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Scott Benner 0:09
Hello, everyone and welcome to Episode 415 of the Juicebox Podcast. Today on defining diabetes Jenny Smith and I are going to define adrenaline highs. Today's episode is part of the defining diabetes series, which lives here inside of the Juicebox Podcast. It's where Jenny Smith and I take terms from your life with type one diabetes, and explain them in ways that we hope make them useful and understandable. Myself friend, Jenny Smith has had Type One Diabetes since she was a child, I think for over 31 years now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. And she is one of the few people who when I know I'm going to talk to her, I start smiling inside. Please remember, as you listen 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 are becoming bold with insulin. Now the music will build to a crescendo and we will begin.

Jennifer Smith, CDE 1:27
Did you notice my different room? By the way?

Scott Benner 1:29
I wasn't sure if you redecorated Are you move but you're definitely right.

Jennifer Smith, CDE 1:33
This is actually where our router is. So I'm in our This is our basement. And so it's where we have like all it's a finished basement. So we have like our TV and everything down here. But I came down here because when it's quiet down here, buddy, bothering me. And two is my connection point. So nice and stable. The microphone is really easy to move in my computer is obviously mobile too. It was

Scott Benner 1:59
just like, here I go. I have to admit the other day Kelly seemed very upset. And I think it was because I get to work upstairs in a closed room. And she's downstairs in the dining room and we have an open floor plan. So people are just like, Hey, Mom, what's up or the kids will like come in and lay on or you know, like something like that. Just like I'm just trying to get a vaccine out so people can go back to work. Take your time right on top of me. It's fine. Yeah, so I get the private place idea. I have to say, I'd like to talk about adrenaline highs. Ah, because so I've tell us so I've told the same story on the podcast forever. And I'll do it very quickly here. Arden, I don't know it was eight or nine years old playing in this like Sunday morning Basketball League. It's just very fun thing where the girls all got the same color t shirt, they'd show up at a gym and play. And we'd show up one day and come in the door. You know, her blood sugar's are perfect. And she'd play and nothing would happen. And then you'd come back the next week. And we'd come in or blood sugars were great. And she'd play and our blood sugar would jump up to like 250. And it sometimes would jump up and sometimes it wouldn't. And after a number of weeks, I just I remember saying to Kelly like we can't let this keep happening. And she's like, well, how are you going to do something about it if it happens sometimes and not other times. And that's when I did you know devise the the idea of will Bolus for a juice box. And if she goes up, then the insulin will work on the number and if she doesn't go up, we'll give her the juice back. Right. Yeah. which ended up being a way that I talk to people about how to use more insulin when they're not sure how to when they're like well, I don't understand, like, I think this meal needs more. But I don't know how to like have the nerve to just use more. And I end up saying well Bolus for a juice box on top of it. And then what most people find a lot of the times is that it turns out, I needed that insulin anyway and you're never drinking the juice. But if you have to you have to and then you kind of figure it out from there. But it took me a long time to recognize that Arden was competitive. And if she showed up one Sunday and saw five little girls across from her on the course that they thought they could easily beat her blood sugar didn't go up. And if she thought they were in for a fight, our blood sugar jumped up. And that's adrenaline. Now here's the downside of bolusing for adrenaline is the minute the adrenaline's gone. It's like somebody opened up a trapdoor on your blood sugar, and just let it all out at one time. So that that adrenaline to me in my mind is artificially holding up your blood sugar, you can combat it with insulin, but if the adrenaline should go away prior to the insulin, you're kind of in trouble. Is that how you find it?

Jennifer Smith, CDE 4:46
Kind of and or I guess the same example would really be let's say they get hyped up for a game in which your example being it's it's a team that you know is a really tough team, whatever. Well what ends up happening is your adrenaline goes up and let's say team, the other team is having a really bad day and your team is doing like, phenomenal. Well, that adrenaline level may very well then go down faster than if the game was this back to back kind of need for I mean, adrenaline really is the, it's the fight or flight hormone, right? gets you ready, it gives you the surge of like release of glucose into the system, because your body needs the energy to get moving. Right. So, I mean, if that all of a sudden is not so significant anymore, at the end, or at the end of the game, you won the game great, all is fine and good. And down goes the adrenaline and down comes the blood sugar, then you're left sort of feeding insulin that you gave earlier, so that you didn't have you know, a 250 blood sugar with the adrenaline surge. But you do end up having to cover it because it's not adrenaline isn't the same. It seems as a deficit of insulin from like lingering stress, or food that you didn't end up covering, or something that's going to stick around that you definitely needed that extra insulin for in fact that in that scenario, it may not even be moving the blood sugar down. So okay.

Scott Benner 6:15
Yeah, we would, what we would do is the way we timed it out was insulin, adrenaline, leave basketball game, run to food. And then it was a Sunday morning. So we would just run into a diner and she'd get a waffle. And it was kind of perfect, because we'd basically we'd basically Pre-Bolus the waffle with the adrenaline fight. And then, of course, on the back end, yeah, yeah. This is a very early on example, in our, you know, in our life with diabetes, and but it is how I learned about those things. And more recently, you hear people like, Oh, I was sitting around watching the election results, and my blood sugar's were really high. That's anxiety, stress and adrenaline, right? Yeah. Yeah. Okay. That's so adrenaline. I

Jennifer Smith, CDE 7:02
think, I think there might be some to ice, you know, working with a lot of like school aged kids. There's often this, I hear it over and over, my child is on the bus. As soon as they get to school, and they enter school, their blood sugar climbs, they could have been at this beautiful steady for an hour past breakfast already. And now they enter school. It's kind of like the foot on the floor. Yeah, kind of thing, right as they enter school, and up goes their blood sugar. But on the opposite end of that, you know, we end up like, maybe we pump in more insulin through that time period of the day, then or maybe we pump it in through lunchtime, because they're super just anxious or stressed about school, or they just get that much that much excitement out of going to school and performance whatnot. As soon as kids leave school, the same thing as what you saw with your daughter. It's like, I'm heading home. There's nothing else I have to do. I can lay on the couch and watch cartoons or whatever it's going to be you know, but down comes the blood sugar and you've got this load of possibly hours worth of popped up diesel rates. Yeah, or extra insulin being given now at a time period, whereby is like, yep, I don't need any more. Thanks. Thanks so much.

Scott Benner 8:10
Arden, it happens exactly like that, like school ends, she get out, she gets outside. Like if she comes out to my car with an 85 blood sugar. In my mind, I think she's got 10 minutes, she's got 10 minutes to get to a snack. Like that's it like, like, and I that is the way I think of it is that all the things that we did during the day to keep our blood sugar stable is a Pre-Bolus for what's about to happen. And you have to, you have to know it's coming. If it's if it happens to you or your kid, and I'm assuming it happens to adults too, leaving work like stressful jobs. Anything really social interactions. I mean, when we are allowed to interact socially, again, I think that it would be the same thing like you meet somebody you're nervous to meet. Or you know, you want to make a good impression. You know, there's so many different things. It's funny like so I googled it, adrenaline impacts blood sugar, and you don't get enough back from it. That's not very what I want to say. More like studies and stuff like that is there's no like there's no like real world people saying oh yeah, if your blood sugar goes up, it could be from adrenaline or vice versa. If it drops, maybe your adrenaline's going away, your stress has gone away. So I just wanted to go over it because I don't know that it's um, well enough understood. And I know we talked about it in the podcast, but never like, give it its moment. So adrenaline is a

Unknown Speaker 9:38
Is it a?

Unknown Speaker 9:39
It's a hormone ephrin

Scott Benner 9:41
it's definitely okay. And so, similarly, and we won't get into it here but around menstruation, it's progesterone that causes the one of the problems right

Jennifer Smith, CDE 9:51
one of Yeah, one of the main hormones. I mean, there are others but yeah, progesterone is one of the big ones in that tree. Pre cycles start time period. Yes. I mean, there's always there's also a whole bunch of other, you know, hormones in the female body things like estrogen and luteinizing hormone and all these other kind of components that happen throughout the cycle. But progesterone is the big one. And that's the really big one, too, that in the early phases of pregnancy, and as pregnancy progresses, that's a major impact on sensitivity to insulin and increase in insulin resistance.

Scott Benner 10:32
Yeah. Okay. Because there's somebody contacted me actually should find their note, but I will do it in a different episode. But she said, like, I narrowed it down to the spot in my cycle, where the progression comes in, like is where I get this, this big impact. And I'm like, that's super interesting. I wonder if using a birth control pill, does that lessen the impact?

Jennifer Smith, CDE 10:55
I've found that I mean, from again, all the women that I've worked with, there are so many kinds of birth control pills on the market today. I mean, like every other drug on the market, they're, like, 20,000 of them, right. And I think it really is relative to the dose that's being given that type of birth control, whether it's IUD or it's the typical like pop the pill kind of birth control pill. They all supply a different amount of hormone control for that. I've seen some women who have they swear they have no change in their insulin needs, their blood, sugar's anything with their pill, and some women who swear a 10 pound weight gain. Now they're dosing with, you know, 25% more insulin than they ever did before. So,

Scott Benner 11:43
yeah, I have to say no, and then we'll move on to another one, that some of the biggest helps the people with diabetes, or other people's anecdotal information. And I also think sometimes it's the biggest impediment to people, because some people just see one thing, and it's not true. And then they share it. And it's, oh, this does this. And now that's in your head, you know, and you and you just stop thinking about it. Because you believe Oh, I know, now this, this person online told me, you really do have to

Jennifer Smith, CDE 12:14
kind of like the same thing as looking at one person's like straight, beautiful graph that they post. But you don't know what went in to doing that.

Scott Benner 12:22
Yeah, how that happened? Or didn't How

Unknown Speaker 12:23
did that happen? Right? You

Scott Benner 12:24
have to know more, not just the thing they say, right? Well, Jenny is a frequent contributor on the show. She doesn't get paid to be here. But she is for hire, at integrated diabetes.com should go check her out. I'd love to make a couple of brief announcements, housecleaning, if you will. Before I go. First, you may remember that back in August of 2020, I was celebrating the 2 million downloads of the podcast was very exciting. Well, it is 114 days later, and we are celebrating the two and a half million episode of the podcast. Now those numbers may only mean something to me. And I imagine they wouldn't to you, but a half 1,000,114 days is really exciting. And I just want to say thank you to each and every one of you for your continued support your listenership. And for sharing the show with others, I am truly grateful that the show has resonated with so many of you. And I love making this podcast for you. I want to shout out the oldest sponsor of the podcast on the pod.

Unknown Speaker 13:37
They

Scott Benner 13:38
supported the show by buying ads before anybody could have imagined that we'd have two and a half million downloads. And it's very possible that there could be four by the end of the next calendar year or more. I don't even know it's the way you guys are sharing the show. It's It's amazing. But my point is, is that back when the show had nobody listening, and I was like, I think I can get 1000 people a month to listen. They bought an ad. And they did that when I asked if they'd be willing to support this thing that I meant to do. And for clarity, if you haven't been listening along, what I meant to do was help people with type one diabetes. That's what I wanted to do. I wanted your lives to be lighter, easier, healthier. That was my goal. And I told them that it was going to take some time. And then if they could help me by supporting it financially a little bit, then I think I could turn it into something. Well, you have to give them a lot of credit. Actually one person in particular I'm raising my glass to right now. And she knows who she is. But she bought an ad when there was almost nothing to buy an ad on. And I'll never forget that. That first ad allowed me time to build this podcast. allowed me to go to my wife and say, Look, it's not just this, you know, it's not just another thing I'm doing online for free to help people, this might actually pay a bill one day. And that was enough to let my wife say, Alright, you know, try it, I'd like to help people to, you know, but we're just like you, we have kids going to college, and we need food. So I couldn't just spend all my time up here. And on the pod, they really came through. I'm forever grateful for that moment. Because this podcast has become something that I am truly deeply and genuinely, very, very proud of. Just to reminisce, for another moment, I recall back at that conversation with Omni pod, telling them, you know, I'm not sure if I'm ever going to turn this into something, it's going to be that valuable for you. Meaning you know, that you'll be able to reach people with your message. And by the way, their messages, try your free no obligation demo of the Omni pod today, at my Omnipod comm forward slash juicebox. But that's not the point. The point is, is that they were okay with that. And I like being involved with people like that. Somebody who said, Look, if it helps people, and it never turns into a business, we're still here to help people with diabetes. I remember that moment as clear as day. And I sometimes wonder if they would have said no, if this show would even exist. Anyway, trying on the pod, they're cool. Speaking of cool people who support the show, we've had all the meetings and all the conversations, and everyone's back in 2020, this podcast will have advertising from Omnipod Dexcom, the Contour Next One blood glucose meter, touched by type one, G, Volk, hypo pen, maybe someone else are still getting things together. But great, great sponsors that I have full faith in, which gives me the ability to speak about them freely from the heart. And I like that I would not know what to do if I had to shuck and jive for you and tell you I liked a meter that I never used before. I I don't think I could bring myself to do that, actually. So I'm really thrilled that everybody's back. Thank you so much for the continued support. And thank you to all of you for making the show something that anybody would want to get behind. And speaking of supporting things that also support the podcast. Don't forget to join the T one D exchange registry. All right, ready, let's test me one take, I won't stop. Join the T one D exchange registry at T one d exchange.org. forward slash juicebox. When you add your information to the registry, and you're a US resident with Type One Diabetes, or a US resident, who is the caregiver of someone with type one, you will be adding data that will help people with type one diabetes in countless ways.

Would you like to try a free no obligation demo of the Omnipod tubeless insulin pump or my omnipod.com forward slash juice box fill in a little bit of information and an insulin pump for you to try on and where Don't worry, it's not working, you'll be okay. We'll be at your house in no time. And to learn more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com forward slash juicebox would you like to use the most accurate and easy to carry blood glucose meter that I've ever seen? Of course you would Contour Next one.com forward slash juicebox check out that Contour Next One. Check out that oh I almost did it without flubbing check out that Contour Next One meter now you can also find out more about there. I just lost the word tester program. And you may even be eligible for a free meter. two meters terrific. Seriously check it out. Contour Next one.com forward slash juicebox this is what happens when I don't edit myself ready. My daughter uses g Vogue hypo pen and you should to G vo glucagon comm Ford slash juice box. You want to see people doing great things for people living with Type One Diabetes, you're going to want to go to touch by type one.org and visit them on Facebook and Instagram. Did I forget anybody Dexcom on the pod Contour Next One. g Volk pypo pen touch by type one T one D exchange. I did it. That's it. Thanks so much for listening. I hope you have a great weekend there's going to be a really special. There'll be saying I promised I wouldn't edit now I'm tripping over my words. There's gonna be a really great show coming next Friday. That's gonna have an announcement. Little interactive thing you guys could do if you want. But uh, that's for next week. Thanks so much for listening to the Juicebox Podcast and thank you for making the show so incredibly fulfilling. For me and for the listeners, which I guess this year, take care. I'll see you soon.

He's still here. I'm just gonna let the music run. Let me turn it up.

Because I better very repetitive I get so that I can talk over top of it while it's low when you hear music, but you know it's not distracting. You did. How was everybody's Thanksgiving you guys do all right. Wait, do I tell you how our Thanksgiving when I'll put that in an episode next week. Boom, boom.

We're getting there. Like 10 or 15 more seconds, you can make. Oh, by the way, if you're enjoying the show, please leave an amazing rating and review on Apple podcasts or wherever you listen to your podcasts. And if you're listening to podcasts that Subscribe, Subscribe, subscribe. Links to all the sponsors are available at Juicebox podcast.com or right here in your podcast player show notes.