#350 Diabetes Pro Tip: Bump and Nudge II
Scott Benner
Diabetes Pro Tip: Bump and Nudge II
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, everybody. Welcome to the 18th installment of our diabetes pro tip series. This episode is diabetes pro tip, bump and nudge. This episode of The Juicebox Podcast is sponsored by Omni pod Dexcom and the Contour Next One blood glucose meter, you may be eligible for an absolutely free meter. Find out more at Contour Next one.com and the Dexcom g six continuous glucose monitor the same CGM that my daughter has been wearing for years. Find out about that@dexcom.com forward slash juice box. And of course, the tubeless insulin pump. The end all be all of insulin pumps. The Omni pod is available at my Omni pod.com Ford slash juice box. And when you get there, you can get a free no obligation demo of the Omni pod sent directly to you. Welcome to another edition of our diabetes pro tip episodes. Today, I and Jenny Smith. You know Jenny from integrated diabetes, Jennifer holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She's a registered and licensed dietitian, a certified diabetes educator and certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. Jenny is absolutely the bestest. She is. If you don't believe me, go back to Episode 210. And start over with the diabetes pro tips. Honestly, if you're just finding this series, check out diabetes pro tip comm you'll be able to see them all or like I said, you can go back to Episode 210 right there in your podcast player to get started. these really are designed to be listened to in order. If you're new to this, starting at the 17th episode of the pro tip episodes is probably not the way to go. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, please also always consult a physician before making any changes to your health care plan. or becoming bold with insulin. Alright, you ready to talk about bumping and nudging? Here we go. So let's start like this. I just put up like the 300 and 45th episode of the show, which is mind bending to me honestly, what was the first first year first up because you'd been blogging for a long time before I blogged from 2007 consistently until 2015 when the podcast started. And now I have to admit the blocks a little more of a way of me sharing, I don't sit down and write from my heart as much as I used to. Because, right, it's so much easier to do on the podcast, and you reach more people. But I blogged for that many years the blog was strong, it was a million million and a half clicks a year 111 block of maybe two or three years, I got to like 2 million clicks, which was really big. But then I saw it kind of like trending away. And so in 2015 I started the podcast. And I really thought it was going to be I guess this isn't maybe a neat place to say this. I thought I was going to go back and read my most popular blog posts, like into this microphone. Because that was my expectation for us. Like, you know, some of these blog posts are really helpful to people. I'll read them and make them audio. I did that for 20 minutes one time, stopped, deleted the file and was like, This is stupid. Yeah, yeah. Nobody cares about this.
Jennifer Smith, CDE 3:40
And well, I can't say there are some people that would care about that. I've actually got a couple of clients who really, they love the podcast because their their audio. And when they read things, it doesn't stick. And so they have to reread and reread. And finally some of the adults that I've got are like, I just put the book down, because they're like, I can't keep reading. I'm not retaining it. But if I hear it, it's there. It's in my brain. So
Scott Benner 4:08
no, I hear that I and I should just felt boring to me. Like I thought someone would like it. But I mean, if I'm being honest, I was trying to reach more people, not just, you know, people who would literally be willing to listen to somebody read something dry. You know what I mean? Right? I mean, at least put some music behind it. I can imagine how funny that would be if I was reading with music behind me and there was like this guy's talking about it would be terrible. Yeah. And then it picked up and picked up. And, and like, you know, but for people who may be coming in late to it. After a number of years of the podcast, I started thinking there's like a real system here. Like I knew that while I was blogging, but when I could hear it, I thought oh no, it's this piece in this piece and these these four or five ideas and when you bring them together, there are 5581 say like you just do these things and that's what happens you know, and I And I had had you on the show, maybe twice. Mm hmm. And I always wanted you to be back. I thought she's the best guest I've ever had. Like, I mean, honestly, you, when you when it comes to diabetes, you and I think exactly alike about it from two completely different perspectives, which is right, weird and interest. Nice, right? Yeah. And it's nice. And so I was somewhere one day, and I thought I know what I'm going to do. I'm going to take the tenants of the podcast and break them down with Jenny, if she wants to do this, I'm going to get a hold of her and see if she wants to do it. And that was a weird leap for me, because until then, my real belief was that if you just listen to all the episodes, you'd hear things come up very kind of organically, and they would stick to your brain better, because you heard them conversationally, and I was a little scared to do just specifically with more bulleted specific topics, but then I realized I could do it with you. Because we have a rapport. Like, I've talked to other people in the podcast, and I try to talk them about stuff. And I find I'm stopping and starting and like, I'm like, oh, they're talking over me. I'm talking over them. I can't find a vibe, you know, I knew I had that with you. So I contacted you. And you were like, I'll do it. And at the time, I was like, it'll be like six or seven, Jenny. And I sent you a little list and you were really great. Like you took the list and you were like, I'd put them in this order. I think they make more sense in this order. And I was like, Okay, great. And now I'm going to look, I'm actually going to diabetes, pro tip comm now because that little idea now has its own website, which is even strange. It's great. 1-234-567-8910 1112 1314 16 there are 17 pro tips. And this is going to be the 18th one, and then we're going to do pregnancy and we're gonna keep going right? And it's spawned like defining diabetes, which I never thought was a thing that was needed until this one person sent me a note that said, Hey, I wanted to thank you. Because until I listened to the podcast, I didn't realize I was on MDI. They took and you told me that right. And that made me think, wow, there's some people really not understand some of the terms we're using. Let's define the terms for them, but simply not an hour conversation. Right. Right. A little bit. Anyway,
Jennifer Smith, CDE 7:21
through that also not a not a dictionary definition. I think, as I said, you know, before some people get things because they hear it in a different way, or they read it in a different way. And I think the great thing about the podcast too, even with the pro tips, part of it is that it's broken down much more like layman's, applicable, it's, it's not what you get in a typical doctor education clinic. And we did
Scott Benner 7:45
it a couple of times. And I was like, Damn, this is good. It went so well that I was like, give me your address. Jennifer, I am sending you a microphone.
Unknown Speaker 7:54
sounds better.
Scott Benner 7:55
Let's go. But one of the things that we did was bump and nudge, it gets talked about in the episodes, but it doesn't have its own episode. And I always kind of thought that was okay. Until in the last year. I looked at algorithm based pumping, and saw how my bumping and nudging was too much. It had gotten out of hand and it didn't realize it because it was so easy for us to do that. We never looked back at the root cause of why we were bumping and nudging. And so this has been bothering me for like six months now. And I said the Jenny, I need a pro tip episode on this because not that bumping and nudging is a bad idea. It's a terrific idea. Right, but you need to understand it more. It's a bigger topic than I thought it was. Mm hmm.
Jennifer Smith, CDE 8:49
And I think you really I think you really like realized it when you guys started using to do it yourself. Right? As
Scott Benner 8:58
soon as day one came.
Jennifer Smith, CDE 9:01
We talked and I was like, how much are you using Temp Basal? Yes. How much? are you adding little micro corrections or adjustments or whatnot through the day? And you're like, Oh,
Scott Benner 9:10
I don't know. I never thought about it before. So So Jenny's The one who said it to me, because we were trying to find it was such an easy thing. Like you guys would hear me say before, like, I don't know, artists, insulin to carb ratio doesn't matter to me. I don't know what anything is. none of it matters, right? I know, we're basal rate. And I know food. I look at food and I see food. But
Jennifer Smith, CDE 9:31
you're like, Oh, that looks like five units. Oh, that looks like I got to split it up and give some now and a whole bunch later. Right.
Scott Benner 9:37
Right. And being flexible, which is terrific and important. What I didn't realize it was doing to me. You have to kind of like step back and look at a timeline of months, maybe the develop into years is that at some point, you know, meal x took two units at this bazel rate of whatever it was and Then it took two and a half, and three and three and a half and four. But it happens so slowly, I didn't notice. I didn't realize that I was now bolusing, six units for something I used the Bolus for units work. I mean, I did. But I never stopped and thought, I wonder how much of this meal insulin is attacking the food and how much of it is staying in our system for hours afterwards, and maybe acting as bazel. Right. And so I had bumped so much with insulin that I lost track of what Arden's baseline need was, it didn't matter because we were doing so well. But it didn't matter. And I learned that when I when I said, I don't this algorithm won't work. This is ridiculous. Her blood sugar's all over the place, right? It's just crazy. And it's because I had lost track of how much insulin we were actually using versus how much my settings said, we were using that did I say that clearly how
Jennifer Smith, CDE 10:57
much was actually needed, versus how much you were just intuitively correcting with right adding a little bit extra because you needed it, but not really realizing Hmm. In general, I'm always adding extra here. And it probably is a setting issue. It's an I shouldn't be adding this much more all the time,
Scott Benner 11:18
right. And it becomes such a way of life. Right? I didn't think of it anymore. So now, I want to leave that thought here. And we're going to come back to it later. Because I do think that being fluid around diabetes is incredibly important. And that you can't just keep resetting your basal rates every day for all the variables that are going to come up in your world. And I noticed a long time ago, that idea that concept is what causes people problems, right? The idea of like, well, I'll go to my doctor. And we'll find a basal rate. And oh, my doctor was great. They saw between 2am and 4am, we had some highs. So we moved our bazel, up at 1am or 12:30am. And it worked. But then they started getting low, you know, a couple weeks later, but I just fed the lows for two and a half months, then went back to the doctor, the doctor moved the bazel again, and that's how people that was considered a successful use of your physician and your insulin, right. And it probably still is in many people's minds. I saw that and thought this doesn't work. I don't want to be involved in this. And I've said it before. And I'll say it again, this podcast is a it's partly in place, because I don't like the math around diabetes. I don't like the waiting. I don't like the we'll wait and see. I don't all that stuff makes me uncomfortable. Like all the things that you're supposed to do. I just was always like, oh, that seems wrong. Like I don't I don't want to do that.
Jennifer Smith, CDE 12:53
within it. I think you also have to say that the technology that we have available today makes it more user friendly for people to learn how to make their own adjustments in the here and now. That might work then for a while and then they make more adjustments. But you know, years ago without technology, going to the doctor every three months, every six months, like I used to do when I was younger? That that was the wait to make adjustments now. Could we have taken and done more the more data analysis in between the doctor visits we could have in my mom actually did. She was like, This isn't working anymore? Let's just adjust here, let's Nope, you need some more insulin here. And I don't
I don't think she ever like,
you know, set it like that. But her explanation was always like, Well, this was just too high. And if it's going to be too high again tomorrow, then you're just gonna use more insulin for the next meal. Right? Right.
Unknown Speaker 13:51
Okay, my Whatever. I'm
Scott Benner 13:53
with you, you're cooking, right? So you seem to care. So I'm gonna go right here. But another issue in the space of people talking about diabetes in the past. It's kind of it's a number of folds, but one of them is that nobody ever wants to say too much, right? They're always like, worried that they'll say something, and it won't apply to the third person that hears it. And I so that was part of what the pro tips were for was to take information down to a point where you know what this really does apply to everyone. Like not saying things that only worked for you or me or noticing that my daughter needed something different after she started getting your period than she did before. And taking the time to talk through those differences were writing about it is hard because you write something down. It's static, you know, I write a blog post around about my nine year old daughter. somebody reads it, it now feels like a rule. I don't spend time with my nine year old child is going to be the applicable method that I use and you don't take time to philosophize out that I bet you this will be different when she's 15. And you just Writing doesn't work that way. But you can conversate that way. And so a lot of people in the past who were impacting the diabetes space, were parents of younger children, who until your child gets older, you don't realize you think this is diabetes, but this is diabetes. In a kid that's not, I don't know, like, coursing with hormones or growing as much as you think. Or as active as you believe they are. Like, you know, like, when you're eight, you're like, Oh, my kid plays baseball, like yeah, okay, wait, or your kid really plays baseball, like like, Right Whale, they weigh 200 pounds, and they're flying around, it's 110 degrees outside, and they're throwing things through walls like it, it's an impact on your body weight, or your kids playing ice hockey, as a high schooler, like, you know what I mean? Like, we've got
Jennifer Smith, CDE 15:51
breakfast from six until eight in the morning, they've got practice, again, from you know, four until eight, six o'clock at night. I mean, sometimes, those practices I'm amazed with the kids that I work with, their parents are like, Oh, she's got tennis for you know, from six o'clock until 730. And then she goes off to school, then she's got another practice from four to six and like, like, seriously, like, she's the tennis thrower.
Scott Benner 16:15
That's how you make a tennis pro. One in a million times. The other 990,000 times is how you make a kid who hates tennis eventually, right?
Unknown Speaker 16:25
Okay, exactly what
Scott Benner 16:27
these people were doing great stuff. And they were talking about these ideas. But they didn't realize how specific they were to the age group they were talking about. And, and I think that that's why this longer conversation why I mentioned how long the podcast has been up has been important, because in my heart as crazy as it sounds, I think if you want to have great success with your type one, diabetes, go back to episode one. And you'll listen through, because you'll take a journey through somebody who's talking about a kid with a nine or 10 year old body that, you know, you actually can hear in this podcast art and get older art and grow art and have problems her start to get her period, changing devices, meters, like all the way through me. And I know it sounds crazy, but in, you know, 347 hours as of today, I think when it's over, you'll go Okay, and then your kids just gonna have anyone seeing the fives it like if you want it to be or maybe you you'll make an adjustment. It'll be in the sixes, right? It'll also works for adults. And that was I was really cool. I hadn't had that, like greater expectation. I thought it would, but it didn't have a lot of a lot of adults weren't reading me as a blogger. You know, do you mean, there were some, but there weren't a lot. Anyway, at some point, I recognized that I was really long winded, I guess the people there, I guess there are used to that. Not at this point. But it's a very long way of saying that you can't just set your basal rates up, set up your insulin to carb ratios, and go with that's what the pump told me. And that's what the doctor told me to put in the pump, right? Because things are going to change, sometimes day to day, sometimes hour to hour activity to activity, there are going to be too many variables. And you can't stop every time like imagine if I had to get up tomorrow and go today is going to be a sedentary day. I will now go fix all of my basal rates for sedentary and change my insulin to carb ratio for sedentary By the way, do you realize that that could end up for some people meaning more for some people meaning less, it could end up meaning less for Basal and more for insulin to carb or vice depending who you are and what you eat. And so when all that exists, what ends up happening to people is they just go Ah, today was a good day, today was a bad day. Right? They leave the settings and then they have good days and bad days. And what I thought was, if we stay fluid enough, you can almost be ahead of what's happening and make these adjustments. Okay, right. All right. That's a long, long explanation. But to me, that's what led me to bumping and nudging. Now, for context, while Jenny and I are talking about it, I think of bumping as using insulin, bumping your blood sugar down. And I think of nudging as nudging your blood sugar up with carbs. Jenny thinks of it the exact opposite way. So don't get confused. If one of us does one thing and one of us does the other. But in the end, the idea is to keep yourself between these smaller parameters. Yeah, right, arrange a smaller range.
Jennifer Smith, CDE 19:39
And the range is defined by you,
Scott Benner 19:41
right? Doesn't matter to me what range you choose.
Jennifer Smith, CDE 19:44
Right? It's it's your chosen range, but the idea is to use food in an insulin and in a good advantage in both directions so that you can stay within that target,
Scott Benner 19:56
right. And so some of the things I learned as I
Jennifer Smith, CDE 19:59
was able to could see us by the way, your hands
Scott Benner 20:03
around good, bad. Oh my god, you keep saying that out loud. And someone's gonna ask you to turn this into a YouTube thing and then we're gonna be on camera and neither of us are going to be happy about that. Because you're gonna have to hang up that stuff behind you and I'm gonna have to get a haircut right. So
Jennifer Smith, CDE 20:19
which by the way is just like bags and you know, it's not random strangeness. It's like bags and like coats. That's it.
Scott Benner 20:26
Jenny is now apologizing for something you can't say that's very Midwest of you. By the way. You're like, Oh, it's it's not unclutter. It's nice people, it's a very important thing for the children hanging their bags.
Jennifer Smith, CDE 20:40
The easiest for them to get to.
Scott Benner 20:43
We're off topic now. So anyway, so I'm gonna do a little thing here. And please jump in whenever you want. In my mind, I take the I guess I should first say that I understand this would be more difficult without a continuous glucose monitor. I really do. What I'm saying would be harder, you could do it. I still think you could do it, you'd have to do it a little less aggressively, probably. And you'd be testing more but but what in my mind, what I see is that graph that goes along my daughter's Dexcom has a high line and a low line. And I take those lines from running. Oh, my God, which way is this? Is this parallel? to the ground? Yeah, it is. Right? I correct? Well, yes, I was asleep a lot in high school, nothing to this podcast, just so you know. So I take those two lines that are spaced apart evenly, that run parallel to the ground, and I flip them up on their end. So they're a little vertical, they're running vertical in my mind. And now they are a video game. To me. They're like driving, right? There are it's a football field, I don't want to run out of bounds on the left, or on the right. That's all it is. To me. There's in play and out of play. So when I describe it, and like talks, I discussed it like driving is interesting because it's um, you make a lot of imperceivable moves when you're driving that if you jerk the wheel around, you swerve and you don't want to do that. So as you notice yourself approaching a, you know, the shoulder, you just turn the wheel back a tiny little bit and you come back into toe again, right, like you're, you're it comes back. Same thing with you know, if you're going to cross into the other lane, you just come back a little bit, you don't jerk the wheel around, because if you drive the wheel around, you end up in the in the ditch or in the other lane, or you end up with much higher or lower blood sugar's than you mean. Right? So I bumped myself back, I bump, you know, a nudge back. I used that insulin to help Arden stay in range. The problem that comes with jerking the wheel is that once you're in the ditch, you have to overcorrect again. And then you're on the roller coaster. Right now I've said rollercoaster which now takes the graph back to being you know, the way it belongs in your mind for a second not vertically, but you're up and you're down and you're just overcorrecting the whole way with food with insulin, and you get the timing of the insulin so far off that some people eat done doesn't stop. It goes, it goes into and you just keep going that way. Yeah. For for not just for a day, for weeks and months and lifetimes of just that's what my blood sugar does. It bounces up and down. And people say that it's heartbreaking me like No, just turn the wheel a little less like right, like, right, it's okay. I understand how it happens. And I think there are ways out of it. So I want to talk about some functional ways out of it. I guess people should understand the difference between a falling and a drifting blood sugar. So why don't you talk about that for a second?
Jennifer Smith, CDE 23:57
Yeah, drifting is slow. And dropping is fast. I think that's the easiest way, drifting down and or even drifting up, happens gradually over time. So again, if you're using a continuous monitor of any kind, you'll see this slow, continual change in blood sugar, little little nudges, kind of happening over the course of time. And since on all CGM, each of those little dots on your graph represents about five minutes, each little drift up or down. Could be a change in glucose over a five minute time period, right? Yeah. So drifting being slower means you have more time to implement a change right now. That could also be a smaller change, than having to make drastic adjustments with food or insulin, right. When you're doing Dropping or rapidly rising kind of the opposite. That requires more whether it's more insulin or more food, it requires more because the change is happening very quickly now. And usually I see drifts happening either with a horizontal arrow on your CGM. Or you might get that slight angled arrow either down or up. That's I consider those drips, yeah, I consider drops or rapid rises, when you've got arrows pointing straight up or straight down. That's fast. So you need to do something now.
Scott Benner 25:40
And so to start with lows, if you're 75, straight down on Dexcom, that could mean two or three points per minute. Is that right? So every five minute change, you could go, you could end up moving 50 up to 15 points or something like that. I don't hold me to that. But fast is the point. Correct? So yeah, you don't like you know, when you're, when you're 80, straight down, you don't say, Hey, you know what, I'm just gonna, I'm gonna do a Temp Basal off for a half an hour here, that's not going to work. And there's reasons prior in the diabetes pro tip episodes, seriously, listen to them in order that will make sense to as why. But if you're just drifting down one of those situations where it's noon, and you're 100, and then it's 1215, and you're 95, and you just got this little drift happening, you could possibly be at the end of a bolus that ended up being a little too strong, right. And maybe there's, you know, an imperceivable amount of insulin left in there, quarter of a unit, a half unit, depending on your size, maybe it's two units if you're an adult, right. And if you take away your basal insulin right there, it's possible that you can trade that extra bolus that's left and create. What I sometimes talk about is like a black hole of Basal, right? So keeping in mind that everything you do with your insulin now is for later because insulin doesn't work immediately. Like, what if at noon, when you started to see that drift down, you took some bazel away, and that created a level. So now at the end of that, too strong Bolus was acting as your bazel. And your bazel wasn't there. But keeping in mind, if you shut your bezel off at noon, it's not going to probably start impacting you for at least one o'clock. Yeah, right for a while. But at the same time, you were only drifting Anyway, it was probably going to take you an hour to get from 100 to 60, where you'd then be drinking a juice. But instead, as you're hitting that 70 Mark, you're all the sudden into the timeframe where there's no basal insulin, and you just level out, that doesn't always work. I've done it and thought I'm a genius. And I've done it and thought, Oh, I missed that like, but trial and error will teach you because there are a lot of different.
Jennifer Smith, CDE 28:01
And I think some some visual into that, too. As you said, You know, sometimes it works. And sometimes it didn't quite hit the mark. But you weren't necessarily wrong to take these away. I think especially again, with the technology that we have today, not only can you see the drift, but if you are somebody who's using an insulin pump, you also have the visibility of insulin on board, right. So if you have an idea how much insulin is left, like you said, an earlier bolus, maybe you were a little heavy handed in it, or it was just you know too much, because you haven't quite figured out your ratios, or maybe it was, you know, a guesstimate completely, or whatever it was, you still have some insulin on board, if you have an idea of where your bazel is right now. And you know how much insulin is on board, taking bazel away could substitute for some of the iob that's left? Absolutely. And like you said it could nicely smooth things out and you just drift into a stable blood sugar. That might work if you've got iob of one and your basal rate at that point is like point eight or point nine or even one that could absolutely smooth out if you've got three units of iob and your Basil's at point five, not gonna hold you to half you in a way it's going to help a little but you're still going to ask him
Scott Benner 29:17
to get the result. Right. All right. So in my mind's eye Alright, we're gonna do it quick. The Contour Next One blood glucose meter is the finest blood glucose meter I've ever used with my daughter. It is small, but it fits in your hand nicely. It's easy to read during the night or during the day has a bright light for when you're checking blood sugars at night. And the blood test strips allow you to go back in to get a little more blood if you miss the first time. All these things together, coupled with the fantastic accuracy of this meter, make it my choice. That's the best blood glucose meter out there. Go to Contour Next one.com Now to find out if you're eligible for a free meter. And if not, meters aren't that expensive. Just ask your doctor say something like, hey, I've been using this old janky meter forever, I want to get it Contour. Next One. And I bet you that it'll be about as much effort as you have to put into it. All right, what's next Dexcom g six continuous glucose monitor is what's next, see the direction and speed of your blood sugar at a glance right there on your iPhone or Android share a loved one's blood sugars, those same numbers, directions and speeds with up to 10 people. That means that if your child has type one diabetes, or you do, you can share your blood sugars, and the alarms and everything that goes with it, it's up to 10 loved ones, through the magic of the internet. dexcom.com forward slash juice box to find out more. This is an indispensable tool, you hear me talk about it all the time. If you don't have a dexcom Today is the day to find out if you can, if you should, if you will. And you can and you should. And you will dexcom.com forward slash juice box. My omnipod.com forward slash juice box will offer you a free, no obligation demo of the Omni pod right there, come right to your house. That's an insulin pump demonstration that you can wear. Try on, see what you think, in the comfort of your own home. After that, you decide I want this on the pop thing, contact them back and you're like, yo, yo, let's do it. And you move forward where you don't want it. They don't bother you. It's no big deal, right? They're not gonna, they're not gonna, you know, I'm saying they're not gonna shake you down. They're like, come on, we sent you a demo, they're not like that, but just want you to have the demo. If you like it, you like it. If you don't, you don't, but you be the judge. And you can be that judge by going to my omnipod.com Ford slash juicebox. There are also links in the show notes of your podcast player, and that Juicebox podcast.com. Please support the sponsors. And now back to bumping and nudging.
In my mind's eye, years ago, I used to think of scales. So think of like the scales of justice, where each side has this big dish and you could, you know, pile weight, you know, and so think of insulin on one side, and carbs on the other or weight, the weight of your blood sugar on the other. And you can kind of imagine yourself throwing in a little on one dish and going Oh, that was too heavy and taking a little out. And you know, we're taking some out, like that's how I think of insulin, like put a little intake a little out. You know, and then, you know, I say a lot on the podcast, and that I think we talked too much just about how insulin impacts the number. And there's so many other things to think about how food impacts insulin, right, like, like, you'll hear me tell a story about like, creating a drop, and then catching it with food. And right to me, that's how the food impacts the insulin. And it's just, there's, it's a weird thing. But there's a lot of different ways to think about what's going on that little game that's going on in your body between, you know, the sugar that's in your blood, or that's going to be in your blood or the foods that's going to put the sugar there and the insulin that's trying to take it out again. So anyway, you can bump with a Temp Basal, right? It just is like to take it away like Jenny and I have explained. Also the same goes for going up. If you see, you know, a 90 that turns into a 95 it turns into 100 it's going to be one of those slow drifts up. There's nothing worse than that, in my opinion, I always think of it as the, um, the mountain climber on the prices right? That because every time you're like it's gonna stop, there's no way that guys falling off the end, they're gonna figure this out like and it just totally who and it just goes on forever, right? And then that little guy just pops off the end. And then Drew Carey takes your money back from you and you're screwed. You walk away. Right? So like, you see this 90 blood sugar that's drifting up. Two hours later, it's 250. And you think I did something? Yeah, like I should have done something, you know, maybe that's a Temp Basal increase, maybe it's a Bolus. But all All I know is that a 120 or one, you know, whatever you wherever you decide to be diagonal up, can be brought back to a stable 90 with far less insulin than it will take to address the 252 hours later. Correct. And when you're only using small bumps of insulin, you're very less likely to cause a low and so when you see that 120 To me, that's you approaching, you know the the line on the side of the road. And you just want to come back almost an imperceivable amount with the wheel or the tiniest bit of insulin to bring it back in line now, right? I have done this with my daughter for years with an amazing amount of success. And I've seen people, scores of people who listen to this podcast do it too. And it works. It really does. But the idea is that you're not always going to get your Bolus, right. You're not always going to have the right amount of Basal going for your specific situation that's happening right then in there. Correct? Wow, I'm more I think you're with me. Don't tell your husband.
Jennifer Smith, CDE 35:45
I think you know, and two of you want, if you wanted to add some definition to like people always ask, Well, how much? How much when I start to see this drift? How much should I add? Well, you know, one, again, everybody's physiology is a bit different your sensitivity to insulin. So a point one might be what works for you a point seven might be what needs to be in, you know, somebody else's case. But I think if you give definition to direction of blood sugar, again, using today's technology, beneficially. And you mentioned before, kind of the directional arrows, and what that indicates, as far as a drift up or a drift down, and how much is happening. If you're wondering how much to add with insulin, when you do start to see a drift up, the angled arrow is really kind of a rate of change of about one to two points per minute. Right? So if you're aiming to see, okay, I'm at 90, I've not done anything. And now my blood sugar, it looks like it's starting to come up. I don't know why, but it's happening. If you excuse me, you know, experience that a 90 with a angled arrow up one to two points per minute in the next 30 minutes. If you do nothing, your blood sugar could be 30 to 60 points higher. Right? Right. So if you use that to your advantage, and you say, Okay, I could be on the low end 30 points higher, it could be one at 120, I kind of know what I would use to offset, you know, a 50 point rise in my blood sugar, maybe I need to just add a little bit like point two, or maybe I need to take a point five extra, you know, that's kind of a way that's a little bit more, if you're the math person right, may help you to get a little bit more precise and not worry about then ending up on the downdraft later.
Scott Benner 37:39
And if you are me, what you do is you try something and then the next time you try something different if that didn't work, right, less or more, yes, just more or less whatever try. And it's important to remember that it's not, you're not going to get it right the first time. And even if you do get it right the first time, the variables may change the second time it becomes an art, like it really does like just knowing how much to push just a little bit like you know, you squeeze too tight and it's too much you're not laughing you're let go. And and using Jenny's example right there and flipping it to getting lower. You don't always need the whole juice box, you don't always need every piece of candy in the package that sometimes you can nudge with food, right. And I know that 15 carbs 15 minutes is the rule of thumb. But if you're using a CGM, you can see it better. You don't have to 15 carbs 15 minutes is when people are blind to what their blood sugar is. And they're trying to stop themselves from having a seizure. That's important. I'm not saying no. Okay, and I'm not telling you not to do it. But I'm telling you that if you do it, and find yourself to be 300 later, you didn't need all 15 carbs, right. And, by the way, if you do get into a panicky situation, and you've got to just horkan carbs, I'm not going to tell you to not do it. What I am going to tell you is that when you when the dust settles, you need to figure out how much insulin you've got a bolus for that food you just took, right right like maybe not for all of it, but some of its going to need insulin you have to stop the bouncing you've got to make sure you can't get on that roller coaster like don't get on it. it's maddening. And the only way off of that roller coaster By the way, in my opinion is you stop taking in carbs and you get back to level again, like like I can listen I can knock Arden off that roller coaster while she's still eating but that is a ninja level event. Like like you need to be really good at that to stop to stop a roller coaster in between food
Jennifer Smith, CDE 39:46
and you'll get it takes understanding sensitivity. Are you very well known and I'm sure Arden does as well. You guys know her sensitivity and you've paid enough attention to say okay, we need this much right now. Because of all of these other variables in the picture, or you need this much less right now or whatnot, and you do get to that level when you start to pay enough attention, you know, to your personal sensitivity and the precision that you need. Um, I think you know, the 15 and 15 is age old. I mean, that's what I started with 32 years ago, it's 15 and 15. And we didn't have the visibility of blood sugar changes at that point, we didn't or even
Scott Benner 40:26
meter by the way that only takes a tiny drop of blood, right isn't and this beautiful Lance that, you know, it doesn't hurt that badly while you're doing it, you were right stabbing yourself with a sword dumping or dumping your rocks in a way we kind of
Jennifer Smith, CDE 40:42
called it the guillotine It was like this big old drone that like hammered down on your finger. And like I would like I would like inch my finger like slightly away from like the little underneath platform from where it like jabbed my finger, I would like just hold it back. So it didn't quite jab it. That was my like, adjustment to the land set depth, right, that was the only adjustment I had at that point. But your point being really that you have some tools now that allow you a lot more precision in how you bump in know you do. And with smart tools. Today, too, I think this is a good place to mention it is with our, with our smart hybrid closed loop systems that are on the market today. That adjustment with carb, the 15 and 15 is 100% too much 100% too much with most of these systems on the market today. When you're adding a little bit of carbohydrate, we're talking like a little bit of carb, because the system has already been helping you coming into this drop in blood sugar. So 15 grams, hundred percent is going to be way too much. You might need two or three Skittles, which is like two or three grams of carbs, you might need half of a glucose tablet, you might need a quarter of a juice juice box. So
Scott Benner 42:06
what you know, I want to go a little deeper into this, like faster rises and falls. You see people online every once in a while it's very common, actually. They're injecting and they all put in the measurement for their slow acting insulin as fast acting by mistake like oh, I take like you'll see an adult like I take 20 units of Lantus every day. And I just gave myself 20 units of novolog. And they're online. What do I do? What do I do what I do? And I'm just like, figure out how many carbs that takes and eat them. Like, that makes sense to me. Right and and give that a try. So say you do that. Not that but say you have a meal that really needed five units. And for some reason you thought seven. And the next thing you know, 40 minutes later, there's an arrow down on your CGM, you're falling fast, you need to eat the carbs to stop that. So it's a much bigger nudge, right? It's more like a nudge with a sledgehammer now, and you need to eat the carbs to stop that. In the same thought process. If you miss greatly with that insulin, it should have been seven and you use five and 30 minutes later, your two arrows straight up. I don't mess around there. Like I am stopping those arrows, right? And you think, Well, okay, see, I don't know, say was literally like a mistake you meant to do seven and you did five she's like, okay, two units, that two units isn't going to do it anymore. Because you have all this momentum, right? Like there's this momentum, you have to stop the momentum, you've got a higher number than you thought about when you decided on the insulin the first time, there's a lot to think about. There's the number, the momentum and getting you back without making you Well, there are times that I'll take what I think the amount is that's going to stop the arrows plus the amount that's going to change the number back to where I want it to be. And I realize if I give her this insulin right now, she's going to end up low later. Mm hmm. But I still give it to her. And then there's a moment where I take the bazel away away, right? To try to do what I mentioned earlier, eat up that extra. So I needed all that force from that insulin up front because of the situation we're in. But I don't need the tail of it later. But the tails going to be there. So what if I took her bazel away so that it wasn't bazel plus the tail, right? And so I get the benefit of the up front without the kick in the pants. Again, what comes later, right, right. That's another way to think of bumping and nudging in my opinion. So there's any teacher
Jennifer Smith, CDE 44:51
learning that tools it takes learning the tools to use, you know, things like people who are using MDI or multiple things injections, it becomes harder because you can't take these away. Yes, it's injected, it's there. So if you are heavy handed with a correction, because you really want that double arrow to stop, you're going to be have to be, you have to be ready on the back end with carbs. To stop right
Scott Benner 45:17
off, you want to do you want to know what a pump does that multiple MDI doesn't do, it stops you from having to take a bunch of injections, it allows you to do temporary basal increases, decreases, extended boluses. That's it. And you know, you don't have to carry pens with you and right, wonder if your insulin is getting warm while you're at the water park. Like Like that's, that's, that's it? I mean, I think, to me, it sounds like a very little bit. But it's a lot. If you're going to be reactive like this and stay flexible and things like that. I'm not saying you can't do it with injections, I know plenty of people who do you have a very commonly are adults, or, you know, kids who just don't care about the injections, because there's going to be a moment when you're going to put in a little insulin and realize it's not enough and have to put in a little more. And now that's two needles, you know, instead of two pushes of a button, I think there are
Jennifer Smith, CDE 46:13
certain kinds of food which we've talked about, in other episodes, reading a pump to cover differently over a longer period of time. With a with an injection, you can't do that, unless you're willing to just take more injections with more insulin.
Scott Benner 46:26
So now here's the next thing about bumping and nudging, you get what you expect a little bit. And I want to just before I tell you about that, I want to tell you that what Jenny just said, shouldn't have been glossed over. There's other parts to this, I'm talking about bumping and nudging within a fairly perfect system, meaning I have my daughter's bazel well in hand, I'm not that far off with her meal boluses. If I missed like, we're not just like running around with our hair on fire gun, like, yeah, you know, like, and I just
Jennifer Smith, CDE 46:54
hear feed here, give more here.
Scott Benner 46:58
be insane. And I do mean this without sounding like I'm trying to pimp the the content, if you go back and start at the beginning of the pro tips. Or if you want to power Listen, by the way, those of you who start at the beginning of the podcast and listen right through, you have my respect, I thank you very much. Because why the downloads are so good, and it really helps me. So thank you very much. But at least go back to the pro tips and listen through, because then you'll get to a point where bumping and nudging really is a good tool.
Jennifer Smith, CDE 47:30
But it doesn't happen not hundred percent of the time. It's not always gonna work.
Scott Benner 47:35
Right, right. Like there are gonna be times where it doesn't work. And it happened to me last night with Chinese food. So we came out of a pump change and went right into Chinese food, which just shows my arrogance, really, because I was like, this won't be a problem. But what I didn't take into account is this for the past 72 hours, Arden has just needed more insulin, like there are foods that don't make Arden spike that are making your spike for the last three days. I don't know why it's not important, why it's just happening, you know, like, like, soup, just having like a clam chowder out of a cannon. I can't get it under like 250, like 45 minutes later, like, I'm like what's happening, you know, and it'll go away. Because the day before this started, her blood sugar was like 85 for 17 hours in a row. So, you know, it'll, it'll cycle through, we'll figure it out. Maybe it'll end up being a variable that needs adjusting. I don't think it will be but I'll see. But that's not the point. The point is, we came from a pod change, right into Chinese food. And boy, look at that. I did not do well with that. And so I want to first tell you that when I say oh my god, I did not do well with that. What I mean is her blood sugar was between like 175 and 210 for a number of hours afterwards. I know you're thinking Shut up. I would love that. Right? Yeah, yeah, people are like, Really? That's your complaints? Not a complaint. It's just I missed, right. Right. And there was the time five hours honestly, where she needed I bolused a bunch of times and I never once got it right I was never strong enough with it. And I have to admit, it was because I was tired and I didn't want to be up all night. So I just I erred a little on the side of caution not a lot and and I kept pushing. So but I did not cause her to get low afterwards, which was which is a win. It felt like that to me and I'll tell you why. And I want to put this in this episode too. So very recently, I wore the Dexcom Pro continuous glucose monitor and I was very happy to find out that I am apparently not pre diabetic as I was texting Jenny's I was putting I'm like you know this I'm gonna find out I have type two diabetes, right like I'm I was very happy that I didn't. Obviously, I was grateful, but I got to see What a pancreas does when it's doing what it's supposed to do. And I have to tell you that there is nothing I ate no matter how low glycemic or high glycemic, they got my blood sugar over. Yeah, I mean, I told Jenna I had eat two pieces of cake to get my blood sugar to like 135 141 time, right? But as I look back over the day, my standard deviation was like 11. You know, my, my average blood sugar was I don't like 90 or 80 or something 85 or 90, right. But I still went up a little gracefully 120 most of the time back down again. You know, that happened when I ate. And I had already changed my mind about my expectations for Arden. It over the last couple of years, you guys have heard me loosen up on the idea of like stopping every spike like I don't, I'm not a flatline person. I don't feel like my daughter's blood sugar needs to be a flatline, I do believe that she has type one diabetes, and that letting a flatline get away from you turns into a disaster that takes way too long to fix, which is why all this is important. But I don't care if she eats in her blood sugar goes up to 121 30 and comes back down again. I think that's fine. As long as she's not low on the other side, I start getting a little hinky over 140 in my heart, I'm a little much, you know. And it's not to say I wouldn't try to stop at 120 if I thought I had the answer to it. But I don't know it just it seems important for me to tell you that if your pancreas is working your blood sugar is not always at five, it you know, it just isn't. So be a little easy on yourself, have good expectations, but understand that my daughter, you your kid, Jenny, you don't have the mechanism to adjust, it isn't just going to put the brakes on for you. So that's why you can't you know, I say you'll ever get high if you don't get high. That's sort of what I mean by that, like stop the arrows stop before it starts, right?
Jennifer Smith, CDE 52:03
Well into this kind of experience that you had to I think one of the funny texts from you was relative to Pre-Bolus.
Scott Benner 52:13
Yeah, I was
Jennifer Smith, CDE 52:14
tested in your life. I Pre-Bolus better than my own prank. Pre-Bolus is I think is what your text was because you had seen a difference in what you had done for the same meal for Arden with her Pre-Bolus Yes, versus what your own pancreas was doing. And I think you said something like, I wish I could get my pancreas to Pre-Bolus. And I was like, well, your pancreas kind of does actually do that the working pancreas body kind of does do this like pre Bolus. Bolus, right?
Scott Benner 52:47
So Jenny's tried to explain to me I got if this is true, she said that sometimes when you smell food or you get hungry, your body anticipates that your blood sugar is going to go up and gets a little working on things prior. Right? That's really cool. But what she's pointing out and I am a little embarrassed is that after a couple of days, I would look at, like I'd be cooking and I would think to myself, like I think rubbing my stomach wherever I thought my pancreas was, you know, I don't even know. And so I was just like, man, now do it. Now, brother. We're about to have pasta. Go, you know. But no, Jenny's not wrong. And I'm not bragging. I was better at stopping spikes with Arden than my body was for me. And I was really, like, comforted by that. You know, I was like, wow, this, this post on that podcast really works. And I was I was just really, I was really thrilled. You know, it's like, wow, I because it felt like it wasn't overkill. Do you know what I mean by that, like, I thought, Oh, I'm not taking this too seriously. I'm taking this the right amount of serious, right. And it just really was it was a it was a great experience. I want to thank Dexcom for letting me wear the Pro. And it was really nice. I was the only that that was only worn by national media outlet people. And me, and I was very grateful. And I really appreciate that Dexcom appreciates the podcast and sees it as what it is. Yeah, not, not not I'm just not a guy with a podcast. Like I was like, wow, they really like made me feel good. Anyway, point is the last point, I guess if all this is, is that bumping and nudging is terrific. It's great while you're learning things, while you're learning about how to Bolus for meals while you're learning about activities. You know, all that stuff's great, but it's not a long term, everyday solution. And I didn't recognize that people wouldn't translate out of it eventually, like just go like, oh, okay, um, didn't happen to me. You know, I said at the beginning I didn't realize it wasn't happening to me. And then finally, and again, I have to thank the people listening, because we started the private Facebook group, which I'm not particularly active in. But see, every day, I started watching and this is when I said to Jenny, I need a pro tip on pumping. And I was like, Oh my god, these people are doing this all the time, like, constantly. I'm like, it's not for constantly. And so here we are. So if you heard us do defining diabetes, bumping nudge, which literally just came out last week, I said in there, what I didn't realize about bumping and dodging when I started doing it was that it's as much of a diagnostic tool as it is, you know, a tool for keeping your blood sugar's in order. Correct. So Jenny, when you start seeing yourself pumping and nudging too much, what should you be doing?
Jennifer Smith, CDE 55:53
Then you should be going back.
Personally, what I do, and with the people that I work with, what I do in their in data analysis is, I look at a cumulative and I say, over the course of this time, whether it's a week, or three days, or two months, or whatever we want to look at together, we can say, well, goodness, we've had a lot more use of Temp Basal that are not specific to like activity reason, or a food based reason, like you always eat Friday night pizza, or whatever it is, and you need that kind of a tool for but goodness we're having, there's a lot of corrections happening after meals all the time, or there's a lot of you know, you're using Temp Basal to cut off insulin all the time, if that's happening. And while it might be proving to give you the results that you want, there's a bigger picture, they're saying there's either not enough insulin for some reason now. So we need more in the bazel. Or we need to add a change to your ratios so that you do get more robust type of Bolus for food. And then you shouldn't have to follow it so heavily after and adjust with extra insulin all the time. So that becomes looking at information and saying, for whatever reason, I just need more bazel. Now let's pop it into place for whatever reason, my ratios look like they're not covering well, or they're covering too much. Let's take some away, let's add some in. And let's make sure that I'm not bumping and nudging now 100% of the day, because that shouldn't be the case. Right? Right. You shouldn't have to work that hard, essentially. Yeah,
Scott Benner 57:29
one of the I think one of the benefits of the podcast is that it eventually should make the management of diabetes simpler and less impactful on your, your moment to moment, you shouldn't constantly be like, Okay, a little more, a little less, a little more like, that's no algorithms do that. But you shouldn't have to do that. Right? If you find yourself doing it, look back and and just try to separate a variable from a constant and address the constants and keep bumping the variables. That's, that's all it gets that easy. I took me a while to figure it out. And that's why I'm here saying it to you because I thought, oh, gosh, what if people don't figure it out? Like I started having this heart in my head that people would just be like, bumping
Jennifer Smith, CDE 58:18
following my child until they're 50. And I'll be 89. You know, what's happening to their bush
Scott Benner 58:24
picture, people in my head that haven't seen the sun in three years have their hair all wired, like they've been electrocuted, and they're like, my kids, my kids, is 5.5, their blood sugar hasn't gone over 110 in six years, I'm fine. Like, please don't be like, Oh, my God, that would break my heart. If that's what's happening to you. And don't get me wrong. By the way, in the beginning, while you're starting to figure it out, you may be alone.
Unknown Speaker 58:49
That is one field, you should
Scott Benner 58:50
be able to get past that. Right. And I hope this has been helpful. Did we miss anything, Jenny? Because you guys, don't you really everyone listening should should just take a second to realize that Jenny, and I don't have any notes in front of us. Like we're not working off a list. And I still think we got in the timeframe through everything I wanted to say. Do you feel like Yes,
Jennifer Smith, CDE 59:10
absolutely. You did a good job. I should
Scott Benner 59:13
ring a bell. I'm gonna spike. That's right. I want to say this is something I was going to say later when I was editing it together. But I want to say it was Jenny here instead. I appreciate that the people listening care about this. Like, I really do. Like, I think it's wonderful that you all want better or easier or simpler, and aren't just throwing up your hands and saying, I don't know. There's good days and there's bad days. I think it's really wonderful. I think that we're creating a feeling throughout the diabetes world that's going to help people in the future it might not help you as much as it's going to help someone else. But I got you know, it's funny, it's not a note, but some He posted this on social media the other day, and I'm not gonna put their comments and their name into it. But I want to tell you like how amazing I thought this was. This person is relaying that their child, a 13 year old who's only been diagnosed for four weeks, listens to the podcast with their parents went into the doctor four weeks later advocated for themselves for a pump, explained Wow, explained that she wanted to use extended boluses. She tried it with MDI showed her doctor how she tried it, explained that she wants to do Temp Basal adjustments in the anticipation of exercise and activity and started rattling off everything she learned from the pro tip episodes. Wow. And even rolled in with her on the pod demo, the cast and persuaded the endo to approve the pump at the next appointment. And that that's awesome that endo normally makes you wait six months. And that's from these episodes. And so I imagine not just the happiness for that child that's coming. But that maybe now the doctors like huh, why am I waiting? You know? Am I making people wait, couldn't I just do this with them? Right? That's exciting for me. And it's so it's everyone's desire to do better. And then your willingness to say it, when you get to the doctor's office, it's,
Jennifer Smith, CDE 1:01:26
well, then maybe even from that doctor's perspective, maybe you know, this person obviously went in and said, hey, I've learned all of this from this one place, maybe the doctor now has a reference to say, Hey, you know, if you want a little bit more, and you come back to me knowledgeable enough and can say, Hey, this is what I know. Now, this is what I want to be able to use why I want to be able to use it. Again, I think a lot of clinicians are just conservative because they're worried,
right? They're conservative,
for many reasons, but I think worry is a big one. And they want some outcomes showing. Yes, my patient is now ready for this. And unfortunately, I think again, with the technology we have today, I think people are more ready earlier than they may have been years ago. Um,
Scott Benner 1:02:18
so I think that I don't think that people should make the mistake that this is some special girl. Do you know, like she is seriously it's, it's, it sounds self aggrandizing I really don't mean it to be she just listened to the 17 or 18 prototype episodes. And in four weeks, look where she is. And, and I don't know that everybody could be but I think my experiences are that a lot of people are and so that it's possible. I'm in my heart. I hope right now that doctor is listening to this going, Wow, that sounds like something that happened. And like I hope he went was like, I wonder what that kid listened to, you know, like, that's what I want. I want everybody to be healthier, and easier and less encumbered and anxious and all the crap that comes with having diabetes. So, Jenny, I think that's good to hear that. Thank you.
Jennifer Smith, CDE 1:03:04
Yeah, no, and I think that's a good cumulative of kind of, I mean, my overall when I had set out, going to college, knowing what I wanted to go to school for and eventually what I wanted to become, just, it was a very, it was a very, like, General, I want to become a diabetes educator, because I had had really awesome educators as a kid myself. But I never like I didn't have a broad like idea of what I really wanted. I just wanted, I knew I wanted to be able to share what I knew, with people and I wanted it to make a difference. Like it made a difference for me when I was younger, you know, and didn't have the technology or anything that we have today. Right? So, you know, in what I get to do every day, that's, I love it. But what I like more is that
I love this connection that I've that I've
had because of you because of the podcasts and the and what you've put together. I feel like I've reached so many more people than just the individual people that I get to work with every day. You know, I feel like kind of especially these pro tips what we've put together it's just able to reach so many more people in a way that's it's free. Yeah, you know, great and I'm Thank you
Scott Benner 1:04:23
Are you made me I felt like little butterflies and I looked I looked away from Jenny last year just now embarrassed that I couldn't keep looking at her through a video stream while she was saying something nice. I need therapy. Anyway thank you i It is really is terrific. It would obviously not be the same without you. So I really appreciate it. Cool. All right. We did a good job here. I'm gonna go back to your life which is probably just talking to somebody else about IP. So the second
Jennifer Smith, CDE 1:04:51
actually it will be my husband went off to work and my my kids are a band on the house. They're watching I think they're watching Dino Dan right now and I Hear my little man outside the joystick, Mommy, I want to snap
Scott Benner 1:05:06
a minute doing important work. Go back to what you're doing. Go take care of him. And thank you very much.
Jennifer Smith, CDE 1:05:13
Yeah, absolutely Have a great weekend
Scott Benner 1:05:15
to all of the episodes that include the words diabetes pro tip in their title are available right here in your podcast player, or at diabetes pro tip.com. The next pro tip will be out pretty soon. It's all about pregnancy with Type One Diabetes. Thanks so much to Dexcom on the pod and the Contour Next One blood glucose meter for sponsoring this episode of the show. Go to Contour Next one.com to see if you're eligible for a free meter. And if you're not, check with your doctor about moving up, right? You've been driving that old car too long, you deserve something new Contour. Next One. If you'd like a free, no obligation demo of the Omni pod sent directly to your house. Well, you sound like the kind of person who's ready to go to tubeless insulin pumping. I know what you're thinking. insulin pumps don't have tubes. Well, the Omni pod doesn't the rest of them do. But the Omni pod doesn't. My Omni pod.com forward slash juice box. no obligation free demo gets sent right to you takes three minutes to make happen at that web address. And of course, the continuous glucose monitor that has fallen from the heavens, the Dexcom g six, continuous glucose monitor, check it out@dexcom.com Ford slash juice box. If you have not listened to all of the pro tip episodes, I implore you to do so seriously go back to Episode 210. Or find them at diabetes pro tip calm, I think you're gonna really like them. And I think they're gonna make a really big difference in your life with Type One Diabetes. If you've already listened to all of those episodes, and you want more Jenni, find the defining diabetes episodes and ask Scott and Jenny there's more good Jenny goodness out there you can find it. I want to thank you for listening. And if you're a person who has shared the show with someone else, you have my gratitude. It is how the show grows. And I very much appreciate your time and effort. I will talk to you all soon.
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