Scott Benner 10/22/21 Scott Benner 10/22/21

#564 Diabetes Variables: Pump Site Placement

Diabetes Variables: Pump Site Placement

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

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DISCLAIMER: This text is the output of AI based transcribing from an audio recording. Although the transcription is largely accurate, in some cases it is incomplete or inaccurate due to inaudible passages or transcription errors and should not be treated as an authoritative record. Nothing that you read here constitutes advice medical or otherwise. Always consult with a healthcare professional before making changes to a healthcare plan.

Scott Benner 0:00
Hello friends, and welcome to Episode 564 of the Juicebox Podcast.

Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is pump site placement. 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. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com asked for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean, you could ask try to trade a lamp for a better Pre-Bolus time. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org. forward slash juicebox. Take the quick survey, help the podcast help people living with Type One Diabetes.

I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen, and I'll do this so that you get an inner, an inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means it fits in your pocket, it fits in your purse, anywhere you need to keep your gear, the Contour. Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. Room, it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance, click click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test strip by doing that, or ruin the accuracy of the test. Second Chance test strips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me text messages the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well, you know, I want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh, this thing must need so much blood but it doesn't it needs a very little bit. It's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay, last part go to contour next comm forward slash juicebox. There's like zero sincerely, I'm not just trying to drive you to a link, what am I really want you to go to the link. But that's not the point. There's a lot of information at the link. So if you really want to understand all this contour next.com forward slash juicebox. And I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juicebox. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Can we do pump site placement? Sure, all right. So it's always feels weird to start over when we do the string stuff. Back to them and add It, I hear myself go hey Jenny today, can we talk about pumps? I

Jennifer Smith, CDE 5:04
know we've really been talking for like, 45 minutes.

Scott Benner 5:07
We've been talking forever. We've done like a bunch of these like, and I feel silly. But anyway, hey, Jenny, can we talk about pump site placement today?

Jennifer Smith, CDE 5:15
Absolutely. Excellent. Yeah,

Scott Benner 5:16
we just leave all that in so people know why I'm laughing. So it doesn't matter, right? If it's injected, or pumps, there are just going to be places on a person's body that I don't know what to say, does it absorb the insulin better? Does it use the insulin more efficiently? Like how do we think about it?

Jennifer Smith, CDE 5:39
I think they're both kind of the right way to say it. Because honestly, underneath the skin, I mean, the goal is to have insulin absorb, right, and to get used in an efficient like, pattern of in, gets used goes out, it's finished working. I mean, many people, on pops, I think more than people using injections will start to notice places on their body that definitely absorb the best. And other places that they get good use out of, but they might actually have to have a secondary Basal profile that's notched up a little bit more, because they just don't quite meet the same glucose targets, with the same diesel from let's say, a stomach site versus a butt site, or, you know, whatever it is. And then there are some people who can't use certain sites at all. I mean, I personally cannot use my leg. It just, it just doesn't work for me. I either get occlusion alarms, or the sight hurts. And I've also noticed with that then it's just not getting absorbed accurately enough, I guess is the easiest way to kind of explain it. It's it's much less consistent absorption there. So I just I just don't use my legs.

Scott Benner 7:11
Do you think that's because do you think there's a reason to point to do you have like a stronger leg? Is that muscular? For

Jennifer Smith, CDE 7:17
me? I truly believe it's because I just have pretty much just muscular legs. I mean, I've done biking and dance, and lots and lots of things over the years and I continue to run and do yoga and bike and yeah, I think it's that now the interesting thing is that I can wear a sensor on my leg. I just can't put a pump site with insulin there.

Scott Benner 7:44
Okay, is there anything about like I've heard people say over the years and I've never understood if it was true or not like I can't put my pump near like the you know, muscle in my thigh or towards a larger muscle because the muscles they feel like the you know, the way they say it is that the muscles burning up the insulin, but I don't I don't imagine that that. Isn't it just that there's not enough like fatty tissue there to move it around? Or no?

Jennifer Smith, CDE 8:08
Well, you know, muscles are, they've got a basketball nature to them, right? So they've got lots and lots of vessels that contribute to keeping the muscles doing what they're supposed to be doing and supplying nutrients and everything into the tissue, right? Whereas fat is just I mean, you've probably seen pictures of like fat blobs, right? Fat balls, right? Imagine Yes, imagine a styrofoam ball, that's a good idea. So when you have insulin infusing pretty close to a muscle, let's say and this is kind of general, you would expect potentially that you are going to get if you haven't gotten occlusion from nicking a vessel and getting kind of a clot at the end of the canula. And then the muscle because of the nature of vessels, you may actually get faster absorption in an area. Like I've in particular, noticed if I've ever had a site that has bled after I've taken the site out, but it wasn't really like it wasn't painful. There was no reason to change it prior but it just was one of those like gushers that you like pull out and then I look back at the couple last days and I'll be like, yeah, my blood sugar look pretty perfect. Like it was almost like I didn't have diabetes. Like it was just all working like so beautifully that I felt like this is just it. I'm just at like this beautiful like point, right? And then I see Oh, there's the reason right next to my blood supply.

Scott Benner 9:46
That's what you think you said that it's almost like you're in a very tiny way. mainlining the insulin a little bit.

Jennifer Smith, CDE 9:54
And that's what I guess yeah. And it's actually just closer to the absorption line. You know, because when We put up Pump site or even in jacked insulin, you're supposed to be sub sub Q, right? underlying tissue, which is mostly your like, it's like your thermal layer of protection for your body, right? That's where we're supposed to be absorbing insulin through. And thus the timeline and the absorption for the trend in rapid insulin, regular insulin, long term insulin. It's all based on how it's supposed to get absorbed in us through that timeframe, through that tissue.

Scott Benner 10:29
And so I think it's important here to mention that, when you buy a pump, any pump, it's going to give you some instructions and tell you hear the places you can wear your pump. All that means is that those are the places that the company who made the pump had the time and money test to test so that they can prove to the FDA that these places worked. And I assure that Omnipod probably isn't thrilled if I'm saying this, but you can put your pump somewhere else. Yes, yes, you could try other places I've seen from Chris Freeman, where it on his chest, you know, when he's in the middle of, you know, in the Olympics, and I mean, I've said it before the guys like, I don't know what his real body fat is, but he doesn't appear to have any. And you know, and it's on us, it's on his pack. I've seen ladies wear them in their, on their breast. I've seen people wear them on their hips, their thighs, their calves. I watched somebody do it on their forearm once it's like a test, you know, there's no place. I don't think there's any place where it isn't reasonable for you to try based on what I've seen from the community and from people in general. But you are going to find places that work better. But then I think that leads us into talking about, you can't have too much of a favorite place because you'll ruin it.

Jennifer Smith, CDE 11:46
You have to rotate Yes. Very important to rotate

Scott Benner 11:50
have to have to look at your sites and see for Arden they get a little like if she's using them too much I can start to see in them little vascular, maybe like a little red on top. Like that's the first like sign for me. And then you can start rubbing your your you can rub your hand over top of it. If it gets bad. You can feel like it'll get lumpy or hard. Yes, right. That kind of thing. So yeah, you have to have a place to go. And it is going to change them. Like Jenny said it could possibly change how much Inslee Arden just went off the side of her thigh to the top of her thigh. And I had to increase everything by about 20% for that just from the social side at the top of the thigh. So and I think too, for little kids. As long as we're talking about sites for a second. Here's probably a good place to talk about when you start doing things with little kids or you know, sometimes adults. They build rules in their head. So that's where my pump goes. It can't go there because it goes there. I always wear it here kind of becomes a psychological thing at some points to you know, and then you'll see kids will fight against it. Like I can't put it on my arm. It goes on my leg. Yeah, right. I aren't in 17. And I think she has it. I think she believes her, her CGM goes on her hips. Because that's because that's where she likes it where she likes it. And it works fine and everything. And if I ever say to her, Hey, why don't you try putting your pot on the back of your arm. It's a flat No. And it's only because in my opinion, she remembers it being there in a softball game one day, and we didn't think about it. And she threw and then the pod like yanked on her arm as she was as she came across, she had a bad memory of it. And now even years later that she's not throwing us off ball anymore. years later she's has an aversion to putting it on arm. You know, so sure, if

Jennifer Smith, CDE 13:43
there's like an associated kind of experience there.

Scott Benner 13:47
Yeah, and then it comes out as this is where it goes. And I will fight to the death to keep it here. And then you run into a problem where you don't have ways to to rotate sites. Yes, and then you're gonna run into a problem and the way I've always put it the Arden is look you keep putting it there and one day you're not going to be able to use that spot at all. And that's that's the thing that helps her move around. Now, I think the other good thing to talk about about that is, you know, I really have experienced with the Omni pod but sometimes it's just as simple as turning it 180 degrees like you really like it on your abdomen. Great. Have it point towards your belly button this time and have it point towards your side the next time. Yes, you know, those are still

Jennifer Smith, CDE 14:25
when I do the same thing you know, especially for backs of the arms, which for many little kids, because especially for tiny little kids who really don't have a lot of tissue or are very, very averse to having it on their abdomen for some reason, you know, then that back of the arm like you said it's it's essentially just turning the pod with that viewing window facing up versus the next time turning it with the viewing window facing down to technically that and even have two sites on the back of each little arm that you could potentially use Which makes for places between two arms. And at assumably? Three days per site. It's a fair amount of these before you get back to site number one on the first star,

Scott Benner 15:12
do you think specifically on Omni pod? Use it vertically? On limbs? right?

Jennifer Smith, CDE 15:19
Correct. Yeah, perpendicular up and down with the viewing window, either facing the sky or facing the floor on limbs. Exactly. And then on, like, your torso region or your upper but you would use it in sort of a horizontal fashion.

Scott Benner 15:35
Is that because of just the nature of the shape of the pod?

Jennifer Smith, CDE 15:39
Yeah, that's from what I know. It's nice. It's based on the wear comfort wear of the pod itself? Yes.

Scott Benner 15:47
Do you know a second ago because I didn't want to look stupid. I just checked it vertical, up and down? Like I googled it right before I said it, and then it made me feel so much better, because the rest of the world doesn't know either. It's it's a very popularly Google thing is horizontal, left and right, is vertical up and down. What is vertical? What does the vertical line look?

Jennifer Smith, CDE 16:10
Pretty funny? Is that

Scott Benner 16:11
closer attention in school? Anything about this that we didn't cover?

Jennifer Smith, CDE 16:17
Um, I don't think so I think in terms of site you covered, you know, all the places that are approved versus the ones that people are trying, not necessarily approved. So yes, but

Scott Benner 16:30
it's a variable, because you are going to get it in your head that these are my settings, and then you're going to move the site somewhere else. And then you start, I love it, people immediately go, this pump doesn't work. That's always my favorite reaction to everything,

Jennifer Smith, CDE 16:43
right. And I've got a number, I mean, as a secondary to that site to site going to number of people, myself included before using, you know, the system that I actually use. I actually just had separate basil profiles that I would use from one site to the next, more specifically, all the body sites on me work pretty much the same, except for my upper but my upper back just seemed to need more insulin whenever I used it. So I had a profile that was specific to that.

Scott Benner 17:13
So do you think that and I'll let you go. But do you think that the advent of g7 Dexcom. Like when it changes form factor? I keep thinking people are gonna start trying like, a lot of different places, because it's going to be easier to put in different places all this probably,

Jennifer Smith, CDE 17:29
I would expect. Yes. I mean, as it is, a lot of people are wearing their CGM is on places that I would honestly like there. I've seen it on their forearms. I've seen it like, places I would never think of popping it in. But I think getting accurate results. I

Scott Benner 17:48
guess I have to admit, there are times I see those pictures, and this is exactly what I think and I'm just gonna have to bleep this out. I think, man, skateboard, huh? I wonder if we can make it work here. I'm gonna

Jennifer Smith, CDE 18:01
I know I don't even have like, I don't it's all muscle there. I don't know where it would sit under my skin. I would hit something and it would be immediate pain or blood.

Scott Benner 18:12
I I just think of those people as they're they're explorers. They're just like, I wonder what will happen if I walk across Antarctica? You know?

Jennifer Smith, CDE 18:20
Exactly. Go find out exactly. I'm

Scott Benner 18:22
not doing it but whatever. Okay, thank you very much. First I'm going to thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com. forward slash juicebox are also links in the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate you listening and supporting the Juicebox Podcast. Tell a friend!

#560 Diabetes Variables: Sleep

Diabetes Variables: Sleep

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

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Scott Benner 0:00
This is Episode 560 of the Juicebox Podcast. I am. I'm impressed with myself if you all knew me personally, you would be amazed that I've done this, honestly, that I didn't like, you know, get like five minutes into it was like it was a lot of work. Oddly not like me, but maybe it is now. Who knows, live learn, right? Grow change, etc.

Friends Today I'm back with another episode of the diabetes variable series with Jenny Smith. Today's topic, as you saw in your podcast player is sleep, Jenny and I will talk all about sleep and how that is a variable for your type one diabetes management. While we're doing that, you'll remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And further, you'll remember to consult a physician before making any changes to your health care plan, or becoming bold with insulin. Jenny Smith is a guest on the podcast but she has a real job at integrated diabetes comm where she helps people with their diabetes in exchange for funds and goods as capitalism works. Integrated diabetes.com ask for Jenny. Now that I'm thinking about what I just said, I don't think you can exchange goods for services with Jenny. But I mean you could ask offer a sofa, see if she'll help you with your Basal insulin. Are you a US citizen who has type one diabetes or a US citizen who is the caregiver of someone with type one, please if you are, go to T one d exchange.org forward slash juicebox take the quick survey help the podcast help people living with Type One Diabetes. I want to put the ad right here because I don't like splitting up shorter episodes. But that's not what Contour Next One paid for. But I feel like they'd be okay with it if you guys promise just to listen to the ad, okay. All right, you promise to listen. And I'll do this so that you get an interrupt an inner, inner inner I was gonna say an interrupted, I meant an uninterrupted episode. with Jenny and I know this is this. It's a clunky start. But watch how I finish the Contour. Next One blood glucose meter is top shelf to understand it is super duper accurate, incredibly easy to use, and easy to hold and transport. This means if it's in your pocket, if it's in your purse, anywhere you need to keep your gear, the Contour Next One slides right in and doesn't get in the way. It also has an incredibly bright light for you know, when you're sleeping, and it's dark. room it lights up like thing from a movie that we can't say because I think it's copyright infringement. And it allows the room to glow. It's as if heavenly light has shone down upon your finger. You strike it with a lance click, blood comes out. You take the Contour Next One meter, put in the strip, touch the strip to the blood. Oh, is it not enough blood, no big deal, this trip has a second chance to feature just get a little more blood, squeeze, squeeze, squeeze and go back and hit it again. You have not ruined the test trip by doing that. Or ruin the accuracy of the test. Second Chance test trips from the Contour Next One blood glucose meter. I mean, what will they think of next. Also, the screen is incredibly easy to read. And if you would like to pair your meter to a rockin who is sending me got text matches the middle of what? Hold on. Alright, I'm back. Sorry about that. If you want to pair the meter to an app Contour Next One has a really terrific app too. So you can use it with or without the app. Last thing I want to say is that well you know i want to say two last things. So last thing like let's call it one I want to say is that I'm always afraid that when I talk about Second Chance test strips that you'll think oh this thing must need so much blood but it doesn't it needs a very little bit it's not a big blood drop that you need. I'm just saying that if for some reason you don't get quite enough, you can go back and get more. Okay last part go to contour next comm forward slash juicebox there's like zero sincerely, I'm not just trying to drive you to a link What am I really want you to go to the link but that's not the point. There's a lot of information at the link. So if you really want understand all this Contour Next one.com forward slash juicebox and I'm just going to finish with this. There are a lot of you walking around with subpar meters. It's not necessary. You're already paying the money. You're paying the money for the meter, you're paying the money for the strips, you might as well get a good one Contour Next one.com forward slash juice box. Get yourself a blood glucose meter. That equals your effort. You're trying right you need good information back from your gear. Jenny Campbell Do sleep as a variable for managing insulin. I don't know, I don't have a lot of feeling about this, honestly, it's not one of the things that I've noticed. But maybe I'm not looking hard enough. And when people sent in variables for the list, sleep, sleep deprivation, getting good sleep versus getting bad sleep, like broken and unbroken. Everybody sent that in as a variable. So I don't understand why that would impact anything.

Jennifer Smith, CDE 5:35
Well, you know, overall, sleep provides a lot in terms of recovery, and build of like cellular sort of restructuring and whatnot in the overnight time period, right? That's, we're supposed to get these waves of light sleep, deep sleep, etc, that help our body to actually then recoup and be ready for another day. When it comes in terms of type one management, that's one of the biggest things that most people say is, I just want better sleep, the daytime, I can struggle through manage through if I've had good sleep overnight, I can deal with the daytime management. So from one, sleep deprivation can lead to poor overall management, because you don't have as much with all that we have to manage in today's world beyond our diabetes, that's another layer that we have to consider. And if you haven't slept well, you're not going to be thinking as clearly, right. on another level, though. There are a lot of different hormones that are regulated through the sleep cycle that have relation to appetite, and the turn on the turn off of appetite during the daytime. And so for someone, again, managing diabetes, if you are not sleeping well, it is very likely that some of those hormones that are supposed to be being managed for then transitioning into what you're craving, unable to manage in terms of your intake through the course of the day, those are not going to be regulated the right way either. So there's a lot to sleep, that does translate into diabetes management, right.

Scott Benner 7:31
So the one, the one thing that popped into my head, when I saw this as a variable was that I thought I for sure had heard that shift work could be bad for people in a way that I never expected that he could make you more, the way I looked it up it's a shift work can have an adverse effect on type two diabetes, it can also put a person at higher risk of developing type two type two in the first place shift work, particularly that involving overnight and varying shifts can make it more difficult to manage glucose levels. It doesn't it doesn't really go on but I really I just remembered hearing that that there's something about the is that this circadian rhythms, the

Jennifer Smith, CDE 8:12
circadian rhythm really. And I it's interesting, because I just attended the ADA scientific sessions with our virtual conference. But some of the sessions that I did attend were specific to the circadian rhythm, and sleep and appetite and weight management, which does relate to much more into type two. But it's also a realm of something that many people with type one try to manage really well to write. So in terms of what they found is those who had a much more stable daytime structured schedule, and they slept overnight, even if the sleep was not as good but they had their normal sleep time in the overnight time where typical circadian rhythm kind of is meant to be. They found that people had better weight management and had better glucose control. The other piece to it was that with shift work in the picture, schedules are often very disrupted with shift work. It's not often that people have consistent enough schedule with a shift like I think of many of the nurses that I've worked with, who have some shifts and some weeks that are an overnight shift, and then they've got several days off and then they go to a daytime shift, then they've got several days off and then they go back to like the evening or the overnight shift, right? That's a complete disruption to what your body is even trying to set as a some type of stables schedule. It just it doesn't happen. So in terms of like all management It's really hard to then get a grasp on insulin doses and or even use of medication. And food intake gets disrupted, now you're eating at two o'clock in the morning because that's technically your lunch hour went in four days from now, your lunch is going to be back at 12 or one o'clock. And I know

Scott Benner 10:19
I remember we've talked about that before, too, that that actually still impacts things like feet on the floor and stuff like that, too. Like if you wake up at three o'clock in the morning, suddenly that feet on the floor impact is happening at that time of the day. Absolutely all that other stuff that's really fascinating.

Jennifer Smith, CDE 10:34
I mean, I in terms of that, I even remember noticing that myself if I would get up overnight for more than just a tuck a kid back in bed and then go back to bed myself five minutes, I didn't get that impact. But if I was up with a foster child or for nursing overnight or something like that, and I was up for enough of a period of time, I definitely saw that happen when otherwise overnights were flat.

Scott Benner 11:00
You know, I was just thinking about you ever been like gotten sick or exhausted and you fall asleep in the middle of the day? And the sun's up? And you're in a deep sleep Lee, when does that happen? Back to had to have happened to at one point, and you wake up at seven o'clock at night. And it's dark. And it's the kind of dark where you're like, it could be midnight it could be 2am I don't know what time it is. And you can't it gives you that really horrible strange feeling of like you don't know where you are. It feels very disorienting, right? Yes. And the only time the only way to fix it is to go back to sleep and wake up with the sun again. Yeah, yeah, it's a I have it here just us is it circadian circadian circadian rhythm or circadian cycle is a natural internal process that regulates the sleep wake cycle and repeats roughly every 24 hours. It can refer to any process that originates with an organism, okay, we don't care about that part. But the other thing there. And the only way I can relate to this, and I've had someone on recently to talk about it, is that I am very steadfastly eating within a an intermittent fasting schedule, is really made a vast improvement on how I feel. You know, when I spoke to Jen Stevens about it on the podcast, she was talking about, you know, just pick a she talked about is in the eating window, not as like, she didn't think of it as fasting as much. And so I'm just pretty much sticking to an eight hour window. Yep. She told me if I take my window down to fewer hours, I'll start losing weight. And I haven't gotten to that part yet. I was waiting for the kids to go back to school. So we're getting up to that. Now I'm going to shorten the window up a little bit. But basically, basically, I'm not eating after the sun goes down. I'm 11 to seven ish. I'm trying to eat around in that situation. And one of the things she talked about is how, why does that work for people for weight loss, and she said it. it lessens your need for insulin. So your body goes through big portions of the day where you're not your body's not calling for insulin, like it's the opposite of the idea of like, eat small snacks all day long. She's like, I don't like that idea because your body is always using insulin. Now she was talking about, you know, people who don't have diabetes or type twos, how that could affect them. But then I realized Arden's a person who doesn't eat breakfast. So over like most of the time, like on a regular school day, so overall, Arden's eating in an intermittent fasting window. And she can fast with a stable blood sugar, like no one I've ever seen in my life. Like, you know, now that you're on the algorithm, and you can see it Arden, if Arden doesn't eat for 12 hours Arden's blood sugar is just he just is. And so I don't know that all those things fit together. But I think all the ideas fit in here somehow, you know, the idea of being on that cycle, and that your body works better in cycles, and that it needs time off and time to do things. I mean, I'm obviously no expert, but all that makes sense to me somehow.

Jennifer Smith, CDE 14:15
Yeah, absolutely. I mean, the, they're seeing their circadian rhythm, the hormone component and the overnight time period. I mean, they are all kind of tied in along with the intermittent fasting idea. In fact, one of the other ones that I listened into was all about, like those who did the best weight management wise, kind of from short term analysis to long term like a year out from having lost weight, and then what's the maintenance of that in terms of their ability to maintain and some of them were doing intermittent fasting, but they did it. I also don't really like the fasting component because you're fasting in a given time period, but you're not Really just not eating, right? I mean, people think of fasting as like 24 hours, you're just not eating anything really you just containing the time period. And they found that people that did intermittent fasting with breakfast being the bigger of the meal, lunch being a bit lighter and the last meal of that time period, especially when it's eaten, I think it was before, like 7pm did the best with overall loss, and then maintaining that loss, compared to people who just shifted that eating timeframe by about, I think it was a three hour chunk of time forward, and eight later into the evening, but still within a time block. That was an intermittent fasting, like I only eat within the six hour eight hour time period. So the later eating tended to increase the risk of gaining weight back and or just not losing as much weight, which was interesting to

Scott Benner 16:00
the reason I brought it all up is because if you're if you're sleeping on a pretty consistent schedule, then it makes sense that you'll be able to eat on a pretty consistent scale. Yes, right.

Jennifer Smith, CDE 16:10
Exactly.

Scott Benner 16:11
I and I mirror what you said in what I'm seeing that. First of all, it's easier to eat bigger in the beginning of the day, because you've come out of a window where you haven't eaten for a while. That is the time I am the hungry. It's like I don't want to you know, I don't I don't wake up like I haven't eaten yet. It's 1151. And I'm not hungry. So but I will go eat now when you and I are finished. Sure. And I will eat probably my larger meal of the day. Yeah,

Jennifer Smith, CDE 16:41
and it's in the day. Yeah, you're not putting it in the evening, when you're less likely to be up and moving and going about your business, you're not going to bed on a really full stomach that your body then has to do something, digestion specifically, in a time period that is not meant to be doing that, which

Scott Benner 16:58
I was gonna say can affect your sleep, which Yes, talking about and we've talked about it in a number of other episodes, leaves your body with a task of having to work on food, and digest food at a time when it's trying to take away that process to do other things. So yeah, you're basically asking your body to do something when it was getting ready to shut down that function and do other things. Right? So don't go to bed on a full stomach.

Jennifer Smith, CDE 17:24
Yes, yeah. That's it. Easy, easy statement to say harbor?

Scott Benner 17:32
Pizza much better and even. It's just obvious. Okay, um, can we do pump site placement? Sure. Alright. So it's always feels weird to start over when we do these strings. Because I come back to them and edit it. I hear myself go, Hey, Jenny, today, can we talk about pumps?

Jennifer Smith, CDE 18:02
We've really been talking for like, 45 minutes. We've been talking forever.

Scott Benner 18:05
We've done like a bunch of these like, and I feel silly. But anyway, hey, Jenny, can we talk about pump side placement today? Absolutely. Excellent. Yeah, we just leave all that in so people know why I'm laughing. So it doesn't matter, right? If it's injected, or pumps, there are just going to be places on a person's body that I don't know what to say, does it absorb the insulin better? Does it use the insulin more efficiently? Like how do we think about it?

Jennifer Smith, CDE 18:36
I think they're both kind of the right way to say it. Because honestly, underneath the skin, I mean, the goal is to have insulin absorb right and to get used in an efficient like, pattern of in, gets used goes out is finished working. I mean, many people on pumps, I think more than people using injections will start to notice places on their body that definitely absorb the best. And other places that they get good use out of, but they might actually have to have a secondary Basal profile that's notched up a little bit more, because they just don't quite meet the same glucose targets with the same basil from let's say, a stomach site versus a butt site or, you know, whatever it is. And then there are some people who can't use certain sites at all. I mean, I personally cannot use my leg. It just it just doesn't work for me. I either get occlusion alarms, or the sight hurts. And I've also noticed with that then it's just not getting absorbed. Back early enough, I guess is the easiest way to kind of explain it. It's it's much less consistent absorption there. So I just I just don't use my legs.

Scott Benner 20:09
Do you think that's because do you think there's a reason to point to do you have like a stronger leg? Is that muscular?

Jennifer Smith, CDE 20:15
For me? I truly believe it's because I just have pretty much just muscular legs. I mean, I've done biking and dance, and lots and lots of things over the years. And I continue to run and do yoga and bike and yeah, I think it's that now the interesting thing is that I can wear a sensor on my leg. No, I just can't put a pump site with insulin there.

Scott Benner 20:42
Okay, is there anything about like, I've heard people say over the years, and I've never understood if it was true, or not, like, I can't put my pump near like the, you know, muscle in my thigh or towards a larger muscle because the muscles, they feel like, you know, the way they say it is that the muscles burning up the insulin, but I don't know, I don't know, imagine that that. Isn't it just that there's not enough like fatty tissue there to move it around? Or no? Well,

Jennifer Smith, CDE 21:06
you know, muscles are, they've got a basketball nature to them, right? So they've got lots and lots of vessels that contribute to keeping the muscles doing what they're supposed to be doing and supplying nutrients and everything into the tissue, right? Whereas fat is just I mean, you've probably seen pictures of like fat blobs, right? Fat balls, right? Imagine Yes, imagine a styrofoam ball, that's a good idea. So when you have insulin infusing pretty close to a muscle, let's say and this is kind of general, you would expect potentially, that you are going to get if you haven't gotten occlusion from nicking a vessel and getting kind of a clot at the end of the canula. And then the muscle because of the nature of vessels, you may actually get faster absorption in an area. Like I've in particular, noticed if I've ever had a site that has bled after I've taken the site out. But it wasn't really, like it wasn't painful. There was no reason to change it prior, but it just was one of those like, gushers that you like, pull out. And then I look back at the couple last days, and I'll be like, yeah, my blood sugar look pretty perfect. Like, it was almost like, I didn't have diabetes, like it was just all working like so beautifully that I felt like, this is just it. I'm just at like this beautiful like point, right? And then I see Oh, well, there's the reason right next to my bud spy,

Scott Benner 22:44
you think he said that it's almost like you're in a very tiny way mainlining the insulin a little bit.

Jennifer Smith, CDE 22:51
And that's what I guess yeah. And it's actually just closer to the absorption line. You know, because when we put a pump site or even inject insulin, you're supposed to be sub sub cute, right? underlying tissue, which is mostly your like, it's like your thermal layer of protection for your body, right, that's where we're supposed to be absorbing insulin through and thus the timeline and the absorption for the trend in rapid insulin, regular insulin, long term insulin. It's all based on how it's supposed to get absorbed in us through that timeframe. Okay, through that tissue.

Scott Benner 23:27
And so I think it's important here to mention that when you buy a pump, any pump, it's going to give you some instructions and tell you here the places you can where your pump all that means is that those are the places that the company who made the pump had the time and money test to test so that they could prove to the FDA that these places worked it and I assure that on the pod probably isn't thrilled if I'm saying this but I you can put your pump somewhere else. Yes, yes, you could try other places I've seen from Chris Freeman where it on his chest, you know when he's in the middle of you know, in the Olympics and that I mean, I've said it before the guys like I don't know what his real body fat is, but he doesn't appear to have any. And you know, and it's on us, it's on his pack. I've seen ladies wear them in their on their breast I've seen people wear them on their hips, their thighs, their calves. I watched somebody do it on their forearm once is like a test, you know, there's no place. I don't think there's any place where it isn't reasonable for you to try based on what I've seen from the community and from people in general. But you are going to find places that work better but then I think that leads us into talking about you can't have too much of our favorite place because you'll ruin it.

Jennifer Smith, CDE 24:44
You have to rotate Yes, very important to rotate

Scott Benner 24:48
have to have to look at your sights and see for Arden they get a little like if she's using them too much I can start seeing them a little vascular maybe like a little red on top like that's the first like sign for And then you can start rubbing your, your you can rub your hand over top of it, if it gets bad, you can feel like it'll get lumpy or hard. Yes, right, that kind of a thing. So yeah, you have to have a place to go. And it is going to change them. Like Jenny said it could possibly change how much insulating Arden just went off the side of her thigh to the top of her thigh. And I had to increase everything by about 20% for that just from the social side of the top of her thigh. So and I think too, for little kids. As long as we're talking about sites for a second, here's probably a good place to talk about when you start doing things with little kids or you know, sometimes adults. They build rules in their head. So that's where my pump goes. It can't go there because it goes there. I always wear it here kind of becomes a psychological thing at some points too. You know, and then you'll see kids will fight against it. Like I can't put it on my arm. It goes on my leg. Yeah, right I Arden 17. And I think she has it. I think she believes her her CGM goes on her hips. Because that's because that's where she likes it where she likes it and it works fine and everything. And if I ever say to her, Hey, why don't you try putting your pot on the back of your arm. It's a flat No. And it's only because in my opinion, she remembers it being there in a softball game one day and we didn't think about it and she threw and then the pod like yanked on her arm as she was as she came across, she had a bad memory of it and now even years later that she's not throwing a softball anymore years later she's has an aversion to putting it on arm you know so sure if there's like

Jennifer Smith, CDE 26:41
an associated kind of experience there

Scott Benner 26:45
Yeah, and then it comes out as this is where it goes and I will fight to the death to keep it here and then you run into a problem where you don't have ways to to rotate sites yes and then you're going to run into a problem and the way I've always put it the Arden is look you keep putting it there and one day you're not going to be able to use that spot at all. And that's that's the thing that helps her move around now I think the other good thing to talk about about that is you know I really have experienced with the Omni pod but sometimes it's just as simple as turning it 180 degrees like you really like it on your abdomen great, have it point towards your belly button this time and have a point towards your side the next time Yes, you know, those are still

Jennifer Smith, CDE 27:23
when I do the same thing you know, especially for backs of the arms which for many little kids because especially for tiny little kids who really don't have a lot of tissue or are very very averse to having it on their abdomen for some reason you know, then that back of the arm like you said it's essentially just turning the pod with that viewing window facing up versus the next time turning it with the viewing window facing down to technically then even have two sights on the back of each little arm that you could potentially use which makes for places between two arms at assumably three days per site. It's a fair amount of these before you get back to site number one on the first or

Scott Benner 28:10
do you think specifically on on the pod? You use it vertically? On limbs right?

Jennifer Smith, CDE 28:17
Correct yeah perpendicular up and down with the viewing window either facing the sky or facing the floor on limbs exactly and then on like your torso region or your upper but you would use it in sort of a horizontal fashion

Scott Benner 28:33
is that because of just the nature of the shape of the pod?

Jennifer Smith, CDE 28:37
Yeah that's from what I know it's nice it's based on the wear comfort wear of the pod itself Yes

Scott Benner 28:45
Do you know a second ago because I didn't want to look stupid I just checked it vertical up and down. Like I googled it right before I said it and then it made me feel so much better because the rest of the world doesn't know either. It's it's a very popularly Google thing is horizontal left and right is vertical up and down. What is vertical? What does a vertical line look?

Jennifer Smith, CDE 29:08
Pretty funny is that paid closer

Scott Benner 29:09
attention in school. Anything about this that we didn't cover?

Jennifer Smith, CDE 29:14
Um, I don't think so. I think in terms of site you covered you know, all the places that are approved versus the ones that people are trying that necessarily approved. So

Scott Benner 29:28
yes, but it's a variable because you are going to get it in your head that these are my settings, and then you're going to move the site somewhere else. And then you start I love it, people immediately go this pump doesn't work. That's always my favorite reaction to everything.

Jennifer Smith, CDE 29:41
Right? And I've got a number I mean as a secondary to that site to site going to number of people, myself included before using, you know the system that I actually use. I actually just had separate basil profiles that I would use from one site to the next more specifically, all Body sights on me work pretty much the same except for my upper but my upper but just seem to need more insulin whenever I used it. So I had a profile that was specific to that. So do you

Scott Benner 30:12
think that and then I'll let you go. But do you think that the advent of g7 Dexcom. Like when it changes form factor? I keep thinking people are going to start trying like a lot of different places because it's going to be easier to put in different places all

Jennifer Smith, CDE 30:27
this probably, I would expect. Yes. I mean, as it is, a lot of people are wearing their CGM is on places that I would honestly like they're, I've seen it on their forearms. I've seen it like, places I would never think of popping it in. But I think getting accurate results. I

Scott Benner 30:46
guess I have to admit, there are times I see those pictures, and this is exactly what I think and I'm just gonna have to bleep this out. I think, man, skateboard, huh? I wonder if we can make it work here. I'm gonna

Jennifer Smith, CDE 30:59
I know I don't even have like, I don't it's all muscle there. I don't know where it would sit under my skin. I would hit something and it would be immediate pain or blood. I

Scott Benner 31:10
I just think of those people as they're they're explorers. They just like I wonder what will happen if I walk across Antarctica? You know?

Unknown Speaker 31:18
Right, exactly. Go find out exactly. I'm

Scott Benner 31:20
not doing it but whatever. Okay, thank you very much. First, I'm gonna thank the Contour Next One blood glucose meter remind you to go to Contour Next one.com forward slash juicebox. There are also links in the show notes of your podcast player, and links at Juicebox. Podcast calm. Thank you very much for visiting with the sponsors. I appreciate it. Thanks, also to Jenny for being here. Thank you so much, Jenny. We love talking to you. At least I do. I think I'm speaking for everyone else. But in fairness, some people might hate your guts. I have no idea. Is it possible that anyone doesn't like Jenny? I don't think so. Thank you so much for listening. There are way more variables, go check them out at Juicebox Podcast comm or right there in your podcast player. Really appreciate your listening and supporting the Juicebox Podcast. Tell a friend. That is my least favorite part of making the podcast asking you to like tell somebody else. Don't forget to subscribe and your app like it's, I feel like oh, I feel like an idiot having to say that. It's like I see a YouTube video, you know, and they're like, hit the bell do the thing. And I'm like, Oh, this is so sad. And then I come here and I have to do it here and it just it's hard to get people to listen to things and and subscribe and you know, it takes so much for them to learn that the contents there and that it really might be valuable for them. So then I end up saying like, just please tell someone who else you know and just, I don't it makes me feel weird. I don't like it, but I do it because it is important. So thank you so much for listening for supporting the show. If you know somebody else who you think might enjoy the show, also please share it with them, show them how to start listening. podcasts are not intuitive for everyone. Subscribe in your apps people. I just did it. I was like hit the bell thing. You know what I haven't mentioned this in a little bit. The Facebook page is really great. No joking. Juicebox Podcast Type One Diabetes on Facebook. It's a private group with I think it's got like 16,000 people and now everyone's talking about diabetes to really on Facebook like experience. So that is to say it's a good experience with a lot of great people. Check it out.

#556 Diabetes Variables: Growth Hormone

Diabetes Variables: Growth Hormone

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 556 of the Juicebox Podcast.

Something kind of weird happened, and I'm going to share it with you. So this is a diabetes variables episode. It's about growth spurts. But it may or may not surprise you to know that Jenny and I record a number of variables in a sitting. So I have a little list. I say, hey, Jenny, next up, I'd like to talk about growth spurts, then we talk about it, we don't pre plan we just have a free flowing conversation. Now to prove that, I'm going to share something a little embarrassing with you, Jenny, and I only record about once a month. There's pretty big gaps of time in between when we see each other normally. So we did growth spurts, and I forgot to cross it off my list. So they ended up on my list again for the following month. Neither of us remembered that. And we ended up doing and we ended up doing this variable twice. And I'm going to leave both versions in here for you. So you can see the differences right in between the conversations and they did go differently. It's very, very interesting. I mean for me, and I hope for you as well.

This show is sponsored today by the glucagon that my daughter carries. g vo hypo Penn. Find out more at G Vogue glucagon.com forward slash juice box. Let's not forget to Jenny is just a person who comes on the show, but she has a real job she works at integrated diabetes comm if you want Jenny can help you with your diabetes. That's not an ad. It's just me saying I love Jenny and I want to help her. Okay, get ready, you're going to hear the same variable twice. Alright, I record I hit record. Hey, Jenny, I want to talk about a variable today. growth spurts. And I think that I think that probably is going to lead into hormones too. And puberty. So I feel like they may go together. Am I right about that? Or no?

Jennifer Smith, CDE 2:24
You say because they all have to do with growth hormone and changes in the body? And yes,

Scott Benner 2:31
okay. So the reason it comes up as a variable in my mind, and this is from me, being able to watch people interact online, is that, you know, children get diabetes at all ages, obviously. But the younger ones, eventually their parents kind of get into a rhythm and things are just like, working right? And then all of a sudden they see on their graph at a certain time of the night. This just never ending upward trend of blood sugars. And, and that's why I think it merits its own variables episode. Yeah, absolutely. Because it comes out of nowhere and they don't know what to make of it. Is there an age? There's not right, like it could happen to you. I mean, I'm sure there's an age range, but when to like let's start with boys, when the boys start hitting puberty.

Jennifer Smith, CDE 3:25
Honestly, I mean, the range I would honestly say is probably somewhere between 10 on the very early age range, 12 ish, 13 ish most likely, all the way through potentially like that 18 to 20 because boys can grow longer, give or take boys can grow for a longer period of time than girls. Girls typically grow visibly like in height especially girls typically grow up until about the age of 1617 ish. Boys grow a little bit longer than that. So I would say anywhere between 10 to 20 as a very wide range and probably more like 12 to 18 out of on a shorter range

Scott Benner 4:16
for boys the Google magic here tells me that people don't know either because they're people Google you know can a 12 year old can an 11 year old can a 10 year old boy hit puberty and so I thought well why don't I just like go over some signs of puberty. That way you don't have to worry about the age so much but then what came up is hilarious so laughing instead of first signs of puberty and boys. This is a great this is such a strange sentence the first sign of puberty in boys is usually that their testicles get bigger and the scrotum begins to thin and red. So I don't know how you're gonna check on that.

Jennifer Smith, CDE 4:51
Right exactly unless you've got you know a very like comfortable like you know family I don't know and or you take Do the doctor and you say I'm not comfortable looking at this, could you please check this out for my child?

Scott Benner 5:04
Right? Because I was hoping for like, you know, shoulders brought in or just look at that you could just kind of look at you know,

Jennifer Smith, CDE 5:12
yeah. And I don't know I mean for boys, another sign is often times that voice change starts right? Like some crappy voice, some deepening of the voice from the, from the kid to sounding voice which, you know, my little guys still obviously have they're only four and a half an eight and a half. So they still obviously have that like little kid. But that's another typical for boys. I mean, some that occur in both boys and girls are obviously like, some underarm hair and like hairier legs and that kind of thing.

Scott Benner 5:53
I will say for moms, I think you can, the way your son smells starts to change you like that's it. That's a good one to look for

Jennifer Smith, CDE 6:01
when they start to need deodorant. Right? You're exactly right. When they start to need deodorant. They have a definitive funk after they're done playing an hour of soccer, you know?

Scott Benner 6:13
Yes, yeah, yeah, I don't I want to be clear, I don't think you should like tell your kid Hey, if you're when your testicles start getting bigger, and you're screwed them, what does it say? begins to thin and red. Yeah, I don't think that's a good way to go. But so but when you see that the indication to you around diabetes should be there are going to be more growth hormone now. And so we're going to probably have to meet that with insulin. But does the Why does that impact? Why is that impact so obvious overnight to so many people? Is it because that's when growth really happens? What do you think it can be that some people's overnight basil rates or a week or two, like that just popped into my head?

Jennifer Smith, CDE 6:53
Well, I know that you know, we actually have, Gary actually has in his thinkbook a really nice chart that actually defines sort of insulin needs through the life cycle. And it goes from like infants, kids teens, into like adulthood, and then older age people. And what we actually find is that kids and teens have the highest insulin needs overall, you know, if you're completely opposite, it doesn't opposite of this, it doesn't necessarily mean anything's wrong with you, it's just the majority of kids and teens will have a much heavier base basil need overnight. And it often then sort of dips down a bit kind of comes through the course of the day, whereas adults, and definitely older adults, often have a lower bass diesel overnight. And then it kind of nudges up a little bit more at certain times of the day, especially that morning time period, right? hormones in the teen years, I think are they're heavier in terms of visible insulin need. Because once you get to the point of being 10 plus years old, you're most likely if you've been living with type one for a number of years already, you're most likely already at a point of more insulin than you were as a little kid. And so then the hormone impact on top of a rate that's let's say, already, like one unit in our teens might go up to 1.4 or 1.8 2.1. I mean, the amount of extra insulin needed from a hormone standpoint, during that whole team growth cycle looks really heavy, because your base often starts heavier already. Whereas where your little kid, you might have a basil of point one, five, and it goes up to like point three. And yeah, that's, I mean, that's a big shift. But it's not as dramatic as like, the bigger doses, right?

Scott Benner 8:55
Yeah, it's why that I know, I've said a couple of times, and I hope it doesn't seem pejorative, but you know, when you're managing a seven year old really well, that gets almost like diabetes training wheels, a little bit like yours, there's still a lot more coming in, you need to know that, that it's on its way but I think more importantly, when you see it, you need to be able to react to it and just understand it, you know, what happens that people see and they're like, oh, something magical is happening, and I don't know what to do and you know, like, and they get all flustered, instead of just saying, well, there's a need here for more insulin, let's just meet it. Yes, and I do understand that. The can the concern can be it's the first time you've seen it. If I come at this very aggressively, what happens if I'm wrong and I'm too aggressive then on the other end, we see some sort of a drop. But I mean, after you notice these things over and over, and again, you have to you have to get ahead of them. Right? You know, and

Jennifer Smith, CDE 9:47
they will happen or and it to say over and over again is really important because they will happen over and over again. And again. If you've had a child who's had or a teen who's had diabetes since they were younger, you've already seen As a more sick, let's call it nature to hormone shifts, growth cycles and this you get to a point of insulin need and then it shifts again. And then it shifts again and then it shifts again. Well, kids grow and they keep growing.

Scott Benner 10:16
It's waves to its waves. And it doesn't necessarily have to happen when you think like there was a time for a long time that Arden was the smallest girl around like she's five one she weighed 70 pounds, like, you know, that kind of thing. And our I mean, I think Arden's done growing now but aren't five seven, you know, she's one of the tallest girls in the town we live in. I mean, so much so that if she meets people like guys that used to coach her softball team when she was little she can they don't even know it's her. You know, like she's

Jennifer Smith, CDE 10:50
okay she is taller compared to her little petite. Yes, pretty self.

Scott Benner 10:55
And when I go back and look, sometimes it was weight. Sometimes it was height sometimes she started maturing at one point she was rather curvy. She is not anymore like it. It went through a lot of different shifts. Yeah, seasons. By the way, Jenny, signs of puberty for girls. Why do they use words that make me want to giggle breast buds? buds, okay, right? pubic hair, which they listed for the boys. But after I said, fitting and reading, I didn't. armpit armpit hair for girls again, acne could be an indicator. And then a higher growth rate. I guess when girls start growing tall, they they keep going. Right? And then what I mentioned earlier, I said kind of curvy, but hips thighs, you start getting Yep, you start getting fat and all the lady places. Yeah, like not fat, like,

Jennifer Smith, CDE 11:50
well, you just I guess another term is like you fill out really, you know, you go from really a kid based, very, like, I call them like square bodies, kids have like, really no hippie, kind of there's they just started like, straight down from like armpit all the way down their legs, they're just this like rectangular box. And I've got like good visibility of it. Like, with my third grader, he and his friends have like, grown considerably over the course of the summer. Like just seeing them now in these first couple of weeks of school, the differences in the heights of kids and whatnot, but they all have boys and girls, they all have this straight, like rectangular box shaped like part of their body. And then once puberty hits, that changes and it's especially visible for girls as you know, breast development kind of comes into the picture. And hips kind of change and shift and wait, especially for girls who may not have the best like nutrition plans or the you know, maybe activity and the best types of foods, they can tend to during that puberty time game more than they may actually need to because the hormone shift is causing a lot of shifts in hunger and you know, the appetite and the way that their body is sort of maneuvering change.

Scott Benner 13:18
Let's I want to add a couple things here and we'll stop but my son's like 21 and a half now and he texted me the other night. Hey, I just I just squatted 375 pounds. I'm like really? Please don't hurt. Wow. Yeah. And and now I realize that even just a handful of years ago, even though he was a strong athletic kid, I still could have manhandled him if I needed to do you know, like, not that that was our situation. But if if it went down to me, I think I could have taken care of it. And, and now, I'm pretty sure that if that happened, he would just grab me by my face, and he could just like throw me out of the way if you wanted to. Yes. And so point is don't be worried. Yeah, well, he's still maturing. Like I know that's a weird thought. But he looks it was this spring we went out on the baseball field for the first time and I said this is the first time I feel like I'm having a catch with a man I actually told this was the very first time I've had that feeling. And he was a college athlete prior to that, right you know, and so but that was the first time he looked at me and his shoulders were bigger and his chest was broader. And you know, I thought oh, this is I'm out here with another guy get on it. It's not a kid anymore.

Jennifer Smith, CDE 14:31
Well, that's why I said you know, guys can tend to grow and some of that growth is more like I said about like, the early teen girl like filling out. Guys, especially if they're really paying attention or they're into a specific sport or something. They tend to plus 18 years, they get that fill out, their shoulders brought in a little bit more their body actually kind of gets more to the point of like, like visible structured

Scott Benner 15:00
He talks about weird ways that I think my he goes, I think my frame can handle about 205 pounds. Like he's like 190. Now when he was trying to gain weight, but it's interesting the way he, like, you're right, like athletes think about it in a different way I do. I'm always like, I wonder how much thinner I can get. I would like to not look like you know, I don't want to have like fill out and but my fill out is different because I'm 50. And let's, let's just add at the end that a birth control pills. Yep, can can mimic all of this right?

Jennifer Smith, CDE 15:33
They can I mean, and again, most most girls are not really started on birth control until there's a visible issue in terms of their normal menstrual cycle during the teen years. Right. And or you think that there's definitely a purposeful reason for birth control, right. But most often in the teen years, it's because the cycles are very irregular, or very heavy, or very, very painful, almost kind of like a debilitating type of you know, pain. So then birth controls bring in another level of like hormone, but many times with birth control for the women who things have not been as regular, the regularity that's brought in because of them can actually make blood sugar control a little bit easier in terms of the cycle. Some birth controls can contribute to some weight gain, and some of the newer ones on the market and or the adjustments to the doses and whatnot for for what women need. The can be just kind of stabilizing, they won't necessarily cause gain or loss. Yeah.

Scott Benner 16:42
So Arden had to do it for reasons that you just mentioned, irregularity having, like etc. and took us a couple times I'm still not sure we found the right one to be honest. So yeah, like I mentioned to you before we recorded like she has like a she's not she's hungry, but she can't like imagine what food tastes sounds good to her. She also is having trouble stomaching meat. And there's part of me that wonders if it is maybe a birth control pill? That's because does it mimic you being pregnant in some way to and doesn't sometimes like that happened with foods? I mean, I could be

Jennifer Smith, CDE 17:17
wrong during pregnancy? Yes, during use of birth control, it essentially continues to cycle you through without oscillation. So there is no potential for pregnancy because it just shuts off the ability to obviouly right. I mean, that's a general statement.

Scott Benner 17:34
But my question was that does. Is there anything about taking the hormones that gives you similar situations to like, when you have cravings when you're pregnant? Or maybe I'm just maybe that's not right. I

Jennifer Smith, CDE 17:45
don't believe so. I mean, not from anything that I've seen with the women that I work with, nor that I've necessarily read about in terms of cravings, if anything, because it's stabilizing hormones, or should be more to keep a regularity to the cycle. Usually, most women have the same types of cravings the couple days before their period that they would have even if they weren't on birth control, like the salty sweet kind of like could eat anything and then maybe the rest of the time, their appetite is just kind of back to normal.

Scott Benner 18:22
Yeah, so it's interesting. I've experienced it now twice in my life once dating and once father and the child. It's a different feeling like in both situations, but it's really interesting you ladies are very, very interesting people. Okay, yes, we are like I could, I could spend the rest of a couple of lifetimes probably not understand what it is I'm looking at still.

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Jennifer Smith, CDE 20:52
I mean, for the most part, yeah, a lot of children's growth in the hormones that impact growth happen into the after bedtime time period. And while kids overall insulin needs are higher overnight, in general, that's pretty typical. So even on the nights that kids aren't in a growth phase, you know, with increase in hormones, most kids still have a rise in blood sugar after they go to bed. But it's not as profound of an increase as during a growth phase. And there are other like, cues, you know, you said, well, has your child gained weight, are they a little bit taller, a cue to me of just my own kids who don't have diabetes, but I know when they're going through growth, because it's visible in what they eat. And their sleep or their like fatigue level. So both of my kids will eat and eat and eat. I mean, kids eat right, but they will eat more, like they will get asked for like to burn breakfasts, they're kind of like habits when they're growing. It's like at first breakfast, second breakfast. First one, you know. And other times, like my little guy, right now, he's definitely in like, a stable time period. Because his breakfast I have to, like, urge him finishable finish your breakfast, you know, whereas usually it's down in like, four minutes, it's gone. You know, so that's something visually to pay attention to, too, because if you're going through that, you can say, Okay, I'm going to expect an increase in need.

Scott Benner 22:41
My son, when he was going through his real growth, time, you know, 12 years old, 13, like through there actually, boys are usually a little later, but his calves would get bigger, and then he would get taller. That's what happened every time. So it was just the craziest thing you'd watch his calves get bigger. And then we'd say a coal is gonna get taller soon. And then he would. And I funny that you noticed this cow. is a baseball players always insurance. He never Okay, he's never wearing pants. So it was just one of those things aren't in sleeps more. You know, when when her body is going through changes? I mean, but but I guess the it to bring it back to diabetes for a second. Its growth spurts is a weird thing. Because yes, yes, I just my tongue just came out of my mouth didn't go back in at the right time. Yes, I was like, Am I having a stroke is this but but yes, growth spurts cause your insulin needs to change. But it's a throwaway answer online when people don't know what to say. Like, what is this? Oh, it must be a growth spurt. Do you mean like, it's one of it's one of the diabetes. You know, I'm saying buddy. Like, I get that vibe. And I think at least if people can see it, maybe then they won't write off other things as being a Grossberg if that makes right. You know what I mean? Yes.

Jennifer Smith, CDE 24:08
Well, and it also goes along with, as we know, experience, right? If you are newer in a diagnosis of diabetes with a child, there are things that you'll have to experience to be able to see what to do and what the impact for your child or teen is gonna look like. Right? And then you then you use that as you move forward. You use those experiences to kind of build on, but if you've been doing it a while, and it's always a throw your hands up in the air.

Scott Benner 24:41
Yeah. Yeah. So I'm probably gonna talk myself out of downloads here. But the truth is, if you came to me and said, Scott, I want to do a variables, episodes about diabetes. And you came on and you said, Hey, Scott, today's topic is puberty and hormones. What do you think? I'd say? Yeah, insulin needs changed. You should just Be flexible and change with it. But then I would say that in every episode that was sort of, like the, in my heart, and I think at the core of what makes the podcast valuable for people is, I don't really care why your blood sugars are doing what they're doing. Just meet the need with insulin and move on is But still, when you're in the moment, it is. Listen, it's not only necessary, it would be difficult to try not to diagnose things. And so I love these valuable episodes. I'm being a little facetious. I love them because it gives people something to go Oh, like, maybe they're growing. Like, I don't know, a ton of technical stuff here, like, your kid might grow and need more insulin. Give them more insulin, don't stare at 220s overnight for a week and go I don't know what's going on. Because, you know, because maybe it's a Grossberg give them more insulin but right maybe an aliens flying in their room and giving them sugar to if that's give them more insulin, like care why

Jennifer Smith, CDE 26:00
it's happening. Probably bigger problems there then just

Scott Benner 26:03
better window locks at the very least. So that's the kind of overnight like, while your body's making it, blah, blah, blah, like, right, like you're, it's giving you things you're building. But don't overlook the idea that as the body gets bigger, if you're being medicated with something, you're going to need more there's a reason your doctor asks you how much you weigh. When you when you go, I remember having a surgery one time. And Jenny, this is uh, not exactly a humble brag, but I don't look my weight to most people. And so I go into get a surgery. And you know, they get they give me the medication, and they come back in the room, the pre op room, and they're like, are you okay? And I'm like, yeah, I'm great. What's up, like, you should be half asleep by now already. And I was like, feel good. And then nurse picks up the chart looks, looks, looks, looks looks, how much do you weigh? And I told her, and she goes, Oh, oh, the doctor thought you weighed much less. And then

Jennifer Smith, CDE 26:59
they didn't check your weight before you show

Scott Benner 27:03
her Am I is this gonna go Okay, you know, but the part I took from it was that because of my body weight, I needed more medication. And then the same thing happens here. If your body weight goes up, you're probably going to need more insulin and, or right maybe, but it's worth looking into it because I've talked about here before, but it beat us in the butt before when Arden we finally got Arden's thyroid medication straightened out. And then she got bigger. And suddenly she's having these terrible symptoms. And our brain didn't say thyroid, because we thought we fixed thyroid already, right? So then we're taking her to heart specialists, when it turns out what she needed was like 15 more micrograms of terrorists, or something, you know what I mean? Like, so please look at that. Growth and growth spurts.

Jennifer Smith, CDE 27:52
Well, and I think the big thing too, that you kind of touched on. But more specifically, when kids grow, they don't, they always up grow, they don't down grow. If your child is growing, you will need more insulin and likely more insulin in that time period of growth, be it two or three days be at five days. Usually growth phases are not extensive, right in terms of like a month long amount of increase. But you will also find because of the growth, your baseline insulin is not where you're going to land back to, after the larger need for growth, you'll usually find like a middle ground between the low need the high need for growth, and now you're settled in after the growth. That's kind of where you're gonna aim to get to.

Scott Benner 28:46
So there's a spot where your basil is at where even your meal needs your correction factors. And then during the growth, they're going to increase. Yes, but they may drift back down. Lower from where the growth is happening, but not all the way back down to where you began. Correct. Excellent. Cool. Thank you.

Jennifer Smith, CDE 29:06
Yes.

Scott Benner 29:12
A huge thank you to one of today's sponsors. g Vogue glucagon, find out more about chivo Kibo pen at G Vogue glucagon.com forward slash juicebox you spell that GVOKEGL Uc ag o n.com. forward slash juice box. Let me do a little round up here at the end of the week. dexcom.com forward slash juice box omnipod.com forward slash juice box Contour Next one.com forward slash juice box touched by type one.org. Trial net.org. forward slash juice box. Those are the sponsors hit the link support the show I hope you enjoyed that kind of little look behind the curtain. It's never happened to me before. And when I realized that it happened, I thought, wow, this is super interesting. And I first I thought, I'll just delete one of them. And I'll give them the other one. And then I listened through both. And I thought, these are fundamentally different conversations. And such a good indication that Jenny and I really do sit down and have off the top of our head conversations about stuff like this. And I think it's interesting to see how the conversation can be drawn in different directions, just by somebody asking a question, or having a thought one day that they didn't have the next. That was really cool. And it gave me an idea. So in 2022, Jenny and I are going to go back privately, separate of each other, and listen to a diabetes pro tip episode. And then we're going to come together the next day. And we're going to record an update to the diabetes pro tip. And we'll do that all through the year in 2022. How cool is that? Right? I think that's gonna be really interesting and fun. And I think valuable. I really think we might look back at ourselves from a couple of years ago and say, Oh, I would have I should have said this here or since then I've learned this And now I'd like to expound a little bit. Anyway, that's a little teaser. That's gonna be a long while from now, but it's something to look forward to. Alright guys, seriously, thanks so much for listening. I love making this podcast. I'll be back soon.