#693 Ask Scott And Jenny: Chapter Seventeen

OmnipodJuicebox PodcastDexcomInterviewType 1 Diabetes

Jun 3

Written By Scott Benner

Scott and Jenny Smith, CDE answer your diabetes questions.

What number do you correct at during the night?

When you do the thing that you know it’s going to happen, and it does not happen over and over again, how do you adjust? How long until I assume I need more insulin?
How do I manage pre bolusing when I have gastroparesis?
How do I find a great healthcare professional in my area who is open to all these ideas?
Let’s talk about stomach bug and diabetes management.
Do type 1 get sick easier?
Let’s talk about insulin needs during and after an illness.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

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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
At the beginning of every episode, I tried to record a different opening. And I always just end up back at Hello friends, and welcome to episode 693 of the Juicebox Podcast. It's classic.

Today, Jenny's back for chapter 17 of ask Scott and Jenny and I think this is the last ask Scott and Jenny for a little while. So dig in and enjoy. Please remember, while you're listening to Jenny and I, that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please Always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you're interested in hiring Jennifer, she works at integrated diabetes.com. Also, if you have type one diabetes, and are a US resident, or are the caregiver of a US resident who has type one diabetes, you can go to T one D exchange.org. Forward slash juicebox. Join the registry, take the survey help people living with type one diabetes, it's completely HIPAA compliant, absolutely anonymous, and supports not only people living with type one, but the Juicebox Podcast. And I'm Juicebox Podcast so you'd be helping me out. T one D exchange.org. Forward slash juicebox takes fewer than 10 minutes. This episode of The Juicebox Podcast is sponsored by us Med, go to U S med.com. Forward slash juicebox. Or, or call 888-721-1514. Whether you go to the link or call the number, you're going to be chatting with us mid and finding out about your benefits. That's right, you get our free benefits, check out that phone number, or at the link. The podcast is also sponsored today by Ian pen from Medtronic diabetes in pen is an insulin pen that does a lot of stuff that a pump does when you pair it with the app that comes with it. And it's pretty darn nice. Check it out at in pen today.com I'll be talking more about in pen and US med a little later in the show. You don't want to miss it because it's late at night here where I'm recording and I'm probably gonna say something stupid. That's the thing that happens when I'm tired. Hey, Jenny, how are you?

Unknown Speaker 2:41
I'm fine. How are you? Scott?

Scott Benner 2:42
Good. We're gonna do more ask Scott and Jenny today. Oh, yay. Yeah, people tell me we seem very relaxed and happy while we're doing these.

Jennifer Smith, CDE 2:52
I hear you can see our faces. We are pretty happy people don't really frown too much.

Scott Benner 2:58
I just somebody told me that we seem like it's fun. And I said it is fun. And then I thought Oh God, are we like diabetes? dorks like we're just having fun like, going like, hey, it's an interesting question. Let's think about it for a second. So apparently, that's what that's what we are. Alright, let's just start a Start Here. There were a lot of questions. Questions, right? Um, which one do I like to start with? Alright, here's a very simple one. What number do you correct at during the night?

Unknown Speaker 3:29
Ah,

Scott Benner 3:31
so do you think this question comes from people who were pretty much told not to correct their high blood sugars at all?

Jennifer Smith, CDE 3:39
I would say maybe it started there. Yes. Because that is certainly something that's still taught not to correct. I think sometimes it's in the beginning stages, maybe after diagnosis, because they're still trying to sort of figure out how much insulin works. And in a time period where you're supposed to be sleeping, it's kind of a worrisome thing to have to sit up and wait to see what happens when you take extra insulin. But honestly, it kind of boils down to knowing that your settings are right, it's knowing how insulin works for you, how much does it take for this amount of insulin to do the job, and overnight, I mean, unless you talked about a lot of the variables. We've already talked about things like pizza and fat and do bla bla bla, or exercise overnight. If you've got your insulin sensitivity factor pretty dialed in, you should be able to correct a value and take the doses if you're using a pump. First, you should be able to take the correction offered and it should get you to the target that you've got set in your pump or pretty close to it right. So I I think in terms of defining a number, it also starts with the Finding what's the target you're aiming to sit at? If you are comfortable at 110, then you're probably not going to be correcting a 115. Right? But if you really want to sit at 85, then you're probably going to correct the 110 to be able to get down to that.

Scott Benner 5:21
So I see this question like coming from two different perspectives. So if you were to ask me, where would you correct? A blood sugar? I would tell you, it wouldn't matter if it was overnight or during the day, or if we were in a car ride or at the top of, you know, a mountain. Although the top of the mountain, maybe it would, because there would be some difference. Yeah, there'll be differences there. So there's a bad example. But, you know, Jenny makes the point already. If you trust your settings, then you can correct a 95 blood sugar without making yourself low. Right? Correct. And Arden's using DIY loop. So I mean, her loop is correcting at 90, you know, like, so there's the answer. If your settings are super tight, and you know what's going to happen, is gonna happen, then you can correct anything. But I tend to think that this question comes from people who are maybe more new to the podcast, maybe or, or have are seen, like wildly out of control blood sugars. I read this question as what number is high enough that I put in insulin? I'm not going to make a low blood sugar later? And I have to tell you, I think the answer to that question is go listen to the protests. So that that stuff doesn't happen to you.

Jennifer Smith, CDE 6:37
Agreed, at least not all the time, or Yeah, often, right. I mean, those random i, we talked not long ago, and like I had this horrible high blood sugar overnight, they didn't hear my alarms, and you know what I mean, things like that they can and and will happen. But overall, as I've said, and as the pro tips different definitely cover, it's if you know that your settings work well. And you're not happy with the number that you see, when you wake up to go to the bathroom at night or your alarm goes off or something, you shouldn't be able to correct that number and get to the one that you really want to sit at. So I don't I don't think it's necessarily defining what number to correct above. It starts with Where do you want to be? And if you're not there, do you know that taking extra insulin to get you there, we'll do it without causing alone.

Scott Benner 7:28
Now, some practical thoughts from me on this would be if you see a 200 blood sugar, and you aren't sure how to safely bring it back to 90, if that's your goal, at least wax something out of it, like throw in something like if you could make a 191 50 doll better than 190, right? You know, take something out of it put in put in some sort of a Bolus. And actually these moments are where you really learn, because I can't tell you what number to correct that or how much to correct. But if you do it over and over again, you know, you can look at that 190 a stable 190 At two o'clock in the morning, put a half a you in London as an example. And it ends up being 170. And you think, Okay, well, I wonder what would happen if I put a unit on it, maybe it would end up being 140. You know, you're gonna learn from trial and error. So that's it. It's a roundabout way of answering that question. But I think there's more. Like there's more good, good, good, usable thoughts in there than there is? I mean, I can't tell you what number to correct that that just, that seems like something that seems like something a newer diagnosed person would ask an endo, and then the endo would pick some huge number that they thought there's no way they can make a low out of you know, correct. Yeah. So anyway, all right. It's an interesting question. It says, when you do the thing that you know is going to happen, and it doesn't happen over and over again. How do you adjust to the new normal? And the question ends with is it just time? So I think the question here is, you know, I've been using a unit to make a 150 100 for a year and now all the sudden it's not working, how long until I? I assume it needs more insulin in that example.

Jennifer Smith, CDE 9:17
I mean, I would go about it the same way, a dress a lot of adjustments that I work on with women in pregnancy. Three days, we have a trend, let's make a change because something clearly has. It's not working the same way any longer, right. I think a lot of times if you have been stable for a really long time, it can seem almost like something else must be the problem, right? Maybe my insulin went bad or it's got to be a bad site or something else was the issue. It's it can't be that my setting has all of a sudden just needed a change, right? But it could be Yeah, I mean, we know that diabetes is not this, you get to a point and everything just sits there. Right? If it was man that would be easier to test things and be like, great. I'm done for life. Now I just have to count my carbs.

Scott Benner 10:14
That's it whole podcast would be about how to get to that point. Right,

Jennifer Smith, CDE 10:17
exactly. So. So yeah, I mean, a couple of days of a trend, as long as you have considered variables, you know, even illness in the picture or a change in your schedule, a change in your sleep schedule could certainly mean and we talked about sleep a little bit before, that interrupts your sensitivity to insulin, more to the case of being a little less sensitive than more sensitive. So if there aren't any known variables in the picture, nothing that you've really changed, then I expect that you probably need to retest and say, okay, one unit doesn't drop me 100 points anymore. I guess I'm going to have to use a little bit more, I'm going to change my ratio, or my normal sandwich at lunchtime, or salad used to take two units of insulin. And now I'm getting higher, or lower, maybe after and it's been a couple of days.

Unknown Speaker 11:13
Yeah, I injure ratio

Scott Benner 11:15
in my mind I, I'd look at so the first thing I always do is I go to gaps of time, where there are no active meals or active boluses. And I look for stability. Because that's how I think about base. Yep, like basil should. Basil should be pretty easy to check in those moments, especially if you have a CGM is I guess what I'm saying? So if I find stability in those moments, and that's the ability existed a number I'm happy with, I think, okay, then Basil is good. Maybe this is just carb ratio. You know, maybe I'm not Pre-Bolus thing enough all the sudden, like, who knows? Like, that's great. Why would end up looking after that? Yeah, I think so. And as far as time goes? I don't know. I mean, if three days seems to be the standard for people, you know, I and then the question is specifically about once it's set in stone that this is new. So yeah, I mean, three days is reasonable to me.

Jennifer Smith, CDE 12:14
Yeah. And I would say within that defined time period that you're analyzing, it's not like when I notice things that change, it's not that I'm just letting things sit higher or lower. To actually see, I am adjusting within that time period, so that I'm not left consistently high or consistently too low. And sometimes enough of those changes within the analysis time period. Gives you a good vision then for how to change the rate or the ratio by day three,

Scott Benner 12:48
let's say and I say Just don't forget what you changed it from because if magically a day or so later turns out you are sick and or something like that you didn't know it. You don't want to forget what your ratios were. So you can go back to them because that has happened to me before. Mike. Wait, it worked before what was it?

Jennifer Smith, CDE 13:07
Change it from? I was it's funny. I'm, I'm, I am getting a new phone. And I was going back through all of my pictures and I'm amazed how many of my like screenshot photos all right, like diabetes stuff. Like I changed this to this or look at this super awesome, like completely just flat day or whatever. I was

Scott Benner 13:31
awake. I was away for a few days, and we had to change Arden's insulin sensitivity. And I said screenshot those, send them to me and then change them because yeah, I'm not gonna remember either you. Oh, here's an interesting one.

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this is a question that I've actually been asked a handful of times over the years. And the first couple times somebody asked me I thought I don't know anything about gastroparesis. I can't answer this question. I have no idea. And then I spent some time talking to people who have it. And my understanding loosely ended up being that sometimes I eat and my body starts to digest food. And so I get the impact that I expected. I know how to line up the insulin. And sometimes that food just sits in my stomach doesn't get digested. And like the question says, I have all this act of insulin. How do I know which is going to be which and one time I said to somebody, oh, maybe you could try bolusing the way that I think of bolusing for infants and smaller people, like get a little bit going. And then when you see the impact, quick Hurry up, throw the rest in. And I've never heard back from anybody that that didn't end up being valuable for them. But I am wondering what use help people

Jennifer Smith, CDE 19:10
know that it is similar because it's like a small child where you don't know exactly like they love their favorite plate of food and you put it down today and they eat three nibbles and they're kind of done right. So it's a question of how much and when is it actually going to completely get digested in this case? Or absorbed I should really say and a timeframe that may help as I've worked with a number of people with gastroparesis is that on a more empty stomach, which for most people is first thing in the morning, you're going to get more more consistent, absorption, digestion because there's nothing there's nothing left over in the stomach. by them, right? By the morning time, we have, for the most part this like clear route system, if you will, right. And the body is more likely to also, as everybody with diabetes experiences want to get that food in to get your body some energy to get going for the day. So if there is a time period of the day, if you expect a need for a real Pre-Bolus, because of sooner, quicker absorption of the food, it seems to be morning time. And then as the day rolls on, and as you put more food, whether it's meals or meals and small snacks or whatever, through the course of the day, it tends to be the end to be all of the night, that is often the hardest to gauge when to dose the insulin, because by that point, with a with a slowed down digestion and absorption of the foods earlier, you've already still got stuff sitting there. So that may be in a timeline through the day may give some visual as to or a structure, I guess, to looking at what this person might be seeing happen, saying sometimes I seem to need the Pre-Bolus and it works just fine. And other times maybe it's a time of the day. Okay, so begin with first

Scott Benner 21:12
kind of track that to see if you're seeing it more at one time a day than the other. Possibly most likely, at the end of the day, I guess as the body is having more and more food added and more and more trouble dealing, right. Okay. Right.

Jennifer Smith, CDE 21:28
I mean, the other thing would be the case of also just trying to figure out your more typical foods. And if they are more causative to immediate need for Pre-Bolus. Or I just have to follow this kind of a meal out. And as you said, Put the insulin in in a slow duration. You know, an extended Bolus, for example, often works fairly well, if you've tracked enough around particular meals to know what their action seems to be like most often for you.

Scott Benner 22:04
Is this a mimicking of like pizza? In a person who doesn't have guests? Or is that a similar or not?

Jennifer Smith, CDE 22:10
It's that's a similar thought. Yes, I mean, not for the reason of fat in this. It's just a slowdown in the body's ability to digest the right way and absorb the food the right way to give the glycemic effect that you would expect from that particular food.

Scott Benner 22:29
I'm always kind of in the back of my mind when we're talking about timing. I always think I always wonder how many people are listening thinking I never considered that before. I just thought I just thought it was just you know, I count the carbs. This is the insulin for it all goes in all works out doctor told me to do it, it'll be fine. You know, in considering this. I mean, it's, I mean, for the people I've spoken to it's a terrible thing to be afflicted with it. Really, it really sounds difficult.

Jennifer Smith, CDE 22:57
Another consideration that I know people have tried to as you know, today's rapid acting insulins, while I don't love the name of them, because they're not really rapid. Right? A rapid is like, Okay, right now, it's done, it's working. But they are certainly more rapid than the AR that I was on when I was first diagnosed, right. But in the case of potentially needing that lingering effect of an insulin, some people actually do better with a regular insulin. So that it's it's creep out in action is longer in taking effect. And again, timed right with meals that are well planned or, or well evaluated. Almost like the same thing for breakfast, lunch and dinner. That type of insulin could meet the food better than a rapid insulin could.

Scott Benner 23:52
So back to the old timey insulin.

Jennifer Smith, CDE 23:54
Sometimes that can work better.

Unknown Speaker 23:57
Yeah, great. Well, good question.

Scott Benner 24:00
Yeah. Here's one. How do I find a great CDE in my area who is open to all of these ideas and works well with teens? I have. I'm gonna I'm gonna ask you first. What do you think people should be looking at when they're looking at doctors?

Jennifer Smith, CDE 24:19
From I'll give my adult perspective, first, adult perspective when I call to get into a new endo office. Some of my first questions include things like how many type ones does your practice see? Oh, okay. Yeah, comparative to type twos or other types of diabetes or other types of endocrine disorders, right. I mean, you have may have an endocrine office, but they may be more heavily thyroid based. I mean, they made you know, I would say dabble may be the word in diabetes only be because that's in their realm that they don't necessarily do that most. So that's a question I ask is, what's your population of people with type one? And then what goes right along with that is? How much technology do you do you use in your office? Do you use one pump? Or you recommend recommending only one type of device? What type of data like evaluation software do you have? How can I send my information to you? How often are you going to get back to me? I have a lot of questions. I'm trying to really do better. I need somebody to answer questions weekly for me. Is there somebody in your office that can do that? Do you have another question about just the endocrine office? Do you have a CDE? In your office? Do you have an educator who works physically in your office with your practice? Because again, then there's a little bit more collaboration in terms of the endo and that educator, they know each other, they're going to be more on the same page, if you will, you're not going to get information from one that's kind of contradicted by the other, which can make your decisions hard then because then you sort of feel like you're stepping on somebody's toes. If you're going outside of what one recommended.

Scott Benner 26:25
It's a terrific response. Because I, because Arden still goes to a, you know, to a children's Endo, I never I it's as you were saying, and I'm like, Gee, Scott, that's so obvious. Like, how did you not think that but it shocked me, I thought, oh, an endocrinologist might not be well versed. And they in even in diabetes, right? Like it's they could be doing Oh, anyway, I was like, wow, that's such a great answer. I never thought any of that

Jennifer Smith, CDE 26:49
know, when we lived when we moved to Northern Virginia, or the DC area. And I was on the search for an endo there. I went through three endos, before finding an endo who actually met my need. Because

Scott Benner 27:06
what were the reasons you didn't like the ones you found?

Jennifer Smith, CDE 27:11
The initial the initial person just was not up to date, that's the best way to say it. They were just not up to date with keeping up with how people were managing today. They were very much to old school. And the second office was, it was not enough. They had technology, but they were very much toward one type of technology. Gotcha. And just really were not keen on the others. Not that they wouldn't allow prescribing, but they just didn't know enough about them. And that wasn't cool to me. So

Scott Benner 27:54
one of the one of the one of the companies sent really great bagels and pens that wrote really well. And so that was the pump they talked about. I got Yes, I got pretty much. Yeah.

Jennifer Smith, CDE 28:05
So yeah. And then the office that I eventually ended up going with was, it was a small private practice. Actually, it wasn't affiliated with any, like, hospital system or anything. And he just he really, what got me with my first visit was that he took the time to sit down and ask about my life, and how I manage specific things. It wasn't just a generalized visit

Scott Benner 28:34
the the things that you know, that they need to know to actually answer your questions, right. Okay. Yeah, not just you have, what's your carb ratio?

Jennifer Smith, CDE 28:43
Right? What's your a onesie? What's your carb ratio? Let me take your pump from you and physically touch your device and change everything and handed back to you. Hey, go run, run, run from those offices,

Scott Benner 28:54
eat healthy and exercise. I'll see you in three months. Thank you. Well, I will just throw in here, that if you go to juice box docs.com There is a growing list of doctors that people who listen to the podcasts and an end if you have a doctor who fits the bill, please send it to me so I can add it to the list. I would say for Arden, you know, we went with a big institution that was near to our house. And I don't know like I I don't I can't I'm such a bad person to ask about this because I'm me. So I don't know how valuable it is or it isn't. I really couldn't tell you. I can tell you that I've been in situations where I've been asked to go talk to other patients, which is weird. And I often there are times I get asked more questions than I get to get ask in a visit. So sometimes my answer is if you know what you're doing. Good doctors are the ones that stay out of your way and write you the scripts when you need them.

Jennifer Smith, CDE 30:00
and can support and discuss, especially if you've come prepared to a visit, to talk about, I've made these changes, these are these are the reasons that I figured out how and why to make these changes. Do you see anything else? Do you think I'm on the right track? And if you've got a good doctor who can sit down with you and go back and forth and discuss, then you've got somebody who, you know, is good, right? If not, and all they really just want to do is look at data without any explanation to it, then,

Scott Benner 30:34
hey, I find value in the fact that Ardens doctor can do her a one C, and it goes through my insurance, okay, and we don't have to go to another lab to do it. Like, to me that's like a bonus. Yeah. But I would say, I mean, I would say we've covered it here. But how do you find a doctor, that's going to work well, with teens, it's you're going to talk to them and see if it works well. And if it doesn't, you're going to need to have the nerve to move on. That's all.

Jennifer Smith, CDE 31:00
And honestly, in today's world, like I had none of as a growing up child teen. The online community is quite a good resource. And people give their honest opinion. And I think in especially in in our diabetes community. If somebody's had a good experience with a doctor fourteens or a doctor for kiddos or a doctor for real little littles or college kind of connection doctors. It can that's one thing that I think it can help to ask, because people are very happy to share when they've had a good experience.

Scott Benner 31:37
Yeah, listen, feel free to go into my Facebook group and ask specifically about certain doctors. I don't mind if you do that and be surprised that that group has gotten big enough now where you might actually get a couple of answers I we're starting to get to the point where people are bumping into each other in like cascos and wearing shirts from the podcast going, Oh my God, listen, that podcast too. So you might actually find more people than you think. I mean, unless you're in a very rural place, but you know, okay, well, thank you. So here's the question, I have no idea how to answer. There's a stomach bug going around. This person asks me directly have I ever had to take art into the ER for not being able to manage blood sugars and ketones when she was vomiting? Seems like it's a common thing to have happened with illnesses that cause vomiting. I will tell you that when I see this time of year comes up and people start posting about my kids throwing up what do I do? I'm thrilled that I made that Facebook page because people who know what to do come pouring in. I don't think Arden has ever vomited in her life. Wow. Yeah, she doesn't get Yeah, that's amazing. She doesn't get sick. I don't know when here throws up like it's we're not a throwing up family. So Arden's never vomited. She gets sick incredibly infrequently, which I think is just obviously hurt her stellar auto immune system is very strong. Kill nearly anything, Jenny. One way your thyroid, your pancreas an illness, it runs roughshod over everything. Let's get rid of, but she um, she just doesn't get sick like this. She's never had a stomach virus. And Arden's also, she's a bit of a warrior at me, she she would choke something down if she had to, she wouldn't like it, but she would do it. Having said that, she has had the flu as a small child. And I do remember that week of my life, very unfriendly, which I don't think it's a word, but it was not. I also had the flu. So she had the flu, I had the flu, and she was only a couple of years the diabetes, we were still using needles in a meter. And I remember giving her like small sips of Gatorade to try to keep him. Basically what I did was like flip the whole process around in my head. And I started thinking of instead of how does insulin bring blood sugar down, I started thinking about how does how to carbs bring blood sugar up, like how do I bump the bump nudge the other way, basically. And that is what we ended up doing. There was a time I actually gave her a lollipop to suck on. Because I thought this is it. Like she gonna she's going like like her blood sugar was falling during this flu. She wouldn't eat anything. And I pulled out a lollipop and I was like you're stuck on this. And that worked. I don't know, though. Like I saw a lot of people talking about it recently. So has it been going around?

Jennifer Smith, CDE 34:34
It has honestly I would say in the past month. I've had so many kiddos who have had some stomach bug of some kind and I think defining to I would hope that these days most people realize that the flu is not a stomach bug, right. Two different things. They're very much two different things. Which is why when you said she had the flu she did not have a stomach bug.

Scott Benner 34:59
No she He just was he how sick she couldn't eat anything? Yeah, that's correct. Yeah, that's a similar problem, you know, correct. Yeah.

Jennifer Smith, CDE 35:06
But it's a true stomach bug usually runs its course pretty quickly. For the most part, it's usually about 48 to maybe 72 ish hours. One, the two of those days being the real, like vomiting and possibly like diarrhea, not being able to take very much in, if that's the case, insulin adjustment, for the most part usually needs to be taken down. If you're thinking about digestion, you don't get as much absorption, even with the things that you are able to possibly take in. It just gets passed through. So which brings in the concept of well, what do I do about dropping blood sugars, right? Overall with a stomach bug where food intake has really taken a nosedive, taking insulin doses down by 2025 30%, and a base Basal amount. And then for any food that is able to be taken in whether it's Gatorade, or popsicles, or jello or you know, some type of electrolyte beverage with some carbohydrate in it. Don't dose unless you know that it's going to stay in.

Scott Benner 36:18
Yeah. Yeah, really? No, I that was the one that those are the that was the moment where I thought, I mean, if our blood sugar goes to 150, or 180, or 200, I'll bring it down slowly from there. But I'm not going to try to get ahead of it when I don't know what's going to happen. Right. Yeah,

Jennifer Smith, CDE 36:35
exactly. So it's, it's cautionary and kind of the question of, well, when do we end up going to the emergency department, right? I mean, the sooner that you start, not that you're not paying attention already to blood sugar, especially with the technology we have today, it's kind of hard to ignore what a CGM is showing you. But in the case that you've been paying attention, and you can start to see things happening one way or another, make adjustments sooner than later. Is is really it right? fluid status is also really important with a stomach bug. Because if food or anything is coming out either way, you're really losing hydration, you're so you have to make sure to replace that. Hydration often is more of the reason that I see people end up going in, because they literally can't keep anything down. Okay? Which then with diabetes, water or anything, they just can't

Scott Benner 37:34
keep that up, we're looking at DKA, right?

Jennifer Smith, CDE 37:37
We're looking at even DKA at a much lower value based on the fact of ketones, right? I mean, you could be in DKA at a lower glucose value. Because ketones have climbed so much, because you're dehydrated, you're not putting any food in your right. So they're, they're bigger things in the picture there that do need to be managed. I always also recommend that if with diabetes, you go to the emergency. As soon as you get there, and you know that you're going to be at least admitted to the emergency department, ask for an endocrine consult.

Scott Benner 38:13
Okay, right away. Yeah,

Jennifer Smith, CDE 38:15
right away. Because, I mean, emergency doctors, they see everything, they're really good team of people, but diabetes is not their specialty. It's, it's just not, don't let them take your insulin pump off. Don't let them disconnect your insulin or not give you your insulin if you've got a Basal injected insulin, you know, bring it along with you. For the safety of knowing that you you could give it if you needed to. But I think that's the big reason that I always say let's get an endocrine Council going there because you need somebody on your team who really does understand

Scott Benner 38:52
because a bit better, right? Because you can't, you can't even though you're in this fairly dire situation. You can't stop taking insulin because you're you're going to go into DKA and it could be a person who sees a low blood sugar their first thought might be we'll take the insulin away but your thoughts got to be IV glucose drip will fight this that way. Right? Yeah. Okay. You know, it's funny as you were talking about this, I swear to you all of my anxiety from the first time someone explained this to me when Arden was first like diagnosed came like rushing back into my chest because I remember thinking so there's going to be a time when this process and her body that we have to keep going artificially with this insulin becomes impossible to keep going and if we stop the insulin, she's going to just die a different way. Like you like that is how it how it felt when she was little, you know? Yeah, you really made me I got flushed while you were talking. Sorry. I don't know why I wanted to ask the ask the question because I know how scary it is, especially in the beginning, and especially if you're prone to this sort of thing. And I do see that sometimes kids get this illness sometimes. Some of them get it every year. Yeah. And so.

Jennifer Smith, CDE 40:13
And I think another one too, depending on as you just said, Your child is one who you know, is going to get this at some point. Make sure that that's a discussion within your endo visit at least once a year to revise or revisit what your plan of action has been. How has it worked? Yeah. Because then if you can see what didn't work, you can improve upon that for next time. We did this and we did this. We still ended up having to go to the emergency department. We still couldn't get around it at home. What can we do better or more aggressively next time? To avoid going to emergency?

Scott Benner 40:51
Yeah, I'm gonna, I'm gonna go right into another question that's similar, but I'm gonna say first, that the first time someone, you know, through the emergency line told me, I had to inject a unit a half of insulin to clear Arden's ketones. When I couldn't get her to eat anything. I was like, no, no, no, no. I think you're wrong. Lady on the phone, I'm not doing that. And then I just I said to Kellyanne like, they told me I have to give her insulin she's like, but she can't eat anything. Oh, my God, I'm gonna do it. And I did it. And it worked. And, you know, so knowing? Yeah, it really is. So your to your point about constantly being aware of what you're going to do your steps, that ratio is a good thing to know about as well. You know, how absolutely how much insulin we're going to use to clear ketones. Next question is, I feel like my son has been sick more in the last year since diagnosis than any other time in his life. Is this in my head? Or do type ones get common colds easier? When do you feel like you can trust that the other important adults in your life to care for you? This is a two part question how long? Alright, let's go with the first part first. Okay. Two people with type one gets sick easier, Jenny?

Jennifer Smith, CDE 42:09
I'm going to say no. But with a little added note there, okay. Right. So people with diabetes in general, that is well managed, with lower variance would be less likely to get sick frequently, only because the stress factor of variable blood sugar, and or numbers that are higher, which leaves your body stressed already, those aren't in the picture, right? So the more variable and the higher your blood sugars are, the more likely that that stress on your body is allowing an illness to actually also make its entrance and that your body can't fight it effectively. That's the easiest that I can kind of describe

Scott Benner 43:10
that. So because we're slightly post COVID Right now, post COVID, or post COVID ish. Let's say that. I'll use this as an example. When COVID first happened, everybody was yelling, why someone calling me Do not call me. But you're so important to talk to, you know, stop it. Everybody was like, you know, remember it was you know, it's like, well, we want to vaccinate the people who are at risk. And then there's that big argument that you hear people say, Well, I have type one diabetes, I'm at risk. And then someone says, I have type one diabetes, that doesn't put me at any more risk than anybody else, you know, like, okay, great. That's gonna be fun online. Anyway, to your point, that someone, I'm going to just use you as an example, who you know, eats a pretty clean diet and whose blood sugar is very stable and managed and lower. almost normal. We've never asked her anyone say that interesting. You know, we've never once said that, wouldn't it be great if it was a great if you're like, I'm pretty steady. 788 right around there usually get everybody be like, Why have I been listening to stupid podcasts?

Unknown Speaker 44:21
Like, oh, my God.

Scott Benner 44:24
You're not coming on anymore. What? But I'm not gonna ask anyone. But, but somebody who's just cracked me up. I never thought of that before. Isn't that funny? We've been doing this for years. It is never occurred to me to ask you. Yes.

Jennifer Smith, CDE 44:41
Well, I'm happy. I mean, I don't care. I've talked about it all the time. My patients asked me and I tell them all the time. So my last one was 5.5. By

Scott Benner 44:48
God, I mean for me, not for you. That's very nice. But so but so somebody in your situation. I would think that for reasons you just stated your They're healthier to begin with, right? And that I don't know that other people see one ad all day as cuz it might be the best they've ever been able to accomplish, you know, but to give an example, last night so Arden's working on this big project for school and she got all like, hunkered down with it, I wasn't home, and she has been doing more on her own. And I think her site went a little funky, where she was too sedentary or something happened. And Arden had like a 175 blood sugar for like six hours. And, and by the end of the night, she's like, my back hurts and my ankles sore. And she did not feel good from her blood sugar just being 170 for like six hours. So you know, if you can think about what that could do to somebody over six hours. What if you're always living like that, you know, like, what else is happening to your body? So So just getting type one diabetes does not make you automatically have more cigarettes, right? No, it does not if you're not maintaining your your blood sugar's that could be difficult on you could be difficult, correct? Yes, I we have so many questions here that are right around this. And we have a couple of minutes left. So why does blood sugar either go low in sick or high? And then after illness? Sometimes you need a higher Basal. Is that higher Basal temporary. So isn't this different for everybody how illness that impacts you or not really,

Jennifer Smith, CDE 46:25
I've found that it's definitely different for everybody, I would say the grand majority of people it is if you have something like a respiratory bug, sinus infection, some type of bronchial something or another, you will usually experience a rise in insulin need during the illness. In fact, after having had diabetes long enough, you might even find that going back in your records, before you even had symptoms. You had higher blood sugars for a couple of days. And they may have seemed odd. And then finally, one morning, you wake up with stuffy head kind of sore throat, you know, not feeling the greatest, those climbing blood sugars even before you were symptomatic. Or often because your body was fighting something off, it was trying to manage and deal with something right. But most people have a higher insulin need during an illness, especially the height of the illness really where you're not feeling well at all. And then sort of a slide back down to where you were before, a baseline of need. Stomach bugs can be a little different stomach bugs could reduce your insulin need during and because it takes some time for your digestive system to recoup. In the aftermath, your insulin needs could actually stay low for a week, give or take. And then they start to go back up to more normal. If you're the kind of person who is found that an illness really drops your insulin needs, and then after your insulin needs climb up, I mean, do they climb back up to where you were before you were sick? Then they're not necessarily higher. They look higher than they were while you were sick, but they're just kind of going back to where they were

Scott Benner 48:18
right. This is an offbeat question. But do you take probiotics?

Jennifer Smith, CDE 48:23
Where do you I do take a probiotic you

Scott Benner 48:25
do? Like every day?

Jennifer Smith, CDE 48:28
In the morning in the morning? Okay.

Unknown Speaker 48:31
A refrigerated one.

Scott Benner 48:32
Do you take

Jennifer Smith, CDE 48:34
there you take refrigerated ones.

Scott Benner 48:36
You're always told to take refrigerator ones? Yes. Okay.

Jennifer Smith, CDE 48:39
Oh, that was for my naturopathic doctor. That's not like, you know, just Googling information or whatever. But that was my naturopath had said, if you're gonna get a really good probiotic, get one that's been refrigerated that you keep refrigerated.

Unknown Speaker 48:52
So you take vitamin D, do take vitamin D, zinc, every day, I take sync.

Scott Benner 48:59
Okay, we're gonna talk about that one time. It just popped into my head just now. And I was like, we're gonna talk about this. Not now, but but

Jennifer Smith, CDE 49:08
I've taken them a long time. It's not just been the past two weird years or anything. Right. And those have been things that I've taken for a while.

Unknown Speaker 49:19
So yeah,

Scott Benner 49:20
I I even notice if I don't take iron. It takes a couple of weeks of me forgetting iron for my nails to start breaking. Breaking. Yeah, like it just out of nowhere. Like I'll touch something and they'll just split. And then when it happens, I think oh, why have I not been taken that iron? And then I go right back to it. It's that's very interesting. Okay, we're gonna have to do supplement conversations at some point. Okay, well, Jenny for now. Thank you very much for doing this with me.

Unknown Speaker 49:47
Absolutely. It's always fun.

Scott Benner 49:53
Candy Smith is on the show. And everybody loves Jenny. Thank you, Jennifer. Integrated diabetes.com That's where you can go higher Jenny. Thanks also to in pen from Medtronic diabetes. Don't forget to go to in pen today.com I did that great ad read in the middle. Don't make it a waste okay, like let's let's not make me look silly here I did a good job you go do your part. I also want to thank us men remind you to go to us med.com forward slash juice box or call 888-721-1514 Get your free benefits check today. Getting your diabetes supplies does not have to be a hassle links to the advertisers or the show notes of your podcast player and at juicebox podcast.com. If you can't remember the links that I have said ad nauseam in this hour. Before I go, I'm gonna remind you that the Facebook group is poppin Juicebox Podcast type one diabetes on Facebook, it's a private group. So you're gonna have to answer a few questions to prove to the Facebook overlords that you're a real person. But then after that, you're right it Did you hear that I gave you a it's like a sound effect really, but it's just my hands rubbing together. But right in what else I want to tell you diabetes pro tips are available at juicebox podcast.com In your podcast app at diabetes pro tip.com. But if you're gonna use your app, just go back to Episode 210. That's where it begins with an episode called newly diagnosed starting over can't remember that join the Facebook group. Go up to the featured section. There's beautiful lists right there of all the series, not just the protip series, but defining diabetes defining thyroid, the variable series, how we eat, there are so many to choose from. Actually, I can't remember them all now, which is why I just said there's so many to choose from. What else do I need you to do? Well have a good day. I mean, I definitely want you to do that. Have a good day. I had a good day today. Drink plenty of water. You don't I mean like stay hydrated. They say it's good for the skin, your eyes, clarity of your views, and insulin keeps that insulin moving around your body. Very nice. So you do not want to be using manmade insulin without being hydrated. It's gonna get Funkytown on you drink a glass of water. And then I have another one. What else? Have you said hello to a stranger recently, I always find that to be uplifting. Maybe some eye contact you know hey, how are you are good day, that kind of thing. That works. Let somebody in in traffic. That's a good thing to do till somebody wants to get over just guy. Yeah, come on over. Makes you feel good. Makes you feel relaxed inside. Like I did a good thing. You know, and it doesn't hurt you it really you can just pass them later. Anything else? What do you do to to kind of give back to the world and yourself to yourself personally inside your deepest, darkest self? How do you light Matt load? Right? You go for a walk? You sing in the shower? Do you sing in the shower? You crazy kid you do, don't you? I don't have watch YouTube videos in the shower. That nobody else does that and my being mocked silently through the either. I don't appreciate it. Yeah, like throw up a YouTube video. Throw it up on the side of the shower. You know, check it out. Learn something new. Sometimes I'm learning about like computer stuff I need for the podcast or cars or I don't know. Comedy. A lot of times it's comedy. Yeah, I just found a guy the other day I really liked his name. Sadiq Ali Ali Sadiq. I think it's Elise Sadiq. I found him I found him interesting. Totally good story. Let me see what his name is. I'm really sure it's Ali Sadiq. It is really funny guy. Actually just put up his last special on the YouTube. I really enjoyed it. This is it's not usually what we talked about here. But at least Siddiq. I thought you were funny man and tell other people about it. You told a great story. good storytellers are hard to find. What else do I want to say to you? It's very late here. My eyes are bugging out of my head. You know when your eyes get like, hot because they're dry. I'm up to that part right now. I should go to sleep right? This is the last thing I have to do tonight. So I'm going to do that. I'm going to say this. Thank you so much for listening. I really appreciate it when you leave ratings and reviews for the podcast especially when they're good ratings and reviews like five stars and you're like oh my god I love this podcast like stuff like that. That's stuff I love. I love it when you join the Facebook group Facebook group very proud of

you catch me on the Instagram if you want to please go to the T one D exchange and take that survey for me. He one the exchange.org forward slash juicebox are really honestly can I speak the like people for a second? Like I know in the beginning I want to kind of time limit on like T one D exchange. But it really is easy to do. And your answers, which are also simple answers to simple questions genuinely help people with type one diabetes. It really genuinely helps people and I get money And then I take that money and I, I buy computers and I pay for my electricity, I get food, I send my kids to college, I buy gas for my car in I mean, I keep myself going and then like me, I'm like all like kind of like, you know, financially okay. And then that allows me to make the party. Yes, you understand commerce, I imagine. But this is why that's important. I get money for the ads, I get money when you fill out the survey, the survey actually helps people. It's not like I'm doing some crap thing where it's taken advantage of you or something like that. It's meaningless, or you're gonna get like, you know, emails from like, I don't know, people bugging you about buying solar panels or something like that. I mean, it's about diabetes. It helps people diabetes, it helps me it helps everybody. In 10 minutes, T one B exchange.org. Forward slash Juicebox. Podcast a bit of a tangent. Are you still listening? Since usually, I haven't done this in a while or I've just rambled on at the end of the show. I mean, if you're still listening, you're a fan and I appreciate you extra that people stop listening. They're great, but you're better