#364 Diabetes Pro Tip: Pregnancy

Diabetes Pro Tip: Pregnancy

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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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
Good and fresh.

Jennifer Smith, CDE 0:01
Because I'm not gonna sing this. I don't

Scott Benner 0:04
say oh, no, no, because this episode is going to be basically me going. Uh huh. And you saying a lot of different things. So okay, I want to if I can, yeah, do a protip episode about pregnancy. And I mean, like, pre planning leading up to it, what to expect how to prepare what to do, what's going to happen if this happens, what I do, and if we can, how do I do it without a glucose monitor? Is that all doable in the next hour? Right, well, let's do

Jennifer Smith, CDE 0:38
the mean without a continuous Yeah. Without

physically without knowing anything.

Scott Benner 0:44
That's possible. But isn't it funny? I call them glucose monitors or blood glucose monitor. Why do I do that? I don't know. Anyway, with without a CGM,

Unknown Speaker 0:53
gotcha, gotcha.

Scott Benner 0:54
Okay. Because I would like to, I want to do that as well. So anyway, I am, I'm going to be on the outside looking in here for this. But I do think that the place to start if you agree, is understanding what the pre planning is like? Because you can't, or you shouldn't, I'm guessing if you have type one diabetes, if you're the lady, you should not just if you can help it be in a situation where we got bored on Friday, and now we're going to have a kid. Right, right. There should be some more planning than that. So how far out? Does the planning have to be in is that maybe person the person and based on their situation? Hello, everyone. Welcome to Episode 364 of the Juicebox Podcast. This is the next in the diabetes pro tip series. And this is the 19th installment of that series. The diabetes pro tip series begins at Episode 210 with an episode called newly diagnosed or starting over. And then the episodes of course are in the body of the podcasts from they're they're spread out a little bit. But if you'd like to see them all in one place, you can find them at diabetes pro tip.com. Today, Jenny Smith and I will be doing a diabetes pro tip about pregnancy. That's the beginning then how do you make the baby with the type one. Please remember, as you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. or becoming bold with insulin. There'll be just a little more air for the music and then we're gonna get back to Jenny.

My friend Jenny Smith has had Type One Diabetes for over 30 years. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. Jenny has also had a couple of babies while living with Type One Diabetes. And I'll tell you this, if you could certify being delightful and wonderful and lovely. Jenny would be a certified delightful, lovely and wonderful person. This episode of The Juicebox Podcast is sponsored by Omni pod, the tubeless insulin pump, you can get a free no obligation demo of the Omni pod today sent right to your door by going to my Omni pod.com forward slash juice box. When you do that, on the pod, we'll send you the demo to your house and not pressure you about it at all. You can just try it on and wear it and see what you think there's zero obligation free and no obligation equals can't lose my omnipod.com forward slash juicebox. The show is also sponsored by Dexcom, makers of the G six continuous glucose monitoring system. Find out more about the dexcom g six today@dexcom.com forward slash juicebox. Every day we make decisions about my daughter's insulin use. And those decisions come directly from the information that we get back from the dexcom g six dexcom.com forward slash juice box. Alright, let's settle in. We're going to talk about being pregnant with Type One Diabetes. Jenny's going to give you her opinions about how to do that best for your health and for your baby's health. And by the way, if you ask Jenny privately, if you pulled her aside and said, Hey, Jenny, this thing we tell people about you know how to manage while they're pregnant. Isn't that how you wish everybody was managing all the time? and Jenny would go, huh? I think so. So there's gonna be a lot in here for everyone. Not just those of you who are looking To make a baby. So how far out does the planning have to be in is that maybe person, the person and based on their situation?

Jennifer Smith, CDE 5:09
Yeah, and kind of like we always talk, it is sort of person to person, you know, overall, if you've all along had pretty good management, you've put lots of the tips and tricks into play, and you know how to your insulin works, you know how food and activity and all of those things work for you. Maybe three months, maybe, you know, maybe you get married, and it's a quick turnaround. And you're like, yeah, we're ready. And like you have everything in placing, you know, your glucose is where it should be. And I mean, there are other parameters to check to, especially with diabetes, things like thyroid, all of those things should definitely be checked and analyzed and evaluated prior. But everything checks out. Great. If not, then yes, it could be three months, it could be six months, it could take a year. You know, if you're somebody who's starting out you, you know that you and your partner really want to have a child, but you don't really have things in place to do that safely from a discussion maybe that you've had with your doctor or your ob team or whoever, then it might take a long time, because I think it takes going back to really like the pro tips episodes. Really, if you're trying to get things contained. That's that's the starting place. Because while while you know where you need to maybe get, or maybe you don't glucose target range for pregnancy, should really be started prior to conception. Because then it's not such a big changeover from saying, Okay, well, I've been aiming for a target of 80 to 180, let's say, right? Well, Pregnancy target is, you know, fasting 65 to 95. That's when you wake up in the morning, is that is that anyone see in the fours?

Scott Benner 7:00
Is that is that high fours,

Jennifer Smith, CDE 7:02
have to look for the E one C. listing. Because what exactly where that is, I think

Scott Benner 7:08
what we're talking about here is that you have to know how to manage your blood sugars tightly, and see some consistency through weeks and months. So that it's not just a fluke, like one month, you're just like, Oh, I did it. And you have to be able to do it without low blood sugars that are going to be dangerous for you or the baby to write, you know. And so yeah, get it right, and then prove it over and over again,

Unknown Speaker 7:33
over and over again, or

Scott Benner 7:34
your period through different meals, because you also could, I just finished what I really enjoyed, I haven't, I did a four part series with a pregnant person who has type one. And we interviewed together after her first trimester after second after third and just yesterday, when her baby is three months old. And so I went through the whole process with her to try to understand it. And her a one C was like 4.8 during her pregnancy. And she was describing needing insulin, more than double than what she normally needed. And that like swallowing that pill of like, Oh my god, there's way more insulin needed here. I have to do it. And yeah, I want to get to all that. But But yeah, to me, what you're saying is, you can't be a person who's got an A one C of nine and say I'm going to have a baby. I'll just get pregnant now. And I'll fix it. Because what could those things lead to? Like what what Ohio one season pregnancy lead to?

Jennifer Smith, CDE 8:36
So that's where the like the typical national standard is? A one c less than 7%. at conception, right? That's, that's the broad goal. And we aim for a little tighter than that. Because as you're kind of getting to, it's easier to have things tighter to begin with. Rather than say, Oh, goodness, I've not really done anything, or I didn't plan it. And I also haven't done anything. And now I really have to tighten everything up. That's a lot of change all at one time, along with a load of hormones impacting things at the same time. Yeah, so it's a lot, right. So the standard for under 7% at conception is really because what they've seen in research is the risks of things like early miscarriage, or many of the genetic problems that can come up from those early weeks of forming all of the different body systems, right, all of the different body organs and everything. That's what's happening in that first trimester. So the goal being under 7%, your risk is about even with the general population who doesn't have diabetes, for those same types of problems to happen, okay. Okay. How hire the one See, the more potential for early loss or or miscarriage, the more potential for the heart to not form the right way or any of the organ systems, you know, a lot of those genetic types of things could happen. Also a lot of things that are not specifically genetic, like they don't come from down the gene line. But they just happen because glucose levels aren't allowing the cells to divide and form into what they're supposed to do. So

Scott Benner 10:32
anywhere from a miscarriage to birth defects, correct. Okay. And is it a mortal lock that that's going to happen? I mean, you know, how, you know how some people are like, I smoked all through my pregnancy, and he's fine. Like that, like, Are there dumb luck people? And I'm not that I'm saying roll the dice on that. But, but were you definitely going to see something or maybe not even know, like, Is it possible? You know, is it is it out of this world to think that you could have a high one C and your child could develop asthma? And that, even though you're never going to know, it could have something to do with that? I guess that would be speculative. But that's

Jennifer Smith, CDE 11:08
it is yeah, complete speculation, because there's really not. There's a lot of research done on later outcomes in kids who've been, I guess, born from women who have had diabetes, right through pregnancy, but a lot of it is more assumption of putting information together, right? You're never really going to know and you know, the opposite of that. Let's say you, you did plan to really take care and adjust and make changes and you know, things do happen. People get pregnant

Scott Benner 11:43
and it happens. I've seen it happen personally. Yes, yeah. There we go. No one's planning on it. And the next thing you know, you're moving to a place to have more space.

Jennifer Smith, CDE 11:55
Because you're gonna need it. There's gonna be another person,

Scott Benner 11:58
someone by mistake got knocked up. Cuz, you know, long day, everybody missed each other. And the next thing you know, I gotta leave my condo. That's all.

Jennifer Smith, CDE 12:06
There you go.

So you know that it happens. And I mean, and I've worked with a number of women through pregnancy, who that has been the case while they were planning eventually wasn't really right now and a once you really was not where we would aim to have it be the highest I've had someone start a pregnancy, which was really not planned. It was a teen pregnancy

was 11.3.

Scott Benner 12:36
Wow. And now they come to you right away. And and no, it took too long.

Jennifer Smith, CDE 12:41
They didn't they, you know, they came in early second trimester it was, you know, they had gotten through their first trimester with ob team and some endocrine, I can't even remember how the family found integrated to, you know, get in contact and get some consultation. But I worked with her through her whole entire pregnancy. And we pretty quickly got her a one seat down. Yeah. And then, you know, by the end of pregnancy, her a one C was 5.7.

Scott Benner 13:11
Wow, that's great.

Jennifer Smith, CDE 13:12
So I mean, and she has, she's a beautiful little kid, now that there are no problems there. So can things be okay? Yes, they can. But the risk increases dramatically as the a one C and the glucose levels are not man.

Scott Benner 13:29
Yes, it's me, for me personally. And given that you can get pregnant by you know, not on purpose.

Jennifer Smith, CDE 13:36
by breathing out someone, yeah. That's what I was told.

Scott Benner 13:40
But I think what we're saying is that, you know, say you live in a nice, safe town, you don't really need to lock your door, but you do anyway, there are certain steps you take, just because why would we take the risk if we don't need to? Like, if we know we're going to have a baby, why would we start with a 71 seat and go, I bet I can get it down before something weird happens to the kid like, you know, like, like, let's not do that if we don't need to. Right. If we get caught in that situation, then, you know, figure it out, write it down? It's correct. It really is. It's such as it's, I don't know, I just I'm thinking back now to the conversation I had, that the person who I mentioned from the, you know, the four different moves to the pregnancy came to my attention because her first pregnancy ended in the midst of miscarriage. Right. And so and I've been contacted by people who there's a person I'm still hoping to get on the podcast, she found out that she had diabetes, because she was pregnant. Yeah, you know, like, she got pregnant. They ran a blood test. And they were like, oh, you're not just pregnant. You have type one diabetes. And yeah, I did not know prior to that. That person's doing terrific. has a really cute kid, and I'm hoping to have her on one day. But um, anyway, it's just Yeah.

Jennifer Smith, CDE 14:54
You know, the other thing I wanted to mention here too, is that despite all the things that you can do ahead of time. Sometimes things do happen anyway. Right? I mean, I, I'm actually my personal is our my first pregnancy I had a miscarriage. So, you know, and I did everything ahead of time I had been doing everything for several years before we were like, yes, we're like, finally ready to definitely have a child. Right. And I had done everything. And in fact, my, my maternal fetal medicine, which is a high risk ob doctor that typically manages through high risk pregnancies. You know, she was like, this has nothing to do with your diabetes. She said many, many early pregnancies. In fact, she said many women, they kind of their visit late, especially, they've been pretty regular. They're a little late in their in their, you know, period starting. And then it starts like five, seven days late. And they're kind of wondering, she said, oftentimes, those are very early miscarriage where the body actually didn't even start up anything truly. Many miscarriages in terms of a person without diabetes, and a person with diabetes, who has managed well, they're just because the body knows that there's not something quite right.

Scott Benner 16:16
It just feels like a false start. And that's right. Oh, that's

Jennifer Smith, CDE 16:19
and it's sad. Yeah. And so, you know, I mean, it's sad in any regard. But I think if you can do the things ahead of time to prevent it, then you know, that you've done everything possible,

Scott Benner 16:33
takes away from the idea of is this diabetes? Or is this something else that you can see yourself as more than having type one, say, you can see normal things that happen to people, I just saw someone recently who had a seizure, and thought it was because of their blood sugar, but then figured out, it was, you know, but that was their first thought was, oh, I must have my blood sugar must have gotten very low. And it turned out not to be right, you need to see yourself aside of diabetes. And the best way to do that is to make diabetes a lesser impact on you so that you're not always worried about is this happening because of that, right.

Jennifer Smith, CDE 17:09
And I think that that's a good point, though, for the pre, the pre conception, the pre planning stage, to know, the impact of this versus the impact of that versus, you know, I do this activity. And this happens, there's a lot that goes into that, beyond just having well managed blood sugars, there are a lot of other things to consider in that right. Nutrition is one of them. And then the other factors that are very common in type one, or autoimmune disorder is are your other autoimmune conditions? If you do have them? Are they well controlled? thyroid is another very big one that's really, really important to have tightly managed prior to conception. Because thyroid levels do change through pregnancy, and they will manage and evaluate and do more blood tests and adjust your medication. But you also have Chi, you have to have kind of a baseline right to know coming in. Yes, things are good.

Scott Benner 18:10
You know, it's funny, you mentioned that because just an hour ago, I took art and to get her blood test, because we've been managing her thyroid through her endo forever. But it's always just like, well, she's in range. It's fine. It started with still having a lot of, you know, side effects of what you would consider hypothyroidism. Sure, I finally found an endocrinologist who doesn't care exactly what the number says they care about how you feel. And so she's doing all these other things with her. And I hope to have that doctor on at some point when this process is done with Arden, but it's fascinating. She's taking. So Arden uses terrassen. And the amount of tear sent that her first doctor had her on is half of what the second doctor had her on. And she looked and she said yes, her numbers fine, but her symptoms are terrible. And she said given her weight, I would think that this should be more medication like so she was just she's very tuned into it. I just think that I would like to do a lot more about thyroid. On the podcast. I just you have to find the right people to talk to him. They're difficult to locate, you know? Yeah. But yes, so that as well. So what do I do I've and I don't want to skip over what Jenny just said about nutrition to like, Don't get so focused on your blood sugars that you're like, Wow, look at me. I've got a four eight I can eat all the Twinkies I want I learned how to keep my foot the kids gonna need like some greens and protein and stuff like that to grow it but I don't want to tell you how to plan your family. What I am wondering is I've decided I've got some money, I found a space I can put the kid nice. The Safe closet if I want to go out maybe they can't get hurt, you know, and moving forward. Do I make with the bangbang fun part or do I go find a doctor first? What's first?

Unknown Speaker 19:57
Yeah, that's

Jennifer Smith, CDE 19:58
again, the other part of it. Not only your management, having a team in place prior to conception is really, really important. Because I've had a number of women that I've worked with who have thought that they would just go with who was preferred with their insurance, right plan. And a number of them have transitioned once or even twice through pregnancy, because they were so unhappy with the care that they were receiving. A lot of it's specific to diabetes, and the consideration of diabetes in the pregnancy. I mean, ob teams, and definitely high risk, Maternal Fetal Medicine teams, they know pregnancy, but it really takes the right team to know pregnancy and diabetes together. And pregnancy and diabetes with Type One Diabetes is very different than gestational diabetes. And so if you've got a practitioner who, you know, says yes, or they're you call and you ask around to a couple of offices to talk to their nurses and get a bit of an idea about how the clinic runs and how appointments run and the doctor and experience and Oh, we've got lots and lots of experience with diabetes, what kind of diabetes right is the question you should be asking? Because they may have a good amount of gestational diabetes management experience. It's very different with type one,

Scott Benner 21:30
you don't want to get caught in the medical equivalent of Oh, my aunt has that? Yeah, correct. Right. Right. Type on your end as type two, it's different. Thanks for right.

Jennifer Smith, CDE 21:38
So do your shopping is really, you know, the case, the other piece, when you're doing your shopping, essentially, for your care team is, if you've got a really great endo that you're working with already, that would be a first, like, stop to actually ask them. Are you going to be my diabetes backup manager through this pregnancy? Because I've had some NGOs who defer to the Maternal Fetal Medicine team, which, that's okay. As long as the Maternal Fetal Medicine team has got it,

Scott Benner 22:13
man, they understand the diabetes piece,

Jennifer Smith, CDE 22:14
and they understand the diabetes pieces. Well, I've also, you know, and teams differ, you know, some ob is, once you get pregnant with high risk anything, they're hands off there, like you're going to high risk, high risk is going to manage the pregnancy for you.

We want to you

Yeah, right, we won't see you until baby is born. And you are post delivery time, right? Other teams, the OB sees you for the basic ob visits just for the monitoring, and that kind of stuff, you'll be shuttled away to Maternal Fetal Medicine, potentially, then for the high risk types of things. anatomy scans, fetal heart echoes all of the higher risk types of evaluations, especially in the third trimester. So it, it pays to ask around, it pays to even see if offices have a preconception consultation that they will do. So you can talk to the doctor and you can bring them this is how I manage I'm well managed. This is what I've done to get to the point of being ready. Because the more that you can show, any team like that, what you know, and how well you're doing, the more comfortable they're going to be helping you to manage the right way. Yeah,

so

yeah, it it takes, it takes looking.

Scott Benner 23:33
Okay. So if do some shopping, fine, we find the doctor. We, we we decide to move forward. We start doing what we're doing. I end up pregnant. Me, I don't know why. You don't pretend I'm a lady for a second. I'm pregnant now. And I have diabetes. So pretend everything about me is different. I'm a lady. I have diabetes. I'm pregnant. Now. How soon do I start? noticing like well, I noticed that my blood sugar's before I notice in my pregnancy test.

Jennifer Smith, CDE 24:05
For the most part in the first several weeks post conception, blood sugars are going to start to look wonky, wonky. And I think the easiest way to describe it is if a woman has experienced a rise of any kind in blood sugar during their normal monthly cycle, whether it's the three to five days before the couple days of once they get it or even around ovulation. Hormones from the start of pregnancy are significant and they will make a big difference in blood sugar. Most women in about the first week to let's call it five to six weeks will experience a rise in their insulin need because of those hormones and the impact that they have. So you know, if you haven't been trying and you know that you've been trying As soon as you know you're done try get on the these are my diabetes pregnancy targets that I'm aiming for if you haven't been doing it, you know so tightly prior to trying then definitely do it as soon as you're done try

you could be pregnant.

Scott Benner 25:18
Alright, let's take a detour for a second and and and let Jenny rant for a minute. Yeah. Why? It's might be something I know about her that she's never said here but why are there different ideas of health for pregnant people with type one diabetes and non pregnant people with type one diabetes if it's great for the baby isn't it great for all of us, huh?

Jennifer Smith, CDE 25:41
There you go. Yes, it opens up a whole can of worms, Pandora's box, so to speak,

Scott Benner 25:47
we have an hour. Let's start with Dexcom, shall we? How would you like to always know your number? With just a quick glance at your smart device, I'm talking about Apple, or I'm what's called Android, I'm talking about Apple or Android, you can see trend lines that show you where your glucose levels are headed, and how fast they're getting there. So you can take action. Before something goes, you know, in a way you don't want. You're going to be able to set customizable alerts and alarms. So you can decide what your optimal ranges were alarm for Arden's blood sugar at 70 and 120. Allowing us to stop highs and lows before they happen. You're going to be able to share glucose data from the user to up to 10 followers. That could be a mother, a father, a grandmother, a teacher, a school nurse, or just a well meaning friend 10 people of your choosing can see your blood sugar can be alerted if you're super low. Wouldn't it be nice to have a backup or to be able to make decisions about insulin for your child through text messages? Right. That's how we do it with Arden. You've heard me a million times help Arden with her lunch at school because it's like I'm there all the information that I would have if I was with her I have when I'm not with her and that makes decisions easier. dexcom.com forward slash juice box Get started today with the Dexcom g six continuous glucose monitor. This morning I helped one of Arden's friends with a serial bolus did it remotely. So I could see Arden's friend's blood sugar on her dexcom. And I knew she had an omni pod tubeless insulin pump, and we just set up an extended bolus to help tackle this cereal. So using the Dexcom data, we decided when to Pre-Bolus and using the Omni pod, we set up an extended Bolus, think we put in 70% of our insulin up front and allow the other 30% to go in over the next 30 minutes. That's just one thing you can do with an omni pod, set up an extended Bolus, you can also do Temp Basal increases and decreases. You know most insulin pumps are going to do that. But here's what on the pod does that the rest of them can't do on the pod can get you your insulin without tubing. It's tubeless. And that means that you can wear it wherever you want, right? You can show it off on your arm or hide it on your abdomen. It's up to you. Do you want people to see your insulin pump? Or don't you? Are you playing a sport for lifting weights? Or going for a run? Where would it be easiest for you? It'd be in a wedding next week. Put it where it won't be in the way. Do you see the versatility that the army pod gives you? You know, maybe I'm not doing such a good job of explaining it, you should try it for yourself. Go to my Omni pod.com forward slash juice box to get a free no obligation demo of the pod sent directly to you. You can actually wear a non functioning pod to see if what I'm saying is true. And once you decide that you'd like to go with Omni pod, you'd like to set up an extended bolus on an insulin pump that no one can see. It doesn't have tubing that you can go swimming with or running with or play soccer with or take a shower with just calling the pot back and tell them you want to keep going. But there's no obligation. There's no cost to try the demo. It's worth a shot. Miami pod.com forward slash juice box dexcom.com forward slash juice box links in your show notes at Juicebox podcast.com. Upgrade your stuff.

Jennifer Smith, CDE 29:51
It's a great question and it's one that's always kind of been like in the back of my mind even before my husband and I were like yes, it's like We definitely want to have a child within the next year, right. But I had already prior to that readiness, I had already been focusing on much tighter targets than my endo ever told me to aim for. knowing what I know the research that I've done information about long term outcomes of blood sugar management and control, right. And it was several years ago, actually, that I worked with a woman through her pregnancy and postpartum, she said to me, so my doctor wants me to loosen up my targets. And she's like, now that I've gone through pregnancy, managing the way that I did, and knowing what people without diabetes, what their body manages for them. Yeah, she's like, why would I go back? To loosen targets? Right? Why would I do that? And so it was, I mean, it really like brought it to the front of my head from like, a subconscious level of that's what I always aim for. So I guess I didn't really think about it. But that's right. It's it's a great question. Why are we not overall, consistently aiming? Whether you're a man or a woman? Why are we not consistently aiming for blood sugars that are in the non diabetic range? Why Why is that the case? Now, outside of this? There are some good reasons things like older adults, hypoglycemia unawareness, there are some medical types of conditions or certain scenarios, let's call it that could need a broader range and or a higher range for safety kinds of reasons. But the general population, it's a good thing to bring up because that's, it's true. Why are we aiming for less than 180? after meals, really, it should be lower, and I

Scott Benner 31:54
brought it up, because in my sort of peripheral understanding of this, this whole time that I've been in the diabetes space, I've always thought of it as people with people with I was gonna say, people with pregnancy, people who are getting pregnant, are somehow asked to do some superhuman thing with their health. That's not even necessary. And it took me a while to realize that's not what we're really saying. What we're saying is that every Listen, there's a lot of people have type one diabetes, and we all have different access to different technology insulins, all these different things. And so there's a, there's a blanket statement out there, like, if you're a one sees, you know, under this number, you're probably have a really great chance of being okay. As it gets lower your chances of problems get differently, you know, maybe they lessen, but then once in a while someone will put out a report, this is all there's no benefit in having a one c under this number for some reason, right. And I every and we've talked about on here before and I see that I think I don't, I don't believe that that's true. And I think that that's gonna be one of the things that 10 years from now someone's gonna say, oh, there was a report 10 years ago that said this was wrong. Yeah. But, uh, whoops. You know, and I also think that it's a, it's an emotional idea. Like, if someone has a seven, you don't want to make them feel like a failure, because they're not five and a half. Right? Right. Because they're not, but it doesn't mean that they should stop trying for the right not make themselves crazy, or, you know, like anything but right. But better goals. It's, I don't know, right? It just, you know, it's like, if I went out and ran a 300 yard dash today, I think I'd finish it. And I don't know, probably an hour and a half. And so right. Now, that might be my personal best. But I saw in the Olympics, it can be done, you know, in about seconds, about 15 seconds. And so I can't just sit here and say, Oh, I did the best ever, because that's my best because it's not and it's your health or your child's health. And you can't just I I mean, I think that one of the underlying concepts of this podcast is that you can't just say, oh, oh, it's fine. It's good.

Jennifer Smith, CDE 34:06
Or it's good enough.

Scott Benner 34:08
300 after pizza usually go to 400. That was a huge win.

Jennifer Smith, CDE 34:11
That was that right? And maybe that was a win. Maybe that was a win, you know, but if it's, yeah, it's totally better. Again, try again, try but try again. Yeah. And that's it. So yeah, that's a very good point to bring, I think target targets in pregnancy are in a way they are tighter because we do have certain parameters such as in the post meal time period. The targets are at one hour post meal, the goal is less than 140. At two hours post meal, it's less than 120. Yep. And really, if meals aren't in the picture, you should be averaging somewhere around you know, like the 65 to like 100 ish range. That's, that's, that's what you should be aiming for. Now, the person who's not pregnant if they're sitting at you know, 121 Great, they might feel really good at 121. in pregnancy, that's the high end of really where we would want to hover long term. So there are some parameter differences. And I think it has to do also with everything that the mother is doing to her body does have impact on the developing baby then

Scott Benner 35:21
right? Thank you. So line by that is 221 blood sugar. If if you're a person, like we've been able to see my wife's blood sugar in the past, my wife's blood sugar sits at like, 75 most of the time, right? Yeah. And so if, if, if that's what your normal is, and you're 121, I'm going to tell you some quick math tells me that's 46 points higher than what your body would have done without diabetes, which is a significant difference significant. It's a significant concentration of glucose in your blood, messing with the development of that baby. That's what I'm, or if you're not pregnant, messing with your life, you know, so

Jennifer Smith, CDE 36:02
as far as like messing with the baby, I think another piece to bring in is once the baby, I always find this concept really interesting that a pregnant woman who has diabetes, Type One Diabetes specifically has a pancreas that's doing pretty much nothing, right? The betas are either almost completely dead, or they're all gone. Right? what they have and are growing, this little person has a working pancreas inside of its body. Yeah, right. I mean, that's, it's amazing just to think of like a developing baby to begin with, but then to think of all the little parts and pieces that are growing and working the way that they're supposed to, in that like little being. And it's amazing to me, so when you consider blood sugar in pregnancy as well, your baby has a functioning pancreas very early on, right. And it starts to make insulin in response to what your body is telling its blood sugar. Right, so the flux of your blood sugar tells then how it kind of it goes along with how much glucose or how much food gets funneled in to the baby, the higher your glucose levels are, the higher the baby's glucose levels will get now, baby's glucose levels again, they're being controlled well within a normal non diabetic target, because that's what its body is doing. But the more the pancreas has to work to combat your high glucose levels, the more like swapped in glucose, the baby is going to be continually. And that's why like later on post delivery, if the baby's body has been so used to pumping out excess insulin all the time, as soon as the baby is born, and you've heard about babies have been born with really low blood sugar. Yeah, as soon as that umbilical cord is cut the mother's food source to the baby, it is gone. Right? And if the baby has come into delivery, with a pancreas that's spitting out excess insulin because the mother's glucose levels were so high, its blood sugars are going to plummet.

Scott Benner 38:17
Interesting. So that makes sense, obviously, but that's Yeah,

Jennifer Smith, CDE 38:21
interesting.

So that's another piece of like, we talked about the tight control in pregnancy. Tight is it's, it's there for a different reason, really. And so the ranges and how long glucose should stay at that elevated like 140 Mark, and then be back down, really into the normal range. There. There's reason for that.

Scott Benner 38:43
Yeah. It's funny, we all talk about it. So academically, like you know, 140 in the first hour 120 in the second hour back down and stable until I work glucose monitor and watch my body do it. It really didn't mean as much to me as it did say it right, because my understood my entire understanding of insulin is through Arden's perspective. Like I've never thought about it before about about somebody else's ever once. And there's no lie, your blood sugar just sits in the 80s, you know, and that pops up a little it comes back down, it comes back down and levels out and maybe you see a protein rise or something from fat later, it comes back up a little bit, but boom, right back down again. I ate my face off and couldn't get my blood sugar to go above 145 one, you know,

Jennifer Smith, CDE 39:35
that cage or something?

Scott Benner 39:37
Totally took in as much food as I could and I couldn't get over 135. So, you know, so, but how do we? You know, it's interesting, right? Because this podcast works because we talk to people honestly about stuff like this, but most people's perception of how to talk to people, so don't make anyone feel bad. And I don't want anyone to feel bad like Don't want someone to hear this and think I can't do that. Because I think you can. I think that I think that it's very possible that Jenny and I could have cottoned on and said, this is a diabetes protip episode about pregnancy, go back and listen to the other protests, and then have sex. Yeah.

Jennifer Smith, CDE 40:17
Right. We'll see

Scott Benner 40:18
you next time. It may be could have been that, really. And so if you're in the scenario right now, where you're listening to this, and you're like, Oh, I can't do this, or I have a different kind of diabetes, you probably don't, you know, like, you know, a blood sugar that sits stable at 7075 80. That's basal insulin, that's just getting your base. All right. And so it's real doable. So if you've made it this far, you must really want to have a baby. And, and it really is doable. I really do say go back to Episode 210, find the beginning of the pro tips, or go to diabetes, pro tip comm where they're all listed, and listen through them, I think you could change your management. Now. Here's the thing you've been pregnant, like you said a number of times with type one, is it more difficult? And by difficult, I mean, intensive with your focus and paying attention to your diabetes while you're pregnant, while you're not pregnant? And what's different about it, like what are people going to find once they're pregnant? So I've got my three months where I'm doing great, but now all of a sudden, there's a baby in there, what changes?

Jennifer Smith, CDE 41:26
It's more intense, I think, because of the impact of the hormones once you are pregnant, right? So you knew what you were doing? You knew, let's say you had your list of 30 awesome foods that you had figured out or 30 awesome meals, and you knew what to do for them and how to Bolus and you could knock out your 10 mile run, you know, twice a week and whatever, you figured it out hormones in the picture, change

Scott Benner 41:49
that. Okay.

Jennifer Smith, CDE 41:50
And so and that sounds kind of scary, but it's it's kind of a roll with it sort of thing, right? You and if you've learned things, again, from the pro tips, you've learned that don't let it just sit there fix it, right? Don't wait six days to see is this really a trend? If you've got a high blood sugar in pregnancy, Okay, one, it might be hormones, great. Okay, but then let's get it down. In many of the ways you've already tested, that you know how to get your blood sugar down, use those tools, you may need to use the tools, you know, in a more hyped up way, right, let's say you always knew that an angled arrow or a straight arrow up required an extra half a unit of insulin. With pregnancy hormones in the mix, maybe it requires a whole entire unit to offset that. Because those pregnancy hormones cause some insulin resistance. And in early pregnancy, it's a very quick, noticeable rise in insulin need. The end of the first trimester typically things dip off a little bit, they plateau as there's a transition from where the pregnancy hormones are made transitions from ovaries into your placenta, there's a little bit of a transition there. So you might run some lower blood sugars in late first trimester, before second trimester starts. And this is where I kind of call it like, if you've ever been at a theme park, and you get on the roller coaster, and you're right at the bottom, and it just starts to get you going up and you're up and you're up. And you keep climbing and you keep climbing. That's from second trimester or about like 18 ish plus weeks, that slow steady climb and insulin resistance, thus requiring more and more and more insulin over time. I mean, the heaviest resistance is definitely the third trimester, typically somewhere between about 30 to 32 weeks until about 36 weeks is the heaviest resistance. So you accommodate by making adjustments. And again, this is where that team that you set up to begin with should be a huge advantage to you. Because during pregnancy, Pregnancy brain or mommy brain is not a myth. Yeah, it is something that is there. You might get lost in in data. And so having a team that's really really good and willing and able to help you frequently through pregnancy with adjustments, despite you making your own, you may need a second set or a third set of eyes looking at things and being able to say that was great, but I think we could bump this a little bit more we could change it a little bit more here. Oh, this looks like it's happening now.

So I guess that's

Scott Benner 44:39
well, I was just as you were speaking, there's this conundrum around more insulin like you know, my body needs more all of a sudden give it more and we call it insulin resistance. And I'm always resistant to call it insulin resistance. I'm always thinking of it as just more need, but how do you convey that to a person Right, how does a person who believes that their bazel is one unit an hour? How can they make the leap to now believe it's two units an hour or that a meal that was three units is six units all of a sudden, like, That's such a huge leap in your head? And I wonder if it wouldn't help people just to think of insulin resistance as magical carbs that just appeared inside of your body, right? Like so. Like, instead of insulin resistance, pushing your fasting blood sugar from 85 to 150, think of, well, how many carbs would have moved me that far? Right? And how much insulin would I have used for those carbs? So that's in there, there's a math equation of how much insulin Do I need. But what I realized most about the podcast is that people need a way to think about it, right? They need a way that it makes sense to them. Because otherwise, they want an equation that's going to tell them when I'm pregnant, I need this percentage more, or the food's gonna need this much more. And I don't know that anyone's gonna give you that answer. The way you want it, so

Jennifer Smith, CDE 46:02
and so it's, I think it is it's more but I think if you know, when you're talking about like the math, as you said, If you know that your typical fasting now in pregnancy has been like 7881. And now all of a sudden, you're waking up 103109 110

that kind of range?

How much of an insulin adjustment is needed? In that overnight bazel? Then and where did it go up and and what to adjust. Because again, if you've done your homework ahead of pregnancy, you have an idea of where things started. And as you see those slight changes, you're more attuned to them in pregnancy, you just you see things on a super highlighted level, let's call it um, you know, you're paying more and more and more attention, you asked, you know, what's the difference between paying attention outside of pregnancy versus in pregnancy? I think just the pregnancy itself, drives a woman to think I'm now caring for another little being that's growing, and I have, I have the ability to let this baby develop really healthy from the get go. And I am a big part of that. Right? So you become really kind of like hyper focused on evaluating what's happening to your blood sugar. I mean, I looked at my I looked at my Dexcom more while I was pregnant, I was constantly like clicking to see, you know, what was going on? Where was it going? What was happening? Because one I wanted to be able to see, Is this normal or up? have I gotten a new load of like pregnancy impact? And do I need to make a shift now? Oh, look, this is like, day two, that I've now had to correct my blood sugar with a little more after lunchtime. I need to obviously add more insulin to my Bolus, I need to change my ratio. Did you have

Scott Benner 47:59
anxiety around that? Samantha mentioned in the episode that she sometimes felt like she was hurting the baby when her blood sugar would get high? Yeah, it was hard to deal with sometimes.

Jennifer Smith, CDE 48:09
And then I think that's a, I would say 95% of the women that I work with their pregnancy that's at at least once it's mentioned, well, my goodness, my blood sugar, you know, over the weekend, we we had like a baby shower, and I had like a bite of a cupcake and my blood sugar was 201. You know,

I got a doubt really, you know, right away.

Unknown Speaker 48:29
They're like, okay,

Jennifer Smith, CDE 48:29
that's that's okay. And they're, you know, they're very, I think the worry really is one they need to voice it. Because if it was concerning, yeah, too. It's the fact of worrying about that baby. Did that really high blood sugar for one hour? Cause my baby to now have three eyeballs or to now weigh at 12 pounds? No, it's it's more understanding that the consistent lengthy, high blood sugars, that's problematic. These one off, I mean, was my blood sugar sitting at 83, the entire pregnancy dislike flat, beautiful, I actually go back to my Dexcom records from that time because I printed them out. But I have them in like my pregnancy file.

Scott Benner 49:12
Just let everybody take a second to say to themselves personally, whether they're doing chores, the house working out or your grocery shopping to go. I knew Jenny had her Dexcom

Jennifer Smith, CDE 49:24
they're good. They're reference for me, as I work with people, and I was really glad having done that my first pregnancy, because we knew that we wanted more kids. Yeah. And I wanted to have a reference to be able to say, this is where things shifted. So once you get through a first pregnancy and you get an idea, yeah, I needed more around 20 weeks, I needed more again, in Basal and in Bolus and I needed to lengthen my Pre-Bolus that's another big one that shifts through pregnancy. You might you know, pre pregnancy you might do 1520 minutes. kind of works. Things are stable, that works really great once you're pregnant. As you get more pregnant, the time of Pre-Bolus gets longer and longer and longer. So by about mid pregnancy, you should be at about a 30 minute Pre-Bolus for most meals,

Scott Benner 50:22
how much of what's happening to a pregnant person is in in regards to their insulin use is that they're pregnant, that they're cooking a little person inside of them, they've got a bunch of hormones going on. And by the way, all of you have to be so impressed that I talk about this stuff so much. And I've never told that joke from the 80s. How do you make a hormone? I keep it inside every time I hear it, just so you know. And and so how much of this has to do with that? And how much does it have to do with gaining weight, too? Is that a part of it? So like, side of the diabetes piece, or a side of the pregnancy pace, you are gaining weight as well,

Jennifer Smith, CDE 50:58
right? you're gaining weight, and you should you should be gaining weight. And that is a very big piece of it. Yes.

And you know, healthy weight gain. If you've if you're at a really good target, happy healthy weight prior to pregnancy, you could gain somewhere between 20 to 3025 to 35 ish pounds in pregnancy, that would be considered normal. You have to expect, I guess you have to understand where does that wait to come from? Because in both of my pregnancies, my first pregnancy, I think I gained, I think it was 26 pounds. My second pregnancy, I gained 21 pounds. And you have to expect that let's say you have an eight pound baby, that's like a third to maybe half of your weekly depending, you know, that's a big chunk of that already now, like put on the floor plopped out after you delivered, right, hopefully not the floor, but right, it's like not on you anymore, right. And then you have to expect breast tissue development for lactation, you have a placenta, you have all the amniotic fluid, your fluid levels in your body double through pregnancy. That's why a lot of women experience swelling and whatnot in their legs. By the end of the day, at in late stages of pregnancy, your blood volume increases to pump all of that extra blood through you and the developing tissue and the baby. So you've got a lot of gain, that disappears, literally once you deliver the baby. So really, women end up you hear people complaining on his last five pounds, I can't seem to get rid of it after pray. That's really it is that game? Yeah, most women gain somewhere between about three to seven pounds of fat gain through pregnancy. And it's normal, your body should be doing that. Because if you plan to nurse or breastfeed your child, your body needs a reserve. So it's packing things away. So you can make plenty milk to supply this like

never ever,

ever empty baby.

Scott Benner 53:03
It was about to show off and say that that was for breastfeeding, but then you beat me to it. I was like, oh, something finally that you did.

Unknown Speaker 53:09
Yeah, but

Scott Benner 53:10
I can't prove it now. So it doesn't matter.

Jennifer Smith, CDE 53:12
And typically, as long as you nurse, you're usually most women are gonna retain about that three to five pounds. Once nursing is done, depending on how long you plan to nurse, usually, as long as you return to your normal activity, and you haven't been eating bonbons crazy, just because you want to typically that weight does come off once you're through nursing.

Scott Benner 53:36
Alright, so we've gotten through the pregnancy things have gone well, the day the delivery comes, please talk to your doctors well ahead of hand and understand that just speaking to your doctors doesn't mean that the nurse at the hospital is going to know that you're taking care of your blood sugar during your during your delivery, right. And it's going to if you've been doing such a good job this far be really weird to hand it off to somebody, you know, in the last 50 yards, and you're like I can see the end. Now you take care of my blood sugar. So you know, if you have a spouse or a family member, that you can, you know, teach how to help you or

Jennifer Smith, CDE 54:17
be there with you right in

Scott Benner 54:18
case something gets funky and they end up putting you out or something like that. I guess obviously, if they go to a C section, you're going to get handled like a surgery case then too, but if you're just having a regular vaginal birth, you should be able to manage your blood sugar through that time pretty

Jennifer Smith, CDE 54:32
well. And potentially even a C section you know, really? Yeah, really and hospital hospital. I think this is where protocol. Like you said initially, it's really important to have this talk with your team much sooner than delivery could possibly happen. I mean, they're always certain instances delivery at like 28 weeks or 30 weeks or whatever those are really, it's not often and that's a very specific scenario of management. Right. But for the most part with women that I work with your pregnancy, we establish and detail a labor and delivery plan. Okay, and it goes through. These are the expectations of glucose management, this is where you should target through dip through laboring and delivery. This is how much insulin adjustment you could expect to need to make. And again, every woman responds to laboring and delivery a little bit differently, some women's needs with the active nature of laboring, some women's needs go down by 50%, great use attempt, these will decrease, right? Some women's needs go up a little bit with the stress of all of the contractions and everything great. So you might need a little nudge kind of boluses of insulin in order to get a little bit, right. A little bit extra, whenever you're correcting in delivery, our recommendation is typically take about 50% of what your pump is recommending to correct a blood sugar while you're laboring, because, again, you're you're active. I mean, it's not like you're out running a marathon. But a pregnancy can take longer, or a delivery can take a lot longer than marathon takes a person, right? So you can expect that that correction that you're giving now is going to get active pretty quick, and it's going to have a faster impact on your blood sugar. Okay. So those are some of the things that we highlight. We also have a pattern established in the care plan, so that the doctors know where your rates are, what your sensitivity is going into the laboring and delivery. And then there's also a post partum part of the delivery plan that notes. Now insulin needs are decreased considerably. This is what your postpartum pattern should look like. A lot of the women I work with take it into their ob team, they get it signed off, it becomes part of their medical record. So then once they go into the hospital, that's the plan of care. The nurses know the targets. They don't have to continue to explain it over and over and over and over to all of the nurses as they're rotating through their eight to 12 hour shifts.

Scott Benner 57:13
Yeah, yeah, that's Samantha brought that up, too, that the first nursing staff was great after the pregnancy and then when they switched over, the next group didn't know what the first group knew. And then now you're explaining about your blood sugar's and that all gets and you've just had a baby said she was wasted from having the baby. Yes, the whole thing. Okay, so I have a couple more questions. And I know we're running out of time a little bit. Oh, we're good. Okay. Make the baby baby comes out. Everybody comes to the hospital, like oh my god, the baby made a baby. It's great. You see your friends of yours. You're like, Oh my god, they shouldn't even be near kids. Somehow you let them hold your baby. If you're younger, trust me that will happen when you're 25 or 30 year old friends is going to be holding me like that's probably a mistake letting Jimmy near the baby. And you know, so that all happens. Your home now. Now, you've got to take care of a baby. Yeah, I see a lot of people say well, it's hard to take care of the baby and my blood sugar the way I was taking care of it before. But it did you find I'm using you as an example here because you're very good at handling your blood sugar. Did you have trouble after you had a baby keeping carry yourself?

Jennifer Smith, CDE 58:21
I think you know, this is where again, planning your care team kind of thing comes into play. And while your mom your aunt, your best friend, you know your uncle's brother, who isn't really your uncle, but as a good friend that you call a friend or whatever it is. whoever's going to be there anyone post delivery that you trust, not Jimmy, who

Scott Benner 58:46
might get the baby to know

Jennifer Smith, CDE 58:49
he can't get the baby to but

somebody you're going to trust to be there once you come home from the hospital. Yeah, that is a really, it's good to plan something for at least a week, maybe even two weeks for someone to really be there to help with things because one delivery in and of itself is it's a labor. Yeah, that's why they call it labor. Right? It's it's work you'll you may with a vaginal delivery, as long as you're feeling okay. You may not be in the hospital for very long. If you have a C section delivery, C sections typically are about a three to three to four nights stay at it depends on healing and how things are going and all of that kind of stuff, right? But definitely when you get home. It is it's harder because you're now not taking care of just you and diabetes. Now, it's like you've got a second child, even though if this is your first real child. I always considered diabetes, kind of like a toddler that never really grows up. Like constantly sort of like caring for it right? And so it's almost like This first child diabetes gets pushed off in the corner and you're like, yeah, you're just gonna have to sit there for a bit, because mommy's gonna take care of

Scott Benner 1:00:06
you fine, he can do fine. You're gonna be fine.

Jennifer Smith, CDE 1:00:08
That's right, right. So you know, some things to kind of, along with that care person, they're beyond your spouse or your significant other, you know, whatever. Somebody else that can be there. So you can focus a little bit, because in that time period, especially the first month, things will change considerably with insulin sensitivity, especially if you're nursing. There are a lot of changes that will take place and blood sugars are going to look a little bit more roller coaster than you probably want. How important are blood sugars to the breastfeeding process? Does that impact the milk at all? So there's a lot of like thought around it a lot of research, that's sort of like a 5051 of the big things is, high blood sugars can actually impair good lactation. So if you leave your blood sugar's sitting high one, as we've talked previous episodes about, like hydration, your blood sugars are sitting high, you are not well hydrated, you are in a and milk is liquid, not not only a more coming out as your nursing, blood sugars are high, and you're not drinking enough. Oh, I see. So right. So hydration is really, really an important part of not only the blood sugar, but also continuing to be able to supply enough liquid that's going to get sucked out of your body. Yes.

Scott Benner 1:01:32
Mine too. If you've never had a baby before, they don't sleep the way real people sleep. So there's a tired factor that is really hard to put into words. It's not easy. Yeah. Yeah. So there's a lot going on. I mean, listen, we've gotten this far, I should probably tell you having kids is a huge mistake. You should? No, no, I don't mean that. Having them is great. It's getting them and taking care of them and keeping them alive and being you know, good to them and teaching them things. All that is a harsh show. But the kid itself is lovely. Like we just walk through the room, you're like, Oh, look, the kid. That's nice. Oh, yeah, in that moment, you don't think about when they're yelling at you when they're eight, or that you paid a guy who was probably homeless to be spider man and a third birthday party or something like that, like, those are the things you know, they want you to have a dog, and then your dog cuz you're like, oh, the kid should grow up with a dog. And then at 630 in the morning, everyone's asleep, but you and you're outside with a damn dog. You know, like, you know, I'm saying kids are great. A lot of what goes with it is hard.

Jennifer Smith, CDE 1:02:39
And it's hard. And especially right after your baby is heartbeat, especially if again, it's your first pregnancy. Yeah, it's it's a harder time. And this is again, where help comes in the form of also, like, pre planning. For the post delivery, the time period, you know, we I had done a number of like soups, and things that I could put in the freezer, that were easy to pull out, I knew the content of them, because I knew what was in them, I either made them or my mom made them. And I froze them if needed a heck of a lot easier. Also, having some of those foods that are definite known foods and how you react to them. Yeah, can be a huge help in the aftermath. So it's just not it's not more struggle, as you're already managing. Nursing a child putting a child to sleep, learning how to not like have pooped all over the place as you change them. You could

Scott Benner 1:03:37
experience postpartum depression, which is incredibly common. There's a lot that could happen. And by the way, a lot of guys will eventually turn into good fathers, but it doesn't, they don't have a nature provided switch, like I'm telling you, you're gonna have a baby and be like, this is the most important thing in the world. I watched what happened to my wife, she almost didn't even care that I was alive. When the baby came out. She was like, the baby's here. And that guy, you know, like, it was you if you're, you know, lucky, you're gonna get a great connection, and you're gonna feel that desire to take very good care. It takes guys longer to figure out how to be fathers than it takes women to figure out how to be mothers, generally speaking, even if you've got a guy, even if you're listening to right now you're like, no, my guys a good guy. Listen, I'm a good guy. It took me like two years to figure out how to be a good dad. Right? Like, you have to watch it and go, Okay, this is what I think they want. But this is what they actually need. There's a difference in there. I still struggle with To this day, I'll probably be struggling with it on my deathbed. I'll be 80 years old, just drifting off, and I'll hear someone in my family go, huh, he did that wrong, you know, like so. There's, there's that too. There's a lot that's going to happen to you when you have a baby and you're going to have diabetes too. And it is It would be very much my hope that you don't take all this wonderful stuff that you've learned pre planning for your pregnancy, through your pregnancy through your delivery, and just do that human thing of going that baby's more important than I am. And so I'll let my stuff wait.

Jennifer Smith, CDE 1:05:17
You know, I think a friend of mine who also has type one, she had a son prior to our first son. And she gave me some really good advice, and said, you know, what? If inter we're talking about like, low blood sugars around nursing, right, and she was like, you know, what, if my blood sugar is low, and the baby is screaming, that the baby is safe, not sitting like on the edge of the counter waiting to fall off, right? But like, fine, I am important to take care of myself, it's important that I take care of myself. I'm important too. I have to manage my low blood sugar. Maybe I have to manage my high blood sugar and the baby screaming, it's okay. Yeah, maybe it's gonna be okay. Screaming really. I mean, you're not going to let him scream for like three hours. But yes, in the case of 510 minutes, while you are taking care of you treating a low blood sugar, or even just bolusing for your meal before you actually sit down to eat it. That's another piece that I we talk a lot about Pre-Bolus thing in the typing in this podcast. And that's a piece that often goes out the window, because depending on what your schedule is, like, what your significant other schedule is, like, you may at times be home alone in your maternity leave with the baby.

Scott Benner 1:06:41
Yeah, I there's part of me that believes that we should be making a sign and selling it through the podcast that just says that's a real homie. You know how to like you see those beautiful signs and people's kitchens. It's like the cook is blah, blah, blah. So there should just be one that says Pre-Bolus, hung in people's homes so that it gets drilled into your head over and over again, because this is the easiest thing to mess up. Like, forget, you know, I did it this morning, this morning, we got back from the blood draw and Arden's like, I'm gonna have eggs and turkey bacon and toast. And I was like, does that mean I'm making it for you? And she's like, yeah, so I'm thinking, Well, I have an hour till Jenny and I record. And I can get this done by then. And I started focusing on getting it finished. And then I turned her and handed her a plate and thought I didn't give her any insulin

Jennifer Smith, CDE 1:07:25
damage. And of course, she didn't think of it either. Nobody thought of it.

Scott Benner 1:07:28
No, we'd gotten up super early to go to this blood draw place. And you know, like all this stuff. So I said to her, we're going to Bolus now and please eat the toast last that was like the best I could come up with, you know, in the moment, and we ended up having to use an extra unit to overcome the

Jennifer Smith, CDE 1:07:44
offset. Yeah.

Scott Benner 1:07:45
So okay, did we miss anything? Is there something in the back of your head burning?

Jennifer Smith, CDE 1:07:51
I'm trying to think of, maybe I guess the one last thing along with the postpartum time period is definitely stay connected to your care team. Um, you know, because that's, as you mentioned, already, there is potential for postpartum there's a difference between just being a little bit like, down in the aftermath of delivery. And true, like, you crawl in bed, and you're like, I don't, I don't want to do anything else. I, I will nurse the baby. But then the baby goes over here, it's almost like a, it's a disconnect that happens in true postpartum depression. Yeah. And so staying connected to your care team, is really, really important. Making sure you have those postpartum follow ups kind of scheduled before you even leave the hospital. It's really, really important. Maybe staying connected with your diabetes educator or your endocrine doctor, whoever was also a really good advantage through pregnancy, stay connected with them so that, you know, they can even nudge you may be to say, Hey, you know, can you just pop your your pump in and upload it and I can take a peek and I can make some recommendations for you.

Scott Benner 1:09:03
Let's hope you

Jennifer Smith, CDE 1:09:04
let somebody help you. Really? I think I'll go ahead

Scott Benner 1:09:09
if you think it can't happen to you. And my wife and I, we were just talking about this recently. She said for the first two weeks after our son was born, she had no feeling at all about having a baby. Like she just felt like we brought home a lamp. You know, like it really she's just like, I don't know, if I like this thing or not. Plug it in over there, leave it. We'll see how it goes. Hey, man, and she said that all of a sudden, one day, a couple of weeks in, I was at work. And she said she just was holding coal and just started crying. She's like the baby's The most important thing. Like it all hit her at once. It was almost like you expect it to happen when you need it. But it didn't happen to her right away. And then she had that like, Oh my god, I have a baby and I don't care. Like right we're not even not care but like there hasn't been this ramping up connection connection immediately. Right. Yeah. So and that's a rabbit hole. People could fall down especially if you've been depressed in the past or you know something like

Jennifer Smith, CDE 1:10:03
and especially with another condition to manage like diabetes. Yeah, there's there's more to manage than just connecting with this new little person. Yeah, so um, so stay connected

Scott Benner 1:10:14
to somebody that can walk you through it and if you're feeling that way have to tell somebody like don't hide it. Just tell somebody.

Jennifer Smith, CDE 1:10:21
Just tell

Scott Benner 1:10:22
right? Yeah, and I should say here as we finish up if anybody wanted to buy a book about pregnancy with Type One Diabetes, should they buy one called pregnancy with Type One Diabetes your month to month guide to blood sugar management available on Amazon and written by ginger Vieira and Jennifer Smith CDE should Oh, yeah. Okay.

Jennifer Smith, CDE 1:10:40
Yes, they should. Absolutely. I think the farthest I've heard that somebody purchased our book is Valley. Um, wait. Oh,

Bali. Bali? Yeah.

I'm in Bali.

Scott Benner 1:10:54
Yes. Bali the place in Vegas where I can lose my money in

Jennifer Smith, CDE 1:10:58
Bali. Bali. Yeah,

Scott Benner 1:11:00
there's someone in Bali right now has a little baby. A Bali baby. Yeah, yeah. She's pregnant. Oh, look at that. All right. Well, all I know is ginger has been on the show before you obviously know, Jenny, the books only 12 bucks. It definitely is worth your while.

Jennifer Smith, CDE 1:11:15
And it goes through everything kind of in a much more broad sense of what we've touched on kind of in each of the sections of print planning pregnancy, whatnot. It's, it's a good book. I'm glad that we did it.

Scott Benner 1:11:28
Well, I'm glad you're proud of the book. And I know it's, uh, I know that I can easily get behind you and ginger, ginger, who doesn't get to be on the show as much as I would like ginger on the show because she lives in a terrible part of the country with bad internet connections. So she's not allowed to come on. That's all because every time I interview it sounds like this. I can't do that. So you know, if ginger movie

Jennifer Smith, CDE 1:11:51
wants to listen to that,

Scott Benner 1:11:52
you'll know ginger moves. Because one day she'll be on the podcast more often. Because I have very fun conversations with her where I'm like, oh,

Jennifer Smith, CDE 1:11:59
Ginger is way fun.

Scott Benner 1:12:00
They're probably I'm like people would love to listen to this

Jennifer Smith, CDE 1:12:03
actually prompted me

to um, she her little girls like to scooter. Like the not electric ones. Yeah, the like, random razor or whatever. And so she I saw that she had posted something I liked their scooter so much that I just bought a cheap, like, used one myself. And I was like, I'm gonna buy myself a scooter. Like my boys loved a scooter. And so I bought myself one. It's green. It's super awesome. Yeah, many times I have to take it away from my seven year old because he's using my scooter. But it's

way fun, and it's better workout than I ever expected.

Scott Benner 1:12:36
We'll see. When you saw ginger with the scooter online. That's how you reacted. I just sent her a sarcastic text message suggesting that she stole it from a child.

Jennifer Smith, CDE 1:12:47
I think I saw that. Yes,

Scott Benner 1:12:49
I put it online. I was like, I know you stole that from someone. And then she's so funny. She came back. She's like he looked like he was done with it. And so anyway, Ginger moves somewhere with good internet connection, you can be on the podcast. Thank you very much, Jennifer, I will talk to you. I know you're in a rush. So I'll talk to you soon. All right. Huge thanks to Omni pod index comm for sponsoring this episode of the Juicebox Podcast. There are links to all of the sponsors right there in the show notes of your podcast app, or you can find them at Juicebox podcast.com. But if you'd like to get a free no obligation demo of the Omni pod sent directly to you my on the pod.com forward slash juice box. And to find out more about the Dexcom g six continuous glucose monitor dexcom.com forward slash juice box.

Jenny and gingers book, Pregnancy with Type One Diabetes, your month to month guide to blood sugar management is on sale at Amazon. It's a little under $12. And you should pick it up if you're thinking of having a baby or if you're having one right now. Jenny Smith works for integrated diabetes and she is for hire. Check her out at integrated diabetes.com

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