#1022 Diabetes Pro Tip: Weight Loss

September 24, 2023Scott Benner

In this episode of the Juice Box Podcast, Scott introduces the highly requested Diabetes Pro Tip on weight loss with type 1 diabetes. He reflects on the success and growth of the Pro Tip series, which condenses tools discussed in the podcast into individual episodes.

You can listen online to the entire series at DiabetesProTip.com or in your fav audio app.

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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 0:04
Hello friends, and welcome to the diabetes Pro Tip series from the Juicebox Podcast. These episodes have been remastered for better sound quality by Rob at wrong way recording. When you need it done right, you choose wrong way, wrong way recording.com initially imagined by me as a 10 part series, the diabetes Pro Tip series has grown to 26 episodes. These episodes now exist in your audio player between Episode 1000 and episode 1025. They are also available online at diabetes pro tip.com, and juicebox podcast.com. This series features myself and Jennifer Smith. Jenny is a CD and a type one for over 35 years. This series was my attempt to bring together the management ideas found within the podcast in a way that would make it digestible and revisit double. It has been so incredibly popular that these 26 episodes are responsible for well over a half of a million downloads within the Juicebox Podcast. 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 healthcare plan or becoming bold with insulin. This episode of The Juicebox Podcast is sponsored by assenza diabetes makers of the contour next gen blood glucose meter, and they have an amazing offer for you. Right now at my link only contour next one.com forward slash juicebox free meter, you can get an absolutely free contour next gen starter kit. That's contour next.com forward slash juice box free meter. while supplies last US residents only. The remastered diabetes Pro Tip series from the Juicebox Podcast is sponsored by touched by type one. See all of the good work they're doing for people living with type one diabetes at touched by type one.org. And on their Instagram and Facebook pages. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox. Every time I think there's nothing more to do for the protests, then somebody asks something and I think no. Oh, that that would work there too.

Jennifer Smith, CDE 2:33
Is the variables in life that I think will always bring in something to discuss in terms of what it could be in? In diabetes? Like management? Yeah,

Scott Benner 2:44
no, I'm really happy. I'm really happy to hear from people because I think that others perspectives can make me go Oh, yeah, wow. Just because that hasn't happened here. Doesn't mean that's not happening somewhere. And then it gave gives, you know, good focus for what to do. So this is it. We're gonna talk about trying to lose weight when you have type one.

Jennifer Smith, CDE 3:03
As I mentioned, I think I did to I texted back to you. I was like, this is a big topic. It's not just like five minutes of just go out and start running. I mean, it's it's kind of like a rabbit hole. Honestly. I mean, there are many different like, little avenues to kind of talk about, and you had a lot of really good questions that came in, or like comments about, Gosh, I don't understand this, or why isn't this quite right or whatever. So, yeah. Yes. Great topic.

Scott Benner 3:33
So I'm gonna have very little to say here, probably. And I apologize for that. I guess this is the time, the time we pretend like I just came on your resume. And I'm like, Hey, how do I help? And then you just talk. But what what's the, I mean, where do you think we should start? Because to me, I think we should start at the idea that people correlate taking insulin with gaining weight. And then they don't think about calories and right, go. Hi, Jenny. Can you help me please?

Jennifer Smith, CDE 4:06
Well, maybe. I know, it's a good place to start in terms of like, one thing that everybody with diabetes specifically thinks about is that it's insulin. And I think a good place to even go with why does that start is because it's often something that a practitioner will tell people, you know, using insulin, you may be likely to gain weight. They think that was one of one or a couple of like the comments that came back about this topic. were specific to you know, why have I been told that I'm going to gain weight or why, you know, why is this going to happen? Or why did I lose weight and now I'm gaining all of this weight back like after diagnosis, right? So insulin itself whether your body makes it or you take it with an injection or with a pump, it's a storage hormone. That's its job. It's supposed to Have a certain quantity of carbs, sugar really out of your bloodstream and into places to either be used or stored, right. So in terms of management, insulin can make you gain weight. In terms of like initial diagnosis, a lot of people with type one specific have lost weight. prior to diagnosis, maybe it was very rapid. Or maybe it was like a lingering loss that people were like, well, I could just keep eating the whole cake. And gosh, I don't gain any weight, and I'm actually losing weight. And then they're like, Wait, this is wrong, this is bad, that shouldn't be happening. So they go to the doctor, right, they get a diagnosis of diabetes, they've lost weight. And in terms of that loss, it's often relative, it's usually relative to the fact that their blood sugars have been so high, that their body isn't storing those calories, right. So you're essentially paying them out, thus, DKA, and all of those things that can come about, you know, around diagnosis time, but because you're losing all those calories, and your body's not packing them in, once you have back, the piece of the puzzle that was supposed to help you use that food that you were taking in, your body is going to start storing it.

Scott Benner 6:14
And so and so. And that is the one confusion you see from newly diagnosed people is like, I don't understand I lost all this weight, and they don't understand the function of it. So explaining the function of it, I think is great. I think boiling it down into one simple idea is that you were dying. And yeah, and your body is using itself up and not storing at the same time trying to stay alive. And then all of a sudden, everything's okay. Now, the more weight listen to if I'm, if I'm talking about a school here, you just taught me but if you've lost a lot of weight, before you get to this skinny, emaciated, those are my ribs, you probably had weight to lose to begin with, right? Because it was there to lose,

Jennifer Smith, CDE 6:54
likely and especially more as the adults who are diagnosed yes, if you had weight to lose for whatever reason, you may have just thought, like I said, Oh, good, I'm actually able to take weight off. Now, I don't know why I'm still doing the same three mile walk every day. And now it seems to be working better, great. But yeah, once you get to that, like, shouldn't be able to see my lower ribs, or Gosh, my face looks really sunken in when I look at old pictures. That's not what you want. And

Scott Benner 7:24
I think that, again, it's probably sound, I don't want it to sound like distasteful, but if you had weight to lose, you were probably it's likely that you are taking in calories, that helps you stay at that weight. Meaning that when you start taking the insulin back in, there are calories there to be packed away to facilitate the weight gain again,

Jennifer Smith, CDE 7:45
and that's in any case, whether you could have lost weight, you know, and successfully, hopefully helpful, you know, left it off. But the goal was starting insulin is, in general, to maintain a healthy weight then right to get Yes, you will come back from the weight loss. But you should also with the proper insulin dosing, you should be able to get back to a stable healthy weight, you know, if you lost 40 pounds when you were diagnosed, and hey 20 of that you could have definitely lost and the other 20, you really didn't need to great, we should gain back maybe 15 to 20 pounds. And then we don't need the other kind.

Scott Benner 8:27
What is the functionality of the proper insulin dosing that makes you gain too much or not enough

Jennifer Smith, CDE 8:34
in terms of insulin dosing, that's correct. The amount of food you put in to work with it, of course, is a piece of the puzzle there. But if your insulin is being balanced along with your use of the energy that it's working with, then you should be able to gain energy back to your body that gets stored that keeps you at a healthy weight. And you shouldn't then continue to gain if the dosing is correct. And it's so it kind of goes back to, on a baseline initially make sure your insulin doses are right for you. And a lot of people wonder, you know, they I just leave it to my doctor. Yeah, it tells me how much more or less to take.

Scott Benner 9:15
And does that mean that if you're not using enough insulin that your blood sugars are left higher, so you're still having some of the action that you noticed before you were diagnosed? Right, you're, you're a little you're too high and your body's not storing the the calories correctly, the glucose clerk correctly and so you're not gaining as much weight so you could have unhealthy blood sugars, but feel like your weights good. And then you kind of come to that point. You're like, Oh, I'm good. And that really is the beginning idea of diable anemia too, right? Manipulating the insulin to keep your weight down. Okay, so yes, going the other way. If you're too low all the time. You'd have trouble putting on weight.

Jennifer Smith, CDE 9:57
If you're too low all the time. I'm one, you've, that's actually kind of an, it's an opposite of what you would think really, if you're low all the time. And that's a big reason, then when we start working with somebody we analyze insulin to begin with. And the first thing we look for, even if there are highs, high highs, we first look for lows. Because if weight management is another piece that they're really concerned about, then all of those lows that you're treating, you are feeding insulin, and you're feeding insulin, which ends up packing away the excess that you're taking in, and you maintain a weight that you don't want, or you keep gaining weight that you don't want.

Scott Benner 10:42
So this, this puts you in the position of having to look at carbohydrates as medicine, and being scared because you're low, taking away more than you need. And then suddenly, your belts back up again. And maybe you've got enough insulin in there to handle the carbs for your blood sugar. But you've taken in way more calories than you once got it. Yeah.

Jennifer Smith, CDE 11:03
Yep. So that's, that's that insulin is, it's kind of the key place to start, really. And, you know, then a lot of people ask, well, how much insulin? Should I really be on? How does this enough for me? Is that enough? For me? I know, we just talked about that kind of in depth in another episode, but really, you know, figuring out about how much insulin you need based on a weight to begin with, that's kind of a starting place that you could go to, how much total daily insulin are you using right now? What's your like current body weight, etc? Should you be using this much insulin? Is it taking this much more insulin to counter things? Or are you using like a heck of a lot more like let's call it Bolus insulin, right? But you see that your Bolus insulin is for a lot of corrections. And when you're looking at your data, you can see that the corrections are following lows. There again, more insulin than you really need. And thus your body is going to pack away by allowing the insulin to use up the food.

Scott Benner 12:10
It's funny because I wasn't 100% sure what you were going to say today. And yet I feel like we're into this situation, again, where the podcast should maybe be three minutes long. And it should say limit your variability use the right amount of insulin. And it kind of addresses so many things. I know this isn't weight loss specific. But let me just ask you one question. How many people you know what percentage of people do you think just a guess, are, are getting to reasonable outcomes by mistake. Like their bolusing too much, but they're eating on time and their Basil is too low and it works out or their Basil is too high and they eat before they get low. And they don't have to Bolus too much and it like how many people are getting there the wrong way. But it seems like it's working and then have underlying issues that they don't recognize.

Jennifer Smith, CDE 13:07
Like I wouldn't say it's, I wouldn't say it's anywhere near a majority of people. Honestly, I'd say it's a small percentage of people who have figured out insulin needs. Even though the dosing strategy that they're using might be wrong, like you said, maybe there's way too little basil, but they're offsetting it with boluses. And maybe the little amount of basil they're using is right for their overnights. And that's why it looks stable or, you know, vice versa, whatever. But I don't think that's the majority of people, I think the majority of people who are having issues with blood sugar fluctuations that they don't want, and also likely are having some issues with weight management of some type. It's, it's a start of let's look at what the initial factor could be insulin, okay. And then you move on further. And, you know, lifestyle is a big part of it, obviously. So then we look at things like calorie intake. And I think some of the some of the questions that came in were kind of, you know, around that, well, you know, I've run a calorie deficit and I've like run myself ragged going to the gym or, you know, exercising 90 hours a week. And it's still not working. But I, you know, and then you know, there's the fasting component and all of these things that people try to put into the picture. But from the standpoint of calorie, your calorie needs should meet your baseline kind of need in general. And then if you are working out on top of that, or you know, a training athlete or whatnot, then calorie needs go up. But at a minimum, there is kind of a minimum, on average that needs to be there. It's about 1000 calories a day, give or take person to person. But when you start dipping below that oftentimes what ends up happening is your body conserves. Because you're not meeting a need. And then you wonder, well, I'm at a deficit, why am I not losing? Because your

Scott Benner 15:09
body thinks you're lost on a desert island and it doesn't. It's trying to hold on to everything you put inside. Exactly. I had that problem where I've been eating more food, I've lost weight and eating less. It didn't, it didn't impact me as a fact. In fact, it sort of made me go the wrong way. So okay, so if someone asks you, is it not as simple as hey, I need to lose weight? Can you tell me where to start? Is it really person to person? Like, because what do you have to do first, like, like, think about if you were listening to this right now? And you could be any of the very people who are listening, like where do people start?

Jennifer Smith, CDE 15:48
I would definitely say with Well, first might even be an analysis of where are you? And where do you want to be? Or where have you been weight wise? Right? What's your goal to get to? And how much more are you above that than you want to be. And also, in that timeframe, it goes back to insulin analysis. If you've gained weight, as many people have in this past year. If you have gained weight, but your insulin doses haven't really shifted, there in lies a piece of the puzzle to write usually, for about a 10% change to your baseline like weight, you're probably going to expect a need to change your, your Basal and your Bolus ratios by about 10% as well, to be more aggressive and to take, you know, take into consideration that gain now when people are looking for loss. They're like, Yeah, but I don't want to use more insulin, because that's not going to

Scott Benner 16:52
work. And they think, oh insulin, put the weight on them. Correct. Okay, gotcha.

Jennifer Smith, CDE 16:56
But really, they need to first manage their blood sugars, right? And then they can start working on whittling away or whittling back and some of that comes into. Okay, let's look at the lifestyle things. Let's look at Are you exercising? Are you active enough? Does your calorie intake meet what your actual need is? You know, where can we whittle away some things so that weight comes down and along with it, then as you do lose? The same thing happens with insulin, your insulin doses should be adjusted back based on loss.

Scott Benner 17:30
You are making me think strongly about when somebody comes to me and says, Hey, I just got diabetes, and I play a sport or my kid, you know, is on the team. And we're so worried about this. And I very badly don't want to give them a band aid answer about how to get through the sport. I want to tell them let's take the time now and get your insulin right so that during the activity there really isn't any issue. And it's hard for people to believe that once they've seen it once they see cause and effect once they see I ran around and my blood sugar went down. They imagined that is going to happen no matter what all the time. And I Ardennes. I'm sure you're the same way. But Arden's insulin, so well balanced at this point, like activity doesn't make her lower or higher. Really, it's not, it doesn't really change too much.

Jennifer Smith, CDE 18:18
Yeah, it depends. I think that brings in, you know, the consistency of exercise or activity, right, the more attune your body is, let's say you go out for an hour every single single day to get some form of real exercise, right, your body gets used to that. So initially, you might see that your insulin needs drop off within the hours of the active time, right, and maybe even stretching several hours later, depending on what you did. But over time, that impact is lessened, you will usually need to be less aggressive with insulin adjustment, or maybe not at all. I mean, I can typically take my kids to the park and not really worried too much about that unless I know I'm really going to run around crazy with them. And I likely have insulin on board. Right. So then something needs to be you know, offset. But so yeah, I mean, once you get to the point of like lifestyle adjustments and a base insulin that's working, your fluxes in insulin dose then will be minimized. I think oh, sorry. Go ahead.

Scott Benner 19:23
I think people need to be certain to that. Once they start exercising their body is going to use the insulin better. The answer then is not to feed the low it's to adjust the insulin. You know maybe the first time you have to feed it but then you have to learn from there and make an adjustment so that you're not constantly battling yourself because that is what happens right? They exercise they get low they eat it adult the adult it overpowers what they meant to accomplish. Okay,

Jennifer Smith, CDE 19:49
and then they and then you end up getting frustrated too. Well, goodness. You know, I go to the gym but I have to eat like a whole sandwich and a half a banana in order to go to the gym and not have a low blood sugar. What's the purpose? stuff that when I'm trying to lose weight, and then I stopped doing it because and they stopped doing it right, or on the other side of it, you know, someone who may actually, okay, I'm going to really focus in on my diet, I'm going to clean it up, I'm going to, you know, cut my macros down and actually meet the caloric need that I'm at right now. And then what they end up with many times are lows, especially the cleaner the diet gets, and the more accurate intake of calorie value is for that person, your insulin needs will actually come down sooner. So to avoid lows and needing to treat in the time period where you're really trying to be, let's be good. Let's say, just take your insulin doses down by maybe even, it's just your Basal take it down by maybe five to 10% across the board, okay?

Scott Benner 20:49
So it's get your insulin, right. So it's understand diabetes first. And then it's the normal stuff, we all talk about it being active, getting your heart rate up. A sedentary lifestyle leads to more resistant blood sugars, which leads to more insulin, which probably leads to more lows, because you get out of balance, blood sugars, and what you just said, about clean eating. We don't really talk about it. Like we like if we were all out in a field, okay, let's just say that if it was 400 years ago, and somehow insulin existed, but we were still just farming and breakfast might be an apple you found on the ground, and maybe on Wednesday, if you're lucky. The guy up the street kills an elk. And we get a steak Right? Like if we were still eating like that, and we had manmade insulin, people would not be using nearly as much insulin as they use now, Jenny's Oh, no,

Jennifer Smith, CDE 21:46
not at all. I mean, if you were living on like, Barry berries that you picked along the trail that you were tracking the elk on and then you stopped and you ate some of the watercress to get your Vitamin C out of the like stream that floated by whatever. No, what No,

Scott Benner 22:04
you might not need as much as right now

Jennifer Smith, CDE 22:06
you wouldn't. You're also active level that I mean most like let's call them, you know, cave dwellers or whatever at that point of life, right? activity was part of your day. They didn't have a gym that they went to. Their hunt for the bison man was like, active.

Scott Benner 22:24
I bet you're running from a mountain lion burns carbs. What do you what do you think? So I guess my point is, is that while I'm not telling anybody how to eat, and I'm not certainly telling you that my daughter's counting macros or anything like that. Processed foods, right? Manmade foods, stuff that comes in bags, oils that don't belong in your body, all the stuff that we consume all the time that we're not aware of. It's making your variability greater and it's making it more difficult for you to use insulin.

Jennifer Smith, CDE 22:56
True. In fact, I've also kind of heard people and there's truth to it.

Scott Benner 23:02
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Jennifer Smith, CDE 26:18
Many people have found that if they eat a true cart, let's say they eat an apple and they Bolus for it, they end up with the ratio that they're using for that simple like very clean carb to go low. Okay, and then when they mix it up, and let's say they have potato chips or something along with the Apple or they have something, you know, more processed along with it, their carb count ends up looking clean, like okay, it comes out I don't get low later. So what gives it really is that the body processes more natural food in a better way. There's there's less leftover to kind of linger in impact. And a lot of people are basing their insulin to carb ratios, more specifically, around combination meals that are not quite as for lack of a better term clean,

Scott Benner 27:16
right. So your heavier insulin ratios work better if you have the orange with the potato chips, but if you just eat the orange, the orange doesn't need as much insulin. So the ratios you have are too heavy. Correct. I now Arden's ratios are heavier, because she doesn't she eats a diet that has processed foods mixed into it. But she'll go on a kick around this time of year about oranges, where I have to buy like 10 pound bags of oranges to keep around the house. And she's like I want an orange I want lunch. Now these are big, like softball size oranges that I'm sure to Cara, Cara oranges. Those

Jennifer Smith, CDE 27:51
are my favorite. Yeah, I

Scott Benner 27:52
think they are and they're really good, right? And but I bet you and I've never looked, but I bet you that the card count on them has got to be more like 25 or something like that. Like he could be more right. But I only give her enough insulin for like 11 carbs. And and she does a little 130 Rise and comes back again. Because I you know because I know her ratio is higher to handle other things, which is why you look at plates and go okay, tonight, I don't need as much, you know, for that. But this is not this is not going to be a satisfying, you know, people just want to hear like, please just tell me what to do. And I'll do it will work. But nobody wants to hear. I guess this I know, I don't like you know what I mean? I don't have diabetes, and I saw I'm listening. I was like, Oh, this is how I would lose weight. So you know, it's it's just do you think that we've just spent so much time as the society looking for marketable sellable ideas about how to get around? The idea of being in shape? There's no, it's, it's exercise and calories. Right.

Jennifer Smith, CDE 29:01
And I think that's the reason that there are so many I mean, if you look at around the first of the year, there, I can't remember which publication it is. But they come out with an analysis of I think, like the top most, or maybe it's the 25 top most like used column diets, right, in the past year, and what's kind of proven true to what it promotes and what really isn't, it's kind of like flimsy right. And some of the top ones are things like the Mediterranean diet. And you know, by no means am I promoting that or whatever. I'm just saying that that ends up being taught from a lot of different health parameters. And it's also a clean way of eating. Most people think Mediterranean and they think well lots of breads and lots of starchy things and that's actually not true. A lot of it is plants, especially the really good non starchy vegetables. types of plants. And then if there are grains that are the heart of your grains, right? I mean, it doesn't tell you to eat your carbs as a bag of Doritos. It tells you to go and eat some quinoa on your salad with, you know, an orange on the side. Right. But I think it brings in diets. Yeah, it's idea that there is the perfect thing out there. Right.

Scott Benner 30:23
Right. And that it's going to be doable for somebody because maybe, listen, maybe macro accounting, maybe there's a biologist somewhere that could give you the perfect diet for your body. But where am I getting that from? And where are most people getting there, I have to tell you that a couple of weeks ago, I started getting achy, right. And then I looked in the mirror, and I was like, my face looks puffy. And I went to the Costco and I bought two little roaster, chickens. And for steaks, I smoked them all, slice them up, put them in the refrigerator, and I've been eating those and salads and some of those oranges because they're around the house. for about the past eight or nine days, I'm easily 10 pounds lighter than I was. And I know that I know I'm a fluctuating person, like I know I jump around like because what will happen is at some point, someone's going to give me a piece of bread and I'm going to pick oh my god, bread Does everyone remember bread, and then then I'm going to eat a lot of bread for a week. And then I'm gonna go now my back stuff. And I feel like I gained five pounds and all that stuff. But just if I explain to you that most of my meals have been like a couple of eggs in the morning, and a couple of tiny slices off of that steak, and then at lunch, some some of the chicken and some of the steak with a salad. And I've I feel great. And I know it's true, like because I've been through it enough now now to talk my stupid childish insight into like, just continuing on that way that I don't know if I'm ever gonna get to do but I do know, it's honest. And it works for me. And I've seen it work for other people to like you take out processed food and carbs. And you're you're better off like, I don't know, it just seems obvious. But

Jennifer Smith, CDE 31:56
it's it's, you know, like you said, you're not focusing on like macros, you're not focusing on how many do I need in a day, you're what we end up finding. And I think this is the premise behind a lot of the like, the Palio kind of diet and the Keto type of diet, right, it's, if you're following the rules of those plans pretty well, they can be very clean eating plans, they can, there can also just like being vegetarian can be or vegan can be very healthy way of eating. But there are also like the complete like backside of that where you're eating a lot of processed vegan or like the Keto like kinds of things that are like the treats and whatnot, if you're focusing your intake on a lot of that kind of stuff, you're lacking in quality, and then your macros may very well without you realizing it be completely out of order. And I think that's why a lot of like plans like this end up failing, you know, I followed keto. And it was supposed to be this magic, like weight loss, and I also have diabetes, and it was really supposed to help with my blood sugar management and whatnot, well, I haven't lost any weight, well, maybe there are some things then to evaluate within it, you know, the keto diet is a way to get your body to start utilizing fat instead of carbs. So if you haven't really analyzed how you've broken that down to make sure that you are one maintaining ketosis in the right way. And that the kinds of like carbs that you're eating are really not offsetting, then it may not work well for you

Scott Benner 33:42
don't you find that you have to be in tune with what your what satisfies your body? Like, not what satisfies your brain, right? But what satisfies your body. And I've absolutely I've seen myself go either way, like where you're just eating for taste and flavor and comfort. And that's never usually good for your body. And then there's a way where you're just sort of never hungry. It's that's where I am this week. I have not been hungry this week. And if I have had any like Inkling towards a sweet, I've been specifically careful to take just like dark chocolate, like just a little bit of dark chocolate like this will this will get me through like, what I'm assuming is basically withdrawals from flour and sugar and stuff like that, you know? So I don't know like, are you telling? Are you telling me that all these questions aren't even worth looking at? Or should we ask them? No,

Jennifer Smith, CDE 34:32
I think they're very worth looking at because I think some of them may relate to what we've kind of already gotten into. And then some of them, I think are really good questions in terms of the why it wouldn't be working right? Or why it might actually work. So yeah, let's pick a favorite

Scott Benner 34:53
or should I just pick, you just pick? Well, so Jennifer's asking about her son, she says any any advice on how to balance All this high carb gluten free food for my growing always hungry 14 year old T one D with celiac. So she has a son who seems to need blending down. And at the same time, she's giving him a lot of carb heavy stuff, because it's like it's some of this. For the celiac diet, it seems like right? The gluten stuff,

Jennifer Smith, CDE 35:22
right. And that's, I mean, celiac is a hard addition, it definitely is. Because while we now have a plethora of gluten free, very tasty products on the market, most of them are made with very, very processed, very high glycemic, I mean higher glycemic than even your wheat based bread, you know type of pasta, whatever it might be. So when you start processing things like rice into a flour, or you know, potato into a flour, you have a quicker digestive component to that, and it raises the blood sugar faster, its glycemic index is just high comparatively. So when you have to do these types of things, especially if you have a teen who is growing is active, but also could maybe use some slimming down or maybe needs to gain a bit of weight. One, it's maybe sitting down honestly, with a dietitian to see what are my child's growing nutrition needs right now? Are we you know, keeping kind of a log a couple of days of what are they really in taking? And then looking at what their nutrition needs should be for the point in life where they are, you know, are they moderately active? Are they heavily active? Are they kind of couch potato video gamers? What is it? And what do they need? And then looking at the kind of food that you put into their caloric need? Again, I mean, parents are typically the purchasers of the food in the house,

Scott Benner 37:06
give or take, you don't think this 14 year olds got a credit card? Yeah, I mean,

Jennifer Smith, CDE 37:11
and my kids, gosh, I mean, if we walk down the aisles in a grocery store, and they see like, the pretty packages, and you know, like, I never go, we don't eat cereal, so I don't go down the cereal aisle, but they'll always have something on like an end cap, you know, at the grocery, especially my eight year old, like, boy, that looks really good mom, I'm like, Yeah, and it's not really good for your body.

Scott Benner 37:35
That's why they have to make the picture. So nice. There's no fun here, stop it. Well, so I

Jennifer Smith, CDE 37:44
think, you know, from from that standpoint, you have to look at what is the child in need of? Are you meeting it? Are you creating access? And then potentially from a gluten free standpoint? Yeah, finding substitutions that can be fit in to meet his tastes, because all kids and teens are different, you know, as much as you want them to eat asparagus. They might not. Yeah, so you know, right?

Scott Benner 38:09
So, so you have to be it's Listen, I know if you've been listening for a while, you know that I took me a while to diagnose my low iron thing years ago. And during that a doctor made me eat like gluten free for a month. And I gained a lot of weight because I went out and bought all these gluten free items. And somehow in my mind, I was like gluten free equals health. That's how it felt to me. So I was like, Oh, it felt like zero calorie stuff when I was going in. And man, it was just not. I think if this was me, if Jennifer was me, and I didn't know what I was doing. I think I'd introduce like, lower carb more meat friendly, like meals, like that's what would occur to me first, right? Make some chicken, make some steak, put it with a salad or a vegetable and maybe cut down on carbs. But then you got to remember like we spoke about earlier, not to dose it as harshly as you would some of this gluten free stuff or you're just gonna create a low and you're gonna then have what you did by with

Jennifer Smith, CDE 39:05
them. Right? And I think you know, when we look at, you know, going back to just that like clean eating idea. Quite honestly, you can be gluten free if you're choosing to not buy as much processed food pretty easily. Yeah, I mean, you know, things like quinoa or like a wild rice or even like a brown rice or what? That's 100% gluten free.

Scott Benner 39:32
It's the fun stuff where it causes your problem. Right? It's

Jennifer Smith, CDE 39:35
not taking it out of the diet. It's just that you know, and I know the struggle with kids I work with plenty kids and teens to know that what they get at home under mom and dad influence because this is what you're eating turns around. It changes considerably once they start to do things with their friends, you know, now gluten free in the picture. If the child is is paying attention to that and knows that they just can't have gluten, they may already then have limitations even compared to what their friends are eating because they know that they just can't do it or they're not going to feel good, right? But in that circumstance, then it kind of takes sitting down and figuring out well, what that what will possibly be there that you could have, knowing that it's still more of like a process treaty kind of thing. But also that, you know, we're not going to do this at home. But you can have it when you're out.

Scott Benner 40:34
Okay. Laura has a question. It says, Is it true that insulin on board prevents the body from breaking down fat? Meaning that in order to burn fat, you need to have stretches of time with only your Basal insulin and no insulin onboard? That's interesting. I've never heard that.

Jennifer Smith, CDE 40:50
Yeah, it is, I guess it's an interesting way to frame it. I mean, we know that in the, we know that in the overnight time period, without any food on board. And on Basal only our body does get into more of that, like fasting state, right, of actually transitioning to some fat burn, etcetera. Because you're on a low level of insulin,

Scott Benner 41:13
I see what she's saying, okay.

Jennifer Smith, CDE 41:15
But when you have insulin on board, technically, there's a reason for the insulin on board. Right? Right. You're dosing for food, so that insulin on board should be covering food that is there. So yes, your body's processing carbohydrates. And your body is not at that point, then going to be in fat burn mode, it's kind of correct in a way of stating it. Yes. I mean, the same thing for a high blood sugar that you've corrected, now you've got iob. And the high blood sugar indicates that there's excessive sugar there, and your body needs to process it. And as such, it's using the insulin to process it and break it down and get it in the right places. So again, technically, as long as there's not an insulin deficit in that high blood sugar scenario, and the insulin is working to get it down, then your body isn't also breaking down fats, either,

Scott Benner 42:16
then is that a vote for intermittent fasting for type ones?

Jennifer Smith, CDE 42:24
It could be and can intermittent fasting work, right? It can. But again, a blanket statement is to stay that any plan that you choose no long term that you can continue this, right. The problem with the diets that are out there isn't the diet itself. In fact, there's a lot of research around a lot of the diets that proves long term, these people have had this success in weight management and cardiovascular benefit, et cetera, et cetera. But they've stuck with it. Yeah, it is the Oh, I'm gonna do intermittent fasting, oh, I'm going to do the keto diet, oh, I'm going to do the, you know, cabbage soup diet for the next month. And once it starts kind of showing benefit, I'm like, I can do, I can kind of step outside of the rules, the parameters, which are often for diets, very black and white. Yes, do this, this and this, but don't do this. And as soon as you do that, don't do this. You've broken the piece of that plan. That was getting you to your goal,

Scott Benner 43:32
right. I found intermittent fasting, the easiest to stick with, because to me what it was was as long as I don't eat, like don't eat after ate, and don't eat before noon. That is basically how I did it. And I have to admit, it's very effective. Now, I realized while I was doing it, that Arden basically does that already, without the late night thing, but she's so young, I don't think it matters, right. But she gets up in the morning and is not normally hungry in the morning. And so I've had to over time thoughtfully balance out how her insulin works in the morning, right? How do I come out of sleep into feet on the floor off to school without a rise that needs a bunch of insulin so that I don't create a low because she really doesn't want to eat until she's done with school or till lunchtime, right? Sure. So basically, Arden does intermittent fast, except she doesn't do 16 Is it 16 Wait 1819 2016 Eight that was embarrassing. Oh, lot of people would edit that out but I'm not going to. She doesn't do 16 Eight and as much as she probably does, like maybe 1410 Something like that. But also she's 16 So she can you know she can like we over Bolus her meal last night for dinner. We had stuffed peppers like turkey stuffed peppers, and and a salad. And my wife, my wife like swung at it really hard and about a half hour after she ate I was like her blood sugar is like stuck at 70 I was like, This doesn't look okay to me like I think this is gonna go the wrong way, you know. And so as it started to trend away, Arden got a little lighter I and she goes Cinnamon Toast Crunch please. So she knew she had basically Pre-Bolus cereals. So she was like, let's do it. And she had some of that had my wife going, I'm gonna guess 10 or 15 carbs less on the Bolus. She hit it right on she was so close. But you know, that's a young kid. And Arden's also helped by other things that I think are worth mentioning here too. Because those of you listening have type one diabetes or love somebody who does, you really have to get your thyroid levels checked. Like you'd could be fighting against a borderline thyroid problem that's making weight loss impossible you know and if you're going to do that you really need to go back and listen to the thyroid episode with Dr. BENITO because the range that your doctor is going to say your thyroid your TSH levels okay in a real badass endocrinologist will not accept you know what I mean? They will not like if you're over a two Dr. BENITO is giving you thyroid hormone. Like then there are people right now who are listening are like oh my TSH is a five My doctor said it's okay. I'm borderline. Yeah, yeah, right. But I but my hair does fall out a little bit or I'm having trouble losing weight or I'm a little nasty sometimes or whatever the other things come. I'm just telling you if your thyroids moving the wrong way, deal with it, because it makes a lot of life easier.

Jennifer Smith, CDE 46:36
And it's a lot within this whole topic of weight management. Absolutely. If you've the Hashi Moto is which is very common autoimmune. Once you've got you know, type one, it's good to get tested thyroid levels at least once a year if not every six months, especially if you've got other family who has a thyroid disorder known already. But that's huge in terms of metabolic

Scott Benner 46:59
Yeah, but you have to you have to advocate for yourself. You can't say oh my god, Scott, you're right. I am tired all the time and I can't lose weight and blah blah, blah, and then go to the doctor and the doctor say oh your TSH is for you're fine. Your TSH just for you are not fine. That's the equivalent that to me is the thyroid equivalent of in diabetes. When somebody says your blood sugar average blood sugar is 180 You're doing great. Right? Right. You might you know you're not dying, but you you're not living at a healthy level. And that has other impacts on your life. This thyroid thing is it is crazy. It is like the equivalent you trust me at this point. I've seen everyone in my family except for me deal with it. It's like taking a long metal like paperclip and just touching it on a computer circuit board to it just mess with stuff. You know what I mean? Yeah, but and with

Jennifer Smith, CDE 47:45
with Arden's doses, have you noticed that when things get out of order, do you notice a shift in her insulin need, because that's very common right away that, you know, metabolically, she's feeling more sluggish, sluggish and fatigued. And insulin is just not working, like it was supposed to work. And if there's a timeframe in terms of adjustment, or even just starting on a thyroid medication, where you will then start to notice a shift back to normal insulin dosing. See, again, that insulin manipulation in terms of the weight management piece with thyroid in the picture have to be very kind of eyes on right to make sure that you're adjusting than where you had bumped everything up in terms of insulin need, you're going to need to start bumping down. And if there's weight loss in the picture at the same time, definite need to bump down or you're going to just run lows Yeah,

Scott Benner 48:41
I there's some times I think I should even have a flowchart for myself like if this then that kind of chart because you're right, if the thyroid level starts to get away, then her insulin needs go up. And then we adjusted it doesn't happen right away and our insulin knees start coming back down again, the same thing with she had to start a birth control pill to regulate her periods. Hall. I lost three months of my life to figuring that out. Like it was just first they gave her a pill with not enough estrogen. And so it was basically just two wasted months. She was exhausted all the time because she was bleeding constantly. So I had to get her through those pills. Those aren't the right pills put her on the right pill that started working the bleeding regulated. Yay. Now she's lost so much blood I had to go get her an iron infusion. Got her the iron infusion. Now we're waiting for that to come back up when the iron infusion comes on board her insulin needs are going to change again. Yeah, vitamin D levels seem to impact insulin knee Yes. I just

Jennifer Smith, CDE 49:44
in fact many people for vitamin D that you bring it up that's another like peace and I think in terms of like, like, again going down the rabbit hole of discussion and weight management the we're kind of on the track of like medications and medications in terms of thyroid as well. less things like iron, but vitamin D, you know, your lab will tell you optimal is between or standard is 30 to 100. Optimal according to the female specific physician that I'd worked with years ago, before I had my first son, she was like, you know, optimal range is really 50 to 70. For vitamin D, she's like, and if it is not in there, you need to be being supplemented, because otherwise, especially with diabetes, vitamin D works on the cellular level. And it allows insulin to be seen correctly, it for lack of a better term, by the cells. And so it lets insulin actually work the way that it's meant to have one of the many things that can, so if your vitamin D level is off, supplement, I mean, in general, someone with type one, adult wise, should be supplementing at least 2000, I use a day. And if your levels are not optimized at least 4000 a day. And if they're really on the low end, you need to be doing like the hyper significant doses of vitamin D for a short period of time, if you like. And then

Scott Benner 51:10
for 50,000, I use and you take one once a week, or something like once a

Jennifer Smith, CDE 51:14
week, or I've even seen some doctors do like 110 1000 iu a day for you know, a couple of weeks and then retest. But vitamin D is huge. And

Scott Benner 51:23
I'm not a doctor, but there's something about vitamin D deficiency and autoimmune that go hand in hand. So just look at the studies out of Finland, right? I tell you, I listen, I take 5000 a day, and I take 5000 A day of vitamin D, I take a zinc tablet, I taken a sorbic acid with iron, and a B 12. And that's that's what I do every day. And that's what you know, my kids do and and everyone here is doing because when the D levels drop, again, problems with insulin, I'll tell you right now too, because Jenny mentioned ranges that you need to be in versus what lab values will tell you, Dr. BENITO back on the thyroid thing said, if you were a woman of childbearing years, anything under 70 for your ferritin is too low. And they're not going to tell you you're low till 20. So she's like, if you are having a period, you gotta be above 70. So there's a lot of things. And then all of these things also impact your body's ability to work correctly, which is in part and parcel of losing weight or

Jennifer Smith, CDE 52:29
losing weight, right. There was one in here that does go along with medications that I think is a really important question. This woman has a son on a medication that is more for like attention. And it's specific to using it versus not using it school year versus spring date break or summer time and what ends up happening in terms of insulin needs. And I think it's an important one, because I've seen a lot of kids who are using Add ADHD kinds of meds. And a very, very common thing with those is that it decreases appetite. Okay. And if they're using it in their school day, and they're also the brain uses carbs, and so the more thinking that's going on, and the potential that they're really not hungry, they may not even finish the lunch that you packed for them, they may pick at the lunch that comes from the school lunch, because their brain is just saying, I'm not hungry enough to eat, okay, you may end up having to have two types of Basal profiles, maybe one for like a spring break time off another one for school days. And again, as kids get more into the teen years, that becomes really beneficial in terms of growth and the potential for weight gain in the wrong direction. Because if you're constantly feeding loads again, or constantly adjusting insulin up and down, but it's kind of willy nilly and not quite right on with need. It's a medication adjustment kind of thing that goes along with adjusting insulin again.

Scott Benner 54:11
We're right up on it. But there's enough questions in here that all circle around menopause. Do you have any feelings about what happens at that time and Chinese? Yeah,

Jennifer Smith, CDE 54:20
that's a fun one. For myself. In general menopause in and of itself. I mean, perimenopause really is the start of kind of that time period in a woman's life where your cycles might start to get less evenly spaced. Right. Let's say you were the typical like 29 days and you was right on spot and now like, huh, now it's like 26 days and next month, it might be 32 days and then maybe 29 days and, you know, periods can get a little bit more aggressive, or kind of look more spotty, but that perimenopause kind of leading into menopause, which is really A woman has not had a cycle in a 12 month time period, right? So insulin needs can look very jumpy, you might even find that, again, as we get older. And these things come into the picture from a female perspective, our metabolism does slow down, we oftentimes start to need a little bit more insulin, or it takes a little bit more activity to maintain or burn off what we were able to do when we were 30. That doesn't work anymore when you're 45 or 50. So I mean, menopause, perimenopause, it brings in a whole circle of hormone impact, right, that may more aggressively change your insulin needs, especially around your cycle times.

Scott Benner 55:50
So not unlike, well, I guess, more aggressive but not unlike having your period and seeing right hormone fluctuations throughout the month,

Jennifer Smith, CDE 55:58
right. And then once you're in menopause, oftentimes, you know, outwards of a year or two post no longer having a cycle. Many times, then insulin levels should get more stable, because you don't have that hormone flux. And as we age men and women have less and less and less growth hormone cycling anyway. And so we end up especially women passed about the age of 65, or people passed about the age of 65. Oftentimes, their baseline Basal needs definitely go down. Okay. And the reason they are is because their hormone Cycling has kind of started dropping off.

Scott Benner 56:39
Okay. All right. Did we do this justice in an hour? Because I feel like we did, but I don't know much.

Jennifer Smith, CDE 56:45
I think that we did as much as we could get it in an hour. I mean, if we really wanted to focus in again, dig really deep into that information hole. There's a whole bunch of out meds that are very specific to like weight loss, and, you know, things like the GLP ones, and things like the SDLT twos, and what, despite them being type two meds, they are getting a lot more. They're kind of climbing on the ladder of benefit for those with type one and who are just insulin users. And they do have promise in terms of weight management, if use the correct way. Okay. So

Scott Benner 57:32
do you feel comfortable talking about that? Because maybe say here that if you liked this episode, look for that one coming in? Yeah. Okay. Great. Thank you. Yeah, Jenny, you got to do all the talking. I was at some points. Uncomfortable. Not for because you I was like, huh, there's not a lot for me to do here. I was just checking. I was just saving files and checking rates and looking at questions I was like,

Jennifer Smith, CDE 57:58
so like, I should have just gone and gotten an extra cup of tea. Kind of nice.

Scott Benner 58:01
I should have just said, Jenny, tell me about weight loss. I'll be back.

Jennifer Smith, CDE 58:05
It really is. I was looking at all the questions. I mean, there are a lot of really good questions, but I think a lot of them honestly. Go back to insulin. dosing it the right way for what you're kind of taking in. And then also, secondly, looking at what are you taking in,

Scott Benner 58:25
right? And obviously, in my mind, these questions all are, they're similar, they're tied together, whether it's vitamins, or your thyroid level, or your calories or, or whatever it ends up being is there is a balance that optimizes your body, it's not going to be the same for everybody. Some people's vitamin D level can be crashy load to the floor, and they'll never notice it, and it won't matter to them. But for some people it does. And when you get those things in the right balance, then you feel better and feeling better. To me. It's like you feel stronger, you're more rested, like all this stuff happens. You're clear in your mind. But how but some of these things nobody would even know to look into. No, you know, even vitamin D like I can remember 10 years ago, my Ardennes nurse practitioner gone. We're gonna start checking vitamin D was almost like a mandate came down from a mountain. You know what I mean?

Jennifer Smith, CDE 59:15
Yeah, actually, I don't even know when that would have been. But if it wasn't, I remember when I was working in DC, and the endo practice I worked with within the, our director was very, like high up within the whole, like diabetes management like realm of information. And his he was like, we're testing vitamin D levels for every person with diabetes. And at that point, it was really just, if the thought was it was relevant more to type two. But as we started testing, then I went to my own Endo. And I was like, you know, I run I'm outside all the time. I have like, you know, like brown skin from being outside. Like, I don't take my eye like I'm sure it's fine. In fact, I didn't mean the level came back and my doctor himself called me not as nurse. He was like, This is really weird. But he's like, I want you to go and get it tested again. He's like, This can't be right. And my level was 18. Yeah. 18. And so when I got it tested again, nope, it was 18. Again, he was like he did he that was the one time a week, the 50,000. I use, I came back in eight weeks, it had moved to 21. And he was like, huh, so I he sent me to see like a naturopath, who was also a physician who knew a little bit more in that realm. And she actually had me started, she started me on oral drops, okay. And the drops get absorbed through your oral mucosa rather than having to go through your gut. And because we know there's a lot in terms of gut and absorption in autoimmune disorders, she's like, I guarantee your body's not absorbing it. She said, that's the problem. And is it within about I think it was 10 weeks after that, I got it retested and was already up in the high 40s. Yeah,

Scott Benner 1:01:04
you know, I have to, I thought I was gonna have to live getting iron infusions my whole life, because I couldn't absorb it through my gut. And I do probably have some, like, weird stuff going on down there. And instead, I mix it. So first of all, I use a really pure, like, supplement from a company that, you know, you can do your own research and find one that you like for yourself. But I researched out found a really pure supplement, and I have to take the iron within his sorbic acid at the same time. I do that it absorbs great if I take just the iron tablet without the sorbic acid, we won't work. Yeah, that's it. There's a over the counter when called vite Tron or vitamin D or something like that. It's it's iron that comes with its C, vitamin C, together that helps that too. But yeah, these are the kinds of things no one's going to tell you about or they're just gonna blurt out. We're testing for vitamin D now, then you come back, quote, unquote, in range, and they don't give me one anyway. And you're like, Well, this was a lot of fun. So anyway, everybody balanced your body, balance your insulin. Things should get better. That makes sense. All right. Thank you, Jenny. Yeah, you're welcome. Absolutely. I want to thank assenza diabetes for sponsoring the remastered diabetes Pro Tip series. Don't forget you can get a free contour next gen starter kit at contour next one.com forward slash juice box for E meter, while supplies last US residents only. If you're enjoying the remastered episodes of the diabetes Pro Tip series from the Juicebox Podcast you have touched by type one to thank touched by type one.org is a proud sponsor of the remastering of the diabetes Pro Tip series. Learn more about them at touched by type one.org. A huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G voc glucagon.com. Ford slash juice box, you spell that GVOKEGLUC AG o n.com. Forward slash juicebox. If you're living with diabetes, or the caregiver of someone who is and you're looking for an online community of supportive people who understand, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, there are over 41,000 active members and we add 300 new members every week. There is a conversation happening right now that would interest you, inform you or give you the opportunity to share something that you've learned Juicebox Podcast, type one diabetes on Facebook, and it's not just for type ones, any kind of diabetes, any way you're connected to it. You are invited to join this absolutely free and welcoming community. I hope you enjoyed this episode. Now listen, there's 26 episodes in this series. You might not know what each of them are. I'm going to tell you now. Episode 1000 is called newly diagnosed are starting over episode 1001. All about MDI 1002 all about insulin 1003 is called Pre-Bolus Episode 1004 Temp Basal 1005 Insulin pumping 1006 mastering a CGM 1007 Bumping nudge 1008 The perfect Bolus 1009 variables 1010 setting Basal insulin 1011 Exercise 1012 fat and protein 1013 Insulin injury and surgery 1014 glucagon and low Beegees in Episode 1015 Jenny and I talk about emergency room protocols. In 1016, long term health 1017 Bumping nudge part two, in Episode 1008 teen pregnancy 1019 explaining type one 1020 glycemic index and load 1021 postpartum 1022, weightloss 1023 Honeymoon 1024 female hormones and in Episode 1025, we talked about transitioning from MDI to pumping. Before I go, I'd like to share two reviews with you of the diabetes Pro Tip series, one from an adult, and one from a caregiver. I learned so much from the Pro Tip series when our son was diagnosed last summer. It really helped get me through those first few very tough weeks. It wasn't just your explanations of how it all works, which were way better than anything our diabetes educator told us. But something about the way you and Jenny presented everything, even the scary stuff. That reassured me that we could figure out how to deal with this, and to teach our son how to deal with it too. Thank you for sharing your knowledge and experience with us. This podcast is a game changer 25 years as a type one diabetic, and only now am I learning some of the basics, Scott brings useful information and presents it in digestible ways. Learning the Pre-Bolus doesn't just mean Bolus before you eat but means timing your insolence so that is active as the carbs become active, took me already from a decent 6.5 A one C down to a 5.6. In the past eight months. I've never met Scott But after listening to hundreds of episodes and joining him in his Facebook group, I consider him a friend. listening to this podcast and applying it has been the best thing I have done for my health since diagnosis. I genuinely hope that the diabetes Pro Tip series is valuable for you and your family. If it is find me in the private Facebook group and say hello. If you're enjoying the Juicebox Podcast, please share it with a friend, a neighbor, your physician or someone else who you know that might also benefit from the podcast. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Jenny Smith 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 a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She's also had type one diabetes for over 35 years and she works at integrated diabetes.com. If you're interested in hiring Jenny, you can learn more about her at that link.