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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.

• 00:02:36 Understanding insulin sensitivity factor.
• 00:10:43 Adjust insulin sensitivity for accuracy.
• 00:12:15 Managing diabetes requires adjusting for variables.
• 00:20:42 Adjust insulin needs as life changes.
• 00:26:01 Importance of insulin sensitivity factor.
• 00:28:31 Empowering, informative podcast for diabetics.

Scott Benner 0:00
Hello friends, and welcome to episode 822 of the Juicebox Podcast

Hey everybody, today's episode is Jenny and I helping you figure out your insulin sensitivity factor. There's a little bit of math involved. Don't worry, it's not really like super confusing or anything. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you like Jenny and you want to hire her, you can she works at integrated diabetes.com. Are you a US resident who has type one or is the caregiver of someone with type one? Oh, if you are, this is great news, because you can go to T one D exchange.org. Forward slash juice box and fill out the survey. Every completed survey benefits the podcast and type one diabetes research T one D exchange.org Ford slash juice box. At the end of this episode, I'll tell you about more Juicebox Podcast episodes and series that will help you with insulin sensitivity factor. So hang out to the end

this episode of The Juicebox Podcast is sponsored by touched by type one now you can find touch by type one. Now you can find touch by type one at their website touched by type one.org. You can find them on their Instagram page. And on Facebook. Touched by type one has great programs like their annual conference which I speak at sometimes their awareness campaign Bowling for a cause they're dancing program called dancing for diabetes, the D box they have a golf outing touched by type one is helping people living with type one diabetes. And they'd like you to just to check them out touch by type one that work. That's it for the ads today. So I just wanted to tell you that if you're enjoying the Juicebox Podcast are finding it helpful. The best way you can support the show besides clicking on the sponsor links, or typing them into a browser would be to share the show with someone else. A doctor, a friend, a stranger, somebody who you think may enjoy or benefit from the Juicebox Podcast. Hey, Jenny. Hey, Scott. We're going to talk about setting up insulin sensitivity and getting your numbers right where you start and and how you can figure out where to go from there. Fantastic. How do we set up insulin sensitivity?

Jennifer Smith, CDE 2:51
Yeah, and I like that you call it insulin sensitivity factor or what you might see written down as I S F insulin sensitivity factor. It's also called correction factor. So if you've heard any of those words, it's all representative of the same thing. This idea

Scott Benner 3:11
correction factor, insulin sensitivity and insulin sensitivity factors seem to be the three ones that get used most in the zeitgeist they all mean the same exact thing.

Jennifer Smith, CDE 3:21
Yes. And from an abbreviation most often you'll see I SF I igloos s Sam F. Frank, there you go.

Scott Benner 3:30
I think that you weren't being clear with your enunciation.

Jennifer Smith, CDE 3:33
I thought that Yes.

Scott Benner 3:38
I think more likely, you're just trying to cover for my bed.

Jennifer Smith, CDE 3:42
No, not at all. Not at all. i It's funny, because I say that mainly because just as a side note, I hear I get so many like codes for seeing people's data and whatnot. And if we're talking, I always make sure that I've heard them correctly so that I can input it the right way. Otherwise, the program's like, no, that's not right. And then, you know, so anyway,

Scott Benner 4:06
I just thought I had a weird accent. You're like, there's no way people understood what he just said.

Jennifer Smith, CDE 4:10
If anybody has the weird accent, it's me. So I think

Scott Benner 4:13
of it as insulin sensitivity, I have to admit, when Arden was first diagnosed, I thought of it I guess with the old terminology, older terminology, and then going to a pump brought me to insulin sensitivity factor. And then I think going into looping made me say just insulin sensitivity. And it's not it's more about how I think about it than it is about what you're calling it. If that makes sense. So correct. And

Jennifer Smith, CDE 4:38
that's that's kind of why I like I like I like both terms. Sensitivity, I think gives you more visual to response, right? How you're going to respond to insulin to take your blood sugar to the place you want to get it to. But now Don't get too low, right? correction factor I like because it really, it implies why you're taking that insulin, you're correcting the number that you don't want to be sitting at back to the place that you want it. So I think they're both relative, obviously.

Scott Benner 5:18
But there is no, I don't want to get bogged down in this, but there is value in the words you use, and how they make pictures in your mind. And for me, calling it insulin sensitivity. It just makes the most sense to me. So okay, so what is the insulin sensitivity?

Jennifer Smith, CDE 5:38
Yes, so insulin sensitivity is how many milligrams per deciliter or millimoles, your blood sugar will get dropped by one unit of insulin. Okay, so if your ISF is 51 unit of insulin should bring your blood sugar down 50 milligrams per deciliter, right? Or I say 50 points just to make it easy. From where you're starting? And is it instantaneous? No, it's not, that we've talked about is this, it's rapid insulin, but rapids a bad name, it's going to take some time for that to happen. So you're gonna have to give the correction a little bit of time to get working, see its action. And to fully evaluate, does it bring you back close enough to the target that you're aiming for? within a defined period of time, which may be the active time of rapid insulin,

Scott Benner 6:39
right? Is there an when you're figuring this out? What's that length of time that you consider? Like how long because I can remember, I'm just going to keep using this as an example because I used it in other episodes, but are done with the school. And her sensitivities changed at school, and we had to, we had to change them. So that I just went back to basics, I did what we talked about in the basil episode I got, I made sure I got her basil about where I thought it was gonna be, I set up her carb ratio about where I thought it was gonna be. And then I had to get her insulin sensitivity, right. And basically, what I did was I put her she was sitting very stable, like a, I forget where it was, she was sitting very stable, like 180, while we were figuring this out, and I just gave her a unit of insulin. And I said, Let's not do anything. And we'll wait a couple of hours and see where you end up. And then I that's where I started building from that and the math.

Jennifer Smith, CDE 7:37
Right? And from a fairness standpoint, for any of those people who are using algorithm driven pumps to really analyze correction factor on its own, you have to turn the algorithm off. And I did you write it? I know you did. But just from a, from a reference point, because otherwise you don't, you don't want something else helping you along the way. You just want a point of this as the insulin, everything else was left turned on, Basil was working like it should have. This is where it ended up getting me right. And it you know, an asking of time, not only in that example, were you looking at does the rate show that I used work? Did it get her to the point of where I wanted, you could also have kept it you could have kept it going for a little bit longer to see the point of stabilization, like where did it land at the target? How many hours after the correction was that? Yeah, that gives you a little bit more visual of, of your insulin on board time or your active insulin or duration of insulin action, right? Let's say by three and a half hours after that Bolus, she landed nicely where you wanted. And then she was like, Well, I'm just going to sit on the couch and watch a movie. I'm not eating anything. There was, you know, again, you left your algorithm off. If it settled there, lovely. One, your basil is right. But to the Bolus action time was more defined, you could see where it hit and stabilized. That should be about your active insulin type. Yeah.

Scott Benner 9:16
Yeah. And that's not easy to come up with either No, and especially because those are dummy settings in normal pumps. And in and if you're using an algorithm at this point, now, if you're using the loop, okay, you can figure it out that way. I don't know enough about how control IQ works. And Omnipod five is, you know, kind of does its own thing. So that's even hard to know. It's proprietary.

Enough. There you go. But for me, I Arden was looping at that moment, when we did that I shut the loop off. And I just ran it like a regular pump. I was confident in the base that we had set up. And so I think in the end that one unit moved or Like 45 points. And that's and now Arden's insulin sensitivity is set up somewhere between 41 and 45, depending on the time of day. And that gives the algorithm, the wiggle room, the wiggle room, it needs to do what it needs to do. Like, if I made Arden's insulin sensitivity, one to 40. And she was on a regular pump. And it was just like that constantly. That would be too aggressive. Sure, yeah. So she'd get low at night, if I did that. Right. Anyway. Okay, so what's the math on this one?

Jennifer Smith, CDE 10:36
So what's the math on this? This is where there's another rule that comes into play. Many people start by just saying it's the 1800 rule, right? So you're essentially going to take, again, what is your total daily dose, and you're going to divide that into 1800? To get a starting point for your correction or your sensitivity factor? So if we take 30 units of total daily insulin, and we divide that into 1800, what are you going to get?

Scott Benner 11:07
I'm doing it right now. Oh, really? 8,000,400? And? I have a 6060.

Jennifer Smith, CDE 11:18
Correct? Absolutely. That's easy math, right. 30 into? Yes. So you're gonna start with a 60. And let's say you're, you've looked enough at having corrected insulin, or corrected blood sugars, and you're like, but my factor is already at 55. And my corrections don't work, or my corrections at night, work really awesome at 55. But during the daytime, I'm getting low with this 55. So maybe 60 In the daytime is more what you need more what the math tells you. And maybe at night, you just need it to be more aggressive, the lower the correction factor value or sensitivity factor value, the more insulin you're going to get,

Scott Benner 12:01
right? Also, it's super important to say that if your blood sugar's 130, and you wished it was 90, and you've got your sensitivity factor set up, it was you know, one unit moves me 60 And you and your pumps target is at 90, you're 16 you're like, hey, Bolus, it's gonna take a fraction of that amount of insulin to get you to 90 Correct. But if your blood sugar's 250, and you want to be 90, that factor might not work. Because you're a good point, right? Because there's a lot of other variables that we're not thinking about. And they could be anything from undigested food to a bad, a miscalculated meal Bolus that you're still dealing with, you could have ketones, which would come into a point, you might be dehydrated, there are so many things. So so you're getting these settings set up in. I don't want to say perfect, but near perfect conditions. They work in my perfect conditions. But now when I'm out in the world fighting with it, it's almost like learning jujitsu, I imagine probably you're on them on the mat, it probably works because the other guy across from us doing the same thing. But when you get into a street fight, and you're Indiana Jones, and you know, and you start going, I'm going to do jujitsu, and then Indiana Jones pulls out a gun and shoots you. And then you go, Oh, well that he just didn't help as much. So, like So given the fact that I'm now imagining that a lot of these people have never seen Indiana Jones.

Jennifer Smith, CDE 13:24
But when so sad, go watch it. Yeah, exactly.

Scott Benner 13:28
But but the point is, is that you get these things, right. And then you have to take them out in the world and actually use them. And, you know, variables change.

Jennifer Smith, CDE 13:37
I like that. What you brought in there in terms of a variable, because it's one that I talk to people often about when we're looking at settings and adjustments. My questions often go to, well, this correction never seems to be working well. What are you eating at 10 o'clock at night, your corrections overnight don't work? Well, they may not work, because the data isn't clean, for lack of a better right. If you're sitting down and eating a whole pizza at 10 o'clock at night, and then your correction at one o'clock in the morning isn't working very well. I can guarantee that the reason it's not is because there's food in the picture that your correction factor doesn't know is there. Right? So you're you're unfairly judging this sensitivity in a window of time where you're going to be more resistant.

Scott Benner 14:33
And total daily insulin. We're just not we're not saying it for some reason, but total daily insulin you can get out of your pumps settings. Yeah, tell you how much and you can't just don't just look at yesterday. No, yeah. Because look at yesterday, look at the day. I mean, I don't know how far back do you go to come up with a real one for you? I usually like to look

Jennifer Smith, CDE 14:53
at an average of about seven days in general, especially if it's seven days worth of pretty Typical day, you know, somebody's just come back for vacation and their past seven days is all jacked up. Because, you know, it's been vacation, right? It is what it is. That's not valuable, true insulin amount information, I might need to go back further than that to more typical days and get an average there.

Scott Benner 15:21
Do you knock out the outliers? Like if, if you look at seven days and five of the days, you're right around 50 carbs, or and, and you look Oh, yeah, I used 50 carbs, and then ended up being this much insulin. Let's just say it was just keep using 50. It's I use 50 units of insulin on Friday. He's 50 units of insulin. On Thursday on Wednesday, I use 48. On Tuesday, I use 52. But on Monday, I use 12. Like, do you knock that one out? When you're doing the average? That person, right? Yeah, absolutely. And the same thing as if on Saturday, you were at a birthday party, you're like, Oh, my God, I used 90 units of insulin. So okay, so you take your kind of AV, you got to do an average of those days. Correct. All right. So much math. This is why the Pro Tip series.

Jennifer Smith, CDE 16:09
I know that there is a lot of it. But I think this is important to go along with that. Because I know we did the protests a while ago. Jimmy, holy cow, really? Wow.

Scott Benner 16:23
When we started, there was

Jennifer Smith, CDE 16:24
a while ago, and I'd have to go back to them and listen yet again to remember exactly, but I don't know that they're obviously we're doing this because that wasn't a big piece of

Scott Benner 16:34
well, people. People asked for the math, right? Like, I want to know the math of setting up my Basal my insulin to carb ratio, my insulin sensitivity. And I just keep telling people, I would just go listen to the Pro Tip series, because in my mind, it's mindset, like so much about managing diabetes as mindset. And the math is not not important. It's very important. And so here are the episodes. Right? There's the the five, what is it? How many rules are there? There's the rule of see, I already forget, we've been doing hundreds the rule of 500 for the insulin to carb ratio, right? Yes. Okay. And this one's the 1800 rule for the insulin sensitivity. Yes, and the Basal was.

Jennifer Smith, CDE 17:15
And the Basal was not really a rule, it was based on weight to get either a total daily dose of insulin and then break it down or based on weight. And just looking at what your Basal needs would be all of them factoring in, like age, as well as where you are in activity level.

Scott Benner 17:37
And you hear me say all the time that I think managing diabetes is about its timing and amount, it's about using the right amount of insulin at the right time. So yes, you need the math to know where to start. But then you have to look at what's happening to adjust your math to fit the honesty of like, you know, of the fight you're in, not just what you hope the fight was going to be. You have to you have to take account of the variables in your life, your level of activity, the way you eat, even if you're a hydrated person or not, like you know, we say things like be hydrated. Like, that means that everybody here is gonna go like Oh, okay, and then start hydrating, but I'm going to tell you that a week ago, I promised myself I was going to drink more water. And last night, I went to the bathroom at the end of the day. And I was like, did I drink any water today at all? So so it's nice that good. So it's nice to say you're going to do it. But the truth is, you might not be doing it. And if you're not hydrated, your insulin won't work as well as an example of something that could change, change the urine.

Jennifer Smith, CDE 18:39
And in terms of that activity level, I think it becomes really important. You know, we talk about these rules, 500 1800 whatever, but I think just we you had asked in the Bolus one about 500, could we make this more aggressive with another factor? Could we make it less aggressive? We could, I mean, that is the strategy to in terms of figuring out this 1800 rule. Like I myself actually know that I'm, I'm closer to the needs if I use like a 2000 rule, because of the activity level that I'm at because metabolically I know where my sensitivity lies. And so my insulin needs would, I would be very much too aggressive if I use the 1800 rule and it's a middle ground there's like 16 1700 makes your makes your insulin sensitivity factor more aggressive write a lower number, you get more insulin, whereas like 2000 it makes it more conservative.

Scott Benner 19:38
Do you remember the conversation we had about Arden because do ya cuz you were like you You told me to go with a lower number. And because that we started getting mixed in with the food that she was going to be eating it. But then the interesting thing was in the first handful of days at college, she needed a more aggressive insulin sensitivity factor but then once this the As the day started becoming repetitive, and she was getting a lot more activity, I had to back that off, right. So in the first four or five days before she was really moving around the campus, I had her all the way at 40. And then when she started getting more active, I had to move her more like 4344 45, depending on the day. And that's, that's her insulin sensitivity was 4344. Also, I don't want people to get caught in the idea of well, these are my settings, and then my life change. Now my a one C seven, but it doesn't matter, because these are my settings. So I guess diabetes, is this happening to me your life is changing. Your body is changing, something's changing, you have to meet that need. Correct? That's it. Yeah. And just don't sit sedentary and go, Okay, well, things have changed, but I'm not going to do anything about it. Like you have to do something about it. You know,

Jennifer Smith, CDE 20:53
right. It's so mean life is life is ever changing. It is yeah, you will continue to grow, you will continue to get older, we don't unfortunately, get younger. Your insulin needs will shift and change, you have been a really active college student. Now you've moved into taking your first job, and it's a desk job and, you know, you will have to shift and adjust. You really

Scott Benner 21:18
will, yeah, don't don't, please don't just look at your stuff and go Well, this is this is what's happening now like you can, you can affect those things. And, and I think you can also not to beat a dead horse, but the Pro Tip series will put you in a mindset about managing insulin. I mean, this stuff will be great for you. But it'll really, it'll take you to another level. I mean, those that is really a long, the Pro Tip series ends up being what is now over 25 episodes, I think, but it's just a very long conversation between you and I about what it means to take care of your diabetes, you know, right? Like, I know, you

Jennifer Smith, CDE 21:54
imagine if we had done all of that, that would have been a very long discussion.

Scott Benner 21:58
And insane. Well, no, I mean, it never would have worked. Like you need to like you have a conversation. And you know, people don't know how you and I do this, but like these three episodes were all recorded at the same time. And so you'll see a flow through between the three of them. But the prototype series was recorded over a number of weeks in the beginning, and then we added 15 More episodes over the years. And even the way you talk about diabetes is different than the way you used to. It's not like in, it's not in its tone, your tone is different. And you're more mature, you've had more experience talking to people, you have more like anecdotal like conversations you can reach for and things like that the same things happened to me. I mean, you know, you know, we joke about it all the time. But, you know, you think it's, you know, your eight year olds insulin needs and how to handle them or like, you think they're hard while you're doing it. But when your eight year old turns 14, you'll be like, Oh, I wish the kid was eight again, because that was really easy. And but you then you have those experiences. And then when you're having a larger conversation, the things you think to reach to to make your point become more mature as well. And so I think I think it's been terrific. And, and I think this will add to it. But absolutely, there's more,

Jennifer Smith, CDE 23:16
I think I think the other thing in each of our conversations, too, is that you are very good at knowing the episode number most often. I'm like, I know, we talked about that in another episode. But I think it's nice, because we can continue to refer back and say, Hey, if you want more about this, go listen to this, right? It's really in depth.

Scott Benner 23:38
Yeah. And you're going to need it too. I mean, can you do the math and set it up? And just do what you do? And every six months, look at the math again and change it? I mean, if that's what you want to do, I think that's probably viable. And you'll probably end up with I mean, if you did the math or kept the math up to date Pre-Bolus Your meals and took into account different foods. You probably have an A one C in the mid 60s, right? Yeah. And and as your life changes, you got more sedentary or your eating habits got worse, you might see your agency go up if you didn't adjust. Or if you started walking, you might see it go down a little bit. Right, you know, but but the rest of it the like what to do in the moment without having to think about it. Like I think that's where the podcast shines. Like I think that's where you hear these conversations over hours and weeks and months. And something happens and then you just sort of do the right thing. And you almost don't even know why you're doing it. It's just you heard it talked about so many times. It's just what occurred you to do in that situation. Right? Yeah, right. That's excellent. I can't thank you enough. It's actually as the end of the year comes generally I usually Thank you privately but here I mean, listen, the podcast is it's never going to be what it is without you. So Oh really? apprec No, thank

Jennifer Smith, CDE 25:00
you absolutely no, this is this is wonderful and I'm, I'm proud and really glad that I have the opportunity to help you. Thank you

Scott Benner 25:09
means a lot your friendship and your and your participation mean a lot to a lot of people, but it means a lot. So thank you. Thank you. Well, obviously, we're gonna thank Jenny and remind you that she works at integrated diabetes.com. If you'd like to hire Jenny, that's where you will find her. I'd also like to thank touched by type one, for sponsoring this episode of The Juicebox Podcast, please find them on Facebook, Instagram, and it touched by type one dotwork. I hope these three little episodes have been valuable for you. If you're thinking three episodes, what are you talking about? Well, this was part of episode 828 21 and 822 820, the math around Basal insulin 821 The math around insulin to carb ratio. And of course, this episode was the math around your insulin sensitivity factor. I'm gonna tell you a little more in a second. But thanks so much for listening, I really appreciate it. Now that you understand better how to get your settings close to where they need to be, you should probably learn the rest. If you're new to diabetes, check out the bold beginning series. And if you've been around for a while, and you're feeling comfortable, and you understand the basics, head over to the diabetes Pro Tip series. These are available in your audio app at juicebox podcast.com. And there are lists of them in the feature tab of the private Facebook group Juicebox Podcast type one diabetes, all of this information is absolutely free. It's accessible in your audio app online, or wherever you're comfortable listening. Check it out. You can do it, you really can't. There's a diabetes, we have a defining diabetes Episode Episode 408, called insulin sensitivity factor in case you want to learn more. There's an episode 295 Defining diabetes, insulin resistance, which might help you understand why this setting is important. And don't forget, if you're using an algorithm based pump, understanding your insulin sensitivity is incredibly important in in getting those settings correct as well as as well as Basal insulin to carb ratio, everything we've talked about in these three episodes. But if you want to build on what we've talked about, please go find the diabetes Pro Tip series and the other collections of information within the podcast. I'm going to just I'm going to read you something before you go because I understand that I'm I'm saying here's some information go check out other stuff. And I know a lot of people charge money like they they give a little bit of information and they want you to pay for the rest. I'm not doing that. The entire podcast is free. It always has been it always will be. There's there's no hidden costs anywhere. There's no pay walls, it's all on your time you can do it you know as quickly or as slowly as you want. As far as listening goes. I want you to go find these things because I know they work. So I've gone to a website that keeps track of the reviews for my show. A one C 5.6 Just like you promised from 7.2 Scott empowered me to trust my instincts when dosing and to be bold with insulin. I love listening to this podcast it makes me feel not so alone. I'm just gonna click on More here for you saving my soul never in a million years that I think I would be here but I guess who does this podcast and it's private Facebook group saved my soul in a time when I didn't think it was possible. The earthy, stripped down conversational aspects of Scott make you feel empowered. I'm a type two with a type one granddaughter learn so much from the podcast. This podcast has changed our lives. Just started listening, you're going to feel empowered, positive parent easy to understand management information with a side of laughter to reduce burnout. I'm telling you right now I could read these all day. I'm not reading them to you to boast. I'm reading them to you. So you'll go find the other series diabetes variables, mental wellness, diabetes pro tip F there's just they're there. Just go take please. I made them for you. Go listen to them. juicebox podcast.com. On top in the menu, you can see a list of a bunch of the series where like I said in the private Facebook group, which is a font of information and support of its own Juicebox Podcast type one diabetes. I hope you check them out. I hope these podcast episodes have been helpful for you. I'm going to be back very soon with another episode of The Juicebox Podcast. Thank you so much for listening