#712 Bold Beginnings: Terminology Part II

OmnipodJuicebox PodcastInterviewType 1 DiabetesBold Beginnings

Jul 1

Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.

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.

Bump & Nudge - Rage Bolus - Compression Low - Interstitial Fluid - Fat & Protein Rise - Dawn Phenomenon - Somogyi Effect - Feet On The Floor - Insulin Sensitivity Factor - Adrenaline Highs - Insulin Deficit - Growth Hormone - Stacking Insulin - Hydration - Lada Diabetes - Mody Diabetes - Crush It & Catch It - C-Peptide - Beta Cell - Insulin On Board - Pump Break - Barriers - Black Holes - Dictate The Pace - Carb Absorption & Digestion - Antibodies - Hypo & Hyper - Types of Diabetes

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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 712 of the Juicebox Podcast. This is the second part of a special bold beginnings episode, part one is already available, and episode 711.

Welcome back to the bold beginning series with me and Jenny Smith. Today's two parter happens in Episode 711 and 712. This is bold beginnings terminology part two. In these two episodes, Jenny and I define every word that's available to you in the defining diabetes series. At the time of this recording, there were over 40 definitions. We did a quick definition for newly diagnosed people and left you the episode number so you can go back and get a more complete definition. If you've just been diagnosed. Or if you're trying to figure things out, it is our estimation that this two part episode, part of the bowl beginning series will catch you up on terminology very quickly. If you're looking for the defining diabetes series, it's available at juicebox podcast.com diabetes protip.com. And in any audio app that you listen in, join the Facebook group Juicebox Podcast type one diabetes to find the lists of all the series in the featured section. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. And because of the format of this episode, I'm going to put the ad right here for you so that you don't have to take a break while you're power listening through these definitions. Isn't that cool of impelled to let that happen? Thank you and pen, even though I didn't ask you, but I know you're listening. So just be cool. All right. All right, ready the pen. It's an insulin pen. But it's more than that. Because it's attached to an application on your iPhone or Android phone. This application is going to do many of the things you've heard about people getting from their insulin pumps, you'll be able to see your current glucose right on the screen, a dosing calculator, active insulin remaining meal history, dose history, glucose history, activity logs, and you can generate reports based on your data. Not only that, but you're getting a great insulin pen, everything you expect the cap the needle, the insulin cartridge holder, it's an insulin pen, just like you've come to expect. But it gives you more with this attached app. You can go right now to N pen today.com To find out more and get started. And I'm gonna tell you what terms and conditions apply, but you may pay as little as $35 for the in pen. Medtronic diabetes does not want costs to be a roadblock to you getting the therapy that you need. Within Penn's Access Program. You may pay as little as $35. Where will you find that out? At in Penn today.com. On this site, tons of frequently asked questions that you're going to be interested in just scroll to the bottom. What is the M pen? How much does it cost? Our insulin cartridges included? Does M pen work with long acting insulin? Can I pair more than one M pen to an app? You want to know the answers to those questions? Go right now to in pen today.com and get your answer if you're ready to try the M pen when you're at the link. Just follow the easy instructions it says ready to try you complete a short form. And just like that you're on your way. In pen today.com forward slash juicebox in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in Penn today.com. Yeah, okay. Haha, there it is. So Jenny and I are back. This is another day we recorded from Bolus to feeding insulin. And now we're gonna go to Episode 347 and the defining diabetes series. This is another made up I think this is one of the last ones that I made up for a while. Yeah, it is. But this one's called bump and nudge. So, you know what, Jenny, I've described how I think of it all the time, but you've heard me talking about it so much. How do you think about it? Now that I've explained it to you?

Jennifer Smith, CDE 4:39
Well, it's just, I mean, I just think it's learning how to use insulin. Better to bring your blood sugar into the place that you want it to as well as not only insulin, but food, right, because it's kind of a both. It's a both system. Use insulin to get your blood sugar to come down. Until where you want it to. And if you maybe use just a little bit too much, then you're using a little bit of food to kind of keep it stable, avoid it from dropping too low.

Scott Benner 5:09
So there's been this. There was once a discussion online where people said, do you think of somebody asked me one time, do you think of bumping his insulin or bumping his carbs, and everybody, because I've never really said it before, but in my mind, I nudge with food and bump with insulin, I think and I'm the opposite. You think of it the other way, it doesn't really matter the way in 20 seconds. The way I describe it to people is when you're driving in a lane, and there's a line on your right, a line on your left, if you start to slowly drift towards the line, you don't quickly yank the wheel back the other way, you just sort of bring it back just ever so slightly to come back into toe again, right? To be straight again. So instead of waiting till your blood sugar, 60 and falling, what if when it was 85, and it was just sort of drifting down, if you just had a couple of carbs, if you just sort of nudged it back up again, or bumped it back up again, it really doesn't matter which one strikes you in your mind. And similarly, why not lower your CGM alarm to more like 120 so that when you're kind of drifting up gently, you can give a small amount of insulin and bump that number back down. Because a lot of times less insulin gives you less of a chance of a low later so just instead of waiting to your wildly, you know, instead of waiting till you're off the road in the weeds and bouncing through the holes, when you see the line just sort of come back a little bit bumping and nudging. It's really the whole thing. So that's episode 347. And Jenny episode 352 is rage Bolus. Go ahead, do Rachel.

Jennifer Smith, CDE 6:46
Yeah, rage Bolus, everybody with diabetes. I would think honestly, everybody with diabetes or caring for somebody has raged Bolus, at some point, essentially, you've gotten so frustrated by a high blood sugar or even a climb that you didn't expect. That looks you know, those double arrows up like I'm just gonna get on top of this. Now this is not bumping and nudging. This is completely like the other end of I'm just gonna take a lot of insulin, and I'm gonna get my blood sugar come back down,

Scott Benner 7:19
but you haven't done it. You end up using so much normally, that you create some sort of a fall

Jennifer Smith, CDE 7:24
later. Correct. A pretty dramatic fall for the most part. Yeah,

Scott Benner 7:29
so it's like taking a bucket of insulin. Just be like, I can't take this anymore. It generally doesn't go well. There there is. We'll wait till we get to it. So that's episode 352. Rage Bolus. Episode 358 is compression low and interstitial fluid. I think we started off making a compression load defining and ended up explaining what interstitial fluid is because I compression low if you're wearing a CGM, you've got this wire under your skin, the sensor whatever they call it, filament, doesn't matter. It's a thing. It's under your skin. These are all things that they've been Yes, those are all good words. It's measuring your interstitial fluid.

Unknown Speaker 8:08
And if you glucose in your interstitial fluid,

Scott Benner 8:11
thank you. And if you lay it right on top of the of the sensor, it compresses into your body. When it does that, it pushes the interstitial fluid away from where the wire is. And therefore, your you get a low reading that isn't real. Correct? Because in that area right around the wire, there is actually less glucose. Yes, but there may be not your body's idea of it. Right. So what else? Yes. And on a Dexcom, at least when it happens, you sort of teach yourself you can almost see it, like you know what I mean? Like you're like, Oh, that's a weird break. I bet you that's a compression low. And it's not always I mean, I would still test to be certain. But anyway, that's what a compression low is. It's a it's a blip that comes up on your CGM out of nowhere that looks like you're falling, but really just might be that the transmitter and the sensor had been pushed into your body and disparate and displaced your interstitial fluid. Yes,

Jennifer Smith, CDE 9:09
and a good as you brought up, you can really see a compression low pretty easily on CGM data, because it's it's the glucose data is tracking really smoothly. And all of a sudden, it looks like things just like dropped off of a cliff. And even those little pinpoint dots of glucose value will often have a disrupted area between the last one that looked like it was pretty stable in in target. And the next one, which looks strangely low. Oftentimes, parents will move their kid and roll them over in bed and it writes itself.

Scott Benner 9:49
Yes, I've definitely walked into Arden's room and been like rollover rollover going on. Like what what am i You're laying on your sensor, and then she flips over. But in the beginning, I mean listen I would never say not to test for it like, you should, because also a drastic drop looks like a drastic drop. So I'm just saying you can kind of start to see them after a while. Episode 360, fat and protein rise. So I guess to define that, in just a moment, it would be that you're going to be diagnosed, and somebody is going to tell you that you count carbs, and you cover carbs with insulin. And that's it. And there are free foods, free foods like cheese, and meat, and things like that, because there's no carbs in them. problem becomes with the protein, specifically, your body digests the protein turns it into glucose, right? So later in the, in the process, you could see a rise from that fat, however, has a slightly different scenario, can you tell people like that,

Jennifer Smith, CDE 10:57
it's more fat, it's more resistance with fat, where I think of a simple thing to think of is, if you're, if somebody's like, taking insulin and sitting on it and not letting it work quite as well, that's what fat does. That decreases your body's ability to use insulin by about 50%, give or take. And so in there, multiple ways of attacking coverage and all of that, when are you going to start to see fat impact, it's usually two to three hours after a meal, and it will last a long time. Whereas protein, protein starts to impact blood sugar somewhere one to three hours after a meal. If it's a large quantity, or you've had a small carb containing meal with a fair amount of protein or a large amount of protein, then you may need to actually cover protein. So this isn't, you're always going to have to Bolus or cover fat and protein. That's not really the truth. But there are some specific scenarios in which you would have to cover both of them or just remain high.

Scott Benner 12:09
Right? There are multiple episodes throughout the podcast that go deep, deep into how to Bolus for fat and protein, Episode 378. Don phenomenon. I might have to really get you to lean in on the technicalities of the next three really. So really, yeah. Because I know what the dawn phenomenon is, like, I know that there's this time around, ready, you're testing me two or three o'clock in the morning, right? Where your body kind of gives off some glucose glucagon from your liver, something from your liver. Is that right? Or

Jennifer Smith, CDE 12:45
it's also kind of the beginning of like, cortisol sort of, I mean, it's two o'clock early. So most people it's somewhere between three and 8am. I mean, for like the widest swath of time potential, right? I mean, there are multiple thoughts for why do some people see it more considerably than others, but most people who have tested will definitely find that as they get through and into sort of later, early morning hours, things start to kind of creep up a little bit. And it may also then go along with the foot on the floor, which I don't know, did we do that one already? We're gonna go, we're gonna get that. Okay. All right. So yeah, Don phenomena is really that early morning has nothing to do with getting out of bed. It's the body's need for a little bit. A little bit more insulin, based on your body's preparation for you getting up to get going in the beginning of the day.

Scott Benner 13:46
Okay, then 379 is smokey effect. Smokey. You always say differently than I say.

Jennifer Smith, CDE 13:53
I always say smokey, the fact that people say some Oh, geez. Smoky red. Yes, it's yes. All I know

Scott Benner 14:00
is I don't know what it is. We've done an episode about it. And I have no recall that whatsoever.

Jennifer Smith, CDE 14:08
Yeah, well, I think actually, it was really kind of funny. In that episode, we, we actually looked up where the name came from. It was a doctor and it's a doctor. Yeah. So smoky effect, or phenomenon or whatever is really, when your blood sugar gets too low. Overnight, specifically, you get this dump of like glucose or not really glucose, but your body starts to break down its stores of glucose sends it into the bloodstream. It's a it's a good effect. That's supposed to save you from the low right. But on the opposite of it, the trigger of those hormones can then send your blood sugar's rebounding high later on with a CGM, and thankfully, many people have the option to use a CGM. Now, we can really catch is the high blood sugar you're waking up in the morning? Because you've had lows overnight? Or is it really because nothing low happened and you really just need more insulin put in. Basal.

Scott Benner 15:13
It's really interesting that that the advent of a CGM takes away that. I don't know what's happening idea. Yeah, it's really cool. That episode three ad is feet on the floor. So the way I see it with Arden is she can be super stable, right like at overnight, and her alarm starts to go off art and say, let the alarm go off 16 times kind of person, right. And then she's got snooze herself. She's losing herself into reality. And so as she's losing herself into reality, I begin to see her blood sugar pick up, then she just a little bit at 80 to 85 over like 30 minutes, right? And then she wakes up and her feet hit the floor. And I believe that what happens is your brain and your body start preparing yourself for the task ahead. And I guess that's adrenaline and some other things and and then you just start seeing arise. And then the problem ends up being is that is how it gets caught up in everyday life. Like because breakfast can sometimes be difficult for people to Bolus for. And on top of that they have a rising blood sugar perhaps from feet on the floor that they haven't covered with basil. And anyway, that's feet on the floor. Am I right?

Jennifer Smith, CDE 16:24
Yes, it's you got it, it's typically noticed right upon getting out of bed specifically, especially if you've kind of curtailed the dawn phenomenon, you may actually find a secondary need to add some extra insulin as soon as you actually get out of bed. Yeah. And that, for the most part isn't really well covered with a Basal change. It's much better covered with a Bolus to accommodate for what you know is going to happen.

Scott Benner 16:56
Go check out the episode. I think this is a good time, Jenny, for us to just interject for 12 seconds and say to newly diagnosed people. I know this seems overwhelming. But these things will just sort of like you can go listen to these defining episodes, get a firm idea of what these things are, you're not going to remember every one of them right away. And eventually, as crazy as it sounds, all these things that I've listed here. So far, my brain just does the processing on all of this in the background. I don't I don't I don't stand in a situation where my daughter's blood sugar randomly jumps up and down and think I wonder if she's brittle. Like you know what I mean? Like it just right, you just start to you know, when I see a drifting blood sugar, nowhere near a Bolus, I don't think over feeding the insulin, I just think, Oh, the basil looks heavy. And so you know, eventually it does sort of begins to just make sense without you having to think about it. So Episode 408, insulin sensitivity factor, which people could see in their devices as I S or ISF,

Jennifer Smith, CDE 17:59
right? Or even correction factor, CF or CF, right,

Scott Benner 18:02
in general will get me I'm on a roll here. The Jenny's like why am I here? If you're not gonna give me? Because I don't want to do it. I don't want to do that. Excellent. That's why

Jennifer Smith, CDE 18:14
I'll just, you know, make little little comments along the way. That's all right.

Scott Benner 18:18
So one unit of insulin moves your blood sugar blank amount of points. That's your insulin sensitivity factor or your correction factor, depending on how it's written in your pump or algorithm. That's it, right?

Jennifer Smith, CDE 18:32
Correct, exactly. It's the way that one unit of insulin will navigate your blood sugar down.

Scott Benner 18:40
So if your insulin sensitivity factor is 50, and your blood sugar is 120, giving yourself a unit should get you to 70. correctly, in theory, there are a lot of other variables that would stop that. And if you're just listening first, and you're not going to get a chance to get to that episode, I do want to throw in here, as your blood sugar gets higher, that may become less effective. So it's possible that a 120 will move to 70 on a unit in that example, but not probable that a 250 would go to 200 with the same unit of insulin does that it's Yeah,

Jennifer Smith, CDE 19:14
and most most people who watch and pay kind of enough attention when they're starting to try to figure things out more. They will notice it really works. It really works. And then all of a sudden they've got a bad site or they've got, you know, a missed dose of insulin, their blood sugar climbs, what I find it's usually above like 220 to 250. above that. It seems to take a little bit more insulin than what your correction factor or sensitivity factor would calculate your correction dose to be

Scott Benner 19:44
okay. Well, you tell people what episode 415 is

Jennifer Smith, CDE 19:48
for 15 adrenaline highs. Oh, well, you know, adrenaline is a fancy hormone that kind of goes right along with fight or flight right. So what Does your body do your body's stimulates with adrenaline to really give you this rev up? I mean, you know, your heart rate increases your body is just in this ready state. Well what ends up happening, adrenaline spikes your blood sugar for most people. Now whether or not you actually have to correct that adrenaline spike is another thing to pay attention to. A lot of people see these adrenaline spikes around like you're a game, like the coolest team that you're going to play against, you know it this coming weekend, and you get this spike up in blood sugar that you've not ever really seen before. Very likely, it's adrenaline, or just excitement. I know that before. When I first started doing some of my my initial like, races, which were not very long, they were like 10 K's. But it was exciting. And I'd get there with this nice smooth like blood sugar. And then like 10 minutes before the gun was gonna go off, I get this crazy quick kick up. Really what's going on? Right? So

Scott Benner 21:05
I think also go listen to that episode seriously, because there are also situations that you can't imagine yet where it might not happen. For instance, a baseball game might make your kid excited, but baseball practice might not. And also, adrenaline needs insulin most of the time. But when adrenaline leaves and insulin remains behind. That's a Oh situation. So adrenaline holds up your blood sugar really well, when it's there when the adrenaline goes away out of nowhere. If you've Bolus for that insulin still active, and the adrenaline is gone. Now it's almost like it's almost like an unseen hand reached into your stomach and snatched your lunch out and it just isn't there anymore to correct to combat the insulin episode for 15. I realized now I'm going to have to edit out every time I went before every one of these numbers are now just leave it in who cares? Adrenaline highs we just did now that the next one episode 423 Insulin deficit? Do you remember? Did we put this in to sort of give a description to people of why their blood sugar's kind of drift up? I almost don't remember making this one for some reason?

Jennifer Smith, CDE 22:15
I believe so. I wonder if the other one was was this? Oh, no, because black holes is

Scott Benner 22:22
down farther? Well, let's just define insulin deficit, then. Sure. Just yeah, probably an insulin deficit

Jennifer Smith, CDE 22:28
is missing insulin. And the result is typically that your blood sugar is going to go up. That's, that's it.

Scott Benner 22:36
We probably stuck it in there. Because you'll hear me say throughout the podcast, you know, if your blood sugar is high, you're probably didn't use enough insulin and slow, probably use too much insulin. So you know, like it's a good place to start. So insulin deficit is just what it sounds like. growth hormones, Episode 426. I mean, the reason we define that around diabetes is because when your kid goes to sleep at night, and is inundated with growth hormones, their blood sugar is going to go up. So I don't know that growth hormones needs a description here from us. But it does need us. I think it does. Ask us to tell you to go to listen about it. Because it's really important, it is going to impact your use of insulin.

Jennifer Smith, CDE 23:17
Especially in in all ages. I think most specifically for those who have kids with type one teens with type one. Women who have not quite figured out their monthly cycle yet around their hormones that go up and down. So it's definitely an important one to understand. Yeah.

Scott Benner 23:37
Okay, stacking insulin is episode 440. And it is very likely that you are going to be diagnosed, and a doctor is going to look at you very sternly in the face and tell you never stack insulin, right? happen without much explanation, right, they're just gonna say don't stack. Stacking Insulin is the idea of you just sort of layering new boluses on top of each other blindly, because you see because it's almost it's almost raged bolusing and steps. Does that make sense? Like instead of like, like, instead of throwing in five units all at once it's a unit than a unit and then a unit and a unit, you just keep stacking them up on each other. It's kind of the same idea. I've never thought of it that way before until just now. But here's the thing, you really don't want to stack insulin. You want to Bolus correctly for what you're eating or for the correction you're trying to make. But it's not stalking if you need it. So if your insulin is well proportioned and your understanding of covering your foods is good, and you eat at three o'clock, and at 325 go I'm gonna have another serving of that. That's not stalking. No, that's Bolus correct. And the problem is, is that when you get when you're in your first week of blood sugar's and people say don't stack insulin One A lot of people here as don't use insulin frequently. Do you agree with that?

Jennifer Smith, CDE 25:06
Right. And I, I've also heard it in terms of the comment about don't stack insulin, many will be given sort of a timeline of use of insulin, like, if you take insulin here, don't take insulin for another three or four hours, right. But that lacks a lot of good explanation, as you just tried to do you know, if you or your child eats lunch now, and then you decide, well, I'm still hungry, or he or she is still hungry, and they really want something more, there's a reason to take more, even if it's within an hour of having just Bolus for other food. If you're eating again, you need to take more insulin for that that's not stalking. If you take insulin for a meal, blood sugar is rising, and you think, Well, I'm just gonna give more insulin because my blood sugar's rising, you could potentially get into stacking insulin because you really haven't seen the true impact of that. Let's call it a three to four hour active insulin window of the first Bolus, right?

Scott Benner 26:10
Or you could just be right, you might have miscounted carbs where the glycemic index or load might be wrong. Here's what I'm gonna say, listen to this episode, because it's important, but these episodes should probably at some point lead you into the diabetes Pro Tip series, which will make all of these definitions make a lot more sense. Episode 442, hydration, I think we all know what hydration is. So I don't know that it needs to be explained here. But you should go check out the episode because hydration has a huge impact on how insulin works. That's that's why it's in the defect in the definitions,

Jennifer Smith, CDE 26:46
insulin movement of any nutrients around your body. It also impacts CGM accuracy significantly, significantly So, absolutely. Listen to hydration.

Scott Benner 26:57
Yeah. For 55 Lada diabetes, latent autoimmune diabetes in adults.

Unknown Speaker 27:06
Yes,

Scott Benner 27:07
yeah. If you guys could just see Jenny looking at me right now going, he's not gonna get this.

Jennifer Smith, CDE 27:16
I was, I was like, I know we've done this so many times. That you know this constantly

Scott Benner 27:21
and it's, you know what the problem is where it breaks my brain is that it's latent autoimmune diabetes, la dee, but then it goes in adults, and there's no either.

Jennifer Smith, CDE 27:32
Yes. I mean, it really what, right? It's just a slow progressing form of autoimmune diabetes, or a slow progressing form of type one, for the most

Scott Benner 27:44
part, which you mainly see in adults.

Jennifer Smith, CDE 27:46
Correct. Exactly.

Scott Benner 27:49
Then we have Modi diabetes, which I'm going to admit, I couldn't define if my life depended on it, which I'm sure you're disappointed in right now. But can you please do it?

Jennifer Smith, CDE 27:58
Nobody diabetes, yes, maturity onset diabetes of the young.

Scott Benner 28:02
There you go. So is it a lot of for young people?

Jennifer Smith, CDE 28:10
Not really. It's definitely different than Lada. And Modi has many different, it's genetic. Od has many, many different types of Modi, if you will, that's the easiest way to say it. And getting the proper diagnosis of your type of Modi becomes really important for getting the right type of medication and management strategy.

Scott Benner 28:39
So it's one of those things that often if you have it, you're not going to know right away because doctors are gonna have trouble figuring it out, too. Yeah. Which is why they're specifically episode 463. Crush it and catch it. That is the thing I made up. So it is and you really don't start with crush it and catch it right like listen to these listen to the pro tips then come back to that when maybe but it for to define it. It's the idea that sometimes you have a high blood sugar that is so high. And if you have a CGM I sort of just learned how to like Crush It, like crush it with insulin and then catch it so that it comes in for a smooth landing without creating a high later and without getting a low. Anyway, it's not a day one idea for 60 days, like no, I'm not even saying anything about this.

Jennifer Smith, CDE 29:30
Hey, no comments there whatsoever. Well, I the comment I was gonna say is actually it kind of goes a little bit along with rage bolusing but crush it and catch it means that you really are. You're not. You're not anger bolusing you're like I see the problem happening. You're taking emotion out of it. I'm going to do this, but I'm really going to be diligent about paying attention. And I'm going to catch it later because I know that this is likely more than I need it.

Scott Benner 29:58
It's a it's an aggressive has fought for move. It's it is yeah. And yes. And again, don't do it on the first day for 66 C peptide and beta cells, C peptide, what is that. So

Jennifer Smith, CDE 30:12
C peptide is a substance, it's made by the pancreas along with insulin, they're sort of both parts of a big molecule, right. And when insulin gets released into circulation, the C peptide kind of gets cleaved, or broken off, if you will. And it's kind of C shaped from what I understand. And so it doesn't do anything. The insulin is the piece of that molecule that we want. But C peptide is measurable in the bloodstream. So when you're diagnosed with autoimmune diabetes, or type one diabetes, C peptide levels can be tested to see that they live below what would be expected to be normal pancreatic output of insulin. And if the C peptide then shows what's actually coming out of the beta cells in the pancreas. If they're low or under a value, then usually, you know, goes right along with a type one diagnosis along with antibody testing and that kind of stuff. But see, peptides can be measured in somebody who has type one and has had type one a long time as well. And a lot of people ask, well, I take insulin, you know, I injected I pump it, isn't that gonna mess? The tough stuff, not at all. The A C peptide is really only something that comes with your own beta cells, that molecule that's made along with insulin, it's only coming from that it doesn't come from our formulated insulin, but you're

Scott Benner 31:39
gonna hear the word around because people are gonna say, if you're newly diagnosed, and P sometimes people like I'm not sure if I have diabetes, someone's gonna say to you, Well, have you had a C peptide test? And that's, you know, to pretty much tell you if you have type one diabetes, right, right. And a lot of times the, the reason that comes up is a lot of times type twos, can be misdiagnosed, or type ones can be misdiagnosed as type vice versa, that yes, breaks down, we also hit beta cell and their beta cell is the cell in your pancreas. That makes sense Elon, and you can go learn more about it in 466. Episode Four, excuse me, Episode 648. Insulin onboard. To so just to define it, it's a once a year pumps, your algorithms in pen, for example, a smart insulin pen will tell you based on your settings how much insulin you have active in your system, the insulin on board, you being you being bored, and it's on you. Here's the weird thing, isn't it on board, it's a it's such a it's such a commonly used phrase and diabetes. And yet, it's not actually specific to human beings. If you think of it outside of this, not the point anyway. And so on board is how much insulin you have active in your body as measured by your device. And it's based on your settings. Learn more about it in there because if your settings are different, your insulin onboard might look different. And,

Jennifer Smith, CDE 33:07
and that one setting is your duration of insulin action, or your active insulin time. That's really where insulin on board, anything your system is telling you about an amount. It's coming from a setting that you set or that your doctor recommended that

Scott Benner 33:21
you set. If you switch to a pump, you may remember your pump training when he came up on it and it says, What's my insulin action time and the nurse went, Ah, I put three or four hours in there. Because they don't know. And you never get told to go back to it. But you should and you should understand it better. I just had to throw away a phone call from my mother who calls always at the worst times. she I think she has a camera in my bathroom and knows when my when I step into the shower, I'm pretty sure. Episode 652 is pump break. Some people use insulin pumps and take a break sometimes. That one's pretty self explanatory. Episode 656. Jenny, we're gonna get through this whole list. Yay. Episode 656 is about barriers. So I don't use barriers. Arden doesn't use them I should say but a lot of people do. Jenny, could you highlight? Yeah.

Jennifer Smith, CDE 34:17
Barriers essentially are for people who have irritation to any or potentially all of the adhesives that are used to put a product onto the body, whether it's a CGM of any kind, a pump and pump infusion set or Omni pod the infusion or the the adhesive around the pod. It's essentially a way to create a barrier between the skin and the adhesive of that product. Some of the barriers are a spray or like you know something like Flo knees let's say or like a spray Benadryl or something enough to create them a little bit of a barrier to prevent irritation from the adhesive. Other barriers, though, are another sticky sort of tape, if you will type of product that you would put on to your clean skin. And then you would put your product on top of that, to prevent that adhesive from causing a problem for you. And the

Scott Benner 35:20
truth is some people have trouble with things sticking some people have trouble with irritation, some people aren't bothered by it at all, and we'll find out who you are. And then that'd be a great episode for you to listen to. Yep. All right, Episode 660. Oh, the next to actually I made up Episode 660, as Jenny is gonna get the finished strong with the rest of them is called black holes. And so it is a look into how my brain thinks about creating deficits of insulin in the future. Is that fair? That's fair. Okay. Yes. So again, that might not be day one. But it is a is an episode that a number of people reached out and said you talk about black holes in the episode, but you've never defined it as like, well, I will make a defining episode about it for you. Much the same as episode 664 dictate the pace is, it's again, it's just a look at how I think about diabetes really where I think you should sort of be out in front of it strike first however you want to put it. It's I don't think you should cover up and let diabetes happen to you. I think you should happen to it. So that the next thing that happens is quantifiable. You know, instead of Oh, diabetes happened, this happened, my blood sugar went up, it went down. I don't know why I like saying I Bolus and then I got low. And at least I know now I can change that Bolus. I see. You know, I see I did something and then something else happened? Correct. 664 dictate the pace. Okay, Jenny 668. For you carb absorption and digestion. Yeah,

Jennifer Smith, CDE 36:58
so we're taught a lot about carbs initially, or you'll be taught a lot about carbs initially. The simpler the carb, the faster the impact on blood sugar. And then what you eat with that type of carbohydrate could also lead to a shift in how your body digests or processes that food to make it visible in blood sugar effect, right? So simple food being something like a big bowl of green grapes, versus a big bowl of kale chips. They both have carbohydrates in them, but they're both going to absorb differently, you're going to digest them a little bit differently. So to speak, right? It's not like your body changes how it digests but because one is simple, pretty simple carb, you're going to get much more rapid impact from some foods than from others. So

Scott Benner 37:56
yeah, the carb absorption and digestion impacts the timing of the insulin, sometimes the amount of the insulin, it's important to understand what it is and how it works. Do another one Jenny 672 antibody,

Jennifer Smith, CDE 38:10
antibodies. So antibodies in general, are just a protein in your blood that's essentially produced to counter a specific bad guy that's come into your body, right? Like an alien, a foreign substance, something, something that's not supposed to be there, right. But we take that into diabetes specifically. For some reason, especially for type one, autoimmune diabetes, you will have your body respond, unfortunately, in the wrong way with the destruction of the beta cells, but there will be antibodies that show whether you've had an auto immune response, and that's the reason or you won't have antibodies. And a marker in the blood essentially, that will tell you

Scott Benner 39:03
and it's generally possible now that you have an autoimmune disease that you might see others and antibodies are going to be words that come up again, if you end up with something like hypothyroidism and or celiac or celiac or something to that effect. And speaking of hypo Episode 677, hypo and hyper just defines hypo and hyper hypo, low hyper high. Still feel like you should go listen to the episode

Jennifer Smith, CDE 39:31
glace glycemia, because they are together right with hyperglycemia. Hypoglycemia is just glucose,

Scott Benner 39:37
we sort of go through the words or the prefixes and you can see how like you can have hypoglycemia, you can also have hypothyroidism, you can have hyperglycemia, hyperthyroidism, etc. It's interesting, Jenny and I are we're delightful as we record these, so you should definitely listen to it no matter what. And so far on June 13 2022, the last EPA sort of defining diabetes is Episode 681, where we just go over all of the different types of diabetes. You heard a couple out here in this list. Yeah, we like you know, we really dove in. And we found we found all the diabetes, not just Lada and moody and type one and type two. But there's there's other stuff and it's interesting. As you can see, Jenny, as we wrap up this episode, you and I started making these defining diabetes episodes at episode 263. Bolus, I'm going to look just real quickly. If you'll indulge me for a second. Of course, I can look very quickly and see. 236 Excuse me? Episode 236, which was defining diabetes Bolus was the first one. June 21 2019. That is nine days shy of three years ago. Wow, that crazy? Am I wrong? 2021? No, I'm right. But you make the same level of sad excitement is when I do a lot of it. Everyone listening is like the guy with the podcast wasn't 100%? Sure. But a lot of it. Yeah, I can't know everything. I knew what it

Jennifer Smith, CDE 41:21
meant. It was just the words to know what the actual acronym was right? To know, you have to give yourself more credit,

Scott Benner 41:28
defending me like my grandmother, thank you very much. Scott Aloni knows,

Jennifer Smith, CDE 41:33
only because I like you.

Scott Benner 41:35
But I mean, the point is, is that when we started it on 236, did you really think we would have done another one last month?

Jennifer Smith, CDE 41:45
I don't know. I didn't know how many you're like, we're just gonna keep getting ideas. And then we're just gonna keep doing this. Like, that's great. I like doing this.

Scott Benner 41:53
But 681 types of diabetes we recorded in May of 2022. I'm just saying that's a long time, it's a long time and expect the list to grow. Because I think Jenny and I both completely agree that management of diabetes is, at first, its understanding, it's understanding that you have tools. And these tools are sometimes thrown around as words that you don't know. And you can't possibly you don't I mean, like if the word ketone never came up in your life, and then all of a sudden, someone's like, you have diabetes. And by the way, ketones are bad. You don't want to go into DKA. You're like, oh my god, like, right, what? And you know, so the way I like in my mind is, you can have a screw and a screwdriver. If you don't know what a screwdriver is, it might not help you. So learn these the definitions. And hopefully, one day when someone shows you a screw, you'll be like, Oh, I know what to do. And you'll reach in your pocket and pull out your screwdriver and just whip it right and that aboard and you'll be on your way. And, and I think these go a long way towards doing that. I also think they go a long way towards preparing you to listen to the Pro Tip series. You know, so Jenny, if you just heard her say a second ago, she enjoys doing this? I know you do. She loves helping people with diabetes. And I'm very proud that you're involved in these. I don't tell you this stuff off and on the podcast. So let me just do it. I'm looking at her. So it's embarrassing. These definitions, and you know, the Pro Tip series like I know, I'm the one who said like, let's do this, and let's do this. But let's be honest without you. They're not what they are. So I would thank you I would clap, but it's a podcast and it's meaningless. But right now, there's noise while I'm listening. Yeah, you've just been an continue to be such an asset to people with type one. And thank you. I feel I feel as

Jennifer Smith, CDE 43:50
Yeah, and I'm glad that you've started something that's grown into such a community of support for people. And that's the reason that I enjoy continuing to help you to put good information, I think that we're good is really important, because there's, there's a lot of misinformation. I'm not gonna call it bad information. But I think especially in doing these definitions, it's really important for people to understand what things mean words they might have heard, and they may be too embarrassed or too overwhelmed to ask, well, what does that mean? I don't get it. Can you explain that differently to me, and that's really, really important for you to live better.

Scott Benner 44:27
Yeah, I want to say that part of the value and kind of why I brought up how long it's been since we did the first one. And by the way, 236 was still 236 episodes into the podcast is yours for the podcast. It's because I saw someone online the other day. I don't want to say they were ripping me off. But let's say they were okay. They were doing their own defining thing. And I and I never listened to other people's stuff. But I thought let me just see for a minute and I looked and this person hadn't been involved with diabetes for very long. They hadn't been making their content very long. And then they did a a haphazard job of explaining the thing. It's still I think for their level of understanding, I think they did a great a great job. But there's something to be said for you. With 30 plus years of living with diabetes, plus your CD plus you, you talk to people literally all day long, every day of the week about type one. And me who's been making this podcast forever? I have. I mean, besides doctors, there's nobody who talks to people with diabetes more than I do, I don't think right, I record six, seven hours of conversations every week. And there's something about knowing, like being able to say something with confidence and put it into context, which you do for me all the time, because I'll say things. And you'll come around and be like, yes, in this specific situation. This is exactly what I just said. But don't forget about this aspect of it, which is not how my brain works. And so there's something between all the experience all of your training, my ability to tell a story, your ability to keep me honest, like it all just, it's why it's good information, I think, right? That's what

Jennifer Smith, CDE 46:09
I think because you also have a lot of pieces that people can go to specifically. And in many I've heard you say, in many of the episodes, or many of the ones that I've listened to myself, you'll say if you want more about this, go here, we've explained this a little bit better, or this whole episode is all about this. It's not just something that's brought up, and then it's gone. There's no worries, the person hanging in there listening to the rest of the conversation, but really, they wanted that little nugget that you kind of just accidentally brought up. They wanted that. And that's that's a really big piece of tying something that's very beneficial. Like in terms of education, together, you have to be able to send somebody to the right place for exactly what they want.

Scott Benner 46:58
We've been able to do this for so long. And I really served sincerely, maybe the sponsors like kept this podcast going and keep it going. But we've been able to do it so long, that it's now a compendium of information, not just an episode about what honeymoon means, right? Yeah. And I just got to note, I know you have to go. I just got a note from a woman online the other day, she said, I just finished the last episode of the podcast, she listened from one to at this point, she listened to 698. Right, like straight through and then showed a graph and talked about our agency and our success. And she said, I listen to this podcast straight through and look at my blood sugar. And, you know, it's because of this. So if you want it if it's in here,

Jennifer Smith, CDE 47:40
that's like almost a month worth of like, continued like, that's 24 hour day after 24 hour day, that's 28 straight days of 24 hours, you know, assuming I know some of the episodes aren't quite an hour, and some are longer than an hour. But in general, that's 28 days of not stopping listening. Yeah, that's a lot.

Scott Benner 48:01
That's a person I don't think you or I could sneak up behind on the street and talk and they would just spin around and go oh my god, Jenny's here. So anyway, my point in saying that is the information you need to live with insulin is inside this podcast. If you go get it. I think that's great. If you jump around, I understand. But I mean, listen to these defining episodes before you go to the Pro Tip series. I really actually think that's important. So agreed. Anyway, thank you very much, Jenny for doing Yeah,

Jennifer Smith, CDE 48:28
you're very well thank you for asking me continuing to have me Well,

Scott Benner 48:32
when I asked Stop it, you're making me embarrassed.

A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Head over now to in Penn today.com To get started. And while you're doing that, make sure you've heard episode 711 which is the first part of this conversation. Hope you're enjoying the bold beginning series. If you are gonna look for other episodes that you think you might also enjoy. Jenny Smith works at integrated diabetes.com In case you want to hire her, and I'm gonna leave you a little bit of information after the music about how you can find out more about the podcast subscribe, and other such things

alright, some quick stuff you'll want to know. The private Facebook group now has 26,000 people in it Juicebox Podcast type one diabetes, people using insulin. You can hang out watch what they're saying talk, ask questions, pick brains, or just lurk whatever you need. It's there. Juicebox Podcast type one diabetes, including lists like the bowl beginning series, defining diabetes, the diabetes pro tip episodes, diabetes variables, all listed in the feature section of the Facebook webpage Juicebox Podcast, type one diabetes it's a private group, so you'll have to answer just a few questions so that we know you're a real person. Everything else you need to know about the podcast can be found at juicebox podcast.com, or diabetes pro tip.com. If you're looking for a great endocrinologist, we have a list at juice box docs.com. It's curated by the listeners, doctors who are down with how people who listen to the podcast they care their type one. You want that part to be easy to write juicebox docs.com completely free. Everything's free by the way, find me on Instagram, find me on Facebook, find me somewhere. If you're enjoying the show, please leave a beautiful rating and review in whatever app you're listening in. Like five stars. This is amazing. And then give a really great description. So the next person who sees your review will know that it's worth listening to. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast and don't forget that episode 712 The second half of this episode is available right now in your podcast player or at juicebox podcast.com.