#344 Defining Diabetes: Feeding Insulin
Scott and Jenny Smith define diabetes terms
Defining Diabetes: Feeding Insulin. Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
App is free & already on your iPhone ⤴
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Podcasts - iHeart Radio - Radio Public or their favorite podcast app.
Check out the Diabetes Pro Tip episodes and Juicebox Docs
+ 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 Dexcom Omni pod. The Contour Next One blood glucose meter and touched by type one. Please visit touched by type one.org dexcom.com forward slash juicebox. My omnipod.com forward slash juice box or Contour Next one.com. To find out more about the sponsors. In this episode of defining diabetes, Jenny Smith and I will be defining feeding insulin. Now, you know Jenny, she's in all the pro tip episodes and defining diabetes and ask Scott and Jenny. She's also a person who's been living with Type One Diabetes for over 30 years. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring system. Jenny services are for hire, check her out at integrated diabetes.com.
We're gonna get started in just a moment. But before we do, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical more. Otherwise, please always consult a physician before making any changes to your health care plan. or becoming bold with insulin.
There are people and I am not bothered by it. I'm just telling you there are people who come into the podcast as new listeners who if they hit the right episodes, once they get through an episode where you're not on it. They're like, Where's the woman go? No, no, I'm like, No, I understand. And like she's on these and these knees. And they're like, Okay, I get it. Like I got a note one time, please. Like, I don't understand where did Jenny go?
Jennifer Smith, CDE 2:01
Still here, I was like, Jenny,
Scott Benner 2:02
Jenny records podcasts like, like, she's tanning. Like, she's canning vegetables, he just makes a bunch of them, and then brings them out when she needs them.
Jennifer Smith, CDE 2:11
I feel like people think that I like live in your closet.
Scott Benner 2:15
Let me get Jenny Hold on a second.
Jennifer Smith, CDE 2:18
There she is right over here.
Scott Benner 2:19
There you go. Ask me your question.
I use this phrase. And in my mind, it paints a tapestry of idea. And I hear back from people and they'll say like, I don't understand what you mean. So. So I use this a lot. I say feeding insulin. So you know, I'm like, oh, you're feeding the insulin. And that apparently doesn't make sense to some people. So when I use that phrase with you, what does it make you think of?
Jennifer Smith, CDE 2:56
Yeah, feeding insulin means that you're having to actually, I guess on a negative side of feeding insulin, it means that you're putting in food to compensate for there being an excessive insulin that shouldn't be there. Right. So whenever you're feeding insulin, especially, and that's something it's a term I use when I'm talking to people about weight management. Because if you're constantly adding extra food, because insulin is driving your blood sugar down, then there's a problem. there's a there's a balance that's off, you're getting too much insulin from somewhere, whether it's bazel, or too much bolus or whatever, and you're constantly having to put food in to avoid drops. I'm now on the positive of feeding insulin. I mean, that's what we do. We we feed insulin with the carbs that we put in, but hopefully there's a balance there when we're feeding insulin that way. So and if you find yourself feeding insulin too much, you can you'll have weight issues. Yeah, that wrap around that too. And we talked about that a lot. The idea that because you have type one diabetes, and you're using manmade insulin, food seems like medicine. And so you stop thinking about it as calories where you know, sometimes, I mean, don't get me wrong, you know, in the moment, when you're falling, don't don't hold up Skittles and go, No, you know,
Scott Benner 4:12
a moment on the lips, a lifetime on the hips, don't think that think oh, I want to stay alive and eat the Skittles. But right, the idea is to not have to feed that insulin. So if you want to get a look into my mind for a second, there's gonna be an old reference, I guess. But if Pac Man is insulin, and the dots are glucose, you don't want Pac Man to have energy when the dots are gone, because he's gonna turn on you and bite your face. Right? Exactly. And he needs to have more dots until until he's done. And so, but there's ways to reverse engineer that idea as well. And I don't think that people would think about it this way. But I think I just created that situation with Arden just now. So by way of an example, she gets up in the morning, she still goes Going into school at home. And it's the end of the school year, she has to return her books to school. So she she leaves the house, Kelly takes her. And I don't know if she was excited or not, I don't know. But her blood sugar was sitting around 110. I was recording a podcast earlier today. And I told her, I'll make you breakfast when I'm done. So she left the house and the 110 went diagonal up and it went 115 120. You know, it kept going her auto bolus started bolusing at it from the loop and it leveled off at 140. Then she gets home and she's hungry. And so we bolused for the 40 points plus her meal. And we're going to create a fall that happens. And we're going to in essence, feed the insulin to stop the fall at a level number. And so there's, that's there's a positive way to think about it. I think when I use the term in public, or in my mind, I don't think of what I just did is feeding the instant I think of it as Pre-Bolus saying and timing the food instead of timing the insulin. Does that make sense? Okay, yeah,
Jennifer Smith, CDE 6:11
absolutely.
Scott Benner 6:13
Absolutely. But when I generally save, you know, you're feeding the insulin, my intent of that is to say, hey, it's possible, your bazel is too high. Because I you see, you find yourself feeding your insulin I when when people show me a graph, and it bounces. My first question is always, are you stopping highs with insulin on this graph a lot or stopping lows with food a lot? Right? And that moves me towards too much bazel or not enough? bazel? It's my first question. So anyway, when I say feeding insulin, or when you hear somebody saying that, I think that is a complete explanation of what I mean by that. Do you
Jennifer Smith, CDE 6:50
know, absolutely. And I think you know, when you talk about it in terms to have, like that weight management piece of it, I was just, I just worked with somebody who she said, You know, I feel like I'm eating more normally now. And I don't feel like I'm eating as much. And I'm actually feeling more. She called it real appetite. And I said, That's right, when we adjust your, your baseline levels of insulin the right way, technically, and she's not using loop. She's just normal conventional pumping, right? So um, you know, when she gets hungry for a meal now, she knows that she's really hungry. That it's not because her insulin is telling her, Hey, there's too much of me here, like your Pac Man example. Yeah, I need more food. Please put more in. So now she has more real understanding of what appetite feels like, rather than just insulin appetite.
Scott Benner 7:50
So I realize I'm just asking you, and it's your personal experience. But is hunger? Because you're low? Does it feel different than hunger? Because you're hungry? Where is it the same feeling?
Jennifer Smith, CDE 8:02
To me, there is a definite difference, like from my personal experience, and I think everybody might be different, but I can tell the difference. When I have hunger from being low. It's more, it's much more ravenous. It's, I need food now. And it's definitely like, I don't want to sit down and eat a nice salmon fillet and a salad hunger. It's, I would like to eat the whole entire, like container of glucose tablets, which we know it doesn't taste very nice. Yeah, right. So it's, I would say it's definitely more of you need something now. Whereas if I've, like skipped a meal, because I've been out in the yard gardening through like lunch hour or something. I can tell by the time I get to like the mid afternoon, even if my blood sugar has stayed normal, you know, hopefully has stayed normal through that time. I am. I'm hungry, right? Like I can tell the pit of the stomach kind of hunger difference from a low blood sugar. It's an it's a more now craving.
Scott Benner 9:06
I figured that out first. It was a time of day thing when Ottomans say she was hungry at like 930 at night. I'm like, she's not hungry. What is that? And then inevitably, in the next 20 minutes, her blood sugar would start to fall and I was like, Oh wow, she's feeling the drop before it's happening. And it registers this hunger for anyway, I think it's funny. It's the two small words but I think feeding insulin It teaches you a lot about how to use it you it is not your goal to be doing that. And and if you find yourself doing it too frequently, it is very possible that either your basal insulin is too strong or you're over bolusing it meals and creating Lowe's later you should not I know that seems obvious, but I don't think it is that people once they get caught in the in that little Have, I'm always low and I'm feeding, they get to that feeling of like, this is just what my diabetes is. But it doesn't have to be that way.
Jennifer Smith, CDE 10:06
Right? Especially with today's very smart, smart technology that we have to use, you know, years ago, when I was diagnosed, you did actually feed the insulin, because that's how the insulin works. And you know, your, your intermediate cloudy insulin, it peaked at a certain time. So you had to eat a meal and a snack at a certain time in order to coincide with when it's action kind of was there. Today's insulin, even though it's not as rapid as we want it to be.
Scott Benner 10:34
That's not as necessary.
Jennifer Smith, CDE 10:35
It's not as necessary. Yeah. So
Scott Benner 10:38
I, I hear that. Okay, thank you. Hey, here's some quick contact information for the sponsors. If you're interested, to get the dexcom g six continuous glucose monitor, you're gonna want to go to dexcom.com forward slash juice box, and hit the button that says get started with Dexcom JSX. It's just that simple. If you get there and you want to read a little bit, definitely check into it. Zero finger sticks, customizable alarms, and alerts, smart device compatibility with Android and iPhone, the ability to share data, or data, this depends on where you live in the country or the world. Although right now, some people are like it's data, or data, you're fighting with each other, but you're just fighting with the voice in your head. So don't do that. You can any anyway, no matter how you say you can share that data with up to 10. People, it's amazing, right? Your kid could be at school being tracked by their mother, father, grandmother, school nurse, or just a friendly guy, you met up the street, you're like, Hey, you want to watch my kids blood sugar. I mean, if you're, you know, if you're a hippie, you might do that, although do hippies have cell phones, I don't know, it's not for me to judge. Anyway, dexcom.com forward slash juice box, you're also going to want an omni pod tubeless insulin pump, that you're going to get my Omni pod.com forward slash juice box. And on the pod has quite a little deal where they'll send you a free, no obligation demo of the AMI pod to your home so that you can wear it and check it out. I've worn it on the pod demo before. It's astonishing how quickly you forget you're wearing something. And you'll really get a feeling for what it's gonna be like to have a tubeless insulin pump, right, just this little device that's with you, and nothing else to clip to your belt or stuff in your bra or do anything like that with and there's no obligation. So I mean, if it doesn't cost anything, and they're not holding you to it, you might as well give it a try my omnipod.com forward slash juice box. And of course, if you go to Contour Next one.com there's a button at the top of the page to see if you're eligible for an absolutely free blood glucose meter. And I have to tell you a little more context now because at the moment, I'm wearing a Dexcom Pro to get the feeling for it. You'll hear me talk about that later. But because I'm doing that I'm testing a lot. So not just with Arden, but I'm testing myself to get a feeling for you know where the CGM sitting with accuracy. And all that stuff that I've been telling you has been my experience about using the meter with my daughter goes double for me. Small, convenient, accurate. pocket size. It's great, the light works great at night. And trust me My eyes are you know what I mean? And I what they used to be Contour Next one.com and of course, touched by type one, please, please please go to touched by type one.org to check out the good work that these amazing people are doing. For children living with type one diabetes, and people with type one diabetes in general. They raise money to support a cure. They put on all these kinds of great programs to support the community. You can be part of it touched by type one.org. We're just gonna tell you one more thing before I go short episode today. So today we defined feeding insulin. But there are many other defining diabetes episodes. It starts way back in Episode 236. And some of you are going to say Look, I know what Bolus says Scott, I don't need that episode. But you'd be surprised about how many new people with type one diabetes don't. So Episode 236 is Bolus 241 honeymooning 245 time and range 247 standard deviation 249 extended Bolus 251 algorithm 253 non compliant 255 glycemic index and glycemic load 258 Pre-Bolus 260 Trust will happen to 69 low before high to 84 brittle diabetes 286 stop the arrows 288 ketones, 295 insulin resistance and overall singing Of course today Episode 344 Feeding insulin. And there are many more on the way that was all very confusing to you, you can go to Juicebox podcast.com and scroll down. All of the episodes are there. Actually the Ask Scott and Jenny episodes are there as well. And the diabetes pro tips and of course, all this is condensed way down at diabetes pro tip comm if you want to check out the pro tips, we're share them with somebody. That's diabetes pro tip.com.
The point is at the end of tip, see what i'm saying diabetes pro tip, there's no s. No s at the end of tip. It's just tip, and then the dot and then the calm. That's my tip for you today about how to spell diabetes. Perfect. Thank you very much to Jenny Smith for coming on the show as she always does to help us understand terms and ideas. bigger, more vexing Type One Diabetes issues. She really is the best Asus there is an S at the end of best assist, but not at the end of diabetes pro tip calm. I mean the English language is funny punctuation right
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!
#295 Defining Diabetes: Insulin Resistance/Overbolus
Defining Diabetes: Insulin Resistance/Overbolus
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care.
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Pandora - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ 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 sponsored by our newest sponsor the Contour Next One blood glucose meter. This is the blood glucose meter that Arden has been using for well over a year, maybe a year and a half. And it is without a doubt noble, the best, most accurate blood glucose meter. Arden has used in what is now 14 plus years of diabetes 14 Plus I love math widow. She's two inches, I've noticed 15 she's almost 68345 678-910-1112 I lost count for like 13 years when I say it's been so long, I forgot what I said. She's 15 she was diagnosed which too, anyway said a lot of meters since then. A lot of years, a lot of meters. This one is without a doubt. absolutely the best. You know what, I'm just going to tell you why right now sample size, not a lot. If you miss with your little like you know, you touch the button or sometimes you touch it, it doesn't work that doesn't waste a strip, you have a nice long time to put it back on again and get more blood without affecting the test that of course, amazing. If you want the Contour Next One has a app that comes with it, which is a darn handy, you can check that out. I can tell you from personal experience that Arden has never had a meter that has more closely and more frequently agreed with her Dexcom JSX really gives you a lot of good feeling when that happens. The meter is an industry leader in accuracy. And I will actually share some of those numbers with you in a future episode. The app by the way is available on the Google Play Store and the App Store. By Contour Next One is compatible with Apple Health. And those of you using an omni pod dash, the Contour Next One will send the information right into the dash magic, Bluetooth magic. All right, listen, for now, I want you to go to Contour Next one.com. Now contour spelled the classic way CLN to you our next again, only one way to spell Next one is the word not the digit. So Contour Next one.com head over there today. Check them out. But you know, if you're going to do it, here's the link in the show notes or the one that you'll find at Juicebox podcast.com get Arden's meter today, it is spectacular.
Jenny Smith is back today Jenny and I are going to define insulin resistance. And it's not exactly the way you think of it, which is why we're bothering to take the time to talk about it. We're not just like, whoo, pick something everybody knows. You think you know about insulin resistance Jenny gonna shine a bright light, a bright light on what it means. While you're listening to Jenni spin her genius. Try not to forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And that you should always consult a physician before making any changes to your health care plan. or becoming bold with insulin. I could say that my sleep by the way. All right, I'm not gonna make you a bag. We're gonna get right to Jenny. Don't forget, by the way, if you want to hire Jenny, she works for integrated diabetes, you go to integrated diabetes.com to find out about Jenny. Jenny is not a sponsor. Jenny is my person. So I don't get anything out of it if you go except good feelings. So you can go through my link if you want. If it makes it easier for you. You just type right into the browser don't matter. Here we go. Here we go. There we go. Here we go.
I would like to define insulin resistance
Jennifer Smith, CDE 3:59
and insulin resistance. That's a good one a very good one. And I'll tell you why.
Scott Benner 4:03
Why does this one come up on my list? It's because again, I think it's the same thing as brittle in a different in a different avenue, the same idea? Maybe not always. But I think I think there's insulin resistance and there's reasons for it. But first, can we define it?
Jennifer Smith, CDE 4:21
Sure. I mean, insulin resistance is essentially the body's pushback, a simple, I guess, simple definition, the body's pushed back in appropriately using insulin, right? It's just not it appears that insulin is just not working the way that it's supposed to people with insulin resistance and that which is a technically a hallmark of type two diabetes is insulin resistance because in the early phases of type two development, there's actually a huge output of the pancreas producing more insulin like loads of insulin to actually overcome the higher blood sugar levels, but their body's cells are not responding to the insulin, the right way to the body just keeps pumping out more and more and more insulin and offense. Eventually, with type two, the pancreas gets pooped out. I mean, those cells are like God, we just we can't put out like more and more and more, we're doing enough and it's just not working. It's a bit different in type one diabetes. I mean, there are, there are some hallmark, like diagnostic reasons for true insulin resistance in type one. One of them is weight management, the the heavier that you are above, your body's like, target healthy weight, the more resistant you're going to be to using insulin, the insulin is just not going to work as well in the body. Another one specific to women is something called pcls, polycystic ovarian syndrome, and that, that actually causes a whole like series of metabolic changes, one of which, however, is insulin resistance. A woman with pcls will usually need a lot more insulin to manage. And it's based on a hormonal component to the ovarian syndrome that's kind of going on.
Unknown Speaker 6:20
So
Jennifer Smith, CDE 6:23
in general, though, insulin resistance with Type One Diabetes, if you are, you know, your healthy weight, active and whatnot, everybody's insulin needs are very different. So when we talk about insulin resistance, I think a lot of people might look at a friend of theirs, who's the same height, weight, you know, doing the same kinds of things. And you're like, Well, why am I using double the amount of insulin is dumb? What's the deal, I must be insulin resistant. That's not the case at all. I mean, I've got a friend who's actually, she's tiny. She's had diabetes several years longer than me. And I've had 31 years, and she actually uses more insulin than I use. She's only five feet tall, and she probably weighs 10 or 15 pounds less than I weigh. And, but she us and she's very active. Um, she's actually roller derby. She's done a couple of like, full distance Ironman, you know, events. And so, in that, I think sometimes there's a lot of confusion, confusion around how much insulin Should I personally be using? It's different for everybody. Gotcha.
Scott Benner 7:31
Okay. So I brought it up. Because engineer, can we slide your phone slightly away from the microphone, I think, yeah, absolutely. I think I brought it up. Because I know it's a real thing. And I wanted you to explain what it really was. But I also know that people default to saying it too frequently, when I don't think that that's what's going on. Right. So a great example would be if you're dehydrated, and you know, you're using insulin, and it's not giving you the you know, the response that you expect. And then you hear people say, Oh, I was, I was really insulin resistant today, but you weren't really insulin resistant. Today, you were really dehydrated today. And so and it because and the reason I bring it up is because I think the idea of insulin resistance allows people to think this is something beyond my control. So I'll just accept it. That's what that's why I brought it up. Because that worries me for people when that happens, right? Great example, is I've been helping this really wonderful family recently with a 16 year old boy who's, you know, an athlete plays ice hockey. And yesterday, the kid went to an ice hockey game and got to play the game, like right around like 95 the whole time, you know, didn't cross out crash low afterwards or anything like that. And I realized that prior to that, they were doing the like, will get his blood sugar higher thing. And you know, and he didn't feel well, he feels so much better now. And all this stuff is great. And it's really cool. But they were living in a false narrative before, right? Like, this is what's happening to me. And so I have to accept it, or I have to do this thing that I don't want to do, because this is what's happening. And and I don't think people should. I don't, I don't want to say I don't think it makes me sad. Honestly, when that's happening, you don't mean like, I don't like the idea of someone running around going, Oh, my blood sugar was 250. Today, I was just insulin resistant, when there could have been a real reason for it. So try to just keep in your head. The difference between what Jenny just explained with insulin resistance really is like for instance, a pregnant person could use a significant amount of insulin right then then they would even have five seconds before they're pregnant. We're in their first trimester versus their third trimester, like all these different ideas, but that's not that's so that's that. Okay, so I just please
Jennifer Smith, CDE 9:53
and I think a good thing to kind of put in there with that is that there may be times when Insulin resistance is a piece of what is happening, like you just brought up pregnancy, right? There is a piece of points in pregnancy where Yes, insulin resistance comes into the picture. But why is it there? It's not that you're going to be insulin resistant for the next 90 years after the child is born. It's the fact that there's a hormone piece in the picture that's causing you to actually you need more insulin, you just need the hormones are causing that issue. So it's not like a type two, where the cellular level of response to insulin is actually a piece of
Scott Benner 10:34
your so is it fair for me to say that, like I bring up on the show your body is for whatever reason, telling you, I have more of an insulin need in this moment. And you need, you just need to meet it. So if you are insulin resistant in that moment, there is enough insulin to use to overcome that blood sugar, right? It just it gets to a scary point for most people. And they're like I can't, the numbers get wrong, the numbers get wrong in their head. Like, I'm usually my base is usually a unit an hour. And I've never bolus more than four units for food. So they just won't go bigger than that guy. And people who and people who haven't gotten their bazel right and done all the things we talked about in the podcast probably shouldn't start crazy bolusing like that, because they are going to have a heart problem. But but the breath but the reason I bring up the boy with the hockey is because he can stay stable while skating and playing hockey now because his bazel insulins, right? Because he's bolusing on time with his meals because he doesn't have any unbalanced active insulin in his system that just pops up at weird times. And doesn't have a fight with food anymore. So it just kicks his ass instead. Like, right, correct. Okay. All right. Thank you. This is my my, my defining diabetes list is about like, all the sad things I hear people say. Can unit
Jennifer Smith, CDE 11:52
No, let's clear that up. No, that's not right. Let's make sure you understand that better. Yeah, I
Scott Benner 11:57
just I look and I think oh, it's sad that that's what, what what is thought? Right.
Listen, I'll give you a quick story, right? And then I'll ask you to define overbought listening. I made a diabetes podcast, the very, very beginning of 2007. And because of Excuse me, I made a diabetes blog in the very beginning of 2007. And because of the nature of the internet at that point, I didn't really know the other diabetes box. Like there was a little while where I thought to myself, Hmm, I am doing something so cool that no one else is doing Why did no one else think of doing this? I am a genius. I felt like the Magellan of like diabetes blogs. Right? I was just looking around. I'm like, why couldn't know how Scott's idea is so much stronger than everybody. Then I realized there were a couple other diabetes bots. Right. And there had been a number of them proceeded mine. I had no idea about them when I started mine.
Jennifer Smith, CDE 13:14
But I had, I think, I think Carrie sparlings was one of them. I think she started in 2005 or 2006.
Scott Benner 13:20
Definitely, definitely carry Scott Johnson probably.
Jennifer Smith, CDE 13:24
Yeah, maybe diabetes. Yeah,
Scott Benner 13:26
maybe George Simmons to like, if I'm thinking correctly, there were a handful of them. I was in the beginning. I just wasn't the beginning. But I had, I had this feeling that I was right. And similarly, I do this thing where I avoid other diabetes information. I know that sounds weird. Maybe when I say to people, but I don't listen to other people's podcasts. I don't read other people's blogs. I don't want to be impacted by other people. Because I want to come to these ideas on my own. Because when I come here, well, not only that, I can explain it if I know how I got to it. Right? When somebody just tells me set this there, that doesn't help
Jennifer Smith, CDE 14:03
me. It's like reading a definition out of a dictionary.
Scott Benner 14:07
Yeah. And then it doesn't help me to help somebody else. So I come up with this idea that we talked about in the podcast here, my house in my own head. What if I can't Pre-Bolus one day, how do I handle that? And then I came up with that kind of math that you've heard me talk about in other episodes, where I'm like, Oh, Bolus for the carbs. And then I'm gonna imagine the spike in Bolus for the spike. And then I'm gonna imagine the correction I'm gonna I'm gonna put it all in right now. And maybe I can get all this insolence so far ahead of that, that like a time travel movie, none of those things will ever happen because I killed the thing before it was supposed to happen, right? Mm hmm. Literally how I thought of it. And I started speaking about it and I called it over bolusing because I'm over bolusing. You can see how thoughtful so
Jennifer Smith, CDE 14:54
pretty fancy term there over bola. Thank you.
Scott Benner 14:57
And so our insulin board Over bolusing stop the arrows I am talking to myself like I'm for. And so. But anyway, it works. And then I was like, Ah, here I am again invent and stuff. And then one day you said to me, oh yeah, Gary calls that this and I was like, Wait, what? Yeah, but that completely makes sense that somebody else would have had the thought to. So what I call over bolusing is exactly what I just explained. It's the concept of getting in more insulin than you need for the current situation with the understanding that this current situation is going to get worse soon. And so you get ahead of the problem. But correct, but Gary calls it Super Bowl is saying, right?
Jennifer Smith, CDE 15:45
Actually, it's john Walsh, john. And we use that we use the term Gary uses the term too, but it originally came from my understanding came from john Walsh, who wrote pumping and pumping insulin. Okay, which from what I understand from people is a really great book. It doesn't it doesn't tell jokes resource. You don't get to hear Jenny while you're reading it. So Well, I mean, how?
Scott Benner 16:07
But but so
Jennifer Smith, CDE 16:08
it's, it's written in layman's terms. It's a good. I mean, it's not like a bedtime story or anything. But I like it from the standpoint of, you know, one of those books where you can go to a chapter that's like, how do I manage around exercise? Or how do I figure out bazel? Or how do I deal with these spikes post meal and over Bolus, right? Or Tino people? I think like you people think about, should I just take more insulin? I know that yesterday when I ate my cereal for breakfast. This is what happened? Well, what if I just took more insulin right now? Yeah, that's the same concept. It's, it's over bolusing, it's super bowl of thing, it's whatever you want to name it, it's just you head off the spike by just dosing more earlier,
Scott Benner 16:51
okay. And so to really to break it down, and we've done this and other episodes, but I want it to be here as well say that you've counted your carbs perfectly, but you have not Pre-Bolus. So you know, you're going to get a spike. And you decided that the meal is three, you know, three units, but the spike is going to happen because you didn't Pre-Bolus. And in your history, you found that that spike is going to go up to 225. Before it kind of before plateaus and levels off. And you know that it's going to take a unit to correct that to 25 back to 90. So then you put in 40 units instead of three, because you weren't able to pre Boss, I will I will absolutely tell you that. And I've said this one other time on the podcast. We don't Pre-Bolus as much as we used to, because I know how to overhaul us, right and it and I don't not do it. I always Pre-Bolus whenever I can. But when I can't, I guess I should have said I don't panic the way I used to write I just take care of it right then in there. Mm hmm. And, you know, that's a that's a definitely a another thing that you have to try over time, and there's going to be you know, there's gonna be
Jennifer Smith, CDE 17:59
some experimentation
Scott Benner 18:01
definitely gonna be experimentation for you to fail.
Jennifer Smith, CDE 18:03
And you know, you figure it out, you're super, you're like, I call it secret sauce to over bolusing. Right? You figured it out and you make it work. And, you know, I would say probably 98% of the time, you probably nail it because you've figured it out. And in terms of like, you know that that one unit you said before for the 225 blood sugar? Well, I know it's going to get here, you know, it's going to take a unit to correct and bring me down in a mathematical way, just for like definition of how could you figure that out, you can actually sort of back use your correction factor. You can say, you know, if I know that I'm going to start with a blood sugar of 100. I'm going to go all the way up to 225. And one unit brings me down 100 points, your correction factor is one to 100. Okay, one unit should drop you 100 you can say okay, 225, one unit will bring me down to 125. It's pretty close to 100. So let's just give a whole extra unit to the front of this food bolus, the pump suggested or I calculated three units for the food, I'm going to add on a unit without the time to Pre-Bolus or maybe it's just a really carby meal like cereal tends to be and so you head it off with that extra but that's a little bit of the math if you want a little bit more way to figure it out ahead of time. And then you know as we talked before, john Walsh's method with super bolus is really just to take, he does it by taking the bazel behind the meal. And he tacks that on to whatever the food beast Bolus is up front. So if you're, you know, if your Basal is running at one unit an hour behind the meal for two hours, that's two extra units of insulin. You take that two units, you pop it on to the Bolus up front, take it all at one time. And his recommendation is to then take the bazel down to zero. So your front loading with the insulin but you're also knocking off the back end effect so you end up not going low. Now again, there's some experimentation to that as well. Well, there's I've got some teens and young adults and even some kids who are taking the bazel down to zero, it doesn't work, they end up the Super Bowl is works, it prevents them from getting like that big spike, but they end up then staying too high later or going up again later because the bazel has been taken back to nothing. They still need it. So they need some of it. I've got a college student I work with and she does a 50% bezel reduction with a super Bolus. Okay, so there's some experimentation just like you found with your over Bolus.
Scott Benner 20:32
But yes, that's a good one. Listen, I made that word up in my house and I didn't know anything else existed. So in my mind, I'm again Magellan.
Jennifer Smith, CDE 20:40
You are you're over Bolus word you are. Yes.
Scott Benner 20:42
And if john Walsh had a podcast, he could tell us about his Super Bowls, but he doesn't. That's it all right now.
For all the people who don't actually get my sarcasm, I feel bad for how angry they must be at me while I'm talking. Like that guy. Every episode of the podcast and with Jenny giggling Thank you so much, Jenny Smith, for coming on the show today and sharing your wisdom with everybody. Don't forget to check Jenny at integrated diabetes.com link in the show notes at Juicebox podcast.com. And of course, our new sponsor the Contour Next One, you want to do yourself a favor, you want to do something, it's not going to cost you a lot of money but is going to add a ton of confidence and good feelings to you. To your life to your feels inside. Take away the stress and the anger. Take away everything. The worries go away. I'm feeling mountain away. Right? You never thought of it before. But a really solid, super easy to use small, like you know, completing your pocket putting the bag No problem, but it's still substantial in your hand. Right feels well made. You can hold on to it. You know, I mean, it doesn't feel delicate, like oh, I'm gonna lose it or it's gonna break. It's good. It's solid. It's not big, but it feels good in your hand. I like it. I'm just telling you right now. I don't want to do dirty the other meters that aren't used over the time but I'm thinking there's been a couple and ain't one of them been half couldn't hold a candle to the Contour Next One my friend understand Contour Next one.com such a simple thing. You've been walking around with his old dirty nasty meter that you don't trust for EVs. Why are you doing that? So simple to get yourself going with the right one? That easy? Right? Tell your doctor next time in the office. Yo, yo, how come? I want to get the Contour Next One meter. Make it happen. write the script script out. Or like I said, Contour Next One comm check that out to all kinds of ways to upgrade your diabetes. I'm all sorts of jacked up right now. Do you want to know why? You probably don't care. I gotta fly tomorrow. Oh, I hate flying. I'm trying to keep my energy up. I can't wait to get to the jdrf type one nation event in Oklahoma on Saturday, and go in there and do what I think is gonna be the magic. I am gonna really whip it out. I think I've given like four talks in the day. It's gonna be wonderful. I'm super excited about that. Here's the part. I'm not excited about driving to the airport early in the morning tomorrow. Oh, not good. getting on a plane with sick people. You know, they're sick. Right? And I'm not a germaphobe but it's January is cold out. You know, people like wipe their hands on their nose. Touch a part of the plane, and I'm gonna touch a part of the plane. Next thing you know, I'm not gonna feel good. I don't like that. Then I gotta fly somewhere. Now, I don't mind flying. But I hate layovers. And apparently, there is no way to get from where I am to Oklahoma without laying it over. So I'm gonna fly North tech go, like sad. I don't really know where Oklahoma is. But I'm like Southwest. I think I'm probably going right. Oklahoma, Oklahoma, where the wind? Yeah, it's probably like Southwest. I have to fly north to go Southwest. I don't want to do that makes me upset just thinking about so instead of being upset, I'm keeping up my good energy today. being excited, have a little bit of fun, trying to keep my focus off of it. I'm going to do my best to put up a couple pictures on the social medias while I'm there. So you if you're following me on Instagram or Facebook, that's where I would do that. What else? Yo Are you in the private Facebook group for bum in the bowl with its own Facebook page and there's like a private group of people talking about management stuff and other good things. Lots of good peeps in there. Go check it out if you want. Gotta be something on someone to tell you. has to be
I'm speechless. What is this gonna happen again? All right, I'm gonna go pack and get to Oklahoma. I hope I see you there. Or at one of my many events coming up, check them out. Go to Juicebox podcast.com scroll to the bottom, click on You'll see where I'm going to be in 2020 got a lot going on. Think I just added the Phoenix area in May. It's not locked down yet but have a good feeling about it. Um I might be having a good time recording. I don't want to stop but I have nothing left to say you're probably pissed now. I'm gonna let you go. Goodbye.
Please support the sponsors - Contour Next One
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
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!
#288 Defining Diabetes: Ketones
Defining Diabetes: Ketones
Scott and Jenny Smith, CDE define the terms that are at the center of your type 1 diabetes care. This episode is a companion to episode 287.
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
Hey everybody, welcome to Episode 288 of the Juicebox Podcast. Today's show is a defining diabetes episode that is a companion piece to Episode 287. So Episode 287 is a diabetes pro tip with Jenny Smith, about illness injury and surgery. This defining diabetes episode is all about ketones, they go together. So if you're having sickness and illness, you might have ketones. And that would make all this important to understand. Today's episode of the podcast is sponsored by the merch store at Juicebox podcast.com. That's right. Juicebox Podcast merchandise is sponsoring this episode, which is to say that I am now why am I taking the time to tell you about this large price drops on all of your favorite stuff. The merchandise supplier I'm using has dropped their prices, which allowed me to pass that savings on to you some of the drops in cost are significant. So go take a look. Juicebox podcast.com, you click on the link in the like, so what do you do? Maybe I don't even know Juicebox podcast.com then there's a little thing in the top corner top left corner, it's like three little lines. That's a menu. You guys know that. And then it gives you a little drop down emerges one of the things you can choose. And there you'll see some reductions. 3421 of them's down like $6, maybe me say, well, there's some shirts that went from 2490 to $16. So check it out. All of the money that I make on this stuff goes back into the podcast, I have recently upgraded audio equipment, and your new computer. And I have to add a microphone, because I think Arden is going to come on the show in 2020. So I'm gonna need another mic. Anyway, all that stuff that you guys buy goes towards helping me with that. I really appreciate it Juicebox podcast.com. And now defining diabetes with Jenny Smith, you know, Jenny from integrated diabetes, right? If you want to hire Jenny, go to integrated diabetes.com Check her out, send her an email, her email addresses also right there in the links in your show notes. And you can find it also at Juicebox podcast.com. Alright, ready, defining diabetes Episode 288, the companion piece to 287 with Jenny Smith.
This one's gonna be really appropriate because some of the stuff we've done recently. I'd like to define ketones. Hmm. And then explain to people when they happen and why they happen and how they change your insulin needs. So in the reason that this throws me for a bit of a loop, is because there's the keto diet that works off of ketones, but those aren't that no not for ketones. There's a keto diet that works off of ketosis, and there's nutritional ketosis, okay. And there's ketones that you get from not having enough insulin because you've been put into ketosis for not having enough insulin, but Betty being put into ketosis for not having enough insulin is not the same as being put into ketosis because of your nutrition. And I don't understand why that sounds like something. My wife said to me that I didn't understand. And I just nodded along with because I didn't want to get yelled at. Right like that. Totally. When, when, like, I was talking to Vicki on the podcast the other day, and about her ketone diet and how or her see it throws note about her keto diet and how she bonuses for it. And when she explained that part of it. I am not gonna lie to you. I nodded along like Vicki and I were married. How's it go? I get that I completely understand. Yeah, sure. That makes a lot of sense. Thank you. I
Jennifer Smith, CDE 3:41
looked at your like, a Ha ha ha.
Scott Benner 3:44
I asked the question, I was gonna ask the wrong question. And then I was gonna look like an idiot. And I didn't want to do that. So I thought I will just talk to Jenny about this. So I guess let's break it down into ideas. First, type one diabetes, I don't have enough insulin is one of the reasons I could produce ketones. Is that right?
Jennifer Smith, CDE 4:04
Right. And so in name wise, you're right. It's kind of like ketosis versus ketoacidosis. Two different things. Right, keyed ketoacidosis essentially reverse to decay. It could be a potential complication of you know, having type one diabetes, because we are at a complete insulin deficit, right. That's the reason we either pump it, inject it, inhale it, whatever you're going to do, you got to have your insulin right. And essentially, if you are in DK a, it essentially makes your blood too acidic. And that changes the normal function of many of organs in your body like your kidneys and whatnot. I mean, you have to get treatment for DK you do. Hydration is a huge part of it. And DK A is a result of a A significant deficit of insulin. It can happen for lots of reasons, either, you know, your pump site has failed and you didn't realize it and you're sleeping overnight, and you don't have a CGM, and you didn't get an alert for it or could be because of illness, and high blood sugars and not eating. And sometimes starvation, ketosis can lead in illness, to DK A, B, because of the way that the body isn't getting enough food and the potential for higher blood sugars and not correcting them and whatnot. So ketoacidosis is not what you want, right
Unknown Speaker 5:34
at all.
Jennifer Smith, CDE 5:36
And it can happen very quickly, I mean, in less than 24 hours, you know, you can in a body that doesn't make any insulin, you can be in decay very quickly. So, ketosis is difference, it's essentially the presence of ketones, which aren't harmful. And I will say that, again, ketones are not harmful. In fact, most people I mean, who who has diabetes has regularly tested their ketone level, unless they're ill or have a high blood sugar. That's when you're told to test your ketones, right? Right. ketones, however, are very common. If you test first thing in the morning, you are in a fasting state. Okay. And so in the morning, if you tested ketones, even if you're not on a ketogenic diet, or a low, low carb diet, many people wake up with ketones low level very low level in the morning, because they're in a fasting state. And in a fasting state, your body is essentially relying on fat stores to keep you going, as overnight, you're not eating in any fasting state, you're not technically eating, but your body still needs to get energy or derive energy from something. Right. So it resorts to fats.
Scott Benner 7:04
So basically, and that is God I'm sorry. that produces Yeah, go ahead. I was. Basically, when you wake up in the morning, had you gone to say you went to bed at 10pm, and you woke up at eight? For the last 678 10 hours? You've been at the beginning of your low carb diet? Because you haven't you? That's right, right, you have you haven't taken a carb. So the body begins to do what it does in a low carb situation.
Jennifer Smith, CDE 7:30
Yes, and your body is essentially tapping into your stored fat to burn something for energy in a place where there is no food coming in. Unless you're the person who sleep walks to the fridge and eats overnight, I can guarantee you're not going to be in, you know, you're not going to have low level ketones, fasting ketones in the morning. But in terms of people who do choose the ketogenic diet, essentially, you are teaching your body to no longer rely on carbohydrates for energy, but you're not doing it in a deficit of insulin. People with diabetes who are following a ketogenic diet, and are eating very low carb, and by defining low carb on a ketogenic diet, it's typically less than 50 grams of carbs a day, most are following less than that usually more around like 30 grams or less a day to maintain nutritional ketosis. And so what does the body revert to? It burns fat. And so those those diets on a kind of a flip side of what we the ABA typically teaches, which I will say it here is has tended in the past to be very carb heavy. Um, that's where I'll leave that. But the flip is the is true for a ketogenic diet, they essentially consume about 70 to 80% of their nutrition calories from fat, right? And very little from carbohydrates, somewhere between, you know, maybe five to 10%. And then protein is also very lean. In a ketogenic diet. It's not a high protein, high fat, it's a high fat, mild to moderate protein and very low carb intake. Do you in that diet? Vicki told me that you get the glucose because your body turns the protein into glucose, if you ever heard that before. Yeah, yes, actually. So with that's why you have to be kind of really conscious of what you're taking in. If you're aiming for a true ketogenic diet. If you're truly maintaining ketosis, you can't have a lot of protein, you have to look at how much is coming in because you're so low carb that in a low carb environment, your body will resort to protein conversion.
Scott Benner 9:59
Okay, today glucose,
Jennifer Smith, CDE 10:01
okay, so if you're taking in too much protein in such a low carb intake your bodies instead of taking in the fat and using it for fuel and being in true ketosis, your body is going to say, hey, there's some protein here in excess of what I need. Let's just use that for glucose. So it's it's a fine line of managing, which is why, you know, when somebody comes to me and wants to talk about ketogenic diet, I, you know, there's nothing specific about any diet that I'm like, nope, don't do that. Don't try it at all, whatever. I'm happy and willing to work with whatever kind of plan you want to work on. But you have to understand the difference between all of the things that are out there, you have to do your homework, and it takes work. It takes upfront work of really understanding, healthy and safe, nutritional ketosis.
Scott Benner 10:53
I put the I put Vicki's episode talking about bolusing for her keto, for keto diet and your my episode about fat and protein, I put them up on the same day, because in my mind, they looked at two different things from the same angle and different with different theories, like but they they all fit together to me correct. I thought you really needed to hear both of them to understand. So okay, so two things I want to go back to the first thing is, if my blood sugar is very low, and I feel like you said this before, but I want to make sure I'm clear, but I'm sick. I could still end up in ketosis because I'm likely not eating. And am I getting? Am I getting a mixture then of ketoacidosis?
Jennifer Smith, CDE 11:34
If you're? Yeah, yeah, you're right. If you're, it's a it's a fine line. And it's one that we talk about a lot with people now, on low carb diets and talk we in talking about illness and illness management. If you're already in ketosis, and you are then not really eating and blood sugars aren't necessarily going to be excessively high unless there may be an infection. We know that infections are such a stress on the body that you will likely have higher blood sugars, but high that's typically defined with the worry for DK a is greater than 240. And that's why many meters and pumps and whatever you put in a blood sugar is more than 240. It says check for ketones, you know, right? Right, I probably remember that from you know, PDM, it tells you right away check for ketones with the blood sugar. But if you are ill, and you're running higher blood sugars than normal, let's say you are typically running at 90 because you're on a new, you know, ketosis type of diet. Now your blood sugars are running at 141 40 might not be a bad blood sugar. But it's and I hate the word bad. But you know, for somebody who 90 is normal 140 is like oh my gosh, I'm you know, at 140. And quite honestly an illness, you may end up getting yourself into the potential for trouble with ketoacidosis, even at a number that doesn't look, quote unquote high. So again, what goes into that is the management of hydration, the management of the amounts of insulin that you need, if you're typically running at a 90 blood sugar, but your blood sugar's now 140 or 150 and you're not eating and you have normal ketones floating around in your body, those ketones could get higher than they should be in nutritional ketosis leading you into decay. So that's, that's again, we're defining like ketosis versus ketoacidosis. Those ketone levels are very, very different in ketoacidosis. If you're doing a blood glucose or a glucose, blood based ketone test, not a urine but a blood based ketone test with a monitor, you will have very high ketone levels, I mean, four or five, six, on the scale of measurement. in ketosis, typically, ketosis is, depending on what you need, could be anywhere between a value of like 1.5 to three ish for normal ketone levels in nutritional ketosis, and people who are really trying to follow a ketogenic diet. They typically follow their ketones if they're trying to maintain that they're doing a good job about maintaining and once once they have a pretty standard to what they're eating and taking in and whatnot through the day. They may do it less often, unless something changes again for them. But for the most part, they they really try to follow their ketone levels to make sure that they're in that safe, like nutritional ketosis range.
Scott Benner 14:42
Okay. Jenny was probably stunned like watching me think, but she I don't think she does very often. Usually, I'm just waiting, listening.
Jennifer Smith, CDE 14:51
You were looking at the ceiling at a viewer
or something, you're like what's coming
Scott Benner 14:57
to absorb what you're saying. I and I have one little Last question wrapped around this. And I am wondering if I'm not seeing what I think I'm saying. So I have one real clear memory of Arden having the flu. Yeah. And she, her blood sugar was low. This is prior to CGM, her blood sugar was always around like 75 or 80. While she had the flu, sometimes she'd be low, she was sucking on candy for days ever, I'd be like, Here, put this in your mouth, you know, and she'd sock on it, I'd reach it. I don't give it back. You know, like I was literally like, just trying to get sugar and, but then all of a sudden she's got ketones. And they're like to on the blood glucose meter that we have, or the blood ketone meter that we have. And I call the hotline to the, you know, the hospital, and they're like, you have the Bolus for those ketones. And I said, What do you mean, they said, but she's two units, one unit for each number, like she was one if she was one on the ketone meter, we'd have you given one unit if she was to have to. So her blood sugar's by five. She's like six years old, she weighs nothing. And they want me to give her two units of insulin. And so I was just like, You're sure. And they're like, yeah, I had the flu. So I was probably like, Yeah, all right. Well, I mean, I guess if this is how we go out, like, let's try this, you know, and I like, and I gave her, they what they're telling me to do, I'll blame this lady at the funeral is what I was thinking, right, like, so I gave her the two units, and it worked. And she didn't get low. And till To this day, I can't explain that. Like, I don't understand that well enough to explain that to anybody. I know what happened, I watched it happen. So
Jennifer Smith, CDE 16:37
right, and what it deals with, like on a physiologic level, I to explain it, I guess in a simplified way, because I don't I don't know all of the physiology completely behind it. But in a setting of ketones from like a DK, or you know, ketoacidosis kind of setting, the body requires more insulin to overcome the ketone level in the body. And so even at what what was looking like a normal level of glucose for her, in fact, on the lower end right at and you're thinking, Oh, my gosh, she's not eating anything, and I'm going to give her two units of insulin, what you needed the insulin for was clearing of the ketones. And along with that comes hydration as well. And I would expect they probably were encouraging you to kind of be a force as much fluid as possible, right, get it in. But, I mean, there are some very defined ketone management strategies for how much extra insulin you should be given based on where your glucose is, what your ketone level is. It has to do with how much insulin do you currently use from a base basal amount, and how much extra should you give to a correction for blood sugar to overcome the ketones that are also there along with that blood sugar. So typically, let's say blood sugar of 200, you would use one unit to bring you down to your target of 100. With ketones, there's a there's a percentage extra that you would need to incorporate to say, okay, 200, to also clear, the ketones along with bringing this blood sugar down, you're going to need a certain amount extra to that one unit you would normally take to actually start bringing it down and get rid of the ketones. So
Scott Benner 18:34
when they tell you your bolusing, for the ketones, there's really a much bigger physiological thing going on. It's just sort of how we are. Right? Correct. Okay. So is this attached to the concept of if my blood sugars been say, I'm not sick? And you know, it's a regular day, but my budget has been 300 for a few hours. And where you would hear me say, high blood sugars require more insulin? This is why is it possible? Is this part of it? Do you think or, like what, you know, when your blood sugar is high, it's stuck, and you need more? Do you think you have ketones at that moment? You don't realize? Or no,
Jennifer Smith, CDE 19:13
because I don't, you know, I don't think most people really are again, testing. If they've got a one off high blood sugar for eating the whole cake versus only eating one slice, you know, I mean, in that setting, the high blood sugar that requires a little bit more insulin, I think that there are more variables there potentially, again, a miscalculation to carbs, right. So of course, you're probably going to need some extra insulin, not just to correct the blood sugar but to correct for food that you didn't account for before in the original Bolus. Also, I mean, and I kind of call them sort of sticky blood sugars right sticky and the fact that you just you have to take more insulin and thus, the strategy of sometimes even using a temporary bazel increase around a house Blood Sugar along with a bolus to get it to start moving more effectively? You know, that's a really good question. If ketones are maybe potentially in the picture there already, or, you know, how quickly do ketones really start to kind of develop, I mean, they're more so in the picture of like a true ultimate insulin deficit, right? I have a feeling that it has more to do with kind of what we actually just talked about a little earlier is like that resistance.
Scott Benner 20:29
I was just thinking,
Jennifer Smith, CDE 20:32
is that like, a resistance is there, you know, some, um, but for most people, I would say people recognize that above about a 250, blood sugar, it takes a bit more insulin, for whatever reason to bring the blood sugar down.
Scott Benner 20:50
Yeah. So with all these, you, if your brain can wrap around all this, bless you, I think that's great. And if you can think of all this stuff in the moment and make better decisions within something, that's great. But just in case, you're like me, Scott has very kindly boiled this all down to more insulin. So just I know, it's, that's just the day when I realized there were all of these different factors happening. And I couldn't figure out what they all were, I just thought I don't I just resolved myself to the fact that this requires more insulin. And I'll use a more and that'll work. And it does. So. All right, cool. Wow, that one I don't even know I don't even think I can call that a defining divide. That was like a mini like, pro tip episode on like a bunch of words that are all sound the same. That By the way, again, when people use a develop language, don't make one thing ketone, the other thing ketosis, and then the diet keto, you confuse people, I go right back to the looping thing. If I want my my, my sensitivity factor to be more powerful, the number should get larger, not smaller, whoever said that way, wasn't thinking about me in my regular life. And I feel, I felt that we're thinking
Jennifer Smith, CDE 22:00
about math, we're not thinking about the regular layman brain. It's great. I got a lot
Scott Benner 22:05
of engineers telling me how to think about my insulin. So I just I'm just telling you that you don't say keto ketosis and ketoacidosis expect people to keep that all straight. But anyway, try. Try. That's kind of the same
Jennifer Smith, CDE 22:17
reason that that Dexcom uses the GI instead of a one C in their prediktor. In their clarity reports, they had to get rid of that being an A one c because it technically a one C is specific to the hemoglobin and whatnot from a test in the bloodstream and whatnot. So they, I would assume legally, they couldn't use a one c this and they had to figure out a new fancy word for it. So glucose management indicator was the next best like term, whatever,
Scott Benner 22:49
doesn't even realize she just teased another episode for you. So we're not talking about that. Oh, but that is definitely one of the things we're going to talk about eventually. Thank you Jenny Smith for being here with me today and talking about ketones Don't forget go to integrated diabetes comm To find out more about Jenny, and to hire her to help you with your blood sugar's and etc. Thank you also to me for sponsoring the episode, which is to say I'm thanking you for considering buying some merchandise Juicebox podcast.com, upper left corner, click on the menu go to merge, you're going to see a huge drop in costs for almost every item that's available. proceeds go to me, I pay taxes on those proceeds. And whatever's left, I'm going to buy a computer with a microphone. So this episode came out at the beginning of the week when it normally would come out on Friday, but there will still be an episode on Friday, don't you worry. And look where we're at December 2019 388 episodes into this podcast. So let me say you're going to get one more on Friday. And then I might start going to a Monday Thursday schedule instead of a Tuesday, Friday schedule. I'm thinking about that. So anyway, there's gonna be one on Friday the 13th. And you'll get the 16th and 19th. And I don't let up just because of the holiday, you're gonna get one of the 23rd. And then the day after Christmas, to for like five more. And then on the 36 there's six more left in this year. I could have just said there are six more episodes left in December. But you know, what am I gonna do? You don't want a shirt and you still want to give me a gift. You can donate to the podcast. Again, I'm not a charity, so I'll pay taxes on it and whatever is left computer payment, or if you can't afford any of that, but you still really want to help help my soul by leaving an amazing review. Like go to Apple podcasts, you know, and your podcast player whichever one you're using, wherever you can, like leave a review. And if the show has been truly helpful to you, please describe to others how it has been, because that might make them think maybe that could be like that for me. And then maybe they would come check out the show. And of course you can always Just share the show with a friend or an acquaintance, somebody who you think may enjoy it. Last thing, if you're a thoughtful person about your management, and you try to stay away from the drama about type one diabetes, but you're looking for community, may I suggest the private Facebook group for the podcast, the juice box discussion group, you have to answer like a couple quick questions like, you know, what my connection to diabetes is, basically to make sure you're not like a robot. And then once you're in, you'll have a community of now 1800 people who are answering questions to each other. It's a very collaborative and supportive group. If you're into something like that, you know, no drama, no head games. Check it out. All right, there's gonna be links to all of this in your show notes, and then the episode guide at Juicebox podcast.com. Today, links for Jenny Smith links for the merge links for the private Facebook group. You know, I said that was the last thing but but one more last thing. I am incredibly just looking proud to say that this podcast ran at six new episodes in 2019 86 new episodes. And I believe that in 2020, that number will be more like 100. This really cool, because obviously, these episodes wouldn't exist. If the interest wasn't there. I wouldn't be here like pumping out all these episodes. If no one was listening, I'd be like, oh, okay, I guess nobody cares. And then I might stop. But it's clear that you guys care. The downloads are insane. In the time, it took me to tell you about the 90 some episodes that ran when I say 86 episodes that ran in 20 1940 people downloaded the podcast. Again, that time frame. It's incredibly cool. So I appreciate your support. Appreciate listening to old episodes telling other people about the podcast really is absolutely our warming. All this makes me incredibly excited to start season six right away in January. When Let's take a look. Pulling up my calendar. Looks like you'll get one in January right around the second right after New Year's for the first time. I even think I know what episode I'm going to give you that. I think I have something uplifting for the new year. We'll start off strong.
Alright guys, thank you so much for listening to the Juicebox Podcast for sharing it for buying the merch for continuing to support the Oji sponsors Dexcom and Omni pod and dancing for diabetes. And of course, the love I expect you're going to give next year to new sponsors the Contour Next One blood sugar meter that Arden uses and G Volk g vocus. glucagon pre mixed prefilled ready to go more about that next year. So next year, we're going to talk more about the Contour Next One from a sensia G vocht. glucagon, of course, always on the pod dex calm and dancing for diabetes. And who knows what else. But for now, those are the sponsors that keep the podcast floating. You are the oars that propel it along. Imagine that. You're the oars. We're cruising through the clear water. Just once in a while hearing the oars just break the surface. We're moving along gracefully. Hmm. gracefully. Stiff wind in our back. Helping people get their blood sugar's where they want. Hmm. As they were still you get it right. And then variabilities coming down, people's stress is melting away. As the show becomes more popular. it affords me more opportunities to go visit people in real life give these great talks. We're winning understand, we're way ahead. All the other boats are behind us and they're just like splashing through their oars are just like slapping the water because they don't think about us. Barely breaking the water. cruising along. That's the Juicebox Podcast. Alright, this is it. We're done now.
If you're interested in see me live, my event schedule is at the Juicebox Podcast bold with insulin Facebook page, so it's bold with insulin on Facebook. Go to the event link. There's also artist a.com scroll to the bottom and click on events coming up Oklahoma City that's coming soon. January 11. Dallas February 16. That's it the greater Dallas type one nation event, Georgia type one nation event February 29. I'm going to be doing an evening in Appleton, Wisconsin or right around that. Yeah, Appleton, Wisconsin. I'm pretty sure it's exactly where it's at March 26. It's a Thursday night, I think from like five to 8pm. Just Scott talking, not one of those type one diabetes events, sort of a Juicebox Podcast live event, just for you, Wisconsin, that on May 30. I'll be down in Orlando, Florida for the touch by type one event from dancing for diabetes. And on August 22, Richmond, Virginia type one nation event. And I think I think we're still in talks in Indianapolis. somewhere else, I'm not sure but if I do many more of these, my wife's going to shoot me. So I think this might be it for the short term. But I'm always interested in hearing about 2020 at the end of the year 2021. If you know somewhere you'd like me to be, reach out. I'd like to be there.
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!