Scott Benner 12/4/20 Scott Benner 12/4/20

#415 Defining Diabetes: Adrenaline Highs

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain adrenaline highs.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - 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 0:09
Hello, everyone and welcome to Episode 415 of the Juicebox Podcast. Today on defining diabetes Jenny Smith and I are going to define adrenaline highs. Today's episode is part of the defining diabetes series, which lives here inside of the Juicebox Podcast. It's where Jenny Smith and I take terms from your life with type one diabetes, and explain them in ways that we hope make them useful and understandable. Myself friend, Jenny Smith has had Type One Diabetes since she was a child, I think for over 31 years now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. And she is one of the few people who when I know I'm going to talk to her, I start smiling inside. Please remember, as you listen that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Now the music will build to a crescendo and we will begin.

Jennifer Smith, CDE 1:27
Did you notice my different room? By the way?

Scott Benner 1:29
I wasn't sure if you redecorated Are you move but you're definitely right.

Jennifer Smith, CDE 1:33
This is actually where our router is. So I'm in our This is our basement. And so it's where we have like all it's a finished basement. So we have like our TV and everything down here. But I came down here because when it's quiet down here, buddy, bothering me. And two is my connection point. So nice and stable. The microphone is really easy to move in my computer is obviously mobile too. It was

Scott Benner 1:59
just like, here I go. I have to admit the other day Kelly seemed very upset. And I think it was because I get to work upstairs in a closed room. And she's downstairs in the dining room and we have an open floor plan. So people are just like, Hey, Mom, what's up or the kids will like come in and lay on or you know, like something like that. Just like I'm just trying to get a vaccine out so people can go back to work. Take your time right on top of me. It's fine. Yeah, so I get the private place idea. I have to say, I'd like to talk about adrenaline highs. Ah, because so I've tell us so I've told the same story on the podcast forever. And I'll do it very quickly here. Arden, I don't know it was eight or nine years old playing in this like Sunday morning Basketball League. It's just very fun thing where the girls all got the same color t shirt, they'd show up at a gym and play. And we'd show up one day and come in the door. You know, her blood sugar's are perfect. And she'd play and nothing would happen. And then you'd come back the next week. And we'd come in or blood sugars were great. And she'd play and our blood sugar would jump up to like 250. And it sometimes would jump up and sometimes it wouldn't. And after a number of weeks, I just I remember saying to Kelly like we can't let this keep happening. And she's like, well, how are you going to do something about it if it happens sometimes and not other times. And that's when I did you know devise the the idea of will Bolus for a juice box. And if she goes up, then the insulin will work on the number and if she doesn't go up, we'll give her the juice back. Right. Yeah. which ended up being a way that I talk to people about how to use more insulin when they're not sure how to when they're like well, I don't understand, like, I think this meal needs more. But I don't know how to like have the nerve to just use more. And I end up saying well Bolus for a juice box on top of it. And then what most people find a lot of the times is that it turns out, I needed that insulin anyway and you're never drinking the juice. But if you have to you have to and then you kind of figure it out from there. But it took me a long time to recognize that Arden was competitive. And if she showed up one Sunday and saw five little girls across from her on the course that they thought they could easily beat her blood sugar didn't go up. And if she thought they were in for a fight, our blood sugar jumped up. And that's adrenaline. Now here's the downside of bolusing for adrenaline is the minute the adrenaline's gone. It's like somebody opened up a trapdoor on your blood sugar, and just let it all out at one time. So that that adrenaline to me in my mind is artificially holding up your blood sugar, you can combat it with insulin, but if the adrenaline should go away prior to the insulin, you're kind of in trouble. Is that how you find it?

Jennifer Smith, CDE 4:46
Kind of and or I guess the same example would really be let's say they get hyped up for a game in which your example being it's it's a team that you know is a really tough team, whatever. Well what ends up happening is your adrenaline goes up and let's say team, the other team is having a really bad day and your team is doing like, phenomenal. Well, that adrenaline level may very well then go down faster than if the game was this back to back kind of need for I mean, adrenaline really is the, it's the fight or flight hormone, right? gets you ready, it gives you the surge of like release of glucose into the system, because your body needs the energy to get moving. Right. So, I mean, if that all of a sudden is not so significant anymore, at the end, or at the end of the game, you won the game great, all is fine and good. And down goes the adrenaline and down comes the blood sugar, then you're left sort of feeding insulin that you gave earlier, so that you didn't have you know, a 250 blood sugar with the adrenaline surge. But you do end up having to cover it because it's not adrenaline isn't the same. It seems as a deficit of insulin from like lingering stress, or food that you didn't end up covering, or something that's going to stick around that you definitely needed that extra insulin for in fact that in that scenario, it may not even be moving the blood sugar down. So okay.

Scott Benner 6:15
Yeah, we would, what we would do is the way we timed it out was insulin, adrenaline, leave basketball game, run to food. And then it was a Sunday morning. So we would just run into a diner and she'd get a waffle. And it was kind of perfect, because we'd basically we'd basically Pre-Bolus the waffle with the adrenaline fight. And then, of course, on the back end, yeah, yeah. This is a very early on example, in our, you know, in our life with diabetes, and but it is how I learned about those things. And more recently, you hear people like, Oh, I was sitting around watching the election results, and my blood sugar's were really high. That's anxiety, stress and adrenaline, right? Yeah. Yeah. Okay. That's so adrenaline. I

Jennifer Smith, CDE 7:02
think, I think there might be some to ice, you know, working with a lot of like school aged kids. There's often this, I hear it over and over, my child is on the bus. As soon as they get to school, and they enter school, their blood sugar climbs, they could have been at this beautiful steady for an hour past breakfast already. And now they enter school. It's kind of like the foot on the floor. Yeah, kind of thing, right as they enter school, and up goes their blood sugar. But on the opposite end of that, you know, we end up like, maybe we pump in more insulin through that time period of the day, then or maybe we pump it in through lunchtime, because they're super just anxious or stressed about school, or they just get that much that much excitement out of going to school and performance whatnot. As soon as kids leave school, the same thing as what you saw with your daughter. It's like, I'm heading home. There's nothing else I have to do. I can lay on the couch and watch cartoons or whatever it's going to be you know, but down comes the blood sugar and you've got this load of possibly hours worth of popped up diesel rates. Yeah, or extra insulin being given now at a time period, whereby is like, yep, I don't need any more. Thanks. Thanks so much.

Scott Benner 8:10
Arden, it happens exactly like that, like school ends, she get out, she gets outside. Like if she comes out to my car with an 85 blood sugar. In my mind, I think she's got 10 minutes, she's got 10 minutes to get to a snack. Like that's it like, like, and I that is the way I think of it is that all the things that we did during the day to keep our blood sugar stable is a Pre-Bolus for what's about to happen. And you have to, you have to know it's coming. If it's if it happens to you or your kid, and I'm assuming it happens to adults too, leaving work like stressful jobs. Anything really social interactions. I mean, when we are allowed to interact socially, again, I think that it would be the same thing like you meet somebody you're nervous to meet. Or you know, you want to make a good impression. You know, there's so many different things. It's funny like so I googled it, adrenaline impacts blood sugar, and you don't get enough back from it. That's not very what I want to say. More like studies and stuff like that is there's no like there's no like real world people saying oh yeah, if your blood sugar goes up, it could be from adrenaline or vice versa. If it drops, maybe your adrenaline's going away, your stress has gone away. So I just wanted to go over it because I don't know that it's um, well enough understood. And I know we talked about it in the podcast, but never like, give it its moment. So adrenaline is a

Unknown Speaker 9:38
Is it a?

Unknown Speaker 9:39
It's a hormone ephrin

Scott Benner 9:41
it's definitely okay. And so, similarly, and we won't get into it here but around menstruation, it's progesterone that causes the one of the problems right

Jennifer Smith, CDE 9:51
one of Yeah, one of the main hormones. I mean, there are others but yeah, progesterone is one of the big ones in that tree. Pre cycles start time period. Yes. I mean, there's always there's also a whole bunch of other, you know, hormones in the female body things like estrogen and luteinizing hormone and all these other kind of components that happen throughout the cycle. But progesterone is the big one. And that's the really big one, too, that in the early phases of pregnancy, and as pregnancy progresses, that's a major impact on sensitivity to insulin and increase in insulin resistance.

Scott Benner 10:32
Yeah. Okay. Because there's somebody contacted me actually should find their note, but I will do it in a different episode. But she said, like, I narrowed it down to the spot in my cycle, where the progression comes in, like is where I get this, this big impact. And I'm like, that's super interesting. I wonder if using a birth control pill, does that lessen the impact?

Jennifer Smith, CDE 10:55
I've found that I mean, from again, all the women that I've worked with, there are so many kinds of birth control pills on the market today. I mean, like every other drug on the market, they're, like, 20,000 of them, right. And I think it really is relative to the dose that's being given that type of birth control, whether it's IUD or it's the typical like pop the pill kind of birth control pill. They all supply a different amount of hormone control for that. I've seen some women who have they swear they have no change in their insulin needs, their blood, sugar's anything with their pill, and some women who swear a 10 pound weight gain. Now they're dosing with, you know, 25% more insulin than they ever did before. So,

Scott Benner 11:43
yeah, I have to say no, and then we'll move on to another one, that some of the biggest helps the people with diabetes, or other people's anecdotal information. And I also think sometimes it's the biggest impediment to people, because some people just see one thing, and it's not true. And then they share it. And it's, oh, this does this. And now that's in your head, you know, and you and you just stop thinking about it. Because you believe Oh, I know, now this, this person online told me, you really do have to

Jennifer Smith, CDE 12:14
kind of like the same thing as looking at one person's like straight, beautiful graph that they post. But you don't know what went in to doing that.

Scott Benner 12:22
Yeah, how that happened? Or didn't How

Unknown Speaker 12:23
did that happen? Right? You

Scott Benner 12:24
have to know more, not just the thing they say, right? Well, Jenny is a frequent contributor on the show. She doesn't get paid to be here. But she is for hire, at integrated diabetes.com should go check her out. I'd love to make a couple of brief announcements, housecleaning, if you will. Before I go. First, you may remember that back in August of 2020, I was celebrating the 2 million downloads of the podcast was very exciting. Well, it is 114 days later, and we are celebrating the two and a half million episode of the podcast. Now those numbers may only mean something to me. And I imagine they wouldn't to you, but a half 1,000,114 days is really exciting. And I just want to say thank you to each and every one of you for your continued support your listenership. And for sharing the show with others, I am truly grateful that the show has resonated with so many of you. And I love making this podcast for you. I want to shout out the oldest sponsor of the podcast on the pod.

Unknown Speaker 13:37
They

Scott Benner 13:38
supported the show by buying ads before anybody could have imagined that we'd have two and a half million downloads. And it's very possible that there could be four by the end of the next calendar year or more. I don't even know it's the way you guys are sharing the show. It's It's amazing. But my point is, is that back when the show had nobody listening, and I was like, I think I can get 1000 people a month to listen. They bought an ad. And they did that when I asked if they'd be willing to support this thing that I meant to do. And for clarity, if you haven't been listening along, what I meant to do was help people with type one diabetes. That's what I wanted to do. I wanted your lives to be lighter, easier, healthier. That was my goal. And I told them that it was going to take some time. And then if they could help me by supporting it financially a little bit, then I think I could turn it into something. Well, you have to give them a lot of credit. Actually one person in particular I'm raising my glass to right now. And she knows who she is. But she bought an ad when there was almost nothing to buy an ad on. And I'll never forget that. That first ad allowed me time to build this podcast. allowed me to go to my wife and say, Look, it's not just this, you know, it's not just another thing I'm doing online for free to help people, this might actually pay a bill one day. And that was enough to let my wife say, Alright, you know, try it, I'd like to help people to, you know, but we're just like you, we have kids going to college, and we need food. So I couldn't just spend all my time up here. And on the pod, they really came through. I'm forever grateful for that moment. Because this podcast has become something that I am truly deeply and genuinely, very, very proud of. Just to reminisce, for another moment, I recall back at that conversation with Omni pod, telling them, you know, I'm not sure if I'm ever going to turn this into something, it's going to be that valuable for you. Meaning you know, that you'll be able to reach people with your message. And by the way, their messages, try your free no obligation demo of the Omni pod today, at my Omnipod comm forward slash juicebox. But that's not the point. The point is, is that they were okay with that. And I like being involved with people like that. Somebody who said, Look, if it helps people, and it never turns into a business, we're still here to help people with diabetes. I remember that moment as clear as day. And I sometimes wonder if they would have said no, if this show would even exist. Anyway, trying on the pod, they're cool. Speaking of cool people who support the show, we've had all the meetings and all the conversations, and everyone's back in 2020, this podcast will have advertising from Omnipod Dexcom, the Contour Next One blood glucose meter, touched by type one, G, Volk, hypo pen, maybe someone else are still getting things together. But great, great sponsors that I have full faith in, which gives me the ability to speak about them freely from the heart. And I like that I would not know what to do if I had to shuck and jive for you and tell you I liked a meter that I never used before. I I don't think I could bring myself to do that, actually. So I'm really thrilled that everybody's back. Thank you so much for the continued support. And thank you to all of you for making the show something that anybody would want to get behind. And speaking of supporting things that also support the podcast. Don't forget to join the T one D exchange registry. All right, ready, let's test me one take, I won't stop. Join the T one D exchange registry at T one d exchange.org. forward slash juicebox. When you add your information to the registry, and you're a US resident with Type One Diabetes, or a US resident, who is the caregiver of someone with type one, you will be adding data that will help people with type one diabetes in countless ways.

Would you like to try a free no obligation demo of the Omnipod tubeless insulin pump or my omnipod.com forward slash juice box fill in a little bit of information and an insulin pump for you to try on and where Don't worry, it's not working, you'll be okay. We'll be at your house in no time. And to learn more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com forward slash juicebox would you like to use the most accurate and easy to carry blood glucose meter that I've ever seen? Of course you would Contour Next one.com forward slash juicebox check out that Contour Next One. Check out that oh I almost did it without flubbing check out that Contour Next One meter now you can also find out more about there. I just lost the word tester program. And you may even be eligible for a free meter. two meters terrific. Seriously check it out. Contour Next one.com forward slash juicebox this is what happens when I don't edit myself ready. My daughter uses g Vogue hypo pen and you should to G vo glucagon comm Ford slash juice box. You want to see people doing great things for people living with Type One Diabetes, you're going to want to go to touch by type one.org and visit them on Facebook and Instagram. Did I forget anybody Dexcom on the pod Contour Next One. g Volk pypo pen touch by type one T one D exchange. I did it. That's it. Thanks so much for listening. I hope you have a great weekend there's going to be a really special. There'll be saying I promised I wouldn't edit now I'm tripping over my words. There's gonna be a really great show coming next Friday. That's gonna have an announcement. Little interactive thing you guys could do if you want. But uh, that's for next week. Thanks so much for listening to the Juicebox Podcast and thank you for making the show so incredibly fulfilling. For me and for the listeners, which I guess this year, take care. I'll see you soon.

He's still here. I'm just gonna let the music run. Let me turn it up.

Because I better very repetitive I get so that I can talk over top of it while it's low when you hear music, but you know it's not distracting. You did. How was everybody's Thanksgiving you guys do all right. Wait, do I tell you how our Thanksgiving when I'll put that in an episode next week. Boom, boom.

We're getting there. Like 10 or 15 more seconds, you can make. Oh, by the way, if you're enjoying the show, please leave an amazing rating and review on Apple podcasts or wherever you listen to your podcasts. And if you're listening to podcasts that Subscribe, Subscribe, subscribe. Links to all the sponsors are available at Juicebox podcast.com or right here in your podcast player show notes.

#408 Defining Diabetes: Insulin Sensitivity Factor

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain insulin sensitivity factor (ISF)—or correction factor—which is how many points one unit of insulin will drop your blood glucose level. They discuss how the ISF is initially determined, that it does not necessarily remain the same throughout the day, and the importance of considering modifications to the ISF value for hormonal or other changes along with other setting changes.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:11
Hello, everyone and welcome to Episode 408 of the Juicebox Podcast. Today's show is the defining diabetes episode, Jenny Smith and I are going to talk about insulin sensitivity factor, also known as correction factor. This episode is part of the defining diabetes series. Actually at the very beginning of this, I'll go through all of the other definitions that Jenny and I have done together. But you can go find them in your podcast player. Please remember while you're listening 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. My friend Jenny Smith has had Type One Diabetes since she was a child I think for over 31 years now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. There are very few people I asked Type One Diabetes questions of Jenny is at the top of that list.

The Juicebox Podcast is sponsored by the dexcom g six continuous glucose monitor the Contour Next One blood glucose meter, the Omni pod tubeless insulin pump, g Volk hypo pen and touched by type one. You can find out more about all the sponsors right there in the show notes of your podcast player. Or Juicebox podcast.com.

Jennifer Smith, CDE 1:52
My cat might come in visit here cool.

Scott Benner 1:55
Oh, how come we've never seen your cat before?

Jennifer Smith, CDE 1:58
Do you want to see my kitty cat?

Scott Benner 1:59
her or him?

Jennifer Smith, CDE 2:02
It's this one's a girl. We've got to two this is Lucille Ball buster. I don't know if you're a fan of Arrested Development.

Scott Benner 2:11
I know the show very well. That's where the names

Jennifer Smith, CDE 2:14
muster. One of our license plates is go bias and the other one is on young.

Scott Benner 2:22
We've already done a lot we have we've done laughs ready we've done Bolus timing range. bazel honeymooning standard deviation noncompliant algorithm extended Bolus Pre-Bolus Trust will happen glycemic load and index stop the arrows insulin resistance and over Bolus brittle diabetes low before high ketones bumping nudge rage, bolus compression loads and interstitial fluid. Oh my gosh, we've been doing this a long time. fat and protein rise feeding insulin dawn phenomenon feed on floor and the smokey effect. So that was the last one we did. Yeah, we did feed on floor Smokey and Dawn phenomenon like kind of all at the same time. So good question, what is left? I think more than I thought, actually, because I get to watch people talk about it online. I keep getting notes from people who say that these, like I think of the the defining diabetes series is like this nice little like addition to the show. For a lot of newly diagnosed people. They start with that, because they're getting so many terms thrown at them. They don't know what they are. So there's some that I'm gonna admit, I don't completely get all the time. Like I know how to use them in practice, but not theory. So I want to start with insulin sensitivity factor. Oh, that's a good one. But I want to I want to talk about it. Like, in every way, like how do people think of it MDI pumping algorithm?

Unknown Speaker 3:46
Okay,

Scott Benner 3:46
yeah. Okay. Yeah, I don't know anything about this. So so if I come into your eye, if a person gets diagnosed, and they show up in the, in your, your office, and you're like, Okay, here's what we're gonna do, we're going to set your insulin sensitive sensitivity factor at how do you get to that number? What is it and why is it?

Jennifer Smith, CDE 4:04
Yeah, I mean insulin sensitivity factor, and to clarify for some, like both on Omni pod as well as on tandem in the pump. Now it is called correction factor. Okay. So if you want to think about that, I think it's a little bit more, it's a little clearer what the term kind of implies insulin sensitivity factor correction factor, they're essentially both the same. What it means is, how many points or how many milligrams per deciliter, or if you're using millimoles, the same. one unit of insulin will adjust your blood sugar down by so let's say right now you started at a blood sugar of 180 and your ISF or insulin sensitivity factor it's at and you wanted to get your blood sugar to a target of 100 unit will drop you at points to get you to 100

Scott Benner 4:59
Okay, So it's so I think of it as correction factor. I guess, interestingly enough, yeah. Okay. But in honesty, if my blood sugar is, by the way, I have this like, I'm just doing that theory I go if my and then people are like you don't have diabetes, like I know If a person's blood sugar is 180 in your scenario, and you want to get it to 100, your correction, you know, your correction factors, you know, one unit per 80, obviously, a unit should move to 100. But

Jennifer Smith, CDE 5:29
should is the right, well, what

Scott Benner 5:31
if my blood sugar's 280? Now the same correction factor isn't going to work the same way.

Jennifer Smith, CDE 5:39
Often, what most people find is that over about a blood sugar of 250, which is also where your pump starts reminding you if you are a pumper, and or even if you're using MDI, you're often told if your blood sugar's above 250, check your ketones, right? So above that 250 Mark, it seems we kind of get like this sticky momentum of insulin, it doesn't quite work as it does when your blood sugar is high, but not yet. 250 or above. So it's a good question, because a lot of people get really, really irritated. I'm taking what I usually take, and last night at work totally fine. And last night, my blood sugar got high and it didn't work at all. Well, I mean, outside of any other variable to consider, let's say it's truly just the same scenario. Maybe blood sugar one night was 189. And the next night it was 297. Yeah. Right. So it does take a little bit more insulin to move your blood sugar. When it's higher than that about 250 mark. And I think something else in the picture there is you have to consider the deficit of insulin and maybe how long that deficit has been going on, like how much is really missing? Yes, one unit, again, in our example, should move your blood sugar by 80 points. But if you've been sitting at a 250, plus blood sugar for several hours, you're at a pretty significant deficit of insulin, almost like a glucose toxic setting, if you will. And so it's gonna take a little bit more insulin as well, as we've talked about it before. I think we had either part of an episode or whatnot all about hydration. I think it was in the CGM one, right. So hydration is key there too. So if you're not moving stuff around, your insulin isn't going to circulate or get moved and get it working as well as it should either.

Scott Benner 7:33
So isn't it is an insulin sensitivity or correction factor? is first of all, it's a it's a guess more than anything, right? Like you try it like the doctor sets it up for you it works or doesn't they turn it up or down? So it's a guest to begin with, that you dial in over time? That really is a measurement when there are no other influences impacting.

Jennifer Smith, CDE 7:59
That's an Yeah, in a roundabout way. Yes. I mean, the doctor does use a formula to give you a starting place for that insulin sensitivity factor. Most doctor use, they use what's called the 1800 rule, I'm sure you've probably heard of that before. essentially take your baseline insulin, your basal insulin, and you add that dose to the amount of bolus insulin you use on average for a couple of days. And then you divide that number into 1800. And that is supposed to give you a relative idea of what your sensitivity to insulin is, or will be, meaning one unit should drop you about this many points. So let's say your ISF is 60. You divide that into 1800. Right? So 30 is that kind of outcome?

Scott Benner 8:48
I like my way better.

Jennifer Smith, CDE 8:53
I kind of your way is sort of like it's adding precision to it. Right. And I think it also adds into and you've had Kenny on quite a bit, right? Yeah. And he does a lot with ISF right and it correctly too, because really if you look at ISF a lot of people also have one ISF that runs midnight to midnight they use the same darn number all day long. Now I can tell you from personal that does not fit the bill. I have several ISF that run through the course of the day dependent on what I've seen in that time of day when I've only corrected blood sugar again without like multiple variables in the picture. And I know that this works here and this works better here. So while the math of 1800 rule figures out to one stable number, right, that's not gonna really hit it.

Scott Benner 9:50
Yeah. I to me to the the setting of it. Setting up of it is take so much time because of the processor and like see the doctor They'll look at some stuff. Three months later, if you're lucky, we'll adjust it again. You know, it's just that feels untenable, the distance of time. And the way I think of it is like, try this, see what happens, then just move it until it's right and then stop. And I know that's, I don't know why that's scary for people. I'm not like, I'm not saying like, hey, the doctor said, you know, you're one to 50. Try one to one. You know, I'm not saying go crazy. Like I'm saying, you know, if he says one to 50, and you're like, that's not working, make it 145 and see what happens, then you know, and keep going. But you brought Kenny up, who comes on to talk about algorithm pumping a lot. And he's actually going to record with me next month, again. But so when you're using it in a in an algorithm, like in a loop or something like that, Mm hmm. I think ardens right now is like one to 43 I think one unit moves are about 43. And it can move around. It does be perfectly honest, now that Arden's getting older, I can tell you artists, three different people with diabetes every month, she's the she's the having her period person, she's the about to have her period person here. And she's the oscillating person, like there's three different like people she is. And her insulin sensitivity moves from about 42 to 45, or 46, depending on which week Brin and all I do is watch a trend, if she starts trending up and make her sensitivity stronger. If she starts trending down, I take it back a little bit. That's pretty much it, you know, and, and move her bazel a little bit in that time as well. usually pretty commiserate with the insulin sensitivity, the insulin says, yep, you know, it's getting stronger, the base is getting stronger, or vice versa.

Jennifer Smith, CDE 11:51
I think one other thing to comment on that, too, is as you bring up like the doctor adjustments, it's that ISF I've seen over and over is one of the pieces of insulin dosing that gets adjusted the least with the least frequency. Hmm. Most people play with their bezels, often kind of incorrectly because they're not quite sure what's wrong. They know that they need more, but they just add it in one place that they can think of to do at first, okay. And then they may play with their insulin to carb ratio. And ISF is sort of like the last thought. And unfortunately, like you just mentioned, if bezels are going up, because it's that time of the month, likely the other factors need to be adjusted along with that, because there's a resistance factor there that if you only dial in a bazel adjustment, yeah, it's not really gonna hit the need across the board. Well,

Scott Benner 12:50
so you're making me feel like that's how I see people end up with these bezels that are, it's funny, people's bezels are either way too weak, and they over compensate with their meal insulin and they bounced around, or their payables are way too strong. And they're like, Oh, my insert my food, I barely use anything. It's because like, it's because if they were to skip a meal, they dropped that because their bazel is so strong, right? That is, that is interesting, isn't it? Okay. All right, I can

Jennifer Smith, CDE 13:17
tell you kind of along the same lines as I have, and have for a long time, it was kind of like a peeve of mine. Honestly, in tandems pump, you can have a bazel profile that dials in not only the bazel, but also the insulin to carb and the ISF that work with that bazel profile. So all you have to do is enable that profile. And now you've got the insulin to carbon, the sensitivity factor that work with it. So like for a woman with her period or whatnot, you figured out that you need an insulin to carb of eight instead of 10. Great that's in the profile, you need an ISF of something like 40 versus 50, that's in the profile. So all you do is enable it and turns on. The other pumps don't do that you physically have to even though if you might have figured out you need more bazel for that time period, you might enable it. But if you haven't changed your insulin to carb, or your sensitivity factor, which you physically have to manually go in, have remembered or made a note of obeah I remember I used an eight last month and that worked a heck of a lot better than a 10. Right? Well, now I have to change it every single month. I have to change it.

Scott Benner 14:22
Yeah. Now listen, having it, it would definitely profiles are important. I think they really are to get them set up so that you can jump from one to another more seamlessly because I lose track sometimes too. You know, sometimes I'm like, what was it 43 or 42 last time this happened or, you know, but at the same time, like I I move everything together, like I think of it is like if I'm gonna send a soldier and I send them all in, you know, it's it's charged not You go first and we'll see what happens like and that way, by the way, you don't have to send as many, you know, so you just a great example, a little more Bolus a little more bazel. A little more factor. Everybody just turned it up a little bit, you know, and how far I don't know, like people would need to play with it for themselves to figure it out, but right, okay. And what I do notice, well, you know what I'm gonna I'll bring this up, I'll bring it up with Kenny because I am going to let Kenny like go on and really discuss his ideas about you know, one basal rate and then you know, working off of that, which like you said doesn't Yeah, it doesn't work for you and it doesn't work for Arden. Exactly. But I think for younger people it works. It can work really well. Better. Yeah, I just I'm I I definitely believe in that. What I said a minute ago that people get their bezels jacked up so high, they think they don't need anything for food. They don't realize that they're just there carpet bombing their entire 24 hours with bazel It's way too much. All right, thank you. You can check out the Dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box. Get a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com Ford slash juice box. Learn more about the Contour Next One blood glucose meter at Contour Next one.com Ford slash juice box. Don't forget to check out g Vogue glucagon.com forward slash juice box. And of course touched by type one.org. Support the sponsors support the show. Jenny Smith works at integrated diabetes. And you can find out more about what she does at integrated diabetes.com. Thank you so much for listening. If you hold on one more second, I have just a couple more things to say.

If you'd like to hear more from Jenny and myself on management of type one diabetes, you should check out the pro tip episodes they begin at Episode 210 in your podcast player, where you can find every one of them at diabetes pro tip.com. Same thing about these defining diabetes episodes just search in your podcast player for defining diabetes. You have a great doctor, or would you like to share one with someone else? juicebox docs.com is an ever growing list of diabetes medical professionals that have been sent in by listeners just like you. Thank you so much for listening to the Juicebox Podcast. There will be another episode this week. I hope you're

enjoying the show. please consider sharing it was someone else leaving a wonderful rating and review on Apple podcasts and hitting that subscribe button wherever you're listening

#380 Defining Diabetes: Feet on the Floor

Scott and Jenny Smith define diabetes terms

The third in a three-part series describing what naturally occurs to blood sugars when we first wake up and prepare to start the day. Scott and Jenny tackle basic T1D terminology in this easy guide for newly diagnosed T1D and/or caregivers of someone with T1D.

+ Click for EPISODE TRANSCRIPT

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 feet on the floor. But there are two others that go with it. The other one's called defining diabetes, smokey effect. And the third one defining diabetes dawn phenomenon.

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's my favorite person. feet on the floor is something that I didn't know people called a thing until I heard somebody say, Oh, that's that's feet on the floor. And I've always thought yeah, I didn't know that. I just found it. I figured it out. And then I attacked it, then I stopped thinking about it again. You know, so I've in in Arden's life, I've attacked feet on the floor a couple of different ways. So but first, like, I guess we'll, we'll define it. I think of it as if anyone's ever played on a football team. There's this thing you do right before the game, they get everybody together and whip them into a murderous frenzy, and then they send you out on the field. They're literally like saying just shy of go rip everyone's head off. Go do it now. And I feel like that's what your body does. When you stand up. It's like, we got to go, this is it. We're gonna go take a shower. We're gonna make lunch. I got to be on time I got to get to school, and it just Jacks you up so that you can accomplish those things. I know that's not technical. That's how I think of it. Is that about what's happening? Like, what is your body doing when you wake up? I'm assuming cortisol and

Jennifer Smith, CDE 4:14
Yeah, well, bunches of different hormones that are supposed to be there. And again, they're, I mean, if you think of them in terms of the flight or fight hormones, right. They're kind of the same thing. It's not like you're trying to run away from a saber toothed Tiger first thing in the morning, but at least not in today's world. But there are all the things as you just mentioned, in today's world, especially as an adult, there are a lot of things that are on your plate. As soon as you get out of bed in the morning. Yes, I have to get myself ready. If you have children or a spouse or anybody that you're a caretaker for that. You have to get ready. You might have breakfasts that you have to make things that you have to pack calls that you have to make, I mean the list just it goes on and on with the chores in the morning time and even kids Think well, why does it happen with my 12 year old child then? Well, kids have a lot of things that they're not really verbalizing. But their brains are thinking through, especially once they get out of bed. And in a life with diabetes, there are things that they're thinking about, again, they might not be talking about them right away. But, you know, what am I gonna have for breakfast this morning is mom and our mom and dad going to be really worried because my blood sugar is gonna go high. If I choose to eat pancakes today. I mean, there are lots and lots of things that are reasons for the rise. But the base reasons really are those like the cortisol kind of the get go, your body wants to ramp you up, and kind of move you give you energy.

Scott Benner 5:40
So what people call feet on the floor, I think of his bolusing for life. I don't know another way to put it really. So you know, if Arden were to wake up at a, an 85 blood sugar, and lay in bed for two hours looking at Tick Tock and Instagram, her blood sugar would not go up. It's got nothing to do with the timing. It's it's quite honestly, she gets out of bed. And then 1520 minutes later, her blood sugar can go from 85 to 120 and catch a diagonal up arrow and keep going if you don't stop it, right, so I always just have her wake up and bolus. And I don't know how much you know me. I don't know, let's throw some insulin in there. Get on the right side of this game, you know, unit today. One little eye care insulin, get it going. And, and that works terrifically. It really does. But I mean, honestly, this is gonna seem like a strange story to put in here, I guess. But when I was 16, for about three or four years, while I was 16. In my hometown, I volunteered as a fireman was a common thing for people to do. And I trained, you know, I got trained, I think we had to do like 100 hours of training, and then you know, you become a fireman. And when there was a fire at night, like in the middle of the night when you were sleeping. We used to have this old technology was so bad back then it was just this box that sat in your house. And they would send out this radio frequency and the box would pick it up, and then make this horrible, harsh, shrill scream that would wake you up, right? I want to say the company was realistic that made it I'm not gonna remember. But this thing I can't even like, I wouldn't even want to tell you that you'd have to cover your ears, it just would go. But so high pitched and loud. And you'd be standing up, I'd be standing on the floor in my underwear. unaware of how I stood up, it was so loud, right. And a few moments later, you're at the Firehouse, you're getting dressed, you're now in a truck, and you are flying down the road as wide awake in this alert as you have ever been in your entire life. I am crystal clear at that moment. Like that's when I should be taking my SAP. You know what I mean? And that has got to be this. Like just your body just going like holy Hannah. We got to go, you know, and this happening. And now I guess in a modern world. People talk all the time about like, Oh, I don't like to get upset because my cortisol levels go up and I get fluttery or nervous or, you know, anxiety hits me for some people. I think it's it like I think a feet on the floor is his life and you have to give yourself insulin for it because it doesn't go away once it's not like adrenaline. Right? adrenaline pushes you up. And then when the adrenaline's gone, your blood sugar drops back down again.

Jennifer Smith, CDE 8:39
Mm hmm. It's definitely different thing first thing in the morning. And I think that's it's a compounding factor when people are trying to figure out that morning breakfast, right? Because if you haven't realized that the rise is already starting, before you go ahead and even if your Pre-Bolus thing for breakfast, and you're thinking, well, gosh, I've waited 15 minutes. Let's try 20 minutes. Let's try 30 minutes. Let's try 45 minutes. And like finally you're at the hour point and your budget or you're still rising and you're like, Yeah, but I Bolus for my food. You're missing possibly a quarter a half maybe a whole unit and a half of insulin for this feed on the floor. impact. Yeah. And so that's it kind of like I said, it sort of covers up what might be going on behind a breakfast and the food kind of Bolus. Yeah. And so it's making you feel like well, gosh, I just I obviously need more insulin. So I'm going to dump more insulin in then and then you end up like you said, it sticks around for a long time if you don't get ahead of it and by getting ahead of it. I think most people that I talked to in teaching about it, it's you wake up, look at your CGM or do your finger stick and give your give your Bolus for that feet on the floor in me Utley. And sometimes it takes like I said before, a little bit of analysis, let's say, your feet on the floor doesn't really start, maybe it's an hour between waking up. And then it actually starts to rise with again, no food or anything else in the picture. But maybe you're the person who sees it within 20 minutes. That's me. I can wait at a blood sugar of 68. And I can have it start within 15 to 20 minutes,

Scott Benner 10:25
but you also don't strike me

Jennifer Smith, CDE 10:26
Oh, that I don't need to treat that low. Yeah, because

Scott Benner 10:30
it's gonna go up. You also strike me as a person who is active in your mind as well as your like your body. Like you're not you don't get up in the morning and think like, well hang around for a couple of hours. And then like you're moving right? Yeah,

Jennifer Smith, CDE 10:44
I don't have hang around. Yeah. And

Scott Benner 10:46
what's that? I said something that is literally say to you on an episode recently, and you're like, you have all kinds of free time. And I was like, I don't what do you Oh, when I said I fixed my carpet. When I got to pull it out. You're like, Where do you get time for that? I was like, Well, wait, lady, there's a big hole in my car. But I can't just leave it there. You know, Jenny couldn't even imagine. She's like, cut the carpet off. start over again. It's, it's done.

Jennifer Smith, CDE 11:09
Go Why just put like, you know, like, I don't know, I'll play it over it and be like, don't stop here. Mom will take care of it later. And then like three months later, I'd be like, my set plates. Do I

Scott Benner 11:20
really like that? But No, but seriously, like, you have that, like, you have that attitude. And I have to tell you, that I'm not good. I'm a busybody, I'm not good with free time either. As soon as I have too much free time, like I could make another podcast episode. Like I think that right away. I'm like, maybe we could move people along a little sooner I could be working is what I feel like. I this weekend, I talked my wife into relaxing, which she's terrible at. And so everyone's sort of outside, we have a little little patio out back. Everybody's sitting around. We drugged like a television outside. People are watching sports and just hanging around. And I realized the other day, I don't think I ever sat on that patio. And I was mad at myself when by the time it was over, you know, but I just couldn't. I kept thinking of things I had to do, which I know is bad. Don't write me. I know, it's bad. I know it's killing me. But um, but your feet on the floor is what I think of his life like bolusing for life. And really, when you stop and think about these three little episodes, which I'm gonna put up all at the same time, so people can find them all at the same time. You're thinking about, you don't realize you're thinking about what if? What if smokey happens, right? What if you What if you that happens? What if while that's happening, you start experiencing dawn phenomenon. And then you jump up and you're a more high strung person. And you've got this going and you're back here trying to Bolus for toasts with two years. Right, you're a lot already

Jennifer Smith, CDE 12:45
out of three things that you didn't realize could be impacting and the toast had nothing to do with the 290 blood sugar. Yeah.

Scott Benner 12:53
And it makes me think about how many people like to say, Oh, my, my blood sugar goes up every time I take a shower in the morning. But what if it's got nothing to do with the shower and everything to do with the feet on the floor? Correct. We've done it Jenny, this is that if people just listen these podcasts there, he wants to be in the fives. Some of them will make themselves crazy, but I mean, a lot of them will end up in the

Jennifer Smith, CDE 13:19
hopefully you don't need extra meds along the way.

Scott Benner 13:23
Just find yourself in the corner mumbling about oh gee and feet on the floor, and I gotta move my basal insulin so that it combats the dawn phenomenon. And then I'll just go to work and take these four kids.

Jennifer Smith, CDE 13:39
makes me kind of think of what's his name Gollum from Yeah,

Scott Benner 13:42
yeah, just shrink up and start talking to precious and rubbing your head. Yeah, yeah. So anyway, that's why honestly, is we kind of finished this one up. Without joking about it. That's why my theory is always just like, more get ahead. Don't let this stuff like make all of this stuff. Absolutely not even something you think about by being just being first by acting first. I am such a big fan of punching first with diabetes, so that you can at least say I did this and what happened next, I had some impact on instead of covering up defensively and waiting for all this stuff that happened to you and then trying to react on the go You just can't react the diabetes you have to be you know, you have to be first you have to be active I think

Jennifer Smith, CDE 14:31
and in some of that, too, like you said, you know, needing more is the idea of more is important knowing Okay, clearly I didn't do this well, so I just needed more. But I think also looking at, as I said before, you know a couple of trends in the morning time to be able to define Why do you need more? Is it just today or huh? Look at this. I see the trend of lows overnight and now then when I'm high in the morning, then I need more or Every morning I get out of bed at this time, and I've made a note of it. And no matter what I do, I don't even eat for three hours and my blood sugar's already going up before I eat well, clearly, this is the problem. So then it gives you more definition to maybe even quantity of the more, you know, how much more could I possibly need? You know, more three units versus more half unit to two different ideas.

Scott Benner 15:24
I don't know more, just more, did you get higher than more than that? Did it happen the next day, then more than that? What if it's too much, it hasn't been too much. So far, you know, if it gets to be too much, not for nothing, then do less. Every month, just I don't know another way to think about it. Because when I see people try to think about it logically, like like, I guess logically is the wrong word. But mathematically, maybe I see people making themselves crazy, because there are so many of these variables that you can't quantify. And even if you could, you can't quantify them in real time, while living a life, you know. So I just like putting a nice layer of insulin on everything and trying to keep the blood sugar down. And that way, if you don't get high, you don't get high. And that's it. I'd rather stop a lower falling blood sugar, and fight with a high one high. That's all it's so simple. All right. This is this was it feet on the floor, which, again, I would like to call bolusing for life, but then no one's gonna know what I'm talking about. 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 Omni 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 going to 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 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 Virginia and 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. 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, 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

Donate