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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 689 of the Juicebox Podcast.

On today's episode of the podcast the 16th episode of the Ask Scott and Jenny series today, Jenny Smith and I will chit chat and answer questions sent in by you, the listeners. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you love Jenny Smith, you actually can hire her she works at integrated diabetes.com. If you're a US resident who has type one, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. Join the registry, take the survey help people with type one diabetes in fewer than 10 minutes, all while supporting the Juicebox Podcast, T one D exchange.org. Forward slash juicebox. I got that done so quickly. And in one take. I'm very proud of myself, swell of music. And then we'll get going

this episode of The Juicebox Podcast is sponsored by touched by type one, head over to touched by type one.org and find them on Facebook and Instagram. They're a wonderful organization. They're helping people with type one diabetes, and they'd like you to take a look and see what they're doing. Touched by type one dotwork. Today's show is also sponsored by us med. That's right us med is the place where I get Ardens diabetes supplies, and you could to us med.com forward slash juice box or call 888721151 for us med wants to give you your free benefits check and get you started today, use the number or the link. Actually, there are links in the show notes of the podcast player that you're listening in right now. Or at juicebox podcast.com. If you can't remember touched by type one.org and us med.com forward slash juicebox.

Jennifer Smith, CDE 2:33
We're doing questions, right? Just questions. So these are always fun, I like to

Scott Benner 2:39
so I will share with you and I'm recording this so maybe it'll put put me on the spot that in my mind I imagine a scenario where you and I on video live. Do ask Scott and Jenny's online one day. That would be kind of fun. Okay, and I have it's so close to figured out though. Here's the problem.

Jennifer Smith, CDE 2:59
See, I didn't run away.

Scott Benner 3:02
You didn't click off now. That's enough, buddy. Think bridge too far. Thanks. But no. So yeah, it's it's in the future idea. So what I want to do is like, I would do it in the Facebook group at Facebook allowed for the technology to put your mi video in there live and let people interfere but it doesn't. But there are some third party things like Facebook who do support this. And if people will say, well just do it over zoom the way you always do it. That's nice. But you only get a couple 100 people that way. I think that I imagined my Facebook group with 25,000 members in it. And I think geez, what if even just, you know, a small percentage of them happen to be online, you know, you'd get a few 100 People who RSVP and maybe you'd grab hundreds and hundreds more who happen to be online when it happens. So that's my idea. But the technology needs to catch up to my idea, but I think it's getting close. So cool. Keep your fingers crossed for that. In the meantime, how can I successfully encourage my 35 year old son to manage his type one and try technology? I lost my twin sister who was also type 120 years ago because of mismanagement, and he's following in her footsteps. I don't know how to approach him without causing him to become defensive. And he magic words. He's an ostrich who keeps his head in the sand. Yeah,

Jennifer Smith, CDE 4:25
that's a that's a hard one because it's from the standpoint of it being an adult that you're trying to usher some change into their life. People have to be wanting of information to begin with. Right. And sometimes the road to that starts with acknowledging something that's really important to him. That is more directly in his line of vision being impacted by the way that he's currently managed. During his diabetes, write, like your whatever it is, if it was, I really love running. And every time I go out for a run, I'm really frustrated, because I just haven't like figured out that piece, right? If you can find something that he really loves in his life, and bring in how that could be better, especially if he's frustrated with an aspect of that, that may be an in of sorts to getting him to see the ability to even use just a CGM to be able to better follow how he's planning, you know, to move forward through his day. I mean, I would say, certainly, maybe send him some of the podcasts, get an email and say, Hey, this might be a really good one to start with listening to you. But again, for an ostrich in the sand, sort of, you probably wouldn't really click on it. It's a hard, it's a hard situation,

Scott Benner 6:08
let me tell you that we we received as you know, a so many ask Scott and Jenny questions recently, but I chose about five or six of them and move them over to talking to Erica Forsythe about them, because she's a type one forever. She's a therapist on top of that. This was one of them, that I think I'm going to leave in both folders. I'm gonna I think I'm going to ask you this. And I'm going to ask Erica, this one. And I'll tell you why. Because I have no, obviously my oldest child was 22. And even at that age, I understand what this person is saying. Like they're people are adults, whether they're doing something good for them, or bad for them or right or wrong, or however you want to think about it, you've probably lost the ability to impact them by just saying, Hey, you probably should be doing something different, right? Correct. I don't think humans in general learn that way, which is my my go to example from my childhood always was, how many 14 year old girls have to come on Jerry Springer pregnant before other 14 year old girls go, you know, I probably should not get pregnant. And the truth is, it never happens,

Jennifer Smith, CDE 7:18
right? Like I should maybe not do what's causing the pregnancy,

Scott Benner 7:21
or just look up and think that I don't want that to be my reality. Right. Right. And so my point is, is that even in the in the face of good information, or good fellowship from people who care about you, or even seeing it happen in front of you, and you go on, like, Oh, that's a dumpster fire, it still doesn't stop people, people still have to go through whatever their path is. And some people find their way out, and some people don't. And it's a shame, but I think it's kind of true. And so, when I looked at this question, I related it back to what I tell people with younger kids, because in my mind, this guy is is in some way burned out on diabetes. But my expectation always is that, alright, sure, maybe there are people who are just flatly going to ignore it. But the truth is, they don't completely ignore, because if they did, they'd be in decay. And a couple of days they'd be gone. Right? Right. So they're putting some effort into it. It's my expectation that if the effort translated into reward, that that would be how you'd build more excitement, like they need to see something happen that's positive. And I just think that some people are caught me, you could just take one aspect of diabetes, right? Chasing blood sugars. If you start chasing a blood sugar on day one, and you don't know how to get ahead of it, you could do that your entire life. Correct, right. And I'm sure you see people that happens to all the time, I've seen people that happens to all the time. So if I had any advice in this, and this would be just me, literally reaching into my brain and pulling things out that I've seen before. I would wonder what would happen if this mother went to her son had a launch, sat down privately and said, Hey, I know how much you're struggling. And I see that it's not getting better. And it's got to be incredibly frustrating for you. I've learned how to do a couple of things that I didn't know about when you were younger. But I understand now, let me just lay a couple of ideas out here for you. Can I move in for a week? Can we get into a text chain can like let me be your lifeboat for a little while. I think we could get this going a little better. And then let's see where it takes us from there because maybe even just stopping the bouncing blood sugar, so the high blood sugars might bring more clarity to this this gentleman and maybe then the idea of a Pre-Bolus thing would start to make sense and you go hell if I'm gonna feel this much better. I'll put insulin in 15 minutes before I eat, you know what the heck? Right? I just think that there are times Let me rephrase. I think it's interesting that we would see a person who was addicted to, I don't know math and say, Well, I can't help them, somebody else has to help them, they can't help themselves, we have to take them to a professional. The problem with diabetes is there's no professional where you can drop off your mismanaged loved one. And say, right, can you can you get them straight for me? Right? So I think it's up to this, I think it's up to the person who asks the question, to just say, I'm going to become part of this. In any small way, I'm going to take a long look at this, I am going to help this, I'm gonna help my son chip chip chip away until he gets to a better place, I actually think it's possible just I think it's a lot of work. And you need a really long vision of what it is you're trying to accomplish. You're just not sending somebody a text and saying, listen to episode 11, you know what I mean.

Jennifer Smith, CDE 10:54
And then also, maybe from an understanding or a knowledge base, as well, right? If this mother has learned more than she knew, in his life, growing up with diabetes, or whatever, and she knows now knows more now, she may also be able to recognize some of the deficit in information that her son hands. And so from an information standpoint, like you said, sitting down and saying, hey, you know, I learned all of these, like new things. And I think, if you're willing, I'd like to help you start here. And or, if you don't want to work with me on it, maybe I can, maybe I know somebody that you could start working with it kind of develop a relationship, again, with a better clinician than he may have, you know, if it and again, that's where I think sometimes clinicians are at a loss because they, they don't have a very long visit. And they don't have a lot of resources, right? For something like this, they just often dump on more insulin, because something might be stuck high, for the most part, in a situation like this. And they think that they can at least smooth things a little bit. But they're not really addressed. It's like putting a bandaid. It's not addressing the issue.

Scott Benner 12:12
You know, I don't think I've ever directly said to somebody, you should go see Jenny. But this is an example where a person like you would be helpful, because even as I say, maybe the mother could do this. I don't know what their relationship is. And I've seen it. I've seen a lot of men walk out the little boys on a baseball field and talk to them and it goes well, and then the minute they walk over to their own son, they're yelling and screaming at each other. Right? So maybe it's not okay, maybe it's best not to coach your own kid. But But yeah, I think you have to think wherever we are, we're so far into it now that a well meaning handwritten note, or Hey, buddy, I love you, you can do it. Like you're beyond that. Now, you know, this person needs to see some stability in blood sugars, that makes them feel better and right. And they're saying they don't want to try technology. I mean, so then, could you talk them into eating a lower carb lifestyle for a couple of weeks, you know, just to just to kind of reset everything and learn about how insulin works first, right? I don't know that this question is any different? Interestingly enough, aside from the part where there's resistance from the person with diabetes, I don't know if this question is any different than how people feel when their kids are diagnosed, and they don't know what they're doing. And it's frustrating. And, but you know, you have little kids, I was talking to this woman the other day, I said that 11 years old, her son was so like, easy to manage, because he did what she told him, and then a little, little bastard got a little bit of testosterone going, you know, then all of a sudden, he's like, I ain't listening anymore. And, and she's like,

Jennifer Smith, CDE 13:48
independence, right? I mean, there's a reason that we move through stages of independence from little on. And that's

Scott Benner 13:55
right. Going back to this example, this lady said, look, here's a kid with a five a one, see, from what I learned on the podcast, hits, you know, a little bit of gets a little older. So armpits start to smell a little bit. And as a once he goes into the sevens, just because he doesn't do the things that they all know we're going to work. So, you know, and then she's going to be there because this is still a smaller child, and she's going to keep pushing and pushing and pushing and getting back to where he needs to be. But this is a different situation. I mean, if it is, you know, if this man is 35 years old, I'm guessing his mom's at least 55 years old, most likely in her 60s and, you know, the dynamics

Jennifer Smith, CDE 14:35
and may not live close enough. I mean, they may live across the country from each other and she only sees the downward trend. And unfortunately, she has a very bad like, you know, history of seeing I think she said her sister, right. So, that's hard to see, especially in your child. Yeah. Then

Scott Benner 14:59
well, and To your point I take to heart and I want to add to it for the kid. That means that when he was 15 his aunt died of type one diabetes he either had it then or got it at some point. And you know how people think like my dad died at 49 from a heart attack and people then don't expect to live past 49 when that's their story, right? You know, it's, I mean, it's silly but all right, you know, like I understand how it could make you feel that way. I appreciate you talking about this but yeah, okay. Let's do something slightly not as depressing Jenny here's a very simple question

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What are your thoughts on service dogs for type ones?

Jennifer Smith, CDE 17:28
Oh, that's a great question. In a simple answer, I think they can be a really wonderful again, tool, if you will. I do think that there are there are people that they are really valuable for. And then there are people that like I've I've never really considered getting a service dog. I haven't. That's me, that's my personal. But I have a number of friends who have service dogs. And they are a large benefit. And I think not only from the diabetes aspect in terms of acknowledging and alerting. But also from an emotional standpoint, the fact that you have a technology like CGM, that do already give you alerts and alarms. We know that technology can be wrong at times, it can fail, we can fail to hear an alarm, especially overnight, I hear that a lot from kids and teen parents, that the alarms are just if they weren't there, the child would just not wake up to the current alarm, they just wouldn't, right. So from the standpoint of an alert dog that actually works and works and works and works and works until you're physically like up and or some of them can be trained to go and get another person if there's another person in the home. I mean, they're I think they're a positive thing. That's but I also think from knowing about them. I think it's really important to do your homework on where you get the service dog from Yeah. I have, you can not only get ripped off, but you also have to know what, what do you want the service dog for to begin with. And then from a training standpoint, there are places that will do 100% or so of the training for you. You come and you learn how to interact you are almost paired or matched with that service dog. And you learn how to continue and foster the training in order to make sure that they stay alert to you and your needs. There are some service dogs that you can can get where the training is more of an online and it's more the person with diabetes that goes through the majority of the training and, and does it with their service animal. I, I have had I've had friends who have done it both ways. And for them, their decision was right the way that they did it for what they really wanted to use their service dogs for. I've got friends who literally don't go anywhere without their service dogs travel with them on a plane or a train. I have one friend, her service dog actually just passed away said, I know her service dog because I've met her service dog but I mean she is she rode for like the JDRF bike rides and everything. She actually bought a special trailer for her service dog to pull behind her bike Wow, to go along with her. So in that, you know, a guy guess you have to again, consider how much contact do you need or want within your diabetes life, I've got another friend who her service dog is with her. But when she flies or goes to a conference or something, she does not bring her service dog along. her service dog is mostly for her home based area or anytime she drives someplace. So do your homework, get from a really reputable place? And know what you need your service dog for what your what are your expectations that that that will provide for you or for your child or your TN? So Well,

Scott Benner 21:33
I think everything you said makes 1,000% sense. And I kind of agree with you. It's not it's not a thing we ever considered seriously. I do know in the beginning my panic, my wife was like, mate, you know, maybe we should do this. Maybe we should do everything you know, right? I would just say this, I've never done it. I know a couple of people who have them who are absolutely delighted by them. It is a way of life. You know, it's not the service dog, it's not a thing you put on a shelf when you don't want it, you know you've cracked, it's a it's basically another person that exists with you. And you're responsible for them. And there's a ton of upkeep and training and and love and everything else has to go into it. All I'll say is that Arden's Dexcom has never vomited on the carpet in my foyer. So both of my dogs have.

Jennifer Smith, CDE 22:23
Oh, that's interesting. That's kind of funny. I our current lab has only I think he's almost eight. And he's only thrown up like once in his whole life with us so far, I think so

Scott Benner 22:35
I'm just Dexcom is not gonna poop in,

Jennifer Smith, CDE 22:39
they won't, or fart in the middle of the night and have this horrid smell.

Scott Benner 22:44
Or if you go back to any number of the beginning years of this episode of the podcast, you will hear them snoring in the background and everything else. So anyway, if I think I think you're right, I think if it's something you want to be involved in, and you understand the level of commitment, and it's something you're willing to do. I see it as being a great, a great idea, you know, but it's also a cost. And I do want to say I've seen people ripped off by training companies that are not reputable. And I mean, the cost is significant, too, right? You're talking about 10s of 1000s of dollars. Am I right?

Jennifer Smith, CDE 23:20
I don't even know honestly, what the cost is, I would have to go back. In fact, you know, for some references to some good places, I can certainly ask my friends where they got their service dogs from for some references. And you know, then I'll give them to you to supply. But yeah, it's expensive in terms of cost. I don't really know what the cost is. But it's it's not $2. Yeah,

Scott Benner 23:45
no. Okay. Hey, I think we have time for one more. Cool. Why does lack of sleep make blood sugars less stable, even away from food exercise active insulin, I usually see a lot of 9095 9100s, etc. With lack of sleep, when otherwise on just basil, my numbers are a lot more steady. Well hold on a second. I don't know if I understood. Let's go back to the beginning. Because yeah, I don't think again, I don't understand her explanation. I understand your question. Why does lack of sleep, lack of sleep make blood sugars less stable? Do you think that's true? being tired makes your blood sugar less stable,

Jennifer Smith, CDE 24:25
less stable. Typically, what we see is with a poor night's sleep or consistent poor sleep, that your blood sugar's will be higher on average. And if that's what's meant by less stable, possibly, you know, especially if their roller coastering up and then you're correcting and they're coming back down. I mean, that could be less stable than what this person sees when they have good sleep overnight. Typically, yes, we see higher blood sugars with less sleep. That's the general

Scott Benner 24:59
I mean, listen, I don't have diabetes, but if I'm tired, I'm more likely to be distant. I get a little foggy, I can be more irritable, right? Like there's, there's a lot of things that come with not sleeping, you need to sleep. Obviously, if you didn't, I mean, life would be twice as twice as long. Right? But, you know, it's just so I'm not understanding the question afterwards. I usually see a lot of 9095 9100s with lack of sleep, when otherwise on just basil, my numbers are a lot more steady. See, I don't understand because 9095 9100 seems to me it would

Jennifer Smith, CDE 25:36
be steady and very good. Well, I wonder, yeah, I'm not quite sure. I mean, one big piece in terms of lack of sleep and unsteadiness or again, a rise in insulin is or a rise in blood sugar, excuse me, is relative to what happens to cortisol. Right? When we have when we are sleep deprived, if you will, cortisol increases and with that impact, typically can increase insulin resistance. So it sounds almost like steady numbers on Basil is what the person was trying to say. But with a lack of sleep. The numbers get jumpy. I wouldn't say that the numbers that were stated sound jumpy. They sound actually very stable. But overall answer to Question poor sleep higher blood sugars, insulin resistance, typically, that's the gist of it. Yeah,

Scott Benner 26:37
it almost makes me feel like when I read her description at the end, she says with just basil. My numbers are a lot more steady. I almost feel like they wanted to say a lot less steady. I I'm trying to decide this person saying that when they have lack of sleep, they have better blood sugar,

Jennifer Smith, CDE 26:52
better blood sugars. Yeah. Which wouldn't be the case typically.

Scott Benner 26:57
That doesn't make sense. Okay, but so but still lack of sleep can impact your blood sugar's you would normally see it as a rise as a rising.

Jennifer Smith, CDE 27:05
And if it was a really poor night of sleep, you may actually have a lot of other hormones are, are thrown kind of loopy in terms of the whole rest of the day, you may actually have a change in the regulation of hunger hormones, which might mean that your hunger is disrupted through the course of the day. And you may nibble more. And I mean all of these. Again, we've discussed variables. Yes, all of these variables could have an impact on overall blood sugar, just because of a poor night of sleep. Right.

Scott Benner 27:35
Okay, so All right. Well, thank you. I appreciate it. Yes, with me, sure.

First, I'd like to thank all of you for sending in your questions over on the private Facebook group. That's where I got these questions from Juicebox Podcast, type one diabetes on Facebook 25,000. Members, just like you head on over. I also want to thank Jenny Smith, my friend, and diabetes guru, integrated diabetes.com If you're looking for Jenny, and a special thanks to us med for sponsoring this episode of the podcast, US met.com forward slash juice box or call 888-721-1514. And of course, don't forget, touched by type one.org. I have a link here about service dogs that Jimmy sent me. It is. Oh, it's pretty easy. www care. Es que es.com. So it's C A R E S k s.com. When you get there, you're going to be at Canine assistants rehabilitation education and services. This is the website that Jenny was talking about earlier. Hope if you're looking for a diabetes alert dog, that this will help you. There are like 15 Other ask Scott and Jenny episodes right now if you're looking for a list of them, the private Facebook group is the place to find them. There are these wonderful lists that Isabelle made for me. They're up in the featured section of the Facebook page. And that's pretty much all I have about that rollout theme here a little bit. That's okay. Scotty started a little bit. Tell you what, let's just say this. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.