#880 Type 2 Diabetes Pro Tip: Diabetes Technology

April 2, 2023Scott Benner

A series for people with pre and Type 2 diabetes.

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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.

00:00:20 Technology can help manage diabetes.
00:07:03 Understanding glucose monitoring for diabetes.
00:12:18 Continuous glucose monitor provides valuable information.
00:17:23 Use technology to improve diabetes management.
00:23:35 Understanding glucose monitoring is crucial.
00:29:00 Be your own advocate.
00:34:07 Advocate for your healthcare coverage.
00:41:40 Diabetes requires ongoing management.
00:47:43 Perceptions of diabetes and insulin.
00:54:17 Know your blood sugar's impact.
00:54:57 Support podcast by supporting sponsors.

Scott Benner 0:00
Hello friends and welcome to episode 880 of the Juicebox Podcast

well just like that we're up to our sixth installment of the type two Pro Tip series today Jenny Smith and I are going to be speaking about technology, diabetes technology and how I N Jenny believe it will help you immensely with pre diabetes and type two. Please remember today while you're listening, 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. Couple quick things cozy earth.com use the offer code juice box at checkout to save 35% on everything, clothing, bedding towels 35% off cozy earth.com with the offer code juicebox. Speaking of saving money, if you're looking for therapy at better help.com You will save 10% off your first month of therapy by using my link better help.com forward slash juicebox. And of course if you have type one diabetes and are a US resident go take the survey AT T one D exchange.org. Forward slash juicebox.

This episode of The Juicebox Podcast is sponsored by Dexcom. Now Dexcom makes a G six and G seven sensor. They're both terrific. Check them out@dexcom.com forward slash juice box continuous glucose monitoring that's being able to see your blood sugar like right on your phone or our receiver the the direction it's moving in the number it is and how fast it's moving. Very very important information we're going to talk about it actually in this episode. Not to be confused with CGM BGM blood glucose monitor when you you know, check with a blood drop on your finger. If that's what you're looking for, you want easy to use an accurate you want the contour next gen blood glucose meter contour next.com forward slash juicebox links in the show notes to Dexcom cozy Earth BetterHelp contour all the sponsors, and those links also exist at juicebox podcast.com.

Jennifer Smith, CDE 2:34
Because when that turning it off, I'm just turning the sound down because I've been Today's my birthday. So I've been getting texts all day.

Unknown Speaker 2:42
Happy birthday. Why do I not know that?

Jennifer Smith, CDE 2:45
I don't know.

Scott Benner 2:46
It's three days after my son's really cold just turned 23 I'm assuming you're 25. So

Jennifer Smith, CDE 2:54
my stay at age always, I think would be 37. If I had to pick an age, it would be 37.

Scott Benner 3:01
Do you know the about the number 37?

Jennifer Smith, CDE 3:04
No. What about it

Scott Benner 3:05
when asked to randomly choose a number between one and 137 is the number most often chosen? That's absolutely true. Wow. Hmm. So it would be my favorite age. Anyway, I love that thing. I love that. That. I don't know what yeah. Oh, even it's just so interesting. That's it. Yeah, I

Unknown Speaker 3:27
like little factoids. Oh,

Scott Benner 3:28
happy birthday. We're recording so everyone you're getting Jenny on her birthday. She's gonna be all jacked up from whatever granola cake she's gonna have.

Jennifer Smith, CDE 3:38
I don't know. I asked my husband if he was going to bake me a cake. And he's like, was I suppose

Scott Benner 3:44
that is not written on my list.

Unknown Speaker 3:48
On my to do list for her birthday. Did you request this? I'm like, No, I

Scott Benner 3:52
didn't my Christmas time Kelly said something. Like, did you send a link? I said, if you didn't send a link, I don't see how this is gonna happen. Like I write, I want to be a person who it's a weird time, isn't it, Jenny? Well, you just you don't go shopping the same way anymore? No, you know, not really used to wander around like this looks nice. I bet you they'd like this, you know. And so anyway, I'm well, happy birthday. Well, thank you. Thank you for joining me on your birthday to talk about diabetes technology as it applies to people with type two. Yay. I'm going to I'm going to say that I'm going to start like this. I googled it. I put myself in the position of people listening and I thought okay, someone's just told me I have type two diabetes, what would I do? I would go to Google, or your favorite search engine and I would type in type two diabetes. And now we start seeing what people Google type two diabetes symptoms, diet medications, treatment causes, risk factors. You know what I don't see in the top 10 technology. Nobody's looking for that idea. And okay, so Scott will type in the word technology. I'll bring it along technology for type two, yes, type two diabetes technology is the goo. Right? And we come back to, you know, an NIH article that if you look at is a lot of words, and probably confusing for people. There's a diabetes.org. So the American diabetes Association article, which shows me a picture of a meter and a lance, and then I scroll down, I see an in pen and they talk about a smart insulin pen. And then I see another meter. And then I get to the word CGM, but I don't see an actual CGM anywhere and then an insulin pump at all. I don't see a photo of it is what I'm saying. Wow. Yeah. And so I'm like, Okay, what is this page meant to do? This is a brief overview. That doesn't really. I'm trying to put myself in that position again, like, Okay, well, here's a bunch of words. I don't know CGM don't know what that means. Blood glucose meter. Sounds scary. I don't know what I need an insulin pen for the guy just told me I have diabetes. I probably like it. So I want to go over wind

Jennifer Smith, CDE 6:13
or it sounds scary because insulin? Well, it sounds like that's not what you want. Right?

Scott Benner 6:20
And what I it's funny, we're putting together a list for a different series, about myths about diabetes. And over and over again, people say, I wish people would realize that using insulin doesn't make your body give up. And so, so I realized that people must think that like, Oh, if I assist with insulin, then my body's gonna think I don't have to do this anymore. Which by the way, that's not how things work. But, but apparently, it's kind of colloquially how people think about it.

Jennifer Smith, CDE 6:53
And honestly, you're right, it is and or that it's, it's a failure, right? They've clearly done something incorrect. And this is now Gosh, I'm now on insulin, right? But honestly, to clear up, the first myth is that if you actually start to help your body by supplying some insulin, those beta cells that make it in your own pancreas, are not overtaxed. And so it helps in an in a preservation way to actually use insulin. And sometimes it again, you know, when we'll talk about medications as well, sometimes insulin might get going. And you may actually, depending on lifestyle changes and other meds that might be added as well, you may be able to come off of the insulin, because now your body is at a glucose level. That's better. Yeah. Right.

Scott Benner 7:46
So let's, let's start at the beginning, because I think everyone would type who's gonna get a meter shoved at them in the office, right? They're gonna give them a glucose meter,

Jennifer Smith, CDE 7:55
one would hope that that's what's prescribed at diagnosis, yes, at least a glucose monitor to be able to check with a finger stick. And it was some of in terms of questions as well, in technology, there are glucose meters as well that you can use alternative sites. So I think that's important for people to know when they're considering this, that while they might know they have to poke their finger, let's say you don't want to do that, or you use your fingers for many other things in terms of your job. And you're worried about the impact on that. There are meters that are approved for alternate site testing, palm, like the forearm, the base of the thumb, all of those kinds of places can also be used.

Scott Benner 8:38
So thanks. So it's interesting to talk about. So what my daughter has had type one diabetes for so long, I've been around diabetes for so long. Like I'm trying really hard to put myself in the position of somebody who would be listening to this. And you're right, the first thing I'm going to think is, I don't want to poke a hole in my finger and make it bleed. Right, right. And then the next thing I'm gonna do if I do that, is I'm gonna start having that realization of like, well, okay, well, I tested my blood sugar at 8am. And I tested it again at noon. Now, I just know what my blood sugar was at 8am and noon, and what do I do with that information? Correct? Yes.

Jennifer Smith, CDE 9:15
And so that's where as you said, Well, somebody in the office, they're diagnosed with type two, they're going to get a prescription for glucose meter of some type. An important thing to know is sometimes that that brand might need to be adjusted and something new might need to be prescribed based on what your insurance may or may not cover. But along with that, the doctor might also give you some information about what glucose targets to aim for. When you check your blood sugar. We're looking for numbers between this number on the low end and this number on the high end. So you go home and like you said, you check your blood sugar breakfast, you check it again at lunchtime, you're like great. It's in this range that the doctor told me so. Is it always going to be in that range, because whenever I check it at breakfast, it always looks like it's somewhere in here. And when I check at lunchtime, some days it is and some days it's not. But what does that mean? Yeah. What do I do with this?

Scott Benner 10:13
What you don't know is what's happening in between those times to what happens between those in those four hours? Is your blood sugar staying reasonably stable? Is it shooting way up? Are you using a medication and it's going too low? Like, these are the things you you need to know. So okay, I have a meter. I need to know what I need to know the price, I think the problem is going to be as the doctor is going to tell you to test a certain couple of times now it's going to be at so I think it would be important for people to know why they're testing. It's not just to come up with a number to show somebody, you're trying to see it starting with food, you're trying to see what impact does this food have on my body? Right? Yes. And so maybe you're beginning with no medications at all. You're not even on Metformin yet. Who knows? Doctor says you have pre diabetes, here's a meter. Okay, well, I might learn that eggs and bacon don't seem to move my blood sugar very far. But pancakes do, right, or pancakes by themselves move at one. But it's weird. When I put the bacon with the pancakes, it seems though it's different, lasts longer, it's different. My high blood sugar lasts longer for some reason. So the gold standard here would be pairing your meter with a continuous glucose monitor. So that's jargon for people who don't know, but it's a wearable device that will show you your blood sugar in real time on a receiver or your smartphone. Now, it's not just the number, but the speed and direction that the blood sugar is moving. Correct?

Jennifer Smith, CDE 11:45
Absolutely. And so that in terms of coverage for someone with type two, is something that needs to be evaluated, right? Because depending on what kind of medication you're using, what kind of insurance plan you have. Many times sensors are covered under two different options, either durable medical equipment, or for some people, they may have what's called pharmacy benefit. So it may depend and you may have to look into your insurance plan and see what they cover for you. And if in fact, it's coverable, I would absolutely get your hands on a continuous glucose monitor.

Scott Benner 12:24
No, I think that I can't say enough about what that information brings you. Because, you know, it's charting your glucose constantly. And if you you know, think about one fix, if I don't know, if you just, you know, draw a timeline out in your head on the left is midnight, and on the right at midnight, again, we put 24 hours in between, I could test my blood sugar a couple of times along the day and have a couple of data points. But what if you had data points every five minutes for 24 hours? When you connect them what you get as a graph, and you get to see rises and falls and the harshness of? What do I mean by harshness? Does my blood sugar shoot straight up when I eat? Yes, does it rise slowly. And this information, you're hearing it right now and you're thinking I don't know why I need this. Jenny and I are telling you, it's going to help you so much.

Whether you have a Dexcom or not, you still want and need an accurate easy to use blood glucose meter, you're looking for the contour line of blood glucose meters, contour next.com forward slash juicebox. Head over there, check out the contour next gen the Contour Next One, that test trip program they have my gosh, it may be cheaper for you to buy this stuff in cash than it is for you to buy the meter you have now through your insurance and the meter you have now probably doesn't work half as good as the contours. It really is it's just worth checking out. Contour next.com forward slash juicebox. My daughter loves these meters. I love them. Easy to hold easy to see great screens great lighting. Second Chance test strips. You cannot go wrong super accurate contour next one.com forward slash juicebox. All right, you've got a great meter. Now you want a great continuous glucose monitor a CGM, the Dexcom G seven. My daughter is wearing one right this second. I'm actually texting with her right now about it. dexcom.com Ford slash juice box so tiny, easy to put on. She inserted her first g7 When I was with her last week, and she goes that it and I said Yep, she goes it's on and I said Uh huh. She was I didn't feel just like that dexcom.com forward slash juice box. And now guess what? Arden can see her blood sugars in real time. You can do that to the speed and direction understand what I mean now Not just is my blood sugar 85? Is it 120? But is it rising? Is it falling? And if so, how quickly these are important, important distinctions, decks com.com, forward slash juicebox. There are links in the show notes of the podcast player you're listening in right now like say you're listening to in Apple podcast, there's a link in there, Amazon Music link. What's the other one Spotify link anywhere links, links, links, click on them support the podcast and get yourself some great gear at the same time. If you can't, or you're not listening in a podcast app, juice by juicebox podcast.com. You'll find the links there as well, to contour Dexcom cozy Earth where you'll get 35% off of everything that's on their website. Oh, gosh, betterhelp.com 10% off your first week of therapy@betterhelp.com. Forward slash juice box need the forward slash juice box to get the 10% off? It's all right there. All right, thank you very much. Let's get back to the show.

Jennifer Smith, CDE 16:22
You're right. And if, if you're if your desire is to do as much lifestyle change as you can, right? Like you've told the doc, no, I don't want to take any medications. Okay, then get information to show what lifestyle changes you're putting effort into. Because it is effort, you're trying to make a change a habit that you've not had before. Stick. So if you can go back to the doctor and prove and say, Well, if I do this, and I do this, look at look at the results that I can achieve. Right? I can do this. The other thing that it also is helpful in is if you've done all of this lifestyle shift, and it's worked for two years, or four years or five years, and now your numbers are looking different, and you haven't changed anything. In fact, you find that you're actually working harder, because you started to notice things were shifting, and you didn't know why. So you're like, Okay, I'm going to do a little bit more of this, or I'm going to cut a little bit more of this out, and it's not working. That's your first insight to then go back to your provider and say, Okay, you were talking about this years ago, or a couple months ago, I've put all my effort in. And I don't know what to change anymore. I'm eating lettuce, and still, I'm sitting at a high blood sugar. So clearly, the technology can show you more information, and help you to be the one to then go to your providers. With that

Scott Benner 17:52
it also occurs to me that you could make big changes for yourself. And I mean, it's it sucks to say, but you can be eating food for an example that you really believe is the right thing, and maybe it's not. And then you go back to the doctor and say, Hey, listen, I've really improved my diet, and I don't have any change. The doctor believes you Well, you did improve your diet, and they keep thinking it through. Meanwhile, you chose, I don't know, you thought mashed potatoes were a vegetable. And you're like, you're like, I don't know, I am eating so many vegetables now. And if you had, if you were testing your blood sugar, if you had a glucose monitor, you would see, even though I think this is something this is still impacting me harshly, and I and then you would know, to eliminate that thing or, you know, come back, he would also see how exercise would help your blood sugar. You know, and maybe even that, like, think about putting a bunch of effort into something. And you're still expending the effort, but you're putting the effort in the wrong direction. That's right. You don't want to get so frustrating. Yeah, it is. Yeah,

Jennifer Smith, CDE 18:56
yes. I mean, you know, in all of the technology, I think, and I've said before, if somebody was going to take technology away from me, I, I would not let somebody take my continuous monitor. Yeah, I would not very happily give up by pump. But I would give it up before I would give up my continuous monitor. I would. And I think for some, some people, maybe it's not in the mix. So then what do they do with the numbers that are just coming from a glucose meter years ago? The accucheck meters used to come with sort of a plan of action, specifically in type two education, and we called it testing in pairs. And so if you can test around a meal as we're talking about mashed potatoes, right, this is your vegetable of choice that you're like him eating more vegetables. Let's see what that's doing. If you test before the meal, and you test about an hour to two hours after the meal, that paired testing gives you a visual of where was I? What effect did this meal have. So even if you don't have or can't, for some reason, get a continuous monitor, you can use your glucose testing supplies more accurately to get information. And you may, maybe you only get two test strips a day, maybe you do testing and pears at breakfast, and the next time you do it at lunch, and the next day, you do it around dinnertime, and you get a rotation over two weeks. Again, you've at least got more information for you to use. And for you to go back to your, you know, physician with and say, I do really well at these points, but this part of the day, I can't, I can't do anything the right way or I can't figure it out, right

Scott Benner 20:40
visually. It's just it's going to feel like a lot like something has, first of all, something happened to you. You have a an illness that you're now dealing with. It's not something you expected or want. And it's an extra effort. And then what I love about having the data in front of me is that it's very visual. You don't really need to understand everything to look at a midline and go okay, well, this is where I'm shooting for. And here's where I am. Right, and here's an eight here. Wow, I ate at nine and at 10 o'clock, my blood sugar was high and it stayed high for two hours before it came down. That's easy to interpret. You know, for anybody you don't even need to understand the who's in the wise to see this is what's going on around companies that make these things Dexcom makes the g7 libre will make at this point. The libre three. Abbott Yeah, that makes the libre and that's from Abbott. And then there's a Medtronic sensor. Do they sell it separate of their?

Jennifer Smith, CDE 21:42
They do? Okay, yep. You can get just their sensor system. Absolutely. Yeah.

Scott Benner 21:46
And so I mean, if you

Jennifer Smith, CDE 21:49
there's one more you missed

Scott Benner 21:51
Sen. Sonic.

Jennifer Smith, CDE 21:52
Yeah. Sounds Jana. Yeah.

Scott Benner 21:54
It's implantable.

Jennifer Smith, CDE 21:56
Ever since Yes, ever since makes

Scott Benner 21:58
it right. And that's an they actually implant something under your skin and you hold a reader up to it.

Jennifer Smith, CDE 22:03
You do. So the there's is an implantable. It's tiny, tiny, you know. And it gets implanted in a doctor's visit. So it's not something you do in your own home, right. And then there's a little device, if you will, that pops on top of the patch on your arm that goes over the area where the sensor is implanted in your skin, and then the app if they do have an app, and it allows you to see all of the continuous data in that as well.

Scott Benner 22:40
And how long do you wear it for six months? Something

Jennifer Smith, CDE 22:43
I don't think then I believe the newest one is six months, it used to only be three months. It used to be 90 days. I believe the newest is six months. And I had I had somebody who loved it. The only reason he changed to using Dexcom was because the change in his pump technology required use of only Dexcom. So

Scott Benner 23:03
yeah, and it's ever since but I think a sense he owns it. That's some backroom stuff. But I think the people who make the Contour Next One blood glucose meter actually purchased the small company. I think so. Oh, you know what, here? This is amazing. It's a phone call I've been waiting for for three days it comes now. Great.

Jennifer Smith, CDE 23:26
That's not a good thing. I

Scott Benner 23:27
don't know. We'll get it later. I'll call back. But yeah, okay. So the point is there, there are things that are called continuous glucose monitors. You'll hear people say CGM, and these things are giving you like we're saying the data all the time. There's also a BGM, or a blood glucose meter, which is the finger stick. And I know that all sounds you know it confusing. In the end, you can't have I don't think you can have too much data. Access to see it like you'll figure out what parts of it you need eventually. But just going in blindly like, well, I changed my thing. And then they check they check me once see in a few months, and it didn't go up or didn't go down. Like it doesn't tell you much.

Jennifer Smith, CDE 24:11
It doesn't. I think the other thing with all of that information is that for for someone to start to understand, you have to also know that the variables that life puts in to your day to day are a piece of that glucose graph that you're looking at, right. And unless somebody really gets some good information about what they're looking at, sometimes that CGM data can become frustrating. Right? If they have nobody to go back to and ask about how to read it, or what does it mean when this happens? And that's where education is. It's definitely a second piece to the information

Scott Benner 25:00
because you you see the rise in your glucose. And if you really don't know, you don't know, it just, you know, I, you could have eaten a meal where you had three items on your plate and two of them have nothing to do with it. The third one you don't think of as being impactful, but it is sometimes a mix of foods, you know, impacts differently. So you have to be able to and that's another great thing that this data does, especially with a CGM where you can say, hey, look, this is what happened. I ate this, this and this here. And this happened. Can you tell me why that might have happened? Or do I need a medication? Like is it is my body just not going to handle this? I'm like you said I'm down to salad lady. I need a cucumber, my blood sugar went up. I need help. You know, I need right. Yeah. And that's also going to be a good way to tell you like do I need insulin? Do I need one of these injectables, things we're going to talk about in other episodes? If you do end up using insulin, am I going to use it? Am I going to inject it with a syringe? Am I going to get an insulin pen? Am I going to get a an insulin pump? You know, right. And and I would assume with type two, that has a lot to do with lifestyle and the emphasis the impact that your that your diabetes is having on your blood sugar's are no, I mean, if you have very, I mean, if you're a one sees like a six and a half, can you still wear an insulin pump?

Jennifer Smith, CDE 26:27
Could you? Sure you could. But the biggest evaluation is that if you're keeping a 6.5 right now, with effort on your part and lifestyle and medication that you're using, it's very unlikely that you're going to get prescribed and may not even get covered by insurance because of where you are. That's not a bad thing, right? I mean, you're doing a really lovely job and great right now, you don't need insulin. At some point. If you do and you've been doing everything you can and your glucose continues to creep up and the agency keeps creeping up. At that point, could insulin be being considered? Certainly. And if the variables in your life dictate, you would do better with a continuous insulin infusion? Then yes, an insulin pump could be considered. Absolutely, I mean, it's, it certainly allows a lot more flexibility in terms of dosage. And the decrease in the amount of stuff in a way that you have to carry around. You don't have to keep, you know, insulin vials or insulin pens with you or syringes around with you. The pump is connected to you. So hopefully you don't forget, when you walk out the door.

Scott Benner 27:41
Well, it just seems that with the feedback I'm hearing and conversations I have with people that, you know, there's a hesitancy to bring things into your life, whether they're technology or insulin. And I understand that, like, I get the idea of like, I don't want to do this, or I don't understand what this is. But and then there's that leap right when you you get to the doctor's office, and maybe the doctor's office doesn't understand that well, either we talked about this a lot with type one, you know that you can go to the doctor. And I mean, how was it put most kind of generally speaking, if you have type one diabetes for six months, you likely know as much about it, as your doctor does. If you had it for a year and a half, you now could probably go teach a class somewhere and the doctor would be like, Wow, that's interesting. You know, and so having it is the best teacher. But what happens when you have type two, and you left the office and the guy didn't even give you a meter? Right? You know, and wouldn't and if you said to him, I'd like to have a continuous glucose monitor there, you don't need that. Or your insurance is gonna cover that, or whatever the and then that's the thing you remember forever, right? And

Jennifer Smith, CDE 29:00
so you may need to, as we've talked already, you may need to be your best advocate, you may need to be the one that you do the research, okay, you've gotten this new diagnosis, this new condition that will be there 24/7. And you need to learn more about sometimes some of the best places to learn are going to be asking your questions, and doing your own research. And even if you don't understand then at least you have more information to go back to your doctor and say, but I read this and you didn't tell me about this, or I read about this and this looks like it would fit with my lifestyle. Hey, do you think I could give this a try. And if you don't feel like you're if you're seeing a general, you know, medical practitioner or just a PCP don't expect that they're going to be an expert in type two diabetes. So if you feel like you're just getting the baseline, but you have much more in depth questions about things, there's no reason that you couldn't request even one consul rotation with an endocrine doctor. Yeah,

Scott Benner 30:03
I'm passionate about it. Because there's a person in my life that I want. I want for them to wear a CGM. I think it would greatly improve their situation. And this person, generally speaking, listens to me, I'm a trusted person in their life plus all of this on top of it, I can't get them to do it. Yeah, you know, and I even said, I was like, just, I think back then I was like, just grab a libre for cash, it won't even be very much, and just wear for 10 days. And I think you're gonna see, I will, I'll talk to my doctor. Yeah.

Jennifer Smith, CDE 30:39
You know, outside of this person, that does bring up something, I think that's important to understand, too. Let's say you have a physician who is willing to write you a prescription for a continuous glucose monitor. But your insurance is not covering it. Right. And maybe there's red tape and stuff that you have to kind of navigate yourself through in order to get one but you want it now, right? You know that it's important for you to learn from, you can, it would be out of pocket. So again, you'd have to have the means to be able to buy it yourself. But Costco if you have one of those, and it has a pharmacy, you can have your doctor write a script that goes right into Costco as pharmacy, and you can actually pay out of pocket without it going through insurance at Costco. So those are options that again, you're paying yourself out of your own wallet. But in the meantime, what are you learning from that? If you've got the means to do that, right,

Scott Benner 31:36
a couple of $100. And right now you have enough data to eat also to take that data back to the doctor go, Hey, chucklehead what I learned, I figured something out. I wasn't gonna figure it out without you. Now I'm on talking to my insurance company. Show them this. And there are, listen, it's a rabbit hole about insurance, right. But But insurance companies are set up to say no. And then it doesn't mean that's the answer. You have to prove your case. Right, right. Yeah. And it's just, I mean, it's tough because one of the CGM companies does a sponsor the show, so I would understand if somebody was like, Yeah, this guy is trying to sell a CGM. I would just tell you this. Like don't get a Dexcom fine. Go get a libre, it doesn't matter. Doesn't matter to me. What matters to me is that you have this like information if you if all things being equal, I take a Dexcom over libre, that's fine. That's me. Right? But just get the information any way you can. I can't, I can't. I just can't stress it enough like a meter is going to be like turning on the first. I don't know the first click of a four step light bulb. You're like, oh, well, the rooms a little brighter. But you get to that CGM, the lights all the way up every there's no shadows. Nothing can hide and you know what's going on now and then you can make a decision? You know?

Jennifer Smith, CDE 32:58
Absolutely. I mean, when I when I first started using a CGM, thankfully, I had really good insurance up to that point. And my doctor had written a script for test strips for my blood glucose meter for up to 15 times a day. And I was checking 12 to 15 times a day, because I wanted all of the in between data, but I was still missing so many data points. I mean, without a CGM, and using insulin, which some people with type two will use insulin, so you can take a fear factor out of the picture. If you have the ability to see what's going on. And prior to my CGM, I had an alarm set for two o'clock every morning. Yeah, I got I got up, I checked my blood sugar if it was in a place that was okay, I went back to sleep. And if not, or it was lower than where I went to bed. I was eating something, right. So now with a CGM, I was like, Oh my gosh, I can turn these alarms off. It was lovely. But again, somebody with type two, maybe you are using insulin or you're using some of the meds that can create hypoglycemia or low blood sugar, a CGM would be a huge benefit.

Scott Benner 34:11
So that's sort of a backdoor into getting one if your insurance company is being tough. If the doctor puts you on the medication, you can say, well, I'm scared of hypoglycemia. So I need a CGM, because a beater won't help me at two o'clock in the morning when I'm asleep. You have to it's what I'm saying about the insurance like you have to just kind of thoughtfully work your way through it. Sometimes. You do. Yeah.

Jennifer Smith, CDE 34:33
And there are letters of medical necessity essentially, are statements of medical necessity that a good doctor will be very happy to write for you to further the potential that an insurance company is going to look at and say, Okay, I see these checkpoints, hypoglycemia, risk medications that could, you know, cause hypoglycemia or job risk, right, where you actually really aren't more risk of hypose or the They may be pieces that your doctor adds to the letter in order to get you coverage.

Scott Benner 35:05
And there's a way there's a way to get covered without, I'm not even saying I'm not saying like fudge the truth, like there's no real reasons for it get like a ton of them. I know you said earlier, find people like do your own research, I'm going to put a plug in here for the Facebook group for the podcast. So yeah, it's called Juicebox Podcast, type one diabetes. But the truth is, there's a lot of type twos in there as well. It's, it's basically people who have diabetes. And I would say, it's funny, here's a little back room, I would change the name. But people with type one are more. There, they generally speaking, seem to be more involved in their own advocacy. And so I'm trying to draw people to the page. And if I put the word diabetes in it, and I don't say type one, or I say type one and type two, you'd be surprised. Like, I mean, even this series, Jenny, like to be completely honest, I'm making it hoping that people with type one diabetes, who have family members or loved ones with type two will say, hey, yeah, has helped me with type one. And now they have some information about type two, you should check it out. And so but go there, if you have a question about a CGM, or a meter, or you know how a foods hitting, no one's going to know better than a person with type one diabetes, like if you have type two, I mean, honestly, right. If you have type two, either you're making insulin, and it's not being used correctly. Right? And or sometimes you have also a decrease in insulin production like this is happening. A person with type one diabetes just is not making any insulin, there's none. You know, if you think I couldn't believe when I hit an avocado, I have type two diabetes, that my blood sugar went to 140 for two hours. Just if a person with type one diabetes ate an avocado without insulin, their blood sugar would be like, you know, 400 to five higher? Yeah. And so these people really understand how does food impact me? How did the medications impact me? Like how does insulin work? This is these are people's minds, you can you can pick their brains, and really come away with something. And I

Jennifer Smith, CDE 37:10
would also say in terms of talking a lot around the coverage piece of this technology. I think people with type one have also really learned a lot about advocating within insurance companies and advocating with their practitioners to get things covered the right way. They know who to ask to speak with when they do call their insurance company, who are who can I speak to this is the person to ask to talk to not the general person who answers the phone, right? You need somebody higher up, you need somebody who's going to listen, who's going to actually see, Oh, I see you sent a letter in two months ago. Well, it's sitting on the desk. So

Scott Benner 37:53
there's a person in my group who helps people all the time, and she writes letters to insurance companies that the insurance companies, she's so good at it, they just read it and I go, Hannah, she checked all the boxes, we can argue with this. That's awesome. Are you very good at it? Very good at it. And so, and that's it's Jenny's point is that, you know, you don't know I, you know, I used I say I used to say this all the time about type one diabetes, like, instead of suffering, and saying, Well, I don't know how to do this, or my doctor didn't help me. Go find someone who knows how, and look at them and think, What are they doing? I'm gonna I'm gonna copy them. You know, like, if they're having success, let me figure out what they know that I don't know. And type two. But I know a lot of people with type two diabetes. And I wouldn't think I'm going to try to be fair, but I think if we collected them all in a room and asked them a bunch of questions about their type two diabetes, and how to take care of it, you'd be surprised at how little they know about it.

Jennifer Smith, CDE 38:52
How little and also, I think how different the thoughts about navigating and managing are.

Scott Benner 39:01
Yeah, no, I listen, I have a I have a family member who passed away the other day, at and at 65 years old. And you're going to all you want, you can say, Well, you had this problem, we have that problem. You have this problem. What do you had was type two diabetes. What I don't know what we'll end up with, they'll end up saying, God, him. But his blood sugar has been elevated for 25 years. Right? That's why he died when he was 65. And they might end up saying it was an infection. Or he I don't know, I haven't heard that he had

Jennifer Smith, CDE 39:30
a heart attack or right that

Scott Benner 39:33
he died because his blood sugar was elevated for a long amount of time. And so this is why I'm talking to you all about it. Because it seems like every third person I bumped into says they have diabetes. And then I watched them a little bit and I'm like, they don't act like they have it. You know, and I and I and then I talked to them and I realized like they don't know what to do. Right? Yeah, every time like everyone's Listen, some people I talked to a gentleman recently. He was just very I think I told you this privately. I don't think I said this on the podcast. But I said, Oh, you know what happened? He said, Oh, they gave me an injectable medication. And I said, how the work goes, oh are great. I was like, Oh, good. He goes, I stopped taking. Oh, yes, you did. I do. Remember. I'm like, what now? And he goes, Yeah, he's like, I made my hunger go away. I lost 25 pounds, he says, but my hunger went away. And I was like, so now I'm just, I'm standing there. I interview people with diabetes for a living. I don't know what my next question is, like, what am I supposed to say next? And I went, right. Why did you stop?

Jennifer Smith, CDE 40:36
Right? And I think I remember you saying that he was, he was used to be used to being seen as the bigger like, he was like, a big guy, right? Like, he's the big guy. And like, everybody saw him as like this strength, right? I

Scott Benner 40:50
like to eat. And I was like, fair enough. He said it. I was like, fair enough. And so, um, but my brain couldn't process any of it. I was like, I don't understand. But I but what I recognized when I walked away is I bet you a lot of people feel this way. Like, like, I don't you know what I mean?

Jennifer Smith, CDE 41:08
Like, right? Or they think that it was similar to all the quote unquote, diets, right. And the reason that diets don't work is because you, you make the changes, let's say you really study it, you do it, like this gentleman, he took the medication, it worked. I mean, it worked like it was supposed to work, and he lost weight, a fair amount of weight. And then you're like, Well, it worked. Okay, great. I just, I can stop it. Now. It's over, it fixed me. But fix isn't the right thing. When you have diabetes, you have to continually navigate choices and management and strategies, and you, you may need different medications at different times, different technology at different times. But it will, it will always be something there in the picture for you to consider.

Scott Benner 42:00
It makes me what you just said makes me think of if you ask any doctor, what's the biggest problem when you put somebody on an antidepressant? When it works for them, the biggest problem is they're depressed, you give them the medication one day, they're not depressed any longer. And the first decision they make is, well, I'm not depressed, I don't need the anti depression medication anymore. And they stopped taking it. And then sometimes the depression comes back. And it's just, it made me feel like that when you were talking about that, like, he's like, I have diabetes, the doctor said, This is not a person who's this is not a person who said to themselves, like I need to do something, a doctor told him, he needed to do something, right. And so he did the thing he was told to do. And then he got to a point where it's like, Hey, I lost 25 pounds, but I really would like to eat more. So I'm gonna start taking this now. And the 25 pounds will come back, by the way, for reasons he doesn't understand. But he doesn't understand about insulin resistance, and his body's pumping out insulin like a fire hydrant, but it's not working. And so he's storing more fat and like, you know, that stuff?

Jennifer Smith, CDE 43:02
No, not at all. And at some point, you know, many of these injectable meds also have other beneficial pieces to them, which we'll talk about when we do the medications, but he was not only getting the benefit of weight loss, but that weight loss on the rest of his body, and the long term effect that that has, and all the other organs in the body that could be impacted. He may have had he continued taking it decreased or maybe eliminated the need for insulin someday.

Scott Benner 43:35
Yeah, he couldn't return back to a different place. And the right part of me that thought I didn't say this, because it felt like it wasn't. It didn't feel like it was the right thing to say. Right. But there was part of me that wanted to go, let me just, let's skip over. What what makes sense here and just go to what he wants, like, let's just treat him like a person who's like, look, I don't care. This is what I want to do. I thought get an insulin pump. If you're going to eat at least cover it with insulin like so. You know, because it's

Jennifer Smith, CDE 44:04
more precise. Yeah, absolutely. It's more precise. Absolutely. And so if I mean and those are, those are the big discussions that a practitioner then a clinician then has to have that stepped up conversation, okay, you had this result you had this benefit, it was working, you don't want to do this anymore. You tell me you want to eat okay? The best way to cover the food then is your blood sugar's are going up. No other medication is really going to hit as well to cover what you lifestyle wise are choosing to do. So now we have to add insulin. Yeah.

Scott Benner 44:39
Here's the part that I think gets lost is that a lot of times, you know, a doctor is gonna tell you what, like, well, here are the steps you do these steps this will work. But it doesn't take into account the human part of it. The willingness, the desire, the understanding, like all that it doesn't matter and so if so if I am a person who Who finds myself in the situation, but I've been eating, I don't know, like, like a sweet every day with my lunch, I might go out, I'm not that sick. And I'm okay being 25 pounds heavier, I want to have whatever this is at lunchtime. And it's just, I don't know, like, this is not as easy of a situation as get the right technology. And it'll just work. But you'll be shocked at how much better things will be with the right technology.

Jennifer Smith, CDE 45:32
And well, I think as you bring it in, in terms of the consideration of this friend of yours is the fact that I'm assuming he was not using a continuous glucose monitor, and maybe wasn't even doing finger sticks often enough to make any kind of information or informed decision about what his changes were doing. Had he at least then using finger sticks, you know, testing in pairs or a continuous monitor, he could have seen the very big shift in use of this medication to non use of it. And okay, I can eat more again, but look at what the difference in my blood sugar. Look at this difference. And the aha

Scott Benner 46:14
moment that a lot of people are gonna get out of it. Like, really? Yeah, I don't have diabetes, I've worn a Dexcom there are things that I was like, Well, I'm not gonna eat that anymore. You know, like, like that. I don't like the way that

Jennifer Smith, CDE 46:25
or I'm gonna take a bite. And that's going to be my taste, right? Yeah,

Scott Benner 46:29
I can have a like, I'll tell you I during wearing a glucose monitor, I eat a slice of pizza, no diabetes, my blood sugar doesn't change. And I'm like, I wonder how much of this pizza I'd have to gorge on. Right? But I found the number and it was like three slices. And then my blood sugar went into the 160s and sat there for a long time. All the fat? Yeah. And I was like, oh, goodness, like, okay,

Jennifer Smith, CDE 46:53
so your experience is what? You can do this much. But I shouldn't.

Scott Benner 46:58
I could have had two slices without it hitting me. Three slices was it. And so like, that's, listen, forget the How many slices of pizza is the information and forget that it's pizza. Like maybe you'll say like, Hey, a handful of grapes, I'm okay. A bowl full of grapes, I'm in trouble.

Jennifer Smith, CDE 47:15
For a gentleman like your friend, that information would have been able to show him, hey, I really liked the food that I liked to eat. And I haven't had an appetite for it. But now that my appetite is back, I can eat this much of my favorite. Yeah, but when I eat this much, it doesn't work out so well. So for him bringing in a little bit of change, but not major shift in what he was choosing, in terms of his preferences may have been the big thing that helped.

Scott Benner 47:42
Yeah, I also think that it, it shines a light on what's possible. And I do think that a lot of people could get stuck in the feeling of like, this is my lot in life. Like, I'm not getting out of this. And and it doesn't matter what I do, it's not going to work. I mean, colloquially in the south, right? Like people say like, I have the sugars. Like it's that it's it's that common, like, Oh, does

Jennifer Smith, CDE 48:05
she have sugar, sugar, sugar, diabetes, I hear that a lot.

Scott Benner 48:09
And it's almost like they think it's a, like, it's a family thing they were gonna get like, it's like it's like a it's like an old sofa being passed down to my goal. It's finally my turn to have the sugars and right what am I going to do killed my, my grandmother and it killed this lady in my aunt's gone and like it's gonna, I guess it's here for me. And then you just sort of go with it, you know.

Jennifer Smith, CDE 48:30
And sometimes that's an association too, with what they saw them doing in terms of medication, that the lifestyle pieces weren't considered as, what was creating a bigger piece. It was once grandma was started on insulin, she had her legs amputated, or she started on dialysis, or she had a heart attack, or she had her vision, you know, go down considerably. So it's the insolence fault. And so then there's a fear piece in, oh my gosh, my doctor is now telling me I have to use insulin. That means that all of these things are going to happen just like they happen to grandma. And that's, it's an unfortunate entire myth.

Scott Benner 49:13
Right? Right. It's just it's exactly right. It's people see it happen in that order. And they assume instead of saying which would listen, which would be the common sense thing is that my grandmother has not been doing anything for her diabetes for 40 years. It's gotten so bad now she's in a doctor's office being told take this insulin because we don't know what else to do for you. And then then five seconds later, her head pops off and you go or head popped off because she used insulin. That's not why it's it's a that's not what might be because 40 years ago, this didn't happen. This didn't happen or maybe somebody could have just given her insulin 40 years ago when she would have been okay, like right.

Jennifer Smith, CDE 49:51
And another one too. Oftentimes when insulin is initiated another piece that with higher blood sugars for a sustained time, some But he might have had some shifts that were slow and progressing, especially in their vision. And sometimes when insulin gets added, and you have a very quick shift in response in the body and your glucose level starts to come down again, a negative might be that your vision changes severely. Yeah. And you think, oh, oh, again, here, it's the insulin, I started taking insulin. Now I can't see anymore. My glasses don't work and right. It's not really the insulins fault. It's now your blood sugars are where they were supposed to be. But they were corrected too quickly. And

Scott Benner 50:36
now we have a shift. And, look, I'm just gonna say this at the end. i You said something earlier that freaked me out. You're like, what if their prescription only gives them two test strips for their blood glucose meter a day. And I'm like, Oh, God, that could happen, couldn't it? And then I'm like, okay, so you do the two things to try to give yourself a little point a point B. But I was thinking even with a meter, like just go crazy for a couple of days and test once an hour, and use 50 strips up in two days. But then you can actually I did this with a lady with type one lunch, she couldn't afford a CGM so fine. But she didn't want to like give up. So I'd had her do the thing. I said, draw a timeline out 24 hours, test yourself every hour, and then just sort of take the dots and connect them a little bit. And at least you'll get a feeling of a graph, right a little bit like I was unsure, there's gonna be gaps. And we won't know if you dropped quickly or rose quickly, and we didn't see it. But it'll give you an it actually helped him.

Jennifer Smith, CDE 51:33
Sure. And as long as she was doing the majority of her typical things in the day, cotton, most common meals for coffee every 9am, the drive into work, which was an hour in horrible bumper to bumper traffic, if all of those were the standard of her day, then her 24 or 48 hours of finger sticks was very worthwhile. Yeah.

Scott Benner 51:54
And maybe it's, I don't know, maybe you go to the pharmacy, and it cost you 50 bucks. It's just I can't tell you, I listen, I don't want to be like hamfisted. But then people don't have 50 bucks. So it doesn't matter, like so if you can scrape it together, save yourself, you know, you can pull a couple 100 bucks together and grab a CGM and wear for 10 days. It sucks and all and I'm not saying $200 isn't a lot of money. I'm saying again, you know, what you

Jennifer Smith, CDE 52:23
may learn from it could help you so much farther in to the future.

Scott Benner 52:28
One another way to think about it, is that when I was raising my kids, and people would give them a birthday card, and they'd put money in it $25 Like, you know, some people were like, You take that from them, tell them to put it in the bank, so they can see what it is to save it. And what I thought was, well, I'm gonna tell them that's important. But I want to let them use the money. Because the feeling that comes from wasting $100 You don't forget that. You don't forget, I had $100. And now every day I walk past this thing on a shelf in my room that I don't touch. And that's the $100 right there. Like that shows you value sometimes my point is, is that there's value beyond the money. Do you mean like, and both of my kids now are like, you take them shopping and they pick like I've seen Arden all the time, she picks up three pieces of clothing. She's like, I like these three. And then she puts two of them back. Yes, for my son's moved out on his own now. I made a budget that I'm being careful about this. I'm doing that. Because one day he had 50 bucks when he was eight years old. And then he suddenly didn't have it anymore. And that $50 was worth a lot more than $50. It informs a lifetime of decisions. I'm telling you scrape the money together, beg, borrow steal, throw a CGM on for a couple of days. And man, it'll just it'll it'll put you into a different level of understanding all this. So anyway, did we miss any technology?

Jennifer Smith, CDE 53:58
I don't think I think it because we're going to talk about medications at some point. I think that yeah, I think there's technology within the insulin realm. I assume we'll just talk about it then.

Scott Benner 54:09
Yeah, I think I'm going to start saying at the end of every one of these episodes, know what your blood sugar is, and know what's impacting it. And yeah, that's where you're gonna make great decisions. Okay, Jenny, thank you. Happy birthday again.

Jennifer Smith, CDE 54:20
Thank you. You're welcome.

Scott Benner 54:26
Huge thanks to Dexcom for sponsoring this episode of the podcast dexcom.com Ford slash juice box check out the Dexcom G seven or the Dexcom G six, and of course contour next.com forward slash juice box where you're going to find the entire line of contour products betterhelp.com forward slash juice box 10% off your first month of therapy. use the offer code juice box at checkout at cozy earth.com to save 35% sitewide support the podcast by so According to sponsors, there's links in your show notes and links at juicebox podcast.com. If you're enjoying this type two diabetes Pro Tip series, please share it with someone who you think might also enjoy it. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.