scott Benner 12:53
Now he did say he had a little one he been using. So I'm like, maybe he was using I mean,

Jennifer Smith, CDE 12:58
or maybe he was using the big one to refill his little one who wasn't open to me. So

Scott Benner 13:03
let's try not to be too full for

Jennifer Smith, CDE 13:05
giving him a little credit.

Scott Benner 13:06
He's two years into college. He just committed to his major he the other day. He's not exactly out in front kind of kid. Yeah. So anyway. Oh, I want to tell you something real quick. And then we'll start this recording. And All right. Let's get back to our Ask Scott and Jenny list. I say what's

Jennifer Smith, CDE 13:30
on the plan today? Well, I gotta tell you, oh, no, I never know. I appreciate

Scott Benner 13:34
that about you, by the way that you've never once been like, exactly what we're gonna talk about before we talk about, which is why it is a surprise. This time, I actually marked the ones we did with a little word done next to it, which trust me is a major, major consideration for me because I'm not normally even that smart.

Jennifer Smith, CDE 13:54
You're smart. You're just not that organized, right?

Scott Benner 13:56
Well, sure. I keep a lot of stuff in my head. I don't write stuff down. I'm not I don't check boxes and stuff like that. But sometimes like this is a necessary thing to me. All right, I'm gonna start with

Jennifer Smith, CDE 14:09
Well, our list here is also very long. So putting done next to them was Oh, yeah,

Scott Benner 14:14
it's a long list. I'm just telling you. I'm not normally that smart. Bethany asks, Is there a way to estimate how long an increased bazel will be necessary based on the amount of fat carbs or protein in a meal? So she's looking for if there's this many carbs then do it for that long, but I don't know if there is or not,

Jennifer Smith, CDE 14:35
not typically I and that's why we have the we have a standard of what we say start with right for fat end of the meal increase the bazel by 50% over the next six to eight hours. experience will show you whether or not that works well. I for one have found that an increase in bazel for a while That meal in the daytime, I don't need as much of an increase, and I don't need it for as long at night. So for example,

Scott Benner 15:09
if I think,

Jennifer Smith, CDE 15:10
I think it's because during the day I'm, I'm up, I'm moving after the meal time, like if I go and I have a higher fat type of lunch, let's call it pizza or whatever, right? That's the typical example. Usually in the evening, I would need that 50% increase, and I typically need it for about six hours, during the daytime lunch, I usually need maybe a 30% increase, and I only need it for about three or four hours. Okay. And I I have to save from just experimentation. I think it's truly because after lunch, I'm not going to lay down for a four hour nap. I'm up, I'm moving, I'm doing things. I've got things to do around the house or with my kids or whatever. I'm just busier were in the evening time after a dinner like that. Well, I might be doing some things like putting my kids to bed or doing the dishes or maybe in the laundry or something. But for the most part, a lot more like sedentary. I went to the evening.

Scott Benner 16:09
Yeah, that makes sense. I listen, obviously, I think about it in pictures. But in my mind the basals a, it's a heavy jacket. And you mean you put it on while you need it. And when you get too warm, you take it off. So it's easy to say if you have a CGM. But if you don't then just test at more at intervals, I also believe that after experience, you know, the answer will come to you. Let's say it ends up being four hours that you need this basal rate for, you know, the second and third time it ends up being four hours. Well, I mean, then I stopped testing and I assume it's four hours. Right? You know, but you have to try it to know,

Jennifer Smith, CDE 16:45
to know, and the same thing kind of goes for protein, you know, the, the bolusing strategy for the most part, not bazel increased. But the bolusing strategy for protein says try to start it at the end of the meal extend the whole bolus out over the course of a three hour time period. Well, on average, people probably needed somewhere between two and four hours, depending on the portion of the meat, you know, if you're only bolusing for 12 extra grams of protein versus the night that you go for your 16 ounce pound of steak and your bolusing for 40 grams of protein. Very likely, that's going to also define a time to extend it out over Hmm. Because of the portion, right, it's kind of like the load impact versus just, you know, yeah. So that that can help with that too. The other thing for protein is kind of the kind of protein, you may find that leaner proteins such as, like a lean chicken, or even most fish tend to have a lower impact on blood sugar over the hours after even if the quantity is large, you might still have to cover it but maybe not quite as much as something like red meat. Okay. Red meat has not only does it take longer to digest, but it also has a lingering impact. Yeah, so those are some things to consider. I wish people

Scott Benner 18:15
could see that out last night Arden had a an avocado salad and edamame a for dinner. Yeah. And I want to say that i bolused 40 or 50 carbs for that. Like, and that I think is stuff people look at and go there's, that's free, almost that's a vegetable. And then I looked at the fat and the avocado was a big part of it. Like I think the true carb count, if I was really paying attention was probably more like 30 carbs when she put the dressing on and stuff like that, which she didn't use a ton of. But I looked at the fat and I was like, all right, like we're gonna need more power here. This there's going to be more glycemic load here from the fat and not in the way you think of it normally not, not from carbs, but just from its ability to hold it up which I think yeah, I think that might lead us into Jamie's question here. Now Jamie bemused, Jamie says maybe this is a pro tip and you tell me if you think it needs its own miniature discussion? Because this is something I've I don't think we I don't think I put a ton of effort into understanding but I know that some people do. She's asking about eating food in a certain order. Her examples last saving fruit for last, when you aren't as low as you would be when you started the meal or like the other way around, like what do you do? You know? So the

Jennifer Smith, CDE 19:36
timing or the placement of the food intake?

Scott Benner 19:39
Yes.

Jennifer Smith, CDE 19:41
Is to a degree, there is some there is some strategy for what she's kind of talking about. You know, if you are starting on the higher end, blood sugar wise, and let's say you didn't have as much time to Pre-Bolus as you would have really liked to Sure. If you Start the meal with, like, Iceberg lettuce and the protein part of it right, you're gonna have that sitting in your stomach first getting worked on first before you maybe get to your baked potato or your rice peel off, or your fruit on the end or whatever it might be, starting with the lower glycemic or almost no carb kinds of foods first, yeah, puts that into the stomach to get going. We know that proteins and fats take longer time to process and digest to begin with. And well, I mean, I kind of always think of my stomach kind of like a cement mixer. Right? It's not just taking your chicken and digesting it, and then moving on to your berries and then digesting those. I mean, it does all get churned together and processed, you know, with stomach acids and whatnot. But for the most part, yes, if you can start the meal with the things that you know, are going to be slower, letting the insulin kind of get working and going, and then add in the carbs at the end. Absolutely. That's a strategy strategy to use. Yeah.

Scott Benner 21:01
And I mean, I've had I've sent Arden into a meal more times than, you know, I can count where she's, you know, 70, or 65. And the last thing in my text was like, start with, you know, whenever the simplest sugar is, right, is that

Jennifer Smith, CDE 21:15
what the right the apple or apple sauce or whatever,

Scott Benner 21:18
right? I've said before eat the banana first. And I know that's not exactly. I don't think she looks at it and thinks I should eat the banana first, although I don't know. Because yesterday, what did she say to me yesterday? That was she said, Can I have a snack? And I was like, yeah, sure she goes, so what do you want? And she said, Oh, no, wait, it was at the end of breakfast. And she's like, Can I have a little more food? And I said, Sure. What do you want? She said, can I send bacon and an orange? And I was like, yeah, you want a bacon with orange. And we had a little bacon left on a plate. And I had oranges. And I thought, all right, and she looks so happy. She's like, the orange and picking it the bake? And I was like, well, that's a weird mix. Definitely what she wanted. So, you know, I mean, I think that's, I think it's reasonable to be thoughtful about it. Now, I do know, there are some people who steadfastly eat their meals and orders to keep these incredibly stable blood sugars. I don't know, I can't speak to it. And I don't know that I would want to live my whole life that way, either.

Jennifer Smith, CDE 22:22
Right, you know, strategy wise that what you found works, and that makes you happiest, because then you're not dealing with the flux in blood sugar. Great, if that's your strategy, have at it, keep up with it, you know, everybody finds what works, or hopefully, they're learning to find what works, right. But I mean, even even in consideration it if you're looking at a dessert, like at the end of a really big meal, a good example is something like a Thanksgiving dinner, or a holiday meal, or you've had all of these like, heavier, more dense types of foods. And then at the end of the meal, you add like grandma's apple pie with like marshmallows baked on the top of it, or whatever it is, you know, you're thinking, Oh, my gosh, this is all sugar. Well, what else do you have to consider, you have to consider all that other food that's sitting in your stomach. So, so heavy, that might actually be a time that while normally you'd take Bolus and Pre-Bolus everything, not even choosing an extended Bolus. Yeah, at this point, you've got all this extra food sitting in your stomach. And while this is simpler sugar, its impact is going to be drawn out. So you may actually want to do an extended bolus for this dessert. Because otherwise you're going to go low,

Scott Benner 23:43
because it's flopping into your stomach and laying on top. It's not part of what's happening. Right? Correct. Yeah. See, that's the stuff that is it's smart to understand. And I just think I think of it is experiential, like I just might go I know from experience this doesn't need a Pre-Bolus the way it would normally we already and I think of it as like, we already have so much insulin in the processes or I guess what we're saying the same thing. The process is already happening. Now we're just throwing in, you know, like another teaspoon into a gallon of water. And yeah, okay. By the way, all of Jamie's questions are like I think this would be a good pro tip. I think she's trying to produce the podcast here which by the way, there's some really good questions here. I don't think this one needs its own episode. So I'm gonna ask one more of Jamie's questions because she asked specifically. I want to know Jenny's take on artificial sugar. So artificial sweeteners. I know they affect people differently. But in she said In your opinion, which ones seem to have the least impact. She said, I also feel like a lot of people don't realize you can see rise from zero carb drinks. I will tell you that Arden doesn't drink a lot of soda. But if I start seeing her blood sugar gets sticky. I look to see if she's gonna Diet Coke. And that sometimes that holds her up a little higher. It's not like don't get me wrong doesn't make her 300. But it could make an incredibly difficult 140. Right? It doesn't want to give up.

Jennifer Smith, CDE 25:12
So there are I mean, if you wanted, gosh, I'm trying to remember what the university was that did a study on. Like, how much of the on the market artificial sweeteners is considered safe, according to the type of artificial sweetener in the product. Right? So if you've got something like equal, you're talking about the artificial sweetener, aspartame, okay, right? If you're talking about Splenda, you're talking about sucralose. So and then, of course, there is sweet and low, which is this the saccharin kind of component right? Now, there are also what I call alternative sweeteners that I think sometimes get falsely right, that get falsely kind of categorized with artificial stevia, being one of those alternative sweeteners. It comes from a plant Yes, it is processed the the sweetening pieces that come out of the stevia plant get processed in order to make a product that you can like, you know, put into your, your drink tea, coffee, whatever sweetened beverage, you know, sweetened a baked product, with what with whatnot, but the studies around impact from stevia, comparative to those that are truly artificial, by artificial, I mean chemical in nature, they don't come from natural, outdoor plant life. Right, they are created in a lab. So those, there are acceptable limits to like how many packets a day technically you should have, or how many soft drinks you should have with how much or, you know, beverage or how much how much per packet or whatnot, and each of the different sweeteners does have a limit to it. I mean, it's, it's a lot. I mean, most of them, it's like 15 packets a day, you're 25 packets a day. I mean, maybe some people are having that much I,

Scott Benner 27:29
I hope to you,

Jennifer Smith, CDE 27:31
it seems like an awful lot to me. And I

Scott Benner 27:33
know, can I say something now that we've met in person? Yeah, not that this doesn't come across the video, you're in really good shape. Like you take really good care of yourself. And so like Jenny's fit, you know, she she's trying to embarrass us right now, only only I can see her and she's still embarrassed. But I mean, I thought you'd have a take on this, like, you know, I guess some people might be like, here's a glass of unsweetened tea, I'll put five packets of Splenda in it or something? I don't know,

Jennifer Smith, CDE 28:00
you know, right. And I mean, that it's a it's a question that she asks a good question, because it's something that whenever I'm talking nutrition with people in a visit, it often does come up, you know, what do you think about the artificial sweeteners, especially in the women that I work with through pregnancy? Right? It's a very common question, should I be you know, should I stop drinking my diet coke, blah, blah, blah, or whatever it is, you know, I, you know, we there are studies, I think that they're kind of like a 5050. There are studies that kind of err on the side of these are chemical in nature. They're, they're not natural. They're not like going out and pulling the broccoli off of your garden stock, right? It's something that some very smart lab chemistry person put together and hey, it's got a sweet taste. And hey, it doesn't. For many people, it doesn't raise blood sugar. I can't say that's 100% true for everybody. Like you said, Yes. Sometimes you'll see a rise and sometimes no sweetener sweetener.

Scott Benner 29:07
Yeah, I don't know if it's the I don't know if it's the artificial sweetener specifically, or if it's impacting or in a different way or I don't know what it's doing to her but her if she drinks too much Diet Coke, her blood sugar gets more difficult.

Jennifer Smith, CDE 29:20
Right? Right. Yeah. Right. And, and I've actually had some people I used to tea but teach a an in hospital type to class for people with type two diabetes. And even they, it was a very common question, and I can very much remember one older woman. She was like, in her upper 60s, the cutest little lady. And she was like, I can't drink those diet beverages. I just can't drink them. I'm like, Okay, well, why you know, the class is always like a discussion about you know, what works for you, blah, blah, blah. Just like every time I have them, my blood sugar goes right up and So and then obviously didn't have a continuous monitor or anything, she was really only doing it by finger stick analysis, you know, and whatnot. But I mean, she, her records actually showed I mean, she'd have nothing in the afternoon except her diet soda. And by dinnertime, her blood sugar was going up. If she didn't have it, it wasn't going up. It didn't happen. So, yeah.

Scott Benner 30:25
So aside from what you just said, which makes total sense that, you know, limiting the chemicals going into your body, probably a smart move. I don't eat that much sugar to begin with. So when I have a cup of tea, if I use two teaspoons of sugar, I mean, whatever, right? Like it, if Listen, if two teaspoons of sugar in a cup of tea is going to take me down Jenny, then I guess that's gonna take me down. You know, I mean, I, I just feel like that it wins. But

Jennifer Smith, CDE 30:50
I think eight grams of carb there.

Scott Benner 30:52
Yeah, I don't love I don't I don't need a lot of sugar at all. But, you know, at least it feels natural, to some degree, you know, so I didn't make it in a lab.

Jennifer Smith, CDE 31:05
You know, that's kind of what I say even about like the sugar free like the sugar free candies and whatnot that are out there. I mean, it kind of brings in along with artificial sweeteners. Of course, there's also then the alternative, like I said, the stevia. But then there's also another sort of bank of sweeteners, which are those sugar alcohols, right. And sugar alcohols, again, they come from, from plant based foods, most of them come from fermenting fruits and vegetable, carbs or sugars, so that what ends up happening in the body is the fermenting process allows a much slower impact on blood sugar than you would get from all out sugar. So most, you know of those sugar alcohols they provide only about half the amount of impact that true sugar does. And it's kervin action is very very slow. They also if you eat too many of them are not very nice digestive Lee on you. But I always feel like you know if you're going to eat three sugar free Hershey candy kisses, I would rather have the real thing. Yeah. And that's purchase personal at like you said you'd rather have the real sugar in your cup of tea than something that's artificial. And if you account for it in your day, total, you're keeping track of things. calorie wise, most of those sugar free products aren't lower calorie overall than the counterpart of regular things. Oftentimes, when they take sugar away, they have to add back something else that tastes a little bit better. And it's often fat. Yeah.

Scott Benner 32:46
Well, I listen, I will have chocolate once in a while. And there's a company that makes a chocolate chip that I find to be like a really quality chocolate chip. And instead of having like a Hershey Kiss, or something like that, not there's anything wrong with a Hershey Kiss, but there's a, you know, there's a quality issue there, like market chocolate versus, so I'll buy like a bag of chips. And if I want chocolate, I'll take like, I don't know, four or five chocolate chips. Yeah, by the way, the bag of chips is like $3 and it lasts forever. You know? So there's ways to, you know, substitute things and and correct and get more. I don't know, this isn't English, but more real food into your snacking. Even snacking like this, you know?

Jennifer Smith, CDE 33:32
Right, right. Okay. And I do know, I remember, if somebody wanted the actual information about how much artificial sweetener they can take in. It was a study done by the University of Alabama at Birmingham. You can actually go to their website and they give you information on how much saccharin aspartame and sucralose is appropriate. It's based on 150 pound person.

Scott Benner 34:00
So yeah, so be 150 pounds. You're taking this that into effect,

Unknown Speaker 34:03
FYI,

Scott Benner 34:04
restructuring your multiplications and your divisions in your business. Well, all right. Well, this question from Libby may not apply in our new world. But flying in an airplane and pumping with an insulin pump. So does air pressure deliver insulin? Is that why some people find themselves lower after a flight if they're wearing a pump? Jenny Jenny has read she just readjust her jaw six different times and a word. Yeah.

Jennifer Smith, CDE 34:36
Well, I want to I want to address it in terms of being true in also that there are no

Scott Benner 34:45
studies. There

Jennifer Smith, CDE 34:46
are no true studies that are approved by some fancy university or research laboratory that has actually done this. However, there is anecdotal let's call them evidence from people have diabetes where insulin pumps, and they've actually documented what happens when you fly with especially a tube insulin pump, okay? It's more, it's more of a known issue with a tube insulin pump, that in the ascent and descent with a tube pump pressurization can actually either withdraw insulin back into the reservoir, thus creating an air bubble in the tubing, and potentially then causing a lack in pumped insulin. Some people experience not only a high at some point, or a rise that they can't explain because they haven't had any food or anything else happening on a long flight. Or, in this example, a drop down often, and a lot of people refer to them as like the baggage claim lows, where they finally get to the baggage claim. And as long as their hike through the airport hasn't been like six miles, you know, they're huffing it. For the most part, people end up waiting for the bags and have a low blood sugar. And why it's because potentially on descent, there is a pump out of insulin from that piston from the pressure that pushes the insulin through the tubing and delivers almost a bolus of insulin, then that's it's not registered by the pump, you can't go into your insulin dose history and see oh two units was accidentally delivered. The pump doesn't give you that because it wasn't there were no button pushes get it.

Scott Benner 36:33
So it's like having a like a like a flatbed hose full of water and the water is just sitting in it, but you grab one side and give it a squeeze and it runs out the other side. So the air pressure increases and forces the insulin through an air to come out of your set. So that's where it goes

Jennifer Smith, CDE 36:48
correct. And our recommendation to kind of counter it is on ascent and descent, essentially, you disconnect. So for those with tube pumps, you would disconnect disconnect from your sight as soon as your rising or taking off. Once you get to cruising altitude, you go ahead, look at the tubing, if there are any air bubbles, prime the tubing, flush the air bubble out, reconnect cruise through, you know your three hour flight or whatever it is, as soon as you start your descent, go ahead and disconnect when you land. Go ahead again, take a peek at the tubing. If there are any air bubbles or anything, you essentially flush them out and reconnect. Yeah, that way you get rid of both potential problems makes sense.

Scott Benner 37:33
I happen to I'm googling while you're talking. And Medtronic has a little update on their site about just being more like attentive, which I think is any company's way of being like, you know, we don't really know what's gonna happen. So you pay better attention. And I'm not picking on Medtronic, I'm sure there's a version of this language is probably on everyone's site. But you're saying with Omni pod it might not exist?

Jennifer Smith, CDE 37:57
Yeah, there's I've only had, I've only had one person that I work with. Who has definitely she's noticed something happens. She always she never has highs. She has lows.

Scott Benner 38:12
But that's right. So

Jennifer Smith, CDE 38:13
but again, that's an N of one with one pump. And I you know, I've I've flown often enough I've worn Omni pod since 2006. I've flown a lot in that what? Almost 14 years ish, right? And I can't say that I've noticed anything. That's a trend when I fly. That would indicate Yeah, this is definitely happening three quarters of the time. We

Scott Benner 38:39
don't treat them differently during air travel at all. I mean, you know, maybe when you get out of the car at the airport, we're not I wouldn't bolus a 120 you know what I mean? Like I want to get through security and all that stuff with nothing going on. But as soon as we're back through, everything goes back to normal. We bolus normally on the plane and every other Yep. So yeah. Okay.

Jennifer Smith, CDE 39:01
The only thing that I guess it's not really in answer to this, like pressurization. But the one thing I do Do for travel and a lot of people notice is that many times when you're sedentary for more than about a two hour time period, you might actually need a temporary increase in your bazel just from the sedentary nature. You know, when I fly long distance, and I'm going to be sedentary for more than that two hours, I find that I need about a 15 to 20% bazel increase just

Scott Benner 39:28
to cover the fact that you're

Jennifer Smith, CDE 39:29
just not active anymore, just to do right.

Unknown Speaker 39:32
Okay. So, all right. What else?

Scott Benner 39:36
Well, Shannon has one here. Okay, that I don't know if we're gonna have the answer to or not. But let's take a look. It's a long one. So I'm going to synopsize she's curious about the health of older people with type one who have had what she's calling wild blood sugars in the first part of their life, but then learn tighter control later. Will they have you know, issues like that? or other health complications. And the last part is people who had to survive without CGM. Okay, so people who lived before all this technology, you know, like me? Yeah. Like

Jennifer Smith, CDE 40:15
I lived before all this

Scott Benner 40:16
fallacy. Oh, you know, I mean, I would I would say what we've said in the past is you can't bank health. Right. So you, but

Jennifer Smith, CDE 40:29
I don't know it also is not a like it, you know, the question really did really poor control leave lead into issues now that even with good control won't negate them all? we don't we don't know. Right, right. I mean, for the most part that earlier, less than optimal management wasn't good. I mean, it wasn't helpful, right. But does it mean that down the road with more optimized control, especially with the technology that we have, likely the control now is a huge benefit. And the fact that you were likely younger, and had the benefit of youth at that point, versus being older and now having really tight management, that's the benefit now that you're older. And as body systems age, things can break down faster? It is. It's just the life cycle. Right? It would

Scott Benner 41:34
make sense that while your body is older, and you know, by definition, more frail, that the better control, the better off it would be. I also do you remember back when they used to tell you like, Oh, you know, don't worry about blood sugar control in the first couple years when outlawed little kids even when Artem was first diagnosed. I was like, that doesn't make any sense to me, like a little bit it does. Now when I look back on it, like the idea of like, okay, she's young, and hopefully she's vital and healthy. And if you know, we scratch her arm, it's going to heal back over. And so if we scratch some veins on the inside of our body, they should heal. Okay. I don't know that that would be true for everybody. But I get the overall idea. But I think the danger of that idea back then, at least the way I saw it was that you were giving people the idea that blood sugar management didn't make a damn bit of difference. If you were young enough. You know, you've got five years to figure it out. Like I remember being told that when she was two, like, Don't worry, she's little. This won't hurt her right now. Like that does not make any rational sense to me.

Jennifer Smith, CDE 42:36
Yeah, my nephew was actually kind of the same thing. He was diagnosed when he was seven. And that was actually something that their pedes endo actually told them where I heard it. 100% it was, you know, don't worry right now he's not, he's not in his teen years. And you don't have to worry about anything? Well, from a, from a true standpoint, what I know is that we want to aim for more optimal, regardless of what age you are. Yeah, there are, there are some, like factual studies that have actually shown that once kids get to the teen years, with the hormones of growth within the teen years, that starts to make more impact on potential future complications. If glucose levels are poorly controlled, in that timeframe of life, comparative to earlier on, when the hormones are different, there's still growth going on. Obviously, you can see it in your kids as they grow when even when they're little, and they're not a teenager. But the difference being more of those like sex hormones really into the teen years have more of an impact. For whatever reason, I'm in the standpoint of glucose control being better or worse, and then what happens down the road? So

Scott Benner 44:02
trying to imagine like, you know, changing the sentence slightly, like, how about this one? Your four year old can smoke cigarettes, they're young enough, their body will fight it off. Would you say that? No.

Jennifer Smith, CDE 44:13
How about No,

Unknown Speaker 44:14
no, no, just a little crack cocaine. She's only six. Yeah, like, she'll bounce back from that

Jennifer Smith, CDE 44:18
wants to have the beer for dinner every night. Let her have

Scott Benner 44:22
a little she's only eight. It's never gonna impact her long term. Like, none of those things make sense to me. Don't right. And so when I was told that I was like, Listen, I am not buying into this mess. You know, uh, but at the same time, it didn't go well for you in the beginning. I think it is a lot akin to smoking cigarettes. The sooner you quit, the better off the rest of your time is gonna be.

Jennifer Smith, CDE 44:47
That's right. That's I mean, that's the reason that you know, parents are told not to smoke at home with their kids.

Unknown Speaker 44:54
Right, everybody.

Jennifer Smith, CDE 44:57
I mean, it's actually something for my nephew. I told him parents when they said, well, the doctor says it's okay, if you sit at you know, 200 all night, it's pretty safe. And as long as you staying under 250 That's okay. And I'm like that that's not okay. I mean, I really had to, like, emphasize to them that that that's not okay. He might only be seven, eight years old. But these numbers are not where you want him to be.

Scott Benner 45:21
Right? Well, um, here's what it reminds me of. And I probably said this once before, but it fits right here very well. I once helped a person in their late 30s make a pretty drastic transformation to their management pretty quickly. And when it when it kind of, you know, our time together came to an end, this person was really grateful that their blood sugar's were now, like in range and controllable, and, you know, not so variable, but angry and sad that someone hadn't told them about this sooner because they had had diabetes for you know, the better part of 25 years. Right. And and we're really concerned about exactly this question, like, What's going to happen to me in the future? Based on what happened to me, you know, in the beginning, and why would nobody have explained to me that, you know, Pre-Bolus things important, or any of the other little things that we talked about together? And the best I could say, in that moment, because I was out of my depth, you know, what I mean? Like, I don't have diabetes, no one's ever lied to me about my health care for dozens of years. And so I just said, Listen, you know, now, just do a good job, move forward. You can't change the past, you know, any other birthday card euphemisms you can think of, there's no sense in hanging on to anger about this, like you have a real chance. Like, let's see what happens. You know, I keep doing it. And and let's hope for the best and right. I mean, do you really have any other options than hoping for the best?

Jennifer Smith, CDE 46:53
No, there's not. And even, you know, if you knew what wasn't working in the past, it was likely because technology wasn't where it was today, right? I mean, my my mom definitely says, as I've said before, if she had the technology, now, she would have felt a lot more comfortable sending me off to a sleep over that the parents weren't given like a two page sheet of instructions of what to do, you know, she would have been able to follow things from home and felt a lot safer when she sent me to sleepaway camp. And, you know, all of those pieces of management that were there, we did the best that we could, but I'm quite sure that in between the finger sticks, I had a date, I'm sure it looked like a roller coaster, because we didn't know what was going on.

Scott Benner 47:40
I think that at some point in the very beginning, the statement 200 safe overnight, don't let it go over 250 I think that was probably reasonable at some point, you know what I mean, because of the lack of technology. And when they say safe, they didn't mean safe to your health, they meant safe, that you won't drop too far and get really low. Like that was the that was just try to understand that at some point, because of where the technology was, in the past, the entire focus of type one diabetes management was don't have a seizure, right? And don't go into DK, it was literally these two opposites. They didn't care about anything else, because they didn't know to care about anything else, because they didn't have the ability to care about anything else.

Jennifer Smith, CDE 48:25
And for little kids who don't often have symptom awareness.

Scott Benner 48:29
Even more important, even more important back then. Right? They can't tell you the problem ends up being is that as we leapt forward and leaped forward and leapt forward with technology,

Jennifer Smith, CDE 48:39
the education didn't

Scott Benner 48:41
Yeah, and and, and these, you know, tried and true methods of well, 200 safe and don't go over 250 they got passed down generation to generation. So what you're really seeing is that there's one group of people, health care providers, right, who have an origin story. And that origin story builds on how they talk. But a different group of people over here, device manufacturers, right? They're trying for something different. These two people do not intersect in their day to day business and the way they talk with other people. So while this guy's telling you to hundred safe, this company is over here telling you Hey, I think our gear can keep your blood sugar at 85. Which one sounds scarier? When the doctors telling you just to hundreds, okay, you don't want to get low and then the next person is like, Hey, 85 is possible. That sounds scary. Right? And so you're never going to reach the masses. Until healthcare professionals have the ability to believe that the technology does what it does, and are willing to say it out loud. And you know, I don't know. Good luck with that. Good luck getting a bunch of people to say what they think you know, instead of what they think is safe to say. Luck. That's gonna be very interesting. You know, if the FDA would let not let but I guess if if device manufacturers could get into the business of teaching their devices beyond, this is how it turns on and the sound turns off, then they might have the, the onus might be on them to show you how to use it correctly. Right? And because then they could really market their their devices as living healthier, not just easier, because that's how that's how they're stuck. That's how they're stuck marketing right now. It'll make your life easier. It'll be a smaller part of your life flexibility. Yeah, yeah. You don't want to have to disconnect to do this right on the pod. And like, like, and that's the stuff there. I don't want to say stock saying cuz that's a lot of valuable information in there. Yeah. But they don't get to say the rest of it. Like, why don't you try the Basal increase when you have pizza? Like, they can't say it, they can say the pump does a Temp Basal increase? They can't tell you why in the heck you might want to try. Try it. And therefore it's a tool you don't really it's a screwdriver, and you don't know how to use it. You don't know what it's for, you know, just know you have it. Anyway. Alright, that went down a weird road. Um, let's see. Sarah says, Sarah has three names. And her middle name is fun. Sarah says, I'm not sure if this is big enough. There's nothing too small to Jenny and I won't talk about. But is it true that younger children are harder control to control compared with older ones in terms of their blood sugar? Does body size make a difference? I always look at people stable graphs with such envy, as we seem to go up and down so much. That sounds like their daughter's two years old. Is that more normal in younger children? Or is that more proof of my inexperience? Because we're only about a year and a half into this? Well, I think it's probably both an indication of your inexperience and normal. I always tell people, you know, figure out how to use the insulin so you can feed them so you can fatten them up because this is easier when they get bigger. But I don't know if that's just me, or if that's true.

Jennifer Smith, CDE 52:07
Ya know? And they're they're kind of a number of questions within the question, right? There's, there are a number of things to kind of bring about our younger kids harder to manage than older kids. I think it's, it's a different strategy of management. Because variables through the life cycles change whether you're two or 82, there's always going to be something that's a little different in young children, you know how fast growth happens. So growth, impact is always going to be more profound than when you get to, let's say, the teen years, especially for like a teen girl, let's say, who's not growing anymore. But now she's got hormones and a monthly cycle and things like that. So that's in the picture, despite growth not being in the picture, right? You know,

Scott Benner 53:00
we talked about it wrong, though. We always say diabetes is always changing. Diabetes is the same, their bodies are changing. That's right. Right, right. So you know, when your kids littler, and like Jenny's saying they're putting on a pound or two every couple of weeks, that's making your bazel not correct, as they get bigger and bigger, right? Or at the same time, they become more active, they start to walk or they start to do more things. That changes the impact. And, and so is it harder, it's the same, it just changes more frequently, or growing, right? And then right, when they get to that point, you're talking about where they're like a, you know, an adult woman who's getting their period. It's still happening, but it's happening cyclically by week, this week is different than that week, and that week is different than this week, and you have to know what week you're in.

Jennifer Smith, CDE 53:49
Correct? Yeah. And then, you know, with little kids too, you know, the other the other part of little kids that can increase the amount of variability which she brings in, you know, I feel like we're all over the place versus some of these graphs that I see it that are just nice and flat. Well, the variability with a small child, 235 years old or whatnot, you know, and I mean, I know myself with even the way that my three year old eat, he could love the same exact breakfast and eat it 100% for five days in a row, and I give it to him On the sixth day, and he eats three nibbles, and he's like, I'm all done, mom. Okay, well, great. Now, if I had to, like Bolus for that, and I work with so many kids that I see this as a consistent problem, right? I mean, that as variability. Now you've bolus for this amount of insulin, and there's not this amount of food there. So you have to offset it in some way. Well, that brings in a potential roller coaster. If you haven't quite yet figured out how to offset what you sort of front loaded with.

Scott Benner 54:54
Right. I I always say that I think the key to Pre-Bolus in kids is to choose what ever amount, you know, they're gonna eat. Like it might just be five carbs, but nope. But have you ever sat your kid down, they've just been like, I'm not eating this at all that they put something in their mouth, right or they switch to something. So if it's a 20 carb meal, and you have that feeling of like, I don't know is this the day the kid just doesn't eat their breakfast Pre-Bolus five, you know, carbs have it right and get some insulin on your side. And then when you see Oh, this foods going in, then put the rest of it in right away, or they throw up their hands or like not today, lady, then you've got some time to decide what else they could eat, you haven't personally insulin for the entire 20 carbs. Now you're sitting there, just staring through the wall going, Oh, my God eat food. Because there's, because there's reasons you don't want to do that. You know, because you don't want to cause a weird relationship with your type one diabetic and food, you don't want them to feel like food is the thing they have to do even when they don't want to. There's some really good psychological reasons not to do that. Ah, you also don't want to get into the roller coaster situation where their blood sugar goes to 300 and then comes crashing down and then they have to feed them and that becomes your day. So you have to Pre-Bolus something. You know, it's so funny that I was corresponding with a person who was gastroparesis one time. And they were saying I really want to Pre-Bolus but I don't know how because some days my body starts to digest my food. And some days it doesn't. Right. And after a long phone conversation, I said, you should do what people do with little kids, and just get a little bit started. And then as you see your blood sugar, wanting to go up getting the indication that your food is being digested, then throw the rest of it in, right, that ended up working for that person,

Jennifer Smith, CDE 56:42
or throw some in and extend the rest of it, or keep

Scott Benner 56:45
eating it out into the future. But get it

Jennifer Smith, CDE 56:46
moving. Get it moving.

Scott Benner 56:48
And when I said that she's like, That's brilliant. I was like, that's not brilliant. That's desperate. I did not know what else to say. Like, well, but you've

Jennifer Smith, CDE 56:56
had enough experience with other situations in which that that sounded like a good alternative.

Scott Benner 57:03
parallels to try it. Yeah, yeah,

Unknown Speaker 57:05
absolutely.

Scott Benner 57:06
Absolutely. I was gonna say that I think that a pit that we all fall in it's one point or another with diabetes. Or maybe life in general, is feeling like there are rules that we don't know. And that we have to find those rules so that we can follow them when obviously, that's not how life really works.

Jennifer Smith, CDE 57:28
There are guidelines, I always feel like it's like this is your guideline to like, the exploration of the woods behind your house, right? There's no rules to follow. It's just don't go near the growling bear in the bush over there best practices, maybe some best practices, you know, that kind of a thing. The other thing that I did want to say is, you know, it's really hard with today's online community with diabetes, which is phenomenal. It is great. I wish I had had it as a teenager and even an adult into college. It would have been fantastic. But I also think that we unfortunately, start to compare to what other postings show. Right? And I I don't think that's fair to do. So in this case, you know, this mom was like, why see these straight graphs all the time? You don't know what went into that straight graph. Yeah. You don't know the food intake, you don't at the activity level, you don't know where they are in diagnosis, or whatnot, there's, there's a lot more that goes into that flat or that curvy or that, you know, up down roller coaster or whatever kind of graph. And so it's easy to stay, it's hard to like, accept, but don't judge your own management off of what somebody else has posted.

Scott Benner 58:56
Yeah, the things that they say are the important parts of getting that so I'm going to show Jenny something that she doesn't see they're gonna see versus that where's my camera? Can you see that? Mm hmm. Okay, so that's three different people I'm tracking on Dexcom. Wait, what are their blood sugars?

Jennifer Smith, CDE 59:12
Ah, one is 98 with a horizontal, straight, steady, and other one is 93 with an angled arrow up, and another one is 130 with a steady straight horizontal arrow,

Scott Benner 59:25
okay. Do you know what those three people have in common? They all have diabetes. They're managing their diabetes. This is gonna sound horrible to somebody. But trust me, I'm not trying to be like that. I'm not being pompous. They're using my style. Sure, that's what they have in common. They're reacting to certain things, doing certain things, not letting some things happen. Like that kind of stuff. There's a it's a system, they have a system on their head. They're following that system. And so at the same time of day, those are three people blood sugars that are pretty much the same, you know, they're there. They're stable in a great spot. Yep. It's because it's, it's the style. It's your style of management. So when when Sarah asks, Is this my inexperience? Not my circle, it might be an experience, it also might be that you're very experienced that something that doesn't work, right, you know, and now you're just beating your head against that wall going out, understand, this is what I was told to do. Why isn't it working? So there's one of those kids on there, I was texting with their mother last night. And I was like, you know, you need to give her some insulin right here. And she's like, I don't want to her blood sugar is only 140. And I was like, I don't care. Like, if you don't stop this 140 and make it 90, then two hours from now, when she goes to bed, she's going to be 200. And then you're going to get into a different space. And so my concept is, if you don't get high, you won't be high, you will be high. Right? And and it turns out if you put those concepts into practice, I mean, the pro tip series you and I did is just it's that's it. Like that's the whole thing right there. If you do those things, that's it. If you if you gave me three more kids, their blood sugar's would be right around there right now, then there's anomalies that happen, like, you know, I don't sometimes, you know, people eat things. They don't say what they eat, or they miss count carbs or don't don't aren't intuitive enough about glycemic load and index and stuff like that. But for the most part, you take the steps. It usually works,

Unknown Speaker 1:01:31
right? I mean, I don't

Scott Benner 1:01:32
know another way to say it. Like, I'm not trying to say it's easy. It's not easy. But there there is a formula in there to leads to that. Mm hmm. So that's two kids in there that are, you know, one of them's probably still asleep, one of them they're in, they're in different time zones, but they all have the same experience

Jennifer Smith, CDE 1:01:49
strategy.

Scott Benner 1:01:50
Yeah. So Sarah, I think you figure out what works. And then stay flexible while your kid is growing. And keep applying the tools. Understanding that the game is changing, right? A little bit. So yeah, if that makes any sense or not.

Jennifer Smith, CDE 1:02:08
And certainly reach out, you know, for help. Remember to ask more. Remember to ask more questions, even at your doctor or endo visit or CDE visit or whatever it is. Remember to ask more in depth questions in order to get more in depth help. Oftentimes, I think people end up going in not really knowing what to ask because they haven't gotten help before. So they just leave it up to the doctor to kind of give information, and then they get nothing back. And they think Well, my bad, dark, dark doctor is not very helpful. But if you don't bring in more I see this happening around gymnastics every day. I see this happening every Tuesday, Wednesday, Friday. Can you help me? Great. Now the doctor has more to go into the data and pull and get a trend. Yeah. And offer better suggests you have to

Scott Benner 1:02:59
you have to step back and have a macro view of diabetes. But you have to have micro questions. Right? Like, right, so like, you can't just yell. I don't understand every night at midnight, her blood sugar's high. But that's your macro view of it. That's not helpful to the person trying to help you. What's your micro view of it? What's happening in the hours just prior to that? Those are the things you need to know. You know, it's this one kid's blood sugar's were not great. Three days ago. And if you looked at the tech, I did it through texting. If you look at the questions, I asked them, most doctors would not look and go, Oh, well, those are the questions that need to be answered to fix this kid's blood sugar. I ask really odd things that answer the questions I need answered. And so my point is, is that those are the questions to me, you ask? Those are the like the micro specific questions. Yep. And I don't know how you Sarah, I don't know how you figure that out other than experience time and don't give up. But I can tell Sarah and anyone listening this? My experience has been that people who are thoughtful and concerned and care and ask questions like the one Sarah's asking, those are the people who make out well, because they're there, they're interested.

Jennifer Smith, CDE 1:04:14
Right? And they're trying and they keep looking until they get an actual answer that helps.

Scott Benner 1:04:19
That's it. They're interested in, they're trying and they care. And to be honest, that's pretty much what you need. Right? As long as you don't give up. You'll find it at some point. You might not find it for me, you might find it somewhere else. But right you'll find something that somebody says that clicks with you and makes it all feel kind of easy at that. Right. Jenny are we at a time?

Jennifer Smith, CDE 1:04:37
You have about nine minutes left nine minutes, or something easy for nine minutes?

Scott Benner 1:04:45
Um Oh, there's no answer to that one at all was like, oh, half an hour conversation and a lot of people asked it to, uh,

Jennifer Smith, CDE 1:04:57
maybe it's a maybe it's a

Scott Benner 1:05:00
Well, let's find out what you think. How do you calculate your bump and nudge ratios? So when I say to somebody, hey, that blood sugar's 140, I'd like it to get back to 90, bump it back down. That's not a, it's not a measurable idea to people, I guess. Okay, so I usually say how much insulin Do you think moves it from there to there and just go with your gut.

Jennifer Smith, CDE 1:05:30
Right. And it kind of starts then with kind of brings you back to the pro tip series of figuring out things like bazel and sensitivity factor. And even, you know, that kind of stuff. Because really, anytime you're playing with the bump the nudge, you're playing with the assumption that you know, a certain amount of insulin, let's say one unit will move your blood sugar, a certain number of points, right. So if you know one unit changes your blood sugar by 60 points. And you know that your cup of coffee in the morning without bolusing. for it, you've noticed that it kind of raises your blood sugar by 65 points on average, well, you know what, then you need to start taking a unit of insulin to stop the 65 point rise, because one unit offsets you by 60 points to drop you from too high, right back to where you want to be. Right. So the bump and nudge is kind of if they're looking for a math, it goes along mostly with sensitivity factor or correction factor. It goes along with how much do I want to knock this down, and how sensitive I am I to insulin at this point in the day, because many people also have sensitivity factors that differ based on nighttime daytime, afternoon or whatnot. I myself have two sensitivity factors, one that lasts through the day time, one that's overnight for me. So you know, I'm more sensitive to insulin overnight. So I don't need a load of correction. If I choose to Bolus for a higher number that gets up there overnight. I don't need as much overnight as I do during the daytime. Yeah,

Scott Benner 1:07:11
I have to say I don't think I take it for granted because of the podcast. And but if I wasn't talking about diabetes as much, I probably would, that idea that I can look at Arden's blood sugar to 11 o'clock and say, that needs a half unit and look at that same blood sugar at 7pm and say, hey, that's a unit or at four o'clock in the morning. It's point two, it just, I don't know how to explain, other than to say, I look at the blood sugar, I look at the situation. And then I know how much to give her. But I don't know how to tell you what I saw. And how it led me to that answer decision. Yeah, other than to say have diabetes for a while. And all of a sudden, you'll just sort of know.

Jennifer Smith, CDE 1:07:54
Some of it is some of its experienced definitely like I you know, I can say that. Gosh, if I know that one unit again, changes my blood sugar by 60 points. But I've also got like a load of fat in the picture. Well, gosh, yeah, need a lot more of a nudge than you would if it was just because of miscounted carbs.

Scott Benner 1:08:12
And I'm not saying that I haven't adjusted a blood sugar at 1am at an hour and a half later been woken up by the same high blood sugar and then thought, oh my god, what we ate for dinner. Now I remember like that's gonna happen, you know. But the good news about that is, is that I was trying to stop at 140. And it's still 140 I didn't stare at the 140 hope for the best watch it turned into a 220 Bolus for it, forget about the pizza, get up again at three o'clock when it's 250. Like didn't even like eat right, don't let it get out of hand so that it's manageable, and then the bumping in the nudging becomes less, in my mind dangerous because you're using less a less a smaller amount of insulin to accomplish something. So I say if you ever seen me speak, which might never see again. But that jokes funny for a couple of reasons. And everyone listening is only gonna get one of them. But that's okay. Yeah, thank you, Jay. which you may never see again, if you know, I'll say look, I'd like to see a stop a 110 or 120 diagonal up because you might stop it with point two or point three or if you're an adult with a unit like a tiny bit of insulin, you come back to 90, and you sit stable again, the likelihood of you getting low after that is small because you've used such a small amount of insulin to begin with. So that's how you keep from overcorrecting. And that's how I think of bumping and nudging. But and

Jennifer Smith, CDE 1:09:34
that is that is really where our where our hybrid closed looping systems, like control IQ, you know, with tandem, that's really where those systems are going. The idea that the bump and nudge becomes less of your play and more of the pumps interaction because it's got CGM data to interact with and it can see a rise happening. It knows Okay, I've got this value, I don't want this person to get above. So it starts nudging it either with a temporary bazel change, or with these little micro, you know, boluses, the control IQ system is in a system so far in what it can do, but I think that's where, you know, further progress into the pump company. Is that where they're going with the technology? Yeah, because they don't want Well, they don't people with diabetes don't want, while you know how to pump and nudge now, you don't want to have to pay attention so much to have to do it all the time.

Scott Benner 1:10:33
I always tell people to bumping and nudging is a teaching towards some point, you should learn from the bumping that you should have done something different meal, you know, like it's not a it's not a long term idea. It's part of a bigger teaching idea. And having said that, when I watch an algorithm change basal rates and you know, put insulin in, I'm like, that's what I do. Wow, I'm not gonna have to do that. And exciting. And by the way, bumping in nudging is, you know, it's my idea, the words, and they're for sale. Like if a pump company wants to buy them for marketing materials, I'm open to having a conversation, you know, just let me know. Anyway, Jenny, I'm gonna say thank you. Hold on one second. Thank you. You can actually hire Jenny Smith, did you know that she works at integrated diabetes. And they have a website aptly named, integrated diabetes calm. So that's where you can find more about what Jenny does in the professional life. I don't know how often I mentioned this, but I like to bring it up once in a while Jenny is not a paid contributor to the podcast. She just really likes being here. So this is not an ad. She's just a friend who likes being on the show. But that doesn't mean you can't you know, there are a couple of bucks. Get some help with your blood sugars. That's what you need. Thank you so much for listening to the Juicebox Podcast. Thank you for supporting the sponsors sponsors like Dexcom that you can find out more about@dexcom.com Ford slash juice box. And how about tubeless insulin pumps? Well, there's only really one, but it's called Omni pod. And you can find out more about that. And get yourself a free no obligation demo sent right to your home by going to my Omni pod.com forward slash juice box. And to find out more about Arden's blood sugar meter, the Contour Next One, you go to Contour Next one.com forward slash juice box, you're seeing a theme here you get it. And of course touched by type one is that touched by type one.org great organization doing wonderful things for people living with type one diabetes, and all they want is for you to know they exist. So go check them out. Touched by type one.org you think we'd get a juice box slash in there, but it's not happening? Okay. I'm not hurt. Oh my god, that was exhausting. I'll see you guys later. Bye. It's hard to talk like that for a long time. Everything's real deep and you're trying to enunciate and to not over speak or understand like, Hello, this is the word of God. You know, all fields like that a little bit. It's been a long week, too. It's Friday. I need to get to the weekend. Actually. I'm turning 49 on Sunday. And I'm feeling every moment of it. I'm not I'm okay. Am I it's hard to tell. Who am I arguing with

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#262 Ask Scott and Jenny: Chapter One

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categories Omnipod, Juicebox Podcast, Dexcom, Interview, Type 1 Diabetes, Pre Bolus, Ask Scott & Jenny
tags Juicebox Podcast, Omnipod

#328 Ask Scott and Jenny: Facebook LIVE Edition

April 24, 2020Scott Benner

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions LIVE on Facebook.

How do I attack meals that cause spike without crashing later? Is it with a longer pre bolus? More insulin? How to evaluate your bolus strategy.

Any recommendations for helping with Freestyle Libre accuracy?
What are the pros and cons of CGMs being used on patients in hospital settings?
What is the best way to tackle losing weight for a type 1?
Should I calibrate Dexcom on day one if off and how do you manage that if using an algorithm?
How do you know if it’s a bad site or another variable?
What are good tips for managing diabetes when you are trying to get pregnant?
Is there anything physiologically wrong with a post meal spike if it comes down later without extra insulin? Should we try to master that meal?
Let’s talk about pod changes and patterns.
Is it possible to have the opposite of Feet on the floor?
Let’s talk about female sex hormones.
How do you manage the inconsistent eating pace of a toddler?
What is honeymooning?
Is there a cure on the horizon and near future?
How do you manage kids and growth hormones? Finding the right amount of insulin.
Can you explain insulin deficit?
How do you manage unexpected diabetes variables like unplanned exercise, sudden stress?
How do you know when to start eating when pre bolusing and looking at the Dexcom arrows?
What factors affect the hypoglycemic risk value on the Dexcom Clarity app?

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

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Scott Benner 0:01
Hello, everyone, and welcome to Episode 328 of the Juicebox. Podcast. Today's show is the audio from a recent ask Scott and Jenny, Facebook Live. Now the audio is super good. It's clean, clean the way you like it on a podcast. Don't worry, it's not all Facebook. It's not like Jenny's like, I think that we should do this thing with the input doesn't sound like that at all. Sounds crisp and clear. Right? Imagine Wolf Man jack and your house is like, hey, their kids. No one knows who that is. But that's not the point. The point is, it's a good recording for podcasting. And I didn't want you guys to be left out. So I was just trying to do a little live thing on Facebook if people you know, something to do during the day while they're trapped in their house. But then I wanted to get that audio right up here for you guys to listen to, in your ears the way podcasts are supposed to be heard. Anyway, Jenny and I started with one question from my ask Scott Jenny list. And then we let the viewers of the live ask the rest of the questions. I thought it went great. actually had a fun time was nice to hear from everybody. I'm giving you this episode. As a bonus this week. This is the third episode this week. So there won't be any ads on it. But it isn't going to stop me from mentioning the advertisers so that you remember that the good people at Dexcom on the pod Contour Next One blood glucose meter and touched by type one are the reason why I could be messing around yesterday doing a Facebook Live. So I'm gonna put links at the end. And they're going to be in the show notes here. If you'd like to check out any of the sponsors, clicking on the links is very helpful to me. And I appreciate when you do it. Alright, so let's get to it. This is episode one. I say 328. It's a live ask Scott and Jenny from Facebook. And you need to remember while you're listening to it that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. And just like that, you're listening to Scott and Jenny. redirecting to Facebook. Oh, there it is. I'm making a funny face. There we go. We're alive. Oh, that was easy. Okay, so obviously, it's gonna take a couple of minutes for people to get on. Gonna first say that. I'm Scott Benner. This is Jenny Smith. You may know Jenny and I from the diabetes pro tip episodes on the Juicebox Podcast. Jenny also does ask Scott and Jenny and defining diabetes. And today we thought we would do an ask Scott and Jenny live. Now we have a question to get started with that came from one of you. But we're totally willing to see some questions from other people. So first, I need somebody in the chat on Facebook. Tell me if you can hear me and Jenny Say something. See if I can hear you.

Unknown Speaker 2:53
Hello. Okay.

Scott Benner 2:55
Just somebody tell me in the comments if if you can hear us. Oh, hi, Maddie, how are you? Have you never seen Jenny live before?

We already have 18 people? Awesome. 24. We'll start right at three o'clock because you guys are on time. I like prompt.

Jennifer Smith, CDE 3:18
You got a minute or maybe less? I don't know my plaxis 150 or 259.

Scott Benner 3:23
They should definitely be everybody can hear. Cool. All right. They should definitely be rewarded for being on time that people will come later. Gonna have to watch, you know, watch the replay or hear it on the podcast. I can hear both of you. All right, Laura. Thank you. Whoo. All right. So if you guys have questions, throw them in there. And we'll see what we can do. But Jenny and I thought we would start with let's see, I have it here. I have it here. Here it is. Um, oh, you know what, before we start, did you guys know that? I'm Jenny. I'm gonna give your phone a few days here. Jenny Smith is an RD LD CDE T one day. She has a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes a pumps and continuous glucose monitoring systems. Jenny has had Type One Diabetes for how long journey

Jennifer Smith, CDE 4:17
on May 15. It will be 32 years. Okay, so that's a long time.

Scott Benner 4:23
And that is definitely a long time. So any of you who have heard us on the show before? No. This is basically what you know, it looks like for Jenny and I when we record and you guys just don't usually get to hear so we're gonna get started with the first question. Yeah, it's how do I attack meals or times of day that cause a huge spike, but come down eventually. If more insulin is added, I go low later, when I wait longer, like when I Pre-Bolus I go low earlier in the meal. Now by the way, guys, there's a disclaimer here. We're not healthcare professionals. This is not advice in this cause, just us talking and you hanging out so if everybody's okay with that. Cool if you're not jumping, all right, I went, we did not do any problems for you people just get it. You don't like it? Okay. All right. All right, Jenny. So I, you know, I hear this question a lot. I tried to Pre-Bolus. But I got low before I ate or, you know, I tried to shorter Pre-Bolus. And I just got high later, what are some of the reasons that can happen?

Jennifer Smith, CDE 5:23
So to begin with beginning of the question would be your bolusing getting high, and eventually, without correction, it comes down. That initially would be a bolus timing thing, right, where you need to Bolus sooner to stop the rise. It's an indication that there is enough insulin there because ultimately, the Bolus you took does get you down to where you want it to get later after the meal. There's just not enough time between taking the insulin letting it get started, and the food actually impacted blood sugar. But the further part of the question sounds more like if you add more insulin, like upfront thinking there wasn't enough to begin with or you correct, and then you end up going low in either of those scenarios. Clearly, there was too much insulin, right, you didn't need more insulin, you just did it in a different bit of timing for taking it right. The third part of it. So like little segments here. The third part of it really is, if you do take the amount based on your ratio, you end up climbing, or you Pre-Bolus with enough time, and you end up sinking within the time period after you Bolus, but then you still climb up later. That could be especially for those who are using an insulin pump. That could be not only a timing issue, but also a delivery of insulin issue. Okay, right, where you would probably need to use all the pumps have some type of extended bolus feature. Could it be combo bolus extended bolus dual or squarewave. bolus, all the pumps call it something different. But essentially, it allows you to take a certain percentage up front, potentially in this scenario to stop the bump up, gives you let's say you decided to take 50% of the Bolus now and then distribute the other 50% in the back end, what it allows is the 50%, you take now you can Pre-Bolus thus decreasing the amount at the beginning that you get. So you don't have a drop, but you also get the Pre-Bolus benefit of not having that rise up after the meal. And then the later impact is that you still get a finish of that end of insulin, which you knew was enough. You just needed to distribute it a little bit longer to impact, you know, the full content of whatever this meal, I guess, added.

Scott Benner 7:50
Okay. And I like obviously I agree with you. But what I was gonna say is that when when I see that I don't often see a Pre-Bolus It's so like heavy that she crashes before she gets low. And so I think that ends up being a situation where people are like, well, I Pre-Bolus and then I got high anyway. So I'll keep trying longer and longer and longer. But it's not at some point, the length of the Pre-Bolus is just not your issue. You know, and and I hate to I don't want to put a number on it. But you know, if your Pre-Bolus thing, 30 minutes in the future, you're probably coming out of a much higher blood sugar to begin with, and you have issues on the back end that you're not dealing with. I find myself saying a lot that diabetes, using insulin specifically is like time travel, everything you do now is for later, right, right. But everything that's happening to you now is from before. So if you're putting in a healthy Pre-Bolus, like you said on a good site that you can count on, etc. And you're you know, you're still climbing afterwards. I mean, the Pre-Bolus probably at this point isn't the question. And there's little things for CGM users, you can kind of look at the trend, the angle of the trend, right. So if you're, if you're shooting straight up like this, you've either missed, I think, huge with the amount of insulin you're using, or you know, if you just bolus and five minutes later start eating a real sugary thing. You're going to shoot straight up, if you come more on that, that kind of gentle rise that I tried to describe as the it's the minor or no, not the minor, like the the mountain climber on the prices, right? Any guy keeps like rolling back and forth like this, right? Because when you have a Dexcom and you you have that gradual lineup, everyone's done it, they stare at it, they're like it's gonna stop, it's gonna stop, it's gonna stop and then eventually that guy falls off the end and true Carrie says you can't have the money and it's all over right and your blood sugar's 280. And, and then that's sort of the end of it. So like Jenny's saying, there's just 1000 different ways. But in the end, what you're trying to do is manipulate your insulin and put it where it's needed. So you need that nice Pre-Bolus but if an hour later You started having this crazy rise, like she said, an extended bolus, or even coming back and readdressing with more insulin, at some point is the answer you get low later, when you put so much insulin up front, to control that line, that eventually when the impact of the food goes away out here in the future, the insulin still leftover and you crash low. So you've got to, you know, for the lack of a better term, you have to put the insulin where it's needed. I always say when you're about, you know, you have to address your body's need with with the right amount of insulin. So, right, that's cool. That's a really it's a great question. I appreciate that question. And people have left other questions. So dig in here, and see what I can

Unknown Speaker 10:40
love questions, right? Oh, yeah. But I'm

Scott Benner 10:43
on the wrong browser to see I got to get into it. Everybody chill out a second, this is my first time doing this. So a lot of pressure, like running the show, and

Unknown Speaker 10:52
like asking the questions.

Scott Benner 10:54
I was gonna feel under pressure here. Alright, I'm on a different browser. So one browser is sending you guys the Facebook Live? And then I'm going to look on a different one. Where am I looking at? I mean, the wrong I have too many Facebook groups.

Jennifer Smith, CDE 11:16
While you're looking, I'm going to add something extra to that comment. And question from before to it you were talking about, you know, the trend kind of even coming into the meal. And that can definitely determine things, you know, if you were if you were at an excessive insulin coming into a meal, and you are already on this slope headed down, right, and or if that's commonly happening within the same meal time, it could be that your Pre-Bolus thing with a load of extra previous insulin on board. Thus, you're consistently coming down in this time period of the day. And so any Pre-Bolus, it's going to look like that Pre-Bolus is causing you to drop within the first time period of that meal. So you're less likely to Pre-Bolus as much as you need to from previous experience. And thus you're getting this rise up that you wouldn't have if the hours leading into this meal. Again, if it was a consistent problem at this time of day, it sounds like the hours ahead in this setting, could need to be evaluated. Maybe the bazel is too high heading into this meal, okay, or maybe the insulin to carb from a snack three hours ago, is also giving you too much insulin. So you're consistently coasting down into this meal time. So you've got this excess behind the scenes insulin. So are some other things that could be evaluated to cool.

Scott Benner 12:36
Alright. And somebody said I was lower than you. So I just turned my voice up. So if I got if I'm now too loud, somebody told me. All right, Anna asks, I have been having trouble with the accuracy of my freestyle libri. Sometimes there's a big difference. I think I will change Dexcom was I finished? The my inventory I currently have at home. But do you have any recommendations in the meantime? While I'm using these?

Unknown Speaker 12:59
That's a good question.

Unknown Speaker 13:00
Yeah. Is there an answer?

Jennifer Smith, CDE 13:02
Well, is there anything to adjust? There's nothing from our, from our practice, all all of us within our practice. At integrated, we've all used the libri all got our like trial, you know, couple of sensors to try out and I try to as many people often do you make yourself the guinea pig, right, you try a couple products at one time to see what's actually Right, right. So I wore my Dexcom along with the lever a and the three sensors of the libri that I wore, they were all consistently reading lower than my actual sensed Dexcom and fingerstick values were consistently center to center they were all consistently different. And enough that from a blood sugar and a meal bolus and a correction standpoint strategy, it would have been enough of a difference to make adjustments kind of diff difficult to base off of, is there anything that you can do about it? In this setting, what we usually recommend is for the prime times that insulin is going to be dosed based on a glucose value, do a finger stick, get a finger stick and dose off the finger stick don't dose off of your libri what you can know from any sensor system that might be reading a little bit off or different than you know it should be is that while there is a difference in the number, the trend is still a good, it's still a value for you. So you can still tell whenever you're trending up or trending down, and you can use that to your advantage for future planning. Okay, so but you wouldn't necessarily dose off the value.

Scott Benner 14:43
So um, I guess what he's saying is when you find you're not trusting the device, test, but still look for I mean, I guess I've never used the library but arrows and direction and rate of change and stuff like that. And then when you really need to know I guess what we're saying? Is that if it's a pre meal, and it says you're 120, but you think you might be 150. That's important to know when you're making your Bolus, right. Okay. But Hmm, it's still important. I don't want to minimize the idea that a big a big difference is a problem, but at least you can be safe. When you're when you're putting in like more when you're

Jennifer Smith, CDE 15:19
putting in insulin. Yeah,

Unknown Speaker 15:21
yeah. Cool. So,

Jennifer Smith, CDE 15:23
to let her know that that's not uncommon. Gotcha. A lot of people find the variants,

Scott Benner 15:27
it's gonna be hard to keep. See, I want to, we only have an hour, so I need to keep Jenny movie but Jenny will talk and like, get all her knowledge out. And then we're gonna answer one of your questions if we do that. So Maddie, how do you Jenny see CGM being used in patient hospital settings now that we're seeing COVID-19 error How is going to help diabetics? And Maddie, what I'll say to you is, did you hear the episode of the podcast that went up today? Because Dr. Dan disalvo came on and talked about how decks coms are being used in hospitals right now. But so I have something to add, but you go first.

Jennifer Smith, CDE 16:00
That's pretty awesome. Because I have I've not obviously listened. I've been working with people all day. So I'm, so I have I both pro and con feelings to it. Okay, so from the standpoint that great, there's a lot more information, there's a lot more data, it can be beneficial. On the con side, however, there's a lot of data, and healthcare workers in hospital who we already know, have have little experience with type one, consistent glucose information management, they are used to doing finger sticks every several hours, to base decisions on right, whether it's dosing or whatever adjustments in doses. With all of this extra information, the trends, the alarms, the things that are going to be visible to them. Yeah. There's no, there's no quick education that can be done within 10 minutes to the thousands of health care, nurses, doctors, whoever that's looking at this information to help the person wearing it. Yeah. I feel like there's a lot of information, they're not going to know what to do with it. So that's what I feel like I feel like it's good. But it's also, I don't know,

Scott Benner 17:20
let me share with you what Dan said. Dr. salvo told me that what it was really helpful with in the moment was, it was preserving PP for nurses because they were, you know, they do finger sticks on patients a lot. And now you're asking them to go in and out and change their gear every time. So now they're, I guess, Dexcom. If I, if I heard him, right, gave the patients like Android phones. And so there's a cloud service. And now the nurses are able to look at the patients through the share and follow, right? And then they're like, okay, you know, they come down the line. And here's Mary and Mary's blood sugar's this, it seems pretty reasonable. I don't need to go in there. So that was the idea. What I heard while he was talking was a great opportunity nationwide for health care professionals to see how glucose monitoring works, right. And maybe, maybe in the future, things will go better. I told him a story of when Arden had a surgery. And you know, the nurse didn't know anything about it. I just kept talking to nurses till I found wonders like I have a friend who has diabetes, I go, you're my friend. Now come over here and explain to all these people why we need to leave the CGM honor during this procedure. But anyway, that's what I thought of it, Matty, I thought it was I think it's, um, it's great for that saving of the PP. And on the other side, I think it's a good first step in bringing the technology out to people. So

Jennifer Smith, CDE 18:35
yes, yeah. I also think, you know, in that scenario, as if they're using it based on the protocol that they would have used finger sticks, and they're only checking at certain points to see what the values are or responding to alarms. Yeah, it's absolutely valuable. I just hope that I would expect somebody has schooled them in what to pay attention to what not my, my

Scott Benner 18:57
thought was that it was, it was going to be used in a really, I don't know, like a limited way in the beginning. Just to keep you know, from being with people. I saw Donnie ask about managing weight with type one. So and he said, Thank you for being here. So thank you very much, Danny for being here as well. Yeah. Best way to tackle losing weight for type one. Why do why can people with diabetes who are using insulin have trouble with weight loss?

Jennifer Smith, CDE 19:24
The first thing is definitely insulin management. That's that's a huge piece of it. Because insulin is a storage hormone. It's meant to move food glucose out of the system into the cells, either it gets used by your muscles or it gets packed away into fat, right? So from a physiology standpoint, even if you look at a body that doesn't have diabetes, if you out eat what you really need, then overall your body can only pack away that extra calorie, right? Okay, and it does it with insulin. Right to manage the normal blood sugars that should be there. Same thing is happening though. And so person, even without diabetes can gain weight, that that's how they gain weight. Essentially, their body should packing away more than what they needed because their body is managing blood sugar the right way. In a body with diabetes, though, because insulin management is something that we control, body's no longer doing it for us. It's something that we have to, we have to adjust more precisely than people are often given tools to manage. Right. So overall, one, make sure that your baseline dose that bazel is right to begin with, it's in the right place, then the next thing to tackle is the food management, strategizing around meals timings, you're not using more insulin to cover then you actually need to, you're not covering with extra food when drops happen, because you used too much insulin that you didn't really need to have there. And then the other piece, of course, beyond that is, are you eating what your body needs to eat? You know, because if even in this case, if you've got great looking blood sugars, but you're constantly like popping food in and covering it with insulin, you could have wonderful looking blood sugar values, you could still be out eating what you need.

Scott Benner 21:17
Right? So I usually it's funny, I saw john pop in and he said, Don't feed your insulin, which is this is what I was gonna say. I think I think that when people who listen to the podcast have, there's two trains of thought, when you're learning how to use the insulin in the beginning, I will say be more aggressive, you can always have juice later. I don't mean that for the rest of time In Memoriam. I mean, while you're figuring it out, like if you continue to bolus and get low, fix the bolus, don't keep fit, you know, don't keep drinking juice. But it's a great point. Because people with type one can start to think of diabetes first. And instead of health, right, so all of a sudden, an Oreo cookie is not a bad thing, because I need it because I'm getting low, except your real issue is you need to stop yourself from getting low. So you don't have to eat an unscheduled Oreo. And by the way, don't eat Oreos, they're, they're poison. But But you know, like, I really I don't think there's any food in them whatsoever. But my point is, is that don't feed the insulin, but learn the steps so that you can do that. And Jenny, this is a wonderful place to say that diabetes pro tip calm is now open and available to find all the diabetes pro tips with Jenny and I all in one place in case you guys have had trouble finding them in the podcast player.

Jennifer Smith, CDE 22:34
Yes. And we've also gone over that weight piece in there. It's a great episode at least one if not a couple mentions.

Scott Benner 22:42
Yeah. All right. I have. I have one for you. And one for here's a quick one. Yeah, Jenny, you are g six. And so does Arden. Do you ever calibrate on day one? If it's off? No, you don't you let it go?

Unknown Speaker 22:57
Let it go.

Scott Benner 22:58
And how do you manage that with your algorithm that you're using?

Jennifer Smith, CDE 23:02
I manage it by doing finger sticks. Because I have had, as we talked about right away. I've had diabetes long enough that finger sticks have always been a norm. Even once things got approved for not having to do that anymore. I still do that. So that's my thing. And with the algorithm that I use for my insulin management, I can I can populate in my finger stick value for my algorithm to use that value rather than the CGM value. And then I get proper dose adjustment.

Scott Benner 23:41
And you have an apple iphone, right?

Unknown Speaker 23:43
I do. So you go Apple Health,

Scott Benner 23:45
you go into the health kit, and you tell it, you add your blood sugar there, and then that program you're using, yes, the loop app will see it and then it knows what your posture is. Correct. And so my my way of dealing with it is if it's close eye roll, you know to me like if and I test to their their advertisers on the show, but we use the Contour Next One meter, I find it to be incredibly accurate. And so in those first number of hours while the sensor wire still you know, baking in, I will test but I'm going to tell you that if it says she's 70 and she's really you know, and she's really 90, I might let it go a little longer to see what happens. But there are times I do calibrate to get it together. It's not a frequent thing. I probably only calibrate on day one when I calibrate but having said that we don't do it very often law we leave the finger sticks though

Jennifer Smith, CDE 24:42
and there are a There's your so many that trains of thought in terms of that that I've run into in working with people, some people who've got this like system, it works really well for them. Awesome, great, even if it's not what's recommended if it's working for you. I'm not going to tell you this Stop doing that. Right. But from the standpoint of education, you know, we recommend following the recommendations of Dexcom. Don't calibrate in the first 24 hours,

Scott Benner 25:13
you would never do anything like that. Somebody asked for links, I just put them in the comments. And honestly, Jenny and I are not used to being seen we, you know, I mean, for those of you who are new, I have a podcast called the Juicebox Podcast, and Jenny is a frequent contributor to it. And she's not on every episode. So if you really like her, and you hate me, you're gonna be pissed when you like tune in today, and she's not there. But anyway, calibration day one. Actually, that's sort of covered. The next question I had for you. If there's a person who is excited about algo, their algorithm pumping in the in the future, right, but is worried that because they don't always see their CGM rock, you know, rock solid, and they're afraid of what's gonna happen next, what I would say to that is, you know, Arden has definitely done both ways. And it's never been an issue. Like, I've never ran around the house going, like, Oh, my God, everyone's gonna die. Because you know, Dexcom was off and we're using an algorithm, it just, it's a it's a reasonable worry if you've never done it, but once you do it, I don't think it's something you'll think about again, does that strike you like that?

Jennifer Smith, CDE 26:19
No, it does. And it's actually a question that I've gotten more than a number of times from people that I work with, especially parents of kids, you know, wondering, Well, what about those? compression lows? Right? What happens if an algorithm is using that? And now it's not really low? What will have happened? Well, you know what, because the system if you're using one of these hybrid types of systems, whether it's, you know, on the market, or yet to be on the market, um, if you're using one of them, it's going to adjust based on that change in blood sugar, that's being seen, right. But most often, especially in this example, of a compression low, that writes itself pretty quickly. In fact, you can tell it's a compression low, because it looks like your blood sugar is literally like nosedived off of a cliff. Yeah. And then it comes back up very quickly. I mean, you could you can tell it's wrong. Well, yes, the system will have reacted to that drop in blood sugar, it may have taken away insulin where it was supposed to, but within the quick timeframe of it writing itself, that algorithms also going to write what it took away behind that, right. So I've personally, I've had sensors that have been off, thankfully, not very many, my Dexcom, thankfully, has been very accurate for me. In all the years, I've used it. But I have had compression lows. And since I've been using, you know, this algorithm, I haven't noticed that that's honestly been an issue. I've never had any problems of excessive high blood sugars or no problems with like, strange, odd low blood sugars that shouldn't have been there because of this sensor. You know, okay, she being off.

Scott Benner 28:00
Yeah. I hear you. I'm, I'm down. I think it's, it works. I mean, I've I'm not gonna tell you I haven't gone Norton's room been like, She's like, the first thing I do if she's laying on her side, because she wears hers on her, like her body, her hips. So I'll touch her hip that she's not laying on. And if it's not there, I'm like rollover. Just kind of like shutter and, and then you'll wait a minute, it comes back. interesting side note about a compression low with a CGM. The number it's reading is actually correct still, although not indicative of what your blood sugar is. So it's reading your interstitial fluid, which is you know, freely running through your body. But when you press down, it disperses it. So it's dispersing some of the glucose that it's reading. So it might tell you your blood sugar's 60, all of a sudden, the truth is, the interstitial fluid around the wire, the glucose value is 60, your whole body might be 110. But that's why when you roll off of it after it gets to the algorithm gets to think a couple more times, it'll come back and tell you Oh, no, you're one time. And that's it. How does that engineer makes a great point, if that happens, the worst thing that's gonna happen is the algorithms gonna take insulin away, you might get hot, but you know, you might get a little higher, but you're not going to be in a dangerous situation. And that's a great trade off, I think, yeah, you know, Jenny, I'm gonna ask you, somebody jumped on and said that I recently said on the podcast that I don't abide a bad pump site that I get, I get away from a by a pump site pretty quickly. But she wants to know, how to, you know, it's not just your period, or, you know, and so I'll you know, because you and I deal the same way about that we don't stick around for like,

Jennifer Smith, CDE 29:39
I don't stick around. And and I guess, you know, from a female perspective, if you're like, well, gosh, is this my period? Or is it you know, a bad sight or whatever? I mean, most women, most not all, but most women have a pretty consistent timing rhythm to their cycles. Yeah, right. So if it's You know that it's probably coming into that time, or you know that it's that time and your high blood sugars are usually associated with that. You wouldn't necessarily think that this is unless you, you haven't changed your, let's say, your settings or your insulin doses as you needed to for this time period. And if you forgot to do that, obviously the high could likely be associated with that. The best way to tell though I mean, because even in your period, you could certainly have a bad sight. Like two things hitting you at one time. That's not fun, either. It's

Unknown Speaker 30:31
okay, hit from both ends. Right? That's not

Jennifer Smith, CDE 30:33
that's not joyful at all. So, you know, if that's the case, I think, regardless, for anybody, whether you're male or female, if you've got an odd looking high blood sugar,

Unknown Speaker 30:45
yeah, that

Jennifer Smith, CDE 30:46
shouldn't be there. Right? You know, you've done everything you would normally have done. And this is just a weird, all of a sudden, you're like, double arrow up and you're to something. You take a correction, right? In my case, and what I recommend, if it's not coming down within the next 30 to 60 minutes, that's it's done. Yeah, it is done. I don't play with it, even if I pull it off. And I'm like, well, it doesn't look like I don't know, whatever the problem was, that the candle is not bent. It's not bloody, it doesn't look weird. Sometimes it might look a little bit wet, or mediawiki. So maybe for some reason, the site was like leaking up along the canula. And you didn't really get as much insulin as you should have. Yeah, um, but yeah, I don't, I don't play with like numbers that aren't where they want to be. Right. And

Scott Benner 31:32
there's a couple of ways that the way I taught myself so the answer to a lot of these questions ends up being repetition, you do something over and over again. And one day, it just makes sense to you, right? And you don't you lose that checklist in your head, like, well, I said, this is it, this, like you stopped doing that. You just see it, you recognize it, and you go, so before I could recognize it, I would inject with a needle. So if the pump didn't act the way I expected it to, I'd come back with a syringe. Now if there was no reaction after that, then I was pretty sure that my site was over also, last day of a sight, you know, or you just put it on and it just never ends up working. Because I know some people switch their pumps and they, they they'll experience a little bit of a high when they put it on. There's a lot of you know, talk about why that is I part of me thinks in children that it's anxiety. It's the you know, it's the that whole thing kind of gets you jacked up a little bit. That could be it. That's what it used to be for Arden. She's obviously much more relaxed around it now. But we've changed upon this morning, it went on and we did a more aggressive bazel rate for the next hour to try to her blood sugar was good at like 110 but to try to mitigate any kind of arise you know, same thing on the other side, if you think it's not working anymore, once you get it back on, you have to really think about for a second How long has this like not been working? And now I'm just going to slap on a new site and go oh, everything's fine now because the insulin deliveries back it's not because everything for now is for later and everything that's happening to you now is from before I get insolence always from before, go back to the beginning if you're falling late, but that's really it. Now the next one is more for you. Although people are asking follow up questions, so hold on. This is great info inside. Oh, great. Okay. Oh. By the way, there are people in the comments helping each other somebody was like, what's the compression level before we could explain it they jumped in You guys are awesome. Jenny, I drew a picture of a lady with a big belly to remind me that someone asked about good tips for thinking about getting

Unknown Speaker 33:41
everywhere just didn't write down pregnant. But anyway, I'm not showing anybody it's not a good drawing but

Jennifer Smith, CDE 33:47
good tips for getting pregnant. So preconception time. Um, we we kind of define preconception time, the three to six months, potentially even a year up to when you want to start trying to conceive. And the goal there is to aim to get glucose values into the pregnancy target. If you think about and or don't know what the targets are for pregnancy. The goal is to be under 7%. And then in pregnancy and even see more around 6%. Within the fives if lows aren't the big reason for being in the fives. But typically, most practices will say under 6.5%. through pregnancy more around six is the preferred just from the standpoint of health of you and the developing baby. For the preconception time then it's really focusing in quite a lot on what are the variables that you can learn and manage better in your life. And if some of the variables like every Friday night you eat the whole box of chocolate, you know ice cream bonbons And you can't manage around that. You know what, for nine months, you can manage not eating your bonbons on Friday night? Yeah, I mean, that's, you know, those are the things those are the strategies that you sort of learn in that preconception time. I mean, the beginning tips really are, look at what preconception or look at what pregnancy targets for blood sugar should be. Because aiming to get those as close preconception will make it so much easier. Once you're pregnant, as you don't have to shift this whole mental. Oh my gosh, now my blood sugar has to be 90, and it's been riding at 150.

Scott Benner 35:36
Just count on, I'm going to get knocked up, and then I'll do this better. Right, right, just and that probably wasn't the right way to say that. But you know what I mean, thoughtfully and through love, make a baby and then trying to get better at your blood sugar, get better first, prove it to yourself that you can do it over and over again, Jenny, if you had to say to somebody, how a way they could get better at this, what would you tell them to do?

Unknown Speaker 35:57
What would I tell them to do? Like a web address? Yes, well, they can call me

Scott Benner 36:03
just put Jenny's email address in the comments.

Jennifer Smith, CDE 36:05
They could. They could also i we've got, I wrote a book with a good friend of mine, Ginger Vieira, who's written a couple of her own books. It's, it's pregnancy management for type one diabetes. You can find it on Amazon. And we actually have a big preconception, month to month guide for pregnancy management, postpartum lactation, we've got all of the information in the books, I would

Scott Benner 36:31
also bet that sometime later this year, there might be a pro tip episode about being pregnant with somebody too, because that just sounds like a good idea. And I typed it into our running list of ideas for the podcast. Awesome. Yeah. Okay, that's a great answer. I wanted to just say that.

Unknown Speaker 36:48
I think

Scott Benner 36:50
I think that once you figure this all out, you get pregnant, you keep your blood sugar, super stable, and you're a onesies nice and low forever. It's gonna be difficult, but try not to lose track of it after the baby comes. Like, just you can do it. If you did it, then you could do it forever. You know what I mean? Like, you know, it's interesting, as I interview more and more people over the years, to see that some people who have trouble managing their diabetes, for themselves, don't have trouble managing it for someone else, you have no idea how many people have come on and said, I met somebody and I fell in love. And I got married, and I wanted to be healthier, so that our relationship or I had a baby, and I realized I wanted to do more. That's not specific to diabetes, by that it's a very human idea. But yeah, keep putting yourself at the top of your list of things to worry and be concerned and

Jennifer Smith, CDE 37:38
he can take care of you. You can take care of other people.

Scott Benner 37:40
100% I think and Wait, do you see having a baby? It's It's wonderful. Nothing like having a kid my wife and I were just sitting on the other night going, we think having these babies was really, really good idea. No, we were choking, because they were both being annoying at the same time. People are thanking us, which is very lovely. Thank you very much. We really appreciate that. You guys listen. evany asks a question back about bolusing. That I feel like I have something to say he said, Is there anything physiologically wrong with a post meal spike? If it comes down later, without extra insulin? Would you try to master that meal? I think you probably can. I mean, unless it was, like you said, Well, you know, I can't even say unless it's cereal, because I can get cereal, right? Sometimes, too. So yeah, I have an In my opinion, if you're going up, hanging up, coming back and leveling out again, and never getting low, there is a way to get more insulin up front. And you know that and we talked about it earlier that really Evan should go back to the beginning of the live, right.

Jennifer Smith, CDE 38:44
Yeah. And I also think, you know, from the standpoint of that kind of management, what it also leads into longer term, if you consider, for the most part, you're looking at your day, let's say you're using a CGM, and you can see how much of the time you're in range and where you want to be. And you're only, let's call them problematic times are these spikes above where you really would want to be after a meal. Yeah, but the end result is that you're back in target. And that looks awesome to you. Right then, one managing the timing, again, it's all about timing the insulin right, but to that peak is still leading into your overall a one C, okay, it's still leading into time out of range. And those post meal spikes also lead towards things like some of those many things people don't want to talk about, but the complications, more of those microvascular complications with these peaks that come into play, the more you can minimize and have more gentle roles, the better long term, so right.

Scott Benner 39:57
To do your best and keep messing around little sooner, a little later. Little more or a little less in there somewhere is the answer. It sounds like he's got the amount right and the timings off. Listen, even if you don't listen to podcasts, I maintain that most of managing insulin is timing and amount, it's just about getting the right amount in the right place where the need comes in. If you can get more up front to stop that initial spike, it might not have to be that much more, you'd be surprised it could end up being a couple more minutes of a Pre-Bolus or another half a unit of insulin or something random like that. That's still because that momentum from the food is so great. At that moment, it'll eat up that insulin, it won't leave you extra on the back end that will make you low. Right, hopefully. Julia asked, What do you consider a gentle roll? Did you just use the words gentle roll? Okay. Do you mean like one of those little Pillsbury things with the?

Unknown Speaker 40:47
Oh, no, no, no.

Scott Benner 40:48
Julia, I can I can talk Jenny as a matter of fact of Jenny's husband ever leaves her we're perfect for each other. what she means is not like, not like sharp, sharp down. She means like, it's cool if you go like this a little bit. By the way, this. So much of what we do is, is easier when people can see our hands moving Jenny and my hands move a lot while we're talking.

Jennifer Smith, CDE 41:11
And the funny thing is, nobody can ever see like our expressions or anything because it's just all voice. There are times when Jenny goes, I wish

Scott Benner 41:17
people could see what we're doing right. And I'm like, Yeah, they can't so Oh, Rachel, it is the best podcast ever. Thank you for saying though. I asked if the group earlier forgot. I would ask here. I had been pumping on the pod for six months. And I've just noticed the pattern. Day one runs high. Day two, good day three low. Any ideas how to combat this? More or less insulin? She's heard of the opposite problem. Brittany has a day three being a little higher. I would say that's if I see anything. It's day three higher Ardennes pumps either work, right out to 80 hours, or right around

Unknown Speaker 41:55
two and a half days.

Scott Benner 41:56
Yeah. 70. I was gonna say right at 70 hours ish, then I have to start paying attention more.

Jennifer Smith, CDE 42:01
I've actually personally noticed that when it does, it's not a time factor. It's more of a when my pod gets to about the 20 unit mark, I can almost guaranteed if I continue to use it after that for boluses or anything. Yeah, I will ride higher. Even though the pump tells me I've delivered the insulin. And it's the same way it's the same factors ratio is everything that I've used. It's it's a, it's a dose amount from what I and I've used Omnipod since 2006. So I got a lot of experience of yours.

Unknown Speaker 42:35
Yeah.

Scott Benner 42:37
I was telling Jenny the other day Arden's been using it since 2006. And it's, it's amazing. Like, I have nothing bad to say, uh, you know, a number of people asked, they said, they have the opposite of the feet on the floor up, they have a feed on they wake up in the morning and their blood sugar drops pretty drastically. Have you heard about that? from anybody?

Unknown Speaker 42:57
I've actually not.

Scott Benner 42:58
So so then would we consider maybe that the bazel leading up to their wakeup time is too strong?

Jennifer Smith, CDE 43:05
The question would be first, which is always my question to people are is your wakeup time the same? Please, it is the same. And you're noticing that drop, as soon as you get out of bed in the morning, okay, then the next thing to do would be try to sleep in and see if the drop happens. Because my guess would be the drop is there. Because you're getting up at the same time you think it's because you're getting out of bed. But it's because as you just said, the bazel in the hours preceding that are probably too high, and the drop was going to happen anyway. Um, so If, however, you find that when you wake up in the morning, and or sleep in completely different, let's say the sleep in stays totally stable. And when you wake up and get out, that's when the drop happens. Yeah, that's it. I mean, it's the complete opposite of what a good majority of people see. I'm not saying that it's not your personal experience. I've got friends who have a drop in their blood sugar with adrenaline rather than the typical peak in blood sugar because of adrenaline. So it could be the case, it, I would say that it's going to be a little bit, it'll be a little bit harder to maybe manage a drop. Because if it's related to when you get out of bed and not really wanting to like eat glucose tablets, or drink some juice just to stop the drop, though only a couple of options would be, well, if you can get up at about the same time, you could technically decrease the bazel leading into that time. So the drop doesn't happen. The only thing there is if you if you get up later, then you're not really going to need that

Scott Benner 44:48
decrease higher than listen because of this whole Corona thing Arden has been she shifted her life drastically. She's staying up way later and getting up way, way late. Yeah. And so I know if by 6am, I don't take away the power of her bazel by half, she's going to be low by eight o'clock. Like, because her daytime numbers are, you know, the insulin we use during the day is just different than what we use at night at night. She needs far less. I don't know, I hope that was helpful. Let's say I know I have a drop because I'm not waking up at the same time. Every day when I had a normal work schedule. There was no drop when I wake up. So then Laura, look is did you do you have a stronger basal rate in the time you're supposed to be awake? Because if so then that's it. Your bazel is just building up and building up and you have nothing going on inside of your body that needs resistance from extra insulin, then, at that point, a bazel. could act like a bolus eventually. Yeah, right. Okay, cool. I like the way I said that. Well, Melinda, thank you for loving the podcast. Thank you. This morning, I was 111. Justin says when I woke up later in bed and read the news got up 45 minutes later and went to 72. Hmm. And that's not Justin, it's tough. I can't have a conversation. But was that not bazel related. Somebody here said they have a new bazel program that's called pandemic. So that's a good point, too. Don't just change your settings, you can make a new program so that when this is all over, you can switch back to the way it was. I've had to you know what, I have a question for you, Jenny. This happens sometimes when we do the podcast. Let's do it now. And then I'm going to get to a question about kids and growth hormone. I was interviewing someone today who talked about when they got pregnant, they suddenly needed much less insulin. And I was saying to them, it's interesting, because for three days before Arden's period, she almost needs no insulin to and I'm wondering what hormone we're going to figure this out, I know this isn't going to something you're going to know now. But we're gonna figure this out and talk about later in the podcast, there must be some hormone that's released. For oscillation. That must also exist while you're pregnant. And maybe I'm wrong. But I'm going to find out if that's true. Because those two things like a bell went off my head as Ooh, maybe this is it. Because Arden Will you know, Jenny and I've talked about it privately, Arden will use like almost no insulin for a number of days before some of her periods. Not all of them, you know, just to keep things interesting. But do you think? Did I just say something you've never thought of before?

Jennifer Smith, CDE 47:25
No, it's well, and typically, oops, some reason went off my screen. There you are. Hi, hi, sorry. Um, I was gonna see the horrible and that's present in the lead up to your cycle, as well as the horrible and that's present very heavily prevalent in the first part of your pregnancy in that first trimester up to about like, six weeks is progesterone. Your body is having this ramp up, almost up a hill climb. And when you get your period, because your body's like, hey, you're not pregnant. So then the progesterone kind of like falls off the cliff, right? You come back down to this normal level. So most women, not Arden, but most women have a right up in blood sugar in the days before their cycle starts. And then it calms down. Same thing in those early weeks of pregnancy. Typically, women will actually see a heightened need for insulin in the first about six to seven ish weeks. And then around eight weeks of pregnancy, there is a bit of a dip off for a couple of reasons. Um, you know, hormonal II and what the body is doing, why there would be a dipped in blood sugar prior to the first day of a cycle, or maybe in the first part of pregnancy, when normally most women are experiencing a rise, the hormone, hormone drive there, I can't say that it's different. I would have to research let me give

Scott Benner 48:56
you a number another variable for this story. And I guess this is me ruining an upcoming episode. But what if the pregnancy didn't last much longer than eight weeks? Maybe there was something else going on? Sure. Yeah.

Jennifer Smith, CDE 49:09
In fact, that is if you've had a normal increase in insulin in early pregnancy, and if prior to that eight to 10 ish week point where usually your insulin needs at least stabilize and or dip down a little bit. If that dip happens sooner. Oftentimes, it can potentially be an indication of like miscarriage only because the hormones are not staying steadily, you know, there's not a steady climb. There's also you know, an early pregnancy. If you've ever had miscarriage before and or you're just worried. You can always get this the HCG hormone tested, which is the early pregnancy hormone that's released that actually gives you that positive result in your pregnancy home pregnancy test. So that hormone should add Actually, mostly double, sometimes triple in those early weeks of pregnancy, which is, it tells you is that your pregnancy is progressing the way that it's supposed to. Okay. Um, so those hormones, you know, that might have some indicative factor too. But that would be something I'd had, that's a great way to look into

Scott Benner 50:20
a little more research sound like there's more in there for to understand, hey, I want to go back to Justin for a second talking about getting up and getting low. Justin, I just had a thought maybe you should do a bazel test day, maybe you're eating enough to feed a basal rate that's too strong. And that way you sat in bed, you looked at the news and everything, maybe that is what's happening, maybe it's not, but if you bazel test and find out you're always low, maybe, you know, like, when I talk about, like, you know, manipulating bazel rates, sometimes when you manipulate them too much, Justin, you're in some belong somewhere else. So you can you might be I could be wrong. But you could be in a situation that a lot of MDI people find themselves in where when they switch to a pump, and they realize that their basals way wrong. But you know, people are like, Oh, I switched to a pump, my blood sugar started going up. Well, it's possible, your bazel, you know, before was too strong or too weak, you know, one way or the other. And so, I guess the way I like to talk about it is, so then what's happening? You can't draw a parallel to the things you think they're attached to. So I don't know, Justin, that's maybe worth a shot. Somebody here said I've been diabetic for 31 years, Melanie. Hi. And you guys have changed my life. That's lovely. Isn't that nice? Thanks, Jenny. I feel nice.

Jennifer Smith, CDE 51:33
And they can see a smile.

Scott Benner 51:35
Yeah, because we really do smile. Yeah, cuz I read those two jenine. And you probably think we're just all like, just jaded and like a doesn't matter. But no, it makes everybody really happy. It does. Sabo. Can Type One Diabetes go into remission, I can answer that one. No. That it definitely can't. Oh, what's the proper way to bazel? test? Caroline? In my opinion, that's a long conversation. It's not an easy conversation to have. But Jenny and I have had it in the pro tip episodes. So find the link, go to diabetes pro tip comm and look for the Basal testing episode. I listened to all of them If I was you, but at least to get to that one. Justin says, like, maybe we're onto something. All right. You're good to go for a little longer. Yeah, Caitlin. My toddler has decided to wait, we're gonna go somebody else said something about Caitlyn disappeared, my toddlers decided to pace himself differently during meals resulting in dipping down into the 60s mid meal. I'm concerned about our low percentage has hiked to 6%. and wondering if we should make changes.

Jennifer Smith, CDE 52:43
So if your toddler is now decided to like, pick it things like he'd rather he or she graze like over the next one and a half hours instead of like slamming it all down within 15 minutes. That was the case. You know, kids are different. I've got a three year old, they sort of roll and change without telling you they're going to Gee, sounds like the dose is probably not wrong. It would be again, the timing of the insulin distribution. So if the picking of the food he he or she ends up eating everything, but it's in a slower timeframe. If you're on a pole and extended bolus,

Scott Benner 53:27
yeah, so extended bolus you could do two different boluses if you wanted if that's get that idea scared you. Kenny says try to get them to eat the carbs first or the shorter to help it there's a you can manipulate the food. You know now you're going to get me into my my coma when I'm on stage and I start talking. Too often with diabetes, we think of just one thing, how does the insulin impact the number, but you should be wondering about how the food impacts the insulin, how the food impacts the number, how the insulin impacts the food, like there's all different sort of perspectives you can use to think about it and one of them in there is the answer. And Marcel makes a good point. Maybe the person who asked if diabetes could go into remission maybe they were asking about honeymooning and, and so, so back to that some people really can. Maybe we should go over honeymooning real quick, but honeymooning is a spot where you have Type One Diabetes you have this insulin need. And then sometimes for a day, three days, three months I've spoken to people it's gone on for years for suddenly it feels like their pancreas is shouldering the burden a little more again, and then they call that a honeymoon. Well, I think that's a fairly good explanation of what honeymooning is so it does eventually for most people go away.

Jennifer Smith, CDE 54:45
Right and you're eventually you will return to using insulin completely

Scott Benner 54:50
right for right. If I go away, I mean, your pancreas is gonna, it's gonna give up finally poop out go down like Bugs Bunny eventually. And then for those

Jennifer Smith, CDE 54:57
who are diagnosed as adults or What we call often call ladder. Some adults, it can actually have a very long honeymoon Yeah, where they may very well be able to control even without insulin for months at a time after they're initially diagnosed with just lifestyle changes before they actually start to need to use a basal insulin and eventually a bolus insulin, etc. So

Scott Benner 55:27
let me address this one question. Then there's another one here. I like that I want to go to back to Sabah because he's asking, Is there a cure on the horizon and near future? I don't know that there's any cure on the in the near future. I have a very simple concept around this. I live with a lot of hope for advancements, but I make decisions day to day like they're never coming. Because far too many people I see ignored thinking, Oh, this will be over soon. I can my body can take bad management for a little while. I that's how I feel about it. I act like it's not gonna happen. I hope I'm hopeful. But, you know, somewhere in the middle there i think is the answer. And Jenny, do you know of any cures on the horizon?

Jennifer Smith, CDE 56:08
I don't there's, as there have been long term, there's a lot of research, there's a lot of animal based studies that show some warrants some benefit. But you know, 32 years with diabetes, I explicitly remember my doctor telling my parents not to worry that within seven years, it was seven years when I was diagnosed within seven years, right? You won't have to worry about this anymore. And, you know, even into my teen years, then my team brain even started to tell me, this is like lifelong, right? Just the hope has always continued to be there that maybe there will be some grand discovery, and it'll get through and everybody will benefit from it. You know, I am, I'm hopeful more in technology, and where the technology piece is going for helping management. But I am hopeful, but I don't see it.

Scott Benner 57:06
I agree. I hate saying that. I know it sucks to say it, but I'm on the same page with you. And not for any nefarious reason, just that if you really if you go look, I think as a species, we've cured like eight things. And a few of them are just inoculations. They're not even really cure. So I'd live like, I'd live like it's not gonna happen with my actions around diabetes, but I'm always hopeful. I and here's another thing not to make light of it, though. But somebody said on the podcast recently, no one's going to cure diabetes, and you're not going to know about it. It'll be on the news. You know, you'll figure it out or turn yourself into a mouse because it seems super easy to cure them from type one diabetes. Maybe that's what we should be doing. Looking how to turn people into mice. Hmm, now we're getting somewhere. Yeah, I'm sorry. I feel bad about that. But all right, Mallory says, No, wait, Mallory. I'm sorry. That's not the one I was gonna read. And I'm like, Damn, they almost got the mind. A Kelly said nearly every night after my son falls asleep, he shoots the 300. I've increased bazel by as much as 95%. But once he's there, I can't bring him down. When he wakes up, can I answer first?

Unknown Speaker 58:13
Sure.

Scott Benner 58:16
Hold your thought, I'm just gonna put something on that you can come through with Trust me. Just because your kids bazel rate is I'm going to make up a number here, a half unit an hour and 95% puts into a unit an hour doesn't mean that's how much insulin he needs in that time. So you may have to extend on your pump, the amount of bazel you're allowed to use to get to the point where you can keep him down because there is an amount of insulin that will stop that kid's blood sugar from going up and hold him steady. What were you gonna say?

Unknown Speaker 58:46
What I said, You're so funny. So

Jennifer Smith, CDE 58:48
pretty much along that line? Yeah. One is, you've got data that shows you that this is happening every night, right? You're not like, Oh, this is only two days. And now it's not happening anymore. This is it sounds like it's every night. So one, you know, insulin needs to change to right along with what you said. It's in very low level bazel rates, especially in many kids. If you're turning Bayes a lot by 95% at a bazel. That's point one. You're not hitting the mark, by any means.

Scott Benner 59:21
Remember, you're not going to

Jennifer Smith, CDE 59:23
write it. That's that's not hitting them. You can even look at it a little further if you take into consideration. What what's the climb in blood sugar. Let's say the child is starting at a blood sugar of 91 at bedtime and climbing up to 303. Right? That's a huge increase in blood sugar. You can also take a look at Well, what is your correction factor? Most little kids have correction factor somewhere around like one unit changes their blood sugar by 150 points or by 200 points. If your kid is climbing 200 points, that little notch up 2.2 When your kid really needs a whole unit to correct a 200 blood sugar climb, right? That's how much you need to change the base and why

Scott Benner 1:00:08
Yeah, here's the thing, you'll hear me say this a lot. If you listen to the podcast, you need more insulin. That's it. If you have more insulin, it wouldn't happen. And by the way, for the person who asked about the group, and by the way, too, for a little kid, that could be growth overnight. Right? And for the person who jumped in and said, their kids in the teens and going through growth, and they can't keep their blood sugar down. Here's my answer to that to use more insulin. Because there is an amount that will stop it. Trust me, there's an amount like, now the question is, how do you get to that amount in a way that doesn't feel frightening? Especially for somebody who's now talking about Look, it's supposed to be point five, I made it one, how am I possibly going to go higher than that? That feels frightening. I've told the story in the pious, long time, so I'm not going to waste it here. But there's an amount you can do just find yourself being more aggressive cover with a fast acting is used if you've gotten too much, but the truth is Peters bazel up a little too high. He's not going to go from 300 to negative 10. Out of nowhere, you know, and keep in mind too, that if you see arise at midnight, that doesn't mean change the bazel at midnight, it could mean change the Basal at 11 o'clock even or it could be a little earlier a little sooner, depending on how his body or her body reacts to the increase of bazel. Just like you putting in a bolus doesn't start working right away. Putting in a bazel doesn't start working right away. There are more thank yous in here. Those are nice. Thank you. Jen, do you have to go at the top of the hour?

Unknown Speaker 1:01:34
Oh, no. I've got about 15 minutes.

Scott Benner 1:01:37
Jenny's giving you her personal time. That's lovely. The takeaways more instant mirror it always is. Kara? I'm glad you think this is awesome. Okay, so she got correction factors thinking about it so that way. Jeff is saying protein and fat that are hitting around dinnertime. Okay, Scott. Jamie said, Scott, I've heard you say things about being an insulin deficit. From overnight, I'm pretty sure I understand what you mean, I suspect it's a reason why some people go higher than expected in the morning. It was a lightbulb moment for me. So I'm sure others may find it helpful. Anyways, I love you guys to explain what you meant here. I'll let Jenny explain what I meant. So I can drink something.

Unknown Speaker 1:02:27
Yeah,

Scott Benner 1:02:28
I see what I mean, afterwards, just you go first, relax.

Jennifer Smith, CDE 1:02:32
So if you're at a bazel deficit, essentially, you're coming in to a time period when first thing in the morning most people are trying to put food in right away, right. And if you're coming in at a deficit of insulin behind the scenes, then the impact of that food even with potentially a Pre-Bolus, it, you're still going to rise because there wasn't enough behind it in the hours leading up to that meal time. If you're at a deficit of insulin as well, you're likely seeing that you're writing in at a blood sugar that's higher than you want to be or it's higher than the target, you've had your your pump set to keep you at. And that's a telltale sign right there. And that's only then going to lead into that real time, also causing more of a rise up than you want. Because you're already starting higher than you wanted to begin with.

Scott Benner 1:03:26
I would and I think of it, if you want a different way to think about it, it's like eating a meal without a Pre-Bolus. Right, because there's just you, if you don't Pre-Bolus a meal, you start eating that foods gonna win way before the before the insulin starts working. Same idea, like Jenny said, people jump out of bed and they eat. And you know, we just explained to the last person that you turn, you put a basal rate on at, you know, not at midnight for a jump up at midnight. So if you're getting up at seven in the morning and beginning to eat right away, your blood sugar's jumping up, it's possible your basal needs to be stronger, starting at 6am. And you still have to Pre-Bolus it's not all the base, or you're gonna have to Pre-Bolus and you're gonna have to have the base. All right, it's all just the timing and amount. Everything you see with Type One Diabetes, in my opinion, is about the balance of insulin and using it when it's needed. And you have to be able to step back sometimes to see the bigger picture. People get hyper focused on what's happening in the moment. I get up in the morning and my blood sugar gets high. That's it then they stop there. It's not about that. It's about before I've now this is going to be the third time I send everything. Everything you do now with insulin is for later, but remember now is always some other times later. Ah, that's how Arnold Schwarzenegger tried to kill those people in that movie. Right. Time travel time travel.

Unknown Speaker 1:04:47
Okay. Yeah, that's all. I think

Jennifer Smith, CDE 1:04:50
the other part of it too is that there is a very there's a very emotional level to managing your diabetes. Managing somebody that you love. Diabetes, yeah, right. And so, as hard as it can be, sometimes you have to step outside of yourself. And you have to kind of say, especially for the person who's managing their own diabetes, you kind of have to step back, take the emotion out and say, Okay, um, hi. I love being high, but I'm high. Let's, let's look at the information and see what I can do to fix it. Right? Um, sometimes taking that emotional piece out of it also makes you think a lot clearer about what you want to do. I mean, that's, that's the big reason for baseball maker.

Scott Benner 1:05:40
I maintain, I maintain that I'm as good at this as I am, because it's not happening to me. If I had type one diabetes, I wouldn't have this podcast, I'd be a mess. I'd be on the floor with my 10 a one See, God, I gotta know what's happening. You know, but it was for my daughter, right? Like, no, I don't know, like I you know, it's for her. So that I'm able to, I'm able to be more aggressive because I have a bigger fear of letting her down than I would have letting myself down. I think. So a lot of the things you'll hear about on the podcast, which by the way, you can listen to on any podcast app, absolutely. For free, just search for Juicebox Podcast, there's over 325 episodes, the podcast has been up for almost six years. You know, if you don't have a podcast app, they should be free. If you can't find one, go to Juicebox podcast.com. Scroll to the bottom there are links to all your different phones to get you on. And someone just asked a question here, how to manage unexpected activity, but a bunch of people just jumped in and said have a snack. decrease your bazel Yeah, that's it. Now listen, something somebody said was amazing. I'm gonna assume it was me and we'll just move on.

Unknown Speaker 1:06:50
I don't really know what she's talking about.

Scott Benner 1:06:53
Yet, so they're talking about that they're talking about activity around all this. Also, I want to bring up around you know, a lot of people stress, anxiety, or all of a sudden sedentary lifestyle because you're not going to work anymore. All those ideas somebody in here asked about they said their blood sugar's jumping up at night, not always, since the pandemic has started. And I wonder if when your brain slows down after your days over, do not find yourself thinking or worrying about Coronavirus because stress, anxiety, pain, there are a lot of things that can make your blood sugar go up. So I would I would look into that a little bit.

Jennifer Smith, CDE 1:07:30
In fact, there's it's really funny that you bring that up because, uh, somebody that I work with, she actually just emailed me. It has nothing to do with diabetes, but my brain was right away, like bringing diabetes into the picture reading it, it's all about dreams, since Coronavirus became the thing that it is, yeah. And the fact that dreams are, they are the way that our our mental self kind of manages through things. And we can learn some things, you know, if your dreams are kind of scary, or if they're really scary, or if they're just sort of like hinting at weird things. You know, I mean, it's the way that your body manages to sort of work through some of the thoughts that it didn't have in the daytime, right? Or that were sort of in the background. And with diabetes in the picture. Some of those can be very stress inducing in the overnight time period. So you know, if you're looking at, you know, many of your overnight values and you're thinking Whoa, why is this weird? This night was really weird. I had this strange rise and I woke up high and that's usually not happening for you. Maybe you had a horrible dream about

Unknown Speaker 1:08:37
something that you know, and it's not about never hugging another person again.

Jennifer Smith, CDE 1:08:44
Could be I had a I had after all this started I had a horrible dream about zombies. Did you? Horrible like I woke up in like a panic. And I usually I don't remember many of my dreams. I usually see sleep pretty soundly. Yes. Dream had me like, I was like all levels.

Scott Benner 1:09:03
When Natalie just jumped in and said playing video games makes her teenage son's levels go up. That's adrenaline, I would imagine. And Natalie I bet you they come back down again. Right? And because that's that's another thing. So stress, anxiety, those sorts of things are always going to well always have the ability to impact I'm sure there's some people get stressed out in their blood sugar's don't go up. But it does happen to a number of people enough that it's worth paying attention to.

Unknown Speaker 1:09:27
Yeah, and

Jennifer Smith, CDE 1:09:28
sometimes you can address the rise. If you know that it's not going to come down sometimes sometimes you have to correct for it. Many times adrenaline rises, though. We often don't have to touch oftentimes once that stress factor or the adrenaline like surge sort of passes. You'll see things come back down.

Scott Benner 1:09:46
You know it's funny somebody jumped in as you were making this and said a bedroom could make your blood sugar go up at night, mira said and there people my daughter's goes up with Xbox so if you know, listen, it's not the easiest thing to to Guess schedule. But if you know, Xbox time is going to be in a certain place, you probably could do with Temp Basal increase. Right. And that would

Jennifer Smith, CDE 1:10:08
that would definitely kind of like weightlifters if you know, you've watched enough to know how much blood sugar typically rises during Xbox use, you could technically take an amount of insulin as a bolus to offset the typical rise that you see based on what your correction factor is.

Scott Benner 1:10:23
Let's see if we can get one more thing in, because we have to go so somebody asked about their Dexcom user, and they're talking about Pre-Bolus. And when do you know when to start eating. So for my daughter, in a perfect situation, I like to see a diagnose Down Arrow before she starts eating. And you also have to get right in your head what's high and what's low, too, you know, for me, I don't want my daughter, I try very hard for our not to go under 70. That's my goal. And I try for not to go over 120 do we always do that we do not always do that a number of times a day, she ends up higher, it just happens sometimes. Okay, all the things that you just heard about happened to us to my daughter's a one C has been between five two and six, two for almost six years. But she got out of bed didn't have enough insulin going because she slept in try to eat something with a lot of carbs and her blood sugar's 200 right now. And it's and we're going to get it back down as fast as we can without it getting well it's not you're not shooting for perfection. You're just shooting for as much time and range you can get in there. But back to the initial question, I like to see a diagonal down arrow. But now I know how fast the food is going to hit or just you just have to practice right like, started 100 put in the blood sugar when you get to 91. Diagonal down, eat, see what happens? Did you go up to 150? But then level back out? Cool. Maybe you could have waited till 85 diagonal down. Maybe that would have taken you do 130 c? It's just trial and error. You have to go over and over again.

Jennifer Smith, CDE 1:11:53
Experience teaches you? Yeah, a fair amount.

Scott Benner 1:11:57
JOHN, I don't know that. Jenny knows this answer. But I'll ask before she goes john wants to know if you know what factor? What factors affect the hypest hypoglycemic risk value on the dexcom clarity app, you know what it takes into account to come up with that? I don't,

Jennifer Smith, CDE 1:12:13
it I don't, but my assumption is that it calculates the percentage of time that you've been low, within the timeframe that you're looking at, to classify what your risk is, you know, if you're, you know, 1% of the time low, I guarantee that your risk factor for most is not high. Whereas if you're pretty consistently at 10%, low, even if it's not really red low, it's just that pink low, right? Because there's a different designation. There's a 55, red low, right? But I mean, if you're really low, pretty consistently, that risk factor obviously goes up. I don't know exactly what parameters they're using to establish that percentage value for you. Um, but

Scott Benner 1:13:09
Alright, so let's roll through these last three, Jamie brought up that if she waits for a diagonal Down Arrow for her credit goes lower, so it's gonna be different for everybody. Yeah. Lisa is saying hello to us from Sweden and said, we've both been very helpful in her first six months of being a type one mom. Hi, Sweden. That's cool. And Sue asks, do we recommend the in pen which I think we both though?

Unknown Speaker 1:13:29
Yes,

Scott Benner 1:13:30
yeah. If you can't pump, you can get a lot of the knowledge that a pump has from in pen pairing with their in pen app and your your glucose monitor and even a meter. Not as much luck and Jenny's holding one right there.

Jennifer Smith, CDE 1:13:42
I've got the pink. You can get them in different colors.

Scott Benner 1:13:44
Yeah, I've got blue in here somewhere. But it's a demo. So. Yeah. Okay, so listen, Jenny was only supposed to be here for an hour. It's 409. She got to go back to her life. I want to say that at one point. This was up to 120 people and it never got below 80 even 15 minutes after it was supposed to be over. So awesome. Really appreciate all you guys. Thank you so much for listening to the podcast. If you enjoy the podcast, please share it with somebody else. It's the only way it can grow. I do not have money to to do any kind of meaningful. You know, advertising for the show in the last comment here again is Jenny's email address. You can hire Jenny. She works at integrated diabetes services. You can have one on one calls just like this with her. Check it out. See if your insurance has covered it or if you want to pay cash, whatever you want to do. Jenny is very cool. She is 100% my diabetes spirit animal. I've never heard her say one thing that I was like that's wrong. But as I've mentioned on the podcast before, that might just be my narcissism because she agrees with me. I think she's terrific. But who knows exactly, you know, this will be available on the podcast soon. And it will be running on Juicebox podcast.com as well. And it stays here on Facebook. So thank you everybody very much and Hope you guys have a great day. And Jenny, I really appreciate you doing this. Thank you.

Jennifer Smith, CDE 1:15:02
Yeah, no, this was great. Thanks to everybody who commented back and forth to each other as we were answering. It's a great way to help each other. Yeah.

Scott Benner 1:15:10
Very cool. All right, guys. Wash your hands. Stay safe.

Unknown Speaker 1:15:15
I why.

Scott Benner 1:15:19
Don't forget even though this episode was not sponsored, the podcast does have sponsors like Dexcom. The Contour Next One blood glucose meter, touched by type one and Omni pod. There are links to those sponsors in the show notes of this episode, and at Juicebox podcast.com. If you're not looking for those types of things, go into your podcast app and leave a glowing review of the podcast. It would make my day and Jenny would smile about it too. Alright, let's turn off the music and we'll dance our way out of this

This is a bonus episode and was not sponsored. That said, these are the show sponsors.