#263 Diabetes Pro Tip: Fat and Protein

Diabetes Pro Tip: Fat and Protein

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 263 of the Juicebox Podcast. Today's episode is sponsored by dancing for diabetes Dexcom and Omni pod, you can go to dancing number four diabetes.com my omnipod.com forward slash juice box or dexcom.com forward slash juice box to find out more. I hope you're ready for another diabetes pro tip because this episode with Jenny Smith is all about fat and protein. That's right. How do you Bolus for the thing that they tell you? It doesn't need insulin, but really does. We're gonna tell you right here. And after you're done with this episode, Episode 263 special bonus episode number 264 is available right now. That episode is with Vicki. Vicki is eating keto. She's going to talk us through how she boluses for her keto diet. Because guess what, you need insulin for protein. In fact, if you don't know that, you're gonna love this episode. Now, even if you're not eating keto Vicky's episode is going to give you a ton of insight into the timing of fat and protein. It's actually sort of interesting to look at. If you're not a keto Well, it's interesting if you aren't keto, but if you're not, it's still really insightful. Because you get to strip away the carbs and just see where the protein comes into effect. It's almost like that, you know, do Row row row your boat, you start singing and then the other side of the room starts singing like when does the second tier of row row rowers come in? When does the fat and protein start working? Please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your medical plan or becoming bold with insulin. You however, do not have to talk to your doctor about going to Juicebox podcast.com, picking up a T shirt or a mug or something like that, you know, to help support the show a half an hour before you and I started recording this someone sent me a message on Instagram and said, How do I deal with fat and protein overnight because I was bawling all night with my kids. So I texted them back and I said hey, great timing. Can you see my recording calendar from where you're at? And hold tight? Because the answers coming? This is another one that Jenny proposed that I'm really interested in. And I don't know how much help I'm gonna make. Why don't we start with what I know? Because it's so little. So forever seriously. So for everyone who listens to the podcast and knows that I'm just sort of fluid with insulin, right? Like more, more need equals more insulin. And so because of that, I don't usually stop and think about whether that means it's protein or fat or what it is just if Arden's blood sugar seems to require insulin, I give it more. I'm assuming I'm been handling fat and protein rises for ever.

Jennifer Smith, CDE 2:58
You're not dissecting her meals, you're just saying I see the need. I'm giving more insulin. That's kind of what you do.

Scott Benner 3:05
Yeah, I see diabetes is a forest fire and I fly over it with a giant plane full of water and just drop all the water on top of it. And I go, oh, I've got most of it. And, and

Jennifer Smith, CDE 3:16
Oh and look at that's where the fire started where the fire man comes in and looks at and Scott's like, I didn't really care where it started. I just want to take care of anything

Scott Benner 3:24
was to me, I'll go get another plane full of insulin and drop it back on again. So. So I never really think about stuff like that I do a little more obviously, as you and I have been speaking as the years go past, but I find it to be it's another level. Like sometimes I joke about things being like like ninja level, like, I think that you don't really need to know about fat and protein if you're doing what I do. But you do need to know if you want to start understanding things in a bigger way. So I'm really excited to do this. Now, the only thing I know about protein is that I do indiscriminately bolus for protein. I don't know why I do it. But I do it. So where some people might look at a plate and go, Oh, there's potatoes. Well, that's, you know, this many carbs. But then there's a, you know, a cheeseburger. Well, that's me, I don't do that. And here's a roll that rolls 25 carbs, and you know, and we're gonna have broccoli, and I don't know, broccoli probably has five or six cards or like, so I look at my job I look at I look at a plate, I go broccoli, and six, the roll. Let's call it 30 then I look at the potatoes and they go I don't know 35 and then they look at the burger and I go, yeah, let's call it 10 and we'll extend it for a little bit. And and so that's me looking at a cheeseburger with mashed potatoes and broccoli, right. I don't know why I do that with the. I've heard that. I know. People who eat incredibly low carb, who tell me that they bolus for their protein but farther out from when they actually ingest it. Huh, is any of that right? If visiting dancing for diabetes is wrong, I don't want to be right. Not about this, I want to be right about the fat and protein thing. But I would not want to be right about visiting dancing for diabetes being wrong. If it was wrong, which it's not, I think you should definitely do it. Dancing, the number four diabetes.com. You know, studies show that if ads are incredibly confusing, they work so much better. Check out dancing for diabetes on Instagram and Facebook, throw them all like to really great organization, dancing, the number four diabetes.com. Even if you're not interested, could you go like their pages? Because they paid for this. And now I'm listening back to it. And I didn't do a very good job. So let's at least give them their money's worth. Is any of that right?

Jennifer Smith, CDE 5:47
Because, yeah, so I and again, I from the standpoint of looking, you're not doing this in a blind way, you have, you have the method that you've developed for analyzing looking at Arden's control and her management and what happens here and what happened there. And you remember it, you've got like this, like library of like, times have this has happened, you can like pick from them, Scott, and you're like, I know this happened last time. So let's time this time for the burger and broccoli, we're gonna give 10 for the burger, because I know what happened last time and something was off, and the carb count for everything else was right. in context, though, for everybody who's listening, and why would you need to Bolus for protein. It's really typically two points that you'd need to Bolus for protein one, you brought up the low carb eaters, or those who are eating lower carb at times, if you've got a meal that's typically less than about 15 to 20 grams of carb, and a normal amount of protein, not like this big 16 ounce steak, but a typical, you know, five ounce chicken four or five ounce chicken breast, let's say, You're usually going to need about 4050, sometimes even 60% of the amount of protein in the aftermath of that meal in order to accommodate for your body's own digestion of protein in a low carb environment. Because remember, carb is the body's natural first fuel, right? If there's not enough of that first fuel there, your body looks to another source, like protein digest sit down, and you get a usable amount of glucose out of protein. Even if it's not a huge amount of protein eaten in a lower carb environment. The opposite of that would be let's say, she has a high carb meal, or anybody has a high carb meal that's like the meat lovers pizza, okay, and which is not only a huge amount of carb, as well as a huge amount of fat, but you've got this large amount of protein, let's say instead of your standard, like 25 gram portion of protein, which is like about the size of the palm of a woman's hand, that's about 20 to 25 grams of protein, that's pretty normal amount, okay, if you've got this huge amount of protein that you're taking in, even in a normal amount of carbs, or a high amount of carbs, you're still gonna need an Bolus for about, let's say, 50% of that protein, but it's going to be a drawn out type of insulin need. So both of those scenarios would require you to take, you're doing like a dual bolus, you're extending some of it assuming you're meeting that protein kind of need for a while. Protein bolus typically is a good idea is at the end of the meal to set an extended bolus with zero percent delivered up front and 100% extended out over about a three hour time period. And that's just for aware proteins impact usually starts impacting about two ish hours after a meal. And then by about three hours, you're too high and you might sit high and correct to try to get it back down. When in effect had you used what you use to correct to actually Bolus for the protein you wouldn't have had the rise to correct to begin with.

Scott Benner 9:17
Yeah, I got it. It's parallel to the idea of over Bolus and like when you can't Pre-Bolus and you throw in a ton of extra to handle the rise before the right yeah. Okay. So yeah, exactly. I Bolus the meal normally. Then I finished eating and I put in this amount for the protein in an extended bolus, zero right up front, the rest of it out over maybe three hours.

Jennifer Smith, CDE 9:39
Correct.

Scott Benner 9:40
Correct. So basically, I'm creating a heavier blanket of insulin over the timeframe where the food is going to have

Jennifer Smith, CDE 9:47
where the protein is going to have the impact or where you're assuming from previous experience with meals like that. That impact is going to kind of fall in and fat is even longer. As we've kind of talked about before fat can have impact on To 10 to 12 hours after eating high fat.

Scott Benner 10:02
How does that technically happen? So these are where my questions exist. And by the way, I just everyone listening, I just stared at Jenny while she said that and thought, Oh, I'm in a Master's class about diabetes. And so, so fat as an example, when How does fat does it slow down digestion? Like, why does fat hold up blood sugar? I don't understand, I guess.

Jennifer Smith, CDE 10:26
Yeah, so one, it's also usually the reason as you just said, fat does slow digestion a bit, it's a it's a tough nutrient for your body to break down and make use of. So even if there's a ton of carb with it, it's often the reason that somebody eats a pizza. And they're like, wow, I must have nailed that carb count, because my blood sugar is like, beautiful rock, steady, flat, no rise at all. And then all of a sudden, later, they get this like creep, and the creep happens, and it happens. And then you ride high, and you're like throwing insulin at it and dumping the plane worth of insulin. Here, you know, it's, it's and it's annoying, right, especially for people who may not realize where it's coming from, because they've never been told what it potentially could be. So it's not a missed missed amount of car. But it is the reason that you had that nice flat look, in the aftermath of eating that, let's call it pizza. Otherwise, if you just ate the pizza crust, I guarantee that pizza crust is going to give you a rise without the fat being there, right? Even if you did Bolus,

Scott Benner 11:32
right, right, right,

Jennifer Smith, CDE 11:32
right bread or potatoes or whatever it is. Now fat The other reason it impacts blood sugar is because as it gets to the system, a creates a rise in triglycerides in the bloodstream, which is a stress on the system. So we know what stress does to blood sugar, right. But as a stressor, if it impacts insulin use as if, as if it's reducing it by about 50%. So let's say your bazel overnight is running at 1.0 units an hour, and it works beautiful, you've tested it, you know that it does what it's supposed to do. But in the effect of pizza or anything high fat, nachos and cheese or whatever it you know, the whole bucket of chocolate, whatever, you essentially have a bazel now that's functioning almost at like point five instead of one. And so you are not getting the impact of all the bazel you need your blood sugar climbs because of the fat and it stays high because of the fat and it can be long duration. So I mean, you know, we typically recommend people accommodate for a high fat meal or something, you know, high fat in nature, like the whole hog and does sundae bar or whatever. 50% increase in bazel at the end of the meal. And you extend it out over eight hours.

Scott Benner 12:52
Wow. 50% bazel increase over eight hours for a ton. Yep,

Jennifer Smith, CDE 12:56
see a ton of fat.

Scott Benner 12:59
That's where it's a Jenny. So there's a couple of things in there. But the one thing she just said was how the the impact of the food sort of gives the appearance that your bazel is only at half power. Because Because now your body needs so much more insulin. It's funny, because that stuff we say I've been saying for years, but I never thought it that way. Right? I never considered Wait, you just said it. I always say right, the by like, you know, in high carb situations, you need more bazel. That just makes sense. If you know if one unit keeps you stable when you're not, you know, when you're not putting the body through through the paces, then when you're out then when you're attacking it with ice cream or pizza or something like that, it stands to reason that you would need more in that situation, right to meet the need. But it's interesting the way you put it, I hope that maybe that'll find a strike other people maybe at the core of their thinking, because that's a neat idea. Like when when you're using that kind of food, it's as if you don't have enough bazel by half rats, they have something to like measure with even the idea of eight hours. I think the genius behind the extended, you know, the Temp Basal increase over that much time is if you do start to trend down at some point, you can just make a the foods out of my system. Now I can shut it off. Maybe I'll have to re correct this a tiny bit, too, you know, but that's it.

Jennifer Smith, CDE 14:15
Right? Right. And or maybe you got enough temping increase for quite a while. And now it's going to navigate down as you turn it off, and you may not necessarily get 100% back to target, but you're certainly going to navigate down to a much lower number than you would have been had you not done that at all.

Scott Benner 14:32
Yeah, yeah. I mean, and you have to know by now, if you've been listening this long, that you would rather stop a lower falling blood sugar than a fight with a high one. That's it. It's simple. How much truth is in the way my brain thinks about, like, more dense carby stuff like a soft pretzel or pizza or something like that, in that it sits in my stomach and it breaks down slower so that it has more opportunity to run. So my blood sugar being impacted by over a longer period of time sometimes passed when the impact of my Bolus is there. Mm hmm. Do I think about that correctly? Or is that just the cart? Yeah, that

Jennifer Smith, CDE 15:10
works. No, it's, it's a great way to kind of think about it and also plan to Bolus for it. And some of that also takes experience, right? It takes experience seeing, well, gosh, whenever I eat this soft pretzel, it's all carb. And unless you're like dipping into the cheese sauce, or something high fat that kind of comes along with it, the vat of butter, if you're just eating the soft pretzel, it's all carb. But the dense nature of it, maybe what requires a little bit more drawn out, because you don't necessarily need that quick impact all up front, you may need some, but then you're going to need it for a little bit longer in the aftermath. And the same is true for some of those, like more wholegrain hardy types of starchy foods, things like wild rice, or qinhuai, or you know, those kinds of things, they've got better fiber complex to them, they've not been processed, they're going to break down slower, and they're going to have a lower glycemic impact. So you may need to draw out the Bolus a little bit in order to prevent having a low before it kind of impacts or hits you later.

Scott Benner 16:19
Right, you have to stop thinking about the food goes in, and my blood sugar tries to go up right away. So I'll get that's not that's why your timings messed up. Like you have to understand a little bit how the food makes its way through your system. Mm hmm. high carb, low carb, high fat, low fat, you know, an in between there, the, the, you know, I used to tell people, like try to imagine an overlay machine like but then that got like an old idea, you know, like, you're in school and they do the, you know, the somebody would write on a piece of plastic and it would they'd shine up on the board. Say take two pieces of plastic instead and make one like a line of the impact of where your insolence pitting and one a line of where the food's hitting the goal is you have to slide those like those pieces of plastic left and right and make a me Italy match up? Yeah, you absolutely can't. You can't just throw in all the insulin now and just hope it hits because you hear people all the time, like, Oh, I bolus and I got low. And then I got high later. Now this makes sense, diabetes. And I'm like, No, you're so close to you. It's interesting. Jenny, earlier you said that I look at a plate. And I just know from experience and everything. I also think I just know, I don't know why I know. It's important to understand, like, I can't quantify it for you. Sometimes I can just look at a plate and go that's this much insulin, I know it. And it is obviously from something but at the same time, I have privately for the one person who called me an egomaniac in a recent review. This is not me being egotistical. I'm just telling a story. But I I fixed two kids bazel rates this week, mm remotely. And they sent me a graph. And as soon as I looked at the graph, I thought, Oh, I know what's wrong with this. But I couldn't explain it to you. Like, do you know what I mean? Like I couldn't write a manual about why this graph right points to what it points to. But I knew as soon as I saw it, I think everybody can get to that. Because I know who I am. I know what I got in school is for grades I can't possibly be smart. Right? So, you so seriously, like I think time just teaches but and please, guys, this is not an invitation for everybody to send me their thing. But But I am By the way, it did make me think, Jenny, I think there's got to be a way to start a service where you take people's graphs and make bazel recommendations back from the graphs. Because once you get people moving in the right direction with their bazel, they start to see it. And then they can then they can dial it in on there. And then they don't need you this this person this lovely person's texted me. You have to let me send you something cuz I'm going to be bugging you for the rest of my life. And I laughed and I said, Hey, you can't send me anything. And I don't, I don't want anything. And and but but be you're not going to need me for like, ever, like three days right? Now, this is gonna just make all the kind of sense in the world to you. It just starts to you start to see it, you know, right? Right? Which the matrix movie because it's such a great reference. But things start to slow down.

Jennifer Smith, CDE 19:26
You know, they do and they start to they start to come together in a way like like Neo sort of all of a sudden, all of those images that are flooding the screen in the matrix. Like he said, that's a great movie to bring up in context here. Because it just it comes together and his brain is like, I can see it all. It's clear. And I mean, diabetes, life with diabetes changes, variables come up, and there are always going to be new avenues to explore and figure out but the intuition of the day to day management, the intuition gets easier, and I think that That's what you kind of you manage off of a lot of really good built in intuition of, it's this, this feeling and you can't, you can't often I think other people would agree, you can't often put that down in writing, you can't say, I know how I know how this is wrong, I can't tell you why. But I know this is how to fix it. I know this needs to be adjusted here, you need something else here or whatever. Now, some of it can be, you know, some of that intuition can be simplified. If you do do some, you know, we're talking all about like food and the impact carbs, and fats and proteins and some of that, if you know, I've gotten a little bit into the science of why there's impact there from these foods that we don't really ever talk about fats and proteins are kind of like, swept under the table, when Diabetes Education comes, you know, comes up, it's usually all carbs, right? We focus on carbs, we learn how to carb count. And I mean, the basics of carb counting are pretty easy with a label, you look at the label for the serving size, you look down the label for the total carb amount. Next down, you might look at fiber, if there's enough of it, you might need, you know, deduct a little bit of it. But that's what we're taught. And then you're given this little ratio that's like, oh, for every 10 grams that you count from a label, you need this much insulin to take with it, right. So it's, it's a very mathematical figure. But if we take it sort of one step farther than that very simple carb counting, as you mentioned before, not all carbs are created equal, you know, you could have 10 grams of counted, you know, celery, versus 10 grams of counted watermelon, there's going to be a different impact blood sugar wise from those carbs, even though the carb count is exactly the same. And so that it kind of brings in, can you be precise in carb counting to a degree, you can look at labels, you can measure, you can use weighted scales and all of that kind of thing, you can get precise, but from the standpoint of then understanding why blood sugar did this versus did this, you know, upswing stable flat drop down, that actually it takes it a step further into glycemic index, and the nature of that food and glycemic index also in it encompasses the components of a meal to not just the carb at the meal. But like I said before, with the pizza, you could have just the flat old pizza crust and Bolus for that with just all the carb that's there. Your Aftermath blood sugar is going to look very different than when you eat it as like a meat lover or an all over cheese pizza. There are different components. They're impacting how those carbs are going to change your blood sugar.

Scott Benner 22:54
In case you missed it Episode 255 is a defining diabetes episode with Jenny, where we go over a glycemic index and load. Kelly and I went to the movies this weekend with Arden and her friend, we went to the snack stand and Arden chose a box of cookie dough bites day slushie I don't know if that's something that translates all over the country, but just imagine pulverized ice with sugar water through it. Now, I'm not scared, right? I've got all the rules in this podcast and I've got Dexcom I feel comfortable. Flip over the box with a cookie dough bites. 76 carbs for the whole box. I say Darden Are you gonna eat the whole box. She says, I don't know, the Slurpee, you're gonna drink the whole thing. She says I don't know. I look at the lady at the stand. I went any chance you got a carb count for this slushy thing. She looks at me and says carb What? I say Don't worry everybody because we have a dexcom g six continuous glucose monitor. I know what I'm going to do. So I just ballpark the carbs. Right? I use the 76 carbs for the candy thinking there's no way she's gonna eat all the candy. But, you know, the slushy obviously has a ton of carbs in it that I can't even begin to guess we're just going to start with 76 carbs, boom, insulin goes in. Now we wait for the dexcom to tell us that Arden starts trending above you know 120 as soon as she does Janga more insulin. Throughout the hour and a half of the movie we put on a number of different smaller boluses which kept Arden's blood sugar around 170 and then we got her back down as soon as the slushy cookie dough concoction stop going in. You know what I call that success? Arden Sala movie she had a snack, there was an unknowable amount of carbs that impacted her in all different crazy ways. She did not get terribly high and she never got low later, we accomplished that the dexcom g six continuous glucose monitor, head over to dexcom.com forward slash juice box to find out more. Results are mine and yours may vary. And when those variables are invisible to you, it causes you to say oh, that's Diabetes, I can't do anything about that. That's just nice. But there is like I've, I've been saying forever Jenny's just put it into specific words, which is beautiful. But I've been saying forever. If your blood sugar is getting really high or really low, you're not using the insulin correctly. I know that doesn't help you figure out how to use insulin, but it should help you to know that there's still an answer. And right, because you don't see it in the moment doesn't mean it doesn't exist. It would be no different than if I sat down and looked at multivariable calculus. And then, and then I said, you there's no answer to this. Well, a person who understands multivariable calculus would say, of course there is, you just, you just don't understand calculus. And so the trick is with diabetes, how do you find the ideas that help you get through this stuff without everything turning into a calculus problem? Right? Like, how does it just become day to day super simple and easy. And the reason you need to listen to Jenny is not only because she, you know, teaches this stuff and integrated diabetes, not just because she's been living with Type One Diabetes for a very long time, not just because she's a CD, or a nutritionist, all that stuff, but she lives in a part of the country where food literally tries to kill people. So that wow, I my brother and Jenny live reasonably near each other and the things my brother describes his food. When he got there, I was like, Brian, that's not food, don't eat that. And it's like,

Jennifer Smith, CDE 26:27
man, I would have to say Madison is sort of a little bit of an island in the state of Wisconsin. So Madison is a little bit a little we're a little beyond what the typical wisconsinite but yes,

Scott Benner 26:39
I'm just saying if you're rolling into a moment with a you know, bratwurst on a roll with a beer with some popcorn,

Unknown Speaker 26:45
curd,

Scott Benner 26:47
cheese curds, deep fried like you, boy, you you need to know what you're doing, you know?

Jennifer Smith, CDE 26:51
Right? Absolutely. And that's, you know, that's where understanding and learning things like, hey, fat, and protein and all of these factors, they can have an impact for you. It's not all cut and dry. Count the carbs, take the insulin and you've got it made it it's not and i i hate saying that because it sounds like well, gosh, I'm never gonna get a handle on this if I have to start being a mathematician and you know, figuring it all

Scott Benner 27:17
out. But you will if you just, if you think beyond what you were told. So somebody like Jenny said, they'll flip the box over a half a cup of this is 10 carbs, you know, you get sick, you know, you get a unit for every 10 carbs. So that's a unit like that. But then once that doesn't work, you know, you guys have heard me say it a million times. It's insane to go back the next day recount the same 10 carbs and go Okay, unit, because that's what the math The doctor told me. No, no, I used the unit, my blood sugar went up. It took me three quarters Veena to correct it next time. Let's try a unit and a half. Or, you know, yeah, let's try more because more it took more, you know, correct. You just have to, like, do some evaluation is that Yeah, you have to I'm following you for the people that I speak to over and over and over again, there's a moment where you just have to trust your gut. Like, you have to trust that what you're seeing is actually happening, which is why I made one of the tenants of the podcast, you know, trust that what you know is going to happen is going to happen, you know, and that's just that's simple. Like, it's not, I say all the time, like it's not stalking if you need it. And somebody I got a private message of the day it said that sentence unlocked my world, just, you know, change my life. And I thought, I'm glad I randomly said it because I didn't think of it ahead of time. I you guys have been listening for a long time you realize there's no notes in front of me. I've planned none of this is a matter of fact, Jenny and I start recording I go hey, we're gonna do like the fat and protein today. Okay, and she goes, Okay. It's, it's about unlocking your mind from what, you know, the confines that you are giving at diagnosis. And it's really it's, it's energizing to see it happen to people early in their diagnosis, because then you know, they're not going to live their whole life like this, but it's rewarding to see someone who's lived with diabetes for a long time. Have like the light turned back on for them. Yeah, I mean, the messages you guys send Are you guys owe me tissues? You know what I mean? No. It's really something. Okay, so I did we do we did carb counting basic site, like flip the box over, take a look,

Jennifer Smith, CDE 29:22
you'll buy box over? Yeah, I mean, if you wanted to go beyond the carb counting basics and get more into a little bit, I mean, taking it beyond would really be looking at the glycemic index, but then one beyond would be glycemic load. You know what that is Scott.

Scott Benner 29:38
Those are gonna be defining diabetes things we're going to do after we stop recording this journey.

Unknown Speaker 29:42
Okay, awesome.

Scott Benner 29:44
All right. Okay. We did well with this, I think.

Jennifer Smith, CDE 29:46
Yeah, I think so.

Scott Benner 29:49
Okay, don't forget that defining diabetes episode about glycemic index and load is back in Episode 255. Let your podcast player keep running because Episode 264 is the next episode. And it's with Vicki who will tell us how she handles a meal on a ketogenic diet. keto, right, here's the great thing. Even if you're not on a keto diet, even if you're not doing low carb, the information is amazing because it shows you the timing of when proteins and fats hit a person. Try to imagine that Vicki's gonna explain a meal to you, that includes no carbs. And she's going to show you where the fat and protein comes into play. So you can kind of in your head separate out when the carbs head to where the protein hits. Trust me, this is the capper for the episode with Jenny, I promise you go right from this one into 264. Thank you so much to the sponsors Dexcom on the pod and dancing for diabetes, you can go to my omnipod.com forward slash juicebox dancing the number four diabetes.com or dexcom.com forward slash juice box to get started today, we're gonna find out about the answer for diabetes. Don't worry if all that confuses you. You can find links in the show notes of your podcast player or at Juicebox podcast.com.

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#256 Diabetes Pro Tip: Exercise

Diabetes Pro Tip: Exercise

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

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Alexa - Google Play/Android - iHeart Radio -  Radio Public or their favorite podcast app.

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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
It's time for another pro tip episode with Jenny Smith. Hello everyone, and welcome to Episode 256 of the Juicebox Podcast sponsored by Omni pod Dexcom. And dancing for diabetes, you can go to dancing the number four diabetes.com dexcom.com, forward slash juicebox, or my omnipod.com forward slash juice box to find out more about the sponsors. Jenny is a certified diabetes educator. She's like a nutrition thing. Like she does a whole bunch of like technical stuff that she's got degrees for, she works at integrated diabetes, if you'd like to hire her for yourself, you know, have these conversations with her one on one, you go to integrated diabetes.com where you can go into the show notes of your podcast player where I have Jenny's email address, email her directly, all different ways to get hold of Jenny Smith. All these links, of course are at Juicebox podcast.com. If you get confused, and you need to find them somewhere, please remember that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. And to always consult a physician before making any changes to your medical plan or becoming bold with insulin. I liked your idea, a lot of beginning ideas around blood sugar management with exercise because I hear from people constantly. And I always think that my answer to them is incomplete. Because it's one of those things that I think I just know how to do. And I don't know why I know how to do it or why it works sometimes. You know, I everyone who listens knows that Arden played really competitive softball for years and years and years. Mm hmm. And that that means at this part of the country, that means being outside in incredible heat. weekend after weekend, sometimes from 8am till 5pm playing 234 softball games, you know,

Unknown Speaker 1:45
right?

Scott Benner 1:46
And I strive for a nice blood sugar around 90 or I don't change my goals because of what she's doing. Right. And I also am not much of a pre planner, but I do I have spoken to people who are like, Look, you know, I'm an adult, I'm going to go to the gym at five o'clock after work, I need my blood sugar not to fall at five o'clock when I start working out or later sooner. And how do I do that? And I have to tell you, I know it's around bazel insulin and pre, you know, basically like setting Basil's up ahead of time or afterwards to catch lows and stuff. But I'm so reactive. I don't think about it that way. So how do you talk to people about it?

Jennifer Smith, CDE 2:23
Yeah, you don't really have a I mean, as you've done for a long time, you're sort of like, you're surfing the wave of what's happening for art. And you're managing very well doing that, because you've intuitively learned how she reacts to things for the most part, right. But to teach people in a general sense, I think one, you said it correctly. I think it's around bazel. Well, you're right in that it's around insulin. Most people

I know I was waving at him too.

So the the insulin is really a big piece. And a lot of people again, they focus on a number when they're going into exercise, but they're not focused on what's what's the causative to that number, what's affecting that number and where it may directionally go. So we talked about, you know, your person here example wise, he's going to exercise every day at 5pm. Well, for them, that's kind of a nice timeframe of the day because the goal there in a simplified way would be, you know, active insulin onboard, so no bolus insulin, you know, and they, let's say, as an adult, they only eat lunch at noon or one o'clock, tected, by five o'clock that bowl is should for the most part, unless they're looping, that should be gone. Right. And it would mean then, you know, aiming to either not have an afternoon snack, or in which there's no Bolus that would be riding into the exercise. And then the Basal component, there is a lot of debate about Should I adjust my Basal for exercise? When should I do it? How much should I do it by and that's where it comes to be an individual nature of adjustment, because it takes you have to take into consideration the intensity and the duration of the planned activity. You know, if this example, you know, guy is gonna go for an hour and a half spin class, high low, it's sort of a high intensity interval sort of workout. And if he's only going in on bazel, he could shut his bazel down, not off, but lower has bazel incrementally enough, well, before he actually starts moving, so that he shouldn't technically need much of any food at all, to continue that let's say 90 minute spin class, for example, adjustment to bazel. Most people feel like they have an idea, I turn it off, you know, I turn it down or I turned it off 30 minutes before and I still went low or I continued I was low by the end, and then I continued to be low. And the problem is that as we've talked before circulating insulin level isn't lower or higher, until about 60 minutes post adjustment. And when you're really aiming to get into a specific target, for beginning exercise, your circulating insulin level should be low enough by that point, because, as is a kind of propelled intense, intense action of the insulin on a basal level that you have now circulating, and if you're normally at a 1.0 unit per hour basal rate, and you knock it down by 50%, that 50% reduction should be started at least 90 minutes, if not two hours prior to when you jump on that spin bike.

Scott Benner 5:46
I'm checking out dancing for diabetes.com right now went to their blog, there's a lot going on over there. It's like they had a fundraiser recently a game night in Orlando, group dance auditions are now open for their annual dancing for diabetes show. Others a follow up here from when they were at friends for life, are announcing new partners in their D box program. They have this box of like great stuff that they send out to newly diagnosed people, I some actually some Juicebox Podcast stuff in there as well. But they just added sugar, medical and trialnet You can find out all this yourself, you don't need me to read it to you dancing, the number four diabetes.com check out their blog.

Jennifer Smith, CDE 6:24
So this gentleman, you know, he should really reduce his bazel by 3pm. And he should reduce it for the intensity and the duration, at least by 50%. Again, these are kind of starting places, and you'll find what adjustment works specific to you. But it's a good starting place. Now if he was just going to go for a walk for 60 minutes at a moderate pace enough to kind of bring up his heart rate a little bit but not crazy. Maybe his adjustment is a 25% basal reduction, but it still needs to be taken back by at least 90 minutes to two hours before he takes that walk.

Scott Benner 6:59
It reminds me of a number of things. One, there was a I forget what it was called. Gosh. There is a thing that happened in in I can't think of what the name of the website is it's gone now. Manny Hernandez his website that's not Oh, two diabetes. They used to do that thing every year where they they kind of challenged you to get out and do exercise, right? And yeah, your blood sugar and see where it would fall.

Jennifer Smith, CDE 7:23
So that was in November for the diabetes bump. Diabetes awareness. Yeah, check your blood sugar. Now walk or do something fun for 15 minutes of movement and check again,

Scott Benner 7:32
and people would see that their blood sugar's would come down. Yeah. So it's the same idea except with lower lower numbers and tighter tolerances for exercise your blood sugar is going to fall or try to fall because of this exercise. What can you do prior to that, to not to keep the fall from happening. And I think that what ends up happening is there's two false narratives. Well, there's a false narrative that and a problem that people build around exercise and I think about going to sleep through with diabetes. The false narrative is, if I make my blood sugar this high, that when it drops, it won't get dangerously low. Correct. If you're thinking that you are completely missing the point, right, the point should be that your blood sugar doesn't need to drop like that. Let's let's find a way to live where it's not dropping out of nowhere. Correct. And so but I see how that's the fix, right? Like, I see how that's what occurs to people. I dropped 50 points. So, you know,

Jennifer Smith, CDE 8:32
let's start 50 points

Scott Benner 8:34
higher than I really ever want to be right because the guy stuck a pencil in his pocket. And then he brought up the bank. So the pencil cause the bank robbery, like just the falls, not the the falls, the falls. God what am I trying to say? Like, like the Fall is

Jennifer Smith, CDE 8:47
the fall can be offset. If you think ahead about how insulin works, it doesn't

Scott Benner 8:51
have to happen and right and so you shouldn't be planning to stop the fall, you should be planning for a fall to never happen to begin with.

Jennifer Smith, CDE 8:59
Correct or minimal enough that you really are not in danger because of the drop, right? I mean, exercise can even you know, even people who do plan ahead might see something like a 10 or 20 point change in blood sugar during or by the end of their exercise session. That's nothing you know, if you're starting with a blood sugar of 110, and you drop 10 points. Great. You're at 100 now awesome. Nothing, you know,

Scott Benner 9:27
my expectation isn't that you can set your blood sugar at nine while you're, you know, running a marathon, it's never going to move but there are things that play while you're running that you don't think about the you know, the anaerobic style of exercise is trying to bring your blood sugar down, but you've changed your basal rate which is trying to bring bring your blood sugar up also. Maybe you have adrenaline which is trying to bring your blood sugar up. So even people who have that stability, they don't 100% know why they have it like they don't really understand all the pieces that are affecting this number moving or not moving. Right. It's interesting that the other thing that you said that feels probably To me, because I hear so many people, like, every time I speak to someone, I'll tell them the same thing. Look, just start Pre-Bolus sing and your agency is going to go down like a point. And then they inevitably say, Well, I can't really remember to do that. And I'm like, Alright, well, then your blood sugar's gonna die. What do you want from it? Right? You have to Pre-Bolus like, this is how this is what you're gonna say, this exercise thing really is no different. Okay, they're still Pre-Bolus thing, they're just Pre-Bolus thing with their their pre bazeley adjustment with it with a reverse adjustments that have a more positive adjustment. So I wonder how many people fall into that category? When they say, Look, I know I'm going to be at the gym at five. But how in God's name, do I think about it at 330? Mm hmm. You know, in that situation.

Jennifer Smith, CDE 10:47
And so some of the strategies in pumps today, you know, there are alarms or reminders that you can set, you know, even in the PDM. For Omnipod, you can set up alerts and reminders for things, I used to have one set up for reminding me to Pre-Bolus, so that I had enough time between that and actually starting to eat my dinner. I also had a reminder to check my blood sugar at bedtime. Not that I needed the reminder. But it was there in case I had a really hectic night. And I did forget before I like climbed into bed, right? So for things like a reminder, if you are pretty strategic about popping in your exercise every day at 5pm, why not just set an alert or a reminder in your pump to go off or even on your phone? If your pump doesn't do it? Or you don't want to set it there, put it in your phone and call it exercise adjustment or whatever you know. So it is that physical visual reminder, you have to turn the alert off. Oh, why did I set the alert? Oh, that's right.

Scott Benner 11:45
suicides at five o'clock, just just two days ago, someone said my child will look does not seem to be remembering to Pre-Bolus at school. And I said, Oh yeah, Arden was terrible at that. And she said, Well, what did you do? I said, I just set up an alarm on her phone for when I wanted her to Pre-Bolus it would go off and it would pop up and say Pre-Bolus. And then she you know, send me a text and be like, do you want to do this now? And we built on that. And that was years ago. And last year? She says to me, I don't need the Pre-Bolus alarm anymore. And I said okay, okay, no problem. And sure enough, like it just, it happens so many times that now it just it's muscle,

Jennifer Smith, CDE 12:22
like brushing our teeth. It's just memory. Yeah, exactly

Scott Benner 12:26
what you guys are gonna have to do, whether this is about you know, an adult for exercise a kid for exercise, or a kid playing a sport. You can't just, I mean, it sucks, right that you can't just get up and run out the door and go do it. But it's going to take a little bit of pre planning and if your health that where you're, you know, you're, you know, if that means that much to what you're gonna have to do

Jennifer Smith, CDE 12:46
like, and I do think it helps. It's important. I mean, with that statement, you can't you can't just get up and run out the door. Well, you know, what, what if you ended up sleeping in because the alarms didn't go off the right way. And you had planned to get to your kids softball tournament at 9am. And oh my gosh, it's like eight o'clock, and we're like running out the door with like, food in our hand and we're running and trying to get there. It just didn't happen to be able to plan. Well, in that instance. I mean, there are strategic management, you know, ideas, you couldn't adjust the bazel there was no way to do it, right. So in that circumstance, then food becomes your offset to potential changes in blood sugar. You know, if you got up late to go for your normal six mile run first thing in the morning, and you always like to eat ahead of time, then the strategy may very well be okay. Maybe you don't Bolus if you're going to eat and head out the door in the next 30 to 60 minutes, and you're going to take a six mile run depending on how long that takes you, you may be able to take 25% of the recommended Bolus, you may be able to take none of the recommended Bolus. And strategically then manage blood sugar well, because you're feeding the activity you're feeding to avoid a drop in blood sugar, but you're not stacking insulin into a time that it's just gonna get active.

Scott Benner 14:07
Right, I'm smiling so much because this is like the next level of thinking about all this about the manipulation of the insulin. When RM would run off the field like I and I'd have her I know what her blood sugar was. And she if she ran off i'd might say to her Hey, water, you know drink water now. And then maybe watch and then if I saw her blood sugar kind of dipping down the next time she came off the field I'd say switch to the sports drink and you know should switch to the sports drink and then I'd be like switch back to water. You know and it only happens a couple times maybe it maybe never to be perfectly honest with it. She's played softball games where a blood sugar's never moved, you've got her bazel right, your prep right going in or like you said you ate the right things before playing. And these things are sitting nice and stable in your stomach and kind of holding you know, holding the pressure back of of the activity to make your blood sugar lower. But you can reverse engineer all of these ideas like use food instead. Events like, you know, I say it here a, you know a lot and I don't know how clear it is because it's sometimes not 100% clear in my head, but we don't we always just think about how the insulin impacts the number your blood sugar, but we never think about how food impacts the insulin or how food impacts the number. There's so many different pieces to this. It's all not just a one way street, like, all right, things are affecting all these different things. And if you pick the right one, it can manipulate something, right? You ever thought was manipulatable. And it is, you know,

Jennifer Smith, CDE 15:31
and also understanding your variables and how they affect you maybe at certain times of the day is a piece of it as well. I mean, I can tell you from my, from my management, I guess toolbox. I've figured out that my morning runs, I can get up, I can Bolus for about 40 to 50%. of the normal recommended bolus, as long as I'm heading out the door within the next 30 to 60 minutes, that partial bolus for what I ate will help me keep my blood sugar nice and stable throughout. Now, in the afternoon, if I did that, my blood sugar within 1520 minutes would take it would entirely take I would need. I just know my sensitivity at times of day. And so again, on an individual level. Some of the things you know that we're talking about there a beginning piece there where to start, if you've had no strategy whatsoever, these are places to start with what you can try to, you know, I guess implement, but you're going to find that things need to be adjusted, personally for yourself. I raced a strategy knowing my like training run strategy by race day strategies completely different with the adrenaline of everything getting going on a race day morning. I mean, and I'm not a competitive like a pro runner. Right, I could only do four minute mile or something. No, I've just I'm out there, but it's a race day. And so I Bolus 100% for my breakfast on a race day morning. And if I don't my blood sugar is 300 by the time I start the race

Scott Benner 17:19
dexcom.com forward slash juicebox just got a facelift. Nice, it's fancy. Here's what it talks about zero finger sticks. That's right, the dexcom g six continuous glucose monitor is FDA permitted to allow for zero finger sticks. Of course, you can customize your alerts near alarms by setting the range and getting notified when you're heading higher low. There's smart device compatibility. What's that mean? You can see your glucose data in real time on your compatible smartphone, iOS and Android. Go check out which ones they support, sharing your data. Talking about this all the time, right being able to see a loved ones or someone's glucose levels, direction, rate of change all remotely. That could be your child at asleep over a friend that's alone for a couple of nights doesn't matter. Anybody who needs you know, someone to have their back. Dexcom even has Siri integration. I can't tell you about that right now. Or my phone will start talking to me, but you can check it out@dexcom.com Ford slash juicebox. To find out more. The CGM is also by the way indicated for use in children two years and older. It's amazing. Now to take the next step with Dexcom. Just go to my link, and fill in the tiniest bit of information patient's first name, last name, email, phone number, city state, you know, birthday, a little bit of information about what kind of diabetes you have in your insurance. You are on the way, you can do this through the links in the show notes. If your podcast that links at Juicebox podcast.com or by remembering dexcom.com forward slash juicebox. My daughter's results, of course are her own. Yours may vary. But I'm telling you that the dexcom g six is maybe the most important part of your life with Type One Diabetes, being able to see the direction and speed of your blood sugar is monumentally important.

Jennifer Smith, CDE 19:08
If I don't my blood sugar is 300 by the time I start the race, and again, it's experience it's experience of figuring it out. It kind of goes into the difference of what type of sport or what type of athlete Are you are you a an aerobic exerciser or you more the weight kind of the heavy lift or kind of you know anaerobic because those adjustments are different as well. Strategy there for many of the lifters that I work with the Find a need depending on their lifting plan, they find a need to potentially bolus to avoid a rise in blood sugar during a lifting session off at the potential rise that they see is slower with a Temp Basal increase. And again, in their standpoint, that Temp Basal increase needs to be started about an hour before they actually get to their lifting session. or it doesn't help enough and they get a major rise. So I think the biggest thing with exercise adjustment is what has happened. What have you seen? What is your problem? Right? Because if you start with the data that you've got, and you look at and you say, Okay, I just did this way. Totally didn't cut it, this did not work. Okay? adjust, look at your data and adjust and make you know, is it a timing component isn't an amount component, what do you need to change?

Scott Benner 20:33
It's funny because I see a through line from this to correcting a low so when, you know when people get when people's blood sugars get low, and they they eat because they need to, then this you know, uncertainty just allows them to they do nothing and their blood sugars come like crashing like back up again. Right now you're you've just crashed down now you're flying back up. I say all the time. Like you'll know you're like a ninja when you're bolusing. You know, after you've eaten for a low like, you know, your blood sugar is going down to 40 You're shaking, you're out of your mind. You're eating all the food. He stopped for a second go, okay. I'm okay, now I eat a

Unknown Speaker 21:11
lot of food.

Scott Benner 21:12
70 carbs worth of food. What do I do now? Well, the answer is I Bolus Now you know how much? I don't know you figure that out. But that's what I did. I mean, I the first time I did it with my daughter, I'm like I can I'm so scared. Boom, 350 blood sugar. Then next time, I was like, Okay, well maybe like for half of it and half of it didn't work. And so eventually, I could just I kind of eyeball it was usually about three quarters of the carbs. Like, right, and like when you stopped and really thought about it, you know, sure that 2025 carbs stopped the fall and got your level, the other 50 were just your body going eat more, eat more, eat more, eat more, right? If you could have stopped yourself after 25 or 30 carbs, you would have

Jennifer Smith, CDE 21:53
would need to bowl

Scott Benner 21:54
right wouldn't eat the balls. But you know, you can't stop yourself in that situation. And so it's happening. Now you got to do the next thing that makes sense. It's all really just about I hate I hate to I feel like I oversimplify sometimes. But all we're talking about in the last 10 minutes, all you really heard was right amount of insulin at the right time. You know, which is obviously overly simplified. But that's all we're talking about. the right amount might mean and I get scared to when people hear right amount that they that they think of on the positive or more like actually, the right amount might be less, it could be like bazel, right? It could be not bolusing at all, eating a banana going out the door for a run and thinking you know, this bananas, usually three units, but I know if I didn't bullish for this, my blood sugar is going to go up about 80 points because bananas Don't hit me that hard for some reason. Sure. And when I go out for a run, I fall 60 points. So boom, I'm gonna eat the banana. I'm gonna go and you've countered it. Yeah. Yep. All different ways to get in that fight. Mm hmm. I have a couple of notes. The other?

Jennifer Smith, CDE 22:57
Oh, yeah, Oh, please. Oh, I was gonna say kind of on this kind of on the same note there from the standpoint of not having enough time to adjust. Prior to, let's say, for a bazel adjustment truly, another component is you may actually have to, you may have to eat food to curb a potential drop. If you know the drop is coming, and you've only got 20 minutes before you're going to head out the door to go and exercise. And you may have to have 10 or 15 grams of carb in order to stop a potential drop from happening. And that's it's a, it's a hard thing to consider when you're also for the most part as an adult, especially considering exercise as a piece of like a weight management tool. Right? And if you feeling like, well, gosh, every time I exercise, I have to go and eat like three granola bars. And that's like, that's what's the purpose? What's the point of this? Right? I'm exercising but I'm not seeing any changes here. Well, again, some strategic planning can help. But if there's no ability to adjust anything ahead of time, because there's not enough time, you may actually have to quote unquote, eat something. And my my recommendation and most of the athletes that I work with, it's that the circumstance, simplify the carbs that you're eating, and eat in a butter jelly sandwich or a pro bar that's you know, like 300 calories, your body right before you get started moving needs the simplest form of carb you can get, it needs to get into the system to effect quickly and stop a potential drop because usually aerobic exercise drop happened within about the first 20 minutes or get started within about the first 20 minutes. So simpler. The carbs are one, you're not getting fat and protein calories. So you don't have this load of excess. And if you use something simple like the sport drinks, you know whether it's Gatorade, Powerade, vitamin water, whatever it is, make sure it's got some carbs in it and have about, you know, eight ounces which is Almost 15 grams of carb,

Scott Benner 25:02
that's a simple amount, your body is going to use it easily. It's going to help to stop an initial drop, you may need to bring it along and sip it along the way, as well. But at least it's getting used up. And it's not something that's packing away calories have a question, and I don't know the answer to it. So, which just as an indication to you guys, and sometimes I ask questions I know the answer to just so you can hear the answer. But in this situation, I don't know the answer to this question. So your body when you work out, uses up food as fuel, but that we're accustomed to putting that food in us and letting it be used up as a buoy for a blood sugar. So I don't know what my question is. But if I eat a banana, and I sit down, like because my blood sugar is 60 I eat a banana I sit down and expect this to bring my blood sugar back up to 130. And it does. But if I eat that same banana at 60, while I'm doing something that's causing my body, so is are my muscles stealing the banana that I need for the sugar? Does it still go in the blood and I use it and I get it any i do i get both benefits, or do I only get one. And all of this talk about exercise has me just super warm and fuzzy inside about the on the pod. You hear what we're talking about right? Jenny and I are discussing methods for increasing and decreasing your basal insulin in ways that will stop low blood sugars while you're exercising these tools work in a lot of other parts of life, not just for exercise. Now when you're exercising, you need your insulin, you don't need your insulin use a little more, you need a little less, you need to be able to manipulate your basal rates. If you're pumping right now and you're not using the Omni pod. This is not something you can do while you're exercising because you have to disconnect your tube pump to exercise but the Omni pod is a tubeless pump. And you can have it on not just while you're exercising. But while you're swimming or bathing, you never have to take it off. Now let's just take a second let that settle in. Right. The Omni pod is the only insulin pump that doesn't have to be the only insulin pump that you can wear while you're exercising. Because of that, it's the only insulin pump that allows you stewardship over your basal insulin during exercise a little more or a little less, a little sooner a little later. Now, here's the greatest thing about the Omni pod. And I mean this free, no obligation demo, it's a peck a pod experience kit, that on the pod is thrilled to send you an all you have to do is go to my Omni pod.com forward slash juice box for again, your free, no obligation demo pod. They'll send it to you and you can wear it, you can go out and exercise with an omni pod on and see if it's something you'd be happy and excited to do. And if you wouldn't be whatever, no harm, no foul, nobody's gonna hassle you. You don't have to get another pod if you don't want to. But the best way to find out if what I'm saying will work for you is to give it a try. There's links in your show notes at Juicebox podcast.com. Do I get both benefits? Or do I only get one

Jennifer Smith, CDE 27:52
depends where you are sort of in the exercise in early exercise, your body would get the benefit of the banana would actually bring your blood sugar up because your muscles have now are resting, you've stopped you're eating the banana you haven't been exercising for very long. So it should technically bring your blood sugar up maybe not as much as if you were just sitting and not doing anything and eating the banana and not taking insulin for it. But the longer amount of time you've been moving. And the more primed your muscles are to grab glucose and bring it into for for their benefit. right because they're trying to retain they're trying to energize essentially. And this is a really hard concept. I'm glad question wise you brought it up. Because athletes, endurance athletes, especially those who are doing long distance of anything triathletes, long distance cyclists, even kids or adults who are in long term like competition on a weekend like four or five like you said, you know, Arden might be have been in softball from 8am until 5pm. That's a long day of movement of asking your muscles to do something. And most people are like, ah, I've got my bazel dialed in. I totally I rocked it my blood sugar was nice and stable. But man, I felt like I couldn't move. My I just slogged through this whole four hour marathon and I didn't I my blood sugar was great, but I didn't feel the greatest. What's the problem? The problem is that even thinking about yourself as diabetes, a person with diabetes, right? You have to first think about yourself as an athlete. athletes, whether you have diabetes or not, you need energy of whatever source you're choosing to use, you know, even ketogenic endurance athletes use some form of fuel during long distance to maintain and be able to perform and you know, people who aren't ketogenic you need a carb source, and you need it put in strategically over that endurance time so that you can fuel your muscles, you can give it what is needed so the muscles can keep doing what you're asking them to do. Now, from a diabetes standpoint point, what you're putting into fuel your muscles also has to work well with punch for peace, right? They have to kind of balance each other out. But first and foremost, as an athlete, you have to think what am i muscles need to perform the way that I want them to perform, you're doing two different, very different thing. But they're both working on the same

Scott Benner 30:21
pool of food basically. So

Jennifer Smith, CDE 30:23
and, and thus, with insulin adjustment might be very different. I mean, when I am in training long distance like half marathon marathon, my training runs and the actual event, it's surprising, most people who've kind of dialed things in will find that their basal insulin adjustment doesn't go down a lot. For my marathons, I only reduce my bazel by 10%. And this was conventional pumping, right, I only adjusted my bazel down by 10% for the duration of time of the run, because what I expected then was the rest of the bazel to be able to encourage the food that I was taking into fuel along the way into my working muscle because insulin has to be there to propel some of that in the activity helps with the rest of it, it opens the doors on the muscle cells and lets the food in. So if I reduce my bazel too much and fueled along the way, I had these jumps in blood sugar that I didn't need. Whereas if I just kept my bazel a little bit lower, and I feel strategically, you know, every 20 minutes putting in a little bit of something along the course of time and hydration. Again, blood sugar stayed nice, but I also had energy to keep moving.

Scott Benner 31:38
I I should say that at the the other side of Arden's long tournament days. You know no problems like you just said with the blood sugar's throughout the tournament into the evening, their regular bolusing at dinnertime, but around late evening, 910 o'clock going into falling asleep time, all the food was free at that point, like she could eat without insulin like s and by the end when she goes to sleep. I know people see like one way or the other usually Arden's eyes closed blood sugar falls person, like so if something's not right with her insulin, when she goes to sleep, her blood sugar tries to go down. And so even if you gave her a juice at midnight, and turned her bazel off, that still couldn't catch a low after a full day of activity, you had to give her something to eat. That was substantial that would really stick with her in her system while she was sleeping. And even in the morning, even in the morning waking up like getting through the night, okay, and I've done it well and I've done it poorly and poorly would be like you know, three juice boxes to get through the night and a banana or something like that. I would call that poorly. And I've done it well where I've gotten her through with like a you know, something at the end of the day that stuck with her overnight some tamping down with bazel, stuff like that. But even that next morning when she woke up, her blood sugar's were like terrific. They were low, you needed the be of the mind, whatever the base amount of insulin was for the meal, like you know, sometimes you're like, this is two units, then the next day you're like, oh, how come it was more like four today? Whatever the right most minor amount was, but always the day after a softball tournament is all you need her insulin needs? Yep, very low. But that was, gosh, if that didn't kick in nine hours after she got done playing and lasted probably for nine hours after that. It's really it's really

Jennifer Smith, CDE 33:32
Yep. And that's what we call a Gary actually has coined the term dope, like Homer Simpson don't dough is d do Ah, delayed onset hypoglycemia essentially is what that is, right. And it is, again, this is where visually looking and seeing, you know, it was about nine to 10 hours later, that she started having a drop in insulin need. And it lasted for another good, let's say 10 hours. That's experience, you looked at our data, and you said over and over, this is what I see. So that's kind of where you have to go back and you have to look and see, well, gosh, after I have like a three hour run in the afternoon, or you know, a four hour softball tournament in the morning, I ended up being low from dinnertime all the way through the next morning. If that's the case, you can set temp adjustments down again in bazel at a strategic time, so you don't end up having to do a juice box and a bazel off for a certain amount of time because really there you're missing the boat. Right? Your that was your treating now when ahead of time had the bazel been adjusted down enough. The treatment shouldn't have been needed or less of it right? Yeah.

Scott Benner 34:45
No, I I made sure to characterize it that way. Like in the beginning like I didn't do a good job of it all. And you were just the whole evening was just like here, stay alive. Eat this here stay like this. Hey, why don't we just shut your bezel off for a while and see if that helps. That's all Call 911 stuff like that. That's not like, Oh, I'm really, really great job. You know, later, right later a great job was knowing that after dinner throughout the evening, she needed less bazel. Yeah, and that she should eat something reasonably substantial, like a little before bed, like that kind of stuff. But oh my gosh, the first couple times, you know, I did it once in a hotel room, where Oh, my god, it was just embarrassing. You're banging into thing, he'll know where everything is. And it's dark, you know? And I'm just like, what is happening? And then, you know, her alarm goes off. She's like, we have another game. And I'm like, Yeah, that's great. Because I've been up all night. You know? And then the next day, all the parents, all the parents, like, You look tired. I'm like, Uh huh. Yeah, you guys are all drinking all night. I was trying to fix this blood sugar thing. Not that all parents at sporting events are drunks, but most of them are and not a drinker. So I wasn't involved to begin with but they all were like they come down in the morning, like all hung over and I they must have thought I was just like, quietly privately drinking by myself, you know, I looked worse than they did some days. But no, but there's just so much so. So

Jennifer Smith, CDE 36:13
I kind of on the same on the same note not to interrupt but the aftermath sometimes to of exercise can happen right after the lower needs and insulin can be for several hours after weightlifters to may have that rise during but then the impact of lifting and their muscles sort of building repairing restructuring. And the insulin sensitivity sensitization that they get from working their muscles out, can have impact into, you know, for six, eight hours after where they actually need less insulin now.

Scott Benner 36:47
Yeah. I had that. I had that on my notes, like, What does muscle breakdown and rebuild, do? And what you know what to dehydration. I'm reminded about this again the other day, because I said this to a person. And it was like no one had ever said it to them their whole life. And they're like, you know, sometimes my insulin doesn't work as well. In the morning. I was like, you know, have you tried waking up and just banging down the glass of water? And they said, No, why? And I said, well, insulin doesn't get through your cells as well, if the cells are dehydrated, because then the insulin can't travel through, you know, like 10 it and as I'm singing, I'm like, God, you've never heard this before. You know, like three years with diabetes. Like I had never heard that before. It's like, I just Okay, that sounds great. I'll try that. When horns at school. Whenever her blood sugar gets sticky. The first thing I say to her is like, hey, drink some water. Let's see if, you know, we can find a simple, you know, answer to this question. So

Jennifer Smith, CDE 37:38
well, it's kind of like things just move slowly through your system. It's like your blood gets when you're dehydrated, your blood gets like sludge, or like molasses in winter, essentially, it doesn't move, nothing moves through the system very well. Nutrients don't get where they're supposed to go. Everything that's traveling there is slow. Whereas when you're well hydrated, and everything is nice and plump with water, it can move fast. It's like a freely flowing river, right?

Scott Benner 38:03
Yeah, that so. So I have to stay hydrated when I'm being active no matter what. But it is also helping me get a smooth baseline for what I expect out of my hands on and then at least when I see one way or the other, I know is real. And not because I'm dehydrated and or something. What does he eat? How does he impact blood sugars? Because you know, people in the warm weather states always report problems with their blood sugar's as soon as the as the summer comes, but I'm wondering, right, you heat yourself up when you're working out too. Is that similar? Or no?

Unknown Speaker 38:43
Um,

Jennifer Smith, CDE 38:44
you know, that's a good question about the workout. I guess I never thought about it that way. It's probably pretty similar. I'm in exercise, of course, your muscles are just uptaking glucose more efficiently, the doors are opening even with less insulin being there, they're just opening more efficiently exercises like free insulin, really. I mean, unfortunately, we can't live on exercise to use insulin, but it does help. But in the case of overall warm if you think about when you're warm, your vessels move closer to the surface of the skin or right and you sweat and you that's a cooling effect, right. It's your body's sort of way so that your you don't overheat. Well, when that happens, get more circulating. You get more circulation around the actual insulin pumped or injected site. So you allow that insulin to get absorbed faster. I guess is the easiest, most simple way to say it so in warm weather or worse when warm weather comes in. Many people do see an object a friend of mine, once April hits, she's always like my baseline Just need to go down, it's warmer outside, I know that I need an adjustment, nothing else has changed, my weight hasn't changed my in my food hasn't changed, and I am just outside more, it's warmer, she needs less insulin, and then it might go up again in fall and or winter. And exercise, obviously that heats you, you get a lot faster circulation, I mean, that's the benefit to your heart, your you know, circulatory system is exercise does your heart good, makes it pump harder. So with that, and the fact that you're getting warmer, you just get a faster circulation of insulin essentially. And we we

Scott Benner 40:35
haven't really said this here, either, but you have type one diabetes, or the person we're talking about does exercise is very important to you. So this is a piece you have to figure out, you can't just say, I can't figure out exercise you you need exercise, you know, everyone does, but you know, people with diabetes needed maybe a little extra because you're trying to keep your body healthy. While it's trying. While it's trying to, you know, that's trying to beat you up, you need to you need to take away as much power from that as you possibly can.

Jennifer Smith, CDE 41:03
And as a weight management strategy, sort of in the same realm of it needs to be something that happens every day. And many people with diabetes are really struggling and really trying to keep a healthy weight. If you can strategically plan your exercise in the aftermath of a meal. As I said before, you could potentially use less insulin then because you're planning the exercise in a timeframe of after insulin has been injected to influence going to work better, you're also going to enable your body to burn more of that fuel off. Right. So it's a good strategy to just all around, then workout, eat and then workout. Again, ability to reduce the amount of insulin again, prevention of lows, but also just burning calories and not having to take as much insulin. So

Scott Benner 41:57
doing what you what you wanted to what you what you intended to do. When you when you decided to get up and go exercise. I want to look right very quickly, too, because Chris Rutan was on the podcast and we talked a lot about we talked a lot about this kind of stuff, too. And I just want to be able to tell people what episode that was. Be nice if I could figure it out. I am the guy with the podcast you would think I wouldn't know. But well, there are so many of them. Well, that we are getting to that spot, aren't we? I can't figure out what should people like what episode Am I don't know any more. Let's see Where's All right, I'll have to figure it out and plug it in. Jenny's got her own life. She's got to get back though. I will figure it out. And you'll hear it edited. And right here. Chris Rutan was on episode 201. Jenny, is there any anything else that you think we should talk about here?

Jennifer Smith, CDE 42:52
We could probably go on and on with more like advanced stuff. But overall, I think those are the good basics to start with.

Scott Benner 43:00
Yeah, I think this is what we're looking for a basic invoke, we'll hit more advanced things in another episode. Let this awesome. Cool. All right. Well, thank you very much. Thank you. Some quick stuff. There's just a couple days left to enter my giveaway. It's the end of August 2019. If it's past August 2019, forget it. But right now there's a huge giveaway going on, go to Juicebox Podcast calm. There are a ton of great prizes for this giveaway. But among them is a free 30 minutes of talking with Jenny Smith. So if you love talking to Jenny here on the podcast, you know where she's talking and you're talking back to her in your car. Imagine if she could actually hear you. There's nothing to do to enter give it a shot you might want. Thank you so much to Dexcom on the pod and dancing for diabetes, for sponsoring the Juicebox Podcast. These people have been with me for a very long time. And they help keep the podcast free. So give them a shout write check them out of their links or, you know, just find a way to support them. Like for instance, dancing for diabetes has instagramming now, so does Omnipod and Dexcom. Follow them. Do something like that. When you see them online, be like Yo, thanks so much for sponsoring the Juicebox Podcast, whatever you're gonna do. Give them a little Hey, hey, you know, so let me thank you here for all the great reviews. The merchandise are buying the T shirts, I'm starting to see pictures of you guys out in your real lives. We're in shirts that say like stop the arrows and be bold. Very, very cool. All right, there'll be a new defining diabetes this Friday. And then we're going to get into the fall, run, run. My next episode with Jenny Smith will be up in a month. It's going to be about fats and proteins and how to Bolus for them. The month after that. The next episode with Jenny is called Ask Jenny. It's gonna be the first episode where your questions are what I asked Jenny

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#237 Diabetes Pro Tip: Setting Basal Insulin

Diabetes Pro Tip: Setting Basal Insulin

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

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

Scott Benner 0:00
Hello everyone and welcome to Episode 237 of the Juicebox Podcast. Today's episode you know by the title is with your favorite guest, Jenny Smith, Jenny and I are here today to add an 11th entry into my diabetes pro tip series. Please don't let the fact that this is the 11th episode in this series make you think phased array testing probably not that important. If it was they would have moved it up sooner. Not even close. Having your basal insulin correct is the core of everything you're doing with insulin. You can't trust that your Bolus was right or wrong. You can't understand why you got low or why you got high. When your basal insulin isn't correct. Everything you see coming back to you from your blood sugar experiences from your glucose monitors from your meter testing. None of it is actionable. None of it is valuable. If your bazel isn't right. Every time I speak with someone privately we start with basal insulin doesn't matter if you're pumping or injecting, and most people's basal insulin is significantly incorrect. If you're seeing blood sugars that you don't understand, it's easy to see a low blood sugar and think that means less bazel. But that's not always the case. At the end of this episode, I believe you're going to have a firmer grasp of what basal insulin is, how to make adjustments to it and why it's so important. You really need to listen to this one. This is where it all starts. This episode of The Juicebox Podcast is made possible by Dexcom ami pod and dancing for diabetes Dexcom. Of course the makers of the G six continuous glucose monitor on the pod makes the only tubeless insulin pump in the world. And dancing for diabetes is the organization bringing joy to children in Florida and touching people all over the world. With their generosity, you can find out more dancing for diabetes.com dexcom.com forward slash juicebox in my on the pod.com forward slash juice box. My friend Jennifer Smith is not just the CDE. She's a person who has been living with Type One Diabetes for a very long time. Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian, a certified diabetes educator and a certified trainer I'm most makes and models of insulin pumps and continuous glucose monitors. Not only that, but she's my guest in every episode of the diabetes pro tip series. If this is your first one, you have to go back started episode number 210. From there, it goes to 11 and 212 then jumps to 217 1819 diabetes pro tips picks back up at Episode 224. With mastering of CGM to 25 to 26 to 31. And of course, you are listening to Episode 237. This is the 11th in this diabetes pro tip series. And in my humble opinion, it just wouldn't be the same without Jenny. Last thing, actually last two things. First one's easy. You know, I'm gonna say nothing you here on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making changes to your health care plan. Becoming bold with insulin. And the second thing is that Jenny does this for a living. You can check her out at integrated diabetes calm, or her email address is right in the show notes of your podcast player.

A funny thing happened the other day, I felt like we did such a great job of outlining everything that everyone would need to know. And I was so comfortable with it that I started supporting the podcast episodes with like social media posts like Hey, don't forget how important your basal insulin is. And the right the amount of notes that I got that were like, Hey, you didn't do an episode specifically about setting up your basal rates. And I was like I didn't, I felt like we covered it all with what we talked about. But okay, if you want it like so let's add one that's about setting up your bazel testing and getting it right. And I was like, Alright, well, we'll definitely do that if the people are asking for a journey, then we have to deliver.

Unknown Speaker 4:02
That's right. That's what I'm thinking. That's what we're thinking.

Scott Benner 4:06
So, so I wanted I would like to do that. Now, here's how I imagined this. And I'm recording already. So this will probably all end up in episode. I'm assuming there's a super like specific way, because I remember being taught it like, you know, in the doctor's office, like very specific don't eat food for this much time, like make sure to like this whole thing, and this is what your basal rates gonna be. Now, there are times when I think that's antiquated and as much as if you have a CGM, you may be able to figure out your base more quickly. But I'll cover that when we get to my less technical way of doing it. But I really do want to start with what is the accepted medical process for figuring out what your basal insulin should be? Check out dancing for diabetes at dancing for diabetes.com that's dancing the number for diabetes.com you can also find them on Facebook and Instagram. Fantastic organization, you should check them out at the very least get involved if you like what you say. What is the accepted medical process for figuring out what your baseline slash obey? Go crazy, Jenny, because I feel like you're gonna get to talk a lot.

Jennifer Smith, CDE 5:21
The I mean, the accepted, ethical way to do it can also vary. You know, I've heard, I've heard a lot of different but I've also heard enough similarities for you, I guess, our best ethical way to do it within integrated when we start working with somebody brand new. As a first and foremost question, have you verified that your bagels are working well, and bazel evaluation can also be done using injected basal insulin as well. Not in the same way or as extensively as a pumped Faisal rates, right. But you can evaluate the whether or not your basal injected insulin is working pretty solidly to Okay, so both of them can be looked at. As far as pumping, we always start with an overnight evaluation. And the reason for doing overnight testing first is one majority of people, unless you're a shift worker, or overnight truck driver or something, most people are sleeping in that overnight time period, there's no eating, no exercising, there's no food going in anyway, it's like one of the easiest times of day to actually get a bazel test in. Okay, the biggest thing heading into any bazel test is that there isn't any food that's going to be impacting in that bazel time period. And there's no lingering impact of your bullet. So for an overnight test, we aim to say, have your dinner and bolus by 6pm. Because by 10pm, when most people are going to bed, give or take depending on if you're a little kid or an adult or whatever, by 10pm that bolus itself and 99% of that food impact should be gone by 10pm in out kind of the bell curve of effect, right? So from 10pm overnight and into your normal waking time, then we get a true look at what is bazel doing to hold things steady. Now, the other variables in episode about variables too, right? Dude that comes into play with testing. You know, if you are in those couple of days before your period is starting, if you have a nasty cold if you have a lot of exercise because of training or practice or something you don't want to be able to tap on an overnight when any of those pieces are.

Scott Benner 7:54
Right, you know what I wonder, too, is I'm starting to believe that there's a different bazel rate that my daughter needs depending on our site. So I think there's a leg bazel rate for her and I think there's a belly basal rate for

Jennifer Smith, CDE 8:07
that's actually funny I use when I use my upper bulat for my knee pads prior to looping with a Medtronic pump. Okay, I noticed that on my bus, I need about 10% more basal insulin. And so I set up a bazel profile that I call but

Scott Benner 8:32
I could definitely say But

Jennifer Smith, CDE 8:34
yeah, I called it but and I had it 10% higher than my standard tested Faisal rate, right that ran on my other normal sites, which seemed to work the same, you're not crazy and thinking that it could be the case. And it's something I bring up with people too, especially those use Omni pod, which can you can wear it in a lot of different places compared to conventional tube pumps, right. So overnight, the goal of diesel testing then is to have fair stability, and not like this entirely flatline. But the goal is to not have more variants than about 20 to 30 points up or down from where your finger stick value at 10pm is. And the goal at 10pm. One set bolus from dinner and the dinner food is pretty much gone. 10pm your blood sugar you're aiming for it to be somewhere between 80 and 250. I know that looks like a broad range, right? And you're thinking well, gosh, if it was like 150 i'd totally correct that at that time because I don't want to sit at night All night at bedtime, you know, 150 you let it lie. You don't touch it. You don't take corrective. Just let it sit. So if you go to bed at 188 you leave it alone, because the bazel job is to not correct that. The bazel job is to hold you pretty steady. If you're not going to have more than a 20 to 30% variance up or down from that. That means all night long. shouldn't really go more than like, a little bit above 200? Or maybe down to like the 150s? If you started at like 188.

Scott Benner 10:09
Push that then you imagine that the bazel is pretty steady, correct?

Jennifer Smith, CDE 10:13
Correct. If you accomplish that with little variants, but not a lot, and you wake up, let's say at 169, awesome, your bazel, we would hold it, check marked off in our box of records as stable tested, it's good. Let's move on to the next testing period. Now, let's say your bazel does show that it's not right. Let's say that 10pm, one at blood sugar, but by 1am, you're starting to see a drift up. That's significant. And by two or three o'clock, you're like 50, or 60 points higher than you went to bed at? Absolutely, there's something wrong. Now, where do you adjust? That's the next big question. People are like, Well, I was high at two o'clock. So I changed my bazel at two o'clock, so that it wouldn't be high anymore. It's actually it's kind of missing the boat, right? Because where you really want to adjust the bazel is about one to two hours prior to the drift being too high or too low start. Okay, so if you're too high by 2am, you probably need a basal adjustment, at least by 1am. Or maybe midnight, that's higher, so that you don't have the drift up in the next two hours. Yeah.

Scott Benner 11:27
And that's the end for people listening to get confused by that. If you think about Pre-Bolus, and you put insulin and it doesn't begin working for a certain amount of time, either does basal insulin, and you're using much less of it. So to get a real impact from it could take some time for it to build up its efficacy, I guess, right? And then not be able to hold you stable.

Jennifer Smith, CDE 11:48
Okay, correct. Yep. So that circulating insulin level at the great description, it needs some time to bump up or bump down right to the rate that's going to be then effective an hour to two hours from now at that rate.

Scott Benner 12:01
It's the same reason, same reason why when we tell somebody if your blood sugar is super stable at 70, and it's been like that for hours, and you haven't had any food or you know, insulin, and you want to try to bring it up by doing attempt down, you can but if your blood sugar's falling at 70, shutting off your bazel is not going to do anything to affect what's happening right now. Wow. You'll make your blood sugar high, two hours later, right after your seizure.

Jennifer Smith, CDE 12:24
Right. Exactly. Right. Yeah. Or after you had, you know, a 30 grams of a juice box or whatever. Yes, exactly. Yeah. So it's Same, same thing, you know, if you're drifting down, you adjust the bazel down a little bit, fill in the same timeframe, one to two hours prior to that drift, starting, so that you don't get too low, later. Now by how much? I mean, again, this is where it does vary a bit. But usually, you know, if the drift up is somewhere between like, if the like 30 to maybe 60 points higher or lower than you want to be within that time period, and adjustment by point 05 to the basal rate could be enough to make a change so that you're not drifting up or down. If it's more significant drift, and you're really rising like 100 points, you started at 188 by two as you're at 280. That's, that's a pretty big change. Yes. And again, we would probably adjust the bazel at least by point one, maybe even point one, five. Depending,

Scott Benner 13:32
you know, what's interesting is that I know this isn't like any kind of hard and fast rule, or it is, and I've found that by mistake, but I talked to a lot of people with kids, you know, younger children. And it seems to me that the rule of thumb is point one per 10 pounds of body weight with kids. I don't know, I don't know if that ends up working for adults or not. But the more people I talk to, the more I see, like that's what makes sense. And I don't know if it's an anomaly for me. But when you have somebody on a phone call with you, which you know, telling telling you something about themselves. And it's like, you know, I'm doing this and it's not working and blah, blah, blah, and you need somewhere to start like it doesn't you don't even you need somewhere to start. And I always ask like, well, how much do they weigh? And most the time it bears out but then recently I spoke to somebody, it wasn't even close. It didn't matter. The weight was unimportant that that child just did not use the insole in the same way. Right.

I think of bazel in a completely odd way. I think of it like volume. Right, like on a on a stereo. And I just think if you can't hear it, or if the base is not working, turn it off. And if it's too loud, turn it down. And because Arden's using, you know, a dexcom, g six, I, I just turned it up until she gets where I want to be, and then I dial it back a little bit. Is that a bad thing? Am I doing that wrong? Is that is that irresponsible? Which by the way, in the last 10 years has become a word again, I don't know if you know that. You're irresponsible. There was time grammar people would be like, that's not a word. You can't say that. And all the sudden, it's been come acceptable in like the last half a decade or so. So now I feel comfortable to speak improperly again. So you're responsible? Is it irresponsible?

Jennifer Smith, CDE 15:47
irresponsible? Well, I actually use that word with my six and a half year old all the time. So I guess I've been using it more appropriately now. And I thought, yeah, that is irresponsible to do that. Do not do that, you know. So,

Scott Benner 16:03
anyway, I

Jennifer Smith, CDE 16:04
don't think I don't think that that's irresponsible. I mean, you're doing again, and again, in the topic of bazel, specific adjustment, we talking about temporary bazel adjustment, we do that a lot, to dial it up to dial it back to kind of you know, and that's also the concept of looping, right, is that the system works according to what it sees happening to the blood sugar and the insulin that's active in the food that's active, and it may dial things up, and it may dial things back. So that's, I mean, definitely not irresponsible. When you're talking about setting through bazel, though, we really want to make sure that we set the the bazel rate itself in the profile the right way, and you can dial it up, you know, if you want to be truly bold with insulin, you may want to dial it up a little bit more than you think you may need do another bazel test, and then it doesn't work quite well, because now you're ending up lower than you want. And great, just dial it back a little bit in the adjustment that you made. But at least it'll be a better picture. Um, you know, overall, and you can always test over and over again. Most people hate vehicle testing, myself included.

Scott Benner 17:17
Listen, that's I remember getting the sheet of paper handed to me when Arden was two, and they're like, the first thing we're gonna want to do is bazel test. And I looked at the sheet like, Well, I'm not doing any of this, but okay, and you know, looking back, it really should have done it, you know, especially back then when there was no CGM, and you know, none of that stuff, and I really shouldn't have done it. But, you know, no food being digested, you know, no active insulin, like, how am I going to get like a little kid not to eat for five or six hours? And I did eventually figure out that overnight was the place to begin. And you can, to some degree, infer the daytime from the nighttime meaning meaning, you know, if it takes a unit an hour overnight, you're probably not five units an hour during the day, you're probably somewhere near that unit. Right. Right. Right. And it could be I mean, it could be significant i right now Arden is more like a unit overnight and more like two units during the day. Right. So in, but that also will go back and forth. The just, just I will say this, because you you alluded to it earlier, and you were just talking about the idea of bazel testing, like I know a lot of you don't want your blood sugar to be 180 or 200 overnight. But for this test, maybe that's what has to be, I'm really coming to realize that an incredibly flat line one that's 85 for 24 hours a day, is really not reasonable. It's doable, right? And sometimes you'll get it and maybe you'll get it for days in a row if you're really dialed in. But you can't be upset if a blood sugar goes to 160 for 45 minutes and comes back again. It just my blood sugar goes to 160. Like if I sit down to play two pancakes today, my blood sugar is going to be 160 probably for a couple of hours now. different situation, right? And I don't have the other impacts of Type One Diabetes like people with type one, two, and I get wanting to limit it. But everything we've talked about on this podcast for the last number of years, I've seen it intersect with Arden becoming an adult. And so do I think you can keep a 90 blood sugar forever if your kid hasn't hit puberty yet? I bet you can. Right? I think it's super easy. I think that when you get to puberty, I don't think you should beat yourself up if that doesn't happen. And and I can still do it most times you don't I mean, like don't get me wrong. But I don't know. Like it's it doesn't seem as important to me. It almost seems like a video game. Now when I step back, and I watch people online, do it, for instance. And they're like, look at this graph, and I'm like, That's amazing. And then there's part of me that wants to say show it to me 10 days in a row and then I'll get excited right like don't Just show me one in the middle of May and go, Hey, look what I did here. And that's why, you know, on my blog, I tried to put things up that are like, Look wrong, everything went today, Arden say onesies still under sick? You know, I don't know, I just I want you guys to realize that we don't want spikes when we get them, we want to bring them back down again. But if they happen, you cannot run around like you've lost some, you know, game that that's attached to your mortality somehow, you know if your blood sugar is always 200 Yes, but you know if it jumps twice, come on, like ease up a little bit. Okay, right. So how reasonable is it that once I bazel test, I'm actually going to know what my basal rates are. Normally, I tell you about the dexcom g six continuous glucose monitor about the share feature, you know, you can see your kids blood sugar when they're not home. Or you know, if you're an adult, and you'd like your parents still or a friend to be able to see it, you know, sharing files amazing. It's available for Android and Apple and blah, blah, blah. And you should do that. Wouldn't you be great if you could see the direction of your blood sugar and the trend lines and how fast your blood sugar's moving up, down all that stuff that you hear me talk about all the time, hundred percent true, but with the time that's left in this Dexcom ad, I'm gonna say this year, you are listening to the bazel adjustment episode. By now if you're still listening, you must believe how important it is to have your basal insulin correct. And while you can do it without a dexcom It is so much easier with one I mean, oh my god, it's so much easier. Go to dexcom.com Ford slash juice box to find out more about the Dexcom g six continuous glucose monitor. Let me sweeten the deal by telling you this story. It's summertime now Arden's home from school. Last night, she was up facetiming with friends from all over the country. And they were up way too late. So Arden needed to sleep in today. She slept till 130 in the afternoon. And I was able to keep her blood sugar from going below were high. While she slept all of that time away. All that think about that

6am 789 10 1112 one, no food, no intervention, just the information from the Dexcom to help me make decisions about her basal insulin. And those decisions kept her blood sugar between 70. And you know, 120 is where we get I alarm. But honestly, I never saw over about 95 dexcom.com forward slash juice boxes, links in your show notes at Juicebox podcast.com. Get started today. But before you do, let's talk about on the pod, the only tubeless insulin pump in the world, the insulin pump that my daughter Arden has been wearing since she was four years old to 11 years ago. And it has been nothing but the best friend we've ever had in diabetes. last day of school, Arden went to a friend's house to go swimming, had around the pot on last night, need to make an adjustment to her blood sugar picked up her PDM button button button. Just like that No tubing, she's laying in bed facetiming she's not wrapped in tubing, she doesn't have to bounce her controller on her head or stick it in her pants that doesn't exist on the pod was over on the dresser right there. just just just there, just reach over and grab it, push a couple of buttons, give yourself some insulin, take some insulin away, maybe a Temp Basal decrease. I don't know what you're doing. But trust me, whatever you're doing, you want it to be easy, and you want it to be good. And you want it to be wholesome and fulfilling and make your life better. And that's exactly what on the pod does. The best part is on the pod wants to send you a free, no obligation demo, they call it a pack a pod experience kit, they'll send it right to you right to your house. So you can try one on the pod for yourself before you make any decisions. My omnipod.com forward slash juice box or the links in your show notes or Juicebox podcast.com. No more ads, talking about basal insulin the rest of the way.

Other times I bazel test and then I don't have any better of an answer.

Jennifer Smith, CDE 24:05
There might be especially if like I said before, if you're doing some bazel testing, and there are variables at play that you didn't really think to pay attention to in that time period, then absolutely though that bazel test could be not very purposeful. It could be kind of null and void. And this is something I encountered a lot with women. And something I bring up when I work with them to begin with. And in a first visit is one you said you've done beta testing, but to see you know your cycle impact if you have one and two Did you bazel test in that sweet spot of like two to maybe three weeks whether women are on birth control or not. They're sort of like this two to three weeks of sweet kind of plays of management without significant hormone impact. And that's where beta testing used to happen. It needs to happen without the impact of Pre cycle or oscillation hormones kind of coming into play. So if you haven't been tested in those sweet spots, and you're completely wrong, what's happening and what your basic needs are. And once you do have that sweet spot to put into play, and other, this is an important piece that a lot of people ask about too, is great. So then I need to test in these other times, well, that really, you know, what we find is that women mostly need like a 25 to maybe 40% increase in a hormone specific time period of the month. If you know that what you can do is use the Temp Basal, ie How well does this work? And what you can do because the time periods during the day that your Basal goes up or down, physiologically, those times will remain pretty stable. Those shouldn't need to change, it may be that you just need 25% more between 6am and 10pm. Right. So you can plug that into a bazel profile, set it and turn it on or enable it when you need to. But those time periods of the day, they stay pretty stable. Once you've designated Oh, my basal needs go up at 2am. Up, they shift down again at ADM, they're pretty stable until four or 5pm, they might go up or down again. Another piece for bazel testing is that most most people, again, your diabetes may vary. But most people will have about Orwell, most people have one Valley and one peak to their bazel during the day. So let's say they start midnight at point six, it might go up to point eight by two or 3am. Maybe it goes down around 8am 9am to like point six again. And then through the day, it's phase kind of lower, and then it may shift back up into the evening time. Okay, so you kind of had one dip, but one rise through the course of a 24 hour time period. Again, that's most people, not everyone. Most people also have about three to five basal rates through the course of the day or bazel time periods. So, you know, midnight until 6am 6am until 4pm 4pm to 9pm 9pm to midnight, those time blocks. Most people have about three to five different segments of rate need. Through the course of a day,

Scott Benner 27:25
you have to stay flexible too. You can't just say to yourself, look, I've set this basal rate, it starts at 3pm, it ends at 7pm. It always works. And then Thursday comes in at five o'clock your blood sugar starts to drift up, and it won't stop drifting up. You can't lock yourself into that doesn't make sense because my bazel always works. It's not working now. And the reasons you know, I'll be talking about this throughout the years of the podcast, but the reasons are almost unimportant in the moment. The truth is your blood sugar Yeah, yeah, right. You need more insulin, use more insulin. And and I've come to start, I've begun to start saying privately that that the diabetes, your blood sugar, it's requiring more of you. So give it to it. You know, he's telling you something your blood sugar going up is is your body's saying hey, I don't have enough insulin. Don't like wonder why just believe it. You know, like, there's no reason to, I don't know, if you came up to an intersection. And there was a cop standing there with his hand up it says don't go around the corner. There's a guy with a gun there. Just believe the cop and don't go around the corner. There's no reason for you to peek your head around the building. Oh my god, there is a guy shooting there. Like just take his word for it and walk around the block. And so. So when your diabetes is telling you, Hey, I don't have enough insulin, just believe it and give it more insulin. I got this beautiful note this morning from someone who said they were listening to the last episode. And she said, I think she called it like a bat in the head moment where she was just like, oh my god, I'm an idiot. Why am I not using more insulin like like, you know, running around all day looking at her blood sugar going, what's wrong? What's wrong? What's wrong? What's wrong? And she said, We must have said something on the podcast. And she just was like, oh, but sometimes that that happens like because you get so narrow, focused on the things that are supposed to be happening, that you can't break away from them for a second and look at actually what's going on. You know, listen, this is good life advice, too. If you're fighting with a spouse or a girlfriend, and you're saying to yourself, I have the best intentions here. Why is she upset? It doesn't matter. She is you know, so you're doing something wrong. Forget figuring out what it is. You're wrong. Stop or you're wrong. Right. That's it? Yeah, I've given you a number of ways to think about this. Now, when your blood sugar is going up. Give yourself more insulin. As a matter of fact, Jenny my next t shirt is going to say more insulin. That's the next t shirt. I'm going to print if I can ever figure out how to have one absolutely deserves a T shirt. All right. Everybody's always like telling me it's so easy to print t shirts. How can you not figure it out? It's like I'm very busy. Leave me alone. But I'm trying. Anyway.

Jennifer Smith, CDE 29:59
Yeah, I do. That's also a really good point. Because if this is where you could also say, is it a trend now? It Like you said, 5pm, my blood sugar is going up. I don't know why I don't have any active food. I don't have any active insulin shouldn't be going up. I felt like things were pretty good up until today. Great. Well, you know what, tomorrow if it's happening again, the next day, if it's happening again, something shifted. Why? Again, don't play with the why I mean, you can go back and evaluate and look at some things and whatever. But in the moment, you say, you know what, it looks like my blood sugar starting to go up by 435 o'clock every day, and I'm high by six o'clock and I keep adjusting and correcting. Don't do that. Right? adjust it, make an adjustment and go forward. And then you know, what if it shifts back down, right? If a couple of days, you're ending up low, then you shift it back down again?

Scott Benner 30:50
Yes. See, you're you're highlighting something that I've never understood when people say to me how many days till I think it's a trend, and I should change. And I'm always like, Who, what, like by the time you by the time you suss it out three days later, it might go back again, now you've given away three days of your blood sugar at that level, get just learn. Don't ask your wife Are you really gonna wear those pants, like she doesn't like it when you say that to her right leg, Sue, so stop and don't don't do it again, like, my blood sugar went up at five o'clock, I did something about it. Tomorrow, it went up at five o'clock, I did something about it. The next day, I'm not even letting us get to five o'clock, right? I'm just gonna decide, I'm going to expect that what I know is going to happen is gonna happen. And I'm gonna deal with it ahead of time. And if it happens to not go that way, well, then I can dial it back again. But it's so much easier to ramp up your insulin and bring it back than it is to sooner than later.

Jennifer Smith, CDE 31:46
Many times doctors will say, Hey, you know, follow a trend over the course of a week, well, that's five to seven days, then that you have chunked out higher or potentially lower than you want blood sugars, because you're trying to find a trend. I mean, in pregnancy with the women that I work with, we say two days of a trend, we're making an adjustment. And you know what if we need to dial it back again, for whatever reason, we will, but we're not leaving things travel higher or lower. For more than that time period, we will adjust and then we'll adjust again,

Scott Benner 32:18
and for all of you who have ever said to me, yeah, I'm going to handle that the next time I go to my doctor three months from now, you make my brain hurt when you say things like that. Okay, just please do not wait three months to address something even. I just yesterday, had a person who won a giveaway that I did with dancing for diabetes, and they you know, we had a phone call together. And this person, this is great. A person in their 60s who decided to get a CGM and a pump and you know, very excited for themselves. And then she said, You know, I have a doctor's appointment July, I said, No, no, don't wait till July. I said, write an email right now. Hey, Doc, guess what, I'm getting a dexcom g six, and I'm getting an omni pod. Go ahead and send those prescriptions in for me, I want to do that right now. And when we get I'm excited to come to you in July, and I'm going to bring my new stuff with me, you can show me how to do all of it. And I said if you never make it there to show or maybe you figure it out on YouTube or somewhere, whatever. And you know, and and, you know, but or maybe they'll send a trainer to your house. I think that is the appropriate thing to say right? And and but but I was like don't wait till July. So because July is six weeks from now, six weeks from now you're going to tell the doctor what you want. They're going to wait a week because people don't do things right away for you. They're going to send in their prescriptions for you, then you're not going to get this pump for six months. If you get that like start today. Go right now. Be proactive.

Jennifer Smith, CDE 33:38
Yes, with technology the way that it is and electronic medical records and things like my chart and things that you can send back and forth. There is no to not communicate between with a doctor and you know what if you don't get a response from them within 24 hours, you call that office and you ask to talk to their nurse and you say this needs to get to the doctor needs to be saw and it needs to be taken care of.

Scott Benner 34:01
Arden's endocrinologist and I have been adjusting her Synthroid are just taking Synthroid and site ml now and we've we've been making adjustments by email. But what's taking and it's still taking a long time to get it straight. Imagine if I only made the adjustment every three months when I saw her art, it would be like a puddle on the ground. When Arden doesn't have enough Synthroid. She can't pick her head up off of the ground. She just slumped over and she's like, her blood pressure, her blood pressure gets incredibly low. And she looks like she's dying the whole time. And and so once she has more Synthroid, she sits right back up again. It's it's literally like grabbing a marionette bytestrings when she has an Synthroid. But if I had to only make adjustments to her medication quarterly, it might take us two years to get it right. And we might never because she's growing and gaining weight throughout that time.

Jennifer Smith, CDE 34:53
And think of her education in this time period to what would she be getting out of her classes and the ability to perform And any athletics that she likes to do and enjoyment of fun with friends and everything. I mean, that puts a major cramp in any age, whether you're a child or an adult trying to perform in work or whatever. I mean, any adjustment, it needs to be addressed in the here and now not waiting three months to say, Oh, well, Doctor, you can see my is such a child. I've been having a lot higher blood sugar's I didn't know what to do. But I knew I had an appointment. So I waited until I came at that.

Scott Benner 35:30
Yeah. All right, Jenny. We're standing in front of your house. And you had your garden hose in your hand, and your porch caught on fire. Would you stand there with the hose thing? Or the fire coming? You'll be here soon. I don't need to squirt the hose at this porch. Why would I do that? The fireman is coming. He's a professional. I'll let him handle just hold the hose. Get started

Jennifer Smith, CDE 35:49
with my hose.

Scott Benner 35:50
Yeah, why don't I just see what I can get accomplished here. All right. So bringing this all back to your baseline slim, because no one thinks about their basal insulin with nearly the importance that it is I spent the first 10 minutes of a conversation the other day explaining to a person what it was. And after I explained it, I had to explain it again. And and so and you can still hear people go so that's the level here like people on empty out there like so. And I get it like they're newly diagnosed maybe sometimes, or they never got a firm explanation. But we treat basil insulin. Like it's not important. And it's everything. It's it's so much more important like it. Can we say it all the time. Everything starts at bazel phaselis not right, nothing else works coming off of it.

Jennifer Smith, CDE 36:35
Well, and so many people think that bazel job is to bring blood sugar down. Right? Oh, many people I mean, people I've worked with who've had diabetes long term who've come in and you know, I look at their records to begin with and they are confused and annoyed that their basal insulin isn't letting them wake up at a target blood sugar. I just stay high all night long. Well, you're starting the night high. So something I mean, time chunks of the day. Usually where you are now it's because the hours ahead of that. Something isn't right. Yeah, it's not the here and now. It's the what happened before this that got you here. So let's look I wanted my diesel should is here, here and here. And it should be bringing me down. No, that's not fatal job Faisal. dabit. The whole just it if you didn't eat all day long, you shouldn't have much.

Scott Benner 37:24
Diabetes is like a time travel movie. I've come to think of it this way. Right? Like it whatever is happening to you in the moment when the cameras pointed at you has nothing to do with what's in the frame with you. It's not a it's not a murder mystery. It's not somebody stabbing you and going, Oh, this is what's happening right now. It's the guy in Act One, set something down on a table and enact 325 years later that thing is how come you blah, blah, blah, blah, blah. There are things in the past. And there's decisions you're making right now with your diabetes that are going to affect you in three hours, or six hours. And and it's not now so much like it's interesting to how people overreact to the idea of Pre-Bolus Singh originally, because when their blood sugars are out of whack when they're really first starting to get things together, and they're jumping up and down. They're so reactive to everything they see I did something and then this happened. And I always tell people, if you Pre-Bolus and two minutes later, your blood sugar starts dropping that has nothing to do with the Pre-Bolus nothing. That's why when you know when you guys hear me say Arden's blood sugar was at five and I Pre-Bolus there. Because she was stable at five for three hours, the Pre-Bolus isn't going to start working right away. I only needed her to get to lunch 10 minutes later.

Jennifer Smith, CDE 38:38
The only reason it would start working right away is if you physically had that canula in a vessel. Right on it was literally going right into the van tapping into her bloodstream. Right?

Scott Benner 38:48
So in normal situations, which Jenny's bringing up, probably because she knows we actually had a pump. Probably Nick a vein in Arden one and for two days. I couldn't we couldn't get her blood sugar to go above like 50 most of the time, until we finally just changed her sight and everything went back to normal. But that was anyway that had never happened before. That was crazy. For the I'm texting Jenny, like you should have seen that texted Jenny, I sounded like you guys sound but you email me I was like, I don't know what's happening. I wasn't with her. I was in Florida doing dancing for diabetes. My wife's at home going? Seriously. This is what's happening when you leave. And I was like, I don't know how to explain any of this. I said I've looped in Jenny, we're gonna figure it out, you know, but, but anyway, yes. The point is, is that timing of your bazel just as important as the amount of your bazel. And to Jenny's point, for those of you who are thinking that bazel is in charge, you're bringing your blood sugar down. It's not it's in charge of keeping your blood sugar stable. And I say all the time, it's a stupid thing. But do it with me here. Unless you're driving. Hold your hands together in front of you like you know in like the classic, you know, prayer prayer motion, right. Imagine yourself Body function and, you know, sugar on one side and your and your and your bazel on the other side, and they're both pushing each other towards the center. And when nobody wins, right, when your hands don't move to the left or your right, that's a good basal rate, when you start moving towards body function, then your basal is too high, and when your body function starts pushing you away, then your basal is too low, you're trying to just give the bazel enough strength to fight off the background things that are happening in your body. If, right, and when you eat, you know, a reasonably normal meal, that bazel should also, you know, help with your Bolus. But don't expect that if you're going to eat like an entire pizza that your point six bazel rate is going to be okay. Because it's not. And then so that's, that's another thing. So once you get done bazel testing and figuring out your bazel for all your normal times when you're just standing around being you amazing you. That's one thing, what about your basal insulin while you're eating? And those tests have to happen in real life, while you're eating? You have to say to yourself, when I eat a salad with a burger, my blood sugar tries to go up. I wonder what would happen if I did increase my basal rate during that? And you know, I mean, for those you've been listening for a long time

Jennifer Smith, CDE 41:15
or after that

Scott Benner 41:16
we're right, right, maybe it's pizza, it doesn't hit me for 90 minutes after I've eaten it, you know, or any other thing like French fries, or had french fries the other night, it must have made her high like four hours after she you know. So

Jennifer Smith, CDE 41:29
it's not the nothingness is understanding again, that's why we also start with the overnight test it because if you can wake up in target, you are not fighting being too low from excessive insulin dropping you and you're not fighting being too high and having to correct and add insulin in a time that you're most people are insulin insensitive in the morning, right. So we talked about things like adding fat in Yes, your background bazel. If you know it's solid and set to begin with, then you know how to play with that temporary bazel feature to accommodate for long term impact like that, that causes essentially a stress factor, it releases triglycerides into the bloodstream, which causes insulin resistance in the aftermath, it can last as long as 10 hours after eating high fat. So most people need a bazel increase. It's like fat almost causes your basal insulin dose to be reduced by 50%. So if you're running at a rate of 1.0, overnight, and you have this big ol awesome like cheese, meat lovers pizza night, you go to bed thinking man, I nailed that Bolus, I'm going to bed beautiful. I'm like a 103. I'm going to sit here all night, it's going to look awesome. At two o'clock in the morning, you're at 300. And you're like, what the heck, you know, where did this cut, its fat, usually fast starts to impact by about three hours, you get this like drift, and then you get stuck by and you nail it with insulin and you nail it with insulin and you nail it again. And then finally you might start drift down. By the time you wake up the next morning, you could have fought it ahead of time by using a temporary rate adjustment. If you know your bazel to begin with is set Well, you can increase using temporary bazel and offset the impact of that

Scott Benner 43:12
fat. I wonder if I can explain what's in my head correctly. Because when your blood sugar gets elevated, imagine it's 250 coming off of the pizza and you think oh, a unit brings me from 250 to 100. So I'll put it in a unit. That's great. But what Jenny just told you was you're at 150% need for your Basal. So the unit really just keeps replacing the bazel you don't have. So you put the unit in, replaces the bazel keeps you stable at 250. But you still haven't addressed the number. And so then you wait an hour and you go I can't believe that didn't do anything and you put it in another unit. It doesn't do it again, because you're still just replacing the bazel you need a yak up your basal rate and Bolus for the number. And remember, the turning up the Basal at midnight doesn't make doesn't mean it's going to start working really maybe until one or two o'clock in the morning. So what So in the end, let me get very close to the microphone. What you need. And I don't want to oversimplify diabetes is more insulin. That's what you need. You do not have enough insulin. It's your union that T shirt. I'm talking right now. I can't do this podcast forever people more insulin if your blood sugar is high. Hey, if your blood sugar is low, guess what? Let me just go at it right now. Less insulin. There you go. It's not difficult, right? It's difficult to imagine the whole thing, which is what this podcast episode is about. Like we're talking through a number of different scenarios where your basal rate means something. But I think that i think that's it at the beginning here. Jenny explained a more clinical way to do basal testing. I think if you have a CGM. I tell people when we're speaking privately, and they're like, how do I figure out you know, how much more bazel to use? I just go well, you know, if it's a kid and they're like, at point three, I'm like, well turn 2.4 and see what happens. You know, and as they start getting low, Put it 2.35 you know, and it has because your kids blood sugar's sitting at 200. You know, like, with point, you know, point three going in every hour, point four is not going to make them nothing, it just doesn't stand to any reason. Common Sense and diabetes is, you know, just like I tell people all the time, one of the best pieces of technology for managing someone with diabetes is text messaging. It is a absolutely, like pivotal way in how art and I deal with our blood sugar if you don't, if text messaging is a is a diabetes tool, and it the same way, right? Just trying things is a diabetes tool, like give it a shot and see what happens. You know, point four, Okay, now let's see what happens. Not enough. So

Jennifer Smith, CDE 45:46
even for little kids, you know, even the incremental of the smaller rate, you know, the point 05, or the point 025. You know, all of that is an option. It's not an omni pod, but it is an option on the tandem in the Medtronic pump. So that is an option to get smaller, incremental adjustments, depending also on what your sensitivity kind of seems to be. I think the only thing that we didn't really is like the daytime testing, honestly, you know, daytime means that if you really want to know what's happening behind the meal, to make sure that the bazel is doing its job, the meal can't be there, right. So if you wanted to look at morning time, you really have to, for adults, you can skip a meal, because you can deal with that. You can just you can slug it out until lunchtime, and go ahead and eat your lunch and just see what happens in the morning when you wake up. You know fasting blood sugar, you let it sit you don't bolus you don't take caffeine, you don't eat anything. You can have water, herbal tea, or whatever. Don't go for a 10 mile run either. Look at what happened. Oh, kids, I usually say you know what, if you can get them to sleep in a little bit longer, maybe on a weekend, at least you're going to get an idea behind what their normal breakfast time is in that morning time to see did the bazel carry them pretty well, or what I had one mother I worked with, not too long ago. She's like, he woke up and he just started playing with his Legos right away. And he played with his Legos for a long period didn't even care about eating breakfast. I'm like, awesome. Yeah, that was a bazel test. I was like, there was nothing there. no food, no balls, he was sitting and playing with Legos. Fabulous. We've got information.

Scott Benner 47:28
That's cool. That's excellent. Yeah, whatever you can do, just just but do it. Because you need to know. In the end, if you've ever spoken to me privately, what I'll tell you is, in a perfect world, if your Basal is right, your blood sugar is gonna be 90, it's gonna be 85 or 90. Now, I don't expect it to always be that. But that's your goal. And if that's your goal, then it's when you're at 150. It's not correct. And also, when you're bouncing all over the place. If you're one of those people who right now is struggling and your blood sugar flies all over. You may turn your bazel up and get a low blood sugar and think oh my gosh, that's because I turned my Basal up. But it again, it might be about the Bolus you use before. So you know, there's one thing I say all the time. That I think is how you start your Basal rates. First thing you have to do is find a level, just find a stability point hasn't really almost matter where it is just get your blood sugar to sit still. And if you have to nudge with food, to do it, or nudge with insulin to do it, it's fine. Get stable somewhere and start over even when things go crazy here. I'll say that the Kelly I'll be like, Listen, I said we're out like everything's out of whack. Like we got to find a stable points where we can start over again. And you know, you just can't I don't know. It's like It's like trying to catch up. It's like trying to catch up on you know what I mean? Like he you gotta wait till it lands. Anyway. All right, um, do you feel like we've covered it?

Jennifer Smith, CDE 48:53
For the most part, I don't think

Scott Benner 48:55
we have to. I appreciate everyone who reached out and asked about a more specific episode about bazel testing. This was it. I hope you liked it. Goodbye, Jenny. Ah, thank you for listening to the 11th installment in my diabetes pro tip series with Jenny Smith CD. Don't forget that there are links in your show notes to email Jenny or you can go to integrated diabetes.com if you'd like to hire her personally, and have these conversations private like with her. Thank you also to Omni pod Dexcom and dancing for diabetes for being such wonderful advertisers. And sticking with the show weekend and week out really makes it possible for you guys to get the show. And I appreciate honestly how easy they are to work with. You wouldn't see that behind the scenes but they're good peeps. If you just found this diabetes pro tip episode, go back and listen to the rest they start around Episode 210. Also something new you may not have noticed last Friday, I began to post a second episode of The Week called defining diabetes. In the short episodes, Jenny Smith and I will define a phrase from your daily life with type one diabetes. If you're a subscriber, this extra episode will just show up like you're used to seeing everything else, it will just populate your podcast player, you can listen to it whenever you want. Thanks so much for listening. I hope you have a great day and a better week. And a special shout out to all of you on Instagram who share the podcast so much there. It's amazing. Thank you so much. You're helping the podcast grow in ways that you can't even imagine. Before I go, I'd like to share something that I imagine that most of you who have been listening for a while understand. It took so much restraint not to call this episode Jenny's but but I did it. I'm an adult. And I use the diabetes pro tip series because that's what this is. But when Jenny said she made a bazel rate called but I was like oh my god. This episode should be called Jenny's but, or but bazel or Jenny's but bazel I don't know. But I just so hard not to do that.

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