Scott Benner 1/3/23 Scott Benner 1/3/23

#818 Defining Diabetes: DKA

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

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

Scott Benner 0:00
Hello friends, and welcome to the last episode of the eighth year of the Juicebox Podcast. This is episode 818

Welcome back everybody. In this episode of defining diabetes, Jenny Smith and I are going to define DKA diabetic Kido acidosis. While you're listening, 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 health care plan, or becoming bold with insulin. If you're enjoying Janney and you'd like to hire her you can she works at integrated diabetes.com. Are you a US citizen who has type one diabetes, or is the caregiver of someone with type one, please go to T one D exchange.org. Forward slash juicebox. And fill out the survey when you complete the survey. You have helped somebody living with diabetes, you're moving diabetes research forward and you may just help yourself T one D exchange.org. Forward slash juicebox. I have a little bit of time here. So I'm gonna say thank you so much for listening to the eighth year of the Juicebox Podcast, it was absolutely record breaking as far as downloads go. I can't thank you enough. If you're looking for a New Year's resolution that's achievable. Listen to a Juicebox Podcast series. If you're newly diagnosed, find the bulb beginning series. Trying to understand what all these words mean. Defining diabetes has over 50 episodes at this point, you're listening to one right now. And if you're really ready to dig in the diabetes Pro Tip series is the way to go. You can subscribe or follow the show for free on Apple podcasts, Spotify, Amazon music or wherever you get your audio even audible. Melissa says Pro Tip series set us on our desired path from the very beginning from a 12.9 a one C A diagnosis to a 5.2 in one year with a no honeymoon. You can find the series and more at juicebox podcast.com. Right at the top in the menu. Or you can go in the audio app you're listening in and just do a search Juicebox Podcast bold beginnings defining diabetes, diabetes pro tip, or how about the diabetes variable series, you think you know what's impacting your blood sugar, maybe you don't completely understand the diabetes variable series will help you to there's a mental wellness series defining thyroid, a collection of episodes about algorithm pumping. And don't forget the after dark series where people tell stories that most won't share. And finally, if you're looking for support, or community, the Juicebox Podcast private Facebook group is absolutely free, has over 32,000 members. And it's just waiting there for you so much good information. You can dive in and talk or just kind of sit back and watch. Whatever you need. That group has it. Alright, it's the end of the year, I did all my ads. So there's no ads in this one. Let's get right to Jenny and I talking about DKA. At the end, I will leave the links for all the advertisers if you need them. Just since you're so excited, I'll start the recording and then I'll tell you, so it's it's Friday. And I have two options today. We can either record for short defining diabetes episodes, which would be DKA MDI, meet the need and maybe something else. Or we could do this one, which I'm not going to be much help on. So that's why I'm asking you first I'll be able to like kick in with like, Oh, I remember doing that. But I need an episode. The people need an episode about the maths. I shouldn't say it like that. But the mass setting up Basal carb ratio insensitivity, like the real math behind that. Are you up for talking about that? Or do you want to do the emptyeyes?

Jennifer Smith, CDE 4:14
Let's do the let's do defining today. That's where my brain is today. I am just

Scott Benner 4:21
that's what I wanted to know. I didn't want to like spring on your like, we're gonna talk about math now. We'll do it later. The people will get it later. All right. Yeah.

Jennifer Smith, CDE 4:29
No, and I think I entirely agree. I think it's a big piece that you know, most people are just given these doses. And they're like, okay, because that's all they know, to say is okay, I got this new thing, you know, so you tell me and then eventually they learn more and they're like, why am I using

Scott Benner 4:51
and how do I come up with that number, but I just see people all the time, say like, my they told me this was my insulin to carb ratio, or they told me this was my insulin. sensitivity or whatever I I don't know where they came up with that. So okay, so if people are hearing this, you're about to hear a defining diabetes episode. But I imagine that by the time you hear this, our math episode will be up. So we will have Yes, we will do pick around, you'll find it.

Jennifer Smith, CDE 5:16
Good choice. Thank

Scott Benner 5:17
you. Do you see why I asked you? Because it's

Jennifer Smith, CDE 5:20
because it's more, it's definitely more in depth.

Scott Benner 5:25
It's mathy. And this Friday, I don't know where you're at. So

Jennifer Smith, CDE 5:29
yeah, I'm not at that on this Friday.

Scott Benner 5:33
Exactly why. And I think this is an exciting moment. Because, as Jennifer will tell you, I've never once told her asked her if she was up for doing what we were doing. Well, this is what we're doing today. And she's like, all right. Yes. So thank you for asking on this. Friday seemed important. The other stuff is, is conversational. Like, it isn't to the people listening because they don't have the knowledge. But for us, you know, if to pull the curtain back, you know, I'm gonna say in a minute. Hey, Jenny, let's talk about, we're gonna define DKA. And I'm gonna say something. And then, before you know it, it'll be 15 or 20 minutes later, and we'll have a clear explanation of the Hey, in a short conversation, because that information is in our head already. And we don't we hope that it's clear. Listen, better be clear. Have you ever listened to one of our episodes and thought, oh, we should have read on that?

Jennifer Smith, CDE 6:26
No, of the ones that I have. I've listened to most of them, I think, at least once? And I don't think so. Although, sometimes some of the older ones, as we've talked before, I think there's more to some of them now. Yeah. Because of other things that just weren't there to talk about or include.

Scott Benner 6:47
Previously, I'm trying to get I'm trying to clean up some of my list right now at the end of the year. And then I assume you and I are going to talk more about adding on to to the previous stuff. So okay, well, I love the defining diabetes series, because almost every time I say to you, Hey, Jenny, let's define blank today. There's a voice in the back of my head that says, you don't need to do that people know what that is. But then that's never the case for everybody. Somebody always doesn't know what a CD is. Or, you know, my favorite example is that I got a letter one time where the woman was like, I didn't know I was MDI until you told me. Right, but I absolutely, I've been doing it for years, like so. Anyway, so today DKA, diabetic ketoacidosis.

Jennifer Smith, CDE 7:35
Yay, define it. I think even defining it in terms of what the acronym is, is important, because most people just know it as DKA. And they're like, Well, I don't know what that means. Not only do they not know, it means like in words, but they just don't even know what it involves. Right?

Scott Benner 7:52
They just know they don't want it. Right. Yeah.

Jennifer Smith, CDE 7:55
No, nobody wants.

Scott Benner 7:58
I know, I don't want it. And I might have to go to the hospital if I have it. And I don't think so. Okay, so let's go through it. Yeah. I'll start with the Mayo Clinic. I like them. Oh, yeah. Okay, diabetic ketoacidosis is a serious complication of diabetes. That condition develops when the body can't produce enough insulin. Insulin plays a key role in helping sugar, a major source of energy for muscles and other tissue entering cells in the body. Without enough insulin, the body begins to break down fat as fuel. This causes a buildup of acids in the bloodstream called ketones. If left untreated, the buildup can lead to diabetic ketoacidosis. If you have diabetes, are you at risk of diabetes? Learn the word we know that part. Okay. You want to talk to me to give you the symptoms of decay?

Jennifer Smith, CDE 8:46
Well, the symptoms I can certainly do that unless you would like to

Scott Benner 8:50
roll through Jenny,

Jennifer Smith, CDE 8:51
let's go. Yeah, absolutely. Some of these can come even if you're not technically in DKA, but are definitely something to consider thirst. Like, I always say this is like extreme thirst. I still to this day, remember how thirsty thirsty I was before my mom took me to the hospital. Okay. It's like parched to the degree that you could just have like a water fountain attached to your mouth and you still would not feel like you're getting enough water.

Scott Benner 9:25
Someone just yesterday was talking about the diagnosis of their young brother nine months old. And he said something I don't think I'm ever going to forget. My brother was sucking the liquid out of the wet wipes. Oh, wow. And I thought that's so clearly illustrated. The just it's not just an urge, you know, right. Yeah, like just Yeah, just a primal thing. Like your brain is just find liquid put it in your mouth because I've heard people say, I caught my kid drinking out of the toilet. And that's shocking because If the toilet but it's not rocking, it's also a big bowl of water and the kids thirsty. So you're like, Okay, that makes sense, right? But sucking the liquid at nine months old out of a wet wipe, I thought that really, that puts a clear description, right.

Jennifer Smith, CDE 10:14
So I think to define that symptom even a little bit further from an understanding of like biology, what's happening in the body is the high levels of glucose, your body again, tries to do what it can, right. And so it tries to clear that excess glucose out. And that pulls fluid from other areas in the body. And so you get dehydrated with the high levels. And the thirst just keeps going. Because a second symptom that goes right along with thirst is going to the bathroom all the time, like, all the time to the degree that you can't wait to have five minutes to just leave whatever you're doing and go to the bathroom. Again,

Scott Benner 11:00
it just keeps happening. And this is your body's kind of way. It's it's last, its last ditch effort to try to remove these toxins, even though this isn't going to work. Right? Correct. Yeah,

Jennifer Smith, CDE 11:11
right. Right. Because of the extreme deficit of insulin, right? There's only one way to get the body to kind of shift gears. And in the whole grand scheme of things besides insulin, there are electrolyte imbalances and things that are also going along with the ketoacidosis, too, that need to be righted, obviously. But definitely thirst and extreme urination. I you know, for little, little kids. It's really heavy, consistent wet diapers, as well. Okay. For little kids who've been potty trained. It's often that they sort of revert back to wetting the bed, or not being able to get to the bathroom fast enough during the daytime and wetting their pants. Yeah.

Scott Benner 11:59
I was gonna go down a different road. But I want to keep I'm not going to Oh, yeah, so I'm gonna stomach pains, the feeling of throwing up or needing to throw up or to actually throwing up. It really is. Can you hear that? I can buy your truck just went by and I was like, I can't believe you can't hear that. It's just for you. Apparently, sorry. I'm hearing voices. Jenny. This is it. So, you know, shortness of breath, fruity scented breath, which is the thing that finally pushed us over the edge with Arden. And confusion. But now is the initial DKA at diagnosis and a DKA that you could run into after you're diagnosed and you're getting insulin. They're the same thing. But do they Yes, but they present. They can present differently? Because? I mean, why do I mean that because when you're being diagnosed, it's not everybody. But you could be experiencing a slow shutdown of your insulin production. So this thing could come on more slowly.

Jennifer Smith, CDE 13:07
Where that yeah, that's a good I guess, description of the difference, because I remember I was thirsty for a good two weeks prior to actually, my mom's like, we're going to the hospital, right, you know, I was thirsty, thirsty, thirsty enough to keep asking my friends for their milk at lunchtime, thirsty enough to stop at the bubbler? There I'll use a local term, the water fountain, in between classes, going into the bathroom in between classes, all of that kind of stuff. I remember also getting up overnight to go to the bathroom. I remember the week before also having thrown up overnight. But you know, at that, like early teen, I didn't really tell my mom Hey, I got sick overnight. Yeah, just I don't know. It was just whatever it is the brain at that age, right. So yeah, I mean, all of those, all of those kinds of things are a lead up in kids or even adults. Sometimes I think the adults who are diagnosed as type one in adulthood. It's even slower progression. Right. So well, in in the time when you are already diagnosed, though. DKA is more of a, as we've already talked about ketones, right. DKA is more of a it's a quick development, I guess, for lack of a better way. I hope that makes sense.

Scott Benner 14:39
Yeah, that's kind of what I'm saying is that if you're being newly diagnosed, you know, you might not even be listening to this. To be perfectly honest, this might be something that people only find after they found that they have diabetes, but my point is, is that if you if your recollection of it is that it came on slowly, you know, and then you found yourself in the hospital with somebody telling you you have diabetes and you're in decay Once you're on insulin, and your pancreas isn't helping anymore, if you lose your insulin, it's going to happen fast like, and it's going to be serious quickly. And that's that changes. You know, I think how you have to handle it, and we have that whole episode about dealing with ketones. So it's why I'm doing this after that one. I wanted to make sure that one was up before before this.

Jennifer Smith, CDE 15:22
Well, and I think people who also have type one in the family, I think this episode is important, just as even reminder of the common symptoms, because some people or kids may present with a few. Not necessarily all of these things at one time. So even though you may think you have eyes for watching for this, it's important to still be reminded,

Scott Benner 15:50
yeah, I think that based on what the doctor said in the hospital, and my being able to, you know, look back on the situation, I think if we don't go to the hospital when we do, I mean, I don't know what happens the Arden in the next 24 hours, really, you know, like she was in a bad way. Yeah, like they seem surprised that we've bit and to feel good about it. We they seem to surprise that we got her they're conscious. And they said so many kids at this age because Arden was too. She's like they come in unconscious or comas, you know, like really terrible stuff. And, and then when they asked like, how did you know? I said, I her breath smelled weird. And then I said that to my wife, and it sort of set off a chain reaction of us, like brainstorming together for five seconds and going oh, God, she has diabetes.

Jennifer Smith, CDE 16:44
Besides the breath. Did she also I know we defined this to the crucible. Well, she had those for sure. Did she have that too? Yep.

Scott Benner 16:51
We were sitting in a vacation home with a full family. It must have been like 16 people there. It was late at night. And we were playing a board game. And Kelly was still in her bikini I think in a rap like a sarong. And Arden was like draped over her lap. fall asleep, having those respirations and I guess it was just a pause and it and we just thought she was sick. You know, like and, and there was a pause in in the in what was going on? And I don't know why. But I said I said hey, I meant to tell you that Arden's breath smelled weird today. And she goes, What do you mean? I said it was like fruity or maybe metallic. Like that was what I remember saying. And then she gets this terrified look on her face. And then I think we both kind of like quietly in our head start doing the math. And I don't know who said it first. It might have been Kelly. And she's like, Oh, god, she's got diabetes. And this was before the internet, like the way you think of the internet now. So someone had a laptop, and we had to hang over the balcony of the vacation home to steal Wi Fi from another house to Google signs and symptoms of type one diabetes. Yeah. And then we saw like, there were like five things in a list. And then we called my buddy who's the kids pediatrician. And then he found a the closest Children's Hospital and kind of sent us to it. I mean, this is before you could get in your car and be like, I want to go to this like we were like in the middle of the night in a city we didn't know.

Jennifer Smith, CDE 18:20
Right, like driving and hoping you're following the right street to get there swear to

Scott Benner 18:24
you. None of you listening there were under a certain age understand that. But like, we didn't just get in the car and go oh, go to the hospital car. And the car was like, Okay. wasn't like that. It was really just a sad moment not to get too far off the path. But I remember I remember sitting at a traffic light on this, like, desolate Street. And Kelly and I like staring forward like almost on purpose not looking at each other. And I said, Hey, right now before we get there, like she's got diabetes, like get yourself. Right. I was probably talking to myself, but talking to her, you know, I'm like, because this is going to be this is about to be horrible, you know, and we need to hold it together. We were still pretty young. And you know, so far our life had been fairly ideal. Like, honestly, like, we grew up hard. We got good jobs, we bought a house like we thought things right, working, you know what I mean? And then suddenly, I'm just like, we're gonna go into a hospital and someone's gonna say this to us, and then all the things that come after it that we don't know. Right, you know, so instead of being tough, we went into a family room and cried after they took her they didn't go the way I thought we weren't all like it's gonna be okay.

Jennifer Smith, CDE 19:39
I'm surprised you sat at the stoplight. Those are the stoplights were like there's nobody around and I'm in a hurry. o'clock in the morning. I'm like, why am I sitting at a red light when there's nobody here? I can tell you why. And am I admitting to bad thing? No, no, not

Scott Benner 19:58
in any other situation. I would Look left look right and been like Scott's gone. But although nowadays they got the cameras everywhere. Right? Right. But But I did that twice that night. The first time was after we realized what was going on, I went to a, um, a pharmacy, a 24 hour pharmacy to buy a meter. And I stood in the meter, I'll I think, on purpose not choosing a meter. Because I had this conscious thought standing there. And I thought if I don't get one of these meters, she doesn't have diabetes. Like, that's how it felt I was gonna cry. I've never cried while I was doing this with you. I'm sorry. I thought like, I thought I'll just stand here forever. And she'll be okay. I'll never see her again. But at least you won't have diabetes, you know. And I made myself by the meter, I drove back. And then I think that stoplight was the same thing. I was like, I could go, but let's just sit here.

Jennifer Smith, CDE 20:53
Let's just give it some time before we get someplace and get news that we don't want to get. Yeah, give me

Scott Benner 20:59
two extra minutes of art and not having diabetes, I think is at the time. But anyway, that's nothing to do with DK and I need a tissue Hold on.

Jennifer Smith, CDE 21:07
I'm sorry. Well, it does have to do with DKA I think it's because these are all the things that go along with it, that it's not just defining something, it's it's important to know that all these emotions and these things, they're going to be there too. And that's, that's not wrong.

Scott Benner 21:27
I mean, so it's just it's one of those things that I mean, DKA could happen once you have diabetes, it could happen at any time. You can a bank cannula could send you there.

Jennifer Smith, CDE 21:38
You know, forgetting some people faster than others. Yeah, right. And so

Scott Benner 21:41
when you see these being very thirsty, urinating stomach pain, throwing up weak or tired shortness of breath, that you know where that fruity breath being confused. I mean, please, first of all, get yourself a ketone meter, there are blood ketone meters, they're way easier than peeing on sticks. And probably sitting there much more accurate, more accurate. Yeah, yes. And then you've got to go into your, into your sick day care. And you clear those up, they're going to clear those ketones, so you're going to end up in a hospital where they're doing it for you. And I don't know, I should find, as we're wrapping up, and you tell me if there's anything else we need to put here?

Jennifer Smith, CDE 22:19
I don't think so. I think that defines it in a, I mean, a simple way, the symptoms and why it's happening. That's the important piece of it. Yeah, what to do about it is clearly if you think that this is a new diagnosis, obviously, you need to just go get medical care. That's the you need the help. If you're at home, and you have really high ketones, like we've talked about in the ketone episode, you either give it a time to clear it, or if it's not clearing within, you know, a defined period of time. You go to the doctor, don't play with it.

Scott Benner 22:53
That's episode 805. It's inside of the bowl beginning series. It's called Bold beginnings, illness ketone management. So there you go. Oh, Jesus. I have to be honest. Yeah. I didn't think I was gonna get upset talking about you tricked me. That's sorry, don't worry. Oh, thank you for doing this. I appreciate it. All right. Holy crap. I didn't know he's gonna cry. Sorry. No, don't be sorry. I make people cry all the time. So don't worry about I was interviewing a guy yesterday, he got choked up talking about his brother. Next thing I know, I'm like, god dammit, I'm crying. But he just told this crazy. Uh, you'll you know, if you catch it, when it comes out. It's going to be an after dark. This guy and his brother were, they lived. Like, hold on, let me I'm gonna stop the recording for a second.

Sorry, I cut that off. I didn't want to give away an upcoming episode. This is pretty much it. It's the end of 2022. I want to thank you so much for listening to the show for subscribing in an audio app for telling other people about it. For participating in the private Facebook group. It's all very much appreciated. I hope you have a very happy new year. Let's say alright, I'm just gonna at the end here, I'll list all the advertisers their amazing support that they've given to the show for some of them for many, many years. If you need an insulin pump or a glucose monitor glucagon or something, it's a huge help to the podcast if you click through my links, so thank you for taking that extra step.

These links I'm about to give you are right on the front page of juicebox podcast.com And they are on every episode page for the specific episodes meaning like this episode here has a page on juicebox podcast.com. Okay, let's go with the first ever advertiser, Omni pod, bought an ad in 2000 wasn't in 15 when in a month, there weren't as many people listening as there are in an hour now, that's pretty much right. Yeah, took a month to get the amount of listeners in 2015 that in 2020 to happen every hour so on the pod was in early and supporting the show back when they really were just supporting the show. I mean, I don't think I was selling a lot Omni pods back then. Anyway, now you can get the Omni pod five or the Omni pod dash through my link Omni pod.com forward slash juicebox I think the next advertiser was Dexcom I think Dexcom was next Dexcom Of course, makes the Dexcom G six and the Dexcom G seven, you can find out more about that you may even be eligible for a free 10 day trial of the G six@dexcom.com. Forward slash juicebox I should throw in that I think you may be eligible for a free 30 day trial the on the pod dash at my link. But now that I said that I have to say for full safety risk information and free trial terms and conditions also visit omnipod.com forward slash juicebox. Alright, I didn't mean to get into that sorry. I think touched by type one was the next advertiser. Great organization helping people with type one diabetes touched by type one.org They're just looking for you to learn more about them go check out their websites very cool. They have a lot of offerings for type ones. I'm gonna say after that Contour Next One, I think the Contour Next One blood glucose meter fantastic meter contour next.com forward slash juice box may be cheaper in cash and you're paying right now through your insurance. One way or the other. absolutely accurate and amazing meter. We've been using it forever. It's fantastic. I'm gonna say that. Then it was je voc hypo pen, je voc glucagon.com forward slash juice box that is the glucagon that my daughter carries. In 2022. The in pen was a sponsor. They are not going to be back in 2023. So I'm not going to give you their link. And what else us med came on? It's 2022 They're sticking with us. Absolutely fantastic. This is where we're getting Ardens diabetes supplies from us med.com Ford slash juice box or call 888-721-1514 If you're sick of that place that you're getting your stuff from now, you don't want to bang your head against the wall like you are with some of the other distributors check out us med T one D exchange is not an advertiser, which might be confusing for you. I actually get paid every time you fill out a survey but I love what they're doing. T one D exchange.org forward slash juicebox. Go take the survey. You'll help move diabetes research forward and you'll help the podcast I think that's it. Oh no, no, no, no. Excuse me. In October Athletic Greens came on board. And they're going to stay for 2023 Thank you athletic greens. So if you're looking for ag one from athletic greens, it's athletic greens.com forward slash juicebox. I'm using it every day and really enjoying it. Alright, if you're still listening Europe, you're a great fan and I appreciate it very, very much. That's all I have for you Have a Happy New Year. I'll be back very soon with another year of the Juicebox Podcast

#814 Defining Diabetes: CDE and CDCES

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

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Scott Benner 0:00
Hello friends, and welcome to Episode 814, 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 C D E. This will be the 47th 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 there it is the finding diabetes you 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. today's podcast is also sponsored by Ian Penn from Medtronic diabetes, get yourself an insulin pen that has much of the functionality of a pump at in pen today.com The last sponsor of the day is the Contour Next One blood glucose meter. This little blood glucose meter is the bomb. It's the best one I've ever used. I love it. Contour next one.com forward slash juicebox.

Jennifer Smith, CDE 2:13
As an excited Yes.

Scott Benner 2:16
They didn't hear me say I wasn't recording when I said do you want to try it out for what I've come to realize when I'm editing the defining do I any of our stuff together? Then I say to you alright Jenny, let's do this now. And you very jokingly, but very dryly go yes or yay, or something like that. And I listened back to a one time and I thought people must think that she's like, No, I don't want to do this. Because it sounds so like, I don't know, you're just like yeah, sure, buddy. I guess so. Sorry. That's sound like we're here. We might as well do. You got your line? The bed? CD, I guess, which is what I'm going to ask you about right now. Because looking back over the defining diabetes series, we never defined certified diabetes educator, which at this point isn't what they call certified diabetes educators anymore. So we'll start with, but let's start with CDE though. Okay,

Jennifer Smith, CDE 3:15
so C D E, and thank you for asking. C D E is certified diabetes educator, and is no longer the term that is used, although, quite honestly, people still use it because they don't know that we have a new acronym.

Scott Benner 3:37
Well, first, let's go over this. Yeah, what do you need to be to be a CD?

Jennifer Smith, CDE 3:43
Right. So to be a CDE. The typical in common? I guess education backgrounds, nurses, dieticians, pharmacists, mental health specialists, physicians, exercise physiologists, mainly the medical background kind of bachelor degree based medicine degrees. Can the diabetes educator now to take the step into becoming an educator, there are certain criteria that you have to have in order to be able to sit the CDE exam, which is a pretty lengthy exam, it's about four hours. When I took it eons ago, it was still on paper. And I had to fill in all the little sir fill in the circle completely, so that your answer gets recorded in the right way. Right.

Scott Benner 4:42
Those are called Scantrons is drawn. There

Jennifer Smith, CDE 4:45
you go. Yes. I still know where I took it in Baltimore. And then my husband and I had planned to go to a baseball game after that afternoon because we were there and why I got to something else. That's fun, right? So it, you have to log enough hours in education in order to be able to apply to take the exam, okay. And the number of hours used to be years ago, 2000 hours, within a certain defined time period of, like, two years, I think it was. Now it's down to 1000 hours logged of in depth diabetes education, which means that somebody needs to it as they're educating people with diabetes, they have to keep a log of all of the patients that they've worked with, what they educated about the length of time they spent educating. And you also have to be able to state in that application that you are currently in a role of diabetes education a certain number of hours in a week's time. Yeah. Right. So I logged my hours after I took a job. As a dietitian, I started logging hours as I was working with outpatients within just some of the diabetes education from a nutrition aspect to there. And then once I started teaching classes for type two diabetes, I was able to log more hours in terms of things like medication use, and how to use it in you know, using glucometers. And the nutrition aspect and the lifestyle stuff, all that kind of stuff that you have to to know about. And then I got a job in an endocrine clinic after I had actually taken my exam.

Scott Benner 6:44
Well, did that take?

Jennifer Smith, CDE 6:48
My Login took two years, okay. Because I was not initially doing 100% 40 Hour Work Week, give or take in diabetes education, right?

Scott Benner 7:03
Wow. It's a lot. It's a lot to give a lot. Do you see people begin the process and give up on it? Or do you think people fall through mostly because I mean, it's a long Africans, you're already a nutrition, you're your niche, you have a nutrition background, you're a nutritionist, you can work that way. And you're like, Well, I'm gonna start doing this stuff with diabetes, too. I wonder how many people get like a year ago, they're like this never gonna get these 1000 hours. And then you gotta pass the test on top of that. Effort is what I'm saying.

Jennifer Smith, CDE 7:33
And the test is certainly all encompassing, you know, and that's why, despite having multiple starting backgrounds of like medical or health education, right, you really do have to focus in on the specifics of diabetes management. And especially, you know, I'm actually glad I took the test when I did, because now in today's world of medication for type two diabetes, and for type one, there is a number of extra and combination medications and use this but don't use it with this and only use it for this law. It's like,

Scott Benner 8:13
a learning. No, yeah, there's, there's a lot more and plus, now, you probably could take the test digitally, you wouldn't have to color you can.

Jennifer Smith, CDE 8:19
Absolutely. In fact, I actually have somebody I've been friends with for a while and she's taking her exam this weekend.

Scott Benner 8:28
Well, good luck. Very excited. So now, a while back now, I spent almost a couple of years. Somebody just told me one time like, well, we don't call ourselves CDs anymore. We're CDC e ss. Is that right?

Jennifer Smith, CDE 8:41
That's right. Certified. Care. Specialist.

Scott Benner 8:47
How about that? Good job. Well, this stuck into my head, I guess, because I'm actually not reading. So I just, I just like I'm like no, this surprised myself. Okay, so certified diet. You just made me feel like I was five I was like, thank you. I appreciate pat on the back. So CDE certified diabetes educator, CDC II s Certified diabetes Care and Education Specialist. You're going to meet these people in your wallets. First of all, I'd say I hope you meet these people in your Windows Office. Do you think Do they exist more in in care for children or is it equal for adult like Will an adult no like I'm about to have this experience like Arden is going to meet an adult endo soon. Is there going to be a CDE in the in the office? Is there going to be like I don't even think Arden like she she usually just talks to a nurse practitioner to be perfectly honest. She Yeah, she doesn't usually see your doctor I mean, the doctor.

Jennifer Smith, CDE 9:50
I I would say that more pediatric endocrine practices have either an in house educator, they may even have a dietician and an educator. And or it might be a dietician, educator and maybe a nurse practitioner, kind of like you guys have been working with more of a nurse practitioner rather than the Endo. Actually. I would say that's more the peds world, to find them to gather, or to have a peds endo that has a reference to somebody that their their clinic works closely with an adult endos I don't even know if it's 5050. Quite honestly,

Scott Benner 10:43
you're gonna see the really low and the person that helps them see their patients usually had Nurse Practice, correct.

Jennifer Smith, CDE 10:49
And if education is needed, especially upon newly diagnosis, type one or type two, they will usually send you to an education class, where there will be if it's an accredited, accredited by the ADEA. Then there will be a nurse educator who is head of the class or a dietician educator who is head of the class. And those are much more common for type two than they are for type one as an adult, though.

Scott Benner 11:24
Okay. All right. Oh, okay. Well, I appreciate you doing this with me very much person. Absolutely. Figuring out what all this means. I was just still like taking that I knew what CDC Yes.

Jennifer Smith, CDE 11:35
Hi, I'm surprised you because it took me a while to remember myself. It

Scott Benner 11:40
bounces. There's that it's the Certified diabetes Care and Education. Like once you find the little bounce in it. It sticks in my head. But yeah, so for that. I mean, the first time somebody told me they were renaming the CVS, I was like, please leave me out of this. I have a hard time remembering things. I don't want more stuff to remember right? Very much. I'll talk to you soon.

Jennifer Smith, CDE 12:00
Sure, absolutely. Bye bye.

Scott Benner 12:05
When you have diabetes and use insulin, low blood sugar can happen when you don't expect it. GE 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. If you're looking for an insulin pen that does more, you want the in pen from Medtronic diabetes, head to ink pen today.com forward slash juice box to find out all about the ink pen. The Ink Pen features a dosing calculator, active insulin remaining glucose history reports activity logs dose history meal history and it does it all on an app on your phone. Once you have that app and connect your continuous glucose monitor, here's what you're gonna get from the MPN. A dosing calculator, active insulin remaining glucose history reports activity log dosing history meal history. And like I said, connect your CGM and you're going to be able to see your current glucose levels right on the in pen app in Penn today.com. It's where you head off to place your order, you can get it right from there, or you can learn more about it or learn more about it, then order it. I don't care what you do, just use my link. By the way, you may pay as little as $35. For the pen the offers available to people with commercial insurance only Terms and Conditions apply, but head over because you could be one of those people who gets the pen for $35 in pen requires a prescription and settings from your health care provider you must use proper settings and follow the instructions is directed where you could experience high or low glucose levels. For more safety information visit in Penn today.com. Next, I'm going to tell you about the Contour Next One blood glucose meter. The website is contour next one.com forward slash juicebox. I wish you could have just seen my face now I typed it in as I was saying it and I had a typo. And then nothing came up and I was like I think I'm still doing business with contour. But I was just typo. Anyway contour next.com forward slash juicebox. And I want to thank contour. They're back in 2023 is a long term advertiser so that I can tell you about the Contour Next One again next year in 2023. But for now in 2022 This is an easy to use website that has a ton of information on it and the Contour Next One blood glucose meter is legit the best meter I've ever used. It's easy to handle hold using the dark using the light test strips off a second chance testing. It's remarkably accurate. And you can even buy it in cash if you want it. It could be cheaper in cash and it is through your insurance. winds company, find all of that out at contour next one.com forward slash juicebox. I know. But you know nowadays some people are like, Well, I have a CGM, it doesn't matter, but it really, really matters. And you deserve an accurate meter contour next.com forward slash juicebox.

Guys, it was a short episode today, but I want to thank you for listening. I also want to thank Jenny Smith and remind you that Jenny works at integrated diabetes.com. If you'd like to hire her, she can help you with your diabetes, integrated diabetes.com to find Jenny Smith. Hope you're enjoying the defining diabetes series. I find it to be one of the best, you know, just to hear the short conversations and leave with an understanding of a term that is going to come up over and over again in your life. It's really I don't, I'm a big fan of it. Anyway. That's it. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast.

#810 Defining Diabetes: Untethered

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to episode 810 of the Juicebox Podcast well eaten.

I'm excited to have Jenny back today for another installment of defining diabetes. And today, Jenny and I are going to define untethered. This will be the 46th 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. today's podcast is also sponsored by Ian Penn from Medtronic diabetes, get yourself an insulin pen that has much of the functionality of a pump at in pen today.com The last sponsor of the day is the Contour Next One blood glucose meter. This little blood glucose meter is the bomb. It's the best one I've ever used. I love it. Contour next one.com forward slash juicebox. Hi, Jenny, how are you?

Jennifer Smith, CDE 2:14
I'm great. How are you? Scott? Good. We

Scott Benner 2:16
are back together doing some more defining diabetes episodes. Awesome. And I am going to ask you to define something that I've never done before. What does it mean when people say they're pumping untethered?

Jennifer Smith, CDE 2:35
Oh, I guess there are probably a couple of different methods to that. One that I've seen used enough is they will take a Basal injection, right. But they will reconnect to Bolus with the precision of a pump. Remember that pumps can you know dose down to really really tiny unit markers. Whereas injections mean the tiniest marker you can get as a half a unit if you're really really good. You can do a syringe and maybe get close to a quarter unit ish. But pumps can get much lower than that so many I shouldn't say many but some people who choose basil injected insulin may reconnect to do a Bolus. I've also seen it the other way where the Basal actually is what the pump is doing. And then the Bolus is are either injections or the inhaled insulin like a Frezza. I don't necessarily. I don't think of that in the term of untethered though because technically you are connected. Yeah. So there are a couple I guess, ways to think about it. But in general, it's when you're using a basil and then reconnecting to Bolus so you're still using a pump. But not for basil purpose.

Scott Benner 4:04
Well, the lancet.com which is a reputable diabetes website. All right. Cool. Yeah. says yes, people with type one diabetes who use continuous continuous sub content, who boy continuous subcutaneous insulin infusion or pump therapy often remove their pump before extended periods of exercise, because this approach might result in reduced glycemic control and increased risk of hypo hyperglycemia. And keto Genesis. We aim to assess the efficiency and safety of a hybrid approach. This is a paper they kind of wrote about it, in which the Basal insulin delivery was divided between pump therapy and daily injection of insulin. Okay, well, this is interesting. So, so this is this follows the one thing you said so I guess what happens is, there's a whole kind of modern Heat her. How do I mean this? People who use pumps modernly would not think, Oh, I'll wear my pump and then take it off for hours and hours at a time, right? You know, it's kind of an older, like, it seems like one of those hybrid ideas, people who've been doing MDI forever, they've moved on to pumping. And then they're like, I can't pump while I'm playing soccer. So I'll take this damn thing off and blah, blah, blah. So so you're so the one thing you're talking about here is inject your Basal insulin, right? And then you have a tube pump with a sight that you disconnect the tube and connect it back. Why would someone do that beyond exercise, swimming? Or is there any real reason just not wanting to wear a pump? Or,

Jennifer Smith, CDE 5:42
Yes, not wanting to wear the pump. But like I said, earlier, it's the idea that you get the precision and the calculation of iob. And everything using the pump for the Bolus strategy is one of the reasons and I honestly, I've only had a handful of people who've really chosen to do that method. And sometimes there are good scenarios for doing that, such as a diver, for example, or you're going on a dive scuba type of, you know, vacation, and you cannot, you cannot you can't dive with a pump, relative to pressure. Yeah. So in that case, an untethered approach would be beneficial, you could take a Basal insulin, you could keep your site in. And you could return, you know, back up to the surface, and you could Bolus as you needed to. And then disconnect again, because you've got basil in the background from the injection.

Scott Benner 6:47
Okay. The other thing this reminds me of is, there are, I don't know if it's a specific person from a specific time period, if I've just seen this once in a while, from all different places, but I have periodically seen people be scared of the idea of an insulin pump. Because they think, what if it stops giving me my Basal insulin? And I don't know, like, that's one of the main fears you notice. Right? When people come from MDI, and they go to pumping, they say, but what if the thing you know, it's the thing, what if the thing stops working, I won't get insulin, and I'll be dead. At least I know, when I inject my Basal insulin, even if I forget my meals, this is there. Right? So that's what it makes me think of. And I guess it would alleviate your concern. If you had that concern. This is not something you could do with an Omnipod, though, or? Well, no, you,

Jennifer Smith, CDE 7:40
you could you could suspend the basil, you couldn't remove the pod, obviously, I mean, we all know that. But you could suspend for the length of time that the pod allows you to suspend or you could set a Temp Basal of zero for a longer duration, then you can actually suspend, which would essentially be the same idea. But you just have to remember to unsuspend or stop the Temp Basal of 0%. When you wanted to, you know what I mean? Do?

Scott Benner 8:13
Yeah, I'm just trying to think of other ways people might be doing this that I'm not aware of like, what about people who have you ever seen somebody who has, like a big insulin need? And they weren't aware? I don't know. Like, would you is there any world where you would shoot basil and let your pump give you some at the same time?

Jennifer Smith, CDE 8:33
I've Yes, with the woman that I work with in pregnancy, sometimes insulin needs go up so significantly, that the site often gets just oversaturated with the amount going in, you know, if you've got Basal rates that are two units an hour plus and your Bolus is are going to be 1520 25 units, depending on what your insulin to carb ratio is. You're talking supersaturation of this, this little tiny area underneath your skin. So not only do you end up needing to change the site a lot more frequently. You risk you risk sort of the right absorption underneath the skin as well in certain in terms of timeframe, right. So what we can do is with really large doses or need for insulin, you can downplay the basil, at least by taking the basil in a larger chunk from a Bolus of a Basal acting insulin, leave a little bit of Basal drip there. And you mainly use the site for boluses.

Scott Benner 9:39
Right? So inject the bulk of it, let the pump do a minor amount of it and then use the pump for meals and corrections.

Jennifer Smith, CDE 9:48
Correct. Yeah, I've even had some women who've done that as well as potentially once the Bolus has get so large, they can tell that they absorption is just not right for the way that Uh, things normally worked. And so we'll say, Okay, go ahead and use your rapid insulin as an injection for 50% of the Bolus and give the other 50%. You know, in terms of the pump,

Scott Benner 10:15
so, but for most people, there's no, like, I don't want people to listen to something because there's something I should be doing. I just wanted to find so you know what it is, but this is not something most people will have a need to do. Right?

Jennifer Smith, CDE 10:27
For the most part should not be okay, right?

Scott Benner 10:31
This by the way, this is interesting. The Internet tells me, essentially, going untethered means making use of an insulin pump and taking long acting insulin at the same time. This is just from a like a blog post. But it says The term was coined by endocrinologist and person with diabetes. Steven Edelman, did Steve come up with this? That's interesting. Is that a term? I

Jennifer Smith, CDE 10:51
mean, I wonder if he came up with the term kind of like John Walsh came up with the term of super Bolus? Yeah, right. I don't know. Maybe.

Scott Benner 11:00
In the future, will somebody one day Google like crush it and catch it? It'll be like this. It'll be you. Anyway, we covered this Yes. I'm thinking yes. Yeah. Cool. Thank you very much.

Jennifer Smith, CDE 11:14
Absolutely no problem.

Scott Benner 11:19
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. If you're looking for an insulin pen that does more, you want the N pen from Medtronic diabetes, head to in pen today.com forward slash juice box to find out all about the N pen. The pen Pen features a dosing calculator, active insulin remaining glucose history reports activity logs dose history meal history and it does it all on an app on your phone. Once you have that app and connect your continuous glucose monitor, here's what you're gonna get from the NPN. A dosing calculator, active insulin remaining glucose history reports activity log dosing history meal history. And like I said, connect your CGM and you're going to be able to see your current glucose levels right on the in pen app in Penn today.com. That's where you head off to place your order. You can get it right from there, where you can learn more about it or learn more about it, then order it. I don't care what you do, just use my link. By the way, you may pay as little as $35. For the pen the offers available to people with commercial insurance only Terms and Conditions apply, but head over because you could be one of those people who gets the pen for $35. In Penn requires a prescription and settings from your health care provider you must use proper settings and follow the instructions as directed where you could experience higher low glucose levels. For more safety information visit in Penn today.com. Next, I'm going to tell you about the Contour Next One blood glucose meter. The website is contour next.com forward slash juicebox. Wish you could have just seen my face now I typed it in as I was saying it and I had a typo. And then nothing came up and I was like I think I'm still doing business with contour. But I was just typo. Anyway contour next one.com forward slash juicebox. And I want to thank contour. They're back in 2023 is a long term advertiser so that I can tell you about the Contour Next One again next year in 2023. But for now in 2022 This is an easy to use website that has a ton of information on it. And the Contour Next One blood glucose meter is legit the best meter I've ever used, it's easy to handle hold using the dark using the light test strips off for a second chance testing. It's remarkably accurate. And you can even buy it in cash if you want it. It could be cheaper in cash and it is through your insurance company. Find all of that out at contour next one.com forward slash juice box I know but you know nowadays some people are like why have a CGM it doesn't matter but it really really matters and you deserve an accurate meter contour next.com forward slash juice box

guys, it was a short episode today but I want to thank you for listening. I also want to thank Jenny Smith and remind you that Jenny works at integrated diabetes.com If you'd like to hire her, she can help you with your diabetes integrated diabetes.com to find Jenny Smith. Hope you're enjoying the defining diabetes series. I find it to be One of the best, you know, just to hear the short conversations and leave with an understanding of a term that is going to come up over and over again in your life. It's really, I don't, I'm a big fan of it. Anyway. That's it. Thank you so much for listening. I'll be back again very soon with another episode of The Juicebox Podcast.