#470 Diabetes Pro Tip: Weight Loss

Understanding how insulin works is the first step

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 friends and welcome to Episode 470 of the Juicebox Podcast. Today, we're adding to the diabetes pro tip series with an episode that has been asked for by listeners forever. And for that reason in many others, I'm very excited to give it to you today.

The diabetes pro tip series from the Juicebox Podcast began almost two years ago now, when I decided to take the tools that were being spoken about in the podcast, and condense each one into its own episode. That was my original thought anyway, the pro tip series has become so popular that it's just you know, it's like watching a baby grow up and you just kind of go like oh my God, look what they're doing it. It's become more than I expected, and it continues to grow. And today is another another link in that chain, diabetes protip weight loss with Type One Diabetes. Please remember why 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. We're becoming bold with insulin. In just a second, I'm going to tell you a little bit about Jenny, a little bit about the sponsors and where you can find those other diabetes pro tip episodes. Then we're gonna jump right in

this episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, and you may be eligible for a free 30 day trial of the Omni pod dash right now. And you can find out if that so at Omni pod.com Ford slash juice box Get started today with the Dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box. And if you're looking for those diabetes pro tip episodes, you'd like to start from the beginning, they started Episode 210 with an episode called diabetes pro tip newly diagnosed or starting over, he does a series it's made to be listened to in order. And it's of course available to you as a subscriber to the podcast. All you have to do is go back in that podcast player to Episode 210. And there it is. If you're having trouble finding the other episodes, you can look at Juicebox Podcast comm there's a tab at the top that says diabetes pro tip. If you don't want to go to all that trouble, go to diabetes pro tip.com, where you will find the pro tip episodes and the defining diabetes episodes, which I also am very fond of. In just a moment, Jenny and I are going to get started. But first I want you to know that Jenny Smith has been living with Type One Diabetes since she was a child. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer and most makes and models of insulin pumps and continuous glucose monitors. Jenny happens to be the bomb diggity. I love her. And in a couple of weeks, her 33rd diversity is coming up. So if you're in the private Facebook group for the podcast, please take a minute to go to the thread celebrating Jenny and leave her a little message. And I'll be passing those messages on to her on her diversity. Last thing I want to thank the listeners who sent in questions for this episode specifically, we get them about two thirds of the way into the episode. But first, Jenny and I are going to talk about ways to lose weight when you have type one diabetes. Every time I think there's nothing more to do for the protests, then somebody asks something and I think No, no, that that would work there too.

Jennifer Smith, CDE 4:01
Is the variables in life that I think will always bring in something to discuss in terms of what it could be in, in diabetes? Like management? Yeah,

Scott Benner 4:13
no, I'm really happy. I'm really happy to hear from people because I think that others perspectives can make me go Oh, yeah, wow. Just because that hasn't happened here. Doesn't mean that's not happening somewhere. And then if it gives you no good focus for what to do. So this is it. We're gonna talk about trying to lose weight, you have type one.

Jennifer Smith, CDE 4:32
As I mentioned, I think I texted back to you. I was like, this is a big topic. It's not just like five minutes of just go out and start running. I mean, it's it's kind of like a rabbit hole, honestly. I mean, there are many different like, little avenues to kind of talk about and you had a lot of really good questions that came in, or like comments about Gosh, I don't understand this or why isn't this quite right or whatever. So

Scott Benner 5:00
Yes, we actually knew three topics. So I'm gonna have very little to say here probably. And I apologize for that. I guess this is the time, the time we pretend like I just came on your zoom. And I'm like, hey, how do I help? And then you just talk. But what what's the I mean, where do you think we should start? Because to me, I think we should start at the idea that people correlate taking insulin with gaining weight. And then they don't think about calories and get that right. Go. Hi, Jenny. Oh,

Unknown Speaker 5:34
you help me please? Yes, well, maybe.

Jennifer Smith, CDE 5:39
I know, it's a good place to start in terms of like, one thing that everybody with diabetes specifically thinks about is that it's insulin. And I think a good place to even go with Why does that start is because it's often something that a practitioner will tell people, you know, using insulin, you may be likely to gain weight. I think that was one of one or a couple of like, the comments that came back about this topic, were specific to you know why I've been told that I'm going to gain weight or why, you know, why is this going to happen? or Why did I lose weight, and now I'm gaining all of this weight back like after diagnosis, right. So insulin itself, whether your body makes it or you take it with an injection or with a pump, it's a storage hormone, that's its job, it's supposed to move a certain quantity of carbs, sugar really out of your bloodstream and into places to either be used or stored, right. So in terms of management, insulin can make you gain weight. In terms of like initial diagnosis, a lot of people with type one specific have lost weight. Prior to diagnosis, maybe it was very rapid. Or maybe it was like a lingering loss that people were like, well, I could just keep eating the whole cake. And Gosh, I don't gain any weight, and I'm actually losing weight. And then they're like, wait, this is wrong, this is bad, that shouldn't be happening. So they go to the doctor, right, they get a diagnosis of diabetes, they've lost weight. And in terms of that loss, it's often relative, it's usually a relative to the fact that their blood sugars have been so high, that their body isn't storing those calories, right. So you're essentially paying them out, thus, decay, and all of those things that can come about, you know, around diagnosis time, but because you're losing all those calories, and your body's not packing them in, once you have back the piece of the puzzle that was supposed to help you use that food that you were taking in, your body's gonna start storing it.

Scott Benner 7:43
And so and so. And that is the one confusion you see from newly diagnosed people, like I don't understand, I lost all this weight, and they don't understand the function of it. So explaining the function of it, I think is great. I think boiling it down into one simple idea is that you were dying. And yeah, and your body is using itself up and not storing at the same time trying to stay alive. And then all of a sudden, everything's all right. Now, the more weight at Listen, if I'm if I'm talking about a school, here, you're stopped me. But if you've lost a lot of weight, before you get to this skinny, emaciated, those are my ribs, you probably had weight to lose to begin with, right? Because it was there to lose,

Jennifer Smith, CDE 8:22
likely and especially more as the adults who are diagnosed Yes. If you had weight to lose for whatever reason, you may have just thought, like I said, Oh, good, I'm actually able to take weight off. Now. I don't know why I'm still doing the same three mile walk every day. And now it seems to be working better. Great. But yeah, once you get to that, like, I shouldn't be able to see my lower ribs or Gosh, my face looks really sunken in when I look at old pictures. That's not what you want.

Scott Benner 8:52
And I think that, again, I this probably sounds I don't want it to sound like distasteful, but if you had weight to lose, you were probably it's likely that you were taking in calories that helps you stay at that weight. Meaning that when you start taking the insulin back in, there are calories there to be packed away to facilitate the weight gain again,

Jennifer Smith, CDE 9:14
and that's in any case, whether you could have lost weight, you know, and successfully hopefully helpful, you know, left it off. But the goal was starting insulin is in general to maintain a healthy weight then right to get Yes, you will come back from the weight loss, but you should also with the proper insulin dosing, you should be able to get back to a stable healthy weight. You know, if you lost 40 pounds when you were diagnosed and Hey 20 of that you could have definitely lost and the other 20 you really didn't need to great, we should gain back maybe 15 to 20 pounds and then we don't need the other

Scott Benner 9:56
what is the functionality of the proper insulin dosing It makes you gain too much or not enough

Jennifer Smith, CDE 10:03
in terms of insulin dosing, that's correct. The amount of food you put in to work with it, of course, is a piece of the puzzle there. But if your insulin is being balanced along with your use of the energy that it's working with, then you should be able to gain energy back to your body that gets stored, that keeps you at a healthy weight, and you shouldn't then continue to gain if the dosing is correct. And it's so it kind of goes back to, on a baseline initially, make sure your insulin doses are right for you. And a lot of people wonder, you know, they, I just leave it to my doctor. Yeah, it tells me how much more or less to take.

Scott Benner 10:43
And does that mean that if you're not using enough insulin that your blood sugars are left higher, so you're still having some of the action that you noticed before you were diagnosed? Right? Yes, you're a little You're too high, and your body's not storing the, the calories correctly, the glucose collect correctly, and so you're not gaining as much weight. So you could have unhealthy blood sugars, but feel like your weights good. And then you kind of come to that point, you're like, Oh, I'm good. And that really is the beginning idea of diabetes aimia to write, manipulating the insulin to keep your weight down, okay, so that's going the other way, if you're too low all the time, you'd have trouble putting on weight.

Jennifer Smith, CDE 11:26
If you're too low all the time. One, you've that's actually kind of an, it's an opposite of what you would think really, if you're low all the time. And that's a big reason, then when we start working with somebody, we analyze insulin to begin with, and the first thing we look for, even if there are highs, high highs, we first look for lows, because if weight management is another piece that they're really concerned about, then all of those lows that you're treating, you are feeding insulin, and you're feeding insulin, which ends up packing away the excess that you're taking in, and you maintain a weight that you don't want, or you keep gaining weight that you don't want.

Scott Benner 12:11
So this, this puts you in the position of having to look at carbohydrates as medicine, and being scared because you're low taking away more than you need. And then suddenly, you're back back up again. And maybe you've got enough insulin in there to handle the carbs for your blood sugar. But you've taken in way more calories than your breakfast once got it.

Jennifer Smith, CDE 12:31
Yeah. Yep. So that's, that's that insulin is, it's kind of the key place to start really. And you know, then a lot of people ask, Well, how much insulin? Should I really be on? How does this enough for me? Is that enough? For me? I know, we just talked about that kind of in depth in another episode, but really, you know, figuring out about how much insulin you need based on a wheat to begin with. That's kind of a starting place that you could go to, how much total daily insulin Are you using right now? What's your like current body weight, etc? Should you be using this much insulin? is it taking this much more insulin to counter things? Or are you using like a heck of a lot more like let's call it Bolus insulin, right? But you see that your Bolus insulin is for a lot of corrections. And when you're looking at your data, you can see that the corrections are following lows. There again, more insulin than you really need. And thus your body is going to pack away by allowing the insulin to use up the food.

Scott Benner 13:38
It's funny because I wasn't 100% sure what you were gonna say today. And yet I feel like we're into this situation, again, where the podcast should maybe be three minutes long. And it should say limit your variability use the right amount of insulin. And it kind of addresses so many things. I know this isn't weight loss specific. But let me just ask you one question. How many people you know what percentage of people do you think just a guess, are are getting to reasonable outcomes by mistake. Like their bolusing too much, but they're eating on time and their basil is too low and it works out or their basil is too high and they eat before they get low. And they don't have to Bolus too much in it like how many people are getting there the wrong way, but it seems like it's working and then have underlying issues that they don't recognize. Like I

Jennifer Smith, CDE 14:35
wouldn't say it's I wouldn't say it's anywhere near a majority of people. Honestly, I'd say it's a small percentage of people who have figured out insulin needs. Even though the dosing strategy that they're using might be wrong, like you said, maybe there's way too little basil, but they're offsetting it with boluses and maybe the little amount of basil they're using is right for their overnights and that's why it looks stable or, you know, Vice So whatever. But I don't think that's the majority of people, I think the majority of people who are having issues with blood sugar fluctuations that they don't want, and also likely are having some issues with weight management of some type. It's, it's a start of let's look at what the initial factor could be insulin. And then you move on further. And you know, lifestyle is a big part of it, obviously. So then we look at things like calorie intake. And I think some of the some of the questions that came in were kind of, you know, around that, well, you know, I've run a calorie deficit, and I've like, run myself ragged, going to the gym, or, you know, exercising 90 hours a week. And it's still not working. But I, you know, and then, you know, there's the fasting component, and all of these things that people try to put into the picture. But from the standpoint of calorie, your calorie needs should meet your baseline kind of need, in general. And then if you were working out on top of that, or you know, a training athlete or whatnot, then calorie needs go up. But at a minimum, there is kind of a minimum, on average, that needs to be there. It's about 1000 calories a day, give or take person to person. But when you start dipping below that oftentimes what ends up happening is your body conserves. Because you're not meeting a need. And then you wonder, Well, I'm at a deficit, why am I not losing? Because

Scott Benner 16:38
your mind thinks you're lost on a desert island, and it doesn't, it's trying to hold on to everything you put inside? Exactly. I had that problem where I've, by eating more food, I've lost weight and eating less. It didn't, it didn't impact me as a fact. In fact, it sort of made me go the wrong way. So okay, so if someone asks you, is it not as simple as Hey, I need to lose weight? Can you tell me where to start? Is it really person to person? Like, because what do you have to do first, like, think about if you were listening to this right now? And you could be any of the varied people who are listening? like where do people start?

Jennifer Smith, CDE 17:17
I would definitely say with Well, first might even be an analysis of Where are you? And where do you want to be? Or where have you been weight wise, right? What's your goal to get to? And how much more Are you above that, then you want to be and also in that timeframe, it goes back to insulin analysis. If you've gained weight, as many people have in this past year, if you have gained weight, but your insulin doses haven't really shifted, there in lies a piece of the puzzle to write usually, for about a 10% change to your baseline like Wait, you're probably going to expect a need to change your your basil and your Bolus ratio is by about 10% as well, to be more aggressive and to take, you know, take into consideration that gain now when people are looking for loss. They're like, Yeah, but I don't want to use more insulin, because that's not going to work

Scott Benner 18:20
anything. Insulin, put the weight on them. Correct. Okay, gotcha.

Jennifer Smith, CDE 18:25
But really, they need to first manage their blood sugars. And then they can start working on whittling away or wiggling back and some of that comes into, okay, let's look at the lifestyle things. Let's look at are you exercising? Are you active enough? Does your calorie intake meet what your actual need is? You know, where can we whittle away some things so that weight comes down and along with it, then as you do lose? The same thing happens with insulin, your insulin doses should be adjusted back based on loss.

Scott Benner 18:59
You're making me think so strongly about when somebody comes to me and says, Hey, I just got diabetes, and I play a sport or my kid, you know, is on the team and we're so worried about this and I very badly don't want to give them a band aid answer about how to get through the sport I want to tell them let's take the time now and get your insulin right so that during the activity there really isn't any issue and it's hard for people to believe that once they've seen it once they see cause and effect once they say I ran around and my blood sugar went down. They imagine that is going to happen no matter what all the time. And I Ardennes. I'm sure you're the same way. But Arden's insulin so well balanced at this point, like activity doesn't make her lower or higher. Really, it's not it doesn't really change too much.

Jennifer Smith, CDE 19:46
Yeah, it depends. I think that brings in, you know, the consistency of exercise or activity, right. The more attune your body is, let's say you go out for an hour every single single day to get some form of real exercise right Your body gets used to that. So initially, you might see that your insulin needs drop off within the hours of the active time, right, and maybe even stretching several hours later, depending on what you did. But over time, that impact is lessened, you will usually need to be less aggressive with insulin adjustment, or maybe not at all. I mean, I can typically take my kids to the park and not really worried too much about that, unless I know I'm really going to run around crazy with them, and I likely have insulin on board. Right. So then something needs to be you know, offset. But, um, so yeah, I mean, once you get to the point of like, lifestyle adjustments, and a base insulin that's working, your fluxes in insulin dose, then will be minimized. I think, oh, sorry, go ahead, we'll

Scott Benner 20:52
see I think people need to be certain to that, once they start exercising their body is going to use the insulin better. The answer then is not to feed the low, it's to adjust the insulin, you know, maybe the first time you have to feed it, but then you have to learn from there and make an adjustment so that you're not constantly battling yourself because that is what happens, right? They exercise they get low, they eat it out, though it out. It overpowers what they meant to accomplish, okay,

Jennifer Smith, CDE 21:18
and then they and then you end up getting frustrated too. Well, goodness, you know, I go to the gym, but I have to eat like a whole sandwich and a half a banana in order to go to the gym and not have a low blood sugar. What's the purpose of that when I'm trying to lose weight, and then

Scott Benner 21:30
I stopped doing it because

Jennifer Smith, CDE 21:31
and they stopped doing it right. Or on the other side of it, you know, someone who may actually, okay, I'm going to really focus in on my diet, I'm going to clean it up, I'm going to you know, cut my macros down and actually meet the caloric need that I'm at right now. And then what they end up with many times are lows, especially the cleaner the diet gets, and the more accurate intake of calorie value is for that person, your insulin needs will actually come down sooner. So to avoid lows and needing to treat in the time period where you're really trying to be Let's be good, let's say right, just take your insulin doses down by maybe even it's just your basil, take it down by maybe five to 10% across the board.

Scott Benner 22:17
Okay? So it's get your insulin, right. So it's understand diabetes first. And then it's the normal stuff, we all talk about it being active, getting your heart rate up. A sedentary lifestyle leads to more resistant blood sugars, which leads to more insulin, which probably leads to more lows, because you get out of balance, blood sugars, and what you just said, about clean eating. We don't really talk about it like we like if we were all out in a field, okay, let's say if it was 400 years ago, and somehow insulin existed, but we were still just farming and breakfast might be an apple you found on the ground, and maybe on Wednesday, if you're lucky. The guy up the street kills an elk. And we get a steak right? Like if we were still eating like that, and we had manmade insulin, people would not be using nearly as much as long as they use now, Jenny?

Jennifer Smith, CDE 23:14
Oh, no, not at all. I mean, if you were living on like, berries that you picked along the trail that you were tracking the elk on and then you stopped and you ate some of the watercress. Hey, get your vitamin C out of the like stream that floated by whatever. No, what No,

Unknown Speaker 23:33
you might not need as much insulin right?

Jennifer Smith, CDE 23:34
No, you wouldn't. You're also active level that I mean most like let's call them you know, cave dwellers or whatever at that point of life, right? activity was part of your day. They didn't have a gym that they went to. Their hunt for the bison man was like, act.

Scott Benner 23:53
I bet you're running from a mountain lion burns carbs. What do you think? What do you think? So I guess my point is, is that while I'm not telling anybody how to eat, and I'm not certainly telling you that my daughter's counting macros or anything like that. Processed foods, right? manmade foods, stuff that comes in bags, oils that don't belong in your body, all the stuff that we consume all the time that we're not aware of. It's making your variability greater and it's making it more difficult for you to use insulin

Jennifer Smith, CDE 24:24
true in fact, I've also kind of heard people and there's truth to it.

Scott Benner 24:39
Hey, let's not let's not waste any time shall we? just did it nice. How I said let's not waste any time it took me 10 seconds to say let's not waste any time then I went over it for 10 more seconds. I better jump in. Get yourself a Dexcom g six continuous glucose monitor why you'll be able to see trends, directions impacts of insulin on blood sugars, impacts of food on blood sugars, the impacts of life on type one diabetes, you'll see it all with your Dexcom g six continuous glucose monitor. And how does it do that? Well, it shows you your blood sugar in real time, not just the number, but the speed and direction of your blood sugar. Are you 184 and dropping or rising or stable? That's a big deal, isn't it? Because in each of those three situations, you might do something different. A rising blood sugar might get some insulin, falling blood sugar might warrant you paying attention to it, and say it's super stable, right where you want it, you know, you've done the right thing. The Dexcom g six gives that feedback in real time in ways that is so usable, you hear us talk about it all the time on the podcast. So check it out. dexcom.com, forward slash juicebox. Sure, there's alarms, you can set, those are a big deal, too. You can say, I'd like to know if I'm going below 80. Or if I'm going above 140. And it'll tell you don't want to know till you're 160, you can change that, that's up to you. The Dexcom g six is a vital tool. If you're using insulin, I'm talking about type one or type two, check it out, support the podcast when you do use the links in your show notes. Or type in dexcom.com forward slash juicebox. After that, you're gonna want an insulin pump. Right? Maybe you don't have one and you want one, I say check out the Omni pod, you have a different pump. And you're a little sick of the tubing. I say check out the Omni pod. You use an MDI giving yourself the shots and you're kind of sick of it. You know what I say? Check out the Omni pod, do that Omni pod.com forward slash juice box, you have two options when you get there. You can see if you're eligible for a free 30 day trial of the Omni pod dash system. And I mean 30 days is like a long time. And it's free. Or ask for a free no obligation demo pod where on the pod will just send you out one nonworking pod. So you can try it on and see what you think there's a lot of options when you get to that link. All of them are going to give you more information and help you make a good decision. On the pod.com forward slash juice box, use an insulin pump that doesn't have tubing that doesn't need to be taken off when you shower, or run or kick a ball. an insulin pump it doesn't have something on it along to from an infusion set back to a controller that can get caught on a doorknob or just kind of be a pain to carry around. When you like to carry nothing, just have that little pod on that talks wirelessly to a device where you give yourself insulin, not something that's tethered to you with tubing full of insulin. And they if you don't want it on the pod, whatever, do the trial, say you don't like it, don't like it. Nobody's holding you up, can do whatever you want, but at least then you'll have real data to make decisions with. As you know, I think data is very important. Okay, that's it on the pod.com forward slash juice box dexcom.com forward slash juice box links in the show notes links at Juicebox podcast.com. And again, if you're looking for these diabetes pro tip episodes, you can find them they started Episode 210 in your podcast player, where they're available at diabetes, pro tip calm and Juicebox Podcast comm

Jennifer Smith, CDE 28:38
many people have found that if they eat a true cart, let's say they eat an apple and they Bolus for it, they end up with the ratio that they're using for that simple, like very clean carb to go low. Okay, and then when they mix it up, and let's say they have potato chips or something along with the apple or they have something, you know, more processed along with it, their carb count ends up looking clean, like okay, it comes out I don't get low later. So what gives it really is that the body processes more natural food in a better way. There's there's less left over to kind of linger in impact. And a lot of people are basing their insulin to carb ratios, more specifically, around combination meals that are not quite as for lack of a better term clean,

Scott Benner 29:36
right. So your your heavier. Insulin ratios work better if you have the orange with the potato chips, but if you just eat the orange, the orange doesn't need as much insulin so the ratios you have or too heavy. Correct. I now Arden's ratios are heavier because she doesn't you know she eats a diet that has processed foods mixed into it, but she'll go on a kick around this time. If you're about oranges, where I have to buy like 10 pound bags of oranges to keep around the house, and she's like, I want an orange I want like now these are big like softball size oranges that I'm going to

Jennifer Smith, CDE 30:10
cara, Cara oranges. Those are my fav.

Scott Benner 30:12
Yeah, I think they are and they're really good, right? And but I bet you I've never looked, but I bet you that the carb count on them's got to be more like 25 or something like that, like he could be more, right. But I only give her enough insulin for like 11 carbs. And and she does a little 130 rise and comes back again. Because I you know, because I know her ratio is higher to handle other things, which is why you look at plates and go Okay, tonight, I don't need as much, you know, for right. But this is not this is not going to be a satisfying, you know, people just want to hear like, please just tell me what to do. And I'll do it right. So work, but nobody wants to hear. I guess this? I know, I don't like it. You know what I mean? I don't have diabetes, and I'm listening. I was like, Oh, this is how I would lose weight. So you know, it's, um, it's just, do you think that we've just spent so much time as a society looking for marketable sellable ideas about how to get around? The idea of being in shape? There's no, it's, it's exercise and calories. Right.

Jennifer Smith, CDE 31:21
And I think that's the reason that there are so many, I mean, if you look at around the first of the year, there, I can't remember which publication it is. But they come out with an analysis of I think, like the top most, or maybe it's the 25, top most like us call them diets, right, in the past year, and what's kind of proven true to what it promotes and what really isn't, it's kind of like flimsy, right? Um, and some of the top ones are things like the Mediterranean diet. And you know, by no means am I promoting that, or whatever. I'm just saying that that ends up being taught from a lot of different health parameters. And it's also a clean way of eating. Most people think Mediterranean and they think well, lots of breads and lots of starchy things. And that's actually not true. A lot of it is plants, especially the really good non starchy vegetable types of plants. And then if there are grains that are hardier grains, right? I mean, it doesn't tell you to eat your carbs as a bag of Doritos. It tells you to go and eat some keen Wah On your salad with, you know, an orange on the side. Right. But I think it brings in diets. Yeah, this idea that there is the perfect thing out there.

Scott Benner 32:43
Right, right, and that it's going to be doable for somebody because maybe, listen, maybe macro counting, maybe there's a biologist somewhere that could give you the perfect diet for your body. But where am I getting that from? And where are most people getting that I have to tell you that a couple of weeks ago, I started getting an ad, right. And then I looked in the mirror and I was like, My face looks puffy. And I went to the Costco and I bought two little roaster, chickens, and four steaks. I spoke them all, slice them up, put them in the refrigerator, and I've been eating those and salads and some of those oranges because they're around the house. for about the past eight or nine days, I'm easily 10 pounds lighter than I was. And I know that I know, I'm a fluctuating person. Like I know I jumped around like because what'll happen is at some point, someone's going to give me a piece of bread and I'm going to pick Oh my god, bread does everyone remember Fred? And then I'm going to eat a lot of bread for a week and I'm going to go Oh, now my back's deaf. And I feel like I gained five pounds and all that stuff. But just if I explained to you that most of my meals have been like a couple of eggs in the morning, and a couple of tiny slices off of that steak and then at lunch, some some of the chicken and some of the steak with a salad. And I've I feel great and I know it's true, because I've been through it enough now now to talk my stupid childish inside into like just continuing on that way that I don't know if I'm ever gonna get to do but I do know it's honest. And it works for me. And I've seen it work for other people too. Like you take out processed food and carbs. And your your you're better off like I don't know, it just seems obvious. But

Jennifer Smith, CDE 34:16
it's, it's you know, like you said you're not focusing on like macros. You're not focusing on how many do I need in a day? You're what we end up finding and I think this is the premise behind a lot of the like, the Palio kind of diet and the keto type of diet, right. It's, if you're following the rules of those plans pretty well. They can be very clean eating plan. They can. There can also just like being vegetarian can be or vegan can be very healthy way of eating, but they're also like the complete like backside of that where you're eating a lot of processed vegan or like the key You know, like kinds of things that are like the treats and whatnot, you're focusing your intake on a lot of that kind of stuff, you're lacking in quality. And then your macros may very well without you realizing it be completely out of order. And I think that's why a lot of like plans like this end up failing, you know, I followed keto. And it was supposed to be this magic, like weight loss, and I also have diabetes, and it was really supposed to help with my blood sugar management and whatnot, well, I haven't lost any weight, well, maybe there are some things then to evaluate within it, you know, the keto diet is a way to get your body to start utilizing fat instead of carbs. So if you haven't really analyzed how you've broken that down to make sure that you are one maintaining ketosis in the right way. And that the kinds of like carbs that you're eating are really not offsetting, then it may not work well for you,

Scott Benner 36:03
don't you find that you have to be in tune with what your what satisfies your body? Like Not, not what satisfies your brain, right? But what satisfies your body. And I've absolutely, I've seen myself go either way, like where you're just eating for taste and flavor and comfort. And that's never usually good for your body. And then there's a way where you're just sort of never hungry. It's it's that's where I am this week, I have not been hungry this week. And if I had any like inkling towards a sweet, I've been specifically careful to take just like dark chocolate, like just a little bit of dark chocolate like this will this will get me through, like, what I'm assuming is basically withdrawals from flour and sugar and stuff like that, you know? So I don't know, like, are you telling? He's telling me that all these questions aren't even worth looking at? Or should we ask them? No, I

Jennifer Smith, CDE 36:53
think they're very worth looking at, because I think some of them may relate to what we've kind of already gotten into. And then some of them, I think, are really good questions in terms of the why it wouldn't be working. Right what's or why it might actually work. So yeah, let's

Scott Benner 37:12
pick a favorite or should I just pick, you just pick right? Well, so Jennifer's asking about her son, she says any any advice on how to balance all this high carb gluten free food from my growing always hungry, 14 year old T one D with celiac. So she has a son who seems to need blending down and at the same time. She's giving him a lot of carb heavy stuff, because it's like it's some of this. For the celiac diet, it seems like right? The gluten stuff,

Jennifer Smith, CDE 37:43
right? And that's it. I mean, celiac is a hard addition. It definitely is because while we now have a plethora of gluten free, very tasty products on the market, most of them are made with very, very processed very high glycaemic, I mean higher glycaemic than even your wheat based bread, you know, type of pasta, whatever it might be. So when you start processing things, like rice into a flower, or, you know, potato into a flower, you have a quicker digestive component to that, and it raises the blood sugar faster, its glycemic index is just high comparatively. So when you have to do these types of things, especially if you have a teen who is growing, is active, but also could maybe use some slimming down, or maybe needs to gain a bit of weight. One, it's may be sitting down honestly, with a dietitian to see what are my child's growing nutrition needs right now? Are we you know, keeping kind of a log a couple of days of what are they really in taking? And then looking at what their nutrition needs should be for the point in life where they are, you know, are they moderately active? Are they heavily active? Are they kind of couch potato video gamers? What is it and what do they need? And then looking at the kind of food that you put into their caloric need, right, again, I mean, parents are typically the purchasers of the food in the house. Yeah,

Unknown Speaker 39:27
give or take. You don't think this 14 year olds got a credit card?

Jennifer Smith, CDE 39:30
Yeah, no, I mean, and my kids, gosh, I mean, if we walk down the aisles in a grocery store, and they see like, the pretty packages and you know, like, I never got we don't eat cereal, so I don't go down the cereal aisle, but they'll always have something on like an end cap, you know, at the grocery, especially my eight year old, like, boy, that looks really good mom. I'm like yeah, and not really good for your body.

Scott Benner 39:56
That's why they have to make the picture. So nice. Right? There's no fun here, stop it.

Jennifer Smith, CDE 40:04
Well, so I think, you know, from from that standpoint, you have to look at what is the child in need of? Are you meeting it? are you creating access? And then potentially from a gluten free standpoint? Yeah, finding substitutions that can be fit in to meet his tastes, because all kids and teens are different, you know, as much as you want them to eat asparagus, they might not. Yeah, so you know,

Scott Benner 40:29
right. So, so you have to be, it's Listen, I know, if you've been listening for a while, you know that I took me a while to diagnose my low iron thing years ago. And during that a doctor made me eat like, gluten free for a month, and I gained a lot of weight because I went out and bought all these gluten free items. And somehow in my mind, I was like gluten free equals health. That's how it felt to me. So I was like, oh, it felt like zero calorie stuff when I was going in. And man, it was just not. I think if this was me, if Jennifer was me, and I didn't know what I was doing, I think I'd introduce, like, lower carb, more meat friendly, like meals, like that's what would occur to me first, right? Make some chicken, make some steak, put it with a salad or a vegetable, and maybe cut down on carbs. But then you got to remember, like we spoke about earlier, not to dose it as harshly as you would some of this gluten free stuff, or you're just going to create a low and you're and then have what you did buy with them. Right?

Jennifer Smith, CDE 41:27
And I think you know, when we look at, you know, going back to just that, like clean eating idea, quite honestly, you can be gluten free. If you're choosing to not buy as much processed food pretty easily. Yeah, I mean, you know, things like qinhuai, or, like a wild rice, or even like a brown rice, or what, that's 100% gluten free.

Scott Benner 41:52
It's the fun stuff where it causes your problem,

Jennifer Smith, CDE 41:55
right, it's not taking it out of the diet, it's just that you know, and I know the struggle with kids, I work with plenty kids and teens to know that what they get at home, under mom and dad influence because this is what you're eating turns around, it changes considerably once they start to do things with their friends, you know, now gluten free in the picture. If the child is paying attention to that, and knows that they just can't have gluten, they may already then have limitations, even compared to what their friends are eating, because they know that they just can't do it, or they're not going to feel good, right? But in that circumstance, then it kind of takes sitting down and figuring out well what that what will possibly be there that you could have, um, knowing that it's still more of like a process Trini kind of thing, but also that, you know, we're not going to do this at home. But you could have it when you're out.

Scott Benner 42:54
Okay. Laura has a question. It says, Is it true that insulin on board prevents the body from breaking down fat? Meaning that in order to burn fat, you need to have stretches of time with only your Basal insulin and no insulin on board? That's interesting. I've never heard that.

Jennifer Smith, CDE 43:11
Yeah, it is, I guess it's an interesting way to frame it. I mean, we know that in the we know that in the overnight time period, without any food on board. And on basil, only. Our body does get into more of that, like fasting state, right, of actually transitioning to some fat burn, etc. Because you're on a low level of insulin.

Unknown Speaker 43:34
I see what you're saying. Okay.

Jennifer Smith, CDE 43:36
But when you have insulin on board, technically, there's a reason for the insulin on board. Right? Right. You're dosing for food, so that insulin on board should be covering food that is there. So yes, your body's processing carbohydrates. And your body is not at that point then going to be in fat burn mode. It's kind of correct in a way of stating it. Yes. I mean, the same thing for a high blood sugar that you've corrected. Now you've got iob. And the high blood sugar indicates that there's excessive sugar there, and your body needs to process it. And as such, it's using the insulin to process it and break it down and get it in the right places. So again, technically, as long as there's not an insulin deficit in that high blood sugar scenario, and insulin is working to get it down then your body isn't also breaking down fats either. Then is that a vote for intermittent fasting for type ones? It could be and can intermittent fasting work, right? It can. But again, a blanket statement is to stay that any plan that you choose. No longer term that you can continue this, right? The problem with the diets that are out there isn't the diet itself. In fact, there's a lot of research around a lot of the diets that proves long term, these people have had this success in weight management and cardiovascular benefit, etc, etc. But they've stuck with it. Yeah, it is the Oh, I'm going to do intermittent fasting, oh, I'm going to do the keto diet, oh, I'm going to do the, you know, cabbage soup diet for the next month. And once it starts kind of showing benefit, I'm like, I can do I can kind of step outside of the rules, parameters, which are often for diets very black and white. Yes, do this, this and this, but don't do this. And as soon as you do that, don't do this. You've broken the piece of that plan. That was getting you to your goal,

Scott Benner 45:52
right. I found intermittent fasting, the easiest to stick with, because to me what it was was as long as I don't eat, like don't eat after ate, and don't eat before noon. That is basically how I did it. And I have to admit, it's very effective. Now, I realized while I was doing it, that Arden basically does that already, without the late night thing. But she's so young, I don't think it matters, right. But she gets up in the morning and is not normally hungry in the morning. And so I've had to over time thoughtfully balance out how her insulin works in the morning, right? How do I come out of sleep into feet on the floor, off to school without a rise that needs a bunch of insulin so that I don't create a low because she really doesn't want to eat until she's done with school or till lunchtime, right? Sure. So basically, Arden does intermittent fast, except she doesn't do 16 is it 16 wait 1819 2016 eight, that was embarrassing. A lot of people would edit that out, but I'm not going to. She doesn't do 16 eight and as much as she probably does, like, maybe 1410 something like that. But also she's 16 so she can write you know, she can like we over Bolus her meal last night for dinner. We had stuffed peppers, like Turkey stuffed peppers, and, and a salad. And my wife, my wife, like swung at it really hard. And about a half hour after she ate I was like, Hey, your blood sugar is like stuck at seven. I was like I This doesn't look okay to me. Like I think this is gonna go the wrong way. You know. And so as it started to trend away, Arden got a little light in her eye and she goes cinnamon toast crunch, please. So she knew she had basically Pre-Bolus cereals. So she was like, let's do it. And she had some of that have my wife go on. I'm gonna guess 10 or 15 carbs less on the Bolus. She hit it right on she was so close. But But you know, that's a young kid. And Arden's also helped by other things that I think are worth mentioning here too. Because those of you listening have type one diabetes, or love somebody who does, you really have to get your thyroid levels checked. Like you could be fighting against a borderline thyroid problem that's making weight loss impossible. You know, and you if you're going to do that you really need to go back and listen to the thyroid episode with Dr. Benito because the range that your doctor is gonna say your thyroid your TSH levels, okay, and a real badass endocrinologist will not accept you know, they mean they will not like if you're over a two Doctor beanitos giving you thyroid hormone like and there are people right now we're listening. You're like oh, my TSH is a five my doctor said it's okay. I'm borderline. Yeah, yeah, right. But I but my hair does fall out a little bit or I'm having trouble losing weight or I'm a little nasty sometimes or whatever the other things come. But I'm just telling you if your thyroids moving the wrong way, deal with it, because it makes a lot of life easier.

Jennifer Smith, CDE 48:56
And it's a lot within this whole topic of weight management. Absolutely. If you've the Hashi moto is which is very common autoimmune. Once you've got you know, type one, it's good to get tested thyroid levels at least once a year if not every six months, especially if you've got other family who has a thyroid disorder known already. But that's huge in terms of metabolic

Scott Benner 49:20
Yeah, but you have to you have to advocate for yourself. You can't say oh my god, Scott, you're right. I am tired all the time and I can't lose weight and blah blah blah, and then go to the doctor and the doctor say Oh your TSH is four you're fine your TSH just for you are not fine. That's the equivalent That to me is the thyroid equivalent of in diabetes. When somebody says yeah, your blood sugar, your average blood sugar is 180 You're doing great. Right? Right. You might you know you're not dying, but you you're not living at a healthy level. And that has other impacts on your life. This thyroid thing is it is crazy. It is like the equivalent you trust me at this point. I've seen everyone in my family except for me deal with it. It's like taking a long metal like paper. clip and just touching it on a computer circuit board. It just messes with stuff, you know what I mean? Yeah, but,

Jennifer Smith, CDE 50:06
and with with Ardennes doses, have you noticed that when things get out of order, do you notice a shift in her insulin need, because that's very common right away that, you know, metabolically, she's feeling more sluggish, sluggish and fatigued. And insulin is just not working, like it was supposed to work. And if there's a timeframe in terms of adjustment, or even just starting on a thyroid medication, where you will then start to notice a shift back to normal insulin dosing. See, again, that insulin manipulation in terms of the weight management piece with thyroid in the picture, you have to be very kind of eyes on right to make sure that you're adjusting then where you had bumped everything up in terms of insulin need, you're going to need to start bumping down. And if there's weight loss in the picture at the same time, definite need to bump down or you're gonna just run lows. Yeah,

Scott Benner 51:01
I there's something I use, I think I should even have a flowchart for myself like If This Then That kind of chart because you're right. If the thyroid level starts to get away, then her insulin needs go up. And then we adjusted, it doesn't happen right away, and our insulin needs start coming back down again, the same thing with she had to start a birth control pill to regulate her periods. Hall. I lost three months of my life to figuring that out. Like it was just first they gave her a pill with not enough estrogen in it. So it was basically just two wasted months. She was exhausted all the time because she was bleeding constantly. So I had to get her through those pills. Those aren't the right pills put her on the right pill that started working the bleeding, regulated. Yay. Now she's lost so much blood, I had to go get her an iron infusion. Got her the iron infusion. Now we're waiting for that to come back up. When the iron infusion comes on board, her insulin needs are gonna change again. Yeah, vitamin D levels seem to impact insulin knee. Yes.

I just,

Jennifer Smith, CDE 52:05
in fact, many people for vitamin D that you bring it up. That's another like piece. And I think in terms of like, like, again, going down the rabbit hole of discussion and weight management, the we're kind of on the track of like medications, and medications in terms of thyroid, as well as things like iron. But vitamin D, you know, your lab will tell you optimal is between or standard is 30 to 100 optimal according to the female specific physician that I'd worked with years ago, before I had my first son, she was like, you know, optimal range is really 50 to 70. For vitamin D, she's like, and if it is not in there, you need to be being supplemented, because otherwise, especially with diabetes, vitamin D works on the cellular level. And it allows insulin to be seen correctly, it for lack of a better term by the cells. And so it lets insulin actually work the way that it's meant to have one of the many things that can so if your vitamin D level is off, supplement, I mean, in general, someone with type one, adult wise, should be supplementing at least 2000 I use a day. And if your levels are not optimized at least 4000 a day. And if they're really on the low end, you need to be doing like the hyper significant doses of vitamin D for a short period of time, if you

Scott Benner 53:30
like. And then for 50,000, I use and you take one once a week or something like

Jennifer Smith, CDE 53:34
once a week, or I've even seen some doctors do like 110 1000 iu a day for you know, a couple of weeks and then retest. But vitamin D is huge.

Scott Benner 53:43
And I'm not a doctor, but there's something about vitamin D deficiency and autoimmune that go hand in hand. So just look

Jennifer Smith, CDE 53:50
at the studies out of Finland,

Scott Benner 53:52
right? I listen, I take 5000 a day. And I take 5000 a day of vitamin D, I take a zinc tablet, I taken a sorbic acid with iron and a B 12. And that's that's what I do every day. And that's what you know, my kids do and and everyone here is doing because when the D levels drop again, problems with insulin, I'll tell you right now too, because Jenny mentioned ranges that you need to be in versus what lab values will tell you, Dr. Benito back on the thyroid things that if you were a woman of childbearing years, anything under 74, your ferritin is too low. And they're not going to tell you you're low till 20. So she's like if you are having a period, he gotta be above 70. And so there's a lot of things. And then all of these things also impact your body's ability to work correctly, which is in part and parcel of losing weight or

Jennifer Smith, CDE 54:50
losing weight, right. There was one in here that does go along with medications that I think is a really important question. This woman has a son on a medication that is more for like attention. And it's specific to using it versus not using it school year versus spring date break or summer time and what ends up happening in terms of insulin needs. And I think it's an important one, because I've seen a lot of kids who are using a DD ADHD kinds of meds. And a very, very common thing with those is that it decreases appetite. Okay. And if they're using it in their school day, and they're also the brain uses carbs. And so the more thinking that's going on, and the potential that they're really not hungry, they may not even finish the lunch that you packed for them, they may pick at the lunch that comes from the school lunch, because their brain is just saying, I'm not hungry enough to eat, you may end up having to have two types of basil profiles, maybe one for like a spring break, time off another one for school days. And again, as kids get more into the teen years, that becomes really beneficial in terms of growth and the potential for weight gain in the wrong direction. Because if you're constantly feeding loads again, or constantly adjusting insulin up and down, but it's kind of willy nilly and not quite right on with need. It's a medication adjustment kind of thing that goes along with adjusting insulin

Scott Benner 56:31
again. We're right up on it. But there's enough questions in here that all circle around menopause. Do you have any feelings about what happens at that time? And

Unknown Speaker 56:41
yeah,

Unknown Speaker 56:42
that's a fun one.

Jennifer Smith, CDE 56:45
I mean, in general menopause in and of itself. I mean, perimenopause really is the start of kind of that time period in a woman's life where your cycles might start to get less evenly spaced, right, let's say you were the typical, like, 29 days, and you was right on spot. And now like, Huh, now it's like 26 days and next month, and might be 32 days, and that may be 29 days. And, you know, periods can get a little bit more aggressive, or kind of look more spotty. But that perimenopause kind of leading into menopause, which is really, a woman has not had a cycle in a 12 month time period. Right. So insulin needs can look very jumpy, you might even find that, again, as we get older. And these things come into the picture from a female perspective, our metabolism does slow down, we oftentimes start to need a little bit more insulin, or it takes a little bit more activity to maintain or burn off what we were able to do when we were 30. That doesn't work anymore when you're 45 or 50. So a menopause, perimenopause, it brings in a whole circle of hormone impact, right, that may more aggressively change your insulin needs, especially around your cycle times.

Scott Benner 58:10
So not unlike, well, I guess, more aggressive but not unlike having your period and seeing right hormone fluctuations throughout the month,

Jennifer Smith, CDE 58:19
right. And then once you're in menopause, oftentimes, you know, outwards of a year or two post no longer having a cycle. Many times, then insulin levels should get more stable, because you don't have that hormone flux. And as we age men and women have less and less and less growth hormone cycling anyway. And so we end up especially women passed about the age of 65, or people passed about the age of 65. Oftentimes, their baseline Basal needs definitely go down. And the reason there is because their hormone cycling has kind of started dropping off. Okay.

Scott Benner 59:01
All right. Did we do this justice in an hour? Because I feel like we did, but I don't know much.

Jennifer Smith, CDE 59:06
I think that we did as much as we could get it in an hour. I mean, if we really wanted to focus in again, dig really deep into that information hole. There's a whole bunch about meds that are very specific to like weight loss, and you know, things like the GLP ones and things like the stlt tos and what despite them being type two meds, they are getting a lot more. They're kind of climbing on the ladder of benefit for those with type one and who are just insulin users. And they do have promise in terms of weight management, if use the correct way.

Unknown Speaker 59:51
Okay, so

Scott Benner 59:53
do you feel comfortable talking about that? Because maybe you say here that if you like this episode, look for that one coming in? Yeah. Okay. Great, thank you. Yeah, Jenny, you have to do all the talking. I was at some points. uncomfortable. Not for because he was like, Huh, there's not a lot for me to do here. I was just checking. I was just saving files and checking rates and looking at questions I

Jennifer Smith, CDE 1:00:18
was like, so like, I should have just gone and gotten an extra cup of tea.

Scott Benner 1:00:21
kind of nice. I should have just said, Jenny, tell me about weight loss. I'll be back.

Jennifer Smith, CDE 1:00:26
Really is I was looking at all the questions. I mean, there are a lot of really good questions, but I think a lot of them honestly. Go back to insulin. Yeah. dosing it the right way for what you're kind of taking in. And then also, secondly, looking at what are you taking in,

Scott Benner 1:00:45
right? And obviously, in my mind, these questions all are, they're similar, they're tied together, whether it's vitamins, or your thyroid level, or your calories or, or whatever it ends up being, there is a balance that optimizes your body, it's not going to be the same for everybody, some people's vitamin D level can be crashy load to the floor, and they'll never notice it, and it won't matter to them. But for some people it does. And when you get those things in the right balance, then you feel better and feeling better. To me, as you feel stronger, you're more rested, like all this stuff happens. You're clear in your mind. But how. But some of these things nobody would even know to look into. No, you know, even vitamin D like I can remember 10 years ago, my ardens nurse practitioner gone, we're gonna start checking vitamin D was almost like a mandate came down from a mountain, you know what I mean?

Jennifer Smith, CDE 1:01:35
Yeah, actually, I don't even know when that would have been. But if it wasn't, I remember when I was working in DC, and the endo practice I worked with within the, our director was very, like high up within the whole, like, diabetes management, like realm of information. And his he was like, we are testing vitamin D levels for every person with diabetes. And at that point, it was really just, if the thought was it was relevant more to type two. But as we started testing, then I went to my own end to when I was like, you know, I run I'm outside all the time. I have, like, you know, like brown skin from being outside. Like, I don't take my, I'm like, I'm sure it's fine. In fact, my vitamin D level came back and my doctor himself called me, not his nurse. He was like, this is really weird. But he's like, I want you to go and get it tested again. He's like, this can't be right. And my level was 18. Yeah. 18. And so when it got to test again, nope, it was 18. Again, he was like he did he that was the one time a week the 50,000 I use, I came back in eight weeks, it had moved to 21. And he was like, Huh, so I he sent me to see like a naturopath, who was also a physician who knew a little bit more in that realm. And she actually had me started, she started me on oral drops, okay, and the drops get absorbed through your oral mucosa rather than having to go through your gut. And because we know there's a lot in terms of gut and absorption in autoimmune disorders, she's like, I guarantee your body's not absorbing it. She said that's the problem. And is within about I think it was 10 weeks after that I got it retested and was already up in the high 40s. Yeah,

Scott Benner 1:03:25
you know, I have to, I thought I was gonna have to live getting iron infusions my whole life, because I couldn't absorb it through my gut. And I do probably have some like weird stuff going on down there. And instead, I mix it. So first of all, I use a really pure like supplement from a company that you know, you can do your own research and find one that you like for yourself, but I researched out found a really pure supplement. And I have to take the iron within a sorbic acid at the same time. I do that it absorbs great if I take just the iron tablet without the sorbic acid won't won't work. Yeah, that's it. There's a over the counter when called via Tron or by Tron D or something like that. It's it's iron that comes with it. C, Vitamin C. Okay, gather that helps that too. But yeah, these are the kinds of things no one's going to tell you about. Or they're just gonna blurt out. We're testing for vitamin D Now, then you come back, quote, unquote, in range, and they don't give you one anyway. And you're like, wow, this was a lot of fun. So anyway, everybody balanced your body, balance your insulin. things should get better. That makes sense. All right. Thank you, Jenny.

Jennifer Smith, CDE 1:04:30
Yeah, you're welcome. Absolutely.

Scott Benner 1:04:38
Let me thank Dexcom and Omni pod for sponsoring this episode of the Juicebox Podcast. I'd also of course like to thank Jenny, you know, Jenny works for integrated diabetes. So if you want to learn more about what she does for a living, you could even hire her. You go to integrated diabetes comm I think there's even a link in the show notes to email Jenny, but I don't remember I haven't looked in a while. You'll find out, just go route around, see what you can say? Would you like to see if you're eligible for a free 30 day trial of the Omni pod dash, go to Omni pod.com forward slash juice box. And of course, to learn more about the Dexcom g six and to get started, it's dexcom.com forward slash juice box there are links in your show notes, links at Juicebox Podcast comm or you can just type those right into a browser. Since we're at the end, and you're still here, let me tell you a little more about the diabetes pro tip series. First, I'm going to read you a couple of reviews, all from Apple podcasts, this podcast that changed my life, I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible and practical management approach that is taken my agency from 8.3 to 6.3 in less than six months. And that's just right now, it's going to keep coming down. Thank you, Scott, I'll be quoting you forever. My son was diagnosed with type one about five months ago. And I've learned so much from just the pro tip shows and we'll be listening to all of the episodes. This podcast is amazing both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel. And more like you can find ways of keeping your loved ones happy and healthy. And finally, I saw I mentioned this podcast and one of the Dexcom g six groups on Facebook. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years. I wish I had been more proactive in finding the information sooner. I'm going to recommend this to my endocrinologist. So that's a little bit about the diabetes pro tip series and the podcast from other people. You can just subscribe right now in a podcast player just hit subscribe if you're there, and you can listen to the podcast every week, three new episodes every week. If you don't know how to find a podcast player, there's tons of links to free ones at Juicebox Podcast comm where if you want to start with those diabetes pro tip episodes, or in my opinion, I like seeing you start with the defining diabetes episodes which are much shorter, and give you a good basis for all the terminology means and how to use it. All that information is at diabetes pro tip comm you can get there just by typing that into a browser. Or if you go to Juicebox Podcast comm there are links to the top one of those links as diabetes pro tip. start listening. I mean, wouldn't you love to send a review and that says my agency went from eight three to six three in less than six months would be amazing. So I hope you keep listening. I hope you enjoy the podcast. Thank you so much for checking out this episode. Please share the podcast with a friend. And don't forget to subscribe. Thank you so much. I'll be back soon with more episodes of the Juicebox Podcast.

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#449 Diabetes Pro Tip: Postpartum

Baby is here, now what?

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 Music - 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 0:11
Hello friends and welcome to Episode 449 of the Juicebox Podcast. Today's episode is the 22nd installment in the diabetes pro tip series. The pro tip episodes began way back at Episode 210. And obviously have happened 21 times prior to this one. If you'd like to see all of those episodes in one place, you can actually go to diabetes pro tip comm they're all right there. Or at Juicebox Podcast comm you scroll down a little bit to where it says pro tip episodes, and you can scroll through them there. The episodes of course are also available in any podcast player that you listen to. Now, each one of these episodes has one thing in common. My friend, Jenny Smith, Jenny is a CDE, who has had Type One Diabetes for over 30 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. Jenny is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. She is also pretty much the only person I asked diabetes questions to and I love her in these episodes. At the end of this episode, which by the way, if you're a person who's like, Oh, I'm never gonna have a baby or I'm a boy, or whatever it is, you're thinking right now postpartum doesn't apply to me. These diabetes pro tip episodes are, I think terrific. And I think they all go together. There's a lot to learn from listening to this episode, because at its essence, it's dealing with huge variables, which is what you'll find after you've had a baby. So doesn't apply. But it does. You'll see at the end of this episode, I'll tell you where you can find Jenny, I'll tell you where the rest of the pro tip episodes are and what the topics are. And anyway, I think you should listen to this one whether you're going to have a baby or not. Please remember while you listen that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan, or becoming bold with insulin. And last thing, this episode of The Juicebox Podcast is sponsored by the Omni pod tubeless insulin pump, go to my Omni pod.com Ford slash juice box to get yourself a free no obligation demo of the Omni pod or to see if you're eligible for a free 30 day trial of the Omni pod dash ui 30 days free. You heard me my Omni pod comm forward slash juice box go check it out. The podcast is also sponsored by the Contour Next One blood glucose meter. The most easy to use, easy to carry accurate meter that my daughter has ever held, owned or used. Contour Next One forward slash juicebox. Get yourself that Contour. Next One. All right, well, that took three minutes, which is probably two minutes longer than it took mostly to get pregnant. So here's Jenny bump. As time passes, I'm becoming more and more aware of a lot of pregnant women or women who want to get pregnant who have type one diabetes who are listening to the show. And who are enjoying that there's a series back in the show with Samantha where I interviewed her every three months like during her pregnancy.

Jennifer Smith, CDE 3:38
Yeah, I remember you mentioning her and

Scott Benner 3:40
that apparently is making the rounds on the on the internet and the way people listen to things. And I just get a number of emails and I'm sure you do as well that are either that start off with like, I can't, I'm never gonna be able to get pregnant because I can't get myself together. And then they go I can't believe I did it or I'm doing it you know, like that kind of a thing. But then there's that. The rest of it that I guess we stopped thinking about because the baby's out. And I don't know that's that's weird. So a person in my mind, being a person who's never been pregnant and doesn't have type one. That journey seems painfully taxing to me from going from not thinking you'll be ever, ever be able to have a baby to figuring it out to then doing it having these insanely great a onesies while you're pregnant. And I don't know it just feels like it would be super simple to just not abandon it but lose sight of it after you have the baby because of all the things that happened after that.

Jennifer Smith, CDE 4:45
And I don't think it's that. I don't think it's that the good majority of women really think that they're just going to just give it all like all the work that I've put in over the past, you know, nine to maybe 12 months if they really did a lot of really good preconception management to kind of get there and managed, it could have been a long haul of, you know, nine to 18 months, let's call it of trying to really strategically nail things down. But, and I don't think that if you've done that, or even if you've come into pregnancy, maybe not where you wanted, but you really did an awesome job of mastering things and getting things taken care of through the pregnancy. By the end of pregnancy, most women are like, Oh, I'm just gonna, like throw it all in the basket, everything I learned how to do. But there is a big piece postpartum that, especially as a first time mother, is completely 100%. New. Yeah, it's I mean, it is it's like being thrown into like, a new job. In a country where you don't speak the language, they're like, Here you go, it's all yours to like, figure

Scott Benner 5:52
it out. And by the way, the job will die if you drop it or remove it,

Jennifer Smith, CDE 5:57
or you're gonna kill a million people, if you don't do it exactly the right way. That's

Scott Benner 6:00
how it feels, isn't it?

Jennifer Smith, CDE 6:02
That's kind of what it is postpartum. I think a lot of the a lot of the Up, Down comes in, because you're trying to manage something 100% new, or the hormones that shift and change after you deliver can be a roller coaster of effect. And for me, I usually say, in a general sense, the first three months post delivery, is going to be kind of a roller coaster up and down. Mainly because especially if you're nursing or pumping to feed your child, the shift in hormones, and the shift in how much you're nursing how much you're pumping, can drive things, the opposite way that you would think that they might, which makes it very difficult to establish, I would have usually like over Bolus for this or I would have usually been really aggressive to nail down this now climbing blood sugar, but I'm going to nurse in the next 15 minutes. So I really can't do this strategy, because otherwise I'm going to take so there's a lot that changes postpartum.

Scott Benner 7:22
Okay, so not only. So there are some people who enter a pregnancy and already have that agency that they need. But But despite that, whether you're a person who had to get there, or you were there already, once you're pregnant, your insulin needs, they drastically change. I know it's not like trimester to trimester Exactly. Right. But there are times when you don't need as much as you think and times you need so much more that it's hard to imagine how much more you need. Right? Right. So now you have that in your head, you've been pregnant, you're having breakfast that prior to pregnancy, took three units during pregnancy took 12 units, and now you've you're holding the baby, you're thinking is this 12 units? Is it three units? Why does the weight of the world feel like it's on my shoulders? Like you know, am I nursing? All this stuff comes together? And how do you do that? It's so you started by saying the hormones, and I only want to spend a second on this. But you know, I'm older. And growing up, it doesn't happen much anymore, like society has really shifted, you know, in the way people are towards each other. And that might be harder for like somebody in their mid 20s to believe but when 30 years ago, you know, stuff that you think of as a joke now is actually how people would think about women sometimes like oh, you know, she gets upset, or you know what time of the month it is, or that kind of thing, not giving any, like, credence to the idea that when your hormones are jumping on, it's really difficult to deal with. And you're right and, and that women are in a particularly vulnerable situation because of that. So how you feel from a hormonal shift could be physically, it also could mean your your clarity. And I think what you said is just really important to remember, especially for first time mothers, when you have a baby and they give it to you, it does genuinely feel like someone just told you that the fate of the world rests in your hands. And you don't understand what to do. But if you mess it up for certain the universe won't exist anymore. It really feels like that.

Jennifer Smith, CDE 9:32
And some people have really awesome babies that are like the easiest. They just they sleep when you'd expect that they nurse beautifully. They sleep again, like they don't have any like, major poop problem. Like you know, you just have this like what you would call like, I have no trouble with my perfect baby, blah, blah, blah. And then there are women who just don't like some kids are just not type of an infant as a newborn, and I think when you have diabetes to then it brings in management again of something that's completely new. I don't know, should I do this? Should I try this is the doctor right? You know, am I gonna do this wrong to my child, blah, blah, blah. And then there's diabetes in the picture, and the timing of insulin, and the timing of adjusting and remembering to change your pump site or to actually take your basal insulin injection. I mean, there's a world of scheduling difference that comes into the picture postpartum.

Scott Benner 10:34
And I would imagine, too, and this is just me imagining but if you live for nine months within a one seat, and like the low fives, there's got to be a part of you as a type one is just like, wow, I want this for the rest of my life to wait. And now you feel like if it's going away, now, it's another failure on top of, I don't understand why this baby throws up all the time. Or, you know, like, I, I'm sure people are like, Oh, yeah, like I've everyone's heard the joke about like, the baby peed on me one time. Yeah, that's fine. My son couldn't hold down food for months, until we figured out what to give him. And, and the culmination of it was, quite honestly, Kelly holding him at her grandfather's funeral. When basically it felt like somebody took a half a gallon of spoiled milk and dumped it on Kelly, because it just came out of him like that at a funeral. And she had only been a mom for a little time. And it's hard. And it's so it's fun to talk about, like, oh, the baby peed on me. It throws up all the time. But sometimes it throws up at a funeral. And you're hormonal, and your grandfather's bed.

Jennifer Smith, CDE 11:40
Now your CGM is going off because your blood sugar is skyrocketing. Because you're stressed out about said incident.

Scott Benner 11:46
Yep. And I was gonna say my wife didn't have type one diabetes. So then all that other stuff that goes on top of it. So what do you so is it similar? Like, could you sit down and make a flowchart? Is it similar for people at at least at some core level? Or is it going to be different for every woman?

Jennifer Smith, CDE 12:05
There are similarities as you know, we talk about in our in my pregnancy book that I co wrote, it's, there's enough similarity, just like in pregnancy, I mean, everybody's going to have some shifts and changes that are a little bit different, very specific to you. Just like diabetes is very specific person to person, but postpartum Yes, I mean, the transition typically, as soon as you have delivered and the placenta has been delivered as well. It's, it's like the placenta, which is the major like functional hormonal unit. Once that's gone, and baby is out, the hormone shift. It's like a drop off a cliff. It's like, it's gone fast, which is the reason that we usually say, based on where you were, at this point in pregnancy, just before delivery in terms of insulin use, if you didn't know where you were pre pregnancy, so you could see how much things shifted up by the end of pregnancy, then we usually recommend adjusting basil rates down by about 50% Wow, okay, that's the that's expected, it could be a little less, it could be a little bit more person to person, again, may differ. But that's a baseline adjustment. So if you've never been told what to do, and nobody's directing very well expect that postpartum you should cut your bezels by 50%. Another really good idea is to most women know when their due date is. If you're using an insulin pump, especially set up a profile, that's called postpartum, okay, because as soon as you deliver, all you have to enable to do is enable that.

Scott Benner 13:39
Wow, that's that was gonna be my question. Like you're saying, like, placenta comes out, you take a deep breath, and go, I need my pump right now. And and that's it. 50% less

Jennifer Smith, CDE 13:48
50% less. Yeah.

Scott Benner 13:50
So that placenta is please forgive me if this is ham fisted, but it's the it's the equivalent of a giant sausage cheese pizza sitting in your stomach that somebody just reaches in and takes out all the sudden and now you don't have that impact anymore. Correct. Wow. Okay. Yeah, I don't know if anybody's ever seen a placenta but it is very close to a cheese pizza. When you look at it.

Jennifer Smith, CDE 14:12
They're very interesting. organs. I mean, they're, and the cool thing is that your body creates it for one purpose. And then it's gone. It's not like your heart which is like, you know, it's always there for your whole entire life. It's like your body makes this thing just like it makes the baby and then oh, it's all done it's only got this like nine month life

Scott Benner 14:35
that's it. I was just thinking this I it's funny. You said that because I was just thinking the same thing. Like why can't we just tell our body to make another heart? Yeah, like I mean, if we can do that, it could at least you know, vacuum or something, you know,

Jennifer Smith, CDE 14:47
at least also make another pancreas man.

Scott Benner 14:51
I mean, why not? I'm not a doctor, but somebody should get on that.

Unknown Speaker 14:56
I entirely agree.

Scott Benner 15:00
Imagine if you just had a panel on your back and you flip the switch and then nine months later your body just spit out an organ. There you go. Have a little slot on your side. I don't know why this isn't possible, probably because of science, but never. Okay, so baby comes out. We're all like, ooh, and and on taking those weird bloody pictures that people take in the beginning and everything and then I change my basil rate. What am I going to see next, my budget? Does the body begin making milk at birth? Or does it even start prior to that?

So you've decided that you want an insulin pump, you've decided that you don't want it to be tubed. Now you're gonna get yourself an omni pod. I think that's a good move. But there's more that can help you make your decision to things can happen when you go to my Omni pod.com Ford slash juice box, you can ask on a pod to send you a free, no obligation non working demo of the Omni pod that's called a pod experience kit, they'll send you out a pod that you can wear to see how you feel about it. But you can also check on your eligibility for a free 30 day trial of the Omni pod dash system. Right? This is an actual usage trial, you can use the Omnipod dash for 30 days, if you're eligible for this, and you'll be able to find out about your eligibility or asked for your pod experience kit at my Omni pod.com forward slash juice box, it is super simple to do will only take you a couple of moments. And the next thing you know whether you're a type one or type two, using insulin, you're going to be able to find out what it's like to have that on the pot, the insulin pump that my daughter has been using since she was four years old. And then a couple of months. She's going to be 17. for 13 years, Arden has been wearing it on the pod every day. And I promise you it has been a friend in this journey, like no other. So why don't you find out if tubeless insulin pumping is for you. My Omni pod.com forward slash juice box there are links in your show notes right there in your podcast player. Or at Juicebox podcast.com. When you use my link, you're supporting the show Miami pod comm forward slash juicebox give it a try. There's literally nothing to lose. There's no downside to this, have that no obligation demo pod sent to you. Or check into that 30 day free trial the dash see if you're eligible. Here's one more no brainer for you. The Contour Next One blood glucose meter Contour Next one.com forward slash juice box. I clicked it on there myself just now clicked it on there. That was my fancy word for typing. I just brought up the website. Geez, sorry, I just brought up that link right now Contour Next One comm forward slash juice box. Because there's so much here that's good for you. I can't remember it all when I'm making this ad you get there, there's a list of their products. They have resources, like the contour diabetes app, and a blood sugar log book for downloading. But there's also the possibility that you can get a Contour Next One meter for free, you go to meters and strip savings, and you click on free Contour Next One meter to see if you're eligible. They have test strip saving programs, it's it's also there under that tab. And it's incredibly possible that a Contour Next One meter could be cheaper out of pocket than you're paying now through insurance for another meter. Now maybe it won't be maybe it's gonna be better for you to go through insurance, maybe not. But there's that possibility. And you can check into it at Contour Next one.com forward slash juicebox. Why am I telling you to do this? Because this meter is the most accurate meter Arden has ever used. It has Second Chance test strips meaning you can touch the blood not get enough, go back get the right amount without wasting a test trip and you still get that accurate test. That's just amazing Contour Next one.com forward slash juicebox. In the past I never thought about the meter Arden had but now I do. Not only do you deserve one that's accurate and easy to use and easy to carry that has a bright light. But your management will thank you because having accurate data is the best way to make good decisions.

Jennifer Smith, CDE 19:36
The way that it should happen again, everybody's a little different and what happens. But what should happen is a first milk is created. It's called colostrum. And essentially that's very short lived in production before milk comes in. It could be a short lived, you know, few days it could be 24 hours before your milk comes in. But that milk is a very like, it's very simple form of nutrition for the baby, it's kind of what the baby is in need of right here and now, and there's not much of it. So it's not like, if you were to pump it, you're gonna get like six ounces of it. That's just that what you would get, right? So but in that simple form, and with the loss of the pregnancy hormones, now you have this sensitized system that was resistant, leading up to this point. And so there and also lies some mental shift, the shift of, you know, nearing the end of pregnancy coming, you know, Pre-Bolus isn't 15 minutes, it's sometimes 45 minutes by the end of pregnancy, in order to have good flat after meal blood sugars, well, now you have to completely flip that switch, and it's back to maybe I need 10 minutes, maybe I need no Pre-Bolus in the early couple of weeks post delivery. So not only is it that your bezel shifts, but it's also that your ratios, shift your insulin to carb, your correction factor your Pre-Bolus time. So there's, there's a major transition,

Scott Benner 21:18
right? You just become a completely different person with Type One Diabetes, just like that. Right? And so is it similar to, but more drastic to getting your period like being that, like, there's that, you know, what I mean, I don't know if it works for everybody. But Arden's three sometime now that she's on birth control, she's more like two different people during the month. But and, and it can be, it's drastic for us, you know, she can go from a unit an hour to two units an hour, basil, depending on what time of the month it is. And it does, but it doesn't flip like a switch. It's not like, but I can see it happen, happens over hours and maybe a day, but it doesn't happen. It's not like at three o'clock. She's like, I just got my period and everything changes immediately. Why is it that just blown up? Much more? Because I mean, what are you really talking about? So for people who don't know, like, I go into pregnancy, I just said, I go into print, let's just say, Alright, I'm pregnant. I have type one diabetes, if

Jennifer Smith, CDE 22:22
you're a lady with long curly hair, I'm

Scott Benner 22:24
a lady. I have type one diabetes, I get pregnant, my basal rate is 1.5 an hour in the first trimester, is it? How much does it go up?

Jennifer Smith, CDE 22:35
A lot in the early weeks. Typically, we a good round estimate is if you know the percent of increase you've had in the days before your cycle starts. If you've taken enough notice, and you have arrived and you offset it by a percent of Temp Basal or an extra basil dose or whatnot, you can expect those early weeks of pregnancy, typically up to about 678 weeks, that you're going to have an increase in insulin need. That's pretty similar. It might be more dramatic than that. It may be less, but you're going to have a ramp as your body is increasing. Its production of now pregnancy hormones to sustain the pregnancy in furthering along.

Scott Benner 23:17
Okay, so I should have said, my my Bolus was ones that we can keep track, right? It say I'm one usually when I get my period, I'm too. So then we're gonna say in the first six to eight weeks of pregnancy, I'm probably going to be more like two more like I have my period, correct? Yes. And they're right. And then from there it goes, it goes up again.

Jennifer Smith, CDE 23:38
So end of first trimester, most women notice either a plateau, okay? Or they notice a bit of a dip off in their insulin needs. For just that end of the first trimester, usually, we say on average, it's about it starts at about eight weeks, goes through about 12, maybe even 1414 weeks, which is that vertel very early second trimester start time period of sensitivity, you may have needed to back off of your Pre-Bolus time again a little bit, you may have gone down slightly in your baseline basil needs just more sensitivity around meal boluses and kind of almost feeling like things have sort of stabilized like you have a little bit more wiggle room like I can eat three chips in between and not actually Bolus for it because it doesn't seem to do anything. Right, right or right. And then second trimester again, a little bit of a nudge up potentially in early second trimester. But a little bit more stability up until about 18 weeks 18 to 20 weeks. We kind of refer to it as the the slow roller coaster climb. So if you imagine you're at the bottom of the roller coaster to begin with, and now around 18 to 20 weeks you start that slow like click click click the roller coaster Hill and that kind of progresses you Increase in resistance along the way all the way up until about 3536 ish weeks just

Scott Benner 25:07
a steady climb.

Jennifer Smith, CDE 25:09
It's a steady climb. And initially in the second trimester, it's on average, expect to make some tweaks to things about every two weeks give or take in Basal as well as insulin to carb ratio as well as the Pre-Bolus, time continues to lengthen, your correction factor may need to get more aggressive. But usually by the beginning of the third trimester, that's the most resistant time, okay. And often through like 34 to 36 weeks, as you're

Scott Benner 25:38
talking, I'm literally have a piece of paper in front of me, and I'm just kind of moving a pen, as you're talking, like trying to make a graph of what to understand. And especially now it's going to grow up every two weeks. So I know this isn't mathematical. And I'm not telling anybody that if you started with one unit, the day before you got pregnant, but where can somebody end up who started at one unit an hour, where could they end up at 35 weeks.

Jennifer Smith, CDE 26:01
So insulin needs, on average, double or triple from pre pregnancy to the end of pregnancy, or what we would consider just pre delivery time, which is about by 36 weeks, by 36 weeks, we reach again, this sort of like plateau place where again, some sensitivity can start to come back, some women's Basal needs start to dip off just slightly shouldn't be aggressive or heavy. And in fact, it's a time period that if you are having aggressive changes in your insulin in terms of like drops in need, it's a time to check in with your provider. Some of it can be relevant to placental failure. And so it's a time again, if things changed drastically that you would check in. But otherwise, it's expected a little bit of a nudge down a little bit of increase in sensitivity kind of creep back in before you actually deliver. But on average, you know, how much to adjust. Like I said, most women either double or triple their needs from three to about that 36 weak point.

Scott Benner 27:04
And so I now you have the baby. And you could be going from this mindset on three units an hour. back to why Yeah, back to one all of a sudden, exactly. And on top of that all the sensitivity around meals has changed. And and you're telling me nursing is going to drop the blood sugar

Jennifer Smith, CDE 27:24
nursing for most women who have good milk supply, and are able to, you know, pump or nurse completely without you know, most women experience especially in the early weeks, usually about the first eight to 12 ish weeks post a delivery, notice some shifts down in glucose. After nursing, during or after, if your child nurses for a lengthy period of time, you could notice it during the nursing session itself. Some women notice it only at certain times of day versus the whole day, you know, having to consistently pay attention every nursing session they're eating, you know, like to glucose tablets, or having half a juice box or something like that. I mean, our recommendations are once you once you are a few weeks out from delivery, kind of baby by that point has some typical sleep wake poop kind of patterns, you're probably still nursing about every three ish hours, maybe a little lengthier overnight, as long as your baby's nursing well during the day, or feeding well during the day. But you know, most often if you're going to nurse in the aftermath of a meal, a good recommendation is to take the bolus dose down or count carbs, but under dose by you know 25%.

Scott Benner 28:47
So it's dramatic enough that if I eat, I keep saying I if the lady eats before nursing, that meal won't need as much insulin because you're going to need some of that meal. So that means if you're not planning on eating, and you're going to nurse, you need to eat something going into the nursing,

Jennifer Smith, CDE 29:03
typically going into nursing or during the nursing session to prevent a low. Yes, and it could be anywhere. It could be simple. It could be five grams of carb, it could be as much as 15 grams of carb. It just depends. And that's where you know, looking at things like insulin on board. Yeah, you might not be bolusing and nursing directly after but if it's still like within two or three hours after you Bolus, you still have some active insulin from that Bolus. And we tell people I at least I say and I know I feel like you agree with having active insulin while you're exercising is a pretty sure way to make yourself low. But and so I'd want to avoid active insulin during nursing as well or plan for it.

Scott Benner 29:48
And the other thing is there too. If you can go negative insulin and get through exercise without dropping you can't do that with nursing this nursing more taxing on your body then some forms of exercise. Is that fair? Like, is there a correlation to think about it in? There are no,

Jennifer Smith, CDE 30:07
I guess there's some relation to think about it. I think, like, I was thinking of overnight, right? Where for the most part, moms, dads, they're tired at night with a newborn, many people are. And if that's the case, you're likely going to bed at like nine o'clock like nursery child and you're like, Okay, go into sleep, because I'm going to be up again at like midnight, one o'clock to do this all over again. You may have eaten dinner at like, seven o'clock, you're going to bed Well, you're well into basil insulin by let's call it 11pm. Right. So any time you're going to nurse after that, and you're only on basil. And I experienced this myself for both my kids, Basil overnight, if I even if I had it at all, am I of basil. While I was nursing kids overnight, in those early months, it was like near nothing. My basil was like, point 2.25 overnight, it was already down to almost nothing. And if I nursed and didn't still have something minimal, like I actually made these, what are called like lactation cookies. They're made with like oats and flax and peanut butter and stuff that helps with lactation, blah, blah, blah, but I made them so they were each about five grams of carb. But they were nice, because I could eat it, it had some stability to it, it wasn't just pure glucose. So it had some stability. And so I've usually eat it as soon as I started nursing, or something like trail mix some nuts and seeds with a little bit of like dried fruit in it, something that was no more than about five or 10 grams of carb. And that helped with the stability component with rather than the bank I

Scott Benner 31:46
was dying. And so this is another time, you know, where the the food choices you make are going to make things easier for you to get you can and you know, so it's gonna, you're gonna have a different scenario going into nursing, if you're like, Hey, I know what to do. I'll have a handful of this and a little bit of that, and that's gonna work out perfectly. But on Thursday, when you're like, you know what I'm gonna do, I'm gonna have ice cream before I nurse there's gonna be all everything about ice cream still exist there and your diabetes. Okay,

Jennifer Smith, CDE 32:15
in fact, those kinds of things, you know, as we know, ice cream, typically should cause a bit of a rise possibly later fat, depending on how much have you ate, you know, two spoonfuls, probably Yeah. But like the whole point of it, probably.

Scott Benner 32:29
You're telling me that there's a way that I can get I can have ice cream far enough out in the future ahead of my nursing where I could balance that fat rise against the nursing. You know, there are some lunatics that listen to this podcast are gonna try that I saw somebody online this morning, who's trying to stay 100% in range till they get to their endos appointment and they're doing it. That's awesome. Oh, my God.

Jennifer Smith, CDE 32:51
That's a lot of

Scott Benner 32:54
meat. Yeah, I don't know. I don't do that. So I for Arden, I think they just get there. They got a little like, I just want to say

Unknown Speaker 33:04
to them, that's what I want

Scott Benner 33:06
to tell people too. I know it sounds difficult in the beginning to have a baby. But if you want to know how good you will get at it at some point. Here's a great example. About two minutes ago, there was a bang in Jenny's house that was so loud. I thought the world was coming to end. He didn't flinch. She didn't stop talking. It was that's what happens. You eventually you just become a steely eyed missile man. She just did not move. She's just

Jennifer Smith, CDE 33:33
because there are beings all day in my house. I mean, when you work, you know from your own home office, and you have children in your home. I'm sure there will be more bangs. I don't know what they're doing upstairs. But they are having fun. It was so

Scott Benner 33:45
it was just a great example of how you do become really great at parenting after you've had kids for I swear to you, you did Oh, yes. I don't need it. It's almost like you didn't hear it.

Jennifer Smith, CDE 33:56
Don't pay attention. Sometimes. Oh, yep. Sometimes like that. Like I have a big sign that my husband made for me. And it's outside my office door. And one side says quiet zone mommy is working. And the other side is mommy is done. You may enter and be loud is what it says. Well, you know, when I'm working, it's still always in the quiet zone. Well, you know, with an EIGHT and a four year old. They know what the sign says. But that doesn't always still click into place.

Scott Benner 34:28
So yeah, does not overwhelm what they want in their hearts at that moment. That's for sure. I listen artists. It's funny. Arden's gonna be 17 in a couple of months. Wow. Isn't that crazy? And I saw her go into where my wife was working the other day. She looked at me like she was six like, Hey, watch this. slides into Kelly's chair sits on top of Legos. Mom, can you rub my head? Kelly's like, you know, reaching around for the keyboard and everything. So it will it will you won't always feel overwhelmed. How many people do you? I don't I'm not sure gonna say how many people but I mean, do you see women generally able to stick to their diabetes goals after pregnancy? Or should they expect it's going to get out of whack? And they're going to have to do some work to get it back? Like how does that usually go?

Jennifer Smith, CDE 35:18
I, I see that you should expect that there's going to be fluctuation that you will have to learn to adjust to, I myself, I had to learn to adjust. Because, you know, as much as I know, clinically, and professionally, the experience itself speaks volumes about what you need to transition through. And so I think every woman postpartum should expect that things are going to be a little bit wonky here for a bit of time. And I mean, some things that I think, helped me transition where I prepped some meals and froze them prior to baby coming, you know, and whether you have diabetes or not, that can be really, really helpful. You know, some of those kinds of things I also had snacks planned I had, meanwhile, you end up sometimes nursing your child wherever is comfortable, you know, planned places, you know, in the baby's room, in your bedroom, and a comfy chair in the living room, just some things that were like easily reachable, that I didn't have to like, call to somebody to bring me and I just had glucose tablets, and some juice boxes, like trail mix, and that kind of stuff sort of set multiple places around. So I mean, there's some planning that you can do ahead of time. But the diabetes management piece of it, it kind of learned as you go, I mean, I'd say that about the women that I work with through pregnancy, if I had to estimate, I'd say about 50% of them end up sort of sticking with me a little bit longer postpartum, just because especially then the new moms, you know, ones that already have one or two kids. They're like, Ah, yeah, I think I got this, you know?

Scott Benner 37:09
So does being pregnant with type one, give you an advanced. So what do I want to say here? There are so many times when I'm making this podcast, that it occurs to me that success with diabetes hinges, a good deal on your desire to be successful, and your ability to feed that desire with effort. Does that make sense? Yeah, absolutely. And so you, you get pregnant. And then it becomes like this thing we were talking about, in the beginning like this, I have this feeling that you are in charge of the universe all of a sudden, and I will tell you to, and I mentioned it sometimes when I talk to adults who didn't have particularly well managed, like, teen years or whatever, a lot of them have a through line, they started to care more about themselves, where they started caring more about another person, like they want and then they wanted to be healthy or because they wanted to be in this relationship or because they wanted to go to do something or, and the baby falls in that category to me like I want to, I'm going to do this so that the baby can be healthy, and that the number of women I've talked to who were living really unmanaged lives with type one diabetes, and then all of a sudden, 4.8 a one sees, you know, they mean an eating like, a lot because they're growing a baby. It happens. I just see it a lot. And so I always kind of think personally, as a person who's never going to have a baby and hopefully never have type one diabetes. There's something about that motivation in there. That I guess the fight in postpartum is to not, I don't know if it's something you can stop, but for all these things that are going to happen to you postpartum to try to still whittle out a little bit of your energy or effort to devote to your blood sugar.

Jennifer Smith, CDE 39:05
Absolutely. And I think a good reason there too, in terms of diabetes postpartum is glucose management still translates into that time period for the sake of the child even though they're no longer growing in you. And your blood sugars aren't as direct have an impact, postpartum if you are nursing and you are not managing your glucose, as optimally as you know would be helpful. Those higher glucose levels are going to impair your ability to make enough milk. Okay, if left high, your ability will be decreased. You will also be more dehydrated as you nurse it takes fluid out of you if you're not putting it back and glucose levels are also trending high. That in and of itself is a I'm going to make your glucose management more difficult.

Scott Benner 40:03
Does it change the milk itself?

Jennifer Smith, CDE 40:05
To a degree? I mean years ago, we don't we don't talk about this really much anymore. Although I have heard some women who've asked me Should I just, you know, pump when I'm really, really high and then dump it because I've been told that that I sugar, milk is really bad for my baby, I mean, overall, increment of right now my blood sugar is high, because I ate something and didn't really have the right carb count, and I'm knocking it down Should I not feed my hungry child right now, absolutely not, go ahead and feed your child nurse your child, pump, whatever, don't get rid of the milk, your body works really hard to make that milk don't get rid of. But the goal is to have more sustained levels that are still in target to so you're able to continue to make milk and that the amount of milk sugar that's in that that breast milk is stable, right? That it's stable, and at the level that it's supposed to be protein fact, carb content of milk changes as the milk as the baby's kind of needs change through the growth cycle. So you want that amount of natural carbon there to be appropriate. If you're sustaining blood sugars, you know, well above 180, you can guarantee that your milk is richer in carb, not by like loads and gallons. But overall, you're supplying your child with bits more carb, and in a tiny growing body. A little bit can be a lot.

Scott Benner 41:36
Okay, that's it just occurred to me like we talked about undiagnosed people can, their urine can smell sweet, or their breath can smell sweet. I was like, I wonder if it could happen to the milk through that makes sense. So much like most of this about diabetes, sustaining low variability is always just very important. No bouncing around, you know, that kind of thing. But if you just threw, like, say you were a person who had the Weber's like, boom, I'm going back to my nine a one see that milk would be tainted in some way? Not Yes. Yeah. It's not perfect as what we're saying.

Jennifer Smith, CDE 42:11
It's not perfect, right? I mean, it is enabled, perfect. I don't know. But I mean, if you're sustained if you're sustaining these really elevated glucose levels, that's not a benefit. And you're going to I mean, for the most part, you're going to have difficulty maintaining no production.

Scott Benner 42:29
You are, it made me wonder when you were talking about long term? What about people who I know sometimes you see people like nursing a two year old? So it for people who do that? Should they expect that? That hit like your body never gets used to that, right? Like, you're gonna get that thing? Yeah, that blood sugar hits gonna come forever? If you? No, not

Jennifer Smith, CDE 42:47
really? No, actually, no. In fact, after about three to four months postpartum, there's a stable enough nature to the milk supply into what your body or your baby is demanding. That for the most part, things stabilize, wow, a lot easier after about three to four months. In fact, I nursed my kids while after they were a year old. And in fact, I think they were both almost two. I mean, it wasn't all day, it was like, for bedtime, and for nap time by the end. So it wasn't really that they were probably even getting very much, but usually post a year, you're typically not going to see that hit. And the big reason, especially after about six months to a year is because now your baby is starting to eat. Okay, while milk supply is still considered the main nutrient up to a year of age, some kids start eating really, really well, after 678 months. And so you may see a decrease in the amount of nursing that goes on as the baby becomes more interested in food and takes in less, especially the overnight many women, you know, might have a really great child who just sleeps all night. And so they might only nurse once or twice maybe or on eat, you know, some women nurse on need during the day. But those, those sessions are not typically going to cause the drop in blood sugar that the early three months will cause

Scott Benner 44:15
I want to make sure I didn't misunderstand something. So there is a balance between you might not be using as much and your body's becoming very good at making it or is the like At first I thought you were saying like the same lady's body that can make an organ knows that can figure out how to make milk without it being like a tax on the system. Like is there some of that and some of the not being

Jennifer Smith, CDE 44:36
back? I think it's a mix. Yeah, honestly, because for the most part, like I said about at three to four month mark. I would say the women that I get to work with well past the immediate postpartum time period, they find a lot more stability in their glucose even though they continue to nurse beyond that point. Then the lactation or the nursing sessions, don't Have the hit that they do initially.

Scott Benner 45:02
Okay, thank you. It's a quick little parable. Why are I asked you to think of there's anything that we haven't talked about, let me tell you that I was interviewing somebody recently who said that they were listening that I interviewed this person I was I talking to them doesn't matter. I was conversing with a person who said that they're pregnant now. They're listening to episodes of the podcast about pregnancy with you in them, while reading the book that you wrote, and did not connect that you were the person from the podcast, they didn't realize the person that wrote in the book was the person talking in the pocket, and all of a sudden, it hit them one day. And she's like, Oh, my gosh, it's the same Jenny. That's awesome. That was really cute. I want to tell you about that. I almost just texted her. And I'm like, I'm gonna tell her that while we're recording the postpartum episode instead? That's awesome. Yeah, it was really cool. Anything we didn't say that we should have? Oh, I'm

Jennifer Smith, CDE 45:56
trying to think, Mmm hmm. You know, the only other thing that we didn't really touch on, while it should be considered is, depending on how you're feeling postpartum. I mean, most women have like this, I give you restrictions up until about six weeks post delivery, when you're going to have your check in with your ob and blah, blah, blah, and make sure everything's healing well, and you're okay. And then they kind of like, check you off. And you can drive again, or you know, if you've had a C section, or you can get out and start running again, or whatever. And I think that's a piece to consider in the mix with diabetes, because, you know, we know what exercise. Now you not only have exercise coming into the mix, but you've also got nursing coming into the mix, and all these insulin changes that you're trying to make. So one of the big things that sort of fits here is if you have maternity time, not all women do. But if you do have maternity time, use your maternity time to try to establish sort of a route, like a routine or a schedule. And some of that's going to be dictated by the baby, obviously. But even regular for you trying to get your nutrition in timely through the course of the day. You know, once nursing is a little bit more regular the baby's wake in nursing times or more you can fit it in or around the meals and exercise is a big one of that. If you're going to start exercising, try it at a similar time of the day to kind of get a feel for how does this work? You know, what can I get away with? What's too much? What's too little? Because I think that just brings in the whole, like, I feel good enough to go and you know, take a three mile run. But what's this gonna do? I don't know. Let's try.

Scott Benner 47:44
I hear you. So it's not dissimilar to it is interesting, as you're talking about it, it really feels like postpartum is a lot like just being diagnosed but having way more information about diabetes, right? Like Like, what if, what if somehow magically, I knew the things I knew, but never had to put it into practice. And then all of a sudden, there was a newly diagnosed person here, I'd be able to roll with the variables much better because I have better tools. And so you're going to go from having diabetes, maybe not doing it, as well, learning how to do it really well, or already knowing how to do it well, and then it's gonna feel like you're diagnosed again, and you're taking care of a baby at the same time. And all your variables changed again, I'll tell you, this is giving me a different feeling for first episode of season seven 2021 was with a woman named Jill, who was diagnosed as she got pregnant. So she was pregnant for the first time and had Type One Diabetes the first time and I am now talking to you thinking I had a lot of empathy for I might not have had enough like, like hearing about us.

Jennifer Smith, CDE 48:57
That's a whirlwind of change. Not only is she pregnant, but now she's pregnant with something she has no background to managing. And she's got to learn how to manage it through the variables of pregnancy as they shift and change. I would imagine that postpartum was probably a lot more difficult for her than pregnancy was

Scott Benner 49:17
I wonder she's she's active on the Facebook page. She looks like she's doing terrific. She actually also was Miss diagnosed type two diagnosed type one. It's a fascinating story. You have to go listen to it if you haven't heard it. Let me know

Unknown Speaker 49:32
which episode is it.

Scott Benner 49:33
I'm actually going to look right now because I don't know. I've I think I'm at the point now where this I've done so many of these.

Jennifer Smith, CDE 49:42
I know you're like

Scott Benner 49:45
hold on let me look real quick. It is called wait on i thought was January only 21. I'm looking. Why do I not see it. It would it would be helpful if I knew what year it was. Now that I know what year it is, I'm getting down. It's called wine beans, babies and cue. It's episode come up with these names. It's Episode 425. Well, she was misdiagnosed as type two. So you know, she still went on a wine vacation with our friends. Beans, I forget babies because she was pregnant. Because she was told she could go she could. She was told she could get pregnant by a person who told her she had type two diabetes. And then she got pregnant as she found out she had type one diabetes, and a doctor with the last initial of Q set her straight. That's where all that comes from. And that's you just made I can't remember what the beans were Damn it is a good episode. She's really lovely. Yeah, but I know her because she reached out right in that moment. Like she found the podcast and she's like, I don't know what to do. I just found out I'm pregnant. I have a baby coming in. I have type one. So I was like, Well, after you figured this all out and had that baby, you got to come on the podcast. Yeah, tell the story. Anyway, she's terrific. And, and so are you. We've covered this pretty well. I like this a lot. We did a little like personal chatting at the beginning. So we didn't get to do one of the things I wanted to do. But I'll just put that on my list for now.

Unknown Speaker 51:18
Okay.

Scott Benner 51:19
I thank you very much. I somehow find it delightful that your kids were much noisier than normal. While we were talking about having

Unknown Speaker 51:27
this was one child.

Unknown Speaker 51:29
Oh, really? That was just,

Jennifer Smith, CDE 51:30
this is just the four year old. The other ones that

Unknown Speaker 51:32
school? Oh, I can

Jennifer Smith, CDE 51:35
imagine he is. So my mom came my mom came this past weekend to visit for my birthday. And she brought them a ring toss game, which has like it's like a wooden base. And then it's got you know the things to like, throw the rings over. And I'm expecting that either the whole thing was lifted up and dropped on the floor. Or the ring toss was being thrown from a larger distance and maybe all the rings at one time were being thrown? How much

Scott Benner 52:03
of this do you think is the part of the country you live in? Is your mother prepping them for beer pong later is do you think that what this could be? I swear to you, it felt like two adults lifted up your dining room table and dropped it for about eight inches.

Jennifer Smith, CDE 52:19
And the funny thing is, it was like like you said I didn't flinch. Because it was like a background like I don't it's just a background noise.

Scott Benner 52:26
I thought I thought off the Bleep myself out because here was the thought in my head. I thought did she not hear that? Cuz you didn't blink. It was fascinating. Anyway, ladies, have a baby get through all this and one day you'll either be as good at this as Jenny or is numb as Jenny is I'm not sure how to put it.

Unknown Speaker 52:48
Yes, it's

Scott Benner 53:00
a huge thanks to the Contour Next One blood glucose meter and Omni pod for sponsoring this episode of the Juicebox Podcast. You can get your free no obligation demo of the Omni pod or find out if you're eligible for the free 30 day trial of the Omni pod dash at my Omni pod.com forward slash juice box. And of course get yourself a meter that just flat out works get the Contour Next One blood glucose meter at Contour Next One comm forward slash juice box. In just one second, I'm going to tell you how to reach Jenny, and where the rest of those diabetes pro tips are at.

Jenny Smith works at integrated diabetes.com that's all you have to do go to integrated diabetes.com Jenny does this for a living. She could actually help you in your personal life. All right now there's diabetes pro tip episodes. They're right here in your podcast player. Like I said at the beginning, they begin at Episode 210. But I've also made a list of them and put a player at diabetes pro tip.com. So at diabetes pro tip comm you scroll down a little bit, and there's tons of links there to different podcast players that you can click on and keep in mind you should never pay for a podcast player. There are plenty of good options that are free. Where you can listen right there on the website. There's a player embedded and has all the episodes in a row from 210 all the way to this one. Now 210 is called newly diagnosed or starting over I think these episodes are made to listen to an order and kind of together they coalesce very nicely. And there's Episode 211 to 12 to 17 to 18 about MDI insulin Pre-Bolus ng and Temp Basal and then there's to 19 to 24 to 25 to 26 to 31 insulin pumping, mastering your CGM bumping and nudging making the perfect Bolus and variables from there. We talked about setting basal insulin exercising with Type One Diabetes, the rise that your blood sugar may experience from fat and protein, how to handle illness injury and surgery, glucagon and low blood sugars, emergency room and hospital protocols. Talking about your long term health, revisiting the bumping and nudging episode. pregnancy is in Episode 364. We have one at 371 that explains Type One Diabetes to others. So if you've got a babysitter or a mother in law, who doesn't seem to get it, just send them Episode 371. Episode 379 is about the glycemic index and the glycemic load of food which is incredibly, incredibly important whether you know it or not. And then of course, this episode, diabetes, pro tip, postpartum, I think you're going to love this series. If this is your first one, go back and check out the rest. There's a little description at the top of the page. And there's even some reviews from listeners who've already listened to the pro tip series. Don't forget, it's 100% free. And you're not on anyone else's schedule. You don't have to be in a program with a guy you found on Instagram. You don't have to be at a certain place at Tuesday night at eight o'clock, you can listen to these at your leisure. And over and over again, if there's something that you didn't understand. They're there for you. And I hope they help. I don't think you should have to pay someone to understand how to be healthy. And that is just one of the reasons why I've put together this diabetes pro tip series. You can shut this off now. Or you can hang out for a second while I read you a couple of the reviews from the site. type one Tara said through an apple podcast review. This podcast has changed my life. I had a desire to lower my agency and manage my blood sugar's better, but was going at it blindly finding this podcast put everything into a tangible and practical management approach that has taken my agency from 8.3 to 6.3 in less than six months. And that's just right now it's going to keep coming down. It's been 1971 again, through Apple podcasts. My son was diagnosed type one about five months ago. I've learned so much from just the pro tip shows. And we'll be listening to all of the episodes. This podcast is amazing, both for the information and for the shared experiences from Scott and his guests that make you feel less like you just got hit in the face with a shovel. And more like you can find ways of keeping your loved ones happy and healthy. And finally, Marty said, I saw a mention of this podcast and one of the Dexcom groups I follow on Facebook. The pro tip series is filled with such great information. Thank you. For someone who has been living with diabetes for 30 plus years. I wish I had been more proactive in finding this information sooner. I'm going to recommend this to my end. Oh, I want to thank you so much for listening for sharing the show with others. And of course, for subscribing in a podcast app. Please please please hit subscribe in your podcast player. All right. I'll talk to you soon. Take care

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#391 Diabetes Pro Tip: Glycemic Index and Load

All carbs aren’t created equally

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 Music - 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 0:10
Hello, friends, welcome to Episode 391 of the Juicebox Podcast. This episode is a another in the pro tip series. That's right, Jenny Smith is here today, Jenny and I are going to be talking rather loosely, more colloquially, if you will, about the glycemic load and glycemic index. Now, please don't turn off your podcast player. I know that seems boring. But what we're really going to be talking about is understanding that different foods impact blood sugar differently, even if those two foods both have the same amount of carbs in them. This is incredibly important. This is something that many of you just undervalue. So while you're listening today, please keep in mind that I think this is incredibly important. And also keep in mind that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please always consult a physician before making any changes to your health care plan. We're becoming bold with insulin.

Today, I've invited Jenny Smith to come back. Do you know Jenny, Jennifer has had Type One Diabetes for 32 years now. Jenny also holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator, and a certified trainer and most makes and models of continuous glucose monitors and insulin pumps. So you know, Jenny from the pro tip episodes, and from defining diabetes, and from ask Scott and Jenny, I know Jenny from my life. And there's no one I'd rather talk about stuff like this with that her. So today, Jenny and I are going to dig a little deeper into glycemic load and index. There are other episodes that deal with this topic. But it deserves to be in here in the pro tip series as well. Because so many people think a carb is a carb is a carb. And that's just not the case. Today, I'm gonna put the ads up front, so that we can talk straight through this episode of The Juicebox Podcast is sponsored by the Contour Next One blood glucose meter. This is the blood glucose meter that my daughter uses every time she checks her blood sugar. And there's a good reason why it's not because they're advertisers on the podcast, we had the meter before the podcast that Contour Next One is small, easy to handle has a beautiful bright light for nighttime viewing a test strip that allows a second chance blood drop, meaning you can go in, get some blood not enough and go back without ruining the accuracy of the test. And speaking of accuracy, this thing is gold standard. I trust it implicitly Contour Next one.com forward slash Juicebox Podcast get there, there's gonna be a lot more than just the next one meter. Here's some other information you'll find at the website. First of all, contour makes other meters. I use the next one, and I love it. But you may want a different one that's under the products tab. Under the resource tab, you can get the contour diabetes app, which works with the Contour Next One meter, it's really great helps you make a ton of sense of your data. Then we get to the meters and test strips tab. Free Contour Next One meter, it's possible Can you imagine that that you could be eligible for a free meter. So check it out. There's also a choice card that may help you save on test trips. And of course support if you need it. All this should be enough. But while you're there, there's one more thing to look into. And it's this is it possible that the cash price for the Contour Next One would be cheaper than what you pay through your insurance. Hmm. It is possible look into it. So whether you just want the Contour Next One meter, want to read more about how it works. You need to get that app you want to look at other meters. Find out if you're eligible for a free meter. Or look into that choice card to save on test trips. Everything you need to know about this is at Contour Next one.com Ford slash juicebox. Please don't forget to check out touched by type one.org if I'm not mistaken. Dancing for diabetes is coming up very soon. Check them out touched by type one.org also find them on Facebook and Instagram. Last thing before we get going t one D exchange dot org forward slash juicebox, it will take you less than 10 minutes to add yourself or your child's information to the T one D exchange registry, you need to be a US citizen. But once you put that information in there, and it's just there's the simplest things asking you questions about life with diabetes. And then they use this data to help make better decisions in the world for people with type one. One example, just one example is that the data from the T one D exchange, led to the ADA lowering target a one C for children. That's a big important step. Because of how it impacts the practitioners and how they talk to you about expectations. It seems like one of those things you just kind of wouldn't think about, but they need to happen. T one d exchange.org. forward slash juicebox. Support the sponsors support the show I thank you very much. All that's out of the way now. So let's get to my conversation with Jenny Smith, about understanding the difference between one carb and another. And the importance of that difference, and how it's going to impact your management. I know it sounds convoluted. I know it sounds boring. But it's it's everything. So please, lesson.

Okay, Jamie? So I know how people's minds work. And the problem with this episode is it's going to be incredibly important. And they're going to see the title and not listen to it. Right? Nobody. I'm just going to curse and I'll bleep it out later. For some reason. You are adoring glycemic load and glycemic index of foods. You're making me crazy. Okay. So here's the here's the problem. The core of this cod podcast, the concept behind it is, I don't think you should have to limit your diet. The unspoken part of that sentence is I also don't think you should have a bag of sugar every day. Right? So I want. Yeah, listen, if you get crazy one day, and you're like, having a pop tart, or I want to eat a bowl of cereal, I want you to understand how to Bolus for that that's really at the the reasoning for the podcast that it's at its beginning, like I said, but the amount of people who say, Hey, listen, I counted these carbs. And it didn't work. So I don't know what you want me to do about it? Well, what I want you to do about it is understand that there's a difference between 10 grams of potatoes and 10 grams of sugar and 10 grams of Pop Tarts and Cheerios. And are the I'm fascinated by how many unhealthy foods people think are healthy. Which one jumps into your mind when you say that? Because I think of wheat bread right away. Like somehow being wheat bread doesn't make it bread.

Jennifer Smith, CDE 8:19
I think of especially in the past five years, I would say maybe even more than that.

Scott Benner 8:27
I know what you're gonna say God,

Jennifer Smith, CDE 8:28
I think of

meal bars. Okay, I don't know

Scott Benner 8:35
what else to call them. That's not what makes a good.

Jennifer Smith, CDE 8:38
It's kind of like the bread idea. Just because Wonder Bread now says that it's wheat bread versus white bread. That's like if you want real bread, like go back to granny. Yeah, bake some bread how she made her bread, right? And even you know breads today being there's a plethora of them on the market. Right? But just because it says wheat bread doesn't mean that it's healthy bread. I mean, if you're talking about like healthy bread, if you're going to eat it, you're talking about the sprouted like low glycemic we'll talk about the glycemic since the purpose of this whole episode. But right I mean, those types of breads the unprocessed, you can actually physically see the grains in it or the seeds or whatnot. There's a big difference between wonder wheat bread and sprouted grain zekiel bread. Yeah, major difference.

Scott Benner 9:32
Even even when I make bread at the house, I'm only just making white bread, but it's at least sugar, flour, yeast, water, butter. That's it. That's what's in it. Like salt. Excuse me. That's that's what's in it. It's of course the flowers processed and the sugars processed. But you can buy a loaf of wheat bread and the first ingredient is high fructose corn syrup. And people are like, I don't know what

Unknown Speaker 9:59
happened. Right, right? I do.

Jennifer Smith, CDE 10:02
I do, too. Yeah, absolutely. It's kind of like I said to though, with the bars, people, lives are busy today. Very busy. And I actually did a whole, like, I think I did a blog post about this actually, or was in part of our newsletter or something all about, like, sort of the false advertising of nutrition bars, right? You're eating your nutrition bar, because it's like, it's low carb, or it's low glycemic, or it's follows your keto plan, you know, what they're, if you're gonna follow a plan, follow a plan and eat real food.

Most I say most of the time like these, like 9010 8020, kind of, most of the time you're doing real food, you know where it came from, your grandmother could identify it, I can guarantee that if I showed my grandmother who is no longer living something like, I'm not gonna name a brand, but a general like, a store bought processed meal bars to be like, what is this? What is this? What is this, go make yourself a peanut butter sandwich or

Scott Benner 11:12
something? No, those things are so dense, with calories and carbohydrates and all that stuff. My son uses them. So my son does not like to have a full stomach when he's playing baseball. But you can't go play college baseball in the heat without fuel. But he can take like a half of one of those bars and power them through a baseball game. There's so much jammed into it. So he likes them because they don't fill a stomach. But it goes to show how much fuel is in it and, you know, things that impact your blood sugar. I thought, you know, when you said, you know, a bar, I thought you might say vegan food. And I thought you vegan diet. And I thought you might say no gluten stuff. Because I had to remember one time, they were trying to figure out my iron issue. And a doctor said, Hey, don't eat gluten for a month. And in a month of eating not gluten. I gained like eight pounds. And I thought, but I'm eating healthier. And then I looked back and I went No I'm not. I'm just eating things that don't have gluten in them. Right, right. Okay, confused, no gluten with health. And my daughter's friend is a vegan. But she's basically a human garbage can. You know, it's fascinating.

Jennifer Smith, CDE 12:33
It is in terms of I mean, just those two, vegan or even being vegetarian is kind of the first right. Okay, you don't want to eat meat. Great. I mean, for the most part, the only animal that I eat is fish. Okay, I don't eat any of the other animals on the planet. I eat fish. It's occasional, not very often. So for the most part, we are mostly vegetarian. And but you could be a very unhealthy vegetarian, you could also be a very unhealthy vegan. Yeah, I mean, if you're doing a heck of a lot of the processed, oh, but it doesn't have any animal based product in it. Great, but like, How long has it been sitting in the bag or the box on the shelf just because it doesn't have animal product in it? Or? Right? I mean, there are healthy ways to be vegetarian or vegan. There are also healthy ways to be on a ketogenic diet. You know, a lot of the products that are on the market for that type of an eating fueling plan are very processed, you can be healthy and actually eat good real food on a ketogenic diet or on a vegetarian diet or on a paleo or a caveman diet. But much of the processed stuff that's out there like you found with the the gluten free stuff. Yeah. Unfortunately, a lot of the gluten free packaged processed stuff. It's made out of very this brings in glycemic index. It's made out of very high glycemic, quick impacting refined carbohydrate, right rice flour, tapioca starch, potato flour. I mean, the lower glycemic ones would be things like if it's made out of like an almond flour, or like the nut flowers or like a coconut flour or something like that. Those tend to be lower impact, lower glycemic still processed. Yeah, but um,

Scott Benner 14:24
well, the reason I bring it up and I'm sure this happens to you constantly been to me far less because I don't speak to nearly as many people one on one as you do. But I am just endlessly inundated with people who want to know like, I don't understand why this isn't working. I eat healthy. It's almost like when people say it's almost like when people say to me, oh, my blood sugar got really low. I've learned not to infer what I think of is low into what they say in the beginning. When someone say to me, oh, I get really low. I'd go right over it. Now. I stopped and I go What does that mean? What number is really low? Because sometimes the person will say 85. And I'll go, Oh, well, that's not really well. And so it frames my conversation. So when people say I eat healthy, I do. I'm like, what does that mean? Because I need to understand what you're eating to talk to you about the insulin you're using, because we did everything right here. Your blood sugar should not be 200 right now, why don't understand I had a really healthy meal. And then when you talk to them, you know, it's like, oh, I had avocado toast and you think oh, that does sound healthy. Except a they don't know. There's carbs and avocados for some reason. They're completely dis concerned with the fact it's in the avocado, and there's high fructose corn syrup and the toast they made and I'm like, Yeah. Okay. So, so, I don't care how anyone eats. I would think of myself as the only real diet I stick to is an intermittent schedule. I only eat in the certain hours. But other than that, in the past week, I've had Ben and Jerry's ice cream. I'm making ribs tonight for dinner, Texas style, in case anyone's wondering gonna smoke them. And you know, I think last night we had I had chicken parm that I made last night. But keeping with Jenny's point, I made the chicken parm I took a chicken breast, I hammered it flat. I put bread crumbs on it, and a little tomatoes and some mozzarella cheese, you at least you could see what was on it, and

Jennifer Smith, CDE 16:25
you knew what you put in it. Yeah, and I didn't have an idea.

Scott Benner 16:28
And I didn't fry it in any of the in, I don't use processed oil either. And the and the olive oil I use is the only cold pressed I don't I don't use the heat pressed. So those are pretty much the only things that I follow. And besides taking, you know, a reasonable amount of like, you know, vitamins. I don't really do anything differently. But I'm also not really interested. I'm not trying to impact my weight. I just want to be healthy and I want to eat something.

Jennifer Smith, CDE 16:56
And you're not concerned with your own blood sugar overall. I mean, you're concerned with your daughters.

Scott Benner 17:00
Yeah, I want a glucose monitor a couple of times my body handles my diet. So that that's and I'm not overtaxing it. I didn't eat like three pints of Ben and Jerry's ice cream. You know,

Jennifer Smith, CDE 17:11
but I think it's also I think that actually brings up kind of a good, a good visual of the difference between glycemic index and glycemic load when you were wearing that continuous monitor. I remember you either. I think you texted and you texted like how much you physically had to eat. In order to get the CGM to register like a bump up in your blood sugar's showing that your body was actually being taxed.

Scott Benner 17:41
It was fascinating. Yeah,

Jennifer Smith, CDE 17:43
by the amount that you ate. And that actually speaks to the load impact, right. So when we talk about glycemic index and glycemic load, glycemic index is really just it considers the amount of food that you've eaten carbohydrate that will turn into impacting sugar in the next two hours after you consume the food. But that's just the tip of the iceberg in understanding and that's been when I talk to people, you know, who are trying to consider glycemic index and like, you have to take it a step farther, there are depths or there is depth to glycemic index. And a step farther is glycemic load, in terms of glycemic load talks about the amount of the food that you're eating at a particular time. And my favorite example to give is watermelon. Watermelon has a very high glycemic index. If you're not familiar with glycemic index or not quite sure it's a scale of zero to 100, with 100 being pure glucose. So as foods are rated on that scale with a number, that higher the number or the closer to 100, the faster the impact should be on your glucose level. Okay? But again, this is in a simple lab generated testing, right where you're only eating my example watermelon, you're not eating watermelon on top of chicken parm on top of like a whole stick of butter. Right.

Scott Benner 19:13
I also wonder, are these things tested on people with diabetes when they come up with the index or people with a working pancreas when they come up with the index?

Jennifer Smith, CDE 19:22
That's okay, that's, I believe it was I believe it's people with a working pancreas. Yeah, to give a true definition of what the impact could be. When sort of outside insulin dosing isn't in the picture but that is a really good thing. It makes me think, maybe looking that up.

Scott Benner 19:40
Here's what it made me wonder about, you know, when somebody tries to catch a low by turning their bezel off for an hour, and then they create like, a void in front of them a black hole where there's no and then they have the tiniest bit of carbs, like my blood sugar shot way up. I don't understand it. Well, your pancreas doesn't work, and you took away all the insulin in your body and then added even the tiniest bit carbs. So the glycemic index of anything away from insulin is probably 100, right? Like everything probably hits like 100 away from insulin. And so when you've got the right amount of bazel, in, these foods are going to still hit on this chart. And before we go on, like I just want, I'm gonna roll through it real quick and just pull a couple out to give people an idea. whitebread is a 75. Right? White rice is a 73 cornflakes are 81. But an apples 36. Right, strawberry jam is 49, a potato boiled is 78. But a potato mashed is 87. So everything hits differently. And when I stand on stage, I try to simplify it down by saying foods punch at a different weight, some of them just hit harder than others. And that's and it's interesting to they have sugars listed out here. sucrose is 65. Glucose is 103. Honey is 61. And fructose, if I'm saying that right is 15. And

Jennifer Smith, CDE 21:11
so it's fructose is fruit sugar. And that kind of brings into the treatment for lows, then, the reason that glucose tablets technically work the best or anything in which dextrose is one of the first three ingredients in like a candy kind of thing. That's the reason it's going to work the best because glucose is the simplest form of sugar that there is there's no breakdown to it, it gets in and it gets distributed and use. Whereas something like fructose, or galactose, which is milk, sugar, sucrose, they're more come there are more combined chemical sugar structures. So your body has to break it apart, to get the glucose out, okay, to actually impact the blood sugar. So

Scott Benner 21:52
in a scenario where a person takes a glucose tab, and it takes forever for their blood sugar to go back up, but eventually it rockets up, that means they have a lot of active insulin at the tabs fighting with is that is that what you would infer from that,

Jennifer Smith, CDE 22:05
that would be the estimate, you know, if there's iob, and there's a load of it, and there's a low and you only take one glucose tablet, that's like a drop in like the ocean of impact the other. The other reason could possibly be whatever is in the stomach already might be hampering the true absorption of that if the glucose tablets kind of sitting on top of that digestion. And if that other food is really highly fibrous, or very high in fat or a lot of protein, it may take longer for that little bit of glucose to definitely impact and get absorbed. Yes. Okay.

Scott Benner 22:43
All right. So I'm sorry, we kind of got away from it for a second. But it all feels really important, you know, that, that you can't just I mean, all carbs aren't created equal. I guess that's how I've boiled it down for the podcast. But again, the the amount of you out there who I try to say to people, like when they're really learning about the podcast, they're going through the pro tip episodes, and they're getting the ideas down, but they're still spiking, and they're getting low later. I always say like, why don't you just simplify your food choices for a little while, while you're practicing? You know what I mean? Like, I think I think I said to somebody recently, if you got it in your head that you wanted to learn how to box and you went to the gym a couple of times, you took some sparring, and you were starting to get confident. Once you had a little bit of confidence under your feet. Your next thought wouldn't be, you know, I had to go find iron mike tyson and see if he wants to go a couple rounds with me because you're not ready for that yet, right? But people make a couple of good boluses in a row and they're like, I'm gonna try Cheerios like, no, don't try Cheerios, it's day three. You're not good at this yet. You're getting better at it. And so if you're having trouble putting tools into practice, I always say go for things that are you know, that don't punches hard while you're practicing it, cut yourself a break, you know,

Jennifer Smith, CDE 24:00
and also learn and I think I've said this before to some other episodes, but learn the foods are the that are most common for you. Take a look at what you love to eat, write them down. Most people have about 20 foods that are over and over what they eat almost every single day, right? mark them down, look up their glycemic index and see how does it work when you try to cover these foods, even if it's like a meal, let's say you eat chicken and broccoli and rice three nights a week because it's like one of your favorite things in the whole great, write it down. Figure out what you did. What happened if it's especially if it didn't work the way that you wanted it to work out and then eat it again, you know, two nights from now and try it again. Maybe it was more insulin that you needed. Maybe the timing was a little bit different. Maybe it takes into consideration though. Well gosh, tonight ate a whole cup of rice with the chicken and the broccoli. And maybe Wednesday night I decided to eat only a half a cup of the rice with this Same amount of chicken and broccoli. So there's the load impact, right? It's the portion of the rice, the rice itself in one cup versus half a cup versus four cups, still has the same glycemic index, that's not going to change. But the load takes into, I guess, what you have to pay attention to is your eating now like a whole cup versus a half a cup. And that load impact is going to then be the big driver of blood sugar after In fact, you might need to play with timing of the insulin a little bit differently based on portion,

Scott Benner 25:36
right. And so Jenny brought up earlier that I tried to drive my blood sugar up when I was wearing a glucose monitor. And I obviously don't have diabetes. And I took a I think it was a big piece of cake with a lot of icing on it. And I ate it and waited. And my blood sugar did not go up very much at all. And I was

Unknown Speaker 25:53
more right. So I

Scott Benner 25:53
forced myself for you people, I hope you're happy. I forced myself by the way, I did not enjoy it. I did not enjoy the last third of the first piece. And I really didn't enjoy the second piece. And I was just like, Oh my goodness. And and when I get to like 132 something like that my blood sugar like,

Jennifer Smith, CDE 26:14
stayed under the defined like 140 mark. Yeah, no, yeah,

Scott Benner 26:18
I couldn't eat myself over 140 if I tried, and, and, but still, I got to 130 in a life where I wasn't getting to 130 a lot. I was having to like, do what Jenny said to get the 130 was having to stack multiple different tough foods on top of each other, like layer them on top of each other's having to have bread with potatoes, and then something else and more and more. I was I spent one night I don't know if you know those little spearmint leaf candies that are just like they're just sugar with, like, they literally they take sugar, and then they dip it in sugar. You know, I sat with a glucose monitor in front of me just going like just popping one of those in like every three minutes. And my blood sugar would not move off of 89 like it just wouldn't move. And I was just like I'm not trying to

Jennifer Smith, CDE 27:12
paint curious. I was Thank you pancreas. Thank you. No, I

Scott Benner 27:16
hate I told you I had a deep feeling of guilt. eating food and watching my blood sugar not go up like a significant it makes me sad thinking about it. I had a real deep feeling of guilt the first number of days I work. And I was just you know, I'm trying to do these things so I can talk about them on the podcast. And at the same time I'm looking over at my daughter while we're like correcting a 130. So it doesn't turn into a 170 you know, and, and I'm just But anyway, like, let's get back to the fun part. I am throwing these candies into the point where I was like, I hate these things now. I couldn't get my blood sugar to go up. That was it. It was it was pretty fascinating. Having said all that, again, I think that the podcast exists because I think people are gonna have a candy once in a while. I think that when people look at the you know at Harvard's good you know what you can swap out for lower glycemic index things. And I think oh, I could have corn on the cob or a leafy green or peas. Hmm. You know, I think most people are like, I would like corn. Would you like corn flakes or bran flakes? No. I want corn flakes. You know. Even white rice to brown rice is you know, now there are ways like you'll learn how to like for us. We I've switched the house over just a boss MADI rice. It just hits Arden differently. Oh, it just does and who cares Why? Like, I tried four different races. And I finally got to one and I was like this is the one that doesn't hit her as hard. This is the one we eat now.

Jennifer Smith, CDE 28:52
does it differ based on how you cook it or prepare it?

Scott Benner 28:56
I only prepare it one way Jenny. I have the zeros is it's a Roshi, people are making fun of me now a rice steamer I have the greatest rice steamer on the face of the planet. And let me tell you why I am able to afford this rice steamer. I was walking through a Macy's one day and they had this little rack of things that had clearly been returned to the store but bought online that they don't stock in the store. And so they just want to get rid of it because they have no place to put it. And my I luckily for me, is it zeros z OJIRUS hai they make bom bom rice cookers right? Wow. And my eye catches this rice cooker that I know in my heart costs like $500 right and obviously I'm not going to own a $500 rice cooker in my lifetime. No. And I looked over and that thing said 75 bucks. And I moved across that store, like Usain Bolt in his prime. I was like allaway people, I snatched this box up and I was holding it. I was like hugging it back. Everybody just moved, like I felt like everyone else knew as I looked around, I realized I was the only one aware that I was holding a very expensive rice cooker with a $75 price tag on it. And I actually it was so crazy. I went over to an employee, I was like, This is $75. And she goes, Yeah, and I went, I will buy this. Thank you. So I took it. It makes perfect rice. It is fascinating. You put the rice in, you fill the water up to the line that corresponds with the cups, the number of cups of rice use, you push a button, it plays Twinkle, twinkle, little star, and 55 minutes later, you're eating the best ratio ever had in your entire life. I don't know I place tinkle. Take a little star when you start up, but it does.

Jennifer Smith, CDE 30:49
My kids would probably love that. They would think that

Scott Benner 30:51
other than that I am the worst. I can't make rice. I screw rice up six ways from Sunday every time I try to make it so

Jennifer Smith, CDE 30:58
I barely have rice. I only have rice when we do sushi.

Scott Benner 31:01
When my son is trying to gain weight, he wants it in the house too. So I make it and I and it goes in the um, it goes in the refrigerator. He just adds it to everything he's eating. You know? Yeah,

Jennifer Smith, CDE 31:10
my choice is always My kids love quinoa, thankfully. And then wild rice, which isn't technically even rice, it's it's the seed of a long grass. So there's little education for you.

Scott Benner 31:23
I love I love a nice long rice because I like the the this sort of like, you know, spices that go on with it too.

Jennifer Smith, CDE 31:30
Yeah, but those some they work glycaemic Lee better. And I've just found long term that I mean, my family likes it. So it's not like I even have to cook it separate for me, and then something like brown rice. So

Scott Benner 31:42
yeah, I can't believe I spent so much time talking about my excitement about getting a cheap rice cooker in this podcast episode. I'm sorry for all that for everyone who's listening is like yeah, buddy. This is not helping me. I'm not buying a $500 rice cooker? Well,

Jennifer Smith, CDE 31:54
well, because of the way I asked him how you cooked it. And that does bring in as you were talking about the glycemic index before about like a baked potato versus a boiled potato versus you know, the glycemic index can change based on how something is prepared and or how ripe something is. So for example, like your Apple that you mentioned before, I think it's in like the 30s or 40s or something right? Most apples are considered low glycemic, anything under 50. On the glycemic index scale is considered low glycemic slow impact. Apples are there a kiwi fruit is there most of the berries are there. But then you get into the fruit that you really eat at its peak sweetness. You're talking about the summer melon, you're talking about pineapple, papaya, mango, bananas, grapes being cherries. They're all high glycemic, because their sugars are so developed to get that flavor that you want. I mean, I guarantee you're not going to eat it. Well, some people do. My husband doesn't care. He's one of the people can eat like a green banana, put it in a smoothie, he doesn't care. He's like the bananas there. Because I like the nutrition in it. I don't care how it tastes right. I cannot eat a green but

Scott Benner 33:10
he's dry on the outside when you're biting Do you notice that like the fob? Like, why is that doing that to my mouth?

Jennifer Smith, CDE 33:15
In the my mouth? Yeah, I wish people could see us that we make when we're talking. Oh, but I mean, I bring that in because glycemic index is higher for a ripe for fruit. And the impact is going to be faster. And I can tell you if I make a smoothie with a less than ripe banana because it's what we've got, and I want a smoothie. The impact is definitely different for me. And I strategize my bolus timing, different based on that. Based on that,

Scott Benner 33:47
well, you hit one with Arden loves cherries, and they like I have to like swing at those with both hands. You know, when your bolusing there, they're really tough. That is, see I I find all this fascinating. And I find it sad, because I don't think that many people think about it at all. They just count the carbs. And then they're like, well, this I counted the number and the number says 10. So it's 10. I do right? You know what I mean? Nobody thinks about the insulin, because I don't think about the carbs that much like I look at the food and I pick the insulin. I saw somebody the other day. They were you know, they had this meal. And they're like, we used two units or three units. And I was like, What is this like a? Like, I don't understand is this like a four year old kid and it wasn't it was a teen and I'm like, that's not gonna work. And you know, and then I asked them their ratio, and they're like, Oh, it's one to 10 and I was like, You think this is 25 carbs? I was like, This is 60 carbs. You know, if it's one it's 60 and I'd be scared to say 60 as I was looking at it, I was like I'd like to go 70 to be perfectly honest with you and and and they're very 2030 they're not sure. And then the kids blood sugar jump Up to 240. And they don't know what happened. And then they're correcting, correcting, correcting, then the food gets digested out the kids crashing down, and then they're correcting, and then they won't and it goes by and it's just, it's never ending,

Jennifer Smith, CDE 35:12
I think, you know, the topics of glycemic index and glycemic load are, they really are such, they're kind of the, like, further down the road when you're talking about like, just correct carb counting how to get that squared away, right? That is step number one, get, get some carb counting, get some labels read, even if you have to do portion estimation, that's your tool that you're get good at portion estimation, then for again, those foods that are on your, these are the typical things that I eat. Great, then we can move on further to things like glycemic index glycemic load a little bit better bolus timing, and then you kind of then maybe another step further is how is it cooked? Right? Am I boiling? My potatoes? Are my baking my potatoes? Am I you know eating a green banana? am I eating a completely black but

Scott Benner 36:06
what you're you're kidding on something that I know I want to talk about on the podcast more with you in the future, which is F after speaking to so many people, like I realized that there's a an order in which you should pay attention to things when you're starting. Right, right. And like in an overly simplistic way, like I always say, if I was if I was on the Titanic, and I was thinking you, you somehow recognize me as a person who could help people with diabetes. You know, like, Scott, I have a tape recorder, you're 30 seconds. What do you want to tell people about type one diabetes, I'd say get your basal insulin, right? Learn how long your Pre-Bolus is, and then understand the glycemic load index of food. And then I would go under and freeze to death and drown. But But those like if the if I could only say those things to you like three things to you, I'd say that. And then from there, I'd start talking about well, it's timing and amount, you know, and you can't forget about overnight, this happens. And you know, protein and fat cause rises. Like there's the variables, I just think of it as the seed of the idea. Like I always think of like management of diabetes is a tree, it's 100 year old tree with 1000 branches. And every point of that tree is important. But at its core at its seed, it's bazel. And then it's you have to Pre-Bolus and then it's you have to understand the impact of the food. Like that's the start of it, you never, but I see so many people who are out on the tip of the 700th branch going, I really want to understand this part. I was like there's a lot more to understand before you dig into that, you know, they're back at the trunk. And here's the problem, right? No one tells you to Pre-Bolus no one ever tells you basal insulin is important. And the words glycemic index and glycemic load are not sexy, and I don't like to pay attention to them. When I hear them. My brain goes in boring. That's for people who eat good. Like that's how it made me feel when somebody said to me in a doctor's office one day, I'm not trying to run a marathon. I don't care about glycemic load. They instead of saying, hey, you over here, these are the three most important things you need to understand. They told me the most important things and then moved on to stuff that doesn't matter as much. So not that none of it matters at all matters, but there's a core of it. And if you do the core, you're okay. I'm telling you bazel Pre-Bolus glycemic load glycemic index. Is anyone seen the sixes? That's my guess. You want it in the fives. start crawling out in the edges of the tree and figure out the rest of it. But this is an exercise. Yeah, get a pump and go for a walk. Like there's I could say stuff all day, but you know, stop eating Pop Tarts and telling me like it's not fair. I can't help it. Of course, it's not fair. But first your poison.

Jennifer Smith, CDE 38:58
I remember the last time I had an

early college because there was like nothing left in the cafeteria or something. And I was like, Oh my god, I have to eat something but

Scott Benner 39:08
my insulin Chinni assigned to that if you want to goddamn pop tart, eat it. I don't care. Just don't act like you don't understand what happened afterwards because that makes me sad. Like I just you're killing me online. Okay, you're putting things up online. You're making me sad because I want to come say all this stuff to you. I don't have time. And you're breaking my heart. So and and when I when I help people privately. Some people get it more quickly. And some people get it slowly. And then some people give it away like after they know it and I've seen him do it and then they stopped doing it. I'm just going to tell you like I don't follow many people's tax comms. And when I do I don't for long. But when I do, and I've seen you do it, and I've seen you understand it, and then you have a 300 blood sugar. I got to stop following you. It just it breaks my heart like I just can't like it eats me up. You know, I look at the graph and I'm like, Oh my god, like they didn't Pre-Bolus? Or why are they not correct?

Unknown Speaker 40:05
Could have

Scott Benner 40:06
been a bad pump site or could listen, it could have been anything. The problem is, it's just, it's ripping my guts out. I can't look at it anymore. Like with my daughter, I can do something about it.

Jennifer Smith, CDE 40:15
But it's it's hard to follow people. I agree. I mean, with the, with the many, many, many people. I see their data. Yeah, it is. It's hard. Because I think, you know, there's, there's no, there's no stop to, like, my job isn't like, I go to the office, I do my job, I put everything away, I close the door, and then I go home, right? Like, the people that I work with become like, they're almost like family to me, right? There are people that I care about the people that I get the privilege to work with, and help and I want the best. And I sometimes I feel like I could just like go home with everybody. I

Scott Benner 40:57
just texted a person this morning. And I said, if you could just come here for, I think 18 hours. I could just do this for you. And you could see, but they and they know what to do and they won't do it. And I'm just like, oh my god, it just really I listen, I'm not trying to turn this. It's hard on me. Like a really does. Like it just rips me up. Like I'm like you keep making the same mistake over and over again. But it's not out of ignorance. You you quite honestly know not to do it. And you just I don't know if it's fear habits

Jennifer Smith, CDE 41:29
are hard to break.

Scott Benner 41:30
Yeah, or habits are hard to break. But you're just you're doing the wrong thing. Like it's and I've told you it's the wrong thing. 10 different ways. And each time I say you say I understand I now you know what it is. I now know what my wife feels like when she's talking to me. It must be Kelly. I'm so sorry. It must be incredibly frustrating to say the same thing to me a million times, amigo. No, no, I understand. I hundred percent understand it three days later. I'm just doing it again. But But and so it's like, I don't mean to come down on it. I'm not trying to come down with evil. I'm just saying that. Jenny's not wrong, like following someone's blood sugar is it's a lot. And it's tough to win a guy. I don't think I know everything. And I but it's tough. When you look at a graph and you go, Hey, you know what, you need more? bazel? And they go No, you know what I think? And I always think to myself, I actually started saying it out loud. I started going like, why don't we stop worrying about what you think cuz what you think led to this graph I'm looking at, you know, so try what I think first I get and see what happens.

Jennifer Smith, CDE 42:32
That's even try it my way for a little bit. Yeah,

Scott Benner 42:35
here and listen, I'm gonna cost Jenny some money and save all of you and our paying or Freddie, stop explaining to Jenny what you think, let her tell you what's going on. Because you're just in therapy at that point. And that's not getting you to a better blood sugar thing. You know what I mean? Right? How many stories people tell you where you're just like, stop talking, this doesn't matter.

Jennifer Smith, CDE 42:59
And sometimes, you know, sometimes it's a marriage of what I see. And sometimes it's adding in then what they've seen, but they're addressing a certain way, because they think something's happening, that isn't really the reason for it. So it's kind of a marriage of what I see and how to tell them about what to do differently. It's not that what you're seeing is wrong, it's that the adjustments are not quite the right, adjust. You're

Scott Benner 43:24
100% right. And I was being too flippant, like you do need to hear it from them. But it's fascinating how infrequently their interpretation of what they're seeing is right. Right. You know, you need to you need to hear what's happening. You don't need their interpretation of what's happening. It's much it's interesting. Anyway, it's like it's like trying to do I don't know it's it's the weirdest customer service in the world like it people. This is like that except times like a million. So anyway, Jenny has to go. She's She's so I do drop bombs of knowledge and truth all over this episode. So I really appreciate that. I will talk to you soon. Awesome. Huge thanks to Jenny Smith. Hey, Jenny services are for hire. You can find out more about her at integrated diabetes. There's a link right there in the show notes. There's also a link for the Contour Next One meter touched by type one, the T one D exchange, and all of the other sponsors of the various podcast episodes that includes Omni pod Dexcom and G Vogue glucagon. All right, they're right there, right there right there. In your podcast player notes. Those links are also available at Juicebox podcast.com. But I'm gonna roll through them really quickly for you just in case and then I'm going to do a little freeform chatting about this topic. All right, ready, touched by type one.org. Contour Next one.com forward slash juicebox T one d exchange.org. forward slash juicebox. The other sponsors that aren't in that aren't on this episode, but are still incredibly important. Dexcom is available@dexcom.com forward slash juice box, you can get a free no obligation of the Omni pod at my Omni pod.com forward slash juice box and learn more about GMO glucagon at G Volk, glucagon comm forward slash juice box. Okay, now, almost everyone who uses insulin runs into this specific problem. And that problem is this. You count your carbs, you put in your insulin, and everything goes exactly the way you expect. Next day, you make a meal, you count your carbs, you put in your insulin, and nothing goes the way you expect your blood sugar gets low later, or it gets incredibly high. This is confusing, because yesterday, I counted my carbs, I put it in my insulin and everything worked. Today I did it again, some of you will question your carb counting skills. When this happens, some of you will run out and buy a very expensive scale. Very few people say to themselves, I bet the glycemic load of the food was greater or lesser than the glycemic load of the food from yesterday. Now you wouldn't think that because nobody tells you to think it or they say too soon after you've been diagnosed, and you feel like somebody just hit you in the head with a baseball bat. So you're not really listening, or the words glycemic load and glycemic index seem difficult, or maybe next level or whatever. But it's not. It's very simple. Some foods impact blood sugar differently, even if their carb count is the same. That's it, you just have to see it happen, except that it's true. Remember, and adjust your insulin for that food. That's what this entire episode told you. That very simple idea. You make yourself meatloaf mashed potatoes, you put some broccoli with it, you count the carbs. And somehow you've decided it's I don't know I'm making up a number. It's 40 carbs, which by the way, it's more. And you give yourself your insulin, your blood sugar shoots up later you correct with, I don't know, a couple more units, your blood sugar comes back down, it doesn't get low. The next time you have mashed potatoes and meatloaf and broccoli, and you count the carbs and you come up with 40. Again, you have to remember the two units you corrected with, you have to remember that those two units belong in the initial bolus. Maybe not every drop of two units, but pretty close. The reason I say that is because once you have a higher number, it takes more insulin to bring it down. But some of that insulin, if it was in the initial bolus, the spike would not have happened from these potatoes. And by the way later, the fat and protein and the meat that keeps your blood sugar higher layer, which you know, you need to go listen to the fat and protein pro tip episode to understand that.

So the next time you have this meal, I don't care what the carb counts that you have to trust that what you know is going to happen is going to happen. So all these little sayings and isms that you hear throughout the show, they're really just shortcuts to understanding that there is a different glycemic load from food to food to food. Because the next day, you could have a meal with 40 carbs in it that doesn't have those starchy potatoes in them. And I don't know wasn't mixed with the fat and the protein. And all that insulin could end up being too much. Now your meal ratio works. So what you're hearing is that your meal ratio isn't set in stone. It's all dependent on the foods you're eating, the glycemic load and the glycemic index of the foods. But you know, you can go check it out if you want. It's a matter of fact, I'll I'll find the chart that Jenny and I were talking about. from Harvard right now. I find it right now for you. And I'm typing. So I'm vamping a little trying to kill time. Because I don't feel like editing this part out. You're looking for a link called a good guide to carbs the glycemic index from Harvard health publishing and a link called glycemic indexed for 60 plus foods, which will give you an idea of what we're talking about that white bread punches different than corn tortillas. It's sweet corn punches different than porridge that on orange raw hits you differently than a potato boiled, which by the way hits you differently than a potato mashed which by the way hit you differently than a potato fried. These are the things you need to understand when you're watching your blood sugar's move all over the place, and sometimes it works. And sometimes it doesn't you love to hear people say, Oh, you know that about diabetes? One day, everything just works. And the next day it doesn't. It's not really true. If you had the right ratio of insulin, it would work every day. That is true. I promise you. All right, I'll put links in the show notes to those two blog posts from Harvard. I hope you're enjoying the pro tip episodes. If this was the first one you heard, you're probably like, you should definitely go back to Episode 210. And start at the beginning. Diabetes pro tip newly diagnosed, we're starting over and then listen through those pro tips. The pro tips are also available at diabetes protip.com. But you know, listen to your podcast app because that's how kids do things and they know way better about technology than us. Thanks for listening. I genuinely appreciate it. I'll talk to you soon.

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