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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
This episode of defining diabetes is brought to you by in pen by companion medical. In pet is America's only FDA cleared smart insulin pen and app system that eliminates guesswork with its integrated dosing calculator. And that's about the least of what it does. Check out in Penn today at companion medical.com. There are links in your show notes at Juicebox podcast.com. In today's episode of defining diabetes, Jenny Smith and I will define a term that impacts your life with Type One Diabetes. Now you know, Jenny Smith from integrated diabetes calm, she's in all the pro tip episodes and ask Scott and Jenny, you know, Jenny, stop it. Don't act like you don't. If you want to hire Jenny, you can check her out at integrated diabetes calm, Jenny would love to have a private conversation with you. Let's see if she can help you with some of your diabetes questions. But for today, Jenny is going to help me define brittle diabetes.

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 for becoming bold with insulin.

At the end of this episode, I'm going to include a little I want to call it an outtake with me and Jenny, it might not be an outtake, it's a preamble, some chatter we were having before we started, you know, doing the defining diabetes thing. It's fine. And he's a hoot.

I would like to define brittle diabetes. And I am super interested in what you're going to say when I ask you, if it's actually a thing, or if it's an old timey term for I don't know what's wrong with you. It does have a definition, right?

Jennifer Smith, CDE 2:07
There is a definition and as far as like the old timey thing, I would say that that's more that's more appropriate, brittle diabetes. Used to be termed to or used to be something doctors called someone with diabetes that they just sort of threw their hands up and their blood sugar's were all over the place. And there was no, you know, do this and it works and whatnot. I mean, on a day to day basis, we know the variables that can go into management. So I think in today's world with technology and CGM, and being able to follow things, a good number of people who probably would have been called brittle, ages ago, or maybe even in the past five or 10 years with a really old doctor who isn't clearly up on what could be being done. I think they may have been called brittle. But in today's age, with what we can follow and track, many times, we get people who come to us even and they say, no one's been able to help me kind of get this contained. And we look at things and we start with like the basics that we've done before. And in the pro tips, kind of starting with beads, and looking at boluses. And looking at food impact and things that some people may have never really looked at before as the impact and how to pay attention to them. So we can kind of then you're not brittle, you just haven't had good information given to you about how to manage more consistently right. Now, I would say I hate the term, I hate the term riddle. But I would say that there are some people with long term diabetes, like you know, ages and ages, you know, 50 plus years, maybe, who may be at a point that there is there are potentially other complications in the picture. And that can make management of diabetes itself a little bit more cumbersome. And so you might appear a little bit more I guess, brittle. Again, I hate to use that term, because it's, it's, it's old. But when you've got other things like heart disease, or kidney disease, or even things with like neuropathy that might limit or change how often you could be active, or energy levels, all those things can impact blood sugar control. So it's not so much that it's, oh my gosh, I'm just going to throw my hands up and there's nothing to do about my blood sugar because I just can't management manage, nothing ever work. Sometimes its management of a couple of things to get the management of diabetes, more stable.

So

Scott Benner 5:00
with you on the idea of I hate, I hate it even bringing it up, because the first thing I think about is someone who's been living for such a long time with a doctor telling them, there's nothing you can do about this. You're just a brittle diabetic. And they're really buying into that and living a life around it and then turning this on and hearing someone go, that's not a real thing. Like, I don't want them to have that experience. Right. Right. But I also know that we define it, it's almost like taking a diagnosis away, it's like telling them Nope, you're definitely you know, you're crazy to think that your ups and downs, are, you know, something that you're doing wrong, because it's not, you've just not been given enough information to manage exactly, but at the same time, we we've already defined a couple of terms that, you know, bristle people, and I've get a lot of good feedback about I'm glad you tackled this idea. So I want to do this. So, you know, googling it comes up Rare Disease info.nih.gov. So this is the government saying that brittle diabetes is a term that is sometimes used to describe hard to control diabetes, it is characterized by wide variations or swings in blood sugar, in which blood glucose levels can quickly move from too high to low. And that's a fairly new, that's from 2017. That's not an old. Right? So I've always seen it as a, it's a, it's a give up from a doctor, it's just like, I don't know what's wrong, you're brittle. You know, like, like, you know what it reminds me of I and I hate to say this, but 50 years ago, if a woman 50 years ago, probably longer than that. Now, if a woman was emotional, they'd say what like, Oh, she has the vapors. She's prone to, you know, they mean, like, what that really meant was, some lady was saying something some guy didn't want to deal with. And they were like, Oh, you know how she gets, you know, like, you know, it must be hurt. Right? Like all that stuff that kind of like dismissive stuff, which I think really means my wife's trying to talk to me about her feelings. And I don't want to so let's just say she's crazy and get out of this conversation. And I don't think this is much different in that. It sounds to me, like, Doctor see these crazy numbers, right? Imagine it. Imagine no technology, you go in with your meter, and your meter says 35. And then it says 400. And the doctor doesn't know what to say. And the insulin is not as good as it is now. And you can't glucose monitor with a CGM,

Jennifer Smith, CDE 7:18
and the person hasn't had any notes. Because it's three weeks ago, when that happened. They're like, I don't know what happened three weeks ago,

Scott Benner 7:24
they're working off whatever bad advice they got 30 years ago from an endo. I mean, imagine what they tell people today, imagine what they were saying to people 30 years ago, it must have been just like, Hey, you stick that in there. And if you get dizzy, have a candy. You don't anybody was probably similar to that. Right. And so I, I shudder to think that there are people living today who think they're brittle, when I really believe it's possible that they just aren't aware of how to use their their insulin

Jennifer Smith, CDE 7:51
well, and even that definition that came from NIH in 2017, is there's no definition to why the variability could be there. The ups and the downs, we all have variability at times. And if you're, as we've kind of gone through, and many of the things that we've talked about, if you're not, if you don't pay attention, and make some notes about things or keep track of some things, or look at your data, you could feel very brittle, you could feel like nobody's ever going to be able to help me my blood sugar just does what it wants to do. And there's no rhyme or reason to it. And you know, whatever, I've just got bad diabetes.

Scott Benner 8:29
I think we got the bad griddle, Jenny, right, it just means like, easy to fall apart. Like the idea of something better, like a brittle bone, or a brittle twig or something like that. If you don't hold it with kid gloves, and don't move, it's just going to explode and fall into dust. Right? And it's just, if you're living right now and thinking you're brittle, please go back and listen to the prototype episodes. Because it's very possible. I mean, in less than, I hope this isn't the case. But unless you've gotten to the point, with your health, like Jenny described earlier, where there's where there's a lot going on, that's not positive. I mean, still, then you're not brittle, you just have complications, you know, like, it's so anyway,

Jennifer Smith, CDE 9:10
and there is different management then for complications and the diabetes component there. You know, I used to work when I worked as an inpatient diabetes educator and dietitian, there is very different management for people who have chronic kidney disease or who are on dialysis or those complications. They bring something in I also used to work on a cancer ward. And there are people who have diabetes and also have cancer that brings into the picture a whole host of fluctuations that happen. That doesn't mean you call the person brittle, but it means that there's something there to manage to help them also manage the diabetes.

Scott Benner 9:48
Yes, excellent. You know, your wife is upset in 1925. She doesn't have the vapors

Jennifer Smith, CDE 9:55
that she probably needed a hug or just to sit down and actually talk to somebody right

Scott Benner 9:59
should be affected. I opened his mouth and didn't cheat on her, she wouldn't be so upset. So anyway, I know you made me just now think of Nicole who was just on and I don't know if you've ever heard her Nicole's episodes, but Nicole came on prior to getting a kidney to kidneys, and a pancreas transplant. And then she just came on recently to talk about how it's going after the transplant. And one of the things she brought up is because her management was not great by her own admission for a very long time. She has gastro precice to Yeah, he actually has to consider her medications. right because of the gas or priestess like what if the, it doesn't get picked up in the right time? And that's just one of the things you just said. Like there's adjustments that need to be made based on your situation. Right, right. So, so Nicole's stomach isn't brittle. Nicole has no bruises, and she needs to do something a certain way. Correct. I like that. We did this one. Okay. Awesome.

Jennifer Smith, CDE 10:51
Yeah, it was good, too. It was definitely good to bring up because I think it's still it's still talked about too much. It is.

Scott Benner 10:59
Yeah. When I first said it to you, I had the same feeling in my stomach as I had when I said hey, Jenny, let's define non compliant. And you looked at me like really? Scott, should we do that? And I was like, No, no, we should. It's gonna be okay. And you're like, yeah, this is good. We're going down with the ship here, aren't we buddy? Okay,

Jennifer Smith, CDE 11:15
so that was a good one to noncompliant because I hate that word.

Scott Benner 11:20
Huge thanks to Jenny for coming on the show. As always, don't forget that you can hire Jenny right at integrated diabetes comm there are links right there in your show notes. If you want to check out Jenny may think there are links at Juicebox podcast.com. And of course, you can just go to integrated diabetes and give her a shout. Thanks also to in pen for sponsoring this episode of the Juicebox Podcast Do not forget, all you have to do is go to companion medical.com. And there you can find out where you stand with your diabetes care plan because the in pen app displays your active insulin, blood glucose and the last insulin dose. It also reminds you when to take a dose calculated recommend your next dose and warns you if your insulin is expired or has been stored outside of the recommended temperature range. Having an M pen is like having an insulin pump. But it's in a pen. Get it in pen. You get it you can get more Jenny and the diabetes pro tip series other defining diabetes episodes and of course, the Ask Scott and Jenny episodes. If you just can't get enough, Jenny, that's where you can find her here on the Juicebox Podcast. And now you're used to hearing Jenny say smart stuff about diabetes. Get ready to listen to her talk about other stuff where she sounds more human. We've been trying to figure out for Arden all year which is incredible. For network

Jennifer Smith, CDE 12:59
I don't know where you went

Scott Benner 13:01
where network connection and you were gone.

Jennifer Smith, CDE 13:03
are gone. All of a sudden

Scott Benner 13:05
you're like a little Blippi today. Kick your heels Yeah,

Jennifer Smith, CDE 13:08
I don't it's it's pretty windy outside here today and kind of overcast so that might be I don't know whatever happens in the atmosphere of cloud

Scott Benner 13:18
do you get your internet through satellite or you get it through like your cable system?

Jennifer Smith, CDE 13:23
I don't know I've got a little box in the corner of my office and whatever

Scott Benner 13:30
admit what I just said you is gonna end up at the end of one episode where people will feel better knowing that there are some things you don't understand at all.

Jennifer Smith, CDE 13:39
Have any no idea why

Scott Benner 13:42
he knows everything? Like how do you get your internet NO NO IDEA starts looking around the room like so. Anyway that was great. I

Jennifer Smith, CDE 13:52
come in and got a little I've got a little cable thing box in that I think I'm assuming it's the Wi Fi converter whatever it does thing Yeah, I I have no idea. Are you not surprised now that I could like like build a loop and actually make it work and understand it's working.

Scott Benner 14:10
I'm a little concerned that people are running around the country in the world doing things with their insulin just that you made up in your head?

Jennifer Smith, CDE 14:16
No, no, I promise not that. If you ask you this set up all of the internet connections and everything no probably not going to get done. I'll figure it out. Like I can read directions. I'm a direction follower. I got that from my dad. Everything that he brought home you took out the directions and you started with a like all like shelving units and stuff. All he got all of the Tupperware containers out and he put them all like by size and color and everything he organized them and we need one of a and we put it in the a hole and one at well. That sounds kind of weird, doesn't it? The

Scott Benner 14:54
no this is staying Yeah. Jenny just in case you're wondering. This is gonna be like the beautiful like last five minutes on episode people. Like just leaving the stupid stuff you say this is gonna be one of those that stays in.

Jennifer Smith, CDE 15:06
Anyway that I learned my organization of how to put things together from my father, he was very, very organized

Scott Benner 15:12
for clarity. Jenny learned how to put things in the a hole from her dad. So I like him to hear this.

Jennifer Smith, CDE 15:22
He's not unfortunately, who passed away? No, it's okay. He passed away about 10 years ago, he had, he had kidney cancer. So

Scott Benner 15:31
I'm horrified to tell you that I wasn't sorry to hear that he was passed. I was sorry to hear that he couldn't hear what you just said.

Jennifer Smith, CDE 15:37
nature of what I said yes. And he would have, he would have liked it because he had the greatest dad jokes. Like in the world, my dad had a great sense of humor, so he would have loved it.

Scott Benner 15:50
To do something here on the Mac, right? Okay, so I just want to prove to you all that Jenny's a real human being she's not perfect. But she has a great sense of humor. And she does not know how her internet works. At the end here. You know, just let me tell you that podcast just hit 500 reviews on iTunes, which was really touching little plateau, for me. Quite a little milestone. Most of them are really good, which is also very nice. I want to thank you too, because the podcast just hit 1.2 5 million total downloads for the whole show, which is a really incredible thing. And I've probably said before, but it the first month of the podcast back in February 2015. I think there was something like 1000 downloads that month. And now I can't, you know, get 1000 downloads like every couple hours. As a matter of fact, by the time you hear this episode, November of 2019, will become the most downloaded month in the history of the podcast. And that happens a lot. Where the next month like we're one month does better than the last month over and over again. That really is to do with the podcast being shared by listeners. I have no budget for marketing. And I can only hope that when the podcast grows, that means that you found that helpful, or entertaining or thought provoking or something and told somebody else about it. Which I really I didn't expect that either. I know when hindsight it seems obvious, right? Somebody will like it, and they'll tell somebody else. But in the beginning I I really didn't think that would be I don't know, I just didn't imagine. And you know, reflecting here just a couple of hours past Thanksgiving. I'm really thankful for it. Actually, I was looking through my photographs. So I'll leave you go back to your life after this. I was looking through some photographs from two weeks ago. And I was in Kansas City at the jdrf type one nation event. I did four talks that day. Right. It's a think the thing started at 9am. And it was over my for for for those hours, I was speaking in a room. Not concurrently, although almost. And the first hour was just sort of thinking about your diabetes differently kind of talk, I sort of introduced people to the idea of the podcast. But then in the second hour, I talked about, you know, kind of the tools that we talked about here and give people sort of like a one hour if you can imagine, like the whole idea of the podcast on one hour. It's me talking pretty quickly on stage. After that, I did a q&a, where we talked through people's like real life issues. But at the end of the day, I sat down with the teenagers who were were at the event. You know, at first, um, they looked like teenagers coming into a room being told that, you know, this old man here is going to explain, you know, something to you about diabetes. And they sort of all came in like they know, somebody promised them something if they just came and said still. Maybe they had been a cost, you know, but in a couple of minutes. I got them talking and I got them laughing and started talking to them about their health and how they could possibly feel and you know, 10 more minutes later, a couple of more taking notes, and asking questions, and then the quiet ones in the back got engaged. And I don't know I was thinking about what I was thankful for today and you know the things in my life aside, my family and the people I love you guys for listening. I just started thinking about those kids. And I was really grateful that they listened. Anyway, I don't usually say what I'm grateful for Thanksgiving. But I think I'm grateful for you guys sharing the podcast to the point where it got me invited to an event in Kansas City, where I met a few kids whose lives might be different now. Because you told somebody else about the show, I'm going to put a picture of those kids up on my social media. So if you're listening to this, it's going to be right around. Thanksgiving on my social media. You can find the date scroll back.

If you're listening to this later, okay, this is me being all serious and quiet. Thanks so much for listening to the Juicebox Podcast. There'll be another episode on Tuesday, and every Tuesday and Friday from now until at the very least, the end of 2020. Because all of the sponsors are back plus some new ones. So huge thanks to them. Huge thanks to you guys. Hope you have a great rest of your 2019 keep listening to the show and sharing it and I'll keep making it. Hey, one last thing I need some new equipment to record with. So buy some t shirts maybe or a sweatshirt or something maybe at Juicebox podcast.com. Or you can make a donation to the podcast if you want just scroll down and you know every episode, there's a spot there to do that. Anyway, I'm not begging, I just need another microphone, a new preamp, my computer's starting to get to the end of its life. So there's gonna be some expenses coming up in the next couple of months. And if you would like to help with them by you know, picking up a sweatshirt or dropping five bucks on me or something like that. That'd be really cool. If you can't, please don't think twice about it seriously, I don't want you to feel bad not even for a second. Just keep enjoying the show, sharing the show. And I will I will take care of the rest. But But if you're just sitting there right now thinking I got a couple dollars I can handle that. I'm not going to stop you as they say, but I would be very appreciative