+ 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 826 of the Juicebox Podcast

Hey in this episode of defining diabetes Jenny Smith and I are going to define meet the need. 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 healthcare plan or becoming bold with insulin. If you're enjoying Jenny and you'd like to hire her, you can she works at integrated diabetes.com. Are you a US citizen who has type one diabetes or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box and fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward and you may just help yourself T one D exchange.org. Forward slash juicebox. I have an unprecedented amount of time before the music stops. Let me just tell you, thank you for listening to the show. And if you're really enjoying it, leave a beautiful five star review and a rating wherever you listen. Great reviews help other people to find the show.

If you're looking for a New Year's resolution that's achievable. Listen to a Juicebox Podcast series. If you're newly diagnosed, find the bulb beginning series. Trying to understand what all these words mean. Defining diabetes has over 50 episodes at this point, you're listening to one right now. And if you're really ready to dig in the diabetes Pro Tip series is the way to go. You can subscribe or follow the show for free on Apple podcasts, Spotify, Amazon music or wherever you get your audio even audible. Melissa says Pro Tip series set us on our desired path from the very beginning from a 12.9 a one C A diagnosis to a 5.2 in one year with no honeymoon. You can find the series and more at juicebox podcast.com Right at the top in the menu. Or you can go in the audio app you're listening in and just do a search Juicebox Podcast bald beginnings to finding diabetes, diabetes pro tip or how about the diabetes variable series, you think you know what's impacting your blood sugar, maybe you don't completely understand the diabetes variable series will help you to there's a mental wellness series defining thyroid, a collection of episodes about algorithm pumping. And don't forget the afterdark series where people tell stories that most won't share. And finally, if you're looking for support, or community, the Juicebox Podcast private Facebook group is absolutely free, has over 32,000 members. And it's just waiting there for you so much good information, you can dive in and talk or just kind of sit back and watch whenever you need. That group has it. This episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod five, and Omni pod dash. Learn more and get started today at Omni pod.com forward slash juice box, you may be eligible for a free 30 day trial of the Omni pod dash. Hey, Jenny, how are you?

Jennifer Smith, CDE 3:38
I'm good. How are you? Scott? I'm

Scott Benner 3:39
excellent. I'm excited to be here with you today to define, I think a phrase I made up, but it's still an idea that that um, everybody needs to know about meet the need. And I make up those words. I would expect that you did. Okay. All right. I think it needs to be defined because far too frequently. I mean, I think there's a couple of ways people get to it. But the way I see them get to it mostly is there's an idea in some people's heads that there's an amount of insulin that's the right amount of insulin and there's an amount of insulin, it's too much insulin. And instead of meeting the need that their body is, is is expressing asking for Yeah, it's asking for, they say things like well, I don't know anybody else who has a Basal that high or you know, doesn't doesn't five units or 10 units sound like too much and. Right, right. And to that I always respond to you just you need to meet the need. So

Jennifer Smith, CDE 4:42
and I think the interesting thing about that, and defining it in the way that you've defined it just meet the need. I think people will find it very valuable to listen when we do talk about the math.

Scott Benner 4:55
Yeah, right. Well, don't you always Well, I get a lot of notes like this, I just had one the other day from this guy. And he says, we moved my son, I think, I think it was a son doesn't matter. I moved my kid from on the pod dash to Omni pod five, but it's not working. And right away, it's like, it's it's not working, the thing doesn't work, you know, the dang machine doesn't do what they said. And and so I go back and forth with him a couple of times and messages, it must be it must be irritating to message with me because I asked leading questions that I need the answer to and I want you to think about, I don't actually tell you anything if we're talking to each other. So I asked him a couple of questions. And I said, I said, you know, what, what were your, like, average blood sugar's like in the past, you know, where were you sitting stable, and the kid wasn't sitting stable. Like, I'm not saying you have to be at all the time, but the kid was like 90 and 100 120 130. So already, I'm saying, Okay, sounds like there's not enough insulin. And then I asked a couple more questions. And it turns out that there's a lot of corrections throughout the day. So insulin that the kids not getting through carb ratio and not getting through Basal. They're coming in and pouring in extra. And that's when I said to him, I don't know if it's your basil. I don't know if it's your carb ratio, or both. But you are not meeting the need of either of those most likely, right? You're using a lot of extra insulin. You need to get that into, into your settings. Right. Right. And so he's meeting the need. Almost he was almost getting there. But he didn't know he was doing it.

Jennifer Smith, CDE 6:38
He was doing it by adding instead of having the system learn and deliver the amounts that were actually needed. Right, and you can, you can certainly continue to do it that way. It's just more work. It's more work following things and giving all of these adjustments and corrections and things along the course of of time. Corrections should really be not as frequent. Because if you are getting the right amount, whether it's from an automated system, or from just a manual dosing strategy, whether pumper MDI, right, the background needs to cover enough, and then the Bolus is the main reason really, for bolusing is for the most part around food. Yeah, it's carbs, right. So if that is keeping your glucose in the target range that you are aiming for, then your Bolus is meeting your need, because you shouldn't after that have to add a heck of a lot or any correction to get that Bolus to bring you back to your target. If however, you're adding adding, adding and that's just your regular routine every single day, you're constantly micromanaging. There's missing insulin,

Scott Benner 7:52
you and I think a lot of people find themselves in this position where they're like, Well, I don't know, I made my basil point nine five, because, you know, 1.1 like, I can't believe my basil is over one unit an hour. But it's just it's, I don't It's not ego, but it's it's this idea of like, it's embarrassment, maybe like, I'll I use too much insulin, you're not you if it's 1.1 an hour, it's 1.1 an hour, it's not too much insulin, I think carb ratio, the same thing here. People say all the time. Oh my God, my carb ratio. Oh, it's one unit for you know, one unit covers eight carbs. It's terrible. Like I'm like, It's not terrible. That's what happens. Now, maybe maybe your maybe your style of eating is meat that needs that right like so there's an there's another conversation there. If you wanted to eat lower carb or better foods or something like that, maybe your carb ratio would change. But in the moment, it's one to eight artists artists, an 18 year old kid who's in college, Arden's carb ratio is during the daytime. One unit covers four and a half carbs. Okay, so And there's still times where I'm like, oh, geez, that wasn't enough. We need more I'm not embarrassed by it. Because why because art is a one see, even when she went away to college was in the low sixes in and and so we're meeting her need now. Same thing with basil. Same thing with everything, your carb ratio, your adjustments, but it can also, I also think of meet the need, in what I guess would be 180 degrees different way. Meaning if you're low all the time, you're you're not meeting the need, you're exceeding the need. Correct. Right. So in my mind, I haven't said this a long time probably since we made the Pro Tip series but in my mind, I think of a stable line on a graph as possible. If you're if you're Basil is right, you can keep stable. There are other variables that are going to try to derail you and you may not keep stable but there is theoretically out there and amount of insulin minute to me In an hour to hour that would keep you stable whether you were sitting, standing running, eating a cheeseburger or having whatever Jenny eats. I mean, whatever healthy thing she eats. I don't even know how to guess at what your needs, and she's told me what she eats, and I still can't get strawberry

Jennifer Smith, CDE 10:16
bites my chia pudding. Yeah, exactly.

Scott Benner 10:20
So, so no matter what you're doing. Alright, listen, if you're managing yourself as an adult, or child or anywhere in between, if you're managing this insulin thing with an insulin pump, or you're doing MDI, where you're just looking for things to be easier, I think you should check out the Omni pod five, Omni pod five talks to your CGM, and it sees your blood sugar rising or falling, and it makes adjustments to your insulin automatically an algorithm, an algorithm based pump that's trying its best to keep you stable. It's amazing, the technology is insane. And if you're struggling, or just want to step back a little bit on the pod five really could be the way to go for you. You can learn more at Omni pod.com forward slash juice box. Now if you don't want automation, you can still get to Bliss wireless with Omni pod with the Omni pod Dash. And as a matter of fact, you may be eligible for a free 30 day trial of the Omni pod dash and that is something you can find out at my link omnipod.com forward slash juice box. Ali pot five is the only tubeless automated insulin delivery system that integrates with the Dexcom G six CGM, and it uses smart adjust technology to automatically adjust your insulin delivery every five minutes, which helps to protect you against highs and lows without multiple daily injections. For full safety risk information and free trial terms and conditions. You can also visit my link Omni pod.com forward slash juice box. My daughter has been using an omni pod every day since she was four years old, I think you're gonna love it. Now, is it possible for you to do that manually, it's obviously would take most of your life. But with these algorithms, you know, getting better and more plentiful. We're all going to be in that situation someday, you know, where you're going to have stable lines that are lower, you're gonna have some spikes around missed meals, and maybe we'll exercise and get low. But for the most part, the stability away from variables is going to be something else because that algorithm is constantly meeting and re meeting the changing need no matter which way it goes. So can you do that on your own? You can I did it for years, it was a lot of work. But it was doable. And to be honest, I found a rhythm with it. And at some point became less work than you might think. Anyway, you just there's an amount of insulin you need. And don't be embarrassed by it and just do it. And don't don't continue to look at low blood sugars over and over again and go I don't know what's happening.

Jennifer Smith, CDE 13:02
You got your high blood sugar's I mean, when you talk about stability, I think it also requires you to talk about where are you looking to stay stable. Because as you say, Basil alone should hold you stable when there's nothing else in the picture, whether it's food, or stress, or exercise or illness or whatever it might be, your Basal should hold you pretty stable, if it's at the right dose. And that stability, again, should be where you want to be sitting. If you want to be sitting at a 90 blood sugar. Your last Bolus should let you sit there and basil should carry you on as many hours at that 90 to 100 place as you want to be. Again, if you're running, you know I'm comfortable at 120 Okay, then you're a little less. Yeah, hold you there at 120. Right. And you might need 40 units of Basal insulin to hold you at 120 Where somebody else at 120 only needs 18 units of Basal insulin again. So you have to meet your need. Yes.

Scott Benner 14:08
Right. And don't match yourself to anyone else. Like no, no, just I mean, yeah, it's just it's gonna be different for you. Your variables are different. Arden is a different person. When she's home from college than she is when she's she's more active at college. She's up on a schedule. She you know, here last night, for the love of God. I think she went to bed at five o'clock in the morning. I think I walked in there and what are you doing?

Jennifer Smith, CDE 14:34
I know you're 18 But you still need sleep?

Scott Benner 14:36
What are you doing? She was waking me up tomorrow at 10 I was like, how do you think that's gonna happen? That's not gonna I 10 o'clock on my garden. Get up. Get up, aren't I Okay, take another hour. But yeah, I mean, it's just it's very important. It's very important. Technically, meet the need, and it's very important emotionally. And you got to just find a way to let yourself go. Like, I mean, don't get me wrong. If you're in a situation where you have like massive problems and you're using weight, you know what, like so much insulin like I can't even like make my pump last three days or whatever. Maybe you get to talk to your doctor about pairing another drug with it to help you. I'm talking about, you know, generally speaking for most people who are in an average situation, right? Yeah, absolutely. That makes sense to, is that the talk around that, because it's very important, but it's without its without context in the diabetes world. Like, if you don't listen to this podcast, very few people are going to talk to you like this, you know?

Jennifer Smith, CDE 15:38
Absolutely. Oh, absolutely. Most people don't even understand. They don't understand the variable nature of insulin at all. It's the reason that most people are like, Oh, you're on a pump. That just does it. All right,

Scott Benner 15:52
magic pump. Well, listen, even with ice. I paid specific attention to Arden's stuff overnight, because we just switched her to a different version of loop. And so I wanted to just be on making sure everything's going the way I expect. And you can see overnight that even though you're you say to, you're telling the loop, like look, this is your insulin sensitivity, and this is your Basal rate. But the loop still for many hours overnight, it's like hey, I'm just gonna give you half that basil or a third of it, or two thirds of it. Oh, God, I took too much away. Here's I need to add back 120% of it. Like, you know, you're giving it this leeway to drive the itself driving. You know, I'm always talking about like, keep it in the lines. This is just the self driving thing that sees the line on its own. It was oh, and then just rolls back. Oh my god. How did that never occur to me?

Jennifer Smith, CDE 16:43
Yeah, it is. It's kind of like the bumpers on like, the like bowling, right? Yeah, it is. It's like okay, we gotta go back this way. Now Oh, no, let's move you back

Scott Benner 16:53
this way in the bumping and nudging episodes. That's exactly what I'm talking about. It's kind of manually bumping yourself off the off the lines on the road. And an algorithm is just seeing the line coming and bumping itself back.

Jennifer Smith, CDE 17:05
Yep. It's got a predictive nature to it. So it can watch further out from where you currently are.

Scott Benner 17:10
Yeah, so meet the need, no matter what system you're using. And, you know, inevitably I'm gonna get a note for sighs like, you don't talk about MDI, it's the same thing. It's just, you know, you're putting all of your insulin in for basil at one time, instead of it being spread out. Sure, you don't have the ability to take away point five an hour, you know, or something like that, which would maybe be helpful, but you're going to find an amount of injected Basal insulin, that does the job, as well as you can get it and then you're going to have to make adjustments with your meals and corrections, correct.

Jennifer Smith, CDE 17:41
That's absolutely. And that's why, you know, one of the only places that we really recommend if you were going to look at your dose in your MDI is really to look at your overnight to see what is your Basal holding you overnight, is it you know, when you go to bed, you started a number does it hold you there until you wake up the next morning, and if it does, but the number was higher than you wanted? It's not necessarily the basil. It's where your last Bolus left you off. The basil just kept you there. So in that circumstance in my night might not be that you have take more Basal hit might actually be that your Bolus needs to be different.

Scott Benner 18:23
Okay, so Well, I appreciate you doing this one with me. Thank you very much. Excellent.

Hey, huge thanks to Jenny of course for coming on the show as she does if you would like to hire her she works at integrated diabetes.com You should go check her out. I want to thank also Omni pod. I'm serious. I said earlier, my daughter has been wearing it on the pod every day since she was four years old. She's 18 and in college now, the Omni pod has been nothing but a friend to her. And I think you'll enjoy it as well. Omni pod.com forward slash juice box head over there. Get started today. If you're enjoying the Juicebox Podcast, please tell a friend your doctor or somebody. Anybody everybody scream. Anyway, just tell somebody about the podcast. It really helps the show. I'll be back very soon with another episode. Thank you so much for listening.