Scott Benner 7/14/21 Scott Benner 7/14/21

#507 Diabetes Variables: Travel

Diabetes Variables: Travel

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 - Google Play/Android - iHeart Radio - Radio Public, Amazon Alexa or wherever they get audio.

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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 507 of the Juicebox Podcast.

Back again with another diabetes variables episode means Jenny's here, and today we're going to talk about traveling. That is a variable. You know, I asked the Facebook community Juicebox Podcast type one diabetes, for a list of things that impacted their blood sugar, they came up with over 150 of them. Today, Jenny and I are discussing number three, travel and travel time, the world's open back up, it's warm outside. Many of you may be heading off in your car or an airplane or other ways that you travel. We thought this would be helpful for you. Please remember while 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 healthcare plan. or becoming bold with insulin. For those of you who are right now thinking can long car rides my kids blood sugar goes up. Wait a minute. Yeah, that's traveling. Now you're interested. It comes Jenny.

This episode of The Juicebox Podcast is brought to you by me kind of and I want to tell you about my thing. That back in Episode 210 of the Juicebox Podcast. I started making episodes called diabetes pro tip with Jenny Smith. These are ideas from the podcast that you hear, you know sprinkled about in different episodes condensed down in one place. These are management conversations. So I'm going to tell you about them very quickly. Episode 210 diabetes pro tip newly diagnosed are starting over. You may have just heard Dr. maltz talk about it in Episode 506. I think after that to 11. All About MDI to 12 all about insulin to 17 Pre-Bolus ng to 18 Temp Basal to 19 insulin pumping to 24 mastering a CGM to 25 bump and nudge to 26. The perfect Bolus to 31 variables to 37. Setting basil insulin to 56 exercise to 63 fat protein to 87 illness injury and surgery 301 glucagon and low beegees 307 emergency room protocols 311 long term health 350 bumping nudge Part Two 364 pregnancy 371 explaning type one two others 391 the glycemic index and load 449 postpartum for 70 weight loss. I am incredibly proud of this series, it is completely free. You can go back and listen to it in your podcast player right now. Or you can find it at diabetes pro tip.com. You can also get to it through Juicebox Podcast calm. And now I'm going to read your review. I saw a mention of the podcast and one of my Facebook groups. 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 endo. That's a podcast review from Apple podcasts, diabetes pro tip calm. My son was diagnosed with type one about five months ago, I've learned so much from just the pro tips. And I will be listening to all of the other 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 as Scott correctly describes the feeling of type one diabetes and more like you can find ways of keeping your loved ones happy and healthy. Also from Apple podcasts. They're real reviews. You can read them at diabetes pro tip.com. I am not a doctor. This is not advice. But I think if you listen to those episodes, your life will get better. It'll get healthier, it'll get happier, it'll get easier. At least you've got a great shot of that happening. If you don't believe that. Go back and listen to Episode 506 with Dr. Meltzer because she believes it and I do to travel elevation or exercise you pick.

Jennifer Smith, CDE 4:48
Oh, what about travel? That's big right now.

Scott Benner 4:50
Okay. Well, I I just flew on a plane. You did. It felt a little weird. I'm finally breaking a rule. But it wasn't a it was it was fine. I mean, I'm vaccinated. I didn't think I have to admit I didn't think much about it. But my son had to go cross country to work out for baseball. And he was staying for five weeks. He's still actually there right now. And I just was like, Look, I'll come with you. It was all very nebulous. The place is great, where he's working out, but all the pieces around it, like, Where do you stay? How do you run a car when you're 21? Like, I just felt like, if I sent him out there by himself, he would have called four days later crying from the airport and being like, I don't know what happened. Yeah, so I'm like, I'll go out with you. I'll get you set up, and then I'll come back. So the first thing that I think about, I mean, we're gonna do air and like ground travel, right, like, we'll talk about cars and flying. So start with flying. The first thing, the only thing I think about about flying is that people talk about the air pressure, pushing insulin through their tubing and giving them insulin that they don't mean to get. That's the thing I feel like I used to hear about all the time, but we've flown with Arden a million times. And I've never once thought of flying as any different than any other sedentary situation. So I might be the wrong person to ask, but what do you say?

Jennifer Smith, CDE 6:21
So it's a it's a known while, it's a known issue. While there's no real at least, I haven't found any as of yet, there might be something out there that I haven't seen. But from a tube pump standpoint. We advise people based on people's anecdotal information about what they've tried. I mean, they're even photos online, if you look at people have used tube pumps have flown and done their own experiment in flight or before, during or after kind of thing, what they've done is they've taken pictures of their tubing. From a pressurization standpoint, on ascent and descent, there's a pressure shift. And that can either push insulin out, meaning the reservoir actually pressurizes enough to push insulin through the tubing and give an infusion of an extra almost like a Bolus. Or the pressure can pull insulin, sort of the reservoir in making the insulin from the tube sort of retract into the reservoir inside creating a bubble in the tubing, which means then you would miss insulin, as it's being pumped out if you didn't realize what could be going on. So we typically advise on ascent and descent essentially just disconnect from your tube site. Once you get to cruising altitude, or once you land essentially reconnect to or take a peek at your tubing to begin with. If there's any bubbles there, purge them out. People with two pumps know how to do that, purge it out, pop it back in and go ahead about your business. In both regards, then you're not only going to not miss a dose of insulin from a bubble, but you're also not going to get a push of extra insulin, that the pump doesn't register as a Bolus. You don't visually see that in your pump, insulin dosing history, right. So those are tube pumps. Omnipod is it seems different. There's no tubing obviously. That's the reason a lot of people use it, which is great. And I, I have had only I'd say less than a handful. From what I can remember in counting to people that I've worked with, who've noticed because they fly often enough that they've noticed a definitive difference in their blood sugar during flight as well as after flight. Where and these are more lows. They're not highs, but they are lows. One woman who religiously flies first thing in the morning, she doesn't eat any food. She's got her settings, well in place. And mid flight depending on the length of the of the flight, it seems like mid flight she ends up having a low blood sugar. Now is it because she walked a lot at the airport while she was there and didn't realize it. I mean, we've looked at all of those pieces in terms of travel for this individual. But what she actually chooses to just do Is she has a snack as soon as she gets on the plane and she doesn't cover it.

Scott Benner 9:37
So for whatever reason, she just thinks there's something happening a variable that is basically Pre-Bolus thing me, I'll just I'll

Jennifer Smith, CDE 9:46
just take care of it. Exactly. Now after flights, people of all pump you know types can sometimes have like baggage claim lows. That's kind of what I refer to them. You know, if you haven't disconnected your tube pump, you could have gotten a kind of a pulse out of insulin. And now you're traveling through the airport who knows how long depending on the size of the airport, you're kind of walking around a little bit more after flying and moving your legs. You could technically have a low walk into a taxi, you know, stand to pick something up. All of those could be variables in the mix of travel. They may have nothing or something to do with potential extra insulin. Yeah,

Scott Benner 10:27
you're lifting things and you're right tussling around, there's a lot of pressure. By the way, did you get a parakeet or is that a bird outside of your window here?

Jennifer Smith, CDE 10:35
Oh, those are birds outside? Yeah. Oh my god, I would never I don't I don't do birds.

Scott Benner 10:40
No birds in Jenny's house. over to my house. No, I've got cats fish dogs. As crazy as it sounds. Maybe I see diabetes everywhere. But I when I flew with my son out west, we were waiting. It was an It was a nighttime flight was my first experience of flying with the sun. Which was very strange, because we took off here around 630. And it never got dark outside of the plane. And so you know, you're tired. But your brains like No, dude, it's seven o'clock still. And you're like, ah, and so we get there, we're standing at baggage claim. And there's a girl there. She's a mom of a little kid less, maybe two years old or so. But the the woman's I call her a woman. But she felt she felt young to me. She was like in her 20s. And she had a pump on with tubing. And the entire time we stood there waiting for the bags. I felt so parental towards her. Like I never talked to her spoke to her. But I just thought of the whole time because the kid was fussing, we'd all been on a long flight. She's kind of wrestling holding on to the kid. I just kept thinking like,

Jennifer Smith, CDE 11:44
Is there something I could do to help you I could help you. If you

Scott Benner 11:47
want to check your blood sugar just like I just, it's all I could think I started talking to my son. So I stopped paying attention to her. But she was fine. So okay, so the air pressure thing aside from flying is the next idea of travel is being sedentary, right? Correct. not moving around, can make your blood sugar go up.

Jennifer Smith, CDE 12:08
It can and are typical is a recommendation for if you're using a pump to increase using a temporary basil, somewhere between 10 and maybe 30% extra for the duration of time of sedentary travel. So in this kind of goes for both air travel, train travel, you know if you're taking a boss, if you're taking a car, whatever it might be, but sedentary more than about two hours, typically needs more basil at least insulin,

Scott Benner 12:41
right? Yeah, well, so So now so you have steps here. Then if you're using a two pump and you're going to fly, you disconnect, you take off you get up to cruising altitude, you purge the the line of air hooked back up again and then start with some sort of an extended basil and increased Temp Basal, to address the sedentary nature of you just sitting about. That's it. Alright, typically,

Jennifer Smith, CDE 13:03
that's about right. I mean, usually for me, I've found that where I need extra, because we know how long it takes that temporary rate to kind of get circulating. I tended to find a need to increase it while I was sitting and waiting for the flight to kind of come in so that we could get on

Scott Benner 13:23
a flyer. You're not a nervous flier or you know, I like flying. Yeah, it's so relaxing. I love the idea of like not there's nothing I can do about my situation. There's something very freeing about it.

Jennifer Smith, CDE 13:35
Yeah, but I like sitting in the airport watching people that's the like, I do I was I always bring a book along. I never get to reading my book until I actually get on the plane. Because I'm I like watching people and people are interesting.

Scott Benner 13:49
I have I'm going to tell a story at the end of this but so So interestingly enough, now you disconnected to pump get up to fly altitude, purge, reconnect, do your Temp Basal increase so that you don't get high during the flight. But then do you do a Temp Basal decrease like right before the flight stops? So you don't have the baggage check thing? Or do you just throw some food in your mouth as the plane hits the ground? Do you think?

Jennifer Smith, CDE 14:10
No, usually I recommend setting that Temp Basal increase for like three quarters of that travel duration kind of so that by the time you get to the descent, which can take some time, once the you know the pilots like we are going to start descending into wherever it may be, right? I mean, it could be a little bit of time. So I usually say that's a good cue if you didn't set your Temp Basal to run a certain period to just stop that Temp Basal increase, right.

Scott Benner 14:38
So I do and I disconnect my two pump for the descent as well. Okay, yes. All right. So

Jennifer Smith, CDE 14:46
I'm shaking my head and then realizing that nobody can see me. Yeah, do

Scott Benner 14:49
Jenny please, please respond with words. Okay, so here's my quick airport story. I went to Dallas to speak at a thing. It was a Very quick in and out, I don't want anybody to feel bad for me but I'm basically I'm cargo get any mean like they shipped me down I get stuffed in a car I show up, I clean myself off put on clothes that I look better and stand on a stage talk like a lunatic for four hours. And then somebody goes your cars here and they take you back to the airport and jam. And so I'm sitting at the Dallas airport, I'm wrecked, right? It's only been 36 hours since I left my house and I'm already going home. And talking takes I know it's maybe it's think it comes naturally but talking and thinking like it takes a lot out of you. So I'm sitting at the airport still on the clothes that I presented in thinking, just rest up enough to go into the bathroom, and change it to something comfortable for the for the flight home. That's I've got my headphones in, I'm trying to relax. And this woman if she's listening, she was lovely. I can see her from across the terminal. She is coming at me. Like and she's walking with a lot of purpose. And the closer she got, the more I thought wow, I think she's really coming over to me there are a lot of people there. So I started taking out like my my earbuds. And I was I've made eye contact with them like Hi, how are you? Can I help you? Like, but what I'm really thinking is don't murder me in the airport. Like cuz I don't know, like, I don't know what's happening right now. And she goes and

Jennifer Smith, CDE 16:18
you're tired. Your brain isn't working.

Scott Benner 16:21
I'm like, What is she goes, are you Scott? And I was like I am. And she goes, I love your podcast. And so and so my brain just goes through? Well, she was just that the thing. I said, Did you just hear me speak? And she goes speak Where? And I'm like, Wait, you're not here for the thing. And she goes, No, I'm here. I think she said her daughter was an attract meet in college, they flew into sere. And I was like, so it's coincidental that we're sitting in the airport together. And you know who I am? And she was like, Yeah, and I was like, Oh, I was so freaked out, you know, like really, really, really freaked out. And she said a lot of nice things. And it was lovely. And she walked away and I and etc. But I never like you don't start a podcast thinking one day across the country, somebody will recognize you and identify you. But there I was back in New Jersey, in the little bus going back to where my car was parked and talking. And this woman turns to me and she goes, are you Scott? And I was like, wait, what's happening? Why is this happening again? She was I recognize your voice. I love your podcasts. I was like, Ah, so it's very, very, very strange. But generally speaking, I'm a heads down flier usually,

Jennifer Smith, CDE 17:33
are you you

Scott Benner 17:34
don't really I just put my earphones on. And I kind of keep my I do look at people, because it's fun. But you know, then I'm sure they're also looking at me going like picking this guy's stupid headphones on not paying

Jennifer Smith, CDE 17:45
I found I've found that, especially with the amount of people that I work with and talk to and like the different personalities in travel. I've, I've got kind of a good personality filter. I've found, like interaction wise, you kind of you learn how to talk to certain people and interact and whatnot. And that's kind of the traveler that I am you. You get this like almost Sixth Sense feeling about people that really could be a good interactive like discussion. And other people who are like, nope, they sit down, they get their book out, they put their headphones on, you're like, yeah, I'm just gonna leave you alone.

Scott Benner 18:25
I was sitting next to a woman in the terminal. And then we took a five hour flight. And then an hour and a half later, I'm standing at a train station. And she and I are the only ones there. And I just looked up at her I went it's weird that seven hours ago, we were sitting next to each other across the country. And now we're standing here and she goes, I was just thinking the same thing. And we had a nice little conversation. Listen, the truth is if I'm not tired, I will talk that I love talking. I will talk to anybody my son's like, Why do you talk to people you don't know? And I was like, I don't know, man. Like we're not alive that long. Like, let's write what's the point? And he does it. But he doesn't think he does it. Oh, never pointed out to him. But that's funny. Yes. I don't say anything. Okay, so what do you hear all the time from people? I put my kid in the car and their blood sugar shoots up. It's not the car though, right? It's that you have this little thing that moves around like a ball of kinetic energy. You've got it and now you're making it sit in one spot and it stopped and now suddenly the basil that works while the kids super active is not enough for while the basil for while the child is is steady. But does that happen to adult? I guess that would happen? It does. Yeah.

Jennifer Smith, CDE 19:33
Yeah, absolutely. I mean, we used to live down the east coast, we would drive up from DC up to New York or whatever, which is a long enough drive, especially depending on traffic that I always found I needed a Temp Basal increase to accommodate for that. I also found as I do with a lot of the people that I work with that food, if I mean if you're used to a Pre-Bolus that's 15 minutes. I found I needed longer. Yeah, it was just that sedentary nature that really like, was horrible. So yeah, and with the shoot up for kids, I think sometimes it might be anticipation of what they're going to do, right? I mean, if you're living someplace that you're going to take this awesome vacation, once you kind of get there, and the child knows about it, they get in the car that's like, that's like adrenaline. They're like, excited, or they're going to go and spend a week with their favorite grandfather or grandmother or whoever it might be. They know what they're gonna do. It's like, all of this energy that's now like, sitting. Yeah, and they can just run it out. So it goes up.

Scott Benner 20:45
Now it's the same thing. You know, Arden's insulin needs can go up or down, depending on if she's like in school, or virtual, just like she's even just the walking around the hallways. My mom's in her mid 70s. And she told me the other day, that she hasn't been able to sleep during the pandemic. And then she got vaccinated. So she's out again, moving around. She's like, I sleep so much better now. And I'm like, Yeah, well, you're exercising more. And she's just like, I had to talk her into believing that that was true. Like you're moving around more you've expelling your energy at the right times a day, when it's time to sleep. You don't have extra energy. And she's like, no, we're just sitting right here. We're just sitting there. It's, I mean, listen, movement of some kind, everyday is super important. And children do it so naturally, that you don't notice it as being part of there. Unless you have a boy who's just like constantly throwing trucks against the walls, then maybe you're aware of it. But But um, he kids are like little mini tornadoes. And then yes, I'm still listening is a car ride across town, like 15 minutes. That's not if you're talking about a long travel situation. Yeah, seated in a car,

Jennifer Smith, CDE 21:52
which is why we usually say, like, defining time, which is what most people want, how long should I expect? You know, a need to change something for is it 15 minutes? Is it an hour, we usually say two hours or more, you're gonna need extra insulin.

Scott Benner 22:10
So all of this really, you know, my mind, in my mind, it's just being flexible. It's noticing something happen. noticing it before it's a problem. And just, I don't even care why it's happening. Like that's almost why some of these conversations are so interesting to me, because I was like, I didn't realize that, if because if I put Arden in a car for a long time, their blood sugar started going up. I wouldn't even care what the variable was. I just be like, she needs more insulin. I don't and I don't argue about it. I just give it to her.

Jennifer Smith, CDE 22:35
Right. But the prep for them for the next time gives you some hindsight to say, this is what happened last time. Yeah, I can do it. Let's do better job this time by attacking it before it happens. Yep.

Scott Benner 22:47
Okay, so I'm excellent. I want to thank Jenny Smith, so much for lending her Sage like wisdom to the Juicebox Podcast. Don't forget Jenny does this for a living and you can find her at integrated diabetes calm. You know, I also want to thank today's sponsor me. Actually, I just want to remind you that the diabetes pro tip series is available right now in your podcast player, just hit subscribe and go to Episode 210. I listed them all for you at the front of the episode. But they're also available at diabetes pro tip calm, which is also accessible through Juicebox Podcast calm. Please try the diabetes pro tip series. As always, is completely 100% free. It's not like I give you some of the information and the good stuff is locked up somewhere behind a paywall. That does not happen on this podcast. Everything is free for you. The show is always free, it is ad supported. And so it is free. Understand I don't have to charge you for content. The content is yours. Share it, use it. It's for you.

#505 Diabetes Variables: Temperature

Diabetes Variables: Temperature

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

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Scott Benner 0:00
Hello friends, and welcome to Episode 505 of the Juicebox Podcast.

Today I'm bringing you the second in our diabetes variable series. Today's topic is temperature. Don't forget while you're listening 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. Obviously today Jenny Smith will be with me Don't forget that Jenny Smith has had Type One Diabetes for 33 years. She holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer on most makes and models of insulin pumps and continuous glucose monitors. Besides that, she's Jenny. So if you don't know what that means, you got to go check out the pro tip series, the defining diabetes episodes and get yourself a good dose of Jenny Smith.

This episode of The Juicebox Podcast is brought to you by touched by type one. To learn more about them go to touched by type one.org or find them on Facebook and Instagram. Touched by type one started as a community fundraiser organized by a middle school student in a small group of her trusted advisors. It has blossomed into an impactful and well respected nonprofit organization, spreading awareness about type one diabetes. Seriously, they do amazing work. Check them out at touched by type one.org. It's the number one touched by type one.org. Their founder Elizabeth is featured in Episode 454 of the Juicebox Podcast. If you haven't heard it, check it out. Okay, here comes Jenny, and our second diabetes variable. Jenny, we've been just started with the variables. And like I said, we've got this list of like 150 different variables that listeners brought up that impact their blood sugar. So today, I was hoping to talk about the temperature meaning like your body temperature, the outside temperature, I guess times of year fits in there. I have to admit, I don't know that I see it that often. I can remember Arden playing softball in like high heat situations. But she was so active that her blood sugar's were always pretty stable. But I do have to admit, I guess after those softball games, she was more her blood sugar tended to rise afterwards. But I never associated that with temperature. I always associated that with shoes playing playing was holding her pretty stable, almost acting as extra basil and she was eating throughout the day too. So I always thought that that eventually that that drift up might have been from the food that happened in betray games and stuff like that. But what do people I mean, I guess we should just start with you Like, you live in a pretty interesting part of the country where the temperature fluctuates, do you see differences with your blood sugar's cold, the hot

Jennifer Smith, CDE 3:41
not for short durations of time? No. And I think this kind of crosses over into the majority of people, if you're going to see something, it's more the length of time you spend in a particular temperature that's kind of out of the normal like comfort level zone, right? Of what I would just say is like room temperature, let's say, you know, the extremes in winter, winter can get cold where I live,

Unknown Speaker 4:07
but and

Jennifer Smith, CDE 4:10
if I'm outside in the cold, I've got loads of clothes on, I'm usually moving, I might be pulling a sled or shoveling or something like that. And so the cold in and of itself isn't my concern. And it doesn't seem to be what the impact on my blood sugar is. It's more the movement in that extreme right. And the fact that I've probably got many more layers on than I would in spring or summer, even fall. And I think with that if there is a temperature consideration, maybe it's just that I'm warmer and moving, and I've kind of metabolically kicked up, then you know what I need? I see lower blood sugars, essentially.

Scott Benner 4:51
Let me break this down for a second. So let's start with something unnatural. What if I just lowered your blood your whole body type What if I just made you 50 degrees? Would your blood sugar move? Like, I know that that's not what like natural life is. But so because I want to work off of that idea, because what I'm feeling like is that people probably think, oh, cold weather makes me low. But they're really going outside in the cold and then being more active and not recognizing it, like so. So at its core, does just the temperature lowering change?

Jennifer Smith, CDE 5:26
Well, it could a could for me, I've not noticed that in particular, I mean, my, my temperature overall, runs lower Anyway, my normal core body temperature is not 98.6. I mean, that's just an average standard that's been given out, I run in the 97. That's my normal kind of temperature. So I would say just knowing physiology, that if your temperature core temperature had dropped, then metabolically, your body is actually working harder to keep you warm, which I would expect then that metabolically burning heavier, you're going to use insulin better, you are going to have a drop in your blood sugar.

Scott Benner 6:13
Okay, so whether you see that happening to you or not, it's still a variable that could impact you. That's a good so like, you could start shivering and your body starts trying to keep you warm, and that uses up resources. And some of those resources are glucose in your blood. Right? Interesting. But isn't it funny how, like one thing we talked about this a lot, but you see one thing? You think, oh, the cold weather makes me low? And I guess it could but then you're like, well, what if I put on a big heavy coat and I'm not really cold? And I'm still getting low? Maybe that's because I'm outside frolicking about fairness. You live in United States, Canada, so?

Jennifer Smith, CDE 6:52
Not really. But

Scott Benner 6:53
it's pretty normal. Yeah. And there's there's a north. Yeah. But being serious the place where you live? Like you you involve yourself in outdoor activities in the cold. Correct, right. So if so I could go skiing and some and somehow misinterpret the skiing impact for the coat legs, it could get confusing, but still, on a metabolic level, there is a possibility there that that would happen there

Jennifer Smith, CDE 7:22
is and I think you bring in another variable that we'll talk about, which is altitude when you talk about skiing. Yeah, that's another piece. A different episode. We'll get there. Yes. But on the opposite of cold, though, is hot.

Scott Benner 7:37
Okay, so what happens when I get hot my blood vessels.

Jennifer Smith, CDE 7:41
So you you're like your blood vessels are the little capillaries, they kind of get closer to the surface of the skin to allow cooling of the body to again, keep your core temperature kind of around that 98.6 where it's meant to be right. So the more cooling effect that you get. And also Where is your insulin being infused and or even injected, it's being infused or injected into that like sub q layer, right. And as the vessels get closer to the surface of the skin, the body works harder to cool itself off. Potentially, you could have more circulation around that area of insulin infusion or absorption. And so that could increase the rate of the insulin working. I know myself for hours outside in the warmer temperature. We lived for a short time after we got married in Orlando. And it was for about a year. And there's no real weather change down there. I mean, people think that it gets cold in the winter, and they bring out their like fur lined parkas, and I was outside and a T shirt and like shorts, and I was like you people are kind of funny. But it is just what you know, it's the extremes. I mean, it is what it is. It's just the norm. But Florida is pretty like it's just warm. I think of it as warm, right? And so the year that we were there, the time period outside, when it was really hot in the summer. I know that I needed less insulin, if I was going to spend time out. I mean, we had passes for Disney. So I would take less basil on the days that we would go walk around at the parks. Some of it I know was the heat and some of it I know was the heat and the movement that was consistent in that type of day.

Scott Benner 9:28
Okay. Did humidity make a difference?

Jennifer Smith, CDE 9:32
humidity seemed to make a difference. Yes. The more humid it was, again, the more your body is trying to cool off and so that like the stickier you're going to be, and along with that temperature and humidity then comes hydration. Okay, are you taking in enough fluid, you know, if you're dehydrated, you may actually see blood sugars that go up, which would be kind of counter to what you would think would be happening if you're well hydrated, then likely you're responding more appropriately to blood sugars, your CGM works better, etc.

Scott Benner 10:06
So if it's hot out, I might see an advanced use of the insulin. And so might work more efficiently. Correct more so than I normally say. But if it's hot out and I get dehydrated, those two things could conflict with each other. Yes. And the dehydration might went out over the. That's enough. Yeah, right. So again, it's what we're saying is that there are things hat variables that happen, that are hard to see in the moment, because you see the big stuff go, it's hot outside, my blood sugar went down, and then somebody else will come along and say, oh, when it's hot outside, my blood sugar goes up. But they also don't say I only drink 16 ounces of water every day. They're missing that piece when they that's what's interesting about online, it's funny not to get too far into this. But you and I were just talking about this privately about something else that the ability to explain the entire scenario. Not everyone has that. So sometimes they just come in with a piece of the puzzle, which then makes it more anecdotal. But then right, you hear four or five people say something like that, and it feels like a rule all of a sudden, right? Yeah. So there are, and by the way, 150 other variables on this list, it could be hot out, you could be dehydrated, while you're going for a walk or on an airplane, or like, you know, like, there's

Jennifer Smith, CDE 11:23
no, that's the variables overlap each other, right? You're not just going to experience one variable in a setting of a day and be like, yep, it was that it was the temperature, right? Totally know.

Scott Benner 11:36
That, and that's why people make the I know this is gonna, cause colloquially, this makes sense. But when people say something like I can do the I can eat the same thing one day, and then the same thing the next day and something completely different happens. Diabetes is so unknowable, except there are other things happening that I guarantee you're not thinking over. See. Okay, did we cover that?

Jennifer Smith, CDE 11:58
I think so. Yes.

Scott Benner 11:59
Nice. We're getting very good at this. Thank you so much, to touched by type one, for sponsoring this episode. Of course, check them out on Facebook, Instagram, and it touched by type one.org. And Jenny Smith, Jenny is I mean, she's the best, it's obvious, right? But she also works for a place called integrated diabetes Comm. So if you ever wanted her input, what she does for a living, go find Jennifer Smith at integrated diabetes.com. Thank you so much for listening. I hope you're enjoying the new variable series. We're going to put a couple of them out in a row here. So look up for another one. There might actually be an episode every day this week. I got to catch up a little bit. If you're not subscribed in a podcast app, this is a terrific reason to be.

#491 Diabetes Variables: Trampoline

Diabetes Variables: Trampoline

Scott and Jenny Smith, CDE share insights on type 1 diabetes care

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:11
Hello, everybody, and welcome to Episode 491 of the Juicebox Podcast. On today's show, we're gonna try something a little different. Jenny's here to start a new series with me called variables. When the episode begins, ah explain to you how we kind of came up with this and where we got the variables from. But today's variable, the very first one in the series is trampolines. Please remember, while 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. If you're looking for ways to support the podcast, it's simple, easy and free to do. Just subscribe in the podcast app that you're listening in right now, if you're listening online, check it out in the podcast app and hit subscribe or follow. And of course, tell someone else about the show. Subscribe and Share. That's all I need you to do.

While there are no ads on this episode, I do want to remind you of the sponsors that support the podcast, the Dexcom g six continuous glucose monitor, please learn more@dexcom.com forward slash juicebox the Contour Next One blood glucose meter Contour Next one.com forward slash juicebox the Omni pod tubeless insulin pump on the pod comm forward slash juice box find out about g vo glucagon at G folk glucagon.com forward slash juice box learn more about touched by type one at touched by type one.org. And please consider supporting the T one D exchange T one d exchange.org Ford slash juice box. You added a variable pro tip episode I didn't like there's a there's a pro tip episode about variables talking to people about how things that you might not expect can impact your blood sugar. And I was not on my radar when I made the first pro tip list. That was all Jenny putting that in. But more recently, I went to the Facebook page and I just asked people tell me everything that impacts your blood sugar. Right? Just everything. And I am looking at a list here, Jenny that is 159 things long. Some of them might be duplicates, and we'll find out as we go. But I thought it would be important for people and I know you agree for them to understand these. These impact things. Yes, yeah. Because they're like, you know, say again, what you just said before we started talking about this, like you were talking about doctors give directions, but don't take stuff into consideration.

Jennifer Smith, CDE 3:10
Yeah, many doctors have their sort of cut and dry very black and white. If this than that, right? It's sort of if you're going to go and exercise just stop your pump, take the insulin away and it will work right. Well, that's, that's given everybody's exercises that they're going to go out and walk their dog for 35 minutes. That's not in any means, especially with exercise that we have today. You could be doing anything for God's sake I two weeks ago I took what do you know what a pound classes like you have these like drumsticks? And you like

Scott Benner 3:49
right sounded dirty to me. So no, I guess I don't know.

Jennifer Smith, CDE 3:53
weighted drumsticks and it's actually it's a good cardio workout actually made my kids do it with me because a friend was doing it. But anyway, I I had no I knew it was going to be a variable. Right? But what kind of variable? Was it going to be more aerobic? Was it going to be aerobic and anaerobic? Was it going to be like sitting and pounding Fiddlesticks have any idea? So how do you plan for a variable like that I you know, planned for it to be like cardio. So from the sense of what a doctor would tell me to do as a cut and dry black and white each time I go and exercise do do this. That's not true. It isn't. And so there are many variables to consider,

Scott Benner 4:36
right? Well, since you went that way with your description, here's number 157 on trampolines. So I said test people tell me some things that make managing blood sugar's difficult and so many people said trampolines that it wasn't funny. So there is something about that specific exercise that crashes blood triggers, right?

Jennifer Smith, CDE 5:02
It's it? Well, if you think about, it's kind of an all over body workout, right? You're using your arms, you're using your legs, you're using your core muscles to stabilize your body. Depending on how much flipping and acrobatic, maybe you've got a basketball hoop inside of your trampoline, like I've seen seen many kids have. So maybe you're doing that along. I mean, it is. And for the most part, it is an aerobic exercise, it will drop blood sugar. In fact, a lot of the kids that I work with who have them, their parents send them out when they've got a high blood sugar to get it to come down. Quick. And it works. Yeah. And it works. So you know, in the case of that, typically, it's insulin adjustment, if you know what's coming. And with kids, oftentimes, in you know, exercise is so sporadic that you can't so then you just have to use extra carbs or sort of ahead of time coverage carbs, as they're heading out to accommodate for the expected drop.

Scott Benner 5:59
Yeah, I guess, even like knowing ahead of time it is. So it's such a violent drop that you see for a lot of people that even taking basil away and doing a really proper job of having that basil create a deficit over top of the trampoline. I don't even know if it would work, right?

Jennifer Smith, CDE 6:15
No, no. And I think a lot of times too, for kiddos because they're eating so frequently, you know, a meal, maybe a snack, maybe another meal, maybe a snack, and then another snack. And then oh, my friends want me to go over to the trampoline and play with them. And parents are like, Oh my gosh, there's three units, then

Scott Benner 6:37
you learn eventually how to handle it. I've seen people say that their kids take like spoonfuls of like peanut butter, like, you know, there's they'll drink a juice before they get on like stuff like that. But that's just one of those examples of the it just it's way more impactful than even somebody who's willing, who understands that activity impacts blood sugars, like it's just out of magnitude that is crazy.

Jennifer Smith, CDE 7:01
It is it really and I think in all the variables, I think the other really big thing that's kind of a consistent across the board is now that we have trending on glucose monitors. It's where are you? Where are you sitting? Right? Because coming into any variable city setting, whether it's exercise or whatnot, you have to know where you are or where it looks like you're heading, because that's also going to impact how much or how little you adjust right

Scott Benner 7:32
here. Like if you just messed up a meal spot and it's starting to spike, you might be able to bounce in there for free because you don't have enough insulin to begin with. But if you're super stable at 140, and you haven't eaten in a couple of hours, even if you don't have insulin on board, you are going to drop from this exercise. Yes,

Jennifer Smith, CDE 7:48
Basal. Yep,

Scott Benner 7:49
this is why gymnast looks so strong. Because that whole and for some reason, the adrenaline doesn't even help it.

Jennifer Smith, CDE 8:00
For the most part, I don't think there's enough adrenaline unless it was like you just said like maybe accom a competition, you know, that like adrenaline competitive kind of component. And then it's not really an all it's like a performance. It might be a two minute four minute sort of like routine. And then they go sit on the bench. Yeah. And so there was like this buildup of adrenaline to perform to do their best. And then they sit there until their next event be one hour later. Maybe I realized

Unknown Speaker 8:29
from your answer that I'm just a big baby because I just met the adrenaline bouncing up and

Jennifer Smith, CDE 8:35
well, there could be two. I mean, if you're really the kind of person who's like, I don't know, where my feet actually gonna hit the net, or am I gonna crash through the ground? I could there could be adrenaline.

Scott Benner 8:44
I was genuinely embarrassed. When you answer that way. I thought, Oh, that's what that's a good answer. But that's not what I was worried about. I'm such a baby. I would never get on skis or do anything like that. So

Unknown Speaker 8:55
Oh, that's funny. Yeah, I'm

Scott Benner 8:55
not up for that. Okay. Thank you. Cool.

First, I'd like to thank Jenny, as always. And I'd like to thank everyone in the private Facebook group for compiling the list of variables that impact diabetes, that you're going to hear moving forward. Was that English? the variables that you're going to hear moving forward were given to me by the peep. Yeah, I think I said that, right. Anyway, oh, you should check out the Facebook page. It's really cool. I think 12,000 people in there now really active people helping each other with their type one. It's called Juicebox Podcast type one diabetes. It's a private group. So nothing you say in there gets outside of it. It's very cool. Anyway, well, now I use the polka music dammit.

I want to tell you more about Jenny. But before I do, I want to tell you that this is the first in the variable series. There are going to be as You heard it a lot more Jenny and I do in short descriptions of the variables that were brought up by listeners. And of course, if you're interested in learning more about what Jenny does for a living, you can check her out at integrated diabetes Comm. I am incredibly excited about this series. In my mind, it's sort of like the defining diabetes episodes, but instead of terms, these are going to be the pitfalls that kind of impact diabetes that you might not know to look for. trampolines was just an obvious place to start. There's so much more coming. I'll talk to you soon.