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Scott Benner 0:00
Hello friends, and welcome to episode 830 of the Juicebox Podcast.

In this episode of defining diabetes, Jenny Smith and I are going to define m D i multiple daily injections. 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. So I'm going to say something really crazy here. Because every time this is so embarrassing. Every time I must have tricked myself out of it. Every time I talk about defining diabetes, what do I say to you? I'm like, I tell a story about the person who said I didn't know that I was MDI until I listened to the show. Well, that experience must have tricked my brain into believing this is so embarrassing that we had done a defining diabetes episode on MDI, which in 46 episodes of it, we have never done do. It's so embarrassing.

Unknown Speaker 2:11
I feel bad that

Scott Benner 2:15
terrible. And so I really think that I just assumed we did because of that one note, until I started listening to your podcast. I didn't know I was doing MDI. And then I've been using it for years is an example of why the defining diabetes series is so important. And yet there's no MDI episode of the defining diabetes. I'm

Jennifer Smith, CDE 2:33
curious where we did define it, then since we clearly since this person was finally like, well, I get what that means now. So we must have defined it within something else.

Scott Benner 2:43
There's an all about MDI episode and protests which people yell at me because they say it's mostly about pumping. But, but I gotta tell you, describing MDI only takes about three seconds. So it's even the management of it, there's not a lot of detail to give to somebody, you know, that really,

Jennifer Smith, CDE 2:59
although I think in terms of detail, I mean, MDI, multiple daily injections, right? Multiple, take it as you will, multiple multiple could be just exactly the way that your doctor said to take it with, you know, each meal, you take your rapid acting insulin, and then you take your Basal insulin one time a day, a defined time of the day, multiple could really be multiple multiple, it could be that you're really on top of it, you don't want a pump, and so you you, I don't want to say micromanage in terms of like a bad connotation to that. But like you micromanage you dose a little bit, you dose a little more. And that's how you learn to manage things. And it works for you. Yeah, so it could be many multiple injections.

Scott Benner 3:46
I would not call it micromanaging. I would say that in the past, there was an expectation for health and outcomes. And if you did more work than that, doctors would have the inclination to tell you that you're micromanaging. And don't worry, it's never gonna get better than this. But that's a different world than this is right now. Correct? I'll tell you. I'll tell you how little MDI has been defined by anybody. Googling MDI meaning gets you with minority depository Institute's, which is an FDIC phrase in the urban dictionary, it says, oh, excuse me, there's another one that says medically determined impairment, multiple Document Interface, metered dose inhaler. You don't get i on the first find it on the first return page of of Google, there's no no mention of it. I have to add the word diabetes.

Jennifer Smith, CDE 4:45
I was gonna say either diabetes or maybe insulin like MDI insulin, I bet it would come up

Scott Benner 4:50
quick. So NIH, has MDI is multiple daily doses of insulin. They're putting in an extra D but not giving it to You double D but single day? That happens to a lot of ladies, doesn't it? Nobody ever knows their bra size really? Right? Don't you always hear women saying I'm never wearing the right bra size? Well,

Jennifer Smith, CDE 5:11
unless you really get like fitted or if you really look at how you're supposed to actually measure to determine what your cup size truly is, then yeah, I mean, that's the reason that many times when you go in, I mean just giving a brand to Victoria's Secret, they will often ask if you've ever been accurately measured for the right size,

Scott Benner 5:36
Jennifer make this the most popular episode I've ever put up until right now. Well, and this is interesting, still, it's limited. And I ah, multiple daily doses of insulin, which is not it's multiple, it's multiple daily injections is how we're talking about it. Most common method for intensive insulin treatment of type one diabetes is also becoming more popular type twos. That's from the NIH from 2017. The next return is from Medtronic. It's interesting, really, yeah, it's really interesting. I guess this is really something that just

Jennifer Smith, CDE 6:15
I wonder if Medtronic has it in there, mainly because, I mean, they're one of the oldest pump

Scott Benner 6:22
companies. I'm gonna look. Yeah, maybe it's just buried on their website somewhere. And it's

Jennifer Smith, CDE 6:27
on their website somewhere in terms of, if you're planning to go for multiple daily injections to a pump, consider the Medtronic pump. No.

Scott Benner 6:36
I'm sure I'll get to that. Again, there's alternatives on the page. But it's iport. It takes oh, by the way, I want to say that in Penn was the sponsor last year and I love them but Medtronic didn't re up with me for in pen so. Oh, yeah. What the hell that's

Jennifer Smith, CDE 6:53
too bad because he pen is a great idea to include in the MDI definition, and I

Scott Benner 6:59
will talk more about it, but somebody, you know, I was ghosted. Oh, so sorry. It wasn't ghosted. They broke up to me to my face.

Jennifer Smith, CDE 7:08
They broke up. They said no, bye. Bye. I'm so sorry. I

Scott Benner 7:11
missed that. I miss Ashley. But anyway, that's just something that only I understand. Okay. So, you know, again, this is them. This is a sales page. They're trying to tell you this is MDI, if you're using it, you might want to try, you know, I port Yeah, the eye port. But I'll tell you a little bit of scrolling says, Hey, there's alternatives MDI, so is this guy, Jenny, is this a money thing? Is this we'd rather you'd be buying a pump and those needles, so we're not going to tell you too much about it. Or, I mean, because it's dark, like the Google returns are stark, not that I can't explain to people what MDI stands for, but

Jennifer Smith, CDE 7:49
it's just in my eye, I would say that there are probably many more people, definitely doing MDI, in the type two realm, then pumps, and because they make up the larger percent of the population of people with diabetes, there still are many more people using injections or MDI. But in, I don't know, is it a money thing? I have no idea. I mean, they have products like in pen, they have products like the eye port, but they don't get a lot of visual. Well, I'm gonna do it all.

Scott Benner 8:29
I'm gonna Google the the actual phrase in a second. But I just want to tell you that, you know, it says, there's other things that people search for that are similar to what yours and I found this so sad. It's got nothing to do with this, but it just says, how much insulin do I need for 300? Blood sugar? It breaks my heart that that's been Googled enough that that's a return just when the word diabetes is Googled. Wow, yeah, that sucks. Okay. Hold on a second, multiple. Daily. Okay, now, maybe this is it. diabetes, UK, well, Medtronic, Medtronic, ensete. I'll be damned. I guess we're gonna have a pretty popular webpage at some point because nobody talks about it. Okay, multiple daily injections. It's like if somebody says, How do you get your insulin? You say I use an insulin pump. How do you get your insulin? I use needles. I do multiple daily injections. So it's, um, is it a viable way, Jenny to live your whole life?

Jennifer Smith, CDE 9:32
Absolutely. Yes. Yeah, absolutely. I think what is missing within it? Is information about how to do that. Well. Because there is in multiple daily injections, there is a lack of precision. Comparative if we're comparing it to a pump, there's a little less precise dosing that you can get, however, can you make it work and have fun Great blood sugars. You can Yeah, absolutely. It's viable. In fact, for for many people that can learn how to use that strategy. Well, you know, you could have really lovely, good control long term, no complications, either just because you're using something that's like, old school or so to speak.

Scott Benner 10:23
Yeah, I genuinely believe the same. And I've said in the past over and over again, that if you're willing to inject a little more, you can do any of the things that we talked about in the podcast with MDR. Absolutely. Yeah. I also think, if I'm being honest, adding a CGM to MDI would would really up your game, you know,

Jennifer Smith, CDE 10:44
absolutely. I think most people, if asked, I'm just assuming here, but it's my, my consideration. Somebody was going to take something technology away from me, I would hand them my pump, I would fiercely hold on to keep she'd be like, Don't

Scott Benner 11:05
I need this, please? I don't know what's happening. You know, I think that I think that if you think about the past, and if I even consider how I was taught to take care of Ardens diabetes, which is test your blood sugar, when she wakes up, give her a correction, if she needs it, test her blood sugar before she eats, use this formula, and don't test her again for three hours. And, you know, I remember back to thinking like, even if like she was like, 153 hours later, like I did it, you know, but Right. But once I got to CGM, I was like, Oh, my God, she went to 300. And then came back to 150. And yay for the 150. But oh, look at that. So I just want to finish by saying that, I think you can manage incredibly well with MDI, but not if you're going to use old school theories and ignore what's happening in between your insulin doses, then, you know, when it's over, and you go, I have a seven a one C, that's not bad. But if your blood sugar was 304 hours in between every one of your meals, then I mean, I know we don't like to use words like this, but that is bad. So you know, you need the right and it's

Jennifer Smith, CDE 12:13
bad. I think, also from a purse from a standpoint, then for that person to think I'm, I'm averaging this number, which is a quality number compared to maybe where somebody was before. But once they have the information, and they see that they're at this number that they've been told is an improvement. But they have this variability that we don't want in the picture, despite an average looking like it's good. I think that information is important to have, and you can only get it with a CGM.

Scott Benner 12:45
Yeah, I agree. All right. I'm also going to wonder for the rest of the day, what the people at Medtronic there who are handling their search engine optimization understands about MDI that I don't understand because it seems very important to them, that when you google NDI, you end up on their website. Interesting. I'm gonna think about that for a while, Jenny, thank you very much for doing this. I appreciate it.

Well, I'd like to thank everyone for listening today. And of course, Thanks, Jenny Smith for being on the show. You can hire Jenny at integrated diabetes.com. That's pretty much it to short episode. And I just wanted to pop back in and say thank you. And Dima putting the ads on this one today. Just talked about some stuff for the podcast or earlier. So please, if you you want to check out other series in the podcast. Go back to the beginning. Go over a number of them for you. Hmm, that's it short and sweet, huh. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.