#664 Defining Diabetes: Dictate the Pace

April 15, 2022Scott Benner

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Dictate the Pace.

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Scott Benner 0:00
Hello friends, and welcome to episode 664 of the Juicebox Podcast.

On today's episode of defining diabetes, Jenny Smith and I are going to define a phrase that I use every day managing type one diabetes, many of you may think of it as a sports thing. But for me, it applies to type one and insulin management in general very, very well. So today, Jenny and I will define dictate the pace.

You know, if you'd like to hire Jenny, she works at integrated diabetes.com, head on over there and check her out. Before you do that, 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, or becoming bold with insulin. If you have type one diabetes, and are a US resident, or are the caregiver of a type one, and R US resident, please head over to t one D exchange.org. Forward slash juicebox. Take the survey, you'll be helping people with type one diabetes, and supporting the show.

This episode of The Juicebox Podcast is sponsored by us med. US med is the online diabetes supplier that you've been looking for. They have a dedicated 800 number for Juicebox Podcast listeners. And you can call today to get your free benefits check 888-721-1514 Or go to us med.com forward slash juicebox. US med wants to bring you better service and better care than you're accustomed to. All right, Jenny, I would like to talk about an idea that I keep in my head around diabetes that I don't think you're gonna see on any in any diabetes textbooks. But I like to dictate the pace. And I think of that as a sports metaphor. In my mind is usually a boxing metaphor more than anything else.

Jennifer Smith, CDE 2:24
I was thinking running, but Okay, okay.

Scott Benner 2:27
Well, yeah, that's a good idea that, you know, you could jump out ahead. And once you have the lead, you're in control of maintaining the lead. Right. Okay. It is a simple idea. Normally what I say it's funny, I'll retell this very quickly. I was in front of like, 500 people one time. And I said, you try to imagine that you invite somebody out to speak at something and they get up on the stage in front of all your people. And he goes, has anybody ever been in a fistfight? You know, the people who are running the event go, what is the guy on stage talking about? And he's here to talk about this. Better this guy? So you hear somebody in the corner, go, he's got a podcast, people seem to like it. I don't, it's not my fault. But I say they said this one time, like, who's ever been in a fistfight? And this little kid I swear to you is like six years old, just jumps up out of his seat and puts up his hand and I'm like, I'm like, You should not be hitting people. It's like, Is anyone else any grown people been in the fight? So this man finally like, kind of put his hand up, but he was embarrassed. He's an older guy, time he goes, I've been in a couple fist fights. And I said, Would you rather hit the person first, or get hit first? And he did not hesitate? He's like, I want to hit first. And I said, Yes. And I was like, that's how I use insulin. I'm like, you've got to hit first. Because then everything that happens after that is dictated by the pace that you've set. Yes. And more importantly, what I hear people talking about all the time with insulin is they act like it's happening to them, you know, they just diabetes is happening to them all the time. I don't know, I get high, I get low. I don't know why, like, right. In that scenario, diabetes has dictated the pace. Yes. And now you're the person frantically trying to catch back up again. In my opinion, you hit first. And that way, at the very least, even if what happens next isn't exactly what you want it to happen. At least you know, you made it happen. And you can kind of step back and make sense of that I Bolus five units for this meal. And, you know, a half an hour afterwards. I'm 65. And it's not coming up. Right, right. I didn't get a spike. So I think my Pre-Bolus was okay, but I'm a little low. And what that tells me next time is well, maybe I'm gonna try four and a half units for that meal next time. But at least you know what's going to happen next. Because you know, if you if you let diabetes go First, if you don't Pre-Bolus your meal, as an example, even if you've got the right amount of insulin, now you're shooting up. And you've added variables, mathematical variables that your brain cannot find or figure out anymore, right? You could kind of get ahead of the idea of I think this meal is 45 carbs. And I think my insulin to carb ratio is this. So it's five units. But once you don't Pre-Bolus, once you give those carbs the opportunity to get out in front. Now, it's dictating the pace, and it's changing the rules as it's going, because no longer you just trying to cover these carbs, you could have started at a beautiful blood sugar. But if you didn't, Pre-Bolus Now, you're not just trying to cover these carbs with this insulin, but you're trying to stop this rise, you're trying to take this momentum out of this rise, and you've got to correct a number and keep the food covered. All without creating a low later. Right. But if you just go first, if you punch first, what happens next? You made happen? Right?

Jennifer Smith, CDE 6:00
And then you can figure it out from there, like you said, yeah, if it's, you know, if it's your first sort of adjustment to a ratio, or you've really decided to get more precise about your carb counting, and you're trying to figure out your insulin dosing now that you are being more precise, or whatever it is, you're putting in effort, and whatever outcome is because you made a decision to do something this way. And it like you said, it makes it a lot easier than to say, okay, you know, I got low after this meal where I know, everything I put in should have been right, maybe now that I'm counting more appropriately, maybe my Bolus ratio is actually too aggressive. Maybe it doesn't need to be as much insulin, or maybe I Pre-Bolus. Really, really long. And that's the reason now I'm actually too low. Yeah. So you know, it gives you points to sort of reference and go back to, to make a better call the next time. If you give enough time, it's kind of like your example, I know, you always use the tug of war game, right? Between insulin and food and insulin and carbs. So you want insulin pulling a little bit bigger. And, and, and sooner, and then you have more control of the out of why things are turning out the way that they did, right?

Scott Benner 7:24
Yeah, I mean, people are gonna put it into whatever perspective they can, that's what I want. I mean, you might not be interested in the same things I'm interested in. But you know, another way to think about it is if you like baseball, and you're pitching, you need to strike the first time, right like is nothing worse than starting with a ball. Now, let's want to know, and you're already behind. And now you're just like, Oh, now everything gets finer, it gets tighter, you have to be perfect, because you're running out of chances. And but if you start with a strike, you're ahead. Now if the guy should hit the ball, and he gets a hit, that's good, good on him. Tough luck for you. But at least you're not fighting with this guy down to balls, no strikes, like like you're dictating the pace you're like are if you beat me, you beat me. But if you don't beat me, we're playing this game on my terms, I'm getting ahead of you, you're the one who's at, at a disadvantage, not me. And once you get that advantage, the worst thing you can do is give up the high ground. Like you always make the opponent fight from down low, right. And that's what you have to do with the diabetes, it's what you have to do with the blood, I think of it as the blood sugar, probably, but you come at it hard. And then you're now dictating the pace, and then it might try to do something else. And maybe it'll even do something that you don't like, but you don't switch places with it. When that happens. This is such a weird idea. But, you know, you strike first, you're ahead, it strikes back, you don't go into defensive mode, you push back again, right, you keep the high ground, always keep yourself in that position. This may be more of a an intellectual exercise than it is an actual physical exercise, when you're not managing insulin, but whether you think of it as a mindset or as an actual action that you're going to take in my mind, the minute you start, you know, I'm I'm joking my sports metaphors all over the place, but the minute you start covering up your face, I mean, think of every fight you've ever seen when I cover up, um, skirt, you know, like you gotta keep moving forward.

Jennifer Smith, CDE 9:39
Right? I kind of think about it in a little bit. I guess in I think about it in terms of how insulin works, right? As we talk time and again about rapid insulin and really dictating the pace means you understand how long it actually takes insulin to start I'm working. And so I kind of think of it being a runner, I think of it like, a warm up, like a Pre-Bolus, to me is kind of like a warm up. I don't leave my house at, you know, huge, like, I don't sprint out of my driveway, right? And my muscles are gonna be like, Okay, we're done now, thank you so much. I need to get things going. And that's why I think about my Pre-Bolus is kind of like that warmup time, until like, insulin is really now like, it's ready. And this is this is the time to put my foot in. Because it's gotten enough time to get its momentum, right and get moving. So that's kind of how I think that's beautiful.

Scott Benner 10:46
Really, because that's like, that's like thinking about it like starting a Have you ever seen a locomotive start moving? Or have you ever been on a cruise ship? Like a job? Okay, if you hire Alright, well, listen, I'm sad to tell you I've been on a cruise ship. And it's, you're up against the dock, and the things not moving, right. And they unmoored it, and then it starts to move. And it's many minutes before you recognize that the ship is moving. Right. So like, it's the old adage, it's like turning the turning a turning a ship takes forever, that kind of thing. But when you just talked about it as warming up to run, I've seen a a freight train, pull pull out of a station, and it starts to move, like it's trying to go and it doesn't move right away. And then it starts very, very, very, very slowly. I mean, almost imperceivable to your eye at first, and then it's moving at a snail's pace. And then it almost looks like it's walking away. But I'll tell you what, 15 minutes from now, that thing's got it moving like a rocket, you know, and you can't stop it. That's a perfect way to think about the insulin. It really is. You can't just you can't just push the button on your pump, and start eating. By the way, especially with some pumps, I'll use Omni pod as an example on the pod puts insulin in on the slower side. Like if you're making a big Bolus, it isn't magically, it isn't magically in 30 seconds from now you might look up a couple of minutes from now you've only got five of the 10 units in

Jennifer Smith, CDE 12:28
and as a good example, how many pods each click is point 05.

Scott Benner 12:33
Really, as its Bolus, click

Jennifer Smith, CDE 12:35
05.

Scott Benner 12:36
If you isolate

Jennifer Smith, CDE 12:39
zero 5.0 5.0. I mean, it takes a while I've I've counted them. I did it. When I first started years and years ago on Omnipod. I asked my trainer, I was like all these little cliques. She said, Yeah, if you wanted to, you could count them up and see how many go into like a one unit Bolus because they're all point zero five,

Scott Benner 13:00
you were the exact right kind of dork for this podcast.

Jennifer Smith, CDE 13:05
I like it. That's okay. I'll be a door. No, I

Scott Benner 13:07
mean that. I mean that in a wonderful way. Yeah. So in my mind, when if you hear me say, like, dictate the pace, this is what I'm talking about. I'm talking about, you can you can picture it any way in your heart, you want to if you're a UFC fan, once they're down on the mat, jump on top of them and keep punching them in the face until they give up like do not stand up, turn your back and get kicked in the back of the head. You know. And I do think that in practical terms, when you're making a Bolus, it's, it's easy to push the button and just think it's going to be okay. But if you're using the CGM, my goodness, 30 minutes afterwards, take a look at it. You know what I mean? 45 minutes, take a look, you know, if you have your setting set to alarm on your Dexcom, for example, like Ardens is 70 and 139 7121. I'm following her. If 30 minutes later, she's 115 Diagonal up. And I'm starting to look at a real harsh up. This might not be going the way I think it's going to go. But if you don't look or if you have your high alarm set at 180 You know, then by the time you want to know soon enough, it's too late now. And now you're and you're immediately chasing at that point when you find out too late. Now you're chasing now you're from a previous episode now you're showing up 15 minutes after the bank has been robbed. Right? So we want to the information is your friend. You know people talk about like data in court, whatever you want. But this thing is telling you what's about to happen or what is happening. And if there's a moment where if you react correctly, you maintain control. And there's a time that you wait too long for that. control changes hands. And now you've given up the high ground. And what that means practically speaking with diabetes, is you're about to spend the next three to four hours, beating your head against the wall, drinking juice, or bolusing, or whatever's going on. Because you let this thing get the better of you. And in my mind, a couple of well placed glances. A little bit of effort upfront, saves three and four hours of what actually feels like a tragedy when it's happened in the middle of your day. Like it really, you hear people and especially overnight.

Oh, it's terrible.

Jennifer Smith, CDE 15:34
I think the overnight is the biggest complaint.

Scott Benner 15:36
Yeah, yeah. Because when you going to sleep now, it because in your mind, you're like, Okay, well, I Bolus this one ad. It's not going to be low in an hour. But if I fall asleep, am I going to wake back up, and then you start doing that thing where you're like, I'll just sit up till 230. And then at 230, it's 150. And you're like, Oh, I guess it needs a little more. And all of a sudden, it's four in the morning. And, you know, it just it paying attention upfront, doing the little things, keeping the timing of the insulin on your side, dictating the pace, however you want to think about it. A little bit of effort upfront saves a ton of problems on the back end. Right? That's all and some of it

Jennifer Smith, CDE 16:15
is also you know, some experience obviously goes into it too. I mean, I would certainly say that it takes a little bit of time to know how to manipulate things, right. I mean, I had a horrible pods like the other night like horrible. Obviously slept through high alarms. I mean, in my heart Hi, alarms are not like terribly high. I slept through a lot of alarms woke up in the morning. I think it was like 250 to 50 am. And I knew before even looking at my CGM I knew that I was high. I knew I was high. And I look at it and like, Okay, this is always lovely at this time of the night right and I Bolus took an injection to Bolus because my news sites I knew at a blood sugar like that we're just not going to get over this Hi, I Bolus are navigated up my low alarm just a little bit in case of need to kind of catch what was falling. And it woke up in the morning at 84. Nice and flat. I felt like I jumped up. Like nobody was there to see me. But that's okay. I did my own little happy dance.

Scott Benner 17:31
Well, I'll do it with you. Because knowing that that's what needs to be and at 230 in the morning, getting your ass out of bed and changing that pop up. Give me your shot. That's not easy to do. But what it did was it saved your next day. It did really poorly. You If you ignore that you wake up you're 300 Yeah, spend five hours fixing that easily. And you feel oh, it was 301

Jennifer Smith, CDE 17:53
I was 301 that I can't remember the last time I saw a number that hi i so it was I mean, very clear to me where my pump had actually like pooped out. Yeah. And in terms of knowing you're talking about before, kind of like that black hole. Kind of there was clearly a black hole that started because I could tell where the black hole ended up causing the rise up to happen. And it just kept going from there wasn't

Scott Benner 18:25
gonna stop No kidding. Yeah, I mean, and you said something earlier to like, you really do need to. Like if this is for somehow this is your first episode of the podcast. Oh my God, please don't start here. You know, like, go back to 210. Listen through the pro tips. Try the defining diabetes series. Like you don't want to jump in at ninja level and try to start rolling. You really will mess it up. There's a lot to understand on top of that, but once you're caught up, listen, I think of the podcast is a compendium like my assumption is if you're listening to this episode, I mean, I don't even know this is probably in the late six hundreds. You know, my thought is that you've heard the stuff before this. So yeah, okay. Well, I really appreciate you taking the time to do this with me. Thank you so much. Always fun, thank you I cannot be the only one of us who is incredibly frustrated with the company that sends the diabetes supplies to our house. I just can't be I mean, if the experience that I've had so far and all these years is even a little reminiscent of what you're going through, then you may be looking for something better. You may be looking for us Med, a company who prides themselves on white glove service. They want you to get better service and better care than you're accustomed to. US med is the number one distributor for freestyle Lee Bright systems nationwide. They are the number one specialty distributor for Omni pod dash, the fastest growing tandem distributor nationwide and the number one rated distributor index com customer service surveys. With over 1 million diabetes customers served since 1996. US bed carries everything from insulin pumps, and diabetes testing supplies, the latest CGM, they always provide 90 days worth of supplies and fast free shipping. US med accepts Medicare nationwide and over 800 private insurers. Come on, give them a call 888-721-1514 Get your free benefits check. Find out why they have an A plus rating with the Better Business Bureau Wouldn't you like some white glove service? I know I would. The phone number again is 888-721-1514 and that number is just for Juicebox Podcast listeners or you can go directly to us med.com forward slash juice box and get that free benefits check there. At that link. You can also see reviews for us met better service better care. There are links in the show notes of your podcast player and links at juicebox podcast.com to us Med and all the sponsors

if he enjoyed this episode of the podcast, there are many more defining diabetes episodes. There's a list of them a complete and full list of them at Juicebox Podcast type one diabetes on Facebook, that's the private group that you might want to join. I am now going to try to list all of the defining diabetes episodes in one take without misspeaking. I'm not going to do the episode numbers you're gonna have to get those from the Facebook group Okay. All right give me a second here on me. Let me center myself

you're ready you're I go. Start started episode 236 With Bolus then Basal honeymoon a one C time and range standard deviation extended Bolus algorithm non compliant glycemic index and load Pre-Bolus Trust will happen low before high Bertel diabetes stop the arrows ketones insulin resistance and over Bolus feeding insulin bumping nudge rage Bolus compression lows and interstitial fluid. fat and protein rise Dawn phenomenon smudgy effect feet on the floor instant sense damn instant sense damp insulin sensitivity why can I say sense of insulin low insulin sensitivity factor adrenaline highs insulin deficit growth hormone stacking insulin hydration Lata diabetes moody diabetes crutch crutch crush it and catch it see peptide and beta cell insulin onboard pump break barriers and today's episode dictate the pace. Once again. There are lists available on my social media. Check it out. Tell you what I'm gonna put it up on Instagram today then you'll be able to find it there in the Instagram wall or still I don't know what you kids call that story. Now that story. Now I don't know wherever you put the pictures. And it'll be on both my Facebook pages the private one Juicebox Podcast type one diabetes and the public page bold with insulin. Actually the defining diabetes series as well as the diabetes Pro Tip series is available at diabetes protip.com and juicebox podcast.com as well as those other places aforementioned. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. Hey, if you're listening in a podcast app follow and subscribe follow and subscribe follow in subscribe.