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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

okay, Jenny, I'm at the office talking to the endocrinologist. Kids just been diagnosed. I've just been diagnosed, and I ask the question if I ate dinner at 7pm and at 7:45pm someone brought out ice cream. Should I Bolus for that too? And my doctor, for some reason, says to me, no, don't do that. You don't want to stack your insulin. Stack

Unknown Speaker 1:55
your insulin. Okay, so not right. So

Scott Benner 2:00
whether they get told incorrectly, where people develop the idea on their own, somebody is going to say to you after being newly diagnosed, don't stack insulin. What do you think of when you because there is a world where you can stack insulin. So what? What is 100% what is that? Stacking

Jennifer Smith, CDE 2:21
insulin is taking insulin that isn't meeting the need for another lovely, I guess, little saying, right? It is insulin that really is kind of being almost given willy nilly, right? You may not think that you're doing it that way, but it is a okay, I've given insulin my blood sugar is still high, or, goodness, the air was going up. Now I'm gonna give more insulin. I think of it as not really having a thoughtful delivery reason,

Scott Benner 2:51
purposeless, except for the fact that you have a high number and you're trying to squash it right, correct, exactly.

Jennifer Smith, CDE 2:57
I mean not stacking insulin or taking insulin for, what you need it for is not stacking, even if you're adding insulin within the defined time period of a three to four hour action window, which is what we call IO B, or insulin on board, is essentially the time frame that we're given to watch for This concept of stacking, right? And if you need the insulin, though, such as, somebody brings brownies over an hour after you finish your lunch and you really want to eat the brownie, do you need insulin for the brownie? 100% you need insulin for the brownie.

Scott Benner 3:33
And here's where the saying that helps people came out of the podcast. It's not stacking. If you need it, that's bolusing, right? That's it. That's the thing that apparently helps people more than anything. Is that phrase, yes. So I don't want you to stack your insulin. That would be bad and wrong, and you're gonna end up low, or like, panicky low later if you do that. But you have to cover the carbs that you take in. That's that you just

Jennifer Smith, CDE 4:00
do sometimes other pieces. This consideration comes up a lot when I start talking to people about why blood sugars might not seem to be responding to that initial amount of insulin, and then they bring in the idea, but if I add more, I'm stacking right? No, you're not. Let's look at the meal content. Is your meal high fat. Is it high protein? Because now you've Bolus for carbohydrates here, and in the end, hours later, you might have an impact from other pieces, other macro nutrients in that meal that are going to require more insulin. Are you adding insulin within the original Bolus? Is time frame of action 100% you are. But if you don't, your blood sugar is going to sit high.

Scott Benner 4:44
If you misunderstand the impact of a food item, like you said, it's got more fat and it's going to extend its time whatever, like you You misunderstand. You count the carbs, or you just count the carbs wrong. You count the carbs. You say, Oh, it's 10, but it was really 20. If you Bolus 7pm eat 10 carbs, you think, Bolus for 10 carbs, 20 minutes later, realize, oh, gosh, that was twice as many carbs as I thought it was. If you put in the rest of the insulin, you're just covering the carbs. You're not stacking insulin, right? It becomes one of those. It's like a boogey man, I think for diabetes, like, right? Like, somebody's going to tell you very early on after you're diagnosed, do not stack insulin. And then that phrase is going to override all your common sense in the future when you're like, I think I don't have enough insulin here, because what does it

Jennifer Smith, CDE 5:33
bring in? It brings in fear, yes, teaching somebody to be afraid of putting in extra of something that might cause, again, a place of fear is brought in with talking about low blood sugar or hypoglycemia, right so, oh my goodness, if I take more insulin right now, it's going to cause a low blood sugar, and I don't want to do that. And again, with today's technology, thankfully, you've got more information to actually be able to stop any detrimental outcome from taking more when you need more. You would

Scott Benner 6:07
think that the new technology would have squashed the better high than low theory, but it hasn't for every clinician, and I'm always interested by what we choose to say, like, better high than low means like, well, I'd rather you have a higher blood sugar than be, you know, like, fighting with a low or passing out, or something that, well, like, okay, I guess I can agree with that. But like, what if we would have just said, like, better stable and in range than low, right? Come that wasn't the thing, but probably because of no CGM. Like, it's easier for me to say that because glucose monitors exist now,

Jennifer Smith, CDE 6:40
I would expect absolutely and I I also think within that realm, there are some people who take it to another place of saying, Okay, I only have these time frames of available eat and Bolus. Within this time frame, I can't do that. I was told I can't take extra insulin. It could be dangerous to take extra so I'm going to eat a breakfast, I'm going to eat a lunch, which is well outside of that action time, and I'm going to eat a dinner, and that's it. Well, goodness, if you're hungry, if you're metabolically up or down, if you're a training athlete, that is not going to be a stretch.

Scott Benner 7:18
I don't know, like I just, I just want to say this one again, right? So just put it here at the end. You can stack insulin. I don't want you to do that, but it's not stacking if you need it, that's bolusing correct, okay? And that is one of those phrases that the feedback comes over and over again, like there's a lot of people's light bulb moments. Yeah. So awesome. I appreciate you talking about

Unknown Speaker 7:39
with me, of course,

Scott Benner 7:50
if you're not already subscribed or following in your favorite audio app, please take the time now to do that. It really helps the show and get those automatic downloads set up so you never miss an episode? Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast if you're ready to level up your diabetes care. The Diabetes Pro Tip series from the Juicebox Podcast focuses on simple strategies for living well with type one. The Pro Tip episodes contain easy to understand concepts that will increase your knowledge of how insulin works. And so much more, my daughter has had an A, 1c, between five, two and six, four, since 2014 with zero diet restrictions, and some of those years include her in college. This information works for children, adults and for the newly diagnosed, and for those who have been struggling for years, go to Juicebox podcast.com and click on diabetes pro tip in the menu, or head over to Episode 1000 of the Juicebox Podcast to get started today with the episode newly diagnosed. We're starting over and then continue right on to Episode 1025 that's the entire Pro Tip series. Episode, 1000 to 1025 i.