#731 Bold Beginnings: Food Choices
Bold Beginnings will answer the questions that most people have after a type 1 diabetes diagnosis.
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Scott Benner 0:00
Hello friends and welcome to episode 731 of the Juicebox Podcast.
Today we have another edition of the bull beginning series, a series that began back on episode 702 With honeymooning, and then it went to 706 adult diagnosis 711 terminology Part One 712 terminology part two, Episode 715 bold beginnings fear of insulin, Episode 719, the 1515 rule episode 723 long acting insulin episode 727 target range, and on today's episode, Jenny Smith and I will discuss food choices. While you're listening, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan. We're becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, please consider going to T one D exchange.org. Forward slash use Box join the registry take the survey when you complete the survey which will take fewer than 10 minutes, you'll be helping people with type one T one D exchange.org Ford slash juice box
this episode of The Juicebox Podcast is sponsored by Omni pod makers of the Omni pod dash and the Omni pod five, you may be eligible for a free 30 day trial of the Omni pod Dash. And here's how you can find out on the pod.com Ford slash Juicebox Podcast is also sponsored today by Dexcom. And the Dexcom G six continuous glucose monitor, head over to dexcom.com Ford slash juice box to find out if you're eligible for a free 10 day trial of the Dexcom G six. When you use my links, you're supporting the show. Hi, Jenny. And welcome back to the bold beginnings. I can't pretend that we didn't just record another episode. I'm sorry. Nevermind. Scott, it's very lovely to see you again. And I just finished one we're moving into food choices. So there's a ton of feedback here from people, I really enough that I'm not certain we're gonna get through it, but we'll give it a shot. And I'm going to start the conversation based on based on the conversation that I had, just recently with a young person in their 20s with type one diabetes, and just we're talking about all kinds of stuff. And in the middle of it. She said having diabetes, diabetes really messes up food for you. She's like it just you start looking at it, like what is that going to do? And you know, is this or you know, maybe I won't eat that because of what it's going to do or it doesn't feel worth it to me to fight with this for three hours. She said she never thought about food like that prior to diabetes and right, it's a fair statement. So let's dive right in. Because there's a ton here. This person says that grocery shopping seemed incredibly difficult at the beginning. And it was also emotional. She said they were trying to eliminate some of the kind of quote unquote, not good for you foods that my daughter was getting. But then she saw me crying as we went down the aisles. Wow, that sounds like really in the beginning. Because you're feeling I'm gonna guess not a therapist, Jenny. But that's a sense of loss. Right?
Jennifer Smith, CDE 3:41
It is. And there's a sense of loss. I think in many things that because food is food is a major part of diabetes management. It is because food is also a basic necessity of life. We have to eat, we can't just say well, I've got affects this. So I'm just going to just not do that anymore, right. But we have to eat food. So what you've been used to doing may need to change. Now, you know, one step into that is was what you were doing? Not the greatest, or was it not as healthy anyway? And could you start to see some of these changes once you mentally get over all of the hard stuff that it takes to navigate through all these thoughts. It can you start to see this as a well gosh, as a family, we could clean this up. We could be doing this versus that and it would be better for all of us. Right? But it is it's it's hard.
Scott Benner 4:51
And not everyone's going to take that path either. You know, and I will tell you that some people see it as a challenge to like I'll just because we have died videos now doesn't mean I'm gonna You can't change me. I'm gonna figure this out, right? It's funny because I'm somewhere mixed into that idea, I'll probably figure it out as we're talking. This first and biggest worry I had was limitations of food. What in the world was I going to feed my kid? Because she only really ate a few things to begin with. Yeah. And those things all had carbs.
Jennifer Smith, CDE 5:27
And that's where then you work with that, because so much has changed with the child's life to begin with. That that's not a starting place for being like, well, you're just gonna eat broccoli today? Because that's so much better for you than whatever it was the child. No, no, that ain't that's not appropriate. But it's then learning Well, the 10 things that your kid does eat. figure those out, yeah, eventually move
Scott Benner 5:54
on. The same person said that they then had an appointment with a dietician a number of days later, where the dietitian lifted the fear by just saying, Hey, listen, you can eat what you want, but you have to cover it with insulin. But then they didn't give them the rest of the information, which is, you know, what this whole thing is about, right? Like is, you know, 10 carbs, this and 10 carbs that might not hit the same, right? So they went from, oh, my God, there's nothing my kid can eat to Oh, doesn't matter, they can eat anything to then realizing we don't seem to be very good at Bolus thing for them. Right? Then Then they ran into that idea of like, well, well, this must be what it is. Now, this next person says I was confused about the different views between low carb and like a regular diet. And I didn't, I didn't realize that you could use insulin skillfully. And still, and still have a great day one, see. And we do that now. But there still are times that we might not want a bunch of insulin on board. So we eat appropriately around that. Correct. So that's, that's a really thoughtful, that's the, that's somebody who's been through it already, and figured it out, you know, or has
Jennifer Smith, CDE 7:06
kept enough, even in a shorter period of time, has kept enough notes, or has done some trend analysis, or looked enough at what is going in and has seen. But when we do this, this works out pretty well. We've got it figured out whether it you know, is an apple or fruit snacks. They've figured it out, right? But then comes in, you know, the other types of things. And they say, well, these are the variables, I think it would be easier if we just have less overall insulin, maybe we could go this route for this type of setting. And it works better for us. Great. That's it's probably adding a good amount of variety anyway, which is healthy in your nutrition intake overall to begin with
Scott Benner 7:52
this next person's point I agree with completely. So, you know, they talked about, you know, I'd never thought about glycemic index and foods before this obviously said the podcast helped her think about it. But that she did make some pretty what she thought were obvious decisions on some things. And she puts a little list here, but I'll tell you for certain little things, like if you have pancake syrup in the house, get a sugar free one. Like that's me just like Why are you punishing yourself for right? You know, like, like, first of all, I don't know if you've ever really thought about it, but you start squirting that syrup on everything. By the time you're done. You have a half a cup of it in there, you're basically drinking 40 carbs of sugar, you know, at a know so
Unknown Speaker 8:35
much more. Much more. But yes,
Scott Benner 8:39
so so if you're gonna have pain, so Okay, fair enough. I still want to have pancakes, have pancakes, use the sugar free syrup. It makes it easier on you. Do you have to know? I mean, there are people listening this podcast who think this podcast is about the idea that you can eat whatever you want. I mean, I think the podcast is about understanding how insulin works, but fair enough. So but yeah, that kind of thing. Or, here's a super easy one. No one's ever going to tell you make sure you're buying bread that has no high fructose corn syrup. Super easy decision to make makes things much, much simpler.
Jennifer Smith, CDE 9:14
And if you go a step further, get sprouted grain bread. So much easier glycemic li than even the typical white breads that might say they're organic with no added corn syrup or whatever. But the more the more unprocessed something is, the better you're going to find your glycemic kind of, you know, outcome
Scott Benner 9:37
if you're a person who absolutely has to have soda and I have to admit, I don't understand that. I don't ever drink soda really. But aren't that I went out to lunch the other day and we're like, can we have two unsweetened iced teas and she goes we're out of unsweetened iced tea and I was like supply chain issues. And we were both like we'll have a Diet Coke and at a meal where I I probably would have drank a couple of iced teas. I did not get through the Diet Coke. It just it's not for me. But if you have to have soda, God bless, drink diet soda, and then you don't have to worry about that thing. Like, there are simple places where just for health in general for that if you don't have diabetes, you could be cutting out sugar. And, and at the same time, it just makes this whole thing easier, especially in the beginning. There's still times when people send me graphs and I'm like, Look, do yourself a favor, eat a simpler diet for a couple of days while you're figuring this out. Like you don't know what you're doing. And on top of that, you're trying to Bolus for Lucky Charms, like you know. Yeah, that's like, that's, that's an angel level decision you're trying to make here. And you just started yesterday, you know, right. Yeah, that kind of an idea. You okay with that you? Like I'm not saying to restrict your diet, I'm saying.
Okay, let's head together to Omni pod.com forward slash juice box. The first thing we'll do is brace ourselves because there's a photo of me there. And it's not. I mean, it's not pleasant. It's the best picture I could take. I don't know what to tell you. Anyway, I apologize. On the pod. They're makers of the AMI pod five. It's the first tubeless automated insulin delivery system. It's an algorithm based system. It's probably what you've been waiting for on the pod five is the first and only tubeless automated insulin delivery system to integrate with the Dexcom G six. It is now available for people with type one diabetes ages six years and older. Featuring smart adjust technology. The pod adjusts insulin delivery based on your customized targeted glucose helping to protect against high and lows, day and night. Where do you find out about this Omni pod.com forward slash juice box. Now if you're not in the market, for an algorithm based system, you might want to take a look at the Omni pod dash and you may be eligible for a test drive a free 30 day trial of the Omni pod dash, you can also learn this add on the pod.com forward slash Juicebox Podcast scroll down to the big purple box and start reading. After that you fill in a tiniest bit of information, and you're on your way. So whether you're looking for the Omni pod five, or the Omni pod dash, you want to go to my link Omni pod.com forward slash juice box. there everything is well explained and easy to understand. A tubeless insulin pump is within your grasp, head over there. Now. When you're done, I'd keep going right to dexcom.com Ford slash juice box. Now here's the good news about this next calm.com forward slash I'm typing I'm sorry, Ford slash juice box. Here's what you're gonna get there are Moreover, not get a photo of me. So it's a nice relaxing and calm experience. No pictures of Scott. Instead what you're gonna get is the breakdown about the Dexcom GS six, you're going to learn about zero finger sticks, glucose readings that are right on your smart device, customizable alerts and alarms and how to get started right now with the Dexcom G six. You can make better diabetes treatment and diabetes management decisions with zero finger sticks and no calibrations. The Dexcom G six lets you see your glucose numbers with just a quick glance at your smart device and receiver get alerted when your glucose levels are headed high or low and share your data with up to 10 followers. And the Dexcom G six is covered by most insurance plans. There's details surrounding all of what I've just said. But those details are@dexcom.com forward slash juicebox you don't want to I mean listen. You don't have to listen to me, right you can do whatever you want. My daughter has been wearing an omni pod since she was four and she's 18. She's been wearing a Dexcom since I don't know she was six or seven. And she's 18. These items are at the core of our decision making process, moment to moment, hour to hour day to day with type one diabetes. And you know what, they could probably help you a lot with type two diabetes as well. dexcom.com forward slash juice box on the pod.com forward slash juice box links in the show notes links at juicebox podcast.com. I am contractually obligated to say that for full safety and risk information about the Omni pod Plus Free Trial terms and conditions you can visit omnipod.com forward slash juicebox. I'm going to get you back to Jenny now who by the way works at integrated diabetes.com In case you're interested in working with her like I'm not saying to restrict your diet I'm saying
Jennifer Smith, CDE 14:52
make make potentially wiser decisions and Dorsey what you're doing Are you constantly having problems No matter what you're trying, maybe you're at the level of getting the majority of stuff. But there are a few things where like the maple syrup, or the regular sodas or you can't get over drinking juice. Okay, we know what I mean juice is recommended for a low blood sugar treatment. Don't drink juice. Just drink juice, eat the fruit don't drink the juice.
Scott Benner 15:23
I grew up in a house where nobody understood nutrition and orange juice was seen as healthy as hell. Yeah, yeah.
Jennifer Smith, CDE 15:30
I'm sure it was yeah, you know, better than soda from an from a from, I guess nutrient quality, especially if you're getting the not from concentrate, whatever. Okay.
Scott Benner 15:43
That is not a good marketing line. It's better than soda that does not breed. But in all of your foods. I mean, I'm telling you right now, no high fructose corn syrup. If you just cut that out of the things you're buying huge deal, if you can. I know. Listen, it's time consuming. But it's try to stay away from things in bags or boxes. These things have preservatives in them that make them more difficult to Bolus for. I made my own potato chips last weekend, which took hours but I found relaxing people made fun of me, but that's okay. And you should see how much less impact that had on Arden's blood sugar versus any kind of potato chip that would come out of a bag.
Unknown Speaker 16:28
And you would because you know what you did to them. It was a rough
Scott Benner 16:31
was soft on it. That's what it was like that. There's nothing else in it. I mean, except for whatever they sprayed on those potatoes before we bought them.
Jennifer Smith, CDE 16:39
Oh, you didn't buy organic potatoes.
Scott Benner 16:42
I don't know if I did or not. I was just for the situation teasing.
Jennifer Smith, CDE 16:46
Well, you know, who knows the organic versus non organic? Who knows what floats through the air? And
Scott Benner 16:52
I'm sure there's a way to get around that distinction already here. Yes. A lot of statements here about my first food shopping was completely overwhelming. We weren't carb counting. And we had to work in 15 grams of carb portions, oh, poor person was not carb counting. So they were eating either 1530 4560 That's a lot.
Jennifer Smith, CDE 17:15
And that would be more of like a sliding scale kind of concept of this many carbs. Take this much insulin. And that's all then use this correction if your blood sugar's in this range.
Scott Benner 17:27
And then the end of her statement, I've seen online a million times and heard from people in general, which was That was way too much food for my kid. My kid wasn't eating 30 carbs at a sitting they were a little but they wanted more than 15. And now they're forced feeding. They're telling the kid you got to finish this because we Bolus for it, which is not a good start to your life. That's for sure.
Jennifer Smith, CDE 17:48
Not at all. I mean, uh, you know that that's really old. I mean, that's, that's really what I learned. And that was really old, old school education. I mean, I could remember when I was taught, I was so excited when I was taught to read a food label. And I could cover carbs with insulin better. I was so excited about that, because it just, I don't know, it widened up things. I still wasn't the grocery shopper. I mean, it was still my mom. But I don't know, it just made a difference.
Scott Benner 18:20
This person said that they ran home from the hospital throughout everything with sugar in it based on no no information at all from anyone just thought that was the right thing to do. And then it took them months to realize that this stuff still had carbs in it. And it probably didn't matter one way or the other. People said I wish someone would have told me the best cards to carry with me. That's a good Yeah, yeah. Because I do. Do you ever see, like, here's one that floors me right? Chocolates not good. A good treatment to stop a low with right? Not at all. It's still a fat, but people do that all the time. Right? Like so you want simple sugar that's absorbed easily through your body. Think about like if you ever had that emergency gel, they tell you to rub it in the cheeks, inside of your cheeks. So juice works really well. A lot of people
Jennifer Smith, CDE 19:09
another really good one are the honey sticks. Okay, especially if you're someone who really doesn't want to do all of the processed Color Fill candies and that kind of thing. The long skinny honey sticks work really well. I've seen a lot of people comment about and I've done it myself when I've had like lack of something in a purse is just the sugar packets at a restaurant. Yeah, they work. Awesome. Dump it under your tongue. It dissolves right away and it is quick. It works.
Scott Benner 19:39
I remember having to do that with Arden one time. And she was like, you know and I said well just pour it on your tongue and I was like melted in your spit. Hold it in your mouth for a little while before you swish it around. You know, get it make sure you get on all your teeth so we can end up with it. But that's also a great Good example, if you're giving people sugar overnight, you might start seeing you might start surveys. Yeah, dental problems. And I've had a dentist on actually, his episode will be out pretty soon. So by the time this is out, it'll probably have been out where he said, you know, look, I'm not telling you to jump up in the moonlight and brush your teeth. He's like, but have water by the bedside. And when you're done, just swish it around your mouth and clear your mouth. That would be a big deal to do that. Yep. Okay, so best cards to carry around simple sugars that were quickly.
Jennifer Smith, CDE 20:31
I wanted to say simple sugar too, if people are looking at labels, the simplest, like most most easily digested carbohydrate is is is glucose, right? Which is why we have glucose tablets. But glucose is dextrose. So on candy labels, if you're looking for a candy, look for glucose, or dextrose, within the first three ingredients, and then you've got something that's going to work really quick,
Scott Benner 20:58
okay. And then after that, I think find what works for you, too. Right. And and let me say this, just don't think that because you open the package, you have to eat them all. You know, if you have a little single serving, like, I don't know, gummy package, and there's 10 pieces in there, five of them might fix your low blood sugar, you know, don't feel weird about throwing the other five away or twisting it up for later or something like that. You don't have to eat them all because you opened it up, which is the thing that people fall into all the time. All right, now's the time. Let's say hold on a second. This person actually made your point earlier that this might be a good time to make a sweeping change in how you eat. If you if you looked up and saw that your diets not a healthy one, it's a good, it's a good excuse to do something about it. So that was yours.
Jennifer Smith, CDE 21:48
And as you said earlier to you know, the least processed or the less processing of food most often means the food is is clean, if you will, right. There's not a lot that's been added to it, whether it's corn syrup, or all of the additives that they keep to preserve it on the store shelves mean the best places to shop and the grocery store. It's around the perimeter. You've got your fresh produce lots and lots of non starchy great vegetables, healthy fruits, you've got your protein sources, it's it's the aisles that are the danger zone.
Scott Benner 22:27
I know. I've seen it. I've seen it before they're there. The grocery store is actually set up. Just the way Jenny said like, look at it one day, they you know, they concentrate kind of the crappy food internally. Yeah, it's interesting. Here's one, what were the free snacks, I wish somebody would have given me a list of free snacks. And that's a funny statement to me. Because, because it's not always free. Right? Like, you know, I understand the concept like a like a cheese stick might be considered or a Slim Jim or something like that, you know if you're but if your blood sugar's I don't know, 120 and having a cheese stick, you know, doesn't have carbs in it. Okay, I get your point, maybe you don't need insulin for it right away. But if you really listen to the podcast, and if you've lived with diabetes for a while, you start realizing that, you know, the fat and the cheese could slow down your digestion, which could push up your blood sugar, or you could eat meat that later would be broken down and stored as glucose that there's nothing that's like legitimately free. I don't think
Jennifer Smith, CDE 23:36
Iceberg lettuce. There you go. Okay. I mean, unless you literally eat the entire head of iceberg lettuce. And I'm not saying that that doesn't have carbs in it. It does. But I mean, Iceberg lettuce, and many of the greens will have very limited if any impact blood sugar wise, right? I mean, on a whole big dinner size plate size spinach salad. I might add to what I'm kind of swag calculating on that. Maybe five extra grams for all of the greens that are there. Really, the rest of the stuff that you add on top of that is what needs counting all of those other nonstarchy you know, bell peppers and onions and mushrooms and cucumbers. They have carbs in them. They were I mean the concept of free again is kind of an old concept. It kind of is like that 1530 45 grams per meal and you take this amount of insulin. I got to know free foods as as a newly diagnosed as my aunt and uncle would bring to family gatherings big vegetable trees, because Jedi could eat those foods for free. And man did I eat them? I'm quite sure if I had a CGM. My mom would have been like man we got a dose for cucumber.
Scott Benner 25:03
Garden goes on kicks for sheets, tons of carrots. And we believe we Bolus for the carrots like
Jennifer Smith, CDE 25:08
oh yeah, Carrots are one of the curvier, non starchy type of vegetables. Definitely,
Scott Benner 25:13
the point is this is that in the beginning, you might not know what you're doing, you might have your Basal too high. And so you don't notice things like this. But as you start to get your settings, right, understand diabetes more, you're going to start seeing the impacts of those so called free foods. Now, don't get me wrong, if you've got a four year old and they want a snack six times a day, I take your point, and you should definitely find those ideas. You know, a little piece of cheese is definitely going to be less of a hassle for you blood sugar wise than given them an orange slice.
Jennifer Smith, CDE 25:47
And for a four year old from a standpoint of portion, the cheese stick or the Slim Jim or you piece of you know, grilled chicken or a boiled egg or whatever it may be, it's probably couldn't have pretty little to no impact whatsoever in the portion that that child is eating, versus the adult who's like, Well, I'm just going to eat a big ol six ounce chicken breast because there aren't any carbs in it. Wow, that's not going to work out so well.
Scott Benner 26:14
And that makes me think too, if you do have a toddler or a kid who's running around all the time, there may be an amount of, of carbs they can take in throughout the day that will look free. Because they were going to go low, and you're just kind of counterbalancing it before you see it.
Jennifer Smith, CDE 26:33
Yeah, you kind of bolstering with little snips in between. And that's often the way that toddlers eat too. Right? Little bit here a little bit there. They may eat two strawberries, they might eat, you know, a bite of cheese, they might that's just what they do,
Scott Benner 26:48
right? So if you're in a situation where you think, Oh, my God, my kid eats throughout the day, and they never eat insulin, try thinking about like this, instead, it's not a free food, you're pre carving a low before the low happens, right? You're treating before it happens, and you don't even realize it. Yeah, could be the situation. I wish somebody would have given me a list of foods. That's interesting, because then that's, you know, we get into eating styles. And I don't know that doctors would want to be pushing an eating style on you one way or the other. But, I mean, you should definitely see a dietitian who could help you with that. You know, and I
Jennifer Smith, CDE 27:25
would, I would request a dietician, who specifically is a diabetes educator, if possible, if where you live, that is a possibility. I will say that being a dietitian, myself. I know diabetes, for many reasons, obviously. But had I gone into the realm of cancer management. As a dietitian, even my life with diabetes would have taught me something. But I may not be quite so good at education outside of that, because that wasn't my realm of professional work. I've learned a lot by working with so many people with so many different needs and interests and requests and whatnot, to kind of draw on, so definitely do your homework, as we've said before, with any clinical team, do your homework and find somebody that can work with you,
Scott Benner 28:21
this person said, you know, there are just days when I need a break. And so I eat very low carb, or, and I think that's completely reasonable, first of all, and said, there should be options that people know how to do that without being scared. Because if you if your settings are set up for a lifestyle, and then you suddenly swap that lifestyle to something else, your settings are going to be too heavy, then, and you're going to have trouble. But she's like, it would have been nice if someone would have explained to me that, hey, if you just don't want to eat a bunch of carbs today, switch to this basil program and do this. And I take your point, I think that's a really good point, actually,
Jennifer Smith, CDE 28:59
indoor cover your meals, you know, learn how that learn what that means in terms of meal coverage, because it really should be a swap out of okay, my Basal does this because I've tested it, that should be worked pretty well. I mean, I've got a lot of people I work with who for religious reasons, do all day fasts, right? And so we've been fine with that having tested basil, that sometimes on a fasting day, they may even need a 10% reduction in their base basil, these there really is no food impact whatsoever through the course of the whole entire day. But the meal times themselves. If you're doing a type of fasting, that's more vegetables and protein or just a little bit through the course of the day or if you're doing any intermittent fasting where you're really only eating for six hours of the day, or eight hours of the day. You may see different impacts than you do with all day food intake of more, you know, mixed meal
Scott Benner 29:56
Yeah. Do you give time or do you have to go No, I've
Unknown Speaker 30:00
got let me check me. Let me check my schedule. I have five minutes. All right,
Scott Benner 30:08
so we'll do one more. And then we'll kind of come back to this one. This person says, I wish someone would have told me that it's okay. Right to eat one way to eat another way. But instead, I got a very restrictive care team that shamed us. And it was it was really tough. You know? That's the I'll tell you though, of all the things like I'm really freewheeling on my Facebook page, meaning like, I let people talk like adults, you know, there are very few rules, but shaming people about their food choices. I am not okay with ever, no, especially around diabetes, you can you can cause eating disorders with very easily. You know, eating disorders with people with type one is, is you know, more common. If someone wants to eat Kentucky Fried Chicken every day and learn how to Bolus for that's their life, you let them do that. If someone never wants to take a carb and once their blood sugar to be, you know, at 24 hours a day, that's their decision is their decision. Yeah. And then I see then everybody's tries, you know, everybody tries to make their point. And the one thing I wanted to ask you before we go on this one is do you I mean, you're listening, you're a trained dietician, right? So you have type one diabetes, do growing children need carbs to grow correctly? Freaking word?
Jennifer Smith, CDE 31:32
Yeah, that's a very good question. I think the bigger the bigger piece to it that I always look to analyze, when I get the questions from parents is calorically, what's necessary. And within that then also becomes food preferences and what they currently look like, and what you're considering transitioning into for your child, let's say, you think that it would be easier to just be carb free, or to be low carb, let's say, I mean, most people who are not entirely carbon free, children do need a very set amount of nutrition, intake through the day, carbs, proteins and fats, proteins and fats are really the very essential. I mean, they are protein is the building block of your body, you need fat for a lot of different functions, hormone, and all that kind of stuff in the body. And carbs are the preferred energy source of the body. They are, they're fast, they get in, they give you this energy boost, and then they kind of digest and they come out. And that's sort of the reason that we eat every several hours, if we are eating more normal carb types of meals. So our carbs necessary, carbs are necessary, I think in a certain amount, what that amount is boils down to, what are you looking at doing? And how can we meet the overall nutrition need of your child where they are? Are they heavily into sports? Are they more sedentary? What is their growth percentile? Are they growing on par with where they started out prior to diagnosis? Do we need to make any adjustments and then we can look at you want to aim to try lower carb because it might be a little bit easier in terms of glycemic control. Okay, but then we need to navigate those other pieces to make sure that they're meeting their growth needs.
Scott Benner 33:28
Okay, the fat and protein stuff fatten, right, it's funny, you're making me think of Arden's friend who is a she's like I'm a vegetarian are, you know, and but then she basically just eats like, potato chips and stuff like that. Yes, that's not I think you're missing the point.
Unknown Speaker 33:45
I don't be a vegetarian, but
Scott Benner 33:49
it's, um, I think that's what you just said just resonated with me so much. It made me feel like if everyone had you with them, I don't even mean diabetes, or a person like you to stand behind you and go, Okay, look, here's your lifestyle. Here's your need. If we eat these things in the course of the day, that's going to put your body in the best position possible. Right, right. And then the problem is that people don't get caught up in what you need carbs to grow, like, okay. Okay. Maybe you do and maybe you don't maybe let's just say you want to have carbs in your diet. And then there's a person over here is eating like a pretty keto diet and they don't want that. Just let live and let live like just let it be your name and their
Jennifer Smith, CDE 34:33
their parameters. Most often the people that I've seen who are keto or more paleo, or more just considering low carb. They've done enough homework or they've come in with I'm trying to do this. This is what I really want to stick with. I'm missing something. Something isn't quite right. I don't feel quite right or whatever. So then we have some things to look at to make sure we're meeting glycemic goals as well as for kids, especially again, bro. Schools. I mean, protein is it's a big piece of piece of growth and change. And kids are growing rapidly. They they need a good quality, you know, nutrition intake. I think the bigger thing if you're looking at carbs, are you looking at going low carb and getting an answer to whether carbs are necessary carbs, like celery and cucumbers and kale and spinach, and berries, if you're going to add carbs in small amounts, those are the ones you want. You don't want the processed, like keto carbee foods that are just like tricking the body.
Scott Benner 35:43
The only time eliminating carbs from someone's diet makes me sad, is when I see them do it because they can't figure out insulin. Correct. That's all like if you want to do it as a choice, I understand. And if you figure out insulin and then decide I still want to be low carb, I understand. But I feel badly when someone just didn't you know, all the things we've talked about in this podcast forever didn't learn how to Bolus didn't learn how to Pre-Bolus Didn't understand glycemic load all that stuff, you don't understand any of it. And you're just stuck in a space where you like when I eat carbs my blood sugar goes way up. I eventually give myself insulin I get super low and I'm bouncing all over the place in the dam and I'm not eating carbs anymore because I don't want to be on unwell. That That to me? I don't know. I wish they knew if they knew when they decided to do it. I understand. But if they don't know and they just are being pushed into it because they're scared. Well, I would rack you know, I would hope that somehow they could learn before they made
Jennifer Smith, CDE 36:40
that decision. No, I 100% agree. They're 100%.
Scott Benner 36:44
Alright, so Jenny, the next time we do this, we'll come back and make sure we're done with this list. Before we move to the next one, you can go back to your thing. Sounds good. Have a great weekend. Thank you, you too. Thank you.
First, I'd like to thank Jennifer Smith for helping me again on the podcast today and remind you that she works at integrated diabetes.com. I also want to thank Omni pod and Dexcom for sponsoring this episode of The Juicebox Podcast. Go check out all the trials and offers at Omni pod.com, forward slash juicebox and dexcom.com forward slash juicebox. Those links, of course are available in the show notes of your podcast player, and at juicebox podcast.com. I hope you're enjoying the bold beginning series. There's way more coming so keep downloading them every Friday. If you've been enjoying the podcast, here's a couple of things you can do. That will help me you can leave a great rating and review wherever you listen. You can follow or subscribe in the podcast player or audio app that you listen in. You can tell a friend about the show. If you see a question online where people are like, I don't understand this. You could say oh, you should try episode bla bla bla of the Juicebox Podcast. That would be lovely as well. What else? Hi, listen, subscribe. Tell a friend. Oh, here's another one. You could join the Facebook group Juicebox Podcast type one diabetes now with over 27,000 1000 members, over 110 new posts a day. What am I trying to say? It's jumping over there, full of great information. And great community members go meet somebody just like you. I'm going to share a little something here at the end, I assume you're a real big fan. If you're still listening once you know the podcast is over, but we're at the halfway point of 2022. The podcast is now as popular by download or stream you understand you can download an episode or stream it while you're listening a download or stream count the same for me. And in 2022 The show has as many downloads or streams already at the halfway point of the year as it did in the entire year of 2021. Now, not only is that true and amazing, and I thank you very much. But the best day in 2021 like the day with the most downloads, it was the day of the year I was like I cannot believe this many people downloaded the show today. That kind of thing. Right? That amount. The best amount from 2021 is now about I'm not great with percentages. Give me a second. Hold on a second. I'll be right back. I'm back I use the calculator. Okay, sorry. So the that that show that one show that had the most downloads in 2021. It has As about 21% fewer downloads than an average day in 2022. Does. That is bananas? As a matter of fact, what I would consider a slow day on the podcast is now only 14% lower than what the best day of 2021 was. That is crazy growth. It is because of you. It's because you're sharing, you're listening, you're subscribing. I can't thank you enough. It's really astonishing. And really, you could knock me over with a feather when I see stuff like this. Absolutely wonderful. I really appreciate you supporting the show. I hope you're enjoying the bowl beginning series. Don't forget, there's a ton of other series within the podcast. If you go to that private Facebook group, scroll to the top click on the feature tab. There's lists of all of them. I'm not going to bother you here with all of them. But there's so many about how people eat and the Pro Tip series defining diabetes stuff. Stuff about thyroid and pregnancy, mental health, on and online. Go check it 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 731
1. Why is regular blood sugar monitoring important?
2. How should insulin doses be adjusted?
3. What role does diet and nutrition play in managing diabetes?
4. What are the benefits of using insulin pumps and CGMs?
5. How should diabetes be managed during travel and unusual circumstances?
6. How can the psychological impact of living with diabetes be managed?
7. Why is having a diabetes care team important?
8. How can staying informed about the latest diabetes treatments and technologies help?
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#727 Bold Beginnings: Target Range
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 727 of the Juicebox Podcast.
Welcome back to another episode of bold beginnings today, Jenny Smith and I will talk about the target that you're trying to keep your blood sugar in that range that we're all hoping to stay in. While you're listening. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. Hey, can I bother you to please go to T one D exchange.org. Forward slash juice box join the registry, take the survey, that's all takes fewer than 10 minutes. You just need to be a US resident who has type one diabetes, whereas the caregiver of someone with type one head over there today. It's completely anonymous, absolutely HIPAA compliant, and all you need to do is complete the survey to help people living with type one diabetes. The bold beginning series began back on episode 698. And there is a complete list of episodes available on my private Facebook page called Juicebox Podcast type one diabetes, it's up in the featured section should go take a look
if you're enjoying this series, you probably should head over to the defining diabetes series and the diabetes Pro Tip series to learn more. This episode of The Juicebox Podcast is sponsored by Ian pen from Medtronic diabetes. And you can learn more about the in pen right now at in pen today.com
Jennifer Smith, CDE 1:55
thanks sorry, I was late. I was changing a screaming pad.
Scott Benner 1:58
So it's no trouble at all. The fun stuff life. We we were recording so cool. Ardens Dexcom has been expiring at 11:30pm for like, seven months right? Like we just I don't know what happened. You know, we ended up changing it
Jennifer Smith, CDE 2:16
like that like the ad hour like you let it go and or is that like the empty hour or
Scott Benner 2:22
the Dexcom? Dexcom. Not to CGM is Dexcom. Not okay. Now I see. Yeah. So we ride that thing right to it like right till the end. Yeah, I am, too. And every, every time we've changed it over the last six, eight months, however long it's been I might have lost track. I walked to her, she texts me whatever. And we look at each other bleary eyed, so tired. And I realize like, Oh God, I'm up for at least two more hours now. Right? And I look at her and go, the next time this is done. We're just going to change it a few hours earlier. She goes That's a good idea. We should definitely do that. Right. Yeah. This time. I set an alarm. I like told my phone basically. Hey, Siri, in nine days, and blah, blah, blah, hours remind me to chase. So yesterday afternoon, it goes off when I Oh, cool. We're gonna finally do this. And then we forgot.
Jennifer Smith, CDE 3:15
Because you turn the alarm off, right? I do that I turn the alarm off. And then like, Oh, what was that? Again? This was due four hours ago. We
Scott Benner 3:22
had a whole conversation about it yesterday. And I said, Listen, let's change it around five o'clock. That's a good idea. We'll do that. And then next time, we can adjust it into the three if we want her to the seven if we want we'll decide, right? And she's, she's like, Yeah, 1030 Last night, I texted her, I feel bad. I just texted her the F word. She's like, what's wrong? And I was like, we didn't change that. Thanks, God. So we ended up doing it like 1030 Last night.
Jennifer Smith, CDE 3:49
Well, let's do was an hour earlier.
Scott Benner 3:51
You're trying to make me feel better. But that's not
Jennifer Smith, CDE 3:53
ours better than you know. i You try.
Scott Benner 3:56
I'm old. I can't be up that late anymore. It's not good for me. So anyway, today, for the bulk beginning series, we're going to record the topic of range. So, so far, Jenny, I know it doesn't seem like it has been together is so delightful that it doesn't feel like time has passed at all. But we've recorded honeymoon, being diagnosed as an adult terminology would end which ended up being two episodes because it was long. There was lots in there there was we've recorded highs and lows, which basically is fear of insulin. We've recorded the 1515 rule, long acting insulin, and today we're going to do range and maybe we can sneak in food choices if we have enough time. Oh, that puts us only 1-234-567-8910 1112 just 14 more topics away from buttoning the series right up so we're doing terrific. I know as
Jennifer Smith, CDE 4:56
you said the the other than not that today his tactic but the food choices in my head right away flashed this like this like dangerous.
Scott Benner 5:08
We're gonna make people hate us. It's like Oh Please don't hate me. We I think in one of the the fear of insulin we we drifted into it for five seconds and even if we were talking about there I thought some of them's not gonna like hearing this but whatever. But for right now, yeah, range is a nice easy one. Great Yeah, no one's gonna be mad at us for talking about this probably. Okay, so again this series is for people who are newly diagnosed. And the way it began was we reached out to the Facebook group and said to them, what do you wish you knew in the beginning? And here are some of the responses that fit in this topic. What range to be, or to shoot for was really hard to understand. I would have been, it would have been easier to explain that they want him to run on the high side. So let's see right away. This is interesting, because we're getting a look into what doctors say, right? Apparently, they wanted the kid to be higher. But the mom found the online world pretty quickly and decided that wasn't a good thing. So what did she say here? Okay, they wanted him to run higher as his body adjusts for a few weeks was what she initially found out is what they meant.
Jennifer Smith, CDE 6:33
As they said, it probably wasn't explained that way.
Scott Benner 6:35
No, she's like, clearly what was going on is they wanted to figure out the doses. But none of that was communicated whatsoever.
Jennifer Smith, CDE 6:44
Correct. It was a poor communication. See bad pod? Sorry, my noises are going.
Scott Benner 6:50
even heard that one in a while? No, I
Jennifer Smith, CDE 6:53
know, my my high alarm, which isn't really I mean, it's not high. My high alarm is set for 130. Really not high. But it's just telling me clearly. Anyway. Yeah. So you know, initially, she should have been told, Hey, this is what we're aiming for. Here. Because of these pieces, we aren't quite sure how sensitive your child is going to be once we introduce insulin. And as the body starts having like more normal looking blood sugars, the body starts responding or coming out of DKA or whatever, right? And then we're going to transition down to a healthier target range, right. But that's it's not usually clearly explained.
Scott Benner 7:37
And obviously not because the very next statement is someone said, I wish they would have told me that being 200 for a few weeks was okay as the body adjusted, but that we were going to taper down to a more realistic and healthy range. That it may take a while to normalize blood sugars. So yeah, you're right. This is this is the thing that people don't get told. So let's kind of break that apart for a little bit. So I mean, you're diagnosed, I'm assuming most people are diagnosed with a higher blood sugar that's probably been higher for a while. And they even though they get you down in the hospital, you know, it's funny, I say that, like, that's the norm. But how many people have I talked to who go to a hospital or sent home right away, or were diagnosed during COVID and weren't even allowed in the hospital? Right? So what happens is there? I mean, obviously, you don't walk into the hospital with a 700 blood sugar, and they're like, we'll just fix that right now. Like there's a very slow type titration that takes place in the hospital, if you're if you're there is that for safety reasons.
Jennifer Smith, CDE 8:39
It is for safety reasons. You know, if you adjust the body from the idea that you're not quite sure how long blood sugars have been so elevated, right? For kids, it's probably not been that long of a time. It happens very quickly that turnover or that transition. But there is a slow progression of beta cell loss. I mean, if you look at the research in the development of type one, there is this progressive nature to actual diagnosis. But the high blood sugar's aren't really until that very end point near diagnosis, but you still need to be very careful about bringing those blood sugar's down. Because the body adapts pretty quickly to its new set range. And if you've been running at 300 Plus for a week or two weeks or three weeks, that needs to be certainly brought down slowly not to the point of you're waiting eight weeks to bring those high blood sugar's down but in the hospital if you have had a chance to have an inpatient stay, or a closely followed outpatient, you know, diagnosis and, you know, collaborative work with a with a health care team. They will still try to really bring things down slowly because again, once you add insulin into the picture via injection, whatever betas may be left, actually, they get a little bit of a rest, and then that we've talked about honeymoon already, that honeymoon could kind of come back into the picture. So they do have to be very careful.
Scott Benner 10:15
Yeah. And I'm assuming that the wider range is because of that partially. And because of also partially, they're not sure if you're going to get home and get a little, you know, rejuvenation out of those beta cells and suddenly went down. They don't want to tell you, it's one unit for 10 carbs, and then get you home and find out that, you know, it's a half unit for 10 carbs, because you're getting some help on your pancreas. Right? That's, that's, that's the one half of the reason why they would show you a wider range with a higher ceiling. But the other one could be, they just don't know yet. Right? Like, they're not sure what's going to happen. And Correct, right. And so this person here says, one of the most useful things that I learned from the from the podcast was that I didn't have to accept these out of range spikes at meals, just because she had diabetes, that I can make adjustments to flatten those lines, etc. So I'm going to hold hold the half of her thought there. So that's the next part that I think is important, because you said it a moment ago, if it's not communicated to you, well, this is a completely new thing for you. And they could tell you, I don't want your blood sugar to be under 100. Or, and but it's okay. If it goes up to 200. After meals, they might say something like that. I say this all the time. Like if you don't give more context, your statements in the beginning, when you're teaching something to somebody, they're going to assume that's the rule for forever. And that is what I see with people is that they don't think the people who don't make it online, the people who don't find somebody to talk to just assume, Oh, it's 100 to 200. And these are people you will hear from that have had diabetes for three or four years who are treating low blood sugars, you know, air quotes at 110. Because they're trying not to go under 100. And, and it just skews your way of thinking about it forever.
Jennifer Smith, CDE 12:06
Absolutely. In what you learn, in many things, not just diabetes, but it definitely makes sense when I'm talking about a health condition that's so dramatically impacting right now. And kind of forever. What you teach in those beginning stages, becomes almost a very hard rule that it's very hard to clear out of your brain. I kind of think of it almost like when my little one was starting to ride a bike. My husband, and he, he disconnected the front brake. And he taught my son. The reason was because he didn't want him squeezing as hard as he was. And he was like four years old, right? And like any explained, I don't want you flipping over the front. Well, now he doesn't he still doesn't like that front brake connected, because he was taught that he could have an accident in which he flies over. First, right. That was what he learned initially. And it's hard to unteach
Scott Benner 13:04
I also think that with people with diabetes, you see that with where they where their devices, like the the first place they put it is the place they think it belongs, you know, and that happens to kids a lot too. It still happens to Arden I moved Arden's Dexcom for her yesterday's we were talking about in the beginning, which I think will be in the episode. And she wears them on her hips. That's it. And I put it on and she goes, That's too high. And I'm looking I'm like, it looks fine to me. You don't I mean, and if it was higher than the last time it was there, it was by a half an inch, you know what I mean? But she acted like, and she's pretty reasonable. She's like that, like it
Jennifer Smith, CDE 13:42
was on her forehead instead of like,
Scott Benner 13:44
what are you doing? It's under my arm, you know, like, like it was. So it's just in her head. That's where it goes, I think. Okay, so back to this lady's point about I wish I would have known that the blood sugar's don't have to spike up after meal. She also says on the flip side, I would have liked to have known that we that lows weren't a thing that happened. Her main message here is she left the hospital believing spikes and lows were part of it.
Jennifer Smith, CDE 14:13
And we're going to be what she should see.
Scott Benner 14:16
Yeah, yeah. It's funny her description. It's not well written, I'm sorry to the person who wrote it. But But because so reading, it's not going to help you much. It's why I'm picking through it. But the intent of this statement is, it's almost like she's in a bad relationship. But somebody told her this is what it's like to be married. So you just have to deal with it. Like, right? Yeah, it's, um,
Jennifer Smith, CDE 14:38
it's interesting. That's too bad.
Scott Benner 14:40
Yeah. Right. Like, I mean, you know, way back in the Pro Tip series. You know, I said all the time, and I haven't said it enough lately, but it's my least favorite part about diabetes is when people get caught in a situation where they find themselves saying, well, that's just diabetes. That's how it happens. You can't avoid that. And you can and she's like, I wish someone would have told me that it was possible, even if even if I wouldn't have been able to do it right away the knowledge that it was on the horizon would have been a nice idea. Right? Absolutely. Now, I think the reason people don't get told that is that many times, they're with physicians who don't know how to stop spikes and highs and, and that's why you don't get told it's possible to fix.
Jennifer Smith, CDE 15:23
Well, and I think when you're talking about range to range is something that will evolve, so to speak, as you become more comfortable, and comfort comes from learning more, and experimenting more and paying attention to what happens for yourself or your child or the person that you're helping to care for. So that range may tighten, and be different than when you were first diagnosed, or even different than when you were six months out from diagnosis, right. And they may shift through life or through each variable, you might have different ranges that you're aiming for. So I don't think that there's a, there's not a hard and fast range.
Scott Benner 16:10
No, I imagine that you probably talk to people who are older, elderly people, you probably start shooting for a wider range. And, and that makes sense to and younger kids who I don't know run around a lot during the day and you know, get bursts of exercise that you don't expect, you might have a different range for them. But none of that changes. The goal, right should be the goal range, and the places you have to adjust that range for your specific situation. Again, I just think the biggest problem with this, this this piece is that is it, nobody tells you the first numbers I said out loud are not the thing you're going to be doing your whole life. There's some other statements here from people. I wish someone would have told me that everything seems to affect my blood sugar. So the I think the variable series does a good job of shining a light on that if you want to know about some things that that that can impact your blood sugar that no one at the hospital or a doctor's office might bring up. This, the next statement is I would have liked to known what main factors can increase or decrease the need for insulin. And then you know what I mean? So food
Jennifer Smith, CDE 17:19
again, there's variables, that's certainly relative to the variables too.
Scott Benner 17:23
But I think I think that it also it shines a light on the, you know, all carbs aren't created equal idea. Yes. Because the in the beginning, in the beginning, when you you're told that formula, which is what the next statements about them trying to lead into that. And then it you know, one day eat, I don't know, doesn't matter have french fries, the next day, you eat a salad that has some carbs in it, and it doesn't work out the same way. It fries your brain. You're just like, Wait, yeah, it was 12 carbs, they were both 12 carbs. Right? And then you start saying silly things like I did the exact same thing today that I did yesterday. And it didn't work except you didn't see all the variables, and it really wasn't the exact same thing. You know. So this, this person says, What did those numbers and that correction formula even mean? My son was diagnosed, and we were sent home with a mathematical formula. We're told to follow it daily. But I still don't know what the numbers are even referring to. And John, Jenny, as you know, that feeling is what spawned my blog in this podcast. So do you know what formula she's talking about?
So you're using multiple daily injections for an insulin pen, and you want more, but you don't want to move to an insulin pump. That's okay, because the option of the in pen from Medtronic diabetes might be the perfect solution for you. The in pen is an insulin pen. But it does more because it connects to the app that gives you your current glucose readings, meal history, dose history, activity, log dosing calculator, active insulin remaining glucose history and reports for you or your doctors to look at. Doesn't that sound like a lot of good information to have right there on your smartphone? I think it is, too. So how do you get started with the M pen you go to in pen today.com. When you get there, you're going to be able to see everything that I've already told you about and more. Not only that, but if you'd like to talk to somebody about the M pen, right? If you'd like to schedule an online health care provider visit, you can actually do that at my link. And you can also just get started in pen today.com. If you'd like to see how the dosing calculator works, there's a video there. You can click on it and watch it. I just clicked on it now, but I'm not going to watch it because I've seen it already. Plus, you wouldn't be able to see it. Anyway, to go learn More about the dosing calculator dosing reminders, card counting support, and the digital logbook, head over there and watch the videos. You may even be eligible, right? It's possible. And this means here's what this means. There's like a little disclaimer here. This offer is available to people with commercial insurance, and Terms and Conditions apply, but you may pay as little as $35. For the embed, go check it out. There's so much on that link, you can't go wrong in Penn today.com. In Penn requires a prescription and settings from your healthcare provider, you must use proper settings and follow the instructions as directed, or you could experience high or low glucose levels. For more safety information visit, you guessed it in Penn today.com. Hey, this isn't an ad, this is for the podcast, I'm gonna put this in here, I don't usually do this. But if you're listening to the bold beginnings episodes, when they're over, you might want to move up to the defining diabetes episodes and the diabetes Pro Tip series just like I was talking about earlier in the episode, you can find all of them at diabetes pro tip.com, or juicebox podcast.com. When you get there, you're gonna see something that says type one diabetes Pro Tip series from the Juicebox Podcast. And there's a little introduction there from me. And basically what it says is, look, my daughter has had an A one C between five, two and six two since 2014. With zero diet restrictions. This information works for children, adults, and for the newly diagnosed. And for those who have struggled for years, I believe that anyone living with type one diabetes can use these simple concepts to stabilize their blood glucose levels, lower agency and improve glycemic variability. Again, with zero diet restrictions, check out those episodes, diabetes pro tip.com, or juicebox podcast.com. And of course, they're right there all the episodes in a podcast player of your choice, whether you're on an iPhone, or an Android. And please keep this in mind too. All of the content within the Juicebox Podcast is free. And it's always going to be there's no need to pay for this information. I just want you guys to be as healthy as possible, support the podcast in any way you can through the advertisers filling out the survey at the T one day Exchange, or just telling somebody else about the show, will you support the show, the content keeps coming and it stays free
Jennifer Smith, CDE 22:37
I would expect they were sent home with a little bit more of a specific or a precise, I wouldn't necessarily call this a sliding scale that's more of a hard and fast if your blood sugar's in this range, take this many units of insulin right. Where this gives a little bit more precision because that formula gives you a way to calculate a dose just for correction insulin When blood sugar is high. So they may they will give you a target blood sugar. So your formula should say current blood sugar meaning where it is right now whether it's from a finger stick are from your CGM, your current value right now. And then you're going to subtract from that target your target. So if they told you to target 150, great, you're going to subtract your current 250 blood sugar. And then you're going to take away the 150 target, which leaves you 100. Right. But that number looks odd until you factor in what they've given you. And it's called a correction factor. That correction factor is how many points one unit of insulin or for some little kids, they might have said how many points or half a unit of insulin may drop your blood sugar, right. So let's say your correction factor that you've given been given in this formula. Target blood sugar 150 correction factor is 100. So, so we're going to take 100
Scott Benner 24:17
If you had a 300 blood sugar, you would subtract 150, which is your target which would leave you with 150 Correct but in your in your thing you need but
Jennifer Smith, CDE 24:27
and then you have to divide that value by the correction factor they
Scott Benner 24:31
gave you to use. In this example, we're using a correction factor of 100, which means we're assuming all unit of insulin is going to bring your blood sugar down by 100 points. So 150 divided by 100 gives you how many units to take. And that would be 1.5 1.5 units exactly based on all of that and then the problem is that all seems so like specific. And then when that when it doesn't work, you're like, it's impossible. I've got this mathematical formula that gave me all the people in the white coats for like, here's what you do. And they explain it hopefully the way Jenny did, which was very clear. But they don't tell you something in this example, like, when your blood sugar's really elevated, you may need more need more insulin, right? Right. And then you could
Jennifer Smith, CDE 25:23
or if it's right after you finish playing three hours of soccer in, you know the field with your child during a tournament, and now you're correcting a blood sugar that's too high. Well, activity is the variable in the picture now. So you may use this formula. And you may see a really dramatic drop in blood sugar and think, Well, gosh, it usually works. Maybe something's changed and nothing's changed. It's the fact that there's no exercise in the picture that makes the insulin work better. So these formulas are a place to start. Right. And they do need some adjustment. Pretty soon after initial diagnosis.
Scott Benner 26:02
I've also found over the years that having a CGM Arden has the Dexcom that it takes away. I don't think about the the range as much anymore. As soon as I think about, like rolling. Like gentle lines. Yes. Right. That's more how that's more how my brain thinks about it. Now, instead of like, I'm trying to stay under this number or stay over that number. I just think I'm really trying for there not too many sharp falls, or sharp peaks. And they, you know, I don't know like, I don't even think of them as numbers, I think them as lines. Right?
Jennifer Smith, CDE 26:42
It's exactly it's almost like the sky and sort of the ground, if you will, and you have this range that you're trying to fly like a glider plane through, and you want this nice, gentle rolling effect rather than these big JJ like roller coasters is not what you want. It's also
Scott Benner 27:02
really interesting how a visual representation of it changes your feeling about it. Because you know, if your high alarm just went off at 130 Arden's high alarm is 130 on her phone. And it's i It's 120 on mine, so I can react a little quicker to if I guess I have to find or somewhere or something. But it's funny that when you look at it visually, you're like, Oh, my God, what's this crazy spike here. And then you go back and realize it went up to 120. Right, because it visually looks like a crazy spike. But that almost trains your mind to work within the range that you've set up. Anyway, if you're lucky enough to get a CGM, you'll, you'll see what I mean. Last thing here for range, someone says the quicker that you can learn about your glycemic sensitivity and insulin sensitivity, the quicker you can use that information to make broader changes. And this does really affect your time and range. So I'm guessing we've already talked about this, right? But they probably were eating some foods that hit a lot harder than than the ratios, their insulin ratios could handle. Right? All right. So find that in an episode called food choices. That's either out now or will be out very soon, depending on when you're hearing this. Yay. All right, Jenny, take a deep breath. We're gonna do the food choices. Fantastic. So much here too.
Jennifer Smith, CDE 28:28
I am quite sure you got the gamut from one side to the other. And in some of it, I think it's interesting what you texted to me the other day because some people are so quick to latch on to one nutrient being the the the end all be all of this is what solved it for me.
Scott Benner 29:01
Jenny and I are going to continue that conversation in the next bowl beginnings episode called food choices. But for now I'd like to thank in pen from Medtronic diabetes, and remind you to go to in pen today.com To get started right now with an insulin pen that talks to an app on your smartphone, giving you much of the functionality that people have come to expect from insulin pumps. If you'd like to check Jenny out, she works at a place called integrated diabetes.com. Her services are for hire. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.
Test your knowledge of episode 727
1. Why is continuous glucose monitoring (CGM) important for managing type 1 diabetes?
2. What are the differences between types of insulin?
3. How does exercise impact blood sugar levels?
4. What role does diet and nutrition play in diabetes management?
5. How can psychological aspects of living with type 1 diabetes be managed?
6. Why are regular medical check-ups and consultations significant?
7. How have technological advancements benefited diabetes care?
8. Why is building a supportive community important for managing diabetes?
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#723 Bold Beginnings: Long Acting 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 723 of the Juicebox Podcast.
When Jenny and I pressed record on this bulb beginnings episode, we thought this isn't going to take long at all. And it didn't take long, but it didn't. It didn't go as quickly as we thought. What I'm saying is, there was more to get into than we initially considered. And that's why I like these conversational episodes. Today's is about long acting insulin. 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 juicebox. 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. Today's episode is also sponsored by touched by type one, they'd love it if you'd find them on Facebook, Instagram, or it touched by type one.org. Jenny we have on our bold beginnings list. long acting insulin. It's a pretty short episode, I think based on the feedback but based on people's questions and statements about what they thought would have been helpful to know at diagnosis, we're going to include it here. Okay, so long acting insulin right away hits my brain wrong because I want to call it Basal insulin in my head, right? Same thing though long acting Basal we talked about a long time. Some examples are level mirror Lantis receba God give me more to jail,
Jennifer Smith, CDE 4:15
Basil Glar. I'm Yes. There's also if you want to include it in the same category in terms of considering long acting and basil as one thing, then we also have to include what was the old version of a Basal insulin, and that we now refer to it as more of an intermediate insulin, okay, it's an or NPH it's the kind that looks cloudy in the vial. And that has it has a shorter life. You have to dose it twice a day, but it's still considered long acting in terms of it covers that Basal insulin need, just not as long.
Scott Benner 4:58
I'm realizing as we're talking Get it this is going to be more than just about long acting insulin. So there are places in the country in the world where you may still be given mph when you're diagnosed. That's right. Okay. Absolutely. And that if people are given mph are they going to hear the word sliding scale every time?
Jennifer Smith, CDE 5:20
Many times, yes. Because of the way that that intermediate acting and or NPH works, it does. Today's Basal insulins or long acting are like a flat scape right there like a horizontal kind of, they go in, they start working and they have a flat impact once they're in a steady rate of action, whereas the intermediate acting insulins are dosed twice a day, because there is a bell curve or a peak in action, and then it floats back down, and then you take it again, and there's a peak in action, and then it floats back down. So sliding scale goes along with that, because oftentimes, if you're using n or NPH, you're also going to be using the more short acting kind of insulin called regular insulin. It takes a little longer for it to start working, but they're often dosed together, okay to to take care of two things, one mealtime coverage initially, and then the long acting insulin or that intermediate, and it's going to peak around the next meal time, or that's the goal of dosing it. So you may have short acting, and the intermediate together, the peak of the long or intermediate acting is going to be around a mealtime where you may not take extra insulin, because that peak is supposed to be covered by your next food intake. And thus, the term sort of sliding scale, take this much if your blood sugar is between this value and this value, this number of units of insulin, it's it's not precise. It requires you to get some information from the doctor prescribing that designates a specific amount of food to eat at each mealtime. Because those that sliding scale is specific to an amount of food that cover or an assumed amount of food to cover. And if you vary from that, you're going to have more erratic glucose control.
Scott Benner 7:40
Can I ask you why in 2022? Would people be given that insulin still
Jennifer Smith, CDE 7:45
depends where you are in the world? Okay. And we live in a very, I mean, we have a community here in the United States. That is, we complain about what we can get, but we can really get we shouldn't have complaints compared to third world countries and places that just really, I mean, they may not even have a glucometer to use in their own home. Right?
Scott Benner 8:10
Well, even beyond that, I still hear from people in some provinces in Canada, who are given mph when they're diagnosed and sliding scale and told shooted at this time of day, eat this many carbs at this time of day. And that's I mean, that really is management. Like you're saying based on modern management now, that's managed from the 80s.
Jennifer Smith, CDE 8:32
Yes, yeah, that was my management. Yeah. Hi, I did it.
Scott Benner 8:39
But it leaves you it leaves you open to a lot of, I think unknown sweat. Like I can't imagine doing like a regular and mph regimen and wearing a CGM. Because you probably see your blood sugar's get pretty high, stay high, come down low get low, like the whole thing.
Jennifer Smith, CDE 8:57
I believe that there will be a lot of frustration. Another reason that in again, a good number of the people that I get to work with are pregnant women, right. And there are still some OB practices that move towards the potential use of the n or the MPH at a specific time of day to cover a hormone impact that may not be being offset the right way, even if the woman is on a pump. Or we've navigated by adjusting doses and everything. Because the short action time of that n gives the allowance for peaking at the point of where you want more insulin really heavy hitting and sometimes it can be a beneficial added tool in that particular you know population
Scott Benner 9:51
but if I'm just a person diagnosed now modern times and somebody said here's it's regular an MPH and you're going to eat on a sliding scale, that's a red flag. To me, right? Yeah. We give like a lot of it's funny. I don't think of this as an advice driven podcast at all. Like, I never think to say like to somebody like don't. But if somebody says that to you, if you want my opinion, either tell the doctor, I want more modern insulins like the ones we're going to talk about in a second. And if the doctor doesn't know what you're talking about, you're looking for another doctor.
Jennifer Smith, CDE 10:20
Move on. Yeah, exactly. Yeah. Because especially if, and this again, is speaking to the terms of access, right? What people with good health care coverage and whatnot do have access to you should not be being put on an MPH and and regular insulin from the get go, you should have the option to do a much more flat acting insulin. And the oldest on the market is Lantus, at this point, followed pretty closely by love Amir, and then the newer ones are the two Jao and the truss EBA and the basic glower and you know,
Scott Benner 10:58
we're going to talk about them. Now, I just, I'm just going to add here, if for financial reasons, you're on regular and mph. I mean, Jenny's talking to you right now, many years later, after using it, it can be done. It's just not, it's not a preferred method at this point. So if you can get
Jennifer Smith, CDE 11:13
Yeah, and the biggest thing there is a little bit more scheduled to your day, can it be done? Absolutely. It can be done, and it can be done with success. If that's the case, then I you know, encourage trying to figure out a set structure to where you put your food in the day, because that's how your insulin is working.
Scott Benner 11:33
How much I don't mean to get off on a, like a personal conversation here too long. But how much of your, the cure Am I think of you as a person who eats without trouble? Like, I don't think of you as a person who eats healthy foods and is like the moaning at the whole time? Or does what they're supposed to do? And they're like, I really wish this was a flaming hot Cheeto. I wish I tried once, and I don't understand why you people like those. But that's okay. What I'm saying is this, how much of your regiment as a child, do you think impacts your eating style now? Has to write
Jennifer Smith, CDE 12:09
absolute? No, that's a, it's a great questions. question I've been asked a number of times, otherwise. I think it influenced a lot. And I think it influenced a lot because that was what my parents had to go by the I mean, the information was like, this is like the Bible to follow, right? You will feed your child and get her up at this time, and dose her insulin, she will have a snack here, it can be these types of foods. And it was figured out according I mean, you know, my my macro needs based on my growing body, it was figured out in that realm from a dietitian standpoint, as well as from a diabetes need standpoint. And I think a lot of that definitely moved me into kind of where I am today, as you I mean, as it is, I still get up. I am quite certain that the reason I'm an early riser, is because I had to take my insulin in the morning at a very specific time. Because my evening insulin was also a very specific time, and it had to be like 12 hours apart. And my parents were very strict about you know, so I don't get up early
Scott Benner 13:23
your health now is a is a testament to their taking that sliding scale seriously and really sticking to it. But it just occurred to me now it's like, oh, that's probably why your regimen you're regimented person because of that, you know? Okay, so
Jennifer Smith, CDE 13:40
it's also just my personality, and wherever it came from, I don't know. But yes,
Scott Benner 13:46
like your parents, obviously, were regimented to some degree too, because they were able to put it into I mean, listen, someone came along, like, Hey, your kids got all this stuff. And they're like, no problem. I'll have her up at 603. She'll be eaten at 645. It's gonna be 17 and a half carbs, you know, and we'll inject this and it's gonna, I interviewed a guy the other day, who grew up with a type one dad back in the was that was born in the diagnose the 50s. So it was a long, long time ago. And he said, one of the things he remembers and almost resents from childhood is that they had to eat at the exact same time dinner every night. So it didn't matter if he was playing. Everybody else would be like, Oh, come in later. It's like we had to eat because of my dad. Yeah, yeah.
Jennifer Smith, CDE 14:27
But I think it helps eventually. I mean, my dad was diagnosed with type two diabetes later, you know, in life. I was in college once he was diagnosed. And I think that sort of helped my mom move into that management with and for my dad, too.
Scott Benner 14:44
So she probably didn't have she was probably like, oh, this will be easy. Like I got this Hold on, let me get out my old books and Ledger's. But so Okay, so you're diagnosed. Hopefully you don't get mph and regular. Hopefully you get some sort of a Modern Basal or long acting insulin. Jenny just went over them lever Mir and Lantis are the older ones to Jao and TriCity Barsi. But the newer ones, depending on which one you get their action times are going to work differently. So the story I always tell is that Arden got that's funny now that I think about Arden got Lantis and it burned. So they, so they moved her to love Amir. And I remember being told that either Lantus or levemir definitely lasts for 24 hours, blah, blah, blah, this is how it works. You inject it once a day, and 24 hours later, you injected again, but we were seeing these highs on the level mere about 18 hours after she injected basil. And that's the first time somebody told me oh, you should try splitting your Basal insulin putting in some of it now and some of it 12 hours later to keep the coverage. more even. That was a big deal for us when she was MDI you know, splitting that love Amir, but now the more modern ones. You like I know you don't you're not in favor of splitting Lantis right. Personally,
Jennifer Smith, CDE 16:06
I'm not personally in favor of it. I've had probably definitely less than a handful of people that it did seem to work. Okay and and better for, but in general know, the Lantus, the two Jao, the, you know, trust Seba, all of those they are definitely supposed to be a 24 hour acting insulin right. Some people do find that Lantus doesn't quite get them to that 24 hour mark, that it sort of legs off, maybe somewhere after about 20 hours, and they have a little bit of potential need for more insulin, and that may be accomplished by just adjusting the dose of the rapid acting insulin if a meal falls within that time to make up for that little bit of deficit before you retake it. But the newer insulins definitely especially true Siva, Siva has a definite 24 hour and often in other in many people, it actually has a longer lingering effect.
Scott Benner 17:11
So I've anecdotally heard a few people who split Atlantis and say it works but you are very steadfast about saying that you don't so love Amir. Sure, you could split it if you don't think you were getting 24 hours. It worked for us, Lani, people need to split love Amir right. Lantis maybe not. Now those others? Definitely no. Yeah, they're just a no, don't split your Seba. Don't none of those they listen, you're saying they last 24 hours. I hear from people who say that it feels like it overlaps into the second day sometimes Correct, right?
Jennifer Smith, CDE 17:46
Yeah, in fact it in. I worked with a couple of like high school athletes, boys, who were MDI chose to be MDI for a number of reasons. And we worked it out, you know, to the point that we could navigate but what we ended up finding was that with the dose of True Seba, they actually needed a titration down in the dose by the end of a full week of athletic overlap, because there was so much overlap of the truck Seba and the activity factor that they were running in the toilet almost able to eat without bolusing for meals days by the end of the week, because because of the action.
Scott Benner 18:32
Oh, isn't that interesting? So So here's the thing. These are all injectable insolence. If your MDI are using an insolent, you know, or a pen or syringes, it doesn't matter which way multiple daily injections if you're using, you know, needles and not an insulin pump. So if you're using again, like with the mph, if somebody says, Hey, here's mph, say please don't please give me more modern insulin. And if someone says to you, hey, here's love America, please don't Can I have a more modern Basal insulin, please? Yes, you know, it's going to make things easier. Because Basal insulin, long acting insulin, whatever your doctor is going to call it is the background insulin that is working on. Basically its job as body functions, right body functions to try to push up your blood sugar, it's trying to keep you stable somewhere it's got it should have nothing to do with how you're impacting your food. In a perfect situation. You don't you know, you inject it once a day, it kind of think of it as time release, it kind of stays in your body and slowly gives off itself and works over these hours. It's, it's really, really important. And if you go back and listen to other episodes of this podcast, you dig into the Pro Tip series or any other stuff, you're going to hear me Jenny, anybody who's talking about say, Basil first, you have to get your basil right or other things are not going to work. And so you these First couple of leaps you have to get past are you giving me love Amir? Or are you giving me true SIBO? Are you and by the way, I don't know who makes there's there are different companies and etc. And you might have to work a little bit to find the insulin that works best for you. I don't care which one you use, I'm just saying you're gonna have different expectations, depending on which drug you have. Correct. If you don't have your basil correct, it's going to impact everything else, it's going to impact bolusing for meals, it's going to impact sleeping activity, it's going to mess with everything.
Jennifer Smith, CDE 20:34
Yeah, it's it's like building the foundation of your house out of straw instead of concrete.
Scott Benner 20:42
We did a nice stable base and is your long acting or Basal insulin. Now, some statements from people correcting overnight or splitting my Basal insulin was a huge help. So they were it sounds like they were correcting. They were probably shooting their basil in the morning. And by the late night, it wasn't working as much. So they were using corrections which now that's not long acting insulin that's fast acting insulin or meal insulin, but you may hear it called like Novolog a Piedra fiasco looms Avalon compute a few Milan for some reason, which is weird. And sudden this person realizes Oh, I don't have to correct your Bolus in the evenings if I just get my Basal insulin right. Yeah. Next person says, I wish I would have known the onset of action in the duration of action. From my long acting, considered splitting if appropriate, some long acting insulin so they're making our point for us. Since newly diagnosed will be MDI a nutshell summary of long and short acting insulin, perhaps with the end for emphasis on how Basal insulin impacts everything. So these this these are people who love the podcast are like if this is what I wish I knew now that I knew before. Okay, so let us dig into that for just a second here. A Nutshell summary. I think we've kind of done it long acting insulin Basal insulin. The ones we mentioned, short acting insulin meal insulin, again, the ones we mentioned, but what are they for? Basal insulin, again, is a base stability for your body function, you know, other stuff. Meal insulin is there to correct a high blood sugar or to combat food that you're eating. Correct. That's it, right? Yes, absolutely. One of the most frequently confused things the beginning of diagnosis is Basal and Bolus is Basal and
Jennifer Smith, CDE 22:39
Bolus. Yeah. And I think the words are, again, they're really clinical words, if we just broke it down to say, this is what this kind of insulin I'm prescribing is going to do for you. You must take it every day at about the same time, every single day, this is going to give you this background coverage that has nothing to do with food or anything else. You need it because your pancreas would be dripping this all day long. You know, and then the other explanation just being this one is going to work when you choose to eat food. If you don't eat, you don't take it unless you're high. And then here is your correction scale, blah, blah, blah.
Scott Benner 23:17
Yeah, it's just over the years, all the words have been co opted, you know, people explained the mountain and said Oh, correction insulin, that is a good way to think of it. I'll call it that. Instead of calling it Bolus insulin or mealtime insulin or and you'll The truth is, I don't know, Jenny, a couple of months into this. That's all going to make sense to you. Right? Like we're talking about it now. Like we're just like, you know how green is grass and blue is the sky everyone. When you're first diagnosed, you're like Basal Bolus long acting short acting. To Siva, who names that things
Jennifer Smith, CDE 23:52
when you want to take with you. In fact, for newly diagnosed I often recommend when you get those prescriptions home, make sure you read how to take them when to take them in the refrigerator, put a note on them a sticky note, something that specifically says this is your right away 6am In the morning long acting insulin. This is my take with food, correct blood sugar, insulin, and as long as you need to keep those sticky notes on there until it clicks in your head. Which one is for what? Keep them on there? I mean,
Scott Benner 24:25
once a month without fail. In the Facebook group. There is a long thread where someone says, Hey took the wrong entrance with the wrong insulin. What do I do and it always goes this way. It never goes the easy way. It never goes. I meant to take four units for a meal when I put it for extra units of basil. It's my basil 20 units and I just took it I just took 20 units of Novolog instead of 20 units of land. Yes. And what do I do? Beautiful watch people come in. They talk them through it real quickly do the math 20 units. So I know it sounds like a lot on how many carbs covers 20 units, it's snack time. You know, like, that kind of thing. And people I watched them get each other through it. It's really it's, it's, it's beautiful.
Jennifer Smith, CDE 25:11
At some point, I mean to delve down the rabbit hole a little bit, honestly at some point, there will hopefully be micro dose glucagon. That would help in an instance like that mistake that you know nobody intended to do, but that you wouldn't have to end up eating 200 grams of carb to offset what you did accidentally, right that, oh, I can do this much glucagon. And this will take care of this much of it and right
Scott Benner 25:41
without eating a pint of Ben and Jerry's ice cream or something like that. Yeah. Now, here's the thing, right, you're newly diagnosed, this all is probably what you're hearing because you're MDI, but long acting insulin, when you move to an insulin pump, if you move to an insulin pump will be replaced, you will not use with a pump, you will not use long acting insulin anymore. You'll use short acting meal insulin Bolus insulin in your pump, and your pump will replicate a Basal program for you, giving you tiny little bits constantly throughout the day to create. So instead of you kind of putting in that quote, unquote, time release Basal insulin and it being let go, you know, pharmaceutically, it's going to go into a pump and be electro mechanically
Jennifer Smith, CDE 26:26
Correct, right? Think of your pump like your pancreas. Honestly, yeah, your pancreas doesn't use two kinds of insulin. It uses the same type of insulin that those little beta cells pop out. And it does it for different reasons, right. So the pancreas or the pump is going to do the same thing. Use one kind of insulin, but in a different way. And here's where in vs. Big dose in,
Scott Benner 26:52
right. And here's where you start gaming. You know, if you asked me what the difference between pumping and MDI is, the first thing I think of is having agency over the Basal program and being able to change it. So earlier in this episode, Jenna use an example of young guys, athletes who are on MDI, who have a Basal an amount of Basal they're shooting Monday, Tuesday, Wednesday, Thursday, Friday, but because their activity is getting greater and greater as the week goes, the truth is that their Basal needs get lesser at the end of that active week. If you were on a pump, you could I'm just gonna make up numbers, you could be using one unit an hour on Mondays, one unit hour on Tuesdays, and Wednesdays point eight Thursdays point seven, right and to, to make adjustments based on what you know, that activity was going to do. Right? I'm not trying to tell you, you have to have a pump, I think any way you manage is is great if it works for you. But you do get more control over your Basal profiles once you're on a pump. And it is really amazing. And if you ever get past regular pumps into algorithm based pumps, you can really start seeing how manipulation of basil creates the
Jennifer Smith, CDE 28:05
precision comes in. Yeah, even Yeah, much clearer, because you
Scott Benner 28:09
go it's funny, we kind of made a timeline here. I want to say by mistake, but I was kind of thinking about it. So I'm gonna take a little bit of credit, but I'm back from the mph to the more modern Basal insulins to the idea of pumping to the idea of algorithms. Yep, just all those things are different levels of insulin being used in the correct amount at the correct time. Right.
Jennifer Smith, CDE 28:37
And it's an evolution definitely, I mean, what you're talking about is a is a movement forward from what was to what we have the opportunity to use now. And I think it's interesting having lived you know, 34 years with with diabetes, I have evolved through all of this now, I didn't start that with like boiling my needles and only peeing on a urine strip. Thankfully, I had some technology at my hands when I was diagnosed, but I feel like I've lived through a lot of the the true technology shift and change. And it's, it's amazing. It really is. So
Scott Benner 29:18
so I'm gonna I'm gonna recap, which I don't ever do. Someone gives the MPH go. Can I please have more modern insulin someone gives you Sorry? Pharmaceutical companies, although I don't not apologize, though, pharmaceutical company. They're doing okay. You know, if someone gives you 11 Mirror Lantis say, could I get something more modern than this? Once you've got that figured out. If there's more that you want, well, then you're probably interested in an insulin pump. And after you have an insulin pump, and you understand how that works, you might be interested in an algorithm. So this is an I don't know what comes after algorithm.
Jennifer Smith, CDE 29:53
I don't maybe a truly closed loop system that requires very little thinking other than Oh, it's the day that I have to put on my new pump and fill it up with insulin. Here you go.
Scott Benner 30:02
So in your mind, is that like a dual chamber with glucagon and insulin?
Jennifer Smith, CDE 30:08
That's what it would have to be, honestly, for it to truly work the best way possible. Yeah.
Scott Benner 30:15
Okay. All right. Well, if you're just diagnosed, don't bother thinking about that yet. I've been hearing people talking about that for 10 years, and I don't think we're anywhere near and so just
Jennifer Smith, CDE 30:25
the basic, learn the basics. Just be happy.
Scott Benner 30:29
Understand your insulin today and go about your. Alright. Thank you very much. Cool. Absolutely. All right. So we got that one out of the way. I just as I was reading, and I was like, There's way more to this than what the people asked
Jennifer Smith, CDE 30:40
what it's good to have brought in, I was hoping that you would bring in the fact of pumps, because we refer to Basal Bolus and a pump. But it's a change in mindset. I don't know how many people ask, even in today's world, when they're starting on a pump with you, they're like, well, when do I do I still keep taking my Basal insulin at the same time. I'm like, Yep, no, put it in the fridge, put a sticky note on it that says Do not touch
Scott Benner 31:05
Done with this now. Done. Yes. I mean, I told you the story recently, right of I don't mean to use her twice in the same series, but a woman who had had diabetes for like, 40 years. Yeah, I asked her about her Basal insulin, and she told me the wrong insulin. It's no, that's, that's something else. I mean, that's basic stuff there. We need, we need to understand that.
Jennifer Smith, CDE 31:27
Well, and that also speaks unfortunately, to whoever her practitioner is, has clearly not asked enough in terms of discussion, that's a back and forth discussion, to hear that this person was completely missing, or misunderstanding or whatever it was, I mean, that should have been addressed in the clinicians office.
Scott Benner 31:49
Yeah, you know, we're still recording Jenny, just because I didn't stop it. But and this is going to come up later in this series about picking medical help. But there there is definitely something to be said for that. Like, not everybody knows what the hell they're talking about. And it doesn't stop them from talking. You know, so you're you are newly diagnosed, you don't know what's happening, and you take everything as gospel out. You know, my my little story about insulin that I'll add at the end of this episode is that Arden uses a Peter to works really well for her. But we were given Novolog in the hospital, which is fine. But the point is, is that when someone handed me Novolog, and said here, this is insulin, I thought, well, this is insulin, there's this is it, there's no other insulin,
Jennifer Smith, CDE 32:37
insulin is just insulin, right? The word insulin indicates one thing.
Scott Benner 32:41
I even think it's ridiculous when we're rattling off, all the names are different than something how many of these do we need? Exactly. But you know, like, I just thought Novolog is insulin. It's for her Mealtimes are her corrections. And when NovaLogic didn't work, as well, for Arden as it did for other people, it never occurred to me that I could just say, can I try a different insulin, please? Yeah. And it? Because that's the I mean, to somebody's point earlier about having something drilled in your head in the 1515 episode. It was it just I believe them, like a person in a white coat, handed me over log and said, This is insulin, and my brain just said, Okay. You know, and then that stops you from asking questions. Yeah, yeah,
Jennifer Smith, CDE 33:22
absolutely. And I think I think there too, is the word insulin. And it really encompasses a lot. And there's a lot to understand about it, as we've just talked about. I mean, my understanding of insulin definitely shifted. Once I had done my own research when rapid insulin came on to the market. And I was reading more and learning more myself. And I went to my own doctor, and I said, Hey, I have to take my insulin, like 45 minutes before I can start to eat. This doesn't work with my life. There's this fancy new, more rapid acting insulin, can I please get a prescription for it? My doctor was like, Sure. Here's your new blog. Right. And before that I had been using our I mean, that dramatically changed. And my doctor knew about it, but I don't know that my doctor would have brought it
Scott Benner 34:22
up, right? No, because it's working. And why by the way, did you ask that question with a perm? Did you have a perm when you were saying that? I actually way up in the air. Well, I actually
Jennifer Smith, CDE 34:33
have naturally curly hair, so I've not ever had a perm. Is your hair straightened? It straightened right now? Yeah. I never think of it that way. But it's naturally curly. Otherwise,
Scott Benner 34:45
yeah. And to your to just tack on to that idea. The looms?
Jennifer Smith, CDE 34:50
They did have the big big bangs.
Scott Benner 34:52
You have big metal here. Did you have metal hair at any point?
Jennifer Smith, CDE 34:55
Oh, I guess maybe that I don't know that it was metal hair. I don't think my dad had would let me leave the house looking like that quite honestly. But I had the big bangs like the get it up there.
Scott Benner 35:07
A lot of girls I grew up with looks like that they put their finger in a socket and when their hair shot up in the air, they just sprayed it. They're good. All of us had molds at some point or another. But what was I gonna say? Oh, fie Aspen loon Jeff mealtime mealtime insulins that have a quicker onset? Yes, if they work for you. That makes Jenny's point right Jenny used to have to take regular and mph Wait 45 minutes to eat. Somebody gave her human log and suddenly you only had to wait what? 20 minutes to eat maybe? Right? Yep. And we'll talk about this in the Pre-Bolus episode that's coming up. But at the same time fiasco loom Jeff more modern fast acting insulins they hit even quicker. And you know, and who knows what comes next. I always think about when I was first getting into this interviewing people, I think I was talking to Aaron from the JDRF and he said we need faster acting insulins and better cannula material and I thought like huh, that's interesting, you know, like what he's seeing the other part like because your cannula from your pump to explain that idea looks like a foreign body to your to your body so kind of gets attacked by white blood cells. Eventually it could stop the insulin from working as well as you want to bring but not infection but just the inflammation to the air information which slows down the the absorption of the anyway, Aaron's like we need better cannula material and faster acting insulin. And those are two things you wouldn't think to pray for at night when you went to bed. But if you have diabetes,
Jennifer Smith, CDE 36:38
and smarter insulin I'm it's interesting from a JDRF perspective, it was years ago when I attended a JDRF. It was like a scientific presentation in the evening. And there was a gentleman from the East Coast, I think he was somewhere in the Boston area. A scientist who had done enough studies to get it to the animal based study of insulin that had almost an on off switch or a thermometer, if you will, that you injected it. I believe it was once a day. And that dose allowed your glucose level to stay within a determined target range turning on when it was climbing and going above that turning off when it was falling and coming down to the lower end of the target.
Scott Benner 37:26
Yeah. Which well make no mistake. That's the that's the golden chalice right there. Right? Yeah, yeah, I mean, and we can stop doing this podcast and I bad news for all the pump companies. You're out of business to
Jennifer Smith, CDE 37:39
be living on the beach in Tahiti? Well, probably not because that's pretty expensive.
Scott Benner 37:44
Chinese, like I'm taking whatever money I made telling people about diabetes, I'm going to the warmest place I can find I'm writing the rest of this thing out.
Jennifer Smith, CDE 37:52
So read books and
Scott Benner 37:55
does it I'm gonna let you go. But it feels like that. Right? Like, if somebody just took diabetes away, you'd be like, I've done enough for one lifetime. I'm good.
Jennifer Smith, CDE 38:03
Yeah, absolutely. I mean, I if there if there were there is a need in diabetes. I, I hope that I can continue to work and help. But if there is ever something that comes out, that's like, no, people don't have to think anymore. You still have to eat your food and drink your water and get exercise. But here it is. I'll be like, fantastic for everybody.
Scott Benner 38:25
Big Mike drops, and he's like I'm out of here. You get in the car or you're not coming because I'm leaving. Excellent. Alright, thank you so much.
A huge thanks to Ian pen 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 and 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 ball 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 episode 719 is the 1515 rule. And of course in this episode we talked about long acting insulin. 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 disorder to eating psychedelics, living with bipolar people who have type one diabetes, and other extraordinary challenges often will be found in the after dark 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 style 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 looks 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 are starting at episode 210 newly diagnosed you're 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 723
1. Why is recognizing the symptoms of type 1 diabetes important?
2. How is insulin therapy tailored to individual needs?
3. What is the significance of carbohydrate counting in diabetes management?
4. What role does technology play in managing diabetes?
5. How should diabetes be handled during sick days and stress?
6. What impact does physical activity have on blood sugar levels?
7. Why is building a support network important?
8. How can staying informed about advancements in diabetes research and treatments help?
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