Scott Benner 11/23/22 Scott Benner 11/23/22

#795 Defining Diabetes: Kussmaul Respirations

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny define Kussmaul Respirations.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

+ Click for EPISODE TRANSCRIPT

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

Scott Benner 0:00
Hello friends, and welcome to episode 795 of the Juicebox Podcast.

I'm excited to have Jenny back today for another installment of defining diabetes. And today, Jenny and I are going to define qu small respirations. This will be the 45th installment of the defining diabetes series. It's a series that takes the time to define the terms that you use every day with diabetes, from fat and protein rise to brittle diabetes, bolusing and everything in between. Check out the finding diabetes short episodes that let you feel like you know what you're talking about. And bonus, after you listen, you will actually know what you're talking about. There are a number of different series within the podcast. So if you go to juicebox podcast.com, to see a list of them. If you do it on a browser, you'll just see it at the top. And you notice the finding diabetes click on it. If you're on your phone, there's a little menu like the three lines, it's a menu click on that, then it shows you to find diabetes. There you will get a complete list of the episodes, as well as an online player and links to a number of different popular podcast apps and links to the other series like bold beginnings thyroid disease algorithm pumping diabetes variables, ask Scott and Jenny mental health afterdark and the diabetes pro tip episodes. This show is sponsored today by the glucagon that my daughter carries G voc hypo Penn Find out more at G voc glucagon.com. Forward slash juicebox.

Jennifer Smith, CDE 1:46
I like when are my kids going to be home making noise? Okay, so

Scott Benner 1:49
I'm recording. Okay. Jenny, we have finished up with our bowl beginning series. So let us move on or back to maybe I should say, a couple of defining diabetes terms which I've had on the list here for a while. And we have not gotten around to

Jennifer Smith, CDE 2:06
are these easy ones or hard one? No, I

Scott Benner 2:09
think they're, I mean, they're easy enough. They're just sort of terms that I don't know what happened. Like they, they didn't pop up the first couple of times and what I said to people like what should we define or even when I at the beginning said, what should be defined. There's also stuff on the list that's come up because you and I have been talking along the way and I've realized, wow, I don't know what that means. So I think if I don't know maybe other people don't know why they're. So let's, let's do some there'll be some short ones today. Awesome. Okay, I'll mispronounce some things. And you've you've you've sent me straight and then we'll start talking. What is a coup small respiration?

Jennifer Smith, CDE 2:51
Ah, that's a very good one. And we've certainly talked about something that would be where you would see this right. And we've talked about DKA. And we've talked about ketones before. Correct. So essentially, it's a really deep, a deep, like, heavy, almost like labored breathing that comes most often with DKA or diabetic ketoacidosis. Right? Because of metabolic acidosis. Essentially,

Scott Benner 3:31
it's interesting. I like watching you pull it out of your head because I'm looking at it written in front of me. And I'm like, okay, so cool that she's just getting this so. Yay. So my experience with it. Is that on the evening, wow. On the evening in 2006 when we realized Arden had diabetes, where we realized we thought she did. It was the end of a number of days where she was just listless. I don't even know how to say it like she was beyond like a zombie. You'd move her from one place to another and she just plopped down you know, she was so young, like two years old just just turned two years old. And that day, we were on a beach vacation. So Kelly took hold of the beach. And I stayed home but in the in the beach house with Arden. And I thought no, no, I'm going to try to get her. I'm going to try to take her to the beach. She'll see the beach in the ocean. She'll get really excited. I got her already. I took her the ocean and we kind of stepped I sat her down and she just I put her in the sand. And she just didn't move out there. Yeah. So we I took her back to the house thinking okay, well, she's still sick obviously. And late late that night, the whole family sitting up playing board games or card game or something was like a big family thing. It wasn't just the four of us. My wife's extended family was there. And I remember like looking across the room, trying to figure out what was wrong with the Arden And she was panting Yeah, even in our sleep like she was sleeping and she was just, like really quickly in out in out panting, panting, panting and I realized now that's what this is, right? This is. And so I have here a small respirations are fast, deep breath that occur in response to metabolic acidosis. Small respirations happen when the body tries to remove carbon dioxide and acid from the body by quickly breathing it out. Diabetic Ketoacidosis is the most common cause of small respirations.

Jennifer Smith, CDE 5:33
Correct. So it's also a reason that a lot of times when you bring when you would go to the emergency department, they'll usually do like an electrolyte panel, they'll look at something called bicarbonate levels and those types of things because this acid kind of component of the body that comes and causes that labored breathing is really because of the increase in acid production, and the ketones and everything that your body's like, must get rid of this thumb away. You know,

Scott Benner 6:09
it's so interesting that your body tries, I wonder if it works at all? Like, is it? Is it dissipating it a little bit? Or is it like a panic? You don't you mean?

Jennifer Smith, CDE 6:19
Like? Yeah, that's a good question. I mean, you know, the, the breadth of people who have really elevated blood sugars and are in DKA. Oftentimes smells like acetone, right? Or a real sweet fruity kind of smell. So I would expect some of its being expelled. Much like, you know, the body is also the reason people often come in severely dehydrated in DKA, is because the body is also trying to rid those ketone bodies and everything by pulling, pulling pulling fluid from the other parts of the body, dehydrating the body but creating a loss through urine.

Scott Benner 7:01
Okay, yeah, well, I've seen, like these kinds of historical writings, where they said that the Egyptians used to refer to a disease called the Great drain, is that right? And they thought people urinated themselves to death. But historians believe that might be type one diabetes.

Jennifer Smith, CDE 7:20
In fact, it ages ago, one of the very easy tests was physicians would just taste the urine. Because it was very sweet,

Scott Benner 7:31
right? And then that meant diabetes. It's interesting. When someone asked us to describe the smell from Arden's breath. I described it as metallic, and calm, and Kelly described it as fruity. So it's interesting, good, because it just a little side note here. DKA symptoms may include fruity, scented breath, weakness, vomiting. So Arden was obviously I mean, just based on this conversation, she was in DK at that point. Oh, I would. Absolutely. Yeah. Even though it's funny, because I asked that question of people when I interview them. And oftentimes, they don't know the answer. And now I realized, as I look back, I don't know if anybody ever said that to us or not. And if they did, if I would have even known what that meant. In that moment. You don't I mean, like, or like, now I know to be like, Oh, no. But back then if somebody would have said, Hey, your kids and tk I would have been like, yeah, it's three o'clock in the morning. I don't know what that is. Right. You know,

Jennifer Smith, CDE 8:32
the interesting thing I was curious about your question about whether anything is actually expelled with all of that. So I did a quick look. And it says that the rapid breathing increases the amount of carbon dioxide exhaled, thus lowering the serum carbon dioxide levels and helps to result in some degree of compensation. So there is definitely something coming out that the body is, you know, having this increase in respiration, so so it's helping you not that it's going to definitely help 100% trying to do something

Scott Benner 9:12
else and cracks in the dam and you've got 10 fingers, like, yes, it may be to that level. Well, yes. Hey, listen, if it buys you any kind of time, then thank you, but it really is another it's just really another example because we talked about this sometimes with low blood sugar, right? Like talking about how your body seems to shut down systems in order of importance as your blood sugar gets lower and lower. This is another example that this is your body just like trying to take one more breath. You know what I mean? To stay alive a little longer. super interesting. Okay, so I mean, I don't think anybody who's going to hear this episode is going to hear up before they they know they have diabetes, but if you see this happening, it's it's Dr. Time also there's one other example of why I want to just insert this here since we'll have people's attention. Of course. There's apparently another let's see what two conditions is small breathing associated with disruptions to these compounds can cause small breathing, which is typically associated with conditions that cause metabolic disturbances such as kidney failure, and diabetes. So you could see this in a person and it be kidney failure over diabetes. It's interesting.

Jennifer Smith, CDE 10:27
Again, because the kidneys are very, very much an expeller of many things, right? I mean, there's a filtration system that kind of ends up going on with the kidneys and when your kidneys are not functioning the way that they that they're supposed to. It leaves more of that to sort of float back into your body rather than be removed.

Scott Benner 10:46
Okay, so All right. Well, all right. Well, thank you for doing this with me, I appreciate it. When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. G voc hypo pen is a ready to use glucagon option that can treat very low blood sugar in adults and kids with diabetes. ages two and above. Find out more go to G voc glucagon.com. Forward slash juicebox. G voc shouldn't be used in patients with pheochromocytoma or insulinoma. Visit G voc glucagon.com/risk. Good. Let's see. That's just one I always think. How do we get past? That's

Jennifer Smith, CDE 11:28
one I don't think I have. Honestly, I don't think I have ever used that term in any education I've ever done with anybody. Well, mainly because they come to me and they already have diabetes. Like, pay attention to this. That's not going to happen unless you are really in DK again.

Scott Benner 11:48
Get used online so frequently that I thought, well now people are saying it out loud. If they don't know what it is it's going to be another it's another tripping point if you don't know what it is right? Yeah, okay. A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Capo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juice box. And don't forget, there are 44 Other defining diabetes episodes that you can find at juicebox podcast.com. Or by just searching your podcast player. For the words juice box, defining diabetes, they'll all just pop up in front of you.

Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. I want you to know that I got that pop that that cheek pop first trot right in the microphone. If you're lucky, I'll do it for you one more time before I'm done. Thank you again for listening. Please share the show with someone else who you think might also appreciate it. And if you hear teaching yourself definitions because you're newly diagnosed, please don't miss the boat beginning series. It's terrific and great for people who have just learned that they have diabetes. So here sorry. That was pork. That was that was good, right? muttrah too fast. Here we go. Nope. Okay, I'm done. That was terrible. Should I leave that in? Yeah, okay. Oh, shoot. Jenny works at integrated diabetes.com If you want to hire her, she's terrific. Check it out.

#681 Defining Diabetes: Types of Diabetes

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain the different types of diabetes..

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

Scott Benner 0:00
Hello friends, and welcome to episode 681 of the Juicebox Podcast.

Today, I'm back with Jenny Smith for another episode of defining diabetes. And today Jenny and I are going to define all of the different types of diabetes. And there's more than you might think there's type one and type two. Sure. But what about type one and a half? Is there a type three, a type eight, we're gonna find out. While you're listening today, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. If you're a US resident who has type one diabetes, or is the caregiver of someone with type one, the T one D exchange is looking for your thoughts. Those thoughts come in the form of answers to survey questions that you can find at T one D exchange.org. Forward slash juicebox. completely anonymous, HIPAA compliant, easy to do, helps people with type one, t one D exchange.org, forward slash juicebox take you less time that it takes for you to figure out that Wordle. And you'll help somebody that word doesn't help anybody.

By the way, I got the word of last night and three, I was pretty proud of myself. I digress to say this. This episode of The Juicebox Podcast is sponsored by us med. Get your diabetes supplies from us med. I'm going to in this episode of the podcast when I get to the US med add, I'm going to read something that a listener sent me for now know this white glove treatment, always 90 days worth of supplies, they have fast free shipping, you get it every time us med check them out at us med.com forward slash use box or an 888-721-1514 at that link. And that number. You get yourself a free benefits check and get started today with us, Matt. Hey, Johnny, how are you?

Jennifer Smith, CDE 2:22
I'm fine. How are you? Scott? Good,

Scott Benner 2:24
good. Good. I want to do a defining episode today about the types of diabetes. Oh, fancy. I was surprised by this. So I mean, first, let's just get the one out of the way that I think will be easiest forest, type one diabetes. What is it?

Jennifer Smith, CDE 2:43
Essentially, conditioning the body that means that your pancreas is no longer producing insulin from the beta cells, right? I mean, there's been destruction of those beta cells to the effect that you now have virtually no or have no insulin production left. So

Scott Benner 3:04
you might also hear it called juvenile diabetes, insulin dependent diabetes. I think it's important to say it's a chronic condition. There's no known cure for it. And it's autoimmune. Correct, right. So this happened, because, you know, go listen to another episode about there's a defining diabetes episode about antibodies, that one listen to that one, if you want to know more about it, but the bare bones idea is you didn't do anything to get diabetes, your body just got a little confused, took off after your beta cells instead of the flu or coxsackievirus or whatever else you had that your body should have been doing that day. And now you do not have functioning beta cells in your pancreas. Correct. Alright, so there's not going to be much to this, obviously. But we want to put them all in here together. So type one diabetes, that's what it is. Boom. Now, you would think obviously, we're gonna go to type two diabetes, because you all know how to count you think one and then two comes after but no, there's that would be too easy. There's a type 1.5 diabetes. That's Lada. Right.

Jennifer Smith, CDE 4:15
That's Lada. And in fact, I've I mean, I think more lately, it's definitely been referred to as lotta latent autoimmune diabetes of the adult, right. I have heard the term one and a half a lot less often, which I think is actually not a bad thing. Because if you consider the true nature of that type of diabetes, it tends to be a lot more similar and is often classified with type one, but happens truly in adults, and is for most people a slower progression to diagnosis. Okay. So still is an autoimmune disorder or you know, an autoimmune condition where the body has destroyed beta cells. In adult, it seems to be a slower progressive destruction. So again, a sort of a slower diagnostic. In fact, I've had a number of people that I've worked with who've actually been misdiagnosed, because it was so slowly progressing, that they were just initially diagnosed type two, and they really weren't.

Scott Benner 5:27
Yeah, I hear about that a lot. Actually. The type does lotta have characteristics of both type one and type two? Was it somebody being like, cute when they named it? Like, it's almost type two and almost type one, and it's in the middle? Nothing like that.

Jennifer Smith, CDE 5:41
That really, I mean, again, there are there are characteristics I think in people who have either type one or type two, that could cross and look similar to the other type of diabetes being the two main types, type one and type two, right? And then you could have some insulin resistance in type one, which typically isn't the reason that type or it isn't the reason that type one is there, right? But they could have some resistance, which is much more classified with type two. So somebody with LADA could certainly have some of both of those pieces, but Lada will be diagnosed because there will be antibodies present. Okay.

Scott Benner 6:21
So if I want to think about that in a really basic way, it's a very slow onset type one diabetes that only happens in adults.

Jennifer Smith, CDE 6:30
Right? A B would not be a child and be diagnosed with ladder

Scott Benner 6:33
because of the super slow onset. People can confuse it for type two diabetes.

Jennifer Smith, CDE 6:38
In a general Yes, in a very easy way to see it. Yes. Yeah.

Scott Benner 6:42
Because it's you're still getting work out of your pancreas. But it's not shutting off kind of abruptly, like you see with type one. Correct, right. So when you're saying a slow onset, it's not like a honeymoon. It's, it's much more protracted than that.

Jennifer Smith, CDE 6:59
It is, in fact, people with people diagnosed with Leida Lada often have once they actually get diagnosed and have the right tools to manage insulin being major one of them right, they often then may have a longer honeymoon after they're actually diagnosed. And in fact, people with LADA also often have more beta cell preservation. Longer term, they still obviously have to use insulin, but their insulin doses may look very small, comparative to others who have had type one for a while and their same age and same body type and same activity level and whatnot. So there are you know, defining differences between type one and Lada diagnosis.

Scott Benner 7:55
I find it interesting when you Google something to see what else people ask about. Yeah,

Jennifer Smith, CDE 8:01
I'd be curious what did you Google? Well, I

Scott Benner 8:03
just definition type 1.5 diabetes. Because you mean you know you're gonna know way more about this stuff than I am. So I wanted to I wanted to be ready a little bit. People listening are like Oh, thanks.

Jennifer Smith, CDE 8:16
You wanted to put on your your graduation cap.

Scott Benner 8:19
I didn't want to do it. I didn't want to do it. A lot of people do and on podcasts and just philosophize out loud about things they think they heard one time so but I do want you to have a little bit of that because I think that that is how people start with Oh, I heard this or I thought that but so other things people ask about Latos what is the difference between type one and a lotta? How can you tell if you have Lada? What do you consider Lada? Does lotta diabetes, shorten your life? Oh, that's sad. Let me get some insulin should be fine, right? Correct. Shouldn't be shortened anything. But anyway, like not to even Delve. Although what's the difference between Let me see how it talks about the difference?

Jennifer Smith, CDE 9:01
I mean, I'm curious and who defined it would be another good and well, I guess in terms of source

Scott Benner 9:05
Yeah. So you I mean, you did a great job. This one comes to it goes to beyond type one.org. As a form of type one diabetes a lot is the result of your immune system attacking the beta cells in your pancreas to produce insulin. The only difference is that the attack is slower, which means so you don't need these people. You got Johnny, it's all good.

Jennifer Smith, CDE 9:25
But I'm glad that I'm in agreeance with another source of good information like beyond type one, let's

Scott Benner 9:32
say I don't even know what we would have done right now if I would have read something that completely contradicted what you said. I would have been like, Jenny's fired and then you as I was going away, you'd be like you don't even pay me and then that would have been the anyway. Alright. So now I got into this weird space. I know you think now we're definitely going to do type two. Not quite yet. Hold on. Where I saw someone online and we'll talk about this maybe at the end of this. I just put up a post and I was like, guys, hey, Listen, what else belongs in the defining diabetes series. And this person says, I keep hearing about type three diabetes. So I was like, alright, so I googled, and I got type three diabetes is a proposed term to describe the interlinked association between type one type two, and Alzheimer's disease. Yes, the term is used to look into potential triggers of Alzheimer's disease in people with diabetes,

Jennifer Smith, CDE 10:28
linked to insulin resistance, and insulin resistance and an insulin. Kept to remember that insulin like growth factor is what they're looking at insulin resistance specifically in the brain. And what they're, they've also often linked to type two and Alzheimer's disease, which is sort of what triggered this type three name overall. So there's a lot of medical research about blood sugar, and brain health. It's, it's amazing if you look into it, not only not only Alzheimer's, but Parkinson's and many of those neurological conditions disorders, there, there are a lot of big links with blood sugar.

Scott Benner 11:21
So then I went down a rat, another rabbit hole, oh, my god, what is type three C diabetes. And I was like, Where will this end? And then I kept googling. There's a type four, and a five and a six, and a seven, and an eight. And I stopped at eight because I got freaked out.

Jennifer Smith, CDE 11:43
And I, I mean, those are very specific to other system issues in the body. They're not, they're not definitely like type one type two gestational, they're not Lada they're not in that same realm of categorization. I mean, even when we were defining type one, you know, type one in another, and I'm sure it has some type of letter categorization to it. But I've worked with people who have actually had pancreatic cancer, and pancreatic, you know, removal from their body, which means that there's not one autoimmune reason that they are deficient in insulin or beta cells. They just don't have the gland anymore that makes it

Scott Benner 12:30
right. Like, what did they just when you have a penk Ritek? When they take out your pancreas for reasons that are like another thing? Do you? Are you assigned a different type? Or are you just type one that

Jennifer Smith, CDE 12:44
I believe that if it's a pancreatic cancer that falls into the type three C categorization. And I know that I've worked with only two people who have actually had cystic fibrosis. And as a result also had what we just treated the same as what we would do with type one diabetes, right? From a standpoint of management, its insulin management, both of them were on pumps, you know, so, but that's not true. Type One, there's another body condition there. Yeah. Because

Scott Benner 13:26
the auto immune didn't cause it. You're right, you're gonna live like a type one after that. But you didn't technically ever have type one diabetes. And that I've interviewed a number of people who have had their pancreas removed for other reasons. And they are they do want that distinction. The people I've spoken to so far, you know, I've also heard people who are well welcomed into the type one community and there have been times where people have said, like, you don't have type one diabetes, like you don't belong here. I don't know. I don't believe in that. That's no good for me. If you're using insulin, you need this help. And that's that. So anyway, let's just look for a second type for diabetes is a proposed term for diabetes caused by insulin resistance and older people who don't have overweight who don't have overweight or obesity. This is a 2015 study. So I think they just as they're studying more and more things, they just keep applying this because now when you get to type five, it's called moody five.

Jennifer Smith, CDE 14:27
Mo D Why is is mono

Scott Benner 14:30
moody. Excuse me? Yes. Yes. I'm sorry. I put one too many O's in my that's mature onset diabetes. Wait, why is my phone making noise Jennifer? I don't know. Somebody wants to reach you. I'm gonna curse here. This can Walgreens okay. You leave a prescription sit at Walgreens for five seconds. And they call you they are up your ass. It's here and get it. It's yeah, I'm like, if I know thank you be there. All right. Have it calmed down now I won't stop now it's good telling me when the pharmacist takes lunch is it noon

Jennifer Smith, CDE 15:11
and they take an hour lunch at least they do at my Walgreens well God

Scott Benner 15:14
bless that's fine but I don't need to hear about it on the machine every time they call like this happened yesterday.

Jennifer Smith, CDE 15:21
See they don't call me they send me a text message well I'm gonna behind don't have to hear anybody if you're

Scott Benner 15:26
listening to Walgreens you screwed yourself because I'm gonna opt out of this you know and I do find it goodbye she goes at the end goodbye goodbye podcast

Jennifer Smith, CDE 15:36
here was very important that she made sure that you know that your prescription is all set. I think

Scott Benner 15:41
it was a computer even Jenny I don't know if it was a heart but okay, so. So Modi is

how about I read some things from the online. I won't tell anybody's name or if I you know if the people are talking about other companies, I certainly won't, won't say them. But here's one. So far one conversation with us med has been infinitely more helpful than every conversation I've ever had with blank blank. Thank you so much for letting me know about us med. Is it possible another person says that it really will be this easy. It's hard to believe when you've had to deal with other companies that make getting your diabetes supplies so difficult. It's hard to believe that anything could be better, but it can be with us med here's what you do. You go to us med.com forward slash juice box get your free benefits check and get started. Don't like the internet. Use a phone 888-721-1514 They accept Medicare nationwide. US med accepts 800 private insurers they have an A plus rating with the Better Business Bureau. They carry everything from your insulin pumps to your diabetes testing supplies and everything in between. They have all the latest CGM Dexcom G six libre two. And they've served over 1 million diabetes customers since 1996. US med is where Arden is going to get on the pod five from us med they want you to get better service and better care than you're accustomed to. US med is proud of their white glove treatment. Give them a chance. Hit the link, call the number 888-721-1514 We're gonna us med.com forward slash juicebox. There are links in the show notes of your podcast player or at juicebox podcast.com. To us Med and all the sponsors. You could even find the T one D exchange there. T one D exchange.org. Forward slash juicebox. Take the survey Dexcom on the pod contour, G voc touched by type one. They're all there. Check them out. Listen, if you have a need for these things, I hope you use my link. That's really it. When you support the sponsors. You're supporting the podcast, I'm not telling you to go buy an insulin pump you don't want. That would be silly. But if you want it on the vaad use my link and one of Dexcom cha cha cha, you know what I mean? A one, two, cha cha three, four, cha cha cha

Jennifer Smith, CDE 18:27
Well, we have time at some point, I will tell you, if I never told you my Walgreens story, I wrote a letter to the head of Walgreens, you

Scott Benner 18:33
wrote a letter to Walgreens several years ago. Let's save that for the end of the year state of the Jenny address.

Jennifer Smith, CDE 18:39
Oh, yeah. That's an interesting story.

Scott Benner 18:43
I want to hear. So is Modi type five. Have you ever heard that?

Jennifer Smith, CDE 18:49
I've not heard Modi called type five. But I wouldn't be surprised if they've defined it within the category of all of the numbers of types of diabetes. I guess I've only really heard it called Modi. Now Modi in and of itself also has many. It's it's very strongly a genetic thing. Right. And it's different from both type one and type two. And the way that it's managed really depends on the type of Modi you have so Modi or type five diabetes. There are there's another little offshoot to that to say you have Modi this Modi you have Modi with these genes you have Modi with these genes, and some of them may be managed. Some of them may be managed with insulin similar to type one. Some of them may be managed with an oral med some of them may be managed with a baseline of a Basal insulin and lifestyle. So there are many depending on what your gene Mody type is, for lack of a better way to describe it. If there is a more standardized, I guess plan for how to help you take control.

Scott Benner 20:09
Well, CHOC Children's Hospital of Philadelphia has Modi as a form of diabetes caused by a mutation of a single gene. The mutation causes pancreatic beta cell to function abnormally, leading to insufficient production of insulin. In some cases, insulin resistance develops. In addition, the pancreas may not produce enough digestive enzymes on this link, they are calling it Modi five. Yeah. And then when interesting when you go back to like, so I just kept googling because I got like, I was like, was there Modi six, and there is Modi six arises from mutations of the gene for the transcription factor referred to as neurogenic. Differentiation one, so then you're that that is what's happening is we're getting into genetics. Now, you're asked, is there a type seven diabetes, a form of diabetes that is characterized by an Auto Sum node dominant mode of inheritance, onset and children or early child adulthood? Usually before 25, a primary defect of insulin secretion and frequent insulin dependence at the beginning of the disease? I'm telling you, I stopped at seven. Because I didn't know where to like, I just didn't know. But let's for fun, let's just change the to eight. And there

Jennifer Smith, CDE 21:26
is there is a registry as well, or I guess it's Chicago, there's a mean place in Chicago, I don't know the name of it. That actually keeps a registry of all people who have actually been tested, and have been given the diagnosis of one of these types of Modi. So it's interesting that it's, it's quite rare, I guess, is the the next thing to bring into this is that don't walk around thinking, Well, I've diabetes, Do I really have like, Modi? Number six? Yeah.

Scott Benner 22:02
No, probably not. Right, or Modi? Eight, which is the slow progressive pancreatic extra and dysfunction, fatty replacement of pancreatic para blah, blah. Who knows there? I'm getting into words. I can't, I can't. But anyway, yeah, I was gonna say the exact same thing, which is why I love you, which is you don't have Modi aid, calm down. And you know, although I might get one email from one person is like, I've got it and then send that email, because I'd love to have you on the show. Because interestingly, I've,

Jennifer Smith, CDE 22:31
I've, again, I've worked with a lot of pregnant or pregnancy, and I've worked with two women who had diagnosed Modi. And it was an it was an interesting, it was an interesting transition through the course of pregnancy, because things changed very differently, comparative to other pregnancies, both type one type two, and even gestational which I have now a lot of knowledge working with things changed very differently along the whole way. So

Scott Benner 23:07
well, then, in your opinion, if someone has type one, and they're treating it like type one, but they have a lot of insulin resistance or something else, at what point do you say can I get the genetic test? And does getting the test help you? Or does it just give you a diagnosis?

Jennifer Smith, CDE 23:22
I don't think you know somebody specifically with a diagnosis of type one who my first question would really be did you have diagnostic testing that showed it was actually auto immune dysfunction, right? Then it is type one, if there is significant insulin resistance, my next step is to say, well, you have Have you ever been tested for PCOS or polycystic ovarian syndrome? Right? Because that is, especially in women. That's a pretty significant reason that many women with type one may actually have some significant resistance over what they think their insulin needs should be based on what their lifestyle kind of looks like.

Scott Benner 24:07
I just wrote down PCOS as another defining idea. Honestly, our conversations today have given me a number of them. Okay, so here's my last question. I heard somebody say this online, and I couldn't tell if they were confused. Or if this was a thing. Can you have type two diabetes and then get type one diabetes? There's no reason you couldn't, right? You couldn't have type two and then have an autoimmune attack? Right? You wouldn't have them both at the same time.

Jennifer Smith, CDE 24:34
No, you wouldn't. And in the grants. Sure. Could that happen? Yeah, I guess. Now, the question also becomes, did the type two ever actually get tested to truly get the correct diagnosis when they were told they were type two. And now things have shifted and they get, let's say, maybe a smarter clinician who's like, Hey, I don't know let's do some testing. And then all of a sudden they end up being Type one there type two, probably did not change from type two into type one. No, no, I mean likely had antibodies all along that initially were never diagnosed the right way. And so they've transitioned to now Yes, being told their type one. But the antibodies have probably always been there.

Scott Benner 25:18
I 100% agree that most people who are going to have go through that process, that's exactly what's going to happen to them. Anecdotally, from what I've heard from so many people, but what I'm saying is, could you not get type two diabetes legitimately have type two diabetes, and then later in life, have an autoimmune attack that gave you type one?

Jennifer Smith, CDE 25:35
You could? I would, I would not leave anything to the realm of not possible in our world.

Scott Benner 25:42
I want to hear from somebody who has had that happen to them. But there is no world where you would. But after that happened to you, would you still now we're just philosophizing, would you still have type two diabetes and type one diabetes,

Jennifer Smith, CDE 25:55
you may still retain some of as you've asked before about resistance, you may still retain some of the characteristics of type two possibly want to hear from those as well. Yeah, that would be that would be certainly interesting. Now, I thought you were going more in the realm of somebody with type two, which I know we haven't defined type two yet. We'll get there. But somebody with type two who let's say, you know, they, they know that they don't have type one, they had a really good doctor, their doctor did do testing and everything. There were no, you know, antibodies or anything there. And they were doing really well with lifestyle and maybe oral medications and whatnot, and now they have to use insulin. That doesn't mean that they're type one. If they just because you have stopped being able to solely make use of oral meds, and you have to start using insulin as a type two. You are still a person with type two diabetes. Yeah. Okay. Why not a person with type one just because you're using insulin,

Scott Benner 26:59
right? You're a type two who uses insulin? Yes. And then a doctor would call it insulin dependent type two, right? Usually, that's how they talked about it. Your chart? Yeah. Okay. All right. So here's the last bit. I get to have more and more people with type two diabetes in the Facebook group, which has been really wonderful because I'm seeing people with type two who use insulin having a ton of success by listening to the podcast. I know people with type two in my own life, some of my own family. I've talked to people for years who have it, I have consistently been stunned by how little people with type two diabetes seem to understand type two diabetes, how little they're taught about it. How often it's enough of a boogeyman in their life that they don't even want to look into it. And, and for me, I just always find it to be sad. I wish if they knew more, they would know more. I personally, I've been dying to have more types who's on the podcast, it's hard to get them to come on. Because really, yeah, it's an I wish they would. Because I would like to, from my perspective, I'd like to have type twos come on and teach me about type two diabetes. I would love to have those conversations just so other people can hear them. But for the purposes of a definition, I want you to tell me what type two diabetes is. Because as I sit here, I wonder if I know. Yeah,

Jennifer Smith, CDE 28:25
I mean, essentially, type two diabetes is not autoimmune. That's one of the first things. It's an impairment really, in the way that body the body is able to use sugar. That's the simple definition of it. Why does that start? There are many thoughts in terms of why, certainly lifestyle is one of the biggest ones that most people hear in terms of, you know, activity level, weight. Genetics can also play a big role in type two diabetes, as well. And why does the body eventually stop using sugar so well, it's on a cellular level, right? It's the way that the body is really responding to the intake of food and breaking it down into your body's main fuel source, which is sugar for most people. The reason for the decline in insulin production happens over a long period of time, which is the reason that many people who are at time of diagnosis with type two, they have often been living with type two diabetes, without realizing that their body was having a problem for somewhere between five to even 10 years. So what ends up happening is that the cells become less able to use sugar. Which what does that do? It leaves more sugar in the bloodstream than should be You there. And the body, body is an amazing thing. It's, it's a self healing machine, it tries really hard to do its best to keep you healthy. So what it does is it sees more sugar, and it tries to ramp up the production of insulin. And for a time, that can work. So people that are having this in this sugar, you know, resistance, essentially, or inaccurate use of sugar, their body is ramping up insulin production enough that their blood tests may or may not show any problems. Which means that again, the doctor doesn't think that that there's a problem there. And then over time, what happens when you overuse anything? It gets tired. Yeah, and so these data cells get worn out from trying and trying and trying and trying to hyper there's that word hyper produce insulin, and they they can't keep up anymore. And so now in terms of testing, fasting testing, or especially Testing, testing, in the post meal time period, those are the points that a doctor could find glucose excursions that are well beyond what a person without any dysfunction in their body should have. So it's kind of a cascade of things that happens over a long period of time. Very unlike diagnosis of type one, which is pretty quick onset for most people. Yeah.

Scott Benner 31:34
We're gonna, I intend to dig into this more throughout the podcast, because in my, in my heart, like, I think, when you have a person with type one diabetes in your life that you're taking care of, it takes a toll on your health, too. And I, I'm trying to think big picture and long term here, but how many people who have young kids with type one right now are going to end up sleep deprived or time deprived and suddenly start ordering out more or cooking from boxes more something like that, and, and maybe they'll end up in a similar situation with type two diabetes down the road, I want them to be aware of it as much as they can. Because that number, like when you hear people talk about how many people have diabetes, there are, and they don't in the world, and they don't distinguish between type one or type two or certain country, the number you always see that's frightening is the Undiagnosed number. Yes, that that expectation of what that number is, is is insane. It really is. And I mean, it is it is type to impact the impact double, once you have it, is it impactful, always with diet, or just sometimes with diet? Like it's not like, like, if you could force everyone with type two diabetes to eat exactly the same way, they wouldn't all have the same outcomes, right?

Jennifer Smith, CDE 32:55
Not necessarily. And I think that goes along with again, where do you catch diagnosis, you know, if the body is then so stressed over trying to do as well as it can for you, for a long time, there, there may have been enough beta cell destruction, that you're never really going to get back to a baseline of no kind of medication, right? some lifestyle changes can last a very long time. But it's it's like anything, it's the sticking to that management plan. And not veering from it. Right. And then I think the other piece that you bring in, in terms of like, knowledge is, the sticking with it is it's a really hard thing, and when you've been sticking with with it, and then your doctor says, well, your numbers are still climbing. And you think, Well, gosh, I'm doing everything. And it was working. What is the point now, if you're gonna throw medication at me, despite my really good efforts at doing everything, and that's where you know, and working with a lot of type two population in the past. There's a lot of like, defeat in that. And the explanation that I always give is, your your type two is a it's a progressive condition. It is. And at some point, you may need medication. At some point further down the road, you may need insulin, it does not mean that you failed, it means that you've had this amount of time that you've really given your all and you've really done a great job to keep your body healthy. So you know what, now when medication gets added, it will likely work for a really good amount of time as well before potentially needing to progress on to another kind of medication or even insulin.

Scott Benner 34:55
I have a recording already done and I have another one coming up with a with Both with type twos, who through the podcast have really astonishing outcomes like really well, a woman with a, an A one C, I just saw her online the other day in the Force. She's so excited, you know, and I was so happy for it. And I've already recorded with her and she's such a character and so wonderful. I can't wait to put it out. And then I have a guy coming on, who not only got his a one CD together, but his blood sugar's and his weight and all this stuff is happening from a podcast that I started, so my daughter would know how to Bolus, you know, like, that's really crazy, right. And as like you and I talking today, I have so many notes in front of me about what I want to do with the podcast moving forward. I just, I can't wait to try to help more people. The I don't know, Jenny, if you know this, but we are recording on the first of April. And we are here, right? Yes, it's April Fool's Day. This is not a joke. But the podcast in the first exact 90 days of 2022 had a million downloads.

Jennifer Smith, CDE 36:05
That's super awesome.

Scott Benner 36:06
it the year before it took twice as long to get to a million in that year. In a couple of weeks, the show will have a total of 6 million. And I think a year from now, it'll be more like 12 million total downloads. That's super, that's super, it's insane. Like I what I see, I see it

Jennifer Smith, CDE 36:29
honestly is super in terms of that's the number of people that it's reaching. I mean, I'm excited for you. That's super awesome. From what you've been able to put out and be able to do. But I'm excited from the standpoint of the people that that means it's helping in some some way they're getting something out of it.

Scott Benner 36:48
That is That is how I think about it. I also think about about paying my bills, but that's a different situation. But I really do, I mean seriously, to be serious, like I really do think about it that way. Like I used to have that. I know I've said it before long time ago on the podcast, it as close to the feeling is I can describe to you. When you help somebody like this when you do something and you see it help a person and I mean really help them like a person with type two tells you they're a onesies, 4.5, or a person with type one tells you, hey, I just ran a marathon based on what I experienced from your podcasts or my A once he's been in the fives for three years because of what I heard from you. It just sounds completely bizarre. I'm telling you that when I reached 10 people, I immediately think, why couldn't I find 100? And when I found 100, I think why can't I find 1000? In the first time I got to 100,000 I thought this could be a million. And

Jennifer Smith, CDE 37:42
you're like, where are all the people hiding? And how can I find them to give them what's important? Well,

Scott Benner 37:47
when you see them when you see what happens for them. And then you realize that the the really one of the only thing standing between them in the situation they're in now in the situation they could be in is just access just hearing it one time. Like you think like my whole, like 24 hours a day should be about I should be walking around with a sign right? Like, says Pre-Bolus on it is your right, I don't know, you know, like you start to have that feeling I have over the years alleviated myself from some of that guilt, which and it was guilt in the beginning. Like I felt like I wasn't helping enough people. And now I just see it as I know, this thing helps them and how do I get it to them. And so the people listening are how it happens. They spread differently. It's amazing share

Jennifer Smith, CDE 38:33
sharing it. I mean, and I think that's, that's an important piece. I mean, I I've met two or three people just in my community who have either mentioned it not knowing who I like, or that I contribute anything Association, but just in passing kind of thing. And I met one actually at our community pool last summer. A mom and her little girl and her daughter had noticed my Dexcom on my arm and I could tell that they're kind of like looking at me and she came over and she's like, we just wanted to say hi because my daughter also has type one and she noticed you know, your your Dexcom and we got to talking and we introduced names and I was like going Jenny, you know and she's like, you're not chatty. Like Jenny in what way and she's like, Do you are you on that podcast? Like me? Yeah, you had your airport

Scott Benner 39:31
moment. That's lovely.

Unknown Speaker 39:33
Did it was lovely.

Scott Benner 39:35
I think the kids call that meta, don't they? I don't know. I don't I don't have time to define meta. We're out of time. But that is

Jennifer Smith, CDE 39:44
just so nice. You know if when you hear back like that, it's

Scott Benner 39:47
it's amazing. I don't know. I don't know another way other than Mike hamfisted comparison to a movie. That's about a real life tragedy. And I even as I'm saying and I'm like don't make this comparison it's not a comparison. I'm Trying to it's that feeling. It's that moment in that movie, where he thinks I should have done more. I used to I used to feel like that constantly. Like, why am I not doing more? And then and then when it starts doing this, you're like, oh, it's working. You know, and I shared that thing with you yesterday. Yes, yeah, that's just insane that a woman was messaging with her doctor. And I want I want to pull it up real quickly. If she's messaging with their doctor about a problem, and the doctor responds, the doctor, the endocrinologist responds, and says something like, Hey, you know, might not be a bad idea to do this. Blah, blah, blah. There's a Juicebox Podcast episode about that. It's number 263.

Jennifer Smith, CDE 40:44
When you texted to me, I was like, and this doctor, like, knew the episode number. I don't even know that I have to look the episode numbers up. I don't even know.

Scott Benner 40:53
I'm the worst person to ask about what's in this podcast. And I'm so busy making it I don't know anything about it. But it's, I saw that and I thought, oh, my gosh, that's incredible. Like, it's only the is a podcast is only eight years old. It only really started flourishing four years ago. And today, somebody's being messaged by an endocrinologist. Hey, listen to this podcast. I was I was as proud as I could have been when I saw that really, really something else? I'm sorry. Did we do justice? Just do an overview of type two diabetes?

Jennifer Smith, CDE 41:22
We did? I think it yes. In fact, I think the only other thing that I think probably would be of interest at some point might need to be added to your plethora of notes that you have there. Now, we've talked a lot about insulin. But there are so many things to get into in terms of meds.

Scott Benner 41:39
Yeah. Do you have five minutes or do you have to go?

Jennifer Smith, CDE 41:43
I have to go I yeah, I would love to but it would be more than five minutes you're

Scott Benner 41:47
you know, I don't mean about that. I what I was gonna say is that I have a list a list of things here from people that they want added to the defining series. Oh, awesome. And the meds was on there. So I'll break this list down and put it in our shared folder file so you can see it cool. But I really appreciate you doing this with me today. Thank you so much. No problem. Have a good weekend.

Jennifer Smith, CDE 42:09
You too. Thank you. Bye.

Scott Benner 42:17
First, I'd like to thank Jenny Smith and remind you that she works at integrated diabetes.com She's for hire, you can get ready to help you with your diabetes. Let me also thank us Med and remind you to go to us med.com forward slash juice box where to call 888-721-1514. To get your free benefits check us med take the survey AT T one D exchange.org. Forward slash juicebox. Find the diabetes pro tips at diabetes pro tip.com or juicebox podcast.com or by going to Episode 210 In your podcast player.

If you're listening to the podcast right now in an audio app, but you're not subscribed or following, please subscribe and follow to the Juicebox Podcast. If you love the podcast tell a friend about it. Best way to help the podcast is to tell someone else about the show. I think this is all I have for you right now. So I'm going to go but you know what I want to say before I leave. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

#677 Defining Diabetes: Hypo and Hyper

Scott and Jenny Smith define diabetes terms

Scott and Jenny Smith define diabetes terms In this Defining Diabetes episode, Scott and Jenny explain Hyper and Hypo.

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends and welcome to episode 677. It's a short one, but it's good

Hello, everybody on this episode of The Juicebox Podcast, Jenny Smith and I will be defining hyper and hypo as it relates to all things, not just diabetes. Please remember, while you're listening that nothing you'll hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician. Before making any changes to your health care plan, or becoming bold with insulin. I'm going to just ask you the briefest of favors. If you are a US citizen who has type one diabetes, or is the caregiver of someone with type one diabetes, please go to T one D exchange.org. Forward slash juicebox. When you get there, join the registry take the survey takes fewer than 10 minutes, I would consider it a personal favor T one D exchange.org. Forward slash juicebox. If you're enjoying the Juicebox Podcast, please share it with someone who you think might also enjoy it. If you're loving the defining diabetes series. There are so many of them to choose from right there in your podcast player, where diabetes pro tip.com. This episode of The Juicebox Podcast is sponsored by us med. US med is a place where you get diabetes supplies, and they do it. Well they do it better. They offer you better service and better care than you're accustomed to getting. All you need to do to get a free benefits check is to go to us med.com forward slash juice box or call 888-721-1514 Hi, Jenny. Hi, Scott. How are you?

Jennifer Smith, CDE 2:05
I'm fine. How are you today?

Scott Benner 2:07
Good. Have you seen the little animations of you and I talking on Instagram and and Tiktok yet?

Jennifer Smith, CDE 2:14
I have I saw when you originally showed me what was going to be there but I have not seen recently. Because I have to admit I'm not a tic tac, or Instagrammer.

Scott Benner 2:26
So the person making the videos Maggie, who is a great young artist whose sister has type one diabetes. She has now added what I'm gonna call googly eyes to us. So while we're talking now the eyeballs move around inside of the eyes. Oh no, I'm absolutely like enamored by it. So

Jennifer Smith, CDE 2:43
I'm sure that if I showed it to my boys, they would probably think it was the coolest thing in the world to see

Scott Benner 2:47
your voice coming out of a cartoon. Yeah. Oh, yeah. All right. Well, you should check it out. I don't think you should get on Tik Tok because I have to tell you, it really is a time suck. Like it is it is the scrolling. Like I got it just to put this stuff, you know, for the for the podcast app. And then I'm like scrolling and I'm like, oh my god, I can see how people get lost in this. It's fascinating. So

Jennifer Smith, CDE 3:06
yes, I have stay away. I have more things that I need to do then.

Scott Benner 3:11
Yeah. If you're not on Tik Tok, you're doing okay. I think I was hoping today that we could define something that I mean, in all honesty, I had skipped over we I'd made a list and thought this isn't necessary. But it is. So we're going to do it. I want to define hypo and hyper just those words, and then we'll attach them to diabetes, and a couple of other things. So you know, everybody understands, again, Isabel helping me with the Facebook page, she said, I know this seems basic, but you really could use an episode on what hyper and hypothyroidism is people ask especially new newly diagnosed people, we don't have anywhere to send them. So here we are. Great. Awesome. Okay, so let's start like super simple, right? We're just going to use the dictionary. Hypo is a noun, and it means

Jennifer Smith, CDE 4:11
under or beneath a level of where you want to be. Right? And, yes, I mean, hypo hypoglycemia, hypo thyroid, hypo, many other medical terms that come along with hypo, it is like, it's low, right? It's under where a level of comfort would be.

Scott Benner 4:35
I also should have said and this is going to be a good indication to all of you that I stopped paying attention to my English teacher in about seventh grade, but it actually can be used as a verb as well, but we mostly think of it as a prefix, under beneath down less than normal, in a lower state of oxidation, for example, in a low and usually the lowest position in a series of compounds. So glycemia You know, I didn't think of this but darn it. Let's define. Let's define glycemia for a minute. Why not? I don't even think glycemia is a word, right? It is the presence of glucose in the blood. Now I'm learning. Yes. All right, like this podcast, okay? Jenny, then you

Jennifer Smith, CDE 5:21
can then you can put them together low presence of glucose in the blood. Yeah. Jenny, I hypoglycemia.

Scott Benner 5:29
I was gonna say I would listen to this podcast. Okay, so glycaemia the presence of glucose in the blood. So hypo, beneath normal, less than normal, presence of glycine, of glucose in the blood, and then hyper, which, if you've anyone's ever had a hyper kid, you know, this won't sound crazy, highly excited, extremely active, excessively excessive. That is or exists in a space of more than three dimensions that one doesn't really like It's like hyperspace. Oh, yeah, I really should have paid attention in school. This is all very interesting. I feel like an idiot. Okay, so but excessive, is where we're going to ride on this. So hyperglycemia excessive presence of glucose in the blood. That's it. Now, why somebody couldn't just call it high blood sugar and low blood sugar. You know, smart people, doctors, they fancy.

Jennifer Smith, CDE 6:25
Right? Well, and they're just medical terms, right? I mean, hyper and hypo, even in the sense of other medical conditions that carry that same prefix, if you will. They're just a medical term, rather than saying high and low blood sugar or high and low blood glucose even I also think, just glucose and sugar, right? I mean, when you say, my blood sugar is this, some people say my blood glucose is this, it's just another word for the same thing.

Scott Benner 6:54
Do you have a preference? Personally, when you write it out? And you know, someone else is gonna say it? Do you think blood glucose or blood sugar? How do you write it out?

Jennifer Smith, CDE 7:02
I abbreviate the G, because that's my quick way to type up something.

Scott Benner 7:08
After writing blogs, for so long, I did the same thing. But in the beginning, I had this like this blood sugar sound. I don't know. Like, I like this is not sound, I don't know, appropriate or something like that. But I don't think of it now. It's however it comes off my fingers when I'm typing. Like when I'm talking to somebody, I don't think of it one way I don't care. I

Jennifer Smith, CDE 7:28
guess if you, if I think about when I write about it, when I'm writing more professionally, I use the term blood glucose. And when I'm writing more from just a general kind of public, I typically use blood sugar. Okay, not that people don't know what glucose is, especially within the diabetes realm. I just think that blood sugar is often more what we say. Yeah. And so it's more readable. I don't know if that makes sense.

Scott Benner 8:02
Yeah, I think it just makes it feel more affable, honestly, just sure available to people. As an example, and we're not going to turn this into a third grade English lesson, but hypothyroidism is a condition in which the thyroid gland doesn't produce enough thyroid hormone. So back to hypo, low last, etc. Hyperthyroidism, the overproduction of a hormone by the butterfly shaped gland and the neck called the thyroid. Excessive too much. I just pulled up a couple of other words to make the point that it's not always about. It's not always about medicine. Hyperbole, as an example, is an exaggerated statement. We're claimed not meant to be taken literally hyper hyper. Right? Is the prefix. My, my last thought is just to get away away and Jenny used to be a nurse. Right, Jenny? What is hypo perfusion?

Jennifer Smith, CDE 8:56
Good to correct you I wasn't a nurse, or I'm not a dietician.

Scott Benner 9:01
Sorry. It's the same thing.

Jennifer Smith, CDE 9:05
Oh, well, you know, if I had thought that when I was going to school, then I probably would have ended up being a nurse. But yeah, so that different,

Scott Benner 9:15
I make a suggestion. Sure. We'll have to add CDE to the defining diabetes series.

Jennifer Smith, CDE 9:23
That would be great because you can have many credentials that precede CDE, which is actually not CDE even anymore. It's now c d c e s certified diabetes care and education specialists to make it even more complicated than it ever was.

Scott Benner 9:40
Have you given over to that yet? Because you you said you were gonna fight it in the big guy

Jennifer Smith, CDE 9:44
in credentialing just in terms of my signature and the way that I you know, put, again, sort of publications and that kind of stuff out I do. But I still call myself a CDE because I that's just like, what I've been long term.

Scott Benner 9:59
I have to Say I like these. Oh my gosh, I've gotten too hot tea and it doesn't matter. Oh no. I'm just gonna start drinking scalding water. When I'm recording from Elon just, I'll drip a little lemon in it and pour down my throat. I was gonna say I like the free flowing pneus of our conversations, because my just miss speaking for a second, immediately made my brain go, Hey, why are we not defining this stuff for people? Because people all the time, say, who just see today? I don't know, I saw the lady. You don't I mean, like, the doctor is the doctor, an endocrinologist? I don't know, what's the woman I don't know. Like, like, you know, she writes the prescriptions. It seems like she's got a medical degree.

Jennifer Smith, CDE 10:37
That's I saw these people. And they told me to do this. And I don't necessarily know what they are, you know, in fact, in terms of like that defining of even clinicians, many endo offices now sort of transition often on between, you see the Endo, you see the nurse practitioner or you see the Endo, or you see the PA, a physician's assistant, right, and you go back and forth. So it's not every three or four months, you're seeing the same Endo, you may see them only twice a year and in between, you actually follow up with the nurse practitioner, the physician's assistant, because that's the time that they have.

Scott Benner 11:13
So my brain like, I know, you have a firm background in nutrition. Like I understand all that. And I guess my brain just was like, well, she's the CDE she must have had to have been a nurse in the middle of it. And now so Okay, so we have more stuff anyway. Just

Jennifer Smith, CDE 11:27
remember things in nursing school that I was like, Yeah, I don't want to do that. I don't want to ever ever do that to a person. So no, I'm not going to be a nurse.

Scott Benner 11:37
Well, then just for fun.

Jennifer Smith, CDE 11:38
I I very much appreciate the nurses who do and can do those types of things. But I That's not me. I can do blood. You could bleed all over me. I could do wounds, weird looking gashes.

Scott Benner 11:51
Where's the line pee?

Jennifer Smith, CDE 11:53
Oh, the line is mucus. Oh,

Scott Benner 11:57
I wish you could have saw the face Jenny just made we should make it a poster. I just sideways or tongue came out or one of her eyes went one way she's like,

Jennifer Smith, CDE 12:05
yes. No, I was I was an ICU dietitian. So I did like tube feedings and IV nutrition and all that kind of stuff. And I would have to move away when they were doing like suctioning of patients and stuff. I like the noises and not for you. Not for me. Nope. My Oh, come back. Thank you. My wife

Scott Benner 12:27
is like three clinicals away from being an RN. And I mistakenly got her pregnant before she could finish off. So I do remember that she never got back to it. But she even said that. She thought by the time if she would have finished she's like, I don't think I could have like actually helped people. Like it just was Yeah, her vibe. And it wasn't about the people. It was more about the that stuff. Okay, but anyway, just for shits and giggles Do you know what hyper perfusion is? Now that I brought it up? Because if not, I gotta tell people.

Jennifer Smith, CDE 12:57
What and why? I'm curious actually. Why?

Scott Benner 13:00
Because it had the word hypo in it. And I thought I wonder if anyone just randomly know what this is? Oh,

Jennifer Smith, CDE 13:05
well, it has to do with like blood flow. It's hyper. Hyper is more and hypo is a reduction in the amount of blood flow.

Scott Benner 13:15
This is why you're listening to the podcast because Jenny knows stuff about stuff she doesn't know about. Hypo fusion has nothing to do with diabetes, but it describes a reduced amount of blood flow. There you go. You can't trust somebody who knows stuff. They're not supposed to know who you're supposed to trust.

Jennifer Smith, CDE 13:29
Correct. There you go. Well, thank

Scott Benner 13:31
you so much for doing this. I

Jennifer Smith, CDE 13:32
really You're welcome. Absolutely.

Scott Benner 13:36
That was good. That was hilarious. Actually. It's always fun. Good time. All right. hyperperfusion. I'm getting rid of tabs on my

Jennifer Smith, CDE 13:43
Yeah. Are we stalled for a second? I need to I think I forgot my orange link in my kitchen. And I need to go grab it because my loop is red right now. We'll be right back.

Scott Benner 13:54
No problem. While Jenny's off getting her orange link. I'm going to tell you about today's sponsor, US med

just the other day, I had Omni pod send Arden's prescription for Omni pod five over to us med. All of this happened without problems. That's what we want. Right? Nice and easy access to our supplies. US med offers that with their white glove treatment. US med accepts Medicare nationwide and over 800 private insurers. They carry everything from insulin pumps and diabetes testing supplies to the latest CGM, like FreeStyle Libre two and the Dexcom G six. US met always provides 90 days worth of supplies with that fast free shipping that I've been telling you about. If you want better service and better care than you've been accustomed to getting with your other suppliers, check out us med. They've helped over 1 million diabetes customers since 1996 are the number one rated distributor index com customer satisfaction surveys, the number one specialty distributor for Omnipod dash, the number one distributor for FreeStyle Libre, and the number one fastest growing tandem distributor nationwide. US med get your free benefits check right now. Us med.com Ford slash juice box or call 888-721-1514. There are links to us Med and all of the sponsors in the podcast player shownotes that you're listening in right now. Or at juicebox podcast.com. And don't forget to take that T one D exchange survey AT T one D exchange.org. Forward slash Juicebox. Podcast support T one D exchange, you're helping people with type one diabetes, and you're supporting the Juicebox Podcast, keep the show free and plentiful by supporting the sponsors.

on next week's defining diabetes, Jenny and I will be defining all of the different types of diabetes. And there are more than you think. To find a list of all of the defining diabetes episodes, go to Juicebox Podcast type one diabetes on Facebook, it's a private group for people who listen to this podcast. And right there at the top of the page. You click on a little tab called where the is it God, I can never remember the name of this. I'm going to curse. I'm going to curse. I don't want to curse just trying to finish this ad and I'm done for the week when I get this done. Like I actually get a day off tomorrow. I mean, I still have to record but I don't have to edit and I just want to tell you the name of this. Featured, you go to the Juicebox Podcast type one diabetes, it's a private Facebook group. Almost 25,000 people in it. They use insulin, they chat with each other, they help each other. And under the featured tab at the top. There's lists of episodes in different series, including the defining diabetes episodes. So if I didn't sound too crazy, just then maybe you'll go check them out. I just didn't want to curse. That's the end of my week and I had knee surgery. I'm feeling okay, but I'm not supposed to be sitting here right now. I'm supposed to have my flights. This is not your problem. Just go find that. Just go find it. It's Juicebox Podcast type one diabetes. It's a private group answer a couple questions you get right in. It really is a magical place. I'm not kidding

you. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.