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Scott Benner 0:00
Hello friends and welcome to Episode 463 of the Juicebox Podcast today, Jenny and I are going to define a diabetes term that I made up.

Don't tell the other episodes, but I quite like the defining diabetes series. What was once just in my head and idea of like, oh, I'll tell people the definitions of words so they know the tools they're using and what they're supposed to do. But I've come to see these episodes is more than that as time has passed, I think they're their own special little. I don't know, I just like them. Like a Mini Pro Tip series, defining diabetes. They're just good. And they're helpful. Actually, they're made even better with the presence of Jenny Smith, my friend and certified diabetes educator who helps me on these and the pro tip episodes. Today, Jenny and I are going to define crush it and catch it. There's a little more to it, actually, there's crush it, catch it. And well, you'll find out in a second. But I just like crush it and catch it. The rest of its like implied once you understand you'll see in a second. Please remember while you're listening 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. We're becoming bold with insulin. Hey, new listeners. Did you know bold with insulin actually comes from the title of Episode 11. I thought I would tell you that because now that the podcast is seven years old, it's possible you don't even know how this thing got started. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. It's the meter my daughter uses. It is the most accurate meter I've ever held my hand. And it's absolutely lovely. Check it out at Contour Next one.com forward slash juice box. You know what else this show is sponsored today by the glucagon that my daughter carries g vo hypo pen, Find out more at G Vogue glucagon.com forward slash juice box I have come to I broken down the idea of how do I get a blood sugar back down into three simple words. I crush it, catch it and start over. Okay, so if I see it, if I see a blood sugar that's high, and it's stuck, instead of messing with it, I crush it, catch it and start over. Now sometimes I crush it and it catches itself. And those are days when I'm like oh, I really did it. And then there are some days when I crush it so hard, it needs to be caught with some sort of fast acting glucose. This comes up a lot when I'm talking to people because I just feel like I feel like staring at high blood sugars is a bad idea. Now when I used to say this, people say oh, it's not good to bring your blood sugar down too quickly. And I know it isn't. But is it not? A good idea when your blood sugar is high all the time to bring it down too quickly. But what about a person whose blood sugar is normally like 85 to 105 and it sits there most of the time but then you get this big spike from something you messed up or did wrong or bad pump side or whatever? Is there any value in watching it and bringing it down slowly over four hours versus crush it? Catch it

Jennifer Smith, CDE 3:40
there when I'm glad you kind of brought it up because that was like the first thing on my mind to like spit out

Scott Benner 3:46
was I know you would

Jennifer Smith, CDE 3:48
it really does depend I mean somebody who's typically sitting in a nice beautiful, you know, glucose range that they're happy with. And now oh, you know, grandma's apple pie came along and I thought I'd only one piece and now I've eaten three and Oh, I didn't Pre-Bolus that I you know all the things that go into a higher blood sugar that happens occasionally. The occasional high blood sugar that you do your little you know, crush it catch it kind of component. Is that detrimental? No, I mean, you're taking care of the high blood sugar, you're bringing it down, you're doing it quickly. I would say that the opposite of that though, you know for a high blood sugar that's that's randomly high. And you're kind of worried about doing that and bringing it down so quickly is there is there trauma, the same way on just leaving it hanging high and come down slower by just taking a small amount and gradually getting it down? I think they're both honestly about the same in terms of any potential like you know, back end, which I don't see there at all, you know problems and you either take care of it on the back end On the front end quick and it comes down. And now you don't have to do it the high blood sugar anymore, or you end up with a high blood sugar for hours watching, it's like slowly come down. And you may not feel great during that lengthy time. But on the same if you crush it early, and it drops really fast, you also might feel the drop. Yeah, too. So you know, in either of those, I don't think that it's necessarily bad. The long term of consistently doing that, like if you are the roller coaster, and you're constantly crushing highs, and on the back end catching them with a load of extra food. They're in something needs some adjustment,

Scott Benner 5:41
right? And so that phrase would not come into my mind. If Arden was constantly high, I would think oh, there's so many other things that I don't understand. I am really talking about specifically, when you just have this, like out of nowhere, like where did this come from? Because I think one of the problems with messing with it for hours is that that runs into another meal. And now you don't have any resolution of the carbs. And this the insulin right? Like there's no, like I found myself years ago always saying to my wife, look, we need to get this down, get it level, get this insulin out of her so we can start over again. Because if not, you have all these other variables going on. You don't know which ones are impacting and then you go into another meal and it takes years to be able to just on the fly, go Okay, there's still some active insulin but the food's gone now. So I'll Bolus this and I'll take away 10 cars because I know there's some insulin left like most people can't do that off the top of their head, right? So I my my theory has always been get it down as fast as you can. Because the insulin you use to get it down is kind of gone after that, like it gets. I don't know if this is a technical term, but it feels like it gets used up dealing with the carbs Does that make sense?

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Jennifer Smith, CDE 9:12
Yeah, I usually say it gets eaten up faster. It's like there's so much sugar for it there when you've got a high blood sugar that all that insulin gets sort of used up faster. There's it's kind of like the same concept of a Pre-Bolus is you're getting the insulin action going now to hit what's coming and get it used up and on the back end. If you've done it right and you figured it you should have a smooth landing.

Scott Benner 9:40
It's always it always appears in my mind like a fistfight that just goes to the death that just like when it's over, both fighters just drop over backwards and on their way down. They're like well done and then they're they're just gone. they ever get back up again. You know, and, and you're right. That is how I talk about and how I think about Pre-Bolus Singh, which is to put Both people's aggression at the same time make the insulin working while the carbs are working. So that one's not not doing its job without the other one because how you get a higher low blood sugar. But so in a bigger idea. I hear it's exactly right, like so what do you do in that situation? Like, how does Jenny handle a high blood sugar that she gets?

Unknown Speaker 10:22
She doesn't like high blood sugar.

Jennifer Smith, CDE 10:27
I like your I like well, one, you know, with using the system that I use for managing, I don't typically deal with that unless I have a pump site that's gone bad and hasn't been dealt with obviously. And for some reason, I haven't paid attention to any alerts and alarms that are going off on my CGM. So there are lots of catching points that obviously I haven't I know a lot of people use similarly. But with high blood sugars, I do the crush it catch it kind of thing. More than not,

Unknown Speaker 11:01
I think there's because I don't

Jennifer Smith, CDE 11:02
want to sit high. I don't like sit and kind of like you with my day the way that it goes. I don't want to have to wait out a high to eat. As often my meals are with my kids. And I don't. I don't want to sit there while they're like chowing down. I'm like mommy's got to sit here.

Scott Benner 11:26
Kelly's not saying she feels that her kids will feel odd. If she's not eating. She's saying she doesn't want to watch somebody eat and not

Jennifer Smith, CDE 11:32
be eating at the same time. Right. That's the enjoyment of a meal together.

Scott Benner 11:36
I think it's a abundantly clear why you and I get along about talking about diabetes. So I was thinking now for the alternate viewpoint. Here comes Jenny with exactly what I just said. Yeah, I just think that I think it leads to so much more success. Because that staring at highs is stress inducing, and like people are like, well, I don't know, I'll make myself low. And I get that, like, if you're hearing this episode, first. Go back and listen to the pro tip series. Don't start with this. This is like ninja level, like I already understand what's going on 1000 times over. And I've got a high blood sugar. You know, if you Oh, sorry, I don't know, I was gonna say if you usually have high blood sugars all the time, your basil is wrong, you don't understand how to Pre-Bolus like, all these other things are first not this. This is not step one.

Jennifer Smith, CDE 12:28
No, no. And I was also gonna just sort of go back and say, you know, my, my day to day like crush, it is definitely much more the case overnight. I mean, my husband will wake up to an alarm. But he is definitely much more the like, sleep through a train coming through the wall than I am now have being a mom and waking up to everything. So overnight, I can say because I am, I am my own manager. I don't have anybody catching or following or anything for me. So if there was a conservative time that I'm going to do less aggressive correction for a high, it's definitely going to be overnight. And it's usually if I've had a highlight that overnight, it's usually like, the pump site is bad, or it's gotten pulled out and like I've got this dangling pod on my body and I haven't obviously gotten insulin and then it leads to well, how much insulin do I have left? So it's kind of a questionable, and I'm a lot more conservative. Sure, for my own self overnight. Because

Scott Benner 13:33
Yeah, I would think that for an adult, it's different than for a caregiver for certain and, and I don't want to give anybody the impression that I use, you know, 50% more insulin than the situation needs. And then I just give her like a filet mignon dinner at the end, like, although, I could go into how you can get out of a high and go into a meal by correcting the high end Pre-Bolus eating the meal, even sometimes hours ahead of time, and then just introducing the food at the exact right time. Maybe that does fit in here. But we're not talking about that right now. So I don't I mean, I don't want anybody to think that I'm overdoing it over time, I've learned that you know, I can be really aggressive here and maybe I'm gonna mess by eight carbs worth of insulin, right like just a little bit and you can kind of, you know, add a little bit in I there's an episode called Utah Gen, where I talk about how I how I helped the person over the phone. This is probably not something I should have recorded. But how I helped the person over the phone bring like a seven year olds budget or from 400 to 70 and like two hours, and it involved crushing it and then introducing a meal at the right time. And that kid's blood sugar went like 76 I think if I'm remembering it just leveled right out, it was like that was one of my, my most happy moments in my life. Walk around my house with my head. So I was like I did it. And then she ruined it by feeding him but that's not the point. Anyway, it's a great app. But not what I was talking about. Alright, Jenny, I'm gonna stop putting his

Jennifer Smith, CDE 15:03
reference to it, though. I mean, in terms of like that introduction of the meal at the right time, I think when you said this is like ninja level? Yeah, I agree. Because over time you have an idea, you have a sense of how much to potentially crush it with. And where, with hindsight, you can tell where you're going to need to add something because it's you're not going to, it's not going to catch it on its own, you're going to have to help with the catch.

Scott Benner 15:30
Yeah. And if somebody is listening to this and thinking, Oh, yeah, I try that all the time. I always mess it up. I really genuinely think go listen to the pro tip episodes, because then you'll get through the little reasons why you mess that up. Because, you know, I could go one of them is that people are constantly chasing blood sugars. They're always like on the wrong timeline. I don't like no one other way to put it other than to say, insulin you use now is for later, but a better way to think of it is that insulin from before is affecting you now. And if you're trying to affect before, now, you're caught in a time travel movie, and you're on the wrong end of it. So anyway, try the pro tip series. Okay, Jenny, thank you very, very much.

Jennifer Smith, CDE 16:12
Yeah, you're welcome.

Scott Benner 16:19
A huge thank you to one of today's sponsors. Gvoke glucagon. Find out more about Gvoke Hypopen at Gvokeglucagon.com/juic box. you spell that? g v o OKEGL. UC, ag o n.com. forward slash juicebox. Have you been thinking about that Contour Next One blood sugar meter. Have you been thinking about that Contour Next One blood glucose meter since I brought it up earlier, this is your time. Go check it out. ContourNextone.com/juicebox. You can find links in the show notes, too. Hold on a second, I'm gonna run out of music. You can find the links in the show notes to today's sponsors to Jenny Smith. And to all of the sponsors of the Juicebox Podcast. Right there. In your podcast player. There are show notes in your pocket, podcast podcast, there are show notes in your podcast player, you can click on them from there. And you know, the links are there. Or I don't want to get too technical when I say the links are there, or you can find those links at Juicebox podcast.com. Allow me to take this moment to thank you for listening to the Juicebox Podcast for sharing the show with other people. And for making last month march of 2021. The most popular the most downloaded month ever in the history of the podcast. I'm not giving away the numbers. But last month, did by a multiplier better than the first year of the show. Is that not crazy? Anyway, I have you to thank. So thank you. I appreciate it. Again, when you share the show when you subscribe in a podcast player, when you tell somebody about it, when you leave a review, and you're like oh my god, I love this podcast as a review. And then you give like a really thoughtful reason why those reviews are very helpful. Mostly for listening. That's the best thing you can do for the show, listen and tell someone about it. I really appreciate this. I feel like I've gone on too long about this now, but there's no going back. And I don't feel like editing it out. So I'll see you soon with another episode of the Juicebox Podcast. I'm just going to keep talking you can leave if you want to. But some people don't know about the other episodes that I think would be really helpful to them. So I'm going to take a moment. Juicebox Podcast comm is the website for the show. Everything you need is there, there's menus at the top. And you'll be able to find the diabetes pro tip episodes, and the defining diabetes episodes under one link, the link that says diabetes pro tip. If you can't remember that you can just go to diabetes pro tip comm where I've also put those episodes. I know a lot of you find the show. And people tell you Oh, if you listen to this podcast, like your variability will get better and you're able to go down you just have a better idea what you're doing. And everybody's like, Well, how do you do that? I think it's by listening to the show. I think that listening gives you a firm understanding through conversations with many people who are parents of children with Type One Diabetes, or adults who have lived with diabetes for a long time. Just hearing the conversations, hearing ideas come up, things get spoken about. I find very helpful. I find it builds your kind of diabetes knowledge. But if you really just want to dig into management ideas, you are looking for the defining diabetes episodes just like this one and The diabetes pro tip episodes. So again, diabetes pro tip comm they're also right there in your podcast player, the thing you're holding right now with your phone. The Pro Tips begin at Episode 210. They do not run concurrently. So you have to find them. And I think I say I think but I'm looking so it seems disingenuous. I was buying time the defining diabetes episodes begin at Episode 236. There are many of them actually.

Probably number in the dozens. And I don't see any end to them as we define. You know, I don't even see them as like definitions. I started talking about this the beginning like it's not just like Bolus means this. It's Jenny and I, we define it, but then we talk it through. And now you know what that tool is, it would be like, it would be like if you came from another planet, and someone handed you a hammer and a pair of pliers and a screwdriver and told you to go put together a bed. You might not know what the hammer is for. You wouldn't even know what it was called. So if you were helping me and I said Pass me the hammer you wouldn't know. So I like for you to know what a Bolus is what basil is why hydration is important. What's an insulin deficit? His feet on the floor a thing? What is the fat and protein rise a compression low or rage Bolus? Like I want you to? I want you just to instinctively know this is a hammer. I know what a hammer does. And that way when you need the hammer, you won't hesitate. To me that's what the defining diabetes series is about. And then while there is no doubt that I would love for you to listen straight through this podcast, start at first one and listen all the way through. I know not all of you are going to do that. If you did, you would glean everything that is inside of the pro tip episodes. Don't skip the pro tip episodes. Just listen to them straight through Episode 210 diabetes pro tip newly diagnosed are starting over and they go on from there. If you're not an MDI, still listen to the MDI episode. Right if you're on MDI, still listen to the Pre-Bolus episode. If you're on MDI, listen to the insulin pumping episode. If you've never had to CGM in your life still listen to the mastering a CGM episode. Don't miss bumping and nudging the variables exercise like don't just skip one because you think oh, this isn't for me. Those are going to lay down a firm foundation around your diabetes management in my opinion, and they're free so why the hell not right. Okay, thanks so much. Now I'll really see you next time. Bye bye. Hit subscribe.