#899 Diabetes Pro Tip: Transitioning

Diabetes Pro Tip: Transitioning

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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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.

Scott Benner 0:00
Hello friends, and welcome to episode 899 of the Juicebox Podcast.

My diabetes Pro Tip series for type one diabetes began in February of 2019. Today I'm adding another episode. Jenny Smith and I are going to be talking about transitioning. We're going to do an overview of transitioning from your blood glucose meter to a CGM, from MDI, to pumping from pumping to algorithm pumping. And at the end of the episode, I'm going to add feedback from Juicebox Podcast listeners about all of these topics. While you're listening today, 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 are becoming bold with insulin. If you'd like to help type one diabetes research, all you have to do is complete the survey AT T one D exchange.org. Forward slash juicebox. The T one D exchange is looking for US residents who have type one diabetes, or are the caregiver of someone with type one to complete a very short and simple survey. The answers that you give will help move type one research forward T one D exchange.org. Forward slash juicebox.

The diabetes Pro Tip series from the Juicebox Podcast began on February 25 2019, with an episode called newly diagnosed restarting over after that episode 211 was all about MDI episode 212 all about insulin, Episode 217 Pre-Bolus Singh, Episode 218 Temp Basal 219 Insulin pumping to 24 mastering a CGM to 25 Bump and nudge to 26 the perfect Bolus to 31 variables 237 setting Basal insulin 256 Exercise 263 fat and protein 287 illness injury and surgery episode 301 was glucagon and low blood sugars episode 307 Emergency Room protocols episode 311 long term health 350 Bumping nudge to 360 for pregnancy 371 explaining type one episode 391 was glycemic index and load 449 postpartum 470 weight loss 608 Honeymoon 612 female hormones and today episode 899 transitioning, you can find these episodes in your audio app Spotify, Apple podcasts or anywhere you get audio. You can also find them at juicebox podcast.com. And at diabetes pro tip.com. As always, these episodes and the entire podcast are absolutely free for you to listen to the information inside of this podcast. And more specifically inside of this Pro Tip series. This information is at the core of how my daughter has kept her a one C between five two and six two for over eight years without diet restrictions. Myself and Jenny Smith Jenny of course is a CDE who works at integrated diabetes.com Jenny and I we go over the topics go over the ideas in easy to listen to and digestible ways you can apply this information to your life whether you're an adult with type one who's been living with it forever, or a parent whose child was just diagnosed, I implore you to check out the entire series. It really will help. This episode of The Juicebox Podcast is sponsored by cozy Earth cozy Earth sells sheets and towels and joggers and comfortable things really that's what I should have said cozy Earth has comfortable things whether it's sheets or towels or clothing. It is soft, it is warm. Unless you don't want it to be warmed I don't even know how to describe the sheets or they keep you cool or they keep you warm. Depends on what you want. I don't even like I don't know if there's a word for it but your body is temperate in it is temporary the word. I looked it up it is a word it. How do I put this? I wear my cozy Earth gear on an airplane the other day. I wasn't too hot. I wasn't too cold. When I got home. I got my bed with my cozy Earth sheets. I wasn't too hot. I wasn't too cold. Everything is soft. It feels terrific. Check it out at cozy earth.com where the offer code juice box will save you 35% at checkout The podcast has a number of long term sponsors, Omni pod Dexcom contour G voc, US med touched by type one, athletic greens. Of course, you heard about the T one D exchange earlier cozy earth. All of these sponsors are prominently displayed at juicebox podcast.com. Or in the show notes of the podcast player you're listening in right now, when you support those sponsors by clicking on my links or typing in those web addresses, you are supporting the production of this podcast. So please, if you have the need, use my link. What I would like to talk about today is transition. Just a an overview concept for this one, but transition from just finger sticks to CGM transition from MDI, two pumping, transition from pumping to algorithm. Sure, can we do that? Yeah. All right. I thought we could all thank Isabel here for having her finger on the pulse of the people in the Facebook group and knowing exactly what people ask about, and what they seem most confused about. Why don't we start with MDI, because everybody starts there, right? After you're, you're doing it for a while, like, let's put ourselves in that place. We've been doing MDI for a while it's working pretty well, or at least at a baseline. We're shooting a Basal insulin once a day, and we are shooting a meal insulin to correct blood sugars and to cover our carbs. That's the basics of MDI. Okay, correct. So then we're in a doctor's office, but I'm gonna make up some numbers. Let's, let's say our basil. It's like, I don't know, let's say our basil is 10 a day. And let's say were, I don't know, one to 10 for carb ratio. Okay. All right. Let's say our correction is one to 100. Let's keep it all very like, like that, so that it's easier to talk about. Okay, round 10 numbers and numbers, we're gonna do that. So the math makes sense when people are listening. So we're in the doctor's office, and the doctor says, you know, you might like a pump?

Jennifer Smith, CDE 7:24
Is he gonna say it just like that?

Scott Benner 7:25
I mean, if it's a lady, she might be like, You made like a bump? I don't know, like, people are anywhere in between. There's some women have more masculine voices, Jenny, this isn't the point of what we're talking about. Yeah. So they see, you might like a pump. You are. I'm guessing, gonna have a couple of different reactions. I see a lot of people scared. Oh, no, don't change something. I see a lot of people are like, yes, please, because this isn't working. And maybe this will they don't know why they think that just right, they're hoping for a change. So the first thing that's going to happen is the doctor is going to translate your Basal insulin to this pump. So Jenny, you do that math for me? I correct I get 10 units a day injection, what are they going to do on the pump for me

Jennifer Smith, CDE 8:13
most often on a pump, because it's expected that your Basal insulin which and this is kind of outside of it, but within your Basal insulin will now be given by the pump as rapid acting insulin. So that's the first thing to understand is that you're injected Basal insulin, which is a specific long acting kind of insulin will now sit in your refrigerator as a backup in case of pump failure, right? So you don't put Basal insulin into a pump. The only insulin that goes in the pump is your rapid acting insulin of any of the brands, right. Depending on the pump, company, they all have a little bit of different kind of recommendations for type of rapid insulin, but it's a rapid insulin and to translate your Basal dose of what we said 10 units into a pumped Basal delivery, you would essentially take 10 units into a 24 hour day. Right? And that translates into a a dripped amount, right? Because insulin pumps drip drip, drip drip consistently to deliver that total amount of basil that you want.

Scott Benner 9:32
Okay, so let's clean it up for people who get lost very easily. You may be injecting trusty Abba love Amira, Lantis what are the other ones,

Jennifer Smith, CDE 9:43
Basil Glar or these are all based in jail.

Scott Benner 9:46
These are basil insulins. These are now gone. You don't use those anymore, because as Jenny points out, you're going to take your mealtime or your fast acting correction insulin, put it in the pump, and it's going to split it up. Those 10 units are going to get split up Over, not just over hours, that's how the settings the pump work, right? You're gonna come up with what is it going to be like point four, maybe an hour if you're 10 a day about like that, right?

Jennifer Smith, CDE 10:10
Right, depending on your pump, all of the pumps differ in their precision of a single drip of insulin. Some pumps can drip as little as point one, one, some can drip as little as point oh, two, five or point oh, five. So it just depends. But if you broke this down 10 units a day into 24 hours a day would be a rate of about point four, two, if you do rounding, right? Yes, some pumps, you may have to round that 2.4, because they can't deliver the point oh two.

Scott Benner 10:42
And you're, you're gonna hear that if you're MBI. and think, oh, at the top of every hour, it's gonna give me point 14 incidents on but it's not doing that it's going to break the rack to wait for Twos Up over the entire hour

Jennifer Smith, CDE 10:53
over the course of the time. Exactly. Now, the other step to this calculation is that we expect that your Basal insulin you've been injecting I'm trying to think how to say it. So people don't think their insulin is not working. But when you inject Basal insulin as its type it, it will not be absorbed as efficiently I guess is the better way to say it as it would from a pump where it gets infused in those little tiny drips over a very precise amount of time, a very precise dose. So your rapid insulin in your pump gets infused out of sight. And so we usually take your base Basal dose down by about 10%. Some, some physicians even go down by 20%. But the general idea is taking your base dose down by 10%. So 10 units a day taken down by 10% is one unit less, so nine units instead of 10 units. So if you do the math there, nine into 24 gets your rate down instead of point, let's call it point for an hour, down 2.37 an hour, which again, we'd probably round down to point three, five.

Scott Benner 12:05
And you're going to want to keep an eye on that because I've seen it go either way. I've seen that be right. And it's amazing. I've seen that be now not enough insulin, and people are getting high blood sugars. And they immediately like you hear them say like the pump doesn't work like well, you gave yourself less insulin and turns out you need right. So pay close attention to that.

Jennifer Smith, CDE 12:27
It also translates into the next step. Once you've been making some notes on this 24 hour dose of let's call it point three, five units an hour. And you can say Well, it seems okay here. But then at this time of the day, I'm always high no matter what I can skip eating and I'm high I can eat and I go even higher. Well, that's when the next step is Basal testing. Right, we need to really look at it and say, where is that point? Three, five, sufficient and where is it not? And where might it be too much.

Scott Benner 13:01
And you might notice, and this, this might sound a little heavy if you're thinking of switching but you could put your pump on your belly and have a different reaction to the insulin that is if it's on your hip or your thigh, you know, there's reasons like Arden's thigh doesn't work as well as her stomach does,

Jennifer Smith, CDE 13:19
you know, neither does mine, I don't use my thighs anymore. Yeah, back of your arm might

Scott Benner 13:23
be better than your, the back of your butt. Or who knows, like right and with

Jennifer Smith, CDE 13:27
with this being new from coming from MDI, to going to using a pump, I would suggest initially utilizing and testing out within an area of the body, you know, we talk a lot about rotation, not only should you be rotating, if you're doing MDI, your injection should be going multiple different places, not just the same site over and over. The same goes along with pumping, those sites need to be rotated. If you're new to pumping, however, you really want to get an idea if your settings are fairly good. Stick with rotating around your abdomen, right? Get an idea. And then once you have that fairly well set, you can then move to upper body or the back of the arm or maybe your thigh or you know your lower back and see if you notice any difference some people do and some people don't at all.

Scott Benner 14:19
No, right? No. I mean, there's it's your body composition, hydration, how you know where it's actually going inside of you. Is it subcutaneous Is it very close to a muscle? We don't overwhelm people, but the muscle can kind of I don't know what the term is like what a large muscle group can. It kind of lessens the impact of the insulin but for the life of me, I can't think of why right now. Do you know what I mean?

Jennifer Smith, CDE 14:44
lessons? I know I don't know what you mean.

Scott Benner 14:46
I always thought that's why the thigh wasn't a good spot because it was a large muscle.

Jennifer Smith, CDE 14:51
Well, it might have more to do with how well the insulin at that site is getting absorbed. Like that's a big reason that I don't use My thighs is because whenever I tried using it, either I got a clusion alarms because the cannula was bumping into muscle or potentially that I had nicked, like a small vessel under and it had been clouded kind of near that site were was trying to infuse. And so that backs up into the pump and the pump tells you hey, the delivery of insulin has stopped. It gives you nice alarms. Right? So I think in some cases that may be part of the issue is the proximity to muscle, yes. But also I it was either painful or I got occlusions like it just never worked on my thighs.

Scott Benner 15:41
Okay, I'll say, Look, I'm learning from the podcast. Finally. Finally, I learned about this every day, you learn a lot. Okay, so now we've, I think here's a good place to insert that it is possible that there are some people on MDI who are achieving reasonable lower blood sugar's some how do I say this? Sometimes your doctors over baseline you because they don't think you're covering your food correctly. And

Jennifer Smith, CDE 16:12
or they may not have looked at your records enough to know why they've you know what I mean? Like, it might just be easier to backup with enough Basil with what they're seeing in your data. Yeah. And it may as you're saying, it might be wrong,

Scott Benner 16:26
right, right. So like, imagine if you're a person who has been getting more basil than they really technically need, but you kind of forget meals, sometimes you don't cover all your food. But now all of a sudden, you have this pump, you're like, Oh, it's so easy. Now, I just push the buttons for my foods, and now you're covering your meals well, and you're like, why am I low all the time? Right? It might be because you're using more insulin than you have been in the past. So those are things to look for that I see people struggle with the beginning with a pump. And I do want to say I think there's a, I think there's a period of transition there. It's not going to be like if you're nervous. It's not unfounded, you know, like you are starting a whole new way of doing something. But it really is just another way of delivering insulin to you. It's not that complicated.

Jennifer Smith, CDE 17:16
And I can say personally, when I switched from MDI, having done MDI, a long time before I started using a pump. By the time I started using a pump I was already doing. I was already doing somewhat of a Pre-Bolus. But it wasn't the same once I switched to a pump, there was a definite time difference between my Pre-Bolus with injections, and there still is, yeah, I can take an injection and my Pre-Bolus Time is not as long as it is on a pump. Right? Again, and of one. But that's what I noticed. And so those are some things to pay attention to between MDI and what you're doing along with what you said about maybe the doses you were taking on MDI, were covering a certain way for your rapid insulin for meals and corrections. And now that you're on a pump, your meals, the food hasn't changed, your strategy has stayed the same. And things are looking

Scott Benner 18:14
weird, right, right there, you do have to step back a lot and try to see what's happening. One reasonable reason for that could be reasonable reason why it wasn't right. But anyway, you use an omni pod and delivers insulin a little slowly. Like it doesn't just like you take a needle and you go Yeah, the pump is pumping over time. And I don't imagine you use very large bonuses, but larger bonuses take longer. I've seen I've sat at a restaurant with Arden and, you know, you forget you've done it and you kind of still here like that, like think like click clicking. It's still giving her insolence feels like it's been five minutes, you know, and yeah, so that's, that could be part of it. Anyway, these are things you're going to learn along the way. They're new lessons, but they're not a reason not just try, because you're going to gain what you're gonna gain so much, right? Like if, to me a pump is at its core, I've always thought of pumping as a way to be able to manipulate basil. Whereas on MDI, I shoot it in, it's in there, nothing left to do. If it's too much, if it's too little, it's what it is, you know, with MD with a with a pump, you know, you can go back and listen to the Pro Tip series. I think about like, wow, if we sit down to a meal, that's all of a sudden much carb heavier than what I usually eat, I could do a Temp Basal increase, they try to help me with this. You know, I was thinking a minute ago when we were talking about breaking the 10 units down into point 4.35 That if you think about putting a sprinkler out on a dry, dry lawn, right, and you need to give your lawn 10 Guys gallons of water, you could come along and dump it on all at once, it'll just be there, that'll be it right, or it could break it up into a little point three, five gallons every hour and go back and forth. And just a light covering, covering, covering, covering, you're never gonna soak it down, you're and it's just I think of basil like sort of like that. Sometimes you're just,

Jennifer Smith, CDE 20:20
and that's a good way to think about it too. Because if you consider that slow Basal drip that you are getting from a pump, when you inject your Basal insulin all in one clump, right? You can, depending on the kind of activity you like to do, you may have found that you have to pay attention to Gosh, I'm doing like a really heavy arm workout, I'm probably not going to inject my Basal insulin into my arm today, I might inject it someplace else, right? Because there's this whopping dose sitting underneath your skin. And any kind of insulin, whether it's rapid, or Basal can get enhanced in action, the more active you are, and especially if you're using that site. So, you know, those are the kinds of things that having those tinier doses that you can manipulate and adjust, especially with the variables that you know, are coming in the day.

Scott Benner 21:21
If somebody's listening and thinking like, well, they have spent the first 15 minutes talking about Basal insulin, it's because it's really important, and nobody tells you it's important setting. So if you listen to this podcast, like while I do MDI, they're always talking about, like, their settings on their pump or anything. This is still settings, you know, if it's MDI, it's your settings, it's, you know, these Basal carb ratio, correction factor, they're all settings. So it's just very important to have them. If they're not accurate to your needs, then everything else is just going to be a mess. And especially Basil, basil is wrong. The whole day is confused. So okay, so we've translated our basil, our insulin to carb ratio, does the doctor keep it the same? Do they usually like what is common?

Jennifer Smith, CDE 22:06
They may keep it the same, especially if your records prove to show that it seems to be for the most part working fairly. Okay. Right? Could there be improvement somewhere, possibly, or whatever, maybe that's also part of the reason that they feel like a pump might actually be better. Maybe you're the kind of person that just eats really slow digesting food. And so you've had problems with taking your insulin and having these big drops in your blood sugar too fast, and then it ends up catching up with you. And then you end up high later, and you've treated low blood sugars, right? And there's not a timing thing that you can really get quite right with MDI. And maybe the doctor says, Well, why don't we try a pump, because hey, you're eating these types of foods more frequently, we could actually use some of the smart features on our conventional pumps that allow you to take some insulin for food, we're calling these extended boluses. And you can just kind of like basil. It's almost like a secondary use of basil. But for a Bolus, where you drip drip, drip drip drip a Bolus in over a certain amount of designated time, you

Scott Benner 23:13
know, there's just, there's so much you're gonna get out of having a pump there, there's also going to be some things you need to know, sites can, like they're going to tell you whatever pump you have, they're gonna say this pump you can wear for X amount of days, or X amount of hours. But sometimes sites go bad. You know, sometimes new sites don't work as well in the beginning. Those are little things that you'll learn along the way. There's, if depending on Arden's blood sugar, she might put on a new pod, and we might just Bolus a little bit to get the site working. This morning. I woke up in the morning, I saw that artists blood sugar was trending up overnight. And listen, for those of you just switching like Arden is looping, but I can see how much insulin is left on a pod remotely, which most of you aren't gonna be able to see. But I can see she was down to like 30 units. So this is the end of her sight, right. And I just spent the weekend with her. And doesn't matter. But we were in a lot of restaurants this weekend. So Arden got a lot of insulin this weekend. And in my heart, her blood sugar is drifting up because this site is kind of done. So because you have experience, yes, I can just tell and you will be able to one day as well. So I sent her a text and I said I wouldn't go to class with this pump one. Because if she does, she's going to spend her whole day with blood sugar around 150 And she's going to be fighting with them constantly. And bolusing and they're not going to work and and by the way, if that happens, and then all of a sudden she gets crazy active out of nowhere. She might experience a low blood sugar from all this insulin kind of sitting in this right over us. Yeah, getting this pole right. And so like that's Here's the thing you'll learn along the way, you'll learn, you know what people worry about so much like, well, you know, do you travel with pumps? If we go too far from our house, we do. If it's a 15 minute turnaround, we don't like, you know, what, I'm gonna have to have insulin with me now, like, I don't know, we don't travel with insulin that frequently, as long as we're in your home base, you know. But if we go far, you know, half hour, 45 minutes, and it's not something we want to turn back from, we'll take insulin with us, you know, you just you, my point is, is that it becomes all second nature at some point. Just like everything else about diabetes, you're gonna have experiences they're going to teach you, you'll learn from them and move on. Speaking of moving on, you'll think I'm gonna go from MDI to pumping, to pumping to algorithm pumping, but I want to do CGM is first. So you have a meter. And that's how you check your blood sugar. And that's all you have. When you're in the doctor's office. The doctor is like, you know what you want to do?

Jennifer Smith, CDE 25:59
It must be the same doctor.

Scott Benner 26:01
I got one of the drawer here. Take this a sample you try. You'll love it. They're gonna try to give you they're gonna say to you, hey, you might want to leave Ray, you might want to Dexcom if you're on a Medtronic pump, they might ask you to do whatever the Medtronic CGM is called. And you're gonna say I don't need that or you're going to be newer. You're gonna Yes, please.

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Wherever you fall on that you do want it. Your insurance covers it you want it? That's for sure. Right? Tell me why.

Jennifer Smith, CDE 28:49
And I think it applies in all realms of diabetes as well. Right? Not just in type one diabetes, but also type two diabetes and even worthwhile and gestational diabetes. I know there are some rules in terms of when it can be prescribed whatnot. But I think it's beneficial all around what you miss with finger sticks are all of the little dots in between. So where things are trending, right, so if it is something that your doctor does bring up? Absolutely say yes. Right. You may not know how to look at the information or what you're getting from it initially. But it's so worthwhile.

Scott Benner 29:30
You want to know what you don't know. And with finger sticks, especially if you're newer to diabetes, or if you just been doing them your whole life and this is how you tend to think of it. You do the well i i test before I eat or I test before I go to bed or I test before I drive. And right. And I know you've asked yourself what's happening when I'm not looking right like and if you haven't asked yourself that. I wonder how do I go from two 50 to 50 in an hour, like how does that happen? And you'll learn you'll start seeing the impacts of activity and the lack of hydration, and different foods that you eat. The age of your, your insulin pumps cite all these different things that have a huge impact on the way your blood sugar moves. And now suddenly, it's there. A CGM is going to show you minute by minute. I think it's every five minutes. Right.

Jennifer Smith, CDE 30:32
And I think there are there are some people who have been using it long enough that can say, there can be some frustration around the amount of data that you get. And I wouldn't disagree with that I but I do think it's how you interact with the data, right? It's how you actually take a look at things and what you do with it and what you learn from it. And you'd have to, you have to expect that in the first month. Let's call it of using a CGM, you're gonna see a lot of stuff. And so rather than being so very emotionally reactive, again, taking a step back and kind of looking at the data to be able to make better decisions about what you felt like was probably happening, and now you can actually see it

Scott Benner 31:21
right. Well imagine you have your sprinkler out on the yard, and you have to keep the dirt moist because you've planted grass seeds, except every time you look out, it's kind of dry. That's the CGM. You look at the CGM ago Oh, from 3am till 6am. My blood sugar's 140. It's pretty stable, but it's 140. I wish it was lower or moister. I can turn up the sprinkler a little and put on a little more insulin and make it where I want it to be like push that number download

Jennifer Smith, CDE 31:48
and the CGM can show you that if you're really looking at it. That way the CGM can show you where did it start to lose? Right effect? Where do I start to need to add more insulin? It's not once you get stuck higher or once you get stuck lower than you want. It's before that so any drifts up or drifts down. You can see that very clearly on a CGM I, you have a really good example I think from when Arden first started using her CGM, it was like that overnight thing that you were constantly missing was at Lowe's when you had finger sticks, and I would put all you could see them.

Scott Benner 32:27
I thought I was a genius. I've said it before I would put Arden to bed at 180. And she'd wake up at 90. And I was like, Look how good I am at this. And what would happen. We put a CGM on her. She was 180, she'd go down to the 50s sit there for hours, I'm assuming her liver would be like, hey here, try not to die. Here's some, you know, here's some, here's some glucagon, I'll give you a little bit. And then she drift up to 90 overnight. It was happening constantly. So the reasons for that are mind numbing is not for this conversation. But we were bad at bolusing for dinner. We were her basil wasn't like there were so many things that weren't right.

Jennifer Smith, CDE 33:03
But you didn't know it because you couldn't see what was happening unless you really did a finger stick even an hourly finger stick, it would have caught a drift. But it still would right? But it would have still been confusing unless you've sat down and you connected all those dots. And you could say, well look, look at this. And you probably I mean not necessarily wanting to see your child sit at 50 for three hours before your body actually reacts and gets you the glucose that is needed to bring it up. But you'd have on a first finger stick probably under 70, you would have ended up treating so you also wouldn't have had the information to show. Well, how much do we need to take away? And what do we need to do differently?

Scott Benner 33:45
I can't I can't say how valuable it is to be able to see a graph and to enter look at it every three hours or you know what's it look like over six hours, like Jenny's point is great as the you you don't know why? What happened happened? It's um, if you're married here, it's nine o'clock at night. And you're now in an argument. Right? And you think I don't know what just happened. But mostly this is guys like they're like what? They searched the last five minutes their brain and I've not done anything wrong in the last five minutes. But if you could step back and see a whole graph of your day, you'd realize that at 630 at dinner, you said something really stupid, and now it's hit me at nine o'clock. So I think that that can be similar. You could have cheeseburger with french fries at dinner at eight o'clock at a restaurant and hit it with a great Bolus. And you're like, oh, wow, my blood sugar's still where I want it to be it's 140 After dinner, that's not bad. And two hours later, it starts to jump up. And that doesn't make any sense to you because you haven't listened to the Pro Tip series. You don't know about the fat and the French fries and the slow digestion and how your blood sugar is gonna go up afterwards. But at least if you see it on a graph, and then you go have those French fries and that burger again. You see it happen again. You can go Oh, I could get get ahead of this, right? Yeah, I could not say that stupid thing at dinner. And now we'd be watching television and she wouldn't be yelling at me.

Jennifer Smith, CDE 35:06
Right. And if you have a pump, you can also address it a different way than waiting for it to finally start rising and getting too high, you can offset it ahead of time knowing what is coming, because you've had the experience that, oh, it always hits around two hours. So I'm going to start doing something about an hour and a half before that. So that it actually doesn't happen. Right. So I mean, yeah, it's million

Scott Benner 35:32
ways to handle that if you're Yes, right. For for art in an hour after she has french fries, we have to Bolus for the fat. And there's a calculation you can do. And there's that heads off that secondary rise and doesn't cause a low later. That's the other great thing is the everyone. When you don't have enough data, you think, Oh, if I just keep throwing more insulin here and there, it's gonna be it's not true. Like you can match the need up with the impact of the insulin and never cause a low, right. And that's something you're going to learn looking at a CGM that, that uh, that a stable line on a CGM is really your insulin, your insulins pulling down and your food and your other impacts are pushing up. And neither of them are winning, like so if you can kind of imagine that line going off into affinity nice and stable. There's invisible lines. cables attached to it. One's trying to pull it up. One's trying to pull the line down, and neither can win because you have a great balance between your insulin and your knee. Yeah, so that in the CGM, like, seriously, like, I don't care, like there's Dex comms and advertiser, it's not like I'm saying that like, get a CGM. It's of any,

Jennifer Smith, CDE 36:43
right? Absolutely. I mean, I've said before, many times if somebody was going to take my technology, I would fight for my CGM. Before I'd fight for my palm. Yeah, no 100% would keep my CGM.

Scott Benner 36:58
I'll throw this here too. Even though it's about like, leaving quote unquote, finger sticks, you're never going to leave finger sticks by the way, you're going to need them. You're gonna test when you're not sure about your CGM. You're gonna test when you're making big decisions. I listen to my daughter's blood sugar looks high on her CGM, and we're gonna make a big Bolus. I said, Look, you gotta test we got to know this numbers, right? We can't just start throwing insulin in here. And you're actually 40 points lower than this, or whatever.

Jennifer Smith, CDE 37:23
And I think it's also really important to acknowledge what you know about how you feel around certain blood sugars. Because again, technology. It's wonderful. And it's so much better than it was years ago. But it may still not be accurate at certain points. So always those finger sticks are important to continue to use. Because if your symptoms or how you're feeling doesn't go with what your CGM is reading, I guarantee a finger stick isn't gonna lie to you not unless you still have like, apple juice on your fingers.

Scott Benner 37:58
I was gonna say and I didn't get to it just an accurate meter, just a blood glucose meter. Yes, they're not all the same. They don't all work as well. Don't just take the one that doctor handed you from the drawer, do a tiny bit of research use the one that I that advertises here because that's the one we use and it's amazing and, you know, like or do what you can do your own research and find out I will throw out a little story here. Because I did spend the weekend with my college age daughter, which I haven't done in a while as a visitor at school. Second night she was with me. We replaced her CGM. Okay. So at five o'clock at night, I said, Hey, your Dexcom is going to expire one in the morning. You should switch it now. It's before we're going to eat dinner. We'll get it back online. It will have it we can do some finger sticks through dinner. And then it'll be rolling and working well by the time we go to sleep, because it does take a little while for some people where to look right. You know, she does. I don't want to do that right now. So then when do we change her CGM? 10 o'clock 11 o'clock, you know, like, oh, so then it's done. So then it's wonky for the first couple hours. And for Arden, if her Dexcom is wonky, it's wonky low when she first puts it on minus two. Okay. So like, I mean, it'll be like you're 42. And she's 10. Like that kind of thing. Yep. So there's a lot of consternation in what you should do. I'm a fan of letting it be on for a little while and calibrating it to help it get along a little more. But now we're asleep. And it's like BP people. All I could think was I told I know I said this. Nobody listens to me. But that's fine. And I'm like, and I know she's not that low like and but it's worrying. So now she's, she's asleep. And I get up and I'm checking her blood sugar and she wakes up. She's like, What are you doing? I'm like, your CGM is going off. She goes, I'm fine. It's like okay, so I tested her and she was 130. And I was like, okay, so she's right. And I did a calibration and it came together. Other pretty quickly. And that was it. Having said that, we could have done that at five o'clock. There. So there is a way to time, your technology. Now the new g7 is going to have a shorter warmup period, which will help overlapping you'll be able to soak your sensor, which I'm not going to bother explaining here. But yeah, but as the technology gets better, so should those things. But that is not to say it's not, like hands down. The most valuable thing that's happened to people who have any kind of diabetes. Since I've since I've been aware of diabetes, so absolutely. Okay. All right, Jenny. Now we got our CGM. We're using a pump. We're looking online. And we're like, see, this isn't that the doctor is not gonna go you know, you got to do. That's not gonna happen now because this stuff's also new. Maybe Maybe you're really in tune doctor might say, why don't you get an algorithm? But for the most part, I don't think I think that's the thing you're gonna figure out on your own a little bit. So all this stuff we're talking about about, you know, the Bayes will be incorrect. And you might need a Temp Basal here. You might need an extended Bolus for fat you might need all this. There are pumps that make those decisions autonomously. Yeah, you have to be wearing at this time, you have to be wearing index calm, because it works with that correct. But

Jennifer Smith, CDE 41:19
or med tronics. Um, CGM? Yeah. Because they're their system also works with their pump.

Scott Benner 41:25
Yes. So there's a Medtronic version of this. There's a tandem version of this. There's an Omnipod version of this. All their algorithms are proprietary, they work slightly differently, but long, and the short of it is they're going to give you insulin when you need insulin, and they're going to take insulin away when you don't need it. They're going to endeavor to stop you from getting low, and endeavor to stop you from getting too high. You

Jennifer Smith, CDE 41:48
still know how they do that it was with targets. Yes. Right, right, specific targets in each of the different pump systems. Medtronic newest one was just approved, which is really nice. But they all have specific targets. So how that algorithm works is based on when and how to give you more or less based on a target and based on what the system is projecting off of your current CGM trend. So it's a very interesting, like the algorithms don't just willy nilly deliver or take.

Scott Benner 42:24
Like, I think maybe now more,

Jennifer Smith, CDE 42:26
right? Yeah, exactly. There's a map to the algorithm right

Scott Benner 42:29
Gremlin inside of your pub flipping a coin going, Oh, my God heads. Let's do it. So but it's it's it's stunning. Now there's another version. There's a number of other versions there are Do It Yourself versions. There's Android APs. There's loop. I think, Jenny, you loop. Right. I do. I think you would

Jennifer Smith, CDE 42:48
have been looping for five and a half years.

Scott Benner 42:52
And Arden has been doing it. I think since 2019. Maybe? So yeah. And you're Arden's using loop three, as am I and you just switched to it as well. So like, they're all just different versions of an algorithm making decisions about insulin based on your CGM trend. That's Yep. They're astonishing. They work incredibly well. They are not magic. I know in all settings, all knowing how to Bolus for certain foods, understanding the impacts of things, your digestion, your hydration, like all the things that are important about MDI are the same things that are important about pumping are the same things that are important about using an algorithm.

Jennifer Smith, CDE 43:38
And you made I know, people can't see you, but you were very in a line going from MDI, to pumping to algorithm. And I think that's, it's a really important piece. For those who are listening to understand if you're kind of listening to this, because these are not pieces in your life already. Right, and you want to get an idea. There is 100%, I'd say 1,000% value in learning on MDI. And then moving to a conventional pump, that does not do anything for you, meaning it does not use an algorithm. There's absolute value in that, you know, we talked about testing, and evaluating settings, and learning about all the variables, food and activity and everything and how to adjust your pump or your insulin doses to accommodate for those variables. I think as you mentioned, when you said you owe your pumps, like, hey, let's start on algorithms. I can't go as deep as you. So it's a totally different doctor, right? But in that sense, there are I think more doctors today who are thinking algorithm, but in my personal and professional In all opinion, I think some of them are thinking that too fast. Okay? They are they are moving somebody to, hey, you're MDI, let's move to this algorithm driven system, whatever the system is, whether it's Omnipod, five, or tandem or Medtronic. There is, there's a missing piece in the middle there, that if for some reason, and we talked about CGM is potentially not being always accurate or technology failing. If your pump fails in its algorithmic dosing, and you have nothing to step back to, you're at a loss. And it's important to understand that, you know, so I can't emphasize.

Scott Benner 45:42
It's incredibly important. Jenny's been talking to me about this privately for years. Honestly, she's like, people can't just be put on the machine, the machine does the whole thing. And they don't understand why it's happening. Because, you know, the general argument is, what if the machine stops working? I don't even think that's the need for that. No, I think the need is, is that this is a thing you have to understand. Like it, no matter what none of this machine stuff is at the point where you don't need to know how to how it works. It's not AI, it's not even a computer like you know, used to have to know how to fix your computer, because it would break all the time. Nowadays, you buy a Mac, it'll just do the thing you want it to do, you'll never have to touch it, and it'll die. At the end, you're like, Oh, my Mac doesn't work anymore, you get another one. And you don't need to understand how a computer works. To use a computer. You need to understand how diabetes works. To have diabetes, I don't care what version of care you're using, I don't care what the next one is. Now, if someone magically comes up with something one day, where it just works, no matter what, like a, like a laptop from Apple, okay, then then okay, then God bless. If you want to skip it, then skip it. But I'm still gonna say, that isn't happening anytime soon. Because of not just the things we've mentioned today. You know, your insulin pump site might not work on time, like your CGM might not be right right away, like all the other things, it just not happening anytime soon. So you don't want. The worst thing I can imagine is that you put an algorithm on a nine year old who it works for. And then five years later, the kid hits like puberty hard or something and you have no idea, like the algorithms doesn't know you just became a completely different person, you're gonna have to change your settings to make that work, right. And that takes experience. And if you I think if you ever find yourself listening to Jenny and I talking and thinking, How come whenever something comes up, they just fill the next space with something valuable. It's because Jenny's been living with diabetes for over 30 years. And I've been staring at my daughter for 15 years watching her have diabetes. And I have a never ending supply of experiences and answers in my head because I learned through them. Yes, that's why and that's why you? Yeah, like you didn't go to like diabetes University where they told you something secret that they don't tell everybody else, right?

Jennifer Smith, CDE 48:14
No, no, no, not at all. I mean, I have valuable behind the scenes, like information about disease states and those types of things from a medical knowledge base. Absolutely. And understanding them helps me to understand some of the navigation of that with diabetes, but the lived experience and the work that I get to do with so many people, that's the valley that you can't teach that. In a university, you you can't teach, there's no degree and diet.

Scott Benner 48:47
And for your situation, you've been helping people for so long it professionally. I tell people all the time, like, it's, it's gonna sound self serving, but it's not like it's that I was able to get advertisers for the show. So I get to turn the show into a job so that I could put this much effort into it. Because I learned every day I talked to people, like you'll hear me say like, Oh, I was talking to a guy the other day, he said something about this. That's me. hearing something I'd never heard before and right and retaining it and being able to apply it to a situation go, oh, you know where that'll help here. And then you get to keep expanding those conversations. I'm going to get to something here and you get to keep expanding those conversations till they help other things. We did fibroid episodes. Now we hear from people are like, Oh my God, my life is different. Because I got my thyroid managed well, I'm getting a lot of my I didn't realize about my iron and my ferritin like a lot of women especially are getting back to me like they're feeling so much better, because it's something they heard on the podcast. They heard it on the podcast, because I was able to focus on this because this is what I think about And now and now it's coming to digestion. And that because we had to figure out a problem with my daughter's digestion. And then we shared Get on the podcast now I've seen that help other people. That goes for little things about diabetes too. Yes, that's how this stuff spreads. This is a repository of information, but you're gonna build that in your own mind. Correct. But not if somebody slaps an algorithm on you and tells you don't worry about the thing. I'll take care of it.

Jennifer Smith, CDE 50:18
Right? Because it one that's such a, that's such a big thing that I hear well, shouldn't it be helping me with this shouldn't be doing this shouldn't? The one word I hate is learned, shouldn't have learned that I don't need this much insulin at two o'clock in the morning. Nope, your system isn't learning. I promise you it's not learning. doesn't keep track of two o'clock in the morning, gosh, I gotta give less insulin for this person. It's not that's it's not smart.

Scott Benner 50:44
Now. And Jenny, do you know oddly enough, as we make this episode, I put up an episode today called Rise of the Machines, where a guy comes on to talk about his Android APS system and how it he does believe it's going to learn in the future. Correct is so exciting, but not now. Like, what's one of his examples? He said, location services. So if you say I'm having pizza, and it realizes you're at Domino's, okay, and you have an experience with insulin, at some day, it will remember that experience. Yeah, if you go to a different pizza place and have a different experience. It'll remember that if you go to a pizza place, it'll remember that if you head back to Domino's, it's gonna go Oh, we're back at Domino's. This. That's not happening right now.

Jennifer Smith, CDE 51:33
No, in fact, there is there are some. There are some apps that actually you can track that way. Like you can take a photo of something and tap the location indicator. And the next time you come back to that location, you'll be able to see what your dosing looked like what your CGM trend looked like. So you can learn from Bob's pizzas, Friday night, last week to this Friday night, maybe I should change my strategy, it looked like this. And I want to improve this right or do it differently. But those they need to be married right into the pump so that not only do you have Okay, now I'm at Bob's pizza, this is what I had. And hey, let's the pump then can acknowledge and I'm going to do something different for Jenny.

Scott Benner 52:17
But for that happening just automatically, that's not here yet. 2023 on the pod five doesn't do that. Tandem T slim doesn't do that the control IQ doesn't do that. The mechanic doesn't do that. Now, it may have happened one day. Sure. But the other I think the other thing is, I know you want your days to be easy, and they can be they can be much easier than they are now they can be more your intuition can come into play as you grow. But this is a lifelong thing. And what you want is you want to get to the point where I saw Arden get into this weekend, where we sat down to this meal, there were 16 different things. And she just looked at it and picked up her phone and went and pushed the button. Yeah. And I was like, how much did she give? She was I don't know, I told it was like 85 carbs. And it was and she and I was like, okay, and then she was okay. And it was okay, just looked at a table at a restaurant. And she's like, I think about this much. And and that's boy, forget this podcast and everything else. It's that's where you want to get to where just where you wake up at two in the morning, you see a high blood sugar and you go, Oh, I know what this is. And that does come it really does come. So anyway. But you're gonna transition along, by the way, I think algorithms are amazing. And

Jennifer Smith, CDE 53:42
yes, they are. Absolutely I I love my algorithm. Absolutely. But I've also learned to work with it. And I've learned what it can do and what I still need to tell it to do. I think that's the big thing about algorithms is knowing that you still have a fair amount of action to put in to it so that the algorithm can work with you.

Scott Benner 54:04
Yeah, yeah, I wouldn't want anybody to think like, oh, you're using a do it yourself loop. It's magical over the other comp there. It all is about the same. Like they all need your help. They all need your intuition. They all need your knowledge. There's nothing if you think you're going to just put a loop on or on the pod five, and it's just going to be perfect. Like you don't have to do anything. Like that's not going to be the case. No. Yeah. So but don't be afraid. No, like I I'll say something here on the hall, save myself Saturday, make a beat and make myself sad. Yesterday was my friend Mike's would have been my friend Mike's birthday. And I don't want to bring all this down. But Mike had diabetes. Type one when we were teenagers. He's not with us any longer. I believe that one of the reasons Mike's not with us any longer is because Jenny alluded earlier that I was stepping along with my hands while I was talking about things like Mike Never came along. He just somebody gave him regular and mph. And he used it long, long after he should have been, you know, didn't have updated meters and didn't you know, he didn't do the little things that you do to come along. I mean, I guess what I'm saying is you don't want to be managing your diabetes like it was 10 years ago. Right? I don't think so.

Jennifer Smith, CDE 55:25
I think you're also bringing something in here. That's really important to consider, because you've, you've talked about, you know, practitioners bringing up hey, why don't you try a CGM? Hey, why don't you try a pump? If, if you're the one always going to your doctor asking for what's new. I don't know. I you know, and your doctor is very willing and can talk about it then with you. Maybe they didn't bring it up. But they're very, they're knowledgeable about it. Once you do get on it fine. But if this is someone who's never really brought it up, and kind of like, shrugs their shoulder and like, sure you could try it, whatever you may need kind of like your friend maybe didn't have a doctor who was keeping up with what could have been better for him.

Scott Benner 56:10
Yeah, yeah. Yeah, you don't you have to take this as a, I don't know, if you want to call it a disease or like, some people don't like that word. But this is a way of living, that it begs you to be involved in it? Yes. Like, it just, it just really does. You have to be aware, you have to take some time to learn what is happening with technology, what's happening with insolence, you know, and you need to move along with it. Because if you look back 50 years, I still interview people who are like in their 70s and have had diabetes forever. And they don't even understand why they're alive. Like, like, you don't want your life to be a coin flip. You don't I mean, like there are things you can do to to, to give yourself better health outcomes. And those health outcomes are not just health outcomes, their quality of life, they're your they're your psychological state of being like there's so much good that comes from just understanding. I know that sounds silly, but how to set your basil right? And make sure your correction factors, right. And you know how to cover the foods you eat?

Jennifer Smith, CDE 57:16
Absolutely, I think and on a bigger scale. We're also we're all supposed to be a participant in our life, right? health in general, you may have been given good health to begin with, but you're the keeper of that health. Right? It's just like, you're the keeper of the car. If you continue to let the salt buildup on you never wash it off, you're gonna have a rusty car. Well, you're your body's the same way, right? You're the keeper of your health, you got to do things to maintain your health, diabetes, it stepped up a level it is

Scott Benner 57:50
absolutely. And so prepare to transition by getting as much good information as you can, but then at some point, just have to do it. You have to just dive in and do it and then learn a new thing. And then once then you'll be surprised at what else comes from that. And anyway, listen, it's also not to say that you couldn't get an algorithm pump right now and teach yourself backwards. I actually think you can. Sure. I think some people have a harder time with that than others. And I don't want you to be in a position where you're lost and something's happening. And you don't understand why because it won't be any different than a person that gets over Basal on MDI and thinks they're doing okay, but it's not really covering their meals well, right, you know, and then doesn't get hungry one day, and then it's up low all afternoon doesn't understand what happened. Like diabetes. There's no reason that if, if you have an if you have enough information and understanding diabetes doesn't have to happen to you. And I think that's maybe the most important part like I would if it feels like it's happening to you, instead of you are doing something and then something's happening. I think you have to have to look and get a deeper understanding, because it shouldn't just be happening to you. That's all. Okay. Awesome. Thank you Jerry.

Huge thanks to Jenny for helping me once again on the Juicebox Podcast, you can learn more about what she does for a living at integrated diabetes.com Jenny might be able to help you. Thank you very much cozy Earth for sponsoring this episode of The Juicebox Podcast get 35% off your entire order at cozy earth.com By using the offer code juice box at checkout. And don't miss the rest of the diabetes Pro Tip series and the other series within the podcast. If you give me a little gifts, give me two more minutes of your time after the music and I'm gonna tell you a little more about this series and the others But first tips from other listeners. I want to thank everyone who left their tips for this episode on the private Facebook group Juicebox Podcast type one diabetes and the people who left their tips on the public group bold with insulin. This first one is for going from pumping the algorithm test your basil and your ratios before you move to an algorithm. The first few weeks may be frustrating, don't give up. Reach out to people online for advice. They probably have been doing it longer than you. This person leaves a little bit of advice from going from MDI to pump says the first night they kept getting low and didn't remember that they could turn their basil down. We talked about this in the episode having access to your Basal insulin. Next one says Oh, I love this one. Listen to the diabetes Pro Tip series from the Juicebox Podcast Take notes. Here's another one from this person. Some sites have dramatically different absorption rates. We talked about that in the podcast. Here's one for Dexcom. Learn to look at the dots instead of just the number in the arrows. This person says when you're going from just having a meter to a CGM. Remember the CGM is just one of the tools in your arsenal, it's not a full replacement for a blood glucose meter. Use both tools effectively. Don't get overwhelmed. They are just numbers and data. It's not a grade for you. It's good advice to this person says no matter what you're doing, whether you're changing from MDI, to pumping pumping to algorithms, your ratios are likely going to change. And that takes time to figure out. This person says not all algorithms are the same. So make sure you understand which one you have and how it works. Their example here is if you're having trouble with a T slim product, don't use someone's advice from the pod five, it won't be the same. Don't assume that your CGM is always correct calibrated if symptoms aren't matching the number, use finger sticks to make sure other person preaching patience, and says not to make perfection your goal, just shoot for shorter peaks, and more shallow valleys in the beginning and over time, your skills will get better. And those peaks and valleys will flatten out. This person says be prepared when your technology doesn't work. And please don't expect perfection. Another person basil testing, there's a great episode about Basal testing in the Pro Tip series. Here's one that just says don't give up. I like that one. I like this one here. Don't use too many new or different foods when you're trying to figure something out. So stick to meals that you are good at bolusing for that way you remove variables, right, like you know, on MDI knew how to cover this food. So I'm doing the same thing on pumping, what's not working, then you can look at your settings and see what's different. I'd say that's a great one. I like that a lot. Educate yourself on how your pump works. Don't just trust that your rep set it up correctly. It's a lot of settings in there. It's a good one. We were used to coasting high no matter what this is an MDI, person to pumping. And we rounded up way too much on our carbs. When we switch to a pump, it took a few weeks of lows to get out of that habit and trust that the pump knew what it was doing. Interesting. So if the settings are good on the pump, I see what they're saying their settings on MDI weren't great. So they were always just, you know, doing more. But when the pump was set up, well, they didn't need to do that anymore. It's interesting. That's a good one. Here's a great one. Don't just put in settings into your palm, write them down somewhere. If something happens to the pump, you need to have them to put back into a new one. And keep a pen or needles handy in case you need to do manual injections. Even on a pump, you might have to do that sometime. That's very good to your settings in a manual pump may not work in your algorithm. This person talking about a CGM says when you start a sensor start at a time of day when you haven't eaten for a couple of hours. And you're not going to eat for a couple more hours if you can. Evening is good, especially for kids in school so the sensor doesn't run out at school. Oh, that's a good one. So he like you don't want to like put it on. I think what they're saying is you don't want to put it on at nine o'clock in the morning on Saturday. Because then at nine o'clock in the morning, you know, on a weekday it might run out. That's a good one. Don't feel bad about removing a sensor if something's wrong, whether it's causing pain or discomfort because you can always call the company and they'll respond with a replacement. You may have heard leaders or readers, that's not always the case. This person says if you haven't heard that phrase, you will eventually take pictures of your CGM sensor codes and transmitters put the expiration date into your calendar with a reminder and that way it won't sneak up on you. Here's one for going from MDI to pumping make sure the correct factor is calculated using the number, the pump shoots for not the one you were shooting for on MDI. Interesting. So what she's saying I think is if the pump gets set up in the target is 100. But when you are MDI the target was, then your correction factor won't be correct. Interesting. This is funny, I can't read you the whole thing, but it says, eventually, something's gonna go wrong. And your tech savvy husband is somehow going to push the wrong button and deactivate everything. I don't think that's as much advice as somebody who wanted to tell a funny story. Going from a blood glucose meter to a CGM. Don't look at the thing every five minutes for me that led to me overreacting to blood sugars, that may not have warranted a reaction at all. Set your alarms at a useful level. This one's terrific the person who sent this one and use that to guide your decisions rather than checking constantly on CGM. I'm a big believer in this by the way, if it doesn't beep, I don't look, there's a person here echoing this sentiment that blood sugars can be fluid, and that it's possible you can overreact and be the reason it's jumping up and down. I think that's worth repeating actually. When you're going from MDI to pumping, you don't need to wait to do a correction Bolus, make use of the insulin onboard information that the pump has great one, that's a great little tip. There's a comment here with a ton of information for the Omni pod five, I'll tell you there's actually an omni pod five Pro Tip series. Definitely listen to that before you go to Omni pod five. But I do want to add a little bit here from this post. Fluid insulin delivery, like an algorithm has to do suspending and increases and decreases and that demands a different approach than a static Basal. So in a regular manual pump, where you might just say, um, one util an hour all day long. You're making a lot of adjustments throughout the day that you don't realize, because there are times you don't need that insulin at a unit an hour might need it more may need it less. That's why the initial settings on these are so important and you kind of stepping back and watching it work for a while to see where your settings may need to be adjusted. Or maybe the way you use your insulin needs to be adjusted Pre-Bolus etc. This person says that a pump was not a cure all for their problems. And they found it very deflating when they went from MDI dual pump and it just didn't make everything better. That's important, Jenny and I definitely went over that in this episode. But keep in mind, this person says here that your doctor's office might say we don't give a pump till one year or you can have a pump till after you've been on MDI for six months or something. That'll sound like a rule to you when they say it. But that's not really a rule. You can, you can push. This is a reiteration of something we heard before. But when you're going from just a blood glucose meter to a CGM, you might want to take some time to just absorb everything. You don't want to just jump in and start tinkering right away before you know what it is you're doing. You know why you turning this dial on that dial really kind of lived through it for days, maybe weeks, even before you just say, alright, I see a trend here. I know what's happening. This is an interesting one. This is for somebody going from MDI to pumping. They don't want you to forget the tricks, you know, brain like if you see a blood sugar, and it's kind of stuck and it won't move and back on MDI, you want to inject it in a unit, there's no reason why you can't give a unit with the pump. Just because the pump says, Hey, there's still insulin onboard, it doesn't mean that that insulin was calculated correctly, and is really about to make an impact. I think they're saying trust your gut. This one's a little long, but the person says everyone's experience is going to be different. So roll up your sleeves, go into it with an open mind and be ready to dig in and do some problem solving. And don't forget to listen to the podcast, they go on to say when going from MDI to a pump, you really have no idea what to expect, you can only kind of hope that you start out with great settings. But that may not be the case. So many people end up having a poor experience when they switch and then they share that online. And then this person was like scared. That's what was gonna happen to them. But then that wasn't what happened at all.

It was incredibly easy, she said, and his numbers got much better very quickly. So I think the I think the message here is, sometimes people just share bad news online, doesn't mean everything's bad news. Here's a little tip. A pump company puts their pump through the FDA for approval, and they choose a couple of insolence to use in the pump. Those insulins are then approved in the pump. It doesn't always mean that the ones that aren't improved in the pump won't work in the pump. It just means they didn't put it through FDA testing. I want to thank everybody who share those tips and remind you that those people exist in the private Facebook group for the Juicebox Podcast. There are so many other management based series within the podcast. You're listening, of course right now to the diabetes Pro Tip series diabetes Pro, tip.com, juicebox, podcast.com, and in your audio app, but there's also the defining diabetes series, diabetes variables defining thyroid, bold beginnings, ask Scott and Jenny. And we have collections of episodes about algorithm pumping, which we talked about a little bit today, you can find out way more in the algorithm pumping episodes. There's the after dark series where we talk about all the things that people don't usually talk about about diabetes, how we eat mental wellness, there's so much to choose from. And if you happen to know somebody with type two, there's a brand new type two diabetes series for people with type two or pre diabetes. Check them out at juicebox podcast.com. Here's a little feedback from other Juicebox Podcast listeners. After devouring the Pro Tip series, I got my daily average down by 30 points. And I'm excited to continue learning from this all in one resource. If you're struggling with insulin, this is the place to figure it all out. I am so thankful that a friend recommended the Juicebox Podcast to me, and I wish that I would have found it at the beginning of my journey. I have been binge listening since I found this podcast. My son and husband both have type one man, I wish I had this when my son was still living at home. I'm learning and sharing how we're going to get our agencies lower. I've had type one diabetes for 20 years, and it was never well controlled until I started listening to the Juicebox Podcast. I've become bold with insulin. And this podcast is unlocked the solutions to so many issues I've struggled with for years. I can read you these reviews all day. But I would prefer to stop because it seems it's tricky to do this right? I just want you to go listen to the Pro Tip series, find the defining diabetes. If you're new, go check out bold beginnings. All of the information that you could possibly want and need about managing your insulin is in the Juicebox Podcast. Subscribe now in a podcast player like Apple podcasts or Spotify, Amazon music or wherever you get your audio. And don't forget to check out the private Facebook group, which is also free Juicebox Podcast type one diabetes 37,000 members and it grows by hundreds of people every week. What a resource. Please don't miss out on this community.

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