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Scott Benner 0:00
Hello friends, welcome to the sips series.

These foundational strategies were nominated by listeners. They told me, these are the ideas in the podcast that truly made a difference for them. So I distilled them down into short, actionable insights. There's not going to be any fluff or complex jargon, just practical, real world diabetes management that you can start applying today. And I know your time is valuable, so we're keeping these short. Another small sip will come out once a week for the foreseeable future. If you like what you hear, check out the Pro Tip series or the bold beginning series for more. Those series are available in the menu at Juicebox podcast.com and you can find complete lists of all of the series in the featured tab on the private Facebook group. Please remember that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. The questions you have, I guarantee you there's answers to them in the Juicebox Podcast, and it's all free. You

Jenny, insulin used now is for later. What's happening to you now is from insulin you used previously. Correct. So this is in a number of different episodes. I talked about it in 506, listening to the doctor. It's in a bumping and nudging episode. It's in an episode of The Pro Tip series called The perfect Bolus. But in general, it just struck me one day, while I've been talking to people for so long that a lot of people look at their graph, where they look at their finger stick, and they try to assess this thing that's happening to me right now, and they only see the other things happening right now. Like, didn't mean, like, it's almost like, if someone tapped you on the shoulder, you wouldn't think to go back three hours to see who you let into the house. Like, right? You know what I mean? Like, just, you're like, Oh, who's here? What's happening, right? So there

Jennifer Smith, CDE 2:24
are lots of different points in your day where if you start to use your data and evaluate your data, you'll be able to see this spelled out pretty easily. I see it a lot again, in Bolus strategizing, where you haven't been Pre Bolus in great we've gotten to the idea of starting to Pre Bolus and then, well, I can't Pre Bolus because I'm going low within five minutes. So this brings in the perfect picture of it's not that Bolus, that Bolus did not drive your blood sugar low in five minutes. I promise. I'd bet a million dollars that I don't have that it was not this Bolus. Instead, I again looking at graphs and everything we talked about those trend lines and the arrows in CGM, if you're already dipping coming into a meal Bolus time, right? You have insulin pulling that blood sugar in that downward direction already, so the fact of getting low in five minutes after taking that Bolus, it was not the Bolus fault. Instead, we should look for a trend, and if this is always happening coming into a meal, then first we have to stop that trend down so you can adequately Pre Bolus and get some confidence around Pre Bolus saying because you're not going low anymore. Yeah,

Scott Benner 3:43
I'm gonna get back to insulin now, is for later in a second, but the amount of times that I've heard people say I can't Pre Bolus because I Pre Bolus yesterday, and like you said, it's five minutes I didn't have a time to eat, and my blood sugar dropped at the floor. But these are the same people who are telling me, like, insulin takes forever to work, and I don't know, like, it's never does what I want it to do. And so my point, I guess, is that you have to time shift in your head a little bit. And I guess the way the the sayings ended up being insulin now is for later. Was my way of saying that what's happening to you right now is not because of what you did with insulin just now and then to like, adjust it out further. I started finding that it was easier for people to think about like, Well, what I did in the past is impacting what's happening right now, correct? Yeah, there's 1000 different examples of this. If your blood sugar is getting high at, you know, midnight, it's probably from dinner. Could be, could be, might not be, I don't know, but you need to assess it that way first. Like, maybe, you know, maybe your doctor turns your basal down at 10pm and that's why you're getting high at at midnight that night. But that's still the same idea. It is. Yes, the thing that happened at 10 is what's impacting you at midnight. So. Once you understand that you have a good, like, feel for it, then you can start understanding greater that what I'm doing right now is for later, and so I can make decisions in the moment that will make 23456, hours from now, better. It's more stable. Yeah, yeah. You just gotta have to wrap your head around it's not like stepping on the brake of a car. It's not like I need to stop now I'll push on this pedal. And

Jennifer Smith, CDE 5:27
that's the whole idea around understanding insulin to begin with. Is that we have something that I really wish we could change the name the way that we think about it. We call it rapid insulin. It is not rapid. It may be more rapid than I lived with eons ago, which took a really long time to get moving, but it still is not instantaneous. And I think those two words people think of as being the same thing, and it takes movement for that insulin. And one of the first places I bring in the concept of that insulin, you know now is for something you're going to impact later, is in the basal testing time period where we're really looking at segments of the day without any Bolus or anything in them, and we can say, Okay, well, blood sugar rising, like you said, at midnight. We don't change the basal rate at midnight, right? It's a backed up, because that's going to take at least an hour or two of circulating change in a basal amount to impact by midnight to stop the rise or fall.

Scott Benner 6:31
But do you know how many people just heard you say that and thought, Wait, you don't I know? Yeah, yeah. Why not? Like I'm getting low at midnight. I'll change my setting at midnight. It's because insulin takes time to begin working. And Jenny's point is so good that, you know, when they came up with faster insulin and called it like rapid acting insulin, compared to what they were replacing, it was rapid. It was insanely rapid. They were like, Oh my God, look at it. It's like an hour. It's working, right? Yeah, it is one of those things that, like, you know, we name something because of, you know, what made sense in the moment. And now that's not people's expectation of rapid anymore, especially in this, I mean, in a, I hate to say I sound old, I think, but like in a social media, like, right now, yeah, rapid doesn't mean that. So anyway, insulin used now is for later. What's happening to you now is from insulin you used in the past, correct? Here's an example, just because you're 75 like, people are like, Why can't Pre Bolus my meal, I was 80 before I ate. And I always tell them, like the number, like, being 80 doesn't make the insulin magically work faster. Like, you know, I know you have a shorter distance to go to being low and being you know, concerned, but you can still with a stable 80 blood sugar that is not being impacted by anything that happened before, you can still Pre Bolus, just like you would Pre Bolus anything else, correct? Yeah, that's all Yes, all right, excellent. The music, if you or a loved one was just diagnosed with type one diabetes, and you're looking for some fresh perspective. The bold 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.

Are you 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 want to thank you so much for listening and remind you please subscribe and follow to the podcast wherever you're listening right now, if it's YouTube, Apple podcast, Spotify, or any other audio app, go hit follow or subscribe, whichever your app allows for, and set up those downloads so you never miss an episode, especially an apple podcast, go into your settings and choose, download all new episodes. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. The episode. Episode You just heard was professionally edited by wrong way. Recording, wrong way recording.com.