#1462 Small Sips: More Insulin
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A longer-acting insulin strategy helps manage high-fat and high-protein meals more effectively.
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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 00:00 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 let's go over more insulin. Yay. So these are topics picked by listeners that they found to be extremely helpful, and we're going to do a tiny little dive on each one of them so that we have some short form content around it. So cool. Apparently, in episode 121, is the first time I talked about just the concept of more insulin. Since then, it's come up in a diabetes variables episode and in a pro tip episode. But this is a takeaway from that episode. It says, apparently, this is me talking. It's gonna be odd to, like, say my own words out loud on a second insulin, because it's restricted by little pieces of tubing, though, that's you hold on a second. So you need to make it work. And then the end of them, then the reason is the moment as
Jennifer Smith, CDE 02:16 I'm reading it, I think what the person is making sense of or what whoever one of us said, this is the fact of in the moment, if you're trying to decide whether or not you need more insulin, you don't necessarily need a historical look at is there a trend to it in the moment? It's more like right now, I know I need more. This is happening, so give more. And then if you feel like in your brain, this could be a trend that you've kind of seen happening time of day, time of the month, whatever it is, then go back and historically, look at the information, because it may suggest that there's a setting change that actually needs to be made, but right now, don't putter around trying to figure out the reason. Just give more insulin if you really think that that's the right thing to do. Now,
Scott Benner 03:13 100% so this comment came from a listener named Monica, and what she said was, what helped me most was the idea of meeting the need and figuring out why later. So what ends up happening to people, more often than not, right, is they get a little, I guess, what you call paralysis by analysis. And you know, blood sugars have done a thing. Usually gotten high. They don't understand why. And instead of addressing it, they very often stare at it, worried about a couple of different ideas. They don't want to stack their insulin. They've been told not to stack they've been told that they can't Bolus often, you know, until three hours after the previous Bolus is finished, right? And from my perspective, if you've given yourself some insulin for food, and your blood sugar is shot way up and it's sitting there. My expectation is that something went wrong with either the carb counting, the insulin to carb ratio. Maybe you didn't understand the fat content. If you're hearing that now and thinking, I don't know what fat's got to do with it, don't worry. We have an episode for that too. But something happened, and the need for insulin is greater than what you calculated. That happens probably every day to people, all day long. I think it's important what you do next. I think if you sit and stare at it and wait for it to come down, often, it doesn't, and then you end up making a large Bolus, everything crashes low later. That happens because the foods finally digested out of your system. It's not impacting your blood sugar anymore. Now you've put in, put in all this, this insulin for the number, you come crashing down. People might say, Well, then why would I not come crashing down if I put the insulin in sooner? Well, while the food's still in. Are impacting you, you're gonna have more of a balance between the insulin and the need for the insulin. So when you talk about this with people, when when they see high blood sugars, what is it that that you find yourself saying to them most
Jennifer Smith, CDE 05:12 often, if you're seeing high blood sugars, my first consideration is, is it a normal right? Is this a normal thing that suggests a change to a setting? If it's abnormal then? And I can see where the question here really is, in the moment, address the issue and then move forward and figure out kind of why. But in the moment, sometimes there are considerations as to, Why could it be that the site is bad? Is it leaking? Does it smell like insulin? So there are still things outside of willy nilly, just saying, I'm going to take more insulin. There are some things to assess right here and now. Is it a problem? Is it a disconnected site? Did your cat chew through the tube? Blah, blah, blah, right? But outside of that, it's really addressed the high blood sugar, and I guess in a time frame of the previous dose having been taken, you know, if you like, you just said, if there is mis timed insulin, it might be that you had enough insulin there. You just didn't give enough time for the insulin to start working. So now adding more insulin could lead to a drop later, because you really don't technically need more insulin you just needed to time it better and more insulin right now is still going to have its action profile to get going and to impact things, whereas if it's in the aftermath of a meal miscounted because you were less than precise, you didn't have the information you needed, very likely you need more insulin. So give some more insulin in a safe manner. You know, if your insulin needs around a meal are usually a unit for a fairly good sized meal and your blood sugar is high and you're like, Well, I'm gonna knock it down with another two units. That's really not the greatest idea. Be conservative, but more aggressive in your range of what you know about insulin and how it works for you,
Scott Benner 07:01 right? Yeah. I mean, I don't want people to ignore the idea that there could be something wrong, but the amount of times that you see somebody say, Well, I don't know. Like, is the can you live in? Is my is, did my insulin go bad? Like, that stuff doesn't really happen that frequently. You want to rule them out. It shouldn't, yeah, right. It shouldn't happen that free. But you know, if that stuff's happening very frequently, you have a larger issue. But my problem with that, it's not a problem, but, but what I've seen from people is that they'll get so frozen on the things that are probably not happening that they don't do the obvious thing, which is just say, well, maybe I count these carbs wrong or the right. You know, like, I mean, we talk in all kinds of episodes about glycemic load and glycemic index, the idea that 10 carbs worth of one thing will require more or less insulin than 10 carbs of something else. So if you've eaten something and thought, Oh, well, this said 40 carbs. And you know, my insulin to carb ratio is good. It works all the time for me, but this thing has more fat in it, more protein, and it's something that's going to push your blood sugar up. I just think that once people start using the insulin, not more aggressively, but where it's necessary and how it's needed, they start having experiences that show them I did this, then this happened, and then it empowers them moving forward, it's almost like kind of the same thing as not sitting on the same settings for a year and waiting for a doctor to tell you, you know, do something about it. I think that once people with type one diabetes have a firm idea of how insulin works and how to manipulate it, I think that leads to a leveling up of your understanding and lower a one CS, and less variability in all the good things that you're looking for,
Jennifer Smith, CDE 08:44 and more comfort level with using again, more insulin when you need it. You have a comfort level from understanding insulin usually works this way. For me right now it doesn't seem to be that way. So I'll give more insulin again in a safe manner. But also, as we go back to considering, is it a site issue at this point? If you've given more insulin, and it doesn't move your blood sugar, and it was a good enough of more insulin, absolutely. I mean, my go to is one correction on a high that looks weird, and if it doesn't work, I am changing my site. Take care of it, bring the blood sugar under control.
Scott Benner 09:22 I'm in favor of injecting if you're wearing a pump to check to see if the site's bad. But also, I think important to bring up here, if you're on an automated system and you just willy nilly put in more insulin, like you, you know, say, you said, Oh, this is 40 carbs. And then 45 minutes later, you're 250 and you think, Oh, I'm gonna put in another unit and a half, if you put that in the automatic system that you're using now believes that you have way too much insulin. It doesn't look at the number and have the same conscious thought you're having. It says you told me 4040, was this much insulin. I don't care about what your blood sugar is, right now, I believe I've got enough insulin in here you put. More, it's going to take away your basal, and then you're just going to end up trading your like little mini rage Bolus is for the basal that it takes away. You will stay high forever, like that,
Jennifer Smith, CDE 10:10 for a much longer time. That's right. I mean, the aid systems are wonderful, all of them, FDA or non FDA approved. They're all really fantastic in many ways. But you're right, and that's why an injection, it's a way to quietly, sort of unknown to the system, give insulin and evaluate is the insulin working from the injection? Well, clearly, then the site is the problem, because that didn't bring it down.
Scott Benner 10:37 Yeah. So I'll leave a couple ideas here for people to check out. If you think, Oh, I don't want to stack insulin, we have episodes about stacking. I'll tell you that in a one sentence. Takeaway, I don't think it's stacking if you need it. I think that's bolusing, but I do think you can stack insulin. I do think it could be dangerous, so. But those are two different thoughts if you want to learn more about glycemic load and index and why some carbs might hit you differently than others. Again, in the Pro Tip series, there's a great, longer conversation about that, but for now, I would like your takeaway from this to be, if my blood sugar is high, I shouldn't just stare at it. I should do something about it. That, to me, is the takeaway from this idea. Yes, awesome. Thank you. Of course, you 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 beginnings 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. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. If you're not already subscribed or following the podcast in your favorite audio app like Spotify or Apple podcasts, please do that now. Seriously, just to hit follow or subscribe will really help the show you.
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