Scott Benner 7/6/23 Scott Benner 7/6/23

#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

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 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.

#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.

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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

#930 Best of Juicebox: Diabetes Variables: Bad Sites

Diabetes Variables: Bad Sites. First aired on Oct 21, 2021.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 930 of the Juicebox Podcast.

On today's episode of Best of the Juicebox Podcast, Jenny Smith and I are going to be talking about bad sites. That's bad sites for your insulin pumps, doesn't matter what kind of pump you have. Sometimes those sites just kind of stop working, they go bad, we're going to talk about it. 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. You can get 35% off your entire order at cosy earth.com. When you use the offer code juice box, you can get a free year supply of vitamin D and five free travel packs with your first order of Athletic Greens that's ag one from athletic greens at athletic greens.com forward slash juice box and to get 10% off your first month of therapy with better help go to better help.com forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter contour next.com forward slash juicebox. That's where you're going to find an amazing array of meters from contour. They have beautiful Second Chance test strips so you don't waste any strips and they are so so so accurate. So accurate contour next one.com forward slash Juicebox Podcast is also sponsored today by us med now us med is the place where Arden gets her Dexcom and Omni plod, plod and Omni pod supplies from sorry, they have Omni pod five Omni pod dash Dexcom G six G seven libre three. Tandem they got stuff us med.com forward slash use Box, get your free benefits check today and get started with us med don't like the internet. Here's a phone number just for Juicebox Podcast listeners 888-721-1514, give them a call and tell them hey, I'm thinking of switching to us med Can you help me out? Hey, everybody, this is the next episode in the diabetes variable series. So it's going to be me and Jenny Smith. Jenny, of course, is a 30 plus year type one, a CDE a nutritionist she's the she has a whole bunch of stuff. And she's here today to talk about a new topic, something that might come up in your life that very well may impact blood sugars. Today, the variable that Jenny and I will be talking about is bad sites. On the front page of juicebox podcast.com. A lot of the series that are within the podcast have their own space, like on the website so you can see them because I know there's a lot of episodes. Today I've added the variable series. So that's there now as well. So if you're looking for a certain episode, you're not sure what episode number it is head there and do a little scrolling. You'll find it. All right, Jenny. So I have four of them set aside to try for today. One of them. I can't wait to see how you respond. But the other ones are our I want to start with a couple that are shorter I think and and then see see what we're gonna get to so Okay, this one I think is going to be a really short variable. But I want to talk about bad sites. So just you're using an insulin pump. And the site stops being as effective as you expect or as you've I guess experienced already with the site. But people have the hardest time bailing changing up site. Yeah. It's that they the hope that sticks with them is sometimes fascinating. I can't tell if it's the if it's this thing supposed to last this long, dammit. Like, I'm not giving up or I mean, I even get if it's money. But right. You know, like if you're saying, I don't want to take this thing off, but if you have insurance. So I guess the first thing to say to people is if you have insurance, and you experience bad sides, your provider can write you a prescription for more stuff, if that becomes necessary

Jennifer Smith, CDE 4:43
to change more frequently, not at all. No. In fact, with all the pumps, I think there are people who definitely find I get to day two, I can maybe make it to day two and a half if it looks like it's really really still working well. But I don't push it anymore to day three. So yes, I mean if you're one of those people that just don't push it, know what you know? And ask your doctor to write for changes every 48 hours instead of every 72.

Scott Benner 5:09
Yeah, it's so an example is you know what the funniest thing about diabetes is whenever I go to talk about I always have a fresh example because never stops. But Arden and I are gonna go shopping this afternoon together, we're going to find little baskets to put on her shelf that she put up, she put up shelves, and she wants to put baskets on the shelves. I've been a stay at home dad for a long time. So that seems like a reasonable way for me to spend my afternoon to me,

Jennifer Smith, CDE 5:33
but for bunny eggs or something or what is she putting?

Scott Benner 5:37
I don't know what she's putting out there. Hopefully she's not hiding, you know, paraphernalia. Which I don't believe she is. But not the point. The point is that I woke up this morning to find that Arden's blood sugar had been fairly sticky at like 140 overnight. And I thought, Oh, we must have missed on the last thing that she ate. And you know, the basil is holding her nice and steady. I'll Bolus this i Bolus it and it doesn't move. And as soon as that happened, I thought this site is shot. Like it just it hits me like immediately. Now do I yank the pump off or right away? No, I turned to all of her settings up a little bit, it made all her insulin stronger. And it worked. And then when the settings reverted back, it drifted back up again. So in my mind, she's not getting insulin correctly anymore, because I'm not getting what I expect. And so I told her just before you and I did this, I said, Listen, do one more Bolus, because that's going to bridge this time, I'm going to be talking to Jenny. And then I said, and then we're going to pull your pump before we go before we go out. Because I mean, to get eight more hours out of this thing. I mean, I guess we could just jack it up. It's probably leaking, right? Or something good? Or what? So what are all the things that could go wrong with a site?

Jennifer Smith, CDE 6:55
Yeah, it's like a rabbit hole of information about site, right? It really is. So what could it be, it could be that the site is in a place that just got bumped or nudged or something. And so now, it's not really working as well under the site, maybe you develop like a little tiny, like, I don't know, like a class, let's say, but it's not absorbing quite as well. Thus, when you bump everything up, and now you're jacking in a little bit more insulin, it's kind of pushing out enough to overcome whatever the reason for the resistance is at the site, it just could be that this area, especially if you've documented enough to know the, you know, the right hip and the left hip don't absorb as well after day two, so let's just change it when it's in those locations sooner than later. So it could be the site, right? You know, variables of site, it could be infection at the site, especially in infections, I usually, usually you know that you have something starting even if it's a mild infection, I'm not talking something major, but usually the site hurts. It's sore. You might even notice a little bit of bruising like outside the cannula kind of area, but definitely it's sore and sites should not be sore. I mean, they should be with the little flexible cannula under the skin. And or even the ones who use the steel infusion sets. It shouldn't hurt.

Scott Benner 8:28
Okay. So I have I'm going to make an admission here or not an admission and admission. I'm going to admit something. omission is when you leave something out. Yeah, admit Okay,

Jennifer Smith, CDE 8:39
when you you have to add MIT something. What are you going to admit?

Scott Benner 8:43
Arden's had diabetes since she was two. And I hear people say my pumps occluded all the time. I've never figured out what they mean when they say I mean, I understand the word. But I mean physically, like the word makes me feel like somebody stuck bubblegum in your tubing, you know, like, but that's obviously not it. So, when people say I got an occlusion, what are they talking about?

Jennifer Smith, CDE 9:13
A true occlusion is different than a site that's technically gone bad. In a site that is occluded, occluded, means like you know, like the tubing is straight underneath the skin. And typically tubing will be bent visually, to some degree when you remove it and most pumps I know at least Omni pads. If you have an occlusion and your pod errors, it will tell you that it's either a pod error, or it will tell you that a pod occlusion is detected and to change the pot at that point. So and all of the pumps will register an occlusion based on a certain amount of insulin that gets backed up into the pump and it triggers the alarm to say this in insulin hasn't gone in up to this certain amount and each pump has kind of a designated amount that triggers that occlusion alarm. So an occlusion is definite ly different than a sight problem. Now an occlusion could be, it could be something that starts to make the site not feel good to because obviously, if you've got like a bent cannula under the site, that might be more irritating than something that's just supposed to be sitting straight, right? Most often though, what I've found is that an occlusion will happen soon after a site change,

Scott Benner 10:41
okay? But a bad not always,

Jennifer Smith, CDE 10:44
but a bad site could be two, three days in etcetera. But an occlusion usually is sooner than later in the life of a site, mainly because it usually happens on the site being put under the skin, okay? Something has triggered it to bend, et cetera. Could it happen while you're wearing it? Yes, it could,

Scott Benner 11:07
if we're like, from the inject,

Jennifer Smith, CDE 11:10
more likely from the actual puncture under the skin,

Scott Benner 11:13
I should knock on some wood. But in 13 years or more of using Omnipod arms had one bent cannula ever, and I've never seen the occlusion thing. I actually think it's kind of cool that on the pod, if Omnipod thinks you're not getting insulin correctly, the thing just errors and shuts off. Yes. Like, it's just like, look, this is bad for you. I'm gonna force you to put on a new insulin pump now. Yeah, I've always thought

Jennifer Smith, CDE 11:35
to it has more checks and balances to alerting sooner than later that something isn't right, internally than the other pumps.

Scott Benner 11:43
So I also don't see them as much since they took the manufacturing in house. Oh, interesting. Yeah. Since they moved from China to I just did an interview with them not too long ago. But since they moved that they have a if you've never seen it, it's astounding. Like the facility in in mass in Boston. Yeah. So maybe that's it, too. Okay, so So here's the bigger question, I guess and how to wrap this up. You learn what a bad site and bad sites just a colloquial phrase, it's not a technical term, it's a phrase that stops working the way you want it to, excuse me a site that stops working the way you want it to work, you start to notice them after experiences, like and then you kind of like figure out when you can be like, This is bad. I'm jumping on this. So there's no real. I don't think there's any way in this conversation to say just look for this, this and this other than to say, if the site's not acting like you expect, if it's towards the end of the site, life, maybe switching now's a good idea. Do you have anything to add to that? Or is that kind of it?

Jennifer Smith, CDE 12:46
It's kind of true. I mean, if you have enough hindsight from your life with diabetes, right, from experiences, you can say, Well, my lunch usually does this my breakfast usually does this, my run in the afternoon usually does this kind of thing. And if it's not, and considering other variables that could be impacting towards a higher blood sugar. If none of those are really in the picture. I usually our recommendation, take take a correction. Like you kind of did you drove a correction in and you're like, huh, I didn't do anything. Don't, don't play, just change it out. Just change it out. Get some insulin going again, who knows what the reason was, I mean, you could play with thinking about what the reason is forever. Just change it out deal with the high blood sugar and move on.

Scott Benner 13:35
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But are you just already online getting it done? Are you even listening to me anymore? Where have you already called 888-721-1514 don't like the phone us med.com forward slash juice box. The other day I got an email from us Med and it said are you You want some more supplies? I guess it was time and I said yes click the button and then they just showed up. You want to do it like that. It's pretty damn easy. Us med.com forward slash juice box if you enjoy this episode of The diabetes variable series there's more it begins episode 491 With trampoline Did you know that was a variable that could impact your type on and your blood sugar again? Also episode 505 temperature 507 Travel 511 Exercise 524 hydration. We talked about food quality in Episode 526 In Episode 530, leaky sites and tunneling episode 535 playing video games that can impact blood sugar 540 stress 544 masturbation 548 School 552 Bad sites you just heard that one here 556 growth hormone number 560s Asleep episode 564 Pumped site placement episode 568 A full moon episode 572 diabetes technology five ad is weight gain five ad for Walmart Walmart can change your blood sugar get out of here and episode 588 We call it the final episode sort of. And then there were two more 592 menopause and 596 alcohol. You can find a complete list of these just like I read to you at juicebox podcast.com. Up at the top you click on diabetes variables takes you to all of them. Or if you're a member of the private Facebook group, you just go into the feature tab. And there are lists of all the series there. That group of course, this Juicebox Podcast, type one diabetes, but we don't care what kind of diabetes you have. Come on over and check us out. There's almost 40,000 members in there, and the group is completely free for you to use just like this podcast. If you enjoyed this, please share it with someone else who you think might also enjoy it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're interested in learning more about betterhelp.com, forward slash juicebox therapy available from BetterHelp. There'll be an ad that plays after this. But that's all that's left. So if you're not interested in learning about that, go ahead and shut this off. A huge thank you to one of today's sponsors better help, you can get 10% off your first month of therapy with my link better help.com forward slash juicebox. That's better. H e lp.com. Forward slash juicebox. If you've been thinking about speaking with someone, this is a great way to do it on your terms. Better help.com forward slash Juicebox Podcast is sponsored today by better help. 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