#371 Diabetes Pro Tip: Explaining Type 1

Explaining Type 1 Diabetes to friends, coaches, employers and more

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. Welcome to Episode 371 of the Juicebox Podcast. Today's show is a diabetes pro tip episode, mostly sort of, you'll see what I mean in one second.

The pro tip series that exists inside of the Juicebox Podcast is mainly about management of type one diabetes. There's also some informative stuff like what can you do when you go to the emergency room to make your experience easier. And today, I'm going to be filling a need that's been presented to me by the listeners. So I don't know if this episode is for them to get ideas from, or for them to share, or maybe both. But in this episode of the Juicebox Podcast, I, along with Jenny Smith, Jenny, of course has had Type One Diabetes for 32 years. She's a certified diabetes educator and an all around amazing person. And me, Scott, who's you know, just the host of the podcast, and the parent of a child with Type One Diabetes. So this episode is for people who need to understand Type One Diabetes more, or for those of you with type one who struggle to talk to those people about what type one diabetes is. See, if you're like the school nurse, or a teacher, maybe my boss, friend, neighbor, somebody wants to have my kid over for a sleep over this episode is for you to try to understand better what type one diabetes is and what your role in it can be. And if you're a person living with type one or the parent of someone living with type one, and you're struggling for how to talk to people about it, this will be beneficial for you as well. This episode of the podcast does not have any ads. But I do want to let you know that the Juicebox Podcast is proudly sponsored by dexcom, makers of the G six continuous glucose monitor and Omni pod, the world's only to boost insulin pump. That greatest blood glucose meter in the world in my opinion, the Contour Next One blood glucose meter. We're also sponsored by g Volk, glucagon, Lily's chocolates touched by type one, and the T one D exchange. There are links to all of the sponsors in the show notes of your podcast player. And at Juicebox podcast.com. When you support the sponsors, you're supporting the show, but like I said, there's no ads in this episode because I don't know you're gonna give this what to your kids, you know, baseball coach, and what's he gonna do by an insulin pump. Having said that, dexcom.com forward slash juice box my omnipod.com forward slash juice box Contour Next one.com forward slash juice box touched by type one.org g Volk glucagon.com, forward slash juice box. And if you'd like to get involved in some amazing Type One Diabetes Research, T one d exchange.org. Ford slash juice box. Last thing before we start, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. or becoming bold with insulin. And a huge welcome to those of you who don't usually listen to a type one diabetes podcast, those of you who care enough to try to learn a little more about type one so that you can be a better support system for the people you know, and love living with Type One Diabetes. This means a lot to them. I'm sure they're really, really excited that you that you took the time. So I hope we can make this informative and fun for you. I think we have let's get started. I want to jump right into this because this has been interesting since I brought this up to you the other day, I I sat down myself and I thought who in my time Have I spent have I had to describe diabetes to you know, when I started kind of making a list and then a lot of people a lot of people and and then I went online and I said you know into the private Facebook group for the podcast and I said Hey guys, Jenny and I are going to do this thing. Who do you wish you know, we could talk to and here's how the list came back. grandparents, teachers, parents, babysitters, somebody who might have my kid for a sleep over my child's friend's parents, a coach of a team spouses or significant others, co parents, roommates, extended family school nurse co workers bosses bus drivers and and what and family of adults with type one. So people who are diagnosed as adults who then are around other adults who never get Getting it. And then very much at the end of the list, someone said, Oh, I wish you could explain to chaperones and I started thinking,

everyone should have just answered with the same word, it should have said, people, because this is just, this is like everything else around diabetes like you like, oh, explain it specifically to a coach. So what I'm going to tell you is, I think we're going to have a conversation, that, whether you're one of the people I listed, or just a person who knows somebody with Type One Diabetes, when you're done, I'd like you to understand the basics of type one better, maybe a little bit of terminology. So things are happening, and maybe more so the mind of the person with type one, what's happening to them, and how you could be supportive of them. I think that's the goal here like not to speak to like, like there was there. In the beginning, I thought, oh, we'll do a couple of minutes talking to grandparents. And then a few minutes talk, and I'm like, No, no, it's all the same thing. Really. Right.

Jennifer Smith, CDE 5:59
Yeah, it is. And I it's really funny, you bring this topic up, because it's actually we do a monthly newsletter, and my my article last month was sharing your diabetes. Okay? And it was kind of along this same line, it was, how do you talk to other people about your diabetes and give them the baseline of what you need them to really know. Without, like a textbook, that's like 4000 pages long, overwhelming, it's overwhelming. And I some of the big points were one, set a time to discuss specifically diabetes, with these people, or this person, or this coach or whoever it is, I like your term, just people in general, right? Pick the person. You need them to know this, this and this, these are the important facts. Because it's a lot easier if you've set a time for it, than if you go to the coach at the end of practice. You're like, Hey, can you just take five minutes with me, I really want to talk to you about you know, Billy's like type one diabetes, and the coaches got, like, you know, soccer balls over there hungry and trying to get home. So to go

Scott Benner 7:15
home and get yelled at. There's a lot going on in my life right now.

Jennifer Smith, CDE 7:18
Right, right. So setting up a time and, again, the timeline of what are the important things you want these people to know? Like you said, the basics.

Scott Benner 7:27
Let me add this to that. The other things that people came back in their, in their responses very overwhelmingly was, I want this episode to be something I can text to somebody like a link and say, Please, can you listen to this and understand diabetes? Because many of the people who came into speak said, Look, I'm not very good at describing it. Like I can take care of myself. But when I start, there was an overwhelming feeling of when I start to explain it to somebody else, I either get frazzled or too detailed. You and Jenny do it. And I'm like, Alright, well, we'll do it. So Jenny's after you listen to this episode, and you decide you really want to help a person you love with Type One Diabetes, or someone who's in your class, or because there was one very specific woman who said, I'm a college professor, I wish I could explain it to my students. better, right. And so whoever you are, in this scenario, here's what I can promise you, Jenny, and I will not make this boring. And we will not make it overly, like taxing. It won't be so technical, you won't understand. And it should be a good runway up to you having that conversation that we just spoke about with this person in your life who has type one diabetes. So that's my overarching goal, Jenny, don't mess it up. Okay. Okay. I'm talking to myself. I don't want to mess it up. Do we start with? Well, we usually talk about diabetes in such a specific way. But why don't we start with just a really simple description of Type One Diabetes? You want to go?

Jennifer Smith, CDE 8:56
Yeah, absolutely. I mean, Type One Diabetes is the body's inability to create insulin, or to put it out into the body. And so without it, your blood sugar gets too high. So type one diabetes is a deficiency of insulin, it's specifically an autoimmune disorder, which means the person did nothing to cause type one diabetes. It's not because they sat in a hole hose for, you know, three years or whatever. So and I think that's a, that's an important one to put out there. And just the simple explanation, because there is a lot of misunderstanding around just the term diabetes. Sure. So

Scott Benner 9:37
yeah, and it is a lesson it's a genetic issue, right. It's an autoimmune disease. You know, you can use an example my daughter was two years old when she was diagnosed, she weighed 19 pounds and I you know, Federer, the same stuff, all of us feed our kids. And and her body just was like, you know, got confused one day, I mean, that's even that right for these people listening, I don't know exactly what triggered my daughter's type one onset, what I can tell you is that testing can prove that you have markers, that that make you more likely to get diabetes. I don't know if my daughter had them, obviously, because no one ever checked her. But she got sick. And, you know, it's always been my belief that her immune system got confused. And instead of killing her virus, Winton killed her pancreas for the lack of a better term. And I want people to understand, too, that the advent of insulin is still fairly new 1921 one, right. So, for context, if my daughter's pancreas would have crapped out in 1919, she would have died in a couple of weeks, right? That's correct. Okay. The insulin is the only thing keeping people with type one diabetes alive. Otherwise, the first time your blood sugar starts heading up, it will just keep going up and never stop. That's right, right. And you'll slip into a coma and die. Okay, I told you, this wasn't gonna be too technical. So so people are getting this insulin in, in a ton of different ways. And so I think that would be important, what are the different ways people get insulin,

Jennifer Smith, CDE 11:14
initially, and some people even long term after diagnosis continue to take injections. So the age old, you get a little like bottle or what we call a vial of insulin, they now come thankfully, and easily dispensing pens. And you dose it through the course of the day based on many factors. There's other ways such as an insulin pump, that you could take your insulin, kind of a fancy little page or size device that sort of drips it into the body through a tube, or if you're using a tubeless, one like Omni pod, then that would be another way to do it. So essentially, an injection or a pump, those are two ways to get in the body. Now there is one other way. I mean, if we wanted to be truthful about it, there's also an inhalable insulin called a frezza. So that's another way to use

Scott Benner 12:03
it, most people inject insulin correct. And so inject like Jenny said, with a pen, which really is just a very fancy syringe, you might see someone do it with a syringe, you might see someone wearing a device on their body, or carrying a device that's connected to their body with a tube, there's different ways. But in the end, you need to get that insulin under your skin, right. And this could happen for a number of reasons it could happen because you're eating, it could happen because your blood sugar just went up on its own, and you need to bring it back down. When it needs to happen, it needs to happen. And I want people to understand that asking a person with Type One Diabetes to go into the bathroom, and extensively hide while they're injecting is not the right thing to do. So if please, there's, throughout this, I'm going to tell you say things like, please don't ever say this, here's one of them, people around here might be uncomfortable with your diabetes, you can't do that to a person. Yeah, if they're uncomfortable, they can leave, I need to give myself this insulin. So my blood sugar doesn't go up really high. And don't get me wrong, like not getting the insulin is not going to you know, it's not going to kill you in the moment if your blood sugar is going higher, but here are a lot of things that could happen. They're thinking could become cloudy, right? Right, they could become agitated. So if you're a teacher, you don't want your kids blood sugar high, because they're gonna have trouble concentrating, thinking, they're not going to learn norming performing in all kinds of different ways. Same thing with sports, your blood sugar gets too high, you slow down your body has a difficult time, you know, I can see it my daughter's foot speed. If my daughter's blood sugar gets over a certain number high where it doesn't belong. I can literally see her slow down while she's running, she just can't go as fast.

Jennifer Smith, CDE 13:56
Right?

It would be the same thing too. I think in like a corporate world type of setting where someone may feel like it wouldn't be acceptable in order to use their insulin or to respond to their pump, telling them to take the insulin or whatnot. And the same thing if they're being asked to present or to discuss something that's very, very important. They may not have the ability to do that in if their blood sugar is not in the right place. Yeah.

Scott Benner 14:25
So you need to give people the freedom to do what they need to do. If you want them to be themselves, or be able to do the thing you're asking them to do or hope that they can do. They need to be able to take their insulin and feel comfortable about it. It's difficult to have. This is a lifelong disease like it's not going to it's not going to get cured anytime soon. It's not going to it's not going to go away. It's not going to one person said make sure people understand it doesn't just transform into type two diabetes, like it's a progression from one to two right? Right, so having type two diabetes, completely different thing, right. And so this person, it's hard, it's really difficult. Like, I really want people to listen and think that every time you have a body function that puts pushes up your blood sugar. And so for people whose pancreas is work fine, could be adrenaline, stress, pain, so many different things can make your blood sugar try to go up, when that happens to you out there with a working pancreas, your pancreas just stops it, you don't even see it happen. Like if you were monitoring your blood sugar in real time, and you got some adrenaline like it might blip for a second, but it would come right back. A person who doesn't have that their blood sugar is going to shoot up and keep going or get too high and stay there. And then they need to put that insulin in into their body, to bring it back down again. It's just it's 24 hours a day and to have somebody make it more difficult for you is, is kind of terrible.

Jennifer Smith, CDE 15:57
And I think in terms of even bringing up the technology that is available, such as an insulin pump in terms of delivery, I know that there's also the misconception even in our day and age right now. Oh, you've got a pump. It takes care of it all. Yeah. And that's a that's not true. 100% not true at all, there is so much that the person with diabetes has to interact with in order for that technology to do what it needs to do for them. So just because they're connected to these devices, can be helpful. But it's not doing anything without their interaction with it.

Scott Benner 16:36
Yeah. And it's, it's easy for people who don't understand to make an assumption, like, Oh, they got the machine, the machine fixes it. Right, right, or something like that. And I want to be really clear for everyone listening, like, I'm not coming down on you, there are plenty of disease states that I don't understand in any meaningful way. But what that does is it stops me from, you know, saying things about it that I don't understand. And like, there's a ton of different things. You might think, Oh, this is helpful. Like, if you find yourself with a parent of a child with type one, and they've just been diagnosed, and you think, Oh, this parents so smart, or look how well they're handling it. It's not right to say to them something to the effect of you know, well, God gave the child with Type One Diabetes to the right person, because you can really handle it. Right. Really think about that sentence. But you know, when you're in it, because it happens to a lot of people. No one's lucky that their kids got diabetes. Nope. No adult feels lucky. No one walks around going, thank God, I'm a head screwed on straight kind of person. And I'm the one who got type one cuz Jimmy up the street hot mess. And if he would have got it, it would have been way worse for him. It's bad for everybody. Okay, it's just that's a, so be careful how you speak to people. Right? I think I think about a person who's been on this podcast before who had a child who passed away and I asked like, what's the right thing for someone to say to you? And she's like, there is no right thing for someone to say to you. And and, you know, anything you do is just going to, it's not going to make anything better. Unless you offer like sincere, simple support. Hey, if there's anything you need, I don't know what to do. But if you tell me I'll do it for you that works with this as well. You know,

Jennifer Smith, CDE 18:18
I think it's I think it's along the same line as offering up information about your neighbors, Grandma, who is something Something happened because they had diabetes, I same thing. It's like, don't, don't offer up in terms of like a connecting point. You know, if sure if you've got a cousin who has type one or you know, an uncle who had type one, and you have a little bit of understanding that might even further your discussion in terms of what the person with type one talking to you could put back into the conversation. But unless you've really lived with it, or you have taken care of somebody with type one, please don't. Yes. Tell them about your neighbors, uncle's friends,

Scott Benner 19:04
Jenny's politely saying don't look at somebody go diabetes. Oh, where have I heard diabetes from my grandmother? Oh, you know what? Oh, my grandmother had diabetes. They cut her leg off. That's not a good thing to say to somebody don't do. Yeah, right. And just Yeah, don't don't do that. Okay, so keep keep those thoughts inside. Because that's not helpful. And it might have nothing to do with the person you're talking about your grandmother's situation, very well could be a ton different than this person situation. And that's important to understand, too, is that in this day and age right now, I know this sounds kind of strange. But this is the best time in the in the history of the world to be diagnosed with Type One Diabetes. So people have a much greater chance of staving off, what could be long term complications, and they have a much better chance of managing day to day in the moment in a way that won't impact their lives too badly. Now, I feel strange saying this because on one hand, what I'm telling you is that These people need some leniency, they need some understanding, they need a little space because they're making decisions about how their bodies, you know, working. And at the same time, I want to tell you if they can do anything, and so don't limit them. You know, and that's hard to do too, because you might not feel like you're eliminating them, you may feel like you're protecting them. And correct, they don't need that. And if they do need that, they'll they'll ask, they'll ask you for it.

Jennifer Smith, CDE 20:27
Yes. Right, exactly. Which is part of this, you know, the purpose of this is understanding, if they're having a conversation with you about what you need to know, the reason is, because a lot of times they want you to know what to do in case they need help, right? Some understanding about this is diabetes, this is what you know, might see me carrying such as the devices, this is I might make some noise, my products might be bet tie, or whatever, you know, but in case of this, this and this, these are the things that you could do to help me and this is how to help me right?

Scott Benner 21:03
Because they may at some point need that help. Right? And so you understanding like say you're a teacher, you understanding like signs of visible signs of hypoglycemia, okay, so low blood sugar, and I'm going to read your list which I'm not a big list reader on the podcast, but this person could feel shaky, be nervous or anxious. They could be sweating, have chills, feel clammy, irritable, impatient, confused, their heartbeat might pick up, they could feel lightheaded or dizzy, voraciously, hungry, nauseous, their skin sometimes can get pale, they'll look tired or could feel tired, they could end up feeling weak, their vision could get blurred or impaired. My daughter talks about her mouth gets tingly and numb if her blood sugar gets too low headaches, trouble coordinating themselves, clumsiness I'm this is coming right from the A's website, the American Diabetes Association associations website. in their sleep, they can have nightmares or crying their sleep. And if their blood sugar gets too low, they can and if it gets low enough, we'll have a seizure. And so they'd like to know if they're not making sense when they're talking so that they can take in some carbohydrates of some kind to bring their blood sugar back up. And so you being a person around them, like like a coach. And you have to figure out the line, right? Because these things while they can happen, may very well not happen. So think of the other side of it. You know? You've got a little girl on your soccer team and she's running around and every three seconds you're jogging next to her going, Becky, do you feel okay? All right, Becky, Are you dizzy? You don't feel clammy? Do you? Hey, Becky, Becky, Becky, Becky, you're ruining Becky's life when you do that, okay? Don't Don't do that. But at the same time, you could look over once in a while and visually, just, you know,

Jennifer Smith, CDE 23:00
evaluate the performance. If you're the coach, you know, how your kids usually perform or do things, you know, how they interact with their other teammates and whatnot. So yeah, it may not be

Scott Benner 23:12
at all, a strange thing to say, like, Look, we have a two hour practice. Everyone sits down, you know, halfway through and drinks water. I'd really like it. If Becky tested her blood sugar, then, you know, because I don't maybe you don't feel comfortable as the coach like you don't want to be on the hook for like seeing if this kids about the fall over or not right? I get that. So talk to the parents and say, Look, can we just coordinate a blood sugar check, you know, at some point, you know, for safety, and then make it normal. Don't call attention to it don't like it's happening. And everyone doesn't have to stare and people are going to stare in the beginning. But you got to just give the kid the the space to let it happen because everyone will get used to it. And I guess that's what I want to bring up with them. When my daughter was very little the first day of school. I'd go in and it's and I would give a talk like to the kids like five minutes on the literally the first day. Hi this is Arden. Arden has type one diabetes, her pancreas doesn't make insulin. Once in a while you're going to see Arden pull out this thing and give herself insulin with it her controller for her pump. Hey, you know what Arden is just like the rest of you. She doesn't need, you know, she doesn't need you to check on her constantly. But if she looks like she's busy, she's not making sense. It would be nice to tell your teacher, right? But it still didn't stop this one little girl from mothering her. And so she came home one day and she's like, this kid will not leave me alone. Like like and she goes it seems really sweet. But she won't stop I need this kid. Stop back off. Do you Yeah, like leave me alone. So that there's there's a balance in there somewhere where you can be supportive and understand Ending without being a burden to them or making them feel different. Or look that. And this is very important. Like it really goes

Jennifer Smith, CDE 25:10
across the board and what you're saying to not just the little kid component, but the teacher or the coach, like you said like bugging, bugging, bugging, are you okay? Do you feel okay, do you need some more juice? You know, that kind of thing? Or even goes cross crosses over into spouses, significant others? Yeah, you know, especially and I would expect that later in marriage, or later in partnership, you've had enough visualization to not be like bugging, bugging, but in newer relationships, I think an upfront important talk when you know that it's going a little bit further than just let's go out and get a drink or whatever, right? I mean, it's important to bring up this is how you could help me. Don't bother me, though. You know, don't, don't tell me not to have the potatoes with my dinner when we go out for dinner. Because Oh, my goodness, they have carbohydrate, in my usual how the potato

Scott Benner 26:01
makes your blood sugar go up? Thanks. That's what I want you thinking about right now? unless the person says, Look, I have trouble saying no to potatoes. So if you could like if they want it, that's different, right? It's could

Jennifer Smith, CDE 26:13
you remind me not to do exact Yes,

Scott Benner 26:15
when I see the french fries, if you could just go Hey, you told me last time, I shouldn't get french fries to bring it up. I don't think anything that we've said in the last couple of minutes about kids and coaches and teachers doesn't specifically apply to adults in adult situations, either. It's correct. It's all exactly the same. It's why I didn't want to break these up into like, okay, now, here's 10 minutes for your boss. If someone's working for you, and they have type one diabetes, they're going to have some needs. And the most important thing is to support them and not make them feel awkward or odd about it. And I'll tell you why. As a person who I'm hoping cares about other people who have type one, you know, you could create a, an eating disorder by telling someone, don't don't use your insulin here, because what you're saying to them is don't eat right now. And then they start associating the awkwardness of giving themselves the insulin with eating, and then they'll stop eating. And I know that sounds like oh, that won't happen, that happens a lot,

Jennifer Smith, CDE 27:12
or hide their eating right, or in an effort to not like show others. I mean, there there is, it's I mean, it's a whole nother broad topic in terms of diabetes, the eating disorders that are associated with diabetes. I mean, food is a huge part of diabetes management it is. And so it's not odd, that it can become an issue. But it certainly is something that in terms of being supportive for another person who has diabetes, you don't want to push the envelope that way.

Scott Benner 27:42
And I know that people listening right now don't know us. And they are like, it's 2020. Like, everybody seems super sensitive and social justice II and everything. We're not like that. Like, I'm not saying that at all. Like, I you can hear my terrible accent, I'm from the northeast, I'm good with like, Hey, get up, you'll be fine. I'm good with that I really am. But what I'm saying is, there's a real opportunity to mold a person in a positive way, or a negative way. And that goes for everybody I understand. But around this specifically, it does not take long to make someone feel different in a bad way. You know, and it'll stick with them, especially you teachers, who, you know, hear an alarm and are annoyed because you're trying to teach and it's alarming. Try to keep in mind that when that's happening, the student whose blood sugar is falling, who's now scared that they're going to pass out or die or something like that. They don't want this to be happening either. Correct. And you can't say let me just finish this lesson. Or they need to address because we've talked about high blood sugars, but low blood sugars are more immediate, immediate, yes. Right. You can't just ignore because a blood sugar that's falling could be falling quickly. And one of those issues could pop up out of nowhere. So if this kid's wearing a monitor that tells them like, Hey, your blood sugar is getting low, or they say I feel dizzy, I need to test or you know, like, you can't just say okay, well wait till after recess is over. Or as soon as I get done explaining this math problem, like they need to do it now. Which is another great reason to normalize it, let them take their meter out at their desk and check their blood sugar. It's not going to hurt anybody. And and they'll have an answer immediately about what to do next. But the five minutes you want them to wait could end up being much too much time for them. Yeah,

Jennifer Smith, CDE 29:34
yeah, absolutely. I mean, in terms of you know, even that also acknowledging what they're using to treat a low blood sugar is, is something that you also don't want to form any, like, wrong feelings about someone might use, you know, in terms of carbohydrate, it's just simple sugar that we really want to use to treat. So simple in terms of it could be juicy It could be Skittles, it could be something that we call glucose tablets. It could be honey in there multiple things. And everybody seems to have a preference for what is great for them and even flavor preferences. So just because the kid in your class is using like Skittles, and you're thinking, oh my goodness, Skittles, why are they so unhealthy? Right?

Scott Benner 30:23
Yeah, you don't understand what you're talking about, which is a good is a great example of keeping your mouth shut in that situation. Like, they're not eating Skittles. Because you're, here's what's gonna happen to you, you don't know what you're talking about, the kid takes Skittles, and you think in your head, this is why they have diabetes, look how they eat, no, they need sugar to go into their body so quickly, that it can literally fight off this extra insulin and stop from making them too low. So know what you don't know, I think is important. And if you want to know find out more, but don't say silly things to people that, you know, it's not there. It's not their preference to have diabetes, the kids not looking for Skittles, you know, like, an adult doesn't want to get up in the middle of a business meeting and bang a Gatorade back. They're not like, Oh, you know, what I want to do today in front of 30 people who I'm trying to get to take me seriously. And that's the other thing too, is that you have to understand that adults often are hiding their diabetes at work, because they don't want you to judge them and like and lose out on on professional opportunities. Correct?

Jennifer Smith, CDE 31:25
Yeah, promotion and those types of things. And I think that's also in terms of people with diabetes. As I mentioned, initially, you have to really know, who do you need to share your diabetes with who is really important as an adult, it might be your boss, it might be the co workers at the team members that you work with, as a child, it might be you know, your teachers, and hopefully your parents will help with that. Even some of your really good friends. I mean, I remember as a kid, when I was diagnosed, it was really helpful to have some of my really good friends know a lot, you know, in terms of like, their understanding language, teaching them things about why I was you know, doing a finger stick and all of that, but I think it comes down to defining who do you need to share with and what applies to this situation? You know, you're probably not going to teach your soccer coach about carbohydrate counting. I mean, that's, that's not purposeful. But you're gonna teach them things like hypo awareness and you know what to do in case who to call emergency contact to there are defined pieces, I think to teach everybody

Scott Benner 32:37
Yeah. And so it's also important to understand the diabetes is mostly an invisible disease meaning that the people around you unless you're having a struggle, aren't ever going to see it. As a matter of fact, I pulled this up here just to so that people can have a an idea. Former Chicago Bears quarterback Jay Cutler has type one diabetes. Bret Michaels has it Nick Jonas has it and rice the author has it. Mary Tyler Moore, my close friend of mine coaches for the Philadelphia Phillies Sam fold he has he used to play for the Oakland A's he was in centerfield had type one diabetes. There are plenty of people. The Justice Sonia Sotomayor, right. Right has type one. So you

Jennifer Smith, CDE 33:22
can do was a baseball player?

Unknown Speaker 33:26
Atlanta.

Scott Benner 33:28
Oh, yeah. There's a guy Well, there's a guy pitching for the cubs. He's been on the show before Brandon Morrow he has it. I think the tight end of the Ravens has it. There's, there's nothing you can't do with Type One Diabetes. there's a there's a guy that I know really well, who's a four time Olympian who has it, right. So and, and the point is, is that you look at those people, and I don't tell you they have type one diabetes, and you're never going to know these people are doesn't mean it's easier for them. They don't have the easy diabetes, because you don't notice it. They work very, very hard at their health. I know it's hard to imagine, but I the best I can say is imagine that you had to think Breathe in, breathe out, breathe in, breathe out, or you wouldn't breathe. Like that's what it feels like having type one. I'm going to eat something I need insulin, it has to be this much. Not that much. I don't want to get too high. I don't want to get too low. I can't have a bunch of insulin in me when I go for a run later because I might get low then it is like constant kind of tapping on the back of your head. You know, I call

Jennifer Smith, CDE 34:31
it diabetes inner monologue. Okay, let's see

Scott Benner 34:34
Jenny. Jenny's had type one for 31 years now. 3232 Okay, regulations. And, and she can tell you that you Jenny's really, really good at managing her diabetes, but that doesn't make it No, of course, but that doesn't make it not in her mind. And and so it's there,

Jennifer Smith, CDE 34:55
right and then everyday conscious effort.

Scott Benner 34:57
Yes. It's so if you're a nice That so that you'd hear that and so that if you are the spouse of a person who has type one, or your child has type one, but your spouse takes care of most of the management, you may not understand what's going into it on an emotional and physical and maybe sometimes lack of sleep level, it's really hard. It's incredibly hard to do well, it's also incredibly hard to do poorly. So if you're really great at managing or terrible at managing, that that comes with different struggles, people who are great at it understand, you know, the timing and how to take care of things in a way that maybe some people don't get to understand. But the people who are struggling, are aware every moment of the day that they're probably on their way to complications that are serious, because they can't figure it out, or because no one will help them. It's constantly in their head. Now, if you're co parenting, I can't tell you how many people come to me and say, can you please find a way to talk to people who are like a divorced spouse? Or, you know, a step parent or somebody who's not for the lack of a better term in the fight constantly? Right? They only see, oh, look, he's fine. Yeah, this isn't that hard, or his blood sugar just went up for seven hours, that was no big deal. It is a big deal. And and, either, you know, I, I don't normally get preachy, but either figure it out, and help or get out of the way. But don't let your ego stand in the way of someone managing their health, which happens a lot. It may not be happening to you person listening right now. But it happens a lot more than you might want to think. Right? You know? Anyway, I didn't mean to get like that. I just, I don't know if you saw the notes from like my X, you know, my kids blood sugar's terrific for a week and then they go to my exes for the weekend and his blood sugar's 300, all weekend long. so incredibly unhealthy. And, and I

Jennifer Smith, CDE 37:05
see the same thing with you know, as good as family caregivers could be like, you do the best that you can as parents, and then you have a weekend away, and you're like, Yay, we've got a weekend away. But even in terms of those parents that weekend away, is not free of diabetes thought, right? You know, their thought has gone into prepping whoever the caregiver is prepping their child for they may not know this. So you know, text me if something comes up, or you know, the grandparents or caregivers or godparents or whoever there are, that's taking care of them thinking, well, can't they just have a little of this? Or Can't we just give this to them, and we don't have to really worry about it, everything, everything is considered in diabetes. And as you said, you know, that couple of days that they're running now at 300, because you didn't follow the set of directions that you were given. That's making a difference in that person or that child's life. Yeah,

Scott Benner 38:04
no, and, and so that people can understand when your blood sugar is high, There's too much sugar in your blood and no way to release it, the insulin is what releases it, we're not going to get into super technical stuff. But when you hear later, you know, when you turn on the news, and some guy died of complications of type one diabetes, now, you know, what they really died from was a heart attack or a stroke, or an aneurysm or something that comes from too much for the lack of a better term sugar scrubbing away, you know, in the inside of your body, is it going to happen today, if a kid's blood sugar goes up to 300 watts, because you messed up the insulin? No. But if it keeps happening, it will happen very likely one day. And so you're making a decision today on Sunday to maybe save someone's life 30 years from now, but that's, that's worth understanding, you know, and just because it's going to be later doesn't make it not super important. And don't forget to you're helping them be clear minded, you know, thoughtful, being able to learn or perform like a lot goes wrong inside of the functioning of your body when your blood sugar's high. It just, it's just very important. And the people who love you and are hoping you'll understand are, they don't know how to explain it to you. So they asked us to make this. I will tell you, Jenny brought something up a minute ago that I wanted to kind of like add on to if there was a super simple way to make it, okay. Everyone with diabetes would be doing it already. And you wouldn't have to worry about it. There's no shortcut to it. So if you're having a pool party, I think you really need to try to understand how terrible it is to not invite one kid because you're scared or you don't understand or you just don't want the hassle. Like, just find some time talk to the parent come up with a simple plan that everybody can deal with because that kids sitting at home and they're thinking I'm not at this pool party right now. I'm not gonna sleep over right now, because I'm a problem. That's how it feels to them. Right? I'm broken, and nobody wants me around. And you can't you can't be a part of making people feel that way.

Jennifer Smith, CDE 40:11
No. And if you don't know, like you said, it's, it's ask, you know, a lot of the kids that I work with, that's one of the big things I bring up with parents, you know, it's, if there's going to be asleep over something they've been asked to, again, defining a time to sit down with those parents, or even the good, the good friend's parents, and make sure that they have a basic baseline kind of understanding. But I think it also takes from the standpoint of not not being the parent with a kid with type one or not being you know, the employer who has type one or any experience with it, it takes asking, really just I mean, don't be afraid to ask any question is a really good question. As long as it's not, I guess derogatory, or, you know, it doesn't come out as well, should you really be doing that? You know, I don't know very much about this. But should you be doing that

Scott Benner 41:03
I know, a lot of people have type one diabetes, don't ask them if they should be eating something that doesn't sit well with them, you know, they'll, they'll, they can eat anything they want if they know how to use the insulin to manage it. And and so in the end, it's just that idea of us being supportive. And like Jenny said, if you don't understand, try to find out and understand that when you go to find out, it's very possible that the person you're going to ask them mother of a kid who's had diabetes for six weeks, she might not understand yet, either, you know, and so her her instructions might seem like a lot, or Babli, like, or I've babbled a lot of people when my kid first had diabetes, I'm like, Listen, you don't understand, she can't get highs, you can't get low and you start rambling. And before you know it, you're like, Oh, great. I'm the crazy person in the room.

Jennifer Smith, CDE 41:51
You get the glazed over eyes. And they're just like,

Scott Benner 41:54
I always imagined, somewhere between like, I'm so glad this didn't happen to me, and why won't they shut up, but they won't shut up because they're scared, right? Because this stuff as much as it seems like, you can make it seem mathematical. Diabetes is not like I take a pill every morning. And I'm okay. It's very fluid, it changes pretty consistently, depending on a ton of factors. And the people who really understand it, or the people who are living with it, are just sort of struggling moment to moment, because they don't know what's going to happen next, it feels like you're running for your life in a disaster movie. And you know, you're like a bridge collapses underneath of you, and you pull yourself up on the bank. And then as soon as that's happening, a zombie bites your leg and a building falls on your wife, you know, like, you're just like, wait, when is this gonna slow down? You know? And at the same time, I know, I just said that. And it's true. This is gonna sound crazy. Don't treat people like they're running through a disaster movie, because they're trying to find some normalcy. And you could be a big help in that.

Jennifer Smith, CDE 42:59
And I think sometimes, within that understanding, let's say you're the teacher, or you're the boss, or you're the coach, and you've, you've been schooled, right, somebody sat down with you, and they've given you information. They're like, this is the plan of action. And then next year, they come to you, and they're like, Okay, do you understand everything? And you're like, yeah, yeah, yeah, I got it, you gave me this whole, like, you know, hour long, entire, you know, information session, you're like, Okay, but this year, this is a little different, right? This is what we're experiencing now. So know that, like, with Type One Diabetes, also kind of, it's a little bit more fluid. There's, there's change that ends up happening, you know, last year, to juice boxes at the middle session of a soccer match, might no longer need to be there. This year, the reaction is a little bit different. So, you know, also continue to ask questions along the way to say, Well, does anybody anything changed for you? Or you know, is it is it still the same? Do we need to consider anything different? I think that's why in the beginning of the year for kids, especially, there's always a there's a point at which you need to go in and you need to reestablish that care plan for this year, what's going what needs to be different, what needs to change? Because Because life changing, right?

Scott Benner 44:13
And and seriously, because your grandmother or your aunt or your uncle has type two diabetes, you don't understand type one at all. There's nothing about that. That translates over to this in any meaningful caregiving kind of a way. I remember just recently we were having a conversation before a school year. And one of the teachers, you know, my daughter's information about her blood sugar is on her cell phone, right, which is really cool. And so the teachers like, well, we take the cell phones away at the beginning of the class, and I laughed, and I was like, that's fine Arden's not going to be giving you her cell phone, she needs it, you know, make life and death decisions. And she's very good with their cell phone. She's not going to abuse it and everything like that. She was well what do I tell the other kids? And I said, I swear I said this in a roomful of about 10 teachers that tells me them if they want to get a lifelong incurable disease, then they can keep their cell phone on them too. Otherwise, they should shut up and like, and you have to have the nerve to do that, like you should turn to 20 other kids and go, listen, her situation is different than yours. I don't even care if you but just stop, you know, like it's a it's a big deal. Imagine wanting to use someone's diabetes as an excuse to keep your cell phone or to be a malcontent for a second, and then you as an adult, don't just shut that down right away. Instead, you're like, Oh, well, you know, Kim does have a good point. It's not fair. Of course, it's not fair. It's also not fair that my daughter's carrying a juice box with her and like, something called glucagon in case she passes out to somebody can stick it in their leg. It's not fair either, you know. So just think I'll tell you a common sense, is, is a huge help with diabetes. It really is, and and especially about being around them. But let's look what I think everybody understands. Now, hopefully, why don't we drill down a little bit more about how in a situation whether you're a teacher or grandparent who's babysitting or something like that, or a, you know, a boss who's trying to, you know, keep somebody healthy? Like, let's give them more nuts and bolts of what goes on in the day of a person with type one diabetes, and how they may be able to be helpful in those situations. So, I mean, but before we do that, Jenny, I'm sorry. Can you explain to people what it feels like to be high and what it feels like to be low? for you personally, it's gonna be different for some people. But

Jennifer Smith, CDE 46:35
yeah, so lows. As I said just a bit ago, low symptoms for the person can change through the course of life with type one, too. So my lows now, I feel as though I have like these racing thoughts. I feel like things are going really like exponentially fast. But I feel like I'm moving through mud. Like, I feel like I just can't get there. Even though everything in my brain feels fast. I feel like I'm just moving at like a snail's pace. It feels horrible. I also, for a long time, it started in college, and I didn't have this symptom before, but kind of like you mentioned that like nom, with Arden, I have like this numb, tingly tongue kind of feeling for low blood sugars. And I've never thankfully knock on wood. I've never gotten to the point of needing glucagon, I've never had to use it in my 32 years of life. Nobody's had to give it to me. I have had to have assistance for treating a low. But um, you know, sometimes I've, I've, like started talking kind of weird, like, not really what the whole conversation was about or like mumbling and sort of rambling. And my husband said, like, your blood sugar's kinda low. And this was before CGM, like we were married early on. Yeah. You know, he knew some of the things to watch for. So I mean, those are my lows. Now, when I was younger, I definitely was shaky. I mean, it was very visibly, my blood sugar was low. And again, that was a time when there were no continuous monitors and pumps were not really beneficial. So but highs, highs, I get really, like tired, and really kind of, like more annoyed, I don't get annoyed, I don't get that like, irritated angriness with lows like many people can get, I get that more when I'm high. And I feel like I just can't put a lot of really good, like thoughts together consistently, I feel slow, so hard to put the

Scott Benner 48:52
effort in for anything. And it's not something that you can just fight through. It's not like that. It's not, it's not like I didn't get enough sleep last night, but I need to be at work. It's an absolutely physiological issue that is limiting you. So for people listening, it's sugar, glucose is the is the energy your brain runs off of. And having the right amount of it is perfect. Having too little of it, you know, is goes the way we've discussed and having too much of it does something to your body with a working pancreas just keeps you in a great range all the time. So you don't experience all these things. But a person who maybe could do something so simple as Hmm, let's see. Let's say you have a kid in your class who says I have to give myself my insulin right now because I'm eating in 10 minutes. And you say no, no, we're gonna finish this first. Don't do that. I don't want you giving yourself insulin in front of all these people. Well, you've now missed time, their insulin with the impact that the food's going to have on their body, which will very likely drive their blood sugar higher and cause what Jenny just described. Similarly, if they say I put my insulin in 10 minutes ago I know you want to talk for five more minutes, but I have to start eating now. You can't say no, because then their blood sugar could go the wrong way the the insulin will continue to pull the sugar out of their blood, it doesn't know how to stop like a, like a healthy body does,

Jennifer Smith, CDE 50:14
it's expecting there to be food there to work with.

Scott Benner 50:16
Yes, and when that foods not there, they can get awfully low and all the way up to like, I don't want to, like, you know, I don't want to make you feel like I'm trying to be dramatic, but you could kill them. And you know, anywhere from shaky to not making sense to angry to seizures to passing out to dying, like if you take too much of that sugar out of their blood. That's like taking electricity away from a light bulb, and you can't turn it back on again, by putting the sugar back in after it's off. So it's really important. And at the same time super important not to make people feel like pariah and and not to give them long term, serious psychological issues around this thing that they you know, I'm gonna say this, but I don't think it matters. They have nothing to do with getting it. But even if they did, why would you? Why would you want to make them feel that way? You know, and I think that's important. And I don't think any of the people listening to this want that. You just don't know what they're talking about. And then you make assumptions. You know, I don't know if a lot of the things that we think are is anecdotal, you know, we kind of went over like, oh, diabetes, that keys off. My grandmother had diabetes, I understand diabetes, I live with my grandmother for three years. No, that's different. That's probably type two diabetes. And your grandmother probably took a couple of medications and, you know, different thing. But the person who says that? I don't think they say that out of malice. I also don't think the person who tells you, you're so strong. Thank God, this happened to you. And not me. I don't even think I don't think that person means that with mouse. No, you know,

Jennifer Smith, CDE 51:51
they're in any conversation, we're always trying to find a connecting piece, you know, I mean, communication is that it's a given a take between two people or six people or whatever. But if you're in the, if you're the person that doesn't know, then ask more than talking. Yes. Right. It's, it's always, well, goodness, I, you know, I didn't know that you had type one diabetes, tell me what that's like. I mean, that's a very easy, simple, you know, and if the person really doesn't want or need to share with you, maybe they would just say, Well, you know, I manage it, and it's okay. But if they're, if you're sharing with them for a reason, then continue to really be more the ask the questions. But don't share too much. Unless you truly have some experience to share. I feel

Scott Benner 52:38
like before we go over nuts and bolts like management ideas that people will have to intersect with, I think what we should really be saying here is, in case you haven't been paying attention for the last 49 minutes, this is about communication. And most people are terrible communicators. And it's because they don't listen enough, and they interject their thoughts. And and it's a very human thing to feel like, you know, but you don't like I could sit here for the rest of my life and make a list of things I don't understand. You know, but I'll tell you what, put me in a situation where one of those things, I probably puff up a little bit start reaching into my common sense, or, you know, a little bit of my anecdotal information I have, and I start saying, No, no, I know what's up here. You know, it's, it's like talking about, I know, we're recording this during Corona. But like, it's, it's that thing, when people step up, they go, Oh, no, no, you know, what you have to do you have to do this. How do you know that? Right? Is it because you're a Harvard researcher? Or is it because you heard a guy say a thing, and now two people said it, you're like, Oh, that must be true. And that's just how our brains operate. And it's very valuable day to day. It's not very valuable when you're trying to talk to somebody about something important like this, that you don't understand. And they very well may be struggling with as well. Right now. So anyway, All right, I'll start you jump in. Okay, I'll do breakfast, you do lunch, and we'll go from there. My daughter gets up in the morning. And if we're lucky, her blood sugar's been stable overnight. But if she's been low overnight, we may have had to take away some insulin, or give her food, she could wake up a little higher. Because of that, it could throw off the timing of her eating, she might end up being late for school because of that. She may end up being a little rundown. You can wake up if you have a bunch of low blood sugars overnight, you wake up with, but people some people call a low blood sugar hangover. Yeah, right. And so that could be that. So you got to give these people a chance to get their lives moving. And then they've got to get to work. And what if I get myself insolence or on time and I have to get my car then and drive to work and now I'm scared I could get low while I'm driving like these poor people or you're just eating, you got a pancreas, it works. You get up you make some eggs, you throw them in your face, you run out the door, and it's all good. People with diabetes are already 45 decisions into life and it's 730 and they haven't been in the shower yet. So they so they get that together. My daughter, you know, heads off to school and, you know, half an hour, 45 minutes later, she needs to know what her blood sugar's doing. So she's gonna have to look. So you see, my daughter looked down at her phone in the first in first class, she's not ignoring you, she's making sure that her blood sugar doesn't get out of whack. And then she's got to start thinking about like, Oh, I'm getting low, and I have gym two hours from now. And, and lunch is going to be in three hours. And, you know, I have to give myself insulin during social studies so that it's working for, you know, all that stuff, right. And they have to count their carbohydrates and their food. So I'm going to ask Jenny to explain like, what what they're doing, they're around their meals.

Jennifer Smith, CDE 55:41
Yeah. So I mean, carbohydrates are, it's just a big word for sugar, right? I mean, all all carbohydrate foods, like starchy foods, fruit, even vegetables have some kind of carbohydrate or sugar in and when we take insulin, insulin is meant primarily to cover the impact of carbohydrates. So timing is really important around that in terms of like you said, she might need to take her insulin in social studies so that by the time she gets to lunch, the insulin is already there, the way that our insulin today works, it's meant to meet with food in the system. But our insulin has to actually do what we call peaking, kind of get in get working get circulating in order for food, carbohydrates was which digest really fast. Once they start, you know, getting into the stomach, that insulin has to meet it at the right time. And so when we count our carbohydrates, it's a certain amount that goes along with a certain amount of insulin, so that our blood sugar doesn't get too high after that might involve looking at a food label that might involve looking up information on your phone. So that maybe you're you know, visiting an app that's got a calorie or a carb counter in it, you may see somebody again on their phone or their device looking something up, and I guarantee with diabetes and fits around a mealtime, it's not that they're ignoring you or trying to be rude, it's likely that they're looking for information, or maybe that they're telling their pump to do something important. Coming into that meal time.

Scott Benner 57:13
And if you stand in their way of doing that, then most people to feel like they fit in Next time won't do it, then you'll make their insulin late and they're going and their blood sugar's gonna be higher. Not everybody is me, I don't care what people think I would just do whatever, you know, and I've raised my daughter that way. I'm like, Oh, don't worry about them just do what you need to do. But But you have to understand that many, many people can't overcome social pressure. And so you pressure them even on the way you don't understand, you may send them in another direction. So they count all these carbs that give themselves their insulin. Now they're not sure if it's going to work, their blood sugar might go up and might go down. Now they might have to have their meter out to check their you know, they might have to poke a hole in their finger, make some blood come out, check it with a test trip, some people might be wearing a glucose monitor that's feeding their, their blood sugar live to them on their cell phone, there's a lot of gear they have. It's not, you can't restrict their access to their gear is is a big thing. Because I've seen people say like, Oh, just leave your bag here. Like I need that bag. I can't just leave it here. And that might mean if you're a teacher, that at recess for this year, you're gonna be wearing some kids bag over your shoulder at recess, and just I know it sucks, but just do it. And that's it. For for, for I was good place.

Jennifer Smith, CDE 58:29
Oh, I was gonna say along with that, like in terms of like, Oh, you have to leave your bag here, whatnot, I've worked with quite a number of adults, especially who are government employees weren't allowed to run their phones aren't allowed to have certain devices like a phone or whatnot within their government building. And I think the important thing, I mean, if you are certainly, you know, within the realm of being an employer, for people with type one I policies need to change then that's the biggest thing that I can say, because while the device itself might have pieces that you don't want within the building, you're really restricting their ability to have a healthy life in terms of also what you're asking them to do performance wise on the job, things change. And that

Scott Benner 59:11
goes right to what I was gonna say with like school nurses, like, I know you've been a school nurse for 25 years and no kid has ever died from type one diabetes, except the way that you took care of it 15 years ago is not the way people take care of it anymore. It's much more fluid. It's It's It's better. It just it really is and and saying to somebody Oh, it's okay. Or I'd rather their blood sugar be high than low? No, you wouldn't rather their blood sugar behind them low you'd rather the blood sugar be normal normal than either of those things. Stop finding either ores in your head, I don't want to go down the wrong road away from away from diabetes, but everything's not black, white. It's not this or that. There's all kinds of other options and gray areas and just because your brain picks I'd rather be high than library Rather than behind the load that doesn't make you right. And that doesn't mean that's the only option. There are a ton of options. Kids having to leave class, to go to the nurse to do diabetes related things. That's bad. Okay, I know you think it's Oh, they need to be around me. So they do it right, you need to everybody needs to teach them how to handle it on their own, because lose losing five or 10 minutes of math when you're too, you know, in second grade is one thing, but losing 10 minutes of advanced trigonometry is another thing, you know, like, or

Jennifer Smith, CDE 1:00:31
may miss the whole concept.

Scott Benner 1:00:32
Yes, and it's gone. And and, and if you learned how to manage on your own in the moment, you can just kind of find a need meet the need, keep going instead of wait till the needs a problem, go to the nurse spend a half an hour getting out of the problem going back much better to be proactive than reactive. And the going to the nurse thing all the time is reactive, it's waiting for a problem. These things can can be done in classrooms. It technology's amazing. My daughter has been managing her blood sugar through text messages with me for a decade. Right and, and she does no lie. Since the last day of second grade, my daughter who was a junior in high school has not been to the nurse's office for anything diabetes related in all that time.

Jennifer Smith, CDE 1:01:20
Well, and even in terms of like safety, too, you know, I know that there are a number of schools and families that have worked with Well, they have to send my child to treat the low blood sugar to the nurse's station, it's down three levels and across the building and whatnot. And like, blood sugar is low, they need to treat it in class. Now, there's no reason that you're sending a kid whose blood sugar is dropping, you know, for a five minute walk through the halls in order to go suck some juice down in a nurse so they can watch and make sure they drink the whole box. That's ridiculous. Like

Scott Benner 1:01:50
they're like, well, we'll send a kid with him like, Oh, great. So there'll be another eight year old there, because I'm always putting eight year olds in charge of important things. You know, hey, listen, you just go with Jenny. And if she passes out, you know what to do your aid. Exactly. 20 year old wouldn't know what to do, we'd be like, oh, what happened? Jenny fell over, we left her there. And she died. Like, you know, like, they just don't put kids in charge of stuff. It's weird. Like I get if it's a little like, Oh, she just wants to have somebody to go down with and it's all nice. But the nurse's office is for emergencies. And here's the crazy thing. Having Type One Diabetes is not an emergency, it's just a, it's just an extra thing you do during the day. So stop treating them like they're sick, Trump's stop treating them like they're broken. They're, they're just they're not, you know, and so and so listen, they're gonna have to get on the bus, or you're gonna have to drive home from work. And you're still thinking about your blood sugar. And so if someone comes to you and says, Look, I need you to watch my kid tonight for a couple of hours, or you're the babysitter, or a grandparent, it's very doable, someone's gonna say to you look, eight o'clock, test their blood sugar, you know, text me the number, I'll help you do what you do. If you know if the numbers in this range, that's cool, give him this much insulin, let him eat this snack, you know, and here's what the snack is. Just follow the instructions, the person giving you the instructions is fairly confident that they're that they're right. And questioning them all the time is bizarre, you have any idea how many school nurses fight with parents, like I've been taking care of this kid for 10 years. And you want to tell me how to do it now because that's how we've always done it here. Very strange way to come at something. I get that you don't want to get into a long conversation with a family who maybe doesn't understand and maybe least common denominator, it might make it easy for people who don't know, but instead of doing that to them, like what if you said to them, Hey, I think there's a way we could do this that your kid could be healthier or you know, that kind of thing. And, and I want to say to I'd like to give Jenny a chance here to talk about what it would feel like if her spouse had those kind of like anecdotal thoughts and was leaning on her all the time. First of all, I'd be dead. She'd bury him somewhere. It's over. She wouldn't take it. But But like, what would it be like for another adult who you respect in all other things, to suddenly have thoughts about your health that that aren't warranted or founded?

Jennifer Smith, CDE 1:04:21
It would be it would, it would feel horrible. I mean, this fact that somebody that like you said you care so much about and that you have a lot of good rapport and almost every other thing that you talk about and live with and decide about together. I mean, it would make you feel kind of countered, honestly, in terms of what you've been doing and also like visually how you feel like they're now seeing you. Like is it all about this is this all they see now is a really gosh, they're they're really worried about this or they feel like they don't have any, there's no confidence there. And what I in what I'm able to do for myself, you know, I've been managing this for 30 some years. They feel like I can't do it anymore, that they're constantly asking like, are you okay? Or did you just check your blood sugar before bed tonight? Because, you know, I heard your ducks come later

Scott Benner 1:05:13
today, feeling like feeling like someone looks at you and sees diabetes, not you is is is kind of crushing, you know, and that's another great little tool you're looking for a tip don't lead with how's your blood sugar every time you see somebody, something else first, how's the day? Isn't it sunny out, blah, blah, blah. Like even if you're the school nurse like just walking in there. It's a drudgery for kids, right to do that.

Jennifer Smith, CDE 1:05:36
Like it's very rare for my husband to actually like, ask, even if he hears like my Dexcom making a noise or something. It's very rare for him to ask I he does have the follow app on his phone. And even with that, he never I think it was maybe a month ago that he texted me to ask, you know, I've gotten these like urgent, low alerts. He's like, you know, and I've gotten a couple of them like, are you okay? It's kind of all he asked, or, you know, and I was like, yep, it's the sensor. That's totally off. I was like, I just restarted it this morning. Yeah, I actually texted him a picture of like, my actual, like, finger stick. I'm like, I'm like, 92. Totally fine. He's like, okay, I just wanted to make sure that he's like, cuz I keep getting them. And I just want to make sure that everything was okay. But other than that, usually it's not, you know, it's not even something I do.

Scott Benner 1:06:31
But it wouldn't be pleasant if if he was constantly.

Jennifer Smith, CDE 1:06:34
No, in fact, usually my my late native work, in which he doesn't work, he usually makes dinner, and he'll actually usually text me and ask, you know, hey, I was gonna make this this evening, you know? This is how much carbs in it, because you know, is that I need to Pre-Bolus or he'll have measured something for me. And this is how much was in it? Or, you know, when do you think you're going to be done, because he knows that the Pre-Bolus component is really important. So those kinds of pieces are really helpful. They're not, like, annoying to give example. It's

Scott Benner 1:07:08
a good example of him. Like, look, what are we saying, Listen, talk, ask questions, be empathetic, do things that are actually helpful, not that you think are helpful, right? I learned that from being married, by the way, that the things that I think my wife wants aren't necessarily the things that she wants. And that you know, and that I would be much more helpful if I did the things that would actually be beneficial to her and not the things that I feel would be beneficial, right. So listen, talk, ask questions, let them talk, realize it's hard for them as well. And like Jenny said, at the beginning, set a time to sit down and talk about this. And if you don't understand, keep asking and understand that things could continue to kind of morph and grow and change and that what you know, today to be true, very well may not be true a year from now. Right? You know, you've no idea how things evolve and change hormones and kids are huge stress is, is can sometimes be hard on your on your diabetes, but I really do want to make sure that no one leaves this feeling like oh, well, people with type one diabetes, I shouldn't hire them. I shouldn't put them on my kids baseball team. It's not the case. With with good support and understanding. I mean, this Okay, you guys are listening. Because somebody sent you this episode, you don't know this podcast, you don't know me. I've met thousands of people with type one diabetes in my life. And overall, some of the kindest, smartest tuned in people that I've ever met in my life, like, imagine how tuned in you are when you have to understand the inner workings of your body constantly. You want these people on your side, like they're, they're great teammates, they're there. They're great coworkers, there's just a little bit that they need you to understand. And then you'll find a rhythm. That's the other thing is like, this isn't forever, you'll find a rhythm together, whether you're, you know, you know, the parent of a friend of a kid or something like that, or whoever you are, in this scenario, you do this more times, it won't be a thing anymore, you'll just you'll have it, you know, and it's worth doing because you're going to get to know some great people who otherwise may be marginalized. And I don't know, just think about it, like you've an opportunity to put in a little bit of effort to figure something out. And keep a kid from being the kid who's not invited to a birthday party, or a person who loses a job that they're completely qualified for, because they got low at work, and nobody knew how to help them that made all of you nervous, you know, right, that that sort of thing. I want to say to that, if you really want to dig in more, there are episodes of the podcast called defining diabetes. And they're very short and they they define very specific things. So like if we set a word here, like Bolus or Pre-Bolus, that you didn't understand, it will explain that to you very simply. And if you really want to dig down deep and understand what people Thinking about when they're managing their blood sugars. There's an entire series of episodes called diabetes pro tip. Right? So it's diabetes pro tip Pre-Bolus diabetes pro tip something, there's maybe 20 of them by now, if you really want to understand what people with type one diabetes are thinking about, those episodes will take you well inside. And same thing for people listening who are like, I can't make anybody understand Pre-Bolus sing like just you could send them one of those. So

Jennifer Smith, CDE 1:10:27
yeah, I was actually going to mention that too. So yay.

Scott Benner 1:10:30
Thank you very much. And this is the first episode that Jenny and I recorded with a new microphone. And I have held in my excitement about how good she sounds the entire time we were doing this. So for regular listeners to the podcast, you they're all right now going like Jenny sounds so much better. And for everybody else, they're like, Huh, I didn't know that was a big deal.

Jennifer Smith, CDE 1:10:49
I asked Scott, if it was actually gonna get rid of my Wisconsin accent. And he's like, Yeah, probably not. Not. No, it'd be so much clearer.

Scott Benner 1:10:55
You talked earlier about the night, your husband when you work late, your husband cooks. And there were four words that if I hadn't spoken to you so much, I don't know that I would have known what you were saying.

Jennifer Smith, CDE 1:11:05
Oh, really?

Scott Benner 1:11:06
No, that's right. I said water a couple of times in here. So everybody who's not from Philly is like, What is wrong with this guy, thinking I'm having a stroke, probably. Anyway, I really hope this was valuable. I know, it's not possible for us to cover everything. But the goal was for you to be the person who's in some way supporting someone with Type One Diabetes, or once to understand better. And I hope that by listening to this, you have a better understanding, I think you will.

Jennifer Smith, CDE 1:11:34
And also know that you are really important in terms of the person's like feelings about things and that that background support piece, you're a really important part of that as long as you understand things in the way that you need in order to provide that support. So

Scott Benner 1:11:52
I think that in the last thing, I think I want to say is that as my dog barks, that you don't want to separate yourself from a person's life because you're scared of their thing. Like that hurts like it might because I talked about co parenting earlier and spouses who aren't as involved, I believe, sometimes they just don't want to mess up. So they step back, but you end up alienating the person with diabetes and stranding the person who's trying to help them. And and I know, it's a lot to figure out, but you could like Trust me, I know, as you're listening, you don't know me. But I'm, there's nothing special about me and I understand diabetes really well. And everything I know about it. And Jenny knows about it, we put into those pro tip episodes. So if you're just a dad or a mom, or you know who's like, I don't want to get involved, because I'll mess it up. You know, you're doing other things that I think you don't mean to be doing in your relationships. And if you understood it better, I think you could do better, but hell yeah, I really would. Anyway, I could keep talking about this forever. So let's just stop. Jenny, thank you very much for doing this with me. Of course. This is usually the place where I thank the sponsors and the guests, but instead, thank you for listening. Thank you for wanting to know more about type one diabetes, for spending the time to try to learn. If you have more questions, you can look for episodes of the show called defining diabetes, or other diabetes pro tip episodes. Just look right there in your podcast player and check it out. If you're looking for a place to pick around even a little further, there's a blog at Juicebox podcast.com. Thanks so much to Omni pod Dexcom touched by type one, the Contour Next One blood glucose meter. Lily's chocolates, g vote glucagon T one D exchange. I think that's it. That's all the sponsors we have. It's a lot of sponsors. Thank you for being sponsors. Seriously. Get a free no obligation demo of the AMI pod to blend in so tubulin tubeless insulin pump at my omnipod.com forward slash juice box. Their demo is absolutely free and has zero obligation. Learn more about the Dexcom g six continuous glucose monitor@dexcom.com forward slash juice box. Get what I think is the best blood glucose meter on the planet at Contour Next one.com forward slash juice box. lend your voice to insanely incredible Diabetes Research. T one d exchange.org. forward slash juice box. You want to pre mixed pre filled glucagon. It even comes in a hypo pen. It's amazing Jeeva glucagon.com forward slash juice box no more mixing up your glucagon payable and Lily's chocolates. Make some great chocolate with far less sugar in it than you expect. Their ads will begin in the second half of 2020 and they will be accompanied by a savings coupon so you can try some lilies and save some money. That's coming soon. Check out my absolutely favorite diabetes organization at touched by type one.org. I know this episode didn't quite fit in with the other diabetes pro tip episodes, but I do think this is the place to put it. As I think about everyone learning about their type one, at some point part of it becomes talking to other people about type one diabetes. So this is where this belongs. Thanks so much for listening. I'll see you soon.

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#364 Diabetes Pro Tip: Pregnancy

Diabetes Pro Tip: Pregnancy

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
Good and fresh.

Jennifer Smith, CDE 0:01
Because I'm not gonna sing this. I don't

Scott Benner 0:04
say oh, no, no, because this episode is going to be basically me going. Uh huh. And you saying a lot of different things. So okay, I want to if I can, yeah, do a protip episode about pregnancy. And I mean, like, pre planning leading up to it, what to expect how to prepare what to do, what's going to happen if this happens, what I do, and if we can, how do I do it without a glucose monitor? Is that all doable in the next hour? Right, well, let's do

Jennifer Smith, CDE 0:38
the mean without a continuous Yeah. Without

physically without knowing anything.

Scott Benner 0:44
That's possible. But isn't it funny? I call them glucose monitors or blood glucose monitor. Why do I do that? I don't know. Anyway, with without a CGM,

Unknown Speaker 0:53
gotcha, gotcha.

Scott Benner 0:54
Okay. Because I would like to, I want to do that as well. So anyway, I am, I'm going to be on the outside looking in here for this. But I do think that the place to start if you agree, is understanding what the pre planning is like? Because you can't, or you shouldn't, I'm guessing if you have type one diabetes, if you're the lady, you should not just if you can help it be in a situation where we got bored on Friday, and now we're going to have a kid. Right, right. There should be some more planning than that. So how far out? Does the planning have to be in is that maybe person the person and based on their situation? Hello, everyone. Welcome to Episode 364 of the Juicebox Podcast. This is the next in the diabetes pro tip series. And this is the 19th installment of that series. The diabetes pro tip series begins at Episode 210 with an episode called newly diagnosed or starting over. And then the episodes of course are in the body of the podcasts from they're they're spread out a little bit. But if you'd like to see them all in one place, you can find them at diabetes pro tip.com. Today, Jenny Smith and I will be doing a diabetes pro tip about pregnancy. That's the beginning then how do you make the baby with the type one. Please remember, as you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan. or becoming bold with insulin. There'll be just a little more air for the music and then we're gonna get back to Jenny.

My friend Jenny Smith has had Type One Diabetes for over 30 years. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitors. Jenny has also had a couple of babies while living with Type One Diabetes. And I'll tell you this, if you could certify being delightful and wonderful and lovely. Jenny would be a certified delightful, lovely and wonderful person. This episode of The Juicebox Podcast is sponsored by Omni pod, the tubeless insulin pump, you can get a free no obligation demo of the Omni pod today sent right to your door by going to my Omni pod.com forward slash juice box. When you do that, on the pod, we'll send you the demo to your house and not pressure you about it at all. You can just try it on and wear it and see what you think there's zero obligation free and no obligation equals can't lose my omnipod.com forward slash juicebox. The show is also sponsored by Dexcom, makers of the G six continuous glucose monitoring system. Find out more about the dexcom g six today@dexcom.com forward slash juicebox. Every day we make decisions about my daughter's insulin use. And those decisions come directly from the information that we get back from the dexcom g six dexcom.com forward slash juice box. Alright, let's settle in. We're going to talk about being pregnant with Type One Diabetes. Jenny's going to give you her opinions about how to do that best for your health and for your baby's health. And by the way, if you ask Jenny privately, if you pulled her aside and said, Hey, Jenny, this thing we tell people about you know how to manage while they're pregnant. Isn't that how you wish everybody was managing all the time? and Jenny would go, huh? I think so. So there's gonna be a lot in here for everyone. Not just those of you who are looking To make a baby. So how far out does the planning have to be in is that maybe person, the person and based on their situation?

Jennifer Smith, CDE 5:09
Yeah, and kind of like we always talk, it is sort of person to person, you know, overall, if you've all along had pretty good management, you've put lots of the tips and tricks into play, and you know how to your insulin works, you know how food and activity and all of those things work for you. Maybe three months, maybe, you know, maybe you get married, and it's a quick turnaround. And you're like, yeah, we're ready. And like you have everything in placing, you know, your glucose is where it should be. And I mean, there are other parameters to check to, especially with diabetes, things like thyroid, all of those things should definitely be checked and analyzed and evaluated prior. But everything checks out. Great. If not, then yes, it could be three months, it could be six months, it could take a year. You know, if you're somebody who's starting out you, you know that you and your partner really want to have a child, but you don't really have things in place to do that safely from a discussion maybe that you've had with your doctor or your ob team or whoever, then it might take a long time, because I think it takes going back to really like the pro tips episodes. Really, if you're trying to get things contained. That's that's the starting place. Because while while you know where you need to maybe get, or maybe you don't glucose target range for pregnancy, should really be started prior to conception. Because then it's not such a big changeover from saying, Okay, well, I've been aiming for a target of 80 to 180, let's say, right? Well, Pregnancy target is, you know, fasting 65 to 95. That's when you wake up in the morning, is that is that anyone see in the fours?

Scott Benner 7:00
Is that is that high fours,

Jennifer Smith, CDE 7:02
have to look for the E one C. listing. Because what exactly where that is, I think

Scott Benner 7:08
what we're talking about here is that you have to know how to manage your blood sugars tightly, and see some consistency through weeks and months. So that it's not just a fluke, like one month, you're just like, Oh, I did it. And you have to be able to do it without low blood sugars that are going to be dangerous for you or the baby to write, you know. And so yeah, get it right, and then prove it over and over again,

Unknown Speaker 7:33
over and over again, or

Scott Benner 7:34
your period through different meals, because you also could, I just finished what I really enjoyed, I haven't, I did a four part series with a pregnant person who has type one. And we interviewed together after her first trimester after second after third and just yesterday, when her baby is three months old. And so I went through the whole process with her to try to understand it. And her a one C was like 4.8 during her pregnancy. And she was describing needing insulin, more than double than what she normally needed. And that like swallowing that pill of like, Oh my god, there's way more insulin needed here. I have to do it. And yeah, I want to get to all that. But But yeah, to me, what you're saying is, you can't be a person who's got an A one C of nine and say I'm going to have a baby. I'll just get pregnant now. And I'll fix it. Because what could those things lead to? Like what what Ohio one season pregnancy lead to?

Jennifer Smith, CDE 8:36
So that's where the like the typical national standard is? A one c less than 7%. at conception, right? That's, that's the broad goal. And we aim for a little tighter than that. Because as you're kind of getting to, it's easier to have things tighter to begin with. Rather than say, Oh, goodness, I've not really done anything, or I didn't plan it. And I also haven't done anything. And now I really have to tighten everything up. That's a lot of change all at one time, along with a load of hormones impacting things at the same time. Yeah, so it's a lot, right. So the standard for under 7% at conception is really because what they've seen in research is the risks of things like early miscarriage, or many of the genetic problems that can come up from those early weeks of forming all of the different body systems, right, all of the different body organs and everything. That's what's happening in that first trimester. So the goal being under 7%, your risk is about even with the general population who doesn't have diabetes, for those same types of problems to happen, okay. Okay. How hire the one See, the more potential for early loss or or miscarriage, the more potential for the heart to not form the right way or any of the organ systems, you know, a lot of those genetic types of things could happen. Also a lot of things that are not specifically genetic, like they don't come from down the gene line. But they just happen because glucose levels aren't allowing the cells to divide and form into what they're supposed to do. So

Scott Benner 10:32
anywhere from a miscarriage to birth defects, correct. Okay. And is it a mortal lock that that's going to happen? I mean, you know, how, you know how some people are like, I smoked all through my pregnancy, and he's fine. Like that, like, Are there dumb luck people? And I'm not that I'm saying roll the dice on that. But, but were you definitely going to see something or maybe not even know, like, Is it possible? You know, is it is it out of this world to think that you could have a high one C and your child could develop asthma? And that, even though you're never going to know, it could have something to do with that? I guess that would be speculative. But that's

Jennifer Smith, CDE 11:08
it is yeah, complete speculation, because there's really not. There's a lot of research done on later outcomes in kids who've been, I guess, born from women who have had diabetes, right through pregnancy, but a lot of it is more assumption of putting information together, right? You're never really going to know and you know, the opposite of that. Let's say you, you did plan to really take care and adjust and make changes and you know, things do happen. People get pregnant

Scott Benner 11:43
and it happens. I've seen it happen personally. Yes, yeah. There we go. No one's planning on it. And the next thing you know, you're moving to a place to have more space.

Jennifer Smith, CDE 11:55
Because you're gonna need it. There's gonna be another person,

Scott Benner 11:58
someone by mistake got knocked up. Cuz, you know, long day, everybody missed each other. And the next thing you know, I gotta leave my condo. That's all.

Jennifer Smith, CDE 12:06
There you go.

So you know that it happens. And I mean, and I've worked with a number of women through pregnancy, who that has been the case while they were planning eventually wasn't really right now and a once you really was not where we would aim to have it be the highest I've had someone start a pregnancy, which was really not planned. It was a teen pregnancy

was 11.3.

Scott Benner 12:36
Wow. And now they come to you right away. And and no, it took too long.

Jennifer Smith, CDE 12:41
They didn't they, you know, they came in early second trimester it was, you know, they had gotten through their first trimester with ob team and some endocrine, I can't even remember how the family found integrated to, you know, get in contact and get some consultation. But I worked with her through her whole entire pregnancy. And we pretty quickly got her a one seat down. Yeah. And then, you know, by the end of pregnancy, her a one C was 5.7.

Scott Benner 13:11
Wow, that's great.

Jennifer Smith, CDE 13:12
So I mean, and she has, she's a beautiful little kid, now that there are no problems there. So can things be okay? Yes, they can. But the risk increases dramatically as the a one C and the glucose levels are not man.

Scott Benner 13:29
Yes, it's me, for me personally. And given that you can get pregnant by you know, not on purpose.

Jennifer Smith, CDE 13:36
by breathing out someone, yeah. That's what I was told.

Scott Benner 13:40
But I think what we're saying is that, you know, say you live in a nice, safe town, you don't really need to lock your door, but you do anyway, there are certain steps you take, just because why would we take the risk if we don't need to? Like, if we know we're going to have a baby, why would we start with a 71 seat and go, I bet I can get it down before something weird happens to the kid like, you know, like, like, let's not do that if we don't need to. Right. If we get caught in that situation, then, you know, figure it out, write it down? It's correct. It really is. It's such as it's, I don't know, I just I'm thinking back now to the conversation I had, that the person who I mentioned from the, you know, the four different moves to the pregnancy came to my attention because her first pregnancy ended in the midst of miscarriage. Right. And so and I've been contacted by people who there's a person I'm still hoping to get on the podcast, she found out that she had diabetes, because she was pregnant. Yeah, you know, like, she got pregnant. They ran a blood test. And they were like, oh, you're not just pregnant. You have type one diabetes. And yeah, I did not know prior to that. That person's doing terrific. has a really cute kid, and I'm hoping to have her on one day. But um, anyway, it's just Yeah.

Jennifer Smith, CDE 14:54
You know, the other thing I wanted to mention here too, is that despite all the things that you can do ahead of time. Sometimes things do happen anyway. Right? I mean, I, I'm actually my personal is our my first pregnancy I had a miscarriage. So, you know, and I did everything ahead of time I had been doing everything for several years before we were like, yes, we're like, finally ready to definitely have a child. Right. And I had done everything. And in fact, my, my maternal fetal medicine, which is a high risk ob doctor that typically manages through high risk pregnancies. You know, she was like, this has nothing to do with your diabetes. She said many, many early pregnancies. In fact, she said many women, they kind of their visit late, especially, they've been pretty regular. They're a little late in their in their, you know, period starting. And then it starts like five, seven days late. And they're kind of wondering, she said, oftentimes, those are very early miscarriage where the body actually didn't even start up anything truly. Many miscarriages in terms of a person without diabetes, and a person with diabetes, who has managed well, they're just because the body knows that there's not something quite right.

Scott Benner 16:16
It just feels like a false start. And that's right. Oh, that's

Jennifer Smith, CDE 16:19
and it's sad. Yeah. And so, you know, I mean, it's sad in any regard. But I think if you can do the things ahead of time to prevent it, then you know, that you've done everything possible,

Scott Benner 16:33
takes away from the idea of is this diabetes? Or is this something else that you can see yourself as more than having type one, say, you can see normal things that happen to people, I just saw someone recently who had a seizure, and thought it was because of their blood sugar, but then figured out, it was, you know, but that was their first thought was, oh, I must have my blood sugar must have gotten very low. And it turned out not to be right, you need to see yourself aside of diabetes. And the best way to do that is to make diabetes a lesser impact on you so that you're not always worried about is this happening because of that, right.

Jennifer Smith, CDE 17:09
And I think that that's a good point, though, for the pre, the pre conception, the pre planning stage, to know, the impact of this versus the impact of that versus, you know, I do this activity. And this happens, there's a lot that goes into that, beyond just having well managed blood sugars, there are a lot of other things to consider in that right. Nutrition is one of them. And then the other factors that are very common in type one, or autoimmune disorder is are your other autoimmune conditions? If you do have them? Are they well controlled? thyroid is another very big one that's really, really important to have tightly managed prior to conception. Because thyroid levels do change through pregnancy, and they will manage and evaluate and do more blood tests and adjust your medication. But you also have Chi, you have to have kind of a baseline right to know coming in. Yes, things are good.

Scott Benner 18:10
You know, it's funny, you mentioned that because just an hour ago, I took art and to get her blood test, because we've been managing her thyroid through her endo forever. But it's always just like, well, she's in range. It's fine. It started with still having a lot of, you know, side effects of what you would consider hypothyroidism. Sure, I finally found an endocrinologist who doesn't care exactly what the number says they care about how you feel. And so she's doing all these other things with her. And I hope to have that doctor on at some point when this process is done with Arden, but it's fascinating. She's taking. So Arden uses terrassen. And the amount of tear sent that her first doctor had her on is half of what the second doctor had her on. And she looked and she said yes, her numbers fine, but her symptoms are terrible. And she said given her weight, I would think that this should be more medication like so she was just she's very tuned into it. I just think that I would like to do a lot more about thyroid. On the podcast. I just you have to find the right people to talk to him. They're difficult to locate, you know? Yeah. But yes, so that as well. So what do I do I've and I don't want to skip over what Jenny just said about nutrition to like, Don't get so focused on your blood sugars that you're like, Wow, look at me. I've got a four eight I can eat all the Twinkies I want I learned how to keep my foot the kids gonna need like some greens and protein and stuff like that to grow it but I don't want to tell you how to plan your family. What I am wondering is I've decided I've got some money, I found a space I can put the kid nice. The Safe closet if I want to go out maybe they can't get hurt, you know, and moving forward. Do I make with the bangbang fun part or do I go find a doctor first? What's first?

Unknown Speaker 19:57
Yeah, that's

Jennifer Smith, CDE 19:58
again, the other part of it. Not only your management, having a team in place prior to conception is really, really important. Because I've had a number of women that I've worked with who have thought that they would just go with who was preferred with their insurance, right plan. And a number of them have transitioned once or even twice through pregnancy, because they were so unhappy with the care that they were receiving. A lot of it's specific to diabetes, and the consideration of diabetes in the pregnancy. I mean, ob teams, and definitely high risk, Maternal Fetal Medicine teams, they know pregnancy, but it really takes the right team to know pregnancy and diabetes together. And pregnancy and diabetes with Type One Diabetes is very different than gestational diabetes. And so if you've got a practitioner who, you know, says yes, or they're you call and you ask around to a couple of offices to talk to their nurses and get a bit of an idea about how the clinic runs and how appointments run and the doctor and experience and Oh, we've got lots and lots of experience with diabetes, what kind of diabetes right is the question you should be asking? Because they may have a good amount of gestational diabetes management experience. It's very different with type one,

Scott Benner 21:30
you don't want to get caught in the medical equivalent of Oh, my aunt has that? Yeah, correct. Right. Right. Type on your end as type two, it's different. Thanks for right.

Jennifer Smith, CDE 21:38
So do your shopping is really, you know, the case, the other piece, when you're doing your shopping, essentially, for your care team is, if you've got a really great endo that you're working with already, that would be a first, like, stop to actually ask them. Are you going to be my diabetes backup manager through this pregnancy? Because I've had some NGOs who defer to the Maternal Fetal Medicine team, which, that's okay. As long as the Maternal Fetal Medicine team has got it,

Scott Benner 22:13
man, they understand the diabetes piece,

Jennifer Smith, CDE 22:14
and they understand the diabetes pieces. Well, I've also, you know, and teams differ, you know, some ob is, once you get pregnant with high risk anything, they're hands off there, like you're going to high risk, high risk is going to manage the pregnancy for you.

We want to you

Yeah, right, we won't see you until baby is born. And you are post delivery time, right? Other teams, the OB sees you for the basic ob visits just for the monitoring, and that kind of stuff, you'll be shuttled away to Maternal Fetal Medicine, potentially, then for the high risk types of things. anatomy scans, fetal heart echoes all of the higher risk types of evaluations, especially in the third trimester. So it, it pays to ask around, it pays to even see if offices have a preconception consultation that they will do. So you can talk to the doctor and you can bring them this is how I manage I'm well managed. This is what I've done to get to the point of being ready. Because the more that you can show, any team like that, what you know, and how well you're doing, the more comfortable they're going to be helping you to manage the right way. Yeah,

so

yeah, it it takes, it takes looking.

Scott Benner 23:33
Okay. So if do some shopping, fine, we find the doctor. We, we we decide to move forward. We start doing what we're doing. I end up pregnant. Me, I don't know why. You don't pretend I'm a lady for a second. I'm pregnant now. And I have diabetes. So pretend everything about me is different. I'm a lady. I have diabetes. I'm pregnant. Now. How soon do I start? noticing like well, I noticed that my blood sugar's before I notice in my pregnancy test.

Jennifer Smith, CDE 24:05
For the most part in the first several weeks post conception, blood sugars are going to start to look wonky, wonky. And I think the easiest way to describe it is if a woman has experienced a rise of any kind in blood sugar during their normal monthly cycle, whether it's the three to five days before the couple days of once they get it or even around ovulation. Hormones from the start of pregnancy are significant and they will make a big difference in blood sugar. Most women in about the first week to let's call it five to six weeks will experience a rise in their insulin need because of those hormones and the impact that they have. So you know, if you haven't been trying and you know that you've been trying As soon as you know you're done try get on the these are my diabetes pregnancy targets that I'm aiming for if you haven't been doing it, you know so tightly prior to trying then definitely do it as soon as you're done try

you could be pregnant.

Scott Benner 25:18
Alright, let's take a detour for a second and and and let Jenny rant for a minute. Yeah. Why? It's might be something I know about her that she's never said here but why are there different ideas of health for pregnant people with type one diabetes and non pregnant people with type one diabetes if it's great for the baby isn't it great for all of us, huh?

Jennifer Smith, CDE 25:41
There you go. Yes, it opens up a whole can of worms, Pandora's box, so to speak,

Scott Benner 25:47
we have an hour. Let's start with Dexcom, shall we? How would you like to always know your number? With just a quick glance at your smart device, I'm talking about Apple, or I'm what's called Android, I'm talking about Apple or Android, you can see trend lines that show you where your glucose levels are headed, and how fast they're getting there. So you can take action. Before something goes, you know, in a way you don't want. You're going to be able to set customizable alerts and alarms. So you can decide what your optimal ranges were alarm for Arden's blood sugar at 70 and 120. Allowing us to stop highs and lows before they happen. You're going to be able to share glucose data from the user to up to 10 followers. That could be a mother, a father, a grandmother, a teacher, a school nurse, or just a well meaning friend 10 people of your choosing can see your blood sugar can be alerted if you're super low. Wouldn't it be nice to have a backup or to be able to make decisions about insulin for your child through text messages? Right. That's how we do it with Arden. You've heard me a million times help Arden with her lunch at school because it's like I'm there all the information that I would have if I was with her I have when I'm not with her and that makes decisions easier. dexcom.com forward slash juice box Get started today with the Dexcom g six continuous glucose monitor. This morning I helped one of Arden's friends with a serial bolus did it remotely. So I could see Arden's friend's blood sugar on her dexcom. And I knew she had an omni pod tubeless insulin pump, and we just set up an extended bolus to help tackle this cereal. So using the Dexcom data, we decided when to Pre-Bolus and using the Omni pod, we set up an extended Bolus, think we put in 70% of our insulin up front and allow the other 30% to go in over the next 30 minutes. That's just one thing you can do with an omni pod, set up an extended Bolus, you can also do Temp Basal increases and decreases. You know most insulin pumps are going to do that. But here's what on the pod does that the rest of them can't do on the pod can get you your insulin without tubing. It's tubeless. And that means that you can wear it wherever you want, right? You can show it off on your arm or hide it on your abdomen. It's up to you. Do you want people to see your insulin pump? Or don't you? Are you playing a sport for lifting weights? Or going for a run? Where would it be easiest for you? It'd be in a wedding next week. Put it where it won't be in the way. Do you see the versatility that the army pod gives you? You know, maybe I'm not doing such a good job of explaining it, you should try it for yourself. Go to my Omni pod.com forward slash juice box to get a free no obligation demo of the pod sent directly to you. You can actually wear a non functioning pod to see if what I'm saying is true. And once you decide that you'd like to go with Omni pod, you'd like to set up an extended bolus on an insulin pump that no one can see. It doesn't have tubing that you can go swimming with or running with or play soccer with or take a shower with just calling the pot back and tell them you want to keep going. But there's no obligation. There's no cost to try the demo. It's worth a shot. Miami pod.com forward slash juice box dexcom.com forward slash juice box links in your show notes at Juicebox podcast.com. Upgrade your stuff.

Jennifer Smith, CDE 29:51
It's a great question and it's one that's always kind of been like in the back of my mind even before my husband and I were like yes, it's like We definitely want to have a child within the next year, right. But I had already prior to that readiness, I had already been focusing on much tighter targets than my endo ever told me to aim for. knowing what I know the research that I've done information about long term outcomes of blood sugar management and control, right. And it was several years ago, actually, that I worked with a woman through her pregnancy and postpartum, she said to me, so my doctor wants me to loosen up my targets. And she's like, now that I've gone through pregnancy, managing the way that I did, and knowing what people without diabetes, what their body manages for them. Yeah, she's like, why would I go back? To loosen targets? Right? Why would I do that? And so it was, I mean, it really like brought it to the front of my head from like, a subconscious level of that's what I always aim for. So I guess I didn't really think about it. But that's right. It's it's a great question. Why are we not overall, consistently aiming? Whether you're a man or a woman? Why are we not consistently aiming for blood sugars that are in the non diabetic range? Why Why is that the case? Now, outside of this? There are some good reasons things like older adults, hypoglycemia unawareness, there are some medical types of conditions or certain scenarios, let's call it that could need a broader range and or a higher range for safety kinds of reasons. But the general population, it's a good thing to bring up because that's, it's true. Why are we aiming for less than 180? after meals, really, it should be lower, and I

Scott Benner 31:54
brought it up, because in my sort of peripheral understanding of this, this whole time that I've been in the diabetes space, I've always thought of it as people with people with I was gonna say, people with pregnancy, people who are getting pregnant, are somehow asked to do some superhuman thing with their health. That's not even necessary. And it took me a while to realize that's not what we're really saying. What we're saying is that every Listen, there's a lot of people have type one diabetes, and we all have different access to different technology insulins, all these different things. And so there's a, there's a blanket statement out there, like, if you're a one sees, you know, under this number, you're probably have a really great chance of being okay. As it gets lower your chances of problems get differently, you know, maybe they lessen, but then once in a while someone will put out a report, this is all there's no benefit in having a one c under this number for some reason, right. And I every and we've talked about on here before and I see that I think I don't, I don't believe that that's true. And I think that that's gonna be one of the things that 10 years from now someone's gonna say, oh, there was a report 10 years ago that said this was wrong. Yeah. But, uh, whoops. You know, and I also think that it's a, it's an emotional idea. Like, if someone has a seven, you don't want to make them feel like a failure, because they're not five and a half. Right? Right. Because they're not, but it doesn't mean that they should stop trying for the right not make themselves crazy, or, you know, like anything but right. But better goals. It's, I don't know, right? It just, you know, it's like, if I went out and ran a 300 yard dash today, I think I'd finish it. And I don't know, probably an hour and a half. And so right. Now, that might be my personal best. But I saw in the Olympics, it can be done, you know, in about seconds, about 15 seconds. And so I can't just sit here and say, Oh, I did the best ever, because that's my best because it's not and it's your health or your child's health. And you can't just I I mean, I think that one of the underlying concepts of this podcast is that you can't just say, oh, oh, it's fine. It's good.

Jennifer Smith, CDE 34:06
Or it's good enough.

Scott Benner 34:08
300 after pizza usually go to 400. That was a huge win.

Jennifer Smith, CDE 34:11
That was that right? And maybe that was a win. Maybe that was a win, you know, but if it's, yeah, it's totally better. Again, try again, try but try again. Yeah. And that's it. So yeah, that's a very good point to bring, I think target targets in pregnancy are in a way they are tighter because we do have certain parameters such as in the post meal time period. The targets are at one hour post meal, the goal is less than 140. At two hours post meal, it's less than 120. Yep. And really, if meals aren't in the picture, you should be averaging somewhere around you know, like the 65 to like 100 ish range. That's, that's, that's what you should be aiming for. Now, the person who's not pregnant if they're sitting at you know, 121 Great, they might feel really good at 121. in pregnancy, that's the high end of really where we would want to hover long term. So there are some parameter differences. And I think it has to do also with everything that the mother is doing to her body does have impact on the developing baby then

Scott Benner 35:21
right? Thank you. So line by that is 221 blood sugar. If if you're a person, like we've been able to see my wife's blood sugar in the past, my wife's blood sugar sits at like, 75 most of the time, right? Yeah. And so if, if, if that's what your normal is, and you're 121, I'm going to tell you some quick math tells me that's 46 points higher than what your body would have done without diabetes, which is a significant difference significant. It's a significant concentration of glucose in your blood, messing with the development of that baby. That's what I'm, or if you're not pregnant, messing with your life, you know, so

Jennifer Smith, CDE 36:02
as far as like messing with the baby, I think another piece to bring in is once the baby, I always find this concept really interesting that a pregnant woman who has diabetes, Type One Diabetes specifically has a pancreas that's doing pretty much nothing, right? The betas are either almost completely dead, or they're all gone. Right? what they have and are growing, this little person has a working pancreas inside of its body. Yeah, right. I mean, that's, it's amazing just to think of like a developing baby to begin with, but then to think of all the little parts and pieces that are growing and working the way that they're supposed to, in that like little being. And it's amazing to me, so when you consider blood sugar in pregnancy as well, your baby has a functioning pancreas very early on, right. And it starts to make insulin in response to what your body is telling its blood sugar. Right, so the flux of your blood sugar tells then how it kind of it goes along with how much glucose or how much food gets funneled in to the baby, the higher your glucose levels are, the higher the baby's glucose levels will get now, baby's glucose levels again, they're being controlled well within a normal non diabetic target, because that's what its body is doing. But the more the pancreas has to work to combat your high glucose levels, the more like swapped in glucose, the baby is going to be continually. And that's why like later on post delivery, if the baby's body has been so used to pumping out excess insulin all the time, as soon as the baby is born, and you've heard about babies have been born with really low blood sugar. Yeah, as soon as that umbilical cord is cut the mother's food source to the baby, it is gone. Right? And if the baby has come into delivery, with a pancreas that's spitting out excess insulin because the mother's glucose levels were so high, its blood sugars are going to plummet.

Scott Benner 38:17
Interesting. So that makes sense, obviously, but that's Yeah,

Jennifer Smith, CDE 38:21
interesting.

So that's another piece of like, we talked about the tight control in pregnancy. Tight is it's, it's there for a different reason, really. And so the ranges and how long glucose should stay at that elevated like 140 Mark, and then be back down, really into the normal range. There. There's reason for that.

Scott Benner 38:43
Yeah. It's funny, we all talk about it. So academically, like you know, 140 in the first hour 120 in the second hour back down and stable until I work glucose monitor and watch my body do it. It really didn't mean as much to me as it did say it right, because my understood my entire understanding of insulin is through Arden's perspective. Like I've never thought about it before about about somebody else's ever once. And there's no lie, your blood sugar just sits in the 80s, you know, and that pops up a little it comes back down, it comes back down and levels out and maybe you see a protein rise or something from fat later, it comes back up a little bit, but boom, right back down again. I ate my face off and couldn't get my blood sugar to go above 145 one, you know,

Jennifer Smith, CDE 39:35
that cage or something?

Scott Benner 39:37
Totally took in as much food as I could and I couldn't get over 135. So, you know, so, but how do we? You know, it's interesting, right? Because this podcast works because we talk to people honestly about stuff like this, but most people's perception of how to talk to people, so don't make anyone feel bad. And I don't want anyone to feel bad like Don't want someone to hear this and think I can't do that. Because I think you can. I think that I think that it's very possible that Jenny and I could have cottoned on and said, this is a diabetes protip episode about pregnancy, go back and listen to the other protests, and then have sex. Yeah.

Jennifer Smith, CDE 40:17
Right. We'll see

Scott Benner 40:18
you next time. It may be could have been that, really. And so if you're in the scenario right now, where you're listening to this, and you're like, Oh, I can't do this, or I have a different kind of diabetes, you probably don't, you know, like, you know, a blood sugar that sits stable at 7075 80. That's basal insulin, that's just getting your base. All right. And so it's real doable. So if you've made it this far, you must really want to have a baby. And, and it really is doable. I really do say go back to Episode 210, find the beginning of the pro tips, or go to diabetes, pro tip comm where they're all listed, and listen through them, I think you could change your management. Now. Here's the thing you've been pregnant, like you said a number of times with type one, is it more difficult? And by difficult, I mean, intensive with your focus and paying attention to your diabetes while you're pregnant, while you're not pregnant? And what's different about it, like what are people going to find once they're pregnant? So I've got my three months where I'm doing great, but now all of a sudden, there's a baby in there, what changes?

Jennifer Smith, CDE 41:26
It's more intense, I think, because of the impact of the hormones once you are pregnant, right? So you knew what you were doing? You knew, let's say you had your list of 30 awesome foods that you had figured out or 30 awesome meals, and you knew what to do for them and how to Bolus and you could knock out your 10 mile run, you know, twice a week and whatever, you figured it out hormones in the picture, change

Scott Benner 41:49
that. Okay.

Jennifer Smith, CDE 41:50
And so and that sounds kind of scary, but it's it's kind of a roll with it sort of thing, right? You and if you've learned things, again, from the pro tips, you've learned that don't let it just sit there fix it, right? Don't wait six days to see is this really a trend? If you've got a high blood sugar in pregnancy, Okay, one, it might be hormones, great. Okay, but then let's get it down. In many of the ways you've already tested, that you know how to get your blood sugar down, use those tools, you may need to use the tools, you know, in a more hyped up way, right, let's say you always knew that an angled arrow or a straight arrow up required an extra half a unit of insulin. With pregnancy hormones in the mix, maybe it requires a whole entire unit to offset that. Because those pregnancy hormones cause some insulin resistance. And in early pregnancy, it's a very quick, noticeable rise in insulin need. The end of the first trimester typically things dip off a little bit, they plateau as there's a transition from where the pregnancy hormones are made transitions from ovaries into your placenta, there's a little bit of a transition there. So you might run some lower blood sugars in late first trimester, before second trimester starts. And this is where I kind of call it like, if you've ever been at a theme park, and you get on the roller coaster, and you're right at the bottom, and it just starts to get you going up and you're up and you're up. And you keep climbing and you keep climbing. That's from second trimester or about like 18 ish plus weeks, that slow steady climb and insulin resistance, thus requiring more and more and more insulin over time. I mean, the heaviest resistance is definitely the third trimester, typically somewhere between about 30 to 32 weeks until about 36 weeks is the heaviest resistance. So you accommodate by making adjustments. And again, this is where that team that you set up to begin with should be a huge advantage to you. Because during pregnancy, Pregnancy brain or mommy brain is not a myth. Yeah, it is something that is there. You might get lost in in data. And so having a team that's really really good and willing and able to help you frequently through pregnancy with adjustments, despite you making your own, you may need a second set or a third set of eyes looking at things and being able to say that was great, but I think we could bump this a little bit more we could change it a little bit more here. Oh, this looks like it's happening now.

So I guess that's

Scott Benner 44:39
well, I was just as you were speaking, there's this conundrum around more insulin like you know, my body needs more all of a sudden give it more and we call it insulin resistance. And I'm always resistant to call it insulin resistance. I'm always thinking of it as just more need, but how do you convey that to a person Right, how does a person who believes that their bazel is one unit an hour? How can they make the leap to now believe it's two units an hour or that a meal that was three units is six units all of a sudden, like, That's such a huge leap in your head? And I wonder if it wouldn't help people just to think of insulin resistance as magical carbs that just appeared inside of your body, right? Like so. Like, instead of insulin resistance, pushing your fasting blood sugar from 85 to 150, think of, well, how many carbs would have moved me that far? Right? And how much insulin would I have used for those carbs? So that's in there, there's a math equation of how much insulin Do I need. But what I realized most about the podcast is that people need a way to think about it, right? They need a way that it makes sense to them. Because otherwise, they want an equation that's going to tell them when I'm pregnant, I need this percentage more, or the food's gonna need this much more. And I don't know that anyone's gonna give you that answer. The way you want it, so

Jennifer Smith, CDE 46:02
and so it's, I think it is it's more but I think if you know, when you're talking about like the math, as you said, If you know that your typical fasting now in pregnancy has been like 7881. And now all of a sudden, you're waking up 103109 110

that kind of range?

How much of an insulin adjustment is needed? In that overnight bazel? Then and where did it go up and and what to adjust. Because again, if you've done your homework ahead of pregnancy, you have an idea of where things started. And as you see those slight changes, you're more attuned to them in pregnancy, you just you see things on a super highlighted level, let's call it um, you know, you're paying more and more and more attention, you asked, you know, what's the difference between paying attention outside of pregnancy versus in pregnancy? I think just the pregnancy itself, drives a woman to think I'm now caring for another little being that's growing, and I have, I have the ability to let this baby develop really healthy from the get go. And I am a big part of that. Right? So you become really kind of like hyper focused on evaluating what's happening to your blood sugar. I mean, I looked at my I looked at my Dexcom more while I was pregnant, I was constantly like clicking to see, you know, what was going on? Where was it going? What was happening? Because one I wanted to be able to see, Is this normal or up? have I gotten a new load of like pregnancy impact? And do I need to make a shift now? Oh, look, this is like, day two, that I've now had to correct my blood sugar with a little more after lunchtime. I need to obviously add more insulin to my Bolus, I need to change my ratio. Did you have

Scott Benner 47:59
anxiety around that? Samantha mentioned in the episode that she sometimes felt like she was hurting the baby when her blood sugar would get high? Yeah, it was hard to deal with sometimes.

Jennifer Smith, CDE 48:09
And then I think that's a, I would say 95% of the women that I work with their pregnancy that's at at least once it's mentioned, well, my goodness, my blood sugar, you know, over the weekend, we we had like a baby shower, and I had like a bite of a cupcake and my blood sugar was 201. You know,

I got a doubt really, you know, right away.

Unknown Speaker 48:29
They're like, okay,

Jennifer Smith, CDE 48:29
that's that's okay. And they're, you know, they're very, I think the worry really is one they need to voice it. Because if it was concerning, yeah, too. It's the fact of worrying about that baby. Did that really high blood sugar for one hour? Cause my baby to now have three eyeballs or to now weigh at 12 pounds? No, it's it's more understanding that the consistent lengthy, high blood sugars, that's problematic. These one off, I mean, was my blood sugar sitting at 83, the entire pregnancy dislike flat, beautiful, I actually go back to my Dexcom records from that time because I printed them out. But I have them in like my pregnancy file.

Scott Benner 49:12
Just let everybody take a second to say to themselves personally, whether they're doing chores, the house working out or your grocery shopping to go. I knew Jenny had her Dexcom

Jennifer Smith, CDE 49:24
they're good. They're reference for me, as I work with people, and I was really glad having done that my first pregnancy, because we knew that we wanted more kids. Yeah. And I wanted to have a reference to be able to say, this is where things shifted. So once you get through a first pregnancy and you get an idea, yeah, I needed more around 20 weeks, I needed more again, in Basal and in Bolus and I needed to lengthen my Pre-Bolus that's another big one that shifts through pregnancy. You might you know, pre pregnancy you might do 1520 minutes. kind of works. Things are stable, that works really great once you're pregnant. As you get more pregnant, the time of Pre-Bolus gets longer and longer and longer. So by about mid pregnancy, you should be at about a 30 minute Pre-Bolus for most meals,

Scott Benner 50:22
how much of what's happening to a pregnant person is in in regards to their insulin use is that they're pregnant, that they're cooking a little person inside of them, they've got a bunch of hormones going on. And by the way, all of you have to be so impressed that I talk about this stuff so much. And I've never told that joke from the 80s. How do you make a hormone? I keep it inside every time I hear it, just so you know. And and so how much of this has to do with that? And how much does it have to do with gaining weight, too? Is that a part of it? So like, side of the diabetes piece, or a side of the pregnancy pace, you are gaining weight as well,

Jennifer Smith, CDE 50:58
right? you're gaining weight, and you should you should be gaining weight. And that is a very big piece of it. Yes.

And you know, healthy weight gain. If you've if you're at a really good target, happy healthy weight prior to pregnancy, you could gain somewhere between 20 to 3025 to 35 ish pounds in pregnancy, that would be considered normal. You have to expect, I guess you have to understand where does that wait to come from? Because in both of my pregnancies, my first pregnancy, I think I gained, I think it was 26 pounds. My second pregnancy, I gained 21 pounds. And you have to expect that let's say you have an eight pound baby, that's like a third to maybe half of your weekly depending, you know, that's a big chunk of that already now, like put on the floor plopped out after you delivered, right, hopefully not the floor, but right, it's like not on you anymore, right. And then you have to expect breast tissue development for lactation, you have a placenta, you have all the amniotic fluid, your fluid levels in your body double through pregnancy. That's why a lot of women experience swelling and whatnot in their legs. By the end of the day, at in late stages of pregnancy, your blood volume increases to pump all of that extra blood through you and the developing tissue and the baby. So you've got a lot of gain, that disappears, literally once you deliver the baby. So really, women end up you hear people complaining on his last five pounds, I can't seem to get rid of it after pray. That's really it is that game? Yeah, most women gain somewhere between about three to seven pounds of fat gain through pregnancy. And it's normal, your body should be doing that. Because if you plan to nurse or breastfeed your child, your body needs a reserve. So it's packing things away. So you can make plenty milk to supply this like

never ever,

ever empty baby.

Scott Benner 53:03
It was about to show off and say that that was for breastfeeding, but then you beat me to it. I was like, oh, something finally that you did.

Unknown Speaker 53:09
Yeah, but

Scott Benner 53:10
I can't prove it now. So it doesn't matter.

Jennifer Smith, CDE 53:12
And typically, as long as you nurse, you're usually most women are gonna retain about that three to five pounds. Once nursing is done, depending on how long you plan to nurse, usually, as long as you return to your normal activity, and you haven't been eating bonbons crazy, just because you want to typically that weight does come off once you're through nursing.

Scott Benner 53:36
Alright, so we've gotten through the pregnancy things have gone well, the day the delivery comes, please talk to your doctors well ahead of hand and understand that just speaking to your doctors doesn't mean that the nurse at the hospital is going to know that you're taking care of your blood sugar during your during your delivery, right. And it's going to if you've been doing such a good job this far be really weird to hand it off to somebody, you know, in the last 50 yards, and you're like I can see the end. Now you take care of my blood sugar. So you know, if you have a spouse or a family member, that you can, you know, teach how to help you or

Jennifer Smith, CDE 54:17
be there with you right in

Scott Benner 54:18
case something gets funky and they end up putting you out or something like that. I guess obviously, if they go to a C section, you're going to get handled like a surgery case then too, but if you're just having a regular vaginal birth, you should be able to manage your blood sugar through that time pretty

Jennifer Smith, CDE 54:32
well. And potentially even a C section you know, really? Yeah, really and hospital hospital. I think this is where protocol. Like you said initially, it's really important to have this talk with your team much sooner than delivery could possibly happen. I mean, they're always certain instances delivery at like 28 weeks or 30 weeks or whatever those are really, it's not often and that's a very specific scenario of management. Right. But for the most part with women that I work with your pregnancy, we establish and detail a labor and delivery plan. Okay, and it goes through. These are the expectations of glucose management, this is where you should target through dip through laboring and delivery. This is how much insulin adjustment you could expect to need to make. And again, every woman responds to laboring and delivery a little bit differently, some women's needs with the active nature of laboring, some women's needs go down by 50%, great use attempt, these will decrease, right? Some women's needs go up a little bit with the stress of all of the contractions and everything great. So you might need a little nudge kind of boluses of insulin in order to get a little bit, right. A little bit extra, whenever you're correcting in delivery, our recommendation is typically take about 50% of what your pump is recommending to correct a blood sugar while you're laboring, because, again, you're you're active. I mean, it's not like you're out running a marathon. But a pregnancy can take longer, or a delivery can take a lot longer than marathon takes a person, right? So you can expect that that correction that you're giving now is going to get active pretty quick, and it's going to have a faster impact on your blood sugar. Okay. So those are some of the things that we highlight. We also have a pattern established in the care plan, so that the doctors know where your rates are, what your sensitivity is going into the laboring and delivery. And then there's also a post partum part of the delivery plan that notes. Now insulin needs are decreased considerably. This is what your postpartum pattern should look like. A lot of the women I work with take it into their ob team, they get it signed off, it becomes part of their medical record. So then once they go into the hospital, that's the plan of care. The nurses know the targets. They don't have to continue to explain it over and over and over and over to all of the nurses as they're rotating through their eight to 12 hour shifts.

Scott Benner 57:13
Yeah, yeah, that's Samantha brought that up, too, that the first nursing staff was great after the pregnancy and then when they switched over, the next group didn't know what the first group knew. And then now you're explaining about your blood sugar's and that all gets and you've just had a baby said she was wasted from having the baby. Yes, the whole thing. Okay, so I have a couple more questions. And I know we're running out of time a little bit. Oh, we're good. Okay. Make the baby baby comes out. Everybody comes to the hospital, like oh my god, the baby made a baby. It's great. You see your friends of yours. You're like, Oh my god, they shouldn't even be near kids. Somehow you let them hold your baby. If you're younger, trust me that will happen when you're 25 or 30 year old friends is going to be holding me like that's probably a mistake letting Jimmy near the baby. And you know, so that all happens. Your home now. Now, you've got to take care of a baby. Yeah, I see a lot of people say well, it's hard to take care of the baby and my blood sugar the way I was taking care of it before. But it did you find I'm using you as an example here because you're very good at handling your blood sugar. Did you have trouble after you had a baby keeping carry yourself?

Jennifer Smith, CDE 58:21
I think you know, this is where again, planning your care team kind of thing comes into play. And while your mom your aunt, your best friend, you know your uncle's brother, who isn't really your uncle, but as a good friend that you call a friend or whatever it is. whoever's going to be there anyone post delivery that you trust, not Jimmy, who

Scott Benner 58:46
might get the baby to know

Jennifer Smith, CDE 58:49
he can't get the baby to but

somebody you're going to trust to be there once you come home from the hospital. Yeah, that is a really, it's good to plan something for at least a week, maybe even two weeks for someone to really be there to help with things because one delivery in and of itself is it's a labor. Yeah, that's why they call it labor. Right? It's it's work you'll you may with a vaginal delivery, as long as you're feeling okay. You may not be in the hospital for very long. If you have a C section delivery, C sections typically are about a three to three to four nights stay at it depends on healing and how things are going and all of that kind of stuff, right? But definitely when you get home. It is it's harder because you're now not taking care of just you and diabetes. Now, it's like you've got a second child, even though if this is your first real child. I always considered diabetes, kind of like a toddler that never really grows up. Like constantly sort of like caring for it right? And so it's almost like This first child diabetes gets pushed off in the corner and you're like, yeah, you're just gonna have to sit there for a bit, because mommy's gonna take care of

Scott Benner 1:00:06
you fine, he can do fine. You're gonna be fine.

Jennifer Smith, CDE 1:00:08
That's right, right. So you know, some things to kind of, along with that care person, they're beyond your spouse or your significant other, you know, whatever. Somebody else that can be there. So you can focus a little bit, because in that time period, especially the first month, things will change considerably with insulin sensitivity, especially if you're nursing. There are a lot of changes that will take place and blood sugars are going to look a little bit more roller coaster than you probably want. How important are blood sugars to the breastfeeding process? Does that impact the milk at all? So there's a lot of like thought around it a lot of research, that's sort of like a 5051 of the big things is, high blood sugars can actually impair good lactation. So if you leave your blood sugar's sitting high one, as we've talked previous episodes about, like hydration, your blood sugars are sitting high, you are not well hydrated, you are in a and milk is liquid, not not only a more coming out as your nursing, blood sugars are high, and you're not drinking enough. Oh, I see. So right. So hydration is really, really an important part of not only the blood sugar, but also continuing to be able to supply enough liquid that's going to get sucked out of your body. Yes.

Scott Benner 1:01:32
Mine too. If you've never had a baby before, they don't sleep the way real people sleep. So there's a tired factor that is really hard to put into words. It's not easy. Yeah. Yeah. So there's a lot going on. I mean, listen, we've gotten this far, I should probably tell you having kids is a huge mistake. You should? No, no, I don't mean that. Having them is great. It's getting them and taking care of them and keeping them alive and being you know, good to them and teaching them things. All that is a harsh show. But the kid itself is lovely. Like we just walk through the room, you're like, Oh, look, the kid. That's nice. Oh, yeah, in that moment, you don't think about when they're yelling at you when they're eight, or that you paid a guy who was probably homeless to be spider man and a third birthday party or something like that, like, those are the things you know, they want you to have a dog, and then your dog cuz you're like, oh, the kid should grow up with a dog. And then at 630 in the morning, everyone's asleep, but you and you're outside with a damn dog. You know, like, you know, I'm saying kids are great. A lot of what goes with it is hard.

Jennifer Smith, CDE 1:02:39
And it's hard. And especially right after your baby is heartbeat, especially if again, it's your first pregnancy. Yeah, it's it's a harder time. And this is again, where help comes in the form of also, like, pre planning. For the post delivery, the time period, you know, we I had done a number of like soups, and things that I could put in the freezer, that were easy to pull out, I knew the content of them, because I knew what was in them, I either made them or my mom made them. And I froze them if needed a heck of a lot easier. Also, having some of those foods that are definite known foods and how you react to them. Yeah, can be a huge help in the aftermath. So it's just not it's not more struggle, as you're already managing. Nursing a child putting a child to sleep, learning how to not like have pooped all over the place as you change them. You could

Scott Benner 1:03:37
experience postpartum depression, which is incredibly common. There's a lot that could happen. And by the way, a lot of guys will eventually turn into good fathers, but it doesn't, they don't have a nature provided switch, like I'm telling you, you're gonna have a baby and be like, this is the most important thing in the world. I watched what happened to my wife, she almost didn't even care that I was alive. When the baby came out. She was like, the baby's here. And that guy, you know, like, it was you if you're, you know, lucky, you're gonna get a great connection, and you're gonna feel that desire to take very good care. It takes guys longer to figure out how to be fathers than it takes women to figure out how to be mothers, generally speaking, even if you've got a guy, even if you're listening to right now you're like, no, my guys a good guy. Listen, I'm a good guy. It took me like two years to figure out how to be a good dad. Right? Like, you have to watch it and go, Okay, this is what I think they want. But this is what they actually need. There's a difference in there. I still struggle with To this day, I'll probably be struggling with it on my deathbed. I'll be 80 years old, just drifting off, and I'll hear someone in my family go, huh, he did that wrong, you know, like so. There's, there's that too. There's a lot that's going to happen to you when you have a baby and you're going to have diabetes too. And it is It would be very much my hope that you don't take all this wonderful stuff that you've learned pre planning for your pregnancy, through your pregnancy through your delivery, and just do that human thing of going that baby's more important than I am. And so I'll let my stuff wait.

Jennifer Smith, CDE 1:05:17
You know, I think a friend of mine who also has type one, she had a son prior to our first son. And she gave me some really good advice, and said, you know, what? If inter we're talking about like, low blood sugars around nursing, right, and she was like, you know, what, if my blood sugar is low, and the baby is screaming, that the baby is safe, not sitting like on the edge of the counter waiting to fall off, right? But like, fine, I am important to take care of myself, it's important that I take care of myself. I'm important too. I have to manage my low blood sugar. Maybe I have to manage my high blood sugar and the baby screaming, it's okay. Yeah, maybe it's gonna be okay. Screaming really. I mean, you're not going to let him scream for like three hours. But yes, in the case of 510 minutes, while you are taking care of you treating a low blood sugar, or even just bolusing for your meal before you actually sit down to eat it. That's another piece that I we talk a lot about Pre-Bolus thing in the typing in this podcast. And that's a piece that often goes out the window, because depending on what your schedule is, like, what your significant other schedule is, like, you may at times be home alone in your maternity leave with the baby.

Scott Benner 1:06:41
Yeah, I there's part of me that believes that we should be making a sign and selling it through the podcast that just says that's a real homie. You know how to like you see those beautiful signs and people's kitchens. It's like the cook is blah, blah, blah. So there should just be one that says Pre-Bolus, hung in people's homes so that it gets drilled into your head over and over again, because this is the easiest thing to mess up. Like, forget, you know, I did it this morning, this morning, we got back from the blood draw and Arden's like, I'm gonna have eggs and turkey bacon and toast. And I was like, does that mean I'm making it for you? And she's like, yeah, so I'm thinking, Well, I have an hour till Jenny and I record. And I can get this done by then. And I started focusing on getting it finished. And then I turned her and handed her a plate and thought I didn't give her any insulin

Jennifer Smith, CDE 1:07:25
damage. And of course, she didn't think of it either. Nobody thought of it.

Scott Benner 1:07:28
No, we'd gotten up super early to go to this blood draw place. And you know, like all this stuff. So I said to her, we're going to Bolus now and please eat the toast last that was like the best I could come up with, you know, in the moment, and we ended up having to use an extra unit to overcome the

Jennifer Smith, CDE 1:07:44
offset. Yeah.

Scott Benner 1:07:45
So okay, did we miss anything? Is there something in the back of your head burning?

Jennifer Smith, CDE 1:07:51
I'm trying to think of, maybe I guess the one last thing along with the postpartum time period is definitely stay connected to your care team. Um, you know, because that's, as you mentioned, already, there is potential for postpartum there's a difference between just being a little bit like, down in the aftermath of delivery. And true, like, you crawl in bed, and you're like, I don't, I don't want to do anything else. I, I will nurse the baby. But then the baby goes over here, it's almost like a, it's a disconnect that happens in true postpartum depression. Yeah. And so staying connected to your care team, is really, really important. Making sure you have those postpartum follow ups kind of scheduled before you even leave the hospital. It's really, really important. Maybe staying connected with your diabetes educator or your endocrine doctor, whoever was also a really good advantage through pregnancy, stay connected with them so that, you know, they can even nudge you may be to say, Hey, you know, can you just pop your your pump in and upload it and I can take a peek and I can make some recommendations for you.

Scott Benner 1:09:03
Let's hope you

Jennifer Smith, CDE 1:09:04
let somebody help you. Really? I think I'll go ahead

Scott Benner 1:09:09
if you think it can't happen to you. And my wife and I, we were just talking about this recently. She said for the first two weeks after our son was born, she had no feeling at all about having a baby. Like she just felt like we brought home a lamp. You know, like it really she's just like, I don't know, if I like this thing or not. Plug it in over there, leave it. We'll see how it goes. Hey, man, and she said that all of a sudden, one day, a couple of weeks in, I was at work. And she said she just was holding coal and just started crying. She's like the baby's The most important thing. Like it all hit her at once. It was almost like you expect it to happen when you need it. But it didn't happen to her right away. And then she had that like, Oh my god, I have a baby and I don't care. Like right we're not even not care but like there hasn't been this ramping up connection connection immediately. Right. Yeah. So and that's a rabbit hole. People could fall down especially if you've been depressed in the past or you know something like

Jennifer Smith, CDE 1:10:03
and especially with another condition to manage like diabetes. Yeah, there's there's more to manage than just connecting with this new little person. Yeah, so um, so stay connected

Scott Benner 1:10:14
to somebody that can walk you through it and if you're feeling that way have to tell somebody like don't hide it. Just tell somebody.

Jennifer Smith, CDE 1:10:21
Just tell

Scott Benner 1:10:22
right? Yeah, and I should say here as we finish up if anybody wanted to buy a book about pregnancy with Type One Diabetes, should they buy one called pregnancy with Type One Diabetes your month to month guide to blood sugar management available on Amazon and written by ginger Vieira and Jennifer Smith CDE should Oh, yeah. Okay.

Jennifer Smith, CDE 1:10:40
Yes, they should. Absolutely. I think the farthest I've heard that somebody purchased our book is Valley. Um, wait. Oh,

Bali. Bali? Yeah.

I'm in Bali.

Scott Benner 1:10:54
Yes. Bali the place in Vegas where I can lose my money in

Jennifer Smith, CDE 1:10:58
Bali. Bali. Yeah,

Scott Benner 1:11:00
there's someone in Bali right now has a little baby. A Bali baby. Yeah, yeah. She's pregnant. Oh, look at that. All right. Well, all I know is ginger has been on the show before you obviously know, Jenny, the books only 12 bucks. It definitely is worth your while.

Jennifer Smith, CDE 1:11:15
And it goes through everything kind of in a much more broad sense of what we've touched on kind of in each of the sections of print planning pregnancy, whatnot. It's, it's a good book. I'm glad that we did it.

Scott Benner 1:11:28
Well, I'm glad you're proud of the book. And I know it's, uh, I know that I can easily get behind you and ginger, ginger, who doesn't get to be on the show as much as I would like ginger on the show because she lives in a terrible part of the country with bad internet connections. So she's not allowed to come on. That's all because every time I interview it sounds like this. I can't do that. So you know, if ginger movie

Jennifer Smith, CDE 1:11:51
wants to listen to that,

Scott Benner 1:11:52
you'll know ginger moves. Because one day she'll be on the podcast more often. Because I have very fun conversations with her where I'm like, oh,

Jennifer Smith, CDE 1:11:59
Ginger is way fun.

Scott Benner 1:12:00
They're probably I'm like people would love to listen to this

Jennifer Smith, CDE 1:12:03
actually prompted me

to um, she her little girls like to scooter. Like the not electric ones. Yeah, the like, random razor or whatever. And so she I saw that she had posted something I liked their scooter so much that I just bought a cheap, like, used one myself. And I was like, I'm gonna buy myself a scooter. Like my boys loved a scooter. And so I bought myself one. It's green. It's super awesome. Yeah, many times I have to take it away from my seven year old because he's using my scooter. But it's

way fun, and it's better workout than I ever expected.

Scott Benner 1:12:36
We'll see. When you saw ginger with the scooter online. That's how you reacted. I just sent her a sarcastic text message suggesting that she stole it from a child.

Jennifer Smith, CDE 1:12:47
I think I saw that. Yes,

Scott Benner 1:12:49
I put it online. I was like, I know you stole that from someone. And then she's so funny. She came back. She's like he looked like he was done with it. And so anyway, Ginger moves somewhere with good internet connection, you can be on the podcast. Thank you very much, Jennifer, I will talk to you. I know you're in a rush. So I'll talk to you soon. All right. Huge thanks to Omni pod index comm for sponsoring this episode of the Juicebox Podcast. There are links to all of the sponsors right there in the show notes of your podcast app, or you can find them at Juicebox podcast.com. But if you'd like to get a free no obligation demo of the Omni pod sent directly to you my on the pod.com forward slash juice box. And to find out more about the Dexcom g six continuous glucose monitor dexcom.com forward slash juice box.

Jenny and gingers book, Pregnancy with Type One Diabetes, your month to month guide to blood sugar management is on sale at Amazon. It's a little under $12. And you should pick it up if you're thinking of having a baby or if you're having one right now. Jenny Smith works for integrated diabetes and she is for hire. Check her out at integrated diabetes.com

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#350 Diabetes Pro Tip: Bump and Nudge II

Diabetes Pro Tip: Bump and Nudge II

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

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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, everybody. Welcome to the 18th installment of our diabetes pro tip series. This episode is diabetes pro tip, bump and nudge. This episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and the Contour Next One blood glucose meter, you may be eligible for an absolutely free meter. Find out more at Contour Next one.com and the Dexcom g six continuous glucose monitor the same CGM that my daughter has been wearing for years. Find out about that@dexcom.com forward slash juice box. And of course, the tubeless insulin pump. The end all be all of insulin pumps. The Omni pod is available at my Omni pod.com Ford slash juice box. And when you get there, you can get a free no obligation demo of the Omni pod sent directly to you. Welcome to another edition of our diabetes pro tip episodes. Today, I and Jenny Smith. You know Jenny from integrated diabetes, Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. Jenny is absolutely the bestest. She is. If you don't believe me, go back to Episode 210. And start over with the diabetes pro tips. Honestly, if you're just finding this series, check out diabetes pro tip comm you'll be able to see them all or like I said, you can go back to Episode 210 right there in your podcast player to get started. these really are designed to be listened to in order. If you're new to this, starting at the 17th episode of the pro tip episodes is probably not the way to go. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please also always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Alright, you ready to talk about bumping and nudging? Here we go. So let's start like this. I just put up like the 300 and 45th episode of the show, which is mind bending to me honestly, what was the first first year first up because you'd been blogging for a long time before I blogged from 2007 consistently until 2015 when the podcast started. And now I have to admit the blocks a little more of a way of me sharing, I don't sit down and write from my heart as much as I used to. Because, right, it's so much easier to do on the podcast, and you reach more people. But I blogged for that many years the blog was strong, it was a million million and a half clicks a year 111 block of maybe two or three years, I got to like 2 million clicks, which was really big. But then I saw it kind of like trending away. And so in 2015 I started the podcast. And I really thought it was going to be I guess this isn't maybe a neat place to say this. I thought I was going to go back and read my most popular blog posts, like into this microphone. Because that was my expectation for us. Like, you know, some of these blog posts are really helpful to people. I'll read them and make them audio. I did that for 20 minutes one time, stopped, deleted the file and was like, This is stupid. Yeah, yeah. Nobody cares about this.

Jennifer Smith, CDE 3:40
And well, I can't say there are some people that would care about that. I've actually got a couple of clients who really, they love the podcast because their their audio. And when they read things, it doesn't stick. And so they have to reread and reread. And finally some of the adults that I've got are like, I just put the book down, because they're like, I can't keep reading. I'm not retaining it. But if I hear it, it's there. It's in my brain. So

Scott Benner 4:08
no, I hear that I and I should just felt boring to me. Like I thought someone would like it. But I mean, if I'm being honest, I was trying to reach more people, not just, you know, people who would literally be willing to listen to somebody read something dry. You know what I mean? Right? I mean, at least put some music behind it. I can imagine how funny that would be if I was reading with music behind me and there was like this guy's talking about it would be terrible. Yeah. And then it picked up and picked up. And, and like, you know, but for people who may be coming in late to it. After a number of years of the podcast, I started thinking there's like a real system here. Like I knew that while I was blogging, but when I could hear it, I thought oh no, it's this piece in this piece and these these four or five ideas and when you bring them together, there are 5581 say like you just do these things and that's what happens you know, and I And I had had you on the show, maybe twice. Mm hmm. And I always wanted you to be back. I thought she's the best guest I've ever had. Like, I mean, honestly, you, when you when it comes to diabetes, you and I think exactly alike about it from two completely different perspectives, which is right, weird and interest. Nice, right? Yeah. And it's nice. And so I was somewhere one day, and I thought I know what I'm going to do. I'm going to take the tenants of the podcast and break them down with Jenny, if she wants to do this, I'm going to get a hold of her and see if she wants to do it. And that was a weird leap for me, because until then, my real belief was that if you just listen to all the episodes, you'd hear things come up very kind of organically, and they would stick to your brain better, because you heard them conversationally, and I was a little scared to do just specifically with more bulleted specific topics, but then I realized I could do it with you. Because we have a rapport. Like, I've talked to other people in the podcast, and I try to talk them about stuff. And I find I'm stopping and starting and like, I'm like, oh, they're talking over me. I'm talking over them. I can't find a vibe, you know, I knew I had that with you. So I contacted you. And you were like, I'll do it. And at the time, I was like, it'll be like six or seven, Jenny. And I sent you a little list and you were really great. Like you took the list and you were like, I'd put them in this order. I think they make more sense in this order. And I was like, Okay, great. And now I'm going to look, I'm actually going to diabetes, pro tip comm now because that little idea now has its own website, which is even strange. It's great. 1-234-567-8910 1112 1314 16 there are 17 pro tips. And this is going to be the 18th one, and then we're going to do pregnancy and we're gonna keep going right? And it's spawned like defining diabetes, which I never thought was a thing that was needed until this one person sent me a note that said, Hey, I wanted to thank you. Because until I listened to the podcast, I didn't realize I was on MDI. They took and you told me that right. And that made me think, wow, there's some people really not understand some of the terms we're using. Let's define the terms for them, but simply not an hour conversation. Right. Right. A little bit. Anyway,

Jennifer Smith, CDE 7:21
through that also not a not a dictionary definition. I think, as I said, you know, before some people get things because they hear it in a different way, or they read it in a different way. And I think the great thing about the podcast too, even with the pro tips, part of it is that it's broken down much more like layman's, applicable, it's, it's not what you get in a typical doctor education clinic. And we did

Scott Benner 7:45
it a couple of times. And I was like, Damn, this is good. It went so well that I was like, give me your address. Jennifer, I am sending you a microphone.

Unknown Speaker 7:54
sounds better.

Scott Benner 7:55
Let's go. But one of the things that we did was bump and nudge, it gets talked about in the episodes, but it doesn't have its own episode. And I always kind of thought that was okay. Until in the last year. I looked at algorithm based pumping, and saw how my bumping and nudging was too much. It had gotten out of hand and it didn't realize it because it was so easy for us to do that. We never looked back at the root cause of why we were bumping and nudging. And so this has been bothering me for like six months now. And I said the Jenny, I need a pro tip episode on this because not that bumping and nudging is a bad idea. It's a terrific idea. Right, but you need to understand it more. It's a bigger topic than I thought it was. Mm hmm.

Jennifer Smith, CDE 8:49
And I think you really I think you really like realized it when you guys started using to do it yourself. Right? As

Scott Benner 8:58
soon as day one came.

Jennifer Smith, CDE 9:01
We talked and I was like, how much are you using Temp Basal? Yes. How much? are you adding little micro corrections or adjustments or whatnot through the day? And you're like, Oh,

Scott Benner 9:10
I don't know. I never thought about it before. So So Jenny's The one who said it to me, because we were trying to find it was such an easy thing. Like you guys would hear me say before, like, I don't know, artists, insulin to carb ratio doesn't matter to me. I don't know what anything is. none of it matters, right? I know, we're basal rate. And I know food. I look at food and I see food. But

Jennifer Smith, CDE 9:31
you're like, Oh, that looks like five units. Oh, that looks like I got to split it up and give some now and a whole bunch later. Right.

Scott Benner 9:37
Right. And being flexible, which is terrific and important. What I didn't realize it was doing to me. You have to kind of like step back and look at a timeline of months, maybe the develop into years is that at some point, you know, meal x took two units at this bazel rate of whatever it was and Then it took two and a half, and three and three and a half and four. But it happens so slowly, I didn't notice. I didn't realize that I was now bolusing, six units for something I used the Bolus for units work. I mean, I did. But I never stopped and thought, I wonder how much of this meal insulin is attacking the food and how much of it is staying in our system for hours afterwards, and maybe acting as bazel. Right. And so I had bumped so much with insulin that I lost track of what Arden's baseline need was, it didn't matter because we were doing so well. But it didn't matter. And I learned that when I when I said, I don't this algorithm won't work. This is ridiculous. Her blood sugar's all over the place, right? It's just crazy. And it's because I had lost track of how much insulin we were actually using versus how much my settings said, we were using that did I say that clearly how

Jennifer Smith, CDE 10:57
much was actually needed, versus how much you were just intuitively correcting with right adding a little bit extra because you needed it, but not really realizing Hmm. In general, I'm always adding extra here. And it probably is a setting issue. It's an I shouldn't be adding this much more all the time,

Scott Benner 11:18
right. And it becomes such a way of life. Right? I didn't think of it anymore. So now, I want to leave that thought here. And we're going to come back to it later. Because I do think that being fluid around diabetes is incredibly important. And that you can't just keep resetting your basal rates every day for all the variables that are going to come up in your world. And I noticed a long time ago, that idea that concept is what causes people problems, right? The idea of like, well, I'll go to my doctor. And we'll find a basal rate. And oh, my doctor was great. They saw between 2am and 4am, we had some highs. So we moved our bazel, up at 1am or 12:30am. And it worked. But then they started getting low, you know, a couple weeks later, but I just fed the lows for two and a half months, then went back to the doctor, the doctor moved the bazel again, and that's how people that was considered a successful use of your physician and your insulin, right. And it probably still is in many people's minds. I saw that and thought this doesn't work. I don't want to be involved in this. And I've said it before. And I'll say it again, this podcast is a it's partly in place, because I don't like the math around diabetes. I don't like the waiting. I don't like the we'll wait and see. I don't all that stuff makes me uncomfortable. Like all the things that you're supposed to do. I just was always like, oh, that seems wrong. Like I don't I don't want to do that.

Jennifer Smith, CDE 12:53
within it. I think you also have to say that the technology that we have available today makes it more user friendly for people to learn how to make their own adjustments in the here and now. That might work then for a while and then they make more adjustments. But you know, years ago without technology, going to the doctor every three months, every six months, like I used to do when I was younger? That that was the wait to make adjustments now. Could we have taken and done more the more data analysis in between the doctor visits we could have in my mom actually did. She was like, This isn't working anymore? Let's just adjust here, let's Nope, you need some more insulin here. And I don't

I don't think she ever like,

you know, set it like that. But her explanation was always like, Well, this was just too high. And if it's going to be too high again tomorrow, then you're just gonna use more insulin for the next meal. Right? Right.

Unknown Speaker 13:51
Okay, my Whatever. I'm

Scott Benner 13:53
with you, you're cooking, right? So you seem to care. So I'm gonna go right here. But another issue in the space of people talking about diabetes in the past. It's kind of it's a number of folds, but one of them is that nobody ever wants to say too much, right? They're always like, worried that they'll say something, and it won't apply to the third person that hears it. And I so that was part of what the pro tips were for was to take information down to a point where you know what this really does apply to everyone. Like not saying things that only worked for you or me or noticing that my daughter needed something different after she started getting your period than she did before. And taking the time to talk through those differences were writing about it is hard because you write something down. It's static, you know, I write a blog post around about my nine year old daughter. somebody reads it, it now feels like a rule. I don't spend time with my nine year old child is going to be the applicable method that I use and you don't take time to philosophize out that I bet you this will be different when she's 15. And you just Writing doesn't work that way. But you can conversate that way. And so a lot of people in the past who were impacting the diabetes space, were parents of younger children, who until your child gets older, you don't realize you think this is diabetes, but this is diabetes. In a kid that's not, I don't know, like, coursing with hormones or growing as much as you think. Or as active as you believe they are. Like, you know, like, when you're eight, you're like, Oh, my kid plays baseball, like yeah, okay, wait, or your kid really plays baseball, like like, Right Whale, they weigh 200 pounds, and they're flying around, it's 110 degrees outside, and they're throwing things through walls like it, it's an impact on your body weight, or your kids playing ice hockey, as a high schooler, like, you know what I mean? Like, we've got

Jennifer Smith, CDE 15:51
breakfast from six until eight in the morning, they've got practice, again, from you know, four until eight, six o'clock at night. I mean, sometimes, those practices I'm amazed with the kids that I work with, their parents are like, Oh, she's got tennis for you know, from six o'clock until 730. And then she goes off to school, then she's got another practice from four to six and like, like, seriously, like, she's the tennis thrower.

Scott Benner 16:15
That's how you make a tennis pro. One in a million times. The other 990,000 times is how you make a kid who hates tennis eventually, right?

Unknown Speaker 16:25
Okay, exactly what

Scott Benner 16:27
these people were doing great stuff. And they were talking about these ideas. But they didn't realize how specific they were to the age group they were talking about. And, and I think that that's why this longer conversation why I mentioned how long the podcast has been up has been important, because in my heart as crazy as it sounds, I think if you want to have great success with your type one, diabetes, go back to episode one. And you'll listen through, because you'll take a journey through somebody who's talking about a kid with a nine or 10 year old body that, you know, you actually can hear in this podcast art and get older art and grow art and have problems her start to get her period, changing devices, meters, like all the way through me. And I know it sounds crazy, but in, you know, 347 hours as of today, I think when it's over, you'll go Okay, and then your kids just gonna have anyone seeing the fives it like if you want it to be or maybe you you'll make an adjustment. It'll be in the sixes, right? It'll also works for adults. And that was I was really cool. I hadn't had that, like greater expectation. I thought it would, but it didn't have a lot of a lot of adults weren't reading me as a blogger. You know, do you mean, there were some, but there weren't a lot. Anyway, at some point, I recognized that I was really long winded, I guess the people there, I guess there are used to that. Not at this point. But it's a very long way of saying that you can't just set your basal rates up, set up your insulin to carb ratios, and go with that's what the pump told me. And that's what the doctor told me to put in the pump, right? Because things are going to change, sometimes day to day, sometimes hour to hour activity to activity, there are going to be too many variables. And you can't stop every time like imagine if I had to get up tomorrow and go today is going to be a sedentary day. I will now go fix all of my basal rates for sedentary and change my insulin to carb ratio for sedentary By the way, do you realize that that could end up for some people meaning more for some people meaning less, it could end up meaning less for Basal and more for insulin to carb or vice depending who you are and what you eat. And so when all that exists, what ends up happening to people is they just go Ah, today was a good day, today was a bad day. Right? They leave the settings and then they have good days and bad days. And what I thought was, if we stay fluid enough, you can almost be ahead of what's happening and make these adjustments. Okay, right. All right. That's a long, long explanation. But to me, that's what led me to bumping and nudging. Now, for context, while Jenny and I are talking about it, I think of bumping as using insulin, bumping your blood sugar down. And I think of nudging as nudging your blood sugar up with carbs. Jenny thinks of it the exact opposite way. So don't get confused. If one of us does one thing and one of us does the other. But in the end, the idea is to keep yourself between these smaller parameters. Yeah, right, arrange a smaller range.

Jennifer Smith, CDE 19:39
And the range is defined by you,

Scott Benner 19:41
right? Doesn't matter to me what range you choose.

Jennifer Smith, CDE 19:44
Right? It's it's your chosen range, but the idea is to use food in an insulin and in a good advantage in both directions so that you can stay within that target,

Scott Benner 19:56
right. And so some of the things I learned as I

Jennifer Smith, CDE 19:59
was able to could see us by the way, your hands

Scott Benner 20:03
around good, bad. Oh my god, you keep saying that out loud. And someone's gonna ask you to turn this into a YouTube thing and then we're gonna be on camera and neither of us are going to be happy about that. Because you're gonna have to hang up that stuff behind you and I'm gonna have to get a haircut right. So

Jennifer Smith, CDE 20:19
which by the way is just like bags and you know, it's not random strangeness. It's like bags and like coats. That's it.

Scott Benner 20:26
Jenny is now apologizing for something you can't say that's very Midwest of you. By the way. You're like, Oh, it's it's not unclutter. It's nice people, it's a very important thing for the children hanging their bags.

Jennifer Smith, CDE 20:40
The easiest for them to get to.

Scott Benner 20:43
We're off topic now. So anyway, so I'm gonna do a little thing here. And please jump in whenever you want. In my mind, I take the I guess I should first say that I understand this would be more difficult without a continuous glucose monitor. I really do. What I'm saying would be harder, you could do it. I still think you could do it, you'd have to do it a little less aggressively, probably. And you'd be testing more but but what in my mind, what I see is that graph that goes along my daughter's Dexcom has a high line and a low line. And I take those lines from running. Oh, my God, which way is this? Is this parallel? to the ground? Yeah, it is. Right? I correct? Well, yes, I was asleep a lot in high school, nothing to this podcast, just so you know. So I take those two lines that are spaced apart evenly, that run parallel to the ground, and I flip them up on their end. So they're a little vertical, they're running vertical in my mind. And now they are a video game. To me. They're like driving, right? There are it's a football field, I don't want to run out of bounds on the left, or on the right. That's all it is. To me. There's in play and out of play. So when I describe it, and like talks, I discussed it like driving is interesting because it's um, you make a lot of imperceivable moves when you're driving that if you jerk the wheel around, you swerve and you don't want to do that. So as you notice yourself approaching a, you know, the shoulder, you just turn the wheel back a tiny little bit and you come back into toe again, right, like you're, you're it comes back. Same thing with you know, if you're going to cross into the other lane, you just come back a little bit, you don't jerk the wheel around, because if you drive the wheel around, you end up in the in the ditch or in the other lane, or you end up with much higher or lower blood sugar's than you mean. Right? So I bumped myself back, I bump, you know, a nudge back. I used that insulin to help Arden stay in range. The problem that comes with jerking the wheel is that once you're in the ditch, you have to overcorrect again. And then you're on the roller coaster. Right now I've said rollercoaster which now takes the graph back to being you know, the way it belongs in your mind for a second not vertically, but you're up and you're down and you're just overcorrecting the whole way with food with insulin, and you get the timing of the insulin so far off that some people eat done doesn't stop. It goes, it goes into and you just keep going that way. Yeah. For for not just for a day, for weeks and months and lifetimes of just that's what my blood sugar does. It bounces up and down. And people say that it's heartbreaking me like No, just turn the wheel a little less like right, like, right, it's okay. I understand how it happens. And I think there are ways out of it. So I want to talk about some functional ways out of it. I guess people should understand the difference between a falling and a drifting blood sugar. So why don't you talk about that for a second?

Jennifer Smith, CDE 23:57
Yeah, drifting is slow. And dropping is fast. I think that's the easiest way, drifting down and or even drifting up, happens gradually over time. So again, if you're using a continuous monitor of any kind, you'll see this slow, continual change in blood sugar, little little nudges, kind of happening over the course of time. And since on all CGM, each of those little dots on your graph represents about five minutes, each little drift up or down. Could be a change in glucose over a five minute time period, right? Yeah. So drifting being slower means you have more time to implement a change right now. That could also be a smaller change, than having to make drastic adjustments with food or insulin, right. When you're doing Dropping or rapidly rising kind of the opposite. That requires more whether it's more insulin or more food, it requires more because the change is happening very quickly now. And usually I see drifts happening either with a horizontal arrow on your CGM. Or you might get that slight angled arrow either down or up. That's I consider those drips, yeah, I consider drops or rapid rises, when you've got arrows pointing straight up or straight down. That's fast. So you need to do something now.

Scott Benner 25:40
And so to start with lows, if you're 75, straight down on Dexcom, that could mean two or three points per minute. Is that right? So every five minute change, you could go, you could end up moving 50 up to 15 points or something like that. I don't hold me to that. But fast is the point. Correct? So yeah, you don't like you know, when you're, when you're 80, straight down, you don't say, Hey, you know what, I'm just gonna, I'm gonna do a Temp Basal off for a half an hour here, that's not going to work. And there's reasons prior in the diabetes pro tip episodes, seriously, listen to them in order that will make sense to as why. But if you're just drifting down one of those situations where it's noon, and you're 100, and then it's 1215, and you're 95, and you just got this little drift happening, you could possibly be at the end of a bolus that ended up being a little too strong, right. And maybe there's, you know, an imperceivable amount of insulin left in there, quarter of a unit, a half unit, depending on your size, maybe it's two units if you're an adult, right. And if you take away your basal insulin right there, it's possible that you can trade that extra bolus that's left and create. What I sometimes talk about is like a black hole of Basal, right? So keeping in mind that everything you do with your insulin now is for later because insulin doesn't work immediately. Like, what if at noon, when you started to see that drift down, you took some bazel away, and that created a level. So now at the end of that, too strong Bolus was acting as your bazel. And your bazel wasn't there. But keeping in mind, if you shut your bezel off at noon, it's not going to probably start impacting you for at least one o'clock. Yeah, right for a while. But at the same time, you were only drifting Anyway, it was probably going to take you an hour to get from 100 to 60, where you'd then be drinking a juice. But instead, as you're hitting that 70 Mark, you're all the sudden into the timeframe where there's no basal insulin, and you just level out, that doesn't always work. I've done it and thought I'm a genius. And I've done it and thought, Oh, I missed that like, but trial and error will teach you because there are a lot of different.

Jennifer Smith, CDE 28:01
And I think some some visual into that, too. As you said, You know, sometimes it works. And sometimes it didn't quite hit the mark. But you weren't necessarily wrong to take these away. I think especially again, with the technology that we have today, not only can you see the drift, but if you are somebody who's using an insulin pump, you also have the visibility of insulin on board, right. So if you have an idea how much insulin is left, like you said, an earlier bolus, maybe you were a little heavy handed in it, or it was just you know too much, because you haven't quite figured out your ratios, or maybe it was, you know, a guesstimate completely, or whatever it was, you still have some insulin on board, if you have an idea of where your bazel is right now. And you know how much insulin is on board, taking bazel away could substitute for some of the iob that's left? Absolutely. And like you said it could nicely smooth things out and you just drift into a stable blood sugar. That might work if you've got iob of one and your basal rate at that point is like point eight or point nine or even one that could absolutely smooth out if you've got three units of iob and your Basil's at point five, not gonna hold you to half you in a way it's going to help a little but you're still going to ask him

Scott Benner 29:17
to get the result. Right. All right. So in my mind's eye Alright, we're gonna do it quick. The Contour Next One blood glucose meter is the finest blood glucose meter I've ever used with my daughter. It is small, but it fits in your hand nicely. It's easy to read during the night or during the day has a bright light for when you're checking blood sugars at night. And the blood test strips allow you to go back in to get a little more blood if you miss the first time. All these things together, coupled with the fantastic accuracy of this meter, make it my choice. That's the best blood glucose meter out there. Go to Contour Next one.com Now to find out if you're eligible for a free meter. And if not, meters aren't that expensive. Just ask your doctor say something like, hey, I've been using this old janky meter forever, I want to get it Contour. Next One. And I bet you that it'll be about as much effort as you have to put into it. All right, what's next Dexcom g six continuous glucose monitor is what's next, see the direction and speed of your blood sugar at a glance right there on your iPhone or Android share a loved one's blood sugars, those same numbers, directions and speeds with up to 10 people. That means that if your child has type one diabetes, or you do, you can share your blood sugars, and the alarms and everything that goes with it, it's up to 10 loved ones, through the magic of the internet. dexcom.com forward slash juice box to find out more. This is an indispensable tool, you hear me talk about it all the time. If you don't have a dexcom Today is the day to find out if you can, if you should, if you will. And you can and you should. And you will dexcom.com forward slash juice box. My omnipod.com forward slash juice box will offer you a free, no obligation demo of the Omni pod right there, come right to your house. That's an insulin pump demonstration that you can wear. Try on, see what you think, in the comfort of your own home. After that, you decide I want this on the pop thing, contact them back and you're like, yo, yo, let's do it. And you move forward where you don't want it. They don't bother you. It's no big deal, right? They're not gonna, they're not gonna, you know, I'm saying they're not gonna shake you down. They're like, come on, we sent you a demo, they're not like that, but just want you to have the demo. If you like it, you like it. If you don't, you don't, but you be the judge. And you can be that judge by going to my omnipod.com Ford slash juicebox. There are also links in the show notes of your podcast player, and that Juicebox podcast.com. Please support the sponsors. And now back to bumping and nudging.

In my mind's eye, years ago, I used to think of scales. So think of like the scales of justice, where each side has this big dish and you could, you know, pile weight, you know, and so think of insulin on one side, and carbs on the other or weight, the weight of your blood sugar on the other. And you can kind of imagine yourself throwing in a little on one dish and going Oh, that was too heavy and taking a little out. And you know, we're taking some out, like that's how I think of insulin, like put a little intake a little out. You know, and then, you know, I say a lot on the podcast, and that I think we talked too much just about how insulin impacts the number. And there's so many other things to think about how food impacts insulin, right, like, like, you'll hear me tell a story about like, creating a drop, and then catching it with food. And right to me, that's how the food impacts the insulin. And it's just, there's, it's a weird thing. But there's a lot of different ways to think about what's going on that little game that's going on in your body between, you know, the sugar that's in your blood, or that's going to be in your blood or the foods that's going to put the sugar there and the insulin that's trying to take it out again. So anyway, you can bump with a Temp Basal, right? It just is like to take it away like Jenny and I have explained. Also the same goes for going up. If you see, you know, a 90 that turns into a 95 it turns into 100 it's going to be one of those slow drifts up. There's nothing worse than that, in my opinion, I always think of it as the, um, the mountain climber on the prices right? That because every time you're like it's gonna stop, there's no way that guys falling off the end, they're gonna figure this out like and it just totally who and it just goes on forever, right? And then that little guy just pops off the end. And then Drew Carey takes your money back from you and you're screwed. You walk away. Right? So like, you see this 90 blood sugar that's drifting up. Two hours later, it's 250. And you think I did something? Yeah, like I should have done something, you know, maybe that's a Temp Basal increase, maybe it's a Bolus. But all All I know is that a 120 or one, you know, whatever you wherever you decide to be diagonal up, can be brought back to a stable 90 with far less insulin than it will take to address the 252 hours later. Correct. And when you're only using small bumps of insulin, you're very less likely to cause a low and so when you see that 120 To me, that's you approaching, you know the the line on the side of the road. And you just want to come back almost an imperceivable amount with the wheel or the tiniest bit of insulin to bring it back in line now, right? I have done this with my daughter for years with an amazing amount of success. And I've seen people, scores of people who listen to this podcast do it too. And it works. It really does. But the idea is that you're not always going to get your Bolus, right. You're not always going to have the right amount of Basal going for your specific situation that's happening right then in there. Correct? Wow, I'm more I think you're with me. Don't tell your husband.

Jennifer Smith, CDE 35:45
I think you know, and two of you want, if you wanted to add some definition to like people always ask, Well, how much? How much when I start to see this drift? How much should I add? Well, you know, one, again, everybody's physiology is a bit different your sensitivity to insulin. So a point one might be what works for you a point seven might be what needs to be in, you know, somebody else's case. But I think if you give definition to direction of blood sugar, again, using today's technology, beneficially. And you mentioned before, kind of the directional arrows, and what that indicates, as far as a drift up or a drift down, and how much is happening. If you're wondering how much to add with insulin, when you do start to see a drift up, the angled arrow is really kind of a rate of change of about one to two points per minute. Right? So if you're aiming to see, okay, I'm at 90, I've not done anything. And now my blood sugar, it looks like it's starting to come up. I don't know why, but it's happening. If you excuse me, you know, experience that a 90 with a angled arrow up one to two points per minute in the next 30 minutes. If you do nothing, your blood sugar could be 30 to 60 points higher. Right? Right. So if you use that to your advantage, and you say, Okay, I could be on the low end 30 points higher, it could be one at 120, I kind of know what I would use to offset, you know, a 50 point rise in my blood sugar, maybe I need to just add a little bit like point two, or maybe I need to take a point five extra, you know, that's kind of a way that's a little bit more, if you're the math person right, may help you to get a little bit more precise and not worry about then ending up on the downdraft later.

Scott Benner 37:39
And if you are me, what you do is you try something and then the next time you try something different if that didn't work, right, less or more, yes, just more or less whatever try. And it's important to remember that it's not, you're not going to get it right the first time. And even if you do get it right the first time, the variables may change the second time it becomes an art, like it really does like just knowing how much to push just a little bit like you know, you squeeze too tight and it's too much you're not laughing you're let go. And and using Jenny's example right there and flipping it to getting lower. You don't always need the whole juice box, you don't always need every piece of candy in the package that sometimes you can nudge with food, right. And I know that 15 carbs 15 minutes is the rule of thumb. But if you're using a CGM, you can see it better. You don't have to 15 carbs 15 minutes is when people are blind to what their blood sugar is. And they're trying to stop themselves from having a seizure. That's important. I'm not saying no. Okay, and I'm not telling you not to do it. But I'm telling you that if you do it, and find yourself to be 300 later, you didn't need all 15 carbs, right. And, by the way, if you do get into a panicky situation, and you've got to just horkan carbs, I'm not going to tell you to not do it. What I am going to tell you is that when you when the dust settles, you need to figure out how much insulin you've got a bolus for that food you just took, right right like maybe not for all of it, but some of its going to need insulin you have to stop the bouncing you've got to make sure you can't get on that roller coaster like don't get on it. it's maddening. And the only way off of that roller coaster By the way, in my opinion is you stop taking in carbs and you get back to level again, like like I can listen I can knock Arden off that roller coaster while she's still eating but that is a ninja level event. Like like you need to be really good at that to stop to stop a roller coaster in between food

Jennifer Smith, CDE 39:46
and you'll get it takes understanding sensitivity. Are you very well known and I'm sure Arden does as well. You guys know her sensitivity and you've paid enough attention to say okay, we need this much right now. Because of all of these other variables in the picture, or you need this much less right now or whatnot, and you do get to that level when you start to pay enough attention, you know, to your personal sensitivity and the precision that you need. Um, I think you know, the 15 and 15 is age old. I mean, that's what I started with 32 years ago, it's 15 and 15. And we didn't have the visibility of blood sugar changes at that point, we didn't or even

Scott Benner 40:26
meter by the way that only takes a tiny drop of blood, right isn't and this beautiful Lance that, you know, it doesn't hurt that badly while you're doing it, you were right stabbing yourself with a sword dumping or dumping your rocks in a way we kind of

Jennifer Smith, CDE 40:42
called it the guillotine It was like this big old drone that like hammered down on your finger. And like I would like I would like inch my finger like slightly away from like the little underneath platform from where it like jabbed my finger, I would like just hold it back. So it didn't quite jab it. That was my like, adjustment to the land set depth, right, that was the only adjustment I had at that point. But your point being really that you have some tools now that allow you a lot more precision in how you bump in know you do. And with smart tools. Today, too, I think this is a good place to mention it is with our, with our smart hybrid closed loop systems that are on the market today. That adjustment with carb, the 15 and 15 is 100% too much 100% too much with most of these systems on the market today. When you're adding a little bit of carbohydrate, we're talking like a little bit of carb, because the system has already been helping you coming into this drop in blood sugar. So 15 grams, hundred percent is going to be way too much. You might need two or three Skittles, which is like two or three grams of carbs, you might need half of a glucose tablet, you might need a quarter of a juice juice box. So

Scott Benner 42:06
what you know, I want to go a little deeper into this, like faster rises and falls. You see people online every once in a while it's very common, actually. They're injecting and they all put in the measurement for their slow acting insulin as fast acting by mistake like oh, I take like you'll see an adult like I take 20 units of Lantus every day. And I just gave myself 20 units of novolog. And they're online. What do I do? What do I do what I do? And I'm just like, figure out how many carbs that takes and eat them. Like, that makes sense to me. Right and and give that a try. So say you do that. Not that but say you have a meal that really needed five units. And for some reason you thought seven. And the next thing you know, 40 minutes later, there's an arrow down on your CGM, you're falling fast, you need to eat the carbs to stop that. So it's a much bigger nudge, right? It's more like a nudge with a sledgehammer now, and you need to eat the carbs to stop that. In the same thought process. If you miss greatly with that insulin, it should have been seven and you use five and 30 minutes later, your two arrows straight up. I don't mess around there. Like I am stopping those arrows, right? And you think, Well, okay, see, I don't know, say was literally like a mistake you meant to do seven and you did five she's like, okay, two units, that two units isn't going to do it anymore. Because you have all this momentum, right? Like there's this momentum, you have to stop the momentum, you've got a higher number than you thought about when you decided on the insulin the first time, there's a lot to think about. There's the number, the momentum and getting you back without making you Well, there are times that I'll take what I think the amount is that's going to stop the arrows plus the amount that's going to change the number back to where I want it to be. And I realize if I give her this insulin right now, she's going to end up low later. Mm hmm. But I still give it to her. And then there's a moment where I take the bazel away away, right? To try to do what I mentioned earlier, eat up that extra. So I needed all that force from that insulin up front because of the situation we're in. But I don't need the tail of it later. But the tails going to be there. So what if I took her bazel away so that it wasn't bazel plus the tail, right? And so I get the benefit of the up front without the kick in the pants. Again, what comes later, right, right. That's another way to think of bumping and nudging in my opinion. So there's any teacher

Jennifer Smith, CDE 44:51
learning that tools it takes learning the tools to use, you know, things like people who are using MDI or multiple things injections, it becomes harder because you can't take these away. Yes, it's injected, it's there. So if you are heavy handed with a correction, because you really want that double arrow to stop, you're going to be have to be, you have to be ready on the back end with carbs. To stop right

Scott Benner 45:17
off, you want to do you want to know what a pump does that multiple MDI doesn't do, it stops you from having to take a bunch of injections, it allows you to do temporary basal increases, decreases, extended boluses. That's it. And you know, you don't have to carry pens with you and right, wonder if your insulin is getting warm while you're at the water park. Like Like that's, that's, that's it? I mean, I think, to me, it sounds like a very little bit. But it's a lot. If you're going to be reactive like this and stay flexible and things like that. I'm not saying you can't do it with injections, I know plenty of people who do you have a very commonly are adults, or, you know, kids who just don't care about the injections, because there's going to be a moment when you're going to put in a little insulin and realize it's not enough and have to put in a little more. And now that's two needles, you know, instead of two pushes of a button, I think there are

Jennifer Smith, CDE 46:13
certain kinds of food which we've talked about, in other episodes, reading a pump to cover differently over a longer period of time. With a with an injection, you can't do that, unless you're willing to just take more injections with more insulin.

Scott Benner 46:26
So now here's the next thing about bumping and nudging, you get what you expect a little bit. And I want to just before I tell you about that, I want to tell you that what Jenny just said, shouldn't have been glossed over. There's other parts to this, I'm talking about bumping and nudging within a fairly perfect system, meaning I have my daughter's bazel well in hand, I'm not that far off with her meal boluses. If I missed like, we're not just like running around with our hair on fire gun, like, yeah, you know, like, and I just

Jennifer Smith, CDE 46:54
hear feed here, give more here.

Scott Benner 46:58
be insane. And I do mean this without sounding like I'm trying to pimp the the content, if you go back and start at the beginning of the pro tips. Or if you want to power Listen, by the way, those of you who start at the beginning of the podcast and listen right through, you have my respect, I thank you very much. Because why the downloads are so good, and it really helps me. So thank you very much. But at least go back to the pro tips and listen through, because then you'll get to a point where bumping and nudging really is a good tool.

Jennifer Smith, CDE 47:30
But it doesn't happen not hundred percent of the time. It's not always gonna work.

Scott Benner 47:35
Right, right. Like there are gonna be times where it doesn't work. And it happened to me last night with Chinese food. So we came out of a pump change and went right into Chinese food, which just shows my arrogance, really, because I was like, this won't be a problem. But what I didn't take into account is this for the past 72 hours, Arden has just needed more insulin, like there are foods that don't make Arden spike that are making your spike for the last three days. I don't know why it's not important, why it's just happening, you know, like, like, soup, just having like a clam chowder out of a cannon. I can't get it under like 250, like 45 minutes later, like, I'm like what's happening, you know, and it'll go away. Because the day before this started, her blood sugar was like 85 for 17 hours in a row. So, you know, it'll, it'll cycle through, we'll figure it out. Maybe it'll end up being a variable that needs adjusting. I don't think it will be but I'll see. But that's not the point. The point is, we came from a pod change, right into Chinese food. And boy, look at that. I did not do well with that. And so I want to first tell you that when I say oh my god, I did not do well with that. What I mean is her blood sugar was between like 175 and 210 for a number of hours afterwards. I know you're thinking Shut up. I would love that. Right? Yeah, yeah, people are like, Really? That's your complaints? Not a complaint. It's just I missed, right. Right. And there was the time five hours honestly, where she needed I bolused a bunch of times and I never once got it right I was never strong enough with it. And I have to admit, it was because I was tired and I didn't want to be up all night. So I just I erred a little on the side of caution not a lot and and I kept pushing. So but I did not cause her to get low afterwards, which was which is a win. It felt like that to me and I'll tell you why. And I want to put this in this episode too. So very recently, I wore the Dexcom Pro continuous glucose monitor and I was very happy to find out that I am apparently not pre diabetic as I was texting Jenny's I was putting I'm like you know this I'm gonna find out I have type two diabetes, right like I'm I was very happy that I didn't. Obviously, I was grateful, but I got to see What a pancreas does when it's doing what it's supposed to do. And I have to tell you that there is nothing I ate no matter how low glycemic or high glycemic, they got my blood sugar over. Yeah, I mean, I told Jenna I had eat two pieces of cake to get my blood sugar to like 135 141 time, right? But as I look back over the day, my standard deviation was like 11. You know, my, my average blood sugar was I don't like 90 or 80 or something 85 or 90, right. But I still went up a little gracefully 120 most of the time back down again. You know, that happened when I ate. And I had already changed my mind about my expectations for Arden. It over the last couple of years, you guys have heard me loosen up on the idea of like stopping every spike like I don't, I'm not a flatline person. I don't feel like my daughter's blood sugar needs to be a flatline, I do believe that she has type one diabetes, and that letting a flatline get away from you turns into a disaster that takes way too long to fix, which is why all this is important. But I don't care if she eats in her blood sugar goes up to 121 30 and comes back down again. I think that's fine. As long as she's not low on the other side, I start getting a little hinky over 140 in my heart, I'm a little much, you know. And it's not to say I wouldn't try to stop at 120 if I thought I had the answer to it. But I don't know it just it seems important for me to tell you that if your pancreas is working your blood sugar is not always at five, it you know, it just isn't. So be a little easy on yourself, have good expectations, but understand that my daughter, you your kid, Jenny, you don't have the mechanism to adjust, it isn't just going to put the brakes on for you. So that's why you can't you know, I say you'll ever get high if you don't get high. That's sort of what I mean by that, like stop the arrows stop before it starts, right?

Jennifer Smith, CDE 52:03
Well into this kind of experience that you had to I think one of the funny texts from you was relative to Pre-Bolus.

Scott Benner 52:13
Yeah, I was

Jennifer Smith, CDE 52:14
tested in your life. I Pre-Bolus better than my own prank. Pre-Bolus is I think is what your text was because you had seen a difference in what you had done for the same meal for Arden with her Pre-Bolus Yes, versus what your own pancreas was doing. And I think you said something like, I wish I could get my pancreas to Pre-Bolus. And I was like, well, your pancreas kind of does actually do that the working pancreas body kind of does do this like pre Bolus. Bolus, right?

Scott Benner 52:47
So Jenny's tried to explain to me I got if this is true, she said that sometimes when you smell food or you get hungry, your body anticipates that your blood sugar is going to go up and gets a little working on things prior. Right? That's really cool. But what she's pointing out and I am a little embarrassed is that after a couple of days, I would look at, like I'd be cooking and I would think to myself, like I think rubbing my stomach wherever I thought my pancreas was, you know, I don't even know. And so I was just like, man, now do it. Now, brother. We're about to have pasta. Go, you know. But no, Jenny's not wrong. And I'm not bragging. I was better at stopping spikes with Arden than my body was for me. And I was really, like, comforted by that. You know, I was like, wow, this, this post on that podcast really works. And I was I was just really, I was really thrilled. You know, it's like, wow, I because it felt like it wasn't overkill. Do you know what I mean by that, like, I thought, Oh, I'm not taking this too seriously. I'm taking this the right amount of serious, right. And it just really was it was a it was a great experience. I want to thank Dexcom for letting me wear the Pro. And it was really nice. I was the only that that was only worn by national media outlet people. And me, and I was very grateful. And I really appreciate that Dexcom appreciates the podcast and sees it as what it is. Yeah, not, not not I'm just not a guy with a podcast. Like I was like, wow, they really like made me feel good. Anyway, point is the last point, I guess if all this is, is that bumping and nudging is terrific. It's great while you're learning things, while you're learning about how to Bolus for meals while you're learning about activities. You know, all that stuff's great, but it's not a long term, everyday solution. And I didn't recognize that people wouldn't translate out of it eventually, like just go like, oh, okay, um, didn't happen to me. You know, I said at the beginning I didn't realize it wasn't happening to me. And then finally, and again, I have to thank the people listening, because we started the private Facebook group, which I'm not particularly active in. But see, every day, I started watching and this is when I said to Jenny, I need a pro tip on pumping. And I was like, Oh my god, these people are doing this all the time, like, constantly. I'm like, it's not for constantly. And so here we are. So if you heard us do defining diabetes, bumping nudge, which literally just came out last week, I said in there, what I didn't realize about bumping and dodging when I started doing it was that it's as much of a diagnostic tool as it is, you know, a tool for keeping your blood sugar's in order. Correct. So Jenny, when you start seeing yourself pumping and nudging too much, what should you be doing?

Jennifer Smith, CDE 55:53
Then you should be going back.

Personally, what I do, and with the people that I work with, what I do in their in data analysis is, I look at a cumulative and I say, over the course of this time, whether it's a week, or three days, or two months, or whatever we want to look at together, we can say, well, goodness, we've had a lot more use of Temp Basal that are not specific to like activity reason, or a food based reason, like you always eat Friday night pizza, or whatever it is, and you need that kind of a tool for but goodness we're having, there's a lot of corrections happening after meals all the time, or there's a lot of you know, you're using Temp Basal to cut off insulin all the time, if that's happening. And while it might be proving to give you the results that you want, there's a bigger picture, they're saying there's either not enough insulin for some reason now. So we need more in the bazel. Or we need to add a change to your ratios so that you do get more robust type of Bolus for food. And then you shouldn't have to follow it so heavily after and adjust with extra insulin all the time. So that becomes looking at information and saying, for whatever reason, I just need more bazel. Now let's pop it into place for whatever reason, my ratios look like they're not covering well, or they're covering too much. Let's take some away, let's add some in. And let's make sure that I'm not bumping and nudging now 100% of the day, because that shouldn't be the case. Right? Right. You shouldn't have to work that hard, essentially. Yeah,

Scott Benner 57:29
one of the I think one of the benefits of the podcast is that it eventually should make the management of diabetes simpler and less impactful on your, your moment to moment, you shouldn't constantly be like, Okay, a little more, a little less, a little more like, that's no algorithms do that. But you shouldn't have to do that. Right? If you find yourself doing it, look back and and just try to separate a variable from a constant and address the constants and keep bumping the variables. That's, that's all it gets that easy. I took me a while to figure it out. And that's why I'm here saying it to you because I thought, oh, gosh, what if people don't figure it out? Like I started having this heart in my head that people would just be like, bumping

Jennifer Smith, CDE 58:18
following my child until they're 50. And I'll be 89. You know, what's happening to their bush

Scott Benner 58:24
picture, people in my head that haven't seen the sun in three years have their hair all wired, like they've been electrocuted, and they're like, my kids, my kids, is 5.5, their blood sugar hasn't gone over 110 in six years, I'm fine. Like, please don't be like, Oh, my God, that would break my heart. If that's what's happening to you. And don't get me wrong. By the way, in the beginning, while you're starting to figure it out, you may be alone.

Unknown Speaker 58:49
That is one field, you should

Scott Benner 58:50
be able to get past that. Right. And I hope this has been helpful. Did we miss anything, Jenny? Because you guys, don't you really everyone listening should should just take a second to realize that Jenny, and I don't have any notes in front of us. Like we're not working off a list. And I still think we got in the timeframe through everything I wanted to say. Do you feel like Yes,

Jennifer Smith, CDE 59:10
absolutely. You did a good job. I should

Scott Benner 59:13
ring a bell. I'm gonna spike. That's right. I want to say this is something I was going to say later when I was editing it together. But I want to say it was Jenny here instead. I appreciate that the people listening care about this. Like, I really do. Like, I think it's wonderful that you all want better or easier or simpler, and aren't just throwing up your hands and saying, I don't know. There's good days and there's bad days. I think it's really wonderful. I think that we're creating a feeling throughout the diabetes world that's going to help people in the future it might not help you as much as it's going to help someone else. But I got you know, it's funny, it's not a note, but some He posted this on social media the other day, and I'm not gonna put their comments and their name into it. But I want to tell you like how amazing I thought this was. This person is relaying that their child, a 13 year old who's only been diagnosed for four weeks, listens to the podcast with their parents went into the doctor four weeks later advocated for themselves for a pump, explained Wow, explained that she wanted to use extended boluses. She tried it with MDI showed her doctor how she tried it, explained that she wants to do Temp Basal adjustments in the anticipation of exercise and activity and started rattling off everything she learned from the pro tip episodes. Wow. And even rolled in with her on the pod demo, the cast and persuaded the endo to approve the pump at the next appointment. And that that's awesome that endo normally makes you wait six months. And that's from these episodes. And so I imagine not just the happiness for that child that's coming. But that maybe now the doctors like huh, why am I waiting? You know? Am I making people wait, couldn't I just do this with them? Right? That's exciting for me. And it's so it's everyone's desire to do better. And then your willingness to say it, when you get to the doctor's office, it's,

Jennifer Smith, CDE 1:01:26
well, then maybe even from that doctor's perspective, maybe you know, this person obviously went in and said, hey, I've learned all of this from this one place, maybe the doctor now has a reference to say, Hey, you know, if you want a little bit more, and you come back to me knowledgeable enough and can say, Hey, this is what I know. Now, this is what I want to be able to use why I want to be able to use it. Again, I think a lot of clinicians are just conservative because they're worried,

right? They're conservative,

for many reasons, but I think worry is a big one. And they want some outcomes showing. Yes, my patient is now ready for this. And unfortunately, I think again, with the technology we have today, I think people are more ready earlier than they may have been years ago. Um,

Scott Benner 1:02:18
so I think that I don't think that people should make the mistake that this is some special girl. Do you know, like she is seriously it's, it's, it sounds self aggrandizing I really don't mean it to be she just listened to the 17 or 18 prototype episodes. And in four weeks, look where she is. And, and I don't know that everybody could be but I think my experiences are that a lot of people are and so that it's possible. I'm in my heart. I hope right now that doctor is listening to this going, Wow, that sounds like something that happened. And like I hope he went was like, I wonder what that kid listened to, you know, like, that's what I want. I want everybody to be healthier, and easier and less encumbered and anxious and all the crap that comes with having diabetes. So, Jenny, I think that's good to hear that. Thank you.

Jennifer Smith, CDE 1:03:04
Yeah, no, and I think that's a good cumulative of kind of, I mean, my overall when I had set out, going to college, knowing what I wanted to go to school for and eventually what I wanted to become, just, it was a very, it was a very, like, General, I want to become a diabetes educator, because I had had really awesome educators as a kid myself. But I never like I didn't have a broad like idea of what I really wanted. I just wanted, I knew I wanted to be able to share what I knew, with people and I wanted it to make a difference. Like it made a difference for me when I was younger, you know, and didn't have the technology or anything that we have today. Right? So, you know, in what I get to do every day, that's, I love it. But what I like more is that

I love this connection that I've that I've

had because of you because of the podcasts and the and what you've put together. I feel like I've reached so many more people than just the individual people that I get to work with every day. You know, I feel like kind of especially these pro tips what we've put together it's just able to reach so many more people in a way that's it's free. Yeah, you know, great and I'm Thank you

Scott Benner 1:04:23
Are you made me I felt like little butterflies and I looked I looked away from Jenny last year just now embarrassed that I couldn't keep looking at her through a video stream while she was saying something nice. I need therapy. Anyway thank you i It is really is terrific. It would obviously not be the same without you. So I really appreciate it. Cool. All right. We did a good job here. I'm gonna go back to your life which is probably just talking to somebody else about IP. So the second

Jennifer Smith, CDE 1:04:51
actually it will be my husband went off to work and my my kids are a band on the house. They're watching I think they're watching Dino Dan right now and I Hear my little man outside the joystick, Mommy, I want to snap

Scott Benner 1:05:06
a minute doing important work. Go back to what you're doing. Go take care of him. And thank you very much.

Jennifer Smith, CDE 1:05:13
Yeah, absolutely Have a great weekend

Scott Benner 1:05:15
to all of the episodes that include the words diabetes pro tip in their title are available right here in your podcast player, or at diabetes pro tip.com. The next pro tip will be out pretty soon. It's all about pregnancy with Type One Diabetes. Thanks so much to Dexcom on the pod and the Contour Next One blood glucose meter for sponsoring this episode of the show. Go to Contour Next one.com to see if you're eligible for a free meter. And if you're not, check with your doctor about moving up, right? You've been driving that old car too long, you deserve something new Contour. Next One. If you'd like a free, no obligation demo of the Omni pod sent directly to your house. Well, you sound like the kind of person who's ready to go to tubeless insulin pumping. I know what you're thinking. insulin pumps don't have tubes. Well, the Omni pod doesn't the rest of them do. But the Omni pod doesn't. My Omni pod.com forward slash juice box. no obligation free demo gets sent right to you takes three minutes to make happen at that web address. And of course, the continuous glucose monitor that has fallen from the heavens, the Dexcom g six, continuous glucose monitor, check it out@dexcom.com Ford slash juice box. If you have not listened to all of the pro tip episodes, I implore you to do so seriously go back to Episode 210. Or find them at diabetes pro tip calm, I think you're gonna really like them. And I think they're gonna make a really big difference in your life with Type One Diabetes. If you've already listened to all of those episodes, and you want more Jenni, find the defining diabetes episodes and ask Scott and Jenny there's more good Jenny goodness out there you can find it. I want to thank you for listening. And if you're a person who has shared the show with someone else, you have my gratitude. It is how the show grows. And I very much appreciate your time and effort. I will talk to you all soon.

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