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Scott Benner 0:00
This episode of The Juicebox Podcast is sponsored by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. MDI users, this one's for you. How would you like to live your life less complicated? You can do that within pen in pen is a reusable injector pen that has its own smartphone app. They talk to each other through the Bluetooth. Bluetooth is magic, isn't it? You know what the app does? I'm going to tell you a lot about it over the next few weeks on these Friday shows. But for right now, dose calculator dose reminders reporting actually tells you if the temperature of your insulin has gone out of range. Not only that, it connects to your CGM. Ooh, I got you there tonight. An app on your phone that connects to your continuous glucose monitor that connects to your insulin pen. Now you want to know more about in pen, don't you? Check out companion medical.com Welcome to Ask Scott and Jenny. In today's episode, I Scott and Jenny Jenny Smith from the diabetes pro tip series in defining diabetes. You know, Jenny, Jenny works at integrated diabetes. She's a CDE, a registered pump trainer CGM trainer dietitian. She has type one. And if Jenny was a blanket, she'd be a quilt that you've had for like 10 years that's heavy and soft, warm, but does it make you sweaty, all at the same time? That's what Jenny is Jenny's an old quilt. In this episode, we take two questions from you the listeners and I tell a little story about Arden's YOLO experience. Today, one listener asks, How soon is too soon for an insulin pump? Do you really need permission from your doctor to do something like that? And the next is about basal IQ and how it seems to mess with your extended boluses. You tandem people are going to be up for this. It's also kind of a looping idea. Honestly, it's an algorithm idea. Arden I just made up all this that after after I pushed the FTC pushed a button I was like, Huh, I wonder if this a killer? Probably not. We're gonna be fine.

Jennifer Smith, CDE 2:25
Buffy a good meal. Yeah. Well, it's

Scott Benner 2:28
a weird confluence of situation. So today was like picture day. And so she goes in, they get out of the room, you know, you know, for picture day. And then they start to see in the cafeteria, and she's like, Can I just grab a muffin real quick? And I was like, Yeah, sure. So I'm like, what kind do you think you'll get? I don't know. And I said, Okay, well, why don't you put 20 carbs in now? And you know, let me know what you end up with. And she's like, Okay. And I swear to you, eight seconds passed, and she says, I got a chocolate muffin. I was like, Wait, did you were you standing next to it when you were texting me? Like I didn't understand. I thought she was like in a classroom, maybe thinking of going to the mosque, you know? Anyway, I'm like, Okay, well, you know, we put the rest of the the insulin in. hour and a half later, can I get a chocolate milk? And I was like, sure. What are you thinking of doing that? And she says, I already bought it. And then she goes YOLO and I'm like, you only live once? Is that the message today? Alright, so we Bolus for the milk and I thought everything was going great. And about maybe I'm gonna have to say 45 minutes after the milk. It just went a little curved up as like, Oh, 125 diagonal, a blitz. Just boom. 141 straight up. I was like, Ah, so I texted I'm like, hey, lunches in like, 15 minutes, right? She said, yeah, it's like we're in a bolus now like, really heavy right now for it. So we did, it caught the up arrow at 177. So it's 177 diagonal up now. I just I can't wait to see what happens then afterward. She's like, I don't know that I'm that hungry. And I was like, Oh, good. Good. Everything's gonna be fine.

Unknown Speaker 4:05
Don't you worry.

Jennifer Smith, CDE 4:06
I'll get another one of those chocolate muffins and some chocolate milk for later.

Scott Benner 4:10
If you get a juice box in your purse, right? And she said, Yeah, like, okay, it's gonna be fine. Good girl. See you later. Yeah. Anyway,

Jennifer Smith, CDE 4:18
have a good day. Oh, sure.

Scott Benner 4:20
Go get them killer. So I don't know what's gonna happen. We, uh, Jenny, I think we are going to keep going with ask Jenny.

Jennifer Smith, CDE 4:28
Okay,

Scott Benner 4:29
I've changed it to ask Jenny Scott because I started feeling bad about myself. Now, some of the questions came in that were directed. Okay, let's do this. Okay, so Rachel says, this one's interesting. She said My son is seven years old and he's had Type One Diabetes for only seven months. He still honeymooning pretty hard, and is only using two units a day. I spoke with our CD who she loves when she mentioned waiting until bazel needs are greater. But I'd really like to get a pop. But it sounds like it's not a good time yet. Any thoughts or advice? There are time that I think I get this, right if you're if your basal needs are so low that a pump can't approximate them. You can't use a pump, maybe. But I don't know. You know what I mean? Like, I'm if you want a pump, I think you you can find a way to do it. And I've seen people find different ways to do it. What do you tell people in this scenario?

Jennifer Smith, CDE 5:20
Right? Well, I mean, you know, to you, and it's an hour or two units a day of just the base bazel is essentially what she's saying that she's or her child is on, right? So really, I mean, even if you divide that into 24 hours, it comes out to a basal rate of point 08 an hour, which in pumps usually do either point 025 or point 05 per hour, right? So technically, yes, there's definitely at a point that they could be using a pump, I would recommend if they are looking at a pump to get a pump that has the ability to have increment of probably the point zero to five or even the point 05. But with the ability to have the point 00 as a bazel. segment.

Scott Benner 6:14
Good pimps do that, at this point.

Jennifer Smith, CDE 6:16
All pumps on the market. Do that at that, at this point, Omni pod dash does that at this point, but not the current PDM pod. So if they wanted a tubeless pump, they would have to choose the gas pump to begin with because they couldn't get less than point 05.

Scott Benner 6:34
Rachel's question makes me think, I don't know, maybe I'm cynical. But sometimes I think doctors are just looking for an excuse to tell you something like, Oh, you don't use enough insulin yet. You don't need a pump. Like I know a lot of doctors add just these arbitrary lines on things like you have to do this for a year. And then we can give you a pumper. You know, I want to see this many a one sees in a row, or the one that always fascinates me is you're not taking

Jennifer Smith, CDE 7:00
any stable.

Scott Benner 7:01
Yeah, you're not taking care of your blood sugar correctly. So we're going to take the pump away from that one fascinates me. And I'm like, okay, just so a lot of this doesn't make sense to me, a lot of this always makes me think about my experience, where we asked for an omni pod at our pump training. And we were told no, you don't want that pump. And they were adamant about it and threw a ton of reasons at us, right? Your daughter's too lean? You, you know, I forget there was all these things, you have to carry this thing with you like they did everything they could to get me not to try it. We tried it anyway. It's a story I've told in the podcast. But then a number of years later, we were told by the hospital Hey, listen, we apologize for trying to get you away from this, but we just didn't understand it. We didn't want you using something we couldn't support. So instead of saying that, it was excuses, don't do it because of this, that this or all these things I thought about. I wonder how often that happens to people because Rachel's predicament is interesting in that a pump could accommodate her kids based on needs.

Jennifer Smith, CDE 8:02
Yes, so it could are they going to change because they're very early in this, they're going to change. But the benefit of the pump, outside of an injected amount that you can't change, once it's there is that you can adjust the pump right now, you can adjust the bazel. And with the ups and downs that are coming, so soon in a diagnostic era, you know, in a diagnosis time, the pump could be very advantageous.

Scott Benner 8:33
That seemed like a no brainer to you really, because you could go off, you could set basal rates with insulin for hours at a time. Like that just makes sense. Correct? Yeah, right. So I always tell people, look, it's your kid, it's your diabetes, whatever it is, you know, you're not asking. I know it feels like that in the doctor's office, you're asking for permission, but you're not you say look, I want an insulin pump, write the prescription. And if they don't want to write, I say find a doctor that wants to, you know,

Jennifer Smith, CDE 9:02
but Right, exactly. Find somebody to support. It's kind of like you've mentioned before, just with the as a supportive component, if you're being told that you are not well, well enough control B on a pump. That doesn't make any sense whatsoever. It's also like the offices that only prescribe one brand of pump. Well, the reason that they do is because they've only been educated on that and they've got to a comfort level that they don't see the outside they are on this narrow path of must prescribe this pump because that's what we've been taught to do. But that's not addressing people's individual needs. It's not aesthetics with a pump, pump, are chosen by the user for very specific reasons. And when you as a user like up this comp isn't fitting my need anymore, I'm going to go on to this other pump. I mean, that's what I did. Originally, I was on an animist pump. I had started Doing triathlons. And I was tired of disconnecting. I was tired. And so I had a friend and she was like, Hey, you can wait just a couple of months, there's gonna be this great tubeless pump that's on the market. And I was like, really? She's like, yeah, she's like, I can get you connected with a rep and talk to him and everything. And I didn't from there on it was Omni pod. Because, you know, it fit my life.

Scott Benner 10:22
So, and I know people who for instance, love a T slim, and aren't looking for an omni pod. And good for them, you know, but yeah, so Rachel, don't let your doctor make that decision. I think you can. I think you can do it now. Right? I guess speaking at t slim Bailey says. My question is, if there's any advice for those of us with the tandem x two with basal IQ, says we when we extend a bolus, it almost always cancels that before the extended bolus is finished, because it predicts we will reach 80. But then we do the math and dose the rest because obviously, they call it the insulin. Oh, but now we have to remember to do that. You know, that's a that's my world with looping right there in a nutshell. So I think what we're talking about here is this algorithm based, you know, system, all these systems are making, you have to understand because they're working by adding and subtracting insulin, they don't have a way to magically make your blood sugar come up. So they are trying to keep you from getting well,

Jennifer Smith, CDE 11:22
right. Um, and the basal IQ specifically is trying to prevent a blood sugar less than 80. So really, you know, it predicts out into the future over the next 30 minutes where the trend in glucose is coming. And visa like us job is only to suspend and prevent a low it's a predictive low suspend. It's not quite there. declaration just called I think it's control IQ is what it will essentially be. But their their basal IQ is essentially just to prevent a drop. So with the extended bolus, they're correct. What ends up happening is, if the trend in glucose is coming down with that extended bolus going days, like you kicks in, and it turns off all ads, not just to bazel. But it also cancels that extended Bolus. So to get around it, extended boluses from what our our user in the office, our educator in the office, who uses tandem and has used it a long time herself, for extended boluses, she recommends turning basal IQ off when you've got that extended bolus going. Because it's it's kind of just allowing the extended bolus to work in a time period for what you know the purpose for it being there, right? You've used it before, you know, you need to use it for this purpose. You don't want the bazel or any insulin to be kicked off, because you know how it's supposed to work. And so none of these systems are 100%. Perfect. None of them are cut and dried and forget about it. So what you just said turn off the predictive system. That's the same as in a looping scenario where I would open the loop because I want the loop to stop working for a little while because I'm trying to bring a blood sugar down. Okay.

Scott Benner 13:14
All right. I think I lost you. I don't think I can hear you. Did you lose?

Unknown Speaker 13:19
I hear you.

Jennifer Smith, CDE 13:22
I was shaking my head. I do not even have to remember nobody sees this. They hear it. So yeah.

Scott Benner 13:30
That was like, Oh, we've lost our audio. Anyway, I think I think Jenny's description is perfect there is that there? There's just some things that these algorithms can't see. Right? And variables are only one of them. And so you, you're gonna have to be you know, one of the things I end up telling people about looping is you're still got it you still have to be involved. It's you It's not gonna be like set it forget must interact. Yeah, you're still it's just a different different interaction.

Jennifer Smith, CDE 13:59
Interactive system. You just get Yeah, it's just different.

Scott Benner 14:03
Yeah. Thanks so much to in pen for sponsoring this episode of Ask Scott and Jenny. And don't forget, please, that you can actually hire Jenny. She works at integrated diabetes. There's a link in your show notes and there's links at Juicebox podcast.com. But you really just need to go to integrated diabetes.com. Go to the staff find Jenny, there's her email address, and you're on your way. Alright, little bonus here at the end compliments of in pen. Now in pen, of course is available at companion medical.com. There's also links in the show notes. And what you get when you have an M pen is an insulin pen that speaking to an app on your phone. What you get from that is all of the functionality. Well, almost all of the functionality that you can get with an insulin pump. You can't mess with your basal insulin obviously. But the other stuff like insulin on board, helping you with your carb ratios when you're doing meal boluses. All that's right there. And as you know, these episodes for these couple of Friday's here are going to be sponsored by in pen. Part of what you're going to get is little snippets of a story from one of their users. Fiona Wilde, who is a professional, wind surfing, paddle board. She does something on the water with a big board and sometimes she has a stick in her hand. But what she always has in her backpack is there in pen. So here's a little bit about Fiona's diagnosis. And then of course, in a few weeks, you'll hear the entire episode with Fiona companion medical makers of the in pen brings you this story with Fiona Wilde. And there are links in the show notes and Juicebox podcast.com. If you'd like to check out the in pen for yourself.

Fiona Wylde 15:54
Hey, this is Kiana Wilde and the Juicebox Podcast is super cruzi.

Scott Benner 15:59
When you're first diagnosed, I'm assuming you leave the hospital with like, like pens or syringes and insulin and a meter. Right. That's about it.

Fiona Wylde 16:09
Primarily, because I didn't really think that anything was you know that wrong? I knew I wasn't feeling great. But, um, basically, I just went into my family care doctor. And, you know, I explained that, you know, I hadn't, you know, had dry mouth, I've been losing some weight, you know, I had that infection and this and that, whatever. And he looked at me, and he's like, Is anybody ever tested your blood sugar? I was like, no, what, what is that? You know? And I was like, you know, thinking, Okay, all sorts of tests, you know, what's involved? And he just pulled out a meter. And he said, let me prick your finger.

Unknown Speaker 16:43
I was like, No, thank you.

Fiona Wylde 16:46
Okay, and then he pricked my finger. And the number that popped up on the screen was 586. And I was all happy, because I just graduated high school that morning. So I'm like, great. What's that out of like? 1000? And he goes, No. Yeah, I'm really sorry. But you pretty much have type one diabetes, tears, and I didn't know what that meant. And, you know, I had no idea what diabetes let alone type one was. But I live in a small town and he pretty much said go home, because I just went to the doctor's office on my own. He was like, go home, talk with your parents. And he gave me his personal cell phone number and was like, have them give me a call. And I can talk and you know, help you guys out if you need anything. So then that night, it pretty much I didn't get any insulin didn't do anything. I actually never went to the hospital. Because I was 18. So I wasn't an adolescent. I guess I'm more just kind of strange. But um, yeah. So then I went, and the next day got connected with a diabetes educator. And she went through absolutely everything and you know, explained how insulin works, what diabetes is, and she was spectacular. And she's the one, you know, who showed me how to prick my finger and how to, you know, calculate carbs and give myself insulin for that. And that's when it all started. But the problem was that I was supposed to go to Europe to race for the first time, five days later. And I was like, oh, my goodness, you know, like, first go diagnosis. I was bummed because I was like, okay, like, obviously, you're not going to go like, this is not my priority. Right? Now. My priority is my health. But then after getting influenced started, and like, you know, immediately coming out of the five hundreds, which is good. Oh, you went and spoke with my doctor. I was sitting there with my parents. And I was like, Okay, so, here's the thing, like, I was supposed to go to England to race. My dad was already planning on coming with me. But you know, if it's going to be any problem for my health, like, you know, please tell me and I absolutely will not go you know, that's, I don't want to put myself in any harm. And he looked at me and he goes, that is not the decision for me to make a it's not gonna hurt you. So I think you can make that decision as a family. And I was like, Okay, dad, we're going to England. And then we got on a plane two days later.