#905 Best of Juicebox: Ask Scott And Jenny 11

May 8, 2023Scott Benner

Ask Scott And Jenny: Chapter Eleven

Originally posted on Mar 25, 2020. Scott and Jenny Smith, CDE answer your type 1 diabetes questions. Today, basal vs. temp basal adjustments, how to measure health, standard deviation.

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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 905 of the Juicebox Podcast

welcome back to another episode of the Best of the Juicebox Podcast. Today we're going to be revisiting episode 317. It's chapter 11 of the ask Scott and Jenny series, and it originally aired on March 25 2020. And today's episode we talked about a number of things, including Basal versus Temp Basal adjustments, how to measure health and standard deviation. 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 healthcare plan. We're becoming bold with insulin. If you have type one diabetes, and are a US resident or a US resident, who is the caregiver of someone with type one, I need you I want you I beg of you to go to T one D exchange.org. Forward slash juice box and complete the survey. That's all I'm asking. complete the survey. Take you about 10 minutes. P one D exchange.org. Forward slash juicebox. Help the people help yourself. help humanity be a helper. That's all I got.

The podcast is sponsored today by better help. Better help is the world's largest therapy service and is 100% online. With better help, you can tap into a network of over 25,000 licensed and experienced therapist who can help you with a wide range of issues betterhelp.com forward slash juicebox. To get started, you just answer a few questions about your needs and preferences in therapy. That way BetterHelp can match you with the right therapist from their network. And when you use my link, you'll save 10% On your first month of therapy. You can message your therapist at any time and schedule live sessions when it's convenient for you. Talk to them however you feel comfortable text chat phone or video call. If your therapist isn't the right fit for any reason at all. You can switch to a new therapist at no additional charge. And the best part for me is that with better help you get the same professionalism and quality you expect from in office therapy. But with a therapist who is custom picked for you, and you're gonna get more scheduling flexibility, and a more affordable price betterhelp.com forward slash juicebox that's better help h e l p.com. Forward slash juicebox save 10% On your first month of therapy. Hello and welcome to episode 317 of the Juicebox Podcast. I'm your host Scott Benner. Today, Jenny Smith and I will be answering questions that you the listeners have sent in three questions today. The questions three. As you can tell, I've been locked in my house for a number of weeks now. And I'm getting a little weird. This episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. And by touched by type one, you can go to touched by type one.org or contour next one.com to find out about these wonderful sponsors. My friend Jenny Smith has had type one diabetes for over 30 years. She's also a certified diabetes educator. She has a bachelor's degree in Human Nutrition and biology from the University of Wisconsin. Jenny is a registered and licensed dietitian, a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. And as you'll find out later, very well may be a person who can talk to wildlife. The one thing Jenny definitely is, is a person who would want you to know that nothing you hear on the Juicebox Podcast should be considered advice medical or otherwise, she'd want you to Always consult a physician before making any changes to your health care plan. We're becoming bold with insulin, Jenny she's good like that. She's rock solid, you know what I mean? She wants what's best for you. In today's show, Jenny and I are gonna talk about when to change Basal rates you know when to do with Temp Basal and when to put, you know, a firm change into place. We're going to talk about the measurement for success in diabetes management. And what a good standard deviation might be, not just for you, but for everybody. Bum Bum Bum Bum Bum Bum bum. bumbum bumbum bumbum. The highlight of my entire week has been that the Costco near me had paper towels.

Hey, sorry, I was moving my microphone stand a little. That's okay.

Jennifer Smith, CDE 5:07
I think I have a like, I think I have like, a problem with like, I did a finger stick, okay. And my finger really hurts. really hurts, like, like, and it's kind of like, puffy. Like, can you see that? It's like puffy and red.

Scott Benner 5:29
I can. On the top. It's puffy, but you didn't stick yourself on that.

Jennifer Smith, CDE 5:34
No, I stuck it on the side where I always do and like, I can't see anything from it. I also need like bifocals. Because I have to go like this every time I have to like see something up close. My son brings me like the directions for a game. And I'm like, like, seriously, who wrote these directions? Like, come on.

Scott Benner 5:57
You have no idea how many times because Arden's a, a side stick, like she sticks on the sides of her fingers, too. But you have no idea how many times like in the middle of the night when I do it. I'm so close to her cuticle. I'm like, How did I miss that? Yeah, and I looked down at her and she's not awake, and I go, ooh, she's never gonna know about

Jennifer Smith, CDE 6:17
this. This has never happened before. Like, and it's it like it hurts it physically. I'm like, I can't there's like no hole. I can't tell if there's like gross underneath or anything. But who knows? I don't know. Maybe there's like an alien growing underneath there.

Scott Benner 6:33
Listen, if it's too fast for you to get an infection, obviously. So it's not that did you maybe just hit a nerve, I

Jennifer Smith, CDE 6:43
must have just hit something that was just a much more sensitive spot. Or maybe I hit a spot that I had already hit. It's time it's kind of a favorite thing. Like

Scott Benner 6:54
in her sleep. Right? This is fascinating. In in art and sleep. I will. I will go to fingers that she doesn't use figuring She's asleep. She won't know in her sleep. She'll pull the finger back and give me a different finger that I'm always impressed by because sometimes I'll be like Arden and she's not awake. Right? She just she feels you in her sleep. Take the wrong finger. She's like, No, no, this one. We're still do two of them. She's like either one of these is fine, but not like I tried to use her thumbs when she's asleep. yanks him right back, fold him up in a fist. I'm like, That's hilarious.

Jennifer Smith, CDE 7:31
That is hilarious. That's super funny.

Scott Benner 7:33
So yeah.

Jennifer Smith, CDE 7:35
So how are your How are your older older kids? I hate calling them kids because they're really not kids anymore. But like, how are they doing with everything? I've got some teen nieces in Milwaukee and they are just like, they're like climbing the wall really according to what the brother in law says. They're just like, I cannot be inside anymore. I need to be not near my parents on board.

Scott Benner 8:02
We're gonna turn your question. You're very kind. How are you question into part of this episode. And here's here's why. Arden's insulin needs have gone way down since she stopped going to school.

Jennifer Smith, CDE 8:16
Do they go down in the summer too?

Scott Benner 8:18
Yes, she doesn't like being at school. That's just what it is. So now this whole the the, the incarceration is actually freedom to her. She can go to bed when she wants get up when she wants to handle her work when she wants to. She's much happier. I'm seeing more smiling. I don't think I should ever send her back to school.

Jennifer Smith, CDE 8:44
The reason a lot of a lot. I've got several people that I work with who homeschool their kids. One who I started working with was telling me about her. She's the pilot. Yeah. Her parents school homeschooled her. She's now like, out of college. She's actually doing an internship with one of the airlines and doing wonderful but she was homeschooled. And they didn't see the fluctuations like comparatively with the other kids her age that is working with who were in school. clear difference from a weekend or a holiday away to actually being physically in school

Scott Benner 9:22
right now. There's there's been even the summer takes time for her to like ramp down. Sure, but this was one day, the first day when she was unsure of how this was all gonna work. Her blood sugar didn't change. And then after she got her work in on time, she was just like free and easy and really happy. So it's interesting now my son he doesn't like the lack of activity. Like we were outside in the driveway throwing a baseball yesterday for a half an hour. He brought us he said he's my kids are both very good with money. They Don't ask for a lot of stuff. And he's like, I need a squat rack. For the basement. He's like, I need to be able to like exercise though. And I was like, okay, and the other end, he walked outside, just sat on the front step for a while, you know, just the height, I need to get outside, because he's also a boy. So like, he'll start playing a video game and lose a day to it if he if you let him, you know what I mean? And last night, he told me around midnight, I'm gonna get a shower. And then I'm gonna read for my, my economics class. And I was like, Oh, that's great. And he's like, it's not like, why is it not? He goes, because I'm going to read for an hour to get what I could get out of a five minute explanation for my professor. And I tried to do like, I did the dad thing. I was like, oh, there's nuance to the reading. you'll appreciate it later, he was looking at me, like, I don't care what you're saying. And I was asking, I was like, I tried not to be, you know, I just was like, you know, this is it. It's good. And, but he wants that he's also concerned about how much we pay for school. And that now he's basically learning through, you know, yeah, really fancy YouTube videos. So he's like, why are we paying for this? And I said, call this time is going to turn. It's one of the strange things about about the United States, at least, that I've never understood, like, why has quality distance learning not become more? I don't know. Like acceptable, especially in college. Right.

Jennifer Smith, CDE 11:28
Right. Right. I yeah, I mean, it I think it's getting better now, how people viewed the distance learning like the University of Phoenix, or whatever it is, you know, all the commercials for, but there, there are quality programs, and my sister in law actually did an online master's degree in business management. And she, she does a great job. She's a wonderful job. Cuz she did that. So there's nothing wrong with Oh, no, no,

Scott Benner 11:55
no, but why is it not more popular? Why is it why not? Is it just is like an his level of embarrassment? Like I went to school, like through the mail? Does it feel like that or something like that? You don't? I mean, like, 1960. It took a writing course from Hollywood.

Jennifer Smith, CDE 12:10
Yeah, I don't know. I think I think in today's technology world, it's getting better. In fact, some colleges, as I'm sure you've seen with even Cole, I'm sure he probably has some things he needs to submit, online and do that way already. But I think it's such a big change from the quality of as you know, in high school. And even in college, there's a lot of social networking that goes on that you, you don't get that when you have it at school, you just don't. And

Scott Benner 12:43
we talked about that. There's, you know, you sometimes meet guys that, you know, he's playing baseball with or he's met through school, and you talk to them a little bit, you go, that's an impressive kid for 20. It's going to be impressive adult and you don't know when 10 years from now, that kid or your son's going to wake up one day and go, you know, I have a position to fill and you know, who would be great for this? Yeah, that guy played baseball with 10 years ago. And so there's that piece and there's the social part of it. Like I'm not, I'm not discounting that. But for some people, they just want their degree. They're not looking for you know,

Jennifer Smith, CDE 13:16
they could care less about sitting in class next to the guy who doodles pictures of his dog, right? Yeah,

Scott Benner 13:22
I met the most interesting guy in college yet no one cares. But anyway, it just was it's interesting that they both are they're not happy. We spent number of hours playing poker the other day. You know, there's we keep talking about having a movie night but it hasn't happened yet. Everybody's that we're I think we're kind of quietly keeping things. Activities aside for when everyone loses their mind. And we really, like need the activities and so far, everybody's been okay. Kelly's under the weather, but oh, it's not um, you know, it's nothing related to all of this. Just yeah, it doesn't feel well, just a

Jennifer Smith, CDE 14:03
normal thing. I know. And that's every time you hear somebody like

Scott Benner 14:08
oh, my god, get back to person get away.

Jennifer Smith, CDE 14:12
The cough maybe they were eating a granola bar that didn't go down the right way.

Scott Benner 14:16
We're doing it on purpose for comedy reasons, too. Yeah, that would be my husband. Yeah, just everybody runs out of the room. mom's sick. Don't touch her. She's like I just I got a dry piece of Winona bringing us down with you. So and she cut caffeine out. But she did it too fast. So now she has a caffeine headache, you know, and I gave her a little tea. I'm like here have a little it's not from soda. And this, she might even

Jennifer Smith, CDE 14:43
do better if she if she's willing to do tea. She could even do something like a matcha which has a little bit of caffeine in it and could kind of ease down Calper the caffeine kind of thing because it's also much smoother caffeine than coffee coffee is like you get this big like rule

Scott Benner 15:00
Yeah, we don't drink coffee. Nobody here drinks coffee. Actually, I think the truth is that I don't believe Kelly ever has been I've never had a cup of coffee in my life. So I wouldn't even know what it is. As Jenny takes a large

Jennifer Smith, CDE 15:14
as well. I drink tea every morning, usually a couple of

Scott Benner 15:17
drops. But I'm drinking earl grey with a little bit of honey. Oh, I

Jennifer Smith, CDE 15:20
have a very good friend in Colorado who Earl Grey, and Lady Grey are like her favorites. My

Scott Benner 15:26
favorite thing it really is. Alright, so Jenny, we have a ton of ask Scott and Jenny questions. And we are gonna do like three recordings in a row over the next two weeks so that we have them all set up? Yes. Before we start, let me tell you that and there's no pressure here. But tomorrow at 3pm I'm doing a like it's just a social meet up online. And if you're free and you jumped in for a couple of minutes, I bet you these people would be very excited to

Jennifer Smith, CDE 15:55
unware zoom. And zoom.

Scott Benner 15:58
Yeah, so you could sit like this, click on a link pop up.

Jennifer Smith, CDE 16:01
What? Yeah, we zoom for our staff meetings on Wednesdays. But what at what time,

Scott Benner 16:07
three o'clock tomorrow? Three to 430 it's gonna run. It's gonna be like a free thing. Like people can come

Jennifer Smith, CDE 16:12
time. Like, dude, a two to 330 my time. I should be around. Usually, I'm working on emails at that time. So send me the link. I will

Scott Benner 16:20
even if you just popped in and you were like, Yo,

Jennifer Smith, CDE 16:23
and send me a quick text while you're doing it so that I remember you

Scott Benner 16:27
will. You're gonna find out what it was like to be Elvis in the 60s. Ah.

Jennifer Smith, CDE 16:34
Interestingly, are you recording right now? Okay, I just wanted to

Scott Benner 16:40
read you want to say something private? Hold on a second. by everybody. will gently I hope nobody finds the body. I think you're gonna be okay with where you hit it. You're so I mean, it's Wisconsin. There's so much snow on top of it. No one's ever gonna find it.

Jennifer Smith, CDE 16:58
We've got lots of bugs too, you know? Yeah.

Scott Benner 17:00
So should we just start at the top of this list? Or do you have a favorite in here?

Jennifer Smith, CDE 17:04
No, I the one that I think we had commented briefly. The last time we talked was it last week already? was about there was somebody who asked about artificial sweeteners. And that one was curious to me. But there's a good list of questions. So wherever you want to start, it's totally fine to me. Okay. Well.

Scott Benner 17:26
Can you like there are so many guys. First of all, Rudy was so nice to send in so many questions. But yeah, let's just roll through the top. Okay. Okay. Sarah asks, Please address puberty. Specifically, I think Sarah wants a question answered for her specifically, but 12 year old, pre period, girl, the spikes and drops are insane. There aren't on the pod Dexcom. So I think the question here is when to change basil, and just Temp Basal. Okay, so she's seeing drops and spikes. And she's looking for your when is this a change I make forever? And when is this just something that's happening? But that's interesting.

Jennifer Smith, CDE 18:10
It is. And it's a great, I mean, given the age of the preteen. And you know, her being a female, obviously, there are going to be, as I've talked with a lot of the people I work with who have girls about this age, who have not started a cycle yet. There are often about like a six to maybe 12 month time period before a cycle actually shows up. Okay, that if you start to track these resistant and sensitive times on a month to month basis, you may find anything to answer your question, you may find that it actually flows around the same time every month. And if you can catch that, then yes, you may be able to put a pattern in you know, Omnipod, all the pumps out there allow you to actually set up different Basal profiles to turn on at certain points. So if you can track enough to say, Okay, this cyclic nature of resistance is always coming around the 15th of the month, or whatever it is, right? If you track a couple of months, and you see that and you say, Okay, last month, we used 50% More this month, we're using 40% More, you should be able to set up a Basal profile, then that essentially is that much more at least in Basal delivery, and then just enable it for that time of the month and the duration of days that you see it typically lasts. That's you know, that's kind of then going forward into once a cycle does start, you'll be able to utilize that same kind of pattern. And once the cycle becomes regular, which is usually it takes about a year, give or take for most girls once they start their period to have kind of a consistency to it right So you should be able to use a pattern then, rather than just always employing a temporary basil. It does take using the temporary basil up front though to figure out which amount extra you need to actually create a profile from.

Scott Benner 20:16
Okay. So last night, I learned that Arden has a name for her period and she won't tell any of us what it is. It has a human name apparently human names. Yes. Awesome. I think she likes the feel like there's a person who's inflicting this on her so that she can be focused on the person doing the problem that's on the side. Yesterday I showed Arden's friend Jani, who has not been on the show yet, but will eventually she's somebody whose blood sugar I'm tracking. I showed her how to see that her pod site went bad. So she's rolling along great in the 90s just kind of bouncing, you know, 8996, like all day long, three o'clock in the morning, it shoots up and levels off at like 220. And just stays that way all night till she wakes up at like four in the morning realizes that Bolus is the Bolus takes her down a little. And then she's levels off and kind of rises back up again. And so I just pull up a 12 hour graph. I showed it to her and I said, just look at this. This is a bad site. And she's like, why? And I'm like, doesn't matter. It just is like, look at it, look at it. This is what a bad site looks like all the sudden, your insulin pump is not doing what you expect of it. Common sense here says bad sight is it is this the last day of your set. And she goes it is and I was like okay, change your palm, get yourself down and start over again. The reason I bring that up where it doesn't feel like it maybe fits here is that the way I would handle Sarah's question is I would just do it over and over again until I had that feeling of like, Oh, I know what this is. And I really believe that it's not just me. I mean, I think the podcast has proven that outright, that eventually after you do something enough, you just see it. And then all the thinking goes away. Jenny, what Jenny said is all perfect, do that. But I think that one day, it'll just be a situation where you got this as a Temp Basal increase, or Wow, this is not giving up. This is more. Right. Sorry. Exactly. So long game.

Jennifer Smith, CDE 22:21
It is a lot. It's a marathon, not a sprint. Yes. Entirely. And you know, in the beginning, though, when you're really trying to figure out the difference between a temporary or a true solid adjustment? Yeah. I think you know, when you make, let's say you make you decide you're going to make a profile change. Oh, sorry. Bringing it shouldn't have rang. I had it turned off.

Scott Benner 22:45
I didn't hear it on the sensor. You're good. Oh, good, good, good, good.

Jennifer Smith, CDE 22:49
So, you know, overall, you might make a basil change. And then you're like, Well, what, what gives three days later, you're like, that's not working anymore. And now I'm way back down that might overtime again, prove I need to maybe make a temporary adjustment, rather than a permanent kind of an adjustment. It's kind of similar to growth patterns and kids, you know, where you see a temporary need, because you're now fluxing up and Okay, all of a sudden, this is gone now, and I'm staying a little higher, but I wasn't at the rate of need. Like I was for three days. Yeah, it's come back down a little bit. But now it looks more stable. It's a little higher, but not quite. So yeah.

Scott Benner 23:29
Yeah, I think that somewhere in between, stay flexible, be and reactive, not in a negative way. But in that sort of don't wait around weigh, you know, like, and there's drifts Sara that you'll start seeing on the Dexcom line. And just by the angle of it, I don't know how to explain it to you. But you'll start to look and go, This isn't going to stop. Like this shouldn't be happening here. I'm going to try a Temp Basal increase right here. With Arden's period yesterday, I used a lot of temporary increases yesterday, because she was sitting stable at 190 boluses weren't moving her. And so to me, that meant, you know, Basal jacked it up, it worked a little bit not enough, it was the end of her pump. So we swapped her pump, you know, we just went through the steps of you know, of what it could be and, but we didn't wait around like once you saw it, we moved on it. Well, we all have one thing for certain. And that's an abundance of Time, time that can be used in many different ways. You could perhaps spend your time at touched by type one.org. Or maybe you'd go to contour next one.com To find out if you can get a free Contour Next One meter by just clicking on a link and filling out some information. So here's what we're gonna do, touch by type one.org He has a mission of elevating awareness of type one diabetes. They also want to raise funds to find a cure. But mostly they're looking to inspire people to diabetes to thrive. They have these beautiful programs and services. They're helping kids all over the world with our D box program. They put on one heck of a dance program every year in Florida. Go check them out, touched by type one.org. And once you've done that, you know what you need. You need the best blood glucose meter My daughter has ever used. And by best I mean, the most portable, the Handys fits well in your palm lights up nicely at night super duper accurate. And blood sugar test strips, the little strip things you get a second chance with if you mess up, you know, when you go into the blood, sometimes you're like, I got it, I got it, and then it doesn't beep and you're gonna throw away the test strip, not with the Contour. Next One, you just dive back in again, beep beep looking at your blood sugar. I absolutely adore this meter. As much as anyone could adore a blood glucose meter. The Contour Next One is it. So head over to contour next one.com. And see if you're eligible today for an absolutely free, no obligation meter. And if you know you need a prescription, contact your doctor. They're just sitting in their living room to no one's doing a damn thing. Just throw him an email be like yo, what's up? Let's try this new meter, send out a prescription have gotten nothing but time. Contour next one.com touched by type one.org. Those links are in your show notes right there in the app. Right that you're listening in now. And at juicebox podcast.com. Check them out support the sponsors.

Okay, well, it's so funny. It's another Sarah but a different Sarah.

Jennifer Smith, CDE 27:05
There are lots of stairs just like Jenny. Yeah, it was a popular name.

Scott Benner 27:08
So they're even spelled the same way. It's not even helpful. What would you consider the most meaningful metric or measure of successful diabetes management?

Jennifer Smith, CDE 27:21
Oh, that's a good one. And I think we've actually got we went over that a really long time ago. Any of the of the pro tips or any of those kinds of things? I think if you're looking at measurement from a site like clarity, or one of your pump upload sites that gives you all of the metrics of this is your you know, your average or standard deviation. This is what your glucose management indicator value is showing you what not, what's the best indicator is time in range. That's it in second to that really would be that standard deviation, right? Because the lower the standard deviation, the more smooth management is rather than the jagged up and down kind of Rocky Mountain. But definitely, I would say time and range. Our goal when we work with people is always, you know, at least 75% time in range less than 5% of the time low. Pregnancies a little bit different but

Scott Benner 28:23
yeah, so what are the ranges you give people? What is that range?

Jennifer Smith, CDE 28:28
I work with people on their target range, because everybody is individual.

Scott Benner 28:33
So okay, so if do you feel like most people are being told 8180? Something like that? 71

Jennifer Smith, CDE 28:42
Yeah, 70 to 180. Like, if we look just at tide pool, tide pool has automatically set up as a time and range target as 70 to 180. You can in your settings, go in and adjust that to get it tighter or make it broader or whatever. But yeah, most most practitioners, I would say are aiming for about an 80 to 180. That's the most common that I hear. So again, if you just aiming for what the standard is. That's it.

Scott Benner 29:11
I think that these companies should expand this a little bit. I've been thinking about this. I need a time in range, and a time in Nirvana, like kind of match. Right? Like I want to know.

Jennifer Smith, CDE 29:27
I want to know how to be in range, but I really wanted to be in this sweet spot. Like

Scott Benner 29:31
I'm not I'm not I'm not upset that Arden's blood sugar's 180 for an hour, right? I'm gonna get it back down again. But I want to know when I'm 70 to one to 181 3120 in there, I want to know when I'm, I even want to know like 65 really like because if because if she 65 for a couple of minutes after a Pre-Bolus Yeah, I'm already with that. Right. And so I think that everyone needs to remember that when we talk about this stuff, there's context that you need to give it. And you see all the time there's people online, or look, I was in range 100% of the time today, and somebody will come in and say, you know, what's your range? And then suddenly, they don't come back again. Because you know, they never went over 350. And we're never under 50. I'm using range all day. And even you know, what, if that's for them a success? I'm not taking that from them. I'm just saying that when you're trying to share it out loud and public, you need to tell people what that range is, or it lacks, you know,

Jennifer Smith, CDE 30:33
I've even seen something that goes along with it. I've even seen people then question, well, what are you eating? Because when we're looking at sharing our own information, and kind of patting ourselves on the back, which good for us? Absolutely, it takes work. So go ahead and pat away. But you also have to, when you're putting it out there to the public, you have to give all the information that went along with that. You can't just say look at this nice flat line. Well, people then ask, well, what are you eating? How did you get that? Because there are so many different variables that go into meeting that.

Scott Benner 31:09
So my blood sugar has been between 82 and 86. All day, I've had four hard boiled eggs yet like yeah, like tell somebody the whole story. Right? Exactly, yeah, because it feels bad. Otherwise, like, otherwise you're looking at it, you're like, oh, my gosh, you know, this person's blood sugar. I try to remember as much as I can, to say, you know, art and say one scene has been between five, two and six, two, by the way, coming up now on six years. And she doesn't have any diet restrictions. But I always think the important thing to add is, for all of you that are imagining that her blood sugar is just at three constantly. That is not the case. You know, we just don't look at high blood sugars very long, and she's not low. So, you know, I would say that Ardens deviations never where anyone would want it. A hertz is usually like 40, you know, and, but within range, it's being measured between, it's being measured between 70 and 120. Right. So, you know, and you know, and I know, I still don't want her to spike up, but she sort of doesn't, right, you know, so. And not that she doesn't ever she does a couple of times a month or you know, a couple of times a week or whatever it ends up being. But she just doesn't jump the 300 and stare at it. So I think that while the measurements are really important, the way we talk about them are, is possibly even more important. So I don't see anything wrong with a one, see if it's being done correctly, meaning no protracted lows that are giving you a false sense that your agency is lower. But what Jenny's saying is you do not want your blood sugar bouncing up and down. That is just not good for you. It would probably be better for you to be steady at 150 than to go from 70 to 300. combover. Correct. Exactly. Right. So there you go. Actually, the funny thing here is the next question from Nicole, is, what are your thoughts on a reasonable standard deviation for a growing five and a half year old? Yeah,

Jennifer Smith, CDE 33:11
that's, I think you have to have a little bit of expectation that there is going to be more variability in certain periods of life. There will be I mean, kids, I mean, she's his growing five year old kids are growing considerably from birth, I would say, honestly, until about the age of like, 10 ish, things are kind of similar and patterns of growth. They really speed up. I mean, you can see the difference. Yeah, and we've got one of those, like tree growth charts for our boys. And I usually try to every couple of months to see where are you because I know, you look like you've grown or your pants look way too short again. And I swear I just bought new ones last month, you know, but at some point that growth slows down. And certainly the teen years are a different amount of growth, not the same as far as like height or anything, although it could be for boys differently than for girls. But hormones are a bigger impact there in the teen years. For little kids like that five year old age. You can expect that in for a standard deviation of something like 20 might not be in the cards because you may have a lot more variability. Even if your time in range is kept very good. You still might have a little bit more variability in there. Because if your five year old is like my who is now seven, when he was five, I mean, he could be like I want to eat I want to eat I want to play I want to eat nope, I'm not going to eat all of that. So when you mix diabetes in there and you have to Bolus and strategize and okay now I have taken a little way and now I have to plan for this and whatever. There's going to be a lot more variability perhaps, but aiming That's why I said that metric of time and range would be really more what to look at. Yeah, we don't want your standard deviation to be 80. But if it is going up a little bit more, you know, up and down. That's kind of par for the course with littler kids.

Scott Benner 35:18
I think that common sense is incredibly important here too. Because as you're listening to Jenny, explain this, from a clinical standpoint, you're thinking about what is or isn't said to you by The American diabetes Association, or by your endocrinologist, all that stuff, you have to remember that they're just trying to give, they're not with you, they're not always whispering in everybody's ear, right. So they're just giving a baseline like, you know, your standard deviation should be less than blah, your agency should be here, your variability shouldn't go blank, like, they're just giving you a place to start. I think that it's a, it's kind of incumbent upon all of us to take what looks like the rules, I'm making little quotes with my my fingers, and realizing that that's probably not the best you should be shooting for. It's not it's not the top, they're just trying to keep people. I don't know how to say this. There's a, there's a way that if you're, well, I'm struggling here. Anyone, anyone who's been in a position of power in an organization knows that you're giving common denominator advice to your employees, to you know, the the subjects of your kingdom to like, to whom ever you're talking to, and to hear that advice and take it as gospel, I think is a mistake. Right? Do you know what I mean? Like, you know, like, yeah, do you ever go around a corner and the speed limits 25. But you're in a sports car, and you're like, I could go around this corner? 45. And it would be, you know, that's you, you're in a different car, they put the 25 there for the guy coming through in the 1975 Datsun like, do you mean like his car can't handle this curve at 25? He will roll the car and right, yeah, so for us, for instance, my standard deviation doesn't look good on Arden compared to what people say, except those people have a range between, you know, 80 and 180. While I'm shooting for a range between 70 and 120. And so, my I, I know where our standard deviation sets When I'm happy with our blood sugar, right, and I don't care what anybody else says that works well for us, right. And then people are like, whoa, but then or health or health or health is going to be great. Like, if you tell me that a person growing up with diabetes, who's got an 801 C, and the fives constantly eats whatever they want, doesn't spike high, you know, maybe sees one at twice a day for 45 minutes. If you're telling me that's a problem. I don't believe you. You're I mean, like, or here's this, that's the best we can do. So you know, we keep trying to tighten it down and make it better. But at some point, that's when you get to the the life versus management trade off. Like I got to be alive to weed. Right? Exactly. Right. Yeah. And so the problem with asking these questions are and getting the answers is that no one's going to give you a real answer. They're just going to say what feels safe. Right. And so that's the most part. Yeah, common sense. These pop it

Jennifer Smith, CDE 38:27
what I can kind of say about standard deviation, though, even in let's say, your time and range of whatever range you have set. Even for a five year old, for example, you know, if you're constantly having these big old climbs, and then constantly attacking them, and then having a drop that you're getting into the red zone, and then you're climbing again, because of the red zone, and then you're dropping again. Even if you're in range and doing that, that standard deviation, it's still it requires improvement, right? You don't want this mountain peak, you know, up, down, up, down, up down all day, because even in range, it doesn't feel good for any age person. So the smoother that is, the better the person, the child team, whoever feels

Scott Benner 39:17
if you're looking at up and down and up and down like that and worried about time and range or standard deviation, you're missing, you're Miss focusing your concern, your concern should be Pre-Bolus thing and carb ratio and understanding glycemic index and stuff like that.

Jennifer Smith, CDE 39:31
And also effective insulin right duration of insulin. Yeah, understanding how long is my insulin actually working? You know, we're under that kind of takes it a step further in that variance that you see that standard deviation, because we're kind of in the understanding that our rapid insulin is rapid. I mean, we talked about this before and that it also clears very rapidly. That's not actually the case. If you follow it out, right. There's actually a A lingering dribble of impact. So if you are getting that up, down, up, down, up, down, it's very likely that even with using a pump, you might unknowingly be stacking insulin because your duration of insulin has been too short. And with modern day conventional pumps, what you set it at is what it uses. It doesn't do anything else beyond that, right? So it can't say, Okay, there's still insulin left here. Make sure you take some of this off. But yeah,

Scott Benner 40:30
Jenny's talking with their hands while I can hear birds outside of her window, and she looks like Snow White. I talk with my hands a lot. I don't mind the hands hockey, I'm just telling you about Snow White for a second. Listen, here's what I think. Don't worry about your algebra grade worry about understanding algebra, right? You know, the grade will come if you understand the math. And with this, if you know how insulin works, the standard deviation of calm, the time and range are commonly a one CL come like you can't, don't focus on the grading focus on the work. And, you know, I don't know how many more times I can say this, I keep thinking I'm going to sync the podcast, it's timing and amount. It's understanding how insulin works use the right amount of insulin at the right time. And the rest of this becomes unimportant, you know, its background all of a sudden.

Jennifer Smith, CDE 41:18
And the important thing about that timing and understanding is that it is individualized right for you not to cut and dry of okay, the doctor told me that this should last three hours. So that's what it should last. That might be the case for Johnny. But for Susie over here in the corner, maybe she's figured out that three hours, the doctor told me it looks like it's four hours for me. So it does have to be individualized.

Scott Benner 41:41
I don't know where I was where I rolled up into a talk. And I told people look, here's the truth. I could have flown in here, got up in the morning, got showered, jumped up on the stage, grabbed this microphone and said, Hey, everybody, it's all about timing and amount. Just understand how insulin works. And you you're going to be fine. Thank you good night, and I could have left, you know, would, you know would have left out some of the details about how to get to that. But that's still the truth. Correct. Jennifer Smith is available to work with you. Check her out at integrated diabetes.com. Thank you very much to the sponsors, Contour Next One, and touched by type one. A lot of ones in there. Two ones, you know what you get when you add up to ones. One on One is equals to I'm completely alone in this room. I just want to go outside, touch a handrail. Don't walk past somebody who sneezes and not have a stroke. Soon, probably a couple more weeks, couple months the most. It'll be fine. was still wearing pants or you don't judge me. Listen, I put this up a little early. Right? Because on March 26, at 3pm, we're going to do a big zoom meet up. And I have an idea for that I think you guys are gonna like so if you're hearing this in the moment, check it out. And if not, the video will be running on the Facebook page, you can go back to it. But here's what my thought is going to get a bunch of people together. And we're all going to you know, just chit chat, see how things are going make sure nobody's like, you know, go and do because they've been locked in their house too long. And they after we all do a little Chitty chatty like that. We're going to talk about getting people's Basal insulin, right. So like a big group thing on everyone's Basal insulin. And then we're gonna come back the next week, see how people are doing and then add another step. And maybe during this whole Coronavirus thing, we can bring everyone's variability and standard deviation and a one seat down, when that'd be cool if we just all got together in a group and did something like that. Well, I hope you think it's cool, because I'm pretty excited about it. March 26, Thursday 3pm Eastern time. There's links right now on Facebook, I think the links on Instagram, send me a message if you don't know how to get to it, get there. Gonna go through people's Basal rates, just like it's a private phone call, except we're all going to be there kind of kicking in our two cents, helping everybody out. You know, if the listeners of the Juicebox Podcast can't count on each other during a time like this, then I don't know who we can count on. So while we're all busy being stressed out watching bad Netflix shows, I figured we could spend a little bit of time doing something for everybody's health. I hope to see you there. Hey, last thing if you're not a subscriber to the show, like if you just count on remembering the shows on it would help me out a lot if you hit subscribe and your podcast app would help even more if you share the show with a friend. And if you're not up to like share in the show, maybe just share the zoom with them get together and maybe they'll see something they like and they'll check it out on their own. The podcast is growing so quickly because of you guys. It isn't even letting down during this Coronavirus thing. I'm super impressed. I thought for sure. Like, oh, downloads will slow down, but they haven't. And that's really very touching. Oh, by the way, last thing next week. So the next show that comes on, let me take a look. On the 30th of March, it's going to be an after dark episode. Sexuality from a female perspective. So if your kids usually listen, don't let them listen to that one. Because there's not a lot of bad words in it. But there's a lot of clear talk. So unless you want your kids to know exactly where the round peg in the square hole are, I think you should. I think you should make sure they skip that one. I didn't believe a lot of kids listened until recently, but apparently they do. Which I think is great, but not for this one on Monday. So there's an after dark coming up on Monday. Make sure your kids don't hear it. A huge thank you to one of today's sponsors better help, you can get 10% off your first month of therapy with my link better help.com forward slash juice box that's better. H e lp.com. Forward slash juice box. If you've been thinking about speaking with someone, this is a great way to do it on your terms. betterhelp.com forward slash juice box. Thank you so much for listening to this episode of the Best of the Juicebox Podcast. Don't forget, if you'd like to hire Jenny. She works at integrated diabetes.com. Just head over there and ask for by name. As I'm saying goodbye. I'd like to thank you for listening, sharing, subscribing. If you're in the private Facebook group, anything you do to support the podcast, I appreciate. If you're looking for more of ask Scott and Jenny, there's a whole list of them at juicebox podcast.com. Right up in the top in the menu. And there's a list in the private Facebook group Juicebox Podcast type one diabetes up in the feature tab. They ask Scott and Jenny series always has more coming. So if you have questions you'd like to ask Scott and Jenny, find me in that Facebook group and let me know we'll put them on the list and make more episodes with your questions.