#562 Katie and Scott Talk about Type 1

Katie is the mother of a child with type 1 diabetes.

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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 562 of the Juicebox Podcast.

I'm certain that you've heard me say that I talked to people all the time outside of the podcast about type one diabetes. Well, I can't anymore. This podcast has become so popular. I just don't have the time. But I didn't want to stop having the conversations. So now if somebody asks me, I just say, Okay, can we record it? And Katie is the first person to say yes, Katie was willing to have a vulnerable conversation, where she did not know what she was talking about, and was asking for help. And so we had this conversation together, and I recorded it. And now it's a podcast episode. definitely important to 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. That's very important because Katie, and my conversation is, is pretty full of me. You know, telling Katie what I think so just remember, I'm not a doctor. And this is not advice. It's just the Juicebox Podcast.

This episode of The Juicebox Podcast is sponsored by Omni pod, makers of the Omni pod dash and the Omni pod promise, which I'll tell you about later in the show. But for now, find out if you're eligible for a free 30 day trial the Omni pod dash at Omni pod.com forward slash juice box. Today's program is also sponsored by Dexcom. makers, the Dexcom g six continuous glucose monitor, you'll learn more about that@dexcom.com forward slash juice box. Get started today. I almost scared myself with my own deep voice just as like today's episode. I can't even do it again. I just haven't by mistake. Hold on. I'll try one time for you. I'm ready, rock calm. Today's episode of the Juicebox Podcast. Whoo, you feel that room rattled me right to my core. You are the inaugural one of these. In all of the years that I've been doing this, and one could argue that these phone calls lead to the podcast in some way. I've never recorded one of these. So thank you. And hello.

Katie 2:41
Well, hello. Yeah, well, I have like, a really old, like came with my phone. headset thing. You sound great. And so if you can't hear me, well, it's probably that it's kind of old. Like

Scott Benner 2:55
don't talk about it cuz you look you sound terrific. And I I was a little low on my end, I had to turn it up a little. So that's the only reason I couldn't hear you for a second. So okay, do we want to keep your name out of this? Or do you not mind using your first name or what's up?

Katie 3:10
I don't care. Okay. I don't think there's many people that will know me. So are you

Scott Benner 3:15
afraid you're gonna say, I don't want you to feel empty? Because this is gonna be like a real loose conversation about management where I ask a lot of questions. You answer. I talk for a while. I ask you if you have questions, like it's gonna go back and forth like that. It might take like, 45 minutes. Is that okay?

Katie 3:32
Yeah, no, I, I'm fine with that. I you know, I've been listening to your podcast for a little bit. And I, you know, I've been struggling. And my husband's was juggling with gauges, care gauges, my son. And, you know, your podcast really, honestly changed the game for us. And it's so sad to say, kind of, you know, a podcast changed for us more than our doctors said, you know, so I'm glad to help. I'm cool. With all that, you know, alright.

Scott Benner 4:08
Okay. So just because of the guest, because we're recording it. Just Introduce yourself very quickly and tell me a little bit about your son.

Katie 4:17
So my name is Katie. And gage is my three year old autistic son that also was diagnosed with type one. He was just diagnosed like six months ago. So we're kind of new to everything. Okay.

Scott Benner 4:35
All right. So if I have to stop myself, because I get questions right away, like stuff starts popping into my head to ask you and that's not what we're doing today. This is not a regular episode of the podcast. He started saying that I was like, oh, question here about this and then this, but no, so if if this was a regular phone call if you were so I guess first I should say this. There are three main types of people who reached out to me privately, I'm gonna say they're the type a people who have figured it almost completely out but still get like a weird rise somewhere and they want it to be perfect. And they can't figure out how to make it perfect. And they think I can help them. That one's always an interesting conversation because not that it's hard to take seriously, but when someone's like, Hey, I have a six, one a one C, but I get a little bit of a rise at lunchtime. You know, they're like, oh, you're doing great, like, No, I'm not. So there's that person type a really wants things to be perfect. There is the person who is generally lost, and just doesn't know what to do, and has gotten so desperate that they're willing to reach out to a stranger on the phone. And then there's the third person who I think of as having common sense, seeing that what's going on, doesn't make sense. They feel like they know what they want to do. But it's so flies in the face of what their doctor told them that they're frozen, and they can't act. Do you fall in any of those three categories?

Katie 6:18
Um, I would say probably the last one. Okay. The, you know, definitely not the first. But more like, the second and the last for sure.

Scott Benner 6:31
I have to tell you, no disrespect, but I don't, you wouldn't want to be in the first group. Those people seem to know what I'm talking.

Katie 6:40
There's no, that kind of makes me angry. It's funny, like, shut up. You got to figure it out.

Scott Benner 6:45
But, you know, it's sort of like, you know, once you furnished your house, but you still have one old table in the corner. You could live with it. But you're like, I don't want to fix that up too. So yeah, Everyone, listen, everyone's in a different spot. I would hope that you will be some someday at a point where you actually have that thought, like, oh is a once he's five, nine, but I wonder if I could make it five five. by that. I mean, I don't see why you couldn't. Okay, so they're gonna call would start. I feel like I'm narrating the call, which I'm gonna have to stop doing and just just talk with you. But you would jump on the phone, you'd be like, Hey, I'm Katie. And I'd say hey, Katie, how are you? I hope you don't mind if I clean a toilet or pick up leaves in my backyard while we do this? And you'd say, No, because I mean, what are you gonna say? And then I go, listen, Katie, it's really important for you to know that I'm not a doctor. That nothing we're going to talk about on this call is advice. If I misspeak, or you misunderstand me, and that kid of yours ends up dead, it's not my fault. I'm gonna need you. I'm gonna, I'm gonna need you to respond audibly that you understand. And

Katie 7:50
I totally understand. And all I'm

Scott Benner 7:53
really going to talk about with you is, what I do, and how I see it. Being applicable to what's happening to you, that really is like all this is going to be but I think it's gonna be really helpful for you. So then I started asking questions, and I say, How old? How long? What? insulin? What tech? So he's four. Is that right?

Katie 8:15
He's three three. Excuse

Scott Benner 8:16
me. And look at me already.

Katie 8:21
He's almost four. Really? born July one July.

Scott Benner 8:23
How much does he weigh?

Katie 8:28
I don't know. I would say probably like 40 pounds. It's pretty solid

Scott Benner 8:33
pounds. almost four years old. You say at all? He has autism? Yes. I don't know why that's important to this, but I'm already down just in case I forget. And he's had diabetes for about six months. Yep. Which insulin do you use?

Katie 8:47
So he is he does the shots. The pens so he's on human blog. Okay. During the day, like for his meals and stuff, and then he gets Basal Gar at night. So which is likely Santos Yep.

Scott Benner 9:06
And you have a CGM?

Katie 9:09
Yes, he has the Dexcom g six.

Scott Benner 9:11
Okay. Can you take your phone for me pull out his Dexcom turn it landscape. Go to 24 hours? Take a screenshot of it and text it to me.

Katie 9:21
Cool. You're not gonna be very

Scott Benner 9:24
happy. No, no, no, no, you misunderstand. Don't feel judged. I need to see it. So I know how we can fix it. Don't Don't worry about what it looks like. Now think about what it's going to look like. My next question would be is somebody home with him all the time, or is he in daycare or with another person?

Katie 9:41
So he was on he was in school, a special education school. And he had to leave because they don't have a nurse or anyone felt comfortable giving him insulin. So which is complete bs but Anyway, that's a whole nother story. So he, no, he's no longer in school or daycare. My husband actually left his job to stay home with them.

Scott Benner 10:10
Tell him that worked out well for me. I don't know. How will

Katie 10:13
I know. I was like I told him I was like you'd love this podcast and it's a stay at home Dad. Yes. And?

Scott Benner 10:20
Yeah, really? That's if you're looking for the biggest high side of being a stay at home dad. It's not having to shave every day. And I didn't. I'm sorry. Do you know how to text that to me? You maybe don't right?

Katie 10:33
Um, so is it like you're like a cell phone number? I'll

Scott Benner 10:36
give it to you. Just let me know when you're ready for it.

Katie 10:39
I'm ready.

Scott Benner 10:40
690 and that's totally getting bleeped out. And so zero. Yes.

Katie 10:52
All right. Let's see if that works.

Scott Benner 10:54
It did I have it. Okay. Except you didn't turn it landscape.

Katie 11:00
Oh, whoops. I have very good. Sorry,

Scott Benner 11:03
Katie. This phone calls over. You break one rule and could you do it again?

Katie 11:10
Alright, let's try again.

Scott Benner 11:13
You're in luck. This is going to be easy.

Katie 11:16
Oh, well, that makes me feel better. All right. I have to turn rotate back on on my phone because I always turn it off.

Scott Benner 11:29
Right now the people listening which are people from the future are like, come on, Katie.

Katie 11:35
Seriously, like how old are you?

Scott Benner 11:38
I got things to do. But they're getting this as a bonus episode. So you people stop complaining. Okay.

Katie 11:44
Can you give me a break here? with Katie.

Scott Benner 11:47
I don't know if you heard she had a three year old with autism and type one diabetes. You're lucky she's still in the house. I mean, honestly, you ever go to the grocery store and just think maybe I'll just keep driving.

Katie 12:00
Just gonna stay here for an extra hour.

Scott Benner 12:02
I talked to a woman yesterday who had four children. And while I was I was having what the conversation you and I are about to have with her. And her kids were screaming nonstop in the background. And I said, I said to her Do you ever think you just maybe are going to go and she is it occurs to me so. Alright, here we are. I got it. Thank you. Right. Now I got the graph. And normally I don't have to explain the graph while I'm talking because you're looking at it too. But let me just say out loud for people who are listening. It looks like you have your high alarm set at 250 your low alarm set at 70 that makes sense.

Katie 12:41
Yeah, probably. It sounds bad but he goes high so much that we're like, you know, we might as well set it a little higher because we're gonna Yeah, I mean we get alarms on it, we're gonna

Scott Benner 12:57
fix that we're gonna make it so that that doesn't happen. So I am looking at a graph that runs from about 10am to 10am right about there. Back at 10am the other the day before I see blood sugar's around 250 that came down to about 220 stayed stable for a couple of hours at 220 then it looks like there's food that pops it back to 250 Is that right? That makes sense to you. That first spike up that happens on the left of that graph does that look like a meal Can you still there Katie Oh what happened oh whoa oh wait she's muted That's hilarious. Oh, what happened Katie? Yeah, what happened?

Katie 13:58
Well, my phone I don't know what happened my phone just shut off and now it's like turning on and off and on and on. But you can hear me okay. No. phones. I had to use my husband's phone okay. And they're not headphones aren't working on it.

Scott Benner 14:15
Okay, yeah, go ahead just kind of try to keep it still you just have it up to your head. Yeah, yeah, just keep it from rubbing your face or your hairbrush and by the microphone we'll be okay. Okay, so I went through a ton of ideas what may have happened you struck by lightning in your home. I thought possibly you left your family and I use that perhaps you know, sometimes frozen urine gets dropped from airplanes and goes through people's homes. When that have been crazy. I thought maybe a car crash to your front window.

Katie 14:48
Go with all of that.

Scott Benner 14:49
Then when I texted you didn't answer. I was like, Huh, this is curious. I think our phone just thought

Katie 14:55
yeah, I don't know. It's still turning on and off. So I don't know

Scott Benner 15:00
If like, like it worked yesterday, right? What do you use it for yesterday? Give it a mean. Yeah, no, it's it has done it done that before. But well, let's let that go now. Okay. So where are we? Where was I was looking at the graph, which can you see? Or not anymore?

Katie 15:18
Hold on? Let me see. Are you still there? Of course. Oh my god, I feel so old right now. How old are you 31. Okay, see, I can still see his graph for you. I'm on my husband's phone, though. So if you need something else, that'll be from a different number.

Scott Benner 15:37
Don't worry about it, I'm just, I just want you to, I want to talk through the graph, and you'd be able to see it. That's all to my mind. So I was starting to describe it when you disappeared. What I'm seeing is about 10am to 10am 24 hours. At the very beginning of the graph, I have about a 250 blood sugar coming down, and then it levels off around 220 ish, and it stays there for an hour or so. And then it pops back up again, is that quick pop up some sort of food I'm imagining, probably, okay, and then a Bolus, which did drive the blood sugar down over the next hour or so probably like 130. But then it pops again, wants to go back up, then it drops back down, then it goes back up to 180. And now we're at 4pm is 180. It looks like somebody puts an insulin, he drops down, but then he spikes. Then he drops harshly to 65 ish. It looks like somebody intervenes with some fast acting sugar, which drives or food and drives them super up almost the 300 over the next seven o'clock, eight o'clock, nine o'clock, 10 o'clock time. It looks like it gets it drops down again, it hits 200, around 1011 o'clock. And say stoop stays reasonably stable between 180 and 220. From 10pm until seven or so when I'm assuming he ate, right. Okay, and then comes back up. And now in most recently around 930 took a sharp turn, which looks like food that wasn't covered well with insulin. So. Okay, so there's a lot of stability in your graph. And by that, I mean there are long stretches of time, where the blood sugar's not vacillating up and down wildly. I take that as good news. And you so you don't know how to Bolus meals and your basil is probably a little weak. And we're going to figure out how to tell you how to do that right now. So what is how much basil is he using that basil garden? And when do you inject it?

Katie 17:47
So we don't give it to him till nighttime. Okay, so like right before bed, like nine, nine anywhere between nine and 10 and six units of that

Scott Benner 18:01
basil guy around nine or 10pm? What do you think his correction ratio is? And what's his meal ratio?

Katie 18:09
Correct. is

Scott Benner 18:14
Katie, I lost you. Katie, I lost you. Oh, can you not hear me? I got you two right now. correction is what?

Katie 18:22
I'm 115 115

Scott Benner 18:25
for a unit and meal ratio.

Katie 18:28
So breakfast is 18. Lunch and dinner are 14.

Scott Benner 18:35
All right. This is mostly been set up by your doctor I imagine.

Katie 18:39
Yeah, I mean, the whole we don't really deviate at all from what they say which I know we could but that's okay.

Scott Benner 18:47
I just wanted to make sure it wasn't something you had done. Hold on a second. Seven. You said seven units. Excuse me. How many units are past the guard night? Six, six. Okay. six divided by 24 is point two five an hour. I'm gonna guess he could handle more than that. So, point four times 24 is 9.6. That would be point four. If we did point three five times 24 we get eight or eight. Okay. All right. Now I have to ask you some questions. The lows that I see and or I know they're not all they're not actually low. Actually. Let's go through that really quickly. What do you consider low?

Hey, this is a good place to drop in the ads because we're going to really get rolling after this and I don't want to break up the flow Dexcom g six continuous glucose monitor. Yeah. insulin. Are you using it for your diabetes? Yeah, probably want to Dexcom dexcom.com forward slash juicebox. See your blood sugar in real time right there on your cell phone if you like or on the Dexcom receiver, I'm picking my phone up right now. My daughter is at school, her blood sugar is 115 and extremely stable. Although if I'm being honest, it started to rise up about 35 minutes ago, from where it was sitting at 85. Yes, it doesn't look like food though. Although it could be. But Arden would have had to make a really rock solid Bolus for this to be a food rise. You know what, just for you guys, give me a second. I'm gonna text there. I'll be right back. through the magic of editing I am right back. It turns out Arden did make a Bolus for food. How crazy is this? I can see right on the CGM. I'm looking she's got this nice stability. 910 11 o'clock in the mid 80s. Everything looks good. And then I see a bit of a rise. But it's not drastic, you know. So it either looks to me like Arden's insulin needs changed all the sudden, or she's impacted her blood sugar somehow with carbs. And I just texted her and turns out she did. As a matter of fact, Arden Bolus for 65 grams of carbs, about 11am Oh, look at that. Isn't that cool? 10:55am art and boluses. And I see the rise beginning in the in a few minutes after that. The rise is controlled over the next 20 minutes and is leveling off now in the 115 range. So I'm thinking Arden did a really good job bolusing for whatever she had. But I can see that on my phone. So imagine what else I could see an unexpected drop. I don't expect that rise. Dexcom doesn't just show you that Arden's blood sugar's 115. It shows me that she's stable. If she was rising or falling, it would show me that too. And tell me at what rate that was happening. She could also be sharing this information with up to 10 followers. Right now it's just my wife and I looking at it but could be her school nurse or a friend or a loved one of any kind. dexcom.com forward slash juicebox see the speed and direction of your blood sugar in real time. Let's talk about Omni pod for a moment. Before we get back to Katy. You may be eligible for a free 30 day trial of the Omni pod dash. Go to Omni pod.com forward slash juice box to find out. That's it. A free 30 day trial. Are you kidding me? What do you still I can't believe you're still listening. You should be on the pod.com forward slash juicebox finding out if you're eligible right now. If you are, give it a shot. And if you're not, you could always get them to send you a free, no obligation demo pod just to try on and see what you think. That way you can at least get a feel for what it's like to wear the Omni pod. A lot of options. Head over to alibaba.com forward slash juicebox to find out about them. Now, maybe you're thinking right now Yes, God, I would but I'm waiting for the next big thing from Omni pod. I'm hearing it's coming soon. I don't want to get this thing and get stuck with it. Well, you won't. Because with the Omni pod promise you can upgrade to Omni pods latest technologies for no additional cost as soon as they are available to you and covered by insurance terms and conditions apply. But you'll get those details at my link. You're not locked into anything. There's no reason to wait. Get started today on the pod.com forward slash juice box dexcom.com forward slash juice box links in the show notes links to Juicebox Podcast comm when you use my links, you're supporting the show. Alright, let's get back to Katie. Thanks for listening to this.

Katie 23:55
m I'm so I get worried when it's at like 65 and it's like an arrow down.

Scott Benner 24:02
Cool. Katie, you're my kind of girl. Alright, so lowest 65 just for our conversation. What are you calling hi in your head to 50? Because that's where you set the alarm?

Katie 24:13
No, I mean, I know that Hi. I mean Hi. To me. It's like 180 and above, but

Scott Benner 24:22
that's great. I just want to make sure we're using the same definitions of things while we're talking. So you don't Pre-Bolus meals right?

Katie 24:31
We just started Pre-Bolus Singh. Um, but I don't think that we're timing it right.

Scott Benner 24:40
How long out are you doing that? It looks like I

Katie 24:44
don't know. Maybe it looks maybe like maybe 10 minutes.

Scott Benner 24:48
It looks like five to 10 minutes. So yeah, yeah, that's not Pre-Bolus thing. Enough, that would be like if if you started with a condom and then took it off halfway through and I practice safe sex, he kind of. So um, look at me feeling pressure to be funny because I know it's being recorded. That's interesting. That's a look into my brain. Okay, so here's what we need to do. We need to get your basil right, we need to teach you how to Pre-Bolus better. And we have to talk about the glycemic load and glycemic index the foods he's eating, so what kinds of food is he eating?

Katie 25:24
So he's eating really horrible food.

Scott Benner 25:27
That's a girl, be honest, let's

Katie 25:28
go. I'm just gonna be honest. I'm not going to beat around the bush he he has that the typical autistic diet where he pretty much eats the same exact things every day, which is kind of good in our case, but it's all high carb, like processed crap.

Scott Benner 25:49
Give me some some selections.

Katie 25:53
So like chicken nuggets. We try to get him like we buy him the organic veggie breaded ones that Walmart sells. So there, we pretend that they're healthy. And he eats those premade peanut butter and jelly sandwiches. So I can't work they're called uncrustables. So those are two huge things for him. So that's either lunch or dinner everyday for him with like snack so like a fruit strip. He eats those gogo squeezes. Trying to think like, you know, like Cheez Its anything chippy like he likes so basically carbs.

Scott Benner 26:45
tell you after hearing that list of foods, you're doing really well. Okay, don't I mean, you did not list one thing that is easy to Bolus for.

Katie 26:59
No and and that's the thing is he like he really likes oatmeal. But we kind of had to

Scott Benner 27:06
pretend it doesn't exist anymore. Yeah, cuz

Katie 27:09
we get we give them oatmeal, and he would be like, 300 all day.

Scott Benner 27:12
If brandy is listening, the person I spoke to yesterday, she told her child that because of COVID that you can't get Fruity Pebbles right now. I thought that was brilliant.

Unknown Speaker 27:22
That's a good idea.

Scott Benner 27:25
Anyway, okay. I don't normally have to ask this question. But how well does he understand you? How well are you comfortable that he's going to eat when you give him food, stuff like that.

Katie 27:35
So he's not, he's pretty much completely nonverbal, like communication wise, but he, he pretty much eats everything that we give him. And that's why like, in the beginning of this whole thing, they were like, do not Pre-Bolus you know, because he's so young, you don't know if he's going to eat. But we pretty much know he's going to eat everything. So there's been a couple times where he didn't, and he plummeted, and we had to give him juice. But other than that, I mean, he, he doesn't know that he has to eat everything. Or he's, you know, his sugar is going to

Scott Benner 28:16
drink something if there's an emergency or something like that,

Katie 28:19
right? So if we did Pre-Bolus for something, and he's not eating it, I would just give him something I know he's going to eat, like a fruit strip or something else.

Scott Benner 28:30
Right? Well, so there's, there's a couple of different things here. And I just want to walk you through some ideas before I tell you what I'm thinking. So, you know, to start over again, if the basil is not right, even a well timed Bolus isn't going to work, even if it's right. So say for say somehow, you know, Jesus comes to you and says, Hey, this one unit per 18 carbs is the exact right meal Bolus for gauge. Even if that's true, like, just undeniably true. If your basil is wrong, it won't matter. So imagine that, you know, you're, you're having a meal here and it's 40 carbs and gage is probably getting about two and a half units of insulin for that, right. And his basil is six units a day, but maybe it should really be eight units a day. And if that's the case, some of the Bolus that you're putting in when you're injecting for meals is really just making up for the job of the basil insulin. There's not enough there. So you know, if he needed 10 guys to I don't know, cut your lawn and only five of them showed up. When two more show up. You're still not going to get the job done the way you're supposed to be a hell of a lawn, wouldn't it? But you know, the point is, is that you if you don't have enough basil, then your bonuses are going towards basil job and then they're not able to go towards their job of handling the meals. Additionally, you're by not Pre-Bolus thing, you're letting the food get way out ahead of the, of the of the, the insulin, so there's just no way for the insulin to catch up. So again, if you don't have enough basil, and you're putting in your insulin in a way where it doesn't have a chance, even if you use the right amount of insulin, you're bolusing for the food not that are you correcting when you're boasting for meals? So if he's 220, before meal, are you correcting those who 20 and bolusing? The food? Yeah, okay, and that's still not working. Alright, good. And I say good, because then it makes me more comfortable talking about the Basal insulin.

Katie 30:44
So the Basal insulin that we give him at night, the Lantus or the Basal Gar, um, that is supposed to be holding him over for 24 hours, not just at night.

Scott Benner 30:58
Yes. So okay, your Basal insulin has one job. When you're on MDI, you shoot it in, it goes in, it kind of crystallizes under the skin, and slowly melts away. And its entire job is to over 24 hours until you put it in again, to hold your blood sugar stable at a number. So meaning away from food, and away from Bolus insulin, you know, meal insulin. Your blood sugar should be super stable at a number, and if you're using enough insulin, that number can be as low as you want it to be. So see how super stable he is overnight? Yeah, I mean, if he had more basil, insulin, he'd be super stable, lower. That's it.

Katie 31:53
So when he if he gets on, because we're trying to get him on the Omnipod if he gets on that, I think I've heard you say before that it kind of it like does a whole day not just that, like once

Scott Benner 32:06
what Okay, let's say that let's say we've Can you shoot half units of basil Gar are just full units.

Katie 32:12
It's a it's a half, you can do a half. Okay, good. So let's say no, no, the basil Gar is one unit at a

Scott Benner 32:20
time when you're done. So let's say we figure out that his basil hours eight units a day instead of sex. And when we're done here, I'm going to tell you to try seven like how long I'm going to tell you to try seven tonight and then look at your graph again and decide if it could be more right and I don't know if it's going to be or not but with such a carb heavy diet that's so consistent and I'm imagining Am I right is he active or not particularly active during the day

Katie 32:49
he's pretty active I mean, it's kind of hard right now with it being cold Yeah, um, but yeah, he's he's always moving around, he doesn't sit down for much.

Scott Benner 32:58
So we'll just make up that we come up with seven being the right amount, okay. And then you get an on the pod So what we'll do is we'll take the seven we'll divide it by 20 for the hours in the day and you'll start you're on the pot at point three units an hour of basil. So every hour the pod will give you point three units of basil and it will spread it out over the hour. So it just kind of like spurts little bits throughout the hour, just constantly putting it in until you get point three every hour and it just keeps going 24 hours a day. And the great part about that is is that you can increase it if you're having a particularly stuck day or you can decrease it if you're having a lower day or you're going to like say he's more active so you're going to a trampoline park or something like that. You might then say well I really don't he's not gonna be point three today today is going to be like point one. Like imagine you could reach inside of his body right now and turn up the bathtub or turn it down. You're actually going to be able to do that with a pump. But for now I'm what I'm guessing is at 40 pounds, he could probably handle more like point three. And he's not getting that he's getting six divided by 24 he's getting point two five, and that could be a big difference for him. So another point oh five times 24 is 1.2 more units of basil a day. And it might be four but it might be point four it might end up being eight units. I have no idea but if I was you the first thing I would do is tonight I'd give him seven units of basil var instead of instead of sex. Because this because even when he's down near 100 it's only because you're driving him down with a lot of like injections. It looks like does that make that right?

Katie 34:46
Yeah, I mean we still think that like there's a couple days during the week that we're convinced that he's still honeymooning because we like have to give him juice all day long. But then, there's some Is that it does seem like it, that is what is going on. Okay.

Scott Benner 35:05
So on those days where it seems like he's honeymooning, instead of just giving him juice, I guess you get caught in the loop like, Oh, hello, here's some juice, and then he goes back up, and then he comes back. Oh, cool, here's more juice, just give him something more substantial. Give him a half of one of those peanut butter things or a bite of one of those peanut butter things, put something in his stomach, it's going to stay in his stomach for a while on days like that. Because on days like that, when his body's doing the work, or some of the work, the Basal insulin you gave him is still doing what it's doing. So since you can't shut it off, when you're injecting it, you need to put, you need to then think of the Basal insulin like a Bolus. I know that's like a weird leap to make. But you can give him uncovered carbs. And if you give them enough of them that will sit in the stomach and digest more slowly, then that will hold his blood sugar up longer than June than juice which will go in and try to fight with that extra basil that he doesn't need because his pancreas is making some insulin today. And that it's just the juice gets overwhelmed and basically burned off too quickly to help you. So you have to put something more substantial and in those situations.

Katie 36:15
Okay, okay.

Scott Benner 36:16
So the graph I'm looking at here, is this a pretty a pretty common graph for most days?

Katie 36:25
Yeah, I mean, if you looked at it, like a few days ago, you'd be like, what the heck because that was when he we think he was still honeymooning. And he was like, dropping down quick. Okay, every hour, but I would say probably we've been trying to do it. Like, there's some days I that I'll look at it while I'm at work, and I'm like, wow, he's, he's doing really good today. And, you know, he's in like, the 119 area for most of the day. But he does jump up pretty high. So I'd say Yeah, probably, you know, that's pretty accurate.

Scott Benner 37:00
Okay, so the next thing here is, is the meal and so on. So I want you to try to imagine, tug of war. So we got a rope. And on one side, there's one team on the other side, there's another team, let's call one team insulin and call the other team carbs. All right. And in a normal tug of war, the goal is for one team to win, right, there's a flag hanging in the middle of the rope, and you're trying to pull the flag to your side. Mostly what's happening is your carbs are winning that tug of war. But you're playing a slightly different game, you don't want anyone to win the tug of war, you want the flag to stay in the middle. You want the carbs to pull as hard as they can, while the insulin is pulling as hard as it can, and no one, neither side be able to overwhelm the other. So when you see a really flat line, that's what's happening. What's happening is, you know, you see somebody on line, they're like, look at me, I Bolus for Chinese food, and I'm at and stable and you're over there cursing at them. And and the point is, is that they've balanced the impact of the carbs against the action of the insulin perfectly. You're not doing that. So what you're doing is you're setting up the rope, giving everybody the rope and you're telling the carbs, hey, you go ahead and pull now. But insulin, you're not going to get the pull for 10 minutes. Right? So even if you were to start at a great blood sugar, say he was 85. And he's super stable, say we figured out his basil. He's 85. He's super stable when he's away from food. And you're just like, we're so good at this. And then you go to feed him food, and he eats his crosstable but you put in the insulin five minutes before so the insulin goes in. In five minutes. It's doing nothing. He starts eating that crosstable it starts hitting him almost immediately. And now the rope starts getting pulled towards the carbs. He goes 85 he goes 90 he goes 95 He's 110 He's 125. Now you're diagnol up 131 arrow go straight up. The sound familiar? Yep, yep. Okay, and now he's flying up 151 80 boom, and then all of a sudden it starts to dip a little bit 180 200 it's catching, it's catching? Oh, I think it's gonna work. It's gonna work. No, it's not to 2250 right, that right there is when the insulin started working. Because without the insulin at all, his blood sugar would have went for forever up because he has diabetes. So right when you start seeing it to slow down, and then it starts to level off that time. That's how long it took for the insulin to have him like sway over the food. Right. So now imagine if you put the insulin in 15 minutes before then you'd be telling the insulin go ahead and pull sooner. And you'll keep messing with that a little sooner, right a little later. Sometimes it's a little more, it's a little less, and you figure out timing and amount. gotta use the right amount of insulin at the right time. If you do that, you can eat anything. Anything and your blood sugar won't go up. It has to be the right amount at the right time. Now Some foods are going to take an insane amount of insulin over other foods, you know bolusing well for broccoli is not as hard as bolting well for chex mix, or oatmeal or something like that, but it can be done if you can figure it out. So the first thing you have to do is Pre-Bolus longer. So you actually have to do it what happens, you guys put it in, and then you lose your nerve and give him the food.

Katie 40:23
No, so like in the morning, it's hard because he wakes up and he's like, ready to eat, like, give me all the food. And, you know, with his autism, he gets, he gets really aggressive and upset and it's almost like, Okay, are we gonna, what are we going to deal with? Are we going to deal with them beating us up until the insulin kicks in? Or,

Scott Benner 40:47
you know, up in the morning? Or does he wake himself up?

Katie 40:51
He pretty much wakes himself up. There's some mornings where we were. My husband has to because he has like therapies and stuff. Um, but he, he pretty much is about about Yeah,

Scott Benner 41:06
similar time. Yeah, okay. This is blood sugar start going up before he eats ever.

Katie 41:13
This when he wakes up, it starts to go up. Yeah.

Scott Benner 41:16
Okay. I'm gonna say good, because that means he wakes up. I'd give him insulin. Like, right away. And how was he with the shots? Does he mind them?

Katie 41:28
He doesn't like he doesn't like him. And that's why we want to get them on the pump. Because we literally have to, like, told him like, it's pretty. It's pretty aggressive. You know, like, my husband has to hold him down pretty hard for certain places.

Scott Benner 41:43
I used to have to hold I used to have to run after she giggled and ran away from me. So and then I'd have to grab her and hold her and I'd be like, come on, I had the needle in my teeth. And it was you know, I'm sure it was very hygienic. But my The reason I asked the question was because I was wondering if he just didn't mind the insulin injections could we do to in the morning, like, wake him up, pop in the unit just to get it going and then Bolus for the food? You know, I'm trying to think of ways for you to do that. But you're right. If you get to a pump, then either, you know I what I would do is I would say to myself, how much insulin does a meal this breakfast usually take? Can you tell me about how much?

Katie 42:23
Um, yeah, I've got I've actually got his chart right in front of me. And so he averages usually like, three, like anywhere between two and three in the morning for breakfast.

Scott Benner 42:34
Okay, and you think that when he wakes up how soon is it before he eats?

Katie 42:39
Pretty quick after he wakes up? After he wakes up?

Scott Benner 42:41
When's he eating? timewise

Katie 42:45
Um, so my husband says like, within 20 minutes to half hour,

Scott Benner 42:49
20 minutes to a half hour, but it would be sooner if it could be. Like, like, if you just if you gave him the if you if you like whip the peanut butter and jelly Adam in the bed, he'd start eating it. Oh, yeah. Okay, so you you, I just want to make sure so you have control of when he can start eating. So I have to say if that's the exact scenario you're describing, he wakes up, I inject the insulin as soon as he wakes up

Katie 43:17
with you, at the end he would do for the blood sugar. That is when he wakes up and what you're going to feed them on a Purdue bowl.

Scott Benner 43:25
Yeah. But we're also going to try to get him to wake up at a better blood sugar. But yes, I would. That means to be perfectly honest, at any point overnight last night, I would have tried to move his blood sugar with an objection while he was sleeping.

Katie 43:38
Okay, yeah, we have done that once. He was pretty high one night, and we went in and gave him some but it ended. I don't even think that it did a ton. Well, it's

Scott Benner 43:48
probably because he doesn't have enough basil too. But so that's so understand if the basil is only in there enough to hold him at 200 overnight, and you put in a little bit of insulin, he'll dip down but then his body function will push them back up again. So even though he doesn't have food, his body's still making glucose in different ways. And so I'm waiting, trust me in a couple more years when he starts growing, it's gonna get worse. So it's good. You're figuring it out now. So yeah, I mean, how much like how much insulin would have moved in from 200 to 100. Last night, do you think? Like, forget the chart for a minute, what do you think it would have taken?

Katie 44:29
Well, we did last night before he went to bed. We had to give them a unit.

Scott Benner 44:35
Then that's what it was like 300, like around 930 or so.

Katie 44:39
He was that's probably what Yeah, so we wrote it down it at 910. He was 242. And we gave them a unit

Scott Benner 44:46
and then he popped to 300 and then came back down. Can I ask you Did he jump up from the anxiety of the injection do you think? Do you know because if he doesn't like the shots, anxiety and adrenaline can push your blood sugar up.

Katie 45:01
So he actually was asleep woman gave him his head up anyway, last night. Yeah. So he doesn't mind them money sleeping.

Scott Benner 45:10
I see. Okay, I see what you did here. He's low around six, seven ish. He does this fire up and around 250 you're like, Oh, hell, and you gave him insulin, and it's still powered through that insulin up to almost 300 before it started to come back down. So I know you don't see that. But if you're looking at the graph, that's what I say. Yeah, pretty much. Yeah. So I'm gonna tell you that see the two dots that are the, the harsh shop and then there's two dots that are closer one that's farther away, and then they get tight again, around like maybe eight or nine right in there. Yeah, he's sharply going up there, that's when I would have given him the insulin for that, like you waited like, you really, you You let you let the momentum get on the side of, of the blood sugar. So even though you put a unit in, he only he went 250 to 300, then back down to 180. And then see how he starts rising again once the units out of him. That's because he doesn't have enough basil. That's exactly what that is. And even though the basil was in him all night, and it did try to get him down and only ever got him as low as like 170, maybe 175. So yeah, I think I think another unit of basil is a great start. I honestly think if you do another unit of basil, and try to do a longer Pre-Bolus let's just call it 15 minutes for now. Okay? I think tomorrow's graph looks substantially better. I wouldn't even want to mess with your ratios. Until we could get the basil right? And then get your beginning get your Pre-Bolus is right because I can't I can't tell if your ratios are they might be way too heavy and you don't realize it and and you're just making up for the Basal all the time. Do you does anything that I've said so far not made sense or been confusing?

Katie 47:03
No, I, I mean, it's, it's all making sense. It's all me It all makes sense. When you kind of explain it a little bit better than the doctors that I'm getting to. I didn't even know that the basil guard stays in his system that long. I thought it was just to keep him study at night. No, it's

Scott Benner 47:23
it's all day. It's supposed to be doing that same thing all day. You know, in a perfect world. I know you can't imagine this. But if he didn't eat in a perfect world, that basil Gar should hold him at like 8524 24 hours. It's hard to get right. Don't get me wrong, but that is the that is the overarching goal of that medication. That's what it's for. Okay, I'm gonna ask you to listen to the defining diabetes episodes. Okay, they're short. And so you'll get through them quickly. They're in your they're in your podcast app, but you can find them at diabetes pro tip calm to if you need them in a list. Because there are some pretty basic terms that you don't know yet. And you're so these these shorter episodes like you'll scroll all the way to the bottom there's a list of them there's I think it starts around 236 number 236. It's Bolus basil honeymoon, a one see some of these are, you know, just a few minutes long to 20 minutes long there, me and us and my friend Jenny. She's a CDE and she's had diabetes for almost 33 years now. As a matter of fact, for everybody listening we're gonna do like a big like online card for Jenny for her 33rd diversity. But we'll talk about that later. Standard Deviation extended Bolus algorithms non compliant like there's just a ton of there's a ton of just terms that if you understand not just what they mean but how they work there, they become tools in a toolbox so do that get through those and then once you get through those or at the same time, I mean, you should start the diabetes pro tip episodes. So it's going to be like this phone call except much more focused topic to topic and they started Episode 210 and you'll find them on that page as well. I think you're I think this is usually something I end up saying to a lot of people you are seeing it right like you're seeing the problems and you just don't have enough tools to do something about it. And it doesn't sound like your doctor is doing much more than saying things like let's change his carb ratio to one to 18 at breakfast and see what that does is that about it

Katie 49:42
is exactly what it is. That ain't gonna work.

Scott Benner 49:47
Because one to 18 might be too much. Like if we get his basil right, you might find his breakfast is one to 14 you might find as lunch as 110 maybe not, I don't know, but we're never going to know for sure while his basil is This far off. So and you need to understand what the Basal insulin does, you need to understand what all this stuff does or you can't, like imagine you're going 1000 miles an hour in a car and you're in control of it, you don't know which one's the brake. Like that's where you're at right now. So let's teach you what the brake is. And then you'll do better job when you need it. But I'm saying, just based on this graph, and what we've talked about so far, we're going to try another unit a basil at night tonight. And starting at his very next meal, you're going to Bolus him sooner Can I ask is what's the last time he's eaten today? It's 1047 right now, or is it 1047? Or your? Yeah, okay, what time has eaten last today?

Katie 50:47
Um, he had breakfast around eight. But he's, we gave him eggs first, and then gave him regular food, carb food. So probably, like 830, he was done maybe 30.

Scott Benner 51:06
By 30 1032 hours to the medical What's his blood sugar right now?

Katie 51:11
Um, might be too far away from him. It says 242.

Scott Benner 51:19
All right. I don't like this any more than you do. But go tackle him and give me an answer. Because I want you I want you to make a Bolus here with an intention of getting his blood sugar to 120. If that's a unit, if he really is one for 115, then that's perfect. Give him a unit. And let's see what happens because you either didn't Pre-Bolus his meal, which I don't think you did. Or you didn't use enough insulin for his meal, or a combination of those two things. And so he's now 240, he does not have enough basil. So he's gonna, he's gonna drift up till the food's out of him till it's been digested. And then his basil is just gonna hold them steady, wherever he's at. He's just gonna sit there. So drive him down and see if it'll sit there. Now, if you drive him down to 110, like say you give him this unit. And 90 minutes from now he's 110. And two hours from now, he's still right in that area, and he's sitting stable, well, then, hey, guess what? Your six units of basil is good. We don't have to give him seven tonight. But you need to do a better job at meals. And that might mean that these ratios are off, and you're not Pre-Bolus thing. So let's take a shot at it today. And I'm going to keep in touch with you. Okay, so take a shot out to take a shot at it right now try to drive them down to 110. And then I want to see what happens. Does he go down at all? Does he go down and stay stable? Does he go down and bounce back up. And now if he goes down, and it looks like it's going to be too far, like say he gets to like, you know he's at and he's one arrow down like an hour from now, well, then that was too much. But don't give him an entire juice box. Like give him a couple of steps try to stop the arrow. Because if you just throw in 15 carbs, then it's very likely that his blood sugar is going to stop going down like it did yesterday at six o'clock and then shoot back up again. Because you've got all these carbs in them that are uncovered because you didn't Bolus for them and your basis might be wrong. Does that make sense?

Katie 53:23
Yeah, cool. All right.

Scott Benner 53:28
Is it reasonable to ask you to jump back on and do this again? for like a post mortem for like, 15 minutes tomorrow? Yeah, that's fine. Even though it's Easter.

Katie 53:38
Oh, right. Yeah. Like I don't Yeah, I guess it depends on what time

Scott Benner 53:42
right. Well, whatever time is good for you. I just I don't want to just leave you and in the lurch. I want to I want to figure out what what happens.

Katie 53:51
I'll tell you what, Can I Can I ask a question ask a lot of questions. God. So if we do the unit now, so we've pretty much stuck to and I know it I know it's not right? But we're kind of like we have no idea how to do like a unit without giving them food and stuff. You know what I mean? Like he he's gonna be eating lunch probably in the next hour and a half. I would definitely if we gave him a unit now. I guess our thing is that we don't we've never really done that we've never like corrected for his blood sugar alone.

Scott Benner 54:31
Yeah, so here's how I would think of it for you. If you think he's gonna eat in the next hour, an hour and a half, then most assuredly give him the unit now. And maybe give him a unit and a half and then consider this a correction and a Pre-Bolus. You could do that or you could just give them a unit now and let's see how far we get down. Like say you give me a unit now. And an hour from now he's acting a little hungry, but his blood sugar's 150. Then in that case, What I would do is then Bolus his meal, right, and then wait for a little bit of a downturn like say the one they put the insulin in. And when you start seeing that insulin working is 150 turns into like 130 have a diagonal Down Arrow, that kind of thing, because it's your first time, then go ahead and feed him. And now you've got insulin on your side. Now Now you're holding that rope and you told the insulin Hey, go ahead and pull. So now, the interesting thing about when the insulin poles is it, it doesn't pull it full speed immediately. So it's not like a light switch. It's a slow burn, it's like it's like getting a tractor trailer up to speed, you know how you have this going to shift to like 20 years just to get into like 40 miles an hour, right. So that's how insulin works. It's like, it starts the pole, but the rope doesn't move. And then five minutes later, you're standing back on, I think the rope is moving, I'm not sure. And then 10 minutes later, maybe it did just move a half an inch, 15 minutes later, oh, it is moving 20 now it's moving a little more. Now you've got this, this starting blood sugar, let's say you started 100. Now you're 2025 minutes later in whatever that space is, you're at diagonal down. Now you put that food in, right, he starts eating at 85 diagonal down. And as the food starts to hit him, boom, the insulin kicks in. So now the insolence pulling as hard at it as it Canada 85. Now the food's pulling as hard as it Kennedy five, neither of them can win, and your blood sugar stays at 85. That's how people make a straight line on a graph. It's that easy. You know, it's not incredibly difficult, but it's that easy. It's that it's that simple, but it's difficult. But you have to have your settings right before any of that can work because if you're running in with that plan, with a deficit of basil, and carb ratio that you don't know is working while you're trying to fight with frozen chicken nuggets of fruit strip Go Go whatever the hell that is. And and across the board, you're in trouble. They think that's not those foods are of the most difficult ones. Like the only way you can make that worse is if you gave him oatmeal and put fruity pebbles on top of it, then I think maybe you could make it worse. And he would definitely Thank you Are you kidding me? As I'm saying it I'm like, Oh my God, why is no one ever put Fruity Pebbles? It can

Katie 57:13
sound seems okay, yeah, cuz we vote. You know, when they were in the hospital, they kind of scared us into our train of thought being okay, this kid's only gonna eat three meals a day. Yeah. snacks are gonna be pork rinds and eggs. Like, that's it. Like we

Scott Benner 57:34
were the country issue you live in.

Katie 57:38
upstate New York.

Scott Benner 57:39
Interesting. Okay. Yeah, well, listen, this ain't working. So you should try something different. And his blood sugar is higher. So I think the thing you need to try is more insulin in targeted areas. And I think you need to kind of, you know, like I said, like, do a little studying, we get some of those other episodes and kind of fill your toolbox up, tell your husband I said, Shut up and listen, like, Who cares what he thinks, just do it. By the way, when you're listening, and this is a personal favorite of me. Please don't listen on the same phone. So that I get credit for two downloads. I'd like you to listen. Thank you very much.

Katie 58:16
Hi, listen at work when I'm at work all day. Yeah. So

Scott Benner 58:18
he if he I don't know if he would hate me or like me, but the information is good. And you know, neither here nor there. What do you think something. So I do think that you guys, ironically, are only a couple of days away from a graph that you're like, holy crap, look at this, but you just don't know it. Like, aside from having to tackle him and not knowing anything about autism, if you sent your son here, I could get his blood sugar down and stable in the next four hours. Like I could do that, but I know how to do it. And it'll take a little longer because he's MDI and we have to wait till tonight to get in some basil. And it sucks because he doesn't want a bunch of injections, but I would use humor log to get his blood sugar down today. And then I would get the basil right and have it held there. That makes sense. I also I also definitely wouldn't try to get a pump.

Katie 59:12
I just think Yeah, we're we're trying we're I don't know if you I mean, you obviously know, but they're coming out with a new Omnipod and or an updated version and we're trying to figure out if we get it now. It will qualify for an update updated version 10 that comes out

Scott Benner 59:32
to the algorithm. You want to get the VM on the pod five.

Katie 59:35
Yeah, yeah. Like that.

Scott Benner 59:37
I bet you would give other kids Yes. Oh my gosh. Wow. How many Tommy?

Katie 59:45
Well, we have one that is 11. And we have one on the way so you're preggers?

Scott Benner 59:50
brave and or stupid people. Good for you. Congratulations. Which which Are you brave or stupid? But Tommy.

Katie 1:00:01
Well, we found out we were pregnant. Before gauge, we found out about his diabetes. So

Scott Benner 1:00:07
no, I say, gotcha. I also like found out you were pregnant. Did you have any inkling you might be? Yes. Back then, like you're telling you don't know how it happens if you found out you were pregnant when you got the invitation to the wedding, that's all. Alright, so any other questions?

Katie 1:00:31
I don't think so. I think we'll try that. And, you know, we really, I really don't like, I mean, even in the hospital, they I was so surprised that they let us leave the hospital and his sugar was like, 300. Yeah. And so when we left the hospital, like, okay, they let us leave, and it was 300. So we could probably get away with him being free. You know, we have that mindset. And so when I'm listening to your podcasts, and people are talking about, you know, a high, you know, a high for you is over 120 it's like, holy crap. It is like high all the time.

Scott Benner 1:01:12
I asked. I have a question I prior to the diabetes. I mean, he's always been on test deck, right? I mean, you've known he's had his autism for ever ish, I would imagine six months. Yeah. Yeah. But you have a feeling for who he was before the diabetes. Is he different now? More aggravated, easier to set off moodier?

Katie 1:01:35
Um, I mean, his his lifestyle changed a little. So I think that he's, you know, he's home all the time now, which he wasn't before. So that is different for him. But no, I you're not sure. But I don't I don't think I don't really think so.

Scott Benner 1:01:54
Because a lot of people don't recognize when their blood sugars are high constantly. That it's it's impactful on your brain. And it makes people short tempered and cloudy and confused sometimes. And so you may see a change in him after a couple of weeks of his blood sugar being lower and more stable. Does he know when he's dizzy?

Katie 1:02:17
No, I mean when he's been low before, like very low and he just, you know, acting totally fine.

Scott Benner 1:02:23
Okay, I just didn't want to like bring him down too quickly and have him because he could get because people can get dizzy at higher numbers than dizziness really exists, but it's still real. So you know, when your body becomes accustomed to higher blood sugars, and then even like, I helped a girl one time and she was like, like fallen over dizzy it like 150 but her blood sugar's were constantly 250 so it took her took her a number of days to get accustomed to it. And then she was fine eventually. Yeah, yeah. So that I just wasn't sure about that. So your your overall goals are if we're just talking about blood sugars, our stability spikes that don't go over 160 you I want you to get into a world where 160 is like a mess and 180 is a complete okay. And when you're away from food, or Bolus insulin stability that exists more between 85 and 110 Okay, so that's the ability that we saw last night that was basically between 180 and 220 we want that stability to exist more 85 to 110 overnight and you do that and you start Pre-Bolus the meals and you dial in these settings a little bit and his a one sees next day one to be 6.5 probably and I'm guessing now it's more like Hold on one second. For some reason a guest did not pop right into my head. So let me do a little checking his his a one C in the nines right now.

Katie 1:04:05
So the last time we had it done was actually when he was diagnosed and it was 9.6 I think

Scott Benner 1:04:12
average blood sugar of 230 is 9.6 so it would be interesting for you to know that I just pulled up a little glucose calculator that by the way is available at Juicebox podcast.com. And I typed in 230 because I think that's about your average blood sugar and it popped up a one see 9.6 so I when do you when's he gonna get it done next? I guess he hasn't had it done in a while because the COVID

Katie 1:04:35
Yeah, and it's mean he is like the most difficult person to get blood drawn.

Scott Benner 1:04:43
Gotcha. So you're gonna miss like for people to hold him down. Well, here's the good news. Right? If you if you aren't in by the way, want for years, no trouble ever, never any trouble and one year I forget how old she was. She just decided she didn't like needles anymore. In the windows office like she was backpedaling into a corner up the table into like, if she was Spider Man, she'd have been on the ceiling. And the nurse looked at me like what is happening? I was like, Oh no, and it lasted for a couple years. Like she she was able to do it finally, but in a panic the whole time and then one day it just went away. Now she gets blood draws, she's like, Here you go, she just throws her arms and she watches while the needle goes in. I don't know what happened, but she freaked out for a little while. Not to say that it's gonna get any better for gage. I'm not sure but what I am gonna say is that if you have a CGM, you can be reasonably assured of his blood of his a one sees using like their clarity app. Right? And so maybe that's the thing you can save him from is having to get those blood draws that are just for a onesies.

Katie 1:05:49
Yeah, I think they want to test him for other stuff like celiac, and I can't remember what

Scott Benner 1:05:54
Yeah, they're gonna they're gonna want to test them for celiac, it's very common with type ones. They'll probably want to test this thyroid function as well. Yeah. And the thyroid things uphill, if he has that. That shouldn't be difficult for him. But my God, if that poor kid has celiac,

Katie 1:06:11
I know how the healthy. I have no clue what the cavity? No. I don't think he does. I mean, I think we would know I

Scott Benner 1:06:24
think he would just be walking around holding his stomach constantly going. I think there's something wrong. Yeah. So Alright, so let's do this. Is he still 240? ish?

Katie 1:06:35
Yeah.

Scott Benner 1:06:38
All right. If you want, you can send me his next comment. I'll watch it overnight for you. So we can talk about it. You want to do that?

Katie 1:06:46
Yeah, that was the Dexcom share thing.

Scott Benner 1:06:49
Yeah, I'll follow him for like the next day or so. And we'll get back together tomorrow and talk for maybe a 20 minutes? Sure. Okay. I'm gonna say. So I'm going to push stop on the recording, and I'm gonna give you an email address to send me as Dexcom. Most podcasts would split this into two episodes to try to double their downloads. But I'm not a scumbag like that. So just listen to one more ad, and then we'll get back to it. It's not really an ad Actually, it's um, I don't know how I've explained that before T one D exchange is not an advertiser, I get compensated when you complete the survey. So it's not technically an advertiser, it's me using up my space on my podcast to let you know about it. It's splitting hairs, but neither here nor there. That's how it works. And I think it's important that you know, now that we're past that, that D one D exchange is looking for type one adults and type 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 your computer. After you finish the questions. And they are simple, I actually did it about seven or eight minutes, you will be contacted annually to update your information. And to be asked further questions. This is not an intrusive process, it's just an email. This is 100% anonymous, completely HIPAA compliant and does not require you to ever see a doctor or go to a remote site. So this is your opportunity to impact Type One Diabetes Research right from your home. Now every time someone completes the process using my link, T one d exchange.org. forward slash Juicebox. Podcast benefits. So if you've been looking for a way to help people with type one, research, or the podcast, nothing could be easier or more beneficial. So one more time, go to T one D exchange by using my link. It's right there in the show notes of your podcast player, or you can type it into a browser T one d exchange.org. forward slash juicebox. When you get there, click on join our registering now, and after that just simply complete the survey. It's super easy to do. And it'll help a lot past participants like you have helped to bring increased coverage for test trips, Medicare coverage for CGM, and have made changes to the ADA guideline for pediatric a one c goals, which is a really big deal. People filled out that survey and they took that data and impacted how the ADA talks about a one c guidelines. That's important because that's how endocrinologist hear about goals. So the reason that your endo right now isn't trying to keep you at an eight a one C is in part due to the T one D exchange, and the data that they collect from people who take the surveys. It's a big, big deal. It seems like it might not be, but it's huge. I'm excited to imagine what your participation might lead to. And I'm personally trying to add 2000 people to the registry by the end of diabetes Awareness Month. I hope you can help me one d exchange.org. forward slash juicebox. Thanks for listening to that. Let me catch up here. Katie and I spoke I started following her child on Dexcom. We texted back and forth For a number of days, then we got back together and recorded this follow up. You ready? Here we go. Okay, you are being recorded. So I appreciate you coming back and spending a couple more minutes with me. I expect you're going to talk a lot more this time and ask a lot more this time. So I'm just going to ask you, it's been five days since we spoke, how are things going?

Katie 1:10:27
Um, oh, they're kind of went the opposite direction. Okay. So instead of being I mean, he still has highs, but instead of being really high all the time, he's kind of now we're dealing with a lot of lows. And we're thinking that maybe that has to do with maybe the insula homologue, the the insulin that he gets when he eats, maybe that needs to be cut back.

Scott Benner 1:10:56
Okay. All right, let's figure it out for you, because your graph over the last number of days is exponentially better. Overall. You know what I mean? Well, I agree. Yeah, everything that's happening is happening, lower now, not hire, which is, which is amazing. When you do find, well, this last day, this last 24 hours. If I'm looking at it, and I am then I go back to last night. And I'm looking overnight, so you're correcting high blood sugars. Luckily, your blood the high blood sugars are cracking are now under 200. Which is really exciting. Yeah, and you even when you're high and stable all the way overnight, you're higher and stable between like 140 and 160. ish. And there's just big Bolus at 9am. Drops really fast. And then Okay, so all we did so far was move the base lop one unit, right? from six to seven. Yeah. Okay. And I actually thought for the first couple of days, that looked incredibly stable to me, like, like, I didn't see a lot of lows that were from, I didn't see any lows that were from basil. As a matter of fact, now even looking at the last 24 hours, I don't see any lows that are from basil, I see them from corrected high blood sugars. And you're getting like, like today, as an example, around 130 there's a little bit of like a 6065 blood sugar, and then it pops over the next 20 minutes up to like 75 or 80 levels. And then two hours later, he's 250 so what do you know what happened there so we can talk it through?

Katie 1:12:56
Um, so Zach was actually home with him today. And he went low. And I believe he corrected for he's he saw the low that you're seeing was like, okay, we need to do something because it's going to go lower, you know? Yeah. He gave him like a 15, gram, carb, gram, whatever. Fruit strip. And then it seemed like he was gonna be alright, and then it gradually just started going up.

Scott Benner 1:13:29
Yeah, 1515 carbs of something that sugary without insulin is never going to be okay. I would imagine I mean, unless unless his blood sugar was 65 and two hours down which the graph doesn't make it feel like it that was the case to me. But you have a tea? So are you looking at it? You see it? Yeah, I have a Okay, so just in general we're we're still looking at like timing issues, like you're either bolusing the meal and it's getting away from you and then you're correcting the meal. And it's either dropping super fast, straight down or fat not fast at all, but still falling over hours and hours and hours and ending up lower. So when that happens to me, that's a good indication that your meals are mis timed. Or you're not using an offense and like you're saying or too much insulin You know, one or the other at your meal time so what do you think is happening at the meals?

Katie 1:14:30
I really think that it's the excuse me that it's the actual amount of insulin we're giving him I feel like maybe now it's too much

Scott Benner 1:14:40
because you're on Pre-Bolus thing now. Yeah, cuz he's

Katie 1:14:43
definitely Pre-Bolus thing and i and i know that he's, you know, he's pretty much talking to me all day, like okay, I waited 1015 minutes and and then he eats and then it's like, holy crap. He's like dropping super fast and then you know, we just give them something else. But it seems like since we changed the basil, that he's been having a lot more of these lows after he eats, and the only thing I can think of is that his humalog is just there's too much being given for that now.

Scott Benner 1:15:17
Yeah, because we really did two things on day one on day one, we gave him another unit of basil. And you started to Pre-Bolus the meals. So I think of that as two distinctly different steps. And like I said, the basil, I think is, I know you had to correct a 65 today. But the truth is, is that he was on the lower side from 930 till one, but he was still between like 65 and 75. In that time, so there's still stability there. But what you really need to look at from that is that it came out of a, this nine a 177, blood sugar that somebody hit very hard, because it dropped like a stone in like 35 minutes, down to 60. So everything that's happening after that big drop is, I think, precipitated by the big Bolus that brought you from the 170 ish down to the 60. So that Bolus was see how fast it worked. Like to me, that means you put in a lot of insulin that didn't have a lot of resistance, and then it gets down. And I'm assuming he ate in there as well. Yeah, I think a lot of that, I would be hard pressed to say that the basil is the issue is what I'm saying. I think you're definitely right. And let's talk about why for a second. Because before when you weren't using enough basil, and you weren't Pre-Bolus Singh, you needed more insulin to stop the spike. Because the blood sugar just didn't have any resistance coming from anywhere. It didn't have any resistance coming from a timing aspect because you were Pre-Bolus thing. And it didn't have enough resistance from a basil aspect. So you fix the basil or make the basil a little more aggressive. And then you start putting the insulin in sooner that gets it working sooner. So that just makes sense to me that then you're right. You're probably using you're probably using too much meal insulin back then. And you need to probably take some of it out now. I think that's probably your next step. So what's his insulin to carb ratio?

Katie 1:17:28
I'm trying to remember I had it in front of me. So he gets he gets I'm trying to think because they're all different. 16 I think for breakfast, although we noticed with the with it going down, Zack had changed everything back to to an older number that we had before. Yeah, so he was getting he changed it to like 20 but then that still he's still dropped pretty low. Yeah, it's so I think we're just gonna, like tweak it a little bit. If that if that helps.

Scott Benner 1:18:13
Yeah, no 100% I would say that, that you're gonna have to, like play experiment in here a little bit and keep changing the ratio for the food until you're getting a Pre-Bolus that doesn't result in a spike. Or if there's a spike it comes back down and gets level it doesn't come back down and and fall or you know, you don't have to put in insulin to make it come back down. You just wanted to sort of happen. We don't care if it goes up a little bit as long as it's gentle and not spiky. Right? Yeah. And does it make this the reasoning? Why makes sense to you after I said what I said. Yeah, okay. Yeah, definitely. Cool.

Katie 1:18:51
Do you guys I was already kind of thinking that good.

Scott Benner 1:18:54
Yeah, no, no, you're you. You I felt like you got a lot out of our other conversation. Because cuz you guys really like that the two days afterwards, were just exceptionally good. And you were just still figuring stuff out. It's and listen to say that you're not going to figure out Pre-Bolus in four days is an understatement. Like you're gonna have to, you know, you're gonna need some more time to figure it out. But you're not creating. You're not creating scary panicky lows. And so, you know, and his blood sugar right now is 109 which is just amazing. You know? Do you have any questions?

Katie 1:19:35
No, I mean, the only thing is that we we just got approved like, fully approved for the Omnipod dash cool. And so we're setting up setting up going to his hospital and having them train freenas on it and having them you know, put put it on them for us and all all that fun stuff

Scott Benner 1:20:01
yeah

Katie 1:20:03
and at that time we'll be able to control his basil like hourly right so we can you know if we notice a low at a certain time a day we can just change it

Scott Benner 1:20:18
you should win it'll

Katie 1:20:20
be easier

Scott Benner 1:20:21
oh my god it's so much fun the first time somebody explained to me what an insulin pump was it felt like they gave me like an on off switch for basil which was always my biggest like concern was once you injected it, it was in there and you couldn't do anything about it you know your Basal rate per hour should start in my estimation are around point three an hour watch that the hospital doesn't try to like make it point one or something like that and then tell you like oh we just want to make sure like it's not too much because if they make it point one his blood sugar is going to be 250 constantly and so you know point three it might end up being point two five you know what I mean? At some point maybe overnight it'll be point two like I don't know but it isn't going to be like point one or point one five in my in my estimation so just kind of pay attention to that when you make the switch when you're doing it you know

Katie 1:21:16
um, so we asked to do it in person because they asked if we want to do it virtually or in person but we're not comfortable doing it on our own so the first time at least and so we just have to wait for them to tell us when we can come in person so hopefully because we should be getting getting all the materials tomorrow and in the mail so we should probably next week or the week after at least

Scott Benner 1:21:44
excellent very cool that's that's amazing I think and he's gonna be okay with it right cuz he leaves the Dexcom alone so he should be for the

Katie 1:21:52
pump right every once in a while he touches it but

Scott Benner 1:21:55
it's not really an often thrown across the room or something like that.

Katie 1:21:57
Yeah, actually the day that I was talking to you we got our so I went on to touch by type one and he got the box that they give to people who are newly diagnosed and it came was the demo

Scott Benner 1:22:14
Oh the power demo was in there cool.

Katie 1:22:16
Yeah, so it was cool so I just stuck it on him and to see you know how he does with it on like his back area because we're trying to figure out where to stick all the stuff Yeah. And he he was fine with it so we're thinking yeah, he's gonna do okay I'm excited

Scott Benner 1:22:32
because you to you and your husband? I thought I thought made like a quick adjustment like it all seemed to make sense and you're you're you're doing a great job like I it's I know that his graphs not super like like smooth and straight and everything and you're probably thinking like oh, you know, but it's so much better. Like it really is like it's just do you feel better about it in general?

Katie 1:22:56
Yeah, I mean, I feel way better about it because I was just so glad that Zack actually was on board with it and you know, he felt comfortable with it because he's the one that's with him you know all day long so I was really happy to that you know, you kind of convinced him about all this stuff.

Scott Benner 1:23:18
I ended up texting with him by mistake I think because your phone died like the the day or something after we talked and so I ended up texting with him he asked me a couple questions and I just answered them and you know it's funny because guys text so much differently than women though. It's, it's like yes, no, thank you good. But now I felt like he understood everything I'm seeing. You know, as I look at this CGM tells me that you're doing a good job. And it's and it's making sense to you and you're going to, you're going to figure it out. You know, like it's coming around. I have to tell you right now, of the four people I'm following right now Your son has absolutely the best blood sugar of the four of them, including my kids. So he's doing really good. I got a 109 a 134 or 146 and a 67 on there so Wow, you're you're winning in mind. 67 is pretty stable, though. Alright, let's let's we will have to, we'll have to, we'll have to have a little race at the end. I'm going to I'm going to unfollow him if that's okay with you unless you want me to follow them a little longer. And if you do tell me if like if you're gonna try something and you want me to look back at it, that's fine. I don't have a problem one way or the other. Just tell me if you need me again or if you want me to be gone.

Katie 1:24:41
Okay, I mean, at this point, you know, I think it's fine if you unfollow him. If I feel like I need your opinion on something I can just, you know, we can just read them that okay. Yeah, cuz I think when I know what our next steps are, but, I mean, we're gonna be getting on the pump. Anyways, so not like we're gonna be able to do too much in that timeframe. Yeah,

Scott Benner 1:25:05
I think just keep working on your Pre-Bolus is keep adjusting the amount of insulin you're using it meals, and you know just try to react mean you're doing a really great job like listen when when you and I got on the other day and we started talking I had no idea your son had autism. And that must add like a level to this that I just can't possibly fathom you guys are doing a really, really good job and you're so new at it like this is April, I've only been at this like five months or so right? And so you guys are killing it like you really are. Yeah, definitely don't feel bad about anything, if you even have the inclination to feel badly work on the Pre-Bolus thing. Keep in mind, and then, you know, tell your husband to keep paying attention, like you know, I put a strip of this, this stuff in to correct and it was too much next time, let me try giving him a quarter of a strip of it. You know what I mean? Like that kind of stuff doesn't have to be the whole thing just because he opened it. And, and he'll learn how to kind of bump those blood sugars around a little bit. And you'll be on your way is that listening to the pro tip episodes?

Katie 1:26:15
I think that he maybe has started listening to some because he, you know, was using all these new terms I didn't think he knew. But I don't know for sure. I really don't know. Well, I did though I listened to podcasts all day at work. So I listened to pretty much all of them. And now they were great. really informative.

Scott Benner 1:26:37
I'm glad I'm glad just Hey, look, let him know that I think it would be a great idea if he listened because he's he's super close. He's just got to think about it a certain way, and it'll start working out. Right. I appreciate you jumping back on. Anything else. Any questions? Anything?

Katie 1:26:52
I don't think so.

Scott Benner 1:26:53
I'm calling you. Well, you're very welcome. I'm calling you a win. And I am unfollowing your son done. I am no longer seeing your private life. You absolutely sent me a note if you need anything, okay? Okay. All right, Katie, hold on one second. Gone, because I'm sorry, I'm turning the recording back on because I should have said this to you. There's two possibilities in here. We fixed this basil. And now you have to fix the meal ratios. Or now that your Pre-Bolus thing. Maybe the basil could go back to six. I don't know which is which that's the thing you're going to pay attention to over the next couple of days. So if you start getting better and better at the Pre-Bolus thing, and you start finding stability at like 90, then you say to yourself, okay, great, we're looking good. But if you start getting better at the Pre-Bolus thing, but the stability you have is still too low in the 60s or the 70s. And maybe you have to take the Basal back to where it was. Does that make sense that maybe because you weren't Pre-Bolus Singh before. The basil wasn't the problem. And we kind of fix the problem a little bit like CGM. I'm saying like, as crazy. I was almost cursed. But as crazy as that sounds, it could end up being one of those things.

Katie 1:28:07
Yeah, I mean, I, I can understand that. Um, my thought my only thought is that. So like, at some point today, I'm not looking at as graph right now. But he was studied for a while. And it was read before, I believe is right before lunch. And so I said, Zack, I was like, you know, you're going to Pre-Bolus and then watch him because if he goes, whoa, then you know that it's the human log, and it's not the basil,

Scott Benner 1:28:39
right? I don't, I don't think I want it. For clarity. I don't think the basil is a problem, I just want you to remember that it's an option, that there are two different insulins working here and then by the, you know, by the way, you're gonna get on a pump, and then it's, you know, and then you're gonna have more control over the basil, then you could then you could start doing like point two, five an hour, you know, and see how that goes. And you could get kind of granular with it. Because you know, either six or seven might not be the right thing, maybe it's six and a half a day really needs. You don't. So you'll have that kind of fine tuning when you when you get the pump to write plus, if it you know, like I said, Maybe he needs point three during the day. And he'll need point two, five or point two overnight, like I'm making up numbers. But if that happens, you can you can make that change. And now you're not just counting on this insulin to go in one time a day and magically take care of 24 hours basically. Anyway, I just want to say that to you so that people can hear it too. I don't want to keep you I know it's late in the evening. probably have to go feed your family and avoid things and hide watch TV and stuff. isn't about what you're gonna do. I'm gonna push the button shut this off again. Huge thanks to Dexcom for sponsoring this episode of the Juicebox Podcast. Find out more about the day Dexcom G six@dexcom.com forward slash juicebox. There's links in the show notes and links to Juicebox Podcast comm Also don't forget about that Omnipod promise. And don't forget that it's possible you're eligible for a free 30 day trial the Omni pod dash Omni pod.com forward slash juice box. And lastly, but not leastly. That's not a word, Katie for coming on the show and having this rather private conversation in front of everybody. Thanks so much, Katie. I hope you and your family are doing well. I'll be back soon with another episode of the Juicebox Podcast.

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