#1068 Turkey Tutorial Remastered

November 22, 2023Scott Benner

Prepare for Thanksgiving—or any day—with Scott as he applies all the core principles of the podcast to this potentially anxiety-producing holiday. He discusses tried-and-true concepts like being bold with insulin, bumping and nudging, using increased temp basals and extended boluses to provide a “blanket” of insulin to help make the grazing and unusual mix of food associated with the day easier. Episode first aired on November 21, 2017 as episode 139.

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

Scott Benner 0:00
Hello friends, welcome to episode 1068 of the Juicebox Podcast

Today's episode is quick and to the point. It's called Turkey tutorial. This episode is a mainstay on the podcast if you're new to the show, you might not know it. If you've heard it before you're in for a treat because the audio has been completely Remastered. This episode first dropped on November 21st 2017. What you're getting is a quick kind of, it's a pep talk, and it's a pep talk for how to Bolus on a day full of food. I put it up around Thanksgiving, for obvious reasons, but the truth is, what you hear inside will work for you every day. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. If you're looking to save 40% off of your sheets and towels and other comfortables use the offer code juice box at checkout at cozy earth.com. And don't forget to check out all of the sponsors. Right there in the show notes of your podcast player where juicebox podcast.com.

This episode of The Juicebox Podcast is sponsored by the Omni pod five, Omni pod.com/juice box, my daughter has been wearing an omni pod every day since she was four years old, she is now 19. And I am completely comfortable saying to you that you should go and learn more about Omni pod five, or the Omni pod dash at Omni pod.com/juice box where the same insulin pump that my daughter wears, check out Omni pod. Just gonna go through a couple of ideas, talk about them very briefly. And then I'm going to ready? Let's jump right in. When I'm making insulin decisions. For Arden, I have a bunch of tenants to some basic concepts that I consider each time. So I'm going to mention one of them. I'm gonna talk about it for a little bit. Here's the first one, do you find yourself being accepting of high glucose levels higher than you want them to be because you're afraid of insulin, I understand if that's how you feel. But you need to get over that you have to get past that part until you dispense with your fear and stop looking at a 200 and going well. 200 is not bad. 150 is not too bad. At least it's not 250 until you can stop doing that your own head, it's going to be difficult to move on. So you have to dispense with the fear. Fear and diabetes do not go hand in hand unless you let them. Insulin is like fire in as much as it should be respected but not feared. It's a simple concept. Sometimes it's hard to bring into practice. Don't be afraid Be bold. You'd much rather have a lower blood sugar to deal with than a higher blood sugar to deal with, especially on Thanksgiving. I mean, wouldn't you rather have a 60 than a 260? Right? Wouldn't you rather be fighting with a 70 Diagonal down that might need a little more food, especially on a day when there's so much food around the house anyway, then a 270 Diagonal up. You don't want to be fighting with a 300. That's sort of how a day like Thanksgiving gets ruined, you get a blood sugar up and now the anxiety, the guilt and the insulin in your Bolus and eventually you crack the 300 all sudden it's crashing down. You'd much rather just overdo it a little bit with insulin, and then just have to stop a little bit of a low. The next thing you need to consider is action time. How long does your insulin take to begin working? And how does that affect your blood glucose you need to understand that you're never going to be able to balance the insulin the carbs together if you don't understand how the insulin works, when the insulin goes in how long until it starts moving my blood sugar. This is incredibly important to understand and very easy to figure out. Whatever your blood sugar is right now, if it's 150 and you haven't had insulin for a few hours, give yourself some insulin. When do you see it start to move, do a little testing little trial and error figure it out once you understand how long it takes for the insulin to begin working. That is a key building block for the rest of what you're going to do. Okay, next big thing. Big part. Here we go. When your blood glucose levels are high, you've likely miss timed, miscalculated or combination of the both your insulin exactly the same if your blood sugar is low. You have Miss timed, miscalculated, or possibly a combination of those two. You've lost the balance between carbs and insulin. But there's no great secret about why your blood sugar's high. We sometimes can get caught up in the whys like Is it because of my pump is old or maybe my insulin tool. Do you see people all the time going through all the myriad of things? Why is my kids blood sugar 250 I can't figure it out, here's why you don't have enough insulin. The reason you don't have enough insulin really isn't important in the moment more insulin, it's something to understand in a bigger way, because it has applications throughout diabetes. If your blood sugar's high, you haven't used enough insulin. And if your blood sugar's low, you've used too much insulin. Now, maybe that's a balance between the timing and the amount. But still, it's a basic concept that will hold true over and over again, here's a simple rule of thumb I use all the time it cannot be overstated. Trust yourself, and what your experiences with diabetes have taught you. Very simple. It's a convoluted sentence that makes the point, you have to believe that what you know is going to happen is going to happen. If I Bolus this much I know this is going to happen if he eats that, but I don't give him insulin until he's done, I know this is going to happen, you have to trust that you know what's going to happen is going to happen. And then you need to do something to stop it from happening. Here's another one that's very important, especially on Thanksgiving. Don't confuse carb counting with carb understanding. Because not all carbs are created equal. You can't just say, well, that's 30 carbs, it's going to do this, it needs this much insulin, that's not true. 30 carbs of one food may affect your blood sugar much differently than 30 carbs of another food, it is much better for you to look and say that's two slices of bread. I know when two slices of bread are consumed, it requires this much insulin. Forget that two slices of bread are five carbs less if it's that kind of bread or five carbs more for that kind of how much insulin is it going to take for those slices of bread? When you look at a pile of stuffing? How many pieces of bread are there? How much insulin is that going to take? Don't worry about the count or the amount of the weight? Worry about what you know what happened last time when he ate the sandwich? How much insulin did it take, let's say I looked at a food and I thought I can lower my carbs. I said that's five units of insulin. Then I gave the five units of insulin, I did a reasonable Pre-Bolus. And still, my blood sugar ended up at 250. And I had to do three more units to bring it back down to where I wanted it. Well, if it took five units up front and three units to bring it back, you probably needed eight units of insulin. Give it all up front, get rid of the spike. If you really time the Pre-Bolus Well, we're gonna talk about Pre-Bolus in a minute. But if you're really time that Pre-Bolus Well, maybe you don't need the full eight, maybe it's only seven. These numbers are specious. They're not specific to you. But you need to figure that part out. I use this much, then this happened. So I needed this much more. I probably needed that whole amount up front. That's the rule. I can tell you that I Bolus the amount that I think is correct. I really never count carbs. I never worry about what my insulin to carb ratio is tell me, I worry about what I historically know that food is going to require. Same thing with a high blood sugar. I see a high blood sugar that stuck and I need to Bolus for I don't worry about what the pump says. I worry about what works. Okay, Basal rates for those of you who are pumping. If you find yourself bolusing all the time, your Basal rates are probably not correct. You should not need the Bolus just to keep a blood sugar where you want it. Don't be afraid to adjust your Basal rates even temporarily. Well, let's use Thanksgiving is an example. If there's going to be more food, the food is going to be more consistent than usual on Thanksgiving, increase your basil by how much? I don't know. I can't tell you you can figure that out. But I can tell you that when I make adjustments to Arden's Basal rates, I usually move them 30% of the time. I'm just going to jump in here for just a moment. Omni pod.com/juice box Omni pod is sponsoring this episode of the podcast. And they'd love it. If you'd go check out the new Omni pod five, or the Omni pod dash at my link, Omni pod.com/juice box tubeless insulin pumping. It's the way it's meant to be. Go check it out and get started today. There are links in the show notes and links at juicebox podcast.com to Omni pod and all the sponsors. When you click on these links, you're supporting the production of the podcast. When she has a growth spurt. I'm starting to Bolus too much to keep blood sugar's where I want them. I raised her basil rate I raise it by 30%. See what happens. So you can use temporary basil on days where you're going to be really food heavy. I think on Thanksgiving. I'm going to talk about what our day is going to be like at the end but I'm going to start setting Temp Basal for Arden right away in the morning. Managing type one diabetes is all about understanding the limitations of manmade insulin, having the nerve to be bold when you're using it. And most importantly, acting first. When you wait for diabetes to attack you. You will always be on the Defense Act don't react. I'd rather Bolus and have something happen, then at least I can say, Okay, I did this and that happened next time. I'll do this. It brings up a very simple formula for diabetes. It's the it's the E equals MC were of the Juicebox Podcast, I Bolus to half a unit, the blood sugar moved 40 points, I wanted it to move at points. So next time I'll Bolus a unit, I Bolus 10 units, but my blood sugar still went up to 150. Maybe next time, I'll do this much. I did this, this happen, I wanted this to happen. Next time, I'll do this, the E equals MC squared of the Juicebox Podcast. Okay, let's

talk about Pre-Bolus thing and the tug of war of the carbs and the insulin, I want you to picture a tug of war between the carbohydrates and your insulin, in the middle of the rope is a flag. Now, unlike most tug of wars, the goal isn't for one side to win, the goal is for both sides, the pole and the flag to never move from the center. That is the balance of your blood sugar, that flag, if you start eating, when your blood sugar is 180, you're going to be high, there's not a lot you can do about it unless you're credibly aggressive with with insulin at the time. And that's maybe hard for some of you to do. So give yourself a chance at these meals and Pre-Bolus. Now, I can't tell you how much of a Pre-Bolus is right? But we did talk earlier about understanding how your insulin works. Get that understanding of yourself, can I give myself insulin, 15 minutes before I eat, can I give it to myself? 10 minutes, 20 minutes, it differs for everybody. But what you want to happen when the food starts affecting your body, you need the insulin to already be working. So that while the carbs are pulling up on your blood sugar, the insolent is pulling down, and they're fighting and they're pulling on that tug of war rope but they're not winning, no one's winning, because no one got a head start, you give one of them a head start, that's going to be the side that wins. If the carbs pull first, then they're always going to be winning and you're gonna have a hard time to get back into that game unless you add so much insulin that eventually you all go crashing the other way you don't want that. If the insulin pulls too soon before the carbs start working, you're gonna get really low and you don't want that either. You want the insulin and the carbohydrates to pull at the same time. And the most important thing is they need to stop pulling at the same time. A low after a meal just means that you had insulin left in your body after the carbs were gone. A high after a meal means you had carbs left in your body after the insulin was gone. It's all about the timing. Remember what I said if your blood sugar's high, you've either miscalculated or mis timed and if your blood sugar's low, you've either miscalculated or you've missed time, a significant Pre-Bolus one that allows the insulin to be working when the food starts working, is key. If you want to stop a spike at a mealtime, that's it. Now if you didn't stop the spike, don't just wave your hands ago, I got it wrong. You see a blood sugar that's going up, attack it, especially if you have a Dexcom CGM stop the arrow. But I mean, with a big carb heavy meal like this, your kid eats test again and a half an hour see where you're at. If you're 200 a half an hour after a meal, you miscalculated or miss time, you may need more insulin, how much more is up to you. But you want to stop that rise and get it back where you want to without overtraining. And that is really one of the last points. You can't over treat. You can't over treat a low you can't panic and pack in the whole refrigerator for a low and you can't panic and packing too much insulin for high or you will be up and down all day long. It's about bumping and nudging your blood sugar if you have a Dexcom. Think of that line on your CGM graph is something you're just trying to nudge just up and down like a little video game. Just try not to leave the lines. And if you're testing, and you don't have a CGM test frequently and bump and nudge and bump and nudge, keep pushing that blood sugar back to where you want and expect good things for yourself. Set a goal for yourself of around 100 have around 80 of around 90, because often you get what you expect, especially with a CGM. Please move your tolerance lines to a lower spot. You don't want a high tolerance on your CGM of 200. It's too late by then pull it 130 react upfront. Remember what we said you're either going to attack or be attacked, you would much rather act first. So axial 130 Diagonal up, bump it with a little bit of insulin, see a 70 Diagonal down, bump it with a tiny bit of carbs. Or maybe you can even stop a 90 day going down by just restricting your Basal for a little bit. You'd much rather do little bumps than giant corrections. As someone once said high blood sugars cause low blood sugars because you're sending so much insulin and you're bound to get a low later. When you bump and you nudge they're just these tiny little corrections. They don't really have the opportunity to push you too far one way or the other. So on Thanksgiving morning we're going to wake up we're going to fall one of my wife's family traditions of having cinnamon buns. Now I'm going to get up a little bit before my daughter to make sure that her blood sugar is nice and low and steady so that when I Pre-Bolus for these cinnamon buns, I have a good starting point for the day. There is nothing more important than a good starting point. After that there's going to be food around the house all day I'm going to be using Temp Basal rates increased I will stop them and start them as need be when it's time for them. meal, I am going to look at the plate, I'm going to do my best to decide how much insulin this is going to take. And I am going to Pre-Bolus. I'm going to be bold when I Pre-Bolus. And I'm going to try to time the food in my daughter with the insulin beginning to work to get that tug of war that we talked about. If I miss, either with too much insulin or too little insulin, I'm going to make small adjustments. And I'm going to keep on top of it during the day, it's going to take a little bit of effort, but not a lot. And I'll tell you what, it's way better than having blood sugars all day that make you feel sick to your stomach, that give your kids a foggy feeling that make them have a terrible time and give you the guilt that you know you don't want. And if you're an adult living with type one diabetes, trust me, it's much easier to pay attention up front to make the small decisions that give you good outcomes than it is to be stuck thinking about this all day long. Towards the end of the day, we'll do our best when the pie comes out and the ice cream and all that to keep ahead of it. And if she gets a little low at some point, we'll add a fast acting card where it's necessary, because it is far easier to stop a low or falling blood sugar than it is to affect the high one. But I'm not going to let this day be ruined by the fear and the anxiety and high blood sugars. I don't think you should either. Please remember that nothing you heard today is advice, medical or otherwise, I wish you a ton of luck and success on Thanksgiving. I hope that being bold helps you. And if you're listening after Thanksgiving, these things that I do. I do them every day of the year, not just on Thanksgiving. I just thought today would be a really nice day to say Happy Thanksgiving. Here's some of the things we've been talking about in the last 138 episodes, the Juicebox Podcast, please if you're just finding this episode, now go back and listen, there are hundreds literally, of conversations with people just like you. We talked about type one diabetes, what it's like to live with it, what it's like to try to management. These kinds of tips and tricks are scattered throughout every episode. I think you'll love them. So that episode was Wow, November 21 2017, and episode 139. There are now over 1000 episodes of the podcast. Actually a number of the episodes are grouped together so they're easier for you to find you can go to juicebox podcast.com. And kind of look at these with me if you want or you can go in the private Facebook group Juicebox Podcast, type one diabetes, and go up into the feature tab. They're listed there as well. But we have the diabetes Pro Tip series. Now that's also recently remastered and runs between Episode 1001 1026. But there's also the diabetes variable series mental wellness type two diabetes Pro Tip series how we eat defining thyroid defining diabetes bold beginnings algorithm pumping after dark. Ask Scott and Jenny and much more. You just want to talk about the management, the nuts and bolts of diabetes. Everything you need is right here at the Juicebox Podcast. If you're new to the show and you'd like to hear more, please subscribe or follow in a podcast app like Spotify or Apple podcasts. If you don't know about those apps, you can also find a list of them at juicebox podcast.com.

I'd like to thank you for coming and I also want to thank Omni pod for sponsoring this episode of The Juicebox Podcast Omni pod.com/juice box find out more about the honoree pod five or the Omni pod dash and use my link to get started today. I also want to thank everyone who shares the podcast with other people and remind you to check out the private Facebook group Juicebox Podcast type one diabetes and of course, happy Thanksgiving or whatever meal you're using this episode for. I hope you have a good one. Thank you so much for listening. I'll be back soon with another episode of The Juicebox Podcast.