#1118 Grand Rounds: Pregnancy

January 29, 2024Scott Benner

The fifth Grand Rounds discussion focuses on pregnancy.

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

Scott Benner 0:00
Hello friends, and welcome to episode 1118 of the Juicebox Podcast

Welcome back to the fifth episode of the Grand Rounds series. Of course Grand Rounds is Jenny Smith and myself talking directly to doctors about what you need. And today's episode is about pregnancy. 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. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes, but everybody is welcome type one type two gestational loved ones. It doesn't matter to me. If you're impacted by diabetes, and you're looking for support, comfort or community check out Juicebox Podcast type one diabetes on Facebook. When you place your first order for ag one with my link, you'll get five free travel packs and a free year supply of vitamin D. Drink ag one.com/juicebox If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show

this episode of The Juicebox Podcast is sponsored by cozy Earth. use the offer code juice box at checkout at cozy earth.com. And you will save 40% off of your entire order. US Matt is sponsoring this episode of The Juicebox Podcast and we've been getting our diabetes supplies from us med for years. You can as well. Us med.com/juice box or call 888-721-1514 Use the link or the number get your free benefits. Check it get started today with us med Jenny Welcome back. How are you?

Unknown Speaker 2:11
I'm great. How are you?

Scott Benner 2:13
So good. Christmas is over. I hope your holiday was good.

Jennifer Smith, CDE 2:16
It was really really nice. It was quiet. It didn't do a lot. We didn't go a lot of places. So there. It was just nice to be quiet and enjoy time. Yes,

Scott Benner 2:27
I'm a fan of that as well. We sat around I think one of the best things we did this Christmas is we bought this big Lego thing that everybody could work on. And we like Oh, which fat? Oh, it's a 3d portrait that you hang on the wall. Oh, I see no. Spider Man. Okay, yeah. So we just saw like, it started off all four of us. Then I think Kelly and I got tired. And then Arden kept going for a while. And then the next day I saw Cole come back into it. Arden Arden was the one that was really focused on it, though. She sat down and she really hammered through it. And it's all done now. And now I'm like, Oh, we have to hang it up somewhere. So yeah,

Jennifer Smith, CDE 2:59
they started bringing those out quite a while ago, I remember, my husband's my father in law really, really, really likes Marilyn Monroe, like, really likes her. And they had one of her quite a number of years ago. And we had looked at getting it and at the time, we were like, oh, we'll just wait until it's like a little bit last, like a holiday sale or something that'll get it for him. And then it was gone. anywhere anymore. So we missed it.

Scott Benner 3:26
This was not inexpensive. But I did catch a sale. And I thought it's about the cost to take us all to a movie. And we'll kind of sit together and it was nice. So I'm glad you had a good holiday. Yeah, we

Jennifer Smith, CDE 3:38
did. Thank you, of course. And it's almost the end of the year. This

Scott Benner 3:41
is it. It's December 29. Yeah, we're making a grand rounds episode today instead of doing whatever it is we usually do at the end of the year. Usually we just sit around and chitchat. But this year, we're gonna we're gonna put some effort into these series, which I'm very excited about. Actually, as you and I are recording like the eighth or ninth episode of it today. The very first episode of it actually goes up in a couple days on December or January 2. So yay. I'm excited for people to hear it. Today. I thought we could talk about pregnancy. Well, now this is a topic that when we asked the audience about it, to be honest, not much came back from them. Oh, but of course you were very passionate about it when we were putting the list together. For people who don't know Jenny co wrote a book about pregnancy with type one diabetes called Yes,

Jennifer Smith, CDE 4:28
it's called pregnancy with type one diabetes your month to month management. Your monitor my blood glucose management? Yes.

Scott Benner 4:37
Can you put our sales voice on there? She's like, Well, hello. It's important because not only does it present a number of issues along the way trimester to trimester and after giving birth and through the postpartum time, but I think that from a human perspective, a lot of young women who are dying Most young women that I've spoken to who are diagnosed prior to the years where they want to have children spend a lot of time thinking that they can't have kids or that it's not going to work out well for them, or it won't be a healthy experience. It's a lot of fear leading up to that, right. And I'm wondering if doctors couldn't do a good job of being able to talk to them in those years. So they don't spend that time scared of what's coming. So maybe like, let's start there. Let's talk about what doctors should be saying to young type ones, or you know, anybody at all really, who might be thinking about having a baby one day, that can give them some comfort and guidance, and maybe start getting themselves together in their mind to think that this is doable? Because it is

Jennifer Smith, CDE 5:43
it is absolutely. And I think you're considering it from the right starting point. You know, any young woman who has started monthly menstruation, right or monthly period, should be told what could potentially come from now having a monthly cycle, right? I Pregnancy is a potential. And if women don't understand from an early age on what that may mean, even though in the teen years, I would, I would expect that most women are not considering pregnancy, right? That's just not what their plan is at this time. In fact, it's much more about prevention. Yeah, at that point,

Scott Benner 6:27
the way I hear my daughter talk about it, she just thinks about that if she believes it's going to hurt and she wants to avoid it. That's

Jennifer Smith, CDE 6:35
great. But hopefully somebody teaches her that that's not really the truth. But But yeah, the teen years are when to start that discussion of even if it is in a preventative way it's know that if a pregnancy happens, whether it's unwanted or you know, unplanned, I should say not necessarily unwanted, unplanned or it's later on planned and something you definitely desire, your glucose management is going to shift, it's going to need to change your targets are going to change. Understanding how to navigate insulin management and everything else within that time period becomes tighter and kind of just much more controlled overall. And so from a non scary standpoint, starting out by saying you can absolutely have children, if that's your desire, someday, even though you don't want it now, Someday you may want kids and if that's the case, you can have them. I

Scott Benner 7:34
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Jennifer Smith, CDE 9:57
Nobody in this day and age He should be being told, Well, you have diabetes, and you should consider never having children. Or you should really think that you don't need children down the road, right? They shouldn't be told

Scott Benner 10:10
that it's going to be so difficult that it that it makes them think, Oh, I can't do it or, you know, you put it off. Also, you know, this also impacts people's personal relationships. If you're, you know, getting serious with somebody, and that person one day mentioned, oh, I can't wait to have kids one day. And you know, you're secretly harboring inside of you, I can't have children, my a one C seven, I can't, the doctor said it needed to be six. And I don't I can't figure out how to do that. It just has a lot more impact on people than I think it meets the eye perhaps. Right. And from my perspective, I spend a lot of time like you have talking to people about their diabetes and how to help themselves. From my perspective, it all comes back to the basics, right? Because right now, what I hear from women who are just experiencing a cycle, just a monthly cycle, is I don't know what happens, you know, there's a week where everything goes nuts, I just accepted my blood sugar is going to be higher. And instead of teaching them how to handle that cycle, we tend to teach them that that's, that's the cost of doing business, you know, right. And that's just not right. But now, yes, that impact, which is significant, any woman with a period who has type one knows how significant it is the need for insulin, how it changes and fluctuates. But that's going to happen times a lot more during pregnancy. So if you know how to handle your cycle, prior, I think it gives you a better chance to handle your pregnancy, then it does, yeah,

Jennifer Smith, CDE 11:34
absolutely. It also sets you up with the idea, you know, anybody who's going to a gynecologist for just, you know, the yearly checkups, and all those kinds of things. That's honestly, outside of endocrine, bringing up this topic, especially from a female perspective, your gynecologist should also be bringing this up seeing on your medical history that you have diabetes, it should be a piece of the discussion, you know, what are you doing for prevention? Or are you planning a pregnancy, if you are, this is the protocol, I'll stay with you for this portion, you may need to be handed off to a high risk doctor for this portion of it, or you're going to go right to a high risk doctor for this. And the idea of then how to navigate and what to expect should be part of that discussion. So that again, there's a fear factor that's removed, you can see that it's doable. But you can also see that having kind of your ducks in a line, if you will, is really, really important. Pre pregnancy, that preconception time is so valuable. Once you are pregnant. You know, I usually when I get to start with somebody, I hope that I get the preconception time so that we have, you know, one, two, even three months to work on, as you said, getting things all in order, getting Bolus timing, getting meals that are working really well understanding exercise, insulin dosing, and timing and all of that. Once you know that, yes, it will change in pregnancy. Yes, it'll change a lot in the early weeks of pregnancy, because hormones shift considerably, to keep that pregnancy viable. And if you know that ahead of time, you're not gonna be so surprised. Yeah, if you're planning a pregnancy, you also won't be surprised with what's happening. Because you know, to watch for it, right?

Scott Benner 13:29
I think the diabetes tools are universal. Yes. And it's funny that Jenny and I were talking before we started recording, and it's about something different, but this came up managing insulin is, is a lot about Pre-Bolus, eating meals, having your settings right, knowing how to react if something goes wrong, not staring at a high blood sugar. Like these are just kind of basics that if you go through the Pro Tip series, you'll understand. And then after that, you apply them in different situations. And I really do think that one of the variables that exists for diabetes is pregnancy. Yes, not this, like separate thing off to the side. Like oh, you know, if you have type one diabetes, this is your life. But if you get pregnant, it's a new thing. It's the same thing with Swift are moving harder impacting variables. Like I think that's it, right. But if you have the tools to react, and the knowledge to say, oh my gosh, all of a sudden, my food seems to need more insulin or my I don't know, my, my, you know, my standing blood sugar. My my basil doesn't seem to be working anymore to hold me somewhere away from, you know, away from food, right? I need to react and do something correct. And it's going to, like Jenny said, with these hormonal impacts, it comes hard and sometimes it by the way, it takes it away as quickly as it gives it to you. Right? So this isn't all about more insulin. This can be at times where you have to back your insulin down. You can't be waiting three days or until the doctor calls back or whatnot. Like when you start having these impacts you need to react and Right, I mean, Jenny, to put an emphasis on the point, what's the increase, you can see in the amount of insulin that some women need during certain points of pregnancy, I'm trying to I'm trying to paint a picture of what the how much it can go up.

Jennifer Smith, CDE 15:15
Yeah, it and an overall again, we kind of think about pregnancy, insulin management or insulin dose changes. It's kind of like a long duration variable. So that's a great kind of way to describe it. It's like a marathon, right? It's not this little sprint that you get through and you take care of it. And the next day is all better, right? Things shift and change, we look at variables, and then we say, okay, over the course of a whole pregnancy, women's need for insulin can double or even triple, depending on what their preconception dose looks like, and what variables that are healthy lifestyle variables that they keep in the place. If you remain active. If you know your insulin dose timing, if you pay attention to the changes that you're seeing, and we usually say in pregnancy, a trend over about two no more than three days suggests a shift that's needed in a setting. It's not a variable. It's a setting that needs to be changed. So we change much more swiftly than many, you know, many other times of life, maybe leave it a couple more days outside of pregnancy. But yeah, doubling tripling insulin needs, especially, you know, by third trimester, by about 30 plus weeks, up until about 36 weeks or so that's the heaviest amount of insulin that you're going to see changes in insulin dosing on about a weekly basis. You know, 10% more Basal adjustments to Bolus timing. I mean, by about 30 weeks, your Pre-Bolus time could be upwards of about 45 minutes, right. So we're thinking, you know, we're thinking, well, ahead of the meal, you're thinking, I have to Bolus and we're looking, of course, nowadays, we thankfully have technology that shows where things are and how they're drifting up, down stable. So we can use that to our advantage. But it's really, really intense third trimester

Scott Benner 17:16
of pregnancy is a job in itself. But pregnancy with type one, it's a real job, like you have extra things to do now. And in a world where doctors don't often give autonomy to the patients, right? They will tell them things like well, next time you come in, we'll adjust that or call me first. That scares people, then people can't make adjustments. So in a world where they're not even able to turn a dial for 10%, more or 10% less, because they feel like they don't have the ability to seriously the wording that comes from people all the time is I'm afraid I'm going to get yelled at. I can't move my insulin because my doctor will be mad at me. Can you imagine? My doctor told me if I change my settings, they'll drop me. Right? Right. So you're taking away people's ability to like, read and react and see what's going on. A lot of them don't have that to begin with. Now you're putting them in a position that Jenny just described where their insulin needs are gonna go up maybe weekly. And then once it really hits in that third trimester, I've heard women tell me meals that took three units took nine units. Yeah, right. If you can't make the leap to go up 10% In your Basal without asking somebody? Where are you going to get the nerve to Bolus nine units for something you think, you know, historically? Three, three, you can't make that decision on your own. Right. So I think that it's more about I don't think we can't help people who have become pregnant, right? Like I know you can. I've heard plenty of stories of people like, Hey, I got pregnant, I didn't want I didn't mean to like it when she was eight. And I boom, I snap myself together. And I got it down. I did what I needed to do. But often those stories are followed by then the baby came, Mia once he went back up again. Right? Yes, she got through the pregnancy and good for the baby. But the baby's counting on the mom for a whole lifetime. So Correct. Why don't we do some things that help her throughout her life, not just for nine months. That's why I think that doctors need to hear this, so that they can be pre planning and laying this groundwork. And by the way, here's the big secret. We're not saying anything here. You shouldn't be saying to a man either, because all we're telling you is they need to understand their diabetes and how to react to it and how to make good decisions and how to see things and, and you know, and go, Oh, I know what that means. I need more. I need less, right. That's what they need. They need autonomy. And

Jennifer Smith, CDE 19:36
on a broad scale, what they also need, kind of talking about here is really a care team. Again, when I work when I get the chance to work with somebody prior to conception. A big emphasis is who is your care team? Who do you know is in your corner? Is your endo on board? Or are they going to shuffle you off to mainly be managed by a maternal fetal man? venison, a high risk doctor is your OB GYN to manage along with a high risk is your team six people deep? You know, and everybody, it's like too many cooks in the kitchen and you don't know who to believe about what? Right. So I think planning again, goes a long way when we're talking about pregnancy, which is almost the course of a year, right? And a care team that doesn't slap hands, that you say, I've made these adjustments, you let them know, because that's also very important for you to tell them what you've done. So that they could acknowledge and say, Okay, I would have suggested that it looks like they did that already. Great. We'll go from here, right? So you have to be you have to be on a team. And you all have to have even jobs on the team. And you have to have that discussion to know who is going to do what part of this? Do you want my records every week? Do you want my CGM information? Do you have an online database that I can download and send information so you can send me weekly, you know, feedback that we can connect in between our visits that we're going to have more and more frequently, right? I mean, that's a piece that unfortunately, some women who have not planned the pregnancy did want it, but they weren't quite sure that it was going to happen so quickly. And now all of a sudden, oh, here we are. I don't know who I'm supposed to go and see, it makes that early, tiny, even a little bit more, I guess, worrisome or concerning, because they're not quite sure who they're supposed to be checking in with. And

Scott Benner 21:28
you may see an increase in women with diabetes getting pregnant soon. This is a little extrapolation, but and very anecdotal, but I'm seeing on some GLP groups online, women who are just like, I don't even practice birth control. It's not necessarily I can't get pregnant, I've been trying for 20 years, they're magically getting pregnant on GLP medications. So sure, you know if maybe this is impacting PCOS, to some degree, which is allowing pregnancies and by the way, PCOS and type one can go hand in hand a little bit. So this could be the time, you know, like, you could see an inflation of people who are like, Hey, I'm pregnant. I never thought this was going to happen. I've never been planning for this. Right? You know, I'm not ready for this at all. I just think that it is so incumbent upon doctors to do more than just say, Oh, you had the baby. Now, your needs are going to change? Well, thanks. Yeah.

Jennifer Smith, CDE 22:23
Like, what does that be? Yeah.

Scott Benner 22:24
What am I supposed to do? I've lived my whole life, not knowing what I'm doing. And now I've have these crazy variables, these impacts are swaying back and forth. And the extent of your help is, look out. It's coming. You know, and if you don't know, it's so disheartening to look into a physician's eyes and say, Well, what do I do? And they got, I don't know. Yeah, just great, right.

Jennifer Smith, CDE 22:45
And even if you did have some fairly good care during pregnancy are really phenomenal team during pregnancy. As you said, that postpartum time period is a very significant shift. And it after nine months of navigating and managing and understanding insulin resistance, and I have this Bolus timing, that's like 50 minutes long, and I, you know, I've, I've stayed away from these kinds of things, because I just can't navigate and I'm trying to control in these target ranges, and now postpartum, well, goodness, all those pregnancy hormones, they like, go and get washed out, they're gone, right? But now what do you have, most women are trying hard to nurse at least to some degree, that can have a major shift in terms of sensitivity to insulin. And if you're not ready for that, if you haven't been taught ahead of time, what to expect, and how to set up, let's say you're using an insulin pump or using injections with a certain amount of insulin. If you haven't been taught to set up a postpartum strategy, or a management plan with your insulin doses, you are going to be on a roller coaster, and it's going to be a roller coaster of a lot of scary lows, quite honestly. So again, those are all things to think about. And as a physician, or you know, a clinician who's taking care of women in the ages where they may be able to get pregnant or may want to get pregnant. These are discussion points that are really, really, really important. They should almost be check offs on that list of everything else you're checking off. They should be checkups have talked about and discussed pre pregnancy planning targets, et cetera, or, you know, prevention techniques, so that they don't have something that's unplanned happen. Yeah, it's just Well,

Scott Benner 24:33
I guess a couple thoughts here. The first thing I'm thinking is, I get worried that doctors will hear Yeah, you're gonna give them information. They're not going to know what to do with it, and they're gonna make a decision that's going to hurt themselves. But I would tell them that it's like learning to drive when you put a 16 or 17 year old into a car, right? And you you say, Alright, here's the basics. You're not teaching them how to drive completely they haven't been through all the experiences and they're not going to react as well as a 25 year old or a 30 year old would in an emergency situation, right. But they're never going to get to that if you don't teach them that the brakes, you know, on the left three guests on the right. And this is how you turn and you don't over, you know, overcompensate when something happens, keep your eyes up, get to teach them all the basics, then send them out there in the world, and let them have experiences. And then one day something unexpected is gonna happen. And you'll see how those experiences aid them in that moment. Because I just I hear it too much like, well, they don't know how to do it. And I tell them to Bolus more they're going to make themselves well, if you don't, the other things can happen. Right. And the other thing is, is worse, in my opinion, right? So when we're talking about lifelong problems, life shortening issues, not I got a little low, I figured it out next time. I didn't use this much. You know, you have to give people the opportunity to to fend for themselves. Yes. You can't just act scared and tell them, they'll we can't tell them because they won't know what to do with it. That's not fair. No. Like you need a shot at taking care of yourself. And the other thing I wanted to bring up is, you were talking about the nursing and how it could lead to lows. Right? Hmm, I think that what you really need to understand as a physician is that if you don't prep somebody for that, and it happens, here's gonna be the decision tree. I'm holding a newborn baby, trying to nurse it, I got low, I'm never gonna let that happen again, right? You just put that person say once the up one or two points, because they're going to be fearful with their insulin from now on. In another situation where they didn't need to be if they knew how to use it correctly. Either that

Jennifer Smith, CDE 26:40
or they're going to stop nursing. Oh, I didn't even think because yeah, if the nursing is what's causing the sensitivity to insulin, and every time they nurse, they put two and two together, and then why gosh, if I just stopped nursing, I clearly wouldn't be low all the time, or I wouldn't have all these issues. I guess I'll just switch to formula when quite honestly, it's better to breastfeed, it's better to provide breast milk, whether it's pumped or it's nursing or whatever it is, it's just better for many reasons. And if those if that's what you put together, then unfortunately, somebody has missed their job and teaching you how to avoid that as a problem not only being too high, and also not feeling great, it great. But on the opposite of that being able to continue doing what you wanted to do to begin with, for your infant, you're

Scott Benner 27:29
just not putting people in the best possible scenario, like that point right there about them, maybe stopping breastfeeding, right. And the health implications of it aside, forget, like, put those aside for a second, you have no idea. Unless you've been a woman or been married to one for 25 years, like I have been their entire life. They'll never let go of it. I wanted to breastfeed that baby and I didn't. And it's gonna feel like a like, it's gonna be a mom guilt thing that will never leave them. And that is another opportunity to alleviate another problem from people. And with what are we talking about some pre planning some light knowledge of how insulin works, and some you know more? I don't know, laser focused knowledge about what's going to happen during your pregnancy and how to react to it. It's not undoable People do it all the time. Jenny shepherds people through it, I get notes all the time. What do you hear me jump out of the pockets all the time, one day, someone's gonna name a baby after me. It has not happened yet. But I did get a dog in something else. Not the point. The point is, is

Jennifer Smith, CDE 28:30
that I do get a lot of great name for a dog. You

Scott Benner 28:34
know, it's not, by the way, my name is terrible. Don't name your baby Scott. It's just very short and Curt, and it's not really very melodic. And I don't think you should do it. But my point is, is that I get a lot of notes from people who say that I just had a healthy baby because of this podcast. And it's just a podcast, you're a doctor, like you could you could do this for people all day long. Right? You know, right?

Jennifer Smith, CDE 28:55
I mean, on the same note of what nursing can do, if someone is also not navigating, and they have a roller coaster, or they're just ending up writing higher blood sugars, from a safety standpoint, that's also going to have an impact on their breast milk production. Okay, right. So you know, hydration is really important. Hydration is a very under discussed, unless you're talking to the nurses in the hospital, postpartum, who are really awesome at bringing you water and making sure you're drinking, drinking when you go home. There's nobody who's going to bring you your water. There's nobody who's going to emphasize how important that is. There's nobody really who's going to re emphasize for you. How important not running consistently high blood sugars is for actually providing enough you know, quality breast milk, honestly. So

Scott Benner 29:50
you're already asking a lot of your body before you're trying to make breast milk. And you see it with people living with diabetes all the time, just being the height graded slows down their insulin use the efficacy of the insulin that they have in them. Now they're pushing more insulin to get the same response. They don't know, all of a sudden they get hydrated or they, you know, they they find a better way and boom, they're dropped low they're eating, you turn the whole life into this, right, this chase that that's just you're always chasing diabetes instead of I don't know, like impacting it and bending it to their will to some degree, you know, right. Especially with CGM, you know, right. All of this is just so eminently possible. And if you're cheese, if you're kind of you're helping a person who's pregnant, you don't have them on a CGM. I mean, you've made a mistake, you know, so correct. Absolutely. We'll talk about the other side of it for a second, Jenny, because we're not horrible people who just think that doctors don't do a good job.

Jennifer Smith, CDE 30:47
First of all, not at all, there are many amazing teams out there immensely.

Scott Benner 30:50
Great, you know, just I've seen it over and over again. But it's not what everybody gets, right. And, you know, if you're in a position to help somebody, and you don't understand these things, I mean, this is gonna sound like I'm saying, just listen to my podcasts, but just trust me enough people listen to it already, that if you as a doctor, don't listen, I'll be okay. So I don't I'm not just asking you to listen. But you could take, I don't know, a couple of hours and listen through some of the Pro Tip series, or you could listen to we have like 16 episodes about pregnancy, from like pro tip episodes about pregnancy down to I think I did an interview with one woman after each of her trimesters, and then after she gave birth, right, like, yep, somebody said, it felt like my insulin needs changed as soon as I delivered the placenta. And I thought, Oh, that's so interesting. Who would think about that, you know, like, she's like that placenta came out, and I was turning down my Basal. And heading back home, I've heard other people say, it took days for my insulin needs to change, like, anywhere in between the least, you know, to look for it.

Jennifer Smith, CDE 31:53
I mean, this whole honestly, this whole, like discussion here is really the reason that, you know, we're emphasizing to the clinicians benefit, to provide education provide information to provide a start, so that somebody doesn't feel so lost through what is a fairly long amount of time, you know, in terms of a developing baby, right? I mean, it's the reason that I put together the book that I did with, with my co author was quite honestly, there, there wasn't anything. I mean, I went through my two pregnancies, my first one, especially looking up researching, doing a lot of ahead of time work to know what I was getting into, and to know how I could expect, but where was that information coming from? Like, research articles? It wasn't like a pamphlet online that was like, This is what you should expect. Oh,

Scott Benner 32:49
you're pregnant. Right? Right. Well, that's where I mean, that's how the podcast became what it is, right? I'm just one day thinking like, how do I help my daughter, and then you just pull information together, you put it into practice, it works, you keep what works, you get rid of what doesn't? And then from there, it's about how to communicate it, which is what this is about, like, I don't know something about diabetes, that you can't go read somewhere. I'm not a magic person who understands something that does the rest of you don't get to know. Right, I do understand this stuff. I do know how to implement it. But the thing I think I'm good at is describing it to other people. Right. And I think that is a thing that doctors could become good at, right? But you have to first become proficient at it as if you're trying to save your daughter, you know, like, we're as if you're Jenny, and you're pregnant, you're like, I don't know what to do, I need to figure this out. Right? Like, you have to put yourself in their position while you're collecting the data and feeling the importance of it. Right. And then you learn how to talk to people about it. And the only way you're going to learn is the same way those people are gonna learn how to use insulin, you got to start and you might maybe you'll screw it up at first, maybe you will, right? Like maybe the first time you try it, you may go, oh, I shouldn't have said it that way. And it might take you a couple of people before you really get good at it. But it doesn't take that long. And don't be scared, you know, like, just get out there and try to help somebody. Right? You'd be surprised what happens, you

Jennifer Smith, CDE 34:11
know, and I think because the grand majority of general medicine practitioners are going to see women who potentially don't have pre existing diabetes, you know, before pregnancy. I think there's an unfortunate group of women who have gestational diabetes, right? With testing in that like late second trimester, a glucose tolerance test reveals that their body is not navigating glucose. It's not navigating food the way that it should, and that there is something that needs to be done in order to have a healthy baby. They're on out right. But what I've really seen is the aftermath delivery for women who have had gestational during pregnancy, while there is postpartum, further testing To evaluate that, yes, your glucose levels have gone back to normal your body is responding like it should. I think it's an underserved under educated in terms of lifestyle changes they made in pregnancy, and how important those changes are to keep, because there's a high risk of type two diabetes, if you have had gestational diabetes, right. And so it's an under followed.

Scott Benner 35:26
Oh, yeah, it's treated like we got you. We got the baby. Right. It's over now. Right? Yeah, it's Yeah. Am I gonna get diabetes one day? Maybe? Good luck. Yeah. Yeah. Right. Like, right. Never think about it again. Oh, my gosh, the people with type two Oh, my God, like, you know, if you think people pregnant with type one aren't getting good, good information, people with type two are being just dropped left and right. Like we have somehow, as a society decided that there are some things that happened to you. And when they happen, you get pushed off onto another line, you know, like, oh, oh, they lose. Yeah.

Jennifer Smith, CDE 35:58
And, and or it's not until something really significant is happening. You know, let's say pre pregnancy, a tight woman with type two is managing quite well, right? And is again, undereducated in what to expect to happen. And so they don't know how to keep up enough. And they end up coming in and now blood sugars are all over the place and their medications they were using, they're not working anymore, or medications maybe weren't discussed well enough to say here, you're likely going to need to change to using insulin. Are you ready for that? You know, this is what it would look like. And we're going to have you follow up with a high risk doctor, to ensure that you're being managed really, really well, again, it's a missing part of education. For that group,

Scott Benner 36:43
it's become popular to say that, you know, it's not health care, you know, you're not really getting health care, right? It's not nothing's preventative. We just try to fix you after you're broken. Right, that that's how the system works. And it is how the system works. I'm not saying that. No, no, you're right. Maybe it's not that simple. Maybe it's more that we're not good at preventative. Not that we're not trying. But maybe people just don't know how to do it, or how to communicate it. Because you know what I mean? Like, I know, there's the business and the money side of it. And the money side is directed at what it's directed at. I understand all that I'm not being I'm not being Pollyanna about it. But I do think that part of the reason I wanted to make this podcast series is because I don't think that this doesn't happen just out of apathy. I think it doesn't happen because people don't think to do it like that. Everyone is like they see themselves as either working or broken. Do you don't I mean, and when you're working, you don't have to do anything about it. Like nobody does sit ups when they're thin. I mean, listen, after New Year's go outside, and everyone jogging, you're going to look at and think, oh, they should have started jogging like three years ago. Right? Like, right. But it's not till it hits you where you're like, I have to do something. It's not a very human thing to work on things that aren't obvious. But in this specific situation, if you know how to do it, you're saving a ton of problems. Right on the back end, just like you would with anything else. But here. It just seems more imminently important to me. Yeah,

Jennifer Smith, CDE 38:15
no, absolutely. I think. I mean, you set it in a very nice way you said it, that there is that there is no preventative medicine. And you know, the reason like for that, right? I mean, no money in it. Yeah, there is no, I mean, I did not I there's no way to delicately say there's no money in preventative medicine. If you've got somebody coming in who is really healthy, because you've told them this, this and this in terms of lifestyle. And yes, these vitamins, no, you don't need this, eat carrots, you whatever it is, that's a one visit. And you know what, maybe they're gonna go off on healthy life for the next five years. Because we're come back, you're taught them to be healthy. That's awesome. That's an heart hook. Your system should work. But it doesn't make money. Yeah,

Scott Benner 39:01
it's a shame. I mean, honestly, I understand how it happens and what the cycle is that brings us to that. And then once you get into that cycle, it holds us in that cycle, like that, I'll get ya get all that. So maybe this is the part of the conversation for the patients where I'm telling you, if you just go listen to the Pro Tip series, then when you get pregnant, you should probably be able to do this no trouble. Right? You know, and I do honestly believe that. I don't think that the podcast is magical. I don't think that the information is magical. I just think that it's being communicated in a way that is digestible for you understandable and will put you in a position to make good decisions, right. And I think that really is the key to this because as much as I'm hoping that doctors figure it out and that people listen to this and go I'm going to do that. I'm more certain that you're probably going to run into a doctor that helps you yes or no, it's going to be a coin flip. And you're not going to know the difference when it happens. That way really is the biggest trouble is that you're not going to know if you've got a good one OR, or NOT a good one until it's a little too late. By the way, marriage is like that too.

Jennifer Smith, CDE 40:10
Well, it all starts with three.

Scott Benner 40:12
Yeah, I could explain to you how not to do that too. But it just would take too much time. But listen, if you want a good life, you do the work first. Right? That's it, you do the work first. And then the rest is easy. And whether it's pregnancy or marriage or being a doctor, I mean, we're not really saying anything that difficult here.

Jennifer Smith, CDE 40:33
It's not rocket science. And we've said, I don't know how many times we've said that is not rocket science,

Scott Benner 40:37
effort upfront, everything else gets easier. That's all. So I know, not everybody is going to make a baby on purpose. Or, you know, and that doesn't make your pregnancy invalid, obviously, or that the love, you're going to have invalid. But if you're running around with an ad, one C, and you're a woman who could at any point be pregnant, I'm going to tell you that this podcast is full of stories from women who are in that situation. And when you hear them tell that story, what you're going to hear them say at some point is, I wish I would have learned how to do this sooner? Yes, I just don't want you all to be in the position where you're always saying, I wish I would have. Instead you could say you know what I did? You know, I learned about this thing that really impacts my life, and it made my whole life better. Right? That's what I'm hoping

Jennifer Smith, CDE 41:26
for. And if you learn it the way that it's presented, and again, digestible, right bits and pieces that you can take, you can apply based on what you see happening long term in that post partum time period, you're going to stick with what you know, because of the fact that you have been applying it already. So it's not going to get all thrown out the window because Oh, it's all over now. And I can just go back to completely forgetting everything that I've learned, you're more likely to continue it, especially if you've planned to have another child someday, right? You don't want to start out from ground zero all over again. You might as well continue with what you know, and keep things in a range, that long term is going to keep you healthy, whether you have kids or not.

Scott Benner 42:13
Yeah, that happens for some people. And then for other people, they fall into that trap where everything gets slotted above, it's the baby first, and then things that affect the baby. And then the next thing you know, you're not even thinking about yourself 20 steps down on your list, right? And when you have diabetes, that can't happen. No. So you if that's mom guilt, I don't know what does that right? What makes you although I was a stay at home dad for 20 years, I was the one like I'd make food and then like eat what was left

Jennifer Smith, CDE 42:41
your family first and then you took the scraps, right?

Scott Benner 42:44
And you think nothing of it while you're doing as a matter of fact, you feel kind of, I don't know what the word is, but you feel good about it, almost like I put people before me, it can't be like that with your diabetes, I tell my daughter all the time, all of the time. You are first. I don't care in what scenario in life. If you're out driving with your friends, if you're off to college, if you've met a boy, if you're just living your life sitting around the house, it's diabetes than anything else you want to put after that we cannot ignore the diabetes first, because it will ruin everything else if we ignore, right? Absolutely. It's diabetes first. And when you do that, it makes diabetes. This is gonna sound strange. But if you make it first, and you understand what to do, and you have the tools, which are very accessible here in the podcast, then everything else like I just said gets easy, like and then all of a sudden you don't think about I think people must believe that I'm constantly think or Jenny's constantly thinking about her diabetes. I mean, honestly, Jenny, you really think about it that often?

Jennifer Smith, CDE 43:48
No, in fact, I don't. I mean, I know a lot of people who sit with like, you know, their apps open and whatever their tools and they look at it, unless my thing makes noises yet me

Scott Benner 44:00
for some reason. It's three o'clock in the afternoon. I haven't looked at his blood sugar. Right,

Jennifer Smith, CDE 44:05
unless it's making noises at me or, you know, my pod is like, decided to give the death toll. The you know, the, for some strange reason that I addressed something but yeah, yeah, I mean, I try really hard to because I know what I am doing. And most of the time, you know, 90% of the time I'm doing similar things over and over. I can let it take a backseat, but not in a way that I'm forgetting about it. It's just because things work because I know how to make them work.

Scott Benner 44:37
It's the driving analogy again. Yes, you can get in a car and drive 100 miles. I just drove 700 miles one way and turn back around and drove 700 miles back again. I didn't hit anything. I didn't come close to dying. Like right like I just been driving a long time I have these tools that I don't even know I'm using that I'm using it doesn't weigh me down. I didn't get home ago. Oh my gosh, my life is ruined. I had to think about driving. Man I think diabetes the same way I just said, I haven't seen Arden's blood sugar today. So I opened up my phone, or blood sugar's 107. It hasn't been below 70 or over 110 in the last 12 hours, yay. But all that is, is Settings and Tools and insulin timing that I've already taught myself that happen almost automatically when we need them to happen, right. That's my point about all this. That's my point about the whole damn Podcast. I'm sick of telling people dammit, Jenny, I made myself upset. Go make a baby weight or throws up on you. It's gonna be a big ball of fun. Congratulations.

Jennifer Smith, CDE 45:42
It is fun. Sure it is.

Scott Benner 45:43
It's absolutely fantastic. Everyone should have a whole bunch of babies there. A lot of the big party. Good luck paying for college. Thank you for doing this with me. I

Jennifer Smith, CDE 45:52
appreciate it. No, that's great. Thanks.

Scott Benner 45:59
I'd like to thank cozy Earth for sponsoring this episode of The Juicebox Podcast and remind you that using my offer code juicebox at checkout will save you 40% off of your entire order at cozy earth.com. That's the sheets the towels, the clothing, anything available on the website. Arden has been getting her diabetes supplies from us med for three years, you can as well us med.com/juice box or call 888-721-1514 My thanks to us med for sponsoring this episode. And for being longtime sponsors of the Juicebox Podcast. There are links in the show notes and links at juicebox podcast.com. To us Med and all of the sponsors. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com. 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. BetterHelp is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapist who can help you with a wide range of issues. Better help.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit. For any reason at all, you can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox. Save 10% On your first month of therapy. If you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, if you kept listening through all that, I really appreciate it. I just wanted you to know that. It's Saturday night at like nine o'clock and I'll make it a podcast and you never know who's gonna listen to it. But the fact that you listened this long, it really means a lot to me. Thank you so much.