#423 Defining Diabetes: Insulin Deficit

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain Insulin Deficit.

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.

+ Click for EPISODE TRANSCRIPT

---

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 0:06
Hello, everyone, and welcome to Episode 423 of the Juicebox Podcast. On today's episode of defining diabetes, Jenny Smith and I are going to define insulin deficit. Today's episode is part of the defining diabetes series, which lives here inside of the Juicebox Podcast. It's where Jenny Smith and I take terms from your life with type one diabetes, and explain them in ways that we hope make them useful, and understandable. Myself friend, Jenny Smith has had Type One Diabetes since she was a child, I think for over 31 years now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. And she used to be one of Santa's elves. Please remember, as you listen that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Now the music will build to a crescendo and we will begin.

This is going to be probably a pretty simple one. And it might not take a lot of talking. But I do want to I do want to give it its own space. Define insulin deficit? How do you think of it? If I say those words,

Jennifer Smith, CDE 1:42
I think it could be defined in a couple of different settings. And insulin deficit is easy to decide to eat whatever you're going to eat, you just don't take insulin for it. So there's a deficit of insulin nearly right. There could also be an insulin deficit. And this one, I think, is harder to determine how much insulin you need to correct and right, the situation of insulin loss is when you have someone using a pump, and the pump site has failed. But you don't quite know that that's what's happened. You're like doing all these extra things, your bolusing extra you're trying to like fix the high blood sugar. And finally, you realize, Oh, my pump site is all wet, or I smell insulin or Oh, look at that my pump site was like kinked instead of you know, when I took it out, that's a harder deficit to repair. Because you're not quite sure. How long is the deficit been going on? How much of the Bolus two hours ago actually went in? Did any of it go in the my blood sugar is here. So that one's I think, a little harder to take care of. But a deficit I mean, it's you're just you're missing insulin Bri has to do with like figuring out where you didn't get insulin.

Unknown Speaker 2:57
That's the reason we're

Scott Benner 2:58
in the situation scenario when your pump site goes bad. I sort of just looked back on as the Dexcom. So it's easier, but I sort of look back at where I start seeing that drift up and up. And if I think to myself, well, that was two hours ago, and she's 225 right now. I just act like none of that insulin that I thought I gave her exists. And I go pretty hard at it and and just try to start over again. I am such a big fan of like, crush it. Stop it start over again. Because I think it's time saving. Yeah, you know, and I and I don't like the idea of I don't know, I know, this is probably completely backwards from what most people get told. But if you have a 300 blood sugar, and it takes you six hours to bring it down. I don't know. That just seems

Jennifer Smith, CDE 3:45
that's a long time of feeling like crud. Yeah,

Scott Benner 3:47
yeah, that doesn't seem right to me. And I don't make a habit of dropping Arden's blood sugar like a stone. I'm not I'm not saying that. And I don't think that's good, either. I'm just saying that if I see that drift up, and it's been an hour, well, then I think all right, an hour ago, she stopped having enough insulin. But the truth is, though, is that I have the comfort in my head to know that her insulin is being used correctly, or it's been set up correctly, so that at any sort of a drift up. I don't think of as an anomaly, I think of it as something went wrong in the process. But that's because I have the confidence to know that the process is going to go the way it's going to go. It's tougher for people who are who are still getting things right or chasing things around. That's a horror that I have trouble putting into words like what does it feel like when something's happening inside of your body and you don't know what it is? Correct. And how do you make the next step? And I do see how people get to while Just wait.

Unknown Speaker 4:50
Right? You know,

Unknown Speaker 4:50
right. So,

Jennifer Smith, CDE 4:52
I mean, that's a really valid point to bring up is, if you're going to be as you coined the wonderful term, if you're going to be with insulin, know how your body responds to it, you can start to learn that, because you have things for art. And so well set that you can say, she wouldn't be drifting like this, I know that there's something not right here, I can add this much more insulin, I can attack it, I can avoid being 300. And if you do it with the pump and the pump site, she just keeps going up. Well, you're going to change that out, you're going to stop it again before and you might like me, I usually just do an injection. I'm not going to wait around for a pump site to start absorbing. Well, I give an injection and I take care of it. Yes. Who, like you said who wants to sit at 300 for six hours,

Scott Benner 5:37
right? You have some sort of a deficit fix. The issue is you can come in inject a correction I always like do like a Temp Basal increase to to kind of get the site moving. And then you're on your way again, I don't think we've experienced a site change high blood sugar in a very long time, because I don't even bat an eye. Now last night we changed Arden's pod and her blood sugar was like 85. And I Bolus the half a unit just because we changed the sight. And and didn't think anything of it. But but but to dig in farther for insulin deficit, like you can have a deficit at a meal, right? Like you could need four units us three, three units, that'd be a deficit of your meal Bolus. I see people whose basil rates are sometimes really steady. Like their their lines are steady, but they're higher, like oh, look how steady I am. But I'm always 140 That to me is a basil deficit. You don't have enough basil, unless you meant for your blood sugar to be at 148. And then even with corrections, you know, like we talked about earlier with, you know, with your with your ISF for your correction factor, you if you You're too late there, but when you're missing in all of those places, these deficits have different impacts, right, like so your basil depth, your basil deficit keeps your raised higher. If your meal deficit, if you have a meal deficit, then you're going to shoot up after you eat. And if you have a correction deficit, you're going to stay up longer, once you're up there and, and all of those things are really just to say that you have to use the right amount of insulin at the right time. And if your blood sugar is high, you probably don't have enough insulin. But a lot of people have deficits. I don't know if this is the right place to talk about this or not. But in the last month or so, since I talked to you last. I've helped to people with control IQ. And I did it blindly. Meaning that I have never seen the settings on control IQ. I don't know what the menu looks like, I have no idea. But I followed their Dexcom. And I said I'm going to talk to you, in my words. And we'll translate them to what you see there. And I was able to get two people's graphs level lower. Yeah. So it was all I almost just did it for fun, which I think says something weird about me. I was like, I wonder if I could do this. And I started with the one I said to the wrong one. I'm like, I have no idea what I'm doing. I'm like, I'm happy to like be a sounding board for you. But just remember that everything I say is going to be a gas, I have no idea. But in the end, it didn't matter. It was all the same. You know what I mean? Like it just you need more insulin here lessons on here. You don't Pre-Bolus you have to Pre-Bolus it was all the same stuff. Right?

Jennifer Smith, CDE 8:25
I think something too. And you bring in like good point about like, Where did the deficit kind of start and you know, with your initial if you're sitting nice and stable, but at a blood sugar 140 or even 150 or whatever, and you're flat and stable at it. What I always recommend to people is, was it flattened stable at a lower number and then you ate and then you got to the 140 or 150. And it never came down after that. Yeah, because that's the not necessarily relative to the basil. That's the Bolus problem. Right? Right. So sometimes it takes like, you have to take a couple steps back to look at where does it look like the deficit kind of got going? Because somebody might think in the scenario of Oh, it's 140, but it's flattened. I'd rather it be at you know, 102 and flat. I'm going to dump more insulin in here. Well, what if you start at 102 then and that basil hike that you popped in? isn't quite right, it's too much but you didn't realize you needed the insulin before that. So

Scott Benner 9:25
yeah, I will probably this will just end up being a different kind of an episode than I thought but I'm so where I go when I see somebody grant for the first I listen, you show me a 24 hour graph. I can fix your blood sugar in about four hours. Like that's how it is right so but the first thing I look at, if I see a graph that's kind of up and down my first question is always are you feeding insulin or stopping highs? Right? If you're feeding insulin I it makes me leap to your base was too strong. If you're always stopping highs, and everything's else faded away from where I where I want it to be. And I'm thinking about 85. When I'm looking at it, then I think, okay, where we'll start is, we're going to pick one basil rate, yep, I'm going to bring everything down, try to get it flat. And then we'll identify spots on the graph where maybe you need less or more overnight or etc, that kind of a thing for basil. And then once I've got that, then we figure out the Pre-Bolus time, you know, and yeah, and I'm, like, Look, you have to Pre-Bolus it's just not going to work. Otherwise, after you've got the Pre-Bolus time, then we work on understanding like the glycemic loads of different foods, and then you're kind of done. Like, I don't I listen, we're stretching this podcast out.

Unknown Speaker 10:43
It doesn't need to be rocket science,

Scott Benner 10:45
get your basil right. Pre-Bolus your meals, understand the impacts of foods, go live your life with diabetes. Right? Right. Like it kind of is like that. But it's fascinating to have that conversation. And you know, just as well having a conversation with a person and watching them have all their different aha moments. And, and they see all the things that they thought they were seeing that weren't right. And you're right, they can they never seem to be able to step back far enough away to see the whole, the whole picture, you know, right. It's really interesting. Okay, do you do it? Similarly, you do it, you do it like

Jennifer Smith, CDE 11:18
I do? Well, we do, actually. I mean, you're you do it kind of, really in the same scenario that we essentially we look for, we look for the lows, we always want to get rid of lows to begin with. Because if you're constantly feeding extra insulin, you're creating a lot more of the roller up and down, because you're constantly adding, and then you might be correcting, and then it's dumping you off, and then you're feeding that incorrect. It's just this never ending cycle. So we avoid the lowest first, even if it means adjusting things to a little bit higher to begin with, to get rid of the lows, and then we can bring that down. Once it's more stable, you can easily bring that down once you're not adding in all this extra food that you didn't really need.

Scott Benner 12:02
Do you find that it's harder to talk people into believing that their Basal is too low? If they're experiencing lows? Yes, like, like when you say to somebody, Hey, your Basal needs to be higher, they're like, No, I'm low all the time. Like if you're low all the time, because your base was too low, or over bolusing for food and you're crashing for the foods out of your system, and then they're gone, then their minds are like, Oh, you know, like, No, no, we're gonna make the basil higher, so that stable times are lower so that meals aren't as impactful on your system, you'll see and it that's a hard thing to talk people into believing it is it that's that's always interesting.

Jennifer Smith, CDE 12:40
It kind of it kind of goes right along with like, it's not really insulin deficit, but it you know, in a way, it's sort of robbing Peter to pay Paul, insulin in one place for insulin and another one place is wrong. And the other one, you're compensating and feeding with more insulin because the other place doesn't have enough of it. So if you get it smoothed out, yeah, then you got this nice, like, you know, but because

Scott Benner 13:06
we need to librium when you do that, when you have it unbalanced like that. To me, the biggest problem it causes is extra Bolus that's still available after food is digested constantly Yeah. And then you're crashing, and then you're feeding the you feed that insulin, and then you fly back up again, then you're correct and crash and then and it's just, it's fascinating to watch people. It makes me better at it to watch to watch it go wrong for people. Because the more that I can look at it, and just say like, Oh, just do this, this and this. It's it's great practice for me every time like, like my wife has said to me one time, she's like, the podcast reaches so many people at this point. She's like, Why are you like, you're giving a lot of time talking to like, one person at a time. Like, no, I'm learning. Like, they're getting help. That's what they get. I'm like, but I'm getting better at it. Like, right, like, by doing you learn? Yeah. So it's Yeah, it is really interesting.

Jennifer Smith, CDE 14:02
Yeah, I think it's, um, it's the way that and that's why I always bring up people's graphs when I'm talking them through adjustment, and why do I see the things the way that I am seeing them, because going forward, I want you to have that tool. I mean, as much as I love all the people that I work with, I want you to be able to have these tools in your own toolbox and go on your merry way. And

Scott Benner 14:24
Jenny can't sit in the matrix and just with a thing plugged into her telling you all how to take care of your ledger for the rest of your life. So it's funny. What I do notice, too, that some people are just in general. So like, I don't, I can never tell if it's they're scared or they're so sure that the things that they figured out are right. But I end up saying to people a lot of times privately, listen, I appreciate what you're thinking here is like but you're just wrong. And you got to let it go. You know, because you just you're fighting and you're wrong. Like I just try this once and see what happens. Yeah. I think

Jennifer Smith, CDE 15:00
it's many of the people that I see that more so in are those that have some pretty significant like hypo anxiety, they're very, very, very worried about having a low and many for good reason they've had a very significant problematic event happen, or, you know, EMTs coming to their house or,

Scott Benner 15:26
you know, be that's a good reason to be scared treated

Jennifer Smith, CDE 15:27
with it, right. I mean, there are a lot of reasons to be scared. But I think I see that a lot more with that group of people with diabetes. Well, I'm talking

Scott Benner 15:39
about that. And I mean this with love, but the Type A lunatics that are just trying to control like everything. And I'm like, Yeah, like you're trying to control six things you don't understand, which is, you know, who's particularly. And I mean, this again, would love particularly bad at this, nurses. I'm not a nurse, nurses and nurses who have kids with diabetes, are particularly thrown by diabetes. It's really interesting. Like, like, I listened had it happen once, twice, three times, I'd say, okay, maybe I'll make it up. I'm on my 30 100th nurse who all react exactly the same way. Like, I think that they're so accustomed to this, the order that they follow at the hospital, not really realizing that that hospital orders just really in place as somebody doesn't drop dead or get too low. It's not really about managing diabetes day to day. But yeah, they're they're the hardest to break free. But once they break free, boom, then they've got it like because then they can use that order that they that they're accustomed to in the right way. It's interesting. It really is interesting how different people react differently. If you'd like to learn more about what Jenny does it integrated diabetes, go to integrated diabetes.com.

The podcast has a private Facebook group that you can find, you know, on Facebook, it's called Juicebox Podcast, and then there's a colon and then it's type one diabetes. There's also a public page called bold with insulin. I'm on Instagram to just hit 10,000 followers there. It was kind of cool because I'm not very good at Instagram.

What a salesman I am. Hey, would you like to see an Instagram page? That's probably not good. Go to Instagram. Juicebox Podcast is sponsored by the Dexcom g six continuous glucose monitor and you can learn more@dexcom.com forward slash juicebox. We're also sponsored by the Contour Next One blood glucose meter. Check it out at Contour Next one.com forward slash juicebox. Want to get a free no obligation demo of the Omni pod tubeless insulin pumps sent right to your home. You can do that at my Omni pod.com forward slash juice box. Learn more about g vo Kibo pen at G Vogue glucagon.com forward slash juice box support my favorite type one diabetes organization at touched by type one.org and follow them on Instagram, and Facebook. And if you'd like to support type one diabetes research that makes a real difference. Check out T one d exchange.org. forward slash juice box. Let me do a little bit of talking for the podcast itself here at the end. As the year winds to a close there's one more episode left. But if you want those diabetes pro tip episodes, go to diabetes pro tip comm or head back to Episode 210. Your podcast player that's where it starts. Diabetes pro tip newly diagnosed we're starting over Don't miss the after dark series. Any of the episodes that are titled after dark and then something else. They're incredibly interesting and topics that people don't talk about very often. More recently, we have type ones who've experienced heroin addiction, believe me it depression, bipolar disorder, divorce. They talk about having sex with diabetes, smoking weed drinking, look for those episodes in your podcast player there after dark. And then you know other words. If you're interested in algorithm pumping, I have a whole series on it. Episode 227 is where it starts with diabetes concierge from there 250 to 304. And then the great three parter Fox in the loop house episodes 312 313 and 420 with Kenny Fox. We even have an episode about the mini med 670 G. Jenny and I talked about that Episode 326 and the blog looks pretty great too. You should check it out at Juicebox Podcast comm or anything else? Oh, no, I don't want to tell you about that yet. How about this juicebox Doc's dot com Have a great endocrinologist or diabetes practitioner or need one juicebox docs.com. Alright, that's it. One more episode left in 2020. It's kind of a relaxed conversation between Jenny and I, I started the year with Jenny. I wanted to end it with her

without them, without the talking overtop of the add music, you can see how incredibly repetitive it is. Isn't that weird?

But if you just talk over top of it, it's kind of handy. Learn more at my omnipod.com forward slash juicebox. See, then it really comes in, then it really does the job. promise that now you want to just chill with me. We'll do the end here. Change this here a little bit. I can tell something's gonna happen. I'll be back soon with another episode. Thanks so much for listening, for sharing the show for leaving great reviews. Wherever you listen. And if you're listening online, find yourself a nice podcast app and subscribe to Juicebox Podcast is available everywhere you get your audio

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#415 Defining Diabetes: Adrenaline Highs

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain adrenaline highs.

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.

+ Click for EPISODE TRANSCRIPT

---

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 0:09
Hello, everyone and welcome to Episode 415 of the Juicebox Podcast. Today on defining diabetes Jenny Smith and I are going to define adrenaline highs. Today's episode is part of the defining diabetes series, which lives here inside of the Juicebox Podcast. It's where Jenny Smith and I take terms from your life with type one diabetes, and explain them in ways that we hope make them useful and understandable. Myself friend, Jenny Smith has had Type One Diabetes since she was a child, I think for over 31 years now. Jenny holds a bachelor's degree in human nutrition and biology from the University of Wisconsin. She is a registered and licensed dietitian and certified diabetes educator and a certified trainer on most makes and models of insulin pumps, and continuous glucose monitoring systems. And she is one of the few people who when I know I'm going to talk to her, I start smiling inside. Please remember, as you listen that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan are becoming bold with insulin. Now the music will build to a crescendo and we will begin.

Jennifer Smith, CDE 1:27
Did you notice my different room? By the way?

Scott Benner 1:29
I wasn't sure if you redecorated Are you move but you're definitely right.

Jennifer Smith, CDE 1:33
This is actually where our router is. So I'm in our This is our basement. And so it's where we have like all it's a finished basement. So we have like our TV and everything down here. But I came down here because when it's quiet down here, buddy, bothering me. And two is my connection point. So nice and stable. The microphone is really easy to move in my computer is obviously mobile too. It was

Scott Benner 1:59
just like, here I go. I have to admit the other day Kelly seemed very upset. And I think it was because I get to work upstairs in a closed room. And she's downstairs in the dining room and we have an open floor plan. So people are just like, Hey, Mom, what's up or the kids will like come in and lay on or you know, like something like that. Just like I'm just trying to get a vaccine out so people can go back to work. Take your time right on top of me. It's fine. Yeah, so I get the private place idea. I have to say, I'd like to talk about adrenaline highs. Ah, because so I've tell us so I've told the same story on the podcast forever. And I'll do it very quickly here. Arden, I don't know it was eight or nine years old playing in this like Sunday morning Basketball League. It's just very fun thing where the girls all got the same color t shirt, they'd show up at a gym and play. And we'd show up one day and come in the door. You know, her blood sugar's are perfect. And she'd play and nothing would happen. And then you'd come back the next week. And we'd come in or blood sugars were great. And she'd play and our blood sugar would jump up to like 250. And it sometimes would jump up and sometimes it wouldn't. And after a number of weeks, I just I remember saying to Kelly like we can't let this keep happening. And she's like, well, how are you going to do something about it if it happens sometimes and not other times. And that's when I did you know devise the the idea of will Bolus for a juice box. And if she goes up, then the insulin will work on the number and if she doesn't go up, we'll give her the juice back. Right. Yeah. which ended up being a way that I talk to people about how to use more insulin when they're not sure how to when they're like well, I don't understand, like, I think this meal needs more. But I don't know how to like have the nerve to just use more. And I end up saying well Bolus for a juice box on top of it. And then what most people find a lot of the times is that it turns out, I needed that insulin anyway and you're never drinking the juice. But if you have to you have to and then you kind of figure it out from there. But it took me a long time to recognize that Arden was competitive. And if she showed up one Sunday and saw five little girls across from her on the course that they thought they could easily beat her blood sugar didn't go up. And if she thought they were in for a fight, our blood sugar jumped up. And that's adrenaline. Now here's the downside of bolusing for adrenaline is the minute the adrenaline's gone. It's like somebody opened up a trapdoor on your blood sugar, and just let it all out at one time. So that that adrenaline to me in my mind is artificially holding up your blood sugar, you can combat it with insulin, but if the adrenaline should go away prior to the insulin, you're kind of in trouble. Is that how you find it?

Jennifer Smith, CDE 4:46
Kind of and or I guess the same example would really be let's say they get hyped up for a game in which your example being it's it's a team that you know is a really tough team, whatever. Well what ends up happening is your adrenaline goes up and let's say team, the other team is having a really bad day and your team is doing like, phenomenal. Well, that adrenaline level may very well then go down faster than if the game was this back to back kind of need for I mean, adrenaline really is the, it's the fight or flight hormone, right? gets you ready, it gives you the surge of like release of glucose into the system, because your body needs the energy to get moving. Right. So, I mean, if that all of a sudden is not so significant anymore, at the end, or at the end of the game, you won the game great, all is fine and good. And down goes the adrenaline and down comes the blood sugar, then you're left sort of feeding insulin that you gave earlier, so that you didn't have you know, a 250 blood sugar with the adrenaline surge. But you do end up having to cover it because it's not adrenaline isn't the same. It seems as a deficit of insulin from like lingering stress, or food that you didn't end up covering, or something that's going to stick around that you definitely needed that extra insulin for in fact that in that scenario, it may not even be moving the blood sugar down. So okay.

Scott Benner 6:15
Yeah, we would, what we would do is the way we timed it out was insulin, adrenaline, leave basketball game, run to food. And then it was a Sunday morning. So we would just run into a diner and she'd get a waffle. And it was kind of perfect, because we'd basically we'd basically Pre-Bolus the waffle with the adrenaline fight. And then, of course, on the back end, yeah, yeah. This is a very early on example, in our, you know, in our life with diabetes, and but it is how I learned about those things. And more recently, you hear people like, Oh, I was sitting around watching the election results, and my blood sugar's were really high. That's anxiety, stress and adrenaline, right? Yeah. Yeah. Okay. That's so adrenaline. I

Jennifer Smith, CDE 7:02
think, I think there might be some to ice, you know, working with a lot of like school aged kids. There's often this, I hear it over and over, my child is on the bus. As soon as they get to school, and they enter school, their blood sugar climbs, they could have been at this beautiful steady for an hour past breakfast already. And now they enter school. It's kind of like the foot on the floor. Yeah, kind of thing, right as they enter school, and up goes their blood sugar. But on the opposite end of that, you know, we end up like, maybe we pump in more insulin through that time period of the day, then or maybe we pump it in through lunchtime, because they're super just anxious or stressed about school, or they just get that much that much excitement out of going to school and performance whatnot. As soon as kids leave school, the same thing as what you saw with your daughter. It's like, I'm heading home. There's nothing else I have to do. I can lay on the couch and watch cartoons or whatever it's going to be you know, but down comes the blood sugar and you've got this load of possibly hours worth of popped up diesel rates. Yeah, or extra insulin being given now at a time period, whereby is like, yep, I don't need any more. Thanks. Thanks so much.

Scott Benner 8:10
Arden, it happens exactly like that, like school ends, she get out, she gets outside. Like if she comes out to my car with an 85 blood sugar. In my mind, I think she's got 10 minutes, she's got 10 minutes to get to a snack. Like that's it like, like, and I that is the way I think of it is that all the things that we did during the day to keep our blood sugar stable is a Pre-Bolus for what's about to happen. And you have to, you have to know it's coming. If it's if it happens to you or your kid, and I'm assuming it happens to adults too, leaving work like stressful jobs. Anything really social interactions. I mean, when we are allowed to interact socially, again, I think that it would be the same thing like you meet somebody you're nervous to meet. Or you know, you want to make a good impression. You know, there's so many different things. It's funny like so I googled it, adrenaline impacts blood sugar, and you don't get enough back from it. That's not very what I want to say. More like studies and stuff like that is there's no like there's no like real world people saying oh yeah, if your blood sugar goes up, it could be from adrenaline or vice versa. If it drops, maybe your adrenaline's going away, your stress has gone away. So I just wanted to go over it because I don't know that it's um, well enough understood. And I know we talked about it in the podcast, but never like, give it its moment. So adrenaline is a

Unknown Speaker 9:38
Is it a?

Unknown Speaker 9:39
It's a hormone ephrin

Scott Benner 9:41
it's definitely okay. And so, similarly, and we won't get into it here but around menstruation, it's progesterone that causes the one of the problems right

Jennifer Smith, CDE 9:51
one of Yeah, one of the main hormones. I mean, there are others but yeah, progesterone is one of the big ones in that tree. Pre cycles start time period. Yes. I mean, there's always there's also a whole bunch of other, you know, hormones in the female body things like estrogen and luteinizing hormone and all these other kind of components that happen throughout the cycle. But progesterone is the big one. And that's the really big one, too, that in the early phases of pregnancy, and as pregnancy progresses, that's a major impact on sensitivity to insulin and increase in insulin resistance.

Scott Benner 10:32
Yeah. Okay. Because there's somebody contacted me actually should find their note, but I will do it in a different episode. But she said, like, I narrowed it down to the spot in my cycle, where the progression comes in, like is where I get this, this big impact. And I'm like, that's super interesting. I wonder if using a birth control pill, does that lessen the impact?

Jennifer Smith, CDE 10:55
I've found that I mean, from again, all the women that I've worked with, there are so many kinds of birth control pills on the market today. I mean, like every other drug on the market, they're, like, 20,000 of them, right. And I think it really is relative to the dose that's being given that type of birth control, whether it's IUD or it's the typical like pop the pill kind of birth control pill. They all supply a different amount of hormone control for that. I've seen some women who have they swear they have no change in their insulin needs, their blood, sugar's anything with their pill, and some women who swear a 10 pound weight gain. Now they're dosing with, you know, 25% more insulin than they ever did before. So,

Scott Benner 11:43
yeah, I have to say no, and then we'll move on to another one, that some of the biggest helps the people with diabetes, or other people's anecdotal information. And I also think sometimes it's the biggest impediment to people, because some people just see one thing, and it's not true. And then they share it. And it's, oh, this does this. And now that's in your head, you know, and you and you just stop thinking about it. Because you believe Oh, I know, now this, this person online told me, you really do have to

Jennifer Smith, CDE 12:14
kind of like the same thing as looking at one person's like straight, beautiful graph that they post. But you don't know what went in to doing that.

Scott Benner 12:22
Yeah, how that happened? Or didn't How

Unknown Speaker 12:23
did that happen? Right? You

Scott Benner 12:24
have to know more, not just the thing they say, right? Well, Jenny is a frequent contributor on the show. She doesn't get paid to be here. But she is for hire, at integrated diabetes.com should go check her out. I'd love to make a couple of brief announcements, housecleaning, if you will. Before I go. First, you may remember that back in August of 2020, I was celebrating the 2 million downloads of the podcast was very exciting. Well, it is 114 days later, and we are celebrating the two and a half million episode of the podcast. Now those numbers may only mean something to me. And I imagine they wouldn't to you, but a half 1,000,114 days is really exciting. And I just want to say thank you to each and every one of you for your continued support your listenership. And for sharing the show with others, I am truly grateful that the show has resonated with so many of you. And I love making this podcast for you. I want to shout out the oldest sponsor of the podcast on the pod.

Unknown Speaker 13:37
They

Scott Benner 13:38
supported the show by buying ads before anybody could have imagined that we'd have two and a half million downloads. And it's very possible that there could be four by the end of the next calendar year or more. I don't even know it's the way you guys are sharing the show. It's It's amazing. But my point is, is that back when the show had nobody listening, and I was like, I think I can get 1000 people a month to listen. They bought an ad. And they did that when I asked if they'd be willing to support this thing that I meant to do. And for clarity, if you haven't been listening along, what I meant to do was help people with type one diabetes. That's what I wanted to do. I wanted your lives to be lighter, easier, healthier. That was my goal. And I told them that it was going to take some time. And then if they could help me by supporting it financially a little bit, then I think I could turn it into something. Well, you have to give them a lot of credit. Actually one person in particular I'm raising my glass to right now. And she knows who she is. But she bought an ad when there was almost nothing to buy an ad on. And I'll never forget that. That first ad allowed me time to build this podcast. allowed me to go to my wife and say, Look, it's not just this, you know, it's not just another thing I'm doing online for free to help people, this might actually pay a bill one day. And that was enough to let my wife say, Alright, you know, try it, I'd like to help people to, you know, but we're just like you, we have kids going to college, and we need food. So I couldn't just spend all my time up here. And on the pod, they really came through. I'm forever grateful for that moment. Because this podcast has become something that I am truly deeply and genuinely, very, very proud of. Just to reminisce, for another moment, I recall back at that conversation with Omni pod, telling them, you know, I'm not sure if I'm ever going to turn this into something, it's going to be that valuable for you. Meaning you know, that you'll be able to reach people with your message. And by the way, their messages, try your free no obligation demo of the Omni pod today, at my Omnipod comm forward slash juicebox. But that's not the point. The point is, is that they were okay with that. And I like being involved with people like that. Somebody who said, Look, if it helps people, and it never turns into a business, we're still here to help people with diabetes. I remember that moment as clear as day. And I sometimes wonder if they would have said no, if this show would even exist. Anyway, trying on the pod, they're cool. Speaking of cool people who support the show, we've had all the meetings and all the conversations, and everyone's back in 2020, this podcast will have advertising from Omnipod Dexcom, the Contour Next One blood glucose meter, touched by type one, G, Volk, hypo pen, maybe someone else are still getting things together. But great, great sponsors that I have full faith in, which gives me the ability to speak about them freely from the heart. And I like that I would not know what to do if I had to shuck and jive for you and tell you I liked a meter that I never used before. I I don't think I could bring myself to do that, actually. So I'm really thrilled that everybody's back. Thank you so much for the continued support. And thank you to all of you for making the show something that anybody would want to get behind. And speaking of supporting things that also support the podcast. Don't forget to join the T one D exchange registry. All right, ready, let's test me one take, I won't stop. Join the T one D exchange registry at T one d exchange.org. forward slash juicebox. When you add your information to the registry, and you're a US resident with Type One Diabetes, or a US resident, who is the caregiver of someone with type one, you will be adding data that will help people with type one diabetes in countless ways.

Would you like to try a free no obligation demo of the Omnipod tubeless insulin pump or my omnipod.com forward slash juice box fill in a little bit of information and an insulin pump for you to try on and where Don't worry, it's not working, you'll be okay. We'll be at your house in no time. And to learn more about the Dexcom g six continuous glucose monitor, you're going to want to go to dexcom.com forward slash juicebox would you like to use the most accurate and easy to carry blood glucose meter that I've ever seen? Of course you would Contour Next one.com forward slash juicebox check out that Contour Next One. Check out that oh I almost did it without flubbing check out that Contour Next One meter now you can also find out more about there. I just lost the word tester program. And you may even be eligible for a free meter. two meters terrific. Seriously check it out. Contour Next one.com forward slash juicebox this is what happens when I don't edit myself ready. My daughter uses g Vogue hypo pen and you should to G vo glucagon comm Ford slash juice box. You want to see people doing great things for people living with Type One Diabetes, you're going to want to go to touch by type one.org and visit them on Facebook and Instagram. Did I forget anybody Dexcom on the pod Contour Next One. g Volk pypo pen touch by type one T one D exchange. I did it. That's it. Thanks so much for listening. I hope you have a great weekend there's going to be a really special. There'll be saying I promised I wouldn't edit now I'm tripping over my words. There's gonna be a really great show coming next Friday. That's gonna have an announcement. Little interactive thing you guys could do if you want. But uh, that's for next week. Thanks so much for listening to the Juicebox Podcast and thank you for making the show so incredibly fulfilling. For me and for the listeners, which I guess this year, take care. I'll see you soon.

He's still here. I'm just gonna let the music run. Let me turn it up.

Because I better very repetitive I get so that I can talk over top of it while it's low when you hear music, but you know it's not distracting. You did. How was everybody's Thanksgiving you guys do all right. Wait, do I tell you how our Thanksgiving when I'll put that in an episode next week. Boom, boom.

We're getting there. Like 10 or 15 more seconds, you can make. Oh, by the way, if you're enjoying the show, please leave an amazing rating and review on Apple podcasts or wherever you listen to your podcasts. And if you're listening to podcasts that Subscribe, Subscribe, subscribe. Links to all the sponsors are available at Juicebox podcast.com or right here in your podcast player show notes.

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate

#408 Defining Diabetes: Insulin Sensitivity Factor

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain insulin sensitivity factor (ISF)—or correction factor—which is how many points one unit of insulin will drop your blood glucose level. They discuss how the ISF is initially determined, that it does not necessarily remain the same throughout the day, and the importance of considering modifications to the ISF value for hormonal or other changes along with other setting changes.

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.

+ Click for EPISODE TRANSCRIPT

---

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 0:11
Hello, everyone and welcome to Episode 408 of the Juicebox Podcast. Today's show is the defining diabetes episode, Jenny Smith and I are going to talk about insulin sensitivity factor, also known as correction factor. This episode is part of the defining diabetes series. Actually at the very beginning of this, I'll go through all of the other definitions that Jenny and I have done together. But you can go find them in your podcast player. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise. Please always consult a physician before making any changes to your health care plan, or becoming bold with insulin. My friend Jenny Smith has had Type One Diabetes since she was a child I think for over 31 years now. Jenny 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 a certified trainer and most makes and models of insulin pumps and continuous glucose monitoring systems. There are very few people I asked Type One Diabetes questions of Jenny is at the top of that list.

The Juicebox Podcast is sponsored by the dexcom g six continuous glucose monitor the Contour Next One blood glucose meter, the Omni pod tubeless insulin pump, g Volk hypo pen and touched by type one. You can find out more about all the sponsors right there in the show notes of your podcast player. Or Juicebox podcast.com.

Jennifer Smith, CDE 1:52
My cat might come in visit here cool.

Scott Benner 1:55
Oh, how come we've never seen your cat before?

Jennifer Smith, CDE 1:58
Do you want to see my kitty cat?

Scott Benner 1:59
her or him?

Jennifer Smith, CDE 2:02
It's this one's a girl. We've got to two this is Lucille Ball buster. I don't know if you're a fan of Arrested Development.

Scott Benner 2:11
I know the show very well. That's where the names

Jennifer Smith, CDE 2:14
muster. One of our license plates is go bias and the other one is on young.

Scott Benner 2:22
We've already done a lot we have we've done laughs ready we've done Bolus timing range. bazel honeymooning standard deviation noncompliant algorithm extended Bolus Pre-Bolus Trust will happen glycemic load and index stop the arrows insulin resistance and over Bolus brittle diabetes low before high ketones bumping nudge rage, bolus compression loads and interstitial fluid. Oh my gosh, we've been doing this a long time. fat and protein rise feeding insulin dawn phenomenon feed on floor and the smokey effect. So that was the last one we did. Yeah, we did feed on floor Smokey and Dawn phenomenon like kind of all at the same time. So good question, what is left? I think more than I thought, actually, because I get to watch people talk about it online. I keep getting notes from people who say that these, like I think of the the defining diabetes series is like this nice little like addition to the show. For a lot of newly diagnosed people. They start with that, because they're getting so many terms thrown at them. They don't know what they are. So there's some that I'm gonna admit, I don't completely get all the time. Like I know how to use them in practice, but not theory. So I want to start with insulin sensitivity factor. Oh, that's a good one. But I want to I want to talk about it. Like, in every way, like how do people think of it MDI pumping algorithm?

Unknown Speaker 3:46
Okay,

Scott Benner 3:46
yeah. Okay. Yeah, I don't know anything about this. So so if I come into your eye, if a person gets diagnosed, and they show up in the, in your, your office, and you're like, Okay, here's what we're gonna do, we're going to set your insulin sensitive sensitivity factor at how do you get to that number? What is it and why is it?

Jennifer Smith, CDE 4:04
Yeah, I mean insulin sensitivity factor, and to clarify for some, like both on Omni pod as well as on tandem in the pump. Now it is called correction factor. Okay. So if you want to think about that, I think it's a little bit more, it's a little clearer what the term kind of implies insulin sensitivity factor correction factor, they're essentially both the same. What it means is, how many points or how many milligrams per deciliter, or if you're using millimoles, the same. one unit of insulin will adjust your blood sugar down by so let's say right now you started at a blood sugar of 180 and your ISF or insulin sensitivity factor it's at and you wanted to get your blood sugar to a target of 100 unit will drop you at points to get you to 100

Scott Benner 4:59
Okay, So it's so I think of it as correction factor. I guess, interestingly enough, yeah. Okay. But in honesty, if my blood sugar is, by the way, I have this like, I'm just doing that theory I go if my and then people are like you don't have diabetes, like I know If a person's blood sugar is 180 in your scenario, and you want to get it to 100, your correction, you know, your correction factors, you know, one unit per 80, obviously, a unit should move to 100. But

Jennifer Smith, CDE 5:29
should is the right, well, what

Scott Benner 5:31
if my blood sugar's 280? Now the same correction factor isn't going to work the same way.

Jennifer Smith, CDE 5:39
Often, what most people find is that over about a blood sugar of 250, which is also where your pump starts reminding you if you are a pumper, and or even if you're using MDI, you're often told if your blood sugar's above 250, check your ketones, right? So above that 250 Mark, it seems we kind of get like this sticky momentum of insulin, it doesn't quite work as it does when your blood sugar is high, but not yet. 250 or above. So it's a good question, because a lot of people get really, really irritated. I'm taking what I usually take, and last night at work totally fine. And last night, my blood sugar got high and it didn't work at all. Well, I mean, outside of any other variable to consider, let's say it's truly just the same scenario. Maybe blood sugar one night was 189. And the next night it was 297. Yeah. Right. So it does take a little bit more insulin to move your blood sugar. When it's higher than that about 250 mark. And I think something else in the picture there is you have to consider the deficit of insulin and maybe how long that deficit has been going on, like how much is really missing? Yes, one unit, again, in our example, should move your blood sugar by 80 points. But if you've been sitting at a 250, plus blood sugar for several hours, you're at a pretty significant deficit of insulin, almost like a glucose toxic setting, if you will. And so it's gonna take a little bit more insulin as well, as we've talked about it before. I think we had either part of an episode or whatnot all about hydration. I think it was in the CGM one, right. So hydration is key there too. So if you're not moving stuff around, your insulin isn't going to circulate or get moved and get it working as well as it should either.

Scott Benner 7:33
So isn't it is an insulin sensitivity or correction factor? is first of all, it's a it's a guess more than anything, right? Like you try it like the doctor sets it up for you it works or doesn't they turn it up or down? So it's a guest to begin with, that you dial in over time? That really is a measurement when there are no other influences impacting.

Jennifer Smith, CDE 7:59
That's an Yeah, in a roundabout way. Yes. I mean, the doctor does use a formula to give you a starting place for that insulin sensitivity factor. Most doctor use, they use what's called the 1800 rule, I'm sure you've probably heard of that before. essentially take your baseline insulin, your basal insulin, and you add that dose to the amount of bolus insulin you use on average for a couple of days. And then you divide that number into 1800. And that is supposed to give you a relative idea of what your sensitivity to insulin is, or will be, meaning one unit should drop you about this many points. So let's say your ISF is 60. You divide that into 1800. Right? So 30 is that kind of outcome?

Scott Benner 8:48
I like my way better.

Jennifer Smith, CDE 8:53
I kind of your way is sort of like it's adding precision to it. Right. And I think it also adds into and you've had Kenny on quite a bit, right? Yeah. And he does a lot with ISF right and it correctly too, because really if you look at ISF a lot of people also have one ISF that runs midnight to midnight they use the same darn number all day long. Now I can tell you from personal that does not fit the bill. I have several ISF that run through the course of the day dependent on what I've seen in that time of day when I've only corrected blood sugar again without like multiple variables in the picture. And I know that this works here and this works better here. So while the math of 1800 rule figures out to one stable number, right, that's not gonna really hit it.

Scott Benner 9:50
Yeah. I to me to the the setting of it. Setting up of it is take so much time because of the processor and like see the doctor They'll look at some stuff. Three months later, if you're lucky, we'll adjust it again. You know, it's just that feels untenable, the distance of time. And the way I think of it is like, try this, see what happens, then just move it until it's right and then stop. And I know that's, I don't know why that's scary for people. I'm not like, I'm not saying like, hey, the doctor said, you know, you're one to 50. Try one to one. You know, I'm not saying go crazy. Like I'm saying, you know, if he says one to 50, and you're like, that's not working, make it 145 and see what happens, then you know, and keep going. But you brought Kenny up, who comes on to talk about algorithm pumping a lot. And he's actually going to record with me next month, again. But so when you're using it in a in an algorithm, like in a loop or something like that, Mm hmm. I think ardens right now is like one to 43 I think one unit moves are about 43. And it can move around. It does be perfectly honest, now that Arden's getting older, I can tell you artists, three different people with diabetes every month, she's the she's the having her period person, she's the about to have her period person here. And she's the oscillating person, like there's three different like people she is. And her insulin sensitivity moves from about 42 to 45, or 46, depending on which week Brin and all I do is watch a trend, if she starts trending up and make her sensitivity stronger. If she starts trending down, I take it back a little bit. That's pretty much it, you know, and, and move her bazel a little bit in that time as well. usually pretty commiserate with the insulin sensitivity, the insulin says, yep, you know, it's getting stronger, the base is getting stronger, or vice versa.

Jennifer Smith, CDE 11:51
I think one other thing to comment on that, too, is as you bring up like the doctor adjustments, it's that ISF I've seen over and over is one of the pieces of insulin dosing that gets adjusted the least with the least frequency. Hmm. Most people play with their bezels, often kind of incorrectly because they're not quite sure what's wrong. They know that they need more, but they just add it in one place that they can think of to do at first, okay. And then they may play with their insulin to carb ratio. And ISF is sort of like the last thought. And unfortunately, like you just mentioned, if bezels are going up, because it's that time of the month, likely the other factors need to be adjusted along with that, because there's a resistance factor there that if you only dial in a bazel adjustment, yeah, it's not really gonna hit the need across the board. Well,

Scott Benner 12:50
so you're making me feel like that's how I see people end up with these bezels that are, it's funny, people's bezels are either way too weak, and they over compensate with their meal insulin and they bounced around, or their payables are way too strong. And they're like, Oh, my insert my food, I barely use anything. It's because like, it's because if they were to skip a meal, they dropped that because their bazel is so strong, right? That is, that is interesting, isn't it? Okay. All right, I can

Jennifer Smith, CDE 13:17
tell you kind of along the same lines as I have, and have for a long time, it was kind of like a peeve of mine. Honestly, in tandems pump, you can have a bazel profile that dials in not only the bazel, but also the insulin to carb and the ISF that work with that bazel profile. So all you have to do is enable that profile. And now you've got the insulin to carbon, the sensitivity factor that work with it. So like for a woman with her period or whatnot, you figured out that you need an insulin to carb of eight instead of 10. Great that's in the profile, you need an ISF of something like 40 versus 50, that's in the profile. So all you do is enable it and turns on. The other pumps don't do that you physically have to even though if you might have figured out you need more bazel for that time period, you might enable it. But if you haven't changed your insulin to carb, or your sensitivity factor, which you physically have to manually go in, have remembered or made a note of obeah I remember I used an eight last month and that worked a heck of a lot better than a 10. Right? Well, now I have to change it every single month. I have to change it.

Scott Benner 14:22
Yeah. Now listen, having it, it would definitely profiles are important. I think they really are to get them set up so that you can jump from one to another more seamlessly because I lose track sometimes too. You know, sometimes I'm like, what was it 43 or 42 last time this happened or, you know, but at the same time, like I I move everything together, like I think of it is like if I'm gonna send a soldier and I send them all in, you know, it's it's charged not You go first and we'll see what happens like and that way, by the way, you don't have to send as many, you know, so you just a great example, a little more Bolus a little more bazel. A little more factor. Everybody just turned it up a little bit, you know, and how far I don't know, like people would need to play with it for themselves to figure it out, but right, okay. And what I do notice, well, you know what I'm gonna I'll bring this up, I'll bring it up with Kenny because I am going to let Kenny like go on and really discuss his ideas about you know, one basal rate and then you know, working off of that, which like you said doesn't Yeah, it doesn't work for you and it doesn't work for Arden. Exactly. But I think for younger people it works. It can work really well. Better. Yeah, I just I'm I I definitely believe in that. What I said a minute ago that people get their bezels jacked up so high, they think they don't need anything for food. They don't realize that they're just there carpet bombing their entire 24 hours with bazel It's way too much. All right, thank you. You can check out the Dexcom g six continuous glucose monitor@dexcom.com Ford slash juice box. Get a free no obligation demo of the Omni pod tubeless insulin pump at my Omni pod.com Ford slash juice box. Learn more about the Contour Next One blood glucose meter at Contour Next one.com Ford slash juice box. Don't forget to check out g Vogue glucagon.com forward slash juice box. And of course touched by type one.org. Support the sponsors support the show. Jenny Smith works at integrated diabetes. And you can find out more about what she does at integrated diabetes.com. Thank you so much for listening. If you hold on one more second, I have just a couple more things to say.

If you'd like to hear more from Jenny and myself on management of type one diabetes, you should check out the pro tip episodes they begin at Episode 210 in your podcast player, where you can find every one of them at diabetes pro tip.com. Same thing about these defining diabetes episodes just search in your podcast player for defining diabetes. You have a great doctor, or would you like to share one with someone else? juicebox docs.com is an ever growing list of diabetes medical professionals that have been sent in by listeners just like you. Thank you so much for listening to the Juicebox Podcast. There will be another episode this week. I hope you're

enjoying the show. please consider sharing it was someone else leaving a wonderful rating and review on Apple podcasts and hitting that subscribe button wherever you're listening

---

Please support the sponsors

The Juicebox Podcast is a free show, but if you'd like to support the podcast directly, you can make a gift here. Recent donations were used to pay for podcast hosting fees. Thank you to all who have sent 5, 10 and 20 dollars!

Donate