#698 Defining Bold Beginnings

Juicebox PodcastInterviewBold BeginningsType 1 Diabetes

Jun 10

Jenny and Scott lay out the newest series on the podcast. Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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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 698 of the Juicebox Podcast.

Today's show is going to be slightly different. Jenny and I are discussing the next series that's coming up on the podcast the series is going to be called Bold beginnings. And it's based on listener feedback. In this episode, you're going to hear me tell Jenny the idea that I had explained to her about the feedback that I got from the audience. And then we take the big ideas from the feedback, almost like bullet points, we go over them, put them in an order we want to record in and talk about them as we go. So basically, you're going to listen to a meeting that Jenny and I had about the next series of the podcasts, but think of it more like a trailer, and extended trailer for a new series. 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, or becoming bold with insulin.

This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes, find out more and get started today with the M pen at in pen today.com. The podcast is also sponsored by us med us med is a place where you can get your diabetes supplies, and US med wants you to have better service and better care than you're accustomed to get yourself a free benefits check right now at us med.com forward slash juice box or by calling 888-721-1514. If you're a US resident who has type one diabetes, 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, it will take you fewer than 10 minutes. When you do this. When you complete the survey, you'll be helping people with type one diabetes and supporting the Juicebox Podcast. The survey is fast. It's easy. There's nothing on there. You don't know the answer to it's HIPAA compliant. And absolutely anonymous, T one D exchange.org. Ford slash juicebox. I have an idea for today. So, in you'll so we're recording already. So if you say no, it's fine. We'll just not do it. But okay, I don't think you're gonna say no,

Unknown Speaker 2:58
I usually don't. Well, you're

Scott Benner 2:59
Yes, you don't usually. So far, you haven't said no. I've said some weird things. But once or twice, you've been okay with it. So I had this idea a couple of months ago. And I kept thinking, again, the private Facebook group is just a font of information, because you can see what people are thinking. Right? Sure. And then eventually, if you see people think the same thing over and over and over again, you think to yourself, Well, this must be a question a lot of people have. So I, I put this question out. And I said, What do you wish you would have known at diagnosis. And what I got back, turned out to be an 80 page Word document full of information. Now, Isabel has gone through and she's taken out, like duplicate questions and things. I was gonna ask how much was duplicate? Not as much as you would think when you hear AVP. But but a fair amount was was duplicate stuff. And she broke and she broke it down into into sections, like put people's questions into, you know, under headers. And I was thinking that we should do individual episodes based on those headers. Sure, and then combine the episodes together in a series. You know, I don't know what I'll call it yet. But it'll be something about questions that newly diagnosed people have, like frequently asked questions of newly diagnosed type ones or something like that.

Jennifer Smith, CDE 4:27
Yeah, I'm curious how did since you've read through all 80 pages, or you're like, Oh, this is 80 pages. That's a lot.

Scott Benner 4:37
I've been making my way through section by section.

Jennifer Smith, CDE 4:41
And because I'm curious if some of the questions are. Gosh, I really would have liked to know this because definitely right up front. This would have been super, super duper beneficial. Whereas some questions may be, well, gosh, this would have been Nice to know upfront, but it's a little bit more. I know you say like ninja level, right? It's a little bit more down the road, definitely you would use this, but you're not going to use this two days from diagnosis

Scott Benner 5:13
and see the way you're thinking about it is the way I was thinking about it. And so what I what I thought was, if we take each header and almost handle it, like it's an ask Scott and Jenny episode. Sure, right. And then and then go through them have conversations, why does my voice break only with you? You don't might be because we're on Mondays.

Jennifer Smith, CDE 5:35
That could be I was actually gonna say if my voice today is very scratchy. I actually canceled clients like two days last week, because I had laryngitis

Scott Benner 5:44
No kidding. Oh, why don't want to talk?

Jennifer Smith, CDE 5:49
No, no, no, no, I think I'm definitely better. My voice is not like, weird, not there for five minutes. So yeah,

Scott Benner 5:56
so what I thought was, and this is good for your situation, is I just want to talk through the document with you. But we're gonna, we're gonna record it. So I sent you an email, which will open up into your apple notes.

Unknown Speaker 6:12
Okay. Let's see, we'll go to my email and see where your email is.

Scott Benner 6:21
I just think that conversationally is the only way to work through all this. Because otherwise, you know, what most people would do, who are creating content for diabetes, they read these, they choose a handful of questions. And they turn it into some bulleted point less than they put a, you know, two sentences after each one. But I think that, when we're talking about it, the length of time that we decide to talk about a question, usually is pretty accurate to answering the question. So some of the most part, I mean, I think we do a good, I think we do a good job of seeing the big picture when we hear people's questions, I guess, is what I'm saying. So do you have my email? I don't really know. Second,

Jennifer Smith, CDE 7:10
do you not talk a lot on weekends? Is that why you are saying that? Maybe it's because it's Mondays that your voice cracks a

Scott Benner 7:16
lot? I don't talk as much over the weekend. My wife would disagree with that, I imagine. But I don't think I do not nearly as much as I mean, I record this show. I mean, the last couple of months have been crazy. I've been recording like five times a week. So I talk a lot a lot. Yeah. And then I put ads on things. I probably I probably sit and talk directly for 10 hours a week. Just like constantly talking. There are times when my throat feels sore. It's not It's unpleasant. Okay, did the tag

Jennifer Smith, CDE 7:47
I'm right there with you. I talk all week as well. Sometimes at the end of my like, really long days, which are Mondays and Fridays. I get done. I have to like, take a couple breaths before I like walk out of my office space because two children like they just they want you know, they want like, Oh, now can I talk to you and you know, kids my age have no inner monologue whatsoever. And it just all comes out. And I'm like, Oh my gosh, Mommy needs quiet tie with a bubble bath.

Scott Benner 8:19
I'm in a mood right now. If you want to know how to Pre-Bolus a bagel, that's all I can tell you at this moment. Does your head does your head gets swimming. afterwards. Mine does. Yeah, the if I sit down and do a talk, like for hours, or even when I'm the one of the reasons I don't like people to look at me when I'm recording with them is because I stare at a spot on the desk bond accessing what I understand about diabetes like and I just I talk like

Jennifer Smith, CDE 8:43
plugging yourself into a file, right? Yeah, here's my file. I'm gonna connect to it. I download everything I needed for this circumstance. And then you unplug. Yeah, I do

Scott Benner 8:53
wonder if people don't understand, like people who don't do this would understand that. It's just, there's a there's a, uh, I don't know, a lake, a damned off lake full of information in my head. And if you get me to open it up, I can just let it out. But if you but if you ask me right off the cuff, I'd be like, Oh, hold on a second. So you're saying this happened. But once I started talking about it, it just if it just comes out smoothly, so know why that is?

Jennifer Smith, CDE 9:21
And that's kind of sometimes the reason that I get a little bit thrown off when people who are not in my diabetes world, whether it's friends with diabetes, or people I'm working with or colleagues like you or whatever, the general public without diabetes, when they ask you these very random questions. I have to be very careful about how I start talking about something because like you said, I will go off and then you get the glassy I look like deer in the headlights like this really, I didn't want and all this information. shin and I feel like you're speaking like alien language to me.

Scott Benner 10:05
I find in that scenario, my explanations are are so childish and simple, that if the next thing I said to them was, I have a very popular podcast about diabetes, they think I wonder why? Because I just I'm like, oh, yeah, she's fine. Right. Hasn't outgrown it yet. Right. Yeah. You know, that's not, hey, you know, what, forget it. Like, you know, so it's just, I don't know, I don't get too deep in it. Otherwise, and just like you're saying, I'll just start to talk. Right? And then

Jennifer Smith, CDE 10:40
I don't when I get going, yeah. It's, it's, it's hard to like find the end point, right?

Scott Benner 10:46
No, because there's because the explanation. And I think I mean, to bring it back around to this is the explanation is always conversational, I'm starting to believe that that's sort of why it's harder for doctors, because, because they're in that they fall in that same category as a person writing a blog about it, which is, I have about 350 words here. Before I lose people, and I run out of time, and or whatever the reason, I gotta get it out, I gotta get out succinctly. And this stuff's not generally speaking, not cut and dry. You know? No, you need the big conversation.

Jennifer Smith, CDE 11:24
So well. And I think that's why the conversational learning, as you do is very helpful to many people, because they're already in the realm of something that they are trying to understand, or they understand because they're living it, when you're trying to have a conversation with somebody who doesn't live in the diabetes world, and or has no connection from family or a friend or whatever. The conversation becomes very one sided, you become whether you wanted to or not, you become the educator, right? And then it's less of a conversation and more of a tutorial. And it's not a fun conversation.

Scott Benner 12:04
Right? No, no. and the Self Editing that happens, whether it's by the doctor, or someone writing a blog, is you know that you get to a point you Oh, I don't want to tell them that because they might misunderstand. Or, you know, I wouldn't want anybody's blood sugar to get to like, you know, to think I don't want anybody's blood sugar to get too low. The way I think of that specific thing is people's blood sugar's get too low, all over the world using insulin, but most of them don't know who I am, and will never hear this podcast, right. But if we give them enough information, they maybe could stop it from happening. And I would prefer for them to have a chance than then to not have a chance it it almost feels like a I don't know, it feels like an action movie to me. Like, you know, we've got to jump over this lava. If right, if we don't, the monsters gonna eat us, right? Well, we might as well jump and see what happens, right? Maybe we'll make it over the lava. And that's sort of how I think about this, like you should have the opportunity to succeed. It's not going to work out right for everyone. Or it might take longer or shorter for some people, but not telling everybody so that some people don't fall into the lava. Does that make sense to me because everyone's gonna get eaten by the monster. Correct. That's just

Jennifer Smith, CDE 13:23
and at some point, somebody's going to be ready enough to jump. Maybe they weren't when you first gave them the information. But if you gave it to them, at some point, they're likely going to try to use some tidbit that you provide it right. They'll

Scott Benner 13:38
have this recollection, they'll think oh, you know, I listened to that. Like, again, I I swear I didn't bring this up on purpose. But this idea of talking about these people's questions after being diagnosed, you can listen to these, and maybe maybe three months from now, you'll say to yourself, Oh, I remember someone said that in this thing. I could go back and look again, I could maybe just go with my recollection. But isn't that better than them being blindsided by it? Another great example, I think, is that this morning, in the Facebook page, someone someone's kid had a seizure, their their Dexcom was I don't know if it was in. If it was starting up, they didn't have access to their Dexcom data for a little while. kid had a seizure. She grabbed the G voc hypo pen, she stopped the seizure. She took the kid to the hospital. He's recuperating. Now, my point is, is that she did it like, like you should see her recollection of it. She had the information about what to do. It's not it's not this harried like, oh, it's not the Scarlett O'Hara post where she's like it. The world's happening to me again, you know, come pray. She's not asking for prayers. She's like saying, Look, this thing happened. It sucked. And we took care of it. And here he is. He's fine. And right and i thought i I was proud of that, like, I wish it wouldn't happen to the kid. But I mean, as a person whose child's had a seizure, it can happen, you know what can

Jennifer Smith, CDE 15:08
happen, right? And I think another another thing that you bring in there without really saying it is that, in this circumstance, the parent didn't get emotional, the parent was rational. They said, This is what's happening. This is what I have to do about it. And this is the next step. And that's what you have to do. I mean, if I had a t shirt that says, said, anything, it would be be calm and think like Spock, it would like seriously, if you just all of these things that you learn along the way, many of them are very just rational, do it decision, right? Don't emotion, don't put emotion into it. Because despite there being feelings about diabetes, and how cruddy it can be to manage things at times, and whatever. A lot of its decision that is, right now, this is what I have to do.

Scott Benner 16:02
And someone brought it up to me recently, and I'm gonna have to look into it more because it keeps popping back into my head. They talked about thinking like an astronaut, because everything that an astronaut comes up through is trying to kill them. Right? So when everything that you say you put it in order, like this one's gonna get me first we'll take care of this, then that one, then that one is the seventh thing, the 70 a thing on that list gonna kill me. It might.

Jennifer Smith, CDE 16:29
But but if I clear up one through 69, it might not it

Scott Benner 16:33
might not. And maybe it will something will change or whatever. And I just, I don't know. I think about life that way. Honestly, not just diabetes. So you know, whatever's our most emergent problem. It took me years to explain to my wife that my to do list was fluid. Like she would write it for she'd write it to do list she'd like you didn't do number one yet. I'd be like, well, number six is on fire. So I can't get one through five doc before six burns the house down. I'm gonna have to move the list around a little bit. It's, it's one of the reasons I enjoy making the podcast by myself. And not because people are like you, you could get an assistant or you should do this or what about an editor? And I was like, huh, I don't know. I like, I like the way I think about it. You know? So anyway, did you get my text? 20?

Jennifer Smith, CDE 17:21
Yes, that's right here. I thought I said yes, it came through perfectly fine, and was enjoying our conversation. It's, it's probably the longest text message that I have in. But I should say it's the longest texted note. As I have. No,

Scott Benner 17:38
did it open in your notes? Yes. Okay.

Unknown Speaker 17:40
It opened in my notes now.

Scott Benner 17:41
Yes. It's all good. Well, trust me, it's the longest one I've ever seen either. So scrolling through it, she's got it broken down to carb guidelines and impact of food. This is Isabel who took care of this she's, which is a pretty long list. It is then there's stalking, range, food choices Pre-Bolus Sing the 1515 rule. Fear of insulin highs and lows. Isabel, you did such a nice job of this honeymoon, terminology, flexibility, guilt, fears and hope expectations. And I'm still scrolling. Wow, that's that's a long one. About the podcast and the community around the podcast, medical team. Holy Hannah, technology and diabetes supplies Jenny, I'm gonna need you to quit your job. So we can do this. And insurance and insurance, long acting insulin exercise, journaling. That's interesting school being diagnosed as an adult, family, extra topics and then stuff that she's

Unknown Speaker 18:57
wasn't relevant to that that

Scott Benner 18:58
she didn't find would be relevant to this idea.

Jennifer Smith, CDE 19:02
Or maybe they didn't fit into a category. So I mean, they might be things that we can look through and see if there

Scott Benner 19:07
Yeah, and the rest will call that at some point if we get to it.

Jennifer Smith, CDE 19:12
So now my brain like I did when we first did the pro tips, like we need to rearrange this listing, right? I would probably go through this and list them out according to what I think would be really important first newly diagnosed really go here first and then next year and next year kinds of thing.

Scott Benner 19:36
I was hoping you would think about it. Honestly.

Jennifer Smith, CDE 19:39
I mean things like a medical team, and

Scott Benner 19:52
you ordered diabetes supplies. And if you're like me, you may have been using a place that made you want to reach up with your hands and Grab your hair and urine couldn't read out of your head because it was very frustrating. Or they say things like, well contact your doctor, you don't have to worry about it, then you had to worry about it because they never contacted your doctor. If this sounds familiar, and you're tired of that, I was almost like crap. But now I said it anyway. So if you're tired of that, I suggest you check out us med. US med accepts Medicare nationwide in over 800 private insurers. They carry everything from your insulin pumps to diabetes testing supplies, and the latest CGM. They always provide you with 90 days worth of supplies, and they have fast and free shipping. US med likes to say that they want you to have better service and better care than you're accustomed to today. Why not give us metta shot, they have an A plus rating with the Better Business Bureau. And they've served over 1 million diabetes customers since 1996. Us mad.com forward slash juicebox. That's the place you get your free benefits check. You could also do it at 888-721-1514. Get yourself some white glove treatment. Instead of that treatment that you're accustomed to. Oh, we'll call your doctor for you take care of the whole thing. There's nothing for you to think about bowls. You know what I mean? Us med.com forward slash Juicebox. Podcast is also sponsored today by Ian Penn from Medtronic diabetes, you might want to know more about it. And if you do want to know more, you're in luck, because Google's God is here to tell you about it. The in pen is a is a pen. It's a it's an insulin pen. I thought that was you know, it's an insulin pen. It's an insulin pen, but it's so much more because it connects to an app on your phone. This app gives you access to a dosing calculator, dosing reminders, card counting support a digital logbook, many of the features that people with insulin pumps get. So if you're looking for some of the features that you can get with an insulin pump, like you know how much insulin is active in your system. If that's something you want, you should look into the NPN. There's also an offer on the internet. Now you have to have, let me just say you have to here's I'll read it to you, instead of me just fumbling through the words, this offer is available to people with commercial insurance and Terms and Conditions apply, right? But you may be able to pay as little as $35 for an in pen, which is crazy. Medtronic diabetes does not want costs to be a roadblock to you getting access to the therapy you need. So go check out in pen today.com a great device, I think you're gonna really enjoy it. There's not much to lose here. So go ahead and check it out. There are links in the show notes of your podcast player, and links at juicebox podcast.com. To end Penn, US Med and all of the sponsors, including a link to where you can take the survey for the T 1d Exchange. Check it out, please support the sponsors. When you do you're supporting the show. I really appreciate it. I'm gonna get you back now to my conversation with Jenny, as we talked about bold beginnings. In Penn requires a prescription and settings from your health care provider, you must use proper settings and follow the instructions as directed. But you could experience high or low glucose levels for more safety information visit in Penn today.com.

Jennifer Smith, CDE 23:49
Maybe even food choices before like the carbs and the carb effect kind of thing. I think that the 1515 rule could definitely go along with the lows and the highs, I think can be kind of included together. Gosh, there's so much in here honeymoon definitely up at the top. I think that honeymoon is really poorly explained from the get go. And it's almost like a skirted over sort of comment. That's not explained very well. And so people get lost in whether it's going to happen or it's happening or how to know what's happening or what to do about it. You know what I mean?

Scott Benner 24:34
Yeah, okay, well, let's, let's do this together now. Okay. Okay. So I'm, you tell me and I'll put them up at the top.

Jennifer Smith, CDE 24:44
Well, I would definitely say honeymooning would be a good first, because that's going to mean for the most part. Within a very quick time post diagnosis. If honeymoon is going to happen, that's where it's going to end. happen. So that would be probably first. And then I'm kind of curious, you know, terminology is almost like the defining, yeah, diabetes. Right. So terminology, these are really good. Maybe just the ones pacifically post diagnosis that would be very important to have information about. So I would say, right along with honeymooning the terminology,

Scott Benner 25:30
okay. I have it there. I am putting him in your order.

Jennifer Smith, CDE 25:35
And then I don't know, I'm kind of like the medical team, I think could maybe be laughed before we move into like a little bit deeper. But I'm wondering like the highs and lows, especially, because there's a fair amount in the fears around highs and lows. And then specifically the 1515 rule. I don't know how many people post diagnosis I get to talk to who specifically asked about that. So clearly, this rule is still being taught. Yeah,

Scott Benner 26:09
exactly. And it's, and it's, and it becomes obvious to people pretty quickly that it doesn't make sense. And then they get stuck. Frustrated. Yeah.

Jennifer Smith, CDE 26:19
Yes. So I would definitely say that. Mmm hmm. I think right along with is there's one about insulin in here. And I think it might even be able to be included around fear of insulin is the Pre-Bolus thing. And I the reason I put it in there is I, I think because from the get go if people aren't taught about timing, you do start to fear insulin. Yeah. Because it seems because it's erratic. Exactly. So I would say, you know, within that 1515 rule, the fear of insulin lows and highs explanation of insulin, and then moving into Pre-Bolus Singh. And I think Pre-Bolus Singh could then move more so into wondering like curb impact, because they kind of go hand in hand.

Unknown Speaker 27:23
There are so many categories here.

Unknown Speaker 27:28
What about what about stalking?

Scott Benner 27:32
Well, stalking is going to be

Jennifer Smith, CDE 27:38
I mean, that kind of goes along with fear of insulin. It goes

Scott Benner 27:41
along with everything. It goes along with, right 1515 It goes along with fear of insulin Pre-Bolus thing you ever have somebody ever have somebody asked you. I had dinner, and I Pre-Bolus. And then I had seconds, what should I do? And it's fascinating. They don't, they're stuck. They're like, I've never had a meal inside of a meal before. What goes on? I can't just Bolus again. And it's funny, because in my mind, I'm like, well, you're taking in more carbs. Why not? You know, and then the I think that what they think is, well, that's so much insulin. And I just put in someone they might be thinking about stalking without ever having been told the word because because it seems like too much to them.

Jennifer Smith, CDE 28:27
And I think the real definition of stalking too in there, or a better definition of stalking, because what you're talking about, in a way it's stacking, but it's not stacking without purpose, right. You know, everything that you eat is going to require insulin, right. And it goes back to the timing of the insulin. And also now that we have wonderful technology, like a CGM. What's your CGM telling you? Yeah. Are you stable? Are you already rising? Are you falling? Are you low falling? Right.

Scott Benner 29:03
So this this lady posted a graph the other day, and it was a 12 hour graph was beautiful. And there was like, I don't know, she took the kid out for waffles and ice cream or something like that in there. And she said something like that her her child had like 250 carbs in this giant like, you know, food. Right?

Unknown Speaker 29:27
That's a lot of food. Holy cow, right?

Scott Benner 29:29
I was like, Wow, no kidding. But she you should have saw the line. And and it was it was so it was so flat. And then everybody comes in and their first thought is that's so many carbs. That's so much insulin. How much insulin was was a smaller kid right. And and she says it was like it was over time I think 17 units she used over out the kid didn't like horsepower. Yeah, this this happen, like stages over a couple of hours. hours. And I kind of chuckled to myself when I read it. Because if Arden has a carb heavy meal, she could use 17 units for a meal. And sure, it's a lot like, you know, I'm not saying it's not, but it's not a lot for that food. It's just it was interesting that people's, that their first thing isn't, Wow, you did that? How can I do that? It was, it was back to their preconceived notions about things. That seems like a lot of carbs, that seems like a lot of insulin. It seems like you know, and, and that's all relative to begin with 17 units. I mean, listen, if you if you had, you know, if you had type one, and you weighed 350 pounds, you might be used in 17 units to move a number, you know, like, like, there's all different reasons why the numbers should be. The numbers are what they are. You know, if Arden goes out has nachos with cheese steak on it, and french fries, you know, we're somewhere near 17 to 20 units. It's you know, because for the fat and everything, there's a lot you know,

Jennifer Smith, CDE 31:04
I don't think I've ever taken a 17 unit bowl. Oh, my

Scott Benner 31:08
like, yeah, well. You eat like a healthy bird.

Jennifer Smith, CDE 31:16
I don't know. I you know, even growing up though, I had definite high insulin needs as a teen. I all teens do. But yeah, I don't know, maybe it was more just from the standpoint that I also started in a very different school of thought and education than we have today. Yeah. I mean, I actually I went to my mom's on Saturday with my boys just for an early Mother's Day. And she's been trying to like do some cleaning and whatnot. And so you know, for my brother and I, she kept really organized files, like every report card we ever had. All of these things. Well, I found in there a scrapbook that I had, at some point put together after my diagnosis with all of my cards, all of my mylar balloons taped into this scrapbook and everything. And I found three of my hospital menus with my choices during that week. You kept all of

Unknown Speaker 32:14
that. I didn't my mother. This is my mom. Yes, this is what she does. But it was snowing.

Jennifer Smith, CDE 32:23
Yes. But it was amazing to me. And in terms of this, that I had a very structured plan that was based on portions and the insulin that went along with it. There wasn't as much variety or variability. And that's just not how my mom did it either. I'm sure other people probably at that time may have. It's just everything was very structured.

Scott Benner 32:50
It makes clear what the technology wasn't there to track anything you did. I mean, if you started if you try to eat 250 carbs back then you would have I mean, you would have been high. I don't see another way. Oh, yeah, your blood sugar would have been high forever. I think that's why some of the the old time he type ones in those group, see, see that? And it fries their mind? Yeah, you know, like you can't do that is always there. I wish the internet was audio. So that because I think you can't do that. In typing, you know, typed out doesn't mean the same thing is how it would sound like, you know, it sounds. It sounds like a direction typed out. You can't do that you're not allowed to do that. What I think they really mean is holy hell, you can't do that. Right. Yes, that's not gonna work. But, but I mean, it does it just, I mean, it does, you know, and again,

Jennifer Smith, CDE 33:44
it goes along with timing of insulin and when to put it in and what you're seeing again, our technology today allows you to do some of these types of things. As long as you're paying attention.

Scott Benner 33:57
Yeah, right. Right. So all right. So we got some stacking fits in there. So right now have honeymooning terminology highs lows 1515 Rule fear of insulin lows and highs Pre-Bolus thing carbon pack stacking

Unknown Speaker 34:14
and then I think I would put do we put food choices somewhere in there? Not yet.

Unknown Speaker 34:24
Um,

Scott Benner 34:26
sort of has to go before Pre-Bolus and doesn't Pre-Bolus

Jennifer Smith, CDE 34:29
thing? Yeah, I would put it in definitely before Pre-Bolus. And then I'm wondering if I was just reading range. I'm assuming we're talking about glucose ranges here.

Scott Benner 34:48
Let me look. Next, make sure I see it the way you said. What range to be out or shoot for. How being 200 for weeks is okay as the body adjusts. But to taper down to More realistic unhealthy range, that it may take a while to normalize blood sugars that have been happening. So it's kind of a broad it is. Yeah,

Jennifer Smith, CDE 35:10
I would probably break it down to range based on what's considered healthy range, what's considered a normal range outside of having diabetes, what is the human body typically aim for. And then I would move into range that might even include things like safe ranges for activity and safe ranges for illness and range that you might hear from your medical providers versus what you're really trying to aim for. Along with, where should your glucose be? What should your target be? Fasting first thing in the morning? What should it be? Or what should you expect after meals? All those things, I think, fit within range.

Scott Benner 36:01
Well, we could do it as as one episode, and just break it up within the episode, right?

Jennifer Smith, CDE 36:10
Yes. And I think I'd I'd move into then definitely, maybe even terminology. And there's one in here that's about I think, the medical care team, right? Because I think they they all in a way go together and medical care team in terms of ranges alone, or they're going to have a very similar range for everybody. They're just going to give you your their blanket statement. You should be here. That your alarms here. Yeah,

Scott Benner 36:44
they're gonna say whatever the ADA said last right. For the most part, 70 to 180 right now is that the numbers,

Jennifer Smith, CDE 36:51
that's the numbers right now, I mean, even even most of the CGM does have that set as their default in terms of data collection 70 to 180, unless you go into your own settings, and actually physically adjust them to see your cumulative information that's scaled to your target range. And again, a lot of people don't even realize that they can do that within their, you know, software, data analysis, like clarity or whatnot. But then even discussing within the medical kind of piece, how to pick a medical team how to ask questions within the medical team, I mean, I'm assuming some of these are the questions within that medical.

Scott Benner 37:32
So what if we didn't worry? What if we put these in order, which we're doing now? Then after we have it in order, then I will apply a topic to every one of our recording dates coming up? Perfect. And then we can be read ahead? And then just sit down when it's time to record and, and have the conversation? Were actually well planned? Jenny, what do you think of that?

Unknown Speaker 38:01
That's a great idea.

Scott Benner 38:04
Listen, I'm gonna tell you, we don't

Jennifer Smith, CDE 38:06
usually ever in fact, we never do. I never know what we're talking about until we click in together and I like gardening. And you're like, let's talk about this today.

Scott Benner 38:14
I'm gonna tell you right now that one of the things about the Pro Tip series that I'm most proud of is just that, that it really is. I mean, we made a bullet pointed list. And then we said the topic out loud and then did what we did. And it's been so valuable for people. I think this is going to do something similar. Now, here's a question for you. This is more of a pocket podcast question. But I'm interested in your opinion. Do we just make this part of the Pro Tip series? Like remember, I said, I wanted to go back and revisit the pro tip episodes. Right? Maybe this is going to do that?

Jennifer Smith, CDE 38:52
It may, it may do enough of that. I think the pro tips are I don't know what the longest pro tip episode was maybe an hour.

Scott Benner 39:01
Yeah, there might be one that's more like our 15 or something like that. But pretty, pretty close to that.

Jennifer Smith, CDE 39:06
Because I think those were very, very specific. And while we talk and veer off and whatever within our conversations, I think if I were to do it, I might actually put this as a pro tip, category, pro tips for newly diagnosed and then put these all up definitely as pro tips, but these are the things within here. If you are newly diagnosed, go here and if there are additional questions based on one specific topic, maybe go to the regular pro tips and look up that you know what I mean?

Scott Benner 39:51
Yeah, no, I do. That's a good idea. All right. So I'm still I'm still pulling topics and bringing I'm up top so that I can see them. So you know, there a lot of Yeah, hold on a second so Okay, so we have still flexibility, medical care team guilt, fears, and hope X and hope expectations, podcast community family journey school journaling, exercise, long acting insulin. I know that when, after the after the topics came back, so I eventually close the thread and I was like, Okay, this is enough. I'm good thanks. And it was very generous of people to come in and spend time but giving real clear explanations of the things that were confusing to them or that they found helpful, etc, right. And then I put it all into this Word document. And I was like, I don't know what to do with this, you know, so I didn't have time. And I thought this is such an asset. I don't want to lose it. But I was like, I don't know what to do with this. And Isabelle said, I'll go through it. And I said, thank you very much. And weeks, took her weeks to like, you know,

Unknown Speaker 41:15
I'm sure. A lot of information 80 pages is no joke.

Scott Benner 41:19
No. And so she went all through it. And I thought, it's a lot. And most people wouldn't put this effort into their content. And I think that's why it's gonna be good. You know? Yeah. So it's even why I'm not scared to discuss it here with you. I mean, honestly, this episode is going to serve as sort of like a primer to let people know what's coming. They probably, they probably won't hear this, too. We have a number of these recorded already, I'll probably put out first get them ready to that it's coming. But there was a there's a voice in my head that says, Don't let people hear you and Jenny talk about this, because they're gonna rip you off. Because that does happen. Jenny, I put up content. And then a week later, everybody's, somebody else has to talk about the same thing like, oh, wow, what a surprise. And but I don't care. Because I think, I think first of all, I think the effort we'll put into, it won't be matched by anyone else. And the information, you know, I would hold up against what anybody else could come up with. And, and the other thing is, I just don't think that this is how, I don't think people put this kind of effort into stuff. I just don't, you know, even going all the way back to the Pro Tip series, like the amount of hours that we spent recording that stuff. You know, a lot. Yeah, and you you know, we say this all the time, but you don't work for me, like you're not getting paid to do that, like, you know, where are you gonna get somebody with your knowledge, and your understanding of how to explain things, and an ability to talk to me because you and I, like, we get along really well. And we vibe off of each other, but we're not similar. Like, you know, it just it just works, you know? And you're not gonna get that so I think we can do this. I think this will be terrific. No, this is really great. Yeah. Okay. So does it repopulate when I move words, do you see it happen right away?

Unknown Speaker 43:08
I see it happen on my screen. Okay. Okay,

Scott Benner 43:11
so you saw me misspell a word. That's embarrassing. Nevermind.

Jennifer Smith, CDE 43:15
Actually, I was gonna ask you what? You had the word long after exercise. And I was like, what else goes along with that? I don't know what long means long time without insulin long time

Scott Benner 43:27
to scroll to make sure we have them all. So I mean, there it is. Right? It's, it's, I think that's everything. I'm gonna go back down and go through it when we're actually you stay up there where the list is. And I'll scroll through and tell you what's here. You can tell me if we have it up top or not. Extra topics. I'm not worried about that right now. Family is family up there. Family is up there. Yep. Being diagnosed as an adult. I don't remember typing

Unknown Speaker 43:57
that is not up there. No,

Scott Benner 43:59
can you add it and we can rename these topics because you know, Isabel's first language isn't English. Oh really? She's French.

Unknown Speaker 44:13
Oh, that's you did tell me Yeah.

Scott Benner 44:14
And I only said that so when she hears this she'll she'll be mad at me for saying that. school.

Unknown Speaker 44:23
School is in there

Scott Benner 44:24
journaling yep exercise. Yes long acting insulin. Yes. Technology and diabetes supplies that's out there. I can add that okay. And then insurance which I know I didn't put up there either. Insurance and the medical team Yes. Yes. Did someone add did I add podcast and community? Yes. While this topic so long I can't get the The header what is it going to be? I'm still scrolling.

Unknown Speaker 45:05
I think the long one.

Scott Benner 45:06
It's guilt fears, hope and expectations is incredibly long. That's here. Okay, there's probably the reason for that is likely going to be that there are a lot of personal anecdotes in here, which took people log in to type out. I'm gonna,

Jennifer Smith, CDE 45:19
I wouldn't expect so to and some of that, you know, we'll go through these obviously ahead of time, but I would expect some of the things within that, especially the fears may be addressed within the other topics,

Scott Benner 45:33
right? Yeah. Yeah, I don't think we're gonna I don't believe that we're gonna have to go through these, these and read everyone's thoughts and answer them. I think I think the way I see this happening is that we prepare by reading them make our own couple of notes, and then we can have a bigger conversation around that and interject people's thoughts when they when they build on everything. Flexibility is up there terminology is up there honeymoon is fear events on lows and highs 1515 Pre-Bolus. thing I'm getting close to the top. Food Choices, range stalking. Carb guidelines and impact of food. Carbon pack gifts,

Jennifer Smith, CDE 46:23
is current guidelines and actual

Scott Benner 46:27
I think that's a topic Yeah. All carbs isn't a topic, better education on how insulin works with specific food groups would have been beneficial.

Unknown Speaker 46:35
The hospitals there's there's curb impact is that the headaches?

Scott Benner 46:41
But hold on a second, you typed it in

Unknown Speaker 46:42
here already?

Scott Benner 46:45
I see what you're saying. You're saying it's possible that I, I shortened it. And I should have wrote that. So I'm gonna put that in there. And I'll change that. Yeah, because this is really interesting. The hospital made it seem very black and white. You eat X carbs, you take this much insulin and go on with your life. Another person said the impact of food nutrition component on blood sugars. Why isn't her blood sugar tracking the same for breakfast day after day, even with meticulous carb counting? You're right, a lot of these are going to be able to like we're going to be able to give an explanation and then point somebody to a different episode to wait where they'll be able to be helped counting carbs as a huge stressor for us easy ways to count carbs and how different things hit you differently would have been great. Yeah, so basically, these last three statements sort of say the same sort of say the same thing. So okay, great. But my point is, is that the luck of having such a large group of people, one of the things that's great about it, is that this is, um, this isn't just a random person saying something now, like we have consensus,

Jennifer Smith, CDE 47:56
this is a pool. This is a pool of you know, I mean, if you were doing like a research project, you would have a lot of participants. Yeah, right. Our research wouldn't be n of 10, which then the general information about like a study like that is like 10 people great, but the world has how many billion people in it right? And now many of them have diabetes. So how relevant is this, but this is a very good yeah, amount of people comments

Scott Benner 48:22
right now, I think this is so be good. And then some people go into more detail, my biggest frustration is that at first they send you home and tell you that your child can only eat carbs during the three main meals. They talk about free snacks outside of it. So you spend hours researching free snacks and loads of money buying them. And then two weeks later in class, they say oh, by the way, she can have carbs whenever she wants just those for it. Here's your new chart, even if they just said we want you to wait a couple of weeks, but at this point will teach tricks and I say okay, yeah, this is this is gonna be good. All right. I'm excited. This is cool. This is what I was hoping would happen. You're up for it. So yay. Do we want to try this last couple of minutes we have do you want to try to put the rest of them in order or?

Jennifer Smith, CDE 49:10
Sure let's see so we have order already for Honeywell and terminology highs lows kind of all the insolence sort of together. I think maybe within the insulin we should also put probably

Unknown Speaker 49:32
let's see highs and lows

Jennifer Smith, CDE 49:33
I think should also maybe be Where's range because the highs and lows kind of go along with range. Okay, so right. So maybe highs and lows and then range. Alright, that's all together.

Scott Benner 49:51
Got it. I feel like guilt fear, hope expectations, podcasts and community Isn't last, like, towards the end may be correct those things so I'm gonna chop those out and put them down lower. Make some space here. I think flexibility is a huge part of it. To be honest. I honestly think your medical team is towards the end newly diagnosed people are not going to break away from a from a new medical team. If it's a bad one, they're not going to even know. Right away. Right? So Correct. Maybe put that more towards the end as well. Oh, great. All right. And long acting insulin could just

Jennifer Smith, CDE 50:40
think long acting needs to be around the well EV around that fears of insulin lows and highs. Because you can also define rapid acting insulin within that even though it wasn't a question asked. I think it's going to be a piece of that fear of insulin.

Scott Benner 50:58
I put it before because I can see myself talking a lot about basil in there. And correct. I just think that basil gets ignored by everybody does. Yeah.

Jennifer Smith, CDE 51:08
It gets ignored by everybody. Except it's the first place that most clinical people adjust first. Yeah, they just don't. Some are Basal here. Yeah. Hi, here. Let's just put some more Basal insulin here. Yeah, probably not. But

Scott Benner 51:23
I put I'm starting to work backwards. I put journaling and family towards the end. Correct? Sure. And so I'm going to put towards the end, we can rejigger these as we need to technology and supplies. That one,

Unknown Speaker 51:38
I might put that with maybe before after insurance before or after insurance. Okay.

Scott Benner 51:43
Being diagnosed as an adult.

Jennifer Smith, CDE 51:50
Um, that might actually, I'm wondering if that wouldn't be too bad to put after honeymoon.

Scott Benner 51:56
Yeah, so that everybody can feel like they're a part of the of the series as it comes out. Right.

Jennifer Smith, CDE 52:02
Right. And because being diagnosed as an adult, you may actually have a more pronounced honeymoon, you may have more of a real honeymoon, depending on how you learn to manage things from the get go. So I think that's good there.

Scott Benner 52:19
And then we left flexibility school and exercising. So I, I would think, I'd like to put flexibility, at least in front of I think flexibility and stalking, right? Yeah, right before guilt and fears might be valuable. Correct. School and exercise. So now schools interesting, because I haven't read them yet. But I'm gonna guess that a lot of these questions were about, hey, how do I just send my kid to school five minutes after they have diabetes. So I don't know about that. And exercise is kind of the same thing. You see people get sedentary after they're diagnosed, because they don't know what to do.

Jennifer Smith, CDE 53:06
Well, I think school and exercise there's something some of these are as well, but they're more visible variables. School is a variable exercising is a variable. So

Unknown Speaker 53:25
choices, maybe,

Jennifer Smith, CDE 53:27
maybe right after school and exercise, or right after flexibility, put school and exercising. Because those both really do require some flexibility in what your typical management style would look like. So

Scott Benner 53:48
you see what I'm doing now? Um, yes, I'm gonna put them in an easier to look at. format. All right, well, this should keep us busy.

Jennifer Smith, CDE 54:03
Along with all the other things that you had us, like scheduled out for the rest of the year, right?

Scott Benner 54:09
I'm gonna, I'm going to, I'm going to put an end to ask Scott and Jenny because the thing about those are, that are great as they can just go somewhere. They're really valuable. They don't need to be attached to anything else. They're great standalone episodes. Right? So I'm going to so basically, at the moment I have I have about three ask Scott and Jenny episodes, a couple more defining episodes, so I'll put up the defining things till they're done. Then I'll put up I'll put up the ask Scott and Jenny's while we're recording these, and then when they ask Scott and Jenny's run out, we should have enough of these to get going. Okay, that makes sense. Fabulous. Right? Neither of us can get sick or get a life.

Jennifer Smith, CDE 54:56
I will promise to try not to get laryngitis again. Yes.

Scott Benner 55:00
Sometimes I look at I was, I was getting ready to go under for my, for my surgery. And I said to my wife, if something should happen, hire an editor. I have like 70 episodes of the podcast that need to go up. I was actually, like, concerned or worried no one would ever hear them, you know. So. Anyway, all right. Well, thank you. This was true. Yeah. I enjoyed listening to this kind of talk through the idea. We'll find I'll find out if I get notes like, could you guys not not record your meetings, please?

Jennifer Smith, CDE 55:37
Well, you know, but I think it's even if you put it up as a as the preliminary pro tip for honeymooning. This is what's coming. If you are newly diagnosed, we promise we are we are getting to some of these big questions that you really want to know sooner than later.

Scott Benner 55:59
910 I'm counting 1112 1314 2020. Okay, so yeah, even the way the podcast runs, usually your episodes go up like once a week on Friday. Okay, you're you're like you're the Friday girl. And but maybe I don't put episodes up on Thursdays maybe so that I can get them out more timely. Maybe I'll put them up Thursday, Friday for 10 weeks, and then we can get them up more quickly. Okay. Thank you so much.

Unknown Speaker 56:27
Yeah, absolutely.

Scott Benner 56:35
A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of the podcast learn more about the impended in pen today.com forward slash juice box. Also like to thank us Med and remind you to go to us med.com forward slash juicebox. Or call 888-721-1514. To get your free benefits check. Take the T one D exchange survey AT T one D exchange.org. Forward slash juicebox. The very first episode of bold beginnings will begin in just one week on Friday. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

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