#608 Diabetes Pro Tip: Honeymoon
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ 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 608 of the Juicebox Podcast.
Today I bring you the 25th installment of the diabetes Pro Tip series. On this episode Jenny Smith and I will discuss honeymooning. I know that a honeymoon can be very difficult to navigate both during it. And as it ends. It's difficult for parents of children with type one as well as newly diagnosed adults. So today, Jenny and I are going to do a deep dive on it. I think it's going to help you. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. If you're looking for the rest of the Pro Tip series, it's available diabetes pro tip.com, juicebox podcast.com, where you can go right into your podcast app right now. Hit search and look for diabetes pro tip Juicebox Podcast, they should all pop right up. But there's great lists on the website.
If you're looking for community around type one diabetes, or diabetes in general, you should really check out the Facebook page for the Juicebox Podcast. It's called Juicebox Podcast, type one diabetes. All you have to do is search for it in your Facebook app, answer a couple of membership questions. And the next thing you know you'll be in there with like 20,000 people living with type one and type two diabetes. You can ask questions, make friends, use this space, any way that's best suited for you just lurk if you want. There's a lot to learn just by looking Juicebox Podcast, type one diabetes on Facebook. I know. I know what you're thinking Facebook, people are going to argue and complain it's going to be horrible. But this group really is special. There's not a lot of that going on in there. And I think you'll like it. Just give it a shot Juicebox Podcast, type one diabetes. Last thing before we get started. If you have type one diabetes, or you're the caregiver of someone who has type one diabetes, and you're a US resident, in less than 10 minutes, you can take a survey that will help people living with type one. It's AT T one D exchange.org. Forward slash juicebox. I've taken the survey myself, it really does just take a few minutes you can do it from your phone or your laptop or wherever is 100% HIPAA compliant and absolutely anonymous. It really does help people living with type one, give it a look. T one D exchange.org. Forward slash juicebox. Okay, so we're recording, I want to tell you that this lovely woman named Isabel has been helping me with the Facebook pitch. And she came to me recently and said, You need a pro tip for female hormones and you need a pro tip for the end of a honeymoon. She said these are things that people ask about constantly. And they must not feel like they're getting what they need out of the podcast on this. Now Jenny, you know, in my heart, the end of the honeymoon just means use more insulin. And when you get your period it means use more insulin but darn it, let's let's just dig into it and find out that the details Okay.
Jennifer Smith, CDE 3:47
Sure. Yes, they're both good. Good topics. Yeah,
Scott Benner 3:50
the details are apparently what is needed, and I am happy to deliver what is needed. And by that, I mean dig it out of your head and record it so people can hear it. Sure. Okay. Because my only experience with honeymooning that my only experience that I'm aware of personally with honeymooning because Arden had diabetes, you know, was diagnosed so long ago, and we had a little meter and some needles. I mean, I didn't really know what was happening in her. So the one thing that I can tell you is that I called my friend who was my children's pediatrician one day, and I I told you this before, but it fits in this this episode. So let's put it here. And I told him I preface my conversation by saying I know what I'm about to say is ridiculous. But is there any chance Arden doesn't have diabetes? And he said and he sounded sad. I think sad that I asked him and he's and he said why? And I said, Well, she hasn't needed insulin for about a day and a half now. Right? And that lasted maybe? I don't know. 72 hours. And then it was just going. Yeah, anyway, that's my entire personal experience with honeymooning but I know how difficult it can be for everybody. So,
Jennifer Smith, CDE 5:10
well, another good question. And that I mean, as you sort of began with, I just give more insulin right? Well, a good piece of honeymoon is or coming out of honeymoon, right? You're, you've kind of moved through that lack of insulin need or really, really, some people can get by on just Basal insulin. They might not need anything for their meals or their blood sugar's don't go high enough to correct or anything right. But did you notice also that after that, like, three ish days, that her insulin needs were higher than they were before that?
Scott Benner 5:48
Well, here's the here's the honest answer. I don't know. I didn't know. You don't remember. No, no, forget that. I don't remember. I didn't know what I was doing. Right. So like, I think that feeling maybe encapsulates more honeymooning and the and the leaving of honeymooning for people more than anything like, right. So somebody you or your child gets type one. It's a whirlwind. It's you know, and if you're honeymooning, insulin needs are changing kind of radically sometimes. So just when you maybe get the nerve to, I don't know, Bolus two units of a Basal, you know, and then the next day Your fight is 60, blood sugar all day that won't go up. And then the next day, you think, well, maybe I shouldn't use the two units of Basal and then you don't and then your body doesn't help that day and your blood sugar's 300. All day. That uncertainty, I think, is the main characteristic of honeymooning, don't you
Jennifer Smith, CDE 6:42
true and honeymoon is it is really different person to person, as well as the like, movement out of honeymooning is different person to person, like you didn't have art and didn't have a very long honeymoon at all. And that's not uncommon from the studies that have been done. It's not uncommon with kids under the age of five who are diagnosed, to have a much more rapid rapid onset of type one very quick, very aggressive, really high blood sugars, you know, unless they've been watching for it, or they know because of previous antibody testing that it could be coming, you know, DKA, all of those kinds of things. And what that results in is causing enough of the betas to be stressed enough and the body kind of decreasing them enough in, you know, in amount that now diabetes presents itself, okay? So but in older kids, and especially in adults, there is often a slower progression of type one, like, you know, here it is, yeah, and all those symptoms, and that often leaves more betas in the picture. Also, what's been found is that the sooner you get containment of blood sugars after diagnosis, you give some relief to those beta cells. And because now, you know, you're either injecting or you're pumping insulin. And so that's something that's helping to take care of the blood sugar levels. And your betas that do remain can actually help out and so honeymoon then often comes in, you know, where, usually somewhere between about one to four months post diagnosis is the typical like, honeymoon, time to expect that to come into the picture and how long it can last again as person to person, it could be a couple months, it could be three days, it could be a year or two that you continue to have this like lack of more typical insulin need.
Scott Benner 8:54
It's the consistency that you're that you're missing and, and yeah, that breaks people's hearts I think I'll tell you after interviewing so many people, I've heard, I believe every variation of time and distance about honeymooning from adults and children and crazy stories where blood sugars are suddenly super normal super out of whack. One lady I'll never forget told me like she thinks her honeymoon lasted years. And then I'm wondering like, is that? Is that honeymoon? Or is it a slow onset? Like is that like, and I guess it doesn't really matter, right? Like, what matters is that you're using insulin now. And in there's going to be this variability to how much until things I guess you could just say settle but obviously it's not settle. It's until your beta cells give up. Right right completely. Do do some people just not see a honeymoon at all. What does that mean? And they're not aware of it. In talking
Jennifer Smith, CDE 9:53
with so many people that I have, and you know, it's always something I asked about his diagnosis. If somebody wants to talk about it, you know, or if it's been very, very soon after I get to talk or, you know, before I get to talk to them, it's been very close to that time period. And it seems like, again, everybody is a little bit different. A little people again, very little people tend to be the ones that I hear the most, we didn't notice very much honeymoon, or, you know, parents are concerned, because they're like, I don't know, I feel like we never had a honeymoon, I feel like, we never needed just like a little bit of insulin, we just went from not using any really using insulin, you know.
Scott Benner 10:37
So functionally, how do people deal with it? So when, you know, let's say, I came to you and I said, Hey, here's my seven year old kid, yesterday, this Basal, and this meal ratio worked perfectly. Today, it's a hot mess. And I'm saving low blood sugars all over the place. I don't know what's gonna happen tomorrow. But as I look back, this is bouncing around. It's two days of this one day of that. But how do you find reasonable stability until things get normalized?
Jennifer Smith, CDE 11:12
Well, some of it again, in that early time period is it's a bit of estimation, you can base it on Well, yesterday was a really sensitive day, if it looks like we fought low blood sugars all night. And we're entering morning time again, today, with lower blood sugar's yet again, that's a good visual that maybe today needs to be covered similar to yesterday, or even less aggressively than yesterday, right. So some high insight can help. But then, you know, tomorrow morning, you wake up high. If you didn't do anything strange overnight, and you're all of a sudden, high, today might be one of those days that you're going to need more insulin. And so it, it's hard because it takes out of the picture, a lot of the things that we've done. In other we've discussed in other episodes, like testing, right, and doing things like Basal testing, in this time period, it's kind of hard, because you don't really know exactly day to day, how things are going to move overall, the general idea that kids before puberty, once remission, has kind of gone away, right? Once that honeymoon period, you're expecting it's over. Insulin needs usually are about point seven to one unit per kilogram per day of insulin.
Scott Benner 12:34
Say it again,
Jennifer Smith, CDE 12:36
point seven to one unit per kilogram per day of insulin. So and if you don't know, pound two kilogram conversion, just take your pound weight and divide it by 2.2. And you'll have your weight in kilograms. But that's a it's a, it's a baseline, you know, if you were really, really, really low to begin with, and now you're doing a really low carb diet as well. You may not really see that insulin dosing kind of go along with what we would expect in terms of overall insulin need, right? Usually, people are considered in remission, if they're at, you know, point five or less point five units per kilogram per day or less of insulin. And then, you know, once you get to puberty, gosh, I mean, you could use anywhere between a unit to two units of insulin a day during puberty, and that's completely normal. Absolutely, and completely normal. So if you're not so sensitive anymore, you definitely see these swings in blood sugar, you know, especially in that growth period overnight or in the aftermath of meals and is lasting and lasting and lasting. guarantee you're probably not in honeymoon anymore.
Scott Benner 13:50
Well, you know, you I've said it to you have said to everybody listening, you have to meet the need. And I don't know, it's clear enough about that. But if one day the need is greater than meet the greater need and if one day the the need is lesser than meet the lesser need and, and flexibilities just it's completely key. It's what you're saying. It's like you have to sort of I don't think that I don't think that during honeymoon you want to look real macro. Not all the time, right? You want to kind of just deal with diabetes and segments of it of half days or hours or something like that. Like here's what's happening right now. If it starts trending one way, then adjust with it if it starts trending the other way then adjust with it. But I don't think there's a lot of value unless you're matching an apples to apples day and going well last Thursday. You know she was really low so I don't want to be aggressive six days later. You don't I mean like today's got no no Yeah, yeah, there's no correlation between now six days ago when you're in this honeymoon fluctuation. And I know that people We're gonna think I'm flipping but I think you could just retitle this episode, diabetes pro tip ministration. And I don't know that we're gonna say too many different things when we get to it, which is why maybe for some people, they gloss over it when we talk about these basic ideas of like, it's not always going to be the same all the time, you can't always ask for a cut and dry answer. I mean, if you want to get through a honeymoon period, and it's, it's particularly, you know, Rocky, I think that just staying flexible, meeting the need, you know, taking a little bit of historical knowledge off of days that were similar to the one you're experiencing now. I think that's really the whole thing.
Jennifer Smith, CDE 15:45
I think that's the best that you can do oftentimes, especially in honeymoon, and then even, you know, coming out of honeymoon, there's, I know, some people use the word like it becomes more stable. Okay. Sure. More stable in the fact that you're not like giving only one unit and that whole talk takes care of your whole day. Yeah, yes, absolutely.
Scott Benner 16:12
But yeah, or that one day, the units necessary. And then the next day, it's not necessary. But there's,
Jennifer Smith, CDE 16:19
I think there's more consistency is, is it exactly and I mean, in honeymoon, again, there are ups their downs, yes, you can, you can choose to use insulin from some hindsight from, again, I know, on a really, really busy day like this, my child needs a lot less insulin, but is running high today. Okay. Again, it's the then meet the need in terms of where the blood sugar is right now. And thankfully, these days, I mean, you didn't have an I certainly didn't, as a kid have any visible to where my blood sugar was going at all. It was a one number, it could be rising in 10 minutes, it could be dropping in 10 minutes. And that's what
Scott Benner 17:03
it was. I wonder sometimes when I'm like, I'm speaking to this person, now, who's got a very small child who I think still their needs are, well, they're not honeymooning, they were just, they had too much Basal going. So it's, you know, by using too much Basal, they were getting drops, that didn't seem to make sense, right. And so it took a day or two to figure out that the Basal was too high, to bring it down a little bit. But in there, while we were trying to figure it out, this person was using pens. And so they were relegated to point five units at a time, right, and I just said you have syringes, and she did was like, just eyeball less than a half. Next time we go for this meal, and did that and fixed a lot of their problems. So while this kind of unseen force, obviously, I'm talking about Basal that we needed to fix though, but you know, let the unseen force be, you know, your pancreas working all of a sudden, was dropping or down? If the limiting factor was the was the measurement on this on the pen. And then you like, for some reason, your brain doesn't jump over that and go, Well, this might be too much. But your brain says this is all I'm able to do. Do you know, I mean, like, and so but the minute we dropped down to like these quarter of units, then suddenly, there was far fewer spikes in the meals, and then far fewer lows afterwards. And I'm just wondering, like, during the honeymoon period? If you are that scared of these crazy drops? Do you maybe just draw back your Basal a little bit? And then on days when that Basal is not enough, just increase your meal insulin a little? Or do you mean like, because also these these poor people are probably MDI in this moment?
Jennifer Smith, CDE 18:55
Correct. Most often, and like you said, unless they have, you know, half half unit dosed or marked syringes in which yes, if you've got to, to get good eyes, or you have a good magnifying glass, you can get kind of a quarter unit fish in there, whatever it might be. They've got a good friend that does just that, and she's done it for a long time, and it works great for her. But again, you have to kind of use those microscopic doses and on pens, it's a hard thing to definitely do because all you can get is a half a unit. I mean, I think on pumps, honestly in honeymoon and I know a lot of clinics often don't encourage people to start pumping until honeymoon is expected to be almost over. And I sometimes I agree with that. Sometimes I don't agree with that. I think it kind of is individual in need. You have to look at what people are able to do and kind of a knowledge base of where are you already but those doses they do, they do shift and change through honeymoon. And then, you know, going out of honeymoon, you can expect the doses to definitely increase your child, your TN, your, you know, adult that you're living with or your partner to or whatever you're going to expect that their doses are going to increase. And while kids are growing at the same time as coming out of honeymoon, there are a lot of factors there. Another piece in the mix that often shifts things to higher insulin, and we've talked about it before we talked about illness and management is that if a child is also sick, within honeymooning and is now requiring more insulin, then by the end of the illness, they may actually either leave honeymoon sooner, or they may just be still at a higher insulin need as during the illness, the pancreatic beta cells were trying to assist, and there aren't very many of them left. So they were getting stressed out and can all can leave less than Yeah. So
Scott Benner 21:07
that's interesting. Yeah, I think that. So I think that the next step here, I mean, besides telling people like, look, it's gonna happen, you know, if it's happening, it's flexibility is key, it's going to be a little more stressful, but only if you I guess, only if you're looking macro when you should be looking micro. And then vice versa. Like you just talked about a lot, a number of ideas where you do want to pull back and see the big picture, but not about the fluctuations day to day those you kind of got to get on like a bowl and ride them, you can't step back and have an existential conversation about whether or not you should be bull riding, you know, so. But but the other stuff, are there illnesses, is there growth, you know, activity, those things are, those are big picture items. So now, okay, so now you've figured out a way to ride through this honeymoon, the thing that I see from people over and over again, is that when it ends, you know, like when the honeymoons over, they can't believe it. They can't pull the trigger. They can't ramp up. Think about it any way you want to. But they get stuck in the game, and don't recognize that the game changed.
Jennifer Smith, CDE 22:23
Yeah, I think the big thing there is that, especially in honeymoon, the sensitivity to insulin makes people very wary of using more. Right, right, because you can get burned, right, by using more thinking you needed more, because yesterday, it clearly didn't work with this, you know, lunch that we provided we're giving the same lunch today. So I'm going to be more aggressive, you know, gave a quarter unit yesterday, today, I'm definitely giving a half a unit and then on the back end of the drop happens, right? The good thing to know is that in, you know, the coming out of honeymoon kind of moving out of that that phase is that you will have again, more consistency in more need for insulin, you won't have as much potential for those drops, where you learned they typically happened even if it wasn't every day, you probably got a good idea of where things needed to be lower in dose or, you know, that won't necessarily be the case. Once you're out of honeymoon,
Scott Benner 23:36
I feel like you I mean, when I tell people about it, I say you just kind of have to reset at that moment. That's when you go back to the setting Basal insulin pro tip, you start over again, you get the Basal straight, you reevaluate how long your Pre-Bolus time is, you reevaluate your meal insulin after you've re evaluated your Basal insulin. And you just kind of start over that. The truth is, is that I think that the transition from honeymoon to out of honeymoon is not actually much different sometimes than the transition from MDI, to pumping in that it's just the it's the same game different players, like I don't know how to like, how to think of it, it's like, you know, right church, wrong, pew. I don't know what the what the the thing is, like you're doing the same thing. But the pieces have all just sort of adjusted a little bit. And you have to just step back, take what you know about the thing you've been doing, and reapply it to the new situation.
Jennifer Smith, CDE 24:31
Right? Correct. And with pumping, you know that you've got a lot more precision that comes along with that. So if you've been doing things as precisely as possible with let's say, Just half units, right, and Basal that's given once or maybe twice a day. Now you can really address where insulin needs are heavier and are lighter through the course of a 24 hour days. Yeah, you can meet the need more precisely, thus, the benefit of doing some Basal testing again, even if you're just doing it overnight, and everybody wants to sleep. So if there's one time a day that you're going to do it, do it overnight,
Scott Benner 25:14
get that part done, get that part done. And you steal a bunch of a one C and some just good feelings. In general, if you're, if you're thinking all 24 hours are just a train wreck, like maybe you can at least get eight or nine of them straight, you know, and say, and it's a jumping off point, figure out the rest of the day. I think that when you were saying something a minute ago, this thought just jumped into my head, and I'm gonna put it here. And I think it fits. I think no matter the situation, maybe I'm talking about just diabetes or life in general. But do something is often the answer. People, there's a people freeze, wondering what the something should be. But if you're watching the same thing happen over and over and over again, if you just change the variables, the stressors on the situation, you might see something new, that helps you understand a bigger picture something different. And so, you know, if blood sugars are, I mean, I don't think it's a joke. But like online, sometimes somebody will throw up a graph and be like, I don't know what's wrong with this. And I'll literally just type more insulin. Because put in some more and watch what happens and then go Oh, cause and effect if they want to know where
Jennifer Smith, CDE 26:29
Right, yeah, not just more like, but where should I put that more insult
Scott Benner 26:35
thing, though, it's like do something right? Like, if you haven't been on vacation in 15 years, take $5 a week and put it in an envelope, you know, do something, try to change the situation a little bit. And I get that it's frightening. And I used to think, Jenny, I used to think that all these things that I saw around diabetes, were so specific to diabetes, but I've been having some personal things going on with my mom's health recently, which Jenny knows about? Probably not. Yeah, about right away. But but the point is, is that I recognize that the confusion, and the the lack of knowing when to jump and feeling like you're overwhelmed and feeling like you don't understand what to do next. It's life, not diabetes, right. And maybe it feels a little more dire in some situations than others. You know what I mean? Like standing in the store, trying to decide between two waxes for your car might not be as crazy as I wonder if I want to add three more Basal units to my kid or something like that. But the truth is, is that that inaction, that's what keeps you where you're at. So if you're sitting where you don't want to be, do something,
Jennifer Smith, CDE 27:47
right, and easier one to honestly do, let's say you are running high, you know, all day long, and you're higher after meals, but you're still just stuck high in that scenario, and a safer thing is just add a little bit more Basal add just a little bit more Basal, right. If instead, in time periods where you're not actually eating, it doesn't look too bad. And then you've got these big excursions after you eat just about, you know, anything, even a microscopic eight grams of carb, maybe and it goes rocketing up, well, then you may be okay with Basal and maybe the next place to add more. And again, not three units more, but maybe add a half a unit or adjust your insulin to carb ratio by one gram to get a little bit more insulin around the times that you see the change that you don't want to see happening.
Scott Benner 28:45
Yeah. Arden's been getting up in the morning going to school, and her blood sugar has been rising. This this school year, like 30 points in the morning. I tried to let the algorithm mess with it didn't work. I tried making just some simple Basal adjustments wasn't enough. And then finally I just said doors like when you leave the house from now on, we just Bolus three units, please. And she's like, what I was like, just throw in three units, get the car, go to school. I was like, because whatever's happening is happening enough. I believe it's happening. I trust that what I know is going to happen is going to happen. And she's using an algorithm. So if you make an uncovered Bolus, it removes her Basal immediately. So her Basal is like 1.2 in the morning. So I figured it was about a unit and a half or so to fix the number or to get ahead of the number. And we got to cover the Basal that's gone. So it's like just three. And then we adjusted off of that and did a little too much the next day we did a little less. The next day, we had a better outcome. The next day she forgot to do it, you know, on the third day and I was like see it happened again, like you know, like do this thing that made her trust the drive Do it and it becomes a little more important to her. I just think it's another example of do something. Right. You know, I, I've been saying online a lot to people lately. And you'll forgive me because I can't pronounce it in its in its origin language in Latin, but I've been telling people lately, Fortune favors the bold. Just try something, you know, they mean stand up thump your chest and go, I'm gonna take a swing here. Let's see what happens. And then you get back to this stuff you hear in the earlier pro tips, you know?
Jennifer Smith, CDE 30:35
Right. Well, and I think the bigger thing too, that you're, you're bringing in is try something, right? But then analyze what that trying did. Right? Don't just try it and be like, Wow, that clearly didn't work. Like, still focus on it? Well, it didn't work, your adjustment either left you to higher like, you know happened for you caused it to be a little bit too low in the algorithm couldn't really save you from that extra insulin well, but now, you know, so you use that for that information. And you move forward and you say, Okay, tomorrow, we're going to do it this way. I mean, that goes into, you know, a lot of things in terms of kind of the exiting of the honeymoon. It does it's try this, it looks like consistently in the past week, he's needed more insulin, right? Okay, great. You're trying to add more insulin? Is it enough? Is it getting to you to the place that you want to be? Insulin needs may actually continued to climb a little bit. It's not like a night and day like yesterday, we needed one unit and tomorrow, we're gonna need 10 units. That's not typically the exit of honeymoon. But over time, that lack of beta cells that is that was helping you write is going to show up very evidently, in that you don't return to that minimal amount of insulin,
Scott Benner 31:57
when you know what made me do this episode when Isabel told me that she thought it was necessary. It was that I had to get over that thing in my head that it's already in the podcast. Like I was like, No, it's in there already. You just have to listen to it. And then I thought, well, it's in there. But it's in a different way. Because what we just talked about, what about that? It really is the way when I'm when I was talking about God, I don't even know what episode it was not that I guess maybe that's a good point. It's hard to find them all. But But, but when I was talking about like sometimes you know, people's meal insulin right meal ratio, sometimes their insulin to carb ratio can be like spot on for a number of meals, but not work for a certain meal. And I always use that silly example, if you have meatloaf and mashed potatoes and green beans, and you count the carbs. And it says the carbs say Oh, this is five units, you make your Pre-Bolus. You spike, you end up correcting later with two units, which brings you down and you don't get low. Well, the next time you have the meatloaf in the mashed potato, seven units, you use you seven units, right? Like you see it happen. And then you take the leap, you stop looking back at the meal ration going no, that's not right, I counted the carbs, it's right, this is five units, very similarly to the idea of you're using a pen that only goes up to a half a unit and you keep using it and then watching a low blood sugar happen. I go, I'm powerless, but you're not powerless. Like you just need to go get a syringe and do it a different way. And you're not at the mercy of your carb ratio just because it works five days a week, but not on Sunday when you have meatloaf like right. So, right. It's all kind of the same idea. Like right, I know it sounds trite. But
Jennifer Smith, CDE 33:37
well, and that's I think it brings in a good a good piece too, in terms of, you know, multiple daily injections, then we move to pumping, and then we move to the fancy features of pumping. And then you might move to an algorithm driven pump, right? All of these things take. They take like evaluation. And a good example from somebody I worked with a while ago, who had started using one of the algorithm driven pumps, and she was fantastic. I love it. It's working so awesome. But it doesn't work on Friday night. I was like, Okay, well what were you doing on Friday night, that this doesn't work anymore for you. And she had this like, whole thing figured out for her dinner Friday nights that she would go out to with her husband. And on a conventional pump. She could use like, you know, a temporary Basal she could use an extended Bolus and she had it down, Pat, that was like just go to manual mode in your pump and use it that way overnight and Saturday morning. Turn your algorithm back on. She's like, why didn't I think of like, oh, I don't know either, but I hope that it helps and it it seemed to be much better than we did
Scott Benner 34:53
last night. Yeah. Because we went to a bar and art and got nachos with cheese steak on top of it and had French fries, and I crushed my first Bolus. I was like, I haven't been this excited about a Bolus and was like I was on top of it. And then I started seeing the fat rise, and we hit it again. And I was like I was over. And then I go upstairs to start working. And suddenly she jumps up her blood sugar jumps out, but I go downstairs to my lab and see what happened. I had some gummy bears, she told me and I was like, no, no, we can't put simple sugar on top of fat and protein. I was like, are you all out of your minds? Without like, significant I said, Aren't you were going to gummi bears in this situation, the Pre-Bolus would have needed to be causing a fall before you put the bear the bears in, you know. And then that would have been okay, but she just did the like my blood sugar's great thing, threw in some insulin, wait a little while and ate it. And it was not nearly enough. We needed to be more drastic with it. And so I was like, so my text, my text said this, I'll bleep it out. It said it said that it said, open the loop Bolus for you.
Jennifer Smith, CDE 36:06
And let and let the Basal run let's
Scott Benner 36:09
back to normal pumping for a minute and stop asking this algorithm do something that it doesn't know how to do. Because it's
Jennifer Smith, CDE 36:15
not it's not a learning algorithm. Unfortunately, it doesn't, you know, it doesn't react the way that we have the experience to say, I know this is what's going to happen. Please don't fiddle with the insulin that I put in purpose.
Scott Benner 36:32
Now's not the time to take the Basal away algorithm. Yes, gummy bears and cheese stick nachos happening right now. Anyway, Jenny, you know, there was in the past, there was a moment when I, I used to worry. And I think like, Well, we've already said these things. And people will find it. And now I realized that that's not how this is going to work that these continuing conversations are incredibly important. I think maybe the conversational part of this episode, and many episodes is more important even than the technical aspects of what was said inside of it. Right? You know, like, if you listen to the Pro Tip series, and you had your brain or my brain, or your experience, in my experience, you could derive from the Pro Tip series how to manage a honeymoon. But for people who are in that situation, I think they need the information here. Right, you know, in one spot. Yeah. And I just, I don't know if I was just like, super hopeful or lazy. I'm not sure. But I used to think like, just go listen to the pro tip episodes, it explains the whole thing, you know, and it really does. So I appreciate this, I think we're gonna have to, you know, like I said, I want to do one for you know, female hormones, menstruation, that kind of thing. Yeah, specific the next time we record. And then from there, I'm going to say this year, Jenny, because it will put us both on the hook. In 2022. Jenny and I are going to go back to certain pro tip episodes, were going to re listen to them on our time. And then incorporate questions that I'm collecting on Facebook, on how to supercharge those episodes. So they're going to kind of create some of them are going to get a part to kind of a situation. That's cool. That's what that's how we will you and I will spend our time seeing each other through the winter of 2022 sequels to certain episodes. I'm thinking of them as director's cuts for oh, there you go. Yeah, for older people who you remember the directors commentaries? Yes. Yeah. You know, where do you mean you'll flip the movie on and the audio goes away, and you just hear the guy go. In this shot. What I was thinking was that if the sun came in from the left,
Jennifer Smith, CDE 38:41
and we could could pan over here and listen to this music from this producer, you know, whatever. See
Scott Benner 38:47
how missoma Hykes eyes are glistening. i I told the DP like I don't know if you ever listened to them. They're pompous exchanges, Jenny and I will not do that. But we're gonna go back and listen to what we've said. Because I've done it a couple of times, like in Episode 500. I went back to Episode 11. That's bold with insulin. And I listened to it and like talked overtop of it like so people listening and episode. I think it's 100 Oh my god. 100 500. Sorry. In episode 100. I just basically did a director's cut of that, because I realized that when I said it, I was just saying it. Like there was and now I've lived all this time since then, and had these interactions with people that maybe there'd be more to add to that. And I think that exists for the Pro Tip series. Like and I'm excited. I'm sorry that you're gonna start getting emails from me that say please listen to this one before we talk again. But
Jennifer Smith, CDE 39:36
no, that's fine. You're busy and I can do it during my workouts. That's not usually I just That's my mental like, my moving like mental sort of like strategizing time is my exercise time. I am not like a sit in one space and like meditate. I'm a moving meditator But I can meditate on the episodes so we can make them better for everybody else. Excellent.
Scott Benner 40:04
I have a question, then I'll let you go. How do you make out listening to your own voice? Does it freak you out?
Jennifer Smith, CDE 40:12
It's I don't know, it's I guess it's kind of weird to me because I like I hear myself speak, you know, in your brain like, but when you hear yourself, it sounds different. I guess. I don't mind listening to myself. But yeah, I don't know. I don't think that I sound like what I sound like when I listen.
Scott Benner 40:35
No, no, no, I sound so right now we're recording, I can hear you and me and my headphones. I sound different in my headphones than I sound on the recording. And if I'm just speaking out into the world, I don't think I sound like the person on the podcast at all, but people think I do. But in my ear, it doesn't sound the same. Although And do you ever get on you ever? You ever say anything and hear yourself and go? Oh, Jenny, you should not have said it. You should have said it like this? Do you ever correct yourself?
Jennifer Smith, CDE 41:01
I do? Absolutely. And a lot of the ones that I've listened to don't like, oh, this would have been a better explanation. Or I could have put this in as an example. And that would have been better. So maybe we Yes, I think it's great to sort of rethink them. Because then we can add extra and
Scott Benner 41:15
I agree that there's there's just always going to be other stuff to say. And as we move forward into 2022, and beyond more people are going to be using algorithms. And there's going to be a whole new layer of understanding for diabetes, there's going to be things that you and I don't have an experience yet that, that through these experiences over and over again of using this technology, you're gonna come out I don't see an end to this podcast, I used to think it was finite. And now I think somebody is gonna need to, you know, make up a cure for this podcast not to be necessary.
Jennifer Smith, CDE 41:47
So Well, that's what I was gonna say I don't think until there's honestly a true like, you don't have to use any technology or anything. You just go in and get your bloodwork done and make sure your doctors like yep, you still look great. It's all perfect. I don't think you know the information that people need, especially with life changing and everything. I think it's purposeful. So
Scott Benner 42:10
I do too. I appreciate you doing this with me. It's the end of the year. So let me thank you for giving your time so greatly to the podcast.
A huge thanks to Jennifer Smith, my good friend for being on this episode of The Juicebox Podcast. Actually, Jenny does the podcast for fun, but she also does this stuff for a living. So if you'd like to hire her, you can at integrated diabetes.com After the music. I'll give you some agenda specifics. Don't forget the Facebook page for the podcast Juicebox Podcast, type one diabetes 20,000 people strong, just like you looking for advice, community and support from people who understand. Please take advantage of it. It's absolutely free, and really valuable.
My friend Jenny Smith has had type one diabetes for over 33 years. She holds a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian and certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. She is also on every one of the diabetes pro tip and defining diabetes episodes. You can find those episodes in your podcast player. We're at Juicebox Podcast comm I actually think there's a list on the Facebook page to up in the Announcements section. Is that what they're calling it now that used to call it all a sudden? I'll find out for you. And then I'm going to tell you about the other stuff that you need to know. Yeah, so if you're on the private Facebook group, they call it featured now used to be announcements now it's featured. So if you go to the featured section, you'll find lists of the pro tips how to start listening to the podcast, defining diabetes, all kinds of stuff that you need. Actually, there's lists of ask Scott and Jenny episodes here. All kinds of good stuff. You should check it out. Look at there's so much to choose from special episodes after dark how we eat okay, I'm not going to bore you with this. But by the way, it's not boring. I'm just trying to fill you in. Are you arguing? am I arguing with nobody? Hold on a second. I want to tell you about the diabetes pro tips. So they began back on episode 210. With an episode called newly diagnosed or starting over, I'm going to try to list them for you pretty quickly. Episode 211 all about MDI episode 212 all about insulin episode 217 Pre-Bolus Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bumping nuts To 26 the perfect Bolus to 31 variables to 37 setting Basal insulin 256 exercise to 263 fat and protein 287 illness injury and surgery 301 glucagon and low V Gs 307 Emergency Room protocols 311 long term health 350 Bump and nudge part two 360 for pregnancy 371 explaining type one that's for other people like so you can share it with like a family member, a loved one who needs to understand type one 449 postpartum 470 weight loss and this episode 608 And there's going to be more in fact, there'll be another one next month on female hormones. Thank you so much for listening. If this is your first episode, please subscribe or follow in an audio app of your choosing. Apple podcasts, Spotify, Amazon music anywhere you get audio. I'll be back very soon with another episode of The Juicebox Podcast.
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
