#747 Bold Beginnings: Flexibility

September 2, 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 747 of the Juicebox Podcast.

On this episode of bold beginnings, Jenny Smith and I are going to talk about flexibility. 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. I don't have the energy to pretend that we haven't been recording for the last hour, Jenny. So we're back. We're back with the bold beginning series talking about flexibility. Maybe an unsung tool along with texting as far as I'm concerned about diabetes. So yes, this first person says that in the beginning, we were not educated on the needs of insulin, and how they would change over time or with exercise or with growth. It was just about finding the settings that fit at diagnosis at diagnosis. I wish I was told that these things would change and the diabetes was a marathon and not a sprint. And that I would need to be flexible. So do you see that a lot with people they're stuck in like this number used to work, I don't know what happened.

Jennifer Smith, CDE 3:54
I do especially for people who have a level of an endo I would say or a level of somebody that they are only really only checking in with, you know, every six months, they're kind of left to their own ability to manage. And even though what was working isn't working anymore. They don't have the tools to evaluate how to make a change, or they don't necessarily maybe feel safe making a change because they've had enough. I call it hand slapping when they go into their physician's office. Well, why did you change this? You know, this number is different in your download. Why did you not do what I recommended six months ago? Well, I mean, there's some explanation something changed. Yeah, I tried to navigate it. Right. So I think that's a reason that some people end up sticking with where they are even though they know it's not working or they realize that something's changed. Because they may not have the know how or the care team to really help them.

Scott Benner 4:57
I think to add to that one of the sadder things I say is when people know that they should be doing something and they let their fear of what's going to happen when they get to the doctor's office stop them. That takes me into this person's statement. I thought that insulin, the initial insulin dose was it and it was set in stone. And then we know we learned very quickly, that the more flexible you are, the more successful you could be that you could change a dose if it's not working. Or, you know, if you're worried about changing themselves, or call the doctor, the nurse, she said she called her CD every day for two weeks. But her takeaway here is don't suffer, try something else. And you will find something that works. I mean, that's just that's a great statement, you have to just keep experimenting and trying things. And if something doesn't work, try something else. And I think the way I put it in the Pro Tip series is that when you're learning to Pre-Bolus a meal, you can if you have a CGM, see what happened. And then the next time say, Well, look, I'll do a little more, a little less, a little sooner or a little later, you adjust your timing and your amount until it starts working for you the way you expect it to or the way you want it to forget. Expect it like the way it the way it can work.

Jennifer Smith, CDE 6:08
Right. And I think the comfort level, from another piece of understanding can you can get comfortable faster, if you understand that. You're going to try something. And if it goes the wrong way, meaning you're not higher, but you're actually lower than you ended up being. You are not in the middle of a desert without tools to help write that drop or that low. Right. I mean, maybe you are in the desert. And if at that point, you clearly need to have supplies.

Scott Benner 6:41
Someone stuck in the desert, they're listening to this podcast they have they're misusing their, their their resources, are resources at their disposal. Use the phone to call someone.

Jennifer Smith, CDE 6:51
Yes, exactly. But you know most of us have, thankfully have something to treat that drop with. And if you are experimenting, have those things on the ready, right? Have them in your pocket, have them in your purse, have them in your glove compartment, whatever. Because you may with experimentation, find that things don't necessarily the first time go the way that you want them to go.

Scott Benner 7:14
Yeah, yeah, be ready for it not to go. Ready. Ready, that's for sure. Be ready. That's right. Yes. Well, here's this next statement says that what I didn't understand was that the carb ratio was a guide even. And the Basal insulin which needs would change, she said, I had a magical idea that if I measured everything, I would nail down the doses. And that would be it, they'd be done. Right. Like she just wasn't measuring the food correctly, she wasn't assessing the amount of carbs. But go to the pro tip about glycemic load and glycemic index to understand that all carbs aren't created equal. She said that we would glide through diabetes with no problem was her expectation, if she just measured the food correctly, the endo made it seem like that as well. And I wish someone would have told me that you have to be flexible, and that dosing changes would have saved me quite a bit of time and stress.

Jennifer Smith, CDE 8:06
And in terms of like clearing that up dosing changes, there are a couple of thoughts around that right dosing changes, meaning as you grow, or as your child or your team grows, their doses will change. Yes. But another like way to think about dosing might be the strategy of the dose might not be the amount that changes meaning your insulin to carb ratio. But this type of a meal may use this type of dosing strategy for insulin. So doses will change. Many people have different insulin to carb ratios through the through the day, depending on the time of day. And as precise as you can be, with a label or with estimation. Absolutely. That goes a long way. But

Scott Benner 8:53
Arden doesn't eat a lot of like sugary candy, but when she does, it requires a longer Pre-Bolus with less insulin than the carbs would indicate. So if she's gonna eat 15 carbs of gummy bears for fun and not for you know, as as low, then, you know, it might not be the exact like in Arden's case, 15 cars would be like three units and 3.2 units or something like that. So she probably doesn't need the whole 3.2 She might need more like two, but she's gonna need it with a longer pre loss because the sugar is gonna hit her so quickly. And but it also doesn't punch with the same weight as a baked potato does. So you don't need as much insulin that might sound in the beginning you that might I might have just somebody who's newly diagnosed could have heard that and thought, why don't you just tell me I have to build my own rocket and fly to Jupiter. Because I don't know how to do any of those things. But this stuff is not difficult once you get it's

Jennifer Smith, CDE 9:53
not and I think one thing to kind of clean that up in terms of the insulin to carb ratio is B Because most people eat a complex type of like meal, there are a little bit of all the different macronutrients carbs, proteins, fats within a meal time. ratios. For most people are really adjusted with that idea in mind of a lingering effect of a meal. So ratios are often more aggressive than they would need to be if we just lived on simple carbs. Simple carbs have a very quick process, they go in fuel the body, they come out. And that's why if you really eat only carbs, you're constantly driving this hunger road, right? So that might explain the difference between ratios for a meal versus ratios for a handful of gummy bears that I just want to eat.

Scott Benner 10:51
By the way, there are some brands, gummy bears are better than others. But I'm not here to push up gummy bears. This person just wants me to make the point that because things are dynamic, and flexibility is important. It's another reason to say that a person who you only see every three or six months might not be the best judge of how to make adjustments was a nice way of saying that. I think the most important thing that someone could have told me is that insulin to carb ratios, Basal rates, correction factors will change forever. I don't know if they change forever. But it changed a lot when you're young. And you're growing. Because I had this notion again, that they wouldn't change little things like Right, like, why would? Why would these things change, you could have been a more sedentary person and suddenly become more active, those things would change. You could gain weight or lose weight, those things would change, you could change the way you eat from more complex meals, like Jenny just described, to plant based or, you know, correct, whatever these things would all change how much insulin you're using. These are not. These are not like set in stone numbers that no matter what happens forever and ever are going to work. This person says My biggest help was just hearing on the podcast that I needed to be fluid that nothing was going to be absolute. A lot after I was diagnosed, I spent five and six hours a day researching how why? What can we do like just everything I didn't know what to do. And after my daughter got her Dexcom we would watch the numbers all day just and it burned them out. Yeah, this is flexibility coming from a different like we've been talking about flexibility about using insulin, but this person is talking about flexibility. Yeah, for life and to pace yourself. It was you know, I would say that took me some time as well. Because I was at one point not good at diabetes, then got much better at it. And then as my daughter started having impacts from hormones, it got hard again. And I had this expectation set in my head that I could keep her blood sugar under 140. No problem. And then all of a sudden, it started to go up more. And those higher numbers gave me made me stressed. Yeah, you know, and I had to say to myself, I'll figure it out. But while it while we're figuring it out, I can't torture myself the whole time. And so that is sort of flexibility with how I was thinking about the numbers, you know,

Jennifer Smith, CDE 13:32
right hand because people get a CGM. Many people not everybody, but many people get a CGM very quickly after diagnosis. Now. So you have you have this scale of information to be able to watch. And I think, you know, in this person's case, obviously, it was the watch from a well, I don't know what any of the variables are going to do. So I just have to watch. All day long. I just I and maybe they were doing it initially from a standpoint of learning. But then you can get into this almost OCD habit of if I don't watch it, what if something happens when I don't see what's going on? Right?

Scott Benner 14:16
Right? Yeah, for me, if you have a CGM, the the key to losing that feeling is to set reasonable alarms high and low. And do not think about that thing. If it's not beeping, just correct. Let's go Yeah,

Jennifer Smith, CDE 14:31
absolutely. And that they meet those targets might get, you know, a little bit more narrow or narrower as you feel more confidence and more comfort and understand insulin a little bit better. Understand. I treated the low. It's good. I know that this amount works. I don't have to worry about it. You know, again, I can say that. I mean, I did so many finger sticks before I got my first CGM so many finger sticks today. Mine might have back They looked like a line of CGM over the course of the day. But I, you know, I was constantly setting an alarm. Oftentimes, I didn't even have to wait for the alarm to go off for an overnight like fingerstick. Because I, I did worry about overnight lows. Yeah. And without a CGM, I had no way to know other than what my blood sugar was at bedtime. And then what it was at like two o'clock in the morning, which when I was on injections with a Basal insulin was my time to go low. And once I was on a pump, and then I started on a CGM, not too long after I had my pump, it became very, like, visible to me that I didn't have to have that alarm anymore. Okay, again, with the alerts and everything that I set well in my CGM, I stopped setting an alarm. I was like, if my blood sugar goes above or below, like you said, I will get alerted. And if I don't get alerted, I can just sleep. It's great.

Scott Benner 15:58
I think it's a great way to just alleviate that stress. It's just I mean, our hours are very tight, I think 70 and 120. But when it's not beeping, we're staying between 70 and 120. And there's no reason to think about it. And they're so tight that if she gets the 120 and she's rising, it's not difficult to come back around and fix it. It's not like you can't, you can set it like, you know, 70 and 300. And go I don't know, I don't have to worry about this thing's not making noise. But yeah, flexibility around diabetes. I mean, listen, flexibility around everything is really important. But around diabetes, it's going to, it's going to help you. I mean, you just heard it a number of different ways, not just dosing, but I think psychologically, too. Absolutely. Cool. All right. Well, Jenny, thanks so much for doing

Jennifer Smith, CDE 16:49
absolutely always fun.

Scott Benner 16:59
Thanks so much to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Check it out at in pen 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 it helps the show and honestly it's easier for you. The episodes come right to your phone, and the phone is right with you constantly. Mine's 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 going to find a Facebook group, with 27,000 members in it, people just like you were 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.