+ Click for EPISODE TRANSCRIPT

---

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
Hello friends, and welcome to Episode 482 of the Juicebox Podcast. Guess who's on the show today?

Today on the podcast, I'm joined by Jenny Smith. Jenny, of course, is from all the defining diabetes episodes, and the pro tip series. And she's here today to answer a question that I have based on watching people. I have a watching people question. I listened to a lot of people who use insulin. Some of them say this thing that doesn't make sense to me. And I wanted to ask Jenny, her opinion. And while you're getting her opinion, please remember 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 healthcare plan, or becoming bold with insulin. You know, I'm wearing headphones, and I can hear myself and my voice sounds amazing right now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's 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. And she just celebrated her 33rd diversity.

The T one D exchange needs 6000 people to join the registry. And I have to keep saying this to you until you do it. So the T one D exchange is looking for T one D adults and T one D caregivers who are us residents. They want you 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. And they are very simple. I completed the survey in about seven minutes. You may be contacted annually to update your information. And they may even ask you a couple more questions. But this is 100% anonymous, it is completely HIPAA compliant. And it does not require you to ever visit a doctor or go to a remote site. See, this is interesting. This is a way for you in just a few minutes to help other people living with Type One Diabetes. Past participants have helped bring increased coverage for test trips, Medicare coverage for CGM, and changes in the ADA guideline for pediatric a one c goals. These are important behind the scenes things that people with type one diabetes need, and you have a unique opportunity to help them. These are not deep probing personal questions. They're pretty simple basic surface diabetes stuff, but they just need the data. Help them at T one d exchange.org. forward slash juicebox. And at the very least, if 6000 of you go right now, but I don't have to say this again. Do it for me. I'm kidding. Do it for the other people living with Type One Diabetes. But I mean, if you want to think of me while you're doing it, it's fine. This topic, absolutely mesmerizes me I could because I can't make sense of it. And I know I can't make sense of it. Because I don't have diabetes. I know this is one of those things that I can't wrap my head around because of it. And it comes mostly from adults. Although I've seen parents lean into it a little bit too. And I'm really want to kind of dig into this with you. Why do some people think that there's an amount of insulin that's too much insulin to use? And that they're actually embarrassed if they use that amount? Or feel like they're failing? Where does that thought come from?

Unknown Speaker 3:52
It's a good question. First off,

Jennifer Smith, CDE 3:54
I would think that it probably starts with some like, sort of off the cuff kind of comment from a doctor. Not that the doctor is really implying what the person takes out of it. Like doses of insulin usually go along with each other, you're not going to have a Basal rate of point two, and have an insulin sensitivity factor of 20, which is unbelievably aggressive, right? I mean, that's not going to typically happen. So in terms of like evenness of insulin distribution, they may have heard the doctor say, well, you're on a lot of insulin. So your ratios should be such and such. Right? So it may initially come from something like that, but um, you know, they even might compare themselves to another person with diabetes, who they maybe they work out together or maybe they are close enough friends that they're just comparing things and they say, well, gosh, you know, I eat really well or I follow this type of exercise pattern and Gosh, it looks like I use like twice as much insulin as you and you're like a couch potato or whatever, you know,

Scott Benner 5:08
the, um, the closest I can come up with listening to people, and I really mean that this isn't from one or two people. This is over the years, I hear this constantly, like, I'm a bad diabetic. I use too much insulin, I've heard those words come out of like grown people's mouths. And sometimes it feels like, it's I don't know if this is gonna sound crazy, but sometimes it feels like it's impacting them almost like an eating disorder, but it's a it's like disordered insulin use it feels like, and no matter how many times I talked to them, and I'm like, Hey, you just need what you need, or your body has a need meet the need, whatever I ended up saying to them. It doesn't feel like it's enough. Like it feels like it's psychological. And you know what I mean? Like it really it's sad to,

Jennifer Smith, CDE 5:56
I think some of it to probably comes from those who are trying to manage weight. Because if you know really what insulin is, it's a storage hormone, right? Its job is to move food from one place your bloodstream into a place to either get used or get stored. So, you know, if that's the fact then a lot of people also don't see what is insulin do if you don't have diabetes, if it's really still being made from my pancreas, its job is still the same thing. So in terms of weight management, you may find that, well, gosh, I use an awful lot of insulin, if I was just using less insulin, maybe my body wouldn't pack away as many calories. And thus, you know, my insulin use would go down. And I also wouldn't be, you know, heavier than I maybe want to be. And it certainly brings into the discussion kind of the, the whole thing's like eating disorders within the realm of diabetes specifically, yeah.

Scott Benner 6:56
So I get the idea. But I've seen it a side of people who are concerned about their eating, like like this, you know, like, if somebody comes to me recently, and wouldn't use their name, but I don't think they'd mind being an example here. So they come in, and they're like, Hey, you know, lately, my, you know, my blood sugar's have been going up, right? Like my, my resting blood sugars are more like 170, they used to be more like 100. and showed me the graph, and I look at it pretty hard. And I'm like, it just feels like you need more basil here. And you know, like, and then we could look at the meals. And, well, that's a lot of insulin, the person said, I don't usually use that much insulin. And I was like, Is there a problem with that? And the person said, It's embarrassing, but couldn't tell me why it's embarrassing that I'm using more insulin. And I

Jennifer Smith, CDE 7:51
guess I would feel like maybe it's the thought that they're not managing well enough. So they need more insulin to compensate for their lack of management, which shouldn't be

Scott Benner 8:03
right. Be the piece of like thought, that's how it feels to me too, that somehow, if I'm using more insulin, I'm doing something wrong. I didn't even see it connected to eating in this person's example. Although it's funny, because when it is connected to eating, it's the last thing people see, when you know, like, I'm using more insulin because I'm taking in more carbs. Insulin makes me gain weight. Although insulin didn't make you gain weight, the calories made you gain weight, the insulin was helping you keep your blood sugar down, they conflate the two somehow, right? You know what I mean? And then it gets, but they're tortured by it. Yeah, like really, really. And I didn't know if you would talk to anybody that this would come up for or if you felt personally,

Jennifer Smith, CDE 8:47
I would say that more. I mean, at least once a week, I have somebody both young and old, meaning both parents of kids with diabetes as well as adults managing their own diabetes. I I'd say you know, their, their typical question is, well, what does somebody else this age use? Is this the right amount of insulin? For me? Am I supposed to be on I guess, this much insulin or, you know, is this too little insulin? I mean, that's kind of the opposite with some kids or whatever. But it's always a question of, shouldn't it be specific to like, my age, or where I am in life or whatnot. And really, there's a physiologic personal physiologic need for insulin for every body. Good. Good point is that I've got a really good friend who is she's tiny, she's like three inches, and I'm not tall. I'm only five three, and she's like three inches shorter than me and probably weighs 10 or 15 pounds less than me and she uses more insulin than me. She's single and more active than I am. So, you know, from that standpoint, it kind of gives you a visual that the right amount Insulin for you as the right amount of insulin for you, as long as it's keeping your glucose where you want it to be, is it in the target that you're aiming for. And in the case of the person that you talked to, you know, their needs had gone up? Why? I don't know, some variable in the picture that was new and causing something to happen, but then just need more. And sometimes it's figuring out, well, is the more going to stick? Like, is there a, is there a body reason like is thyroid? Is there something going on that's causing the need for more? And will it be short lived, while this other thing is going to be taken care of and managed and gotten into control as well? But overall, you know, it is? It's a good question. I know the other piece of that too much insulin, sometimes also comes from people who have sort of been scarred by really like, low blood sugars, in the aftermath of what they deemed was a big amount of insulin for a meal. Yeah. Right. They're very wary of Gosh, I mean, I've worked with a number of adults who won't take more than like two or three units of insulin at a given time, no matter what, no matter what. And so, you know, then it becomes Well, okay,

Unknown Speaker 11:19
well,

Jennifer Smith, CDE 11:20
what's your ratio covering then? Because you can only eat this much at a time. The way that it works.

Scott Benner 11:28
So you see people who spread like little meals out throughout the day? No kidding. Jenny is nodding at me. No. Okay, so so that they won't have to take too much. That's what? So you said, I haven't I have a thought. But I want to go back to something you said. The comparison to others, is huge. And I always thought of it as looking for the answer through somebody else. But when you brought it up, I thought maybe there is just a comparison in their head, like I don't want to do more or less than other people do. Like maybe there's a real human failing in this, it has nothing to do with diabetes, that like comparison thing.

Jennifer Smith, CDE 12:04
Right? And I would, I would say that that's, especially with the teens that I talked to the teens themselves are not really so concerned, it's more the parents that are concerned god, he's using so much insulin, I remember when he was diagnosed, he was six, and he was on this tiny, tiny amount of insulin. Now he's got like, you know, Basil rates that are like 1.9 units an hour. And I'm like, well, he's a T and he's growing. And he needs a lot more insulin. I mean, so comparison wise, you do have to look at time of life. But even with, you know, this T and let's say, compared to his friend, his needs may be very different. His friend might be getting along just fine. On your point nine units of Basal an hour versus his 1.9. Right. So yeah,

Scott Benner 12:52
yeah, I get that. It's interesting, too, because I think my brain I know yours does, my brain kind of slips into that like, slip back, go macro, look at the whole picture. See, like, you were like maybe your thyroids out of whack, or like, I don't think mostly people think about stuff like that. Right, and the impacts of other things on your blood sugar, the one that you just brought up now, which I'm always fascinated by is, you'll get a note from somebody who says, I don't understand, like, kids had diabetes for two years. You know, all of a sudden, his blood sugars are high all the time. And my first question is, have they gained weight last, like three months? Oh, yeah, he's put on like, 10 pounds, I was like, Well, you know, a gallon of gas moves a car that weighs 1000 pounds this far, it moves, it moves a car that weighs 1010 pounds, a little less, you know, like that. And, but they don't see that a lot. Everyone's so locked in on making a number. Be right, and holding on to some hope that it's just going to be like that forever. Maybe that has something to do with this as well, I have no idea. I know, all I can tell you is that when I hear adults say it, there is sadness in their voice. And they feel like they failed somehow. And the other thing that, that I hear too, that I want to know if you've heard and wondered where it comes from, if you know is the idea that you can use too much insulin, and it's not healthy for you. Not that it will make your blood sugar low, but using too much. It's almost like you ever meet a person is like, has pain and you say take an Advil and I go, I don't want to put medication in me like and you go all right, right on, you know, I it feels like that a little bit like they're almost I don't want to say irritated but they're disappointed that they have to take insulin law. And somehow by using less of it, it's going to be healthier for them when that's of course, the opposite. But I do you know what I mean by that?

Jennifer Smith, CDE 14:50
I do and you know, in terms of too much insulin. If you need a certain amount of insulin you need it. I mean, that's the base fact right? But Getting into the fact of where I remember years ago, even before I was I was working clinically. And I started a young girl teens on a pump. And prior to the training, we always go through, like, what's your insulin dosing, so I could figure out like the strategy for the pump settings, right? When she was telling me her doses, and I was like, you're going to be going through a reservoir a day, like, serious, that's how much insulin this this team girl was using. And I was like, we need better insulin. Yeah, you, you 100. At that point, I mean, you 500 was on the market. But it was not at all something that was typically used an insulin pump, we had to actually go about, like getting a doctor's order to use it off label in her pump, in order for her to actually get enough insulin. But at that point, there, there are other reasons. I mean, that's significant insulin resistance, then, if you're not a growing teen, or a growing child, or maybe you know, a woman going through pregnancy, or some other type of like body, like health issue that might be impacting, yes, there are certain doses of insulin that typically you will need for your own body. But if you have all of a sudden, like climbed in need, for some reason, that's a reason to get a check in with your doctor to see if something else is going on. But then Thankfully, there are, there are other meds on the market now that, you know, they're starting to be used. Thankfully, in type one, they started out mainly as type two because insulin resistance is a hallmark of type two specifically. But it's kind of becoming more visible now in the type one community. And so some of those meds that help with resistance, can actually help you get back to a more normal need for your own body of insulin. Because, yes, exorbitant doses of insulin. At some point, you know, as I think we've talked before, like large depots of insulin under the skin take a longer time to disperse and get absorbed. So while that active insulin time of let's call it three to five hours, or whatever, from a single one shot dose of insulin, if you've got two units, probably over the course of that time, you're going to see its action, the way that it was meant to be, if you've got a dose, that's like 30 units in a shot. That's a huge amount of insulin to get dispersed. So in terms of decreasing resistance, especially if it's climbed for you, you may want to explore the other medications that are on the market that are very helpful for that.

Scott Benner 17:56
Well, as as we're sitting here talking, I do think that there's this one aspect that that's kind of creeping into my mind and making sense to me that I've just never thought of, which is, if my insulin needs are going up, I know I'm eating more food or eating less healthy foods maybe? And possibly, it could, it could, that could be I shouldn't say I should I know that could be one of the reasons like say, say for a person, that is the reason instead of wanting to face head on the idea that I'm eating in a way that I'm not thrilled about. I focus on Oh, I don't want to take so much insulin. And then like you said, you have a higher blood sugar, which then keeps your body weight down. hurting you in other ways,

Jennifer Smith, CDE 18:45
right?

Scott Benner 18:47
Correct. I'm trying to like put myself in someone's shoes there. You know what I mean? That whole like,

Jennifer Smith, CDE 18:54
it's a difficult it's, it's it is it's very difficult. And I think even in this past year, with so much change to people's schedules. And I mean, even the people I've worked with, in like cities where they were used to doing their their commute and getting on a train and walking and walking to the office and like that disappeared. And that might have been like 5000 of their 10,000 necessary steps in a day out of the picture. And now you're just getting up in the morning sitting at your desk and look at that you gained some weight and hey, you're going to probably need more insulin. In that time period,

Scott Benner 19:31
I would imagine plus the activity itself. Put your insulin requirement down. Yes. So now there's maybe you're going to gain weight because you're not moving as much and you're lost as much. Yeah, blood sugar. Well, that all makes a lot of sense. Like I it didn't not make sense to me. It's just that it's happened so many times and people seem so sad when they say it. And I just wanted to really like have a conversation and try to understand it because I really I'm at a loss Because I just come at it from like a clinical way when they said, I'm like, Well, I just put more in, you know, we're exercise more, eat a little less sort of like these your options. It's that one specific sentence that I need more insulin, I don't want to use that much insulin, or insulin is not good. Too much insulin is not good for you. I always expect they're going to say, because I don't want to get low. I don't want to have a ton of insulin in me. But right, that's not always the concern.

Jennifer Smith, CDE 20:27
It's just the actual dose. That's the concern. Yes, the number,

Scott Benner 20:31
it's the number that messes them up. It's got nothing to do with anything out like if you, if you, I don't know, let's say I put you in charge of the world. And you decided that a unit of insulin was actually equivalent to two units of insulin. So we started calling two units one unit, then they'd be okay with it. Then they'd be like, Oh, I'm only using three. Right? Right. But you tell them it's six. And they're like, Oh, it's still it's still like in I'm putting my fingers on. But it's still this much insulin in the syringes this much in a little tube. But if the number was different, they'd be okay with it. And that's got to be psychological, right? Mm hmm. Yeah.

Jennifer Smith, CDE 21:12
And I think it kind of goes back to what you brought up initially, is just that, that feeling of, I need so much, I must be doing something wrong. Like the feeling of just you're like beating yourself up. Because why else would I need this much insulin? And that that's not normal? Why should I have to take 50 units every single day? Should I be more on like 20 units a day. I mean, from a standpoint of like, overall weight management, sure, doses of insulin can make a difference. But there are other lifestyle pieces that go into that. It's not just the management of the dose of the insulin.

Scott Benner 21:55
So the way we do it here is is interesting, like are no go through swings of you know, there'll be a day or two where suddenly there's just like, way more carbs than usual. And you don't notice it when it's happening. But then you do notice that if you're especially if you're on an on the pot or something with a cartridge in it when you're like, Oh, I have to change my pumps sooner than I thought I was going to. And yes, and so she used to be like, why are we changing it now? And I was like, it's empty. And then you know, and she goes, Oh, why? as like, why do you think she goes, Oh, I got nachos at Mo's yesterday. And I and I had a milkshake today. And I was like, that is why so I you know, in a very, like, simple way, it helps her go. I am maybe I'm, maybe I'm carb crazy right now and don't realize that I'll pay a little more attention to it. I see it as a kind of a, it doesn't well, because it doesn't impact her adversely. in her mind. I see it as a positive thing. Because she she can kind of see like, Oh, you know, pay attention. Look what's happening to me. But anyway, okay. I appreciate you talking about this with me. Yeah, I really did not meaningfully understand. And I think this helped a little bit. And I want people like I let me ask you this, though. If there aren't outside influences. In general, you're comfortable saying more insulin is not unhealthy for people.

Jennifer Smith, CDE 23:17
As long as it's managing their blood sugar, and everything is in target and they have no other health concerns, then the dose that they're taking, is obviously working to help them maintain control. Yes.

Scott Benner 23:30
So when I say meet the need on the podcast, that's what I mean. I just mean there's an amount of insulin you need. Use it. Use it. Yeah. Okay. Thank you.

How about Jenny. I love Jenny. You love Jenny, who doesn't love Jenny? There's no one. No one law. I mean, maybe once in her life, she kind of guy off in traffic and that guy still like a person to cut me off in traffic, but they don't really know. It's Jenny. They knew this Jenny. They want that. They'd be like, God cut me off. You're fine. Anyway, Jenny does this for a living it integrated diabetes comm and you can check her out there. There's the link in the show notes. Alright, look, one last time in this 25 minutes that you've been with me, the T one D exchange needs your help. And the help they need is super simple to give. You just go to T one d exchange.org. forward slash juicebox. That's my link, use that link. And then when you get there, click on join our registering now. And after that, you complete this simple, quick survey. It's for us residents only. But it's so easy. Like right now, if you did it right now look at your watch. Or you probably want to watch to pick up your phone, touch the face of it. If you did it right now you'd be done in less than 10 minutes. It took me three hours. To bring you this episode, and this is all I'm asking in return one day exchange.org forward slash juice box. I mean, seriously, I the book Jenny, record the thing, edited it. I mean, you notice how there's no like pops and clicks and noises and nothing distracting while you're listening. You're welcome. That was me. Scott, click, click click with the mouse, I fixed the whole thing for you. hours it took like, you're just like, Oh, it was a quick 25 minute episode. It was nice. God said insulins important, blah, blah, no, no, it's more than that. It's deep. It's deep. It's building a narrative in your life about type one diabetes, giving you the tools and the access to information for the free. And all I ask is that you go to T one d exchange.org. forward slash juicebox. I only need 6000 of you to do it. I mean, there were hundreds of 1000s of downloads last month, I just need six of you. And I'm saying of the hundreds of 1000s of downloads. I need 6000. I'm tired of saying it too. I know you're tired of hearing it. I'm tired of saying it. But I mean, at some point, one of us has got to pick up the mantle and do their part. I can only do this I filled out the survey is easy. Alright, I'm gonna stop. I apologize. That was I that was too much, too much. I should just say T one d exchange.org. forward slash juicebox. You need to be a US resident who has type one, or is the caregiver of someone with type one. Please go fill it out if you have the chance. I mean, that's that's how I should say it. But I mean, come on this podcast is amazing. And it's free. Free. And what do I say to you? You know, if you want to try out an omni pod, go to Omni pod.com forward slash juice box I say if you want to check out the Dexcom go to dexcom.com forward slash juice box. I say want to get a great meter contour next comm forward slash juice box I say hey, my daughter's got this G Volk. hypo pan, you should check it out. That's it. I mean, you don't have to check it out. I'm not telling you to buy an ami. But it's not like if you don't buy an ami bike, and I love to listen to him. I'm just saying if you're going to go check it out. But this T one D exchange thing. I mean, you're on the internet constantly. I see the people in my life. I know you don't put the phone down. And I'm not judging you. I'm just saying why you're doing it. You don't I mean, p one d exchange.org. forward slash juicebox. Help a guy out a little bit. Make me beg you what's embarrassing? I'll tell you what, if the T one D exchange contacts me at the end of the month, next month at the end of June and says we've added 1000 new people to the registry. Thanks to you. If they say that, what will I do? I will do an online talk about using insulin. Once a week, in July, once a week. Okay, I'll come on. I'll do it on zoom. It'll be free, obviously, because you helped me out with the D one D exchange thing. And I will answer everyone's questions as long as I can. If we reach 1000. Now if we reach 1500 I'll get Jenny on one of those calls. If you do 2000 I'll do the call. Right? Every day every what I say every week in July, Jenny wants and what else will I do? I'll do something else. That's cool. I don't know what yet, but trust me, I'll come through T one d exchange.org. forward slash juicebox. Use the link. complete the survey. That's it.