Scott Benner 12/17/21 Scott Benner 12/17/21

#596 Diabetes Variables: Alcohol

Diabetes Variables: Alcohol

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

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.

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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 596 of the Juicebox Podcast

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. You see how I've timed that to coincide with New Year's? Huh? 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, or 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 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 Penn, find out more at G voc glucagon.com. Forward slash juicebox. Jenny, this is the last variable we're going to record. It's very exciting.

Jennifer Smith, CDE 1:51
That is very exciting. A whole year of recordings of variables. That's that's a lot of variables.

Scott Benner 1:55
I'm not kidding about it. At one point, I looked at the list and I was like, Why do 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 2:15
Well, alcohol is a variable because alcohol can lower your body's ability 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 wondering, 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 hard liquor, for example, really doesn't have carbohydrates in it. Right? So you may not be bolusing for it. And 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, yes, 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 3:42
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 3:52
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 4:41
And is it the actual alcohol that's bringing you down or is it your or is it the Bolus that you used or know if even if you didn't Bolus you would get low afterwards.

Jennifer Smith, CDE 4:51
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 left 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 counter regulatory 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 6:08
Okay, so So you're basically people might not recognize that your liver is making glucose in, you know, and giving it is giving it off, like glucose, is it glucagon or glucogenic? Or I forget the word,

Jennifer Smith, CDE 6:23
right? I mean, your body's counter regulatory hormones essentially coming from the liver or helping your body to essentially put out in the TR 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 6:51
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 7:02
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, and thus, your Basal is going to be too heavy for you. Okay, in layman's terms, right. I mean,

Scott Benner 7:29
listen, 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, you know,

Jennifer Smith, CDE 7:37
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 8:12
Right. Okay. Does this? Does this need a bigger episode? Or? What do you think?

Jennifer Smith, CDE 8:19
Come on. What do you have more? More questions?

Scott Benner 8:22
No, I just I don't know if it's, I don't know. I mean, it's like, you know, it's 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 8:45
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 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 the 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 may also then if you were expecting the impact of alcohol may lead you to drink more, because I'm

Scott Benner 9:23
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 9:40
Correct. And you also have to consider like, i i much feel like if I 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. And it was a lot of fun. But feeling drunk, feels very similar to a low blood sugar.

Unknown Speaker 10:10
Okay, those tip sees

Jennifer Smith, CDE 10:13
types of 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 10:38
Yeah. And how are you going to be able to handle that I'm 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, driving 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 gonna be able to help you. Like, you know, the, it's not like you have a designated, what if my blood sugar gets low person here? You know,

Jennifer Smith, CDE 11:11
right? I mean, it's the 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 are 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 11:39
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 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. Uh huh. And if I tried to drink this whole bottle, I'm like, Oh,

Jennifer Smith, CDE 12:05
I can't really be too much. Yeah,

Scott Benner 12:06
happens when you start putting, like hops and barley. And don't I be like, Oh, I'm so full. But yeah, but anyway, alright, 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 didn't need to be taken to account. But I think in general, I mean, at least you could try to follow what Jenny was saying about decreasing your Basal. 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,

Jennifer Smith, CDE 12:35
but 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 13:17
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.

Jennifer Smith, CDE 13:35
It will. I mean, will it turn things around versus nothing at all? Yeah, but it's not going to be 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

Scott Benner 13:56
together. 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, Jenny, that somehow we made drinking sad, and I'm sure everybody oh

Jennifer Smith, CDE 14:14
well, people don't see us so they can't tell whether we're smiling or not.

Scott Benner 14:18
Having a great time talking. I'm like I just started thinking like we're taking the thing where people like oh my by 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 it's the first premixed auto injector 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 Vogue glucagon.com slash 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 bad sites growth hormone sleep pumps like placement of 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 calm. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#592 Diabetes Variables: Menopause

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

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Scott Benner 0:00
Hello friends, and welcome to episode 592 of the Juicebox Podcast

well today we have another episode of the variable series. There's actually two more left counting this one. Today's episode is diabetes variables. Menopause. If you experience a hot flash during this episode, 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. 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 and most makes and models of insulin pumps and continuous glucose monitors. She's also Jenny from the Juicebox Podcast. So show some respect. Now there's like 15 seconds of music left here. Go with it. Just sway your hips. bob your head? I don't know. Pretend you're making your own personal tic tock video

this episode of The Juicebox Podcast is not sponsored. I haven't run out of sponsors. I've just fulfilled my requirements for this year. Huh? This is weird, isn't it? Um, what do I want to do here? You should check out the Yeah, I don't want to say hold on a second. Just stick with me. Are you looking for those diabetes pro tip episodes, the ones that begin at episode 210? Well, they're available right here in your podcast player, or at Juicebox Podcast comm they're also available at diabetes protip.com. And if that wasn't enough, at those same links, you'll find the defining diabetes series how we eat algorithm pumping afterdark there's so many to choose from. Let me also throw a little shout out here to the private Facebook group Juicebox Podcast type one diabetes as it crests, 18,000 members. The only thing that's missing is you go home, I'm recording now. Let me let me take a look and make sure that they're what I think they are. Because we did that. I'm recording. So we did that. Bubba we did that variable episode, the width was just kind of going through the rest of the list that didn't seem like they needed their own episodes. And while we were pulling through that we found just a couple that needed their own. So I'm gonna pull those

Unknown Speaker 2:59
up a little more discussion we did. Yeah, we are

Scott Benner 3:03
gonna finish up the variables, which took us all of 2020 long. weird to think of

Unknown Speaker 3:10
it. Yes. That's that's really weird to think. Yeah.

Scott Benner 3:13
Yeah, it is. It's an incredibly strange thought that you and I started this at the beginning of 2021. In here at the end, we're going to finish it up. So, ladies choice you want to do alcohol or menopause. First.

Unknown Speaker 3:28
Let's do menopause. Okay.

Scott Benner 3:31
Well, I don't know how much help I'm going to be with this. Really out of my wheelhouse. Now I don't have diabetes, and I don't have any lady parts. So

Jennifer Smith, CDE 3:44
and you have well and you have no experience helping a lady with menopause. Right?

Scott Benner 3:49
So I don't put Well listen, you're right. I don't. But my but I have a little bit of I mean, maybe I'm starting to but I don't see what it has to do with diabetes. But we'll see because there's a fan in my house now. A year ago,

Unknown Speaker 4:05
a fan like a ceiling fan, or a fan or we're talking about

Scott Benner 4:10
a year or two ago at Christmas time. I bought my wife a ceiling fan for our bedroom. But no lie has got to have a wingspan of maybe six feet. I like my two of them, I could get something off the ground. And it creates such a downdraft in my bedroom that if she turns it up too high, and I get in bed, my eyes begin to water and my lips chat. And I'm freezing like you can't leave your extremities outside of the blankets because they start to get numb. And I look over at her and she's barely got a sheet on it. She's like it's hot in here, right? So yeah, maybe I have some tiny bit of experience with this. I'm not sure. But how does this impact people with type on?

Jennifer Smith, CDE 4:55
Well, for what I mean they're multiple stages right to what we're kind of What we've typically classify as menopause, right. And I think another important thing to consider is, research has proven that women with diabetes tend to enter menopause earlier than women without diabetes. So it's a piece in the mix, not, you know, 100% of women, but many people, many women experience it starting sooner than later. So in terms of adjustments, we tend to start to see changes in monthly cycles, they either get longer, or they might get heavier, the, I guess, pain that may be associated with it cramping, and that kind of stuff can become more intense. And cycles can also become less regular. If you were the typical, like 32 days between my cycles, you might be 26 days and 35 the next month, so things kind of get a little bit wonky. And in terms of what's impacting blood sugar, then, if you had a pretty typical turnaround in insulin need, and you figured it out with a normal cycle, then this change in how your cycle is, you know, occurring now may get disrupted as well, your insulin needs may change, you may not need more insulin for a whole seven days before your cycle starts. You might need it for two days before and then you might need it during versus your insulin needs falling like a typical cycle.

Scott Benner 6:37
Okay, question. Let me Yeah, so you said it might start earlier, but age wise? Yes. Is there an amount of like, like, 10% earlier two years earlier? Like, is there any way to track it? Or? And how do you even know what earlier is right?

Jennifer Smith, CDE 6:52
Yeah, I mean, most, most menopause kind of perimenopause. And then once you're completely through, and you've no longer had a cycle you consider yourself sort of, into menopause is when you've had a cycle. We've not had a cycle for a year, 12 month time period without any normal cycle. So perimenopause can start and usually does over about the age of 45 to 50, for most women without diabetes could even be later. And some of that may have to do with like just genetics. You know, my mom started menopause at 55. If I didn't have diabetes, maybe I'd probably be in about that same bucket of time to consider it starting right. But some of the research that I've looked at actually shows that menopause or perimenopause, the beginning of changes to the cycle can actually be in like the mid to late 30s.

Scott Benner 7:48
Oh, wow. How long does perimenopause last? There's no way to know either.

Jennifer Smith, CDE 7:53
No, it's a big cycle of shift and change, like I said, So you, a good way to know is some of the symptoms, as you mentioned, you know, buying a big ceiling fan for your wife. Some of those are common symptoms in terms of like the hot flash, that's one that most people think about in terms of menopause is I get hot, or I get cold really easily or whatever. So you may have some symptoms that are also cueing you in but a big one, again, as you've been probably tracking and following based on just insulin adjustments that you typically need, if your cycle starts to become irregular, for no reason. And you're in the age group where you could be of an age that IP menopause starting, you know, then tracking even more and paying attention because insulin needs will shift and they really shift mainly because one of the big hormones in a woman's cycle is estrogen. Right. So as estrogen estrogen levels kind of fall as you move through perimenopause, menopause, you can see your insulin sensitivity shift as well.

Scott Benner 9:14
Okay. And shift in likely in the in the way of needing more. Okay, yes. Does any of this stop after menopause? Like once the

Jennifer Smith, CDE 9:27
there's more from the women that I've worked with who are definitely through menopause or I've been working with them? Well, after you know, they've no longer had a cycle. There is more. There's more stability in their numbers because hormones aren't fluxing like they would have been before Right? So there's not this ebb and flow tonight I need more I need less now etc. There's more stability unless something else variable wise changes like weight or their exercise level or you know their eating habits or Those kinds of things. So in terms of during, there's a lot of shift and adjustment. And from what I honestly see, for women working through it, there's a lot of navigating insulin changes that just look weird.

Scott Benner 10:16
Monthly, like, yes. Okay, so, you know, one, one month, it could be seven days before your period starts, you need a lot more than next month, it could be four days, or not quite as much, there's gonna be a lot of you being flexible through this,

Jennifer Smith, CDE 10:31
right. And it might even be, you know, if you knew ahead of time, you know, prior to this expected change happening, if you were needing, I need to adjust my insulin up by seven days before and I needed to adjust it for the whole seven days before my period started. In that perimenopause kind of stage, you might find a flux up where seven days before you need a little bit more. But as you get closer to your period, starting maybe the day before or two days before is when you're really needed the excess, you know, amount of insulin comparative to it just being a steady increased need for those days as it was previously.

Scott Benner 11:13
Okay, so is this because I'm going to ask you, at some point next year to do a pro tip about, about periods, and okay, male hormones in general, the whole thing's just like, I mean, the best I've been able to figure out around Arden is that, you know, like you said, coming up on her period, she needs a little more, it does seem to get, you know, a little more gradual towards the period. It used to be once she had her period, it just like it, it almost got easy during the period. But now she now she's on a birth control pill. That doesn't seem to happen as much anymore. So she's a little more consistent through the month now. And then when she gets through a period, it's not this like, like her period was almost like time off from paying attention to to, to insulin, it was just really easy. And yeah, now it's not as easy that and I realize she's not even getting the hormones, right. Hold on. Let me think about this. Yeah, usually she gets her period, right as you get to the placebo. Right? It's about how it's supposed to work. So then through the period, she's on the placebo. And, and she's not getting the hormone at that point

Jennifer Smith, CDE 12:28
outside of her normal cycle of hormones her normal body doing what it's supposed to do, right. Yeah.

Scott Benner 12:34
And she's taking them because she had no. I mean, like, Arden almost didn't have any quality of life without birth control. Like she was getting her period on this constantly. Too frequently. Yeah. And for like 11 days at a time. And they get like a two or three day break, and it would come back again. Yeah, so it completely depleted her of iron, made to get her a couple of infusions because of that. And just in general, it's it's, you know, it's, I mean, I don't know, but I live with a couple of women who don't look fun. So. Right. So doing it constantly looks a little, a little less fun. Let me ask you, is there any impact on menopause, if you also have a thyroid thing? Where are those things not connected? Well,

Jennifer Smith, CDE 13:23
I would expect that they would be connected in terms of thyroid having just relation to overall metabolism, right. And as your body cycling through a change in hormone production, with menopause, then you're going to have changes. I mean, many women experience weight gain during menopause, even who don't have thyroid issues. So I would expect them to impact each other. So obviously, just as you would normally do continue to have your thyroid levels checked, continue to adjust your medication kind of as needed. One time period of the day. That's interestingly, a time that many women going through like perimenopause into menopause often find more consistent lows is in the overnight time period. Oh, wonderful. Where insulin needs may need to go down overnight to decrease the chance of lows. I mean, thankfully, today, we've got a lot of technology and devices that obviously you know, you can watch things you can set alerts, you can adjust things much more precisely for that. But it is something to definitely know is you're not crazy if you think your insulin needs overnight are much lower than they are during the daytime as we age, we tend to need less insulin. If you look kind of at charts of insulin dosing. Insulin needs overnight are typically highest for like the young and like the teens. And then as you move into adulthood and then later adulthood into kind of like that menopause age. The overnight insulin needs are lower than the younger population, let's say

Scott Benner 15:05
okay, so alright. Yeah, because there's not as much growth hormone. A lot of other Hey, yeah, yeah, I want to say this real quickly before we say goodbye. If you haven't if you have a thyroid issue and you haven't heard episode 413 thyroid disease explained with Dr. Addy, Benito, you should listen. And if your doctors telling you that your four TSH or your six TSH or eight TSH is in range, you probably should find a different doctor who wants your TSH to be more like two or lower. So, but there are plenty of people Jenny's got a horrified look on her face. But there are plenty of doctors who are like you're fine. You're in range and in range they think of as up to like 10. Yeah, yeah, that's not okay.

Unknown Speaker 15:44
Yeah, no, that's not okay. No.

Scott Benner 15:47
All right. Okay, so the wrap up on menopause is it's going to be variable could change month to month, May last years. And I'm going to add probably going to be easier if you have a pump, and a CGM.

Jennifer Smith, CDE 16:02
I would agree it would be easier from a dose adjustment standpoint, yes, also allows you to track kind of shifts in in your, your needs a little bit more, especially if you have any of the sort of automated kind of or augmented insulin delivery systems that you can actually see your data. And you can see where insulin is being adjusted up or down based on your glucose shifts, that can make it a little bit easier to follow and see what your changes look like.

Scott Benner 16:32
Yeah, I'm saying that because if you have an increased need an insulin that goes 24 or 48 hours before you even realize it before, you don't think oh, maybe my you know, maybe I'm just you know, people are like I'm gonna maybe it'll go away. And then now you're right now you're significantly behind and this curve is going up and up. By the time you put in more Basal injected and figure out how to be more aggressive with it. You could be five days into your into this portion almost through the need. Yeah, by the time you by the time you see it, it might be too late. And that could really put you in a position where you start ignoring it, which I don't think you should do at all. So Okay. All right. I appreciate you doing this. Thank you very much. Yes, sure.

If you're interested in learning more about Jenny Smith, she works at Integrated diabetes, and you can hire her to help you with your type one. After Jenny, there's no one really to thank because there's no sponsors here today. Let me just remind you again, private Facebook group Juicebox Podcast type one diabetes, diabetes, pro tip episodes, defining diabetes stuff. I mean, the podcast is chock full of great information. If you're using insulin. I hope you check it out. Follow us on a podcast app, subscribe, tell a friend leave a great review somewhere. Have a nice holiday. I'll talk to you soon. When I'm back with another episode of The Juicebox Podcast

#588 Diabetes Variables: Final Episode (Sorta)

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

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Scott Benner 0:00
Hello friends, and welcome to episode 588 of the Juicebox Podcast. I thought this was going to be the last variables episode. I had a lot of examples sent in by listeners left, but some of them weren't feeling like, like they needed their own episode or were really variables. So Jenny and I were going through them. And then it occurred to me how to finish up the list. is gluten one or no?

Jennifer Smith, CDE 0:30
No, I would not consider that a variable because quite honestly, gluten if you did group it with anything, it would be grouped with inflammation and it would be then grouped with like digestive stuff in terms of inflammation, and once it's gone, it's not a variable anymore.

Scott Benner 0:46
Yeah. Now I'm looking like we did a really good job of getting through these headaches, wet weather and esteem. Some people are just like, it rains in my blood sugar gets funny. Oh, I get low. It says wet weather causes highs and sunny weather causes lows. Wet weather makes you sit around. Right? And sunny weather makes you get up and move around. Is that right? Gotta be yet right.

Jennifer Smith, CDE 1:15
I would expect that that's what it is. Honestly, yes, we'll

Scott Benner 1:19
drop that into something at some point. Ooh, constipation. That doesn't strike you that way.

Jennifer Smith, CDE 1:27
I you know, I mean, the question really becomes with constipation, how much is that leading into pain or stress because you haven't gone to the bathroom? Or is it really in terms of things aren't digesting as well? So we have slow digestion I mean, that's like a bunch of things that constipation could be causing that are then the impact on blood sugar a constant Yeah. It's in and of itself is not a very

Scott Benner 2:07
Arden was little before we knew she was on the she a thyroid medication. Her blood sugar's would be more and more difficult. And then she'd go to the bathroom all at once, and it was level right out again. But it was just, you know, I don't you can't I can see how people might see it and then think it but

Jennifer Smith, CDE 2:25
right. I mean, I can see it in terms of pregnancy. Women's digestion slows in pregnancy. And if they are having significant issues with constipation, again, the question is, is there enough backed up slow digestion that is continuing to impact things enough, from an absorption standpoint that you're missing? Covering stuff that should have been eliminated a while ago? You know, or is it that there's pain because of it or, you know,

Scott Benner 2:57
I have to tell you, we have a half an hour here and our little chatting just now made me realize how to handle the rest of this list, okay.

On today's episode, Jenny Smith and I will go over the rest of your diabetes variables list. We first talked about variables in Episode 231 In a protip called diabetes proto variables. And then wow, two years later, I started the variables series. It began with trampolines went to temperature travel, exercise, hydration, food quality, leaky sites, video games, stress masturbation school, bad sites, growth hormone, sleep pump, site placement, full moon diabetes, tack weight change Walmart today is and the rest I'm not sure what the call it yet. And then by the way, there's going to be two more after this, but you'll hear about that later. While I'm talking to Jenny Smith, who by the way, has had type one diabetes for over 30 years. My friend Jenny holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most make some models of insulin pumps and continuous glucose monitors. She is also simply the best, the bestest. You want to hire Jenny. She works at Integrated diabetes. 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. And as season seven winds down and the end of the year approaches. I'd like to mention all of the sponsors this year we were sponsored by Dexcom they make the Dexcom G six continuous glucose monitor by Omni pod makers of the Omni pod dash tubeless insulin pump touched by type one my favorite diabetes organization, the Contour Next One blood glucose meter, G voc hypo pen that's glucagon. And towards the end of the year TrialNet did a little sample ad with us for about seven weeks. Hopefully they're happy and maybe they'll come back in 2022. I did just add another advertiser for 2022. I'm not allowed to say who it is yet, I don't think. But it's somebody who's been around before. And I'm glad they're back, we'll say that. On top of the advertisers, there's the T one D exchange, who, while they are not an advertiser, every time you hear me talk about them, they don't pay me to talk about them. But they do give me a couple of dollars. Every time you take their survey AT T one D exchange.org. Forward slash juicebox. I've thanked everybody this year, over and over again. Who has bought me a cup of coffee at buy me a coffee.com Ford slash Juicebox Podcast. What else? Have you heard me talking about these bumpers and ads? No, I tell you to go to the private Facebook group for the podcast right Juicebox Podcast type one diabetes that now has like 17,000 or more members in it. So bustling type one diabetes page full of really good people. It's very unlike Facebook, but happens to be on Facebook. I tell you about Juicebox Podcast calm, the diabetes pro tips, the defining diabetes series, the variable series how we eat algorithm pumping, after dark, you guys are just over and over again. Terrific. So much so that November, I'll tell you that today's the 29th when I'm recording this November just became the most popular month in the history of the podcast. As a matter of fact, every month since May of 2021, has been the most popular month of the podcast, this podcast will do over 2 million downloads just in 2021. And it's all because of you guys. It's how you share the show and talk about it. It's when you put great ratings for it wherever you listen,

it's word of mouth, there's nothing else to it, if you enjoy the show, tell somebody else it helps the show to grow. When the show grows, more people hear it. When more people hear it, we have a greater chance of somebody needing one of the advertisers. When that happens, and you click on one of my links, the advertisers come back. And I get to keep making the podcast. And then you get to keep listening to it. It's a circle of life kind of thing. So thank you very much to everybody listening to everybody who's ever shared or told their doctor or a friend or to the lady this year who told me she bumped into somebody at a Costco wearing a Juicebox Podcast t shirt. Like my favorite story of 2021. Two people who listened to this podcast met strangers, right out in public. That's pretty cool. Anyway, I appreciate you guys so much. And I appreciate the sponsors. It's a terrific lineup of quality products, organizations and services for people with diabetes. I'm super proud of it. I really am. I've never once ever thought, Oh, I can't say this ad. You know, I'm lucky to have advertisers like this. And I'm lucky to have you guys listening to the show. So that's it. Here's Jenny and my conversation about the end of the variables list where we basically just go over a bunch of variables. We've gotten to the point on the list of variables that were sent in by listeners where there are multiple ideas that sort of they fit together. You know, they're the, you know, somebody says emotions, but then somebody says getting angry and stewing and being angry, Jenny and I can't do a variable for each and every one of them. So what were tantrums? Yes, right. That's right. So instead, what we're gonna do is run through what's left on the list, and just hit each thing very quickly will tell you if we think it's a variable or not, but probably doesn't deserve its own episode or need need its own episode. And then that'll be it. We'll move on, we're gonna start adding more stuff back to the Pro Tip series after that. So, alright, Jamie, here's what we haven't done yet on the list. And to be clear, the list is 150 things long. We've already done the things that are clear variables that, you know, translate to a lot of people, right. We can't do the, you know, the one thing that somebody is like, you know, pointing to for themselves specifically, we're not going to start doing personal variables. But here's some stuff that we didn't get to, but probably mentioned in other episodes, so showers and baths we talked about in the temperature episode for sure. Right? Yeah. So if you want that head back to their illness we did talk about and obviously being sick blood sugars, was one week could have probably made its own episode, but then you would have seen how it leaned into other ones is somebody just said Life, they're trying to be funny, I get it, right. Life is all variables, high blood sugar moves around because things happen. But that's what the whole variables episodes are about is that there are these little things that happen in your life that you don't, you don't think of as being impactful. And I think what happens sometimes, and Jenny and I were just talking about it kind of privately a second ago, is that we don't see the forest for the trees, sometimes, you know, Walmart makes me low, not usually I sit around and my, my blood sugars are at one level, and I have an insulin use at one level, and then suddenly I get up and running around, I'm grabbing things in the store. And then my blood sugar goes down, Walmart doesn't make yellow activity. When you have a bunch of active insulin, make sure though, but that's the life thing. Right? Like, there are things that happen. I think, I think that the thing to remember here is that you have your settings put together in a way that works best, during the largest swath of your 24 hour period, as you have, you've been able to figure out during your

Jennifer Smith, CDE 11:13
typical, yeah, honestly, your typical day, you have, which is the reason that we do testing on more typical days are not going to tell you do testing of settings and stuff when you're sitting at Disney World. That wouldn't be purposeful, right? So the purpose of discussing variables is to understand that in a day, variables could become part of your day. And this is how to expect your blood sugar to maybe react with this variable in the picture. But it doesn't know it's not always going to be there, you know, maybe 80% of your days of the week, you cost along just fine. Until you know, Aunt Mary comes to visit on Friday, and you didn't expect

Scott Benner 11:58
you decide to cook a big meal and it gets hot in the house. And right like there, I get it. Like you don't want to be thinking about diabetes constantly. But those things are impactful. And if you're, you know, if you're a person, for example, who's fairly sedentary and you're using a heavier Basal profile to combat that, you might not even know that's what you're doing. Right? You know, and then all of a sudden, you're running around putting a lasagna together, it's 80 degrees, you're sweating, you know? Sorry, yeah, it's impactful. You know, it just going down the list. Somebody sent in insulin efficacy, like expired insulin or insulin, let's hit like, extreme temperatures. And yeah, I mean, okay, that's a variable. But I mean, how often is that going to happen? You don't I mean, like,

Jennifer Smith, CDE 12:47
right, on a day to day basis? No, right. But on a, again, a setting where you are out of your normal environment. Let's say you're carrying your insulin around, or you're hiking through the desert with insulin in your pump, or in your backpack and a pen, or whatever it is, that is a variable that now becomes something to consider. If, in fact, you start to see blood sugars that are not the typical for you,

Scott Benner 13:14
right? But if you opened up your vial of insulin seven days ago, it's been working great. And suddenly, it's not working anymore, but it's been in the refrigerator the whole time. That's a weird place for your brain to go. But it happens, correct? Because it does, why does it happen to them? Because they can't imagine bigger picture what could be going on? So they start going through the real obvious of oh, maybe this since it's not working? It's the same thing as when we just did a diabetes technology episode where people are like, this pump doesn't work. But sometimes it's you don't know how to use it. Right? Yeah, you know what I mean? And yes, you don't see the forest for the trees again. And I think that right, not that your insulin can't go bad, like Jenny's saying if it's out in the heat, or if it's if it's way past, you know, a date, but it didn't just magically stop working. So write fairly

Jennifer Smith, CDE 14:01
well, one I would definitely add to that, though, is consider the mode of transit that the insulin got to your house as well. Okay, especially in different temperatures or different areas of the world, right? Because if you like I go to my pharmacy to pick up my insulin, I pick it up, I bring it home, it goes right in the refrigerator, there's no delay, right. Many people get their insulin supplies shipped we do. Right. So depending on time of the year, I always recommend people check you know, was the ice pack or the dry ice or whatever it typically arrives with? Was that in there Was it cold when it arrived? Did you put it right in the refrigerator? All of those things would be considerations in terms of Yeah,

Scott Benner 14:46
perfect. We there's somebody put on here gluten, if sensitive or celiac or other food intolerances. And you said when we went over it privately, you didn't really think it was its own variable, but If it was, it might be bundled together more with another one that's on here, which is inflammation. So, yes, yeah. So people who are gluten sensitive who are not eating a gluten free diet do have inflammation in their stomach lining, and I'm not a doctor, but down there towards the middle of your Yes, yeah. And that inflammation can make you seem what insulin resistant,

Jennifer Smith, CDE 15:25
more resistant, typically, because inflammation is like a stress in the body again, you know, we're talking and I said, kind of goes along with a lot of the inflammatory not only the digestive, but also things like lupus, and rheumatoid arthritis, and fibromyalgia. And all of those types of things are an inflammatory type of condition. And so uncontrolled or mismanaged, they will usually create a sort of a system of stress in the body, which will usually keep your blood sugar's running higher until they are better managed, which kind of goes along with the the gluten component, right? If you're on a gluten free diet already, you shouldn't have that inflammatory nature in your digestive system, you it should be calm, you should be digesting food the right way. If in the case that you went to a restaurant, you've been following a gluten free diet, and you do get gluten containing bread, let's say even though you ordered the gluten free bond, for example, could you have potential change in blood sugar because your body is so sensitive that you notice a difference? Digestive Lee right away and you don't feel good? Right? All of those would come along with kind of some of the things around like a stomach bug, possibly in terms of adjustment and what to plan for and how to adjust.

Scott Benner 16:50
If I say if I say one of these that you think is its own episode, just stop me and go. That's actually okay. Okay, so the next one, I don't think so. Specifically, somebody said, and this is very timely vaccines. So does a vaccine impact your blood sugar? Or does the fact that the vaccine makes your body, you know, introduces something into your body that your body has to fight off and create a resistance to is that process?

Jennifer Smith, CDE 17:16
It's that process, it's really not, I mean, overall, it's not the I got a shot, my blood sugar went up, that the case at all, it's actually the content of it, that creates a system of your body reacting to it, and some people's bodies react fine. With no issues, no symptoms, they go along fine. Some people have the typical like sore arm kind of thing, you know, those kinds of injections like intramuscular, whatnot. And sometimes just that sore arm kind of feeling could be enough, again, inflammation in that site to create a little bit of a bump in blood sugar. I would say that the only thing that would coincide with actually getting a shot in terms of like a vaccination, but they're they're pretty big needles for the most part. So if you could have a quick rise in blood sugar in that like setting, because you're scared here.

Scott Benner 18:11
Yeah, that stuff. But But again, to use the Walmart reference, again, the vaccine, just the sheer, I touched the vaccine to my body, my blood sugar went up. There's a mechanism in there. It's not just that you got a vaccine, it's the rest that happens afterwards. Yes. Is alcohol its own Do you think?

Jennifer Smith, CDE 18:32
I would think so. Yeah, I think that's a good discussion.

Scott Benner 18:35
All right. So I'm gonna mark that as its own episode. Medications in general, people just put medications. So I mean, there are some sugar fillers in some medications, right. Like, there are

Jennifer Smith, CDE 18:53
kids, especially kids, like, you know, antibiotics are often a liquid of some kind that is flavored sweetened to some degree to get the child to take it. So those could certainly and usually do have some type of carbohydrate in them or sugar in them. Other people, though, in terms of medications, could have reaction. And that's where it's really important. Anytime you start on a new medication, ask your doctor if they've checked. So they can tell you whether or not you start paying attention to your blood sugar. Because some medications that you will take long term could definitely have an impact on blood sugar, either making you more sensitive or making you you know, more resistant or whatever it is, while the med is doing what it needs to do for what it was taken for. It may have an indirect you know, sort of impact on your blood sugar.

Scott Benner 19:46
Alright, I have a thought but I'm going to add it to something else. So pain we're in the same situation. We talked about that already adrenaline, like you know, reactions to, to pain. I don't. I don't think that needs its own. I mean I don't think so. For second episode was a pain Yeah, if you're on paying your budget or Miko up we'll see you later. Right? Is menopause its own

Jennifer Smith, CDE 20:12
I would say menopause could be its own definitely.

Scott Benner 20:15
I thought so too interesting. Waking up in the morning Okay, guys, we have great episodes on that. So we have what did we do? We did feet on the floor defining diabetes we did defining diabetes, Dawn phenomenon and now we're gonna we did. How do you say it Jenny's? Oh, this smoky? Yeah, we did that. So go find those defining diabetes. If you're are you thinking waking up in the morning is its own thing? It definitely is. But we've got that covered in space covered. Yeah, yes. Lots of involve our allergies, like illness.

Jennifer Smith, CDE 20:56
Allergies, or like illness or kind of like inflammation, quite honestly, I mean, allergies create right, a reaction in the body that inflames kind of somewhere in your lungs sometime most often like nose sinus cavities. And so that could create enough of a stress on the body to cause a rise in blood sugar until you get it controlled. Now, the other variable with allergies is what type of medication again goes along with meds? What kind of medication are you taking to control the allergies? Some meds for allergies have done definite impact on blood sugar and will cause them to go up? Okay? If especially if they're steroid

Scott Benner 21:38
based. Yeah. And steroids in general, just Yes. Are gonna make your blood sugar go up and yes, and be incredibly resistant. Meaning Yes, you might. I've seen people with like two or three times their Basal rate trying to fight steroids for days and days. Yes, yeah. I actually just interviewed a boy from gosh, where was he from Ecuador, who has an illness that requires them to be on steroids all the time, and the amount of insulin he uses is spec exorbitant,

Unknown Speaker 22:09
I'm sure. Alright.

Scott Benner 22:12
So then it right. dreams, dreams or adrenaline. Like you just get really scared because your blood sugar grew up in the middle like that ever happened to you?

Jennifer Smith, CDE 22:21
I would guess I mean, I, I guess I if I've ever had bad dream, and thankfully, gosh, I don't remember really that many, like nasty, bad dreams where I wake up. I'm like, Oh, my gosh, you know. And at that point, I was probably just happy that I woke up like in my bed and like not in the weird scenario of my dream. Right. So whether I checked my blood sugar or not, I mean, it's typically just a it's it's sort of a an unconscious sort of reflex for me to be like, what's my blood sugar when I get up? Even if it's just to go to the bathroom? overnight? I always check. I would expect though, it would have adrenaline type of impact on blood sugar, if it was a scary enough or a worrisome enough situation in the dream? Yes.

Scott Benner 23:07
Okay. They're out. Cortisol is I mean, hormone hormone. So we've done that already. Singing makes my blood sugar drop.

Jennifer Smith, CDE 23:21
Oh, well, if singing is something that brings you a lot of like happiness and pleasure, then it could very well be that relax, you're relaxing, and you're really you're got those like feel good hormones kind of kicking. It could be that or if you are singing, again, context to the setting of singing, right? Because if you're singing and you're singing on stage, and you're in a theatre production, and you're moving around and changing, that could be a bit of activity as well as just the happiness of singing.

Scott Benner 23:55
Interesting. And then ironically, on the list the next one's emotions. So

Jennifer Smith, CDE 24:00
Oh, yes, I mean, emotions, definitely. I mean, emotions could be adrenaline based emotions, they could be happy based emotions, they these definitely kind of all go together. I would say that happy is often associated with like a drop in blood sugar, or more stability or more sensitivity, right? But I've also seen kids who are super, super excited about their birthday party, and their blood sugar rises, despite them being so happy. That adrenaline rush that they get because it's like they just were dropped off at like Disneyworld. Right?

Scott Benner 24:40
So the adrenaline overwhelms the emotion. Right? Yeah. Is caffeine its own or no,

Jennifer Smith, CDE 24:47
no, I think caffeine is an easy one caffeine. In the majority of people that I work with, and myself included Haftar years ago doing enough testing around x I was like, What is this weird strange thing after I start Drinking coffee. Most people need to Bolus for caffeine. It's it's not an unless you're not already covering like creamers or sweetened creamers or something like that. Well obviously, consider that as a first step Bolus for something that you're adding. But if you're just drinking a black cup of coffee, and you have this rise in blood sugar, nine times out of 10, more than that even is going to be the caffeine and you have to figure out usually I say, figure out how much of a rise you're getting. And then cover it with what would correct that rise.

Scott Benner 25:33
Okay. The next two we've literally talked about in the last couple of moments in a different way infections and excitement so we're good there. I will say this. If this one's an episode, I don't know because I've never understood when people talk about this daylight savings. How the heck does that change things that much it's an hour right.

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How the heck does that change things that much? It's an hour right? It is.

Jennifer Smith, CDE 26:56
And I think it's a it's a pretty quick in what I would expect in terms of explanation. Depending on what you're doing with your insulin doses, it may have some impact. Like, let's say you are the person who has different settings overnight for your Basal, right. And you don't adjust your pump accordingly. So now you could be running settings that are not jiving with the actual timeframe that they're now needed it. Okay. So in a way, could it? Yes. If you're not adjusting, so that your system can give you your right doses. Right.

Scott Benner 27:47
So then that goes right along with this one here. schedule change, same thing. Yes.

Jennifer Smith, CDE 27:52
schedule change, same thing. And in fact schedule change, especially for someone who has a very drastic schedule change from what they had been doing a nurse who had been doing day shifts, who is now working the like 11 to seven shift, right. That's a big change and a definite difference. And most likely we'd have to do some new testing around that to figure it out.

Scott Benner 28:16
Let me see if you agree with me here teething. Oh, hold on. I was almost dead right there. Just almost went down. Oh, no. Can you imagine you'd be like,

Jennifer Smith, CDE 28:29
it'd be like, 911 Yeah, I'm calling for this location, not where I live.

Scott Benner 28:34
Making a podcast with a man in New Jersey just fell right out of his chair. Please help. Teething and getting a tooth is going to be pain, inflammation, and maybe

Jennifer Smith, CDE 28:47
an irritability, more temper tantrums, probably less sleep. I mean, all a collection of variables in one.

Scott Benner 28:55
And we be looking for higher blood sugars from that correct. Okay. Moving. I mean, is Walmart, right? Like you're moving? Yes. Either excited or nervous? And probably more active than you think. So emotions, adrenaline. Yeah, hopefully this is you know, I'm actually enjoying this.

Jennifer Smith, CDE 29:15
But yeah, it's kind of fun going through them because I think people think about it in terms of words, right? People have a lot of different explanatory words for the same thing,

Scott Benner 29:26
the same thing over and over again. Yeah. And they give you an insight into their lives, injuries, breaks and concussions. I feel bad for this person. Oh, that's not good. Yeah, but but that's, uh,

Jennifer Smith, CDE 29:37
maybe they're a hockey player.

Scott Benner 29:38
I hope so. Alright, but we definitely covered that. Okay, so here's one where people I mean, we've talked about illness over and over again, it's in an illness episode. I'm going to skip that. Hormones we've done I mean, carbs and protein. You know, guys, there's tons of episodes on that we you know, if you

Unknown Speaker 30:00
go back and listen.

Scott Benner 30:03
If carbs is like the OG variable, right in diabetes, I don't think that its own episode, but I appreciate you putting it on here. This person, you know, talks about work about how they need different Basal rates on different rotations of their job, which is really just spoke about cyclical hormones in a tween who hasn't had their first period yet. So, I mean, in the lead up to your first period, you can start seeing hormonal impacts. If I was you, I would take that as a nice thing. It's like, they're like training wheels. Yes, yeah. For for learning how to do that. Yep.

Jennifer Smith, CDE 30:43
And I think we talked a lot about that in hormone based episode. Yes.

Scott Benner 30:49
Definitely did absorption injection sites we did site. We talked about sites, scheduled transitions, shared custody of families. I'll tell you what, I don't I get that that's a variable. But I still haven't found a good way to talk about that. And when we do, it won't be in a variable episode, it will be in a longer one. Because agreed there is a huge there's a huge problem. If you're managing one way and someone else is managing a drastically different way. And you're passing this person back and forth. Correct? Yeah.

Jennifer Smith, CDE 31:21
And I've worked with plenty families where it can work really well, as long as everybody's on the same page in terms of the best interest of the child. And it can work really, really poorly.

Scott Benner 31:35
Yeah. If if they were just hey, do you have enough information in your head to do a pro tip about how to do it? Well, you think? Yeah, yeah. All right. I'm gonna mark out for that one. inactivity is, you know, I think obviously, if it's not your if it's not your normal situation, right? If it's not your typical, like you said, then inactivity could make your blood sugar rise, if you're usually more active and suddenly inactive, you would probably get a rise from that. Mm hmm. This one's really interesting. But we already talked about being around different people. This person says that their steps on their blood sugar goes down when they're around their daughter, which is probably just the happiness and comfort thing, I don't believe I would think, yeah, unless their daughter is magically giving off. Insulin in the air.

Jennifer Smith, CDE 32:26
Right? Or again, I mean, it kind of does go back to like us a separate household type of management, you know, maybe the child whose blood sugars now even out when they're with you. It could be because they feel more secure, they feel more supported. They feel like somebody is actually helping them to pay attention versus the other scenario.

Scott Benner 32:47
And here's another one. The next one, my daughter is blood sugar rises, the minute we walk into the my parents house, so either your daughter's really excited to be at your parents house or doesn't like being there would be my guess, right? Correct. Okay, yes. No. Isn't that interesting that you kind of have like a little meter on you, that tells you? Oh, yeah, it's interesting. Time Zones, I think, are the same thing, as you just talked about with daylight savings time, except it happens quicker, right? Instead of happening

Jennifer Smith, CDE 33:17
in time zones are it is it's kind of the same thing as just paying attention to remembering especially if you're on some type of technology that delivers your insulin, right, some type of pump, making sure that you change the time, once you arrive at your final like, stay their destination. So that you have all of your settings that are now coinciding with the time that you're in.

Scott Benner 33:43
What do you think about times of day eating? Do you think do you think that chicken parm with little pasta takes a different amount of insulin at 3pm that it takes at 8pm than it would take at 9am? Or do you think that people's just have such varied Basal rates? Maybe. I mean, can food really hit because I don't think of food that way. I Bolus for something the way Bolus for it. I've never considered the time of day but Arden's settings are really rock solid, so I don't know.

Jennifer Smith, CDE 34:13
Right? Which means that you've tested and if she and I don't know what her settings are like, but if you have more than one insulin to carb ratio through the course of the day, her dose may be different for something like she decides at nine o'clock in the morning she's going to eat chicken parm versus at eight o'clock at night. The doses may be different but your strategy for managing that meal should remain the same in terms of that she needed a Temp Basal increase does she need an override does she need some kind of you know assisted in in something like that. But most often, people's insulin to carb ratios are what are going to drive the control around the same meal despite it being a different I just got that question the other day from a family so well you know, he's getting two and a half units of insulin for dinner for this. He eats it for breakfast Shouldn't he also always get two and a half units? Depends on what the ratio of the time of the day

Scott Benner 35:11
yeah and it's important that I'm glad you pointed that out because the reason I don't notice it is because Arden's carb ratio is the same 24 hours today it's super aggressive and it's the same

Jennifer Smith, CDE 35:23
are her ISF is different based on the system that she's on or her ISF different through the day then that may make a difference?

Scott Benner 35:29
Yeah overnight but not when well d times the same yeah day times always the same. Yeah. Lobby insulin go Yes. We'll work it out later. Let's stay ahead of this blood sugar. Eating girl lots of insulin. She and she eats a fair amount it's um she's a definitely a she's got a good appetite when she has a good appetite. We talked about this one because we found it interesting. Off off off microphone but this person says during wet weather that causes high blood sugars and sunny weather causes low lows. And the best agenda and I can come up with is

Jennifer Smith, CDE 36:13
that you're less active if it's wet and rainy and whatever outside and you're more active when it's sunny, and you're probably outside more or you know just enjoying even being out in your yard and gardening versus sitting inside.

Scott Benner 36:26
It's got to be like barometric pressure doesn't move your blood sugar, right?

Jennifer Smith, CDE 36:32
I've never looked that one up. That'd be an interesting thing to look up. I've never, I've never checked.

Scott Benner 36:37
All right. Well, if it turns out that it does, we will come back and apologize. Yeah, Anastasia, does that make your blood sugar go up or down?

Jennifer Smith, CDE 36:46
I think it's probably what I would expect is that it's more relative to how your body reacts to anesthesia. Honestly, I mean, my personal and one is that I react horribly to anesthesia. In fact, I always tell the anesthesiologist I'm like You Give me whatever cocktail has the most to stop the nausea and whatever after because after everything that I've ever had anesthesia for. I am knocked for a loop and I feel horrible and that actually drives my blood sugar up because I feel horrible.

Scott Benner 37:21
Okay, so alcohol is does that need its own?

Jennifer Smith, CDE 37:26
I think we set Yeah, I think calls definitely. We're gonna make

Scott Benner 37:29
that its own episode. One that we talked about, about people said constipation and stomach motility and Jenny's like I'm not sure about that. But I have seen that a little bit with Arden. If she hasn't gone to the bathroom in a while her blood sugar can get sticky. And then the minute the event happens, it starts to come down. Come down. Yeah, but I mean, it's got to be a pretty drastic scenario. Constipation scenario, like I just haven't gone since yesterday. You know what I mean? Like?

Jennifer Smith, CDE 37:57
Everybody should go to the bathroom every day.

Scott Benner 37:59
I was gonna say that to everybody poops and everybody should poop every day. And if you're not, yes, fine Metamucil or eat a vegetable.

Jennifer Smith, CDE 38:07
My boys love that book. It's I think, actually, it's called everybody poops. They love that. They think it's hilarious.

Scott Benner 38:12
I'll tell you what, at a certain age. I thought it was hilarious too. And that age for me was 37

Jennifer Smith, CDE 38:19
is another fun you want to say? I need a new but oh my god. We laugh and laugh when we read it. It's so funny.

Scott Benner 38:27
Glycemic Index of food is definitely a variable and we have multiple episodes on them. Please go find Yes. Hot tubbing shopping Pre-Bolus thing versus non Pre-Bolus. And these things are all self explanatory playing hockey is act in track and field violin lessons, which is probably stress or anxiety I would imagine.

Jennifer Smith, CDE 38:46
Could be I don't know I was a violin player. But I also didn't have a CGM at the point at which I was playing violin so who knows what was happening?

Scott Benner 38:55
So I'm gonna draw a line here because you're out of time but let's just end with this. Were you any good at the violin?

Jennifer Smith, CDE 39:00
I was really good at the violin I haven't played in years I just I don't really have the time or you know keep up with it. But I yeah, I played from kindergarten all the way through college.

Scott Benner 39:11
Oh, wow. Do you think you could pick it up and like knock something out with it?

Jennifer Smith, CDE 39:15
I could I actually I really right now I need a new bowl for my violin because the strings on my on my bowl are done. So but other than that I could

Scott Benner 39:25
your violin is good. You just need a bow.

Jennifer Smith, CDE 39:27
I just need a bowl. And I've looked into getting it repaired and getting a new one and I just I look at it and I'm like, Ah, I could spend that money.

Scott Benner 39:38
Just don't do it. If I leave this in someone's gonna send you a bow so the other night somebody went on my buy me a coffee link and left me so much money. I was like, stunned Oh, and with this really wonderful note and I wish this was more and it made me I was very happy that they felt that way. And I took the money and I bought hard drives to backup episodes. This sounds awesome. Yeah, but I was also it's weird. It makes me uncomfortable. So that is I know if a bow like if somebody said to me, how do I send a bow to Jenny? Okay? No, you'd be like, Oh my god, don't do that, please.

Jennifer Smith, CDE 40:16
No. I mean, I've gotten really nice thank you is, which are, I think they're, they're the most appreciated. I just, I love hearing how much this helps people, honestly. And those are, those are the best, like feedbacks kind of thing. You know,

Scott Benner 40:33
sorry. I really do. Okay, so the next time we get together, we'll do a couple of them that we've that we've set on and then we might do another run through the rest. And I thought this was good. So awesome. Cool. All right. Yay, one second. Yeah, I like it when things work.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kaipa pen at G folk glucagon.com Ford slash juicebox. you spell that GVOKEGL. You see ag o n.com. Forward slash juicebox. That's it for this one. Thanks so much for listening. And for sharing the show. I'll be back soon with another episode of The Juicebox Podcast. If you want to wait till after the music, I'll run through the links for every one of the advertisers just in case you need them.

So on the pod is a tubeless insulin pump, my daughter's been wearing it forever. And you can find out more get started and see if you're eligible for a free 30 day supply of yummy pod dash at Omni pod.com forward slash juice box. The Dexcom G six continuous glucose monitor is a mainstay at this house dexcom.com forward slash juice box. The Contour Next One blood glucose meter is in fact the meter that my daughter uses. It is literally the favorite one that I've ever held or used. I am not kidding. Contour next one.com forward slash juice box. If you want to see people doing wonderful things for people with type one diabetes, go to touched by type one.org Or visit them on Facebook, or Instagram. And of course the GMO hypo Pan was today's sponsor, so we don't need to do that one. You can find out if you have auto antibodies that lead to type one diabetes at trial net.org forward slash juicebox. Tell them I sent you touched by type one mentioned oh and the T one D exchange. Take the survey. If you're from the United States and you have type one, or you're from the United States, or you're from me, I came to say the words. I'll try again. Or you're from the United States and you're the caregiver of someone with type one. You can take the survey probably in less time than it told me to. Then it took me to tell you all this because I see him a little gobbly goo in my mouth. He won the exchange.org forward slash juice box check out the Facebook page. There's a public page called bold with insulin, a private page Juicebox Podcast type one diabetes, I'm on Twitter and Instagram and tick tock just look for Juicebox Podcast. diabetes pro tip comm is where the diabetes pro tips and the defining diabetes stuff is. It's also at juicebox podcast.com. It's also in your podcast player. There's great lists of them in the Facebook page. I think that's pretty much it. I really appreciate you listening. I'll be back really soon. Take care