#218 Diabetes Pro Tip: Temp Basal
Scott and Jenny Smith, CDE share insights on type 1 diabetes care.….
I am thrilled to welcome Jenny Smith, CDE back to the show. Jenny will be joining us for an extended series of conversations that focus solely on the management ideas that we discuss on the podcast.
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com.
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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 and welcome to the fifth installment of my series diabetes pro tip. Today, in this short but very important episode, Jenny Smith and I are going to talk all about how to manipulate your basal insulin.
Jennifer Smith has a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. I first met Jenny when I had her on the podcast back in Episode 37, an episode called Jenny Smith diabetes guru had her back in Episode 105. And she and I talked all about a one C's really breaking down what they meant, what was important about them and what wasn't. One day, I just had this idea to bring Jenny back on to talk about all the concepts that we talked about here on the podcast, but real granularly just, you know, really break down ideas in a way that I thought you guys could absorb and remember and share and revisit. And that's what this series has been. Hopefully you've been enjoying it. This is the fifth installment of the diabetes pro tip series with Jenny Smith CDE. And please remember that nothing you hear on the Juicebox Podcast
should be considered advice, medical or otherwise. And to always consult a physician before making changes your medical plan for becoming bold with insulin, temporary basal rates, do a number of different amazing things
Jennifer Smith, CDE 1:45
laugh and laugh compared to what your doctor told you. Yes,
Scott Benner 1:49
and and so here's how I always think about it about basal rates in general, it is bizarre for us to think that we can set up a static basal rate that will always work at 2pm for the rest of this week, or this month or our lives, right. It's just an odd statement. I don't have diabetes, my blood sugar varies based on what's happening in my body or what I eat. And I bet you even though I have no medical training whatsoever that my body is more aggressive with the amount of background insulin that I get the amount of force it pushes on my blood sugar at different times.
Jennifer Smith, CDE 2:24
Because it's got natural compensation. Yes. And I think that that that piece about about measles is also really, really, really important for women. Right?
Scott Benner 2:33
Okay. Yes, because of their periods. Or, by the way now I've been told not to say, Lady time by people that maybe I should say, period. So then I went back to period to make that person happy. Then I got a beautiful note from somebody the other day, you said I think lady time is delightful. And I'm like, I can't win. But that's not the point. So so so here's a couple of ideas. We get Chinese food coming into the house, right or not so or something that's high carb that breaks down slowly in your system. Oh, my Pre-Bolus for Chinese food is this Temp Basal increase 95% for two hours, boom, I start right there. Then I get a healthy Pre-Bolus in you know, and I start the I want to decline when when Arden starts eating her food. Chinese is a good example. Because it's not it's simple sugars and complex carbs at the same time, right. So the coating on the meat might have a lot of sugar in it like the sauces will hit you quickly. But that rice could sit in your system forever and take hours and hours and hours to to break down and to go away. So I think of it as carpet bombing insulin, I want to I want to cover the entirety of the timeline that this food is going to have impact on art and with an increased basal insulin. It I would also use an increased basal insulin, when Arden's hormones are affecting her. Yeah, we just got done doing that this week, there was a day and a half or Arden ran a Temp Basal increase of 80% for two days straight. Yep, get a straight. Yep. If your basal is not right, your bonuses aren't going to work, right? Because you're just replacing bazel with your bonuses. So even again, you count your carbs 100%, right. But if your basal insulin is set at, let's say a unit, but it should be at two units, then when you make a bolus for a three unit snack, the first unit of it is only covering the bazel you don't have plus you haven't had enough bazel leading up to that. So you're probably insulin resistant and having a higher blood sugar to begin with. None of this works without base when people come to me and say, Oh my God, look at my rollercoaster. I'm 60 I'm 400 Um, but the first thing I say is okay, let's get your basals right. If your bases aren't right, the rest of it doesn't work. Right
Jennifer Smith, CDE 4:54
and temporary visas then are not going to work either because they're working off as a setting. That's not that's not right. To begin with,
Scott Benner 5:00
yep. Inevitably, while I'm talking about basis with people, they say, Well, what about my insulin to carb ratio, and I went, that's not even worth thinking about your basis, right. So now you can think about basal insulin as basal insulin used, you know, in the normal course of your day to keep your body function low when you don't have any food, and but if you really start to think about them around food, that's when they become incredibly powerful. Why. And so, there's also a time where, like I alluded to before, you can bump in nudge with bezels. Right, so not only can you create a hard bazel, that helps you with carb, heavy meals, but you can look at a blood sugar that's at, you haven't had insulin for hours, and then suddenly, it just a 75. And it sits there for a little bit. And instead of feeding that 75, you can Temp Basal back. So Temp Basal is unlike the, you know, when I think about the tug of war with with Pre-Bolus. Basal is I think of this way, I imagine if you and I put our hands out, stood up and put our hands together our palm the palm, and we pushed equal amounts on each other. That's it, you don't fall back, I don't fall back. That's a perfect bazel rate. Right now, there might be a situation where my my blood sugar starting to fall. So I need the body function to push a little more. So I, I take a little power away from the bazel, which allows me to push up. Same thing if I'm at a 90 that's going to a 95. And it's creeping up. But a bolus is definitely even a tiny bolus is going to make me later I might just do a Temp Basal increase to stop that kind of creeping. Yeah, this all occurred to me when I interviewed someone about artificial pancreas, and they told me that most of the adjustments that an artificial pancreas makes is through basal insulin. Yeah, not through boluses
Jennifer Smith, CDE 6:57
100%. If you're doing anything within the looping community to do it yourself, insulin pumps, either open APS or looper, Android APS are whatever that is. That's the gist of the algorithm. It is most of most of the incremental adjustments based on the trend in glucose are being done by positive and negative what's called temping, you get a bit of a bump up, you get a bit of a bump down, he had a bit of bump bump up, and it's all being based on your current bazel setting. Right? Right. But the incremental ups and downs are what keep you stable.
Scott Benner 7:34
This past week, I visited the army pod headquarters in Massachusetts, where they've just moved their production facility. It's about to go live. And I got to tour the floor, where you're on the pods are going to be made from now on, right here in America, right in Massachusetts. I want you to know that what I witnessed in Massachusetts on that assembly line, it didn't just renew my excitement about Omni pod, it shot me over the moon, the accomplishment of bringing a production like that into one facility, putting it under your roof that showed me a real commitment to the people living with Type One Diabetes. Right? This isn't being made overseas somewhere or you know, a bunch of different factories. It's all right there at the Omnipod headquarters, and its state of the art and it's absolutely stunning. This is a company who is behind you for the long haul. I believe that before but I believe it even more now. Here's what you want to do. Go to my omnipod.com Ford slash juice box or click on the links in your show notes or Juicebox Podcast comm when you get there request a free experience kit. That's right up pack. A pod experience kit on the pod is going to send you a pod that is an exact replica of the one you'll get when you start using the product for real, but this one's non functioning, and so it's safe to wear for you to try
Unknown Speaker 8:55
out.
Scott Benner 8:56
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Jennifer Smith, CDE 12:33
So I we I and I usually really, really focus in on all of the scenarios that are likely to come up where temporary bazel is really an important piece of management, that that bumping and nudging that you talk about, you know, unfortunately, most people are only taught about exercise and the benefit of temporary bazel. And they're usually told, well just, you know, just set it for zero percent or turn your bazel off during that time. Well, that's 100% incorrect to begin with. But exercise is one of many reasons that you may want to change your bazel for a, you know, a duration of time, illness, a woman's menstrual cycle, or that woman's time of the month or whatever you're going to call it, that time, you're going to definitely need temporary bazel you're going to need it for sedentary days, I can go to a conference where I'm literally sitting for eight hours. And while I might be walking between conference rooms, the sitting and sedentary, I need a 25% increase in my basil. In order to not run high that whole day. I've figured that out right? I figured out what I need to do to take a five mile run versus a 12 mile run temporary bazel changes. I figured out what to do for different kinds of illness a stomach bug may require a decrease. an illness like a sinus infection or a bronchial infection may require an increase. Even even temporary bazel around food like you mentioned before with the Chinese high fat food, yes. 100% requires knowledge of using temporary bazel because I know we'll talk about extended boluses and things a little bit too but temporary bazel for high fat man that can affect you eight to 12 hours after you're done eating it and it keeps you high and you may go to bed with an awesome looking blood sugar thingy that I made. I nailed that I really got it. What do you get an alarm at two o'clock in the morning where you're 300 and you're like what happened?
Scott Benner 14:37
And those are the examples By the way, when you can't say to yourself, oh, well that's just diabetes. It's not just diabetes, that it's you didn't use the insulin right? And so every time you think diabetes is just this, this, you know, magic fairy that runs around messing with you. It's something happened like you might not know what it is in that moment. But some thing happened. And you can figure out what those somethings are and stop them. And there's a great example high fat, you might need a Temp Basal increase that goes on for hours and hours later,
Jennifer Smith, CDE 15:11
high fat 50% at least 50% increase for at least six to eight hours after the meal. Right?
Scott Benner 15:18
Right. It's just it's, I know, it's a little mind numbing to think that, but that's a lot to think about. But I want to, I think now's a great place to say this. As much as we're breaking things down and really stretching them out. So you can see the tiniest little aspects of these ideas. For people who understand them, I will speak for myself, I do not think about diabetes that frequently during the day, this stuff just kind of happens. I know that sounds crazy. But I look at a plate and I go, Okay, here's what this means. And if and if I miss I readjust. But But I don't spend a lot of time, of course aside of this podcast, but I don't we don't say the word diabetes in our house very frequently, I guess is what I'm saying. We're not always fighting and, and you know, scary lows, and oh my gosh, she's been high for three hours. Like that doesn't happen around here. Right. And you can live that life too, by understanding how insulin works. Isn't Jenny terrific. You know who else is pretty great on the pod and Dexcom. Go to my omnipod.com forward slash juice box to get your pod experience kit today. That's right, a free no obligation demo of the Omni pod is yours to have by going to my omnipod.com forward slash juice box. You want to make these great adjustments, you're probably going to need a CGM. I recommend the G six by Dexcom. Go to dexcom.com forward slash juice box to find out more. These links are also available in the show notes of your podcast player, or at Juicebox podcast.com. I put three episodes out this week, this one Pre-Bolus thing. And the next one insulin pumping. Don't forget, get all three. This diabetes pro tip series was designed to be listened to in order. So if you're finding this one, go back, work your way through them. They build a narrative around type one diabetes. Coming up next month, using your glucose monitor, bumping and nudging and more. You can hire Jenny at integrated diabetes.com. Instead of me talking to her you could be talking to her. You could get Jenny on the phone or by Skype through FaceTime. She talks to her clients in many different ways. Bring up the things that you're struggling with and Jenny will help you go to integrated diabetes.com. To find out more about that. If you're interested in seeing me speak live and you're in the Orlando area, I'm going to be at the touched by type one event put on by dancing for diabetes. Just go to dancing for diabetes.com go to the Events tab click on touch by type one. When you do you can register to attend. This event happens on May 18 2019. It runs from 8am to 5pm. And there are a lot of great speakers not just me. If it's after May 18. Please still go to dancing for diabetes.com. They're a sponsor of the show. They do amazing work with people living with type one diabetes, and I would love for you to find out more about them. They're also on Facebook and Instagram.
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