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Scott Benner 0:00
Hello friends and welcome to episode 1177 of the Juicebox Podcast.

Today, Jenny and I will be answering listener questions in another episode of Ask Scott and Jenny. 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. 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/juice box. If you have type one diabetes, where are the caregiver of a type one and a US resident? I'd love it if you would please go fill out the survey AT T one D exchange.org/juice. Box this survey helps move type one diabetes research forward. It's very simple for you to do. You'll know all the answers to the questions. It won't take you much time and you'll be helping T one D exchange.org/juice box. If you're looking for community around type one diabetes, check out the Juicebox Podcast private Facebook group Juicebox Podcast type one diabetes. Don't forget when you use my links you're supporting the show. So look right there in the show notes of your podcast player or at juicebox podcast.com and make the clicky. This episode of The Juicebox Podcast is sponsored by us med U S med.com/juice box or call 888721151 for us med is where my daughter gets her diabetes supplies from and you could to use the link or number to get your free benefit check and get started today with us met. Today's episode is sponsored by Medtronic diabetes, a company that's bringing together people who are redefining what it means to live with diabetes. Later in this episode, I'll be speaking with Mark, he was diagnosed with type one diabetes at 28. He's 47. Now he's going to tell you a little bit about his story. And then at the very end of the episode, you can hear my entire mini interview with Mark. To hear more stories from the Medtronic champion community or to share your own story. Visit Medtronic diabetes.com/juice box and check out the Medtronic champion hashtag on social media. 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. Jenny and I have recorded an entire episode before we hit record. So we should there's part of me that thinks that one day I should just like wine Jenny up and want to let her talk. And then we should just record that. But

Jennifer Smith, CDE 2:55
we're back. Katherine caffeinated me,

Scott Benner 2:58
Danny, we are back to do an ask Scott and Jenny episode which we have not done in a hot minute. Let me see if I can tell you when the last one happened. But while I'm looking you consider this. What should I do if I miss my MDI Basal dose?

Jennifer Smith, CDE 3:19
Oh, that's a really good question. And I like that that's actually an injection question. We don't get a lot of No, we don't we don't get a lot of them. And I think that there are definitely a lot of people still doing MDI that have great questions. I wish more people would ask them. Yeah. But yeah, so I mean, it does depend. So you know, if you miss, let's say, you're taking your Basal insulin in the evening, you wake up in the morning, you're like, Oh, my goodness, I missed my Basal insulin, right? Me You could down dose your Basal insulin by taking some in the next morning when you wake up, right? Okay, if it's well beyond it, let's say you take your Basal insulin in the evening, and you realize at one o'clock in the afternoon that you missed your Basal insulin. And that's why blood sugars look strange, right? At that point, you are beyond taking that Basal dose, even a portion of it. And what you may end up needing to do is just manage with more rapid acting insulin, right, we're gonna need to cover correct, you may need to even increase a slight amount the amount of insulin that you give, or your carbohydrate or your mealtime coverage, because you're missing that baseline. So you could expect your rapid acting insulin doses to try to be making up for that missing background. You can even see this when you're when you're trying to do Basal testing. Yeah, and you're evaluating and you're seeing well, when I don't eat a meal, my basil causes my blood sugar to go up where it shouldn't. That is a basil deficit. But when you do eat a meal, it looks like everything is perfect. That means that your rapid is covering some of what the Basal should actually be covering.

Scott Benner 5:04
I have a couple of thoughts here in questions too. So there are older and newer infill Basal insulins too so like older like love Amir Lantis, newer like Joseba and what's the other one to

Jennifer Smith, CDE 5:17
jail basic lar. Okay.

Scott Benner 5:19
So they work on so that the knock on the older ones love Amir Atlantis are that they don't really last 24 hours sometimes so you'll even get he'll hear people splitting insulin so I can say that Arden us love Amir, but I'm out of okay, I'm out of the old ass basil game at this point. But if I missed Arden's love Amir at 8pm. And she woke up at 8am. And I was like, oh, hell, I missed it. That's too long at that point you think?

Jennifer Smith, CDE 5:50
Or something like and that's, that's great that you brought up the kinds of insulin for love Amir Yes, it's too long, essentially. Love Amir, for the most part who you those who used it found essentially that they did need to dose it twice a day. Yeah, we thought it was a you split it too. Yeah. So you know, have you missed it at 8pm by then you've missed the window of its most beneficial time period. So if you're going to dose again at 8am, go ahead and just dose with what you dose normally,

Scott Benner 6:17
and just start over like now we just do it at 8am. Now,

Jennifer Smith, CDE 6:21
well, if you just said you were dosing twice a day? Well, we wouldn't. That's why it was yeah, my

Scott Benner 6:25
scenario, I would, I would have just given her half at 8am. And then back again at half at 8pm. But for people who were doing it every 12 hours, or every 24 hours, excuse me, now they're 12 hours behind, and it probably didn't work up to the to the 24 hour mark to begin with. So, I mean, you could if it was live from your Lantus, you could just say, Oh, I guess we do our basil in the morning now and do it right like and start in the morning? Or would you have lows that day from that

Jennifer Smith, CDE 6:51
deal? With love Amir with love Amir, I think that that would have definitely been okay to navigate that way again, because for for most people who had been using it, it was definitely a 12 hour. So they took it and then they took it again, within 12 hour time periods, you miss one dose, you're kind of like over it, you just wait until the next 12 hour dose. If you were more of a Lantus user, though, which is definitely longer lasting, and most people got at least 20 hours of action out of their Lantis, or saw it start to sort of peter out by 18 to 20 hours, right? Yeah. So therein lies the question, you know, you miss it into the next morning, now you're 12 hours into missing your Basal insulin, you could take some how much you could take a quarter, you could take a third of what your total dose had kind of been a helping hand in a helping hand and then essentially take it again at the next you know, the next time period or downplay that a little bit to kind of just coast you through the overnight without being too low. Yeah.

Scott Benner 7:55
And then I guess, be careful for like that 36 hour period that you're not seeing. By the way, I'll point out that in episodes about splitting and so on, you very firmly came down on the side of not splitting Lantis

Jennifer Smith, CDE 8:07
for the most part. Yeah, I Lantis is it's definitely longer than a 12 hour action. So if you're going to split it, you really have to be kind of cautious. I've seen some people with tinier doses, do well potentially splitting it because they get the heavier dose in a time of day where they really need that background insulin for whatever the reason, and then maybe they just need a hint more to nudge them over into that. Let's say you can take it at breakfast and at dinnertime right? heavy dose in the morning, it covers behind the majority of the activity and the variables of the day. But the overnight, they need just a hint more of it in order to not run high overnight or to graze up before they take their morning dose. So you might see something like, you know, eight units in the morning and maybe a unit and a half in the afternoon or the evening time. Right. But that's not the typical for

Scott Benner 9:02
that. And to go to the more modern insolence, they actually seem to lap that 24 hour period, right. So

Jennifer Smith, CDE 9:09
ya know, yeah, and I think you're just gonna say essentially that if you take it and you missed your dose, you may have up to about 36 hours.

Scott Benner 9:19
You might get some coverage in there. Yeah, you might. Yeah, if you did that, say you Mr. CBOE and you waited the whole 24 hours to shoot it again and you just managed on the you know, with fast acting until you got back to your tear tear injection time. Do you think the next day would look a little resistant to or do you think you'd be back to good after you injected it? If you take insulin or sulfonylureas you are at risk for your blood sugar going too low. You need a safety net when it matters most. Be ready with G vo Capo pen. My daughter carries G voc hypo pen everywhere she goes because it's a ready to use rescue You pay for treating very low blood sugar and people with diabetes ages two and above that I trust. Low blood sugar emergencies can happen unexpectedly and they demand quick action. Luckily jeuveau Capo pen can be administered in two simple steps even by yourself in certain situations. Show those around you where you storage evoke hypo pen and how to use it. They need to know how to use Chivo Capo pen before an emergency situation happens. Learn more about why G vo Capo pen is in Ardens diabetes toolkit at G voc glucagon.com/juicebox. G voc shouldn't be used if you have a tumor in the gland on the top of your kidneys called a pheochromocytoma. Or if you have a tumor in your pancreas called an insulinoma. Visit G voc glucagon.com/risk. For safety information.

Jennifer Smith, CDE 10:52
You should be back to fairly good after you injected it assuming that the dose that you had been using before missing a dose was pretty good. Okay. Yeah.

Scott Benner 11:03
All right. So the first thing that came to your mind, it's a good conversation, but the first thing that came to your mind was manage it to your next injection time with fast acting insulin. Okay, so is there a one to one thing they're like if I like if I'm injecting? I don't know. 10 units of true SIBO? Is there an amount of fast acting every couple of hours that would like kind of keep me in the game? Not really

Jennifer Smith, CDE 11:30
not really we would what we would usually recommend is with mealtimes depending on where your blood sugar is, right? And possibly where it's trending again, the beautiful thing about having CGM now is you can actually tell how things have been being held without a piece, you know, behind that would normally be there. Okay? So if you're rising, coming even into a mealtime, you can think ahead and say, well, the rise means I'm probably missing at least half a unit of insulin, give or take person, you know, sensitivity versus resistance. And I've not even like eaten or Bolus for my meal time yet. I need to nudge this up minimally. And I'm going to be conservative about it because I'm not quite sure how much more I need behind this. Okay, right.

Scott Benner 12:13
What's your timeframe for I forgot my 6pm You know, Basal insulin injection, but it's only 730. Just throw it in then. Right? Absolutely. How far away from that six before you can just go hell and just do it. I mean, I know. Three, four hours, maybe I would

Jennifer Smith, CDE 12:30
say four hours, quite honestly, like if you're normally dosing 6pm. I mean, a lot of people take evening Basal insulin, it's like eight to 10pm. Typically, unless they've been told to take it with dinner or around dinnertime. It's usually like

Scott Benner 12:43
more why I think of it that way. Because it was because Arden was so small, it was part of the safety like oh, shoot it near a meal. Plus, you're giving her a needle than anyway. So it's not as that's kind of how we used to think about it.

Jennifer Smith, CDE 12:55
Yeah. Okay. But yeah, if you are normally dosing it at 6pm, and you remember at bedtime at 1030. Darren I missed, you know, go ahead and take it at that point. Absolutely. And then just back it up the next day,

Scott Benner 13:09
where your thought is that because if you forget it at 10, if you remember to you're not awake at 2am to remember it. So unless you wake up in a cold sweat and go oh my god. Right. Yeah. All right. That's okay. I appreciate that. And that was good. Yeah. Well, let's stick with this theme for a second in the inside of the theme a little bit. What should I do if I inject the wrong insulin? So I've seen

Jennifer Smith, CDE 13:32
this so many times. And you know what, it seems to be more of an err on the side of I was supposed to take Basal insulin. And I injected 30 units of rapid insulin, instead of taking my 30 units of Basal insulin. That's the one that I see. 99% of the time

Scott Benner 13:51
never goes the other way. I was making a two unit correction. And I use basil instead of my fast acting. Right, right. It's almost like you just said like this giant dose, even if you're a little kid, you don't you mean like, you know, three units of you know, is is a giant though. So in case this isn't clear to everybody, some of the most, I find interesting and heartfelt posts I've seen on Facebook, or somebody who jumps on and says, Hey, I just shot 20 units of Novolog instead of 20 units of Lantis. And I'm MDI and it's in and what do I do? And I always think what a great opportunity to understand how insulin works. I never say that out loud. Right? Because they're usually running in circles like a chicken without their head.

Jennifer Smith, CDE 14:41
You're not just like, hey, just sit watch what happened.

Scott Benner 14:46
wonder like, you know, like, so for my money. I do the math. I just say, you know, I shot 20 units of insulin. My insulin to carb ratio was one per this. That's how much food get to eat now, maybe add some fat, some ice cream, what a great time for a milkshake to, like, you know, that kind of stuff.

Jennifer Smith, CDE 15:06
Ya know, and that's it depends, you know, if you have a fairly aggressive insulin to carb ratio 20 units might not be a terrible amount, despite not necessarily wanting to add extra food. Yeah, 20 units might be something you can clearly take care of and navigate and manage that problem, right? If you however, usually take one or two units to cover a meal of 30 grams worth of carb, why units is a whopping dose

Scott Benner 15:34
your insulin glucagon time, then, yes,

Jennifer Smith, CDE 15:37
that's that's glucagon time. Or it may even be potentially that with enough sensitivity, you may end up actually just needing to go to the emergency department to be able to say, You know what, this is what I did. I definitely know that I'm going to need a glucose drip, I know that you're going to need to navigate this because I can't eat enough that I see often with kids, where they just their tummy is so little. They can only take so much juice. Sure.

Scott Benner 16:04
Yeah, there's there's no yeah. And yeah, I actually it wasn't making light of it. It's usually it's usually adults, but like, you know, that I see are like, ah, but I've actually managed one of these through, personally. So a girl, I don't remember her name anymore, came on the Facebook group and said, I just did this and she was in a panic. Yeah. And she's home by herself. She was in her early 20s. Right. And then the first comment that came to the Facebook group was call 911, which I think sent her spiraling. By the way that's, that's always like, you know, you always get one or two people are like, Oh, I know, you asked for what color is the sky, but I'm going to call it tell you to call 911 instead, and like, you know, like, so she starts panicking. I can see her panicking. And I just said, Give me your phone number. And I called her and I was like, Hey, what's up? And she was she was upset, or Yeah, I mean, she was panicked. And with good reason. What I did was I said, Alright, look, you know, what's your insulin to carb ratio? It's interesting that she went, I don't know. Oh, so I was like, you know, many people don't know stuff like that. They're like, I just usually do about this much for dinner and like, blah, blah, blah. So I said, Okay, I picked something that I knew how many carbs are in it. I was like, how much would you have Bolus for this? Yeah, that you really like firmly understood. And I said, Okay, so we're gonna put your like insulin to carb ratio at like, one unit for 15 carbs. And she's like, okay, and I said, Well, how many units did you shoot? And then she told me, and then we did the math. And I said, alright, well, you get to eat 125 carbs right now. Like, you know, and then I was like, let's but then she was like a healthy eater. So then that wasn't that easy. You don't I mean, I was like,

Jennifer Smith, CDE 17:40
I might get the honey nut cheerios out.

Scott Benner 17:43
That crap. And I'm like, Oh, God. Okay. So like, I was like, I might Hi, header, open the refrigerator. And we just went through it. Like, yeah, shelf by shelf, line by line, we open cabinets, we found enough stuff. At one point. I said, even if we don't find anything, don't worry. I was like, there's a five pound bag of sugar in the house somewhere, we'll start eating that, don't worry, we'll have it's gonna happen. We're gonna be okay. You know, I said, well mix sugar with water. There's all kinds of things we can because they didn't keep a lot of juice now, so she didn't have a lot of stuff. And she got through it. She was okay. Yeah. So

Jennifer Smith, CDE 18:13
in that instance, in terms of the portion that it might need to take somebody, again, with a stomach capacity to handle sometimes small, heavily packed carb types of foods are often a little bit better, you know, people think juice first, right? But it was also think despite being kind of panicked at that point, you have to say, well, am I like pretty stable right now or where is my blood sugar, you know, my sitting already at like 72. And if you are, okay, we need to get some quick something because it's a rapid acting insulin, and it is going to start working pretty quick, right? Whereas if you're sitting at 180, you've got a little bit of wiggle room there to navigate. And you may actually progress through rather than sitting down to the bowl of 125 grams of whatever it is gonna be, you

Scott Benner 19:02
know, that's not as clear thought to some people as you might think, because a lot of people see 180 and pick almond range. Like, you know, they don't think about the way you and I think about I'd be like, well, we've got 100 points to play with here. And yeah, also, the thing you said about juice, you can get you sick, really easy like that, like that nauseous feeling in your stomach, really, I can't do this anymore. And a big Bolus will burn through a fast acting carbs very quickly to like if you put in, you know, 10 units that aren't for anything and like you said, you've only ever put in two units for your biggest meal in your whole life. drinking juice isn't going to do crap it's going to be it's going to be like Jenny and I tried to stop like a NFL running back. We're gonna be like, Hey, don't don't do this. You know, that's gonna be the end of it. Right? Yeah. For two seconds. dense foods slowly digesting stuff. That's the kind of like, think about those foods that when you eat you always end up bolusing more for have a little of that at this point. Yeah. Oh my gosh. And then, but you said go to the moon. Wanna see room if you're, and I agree with that. But you can't just get in the car and drive to the emergency room. Because before you get there, it's me you in about 15 minutes. If you're lucky, I would imagine it

Jennifer Smith, CDE 20:10
right. If you are the one and you're alone, as this young woman that you are helping was clearly, that's probably not the best idea, especially considering she was very worried about what was going on. It's better to actually get to at least a stable enough place with enough carbs to be able to get to the potential of an emergency department to be able to help again, only as the last and kind of need. And, again, what's the goal between in there? It's glucagon. Yeah, we have glucagon that absolutely can be used in the case of need, you

Scott Benner 20:45
gotta have it with you. By the way, she did not have that either. She didn't have that she couldn't reach her parents. Like it was like a dumpster fire of like, bed, you know, variables for Oh, lo food in the house. Like the whole I don't know, I'll never forget, like, also never forget feeling panicked about it, because everybody was like, just do this. And I'm like, somebody's got to actually help her. Right? Like, you know what I mean? Like, she can't, she was panicking. And she was young. And she was by herself. And I was like, I'm gonna, like, just call me or I'll call you or whatever.

Jennifer Smith, CDE 21:12
And that's what she needed. Rather than reading and reading and reading the 50 comments that came in, I got worried about that. Yeah, you start to go down this and instead of doing your reading, start

Scott Benner 21:24
wondering which one of these is the right thing to do? Yeah, correct. Yeah, so just

Jennifer Smith, CDE 21:28
like one person to take into you need that verbal, that human connection, which is by the

Scott Benner 21:33
time we were done, she was eating bread, obviously, keep bread, that's good. Some bread? We're gonna I that's what I did I mix bread jam on their bread was sugar and peanut butter. And like, anything like that, like I kind of I kept hitting her like fast and slow digesting carbs at the same time. Anyway, honey is

Jennifer Smith, CDE 21:49
a pretty packed one to honey and maple syrup. From the standpoint of the content of car, I mean, a tablespoon of honey is like 17 grams of carb. And maple syrup is even heavier. Yeah,

Scott Benner 21:59
that's a consideration to like bulk of food. Like, I feel like this has been said, but it's worth saying, again, you can't just start with like, I'll eat grapes, like because you're gonna fill up before you get to the car number you don't I mean, like, you need some that's gonna hit you really? Like. And by the way, once you get through that, three hours after you've injected it, let's start over again. You know what I mean? So, right, yeah, just trying to stay alive at that point. diabetes comes with a lot of things to remember. So it's nice when someone takes something off of your plate. US med has done that for us. When it's time for art and supplies to be refreshed. We get an email rolls up in your inbox says hi Arden. This is your friendly reorder email from us med. You open up the email. It's a big button that says click here to reorder. And you're done. Finally, somebody taking away a responsibility instead of adding one. US med has done that for us. An email arrives, we click on a link and the next thing you know, your products are at the front door. That simple. Us med.com/juice box or call 888-721-1514 I never have to wonder if Arden has enough supplies. I click on one link. I open up a box. I put the stuff in the drawer. And we're done. US med carries everything from insulin pumps, and diabetes testing supplies to the latest CGM like the libre three and the Dexcom G seven. They accept Medicare nationwide, over 800 private insurers. And all you have to do to get started is called 8887 to 11514 or go to my link us med.com/juicebox. Using that number or my link helps to support the production of the Juicebox Podcast. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is

David 23:57
Mark. I use injections for about six months. And then my endocrinologist at a navy recommended a pump. How

Scott Benner 24:04
long had you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 24:13
I was medically discharged. Yeah, six months after my diagnosis.

Scott Benner 24:17
Was it your goal to stay in the Navy for your whole life? Your career was Yeah,

David 24:21
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we made the decision despite all the hardships and time away from home, that was what we loved

Scott Benner 24:34
the most. Was the Navy, like a lifetime goal of yours. lifetime goal.

David 24:39
I mean, as my earliest childhood memories were flying being a fighter pilot, how

Scott Benner 24:44
did your diagnosis impact your lifelong dream?

David 24:46
It was devastating. Everything I've done in life, everything I've worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family care givers you know, for me to Medtronic champions community, you know all those resources that are out there to help guide the way but then to help keep abreast on you know, the new things that are coming down the pipe and to give you hope for eventually that we can find a cure. Stick

Scott Benner 25:12
around at the end of this episode to hear my entire conversation with Mark. And you can hear more stories from Medtronic champions and share your own story at Medtronic. diabetes.com/juicebox. Jenny, this one's interesting. I always have a weird feeling when I see people worried about this, but it happens all the time. So let's talk about it from a technical standpoint. Oh, okay. What should my what should I be doing? What should my kid be doing in the event of a school lockdown? My first thought is always what I told Arden was turn off all your alarms first. I was like, because you're gonna get upset, your budget is going to shoot up and we don't need a beacon going off over your head if there is actually a person wandering around your school with a gun. I mean, I guess that is part of it hot like you got to quiet your stuff. Your technology? Yeah, I

Jennifer Smith, CDE 26:03
I was actually going more from the what should you have on your person was

Scott Benner 26:07
thinking you'd go that way. So I went this way? Yeah, yeah, no, or the easy

Jennifer Smith, CDE 26:10
to grab bag, right? It's almost like the the T one D to go kind of bag that you have next to your, you know, garage door or in the back of your car or whatever. It's got packed with like everything. And I think at school for any age kid, especially maybe the the high school age, even middle school where they're probably more so taking care of themselves. They don't have a checkpoint really, right. And so they need to be ready to grab something and run and go wherever they're being told to kind of come together. Right? Yeah. But the alarms that's a that's a great one.

Scott Benner 26:46
I mean, so what we did for Arden was like you said in younger ages, they don't leave a room, usually they stay in a room, they do everything in the room. But once she started moving around room to room, we stocked every room with a few juice boxes, and some snacks fast acting, you know, sugar and something a little more substantial. Something that was you know, is all, like wrapped in a package wasn't gonna go bad the whole year, like that kind of thing. Right? We also started to notice, there were times of day she was low and times a day she wasn't. So we would ever more heavily stock some classrooms than other classrooms. But that's my first thought is, this isn't something you do in the event of this is something you do ahead of time. You know, my pain? Yeah. So I would have each classroom have some stuff in it. Now the the insulin part, I hear what people are saying, because I've watched them have these conversations online. What if this goes 12 hours? What if this goes two days? Like, you know, that kind of thing? I mean, I don't know how you're supposed to plan for that. You can't have insulin in every room? You know what I mean? Like, no, I am a big fan of the kids carrying their stuff on them, right? You know, your controller for your fear pumps, you know, glucagon should be with you not in the nurse's office, you should be in the nurse's office too. But with you, I think you will also start going into like survival mode. Yes. Maybe, you know, dial back your Basal a little bit. If you're on a pump, like, keep out of a low situation, you know, like nothing wrong with 150 blood sugar for 12 hours while you're sitting on the floor, if that's what's gonna happen. Correct. Do you have any other thoughts about that?

Jennifer Smith, CDE 28:19
No, I mean, it is it's a, it's a really, really good question. Honestly, I don't have any other thoughts, I guess, I would say to maybe in terms of what you're talking about, and how you had stocked your daughter's sort of school rooms accordingly. I wonder if also discussing with your school? Where is the place that in an emergency, you would bring the kids right? Or where does her grade go compared to the other grades? Evacuate the kids, if they evacuated them to a safe location or something like that? You need to know where to stack extra beyond the classrooms that she would normally be in she or he would normally be in?

Scott Benner 29:01
Yeah, this is not diabetes related. But I'm interested if you have you spoken to your boys about this, have you ever talked to him about something like this? They're pretty young, but

Jennifer Smith, CDE 29:09
they're pretty young, but they have their schools have done age appropriate education and about what it would mean, if there was somebody in the school that wasn't supposed to be there. That's kind of how it's addressed to be less scary, right. And they've done drills. I mean, that's the schools at least the ones that my boys have gone to, they've done drills, almost like a tornado drill or, you know, something like that to say, this is where we go, this is what we do. The all of those kinds of things are typically practiced Unfortunately, these days. I mean, the most that I had when I was little was like a tornado and a fire drill.

Scott Benner 29:48
Yeah, stop, drop and roll and sit on your desk so that they'll find your body under the desk. And I'll tell you what, I've told my kids now they've both been through high school already. And I will say The caveat is they mostly were in a school with one level. Okay. But the high school did have two levels. I very clearly told them, run to a window, jump out the window, zigzag to the tree line find your way home. That's pretty much what I told him. I was like, Do not sit around waiting for Mrs. What's her name over here to save you? Like she don't know what to do. Okay, she barely understands English. And she's teaching it get out of the room. I says, I swear to God, if you're on the first floor, up on the countertop window, open out the window, zigzag into the trees, get the hell out of there. Like I that's probably not the right thing to do. But I swear to God, that's what I told both of them. And I wasn't kidding. Like, one time they looked at me like really? I'm like, Yes, run away. Run. The hell, you don't have to be faster than everybody just the bare. joking matter. But Jenny? Seriously, like, that's what I told him. I was like, get the hell out of the building and run. So

Jennifer Smith, CDE 30:58
if you can, I mean, in certain circumstances where you're not quite sure where the trouble is coming from? Is it still outside the school? Is it in the school already? Can you hear noises? What I mean? It's it's just a completely unknown. Yeah, yeah. Right. So I don't even know if all schools have windows that open? Well, listen,

Scott Benner 31:18
if it doesn't throw a desk out the window, then follow along, after I'm doing like Get the hell out of you, you know, in, but back to the diabetes portion of it. You can't have insulin everywhere. No, you just can't. So if you have a pump one, I think my my best thought is you go back to very low settings, so that you don't go into you know, you don't waste your insulin, Oh, yeah. And don't go low. And just try to stretch it out as best you can. Yeah, and have food and have food wherever you are. That's my thought. I would even say, if you got into a dire situation, and you didn't have food, and the time really started going on, you know, your kids should probably know how to like Temp Basal off for a while, let their blood sugar rise a little bit, put it back on again, like I mean, it all depends on how much you want to like, talk to them about this stuff, honestly, you know,

Jennifer Smith, CDE 32:10
correct and what and at what age, I guess an age appropriate way. And depending, as you just said, on what they know about their system, do they know enough to be able to go in and these should be things you've practiced ahead of time ahead of a very emergent situation, you should have practiced how to suspend a pump, or how to set a temporary rate or how to take the algorithm off and go back to manual mode so that you can actually do some of these manual kinds of considerations. And some of them, you know, you might have an eight year old who's really awesome and can do all of these things, understandably. And you might not.

Scott Benner 32:46
I also want to say I just did a quick googling. This is a number from November of 2023. I hate to say this, but the odds of a child in the US being killed in a school shooting are one in 614 million. So I mean, it's sad for the people that happens to of course, and obviously but I mean, I think if you're planning on this one, you're you've run out of things to plan for. He's kind of my opinion. But anyway, let's find something more upbeat of the Oh, Jenny. Oh, we're talking I just realized we were saying just realized we're talking about diabetes. When I said that I looked down. I see the word gastroparesis. I see LDL and I'm like, what upbeat things are gonna be here. I'm gonna pick the one up b thing. Okay. Have the latest advancements in diabetes cures, which is in quotes? Which one? Jenny, do you find the most intriguing? Oh,

Jennifer Smith, CDE 33:42
I think the most intriguing for me are the insulins that are the smart insulin type. That's very intriguing to me. Years ago, I attended a I attended a technologies and scientific advancement, sort of presentation in which a gentleman presented on something that he was calling smart insulin. And it worked almost like a thermostat. It was injected once a day, it covered basil and Bolus insulin needs. And it turned on and off based on the glucose level in circulation. So it was it was something that in terms of, you know, navigating, you don't necessarily need even a pump at that point, right. So that type of science is very interesting to me, because outside of a true a true cure for solving the issue. Something like this would, it would definitely take care of a lot of the variables that most people are trying to navigate around. It's not the baseline understanding. That's so difficult. Yeah, it's the navigating all the little individual day to day things that could impact what you know about insulin action for you All right. So that one definitely. And then I think the other one, it's similar, it has to do with insulin, but it's more the encapsulated beta cells. You know, the the, the person who receives them actually doesn't have to have the immunosuppressive drugs that are most typical when you get a transplant. of sorts. Yeah. Right, in order for the body to not get rid of them and see them as foreign. And that's the encapsulation component of it, is to prevent the body from seeing it as foreign. Yeah. That also,

Scott Benner 35:32
so that one was on my list of like bear attacks is one of the, like, one of the companies, but actual, like, beta cells, like inside of a pack of bubble wrap. Yeah, that they put under your skin and your, your immune system can't see through the package to see that there's somebody else's cells in there. So they're working, but they can't get attacked. That one's been they've been at that one for a while. And I have had someone on this podcast, who was in a double blind study. Oh, so they did not know if they were actually having it or not. But she said that by the time they removed it, she was sure she was actually she had it in her insulin needs were pretty much gone. Wow. So yeah. And isn't that crazy, though? She was in a study. So it was working. And they took it out of her and

Jennifer Smith, CDE 36:19
they took it out? You're like, no, no, I'd say that's where I'm like, I find my own island somewhere, you know, where I live, she

Scott Benner 36:25
she was lovely. She's like, I love helping research, I was like, I would have run away, I would have been like, you aren't not taking this back. For me. I wouldn't give you my TiVo back. Definitely not getting this cloud DVR, you can't have that back. You're not getting back my back. So I was gonna say that one as well. And again, I think it's important, we talked about this stuff to say I first started hearing about this, like 15 years ago. So like, don't, you know, don't start saving your nickels up for it just yet. And that is going to be the next part of it is and you can see what GLP is right now. The people with the best insurance are the people who are hooked up or the people of cash are going to go first. And he is going to be for the first week and a half. So just you know, don't get too excited. I will throw in tz yield. Because yes, I've interviewed people from that company a number of times, and they've never said it. And now Sanofi owns it. So I'm not talking about you, Sanofi, I'm talking about the people I spoke to spoke to before who worked at prevention bio, I could always hear in their voice. This is what we're using it for now, to kind of like hold off the diagnosis. But we really wonder if there's not more to it than that. The IG so that to me, was really interesting. In that same vein, one of the prevention bio, Francisco Leone, he said to me, I would love there to be a vaccine for hand Foot Mouth. I was like, what? And he goes, well, so many people are diagnosed with type one after getting Coxsackie virus. I wish there was a Coxsackie vaccine. Because I think if we could slow down people from getting coxsackievirus maybe we could put off people getting type one diabetes, the percentage that we're going to be affected made me cry, because my kid had coxsackievirus when she was two, and then she got type one diabetes. So I'm a he's talk and I'm crying. I'm like, it was a good idea. You know?

Jennifer Smith, CDE 38:15
That must have been the one that was it was a while ago you to him because he came up with the idea of its application in autoimmune disease not specific to type one initially. Yeah, he was looking at something else if I remember correctly, right. Yeah.

Scott Benner 38:30
So if you want to pick through my brain that to me, like it's nice that somebody's trying to stop type one or something like that. I think that if you want to push mankind forward, you got to figure out why our bodies react oddly to things and figure out how to stop that. Yeah, that's absolutely the bigger problem. There's a gentleman on the show today. sarcoidosis, which is an autoimmune coisas. Yeah, had to have his colon removed. And the sarcoidosis is still going after him in different places in his body. You know,

Jennifer Smith, CDE 38:58
quedo, Asus is one of those that affects each person who has it differently.

Scott Benner 39:04
Ya know, it's it's a, it's a hell of an interview. I think it's like, it's in the 1100s. Maybe. But my point is that that's an autoimmune issue. Yeah. Whether you have hay fever, or you get hives, and you don't know why, or your body's attacking your thyroid, or your pancreas or anything, that's the thing. I mean, I think we should be dropping everything and looking at that, because that fixes everything else, you know what I mean? Among

Jennifer Smith, CDE 39:28
many other things, what should we be looking at? And what should we be doing in our world? Rather than looking for aliens in the outer space? Listen,

Scott Benner 39:36
if we don't get hit by a comment, I think 500,000 years ago from now, we're gonna have all the answers we need. So I'm hoping a actually, I mean, you know, let me be serious here because we're kind of coming up on the end here. Yes. I think if you want to hope for something, hope that AI can get to the point where it can run these tests and get smart enough to break them down because much like everything else in the world, what slowing us down is us. We're only so smart, we only, you know, we only work nine to five, you might have to live a whole generation of people to get an idea weeded out of education to get back to somebody focused again, like you want a computer running and re running and running and re running and go and hear, hear hear, like, I think, you know, if you know, that would go much quicker, I'll use as an example. I don't know how many people track stuff like this, in a Tesla in a car, they have self driving, a lot of cars have self driving now, but Tesla's is pretty far ahead of the rest of them. And one thing that that company did was they built their own supercomputer, just to look at the data from self driving to teach self driving, how to get better, to get better. That's what you need for health care. You know what I mean? You need something smarter than us running and rerunning ideas over and over again, I think that's actually the thing you should be hoping for. Yeah.

Jennifer Smith, CDE 40:59
And then maybe it's interesting, because I, if you had something like that, pointing out exactly what some of the things we know about health care and longevity, and overall body systems and how to keep yourself healthy. Maybe people would take it better from a computer algorithm instead, in terms of pointing out, Hey, if you do step one, step two, step three, and do this in your life. You don't have to take XY and Z pills, because you can already solve this without putting money out of your pocket. Right? So maybe they would take it better.

Scott Benner 41:36
Yeah. Also, if you thought that at the end of 60 days of taking vitamin D, you'd actually feel better. But that's not what happens. You take it one day, you don't feel any better. Right?

Jennifer Smith, CDE 41:46
Right? Historical data that maybe would be compiled by a system like this, you would read it and you would say, Oh, I understand. I

Scott Benner 41:53
have to do this for 60 days. Jenny, listen, I'm now months and months and months into a better health regimen. Because of the GLP medication. I'm actually absorbing my nutrients now in my in my my vitamins and everything. Before I think I was taking them they were just like, kind of flushing right through.

Jennifer Smith, CDE 42:10
You had expensive poop essentially,

Scott Benner 42:12
I am expensive, not half the workforce. But But that's very funny, but I am. I'm gonna tell you now, my energy is such that sometimes at night, I think I'm not even tired. Like the end of the day comes and I'm like, I can keep going. Like, I'm like, I go to bed. But I lay there. I'm like, What could I be doing? Yeah, I'm gonna close my eyes and go to sleep. But if I wanted to get up, I could do something for two, three more hours. I'm like, Okay, it's crazy. Like, I know that some of that's weight loss, but I actually think I'm taking in these, you know, this stuff now. All right, we have like, a couple of minutes left, is that right? Yes. This might end up being with a called tickle your with a feather? I don't know if you know that phrase or not? Because I think this is a bigger, bigger thing than we can tack on a couple of minutes. But I am very interested in this conversation. Should people be on statins? If their lipids are okay. Oh, we can't do it now. Right? Maybe the next test Scott and Jenny. I

Jennifer Smith, CDE 43:11
like to tickle with a feather. It's called tickle my

Scott Benner 43:15
eyes of the feather because then you think oh, the next time this asks any chumps on they'll talk about lipids and then I'll go back to it. Yeah, it's like, it's my, it's my own who shot Jr. Which nobody understands? Yeah,

Jennifer Smith, CDE 43:26
I feel like I can be very honest, in terms of what my perception from a medical like physiology standpoint is with that, I hold nothing to any company or whatever. And if you have a healthy lifestyle, and you have healthy intake, and you have healthy lipid numbers, and all of those types of things, you are not the population that a lipid or that a statin is going to be beneficial for you. In fact, there are multiple reasons that you probably shouldn't. Now, I know somebody is going to beat me up about this. I don't care, quite honestly. But these are, these are medications that are to begin with their band aids. They're meant to fix something that isn't quite right in your body. Many times it's lifestyle. Truly, right. And there's a whole there's a whole like host of navigating things. And if you really do your research, and you really look at where funding comes from, you will find the reason

Scott Benner 44:37
Are you saying that if I manufacture a statin and I get insurance that covers that and if you have diabetes, then what's the phrase I'm looking for? Everything looks like a nail if you all you have is a hammer. So, so the doctor goes I was told to give people a diabetes statins.

Jennifer Smith, CDE 44:56
Thank you for saying it. Sure. Go 100% Like, I am not 100%. Like I said, there,

Scott Benner 45:04
you might need them. There are people who need them to get correct. Yeah, there are

Jennifer Smith, CDE 45:08
people who may need them. But the bulk of people, the bulk of people who are being prescribed them, they don't need them. They don't need them. And there are a whole host of reasons around the world of people who have diabetes, that they are 100% prescribed, even to those. And a lot of people question they say, Well, I told my doctor, I'm healthy. All my numbers are in range. I've never taken this before. Why are you prescribing it? Oh, but it's preventative. Those

Scott Benner 45:38
are the people I'm talking about, then to tell you listen, but it's preventing me from one from in case, this happens one day, maybe? Yeah, no, it's I think it's preventing you from being able to afford a cup of coffee because you're buying the statins. Now, listen, I have long not answered this question. Because I'm not a doctor. And I have no idea. And I know it's gonna get confused, because there are some people who need statins. Okay. Right. But yes, I think that what happened was, is they became prescribed bubble and covered by insurance if you have diabetes, and so it becomes whisper down the lane. And before you know it, we're five years into it and a doctor's handouts that it's like, like candy, and they don't even know why it's just what we do for people with diabetes. You know, and

Jennifer Smith, CDE 46:21
a lot of them do. I mean, a lot of them know the baseline of what they've been told about prescribing it, it is called preventative medicine, right? I mean, the other one that very similarly, our blood pressure meds for people who come in who again, healthy lifestyle, healthy intake, all of their, you know, their lipid panel looks lovely. Their blood pressure is nowhere near needing treatment, and they're taking it anyway because they have diabetes, and they've been told to take it because it's preventative. Yeah, just let's

Scott Benner 46:50
say Jenny's not walking around with her man wearing a condom 24/7 They put it on when they need it. Oh my god be so uncomfortable. That's so funny. We'll talk more about that in the next one. And here's a little highlight for people in the next one. We're going to answer this one and the next one, too. Hey, Scott, I've listened to your episodes on GLP and your diaries about your weight loss. Well done. Congratulations. I know you said that you think that GRPs or meds like them will become much more frequently used for people with type one can you please go into more detail about why you think that? Oh, and then this one I'm hearing rumblings about them potentially causing gastroparesis. They cause gastroparesis on purpose. They slow down your digestion on purpose, which is called guest or gastroparesis, just not in the way you're thinking of it if you have type one. Okay, so we'll do that when going down

Jennifer Smith, CDE 47:38
digestion definitely is different. In terms of what's happening right then having actual gastro paralysis

Scott Benner 47:46
caused by type one as a side effect of type one diabetes. Oh, look at this. I've heard Jenny competing in an Iron Man. Oh, there's gonna be plenty of stuff next time. All right. Thank you

Jennifer Smith, CDE 47:55
to half so I want to clear that to half Ironman. They were not full Ironman.

Scott Benner 48:01
Oh my god that you're more worried about than getting yelled out about the statins. Like I don't need to hear from those Iron Man people Jesus.

Jennifer Smith, CDE 48:10
I think

Scott Benner 48:15
a huge thanks to us med for sponsoring this episode of The Juicebox Podcast. Don't forget us med.com/juice box. This is where we get our diabetes supplies from you can as well use the link or call 888-721-1514 Use the link or call the number get your free benefits check so that you can start getting your diabetes supplies the way we do from us med. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. You spell that g VOKEGL. You see ag o n.com. Forward slash juicebox. Mark is an incredible example of what so many experience living with diabetes, you show up for yourself and others every day, never letting diabetes to find you. And that is what the Medtronic champion community is all about. Each of us is strong, and together, we're even stronger. To hear more stories from the Medtronic champion community where to share your own story, visit Medtronic diabetes.com/juicebox Don't forget, we still have Mark's conversation at the very end. It's a terrific kind of mini episode about 10 minutes long, that goes deeper into some of the things that you heard Mark talking about earlier in the show.

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 So much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The diabetes variable series from the Juicebox Podcast goes over all the little things that affect your diabetes that you might not think about travel and exercise to hydration and even trampolines, juicebox podcast.com, go up in the menu and click on diabetes variables. Right now we're going to hear from a member of the Medtronic champion community. This episode of The Juicebox Podcast is sponsored by Medtronic diabetes. And this is Mark. I

David 50:34
use injections for about six months. And then my endocrinologist and a navy recommended a pump. How long had

Scott Benner 50:40
you been in the Navy? Eight years up to that point? I've interviewed a number of people who have been diagnosed during service and most of the time they're discharged. What happened to you?

David 50:50
I was medically discharged. Yeah, six months after my diagnosis. Was

Scott Benner 50:53
it your goal to stay in the Navy for your whole life? Your career? It was Yeah,

David 50:57
yeah. In fact, I think a few months before my diagnosis, my wife and I had that discussion about, you know, staying in for the long term. And, you know, we've made the decision despite all the hardships and time away from home, that was what we loved the

Scott Benner 51:10
most. Was the Navy, like a lifetime goal of yours? lifetime goal.

David 51:15
I mean, as my earliest childhood memories were flying, being a fighter pilot,

Scott Benner 51:20
how did your diagnosis impact your lifelong dream?

David 51:23
It was devastating. Everything I had done in life, everything I'd worked up to up to that point was just taken away in an instant. I was not prepared for that at all. What does your support system look like? friends, your family caregivers, you know, for me, the Medtronic champions community, you know, all those resources that are out there to help guide the way but then help keep abreast on you know, the new things that are coming down the pike and to give you hope for eventually that we can find a cure.

Scott Benner 51:48
Stick around at the end of this episode to hear my entire conversation with Mark, and you can hear more stories from Medtronic champions and share your own story at Medtronic diabetes.com/juicebox. The episode you just heard was professionally edited by wrong way recording. Wrong way. recording.com