#299 Ask Scott and Jenny: Chapter Ten

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

• Can a fast drop in blood sugar values affect your health?

• How do you help your body recover from a high?

• How do you know when to adjust basal rates, correction factors and insulin sensitivity?

• Let’s talk about basal to bolus insulin ratio.

• How do you figure out what type of insulin to use?

• What are the impacts of diabetes on your dental health?

• What is the best insulin pump for you and how do you choose?

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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, everyone, welcome to Episode 299 of the Juicebox Podcast. Today's show friends is sponsored by the Contour Next One blood glucose meter, this is the meter my daughter uses, it is incredibly accurate, easy to carry around. And if you go to the link right now that's in your show notes are the one that's at Juicebox podcast.com. And click on it, it will take you to Contour Next one.com. When you get there, top right corner, there's a yellow button says about getting a free meter, click on it, scroll down a little bit, fill out a little bit of information. And you're on your way. There are some limitations and restrictions that apply. But it'll only take you a second to find out if you're eligible. If you're not go to your doctor and be like, Yo, I want to try the Contour. Next One write me a prescription for that. Think about it. How long have you had that meter that you're using? Is it old? Is it out of date? Is there technology that exists? It's better than the one you're carrying around right now? I bet you there is. And I bet you it's the Contour. Next One.

Welcome back to another episode of Ask Scott and Jenny. This is sort of a super sized episode. What are we going to talk about today? Among other things, how to help yourself coming back from high blood sugar. When should you adjust your basal and bolus rates, different types of insulin the impact diabetes can have on your dental health, which sounds boring, but isn't. And Jenny talks about insulin pumps, she kind of rates them it's fun. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. And if you'd like to get Jenny Smith, working for you go to integrated diabetes comm and click on Jenny's email address. Actually, the email addresses in the show notes. It's the Juicebox podcast.com On this episode, and all the episodes Jenny's involved in so you just want to email Jenny and say something like hey, Jenny, I'd like to hire you. And then you'll start that conversation with her. Now you guys ready? Here comes don't? Don't it's gonna jump up now. Done ready?

I haven't asked Jenny question. My wife met somebody recently, who said that their adult child lived for a fairly long time with higher elevated blood sugars higher a one C, they kind of pulled themselves together, all at once out of nowhere, got it come to come down quickly, but then had like neuropathy problems that the doctor told them was from a fast drop. I'd love you to explain that to me, because I only heard that one other time, but not even put that way.

Jennifer Smith, CDE 2:59
And from the physiology standpoint, I mean, I'm certainly not a neurologist or anything to explain it from the physiology component. But it's the same as I think not that long ago, we had talked about changes in AI as well, with really fast changes in blood sugar. So it's the same thing it's your body has adapted to the high values. And as such, the neuropathy if it was probably there, as well as probably getting worse along the time of the blood sugars being too high. Now with the quick change in blood sugar. The change to how the sensation of those nerves are, I guess, feeling things because of the change in the glucose level, which has been impacting the health of the nerve cells. That's what brings on a more significant and more profound pain than they may have been living with when their blood sugar's were just high.

Scott Benner 3:59
So is that a bit of a false narrative then then the queen? Yeah, it was coming anyway, it might have just come a little quicker because you took this thing that your body was accustomed to, and so greatly changed it

Jennifer Smith, CDE 4:11
and greatly changed. Exactly if

Scott Benner 4:13
I'm diagnosed today with an 11. And I somehow end up with a five, two months from now, I'm not going to give myself neuropathy.

Jennifer Smith, CDE 4:23
No, no, no, the neuropathy was there to begin with the pain symptoms were something that were exacerbated essentially, because of the major shift in glucose that the body was not used to again it I mean, it does take some time to bring blood sugars down and you know more power to the person who was like gosh, I can't live with you know, 400 blood sugars anymore. I'm going to get them down to be like 150 Now instead, but still, that's a major shift for the body to handle. If you do it all at once great but you you may have some of those typical symptoms like again, you may have major shift in the way that you see things, you may think that you are seeing things great when your budget was at 300. And now one is down in normal, now you can't see anything, we have to give your time your body time to a climate to that new, what is healthy value, and then go see the doctor, if it doesn't. If it doesn't get better, you know, within like a month or so of being in target. Same thing with the neuropathy. While it may help to go and see, you know, your neurologist, or whoever's helping you to manage that, likely, they're not going to change too much other than potentially maybe prescribing some additional pain management strategy for you until the glucose levels are stable enough at that target value. And the symptoms kind of go away, or they come to a more normal stable, you know, range. And at that point, then of course, they're preventing further further damage from happening. So okay,

Scott Benner 6:01
well, I'm keeping stuff together here in a little bit of a blend. So elanco wants to know about helping her body recover from high blood sugar. So she's just talking about I think, a day, you know, where you have six hours and you're elevated, and you finally get back down? Is there something she could be doing to fortify yourself to feel better sooner to? Like, I don't know, like other than hydration, I wouldn't know what to say. Like, how do you make that blog go away?

Jennifer Smith, CDE 6:27
Yeah, if it does, it takes some time. I don't think there's necessarily any one cut and dry kind of strategy. Hydration certainly is a big one. Absolutely. Also, you know, if things like regular food intake, or snacks, or even activity, sometimes those can sort of help you clear. That mental fog, as things are changing to even just getting out in sometimes the fresh air and getting a walk and getting movement and whatnot can help as well. So

Scott Benner 7:05
is it a diabetes thing and more of just a human thing? Maybe because you've been put through this situation. And now you got to kind of bounce from it's like, almost like, I guess, like being sick. And then you wake up and you're like, Oh, you have that weird, like, lost feeling. I don't know what being obviously, I don't know what being high feels like. So my job, I just know people's descriptions of it. Okay, let's see, I feel like we've said this before. But correction factors, and insulin sensitivity, basal rates? When do you

Unknown Speaker 7:40
adjust? Like, like you said, when you know what? To a job?

Scott Benner 7:44
Yeah, yeah. Well, when do you When do you know when to adjust? Like, let's say, you know, it's your base, or, you know, it's your insulin to carb ratio or something like that? How long do you wait before you save yourself? This is my new normal, I need to make an adjustment in my pump to cover this is it? To me, this is another one of those like somebody wants you to tell them how much time? I don't know how to answer that. Like, I know doctors will tell you what three days is that sometimes

Jennifer Smith, CDE 8:09
even longer than that some doctors want like a week's worth of data to see that it's a definitive trend. I mean, I usually, I usually say, you know, if you know that, now, all of a sudden, whatever reason is happening, you're waking up at 150, when you used to wake up at 100. And it's been happening in the last three nights, and you have literally not changed anything, clearly something changed. So go ahead, make a change to the Basal or if you're kind of wary about changing your profile set at Temp Basal. In this instance, set a Temp Basal increase at bedtime of a certain percent and see if it hits the mark. If you wake up where you were great. Go in see how much the pump was delivering based on the temp you instituted and make that change into the Basal profile.

Scott Benner 8:54
Great. I would say that this is one of the things that led me to say things like more insulin, because I just kept looking at these scenarios like Jennifer's talking about here. And I just thought there's not enough of a rhyme or reason to this, that I can say to myself, okay, what I'll do is I'll wait X amount of days every time this happens. So just I just decided like, I'm gonna stay fluid. And if it's like this today and tomorrow, great, and if it changes, you know, the next day, right, what am I gonna do? I know, I'm, I'm gonna have to do what I have to do.

Jennifer Smith, CDE 9:31
Right? I mean, sometimes it takes I would say, for me personally, I always look at things after like a two day, you know, if it's tonight, for some reason, in the morning, I wake up in the morning higher than normal. And that's one night, I don't know. Let's see. I'm gonna go to bed at my normal rate where I would usually go to bed. If I see a rise again overnight tonight, in the middle of the night, if I wake up, I'm probably going to pop in some change of some kind, just that I don't wake up high again. And tonight, then I'm going to say, I'm going to go in and change my Basal profile, I'm not going to deal with this, right, I'm not going to wake up to alarms and alerts if I don't have to. And you know what, if I end up dipping down, then well, just two nights that I needed some extra insulin. And I'll go back to what I needed. But an overall change, usually, most people have had diabetes, a number of years, kind of get this intuitive sort of feeling about something has shifted, I know that something has shifted, I don't know why it shifted, I just need, quote, unquote, more insulin.

Scott Benner 10:37
Put that in there. I genuinely think that that's, that's one of those scenarios where you just have to, you just have to stay fluid and take care of it. You know, right? It comes. Because I would rather because I know what the fear is, right? Like, what if I turn it up, and then all of a sudden, five days now that causes a low? In my mind, that would be another time to adjust? And at least for the last five days? You haven't been high? Right? You know, I think it's all in the way you want to look at it. Right? Hey, welcome to the new age of smart diabetes management. Welcome to the Contour Next One blood glucose meter. By integrating your blood glucose meter with a smartphone app, you can simplify the management of your diabetes, blood sugar results captured through the day can be automatically synced and logged in over time, the results may create meaningful insights into how your activities affect your blood sugar levels, which can help improve your understanding of your diabetes. All of this while being on the same platform you use for so many other aspects of your life. Yes, smartphone. So check out Contour Next one.com. There's links in the show notes and a Juicebox podcast.com. That'll take you right there. When you get there, you're going to find out about the simple to use, and remarkably accurate Contour. Next One smart meter, and the contour diabetes app. It seamlessly connects via Bluetooth technology to capture all of your blood sugar readings, and help you to manage your diabetes smarter. When you combine the Contour Next One meter with the contour diabetes app, you're going to have a smart system that allows you to engage the level that is right for you to manage your diabetes. All right, so head into the show notes, hit the link, check it out, some people will be eligible to get the Contour. Next One meter for free. There's a little yellow box at the top of the page, check it out, you might be the one where if you'd like to talk to your doctor about the Contour Next One meter, just be like Yo, I want to use the same meter that the guy on the podcast kid uses. And then tell them it's the Contour. Next One, you will not be disappointed this meter or rocks. Please use my link. It's available at Juicebox podcast.com. We're in the show notes of your podcast player. Okay, very quickly. I'm not going to seem to make sense when I start talking in this next bit with Jenny. But what happened was while Jenny and I were talking Arden's pump ran out of insulin at school, and Jenny and I took a break, I ran across the street, and we changed the pump real quick. Right? So now that'll make sense for you. Ready in 5432 you have to be a little impressed.

Jennifer Smith, CDE 13:17
I'm actually really impressed. Like, your school literally must be like right across the street.

Scott Benner 13:23
It's um, that's pretty close. It really is across the street, right? it's it's a it's a four minute ride. You know, she met me in the office, we rolled down to the nurse and and bing bang, boom, I'm back. So eight. I think I think I was going for 18 minutes total. So

Jennifer Smith, CDE 13:42
yeah, it wasn't long. So awesome.

Scott Benner 13:45
Next time I do an on the pot. And I tell you, you can swap it on the pod fast. you believe me? We've done Arden's on the bench of a softball field. Keep the dust away for a second, right. Anyway. All right, I think we can get through a couple here. Okay. I like this one. Tara wants to know, about bazel bolus ratio. So she says that her endo tells her you know 5050 but then Becky comes in and says we're 30% bazel 70% bolson. Are those fine with it? I feel like I'm gonna say if you are too heavy on the Bolus side, you're probably bumping in nudging too much. And you could probably get some back from Basal. But what is the like why do people say well, what do you say? Because I've heard 5050 to

Jennifer Smith, CDE 14:32
5050 is a starting place It really is. And that's why endo is kind of look at that as a place to start with potentially where adjustments might need to be made. But you also have to consider some other things from the standpoint of like, metabolic bazel insulin need, what I've seen in practice, and seems to you know, be kind of correct is that If you have a pretty active lifestyle, metabolically, you are probably more at an appropriate body weight, and you will respond to insulin better. So sensitivity will be higher. So from a standpoint of background bazel insulin, your basal insulin and an active life may actually be less, you may be kind of one of those people whose bazel bolus ratio is more like 4060 40%, coming from bazel. Because without food in the picture, your body just responds nicely to insulin, it could even be more than that. Maybe it's 35. Or you know, whatever. More commonly, though, for most active, it's about like 4060, give or take kind of thing. On the opposite of that, if you have a really busy life, but you're mostly sedentary and you really are only able to get to the gym once or twice a week, you're probably on the other end of that you probably have a higher metabolic need, because your body's just not responding as well to insulin. So your basal needs may be a lot higher. And it may seem like your boluses aren't really that heavy, then, as far as like an analysis, another good place to look is at the breakdown of your bolus insulin, like how much of your bolus is truly derived from just covering the food that you're putting in. And how much of it is actually corrective. Because if you're constantly like you just said, if you're constantly nudging, by correcting with little bits, because it's just not getting down to target, it may very well be that your background is also not high enough, it could be that you're covering with more Bolus, because in the back, there's just not enough there to keep you you could be using more Basal,

Scott Benner 17:00
right. And so there's a lot of different scenarios. This is interesting. So you know, your activity, if you were a person who didn't need very much bazel to keep you stable, but you had big meals, you might even see a swing like that. Right? Right. Right. So then there is no right ratio, there's no correct ratio, there's a correct ratio for you. But there is a way to check to make sure, hey, let's make sure that we couldn't be doing some of this with Basal and take away some of that bumping in. And I think that's specific to people who listen to the podcast, like the bumping and nudging is great. But if you're bumping and nudging, and your kid puts on 10 pounds, because they're growing, you're going to just keep pumping and nudging when you should be thinking more based

Jennifer Smith, CDE 17:43
on a problem or bazel. Exactly. Yeah, yeah. And you're right. I mean, from the standpoint of somebody who, like I think I commented, I don't know when we talked a couple times before about mango man. He's a type one who is an expert in like nutrition. He's got like a PhD. I don't, I don't remember too much more about him. But he, I mean, he eats like hundreds of grams of carbs in a day, but he's also really, really, really active. And so I would, I would estimate that his Basal needs are probably pretty low. But his boluses are probably fairly big, given that he eats so much carbon at a time. And then it covers it, and it drops him back down to his target. And his bazel holds him there until the next time he eats you know, 200 grams of carbs.

Scott Benner 18:36
I think that that makes 100% sense. And I think that is the clarity for this question. So I think we did good there. Okay, so here's one that I don't know that there's any truth to this one. Katherine's asking about figuring out what type of insulin they should be using. And I know that technically, there's not a big difference between the insolence right, the fast acting insulins, but some people do see differences differences when they use them. But is there anything that we could like literally say, like humalog novolog, a Piedra? Are there fiasco? I mean,

Jennifer Smith, CDE 19:16
are there discernible differences between them? I mean, the fiasco obviously, there, there should be a discernible difference with fiasco. If you get response by using it. Yes. For the most part, the two that are the most similar and action that I would say a good majority of people who've switched between novolog humalog novolog because now their insurance covers it up. Now you're covering human logs. So let's switch you back. They usually don't notice much of a difference in its action. There are people however, who do notice a difference. I personally don't notice the difference between novolog and human log at all. I tried to Piedra and it it didn't work the same for me at all, I especially noticed it when I was using extended boluses, it just didn't have the same emphasis or work the same in an extended fashion as my human log normally did. I've got a friend who she knows that if she's on human log, she uses more insulin on human log than if she goes back to novolog. She knows that. So I, you know, definitively again, majority of people don't notice much of a difference novolog to human log, I think the two outliers there, a Piedra may work a bit differently for you. Again, there are people who can use interchangeably all three of Piedra novolog, humalog and have no difference whatsoever. fiasco is kind of in its own category, really, I think there is there's a definite difference, mainly because it's action is faster. And then there are some people of course, with ABS, but it works great, like me, worked for five months, and it was done. It didn't want to work for me at all anymore. I'm done. That's it. Yeah.

Scott Benner 21:04
I you know, I would say for Arden, she used novolog. And she she used a pager. With novolog, we saw a ton of like double arrows up double arrows down, you know, big spike after a meal, then a crazy crash later kind of a feeling. And for Arden, I've only ever been able to explain it that a PG appears to just work smoother for her. Like it's just more constant and it and predictable for me. And that's it. You know, I don't know that human log wouldn't be better. I never tried it. Right. And and you know, people all the time, like, you know, don't you want to try fiasco? And I'm like, Well, I don't I want to hear about fiasco is that it works for the people it works for and others don't. And here's the other thing about crowdsourcing this information, right? It's that we don't know everybody's other details that they don't share with you like, oh, you're all you see someone line who says, human doesn't work for me. They don't say, by the way, human doesn't work. For me. My blood sugars are mainly in the 250s. Most of the time, I eat an incredibly carb heavy diet. And I don't have a CGM, like you don't mean like, they don't give you all the details about their life. They just say something like, you know, I didn't like that television show. But you know, you don't I mean, like, you don't get enough of the details to know why crowd sourced information is tough sometimes, because it lacks the details that you you often need. The one thing I'll say is that it can't hurt to try, you know, a reasonable endocrinologist should let you try if you want to. Right, Arden did need more a pager than she needed. novolog. So her ratio went up a little bit when we switch,

Jennifer Smith, CDE 22:42
but it worked better, but it works way better, less spiking, dropping. So yeah. And I think that it takes evaluation, you know, if you if you have a sense that there are that there's something that just doesn't seem right. Ask your doctor for, you know, as many doctors have some sample bottles, ask them for a sample bottle of the opposite type of insulin and see if you don't get better response from it. I mean, if and if you don't notice anything different well, then maybe something in your settings needs to change or something in your strategy needs to change, you know, but at least you've tried and you've kind of addressed

Scott Benner 23:20
to see whether or not I will just tell you that for Arden with a Piedra I have. I don't I mean double arrow in either direction. I don't remember. Like it just, it just does not happen. So, um, okay. Uh, let's see. We're doing well, by Well, I mean, we have time left. That one seems like it's a little too much for now. Let me uh, that one's pretty obvious. I could get answered there. Oh, okay. Here's a pretty simple one. What are the impacts that type one diabetes, if any has on your dental health?

Unknown Speaker 24:03
Um, well.

Jennifer Smith, CDE 24:06
Overall, we know that diabetes can affect most places in the body. Here oral health included. People with diabetes more commonly have a potential for bleeding gums, more ginger vitus gum diseases, more potential for receding gums. And, you know, the interesting thing about it is it seems to be for the most part, the higher blood sugars again, can cause more oral health problems. So long story nutshell short, just keep your blood sugars contained to try to avoid dental problems. Does it mean that everybody with diabetes is going to end up with some type of gum disease because of, you know, mismanaged blood sugars. Not necessarily, you know, but it is certainly one of the potential, I guess complications of, of life with diabetes. Now, the interesting thing is, I mean, I have receding gums myself, I've had them for years. But the interesting thing is that, to me, I don't know how it could relate to my blood sugar control.

Scott Benner 25:30
Pills really good. Yeah, it's

Jennifer Smith, CDE 25:31
good. I haven't let my blood sugar's run at like 300 or 200. Even, you know, for years and years. The interesting thing is that it actually started after I had kids. In fact, I didn't have my first cavity. until after I had a child. And my I asked my dentist about it actually, at the time, I was like, are you sure there's a cavity there? Are you sure? Like, I've never had a cabinet in my whole entire life, you know? And he, he said, Well, interestingly, we do know that the oral health of women during pregnancy, because of all the hormone changes, there are some things that can impact like the natural bacteria in the mouth of a pregnant woman. And so he said, it can provide a better environment for bacteria to start causing

Scott Benner 26:19
problems. That's a technical way. Yeah, let me let me tell you what I've witnessed in my life, making a baby drains the life out of you. And for women worse, your feet get bigger. That's not a good thing. anybody whose feet get bigger while they're pregnant, it doesn't go back. So congratulations for that one. And I just think of it as like a demon in a movie that sucks. Like, you know, they go face to face, you can see the life pulling out of like the live person and bringing in the demon back to life. That's what happens. That's what your kids are their life suckers. So um, I will add this, and this isn't specifically about diabetes. But if you are bouncing around on that roller coaster and correcting a lot with sugar, especially overnight, that could impact your dental health.

Jennifer Smith, CDE 27:07
Absolutely.

Scott Benner 27:08
Because you're taking this juice in your mouth. And then it sits in their mouth and gives them cavities when Arden had baby teeth. And we were not good at this. I'm almost horrified to tell you that I think she had they were on her baby teeth. But I think she had 10 cavities one time, like all at once. And you know, she had to, she actually had to go to the hospital to be put under because they were so worried about blood sugar, because we were so bad at her blood sugar back then. You know, like, like now when she goes to the dentist, I'm like, it'll be fine. I'll take care of it. You do your thing. I'll do my thing. Her blood sugar will be okay. But back then had to go to the hospital insurance didn't want to cover it. Yeah, my wife's company actually stepped up and forced the insurance company to do it, which was lovely at the time. It was like a $15,000 bill to put her in the hospital to fix it was crazy. But it was just from the juice. Now. We had it all worked out. And then one time she told me she was sick of the juice she was drinking. But I had found this kind of like impactful juice that wasn't it has fairly natural stuff in it. So I switched her to something else. And in that six months, she got a cavity. And nothing had changed about it. She wasn't using a lot of juice, but that so we switched away from that juice. And she hasn't had a cavity since then. Hmm. So interesting. Yeah, it's not from diabetes directly, but it is indirectly from it.

Jennifer Smith, CDE 28:31
Correct? Correct. And that it's also a hard thing, that overnight component and I'm glad that you brought that part up. Because who overnight really, even as an adult, a knowledgeable adult who wants to treat their low blood sugar and then oh, yep, got to go to the bathroom. I gotta brush my teeth, we got to floss and like chewed on gummy bears, right? Eat the juice or whatever. Nobody wants to do that two o'clock in the morning, right? I don't want to do that.

Scott Benner 29:00
You've already and I do know, some people keep water next to the bed just to swish at least to try to. And that's better than nothing, right? But yeah, to your point. I mean, you're gonna drink juice and then Go brush your teeth. And then imagine 15 minutes later you get low again, a drink some more juice, you're brushing your teeth again. And, and at the same time, you know, to avoid a cavity. Maybe it's not a bad idea. But I mean, I, you know, I'm supposed to take like, one over the counter and acid before I go to bed at night. And sometimes I'll brush my teeth and then I'll take it. I'll be like, oh, like do that for and now again. You know, it doesn't have to be constantly it happens every once in a while, you know? A great while. Okay, well, that's a big question. I'm skipping right over that. We get to that one later. But that's a huge question. That's not a that's not an ask Scott and Jenny. that's a that's a bigger one. Um,

Unknown Speaker 29:56
that's an episode one is

Scott Benner 29:57
a complete episode. I don't know that. I have an answer to any of It. So

Jennifer Smith, CDE 30:03
that's a you need an appointment to discuss this

Scott Benner 30:05
girl again, therapist and six friends. Oh, I see Chris here says that I should just say what are a couple of times so you can make fun of my accent. He doesn't care what we talked about there is satin Jenny as long as I say whatever. And by the way, I've noticed I've never brought it up but when Jenny accesses her brain so when I ask her a question, she accesses her brain to think of it. her left eye closes more than a right eye. And I wonder if she? Oh, yeah, I don't think she knows that. I don't know. It's almost like she's a supervillain. And she's got information somewhere. And she's like, Huh, and she pulls it right out. Because for you guys listening. I don't tell Jenny this stuff up. Like I'm just throwing questions at her. And she's like, okay, answer you like on the spot. Yeah, yeah, it's it's like a driver's test. But you're driving in a car. And you know, they're like, turn now turn now.

Jennifer Smith, CDE 30:53
That's really funny. I've never noticed that.

Scott Benner 30:56
Yeah, exactly. So Alright, so here's one that I think we could finish up our time with. Is there in your mind? Because you deal with everybody in the you know, who uses all kinds of different pumps? Mm hmm. And obviously, you use Omni pod? And that's to you, the best for you. But But is it the best for you? Or if I got you secretly off in the corner? Is it the one you think would if I made you the king of the world? But you put one on everybody or no? And what are the pros and cons of the other pumps at all of them? Actually?

Jennifer Smith, CDE 31:30
Yeah, this is actually a great question. Because I think it's also a big part of the reason that oftentimes people end up coming to work with us is because we, we don't push to one specific direction when somebody comes to us and says, Hey, you know, I'm considering a pump coming from MDI, or, hey, I've been on this pump for like, eons. And do you think that there's something that would be better for me? Should I be considering this one? Should I be considering this one? What's coming out? What's, you know, which company is heading development and kind of moving the fastest and blah, blah, blah, blah, blah? Um, I, I personally would, I've got reasons for staying on Omnipod right now, which, you know. And there, I mean, the reasons really are such that it provides me with a system that allows me to get the best management.

Scott Benner 32:30
So So Jenny is talking around something so I can put ads on my epic, correct? Yeah. So um,

Jennifer Smith, CDE 32:36
so I'm trying really hard. If, if that wasn't a potential, I would say, put on the spot about another pump that I would consider changing to I would consider changing to tandem? Why would I think they are being the newest pump company of the three that are currently on the market? I think tandem has stepped up, they've done a fantastic job of development of making a product that's user friendly, touchscreen, small, convenient to use. And they're continuing to quickly move ahead with their technology. They're they're trying to bring to the table management that can help people better they are. So I mean, if I had to choose, you know, within the next month, because my current setup was no longer going to be available to me, I would say, yeah, I'll, I'll choose tandem, I like it.

Scott Benner 33:45
And so what you think tandem brings overpowers the tubeless nature of Omni pod for you.

Jennifer Smith, CDE 33:52
That's the only drawback I can definitely say the tubeless nature of Omni pod is a huge step above the other two companies on the market. But from I feel like that tubeless piece is it's more aesthetic. It really is. It's something that I as an adult, I can get over it. I don't I don't love tubing by any means. But I can get over it. If a system provides me with something that helps my management, the to versus non tube. I don't really think it has anything to do with what I get from a control perspective. Right. It's more my lifestyle that the tubeless is huge benefit for but I can deal with the tubing. If it means the pump provides me with what I need for good management a

Scott Benner 34:52
gun to your head right now though. Pick a pump,

Unknown Speaker 34:56
Omni pot okay.

Scott Benner 35:00
Good second for you.

Jennifer Smith, CDE 35:01
tandem is a good second and I hate you know, saying I mean Medtronic has been on the market a long time. They're they're also, it's a really good pump it truly is. But for I think for a fair number of people with the current system they have on the market. I've got a lot of people I work with who they like their Medtronic pump, but they choose to use a different CGM, because they're CGM is just not meeting the mark. For many people, myself included I did the pump was okay. It was fine to use. It was a tube pump, it did what it was supposed to do, blah, blah, blah. But their sensor has never worked for me. So you know, from an all around, encompassing, that's why I said, you know, if I had to choose because I no longer could use my Omnipod. I would choose tandem, because at least it still connects and works with Dexcom.

Scott Benner 35:54
Okay, if so, Omni pod ads, say the FDA goes to phone control. And that's okay. That pretty much levels the playing field, and tilted towards on the pod for you away from tandem. Like if you get the same kind of like one screen touchy feeling from it,

Jennifer Smith, CDE 36:13
the ones green touchy feeling getting rid of a PDM that feels like

Scott Benner 36:18
you're carrying a thing? Yeah,

Jennifer Smith, CDE 36:19
I'm carrying like a thing around like, it's even bigger than most glucometers

Scott Benner 36:25
are the new ones. You're so you're, you're you're stuck with the PDM because of what you're doing. And so and, and Right, so the dash is smaller. Right. But still, it's you're carrying an extra thing? Right. And I think to this, this whole question becomes moot, probably within the next 1012 months. Right. Like when, when horizon, you know, if if horizon comes out and, and the other companies are going to, you know, they're going to make their changes again, and it's just a lot of stuff is going to change. The insulin pumps are gonna change a lot in the next year and year and a half, I think.

Jennifer Smith, CDE 37:03
We hope

Scott Benner 37:04
Yes. Yeah. Well, yeah, those are their timelines, right? Like, or what if it all comes out? You're just like, sort of the same?

Jennifer Smith, CDE 37:11
right? Exactly. I do know that there are there are definite nuances between the three, what are considered kind of those hybrid control hybrid, closed loop systems with the FDA approved pumps, right? I mean, 670 G is already out, control, like you, hopefully will be out sometime soon. Even that compared to Medtronic, it's different, the system will work a bit differently, the you know, what it does for you will be a bit different and horizon from everything I know about it, which isn't a heck of a lot. It will also have its specific pieces that are different compared to control IQ and six, seven Digi. So I think each system will do something better than a current conventional pump does. But you know, you'll have to figure out which one is best for you.

Scott Benner 38:04
Yeah, there's gonna be a lot of choosing and I think to a no, I can say that. What I thought was really cool with the pod said was, look, when, when our horizon system comes out, we're gonna have an algorithm. But if you want to use the tide pool algorithm, then use that one, like, they don't care which algorithm you use, which is a is is a huge step towards trying to give you choice. Now, having said that, I don't exactly know when tide pools gonna make it through the FDA either. So there's a lot happening and at the same time, it's unsure. It's uncertain until it actually happens. So all right, well, that was good. I have a bazillion more for next time.

Unknown Speaker 38:38
Okay.

Scott Benner 38:41
Okay is right Jenny. Thank you so much, Jenny Smith for coming on the Juicebox Podcast and sharing your wealth of knowledge with everyone. Don't forget, you can hire Jenny at integrated diabetes.com or right there in the show notes is her email address, you can just send her an email. Thank you so much to the sponsor, Contour. Next One meter, this is Arden's blood glucose meter, it is terrific and it can be yours. Click on the links in the show notes go to Juicebox podcast.com. If you don't have shown us that you can find by the way you do you just might not know how to get to them. Or you can go to Contour Next one.com to see if you're eligible for a free Contour Next One meter. mm meter scrape I swear to God, it's amazing. You're thinking like it's just the blood sugar meter but new stuff bomb diggity. Hey, friends, couple of things coming up on February 16. I will be speaking at the type one nation event in Dallas. He says questioning whether or not he knows where he'll be. Let me click on the link. You get to Juicebox Podcast com scroll to the bottom of the page, click on events and you'll see these there. Type One Nation summit North Texas they call it the greatest Dallas and Greater Fort Worth Arlington chapter. This event is on Sunday, February 16. I'm doing a one hour talk there about being bold with insulin. You can also see me coming up in Atlanta, Georgia, Saturday, September, Saturday, September, I said September. Let's try again. On Saturday, February 29. I am doing a ton of speaking there that day, I'll be speaking in a bunch of different sessions. And one of my sessions will actually be with Jenny, Jenny and I are gonna do a q&a together. That'll be fun. Come out and witness Jenny and I meet each other in person for the first time. You can still get tickets. There's links again here on my page. I'm going to be at the jdrf in Wisconsin on March 26. It's a Thursday night from think five to 8:30pm. It's just three solid hours of me chit chatting about the stuff on the podcast, show up at five leave at 830 a new person while we're rolling through the events, Saturday, May 30, had touched by type one in Orlando, Florida. And they will be at the type one nation event in Virginia. That's rich from Richmond, Virginia, August 22. That's a long time from now. I just had to turn one down the other day that broke my heart. I wanted to do it so badly. But it conflicted with a date. I had something set up on already, but we're trying to figure out something else to do. So I can come out. I can't tell you where because you'll all be bummed out and they really wanted me there and I wanted to come so you can't be like, you can't be like up their butts about or anything like that. They really tried. It was my fault. My schedule didn't link up but I so wanted to go. I love that part of the country. Okay, so yeah, Juicebox podcast.com, scroll to the bottom, click on events, get yourself tickets. Thanks so much for listening. I hope you have a terrific weekend. I hope I see you at one of the live events. I can't tell you how much it means to me that you are listening to the podcast and sharing it with other people. January is well on its way to being the most downloaded month of this podcast. So that's because of you guys. And I really very much appreciate all the effort you put into getting the word out about the Juicebox Podcast. I'll talk to you soon.

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About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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#297 Ask Scott and Jenny: Chapter Nine

Answers to Your Diabetes Questions…

Ask Scott and Jenny, Answers to Your Diabetes Questions

• Let’s talk about the benefits of rotating sites.

• What are the pros and cons of using a temp basal increase versus a bolus?

• How long does it take for a temp basal increase to start working?

• Let’s talk about how an extended bolus works.

• Let’s talk about how temp basal works including how to create a black hole.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

+ Click for EPISODE TRANSCRIPT

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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 everyone and welcome to Episode 297 of the Juicebox Podcast. Today's episode of Ask Scott and Jenny is brought to you by the Contour Next One blood glucose meter. This is the blood glucose meter that Arden has been using for coming up on getting closer to year and a half now. Absolutely fantastic. Wonderful. Actually, let me tell you why. First and foremost, in my mind the Contour Next One has remarkably accurate testing demonstrated proven accuracy with the Contour Next One meter, and Contour Next One test strips tell us that the smallest error range demonstrated by the Contour Next One meter system was determined to be 95% of results met. Right? That's like plus 8.4 milligrams per deciliter, or plus or minus My gosh, there's a lot of information here. Hold on a second. Wow. I might not be smart enough to tell you about this. I'm reading it and I'm not sure if I'm smart enough. Hold on a second. Anyway, the things really really accurate. But Contour Next One wants you to know that I'm going to read it again meter system was determined to be 95% of results met plus or minus 8.4 mega boy versus reference for glucose values under 100. per deciliter or above 100%, respectively. For subject fingers testing is Alright, listen. I think here's what you're gonna need to go to Contour Next. one.com read it for yourself. See if you have better reading comprehension than I do. You know, me, I just dumb things down. I know the Contour. Next One is incredibly accurate. I've seen a lot of testing, it comes right up at the top of every chart I've ever seen. And you know what? A listener just reached out to me like 10 minutes ago. No lie on one second. But this is an ad. Hmm, this is what the company was looking for when they throw in with me. really concise ads like this. was like it's gonna go with the episode. Hey, Linda reached out right? She's telling me about a little bit of about the podcast asked me for somebody to come on if I could. But but in the middle of her note said, let's see what she say, Oh, I wanted to let you know a tidbit about the Contour Next One app. So the app that goes along with the Contour Next One, it works with voiceover users on iPhone for the blind and visually impaired. Isn't that great? Thank you, Linda for telling me that. Okay, well Contour. Next One, if you know, they're still advertisers, next week, after hearing this go to Contour Next one.com. There's links in your show notes and Juicebox podcast.com. The meter is incredibly affordable, covered by many, many insurance companies. And Arden is just having a great experience with it. As Am I let's put it this way. The Contour Next One is a million times better at being a blood glucose meter than I am at reading an ad about the Contour Next One blood glucose meter following that. Okay, listen, this isn't ask Scott and Jenny. I don't want to give it away. But I leave a little bit of like preamble Jenny and I talk sometimes before you get to Harris. And Jenny brought up something about a Reilly link for loops. So I left that in. I thought that was interesting. We talked a little bit about site rotations. And you know the importance of being prepared. We will even remind you to change your smoke detectors at some point and then we're going to get into some basal insulin talk. It's a little more deep dive. And that comes from questions from you guys. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. We're becoming bold with pencil.

Ask Scott and Jenny are questions directly from you the listeners that Jenny and I answer Jenny, of course, is Jenny Smith, who works at integrated diabetes.com. And you can always go there and check out what Jenny does. You know, you could you could pay Jenny and she'll help you with your diabetes. She's She's good like that. It's her job. You know, I mean, it's not like you, like weird or anything like that. Jenny is a contributor to the podcast. For those of you who have not heard this before, and she's just absolutely amazing. So check her out. Jenny Smith had integrated diabetes.com Let's jump right in.

Unknown Speaker 4:36
Hey, no.

Unknown Speaker 4:37
Hi.

Scott Benner 4:38
What happened your Riley link died died like gone.

Jennifer Smith, CDE 4:41
Yeah, like this morning for 13. So my Oscar he's got a cold and he woke up coughing this morning at like 430 so I went in and gave him some cough medicine, some water and whatever. And I noticed that I always have my like Riley link and my pot my phone right next to my bedside. table and I noticed that my Reilly link was like the green light was not solid It was like green. Green.

Unknown Speaker 5:09
Little Blinky.

Jennifer Smith, CDE 5:11
Like, that's not right, you're not supposed to be doing you know. So I turn it off I turn it back on and then there was no green light. And then now I have like this, like I just I I unplugged everything to like try to plug it back in. I like did all this like trying to figure out it's like this flashy Christmas blue, green, blue, green, blue, green, blue, green. And like, That's not right, as I go to the website and look at you know, like Riley link like errors on the get Riley link. And the only things that I can find, seem to indicate that I have if I have like a solid blue, and it stays on that the board might be dirty. So it says to unplug the battery, clean the battery thing out, well, I don't have like one of those little air can do it with. And I don't have an old toothbrush. They've all been like in somebody's mouth in the house. And so I'm like, screw it. I don't have time for this. Today, I will just use my PDM and figure it out later. I think I have a feeling that it's just that it's just gonna work because I I took the old battery from my Medtronic, Riley link. And I plug that in, and I get the same response. So I have a feeling it's the Riley or that it's actually the motherboard that it's has nothing to do with the battery or the connection. I think something's dirty. So I don't know. I mean, I just ordered it in. April. I don't know if I should send a message to Jeremy and be like, Hey, I haven't I've only had this like six months, would you replace it? Or if I should just go ahead and buy a whole new one.

Unknown Speaker 7:00
So

Jennifer Smith, CDE 7:01
this is what I get for not having a backup.

Scott Benner 7:03
I was gonna say in a very unlike me fashion. About two months ago. I just ordered another one. And I thought if I never it's sitting right over there in a box. I thought if I never take it out of the box, I guess I don't care. And then every time hers acts a little wacky, I'm like, ah, I don't care if this breaks. I have another one. Right?

Jennifer Smith, CDE 7:24
Exactly. And right now it doesn't look like there any holdups as far as like getting another one quick. So hopefully I can just get one and get up by next week again.

Scott Benner 7:39
I got a note from a woman this morning, it said that she moved to loop because of the podcast. And then oh begged me to do a follow up. She's like, I need a best practices podcast for loop. And I was like, Yeah, well, as soon as I know what the best practices are. I'm happy to tell you what they are. And I think I'm close by the way we are. We're in a good spot. Hey, I just finally, after a long time of trying. I finally got Arden to try a different site. Okay, the one thing

Jennifer Smith, CDE 8:14
what she what she had, what had she been using?

Scott Benner 8:18
Arden was thighs. And she's belly canula pointed towards her belly button. And she does not like me. No, no, no, no, no. Like, you know, if you said like, Hey, you should try your arm. She looks at you. Like you said, Hey, you know what we should do? Let's shave your head and your head bald, paint a face on the back of your head and make you walk backwards. Right? Right. Like really looks at you weird. Because when she played softball when she was little, and it was on her arm, she could feel the pod wiggle around when she threw her arm. So she got in her head at a young age. That that's not good. Yeah. And Arden is really, for all of the amazing things that she is. Every insertion of every pump is treated like It's never happened before. Even though when it's over, she's like, it doesn't hurt. It's she it's hard to put into words. But as it's clicking, she just tenses Oh, my god until she's almost at a ball. And then when it gets to the fifth click, if it doesn't happen, she goes. There's a little shake it. It's It's It's not funny, but it is yeah. So she's just like, it's she's just incredibly the Dexcom she doesn't do the thing because there's no click. Yeah, I know. That's what it is. It's her. It's her hearing the clicking and it's ridiculous. And she knows it's ridiculous. Like if you had her here, she tell you. I know. It's not a real fear. But my goodness. So. So what she's done is by keeping the same couple of sites, she's a little numb to the insertion, right? So it feels different on a new site. And but I got it To finally I mean by the by God or I don't know what I might have like, I might

Jennifer Smith, CDE 10:05
have thrown Mercer a read for.

Scott Benner 10:08
So she spun the pod on her belly 180 degrees the canyon was going the other way now. And it works so much better because her her thighs were really like we don't have propped up. Oh, no, I don't know, they just don't work well, like like, because we try all different places I never have

Jennifer Smith, CDE 10:26
my thighs have never worked.

Scott Benner 10:28
So better blood sugar is not on her thighs. And I told her, she's like, well just use my belly. And I was like, you only have two spots. And even when I say to her, like very up and down, she moves it like a quarter of an inch. Right? Like our night a little farther than that. Yeah. So anyway, I got her to move. And finally, it was not without some tense moments, but it's done now and her blood sugar's are way better. So

Jennifer Smith, CDE 10:54
Wow. So you can speak to the benefit of rotating site. Yes.

Scott Benner 11:02
This is gonna seem disjointed. But Jenny and I jump back to talking about the Reilly link for a second. And the bridge we got back to it with wasn't interesting. So this is me telling you little more about Riley link. And then we jump in ask Scott and Jenny. At the very least you haven't had it that long.

Jennifer Smith, CDE 11:19
I haven't. And that's the thing. I mean, if I had had it, like two years, I wouldn't even ask, I would just order a new one. But I haven't had it for very long. And I feel like I mean my other one, the one that I have had for Medtronic, the battery still works, I can still turn it on. It still connects, it works perfectly. And I never replaced that one. So and I've not done anything different. Like I'm not like cleaning out attic spaces with whole bunches of dust in my Riley lane. Collect all the dust you can you know, I like

Scott Benner 11:51
sometimes just stop swearing. I actually, you know, we had a smoke detector that started like chirping. And I just was like, you know what the thing seven years old? Like, I just throw it out and put another one up. You know, I

Jennifer Smith, CDE 12:04
actually recommend replacing them every three years.

Scott Benner 12:06
Yeah, so I had just done a bunch of the other ones in the house with these. There were these two that were like, they were going strong. And I was like I'm writing these out. And then when they started because you know, as an adult, what's the worst thing is to spend money on stuff like that, right? Like, I always tell people the worst part about owning a house is that I once had to have a tree cut down. I had like, like, there was this day that I had 1500 dollars in my bank account and a tree. And when the day was over, I did not have 1500 dollars. And I did not have a tree and that I had less than when I started. Not even like I had a new and improved tree, or you know brakes on my car or even when it was just one of those like the money's gone and the thing is gone. Being an adult is terrible.

Jennifer Smith, CDE 12:50
Yes. adulting is hard.

Scott Benner 12:52
Not fun. All right, you ready? Sure. All right. So it's hard to know where to start when there's this many. So I think the top is probably where to start. I'll go with Stacy who says pros and cons of using a Temp Basal increase versus a Bolus. She says that she tends to do extra boluses if her son doesn't have any insulin on board, but her husband tries Temp Basal as more often. Now, I think this is more of a situational thing. Mm hmm. You know, because there are moments where, and this would feed right into another question. But there are moments where I don't have time to wait for Temp Basal to start, right, right. It's a timing issue. So if it's, if it's after a meal, and there's a creep, right, like, it's just like 85 becomes 89. But there's never an arrow and then 10 minutes later, it's 93. And all that, then maybe I would be like, Ooh, this is so close. Maybe I'll try to tamp it for a little bit to get away. Yeah. But if this was a diagonal up arrow, and it was, you know, 115 to 121 to 130, I would think I need the more immediacy of a bolus correct. So I think that's the

Jennifer Smith, CDE 14:07
right way to think about it. I mean, it's a bolus is going to go in, it's a big depot of insulin right there right now, it's, I mean, it's still gonna take some time to get absorbed, there's a large amount of it at one time to get absorbed. The only caution to that is, especially for those who have really big boluses at a time to begin with, if you just bolused 10 units for a meal. And now it's 30 to 40 minutes later, and you see these arrows going up, and you're gonna bolus, you may, in fact, really not, you may not reap the benefit of an additional extra bolus to offset that on top of the large amount of insulin sitting under the skin already, because it's still absorbing especially if you didn't give enough Pre-Bolus timing, you know, all of those other considerations. So there are, there are lots of variables to both uses. I think

Scott Benner 15:06
I think too, it's what it comes down to a lot of like, again, timing. So if you if you have a quick rise, like you said, but it's happening 45 minutes an hour later, and you Bolus You're so off time now that maybe you'll cut something out of that rise, but you probably most definitely make a low later, right. That's why I like to get as much of the insulin upfront as possible, because at least at least when that battle happens between the carbs and the insulin, you know, you're gonna know there's not a ton leftover afterwards

Jennifer Smith, CDE 15:39
at the end. Exactly, yep. And that's the whole purpose of the Pre-Bolus, as well as more of like that super bolus consideration is up front loading of insulin, gets the insulin connecting with the sugar that it needs to connect with to get used. So in the back end, there's less of it.

Scott Benner 16:01
I'm sorry, I know you couldn't hear that. But that's okay. I was getting a phone call from my doctor's office. And for some reason, it came through my computer too. Could you repeat that really wanted to reach you, I'm a guy bounce through everything I own just oh, my gosh. But But would you say that again? I apologize.

Jennifer Smith, CDE 16:20
No, I was just, I don't even know exactly what I just said, Ah, oh, yes. So the larger amount up front, it's, you know, if you if you do a big Bolus up front, and you do it with more, just because you see a rise, or if you initially do like a Pre-Bolus in your front loading, or you do that super Bolus concept, where your front loading with a lot of insulin with the meal as well as the bazel behind it, you've got more action in the beginning for the insulin to connect with the sugar and to prevent that rise so that in the back end, majority of that insulin should be kind of used up that back end impact isn't as heavy. So

Scott Benner 17:09
I think the bigger response to Stacy's question and by the way, Stacy did not get her question as first because she bought a bunch of gear from the merch store today. Just because hers was at the top. But But I think the answer is it seems like early on, you probably had success with your Bolus, your husband had success with Temp Basal. And now you both think it's a tool that works best for you. But the truth is, in certain situations, it's one or the other. It's not like it's not like one. It's not like two tools that do the same thing. And you prefer one and he prefers another? I think that it's there are two different things because of the timing aspect. And this rolls right into another question. Another question that I'll let you here in just a second after I tell you again about the Contour Next One blood glucose meter. Okay, so I did a pretty poor job at the beginning of telling you that it's really accurate, but it's super accurate. You can go to Contour Next one.com to see how they figure that out. It also has something called Second Chance sampling. This prompts you to reapply blood if the first sample is insufficient to take a reading, it helps to avoid lancing a second time. And more importantly, maybe wasting valuable test strips works terrific. Other top features of the meter that you can add events to your readings. You can record events such as diet activities, medication, also add photos, notes, or voice memos to help put your results in context. Hmm, now we're talking right? voice memos, photos. So wait, I could take a picture of a plate. Oh, now you're getting that right, and put it into the app and say this was the meal I had. This is how much insulin I used this but my blood sugar was when I started watching see what the Bolus does how it works. Next time, got some Delete on their smart alerts, you can get alerted when your blood sugar levels are at a critical high or a critical low level with the Contour. Next One. It's very cool the way it does it was sort of colors and lights and everything you'll see. You can also easily share your results with your doctor in person to before your checkup, you are getting a lot out of a tiny little meter accuracy, alerts, reminders, an app that you can interact with, it'll actually help you with your blood sugar's And best of all, this meter is teeny tiny, but not too teeny tiny. So it's not a pain to carry. And it's not a pain to use Arden and I love it. Go to Contour Next one.com where the links in your show notes. Were the ones that you'll find at Juicebox podcast.com. People wanted to know about how long it takes for a Temp Basal increase to start working. And even though I told him like, Look, we've I feel like we've answered this a bunch of times but it'll it'll but right up nicely with this question. So Let's start with the idea of I bolus insulin. And it takes whatever 15 or 20 minutes to start working for, you know, whatever your your your truth is five minutes, 30 minutes. That's going to, of course, vary depending on your hydration, how high your blood sugar is, like all these different ideas. So okay, so let's just say it's 15 minutes. And that's a pretty consistent thing for you. But what if in that same scenario, my blood sugar's 95. And I suddenly do a Temp Basal increase? How long do I see before it starts impacting? I know, you're gonna say 30 minutes to an hour, probably right? Or even longer?

Jennifer Smith, CDE 20:40
Well, it's, it's interesting, because, you know, as we started with the Temp Basal increases a slower creep up in dosing and amount of, of more right of more insulin. So as soon as you increase by using Temp Basal, you do have to wait for the next pulse of bazel that the pump is going to deliver out for it to incrementally adjust that up. So with the next pulse of bazel, that comes out, it's going to be boosted up in the temporary amount you told the pump to increase by, but that pulse, then that initial little extra pulse is still going to take time for that larger amount in it to get noticed in the circulation and to start impacting the blood sugar. So as you do a temporary bazel increase, you may get more, if I'm talking about just Omni pod, in general, the pulses go out as point 05 pulses, right? So the more or the higher your basal rate is over the course of a one hour time period, the more point 05 pulses, you get to deliver a bazel. So if your bazel is normally at point zero, or point five or point six, you get 12 pulses over the course of an hour, right? If you do an increase to that point six, and now you're getting 1.2 units an hour, you're going to get more pulses over the course of an hour to drive that temporary increase that you've told the pump to provide to you. But it's still going to take time for each one of those pulses to get circulating. As far as absorption. So it's, it's kind of hard to define exactly when you should start to see an impact. But I would say some of its dependent if you've got a load of insulin, again, from a bolus sitting under and you're doing a temporary bazel increase. Sure, you might see in in, you might see a change in blood sugar faster, especially if you're doing a really huge temporary basal increase. If you're doing just this minor little temporary bazel increase, and you don't really have any insulin on board at all, it's probably going to look like it takes a lot longer for that temp increase to make an impact.

Scott Benner 23:01
Interesting, because I think this is one of those scenarios where people really do want a concrete answer. And I don't know that there is a concrete answer. I find that when especially when I'm speaking and so you're in really in front of people who are, you know, really trying to figure out something new. They there's always someone who's like, how long how much when, you know, my head, listen, you know, I can, I don't know,

Jennifer Smith, CDE 23:26
the definitive cut and dry and there is no definitive cut and dry

Scott Benner 23:29
exactly how long would I do a Temp Basal increase while I started seeing an impact? And the truth is, you know, so situational and personal and, you know, where's your site, get a good site, you got a bad site, got an old site, get a new site, like there's so much going into it. The other thing that I wanted to mention here that I find shocking, and, and not because I would expect people to know because anybody would tell them. But I don't want to insult anybody, but it seems like a common sense thing. The amount of people who believe that a basal rate is put in once every hour, like if your basal is one unit an hour it like that they think at like 12 o'clock, you get a unit and then one o'clock you get again, that if you really stop just for a second Think about it. That doesn't make any sense. But I guess it does, if no one's ever explained it to you like why and unfortunately

Jennifer Smith, CDE 24:20
at pump training, it isn't often explained to how that bazel rate is delivered. I think it's it's expected as an underlying under understood but not specifically stated. You know, yeah, it's just not it's not commented on unfortunate. In fact, it kind of also relates to an extended bolus. I don't know how many people I've had asked me or kind of explained me Why give this extended bolus. And I gave 50% now and then I did the other one in two hours. So you know, but then I cancelled it an hour later, so I didn't really get any of that that extra drove that I extended for two hours. I'm like, Nope, that's not how it works. Yeah. As soon as you're up front part of that, let's call it a dual wave where you get some now and some extended. As soon as you get that your pump starts delivering in drip, drip, drip drip over the amount of time you told it to extend it, it's dripping in that second part of the Bolus. told it. You need it longer.

Unknown Speaker 25:23
Yeah, right. Yeah, no, it's

Scott Benner 25:27
if you extend to Bolus, and I know this isn't the first question, and let's just use round numbers, that's understandable. Using 10 units, and you want 50% up front and 50% over two hours, then five units goes in, when you push the button, and the other five units gets broken up evenly over those extended amount of hours. It's, it's, you know, it's whatever that ends up being, if it's point two, five every 15 minutes, or I don't know what it ends up being, I'm not doing the math on it right now. But he just breaks it up evenly over the over the amount of time you tell it to extend it out over. And I don't know, I guess for a lot of people, that's just not something that anyone's ever brought up to them, and they can be confused about it. I've been talking about temp basals like, you know, the idea like I got a message the other day, somebody's like, you know, I just realized that what Scott says about like turning off bazel sometimes to catch like a, like a real drifting low work so well. But they were talking about that they can only do it for a certain amount of time they figured out or they'll close the highlighters. It's great. They're figuring it out.

Unknown Speaker 26:28
Yeah.

Scott Benner 26:30
When I was in Kansas City, I was up on stage. And I said something that I'd never said before, because I was like, Look, think of turning off your bazel as creating a pothole in the future that your blood sugar is going to hit. Right. And then someone from the audience said a black hole and Oh, that's so much better. Like let's say that. Okay, so, you know,

Jennifer Smith, CDE 26:53
good. Yeah, I think better one because

Scott Benner 26:55
it's because it's just a complete, it's a vacuum, right? So, so you've got this layer of, you know, one unit an hour of Basal and so on, that's, that's exists in you. But if you shut your bezel off for an hour at noon, and say it takes an hour for your bazel to go out of you, that means around one o'clock, there's going to be this vast nothingness of bazel right and so if you had a drifting blood sugar, and it hit that black hole, it would all of a sudden it would be weightless, right? It wouldn't have anything pulled the gravity would be going down and then you can hit that spot and stay level. And I so like I got done saying it and I celebrate a little bit and I could see a person down front looked at me and I'm like, I just thought of that just now. So I'm it's a good example and I'm just happy with myself. Just give me a second.

Unknown Speaker 27:47
A little celebration, we're gonna move on it's gonna be fine.

Jennifer Smith, CDE 27:52
You know, we should have we should have those little What are those? Those little popper packages, right where you can like pull apart, like, explode like whenever you go to your kind of your conferences, you should bring those along. And if you have those, like aha moments, you should pull one it surprised the audience. You're like, I

Scott Benner 28:08
just had a moment I think the surprise would be they'd stopped coming. They'd be like, this guy's like, doing Gallagher up here. It's gonna it's gonna break a watermelon since there's an old reference, nobody's gonna get.

Unknown Speaker 28:20
I get it.

Scott Benner 28:21
Jenny really does get it doesn't she? You know, she gets education. Jennifer actually 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, a certified trainer on most make some models of insulin pumps and continuous glucose monitoring systems. She's an active member of the American Diabetes Association, American Association of diabetes educators, and Team Wild. She is also a contributing author for diabetes sisters. What isn't Jenny? What isn't? She? I don't know. If he even likes cooking, did you know that? Alright, luck. Now I've basically just read you like what they write about genuine integrated diabetes. If you want to hire go there, look for that information and click on email, Jennifer. There's also a link in the show notes of this episode, where you can email Jenny directly. She really is terrific. I appreciate her coming on. What else do I appreciate? I think you know, I'm gonna say the Contour Next One blood glucose meter. Give it a try today, at least go check it out. Please use my link if you do. If you can't use the link that's in the show notes or Juicebox podcast.com. Right on just type in Contour Next one.com into your browser. How about a little bit of an announcement about where I'm going to be upcoming in case you want to get some tickets and show up and be like, yo, that's Scott, the guy from the podcast, you can do that. On February 16. I believe that's a Sunday for the greater Dallas type one nation event. If you want to find that without googling, you can go to my Facebook page and go to events or go to Juicebox podcast.com. Scroll to the bottom and click on events. There's links there so that's the greater Dallas type one nation I'm only doing one hour there that They not the whole Juicebox Podcast extravaganza like you're gonna get on February 29 in Georgia at the type one nation event. You guys are really gonna love this one. I'm doing an hour on my own and then a second hour, you know who comes to join me? Jenny Smith in that cool Jenny's gonna go off do her own thing. I'm gonna do a little talky talk, and then as mine and she's gonna roll in, we're gonna do a q&a together. Now, that's exciting. If you're in the Atlanta area, forget me. Honestly, meeting me is quite a letdown. But Jenny Hmm. That's what you're looking for. That's at the Georgia Tech hotel and Conference Center. Actually, I'm sorry. The one in Dallas is in Irvine. The Irvine Convention Center is at Irving. I don't know what you guys say in Texas. It's spelled Irvine, it might be said Irving. shimmy OSHA Maazel. I don't know. After that on March 26. Speaking of shimelle show Maazel in Appleton, Wisconsin, Tickets are available now for that too. That's a three hour build with insulin talk on a Thursday night, I think 530 to 830. Straight through great conversation q&a with me all about stuff you hear on the podcast, if you're out in Appleton, Wisconsin, or somewhere nearby, or you have a sled dog, and you can get to it, really would love to see you there. Those three events are all jdrf sponsored events. Very cool for them to have me out. stuff in the future. I don't know if you can get tickets for yet. Maybe you can maybe you can't touch by type one in May the end of May, in Orlando, Florida. And on August 22, to type one nation event in Richmond, Virginia. I am currently talking to people about doing something in October somewhere I won't mention yet. Might be a couple of them coming in October. But anyway, these are my events. I hope you can check them out. They're wonderful. And I'm not just saying they're wonderful, because it's me and I believe they're wonderful. Other people say they're wonderful too. So I obviously I think they're wonderful. Because, I mean, what I really show up and say something that I thought like, Ah, this is just okay. It would be silly. I am not you. I don't know me that well. But I am not getting on a plane flying somewhere to do that's just okay. We're gonna deliver the goods when we show up. Okay, you're gonna leave with some info.

I'm comfortable saying that. A because obviously, I have a narcissism that allows me to do that. I'm kidding. For those of you who will now leave reviews and says, this guy's really narcissistic. He even says it on the podcast, how wonderful of you to pick up on that. Those of you who don't seem to understand sarcasm, and the but the real reason I can say that is because I just got back from Oklahoma, and I saw messages online, one of them was really touching. It's like a vlog a vlog for you older folks is when people blog, but with video, you get it vlog. It's really Oh, anyway, and this person put a vlog out that was just touching about the talk that I gave. So I'm there to motivate. I'm there to inspire. I'm there to answer as many questions as I can to try to set you on the ideas of the podcast. And of course, to take an incredible amount of selfies that make me feel self conscious. That's why they call them selfies. Thanks very much for listening to the Juicebox Podcast this week for leaving the really cool reviews that you guys left on iTunes recently, the social media posts, you know, that I see on Instagram and Facebook, for your participation in the private Facebook group where people are trying to help each other both adults and parents of children with type one, I really just appreciate the support overall. The reason I bring that up is because when I go out to these public events, I meet a lot of different people, different ages, different situations, different agencies, different goals. And I can tell you that when I leave, a lot of these people are better off than when I got there. And when you see some of their situations, it's hard to it's just hard. Not everybody's having the same success. So to be able to go around the country and find people who wouldn't find a podcast. And to be able to help them or get them started or move them in the right direction is an incredibly and this is overused by people all the time, but as an incredibly humbling feeling. And the fact of the matter is that I would not be in that situation, to meet those people to potentially help them if it wasn't for the success of the podcast. So every time you tell someone else about it, and the lore of the podcast grows and it gets more downloads that motivates people to ask me to come out and talk. So for the really good feelings I've had recently meeting people in person, and for the private notes that I've received afterwards from those people after they see improvements in their health, I thank you for them. I thank you for myself. I really appreciate the listen. And I did a pretty good job of ending this episode on a real bummer. So let me say something happy at the end. And it's personal. But still, my son is still home from college. He actually goes back in a couple of days. And I was sitting at my desk late last night, getting this episode together a little bit, getting ready to edit it today. And he came in and he sat with me for a little bit. We got talking about a bunch of other stuff. And he asked me what I was reading. And I was reading an email from one of you. And it's lovely and personal. But my son got to see what I do, which was very nice. He doesn't know really, you don't I mean, like, he knows I have a podcast, he knows it's about diabetes. But he got to hear from a person who said, some really kind things about the podcast, and I think he was proud of me. So that was really nice. You guys did that to keep sending the emails, keep being bold. You're all going to do fine. It's going to get better if it's not going better. And if it's going great sky's the limit. Keep going. I'm proud of all of you. I'll see you soon.

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About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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#295 Defining Diabetes: Insulin Resistance/Overbolus

Defining Diabetes: Insulin Resistance/Overbolus

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

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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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 sponsored by our newest sponsor the Contour Next One blood glucose meter. This is the blood glucose meter that Arden has been using for well over a year, maybe a year and a half. And it is without a doubt noble, the best, most accurate blood glucose meter. Arden has used in what is now 14 plus years of diabetes 14 Plus I love math widow. She's two inches, I've noticed 15 she's almost 68345 678-910-1112 I lost count for like 13 years when I say it's been so long, I forgot what I said. She's 15 she was diagnosed which too, anyway said a lot of meters since then. A lot of years, a lot of meters. This one is without a doubt. absolutely the best. You know what, I'm just going to tell you why right now sample size, not a lot. If you miss with your little like you know, you touch the button or sometimes you touch it, it doesn't work that doesn't waste a strip, you have a nice long time to put it back on again and get more blood without affecting the test that of course, amazing. If you want the Contour Next One has a app that comes with it, which is a darn handy, you can check that out. I can tell you from personal experience that Arden has never had a meter that has more closely and more frequently agreed with her Dexcom JSX really gives you a lot of good feeling when that happens. The meter is an industry leader in accuracy. And I will actually share some of those numbers with you in a future episode. The app by the way is available on the Google Play Store and the App Store. By Contour Next One is compatible with Apple Health. And those of you using an omni pod dash, the Contour Next One will send the information right into the dash magic, Bluetooth magic. All right, listen, for now, I want you to go to Contour Next one.com. Now contour spelled the classic way CLN to you our next again, only one way to spell Next one is the word not the digit. So Contour Next one.com head over there today. Check them out. But you know, if you're going to do it, here's the link in the show notes or the one that you'll find at Juicebox podcast.com get Arden's meter today, it is spectacular.

Jenny Smith is back today Jenny and I are going to define insulin resistance. And it's not exactly the way you think of it, which is why we're bothering to take the time to talk about it. We're not just like, whoo, pick something everybody knows. You think you know about insulin resistance Jenny gonna shine a bright light, a bright light on what it means. While you're listening to Jenni spin her genius. Try not to forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And that you should always consult a physician before making any changes to your health care plan. or becoming bold with insulin. I could say that my sleep by the way. All right, I'm not gonna make you a bag. We're gonna get right to Jenny. Don't forget, by the way, if you want to hire Jenny, she works for integrated diabetes, you go to integrated diabetes.com to find out about Jenny. Jenny is not a sponsor. Jenny is my person. So I don't get anything out of it if you go except good feelings. So you can go through my link if you want. If it makes it easier for you. You just type right into the browser don't matter. Here we go. Here we go. There we go. Here we go.

I would like to define insulin resistance

Jennifer Smith, CDE 3:59
and insulin resistance. That's a good one a very good one. And I'll tell you why.

Scott Benner 4:03
Why does this one come up on my list? It's because again, I think it's the same thing as brittle in a different in a different avenue, the same idea? Maybe not always. But I think I think there's insulin resistance and there's reasons for it. But first, can we define it?

Jennifer Smith, CDE 4:21
Sure. I mean, insulin resistance is essentially the body's pushback, a simple, I guess, simple definition, the body's pushed back in appropriately using insulin, right? It's just not it appears that insulin is just not working the way that it's supposed to people with insulin resistance and that which is a technically a hallmark of type two diabetes is insulin resistance because in the early phases of type two development, there's actually a huge output of the pancreas producing more insulin like loads of insulin to actually overcome the higher blood sugar levels, but their body's cells are not responding to the insulin, the right way to the body just keeps pumping out more and more and more insulin and offense. Eventually, with type two, the pancreas gets pooped out. I mean, those cells are like God, we just we can't put out like more and more and more, we're doing enough and it's just not working. It's a bit different in type one diabetes. I mean, there are, there are some hallmark, like diagnostic reasons for true insulin resistance in type one. One of them is weight management, the the heavier that you are above, your body's like, target healthy weight, the more resistant you're going to be to using insulin, the insulin is just not going to work as well in the body. Another one specific to women is something called pcls, polycystic ovarian syndrome, and that, that actually causes a whole like series of metabolic changes, one of which, however, is insulin resistance. A woman with pcls will usually need a lot more insulin to manage. And it's based on a hormonal component to the ovarian syndrome that's kind of going on.

Unknown Speaker 6:20
So

Jennifer Smith, CDE 6:23
in general, though, insulin resistance with Type One Diabetes, if you are, you know, your healthy weight, active and whatnot, everybody's insulin needs are very different. So when we talk about insulin resistance, I think a lot of people might look at a friend of theirs, who's the same height, weight, you know, doing the same kinds of things. And you're like, Well, why am I using double the amount of insulin is dumb? What's the deal, I must be insulin resistant. That's not the case at all. I mean, I've got a friend who's actually, she's tiny. She's had diabetes several years longer than me. And I've had 31 years, and she actually uses more insulin than I use. She's only five feet tall, and she probably weighs 10 or 15 pounds less than I weigh. And, but she us and she's very active. Um, she's actually roller derby. She's done a couple of like, full distance Ironman, you know, events. And so, in that, I think sometimes there's a lot of confusion, confusion around how much insulin Should I personally be using? It's different for everybody. Gotcha.

Scott Benner 7:31
Okay. So I brought it up. Because engineer, can we slide your phone slightly away from the microphone, I think, yeah, absolutely. I think I brought it up. Because I know it's a real thing. And I wanted you to explain what it really was. But I also know that people default to saying it too frequently, when I don't think that that's what's going on. Right. So a great example would be if you're dehydrated, and you know, you're using insulin, and it's not giving you the you know, the response that you expect. And then you hear people say, Oh, I was, I was really insulin resistant today, but you weren't really insulin resistant. Today, you were really dehydrated today. And so and it because and the reason I bring it up is because I think the idea of insulin resistance allows people to think this is something beyond my control. So I'll just accept it. That's what that's why I brought it up. Because that worries me for people when that happens, right? Great example, is I've been helping this really wonderful family recently with a 16 year old boy who's, you know, an athlete plays ice hockey. And yesterday, the kid went to an ice hockey game and got to play the game, like right around like 95 the whole time, you know, didn't cross out crash low afterwards or anything like that. And I realized that prior to that, they were doing the like, will get his blood sugar higher thing. And you know, and he didn't feel well, he feels so much better now. And all this stuff is great. And it's really cool. But they were living in a false narrative before, right? Like, this is what's happening to me. And so I have to accept it, or I have to do this thing that I don't want to do, because this is what's happening. And and I don't think people should. I don't, I don't want to say I don't think it makes me sad. Honestly, when that's happening, you don't mean like, I don't like the idea of someone running around going, Oh, my blood sugar was 250. Today, I was just insulin resistant, when there could have been a real reason for it. So try to just keep in your head. The difference between what Jenny just explained with insulin resistance really is like for instance, a pregnant person could use a significant amount of insulin right then then they would even have five seconds before they're pregnant. We're in their first trimester versus their third trimester, like all these different ideas, but that's not that's so that's that. Okay, so I just please

Jennifer Smith, CDE 9:53
and I think a good thing to kind of put in there with that is that there may be times when Insulin resistance is a piece of what is happening, like you just brought up pregnancy, right? There is a piece of points in pregnancy where Yes, insulin resistance comes into the picture. But why is it there? It's not that you're going to be insulin resistant for the next 90 years after the child is born. It's the fact that there's a hormone piece in the picture that's causing you to actually you need more insulin, you just need the hormones are causing that issue. So it's not like a type two, where the cellular level of response to insulin is actually a piece of

Scott Benner 10:34
your so is it fair for me to say that, like I bring up on the show your body is for whatever reason, telling you, I have more of an insulin need in this moment. And you need, you just need to meet it. So if you are insulin resistant in that moment, there is enough insulin to use to overcome that blood sugar, right? It just it gets to a scary point for most people. And they're like I can't, the numbers get wrong, the numbers get wrong in their head. Like, I'm usually my base is usually a unit an hour. And I've never bolus more than four units for food. So they just won't go bigger than that guy. And people who and people who haven't gotten their bazel right and done all the things we talked about in the podcast probably shouldn't start crazy bolusing like that, because they are going to have a heart problem. But but the breath but the reason I bring up the boy with the hockey is because he can stay stable while skating and playing hockey now because his bazel insulins, right? Because he's bolusing on time with his meals because he doesn't have any unbalanced active insulin in his system that just pops up at weird times. And doesn't have a fight with food anymore. So it just kicks his ass instead. Like, right, correct. Okay. All right. Thank you. This is my my, my defining diabetes list is about like, all the sad things I hear people say. Can unit

Jennifer Smith, CDE 11:52
No, let's clear that up. No, that's not right. Let's make sure you understand that better. Yeah, I

Scott Benner 11:57
just I look and I think oh, it's sad that that's what, what what is thought? Right.

Listen, I'll give you a quick story, right? And then I'll ask you to define overbought listening. I made a diabetes podcast, the very, very beginning of 2007. And because of Excuse me, I made a diabetes blog in the very beginning of 2007. And because of the nature of the internet at that point, I didn't really know the other diabetes box. Like there was a little while where I thought to myself, Hmm, I am doing something so cool that no one else is doing Why did no one else think of doing this? I am a genius. I felt like the Magellan of like diabetes blogs. Right? I was just looking around. I'm like, why couldn't know how Scott's idea is so much stronger than everybody. Then I realized there were a couple other diabetes bots. Right. And there had been a number of them proceeded mine. I had no idea about them when I started mine.

Jennifer Smith, CDE 13:14
But I had, I think, I think Carrie sparlings was one of them. I think she started in 2005 or 2006.

Scott Benner 13:20
Definitely, definitely carry Scott Johnson probably.

Jennifer Smith, CDE 13:24
Yeah, maybe diabetes. Yeah,

Scott Benner 13:26
maybe George Simmons to like, if I'm thinking correctly, there were a handful of them. I was in the beginning. I just wasn't the beginning. But I had, I had this feeling that I was right. And similarly, I do this thing where I avoid other diabetes information. I know that sounds weird. Maybe when I say to people, but I don't listen to other people's podcasts. I don't read other people's blogs. I don't want to be impacted by other people. Because I want to come to these ideas on my own. Because when I come here, well, not only that, I can explain it if I know how I got to it. Right? When somebody just tells me set this there, that doesn't help

Jennifer Smith, CDE 14:03
me. It's like reading a definition out of a dictionary.

Scott Benner 14:07
Yeah. And then it doesn't help me to help somebody else. So I come up with this idea that we talked about in the podcast here, my house in my own head. What if I can't Pre-Bolus one day, how do I handle that? And then I came up with that kind of math that you've heard me talk about in other episodes, where I'm like, Oh, Bolus for the carbs. And then I'm gonna imagine the spike in Bolus for the spike. And then I'm gonna imagine the correction I'm gonna I'm gonna put it all in right now. And maybe I can get all this insolence so far ahead of that, that like a time travel movie, none of those things will ever happen because I killed the thing before it was supposed to happen, right? Mm hmm. Literally how I thought of it. And I started speaking about it and I called it over bolusing because I'm over bolusing. You can see how thoughtful so

Jennifer Smith, CDE 14:54
pretty fancy term there over bola. Thank you.

Scott Benner 14:57
And so our insulin board Over bolusing stop the arrows I am talking to myself like I'm for. And so. But anyway, it works. And then I was like, Ah, here I am again invent and stuff. And then one day you said to me, oh yeah, Gary calls that this and I was like, Wait, what? Yeah, but that completely makes sense that somebody else would have had the thought to. So what I call over bolusing is exactly what I just explained. It's the concept of getting in more insulin than you need for the current situation with the understanding that this current situation is going to get worse soon. And so you get ahead of the problem. But correct, but Gary calls it Super Bowl is saying, right?

Jennifer Smith, CDE 15:45
Actually, it's john Walsh, john. And we use that we use the term Gary uses the term too, but it originally came from my understanding came from john Walsh, who wrote pumping and pumping insulin. Okay, which from what I understand from people is a really great book. It doesn't it doesn't tell jokes resource. You don't get to hear Jenny while you're reading it. So Well, I mean, how?

Scott Benner 16:07
But but so

Jennifer Smith, CDE 16:08
it's, it's written in layman's terms. It's a good. I mean, it's not like a bedtime story or anything. But I like it from the standpoint of, you know, one of those books where you can go to a chapter that's like, how do I manage around exercise? Or how do I figure out bazel? Or how do I deal with these spikes post meal and over Bolus, right? Or Tino people? I think like you people think about, should I just take more insulin? I know that yesterday when I ate my cereal for breakfast. This is what happened? Well, what if I just took more insulin right now? Yeah, that's the same concept. It's, it's over bolusing, it's super bowl of thing, it's whatever you want to name it, it's just you head off the spike by just dosing more earlier,

Scott Benner 16:51
okay. And so to really to break it down, and we've done this and other episodes, but I want it to be here as well say that you've counted your carbs perfectly, but you have not Pre-Bolus. So you know, you're going to get a spike. And you decided that the meal is three, you know, three units, but the spike is going to happen because you didn't Pre-Bolus. And in your history, you found that that spike is going to go up to 225. Before it kind of before plateaus and levels off. And you know that it's going to take a unit to correct that to 25 back to 90. So then you put in 40 units instead of three, because you weren't able to pre Boss, I will I will absolutely tell you that. And I've said this one other time on the podcast. We don't Pre-Bolus as much as we used to, because I know how to overhaul us, right and it and I don't not do it. I always Pre-Bolus whenever I can. But when I can't, I guess I should have said I don't panic the way I used to write I just take care of it right then in there. Mm hmm. And, you know, that's a that's a definitely a another thing that you have to try over time, and there's going to be you know, there's gonna be

Jennifer Smith, CDE 17:59
some experimentation

Scott Benner 18:01
definitely gonna be experimentation for you to fail.

Jennifer Smith, CDE 18:03
And you know, you figure it out, you're super, you're like, I call it secret sauce to over bolusing. Right? You figured it out and you make it work. And, you know, I would say probably 98% of the time, you probably nail it because you've figured it out. And in terms of like, you know that that one unit you said before for the 225 blood sugar? Well, I know it's going to get here, you know, it's going to take a unit to correct and bring me down in a mathematical way, just for like definition of how could you figure that out, you can actually sort of back use your correction factor. You can say, you know, if I know that I'm going to start with a blood sugar of 100. I'm going to go all the way up to 225. And one unit brings me down 100 points, your correction factor is one to 100. Okay, one unit should drop you 100 you can say okay, 225, one unit will bring me down to 125. It's pretty close to 100. So let's just give a whole extra unit to the front of this food bolus, the pump suggested or I calculated three units for the food, I'm going to add on a unit without the time to Pre-Bolus or maybe it's just a really carby meal like cereal tends to be and so you head it off with that extra but that's a little bit of the math if you want a little bit more way to figure it out ahead of time. And then you know as we talked before, john Walsh's method with super bolus is really just to take, he does it by taking the bazel behind the meal. And he tacks that on to whatever the food beast Bolus is up front. So if you're, you know, if your Basal is running at one unit an hour behind the meal for two hours, that's two extra units of insulin. You take that two units, you pop it on to the Bolus up front, take it all at one time. And his recommendation is to then take the bazel down to zero. So your front loading with the insulin but you're also knocking off the back end effect so you end up not going low. Now again, there's some experimentation to that as well. Well, there's I've got some teens and young adults and even some kids who are taking the bazel down to zero, it doesn't work, they end up the Super Bowl is works, it prevents them from getting like that big spike, but they end up then staying too high later or going up again later because the bazel has been taken back to nothing. They still need it. So they need some of it. I've got a college student I work with and she does a 50% bezel reduction with a super Bolus. Okay, so there's some experimentation just like you found with your over Bolus.

Scott Benner 20:32
But yes, that's a good one. Listen, I made that word up in my house and I didn't know anything else existed. So in my mind, I'm again Magellan.

Jennifer Smith, CDE 20:40
You are you're over Bolus word you are. Yes.

Scott Benner 20:42
And if john Walsh had a podcast, he could tell us about his Super Bowls, but he doesn't. That's it all right now.

For all the people who don't actually get my sarcasm, I feel bad for how angry they must be at me while I'm talking. Like that guy. Every episode of the podcast and with Jenny giggling Thank you so much, Jenny Smith, for coming on the show today and sharing your wisdom with everybody. Don't forget to check Jenny at integrated diabetes.com link in the show notes at Juicebox podcast.com. And of course, our new sponsor the Contour Next One, you want to do yourself a favor, you want to do something, it's not going to cost you a lot of money but is going to add a ton of confidence and good feelings to you. To your life to your feels inside. Take away the stress and the anger. Take away everything. The worries go away. I'm feeling mountain away. Right? You never thought of it before. But a really solid, super easy to use small, like you know, completing your pocket putting the bag No problem, but it's still substantial in your hand. Right feels well made. You can hold on to it. You know, I mean, it doesn't feel delicate, like oh, I'm gonna lose it or it's gonna break. It's good. It's solid. It's not big, but it feels good in your hand. I like it. I'm just telling you right now. I don't want to do dirty the other meters that aren't used over the time but I'm thinking there's been a couple and ain't one of them been half couldn't hold a candle to the Contour Next One my friend understand Contour Next one.com such a simple thing. You've been walking around with his old dirty nasty meter that you don't trust for EVs. Why are you doing that? So simple to get yourself going with the right one? That easy? Right? Tell your doctor next time in the office. Yo, yo, how come? I want to get the Contour Next One meter. Make it happen. write the script script out. Or like I said, Contour Next One comm check that out to all kinds of ways to upgrade your diabetes. I'm all sorts of jacked up right now. Do you want to know why? You probably don't care. I gotta fly tomorrow. Oh, I hate flying. I'm trying to keep my energy up. I can't wait to get to the jdrf type one nation event in Oklahoma on Saturday, and go in there and do what I think is gonna be the magic. I am gonna really whip it out. I think I've given like four talks in the day. It's gonna be wonderful. I'm super excited about that. Here's the part. I'm not excited about driving to the airport early in the morning tomorrow. Oh, not good. getting on a plane with sick people. You know, they're sick. Right? And I'm not a germaphobe but it's January is cold out. You know, people like wipe their hands on their nose. Touch a part of the plane, and I'm gonna touch a part of the plane. Next thing you know, I'm not gonna feel good. I don't like that. Then I gotta fly somewhere. Now, I don't mind flying. But I hate layovers. And apparently, there is no way to get from where I am to Oklahoma without laying it over. So I'm gonna fly North tech go, like sad. I don't really know where Oklahoma is. But I'm like Southwest. I think I'm probably going right. Oklahoma, Oklahoma, where the wind? Yeah, it's probably like Southwest. I have to fly north to go Southwest. I don't want to do that makes me upset just thinking about so instead of being upset, I'm keeping up my good energy today. being excited, have a little bit of fun, trying to keep my focus off of it. I'm going to do my best to put up a couple pictures on the social medias while I'm there. So you if you're following me on Instagram or Facebook, that's where I would do that. What else? Yo Are you in the private Facebook group for bum in the bowl with its own Facebook page and there's like a private group of people talking about management stuff and other good things. Lots of good peeps in there. Go check it out if you want. Gotta be something on someone to tell you. has to be

I'm speechless. What is this gonna happen again? All right, I'm gonna go pack and get to Oklahoma. I hope I see you there. Or at one of my many events coming up, check them out. Go to Juicebox podcast.com scroll to the bottom, click on You'll see where I'm going to be in 2020 got a lot going on. Think I just added the Phoenix area in May. It's not locked down yet but have a good feeling about it. Um I might be having a good time recording. I don't want to stop but I have nothing left to say you're probably pissed now. I'm gonna let you go. Goodbye.

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About Jenny Smith

Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com

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