#743 Bold Beginnings: Stacking

August 26, 2022Scott Benner

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 743 of the Juicebox Podcast.

On this episode of bold beginnings, Jenny Smith and I are going to talk about stalking. Don't forget the bold beginnings series is all about things that listeners of the Juicebox Podcast wish they would have known in the beginning. While you're listening today, don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you enjoy Jenny Smith and you'd like to hire her, she works at integrated diabetes.com. If you're liking what you're hearing in the bulb beginning series and want to expound learn more, you're looking for the defining diabetes episodes, and the diabetes pro tip episodes. There are lists of them at the Facebook page Juicebox Podcast type one diabetes. In the featured tab that's a private group with over 27,000 members. If you're not on Facebook, check out juicebox podcast.com or just search in your favorite audio app.

This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes, take the right insulin dose at the right time. The right pen is a reusable smart insulin pen that uses Bluetooth technology to send dose information to your mobile app. Offering dose calculations and tracking in pen helps take some of the mental math out of your diabetes management. You can get started right now within pen at in pen today.com. Or perhaps you're ready to talk to a healthcare provider about m pen. Again, in pen today.com. Head over there now to hear about the app that has current glucose on it meal history, dosing history and much more like dosing reminders, carb counting support and that digital logbook, lighten your diabetes management load with in pen from Medtronic diabetes seriously. In pen today.com. Just head over now and check it out. impendent is an insulin pen that you may pay as little as $35 for offers available to people with commercial insurance terms and conditions apply. But $35 for an insulin pen that talks to an app on your phone and keeps track of things. Not unlike an insulin pump. This sounds like something you want to learn more about in Penn requires your prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed or you could experience higher low glucose levels. For more safety information visit in Penn today.com. What do we have here?

Jennifer Smith, CDE 3:10
I closed my exercise ring for the day. Just to be right there. I just want to tell you that.

Unknown Speaker 3:16
They got a little notification on my watch that popped up. It's like your exercise ring has been closed for the day. Like great.

Scott Benner 3:22
It's 11 o'clock. Jenny's done exercising Alright, already. Oh, it's

Jennifer Smith, CDE 3:26
10 o'clock my time.

Scott Benner 3:27
Oh my goodness. That's true. I've so far accomplished showering and letting the dogs out.

Jennifer Smith, CDE 3:34
Well, my dog gets very fussy if he doesn't get a walk. So you know, oh, you walk in the morning time and walking treadmill helps. And

Scott Benner 3:45
yes, that's true. Sometimes when Jenny pops on the camera, she's bouncing up and down a little bit.

Jennifer Smith, CDE 3:49
Because she treadmill. I love my desk treadmill. It's awesome.

Scott Benner 3:53
I know you do. By the way you should have seen when I was doing the AMI pod five series with Carrie. And we were doing different modules basically. And she'd never done this before. So when I started up the second one, I'm like, Hey, Carrie, how are you? And she was like, Why? Because I was like, like acting like we were starting over. I just went through and I was like, Alright, you're right. Probably the people listening know, we recorded this all in one day. She's like, Yeah, I think they would like

Jennifer Smith, CDE 4:24
but when they go up as different episodes it it's important to sort of have an intro. Hello. I'm back to talk to you again.

Scott Benner 4:31
You know, how are you? Great. So hello, Jenny. I'm back to talk to you again about the bold beginning series. Today we're going to talk about stalking. So I think if people listen to the podcast long enough, they're going to hear me or you or any number of people say it's not stalking if you need it. That's Bolus thing. But Correct. You're going to get told by a clinician not to stack your insulin. Correct,

Jennifer Smith, CDE 4:59
right and you'll get get told that whether you're MDI, multiple daily injections, or you are on

Scott Benner 5:06
a pump, yeah, no matter what,

Jennifer Smith, CDE 5:09
no matter what, and I think that there's an interesting learning piece here, that goes a little bit deeper. But if you're at all on an algorithm driven pump, you will learn a little bit more about how stacking when, as you said, when it's needed, actually becomes really important. Because you can see when your algorithm is starting to give more, and you can learn from that, even if you ended up going back to manual, like insulin delivery. So I think the concept of stalking unfortunately needs to be revisited in terms of how we teach people about it. And I love the fact just what you said about if it's not stalking, if there's a reason for you to give extra insulin, right?

Scott Benner 5:57
So let's give some historical context. Because you just said something I've now hearing you say a number of times over the over the past couple of months, is that back in the day, when people were just using meters, and probably not even using them that frequently. Right? The idea of you just putting in insulin and putting in more insulin putting in more insulin, because you saw a high number was purposeless, really right. You know, because you didn't you didn't know why you were doing it other than I have a big number, and I wish it would come down. Correct. And so doctors would tell you Look, don't stack because let's be clear why right? Say you eat a meal. And the meal should have gotten six units of insulin, but for whatever reason, you gave it three units of insulin, then you test your blood sugar two hours later, and your blood sugar's 300, you put in a whole bunch of insulin, you test again in an hour, because now you're worried your blood sugar is still 300. So you put in a whole bunch more insulin, and then eventually everything in your stomach gets digested, it's gone, there's nothing left to hold that blood sugar up, and you come flying down because you have way too much insulin in you. So that's an it's a simplified way to think about it. And there are reasons. And there are ways I should say, to understand how much insulin would impact that high number. You're not going to learn that in this episode. But that's what stacking is. It's just stacking up insulin on top of itself more and more and more now.

Jennifer Smith, CDE 7:25
And I think what it brings in is the concept of understanding insulin on board then. Right? In the past, we weren't really in years or years ago, in the past, we weren't taught about that active insulin time period. So stacking was a really important piece. That was there was a lot of caution to it. Yeah. Because people weren't told, Hey, if you take insulin now, it's going to be working for this many hours going forward. If you correct, this next amount of insulin you take has its own timeline of action beyond that first Bolus that you took.

Scott Benner 8:03
Yeah, I want to say that I saw a lot of content creators, now I'm making air quotes, because of because of apps like Tiktok, and things like that. And it's it's seeped into the diabetes space, right. And everyone knows that content. That's scarier, you know, is more interesting than telling everybody that puppies are nice, and the world's a good place to be, that's not a good way to get people to watch your stuff. So I'm seeing a number of people younger people feeding their low, they're scary low blood sugars on, you know, on apps and stuff like that. So these are probably situations where people used way too much insulin or didn't understand the impact of their exercise or of the different foods that they were eating. And so I don't want to, I don't want to, I am not a person who's like blindly like stalking. That's not real. It's very good. Yeah, you definitely could do yourself in was stacking very easily. But there are other things to understand. And then once you understand them, there is a way to use insulin, where you're not just mindlessly doing it. And it's going to end in some super low blood sugar later, there. There is a way to use more insulin effectively. So absolutely, yeah. So let's see, somebody told me I wish somebody would given me the actual definition of stalking. And that insulin to cover food can be at any time. See, this is a big one. That's

Jennifer Smith, CDE 9:26
a huge that's absolutely it's what you started out with. If you're giving insulin for a reason, right? You need the insulin. Yeah.

Scott Benner 9:34
Because somebody told the event of I think, originally you get told you can't stack up insulin, and that you should check. After three hours view Bolus. They make it seem like you eat and then you can't do anything else for three hours. Right. But what are you what if you made a great Bolus that was really working and three hours from now you were going to see the blood sugar that you desired, but two hours after you ate you decide to have a handful of great Oops. The people that eat the grapes and don't Bolus because they don't want to stack their insulin, right? Yes. Because somebody was not clear about what stacking is. That's bolusing. Right? The thing I said in the beginning with a 300, blood sugar, that stacking? Yes, yeah. So

Jennifer Smith, CDE 10:18
thankfully today we've got a number of devices and things that can help you to keep track of the insulin that you have dosed at a specific time, that can help you to remember visually see how much insulin is left from that Bolus at noon, now that you want to eat grapes two or three hours later, and we'll help you determine what is a safe amount of insulin to take. Yeah, right. But again, I think some of those are under under reported in terms of benefit of use.

Scott Benner 10:50
Well, the the, the attempt to not stack insulin by people has, I've seen it ruin some holidays, that's for sure. Yes, Thanksgiving, Christmas days where there's spreads out and people are grazing and things like that. And you're, you know, running around telling your kid don't touch that don't eat that you can't have that now, like, you know, you can totally have all that like, oh, absolutely

Jennifer Smith, CDE 11:12
holidays or anything like that. 100% of stalking episode for me, and I don't consider it, it's not stalking that's, that's right, it's I'm going to eat this, I'm going to nibble this and then I have some of that. And each of them requires its own little amount of insulin,

Scott Benner 11:30
right. So if your settings are good if your Basal is right, and your insulin to carb ratio is close, and you understand different impacts of different foods, which I know already sounds like a lot. But if that's the case, you can wake up in the morning Pre-Bolus your meal, eat your breakfast, eat again, two hours later, you can eat constantly throughout the day and Bolus every time you eat, I would still, you know, depending, I guess I would say unless you're low, I would continue to Pre-Bolus like snacking along the way. Because all things being equal, meaning all the settings are correct, and you're understanding the impacts of your food. Insulin works, the way it works and the carbs that your system the way that your carbs hit your system. That's it correctly to change.

Jennifer Smith, CDE 12:17
And there, there are some concepts too, especially once you start using a smarter device, let's say a pump instead of using just multiple daily injections. And if you're trying to be a little bit cautious while you're learning to give insulin more frequently, the idea of using things like an extended Bolus or whatnot, still allows you to give the insulin without it all being given at one time. So you can see the effect did it work? Should I have given it all because well, gosh, now I'm having a rise in my blood sugar. I was trying to be cautious. Those are some of the things that you can do to learn to feel okay about adding more insulin for when it's needed.

Scott Benner 12:57
I mean, the statements here, please explain stacking, tell people they should learn about stacking, or this person who said I only I wouldn't let my kid eat except for after a certain amount of time had passed. And so you know, kind of sad socks. Anyway, do you see anything else to add to that? Because it's not? I

Jennifer Smith, CDE 13:20
think that's a good overview. Yeah,

Scott Benner 13:23
I think you can definitely learn more in the Pro Tip series in the defining diabetes series about stalking. And there's an episode somewhere called crush it and catch it, which would be kind of like advanced understanding. Yes,

Unknown Speaker 13:39
that's definitely advanced.

Scott Benner 13:40
That's what advanced but it is a little bit of how I it's funny, because in an earlier episode, right, we were talking about we're talking about Pre-Bolus thing in the, in the beginnings, and I told a story about how I took a high blood sugar and ate a high carb and I took Ardens, high blood sugar, and an incoming high carb meal and used Pre-Bolus thing to get it down. But in truth, I also use stacking a little bit I also stacked up a bunch of different boluses but not in a bad way I put them in like places where I knew they were going to do a good job for me

thanks so much to in pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in Penn today.com. If you can't remember that there are also links at juicebox podcast.com. And links in the show notes of the podcast player you're probably listening in right now. And if you're not listening in a podcast player, I mean, can you please subscribe and follow on a podcast app and helps the show and honestly it's easier for you. The episodes come right to your phone and the Phone is right with you cons Like Minds right here. See, I just picked it up. Everyone always has their phone

so let me just tell you again, because I know there are a lot of episodes of the podcast if you're looking for the defining diabetes episodes, or for the diabetes pro tip episodes there, of course, right in your podcast player, just go to all episodes and you scroll around, and you can find them or search and find them by searching for something like diabetes, pro tip, or defining diabetes. There are also lists available in the private Facebook group, which by the way, is completely free Juicebox Podcast type one diabetes, so not only you're gonna find a Facebook group, with 27,000 members in it, people just like you who are sharing experiences and ideas. But at the featured tab at the top, you'll find all the lists of not just these series, but all of the series that exists within the podcast and there are many, there's even a special website diabetes pro tip.com, where the defining diabetes and diabetes pro tip episodes are even if you just needed to see the episode numbers that correlate with each episode so you can go back to your podcast app and and look for that episode. I may have just made that sound more difficult than it is juicebox podcast.com diabetes protip.com Juicebox Podcast, type one diabetes on Facebook, or just scroll through your podcast app or use the search feature. The defining diabetes series is amazing, as is the diabetes Pro Tip series. You don't want to miss it. If you've been enjoying these bold beginnings episodes and you want to dig down deeper, those two other series. Those are the place to go. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.