Scott Benner 7/28/23 Scott Benner 7/28/23

#964 Defining Diabetes: Carb Ratio

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Carb Ratio.

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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 964 of the Juicebox Podcast. We haven't done this in a while

today's episode of The Juicebox Podcast is with me and Jenny Smith, and it is a another in the defining diabetes series. This episode brings the defining diabetes series to 50 episodes. This whole thing started years ago when I decided that I wanted to define each term that you would use daily with diabetes. The defining diabetes series began on episode 236 With Bolus and it's been going on for years. Today, we're going to be discussing insulin to carb ratio or carb ratio. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. You can use my offer code juice box at checkout at cozy earth.com to save 40% off of your entire order and get a free year's supply of vitamin D and five free travel packs with your first order at drink ag one.com Ford slash Juicebox.

Podcast so this episode of The Juicebox Podcast is sponsored by the Omni pod five, and the Omni pod dash. It's sponsored by Omni pod, but they have two different kinds of Omni buds, they got dash and they got five. You're like us, Scott, it seems like a lot, but it's not, you know where you can go to make sense of it all. Omni pod.com forward slash juice box. While you're there, you can learn all about the Omni pod five, which is an algorithm based insulin pump, or the Omni pod dash, which doesn't have an algorithm, but it's still tubeless and delightful. My daughter has been wearing it on the pod every day since she was four years old, and she just turned 19 This week on the pod has been nothing but a friend in this journey. And I think you would really enjoy it. Head over to my link. Now to learn all about Omni pod, scroll down, take a look around you're gonna see pictures descriptions, here's a little button, check my coverage if you want to check your insurance coverage and get started. Or here's another button. I'd like a free trial of on the pod who take the pod for a test drive. But look for those purple buttons when you get there. Read all about on the pod. But really, here's what you need to know. It's a tubeless insulin pump. You can swim with it bathe with it, your activities will not get in the way. Right? They play in soccer, there's no tubing, you're walking through the kitchen, nothing to get caught on like a drawer or something like that. But man not having to disconnect for bathing and swimming. It's a big deal. I don't think people think about it. But it's summertime right now. And it's just terrific. All those other two pumps you disconnect to get in the water and how many times have you forgotten to put it back on. And then no insulin, high blood sugars, and all the rest. That's not going to happen with on the pod because you don't have to take it off to be active Omni pod.com forward slash juice box, check out the algorithm based pump that works with the Dexcom G six, that's called Omni pod five, or you get the Omni pod dash. Whether you want an algorithm or not, you're gonna get the best damn insulin pump my daughter has ever used, and that I've ever seen Omni pod.com forward slash juicebox. Jenny, we have not done one of these in quite some time. But I am being told by the powers that be which means Isabel in the Facebook group, that we are lacking a defining diabetes episode for carb ratio. And she really thinks it's necessary. Oh, so we miss how did we miss that? Oh, no, I feel like it's my fault. I can tell you that much.

Jennifer Smith, CDE 4:07
Well, we came up with the list and we'd sort of put them together in order to gather. So I missed it.

Scott Benner 4:16
It's also your fault. Perfect. It's also my fault. All right. Yeah. Well, I like that better. It makes me much more comfortable.

Jennifer Smith, CDE 4:22
No one is perfect, Scott.

Scott Benner 4:24
Thank you. I appreciate this. So you're gonna hear some people call it carb ratio, you're gonna hear some people call it insulin to carb ratio, right? There's no other names.

Jennifer Smith, CDE 4:34
Insulin to carb ratio ICR IC insulin to carb. They might do it reverse carb to insulin. But yeah, insulin and carb as a ratio to cover food.

Scott Benner 4:48
Yes, Jenny. There are people who love this podcast and love you. And I don't think you're even aware of this but that I'm gonna get you to say carb so many times is really going to delight them because of Your accent? You don't even know that do

Jennifer Smith, CDE 5:02
you? Do you? I say it weird.

Scott Benner 5:04
I mean, not to you. But I'm so excited about

Jennifer Smith, CDE 5:10
saying I didn't know that I said it. Interestingly, comparative.

Scott Benner 5:15
Interestingly, that's a lovely way to put it. You say? We'll say it again. carb. Yeah. I think it happens more in a sense, you kind of go carob it's like that. It's interesting, right?

Jennifer Smith, CDE 5:26
Yeah, it kind of goes along with the Midwest. Oh,

Scott Benner 5:31
yes. Oh, yeah. 100%. Yeah, but trust me, this is going to tickle people I'm gonna get, I'm gonna get notes about this. Here's what the noodle say, Thank you for having Jenny say carp.

Jennifer Smith, CDE 5:42
That's really fun. I never, I guess I didn't realize people, I probably made the way that I speak,

Scott Benner 5:48
I probably didn't tell you when that happens, but I'll start sending those notes to you. Oh, that would be lovely. So I'll tell you what I'm going to do. I never do this. But I'm gonna go to Integrated diabetes services. Right. And there's a whole thing there from Gary about insulin to carb ratios made easy. So he's got it all broken down. We're not going to dig all through it, we're just going to, we're going to tell you what it is. So I'm gonna give it to you from my head, and then you'll give it to me from you remember how we do this, and then you'll give it to me the right way. So insulin to carb ratio is just a measurement, it's how much insulin you need. One unit covers how many carbs? So Arden's carb ratio is what people would consider strong or aggressive, right? So her insulin to carb ratio right now is one unit for five and a half carbs. Okay, which I think people would think like, wow, that sounds like a lot. But it's the amount that we know she needs. And other people might be like, Oh, my God, I use one unit for every 20 carbs or 40, you might be a kid getting one unit for 100 carbs, I have no idea. But that's all a carb ratio is is it's it's that measurement that you tell your pump, when you're setting up your settings near pump, or the amount you use when you're drawing up insulin in MDI. I don't know that there's another way to explain it is there?

Jennifer Smith, CDE 7:08
No, I didn't have to say very much. So I don't think people are gonna be able to hear me say car, but I know.

Scott Benner 7:17
I'll lead you down another road. So we get back to it.

Jennifer Smith, CDE 7:20
But no, you described it very, very well, essentially, you figure out how much one unit of insulin covers a certain amount of carbohydrate that you eat. And with some evaluation around your meals, you may find that a certain amount of insulin at a certain time of day covers a certain amount of carbohydrate, a little differently.

Scott Benner 7:43
And so like it when you leave the doctor's office, they're going to just give you an insulin to carb ratio. They're gonna say, here's where we're going to start with this. Now Jenny and I have actually done an episode about that. It's episode 821. It's called the math behind setting insulin to carb ratio. It's a catchy title. That was a while ago, wasn't it? That was at the beginning of this year. Does it feel like a long time ago to you seven?

Jennifer Smith, CDE 8:10
It feels like it was a while ago. Yeah,

Scott Benner 8:11
we made it about seven months ago. So. So there, so there is an episode, it's about 20 minutes long. And it explains to you how to set your insulin to carb ratio give you a good starting place. And it tells talks about the math, so you know how to do it yourself. But what I'm being told by Isabel is they're just a lot of people who just don't know what it means to begin with. So yeah, so she just wanted to have a defining diabetes episode for it.

Jennifer Smith, CDE 8:38
Well, and that's really interesting. I wonder, I wonder how many of those people were diagnosed maybe, with the questions that came in how many were diagnosed, maybe as an adult, and were given a set amount of insulin to just take at a mealtime, almost what's referred to as an old scale, or an old sliding scale, kind of concept of, don't worry about how much you eat. Just take three units of insulin with each mealtime. And that's what's going to cover it. And so maybe they've never really been moved into the concept of counting up, how much you're eating and taking a certain amount of insulin to match what you want to eat. Rather than being told you just have to eat about the same amount all the time

Scott Benner 9:27
my mind jumps to, excuse me, my mind jumps to I wonder how many people's doctors keep cranking up their insulin to carb ratio as they get older or gain weight or something like that, and don't reevaluate their Basal. And how many people's insulin to carb ratios are probably wrong. We're more aggressive than they need to be if they're basil was right. That's the thing. I really wonder about it. Yeah. I think that this is I think diabetes is a good example of people wanting to be set it and forget it. It's not Your your situations change. Like you know Arden's a great example at college, there's one quality of food at home, there's a different quality, she needs more insulin in college than she does. At home, she needs more basil at college, her carb ratio stronger at college than it is at home. But that's happening to people all over the place. And doctors, generally speaking, ignore your basil. Like, I know, that's not everybody, but a lot of people's basil does not get considered again. So as you start needing more insulin, I think they start putting it into your correction factor. And they start putting it into your carb ratio sometimes.

Jennifer Smith, CDE 10:37
Yeah, I think the car ratio is the one that's the heaviest in terms of first adjustment. I always actually consider the correction factor or as like the forgotten, like stepchild and corner kind of, like, I have some people that I end up working with initially. They're like, I don't know, what does that do? Or I don't know, that hasn't been changed since I started on a pump 15 years ago. And I'm like, it makes me kind of cringe that nothing's been evaluated.

Scott Benner 11:10
So correction factor. One you live insulin moves your blood sugar, how far right? Correct. When Arden was a few years into diabetes, I started thinking like, I can't move these high blood sugars. Like I couldn't figure out why. And i Nobody told me like I had to dig through it. It was before I'm with Scott from the podcast, and like, so I was like looking through it. And I realized that Ardens correction factor was one moved it they had it set at 301 unit moves or 300 points. Well, that was not even close to being true. And even back then it was more like one to 100 today, today. It's like 143, maybe, you know, and so, but that's also things that we reassess. So you need to know what these things are, so that you know what they do so that you know that you need to look at them when you're having issues. Correct. Yeah. Okay.

Jennifer Smith, CDE 12:06
And I think that's a good point to make. As you said before, this isn't a set it, I figured it out, and okay, now I've got it for the rest of my life, it's not that way at all. You may have lifestyle change, you may have growth in your child or your teenager, you may have something significant that shifts for you as an adult. And so once you have it set and figured it out, once you start seeing it, something isn't working, and I haven't changed any other variables, then you need to reassess, well, gosh, maybe my one unit per 10 grams of carbs isn't working anymore. I'm now always low after lunchtime, yeah. Reevaluate.

Scott Benner 12:47
I just thought of something I never occurred to me before, I'm just gonna say it here, before we end, you buy a brand new car, and they tell you it gets 30 miles to the gallon. And you drive it away, as you drive it away, you think, Oh, they told me to use premium fuel, but I don't want to spend all that money on that I'm going to use regular, now you're gonna get less gas mileage, then the air filter starts to get dirty, and you're gonna get a little more lowering of your gas mileage, and then the tire start wearing unevenly and your gas mileage lower it literally, diabetes does the same exact thing. You know, like, if you moved to an area that's at a different elevation, your car will get different gas mileage. If you move to a higher elevation place, you don't need as much insulin most of the time, like so. They're, they're all these little things. We call them variables when we're talking about them, but they're, they're all these little unseen forces that change how much insulin you need that and they're everywhere, and you're not thinking about them. So reassessing your insulin to carb ratio. And your other settings is really important. So yes, okay. Well, there we go. i Because I said to her, I'm like you want us to describe what a carb ratio is? And she said, Yeah, I'm like, I think that's going to be like a 45 second episode. Are you sure we need that? And she's like, You should see how many people don't know we need somewhere to be able to send them and I said, Okay, fair enough. I'll make Kelly do it. Awesome.

Jennifer Smith, CDE 14:11
I think that was, I don't know. 10 minutes. 11 minutes wasn't bad. It was bad. No, it was purposeful. So yeah,

Scott Benner 14:18
yeah. Right in right now. All right. Thank you. Sure. I might have ruined all your fun by telling Jenny she says curb. Thanks so much to Jennifer Smith. Hey, Jenny works at integrated diabetes.com If you're interested in hiring her I also want to thank Omni pod makers of the Omni pod dash and Omni pod five and remind you to head right now to my link Omni pod.com forward slash juicebox I can't say enough good things about Omni pod. I hope you go check it out. The entire defining diabetes series is in your podcast player. If you want to see a list of the episodes go to juicebox podcast.com up top in the menu, click on defining diabetes. And there's a list. That same list is available in the featured tab of the private Facebook group Juicebox Podcast, type one diabetes. I hope you're following the Facebook groups. There's a private group with 40,000 members, great conversations all day long about diabetes. And there's a public page Juicebox Podcast, give them a follow. You're gonna find them incredibly helpful. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#830 Defining Diabetes: MDI

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define MDI.

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

In this episode of defining diabetes, Jenny Smith and I are going to define m D i multiple daily injections. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you're enjoying Jenny, and you'd like to hire her, you can she works at integrated diabetes.com. Are you a US citizen who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box and fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward, and you may just help yourself T one D exchange.org. Forward slash juicebox. I have an unprecedented amount of time before the music stops. Let me just tell you, thank you for listening to the show. And if you're really enjoying it, leave a beautiful five star review and a rating wherever you listen. Great reviews, help other people to find the show. So I'm going to say something really crazy here. Because every time this is so embarrassing. Every time I must have tricked myself out of it. Every time I talk about defining diabetes, what do I say to you? I'm like, I tell a story about the person who said I didn't know that I was MDI until I listened to the show. Well, that experience must have tricked my brain into believing this is so embarrassing that we had done a defining diabetes episode on MDI, which in 46 episodes of it, we have never done do. It's so embarrassing.

Unknown Speaker 2:11
I feel bad that

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

#826 Defining Diabetes: Meet the Need

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Meet The Need.

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Scott Benner 0:00
Hello friends and welcome to episode 826 of the Juicebox Podcast

Hey in this episode of defining diabetes Jenny Smith and I are going to define meet the need. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. If you're enjoying Jenny and you'd like to hire her, you can she works at integrated diabetes.com. Are you a US citizen who has type one diabetes or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box and fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward and you may just help yourself T one D exchange.org. Forward slash juicebox. I have an unprecedented amount of time before the music stops. Let me just tell you, thank you for listening to the show. And if you're really enjoying it, leave a beautiful five star review and a rating wherever you listen. Great reviews help other people to find the show.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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