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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 friends and welcome to Episode 263 of the Juicebox Podcast. Today's episode is sponsored by dancing for diabetes Dexcom and Omni pod, you can go to dancing number four diabetes.com my omnipod.com forward slash juice box or dexcom.com forward slash juice box to find out more. I hope you're ready for another diabetes pro tip because this episode with Jenny Smith is all about fat and protein. That's right. How do you Bolus for the thing that they tell you? It doesn't need insulin, but really does. We're gonna tell you right here. And after you're done with this episode, Episode 263 special bonus episode number 264 is available right now. That episode is with Vicki. Vicki is eating keto. She's going to talk us through how she boluses for her keto diet. Because guess what, you need insulin for protein. In fact, if you don't know that, you're gonna love this episode. Now, even if you're not eating keto Vicky's episode is going to give you a ton of insight into the timing of fat and protein. It's actually sort of interesting to look at. If you're not a keto Well, it's interesting if you aren't keto, but if you're not, it's still really insightful. Because you get to strip away the carbs and just see where the protein comes into effect. It's almost like that, you know, do Row row row your boat, you start singing and then the other side of the room starts singing like when does the second tier of row row rowers come in? When does the fat and protein start working? 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. You however, do not have to talk to your doctor about going to Juicebox podcast.com, picking up a T shirt or a mug or something like that, you know, to help support the show a half an hour before you and I started recording this someone sent me a message on Instagram and said, How do I deal with fat and protein overnight because I was bawling all night with my kids. So I texted them back and I said hey, great timing. Can you see my recording calendar from where you're at? And hold tight? Because the answers coming? This is another one that Jenny proposed that I'm really interested in. And I don't know how much help I'm gonna make. Why don't we start with what I know? Because it's so little. So forever seriously. So for everyone who listens to the podcast and knows that I'm just sort of fluid with insulin, right? Like more, more need equals more insulin. And so because of that, I don't usually stop and think about whether that means it's protein or fat or what it is just if Arden's blood sugar seems to require insulin, I give it more. I'm assuming I'm been handling fat and protein rises for ever.

Jennifer Smith, CDE 2:58
You're not dissecting her meals, you're just saying I see the need. I'm giving more insulin. That's kind of what you do.

Scott Benner 3:05
Yeah, I see diabetes is a forest fire and I fly over it with a giant plane full of water and just drop all the water on top of it. And I go, oh, I've got most of it. And, and

Jennifer Smith, CDE 3:16
Oh and look at that's where the fire started where the fire man comes in and looks at and Scott's like, I didn't really care where it started. I just want to take care of anything

Scott Benner 3:24
was to me, I'll go get another plane full of insulin and drop it back on again. So. So I never really think about stuff like that I do a little more obviously, as you and I have been speaking as the years go past, but I find it to be it's another level. Like sometimes I joke about things being like like ninja level, like, I think that you don't really need to know about fat and protein if you're doing what I do. But you do need to know if you want to start understanding things in a bigger way. So I'm really excited to do this. Now, the only thing I know about protein is that I do indiscriminately bolus for protein. I don't know why I do it. But I do it. So where some people might look at a plate and go, Oh, there's potatoes. Well, that's, you know, this many carbs. But then there's a, you know, a cheeseburger. Well, that's me, I don't do that. And here's a roll that rolls 25 carbs, and you know, and we're gonna have broccoli, and I don't know, broccoli probably has five or six cards or like, so I look at my job I look at I look at a plate, I go broccoli, and six, the roll. Let's call it 30 then I look at the potatoes and they go I don't know 35 and then they look at the burger and I go, yeah, let's call it 10 and we'll extend it for a little bit. And and so that's me looking at a cheeseburger with mashed potatoes and broccoli, right. I don't know why I do that with the. I've heard that. I know. People who eat incredibly low carb, who tell me that they bolus for their protein but farther out from when they actually ingest it. Huh, is any of that right? If visiting dancing for diabetes is wrong, I don't want to be right. Not about this, I want to be right about the fat and protein thing. But I would not want to be right about visiting dancing for diabetes being wrong. If it was wrong, which it's not, I think you should definitely do it. Dancing, the number four diabetes.com. You know, studies show that if ads are incredibly confusing, they work so much better. Check out dancing for diabetes on Instagram and Facebook, throw them all like to really great organization, dancing, the number four diabetes.com. Even if you're not interested, could you go like their pages? Because they paid for this. And now I'm listening back to it. And I didn't do a very good job. So let's at least give them their money's worth. Is any of that right?

Jennifer Smith, CDE 5:47
Because, yeah, so I and again, I from the standpoint of looking, you're not doing this in a blind way, you have, you have the method that you've developed for analyzing looking at Arden's control and her management and what happens here and what happened there. And you remember it, you've got like this, like library of like, times have this has happened, you can like pick from them, Scott, and you're like, I know this happened last time. So let's time this time for the burger and broccoli, we're gonna give 10 for the burger, because I know what happened last time and something was off, and the carb count for everything else was right. in context, though, for everybody who's listening, and why would you need to Bolus for protein. It's really typically two points that you'd need to Bolus for protein one, you brought up the low carb eaters, or those who are eating lower carb at times, if you've got a meal that's typically less than about 15 to 20 grams of carb, and a normal amount of protein, not like this big 16 ounce steak, but a typical, you know, five ounce chicken four or five ounce chicken breast, let's say, You're usually going to need about 4050, sometimes even 60% of the amount of protein in the aftermath of that meal in order to accommodate for your body's own digestion of protein in a low carb environment. Because remember, carb is the body's natural first fuel, right? If there's not enough of that first fuel there, your body looks to another source, like protein digest sit down, and you get a usable amount of glucose out of protein. Even if it's not a huge amount of protein eaten in a lower carb environment. The opposite of that would be let's say, she has a high carb meal, or anybody has a high carb meal that's like the meat lovers pizza, okay, and which is not only a huge amount of carb, as well as a huge amount of fat, but you've got this large amount of protein, let's say instead of your standard, like 25 gram portion of protein, which is like about the size of the palm of a woman's hand, that's about 20 to 25 grams of protein, that's pretty normal amount, okay, if you've got this huge amount of protein that you're taking in, even in a normal amount of carbs, or a high amount of carbs, you're still gonna need an Bolus for about, let's say, 50% of that protein, but it's going to be a drawn out type of insulin need. So both of those scenarios would require you to take, you're doing like a dual bolus, you're extending some of it assuming you're meeting that protein kind of need for a while. Protein bolus typically is a good idea is at the end of the meal to set an extended bolus with zero percent delivered up front and 100% extended out over about a three hour time period. And that's just for aware proteins impact usually starts impacting about two ish hours after a meal. And then by about three hours, you're too high and you might sit high and correct to try to get it back down. When in effect had you used what you use to correct to actually Bolus for the protein you wouldn't have had the rise to correct to begin with.

Scott Benner 9:17
Yeah, I got it. It's parallel to the idea of over Bolus and like when you can't Pre-Bolus and you throw in a ton of extra to handle the rise before the right yeah. Okay. So yeah, exactly. I Bolus the meal normally. Then I finished eating and I put in this amount for the protein in an extended bolus, zero right up front, the rest of it out over maybe three hours.

Jennifer Smith, CDE 9:39
Correct.

Scott Benner 9:40
Correct. So basically, I'm creating a heavier blanket of insulin over the timeframe where the food is going to have

Jennifer Smith, CDE 9:47
where the protein is going to have the impact or where you're assuming from previous experience with meals like that. That impact is going to kind of fall in and fat is even longer. As we've kind of talked about before fat can have impact on To 10 to 12 hours after eating high fat.

Scott Benner 10:02
How does that technically happen? So these are where my questions exist. And by the way, I just everyone listening, I just stared at Jenny while she said that and thought, Oh, I'm in a Master's class about diabetes. And so, so fat as an example, when How does fat does it slow down digestion? Like, why does fat hold up blood sugar? I don't understand, I guess.

Jennifer Smith, CDE 10:26
Yeah, so one, it's also usually the reason as you just said, fat does slow digestion a bit, it's a it's a tough nutrient for your body to break down and make use of. So even if there's a ton of carb with it, it's often the reason that somebody eats a pizza. And they're like, wow, I must have nailed that carb count, because my blood sugar is like, beautiful rock, steady, flat, no rise at all. And then all of a sudden, later, they get this like creep, and the creep happens, and it happens. And then you ride high, and you're like throwing insulin at it and dumping the plane worth of insulin. Here, you know, it's, it's and it's annoying, right, especially for people who may not realize where it's coming from, because they've never been told what it potentially could be. So it's not a missed missed amount of car. But it is the reason that you had that nice flat look, in the aftermath of eating that, let's call it pizza. Otherwise, if you just ate the pizza crust, I guarantee that pizza crust is going to give you a rise without the fat being there, right? Even if you did Bolus,

Scott Benner 11:32
right, right, right,

Jennifer Smith, CDE 11:32
right bread or potatoes or whatever it is. Now fat The other reason it impacts blood sugar is because as it gets to the system, a creates a rise in triglycerides in the bloodstream, which is a stress on the system. So we know what stress does to blood sugar, right. But as a stressor, if it impacts insulin use as if, as if it's reducing it by about 50%. So let's say your bazel overnight is running at 1.0 units an hour, and it works beautiful, you've tested it, you know that it does what it's supposed to do. But in the effect of pizza or anything high fat, nachos and cheese or whatever it you know, the whole bucket of chocolate, whatever, you essentially have a bazel now that's functioning almost at like point five instead of one. And so you are not getting the impact of all the bazel you need your blood sugar climbs because of the fat and it stays high because of the fat and it can be long duration. So I mean, you know, we typically recommend people accommodate for a high fat meal or something, you know, high fat in nature, like the whole hog and does sundae bar or whatever. 50% increase in bazel at the end of the meal. And you extend it out over eight hours.

Scott Benner 12:52
Wow. 50% bazel increase over eight hours for a ton. Yep,

Jennifer Smith, CDE 12:56
see a ton of fat.

Scott Benner 12:59
That's where it's a Jenny. So there's a couple of things in there. But the one thing she just said was how the the impact of the food sort of gives the appearance that your bazel is only at half power. Because Because now your body needs so much more insulin. It's funny, because that stuff we say I've been saying for years, but I never thought it that way. Right? I never considered Wait, you just said it. I always say right, the by like, you know, in high carb situations, you need more bazel. That just makes sense. If you know if one unit keeps you stable when you're not, you know, when you're not putting the body through through the paces, then when you're out then when you're attacking it with ice cream or pizza or something like that, it stands to reason that you would need more in that situation, right to meet the need. But it's interesting the way you put it, I hope that maybe that'll find a strike other people maybe at the core of their thinking, because that's a neat idea. Like when when you're using that kind of food, it's as if you don't have enough bazel by half rats, they have something to like measure with even the idea of eight hours. I think the genius behind the extended, you know, the Temp Basal increase over that much time is if you do start to trend down at some point, you can just make a the foods out of my system. Now I can shut it off. Maybe I'll have to re correct this a tiny bit, too, you know, but that's it.

Jennifer Smith, CDE 14:15
Right? Right. And or maybe you got enough temping increase for quite a while. And now it's going to navigate down as you turn it off, and you may not necessarily get 100% back to target, but you're certainly going to navigate down to a much lower number than you would have been had you not done that at all.

Scott Benner 14:32
Yeah, yeah. I mean, and you have to know by now, if you've been listening this long, that you would rather stop a lower falling blood sugar than a fight with a high one. That's it. It's simple. How much truth is in the way my brain thinks about, like, more dense carby stuff like a soft pretzel or pizza or something like that, in that it sits in my stomach and it breaks down slower so that it has more opportunity to run. So my blood sugar being impacted by over a longer period of time sometimes passed when the impact of my Bolus is there. Mm hmm. Do I think about that correctly? Or is that just the cart? Yeah, that

Jennifer Smith, CDE 15:10
works. No, it's, it's a great way to kind of think about it and also plan to Bolus for it. And some of that also takes experience, right? It takes experience seeing, well, gosh, whenever I eat this soft pretzel, it's all carb. And unless you're like dipping into the cheese sauce, or something high fat that kind of comes along with it, the vat of butter, if you're just eating the soft pretzel, it's all carb. But the dense nature of it, maybe what requires a little bit more drawn out, because you don't necessarily need that quick impact all up front, you may need some, but then you're going to need it for a little bit longer in the aftermath. And the same is true for some of those, like more wholegrain hardy types of starchy foods, things like wild rice, or qinhuai, or you know, those kinds of things, they've got better fiber complex to them, they've not been processed, they're going to break down slower, and they're going to have a lower glycemic impact. So you may need to draw out the Bolus a little bit in order to prevent having a low before it kind of impacts or hits you later.

Scott Benner 16:19
Right, you have to stop thinking about the food goes in, and my blood sugar tries to go up right away. So I'll get that's not that's why your timings messed up. Like you have to understand a little bit how the food makes its way through your system. Mm hmm. high carb, low carb, high fat, low fat, you know, an in between there, the, the, you know, I used to tell people, like try to imagine an overlay machine like but then that got like an old idea, you know, like, you're in school and they do the, you know, the somebody would write on a piece of plastic and it would they'd shine up on the board. Say take two pieces of plastic instead and make one like a line of the impact of where your insolence pitting and one a line of where the food's hitting the goal is you have to slide those like those pieces of plastic left and right and make a me Italy match up? Yeah, you absolutely can't. You can't just throw in all the insulin now and just hope it hits because you hear people all the time, like, Oh, I bolus and I got low. And then I got high later. Now this makes sense, diabetes. And I'm like, No, you're so close to you. It's interesting. Jenny, earlier you said that I look at a plate. And I just know from experience and everything. I also think I just know, I don't know why I know. It's important to understand, like, I can't quantify it for you. Sometimes I can just look at a plate and go that's this much insulin, I know it. And it is obviously from something but at the same time, I have privately for the one person who called me an egomaniac in a recent review. This is not me being egotistical. I'm just telling a story. But I I fixed two kids bazel rates this week, mm remotely. And they sent me a graph. And as soon as I looked at the graph, I thought, Oh, I know what's wrong with this. But I couldn't explain it to you. Like, do you know what I mean? Like I couldn't write a manual about why this graph right points to what it points to. But I knew as soon as I saw it, I think everybody can get to that. Because I know who I am. I know what I got in school is for grades I can't possibly be smart. Right? So, you so seriously, like I think time just teaches but and please, guys, this is not an invitation for everybody to send me their thing. But But I am By the way, it did make me think, Jenny, I think there's got to be a way to start a service where you take people's graphs and make bazel recommendations back from the graphs. Because once you get people moving in the right direction with their bazel, they start to see it. And then they can then they can dial it in on there. And then they don't need you this this person this lovely person's texted me. You have to let me send you something cuz I'm going to be bugging you for the rest of my life. And I laughed and I said, Hey, you can't send me anything. And I don't, I don't want anything. And and but but be you're not going to need me for like, ever, like three days right? Now, this is gonna just make all the kind of sense in the world to you. It just starts to you start to see it, you know, right? Right? Which the matrix movie because it's such a great reference. But things start to slow down.

Jennifer Smith, CDE 19:26
You know, they do and they start to they start to come together in a way like like Neo sort of all of a sudden, all of those images that are flooding the screen in the matrix. Like he said, that's a great movie to bring up in context here. Because it just it comes together and his brain is like, I can see it all. It's clear. And I mean, diabetes, life with diabetes changes, variables come up, and there are always going to be new avenues to explore and figure out but the intuition of the day to day management, the intuition gets easier, and I think that That's what you kind of you manage off of a lot of really good built in intuition of, it's this, this feeling and you can't, you can't often I think other people would agree, you can't often put that down in writing, you can't say, I know how I know how this is wrong, I can't tell you why. But I know this is how to fix it. I know this needs to be adjusted here, you need something else here or whatever. Now, some of it can be, you know, some of that intuition can be simplified. If you do do some, you know, we're talking all about like food and the impact carbs, and fats and proteins and some of that, if you know, I've gotten a little bit into the science of why there's impact there from these foods that we don't really ever talk about fats and proteins are kind of like, swept under the table, when Diabetes Education comes, you know, comes up, it's usually all carbs, right? We focus on carbs, we learn how to carb count. And I mean, the basics of carb counting are pretty easy with a label, you look at the label for the serving size, you look down the label for the total carb amount. Next down, you might look at fiber, if there's enough of it, you might need, you know, deduct a little bit of it. But that's what we're taught. And then you're given this little ratio that's like, oh, for every 10 grams that you count from a label, you need this much insulin to take with it, right. So it's, it's a very mathematical figure. But if we take it sort of one step farther than that very simple carb counting, as you mentioned before, not all carbs are created equal, you know, you could have 10 grams of counted, you know, celery, versus 10 grams of counted watermelon, there's going to be a different impact blood sugar wise from those carbs, even though the carb count is exactly the same. And so that it kind of brings in, can you be precise in carb counting to a degree, you can look at labels, you can measure, you can use weighted scales and all of that kind of thing, you can get precise, but from the standpoint of then understanding why blood sugar did this versus did this, you know, upswing stable flat drop down, that actually it takes it a step further into glycemic index, and the nature of that food and glycemic index also in it encompasses the components of a meal to not just the carb at the meal. But like I said before, with the pizza, you could have just the flat old pizza crust and Bolus for that with just all the carb that's there. Your Aftermath blood sugar is going to look very different than when you eat it as like a meat lover or an all over cheese pizza. There are different components. They're impacting how those carbs are going to change your blood sugar.

Scott Benner 22:54
In case you missed it Episode 255 is a defining diabetes episode with Jenny, where we go over a glycemic index and load. Kelly and I went to the movies this weekend with Arden and her friend, we went to the snack stand and Arden chose a box of cookie dough bites day slushie I don't know if that's something that translates all over the country, but just imagine pulverized ice with sugar water through it. Now, I'm not scared, right? I've got all the rules in this podcast and I've got Dexcom I feel comfortable. Flip over the box with a cookie dough bites. 76 carbs for the whole box. I say Darden Are you gonna eat the whole box. She says, I don't know, the Slurpee, you're gonna drink the whole thing. She says I don't know. I look at the lady at the stand. I went any chance you got a carb count for this slushy thing. She looks at me and says carb What? I say Don't worry everybody because we have a dexcom g six continuous glucose monitor. I know what I'm going to do. So I just ballpark the carbs. Right? I use the 76 carbs for the candy thinking there's no way she's gonna eat all the candy. But, you know, the slushy obviously has a ton of carbs in it that I can't even begin to guess we're just going to start with 76 carbs, boom, insulin goes in. Now we wait for the dexcom to tell us that Arden starts trending above you know 120 as soon as she does Janga more insulin. Throughout the hour and a half of the movie we put on a number of different smaller boluses which kept Arden's blood sugar around 170 and then we got her back down as soon as the slushy cookie dough concoction stop going in. You know what I call that success? Arden Sala movie she had a snack, there was an unknowable amount of carbs that impacted her in all different crazy ways. She did not get terribly high and she never got low later, we accomplished that the dexcom g six continuous glucose monitor, head over to dexcom.com forward slash juice box to find out more. Results are mine and yours may vary. And when those variables are invisible to you, it causes you to say oh, that's Diabetes, I can't do anything about that. That's just nice. But there is like I've, I've been saying forever Jenny's just put it into specific words, which is beautiful. But I've been saying forever. If your blood sugar is getting really high or really low, you're not using the insulin correctly. I know that doesn't help you figure out how to use insulin, but it should help you to know that there's still an answer. And right, because you don't see it in the moment doesn't mean it doesn't exist. It would be no different than if I sat down and looked at multivariable calculus. And then, and then I said, you there's no answer to this. Well, a person who understands multivariable calculus would say, of course there is, you just, you just don't understand calculus. And so the trick is with diabetes, how do you find the ideas that help you get through this stuff without everything turning into a calculus problem? Right? Like, how does it just become day to day super simple and easy. And the reason you need to listen to Jenny is not only because she, you know, teaches this stuff and integrated diabetes, not just because she's been living with Type One Diabetes for a very long time, not just because she's a CD, or a nutritionist, all that stuff, but she lives in a part of the country where food literally tries to kill people. So that wow, I my brother and Jenny live reasonably near each other and the things my brother describes his food. When he got there, I was like, Brian, that's not food, don't eat that. And it's like,

Jennifer Smith, CDE 26:27
man, I would have to say Madison is sort of a little bit of an island in the state of Wisconsin. So Madison is a little bit a little we're a little beyond what the typical wisconsinite but yes,

Scott Benner 26:39
I'm just saying if you're rolling into a moment with a you know, bratwurst on a roll with a beer with some popcorn,

Unknown Speaker 26:45
curd,

Scott Benner 26:47
cheese curds, deep fried like you, boy, you you need to know what you're doing, you know?

Jennifer Smith, CDE 26:51
Right? Absolutely. And that's, you know, that's where understanding and learning things like, hey, fat, and protein and all of these factors, they can have an impact for you. It's not all cut and dry. Count the carbs, take the insulin and you've got it made it it's not and i i hate saying that because it sounds like well, gosh, I'm never gonna get a handle on this if I have to start being a mathematician and you know, figuring it all

Scott Benner 27:17
out. But you will if you just, if you think beyond what you were told. So somebody like Jenny said, they'll flip the box over a half a cup of this is 10 carbs, you know, you get sick, you know, you get a unit for every 10 carbs. So that's a unit like that. But then once that doesn't work, you know, you guys have heard me say it a million times. It's insane to go back the next day recount the same 10 carbs and go Okay, unit, because that's what the math The doctor told me. No, no, I used the unit, my blood sugar went up. It took me three quarters Veena to correct it next time. Let's try a unit and a half. Or, you know, yeah, let's try more because more it took more, you know, correct. You just have to, like, do some evaluation is that Yeah, you have to I'm following you for the people that I speak to over and over and over again, there's a moment where you just have to trust your gut. Like, you have to trust that what you're seeing is actually happening, which is why I made one of the tenants of the podcast, you know, trust that what you know is going to happen is going to happen, you know, and that's just that's simple. Like, it's not, I say all the time, like it's not stalking if you need it. And somebody I got a private message of the day it said that sentence unlocked my world, just, you know, change my life. And I thought, I'm glad I randomly said it because I didn't think of it ahead of time. I you guys have been listening for a long time you realize there's no notes in front of me. I've planned none of this is a matter of fact, Jenny and I start recording I go hey, we're gonna do like the fat and protein today. Okay, and she goes, Okay. It's, it's about unlocking your mind from what, you know, the confines that you are giving at diagnosis. And it's really it's, it's energizing to see it happen to people early in their diagnosis, because then you know, they're not going to live their whole life like this, but it's rewarding to see someone who's lived with diabetes for a long time. Have like the light turned back on for them. Yeah, I mean, the messages you guys send Are you guys owe me tissues? You know what I mean? No. It's really something. Okay, so I did we do we did carb counting basic site, like flip the box over, take a look,

Jennifer Smith, CDE 29:22
you'll buy box over? Yeah, I mean, if you wanted to go beyond the carb counting basics and get more into a little bit, I mean, taking it beyond would really be looking at the glycemic index, but then one beyond would be glycemic load. You know what that is Scott.

Scott Benner 29:38
Those are gonna be defining diabetes things we're going to do after we stop recording this journey.

Unknown Speaker 29:42
Okay, awesome.

Scott Benner 29:44
All right. Okay. We did well with this, I think.

Jennifer Smith, CDE 29:46
Yeah, I think so.

Scott Benner 29:49
Okay, don't forget that defining diabetes episode about glycemic index and load is back in Episode 255. Let your podcast player keep running because Episode 264 is the next episode. And it's with Vicki who will tell us how she handles a meal on a ketogenic diet. keto, right, here's the great thing. Even if you're not on a keto diet, even if you're not doing low carb, the information is amazing because it shows you the timing of when proteins and fats hit a person. Try to imagine that Vicki's gonna explain a meal to you, that includes no carbs. And she's going to show you where the fat and protein comes into play. So you can kind of in your head separate out when the carbs head to where the protein hits. Trust me, this is the capper for the episode with Jenny, I promise you go right from this one into 264. Thank you so much to the sponsors Dexcom on the pod and dancing for diabetes, you can go to my omnipod.com forward slash juicebox dancing the number four diabetes.com or dexcom.com forward slash juice box to get started today, we're gonna find out about the answer for diabetes. Don't worry if all that confuses you. You can find links in the show notes of your podcast player or at Juicebox podcast.com.