#100 Bold With Insulin: Revisited
Scott Benner
Scott's commentary track of episode 11...
Episode 100 is the first (of many?) commentary track episodes. An opportunity to look back at some of your favorite episodes in the hopes of learning something new from a tried-and-true episode.
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Scott Benner 0:05
I am proud to welcome you to Episode 100 of the Juicebox Podcast.
This episode is bold with insulin revisited. I'm going to go back and listen to episode 11 from the podcast. And while I'm listening to it, I'm going to talk over top of it. It should either be amazing or really irritating. We'll find out soon. My concept here is this when I reach out to you guys, and I ask what episodes have been the most valuable to you, in a, you know, a day to day diabetes way, not so much hearing people's stories, but like real nuts and bolts stuff. You guys always kind of come back with the same handful of episodes to say these are the ones that you know, I love all the episodes, you say thank you, by the way, but these are the ones where I really started thinking I want to listen to this podcast, or, Hey, I think I can make a change. And so I'm gonna go back Joking aside about the talking over myself. And I'm gonna listen to episode 11. Because if I'm being honest with you, I don't remember what I said in Episode 11. But you guys seem to love bold with insulin so much that I'm going to go back, I'm going to listen to it. And when I have something to say, I'm going to stop. And I'm going to say it and I'll you know, I'll stop the other audio track. And we'll talk about a little bit basically, it's sort of a I don't know what to call it really a commentary track. Ever seen it in the movie where like a director sits down and watches this movie and goes, Huh, when I said that originally, I didn't even know what I was doing. But now in hindsight, I'm going to do something like that. And I think it's going to be valuable, I think it's going to be amazing. And I think it's a great way to start off the next 100 episodes, the Juicebox Podcast because we have so many episodes at this point, new people are coming along every day, it's probably unreasonable to think they're gonna go back to Episode 11. They can and some of you do, some of you are fantastic. You go back and you just power listen through the whole show, which is amazing. But my goal here is twofold. I want new listeners that come on to say to have the same experience that you had, you know, guys who have been around for a while. Guys, guys. Hey, you guys, guys and girls have been around, right? You fellas have been listening to the podcast for some time. You know, people have been around with the podcast since the beginning. You know why you're here now. But when new listeners come in, I want them to get that same feeling. And I want them to have any information that you have, that you tell me is so valuable. So that's the one thing. And the other thing is that I tell you all the time that the process of me making the podcast is teaching me things. And so I don't want to go back in here. What did Scott think a year and a half ago? And how much differently? Do I think about it now? Or is this the real staple of my type one diabetes management theory? Like is this just something that's concrete, it has not changed? We're going to find out together. Hopefully this is going to be one to remember. And you know what? While we're talking here before it all starts out. Let's remember two other things. I might sound stupid. I've probably gotten better at this in 100 episodes. And we are sponsored today by Dexcom and Omnipod. And I want to thank them greatly for continuing to support the podcast. All right, here we go. Episode 100 Juicebox Podcast, all within medical information on this podcast and on Arden. state.com is provided as an information resource only, and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education and should not be used as a substitute for professional diagnosis and treatment. Well, I quickly boiled that down to nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, you can find the full version of this disclaimer by going to Arden state.com or Juicebox Podcast my God I'm not going to shut up I'm just scrolling to the bottom Oh, scroll to the bottom. For those of you who have been listening to the podcast since it started, welcome back. And if you are a new listener, thank you for joining us. Let me introduce myself real quickly. My name is Scott Benner. I am the father of a little girl named Arden who has type one diabetes. Artem was diagnosed when she was two years old and is just about ready to turn 11 I write the diabetes parenting blog called Arden's Day, which you can find it on stage.com also on Facebook, Twitter, oh my god, Scott stop plugging into the fog interest. If it's social media and it's Arden's day, I think it's probably me. Okay, welcome to episode 11 of the Juicebox Podcast. I appreciate you coming by. Today we are going to talk about insulin. So there's not going to be any guests on this episode although you may hear basil snoring in the background Basil is Arden's little eight month old puppy who she named after her Basal rate and he is sound asleep and snoring away if you hear him. I apologize. Ironically, Basil Learning is one of the things people write in the most about, like, I love hearing Basil slore. I don't like it. It's hard. It's distracting for me. Okay? So I want to talk about insulin because it's the main component to a lower a one C, and lower blood sugars in general, and going to speak just from my personal experience. Again, nothing here is advice. And you certainly should talk to your doctor before trying anything that you may hear, hear, hear, hear, I hate when I say Hear, hear, that you may hear on the podcast. Okay. So let's go back to art and being diagnosed. She's two years old. We're in the hospital. It's, of course, incredibly stressful and frightening. And not something you were expecting certainly wasn't something we were expecting. And it's bad news. Good news, bad news. Good news back and forth all day long, right? Here's the bad news. Your child's just been diagnosed with an incurable autoimmune disease, their pancreas doesn't work anymore. It's no longer making insulin. But hey, here's the good news. There's manmade insulin. So unlike prior to the finding of insulin, your child's not just going to die in a couple of days, you're going to be able to manage diabetes with insulin Well, yay, that's fantastic. Small pause from the doctor. Insulin, however, is very dangerous. And if you use too much of it, it could cause dizziness, seizure, and even death. Well, why? Okay, great. So let me get it straight. Disease. incurable. pancreas doesn't make insulin, but don't worry here some insulin, but be really careful because the insulin could kill you. Okay, I'm clear. Everything's good. Let's go home. Now I've got it. That's pretty much how I felt right? You know, I'm sure a lot of you felt the same way as well. Here's this great medication. It's clearly a lifesaver, but used incorrectly. It's dangerous. And this is interesting for me, because I can see how these conversations lead me to have ideas for new ones. For instance, Episode 29 is called fear of insulin and the high Beegees that it causes us to accept. And episode 62 is called unfounded diabetes fear, my desire to sort of not use the word fear, I think is where the idea of bold with insulin came from. It's sort of the positive opposite of it. I used to tell people like you can't be afraid of insulin. But the word fear just had such a negative connotation. I just switched it up when I named the episode, but that's okay. They'll tell me what to do. There's probably instructions, right? Except that you know, the instructions that give you a very general and don't work day to day, let alone person to person, it's their guidelines to get you started. And it doesn't take you long to figure out that living with type one diabetes is probably just as much about kind of the vibe of it, as it is about the science. It's probably, I mean, honestly, it's probably three times as much, you know, the vibe is such a huge part of how I manage Ardennes type one, just my feeling about like, I think our blood sugar is gonna go high here, I think it's gonna go low. You know, yesterday, in a similar situation, this happened. It's trying to calculate, you know, what kind of not just how many carbs, but what kind of carbs? How long are they going to stay in our system? You know, how much exercise did she get? Is that gonna affect it? It's a little bit more about the magic than it is about the science and the numbers. But when you first are diagnosed, here's the numbers if this happens, do this. Inject this much insulin if this happens, if you get low, you want to take in this many carbs. Those those directions from your doctor are starting points. They're jumping in spots. I think the problem is that and very rightfully so you're told to err a little on the side of caution with the blood sugar right stay a little higher. So you don't experience a seizure or a low blood sugar incident. i It's insulting that they call them low blood sugar incidences I've seen two of them their seizures. But the idea right is, you know, stay a little high to avoid that. Well, I know for me, you know, back then 2006 No glucose monitor technology, not even an insulin pump, just injecting insulin with syringes. I was probably airing more on the side of caution than I probably should have been. And the more you did it, excuse me, the more you let a high blood sugar be because it felt safe, the more normal it got. And you start thinking well, you know what's wrong with 151 50 is fine. 150 is not fine. I mean it is but it isn't a my blood sugar right now. I don't have diabetes, my blood sugar right now. It's probably 96. Maybe it's 100. Who knows? Maybe it's at the point is is that there's a vast difference between 90 Or a 100 and 150 or 200, or wherever it is, you're comfortable. So I'm actually going to click over to a website here for a second
to talk about this next little bit. So at the moment, I'm on Accu check.com, which is ACC you dash, CH e k.com. I'll put a link in the show notes. But I'm here because they've got this little a one C calculator. So what did we just say? What is my blood sugar? Probably right now, let's just say 100, we'll actually have to say 100. Because accurate checks. Because Accu checks calculator only goes down to 100. So if your average blood sugar is 100, your average a one C for a three month period should be about 5.1. I think this next little bit really, is one of the things that that hits home for people with the idea that, you know, once my doctor told me, Hey, my kids blood sugar is good between anywhere between 90 and 180. And, and I don't understand why their agency so high. And this really, it's worth listening to it, it might be a little tedious the way I go through it, but I really think this hits home. The difference between shaving some points off of your blood sugar and how you're a onesie on top. But what if, like me, you were thinking, well, I'll just say 250, because that seems safer. Well, now you're a one see goes from 5.1 to 6.85. You're almost in the sevens now, because you're erring on the side of caution. But you know, it's impossible to keep a blood sugar stable, you know, without vacillating, up and down for very long. So what happens when you're 150 becomes, I don't know 170? Well, then the agency is obviously going to take a leap, and you hear me click around on the web page. Now it's 7.55. So when I'm online, and I see people who have newer diagnose children, and they say, Well, I, you know, I put my kid to bed at 180, because I'm scared of what's going to happen overnight. And I've seen that that's a number that that people seem to like, right, it's high enough over where they think they're gonna have a problem. But under 200, just enough that it doesn't really kick your guilt in an average blood sugar of 180 is an average a one C of 7.89. So we've gone from 105.11 for your agency, up to 180 7.89. That is a huge, huge difference. So you can see that cutting out just 10 points from a blood sugar right seven, let's do one ad at 7.89. I'll change it to 170. Really listen here to just what 10 points that you'll see. It's 7.55 Well, that's not bad. Well, that makes you think, well, if I could do 170, I could probably do 150, what's 150 6.85 Things are getting better. I think the problem is, is that you're you're told, err on the side of caution. And before you know what that becomes comfortable. And before you know it that comfort turns into a habit. And then it becomes difficult to break because of the fear that you feel. So I will tell you that I'm comfortable with art and sleeping overnight with a blood sugar of 80. I don't have a problem with AD. And I can't even on this website tell you what ad is because because the website will only go down to 100 I'm assuming for legal reasons. So let's just talk about Ardens last a one say Arden's last day one C was after Christmas. So end of 2014 It was 5.9 Wow, it's crazy for me to even hear me say 2014. But those of you who've been listening to the podcast for a long time know that I've been saying now with a lot of luck, I should knock on some wood, probably, that for the past. You've heard me say for the past year and a half for the past two years for the past almost three years now for the past over three years. Arden's agency has been between 5.8 and 6.2. And I actually think it might have been 5.7 at one point, I don't even remember. And that that is amazing. It's great to get to the point where your expectation just is an E one C like that. And there's no more of that horrible feeling heading into the Windows Office, a different calculator on diabetes.org, which is the ADEA website tells me that that I'm a one C percentage of 5.9 is an average blood sugar of 123. So you can see that even though overnight, I'm happy with 80 and trust me Arden will sleep overnight. Most nights at 90, you know down there Why are Dexcom alarm doesn't sound until she's under 80 These days Arden's low threshold alarm is set at 70. You can still see that her average budget were still 123. And why is that? I said I think that's because I think when people think about bloodshed burgers. And I know that we have a Dexcom CGM. And not everyone does not everyone has the benefit of that really great technology. You know, this seems like a great time to thank one of our sponsors Dexcom. I love my sponsors, and I love their products. Makes me happy to read this. As most of you may know, my daughter Arden uses the Dexcom G five mobile continuous glucose monitoring system that tracks heard look, a boy in my reading that tracks her glucose levels throughout the day and night notifying her of highs and lows so she can take action. But that's not all it does. Dexcom also as a share feature, so Arden can have up to five loved ones like her mother and I track her numbers in real time. No matter where Arden is or what she's doing. She always has backup. Now if that's the kind of peace of mind that seems like something that you'd like to know more about, I think you should go to www.dexcom.com Ford slash juicebox or click on the link in your show notes. Please keep in mind, CGM based treatment requires finger sticks for calibration may result in hypoglycemia. Calibration not performed or symptoms expectations do not match CGM readings, you can always contact Dexcom, toll free at 877-339-2664. For detailed indications for use and safety information, mostly just click on the show notes or type this in find out more about Dexcom you're hearing me talk about it here. It's an indispensable tool. I don't know where we'd be without it. To be perfectly honest. You can go to dexcom.com forward slash juicebox. When you do, you'll be well on your way to the things we're talking about here today. And you'll also be supporting the Juicebox Podcast. So good for you. Good for me. Thanks so much. dexcom.com, forward slash juicebox. Let's hear what Passcard has to say now.
But when you think about blood sugars, you think about this rolling craft line, you know, and if you have a great agency, I think people imagined that your graph must be very steady and very low constantly. And I just want to tell you that that's not the case. Arden's graph is not steady. Not nearly as steady as I'd like it to be. And it's not always low. But what I do is I take advantage of the overnight hours, because if she goes to bed and Arden's not a she doesn't go to bed early, she's going to be 11. But I think garden goes to bed between about 930 and 10 o'clock on a school night. And she gets up in the morning around seven. So let's say she goes to bed at 10 and wakes up at seven. So I'm going to just do some quick math here that sounds to me like nine hours 678 It is it's nine hours I've, I've I've done the math in my head. So for nine hours, if I can keep Arden's blood sugar at, I don't know, let's say 100 because the calculator says 100 That that's gives me some leeway for the rest of the day to not be able to get a Pre-Bolus on for lunch in time or to miscalculate some carbs at dinner, or to have some sort of a, you know, a hormone induced rise, that that ends up taking up, you know, two hours of a day where your blood sugar is up at 150. And you can't do anything about it or it's a 200 and you're pouring on insulin trying to get it down. That's why it's an average. So when we average those 24 hours back together, I will tell you that Arden's Ardens graph usually gets two blips a day where her blood sugar goes up. And it takes us a little while to get it back down. But then we have nine hours at night where it's you know, most nights without you know, listen, growth hormones, things that go wrong could definitely be higher. But on the average every month, most nights at 90 100. I tried to keep her down there. I know that sounds scary to some people. But that's a that's a fear that at some point you I think you have to get past because because you can't protect constantly for today, and never think about tomorrow. You just can't do that. Because the long term effects and I know this is something that we don't really talk about a lot because it's sad and uncomfortable. But we all know what the long term effects of type one diabetes can be if you have high blood sugars, and they are significant and life altering and life changing and life ending. So you have to find yourself a balance. You have to find a number that that you think I can live with this. This won't make me neurotic or I'll still be able to sleep. Now you know if your insurance can cover it. The Dexcom share really does really does change how overnights happen because now you're getting an alarm back in your room if your blood sugar's are going down or get below or above a certain level. I was talking about Dexcom way before Dexcom was cool and way before they were a sponsor. It is a game changer. I'm not going to put in otherwise and put Prior to having a Dexcom CGM, I was not as bold with these blood sugars as I am now. And you do have to be aggressive, but cautious. You have to be respectful without being afraid. And the technology helps a lot. And it's a good example of being aggressive. You know, I'll just use today at lunchtime Arden's blood sugar 101 Diagonal down a half an hour before we're going to Pre-Bolus for lunch. So there's a lot of stuff here to think about. But 1030 We Pre-Bolus for lunch with Arden's at school, but she doesn't actually start eating till about 1055. This is one of these things that early on, I had no idea it would be so valuable in the podcast, but I hear back from a lot of you about just talking through blood sugars and boluses and things like that hearing someone else talk it from front to back is helpful, which I'm glad about, I just trust me the first time I did it, I didn't know that. So if she's 100, diagonal down at 10 o'clock, it was fair to say that by 1030, she was going to be a little lower, and wasn't going to give me a lot of latitude to do a big Pre-Bolus Like I would like to do. So I had her eat, like 10 carbs of a piece of candy, just stick a piece of candy in her mouth while she was at school. And when 1030 came along Dexcom had her blood sugar at 85 and steady. Now I knew the sugar from the candy was in there and we were gonna get a bounce at some point. But it wasn't there yet. So I couldn't, you know, I made my calculations like it wasn't there. So I gave her her insulin for lunch 1030. And we did an extended Bolus give her 50% of it right away at 1030 and told the pod the power on the pod give the other 50% as an extended Bolus over the next 30 minutes. So that basically she's getting a Pre-Bolus of half of the insulin and at 1055 when she goes and sits down with her food. The rest of the insulin is in not active yet probably but it's in and it's going. Okay, so now we're to another real staple of how I think about this. It's the concept of understanding manmade insulin and how it works in your body or the person's body you're helping with their diabetes. When you put insulin in, when does it start moving your blood sugar down? How fast does it happen? Understanding how it works is the key to making all these decisions. Not five minutes after 11 i i get a warning on my my phone from her Dexcom share her blood sugar is hit her high her high water mark when we don't we try not to go above 160 artists high threshold today is 130. It's straight up now. Okay, that some of that insulin hasn't been in for very long, and the bolusing more right now is probably not what a doctor would tell you to do. It's not probably not what a doctor would tell you to do. It's definitely not what a doctor would tell you to do. They would tell you that insulin is not even live yet. It's hasn't even started working some of it you extended it. Don't do anything. Don't do anything would be the call the day. But at 169 Straight up which means her blood sugar's rising at two points per minute or greater. I texted Arden and I said I want to increase your Basal by 95% for half an hour and I want to Bolus a half a unit. My half a unit is just my blanket. I don't like the way the arrows going up Bolus. Okay guys, people have heard this podcast for a while now say it with me. Stop the arrow, stop the arrow. If it's rising, if it's falling, all you need to do is stop the arrow don't over treat just stop the arrow. And if you don't have a Dexcom CGM stop the rise stop the fall just bumping nudge bumping nudge Don't overreact errors going up when I don't think it should. Half a unit. Why half a unit half a unit because you know a juice box is for art and 15 carbs about point eight five insulin maybe one unit of insulin. So let's let's Bolus the equivalent of a juice box because I think I'm right history is telling me that she shouldn't be going up this quickly after we've Bolus for lunch. But if she does if it is for you know just a blip and it's going to come back down. Then we'll cover it with a juice box so I don't want to give so much insulin that a juice box wouldn't fix things if her blood sugar went down quickly. But I want to give enough to stop that arrow I want to stop that up arrow I am aggressive about stopping up arrows and you know in the in the Oh, what's this one's got Jim's will be texting in a second if you hear that in the background. But her blood sugar is now it's an hour and a half. Excuse me two hours since that Pre-Bolus and her blood sugar's 150. And I know that probably sounds pretty good 150 82 hours after her lunchtime Bolus at school, but I really wish it was 130 right now. Now with Jim coming up, I'm going to admit to you probably not going to do much about it. I don't think I would Bolus while they were still active insulin on the way to gym. That doesn't sound not not at a 150 If my blood sugar was 200 Right now I would absolutely Bolus but not at 150. So now there's Pascal talking. Today, Scott futures got me, what I would tell you is, if she's 152 hours after lunch than we did not time her insulin correctly, or us enough and or both. And that's something if you listen to podcasts, you're gonna hear me talk more about if your blood sugar is high, you have either Miss timed your Bolus, or miscalculated your Bolus, or a combination of the two. There is no reason Arden couldn't have gone in the gym on this day, with a blood sugar of 110. With no active insulin left, you know, if I just would have maybe given her a little more upfront in a Pre-Bolus or Pre-Bolus, 10 minutes sooner, I don't know anymore, because it's a couple of years ago. But there is a way to balance the timing and the amount of the insulin where her blood sugar would never have gotten to 150. And I can accomplish that now a lot better than I could back then. Does that sound aggressive to you? Does it sound scary? It did to me at one point. And I'm sure it does to you. Now again, the technology helps having a CGM will make it easier for you. Because you'll see a fall before it happens with any luck. And it's not not as scary. So the doctor tells you to err on the side of caution. It's good advice. But then it becomes comfortable and you probably live inside of those higher blood sugar's much longer than you could
you know, you have to change, you know, you need to be more aggressive. You know, the agencies up because you're not using enough insulin or because you're erring on the side of caution too much. But you have to find I think there's a big difference between when you're ready to make that decision. And when you're comfortable making that decision. This is amazing. I can quite literally hear myself learning while I'm doing the podcast. That's why the future episodes I sound more aggressive and more comfortable. It's it's this is stunning. This podcast is a gift for me, if you've ever felt like this podcast has helped you just know that by the process of me putting it together, I am being helped just as much maybe more than you are. To be fair, the balance may be unfair I might be I may be getting more out of this than you are. This is a this is how I'm finding my way through my path by talking about it with you. And I don't know that you're ever going to be comfortable making the decision ready is when in your mind you say to yourself, I understand that my child's blood sugars are higher because I'm not using enough insulin, I understand that the onesies are higher than I want them to be because I'm not using enough insulin. This is so early on in the podcast. It's before I realized that as many people, adults with diabetes would listen to this as parents, which I don't think you're going to be comfortable using more. But I think I can give you a couple of tricks to you know, get yourself there because the comfort comes later. Obviously after you do it a number of times and nothing goes wrong. You become more comfortable, you be a little more bold and you're pushing you're pushing your push an overnight blood sugar of 80 I want to be really clear would have scared the crap out of me before a CGM, I never would have done that. But having the ability to see a blood sugar falling or rising is is a game changer. So once you're ready, once you understand that you need to be doing this. Do it incrementally, you know whatever that means if if you're seeing that a dinnertime Bolus is a certain number, just randomly put a number on it, let's say you're using four units of insulin at dinner, five, six doesn't matter, whatever it is, and you're seeing high blood sugars. Two hours later, an hour and a half later, we'll just use another half a unit and something like that, and see what that does. You know, just try it. Keep an eye on it. You know if you don't have a CGM test, but but give it a shot. Because I bet what you would find is that after a couple of dinner times, maybe that half a unit was good. Maybe it was maybe it was what we needed. So that thought has morphed now into this idea. If I Bolus five units at a meal, and an hour later, it takes another unit for me to bring my blood sugar down, that I needed six units at my meal. Maybe I'll try a little more. Maybe you're on a pump and you can go very incrementally point five at a time. And the next day you try point six over and you get a slightly better result again and just keep trying to show yourself that it's not the end of the world. Show yourself it's not going to cause some great problem. It's not like your blood sugar's are at 90 and you're trying to get Add them to add five. Those are those are tight tolerances. I'm talking about people who are happy to see a blood sugar of 202 hours after lunch, two hours after a meal. People who are looking at a 180 overnight and going hey, it was steady at 180. That's great. Well, what's the difference between steady at 180? And study at 130? Go for study 130. Right? What what are you gonna do? I mean, what are you afraid you're afraid it's gonna fall, you're not gonna have time to figure it out. But I mean, everyone's different. But I don't think Arden starts to feel dizzy until she's under 70. So even if you went from 130 to 80, you know, in Ardern situation, if she goes from 130 to 80, overnight, I'm still in a good space for her. That's 50 points, 50 points. And we did it before and let's do it again. 6.85 is your average a one, see if your blood sugar's 150? If it's 100, it's 5.1. Now, some quick math for me, that's a 1.7 difference in a one see between 150 and 100. So 1.7 for for point for for 50 points, which means that if you can be comfortable at 130 instead of 180. You're That's how far your agency is gonna go down. 1.7. So think about that right? Now. If your child's day once he is eight, eight, would you be much happier if it was 6.7? What if it was nine? Would you be more happy? If it was 7.7 50 points, we'll do that. Okay, let's take a moment to thank our other sponsor Omnipod. Now Omnipod, as you may know, is the world's best and only tubeless insulin pump. So you are pumping insulin without all the tubing, it's not all sneaking around your clothes are getting called on door handles Omnipod it's not like that might be hard for you to picture because in your mind, when you think of an insulin pump, you might think of this thing that you clip on your belt and then this tube goes off to this infusion set on the pod is nothing like that baby, it is the futuristic of futuristic but but you know, I think that this ad for Omni pod is best served by me saying this today, we're going to start talking about the idea of moving a 150 blood sugar to a 131 30 to a 90 that is bumping and nudging. It's another thing at the end of this episode, I'm going to kind of encapsulate all of my, my sort of staples and ideas. But it's difficult to make a decision to move a 120 blood sugar to 90 if you have to inject you know if I need to pull out a pen and stick myself or if I need to get out of needle and drop insulin to try to move you from a 120 to a 90 you might say it's not worth the time. Or maybe it's inconvenient because I'm at school or on the bus. But if you can just pull out this wireless handheld controller and push a couple of buttons and all of a sudden you're delivering enough insulin to move your 120 to 90, you are now bumping and you are nudging your blood sugar's around, you are stopping small rises, excuse me, you're you're stopping little drops with Temp Basal is and you're moving blood sugar 1020 3040 points to achieve this a onesie that you're looking for while keeping your standard deviation where you want it because you're not bouncing all over the place, you're bumping and you're nudging. If you want that kind of control, and you want it to be tubeless. If you want to use the insulin pump that my daughter uses, go to my Omni pod.com Ford slash juice box, they will send you out a free demo so you can really see what it would be like in your life. And you'd be helping the podcast Miami pod.com Ford slash juice box 50 points will take you down that far. Now that is to me. That's when it hit me. You know, when I started really understanding that I felt well, then I want to shoot for lower. Now. This next bit comes from having a Dexcom I noticed something you set a high line and a low line, right? I don't want my blood sugar to go below this. I don't want to go over that. And if it does, I wanted to alarm. I think when I first got the receiver it was 250 for the high. And the low was like 130. Like I was like oh my god under 130. She's low. And one day I realized I do a pretty good job of keeping rodents blood sugar between 130 and 250. Here it comes. I haven't probably ever said it before on the podcast, but I say it all the time. Now. Often you get what you expect. It's advice straight out of kindergarten, but it ends up working. Wonder how much is expectation? That was my question for myself. Accept these lines up. These are my expectations for myself. And I'm able to meet these expectations. What if I close the tolerances on my expectations? So I did. I pushed the high number from 250 to 200. And I don't think you're going to need to guess what happened. I was still staying between the lines. Most of the time.
I set a new expectation for myself. And I was staying with it. So I pushed it again. I said to myself 190 Just a little bit what's 190 If I could stay there, well forget 130 is the low. Let's go to 120. So do you think I could keep her between 190? And 120? Turns out, I could, it turns out if you stop and really think about it, the only difference between a blood sugar of 90 and a blood sugar of 190. So what do you think the difference is between 90 and 190? I'm gonna go into a fairly artful description of it right now. But in the end, the difference is fear. It is your fear. I'm going to talk about it here. And the way I lay it out is going to be the basis for how I talk about it again, in an episode called texting diabetes, which is where we talk about how often and I handle school days, in your mind is that if 190 starts falling, you have time to do something about it. If 90 starts falling, it's more of a panic situation. Do you want to send your child with a budget of 90 in a car with somebody who doesn't know anything about diabetes? No, you probably don't want to. But if you add education, and the ability to speak, communication, and the Dexcom, that you can see the blood sugar as it's happening in case it's beeping away, and your kids back and they don't notice it, then all of a sudden, 90 is not scary. 90 is completely reasonable. Oh, it's 90 Diagonal down. I'll text the parent, hey, you know what her blood sugar is falling? Can you have a drink half of a juice box? Can you ever take a glucose tablet, can you do this, you know, whatever your adjustment is going to be? It's going to be. So think about what I said there, because it's a leap. The only difference between a blood sugar of 190 and 90 in your mind is padding, it's time, it's the ability to react without a low. But after years go by, you won't need that much time to react anymore. If you're newly diagnosed, I completely 100% in my heart, understand that a 90 blood sugar would could be scary for you. And that you might need that time to make better decisions. But trust me as time goes on, you'll get better and better at this, it's not going to get easier, but you'll get better and better at it. You won't need as much time, it won't seem like a panic situation when a 90 is going down. I don't feel like that anymore. I don't. I mean, I don't I cannot remember the last time I panicked about a low blood sugar or even a falling blood sugar. Because I've got so much information right so much time in the simulator that I know what to do to make it stop. I take the information I had from what we've been doing that day, what food reviews how much insulin we've got going. And I look at historically what it takes to stop but 90 Diagonal down what it takes to stop a 72 hours down. And I just make that decision, almost without having to think about it and I get if you're not in that spot, you need to be a little higher. But if you just continue to close the tolerances on what you're willing to accept as a blood sugar, then I believe in least in my experience, if you can hit inside of those lines, then just squeeze the lines a little bit. And I bet you'll keep heading. I really I believe you will. Okay, now if you're not at that place yet, I get that but that's my goal. That's the goal of this podcast is to get you from where you are to where I am as fast as possible and as safely as possible. But without all the heart wrenching the gut wrenching, horrible days and all that stuff. And so I'm going to give you an idea of something that's been going on while I'm editing this episode together. Arden contacted me at 11:26am to tell me it was time to Pre-Bolus for her lunch. But her insulin needs were not exactly matching up with her blood sugar. Her blood sugar was 86 now Arden's blood sugar's been between about 90 and 100. And about 90 and 110 for the last like three hours while she's at school, and we still need to Pre-Bolus We need to get insulin happening, right? I know that my daughter cannot start eating without insulin that is working in her system. But in 86, blood sugar is tough to Pre-Bolus. So what I did was I gave her the entire amount of her insulin in an extended Bolus with 0% upfront today. So that means that the nine units I gave her for her lunch started going in the minute she pushed the button and finishes in 30 minutes. So that there is some act of insulin happening when she sits down 10 or 15 minutes after we push these buttons and starts to eat. And right now her blood sugar is at one and she's probably been in lunch for about 20 minutes. I'm telling you, it will happen it can happen you can get there. Let's get back to talking about insulin Shall we talking about this today? Because a lot of people on the blog asked me after I write about different things about a onesies and things like that I always hear about like, you know, I always talk about being bold with insulin being being bold in general with diabetes, and I get a lot of emails, correspondence privately back from people who say things like, you know, I took your advice about being more aggressive. My son's a one C fell. You know, I'm being bolder, it's hard. It's scary, but I'm doing it. I want to thank you and these are some of the most heartwarming notes that I've written. Even when I stop and think about when I stop and think about kids who are walking around with in range blood sugars that aren't causing them to feel foggy, because their blood sugar is not high, and I think about their a onesies being more aware they want them in that, what that means for them health wise and what that means for their parents stress wise, I mean this all, it's just, it's just information that you want for there to be in the world for people like you to hear, it's more difficult to write about these things, because you feel like everything in writing sort of seems very official. And I don't want people to think that I'm saying do this, and do this and do this and everything will be fine, because that's certainly not true. Your diabetes will absolutely vary from person to person. And it is something that takes time for you to kind of figure out the flow of, you know, to get the vibe of your child's diabetes and, and the things that affect it and don't affect it. I really felt like the podcast was the place to talk about this, because you can hear my voice when I'm telling you like, look, this isn't advice. This is just what I do. This is how I feel about it. And I believe that if you could try to feel a little bit about this, too, in a similar way that you might have some similar luck with with with a little bit of luck. But what pushed me over the edge of the podcast, besides the emails was Arden's last day one see 5.9 right around Christmas time. And we go in and the our nurse practitioner comes in the room with the test result. And she says, My God, you you decreased? Not a lot. I think we went from six to to 5.9. But any decrease is amazing. And she says,
I can't tell you how many people at the holiday time a year. I tell them oh, it only went up a point. It's okay. You did good. She's like you don't see decreases at the holidays because of all the extra meals and food. How did you do that? And I thought about it for a second because I didn't do anything differently than I did the quarter before. All I did was act aggressively, not wildly and appropriately, but aggressively. Arrow up I want to stop that arrow high blood sugar, I want to get it back down as soon as possible. I would much rather get a blood sugar down quickly than to watch it exist for three hours and bring it down slowly. Translation for those you've been listening for longer, it's far easier to stop a low or falling blood sugar than it is to affect the high one. So I'd much rather be playing down around 100 than up in the three hundreds I don't want to spend a bunch of time. nickel and diming to death 300 Oh, try a unit none other half. Do this increase the Basal three hours later. Oh, great. We're finally at 220 That's time to eat again. Back to 350. That is what I mean. That idea turned into me saying to you it is far easier to stop a low or falling blood sugar than it is to affect the high blood sugar. And now that is something that if you listen to the podcast rings true in your head, you've seen it happen in your life. i This is amazing. I love going back and listening to the old podcast I can see where things struck me for the first time. Oh my gosh, this is it's I hope you're still enjoying this. I think this is fantastic. I mean, the less time with the high blood sugar in my opinion, the better. So that's how we got 5.9 We were just bold. We were aggressive. We weren't scared. And when the times came where we did use a little too much insulin we combative the insulin with you know, something that worked quickly for our juice a lot of the time just to kind of go over everything. One last time. Aggressive but cautious, respectful, but not afraid. Definitely have to lean on the technology. I genuinely don't know how to give you advice about doing this without a Dexcom CGM. I feel like it would be impossible for me to do overnights find a way to be comfortable with a study lower than what you're used to now because there's so much a one say that can get cut out. Like we talked about earlier difference between 180 and 130 is huge. Difference between 130 and 80. Same difference. Stop and think about that for a minute at some point Arden's blood sugar overnight was 180. And now I'm comfortable with it at 80. It's obviously not always 180 obviously isn't always 80. But those are our goals, right? There's what we're shooting for 100 points 100 point difference, and that's the story of how Arden's a one C went from nine to eight to seven to 5.9. And don't get me wrong, not just insulin. There were a couple of meals that things we cut out of eating. Arden used to eat cereal for breakfast. She doesn't eat any more. Two years later, I'll tell you she doesn't eat a lot of cereal anymore, but when she does, I know how to Bolus four without a spike. Here's a great blog about Froot Loops on on origins de.com Where Arvind came out of an endo appointment and just asked me one day, how can I get my agency to come down, and I said, you could probably stop eating cereal in the morning that would help. And we got a big reduction out of that. So it's not just insulin and being aggressive. There's basil up from his nap. It's not it's not just insulin, and being aggressive is also diet and exercise and a lot of other things. But, but anyway, while my, my nurse practitioner I talked like she's my nurse practitioner, while Ardens nurse practitioners asking me how do we get a reduction at the holidays. And I explained to her, she paused and she looked so serious and thoughtful and sad all at the same time. And she said, getting people to not be afraid of insulin is probably the hardest thing I do. Then I decided to make a podcast about it. And it looks like we're going to take a little break here while basil finishes barking. And I'm going to come back in a second and just talk about Apple Watch for a second. And a couple of little news things. I'm gonna let you out of here and get back to your life. Okay, I'm going to talk here for a minute. Now, this podcast episode, you know, cheese, I'm at episode 99. In March of 2017, March of 2017, I'm in Episode 99. If I go all the way back, there's a lot of clicking here. But if I go all the way back, and again, back, wow. To episode 11. Episode 11, was put online, April 14 2015. You're gonna get this one in March of 2017. It's two years later. I'm going to tell you that in those two years and 100 episodes, I've learned a lot. I genuinely appreciate that you guys listen to the podcast, because, as I mentioned before, the process of me putting the podcast out is it's sort of the, you know, it's the it's the Okay, I give myself to sit down and think about diabetes for an hour every week. And that time, that time to consider helps me figure out the next thing that I want to say to you. And the next thing I want to say to you is based in something that I have found real success and repeatable success, I don't come on here and just start blabbing about something that worked one time for me, if I'm telling you something here, I've seen historical data that tells me this is worth to share. So over these last two years, I've sort of broken down my idea of managing type one diabetes. So a couple of simple concepts. They are obviously this first one, be bold with insulin, or, don't be afraid, find a way to put your fear away. It's very important. The idea that you have to bump and nudge blood sugars that you can't just take a 120, you want to make a 120, a 90, you want to be able to say Hey, I see a 60, I need to get it to 90 not to 200 Bump and nudge bumping nudge. So lots of ways to accomplish that. It is particularly easy if you have an insulin pump like an omni pod. And you can make those kinds of fine tuned adjustments Pre-Bolus in absolute, absolute gamechanger, if you are not Pre-Bolus Singh meals, it is going to be even, I'm going to come out and say almost impossible to get your agency to come down to get your spikes to go away these these you know after meal spikes, they're not going to go away without Pre-Bolus and Pre-Bolus ng is at its core, the act of understanding how manmade insulin works in your body. The simple idea that if I put a piece of fruit in my mouth, a banana at noon, and I start eating the sugar from that banana is going to begin to push my blood sugar up quicker than insulin is going to start working. So I can't put the insulin and the banana in at 12 o'clock, I have to put the insulin in at 1150 or at 1145 or whatever that time ends up being for you. That's what I mean about you have to understand how manmade insulin works in you. But I need to know when do I put that insulin in so that when I take that first bite of banana, that insulin and that sugar from that banana, they get involved in a tug of war that neither of them can when the food can't pull your blood sugar higher, and the insulin can't pull your blood sugar lower because they're both pulling with equal force at the exact right time. When your blood sugar is at 85. Think about the harmony of that. There's your blood sugar, 85 Insulin pulling down, carbs pulling up and it just sitting at 85 No spike. That's understanding manmade insulin that's employing Pre-Bolus thing that is not being afraid. When you get those ideas, this whole thing just goes to another level for you. And I wish that I could sit down and lay them out Are you like ABC, Do this, do that do this, it works, do 30% of this and blah, blah, blah give you these firm numbers. But what I've learned over these two years, is that what works is it when you listen to me sit down and have conversations with other people who have diabetes. And we talk these things through. That's where the understanding comes from. It's sort of slowly builds in you. And, you know, it might sound like a cheap way for me to say, I need you to go back and listen to all the episodes, but in my opinion, if you want to get to where I am, and I'm not ahead of you, because I know something amazing, by the way, I've just been at it longer than you have, I just have the opportunity to sit down and talk about it and think it over while you're at work. I'm recording another podcast talking to somebody else, having these epiphanies. So I just see myself as slightly farther down a path than you are. And I'm just the guy who's willing to turn around and yelled at you, hey, there's a hole coming up, don't fall on it. Because I think that it's not. But I just think that it's a very human thing. If you have information like this, you need to, in my opinion, you need to give it back, right, so that other people don't have to fight the same fights you had to fight. And that's what this podcast is. So I know it's 100 episodes in my best advice is to go back to the beginning and just listen through, there may be a couple episodes where you listen to go, I didn't really learn anything, Scott, you know, like a filler episode of your favorite of your favorite television show. But it's not really a filler. It's advancing the story. And sometimes you have to listen to me interview somebody so I can get to another idea. So I can advance my story, and then pass it on to you. Okay, I hope you like this, I enjoy doing it, I
might do it. Again, with a couple of the other episodes that you guys seem to really enjoy. I do invite you to go back to Episode 11. And listen to bold with insulin without me yammering overtop of it, if you think that would be helpful. In the end, though, please, you know, I could ask you to leave a review on iTunes. And that does help the podcast get found by other people. But I really think that our community is such that, the best thing I can say to you is if this podcast is helping you, please share it with other people who you think it might help get your agency down, get someone else's down, have somebody else's kid or brother not have the that horrible feeling of their blood sugar fluctuating all over the place, like share this information with somebody else. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And thank you, thank you, thank you so much to Dexcom and Omnipod for sponsoring this podcast. Because if you like the fact that I have the time to sit down and ruminate over these ideas, and come up with these theories and spit them back out to you, that is only possible because we are being sponsored and supported by some really great places and technology that I believe in. Above all else, you go to my omnipod.com Ford slash juicebox or dexcom.com Ford slash juice box to find out more, I would really appreciate it if you did that. And I think you'd be taking a huge step in your carrier if you looked into those devices as well. For those of you that have been there from the beginning, I cannot tell you how much it means to me that you've supported the podcast this podcast went from a couple of downloads a day to hundreds upon 1000s of downloads a day and it just warms my heart. Also, I hope I've gotten better at this you know, I've learned some things like for instance, I don't leave my telephone plugged in anymore when I'm recording. My phone is ringing Hello. Hello.
Unknown Speaker 53:37
Hello. Good afternoon. My name is Robert calling you from Green Energy Solar. Am I speaking with the homeowner? You
Scott Benner 53:45
are Robert but I do not have any interest in solar energy for my house. But thank you for calling. And could you while I've got your put me on your do not call this place? That sounds like a no he just hung up. Sorry about that. I'm not against solar energy. I just don't think it's a perfected thing yet. And I'm really scared about putting like panels all over the roof of my house because I feel like what happens when like the roof underneath gets weaker. Anyway, I have too many questions about I liked the idea of solar. I don't like the idea of putting panels on my house. I don't feel like I have to explain this to you. See, I'm getting better all the time. I just want to thank you from the bottom of my heart for listening to 100 episodes of The Juicebox Podcast. I very much look forward to bring you many, many more. Listen, I want you to be on the Juicebox Podcast. I want you to come on and be a guest. I want you to share your story I want you to tell your tell your problems. Tell your heart aches, you know ask your questions. That's how other people learn. That's how I learned that's how the podcast continues to help people live their lives with type one diabetes, not just live them but live them well. We need to hear the stories so that we can hear ourselves in those stories. And everybody always says every email I get starts Scott I want to be on the podcast but I don't think my A story is valuable enough. I'm telling you that everyone thinks that and so far everyone who said that in email has been 100% Wrong. Everyone's story has been amazingly valuable to me. And to you. Be part of it, contact me, you can contact me at Arden. state.com Scroll down to the contacts juicebox podcast.com Throw me an email. There's links in the show notes. I'm not gonna lie, you're gonna think your voice sounds strange for a couple of minutes. But then you'll get used to it and everything will be fine. It always is.
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