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Scott Benner 0:00
Hello everyone and welcome to Episode 426 of the Juicebox Podcast. Today's show is it the finding diabetes episode with Jenny Smith, and I'm excited to bring it to you. And it's going to begin right after this. g Volk hypo pan has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about, all you have to do is go to G Volk glucagon.com, forward slash juicebox g vo shouldn't be used in patients with insulinoma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Are you looking to help with Type One Diabetes Research? If you are, you can do it right from your home. Right there on your phone or your laptop? Just go to T one d exchange.org. forward slash juicebox. Answer the questions they ask which I've answered for Arden and are very kind of benign. To be perfectly honest, you need to be from the United States and have type one diabetes or be from the United States and care for someone who does. They're just looking for every day input about your type one diabetes life, then they use that data. To make great advancements for people with type one diabetes. I've mentioned them all before. And I can mention them again at the end of the show. But your effort, your tiny little few minute effort could go a long way towards helping everyone living with Type One Diabetes, T one d exchange.org, forward slash juicebox. And if it's been a minute, since you thought about your blood sugar meter, if you really never even considered it in the beginning, when you got it like I wonder if this is a good one or not. That happens to a lot of us, a lot of people just get handed a meter by a doctor not realizing there are many meters available. And that they vary in their accuracy, ease of use and ease to carry. My daughter uses the Contour Next One blood glucose meter and it checks all of those boxes, easy to carry, easy to use, and incredibly accurate. The Contour Next One blood glucose meter also has test strips that are special. In so much as that, you know, I don't know, this has got to have happened to you right you make a blood drop, you touch it with a test trip and it's not enough blood and then you have to throw the test strip away. You don't have to do that with the Contour. Next One, you get to go back in there's a second chance and it doesn't impact the accuracy of the test. It's a money saver, and it's a time saver and honestly it just makes things less aggravating. Contour Next One, that's the meter you should be looking into and you can at Contour Next one.com Ford slash juicebox. It's a very comprehensive website where you can find out about the Contour Next One meter but you can also look into their test trip saving programs and some of you may be eligible for a free meter. There's a lot going on at Contour Next one.com forward slash juicebox I'd ask you to go take a look. Thank you so much for supporting the sponsors are no more ads in this episode. Don't forget to check out the T one D exchange at T one D exchange org forward slash juicebox you definitely want to look into g vo glucagon Jeeva glucagon comm forward slash juicebox. And of course it just spoke about the meter that my daughter has been using forever. There are links in the show notes links at Juicebox Podcast comm when you support the sponsors, you support the show. Before we get started please don't forget 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.

Today's episode is part of the defining diabetes series, which lives here inside of the Juicebox Podcast. Today Jenny and I will be discussing growth hormone. My 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. In my mind, I believe Jenny can do anything.

So I want to just define growth hormone and then talk a little bit about how people might see it in their, in their blood sugar management.

Jennifer Smith, CDE 5:23
You probably have a lot of visual from eons of life with a very small child through teen years, I can

Scott Benner 5:32
picture the whole horrible journey in my head. It felt like, for a long time that I would get Arden's insulin, right. I'd get one night of sleep, and then it would change again. And then it would take me forever to figure out this was in the beginning, and then it would change again, and it would change and she'd get bigger and taller and Arden 16. Now, it's like, five, seven and a half. Like she's a fairly tall person. So she just kept growing like at one point, I was like, just stop here. Here's fine, you know. And it is interesting to watch girls mature too, because she got she would get tall. Then she ate curvier than she could tall again. But with my son who doesn't have diabetes, he would get tall, his legs would get heavy. And then he'd get taller again. We knew he was gonna get hard, because his calves would get like oddly too big for Yeah, for his body. And then boom, he'd get taller. Again, it was very interesting. But but so growth hormone, also known as human growth hormone, is the peptide hormone that stimulates growth, cell reproduction, cell regeneration in humans and other animals, blah, blah, blah. It's really important, and you want your kids to grow, obviously. But every time they grow, why does it happen overnight? Like why do why do people like you? Don't? I mean, like, it's like,

Jennifer Smith, CDE 7:05
yeah, I mean, that's a good question, I would expect. I mean, there's a lot of, there's a lot of processes that your body sort of goes through overnight. Because it's, it's a time period of day that your body has time to pay attention to itself. I that sounds kind of weird, but like you're sleeping, right? You're not running or you're not like, you know, doing math equations, or

Unknown Speaker 7:31
now's a good time.

Jennifer Smith, CDE 7:33
It's also a time period. It's the big reason that a lot of people see a weirdness in blood sugar, if they're eating late at night, and then they go to bed on that, right. Because really, your digestive system sort of slows down, relaxes, it's not really supposed to be digesting so late at night. So the same thing with growth and repair. It's a time period of the 24 hour day that your body has a chance to recoup, regenerate repair. And growth happens in that time period. I swear sometimes when my boys wake up in the morning, I'm like, you grew over looks bigger. Yeah, look bigger this morning than you did last night.

Scott Benner 8:08
Well, not to get too far off the subject. But did you just explain to me why I can't eat too late at night? Or I'll have heartburn? Because my body really is that that's simple.

Jennifer Smith, CDE 8:18
Yeah, it also I mean, to go along with it, too, is relative to heartburn is you know, during the daytime, when we're upright, we have the benefit of gravity working on our digestive system. It's pulling everything through along with the natural like movement and the muscles and everything that move things through the digestive system, gravity is helping Well, when you lay down, you're now flat, right? You have no advantage of gravity at all. And your digestive system slows down overnight. It's not really meant to be digesting like that. So not only for people like you without diabetes, but definitely people with diabetes. I'm curious, you know, I eat this at nine o'clock or 930 10 o'clock at night. And I don't see any problems with blood sugar until like three o'clock in the morning. And it wasn't high fat. I would have expected to affect like, you know, faster, given the fact that it wasn't high fat, and whatnot, but

Scott Benner 9:12
it's a much slower digestion.

Jennifer Smith, CDE 9:14
It's slower digestion.

Scott Benner 9:16
This is why these conversations are good. We figure things out while we're doing this. But so the growth hormone your kids are growing really not

Jennifer Smith, CDE 9:23
relative to growth hormone.

Scott Benner 9:24
I don't know. We found it. It seems relative to me. You know, your body needs those hormones to grow. No different than maybe a woman who's getting your period these hormones come in, they impact your blood sugar and can impact them really, right. Like, there are times there have been times in Arden's life where her basil rate has been double overnight than it is now as she's older. And if it is not, it is gonna happen to everybody. So in the end, and it's I mean, you know, the

Jennifer Smith, CDE 9:55
growth hormone is essentially it's, it's just it's a stress hormone. Really Okay, like, like your adrenaline or your epinephrine, like cortisol, all of these hormones growth hormone included? Are there kind of blood sugar? raisers?

Scott Benner 10:13
Yeah. Right. So when you're when you're kids, so when your kids growing, that's what I, you know, some people say these kind of not trite but overly simplified things about diabetes like, Oh, you know, every time you get it, right, I mean, I told the story, every time you get it, right, it's gonna change. But that's not really what's happening. It's that sometimes your kids growing and then then they're not, then they are again, and this seems to happen overnight. And you're going to have periods of blood sugars that are going up. And it will seem like maybe it's happening for no reason. But it's very likely because your kids growing so

Jennifer Smith, CDE 10:50
right. And it typically, as you've, as you probably saw, too, it's that growth happens over like, oftentimes a couple of days. And then it appears to just be done. Yeah, right. And then it might be a cyclic, like, I've got a couple of families who followed it enough that they're like, every couple of weeks, we get the same pattern. And we know that we need this much more insulin, so we dump it in, we ended up having much more beautiful evenings, sometimes we end up kind of kind of coming to a happy medium between the high insulin need of the growth hormone kicking in, and where they were before, they sort of sit between that they never go back down completely to where they were before they grew. But they're not staying as high as they needed during that growth, hormone impact. So

Scott Benner 11:35
these people are watching. So specifically, they're actually seeing the growth hormone impact. And they're seeing that there's a gentle rise and insulin need as the muscles getting bigger to begin with. Which Yeah, I always just break down to like, growth or body weight, or, you know, if they're bigger, they need more, although I talked to somebody yesterday, and they were freaking me out. They're like my daughter's 130 pounds and her Basal rates, point three, five, and I'm going over my head and like none of that makes sense. None of that makes sense. None that makes sense. And I was like, Wait, how long is she had diabetes? She was four months? I'm like, ah, got it. Okay. You're still getting some insulin from your, from your pancreas. I got it. Okay, so it's interesting

Jennifer Smith, CDE 12:11
that that's a funny one too. I've gotten a quite a number of littler kids lately to work with that. like talking to the parents, it's very evident when I when I look at their, with their at their insulin usage, is they have a very, very low basil, comparative to their insulin needs around mealtimes. And anytime you've got that like this kind of goes back to insulin deficit a little bit anytime there's a deficit in basil. But when you take or have no meal, that basil is working beautifully at like point 05. And sometimes they don't even need that. But when they add a meal, and they need this like whopping three unit Bolus, or they're ending up at 300, blood sugar, that's a good indication that you're still in honeymoon. Yeah, because basil and Bolus, I mean, the old saying is kind of a 5050. We know that it's a little bit up down from person to person. But if you're at such a strange difference where your basil is giving you 10 12% of your total daily insulin and the rest is coming from Bolus, you're definitely still in honeymoon, something still happening. Yeah,

Scott Benner 13:21
that makes sense. Also, like, as you get older, I do want to understand this eventually. Here's not the place to talk about but when you get sick, why do sometimes your insulin needs go down when you get sick? even notice that like there's certain illnesses that goes up with with certain illnesses it goes down with I don't know the difference? Just Yeah,

Jennifer Smith, CDE 13:40
I mean, for the most part, a simple answer is oftentimes, if it's an infection, usually your insulin needs I would say 95%, maybe even more your insulin needs will go up, right? And infection is a significant stress on the body, especially in infection with like a fever, or that really has you like down You can't go to school or you can't go to work or whatnot. Opposite is usually the stomach bug illnesses that require the the lower insulin, okay? Mostly because one, you're not taking in as much so metabolically, you need a bit less. Also, you may not necessarily be keeping things down, whichever way they're kind of coming out. That talks to go back to kind of the digestive system. Whenever you're taking things in that you can in a stomach bug, your body's not absorbing as much out of them. And so your insulin needs go down because you're just not processing

Scott Benner 14:39
them. Listen in the same vein, and I haven't said this in a while on the podcast and I know you have to go but I'm okay one day Arden's gonna listen back to this and be like so tell me again how you discussed constipation. But when, before we before we knew Arden had hypothyroidism, she got really constipated. And the more constipated she got, the higher Her blood sugar we get. And then once she went to the bathroom, boom, or blood sugar came back down again. It's always like, wow, is her body just continuing to leach out of even out of waste? That's fascinating, isn't it? All right.

Unknown Speaker 15:14
I feel a little bit gross today. It's

Scott Benner 15:16
completely gross, but it happens. And this pocket is about what happens. So you gotta you gotta know what we, we can't come on here and talk about the same boring stuff. Everybody else wants to talk about No. Fun. It's just a number. Okay, thanks. big help. appreciate all your insight.

Jennifer Smith, CDE 15:40
He did bring up a really I really I want to look further into why growth is more at night. I mean, that's an interesting question that I guess I've never really thought about other than just knowing that growth hormone comes from the pituitary in the brain and a wonder if it has something to do more with when the pituitary gland is supposed to be active, which maybe that is at night. Okay. I don't know. But that's I'd have to look it up. It's a good question.

Scott Benner 16:08
A huge thank you to one of today's sponsors, GE Vogue glucagon. Find out more about chivo Kibo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGL Uc, ag o n.com. forward slash juicebox. To learn more about the Contour Next One blood glucose meter, please go to Contour Next one.com forward slash juicebox. And I told you I was going to tell you a little something about the T one D exchange and I will in just a second.

If you'd like to learn more about what Jenny does it integrated diabetes go to integrated diabetes.com. The podcast has a private Facebook group that you can find. You know on Facebook, it's called Juicebox Podcast and then there's a colon and then it's type one diabetes. There's also a public page called bold with insulin. I'm on Instagram to just hit 10,000 followers there that was kind of cool cuz I'm not very good at Instagram. What a salesman I am. Hey, would you like to see an Instagram page? That's probably not good. Go to Instagram. Okay, back to the T one D exchange. The T one D exchange is looking for T one adults or T one caregivers who are us residents to participate in a quick survey that can be completed in just a few minutes from your phone or computer. After you finish the questions. They are very simple. I did them in about seven minutes. You will be contacted annually to update your information. And to be asked further questions. This is 100% anonymous, completely HIPAA compliant and it does not require you to ever see a doctor or go to a remote site. Now every time someone completes the process using the link T one D exchange forward slash Juicebox Podcast benefits. So if you've been looking for a way to help type one research, the podcast or both, nothing could be easier or more beneficial. After you get to T one D exchange using my link, click on join our registry now and after that simply complete the survey. Past participants like you have helped to bring increased coverage for test strips, Medicare coverage for CGM, and changes in the ADA guidelines for pediatric a one c goals and it's exciting to imagine what your participation will lead to. Thanks so much for listening. I'll talk to you soon