#286 Defining Diabetes: Stop The Arrows
Defining Diabetes: Stop The Arrows
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ 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 0:02
This episode of defining diabetes on the Juicebox Podcast is sponsored by companion medical makers of the impact. You can find out more about the in pen, ai companion medical.com. On today's show, Jenny Smith and I are going to define a term from your diabetes life. This one's very specific to the podcast, stop the arrows. What does that mean? This is going to be one of those where I'm like, Jenny, hey, I made this up. What do you think of me is
injured. Jenny's gonna tell you. That's how this works. I say Jenny define this. And he goes, Oh, that means this. And then I say something. I'm like, haha, I think this bah, bah, bah. And then she goes, Oh, I agree with you. The baby, sometimes she'll be like, I don't agree with you. And then she'll be more clarifying. And then it's over. Defining diabetes. There it is. That's the magic. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan for becoming bold with insulin. Alright, you're ready for Jenny? She's particularly delightful in this episode.
Why don't we define a couple of more like podcast tenants. And so this is where this is where I asked Jenny to define something that I've made up. And that way she can. Either always fun, right, right. Yeah. Right. Cuz, you know, I had, you know, we did the we did defining, you know, over Bolus, which again, is just a word I made up. And and we'll do some other ones. So we've done a couple. And some of them are bigger ideas are not just words, right? So if I told you that I consider stop the arrows to be a real diabetes term. It is it is to me and I think enough people do it now that that I'm buying into my own my own hype, a little bit on that. If I said to you, can you define stop?
Jennifer Smith, CDE 2:19
You are because on our assessment, on our assessment, many people actually say, I found you from the juice box. And I want to be able to stop the arrows. And many of them actually have it like in quotes, as if they're like, it's Scott's term. So I have to like quote him on. Oh, yes.
Scott Benner 2:38
Let me just say I appreciate the attribution. I really do. I get ripped off a lot in this space, Jenny. But when people say they heard it from me, it makes me feel better. So that I like that. So stop the arrows. What does that mean, to you?
Jennifer Smith, CDE 2:53
To me, essentially, you are both up arrows and down arrows, and very significantly straight up arrows and whatnot, it's essentially just pay, it's reacting to the arrow and saying, I need to stop this and plateau it I want to get it to even out. And that might be with some type of insulin adjustment, it might be with a little bit of insulin adjustment and some food of some type. But that stopped the arrows pay attention to, I think stopping the arrows also has to do with alerts and alarms, too. So I think that needs to be brought into the picture. Because unless you're physically like looking at your screen all day long, you may not see some of the arrows to stop.
Scott Benner 3:36
I don't want people to stare at their glucose monitor, right? I very much am against that idea. Like you. That's why I like your alerts being set in tighter tolerances, so you can find out earlier and do something sooner. So yeah, so when I first thought it, like when I was and trust me, I didn't sit down in a you know, think tank session and to say, I wonder how I could describe to people I was just, in a moment, my life. And I saw these arrows. And I thought to myself, I gotta stop these arrows. And you know, and I just I have to like Why look at this happening here. So in my mind, I see it as you know, you guys have heard me describe it before I just see it is putting more resistance on the side of direction that the arrow is trying to go, the arrow is trying to go up, I try to put more insulin over top of it to push the arrow back down again, if I if I have an arrow going down, I think of it is putting food underneath it to push it back up the other day. I described it to somebody. So I am going to say something. I need to give myself credit for something. I wish I speak in pictures. I really do. And I know that about myself. And sometimes I'd like you know, I'll do the tug of war thing. And then somebody won't get the tug of war thing and I'll be like, Oh my god, they didn't get that. Alright, I'll say it like this. So I was trying to describe stop the IRS as somebody though today. And I thought they're not getting it and then I said hey, you're a football fan, right? Okay, I said okay, so imagine your offense goes out on the field. The regular offensive line center two guards two tackles and a quarterback behind the center and you get sacked. On the next play, you might bring in a tight end and ask the tight end to help block. Now if you still get sacked, you could bring in a running back and tell the running back Hey, after we say hike, stand up, chipper blocker real quick, knock him off his path a little and then go out and try to catch a pass. If that doesn't work, you might bring in another tight end right. So in some scenarios with insulin, five linemen do the job five linemen can keep back a low blood sugar right keep you from getting sacked or keep back a high blood sugar keep you from getting sacked. But sometimes you need tight ends the block too sometimes you'll also need a running back. So sometimes you have to bolster your side so the other side can't get to you. And that's insulin like like it's just how I like that's just how my silly brain sees it like like so if you're trying to get low, like your blood sugar's trying to go low. That's the defense sacking you you need more blockers and then that Caserio, those blockers are carbs, right in the exact reverse situation. If you're trying to get high, then the insulin is trying to sack you. And you need to keep the insulin away from your quarterback like break, you know, or, you know, I'm sorry, if you're trying to go high down, the carbs are driving you up, you need more you need more insulin. So you bring in instead of blockers you bring in like attackers like people to like push back in the end, you're just trying to keep this this never ending back and forth like this, just like a pirate ship just rocking back and forth. You just asking like you're putting 100 people on the deck of a boat and telling them run to the right, run to the left, or the right run to the left like and again.
Jennifer Smith, CDE 6:46
That is how really you just want them eventually to like run to the middle at all
Scott Benner 6:50
stabilizes our do this, do that. And then eventually, exactly, every hundred people be in the middle and they'll be like, oh, what's our job now we got the boat stabilized
Jennifer Smith, CDE 6:57
standstill.
Scott Benner 7:00
I am totally gonna blow my own horn and tell you I've never had that thought before until I just had it right now because my stupid brain works in pictures. Okay, so that's what you're trying to do. I've in the past described it as scales of justice, but have holes in either side, and you're constantly putting an insulin in one side and carbs in the other and just trying to keep them from flopping down on one side. So any way you can think of stopping the arrows. I don't care, like whatever picture you have to paint in your head. But the truth is, is that if it starts getting away from you, you can't stand there and watch it. Right because then your quarterbacks gonna be out for four weeks with a broken collarbone, you need to do something right. So when so when I see, for me, it's diagonal up at 120. So and that's partly to do with Arden's physiology to a 118 diagonal up that goes to a 120 is about to go to a 125 straight up and Arden I know how that works. I can look at that line on that Dexcom graph and see it coming. So right he hits the 118 I can Bolus Mm hmm. And that stops the arrow. Right. And so now I create a plateau and then I watch it. And if the plateau doesn't come back, then I re address and I get it back again. But in my mind, I just messed up the Bolus for the meal somehow, had I put in whatever amount stops that arrow if it was in up front, the arrow wouldn't move up. Right there were also times Today's a great example, where Arjun texts me and says, Hey, I'm going to get breakfast. And I was like, Okay, so the last three times she said that at school. It's been a muffin. So I put in the muffin bolus that I had figured out. And then like 10 minutes later, she was Oh, hey, by the way, they didn't have any muffins. I got a bagel. It's just like now I live on the east coast. A bagels are a real thing here. It's like a real thing for bagel got still here and I threw it at you. I could kill you with it. You know? Like it's a big dopey thing, right? And it's not all like dry like you and like Indianapolis are thinking right now or you know, like often, like you guys out in California are thinking about I'm sorry, this is like a lump of like dough. Okay? So I'm like throwing in more insulin. I'm like, Arden, this is not gonna work, right. But let's just see what happens. And it worked for a long time, actually, for like an hour and a half. We were ahead of it. And I saw the curve up. And as soon as I saw it, I was like, Oh, god, oh, god, it's coming. And I just didn't hit it hard enough. So now Arden's like 195, and she's stable at 195. And we are putting more insulin on to get it back down. But now I'm also thinking about two things. I'm thinking about this, you know, this stability, stable arrow trying to turn it into a down arrow, and she's gonna eat lunch in 45 minutes
Jennifer Smith, CDE 9:53
and lunches. I was just gonna say lunch is coming for you.
Scott Benner 9:56
What do we do with that? Tell you what we're gonna do with it. We're going to start An arrow, then we're gonna stop an arrow. Okay, so we're going to make a really large bolus in about 30 minutes about 25 minutes before she's going to eat. I'm going to bolus her whole lunch. And, and I am going to try to use her lunch bolus to drop this to start an arrow, right. And then I'm going to use the food at lunch to stop the stabilizer, yes. And then I will reassess about an hour after she's eaten. But there's all different kinds of ways to stop ours. And moreover, to stop the direction and the momentum of your blood sugar. You can you know, I've said it a million times. But you can't just think about how your insulin impacts your blood sugar, you have to think about how your blood sugar impacts the food you're eating, how the food impacts your blood sugar, how the food impacts the insulin like these things all have this sort of like weird symbiotic relationship together. And we get it drilled into our head that diabetes is about a number and making a number go down with insulin. So much, so much more than that, if you know how to manipulate those arrows, meaning the direction of your blood sugar.
Jennifer Smith, CDE 11:15
Well, and you've also, you've also paid enough attention, as you said, if you get that angle the arrow up and it's 118 you know what's coming. And you know what's coming, because you've had experience with paying attention before. So sometimes, sometimes I actually talked to people about even watching to begin with when they're trying to be more bold with insulin, when they're trying to be more aggressive. I say, you know what, if you're worried to begin with, pay attention first, see what happens? See, let it let it go up. See how much once it goes up? How much does it take to bring it back down? Because if this is a consistent, that you're always needing one extra unit after lunch every single day. And even if your lunches a little bit different day to day, you're always adding an extra one, one and a half units. Okay? Well, one, something probably is wrong with your ratio, because we need to adjust it which also then just means you need more insulin up front, right? So we can learn from also watching. And you don't have to watch for a week with aiming for high blood sugar's just to be able to watch, you can do it a couple of times and say, okay, I've learned something here. Now I can be more aggressive, and I feel safe about it. So for people who want a little bit of assessment, that's kind of also a way to do it.
Scott Benner 12:32
That's brilliant and 100% necessary and what Jenny just said, you right, what you just said was 100% needed absolutely brilliant. poignant in the moment, do you want to know what happened in my head when you said that? What I thought Jenny just said, you have to take a strike. Do Yeah, you have to take a strike. So you can see how the pitchers throwing, right because you're going to swing it the first one and Miss anyway. And then you've lost the experience of watching the pitch cross the plate. So sometimes
Jennifer Smith, CDE 13:02
I told in my in my one of our to doing half marathon to get to finally doing like a half Iron Man and a whole full marathon and everything. I took a lot of strikes, trying to figure out what I needed to do to manage. And the strikes. They suck from a like perspective of that mental internal management that you always are aiming for. It's gonna work this time and I'm going to try this and there's going to be perfection, there's no perfection. There's, you get to a point of figuring some things out, like, you know, my long distance running strategies, I've figured it out. And unless something is completely just weirdly off 99% of the time, my strategy now works consistently. But I did I that's a great way I took a lot of strikes, figuring it out. How much nutrition do I need? How much bolus Do I need to shave off? Do I need to change a basal rate during or after? Or how far ahead of time or whatever. And so some of it is it strategizing and I kind of feel like a 30 year guinea pig.
Scott Benner 14:14
I'm gonna figure this out. But you know, it's interesting, it occurs to me like you said, that is it You and I have Jenny and I are interesting. Like we I don't think we have a probably a ton of similarities. But we talk about diabetes exactly the same way and we have the same sort of resolve about it. And it's obviously much easier for me to have the resolve than it is for you because you're living it. I just look at a person and go Yeah, don't eat that yet. Okay, now, she's like, I'm hungry. And I was like, I wish I cared. Just don't eat it. Like it's like, you know, and that and even that like right is crazy. I just I grew up in the part of the country where my I've talked about before, like my dad would have cared if I was hungry if a doctor told right, like you can't eat that for half an hour my dad would have been like, again, I didn't know for half an hour, right? You're walking If you're sad, go tell somebody who cares, you know? And so so I've just enough 1970s parenting and made to do that. But but it is interesting when you and I agree we agree so incredibly like Jenny and I don't have like a like we're not like out seeing movies together. She lives in Wisconsin and I live in New Jersey. Although we are going to get to meet each other in person coming up. I think I think I've hopefully I think I've negotiated Atlanta,
maybe. Oh, lanta. We're gonna we're gonna probably bump into Atlanta. I think it's possible in Arizona. And there's no way I'm coming to Wisconsin and not making them bring you so. So anyway. But I love how much we agree about this. Like when people ask me, like, why, why Jenny? Like, why did you choose to do it with her? I said, Well, I had done hundreds of these podcast episodes. And I would always go back to the two times I had Jenny on every time she spoke, I just thought, wow, I agree with this person. Like, like, oh, and I have my narcissism allows me to believe that I'm right. So if I'm right, you agree with me? You're amazing, right? So I don't know if you're actually amazing. But my narcissism thinks you're terrific.
Jennifer Smith, CDE 16:11
I think you're great to
Scott Benner 16:12
see. And Jenny has that nice accent so you don't hear her being narcissistic. You just hear it from me with my Philly thing going on. I got a beautiful text from somebody the other day that just said, I love when Jenny says carp. Really? Cuz your accent that you don't hear. So
Jennifer Smith, CDE 16:31
I you know, I get most of it. I get for the old when I say something with an O in it like Minnesota, or whatever. You know, I in fact, a lot of people just ask are you are you from? You know, Minneapolis. Are you from Minnesota? I'm like, No, I'm from Madison. I live in Wisconsin. I am from the Midwest. I know it's my accent.
Scott Benner 16:53
They were just like, it's just a taxi said I love when Jenny says carb. I actually got a message while we were talking about Vicki's episode that just says, almonds don't have nipples. I'm laughing because I get a lot of like, while we're recording, I still get my messages from people. And sometimes I'm like, Oh, that's from like another episode. That's so funny that they're listening to that while we're recording this one. Funny, but No, but seriously, I you know, that's it. I think if you and I got married and had 17 kids with diabetes, we would just like, walk in like, we'd be like The Brady Bunch of taking care of diabetes. I just I feel bad for the time
Jennifer Smith, CDE 17:29
without adopting your children. No.
Scott Benner 17:32
I was just thinking about like your poor husband. Because one day you guys are gonna have a disagreement about diabetes. And you're gonna say Scott would agree with me about this. And that guy's gonna be like, who is Scott? And why is it coming up here in our house? Because I hear a lot. Jenny, you have no idea how many notes I get from married women who are like, my husband is tired of me saying the guy on the podcast says we should do. Oh, like you don't find that to them. They won't like that.
Jennifer Smith, CDE 17:58
I'll tell you what I'm gonna do Jenny. Yeah, my husband totally. He totally knows your name and it and you know that we would that we do these. In fact, he usually tries to keep our son coenen who's two and a half and he hangs out with during the day while I'm working and doing these with you. He usually tries to keep them as quiet as he can so that there's not like this big like, ah,
Scott Benner 18:17
like in the background. You name a kid. Come on. He's gonna be loud. You know what I mean? That's a that. You might have done that. Yeah, that's what I'm saying.
Jennifer Smith, CDE 18:26
He is a loud Irish little boy. He is Yeah. He is all about I want it. I can do it. No, Mommy, I've got this. He. He's got it all down at two and a half.
Scott Benner 18:39
Hey, you know what I'm gonna do one day. I'm gonna put a survey online to see how many people with autoimmune diseases have Irish heritage. Because I'm telling you, the pale white people have trouble. Seriously, like, like, you know what I mean? Like, there's something about that part of the world that you know, celiac and like, like, that whole thing is very common through that bloodline. And my wife is, is is English and Irish.
Jennifer Smith, CDE 19:08
So she Yeah, and I, you know, Finland, I'm sure you're quite quite familiar with the studies in Finland being the highest rate of development of type one in the world as far as a country. And from the studies that have been done there. They've really kind of narrowed it to the field of one some genetic predisposition. But from that it has to do a lot with vitamin D. One, they're at a very bad, like, latitude for actually absorbing and being able to have their body produce vitamin D the right way from sunlight. But two, they've also found that there's something within the body, the bodies there that actually it just doesn't develop and so they end up having very low vitamin D levels. In fact, I I can't remember the study when it was done. From when to when it was like 2006 or 2011, up to like 2015 or something where the they started supplementing at birth kids that were born in Finland, and once they started supplementing the rate of increase in development of type one stabilized, it didn't keep climbing. So it's kind of like a standard now is just supplement with vitamin D from birth. I don't remember what the dose or anything was. But yeah, there's, there are some very specific like, cultural populations that are very prone to type one diabetes and Orthodox Jewish are also have a very, very, very high prevalence of Type One Diabetes you ever heard the, the idea that the potato famine created depression in Irish people, the Irish,
Scott Benner 20:55
they there carries on to this day. It that's just like, there's the that's the stuff nobody thinks about, like you don't think about stuff like that in your day to day life? Well, that but there's, I don't know, there's obviously there's different groups of people who have been affected for I mean, listen to what you just said, but their distance to the sun? Or because they couldn't grow food for variable. Was it five years or something like that? They in 1800s? They did. They just ate potatoes that make it freakin sad, that's for sure. Yeah, you know, and then they say it actually changed their genetic code somehow to
Jennifer Smith, CDE 21:28
I wouldn't doubt I mean, the body, the body adapts, you know, I mean, that's why we have so many different animals that have like, you know, developed in the sea, and then they crawled out and they grew legs. And I mean, same thing in the human body. I mean, the real reason that we have some of the teeth that we have in our mouth, is because of where we started out. And now we may not really use those teeth the same way. And you know, it's,
Scott Benner 21:55
I just think it's, it's, it's important to remember when you're thinking about your diabetes, that there are there, we talked about the variables, but there are variables that you're never, you're never going to know. And so that's why I like boiling them down into simple ideas, like be bold, stop the arrows, use more, more insulin, because you if you, you see people sometimes online get frozen, trying to figure out what's happening. And when you get frozen like that you're the person in the horror movie that stops running. And oh, yeah, yeah, you don't want to stop and start screaming, he's got an axe, just right. Just remember, you just run Yes, you don't have to outrun the bear, just your friend. Okay, so
Jennifer Smith, CDE 22:37
don't go into the dark room where the funky noises are coming from escape away from the funny noises, you don't
Scott Benner 22:43
have to figure out all the diabetes variabilities just enough of them to get to the next moment. So like, just try to keep in mind you're not, you know, you're not gonna be able to figure out everything that's going on, but you can figure out enough to live well. And that's sort of my goal for everybody. I am going to stop this and say thank you. Okay. Okay, just a couple things here at the end. First of all, of course, thank you so much to companion medical makers of the in pen for sponsoring this episode. You can go to companion medical comm to find out how your insulin pen could talk to an app on your phone, and then talk to your dexcom CGM help you make decisions about things like dosing insulin on board. A lot of stuff actually, you got to go check it out. It does more than I can just say right here companion medical comm check out the impact. Thanks also to Jenny Smith, for coming on the show. And for sharing her knowledge with all of us. I don't think I've ever made this completely clear. I hope I have. But this isn't an ad like Jenny's not a product placement. Jenny's just the person I love having on the podcast. Integrated diabetes doesn't pay for anything. I just share that with you. Because if you think she can be helpful, I want you to find so integrated diabetes.com to find Johnny. And then I have one last thing. The show is so close to another milestone. I would love it if you guys could share the podcast with just one person who you think really might need it. Love it, enjoy it. You know, anybody? Well, not anybody. Like don't go picking up people's phones and bars and just subscribe. You know what, I'm not gonna dissuade you from doing that. Let me let me restate. I would prefer if you found someone who you thought would really like the show or could use it and got them to listen to it. But if you want to pick up people's phones and bars and subscribe them, I'm not going to dissuade you. I'm going to say I don't think it's right. But I don't feel strongly enough about it to stop you.
About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
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#284 Defining Diabetes: Brittle Diabetes
Defining Diabetes: Brittle Diabetes
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ 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
This episode of defining diabetes is brought to you by in pen by companion medical. In pet is America's only FDA cleared smart insulin pen and app system that eliminates guesswork with its integrated dosing calculator. And that's about the least of what it does. Check out in Penn today at companion medical.com. There are links in your show notes at Juicebox podcast.com. In today's episode of defining diabetes, Jenny Smith and I will define a term that impacts your life with Type One Diabetes. Now you know, Jenny Smith from integrated diabetes calm, she's in all the pro tip episodes and ask Scott and Jenny, you know, Jenny, stop it. Don't act like you don't. If you want to hire Jenny, you can check her out at integrated diabetes calm, Jenny would love to have a private conversation with you. Let's see if she can help you with some of your diabetes questions. But for today, Jenny is going to help me define brittle diabetes.
Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your healthcare plan for becoming bold with insulin.
At the end of this episode, I'm going to include a little I want to call it an outtake with me and Jenny, it might not be an outtake, it's a preamble, some chatter we were having before we started, you know, doing the defining diabetes thing. It's fine. And he's a hoot.
I would like to define brittle diabetes. And I am super interested in what you're going to say when I ask you, if it's actually a thing, or if it's an old timey term for I don't know what's wrong with you. It does have a definition, right?
Jennifer Smith, CDE 2:07
There is a definition and as far as like the old timey thing, I would say that that's more that's more appropriate, brittle diabetes. Used to be termed to or used to be something doctors called someone with diabetes that they just sort of threw their hands up and their blood sugar's were all over the place. And there was no, you know, do this and it works and whatnot. I mean, on a day to day basis, we know the variables that can go into management. So I think in today's world with technology and CGM, and being able to follow things, a good number of people who probably would have been called brittle, ages ago, or maybe even in the past five or 10 years with a really old doctor who isn't clearly up on what could be being done. I think they may have been called brittle. But in today's age, with what we can follow and track, many times, we get people who come to us even and they say, no one's been able to help me kind of get this contained. And we look at things and we start with like the basics that we've done before. And in the pro tips, kind of starting with beads, and looking at boluses. And looking at food impact and things that some people may have never really looked at before as the impact and how to pay attention to them. So we can kind of then you're not brittle, you just haven't had good information given to you about how to manage more consistently right. Now, I would say I hate the term, I hate the term riddle. But I would say that there are some people with long term diabetes, like you know, ages and ages, you know, 50 plus years, maybe, who may be at a point that there is there are potentially other complications in the picture. And that can make management of diabetes itself a little bit more cumbersome. And so you might appear a little bit more I guess, brittle. Again, I hate to use that term, because it's, it's, it's old. But when you've got other things like heart disease, or kidney disease, or even things with like neuropathy that might limit or change how often you could be active, or energy levels, all those things can impact blood sugar control. So it's not so much that it's, oh my gosh, I'm just going to throw my hands up and there's nothing to do about my blood sugar because I just can't management manage, nothing ever work. Sometimes its management of a couple of things to get the management of diabetes, more stable.
So
Scott Benner 5:00
with you on the idea of I hate, I hate it even bringing it up, because the first thing I think about is someone who's been living for such a long time with a doctor telling them, there's nothing you can do about this. You're just a brittle diabetic. And they're really buying into that and living a life around it and then turning this on and hearing someone go, that's not a real thing. Like, I don't want them to have that experience. Right. Right. But I also know that we define it, it's almost like taking a diagnosis away, it's like telling them Nope, you're definitely you know, you're crazy to think that your ups and downs, are, you know, something that you're doing wrong, because it's not, you've just not been given enough information to manage exactly, but at the same time, we we've already defined a couple of terms that, you know, bristle people, and I've get a lot of good feedback about I'm glad you tackled this idea. So I want to do this. So, you know, googling it comes up Rare Disease info.nih.gov. So this is the government saying that brittle diabetes is a term that is sometimes used to describe hard to control diabetes, it is characterized by wide variations or swings in blood sugar, in which blood glucose levels can quickly move from too high to low. And that's a fairly new, that's from 2017. That's not an old. Right? So I've always seen it as a, it's a, it's a give up from a doctor, it's just like, I don't know what's wrong, you're brittle. You know, like, like, you know what it reminds me of I and I hate to say this, but 50 years ago, if a woman 50 years ago, probably longer than that. Now, if a woman was emotional, they'd say what like, Oh, she has the vapors. She's prone to, you know, they mean, like, what that really meant was, some lady was saying something some guy didn't want to deal with. And they were like, Oh, you know how she gets, you know, like, you know, it must be hurt. Right? Like all that stuff that kind of like dismissive stuff, which I think really means my wife's trying to talk to me about her feelings. And I don't want to so let's just say she's crazy and get out of this conversation. And I don't think this is much different in that. It sounds to me, like, Doctor see these crazy numbers, right? Imagine it. Imagine no technology, you go in with your meter, and your meter says 35. And then it says 400. And the doctor doesn't know what to say. And the insulin is not as good as it is now. And you can't glucose monitor with a CGM,
Jennifer Smith, CDE 7:18
and the person hasn't had any notes. Because it's three weeks ago, when that happened. They're like, I don't know what happened three weeks ago,
Scott Benner 7:24
they're working off whatever bad advice they got 30 years ago from an endo. I mean, imagine what they tell people today, imagine what they were saying to people 30 years ago, it must have been just like, Hey, you stick that in there. And if you get dizzy, have a candy. You don't anybody was probably similar to that. Right. And so I, I shudder to think that there are people living today who think they're brittle, when I really believe it's possible that they just aren't aware of how to use their their insulin
Jennifer Smith, CDE 7:51
well, and even that definition that came from NIH in 2017, is there's no definition to why the variability could be there. The ups and the downs, we all have variability at times. And if you're, as we've kind of gone through, and many of the things that we've talked about, if you're not, if you don't pay attention, and make some notes about things or keep track of some things, or look at your data, you could feel very brittle, you could feel like nobody's ever going to be able to help me my blood sugar just does what it wants to do. And there's no rhyme or reason to it. And you know, whatever, I've just got bad diabetes.
Scott Benner 8:29
I think we got the bad griddle, Jenny, right, it just means like, easy to fall apart. Like the idea of something better, like a brittle bone, or a brittle twig or something like that. If you don't hold it with kid gloves, and don't move, it's just going to explode and fall into dust. Right? And it's just, if you're living right now and thinking you're brittle, please go back and listen to the prototype episodes. Because it's very possible. I mean, in less than, I hope this isn't the case. But unless you've gotten to the point, with your health, like Jenny described earlier, where there's where there's a lot going on, that's not positive. I mean, still, then you're not brittle, you just have complications, you know, like, it's so anyway,
Jennifer Smith, CDE 9:10
and there is different management then for complications and the diabetes component there. You know, I used to work when I worked as an inpatient diabetes educator and dietitian, there is very different management for people who have chronic kidney disease or who are on dialysis or those complications. They bring something in I also used to work on a cancer ward. And there are people who have diabetes and also have cancer that brings into the picture a whole host of fluctuations that happen. That doesn't mean you call the person brittle, but it means that there's something there to manage to help them also manage the diabetes.
Scott Benner 9:48
Yes, excellent. You know, your wife is upset in 1925. She doesn't have the vapors
Jennifer Smith, CDE 9:55
that she probably needed a hug or just to sit down and actually talk to somebody right
Scott Benner 9:59
should be affected. I opened his mouth and didn't cheat on her, she wouldn't be so upset. So anyway, I know you made me just now think of Nicole who was just on and I don't know if you've ever heard her Nicole's episodes, but Nicole came on prior to getting a kidney to kidneys, and a pancreas transplant. And then she just came on recently to talk about how it's going after the transplant. And one of the things she brought up is because her management was not great by her own admission for a very long time. She has gastro precice to Yeah, he actually has to consider her medications. right because of the gas or priestess like what if the, it doesn't get picked up in the right time? And that's just one of the things you just said. Like there's adjustments that need to be made based on your situation. Right, right. So, so Nicole's stomach isn't brittle. Nicole has no bruises, and she needs to do something a certain way. Correct. I like that. We did this one. Okay. Awesome.
Jennifer Smith, CDE 10:51
Yeah, it was good, too. It was definitely good to bring up because I think it's still it's still talked about too much. It is.
Scott Benner 10:59
Yeah. When I first said it to you, I had the same feeling in my stomach as I had when I said hey, Jenny, let's define non compliant. And you looked at me like really? Scott, should we do that? And I was like, No, no, we should. It's gonna be okay. And you're like, yeah, this is good. We're going down with the ship here, aren't we buddy? Okay,
Jennifer Smith, CDE 11:15
so that was a good one to noncompliant because I hate that word.
Scott Benner 11:20
Huge thanks to Jenny for coming on the show. As always, don't forget that you can hire Jenny right at integrated diabetes comm there are links right there in your show notes. If you want to check out Jenny may think there are links at Juicebox podcast.com. And of course, you can just go to integrated diabetes and give her a shout. Thanks also to in pen for sponsoring this episode of the Juicebox Podcast Do not forget, all you have to do is go to companion medical.com. And there you can find out where you stand with your diabetes care plan because the in pen app displays your active insulin, blood glucose and the last insulin dose. It also reminds you when to take a dose calculated recommend your next dose and warns you if your insulin is expired or has been stored outside of the recommended temperature range. Having an M pen is like having an insulin pump. But it's in a pen. Get it in pen. You get it you can get more Jenny and the diabetes pro tip series other defining diabetes episodes and of course, the Ask Scott and Jenny episodes. If you just can't get enough, Jenny, that's where you can find her here on the Juicebox Podcast. And now you're used to hearing Jenny say smart stuff about diabetes. Get ready to listen to her talk about other stuff where she sounds more human. We've been trying to figure out for Arden all year which is incredible. For network
Jennifer Smith, CDE 12:59
I don't know where you went
Scott Benner 13:01
where network connection and you were gone.
Jennifer Smith, CDE 13:03
are gone. All of a sudden
Scott Benner 13:05
you're like a little Blippi today. Kick your heels Yeah,
Jennifer Smith, CDE 13:08
I don't it's it's pretty windy outside here today and kind of overcast so that might be I don't know whatever happens in the atmosphere of cloud
Scott Benner 13:18
do you get your internet through satellite or you get it through like your cable system?
Jennifer Smith, CDE 13:23
I don't know I've got a little box in the corner of my office and whatever
Scott Benner 13:30
admit what I just said you is gonna end up at the end of one episode where people will feel better knowing that there are some things you don't understand at all.
Jennifer Smith, CDE 13:39
Have any no idea why
Scott Benner 13:42
he knows everything? Like how do you get your internet NO NO IDEA starts looking around the room like so. Anyway that was great. I
Jennifer Smith, CDE 13:52
come in and got a little I've got a little cable thing box in that I think I'm assuming it's the Wi Fi converter whatever it does thing Yeah, I I have no idea. Are you not surprised now that I could like like build a loop and actually make it work and understand it's working.
Scott Benner 14:10
I'm a little concerned that people are running around the country in the world doing things with their insulin just that you made up in your head?
Jennifer Smith, CDE 14:16
No, no, I promise not that. If you ask you this set up all of the internet connections and everything no probably not going to get done. I'll figure it out. Like I can read directions. I'm a direction follower. I got that from my dad. Everything that he brought home you took out the directions and you started with a like all like shelving units and stuff. All he got all of the Tupperware containers out and he put them all like by size and color and everything he organized them and we need one of a and we put it in the a hole and one at well. That sounds kind of weird, doesn't it? The
Scott Benner 14:54
no this is staying Yeah. Jenny just in case you're wondering. This is gonna be like the beautiful like last five minutes on episode people. Like just leaving the stupid stuff you say this is gonna be one of those that stays in.
Jennifer Smith, CDE 15:06
Anyway that I learned my organization of how to put things together from my father, he was very, very organized
Scott Benner 15:12
for clarity. Jenny learned how to put things in the a hole from her dad. So I like him to hear this.
Jennifer Smith, CDE 15:22
He's not unfortunately, who passed away? No, it's okay. He passed away about 10 years ago, he had, he had kidney cancer. So
Scott Benner 15:31
I'm horrified to tell you that I wasn't sorry to hear that he was passed. I was sorry to hear that he couldn't hear what you just said.
Jennifer Smith, CDE 15:37
nature of what I said yes. And he would have, he would have liked it because he had the greatest dad jokes. Like in the world, my dad had a great sense of humor, so he would have loved it.
Scott Benner 15:50
To do something here on the Mac, right? Okay, so I just want to prove to you all that Jenny's a real human being she's not perfect. But she has a great sense of humor. And she does not know how her internet works. At the end here. You know, just let me tell you that podcast just hit 500 reviews on iTunes, which was really touching little plateau, for me. Quite a little milestone. Most of them are really good, which is also very nice. I want to thank you too, because the podcast just hit 1.2 5 million total downloads for the whole show, which is a really incredible thing. And I've probably said before, but it the first month of the podcast back in February 2015. I think there was something like 1000 downloads that month. And now I can't, you know, get 1000 downloads like every couple hours. As a matter of fact, by the time you hear this episode, November of 2019, will become the most downloaded month in the history of the podcast. And that happens a lot. Where the next month like we're one month does better than the last month over and over again. That really is to do with the podcast being shared by listeners. I have no budget for marketing. And I can only hope that when the podcast grows, that means that you found that helpful, or entertaining or thought provoking or something and told somebody else about it. Which I really I didn't expect that either. I know when hindsight it seems obvious, right? Somebody will like it, and they'll tell somebody else. But in the beginning I I really didn't think that would be I don't know, I just didn't imagine. And you know, reflecting here just a couple of hours past Thanksgiving. I'm really thankful for it. Actually, I was looking through my photographs. So I'll leave you go back to your life after this. I was looking through some photographs from two weeks ago. And I was in Kansas City at the jdrf type one nation event. I did four talks that day. Right. It's a think the thing started at 9am. And it was over my for for for those hours, I was speaking in a room. Not concurrently, although almost. And the first hour was just sort of thinking about your diabetes differently kind of talk, I sort of introduced people to the idea of the podcast. But then in the second hour, I talked about, you know, kind of the tools that we talked about here and give people sort of like a one hour if you can imagine, like the whole idea of the podcast on one hour. It's me talking pretty quickly on stage. After that, I did a q&a, where we talked through people's like real life issues. But at the end of the day, I sat down with the teenagers who were were at the event. You know, at first, um, they looked like teenagers coming into a room being told that, you know, this old man here is going to explain, you know, something to you about diabetes. And they sort of all came in like they know, somebody promised them something if they just came and said still. Maybe they had been a cost, you know, but in a couple of minutes. I got them talking and I got them laughing and started talking to them about their health and how they could possibly feel and you know, 10 more minutes later, a couple of more taking notes, and asking questions, and then the quiet ones in the back got engaged. And I don't know I was thinking about what I was thankful for today and you know the things in my life aside, my family and the people I love you guys for listening. I just started thinking about those kids. And I was really grateful that they listened. Anyway, I don't usually say what I'm grateful for Thanksgiving. But I think I'm grateful for you guys sharing the podcast to the point where it got me invited to an event in Kansas City, where I met a few kids whose lives might be different now. Because you told somebody else about the show, I'm going to put a picture of those kids up on my social media. So if you're listening to this, it's going to be right around. Thanksgiving on my social media. You can find the date scroll back.
If you're listening to this later, okay, this is me being all serious and quiet. Thanks so much for listening to the Juicebox Podcast. There'll be another episode on Tuesday, and every Tuesday and Friday from now until at the very least, the end of 2020. Because all of the sponsors are back plus some new ones. So huge thanks to them. Huge thanks to you guys. Hope you have a great rest of your 2019 keep listening to the show and sharing it and I'll keep making it. Hey, one last thing I need some new equipment to record with. So buy some t shirts maybe or a sweatshirt or something maybe at Juicebox podcast.com. Or you can make a donation to the podcast if you want just scroll down and you know every episode, there's a spot there to do that. Anyway, I'm not begging, I just need another microphone, a new preamp, my computer's starting to get to the end of its life. So there's gonna be some expenses coming up in the next couple of months. And if you would like to help with them by you know, picking up a sweatshirt or dropping five bucks on me or something like that. That'd be really cool. If you can't, please don't think twice about it seriously, I don't want you to feel bad not even for a second. Just keep enjoying the show, sharing the show. And I will I will take care of the rest. But But if you're just sitting there right now thinking I got a couple dollars I can handle that. I'm not going to stop you as they say, but I would be very appreciative
About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
Please support the sponsors
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!
#269 Defining Diabetes: Low Before High
Defining Diabetes: Low Before High
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
Bonus content from Pro Paddle Boarder and Windsurfer, Fiona Wylde.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
About Jenny Smith
Jennifer holds a Bachelor’s Degree in Human Nutrition and Biology from the University of Wisconsin. She is a Registered (and Licensed) Dietitian, Certified Diabetes Educator, and Certified Trainer on most makes/models of insulin pumps and continuous glucose monitoring systems. You can reach Jenny at jennifer@integrateddiabetes.com
Please support the sponsors
+ 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
Defining diabetes is made possible by in pen from companion medical. Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And Always consult a physician before making any changes to your healthcare plan or becoming bold with insulin. You're about to hear a snippet of an interview that I've just completed with Fiona Wylde Fiona is a 22 year old professional wind surfer who uses the in pen. So you're gonna hear that little snippet right now. And then Jenny and I are going to come on and define a diabetes term. When Jenny's finished spreading her diabetes wisdom, Fiona will be back to tell you something about the pen that I bet you don't know. To be honest with me, I'm 48 years old, how far would I paddle before I had a stroke? Or an aneurysm? Couple of feet? A couple minutes? How far do you think I'd make it
Jennifer Smith, CDE 0:49
go as far as you want to go? That's the cool thing is that, you know, it doesn't really matter. You Don't you know me, okay, if you were to, you know, jump off the start line and try and go sprinting, you'd probably be out of breath kind of soon. But you can jump on a board, you can go with your friends, your family, if you have a dog and put your dog on the board go cruising around, like, there's all sorts of different things you can do. It's like, it's like a bicycle, you know, you have your people who go out and ride 100 miles, you know, in the weekend, and that's what they do for fun. And then you have some people who have cruiser bikes, or even a bikes that you know, put a picnic basket on the front and go, you know, cruising around paddling is the same in that sense. Like you can, you know, have top line race equipment, go, you know, for speed, or distance, or whatever. Or you can just grab more of a Cruisee board and go have fun, go exploring, maybe you know, paddle into a different place that you've never seen before. Or it's cool to paddle out and look back at what you're looking at every day, and just get a different perspective.
Scott Benner 1:51
I see you're saying this is where people like you who are super athletic, don't understand that other people don't have brains. Like here's your saying I would paddle out to get a different perspective, which does sound neat, except I would paddle out and then have a panic attack that there's no way I can make it back again. Then I would start imagining what giant Canadian fissure in the river that will keep my body when I sink to the bottom. Like that's, that's how it would occur to me.
Jennifer Smith, CDE 2:15
Well, yeah, that just crossed my mind.
Scott Benner 2:19
Wouldn't it be great if if Fiona's entire career was killed today? She can't get over the anxiety of thinking about whether or not salmon could eater? And she's like, I never thought of it before. I can't go back and
Jennifer Smith, CDE 2:33
yeah, okay. Yeah, I'll be alright with that.
Scott Benner 2:37
So first of all, it's amazing. And you said something a while ago already that I jotted down and I don't make a lot of notes and I do this. But did you say that there was a paddleboard race? That was 13 miles? Yeah. Okay, so when when they say go, first of all, I have questions. Does everyone finish you starts?
Jennifer Smith, CDE 2:59
I'm pretty much in the Elite Field. Yeah. Okay. In the open field, there might be a couple that pull out. But it's just, it'd be more like a marathon in that sense. You know, it takes a while. Some people, some people, you know, don't, maybe some people just get tired or fatigued. And then yeah, you have to pull out from but for the most part, and especially within the Elite Field, pretty much everybody finishes,
Scott Benner 3:25
how long does it take to go? Like, like the person who wins? How long does it take them to go 13 miles.
Jennifer Smith, CDE 3:33
With that particular race, too. That's the other thing with water, it all depends on the conditions. If you have 13 miles with wind at your back, and you're going where we call downwind, which you can kind of surf little bumps that the wind is generating the whole time, you're gonna go a lot faster than if you have a headwind or completely flat water. So it depends, but in that specific race that was in North Carolina, around Wrightsville Beach, and that was about a two and a half hour race.
Scott Benner 4:03
So I'm gonna tell you that I'm not 100% certain I could stand on the board for two and a half hours. Like, take all the rest of it.
Jennifer Smith, CDE 4:09
Oh, there's a lot of training. I'm not kidding. Like,
Scott Benner 4:13
your legs like super tired.
Jennifer Smith, CDE 4:14
Your legs are exhausted. Yeah, most people think that all paddling comes down to you know, your arms and your shoulders and all that but there's so much balancing involved, and your legs are bigger muscles, you might as well use them more. So by the end of it, my legs are shot.
Scott Benner 4:33
Jenny and I are going to define a term from the podcast right now. And after that Fiona is going to tell you something else about the impact. I am now going to ask Jenny to define something that's not a real term, right. It's something that was made up on the podcast. So you hear me say a lot that I have these kind of like tenants these ideas that I use day to day while I'm helping Martin with their blood sugar. And there's a bunch of them but I'm now just going to blurt one of them out. And then let Jenny define it from her perspective. So what does that mean to her when she hears it? Because maybe she can add more clarity to it than my oversimplification. So where do we want to start? Because there's a lot of them, I'm going to start with, you'd rather stop a low or falling blood sugar than fight with the high ones. What does that mean to you?
Jennifer Smith, CDE 5:29
Overall, it means that it is, it's easier to navigate carbs in to stop a drop, or to treat a low. For the most part, there are some sticky lows that are sticky and nasty to bring up. But for the most part, a stopping a low or treating a trend down can be easier because carbs work faster, then if you're already high, and at a deficit of insulin, a deficit of insulin is always it's like you're behind the track your way at the end of where you need to be. And so you have to play catch up. And playing catch up takes time, because our rapid acting insulin today is not quite the term rapid it takes time. So it's it's easier even though we've been schooled in this like, fear of insulin kind of thing, because oh, it can cause a low blood sugar lows are easier to treat. And to prevent further dropping, then trying to correct for a high that's rising really fast or stuck high. For some reason.
Scott Benner 6:56
This This to me, I started with this one because this is my getting up in the morning. Thought I'd rather stop a low or falling blood sugar than fight with a high when it has to be your mantra every day I it's there's times it's hard because it feels it can be feel exhausting in the beginning, you know, before you really put all the pieces together and it kind of gets easier. But I partly believe that that's where the idea of being bold with insulin came from me like I thought to myself one day like I just have to be bold and do this. And think bold with insulin. I wasn't thinking in T shirts back then I was just thinking about how to get
Jennifer Smith, CDE 7:30
through the day. Right? But or magnets or whatever,
Scott Benner 7:34
answer buttons, it depends on where you see me. But But no, seriously, like, I think that's at the core every day, like you have to just be in that mindset. Because when you do that, yeah, sure, you might have a couple lows. But I'd rather have a couple of lows a month and have 27 days of good blood sugar's then have you know, 27 days, you know, crap, blood sugars, and three lucky days where it actually works out for reasons I don't even understand. Okay, this is going to be really interesting. We're going to do more of this the next time we talk because I like Oh, I like hearing you can have fun. Tell me what I think you're in Penn app has information from your Dexcom on it. So you open up your M pen app, it knows what your blood sugar is because of your Dexcom do you then just tell it this is how many carbs I'm thinking of having and it tells you it's suggested amount of insulin?
Jennifer Smith, CDE 8:28
Yeah, so I've set prerequisites of okay, you know, this is my carb ratio, and this is what I'm planning on doing. And it'll Yeah, you pretty much put in, you know, how many carbs that you want to do and want to eat? And then you give yourself, okay, you know, it's suggesting this amount of insulin, you're like, Alright, I think that's about right. Or, you know, maybe I'm gonna have a little bit more food than that. So I'm gonna give myself a little bit more. But it's nice, because you can, you know, you can think of okay, what, what do I want to eat? You know, how many carbs are in it roughly. And then it's nice, because I would normally just be like, okay, that for me, that's this amount of units, whereas using that, it definitely gives you more precise. You know, just give me a more precise number of like, no, if you're not, you actually need more insulin than that you're gonna go high. And so that's been a that helps me kind of alleviate a lot more of the like, big swings of up and down.
Scott Benner 9:22
That's excellent. But yeah, that's one of the major things that's missing when you're injecting really, right. Yeah, that whole piece of it plus now. So now the pen app knows how much insulin is on board. So in the same situation, except say you've had a I don't know say you had a snack at 11 o'clock and you gave yourself some insulin now it's just an hour and a half later and you're going to have a meal. We you put in your you know, I'm going to eat 40 carbs. It takes into account the insulin still left from the snack and it gives it gives you a different dose. If that insulin still active, yeah, my gosh and how valuable do You find that information?
Jennifer Smith, CDE 10:02
Well, for me, it's huge. Because, you know, a lot of times I, you know, it's easy to just look at a meal and be like, Okay, that's, I know how many carbs are in here. And that's how much insulin I'm gonna eat. But it's harder when it's like, okay, I already gave myself some insulin for food a little while ago. And I don't necessarily know how much you know, insulin is left or how much has been absorbed. And so then you end up stacking insulin. And for me, well, for anybody really, I think stacking insulin is one of the things you want to try and avoid the most.
Scott Benner 10:34
Now, you do not want to have more insulin than you need in your body, that's for sure.
Over the next several weeks, you'll be hearing a lot more from Fiona. I'll be sharing with you small clips from her interview with me which will go live at the end of this little, this little thing we're doing here with companion medical. And she's going to be sharing tips about how she uses the N pen at the end of these episodes, so you can check them out at companion medical.com But there is of course links in your show notes of your podcast player. And at juicebox podcast.com. I'm not gonna lie if you go through those companion medical No, you're coming from the podcast, which would really help. Hey, you can check Fiona out on Instagram at Fiona underscore wild and wild is Wyl de there's also a link in your show notes for Fiona's Instagram account. She does some pretty amazing stuff for a human being, especially considering she's doing it on a piece of what appears to be Styrofoam over a giant body of water. Thanks so much for the recent reviews that you guys left on iTunes. They were completely sweet and wonderful. Hope you're enjoying the Juicebox Podcast. I hope you've checked out the private and public Facebook groups. And of course, follow me on Instagram at Juicebox Podcast. Thanks so much. Have a great weekend. I'll see you next week
Jennifer Smith, CDE 12:06
Hey, this is Chantel Wilde and the Juicebox Podcast is super crazy.
The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!