#772 Bold Beginnings: Journaling

October 13, 2022Scott Benner

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.

+ Click for EPISODE TRANSCRIPT

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 772 of the Juicebox Podcast.

On this episode of The Juicebox Podcast Jennifer Smith and I will be giving you another episode in the bold beginning series. Today we're talking about journaling, which, though I got confused a little bit isn't about writing down your feelings. 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 are becoming bold with insulin. The ball beginning series begins at episode 698 and includes honeymooning adult diagnosis terminology part one into fear of insulin the 1515 rule, long acting insulin target range food choices Pre-Bolus carbs stalking, flexibility school exercise guilt, fears, hope and expectations, community and today's episode journaling. If you're looking for that list, it's available at juicebox podcast.com. Or on the private Facebook group in the feature tab. The list actually has like the episode numbers with it, which I guess I could have just said but I felt like I had to rush to get you know in before the music ended. Anyway

this episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. If you want an insulin pen that has much of the functionality that you find with an insulin pump, you're looking for the in pen, Learn more at in pen today.com This show is sponsored today by the glucagon that my daughter carries G voc hypo penne, find out more at G voc glucagon.com. Forward slash juicebox. Well, Jennifer, we are so close to being finished with the bold beginning series. Yay, we are going to record today. What we have left is journaling. And then we have supplies like technology technology, durable medical stuff, which I thought was a great idea talking about how to people actually get these things, a little bit about insurance. And then we're going to talk about carb guidelines and food impacts. So we only have four topics left. Yay. Yeah, I feel I feel like we've accomplished something we have how many months? Have we been at this? Do you think?

Jennifer Smith, CDE 2:40
I don't even know. Honestly all have my month they run together? And I have no probably three. I feel like we started like summer ish, right?

Scott Benner 2:52
I'm gonna look, because I'm actually interested. I'll figure it out while we're talking. Cool. Okay. So can I just admit something right here? Sure. The list has been in front of me for quite some time. And journaling has been at the bottom. And the entire time I thought, well, people want to talk about writing their feelings down. Then I thought, Okay, if that's what everybody said, we'll do it. And then of course, today looked at it and I thought, Oh, that's not what they're talking about.

Jennifer Smith, CDE 3:24
That's what I was wondering is like, what and when you said the name of I was like journaling? What kind of journaling? I journal and it's doesn't really reflect on diabetes, but sometimes it does when I'm journaling about that. But that's not in my journal. No.

Scott Benner 3:40
I was so disappointed with myself. When I started reading, I say, Oh, they're talking about tracking food and doing a food journal and a carb journal and a Bolus journal, journaling diabetes stuff, and I thought it never occurred to me because, you know, I don't do that. But I go, but I do see people's, you know, people's comments telling me that for I think certain, I guess certain brains, right? This is probably incredibly important. So the first comment I have here is I counted carbs and tracked it in a food journal like crazy for almost a year, I would record everything my son ate and what happened to his blood sugar afterwards. This was kind of helpful to distinguish patterns. It was very stressful when things were not working correctly. But oh, here we go. I would never food journal again if I knew better.

Jennifer Smith, CDE 4:31
Huh. And that, and I see I don't see, as if like, Well, gosh, why not? It's just sort of like, I think everybody again, you said personality. I think there are some people who can collectively see something happening. They take it in and it gets filed in that place that they know they can pull it out and use it and they don't have to write it down. However there are people in terms of like kind of learner, along with personality, there are some people their learning style is they get it once they've written it down. If it's written a couple of times, it's then in that place in their brain that they can draw from, and they probably don't have to write it down anymore. Right?

Scott Benner 5:17
Yeah, I wonder if the message after we get through this is going to be that if this is how your brain works, this is probably amazing. And if it's not, it might feel like torture.

Jennifer Smith, CDE 5:27
And I think the other piece to it too, is people who have a little bit more consistency in what they do, and probably would benefit from this, regardless of personality or learning style. They're the they're the person or the family that could get a lot out of, we have soccer every Monday, Wednesday and Friday, we always eat this for breakfast, this for lunch, and then dinner is these different meals. But there are like five of them, great journalists figure it out, you will see patterns, I guarantee. But the person who has a very random schedule, and you know, I bring up nurses sometimes, because the nurses that I've worked with often have variable scheduling, they might work overnight, and then they might be off for two days. And then they might work three shifts in a row, different times of day, and then they might be off for another two or three days in a row. While you might get something out of food evaluation, you may not get much out of time of day evaluation, because there's so much that's variable day to day for them. So I think, you know, you kind of have to pick and choose, what are you also trying to figure out what is journaling? The 1000 things that might happen in your day, you're gonna get overwhelmed with that

Scott Benner 6:56
you're not a computer, right? Like, you can't, no, I can't write down so much data that you can't compile it and make sense of it. But what you're saying makes a lot of sense to me, if you have a more repetitive life, you'll probably more quickly be able to see the patterns, right. And if you have an incredibly variable life, what you might end up with is a lot of numbers and lines and dashes that you can't make sense of

Jennifer Smith, CDE 7:18
correct interest. And sometimes because it's your own data, you sort of get lost in it, right? Sometimes it it helps to have an unbiased look. Which means then that hopefully you have a good care team that you can go to and send data to for evaluation saying, I don't see anything here. Can you please try to pick this apart? And you know, when I'm looking at someone's data, sometimes I say, I don't know, it looks like there are a lot of variables in the picture. So let's try this. And this to start out with?

Scott Benner 7:49
Well, that's it really important to bring up because, I mean, in full, full transparency, probably a half a dozen times a year, I send something to Jenny and say, I see this, am I right? Because I'm living it and watching it. You're You're too, right. It's micro macro, like sometimes you get too close to it, and you can't see the big picture anymore. And often, like, I wanted to make this switch a couple days ago, and I said to Arden Hold on a second, I'm gonna check with Jenny. And she was Do you not know if you're right or not? Which I don't think like, filled her with a ton of confidence. And I was like, No, this is the right thing to do. But let's just tell somebody else first who, who thinks about it the same way so that we don't start turning a bunch of knobs and get too far away from where we are because we're so close right now. And she's like, whatever. And it's like okay, by the way, just to digress for half a second. Did you hear the episode that she did recently?

Jennifer Smith, CDE 8:46
I listened to I think I got through three quarters of it.

Scott Benner 8:49
Did you get to the part where she wouldn't give you credit for the oat milk ice cream?

Jennifer Smith, CDE 8:55
I didn't get to that part. Although I have seen many comments about what's this ice cream. Jenny recommended and I was like, it's tasty. I guess the biggest reason was when I recommended it for you guys was trying to find something that was comparable in taste that she wouldn't be like, Oh my God, this crazy lady recommended something that's it's horrid. It is totally not ice cream to me. Right?

Scott Benner 9:17
How long is the hair on Jenny's legs? If she thought I was gonna eat this? Yes. But um, but she just ended up really liking it. So I was like, I was like, Hey, give her credit. She goes, I'm not involved in this thing you do? It was like what do you anyway you have to get to it is hilarious. Okay, so the next comment here is, is super interesting because it goes the other way. Getting a scale and a notebook was huge for our family as well as staying as organized as possible was we had a little makeup. Oh, we had a little makeup organizer set up on our counter in the kitchen with everything we needed. So it was very easy to reference. Then, with a notebook right in front of them. We would write down all of our carbs and in insulin doses times, etc. And that really helped to make sure we didn't both accidentally give her something Oh, that's interesting, a little redundancy too. And reference back to the book, if something weird with her blood sugar happened that we could figure out better after seeing, Oh, what was going on with the insulin versus the food that she ate, get a good scale to help with Clark County.

Jennifer Smith, CDE 10:21
And that's their, you know, in terms of the whole idea of journaling, there in lies, I think this person brings up a good, a good fact that sometimes actual physical written journaling, you can flip back to easier than the databases upon databases that allow you to do the same thing in an app. Because sometimes the apps become cumbersome to try to track through and page back and forth between one day note and then trying to find another days of note, where if you haven't just written down, you can kind of easily page back and forth. I know a lot of people use like the sugar mate, because partners or caregivers or whatever, you can see what every person is logging. And then you can see in the day, and you don't really have to worry about that redundancy, or Oh, my goodness, did I give it did somebody else give it what was done? But yeah, I mean, there, there are multiple ways to journal or I guess, record diabetes, if you will, sort of like texting diabetes, but recording, if you will.

Scott Benner 11:29
So when there are plenty of times throughout the weeks, where my kids look at me funny, because I'm like, well, if I'm going to do this, I have to go upstairs to my computer. And they're like, you can do it on your phone. And I don't want to, I don't want I don't like that. And they they're like you're old and I'm like II say whatever you want. Like I want it big. I want it in front of me. I want to be able to look at multiple things at the same time. I don't want to be flipping back and forth. I take that point. Oh, well, it's interesting. He I would I would be better with it. Interestingly enough, I'd be better with it where I could just reach back three pages and go okay, Monday. That was that would be easier for me.

Jennifer Smith, CDE 12:07
Absolutely. I mean, I did that. And I'm very glad. And I recommend this to a lot of the women that I work with, through pregnancy is I journaled my entire first pregnancy, the whole thing, all the foods every day, day and time of change of insulin doses and everything that I noticed, it was enormously beneficial. When I was pregnant with my second, okay, enormously beneficial, because I could go back and say, Well, this time of the first trimester, this is about what started happening. And then it didn't feel as crazy. Right with what I was noticing. I'm like, No, this is normal. I did do this last time, or I did see this last time, or I did stop doing this type of thing last time about this point. So

Scott Benner 12:54
when something that's so out of the ordinary happens, even though it's happened to you in the past, it still feels very out of the ordinary. And it was helpful to go back and say, Oh, no, this this happened the last time. Yeah, right. That's right. Especially

Jennifer Smith, CDE 13:06
because there were a number of years before between my kids. And so, you know, memory lapses entirely.

Scott Benner 13:17
So that's nature's way of allowing you to get pregnant again. I think.

Jennifer Smith, CDE 13:20
There you go. I guess yes. You don't remember all of this stuff you do, right? Oh, let's do it again.

Scott Benner 13:26
You remembered it, you'd be like No, thank you. That's okay. Once enough.

When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. GE voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Two words like current glucose dose calculator, active insulin remaining dose history, Activity Log reports and glucose history make you think about an insulin pump? They probably do. Because that's a lot of the functionality that you get with an insulin pump. But I just read those words from in pen today.com, which is a website where you can learn more about an even order the insulin pen known as the pen Pen. This pen is special because it connects to an app on your phone that gives you the functionality that I just spoke of. Now you may think oh well, something like that. Scott has to be incredibly expensive. But in fact, you may pay as little as $35 for the implant. That's because Medtronic diabetes doesn't want cost to be a roadblock to you getting the therapy you need. And so with the in Panax This program, you may pay as little as $35. This is something you can learn more about at in pen today.com. While you're there, check out the app, great breakdown of the pen that's there you can see all the parts and pieces, the whosits and whatsits, everything you need to know about in pen from Medtronic diabetes. When you're ready to try it, scroll to that part of the screen that says ready to try. And you'll be that much closer to getting your insulin through a pen that connects to an app on your phone and gives you the functionality you're looking for. In pen today.com links in the show notes, links at juicebox podcast.com. In Penn 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.

Makes sense? Okay, here's the one from somebody that says, Oh, hold on a second, while I mute my phone. Like I've never made a podcast before. Sorry about that. With everything overwhelmingly journaling. Journaling saved my tired brain from remembering everything. Okay, so while everything was overwhelming, journaling saved my entire brain from remembering everything. I keep everything in there food, Bolus timing, dosing, carb counts, questions, to ask questions to ask it and appointment, they use this thing like a Bible, then. Okay.

Jennifer Smith, CDE 16:27
And that is good in terms of connections with your care team. Because if you do on a day have, gosh, originally I should ask about this isn't a question that needs to be answered now. Then reach out now, if it's a question that you're going to bring this journal in, in a month or two months when you have your next visit, because they were just things you wanted to go over. But I really not as necessary to get an answer to right now. Then you don't have to remember all your questions. Yeah.

Scott Benner 16:54
My, my mom just moved from the East Coast to actually to her Jenny has to live with not to live with Jenny, but to live with my brother. Not that my brother lives with Jenny, but they're in the same state anyway. And my brother has been a little overwhelmed. And we had a conversation yesterday, where I said, Listen, you've been lucky this far, you haven't dealt with a lot of health issues. And, and he's like, Well, there's phone calls, and I'm talking to doctors, and they don't do anything you want them. You know, you have to ask three times. It's like, yeah, that's like, that's how this is. So. So I said, look, make a list. And I said, because if you think you're just gonna walk in that doctor's office, and remember to say everything that you need to say, it's not going to work like that. I said, you have to have a list in front of you. It's interesting how, you know, the one thing I'm realizing, as I'm listening to people talking about how they're journaling and listening to us talk about it, is that I would have benefited from it. It's just that my brain doesn't excuse me, I don't know how to say this actually. But like my my printing, my penmanship is is horrendous. Like, I don't mean not, you know, worthy of being hung up somewhere. I mean, I write things down. And then I didn't know what they say. Yeah, I have things written in front of me from yesterday. I don't know what they say anymore. And

Jennifer Smith, CDE 18:16
it's kind of like Dr. chicken scratch really,

Scott Benner 18:19
it's like, it's like something I'll tell you. And, and I wonder how much of that thwarted me from ever trying it because I have I have written things down before I'm like, this is useless. I don't know what this says. I've tried slowing down and writing slower. It doesn't like I can't do it. Like the first three letters and then I get bored like come on, let's get this out. And I can't get back to it. So

Jennifer Smith, CDE 18:45
um, had you had at you know, I mean, Arden was diagnosed long ago, long enough ago that there really weren't the tracking tools that we have now right? Where it takes your handwriting out of the picture it does allow you to keep it all in an app or again or someplace that you can actually read what you wrote down

Scott Benner 19:06
that is why I like being at a computer because I can go back and actually see it also might make a good point that my my book back then might have said woke up screamed into pillow cried. Yeah. Yeah. Chased Arden around room with needle went another room screamed and pillow. I don't know how helpful that would have been. Exactly. I guess the tools and the data coming back really is more modern day.

Jennifer Smith, CDE 19:32
It is definitely I mean, even the ability to download, you know, a pump or a simple glucose meter or have the CGM data drive right into a database that you can look at online or that you can get notifications. Hey, clarity tells me that I did this much better this week compared to last week, right? I mean, that kind of information. Just it wasn't there. Yeah.

Scott Benner 19:58
So I use that that data like in clarity. For example, when I'm returning Arden's blood sugars for something, I move everything to one day, I want to see just what happened today. Where was our average? What was our range today? And then as those numbers come to where I want them to be, then I open it back up and see, am I keeping it for a week? I am I keeping it for a month? Good. And then I kind of build off of it that way.

Jennifer Smith, CDE 20:22
Yeah, those overlays or comparison reports, especially just, you know, talking about like a CGM. From a one point of view, like you said, when you make a change, and you're wondering if it's made enough of a difference, I always start with just compare a seven day, you made a change on this day, look seven days out, do things look better compared to the previous seven days before you made the change? And see, so you can definitely tell whether or not more stuff needs to be adjusted,

Scott Benner 20:52
I cheat a little bit to like, I'll look at seven days and just pick a number. We'll say like, I don't know, variability is at 28%. And I'm like, Okay, over the last seven days, that's great, then I expand it to 14 days. And I don't even go back and look, if the number goes up, then I go, Okay, well, the week before, it wasn't as good. And if the number stays still or goes down, I go. Okay. Now I have some consistency over two weeks. Right? Yeah. Oh, it's interesting. The last person just says, please get a good scale to help with carb counting. I don't know how to comment on that. Because, I mean, that's a burden more for me, but I see the value,

Jennifer Smith, CDE 21:28
there is value. And I think, again, I still use a food scale, but more specific to foods that they never have a label. They're real foods like butternut squash, or acorn squash, or apples or M kind of, you know, those summer into fall kind of vegetables and fruits, or anything that you might get from the grocery store any time of the year, that just does not come with a label, you can get a lot from using a food scale, and you know, a carb factor. And many foods scales now, if you get a smart one actually come with the carb factor already in them. And all you do is put the piece of food on the scale, put the code in, and it gives you the amount of carbon that portion that you're going to eat.

Scott Benner 22:18
Oh, so yeah, cut up apples as an example. I throw it on there. I tell the thing. This is apples, it already knows what the carb factor is for me personally. Tells me for that

Jennifer Smith, CDE 22:29
food particular. Yeah, yeah. Yeah, like I, one in particular, is it eat smart products.com is the website. It's a great food scale, you want to look for the nutritional kitchen scale. It's like a square like clear glass shape. But it comes with a catalogue of about 1000 foods that each have a code. And when you look at the code, then you put that in put the let's say Apple is 205. I only know it because I really like apples this time of the year. And I use it because they're all different shapes and sizes this time of the year. So you put the apple on and it pops back. This is how much fiber it has this is how much carbohydrate in this portion that you're going to eat. And if you are the precision kind of person, then maybe that's what makes the big difference for you. And if it does, it could be a huge benefit for you. Again, I mean, I don't use it for things that might like beans that come in a container that I can look at. I know what a half cup looks like. And you know, I've been doing this long enough that if I don't know what a half cup looks like, I'm in trouble at this point.

Scott Benner 23:37
Okay, so I think the takeaway here is that different people are going to respond well to different ideas. But that's keeping track of something somehow is is a good idea. You don't I mean, even look, as I joke, I don't keep track of anything. Arden left for college, the last thing I did was open up our loop app and screenshotted every page of our settings, and I AirDrop them to myself. And we got we got there and we made changes, and I did them again. And over the last couple of weeks that she's settling into school, I refer back to them a number of times. So

Jennifer Smith, CDE 24:07
Right. And in the beginning, I think the good thing about some tracking, especially if you do have a honeymoon period, the good thing about tracking early is that you'll start to see those differences that cue you in to say, this wasn't just a bad day, right? This was two days or three days I have much more sensitivity or much less sensitivity. And so you know, then something needs to be adjusted in terms of your doses, probably. And you can go forward in a much more precise manner rather than the randomness that creates more of the roller coaster up and down.

Scott Benner 24:44
Okay, well, I'm glad we talked about this then thank you very much. Thank you. Okay, let's see what is next. So that was journaling. I honestly can't read my own writing. It's embarrassing.

Jennifer Smith, CDE 25:00
There was, there was a physician when I was doing my clinical internship, which I had actually done I had done at a hospital where I was already working. And so I knew the doctor, but he had, like, literally, I don't, I would call it chicken scratch, it looks like somebody put ink on chickens like feet, and they just danced around on the page. And we got to the point of realizing some words looked the same. And then you could end up figuring out that the chicken scratch was like the or it's catchy, because it looked the same note to note, so then you could figure out what he had actually written. But, man, yeah, almost

Scott Benner 25:46
impossible. No, I, I looked down at my own writing. And I was like, it feels like someone else wrote it. I have something in front of me right now. Oh, I know what it is. I was speaking to someone from Australia yesterday. And she said, we are in a potty. And I wanted to remember to bring it up later. Because she had she was talking about peeing on sticks to get her blood sugar when she was younger, because she had had a long time, right. But as I looked down at it now, it looks like it says Lee

Jennifer Smith, CDE 26:19
Lee and Patti maybe

Scott Benner 26:20
on poult. Good. Like, I don't know what it's, I don't know what it could say Q. Like cu e, it could say, definitely not wait because the first loop of the w goes down comes up and it goes right into the E. And then there's another E, the two E's don't even look the same. You can't even tell the second eat and the first day are the same letter.

Jennifer Smith, CDE 26:52
I hope you never wrote like nice letters to your wife when you guys were dating because she was finally I was talking about my hobby telling them that he likes me. But I really don't know,

Scott Benner 27:04
a greeting card for Kelly. I sometimes print it out first and then go and I copy it. Because if I just start writing, I hand it to her. And later she goes, Hey, what does this say? And then I'll just I just read it to her or the or I can't read it. And I just go well, here's here's the intent. Like I started. I don't know if it's terrible. It's really I don't I it's my whole life. My printing has been absolutely horrible. And my cursive is not anybody writes that way anymore. But

Jennifer Smith, CDE 27:32
it's it's horrendous. And they don't even they don't even teach it anymore.

Scott Benner 27:35
There's a lot of things they don't teach anymore. Some of it. I'm confused by like typing.

Jennifer Smith, CDE 27:40
I'm amazed at the the use of iPads in school for young kids. It's the hunt and peck method of finding letters to spell things. Yeah. And I told I told Nathan recently, I was like, We need to get it. We need to get a keyboard to hook up to our home iPad. And we need to teach them how to type. Yeah, because for the year, they're gonna hunt and pack their entire life.

Scott Benner 28:10
That was years of their life. You know, watching a person text who's proficient at it is like I watch Arden and her thumbs are just like flying. It's and they don't make mistakes. It's fast. It's fascinating, you know, so I had to teach myself to type to write my book. I did, I did not know how to type. I took typing class. I did it for like a day. And I'm like, I'm dropping this. And I dropped it and I left. I couldn't do it. So when I had to write my book, I sat down. And first I typed looking, and then I would practice not looking. And then as the weeks went on before I knew what I could type.

Jennifer Smith, CDE 28:49
Yeah, I mean, that's how they teach you. It was a mandatory we had to take it as freshmen in high school. It was a mandatory, I still remember Miss Adelman, that was her name. And we had word processors. No, I'm like aging myself. We had word processors A S S, like that's what we did for the whole class. By the end you're like, oh my gosh,

Scott Benner 29:13
Kelly had one in college where there was this little matrix LED screen in front of her that may be held like 15 or 20 characters and you would type and they would come up in front of you. And then they would disappear off to the left. And when you got done you hit save and it was on like a floppy disk if I remember correctly, and then you had to put the floppy disk in and hit print. I mean you didn't even you couldn't even go back to see if you made a mistake or it was and that was like high quality back then. Think about that the next time you complain.

Huge thank you to one of today's sponsors G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGLUC AG o n.com forward slash juicebox. If you're looking for an insulin pen that does more, check out the pen from Medtronic diabetes at in pen today.com. And don't forget to fill out that survey for me at T one D exchange.org. Forward slash juice box

if you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. That really is the best way to help the show, grow, thrive and continue. Tell them to look in their audio app like Spotify, Apple podcasts or Amazon music. If they don't know what that is, send them over to juicebox podcast.com Or take their phone from them and show them yourself. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.