#1242 Type Two Stories: More Jon

Episode 1242: Jon's Journey with Open Source Loop Systems

Jon shares his transformative journey with open source loop systems for diabetes management. This episode covers his transition from long-acting insulin to using a pump, the impact of continuous glucose monitoring, and the role of community support. Learn how advanced diabetes management techniques can revolutionize your daily routine and improve your quality of life​.

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

Scott Benner 0:00
Hello friends and welcome to episode 1242 of the Juicebox Podcast.

Today I'll be speaking with a returning guest. This is John from Episode 688 type two stories, John. And John's here to give us an update on what's been going on. It's significant, you're gonna find this one crazy inspirational, I think, but let's make sure you heard 688 first because John's got quite a story. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan for becoming bold with insulin. Maybe you'd like to save 30% off your entire cart at cozy earth.com I'm talking about the clothing, the sheets, the towels and everything else. Go there, fill up that cart type in the offer code juicebox at checkout and you will save 30% at cozy earth.com. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juice box. If you're looking for community go check out my private Facebook group Juicebox Podcast type one diabetes, but John's over there. He's type two. There's type ones there's caregivers gestational moody doesn't matter to us. This episode of The Juicebox Podcast is sponsored by the ever sent CGM and implantable six month sensor is what you get with ever since. But you get so much more exceptional and consistent accuracy over six months, and distinct on body vibe alerts when you're high or low. On body vibe alerts. You don't even know what that means to you. Ever since cgm.com/juicebox, go find out. Today's episode of The Juicebox Podcast is sponsored by Omni pod and the Omni pod five, learn more and get started today at Omni pod.com/juicebox. Hi,

Jon 2:12
it's good to be recording with against God. I'm John kafele. and I have type two diabetes. I've had two type two diabetes for decades, three or more decades, I've been using insulin for almost 20 years. And I've been able to turn around and manage my type two diabetes and put it into remission at the age starting at the age of 60. I'm 63. As of last week, I told my story originally two years ago in Episode 688. And this is a an update on I guess what I'm doing and things I've learned. Thank you for the opportunity to share. Now

Scott Benner 2:51
it's my pleasure, and you have a lot to update us on. So that's why I was super excited to talk to you. And at some point, we're gonna get to the photo that you sent me to get me ready for this episode. That was a really like eye opening. I'll tell people more about it later. But yeah, please check John out on episode 688. And I don't know, I think these will stand alone pretty well. But if you really want to hear the whole story straight through, I think that would be the way to go. John, I'm gonna start off with something out of left field for you. What would you say if I told you that, when I released the type two Pro Tip series, I lost hundreds of listeners,

Jon 3:26
I would say that that's very unfortunate. And that a big goal I have had is to close the gap between type one and type two, by recognizing at least that type twos that use insulin are part of being bold with insulin, and that nobody else's struggles diminish your own. And that in commonality and a common cause we find strength. So

Scott Benner 3:56
I expected a little bit of blowback like a tiny bit. And I don't want you to get me wrong, I didn't lose like a large percentage of the audience or anything like that. But I lost about 400 listeners in the snap of a finger by putting up type two pro tip. And that was it. And it may be the whole series may have may have been like seven or eight episodes long. And I believe it was spread out over seven or eight weeks. So in a week where I put out five episodes, one of them was an addition to the type two Pro Tip series. And I even came at it by saying to people like look, you have type one diabetes, the show obviously is valuable for you. Maybe this information can be valuable for someone else, you know, with type two, and I thought the show would be a good way to get that information around because historically, I've watched a lot of people try to help people with type two diabetes and not go anywhere. And often. You see companies or organizations sometimes manufacturers, sometimes pharma companies, they try to kind of create a type to community and it just doesn't work over and over again. So I thought, oh backdoored, I'll come in through the type ones who already know this information is good. I'll go share it with my, you know, uncle who has type two. And I'm sure some people did that. And it's fantastic. And I actually know, personally of people that it's helped. But man, I woke up the next day, and I was like, oh, geez, it's not going to be easy to get those 400 people back, like, it's hard to get a person to listen to a podcast and to get 400 of them is a bit of a hump. But anyway, nevertheless, I persist. And here you are, again. I'm not. I'm not given up, I believe, like you that there's commonality between people who use insulin, have type two diabetes and people with type one.

Jon 5:40
Absolutely Good, good. We're stronger together.

Scott Benner 5:44
I don't see another way around it. But I'm kind of leading into it this way, so that you can maybe recap your first episode in a couple of minutes by telling us how you got to hear meaning knowing about the podcast?

Jon 5:56
Well, I've been taking insulin for over 17 years. And a big part of the story is that trying to form my thoughts here, long acting insulin for type two diabetics, people with type two diabetes can be an imprisonment of sorts, when you establish an increasing Basal rate through the use of something especially like to see but with a 42 hour half life, you and you don't modify your behaviors to lower that Basal rate, the amount of insulin that covers inappropriate eating, in the evening, eating a pizza needs to be balanced by the same amount of eating in the morning. And in the afternoon. So what you end up in is a trap you can't get out of and you can't try to modify your behaviors part of the day, you have to modify it 24 hours a day. Does that make sense? Yeah. No, it does. So I asked my GPS for over the years, I moved a lot. I've had different doctors and I would always ask the GP, the general practitioner, I would like to have Basal insulin so I can address mealtime, increases in my glucose and not be trapped in this higher increasing basil. I started at 40, I ended up at 140 and 140 units is a lot of insulin, or at least for me, you know, it's different for different people, but it was a lot of insulin, want to be able to titrate that downwards to establish a real Basal and then use Bolus insulin. And they would never do it. Finally, the last up I got, he replaced a doctor that moved away. And he is my current general practitioner still. And I said to him the same thing, hey, I want Bolus since they always told me to go exercise and lose weight. You told that to a guy who has 500 plus pounds until that guy, two guys 370 pounds. It doesn't really matter. There's something else that needs to be addressed. But this guy told me almost flippantly, the best thing that has ever been said. He said, Ah, you should go see an endocrinologist. And so a month later, I saw Liz and Elizabeth Driscoll over here at Sentara in Charlottesville. And I told her that I wanted to have Bolus insulin. And she said, Yeah, where's Is this your current pharmacy? I'll do that right away. I should also point out the before that in the beginning of our meeting, I told her that I was interviewing her for a job to be my medical assistant, but that I was in charge, and I would be making all the decisions. But the she had the control over the medicine locker as it were, we had to get along. And she was going to, you know, prescribe the right stuff for

Scott Benner 8:36
me. Do you think you knew in that moment? That? I mean, you just kind of you kind of offhandedly said that a guy over 500 pounds doesn't just need to be told to exercise as if like what you're really missing is just a brisk walk. And so like, did you know there were other factors at play in your health? At that moment?

Jon 8:55
Oh, absolutely. You know, the thing is, carbohydrate and sugar addiction is a thing. And it doesn't mean you don't you know, I imagine even if you're a heroin addict, you probably know that the last thing you need to be doing is heroin. And you probably are very intimately familiar with the failures in your life it causes. And clearly a guy is 540 pounds and cannot perform basic hygienic tasks. is aware of that, right? Yeah. Is that addressing what you're asking? It

Scott Benner 9:24
does? Yeah, I just didn't know if you were blissfully unaware and just cruising alone, or if you were aware, but unable to adjust, painfully aware,

Jon 9:34
but deeply addicted and not given access to the types of care that were necessary to break me out of that. Okay. And part of it is I have a lot of resentment over having been prescribed long acting insulin in and then ever increasing amounts, because that really became a prison that I couldn't get out of, and then not being willing to prescribe me Bolus insulin and allow me as soon as I got Bolus, insulin, everything turned around. Now, of course that required me to make use of that, right? You can't just give them the Bolus insulin it changes. But I have the tools at that point. Okay. Yeah. So Liz is happy to work with me. And then she said the thing that changed my life, she said, Have you ever thought about a pump? And I laughed, and I said, I'm here trying to get Bolus insulin for the first time. And you're asking me a person with type two diabetes, you know, how about a pump? And in my mind is the Darth Vader, you know, huffing and puffing through the mass with tubes and steam? And she says, Well, no, there's also a tubeless pumps. By the time I got home from that appointment, I went to the pharmacy, I live in the country. So it's like 40 minutes to get home. But I went to the pharmacy picked up my insulin, I'm there with it. And the insolate rep calls me and says that I was on Medicaid at the time. And he says that, you know, we just had a change in Medicaid in the state of Virginia, and I'm sending you out a whole starter kit if your game for it. And I was like, Well, absolutely. And then everything changed. And I started open source iOS loop in a few weeks of that. So

Scott Benner 11:01
how did you get to that so quickly? I've been professionally

Jon 11:04
involved in open source my entire career. And so I've always been aware of other open source projects and things like that. I've been aware of diabetes. And so I knew there was an artificial pancreas stuff out there. I see. And so I was like, Are you kidding me? I've got the Bolus insulin. I've got the iPhone. I've got the compilers and things. I have the skills. Now I have going straight to the head. Yeah, here I go. Yeah. I'm going straight to the head of the class, baby. Yeah. Nice.

Scott Benner 11:27
Okay, so, Jesus, you use just Basal insulin for 17 years,

Jon 11:33
for 14 years or so. Okay. I can't nail down exactly when I started. It was somewhere in between 2004 and 2007. Plain smoke.

Scott Benner 11:42
I'm sorry, God, no, I

Jon 11:44
was just gonna say I went to a doctor's appointment and had had an eight one C test and it was 14.5. And the doctor is like, how do you I have a very busy career and was responsible for managing operations infrastructures for large internet sites and things like this. And which is like a 24/7 very demanding job. He said, How do you do it? Um, I don't know. And so he prescribed me the insulin and I remember I went back to get started with it. And he showed me to inject your my jeans and to reuse needles from day one. How about that? There you go. So what were you going to even ask him?

Scott Benner 12:16
I know, don't be sorry. I just I want to make sure that everyone understands that idea of this person. So plainspoken Lee, you're eating poorly. And you have type two diabetes, your body cannot keep up with what you're taking in. So they give you this Basal insulin. But then what happens is your your blood sugar start to come down and then your eating goes up, and then you end up with more insulin. Is it just keep perpetuating back and forth like that? Or no. This episode of The Juicebox Podcast is sponsored by the ever since CGM. Ever since cgm.com/juicebox. The ever since CGM is the only long term CGM with six months of real time glucose readings giving you more convenience, confidence and flexibility. And you didn't hear me wrong. I didn't say 14 days. I said six months. So if you're tired of changing your CGM sensor every week, you're tired of it falling off or the adhesive not lasting as long as it showed or the sensor failing before the time is up. If you're tired of all that, you really owe it to yourself to try the ever since CGM. Ever since cgm.com/juicebox, I'm here to tell you that if the hassle of changing your sensors multiple times a month is just more than you want to deal with. If you're tired of things falling off and not sticking or sticking too much or having to carry around a whole bunch of extra supplies in case something does fall off. Then taking a few minutes to check out ever since cgm.com/juice box might be the right thing for you. When you use my link. You're supporting the production of the podcast and helping to keep it free and plentiful. Ever since cgm.com/juicebox. The Fear Of Missing Out is overwhelming sometimes, but the fear of missing out on Omni pod. We don't want you to have that. A lot of people in my private Facebook group talk about their love for Omni pod five. Have you ever seen those posts and thought I wish I could have that experience with an insulin pump too? If you answered yes, you might be experiencing FOMO fear of missing out on Omni pod symptoms may include but of course you're not limited to wishing you could wear outfits without pockets and fantasizing about jumping into swimming pools without disconnecting from your insulin pump first. Maybe you're dreaming about walking past that doorknob or a handle on your dresser without getting your tubing caught. If you're having those dreams, good news, you don't have to suffer from FOMO any longer. You can see what you're missing by trying Omni pod five for yourself at my link, Omni pod.com/juice box, get started today with the Omni pod five Omni pod.com/juice box throw away your FOMO?

Jon 15:12
That's a good question. You know, one element of it is the insulin causes insulin resistance. And the more insulin you take, and the more food you can input, it's a cycle, you know, one feeds, it's a feedback loop that increases the amount of insulin you take for the amount of resistance you have and the amount of food you're eating. And as you turn one of those up, the others turn up with

Scott Benner 15:34
it. Do you mean that as you add Basal insulin, your body becomes less and less effective, and therefore you need more more the manmade Basal?

Jon 15:43
Well, that's part of it. Of course, in my case, in case I think, many I have an extreme eating disorder. And that is the number one propellant in my diabetes, okay? There's, there's genetic predispositions. There's economic and other access to food and things that happen and so forth. There's a lot of things in my case, it was a extreme district eating disorder related to you know, childhood trauma, blah, blah, blah. And it literally fed on itself. So the prison of long acting insulin for person and my condition is that it gives you a license to eat a large pizza for dinner. And to follow it up with big chocolaty treats and things like this. And what that eating is doing is it's creating dopamine releases that our guests just straight up like taking drugs, and it is taking a drug. It's the different method, right? And so you're addicted to that high, you're addicted to that. And so, you know, you hear about like, maybe you don't hear about it, but the idea is a person does is on heroin, and all of a sudden, everything's just hunky dory. Everything's absolutely wonderful in the world. Even if you're in an alley, you know, on a piss soaked mattress by a dumpster, everything becomes wonderful. And that's what food does to a person with my pathology. Gotcha. All right. Well, that was my history. And so if you eat that pizza and everything the next morning, you still have that high Basal rate.

Scott Benner 17:14
Yeah. And so almost functionally, what you think is like, so was there actually a time where your blood sugar was one of the reasons you finally could stop eating at the end of the day? Great. Like, I can't keep doing this. But then all of a sudden, the the insulin felt like a crutch. Or is that not right?

Jon 17:29
Insulin was always an longterm act long acting insulin was a enabler and a in trapper, does that?

Scott Benner 17:37
I think so. No, I think I understand I just, I just wanted you to really spell it out for me. So once you get a pump, and you get to an algorithm, and now you're covering your meals with Bolus insulin, how is that different from just basil?

Jon 17:52
I'll tell you what it was. And it was what I envisioned it would be all along, I remember, I'm an engineer, and so forth. So I have a very certain place on the spectrum with my mind. Once I had that tools in hand, I could see how much the foods I were eating, were directly impacting my glucose performance. So throughout my life, you know, and if you're not too, I can solve any problem. But if you're not driven to solve it, you're glib about it, right? So at one point, I convinced myself that sugar wasn't the problem. It was fat in foods and all these different things, right. And once I started taking Bolus insulin, and really paying attention to it as I do, I saw the effect of every single thing I put in my body. And I quickly realized that for me, grains were not helpful. Okay. And they're not. So I had a budget, right, I had a performance profile, I had a thing I was trying to do. And I was trying to reduce my overall use of insulin from the beginning. And I was trying to achieve at that point, I wasn't trying to achieve normoglycemic values, but I was trying to achieve achieve non life threatening values. Gotcha. And it happened very quickly, though. And I started realizing the different kinds of foods and the ways of eating that were harming me. And I just thought about, I was able to kick the drug, almost cold turkey, I remember it now. Like I thought, you know, I'll just have a sandwich in the middle of the day, just a nice sandwich with a lot of vegetables on it and some meat and just two pieces of bread that I'll dose for. And then what happened was, I realized that even though I could dose for those two pieces of bread, that they had a significant carbohydrate impact and long tail effect that I had to manage that I had to use more insulin to deal with, that I had to pay more attention to. And then it became evident to me that I could just have that vegetables with some meat on top of it and not have the other impact. And it just made more sense for me. Okay.

Scott Benner 19:49
It's interesting that you had that problem first. So I mean, would you consider this disorder lifelong?

Jon 19:54
It pretty much manifested by eight years of age. Okay, well, that yeah, pretty much lifelong.

Scott Benner 19:59
So My point is it's interesting that getting the pump, and I guess I'm assuming a glucose monitor as well. And then like, yes. Is that right?

Jon 20:09
I've been using Dexcom for a little over seven years. Yeah. So I've been using Dexcom for four years prior to being finally given Bolus insulin. It was just a waste. It was just a thing that would alarm all the time. I've gotten phone calls with friends. And they'd be like, Oh, that's your alarm. And I'd be like, Oh, whatever.

Scott Benner 20:27
So it's interesting, though, isn't it that you have the information? It didn't get you to change but then suddenly, once you had another tool, you were like, Oh, I eat the bread. My blood sugar goes up. I'm gonna stop eating the bread. Let's go. I'm on this journey. Do you don't know what pushed you in like over like, it sounds like you think it's the pump, but I don't understand why. No,

Jon 20:47
no, no one. One is observational. The Dexcom is observational. The insulin is interventional. Okay,

Scott Benner 20:54
so you felt more powerful with the the Yes, Bolus insulin, okay.

Jon 21:00
Yes. And it was also a way to get off of the long acting. Gotcha. All right, I understand. And the funny thing is, I didn't titrate the lung acting because I immediately recognized that a pump with its micro Bolus ng is Basal and Bolus. So okay, that was pretty cool. Right there, I was able to holistically I didn't have to titrate it was like, MBI. Right, right. I didn't have to work those against each other, or with each other.

Scott Benner 21:25
You see the impacts, you keep you stay, it's amazing, you're able to just stay on that new path, which is laudable, it's fantastic. But you stay on that new path. And we are in there, do you find the podcast immediately? Okay.

Jon 21:39
Like, immediately, you know, you got search tools, you got Facebook, you can search there, you can search Google, you can do stuff. So you start saying like, who knows, you know, what are the outlets? Where do you learn about how to use insulin? Actually, literally, my thing was, I've got this stuff, how do I learn how to use it. And I'm very antagonistic to anybody that has anything to sell. It's just raises my spidey sense in a big way. And so when people have a miracle diet, or they want to sell you cinnamon, or they want to tell you how you need to do it, it puts me off because as you can tell, I'm pretty much think I know everything already. And I'm very, you know, engaged. And I want to form my own opinions and stuff. And I don't want to just buy a cure. And so social media is a great place. I've been on social media all my life, since the Usenet and things back in the whale days, I just wanted to find a place where I could talk to people that were doing the same things. And when you look for type two groups, on Facebook, I'm a middleman. So I don't Twitter or ticker totter talker much right? Um, looking on Facebook for groups, and every type two group I found was part of a company and had a thing that they wanted to do with you at all. And then your group was about being bold with insulin. And that made a lot of sense to me. And I reached out to you very early. And I said, Help me, what the hell do I do with this? And you know, you gave me some insight and suggested I read the group and do more there. And I did. And then before long, I actually reached out to you. And I said, I wanted to start a type two group. And you suggested that that would be a great thing. But let me know that you were also working on providing type two participation in the group and support in the group. And, and I was like, You know what, I'm just gonna wait and see where that goes. So I'm honored to have been an IRL monitor have been an early guest, and I'm honored to be part of the group. And it's really cool to be here again, with you, Scott,

Scott Benner 23:32
I appreciate that. You're also you're one of the I would say one of the key reasons that the group attracts type twos at this point, too, because you've been so open and clear about what you've been through. So I'd like to do that here, too. I'd like to talk a little bit about what happens. I think maybe we should jump into like the weight loss journey. Like how long does that go on for like, I'm right to say that you're basically a pretty low carb guy, right. And that's been since you found the pumping. That's

Jon 24:03
the funny thing. It's, you know, it's not overnight, right? Okay. And so even before getting the insulin, I was trying to modify my behaviors. And in a year or two before I finally got a hold of that the Bolus insulin, I was actually deeply hypo about a half a dozen times. The rescue squad had to come out four times and they transported me to the hospital twice. And that was because I was taking a lot of insulin and trying to eat a lot less food. And there's there's the prison you see, I'm saying, and so I've been making moves in the right direction all my life. When I was 3330 years ago, I lost 200 pounds, and I reduced from 540 to about 343 50. And then I vacillated between that range 373 50 down to 280, like five times in my life. And so the fact was, I knew how to moderate my mind Hey viewers, but when I got to 270, I couldn't lose any more weight. And so then you just kind of give up, right. And that was a thing that happened. But what I wanted to address is when I got the ball, since when it did turn around overnight, it was a sequence of continuing refinements and adapt adaptations. Okay. And so I got my a one C down from a nine, four with like, no time and range to a six with, you know, 80%, and range. And I've been under 5% for almost two years. Wow. And my standard deviation is under 15. And my time and range, my personal range that I track a 70 to 120. And I achieve mid 90s presets all the time, pretty much. The thing that screws that up is Dexcom, mankind doesn't have a way to measure glucose, whether it's a one C or your finger stick or whatever, it's always an approximation. I'm fond of saying if I became a billionaire, I would focus on not a cure for anything, but how to measure diagnostics, accurate diagnostics, right? Because more so than a cure for diabetes, or a cure for any other thing is effective treatment. That's the thing that we can do now. So that's a passion of mine. measurements include a one C and your data from your Dexcom, you have to take it all together as a bigger picture. You know, I'm saying I achieve those things. But it took a long time. It was quick. But I mean, it wasn't overnight, right? It was a continual process of refinement. And recently, in the last two months or a little bit more by diet bestie and I have have eliminated snacking. And that has had a significant improvement. So even when I was in these numbers, removing the snacking is caused an increase in weight loss and a reduction in my waist size.

Scott Benner 26:45
Well, how many calories do you think you take in a day? Ha.

Jon 26:49
You know, when I started this, I determined only to count carbs, and measure glucose and I felt everything else would fall into place. And that was largely true, you get to a point of diminishing returns on one angle of attack. And you have to add others. Yeah. So now I'm looking at actually, there's other elements of what's going on is I found that my beta cell function was at the level of a person with type one diabetes, it was insufficient to support life. At this stage of the game, I was able to turn it around. And now my latest C peptide shows me at the at the low end of normal. And so you know, they say do something about your type two diabetes now before it's too late. And what I'll tell you is it's never too late. How

Scott Benner 27:36
much insulin do you use today? Like your total daily dose? Versus the first day you put on that pump? Do you like just vaguely you don't need to be exact. But what do you think the difference is?

Jon 27:48
I'll tell you that the day before I put on that pump, I was running 140 units, which receiver, I can't remember where it was immediately, but I got it down to half of that pretty darn quickly, very quickly. And then getting it down the next half likes from 72. Right now my my total daily usage of insulin Bolus and basil combined, is running about 35 units a day. And that's been the case for a few months.

Scott Benner 28:16
Yeah, that's a quarter of a quarter of the amount of that that Basal insulin from beginning of your story. And the increased

Jon 28:23
the larger part of that insulin right when it was at the higher end resulted in things like a 9.4 a one C with no time and rage. And all of that to the to the numbers I have. So it's not even, you can't even do the simple math of one quarter of the insulin right? You're talking about orders of magnitude results. Yeah,

Scott Benner 28:43
I mean, being in the situation you were in and just giving you Basal insulin is really it's almost cruel, honestly, because it's yes, yeah, give me it's slowing down your demise, but it's not really doing anything to stop it. It's just, it's now just crawling forward a little slower than it did the day before.

Jon 28:58
I strongly believe that when a person is with type two diabetes is introduced insulin, it should be done in a very focused manner with reviews. And not just as like go take this and go away and die slowly. It should be here this is now let's do behavioral modifications and other things so that you can reduce the amount of insulin we have to give you right now and also people with type two diabetes who are on insulin should be introduced Bolus insulin as soon as possible.

Scott Benner 29:29
Okay. Do you have any idea what shifted inside of you to help with the addiction to the sugar?

Jon 29:35
I think that my ability to escape that happened much earlier than my access to the tools to enable

Scott Benner 29:42
it. Oh, okay. Oh, so it's not as it's not as instantaneous as the story makes it seemed you had made the decision but didn't know how to do it.

Jon 29:51
Well, that's what I tried to keep there with like, the year before getting it having six extreme hypose Yeah, and And and all that experience. I mean, that was me trying to change my behaviors, but getting slapped into the hypo lows by the insulin

Scott Benner 30:07
I say, Okay, can you put a weight on that? That? Let's go to when you I don't know you found the podcast like what do you weigh that around that time? 350 pounds 350. So you had gotten off 200 pounds on your own? Yeah. For like 30 years for 30 years. So you were up to five something? You lost 200 You maintain that for 30 years at this like 350 ish range?

Jon 30:31
No, actually I went from I went from 350 to 280. Okay, five times. Oh,

Scott Benner 30:36
so you would bounce in over those 30 years, you'd bounce from 350 to 280?

Jon 30:40
Yeah, like about five times four or five times? How did you get from 350 to 280. Same way I got from 540 to 350 calorie deficit for the most part, but also swimming. To get the first 200 pounds. I went and swam a mile a day three times a week at the gym here at University of Virginia. And that was a big part of it. Swimming was my thing. When I was a kid, I had some training.

Scott Benner 31:06
John, can I take a detour for a second? Yes, please. What's it like jumping into a public pool when you're 550 pounds?

Jon 31:14
That's a very good question. A little bit more background about myself. And I touched on this maybe even more depth in my first episode. I was raised institutionalized, I'm diagnosed autistic, and so forth and things. And so it was a pretty weird childhood. And when I was about 17, and living on my own on the road hitchhiking was when I just realized that I'll take my shirt off, if I want to take my shirt off, and I was, you know, over 350 pounds at that point. And I don't care what other people mock me or say about me anymore, because it's just about them. And you've probably heard the concept of flying your freak flag. Hi.

Scott Benner 31:54
I'm sorry, that was your vibe.

Jon 31:56
That was my vibe is you know what? I'm done apologizing for bap. Now, I didn't give myself that break internally as much. But I just couldn't live. I couldn't maintain hiding behind the couch and being afraid of the other

Scott Benner 32:09
kids like when I was younger, but still it made you feel a certain way internally. It was liberating,

Jon 32:15
if that's what you mean. Yeah. Or you mean the shame or something? Yeah, I had to get over that. So you know what, I got the pool I swam. And I'll tell you a funny thing. I was involved in a faculty council that met with the the administrative vice president of the university who is really the BIOS Reading University. And a guy that says, Hey, I see you in the pool all the time. And it's really impressive what you do. And that kind of feedback is rewarding, right? And I'll tell you what, man, I swim my first lap to my last lap at the same speeds going that with that much weight. Wow, it was rewarding. And you know what, when I get to share my successes in the group, it's very rewarding that people exhort me and congratulate me. But more so you know, it's about the lurkers. Right. And so I liked the idea that may be in the group, I can carry a bit of a message for the 40,000 that aren't posting every day. Yeah. And that I was making see that. Go ahead. No, I

Scott Benner 33:11
was gonna tell you that. I do like a weight loss diary, since I started using a GLP last year. And it's not talked about online, nobody brings it up. Like I don't hear from people like, Oh, I'm liking it or anything, but I get a lot of private notes about it. Like this made me feel good. Or I connected with what you said here, or you motivated me to do this or that like, but it's not online, like, whereas with the podcasts when it's about diabetes, you'll get like, people will be out front about it. They're just like, Oh, I heard this episode was really valuable blob above like, they're, they're not afraid to do that. And then like they'll jump on, but no one's mentioned it publicly. But it gets a lot of like private notes. I just think it's one of those things that generally speaking, I don't know that everybody's looking to talk about in public. It's just, it's just interesting. When you put out content the way I do, and you get to watch how people interact with it. It's a real learning experience, to see how people think and feel and what they what they think is important versus what they'll say out loud, sometimes. Just very interesting. I'm sorry, I cut you off. I didn't mean to. No, you

Jon 34:18
did not at all. And that's that's an interesting dynamic that I'm impressed by your ability to deal with the wide variety of people that come to your door, our char tribe. You're very inviting and open to people you tolerate quite a bit. But you work really hard to keep the conversation positive. And so you know what, there's people that are actively participating and everybody that's actively participating, y'all are addressing and speaking to a much larger audience.

Scott Benner 34:48
Yeah, yeah, you don't, you'll never know it. Like, I'll even never know to the extent that it happens, but I get enough feedback to realize Sit does like just to hear from somebody who said, Hey, I've lost 40 pounds since you started your weight loss journey, and I started mine because of you. And I think I don't know this person's name. I've never heard them before. I don't recognize them. I go to my group, I they're not in the group. And I'm like, wow, it's fascinating. Like I just said something positive, maybe hopeful. And I just put it out in the world. And then that person lost 40 pounds. It's crazy, isn't it? It's a message in a bottle. Yeah, man, no kidding gets a really nice way to think of it. Okay, so you mess around between 350 and 280, for 30 years or so. Swimming, not swimming back and forth. I guess the battle between the food and the exercise goes back and forth. I would also imagine that getting to 250 is great. But you're still standing there. 250 go, Oh, my God, I still have weight to lose. Like this is like is my whole goddamn life. Right, like, and so where does it really just start? Like, downhill skiing for you? Like, where do you just like, Where does it start? Where you're like, I'm on this path, and I almost can't get off it now to where you are right now. Tell people what you weigh. Right now. I

Jon 36:06
weighed this morning, I weighed 250.9 pounds on the scale. I've been right at 250 for a couple of weeks now. And

Scott Benner 36:13
this for you a weight is you think this is a good weight for you. Do you think there's more? Do you think you're too thin? What's your opinion of of your body right now?

Jon 36:22
And we'll talk about that surgery and bone. I think yeah, I weigh less now than I did when I was 15 years old. Wow. About that. That's my goal. I have stage one obesity right now. At my height, I was stage six plus, and I had a body mass index about 66. Okay. And now it's about 33. You know, it's imperfect math, right? Unless you do that thing where you get in a sling and go into a saltwater bath. And they weigh you and all that. But the math says, Yeah, so the math says I'm about 33, which puts me in stage one obesity. And my goal is to lose another 30 pounds and become overweight. You like the IRA, I already have that. My goal is to be overweight

Scott Benner 37:09
chested. I've had that goal. So how tall are you just for context for people?

Jon 37:13
I'm six foot one, okay. Or as I like to say, I'm six foot one and a half.

Scott Benner 37:18
I listen, if I was six foot one and a half, I'd added it to Okay.

Jon 37:23
I mean, it affects the BMI calculation and makes it a bit easier.

Scott Benner 37:28
Didn't get shorter when you lost weight. I've seen people lose show shoe sizes.

Jon 37:33
I would think you'd get taller when you lose weight because of less vertical compression.

Scott Benner 37:38
Oh, John, you're saying something there? I was thinking about literally fat under your feet. Well,

Jon 37:43
that's interesting. I'll tell you a thing to maybe interesting is I ended up essentially crippling myself and I use a shower in a chair in the shower, I use a chair in the kitchen, I use electric cars at the store. But I can swim a mile every day before surgery for two months before surgery. I'll swim a mile a day, six days a week. And how do you do that? Right? Well, it's the zero G thing. It's taking the compression off of the spine. And so I'm trying to make that better. I also recently had a comment, I'm glad to be able to get this in here. I had a conversation with my GP was only about two or three weeks ago. And I said we're we need to reevaluate our relationship. And we need to have a relationship where you understand that you are working for me and that I'm in charge. So I had that same conversation with him. And he was happy to do it based on I guess, you know, the results. Yeah. And I said, the first thing I want to do is I want to remove statins, statin from my portfolio. And I said I'd like your advice on how to titrate that how to reduce that dosage. And he said, You know what, let's just take it away completely. And we'll see what's up in two months. And then if we want to, we'll titrate upwards from the minimum dosage and I was like, Yeah, we're, we're, we're we're doing it. So the the reduction of the statins may help with muscular issues.

Scott Benner 38:58
I was gonna say tell people why so we will but let's go backwards a little bit. You've crippled yourself How could go through that?

Jon 39:05
Where you can't wait 540 pounds. And you have what passes for inactive life, right work and all this kind of stuff and it not have issues. A long, long time ago, I had, I think it was an MRI or something. And they said I had compression fractures in the spine. And like, kind of, of course, and so you can't weigh that much. Now. I think we're getting close to the surgery now because after losing all that weight I was carrying around a huge apron of flesh. And imagine if you wore a sack of potatoes around your belly with a belt on your back. What that would do to you after decades

Scott Benner 39:46
pulls on you. Yeah, but John, listen, I've only lost 50 pounds. Okay? And I say only because obviously you're you're in a different league. But what has changed for me? My knees don't hurt. I don't have plantar fasciitis anymore. My back's not always stiff. I feel better generally speaking, like I feel healthier, more awake, more alive. Like all that stuff like, I sleep better, I have significantly less acid reflux almost none, just, you know, all have these different things that have changed with my weight that I swear to you, if you would have asked me prior to losing 50 pounds, Hey, Scott is your plantar fasciitis from your weight, I would have said No, probably not. But I mean, now that you look at it, like, in hindsight, you're like, well, obviously it was, you don't need me like, Why did my knees hurt? Or my knee hurt? Because you know, I have little cartilage break down on my knee like, yeah, okay, it must be genetic or something. Or it's because I had 50 pounds. I don't know how to explain that I'm a pretty bright person. And that I didn't know my knee hurt because I was fat. I know that sounds insane. But I really I didn't know that. I didn't know that I was tired because of that. I didn't understand any of that. And for context, I use the GLP to lose weight. So I haven't significantly changed the things I'm eating. I honestly didn't, I wasn't a particularly poor eater. My body just didn't deal with food. Well, my digestion was wrong, I wasn't holding nutrients correctly. Like all this other stuff was happening, this GLP has changed all of that for me. On my ferritin I just had my bloodwork done. And then I forget, it's like I forget what is 166 or 188. Like, it's it doesn't matter. It's up in that range. I haven't had an infusion in like a year and a half before that, if I didn't have an iron infusion, every six months, my heart would be down to 10. And I was shutting off. My body wasn't even holding my nutrients. And I don't even know how to explain why that is exactly yet. Obviously GLP slows down your digestion, is it just leaving the food in my stomach longer so I can actually absorb the nutrients I'm eating? I don't know, do I have a GLP deficiency? I don't know. But what I do know is my knee doesn't hurt, my back doesn't hurt, my feet don't hurt. I'm more alive and awake. And I swear to God, if you would have asked me two years ago, what that was from, I wouldn't have said my weight. So I don't even know how to explain that.

Jon 42:16
Healthy lifestyle is the fundament for a better life. And whatever disease you have, whether it's curable or you know, like in my case, reversible, in type one, there is no fundamental cure, but there's treatment, eat well shake your bones as much as you can. And things are going to be better.

Scott Benner 42:36
Yeah, I just think that's true. I mean, not that, again, if you would have asked me that. I would have said that. I just didn't think it applied to me for some reason. Right? Yeah. Right. Yeah. So okay, so I'm sorry. So you've got we've got this weight off you now. And you're carrying around a lot of extra skin right?

Jon 42:55
Here, you saw the picture is pretty profound. And yeah, if you look at the size of the hands and some of the pictures, and then transfer that to the picture of the final removal, you can get an idea of the scale there.

Scott Benner 43:09
I mean, you sent me a photo of yourself. It looks like it's taken basically, like from your neck down your splayed, basically, right. And the truth is, is that you have to really focus for a minute to realize it's a person. Like it really is that like, like just, I don't know what the word is altered. And look, it

Jon 43:30
looks like a cattle abattoir kind of thing. Right? It looks like they're cutting cattle open to make meat of it or something. In my opinion. Listen,

Scott Benner 43:39
if you would have told me it was a giant tuna on a boat, and they were getting ready to cut it up. I would have believed that for half a second. Yeah. I mean, how do they measure what they took off it? Was it inches or weight? Or how do they relay it to you? That's

Jon 43:51
a very good question. Because when they take that the skin off, it has the adipose tissue attached to it, you don't lose fat cells. And typically you don't increase the amount of fat cells you have, except for when you get into extreme obesity, you actually do create new fat. So what you do is you to stem them, you fill them, right, they get larger and larger. So when you've lost the weight, there, it's still there. And people who maybe have lost the weight weight as a result of rapid weight loss due to like bariatric surgery or whatever. And then they say you know have to keep it off for 18 months or something. And by the time they take that off there might even have some adjunct liposuction to go with it right to bring everything together. In my case, the doctor noticed that the bulk of the weight loss and also this the other thing, I was down to 270 when I had the surgery, okay, were 275

Scott Benner 44:46
Oh God, John 25 pounds without a skin.

Jon 44:48
So no, no, no, the actual weight of the skin was 13 pounds. But the doctor said Had this been like an 18 month weight loss. It would have weighed considerably more Oh, because of the the condition of the fat cell. Yeah. So what I had was a very emaciated layer of fat. And that ended up causing complications with fluid with drainage later. But on the other hand, in terms of healing, I healed like a Star Trek movie. You know, I mean, like when they pass the hand over the wound, the alien does and it heals right away. Yeah, I healed amazingly fast. And the doctor pointed out and trained the staff on this as well, that drainage is just a standard component of the healing and it's not a complication. Mine took a long time. But everything else healed up so amazingly well. And I would like to say at this point, put this out, too. We as Luke during my operations, the iOS loop app was used during my operation to maintain my blood glucose levels. How

Scott Benner 45:47
long was the operation? Five

Jon 45:49
hours plus,

Scott Benner 45:51
wow. And was there someone there managing your diabetes for you when you're out? Are you just let the loop run it?

Jon 45:56
Well, so you know, there's two people in the surgery that are the the prime operators, one guy's got is keeping you alive, and the other guys is doing the surgery. So the anesthesiologist is key. And I met my anesthesiologist before the surgery. And we had meetings, and he said he was very interested in using loop. And so we use loop during my surgery. So he had my phone on his station, and did not have D five, set up dextrose 5%. Right. He did not have a dextrose solution setup for me, gets ready to do so it needed. He knew my control. And he knew what I was doing. And we we had done a zoom session where I showed him how loop worked. We ran it through my surgery. And by gum, it was just amazing. And, you know, I believe I know it opens the door for other people, because it was really, it's not likely that you're going to get a surgical team to do that.

Scott Benner 46:52
Arden's had short procedures where they've let it run. She's also had procedures where they told me to shut it off, and I pretended to shut it off and left it off.

Jon 47:03
Yeah, but this was like a full on five hours.

Scott Benner 47:06
This was a four to five hours of eight hours of recovery where you're not awake afterwards. No eight hours front end

Jon 47:13
of unconsciousness, right? Because about three hours and I mean, right, tacked on to either end. And you know, I get that out of my Nightscout to

Scott Benner 47:21
I can see Yeah, listen to I mean, the truth is, it's a good example of good settings, and how you can fast with diabetes to if you have if your settings are good, and you're on a good algorithm like that. So Well,

Jon 47:32
having said that, because of my, my diabetes is my diabetes, and what I do is what I do, but I eat once a day, one time in a day later than I should, because I work and I get involved in things. So I eat about 7pm would

Scott Benner 47:46
walk me through your day that you wake up. You don't eat you drink anything. Water. Okay.

Jon 47:51
Oh, coffee, coffee. I love coffee. But I'll tell you about coffee is I don't allow myself to have coffee every day. Because chemical dependency, I

Scott Benner 47:59
say you don't want to get hooked on it. Yeah, I don't drink coffee. But um, when I see some people, they go after it like it's a little too important. You don't I mean,

Jon 48:09
it has a physiological effect. And I need to be I need to be in control of my physiology.

Scott Benner 48:15
You think it would be a gateway to sugar and other things?

Jon 48:19
At this point? No, because I'm hell bent. But I do think it can be something that everything is kind of in moderation. And I think that too much of anything is not good. And, and caffeine is a drug. And I don't want to stimulate those portions of my brain, even if it's not going to get me into sugar. I say, I don't want to be a junkie.

Scott Benner 48:39
No, I hear what you're saying. Okay, so I'd like to know a little more about the surgery. So where does most of the I mean, are they taking it from limbs from midsection, everywhere?

Jon 48:52
I have a 30 inch suture going horizontally across my body just above the pubis just above the mons, right, yeah, and it goes 30 inches from each side, each side. I'm 5046 inches now. So you can imagine. Oh my gosh, I never even thought about this though right now. But 16 inches of me is not hitch or is the hinge right. The other is this 30 inch scar that goes all the way around. And so what they do is they cut that just below my moves. I had to get that choke and they cut me just you know, somewheres below up high north, and then they cut me right above the mons maybe a little bit deep there because he pulled it up a bit, which was lovely. Yeah. And my doc, every surgeon has a different philosophy and so forth. And some people want to be what they call snatched, so they have a tight bod. But I'm not in the tight BOD kind of category. He doesn't want to pull you too tight. So you have to walk over and a hunch for a long time and all this. So anyways, they cut you apply, they cut you down low, and they remove the section tapering towards the edges, right? It tapers down, and then they saw you back up to top into the bottom end. Wow. Yeah, it's pretty profound. Those pitchers you don't understand until you see the pitcher. Now there's

Scott Benner 50:03
no way to understand that actually, was it painful the recovery? Not at

Jon 50:07
all. And it's, again, it's different for everybody else. I have a high pain threshold, I have chronic pain. And it just it for me, I didn't take any painkillers at all. Okay,

Scott Benner 50:15
I do wonder if not to your degree, but I do wonder if this is a thing I'll need eventually. Or if I'll just because it's funny, I don't think about it. Like, I have to say, visually, I don't care. I'm so much happier being smaller that this bit that's around my midsection. Still, they're still fat there. I'm not done yet. But if it was just skin, I honestly don't know if I would care. I'm so happy, just feeling better.

Jon 50:46
And that's a lot of the way I felt about it. But it becomes physically debilitating. It is hygienic ly and sexually limiting. It is caused me to be effectively, you know, crippled, yeah. Now I'm going to turn that around to I said somebody at the store the other day, we're talking, I said, I decided to swallow my pride and take the ride. So I'm in the little electric cart. And it's funny, I used to be in that little electric cart and be a big guy in the electric cart. And now I'm in our society, a normal size guy, as it were, and I'm in the car. And you know, I want to get up and start walking. But I know that halfway through my shopping or a quarter of the way through, I will not be able to continue to be exhaust carry on. So I have to this is spoons theory of disability, you have so many spoons to spend in a day, right? And I don't want to spend all of my ability, starting to shop and not being able to finish. And then before I took the cart, I would do that I would get stuff real quick, go to the checkout, sit there leaning against the candy now trying to support my weight and my pain and sit in the car for 10 minutes before I could drive home. Yeah, so I decided at one point to give myself that break. But now I'm kind of at the point where I want to go there for a small shopping and do it without sitting down in the car. But then I don't want people to say oh, you've been faking it. Or like

Scott Benner 52:00
John's complicated. I got a quick little procedure on my big toe ones. And the next day, Kelly's like, I'm gonna go to the restroom. Like, I'm totally coming with you. And she goes, what you can't walk. I'm like, I know, I want to drive the car rolled around that place like a king on that card. I was like it was amazing. So what do you think? I mean, you're obviously on a path to get your like, what is it? You're trying to get back muscle tone, like, what do you think you're lacking right now?

Jon 52:26
Yes, the first thing I'm trying to do is get some core strength back. And when I was swimming before the surgery that was really working out well. And I wanted to add to that, a home gym component of barbells. And working on some weight training, not necessarily a complete, we would call the long, not the barbells. But the full weight thing. Maybe not that to start but just the barbells and do a bunch of different exercises to start bringing the bat in which would continue to increase the metabolic rate, it would do muscular things that are important for me and all that. I'll tell you a problem is the work I do, I don't get paid very much money at all. And I'm kind of just barely making it. And my car went completely but up. And so I don't have a car and I can't get to the pool. And I am desperately trying to find a used car. I've got a limited amount of money that I can spend on the used car market is insane. Yeah. And I live rural. So by the time I find something that's a candidate, I have to drive a whole day there and back to look at it and there's undisclosed damage. So right now the biggest thing of my life is getting mobile again, and getting back in the pool right away. And thing is, can I start doing some weight or resistance band training right now? Yes, I can. And I need to not use the swimming as an excuse for that. But the reality is that time in the pool with zero G means everything to me. Big

Scott Benner 53:45
deal. Yeah. Yeah. I wonder if your doctor couldn't get a transport for you to the pool under insurance? Well, the

Jon 53:55
problem with that is I have marketplace insurance. I'm thrilled that they cover my diabetic supplies, right? They're not going to go too far into that. The other thing is timing of it. So my work? Yeah, I guess you're right. I trained people how to use Lou, they schedule sessions with me, my calendars available, they schedule sessions with me. And I find that people are on my calendar, right that they just show up. And I have to schedule around that. I'm going to swim the mile that I do, it takes me an hour, but it takes the whole round trip at least 90 minutes. And I've got to fit that in my day. And I've got to be so you can't like oh, the transport is late today. Or, you know, I have to be back at my office home office to do the next session. And so that's a limiter and you know, again, there's all kinds of rationalizations and you have to not let this stop you or slow you down. So you know, I'm once again convicted that I need to get out some resistance bands and work with that. I do have a little treadmill under the desk thing that I give some work with. Yeah, I'm sorry. My answer is I can I can do more regardless and I need to Okay,

Scott Benner 55:00
well, I mean, it's tough. Like if the walking, I mean it, the zero gravity of the water is what's really is what's making it possible for you. Yeah, yeah. Unfortunate

Jon 55:10
it really is. Now, I'm hoping that that plus the weight training can get me core strength, it'll take some stress off of the off of the back. But I also believe that the Statins have been causing me some muscle issues that may be playing into a lot as well. I was

Scott Benner 55:25
going to ask how long of being off of them do you think until you feel value

Jon 55:30
from that? I'm very much enamored of the scientific method and not allowing correlation to be mistaken for causation and things like this. So I really try to get long data on things I can tell you that subjectively it feels like I'm feeling better, I'm sleeping, I don't have cramps. So I can't sleep more, we're more about two or three hours, and I have to get up and walk it off, okay. And I've been able to sleep I've been able to sleep five or six hours, okay, and I'm also ingesting salts. I'm increasing my specific salt intakes, not just salt on my food, but I'm using a salt supplement, I often get very bad debilitating cramps in my legs at night. And those are dramatically reduced as well. So give me another six months. And I'll tell you, you know, I'm sad. But right now, I think it's, it's I don't think it's any worse. I have to have a cholesterol test in another month or two, and just get a handle on what's happening there. I think it's better Good.

Scott Benner 56:28
I'm glad. Just thinking about your predicament. And it's hard to like, I'm trying to look for other ideas that would be valuable for you. But I don't know what they're none are popped into mind. You know?

Jon 56:39
Yeah, basically, I just need to find the miracle used car that's going to work out for me for you know, the $6,000 I've got Yeah, and I just need to run about to do groceries and stuff. And as soon as I do that, I'm going to be a regular fixture at the pool again. And that's going to be a really cool thing.

Scott Benner 56:54
I don't I don't want to get into your I'm not trying to get your finances but okay. All right. Well, I hope hopefully, this is something you can figure out. So

Jon 57:00
I have friends to talk about a GoFundMe, but I'm the guy who contributes to go fund this. So I know this

Scott Benner 57:07
is gonna sound ridiculous, but you said that when he cut you, you know, at your waist. And he cinched it up like you, you were like, which was lovely. And I was like is that my penis looks bigger joke. I couldn't tell if that's what you were doing.

Jon 57:18
No, you know what? It's funny that it's a joke. And I'll be you know what, I discovered that I have one. It's crazy. Like I mentioned earlier, hygienic, and sexual function is vastly improved, you know, when I not to be graphic or anything, but when I put my hand around my pelvis, I feel a bone. I can do the Michael Jackson thing. You know, I'm

Scott Benner 57:41
talking about you. And you and I can prior to that No, right? Like, Oh, hell no. Yeah,

Jon 57:47
let me let me let you I might turn this into an after dark episode. I hope not. But in order to use a public restroom to urinate, I would have to go into a stall because I'd have to drop my trousers to my waist. Lift up my belly and do my business. And you know, what's a wonder? This sounds so silly. I can use my fly now.

Scott Benner 58:09
I tell you that must have been exciting. I'm being serious. So yeah,

Jon 58:13
I am too. Yeah. And they sell hygenic aged we have all to take care of when you defecate

Scott Benner 58:19
when you're that large. I've seen the towel on the stick thing. Yeah,

Jon 58:23
yeah. Yeah, I used to have to take a shower. I'm, it's all of a sudden become too TMI. But it gives depth to the thing.

Scott Benner 58:31
No, of course. So for clarity for people. You at that weight, bowel movement. You had to move to the shower afterwards, because there was no reaching to what you needed to reach.

Jon 58:40
Yeah, and I wasn't gonna get a towel on a stick. Yeah.

Scott Benner 58:43
And that's something man. Oh my gosh, well, your life has changed. 540

Jon 58:47
pounds is profound. That's my 600 pound life. Yeah.

Scott Benner 58:51
But your life has changed so significantly.

Jon 58:55
Yeah. Can you imagine I weighed 250 pounds. i After the surgery, I got 50 inch pants. I took the four inch before that after recovery from the surgery removal of the drains. I was wearing 50 inch pants. And that was like, almost three months after the surgery is how long it took the drains to come out. Right. And I went I bought from Amazon 5250 and 48 and you know, they have to try before you buy and I kept the 50s and it was just this week that I was like my diet bestie and I were talking and she said you know you lost a lot of weight and my pants were falling off and couldn't keep my pants off. Right on so I had to I had to put more holes in my belt. Anyways, I said you know what, I'm gonna go ahead and order a 50 a 48 and a 46 and we'll see what happens.

Scott Benner 59:37
And the 46 fits nice. Oh, it's so wonderful.

Jon 59:41
44 is off there is not the big and tall store.

Scott Benner 59:44
I started last year 38 waist and I'm a 32 now and I swear to you, you go I swear to you, I appreciate you ever I swear to you. I didn't think that was possible. Like, I mean, I really didn't think if I stuck my hands on my sides that my hips and push back then or now, like, I didn't think it was any different. But it is it's so significantly different. It's crazy. Like I put a suit on today, I was out earlier. And I had a suit on him. And I got to this place where I mean, everyone was wearing suits, but people just kept coming up to me like, Oh, my God, you look terrific. And I was like, thank you. I like it's I'm just smaller. That's all there is to it. You know,

Jon 1:00:29
when you have 46 inch waist and you're wearing size 50 or 50 to pass. It doesn't reflect where you are.

Scott Benner 1:00:38
No, it makes it worse. It really does. Like, I'll tell you one of the silliest things that I've done in the last year, super simple. But I've donated a lot of clothing over the last year. And I've always been very careful not to buy a bunch because I'm like, I'm not where I'm going yet. I'm not going to buy a bunch of clothing and then give it away again, like I was living on like the same two pairs of pants, like through the winter. You don't I mean, like doing that thing. Yeah, yeah. And but I, I spend a few extra dollars now on my T shirts, so that they're a higher quality fabric. And I find that I just think I just think I'm presenting better now. And yes, you lose that like clean feeling when your clothing is too big as well. Like it's not just the fabric. Yeah, it's the way it fits you. You look, the old homeless basically, you don't I mean, you look like you're reaching your bag and you took what they gave you is basically how it ends up, you know, coming off.

Jon 1:01:32
It reminds me at the height. Oh, go ahead. No,

Scott Benner 1:01:35
I was just gonna say it actually, it impacts how you feel about yourself. And you don't realize it right away

Jon 1:01:41
when I was at my maximum weight, and went to the big and tall store, and had to go to the far end of the pants, to the 70 fours. And all they have are bright orange and checkered plaid.

Scott Benner 1:01:57
That seems that seems like a joke, doesn't it? Yeah. It

Jon 1:02:00
seems like a cruel joke. Yeah. And, you know, I ordered some jeans just, they're gonna get here tomorrow. Everything's Amazon. I ordered some denim jeans. They're not quite Levi's Bible ones, you know, I'll get this. I don't even know if they still make those. But there's some jeans and I expect, you know, to really dig on that and I'm gonna get shirts. Next couple of shirts.

Scott Benner 1:02:24
Let me ask you a question. I was sharing this with my wife the other day. If I have a larger meal than I'm accustomed to now, and I feel full tick, just have that very full feeling. When I get to a mirror, I almost consciously expect to look better. And and when I don't, I'm stunned. And it's a real I can see that. Yeah. So I told my wife. And as I was saying it to her, she goes, I know exactly what you're talking about. Like if you feel full. When you look yourself in the mirror, you expect to see the old view there. I was like, Oh, my guy suggests. Yeah, please let me suggest

Jon 1:03:01
something that comes to mind. This may or may not be true. But this is a perception I have on it is when you're full like that and satiated. You're on the drug rush. And that same drug rush makes you remember this conditions of that addiction

Scott Benner 1:03:19
could very well

Jon 1:03:21
put you in the mind of that body. Yeah, you become that person that's under the control of overeating, or bad eating. And so you feel like that person and he doesn't change just because of that one meal and you look at yourself and you're like, No, no, I'm still I'm still. Okay. But maybe that's a mechanism to make you think hey, don't it's

Scott Benner 1:03:41
been an illuminating year so far. I have to say.

Jon 1:03:44
I'd like to follow up. I enjoy the journey you've had on that as well.

Scott Benner 1:03:49
Oh, good. I'm glad. Thank you.

Jon 1:03:50
i How's your glucose? How's

Scott Benner 1:03:52
your mine's good pre diabetic diet. Okay. Yeah, I've had my endocrinologist told me last year, she said look, based on all of your, your a one sees over the years that I see she goes, I think it is incredibly unlikely for you to ever develop type two diabetes. And I was like,

Jon 1:04:11
I've noticed super obese people that are dead now, that did not have diagnosed diabetes.

Scott Benner 1:04:17
Yeah. My fasting glucose is they're always like in the, you know, 80s Nice. I think I've shouldn't talk on something probably, but I think I'll be alright. And that that's based. I don't know if I'll get type one diabetes. But well, yeah. That

Jon 1:04:31
gets triggered right? By events, right? You get you get COVID You get

Scott Benner 1:04:35
I've never done trial that personally. So I don't know if I have markers or not. Well,

Jon 1:04:42
you you know as as much as anybody more than anybody the the genetic relationships in the family tree actions. I

Scott Benner 1:04:49
don't think it's not possible, that's for sure. I'm just trying to, I mean, at this point, John, I'm just trying to eat well, and move and continue in the right interaction. Those are my goals.

Jon 1:05:02
Something I wanted to share that that I thought of just a few moments ago, is I like being hungry. Okay. It's a feeling I enjoy. I don't like being hungry to the point where I'm, I'm feeling physically impacted like, you know, I'm low sugar per se but like I'm ravenously hungry, but I like to be hungry and that's a feel. I think that's because that's a feeling I never had. I thought I was hungry. I was obsessed. I was feeding the drug needs. I was hungry for the dopamine. Yeah, but you know, like, so my fasting isn't at all difficult for me. And when I do get a little hungry, I know that dinner is coming soon. I make beautiful food. If you look at my timeline on Facebook, you'll see that I just make really, really good meals. So I was also worried am I going to have a rebound? Where I go from obsessive eating to some sort of anorexics thing, right? And absolutely not. I enjoy my food so much. Good. Good. I'm

Scott Benner 1:06:00
glad I have to say I do too. I had like a like a chicken sandwich last night for dinner. Like I took some chicken breasts and I season them and and and I put a tiny bit of oil in the pan a little olive oil. I fried them up and they were nice and tasty. I put it in a pita threw some lettuce in with it. I graded a tiny bit of cheese over it. I sat and ate it. It was half it was half a chicken breast. And I got done. I'm like I'm full. This is great. I'm good. I don't know what

Jon 1:06:26
the half of the time you spent making. It was as much a part of that meal as for

Scott Benner 1:06:30
sure. Ya know, I love making food. I still do. I like making food for my kids to like, it makes me happy to cook for them. But But beyond that I got up this morning. And I went to a viewing today. So people are like, Oh, Scott in the middle of the weekend a suit but nothing fancy. I did not eat today until about I think two o'clock in the afternoon. And I was hungry at that point. But if I wouldn't have eaten, I would have been okay to. Yep, yep, yep. Now it's 6pm. Like obviously my day is a little upside down because this viewing came out of nowhere and John was nice to move his his recording around with me. I'm probably going to finish with you and go have the other half of that chicken breast into similar pizza again, I'll probably that's probably how I'll end the day. Last

Jon 1:07:14
night I had a cup of soup for my meal. It was a very light. It was a very light day today. I don't know what I've got the frosted to figure that out. Oh, you know, I'll probably I'll probably have an omelet.

Scott Benner 1:07:28
Okay. Oh, I eat a lot of eggs. I love Yep. Yeah. Usually for breakfast, I have a couple of eggs in in a wrap with something some protein usually, you know, something like that. I do that in the morning a lot. Yeah, no, I

Jon 1:07:42
agree. I'm gonna have a sausage. Yeah, it's nice.

Scott Benner 1:07:46
All right, let's it's time for me to ask you if we've missed anything, because I know you had some pretty specific, like, you're very prepared, and I appreciate it. And yet, you're very conversational, which I also appreciate. So I want to make sure we're not missing anything that you meant to talk about.

Jon 1:08:00
You know, I wanted to talk about the consistency and the improvement, the fact that it wasn't just an overnight thing and gone. And so the idea of sustaining a healthy relationship with my diabeetus. And the other factors in my life is I think a big part of my message is that it's not rigorous for me. It's very affirming and positive, it reduces stress in my life. I'm not at odds with the way I eat. And I'm constantly rewarded with the results I see. And I continue to increase those rewards. It's, you know, diminishing returns. It's not really here yet, because there's so many things that I continue to be able to improve. And another part of the message is it's never too late. And I guess another part of the message is, there's more that binds us than separates us. And so a healthy lifestyle, healthy social interactions, healthy interactions with food, all these things will reduce our suffering, and help us to focus on the things that are effective in treating the chronic illnesses we have. And so I really appreciate that your group was open to all

Scott Benner 1:09:11
of us. Oh, no, it's my pleasure. I want very much for the group to be open to everybody. I also think that what helps you as a person with type two diabetes, what helps a person with type one diabetes? And what how, what helps the person who doesn't have diabetes? Speaking about like, just general health, food, that kind of thing? I don't know that any of us are in a different boat than anybody else. Finger you know what I mean? I mean, I think quality food at a reasonable proportion is something everyone should be aiming at. I just think that people with diabetes are forced to pay attention to it sooner in life than maybe people without it are.

Jon 1:09:47
Yes, but you know what the Epilepsy Foundation as a whole webpage about addressing diet and exercise, right? Everybody

Scott Benner 1:09:55
should be doing what you're doing to some degree or another So obviously, it wasn't easy for you, you had mitigating factors, so to a lot of other people, but I mean, it's just very impressive that you stayed after John, you're you speak like a young man, I don't know if you're aware of that or not like, and you have a younger voice, but like, it's important to remember, you're 63 years old, you know, and you're, and you're doing these things. And you have the attitude of somebody who's 25, and just gained 10 pounds and realized, Oh, my God, it's getting away from me, you're trying with that kind of energy. And I think that may be the most impressive part of this whole thing, to be perfectly honest. And if people go back to listen to your first episode, that a number of things stacked against you, when you're growing up, too. So yeah, yeah, it's a bit rough. It's a bit rough. It's a very kind way to talk about a child. But yeah, it was a bit rough.

Jon 1:10:43
I like to say, it's half jokingly or whatever. But I'm a 16 year old guy who acts sometimes like he's 12 and thinks he's like, 25.

Scott Benner 1:10:54
That's good, though. I think that there's I don't think there's anything wrong with that. I just think that it'd be easy for people to listen to you and forget that you're a 63 year old man who's been through all this and whose body has been through what it's been through, and you're still putting in this effort, and you're willing to take slow returns to?

Jon 1:11:11
Well, I believe the biggest gift I have right now is sharing my success with other people that can identify with it and adopt some of the elements, you know, see hoping it and maybe adopt some of these elements to address their needs when they're much, much younger.

Scott Benner 1:11:25
Yeah, I want to say to that, I think the GLP has helped me. So I've always, like as an adult, I always kind of endeavor to find things that make me more patient, because my patients is not is not good, right? So I do things like iraes cactuses, because they grow very slowly. Nice. And if you get it to grow an inch in a year, and you don't kill it, you've really accomplished something. And so I like the idea of doing something that doesn't pay you back right away. The GLP helped me with that, too. And here's how I knew I was going to lose weight on the GLP. I just knew I was going to, but I knew it wasn't gonna happen quickly. And I was able to, instead of saying, I gotta lose weight, I want to be 10 pounds lighter in a week or a month, or like, you know, like having that kind of like fervor for it. I was able to say, I don't care how long this takes, because I know when I get there, I'm gonna be where I mean to be. And that was really helpful. And then because of the GLP, there was weight loss along the way. So I didn't endure to in three weeks in the first six months where I was like, Oh, my God, my weights not going down. always felt like it was working, which allowed me to actually be patient, II call it a crutch or whatever you want. I honestly, I'm looking for doctors to come on and talk about how the medications work. I think I've got a couple lined up. But I genuinely believe I have some sort of a deficiency that it's covering. And just being able to see things moving in the right direction allowed me to act about my weight, the way I do about the cactus, I grow, there's a little light green ring. It grew. And I was able to say that's fine, because it's alive. And I've got all the time in the world. So I'll just wait. I don't know. It's just I think being patient is a big part of having the kind of success that you had. And I don't know what you think about that.

Jon 1:13:24
Well, I can relate in one way directly. I have eight aquariums here. And the largest are 60 and 75, gallons and small Sarkar. 40. I practice a style of fish keeping that is you would call a balanced environment. So a lot of people are focused on changing the water in the tank regularly and adding additives and all this, my focus is on doing as little as possible to achieve a balanced ecosystem. And my aquariums are just gorgeous, full of plant growth, the fish live forever, everything's pretty cool. And for me, that is a part of my diabetes, self care, the ability to maintain those environments in balance is informed by my ability to do it myself. So your thing with the cactus I can really relate to, because my thing with the aquariums is related to my self care. Yeah,

Scott Benner 1:14:15
I've talked about this in the podcast, a couple of little places, but I've almost by mistake become a person who owns a chameleon. And it's lovely that chameleon is absolutely lovely, but it was a gift. And the people who gave me the gift as much as I appreciate it didn't actually buy me the chameleon that I would have bought for myself had I bought a chameleon. So once I learned how to do you know all and it's another one of those things, it's an incredible amount of detail that you know, to do to do it right. And, you know, again, there's this living thing on the other side waiting, you know, for you to to do it right, you know, so I added a second chameleon I have to I'm not going to get any more I promise. The second one I got grows incredibly slowly. For over like three years to become, even to an adult size and may keep growing beyond that. But it needs a really large enclosure. And it's the same idea that there's this little tiny baby thing right now, that looks like it's in a world that's too big for itself. But it's but it's not an I don't get to see it fill up unless I do a good balanced, slow and steady job for this little animal for at least three years, right, then go. And I think of it the same exact way. Like I like that it can't be rushed. I think it's important for

Jon 1:15:36
people. And that's the way I feel about my goals for my diabetic control. My weight is, you know, it's been going actually remarkably quickly, but I never had any impetus to do it. Any of the feed i There's a phrase I use is one millimole at a time,

Scott Benner 1:15:51
that's a great, it's a great way to put it I if you're measuring your weight loss, your health recovery, your diabetes, care, any of that stuff in days or weeks. I think you're putting yourself in an unfair position.

Jon 1:16:03
You'll never get there. You know, you have to do you have to keep hiking. And when you get to the next rest place, you look down and you see the progress you've made. And then you snack, you rest. You drink your water and you get up and you walk the next mile. buy

Scott Benner 1:16:16
another pair of pants two inches smaller and get going again.

Jon 1:16:19
Exactly. I mean, can you imagine when I get to go to town and bypass at a store? Yeah, no, I'm

Scott Benner 1:16:26
excited for you honestly. Yeah, seriously. That's a couple months away. Yeah. Now I've had listen, I feel weird saying this. But you know, there's a death in my extended family came out of nowhere. I had to go to a viewing today. And it was yesterday afternoon, I said to my wife, oh my God, I don't have anything to wear to this viewing. And I ran out last night at like, seven o'clock. And I was like, she's like, What are you gonna do? Am I gonna go to Macy's to get a jacket? Like, you know what I mean? Like, I got a, you know, so be respectful. I met Matt Listen, he's a great guy. And, and he died. And he deserves for me to show up at his viewing in a suit. And it's just how I feel. Right? So. Yes, so I'm out. And I gotta tell you as sad as the reason was, I was shopping. I never had a better half an hour of my life in a store. I mean, I tried every jacket on, I look good. And every one of them. I was like, Oh my God. Like I thought that color wasn't for me. I thought that print was it wasn't that it was I was overweight. I didn't even realize it. And so I you know, I was able to shop I felt terrific. You know, like doing it I at one point, I was like, I'm going to try it on the slim cut. I was like, Oh my God, this fits to like, none of this makes any sense. I walked out of there, I felt like I was 12 feet tall. Like seriously.

Jon 1:17:43
I don't want to be too presumptuous. But you know what? I'll bet you the old man smiled at that. No, I

Scott Benner 1:17:49
hope so. I hope so.

Jon 1:17:50
You know what I'm saying? Yeah, that's, that's the best tribute you could make anybody you love is to take care of yourself. And to be in a place where you can feel that way. I

Scott Benner 1:17:59
was the happiest person that a funeral today you've ever seen in your life on because I was just like, Man, I know, I look good in this suit. As much as it's not about how you look, it's how healthy you feel. It is like, to some degree, I feel better because I look better. And that's just you know, I didn't dislike myself before John, but and I don't like myself more now. But it's just that I'm having a different lived experience at this point. I

Jon 1:18:24
think that's a good way to put it. And when I put on those 40 sixes, I had the 46 and 48. In the 50. I said, Let's start at the 46 I can get done with this. And when they fit. It was like, you know, the heavens opened, there were trumpets, there was like, a little giggity giggity. I mean, it was a high. It felt really good. It felt like arriving

Scott Benner 1:18:43
oh my god even pushing the clothing into like a one of those bins where you make the donations. I've never been so happy to give something away that I just bought. You know, I was like, oh my god, hope somebody else can use this, but it's not mine anymore. And I don't need it. Because, um, you know, 3836 34? You know, actually, when it went to 32, I decided I was like this doesn't make sense, like so.

Jon 1:19:05
And you know what, I have that history of gaining weight back. I broken through that so far beyond that. I'm never going back.

Scott Benner 1:19:13
I feel that way too. My wife was like, Are you going to keep anything? And I was like, No, I was like, I will not. It'll be my punishment to myself. If I have to go back out and buy something at a bigger size. So then I don't know if that's healthy or not. But I just I was like, I'm not keeping any of this because it felt like a crutch if I did, honestly. Hey,

Jon 1:19:30
I did get to talk about everything. And I again, I want to thank you for the opportunity to to share my story again.

Scott Benner 1:19:38
Oh, of course. All right. Well, John, I'm terrific. I'm gonna let you go defrost your meal and I'm going to make my chicken sandwich and we're all gonna go be happy and healthy. Yes. Hold on for me for a second. I'd like to say goodbye privately. Sure, thanks.

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#946 Best of Juicebox: Diabetes Variables: Alcohol

Originally aired on Dec 17, 2021. Diabetes Variables: Alcohol

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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

Scott Benner 0:00
Hello friends and welcome to episode 946 of the Juicebox Podcast

I thought for the Fourth of July we would run a best of episode about alcohol. Don't ask me why just seemed like you know the right thing to do. Today's episode features Jenny Smith and I in a diabetes variables episode, Episode 596 originally aired on December 17 2021. It talks about alcohol and its impact on your type one diabetes care. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you want to check out Jenny, you can hire her at integrated diabetes.com. And if you want to check out the entire bold beginning series, it's available at juicebox podcast.com. Go to the menu at the top click on bold beginnings, you'll see all the episodes there. It's available in your podcast player, any audio app you're listening. And if you're looking for another list, but you don't want to go to the website, you can go to the feature tab in the private Facebook group Juicebox Podcast type one diabetes

this episode is ad free. But please remember to use the links if you have the need. They're in the audio app you're listening in right now in the show notes. Those links are also at juicebox podcast.com. Or you can type them into any browser. I appreciate you thinking about the podcast when you're making purchases when you support the podcast by using the links if you're keeping the podcast free and plentiful. And here's a couple of quick savings for you. If you'd like to start drinking ag one in the morning like I do drink ag one.com forward slash juice box the first time you buy at one with my link you'll get five free travel packs, and a year supply of vitamin D. And if you like comfort, comfort in your sheets, your towels and your clothing. Check out cozy earth.com If you find something you like put it in your cart. And when you're checking out use the offer code juice box to save 35% off your entire order not just one item, your entire order. Alright, check out this episode and please do not blow your fingers off. Happy Fourth. Hello friends and welcome to episode 596 of the Juicebox Podcast. Oh

so this is it. This is the last episode of the diabetes variable series with me and Jenny Smith. And today's topic is alcohol to see how I've timed that to coincide with New Year's. Hmm, that's right, I'm thinking. 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 are becoming bold with insulin. Today I'll be speaking with Jenny Smith. Jenny has had type one diabetes since she was a child for over 30 years. She also holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and certified trainer on most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast so come proper I really hope you've enjoyed the variable series if in the future Jenny and I think up other ones will add them but if not, they're always there for your needs and enjoyment.

This show is sponsored today by the glucagon that my daughter carries. G voc hypo pen. Find out more at G voc glucagon.com forward slash juicebox. Jenny This is the last variable we're going to record. Oh, we've done it. It's very exciting.

Jennifer Smith, CDE 4:28
That is very exciting. A whole year of recordings are variable that's that's a lot of variables.

Scott Benner 4:32
I'm not kidding about it. At one point I looked at the list and I was like why did I like this is not a good idea. But it ended up being great and I really did enjoy it you obviously brought a ton to it. So last one alcohol How was alcohol a variable for for using insulin.

Jennifer Smith, CDE 4:52
but alcohol is a variable because alcohol can lower your body's ability tea to respond to the typical turnaround hormones that would raise blood sugar, you know, if you have a low, and so alcohol in and of itself, and we're talking like, several drinks, or even just one drink, depending on how your body tolerates alcohol. And many people I think are kind of confused what to do about alcohol because they feel like, well, if they're drinking, like, a hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it, and you should, you know, not not necessarily unless it's mixed with like cranberry juice or orange juice or something like that, right. But other types of alcohol such as beer, have a fair amount of alcohol to them. carbs, or sorry, yeah, the alcohol carbs. Yes, thank you. I was thinking alcohol, alcohol. Yes. So there's, you know, I mean, anywhere between 12 to maybe like 22 grams, depending on the size of the bottle or the can or whatever you're drinking, really? So do you cover the carbs? And then what happens later, right? Do you take insulin to cover the bottle of beer that you're drinking? Do you not what happens most people who don't cover the carbs initially will have a higher blood sugar.

Scott Benner 6:19
So is the concern around bolusing for carbs that are an alcohol that at some point, you become a knee braided and are not the best shepherd of your blood sugar, if it gets low?

Jennifer Smith, CDE 6:29
Those are the good questions to always be thinking about. Yes. Because in terms of low from alcohol, low from alcohol is a delayed low, it will tend to happen later on. So our typical recommendation on a normal conventional pump, it's a little more a little more, I guess, difficult if you're doing injections, but on a pump, it would usually say at the end of the night, let's say you've had several drinks over the course of the evening, it's midnight you get home at that point, you want to really decrease your Basal insulin delivery, because that's when alcohol is likely to come into the picture in terms of hitting you and causing you to go low.

Scott Benner 7:17
And is that the actual alcohol that's bringing you down? Or is that your? Or is it the Bolus that you used? Or no, if even if you didn't Bolus you would get low afterwards.

Jennifer Smith, CDE 7:28
It shouldn't really be the Bolus. I mean, again, bolusing has a definite like end point of action, right? Let's call it four hours, just give or take three to five hours, four hours. So if you last Bolus at 10 o'clock, you're low at 2am. Sure, it could have something to do with some of that Bolus still being left in the system. But it could also have to do with the way that the liver turns around and deals with, let's call alcohol a toxin, right. So as the liver is dealing with turning that alcohol around and getting rid of it in the body, your liver is also not putting out the typical turnaround for drop in blood sugar, right? You don't have that counterregulatory hormone production, so that your body has some glucose drip coming out of it saved stores to help you. So in that we usually say for every alcoholic beverage consumed, we really want to take the Basal rate down by a certain percent for about two hours per beverage consumed. Okay, so if you had three beverages at the end of the night, the percent that we would take it down would be by 40% of a decrease. And then the timeframe to decrease would be about two hours per beverage.

Scott Benner 8:45
Okay, so So you're basically people might not recognize that your liver is making glucose and you know and giving it is giving it off like Luca is it glucagon or glycogen or I forget the word,

Jennifer Smith, CDE 9:00
right? I mean, your body's counterregulatory hormones essentially coming from the liver or helping your body to essentially put out in the turret in terms of a low or a drop like that. It's helping your body to put out the glucose, right? I mean, that's why we have glucagon kits, right glucagon kit is a really quick turnaround of telling your body to spit out the glycogen and to turn it around into glucose to sort of bring you up from the low

Scott Benner 9:28
but if you're if you're taxing your body with enough alcohol, the liver gets focused on that. And then as your blood sugar gets low, it doesn't go through that process. In the same

Jennifer Smith, CDE 9:39
way, it doesn't go through that big process of counterregulatory. But also remember the reason that we're taking Basal insulin is to counter the production and natural drip drip of glucose into our system to begin with. So if the liver is busy taking care of alcohol, it's no longer going to help with that normal drip drip drip of glucose. Industrial Basal is going to be too heavy for you. Okay. In layman's terms, right? I mean,

Scott Benner 10:06
listen, I'm it's not a it's not a deep dive into how the liver works. But it is something I don't think people think about for certain,

Jennifer Smith, CDE 10:13
you know, and I think it's something that often isn't even brought up like I, I try really hard with a lot of the teens and those heading off to college that I work with, I try to bring up alcohol at some point, because it will come into the picture. Yeah, I mean, unless you're unless your kid has really sworn off because they just don't have any interest in that. At some point, alcohol will be something they need to think about. And it's really important that they know better how to adjust if needed, than just say, Well, I'm never going to do it.

Scott Benner 10:48
Right. Okay. Does this. Does this need a bigger episode? Or? What do you think?

Jennifer Smith, CDE 10:56
Come on. What do you have more? More questions?

Scott Benner 10:59
No, I just I don't know if it's, I don't know. I mean, it's like, you know, if you're, if it's beer, beer has carbs. If you're drinking, you know, some harder liquor, there's no carbs in them. But you have to look and see if you're going to add fruit juice just seems like maybe I could understand that when I start. But what happens when I'm like three drinks into it? Like, where do I? You know, what do I do when the when the room starts spinning? You know what I mean?

Jennifer Smith, CDE 11:22
Right? I mean, the big things with alcohol, too, that we always recommend is definitely have something to eat with it. Right? So it's not just alcohol. I mean, you probably know that. Or maybe you don't, I don't know, whether you drink or not. But if you don't, if you drink something on a pretty empty stomach, the impact of that alcohol is faster, right? You will feel the impact. Versus if you have it with a meal or at the end of the meal. Are you drinking along with the meal? It's much of a dumbed down. Impact. Yeah, which meal so then if you were expecting the impact of alcohol may lead you to drink more, because

Scott Benner 11:59
I'm also that there might be people who are wanting to get to that spot, too. It's a really difficult thing to talk about, because you're talking about it from the perspective of how do I do this responsibly? And I don't know that everybody starts an evening of drinking with that in mind to begin with, right?

Jennifer Smith, CDE 12:18
Correct. And you also have to consider like, I much feel like if, and I've only been drunk a handful of times, I'm not a drinker. I I'm, in fact, I came, I think the last time I was drunk was probably at my brother's wedding in Aruba. And that was a long time ago. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar. Okay, those tip sees types of and maybe that's not a symptom of yours, but I very much have a similar feeling with alcohol as well as with a low blood sugar. Yeah. So then comes into the equation, you're also already not really thinking very well, because you have alcohol on board. Is your symptom of being drunk? Also a symptom of a low that you're not paying attention to?

Scott Benner 13:15
Yeah. And how are you going to be able to handle that, um, so I'm just thinking of a person I met recently, whose son was away at college and was not a drinker, not a drinker, and then all of a sudden, one night just dove headfirst into it. And then this person had to, like, drive to a place to like, rescue the kid and take them to a hospital. Yes, you know, because then the next problem is, is that you're now around a bunch of drunk people, no one's going to be able to help you. Like, you know, you. It's not like you have a designated, what if my blood sugar gets low person here? You know, right,

Jennifer Smith, CDE 13:49
right. I mean, it's a reason in college that I 98% of the time, I offered to be the driver, when we would go out. And I might have knowing that we were going to be out for a fair number of hours, I might have like, half a beer when we got there. And then I had nothing else the rest of the night giving it a good like four hours of clearance time to be able to be like the driver hole.

Scott Benner 14:16
I can say with confidence that in my life, I haven't had the equivalent of a case of beer. Like I just don't drink for no reason that I can particularly point out to you other than it's not interesting to me. It's just not a preference. Yeah, it's not for me, I just I don't know, like I don't even know how you like consume that much. Like I have a bottle of like, flavored like peppy water here. And if I tried to drink this whole bottle, I'd be like, oh, like it can't really be too much. happens when you start putting like hops and barley into it. I'd be like, Oh, I'm so full. But yeah, but anyway, all right. I appreciate this. I know it's it's not an easy. It's not an easy conversation, because there's a lot of perspectives that that need to be taken into account. But I think in general, I mean, at least you could Try to follow what Jenny was saying about decreasing your basil. And, and, you know, I would add, you know, you gotta have I would want to have somebody there that understood my diabetes a little bit who wasn't drinking, but

Jennifer Smith, CDE 15:12
correct? Absolutely. And I mean even people ask even about wine, you know, a glass of wine, typical table wine is somewhere between three to five grams of carb, per you know, glass, should you cover that? I think a lot of it is also experience, right? What do you know about what has happened and along with what you said, make sure somebody is there who knows, you knows you have diabetes knows how to help you if you don't seem to be acting, the way that you normally would be acting. Because all of those things very much like all of the things with diabetes in general, take a little bit of experimentation. And you have to figure out what works the best for you.

Scott Benner 15:54
Let me let you I know you have to go. But let me ask you this, because I think I remember that this is true. When I'm drinking my glucagon won't work as well, right? That is right. Yeah. Okay. So if you're thinking doesn't matter, if I pass out, I'll just use my glucagon, it might not help. It will. I

Jennifer Smith, CDE 16:13
mean, will it turn things around versus nothing at all? Yeah, but it's not going to be the the same impact from what I recall. And I would I mean, it certainly would look it back up, but I'm quite certain nothing has changed about the recommendations and what we know about your glucagon kit and alcohol in the mix together.

Scott Benner 16:33
Yes. So read the label on your glucagon if you're expecting it to save you when you're, you're drunk, because it might not be as impactful as you're hoping. Okay. That somehow we made drinking sad, and I'm sure everybody oh

Jennifer Smith, CDE 16:51
well, people don't see us so they can't tell whether we're smiling or

Scott Benner 16:55
having a great time talking about I'm like, I just started thinking like we're taking the thing or people like oh, my, my Saturday night happy place. These guys are bumming me out. All right, well, thank you so much. G voc hypo pan has no visible needle, and is the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk. And the diabetes variable series began I guess technically at episode 231 with the pro tip called diabetes pro tip variables but then the variables proper began at 491 with trampoline followed by temperature travel exercise hydration, food quality leaky sites and tunneling video games stress masturbation school bedsides, growth hormone sleep pump site placement, a full moon diabetes tech weight change Walmart, the final episode sort of the last episode menopause and today's episode, alcohol. Check them out. They're all available in your podcast player. We're at juicebox podcast.com. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And now I will sing the simple version of your Grand Old Flag for the Fourth of July. You're right Grand Old Flag Euro Hi Fi in flag you're forever in peace may you weigh in. You are the emblem of the lion that I love the home of the free and the brave. Every part beach true neath the red, white and blue where there's never a boast or brag. Sure Should old acquaintance be forgot. Keep your eye on the Grand Old Flag. Never had a lesson one take for those of you who don't live in America or hate us. I'm sorry about that. Actually, for those of you with ears, I'm sorry about that. Please don't unsubscribe. I'll be back very soon with another episode of The Juicebox Podcast.

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Summary

• Intro to the show. 0:00

• Welcome to episode 915 of the juicebox podcast.

• Nothing on the podcast should be considered medical.

• Understanding insulin action and time of action. 2:49

• Fear of insulin is the biggest sticking point.

• Insulin action and time of action.

• Tug of war analogy, insulin and carbs.

• How blood sugar works in the body.

• Take insulin and start to eat. 8:37

• Rapid is a misnomer for insulin.

• Rapid insulin is 100% in most settings.

• Continuous glucose monitor, dexcom, continuous glucose monitor.

• The story of a 17 year old boy.

• Timing and amount of insulin. 12:12

• Timing and amount is the first step to insulin use.

• The importance of visualization.

• Dexcom g6 continuous glucose monitor.

• Share and follow features for android and iphone.

• How to make good decisions. 15:38

• Omnipod headquarters in massachusetts.

• Request a free experience kit.

• Dancing for diabetes and dancingthenumberfourdiabetes.com.

• Making the first move is the key.

• Diabetes is a science experiment. 19:22

• Diabetes is a daily science experiment.

• The pre-bolus piece is 80% of control.

• I don’t count carbs. 21:28

• Don't get mad, don't count carbs.

• No accurate insulin to carb ratio set up.

• The importance of the arrows in dexcom.

• The least important aspect of dexcom is the direction.

• What is pre-bolus and pre-basal. 24:54

• Temper basal is a fraction of the basal rate.

• Pre-bolus time is 20 minutes.

• The importance of pre-bolus and extended bolus.

• Pre-bolus vs extended boluses.

• Trading bolus for basal. 28:08

• The concept of super bolus.

• Never suspend basal insulin.

• Pre-bolus and multiple daily injections.

• Sponsor, better help. 10% off first month.

#944 Bold Beginnings: Treating Low Blood Glucose

Bold Beginnings: Treating Low Blood Glucose Originally aired Oct 27, 2022. Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio -  Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 944 of the Juicebox Podcast.

Hello, everyone, and welcome back to another episode of the Best of the Juicebox Podcast. Today's episode is from the bold beginning series. This episode features myself and Jenny Smith. It originally aired in Episode 780. That was back on October 27 2022. And it's called Bold beginnings treating low blood glucose. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you want to check out Jenny, you can hire her at integrated diabetes.com. And if you want to check out the entire bold beginning series, it's available at juicebox podcast.com. Go to the menu at the top click on bold beginnings, you'll see all the episodes there. It's available in your podcast player, any audio happy listening. And if you're looking for another list, but you don't want to go to the website, you can go to the feature tab in the private Facebook group Juicebox Podcast type one diabetes

this episode is ad free. But please remember to use the links if you have the need. They're in the audio app you're listening in right now in the show notes. Those links are also at juicebox podcast.com. Or you can type them into any browser. I appreciate you thinking about the podcast, when you're making purchases, when you support the podcast by using the links, if you're keeping the podcast free and plentiful. I'm gonna hit record gently to tell you this little preamble bit that I normally would have said ahead of time, but what we're done, you and this is the last one the not yay, I should say, oh, no, we're done. We're done with the bold beginnings, then we will move on to the long list of things that I have to do with you for next year. So but I'm gonna throw a little curveball in here. So you and I were going to talk about insurance. And then we were finished. But I'm going to bring somebody else in to talk about insurance. Cool. So because otherwise, it would just be you and I, you know, talking about our experiences with insurance, which might not answer some of the people's questions.

Jennifer Smith, CDE 2:37
No, I think that's great. Because I think there are quite a number of people that definitely no more about the navigation. And I think in terms of this topic, it's more how to really nudge yourself into insurance and get what you need, and get to be able to talk to the right person about it. Yeah. So I think that's great. Yeah.

Scott Benner 3:01
So you and I would have done, we would have had fun. And I would have told stories about yelling the F word into phones to get art and things and stuff. But I can do that with someone else who can also hit the technical sides of it for us a little awesome. So instead, you and I are going to add our very last episode to the bold beginnings series together about how to treat low blood sugars. Oh, right. Because you get diabetes. And nobody says to you, hey, you might get low. And the low might be slow. And it might be fast. And it might be harsh, and you might be dizzy. They just say if your blood sugar gets low at 15 carbs, wait 15 minutes.

Jennifer Smith, CDE 3:43
And then it might respond really fast. Or it might not resolve for a couple of hours. And you're thinking Where did the food go?

Scott Benner 3:52
So so so I want to kind of talk through a number of scenarios. And I know, I know, I'm dropping this on you out of nowhere. And of course I don't Is that is that anything new? No. But I don't have any notes whatsoever. Like we've been doing bold beginnings off of people's questions. So, you know, we might have gotten lazy because we're like, we don't have to drive this conversation. I'll just wait and see what this person said.

Jennifer Smith, CDE 4:14
Well, I'm sure there are probably lots of questions that have come in about low blood sugars.

Scott Benner 4:18
There may have been but they were not. They were not called together for me for this situation. So we're just going to fly by the seat of our pants, which I think will be fine. Not like before. All right. So let's think about this. Your newly diagnosed and I guess the first thing we can consider is that you might be honeymooning, still true. All right. So if that's happening, if you're getting help from your pancreas that you don't expect, you might see protracted I saw somebody online the other day whose kids blood sugar was like low all day. And she's like this has to be a honeymoon because, like we're not doing anything different than we've done in the past. So I guess if you're MDI, and you start experiencing low blood sugars that seem like they're being, I guess, impacted by your pancreas still, you can't cut off your your Basal insulin because you've probably shot it already that day. Correct. But you could start limiting, I don't know, would you limit

Jennifer Smith, CDE 5:23
limit your Bolus insulin, right? Right, or you could look at for that day, making your insulin to carb ratio, more conservative. You know, if you're floating around at a ratio of an in honeymoon, I mean, kids, and even some teens might be a one to 30 ratio, right? You could suggest one to 45 or one to 50. Or right, if you know that you're floating, pretty stable when there's not food introduced, but the stable is low, and you're having to give it a little bit of carb to keep it from like, dipping, then it would be the Bolus is that would be the easiest to adjust in that day. And in looking forward into the next day thinking, this might be what it is, you could downplay your basil that day, whether it's morning or evening time dose, you could take it down a little bit, and see if then the next day floats just slightly higher, and leaves you without having to add so much extra carb

Scott Benner 6:31
to treat. And on the day that you get surprised by it and your basil is already in. You can kind of feed the basil a little bit for the day. Yeah, right and spread out and spread out carbs to cover the timeline. But so this is where you need to understand the difference between like a faster acting car, but a more sustainable impact, right. And so if you're being drugged down constantly over hours and hours and hours, a couple of skittles might stop it for a minute. But the minute you bounce back up again, and this extra Basil is there that you don't need, you're gonna get drugged back down again. So you need foods that are slower to digest. Right? You start you start reverse engineering your problems from diabetes and using your problems as solutions, right? Like, right, if you ate pizza, that might take that might sit in your system for hours and hours and hours impact you. So what a great opportunity to have pizza, a little bit of pizza. Or what are

Jennifer Smith, CDE 7:30
pleading some proteins with some carbs. Right, you might want to treat if you're dipping or lower already. And if you do, then knowing what you just said you want some sustaining power after that to not drop yet again, you could do something that incorporates some fat and protein in it to hold things level because again, the other consideration that if if it is a honeymoon based, like drop in blood sugar, it could be that anytime your blood sugar does nudge up from what you treated with simple sugar. It could be that your betas are also like oh, look at that. There's a rise in blood sugar. Let's give some help. And it doesn't really know that you've got basil injected, that's also there.

Scott Benner 8:15
That's see you know, isn't that interesting that you brought that up? It didn't occur to me that I've always just thought of it is like you're getting help from your pancreas, but your pancreas seeds the carbs and attacks them while the insulin you've learned the manmade insulin you've put in is also drawing your blood sugar there. Wow. So you have dumb insulin and smart insulin working at the same time.

Jennifer Smith, CDE 8:37
Correct. And common time for that. And honeymoon is overnight for a lot of people actually, where they may have corrections that work pretty well in the daytime despite them being really tiny, you know, miniscule amounts of correction. But I've got person after person that says I can't correct unless my blood sugar's 300 At night, because if I correct with just a minor half unit of insulin, I'm sitting at like a 60 blood sugar.

Scott Benner 9:06
And this is the reason we're newly diagnosed people.

Jennifer Smith, CDE 9:09
Correct. It's specifically more honeymooning. I mean, you can even see it on nights where blood sugar is going up. You don't correct the high blood sugar because you have the hindsight to know what's coming. Blood sugar could hit 202 20 and it downplays you wake up in a beautiful number. That's that's not injected Basal that did that. Your body helped you?

Scott Benner 9:33
Yeah. Okay. So that's one kind of low you could experience now another one might be activity, right? I'm trying to think of I'm trying to put myself in a newly diagnosed person's situation right, like they go back to their life like I have diabetes. diabetes isn't gonna stop me and then they go play tennis, and then their blood sugar falls really quickly. There we need fast working sugar are correct something that's going to hit you very quickly and stop this freefall. So if you're in a freefall, for whatever reason, you can't eat. That's not the time to have a slice of pizza.

Jennifer Smith, CDE 10:12
That's not the time to have peanut butter cups, the slice of pizza, the nacho meal breaks, not

Scott Benner 10:17
because that's because you're gonna keep crashing before it has an opportunity to start digesting and to stop you. You're looking for simple sugars. I mean, in emergency situations, I know, I know, people don't seem to talk about glucose tablets anymore. Like they've become persona non grata, right. Because they taste achy,

Jennifer Smith, CDE 10:37
they're not the greatest. I mean, they are they are okay. I think the greatest thing about them for me personally, is that I am never going to over treat with glucose tablets. Right? I mean, they do their job. They're doing the job that I want them to do. But they're not like a bag of I don't know, licorice, like licorice. I like black licorice. So you might be like, easy to keep eating with a low blood sugar. Well, that

Scott Benner 11:04
is one interesting thing. There's a plus for for glucose tablets, you will you won't eat them for fun, that's for sure. No. Gel. I mean, I don't even know Do people carry that still, they should, right?

Jennifer Smith, CDE 11:16
We should and or it's easy, especially if somebody needs to help you. Because you can just get it into kind of the gum line and sort of massage it in it. It does work really quickly. So if you don't love the taste of glucose tablets, that glucose gels might work really great. There's a nice liquid glucose, that I just heard about two that I really liked.

Scott Benner 11:39
Okay, so, but in but in general, juice boxes, people are gonna use Skittles gummy bears stuff like that. Right? Correct.

Jennifer Smith, CDE 11:47
Exactly. But the another good thing as you bring up glucose tablets, glucose, or dextrose is the simplest form of sugar, right? So your body doesn't have to go through this breakdown of the structure of of sugar, if you will. And so it gets absorbed really fast. So if you're looking for candy, specifically, you really want to look for candy that has glucose or dextrose as one of the first two or three ingredients. Because it's going to have the fastest impact on a low or really quick drop that you want to stop.

Scott Benner 12:21
Yeah, the timing. So super important. Because I know a story about a person, I won't say their name, but they're an adult. And diabetes for a long time, felt themselves getting low knew it, ate a bunch of carbs passed out, and then just turned back on when the carbs hit them. They were just like, hey, I'm back. And so so there's an it's an example of having the timing wrong. Like you're falling at a certain degree of speed or rate of speed. And you need that sugar to come in and to slow like a parachute almost to parachute that that number fall down and to stop it. You know what a nice level sponsor don't go too low. So things need to work the way you need. I mean, that really is the message of this episode, right? Like if you're one if you're 120, and you're wearing a CGM, and you see this gradual fall, and you look back over at 90 minutes going down, geez, like I Bolus for this meal, it clearly looks like it's too much insulin, I'm going to get low a half an hour from now. Well there, you could just add some more carbs to your meal or have a couple more bites. Correct. And you might stop that. But if that same 120 was falling quickly, you're in a different scenario, you need to use different carbs.

Jennifer Smith, CDE 13:38
You need to use quicker exactly the simple carbs on a quick drop. If you've got a gentle sort of glide down something that's a little more complex, like crack, you know, something like peanut butter crackers, I hear a lot kind of get used because there's a little bit more to the cracker with the peanut butter added to it. Right. So something like that could use it down. But if you're really really dropping then sugar,

Scott Benner 14:06
yeah. And you have to in the beginning, it'll be hard not to overeat a low but that is a skill you need to learn. Because otherwise the bounce comes and then you're like I don't know what to do. I was cheeky of that fear from you've just been low. You don't want to Bolus like you get caught in that. That bouncing rhythm. You don't want to be in that so maybe you'll learn at some point to look at your situation and say half a juice box here. Or you know, take a couple of sips just have two Skittles you know I say to people all the time just because you open the bag doesn't mean you have to eat all of them. Right? Yeah, just eat what you need.

Jennifer Smith, CDE 14:43
All right, which is also why those little tiny bags I mean this is a popular time of the year for a lot of people to end up stocking up on simple car because we have Halloween coming up. Whether you celebrate it or not. It's a great time of the year to find really little packets of somewhere between eight and maybe 15 grams of carb, simple sugar, Candy really prepackaged. So the whole bag of Skittles versus the tiny little packet helps you to contain things a little more. And if

Scott Benner 15:17
you're not lucky enough to have a CGM in the moment and you're just leaning on your, your finger sticks. How frequently do you tell people to after they think after they've identified a low or felt it and treated it? How often do you stick your finger and look, I find myself, you know what I mean? I use a lot more test strips in that moment than you do sometimes for the whole week

Jennifer Smith, CDE 15:41
you do. But you can expect that even simple sugars going to take a little bit of time for digestion, right? So you're really not going to see much shift. If you do a finger stick, confirm your low, treat the low and five minutes later, you're doing another finger stick, you're probably not going to see not much of a difference, right? So that's where old school was that 1515 rule. 15 grams, 15 minutes while you might not need or take 15 grams to treat this low that you have. Waiting about 15 minutes to retest will give you enough information to say, well, I treated it. It doesn't look like it's come up, but it hasn't also fallen. So that should give you enough to say it's not dropping. Clearly, digestion is happening. Well, let's give it another 15 minutes and test again.

Scott Benner 16:33
Yeah, you know, I have two thoughts. So one of them I'm going to make a note about and then the other one I'm going to say if you are wearing a CGM. Sometimes it will not register as quickly. So you can see like a like, Oh my God, my blood sugar's 50. You know what I mean? And you take a bunch of carbs and, and then there's this way to look at the arrow with the Dexcom. At least I don't know how it works with libre, you'll, you're stopping a low blood sugar, let's just say it's 60. And it's the arrows diagonal down, and you take some carbs in and the next reading is 55. And the arrows still down. And then all of a sudden, the arrow will like sometimes disappear. Like almost like the algorithms like I don't know what's happening right now. But the number stays the same. Or sometimes the number or the number will get lower, but the arrow changes. And do you know what I mean by that? Yeah. And so your whereas

Jennifer Smith, CDE 17:32
if you were testing in a look, then it said 55 with an angled arrow down, you've treated it. And now you can see it has a horizontal arrow, but the number is reading like 51 or 50. And you're thinking well, what that really indicates is the system has found a stability, even though the number has slightly nudged down yet, it's not dropping, what you've done is actually making some impact overall. So it's not really time to treat with yet another like whole box of juice.

Scott Benner 18:06
It's so weird. It's a weird moment because the CGM is a little behind. And what you did with the carbs is maybe more in the now, but you can't see it. And so there's like, there's like multiple things happening at once that the technology has, has difficulty showing you. But you can see that something's happening. And so that's when that's when I say to myself, Okay, now this thing looks stable. And we've gotten to, you know, readings in a row that say 50. But I want to know what's really going on, because either the CGM seems confused and I didn't do well. And we're lower than we think. Or we're higher than we think. And I don't want to treat more. That's the perfect time to do a finger stick to me. Absolutely. You have to. Right,

Jennifer Smith, CDE 18:51
absolutely. Especially for those those numbers where you're treating I say at a number less than 60. Honestly, if you're varying at all and decision about whether I should do a finger stick or not. If you're less than 60 and you've treated it and the numbers on the CGM just don't necessarily add up. Or you're mentally not quite like with it enough with a low blood sugar like that. Just do a confirmatory finger stick, because at least that's going to show you real time right now. Where is your number? Yeah,

Scott Benner 19:29
yeah. And I know we're trying not to over treat. But if you get caught and you don't know, like, this is the time you're going to hear me say I'd rather I'd rather just Hi. Yeah. Because Because what you're saving yourself from or saving another person from we don't talk about very much like in diabetes in general, even on the podcast very much like it just doesn't get talked about very much. You're talking about becoming incapacitated. You're talking about having a seizure. You're talking about death, like you're talking about out. There's a lot that happens between 40 and then I don't know how low anybody's ever been right, you know, but while they were still alive, I saw Arden's blood sugar. I saw Arden's blood sugar 22 wants on a finger stick when she was really little. And she was okay still. And I was just like, keep eating, eat, Yeah, II keep going. And then all of a sudden, it was 30. And I was like, Oh, I might have tested, I might have tested her blood sugar 10 times in seven minutes. I was like, but But I mean, it's the truth, right? Like you, you have to learn to do this. Because you use manmade insulin and your blood sugar is going to get low. I just don't care who you are, it's going to happen. So you need to know how to handle it, or how to handle it for somebody else. And you need to know how to handle it without causing a problem in the future. Whether that problem is a high blood sugar, or calling an ambulance, like right, you're it's not. I guess we don't talk. It sounds scary. It's probably why people don't talk about it, huh? Yeah, yeah. So

Jennifer Smith, CDE 21:03
it's absolutely it's it's more around how to treat. There's not even an emphasis on like the overtreatment. It's just treat it. But why, right? Why is it so important to recognize a low sooner than later or deal with it sooner than later? Or stop it from happening? sooner than later? Because there is that scary factor of? I don't know. I don't know why some people can have a blood sugar. I might the lowest I was ever was 26. I don't I was fine. My mom actually thought the number had to be bad. I mean, it was really old. I mean, this was like 1988. So clearly, the meters were not what they are today. But she's like, that's gotta be wrong. You feel good, right? We were camping. Did it again, it was like it was pretty much the same. Just like you need to eat. Here's the juice. Where's it? Where's the regular soda? You know, why could I be there? And fine, when somebody else could be passed out, have a seizure, need an ambulance need assistance? When their blood sugar is 61 and low?

Scott Benner 22:10
Right? Right. Yeah, everybody's going to be different. And so. So let me let me say a couple things here. I use a football analogy, because it's football season, right? You can't like the reason they offensive linemen are these giant blobs of people is because they're trying to stop this insane force that's coming at them. Right? Correct. You can sometimes put carbs in. And you've made such a mistake earlier in the day with insulin or, you know, there's just so much power on the side of the insulin. It's like the carbs aren't there, like you might as well not have anybody blocking because it runs right through them. Right? That's a panicky situation. The first time that happens to you, where you take in a juice box, and realize that it's, it's like you didn't drink it. If you're enjoying the Juicebox Podcast, and you would like it to remain free. Please support the sponsors. Today's sponsors are Dexcom G six dexcom.com, forward slash juicebox. And Omni pod, both the Omni pod five and the Omni pod dash are available at Omni pod.com. Forward slash juicebox. It's a hard moment, you know what I mean? Because this is what you know is going to work. And now suddenly, it's not working for some reason. And you're like, Oh, God, what do I do? You can't find yourself in those scenarios. Wondering what's in the cabinets? Or what's in my bag? Or what do we have in the car, like you have to be prepared? Correct all the time. Just all the time. You know, anywhere you are. There are fast acting carbs. I don't give a crap if you don't use them for six months. I don't care if they get stale, throw them out and replace them. If the juice, you know, when the juice box gets some spongy from being in the car in the heat, throw it away. Put another one in there. Like just don't. Don't ever find yourself in a situation where you're like, it'll be okay.

Jennifer Smith, CDE 24:06
Right? Yeah, right. I mean, It's fall now and I were just like rotating through. We don't really have summer jackets, but like into fall into the winter jackets. We're kind of rotating them into the mix, right? So I bring up my winter stuff. And absolutely in at least like one if not two of my, like fall into winter jackets. They're old, nasty, bad glucose tablets. Like they've gotten the like crystallized sugar like dots, though and like if I had to, I would still use this. So like that juice box that's like nasty and squishy. If that's all you got, you use the squishy juice that

Scott Benner 24:45
you could spread them around your life like your grandma's spreads around her reading glasses. Do you know what I mean? There's just a pair in this room and over here. You need to be listening. You can't be it's a weird scenario. You can't be scared. You can't live your life scared If you don't want to live your life with a 200 Blood shirt, because you don't want this to happen, because also, that's not any safety from not being low, right, as a matter of fact, that might put you in a situation where you're alone more frequently, but, but I like to say about diabetes, that you don't learn these things, you don't prepare for these things so that you can stop a problem. The problem is always going to sneak through somewhere, it's never going to be where you think it's, you know, because if it was where you think, then you'd get ahead of it, right. So you have to be ready for when it happens. And then the last bit of this is, if all else fails. I mean, please be carrying glucagon, you know, with you, like not, it's in the cabinet in the kitchen, but we don't take it, you know, anywhere. I left it in the car when I went pumpkin picking like it needs to be with you. Right. Yeah, exactly. So well, this is a fun conversation.

Jennifer Smith, CDE 25:51
Harder, I think it's a harder conversation than you think about before. Because there's a lot of, there's a lot more on the back end of not taking care of a low well enough. That is actually scary. Yeah. And it doesn't get talked about. We always try to like smooth it out, like not to worry about it so much, and whatnot. But in order to not really worry about it. Preparation is needed. You have to have things in your purse or your car or your backpack or, you know, at your friend's your friend's house that you go to all the time, or whatever it is. I guess it's like being a girl scout or a Boy Scout be prepared

Scott Benner 26:33
how to be prepared. Yeah. You know, when Artem was younger, she spent her whole day in one classroom, right? Or she went to art or something like that. So she had a bag and she took it with her when she hit middle school and high school and she started having English in one room and math in another room. When that started happening. We put supplies in each room. Like we didn't say to ourselves like she should be humping this stuff all over the place constantly. Let's put a little here there was a couple of juice boxes in every room. You know, it's interesting. It's when you learn about your management to how come we're always restocking the English class. And never the math class. What's the time? Yeah, it's the time of day we're doing something that's making a low around this time of day, it's actually an interesting way to learn a little bit about your management is where am I grabbing my supplies from? You know, do you think that? Do you think that every low is different? Because there's there are questions here from people that are like, you know, after I stopped a low with a fast acting, should I put a protein in every time afterwards? But not necessarily, right?

Jennifer Smith, CDE 27:38
Yeah, no, I mean, the idea. Again, it's kind of an older concept. It's sort of like the 1515 rule, it's 15 grams, 15 minutes, and then you essentially may need to follow that up with a snack. But again, there's lack of enough information about why the idea really was simple carb will typically help keep your blood sugar up for about 90 minutes, give or take. Now, again, a variable in the picture is why was the low there. If it's excess insulin, you may actually need to treat with more than what you thought you would need. But the other idea is that the simple carb to keep your blood sugar up is it's meant to sustain you for that time period, before you might eat again. So if you treat a low blood sugar at, let's call it three o'clock in the afternoon, but you don't typically eat dinner until seven or eight o'clock at night. Lows can bring on another low they can. And so if you treat the low, but there's something in the picture that's keeping you lower, could be honeymoon, it could be excess insulin, it could be more movement in the day, whatever. You may actually for longer than two hours before your next meal. It may be beneficial to have a handful of nuts a spoonful of peanut butter a piece of string cheese a boiled egg, whatever it might be. The the idea there is that that's a little bit more sustaining and or a snack that might have a little bit more complex carb to it long with some protein to sustain things. So you're right every low is not the same

Scott Benner 29:20
right art in tried art in psychology right now. She tried to use a falling blood sugar as a Pre-Bolus for her lunch, but it just didn't like she didn't time it well enough. So like at 60. So listen, for anybody who's listening. Here's how I did it. Arden's in another state. She's 13 hours away. I'm able to look at her phone and see where it is. Right so I use Find My Phone to see. Okay, she's in the cafeteria, so at least I know she's right. So now where she should be near food. I text her Hey, what are we doing about this? Because she's got this like seven One day that became 65 pretty quick. And then I looked at the arrow and then I looked at the line and I thought this isn't stopping. Like this is not a low that's going to stop right like this is this is going to be negative 15 If we don't do something about it, right. What are you doing? I'm trying to like Miss like, you don't I mean, I don't want to be upper asked Jenny. And at the same time, I don't need her dropping dead. It's College. Like, I'm trying to find the middle. I'm like, Hey, what's up? And nothing. Now I know she's with the food. So I'm like, you see this? Nothing. Art and I really need to know you're okay. I'm eating now. I'm like, okay, like the food's going in your mouth. Yes. But Jenny 6060 560-560-5550 5540. I'm like, Are you eating now? Yes, I'm eating. I told you. I was What are

Jennifer Smith, CDE 30:49
you eating lettuce leaves. So

Scott Benner 30:53
what's happening? Like, you're eating like handfuls of sugar, right, like, and so, but so I texted her to test her. So then I sent a text to test her cognitive, like, where she was cognitively. Right. And I'm just like, how do you feel? And she's like, I feel fine. And I'm like, Okay, have you been eating for a while? She said, Yes. So I said, Okay, I got it. There's food in there. It's working. The CGM hasn't caught up yet. But I had to stand there. for like three go rounds. That CGM watching that 42 Just sit there knowing she's not really 42. She's in the mid 60s already. I know. I know this. But I only know this from

Jennifer Smith, CDE 31:35
you. Because you've lived with her. You've dealt with it long enough. You knew the questions to ask. You knew how to get her to respond and whether or not she was going to answer you the right way. And that it takes learning Oh, it's

Scott Benner 31:48
yours. Because otherwise I would have been like drinking juice. I don't care if you don't drink the juice. I'm bringing you home. I'm not paying for college. Like I don't you know, like, you know, because the number because we've done everything's over come home and live in this room for the rest of your life. Because the because the number was so scary, right? But I was able to pick together enough information. I swear to God, that CGM. One more time went from 42 to 66. And I was like, Okay, I was right. But I'll tell you, you're like, God, what if I'm wrong, you know what I mean? Like, I don't want to be wrong, but I might be. The next thing I think we should bring up about lows. Because we're in a we're in an algorithm world now. Right? Control like you on the pod five, that thing that Medtronic makes i What is it? Which one is that? Let me learn the number. Medtronic, don't they have an algorithm right now?

Jennifer Smith, CDE 32:39
Say, do they've I mean, they've had an algorithm for a long time I use as a their CGM, right. And I don't know that their does their algorithm have a name like Omnipod, five, six, so their new their new one and the ISC, that number is what you're looking for seven, seven DG. And I know some plays I don't know if it's here. I don't think it's here yet. Seven. ATG I know is available in some places in Europe already. But 777 80

Scott Benner 33:11
I just I feel like they buy they buy ads for in pen. So I figure I, I owe it to them to learn the name. I just can't keep saying the thing that Medtronic has they're gonna be like, How about how about if you're not the podcast that we sell the embed on anymore? Like? Alright, so the 770 GE, right. So yeah, so whether it's one of those algorithms, we all live in a new space now, where the algorithm sees a low coming, and it takes away and takes away and takes away your basil and takes it away. But it isn't, it isn't always going to get it right. And so you might end up treating a low after a prolonged amount of time of not having any insulin. And then your blood sugar shoots back up very quickly, because there's nothing to stop it. And what is the algorithm do when it sees the higher number gives you more it gives you more insulin, sometimes sometimes can happen. That's what I'm saying. It can happen that's a better way to and when that happens. Here's what I know for certain Yeah, gonna be low again later. Because because, you know, they, you know, when you're taking, you know, sugar and for a low if you take in the right amount, you've been getting on a regular you know, on a regular pump or on an MDI you've still been getting your Basal the whole time. So you're, you're correcting that low more in real time. When you do it right algorithm. The algorithm thought it was going to stop you. It does not expect these carbs. And now you jump up and it Bolus is the number or it's pushing basil at the number that the other night. I guess I should have listed lupus one of those Arden had Jenny I think it was around her period and she was tired. She's rundown and she's getting her period at the same time. We had this whole day where she was a little too low. And it persisted into overnight. And so around eight or nine o'clock we fixed the low and I said Listen, take these carbs, go into the settings and shut off micro bolusing without carbs. I was like, where this thing's gonna hit your, your correction, right? And it's gonna push it back again. And she did that we went through the night really nicely. It was a nice learning experience for her because then she brought it up the next day. She's like, should I put the micro balls back on again? And I was like, Yeah, everything looks good now. So, but anyway, you have to be aware of that. So, I mean, I don't know what you do. Me. I mean, there

Jennifer Smith, CDE 35:29
are other you know, for other systems, you can certainly also navigate something like that. If you've treated a low, you know that you've overtreated it, but the system is going to give back eventually, and you know that it's going to be too heavy, similar to your scenario there. The other systems do have, I guess, adjustable targets or different targets that would be higher. So then it would adjust less if you adjust the target up and say, Hey, I'm aiming for this now. So as my blood sugar is going up, it's okay. You don't have to give me as much because I want to be higher

Scott Benner 36:07
anyway. So like an example with Omnipod? Five, you might tell it to shoot for the higher range. And that's correct. And yes, with I'll tell you what, in that exact scenario with art, and I said, I asked her what did you take for the low? And she's like, Oh, I had gummy bears. They hit her really hard. So I was like, Oh, crap, she's gonna jump straight up. But they don't hit her and hold her. They hit her. And then they disappeared on her. So I was like, oh, no, no, don't let that thing Bolus. Yeah. Anyway, this probably all sounds much more confusing than it will be you have diabetes for a few months. It's all gonna make sense. Don't

Jennifer Smith, CDE 36:41
maybe know very well, yeah. There's still some things I throw my hands up. And I'm like, Well, clearly, like Venus is not in the right place in the orbit of something because I, I just I don't know right. Now,

Scott Benner 36:57
you're maybe just said Good. Luck is what I heard.

Jennifer Smith, CDE 37:01
That was so not the case. That's not the beginning of this is what you want to hear. Yes. Forget the maybe nine I shouldn't say maybe should be like the point 1% of the time. You know, it doesn't take much to learn, especially with CGM is in the mix. These days, it doesn't take much to learn how much is needed. And as you were sort of, you know, talking into the effect of algorithms, you'll see, well, gosh, I was used to using this much, I probably need to use a quarter to a third of what I used to use to treat when I didn't have a system that was helping me

Scott Benner 37:37
You know, I saw a woman yesterday say, I don't know the exact numbers, but the gist of it was on control IQ, I needed 14 or 15, carbs stop below and on Omnipod five, I'll need four or five carbs to stop below. Interesting that interesting, I found that incredibly interesting actually. So especially

Jennifer Smith, CDE 37:53
system to system, given the fact that they're both doing a give and take of insulin, but they are they are very different algorithms. Yeah. So that it does make sense.

Scott Benner 38:03
Alright, so check me on this. You need to know how to stop a low they're going to happen. You're not going to stop a low from never happening. You need to understand the different impacts that these different carbs are going to have on your low blood sugars. After a while teaching yourself to stop a low without creating a high is a great tool to have.

Jennifer Smith, CDE 38:22
Yes, if you it will happen. Yeah, yeah. Oh no,

Scott Benner 38:25
you're gonna rebound high until you until you learn how to do it in a real panic situation. Screw everything else save your life. Correct. And that's it right? Have glucagon with you have snacks with you. Don't go anywhere without ways to treat Lowe's, the people who love you and are around you should understand how to help you if you're unconscious or unable to help yourself.

Jennifer Smith, CDE 38:49
And I think another thing as you mentioned, caregivers or loved ones or you know, whoever. I think within that for Lowe's is recognizing the like what you mentioned about cognitive when you're doing kind of a check with Arden the people that are around you enough should be able to tell whether you're responding or or talking or whatnot, the way that you normally would. And in the case that your CGM is off, or you aren't using a CGM or technology, somebody who knows you well should be able to kind of chime in and say, Hey, are you okay? You know, and don't be angry at them for that. It's just a it's a checkpoint to be able to keep you safe. So

Scott Benner 39:38
yeah, also for I guess caregivers, low blood sugars could leave you with people who are difficult to yes help, right? They could become combative or and that's a real concern, especially as they become adults and I There's one story that sticks out in my head all the time of this woman whose husband got low and she just wasn't big enough to overwhelm him. Do what he needed, you know? And she had to call 911 because of that. But yeah, I mean, the people around you just need to know. And people should be following you. If you have CGM, like I don't know if liberi has follow like Dexcom does, but it doesn't. Okay. Arden is in a suite with girls. And the girl in the next room follows her on Dexcom Oh, wow, that's awesome. She only has a 55 alarm and nothing else. But we explained to her I'm like, if this thing's beeping, please go find Arden. And make sure she's okay. That's all. Yep. And it just, I don't know, especially for adults living by themselves or kids off at college, like somebody, you know, has your back because it also not everybody hears the alarms to like I had a low last night. It was only like 65. But I was sleeping. And in my sleep. I thought did I hear something? Like that was all I thought, right? And then I'm like, I woke up and I looked, and I was like, huh, yeah, I'm gonna watch that for a second because the being honest with you, it was a real slow drift. The loop had been taken basil away. I'm like, I think this is gonna bounce. Like, I think it's okay. I don't want to wake her if it's not going to be okay. And it waited and waited and waited. And then I was like, Oh, it is gonna be okay. It went back up again. But I talked to her this morning. And I was like, you know, you're a little last night. She has no idea. But since she had that seizure more recently, if you listen to her last episode, she'll tell you about it. If she has a she experiences any kind of a quick fall while she's sleeping now. I don't know. I don't know how that rewired her brain. But she's boom. I'm up. I drank juice. I'm good. Hey, Dad, I did this. Do you think this is enough? Like she never used to wake up. And now I don't know if she's feeling the fall while she's sleeping right now. Which has only happened twice since she's been away. But anyway. Alright, Jenny, did we do it? We did it. I think so. Yeah. Yeah. For us then.

Jennifer Smith, CDE 42:00
Okay for us. Awesome. Thank you. Oh,

Scott Benner 42:02
I guess we should say something like thank you for listening to the beginning series. And I hope you found it like, helpful.

Jennifer Smith, CDE 42:08
Absolutely. Especially in the beginning when everything is so new. So

Scott Benner 42:11
let us know if you want us to add to this series. If you go back and listen to it and find something that should have been in there that wasn't please send me a note. And Jenny and I will we'll add it if we think it needs to be added? Absolutely. What are we doing? What are we busy or something?

Jennifer Smith, CDE 42:29
Got nothing else to know. Right? But just hanging around?

Scott Benner 42:38
Well, as I mentioned at the beginning, we've already found more stuff for bold beginning. So this was not the last episode. Let me thank Omni pod and Dexcom. While I have your attention on the pod.com forward slash juice box, see if you're eligible for a free 30 day trial of the Omni pod dash. Or if you're interested in the Omni pod five. For full safety risk information and free trial terms and conditions, you can also visit omnipod.com forward slash juice box. And of course, thank you to Dexcom for being a longtime sponsor to the podcast dexcom.com forward slash juice box see blood sugar in real time, the speed direction and the number right there on your iPhone, Android, or on your Dexcom receiver. There's so much more I want to tell you, but I'm on about day seven of this illness that I have. And to be perfectly honest, editing the show together almost killed me. So I'm gonna go take nappy, and I'll see you next week with another episode of The Juicebox Podcast. Hey, everybody, it's me. I hope you enjoyed the episode. I want to remind you about the private Facebook group Juicebox Podcast type one diabetes. I don't know if past Scott said that in that episode. But future Scott, or I guess President Scott wants you to know about it. Juicebox Podcast, type one diabetes on Facebook. It's a private group that now has 40,000 members. And there are conversations going on night and day. Doesn't matter what country you live in. That group is always jumping, you have a question, somebody in there is going to answer it for you. You need a link, somebody in there will find it for you. There are group experts that will help you find episodes of the podcast that can help you. And I'm in that group every day. So please just stop by and say hello. That's pretty much all I have for you today. I hope you enjoyed this episode. I'll be back very soon, with much much more. Thank you for subscribing, following sharing, telling a friend telling a doctor whatever you do to get the word out about the podcast. I really appreciate it. Keep it up. You are helping the podcast to grow

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Summary

• Intro to the show. 0:00

• Welcome to episode 915 of the juicebox podcast.

• Nothing on the podcast should be considered medical.

• Understanding insulin action and time of action. 2:49

• Fear of insulin is the biggest sticking point.

• Insulin action and time of action.

• Tug of war analogy, insulin and carbs.

• How blood sugar works in the body.

• Take insulin and start to eat. 8:37

• Rapid is a misnomer for insulin.

• Rapid insulin is 100% in most settings.

• Continuous glucose monitor, dexcom, continuous glucose monitor.

• The story of a 17 year old boy.

• Timing and amount of insulin. 12:12

• Timing and amount is the first step to insulin use.

• The importance of visualization.

• Dexcom g6 continuous glucose monitor.

• Share and follow features for android and iphone.

• How to make good decisions. 15:38

• Omnipod headquarters in massachusetts.

• Request a free experience kit.

• Dancing for diabetes and dancingthenumberfourdiabetes.com.

• Making the first move is the key.

• Diabetes is a science experiment. 19:22

• Diabetes is a daily science experiment.

• The pre-bolus piece is 80% of control.

• I don’t count carbs. 21:28

• Don't get mad, don't count carbs.

• No accurate insulin to carb ratio set up.

• The importance of the arrows in dexcom.

• The least important aspect of dexcom is the direction.

• What is pre-bolus and pre-basal. 24:54

• Temper basal is a fraction of the basal rate.

• Pre-bolus time is 20 minutes.

• The importance of pre-bolus and extended bolus.

• Pre-bolus vs extended boluses.

• Trading bolus for basal. 28:08

• The concept of super bolus.

• Never suspend basal insulin.

• Pre-bolus and multiple daily injections.

• Sponsor, better help. 10% off first month.