#719 Bold Beginnings: 15/15 Rule
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to another episode of bold beginnings. This is episode 719 of the Juicebox Podcast.
On this episode of bold beginnings, Jenny Smith and I will talk about the 1515 rule. If you've been diagnosed with diabetes, and given insulin, someone has said to you 15 carbs 15 minutes. Jenny and I are gonna break it down right now. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. We're becoming bold with insulin. If you're enjoying Jenny, and you'd like to see what she's doing professionally, checkout integrated diabetes.com. That's where she works. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juice box. Join the registry complete the survey support people living with type one diabetes T one D exchange.org. Forward slash juice box. At the end of this episode, I'll list all of the bold beginnings episodes that have come before it, just in case you have missed one.
This episode of The Juicebox Podcast is sponsored by in pen from Medtronic diabetes. And because this is a short episode, I'm going to give you the entire ad right now. lickety split real quick, you ready. The pen is an insulin pen that connects to an app on your cell phone. When that happens, it gives you much of the functionality that you would get with an insulin pump. It's also completely possible that the in pen may only cost you $35. Head to in pen today.com To find out more. When you get there. If you're ready to try it just fill out the form where it says ready to try and hit submit. But if you want to learn more, do some reading, find out about the pen, insulin cartridge holder dosing window a knob and injection button and a cap just like you would expect from an insulin bed. But then it connects to the app on your phone through Bluetooth, giving you your current glucose levels, meal history, dosing history activity log reports, glucose history, the act of insulin remaining and your dosing calculator. Also I also while you're on the page in Penn today.com You can learn more about the offer that is made to people with commercial insurance terms and conditions apply of course, but you may pay as little as $35 for your in pen. You know what else in Penn offers 24 hour Technical Support hands on product training and online educational resources. All of that is something you can learn about in more depth at in Penn today.com in Penn requires a prescription and settings from your health care provider you must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information again, visit in Penn today.com There are links in the show notes of your podcast player and at juicebox podcast.com. To in pen Dexcom Contour Next One on the pod the T one D exchange G vo glucagon touched by type one, US Med and those are the sponsors for right now. But if you're interested in buying an add on the Juicebox Podcast, find me and we'll see what we can work out. Bold beginnings series is going well people are enjoying it today. Jenny, I put up our terminology episode as a two parter because it was like an hour and it was like an hour and 15 minutes long. So I just kind of cut it in half. I thought it would make it easier for people to be able to find terms within them. But this morning, I was hoping to do the 1515 rule. Ah, so let me find people's feedback on 1515.
Jennifer Smith, CDE 4:17
I am I'm first very curious what people have to say about
Scott Benner 4:21
that. It's it's it's repetitive and and is it Yeah, so you know, just a number of 15 carbs 15 minutes rule one just says no. 15 carbs for a low is probably overkill. Not everyone treats I've learned with 15 carbs, we still only use two or four carbs to do a kind of watch and weight thing. So then a longer piece of feedback is the whole premise of the 1515 rule just does not do well for most people. If we had followed that consistently our toddler would have been consistently over 400 and we would have been having rebound Hi is because of these uncovered carbs. For example, 30 grams can move my child all the way up to 300 blood sugar. Now, I guess we should go over very quickly. 1515 Roll means if you find yourself low, your doctor will probably tell you have 15 carbs, and wait 15 minutes, correct retest. Now, do you think that that's a pre CGM? Theory?
Jennifer Smith, CDE 5:34
It's a, yes, that's where I was going to entirely. It's old. It's old. Like, I think the term brittle diabetes is old and not a purposeful explanation at all. But the 1515 really came from lack of any technology outside of a glucometer, that you could actually do a finger stick to confirm symptoms and see where things were going within another 15 minutes, right, because it is going to take some time for a finger stick value to show a difference in that era of, you know, that kind of use of limited technology. But we have so much information now with the technology we have, that that rule is explained very well by these comments. Absolutely. It's, I know how much it takes to bring my blood sugar up this much when I'm hovering here, or if it's a really quick like jump over a cliff drop in blood sugar, I might need this much more. I think we also understand insulin a little bit better, at least, you know, a lot of the podcast listeners understand insulin a little bit better, and the action of it. And you can say, well, I'm in the clear of any insulin on board. This low is being driven by Basal insulin only. And maybe because I got a little bit more active or busy or whatever, in this timeframe, I probably could get away with three or four grams of carb, and even this out and be totally fine. Versus again, 15 grams that you don't need,
Scott Benner 7:11
it feels it feels like to me even meters not that long ago. I mean, I want to sound like an old person. But not that long ago, even meters weren't all that accurate. And some still, actually but you know, I think now what does the FDA push them towards? Is it is it. You know, the percentage, like if your blood sugar is actually 100, the meter has to report back at least like 85 or 115 are in that range somewhere.
Jennifer Smith, CDE 7:35
There's a percent it's actually the the average difference that's allowable for the FDA to approve the meters each of the meters. I mean, if you're really interested, and you really want the information, don't throw away the little pamphlet that comes with your test strips, because it has that direct information for you. How much off could it be?
Scott Benner 7:57
Well, and but in the past, I mean, I remember people advocating for meters to get better and better to where they are now. And I can remember in the past where people are like my meter can be off by 20 25%. It's on correct. So with all this unknowable data happening, what is your blood sugar really? Is it falling? Or is it you know, is it rising, you would have no idea without a CGM. So this very, it's a safety feature from back in the day where the doctor is like, if you're low, eat 15 carbs, wait 15 minutes and test again. And if you're still low, eat another 15 carbs, right would be the next thing. And yeah, and now hopefully, you know more and more people but so is so I guess here's the question, if you don't have any good tech is 15 carbs 15 minutes still the way to go.
Jennifer Smith, CDE 8:49
From a safety standpoint, yes. Okay. Um, from a standpoint of even newer insolence are more rapid acting insulins that do have a little bit more definitive timeframe of action, it's a shorter timeframe of action. Again, I think that there's more consideration that you can still do even if you're just taking multiple daily injections and using a you know, a meter to check your blood sugar's fingerstick wise, you can still start out on the low end of treatment. If you're willing to go about a little bit more testing to evaluate the need for more. It will it will tighten your ability or it will tighten your range after treating you're not necessarily going to always need 15 grams even if you're blind with you know with no CGM data, let's say I in fact, I would say that many people could probably do well with five to eight grams of carb and not get into trouble with excessively high blood sugars. Again, that's outside of exorbitant insulin on board wording that kind of thing. But outside of that, I still think 15 is an overshoot. But it's a safe enough overshoot that it's definitely going to raise your blood sugar.
Scott Benner 10:11
So I want to kind of bring a couple of different thoughts in here. So first of all, if you're listening to this, because you are more more newly diagnosed, it's important to know that carbs will hit you at different speeds. So, you know, taking 15 grams of a baked potato for a low blood sugar is not going to be a good idea, right? You need fast acting easy to absorb simple sugars, things like that. You also have to be aware that if you have if you have, let's say you have enough insulin working, where you're low falling, and you're going to need 30 carbs to stop it. But you take 10 of a simple sugar, it could look to you even on a CGM, like the insolence just, it's just running through the sugar, the sugar is not even slowing it down, it is slowing it a little bit, but it might not be enough. So the speed, it's we're understanding glycemic impact and load a little bit helps with with stopping low blood sugars, you can eat a baked potato is going to take forever for your body to absorb, which is why the emergency gel for instance, gets rubbed on the inside of your cheeks, right gets absorbed very quickly. I know this is like a scary time for people. You know, so you're you're newly diagnosed, you're falling, here's how this goes. You do the 15 carbs, 15 minutes, eventually, you're happy because while I stopped the low blood sugar, and then you start seeing the next step and thinking well by now but my blood sugar's to 20. Now afterwards, I don't want to I don't want to stop a 70 and make it a 220. And by the way, some people are treating low blood sugars, and they're calling them low when they're first diagnosed at 110. They're like, Oh, no, I'm getting low, you know, right. And so then they see the next piece of it. And you're trying to make sense now of how do I stop this low blood sugar without creating a high one, I would even say to you, I would jump past that idea and say how do I get into a world where I'm not stopping low blood sugars all the time? Yeah, correct. Yeah.
Jennifer Smith, CDE 12:08
Right. And that's what we focus on. Even in education, we first look for lows, or percent of time, lows, are they frequent? Are they at a consistent time of day? Is there a trend to them, for example, and if there is, we go to meet those first, most people who want tighter control, they're actually much more worried about the highs than they are about the lows. But if we can take away a good number of the lows that are occurring in a in a pattern, we can also take away a lot of the highs because it's it's hard to not over treat, especially I think in the beginning when you're really learning about things, and trying to judge how your body is, you know, I guess reacting to stuff. And also how your brain is able to overcome the low and the symptoms and being able to tell yourself, well, I don't need that 15 grams, I feel these low symptoms, they're horrible. I'm only going to treat with this much
Scott Benner 13:11
right. It's all it ends up being that understanding the bump and nudge ideas from the Pro Tip series will help you understand this. In simple simple terms. If if you're standing on the sideline of a football field, you're out of balance and somebody's inbounds and they're just wandering out of bounds, you might just put your hand up and stop them without pushing them. But if they're running out of bounds, you're going to have to shove them to keep them in correct. And so if your blood sugar is and this is where having a CGM becomes really valuable if your blood sugar is 65, but it's super stable at 65, a few carbs and there's no active insulin, a few carbs might move you up to 90 no trouble. But there's active insulin or if the 65 is falling, then you'll need more carbs to counterbalance that. But in general, the blanket statement 15 carbs 15 minutes is either going to lead you to a life of bouncing blood sugars and not understanding what's going on or it's going to lead you to the the idea of like, Hey, I think there's more here for me to understand. Right, just running through people's statements again, the 1515 plan can be too many carbs for those 15 carbs was way too much for me. overtreating lows was a big problem in my management. You don't need 15 carbs for low is something I wish someone would have told me. I mean, you might, but it's not a hard and fast rule. Right. And then this person says that the 1515 rule was drilled into us. And so early on to combat minor lows. They're just doing it over and over and over again. They're seeing what's happening. But they can't, in their mind make the leap. They shouldn't be doing it or they should be adjusting it somehow because of how fervently it was it was drilled and recommended.
Jennifer Smith, CDE 14:53
Yeah, absolutely. And again, I think it's the biggest takeaway, right? Now is if you're using any kind of technology, I guess CGM specific or if you're just really, really on top of doing finger stick after finger stick, because that's what you're choosing to do, then you've got enough information, and enough accurate information to be able to say, in the past couple of weeks, I've done the 1515 rule. It's created this roller coaster up and down that I no longer want. What if I just treat with 10? Instead of 15? Right? What if I treat with eight instead of 50? Right? I mean, there, there's some navigation that eventually you're going to learn how to do your own self experimentation that say, Well, you know, this is what I'm gonna have to do, because that's clearly not working with 15,
Scott Benner 15:49
right? And you're gonna hear people say to you constantly, like diabetes is a science experiment, you're gonna figure it out, etc. That's all they mean. They mean trial and error. Don't do the same things over and over and over again. You know, once you see something and it proves itself out, trust it and do something different. Correct. Okay. So there you go. The 1515 rule, which is not really a rule it's just get says the people so many times people like it's a thing.
A huge thanks to Ian Penn from Medtronic diabetes, for sponsoring this episode of The Juicebox Podcast in pen today.com. To get started, where to learn more. Thanks also to Jenny Smith, who works at integrated diabetes.com. If you're interested in procuring her services, that's where you would do it. I also want to thank you for listening, for sharing the show, and for being terrific. The other day, I received a photograph from the ninth listener who's bought a vanity plate for their car for the Juicebox Podcast. That is, um, that's some cool listeners. It's some great dedication from you. Thank you so much. If you head over to the private Facebook page, which I'll do right now with you Juicebox Podcast type one diabetes. Get yourself in there scroll to the top click on Featured Isabel has all the lists set up for you Pro Tip series variables, etc. One of those lists is the bowl beginning series. I will read from it. Episode 698 defines the bowl beginning series lets you know what we're planning on doing with it. Episode 702 is about honeymooning 706 adult diagnosis. 711 terminology Part One 712 terminology part two, Episode 715 is fear of insulin and today's episode, Episode 719 is the 1515 rule. There's much more to come. But that's where we're at right now seven episodes deep in the bold beginnings series. There's also a list there for defining diabetes that's 44 episodes of terms defined for you that you use every day with type one and type two diabetes very often. How about a nine episode series talking about celiac, and type one, or a 10 episode series about disordered eating 19 episodes dedicated to just me talking with kids, lots of interviews with me and the children 26 episodes Excuse me 27 episodes after dark series everything from drinking to disordered eating psychedelics living with bipolar. People who have type one diabetes, and other extraordinary challenges often will be found in the afterdark series. There's a 411 list called juicebox asst that has 16 Very popular episodes in no particular order. How about a 14 episode series about algorithm based pumps from loop to Omni pod five control IQ and there's way more coming in that series very soon. You can learn how to Bolus for fat and protein. And there are so many ask Scott and Jenny episodes where Jenny and I just answer listener questions. There is a growing list about mental wellness and type one many of the episodes are with licensed Marriage and Family Therapist Erica Forsyth a type one herself. We have a small but but but strong list of type twos. I really would like more of you to reach out to be on the show. Always looking for type twos to be on the show. Please reach out if you're interested in coming on and building that series up for others. Defining thyroid is a 10 episode series that will help you understand thyroid disease. And our pregnancy list has just grown no pun intended to 12 episodes. There's a how we eat series where people come on to talk about their eating Tao carnivore plant based low carb Bernstein FODMAP keto flexitarian intermittent fasting vegan, that list is also on the move, looking for more people to come on and talk about how they eat. There's a quickstart guide episodes from episode four all the way up to episode 100. These are the episodes people say if you listen to you'll get a vibe for how I feel about type one, and it gets you into the podcast. And that's the Quickstart list. Don't miss the diabetes variable series 22 episodes, giving you look into things that impact your blood sugar that you would never think of like hydration, sleep, weight gain, and more. And of course the diabetes Pro Tip series 25 episodes with Jenny and I starting at episode 210 newly diagnosed or starting over taking you through all the steps that I believe will help you bring your agency to where you want it to be. I hope you check them out. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 719
1. Why is it important to understand diabetes symptoms?
2. What role do lifestyle changes play in managing type 1 diabetes?
3. What are the different types of insulin used for?
4. How does diet and nutrition impact blood sugar levels?
5. How can stress and emotional health affect diabetes management?
6. What are the benefits of regular physical activity for people with type 1 diabetes?
7. Why is building a support system important?
8. How can staying updated on new diabetes treatments and technologies help?
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#715 Bold Beginnings: Fear of Insulin
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to episode 715 of the Juicebox Podcast
Hello again and welcome back to the bulb beginning series today is actually the fifth episode but third installment. The way that happened was that episode 702 was about honeymooning 706 was about adult diagnosis. And then 711 was supposed to be terminology, but it got a little long. So that ended up being terminology part one at 711 and terminology Part Two at 712 which makes today's episode 715 bold beginnings fear of insulin. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, you can complete the survey AT T one D exchange.org. Forward slash juice box. Your answers to these simple questions will help people living with type one diabetes T one D exchange.org. Forward slash juice box this episode of bold Beginnings is sponsored by Ian pen from Medtronic diabetes. You can get started today with the M pen at in pen today.com. The podcast is also sponsored by the Contour Next One blood glucose meter. Learn more about Ardens blood glucose meter at contour next one.com forward slash juicebox jetting so far we have I think three episodes of the bull beginning series are out or today actually, as we record this the dolt diagnosis one went up. And today we are going to record fear of insulin lows and highs. And there were a ton of a ton of feedback that came from people again, these are statements from people in my private Facebook group, when asked what do you wish you would have known at diagnosis and surrounding the fear of insulin, low blood sugars, high blood sugars, we got this back. So just a couple of them here in the beginning, it's going to set the stage that don't really need a response, I was scared of insulin. The next one says seriously, the fear of insulin was real. We were scared of insulin as the next one, we had to wake up twice a night for finger sticks. And it felt like we were chasing a blind number. I'm really glad they did have me practice with glucagon. Because when I had to use it, even having to think about it. You know, the person said they wanted to understand glucagon so badly because when they actually had to use it, they were having an experience that was so surreal that there was no time to think my daughter's had a couple of seizures. And I know what that feels like you're like, you just you look at that package. And you just hope your your body remembers what to do, you know, right? The first thing I really want to talk about here is this statement from a person who said, I was handed a bunch of pamphlets and they said read these and oh, by the way, this insulin stuff, it can kill your kid. So don't do it wrong. But don't worry, because we've given you all the tools you need. And this person said they were freaked out instantly, rightly
Jennifer Smith, CDE 3:43
so with that type of explanation. Because I'm really you're given pamphlets to explain something that for the most part, a lot of people who are using insulin, are completely using it like off the Standard label of prescription that their doctor told them. Right? I mean, eventually you get to the point of or many people do have, there is no fear and you understand the action of insulin, you understand how to manage around it. And that takes fear out of the picture. Because you you get it but initially to just be given these pamphlet that's like here. Oh, and be careful because this could kill you. But clearly, exactly. There's no fear here.
Scott Benner 4:27
Everything's Don't worry. We taught you everything you need to know. And you're sitting there thinking, I don't know anything. So how could that be true? It isn't really weird situations like hey, here's a car don't worry, they're super safe, but wear the seatbelt and drive 45 And don't hit anything for God's sakes because you're gonna fly through the windshield and die. But don't worry, we thought you were the brake was so it's going to be okay. And it just a lot of this does end up boiling down to the person that you luckily or unluckily bump into when you're diagnosed to you know, just their ability to explain some because that's statement, you could just say it in reverse. You could say, Hey, listen, we've set you up with all the tools that you need. I know you don't feel comfortable with them right now. But trust me experiences are going to make them feel more and more just just real to you things you don't have to think about. But until you get to that point, it's important to remember that too much insulin could make you low, could give you a put you in a seizure. I mean, if you gave yourself way too much he could kill, you just have to say it backwards. Yeah.
Jennifer Smith, CDE 5:30
And also bring in and these are the preventative things that we're doing from the start. So that that doesn't happen sooner, eventually, you will have low blood sugars, eventually your child will have a low blood sugar, it will happen. I mean, they put out this, like insulin will, can can cause a low blood sugar, insulin will cause a low blood sugar. At some point in your life with diabetes, you will have a low blood sugar you will, right? So just tell somebody that right? That takes it out of the picture of Well, is it going to happen? Yes, yes, it's going to happen. But this is what to do. These are the tools you have, you've got simple carbohydrate, this is what you can expect it to do. You've got glucagon, this is what you can expect that it's going to do for you. You've got these pieces to manage. When that happens, right, which should help somebody feel less fear in using it right. It's not like they're dropping you off in the middle of the desert with nothing around and up. Here you go. But you got to take your insulin.
Scott Benner 6:33
It's like when you do send your kids out driving the first time you're like, listen, drive very safely be aware of people around you. When you have an accident, which is going to happen one day, here's what you do next. You know, do you don't say if because it gives you that feeling of like, well, maybe I'm gonna be one of the people who never happens to. And then you spend your whole life kind of paranoid, paranoid. Aliy that's good. Can't be a word, but you're paranoid, and is now I'll make up words. But you get in this situation where you're constantly trying to stop a thing. It's like trying to stop the sun from coming up. Like one day your blood sugar's and look, the next person says, I wish the doctors would have explained to us the likelihood of lows and how to treat them. No one told us about that. And my son had a bad low first time we came home sounds like the kid was gonna libre to wanders into their bedroom at 1130 going, hey, something's making noise in my room, because you remember that the poor kids only had diabetes for two minutes, you know, right? His blood sugar's 45. And then this poor lady sleeps in his bedroom for the next month. And then she gets a Dexcom that gives her like, you know, alarms that are a little more in the moment, and but a month, she's on the floor or on a bed or something, because now she doesn't know the kid doesn't know. They're all in a panic. Why? Because somebody didn't just say what you just said, you know, the first day my daughter went to kindergarten, I went to the nurse and I said, let me explain all this stuff to you. I explained it all to her. And she goes, Don't worry, we won't let that happen. I said, No, you misunderstand. I'm not telling you this stuff. So you can stop it from happening. I'm telling you this stuff so that when it happens, you know what to do. Right? It's like it's diabetes. We're not going to stop diabetes from being diabetes. You know, right. This lion is going to bite your face one day. Yeah. I don't care how many times you go into the cage within. It's fun. And you're in Las Vegas me like, is that a Siegfried and Roy reference? It is? Yeah, one day the lions going to kill you. Okay? It's at least gonna come at you. At least bite your arm. You need to know how to hold up the whip in the chair when it happens, you know, right? Well,
Jennifer Smith, CDE 8:36
there is actually what I was gonna say, you know, you need to know what to do. But in some cases, I think people get really good tools, and really good explanation. And in other cases, people do not they get these rip off pages that say, well, here you go. This is all the information that you need. Just make sure you read through it. Oh, and here's your medicine. It's called insulin. You have to take it here, here. And here. Oh, and you know, you might have low blood sugar. But then again, what can you do about it? Or what are even some of the tools? Or I guess what are some of the variables that could cause a low blood sugar? So you're ready, right? You can say okay, well activity will cause your insulin that you have to take to work better. So be careful for low blood sugars. If your child eats a meal and then goes and plays soccer for three hours, right? All these things that they should know are sometimes the definite causes of low blood sugar because then at least people are aware of where they might see a low
Scott Benner 9:40
well and everything you're saying supports this next statement, the person said there was so much anxiety my child had a fear that the ambulance was going to come take him away constantly. Your took months to wear away she said so. You know, everything you just said would have given this person, a little bit of calm or even something to say to the kid because that gets Like what's gonna happen? And when you're when your answer is, I don't know, you know, like, that's not supportive in any way for people. One person is this great excuse. We're gonna kind of segue here a little bit. Before we do, though, I want to say, I think it's, it can be worse for adults that are diagnosed, because I think they get sometimes even less. And we talked about this the adult diagnosis episode, and it's fresh in my head, because I just put an edit on the show, and I just heard it again. But that when you're an adult, sometimes you're like, here's the insulin, go to the store, get this prescription filled for needles, and then go see your Endo. And then you call the Endo. And then it was not available for 45 days,
Jennifer Smith, CDE 10:38
or worse, like six months. And in the meantime, they have you visit with, like, a nurse or somebody in between who, you know, there's, there's a definite disconnect for adults. Absolutely. And I think the other piece for adults is a lack of enough initial good information, but also, many times that adult is on their own. Right, they may not have a spouse or a significant other, or a family member who they're close enough with, that they could share this with and get someone to look in on them if you will, right. And that makes it harder, because kids who have a parent or a caregiver, there's somebody that's got their back, right consistently paying attention for them. Adults don't have that it is it is on you.
Scott Benner 11:30
And you can slide into a depression, you can just slide into a complacency. Listen, completely disconnected from from diabetes, my son just graduated from college, it's got a really good degree. It's a bright kid. And we told him, like come home from school, like, you know, just take a little time decompress, and everything, but now he's been home for about three weeks. And I had to go into him the other day and be like, Hey, let's get going now, right? Like, you know, he's he hasn't had your break. Like he doesn't, it's just as simple as situation where he doesn't know the next thing to do. And you kind of turtle up sometimes. And then this is about and then on top of that you're scared of low blood sugars are hot, you know, whatever. Anyway, this next person says, I wish someone would have just told me that you can drink water when you're high. And that will help you know. So that's an example. They don't even understand how hydration affects the way the insulin works. Right? Absolutely. So okay, I wish I had known that it would take some time to decrease a blood sugar, the initial one from the diagnosis number. And I really wish someone would have told me that my daughter might feel low in the hundreds. And and that even though the number was normal, she would feel like she was low, like that was never explained. Do you think people even understand that for the most part? I don't
Jennifer Smith, CDE 12:45
think so. And it's a it's a very good point that this person brings up absolutely, you know, when you when your body has grown accustomed to a glucose level, right. And at initial diagnosis, your body has gotten used to feeling nasty, and it just thinks that that's the norm add a blood sugar of let's say, 300 Plus, potentially. And with that being the case, once your blood sugar starts to come down, now that you're taking insulin, even drifts in blood sugar, not drastic drops, but just a drift under where your body's kind of been residing for a time can start to feel like a low blood sugar. Do you need to treat that? No, but it can be scary. Because it feels like all these symptoms you've been told to watch out for which indicate, oh, my goodness, my blood sugar is too low. But you look at your numbers, whether you're already on a CGM, or you're just doing a fingertip finger stick because you're curious what is going on, then the number doesn't look like it's in the low range. It can be very hard to know, well, what do I do about this? Yeah,
Scott Benner 13:53
and the idea that you will get your body will get accustomed to it after a while but you can't forget while you're explaining all this to people, the feeling is still real. Yeah, you you feel like your blood sugar's 35 and your blood sugar's 110. And it's it can take sometimes days and weeks depending on how long you've been high for your body to get regular. And feel that feel that way when you're in a regular number, I should say.
Jennifer Smith, CDE 14:18
In fact, when I was when I was diagnosed eons ago, things are very different. But there's no fancy stuff.
Scott Benner 14:27
My mom had to go outside and wind up the car to take her to the
Jennifer Smith, CDE 14:32
me sound like I'm like 90 No. But you know, I was in the hospital for a week, a full week. And they wanted me to have a low blood sugar while I was in the hospital, so that I could experience lows or a low symptom and know what to do about it with I'm assuming the idea that there was somebody there with me, and that they could help me see Yeah, how quickly it could be treated? how it would feel different once my blood sugar was normalized again. So I mean, that was part of my week long hospital stay
Scott Benner 15:12
was, did they announce? Or is it just like? Did they tell you? We're gonna make you low while you're here? Do you remember? No, no. Okay, just know. And then you realize
Jennifer Smith, CDE 15:20
I do? Well, they did say that I remember the discussion, you know, with my parents, we would like for there to be an excursion to a lower level, so that Jenny can get an idea of how that feels that you can hopefully be here at that same time. So that you can see how we treated and everything. And I did have a lower blood sugar. I mean, it was by no means low, low, but it was certainly low or dropping. I do remember how I felt. And but the good thing was that I got explanation. Yeah,
Scott Benner 15:52
right. And for the little things, you end up figuring out on your own like sub first, a lot of people you can feel a fall. So yeah, so you feel the fall before the numbers an issue and correct, you know, just stuff like that. It's great to learn these next two statements are interesting. They're made by two different people. And it's a great perspective in into what someone thinks before they've heard the podcast and what somebody thinks after they've heard the podcast. Oh, awesome. So this first person says, I wish they had taught us to use insulin without being afraid of lows. So that's a person who's now been listening for the pot to the podcast was like, I know now, how important using insulin is correctly. You know, the fear of loads is what was stopping me from using etc, etc. But then here's a person who is giving you a perspective from before they heard the podcast, I had way too much fear of insulin, they pretty much had me feeling like I was going to kill my son, probably within the first week. So so there you go, right. Like there, there's got to be a better way to. And I think we've gone over a lot of it already. But there's got to be a better way to let people understand how insulin works, other than just to say to them, don't do it feels like it's 1950. And they're like, if you smile at a boy, you're going to be pregnant. Yeah, exactly. Right. So there's the so if you're getting if you're listening to this, and you got that kind of information, I think you have to, you have to make the leap into the Pro Tip series and and listen through, so you can get an idea for how insulin works. So you can be use it in a more targeted way or a more meaningful way, you know, any way you you kind of want to think about it.
Jennifer Smith, CDE 17:29
Because then it does, it does for many people. And I would say, you know, with this topic of fear of insulin. I think I've seen more adults who have had a fear of insulin, tied with a fear to things being too low, then kids, and many times parents are very, I would say parents are very good about not projecting their fears onto their children write for them. For the most part. I mean, there are some that that's not the case for but I think parents are, they try very hard to internalize worries and fears so that their child doesn't see that as well, in terms of how to feel about something they're going to be living with right. Adults, however, again, are the ones managing their own health there, there may not be a secondary assistive person there for them. So the fear of insulin can be very real, when you're the only one who's got your back. Yeah. So you know, in that I think it does, it's learning about how does insulin work? And how does it work for you. And sometimes, as I've worked with people, sometimes it's getting used to even just knowing what small doses do. And then you can build on that, especially if you really just don't want to eat lettuce salads your entire life and who want to gravitate into other things that may require more insulin. Learning how to use more insulin should start in smaller doses then so that you can get a comfort level with what that does. And with less need to over treat, because there's not as much insulin left laying around. Yeah, right.
Scott Benner 19:21
Well, so here's the other side of it. Here's a comment one piece of well meaning but bad advice that I got from another type one was that a high blood sugar will not send you to the hospital, but a low blood sugar can so it's best to leave yourself high. So it's now it's better high than low, which you know, and then
Jennifer Smith, CDE 19:41
has very bad advice. Yes, very bad advice. Do not listen to that piece of advice.
Scott Benner 19:47
But But it's an interesting way of showing how when you get bad information at first it leads to fear and then you go out into the world. Because you think oh I know this thing that's going to save someone analogy. I have to go tell them. And now you the internet's interesting because when you're listening to someone talk, you have no idea if they've had diabetes for three minutes longer than you were three years longer than you. And when you don't know what you're talking about the first thing that said, you often you go, Okay, well, this person must know better than I do. You know, and that is the one. That's one spot where I'm proud of my Facebook group where people do speak up. And so you know, if someone comes in with a kind of a new idea, someone else will nicely say, hey, look, you know, we all get told that in the beginning, but here's the reason why you don't want your blood sugar to be high, you know, highs, cause lows, and etc. and stuff, you'll find out listen to the podcast.
Jennifer Smith, CDE 20:41
Though I do like in the group, too, that a lot of people are very able to point to either some of the episodes that you've done about specific topics and said, Hey, for a lot more in depth information. And really to clarify this question, listen, here, go here. Try this, right.
Scott Benner 21:00
There's a lot of I tell you, there was a moment where I realized I can't keep up with this, because it used to be me. Like during the day, I'd pop in and out and be like, Hey, look at episode this to do that. Or this? Have you listened to the protests? And one day, I was like, I can't, I can't, I don't I don't have the bandwidth for this, you know, and now, it's 24/7. Isabel helps me with it now, which is terrific. But at one point, I just said to the people in the group, I was like, if you see a question that can be answered by an episode, share the episode. And that's been very helpful for people. Okay, so then you see, the next person knows this and says, Don't accept high blood sugars as a norm, because you'll start looking at numbers and just going out 200, it's not that bad, you know, and that turns into 210, which turns into 250. And on the way, here's an interesting one, I was just told to take my insulin 15 minutes before my food to Pre-Bolus. So I injected 10 units of Novolog. On a 15 minute drive to get my food. I had a low on the highway. And and here's the kicker, I didn't even know insulin could cause a low, I wish someone would have mentioned that. So, obviously, obviously Pre-Bolus thing is very important, right, and to get your insulin timed well, and you'll hear that in other episodes. But this person, the information they got was almost good, like you need to Pre-Bolus. But the person never in their mind thought that the insulin could take them lower than they want it to be like imagine that like, it's right. Jenny, there's an app on my wall hold, I was gonna say it looks like you're looking at like this has to die give me a second.
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Jennifer Smith, CDE 26:17
I thought perhaps you had like water leaking from your ceiling or maybe ghosts on your ceiling or something.
Scott Benner 26:24
I'll tell you I might prefer to ghosts because I don't believe in those. And I would have just thought I just like dizzy. But I kept thinking like that thing's gonna crawl over my head and fall. Sorry. So you're big black and I've never had a plant in this room. I'm gonna have to sell this house. Okay.
Jennifer Smith, CDE 26:40
Now in the house. It is stinkbugs I don't know. I don't know where they have decided that their home is outside that they don't like but they come in our house and I don't care. I just take them outside. I boys who love bugs and love stuff. They hate stink bugs, they will come flying in and be like, ah, there's a stink bug on the ceiling in my bedroom. And I'm like, okay, who's bigger? You bigger?
Scott Benner 27:07
Think bigger? You know, they're an import. Right? They came here. Are they really i This is not what this is about? Okay, I want to say China maybe. But anyway, look it up. Have fun finding out. Okay. So the expert says safe numbers are not high. Even if doctors tell you that. I wish someone would have been, you know, clear earlier. Another person says I wish someone would have started in terms of telling me where to bring those numbers down. How do I do it with basil? Like, where to carbs fit in? Like they didn't have any? You don't? I mean, like the stuff that seems kind of obvious after you had diabetes for a while in the beginning. None of that's going to feel obvious, right? None of it like you know, when you
Jennifer Smith, CDE 27:49
because it's brand new. This is a concept that nobody has taught about at all you may learn in I mean, I remember learning about the tiny little I think it was two paragraphs in my human biology course in high school. And I myself having diabetes at that point, I was like, What is this bunch of like silliness? I was like this dude, no way describes, but I'm supposed to learn something from it.
Scott Benner 28:17
Yeah, in a way, it mirrors how little we tell people about nutrition even and like crap fueling their body. Everybody just is like, Look, I get up, I washed my butt. I get hungry, I put something in my face. And then 10 years from now, when I'm 40 pounds heavier. I go what happened? Right, you know, like, they get it. Yeah, nobody really understands how things work. And listen, I grew up really poorly. I grew up broke, like, my mom had $60 to buy food for three people, right for a week. And we ate, whatever, whatever we could. And it was Yeah, crappy food. And by the time I was an adult, as I was heavy, like I was just like, Mike Kelly and I were together and like, we didn't know what we were doing, we started over again. And you know, we were able to take care of it. But it's amazing how through your life. It's pervasive. You know, like we, how hard how easy it is to have a feeling of hunger and want to grab something that's easy in a bag or something like that, versus like, I'll let me have this orange or something to that effect. It just it gets burned into and you don't know it. And that happens with people with diabetes all the time. Because as we're talking about these newly diagnosed problems, I can tell you that if you don't figure them out early, you're going to be one of any number of people in their 20s or 30s or 40s or 50s who come on the show. Hold on.
Jennifer Smith, CDE 29:39
Jenny, somebody somebody was very importantly wanting to get in, you know, in touch with you.
Scott Benner 29:48
Walgreens again. So, so I've talked to too many people who have had diabetes for decades, who are still making the same. I don't want to call them mistakes but decisions over and over again. And when you then present them with this information. It's sad, because they think well, why couldn't someone have told me this five or 10 or 20 years ago? Like, I can't get this time back now, you know,
Jennifer Smith, CDE 30:14
and I, I think, and this is kind of a, it's a slippery slope to kind of, to walk on, honestly, because I truly believe that it starts when someone is diagnosed. And they are told if we're just talking nutrition, right? They're essentially told, you can eat anything you want, right? And just take insulin, when you're supposed to
Scott Benner 30:39
take it. I mean, that powering statement, correct, it's supposed
Jennifer Smith, CDE 30:43
to be empowering in that. You don't have to worry as long as you just take this thing called insulin. Well, I mean, it brings in a whole nother rabbit hole of discussion, though, of, well, you want your child or you want yourself to be eating and doing what do you see every other child doing? But is every other child eating the way that they should be eating? Right, whether they have diabetes or not, or as an adult? Are you eating the way that your colleagues are eating? Because that's what they're doing? And you're only following suit? Is that really? Do they look healthy? You know?
Scott Benner 31:21
Do you know? I don't know, do you know that there are three aisles in my grocery store that I don't go down, just based on the physical appearance of the people I see in the aisles. I just think I just look at them. And I think I don't want my life to be like that. I clearly don't need this is something in those aisles, is because because then they're I know, I'm I know, this is probably a weird thing to say. But then I look at other aisles where people see more fit. And I don't see them, I don't see these two people in these different aisles. And I'm like, I'm gonna go follow the guy around with the nice calves and see what he buys. You don't I mean?
Jennifer Smith, CDE 31:58
Sure. I mean, if you look at pictures, I mean, honestly, in the ages of development, since I would say, maybe the 1950s or 60s, potentially, when more like processed packaged convenience, stuff probably started to become more than the norm. If you look at pictures like beach photos from like, the shore or something, it is very difficult to see a body that isn't somewhat fit. Most of the bodies look like healthy bodies. Today's pictures would look very, very different. I mean, there's there's got to be something in the food, and how we are packaging what we are eating. That's creating a lot of issue within diabetes. Yeah,
Scott Benner 32:50
and how does it fit into this subject? It fits into this subject, because when you first have diabetes bolusing for real food is easier than bolusing for processed food. And no one's gonna mention that to you. No one. No, you this person says not knowing how fast or slow insulin could hit or not knowing that, hey, this could kill you. At first I was under the impression this is the part that's important. I was under the impression that okay, my kids going to eat and I got this robotic insulin dosing strategy and everything is just going to be fine. And so they were you know, they were told count the carbs, give the insulin, do it like this all just gonna work out. And it doesn't go the same way. And that leads people to say things like, Oh, it's just diabetes, or, you know, one day I eat the same thing. And then the next day I eat and it's all different. No one tells you that the next day your insulin site is a is a is a day older. No one says, you know, you had a, you know, you don't know, right? Nobody gives you enough the details. I had a burrito one day, and I did well with it. But I had a burrito the next day and it didn't work. Well. What did you make the burrito? The first thing was the next day was it from Taco Bell? Because, you know, that's but in people's mind, it's burrito burrito. And, you know, it's just anyway, it's important. This person says, and I'm proud of this, I wish I would have known what Scott says that trust. What you know is going to happen is going to happen for Lowe's. When I treat Lowe's i You need to trust that it's going to work the way you know it's going to work. Otherwise, you're going to create a rebound high afterwards, right? Which can ruin a day. Safe numbers aren't high numbers. My first big concern was hypose. It's what they really hammered home in the hospital she needs to eat this exact amount of food has to be weighed or she's going to have a Hypo. And the person says But what I learned is this hypose are actually pretty straightforward. And they're only a massive pain when my daughter's asleep. High blood sugars produce far more fear me now. I assume there was only an issue with high blood sugars with the out she assumed that high blood sugars were only a problem if there were a presence of ketones and now she He realized that that's not right. So they didn't think a high number was a problem in less ketones were present. Right?
Jennifer Smith, CDE 35:08
Which is often when I mean, there are two angles, right, really low blood sugar fear that really high blood sugar, ketones fear the potential of DKA. But you may have high blood sugars that are just within the realm of high enough without producing ketones, that now you're leading into, if there's enough consistency to it, you're leading into continued damage, right? Long term,
Scott Benner 35:38
this next person says, I wish I would have known that every time the blood sugar shot up, I didn't have to check for ketones every single time like every time this kid gets a blood sugar for like 200. There, they're testing ketones, and there's episodes on ketones and how to understand them. This person's quoting the podcast says instead of beating yourself up When blood sugar shoot up or down, figure out why and try to prevent it next time take this as a learning experience. But you have to know it's not going to be perfect. You know, maybe never, and definitely not in the beginning. You know, and just to speak about that for a second. These things are going to happen right there, you're not going to stop them from happening. There's two, in my mind, there's two responses, you can panic and beat yourself up and be like, Oh, I did it wrong. This sucks. I'm never gonna figure this out. Or you can just realize there's a learning experience happening in front of you, when you step back, take yourself out of it for a second and look at it, I put the food in here, I put the insulin in here, this is what happened next. I bet you if I would have done the insulin a little sooner or a little later, the food, you know, etc. If I would have just slid these things around in the timeline of my eating. I wonder how that would have impacted these bell curves that I'm seeing all my CGM? Are these numbers I'm seeing right here. Right?
Jennifer Smith, CDE 36:51
It is I mean, diabetes, I've I've thought for a really long time how diabetes is it is like a daily science experiment, if you will, right. And sometimes those days, you're given the same little petri dish with, you know, like orange growing spots. And because your day is similar enough to the days before, the dots keep growing purple, because you got it, you've kind of figured it out, you know, your timing, you know what ends up happening if you do it this way, or that way, and then comes in a day where the dots turn orange and purple for free, and whatever, by the end of the day. And usually there's a variable in the picture that you've not encountered before, or was something completely different that you've just, you know, you've never had that burrito from Johnny's corner spot. You know, so
Scott Benner 37:44
it's pretty learn as the person says, I wish someone would have told me to always carry snacks, supplies and emergency treatment with you. I am frequently thrown by how many people don't travel with at least a juice box extra or their meter. Sometimes there's stuff like that, like, I've talked to people, like I don't need my meter. I'm like, How do you know that? Like, if you know that, then this whole thing is easy. Like, like, because you can predict there. It freaks me out a little bit like, you know, yeah, if we drive. If we drive more than 30 minutes from my home, or we're doing something like you're going to go somewhere 2030 minutes away, but you plan on being there for three or four hours. I always say to my dorm, I take a pump with you a little bit of insulin to pump up like you don't want this whole day to be ruined. If something you bang into a door and your pump pops off or things stops working. You don't want to have to stop what you're doing all the way back here. That's big picture stuff. Little easy picture stuff is you need your meter with you all the time. You need your like, I'm fascinated by people who travel without the controller for their insulin pump. Like Well, what if you need insulin? I'll do it when I get back. When you get back. What are we talking about? Like, like, but no, like, and but for lows? You have to have a way to stop a low with you. Yeah, and not just one way. Like, like, many maybe yeah, because what if you drink the juice and it keeps going? Is you know, like, I mean, there's a difference between being paranoid and being prepared? Correct. You need to be you know, in a modern society. You know, somebody in America, who's living in a house where foods readily available, I get, you know, go into your neighbor's house or something like that. Not feeling scared, but you don't start getting into cars and driving to locations where, like, yes, there's a Wawa on every corner. I mean, you know, we're some sort of a convenience store but you're not in there if your blood sugar starts dropping and you're driving your car,
Jennifer Smith, CDE 39:40
correct. So absolutely. I know at the in the turn of a season usually like from from winter into like spring summer. I have different persons, if you will, that I might use and I always end up having to like dig in the pockets of the purses, and fish out like the really old glucosuria cuz they're like, you know, the sugar sort of starts to get harder and whatever. And I'm like, yeah, it's time to change those out. I would eat them if I had to, but they probably aren't gonna taste very good.
Scott Benner 40:12
juice boxes in the pockets, the door pockets of our cars, right? Yeah. And one time we got down to the one where you, you're looking at you think I can't believe this is holding the liquid anymore like this should have been thrown away and replaced. It's like the squishy. Yeah. And we had to give it to Arden. And even when she took the box, she went, Oh, this is gonna be horrible. And I was like, sorry. And you know, and it'll work. It'll work. But it was like syrup. It wasn't even like it was bad. And she's she was looking at us like, You got to be kidding me. I was like, I tell you to replace these things. No one listens to me. So there you go. Here's an interesting one. I felt like I was bringing home a newborn baby. We talked about how diabetes can feel like a newborn baby. But she said that the first low that that she saw was a 74. And they were running around their house like a lunatic. Like we have to stop this. 70 for every minute, which
Jennifer Smith, CDE 41:06
can be scary if it was falling fast. Or if you'd never seen that valley that's absolutely contextually.
Scott Benner 41:11
Absolutely, but in a situation where you're looking at a fairly stable 74. And you're thinking like, life is just about to end. You know, like, you know, it's when I say this sometimes because it's the one thing that I feel sad for people, but it does make me like laugh a little having been in this game for so long. It's when you see somebody like show a graph. And this kid's you know, blood sugar super stable, and then it dipped down to 80. And then the caption says, like, I saved their life with a cookie and like, what
Jennifer Smith, CDE 41:44
it could have, how much it was gonna dip out?
Scott Benner 41:48
Yeah, but but like that idea. But it really what it outlines is that people just are not given accurate depictions of what a good blood sugar is. And, you know, right, I have an email that I've been going back and forth with this gentleman about that. I think this is a great place to put this. He said, I've been trying to keep my kids a one C as low as I can blood sugars as low as I can. But then I ran into this person in the diabetes community who said, No, you can't do that. Because, you know, a blood sugar under 55 causes brain damage. And I always hear those conversations. And I'm like, I'm like, I don't think anybody really knows. But it's a hard thing to respond to. Because I don't want to be the person who says I don't think a 55 blood sugar is gonna give you a brain damage. But I don't want to say that out loud. In case I'm wrong, you know what I mean? But I mean, I don't want my daughter's I don't want your blood sugar to be 55 Jenny, right. No, no, I don't want it to be 55. Doesn't feel nice. But should it sit there for a couple of minutes?
Jennifer Smith, CDE 42:46
That is the couple of minutes. It's kind of in theory, the idea of cumulative time is just like highs, right? So the idea of deprivation to the brain, over long periods of time are consistent over days and days and days of consistently having hours worth of low blood sugars. There is research about brain health, especially in kids. Absolutely. But if your blood sugar dips to 55, and I've certainly had 55 blood sugars, and I don't think that I am brain damage, do I sound brain damage?
Scott Benner 43:21
No kidding. No, you don't set yourself okay. Well, the way I ended up responding was I said, Look, you know, as we went back and forth, and I got contextually better what they were saying. I said, Listen, no one is saying that your blood sugar should be 55 for hours or right. You know, like I said, low and stable. A one sees not not like a life where you're like, oh my god, I'm 40 Oh my god, I'm 400 Oh, my God. Like, that's not good for you. I said you want stability? But if you can't, if you can't achieve an 80 blood sugar without it becoming a 55 you're not using your insulin correctly.
Jennifer Smith, CDE 43:58
Right. Right. And something needs adjustment. Absolutely.
Scott Benner 44:01
Right. So anyway, I mean, I don't know about I agree with what you said, I would not want any, I would not want any measurement in my body to be way off for a long time, right, your thyroid, your thyroid hormones too high for a long time. It messes you up as a human being right? If it's too low, it messes you up as a human being your blood sugar the same way. But you know, we talked about it earlier, you have diabetes, you're gonna get low at some point, like, it's just you're gonna get you're gonna, you're gonna do something, and your blood sugar is gonna be 401 day and it's just gonna happen and your blood sugar is gonna be 55 one day and it's just gonna happen and you are going to be in a situation more times and you care to count your life where you actually think you saved your life with a cookie. Right? Like it is. It is gonna happen. And yeah, you know,
Jennifer Smith, CDE 44:48
I think that's a value to these days of definitely having the technology specifically the CGM technology that we have, because you do have a little bit more visual in terms of that line of sight, right? Where are you? Where are you? Are you stable? Are you stable and sitting at home doing not very much, okay, then great. If you're sitting at, you know, 82, you're probably not going to treat that. Because you're stable. What's wrong with that? If you're 82, and you're going to head out on a 10 mile bike ride, you probably don't want an ad to blood sugar unless you've done something that you know, is now going to hold that sable at that level, right?
Scott Benner 45:29
Here's a couple of other things that are interesting to look at people's brains and how they work back and forth, like people are different, right? This one person says, I wish someone would have told me what happens when you go low, how low is gonna make me pass out what's going to happen in my body, then I wanted that information. But the next person says, here's the thing that messed me up, I thought the smallest mistake was going to kill me. And it created panic attacks. And so they go to different people in a similar situation, they want different things, different things. And that is, in the end, why you have to go out and advocate for yourself and look for information because the doctor doesn't know if you're the the person who's gonna have a panic attack. Or if you're the person who says, Hey, what's gonna happen to me after I pass out? When's that gonna happen? And those numbers are different for everybody. I've seen Arden have a seizure at at, I think 20 was a blood sugar. And I've seen her talking to me when she's 28. Like, there's nothing wrong. So I don't know what to tell you, you know what I mean? It's, it's, there's a it's a theater line, like it's, it's like you're, you're dimming a light. And there's a moment where you still have plenty of room left on the dimmer, but the thing just goes off you go, Oh, that was weird. And, you know, so here's what I would tell people is, I don't want my daughter's blood sugar under 70. If I can help it, I treat it when it looks like it's gonna go to 65. I treat it more urgently when it's under that number 6065 55. I think we've messed up pretty good here. And you know, lower than that, she's going to start becoming incapable of helping herself like it's going to start to get worse and worse. So Right. You know, to me, 70 is, I
Jennifer Smith, CDE 47:09
think another thing that goes along with this too, especially for kids is I've had a lot of parents tell me. I asked my child how they're feeling. And they say I'm fine, Mommy, I feel just fine. The kids, kids don't really I don't know that there's necessarily an age of awareness of symptoms, that they're, you know, that it starts to be like age eight, they'll definitely know what a lo feels like, right? thing for every child or teen, it's probably going to be a little bit different. But a lot of parents worried because their children just have no self awareness of symptoms. And that's hard. Because, you know, I know myself when my little kids get really busy with their Legos or whatever like they are, sometimes I have to call to them like three or four times and get their attendees are so into what they're doing that that awareness of other things is completely not there.
Scott Benner 48:08
And your kids don't have diabetes on top of No, so no. Do you have a little time or you have to go? Get a little time? Okay. The other person's I guess we need an episode on this the research about blood sugar numbers, what is actually less likely to cause long term health highs or lows. I mean, I, I don't know how scientific it is. But I I'm more worried about highs than lows. You know, for a long term health especially, I mean, short term, a low blood sugar gets right now, but you know, long term, I think it's I this is interesting, I focused so long on this, and I don't think I should have the perfect math. She says we were seriously so scared to give a little too much insulin like even by a tiny bit. And then quickly, they realized that everything was sort of a best guess to begin with. I used to on the old Omnipod PDM, you had to hold this arrow up to make the carb count go up. And yeah, and it would like get to, you know, I didn't really count carbs at that point at all. So I was like, Oh, I'm gonna do four years for this. And I'd hold the button. And if it's not there, four and a half hours I can that's fine. It's close enough. Now for little little kids a half a unit. It's a big deal. Actually, a woman made up point in an earlier statement that I never brought up. She said I once took a unit of insulin out, put it in a spoon and then I took 10 units of insulin out put it in the spoon she goes and it freaked me out at how similar those two amounts look. And I thought Yeah, it's it is interesting, isn't it? But in the you know, obviously in a syringe, you can see it better, but Right. That's just an interesting one, right? Like it is. I see people all the time, like, well, I made a Bolus that was 4.1 and I think it was too much and I'm like, but I guess all right, you know, as your as you get bigger and you require more and more insulin, those times
Jennifer Smith, CDE 49:58
one isn't going to make Hello. Which is the reason that many people, you know, especially pumpers get frustrated when they're trying to correct higher blood sugars. And their pump is recommending something like point two units. And they think well point to like, 1.2. What's the purpose of that? It's not going to do anything to help me at this point, right? Yeah. And that's when they get more aggressive. And then you're like, Oh, well, I clearly should have taken the point too. Instead,
Scott Benner 50:26
this person says, I wish someone had told me that my eyesight was changing when I got low, and that it would come back. Like I guess, from dizzy. And also, she said, conversely, I had been high for so long, that my eyesight had gotten bad. And that as I brought my blood sugar down, that change, that was scary. A person here says, I remember thinking that if she's still low, like, do I still do insulin, like when I feed, you know, like, like, okay, she's 60. But she 20 carbs. And we talked about pipettes all the time, you need to cover the amount, there's an amount of carbs to fix the low, and then there's amount of carbs, you don't need some of that needs insulin correct. And, and this one's interesting. I was told there was a three hour rule that we couldn't give any insulin unless it had been three hours since the last dose, this caused many high blood sugars for us, was not explained well. And and it seems like a big one for newly diagnosed people. And I think you should bring it up. She said, so. Yeah.
Jennifer Smith, CDE 51:26
And I think I mean, we talked about stalking, I think recently in an episode, but that kind of goes along with initially, the idea that once insulin, it upon diagnosis, once insulin is starting to be injected, they're very cautious, assuming the potential for honeymoon. So what they're looking for is, let's give a timeline of what we're expecting this rapid insulin dose to work over. And let's be careful about not adding extra within this. But as you know, you always say if you've done it enough that you know that, oh, yesterday and the day before I didn't do anything, except after three hours. And her blood sugar just sat high. Yeah, clearly, there was more insulin that was needed there. So more insulin,
Scott Benner 52:19
you're gonna get into that in the next episode of this, because the next thing we're going to do is the 1515 rule. So we'll get to talk a lot about that. But we're done. We made it through there were a lot of questions in this one. And we chit chatted in the beginning about personal stuff. So I'm pretty before we started recording. So I'm very happy with what we got today. Thank you very much. Yeah, absolutely.
A huge thanks to Ian pen from Medtronic diabetes, and the contour and the Contour Next One blood glucose meter, head over to Ian pen today.com. And contour next one.com forward slash juice box to learn more about the ink pen and the Contour Next One. Just check them out. They're both terrific. Thanks to Jenny. Don't forget Jenny works at integrated diabetes.com. If you'd like to hire her, I hope you're enjoying the bold beginnings series. There's much more to come. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Hey, if you're still here, don't forget that juicebox podcast.com. diabetes protip.com is a place where you can learn more about the podcast in general find all the different series. There's a Facebook group for the podcast that has I think 27,000 people in it. Now we're getting close to that at least Juicebox Podcast, type one diabetes on Facebook. It's a private group. So you'll have to answer a couple of questions before you're led in. Oh, oh, you know what else in that Facebook group at the feature tab at the top, there are complete lists of all of the series that exist for the podcast. And I guess I gotta find a way to get those lists on juicebox podcast.com to I'll work on that. All right. That's enough Chitty chatty right. I hope you're enjoying the podcast. If you are tell a friend. And don't forget to subscribe and a podcast that don't just listen, subscribe or follow in like Apple podcasts, Spotify, Amazon music, something like that. You should be able to find a great free app that you can listen to the podcast in. Alright, I've said it before. I'll say it again. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 715
1. What is the main topic discussed in Episode 715?
2. What is the honeymoon phase in type 1 diabetes?
3. Why is frequent blood sugar monitoring important?
4. What are the roles of different types of insulin?
5. How can diet and exercise impact diabetes management?
6. What factors can affect blood sugar levels and insulin dosing?
7. Why is building a support network important for managing diabetes?
8. How can staying informed about new diabetes technologies and treatments help?
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#712 Bold Beginnings: Terminology Part II
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.
Bump & Nudge - Rage Bolus - Compression Low - Interstitial Fluid - Fat & Protein Rise - Dawn Phenomenon - Somogyi Effect - Feet On The Floor - Insulin Sensitivity Factor - Adrenaline Highs - Insulin Deficit - Growth Hormone - Stacking Insulin - Hydration - Lada Diabetes - Mody Diabetes - Crush It & Catch It - C-Peptide - Beta Cell - Insulin On Board - Pump Break - Barriers - Black Holes - Dictate The Pace - Carb Absorption & Digestion - Antibodies - Hypo & Hyper - Types of Diabetes
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello friends, and welcome to episode 712 of the Juicebox Podcast. This is the second part of a special bold beginnings episode, part one is already available, and episode 711.
Welcome back to the bold beginning series with me and Jenny Smith. Today's two parter happens in Episode 711 and 712. This is bold beginnings terminology part two. In these two episodes, Jenny and I define every word that's available to you in the defining diabetes series. At the time of this recording, there were over 40 definitions. We did a quick definition for newly diagnosed people and left you the episode number so you can go back and get a more complete definition. If you've just been diagnosed. Or if you're trying to figure things out, it is our estimation that this two part episode, part of the bowl beginning series will catch you up on terminology very quickly. If you're looking for the defining diabetes series, it's available at juicebox podcast.com diabetes protip.com. And in any audio app that you listen in, join the Facebook group Juicebox Podcast type one diabetes to find the lists of all the series in the featured section. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. And because of the format of this episode, I'm going to put the ad right here for you so that you don't have to take a break while you're power listening through these definitions. Isn't that cool of impelled to let that happen? Thank you and pen, even though I didn't ask you, but I know you're listening. So just be cool. All right. All right, ready the pen. It's an insulin pen. But it's more than that. Because it's attached to an application on your iPhone or Android phone. This application is going to do many of the things you've heard about people getting from their insulin pumps, you'll be able to see your current glucose right on the screen, a dosing calculator, active insulin remaining meal history, dose history, glucose history, activity logs, and you can generate reports based on your data. Not only that, but you're getting a great insulin pen, everything you expect the cap the needle, the insulin cartridge holder, it's an insulin pen, just like you've come to expect. But it gives you more with this attached app. You can go right now to N pen today.com To find out more and get started. And I'm gonna tell you what terms and conditions apply, but you may pay as little as $35 for the in pen. Medtronic diabetes does not want costs to be a roadblock to you getting the therapy that you need. Within Penn's Access Program. You may pay as little as $35. Where will you find that out? At in Penn today.com. On this site, tons of frequently asked questions that you're going to be interested in just scroll to the bottom. What is the M pen? How much does it cost? Our insulin cartridges included? Does M pen work with long acting insulin? Can I pair more than one M pen to an app? You want to know the answers to those questions? Go right now to in pen today.com and get your answer if you're ready to try the M pen when you're at the link. Just follow the easy instructions it says ready to try you complete a short form. And just like that you're on your way. In pen today.com forward slash juicebox in pen requires a prescription and settings from your healthcare provider. You must use proper settings and follow the instructions as directed where you could experience high or low glucose levels. For more safety information visit in Penn today.com. Yeah, okay. Haha, there it is. So Jenny and I are back. This is another day we recorded from Bolus to feeding insulin. And now we're gonna go to Episode 347 and the defining diabetes series. This is another made up I think this is one of the last ones that I made up for a while. Yeah, it is. But this one's called bump and nudge. So, you know what, Jenny, I've described how I think of it all the time, but you've heard me talking about it so much. How do you think about it? Now that I've explained it to you?
Jennifer Smith, CDE 4:39
Well, it's just, I mean, I just think it's learning how to use insulin. Better to bring your blood sugar into the place that you want it to as well as not only insulin, but food, right, because it's kind of a both. It's a both system. Use insulin to get your blood sugar to come down. Until where you want it to. And if you maybe use just a little bit too much, then you're using a little bit of food to kind of keep it stable, avoid it from dropping too low.
Scott Benner 5:09
So there's been this. There was once a discussion online where people said, do you think of somebody asked me one time, do you think of bumping his insulin or bumping his carbs, and everybody, because I've never really said it before, but in my mind, I nudge with food and bump with insulin, I think and I'm the opposite. You think of it the other way, it doesn't really matter the way in 20 seconds. The way I describe it to people is when you're driving in a lane, and there's a line on your right, a line on your left, if you start to slowly drift towards the line, you don't quickly yank the wheel back the other way, you just sort of bring it back just ever so slightly to come back into toe again, right? To be straight again. So instead of waiting till your blood sugar, 60 and falling, what if when it was 85, and it was just sort of drifting down, if you just had a couple of carbs, if you just sort of nudged it back up again, or bumped it back up again, it really doesn't matter which one strikes you in your mind. And similarly, why not lower your CGM alarm to more like 120 so that when you're kind of drifting up gently, you can give a small amount of insulin and bump that number back down. Because a lot of times less insulin gives you less of a chance of a low later so just instead of waiting to your wildly, you know, instead of waiting till you're off the road in the weeds and bouncing through the holes, when you see the line just sort of come back a little bit bumping and nudging. It's really the whole thing. So that's episode 347. And Jenny episode 352 is rage Bolus. Go ahead, do Rachel.
Jennifer Smith, CDE 6:46
Yeah, rage Bolus, everybody with diabetes. I would think honestly, everybody with diabetes or caring for somebody has raged Bolus, at some point, essentially, you've gotten so frustrated by a high blood sugar or even a climb that you didn't expect. That looks you know, those double arrows up like I'm just gonna get on top of this. Now this is not bumping and nudging. This is completely like the other end of I'm just gonna take a lot of insulin, and I'm gonna get my blood sugar come back down,
Scott Benner 7:19
but you haven't done it. You end up using so much normally, that you create some sort of a fall
Jennifer Smith, CDE 7:24
later. Correct. A pretty dramatic fall for the most part. Yeah,
Scott Benner 7:29
so it's like taking a bucket of insulin. Just be like, I can't take this anymore. It generally doesn't go well. There there is. We'll wait till we get to it. So that's episode 352. Rage Bolus. Episode 358 is compression low and interstitial fluid. I think we started off making a compression load defining and ended up explaining what interstitial fluid is because I compression low if you're wearing a CGM, you've got this wire under your skin, the sensor whatever they call it, filament, doesn't matter. It's a thing. It's under your skin. These are all things that they've been Yes, those are all good words. It's measuring your interstitial fluid.
Unknown Speaker 8:08
And if you glucose in your interstitial fluid,
Scott Benner 8:11
thank you. And if you lay it right on top of the of the sensor, it compresses into your body. When it does that, it pushes the interstitial fluid away from where the wire is. And therefore, your you get a low reading that isn't real. Correct? Because in that area right around the wire, there is actually less glucose. Yes, but there may be not your body's idea of it. Right. So what else? Yes. And on a Dexcom, at least when it happens, you sort of teach yourself you can almost see it, like you know what I mean? Like you're like, Oh, that's a weird break. I bet you that's a compression low. And it's not always I mean, I would still test to be certain. But anyway, that's what a compression low is. It's a it's a blip that comes up on your CGM out of nowhere that looks like you're falling, but really just might be that the transmitter and the sensor had been pushed into your body and disparate and displaced your interstitial fluid. Yes,
Jennifer Smith, CDE 9:09
and a good as you brought up, you can really see a compression low pretty easily on CGM data, because it's it's the glucose data is tracking really smoothly. And all of a sudden, it looks like things just like dropped off of a cliff. And even those little pinpoint dots of glucose value will often have a disrupted area between the last one that looked like it was pretty stable in in target. And the next one, which looks strangely low. Oftentimes, parents will move their kid and roll them over in bed and it writes itself.
Scott Benner 9:49
Yes, I've definitely walked into Arden's room and been like rollover rollover going on. Like what what am i You're laying on your sensor, and then she flips over. But in the beginning, I mean listen I would never say not to test for it like, you should, because also a drastic drop looks like a drastic drop. So I'm just saying you can kind of start to see them after a while. Episode 360, fat and protein rise. So I guess to define that, in just a moment, it would be that you're going to be diagnosed, and somebody is going to tell you that you count carbs, and you cover carbs with insulin. And that's it. And there are free foods, free foods like cheese, and meat, and things like that, because there's no carbs in them. problem becomes with the protein, specifically, your body digests the protein turns it into glucose, right? So later in the, in the process, you could see a rise from that fat, however, has a slightly different scenario, can you tell people like that,
Jennifer Smith, CDE 10:57
it's more fat, it's more resistance with fat, where I think of a simple thing to think of is, if you're, if somebody's like, taking insulin and sitting on it and not letting it work quite as well, that's what fat does. That decreases your body's ability to use insulin by about 50%, give or take. And so in there, multiple ways of attacking coverage and all of that, when are you going to start to see fat impact, it's usually two to three hours after a meal, and it will last a long time. Whereas protein, protein starts to impact blood sugar somewhere one to three hours after a meal. If it's a large quantity, or you've had a small carb containing meal with a fair amount of protein or a large amount of protein, then you may need to actually cover protein. So this isn't, you're always going to have to Bolus or cover fat and protein. That's not really the truth. But there are some specific scenarios in which you would have to cover both of them or just remain high.
Scott Benner 12:09
Right? There are multiple episodes throughout the podcast that go deep, deep into how to Bolus for fat and protein, Episode 378. Don phenomenon. I might have to really get you to lean in on the technicalities of the next three really. So really, yeah. Because I know what the dawn phenomenon is, like, I know that there's this time around, ready, you're testing me two or three o'clock in the morning, right? Where your body kind of gives off some glucose glucagon from your liver, something from your liver. Is that right? Or
Jennifer Smith, CDE 12:45
it's also kind of the beginning of like, cortisol sort of, I mean, it's two o'clock early. So most people it's somewhere between three and 8am. I mean, for like the widest swath of time potential, right? I mean, there are multiple thoughts for why do some people see it more considerably than others, but most people who have tested will definitely find that as they get through and into sort of later, early morning hours, things start to kind of creep up a little bit. And it may also then go along with the foot on the floor, which I don't know, did we do that one already? We're gonna go, we're gonna get that. Okay. All right. So yeah, Don phenomena is really that early morning has nothing to do with getting out of bed. It's the body's need for a little bit. A little bit more insulin, based on your body's preparation for you getting up to get going in the beginning of the day.
Scott Benner 13:46
Okay, then 379 is smokey effect. Smokey. You always say differently than I say.
Jennifer Smith, CDE 13:53
I always say smokey, the fact that people say some Oh, geez. Smoky red. Yes, it's yes. All I know
Scott Benner 14:00
is I don't know what it is. We've done an episode about it. And I have no recall that whatsoever.
Jennifer Smith, CDE 14:08
Yeah, well, I think actually, it was really kind of funny. In that episode, we, we actually looked up where the name came from. It was a doctor and it's a doctor. Yeah. So smoky effect, or phenomenon or whatever is really, when your blood sugar gets too low. Overnight, specifically, you get this dump of like glucose or not really glucose, but your body starts to break down its stores of glucose sends it into the bloodstream. It's a it's a good effect. That's supposed to save you from the low right. But on the opposite of it, the trigger of those hormones can then send your blood sugar's rebounding high later on with a CGM, and thankfully, many people have the option to use a CGM. Now, we can really catch is the high blood sugar you're waking up in the morning? Because you've had lows overnight? Or is it really because nothing low happened and you really just need more insulin put in. Basal.
Scott Benner 15:13
It's really interesting that that the advent of a CGM takes away that. I don't know what's happening idea. Yeah, it's really cool. That episode three ad is feet on the floor. So the way I see it with Arden is she can be super stable, right like at overnight, and her alarm starts to go off art and say, let the alarm go off 16 times kind of person, right. And then she's got snooze herself. She's losing herself into reality. And so as she's losing herself into reality, I begin to see her blood sugar pick up, then she just a little bit at 80 to 85 over like 30 minutes, right? And then she wakes up and her feet hit the floor. And I believe that what happens is your brain and your body start preparing yourself for the task ahead. And I guess that's adrenaline and some other things and and then you just start seeing arise. And then the problem ends up being is that is how it gets caught up in everyday life. Like because breakfast can sometimes be difficult for people to Bolus for. And on top of that they have a rising blood sugar perhaps from feet on the floor that they haven't covered with basil. And anyway, that's feet on the floor. Am I right?
Jennifer Smith, CDE 16:24
Yes, it's you got it, it's typically noticed right upon getting out of bed specifically, especially if you've kind of curtailed the dawn phenomenon, you may actually find a secondary need to add some extra insulin as soon as you actually get out of bed. Yeah. And that, for the most part isn't really well covered with a Basal change. It's much better covered with a Bolus to accommodate for what you know is going to happen.
Scott Benner 16:56
Go check out the episode. I think this is a good time, Jenny, for us to just interject for 12 seconds and say to newly diagnosed people. I know this seems overwhelming. But these things will just sort of like you can go listen to these defining episodes, get a firm idea of what these things are, you're not going to remember every one of them right away. And eventually, as crazy as it sounds, all these things that I've listed here. So far, my brain just does the processing on all of this in the background. I don't I don't I don't stand in a situation where my daughter's blood sugar randomly jumps up and down and think I wonder if she's brittle. Like you know what I mean? Like it just right, you just start to you know, when I see a drifting blood sugar, nowhere near a Bolus, I don't think over feeding the insulin, I just think, Oh, the basil looks heavy. And so you know, eventually it does sort of begins to just make sense without you having to think about it. So Episode 408, insulin sensitivity factor, which people could see in their devices as I S or ISF,
Jennifer Smith, CDE 17:59
right? Or even correction factor, CF or CF, right,
Scott Benner 18:02
in general will get me I'm on a roll here. The Jenny's like why am I here? If you're not gonna give me? Because I don't want to do it. I don't want to do that. Excellent. That's why
Jennifer Smith, CDE 18:14
I'll just, you know, make little little comments along the way. That's all right.
Scott Benner 18:18
So one unit of insulin moves your blood sugar blank amount of points. That's your insulin sensitivity factor or your correction factor, depending on how it's written in your pump or algorithm. That's it, right?
Jennifer Smith, CDE 18:32
Correct, exactly. It's the way that one unit of insulin will navigate your blood sugar down.
Scott Benner 18:40
So if your insulin sensitivity factor is 50, and your blood sugar is 120, giving yourself a unit should get you to 70. correctly, in theory, there are a lot of other variables that would stop that. And if you're just listening first, and you're not going to get a chance to get to that episode, I do want to throw in here, as your blood sugar gets higher, that may become less effective. So it's possible that a 120 will move to 70 on a unit in that example, but not probable that a 250 would go to 200 with the same unit of insulin does that it's Yeah,
Jennifer Smith, CDE 19:14
and most most people who watch and pay kind of enough attention when they're starting to try to figure things out more. They will notice it really works. It really works. And then all of a sudden they've got a bad site or they've got, you know, a missed dose of insulin, their blood sugar climbs, what I find it's usually above like 220 to 250. above that. It seems to take a little bit more insulin than what your correction factor or sensitivity factor would calculate your correction dose to be
Scott Benner 19:44
okay. Well, you tell people what episode 415 is
Jennifer Smith, CDE 19:48
for 15 adrenaline highs. Oh, well, you know, adrenaline is a fancy hormone that kind of goes right along with fight or flight right. So what Does your body do your body's stimulates with adrenaline to really give you this rev up? I mean, you know, your heart rate increases your body is just in this ready state. Well what ends up happening, adrenaline spikes your blood sugar for most people. Now whether or not you actually have to correct that adrenaline spike is another thing to pay attention to. A lot of people see these adrenaline spikes around like you're a game, like the coolest team that you're going to play against, you know it this coming weekend, and you get this spike up in blood sugar that you've not ever really seen before. Very likely, it's adrenaline, or just excitement. I know that before. When I first started doing some of my my initial like, races, which were not very long, they were like 10 K's. But it was exciting. And I'd get there with this nice smooth like blood sugar. And then like 10 minutes before the gun was gonna go off, I get this crazy quick kick up. Really what's going on? Right? So
Scott Benner 21:05
I think also go listen to that episode seriously, because there are also situations that you can't imagine yet where it might not happen. For instance, a baseball game might make your kid excited, but baseball practice might not. And also, adrenaline needs insulin most of the time. But when adrenaline leaves and insulin remains behind. That's a Oh situation. So adrenaline holds up your blood sugar really well, when it's there when the adrenaline goes away out of nowhere. If you've Bolus for that insulin still active, and the adrenaline is gone. Now it's almost like it's almost like an unseen hand reached into your stomach and snatched your lunch out and it just isn't there anymore to correct to combat the insulin episode for 15. I realized now I'm going to have to edit out every time I went before every one of these numbers are now just leave it in who cares? Adrenaline highs we just did now that the next one episode 423 Insulin deficit? Do you remember? Did we put this in to sort of give a description to people of why their blood sugar's kind of drift up? I almost don't remember making this one for some reason?
Jennifer Smith, CDE 22:15
I believe so. I wonder if the other one was was this? Oh, no, because black holes is
Scott Benner 22:22
down farther? Well, let's just define insulin deficit, then. Sure. Just yeah, probably an insulin deficit
Jennifer Smith, CDE 22:28
is missing insulin. And the result is typically that your blood sugar is going to go up. That's, that's it.
Scott Benner 22:36
We probably stuck it in there. Because you'll hear me say throughout the podcast, you know, if your blood sugar is high, you're probably didn't use enough insulin and slow, probably use too much insulin. So you know, like it's a good place to start. So insulin deficit is just what it sounds like. growth hormones, Episode 426. I mean, the reason we define that around diabetes is because when your kid goes to sleep at night, and is inundated with growth hormones, their blood sugar is going to go up. So I don't know that growth hormones needs a description here from us. But it does need us. I think it does. Ask us to tell you to go to listen about it. Because it's really important, it is going to impact your use of insulin.
Jennifer Smith, CDE 23:17
Especially in in all ages. I think most specifically for those who have kids with type one teens with type one. Women who have not quite figured out their monthly cycle yet around their hormones that go up and down. So it's definitely an important one to understand. Yeah.
Scott Benner 23:37
Okay, stacking insulin is episode 440. And it is very likely that you are going to be diagnosed, and a doctor is going to look at you very sternly in the face and tell you never stack insulin, right? happen without much explanation, right, they're just gonna say don't stack. Stacking Insulin is the idea of you just sort of layering new boluses on top of each other blindly, because you see because it's almost it's almost raged bolusing and steps. Does that make sense? Like instead of like, like, instead of throwing in five units all at once it's a unit than a unit and then a unit and a unit, you just keep stacking them up on each other. It's kind of the same idea. I've never thought of it that way before until just now. But here's the thing, you really don't want to stack insulin. You want to Bolus correctly for what you're eating or for the correction you're trying to make. But it's not stalking if you need it. So if your insulin is well proportioned and your understanding of covering your foods is good, and you eat at three o'clock, and at 325 go I'm gonna have another serving of that. That's not stalking. No, that's Bolus correct. And the problem is, is that when you get when you're in your first week of blood sugar's and people say don't stack insulin One A lot of people here as don't use insulin frequently. Do you agree with that?
Jennifer Smith, CDE 25:06
Right. And I, I've also heard it in terms of the comment about don't stack insulin, many will be given sort of a timeline of use of insulin, like, if you take insulin here, don't take insulin for another three or four hours, right. But that lacks a lot of good explanation, as you just tried to do you know, if you or your child eats lunch now, and then you decide, well, I'm still hungry, or he or she is still hungry, and they really want something more, there's a reason to take more, even if it's within an hour of having just Bolus for other food. If you're eating again, you need to take more insulin for that that's not stalking. If you take insulin for a meal, blood sugar is rising, and you think, Well, I'm just gonna give more insulin because my blood sugar's rising, you could potentially get into stacking insulin because you really haven't seen the true impact of that. Let's call it a three to four hour active insulin window of the first Bolus, right?
Scott Benner 26:10
Or you could just be right, you might have miscounted carbs where the glycemic index or load might be wrong. Here's what I'm gonna say, listen to this episode, because it's important, but these episodes should probably at some point lead you into the diabetes Pro Tip series, which will make all of these definitions make a lot more sense. Episode 442, hydration, I think we all know what hydration is. So I don't know that it needs to be explained here. But you should go check out the episode because hydration has a huge impact on how insulin works. That's that's why it's in the defect in the definitions,
Jennifer Smith, CDE 26:46
insulin movement of any nutrients around your body. It also impacts CGM accuracy significantly, significantly So, absolutely. Listen to hydration.
Scott Benner 26:57
Yeah. For 55 Lada diabetes, latent autoimmune diabetes in adults.
Unknown Speaker 27:06
Yes,
Scott Benner 27:07
yeah. If you guys could just see Jenny looking at me right now going, he's not gonna get this.
Jennifer Smith, CDE 27:16
I was, I was like, I know we've done this so many times. That you know this constantly
Scott Benner 27:21
and it's, you know what the problem is where it breaks my brain is that it's latent autoimmune diabetes, la dee, but then it goes in adults, and there's no either.
Jennifer Smith, CDE 27:32
Yes. I mean, it really what, right? It's just a slow progressing form of autoimmune diabetes, or a slow progressing form of type one, for the most
Scott Benner 27:44
part, which you mainly see in adults.
Jennifer Smith, CDE 27:46
Correct. Exactly.
Scott Benner 27:49
Then we have Modi diabetes, which I'm going to admit, I couldn't define if my life depended on it, which I'm sure you're disappointed in right now. But can you please do it?
Jennifer Smith, CDE 27:58
Nobody diabetes, yes, maturity onset diabetes of the young.
Scott Benner 28:02
There you go. So is it a lot of for young people?
Jennifer Smith, CDE 28:10
Not really. It's definitely different than Lada. And Modi has many different, it's genetic. Od has many, many different types of Modi, if you will, that's the easiest way to say it. And getting the proper diagnosis of your type of Modi becomes really important for getting the right type of medication and management strategy.
Scott Benner 28:39
So it's one of those things that often if you have it, you're not going to know right away because doctors are gonna have trouble figuring it out, too. Yeah. Which is why they're specifically episode 463. Crush it and catch it. That is the thing I made up. So it is and you really don't start with crush it and catch it right like listen to these listen to the pro tips then come back to that when maybe but it for to define it. It's the idea that sometimes you have a high blood sugar that is so high. And if you have a CGM I sort of just learned how to like Crush It, like crush it with insulin and then catch it so that it comes in for a smooth landing without creating a high later and without getting a low. Anyway, it's not a day one idea for 60 days, like no, I'm not even saying anything about this.
Jennifer Smith, CDE 29:30
Hey, no comments there whatsoever. Well, I the comment I was gonna say is actually it kind of goes a little bit along with rage bolusing but crush it and catch it means that you really are. You're not. You're not anger bolusing you're like I see the problem happening. You're taking emotion out of it. I'm going to do this, but I'm really going to be diligent about paying attention. And I'm going to catch it later because I know that this is likely more than I need it.
Scott Benner 29:58
It's a it's an aggressive has fought for move. It's it is yeah. And yes. And again, don't do it on the first day for 66 C peptide and beta cells, C peptide, what is that. So
Jennifer Smith, CDE 30:12
C peptide is a substance, it's made by the pancreas along with insulin, they're sort of both parts of a big molecule, right. And when insulin gets released into circulation, the C peptide kind of gets cleaved, or broken off, if you will. And it's kind of C shaped from what I understand. And so it doesn't do anything. The insulin is the piece of that molecule that we want. But C peptide is measurable in the bloodstream. So when you're diagnosed with autoimmune diabetes, or type one diabetes, C peptide levels can be tested to see that they live below what would be expected to be normal pancreatic output of insulin. And if the C peptide then shows what's actually coming out of the beta cells in the pancreas. If they're low or under a value, then usually, you know, goes right along with a type one diagnosis along with antibody testing and that kind of stuff. But see, peptides can be measured in somebody who has type one and has had type one a long time as well. And a lot of people ask, well, I take insulin, you know, I injected I pump it, isn't that gonna mess? The tough stuff, not at all. The A C peptide is really only something that comes with your own beta cells, that molecule that's made along with insulin, it's only coming from that it doesn't come from our formulated insulin, but you're
Scott Benner 31:39
gonna hear the word around because people are gonna say, if you're newly diagnosed, and P sometimes people like I'm not sure if I have diabetes, someone's gonna say to you, Well, have you had a C peptide test? And that's, you know, to pretty much tell you if you have type one diabetes, right, right. And a lot of times the, the reason that comes up is a lot of times type twos, can be misdiagnosed, or type ones can be misdiagnosed as type vice versa, that yes, breaks down, we also hit beta cell and their beta cell is the cell in your pancreas. That makes sense Elon, and you can go learn more about it in 466. Episode Four, excuse me, Episode 648. Insulin onboard. To so just to define it, it's a once a year pumps, your algorithms in pen, for example, a smart insulin pen will tell you based on your settings how much insulin you have active in your system, the insulin on board, you being you being bored, and it's on you. Here's the weird thing, isn't it on board, it's a it's such a it's such a commonly used phrase and diabetes. And yet, it's not actually specific to human beings. If you think of it outside of this, not the point anyway. And so on board is how much insulin you have active in your body as measured by your device. And it's based on your settings. Learn more about it in there because if your settings are different, your insulin onboard might look different. And,
Jennifer Smith, CDE 33:07
and that one setting is your duration of insulin action, or your active insulin time. That's really where insulin on board, anything your system is telling you about an amount. It's coming from a setting that you set or that your doctor recommended that
Scott Benner 33:21
you set. If you switch to a pump, you may remember your pump training when he came up on it and it says, What's my insulin action time and the nurse went, Ah, I put three or four hours in there. Because they don't know. And you never get told to go back to it. But you should and you should understand it better. I just had to throw away a phone call from my mother who calls always at the worst times. she I think she has a camera in my bathroom and knows when my when I step into the shower, I'm pretty sure. Episode 652 is pump break. Some people use insulin pumps and take a break sometimes. That one's pretty self explanatory. Episode 656. Jenny, we're gonna get through this whole list. Yay. Episode 656 is about barriers. So I don't use barriers. Arden doesn't use them I should say but a lot of people do. Jenny, could you highlight? Yeah.
Jennifer Smith, CDE 34:17
Barriers essentially are for people who have irritation to any or potentially all of the adhesives that are used to put a product onto the body, whether it's a CGM of any kind, a pump and pump infusion set or Omni pod the infusion or the the adhesive around the pod. It's essentially a way to create a barrier between the skin and the adhesive of that product. Some of the barriers are a spray or like you know something like Flo knees let's say or like a spray Benadryl or something enough to create them a little bit of a barrier to prevent irritation from the adhesive. Other barriers, though, are another sticky sort of tape, if you will type of product that you would put on to your clean skin. And then you would put your product on top of that, to prevent that adhesive from causing a problem for you. And the
Scott Benner 35:20
truth is some people have trouble with things sticking some people have trouble with irritation, some people aren't bothered by it at all, and we'll find out who you are. And then that'd be a great episode for you to listen to. Yep. All right, Episode 660. Oh, the next to actually I made up Episode 660, as Jenny is gonna get the finished strong with the rest of them is called black holes. And so it is a look into how my brain thinks about creating deficits of insulin in the future. Is that fair? That's fair. Okay. Yes. So again, that might not be day one. But it is a is an episode that a number of people reached out and said you talk about black holes in the episode, but you've never defined it as like, well, I will make a defining episode about it for you. Much the same as episode 664 dictate the pace is, it's again, it's just a look at how I think about diabetes really where I think you should sort of be out in front of it strike first however you want to put it. It's I don't think you should cover up and let diabetes happen to you. I think you should happen to it. So that the next thing that happens is quantifiable. You know, instead of Oh, diabetes happened, this happened, my blood sugar went up, it went down. I don't know why I like saying I Bolus and then I got low. And at least I know now I can change that Bolus. I see. You know, I see I did something and then something else happened? Correct. 664 dictate the pace. Okay, Jenny 668. For you carb absorption and digestion. Yeah,
Jennifer Smith, CDE 36:58
so we're taught a lot about carbs initially, or you'll be taught a lot about carbs initially. The simpler the carb, the faster the impact on blood sugar. And then what you eat with that type of carbohydrate could also lead to a shift in how your body digests or processes that food to make it visible in blood sugar effect, right? So simple food being something like a big bowl of green grapes, versus a big bowl of kale chips. They both have carbohydrates in them, but they're both going to absorb differently, you're going to digest them a little bit differently. So to speak, right? It's not like your body changes how it digests but because one is simple, pretty simple carb, you're going to get much more rapid impact from some foods than from others. So
Scott Benner 37:56
yeah, the carb absorption and digestion impacts the timing of the insulin, sometimes the amount of the insulin, it's important to understand what it is and how it works. Do another one Jenny 672 antibody,
Jennifer Smith, CDE 38:10
antibodies. So antibodies in general, are just a protein in your blood that's essentially produced to counter a specific bad guy that's come into your body, right? Like an alien, a foreign substance, something, something that's not supposed to be there, right. But we take that into diabetes specifically. For some reason, especially for type one, autoimmune diabetes, you will have your body respond, unfortunately, in the wrong way with the destruction of the beta cells, but there will be antibodies that show whether you've had an auto immune response, and that's the reason or you won't have antibodies. And a marker in the blood essentially, that will tell you
Scott Benner 39:03
and it's generally possible now that you have an autoimmune disease that you might see others and antibodies are going to be words that come up again, if you end up with something like hypothyroidism and or celiac or celiac or something to that effect. And speaking of hypo Episode 677, hypo and hyper just defines hypo and hyper hypo, low hyper high. Still feel like you should go listen to the episode
Jennifer Smith, CDE 39:31
glace glycemia, because they are together right with hyperglycemia. Hypoglycemia is just glucose,
Scott Benner 39:37
we sort of go through the words or the prefixes and you can see how like you can have hypoglycemia, you can also have hypothyroidism, you can have hyperglycemia, hyperthyroidism, etc. It's interesting, Jenny and I are we're delightful as we record these, so you should definitely listen to it no matter what. And so far on June 13 2022, the last EPA sort of defining diabetes is Episode 681, where we just go over all of the different types of diabetes. You heard a couple out here in this list. Yeah, we like you know, we really dove in. And we found we found all the diabetes, not just Lada and moody and type one and type two. But there's there's other stuff and it's interesting. As you can see, Jenny, as we wrap up this episode, you and I started making these defining diabetes episodes at episode 263. Bolus, I'm going to look just real quickly. If you'll indulge me for a second. Of course, I can look very quickly and see. 236 Excuse me? Episode 236, which was defining diabetes Bolus was the first one. June 21 2019. That is nine days shy of three years ago. Wow, that crazy? Am I wrong? 2021? No, I'm right. But you make the same level of sad excitement is when I do a lot of it. Everyone listening is like the guy with the podcast wasn't 100%? Sure. But a lot of it. Yeah, I can't know everything. I knew what it
Jennifer Smith, CDE 41:21
meant. It was just the words to know what the actual acronym was right? To know, you have to give yourself more credit,
Scott Benner 41:28
defending me like my grandmother, thank you very much. Scott Aloni knows,
Jennifer Smith, CDE 41:33
only because I like you.
Scott Benner 41:35
But I mean, the point is, is that when we started it on 236, did you really think we would have done another one last month?
Jennifer Smith, CDE 41:45
I don't know. I didn't know how many you're like, we're just gonna keep getting ideas. And then we're just gonna keep doing this. Like, that's great. I like doing this.
Scott Benner 41:53
But 681 types of diabetes we recorded in May of 2022. I'm just saying that's a long time, it's a long time and expect the list to grow. Because I think Jenny and I both completely agree that management of diabetes is, at first, its understanding, it's understanding that you have tools. And these tools are sometimes thrown around as words that you don't know. And you can't possibly you don't I mean, like if the word ketone never came up in your life, and then all of a sudden, someone's like, you have diabetes. And by the way, ketones are bad. You don't want to go into DKA. You're like, oh my god, like, right, what? And you know, so the way I like in my mind is, you can have a screw and a screwdriver. If you don't know what a screwdriver is, it might not help you. So learn these the definitions. And hopefully, one day when someone shows you a screw, you'll be like, Oh, I know what to do. And you'll reach in your pocket and pull out your screwdriver and just whip it right and that aboard and you'll be on your way. And, and I think these go a long way towards doing that. I also think they go a long way towards preparing you to listen to the Pro Tip series. You know, so Jenny, if you just heard her say a second ago, she enjoys doing this? I know you do. She loves helping people with diabetes. And I'm very proud that you're involved in these. I don't tell you this stuff off and on the podcast. So let me just do it. I'm looking at her. So it's embarrassing. These definitions, and you know, the Pro Tip series like I know, I'm the one who said like, let's do this, and let's do this. But let's be honest without you. They're not what they are. So I would thank you I would clap, but it's a podcast and it's meaningless. But right now, there's noise while I'm listening. Yeah, you've just been an continue to be such an asset to people with type one. And thank you. I feel I feel as
Jennifer Smith, CDE 43:50
Yeah, and I'm glad that you've started something that's grown into such a community of support for people. And that's the reason that I enjoy continuing to help you to put good information, I think that we're good is really important, because there's, there's a lot of misinformation. I'm not gonna call it bad information. But I think especially in doing these definitions, it's really important for people to understand what things mean words they might have heard, and they may be too embarrassed or too overwhelmed to ask, well, what does that mean? I don't get it. Can you explain that differently to me, and that's really, really important for you to live better.
Scott Benner 44:27
Yeah, I want to say that part of the value and kind of why I brought up how long it's been since we did the first one. And by the way, 236 was still 236 episodes into the podcast is yours for the podcast. It's because I saw someone online the other day. I don't want to say they were ripping me off. But let's say they were okay. They were doing their own defining thing. And I and I never listened to other people's stuff. But I thought let me just see for a minute and I looked and this person hadn't been involved with diabetes for very long. They hadn't been making their content very long. And then they did a a haphazard job of explaining the thing. It's still I think for their level of understanding, I think they did a great a great job. But there's something to be said for you. With 30 plus years of living with diabetes, plus your CD plus you, you talk to people literally all day long, every day of the week about type one. And me who's been making this podcast forever? I have. I mean, besides doctors, there's nobody who talks to people with diabetes more than I do, I don't think right, I record six, seven hours of conversations every week. And there's something about knowing, like being able to say something with confidence and put it into context, which you do for me all the time, because I'll say things. And you'll come around and be like, yes, in this specific situation. This is exactly what I just said. But don't forget about this aspect of it, which is not how my brain works. And so there's something between all the experience all of your training, my ability to tell a story, your ability to keep me honest, like it all just, it's why it's good information, I think, right? That's what
Jennifer Smith, CDE 46:09
I think because you also have a lot of pieces that people can go to specifically. And in many I've heard you say, in many of the episodes, or many of the ones that I've listened to myself, you'll say if you want more about this, go here, we've explained this a little bit better, or this whole episode is all about this. It's not just something that's brought up, and then it's gone. There's no worries, the person hanging in there listening to the rest of the conversation, but really, they wanted that little nugget that you kind of just accidentally brought up. They wanted that. And that's that's a really big piece of tying something that's very beneficial. Like in terms of education, together, you have to be able to send somebody to the right place for exactly what they want.
Scott Benner 46:58
We've been able to do this for so long. And I really served sincerely, maybe the sponsors like kept this podcast going and keep it going. But we've been able to do it so long, that it's now a compendium of information, not just an episode about what honeymoon means, right? Yeah. And I just got to note, I know you have to go. I just got a note from a woman online the other day, she said, I just finished the last episode of the podcast, she listened from one to at this point, she listened to 698. Right, like straight through and then showed a graph and talked about our agency and our success. And she said, I listen to this podcast straight through and look at my blood sugar. And, you know, it's because of this. So if you want it if it's in here,
Jennifer Smith, CDE 47:40
that's like almost a month worth of like, continued like, that's 24 hour day after 24 hour day, that's 28 straight days of 24 hours, you know, assuming I know some of the episodes aren't quite an hour, and some are longer than an hour. But in general, that's 28 days of not stopping listening. Yeah, that's a lot.
Scott Benner 48:01
That's a person I don't think you or I could sneak up behind on the street and talk and they would just spin around and go oh my god, Jenny's here. So anyway, my point in saying that is the information you need to live with insulin is inside this podcast. If you go get it. I think that's great. If you jump around, I understand. But I mean, listen to these defining episodes before you go to the Pro Tip series. I really actually think that's important. So agreed. Anyway, thank you very much, Jenny for doing Yeah,
Jennifer Smith, CDE 48:28
you're very well thank you for asking me continuing to have me Well,
Scott Benner 48:32
when I asked Stop it, you're making me embarrassed.
A huge thanks to Ian pen from Medtronic diabetes for sponsoring this episode of The Juicebox Podcast. Head over now to in Penn today.com To get started. And while you're doing that, make sure you've heard episode 711 which is the first part of this conversation. Hope you're enjoying the bold beginning series. If you are gonna look for other episodes that you think you might also enjoy. Jenny Smith works at integrated diabetes.com In case you want to hire her, and I'm gonna leave you a little bit of information after the music about how you can find out more about the podcast subscribe, and other such things
alright, some quick stuff you'll want to know. The private Facebook group now has 26,000 people in it Juicebox Podcast type one diabetes, people using insulin. You can hang out watch what they're saying talk, ask questions, pick brains, or just lurk whatever you need. It's there. Juicebox Podcast type one diabetes, including lists like the bowl beginning series, defining diabetes, the diabetes pro tip episodes, diabetes variables, all listed in the feature section of the Facebook webpage Juicebox Podcast, type one diabetes it's a private group, so you'll have to answer just a few questions so that we know you're a real person. Everything else you need to know about the podcast can be found at juicebox podcast.com, or diabetes pro tip.com. If you're looking for a great endocrinologist, we have a list at juice box docs.com. It's curated by the listeners, doctors who are down with how people who listen to the podcast they care their type one. You want that part to be easy to write juicebox docs.com completely free. Everything's free by the way, find me on Instagram, find me on Facebook, find me somewhere. If you're enjoying the show, please leave a beautiful rating and review in whatever app you're listening in. Like five stars. This is amazing. And then give a really great description. So the next person who sees your review will know that it's worth listening to. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast and don't forget that episode 712 The second half of this episode is available right now in your podcast player or at juicebox podcast.com.
Test your knowledge of episode 712
1. What is the main topic of Episode 712?
2. What does the term "Bolus" refer to?
3. What is "Basal" insulin used for?
4. What does CGM stand for?
5. What is the purpose of a CGM?
6. How often should you check your blood sugar with a CGM?
7. What can a CGM help prevent?
8. What is the defining feature of the Bold Beginnings series?
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