#1370 Thanksgiving Insulin Strategies
A turkey tutorial in under 20 minutes. Simple tools to make today more enjoyable.
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Scott Benner 0:00
We are all together again, friends for the next episode of The Juicebox podcast.
Today's episode is quick and to the point it's called Turkey tutorial. This episode is a mainstay on the podcast. If you're new to the show, you might not know it. If you've heard it before, you're in for a treat, because the audio has been completely Remastered. This episode first dropped on November 21 2017 what you're getting is a quick kind of it's a pep talk, and it's a pep talk for HAL to Bolus on a day full of food. I put it up around Thanksgiving for obvious reasons, but the truth is, what you hear inside will work for you every day. Nothing you hear on the Juicebox podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your healthcare plan. 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're looking for community around type one diabetes, check out the Juicebox podcast. Private Facebook group Juicebox podcast, type one diabetes, but everybody is welcome. Type one, type two, gestational love. This episode of The Juicebox podcast is sponsored by the contour next gen blood glucose meter. Learn more and get started today at contour. Next.com/juicebox next.com/juicebox 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 too. So screen it like you mean it one blood test can spot type one diabetes early. Tap now talk to a doctor or visit screen for type one.com, for more info. Just going to go through a couple of ideas, talk about them very briefly, and then I'm gone. You ready? Let's jump right in. When I'm making insulin decisions for Arden, I have a bunch of tenants, just some basic concepts that I consider each time. So I'm going to mention one, and then I'm going to talk about it for a little bit. Here's the bit. Here's the first one. Do you find yourself of being accepting of high glucose levels higher than you want them to be because you're afraid of the insulin? I understand if that's how you feel, but you need to get over that. You have to get past that part until you dispense with your fear and stop looking at a 200 and going well, 200 is not bad. 150 is not too bad. At least it's not 250 until you can stop doing that in your own head, it's going to be difficult to move on. So you have to dispense with the fear. Fear and diabetes do not go hand in hand, unless you let them. Insulin is like fire in as much as it should be respected, but not feared. It's a simple concept. Sometimes it's hard to bring into practice. Don't be afraid. Be bold. You'd much rather have a lower blood sugar to deal with than a higher blood sugar to deal with, especially on Thanksgiving. I mean, wouldn't you rather have a 60 than a 260 right? Wouldn't you rather be fighting with a 70 diagonal down that might need a little more food, especially on a day when there's so much food around the house anyway, than a 270 diagonal up. You don't want to be fighting with a 300 that's sort of how a day like Thanksgiving gets ruined. You get a blood sugar up. And now the anxiety, the guilt and the insulin you're bolusing, eventually you crack the 300 all of a sudden it's crashing down. You'd much rather just overdo it a little bit with insulin, and then just have to stop a little bit of a low. The next thing you need to consider is action time. How long does your insulin take to begin working, and how does that affect your blood glucose? You need to understand that you're never going to be able to balance the insulin and the carbs together if you don't understand how the insulin works, when the insulin goes in, how long until it starts moving my blood sugar? This is incredibly important to understand, and very easy to figure out, whatever your blood sugar is, right now, if it's 150 and you haven't had insulin for a few hours, give yourself some insulin. When do you see it start to move? Do a little testing, little trial and error. Figure it out. Once you understand how long it takes for the insulin to begin working, that is a key building block for the rest of what you're going to do. Okay, next big thing, big part. Here we go. When your blood glucose levels are high, you've likely mistimed miscalculated, or a combination of the both your insulin exactly the same. If your blood sugar is low, you have mistimed miscalculated or possibly a combination of those two. You've lost the balance between carbs and insulin. But there's no great secret about why your blood sugar is high. We sometimes can get caught up in the whys, like, is it because of my pump is old, or maybe my insulin is too old? You see people all the time going. Through all the myriad of things, why is my kid's blood sugar 250 I can't figure it out. Here's why you don't have enough insulin. The reason you don't have enough insulin really isn't important in the moment, more insulin. It's something to understand in a bigger way, because it has applications throughout diabetes. If your blood sugar is high, you haven't used enough insulin, and if your blood sugar is low, you've used too much insulin. Now maybe that's a balance between the timing and the amount, but still, it's a basic concept that will hold true over and over again. Here's a simple rule of thumb I use all the time. It cannot be overstated. Trust yourself and what your experiences with diabetes have taught you. It's very simple. It's a convoluted sentence that makes the point, you have to believe that what you know is going to happen is going to happen. If I Bolus this much, I know this is going to happen if he eats that but I don't give him insulin until he's done. I know this is going to happen. You have to trust that you know what's going to happen is going to happen, and then you need to do something to stop it from happening. Here's another one that's very important, especially on Thanksgiving. Don't confuse carb counting with carb understanding, because not all carbs are created equal. You can't just say, well, that's 30 carbs. It's going to do this. It needs this much insulin. That's not true. 30 carbs of one food may affect your blood sugar much differently than 30 carbs of another food. It is much better for you to look and say that's two slices of bread. I know when two slices of bread are consumed, it requires this much insulin. Forget that two slices of bread or five carbs less if it's that kind of bread, or five carbs more for that kind of bread. How much insulin is it going to take for those slices of bread? When you look at a pile of stuffing, how many pieces of bread are there? How much insulin is that going to take? Don't worry about the count or the amount or the weight. Worry about what you know, what happened last time when I ate the sandwich. How much insulin did it take? Let's say I looked at a food and I thought, I can't lower my carbs. I said, that's five units of insulin. Then I gave the five units of insulin. I did a reasonable pre Bolus, and still, my blood sugar ended up at 250 and I had to do three more units to bring it back down to where I wanted it well, if it took five units up front and three units to bring it back, you probably needed eight units of insulin. Give it all up front, get rid of the spike. If you really time the pre bowl as well, we're going to talk about pre bolusing in a minute, but if you really time that pre bowl as well, maybe you don't need the full eight. Maybe it's only seven. These numbers are specious. They're not specific to you, but you need to figure that part out. I used this much then this happened, so I needed this much more. I probably needed that whole amount up front. That's the rule. I can tell you, that I Bolus the amount that I think is correct. I really never count carbs. I never worry about what my insulin to carb ratios Tell me. I worry about what I historically know that food is going to require same thing with the high blood sugar. I see a high blood sugar that's stuck and I need to Bolus for it. I don't worry about what the pump says. I worry about what works. Okay, basal rates. For those of you who are pumping, if you find yourself bolusing all the time, your basal rates are probably not correct. You should not need to Bolus just to keep a blood sugar where you want it. Don't be afraid to adjust your basal rates even temporarily. Let's use Thanksgiving as an example. If there's going to be more food, the food is going to be more consistent than usual on Thanksgiving, increase your basal by how much. I don't know. I can't tell you. You can figure that out, but I can tell you that when I make adjustments to Arden's basal rates, I usually move them 30% of the time when she has a growth spurt, I'm starting to Bolus too much to keep blood sugars where I want them, and I raise their basal rate. I raise it by 30% see what happens. So you can use temporary basal on days where you're going to be really food heavy. I think on Thanksgiving, I'm going to talk about what our day is going to be like at the end, but I'm going to start setting temp basal for Arden right away in the morning. Imagine type one diabetes is all about understanding the limitations of man made insulin, having the nerve to be bold when you're using it, and most importantly, acting first when you wait for diabetes to attack you, you will always be on the defense. Act. Don't react. I'd rather Bolus and have something happen, then at least I can say, Okay, I did this, and that happened. Next time I'll do this, it brings up a very simple formula for diabetes. It's the it's the E equals MC squared of the Juicebox. Podcast, I Bolus to half a unit, the blood sugar moved 40 points. I wanted it to move 80 points. So next time I'll Bolus a unit. I Bolus 10 units, but my blood sugar still went up to 150
maybe next time I'll do this much. I did this. This happened. I wanted this to happen. Next time I'll do this, the E equals MC squared of the Juicebox podcast. Okay, let's talk about pre bolusing and the tug of war. More of the carbs in the insulin. I want you to picture a tug of war between the carbohydrates and your insulin. In the middle of the rope is a flag. Now, unlike most tug of wars, the goal isn't for one side to win. The goal is for both sides to pull and the flag to never move from the center. That is the balance of your blood sugar that flag. If you start eating when your blood sugar is 180 you're going to be high. There's not a lot you can do about it, unless you're incredibly aggressive with insulin at the time, and that's maybe hard for some of you to do. So give yourself a chance at these meals and pre Bolus. Now I can't tell you how much of a pre Bolus is, right, but we did talk earlier about understanding how your insulin works. Get that understanding of yourself. Can I give myself insulin 15 minutes before I eat? Can I give it to myself 10 minutes? 20 minutes? It differs for everybody. But what you want to happen when the food starts affecting your body, you need the insulin to already be working so that while the carbs are pulling up on your blood sugar, the insulin is pulling down, and they're fighting and they're pulling on that tug of war rope, but they're not winning. No one's winning because no one got a head start. You give one of them a head start, that's going to be the side that wins. If the carbs pull first, then they're always going to be winning, and you're going to have a hard time to get back into that game, unless you add so much insulin that eventually you'll all go crashing the other way. You don't want that. If the insulin pulls too soon, before the carbs start working, you're going to get really low. And you don't want that either. You want the insulin and the carbohydrates to pull at the same time. And the most important thing is they need to stop pulling at the same time. A low after a meal just means that you had insulin left in your body after the carbs were gone. A high after a meal means you had carbs left in your body after the insulin was gone. It's all about the timing. Remember what I said? If your blood sugar is high, you've either miscalculated or mistimed. And if your blood sugar is low, you've either miscalculated or you've mistimed. A significant pre Bolus, one that allows the insulin to be working when the food starts working is key. If you want to stop a spike at a meal time, that's it. Now, if you didn't stop the spike, don't just wave your hands and go, Oh, I got it wrong. You see a blood sugar that's going up, attack it, especially if you have a Dexcom CGM stop the arrow. But I mean, with a big, carb heavy meal like this, your kid eats test again and a half an hour see where you're at. If you're 200 a half an hour after meal, you miscalculated or missed time. You may need more insulin. How much more is up to you, but you want to stop that rise and get it back where you want it without over treating. And that is really one of the last points you can't over treat. You can't over treat a low. You can't panic and pack in the whole refrigerator for a low, and you can't panic and pack in too much insulin for a high, or you will be up and down all day long. It's about bumping and nudging your blood sugar. If you have a Dexcom, think of that line on your CGM graph as something you're just trying to nudge, just up and down like a little video game, just trying not to leave the lines. And if you're testing and you don't have a CGM test frequently, and bump and nudge and bump and nudge, keep pushing that blood sugar back to where you want and expect good things for yourself. Set a goal for yourself of around 100 of around 80, of around 90, because often you get what you expect, especially with a CGM, please move your tolerance lines to a lower spot. You don't want a high tolerance on your CGM of 200 it's too late by then, put it at 130 react up front. Remember what we said? You're either going to attack or be attacked. You would much rather act first. So see a 130 diagonal up, bump it with a little bit of insulin. See a 70 diagonal down bump it with a tiny bit of carbs, or maybe you could even stop a 90 diagonal down by just restricting your basal for a little bit. You'd much rather do little bumps than giant corrections. As someone once said, high blood sugars cause low blood sugars because you're sending so much insulin and you're bound to get a low later when you bump and you nudge. There's just these tiny little corrections. They don't really have the opportunity to push you too far, one way or the other. So on Thanksgiving morning, we're going to wake up. We're going to follow one of my wife's family traditions of having cinnamon buns. Now I'm going to get up a little bit before my daughter to make sure that her blood sugar is nice and low and steady, so that when I pre bullish for these cinnamon buns, I have a good starting point for the day. There's nothing more important than a good starting point after that, there's going to be food around the house all day. I'm going to be using temp, basal rates increased. I will stop them and start them as need be. When it's time for the meal, I'm going to look at the plate. I'm going to do my best to decide how much insulin this is going to take, and I am going to pre Bolus. I am going to be bold when I pre Bolus, and I'm going to try to time the food in my daughter with the insulin. Beginning to work, to get that tug of war that we talked about, if I miss either with too much insulin or too little insulin, I'm going to make small adjustments. I'm going to keep on top of it during the day. It's going to take a little bit of effort, but not a lot. And I'll tell you what, it's way better than having blood sugar. All day, that make you feel sick to your stomach, that give your kids a foggy feeling, that make them have a terrible time, and give you the guilt that you know you don't want. And if you're an adult living with type one diabetes, trust me, it's much easier to pay attention up front, to make these small decisions that give you good outcomes than it is to be stuck thinking about this all day long. Towards the end of the day, we'll do our best when the pie comes out and the ice cream and all that to keep ahead of it. And if she gets a little low at some points, we'll add a fast acting carb where it's necessary, because it is far easier to stop a low or falling blood sugar than it is to affect the high one. But I'm not going to let this day be ruined by the fear and the anxiety and high blood sugars, I don't think you should either. Please remember that nothing you heard today is advice medical otherwise, I wish you a ton of luck and success on Thanksgiving. Hope that being bold helps you, and if you're listening after Thanksgiving, these things that I do, I do them every day of the year, not just on Thanksgiving. I just thought today would be a really nice day to say Happy Thanksgiving. Here's some of the things we've been talking about in the last 138 episodes of The Juicebox podcast. Please, if you're just finding this episode now, go back and listen. There are hundreds, literally of conversations with people just like you. We talk about type one diabetes, what it's like to live with it, what it's like to try to management. These kinds of tips and tricks are scattered throughout every episode. I think you'll type one. Diabetes can happen at any age. Are you at risk? Screen it like you mean it. Because if just one person in your family has type one, you're up to 15 times more likely to get it too. So screen it like you mean it. One blood test can help you spot it early, and the more you know, the more you can do. So don't wait. Talk to your doctor about screening tap now or visit screen for type one.com to get more info and screen it like you mean it the contour next gen blood glucose meter is sponsoring this episode of The Juicebox podcast, and it's entirely possible that it is less expensive in cash, then you're paying right now for your meter through your insurance company. That's right. If you go to my link, contour, next.com/juicebox, you're going to find links to Walmart, Amazon, Walgreens, CVS, Rite, aid, Kroger and Meyer. You could be paying more right now through your insurance for your test strips and meter, then you would pay through my link for the contour next gen and contour next test strips in cash. What am I saying? My link may be cheaper out of your pocket than you're paying right now, even with your insurance, and I don't know what meter you have right now. I can't say that, but what I can say for sure is that the contour next gen meter is accurate. It is reliable, and it is the meter that we've been using for years. Contour next.com/juice box. And if you already have a contour meter and you're buying test strips, doing so through the Juicebox podcast link will help to support the show if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bowl beginning series from the Juicebox podcast is a terrific place to start. That series is with myself and Jenny Smith. Jenny is a CD CES, a registered dietitian and a type one for over 35 years, and in the bowl beginning series, Jenny and I are going to answer the questions that most people have after a type one diabetes diagnosis. The series begins at episode 698, in your podcast player, or you can go to Juicebox podcast.com and click on bold beginnings in the menu this one Hey, kids, listen up. You've made it to the end of the podcast. You must have enjoyed it. You know what else you might enjoy? The private Facebook group for the Juicebox podcast. I know you're thinking, uh, Facebook, Scott, please. But no. Beautiful group, wonderful people, a fantastic community, Juicebox podcast, type one diabetes on Facebook. Of course, if you have type two, are you touched by diabetes in any way? You're absolutely welcome. It's a private group, so you'll have to answer a couple of questions before you come in. We make sure you're not a bot or an evildoer. Then you're on your way. You'll be part of the family.
Speaker 1 19:22
You you
Scott Benner 19:29
starting to see patterns, but you can't quite make sense of them. You're like, Oh, if I Bolus here, this happens, but I don't know what to do. Should I put in a little less, a little more? If you're starting to have those thoughts, you're starting to think this isn't going the way the doctor said it would. I think I see something here, but I can't be sure. Once you're having those thoughts, you're ready for the diabetes Pro Tip series from the Juicebox podcast. It begins at Episode 1000 you can also find it at Juicebox podcast.com up in the menu. And you can find a list in the private Facebook group. Just check right under the featured tab at the top, it'll show you lists of a ton of stuff, including the Pro Tip series, which runs from episode 1000 to 1025 I can't thank you enough for listening. Please make sure you're subscribed, you're following in your audio app. I'll be back tomorrow with another episode of The Juicebox podcast. You.
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