Scott Benner 9/12/20 Scott Benner 9/12/20

#379 Defining Diabetes: Somogyi Effect

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Somogyi Effect

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.

Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm gonna have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One, you go to Contour Next one.com forward slash juice box. And of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that type one diabetes for over 30 years, Jennifer 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 systems. She is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She is my favorite person. I want to do three defining diabetes ideas. Okay, and then see if we can do a Mini Pro tip about glycemic load index. Sure that makes sense. I pick that one. I pick all the sexy diabetes topics.

Jennifer Smith, CDE 3:18
Absolutely.

Scott Benner 3:19
You know what I realized that for the last number of years now, as the new year rolls over, I have this horrible pit in my stomach. And I think I'm never going to come up with stuff for Jenny to do. And I'm gonna run out of it. And now it's September already. And unlike we don't have enough time to record all the stuff that I'd like to record. I just I think back to the person who told me like, no, you're starting a diabetes podcast that won't last long, you'll run out of things to say and I think more now that that person just didn't realize all the things their work to say, you know,

Jennifer Smith, CDE 3:55
right. Well, and I think so many things engine with being with having your, like online kind of groups and whatnot, I think there are a lot of topics and things that end up coming up that you're like, Oh, good one to talk about for certain

Scott Benner 4:12
for certain of all the trepidation I had about starting a private Facebook group. watching all of those people speak to each other. Like sometimes like really lights me up. I'm like, Ooh, that's such a good thought right there or, or somebody has a half a thought, and they can't get to the rest of it. And you can see the rest of it. And you're like, Oh, I wouldn't have thought of the first part. But I understand how to finish this idea. Right. So anyway, it has been it's been incredibly valuable. At this point. I don't see why this podcast would have to end. And in the beginning, I thought like oh, it could probably only go for a certain amount of time. But I think that might have just been bad advice from somebody. All right. So three defining diabetes episodes today that I think of, I'm going to put them up separately, but I think they could probably all go together. I want to do Dawn phenomenon feet on floor and the one I can't pronounce somehow G. A fellow he's Mogi. Is that what it is? Yeah. All right. Let's start with the one I don't know anything about so you can get warmed up. What is the smoky effect?

Jennifer Smith, CDE 5:18
Do you want to actually spell it for people? Sure.

Scott Benner 5:22
I have it here is so mo gyi and then effect in the classic way, with an E, for all of you who always use an A when you mean a.

Jennifer Smith, CDE 5:35
What the interesting thing

is that this topic is kind of one that's sort of like it's like this 5050. I don't know that that's the exact like percentile breakdown of people who believe versus don't really believe that it's kind of the issue, but it's essentially relative to why you might have elevated blood sugars in the morning. Okay, what ends up happening after you have a low blood sugar is it's a rebound, high blood sugar that you end up with in response to having had the lower blood sugar value, some from what we call kind of counter regulatory hormones that are released in terms of a low blood sugar. Yeah, why sometimes it happens, versus not all the time, I think is probably the reason that people question whether it's a real thing. I guess that's the easiest way to because it

Scott Benner 6:38
doesn't consistently happen every time.

Jennifer Smith, CDE 6:41
Correct. Okay. Exactly. I mean, there is in relevance, it seems to be low blood sugars that are usually less than about 55. And that are more sustained in length that seemed to have this counter regulatory hormone output, and can then result in the higher blood sugar later. Now some of it also is we have a low blood sugar, especially with today's technology, you get an alert right from your CGM. And so then you may treat that low blood sugar. And because those counter regulatory hormones are not like, hey, right now, she or he needs this right now. Yeah, they could have lingering impacts, you end up treating this low blood sugar with what would normally work for you, right? 10 grams, it always works, it brings you up, you never go too high from it. But now with the counter regulatory hormones in the picture along with your normal 10 gram treatment, you end up at like 290. When you wake up in the morning, you're like,

Scott Benner 7:45
yeah, so Okay, so I have, I feel like I have some experience with this, not knowing that it was a thing or had a name, or at least a name that is hard to pronounce. And oddly spelled, but it is, but you know

Jennifer Smith, CDE 7:59
that it's actually named after a person gets up. It is it's named after it's the last name of things, the professor or the doctor who saw it happen, and thus named after him. All right, if I remember correctly,

Scott Benner 8:14
I'll try to figure out who he is. While I'm telling you that before Arden had a CGM. I've said this a ton of times on the podcast, right? I would get her blood sugar up to like 190 put her to bed. She'd wake up at 100. And I was like, look how good I am at this. Right. And then one day, we put a dexcom honor and I realized I was pushing her up to 190. In the early part of overnight, she was dropping to like 55 sitting there for an hour or two. And then she'd rise back up and level off at 90.

Jennifer Smith, CDE 8:50
And you never treated the low because you didn't really without a CGM. You didn't really know that it was happening.

Scott Benner 8:56
Never knew it. I took all that anecdotal data about her waking up at 90 and starting at 190. And I never considered she could have gone below 90 and come back up again. I always just thought she was drifting 100 points down overnight. Yeah, right.

Jennifer Smith, CDE 9:09
And that's she had to be hired to go to bed at night. Because otherwise, if she went to bed at 100, she'd be in the toilet by the time she woke up, even though it was happening sooner. Yeah. And then just naturally rising back up from the counter regulatory release.

Scott Benner 9:24
And I want to keep everyone focused on the idea that the reason Arden drifted down overnight was because I did not have any meaningful idea about how to use insulin like so. She She was just like, you know, because I've been helping this person recently. Who hears me, but can accept it. You know what I mean? They just think oh, no, the low happens at night. I'm like, No, you are messing up your meal bolus, then your overcorrecting afterwards and then she is experiencing a low blood sugar later and no matter how many times I say You know, what's happening now is not about now it's about before, you know, it's it's like this a fee for this person specifically. And I would imagine for a lot of people, it's this fear that's been built into them day after day, week after week, month after month, year after year of thinking like this is just random, and there's no reason for anything that's happening here. Because they can't see the causation. Right? They, they just they see the pencil go in the pocket and they think, Oh, it's the pencil. It's not the pencil. You're you're looking here. What's going on over here is what's happening. And when you talk about a hormonal release, is that from the liver? Mm hmm. Okay. And it's just glucagon, right? Or no, it is. Yes. Yeah. But you can't count on it.

Jennifer Smith, CDE 10:50
You can't count on. You can't count it always happening. From my base understanding of it. Yes. And secondly, you can't count on how much is don't.

Scott Benner 11:03
Plus, I would assume you can't count on an overpowering a certain amount of insulin active insulin, like maybe it could catch a drift where the insulin is almost gone. But if you were to put in a large bolus, it would take you right past that it would power right through any glucagon dump and just tank you. Right. Alright. Okay. Apparently it's Stephen. smudgy. And he's a jersey guy. Sup, Steven? Oh, is somebody who's gonna tell you that they heard this on here and come back and let you know about it. This is the guy it's I don't know. He's an internist. Apparently. All right. Well, no, no, wait. Now there's another smokey. There's a guy and he's an orthopedic. How many Smokies Could you be in the world? Yeah, what I

Jennifer Smith, CDE 11:47
found is it says it's a theater at theoretical phenomenon was named after Michael smudgy, a Hungarian born professor of biochemistry at Washington University and Jewish Hospital of St. Louis. I have it here. Who prepared the first insulin treatment given to a child with diabetes in the US in October of 1922. Smokey showed that excessive insulin makes diabetes unstable, and first published his findings in 1938. That's what I found. And

Scott Benner 12:15
he will not take offense to what I just said. Because he died the year I was born. So he has I don't care for quite a long time. Although you got to give this guy props. Born in 1883 he lived till 1971. Wow, that's amazing. 101 a math? What's math? Yeah, that's almost 100. What? 1883 17 years? 1771? Hold on seven, carry the one. It's eight. He was like, 88.

Jennifer Smith, CDE 12:50
Yeah, he was, wow.

Scott Benner 12:52
Go to public school. So

Jennifer Smith, CDE 12:54
I did not know cap Catholic school from first grade through 12th grade.

Scott Benner 12:59
We've just let down the Catholic and public school systems in one fell swoop. Really good. All right. So is there anything else to say about the smokey effect? It causes? It causes high blood sugar high blood sugar in the morning due to low blood sugars overnight because of a glucagon dump. That happens from a low if in fact, any of this is happening. Wow. All right, then. That's a rock solid. It's a rock solid description. It's a rock solid description of something that may or may not exist.

Jennifer Smith, CDE 13:33
Well, and I think the interesting thing about it too, in terms of like pushing it a little further is that it's really something that's considered or named after just that morning, high blood sugar and the potential reason for that morning, high blood sugar beyond another thing that we're going to define which we'll talk about high blood sugars in the morning, too. Yeah. But during the daytime, it's not like you don't have this counterregulatory potential impact either. So you could, again, have a low blood sugar during the day. And you could also have counterregulatory hormone impact in the aftermath. Again, treating it as you normally treat it, let's say 10 grams of carb is your staple treatment, it always works. And now all of a sudden, today for some reason, you're at, you know, a high 200. And you're thinking well, why, you know, so again, it could be the relative nature of the number or the low that you were at, and possibly how long the low was sustained, in terms of those counter regulatory hormones.

Scott Benner 14:45
If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com Thanks so much to the Omni pod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my office. The pod.com forward slash juice box, learn more about the dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply, in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org. forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show. The pentameter of that reminds me of save the cheerleader save the world. From heroes, you remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them. Go into your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app all episodes, scroll down, you'll see them you can go to Juicebox Podcast comm and scroll down a little bit. Right, and you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books you look up. Oh, hold on. Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right, it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginie I explained that to you. ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes. But you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes. Two new ones that are out right now around this, like I mentioned the beginning, I think go together with this one. The other two are feet on the floor. And this Moji effect, there's some Mogi effect. I don't know how to say that word, but you'll see it it'll be the only word that sounds like some Oh gee, when you read it, looking for a great doctor or other type of diabetes practitioner, check out check out Whoo, there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add. Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.

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Scott Benner 9/12/20 Scott Benner 9/12/20

#378 Defining Diabetes: Dawn Phenomenon

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Dawn Phenomenon

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Scott Benner 0:00
This episode of defining diabetes is sponsored by Dexcom Omni pod, the Contour Next One blood glucose meter touched by type one, and the T one D exchange.

I almost made this one larger episode with three topics in it. And then I decided if I didn't break them apart, future listeners wouldn't be able to find them. So this is a defining diabetes episode about the dawn phenomenon. But there are two others that go with it. The other one's called defining diabetes, feet on the floor. And the third one defining diabetes smokey effect. I know I'm not saying that right. So muchi, some moochie, you'll find it. Anyway, the three of them are oddly similar, but completely different. And every one of these ideas needs to be understood. I'm not going to be explaining them by myself. I'm going to have Jenny Smith with me. I'll tell you a little bit more about Jenny in a second. But first, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin.

If the mood should strike you, and you'd like to find out more about the dexcom g six continuous glucose monitor, please go to dexcom.com Ford slash juice box. If you're looking for a free no obligation demo of the Omni pod tubeless insulin pump my Omni pod.com forward slash juice box. Want to add your voice to some terrific Type One Diabetes Research without ever leaving your home can do it right there from your phone in just a couple of minutes. T one d exchange.org. forward slash juice box. To check out the blood glucose meter that Arden uses the Contour Next One, you go to Contour Next one.com forward slash juice box. And of course touched by type one.org. To see Type One Diabetes advocacy done correctly. My friend Jenny Smith has that type one diabetes for over 30 years, Jennifer 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 systems. She is also a frequent contributor to the Juicebox Podcast. And I find Jenny's input about type one diabetes and the management of insulin and things around type one to be completely invaluable. She is my favorite person. This is the one that everyone gets told about right? At some point overnight, I don't know around 3am or maybe all the way up to eight o'clock, your body's just gonna make your blood sugar higher. Maybe

Jennifer Smith, CDE 3:17
I would see in a good. I mean, if I had to give a percent to it, I would say a good 95% of people. Once they know to watch or something and or you know, let's say they've been listening to a lot of like the pro tips episodes. And they're like trying to do bezel evaluation and whatnot. And they're like, Huh, look at that. This is what's actually going on. And I keep fighting it with this and this and this. And it's actually not that problem. It's relative to the basal insulin, right. So the dawn phenomenon is another reason for having a high blood sugar when you wake up in the morning. But it's specific in that these are hormones that are supposed to be being released in this time period of sort of the sleep wake cycle. Yeah. And they're there whether you have diabetes or not. Right, right. It's just that the person with diabetes, obviously with glucose monitor, and we can see what's happening, and it's not controlled. So we have to cover with more insulin in order to offset these hormones, growth factor hormones, cortisol, all these things that are sort of ramping up around to three o'clock in the morning, usually through about eight o'clock in the morning, they're ramping up, and that ramp up in hormone will start to drive blood sugar up if you don't counter it with extra insulin. Most people counter it with extra basal insulin at a certain time period. Their basal rate may go up a notch to impact the coming increase in insulin need.

Scott Benner 4:53
And people on MDI see it more drastically when they inject their Basal insulin in the morning because in those last six and eight hours of a 24 hour basal insulin, sometimes you see a decrease it, especially with the older ones, right level Marin lantis. Correct. And, and so it might look even worse, I have a question that you may or may not know the answer to. What if I'm a shift worker? And I'm awake from three to eight? Do I still see it?

Jennifer Smith, CDE 5:24
No. Again, it's more specific to your typical sleep cycle. Okay, it's attached to sleep not time, right? So if you're a shift worker, and your shift remains pretty stable, right? Let's say that you sleep from noon until 8pm. Every day, your smokey effect might actually be from 3pm until 8pm, then or four 4pm until 8pm. It would be within a sleep cycle, just because it's not technically three o'clock in the morning.

Scott Benner 5:56
You just had smokey, do you mean dawn?

Jennifer Smith, CDE 5:58
What? Oh, Dawn? Yes. Hey, sorry. Yeah, so the dawn really is going to impact you in those waking hours, or those pre waking two waking hours, regardless of when your sleep cycle is. So

Scott Benner 6:12
this 3am to 8am, you know, quote, unquote, norm that people see is probably such a large swath of time, because people go to bed at different times. And so it's maybe more about how long you've been asleep, and how long it is until you wake up, like somewhere in that space. Like, you know, if I went to bed at 10pm, every night, and I saw this increase at 3am, then you're saying that if I was on shift work and went to bed at 10am, every day, I might see the same thing at 3pm.

Jennifer Smith, CDE 6:46
Right, that makes sense. Exactly. Okay.

Scott Benner 6:50
Yep. So that's attached to your sleep, not the time of day. And it would smokey be the same thing, then? Is it? Let me think, hold on, I'm actually have to think this through.

Jennifer Smith, CDE 7:04
That would be a really interesting, I guess it would be the same thing. If you think about high blood sugars in the morning, and you've got your bazel dialed in, you know that it's controlling the dawn phenomenon. And now today, let's say you look at your CGM. And you see that you have a, you had a low blood sugar, you didn't realize you didn't treat it overnight. And now you wake up with this high blood sugar in the morning. That would be more the smoky, regardless, again, of whether or not you're sleeping from 10pm until 8am, or you're sleeping from noon until 8pm.

Scott Benner 7:37
Okay, I have to I have to figure something out in the world and name it after myself. I love that this guy's been dead for 50 years, and we're saying his name. And that is such a fun name. Yeah, yeah. And some doctor in New Jersey got some juice off in the other episode because I googled wrong.

Jennifer Smith, CDE 7:55
Exactly. That's, that's kind of fun. I know, my name wouldn't be very fun to name something after Smith.

Scott Benner 8:00
So so if you're on a pump, and you have dawn phenomenon, you're gonna need an increase in basal insulin, prior to when you see the rise through the rise.

Jennifer Smith, CDE 8:12
Correct. Now, there's an interesting, and you might have thought to maybe bring it up. But here's an interesting thing that some people even see, they might see a small incremental increase. So let's say they adjust their bazel slightly, it's not too much, let's say point 05. It's tiny, incremental change. But then, when they've done their bazel testing, that seems to work. But now that they're noticing more, they see, when they finally do get up, there's this more considerable rise in blood sugar, which a lot of people sort of, and we refer to as like the foot on the floor syndrome. Technically, like a syndrome or like anything, it's, it's just, it's literally you get out of bed and 30 minutes later, your blood sugar could be going from 82, all the way up to 150. And you're like, what the heck yeah, did my bazel testing What's going on here? And I think, in that regard, it's actually easier to pay attention over the course of a couple of days. And see, what is your average Rise of the foot on the floor like impact that you're getting, let's say over the course of three days, you look at this and you're like, yep, my blood sugar went up. 40 points, it went up. 60 points, it went up. 50 points. Great. You're getting an average of 50 point rise in your blood sugar. You know, soon after you wake up in the morning. It's rather than fiddling with your bazel it's actually easier to just Bolus

Scott Benner 9:45
that's what I tell people to do.

Jennifer Smith, CDE 9:47
That's for the rise you're expecting.

Scott Benner 9:49
Yeah, that's what I do for Arden and that's what I that's how I talk to other people about it. Dawn phenomenon, totally tackable with basal insulin, you know on a pump Obviously easier, but making sure that you don't have a deficit of bazel. If you're MDI, in that timeframe, doing that by, you know, moving around on the clock when you inject your bazel. The other one, I guess we're going to do well, okay, so I hope everyone enjoyed that there's going to be another one about feet on the floor, so go listen to that one, too. If you'd like to hire Jenny to help you with your type one diabetes, check her out at integrated diabetes.com. Thanks so much to the Omnipod tubeless insulin pump. If you'd like to get a free, no obligation demo of the Omni pod, do it now at my Omni pod.com Ford slash juice box, learn more about the Dexcom g six continuous glucose monitor, see those trends, see your direction, see your speed dexcom.com forward slash juice box, get the best blood glucose meter on the market, in my opinion, at Contour Next one.com forward slash juicebox. You want to see people doing good things. For other people with type one diabetes, you need to go to touched by type one.org. And of course, to get involved simply in some type one research that helps everyone with Type One Diabetes. And to do that right there from your cell phone or from your sofa without ever leaving your house and just a few minutes, T one d exchange.org forward slash juicebox. You go to those links, you are doing something good for yourself good for somebody else and supporting the podcast. All of those links are available right here in the show notes of your podcast player. And they're also at Juicebox podcast.com. Click the links support the show. You all should know by the way, when I say click the links support the show, the pentameter of that reminds me of save the cheerleader save the world, from heroes to remember that TV show on NBC. Anyway, here's a little look into my head. There are countless other episodes of the finding diabetes available for you right now. And that's probably a lie because they are accountable. There's not so many of them that I can't count them. But I'm not going to count them a couple of ways to get them. Go into your podcast, app search defining diabetes, they'll all pop up. Go into the stream in your podcast app, all episodes, scroll down, you'll see them you can go to Juicebox podcast.com. and scroll down a little bit. Right. And you'll see all kinds of stuff. Let me tell you some of the stuff you'll see on the main page all the after dark episodes. Right now we have after dark divorced, and co parenting after dark sex with type one from a male perspective sex with type one from a female perspective, depression and self harm, trauma and addiction, weed smoking, drinking with Type One Diabetes, there's also all kinds of episodes that are focused on algorithm pumping. And then you know what you get actually click books to look up. Hold on. So Excuse me. Also, I have all the pro tip episodes right there on the front page, and recent episodes. Now if you go to, then you click on a link up top right it says Juicebox Podcast, you click on that. Now all of a sudden, you're looking at the defining diabetes episodes. There's fat and protein rise compression low and interstitial fluid rage, bolus bumping nudge feeding insulin, these little diabetes terms that maybe you're just like, I don't know what they mean when they say insulin resistance. But I have an episode Virginie I explained that to you. ketones stop the arrows brittle diabetes low before high Pre-Bolus trust what you know will happen will happen glycemic index and glycemic load as a defining diabetes. But you know what we have coming up a pro tip about it. There's non compliance and algorithm and on and on and on. If there's a diabetes term that's been set out loud, Jenny and I have defined it on defining diabetes to new ones that are out right now around this, like I mentioned the beginning. I think go together with this one. The other two are feet on the floor. And this Moji effect, the sum Mogi effect. I don't know how to say that word, but you'll see it it'll be the only word that sounds like some Oh gee, when you read it. Looking for a great doctor or other type of diabetes practitioner. Check out check out whoo there goes my voice. Check out juicebox Doc's calm and ever growing list of podcast listeners favorite practitioners? absolutely free go in there, find one or send me one to add.

Diabetes pro tip episodes can actually be found in all the places I just described in your podcast that ended diabetes pro tip.com. If you're enjoying the podcast, please consider sharing it with someone else.

Please support the sponsors

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Scott Benner 7/23/20 Scott Benner 7/23/20

#360 Defining Diabetes: Fat and Protein Rise

Scott and Jenny Smith define diabetes terms

Defining Diabetes: Fat and Protein Rise. 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 Podcasts - iHeart Radio - Radio Public or their favorite podcast app.

Check out the Diabetes Pro Tip episodes and Juicebox Docs

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
This episode of defining diabetes is brought to you by Omni pod, the tubeless insulin pump, and dexcom, makers of the dexcom g six continuous glucose monitor. Find out more at my Omni pod.com Ford slash juice box and dexcom.com Ford slash juice box on the pod we'll even send you a free no obligation demo. In this episode of defining diabetes, Jenny Smith and I will be defining fat and protein rise. Now you know Jenny, she's an 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 systems. 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.

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Let's do protein rise. Because as you know, and these are separate episodes, so you would have heard me say on one of these other define diabetes, but I got the chance to wear a glucose monitor for 10 days. And I ate pizza. And hours later, my blood sugar started to go back up again. I was like oh my god, this is the thing. You could see it. It's not as bad as if you have diabetes nowhere near and I guess for context what it meant what I meant by that was I ate pizza. I was in like that it was at the end of the day. So my blood sugar was more like 95 or I'd been snack. I was listening. I made the pizza from scratch. So you know there might have been some pepperoni and cheese going in. And maybe I was stepping in the sauce along the way while I was working. So I had some food going. I was snacking a little bit made the pizza I ate the pizza. About eight o'clock at night I had two slices of homemade pizzas. So you know, basic ingredients, not giant slices. And it midnight, my blood sugar tried to go off. And I was like what sorcery is this? You know and it and I'm texting Jenny the next day. I'm like, I gotta fat and protein rise yesterday was the weirdest text our text while By the way, Jenny and I will do an episode at some point that just is me talking about wearing a glucose monitor because it's frying my mind. But But anyway, a protein rice, can we say fat and protein rice here? Do you think it's worth just describing them that way together?

Jennifer Smith, CDE 4:11
I think they're both.

They're both food specific. They both happen or start to happen in about the same timeframe in the aftermath of a meal. They both have a little bit of a different impact and a little bit of a different strategy for managing them or preventing them really. But yeah, I think they they go Okay,

Scott Benner 4:32
so we're really good. This is going to be short. We're really just going to define it here because Jenny and I have already done what I think is an exceptional pro tip episode about fat and protein rise. But for those of you who are newer to diabetes and are hearing people say Oh, that looks like protein to me. And that doesn't make any sense to you because your endo told you that protein doesn't have carbs and it does your car. Yeah, capture carbs, you'll be fine. It's not the case. So like I said deep dive in the pro tip episode, but for defining purposes, when you hear someone say that looks like a protein rise, or a fat rise, or a fat and protein rise, Jenny's gonna explain to you what it is right now, because she's better at this than I am.

Jennifer Smith, CDE 5:10
Yay. So protein and fat do have impact on blood sugar, it all is relative, essentially, to portion and sometimes the content of what you're eating at a mealtime, right. So protein and fat rise, usually, you're going to see it started about the same time in the aftermath of a meal sometime between about two to three hours after the meal, sometimes a little bit later. Like your example with the pizza started a little bit later, like the four hour kind of mark, probably because it was a little bit both of protein and fat. Yep, kind of happening, right. But protein typically will raise blood sugar into scenario is one, you've had a really large amount of protein more than the typical three to four ounce, you know, portion at a meal time, or you've eaten a really low, almost no carb containing meal. And so then what ends up happening is the body breaks down protein, in both scenarios, into Google's starts to happen hour and a half to two hours after the meal, you get this like slight rise that happens, if you don't compensate for some of the protein at the end of the meal. With insulin in one way or another, you're going to get a rise, and then you're going to end up correcting to get it back down.

Scott Benner 6:22
And so if you're looking for a very simple way to wrap your head around that concept, you know, when you see somebody market something that's pure sugar, and they say it's fat free. There, and technically they're right, there's no fat in the sugar, and then you eat the sugar and your body goes, What should I do with the sugar? Hmm, you know, don't turn it into fat. So, technically, you're right, there was no fat in it when you ate it, but it all became fat afterwards. So similarly, you eat this protein, and there are no carbs in it. But then your body begins to break the protein down, and all of a sudden, your blood sugar starts going up. And for most people, it makes zero sense because you'll think I ate like zero carbs at my last meal. This doesn't make any sense. But it does. And it's real. And it's always going to happen. It's not, it's not not going to happen. So when I look at Arden's food. And I'll be like, oh, there's, you know, I don't know, a roll. And I always throw in. I don't know, I don't want to give people a number because what I do is completely random. But when I see some meat on

Jennifer Smith, CDE 7:30
random for artists, right, right for art,

Scott Benner 7:34
yeah, six or seven carbs, I add for for the protein if there's cheese involved, or a lot of butter or something like that. And sometimes I go to 10. But, you know, there it is, it's going to happen now, like Johnny said, but pizza, and this will be explained in the pro tip episode. But there's the cheese in the pizza slows down your digestion, which pushed basically, for me pushed off the digestion of the crust, way out into the future. Because as a person without diabetes, I don't think I was getting much of a rise out of the protein or the fat I was, I just my body didn't, quote unquote, get to the dough until a significant time later. So that's what a fat rise or a protein rise is. If you really want to understand it, Jenny did an amazing job of explaining it. And I pretend that I knew what she was talking about in that episode. So I'll put the episode number at the end so people know it. But it's it's game changing. There's also a couple episodes around keto eating, or low carb eating that that go deep into this idea as well.

Jennifer Smith, CDE 8:44
Yeah, the person who had on for the keto was very, very, they were very good. Well explained,

Scott Benner 8:49
oh my god, she's going to just be giddy when she hears you say that just so you know. She's, I will get a note at some point. So I'm talking to you in the future. Now, I'm gonna get a text that said, Jenny just said I did a really good job of my bike months from now and I'll be like, What did she

Jennifer Smith, CDE 9:07
was great. It was it was good.

Scott Benner 9:09
She really understands it now in a different way. To learn more about how fat and protein can affect your blood sugar, check out Episode 263 diabetes, pro tip, fat and protein. It's with me and Jenny. It's a much longer description of what we talked about here. Friends, it's time to get yourself a free, no obligation demo of the Omni pod sent over to the house. Okay, let's talk about the Omni pod tubeless insulin pump, besides being absolutely spectacular, is the insulin pump that my daughter who was about to turn 16 has been wearing every day since she was four years old. That's a long time. Every day on the pod comes through exactly the way we expect it to and in a myriad of ways By being unobtrusive by being tubeless by helping us with extended boluses Temp Basal rates and just being what's the word I want really just it's there, it's solid. You don't I mean, like it does, it does what I think it's going to do when it's going to do it, I get what I expect. And what I expect is a quality insulin pump. That gives me the delivery and the wearability for my daughter that we need. And that means that she can stay attached to her insulin, when she's playing sports without being obtrusive, while she's taking a shower, sleeping, running around in the backyard, jumping on the trampoline, riding a bike, swimming, all of the things that your body still needs insulin for, you know, when you hear people saying, Oh, I disconnect for that? Well, they don't have insulin during that time. And that's very likely gonna cause a high blood sugar. Now, I understand that two pumps need to be disconnected sometimes. But the Omni pod never needs to be disconnected. It's tubeless. Wonderful. And you don't have to take my word for it. Because on the pod will be thrilled, happy, elated, delighted to send you a free, no obligation demo that you can try on yourself. Find out if what I just said is true. But you notice, but still try my on the pod.com Ford slash juice box. Check it out, get the demo, decide what you want to do. If you want to keep going with Omni pod, it'll be easy. And if you don't, no harm, no foul. You were just trying. That's why they call it no obligation. Now I have an obligation to tell you about the dexcom g six continuous glucose monitor. This application is both business oriented because their advertisers and moral because I think everyone should know about the dexcom g six continuous glucose monitor. Here's why. I'm going to use an example from this morning. Arden wakes up her blood sugar is 106 I see it on her Dexcom nice and steady. I hear her moving around upstairs. No big deal. She's getting her facewash getting dressed getting ready to actually go out right now. All of a sudden her blood sugar diagnol up starts moving up. 106 turns into 115 turns into 118 all of a sudden 125 Well,

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Unknown Speaker 14:49
All right, a little

Scott Benner 14:50
bit of music, and we're out of here. Do I have any announcements here? Maybe one Hold tight. You can find the rest of the defining diabetes series as well as ask Scott Jenny and the diabetes pro tip episodes at diabetes pro tip comm you can find them too at Juicebox podcast.com. But, you know diabetes pro tips pretty easy to understand notice after the P, so just the P no si p a.com diabetes pro tip.com. Also, if you have a great doctor or need one, for type one diabetes, check out juicebox Doc's calm, do cs juicebox Doc's calm and ever growing list of Type One Diabetes health care professionals that listeners of the podcast have recommended. Let me give you a couple of examples. For instance, right there in Australia, Rachel Baker, Rn and CDE he does some amazing work. How about up in Canada? Dr. Jeremy Gilbert over in Ontario, that's Toronto. You understand Toronto, Ontario, right? Like Canada does their places weird? I mean, compared to how we do it? How about Melissa and tonic? in Fairfax, Virginia alfonzo Armstead, Nashville, Tennessee, and many, many, many more. And people put in effort when they send in their doctors to give real examples of why, for instance, someone wrote in that Elizabeth Harris in Chapel Hill, North Carolina, she said about Elizabeth. I've worked with Dr. Harris for close to a decade and she's taking care of me through many different stages of my diabetes from the disengaged teenager to the engaged but struggling young adult to well controlled debate goes online. Check it out, juice box Doc's calm. It's not a pay service. None of the doctors are paying me to be there. It's just me trying to take your good experiences and putting them in one place to somebody else can get the advantage of what you've learned about your doctor.