Scott Benner 8/17/21 Scott Benner 8/17/21

#526 Diabetes Variables: Food Quality

Diabetes Variables: Food Quality

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 the next episode of the diabetes variable series with me and Jenny Smith. This is Episode 526 of the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Volk glucagon.com forward slash juice box.

On today's episode of the podcast, Jenny and I will be talking about the quality of the food you eat, and how that is a variable in your use of insulin. 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. Don't forget if you're interested in Jenny, professionally, she works at integrated diabetes.com. And you can hire her last little bit here if you're looking for the diabetes pro tip series, which by the way also includes Jenny Smith. They begin at Episode 210 were are available at Juicebox. Podcast calm and at diabetes pro tip calm. There, you'll also find the defining diabetes series, The how we eat series, the variable series, and all of the other episodes of the Juicebox Podcast, including ones about algorithm pumping, and some of my favorite, the afterdark series.

Before we get started, I just want to briefly remind you that if you're a US resident with Type One Diabetes, or a US resident, who is the caregiver of someone with type one, I would love it if you would check out T one d exchange.org. forward slash juicebox. Consider answering the short survey there. Your answers may help Diabetes Research grow. It's super simple to do completely HIPAA compliant. 100% anonymous, it only took me a few minutes, you can do it from a laptop, phone, anywhere you get on the internet, your answers to those simple questions will support research that may help you or someone you love. He won the exchange.org forward slash juicebox Hey, Jenny, how are you? I'm great. How are you? Oh, I'm so excited to talk about something that I think people are gonna get upset about. So, no, we're gonna do a variable today about Type One Diabetes using insulin. And I'm picking the topic of the quality of the food you eat. So I feel like it's incumbent upon me to start with, I know I am the person who tells you you can eat whatever you want, as long as you understand how to use the insulin. You know, I do want to tell you that I believe that wholeheartedly. And at the same time, it doesn't mean that certain foods don't make things more difficult. It doesn't mean that you know, you're having a meal that you're using 15 units of insulin for when you could have had a different meal that might have used four units of insulin like that's not that's not in dispute. And I'm also not, I'm not judging anyone about how they eat. I think that's fairly obvious if you listen to the entire podcast, but it is a variable of using insulin. It's a diabetes variable. And the truth is that it is easier to Bolus for something natural than it is the Bolus for something that isn't. What do you I think that's a good

Jennifer Smith, CDE 3:55
I think that's a that's a really good statement. I think the word easy. I use it lightly in terms of like diabetes management easier, easier. But in terms of more natural or simple food, versus more processed or like complex nature of something that's been put together in a processing or a process type of way. A food that's simple, like an apple is just an apple, right? It's mostly carbohydrate in terms of like macronutrient content, right? We've got carbs, proteins and fats, and Apple is mostly carbohydrate. And because of that simple nature of one nutrient you have, what we use and the human body makes insulin that works. cleaner isn't the right word, but it works in a more simple way around a simple food. Has this effect, it should go this way your blood sugar should do this. And it should return down here. If your insulin dosing strategy is Right, right. Whereas if you do something like my father in law loves Apple dumplings, like they're in? Is it still a lot of carbohydrate? Absolutely more than the apple. But there's also other stuff in that, that adds a complex nature to your strategy of management after you eat it.

Scott Benner 5:34
Right? So I have zero education on this. But I think if we attack this from a common sense approach, the world's bigger, right, you know, there, there used to be a time where everybody in the village you lived grew the food that everybody in the state, right, so you'd, you'd grow food, you'd pick food, you'd eat food, that's it, people, people started noticing that if you left food laying around, it would rot and be gone. They started finding ways to keep it better. lutzer. Right. Right. Eventually refrigeration happens. salting meats to slow down, etc, etc. Point is, is that we now do it chemically. So if anybody, everybody has to try that thing, where you buy a McDonald's cheeseburger, and then stick it on your, I don't know, countertop, and leave it there for a year, it doesn't mold, notice that it still looks like a McDonald's cheeseburger, right?

Jennifer Smith, CDE 6:38
Only really dry. I don't

Scott Benner 6:39
think we usually curse in these episodes. But that's it's kind of scary. So, you know, like, that's fascinating is what it is. It's so there are so many preservatives in some foods. And the idea is to keep it from degrading. But again, if you apply common sense that that would mean that it makes it incredibly difficult for your body to break down as well. Yeah, that's the idea, right? And simply speaking, talking about type one diabetes, that keeps the food in your stomach longer, which allows the leaching into your blood longer, right, the carbs are leaving it, it's coming out of sugar, the sugar is going into your blood, it's more difficult to Bolus process food than it is unprocessed food. I mean, it's just kind of it's, it's, it's my It is my finding over the last 15 years of, of watching our need food, better anything

Jennifer Smith, CDE 7:36
quantity, and what you add up in a day two on one on top of another on top of another on top of another, you know, I see it the most in like vacation days versus eating at home. Right? People go on vacation, and they're like, Yeah, but I had pizza and I know how to Bolus for it at home. Well, what's the difference? Your whole make your pizza, you know what went into it, it's just you know, flour and baking powder and whatever else or baking soda and you make a crust and you put the stuff on top of it now you go out and who knows what they made it with and how they put it together and what they grilled their fries in and

Scott Benner 8:13
what the company they bought it from put in it so that they could ship it across the country etc, etc. Also, Jenny I don't want to be a stickler, but pizza dough is water, salt, flour, and yeast. Nothing

Jennifer Smith, CDE 8:25
and yes, there you go. See I don't I don't usually make real pizza dough. I usually make like a cauliflower crust or like an almond flour. So my ingredients are a little different.

Scott Benner 8:34
definitely understand that. I just don't i don't want people to think I don't know how to make pizza though. I know you've got a pizza oven. It's quite nice. And the truth is, is that the pizza dough I make by hand my body processes better than when I would buy premade at a store or anything I would buy even from a local place. So and then we run into pizza such a great example because the difference between some some guy that owns a shop in New York who's making the dough by hand using salt water, flour, yeast, and you going to any number of Little Caesars Pizza Hut, like those kinds of places that are spread across the country. I mean, that's not really pizza. that's a that's a baker and a chemist getting together and trying to approximate pizza for you. Right and

Jennifer Smith, CDE 9:27
a lot of the reason like you said it's because of a preservative nature that's needed, right? I mean, in general, there may be some corner shop, Mom and Pop pizza place that whole makes everything like you're gonna get it on the street in somewhere in Italy, right? But typically, much of the pizza shop stuff is been pre made, shipped frozen, they might do the rolling out and that kind of still has to have preservative in it. And again, it leaves into the like, how much of that is where are we kind of over and over and over daily putting into our body? There's a lot of processing. If people were looking at labels, there are a lot of ingredients you can't read.

Scott Benner 10:14
Right? Right. And you sound like, Listen, I'm not unaware, you start talking like this. Most people are like, Oh, great, hippie. I'm glad you. I'm glad you have a ton of time to grow cabbage in your backyard. I don't like and and I'm not saying that. I don't understand that. But you can't not understand it. You can't sit there staring at a blood sugar going. I don't, I don't know what happened. This doesn't make any sense. You don't I mean, like this, this, you know, 10 carbs, one unit. That's the ratio always works. But now suddenly, you're like you said, You're, you're out in a restaurant. I mean, there's a reason restaurant food tastes good. It's like so much other stuff in it. You know? Like, it just is really, there's no doubt, I guess I should say that the days I'm most proud of how good I am of using insulin are usually reflective of the days that aren't eating the poorest. Because it really tests my, my skills. Yeah, yeah, like when you when you get up on a summer day, and somebody's like, oh, we're gonna go to the I don't know, we're going to the pool. And which we, which we do four times a year, which is so funny that I picked that as an example. But you know, you stop, and you grab all this food, you have a big lunch, and four or five hours later after baking in the sun and sitting around people like oh, we shorter wings, you know, right, like any and these things start piling on top of each other. Right? So

Jennifer Smith, CDE 11:37
even my husband says the same thing. We actually, we've been in the pool, all but like, five days this summer. So we've been in the pool a lot. But the days that are like a weekend day where we're actually spending like a couple of hours there or whatever. My husband always says the same thing. He's like, now I'm hungry for something that's like, salty, crunchy,

Unknown Speaker 12:00
right?

Jennifer Smith, CDE 12:00
He's like, I don't know what it is the haften the whatever. So no, I

Scott Benner 12:05
i've i've looked up on days. And Kelly's like, we're getting Chinese for dinner. And I think to myself, like Didn't they have nachos for lunch? Like, you know, I'm like, Alright, then I feel myself like focusing in on like, I need a I need like a diabetes, Adderall. Like I got to really focus here for a second, like, how am I going to leave nachos and go into Chinese and then get her to bed. Like there's a lot that goes into that. And, and so again, there's no judgement for me. But you have to understand if you're listening, that the quality of the food you're eating is going to impact how it how it works. And, you know, super simple like, you know, your carb ratios that work well for natural foods might not work well for other foods. And that's why in the pro tip series, we talked about being flexible and understanding the different impacts of different foods, etc. But the but this is, I mean, it's a serious thing. It's worldwide mostly, everyone has access to food that's been treated with something or has ingredients in it that's meant to keep it shelf stable longer. And while it makes it harder for your body to deal with. GMO hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about, all you have to do is go to G Volk glucagon.com, forward slash juicebox g vo shouldn't be used in patients with insulin, Noma or phaeochromocytoma visit je Vogue glucagon.com slash risk. Everyone has access to food that's been treated with something or has ingredients in it that's meant to keep it shelf stable longer. And while it makes it harder for your body to deal with,

Jennifer Smith, CDE 13:54
well, I think you know, in terms of like going the distance in this conversation to I even like I try out like different like diets, right? I hate calling them diets just because they come out and I'm like, ah, let's see what that does do something different. And I mean, overall, I consider the food that I eat and I feed to my family and whatnot. pretty clean food. I mean, we don't have a lot of processed kinds of stuff. I mean, we've got like canned beans, because they're a lot more convenient than soaking the beans, right. But overall, I did is a couple years ago I did the whole 30 diet. And you've heard of that it's like a it's like a 30 days of like a reset. It's essentially completely grain free. And it's it's non processed at all. I think one of the most process things is probably like coconut oil or something like that on it right? But doing that for a 30 day time period, even compared To what I typically do, dropped my insulin needs and made it very clearly visible insulin action and insulin need based on literally no processed anything.

Scott Benner 15:17
Really? Yes. So even you who listen, for people wondering, Jenny and I see each other while we're doing this, and there are times I think the camera goes on and she's just like, oh, hideous monster. Like when she's because she's super healthy. That looks so natural. Oh, no, no, but but I still like, Listen, my birthday was this week. And they bought me like a little ice cream cake, which is a holdover from my childhood, right. And so everybody, everybody gets like a piece of ice cream cake. And then there's this like, little voice in my head. That's like, the rest of this is mine. people stay away from it. Birthday. I live this long, not you. And so. And I know in my head, like I'm gonna revert to a small child and have a piece of ice cream cake every day for three days until it's gone. You know, and I don't know what is an ice cream cake. But part of me believes it's not ice cream.

Jennifer Smith, CDE 16:13
But it's darn tasty. In fact, by the funny thing about that is that when my husband and I got married, he for our my first birthday, like married, he really wanted to make me a cake. He's not a baker. He can cook. He's just he's not a baker. So he bought me an ice cream like a mini like it was just us. Right? It was one of those tiny little ice cream cakes. That probably was like four servings. And I think we ate it over like two weeks because it was like, my favorite part of the ice cream cake. Is that crispy? crunchy? Like,

Unknown Speaker 16:52
I don't know what's in the middle. And it's not food. Yeah.

Unknown Speaker 16:57
I don't know where it was made. But it's good.

Scott Benner 17:00
I have one more thing to bring up. But let's finish this thought we had an entire conversation where we sat around and said rate the parts of the ice cream cake. And it's so funny. It's not even it's just so is it the like the decorative icing around the corner, which is is it the vanilla? Is it the cookie I'm making air quotes the cookie in the middle are the chocolate and everyone rated the parts of the ice cream cake differently as ever part was my son throws it up on I Snapchat I think through his friends. And he's like, I've got nine responses. None of them are the same yet, for people's favorite parts of the thing I want to add here. I'm not the healthiest person in the world. But I have made a change in my life that I have found to be impactful. And I think it fits in here. So I saw a woman on a television show once which is the best way to make health decisions next to listening to a podcast. And she said don't eat canola, corn cottonseed, soy sunflower, safflower Grapeseed, or rice bran oils, just don't use those oils. And I thought, well, I use canola oil and corn oil. Like sometimes I use sunflower oil. Okay, so I just cut them out of my diet. I just thought like, like you said, with the 30 days, I was like, let me see what happens. So I cut them completely out of my diet. If I cook with it, I need oil, I only use cold pressed, non fermented olive oil, or butter. Like those are the only two things I'll cook with in a pan. And I can't tell you that my life magically changed, right? Like I didn't like suddenly I wasn't a foot taller or anything like that I but but here's the biggest thing that I noticed. If I got kind of like, ooh, she didn't say peanut oil, I'll have some like, like, I'll pull out a deep fryer and make some chicken nuggets or something like that. Or we'll go to a bar and I'll get wings or something. The minute I add in one of those other processed oils, you might as well just wherever I am to the bathroom decide that I'm on my way to that situation because while I haven't had some great impact by removing them, what I realized has happened is I've stopped taxing my body in a way that it wasn't prepared for. So like I'm giving my body a job with this oil that it's barely keeping up with. And and so I don't know that that's quantifiable for people. But I think of that as when you're thinking of foods to cut out of your life. Like just because your body processes processes that doesn't make it good. Like I could eat a rock and like come out the other end. But right I shouldn't do that. And it's not good for you. Yeah, yeah, at some point, you're gonna attach yourself to the point where your body's gonna be like, Yo, man, listen, that's the last Brock I can get out of here. And and I just think that, you know, that's what I saw with the oil. So you can Yeah, heat oils or don't i don't care. But I'm saying that when I stopped taxing my body with them, I noticed that my body was happier. And my body showed me that it was unhappy when I tried to give it back.

Jennifer Smith, CDE 20:17
Well, and you know, the other thing, too, that you probably would bring into that, given this conversation is that a lot of our processed foods contain those types of fats, because they're processed, they're processed and broken down from these plants that would not naturally like it wouldn't be visible that they would be an oil that we would use, right? In fact, it's only like, these haven't been available. They weren't available until like the 20th century, right? Where we finally had enough technology or different types of machines that we could take these oils out of these products and use them. And we found that they had a very good preservative nature, we could add them to things, they had shelf stability. But are they things that we should be eating? A lot of? No, in fact, most In fact, if you're looking just at canola oil alone, most of the resources kind of show that if you are going to eat it, don't cook with it, use it more in like a salad dressing that remains cold, rather than in actually like cooking with it.

Scott Benner 21:30
Because when you heat it up, you change it again,

Jennifer Smith, CDE 21:32
you can't change the chemical structure of it again. So

Scott Benner 21:35
I oddly enough, I'm gonna equate this to I will not microwave plastic, I don't care if it's plastic, if it's microwave safe or not. microwave safe means it won't melt in there doesn't mean it's good for you.

Jennifer Smith, CDE 21:46
Right, it gives I mean, there again, another like rabbit hole of everything that it gives off chemically at Yeah, I mean, I've always done glass,

Scott Benner 21:55
right. So. So that's my point about that is just that, and Jenny ties it in a nice bow. These oils are processed, where this one oil that I've chosen. Extra Virgin Olive Oil cold fermented. So it's not it's not changed by heat. Right? That that seems to be fine. Like, I don't have any issue processing that whatsoever.

Jennifer Smith, CDE 22:20
Right. Right. And I mean, if you broke it down further, a lot of it has to do with why do we? Why do we need some of these? Well, we're looking at the Omega, the Omega fatty acids kind of coming from some of these products. And there are different types of omega fatty acids, their omega threes and their omega sixes. And you're supposed to have a certain like ratio of these coming in one versus the other. And unfortunately, these oils actually have a very high percentage of omega six. Yeah, which we don't really need a high percentage of omega sixes, I have

Scott Benner 22:51
to tell you again, I have no no education to speak of. But in my mind, at least butter is like it's it's from a cow. I mean, like I at least feel that way about it. You know what I mean? And I don't know, I feel weird talking about this. Because again, I'm like, if you saw me, you'd be like, well, there's a guy who's not out of shape and not in shape. You know, like I don't I don't I'm not a I'm not a bodybuilder. I don't I don't think that way about myself. I don't think I'm interested in it. But I can tell you that I've seen it with Arden. I've seen her eat stuff that's processed, and it makes things more difficult. And I've seen it my own body. I think it's just worth it's just worth thinking about while you're doing this. Like I'm not saying you're going to be able to talk to your four year old into not eating Cheetos, but Cheetos or not food,

Jennifer Smith, CDE 23:42
like you have and if they're everyday versus Yeah, right. Gosh, I want Cheetos because we're on vacation and we're gonna have like sandwiches on the side of the road, you know, when a wayside snacking on okay. But yeah, I mean, kids don't nobody needs Cheetos, or Doritos, or, I mean, like calling out big brands here. But truly, if you read any of the books that are really about, like mindless eating, and they all prove points of research that companies make, quote, unquote, food, which isn't real food taste better than it would actually taste without salt and sugar, and flavorings added to it. And that what, it's what hooks you

Scott Benner 24:23
Yeah, it makes you want more? Yeah, I mean, what more we could talk about if you cut sugar out of your diet, you'd go crazy in the first couple of days until it was out of your system. You have crap, you'd have incredible cravings and, you know, all all that stuff. So I mean, to try to keep it in the into the diabetes realm, I guess and keep it around that. It just you just need to be aware of it. Like again, if you want to eat Cheetos all day long. I'm sure there's a way to Bolus for now I'm pretty sure that way exists in this podcast. It'll explain it to you. Right, right. But you can't. I guess we're this episode comes from for me or where my perspective comes from is that I hear from so Many people I'm sure Jenny does too. And at some point, it's frustrating to hear somebody say, I need you to help me My stomach hurts. So what did you eat? I ate a rock. And you're like, well, well don't eat rock, don't eat rocks. You know, what, can't you They told me you could get the rock out like, Okay, well, I guess we can but like, let's not do it again. You know, I'm not gonna tell you that I was at a picnic the other weekend. And I brought my own food cuz I like there's problems like, I'll do it so that I knew there's something there I could eat, right?

Jennifer Smith, CDE 25:33
That's my trick. Like, I know what I could do. Because I know what I added to,

Scott Benner 25:39
I'd be happy to make something which means I want to eat while I'm there. And I don't want to be sick, like five hours after I leave. So. But I rode past the ball once and I looked because you brought it up. I was like, God, Doritos, when's the last time I had to read those? Say, I don't think it's been in forever. I took about four or five Doritos, and I ate them. And I was like, Huh, okay. And then that was it. But I saw a person living next to those Doritos. And their arm, like just kept going back and forth. You know, and because that stuff is like, like you said, some of these foods you have to understand I'm going to go off course for a second. I once tried to explain to my younger brother, that I wouldn't smoke a cigarette, if for no other reason. Because I could imagine 12 really rich people sitting in a conference room laughing at me for buying their cigarettes. And and so there's sort of that process food thing makes me feel the same way. Like I know for sure they make that food so that your body is just exploding at every pleasure center when you have it. Right. And they don't care if you can't get your blood sugar down later or, and you know, I've want to CGM and everything we talked about on the show everything around insulin I saw impact me with a working pancreas. I saw what happens if I ate late at night. And I chose poor food. My blood sugar would sit at 110 all night long. Right? You know, I saw what happens is where it would naturally

Jennifer Smith, CDE 27:06
sit. I mean, some people be like, Oh my god, 110 how horrible right

Scott Benner 27:09
and my works. So here's right, yeah, I 110 for nine hours, because at 10 o'clock. I mean, I did it as a test. But at 10 o'clock, I said to myself, well, I'm gonna eat this thing and see what it does to me. And just like we talked about, I went to sleep, my body slowed down digestion, slowed down, the food stayed in my stomach forever. And it kept driving up my blood sugar. So yeah, that's it. Alright, just got out of hand? I don't think so. Actually, but yeah, for anybody who wants to read about the doctor that I saw, called the oils, The Hateful Eight. And so I think if you google Hateful Eight oils, you'll find it. It's not made that

Jennifer Smith, CDE 27:50
whatever the doctor was referring to also included things that are very relevant to diabetes, including things like chronic inflammation.

Scott Benner 27:57
She was talking a lot about the metabolic impact of Yeah, well,

Jennifer Smith, CDE 28:03
yeah. Yeah. And that has a huge component to diabetes management and insulin and what you see happen and everything. So yeah, absolutely.

Scott Benner 28:17
A huge thank you to one of today's sponsors, je Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juice box, you spell that GVOKEGL Uc AG, o n.com. forward slash juicebox. And don't forget to head over to the T one D exchange and fill out that brief survey your us resident who has type one or a US resident, who is the caregiver of someone with type one, they need your help T one d exchange.org. forward slash juice box only takes a few moments.

If you're looking for a great online community around diabetes and using insulin, look no farther than the Juicebox Podcast Type One Diabetes private Facebook group, it is completely free to join and has over 13,000 members, people just like you talking about type one, strategies, and so much more. Go find it now on Facebook Juicebox Podcast type one diabetes. Thank you so much for listening, for sharing the show for being wonderful listeners. And for whatever else you're doing out there to support the show that I don't know about. Thank you. Thank you. Thank you. I'll be back very soon with another episode of the Juicebox Podcast.

#524 Diabetes Variables: Hydration

Diabetes Variables: Hydration

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to the next episode of the diabetes variable series with me and Jenny Smith. This is Episode 524 of the Juicebox Podcast. This show is sponsored today by the glucagon that my daughter carries g vo hypo Penn. Find out more at G Volk glucagon.com forward slash juice box.

On today's episode, Jenny and I will be talking about hydration, and how that is a variable in your use of insulin. Please remember, while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And always, always, always consult a physician before making any changes to your healthcare plan, or becoming bold with insulin. Don't forget, if you're interested in Jenny, professionally, she works at integrated diabetes.com. And you can hire her last little bit here, if you're looking for the diabetes pro tip series, which by the way also includes Jenny Smith, they begin at Episode 210 were are available at Juicebox. Podcast calm and at diabetes pro tip calm. There, you'll also find the defining diabetes series, The how we eat series, the variable series, and all of the other episodes of the Juicebox Podcast, including ones about algorithm pumping, and some of my favorite, the afterdark series.

So Jenny, we are getting into another diabetes variable. And I was thinking today, since it's summertime here in the US, we could talk about hydration and its impact on blood sugars. Yes, that's a great topic. So is it as simple as Watch, watch, watch me make a three minute long episode of this. Which maybe is fine, right? So I guess let's start at the basis of hydration like are most people probably don't understand what really being well hydrated means.

Jennifer Smith, CDE 2:28
I would say that that's probably correct. And I think that most people don't think that they're dehydrated until they're actually like physically oh my gosh, I have to get a glass of water or I need something to drink. Like you're beyond like that. Now you're definitely dehydrated, you should be getting something. This point.

Scott Benner 2:49
Yeah, kidneys hurt, you're thinking of the hospital. You're right, right. So So I guess that is how maybe most people think of hydration is the idea that like, like there's something significantly wrong, not just that there's not quite enough water in your body. And because of that, specifically with type one, and anybody who's using insulin, the insulin can't work. So can you give them a brief overview of why the insulin won't work if you're dehydrated?

Jennifer Smith, CDE 3:14
Well, one thing to start with is, you know, when you don't drink enough water, the glucose itself in your bloodstream becomes more concentrated. So it's thicker, it's almost like if you imagine the old saying of like molasses in winter, it's kind of like that, when you don't have enough water or liquid to let your blood and fluids flow through your body and your vessels like it's supposed to, it gets kind of sticky. And that leading to higher blood sugar levels means a lot of things including the fact that insulin which we're expecting to get absorbed out of our subcutaneous or underlying tissue, whether you inject it or you pump it however it gets in your body. Unless you inhale it, that's different. If you're putting it into your body via injection or pump, you're expecting your body to absorb it out of that underlying tissue absorption means that you need enough fluid to then sort of transport it into your circulating system. And if your circulating system is slow, because you're dehydrated, right, then the insulin is going to take a bit more to kind of get working if if you will, okay, along with potentially also having some higher blood sugars too. So

Scott Benner 4:37
is there I mean, bit poor hydration can also lead to body temperature rise, right? Yes. Which I guess could have an impact on blood sugars as well. I don't I just

Jennifer Smith, CDE 4:49
it would be a stress to the body. Right. Yes. So the

Scott Benner 4:52
correlation but still important,

Jennifer Smith, CDE 4:54
but still important. Absolutely. I mean, if you think about it, all of the things in your body Rely on hydration right? In terms of like lubricating your skin and your joints and making digestion go the right way. Even just removing things out of your body, the reason that we go to the bathroom is to rid our, our body of some of the toxins and the things that it is sort of disposing of either you know, one way or another of bodily elimination. So if there's not enough fluid there to kind of move digestion. Now you've got other things that could be enough impact and stress on the body that could be raising your blood sugar

Scott Benner 5:35
chivo hypo pan has no visible needle, and it's the first pre mixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is chivo hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G Volk glucagon.com forward slash juicebox g vo shouldn't be used in patients with insulin, Noma or pheochromocytoma. Visit g Vogue glucagon.com slash risk. Symptoms of dehydration feeling thirsty dark yellow or strong smelling urine dizziness lightheadedness, feeling tired dry mouth, lips eyes or ping fewer than four times a day are things to look for. for hydration. I think maybe the other important thing to say here is that if you're dehydrated, a can of coke isn't the answer. Right? Like so. Right? So no, it's I feel like there are so many people right now just waiting for me to say water. But you should be drinking water. Right? And and how much do you know? How much do you drink a day?

Jennifer Smith, CDE 6:49
Um, a lot of water. We go through a lot of water. And I mean, it's the main thing that we all drink. We don't drink milk or any of those other things. We don't drink juice as a beverage. So, gosh, my water bottle is 32 ounces. And I probably go through at least two of those a day. And that's just water. I mean, I drink probably two or three glasses of tea in a day. I drink one cup of coffee in the morning. You know everybody knows what I do.

Scott Benner 7:25
Pleasure drinks like because that's how I think of that. Like I had a die ginger Lv I sound so boring. I had a diet ginger ale The other day I was like, Well, I haven't had this in such a long time. It's

Jennifer Smith, CDE 7:35
my, my pleasure drink. Like if I did this when I was pregnant to start because I wanted something that was like a treat in the evening. But I didn't want something that was going to like ruin everything for overnight. So there's a brand of quote unquote, sugar free cereal, or not cereal, soda. zevia. Okay, and it's sweetened with stevia. Some of them are sweetened with stevia and monk fruit, etc. But it's zero sugar. And my favorite is their ginger root beer. Okay. So if I was going to have a treat, I mean, we usually even only buy it like if we're going camping now. But that was my thing to do, like in the evening. A really big glass with lots of ice and zevia. Okay,

Scott Benner 8:25
well, the so I'm seeing here online that it could take up to 36 hours to rehydrate yourself. If you're dehydrated, like like I guess clinically dehydrated, right is there. So I guess there's also a world where you're just sort of on the bubble and you hear all the time I do it with harden. Like there are times where if our blood sugar's kind of stuck, I'm like drink a big glass of water. See what happens. And you do sometimes see like, it is almost like flipping a switch sometimes. Yeah, so that's not that's a case where you're not as hydrated as you could be. But you're not clinically dehydrated. Correct? That makes sense?

Jennifer Smith, CDE 9:01
Correct. I mean, clinical dehydration is definitely much more of a there's a visual as some of the symptoms, the signs and things that you mentioned already are kind of in place. It takes a lot to be really dehydrated enough to need to go and get assistance. I mean, in general, you know, how much water do I drink? the age old? Oh, you should be drinking, you know, eight glasses of water a day essentially, or what adds up to like two liters of water. Right. So doing that, a lot of people also don't think that that intake is just considering actual drinking. There is fluid in a lot of the food that we eat naturally, you know, our fruits or vegetables. So it's another reason that they should just eat better food because we also hydrate our body. The less processed foods are

Scott Benner 9:57
Yeah, okay, and so on. I think the last thing I want to say, and I know this is difficult but it's you know, diet Snapple is not really good for you. You know, it might taste good to you it might not have sugar in it. So you're excited about it. I am not judging. I am definitely a person who, in my heart of hearts wants my drinks to taste like something. But, I mean, I there exists just no doubt in the world that just drinking water is more valuable, I

Jennifer Smith, CDE 10:30
suppose more valuable. Yeah, I mean, if you do want a little bit of something like flavor wise, you can always add some lemon juice or some lime juice or something like that to the water to get it to have a little bit more flavor. If your reason for not drinking water as much as just because water doesn't taste like anything. Even like some of the sparkling waters, like spindrift and the Waterloo, they get an awful lot of really good like natural essence sort of like flavored it's a sparkling water but sometimes that even is enough for people to drink a little bit more than just plain water.

Scott Benner 11:08
Right. Well, I think that's a an excellent place to leave this so awesome. Thank you very much.

Jennifer Smith, CDE 11:14
Yes.

Scott Benner 11:20
First, I want to thank Jenny for being such an important part of the show. Don't forget you can find her at integrated diabetes comm I'd also like to give a huge thank you to one of today's sponsors, g Vogue glucagon, find out more about chivo hypo pan at G Vogue glucagon.com Ford slash juicebox. you spell that GVOKEGL Uc ag o n.com. forward slash juicebox. Thank you so much for listening, and for sharing the show with others. I'll be back very soon with another episode of the Juicebox Podcast.

#511 Diabetes Variables: Exercise

Diabetes Variables: Exercise

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

+ Click for EPISODE TRANSCRIPT

Scott Benner 0:00
Hello friends, and welcome to Episode 511 of the Juicebox Podcast.

Back again with another diabetes variables episode means Jenny's here, and today we're going to talk about exercise. 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. I don't get to exercise because I'm sitting here making this podcast but I hear from a lot of you that you do the running about Nah, I also hear kids play sports, etc, etc. Anyway, exercise is very important as we know. So let's talk about it. 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. If you love Jenny and want to check out what she's doing in her professional life, she works at integrated diabetes comm or check her out.

This episode of The Juicebox Podcast is brought to you by the Dexcom g six continuous glucose monitor. You can learn more about Dexcom and get started with the G six today@dexcom.com Ford slash juice box. The episode is also sponsored by touched by type one end. And there's another one I know the Contour Next One blood glucose meter. Find out more at Contour Next one.com forward slash juicebox and touched by type one is it touched by type one.org. And they're on Facebook and Instagram. Do please check them out. So the variable of exercise will now bring out that I can't remember the difference between two words because they sound similar. I can kind of remember but

Jennifer Smith, CDE 2:25
arrow aerobic versus anaerobic

Scott Benner 2:27
aerobic versus anaerobic I always pause my I always go aerobic versus anaerobic. Here's how I do it. This is gonna I'm so embarrassed. I start thinking about Jane Fonda in her 40s and a leotard and I think that's aerobics that's moving quickly. And that's the thing that brings your blood sugar down. I can't believe that's how I make the connection in my head.

Jennifer Smith, CDE 2:51
That's funny. Is that the let's get physical? Is that the Joe that would be

Scott Benner 2:55
that would be the girlfriend grease. Oh my god. Oh yeah. My wife's favorite movie is Greece. And now I feel really stupid for not being able to think of she's Australian. Now. I'm gonna know everything about her but her name. Hold on a second. I'm Slavia Newton. JOHN, is that Yeah, Olivia. JOHN would be let's get physical. The thing I think of is, like I said that that leotard from which by the way, is doing the Jane Fonda Workout. And she comes out and she goes, that thing kicks my ass. She's like, I and she's like, how is she doing? It covered head to toe in that like bed stretching. I was like, I don't know, harden. I was like, that was a really long time ago. I'm like, you know, that woman's a famous actress and she's like she is it just became like Internet popular. You know what I mean? Anyway, so So there's two different kinds of exercise. Yeah, something that's aerobics or would playing soccer be aerobic. Yes. basketball. Yes. Okay. Hockey. Yes. Running, obviously, exercise. But now if I lift weights, no.

Jennifer Smith, CDE 4:09
If you're doing lifting in and of itself. I'm not like circuit training or while circuit training could be circuit of weights to some circuit training is cardio and lifting or cardio and resistance kind of combined. But in general, aerobic means that you are breathing in oxygen kind of at that higher rate, you're increasing your heart rate. That's aerobic exercise. Yes. I mean, you could be taking a dance class or doing a Jane Fonda Workout that is all aerobic. Yes, anaerobic is typically like lifting or resistance training. Some yoga can be an interesting combination of both. If you're doing something like a vinyasa flow where you actually have the resistance of your own body weight, but you're flowing through the moves enough to actually get a cardio increase.

Scott Benner 5:04
I feel like you're showing off a little bit by saying that. I've never heard those words together before. I was like, really? Like Jenny's flexing. She knows something that I don't know. But I know you're not doing that. I know you don't have that thought in your body. Everyone know? What, what about yard work? What about yard work where I'm lifting things, but I'm hustling around at the same time. That's both do they cancel each other out?

Jennifer Smith, CDE 5:25
Kind of Bolus? No, I Well, perhaps for some people. But for the majority of people that I work with who do a lot of yard work, myself included at certain times of the year. It tends to be because of the lifting component and the consistent low level movement. I mean, you're not like running between shovelfuls of like mulch or extra dirt for your garden. But you are moving and you're moving enough that the low level aerobic nature tends to create enough sensitivity to insulin to drop your insulin needs.

Scott Benner 6:05
The robot can will went out most likely. Yes. I guess unless you're literally stopping in between bolts to do dumbbell presses or something. Right. Right. Okay. Yes. Excellent. So, if I'm going to do something a robotic, I mean, what I tell Arden is to set a Temp Basal, like an hour before she does it. That's usually what we try. She's not excellent at doing that. She She likes to just test the limits of her algorithm. She's like, it'll catch it. I'm like, it's not magic. You know that thing. And so if she doesn't set one, she will reach that like that 60 range. But you also have to be able to remember that Arden's using an algorithm. So it's taking her basil away, just taking it away too late. It's enough time to stop around 60. But had she done it a little sooner? I think she she's in the 80s no problem,

Jennifer Smith, CDE 7:00
right.

Scott Benner 7:02
But if you're working out on purpose, we're heading out the yard to work. Tell me if I'm wrong, I would avoid active insulin that wasn't countered with carbs. So I wouldn't mind her going out in the yard to work if she had a meal that I knew was really well Bolus, you know, great, Pre-Bolus great carb ratio, then I would think it was okay. I don't mind the food and the insulin fighting while she's outside. But if I were to miss on that Bolus, or if I made too big of a Bolus, active insulin while you're exercising is almost a certainty for dropping, right?

Jennifer Smith, CDE 7:41
Yes, is cardio exercise specifically or the aerobic exercise? Yes. I even have a lot of people who definitely find that that yard work or whatever the aerobic kind of thing is, that like peak in action of that Bolus is typically going to have it sort of height of action during the exercise time. So oftentimes have you can't adjust Basal ahead of time, or there's really not enough time of activity that it's purposeful to adjust the basil for, then adjusting the Bolus down and allowing the food to work to cover what you're doing. aerobics Lee with less insulin in the picture to cover the food, lower insulin with activity paired together, they tend to balance that food out,

Scott Benner 8:38
okay. All right, so But now, if you're going to go do serious lifting, those people have to Bolus before they do that, right.

Jennifer Smith, CDE 8:47
Some do. Some there are multiple ways that people go about anaerobic true anaerobic like lifting sessions or resistance sessions. Some of the lifters that I've worked with have to Bolus after doing some experimentation for seeing how much of a rise they're getting. And when the rise is actually happening. They may Bolus as soon as they start their session, they might do a temporary Basal increase that started about 30 minutes before their session starts so that they're ramped up enough that the rise doesn't get going once they start their lifting. And some find that they actually need to Bolus more in the middle or by the end, because they find the rise in blood sugar is more in the aftermath of the lifting session.

Scott Benner 9:36
Is there something physiologic physiologically that you're aware of that makes that happen? Like is it like, Is it the lifting version of like a fat rise? Like do you mean like, Is there something that actually happens inside of the body that you know of, or just you just know this as a role that the lifting does? I think Jenny's googling she has a very or she's on her notes or something

Jennifer Smith, CDE 9:56
I know I was thinking because some is Some is a adrenaline, obviously. And it depends on what type of I mean, if you're really working with like your power lifters, you've got a huge amount of like adrenaline that kind of gets driven out in order to do these lifts. And usually, if you're like, a strong power lifter with lots of weight, you're not doing loads of reps, you're tending to lift, heavy kind of, to exhaustion of heavy amounts, and then you kind of move on. So, you know, there, that's a component is adrenalin, obviously, it's glycogen also kind of gets released, it's a stored, it's stored in your muscles, it's stored in your liver. So that release of glycogen releases the stored glucose into your muscles to kind of get moving. And that can also cause a spike during sometimes, like I said, some lifters find that it happens after the lifting session. And if it does, again, it's the timing of when to take extra insulin and also how much because despite it causing a rise now and maybe directly after, because of what you've done to your muscles, lifting weights, it essentially tears the muscle fibers apart, right? That's why you lift more and you do more, right, you know, and you give breaks between because those muscle fibers repair themselves in between lifting sessions. And that metabolically increases your body's use of food. Right. So you can end up hours after lifting sessions actually needing that Temp Basal decrease now, or needing to Bolus less, because your body is more sensitized to insulin now, even though it wasn't later,

Scott Benner 11:53
almost like shivering to keep yourself warm, your body's doing something to and it's using up energy to do that. Right. I I'm gonna ask you one last question on this one. Yeah. And you might not have any experience with it. But some people use, you know, steroids to build themselves up, does that change in that and they use them? In part because it shortens the need for recovery time? I wonder if that. I know, that's a weird thing to bring up. But like, I wonder if that impacts that I guess we'd have to find somebody using illegal steroids and has type one diabetes to ask. But I just anyway, I guess there's no,

Jennifer Smith, CDE 12:32
no, it's well, it's it's a question. I mean, in terms of discussing like exercise and potential for blood sugar shifts, because you're using steroids. I mean, steroids in and of themselves, cause a rise in blood sugar. So along with the lifting, which could be causing the rise in blood sugar, you may need to counter kind of both for that. That's interesting. for that.

Scott Benner 12:56
I just yeah, I'll tell you from the after dark episodes, what I've learned is, everybody has needs and they're not always the ones we talked about. So I just wanted to bring it up for a second. All right, yeah. Thank you very much. Yeah, absolutely. Hey, if you're looking for an absolutely rock solid, dependable, accurate, easy to carry, easy to use, easy to see at night, blood glucose meter, look no farther than the Contour. Next One blood glucose meter. Find out more at Contour Next one.com. forward slash juice box. This thing is terrific. The test strips have second chance testing. So if you get some blood but not enough, you can go back get more without making a mess of your accuracy or ruining the strip. How nice is that? Right? It's got a super bright light for nighttime viewing the screens incredibly easy to look at and to read. And the thing is designed in a way that it's just super simple to hold and to use. It's a well thought out. But simple design. Contour Next One comm forward slash juice box. And lastly, the Dexcom g six continuous glucose monitor, see the rate and number of your blood sugar in real time on your iPhone or Android or on your Dexcom receiver dexcom.com forward slash juicebox being able to see your blood sugars in real time is a game changer. It will allow you to make changes to insulin changes the carbs that are meaningful and not just guesses you'll actually be able to see where things impact your blood sugars or your loved ones blood sugars. And the share and follow features allow up to 10 followers. So your child could be followed by you, your spouse and eight other people. Or if you're an adult, and you're looking for some friends or some family members to have your back. You can do that as well. dexcom.com Ford slash juicebox. Thank you so much for listening to this episode of the Juicebox Podcast. Let me just thank Jenny and we'll get out of here. Jenny Smith is a CD. She's a type one for over 33 years. And she's just an amazing font of knowledge about diabetes and using insulin, and she works at integrated diabetes. You can find out about hiring Jenny at integrated diabetes that calm thank you so much to the sponsors to you guys. I hope you're enjoying the variable series. And I Oh, and let me say this real quick, touched by type one, find them on Facebook, Instagram, and it touched by type one.org quick episode today but I'll be back tomorrow with another