#1268 Ask Scott And Jenny: Chapter Twenty-Five LIVE

August 1, 2024Scott Benner

#1268 ASK SCOTT & JENNY: CHAPTER TWENTY-FIVE (LIVE)

• Should we pre-bolus for dessert if we have insulin on board from a meal?

• I had my son before I got type 1 diabetes: Is he at a higher risk of developing type 1 or another autoimmune disease?

• How long should we wait to give insulin again after a meal?

• Tips for teenage diabetic daughter with an irregular menstrual cycle?

• Scott, which clinical trials would you want your daughter to sign up for if given the opportunity?

• What's the reason why my blood sugar goes up when I change my sites?

• What are strategies for bolusing for stress?

• Have you heard of idiopathic type 1 diabetes?

• My doctor told me that I need to reduce my insulin usage to aid losing weight but I'm unsure how to do that without letting my numbers run high?

• I'm interested in looping, I watched tutorials, listened to podcasts but I couldn't figure it out?

• If you were going to take a couple of units of glucagon to address a low, is there a general guideline for adults?

• Do you think GLP for reducing insulin needs is feasible for a slim underweight kid?

• Why is it so hard to bolus for anxiety?

• If your A1c remains 5.8 for the last year on Omnipod 5 manual, would you still consider trying the algorithm?

• Tips for adjusting Omnipod 5 and basal rates for kids with rapidly adjusting needs, illness, etc. and thoughts on what you've seen in practice with loop or tandem being better or worse?

• Can you tell us more about digestive enzymes and constipation?

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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 1268 of the Juicebox Podcast.

Guys, Jenny is back and she and I recently did a Facebook Live, this is the audio from it. So what does that mean? We got on the interwebs. And we talked to people who listened to the podcast if you like this and you're not following the public Facebook group for the Juicebox Podcast or aren't a member in the private Facebook group, well, you might want to become one. So you hear about this the next time it happens. 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. I know that Facebook has a bad reputation, but please give the private Facebook group for the Juicebox Podcast. A healthy once over Juicebox Podcast type one diabetes. The group now has 47,000 members in it, it gets 150 new members a day. It is completely free. And at the very least you can watch other people talk about diabetes, and everybody is welcome type one type two gestational loved ones, everyone is welcome. Go up into the feature tab of the private Facebook group. And there you'll see lists upon lists of all of the management series that are available to you for free in the Juicebox Podcast. Did you know if just one person in your family has type one diabetes, you're up to 15 times more likely to get it to so screen it like you mean it. One blood test can spot type one diabetes early tap now talk to a doctor or visit screened for type one.com For more info. Today's episode of The Juicebox Podcast is sponsored by the contour next gen blood glucose meter. This is the meter that my daughter has on her person right now. It is incredibly accurate and waiting for you at contour next one.com/juicebox This episode of The Juicebox Podcast is sponsored by ever since the ever since CGM is more convenient requiring only one sensor every six months. It offers more flexibility with its easy on Easy Off smart transmitter and allows you to take a break when needed. Ever since cgm.com/juicebox. Good morning, everybody. This is it. Usually Jenny and I look at each other and then we start a recording, and then ask each other questions that you guys have sent in. So you're gonna need to send some questions, and we're gonna be in trouble pretty quickly.

Jennifer Smith, CDE 2:46
We can't just keep saying good morning.

Scott Benner 2:48
We could chat if you want. But I don't know how interesting. Yeah, I'm not sure how interesting that'll be for how long. So this is Jenny. So you know, this is on YouTube. It is on Facebook on a lie on the private group. It's in the public group, and it's on Twitch. So hopefully, I think I could put it on Instagram, but it's weird. So I didn't do it. I think you have to do just Instagram. Good morning, everybody. If you have questions, go ahead and put them up. Okay. And if you are interested in hiring Jenny, you can email her at that link up in the corner. We'll put that up out periodically. Also, lets everybody remind you that that's the disclaimer if you want to read it, but it says that nothing we say you can take as medical advice. So it also says a lot of other things. If you want to read it, feel free to read it. It's actually on juicebox podcast.com as well.

Jennifer Smith, CDE 3:42
Good morning to everybody who's saying good morning to me. Good morning.

Scott Benner 3:47
Hey, Susie, how are you? Alright, so what do we have here? Should we Pre-Bolus for dessert? If we already have insulin on board from a meal? To

Jennifer Smith, CDE 3:57
Great question. It's a question I get all the time you go ahead and go first. Oh, okay. So I think it does differ, right, it differs for the content of the meal that you already had. And it also differs from again, now we have directional from CGM information. So depending on where you're sitting, if you're already rising in the aftermath of that meal, then potentially it's a great idea to Bolus especially if it's a particularly simple carb type of dessert, you know, sitting down to cotton candy versus sitting down to, I don't know, something else that's higher fat creams, cheesecake for example, right. So I think it definitely depends. And then in terms of the the piece here of should we Pre-Bolus for dessert? Not necessarily again, depending on where your blood sugar is sitting. It may depend on whether you need a Pre-Bolus or whether you want Just a little bit of the meal kind of Bolus that's already there play out, and then Bolus right before you start to eat the actual dessert.

Scott Benner 5:08
Right? So can I give like that was a very detailed answer, I'm gonna give a little piece of it that I think of, which is, obviously there are different scenarios. Jenny's just outlined a number of them. But overall, what you eat, generally speaking, needs insulin. So if you've made a terrific Bolus for your dinner, and your blood sugar's at five and super stable, well, great job on the Bolus from the dinner, now you're not eat something else. Again, it's time to probably Pre-Bolus that as well with a little bit and then keep that train rolling nice and flat like that, unless of course you've overestimated dinner. And now you know, the dessert could be part of it or underestimated it. And maybe the dessert plus a correction is needed. Right.

Jennifer Smith, CDE 5:51
And that's, that's again, where I think the benefit of having a continuous monitor really comes into play. Because you have a little bit more, I think it's wiggle room to determine do I need Pre-Bolus? Can I Bolus because it's a really slow kind of dessert. And it'll be okay. Do I employ the use of one of the smarter features like an extended Bolus or something that like that along with, you know, the meal Bolus that's already there. I also had a really great conversation yesterday with somebody about the number on your CGM and the directional arrow. Okay, versus really just looking at the trend line. Right, because I feel like the number on the CGM and the arrow, they go hand in hand, they're almost like a marriage. Right?

Scott Benner 6:41
How do you mean? Meaning?

Jennifer Smith, CDE 6:43
If you go solely based on the trend arrow, and then number, you may make a different decision in this questions example, compared to what the trendline looks like. Okay, the trendline. You can think of it almost absent of a number. Yeah. Because the trendline even if that in a lot of people complain, Oh, my CGM is off the number is off from a finger stick when it's trending this way, or it's going that way or the arrow is off or whatever. But the trend line itself isn't lying. Right? There's a decline happening. There's stability happening, there's a rise already happening. And so in this case, from do I Pre-Bolus, or do I Bolus at the meal or do I Bolus after the desert is eaten or whatever? The trendline can really help you there versus just looking at a number. This

Scott Benner 7:34
episode of The Juicebox Podcast is sponsored by the only CGM you can take off to get into the shower. The ever since CGM ever since cgm.com/juice. Box. Well, I mean, sure, you could take the other ones off, but then you'd waste the sensor and have to start over again, but not with ever since ever since is a six month were implantable CGM. So if you want to take a shower without anything hanging on, you pop off the transmitter jump in the shower, when you get back out, put it back on, and you're right back to where you started. Come to think of it. You could do that whenever you wanted to. Maybe it was your prom night or your wedding day. Maybe you just don't want the thing on for a little while. But you don't want to go all through the hassle of taking it off and having to restart it and you know, starting back over with like wonky numbers and having you know all that that goes with it when you take off the CGM and put it back on Oh, but you don't have to do that with the Eversense CGM. Because ever since is the only long term CGM with six months of real time glucose readings. This gives you more confidence, more convenience and flexibility. The Eversense CGM is there for you when you want discretion, a break, or maybe just a little adult time. Ever since cgm.com/juice box, pop that transmitter off, pop it back on, you're right back where you started without any wasted devices, or time. Getting older means a world of change, but some things still stay the same, like being at risk for type one diabetes. Because type one can happen at any age. So screen it like you mean it. If just one person in your family has type one, you're up to 15 times more likely to get it too. And 50% of type one diagnosis is happen after the age of 18. So screen it like you mean it. type one diabetes starts long before you need insulin and one blood test could help you spot it early and lower the risk of serious complications like diabetic ketoacidosis, known as DKA. So don't get caught by surprise. Screen it like you mean it because getting answers now can help you get prepared. The more you know, the more you can do. So don't wait. Talk to a doctor about how to get screened. Tap now or visit screen for type one.com to learn more. Again, that's screen for Word type one.com and screen it like you mean it. There have been times with the g7 that I know people got upset, because they used to smooth the number out like with software a little bit. So it kind of made you happier when you looked at it. But now I'm noticing that the direction of the line seems more accurate with what's actually happening. Okay, have you so I don't know if you've seen that or not like, there'll be times where like, you'll see I don't know, like a down arrow. So like, sometimes the arrow is indicating down. And at the same time, the number makes it feel like I'm moving in the other direction. And so I do tend to do exactly what you just said, which is put them both together. Yeah. And say that the arrows telling me one thing, the lines telling me another thing? Right, you know, but the this direction seems to be spot on, right, like the direction seems to be spot on for me. Sure.

Jennifer Smith, CDE 10:59
And from that smoothing angle with G seven, I think what I've seen is really that, because they don't smooth as you mentioned, right, G six, the data was smooth. So it was almost a from my understanding, it was, look, the system's algorithm looked at the data points preceding the current. And there was some averaging, which provided that was going on to provide a smoothing into the next numbers you saw, where as g7 took the smoothing out. And so each data point isn't, it's supposed to be an accurate one and an actual data point. Yeah.

Scott Benner 11:38
Emily says here Good morning, I had my son before I got type one diabetes, is he still at higher risk of developing type one or another autoimmune

Unknown Speaker 11:47
disease? I had my son before I got type one. Oh,

Scott Benner 11:50
I see what she's saying. Yeah, Emily, I don't think it changes auto immune probably runs in your family. You know, like, I think what's going to happen was going to happen whether you got type one before or after the pregnancy. That contour next gen blood glucose meter is the meter that we use here. Arden has one with her at all times. I have one downstairs in the kitchen, just in case I want to check my blood sugar. And Arden has been at school, they're everywhere that she is contour next one.com/juicebox test strips. And the meters themselves may be less expensive for you in cash out of your pocket than you're paying currently through your insurance for another meter, you can find out about that and much more at my link contour next one.com/juice box contour makes a number of fantastic inaccurate meters. And their second chance test trips are absolutely my favorite part. What does that mean? If you go to get some blood and maybe you touch it and I don't know, stumble with your hand and like slip off and go back, it doesn't impact the quality or accuracy of the test so you can hit the blood not good enough, come back get the rest without impacting the accuracy of the test. That's right, you can touch the blood come back and get the rest and you're gonna get an absolutely accurate test. I think that's important because we all stumble and fumble at times, that's not a good reason to have to waste a test trip and with a contour next gen you won't have to contour next one.com forward slash juicebox you're gonna get a great reading without having to be perfect correct

Jennifer Smith, CDE 13:27
and really with the testing that we have now depending on how old your son is whether testing is an option yet or not for his age, that really is the best tracking that you can do for the potential now there are other anything we talked about this we talked about the thyroid episodes and that kind of stuff, there are antibody testing that can be doing done for a number of other autoimmune conditions thyroid in included there. So if you are concerned at all that is one of the best ways that you can just keep up with checking Yeah, and

Scott Benner 13:59
actually you'll hear in the last half of the year on the podcast ads for something called screened for type one.com which you could go to now even though I don't have the ads up yet it's literally screened for type a digit one.com And you can look into that they're about screening if you're worried Brenda says but you know what give me you have one more second on that like yeah, I don't know that because you have type one diabetes means there's going to be more autoimmune or not like it's very likely no and possibly yes but you know it at least gives you things to look out for you start seeing tired behavior you know, dry skin hair falling out you think thyroid right you know like crazy weight gain loss all the sudden lack of energy etc like ooh, they drink a lot maybe I should be looking for type one least you know to look now,

Jennifer Smith, CDE 14:46
right and even you know in in kids from a standpoint of celiac being another one that kind of is within that realm of autoimmune and kind of links in with type one kiddos who haven't been been tested, they may be underweight, they may not gain, they may complain of tummy, like my tummy bothers me. Or, you know, kids are not very descriptive in terms of their body stuff. They just tell you something hurts and it doesn't really mean very much unless they keep complaining about it. So those are things when there is autoimmune in the family that you know, oh, and or you have type one, because celiac often pairs with that. It could be something you look at.

Scott Benner 15:27
So Brenda said, how often? Should we wait to give insulin after my daughter? Right? I'm thinking she means how long? But are you saying Brenda? You have to? Are you saying that you gave insulin and now there's another meal or a higher blood sugar? And how long do you wait? Are you trying to ask about stalking? You might have to clear that up for us. I'm gonna go to the next one. While she figures that out. Okay. Oh, she said long. I got her. Okay, how long? Okay,

Jennifer Smith, CDE 15:54
so how long should you wait really, to give insulin after your child eats or anybody really, regardless of age, quite honestly, here. I mean, we have to remember the action time of our current day, rapid insulin, the more rapid like fiasco or loom JEV have a faster onset for most people and a half a faster finish. But in general, rapid insulin still has a timeline of action, as you have talked heavily about even discussed heavily. Right. So how often should you give it? Or when should you start to give extra? It really does, you know, look like evaluating? Did you count pretty precisely? Is it a pretty well known meal? Should the rise that you're seeing not really be happening? And if it is, the question would be, well, goodness, you could probably give a little extra insulin. But again, that now Bolus of extra still has its timeline to get moving. Right. So yeah, you know, I think in this it's like I give and I give in now. Okay, I've given how long do I wait to see if this is going to turn around? And that's the waiting is the hardest thing I think insulin use,

Scott Benner 17:07
I always think that the the part that you can never know, right is did I do it? Right? The first time. If I did, and it's going up, then I need insulin. And if I didn't, then the timings off and this insulin is going to catch back up all the sudden, I don't want to put more in there. I would say Brenda more than anything is as unsatisfying as an answer is this may be is that with? With experience comes knowledge. And eventually you'll just do it. You'll just be like, well, I know what to do. Right. So good luck. And

Jennifer Smith, CDE 17:34
that's why I brought in the idea of Is it a pretty typical meal? Yeah. Is this usually what you would see happen? And if it's not, my mind, personally always starts to say, Well, is it like close to the last day of my pump sight?

Scott Benner 17:50
Right like is this is the is the pump old is you know, that kind of see Brenda's newly diagnosed. Brenda, listen, I'm gonna tell you something else to listen to the bowl beginning series if you haven't. And if you have move on to the Pro Tip series, and I'll put code I'll actually right now I can give you in the top corner. There's the bold beginnings link if you haven't listened to it. Michelle 14 year old diabetic daughter irregular menstrual cycle using loop and g7, sudden insulin sensitivity and then resistance through the month. For example, we'll have a great day then dinner Bolus tanks, her and that's the start of two to seven days of needing to half dose food. Oh, yeah. I would also listen to the Pro Tip series there. And we have a lovely episode on on on hormonal stuff. But we do I mean, listen, Jenny, it feels inappropriate for me to go first. But my daughter has what I think of as three different implications throughout a month. She has an amount of insulin she needs about the five days before her period begins the amount during the beginning of the period and then at the tail end of it and afterwards, they all are different now loop will do a pretty good job with it. And I'm getting a little lazy now because I EPS is making adjustments for me as I go with the dynamic settings. But how do you talk to people about this in practice? Yeah, in

Jennifer Smith, CDE 19:15
practice, I guess I give the general idea of what a typical cycle should be. And I also clear up the fact that your cycle is not just the bleed period, it's not just the men's right? Women have females have a, let's call it a 30 day cycle of hormones. And so what you're describing here is the very normal thing that should be happening in a female body. Essentially, we call day one the first day of bleeding, right the first day of the cycle period. And that oftentimes will be your most sensitive from about day. One or two. Maybe it starts 24 hours into the period starting this in crease insensitivity, and that can often last for usually about 10 to 14 ish days, where a next cycle or a next cycle of hormones comes into the picture around ovulation. Ovulation happens when we're not on any type of birth control, you know, not menopause or anything like that. So we've got ovulation around ovulation, it could be another cycle of resistance, it could be heavier than as you describe Scott, the days before your daughter has her period, that's a time of some intense resistance as the body's hormone levels rise to either support the growing uterine lining If pregnancy is occurring, or a plumping up, and then the period starts, and it sort of discards all of that, and then the hormone levels fall down. So that's why you have this rise, fall in resistance versus sensitivity. So you're not you're not crazy in what you're seeing with your daughter, this is supposed to be happening. And it's really important that you also discuss that with her, this is normal, we're going to adjust this way. So you might have with loop and I don't know what version of loop you have, some of the versions allow you to have multiple profiles set to choose from, and then for loop to interact with. And some of the versions of loop do not where if you just have that one main profile, you may have to make adjustments to it by 1020 30% more insulin. So that loop then can work to its advantage for you by adjusting off of high the higher needs or the lower needs. No loop also has those overrides that you can use a percent adjustment up and a percent adjustment down. But what you're seeing is normal.

Scott Benner 21:41
That's all I did was the overrides with loop. Yeah, we just go percentage higher, and then you know, it was uncomfortable, because you have to save your donor like let me know as soon as your period starts, because we got to like knock this off. And then it can really tell away at the end. And then yeah, it's even strange to call it normal because I think the whole thing is normal. Obviously. It's just, it's just sucks. But like, then the normal like couple of weeks comes at the end. I'll say again, try the Pro Tip series. There's some great conversations in there about menstruation. Actually, I just put information up in the corner because a lot of people are asking about screening. So there's a link up in the corner here about how to get screened for type one for the rest of your family. So that's the answer to this question here. Kobe. Oh, Kobe wants to say something nice, Colby. Thank you very much. I appreciate Oh, yeah. Yeah.

Jennifer Smith, CDE 22:28
Thank you very much.

Scott Benner 22:29
We feel good about that. Don't worry. Let's say hi to you, Jennifer. And thanks. She's 10 months old. He'll do the antibody testing when he's old enough. Okay, that's Emily from a little while ago. Here's a question from the private group. Good morning. Which of the clinical trials would you want your daughter to sign up for? If given the opportunity? Oh, that's for me. That's just like Jenny doesn't have a daughter?

Jennifer Smith, CDE 22:50
No girls.

Scott Benner 22:52
Well, I'll tell you what. More recently I'd signed her up for that GLP study in Austin, Texas that Dr. Blevins talked about? On the podcast. That would be one. You know, if she was really, really early diagnosed, maybe I would look at two Ms. apoB. Right. I know I'm not pronouncing that correctly. That's one that I would I would think about tz old is that what it's called? Now it's easier. If you're really newly diagnosed, I'd look at tz old. But especially for a doctor. The impacts that I've seen a GLP medication have on Arden's insulin needs are significant. And if you're listening to the podcast, I think you can tell that I'm pretty high on the idea of it's going to help people. I would probably do that when Austin Texas, Dr. Blevins, there's a link in the private Facebook group somewhere for it. That's one I haven't looked at, but I think it'd be in Austin. Other than that, which ones are you excited by Johnny?

Jennifer Smith, CDE 23:44
You know, I mean, there are so many all over the place. Again, depending on where you are in diagnosis. That's really how you would search out studies that may be appropriate both age and where you lie in diagnosis or post diagnosis. Many of the studies that are being done are in the newly diagnosed, I find the studies easiest to find for those who've been diagnosed in the past like six months, okay. There are a lot of studies for siblings of children who have type one as well, especially if they are antibody positive, but yet to you know, reach that stage three, sort of of symptomatic type one really being there. I would usually look also at Jazlyn does a fair amount of studies that Barbara Davis Center out of Denver, Colorado does a lot of different types of studies, both in children as well as in adults. There's the diabetes Center, which is in Rochester, Minnesota, they have a lot of studies that come out of there, like the beta cells sort of testing. I know there's a study there are several studies that are I can't remember exactly where in Florida they do it, but they've got a number of the studies coming out from like transplants. Another

Scott Benner 24:56
way to keep up with that for everybody listening is if you go to my Link T one D exchange.org/jukebox. and complete the survey, you will get emails from them when they have stuff coming up. And that's a nice way to hear about things. The next question is, how high is it? What's the reason why my sugar goes up? Right? When I change my sites? Oh, that's an easy one, and still goes up within like 20 minutes, I will see it come down. But before then give myself and some tea Simon exon I think we

Jennifer Smith, CDE 25:24
talked about it in this in one of the episodes. Yeah.

Scott Benner 25:27
But Nellie, I think I recognize her thing, I think she's, she might be a little new to diabetes. So a couple of reasons that could be first of all, there's kind of a little trauma that happens when you know, when you put the the site in takes a little while for it to get going. Sometimes it has to soak in right, you have to get some insulin in there to get it going. You also could be nervous while it's happening and not realize it and be getting a bump in your blood sugar from adrenaline. What else Jenny?

Jennifer Smith, CDE 25:55
Well, the resistance that comes with creating the trauma under the skin, I think the best, the best way for people to see like the light bulb often goes on. If you were a G six user, and you had that two hour startup window, the real reason that that's there is because the sensor needed to get wet, or a lot of people call it marinating right, they even do it longer insertion time, but it really decreases then the inflammation at that trauma site, which allows both insulin to start getting absorbed the way that we would expect it to. The another reason though, often and this is regardless of the type of insulin pump that you use, or the type of infusion set, it really has to do with when you start up a new site, most people remove the old site, because that's what you're taught to do. And what often happens, especially if you're one to change it right after a meal. Often what happens is you pull that old site and it's wet. What that is, is leakage from the old site, the insulin that was under that area has not yet completely absorbed. And so not only are you starting a new site that's now a little bit inflamed and not quite absorbing the way you hope it will. But now you're losing insulin from the other site. And so you're creating a deficit

Scott Benner 27:11
all those possible implications. So I think about simple ways to fix it is you can kind of flood the new site with a Bolus, when you first put it on, you can give a Bolus for the rise, you know is going to happen from the old pump before you take it off. If that site still working well leave the old site on for a while after you've Bolus to make sure all the absorption happens. But I don't think people would realize about the just like you saying, like, you know, you're you're causing a small wound, the body floods the area with like white blood cells and inflammation, everything and it's just not a great host for the insulin right away. Right.

Jennifer Smith, CDE 27:45
Yeah. I mean, I usually go about it. I mean, again, years ago, myself, even before using the pump that I use my old tube pump, I found that pretty quickly after I started pumping that the old site had to be left in, I just disconnected from it, left it hanging out there. And then I to kind of start saturating that new site with insulin, I gave a little Bolus with the new site to really encourage that site to start doing something. Yeah,

Scott Benner 28:15
you guys are interested in hiring Jenny, you can click on that link in the top corner there and send her an email. Thank you. Of course. Thank you. What are you kidding? Strategies? Dakota says for bolusing for stress, is there even a way sometimes my blood sugar rockets when I get to work? Not always just sometimes? Well,

Jennifer Smith, CDE 28:32
that's what I would. This is not only for adults, but also for kiddos. There's a very big difference seen between heading to school, or I call it like foot in the door at school. So this might be foot in the door at work kind of thing. It may also be depending on the type of job, Dakota, it looks like, has it really is it a job where some days, you have a lot of meetings to get to you have to host something, you've got a project that's due that you've got to present versus other days, you just move into the office and you get rolling with the things that you need to do. But there's not really an adrenaline type of interaction. So you may want to look at what your work schedule looks like. Pay attention to what your blood sugar does. And you can make some associations in the moment. You can address it. Yeah, but if you want some historical to it to be able to say when and if you will need extra insulin. That's the best way to do it.

Scott Benner 29:27
I can just tell you that like used to drive art into high school. And I'd look at her graph on the way out the door and if it was going up, we'd get in the car and I'd say just Bolus and she'd like throw a unit in just to go to school. And then she had very aggressive Basal rates throughout the day at school that we had to kill. I could never stop them long enough. They were so aggressive during the day to keep her stable like there was not a big there was not an early enough time to stop them. So I knew that when she left from school, there was a snack that had to happen in like 20 minutes because as soon as She left school and all that adrenaline or nervousness or whatever left her blood sugar started to come down really quickly. Right? Yeah, it was really interesting, actually.

Jennifer Smith, CDE 30:06
Yeah, there are a lot of kiddos that I get a chance to work with who the afternoon after having things ramped up during the day are much more aggressive, like Bolus strategy, usually with the school day ending around three or 330. By about 130. We've started pouring things down because otherwise there was such a considerable drop that many kids could have an uncovered snack in the afternoon, because of just that joy of I'm done with school. Yeah, it's

Scott Benner 30:34
really crazy. I often used to eat for free in the afternoon for sure. Yes. Hey, Jonathan, how are you? Due to love Dr. Blevins saying diabeetus Yes, he is. He is a Texan for sure. There'll be a new episode with Dr. Bill Evans in two weeks, but next week, you're going to get Jim who is 58 got type one when he was 50. Antibodies whole thing he's got type one full blown. You know, using insulin, everything started Manjaro. No, Jenny, and is off insulin completely right now. has been for like a year and a half. Crazy story. We don't miss that one next week with Jim. He won't say diabeetus though. I'm sorry.

Jennifer Smith, CDE 31:08
I know. That was I actually I listened to that episode. And as soon as he said it, I was like, Oh my god.

Scott Benner 31:15
How knowledgeable is he though? He can tell he's off the top of his head just talking about those GRPs. Man.

Jennifer Smith, CDE 31:20
That was why I didn't stop listening after he said diabeetus. Yeah.

Scott Benner 31:27
It's like a cringe. I found him on YouTube. Doing a talking head on YouTube about GLP. And I was like, This guy knows what he's talking about. Yeah, that's awesome. Jonathan said question for Jenny. Have you heard of type one idiopathic type one? Type one B idiopathic type one. Do you know it?

Jennifer Smith, CDE 31:42
Yeah, I not. I mean, off the top. I do I know it by name. I do know it by name. There are so many of these different classifications of type one that isn't specifically what we call just type one. Right? It is a remember correctly. It's a Modi. It's one of the Bodie types of type one. But again, there are type one C, I think there's type one D, I think that it skips a bunch of letters. And there are a whole bunch.

Scott Benner 32:11
We did an episode once where we went through all them. It was mind numbing. It did

Jennifer Smith, CDE 32:16
I can't remember which episode it was. But I do remember doing it. And I think there were a couple that you brought up that I hadn't even

Scott Benner 32:23
well here. I went to our chat GPT Overlord, it said, idiopathic type one diabetes, also known as type one. diabetes is a form of type one diabetes, where the cause of insulin deficiency is not related to auto immune response. Unlike more common, here's some key points about it. insulin deficiency, non auto immune heterogeneous group, this group can include various other causes of insulin deficiency, including genetic factors and other pancreatic issues. It's far less common than type one a. That's what Chad GPT and Jenny knows about it. Jonathan? Hey, tell me why you ask that, Jonathan? Yeah,

Jennifer Smith, CDE 32:55
that would be interesting. I mean, again, I would expect it's something to do with knowing you have this, which means that you had a really good doctor to actually catch that there was a difference. Yeah. Right. And or the question being, well, are there new therapies? Are there there ways to navigate this? And I wonder also, if maybe Jonathan was misdiagnosed initially as a type two, given that there wasn't an autoimmune, notable component. And with further testing, maybe, you know, I

Scott Benner 33:27
get lots of questions here. Karen says my daughter tried recibo, she needed more Bolus s as expected, while she changed the longer transceiver profile. However, by day three, she was in the hospital of high ketones and told the change back to her old long lasting insulin and the only thing I can think of is there just wasn't enough, or you talk because that shouldn't that doesn't make any sense to see the use correctly shouldn't end up with like ketones, it

Jennifer Smith, CDE 33:53
should definitely not. And I'm wondering, again, lots of questions for things that come up like this is it that they adjusted the Basal dose back from what the original base Basal was, and thus, we just needed to go to the real amount of Basal insulin that you had been using? Or, I mean, again, in really rare cases, there are some people who just react very differently to one brand or type of insulin versus another. So again, it could certainly be that your

Scott Benner 34:24
initial concern though, is where my brain left to like Did they get really conservative on or when they switched and maybe maybe her daughter like I'm guessing her maybe her daughter started at one level you know, has increased over time and then maybe they were took it back to be safe and then didn't give her enough? I mean, I don't see why Tracy but would cause that and it is a really good Basal insulin. Yeah, is

Jennifer Smith, CDE 34:48
very good. In fact, the majority of the older school people with type one who use Lantis usually I highly recommend that they switch to the

Scott Benner 34:58
same amount as love them. err. Oh, that sounds like she used more

Jennifer Smith, CDE 35:04
Bolus to that is really interesting. See,

Scott Benner 35:07
though, like, Do you really think that you would expect to need more Bolus if you went one to one change from level miniature? Siba? No, that just I feel like it means she needed more basil with a Joseba.

Jennifer Smith, CDE 35:19
Yeah, yeah. And again, it depends. I mean, all questions, right, that you ask is this daughter going through a menstrual cycle at the time of the change is there but she's,

Scott Benner 35:34
I'm sorry, she's not day three, day three, just a time where I want to say nothing you hear on that Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. Don't listen to us. Okay. Let's move on to Stephen by doctors saying I need to reduce my insulin usage to aid losing weight. But I'm not sure how to do that without letting my numbers run high. And by the way, Jenny, before you say anything, I think Stephen has tried to GLP and it hasn't dropped well with him if I'm not mistaken. Oh,

Jennifer Smith, CDE 36:03
okay. Yeah, that would have been my potential option would be a GLP. One. Again, not knowing any lifestyle things here, it could also be that in order to reduce insulin abroad, look at lifestyle inclusive of intake of food, are you meeting your need, it sounds like you know, you're wanting to lose weight. So oftentimes, if weight is higher than what the body should normally support, then you are going to be a little bit resistant, potentially. So adding in again, some activity and doesn't mean going to the gym or buying a member just take a walk every day. I mean, if you if you again, aren't doing any of these things, and then as I said, already taking a hard look at overall intake comparative to your output of movement and whatnot during the daytime, because they think, and I've said this so many times before that we become really carb centric with diabetes, especially type one diabetes. Yeah. In terms of insulin use, that we ended up covering, covering, but the other parts proteins and fats, they play a really big role in caloric intake. And if they're not being contained, either.

Scott Benner 37:20
Yeah, I find sometimes and I don't know that this is the even situation. But I find sometimes with people with type one, they get so focused on like, can I Bolus for this and they figured out how to do it. They stopped thinking about the food like calories, and it's just like a thing they conquered. They were like I eat a thing. And I didn't I didn't have a bolt like a blip. And I don't think that that's his situation. But I mean, I also might say if you can't handle the GLP, Metformin might help to some degree now. Yeah,

Jennifer Smith, CDE 37:47
it looks like he actually he said his doctors suggesting a medical procedure. He doesn't want to do that. Try GLP. One works out almost every single day of the week and eats less than 30 grams of carbs a day. So that's crazy. Again, Metformin, it could be an option. Absolutely. The Extended release is usually the best tolerated. starting dose is probably not going to show much. But once you get to the upper levels, usually around 2000 milligrams of Day of metformin is more the therapeutic amount.

Scott Benner 38:17
Also, Steven, I wonder if you couldn't find a doctor who would be willing to like dabble in micro dosing GLP is with you. Because right now they're stuck with that dosing strategy. Right? They put you on ozempic They move you move you move, you put you to two and leave you there like, I mean, right? could point to five just make a difference for him. You know what I mean?

Jennifer Smith, CDE 38:36
I don't know if he wondered GLP. One, there are many GLP ones. I don't know which one you've tried. The older generation provided a little bit in terms of weight loss, but really nothing compared to the new generation GLP ones?

Scott Benner 38:50
I don't know if he tried Manjaro know, or just I'm not sure but I do remember seeing online and talking about that it was not jiving well for him.

Jennifer Smith, CDE 38:57
Yeah, I mean, the other you know, in terms of again, the disclaimer of don't take any of this as medical advice but as could be very beneficial. I mean, there are some supplementals such as Berberine that are very beneficial in terms of insulin sensitivity that could help you especially more at mealtimes, which is when it's recommended to take allow cottage at least in Bolus doses of insulin depending on what your you know, sensitivity or body acceptance is to to using that and that could be an option. Also

Scott Benner 39:30
I've seen people use digestive enzymes, magnesium oxide stuff to help things move so that they don't feel backed up on the GLP this one here I'm interested in looping but I couldn't figure it out of watch tutorials and podcast but could not loop T one D PAL is a company that will set it up for you. Yep, Jenner you guys don't deal with all right.

Jennifer Smith, CDE 39:52
We do not we do not we absolutely 100% support all loopers in fact any of the do it yourself types of automated delivery systems we 100% support, we will not build it for you. If there are one of our educators, Catherine, she's very helpful in terms of there are during your build some questions and issues and whatnot that come up. Um, she's very helpful in terms of helping direct you to the right adjustment or to clear an error in the app. No, yeah, but we will not make the app, I do know that there is I can't remember the doctor's name out in California, you have to be part of his practice, obviously, but you will build it. And then does does it usually through something called testflight, which just download the app right onto your phone for you. So that is an option, I will tell you that to one pal. They do a wonderful job. But it is a monthly cost. So just be aware that this is don't want in one and done they build it and then you're on your merry way. It's a monthly upkeep. So when there are upgrades to loop, they do that for you behind the scenes, you don't have to really keep up with any of that I

Scott Benner 40:58
might say my moreover just go to the loop and learn Facebook group and ask if somebody will help you build it I'm sure somebody would and there's Mike is in our group, he would probably help you there's there's definitely people who would help you get it built. And then you know, there's nothing really to maintain after that after

Jennifer Smith, CDE 41:13
in the loop group. I've seen people who have done weekend we're gonna get together at the library together to do the build all together. So you may want to outreach to your community to

Scott Benner 41:25
Sarah saying if you guys if you were going to take a couple of units of glucagon to address a low is there a general guideline for adults, I think I've seen one unit for a year for kids.

Jennifer Smith, CDE 41:35
Actually, that's it's great. You already know the guideline for kiddos. If you can treat a low yourself with the old school glucagon kit, the red kit. The other kit that can be micro dosed is what you're really talking about here micro dosing of glucagon is G voc makes, not their usual one shot done. But they also make the hypo kit. The hypo kit comes with a pick a room temperature stable pre mixed vial of glucagon. And it comes with a syringe that's empty. In general, you would usually use that syringe to draw it up and dose in an emergent situation. If you're micro dosing that though, you would use an insulin syringe, and you would draw up out of that vial. And in order to do it, for adults, it's usually one unit per year of age under the age of 15. And then it's 15 units, or, you know, 30, if you read dosing it that 15 would be the usual sort of micro dose of glucagon to see if you and treat a low that you can address yourself before getting lower. And then you evaluate to make sure blood sugar comes up, stabilizes up and then technically you shouldn't have to read DOS,

Scott Benner 42:51
I believe I've signed a contract that says I can't talk about that. So I'm moving on to the next one. Okay.

Jennifer Smith, CDE 42:58
Well, I talked about it. I

Scott Benner 43:00
have nothing to do with you know, he loves the group we love, you know, a thank you very much. Any news about g7 and Omnipod? Five, there's an LMR. And I saw something on their Facebook recently where they were looking for more people. But that's all I know about. And that's just, I don't know, nobody tells me anything. Just in case you're wondering. I told me

Jennifer Smith, CDE 43:20
last night I have you know more about that than I sometimes

Scott Benner 43:23
I know stuff for a couple of days before they happen, but not, not for weeks or months. And also, I think if they knew they would tell us for certain so I'm not sure why it's taken the time it is to be perfectly honest. Susie says do you think GLP is used reduce insulin needs are feasible for a slim underweight kid. So I think if the person has a real need, like a real like insulin resistance, like you have, like, you know, your carb ratios one to two or something like that, there probably is a place where in the future, they'll find smaller doses to help people but there's no doubt in my mind, you will not be as hungry, it will be more difficult to eat. And if you're underweight or low weight, it could end up being an issue for sure. Right? Yeah, because it

Jennifer Smith, CDE 44:06
really does impact appetite. That's one of the biggest things that I hear from people one to a positive when they're noticing the definite difference in appetite, sometimes to the detriment right, where a person really just has to remind themselves to eat and that's not the goal of this medication at all.

Scott Benner 44:26
It listen, I'm on the GLP I have to remind myself eat somedays like there's no doubt I could go forever without eating and never notice it. But moreover, like, you know, as we were getting hard on it, there were times where we just had to take what we could get. And at one point, she lost, I think more weight than we meant, like she lost a healthy amount of weight. But then she probably lost I would say another seven or eight pounds more than she should have. We thought we adjusted her dose and she's putting that weight back on now. Yeah,

Jennifer Smith, CDE 44:55
I think this is a really interesting question too, because it's the The effect of thinking that with a child that doesn't have a weight issue, it sounds like in fact is more slim to being a little bit slimmer than desired. And the want to reduce insulin

Scott Benner 45:14
Yeah, I wouldn't take a GLP just to use less insulin, need to have like a real insulin resistance issue PCOS symptoms, weight gain, that's just doesn't make sense based on your situation, and

Jennifer Smith, CDE 45:26
are really heavy users of insulin that suggest we have to change the pump site every single day because the reservoir is empty. Absolutely, then, but that often doesn't, most often, in fact, doesn't go along with a kid or an adult who is already fighting to gain or maintain weight. Yeah,

Scott Benner 45:44
yeah, I agree. I don't I don't think that GLP is just going to be a thing that every type one gets one day, I think it's going to be very specific uses. Let's see. Next question. Michelle said so hard to Bolus for anxiety? Are Ms. 10. As she gets there calms down? And then she drops? Yeah, that's trust me. There's conversations all over the podcast about when Arden would sometimes shoot up for sports events, and not always, and we'd end up bolusing for it. And then if she didn't get anxious, we gave her juice to cover it. But yeah, it isn't easy, that's for sure.

Jennifer Smith, CDE 46:18
No, it's certainly not. And sometimes, again, depending on what your targets are, what your goals are, and also paying attention to how your child or your teen or yourself how you feel, honestly, with that, sometimes those sporting events are also really long, right? So you may get that spike on the way there. And if you don't Bolus for it, as soon as the movement gets going. A good majority of kiddos it comes down on its own

Scott Benner 46:44
to drop on its own. Yeah. So hey, this isn't really a question. But I just wanted to say good morning to Yolanda. And you know, I hope she has a good day. And we all trust us. All of us hate this. So no one no one's excited about it. Super excited to have diabetes.

Jennifer Smith, CDE 47:00
No. 30, after 36 years, I could I could easily if somebody knocked on my door and said this is it. Yeah, here's what you get. I'd be like, great.

Scott Benner 47:09
Yeah, Jonathan said it took a long time for him to figure out he was type two, he has an episode, if you want to hear it, it's a type two story. Okay, I asked Jenny to see how common that type why this is an old reply to another question. Okay. Let's see, the

Jennifer Smith, CDE 47:23
type one beat. Yeah, it is not as a response. It is not a common but I also think in terms of proper diagnosis, you really have to have the right clinician to be able to say, this is not the typical, you have these sort of, you know, visible things going on, you don't look like a classic type one, you don't look like a classic type two, it takes further testing. And I think that's also why, as I mentioned earlier with that Modi is, I've heard a lot more about it in the past five years. But Modi is also one of those things that it's really poorly tested for general, in general.

Scott Benner 48:05
So what about this hear that Cassandra is saying that receiver needs three days to get going for full coverage? Yes, so

Jennifer Smith, CDE 48:13
this is so for fully effective, meaning there's almost a ramp up to it, getting going at the full effect. You know, this, I would say is about a 5050 in those that I've seen using trustee, but specifically have a couple of little kids who definitely if we are going to adjust their trustee bar, we have to give it about two to three D days to actually see that it's truly making the difference that we would expect before adjusting again, and other people can go like I went from Lantis to tercio. Myself, and I was curious. So I went off my pump for a number of days just to test receba comparative to what I knew about my Lantis years ago, and I had no issues with it whatsoever.

Scott Benner 49:01
About the same so I'm putting this up because if Isabel or Nico or somebody who's looking can give Jennifer a list of the GLP episodes, that would be great. Somebody else says BC diabetes can build loop for you.

Jennifer Smith, CDE 49:14
Correct? That's Canada, though. Yeah. Just FYI.

Scott Benner 49:18
He's got across the border to get it done. Then, if anyone sees remain five, eight for the last year on Omnipod, five manual, would you still consider looping or? I mean, there's trade offs. Maybe. But, you know, it sounds like you're doing a great job manually. If you're not if you're sleeping, and you're, you know, not having a bunch of lows then. I don't know. It seems like you're doing a great job.

Jennifer Smith, CDE 49:39
And it sounds like the question here is really if I've got this and lows are not a big piece in the picture, and I'm navigating this with good stability, then I think it's really could I do better. Could I get better?

Scott Benner 49:55
She says she's not sleeping. I turned it on. Absolutely. All right, because Susie if you're all dead, but you've got a great day once. And I'm sure you can find a way to get Omnipod five and get your a one C there, you're just going to need to Bolus not an incredibly aggressive algorithm. But you know, and

Jennifer Smith, CDE 50:15
considering that Omnipod five has been being used in manual thus far, it does have some historic insulin data already.

Scott Benner 50:24
Yeah, your starting setting should be rock solid, that's for sure. And then you're just because I know she has a young son, but he's still going to keep growing. So when you see those, like, if he makes a leap and weight or needs or something, you might have to go back and do a reset to keep up with it once in

Jennifer Smith, CDE 50:40
a while and or the insulin to carbon sensitivity get adjusted. Or if you've got a higher target set, lower the target, or you know, lots of

Scott Benner 50:48
little things. Yeah, Sarah's saying thank you, I don't want to breach my contract, which evoke that's for sure. We're going to start looping after Omnipod. Five, we will need to get our settings dialed in. I'm a bit worried since we were never able to fine tune it in Omnipod. Five. Yeah. Well, were you in on the pod five manual and you were trying to fine tune it? Are you waiting for the algorithm to figure it out? Because those are probably two different things. Crystal, I have to tell you that I have recently taken the three episodes, Jenny and I did the math behind Basal insulin sensitivity and sunder carb ratio. And I've actually turned the math into code and put it on my website. But I haven't had the nerve to put it public yet. It's disclaimer it out the ass so that I'm not really worried about but like you can literally plug in numbers about yourself and get a starting place. But that math is available in those episodes for you to figure out for yourself. You know what I mean? You know what I mean? Jenny, like, I can just put them up online. And people can just say like, literally like, this is how much I weigh. I'm an adult, I'm meter active, etc. It just spits out the information. Yeah, I had Isabel do it. And it like it pegged her settings. Wow. So I wanted to do a smaller test group before I made it public. That's

Jennifer Smith, CDE 52:03
a great idea. I'm quite sure that many people would donate their information.

Scott Benner 52:07
Yes, did to find out. But for the moment, there's the three episodes the math behind and you can definitely figure it out. Oh, Crystal. Okay, send me an email and I'll get medical advice. Oh, no, I I'm an idiot. You should definitely not listen to me. Have we heard anything about the twin health program? What does that help? I don't know what that I don't

Jennifer Smith, CDE 52:27
know what that is either. I'd have to look that up myself.

Scott Benner 52:31
Let's look at this.

Jennifer Smith, CDE 52:32
Whether it is a confined by a state or is it a national?

Scott Benner 52:41
Also, I'm going to be at the touch by type one event in Orlando. There's a link to it right there. It's Free to get tickets. I don't know if somebody else is going to be there or not. I haven't talked to her.

Speaker 1 52:50
Me. Yeah, we'll be there. Oh, oh. I already have topics.

Scott Benner 52:55
Oh, well. You can come see Jenny and I in Orlando. When is that? Do you know? Oh,

Jennifer Smith, CDE 53:01
it's September. Something touched by? Yeah, that link

Scott Benner 53:05
will take you to touch by type one.org. You can go to the programs tab hit annual conference. I'll get the date for you. September 14. Oh, September 14. Okay. Yeah. Are we gonna go out to dinner afterwards? Sure. I you can you're gonna have your family with

Jennifer Smith, CDE 53:20
dinner with my family.

Scott Benner 53:22
Oh, oh, good. I have something to do in the evening. All right. Anyway, touched by type one.org. If you guys want to see it's completely free. It's actually Jenny, I'm not gonna ask you to out anybody. But it's a well put together event No. 100%

Jennifer Smith, CDE 53:35
No. Touch by type one is lovely. I think this is the third thing. Is it third year that I've that I'll be there. But it is a wonderful event. Can

Scott Benner 53:47
you look at the screen?

We're working on that. We'll say let's see so far. We're not sure. working it out. We'd love to see a beta two. All right. So awesome. Can you test it to Cassandra? Sure. Like everybody just email me and I'll let you say it. Yay. Are we out of questions? They can

Jennifer Smith, CDE 54:10
pull it off to me too. I'll test it. You. Brilliant. That's super awesome. Okay, well, yeah, the twin health I, you know, twin health is interesting. They have a the one that's connected to diabetes is it looks like an advanced like, like digital, like whole body evaluation. So but know that I mean, I've heard of other things that evaluate you know, taking like poop samples, and that kind of stuff, right to evaluate, evaluate, what kind of metabolism do you have and what should you eat and what shouldn't you eat? And some even go as far as suggesting the impact on glycemic, you know, excursions and shifts and changes? I don't know if this this looks a little bit more comprehensive. But yeah, there are lots of Different things like this out there.

Scott Benner 55:01
Okay? I don't know, I can tell you that I'm working on my gut health designer poop. And I watched

Jennifer Smith, CDE 55:08
that's actually one of my favorite words is poop. Isn't that appeared? I don't know why.

Scott Benner 55:12
That's a little strange thing. It's

Unknown Speaker 55:14
kind of fun.

Scott Benner 55:15
Did you watch the Netflix documentary about gut health?

Jennifer Smith, CDE 55:18
I don't think so. Is it newer? Okay.

Scott Benner 55:21
It's newer. Yeah. Let me see if I can find it real quick. I found it really interesting. But one of the things they talked about was people. It's called watch. It's called Hack your health, the secrets of your gut. I enjoyed it. Okay. And so, but there's a woman in there, this was the craziest thing you have a second. There is a woman in there who decided she couldn't afford to have like a company give her like a fecal implant basically. So she went to her brother. Let's not get into the details of this and because I don't know exactly how she did it, but she got her brother's poop and put it in capsules, like she took it. Now, her gut health improved, but you gotta go watch this to hear the story. In case I'm getting the wrong

Jennifer Smith, CDE 56:05
science plant is what you're talking? Yes. Okay. She she

Scott Benner 56:08
got hormonal acne that she'd never had before. But her brother struggles with it. So she stopped taking his poop. Her acne went away. And she thought okay, but I want the good gut health. She went to her boyfriend got his puppies, but started to pick up his depression. Oh, is that not crazy? Wow. Like, I don't know if that's right or not. But I was like mesmerized while I was listening. I was like, Is this true? But anyway, I thought it was really crazy. That

Jennifer Smith, CDE 56:36
is very interesting. I will have to I will have to look that up on Netflix.

Scott Benner 56:41
Yeah, Crystal. I'm making an episode about this. And it's not done until I'm done. But I've been working with a gut health guy named Josh deck and we record as we do stuff for ourselves. So it'll come out eventually come out. Like my poop honeypot five adjustment and Basal rates for kids with rapidly adjusting needs illness, etc. The lag with on the pot five is rough. Do you have any thoughts on what you've seen in practice with the looper tandem being better or worse? Etc?

Jennifer Smith, CDE 57:08
Yes, it's a great question. My personal as well as professional in practice, what I have seen is that loop is, for lack of a better word, it's easier, because there are adjustments that can be made more or less aggressive, depending on what you're seeing in terms of sensitivities. The next of the ones mentioned here, tandem does a lovely job as well, tandem is the only company for their T slim or their mobi, that actually allows multiple profiles to be set and enabled for their control IQ to work off of. So for kiddos who have a high growth period, and then it goes back to you know, more stability or lower needs, you can have almost like a high, moderate or low need sort of profile. And you could enable those then for again, the algorithm to work with. And that can be a huge advantage. You're You're right. And I think it's unfortunate because I think Omnipod five is a really lovely product. And it does do a really great job, but it is by far the leg if it accommodated, respond

Scott Benner 58:23
to Quick, Quick Change, it really doesn't. It's just not going to listen to artists using IEPs, which is like dynamically changing almost all of our settings and it still doesn't move that quickly. Like it's and it's moving fast. You don't I mean, like it's not unless you're gonna go in there and have settings set up which Omnipod five doesn't, doesn't have like, you know, different profiles, then, you know, that's the quickest way to change is with different profiles.

Jennifer Smith, CDE 58:49
And IPS is definitely you know, above and beyond in terms of its decisions that it makes in its adaptive nature with with the unannounced meal and the small micro Bolus and depending on what it sees in the rise and the rate of change and all it knows it makes a decision on which of those kind of navigates between it's a fantastic

Scott Benner 59:11
Arden kappa six three at college she was a college by herself for six months, she kept a six three a one C and I don't think she was Pre-Bolus thing that much and I don't know what she was eating half the time she was pulling all nighters not eating, eating going all over the place like it really held up. I thought

Jennifer Smith, CDE 59:30
I have to say hi to him. He says hi to both of us.

Scott Benner 59:35
He's in a great episode of the podcast. It's got to be years old by now but it's nice to say yes. And

Jennifer Smith, CDE 59:40
he just agreed. You're just a great guy. Nice that you said hi.

Scott Benner 59:44
Could you Donny get in like love back? Chinese give them flowers as they say if we were famous. That's what we would say we say Jenny gave Donnie his flowers but we're not famous and we just say hello.

Jennifer Smith, CDE 59:54
I know.

Scott Benner 59:55
It's very nice to say started vitamins recommended with the Hashimotos Episode. I've seen improvements in several ways. Oh, that's great crystal are fantastic. It is great. I'm doing a protocol right now of methylated, vitamin B, and A C, Milk Thistle and something else. And I've noticed I'm losing bloating in my, in my upper stomach. So I'm working on that right now. We'll talk about in the podcast one day.

Unknown Speaker 1:00:20
That's great. So

Scott Benner 1:00:21
let's see profiles tomorrow. Yeah, I mean profile. That's what you just what you need sometimes is more or less. I think we only have Jenny for a couple more minutes. For let's celebrate with Jennifer diagnosing at nine at 11 years old. 35 years going only on a sensor for the last five years. Ray once he is six. She's self taught old school diabetes. Good for you. That's fantastic. Really very cool.

Jennifer Smith, CDE 1:00:49
I'd be curious what kind of glucometer she was started with? Because

Scott Benner 1:00:52
that's right around five years ago.

Jennifer Smith, CDE 1:00:54
Yeah, that's right around the time that

Scott Benner 1:00:55
probably had that guillotine like poker that you had to?

Jennifer Smith, CDE 1:00:59
Yes, it was like the being down. Like, I'd hold the platform slightly above my fingers that it didn't quite kill my finger reached.

Scott Benner 1:01:09
Yeah, Amy, you can feel free to send that email to Omnipod. And tell them what you think. Can you tell us more about the enzymes, I tend to get constipated digestive enzymes. I like pure encapsulations. They make one. But you can find them probably at most health food stores. If you have type one, which I know many people here do. You might see a slowing and your digestion they could help to supplement it your meals. And do you have anybody say

Jennifer Smith, CDE 1:01:37
No, I was just gonna say for that one. Also hydration. It's really, really important does hydration and oftentimes even hydration. You think about that being just water. And you can over hydrate with just water. And that can create enough issues too. So hydration with some baseline electrolytes can be very beneficial.

Scott Benner 1:01:57
Yeah. Also, as your I'll tell you what, four or 800 milligrams of magnesium oxide a day and you will take it.

Jennifer Smith, CDE 1:02:03
Go Yeah, and use it at bedtime. Work on your gut all night. Yeah,

Scott Benner 1:02:07
God, do you want to poop do that? Start with 400. But after like two or three days, if you're not going go to 808 will happen. Do you have any clients Jenny with gastroparesis? That's using a GLP?

Jennifer Smith, CDE 1:02:18
I do not personally know. I mean, I could check with the other clinicians in our office and see if they do but I have not in all the years that GLP ones have been out. I've not had anybody use it.

Scott Benner 1:02:31
I'm interested to see how it goes. Because Are there going to be a whole generation of type ones that this is not available for because they actually have clinical gastroparesis. They have nerve damage that slows their digestion, or are we going to start learning more about people just having gut health issues with type one? Right? And you know, they don't have actual nerve damage. They just digest their food slowly. Right? Exactly. Interesting. Jenny, you have to go. I imagine. I have three minutes, three minutes. Okay. You guys have three minutes to ask any question. There's a link up here now to the diabetes Pro Tip series. But you can get all this at juicebox podcast.com. Of course, nothing we said here today was advice, medical or otherwise. And you can email Jenny at work if you'd like to work with her with that link that's right up there. This is the first time we've done this. But we held we got up to 70 people at one point we held 50 people real consistently. So I thought this was a great success. Fabulous. Yeah, super exciting to talk to people like this, especially on a Friday and launch into the weekend. Knows Jenny if this is going to be a thing we do every day as well. Yep. Okay, everybody will take care. I'm going to hang out for a couple minutes. But Jenny's gonna go back to work. Are you literally going to jump into a call and help somebody? I'm jumping into a call. Yes. What kind of plant is in your window?

Jennifer Smith, CDE 1:03:49
It is a Christmas cactus.

Scott Benner 1:03:52
Oh, does it flower often? Well,

Jennifer Smith, CDE 1:03:54
that's the interesting thing. So it flowered around Christmas time, which was lovely because it doesn't always and then in April, it got all these blooms again. And it is in the blooms on a Christmas cactus last for quite a while. And it just started losing. You can see some of the dead ones on it. But it just started losing those blooms like recently. So yeah, Christmas cactus. It's a lovely plant. I

Scott Benner 1:04:19
have a giant one. I can never make flowers come out of it. When the flowers come out. I don't know what I did to make it happen. So you have to sometimes

Jennifer Smith, CDE 1:04:25
you have to kind of shock it. It's almost like bulbs that you take out of the ground. And then you put them in a dark place. And then when it starts getting warm and the ground on freezes, you plant them and that sort of kind of sparks them. So Christmas cactus. I did not do this. So it just was random. But my basement is also which is where my office is it's also colder than the rest of the house. So I think when I brought it down here I moved office spaces. I think the cold kind of shocked it.

Scott Benner 1:04:56
Okay, so anyway, there you go. Wow, the thank yous Jenny, hear from everybody.

Jennifer Smith, CDE 1:05:01
This is really wonderful. I like the live option to do this.

Scott Benner 1:05:05
Michelle stayed up in Australia to talk to us. It's 1am there. Oh, that lovely. And I think Isabel makes a good point. There are maybe 30 episodes of Ask Scott and Jenny where you can hear us pontificating ad nauseam about your questions. So, alright, Jenny, thanks so much. I'll talk to you. Yeah.

Jennifer Smith, CDE 1:05:24
Thank you. Bye, bye.

Scott Benner 1:05:24
All right, guys. That was it. Should we do this again? I literally threw this on Jenny. Like yesterday afternoon. I was like, would you do something tomorrow at 10 o'clock with me? And she was like, Yeah, sure. We maybe we'll do this again. I mean, there's a lot of people here it was great to see everyone want to thank you all, for your support, remind you seriously, you subscribe to the podcast. If you don't, it helps the show immensely. And Apple podcasts or Spotify or wherever you get your audio etc. Please, if you're in the private Facebook group, follow the public page. Because this thing you see here with the chat, it really only works through the public page, this software, it's not the software's fault. Facebook blocked the software from getting into the private groups. So if you want to be part of that, this is a great place to do that. If you love the podcasts, leave a five star review wherever you listen, five stars and a great review that will help somebody else be interested in the show. Please, if you're an apple podcast, don't forget to turn on your automatic downloads and your settings so you don't miss an episode. And so that I get downloads, because downloads is what the advertisers care about. And if you want Jenny and I popping up like this, the middle of our day, Scotty gotta make money somewhere. So keep pumping out those episodes, please. Very, very helpful Spotify as well. If you care. People are saying goodbye. I'd like to say goodbye. And we thought it was awesome. That was great. Appreciate that. I think we'll do it again. Hopefully I saw a number of you clicked on Jenny's link. So Jenny will not that she did this for business. But you know a couple of you check her out. I'm sure she'll definitely come back. Great weekend. Oh, thank you. Oh, my God, please. I'm not camera ready. We will definitely try to do it again. Calvin has gotten a chance for an annual subscribers to have all the episodes uncensored, Calvin, I am working on it slowly. It is very expensive. Every time I uncensor an episode, it costs a significant amount of money through the bank. So I'm trying at least going forward. We're we're trying to do it. But it's another problem. Like even producing two different two different files increases my costs by like twice as much. So I'm trying to build up enough money where I can use that money to pay for that. Okay, all right, you guys are still chatting with each other. Thank you everybody for coming. I'll see you later. I'm going to try to make this when I end the stream. I'm going to try to save it and make it available but it should be floating around in Facebook for you for quite some time. Take care have a great weekend.

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