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Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.

I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about feet on the floor. But there are two others that go with it. The other one's called defining diabetes, smokey effect. And the third one defining diabetes dawn phenomenon.

Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm gonna have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One you go to Contour Next one.com forward slash juice box and of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that 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 monitoring systems. She is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She's my favorite person. feet on the floor is something that I didn't know people called a thing until I heard somebody say, Oh, that's that's feet on the floor. And I've always thought yeah, I didn't know that. I just found it. I figured it out. And then I attacked it, then I stopped thinking about it again. You know, so I've in in Arden's life, I've attacked feet on the floor a couple of different ways. So but first, like, I guess we'll, we'll define it. I think of it as if anyone's ever played on a football team. There's this thing you do right before the game, they get everybody together and whip them into a murderous frenzy, and then they send you out on the field. They're literally like saying just shy of go rip everyone's head off. Go do it now. And I feel like that's what your body does. When you stand up. It's like, we got to go, this is it. We're gonna go take a shower. We're gonna make lunch. I got to be on time I got to get to school, and it just Jacks you up so that you can accomplish those things. I know that's not technical. That's how I think of it. Is that about what's happening? Like, what is your body doing when you wake up? I'm assuming cortisol and

Jennifer Smith, CDE 4:14
Yeah, well, bunches of different hormones that are supposed to be there. And again, they're, I mean, if you think of them in terms of the flight or fight hormones, right. They're kind of the same thing. It's not like you're trying to run away from a saber toothed Tiger first thing in the morning, but at least not in today's world. But there are all the things as you just mentioned, in today's world, especially as an adult, there are a lot of things that are on your plate. As soon as you get out of bed in the morning. Yes, I have to get myself ready. If you have children or a spouse or anybody that you're a caretaker for that. You have to get ready. You might have breakfasts that you have to make things that you have to pack calls that you have to make, I mean the list just it goes on and on with the chores in the morning time and even kids Think well, why does it happen with my 12 year old child then? Well, kids have a lot of things that they're not really verbalizing. But their brains are thinking through, especially once they get out of bed. And in a life with diabetes, there are things that they're thinking about, again, they might not be talking about them right away. But, you know, what am I gonna have for breakfast this morning is mom and our mom and dad going to be really worried because my blood sugar is gonna go high. If I choose to eat pancakes today. I mean, there are lots and lots of things that are reasons for the rise. But the base reasons really are those like the cortisol kind of the get go, your body wants to ramp you up, and kind of move you give you energy.

Scott Benner 5:40
So what people call feet on the floor, I think of his bolusing for life. I don't know another way to put it really. So you know, if Arden were to wake up at a, an 85 blood sugar, and lay in bed for two hours looking at Tick Tock and Instagram, her blood sugar would not go up. It's got nothing to do with the timing. It's it's quite honestly, she gets out of bed. And then 1520 minutes later, her blood sugar can go from 85 to 120 and catch a diagonal up arrow and keep going if you don't stop it, right, so I always just have her wake up and bolus. And I don't know how much you know me. I don't know, let's throw some insulin in there. Get on the right side of this game, you know, unit today. One little eye care insulin, get it going. And, and that works terrifically. It really does. But I mean, honestly, this is gonna seem like a strange story to put in here, I guess. But when I was 16, for about three or four years, while I was 16. In my hometown, I volunteered as a fireman was a common thing for people to do. And I trained, you know, I got trained, I think we had to do like 100 hours of training, and then you know, you become a fireman. And when there was a fire at night, like in the middle of the night when you were sleeping. We used to have this old technology was so bad back then it was just this box that sat in your house. And they would send out this radio frequency and the box would pick it up, and then make this horrible, harsh, shrill scream that would wake you up, right? I want to say the company was realistic that made it I'm not gonna remember. But this thing I can't even like, I wouldn't even want to tell you that you'd have to cover your ears, it just would go. But so high pitched and loud. And you'd be standing up, I'd be standing on the floor in my underwear. unaware of how I stood up, it was so loud, right. And a few moments later, you're at the Firehouse, you're getting dressed, you're now in a truck, and you are flying down the road as wide awake in this alert as you have ever been in your entire life. I am crystal clear at that moment. Like that's when I should be taking my SAP. You know what I mean? And that has got to be this. Like just your body just going like holy Hannah. We got to go, you know, and this happening. And now I guess in a modern world. People talk all the time about like, Oh, I don't like to get upset because my cortisol levels go up and I get fluttery or nervous or, you know, anxiety hits me for some people. I think it's it like I think a feet on the floor is his life and you have to give yourself insulin for it because it doesn't go away once it's not like adrenaline. Right? adrenaline pushes you up. And then when the adrenaline's gone, your blood sugar drops back down again.

Jennifer Smith, CDE 8:39
Mm hmm. It's definitely different thing first thing in the morning. And I think that's it's a compounding factor when people are trying to figure out that morning breakfast, right? Because if you haven't realized that the rise is already starting, before you go ahead and even if your Pre-Bolus thing for breakfast, and you're thinking, well, gosh, I've waited 15 minutes. Let's try 20 minutes. Let's try 30 minutes. Let's try 45 minutes. And like finally you're at the hour point and your budget or you're still rising and you're like, Yeah, but I Bolus for my food. You're missing possibly a quarter a half maybe a whole unit and a half of insulin for this feed on the floor. impact. Yeah. And so that's it kind of like I said, it sort of covers up what might be going on behind a breakfast and the food kind of Bolus. Yeah. And so it's making you feel like well, gosh, I just I obviously need more insulin. So I'm going to dump more insulin in then and then you end up like you said, it sticks around for a long time if you don't get ahead of it and by getting ahead of it. I think most people that I talked to in teaching about it, it's you wake up, look at your CGM or do your finger stick and give your give your Bolus for that feet on the floor in me Utley. And sometimes it takes like I said before, a little bit of analysis, let's say, your feet on the floor doesn't really start, maybe it's an hour between waking up. And then it actually starts to rise with again, no food or anything else in the picture. But maybe you're the person who sees it within 20 minutes. That's me. I can wait at a blood sugar of 68. And I can have it start within 15 to 20 minutes,

Scott Benner 10:25
but you also don't strike me

Jennifer Smith, CDE 10:26
Oh, that I don't need to treat that low. Yeah, because

Scott Benner 10:30
it's gonna go up. You also strike me as a person who is active in your mind as well as your like your body. Like you're not you don't get up in the morning and think like, well hang around for a couple of hours. And then like you're moving right? Yeah,

Jennifer Smith, CDE 10:44
I don't have hang around. Yeah. And

Scott Benner 10:46
what's that? I said something that is literally say to you on an episode recently, and you're like, you have all kinds of free time. And I was like, I don't what do you Oh, when I said I fixed my carpet. When I got to pull it out. You're like, Where do you get time for that? I was like, Well, wait, lady, there's a big hole in my car. But I can't just leave it there. You know, Jenny couldn't even imagine. She's like, cut the carpet off. start over again. It's, it's done.

Jennifer Smith, CDE 11:09
Go Why just put like, you know, like, I don't know, I'll play it over it and be like, don't stop here. Mom will take care of it later. And then like three months later, I'd be like, my set plates. Do I

Scott Benner 11:20
really like that? But No, but seriously, like, you have that, like, you have that attitude. And I have to tell you, that I'm not good. I'm a busybody, I'm not good with free time either. As soon as I have too much free time, like I could make another podcast episode. Like I think that right away. I'm like, maybe we could move people along a little sooner I could be working is what I feel like. I this weekend, I talked my wife into relaxing, which she's terrible at. And so everyone's sort of outside, we have a little little patio out back. Everybody's sitting around. We drugged like a television outside. People are watching sports and just hanging around. And I realized the other day, I don't think I ever sat on that patio. And I was mad at myself when by the time it was over, you know, but I just couldn't. I kept thinking of things I had to do, which I know is bad. Don't write me. I know, it's bad. I know it's killing me. But um, but your feet on the floor is what I think of his life like bolusing for life. And really, when you stop and think about these three little episodes, which I'm gonna put up all at the same time, so people can find them all at the same time. You're thinking about, you don't realize you're thinking about what if? What if smokey happens, right? What if you What if you that happens? What if while that's happening, you start experiencing dawn phenomenon. And then you jump up and you're a more high strung person. And you've got this going and you're back here trying to Bolus for toasts with two years. Right, you're a lot already

Jennifer Smith, CDE 12:45
out of three things that you didn't realize could be impacting and the toast had nothing to do with the 290 blood sugar. Yeah.

Scott Benner 12:53
And it makes me think about how many people like to say, Oh, my, my blood sugar goes up every time I take a shower in the morning. But what if it's got nothing to do with the shower and everything to do with the feet on the floor? Correct. We've done it Jenny, this is that if people just listen these podcasts there, he wants to be in the fives. Some of them will make themselves crazy, but I mean, a lot of them will end up in the

Jennifer Smith, CDE 13:19
hopefully you don't need extra meds along the way.

Scott Benner 13:23
Just find yourself in the corner mumbling about oh gee and feet on the floor, and I gotta move my basal insulin so that it combats the dawn phenomenon. And then I'll just go to work and take these four kids.

Jennifer Smith, CDE 13:39
makes me kind of think of what's his name Gollum from Yeah,

Scott Benner 13:42
yeah, just shrink up and start talking to precious and rubbing your head. Yeah, yeah. So anyway, that's why honestly, is we kind of finished this one up. Without joking about it. That's why my theory is always just like, more get ahead. Don't let this stuff like make all of this stuff. Absolutely not even something you think about by being just being first by acting first. I am such a big fan of punching first with diabetes, so that you can at least say I did this and what happened next, I had some impact on instead of covering up defensively and waiting for all this stuff that happened to you and then trying to react on the go You just can't react the diabetes you have to be you know, you have to be first you have to be active I think

Jennifer Smith, CDE 14:31
and in some of that, too, like you said, you know, needing more is the idea of more is important knowing Okay, clearly I didn't do this well, so I just needed more. But I think also looking at, as I said before, you know a couple of trends in the morning time to be able to define Why do you need more? Is it just today or huh? Look at this. I see the trend of lows overnight and now then when I'm high in the morning, then I need more or Every morning I get out of bed at this time, and I've made a note of it. And no matter what I do, I don't even eat for three hours and my blood sugar's already going up before I eat well, clearly, this is the problem. So then it gives you more definition to maybe even quantity of the more, you know, how much more could I possibly need? You know, more three units versus more half unit to two different ideas.

Scott Benner 15:24
I don't know more, just more, did you get higher than more than that? Did it happen the next day, then more than that? What if it's too much, it hasn't been too much. So far, you know, if it gets to be too much, not for nothing, then do less. Every month, just I don't know another way to think about it. Because when I see people try to think about it logically, like like, I guess logically is the wrong word. But mathematically, maybe I see people making themselves crazy, because there are so many of these variables that you can't quantify. And even if you could, you can't quantify them in real time, while living a life, you know. So I just like putting a nice layer of insulin on everything and trying to keep the blood sugar down. And that way, if you don't get high, you don't get high. And that's it. I'd rather stop a lower falling blood sugar, and fight with a high one high. That's all it's so simple. All right. This is this was it feet on the floor, which, again, I would like to call bolusing for life, but then no one's gonna know what I'm talking about. If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com Thanks so much to the Omni pod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my Omni pod.com forward slash juice box. Learn more about the dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show. The pentameter of that reminds me of save the cheerleader save the world. From heroes, you remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them going to your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app, all episodes, scroll down, you'll see them you can go to Juicebox podcast.com. and scroll down a little bit. Right. And you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books you look up, Oh, hold on. Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right, it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginia and I explained that to you ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes but you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on. On and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes.

Two new ones that are out right now around this, like I mentioned the beginning, I think go together with this one. The other two are feet on the floor. And this Moji effect, the sum Mogi effect, I don't know how to say that word, but you'll see it. It'll be the only word that sounds like some Oh, gee, when you read it, looking for a great doctor, or other type of diabetes practitioner, check out check out Whoo, there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add. Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.