#311 Diabetes Pro Tip: Long-Term Health
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
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Scott Benner 0:00
Hello, everyone, welcome to Episode 311 of the Juicebox Podcast. Today's episode is a pro tip. So you know what that means. It's not just me today and a guest, it's me and Jenny Smith. Today Jenny and I are going to talk about long term health as it relates to type one diabetes. This one's a little less pro tip and a little more conversational. The information rises to the level of pro tip. But the style of conversation is more like Jenny and I got together as friends and I said, Hey, tell me your thoughts about this. And then we chatted about it a little more laid back a little more conversational. But the information is definitely something you want to have in your tool belt. And that's why this episode is part of the diabetes pro tip series that begins back on episode 210. This episode of The Juicebox Podcast is sponsored proudly by dexcom, makers of the G six continuous glucose monitor. And of course, on the pod, the tubeless insulin pump that my daughter has been using for 1112 years, a long time. It's been an honor every day for that time, must be good. I'll never forget the day I was sitting in a hotel lobby when a person asked me what's next for your podcast? What are you going to do to innovate and keep it moving. And I said, I'm gonna do a pro tip series, I think I have all these ideas, and how to bring them all together and really talk through them with somebody equally knowledgeable, but who will come from a different perspective. And I had that person in mind already. That person was Jennifer Smith. Because Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Plus, she's had Type One Diabetes for over three decades. And bonus, I like Jenny. I like the way she talks about type one. It just, there's a goodness about her. She seemed like the right person. And she certainly has been. It's been over a year since the first pro tip episode came out at Episode 210. And today is the 17th. In the series, I believe you got to go check them out. They're all listed as diabetes pro tip is a colon and then the titles afterwards. One last thing you know what it is? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical, or otherwise, please always consult a physician before making any changes to your health care plan or becoming bold with insulin.
Jennifer Smith, CDE 2:47
What are we doing today?
Scott Benner 2:48
We are going to do a pro tip episode that you suggested and prevention of long term complications you said and you said What does optimizing glucose long term do for keeping things healthy? So I feel like what you meant by that is below less variability not low but in you know, lower than what a lot of people go for less variability, lower standard deviation, how is that going to help you throughout a lifetime? And so I feel like between that, and some other safety ideas that I'd like to bring into the conversation. I think we're gonna have a good a good talk here. So I guess first, why don't we talk about a little bit through time, right? Where does everybody and by everybody, I mean, doctors, where do they get the information that they put on their patients? You know, I'd like to see you have an A one C of x. Does that come from the American Diabetes Association? Do they set the tone who sets the tone for what we should be shooting for? Because somebody does it?
Jennifer Smith, CDE 3:51
As far as targets? You mean? Yeah. Yeah. So I mean, well, targets calm. It's funny. I just had a conversation with somebody who listened to the podcast, and I had a first visit with her just before this. And she asked the same exact thing. She's like, I'm getting all of these different targets from different people. And she's like, I don't even know what to believe anymore for a target. She's like, I know where I feel good. I know where I kind of want to be, but what am i aiming for? And I said, Well, there are a couple so the American Diabetes Association aims for your post meal target under 180. Okay, it comes from the American Diabetes Association, through research and gathering of all of this information and, you know, whatnot and looking at complications down the road. cumulatively. They aim for what less than 180. Now, the American Association of clinical endocrinologists recommends less than one six.
Scott Benner 4:48
So less than 160
Jennifer Smith, CDE 4:50
less than 160. Okay, so there are two high in the ranks of diabetes management. Yep. That are different. Already, right. And then we bring into the mix. Well, what are recommendations even further than that, like pregnancy? pregnancy recommendations, you know, are for the most part under 120, fasting under 100.
And post meal no higher than 140.
Scott Benner 5:20
So M is what I'm hearing good good for the shift. Oh, fusion.
Jennifer Smith, CDE 5:24
Yeah, confusion entirely. And then I had a woman in a couple of years ago postpartum, I had her visit with her. And she's like, so I was aiming for all of these targets in pregnancy to keep my baby growing healthy, and myself. And she's like, and then my doctor tells me to loosen up my target in my palm, and tells me I don't have to be so you know, quote, unquote, tightly managed, and she's like, sick, I want to ask your opinion, Jenny's? Like, why wouldn't I want to stay this tightly controlled if it was good for me and pregnancy? And these are targets that people without diabetes? maintain? Because their body does what it's supposed to do? Like, why wouldn't I want to maintain this? Whether I'm pregnant or
Scott Benner 6:03
not? Yeah, yeah. So here's right here. Exactly. And here's what it's making me feel like, so much like, with everything about diabetes, when you try to give someone like this just, I don't know, this is how things are right? Like it 181 6120 whatever anybody ends up saying, that's not personal. And and personal, between should be consideration should be you, your intent, your involvement, your intellect, your understanding, then it should be, am I injecting? Am I using a long acting insulin that's been I was made 20 years ago, or my using one of them that's, you know, been made more recently that people find more stable a lot of the times, am I using a pump? Do I have a glucose monitor? Is that you know, is it a Libra? Or is it a dexcom? Is that the G six? Or is it the G four like, it would seem to me that all of those variables would would make it more or less likely for me to be able to maintain targets that are lower or higher? Right? And so then you get the doctor, like what you just said about the pregnant person? I feel like that doctor was like, Look, you must have had to have killed yourself to keep your blood sugar that low. Right? Like, obviously, it ate up nine, you know, nine months of your life, you did nothing but keep your blood sugar in check, have to pay and watch television, that must have been your whole line months, right? Like, like, you're talking to a guy in 1920. It's like, you know, you didn't even have time to make me my pot roast. Like, like, like that, like Reagan old time idea, right?
Jennifer Smith, CDE 7:41
And now you come into the office and You look like you've got baby spitting your ear, you look like you haven't slept or combed your hair. So let's loot some things. Sure. Right.
Scott Benner 7:50
Right. I think that what would make your day easier is if you were less healthy. But it's not it becomes about and I get that right? Like, I think that out away from the ideas that we talked about on the podcast. Maybe that's real. Do you know what I mean? But when you start telling people, we, when I started asking people, you've been at this for a while now six months, eight months? Is it that hard? They say no. Like most of the people, I don't want to say most of them everyone I've ever spoken to who's picked up the ideas of the podcast, put them in practice, and gotten to the point where it's just second nature. They don't think about diabetes, very much these these targets are meaningless because you get to a spot you stay at that spot. If you leave that spot, you know how to get back to that spot? Right? That seems like it to me, honestly.
Jennifer Smith, CDE 8:40
Right. And from the standpoint of, you know, prevention, I mean, that's the that's one of the biggest things that brought out beyond Well, here's your insulin, here's how to inject it. And oh, by the way, insulin can cause your blood sugar to go too low. complications are always within the first like, new onset diagnosis, discussion. Always something about complication, right. Always, like you have to control things. I love that word control because like, like a moving target and control.
Scott Benner 9:11
Not only that, by the way, it gives you the impression that you're going to be out of control and it's your job to control the chaos.
Jennifer Smith, CDE 9:17
Correct. Right. Exactly. It's like your job to hurt all of the million cats in your yard with no fences. Yeah, right.
Scott Benner 9:23
What if I just didn't let the cats in? How would that be?
Unknown Speaker 9:26
How would that
Jennifer Smith, CDE 9:28
play? Yes, exactly. So you know, the prevention of complications that I mean, there's no, there's no set solution, really, on how to 100% prevent complications. In research. We've seen people with many years of diabetes, some of them poorly, you know, managed, some of them tightly managed, and complications can start for people at different points of time. And that makes it seem like well, gosh, I'm just gonna throw my hands up in the air if I can't 100% prevent anything. But what we do along the way makes you feel good. on a day to day basis with tighter containment of things overall, yes, we are likely 99% likely avoiding the complications down the road, right at 1% that something could happen. Sure, it could be there. But I don't think there are many things in this world that are 100%.
Scott Benner 10:29
Right? perfection. And so to your point, it's, it's presented incorrectly to people. It is like right away, like, you know, it's not your goal not to die. Right. It's your goal to live really well. until you die. Right. Right. And and if you can extend those years, wonderful. But you know, it's just and you just said to about how people feel? I've been talking about that a lot lately. I don't know why people don't think about that. Like just how they feel every day. Like, you know, are they tired? Are they sluggish? All the stuff that we've spoken about over and over again? Why is that not important to them? And I don't think it's not, I think they find it to be something they can't impact, which isn't true. It just isn't like there are times there are times genuine, I'm afraid people will realize that when I keep saying over and over again, it's about timing and amount and common sense. They're gonna go, Hmm, I don't think I need to listen to that podcast. That guy might be right about that. Like, why don't I just tie my insulin better? And when I see something happening, go, Hmm, that makes sense. I should do this now. Yeah. Right. Because, I mean, honestly, there's no pot, if you guys all figure it out, the podcast is over. Basically, I, you know, obviously there'll always be newly diagnosed people who are going to get this terrible information and start down the wrong path. I just I want I want people to think more about how they feel. And I spoke about this in my talk this weekend. And I've said it here before, too, but you have to, you have to believe that if your blood sugar is constantly high, you're altered. You just are like there is a person
Jennifer Smith, CDE 12:09
without short term and long term.
Scott Benner 12:11
Yeah, there's a person you would be intellectually articulately that you don't get to be when your blood sugar's high, or crazy low or bouncing around, right? Because your brains always just, it's, it's, it's just, it's not where it needs to be.
Jennifer Smith, CDE 12:27
I don't know. And within that, even within that day to day feeling, are those behind the scenes. Unfortunate what's happening in the body that you aren't feeling? Like, we know how high blood sugars make us feel. And if you're paying attention, you know, the containment of them, you get out of that you can think better, you can act better you can do the things you enjoy doing. But behind the scenes, internally, what's happening with better management is you're not causing damage to cells. You know, I mean, especially heart disease, I mean, heart disease is a huge component that we have to take into consideration. But it's not like it has to be there in your brain every single day. If you are managing the blood sugars, you're also managing a healthy heart. You're also managing healthy kidneys, healthy nerve cells, healthy eyes, you're managing those internal pieces that until they are damaged enough and give you indication that there's a problem. you're managing that along the way so that you don't get to the end of the road and have heart disease or kidney problems or whatnot, right? Yes.
Scott Benner 13:37
Oh, and where do you stand? Have you ever heard me explain how I think of it with the sandblasting? Have I ever said that? Because here's the place to say if I've ever said it to you, okay, so the way I think about high blood pressure, high blood sugars, and back when my kid was little, and I was looking for motivation, like seriously, like, what, what's gonna get me up at two o'clock in the morning to correct a 150 blood sugar. But when my doctor is telling me That's okay, like, what's the motivation. And whether I'm right or wrong, technically, in my mind, it feels like this. My body is built to withstand a certain amount of certain content of sugar, glucose in my bloodstream. And when there's more there, on a cellular level, glucose is still sharp, right? It's like, it's like if you take a sugar and you spill it on the table, you look at it, its course and you know, it's sharp, and even on a molecular level, like smaller, smaller, it's still sharp. So when you pack too much of it into your veins and your arteries that run through your heart and your eyes and your legs and your fingertips and everything else that's sharp. This is scratching at the inside of that soft tissue and those veins and those arteries, and one day, it'll wear through a little hole. And if it were through a hole in your heart, you have a heart attack. If it wears through a hole in your eye, you have vision trouble if it starts wearing through in your feet, you might not be able to feel your feet and honestly And again, so all of the diabetes complications that are on a list somewhere in your doctor's office to scare the hell out of you. What it really means is, if your blood sugar is too high, you know, what inside of your body, is it going to rub through first and create a breach? And you know, and will that breach, you know, and that breach will hurt. You might, you know, we talked recently about my friend Mike who passed away, he was on dialysis. So the first thing that it rubbed through worse his kidneys. And then as he was on dialysis, the second thing it rubbed through was his heart. And then he had a heart attack and he died. And that's it. And he'll he'll his death certificate says he died from complications of type one diabetes, though. That's it,
Jennifer Smith, CDE 15:43
right? And that's a great, it's a very layman's way to understand it. Because I think that the textbook explanation is, it's too clinical, it's to medical. And I think that's why, for the most part, people are aware of complications. But when you explain it, such as that damage piece, and I used to explain it in the class, the type two classes that I used to teach is that my sugars, cause damage to the inside of your vessels cause damage to the outsides of the nerves and everything and almost like eat it away. So like a sandblast. Yes, it's like cutting and cutting and cutting and calling causing small abrasions, right, scratches, scrapes, that the body actually tries in your body is a it's a, it's a self healing.
Like organism, right, which
Scott Benner 16:36
is why it doesn't happen to you right away it wrapped fixing little making little patches, it's like your road crew in town filling potholes, when you think you just repave the whole road, they're like, nope, best we can do is pop in a little patch in this hole.
Jennifer Smith, CDE 16:49
And it's more inflammation, I mean, long term, those little holes are really from inflammation in the lining, and along with cells and whatnot. And over time, I mean, if that inflammation causes a tear, the body tries to patch the tear. Well, if more and more tears happen, and more and more patches get placed into the vessels, you know, and I know visually, this isn't a podcast, people can see. But as you can see, my hands get closer and closer together to indicate the constriction and the narrowing of vessels. So then we have heart disease and potential for stroke and problems with blood flow, getting to the kidneys to do what they're supposed to do, and circulation to your fingers and your toes and never anything see. And Jenny, the way I think of it is I was just there one day in my house trying to talk myself into not giving up before I understood what was going on, right? So what do I need to do to not give up and this is how I put it, it's really no different than a football coach who just has a player has three brain cells in his head, and he goes, look, see this line right here. Don't let that ball go past that line. And that really is how I dumped it down for myself. I was like, I can't let that ball go past that line. Like I have to try to figure out how to stop that.
Scott Benner 18:05
And I think everything that everyone's listened to since then, is born from that idea. Like, how do I stop this from happening? Right. And I've had that moment where I realized I may not be stopping it from happening to like, maybe my kid genetically is just the one who can't withstand having type one diabetes. I don't know, you know what I mean, but she certainly has a better chance, the way the way she lives right now than she would if I just listened to, you know, just keep her under 200. You know, don't let her spike over 180 or 160, or whatever, after a meal if you right, you know if you can. To me that was just that just made sense. In the moment when I was scared and alone, and it didn't know what I was doing. I just thought like, I need a I need a I need a goal. You know, right? Why? blood sugar? Oh, sorry. Sorry. Go ahead. No, good blood sugar is gonna say blood sugar is a big piece of it. But you know, the other components to those complications, too, are the other factors that also contribute to blood sugar management, right? So the kind of nutrition you take in that interior sedentary versus more active lifestyle, all of those are also huge benefit for long term health, outside of just rolling or managing your blood sugar. And all of those things become exponentially more important. When you have type one diabetes, they're important to a person who doesn't have it. It becomes even more important when you do like sometimes you just feel like, you know, like how many, how many gunfighters are gonna be on the other side before I just I don't have time to get to the mall, you know, you'd be like, I'm gonna get overwhelmed because there's just so much over there. So you have to give yourself a chance. You know, and aside from the idea that exercise helps you keep lower blood sugars like that aside, exercise does all the other things that exercise you know, it's funny, it's worth mention Hear that I realized the other day that some people refer to me behind my back is like, somebody who pushes carbs on people. And I thought, That's odd. I've never considered that before. Excuse me, but I guess more low carb people kind of can feel that way a little bit. But I listened to it. And I thought it through and I don't feel like I do that. I feel like this podcast teaches, talks about preaches maybe how to use your insulin, like how insulin works. And I say all the time, once you know how your insulin works, I don't care what you you know, you do whatever you want. But I think you need to know whether you're low carb, or whether you're a person who's like, wow, I think I could eat that whole box of hohos. Like, like whether whoever you are in that scenario, you know, one side or the other. If you understand how to use the insulin, you can accomplish it. I'm not saying because I know how to bolster Chinese food. You should do it every day,
Jennifer Smith, CDE 20:54
every day. Every day. I know how to Bolus the chocolate chip muffin and the chocolate milk and the Hershey syrup on top doesn't mean it should comprise every meal. Because is that better than an apple with peanut butter? Right? And nutrition wise? Probably not. But
Scott Benner 21:11
is there a danger I found myself wondering of people focusing on themselves so much as diabetes that they forget to think of themselves as person. Like, you know what I mean, like Does, does a piece of this a big cupcake not seem unhealthy anymore, because you know how to stop a spike from happening when you eat it. And that's important to remember that it's still it's still a cupcake. It's still something that's, you know, a once in a while thing, not an everyday thing, because I can Bolus for it. And I think that's so I think Jenny's point is important too, is that there's just a lot more that impacts your health than just your blood sugar. And we sometimes we talk too much, not too much. But we're so focused on trying to understand it because there's so many components that people don't understand that you stop thinking about like, Hey, you know, what else is easy to Bolus for broccoli.
Jennifer Smith, CDE 22:05
It's learning to manage the insulin around what you eat, you decide what you're going to eat, and you figure out how to manage it, like not encouraging people to eat a high carb diet.
Scott Benner 22:17
Not at all. I don't see it that way at all. I see it as understanding insulin. It's it's just how it is I I was speaking somewhere recently, and I looked down and saw a person in the crowd who this has happened to me about three times since I've been doing public speaking around diabetes. But I've looked down to see what I would call like an old school person in the diabetes community. And when I'm talking I can see on their face, they're just there somewhere between angry and horrified that I that I would even deign to talk about insulin, and how to use it. You know, like, you can't tell people. When I'm on when I'm up on stage, I tell people, no different than, you know what I say here, right? I'm like Basil's first beat, we have to have your bazel, right, because we can't just start Pre-Bolus saying and doing other stuff. Because if your Basal is wrong, it could end up being dangerous. So first, we get your Basal right. Now after that, step two, you have to Pre-Bolus your meals. And that's usually when I look down and see like somewhere like a 60 year old mom whose kids had diabetes for 30 years. Like, you know, like their arms are moving around and like, Oh, you can't say that to people, you're gonna kill them. You know what I'm like. And so I'm like, you're thinking about this in a different way. Before that, you're not considering the technology, you're not considering that these are not the same last lambs that you talked to 30 years ago, right? Like these people are here to find this out. They want to know this.
Jennifer Smith, CDE 23:52
And long ago to bring in long ago, timing was an insulin issue. Long ago, I've had diabetes 31 and a half years, okay, I started on our insulin, and the cloudy, but most people started on something called nphr. And I was on L, which was Lily's brand. Okay. Um, I did no carb counting. I use the exchange diet. I took exactly this amount of searches and fruit portion and vegetable and protein and fat at every meal and my mom or dad gave me my insulin mixed in a syringe at breakfast and at dinnertime and I eat it strategic times in exactly the same amount of food there was no other than measuring the food for the right portion. There was no carb counting, there was no insulin based on carb. It was you take your insulin and from the dosing standpoint, my insulin regular insulin you know, it's slow. I mean, we call it short acting balls forever. I mean, it may man would dose me 45 minutes an hour before I even started to eat in order to curb that post meal,
Scott Benner 25:06
right? Yeah. And so everything you just said, is about using the right amount at the right time. Yeah, it's timing. It's all timing. Like I, again, I that I figured it out. I mean, we should all be able to figure it. Really I know myself, trust me, it's there's not a lot like I'm not, you know, I'm not over here. Figuring out the Pythagorean theory after or a theorem, whatever it's called. I see. I don't know, after I get off the podcast. Yeah, I just don't think i think there's so much fear in now that we forget later. And, you know, what we're talking about right now is long term health. And so let me jump to I can't quote it, I don't have it in front of me. I don't know where it came from. But I think everyone's fairly aware of this article that came out in the last six months that tried to say that lower a one C's aren't necessarily an indicator of health. And that, did you see that one they started talking about, like, you can have an A one see it like this here? It'll be fine. It tried to give the impression to me, that the way I saw it was someone trying to say, Look, I know a lot of you are using this technology to do better, but you really shouldn't do that. Like it's not necessary. And I thought, Well, how do you know? You don't mean like, like, I thought the same thing? I thought when I saw vaping The first time I was like, I have no interest in that. But if I did, I wouldn't do it. Because I don't want to be the one to find out 10 years from now what happens? Because no one knows, you know, right? So is there any in your mind, if you're safely at, if you're in the fives, and you're a one, say and look, you know what I'm going to do here, I'm going to actually pull up an email. To make my point, hold on one second, it's going to take me a second to find it. I apologize for that. But I got this email this morning from a person I know who listens a lot. And when she emailed I thought, wow, this is gonna work right into what Jenny and I are talking about. It's crazy. And it's from Laura. And this note from Laura mimics many, many, many, many notes that I get. Scott, I achieved a 5.4 a one C, first time I've ever been under 6.4. But my doctor freaked out at the number of lows. And she's asking, what's an acceptable amount of time under 70? Like, how many times can I dip under 70? And you know, and so I there's First of all, it's it's a two step thing, right? Everybody who goes to any kind of a doctor who's more like the lady in the crowd, who's thrown her arms around yelling, don't talk about it like this. When they get their blood sugar down, and they find a way to keep it stable, and it starts impacting their variability and it starts impacting their agency, the doctors flip out, they make this assumption that they have all these crazy lows and it's throwing them off. So I know what I'm okay with. But what Where do you stand in your personal life? I guess like how often do you find yourself under 70 DFA.
Jennifer Smith, CDE 28:19
So personal versus professional, I kinda, I really aim for the same thing, quite honestly, overall, and this is where I think that that data is very helpful from a CGM standpoint. Because especially and I speak for clarity. The other reports are the other CGM do give you something similar as far as data. But from a clarity standpoint, clarity always gives you that overview gives you your glucose management indicator, their quote unquote a one see right from CGM, not from your blood glucose, right? It gives you your average glucose, it gives you your standard deviation, and also gives you this little like chart that shows you time in range, right? And it is based on what you have your time in range numbers set for 70 to 180 60 to 140 90 to 200. So you have to adjust those parameters, but clarity has it set 70 to 180, for the most part, right? We aim for the lows specific to be less than 5% of the time. So from all of the gathered data, whether it's two months or two weeks, or one week or whatever you're looking at that percentage of time, we're aiming for less than 5% to the low and low being less than 70
Scott Benner 29:43
less than 70.
Jennifer Smith, CDE 29:44
That's that's the goal is to be low less than 70 or less than 70 less than 5% of the time. So from the standpoint of overall a one see though, you know if if a clinician is coming in saying hey, you know why? That's way too low. And they're looking at data, which proves that, well, gosh, you're hanging out in the 50s. consistently. And that's why you're achieving a five point for sure. And if you're low, let's say 12% of the time, okay, there's some work to do to bring that back up into range. So that that 5.4 is actually better for lack of a better word. better, right? It's, it's more real 5.4 in a target range, that's healthy, safe. And good for you overall. Yeah, you're
Scott Benner 30:33
reaching that number with quality decisions, not with not with, you know, being low. Correct. And that's
Jennifer Smith, CDE 30:40
coming out and saying 5.4% is it Oh, my goodness, that them that's way too low and not even looking at what other stuff 5.4 the person could have very low standard deviation, maybe their variability is 20. And they're ranging somewhere between 70 and like, 120 pretty consistent or 70 and 100. Great, fabulous. You're, you're knocking it out, have at it, and you what you're doing.
Scott Benner 31:09
So when I gave the explanation of a Pre-Bolus this week, this weekend, I used something that had happened an hour before because my wife was at home with Arden and I said actually my wife did a great job this morning with breakfast. About an hour ago Arden's blood sugar was 70 and it was time for lunch. Now Arden's at school, and I think 70 is a great blood sugar right before a meal. Arden's blood sugar was able to stay at that level for a number of reasons. But those reasons are evident to us as they play out, because we can see her blood sugar in real time with the dexcom g six continuous glucose monitor. Not only can ardency her blood sugar right there on her iPhone, but I can see it here at home on my phone as well. Because of that knowledge and seeing the stability that had existed within Arden's blood sugar for the hours prior to lunch, we were able to make a good Pre-Bolus and give her a nice launch into her meal time. Now that hour later, Arden's blood sugar is 132. The data that comes back from the Dexcom g six continuous glucose monitor is life altering with Type One Diabetes, but being able to see it remotely, that takes life altering to another level. So if you'd like to know what your blood sugar is, the speed and direction it's moving, and find those things out without a finger stick. The dexcom g six is something you should check out. I have a link you can use dexcom.com forward slash juice box. There are links also right here in your podcast player notes at Juicebox podcast.com. But I think you should check out the Dexcom Arden's results are hers and yours may vary. But I'm telling you right now Dexcom is a game changer. Now moving from continuous glucose monitoring to insulin pumping. I'd like to talk about the Omni pod until you first I have just as much affinity and love for the Omni pod as I do for next time. Arden has been wearing the Omni pod tubeless insulin pumps and she was four years old, she'll be turning 16 in just a couple of months. The Omni pod brings so much freedom along with the ability to pump your insulin right no injections all day long. No slow acting insulin and fast acting insulin let the army pod take care of your background basal insulin for you. It does that put your insulin pump you get your basal insulin from the pump. And when it's time to Bolus for a meal or to crack the high, same insulin, same pump, no tubing, right so not an infusion site on your body somewhere that's attached to this plastic tubing that runs through your clothing out to a controller that has to clip to your belt. You know whether you're an adult or a little kid, you're not looking to have something clipped to you. Here's what you can do. Go to my on the pod.com Ford slash juice box there, you can ask on the pod to send you an absolutely free, no obligation demo of the new pod. It'll come directly to your house. You can try it on and see what you think for yourself. You can see the difference between wearing a shirt and not having tubing running down your sleeve. Every time I've worn a demo pod. What I thought first was it's amazing how quickly I forget that it's there. This is super important. This is something you have to do every day. You don't want it to be constantly bugging you. Check it out my Omni pod.com forward slash juice box with the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And absolutely free no obligation demo can be in your mailbox before you know it.
Actually, my wife did a great job this morning. With breakfast. She made a Pre-Bolus at like 83 right and it was a big kind of bread First, and Arden drifted down drifted down and she actually hit like 63 for like a split second and came back up. So imagine this 63 probably happened 30 minutes after my wife pushed the button, right? And probably 10 minutes after she had already started eating. So if you want to say she missed, I guess you can, but it's funny. Had she been at 68 everyone would have been like, That's amazing. But 63 is a number that somehow gotten to somebody said, so I'm like, so she hits 63 one revolution of the CGM and right back again, and I said, if she didn't have a CGM, you never even would have known that that happened, right? She's She's wasn't dizzy. Nothing happened like that. I can see it cuz I'm looking at it that this same person in the crowd, this person who's you know, you know, from a property from a different era with diabetes, you know, fell just shy of, you know, back of the hand on the forehead. Oh, Scarlet, what happened? I've got the vapors, you know, I mean, like, that kind of thing. And I was just like, I looked over second, I was like, You got us. I was thinking to myself, like, just stop, like, don't like, look at the rest of these people. These people are in Thrall. They're excited. These are people who a half an hour after they put their insulin in, or running around with their blood sugar's 250. And are you really telling me that that's what you want to say is okay for them. Because when I speak to them privately, when they come up to me, as I'm trying to walk around you guys, we're all delightful. But people would come up and be like, hey, look, this is my, you know, my 23 year old son's CGM, kids like 400 and 300 all the time. Like you tell me, it's not worth trying to do better for this kid. And so I think sometimes, both in the community, in people's minds, in doctors minds, in some older doctors minds, there's just more of that idea. And we talked about all the time, like, it's better not to like, like, I don't want you to have a seizure. Like that's it, like when I say don't die advice, like, that's what they're trying to say that I don't want you to have a seizure. I don't want anyone to have a seizure, either. But I don't want your blood sugar to be 300 all day. You know, it just it's, it's not okay. Because we say these nice things out loud, and other people who are maybe well meaning but don't have good information. They're like, Oh, you know, I want you to be safe, blah, blah, blah. But those people you're talking to online, or whatever your whatever that person's ability to get to people is, you don't get to see those people 20 years later, you don't know what's happening to them. And so I'd rather take a bet on what I'm saying being good for them 20 years later, than what I hear some of those other people saying, I think that if you're going to if you're going to roll the dice one way, you ought to roll the dice and try to be healthy, not hope, hope that your body's the one impenetrable thing that diabetes can't find its way through? Yeah, you know,
Jennifer Smith, CDE 37:47
right. Right. Well, and there's also the safety of bringing those high numbers down to, right. I mean, it's like, you don't want to end up going from an average of 280, which means you're drifting well above 300, and not quite into the low to hundreds to average a to 80, right? Yes, you're not gonna say, Okay, today, we're at, you know, an average of 280. And tomorrow, you're gonna be averaging 100,
Scott Benner 38:11
right, that goes on?
Jennifer Smith, CDE 38:13
Well, that would be a pie in the sky one, it's, it's not actually healthy, drops that fast, drop that fast. I mean, you will have efficient changes in your body. And you know, I remember when I came home from the hospital for two to three weeks after I was released from the hospital. And I think I started with an A one C in the 12, when I was first diagnosed, and my blood sugar was coming down and coming down. My vision changed so much, that my mom had to read me my homework in order for me to answer and she had to write things down. Because my vision was so blurred, I couldn't actually see well enough to read what I needed to get my homework done. Right. So and that was gradually. So again, you can imagine bringing a really high blood sugar down that's been consistently stable high. Yeah, it will be problematic.
Scott Benner 39:11
What I said to this group of people was luck. Like, don't go home, I'll shot out of a cannon, you know, and be like, I usually give a unit for this, but now I'm gonna do five I'm like, No, no, a unit in half, maybe, you know, and I was like, the next time go, ha, that could have been more I said, you know, over days, bring it down over weeks, bring it down, not like don't go home and just be like that. Because that's probably not going to go so well. You know. And, and again, bazel first, and it's funny, no matter how many times I say it, and how many times I preach how important it is. The look on people's faces. When you say to them, I need you to get your basal insulin right is like up then I give up. Like it's quick. It's they're so quick to be like, that's not possible. I can't do that. And I'm like, No, of course she can. And that's why I've got it down to like, they're like, well, how and I was like, Look, there's a great app. pisode on it that you could go listen to them like, but if you're looking for how I think of it, I think of it like volume, like I turn it up until it's too loud, and then I start bringing it back down. So you turn it up a little, not loud enough, turn it up a little not loud enough. And what I mean by that is turn it up a little, my blood sugar is not sitting stable, where I want it to, you know, blah, blah, blah, and then all of a sudden, you get to a spot and you go, alright, that looks like it. Or maybe it's Oh, I went a little too far. I'll turn it back down a little bit. I'm like, but don't you know, one woman's like, by basals? point nine. You know, should but my blood sugar's are 250. Should I try one? And I'm like, I mean, okay, and I'm like, but an hour later when that doesn't work. But could you push it up a little more for me? Like, I was like thinking about what you're saying? You your blood, your bazel is holding you at 250. But, you know, point nine, like, but you want it to come down 150 points, but you only want to move it up. point one. I was like, that doesn't make sense, right? Like, don't you feel like it might need more than that. She's like, yeah, I guess you're right. But that but that's a doctor that scared her not to touch her basal insulin. And so she's, it's just it's, I don't know, I'm a little heartbroken. Like, it's a little it's, it's very exciting and uplifting to talk to people and see them have some ideas they're going to take and at the same time, when they come up to you, and they show you how bad things are. You know, after the fifth, sixth 10th one, you start feeling like oh, gosh, like I'm never gonna reach enough people to make a difference in the world like it starts feeling
Jennifer Smith, CDE 41:28
might even like from the adjustment standpoint, sometimes comes from the people who had diabetes, a long enough time to have actually had a long enough experience with bazel injected insulin, and how long it did a week to really see the difference in an adjustment up and or down in the actual dose and the imprecision in which that basal insulin works on a 24 hour scale. Right. And I noticed immense different, going from lantis to using an insulin pump. Right, an immense difference. It was
Scott Benner 42:10
amazing. Is that where that kind of that that adage is like making adjustments here bazel wait three days and see what happens is that what that's from,
Jennifer Smith, CDE 42:19
for the most part because the well, you know, the basal insulin clears technically within like a 20 to 24 hour time period, right from let's say, for the example of Atlantis is supposed to work 24 hours, most people somewhere between like 20 to 24 hours. And so you adjust, you need kind of at least a 48 hour period, at least after that adjustment of incremental change by let's say two units, to see if that was enough to now hold things level and steady. And then it also depends on where you taking your basal insulin in the morning, or were you taking it in the evening, you know, the evening time was a little bit easier to see. Because you could notice an overnight with only true basal insulin there. No boluses no food, no activity component, you're sleeping on that right? And then through the course of the rest of the next day. How did things look in between meals or after the meal bolus was gone? Did you kind of get into the next meal on a nice stable level? Were you where you want it to be? Were you still too high? Or are you drifting way too low? And then we adjust again, you know, so I that it is probably where that like, adjust wait three days to see if the adjustment held things where you wanted them and then adjust again. It's kind of where that would have started. I like Spock because
Scott Benner 43:39
someone from the crowd asked me, How long is it going to take me to get my bazel? Right. And I was like, well, I said if I think if you listen to that episode, and you really understand it. So maybe a few days, you know, she says how long would it take you? And I was like What time is it now? She goes it's like It's one o'clock. I'm like I could have it done by dinner, you know, like so. And then we would adjust off the the rest of the clock moving forward, like but there's a there's somewhere there's a good number. And it's funny because I just I realized, um, I could just keep looking at the CGM and the side I said, Now, if you didn't have a CGM, it take me a couple days to write, right? Because now we're kind of blind. And we're testing and seeing things and, you know, making sense and seeing if we can see repeating that and stuff like that. It was like but, but looking at it. That's like, That's cheating, almost like that. That's pretty easy. But I also infer things from pitches and lines and and there's no and then people all the time, like can you do an episode about how you see that? I don't even know how to talk about it. Like I wish I did like I just look and I'm like, okay, that's not enough insulin. That's too much. This is here. You know what I mean? Like, it's just, I don't know what pops into my head, but I don't know. I really don't know how to quantify it. If I'm being right. Come on. I'm not joking.
Jennifer Smith, CDE 44:55
Well, you've you've looked at things enough and you understand, you understand insulin. Action, I think better because of the way that you've looked at things and the way that you've taught about things. But sometimes it is hard to just nail it down and explain, hey, if this is happening here, this is why and this is how we would adjust for. And that's kind of, that's kind of what we do. Get people's graphs and information and their insulin here. And like bazel testing for a pump, especially, you know, we'll do a bazel test within a time segment, I get the data The next day, I look at it, adjust here, test again tonight. They do great, that looks awesome, we're perfect. We've got it like checked off, move on to the next. So it shouldn't be like six days in a row that you have to test that to make sure that each single one of them exactly was nailed. Because we adjusted it four days ago, nope. If you adjusted, it looks beautiful with the adjustment. Great, we're moving on. We got it. I've learned
Scott Benner 45:53
from talking to people face to face to that. The stuff they want to tell you that they think is going to help you help them is never the stuff I need to know. Do you know what I mean by that? They start giving me like and it's it's not I don't even mean to be funny about it. Like, they're they've been paying close attention. And they're like, okay, like, here's a piece you absolutely have to understand. I'm like, I don't care about that doesn't matter. You know, like, like, I'm like, how much do they weigh? How old are they? What kind of insulin are you using? What's your basal rate right now? You know, where do you sit steady, when you don't have insulin, you blah, blah, blah. And then from there, I'm just like, okay, turn this up, turn that down, make this this. And then let's wait and see what happens. But it's interesting, because the information they've been given so far has led them to ask almost all the wrong questions. Right? That's the part that I find fascinating, right, is that somebody has been directing them along the way. And now I talked to them. And then I talked to them again, two weeks later. And now they want to make a small adjustment. And they're asking the right questions. It's very interesting. Like, it's just where you, it's who talks to you first. Like it really is, it's like, whoever talks to you first, you win, or you lose, like right then and there. You don't even realize it when it's happening. There's somebody being diagnosed right now, in the world, who's talking to an endo, who understands, and they're going to go on one beautiful path, they'll never find this podcast, because they don't need it. And then there's somebody else being diagnosed right now who's being told all that stuff that we, you know, have to debunk, and then reteach. It's just, it's bizarre. I mean, you don't like, get cancer and get two wildly different ideas like this one, cancer, doctors say to you, hey, listen, we're gonna try a little radiation. And then if that doesn't work, we'll try to cut it out. Is there another doctor that says you should go home, blow up balloons and eat birthday cake, and I'll fix the whole thing? Because it feels like it's that far apart. You know, like, one ideas, right? And one ideas? I mean, I'm sure there's variations in between?
Jennifer Smith, CDE 47:54
Well, I think the extremes truly are the people who still to this day, for whatever reason, will go into their clinical diabetes team, and they get the hand me your pump. It's like handing over like, you know, your foot. I think I said that before. And so it did nothing. And you're like, Hey, thank you. Your pump is like, like your butt. Like, no, not really my foot, just a body part over, they like, take it away from you. You're like, oh, my goodness, you've taken like my body part from me, you know, and then they bring it back to you. If they've dumped this data in, they look at the data. They don't ask you anything. The doctor might actually sit there and actually might push your buttons on your pump. Yeah, physically make all the adjustments for you. And your left, then handed back reconnected with your pump. The doctors like, Oh, we adjusted some of the bezels or we did this and this because I thought I saw this happening here. what's lacking there the education do? You adjust? What were the explanations that person could go home and say, Okay, I understood the doctor adjusted here because he was seeing this. I'm going to Now watch this. I'm gonna see did it help? Does it make it better? Did it make it worse? Do I need to readjust this? How should I readjusted? that's missing chunk. Yeah. And, you know, I think that that ease of not educating people nor even letting them push their own pump buttons to make the changes or add in Hey, b d is in a row this past week. I was at gramma Joe's eating like sloppy joes and birthday cake, and is please don't pay attention to that data. It's not my true trend, but the doctor is basing adjustments off of it.
Scott Benner 49:45
It messing up everything else that may have been working better than that. I brought a poor kid up on stage from the college diabetes network this past weekend. And I just we stood arm's length apart. We put our palms together you know standing side to side I said, you know, I'm going to be insulin, and he's going to be body function and carbs. And I was like right now, he and I are pushing, you know, an equal amount into each other. And we could stand here forever like this. I was like, but as soon as I don't push quite as hard, and he started, like overpowering me, I was like now the carbs and the body function or winning, which means my blood sugar is going up. And it should I push too hard. I start driving that down and your blood sugar gets too low. But as long as we stay balanced, and we're pushing equally on each other, this could go on like this forever. While I'm saying it, audibly I can hear people going, Oh, like out in the audience like, Oh, wow. Okay. And I just as I was saying it, I thought a doctor couldn't think of that. Like, like, you know what I mean? Like, cuz dumb me figured it out. And and, you know, put it into words, like, like, that was it and just them watching that. And it's something I'd done before with my own hands like palm the palm. I've explained, I've gotten people on the phone, and I've made them put their palms together and like, and, like done it. And I just think like, it's, it's just, it was so simple. You could see like nodding going on. And people were like, Oh, Okay, I get it, I found a million ways to talk about it. Since then I talked about like, bringing in more blockers to like, you know, stop by Blitz, like in football, like, I've talked about it a million different ways. And every time you kind of paint a picture around it, you get somebody else to understand it. I just don't know. It just doesn't make sense to me. So these doctors are telling you, I want you to be healthy forever. But then they kind of some of them don't tell you how. And so. So optimizing your glucose, right for long term is going to keep you as healthy as hopefully possible. Right?
Unknown Speaker 51:41
Yes, absolutely.
Scott Benner 51:42
What about gaps of fall off? Right? I don't like the word burnout so much. But what if they just stopped paying attention for a week that turns into a month, it turns into six months, is that if I if I come back from it, now, I'm not trying to give people like, like, I feel like I'm saying, you know, you can go off and, you know, go off and do heroin for six months and come back, and it's not gonna hurt you, right? Like, not me. But I'm saying like, if you have one of those moments that a slip up or your life gets, you know, busy, and all of a sudden you start leaving your blood sugar at 140 instead of 120 or 180, instead of 150. Is there any way to quantify what that means to you long term? Or there isn't really right?
Jennifer Smith, CDE 52:27
It really isn't? Because again, there's nobody has kind of quantified exactly what amount of mismanagement equates to this amount of complication down the road? Yeah, if you don't do this for three years, you will have this amount of heart damage 10 years from now, right? There's no, you can't quantify it. But I think you can also not bank
control that was optimal, yes.
Or the next month and saying, okay, I was really, really awesome for six months. And now I'm going to go on like an eidl convention, blow out in Italy, and just that care or pay attention, detrimental stuff could be happening. I don't know what's happening in your body, but you don't either. It's not great for you. But it's, you know, but you, you're not, you can't bank on the six months previous being like a code over for smoothing that out and being like, Okay, this whole month of like, mismanagement doesn't really count because I was so good before
Scott Benner 53:35
it's like sleep, you could get great rest six days in a row, and then stay up 24 hours, you're still going to be exhausted, you can't run, you can't bank sleep, you can't bank health, you can't like that. That kind of stuff is really super important to understand. But you know, it's funny because at the same time when I'm teaching people how to get going, like with a one season I started trying to impress upon them that overnight is easier than you think you know, and like once your Basil's right, you're not bolusing too much or too little, you're not going to get these wild swings. Now you've got this third of the day, you know, and it's like so if you see a 160 in the middle of the week, in the middle of the day, you can feel a little better about it because you had like, you know, your 85 or eight hours last night, right? It doesn't make whatever impact the 180 spike has. And like you said, I don't know what it does or isn't is or isn't doing your body. But if it is doing something being at all night long, doesn't stop that. But you know, like being safe right now doesn't mean that if I burn my finger five minutes from now it you know, it doesn't make it go away. It's still happening. I think that's really that's good information. So what are we in your own personal life? Is that how you think about it? Like just I'm gonna do my best and hope this works out?
Jennifer Smith, CDE 54:51
I do because like, you know, I
I try really hard not to like I go to all my checkups, right? I mean, I Get like, my heart checked, I make sure that I go to the podiatrist, I make sure that I get my feet checked, I've never had any problems, thank goodness. But I still go for all my checkups. I go on, I see my ophthalmologist to make sure they check all the vessels and you know, do the test for the puff of the air in the eyeball, right? is like
Scott Benner 55:23
an idiot when it hits your
Jennifer Smith, CDE 55:26
anticipation of that puff of a puff of air is worse than the actual puff is. But you know, I do all of those things, because I know that they are a check in the long term. And you know, what, if something does come up, then the checking is also prevention for furthering problem, then maybe you say it, check on something and up now something is happening. Okay? One, I might beat myself up a little bit of I could have done this better, I could have done that. But that doesn't help that's asked, you can't go back and fix it, what you can do is continue to go forward and say, Okay, I can try to do better here. Or maybe I need to add this or now I just need to see the doctor every three months instead of every six months or once a year, or they've got this treatment that could help me and it could make it better. And if I continue to do what I need to do, then I can prevent further complications down the road. So
Scott Benner 56:26
yeah, I also want to say that, I think I've never met anybody so far, I should say, that has told me, I decided I don't care, I'm going to run full force straight ahead, I'm not going to pay that much attention to my diabetes. And however long I make it, it's how long I make it. Whenever one of those people runs into a complication, they have always said the same thing to me, I wish I wouldn't have done this, like you don't mean like, I wish I would have bla bla bla or tried something else. Or it wasn't my fault. Even I didn't know. But I wish I would have kept searching. And and I think that that's the truth like it, whether you make it, you know, till you're 40, when all of a sudden, you're finding out at UT dialysis, or you make it to 70. And you're like I made it to 70. And then all of a sudden you're having a heart attack, a 70 year old type one is having a heart attack doesn't go at least I made it this far, you start thinking oh, I would like to stay alive a little longer. You know, like I get it, I don't think many people get to the point of no return whatever it is, and go, you know, I did my best. And I'm happy with this. I think I think that people such really do feel like that, like, Oh, I wish I would have whatever that means, you know, whatever they wish they would have done. I mean, if you're a person who can make it the whole way and just be like, you know, 35 years old, jumping your car over a canyon and realizing you're not making it the other end to go, Oh, well, I did my best. Like, you guys, like that's a special like, that's a special gear you have. But what I'm saying is that caring now will keep you from that feeling of I don't know what that feeling would be what how to describe it. When people talk about their they are disappointed in themselves. And then they can't shake that feeling for the rest of their life. Right? Like every day, they wake up with a problem. And they have this feeling like, oh, maybe I could have done something about this. And then you have to live with the problem and the guilt. And it's hard, you know, so I say all the time. I think with what we talked about on the podcast, diabetes becomes pretty. You know, I don't like to say easy, but I think it becomes like second nature thing for you. I would rather put that effort into understanding Pre-Bolus or, you know, something like that, then I would spending six, eight hours a day fighting with high blood sugars that cause a low that have me eating, that make my life feel like turmoil that I'm not living, I'm just existing through rock. So that's how I feel
Jennifer Smith, CDE 58:56
having and that I agree. And it's kind of the way that I feel about my own management is I do the things that I do every day to make it less of a visible upfront in my face, to let it be more of a Yes, I have to manage it. I still have to look at my blood sugar, I still have to take my insulin, I still have to count my carbs and Bolus the right way and whatnot. But those are like more second nature things that I just do now. And until I have like a bad site or something that I really have to completely put my focus into and you know, take care of
Scott Benner 59:37
the normal things that I do every day are just part of my day. Exactly. And those bad sight moments, because I recognize what you're saying is how Arden's life is and mine with helping are is that most of the time we are just sort of cruising along. And when something really goes funky, and you're all the sudden you have to stop thinking about life and you're now you're focused on this diabetes thing in my heart. I know that some People live like that all day long every day. Right? And that's just because that's an explanation to me like your bad sites a great explanation because you're but all that means is you're not getting insulin the way you need to. Mm hmm. And if if your bagels off if you're not Pre-Bolus if you're not doing all those things in every moment, you're not getting insulin the way you should. And, and so your life's always gonna be, you know, I like that.
Jennifer Smith, CDE 1:00:22
And in the instance, then of
blood sugar's being all over, you never really know unless the pump tells you if you are on a pump, that you have an occlusion and that there is a real problem. You never really know. If there's a problem you should be addressing. Yeah, I mean, I know when I know even ahead of clusion alert coming, that something's not right. Yeah, I can tell. Yep. Um, because things are contained. And if I see something odd happening, and I know that nobody is like, injected me with like the sugar to
Scott Benner 1:01:03
go,
Jennifer Smith, CDE 1:01:04
right, then clearly, I'm not getting in. For
Scott Benner 1:01:08
whatever reason, I don't know, change it out. I don't care what I'm going to address it, I'm going to take care of it. I'll just change my pot out and move on. Let's see you and Arden have a scenario, a life where your expectation is a lower, more stable number that reacts the way you expect it to. We said this the other day, when we were talking like I, I talked about how I think of the site as doing what I expect it to do. So the minute I don't see it, doing what I expect, or I see a blood sugar, that's all the sudden 150 my my I start thinking like, I can look back if I didn't mess this up somewhere. This is this is I'm not getting enough insulin. So I don't mess with that either. Like there's a moment. Like I think some people end up looking at a bad site for days. And then and then they they'll change their property. Oh, it turned out to be the pump 48 hours later. Right? Yeah, I'm not into that. You know what, the second or third time I bolus and what I want to happen doesn't happen. And I'm getting out of it. Yeah, I actually had
Jennifer Smith, CDE 1:02:08
it this morning. I mean, I wasn't, I wasn't actually supposed to change. My pod out until this evening is when it was supposed to expire. And I woke up this morning. Not at my normal like, he ish blood sugar. I was like 130 something I was like, kind of odd, right? And like, that's not where I should be. And I could see all this, like, positive temping that been kind of happening. And so I look at my site. And it's bloody in the window, or my pod site, right? And I'm like, had I not checked, I just gone I've got about three, though I'm higher than I normally am this morning. And I'll just correct some insulin, I'll eat for my or I'll take for my breakfast. And hope all goes well. Well, I just I know that that's not the norm for me. So what did I do? I changed out my pod. And that's it.
Scott Benner 1:02:58
Yeah. Because you're you would have been fighting with that all day.
Jennifer Smith, CDE 1:03:01
Otherwise, right? Oh, correct. In my post breakfast would have been for it. I'm sure. I'm sure. I bet she gets
Scott Benner 1:03:06
to 20. That in that situation? Right. Right.
Jennifer Smith, CDE 1:03:09
Yeah. Right. At least. Exactly.
Scott Benner 1:03:12
So, Jenny, if you and I were one person, we'd be a super diabetes brain.
Jennifer Smith, CDE 1:03:17
Oh, my goodness.
Scott Benner 1:03:22
place? Oh, my gosh, all right. I know you got to get going. I'm not sure if we talked about what we said we were going to talk about, but I found this to be a really great conversation about, about long term health and, and ideas of how to get to it and why it's important. So thank you very much.
Jennifer Smith, CDE 1:03:37
Yeah, absolutely. It was, it was good. I think sometimes, you know, the stuff about complications and whatnot gets, it gets to clinical. And I think people just need a return to all that. That's why I'm aiming for just keeping things tighter, or why I'm keeping things more in this range, or whatever. I mean, they know that the complications are out there. But this is the reason I'm doing that
Scott Benner 1:04:04
instead of talking about a thing that seems like it's so far away or so impossible, that there's no real reason to try to plan for it not to happen. Because it's so far I will always use this example. My father smoked cigarettes all day long, two and three packs of cigarettes a day and not like not some like Marlboro light thing like Chesterfield kings, no filter, you know what I mean? Like it was left over on the floor of the place that they just roll up and sold the people you know, and in his 30s in his 40s, in his 50s, smoke, smoke, smoke, smoke so 60s, he'd come back from doctor's appointments doctor says, I can't even tell you're a smoker and he would wear that with a badge of honor right up until smoking killed him. right up until he had COPD, and then and then he died. So you know, can only you can only you You only stay ahead of a charging bowl for so long right and right you don't want to be you just you don't want to give yourself
Jennifer Smith, CDE 1:05:07
up off the path and be like, let it run by. run by.
Scott Benner 1:05:12
My dogs are barking like crazy. I think someone's breaking into the house. I might be killed soon we'll find out. For me, Kelly, probably Yeah. Oh my god finally dating. Oh, I hope not. All right, I will talk to you soon.
Jennifer Smith, CDE 1:05:29
Okay, awesome. Bye. Bye.
Scott Benner 1:05:33
I bet you didn't know that you can hire Jenny. She works at integrated diabetes, just go to integrated diabetes comm or there's a link right there in your show notes that you can email Jenny directly. Jenny is not a sponsor of the show. She's a friend of the show. But that doesn't change the fact that she's got a mortgage to pay. huge thank you to Dexcom and Omni pod for sponsoring this and so many other episodes of the Juicebox Podcast, my Omni pod.com forward slash juice box go there today. Get the demo pod get a pod experience kit sent to you and get your Dexcom g six continuous glucose monitor right now stop waiting dexcom.com forward slash juice box. This episode is the 17th of the diabetes pro tip series. It began back on February 25 2019. With an episode called newly diagnosed you're starting over and there was 211 to 12. That's all about MDI and all about insulin to 17 to 18 and to 19 Pre-Bolus in Temp Basal and insulin pumping to 24 to 25 and 26. mastering a CGM bumping and nudging and the perfect Bolus, Episode 231 about the variables that come with Type One Diabetes, Episode 237 setting basal insulin 256 exercise in Episode 263. We talked about how fat and protein impact your blood sugar's and they do. Episode 287 illness, injury and having a surgery with type one diabetes in Episode 301, glucagon and low blood sugar emergencies and Episode 307 emergency room protocols different than illness injury and surgery. This is what happens when you're thrust into an emergency room. Not something you were planning for. And of course today's episode 311 diabetes pro tip long term health. Thank you so much for listening to the podcast. Please leave a rating and review in Apple podcasts if you're enjoying the show. But moreover, if you like what you've heard, find someone else who could use it the only way a podcast grows by word of mouth. So I appreciate it when you tell somebody else about the show.
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#307 Diabetes Pro Tip: Emergency Room Protocols
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
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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, everyone, and welcome to Episode 307 of the Juicebox Podcast. Today's episode is another in the diabetes pro tip series. Today's topic, emergency room protocols. This is a really great and complete conversation about how to handle trips to the hospital. And my voice is a little broken up right now you may have just heard it. So especially when you get to the ads in the middle, you'll have you know, I'm not quite like, but it's getting there. So I'm doing as little speaking as like Ken today. That said today's episode of The Juicebox Podcast is sponsored by Omni pod and Dexcom you can get a free no obligation demo of the Omni pod tubeless insulin pump sent directly to your home by going to my Omni pod.com Ford slash juice box. And to learn more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com Ford slash juice box now there are links in the show notes of your podcast player and at Juicebox podcast.com. For all of the sponsors, check them out. So today Jenny Smith and I are going to be talking about going to the hospital with Type One Diabetes. Jennifer Smith is not only a good friend to the Juicebox Podcast, but she is also a person who's been living with Type One Diabetes for over 30 years. So she has first hand knowledge of day to day events that affect management. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitoring systems. She is also my partner in these diabetes pro tips. You can check her out at integrated diabetes.com you can actually hire Jenny, she'll help you through your process. Please don't forget that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan. or becoming bold with insulin.
So Jenny, this whole time we're going to talk today, I think we're gonna just talk about this one.
Unknown Speaker 2:27
email that I got.
Jennifer Smith, CDE 2:28
Yeah. Which was great. And I think I mean, we've touched on some of these points in like some of the I know, we did like up a safety in a hospital preparedness and all of that kind of stuff. But I think this hits a really specific mark of most people that go to an emergency room in a very emergent setting. They don't really know, and why would they know that the staff there is not prepared to deal with Type One Diabetes, they're not and they're not in. I don't say that in a like a god, they're not educated they are they're highly educated, they're educated in a million different things, right. But their focus is so much not type one. And because the scope of how we manage type one, especially in the past 10 years, has changed so dramatically. They the staff, they can't keep up with that they they don't they don't have time to keep up with that. So when you come in, you know, on these fancy gadgets and all these things, and they're like, Well, I know an insulin drip and I know how to, to hook you up to glucose and that's what we're gonna do. Like and you step back and you're like, No, no, no, no, I do this,
Scott Benner 3:49
you could you come to realize what they really understand is just how to keep you from having a low blood sugar incident while you're there. That's what I know how to do. So you may or may not be surprised by the number of emails I get yearly from nurses and doctors who have children who are diagnosed or sometimes who have themselves diagnosed. And inevitably, there are three sentences or three sentences in their email that describe I'm a good nurse. I'm a good doctor. I don't understand Type One Diabetes at all, every time. It's Yeah, you know,
Jennifer Smith, CDE 4:26
I'm working with a family right now. The the father is a physician and the mother is a nurse practitioner and their little child they I mean, they came to us and they were like, We know diabetes, but we don't know diabetes. You know, I mean, we know the coded book description of this is what you do, and that should be cut and dry and playing the limit. Not cut and dry. There is no book anything nuanced just a bit, right. Right. Right. So I don't
Scott Benner 4:59
I think misty would mind her name being used, Misty came into the private Facebook group that we have for the podcast. And she shared that, you know, her child had to go to the hospital. And then she had all of these questions afterwards, and statements and things like that. And when it ended, she said, I would love it if you and Jenny talked about this stuff. And I said, Okay, you go ahead and put a list together of what you think of, you know, as emergent that came from this experience. And Jenny, and I'll try to talk about it. And she really did. So misty, congratulations, this, you are the founder of this feast today. So
Jennifer Smith, CDE 5:38
yeah, and she did not I mean, from the topics that she noted, would be helpful to cover and everything. I mean, quite honestly, it kind of speaks to the amount of medical education you get, yes, it's only in one field. But the amount of medical stuff you learn, when you become either the person with diabetes, or the caretaker for someone with diabetes, I what she has here is very much in a very, very specific way really important, and should quite honestly be like taken to the emergency department heads. And this is what your Doc's should have a list of protocol to follow up. So
Scott Benner 6:19
that's what we're gonna say the real question becomes, excuse me. The real question becomes, what happens in an emergency situation in a medical situation, when you are the most knowledgeable person in the room and have the least power? Right, apparently to you in the moment, right? Doctors, lab coats, people bubbling around, you're not a doctor. But it turns out, you do have power, you just need to know how to assert it.
Jennifer Smith, CDE 6:46
How to wield it exactly. So
Scott Benner 6:47
let me read a little bit here. This, this emails, not miss these initial post in the in the Facebook page. This is the email she sent to me. And so she said, Hey, thanks for considering making this up. Thanks for considering making an episode about emergency care. Going through the sickness with my son, which was the first time he had had a stomach bug since diagnosis almost a year ago, made me start thinking about how to figure out what else I don't know. In this instance, probably the three biggest mistakes made the ER ended up being the doctor turning off his bazel they didn't hang dextrose and refused them an absolute refusal to call an endocrinologist. And she said, I knew that these things weren't right. But by doubting herself and assuming that the doctor must know better than she did. You know, she had no idea in the end, how to make him do those things that she knew needed to be done. And she should have been more assertive, she says and sooner. Mm hmm. So she put she just puts a bulleted list here. That's terrific. I and I think we did go down the list. Right?
Jennifer Smith, CDE 7:55
Absolutely. Because it's it's a great list. And I think some of the points can actually even be kind of melded together in a way. But I it is, it's a very well put together list. It's actually In fact, many of the things on here, when we talk to people, the people that we work with in our practice, and we give them our information about prepping for a hospital stay, we have not only a hospital stay or expecting like for a planned surgery, but we also have a lot of these things covered so that you do know how to advocate for yourself, because that's really what it becomes. When you go to the emergency room. Unless you are the person with diabetes, and you're completely out. Well, you know what? They're gonna do what they can do to save your life. And you have no control there then. But
Scott Benner 8:44
yeah, and maybe you can get into a situation where you don't end up like you've heard people in the past talk about in the podcast, where they have family members sneaking them in insulin, and they're like, you know, like, wouldn't it be nice if that's not how this went? Right? It would be lovely for your, you know, your medical doctors to know about the insulin your body. So Right, right. I have a couple of experiences that I'll I'll interject if they fit, and I know you're going to have some. So first question was, how do I know when it's time to go to the hospital or even at least to call the endo? When it's a specific type one problem, I guess around illness? When do you tell people to call?
Jennifer Smith, CDE 9:23
Yeah, I mean, we usually tell people to call at least to call their endo or I guess even a step before that is make sure that you've addressed with your endo a 24 hour emergent line to be able to contact somebody at because I guarantee that your specific endo isn't going to be there at two o'clock in the morning, everything every time something happens, right. So the step ahead of that is knowing who to call, what's the number who will I actually talked to you? Is it just going to be a nurse triage or is it really that I'm going to get to talk to somebody that's going to give me some information without playing phone tag writing
Scott Benner 9:58
services still exist to you might just be They do person taking a message,
Jennifer Smith, CDE 10:01
right? Correct. I mean, most systems, most healthcare systems do have 24 hour nursing care within your, like, you know, whatever your insurance coverage or whatever system you're in, right? And that nurse should also be the one who can help determine what are your symptoms? What's going on? Or what what's happening with your child? Is this emergent enough? I'm going to call the doctor on call, and we're going to get some answers for you or no, you need to go to the emergency room there. I mean, we've used it a couple of times for for our boys when they have been like, sick fever, like, you know, rolling around, not feeling great. I'm like, Okay, let's call the nurse and see if it's time to go to the doctor, you know, um, but so they're, from our experience, they've been very, very helpful and good. So that's a first step, if it's daytime, certainly try to call your endo office get in a very emergent message that, hey, this is what's going on and have some very good facts to give them, you know, we've checked blood sugar, we've given insulin, we've checked ketones, you know, my child won't take any fluids, or my child can't stop vomiting, or those are very, very important things to be able to give facts, so they know what to do with you.
Scott Benner 11:15
I also think that it's important not to get caught up in the emotion of it, telling stories and like, they need the facts. They don't need the extra stuff. My mother in law was over. And yeah, let that go. That's not
Jennifer Smith, CDE 11:31
a kid's friend was over three weeks ago, and had you know, the flu Two days later, they don't care. They don't need to know,
Scott Benner 11:37
we've all been around a person telling a story who's telling a story. They're five minutes into it, you're bored out of your mind, and then they go. So anyway, it was one o'clock in the afternoon. Wait a minute, was it one o'clock? Or was it 130? Right? I you know, I think and you're like listening, going, it doesn't matter. Just tell me the story. Right? So yeah, and I think to to recall, to remember, is that it's possible, you'll get a really learned person on the phone who can hear you and respond from their own brains knowledge. And you might also get someone on the phone who's just following a flowchart waiting for you to say a key word. So you know, exactly. So expectations, I guess, right?
Jennifer Smith, CDE 12:19
And definitely, you know, like I said, Have the facts in order that you can tell them so they can direct what they need to tell you in the right way. And then, you know, if you really just don't know, you know, when is it actually time to just pick up and go to the hospital? I mean, certainly, we usually say if it's, in this case, you know, her son had a stomach bug. So my expectation is that there was a lot of vomiting, or maybe there is vomiting, and the other end as well, kind of coming out. I don't know, stomach bugs are pretty nasty. And for little kids, or kids of any age, even adults, you could be so like, just out of it, that even remembering to take a sip every couple of minutes or remembering to get, you know, some food in or some carbs in or to try adjusting your insulin this way. Some of that may completely go out the window. So I mean, when is it time to go to the hospital when you've put everything in, and you've adjusted, and you've tried all the sick tape protocol that you've been given to try. And it's not working, and especially if there are more. So that higher ketone level, you need to go to the emergency room, don't play with it.
Scott Benner 13:36
There's the idea. The illness is not fixable, you are ill now you're ill, you're either able to manage it at home in a way that isn't going to become dire. Or you need to be at the hospital prior to it becoming dire. Right, right. That's correct. That's the idea.
Jennifer Smith, CDE 13:52
And a lot of some of the evaluation in this case would be hydration, for a stomach bug, when to go to the hospital, especially for little kids. If they haven't been able to even take anything in fluid wise or fluid with a little bit of carb. It's It's time to go hydration is a really, really, if you get dehydrated, it's hard
Scott Benner 14:15
to recover from that and pay attention to your ketones. I would imagine when you're sick, yep. Alright, so then she says, What do I take with me? Maybe you should talk about this stuff you have prepared in case you're too sick or unable to speak for yourself a list of medications, outlining of what your normal type one care is like, what hospital is best for you to go to if you have a choice. She gets there. She lives very far from her hospital, which is interesting. I live in a metropolitan area. I never think about that. Like, I never I don't realize that some people have to take an airplane to an airport to fly somewhere else. Like that's not the life I live. Yeah, if I wanted to go to a children's hospital right now. I could go to five of them if I wanted to. Right. Yeah, right. So but that's not everybody's story. So what should you I mean, you've talked before though about having a go bag for yourself,
Jennifer Smith, CDE 15:05
yeah, next to the next to the door or even if you keep it in the car, as long as doesn't have any, like meds or anything that will freeze, you know, if you live in a cold place or way too hot place. But I mean, some of those things that should be in a bad bag, especially if you're on a pump, things like extra reservoir tubing, infusion site, even a bottle of water, extra batteries, tapes, adhesives, you know, all those kinds of things, even some extra like glucose, glucose, gel, juices, simple sugar, all the things that you would pack, to potentially take along on like a vacation, let's say, could be in that bag along with and I love that, you know, she pointed out things like a list of meds 100% because you know what, when you're bringing your child someplace emergently like that, while you may the back of your hand know exactly what the rates are of bazel delivery and what they get, and maybe if they're on injections how much and when, when you're in that emergent situation that may completely go out of your brain, and you may be fumbling to remember. So having that all, you know, written down even, you know, if you upload your pump, do a printout once a month of the changes that are in your rates, ratios, you know, time of action and everything that's available on every pump load site, right? download it, put it in the bag, that way it's there.
Scott Benner 16:31
Yeah, yeah, I think to as you were talking, it made me realize I'm gonna do something. So Jenny, and I have topics for some of our episodes. And we just keep them in a simple note in an iPhone, right. And it's a shared note. So I type in a list, Jenny goes back and strikes things out or add things we go back and forth. And as we make changes to it, the other person can see the changes, you could just simply have a note in your iPhone that is shared with your husband and your mother and and those people, that is a list of medications, what basal rates are stuff like that, so that everybody has access to that information. The second,
Jennifer Smith, CDE 17:06
the other really good like I'll like I never take off my ID bracelet. But many ID bracelets like mine on the very back of it. Now of course I can't get it off. But on the very back of my ID bracelet is actually a an 800 number and a website, that's it's free. All they would have to literally do is look at my ID bracelet. and log into that and all of my medical history is there. So if your child wears a necklace or a bracelet or something like that, many like American medical ID does a really good job. Most of the other websites. I don't know if they offer that as a free service when you buy a bracelet, but it's a nice way that again, you don't have to have that list, like printed out. It's there. It's excellent.
Scott Benner 17:55
Okay. Okay, Misty says what are the universal non negotiable things once you're at the ER, like for your safety? She says that in their case, it was not shutting off the pump, you know, they hanging dextrose not sailing way. That's a way that one's Interesting, isn't it that they gave him because the sailing drops your blood sugar,
Jennifer Smith, CDE 18:17
like well, and the dextrose versus the Sallie Mae, you know, in her circumstance, she's right. But in other circumstances, depending on where blood sugar was, you know, hanging sailing versus dextrose. If somebody's coming in, in DK, obviously feeding them more glucose, at least initially, you know, you're gonna actually you need hydration. So there are some pieces that go along with the illness that you've come in for, to pay attention to. But I think what she's really saying here is asking what's being hung? Right? Right. It's it's knowledge to say, okay, you're hanging Sally, and he's come in with a stomach bug, I understand that you're trying to provide some hydration. But let's look at where blood sugar is. Let's look at all these things, then she, you know, again, also very correct. And it's a big thing that I go over all the women and men and parents that I work with. If you go to the emergency room, do not let them take your pump. Do not let them take your pump. I mean, like, if you have to, like scream and yell and whatever, then advocate and don't let them take your pump. If you come in because you've had a pump malfunction. Obviously, your pumps not gonna be doing what you need to
Scott Benner 19:32
take your busted pump.
Jennifer Smith, CDE 19:34
There's a difference in the story, right, but definitely not shutting off the pump. The other thing here too, is they don't necessarily know pumps well enough to even be able to know whether you shut it off.
Scott Benner 19:47
So Jenny just brought something up. And
Jennifer Smith, CDE 19:49
so I kind of, I kind of sugarcoat that in a way, like, they don't know. It's like,
Scott Benner 19:58
it's like when my kids were little We used to go into a spare room, pull the sofa away from the wall a little bit and hide Christmas presents behind the sofa. And the kids never knew where they were because they just didn't know to think about that. Right. So So I have two hospital experiences with Arden. And they both come within the last year. So they're fresh in my mind. One of them is an emergency room visit where Arden had abdominal pain. It was bad. We went into the ER, the first thing I started doing and now keep in mind that this ability to do this comes from a confidence standpoint, like I was confident when I got there, so you know what you're doing. So I got I said to the nurse, and anybody who walked in Arden has type one diabetes, she's wearing an insulin pump and a continuous glucose monitor. Her continuous glucose monitor is reading her blood sugar live, here it is I held it up and showed it to them. And her insulin pump is giving her basal insulin and boluses in case she gets larger, we want to keep these devices on her. Okay. Now you would think they'd be like, Oh, I don't know. But But when people realize, you know, and they realize they don't know, they get a little smaller in the conversation, if that makes sense. like someone's in charge and someone's not. Now it is not the you're not trying to lord it over them. You don't want them to be like, you're not like, Hey, I'm here. I know what I'm doing back up. It's a very symbiotic thing you're trying to set up
Jennifer Smith, CDE 21:21
as you've also come in for help for something else respect.
Scott Benner 21:24
Right, respect what they know, try to get them to respect what you know. Mm hmm. It's very important not to come off crazy during those initial conversations. Correct. flustered, like you don't realize it. But if they look at you and your hair on fire, they read that as I'm not listening to that person, right? You know, and that's good on them, they shouldn't. And also keep in mind, that emergency room people deal with a lot of crazy people. So know if you're crazy or not. And so you have to build a little quick rapport, simple conversations, ask questions. And I also found that I'm was kind of, in my mind scoring the people, what did they understand what right, when did they get a blank look? Or when did they have a response that made sense, you know, try to figure that out, then sometimes, there were people in the scenario I just stopped talking to about diabetes, I directed it more towards the nurse who seemed to understand what I was saying, the one who wanted to give me a little space, and did and that's how I did that. Right. And, and it worked out really well.
Jennifer Smith, CDE 22:27
And I think at the same time in your scenario, kind of bringing in until she mentioned a little further down, not until the nurse really was like, I need to set you straight. And I'm going to call in somebody else to talk to you and set you right and whatever. And she called it an endo consult, quite honestly, when you go to the emergency room, and you know that you may have a stand up and put your hands up and say I got this I know. And you know what you can call an endo bring them in, because I would like another advocate for what I'm doing. right up front. Ask for them. There is always an endo on call. There's there's always a specialist on call that will come.
Scott Benner 23:12
And if I could play psychologist for a second, when the nurse says that the misty that's the nurse saying, well, I really don't know enough to write to be the stop in this situation. I think that woman should stop telling me what to do. But I don't have enough facts to stop her. I'll get a person with facts that come in, then we'll see later that the person with facts came in and, you know, right, told them.
Jennifer Smith, CDE 23:36
You know, hopefully overall, the nurse may have learned something in that setting, too. You know, everything is kind of with diabetes, I find it if people are willing to listen, it's a teaching moment. So you know, hopefully for the next person who comes in or the next parent with a child who comes in this nurse will be a little bit more in the know and be able to say you know what, I don't know enough about this. I do understand that you feel like you know what you're doing? I'm going to call the endo. Let's just make sure everything is is good. Everything is the way that it's supposed to be going based on what you came in here for, you know, three.
Unknown Speaker 24:11
Yeah, exactly.
Scott Benner 24:15
One second, I gotta tell ya, I found myself at a speaking event last weekend. And outside of the event, there were vendor tables, and one of those tables was on the pod. So I went up to the person working the table and I said, Hey, I'm pretty good at telling people about on the pod Could I try? They said yes. And then the next person that walked up to the table, I stepped up. I said hello, how are you? Are you interested in the Omni pod to boost insulin pump? And the guy said Not really. I saw Whoa, why not? Let me tell you. So first I found out was he interested in a pump? And he was then I explained how the Omni pod work did It was a standalone device that didn't have any tubing, but he could wear it while he was bathing or working out, going swimming in the ocean even. Then he started Listen, I talked to him about how important it was to continue to get his basal insulin during those activities, and how if he had a tubes pump, you'd have to disconnect to do those things. And I had his attention. After that, we talked about the personal diabetes manager that's used to control the pump, and even discuss that sometime at the end of 2020. On the pod would be adding an algorithm that their horizon system would be coming out that this was the perfect time to get acquainted with the Omni pod. Just like that he picked up the free no obligation demo, and took it home. And you can get one for yourself at my Omni pod.com forward slash juice box. When you go there on the pod, we'll send you an absolutely free, no obligation demo of the Omni pod. Check it out. All right, I'm gonna keep going and do the last ad for the show right here. And of course, it's for the Dexcom g six continuous glucose monitor, my voice is failing me. But the Dexcom will always be there for you. The dexcom g six is the only continuous glucose monitor that I would ever put on my daughter. It gives back information about the speed and direction that her blood sugar is moving, that is so necessary and needed in our life. It is how we make every great decision about food, insulin, how we stop low blood sugars from happening, how we head off high blood sugars before they become high. It is how we do everything. Every insulin decision we make begins with the information that comes back from the dexcom g six continuous glucose monitor. I look there are links in the show notes of your podcast player and at Juicebox podcast.com for both on the pod index calm. But you can just remember this right here, you'll get to where you need to be dexcom.com forward slash juicebox. Go read about the alerts and the alarms about the share and follow features. Figure out if this is something you want. Don't take my word for it because my word is do it. That mean if you want to trust me just jump right in. But if you don't want to trust me, Go read about it at least go find out how your child or loved one can be anywhere using index calm and you can be somewhere else remotely seeing their blood sugar's my daughter's blood sugar right now is 71. She's at school. It's 1030 in the morning. I can see that right on my iPhone dexcom.com forward slash juice box are the links in your show notes. Were at Juicebox podcast.com. And don't forget, if you're thinking about moving to an algorithm based pump at some point, you're going to want the Dexcom so now's the time. One second, I gotta tell her something.
Jennifer Smith, CDE 27:57
She fallen asleep in class because she's so tired from studying so late last night.
Scott Benner 28:02
She's actually on our way to lunch. She's been at school for 25 minutes and she's going Watch now which is you know,
Jennifer Smith, CDE 28:06
we always we always talk at the time that she's heading into lunch. Yes. And you're always texting her do this or did you do this or eating today?
Scott Benner 28:15
Want me to pull the curtain back a little bit people like hearing about that. So there's a reason why I'm always recording all Ardennes at lunch and I'm much more well thought out than I give myself credit for Do you believe I am. Okay, and then she asks the end. Is it ever okay to shut off insulin. So misty, I'll tell you that. I was rockin Arden's blood sugar for hours in the emergency room and there was no food going into her like we had some juices once in a while we were sipping juices always let the nurse know juices happening. Because the nurse was always like, Look, if you can't manage this, we'll use I don't know what it is dextrose or glucose or something like that. Right? And I was like, okay, you know, but I was trying really hard for that not to happen because just like the nurse who called the endo on misty, I didn't have any perspective for that. I did not know what was gonna happen next. And I use texting Jenny, I was like, what's gonna happen if they give her this? Like, what trying to be ready because I've taken insulin away, like, I don't know what to do. Right. And we kept going for a long time. But finally I just couldn't. I couldn't keep it up anymore. Right. And so they gave it to her. And the woman's like, let it go for a minute to see what happens. She was right like it shot up. But it came back down pretty quickly again, like had I given her insulin for that that would have been a major, like problem, right? Yeah. And then once we got that drip regulated, and then got her bazel rate to where, like I just adjusted her bazel to manage the dextrose instead of what it was usually managing. She was getting a very tiny bit of insulin. Yeah, but a little bit. And that was it. And it's making me realize as we're talking, the tools really do work anywhere. Like they were in that situation too. So I guess confidence and honest actual confidence that comes right that comes from experience that you No, it's gone over and over again, the right way, is really helpful.
Jennifer Smith, CDE 30:05
And I think that, you know, as far as what you were doing, because you know how to manage and you know how to adjust, you know how to turn things down or turn them up or micro adjust with little bits of juice, if you know that if the person can take a little bit by mouth, and it's okay, according to what, you know, their protocol is in the emergency room, or again, like a dextrose drip, if that's an option, and you can adjust accordingly with your basal insulin drip. Great. But it's and I hesitate to say, is it a yes or no? Is it ever okay to shut off insulin? Technically, no, for somebody with type one? I mean, really, it's not. I mean, we, we know what happens if there's 100% deficit of basal insulin, you're not going to see the impact right now. But you are going to see the impact in the next several hours based on that deficit of bazel. That was supposed to be there. Even if they needed less basal insulin, they will always need basal
Scott Benner 31:05
insulin, and you and if you get to that spot where your it all is out of control, they're going to take it over, then they are going to take a minute your life feels a danger. And they don't think that what you're trying helps them you're going to lose control the situation. Right, right. And that's, that's obvious. I want to fill in here that misty said that eventually, it seemed like the ER doc was probably confused about pump therapy in general, and didn't realize that her child wasn't also getting a long acting previously injected insulin. So that doctor did not understand what the pump does
Jennifer Smith, CDE 31:42
know. And that's not a common misunderstanding, quite honestly, like I said, initially. The doctors and the nurses and the staff that work in the emergence and the emergence setting of an emergency department, they know a lot, they really do. But they're they're not schooled in, in this setting. What was the difference? Again, between type one and type two, they're just, I mean, they know if they sat down at a desk to somebody, they could tell you the difference, right? But I think because they don't work it all the time. There really is this disconnect in understanding someone with type one diabetes, and I hope lots of healthcare professionals. Listen, Amy, but there is a definite you don't have insulin production, you have got to have at least the background drip drip, drip, drip drip of insulin. And if you're somebody on MDI, which misty also asked, you know, what about people who are using multiple daily injections, what about them, if and that kind of goes along with the emergency preparedness bag, if you can grab your supplies and take them along to the hospital with you, and you're on multiple daily injections, I guarantee you need to grab your basal insulin, whether it's you know, whatever brand you're using, bring it along, because while the hospital will have within their formulary, a basal insulin to use. They may want not know how much you're using, and they'll base it on a formula to calculate how much to give you. But if you don't tell them when you've taken your last dose, or when you usually take your doses of basal insulin, in the hectic nature of what they're trying to do for you. Maybe you take it at 5pm every night, and you end up going to the emergency room at 3pm in the afternoon, and you're there for seven hours. Well, you know what 5pm comes and you don't get your basal insulin, you're going to be at a deficit, they don't know that.
Scott Benner 33:39
And they're gonna be not inclined to give you a eradications they don't understand. So here she says, How should you advocate for yourself for your child if things aren't happening, right? Like, she's like, what if like asking nicely just doesn't work? I think then it's okay to ask to speak to someone else. Correct. You know, like, at some point, you have to just say, Listen, I really do see that you're trying to help. And I don't I'm I always put it back on myself. So there's a little trick I use sometimes in personal communication, where if things aren't going the way I want them to, and I believe it's because the other person is not understanding me. I put that misunderstanding on me. Right. Maybe I you know, I think maybe
Jennifer Smith, CDE 34:22
I didn't explain it right.
Scott Benner 34:25
I'm not explaining this correctly. But it's obvious that we're not on the same wavelength here. Could I just talk to someone else and maybe re explain, maybe they'll hear me differently, you know, maybe how I'm saying it will hit them differently, whatever. But just know that I've been at this a long time. And I know this isn't right. And so despite this can't be the end result where we're at right now.
Jennifer Smith, CDE 34:48
And that's where I think advocating sooner than later. If you are getting any pushback, even in the first you know, minutes of being there. Ask for a console. With an endo, ask for somebody to come in who can from an understanding place, advocate with you and or for you based on what you then tell them? And I think another piece that obviously goes into it is, what is your typical plan of care for a day? Right? How much insulin, how sensitive Are you all those dosing, you know, strategies that you use all those doses and everything that you use from a ratio standpoint, sometimes having it just written down, rather than trying to explain it visually to somebody who is medically trying to help you at that point. They could read it, and it may just click
Scott Benner 35:41
Yeah. Because they're not used to looking at your pump settings are thinking about it, maybe even the way you talk about it. And I listen, I speak to a ton of people as you do. There are a million different ways that people explain the same things all the time, right? Like you hear somebody say it one way, then someone else says it another way. And then a third person found a fun way to say it. And like, you know, versus the situation, you don't want to be using the fun way around the house to explain the doctor because they don't know what the heck you're talking about.
Unknown Speaker 36:06
No, no.
Scott Benner 36:08
So So Arden's emergency room visit was eventually, it turns out because she had a cyst next to her fallopian tube, caused her like incredible, like stomach pain. So eventually, after a lot of testing for other things, we figure that out. And we found ourselves getting surgery for art and to have the cyst removed. So we must have met with the surgeon, four times prior to the surgery. And every time at the end, I would just say, hey, just wanted to remind you that Arden has an insulin pump, and a glucose monitor, right? And that we want to keep them on her doing, but it's really only a 45 minute procedure. And the doctor was, oh my god. Yeah, that's great. Right? You guys are doing great. Just do it. She just boom, yeah, sure. Then we get to the hospital that day, and we're doing intake. And I realized the first nurse is just getting her set. She's not going to be part of the procedure. But then eventually another nurse comes in, who's obviously going to be in the room, I say, Hi, I don't know if the doctor told you. But my daughter has type one diabetes, and she picks the chart up. And look, she has no I didn't know that. And I was like, okay, and I said, Well, she she does. And she's wearing an insulin pump and a continuous glucose monitor and look at her blood sugar right now, look that I've kept my daughter's blood sugar between 100 and 130 for the last 12 hours, because for this, okay, right? And so keep in mind that that's incredibly difficult to do. And I don't want you to take this the wrong way. I've done it. Okay. So and if you need it for another 45 minutes, I can I want to Okay, she goes, Well, protocol is and I went Oh, okay, so now my brain starts going argue with the doctor said it was okay. No, don't do that. Ask for the doctor, maybe. Then another nurse works walks in the room, I swear to you, I turned away from the woman I was talking to look at the next one went Hi. I don't know if you know this or not like the first nurse wasn't even standing there anymore. But my daughter has type one. And I went all through it. And luck habit She goes, my best friend has type one diabetes. While you're doing great. Let me see your graph. I think my daughter, I think my friend has a dexcom too. We talked about this sometimes. You're doing great. You do whatever you want. Yeah. And that was it. And I said, Okay, great. I said, if she does get low, feel free to give her glucose to bring her blood sugar. Would you like to take her phone into the operating room? And they were like, Yeah, absolutely. And they put it in a surgical bag, they stuck it on the operating table so that it could stay connected to everybody. Once I found somebody who got it, she was thrilled to not be involved in it. Right? Much like your school nurses, and your and your administration school, once they realize you can take care of this and you're like, we don't want to go to the nurse anymore. That's their dream not to take care of your kid, you know. So I found that very same situation kept our blood sugar nice and stable during the procedure. And then as soon as she was out, and her blood sugar tried to go up, I stopped and I was much less aggressive than normal. But I had a goal like I'm going to try to keep under 170 you know without getting her low because she was she was loopy.
Jennifer Smith, CDE 39:17
Yeah, yeah. anaesthesia is not fun.
Scott Benner 39:20
Right. And, and it worked. But it didn't work because I had the conversations with a doctor didn't even work because I had it worked because I kept having the conversation. Right? So don't get into a position where you feel like I've said this once because said it once to somebody doesn't understand.
Jennifer Smith, CDE 39:38
And it's also hard in that scenario when you've explained it. And now you come in and you have to explain it yet again. And then they come in with more people and you have to explain it yet again. It's hard not to start to get like this escalation of, oh my god, if I seriously have to explain this to one more person. I'm gonna like my head's gonna explode. We I mean, you really have to take that level down. So that you can advocate well for yourself, and you don't start to look like the crazy person, right? Really think
Scott Benner 40:08
about the suspension of, I don't know what it is expectation or ego or something like that. You're just, you're just and I always explain, I never explained it from a asking point of view, I was always being Matter of fact about it. Like, you don't mean like there's there's, there's an idea behind having you know, whether you're buying a car or any kind of like a situation like that someone's in charge, right? Like someone's in charge. And when you start at the hospital, by default, the hospital people are in charge. If you become subservient in the conversation, you are immediately under them, and you'll never go anywhere else. Right, right. And it's just it's all human interaction. So you start with Hi, you know, I don't want to sound crazy are full of myself, were really good at this. Let me show you how good we are at it. I promise. I'm, you know, this is the truth. And here's what I'd like to do. Here's what I think I can accomplish with that work for you, then you kind of loop them back into the process again, showing them they're important. It's manipulation, really, but other people call it communication, but you know, what you gotta do?
Jennifer Smith, CDE 41:16
You do. And sometimes it's sometimes even the team might have, you know, in a scenario of going to the hospital, even for like a planned procedure, like the case of art and surgery, right? I mean, in in August, I had surgery for kidney stone. And it was entirely different than the surgery I had just a couple months before that in May. In August for my kidney stone. I had to, like my mom came to the procedure with me after it when she was bringing me home. She's like, I can't believe how many times you had to explain to different people the same exact thing. And I was like, yep, I know. I've done this many times now. And she's like, I know, but she's just like, you know, really proud that you didn't get so flustered. And like she's like, I would have like hit somebody over the head with a charge. She's like, I wouldn't have done that. I'm like, well, you would have but you know, it was actually the anesthesiologist who was the most besides the admitting nurse, who was the anesthesiologist, for me who was really phenomenal. He, he was really interested in my CGM graph he was really interested in in fact, he kept my phone in his pocket. The whole entire procedure, you know, and he, he was awesome. It was actually the surgeon who kept asking me like, how much did you turn your basal insulin down? And like, I didn't turn it down? Because I know what my basal insulin does. Totally fine. Are you sure you don't want to turn? I'm like, Look, buddy. I know what I'm doing.
Scott Benner 42:49
Do your part. I'll do mine. How's that? So
Jennifer Smith, CDE 42:51
yeah, it was but yeah, you'll encounter different people. And just continuing to kind of continuing to know that you have rights, you have rights, you as long as you do know what you're doing. Your Rights include advocating for yourself, and also asking for other care team members to come in, that may be able to help you better, right,
Scott Benner 43:16
right. It's like being on the phone with customer service, you realize the person you're talking to is does not have the power to do what you need them to do. And you got to get somebody else you just gonna have an argument. All right, Misty says, you know, What rights do patients have once they're in the hospital setting? And what she means specifically by that is, can you demand things be done in a certain way? But then it's interesting in her in her question, she doubts herself, she says, and how do I verify that what I'm asking for is actually the best for treatment? So how do you like how do you make the leap in your head that this is what we do at home, but maybe this doesn't work here. Right now, maybe they know more than I do.
Jennifer Smith, CDE 43:53
Some of it's also in terms of, you're going to the hospital with a condition that you know how to manage, but you're going to the hospital, let's say it has nothing to do with that condition. You're going to the hospital because you got severe abdominal pain. Clearly, Scott, you don't have any idea why Arden had abdominal pain, you can't like see into her belly and see what was going on. I mean, some of those things, you have to say, You know what? I came here for this. You're the team, you're the experts, I expect you to figure out what the pain is, but I've got this part of it. I've got the diabetes management part of it because I do this 24 seven, and you don't. So some of those things, you have to you know what you're requesting. I mean, if you're requesting something like jelly beans that your kid needs to eat, but he's throwing up quite honestly, they're probably going to look at you like you're crazy and say you know what jelly beans might be what works really well but he's not going to keep them down. So let's do a deck straw strap. Yeah.
Scott Benner 44:56
Again, I'm a big fan of keeping people in involved. So when I The last thing we did before our knee surgery was I said to the doctor, here are all the places I can put Arden's insulin pump for the day of surgery. Which of them would you like it on? Now, let me tell you a secret Jenny. It would no matter which one it was on, I was actually giving her something like, do you know what I mean? Like, I do the same thing in 504. It's like, I find something in a 504 that I'm like, well, we don't need that anymore. And when I go into the meeting, the next year, I give it back like it's a present. I'm like, Oh, you know what? We don't need this line anymore. Take that out. I'd like to make this as easy for you as possible. Yeah, like, oh, look how nice he is. Right? So in this case, it's a little ego stroke for the doctor. You tell me what's best here. Right was arm or it was thigh. Mater. Like neither of those were going to be in their way. And I let the doctor pick. Yeah, that was it. Right. And And, by the way, double down on my maniacal thinking. I was trying to get Arden to use her arm again. And I thought he'll probably say, she'll probably say arm over thigh. So I'm just going to give her arm or thigh. she'll pick arm. I'll make her feel better. And I'll get Arden's pumped back on her arm. Haha, ha like a double? Yeah, I was like an evil genius in that moment. Uh, what is okay to let slide? And she's like, what hill? Should you die on? I think we're answering that question on the way right? Like you just you what's important to the management of the diabetes? What keeps insulin going as best as you can? So what do I do about pumps settings that I don't, I don't even follow myself all the time becoming and so so she's a fluid person, like she listens to the podcast, right? And so what happens when your management is fluid, and then all of a sudden someone wants to make it static for the situation? Right? To me, I would tell them that, I'd say, look, let's start here. If this doesn't hold it down, we might have to amp it up a little bit. And if it's too much, we might have to take it away. But I don't know, because this is a different scenario than we usually manage it. These numbers are not set in stone like Jesus, that's the that's the core of the podcast, right.
Jennifer Smith, CDE 47:13
And I think a better part of it too, is to explain in a more simple way, maybe to them. This is the baseline that we work off of based on what's happening with glucose, because we've got a trend on our fancy CGM. I can because the pump settings, the smart features of my pump, allow me to do this, if, if his blood sugar is starting to go up, I'm going to do something that temporarily allows me to just stop, I'm also going to temporarily adjust down in this scenario. So explaining that in the simplest way that you can help them to see that what's there as settings, is it's meant to be fluid. You know, it's these are what we start with, and, you know, in the in the case of something like the carb ratios, you know, she's like, well, then carb ratios are a little bit more of a suggestion. They're really not something that we 100% hard number go off of, you know, what, if in the emergency room, you get to the point that they're bringing you food, and your bolusing? You know what, you give them the ratios that are in your pump, and you do what you know, works. What they will usually ask for is what dose Did you give, because they need to put that in the medical record? Right? They don't know that it's been adjusted or adjusted down based on you know, whatever you say, this is what my pump suggested I take this is what I'm taking adjustment up or down that that's a piece that quite honestly, they're not really going to care nor know about. I mean, when I was in the hospital for both post deliveries of my boys, the nurses every shift, they would ask what is your bazel running at? Have you made any adjustments? Where's your blood sugar? Have you taken any boluses? Have you eaten? all they needed to do was really document what was going on? That's it. There's
Scott Benner 49:10
a lot of but covering going on?
Jennifer Smith, CDE 49:12
It is a lot of covering? Exactly. 100%
Scott Benner 49:16
Yeah. And so even if you're MDI, that's really the same advice like, no, if she does make the point that they like to give like a set dose? They do. Right. And so, you know, but then that kind of leads into one of our other questions. Is it ever a good idea to just do things on your own and not tell the staff? And I would have to say, I mean, no, but but probably
Jennifer Smith, CDE 49:42
in some of it is a little bit of like, coding an answer, right? Like I said about the bolusing. Right. It's is it ever a good idea to do things and not tell the staff not to not know, but if you're bolusing for a meal and they ask you Did you go Less or to have you taken any corrections or whatnot? I mean, the simplest answer yes. And this is what the dose is. That's kind of the level that they need. They don't need to know that you factored in. Well, it looks like his blood sugar is dipping. So I adjusted back by this much. They don't, again, too much story, right? They don't need to know that.
Scott Benner 50:19
They're long,
Jennifer Smith, CDE 50:20
because they don't have. Right and then they start thinking, I've got a crazy person who's like just giving willy nilly doses of insulin. I don't I don't agree with it. Let's shut the pump off.
Scott Benner 50:30
Yeah, it might seem disconnected. But you know, when you hear a late night talk show host make a joke about diabetes. And you think, how could they possibly do that? When I know all of this stuff about life would die? They don't know, that's the answer. The answer is they don't know any of that stuff. And so these people you're talking to very well may not know most of what you're saying. So listen to what Jenny's saying. I've said it one way, she's saying it another way, get them to do what you need them to do, if they say five units, because that's what we do. But you know, it's six, and maybe it's okay to do six, if they want to do five, and you think it's 15, that you're probably gonna have to say to them, right, because you're crafting your own safety, that's what you're really doing, right? You're trying to protect your safety against your blood sugars. And going high is how it feels most of the time. But the truth is to, you would need to protect it from going low, you would not want to give yourself way more insulin than your doctor knew about. Because if you did get low, that we wouldn't know how to eat it. Yeah,
Jennifer Smith, CDE 51:30
exactly. And you know, for some of the MDI users that I've worked with, and a very good friend of mine, some don't even really have a true set ratio as a dose to use. And I think you had done this for a while, too. It's like, you can look at a meal. And you can say, like, my good friend, ginger, she can look at she knows her apple and her peanut butter is this many units of insulin. This is what she takes for it all the time, unless her blood sugar's higher, or lower or whatever. But this is always what she takes for it. That's not really a ratio, Could she figure out a ratio to tell them? Sure, right? She could. But technically, there's no ratio there, because you've just figured it out. Because they're standard foods that you eat. And you know that five units or two units or 12 units always works for it.
Scott Benner 52:17
And so when you're not ginger, or you or me, or maybe a lot of the people in this podcast, what do those people do, people really don't understand this year about their diabetes, are you just in the hands of that,
Jennifer Smith, CDE 52:29
and that's where these protocols are put into place, with the expectation that the medical staff knows best, and that the people coming in, aren't taking that type of level of care for themselves. So they have protocols, they've got these, if this, then do this, if this is where it is adjust by this much change to this, add this, plug this in whatever. And those are safety protocols they are. But I think from the staff position, or the medical, you know, person position, you do have to look at the individual, you have to look at the person who like you comes in with Arden and says I got this, I'm following it, we do this, we do it this way. I know where things are. She's beautiful, she's level, I can manage it, versus the person who comes in and can't even tell you the last time that they took their insulin, or what their rates are running at in their pump. Okay, that person baby, the kind that one, the staff should then get an endo consult in and to the staff needs to follow their protocol, because they can definitely say this person has no idea what they're doing.
Scott Benner 53:44
Maybe that would be a wonderful opportunity for somebody on staff to help that person, you know, because at the end of Arden's initial emergency room visit that I mentioned, as we were packing up and leaving and getting ready to go home and everything the nurse did come in and say, I really appreciate all the help. I hope I was good. You taught me a lot today. Mm hmm. You should understand, though, the way you and I started today because it was a little contentious at the big Yeah, I just tried to stay away from it, because 99% of the people I see in here don't understand their diabetes in any way.
Jennifer Smith, CDE 54:18
Right. And the majority of people she sees that come in are likely type two, and have had much less education. Even if they are on insulin, have had much less education than somebody with type one.
Scott Benner 54:33
No, of course. I mean, so it's just in to kind of go on the side of the doctor for a second and talk about it from their perspective. You and I talk to a lot of people in our private lives who are constantly raising and crashing their blood sugar's like all day long, but by what they're doing, they don't realize that they think it's happening to them, but they're doing it, you know, and they don't know what they're doing. And what if I get you into a situation where you have multiple units of insulin going? And your blood sugar's crashing? You want to have a seizure here at the hospital and in front of the nurse who doesn't particularly understand it to begin with, like, you know, but then you know, you have, you just have to understand their perspective, and not just understand it for like, you know, nicey understand it, so that you can tell them what they need to hear, like, right, like, you just, I don't know a better way to say it when you're, you know, when you're arguing with your spouse, right? And you in your heart, you're like, why are they not hearing what I'm saying? It's because they think differently than you think. But if you understood how he thought, or vice versa, you could say to him, the thing that would put him at ease, and help him understand you. And that's what you're trying to do here, you're trying to communicate on a better level than we all communicate on most days. Right? That's all
Jennifer Smith, CDE 56:00
right. And, you know, when I worked clinically with an endocrine group, in DC, at our hospital, we actually worked with the emergency room staff to develop a protocol for both type one and type two diabetes for when somebody was admitted to the emergency department. And we also had a protocol within the type one. If somebody came in on an insulin pump, it was an automatic endo call. They got somebody there. And if the endo couldn't make it, which was most often because they were busy, one of us the CDs got called to the emergency room to help the ER Doc's manage. So you know, not all hospitals obviously have that. But we did it mainly because we saw the need, we were getting called so frequently to the emergency department to manage that they were like, well, let's just get something in place. So we better know what we're doing, and when to actually bring you guys here,
Scott Benner 56:58
right? That's a it's a it's not an easy fix. But you're just ideas that hopefully some of them will make something better for you or the conversation or your health. It's, there's no, there's no like, do this, this and this, and now we're going to be okay. After the song got posted online, I actually sent me a follow up question. And it was from another person. And the idea basically was, what if you're an adult friend of a person who has diabetes, and is not capable of talking, right, can't speak for themselves in the moment? Like, is there a way to advocate for them? I mean, as I read that, I thought, that's a wonderful idea. I just mean, if you're not a blood relative, first of all, you can't, they're not going to listen to you to begin with. I mean, they might listen a little bit, but what are you even going to say you don't understand their diabetes, probably any better than?
Jennifer Smith, CDE 57:50
Right? I think the easiest, the easiest way to advocate then would really be to ask the emergency room staff, if they could get an endo console consult, quite honestly. Because you know, you can, if you know your friend well enough, and hopefully you do, if you're taking them to the emergency room, you haven't just met them on the street corner, and you know, took them in or whatever, this guy passed out, and I decided to help you. It looks like he's wearing this pager with a tube. And I'm not quite sure what that is. But But you know, if you're enough of a friend, bringing another friend to the hospital, you would, you would typically know that they've got a pump, or that they use injections, you may not know how they use it, but you could at least say hey, you know, he or she has the pump on here. He or she wears and uses this thing that tells them what their blood sugar is, you know, those kinds of things would be easy enough to be able to share with the staff at least
Scott Benner 58:52
Yeah, I think instead of trying to find a way to talk to the friend, we have to be talking to you listening who has diabetes, you you have to as crazy as it sounds, you probably have to try to break down your diabetes into six bullet points. And explain that to your friend so that they have that information to ask somebody, listen, you've all been diagnosed, right? And someone downloaded an hour's worth of talking into your head and you got home and went Ah, so you know, like your friend over you know what dinner once in a while when you mentioned your blood sugar. That's not how they're gonna do. But if you had a bullet pointed like five point lists, like make sure they know, this is what my basal rate is. Make sure they know you know that I'm MDI and that means I inject my slow acting insulin and my fat there are two different instant like that kind of like simple stuff, like break it down into t shirt slogans for Yeah, right, exactly.
Jennifer Smith, CDE 59:44
Then even even when you change therapy, then it's important to share with them, Hey, I'm not using injections anymore. I'm using an insulin pump. Even that as a simple statement can be very helpful within those simple bullet points. So, do this, or do this, if I behaving this way, you know, help me this way, whatever, that just the other day I brought up with my husband in the, you know, couple of years that I've changed over the type of pumping strategy that I use. I, my husband was very good with my other pump. He knew how to push the buttons and how to do everything. And since I've changed over, while he knows what I'm doing, the button pushing and stuff. I've never gone over with him again. And just the other day I was thinking, I really need to like reteach him. Yeah, all of this in case of need,
Scott Benner 1:00:39
you know, I really do. Yeah, hundred percent. Jenny, we've done it again, I really believe that this
Jennifer Smith, CDE 1:00:46
is a good episode in a really great awesome that you're, Miss misty, decided that it was a really good topic because
Scott Benner 1:00:55
it was hard for her to do. Really, super, actually. That's what I like about Listen, all of you listening are terrific. You know whether I've ever met you or I'll never meet you, or you'll never say a word to each other. But I've gotten to meet some of the people online a little closer. And it's really wonderful like that Facebook group is little more than a couple thousand people who really understand what's being spoken about on the podcast. So when new people come in, they're really helpful. And I just put a post up the other day where I very proudly said, no one's ever been banned or deleted from this place. And even when they when they don't disagree as much as they think they have conversations. It's really lovely. Actually, that's nice. Yeah, it's wonderful. You can actually talk to people you don't know who disagree with you and not yell at them.
Jennifer Smith, CDE 1:01:44
And it's still okay.
Scott Benner 1:01:45
Yes. So do that while you're at the hospital. Awesome. Let me say this right, before I let you go. Yeah, I don't know that most of what we just said here today does not apply also to when you're in your general practitioners office. Right, like the idea that they probably don't understand as much about your diabetes as you hope they do. Correct. Right. So don't make that assumption. I think I think that's really it. Like, don't assume anyone understands. And, you know, and if you're an adult with type one, and you're worried you're going to be in the hospital by yourself, make that bullet point list for yourself and keep it keep it on you. You know?
Jennifer Smith, CDE 1:02:21
Yeah, absolutely. Even. You mentioned the, like the iPhone with the notes or the you know, the phone with the notes and whatever. I know some people even use, I know iPhone has the the swipe screen that you can actually have your medical ID right up there with all of your information within that medical ID. You can put it right there. Right. In the Health app. Yep.
Scott Benner 1:02:43
Yeah. And again, for all and please don't take this the wrong way. But for you type A lunatics be brief, okay. Yes. doesn't need to be a dissertation. Right. Then one time when she was six, okay. The doctor stopped reading when they got to that
Jennifer Smith, CDE 1:02:59
planters war that I treated this way. 40 years ago.
Scott Benner 1:03:03
My blood sugar was a little higher during that week. And I really think that plantur word infer a medicine is what was so please keep that in mind. I don't have one now. But I mean, say I'm unconscious for four or five months here at the hospital and I develop planners where you decide to take it off for me, I really want you to keep in mind what happened to me. 40. Yeah, just keep it simple. What do they say kiss keep it simple, stupid, right? Like, I don't think they're calling the person stupid. They're saying super simple. And there is a way if you think about it. And if you listen to this podcast, really, you probably have it now. There's a couple of simple ideas that will keep you within a reasonable range and safe. So right tell the doctor that stuff. All right, or just don't get sick. I say is my nose is stuffy this
Jennifer Smith, CDE 1:03:46
year. So it's harder to do that than other years Really?
Scott Benner 1:03:50
100% right. There's a lot going on.
Jennifer Smith, CDE 1:03:52
There's a lot of illness going on. So
Scott Benner 1:03:54
I'm gonna tell Jenny, a really gossipy story that you guys don't get to hear so goodbye. A huge thank you to Jennifer Smith. Don't forget you can check Jenny out at integrated diabetes.com. And to the sponsors of this episode Dexcom and Omni pod, please, please, please get your no obligation. absolutely free demonstration pod sent to you today by going to my Omni pod.com forward slash juice box and then roll right around to the dexcom@dexcom.com forward slash juice box. There are links to all of the sponsors. So not just on the pod index calm but also the Contour Next One blood glucose meter and touched by type one.org right there in the show notes of your podcast player. And of course at Juicebox podcast.com. I'm sorry about my voice. I'm trying. I actually have to go to Atlanta and speak next week. Don't freak out Atlanta. I'll get this fixed. I need a band aid for my uvula. Hey, there's a giveaway going on on the blog. It's ardens de.com. Scroll down a little bit to recent articles. I have one brand New Omni pod pullover it's really super nice and soft. It's given to me for Arden and she never fit in it. So we just found out the back of the closet super nice. There's pictures there. It's a lady small, but if that's your jam, actually, it's a lady's extra small. So if that's your jam, go check it out. Real simple to enter. One of his gonna win it might as well be you. It's been a while since I've said this. So let me just remind everyone who may be newer to the show. The diabetes pro tip series began back in February of 2019 and Episode 210. And in my estimation, these pro tips should really be listened to an order. The first one number 210 was diabetes pro tip newly diagnosed are starting over at Episode 211. We get to all about MDI, at Episode 212. All About insulin. Episode 217 is about Pre-Bolus Singh. There goes my voice. Episode 218 Temp Basal. Episode 219. Insulin pumping to 24 mastering your continuous glucose monitor. Episode 225. bumping in nudging blood sugars to 26. The perfect bolus 231 variables at Episode 237. Jenny and I talked about setting basal insulin. That's what about getting your basal rate right. Episode 256 diabetes pro tip, exercise 263 fat and protein. I bet you didn't know you had two bowls for fat and protein go find out about that in 263 then Episode 287 diabetes protip illness injury and surgery Episode 301, glucagon and low blood sugars and then of course today 307 emergency room protocols and there will be more. Check them out. The feedback on them from listeners is really terrific. I think there'll be an abundance of help to you. I hope you have a great day. Thank you so much for listening, and for sharing the Juicebox Podcast with others. I'll see you next week.
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#301 Diabetes Pro Tip: Glucagon and Low BGs
Scott and Jenny Smith, CDE share insights on type 1 diabetes care
You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio - Radio Public or their favorite podcast app.
+ Click for EPISODE TRANSCRIPT
DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.
Scott Benner 0:00
Hello, everybody, welcome to Episode 301 of the Juicebox Podcast. Today in a pro tip episode, Jenny and I will talk about glucagon, emergency Lowe's, just you know, how they manage that kind of a scenario and what happens if you need glucagon and how do you use it? That kind of stuff? It's not a bummer. Don't worry, Jenny and I laughed more during this one than most of them. So we're gonna go over how to use the glucagon what glucagon is, what is it? Do the three different kinds that we could think of that are on the market? Pretty much it's a nuts the bolts glucagon extravaganza talking about low blood sugar somewhere else you're gonna talk about people having seizures, and hearing them laugh at the same time. I mean, who else is putting out diabetes content laughing about a seizure? It's not funny By the way, it's just the situation was funny. You'll see when you get to it Don't get upset. This episode of the podcast is sponsored by the Contour Next One blood glucose meter and the dexcom g six continuous glucose monitor hmm you can go to dexcom.com Ford slash juice box or Contour Next one.com To find out more about the sponsors and what they got going but trust me what they got going is some amazingly accurate blood sugar measuring tools. Arden uses both of these devices daily and they are exceptional dexcom.com forward slash juicebox Contour Next one.com take a look at both of them support the sponsor support the podcast last thing I'm going to be at the Dallas let's see how they build themselves type one nation summit northern Texas This is the greater Dallas in Greater Fort Worth slash Arlington chapter, big chapter. You're gonna be able to see me and I don't know if you know this Kyle Cochran guy's been a Ford he is a four time American Ninja Warrior. Warrior. Warrior I would not pronounce they are any? Well, any Well, I think I'm having a stroke people. This is the last episode of the podcast. Anyway, Kyle Cochran is gonna be there, I'm gonna be there, there's gonna be some other great resources. It's a really wonderful type one nation event, check them out, you can go to Juicebox podcast.com. Scroll to the bottom, click on events and there's a link right there to buy tickets. It's a great event, February 16. It's a Sunday, Please don't make me fly all the way to Dallas, and not see you. Alright, we're gonna get started. Just remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always consult a physician before making any changes to your health care plan, or becoming bold with insulin. And now, Jenny Smith, and I do the chit chat about the glucagon.
I liked your idea, a lot of doing a pro tips for glucagon. And I was wondering if we couldn't meld it together with like emergency situation ideas as well. Yeah, you know what I mean? So I just realized that what we'll talk about what we're talking about it? Yeah. I don't know how to start this. Honestly. I can tell you that. We buy glucagon religiously. I always have some, when it expires, we always get more. We've never used it. We've had opportunity to use it twice when Arden was little, and both times opted to try glucose gel instead. which worked. Here's the best place to tell the story, I guess. And I'm sure I've said it here before, so I'll encapsulate it a little bit. But, you know, when Arden was really newly diagnosed, she was probably like two and a half years old. And thinking back now knowing everything that I know, she was probably honeymooning still, right. And I had no one ever spoke those words to me ever. I didn't know that was a thing back then. And we got kind of ahead of ourselves one day and Kelly was getting ready to leave on a business trip. She was gonna go overseas. And it was like, six or seven hours before her car was gonna come to take her to the airport. And she's like, hey, I need another piece of luggage. Like, let's go to the mall, get a little piece of luggage looks like alright. So we get over to the mall, and it's a Sunday. And we're hungry while we're there. So we grab, you know, the worst thing in the world like mall, chocolate, Chinese food, just not just more food, more Chinese food. And I was just like, boom, I can have my carbs and I was like, pull up my insulin and the needle, bang go ahead and eat. I figured this out. And she ate the food. We ate we bought the bag we went home. Arden was super little so she fell asleep in the ride home during the ride home only like 15 minute ride. And I carried her into the house and put her in her crib. My wife's packing and my son's watching the football game and Everyone's living their life. And all of the sudden, it sounded like there was a wild animal trapped in the house. Right? There was like this grunting and grunting and grunting. And you know, it's like anytime like, I'm just like, What is that, and they start moving through the house towards the sound that's coming from Arden's room, and I get into a room and look in the crib, and she is having a seizure, you know, and I was just like, I did not 100% know what to do. So I picked her up, and I went through the house to where Kelly was. And we had just this kind of little area rug. And I said, I'm like, Arden's having a seizure. And so I put her on the floor, and I got out the glucagon. So the the red box, you know, it has the, it hasn't changed it forever. And this is the one Lily cells, right. And so the red box, I pop it open, and there's a needle in there, the needle needs to be put together, the needle has liquid in it, I know the liquid needs to be shot into the powder, that it has to be reconstituted and drawn back out. And I'm going to be 100% honest with you, I was so freaked out that I fumbled with that thing. And I was nowhere near getting it put together before Kelly was rubbing glucose gel into her cheek. Right? And I'm not embarrassed because I look back on that time. And I remember when they gave it to us, the nurse made such a big deal of saying, This is life saving glucagon. But don't worry, you'll never need it. And so when she said that, I was like, well, I'll never need it. No, I never, you know, and so good thing is
Jennifer Smith, CDE 6:44
that you knew where it was in the house, at least it wasn't like, you know, in the bottom of the dog's bed or something right, just giving me credit knew where it was. So he knew where it was.
Scott Benner 6:55
So So literally, during you know, the Kelly put the glucose in her cheek, she started to come out of it. I will tell you 100% of the the experience of watching art and have a seizure will never leave me I have never forgotten any of the details of it. She was blind, like she couldn't see anybody. She couldn't talk. But I don't think that meant that she wasn't aware of what was happening. Because there's a I've shared it on the podcast recently. But there's, um, you know, there's a video of her from a year or so later explaining how it felt to have a seizure. And so you even when you touched her, it scared the crap out of her when you touched her, you know? And and so I just never even figured out how to put it together. I had shown it to nurses, I had shown it to people like everything, but when the time came, I was like, not very helpful. Right? Anyway, glucose gel did work. And then we went to the hospital, we call 911. And we went to the hospital. And then you get to the hospital and then the hospital kind of treats you like, you don't really need to be here. Like, there's that kind of feeling. And then you realize like, Oh, it's over now. Okay, yeah, it's okay. So, later, while we're talking, I'll tell you about the second time our next seizure, people are gonna be like, why am I listen to this podcast when we happen to voice? It was in the beginning. So I guess, let's really start at the very beginning, right, like, what is glucagon? And what does it do when you inject it? I don't know where you are right now. But I'm on Contour Next one.com you gotta cut me a break. There's only so many ways to do these ads. Okay. I want you to know about this meter, I'm not messing around about it. Arden started using the Contour. Next One, like I told you before, like a year or so ago, maybe it's a little less a little more. I don't know, my grasp of time is uh, you know, I'm getting old. I don't really know how long ago it was. Here's what I do know, the damn thing is accurate. It's easy to carry around. The test trips are amazing, you can miss on your first try go back again without ruining the test. So you're not wasting test trips. Again, the accuracy this meter is just wonderful. So frequently matches with Ardennes Dexcom. It's amazing. And you can get a free Contour Next One meter at Contour Next one.com. So why not go see if you're eligible for it, it's only going to take you clicking on it to find out where the next time you find yourself at the end, just tell him Look, I'd like to use a more accurate meter than what I'm using. Now. Let's write me a prescription for this one. Get some test trips and get moving with the Contour. Next One. I'll tell you what the next one is next level. The Contour Next One is a highly accurate, easy to use meter. As unique smartlight feature it instantly shows you if your blood glucose is in target range, and that can help you make dosing decisions. Right like real management decisions. You know what else they have wonderful. The contour diabetes app that seamlessly connects via Bluetooth. Understand that you test with a meter boom it pops up magic, like on Your phone. And then this app is more than I can describe to you right now. But it's free, and you want to check it out. So whether or not you use my link found at Juicebox podcast.com, or in the show notes, or if you ask your doctor to get the meter, or whatever you end up doing, in the end, just make sure you click on Like, I'm just kidding. Just make sure you get the meter. It's really wonderful. It's gonna be a great addition to your diabetes toolkit. I cannot stress enough how much we're enjoying it. What is glucagon? And what does it do when you inject it?
Jennifer Smith, CDE 10:30
It's made by the body to begin with glucagon, right. And so in the human body, it's a piece of the glucose management system that your body has in place without diabetes in the picture, right. So you've got this management system of your body releases insulin, your body also releases glucagon, which enables the body to break down glycogen, which is stored form of glucose, right? And so you get this drip, drip, drip, drip, drip, drip drip of both. And that helps to keep things stable through the course of your life. So you know, in a person without diabetes, you've got blood sugars that might start dipping down your body releases a little bit of the glucagon, which enables the body to break down the glycogen into glucose, and it starts to navigate things back up, but it's a seamless system, right? I mean, nobody walking around on the street right now, right now, even the most highly educated biochemist, whatever is probably thinking, well, I wonder what my body is doing. But
Scott Benner 11:33
just one of those things that happens,
Jennifer Smith, CDE 11:35
it happens like breathing, you don't think about it, it happens. But in diabetes, we, we kind of have, like a faulty system, obviously, right? Our body isn't making insulin anymore. But we still do have this like drip drip drip of glucose into our system, or we wouldn't need bazel insulin, right? Yeah. glucagon, however, is, as you explained, well, it's an emergency, we know it as an emergency, we have to use this if this situation is here, right? A low blood sugar, treat a, you know, a friend, a child, a spouse, whoever it might be. So when we inject glucagon, it stimulates a very large amount of breakdown of the glycogen, the stored form of glucose, so that the glucose can get into the system, thus bringing the blood sugar up,
Scott Benner 12:29
it's stored in your liver, right?
Jennifer Smith, CDE 12:33
glycogen is stored in both liver and muscle cells
Scott Benner 12:36
themselves, okay? So in a functioning person who doesn't have type one diabetes, your body really is bumping and nudging on its own, it's giving you is giving you insulin, and then it's saying, Oh, this person needs a little more glucose. And so I'll release a little here, I'll release that. And that's happening constantly back and forth, back and forth all the time. So So when we're diagnosed with Type One Diabetes, when someone's diagnosed, we always I mean, for me at least, like, in my mind, what happened is Arden's pancreas stopped making insulin, but more happened in that right, but we just don't talk about the rest of it usually, like, you know what I mean, like, right in because you hear people say like, my pancreas is dead, but it's not that does Oh, no, it does way more things than
Jennifer Smith, CDE 13:24
that. Absolutely. Absolutely. It doesn't mean you've got more things in your pancreas than just the beta cells 100%. In fact, the the the glucagon actually is made in the alpha cells of the pancreas. So a completely like different little cell hanging out, you know, Lahti die here I am to do this thing, right. So, overall, our pancreas isn't dead. It's just a piece of it. That's nice.
Scott Benner 13:49
It's not purposeful function. Yeah. And, okay. So it's interesting, right, like, so how often do you think how often do you speak to someone who's needed to use glucagon in an emergency situation?
Jennifer Smith, CDE 14:05
Hmm. In if I had been doing this
one years ago,
likely more.
Mainly, because I think that with the influx of the technology that we have now, we've got alerts to actually tell us when things are dipping, before we would even get to the place of needing
Unknown Speaker 14:33
glucagon.
Jennifer Smith, CDE 14:34
Now, I mean, that doesn't mean that it isn't potentially, you know, necessary. We've got the standpoint of prolonged exercise, you know, where you've had, like, people who do like a whole entire Iron Man triathlon, and that's a huge depletion in your body's glycogen stores, even if you've been fueling along the way as you should be. That's a huge depletion. Your body has tapped into your stored glucose to fuel that long duration movement. So, I mean, if you have exercise like that, potentially, you're going to need something to boost glycogen out of the system to bring a low blood sugar up and or you've got too much insulin there to begin with, for whatever reason the dose was wrong or the dose was wrong along with a long, active active day or whatever the scenario, glucagon will potentially at some point be necessary. I knock on wood, I'm not really superstitious, but that's like my grandmother's thing to do. It's like knock on wood. Whatever works, right, but I mean, in 31, in plus years with diabetes, I've never had to be given glucagon. I haven't. I mean, my husband knows how to use it. My parents knew how to use it. My teachers at school, my girl scout leaders, I mean, everybody that I interacted, they all knew how to use glucagon. I went to sleep overs with the glucagon in my bag, I did. Never had to use it. Thankfully, in the amount of people that I now work with, I would say, it's not, it's not common to have had to use it, at least not. I mean, we may talk about this a little bit later, like different kinds of emergencies settings of use, but there is the benefit of also mini dosing. And some adults, especially the adults that I work with, are much more proactive in in trying to offset something they know is not working right, you know, and so, ability to micro dose a glucagon injection and offset a low that you don't pass out from and nobody needs to help you. You can help yourself, right.
Scott Benner 16:52
It's funny the way you put it, because I'm thinking back now, you know, Arden's very infrequently low, but she has like a crazy low once a year that just comes it appears to come out of nowhere, right? And we think back on one of those, you realize that without the sensing technology, like if she didn't have a dexcom those she would have seizures in those moments. Yeah. Right. Because it's, it's unexpected. First of all, it's not like I've done anything different that day than another day. I'm not standing around all day going, who this is gonna be the day never happens. It never happens. When you're like, something's gonna get squirrely today, right now that day, right? Oh, and so you know, you're it's one two o'clock in the morning, and you get the alarm, and you realize she's falling way faster than you would have any expectation for. So there's something, whatever it is pushing down on her blood sugar, and nothing to resist it in the other direction. And it's just falling and falling and falling. So we get, you know, we get an alarm go in, you give her I mean, for me, I give her juice first, because I find that works very quickly. Like it's it, the way I think of it is like let's get something in there working. While we do the rest, right? Then I look at things like they're like palatable quick. I always look for like a banana in that situation. Because it's not hard to eat a banana. It's sugary, right. And then you know, I'll roll back to another juice if I have to. But you'll see those, those crazy lows go like 70 6050. And they fall really quickly. And before you know it, you're treating it 50. And you would have treated sooner you just there was no time you're treating it 50 you're into the 30s. Now you're testing now you're doing the like, Okay,
Jennifer Smith, CDE 18:30
this number,
Scott Benner 18:31
let me double check this right. So you're, you finally have a second there's some food in. So now you hit a finger stick, and it says something like 30 or 26 or something ridiculous. And you're just like, okay, now I'm here waiting for her to either have a seizure or not. Like that is really what it feels like, like I've put the food in, it's in there, it's going to do something. And you know, and you're just, I don't know about everybody else, but I test and then I wait like, not long, you know, it's like four or five minutes later, you test again, and you're looking for just any sign of stability. Did the 38 stay at 38?
Jennifer Smith, CDE 19:08
Did he come to 40? Did it go to 40? Because
Scott Benner 19:10
if it was 40? I don't think she's gonna have a seizure. Right, like, and so I think everyone needs to know how to handle a moment like that. Yeah, you know what I mean? But I'm now now, you know, having seen that moment, a few times in my life. I see, as you're talking that without the sensing technology, she would have went from 50 to 30. And the, the alarm I would have gotten would have been the grunting and the right to see it would have been the seizure. Right. Right. And then and
Jennifer Smith, CDE 19:38
without. Yeah, and without this technology, I mean, I I think fully even to this point, I I still have symptoms for Lowe's. I do even with the technology that I have that alerts me and whatnot. I still know when I know usually even before my system is going to tell me I can tell where I am. What's your number when
Scott Benner 19:59
you know You're low.
Jennifer Smith, CDE 20:01
My number is usually in the 60s
Scott Benner 20:03
Arden's at 60. She knows Yeah.
Jennifer Smith, CDE 20:06
But you know, years ago when I was first diagnosed, in fact, a good a good case where my parents probably could have used glucagon, but didn't. It was the summer like several months after I was diagnosed, we were camping, had been out playing, you know, rafting in the pool at the beach, doing everything that you would normally do when you're on vacation, you know, and it was the evening and my dad was making popcorn at the fire. And we were all gonna sit around and whatever you do at play games, and it was time for me to check my blood sugar because it was like nighttime, right? It was bedtime almost. I sit down, I check my blood sugar. And my mom was like, that numbers not right. And I looked at the number. And I mean, I was the age that I knew numbers, and I knew where my numbers should technically be. And it was 26. You might either like those old like old meters that took like four minutes to test. You just swipe the blood off, stick it back in the machine, push another button, wait for it to actually give you a value. But yeah, 26 my mom's like, That's not right. She's like, Did you wash your you know, all the things I washed my hands again. And like, I tested again, my was like, How are you feeling? I'm like, I feel like I did like 30 minutes ago. I'm like, totally fine Mom, you know, she has to get it was like 25 it was like literally it hadn't moved. Mm hmm. I was like, like, my mom is the kind of person who's just like, oh my god, like, seriously, you know, and my dad was right there. And he's like, well just give her some juice. And my mom. My mom's like, this number isn't juice. This is like we got to do and he's like, give her the juice. She's talking. She's fine. She's answering questions. You know, I mean, I can remember this very vividly. Give her the juice. I drank the juice. You know, my mom's like, okay, let's check again. You know, like, all the thing is certainly, it started coming up. It was slow. And it's a painful Wait, it really is. But my main my mom was like, there. She was like that glucagon is gonna be here in 15 minutes if this juice that your dad wanted to give you is not working? I mean, and who knows? What was the accuracy of a machine like 30 years ago? You know, I mean, my blood sugar could have been 50. Who knows? But, again, I think you also have to judge those scenarios. Like, okay, she can take something into eat, she's talking, he's talking the person's, you know, with me? Can we actually like do the glucose gel? Can you do glucose tablets? Can? Is it safe to do something to chew? Should we just do some juice? I mean, but glucagon is always there, if you don't know. And you can't tell us the glucagon. It's, it's going to work for you. It's the only thing
Scott Benner 22:39
you have at that point to it, right? Because, you know, just as I describing Arden having a, you know, a bad low, she could still eat and reason and talk and all that stuff, right? And so that's fine. But when she was seizing, you couldn't have she couldn't have drank anything or eaten anything that wasn't happening, she was gone. You know what I mean? So she needed she, you know, perfect world situation, we would have used the glucagon in that scenario for certain. You know, it's just it's, and it's, listen, I have to say this, too. It's frightening. But if you think you're going to live a whole life with type one diabetes, and not get into a situation where you test and see a 26. And I think you're wrong. I think it's going to happen at some point I used to tell. It's funny, because you described how everyone in your life knew how to use glucagon. And I've done the same thing, right? You've explained to a million people that it never comes up. And I think that sort of builds a false narrative in those people's heads like, Oh, this diabetes isn't as bad as these people say, right? Because they showed us this emergency thing. We've never used it. It's a it's not a real concern, because it never happens. I do think that's one thing that happens, but But the other thing is that is that you have this kind of feeling of I don't know, like, like, it's it's never going to happen. But it could, it just really could happen. And and if it does, you can't be freaking out in that moment. because trust me, I freaked out once. And if Kelly wasn't there, I don't know what would have happened too hard, because I was like, not processing. Well. And then since then, you know, the second learn. Yeah, you know, storytime the second time Arden had a seizure. We were Disney. And we had spent the entire time day at a park. And we were coming coming back later and I was hot. We were walking. She was eating we were giving her insulin you know, the way we thought we should we were testing she didn't have a glucose meters long time ago. And we're we're within like visual sight of our hotel walking back through the park. And this popsicle salesman's walking on us. It's like 1030 at night. And I remember looking up and seeing this guy holding these giant popsicles thinking like, what devil sent you in my path. You know what I mean? You know, and so But the kids are like, Can we get those? And we're like, Yeah, of course. And we gave her some insulin for it and gave it to her right? Looking back now, I never would have given her insulin for a popsicle. And that's a scenario of knowing your blood sugar or not knowing your blood sugar. And so we you know, she eats the popsicle, we walk back to the hotel kids are again, exhausted, she goes to sleep. The about an hour later, the grunting sound happens. And I'm like, this time, I'm like, oh, there's no raccoon in the house. Arden's having a seizure. I know what this is. And so it was both comforting and hilarious and scary. All three, excuse me, not both, but all three. I went into the other room, goddaughter, sure enough, she was having a seizure, we went right for the glucose gel, because you're like, Well, we know this works. And take the cap off the glucose gel and go to squeeze some out, it won't come out. And in the panic, I just thought, I don't know what I thought. But just the little silver paper was still over the thing, the freshness seal, they squeezed it way too hard. The freshness seal did not come off. But it sprung a pinhole in the back corner of like the sealed part of the tube. So imagine icing tubing, and I'm squeezing it and I am writing in calligraphy all over the ceiling of the hotel room in this laser thin beam of glucose,
Jennifer Smith, CDE 26:23
right? Oh, no,
Scott Benner 26:25
we all look up, everyone laughs we spin the thing around and shoot the glucose gel under our mouth out of the pinhole and out of the thing rubbing her cheeks, she wakes back up again. She's fine. She's kind of looking at you like Yo, what's up, and we get we get her stable, make sure she's not falling, and we put her back to bed. The whole thing took like 15. And that was sort of the end of it. And she's never had one since then. You know, but we learned a lot in that in that time. Absolutely. So if you don't think that's gonna ever happen, I hope it doesn't happen to you. But to live like it can't happen. That's a mistake. And so back to my original point, when when I used to spend time before when I was younger going into school and saying, look, here's what you really need to understand about diabetes, and I would go over the stuff. But I would always end with I know you feel like we're sitting here today, getting ready for when it happens, because it's something we can prepare for. I'm like, but the secret about the diabetes in an emergency is you sort of can't prepare for it. Like, if you knew it was coming, you'd stop it. And that's always the weird part about this stuff is it always happens just when you would never expect it to happen, like because otherwise you'd be sitting around going, Oh, you know what's going on this afternoon. It's totally a seizure situation. Like no one thinks that way. And so I don't know, I just, I think it's incredibly important to be prepared.
Jennifer Smith, CDE 27:48
It is well and one additional to that, like preparation. Let's say you are prepared. You've done all of your homework, you know, you've got the glucagon, you know how you know to use it, your friends know how to use it or whatever. And I, I bring this in because it's something that I do discuss, especially with like older teens and like college students and anybody who does a lot of socializing within their job. I think it's, it's really important to know that there may be a point at which glucagon may not work. That's right with alcohol. Mm hmm. And I mean, there really is, there's a real reason it's not like the glucagon is like, Oh, I'm just not gonna work today.
Scott Benner 28:32
Like, you know, Jenny trust too much. She doesn't deserve for me to work.
Jennifer Smith, CDE 28:37
Right. Right, right. He she had beer and I would rather she has, like, you know, a Mai Tai or something. No, not at all. It's just, you know, it's the there are biological reasons, right? I mean, your liver again, your liver is like this phenomenal organ in your body. It really is. It's, it's fantastic. And it does a tremendous amount of stuff for you. One of them is and we kind of call it your body's detoxifier. Right? I mean, that's a really like nutshell term for the things it does. But the livers task of ridding the alcohol out of the system, which it sees as a toxin. It's going to do that first. Before it does that's its first thing that is its job, it's going to see a toxin is gonna be like this body doesn't need this, let's get rid of it.
And it takes
a while for your body to process that alcohol. So I think it's like one drink takes about an hour and a half to process out of the body. Okay. So in that time period, your liver isn't going to as he efficiently areas effectively check into what's happening with your blood sugar.
Scott Benner 29:45
Yeah, it's a task I really do. Right? It's not
Jennifer Smith, CDE 29:49
but in that if you give glucagon in that scenario, and now you're asking the liver to do another task, it's not a multitasker.
Scott Benner 30:01
doesn't already so are you? I feel like Jenny's saying that a liver is more like a guy, like you give it a thing to do when it does that thing until that thing's over, and then it moves on to something else. I know, this is a generalization, it's sexist. But, you know, I don't know that it's, I don't know that it's that wrong.
Jennifer Smith, CDE 30:20
Yeah, yeah. And drinking in and of itself can also, you know, do some crazy things just to blood sugar levels in general, right. So if it's got carbs, and if it doesn't have carbs, and it's pure alcohol, etc, you may not have been eating with the alcohol. So I mean, there are a host of other things that could go into a low blood sugar in terms of alcohol consumption. But one of the things, of course, is that the livers not doing that drip drip of glucose, right or glycogen to turn into glucose, etc. So your bazel, then that's dripping in the time period that it was beautifully tested, it should be working great. Your basals managing without the normal
Scott Benner 31:03
bukal. They're very important point.
Jennifer Smith, CDE 31:08
So if it's not doing that, then what happens you get a little blood sugar. Now when you take the glucagon, you're now telling your liver, like I said before, to do something to release this glycogen and to give you some extra glucose to bring the blood sugar up. And there's either a major delay or it doesn't, it doesn't do it. They're really in drinking some emergency, you know, if you're with it enough to know that your blood sugar's dropping, obviously, simple carb, you can do the juice you can do that is if you're with friends, college friends, a spouse, a significant other, whatever, they should know where the glucose gel is something safe. If it's not glucose gel, they should know where the honey is, if they don't know where the honey is, make sure it's cake frosting, something that can be squirted into the cheek can be rubbed in massaged in, it starts to absorb and it can bring the blood sugar up.
Scott Benner 32:00
We don't want to have to swallow it to make this process happen. We want it to absorb through the lining in your mouth back.
Jennifer Smith, CDE 32:07
Correct. Exactly. So that's one I think one in that like emergency time of potential Oh, get the glucagon out.
Scott Benner 32:17
Try some other stuff first. Right? stuff first,
Jennifer Smith, CDE 32:20
obviously even calling you know, emergency services, obviously, you're with somebody you really don't know what to do.
Call 911. Yeah. And it's so
Scott Benner 32:29
it's so interesting, because what you just said about, you know, when the liver stops making, you know, it stops dripping out this glucagon, this glucose, we always talk about, you know, you need your basal insulin setup, I'm always saying, right, it's like timing and amount, it's the right amount of insulin at the right time against carbs or body function. And you know, then we talk about body function being like stress or anxiety or pain, or, you know, all that or your liver and what you're doing, that's a body function that's causing your blood sugar to try to go up. And if all of a sudden, it's not trying to do that anymore. Now you're bezels too much. It's too much, right? It's actually off the topic,
Jennifer Smith, CDE 33:06
right? I mean, it's actually the reason that with alcohol, our standard of education that we say to do is for every alcoholic beverage to take your basal rate, if you're using a pump, that is take your basal insulin down by 40%, and set it to last duration, at least two hours for every drink consumed. If at the end of the night, you've had, you know, four drinks, that's eight hours worth of a decreased bazel.
Unknown Speaker 33:37
So
Scott Benner 33:39
right, so let me so now I have this question as we're having this conversation, and maybe I'm wrong. But this thing that we call glucagon that we inject inject in emergency situations, is it actually glucagon? Or is it something that makes your body produce glucagon? cliffhanger? You got to go check out the dexcom g six continuous glucose monitor. You have to if you don't have one, I can't even understand you. I really don't. At least looking into it. I don't understand. How would you? How would you hear all this stuff every week and not think to yourself, I need to see my blood sugar. I want to know what direction it's moving. And I want to know how fast it's going. I want to see my kids blood sugar while he's at school. I want to know what my daughter's blood sugar is at a sleep over. I want to know before I get low, I want to know before i get i three days ago, and by the way, let me say this first. These are my results and yours may vary. Okay. Three days ago, I started helping a person with a blood sugar that was completely out of whack. I'm talking about over 404 hours a day, that low and then when it sat steady, it was well over 250 it was a mess, right? And I was able to help that person make adjustments to their insulin just by seeing their Dexcom that's it took like two days. If I could do that in two days, imagine what you could do with the Dexcom for a lifetime. Please, really, really think about it. I hear all kinds of excuses from people, I don't want to, I don't want to hear it, beep, I don't want this, I don't want that. It's gonna beep to help you. And once you learn how to use your insulin, it's not going to beat that much. Because you're not going to be jumping out of range all the time, like you are now, that's a real tangible thing that could happen for you. dexcom.com forward slash juice box, the links in your show notes or Juicebox podcast.com, Please, I'm begging you just look into it.
Is it actually glucagon? Or is it something that makes your body produce glucagon?
Jennifer Smith, CDE 35:52
No, it I, I understand that it's glucagon.
Scott Benner 35:55
So glucagon makes your body make more glucagon,
Jennifer Smith, CDE 35:58
glucagon injected makes your liver release glycogen and transition it into glucose. Okay,
Scott Benner 36:05
so is this stuff that we're injecting helping bring up our blood sugar? Or is it just making that function happen?
Jennifer Smith, CDE 36:12
It's making the fun, right? It's the glue gun that you inject is telling your body to release the stored glucose and send it into the system. That's what raises the blood sugar.
Scott Benner 36:23
Gotcha. It seems like such a simple thing. But as we were talking, we're a half an hour into this. And I'm like, maybe I don't understand what's in the vial.
Jennifer Smith, CDE 36:32
Unless somebody else knows something else. I've all the years it is glucagon in the it's in that little vial. And it's not as very stable compound at all. I mean, that's why it's in that
Scott Benner 36:43
like the way it is
Jennifer Smith, CDE 36:44
pill form shift the way it is. That's why it expires so frequently. It's why you have to mix it and use it. I mentioned briefly before even using mini glucagon, a small portion of what you mix up, if you are, you know, alone, and you can use it yourself. That vial that you mix up, then it's only good for 24 hours. Yeah, kept in the refrigerator. So
Scott Benner 37:09
and so you're talking right now about the one that comes in the red box, the one that's made by Lilly. So I guess let's break them down a little bit because now there's suddenly on the market more glucagon it forever and ever it was the you got the red box, right. And so inside of that red box really is a vial like a glass smile. And it's got powder inside of it. Then there's a, a needle with and it's an inter muscular needle, it's not an under this, it's not under the skin, like little insolently looks like a all the way all the way in.
Jennifer Smith, CDE 37:40
And it's a pretty good sized needle. It's a hunk of
Scott Benner 37:42
a needle is what it is. And so you pull out the vial with the powder in it. You take the needle, and you inject the liquid, it's in the needle into the vial, then you kind of spin it together, you know, between your two hands. I know you can't see what I'm doing. But anyway, that Yeah, then it, it constitutes it, it mixes the powder with a liquid, then you have to draw it back into this syringe. And then you're supposed to stick that syringe like into the muscle in your butt, right? Or something like that. Or they
Jennifer Smith, CDE 38:08
usually say right into the body. Yeah, I mean, yeah, that's the easiest way checking
Scott Benner 38:13
that glucagon into the muscle. All right. Now that's one glucagon but since that's happened, another company made a nasal glucagon who made that? Do you remember?
Jennifer Smith, CDE 38:24
Um, gosh, I don't remember the name of the company. It's back semi is the name though of the okay. Nice. Oh, God.
Scott Benner 38:31
No, that's sort of like, you know, everyone, I think assumed it was like an aerosol, but it's more powdery. Right? Have you talked to anybody that's used it yet?
Jennifer Smith, CDE 38:41
I've not talked to anybody who used it. I have it myself. I did get a prescription for it. And part of the reason quite honestly, that I got a prescription for it is well, twofold. It's it's certainly much easier to use from all of the research and all the studies. The there's a significant decrease in accuracy of use, okay, or a significant increase in the accuracy of use with the back semi compared to the mixed injectable.
Scott Benner 39:11
Okay. Let me let me take it personally, I'm looking at it so it's actually also made by Lily. Oh, and it's so it looks like it comes in a thing that looks like you know, sailing you'd see it the tube, alien thing you'd spray in your nose, but I'm reading it here it is a powder, dry powder spray in a portable single use ready to use device now. I've only heard from a couple of people who have tried it and so far the people who've tried it have said to me that it burned their nose. So the inside of their nose I don't they didn't say about how well or not well it worked but Jenny's hearing that it works more that it works better than the this
Jennifer Smith, CDE 39:51
in terms of accuracy. It was from what I know it works the same as dosing but the accuracy if somebody else has to give it to you More accurately delivered. Okay,
Scott Benner 40:02
so in a panic situation, your friend is a little more able to stick something in your nose and squeeze it than it is to everything I just described and then stick it in your butt.
Jennifer Smith, CDE 40:12
Correct. Okay, correct. I mean, I guarantee you that, you know, when Arden was two and a half, if you had had something like this, taking it out of the bottle, sticking your nose and pushing it in, you would have had no trouble doing that, you would have been able to figure it out. And I, you know, a big part of having it in the house is because with little kids, you know, I, my seven year old is a smart kid. And while he would know to call 911, he would know to go to the neighbors if I was a home loan with them, and I wasn't right. This is something that I easily showed him in two minutes. And I was like, this is all you got to do and then run to the neighbors. That's that's all you gotta do.
Scott Benner 40:55
You know, you're gonna sleep soundly one day and wake up with a burning, burning in your nose and their front door wide open. Gonna be like mommy's down, and you'll be like, Nah, he's just sleeping. So now there's a third one on the market. And I just left Arden's appointment the other day, and I got our glucagon change to G Volk. So, g Volk, comes in a syringe still, but it is the I think the kind of the genius of what this company figured out is, is that it's, it's pre constituted, you don't have to mix. It's not a powder and illiquid. And it's incredibly stable. So my assumption, I'm making an assumption that you might, you know, maybe people who used to think, oh, one day, we're gonna make a closed loop system with glucagon in it, but we couldn't, because they couldn't figure out how to keep that glucagon stable long enough. I'm starting to think maybe that that might be the next step after these algorithms, you know, I mean, maybe it will be a dual chamber pump with an algorithm. And this, but I went with this one, and I will be 100% honest, why? There's two things. The nasal thing to me, seemed everything what Jenny just said, like, seems super easy to do, and all that stuff. As soon as I started hearing about the burning, I thought, okay, like, that makes sense. And I still was going to go with it. Until and again, this is being very honest, the makers of GE Vogue said, We'd like to come on the podcast and talk about the glucagon. So sometime in the future, you're gonna hear an interview with the CEO, and he's going to tell you why the company started and all this stuff. And it was super interesting and incredibly interesting life. I it's possible that when you listen to it, I mean, if you listen to this podcast enough, you might not be surprised by this, but I don't know exactly how much we're gonna talk about the glue gun, how much I'm just gonna be like, so what did you do after college? That's weird. And, you know, but but that, so I went with it. For two reasons. One, because it's stable. And you know, I don't have to it doesn't have to be metal. Yeah, the injection isn't intermuscular. It's just, it's just a normal like, little needle. And I thought, maybe I can use it for bumping, like doing glucagon. Like little bumps, too. And then and that wouldn't be possible with the nasal. Right.
Jennifer Smith, CDE 43:19
And there is I mean, there is a guide, certainly for using you're talking about like that mini dosing, kind of of glucagon. And there is a guide for it. In fact, it's, it's actually a guide that starts with, you know, a tiny, tiny amount for little people.
Scott Benner 43:34
And you talked about it on the pro tip about celiac illness. We talked about that, right? Yep. Yep. You people can check that out if they want to hear that, but and so incredibly, ironically, I guess, not long after you and I recorded the the illness pro tips, Episode ardyn got sick for a number of days. And unlike most people who are like, Oh, I got sick and my blood sugar went up, Arden gets second or blood sugar goes down. So there was this one time her blood sugar was you know, it was at 70. And I'm like, it's gonna hold it's gonna hold eat something. And then the food didn't do anything to her. And it kept drifting down. And I gave her more and more. And then there was this moment, you know, we're like, 45 minutes into this since she's now 55. And I'm like, Jesus, none of this food is touching her. And so I'm thinking to myself, what's next? Like, I have to do something right now. I walked up to her with a juice box. She goes like this. puts her hand up and she goes, if it's my time, it's my time. But I'm not drinking another juice. Girl super serious and trying to be funny at the same time. I said, Right on, okay, I hear what you're saying. She's like, seriously, if I drink another juice, I'm gonna throw up and I was like, gotcha. So I went downstairs. This is probably the first of all this is completely off label. But it's also why at the beginning of the episode, I tell you, this isn't I'm just telling you what I did. It's not medical advice. And I took my Old no red kid warm Lily and I mixed it up. I went back and listen to what you and I said to each other. This is me like, I'm like, I wonder what I'll do. You know, there's a podcast episode about this Hold on. Then but and I remembered and I drew up like I kind of spit balled it a little bit. It was off based off of weight, I remember that I drew up seven units. And I gave it to her. And it took a little while, but no lie, her blood sugar went back up, not too far. And it leveled out. It stayed there. And I was like, right on, I am definitely getting the gfo instead of the nasal stuff, because this might happen again. Now, that was my reasoning for going that way.
Jennifer Smith, CDE 45:39
The big question about the Evoque would really be the pen itself, how? How, how much is in the pan? Like how many? You know, what's the dosing because when you look at how much to give, it's, I think it's if you're over 50, in the doses, 15 units of mixed up glucagon. And that would be given kind of like we talked about before, and the other, the other episode, a certain amount of time. And then if it doesn't bring the blood sugar above 80, then you re dose with the double the amount. So just with the G Volk, my question would really be how, how much do you know that you're giving
right as a mini dose? Because
Scott Benner 46:20
I used to find out because you're 100%? Right. And and so I'm going to try it? I'm going to find out. And if it's not right, I'll switch to something else. I you know, yeah.
Jennifer Smith, CDE 46:28
Yeah, I pre mix that you don't have to do any of that extra stuff. That's really awesome.
Scott Benner 46:34
I think that as a replacement for the Lilly one, this one's a no brainer, right? Because you don't have to mix it up. And it's not this giant needle. But I think and this is not something the company said to me, my but my assumption is, the real excitement here is about the possibilities for dual chamber pumping, tested stable. And not only that, I think the bigger excitement and I think the CEO alludes to this, if I'm not mistaken, I'd have to go back and listen. But my assumption is, they figured out the science of making something liquid stable, which now means that science could get applied to other things. Sure. I'm guessing I'm guessing this is the very infancy of this company is what I'm thinking and run by nice people. So that's cool. Oh, okay. So we went over the three different kinds of glucagon. What and the when? Right, you're going to use glucagon when somebody can't physically take something in their mouth anymore? Right, right. When Arden had a seizure, we only use the gel and rub it into her cheeks. We were trying to get her to swallow it. If you try to get somebody having a seizure to smell something, you get them to aspirate. It's bad. Right? Right. Right. Right.
Jennifer Smith, CDE 47:49
They may be even a you know, something for, as we know, symptoms of low blood sugar, even if you're not passed out or having a seizure, you could be not together with it, right? I mean, many people complain about their spouse, significant other child child getting very violent, or very abusive, or whatnot. I mean, getting them to eat something is impossible, maybe impossible. So using glucagon, in a scenario, like that may be your only option.
Scott Benner 48:19
Yeah, you might be tackling a,
Jennifer Smith, CDE 48:21
you may be tackling that and holding them down.
Scott Benner 48:25
I'll tackle them that hand me the needle, it's gonna be a lot of fun.
Jennifer Smith, CDE 48:28
Right? Right. So
Scott Benner 48:30
well, that really is, you know, I've heard the stories too. And there's been people who've come on here and told them, but I've heard them privately two of the worst scenario ends up being when you're two adults, and one of us physically smaller than the other one. And the larger person, you know, becomes combative or angry. And I've heard I've heard about people throwing furniture and, you know, saying terrible things. And, you know, yeah, and everything in between. So
Jennifer Smith, CDE 48:58
and from a safety standpoint, you know, if the person is up and moving and in, let's call it like a violent sort of behavior, and you're not safe, just call 911. I mean, that's really, I mean, don't try to get close to them with a needle in China
Scott Benner 49:16
is not a good idea. It's such a bad television show, like you're just standing across from each other one guy's ranting and raving and holding a lamp and you've got a needle in your hand. Every bad movie I've ever seen in your life. Exactly. I think the goal would be not to get that low if you absolutely can. But like we said, these are emergencies. They don't happen on purpose. I think it's just very important to remember, like, you can't plan for an emergency. I mean, you can plan for what to do when it gets here, but you can't plan for when it's going to happen. Right? Right. So let's talk about since we're in this vein right now, and we're using a part time and we have a couple more minutes. Let's talk first about low symptoms. Some of the things you've heard people saying I will start with the one that Arden tells me What is happening? Why or why am I being treated buddy wants to reach you? Oh, you know what actually this is funny. It's um, Express Scripts I have to say okay to prescription glucagon prescription. I'll call them too funny to call them back in a little bit. But I know that's what that is. Now my wife has picked it up downstairs and she's busy listening to a recording. And she's trying to figure out why she's listening to a problem. So are we the other day? She She got a little low, right? And we were going right into our restaurant. So she went like quickly from like, 75 to 60. And I was like, hey, you're dropping, and she's like, Yeah, I know. And I was like, How do you know? And she said, My lips are numb. Mm hmm. And I was like, really? She goes, Yeah, she's like, that's the one that I like, that's my physical tell. She's like, my lips get numb. And she goes, and if you don't take care of it, she's like, I didn't realize before. So she told me a story. She said one time she was out with my wife. And this happened. And my wife gave her a drink to have. And she drank it and orange like, Oh, this tastes terrible. And my wife's like, really? And my wife tried it and said, Kelly's like, no, it seems fine. And Arden kept drinking a little while later, I think we were at a baseball game for my son and I was on the other side of the field. So I came back over eventually. And my wife said, Hey, Arden was low earlier, but we took care of it. She drank this. She said it tasted weird. And so I tasted it. I was like, I'm zone tastes fine, you know. And so it took Arden she said, it took her years to figure out that when that numbness comes, it's affecting, like her tongue in her mouth, too. She feels it on her lips. But she's like everything. Everything tastes weird. At that moment, I was like, Oh, no kidding. So I was wondering if that happened, anybody but what are some of the of like, what happens to you?
Jennifer Smith, CDE 51:51
So and I think that's, it's good to acknowledge symptoms and understand that there are many symptoms because they can also change over the years. Like I, you know, when I was younger, my symptoms were the classic like, I would get, like, visibly shaky, I could hold my hand out and I was like, visibly shaky, beyond just the internal symptom. It was there was a visible cue there too. In college, I also had something very similar to what Arden is describing. But it was more It was more like an internal mouth numbness. It wasn't really my my lips, it was more like an internal mouth like it almost like you know what it feels like to be numbed at the dentist. Like you feel like your whole mouth is thick, and like pudgy. That's what it felt like to me. Okay. Um,
Scott Benner 52:44
hello, now is there for you ate, like, after you brought your blood sugar back did it last?
Jennifer Smith, CDE 52:50
Ah, gosh, I mean, I would say it probably lasted a bit of time after my blood sugar was actually normal. Because I specifically remember it. Like in college, I was still on injection. And so I would often have that as I came into lunch, because they had pretty full mornings of like zooming around on campus and getting back and forth, the classes and whatnot. And so I would often have that at lunchtime. And I can say that, before I headed out into my next course of classes in the afternoon, I still had that feeling even though my blood sugar was already back off from having eaten. So I guess for a bit of time, it seemed to last. Whereas my symptoms now don't last after I've treated, they don't last long, unless it is, unless it's been a significant drop. That's happened very, very quickly. And it takes a while for the carbs to kind of start to make me feel better. My symptoms now are much more like this, like, feeling of everything rapidly moving. Like I feel like the world is spinning and moving. And my thoughts are fast. But I I feel like I'm walking through mud. I feel like I just I can't keep up with the way that my brain is thinking about things.
Scott Benner 54:24
So I wonder if we'll never know, obviously, but I wonder if your thoughts are at regular speed and your body is slowed down? Or if your thoughts are sped up and your body's that regular. I'm so interested in that. There's no way to know but because it's right, like you're one part of you is being fooled about something about something and it feels like it's like you feel like that might be what it is. Maybe it's like that maybe you feel like you're in slow motion. I don't know. Isn't it weird? It feels like if it makes me feel like you're in like a dream right? And you're like, kind of screaming like, you know what's going on, but you can't affect anything. Is it that kind of a feeling or no? Am I wrong?
Jennifer Smith, CDE 55:07
It's somewhat Yeah, the other one is kind of feeling like drunk. Like I get kind of tipsy. And I'm like, I've literally been like drunk maybe three times in my whole entire life feels like and but that's not every time but some of my lows feel. And I'm a I'm a very happy like, drunk person. Like, whenever Everything is fine and happy, I'm not an angry drunk. Ah. So I get kind of tip with a low blood sugar sort of like, Ah ha ha, that's funny when it really isn't funny at all.
Scott Benner 55:47
It's like I'm describing with Arden to like, because she's done that a couple of times. Like, you know, I'll be like, Arden get up you have to do some your blood sugar's low. And she'd be like, I'm just gonna die over here, like, but that's very jovial when she says it, like she's very like jokey about it. Like it's cold and
Unknown Speaker 56:02
funny and totally fine.
Scott Benner 56:04
Just be fine. But you know, yeah, I think it's interesting. So when people have you heard from other people like some of this stuff, because they are, before we go into that, let me ask you this one. When you wake up after you've been low for a while, and you didn't know, why are you so sweaty? Do you know? Why did they did well, though,
Jennifer Smith, CDE 56:23
it's an it's a body response to the low blood sugar. All of the physiologic like mechanisms that make it happen. I can't, too, but I do know, it's very, very common to wake up in a sweat.
Scott Benner 56:38
Yeah, like mad, like, change your clothes after you treat blood sugar, like, yep, take the sheets and wave them around for a while. Yeah.
Jennifer Smith, CDE 56:48
That's exactly right. Even kids. You know, I've heard some parents that comment to that, you know, an older child, obviously, wouldn't be wetting the bed anymore. With a low blood sugar may have mainly because they've not got the conscious, I guess, ability during that time period for their brain to wake them up to actually get up and go to the bathroom. Because they're low, you know, so But I mean, outright symptoms, you know, even blurred vision can be one of those sort of like a tipsy feeling on your feet. The shakiness in the hands, people talking kind of like, kind of like off the rocker sort of like, yeah,
Scott Benner 57:29
they don't make sense. Yeah, we're confused. Yep. And it, I guess it it's funny to like I, I've read, you know, back in the day, like all kinds of blog posts from people where they talk about being low, and everyone describes it like slightly differently, but I think it's situational, too. It's really interesting. There's somebody I keep thinking of having on just to describe below one time because this person's love was, like an amazing story to see if I can figure that out someday. Okay, treating things. Like let's so let's talk about it for like to finish up real quick. My blood sugar's falling, but I don't want to get high again. I'm ahead of it now. Like, you know, I know people know Arden's a juice box person, if you know if, if she's looking for a quick hit, if she's not hungry, juice boxes work for us, we use this very specific juice box. I think it's important to remember that you're not looking to drink so I found the smallest box I can with the most carbs in it, so that she's not having to like I I started helping Arden's friend the other day. Yeah, and you're gonna and she's doing great by the way. Oh, yeah. And but you know, if the first time was like, hey, I need you to drink some juice. She pulled out this juice box and it was huge. And I'm like yeah, you that's here. I sent her a link I was like get these like you're killing yourself you drinking eight ounces of juice to get 15 carbs. Yeah, I only want you to know the juice is medicine. It's not for fun like you don't even so juice boxes work I've talked to people who use jelly beans glucose tablets Skittles like so you're you're looking for something that's a real simple sugar that's getting absorbed in your mouth and then hitting your body quickly when you swallow it like that's it so what sometimes people say milk but I don't think milk is fast right?
Jennifer Smith, CDE 59:16
So that's Yeah, I mean ages ago that was one of the treatment things even on my list when I was little for low blood sugars it was milk right well when you consider like whole milk one there's fat there there's protein there and the body actually have to has to break down the milk sugar in order to get the glucose part out of it. Which is what actually brings your blood sugar up so I I don't ever recommend milk. I really don't I wouldn't. I don't think it's a I don't think it's a good low I mean obviously if you don't have anything else around have added drink your milk, but there are much better simple sugar things to carry along with you. Even dried fruit. And you know when I was little, my mom actually used to give me a little mini mini boxes of raisins. Okay. And then I had, at the end of the school year had these like, dead raisins sitting all over the bottom of my backpack that had to be like, they were disgusting. They were like, you know, full of dirt. And they were gross. But that was what worked. I mean, raisins were easy. They they worked well. They got the glucose tablets when I was little were horrid. They were horrid. I mean, if you think they're bad now, they were like, bad, bad years ago. I mean, now, the only ones and I don't even I don't I don't know if they're on backorder still, but the gluco lift brand is the only one that I love. They taste good. They don't come from a GMO glucose source. All the colors and the flavors come from natural fruit and fruit extract. So they're not artificial. You know, nail Lake number 70, or whatever it is. So but something simple. I like your juice box though. I actually have kind of the opposite. I look for the smallest juice box that has the least amount of carbon it because
Scott Benner 1:01:07
when I drink I
Jennifer Smith, CDE 1:01:09
either have I'm either I'm like half awake. If I ever do you have to treat a low overnight, which thankfully, I haven't had to do in a really long time. But I don't want at two o'clock in the morning to have to be completely fully conscious.
Scott Benner 1:01:21
I say to yourself, I really need this juice box,
Jennifer Smith, CDE 1:01:24
right? I mean,
and so the juice boxes I get are actually there. They're four ounces, and they're only eight grams of carbs apiece. Okay. Yeah. So you know, they work Nice,
Scott Benner 1:01:35
nice. I know, Arden also carries those little pouches or fruit snacks with her. And they always have like eight or nine fruit snacks in them, and it will sometimes texture and be like eat for two for snacks. So the other morning, we were heading to school and she was here, throw this out for me. And she gives me a package of open fruit snacks. I still have four in them, but they're hard as a rock, you know? And she's like, they're hard. And I was like, Okay, I'll get rid of them for you. And but yeah, she always has one of those. So in her bag, she has a juice, a small juice box and a small pack of fruit snacks. And she always has that weather. And yeah, and then there's juice boxes sort of spread around the school. So Martin's in high school, so she changes obviously, you know, Ross's Yeah, so there's, you know, in a closet somewhere, there's a couple of juices in each class. And then wherever she is, and she has to take one out and drink it from reverse. If she does, she just hits the closet and replenishes her purse. Yep, you know, I have to say that we don't you know, the beginning of the school year, it's not as it's not as intense when you're older. And you've done it for a while, we just take two bricks of juice boxes and spread them around like, you know, right rose petals at a at a wedding. We're just like, there are some here are some here, throw some there. And you're done. And then maybe once a year are they'll be like, hey, I need more juice boxes. So she might go through. I don't know, she might go through 1020 of them a year at school. But that's pretty much it.
Jennifer Smith, CDE 1:02:56
Yeah, pretty new. That's pretty minimal. That's actually pretty good. You know, when you when you get to be an adult with diabetes and have kids in your house,
you actually have to be
kind of good at hiding thing,
Scott Benner 1:03:09
or disappears.
Jennifer Smith, CDE 1:03:10
Or it or it disappears, like literally, I mean even I mean even my husband don't drink them or eat them. And he I mean, you know, he'll tell me if they're obviously not there anymore. But I mean, my kids if I have my glucose tablets out, they'd love them. So I hide them and so it's like it becomes really important like purses, by purses, I have like these internal like hidden packs, pockets and many of my purses because when they see an open purse on the table or the floor, they're like, oh, does mommy have any of her stuff in here? Like mommy stuff is for really important reason.
Scott Benner 1:03:44
reminded me that during during a family vacation once there was an argument, because we were we were in a moment where it was summertime. And we need help by the way we now because of Disney new hell like magical popsicles were right they give you a little bump, but they didn't make you go too high or anything like that. And for our net lease, and so we bought these box of popsicles like you know, you get to a shore house you go out and go shopping. And someone said Oh, I'm gonna have a popsicle and cozy Hey, you know, I just needed not to touch those. We've got them in case Arden gets slow, which prior to all the technology was going to happen like you were going to use those popsicles. And one of the parents said that's not fair to the other kids. And I remember Kelly going will tell them to get diabetes and then they can have all the popsicles they want to know but like for right now just don't touch the popsicles. But it actually caused it was like a like you know, that's that's not fair. Our Kelly's like, are we talking about fair because my kids are measuring fair. I think I win. Anyway, right. Do you feel like we did a good job here if you needed to? All right, cool. So I will so let me say goodbye let you get back to your business and Jenny's businesses she does this for a living at integrated diabetes.com this is not an ad. This is just me telling you that Jenny is the bomb diggity. Check her out at integrated diabetes.com there's also a link to her email address right there in the show notes look in your player right there. Thank you so much to Dexcom for sponsoring this episode. Don't forget to take a look at the Dexcom g six continuous glucose monitor today by going to dexcom.com Ford slash juice box or clicking on the links in your show notes. Were the ones you'll find at Juicebox podcast.com. And of course, you need to run out and get yourself a Contour Next One blood glucose meter Contour Next one.com
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