Scott Benner 7/23/20 Scott Benner 7/23/20

#360 Defining Diabetes: Fat and Protein Rise

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Fat and Protein Rise. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.

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Check out the Diabetes Pro Tip episodes and Juicebox Docs

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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
This episode of defining diabetes is brought to you by Omni pod, the tubeless insulin pump, and dexcom, makers of the dexcom g six continuous glucose monitor. Find out more at my Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box on the pod we'll even send you a free no obligation demo. In this episode of defining diabetes, Jenny Smith and I will be defining fat and protein rise. Now you know Jenny, she's an all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. Jenny services are for hire, check her out at integrated diabetes.com.

We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice medical more. Otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

Do you have an absolutely spectacular endocrinologist certified diabetes educator diabetes, nutritionist if you know anybody who's helping you with type one, you have one like that, that you'd love to share with other people? Or are you looking for one that fits that description? Check out juicebox docs.com. If you do JUEBOXD OCS, it's a place where I'm collecting an amazing list of fantastic support for people with type one diabetes, it's absolutely free. If you have somebody great to add, check it out. If you're looking for somebody, check it out.

Let's do protein rise. Because as you know, and these are separate episodes, so you would have heard me say on one of these other define diabetes, but I got the chance to wear a glucose monitor for 10 days. And I ate pizza. And hours later, my blood sugar started to go back up again. I was like oh my god, this is the thing. You could see it. It's not as bad as if you have diabetes nowhere near and I guess for context what it meant what I meant by that was I ate pizza. I was in like that it was at the end of the day. So my blood sugar was more like 95 or I'd been snack. I was listening. I made the pizza from scratch. So you know there might have been some pepperoni and cheese going in. And maybe I was stepping in the sauce along the way while I was working. So I had some food going. I was snacking a little bit made the pizza I ate the pizza. About eight o'clock at night I had two slices of homemade pizzas. So you know, basic ingredients, not giant slices. And it midnight, my blood sugar tried to go off. And I was like what sorcery is this? You know and it and I'm texting Jenny the next day. I'm like, I gotta fat and protein rise yesterday was the weirdest text our text while By the way, Jenny and I will do an episode at some point that just is me talking about wearing a glucose monitor because it's frying my mind. But But anyway, a protein rice, can we say fat and protein rice here? Do you think it's worth just describing them that way together?

Jennifer Smith, CDE 4:11
I think they're both.

They're both food specific. They both happen or start to happen in about the same timeframe in the aftermath of a meal. They both have a little bit of a different impact and a little bit of a different strategy for managing them or preventing them really. But yeah, I think they they go Okay,

Scott Benner 4:32
so we're really good. This is going to be short. We're really just going to define it here because Jenny and I have already done what I think is an exceptional pro tip episode about fat and protein rise. But for those of you who are newer to diabetes and are hearing people say Oh, that looks like protein to me. And that doesn't make any sense to you because your endo told you that protein doesn't have carbs and it does your car. Yeah, capture carbs, you'll be fine. It's not the case. So like I said deep dive in the pro tip episode, but for defining purposes, when you hear someone say that looks like a protein rise, or a fat rise, or a fat and protein rise, Jenny's gonna explain to you what it is right now, because she's better at this than I am.

Jennifer Smith, CDE 5:10
Yay. So protein and fat do have impact on blood sugar, it all is relative, essentially, to portion and sometimes the content of what you're eating at a mealtime, right. So protein and fat rise, usually, you're going to see it started about the same time in the aftermath of a meal sometime between about two to three hours after the meal, sometimes a little bit later. Like your example with the pizza started a little bit later, like the four hour kind of mark, probably because it was a little bit both of protein and fat. Yep, kind of happening, right. But protein typically will raise blood sugar into scenario is one, you've had a really large amount of protein more than the typical three to four ounce, you know, portion at a meal time, or you've eaten a really low, almost no carb containing meal. And so then what ends up happening is the body breaks down protein, in both scenarios, into Google's starts to happen hour and a half to two hours after the meal, you get this like slight rise that happens, if you don't compensate for some of the protein at the end of the meal. With insulin in one way or another, you're going to get a rise, and then you're going to end up correcting to get it back down.

Scott Benner 6:22
And so if you're looking for a very simple way to wrap your head around that concept, you know, when you see somebody market something that's pure sugar, and they say it's fat free. There, and technically they're right, there's no fat in the sugar, and then you eat the sugar and your body goes, What should I do with the sugar? Hmm, you know, don't turn it into fat. So, technically, you're right, there was no fat in it when you ate it, but it all became fat afterwards. So similarly, you eat this protein, and there are no carbs in it. But then your body begins to break the protein down, and all of a sudden, your blood sugar starts going up. And for most people, it makes zero sense because you'll think I ate like zero carbs at my last meal. This doesn't make any sense. But it does. And it's real. And it's always going to happen. It's not, it's not not going to happen. So when I look at Arden's food. And I'll be like, oh, there's, you know, I don't know, a roll. And I always throw in. I don't know, I don't want to give people a number because what I do is completely random. But when I see some meat on

Jennifer Smith, CDE 7:30
random for artists, right, right for art,

Scott Benner 7:34
yeah, six or seven carbs, I add for for the protein if there's cheese involved, or a lot of butter or something like that. And sometimes I go to 10. But, you know, there it is, it's going to happen now, like Johnny said, but pizza, and this will be explained in the pro tip episode. But there's the cheese in the pizza slows down your digestion, which pushed basically, for me pushed off the digestion of the crust, way out into the future. Because as a person without diabetes, I don't think I was getting much of a rise out of the protein or the fat I was, I just my body didn't, quote unquote, get to the dough until a significant time later. So that's what a fat rise or a protein rise is. If you really want to understand it, Jenny did an amazing job of explaining it. And I pretend that I knew what she was talking about in that episode. So I'll put the episode number at the end so people know it. But it's it's game changing. There's also a couple episodes around keto eating, or low carb eating that that go deep into this idea as well.

Jennifer Smith, CDE 8:44
Yeah, the person who had on for the keto was very, very, they were very good. Well explained,

Scott Benner 8:49
oh my god, she's going to just be giddy when she hears you say that just so you know. She's, I will get a note at some point. So I'm talking to you in the future. Now, I'm gonna get a text that said, Jenny just said I did a really good job of my bike months from now and I'll be like, What did she

Jennifer Smith, CDE 9:07
was great. It was it was good.

Scott Benner 9:09
She really understands it now in a different way. To learn more about how fat and protein can affect your blood sugar, check out Episode 263 diabetes, pro tip, fat and protein. It's with me and Jenny. It's a much longer description of what we talked about here. Friends, it's time to get yourself a free, no obligation demo of the Omni pod sent over to the house. Okay, let's talk about the Omni pod tubeless insulin pump, besides being absolutely spectacular, is the insulin pump that my daughter who was about to turn 16 has been wearing every day since she was four years old. That's a long time. Every day on the pod comes through exactly the way we expect it to and in a myriad of ways By being unobtrusive by being tubeless by helping us with extended boluses Temp Basal rates and just being what's the word I want really just it's there, it's solid. You don't I mean, like it does, it does what I think it's going to do when it's going to do it, I get what I expect. And what I expect is a quality insulin pump. That gives me the delivery and the wearability for my daughter that we need. And that means that she can stay attached to her insulin, when she's playing sports without being obtrusive, while she's taking a shower, sleeping, running around in the backyard, jumping on the trampoline, riding a bike, swimming, all of the things that your body still needs insulin for, you know, when you hear people saying, Oh, I disconnect for that? Well, they don't have insulin during that time. And that's very likely gonna cause a high blood sugar. Now, I understand that two pumps need to be disconnected sometimes. But the Omni pod never needs to be disconnected. It's tubeless. Wonderful. And you don't have to take my word for it. Because on the pod will be thrilled, happy, elated, delighted to send you a free, no obligation demo that you can try on yourself. Find out if what I just said is true. But you notice, but still try my on the pod.com Ford slash juice box. Check it out, get the demo, decide what you want to do. If you want to keep going with Omni pod, it'll be easy. And if you don't, no harm, no foul. You were just trying. That's why they call it no obligation. Now I have an obligation to tell you about the dexcom g six continuous glucose monitor. This application is both business oriented because their advertisers and moral because I think everyone should know about the dexcom g six continuous glucose monitor. Here's why. I'm going to use an example from this morning. Arden wakes up her blood sugar is 106 I see it on her Dexcom nice and steady. I hear her moving around upstairs. No big deal. She's getting her facewash getting dressed getting ready to actually go out right now. All of a sudden her blood sugar diagnol up starts moving up. 106 turns into 115 turns into 118 all of a sudden 125 Well,

we bolus right we're trying to stop that rise before it happens. Arden's trying to go out she's trying to do things she needs to eat. She doesn't need to walk into this day. 5060 7080 points higher than she needs to. But imagine had she woken up and tested her blood sugar with a meter boom, she would have saw 106 and thought, Hey, I'm doing great. And then she never would have seen anything that happened next. And then a half an hour 40 minutes later when she's sitting down to eat and tests again, you know in a world without a CGM. Who knows what she is to 25 now suddenly, the first meal is in jeopardy. It puts the rest of the day in question. You're looking at roller coaster going up and down up and down or skipping a meal. Instead, beep beep Arden's blood sugar hits 120 she gets a little insulin right back to where we need to be ready for that meal ready for the day. That uniquely happened. Because Arden has a dexcom g six continuous glucose monitor. Now that's just one example. Imagine all of the other ways that technology can be used for you. Imagine that the way I found out about it wasn't because I was bugging Arden while she was getting dressed. It's because it popped up on my iPhone. Because the dexcom g six has Sharon follow. And that works on Android and iPhone. So Arden CGM told her app or app, put it up in the cloud came back down on my phone. And just like that, we averted a high blood sugar, a burden a problem at a meal. save the day Dexcom g six is gonna save more than one day for you. That's for certain. Find out how you can get a dexcom@dexcom.com forward slash juice box. There are links to Dexcom Omni pod and the other sponsors at Juicebox podcast.com. If you can't remember them, they're also right there. in the show notes of your podcast player, you can click on them right there, like click Like with your finger. But very much appreciate when you support the sponsors because it supports the podcast, whether it's on the pod Dexcom the Contour Next One blood glucose meter or touched by type one. When you check out the links. You're telling those sponsors. I listen to the Juicebox Podcast I heard about you there may keep sponsoring you keep getting the podcast for free. Seems like a good deal.

Unknown Speaker 14:49
All right, a little

Scott Benner 14:50
bit of music, and we're out of here. Do I have any announcements here? Maybe one Hold tight. You can find the rest of the defining diabetes series as well as ask Scott Jenny and the diabetes pro tip episodes at diabetes pro tip comm you can find them too at Juicebox podcast.com. But, you know diabetes pro tips pretty easy to understand notice after the P, so just the P no si p a.com diabetes pro tip.com. Also, if you have a great doctor or need one, for type one diabetes, check out juicebox Doc's calm, do cs juicebox Doc's calm and ever growing list of Type One Diabetes health care professionals that listeners of the podcast have recommended. Let me give you a couple of examples. For instance, right there in Australia, Rachel Baker, Rn and CDE he does some amazing work. How about up in Canada? Dr. Jeremy Gilbert over in Ontario, that's Toronto. You understand Toronto, Ontario, right? Like Canada does their places weird? I mean, compared to how we do it? How about Melissa and tonic? in Fairfax, Virginia alfonzo Armstead, Nashville, Tennessee, and many, many, many more. And people put in effort when they send in their doctors to give real examples of why, for instance, someone wrote in that Elizabeth Harris in Chapel Hill, North Carolina, she said about Elizabeth. I've worked with Dr. Harris for close to a decade and she's taking care of me through many different stages of my diabetes from the disengaged teenager to the engaged but struggling young adult to well controlled debate goes online. Check it out, juice box Doc's calm. It's not a pay service. None of the doctors are paying me to be there. It's just me trying to take your good experiences and putting them in one place to somebody else can get the advantage of what you've learned about your doctor.

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Scott Benner 7/19/20 Scott Benner 7/19/20

#358 Defining Diabetes: Compression Low and Interstitial Fluid

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.

Check out the Diabetes Pro Tip episodes and Juicebox Docs

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of defining diabetes is brought to you by Omni pod, the tubeless insulin pump, and dexcom, makers of the dexcom g six continuous glucose monitor. Find out more at my Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box on the pod we'll even send you a free no obligation demo. In this episode of defining diabetes, Jenny Smith and I will be defining compression low and interstitial fluid. Now you know Jenny, she's in all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. Jenny services are for hire, check her out at integrated diabetes.com.

Do you have an absolutely spectacular endocrinologist certified diabetes educator diabetes, nutritionist you know anybody who's helping you with type one? You have one like that, that you'd love to share with other people? Or are you looking for one that fits that description? Check out juicebox docs.com. If you do JUEBOXD OCS, it's a place where I'm collecting an amazing list of fantastic support for people with type one diabetes, it's absolutely free. If you have somebody great to add, check it out. If you're looking for somebody, check it out.

So this one is Dexcom specific, although you might tell me it's more than Dexcom specific. Okay. Compression low. So if you use a if you use a Dexcom, for sure. And does it work that way for other devices, too?

Jennifer Smith, CDE 2:50
Oh, for like libri. And for Medtronic, yes. Okay. I mean, essentially, because they're all reading the same interstitial glucose from the fluid. So really, when you compress that site, regardless of the sensor brand, what it is right, you get the same impact of the same issue.

Scott Benner 3:11
Okay, so here's, here it is, if you're wearing a glucose monitor, and your blood sugar is just cruising along super stable, and then all the sudden it drops so drastically that it seems abnormal, and you panic. And you're like, Oh, I'm dying.

Jennifer Smith, CDE 3:30
I feel like it looks like a cliff die. That's how I kind of describe it to people. Like you're sitting on the edge of this beautiful cliff. And all of a sudden, like, like right over the edge it going. You're like,

Scott Benner 3:41
supposed to do that. And I Can you see them? I can see them now. Oh, yeah. Yeah, like you look at the graph, you're like, Oh, she's not really low. But But here's what could happen. You could have a glucose monitor early on, see that low, eat a bunch of food, and then 10 minutes later be significantly higher and think I don't understand what happened. I was I've been 110. Then suddenly, I was 55. And I took in enough cars. Why am I 200? All the sudden, right? So here's what happens. A continuous glucose monitor is reading interstitial fluid. And I have to say, we do this all the time. And I'm not a fan of it. Really. I say that. Like I say that, like I know what the hell I'm talking about. Okay, but interstitial fluid. I'm gonna tell Jenny like, what is it? Exactly, because I say it because I know what the function is in my life with diabetes, but I couldn't define those words. I don't believe.

Jennifer Smith, CDE 4:40
Yeah, I mean, in layman's terms, essentially, interstitial fluid is just the fluid between all those cells and everything within the body. So you know, you've got glucose in the bloodstream, and then glucose moves out of the bloodstream in through your interstitial fluid. into the cells in order to be utilized, right. So it's like this pass through effect, which is often the reason then outside of even, of compression mo issue. It's also the reason that there's lag that's visible in all the CGM systems because glucose, blood glucose is your first like real time right now value, right? And anytime that glucose is moving out and into your interstitial fluid, to see glucose levels change there, they have to first come out of the bloodstream, if that makes sense, right. So there's a lag time essentially. And a big part of the leg is often when glucose levels are changing very rapidly in the bloodstream, or around food or quick activity or whatnot. But even so then with compression low, there's still time that it takes for that change in glucose to happen from blood glucose to interstitial fluid glucose. So compression lows are very visible, like you said, you can you can almost 100% kick them out, because that you're coasting along quite nice. And all of a sudden, it just falls down. Yeah, that's not how fast blood sugar changes,

Scott Benner 6:25
it could fall that fast. If an hour earlier, you gave yourself a big bolus and forgot to eat and then there would be a moment in that drop where you were falling like that, but you don't just go from stable to like, floor falls out from under you. That's, that would be uncommon. So this, so this episode just turned into defining diabetes, interstitial fluid, and compression. Lo I just decided, as we were talking, I'm looking online. And you know, obviously, what you said is 100% is what I'm seeing here. interstitial fluid is a thin layer of fluid which surrounds the body cells. interstitial fluid becomes useful has become useful recently in the monitoring of glucose levels with people with diabetes. And let me thank diabetes.co.uk for having great see SEO and popping up in my Google search. So interstitial fluid, as Jenny's described is carrying glucose that your your glucose monitor is monitoring,

measuring, right, thank you,

when you roll over, or sit down, or push really hard on your sensor, and by the way, I'm wearing one right now. So I'm pushing very hard on mine, right now I get to wear one for 10 days for the very first time in my life. And you do that that compression of the sensor into your body is dispersing the interstitial fluid away from the sensor wire. So your blood sugar, interestingly enough, right around the wire is being read accurately as 50, all of a sudden, because you've pushed most of the glucose away from the wire that's doing the measurement. But your body, your glucose in your body hasn't changed. It's just literally changed around where you're pushing on it. That's a compression low a low that shows up because you're laying on pushing on sitting on whatever, your sensor, and what the first number of times it happens to you. I can speak. You know, from my experience with Arden, it'll flip you out, then, but then, like Jenny said earlier, the first thing you can do is look at that graph. And eventually, you'll see what that curve looks like for a compression low. And then it takes How long do you think how many cycles of the CGM before it starts figuring things out again, and the food comes back?

Jennifer Smith, CDE 8:44
You know, I think that's, there's probably a variance, but it's also a very quick turnaround. In fact, I was gonna mention to from the data point, visual, you know, each little.is supposed to represent like a five minute interval, right? Well, when that glucose has fallen off the cliff or nosedived, there's, there are less dots, it becomes less accurate with the number of dots and the like the fluidity of the dots and the movement. So you'll also see as soon as the compression low writes itself, either you move in your own sleep, or mom or dad wake you up because they got the alert and they wake you up and have you roll over whatever. It typically writes itself. Fast after that, and all of a sudden, you'll see almost like, you know, a rocket ship has shot the blood sugar back up to kind of where it had found a look on the graph. Yeah, it's how it'll look on the graph. And you'll also see those dots become a lot more stable and normal. I got a long it takes I think it depends on how soon the compression lowers address, right. You know, for an adult on their own. Maybe they didn't even hear the alert or maybe it took a while for them to hear the alert. And so it takes them a while to move enough. And so then that low might look longer than a typical up down.

Scott Benner 10:15
I find myself wondering sometimes does Arden's phone beep and just that beeping stirs are sleeping off that she turns over, because there's times I'm not woken by it, but in the morning, you'll come and go, What happened here? You know, where it's like steady, steady, steady, 50. back up to the where it was steady, steady, steady, and nobody woke up. But there are also other times where if she's, if she's, I guess sleeping harder and doesn't roll off of it. I have to make my way across the house. And I the words aren't in rollover, you're laying on your sensor have come out of my mouth a number of times in my life. Yes, Arden rollover, you're laying on your sensor, just enough to I'm trying to put it indoors subconscious or, you know, whatever it is when you're saying, like, please stay on this side or something. But isn't it interesting? Arden Where's her sensor? In the same basic two areas, she's on her hip, left to right, left to right. And because you get 10 days in between, we just bounce back and forth. It doesn't you know what I mean?

Jennifer Smith, CDE 11:11
And the likelihood that you're going to hit exactly the same place right on that side after 10 days of not being I mean, it's like a million to one we don't live

Scott Benner 11:21
it around still a little bit. But my point was, is that with like compression was don't happen to us very often, because we have good spots. But if you move it more towards your hip bone or something like that, I guess it just changes how you sleep on iOS, sometimes I just wonder, does she sleep differently? Sometimes and not others, but it's got to be more about the the positioning of the of the sensor. So that's why like stomach sleepers, if you wear it on your stomach, you might you might be getting that, you know, side sleepers on your hips, like there's ways around it. But it's one of those things that you just hear people talk all the time, like, Oh, that's a compression low and people who no say it, like, that's just a compression low, right to the person who didn't know, they were like, I thought I was dying, just so you know. So in the beginning, and probably we should say you should still test them. But like, if you see a 50, you do a finger stick and you're 108 that's what's going on. And don't calibrate your meter or your your glucose monitor. And they're like, if you're keep that in mind if you're 100 Nate, and suddenly it says 50 do not calibrate it. Because it really, really, it really believes it's 50 because it's reading that dispersed fluid and you will mess it up in that situation. So, you know, test when you're not sure. But I think it's fair to say that after a number of years with diabetes, you'll you'll know the difference. And by the way, if it's not a compression low, it won't take long for you to figure it out. Right, you know, because you'll keep dropping most likely. Right, Jennifer? We're just too good at this to be perfect. I think we could probably do this while riding on a bus. reading a newspaper like we could be sure we those two dolls in the Muppets we could be up in the rafters like making fun of the people on stage and at the same time telling people what a protein rises.

Jennifer Smith, CDE 13:11
That would actually be really humorous like skit to do.

Scott Benner 13:16
Wow, these people have found a way to make diabetes even more exciting than it is now. Friends, it's time to get yourself a free, no obligation demo of the Omni pod sent over to the house. Okay, let's talk about the Omni pod tubeless insulin pump, besides being absolutely spectacular, is the insulin pump that my daughter who is about to turn 16 has been wearing every day since she was four years old. That's a long time. Every day on the pod comes through exactly the way we expect it to. And in a myriad of ways, by being unobtrusive by being tubeless by helping us with extended boluses Temp Basal rates. And just being what's the word I want really just it's there, it's solid. You don't mean like it does. It does what I think it's going to do when it's going to do it, I get what I expect. And what I expect is a quality insulin pump. That gives me the delivery and the wearability for my daughter that we need. And that means that she can stay attached to her insulin, when she's playing sports without being obtrusive, while she's taking a shower, sleeping, running around in the backyard jumping on the trampoline, riding a bike, swimming, all of the things that your body still needs insulin for. You know when you hear people saying oh, I disconnect for that? Well, they don't have insulin during that time, and that's very likely gonna cause a high blood sugar. Now I understand that tube pumps need to be done. Connected sometimes. But the Omni pod never needs to be disconnected. It's tubeless. Wonderful. And you don't have to take my word for it. Because on the pod will be thrilled, happy, elated, delighted to send you a free, no obligation demo that you can try on yourself. Find out if what I just said is true. But you notice, but still try my on the pod.com forward slash juice box. Check it out, get the demo, decide what you want to do. If you want to keep going with Omni pod, it'll be easy. And if you don't, no harm, no foul. You were just trying. That's why they call it no obligation. Now I have an obligation to tell you about the dexcom g six continuous glucose monitor. This obligation is both business oriented because their advertisers and moral because I think everyone should know about the Dexcom g six continuous glucose monitor. Here's why. I'm gonna use an example from this morning. Arden wakes up her blood sugar is 106 I see it on her Dexcom nice and steady. I hear her moving around upstairs. No big deal. She's getting her facewash getting dressed, getting ready to actually go out right now. All of a sudden or blood sugar diagonal up starts moving up. 106 turns into 115 turns into 118 all of a sudden 125 Well,

we bolus right we're trying to stop that rise before it happens. Arden is trying to go out she's trying to do things she needs to eat. She doesn't need to walk into this day. 5060 7080 points higher than she needs to. But imagine had she woken up and tested her blood sugar with a meter boom, she would have saw 106 and thought, Hey, I'm doing great. And then she never would have seen anything that happened next. And then a half an hour 40 minutes later when she's sitting down to eat and tests again. You know in a world without a CGM. Who knows what she is to 25 now suddenly, the first meal is in jeopardy. It puts the rest of the day in question. You're looking at roller coaster going up and down and up and down are skipping a meal. Instead, beep beep Arden's blood sugar hits 120 she gets a little insulin right back to where we need to be ready for that meal ready for the day. That uniquely happened because Arden has a dexcom g six continuous glucose monitor. Now that's just one example. Imagine all of the other ways that technology can be used for you. Imagine that the way I found out about it wasn't because I was bugging Arden while she was getting dressed. It's because it popped up on my iPhone. Because the dexcom g six has Sharon follow. And that works on Android and iPhone. So Arden CGM told her app or app, put it up in the cloud, it came back down on my phone, just like that we averted a high blood sugar, burden the problem at a meal, save the day Dexcom g six is gonna save more than one day for you. That's for certain. Find out how you can get a dexcom@dexcom.com forward slash juice box. There are links to Dexcom Omni pod and the other sponsors at Juicebox podcast.com. If you can't remember them, they're also right there. in the show notes of your podcast player, you can click on them right there, like click Like with your finger. But very much appreciate when you support the sponsors because it supports the podcast, whether it's on the pod Dexcom the Contour Next One blood glucose meter or touched by type one. When you check out the links. You're telling those sponsors, I listen to the Juicebox Podcast I heard about you there. They keep sponsoring you keep getting the podcast for free. Seems like a good deal. Alright, a little bit of music, and we're out of here. Do I have any announcements here, maybe one Hold tight. You can find the rest of the defining diabetes series as well as ask Scott and Jenny and the diabetes pro tip episodes at diabetes pro tip.com. You can find them too at Juicebox podcast.com. But you know diabetes pro tips pretty easy to understand no s after the P so just the P no si p.com diabetes pro tip.com. Also, if you have a great doctor or need one for type one diabetes, check out juice box docs.com do cs juicebox Doc's calm, an ever growing list of type one diabetes, health care professionals that listeners that the podcast have recommended. Let me give you a couple of examples. For instance, right there in Australia, Rachel Baker, Rn NCD. He does some amazing work. How about up in Canada, Dr. Jeremy Gilbert, over in Ontario, that's Toronto. You understand Toronto, Ontario, right? Like Canada does their places weird? I mean compared to how we do it. How about Melissa and Tony Nik in Fairfax, Virginia, alfonzo, Armstead, Nashville, Tennessee, and many, many, many more. And people put in effort when they send in their doctors to give real examples of why, for instance, someone wrote in that Elizabeth Harris in Chapel Hill, North Carolina, she said about Elizabeth, I've worked with Dr. Harris for close to a decade and she's taking care of me through many different stages of my diabetes. From the disengaged teenager to the engaged with struggling young adult to well controlled diabetic goes online, check it out, juice box, Doc's calm. It's not a pay service. None of the doctors are paying me to be there. It's just me trying to take your good experiences, and putting them in one place so somebody else can get the advantage of what you've learned about your doctor. Thank you so much for listening. coming up soon on the podcast. There'll be another after dark episode. Another pro tip is coming with Jenny about pregnancy and type one diabetes and of course, tons and tons and tons of interviews and conversations with people just like you. I'll see you soon.

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Scott Benner 7/3/20 Scott Benner 7/3/20

#352 Defining Diabetes: Rage Bolus

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.

Check out the Diabetes Pro Tip episodes and Juicebox Docs

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of defining diabetes is brought to you by Omni pod, the tubeless insulin pump and dexcom, makers of the dexcom g six continuous glucose monitor. Find out more at my Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box on the pod we'll even send you a free no obligation demo in this episode of defining diabetes, Jenny Smith and I will be defining rage bolus. Now you know Jenny, she's an all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. Jenny services are for hire, check her out at integrated diabetes.com.

We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice medical more otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.

Do you have an absolutely spectacular endocrinologist certified diabetes educator diabetes, nutritionist if you know anybody who's helping you with type one, you have one like that, that you'd love to share with other people. Where are you looking for one that fits that description? Check out juice box docs.com. If you do JUIZBOXD OCS It's a place where I'm collecting an amazing list of fantastic support for people with type one diabetes. It's absolutely free. If you have somebody great to add, check it out. If you're looking for somebody, check it out.

Unknown Speaker 2:31
Rage Bolus.

Scott Benner 2:33
So I know that that

Jennifer Smith, CDE 2:36
hasn't rageful I mean, everybody has

Scott Benner 2:39
just like, at some point, you look at your blood sugar or someone else's blood sugar you're helping and you're like, damn it. I just don't care more, more and more. And it's always and when you rage bolus, the idea is that you know you're putting in more than you need, because you're just trying to crush the situation and you're willing to live with a low later to stop what's going on right now. Is that how you think of it?

Jennifer Smith, CDE 3:02
Oh, yes, I you know, a rage Bolus is a you know, even if it's mostly on a subconscious level, like you're not really acknowledging but you're like, I'm just take five units right now because I'm so tired of this like high blood sugar. And I know five units is too much like subconscious level. I probably only need the two units that my pump is recommending. But I just want this blood sugar down. And I'm not waiting six hours for it to happen. I'm gonna do it. Now. It's gonna work right yet.

Scott Benner 3:31
Yes, I Jenny's not wrong. I've done it. She's done it. Everybody has done it. It's actually interesting, because I've got a chance to wear a glucose monitor for a little bit. I think my body does it sometimes too. I it's very interesting. When if I eat too much simple sugar. My body appears to push back harder with insulin than it does if what I've eaten is more balanced. Yeah. Oh, it's so fascinating. But But anyway, taking me out of it and keeping it with people who are using you know, manmade insulin. When you hear someone say I rage Bolus, that's what they're talking about. They're talking about they had a high that they just couldn't do so they hit it with more insulin than they knew it needed just to make it go away. Now, there are great reasons why you could have a high stuck blood sugar. And I again think that if people listen through the pro tip episodes, they might not get into that situation is frequently I have to say that you know now for art and you know if I'm raged bolusing and now I'm making quotes, it's for like a blood sugar. That's 180 that won't move. You know, like no line. I don't rage

Jennifer Smith, CDE 4:43
Bolus is not like 10 units for that no, a lot less because you're starting at a lower high

Scott Benner 4:49
rate really crazy rage balls for us at this point would be three units now. Right But back when her blood sugar was, you know would go to 300 and sit there and I'd stare at it and be like, I don't know what's happening. But it was a lot more insulin than I was just like more and more and more. And then, you know, suddenly you're like, oh god, I gotta catch it with food. And it turns into a whole thing. But my reasoning for wanting to define it is because I think that people use the term when they use it, like in community or online. It's it's fairly accepted that this is something that has to happen. And I do believe that once in a while, you're going to need to do that. But if you're doing that constantly, again, that's a signal that something's wrong, you know, somewhere else. And so please,

Jennifer Smith, CDE 5:40
salutely, right. It's just kind of like you're bumping nudge? Yeah, if you're doing it occasionally, that's the purpose. If it comes into use every single day, there's something that's not right. It's just not right. And

Scott Benner 5:53
you and you can do something about it. I did something very uncommon for me yesterday, I saw a person in a Facebook group that was not my facebook group. And they said that they were getting low to the point of passing out every day of their life. And I just was like, I can't, I can't walk past this,

Jennifer Smith, CDE 6:13
I need to help you. I said,

Scott Benner 6:14
seriously, I can't do this. So I jumped in. I said, Look, I'm very sorry for sharing my content in here. I'm like, but this is diabetes, pro tip calm, you go listen to those episodes, this isn't gonna happen to you anymore. And so I couldn't, I couldn't leave, I just couldn't walk away for I actually felt like I saw a car accident, and the car was on fire. And I thought I might die. But I gotta try to get this person out of here. Because on social media, sharing your own content, and somebody else's place is a lot like risking your life because people can turn on you. You know, but I just couldn't, I could, I couldn't walk away from it. So I feel the same way about rage. bolusing it's, it can really be dangerous to you. And so absolutely, right. So the best way to I know I say these stupid things, but the best way to not get it you know, to not have the rage of all this is the knockout. Hi, which is like now people are like, yeah, thanks, idiot. I know, but,

Jennifer Smith, CDE 7:09
but I'd like to not get high either.

Scott Benner 7:12
Wow, do you have a don't get high episode jerk. But, but turns out I do. So, you know, I don't want to see you in that situation where you're constantly racing, but you understand what it means now. And that's the first step to enlightenment, which sounded way more high minded than I meant it to.

Jennifer Smith, CDE 7:32
We'll also talk so much about rage. bolusing and I think that there's also the opposite of it. But there's no defined like, like term for it like rage. bolusing It's not like rage carving, like when you're affecting like a low blood sugar with this amount that you know is way too much. Like even in your low brain of like fuzziness. You're like, Oh, yeah, if I eat the whole bag of taffy, that's probably gonna make me be 300 but you know what? I'm so low right now. I'm just gonna

Scott Benner 7:59
doesn't matter. And that doesn't matter. You'll get a little bonus definition here. Is that eat the kitchen?

Jennifer Smith, CDE 8:05
I that would be

Unknown Speaker 8:08
it? That's right. Yeah, the kitchen is how

Scott Benner 8:10
I hear people talking about it. Like I felt like I could have eaten everything in the kitchen. Or eat the refrigerator, fridge. The fridge, right? There's other ways to think about it. It's interesting as you describe that, I know you have to go but I really just recognized how that's one of the separation points for me not having diabetes. Like there's I have no context for that. I know what it looks like when I watch but I don't know what it feels like when it's happening. You know, I can I can describe what I see with my daughter, but I don't I imagine it's pretty frightening. And yeah, you know, in just I don't know if you imagine your blood sugar's real high, you you've been like that for hours, you're cloudy, you're moody. And you've got this, you've got this device in your hand and you're like, you know what, I just gonna give myself a lot of this right now and see what's going to be you know, feels like a feels like a jumping off a cliff and you're like, I hear water down there. I can't see it. It's probably down there. You know, you're I go. Anyway, it's, it's it's really lovely to have somebody perspective who, who genuinely has been through it. So thank you very

Unknown Speaker 9:16
much. Absolutely.

Scott Benner 9:19
Friends, it's time to get yourself a free, no obligation demo of the Omni pod sent over to the house. Okay, let's talk about the AMI pod tubeless insulin pump, besides being absolutely spectacular, is the insulin pump that my daughter who was about to turn 16 has been wearing every day since she was four years old. That's a long time. Every day on the pod comes through exactly the way we expect it to and in a myriad of ways by being unobtrusive by being tubeless by helping us with extended boluses Temp Basal rates and just being what's the word I want really just it's there, it's solid, you don't mean like it does, it does what I think it's going to do when it's going to do it, I get what I expect. And what I expect, is a quality insulin pump. That gives me the delivery and the wearability for my daughter that we need. And that means that she can stay attached to her insulin, when she's playing sports without being obtrusive, while she's taking a shower, sleeping, running around in the backyard, jumping on the trampoline, riding a bike, swimming, all of the things that your body still needs insulin for, you know, when you hear people saying, Oh, I disconnect for that? Well, they don't have insulin during that time. And that's very likely gonna cause a high blood sugar. Now, I understand that two pumps need to be disconnected sometimes. But the Omni pod never needs to be disconnected. It's tubeless. Wonderful. And you don't have to take my word for it. Because on the pod will be thrilled, happy, elated, delighted to send you a free no obligation demo that you can try it on yourself. Find out if what I just said is true. But you notice, but still try my on the pod.com Ford slash juice box. Check it out, get the demo, decide what you want to do. If you want to keep going with Omni pod, it'll be easy. And if you don't, no harm, no foul. You were just trying. That's why they call it no obligation. Now I have an obligation to tell you about the dexcom g six continuous glucose monitor. This application is both business oriented because their advertisers and moral because I think everyone should know about the dexcom g six continuous glucose monitor. Here's why. I'm gonna use an example from this morning. Arden wakes up her blood sugar is 106 I see it on her Dexcom nice and steady. I hear her moving around upstairs. No big deal. She's getting her face wash getting dressed, getting ready to actually go out right now. All of a sudden or blood sugar diagonal up starts moving up. 106 turns into 115 turns into 118 all of a sudden 125 Well, we bolus right we're trying to stop that rise before it happens. Arden's trying to go out just trying to do things she needs to eat. She doesn't need to walk into this day. 5060 7080 points higher than she needs to. But imagine had she woken up and tested her blood sugar with a meter boom, she would have saw 106 and thought, Hey, I'm doing great. And then she never would have seen anything that happened next. And then a half an hour 40 minutes later when she's sitting down to eat and tests again, you know in a world without a CGM. Who knows what she is to 25 now suddenly, the first meal is in jeopardy. It puts the rest of the day in question. You're looking at roller coaster going up and down and up and down are skipping a meal. Instead, beep beep Arden's blood sugar hits 120 she gets a little insulin right back to where we need to be ready for that meal ready for the day. That uniquely happened because Arden has a dexcom g six continuous glucose monitor. Now that's just one example. Imagine all of the other ways that technology can be used for you. Imagine that the way I found out about it wasn't because I was bugging Arden while she was getting dressed. It's because it popped up on my iPhone. Because the dexcom g six has Sharon follow. And that works on Android and iPhone. So Arden CGM told her app or app, put it up in the cloud came back down on my phone, just like that we averted a high blood sugar burden the problem at a meal. save the day Dexcom g six is going to save more than one day for you. That's for certain. Find out how you can get

at dexcom@dexcom.com forward slash juice box. There are links to Dexcom Omni pod and the other sponsors at Juicebox podcast.com. If you can't remember them, they're also right they're in the show notes of your podcast player. You can click on them right there, like click Like with your finger. very much appreciate when you support the sponsors because it supports the podcast, whether it's on the pod Dexcom the Contour Next One blood glucose meter or touched by type one. When you check out the links. You're telling those sponsors I listened to the Juicebox Podcast I heard about you there. They keep sponsoring you keep getting the podcast for free. Seems like a good deal. Alright, a little bit of music, and we're out of here. Do I have any announcements here maybe one Hold tight. You can find the rest of the defining diabetes series as well as ask Scott and Jenny and the diabetes pro tip episodes at diabetes pro tip comm you can find them too at Juicebox podcast.com But, you know, diabetes pro tips pretty easy to understand no es after the P, so just the P no si p.com diabetes pro tip.com. Also, if you have a great doctor or need one, for type one diabetes, check out juice box docs.com do cs juicebox, Doc's calm and ever growing list of Type One Diabetes healthcare professionals that listeners of the podcast have recommended. Let me give you a couple of examples. For instance, right there in Australia, Rachel Baker, Rn NCD. He does some amazing work. How about up in Canada? Dr. Jeremy Gilbert, over in Ontario, that's Toronto. You understand Toronto, Ontario, right? Like Canada does their places weird? I mean, compared to how we do it. How about Melissa and tonic? in Fairfax, Virginia. alfonzo, Armstead, Nashville, Tennessee. And many, many, many more. And people put in effort when they send in their doctors to give real examples of why, for instance, someone wrote in that Elizabeth Harris in Chapel Hill, North Carolina, she said about Elizabeth, I've worked with Dr. Harris for close to a decade and she's taking care of me through many different stages of my diabetes. From the disengaged teenager to the engaged with struggling young adult to well controlled debate goes online, check it out, juice box, Doc's calm. It's not a pay service. None of the doctors are paying me to be there. It's just me trying to take your good experiences, and putting them in one place so somebody else can get the advantage of what you've learned about your doctor. Thank you so much for listening to the podcast for sharing it for rating it on iTunes, which they don't call iTunes anymore Apple podcasts. That and I just got a great review the other day that really made me happy, and I appreciate that you guys are enjoying the show. Thanks again, keep sharing June was the most downloaded month in the history of the podcast. Not only that, but I'm talking about june of 2020. June of 2020 was for downloads 100 times greater than June of 2019. But listen to this 525 times greater than June of 2018. So we're coming up on another big milestone for the podcast. That's a try to see what I can do to celebrate 2 million downloads. I don't have any ideas yet, but I'll figure something out. I appreciate you helping me get to those downloads by listening by bingeing by sharing. They're all amazing things that you guys do it support the show. Thank you so much. I'll see you soon.