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Scott Benner 0:00
It's time for another pro tip episode with Jenny Smith. Hello everyone, and welcome to Episode 256 of the Juicebox Podcast sponsored by Omni pod Dexcom. And dancing for diabetes, you can go to dancing the number four diabetes.com dexcom.com, forward slash juicebox, or my omnipod.com forward slash juice box to find out more about the sponsors. Jenny is a certified diabetes educator. She's like a nutrition thing. Like she does a whole bunch of like technical stuff that she's got degrees for, she works at integrated diabetes, if you'd like to hire her for yourself, you know, have these conversations with her one on one, you go to integrated diabetes.com where you can go into the show notes of your podcast player where I have Jenny's email address, email her directly, all different ways to get hold of Jenny Smith. All these links, of course are at Juicebox podcast.com. If you get confused, and you need to find them somewhere, 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 any changes to your medical plan or becoming bold with insulin. I liked your idea, a lot of beginning ideas around blood sugar management with exercise because I hear from people constantly. And I always think that my answer to them is incomplete. Because it's one of those things that I think I just know how to do. And I don't know why I know how to do it or why it works sometimes. You know, I everyone who listens knows that Arden played really competitive softball for years and years and years. Mm hmm. And that that means at this part of the country, that means being outside in incredible heat. weekend after weekend, sometimes from 8am till 5pm playing 234 softball games, you know,

Unknown Speaker 1:45
right?

Scott Benner 1:46
And I strive for a nice blood sugar around 90 or I don't change my goals because of what she's doing. Right. And I also am not much of a pre planner, but I do I have spoken to people who are like, Look, you know, I'm an adult, I'm going to go to the gym at five o'clock after work, I need my blood sugar not to fall at five o'clock when I start working out or later sooner. And how do I do that? And I have to tell you, I know it's around bazel insulin and pre, you know, basically like setting Basil's up ahead of time or afterwards to catch lows and stuff. But I'm so reactive. I don't think about it that way. So how do you talk to people about it?

Jennifer Smith, CDE 2:23
Yeah, you don't really have a I mean, as you've done for a long time, you're sort of like, you're surfing the wave of what's happening for art. And you're managing very well doing that, because you've intuitively learned how she reacts to things for the most part, right. But to teach people in a general sense, I think one, you said it correctly. I think it's around bazel. Well, you're right in that it's around insulin. Most people

I know I was waving at him too.

So the the insulin is really a big piece. And a lot of people again, they focus on a number when they're going into exercise, but they're not focused on what's what's the causative to that number, what's affecting that number and where it may directionally go. So we talked about, you know, your person here example wise, he's going to exercise every day at 5pm. Well, for them, that's kind of a nice timeframe of the day because the goal there in a simplified way would be, you know, active insulin onboard, so no bolus insulin, you know, and they, let's say, as an adult, they only eat lunch at noon or one o'clock, tected, by five o'clock that bowl is should for the most part, unless they're looping, that should be gone. Right. And it would mean then, you know, aiming to either not have an afternoon snack, or in which there's no Bolus that would be riding into the exercise. And then the Basal component, there is a lot of debate about Should I adjust my Basal for exercise? When should I do it? How much should I do it by and that's where it comes to be an individual nature of adjustment, because it takes you have to take into consideration the intensity and the duration of the planned activity. You know, if this example, you know, guy is gonna go for an hour and a half spin class, high low, it's sort of a high intensity interval sort of workout. And if he's only going in on bazel, he could shut his bazel down, not off, but lower has bazel incrementally enough, well, before he actually starts moving, so that he shouldn't technically need much of any food at all, to continue that let's say 90 minute spin class, for example, adjustment to bazel. Most people feel like they have an idea, I turn it off, you know, I turn it down or I turned it off 30 minutes before and I still went low or I continued I was low by the end, and then I continued to be low. And the problem is that as we've talked before circulating insulin level isn't lower or higher, until about 60 minutes post adjustment. And when you're really aiming to get into a specific target, for beginning exercise, your circulating insulin level should be low enough by that point, because, as is a kind of propelled intense, intense action of the insulin on a basal level that you have now circulating, and if you're normally at a 1.0 unit per hour basal rate, and you knock it down by 50%, that 50% reduction should be started at least 90 minutes, if not two hours prior to when you jump on that spin bike.

Scott Benner 5:46
I'm checking out dancing for diabetes.com right now went to their blog, there's a lot going on over there. It's like they had a fundraiser recently a game night in Orlando, group dance auditions are now open for their annual dancing for diabetes show. Others a follow up here from when they were at friends for life, are announcing new partners in their D box program. They have this box of like great stuff that they send out to newly diagnosed people, I some actually some Juicebox Podcast stuff in there as well. But they just added sugar, medical and trialnet You can find out all this yourself, you don't need me to read it to you dancing, the number four diabetes.com check out their blog.

Jennifer Smith, CDE 6:24
So this gentleman, you know, he should really reduce his bazel by 3pm. And he should reduce it for the intensity and the duration, at least by 50%. Again, these are kind of starting places, and you'll find what adjustment works specific to you. But it's a good starting place. Now if he was just going to go for a walk for 60 minutes at a moderate pace enough to kind of bring up his heart rate a little bit but not crazy. Maybe his adjustment is a 25% basal reduction, but it still needs to be taken back by at least 90 minutes to two hours before he takes that walk.

Scott Benner 6:59
It reminds me of a number of things. One, there was a I forget what it was called. Gosh. There is a thing that happened in in I can't think of what the name of the website is it's gone now. Manny Hernandez his website that's not Oh, two diabetes. They used to do that thing every year where they they kind of challenged you to get out and do exercise, right? And yeah, your blood sugar and see where it would fall.

Jennifer Smith, CDE 7:23
So that was in November for the diabetes bump. Diabetes awareness. Yeah, check your blood sugar. Now walk or do something fun for 15 minutes of movement and check again,

Scott Benner 7:32
and people would see that their blood sugar's would come down. Yeah. So it's the same idea except with lower lower numbers and tighter tolerances for exercise your blood sugar is going to fall or try to fall because of this exercise. What can you do prior to that, to not to keep the fall from happening. And I think that what ends up happening is there's two false narratives. Well, there's a false narrative that and a problem that people build around exercise and I think about going to sleep through with diabetes. The false narrative is, if I make my blood sugar this high, that when it drops, it won't get dangerously low. Correct. If you're thinking that you are completely missing the point, right, the point should be that your blood sugar doesn't need to drop like that. Let's let's find a way to live where it's not dropping out of nowhere. Correct. And so but I see how that's the fix, right? Like, I see how that's what occurs to people. I dropped 50 points. So, you know,

Jennifer Smith, CDE 8:32
let's start 50 points

Scott Benner 8:34
higher than I really ever want to be right because the guy stuck a pencil in his pocket. And then he brought up the bank. So the pencil cause the bank robbery, like just the falls, not the the falls, the falls. God what am I trying to say? Like, like the Fall is

Jennifer Smith, CDE 8:47
the fall can be offset. If you think ahead about how insulin works, it doesn't

Scott Benner 8:51
have to happen and right and so you shouldn't be planning to stop the fall, you should be planning for a fall to never happen to begin with.

Jennifer Smith, CDE 8:59
Correct or minimal enough that you really are not in danger because of the drop, right? I mean, exercise can even you know, even people who do plan ahead might see something like a 10 or 20 point change in blood sugar during or by the end of their exercise session. That's nothing you know, if you're starting with a blood sugar of 110, and you drop 10 points. Great. You're at 100 now awesome. Nothing, you know,

Scott Benner 9:27
my expectation isn't that you can set your blood sugar at nine while you're, you know, running a marathon, it's never going to move but there are things that play while you're running that you don't think about the you know, the anaerobic style of exercise is trying to bring your blood sugar down, but you've changed your basal rate which is trying to bring bring your blood sugar up also. Maybe you have adrenaline which is trying to bring your blood sugar up. So even people who have that stability, they don't 100% know why they have it like they don't really understand all the pieces that are affecting this number moving or not moving. Right. It's interesting that the other thing that you said that feels probably To me, because I hear so many people, like, every time I speak to someone, I'll tell them the same thing. Look, just start Pre-Bolus sing and your agency is going to go down like a point. And then they inevitably say, Well, I can't really remember to do that. And I'm like, Alright, well, then your blood sugar's gonna die. What do you want from it? Right? You have to Pre-Bolus like, this is how this is what you're gonna say, this exercise thing really is no different. Okay, they're still Pre-Bolus thing, they're just Pre-Bolus thing with their their pre bazeley adjustment with it with a reverse adjustments that have a more positive adjustment. So I wonder how many people fall into that category? When they say, Look, I know I'm going to be at the gym at five. But how in God's name, do I think about it at 330? Mm hmm. You know, in that situation.

Jennifer Smith, CDE 10:47
And so some of the strategies in pumps today, you know, there are alarms or reminders that you can set, you know, even in the PDM. For Omnipod, you can set up alerts and reminders for things, I used to have one set up for reminding me to Pre-Bolus, so that I had enough time between that and actually starting to eat my dinner. I also had a reminder to check my blood sugar at bedtime. Not that I needed the reminder. But it was there in case I had a really hectic night. And I did forget before I like climbed into bed, right? So for things like a reminder, if you are pretty strategic about popping in your exercise every day at 5pm, why not just set an alert or a reminder in your pump to go off or even on your phone? If your pump doesn't do it? Or you don't want to set it there, put it in your phone and call it exercise adjustment or whatever you know. So it is that physical visual reminder, you have to turn the alert off. Oh, why did I set the alert? Oh, that's right.

Scott Benner 11:45
suicides at five o'clock, just just two days ago, someone said my child will look does not seem to be remembering to Pre-Bolus at school. And I said, Oh yeah, Arden was terrible at that. And she said, Well, what did you do? I said, I just set up an alarm on her phone for when I wanted her to Pre-Bolus it would go off and it would pop up and say Pre-Bolus. And then she you know, send me a text and be like, do you want to do this now? And we built on that. And that was years ago. And last year? She says to me, I don't need the Pre-Bolus alarm anymore. And I said okay, okay, no problem. And sure enough, like it just, it happens so many times that now it just it's muscle,

Jennifer Smith, CDE 12:22
like brushing our teeth. It's just memory. Yeah, exactly

Scott Benner 12:26
what you guys are gonna have to do, whether this is about you know, an adult for exercise a kid for exercise, or a kid playing a sport. You can't just, I mean, it sucks, right that you can't just get up and run out the door and go do it. But it's going to take a little bit of pre planning and if your health that where you're, you know, you're, you know, if that means that much to what you're gonna have to do

Jennifer Smith, CDE 12:46
like, and I do think it helps. It's important. I mean, with that statement, you can't you can't just get up and run out the door. Well, you know, what, what if you ended up sleeping in because the alarms didn't go off the right way. And you had planned to get to your kids softball tournament at 9am. And oh my gosh, it's like eight o'clock, and we're like running out the door with like, food in our hand and we're running and trying to get there. It just didn't happen to be able to plan. Well, in that instance. I mean, there are strategic management, you know, ideas, you couldn't adjust the bazel there was no way to do it, right. So in that circumstance, then food becomes your offset to potential changes in blood sugar. You know, if you got up late to go for your normal six mile run first thing in the morning, and you always like to eat ahead of time, then the strategy may very well be okay. Maybe you don't Bolus if you're going to eat and head out the door in the next 30 to 60 minutes, and you're going to take a six mile run depending on how long that takes you, you may be able to take 25% of the recommended Bolus, you may be able to take none of the recommended Bolus. And strategically then manage blood sugar well, because you're feeding the activity you're feeding to avoid a drop in blood sugar, but you're not stacking insulin into a time that it's just gonna get active.

Scott Benner 14:07
Right, I'm smiling so much because this is like the next level of thinking about all this about the manipulation of the insulin. When RM would run off the field like I and I'd have her I know what her blood sugar was. And she if she ran off i'd might say to her Hey, water, you know drink water now. And then maybe watch and then if I saw her blood sugar kind of dipping down the next time she came off the field I'd say switch to the sports drink and you know should switch to the sports drink and then I'd be like switch back to water. You know and it only happens a couple times maybe it maybe never to be perfectly honest with it. She's played softball games where a blood sugar's never moved, you've got her bazel right, your prep right going in or like you said you ate the right things before playing. And these things are sitting nice and stable in your stomach and kind of holding you know, holding the pressure back of of the activity to make your blood sugar lower. But you can reverse engineer all of these ideas like use food instead. Events like, you know, I say it here a, you know a lot and I don't know how clear it is because it's sometimes not 100% clear in my head, but we don't we always just think about how the insulin impacts the number your blood sugar, but we never think about how food impacts the insulin or how food impacts the number. There's so many different pieces to this. It's all not just a one way street, like, all right, things are affecting all these different things. And if you pick the right one, it can manipulate something, right? You ever thought was manipulatable. And it is, you know,

Jennifer Smith, CDE 15:31
and also understanding your variables and how they affect you maybe at certain times of the day is a piece of it as well. I mean, I can tell you from my, from my management, I guess toolbox. I've figured out that my morning runs, I can get up, I can Bolus for about 40 to 50%. of the normal recommended bolus, as long as I'm heading out the door within the next 30 to 60 minutes, that partial bolus for what I ate will help me keep my blood sugar nice and stable throughout. Now, in the afternoon, if I did that, my blood sugar within 1520 minutes would take it would entirely take I would need. I just know my sensitivity at times of day. And so again, on an individual level. Some of the things you know that we're talking about there a beginning piece there where to start, if you've had no strategy whatsoever, these are places to start with what you can try to, you know, I guess implement, but you're going to find that things need to be adjusted, personally for yourself. I raced a strategy knowing my like training run strategy by race day strategies completely different with the adrenaline of everything getting going on a race day morning. I mean, and I'm not a competitive like a pro runner. Right, I could only do four minute mile or something. No, I've just I'm out there, but it's a race day. And so I Bolus 100% for my breakfast on a race day morning. And if I don't my blood sugar is 300 by the time I start the race

Scott Benner 17:19
dexcom.com forward slash juicebox just got a facelift. Nice, it's fancy. Here's what it talks about zero finger sticks. That's right, the dexcom g six continuous glucose monitor is FDA permitted to allow for zero finger sticks. Of course, you can customize your alerts near alarms by setting the range and getting notified when you're heading higher low. There's smart device compatibility. What's that mean? You can see your glucose data in real time on your compatible smartphone, iOS and Android. Go check out which ones they support, sharing your data. Talking about this all the time, right being able to see a loved ones or someone's glucose levels, direction, rate of change all remotely. That could be your child at asleep over a friend that's alone for a couple of nights doesn't matter. Anybody who needs you know, someone to have their back. Dexcom even has Siri integration. I can't tell you about that right now. Or my phone will start talking to me, but you can check it out@dexcom.com Ford slash juicebox. To find out more. The CGM is also by the way indicated for use in children two years and older. It's amazing. Now to take the next step with Dexcom. Just go to my link, and fill in the tiniest bit of information patient's first name, last name, email, phone number, city state, you know, birthday, a little bit of information about what kind of diabetes you have in your insurance. You are on the way, you can do this through the links in the show notes. If your podcast that links at Juicebox podcast.com or by remembering dexcom.com forward slash juicebox. My daughter's results, of course are her own. Yours may vary. But I'm telling you that the dexcom g six is maybe the most important part of your life with Type One Diabetes, being able to see the direction and speed of your blood sugar is monumentally important.

Jennifer Smith, CDE 19:08
If I don't my blood sugar is 300 by the time I start the race, and again, it's experience it's experience of figuring it out. It kind of goes into the difference of what type of sport or what type of athlete Are you are you a an aerobic exerciser or you more the weight kind of the heavy lift or kind of you know anaerobic because those adjustments are different as well. Strategy there for many of the lifters that I work with the Find a need depending on their lifting plan, they find a need to potentially bolus to avoid a rise in blood sugar during a lifting session off at the potential rise that they see is slower with a Temp Basal increase. And again, in their standpoint, that Temp Basal increase needs to be started about an hour before they actually get to their lifting session. or it doesn't help enough and they get a major rise. So I think the biggest thing with exercise adjustment is what has happened. What have you seen? What is your problem? Right? Because if you start with the data that you've got, and you look at and you say, Okay, I just did this way. Totally didn't cut it, this did not work. Okay? adjust, look at your data and adjust and make you know, is it a timing component isn't an amount component, what do you need to change?

Scott Benner 20:33
It's funny because I see a through line from this to correcting a low so when, you know when people get when people's blood sugars get low, and they they eat because they need to, then this you know, uncertainty just allows them to they do nothing and their blood sugars come like crashing like back up again. Right now you're you've just crashed down now you're flying back up. I say all the time. Like you'll know you're like a ninja when you're bolusing. You know, after you've eaten for a low like, you know, your blood sugar is going down to 40 You're shaking, you're out of your mind. You're eating all the food. He stopped for a second go, okay. I'm okay, now I eat a

Unknown Speaker 21:11
lot of food.

Scott Benner 21:12
70 carbs worth of food. What do I do now? Well, the answer is I Bolus Now you know how much? I don't know you figure that out. But that's what I did. I mean, I the first time I did it with my daughter, I'm like I can I'm so scared. Boom, 350 blood sugar. Then next time, I was like, Okay, well maybe like for half of it and half of it didn't work. And so eventually, I could just I kind of eyeball it was usually about three quarters of the carbs. Like, right, and like when you stopped and really thought about it, you know, sure that 2025 carbs stopped the fall and got your level, the other 50 were just your body going eat more, eat more, eat more, eat more, right? If you could have stopped yourself after 25 or 30 carbs, you would have

Jennifer Smith, CDE 21:53
would need to bowl

Scott Benner 21:54
right wouldn't eat the balls. But you know, you can't stop yourself in that situation. And so it's happening. Now you got to do the next thing that makes sense. It's all really just about I hate I hate to I feel like I oversimplify sometimes. But all we're talking about in the last 10 minutes, all you really heard was right amount of insulin at the right time. You know, which is obviously overly simplified. But that's all we're talking about. the right amount might mean and I get scared to when people hear right amount that they that they think of on the positive or more like actually, the right amount might be less, it could be like bazel, right? It could be not bolusing at all, eating a banana going out the door for a run and thinking you know, this bananas, usually three units, but I know if I didn't bullish for this, my blood sugar is going to go up about 80 points because bananas Don't hit me that hard for some reason. Sure. And when I go out for a run, I fall 60 points. So boom, I'm gonna eat the banana. I'm gonna go and you've countered it. Yeah. Yep. All different ways to get in that fight. Mm hmm. I have a couple of notes. The other?

Jennifer Smith, CDE 22:57
Oh, yeah, Oh, please. Oh, I was gonna say kind of on this kind of on the same note there from the standpoint of not having enough time to adjust. Prior to, let's say, for a bazel adjustment truly, another component is you may actually have to, you may have to eat food to curb a potential drop. If you know the drop is coming, and you've only got 20 minutes before you're going to head out the door to go and exercise. And you may have to have 10 or 15 grams of carb in order to stop a potential drop from happening. And that's it's a, it's a hard thing to consider when you're also for the most part as an adult, especially considering exercise as a piece of like a weight management tool. Right? And if you feeling like, well, gosh, every time I exercise, I have to go and eat like three granola bars. And that's like, that's what's the purpose? What's the point of this? Right? I'm exercising but I'm not seeing any changes here. Well, again, some strategic planning can help. But if there's no ability to adjust anything ahead of time, because there's not enough time, you may actually have to quote unquote, eat something. And my my recommendation and most of the athletes that I work with, it's that the circumstance, simplify the carbs that you're eating, and eat in a butter jelly sandwich or a pro bar that's you know, like 300 calories, your body right before you get started moving needs the simplest form of carb you can get, it needs to get into the system to effect quickly and stop a potential drop because usually aerobic exercise drop happened within about the first 20 minutes or get started within about the first 20 minutes. So simpler. The carbs are one, you're not getting fat and protein calories. So you don't have this load of excess. And if you use something simple like the sport drinks, you know whether it's Gatorade, Powerade, vitamin water, whatever it is, make sure it's got some carbs in it and have about, you know, eight ounces which is Almost 15 grams of carb,

Scott Benner 25:02
that's a simple amount, your body is going to use it easily. It's going to help to stop an initial drop, you may need to bring it along and sip it along the way, as well. But at least it's getting used up. And it's not something that's packing away calories have a question, and I don't know the answer to it. So, which just as an indication to you guys, and sometimes I ask questions I know the answer to just so you can hear the answer. But in this situation, I don't know the answer to this question. So your body when you work out, uses up food as fuel, but that we're accustomed to putting that food in us and letting it be used up as a buoy for a blood sugar. So I don't know what my question is. But if I eat a banana, and I sit down, like because my blood sugar is 60 I eat a banana I sit down and expect this to bring my blood sugar back up to 130. And it does. But if I eat that same banana at 60, while I'm doing something that's causing my body, so is are my muscles stealing the banana that I need for the sugar? Does it still go in the blood and I use it and I get it any i do i get both benefits, or do I only get one. And all of this talk about exercise has me just super warm and fuzzy inside about the on the pod. You hear what we're talking about right? Jenny and I are discussing methods for increasing and decreasing your basal insulin in ways that will stop low blood sugars while you're exercising these tools work in a lot of other parts of life, not just for exercise. Now when you're exercising, you need your insulin, you don't need your insulin use a little more, you need a little less, you need to be able to manipulate your basal rates. If you're pumping right now and you're not using the Omni pod. This is not something you can do while you're exercising because you have to disconnect your tube pump to exercise but the Omni pod is a tubeless pump. And you can have it on not just while you're exercising. But while you're swimming or bathing, you never have to take it off. Now let's just take a second let that settle in. Right. The Omni pod is the only insulin pump that doesn't have to be the only insulin pump that you can wear while you're exercising. Because of that, it's the only insulin pump that allows you stewardship over your basal insulin during exercise a little more or a little less, a little sooner a little later. Now, here's the greatest thing about the Omni pod. And I mean this free, no obligation demo, it's a peck a pod experience kit, that on the pod is thrilled to send you an all you have to do is go to my Omni pod.com forward slash juice box for again, your free, no obligation demo pod. They'll send it to you and you can wear it, you can go out and exercise with an omni pod on and see if it's something you'd be happy and excited to do. And if you wouldn't be whatever, no harm, no foul, nobody's gonna hassle you. You don't have to get another pod if you don't want to. But the best way to find out if what I'm saying will work for you is to give it a try. There's links in your show notes at Juicebox podcast.com. Do I get both benefits? Or do I only get one

Jennifer Smith, CDE 27:52
depends where you are sort of in the exercise in early exercise, your body would get the benefit of the banana would actually bring your blood sugar up because your muscles have now are resting, you've stopped you're eating the banana you haven't been exercising for very long. So it should technically bring your blood sugar up maybe not as much as if you were just sitting and not doing anything and eating the banana and not taking insulin for it. But the longer amount of time you've been moving. And the more primed your muscles are to grab glucose and bring it into for for their benefit. right because they're trying to retain they're trying to energize essentially. And this is a really hard concept. I'm glad question wise you brought it up. Because athletes, endurance athletes, especially those who are doing long distance of anything triathletes, long distance cyclists, even kids or adults who are in long term like competition on a weekend like four or five like you said, you know, Arden might be have been in softball from 8am until 5pm. That's a long day of movement of asking your muscles to do something. And most people are like, ah, I've got my bazel dialed in. I totally I rocked it my blood sugar was nice and stable. But man, I felt like I couldn't move. My I just slogged through this whole four hour marathon and I didn't I my blood sugar was great, but I didn't feel the greatest. What's the problem? The problem is that even thinking about yourself as diabetes, a person with diabetes, right? You have to first think about yourself as an athlete. athletes, whether you have diabetes or not, you need energy of whatever source you're choosing to use, you know, even ketogenic endurance athletes use some form of fuel during long distance to maintain and be able to perform and you know, people who aren't ketogenic you need a carb source, and you need it put in strategically over that endurance time so that you can fuel your muscles, you can give it what is needed so the muscles can keep doing what you're asking them to do. Now, from a diabetes standpoint point, what you're putting into fuel your muscles also has to work well with punch for peace, right? They have to kind of balance each other out. But first and foremost, as an athlete, you have to think what am i muscles need to perform the way that I want them to perform, you're doing two different, very different thing. But they're both working on the same

Scott Benner 30:21
pool of food basically. So

Jennifer Smith, CDE 30:23
and, and thus, with insulin adjustment might be very different. I mean, when I am in training long distance like half marathon marathon, my training runs and the actual event, it's surprising, most people who've kind of dialed things in will find that their basal insulin adjustment doesn't go down a lot. For my marathons, I only reduce my bazel by 10%. And this was conventional pumping, right, I only adjusted my bazel down by 10% for the duration of time of the run, because what I expected then was the rest of the bazel to be able to encourage the food that I was taking into fuel along the way into my working muscle because insulin has to be there to propel some of that in the activity helps with the rest of it, it opens the doors on the muscle cells and lets the food in. So if I reduce my bazel too much and fueled along the way, I had these jumps in blood sugar that I didn't need. Whereas if I just kept my bazel a little bit lower, and I feel strategically, you know, every 20 minutes putting in a little bit of something along the course of time and hydration. Again, blood sugar stayed nice, but I also had energy to keep moving.

Scott Benner 31:38
I I should say that at the the other side of Arden's long tournament days. You know no problems like you just said with the blood sugar's throughout the tournament into the evening, their regular bolusing at dinnertime, but around late evening, 910 o'clock going into falling asleep time, all the food was free at that point, like she could eat without insulin like s and by the end when she goes to sleep. I know people see like one way or the other usually Arden's eyes closed blood sugar falls person, like so if something's not right with her insulin, when she goes to sleep, her blood sugar tries to go down. And so even if you gave her a juice at midnight, and turned her bazel off, that still couldn't catch a low after a full day of activity, you had to give her something to eat. That was substantial that would really stick with her in her system while she was sleeping. And even in the morning, even in the morning waking up like getting through the night, okay, and I've done it well and I've done it poorly and poorly would be like you know, three juice boxes to get through the night and a banana or something like that. I would call that poorly. And I've done it well where I've gotten her through with like a you know, something at the end of the day that stuck with her overnight some tamping down with bazel, stuff like that. But even that next morning when she woke up, her blood sugar's were like terrific. They were low, you needed the be of the mind, whatever the base amount of insulin was for the meal, like you know, sometimes you're like, this is two units, then the next day you're like, oh, how come it was more like four today? Whatever the right most minor amount was, but always the day after a softball tournament is all you need her insulin needs? Yep, very low. But that was, gosh, if that didn't kick in nine hours after she got done playing and lasted probably for nine hours after that. It's really it's really

Jennifer Smith, CDE 33:32
Yep. And that's what we call a Gary actually has coined the term dope, like Homer Simpson don't dough is d do Ah, delayed onset hypoglycemia essentially is what that is, right. And it is, again, this is where visually looking and seeing, you know, it was about nine to 10 hours later, that she started having a drop in insulin need. And it lasted for another good, let's say 10 hours. That's experience, you looked at our data, and you said over and over, this is what I see. So that's kind of where you have to go back and you have to look and see, well, gosh, after I have like a three hour run in the afternoon, or you know, a four hour softball tournament in the morning, I ended up being low from dinnertime all the way through the next morning. If that's the case, you can set temp adjustments down again in bazel at a strategic time, so you don't end up having to do a juice box and a bazel off for a certain amount of time because really there you're missing the boat. Right? Your that was your treating now when ahead of time had the bazel been adjusted down enough. The treatment shouldn't have been needed or less of it right? Yeah.

Scott Benner 34:45
No, I I made sure to characterize it that way. Like in the beginning like I didn't do a good job of it all. And you were just the whole evening was just like here, stay alive. Eat this here stay like this. Hey, why don't we just shut your bezel off for a while and see if that helps. That's all Call 911 stuff like that. That's not like, Oh, I'm really, really great job. You know, later, right later a great job was knowing that after dinner throughout the evening, she needed less bazel. Yeah, and that she should eat something reasonably substantial, like a little before bed, like that kind of stuff. But oh my gosh, the first couple times, you know, I did it once in a hotel room, where Oh, my god, it was just embarrassing. You're banging into thing, he'll know where everything is. And it's dark, you know? And I'm just like, what is happening? And then, you know, her alarm goes off. She's like, we have another game. And I'm like, Yeah, that's great. Because I've been up all night. You know? And then the next day, all the parents, all the parents, like, You look tired. I'm like, Uh huh. Yeah, you guys are all drinking all night. I was trying to fix this blood sugar thing. Not that all parents at sporting events are drunks, but most of them are and not a drinker. So I wasn't involved to begin with but they all were like they come down in the morning, like all hung over and I they must have thought I was just like, quietly privately drinking by myself, you know, I looked worse than they did some days. But no, but there's just so much so. So

Jennifer Smith, CDE 36:13
I kind of on the same on the same note not to interrupt but the aftermath sometimes to of exercise can happen right after the lower needs and insulin can be for several hours after weightlifters to may have that rise during but then the impact of lifting and their muscles sort of building repairing restructuring. And the insulin sensitivity sensitization that they get from working their muscles out, can have impact into, you know, for six, eight hours after where they actually need less insulin now.

Scott Benner 36:47
Yeah. I had that. I had that on my notes, like, What does muscle breakdown and rebuild, do? And what you know what to dehydration. I'm reminded about this again the other day, because I said this to a person. And it was like no one had ever said it to them their whole life. And they're like, you know, sometimes my insulin doesn't work as well. In the morning. I was like, you know, have you tried waking up and just banging down the glass of water? And they said, No, why? And I said, well, insulin doesn't get through your cells as well, if the cells are dehydrated, because then the insulin can't travel through, you know, like 10 it and as I'm singing, I'm like, God, you've never heard this before. You know, like three years with diabetes. Like I had never heard that before. It's like, I just Okay, that sounds great. I'll try that. When horns at school. Whenever her blood sugar gets sticky. The first thing I say to her is like, hey, drink some water. Let's see if, you know, we can find a simple, you know, answer to this question. So

Jennifer Smith, CDE 37:38
well, it's kind of like things just move slowly through your system. It's like your blood gets when you're dehydrated, your blood gets like sludge, or like molasses in winter, essentially, it doesn't move, nothing moves through the system very well. Nutrients don't get where they're supposed to go. Everything that's traveling there is slow. Whereas when you're well hydrated, and everything is nice and plump with water, it can move fast. It's like a freely flowing river, right?

Scott Benner 38:03
Yeah, that so. So I have to stay hydrated when I'm being active no matter what. But it is also helping me get a smooth baseline for what I expect out of my hands on and then at least when I see one way or the other, I know is real. And not because I'm dehydrated and or something. What does he eat? How does he impact blood sugars? Because you know, people in the warm weather states always report problems with their blood sugar's as soon as the as the summer comes, but I'm wondering, right, you heat yourself up when you're working out too. Is that similar? Or no?

Unknown Speaker 38:43
Um,

Jennifer Smith, CDE 38:44
you know, that's a good question about the workout. I guess I never thought about it that way. It's probably pretty similar. I'm in exercise, of course, your muscles are just uptaking glucose more efficiently, the doors are opening even with less insulin being there, they're just opening more efficiently exercises like free insulin, really. I mean, unfortunately, we can't live on exercise to use insulin, but it does help. But in the case of overall warm if you think about when you're warm, your vessels move closer to the surface of the skin or right and you sweat and you that's a cooling effect, right. It's your body's sort of way so that your you don't overheat. Well, when that happens, get more circulating. You get more circulation around the actual insulin pumped or injected site. So you allow that insulin to get absorbed faster. I guess is the easiest, most simple way to say it so in warm weather or worse when warm weather comes in. Many people do see an object a friend of mine, once April hits, she's always like my baseline Just need to go down, it's warmer outside, I know that I need an adjustment, nothing else has changed, my weight hasn't changed my in my food hasn't changed, and I am just outside more, it's warmer, she needs less insulin, and then it might go up again in fall and or winter. And exercise, obviously that heats you, you get a lot faster circulation, I mean, that's the benefit to your heart, your you know, circulatory system is exercise does your heart good, makes it pump harder. So with that, and the fact that you're getting warmer, you just get a faster circulation of insulin essentially. And we we

Scott Benner 40:35
haven't really said this here, either, but you have type one diabetes, or the person we're talking about does exercise is very important to you. So this is a piece you have to figure out, you can't just say, I can't figure out exercise you you need exercise, you know, everyone does, but you know, people with diabetes needed maybe a little extra because you're trying to keep your body healthy. While it's trying. While it's trying to, you know, that's trying to beat you up, you need to you need to take away as much power from that as you possibly can.

Jennifer Smith, CDE 41:03
And as a weight management strategy, sort of in the same realm of it needs to be something that happens every day. And many people with diabetes are really struggling and really trying to keep a healthy weight. If you can strategically plan your exercise in the aftermath of a meal. As I said before, you could potentially use less insulin then because you're planning the exercise in a timeframe of after insulin has been injected to influence going to work better, you're also going to enable your body to burn more of that fuel off. Right. So it's a good strategy to just all around, then workout, eat and then workout. Again, ability to reduce the amount of insulin again, prevention of lows, but also just burning calories and not having to take as much insulin. So

Scott Benner 41:57
doing what you what you wanted to what you what you intended to do. When you when you decided to get up and go exercise. I want to look right very quickly, too, because Chris Rutan was on the podcast and we talked a lot about we talked a lot about this kind of stuff, too. And I just want to be able to tell people what episode that was. Be nice if I could figure it out. I am the guy with the podcast you would think I wouldn't know. But well, there are so many of them. Well, that we are getting to that spot, aren't we? I can't figure out what should people like what episode Am I don't know any more. Let's see Where's All right, I'll have to figure it out and plug it in. Jenny's got her own life. She's got to get back though. I will figure it out. And you'll hear it edited. And right here. Chris Rutan was on episode 201. Jenny, is there any anything else that you think we should talk about here?

Jennifer Smith, CDE 42:52
We could probably go on and on with more like advanced stuff. But overall, I think those are the good basics to start with.

Scott Benner 43:00
Yeah, I think this is what we're looking for a basic invoke, we'll hit more advanced things in another episode. Let this awesome. Cool. All right. Well, thank you very much. Thank you. Some quick stuff. There's just a couple days left to enter my giveaway. It's the end of August 2019. If it's past August 2019, forget it. But right now there's a huge giveaway going on, go to Juicebox Podcast calm. There are a ton of great prizes for this giveaway. But among them is a free 30 minutes of talking with Jenny Smith. So if you love talking to Jenny here on the podcast, you know where she's talking and you're talking back to her in your car. Imagine if she could actually hear you. There's nothing to do to enter give it a shot you might want. Thank you so much to Dexcom on the pod and dancing for diabetes, for sponsoring the Juicebox Podcast. These people have been with me for a very long time. And they help keep the podcast free. So give them a shout write check them out of their links or, you know, just find a way to support them. Like for instance, dancing for diabetes has instagramming now, so does Omnipod and Dexcom. Follow them. Do something like that. When you see them online, be like Yo, thanks so much for sponsoring the Juicebox Podcast, whatever you're gonna do. Give them a little Hey, hey, you know, so let me thank you here for all the great reviews. The merchandise are buying the T shirts, I'm starting to see pictures of you guys out in your real lives. We're in shirts that say like stop the arrows and be bold. Very, very cool. All right, there'll be a new defining diabetes this Friday. And then we're going to get into the fall, run, run. My next episode with Jenny Smith will be up in a month. It's going to be about fats and proteins and how to Bolus for them. The month after that. The next episode with Jenny is called Ask Jenny. It's gonna be the first episode where your questions are what I asked Jenny