#648 Defining Diabetes: Insulin On Board

Scott and Jenny Smith define diabetes terms

In this Defining Diabetes episode, Scott and Jenny explain Insulin On Board

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 0:00
Hello friends and welcome to episode 648 of the Juicebox Podcast.

Today I come to you with another in the defining diabetes series. Today Jenny Smith and I are going to define insulin on board the notorious I O B. Please remember while you're listening that nothing you hear on the Juicebox Podcast should be considered advice, medical or otherwise, always consult a physician before making any changes to your health care plan or becoming bold with insulin. This show is sponsored today by the glucagon that my daughter carries G voc hypo pen. Find out more at G voc glucagon.com. Forward slash juicebox. If you're a US citizen who has type one diabetes or is the caregiver of someone with type one, please go to T one D exchange.org Ford slash juicebox. Join the T one D exchange registry fill out the survey support people with type one diabetes T one D exchange.org Ford slash juicebox.

G voc hypo penne has no visible needle, and it's the first premixed autoinjector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about all you have to do is go to G voc glucagon.com Ford slash juicebox. G voc shouldn't be used in patients with insulinoma or pheochromocytoma. Visit G voc glucagon.com/risk.

Jennifer Smith, CDE 2:04
Insulin on board is an interesting topic it is

Scott Benner 2:08
and I think it's going to become more interesting as more people use algorithms to Yeah, because you're going to start thinking about it a little differently. But insulin on board is a measurement. I'm making air quotes about how much insulin is in your body that is yet to have done its job is how I think people think of it. Do you think of it? How do you think of it?

Jennifer Smith, CDE 2:34
True. And I think in in another way to define it. It's kind of like the expected it's the expected decay or action time over a defined period. So you know you've got this many units of insulin, your insulin action time is defined as four hours let's say you had four units taken 50% should be done by two hours after you Bolus if you have a four hour action window of that insulin right. But that's like the nutshell. Right? of insulin on board. I think insulin on board individually is very ill defined. It is not individualized unless you really test it out.

Scott Benner 3:29
And I so Kenny comes on and I and I think you know Kenny actually can yes on and talks about loop a lot. And if I'm not mistaken, his child's insulin action time he has set pretty short a prior to any kind of algorithm. I had Arden's insulin action time set at like two hours, two hours, I never remember, I never didn't want the pump to suggest insulin. Right. So I so I wanted that, you know, the way I talked about it with people is that there's a setting inside of your pump. And you just get to say, how long your insulin lasts for right, your insulin action time is one hour, two hours, three hours, four hours, five hours. If you use loop has an algorithm, it measures it as six, right?

Jennifer Smith, CDE 4:17
A five to six hours. If you use one particular like action, you know, profile, you can choose from multiple there's a child base, there's a adult based, then there's one that you can adjust the hours within, for the people who are doing some of their own coding and whatnot. They can also self adjust within their code, what they have their insulin action time kind of set for. But yes, each pump, whether it's algorithm driven or just conventional pump, loop pump or not. It is something that each pump has built into it. And again, I don't think that it's very well defined for people even just starting a base Conventional pump in an office clinical training, it's something that gets set, and is less than a minute in explanation as to why it's set for three hours or four hours or five hours. It's set that for three hours, and then you move on to like the next setting. Never go back to it. And they never come back to it. And I don't know how many people in a first visit, when I chat with them, we look at their active insulin time. I'm like, Well, why is your active insulin type set like this? Well, what is that? What does that mean? And where do I find that? Like, that's let's start over from insulin.

Scott Benner 5:41
Because if it because it's a it's a dummy setting, in the in a pump in a regular pump. By that I just mean, if you tell it three hours is your insulin action time, right, then it and you Bolus, I don't know 10 unit new gear at noon, two hours in the insulin on board is still going to indicate is probably being like a third of the Bolus though, correct, right? Yes. And but having said that, if you if that insulin action time was set at four hours, then it would think you had insulin on board of 4%. Right? If you said two hours, it would think it was more like 30%. And my point is, is that this, this number that gets put into your pump by a doctor who just is like I don't know, most people's is like three, and they just dial it up to three or maybe four, or maybe they're thinking I don't want you to over do it. So I'll make it five. None of that has anything to do with the impact of the food and your use of your insulin. It's it's it's a nice thing. But I think we're kind of beyond that now with technology. And you shouldn't be guessing at your insulin action time. Because it impacts insulin on board. And then what happens in real life is you eat some food. You don't do a great job of Bolus going for it for whatever reason, it's two hours after you've eaten your blood sugar's 270, you're indicating you're still going up. And then you look at the pump and go, Oh, we still has insulin on board. I don't want to do anything about this. And or

Jennifer Smith, CDE 7:09
it's recommending point two units, or like point two units. That's like a drop in the ocean. Like what point two is like nothing that's like, that's like, why would I even take it there's no purpose to just do it. And that's where people get frustrated. They're like, Darn it. That's where range Bolus came from 2.2 units, I'm going to take two units instead. And then it becomes like this willy nilly management of, well, I know the pump is wrong. Why is it wrong, though, right. And I think you made a really good sort of like comment that I think leads into insulin action was formulated to cover carbohydrate. That's how insulin rapid acting insulin was formulated to cover the expected in and out effect of carbohydrate. It's why we are very carb centric in diabetes education. Everything's about carbs. It's about counting the carbs, it's about insulin to carb ratios, right. But when we start having more than the typical well portioned, mixed meal, broccoli, grilled chicken and maybe you know, blueberries on the side, or whatever it is. Once it becomes heavier, in those other macronutrients, insulin action time, isn't wrong. But the reason that it doesn't look like your blood sugar is where it's supposed to be. Once insulin is done working, is because the other pieces of that meal weren't covered the way that they should have that. So it I mean, there's a lot of mix within evaluating insulin action time. How long does your one Bolus really stretch out and work for you? Is it getting you to where you want to get blood sugar wise? And then when you bring in pizza, versus the chicken and broccoli? What happens? Right now I'm stuck high and my pump is recommending point two units. I know I need more. We don't need more because your active insulin time is wrong. You need more because there's something else in the picture that wasn't covered. And it needs to

Scott Benner 9:30
be Yeah. So at a basic level these these measurements were set it for perfect world situations, not for the situation you find yourself in right away. There is a world where if you send your if you set your you know, your insulin action time at three hours, your insulin on board will probably reasonably be right if you're always eating the way you described. But the minute you elongate a meal impact by adding fat to it or protein or something that starts hitting You know, an hour and a half later, after you've eaten it, these are these are new impacts on your blood sugar that this, this simple, simplified formulas not thinking about. And I understand, right? Like, you can't explain all the stuff we talked about in the podcast if somebody's in a five minute doctor's visit, right? Right. And so, but the problem ends up being is you set the settings somewhere, and then you tell people, well, this is it. Insulin on board, if you have insulin on board don't Bolus, it's a, it's a generic thing to say. And you might be right sometimes, and and that might be wrong sometimes. But people get into this situation where they're in their home. And they know they should do something. And what rings in their head is the doctor told me not to correct before three hours. And I don't know if you've ever taken 24 divided by three. But there's only so many three hour segments in the day. And that's how you make yourself crazy. So waiting three hours feeling the pressure of this blood sugar's high, I don't want to do the wrong thing. The doctor said I have insulin on board still, it's sort of comes down to there's another epic defining diabetes episode that I think is called. I don't know if it crushed it and catch it. When I probably where I probably say something like, it's not stalking if you need it. You know? Yes, yes, you could stack insulin, do it wrong, make yourself very low. But it's not stalking if you need it, meaning that one meet and

Jennifer Smith, CDE 11:30
if, if you need it, you may want to go to the variables that we hash through in like very, I think really good detail, right? Because those variables are some of the reasons for saying, I'm not stalking, I'm taking extra insulin now. Because this variable is in the picture. And I know that I need it. My pump isn't recommending, but my pump doesn't have my brain. It's it's like a locked, I see this, you only need this. You are in real world. You know, you know what's going on.

Scott Benner 12:06
You need to understand I play there. Sometimes I think I say the same thing a lot. But you need to understand that 10 carbs of rice is going to impact you differently than 10 carbs of grapes than 10 carbs of pizza. And the Bolus that probably works well for the grapes, let's say doesn't work for the rice definitely doesn't work for the pizza. And so you take the insulin you think you're supposed to have you get high, take it again, a doctor would call that stalking. But I would say that if we're talking about the pizza, you just didn't understand how to Bolus for the pizza to begin with. Right? Right, or you used more insulin, or you would have timed it differently. This is the point where I've never really said this before in a defining episode. But if you tuned in to hear about insulin on board, and you're like they talked about insulin action time a lot. I think that if you really want to understand insulin on board, you should just go find the other pro tips and the other defining episodes and educate yourself about the big picture. And then I don't think you think about insulin on board anymore.

Jennifer Smith, CDE 13:11
Well, and I think the other thing, as you mentioned earlier is we become we've become in the past, I would say even three to five years of a lot of these algorithm driven pumps that people are using, I think with learning more about why is the system doing what it's doing. Why does it seem to work better than my conventional pump did? And some people get locked into the well, my system isn't giving me more insulin. I think it needs to be, but it's not giving me more. It's not helping me more? Well, our, our algorithm driven pumps have much more, I guess, a lot longer insulin on board or insulin action times, right. They're much extended comparative to what you may have had set in your conventional pump. I noticed that difference very early, going from conventional pumping to loop I did. And it was also a question for me. I was like, Well, I see it's giving me more and on my conventional pump, I probably would have given myself more with a I've got this much like hindsight that I know I need this much more, and I feel safe doing it and I can do it. But my pump wouldn't have recommended it. These systems are following blood sugar in a way that a conventional pump wasn't. And it's taking into consideration the glucose shift, where again, a conventional pump is not it's locked into one point of data that you're giving it to get back a suggestion. Whereas the algorithm driven pumps they're adjusting based on our rate of change, and the more information you feed it, the better can decide what to give you? And how long to look for that along with gets drawn out active insulin time.

Scott Benner 15:06
Yeah, it's important to know that what if you're experiencing, you know, a rise that you that you don't expect, it's not always just change your meal ratio, because your meal ratio might work really well, for a lot of things, it just doesn't work well for Chinese food, right. So you don't want to change your ratios in the pump, you want to change the way you think about that specific food. And I mean, that's a, that's a trial and error situation. But you you have to be able to look and go, my ratios work most of the time, they don't work for these foods, I have to figure out how to Bolus for these foods better. And and the other thing that what you just said made me want to talk about was, I guess I do actually still pay attention to insulin on board. But it's more about during a fall. So if I'm managing a high blood sugar down, or I have a real steady, lower blood sugar, and I want to know if it's going to drop, that's where active insulin makes is important more concerning to me than it is while I'm bolusing for food, crackers, one bolusing for food, I can see what's happening, I can see the big jump, I can see. Well, I mean, listen, I'm not into bolusing perfectly every time I don't think you should be that way. But if your blood sugar's one at a half an hour, after you ate, you didn't Bolus right. You know, like there was a way to do that better. There, that's easy to deal with. But when you find yourself at 180, or 200, and you start attacking it, and now you're dropping down. Now it's important for me to know how much active insulin is here because I can look at the act of insulin and decide how much juice as an example, would, would right counteract that act of insulin. So almost thinking of it as correcting a high blood sugar was almost like Pre-Bolus thing for the juice. And now put the juice in so they can do their job. And then the rest of it is just putting it in in a place where you kind of come in for a smooth. Yes, yeah. So you don't do it too soon or too late. And it is a lot like trying to land a plane apparently. So. Correct. You don't want to you don't want to fly off into the horizon and you don't want to crash into the ground. So good comparison. Yes. Great. I've never flown a plane in my life. And I never I flown a plane. Have you

Jennifer Smith, CDE 17:20
really? I have. Yeah, like a little, you know, like, a four seater. It's not like it was a huge plane or anything, obviously. But it was fun.

Scott Benner 17:29
Or and Lieberman was on here once and he offered to take me out. His parents live near me. And he was living in he was the CNN CORRESPONDENT Israel when I spoke to him, but I think he's back in the States now. And I was like, No, I'm not getting a small. He's like, we could fly down to here and get a sandwich. And I'm like, No, I don't know.

Jennifer Smith, CDE 17:50
It's it was it's really noisy. I mean, really, really noisy. But it was super fun.

Scott Benner 17:57
All right, so yeah, maybe I would do it. Six parachutes strapped in my face. Thank you very much for talking about it. Yes. On board with me, of course.

A huge thank you to one of today's sponsors, G voc. Glucagon. Find out more about Chivo Kibo pen at G Vogue glucagon.com forward slash juicebox. you spell that GVOKEGLUC AG o n.com. Forward slash juice box. If you'd like to hire Jenny Smith, she works at integrated diabetes.com. And she does this for a living, you should check her out. And don't forget that T one D exchange.org. Forward slash juice box link, go fill out that survey, please.

I want to thank you very much for listening. I want to thank you for sharing the show with other people. I want to thank you for the wonderful reviews and ratings that you leave. I would like to invite you to come check out the Juicebox Podcast Facebook page. It's called Juicebox Podcast type one diabetes, it's completely it's a private group is the words I was looking for. So about 23,000 people in there now they all have diabetes, great conversations going on. You can jump into one of them or just sit back and watch. I'd also like to remind you that today's defining diabetes episode was the latest in a long line of defining diabetes episodes. You can find them at juicebox podcast.com diabetes protip.com, or right there in your podcast player just search for defining diabetes juicebox they'll pop right up in your podcast player. There are so many I can't list them for you right now. And if you like the series, let me tell you about The rest of them. You know what I'm going to come back to this one diabetes pro tips, they begin at episode 210 and cover a bevy of topics. Those are also with Jenny Smith. There's the diabetes variable series also with Jenny variables that impact your type one care Quickstart episodes, how we eat everything from vegan carnivore, low carb flexitarian, intermittent fasting episodes for how we eat popular request episodes, stuff like what's in your go bag, switching to an insulin pump, how to split long acting insulin, bolusing, insulin for fat, all kinds of stuff there. What else we got? There's a great mental wellness series all about type one everything from sneaking food to hard questions to kids ask about type one. In a number of those episodes, I'll be joined by Erica Forsythe. She is a therapist who also has type one, there's a ton of Scott and Jenny episodes, so many to choose from their how to Bolus for fat and protein. We have a number of episodes about that. I have a great four part series about pregnancy with type one diabetes, and a ton more about pregnancy. Some in the defining diabetes episode, some in the pro tip episodes. Just so many we've done so many great conversations with pregnant type ones. And mothers who recount their pregnancies, ton of great stuff. I said ton a lot. I appreciate that. You're letting me go on that. But about algorithm pumping. Like if you're using a loop or any other algorithm actually don't miss the fox and the loop House series or any of the others. We just finished up the defining thyroid series which is really well received by people. And after dark so many afterdark episodes living with bipolar psychedelics, heroin addiction, we sex, divorce, sex workers, disordered eating from male and female perspectives. They're all there in the afterdark series. And last but not least, I told you I wasn't going to list the defining diabetes episodes but you know what Dammit, I'm going to you're ready. I'm gonna hammer through this. So today we did insulin on board. But going all the way back to Episode 236 When the series began, we have defined Bolus Basal honeymoon a one see time and range standard deviation extended Bolus algorithm, noncompliant glycemic index and load Pre-Bolus Trust will happen low before high brittle diabetes stop the arrows, ketones insulin resistance and over Bolus feeding insulin bumping nudge rage Bolus compression low and interstitial fluid, fat and protein rise. Dawn phenomenon smudgy effect feed on the floor insulin sensitivity factor adrenaline highs, insulin deficit growth hormone stacking insulin hydration, a lot of diabetes, moody diabetes, crush it and catch it see peptide and beta cell and of course today's insulin on board and there will be more. You can't use the tools if you don't understand what the tools are. Again, if you want to see those lists, join the Facebook page Juicebox Podcast type one diabetes, go right up to the top of the page where it says featured. And there is a post in there with lists of all of these episodes. And honestly, these are just a fraction of the episodes that are available in the Juicebox Podcast. So if you're not already subscribed, please do subscribe in the audio player that you prefer. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast.

---

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

#644 Defining Thyroid: Proper Dosing

Scott and Jenny Smith define thyroid terms.

In this Defining Thyroid episode, Scott and Jenny explain how to take your thyroid meds.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - 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 0:00
Hello friends, and welcome to episode 644 of the Juicebox Podcast.

Before I start the last episode of the defining thyroid series, like to take a moment to thank you for your support of the podcast makes these little side endeavors possible. What I mean by that is that I couldn't do 123456789 episode series about thyroid. If you guys weren't going to support it, by downloading it and listening to it, it would be hard for me to tell the advertisers I'm going to put a bunch of content in nobody's going to listen to it. So I appreciate you guys clicking and downloading and subscribing, you allow me to do things like this defining thyroid series. Today is the last episode in this series so far unless I think of something in the future. But today's topic is about how to take the medication. And it's a bit of a wrap up too. But taking your thyroid medication is not as easy as just popping it in your mouth. There are some things you need to know. If you take these medications incorrectly, they don't work. So settle in. Listen to Jenny and I go over how to take your thyroid meds, and the reasons why I think you'll find them interesting. Speaking of great sponsors of the podcast, this episode of The Juicebox Podcast is sponsored by the Dexcom, G six, continuous glucose monitor, head over to dexcom.com Ford slash juice box and say hello to Dexcom. Alright, Jenny, we've learned that we have hyper or hypothyroidism, and we're going to start taking medication. Somehow we've gotten lucky and found a doctor who understands it. Thank goodness, we're on our way. But it's not that easy. It is a little tiny pill, you have to take it once a day. But there are a lot of things you can't take the pill with. And there are timing issues about how to take it. So how would you? How would you describe to somebody to take their thyroid medication?

Jennifer Smith, CDE 2:27
It would be good. A good long discussion in terms of I would first ask how are you taking it? And what are you aware of in terms of your intake around that medication? Timing and everything. And a lot of people like I said before, a lot of people are probably doing the really like the very basic that their doctor has said which is don't take it with other pills or supplements. Take it first thing in the morning and take it at least an hour before you eat anything else. That's that's like the general idea of taking your taking your thyroid medications, specifically like the level thyroxin or Synthroid or the the typical names that are what most people are using. Yeah,

Scott Benner 3:14
same time of day every day. I guess most people say the morning because their stomachs empty. Right? Right, Arden takes hers at the end of the day, like before.

Jennifer Smith, CDE 3:26
And if she's not taking any other supplements at the end of the day, and it's well past her dinner time, then for some people, that is another really good time of day to take it. Because they don't have time to wait in the morning time. They don't have that like either they're not going to get up in enough time before they have to leave or go to school or whatever is on their docket for the day. But yes, same time of day is really, really important. And then the other things that, you know, we'll talk about as, as we discussed, will give you a good idea that the time taking it is probably not the it's not the best idea at all. So same time of day. Definitely. I think another one is and this would come from your doctor if you found the type or meaning like the brand that works for you. Make sure that your doctor is always writing on your prescription no substitutions. Yeah. Because I know myself like I've been changed from my typical like, human log branded insulin to the generic human log, which is made by the same company it's just not called human log on the label any longer. Right. And that was my insurances, you know, decision to go to the generic. Um, I have found no issue with that at all. It works exactly the same as my name branded homolog worked so fine and dandy, but for something like thyroid medication it's a really it's something I've heard many people say I tried This substitution it did not work for me. So just have your doctor write no substitutions on the prescription Yeah,

Scott Benner 5:07
the compounding of the medication especially when you're taking Levo thyroxin which is the which is the medication name, but you'll see it as brand names like Synthroid Yuna, thyroid, Tierra sin levoxyl. So those compounds things are really specific, like, correct. I've I saw, my wife was just cruising along on Synthroid, and the same thing happened that you're saying, like, one day, it just got substituted for the generic. And yeah, no one noticed, you know, like, no one noticed. And then suddenly, weeks later, my wife was like having problems. And then you don't, you don't mean like you don't, it takes a long time to figure out again, now you figured out this issue for yourself, you're cruising along, and then someone just doesn't write no substitutions. And just like that, you're having a problem you can't even figure out. So Synthroid is taken by my wife Arden used to take Synthroid, but in the, you know, we were trying to find reasons why she might be having other problems and, you know, we're down to like maybe she's having a drug interaction, which it wasn't but she's switched to tears. And at that point tears since actually, it's not a pill like, like Synthroid to drive like compounded pill. It's here since a liquid inside of gel cap. Oh, interesting. Yeah. And because she had good success on it when my son started something they just gave him to listen to because it worked for her and that was the idea. Other medications that you might be taking, if you have hypothyroidism is a word I can't say low thyroid mean, it doesn't matter. It's cite a military sentence A T three mm in synthetic form. My wife had a ton of success with cider mill until it started giving her palpitations. Like one night, I swear one night we were sitting in bed and she's like, I'm having a heart attack. Something's going I remember

Jennifer Smith, CDE 7:08
you telling me I think we talked like the next day or something. You mentioned that she's like,

Scott Benner 7:13
she grabbed a there's an Apple Watch in the house that basically nobody uses it's mine. But my eyes went I can't see it anymore. I don't like just looking at my wrist going. I wish I could see this. So we it was charged up we put it on her and used it for it has like a little EKG thing on it and everything. Sure she was actually in. Oh, gosh. So I think so whatever that thing measures? I'll find out. I'll put it in here. But we were like, like, are we going to the hospital kind of thing. Like it was like right along there. You're very worried. And then she removed the cider mill. And it just went away. Interesting. You told her endo and and then there's like, take this item away. Now the problem was she was getting a lot of benefit from the side of metal. So you know, there was something to do there my son takes. So my son sees Dr. Benito. And she's a little more of a integrative doctor, I guess. I don't know what

Jennifer Smith, CDE 8:15
he looks at everything. And she pays attention to everything that might impact. Yeah,

Scott Benner 8:19
yes. So my son actually takes a mix of terrassen and armor thyroid. So then the third kind of thyroid medication you might see is a more natural version. Armor I think is made from glands of a pig, right? Dry thyroid glands have a pig. And I think there's another brand name, nature thyroid to or nature throw, I forget how they say it. Okay, it might be the generic of it. So my son takes up blending of terrassen. And a very small amount of armor seems to be working really well for him. But

Jennifer Smith, CDE 8:52
and again, what you're emphasizing is just really making sure that you know, how you've been doing on what you've been using, and continue to use it and make sure that it even if you change doctors, which does happen, right plans change things change doctors leave practices, that you really just have them have a definite list of this is what I was using, and even like symptoms and things like your wife, I can't use this, I had to switch to this because these were the problems that I experienced. So keeping some really good notes about what is working, what doesn't work, what you've tried. And kind of even the doses that you know, you find that definitely work for you. And then you know in terms of medications, especially around taking, you know, just the first step is the timing of when you take your thyroid medications. I mean, talking just about medications, you have to also really be good about knowing which other meds you're taking, that might interact with the thyroid medication in a way that you don't want and And there are, I mean, there are a host of other meds that can change the way that your thyroid med gets absorbed. And then your thyroid meds because you're taking these other medications may need specific adjustments based on how these other meds are helping you as well. So it becomes really important to pay attention. I mean, the the list is extensive i There's antidepressants, and there are the blood thinners and some of the statins, even some of the birth control pills, some of them oral medications for diabetes, reflux, anti acid types of medication, I mean, again, yeah, many that you need to pay attention

Scott Benner 10:44
to, like you said things that you might be taking already, because you have type one, like for instance, an iron supplement or a multivitamin with an iron supplement. Same with calcium, calcium supplements or multivitamins, with calcium supplements, if you took those as the same time as your Synthroid or tiersen, it would just block the uptake of it. And now you're going through the effort of taking this pill anyway. And sort of like what we were talking about with my wife when when she got switched to generic and nobody knew you're going to start having problems and you're not going to know why. Because your brains not gonna say to you like, oh, it's the thyroid pill because in your mind, you take that every day you're doing it right, you know, right, right. So, so to me, thyroid is getting it diagnosed. And then finding a doctor who understands it, who will do the right blood work and mess with your levels. Somebody who's going to treat your symptoms and not your lab results, and then direct you properly about how to take the medication because you're going to go through all these steps and then take the meds wrong. And that is such a prevalent complaint online, which it is, which is about my thyroid meds don't work. But yeah, it could be something stupid, like, like, did you know if you take an acid, like even over the counter and acid I'm saying Did you know Jenny's gonna know this, but maybe I don't know. It blocks iron absorption? Oh, yeah, yeah, so people who have low iron but are taking in acid they don't realize that and then you could take your iron supplement at the same time as you take your an acid and then you might as well just flush the iron supplement down the toilet instead.

Jennifer Smith, CDE 12:21
You know, if you think about Summit, some people take some other meds with like their Frappuccino or their iced mocha.

Scott Benner 12:39
I know it's not fair to put the ad here because you're thinking I drink iced mocha, which I MP doing that now. You'll find out in a second when Jenny finishes her thought. But I need you for a moment to focus focus focus on the Dexcom G six continuous glucose monitor. I'm going to tell you a story from this week in our house. Arden had to go on a steroid pack for six days, I believe this steroid pack monkeyed with her blood sugar pretty bad at times are needed. For units of Basal an hour, I was able to use the information that I got back from Ardens Dexcom G six to make quick and accurate adjustments so that she didn't suffer for days upon days. After starting the steroid pack, we were able to get things dialed in about eight hours. And then as the pack tied traits away, she gets fewer steroids as the days go on. The impact on her blood sugar changed, and we were able to change with it. Now tonight as the steroids disappeared from our system. We also had to change a pod and then go right into a meal. Well, we Bolus pretty good. I'd say aggressively for the meal. And about 45 minutes after the Bolus, it was clear that Arden had too much insulin. It was not a problem because of the Dexcom it immediately showed Arden's blood sugar dropping. It showed us the arrows that indicated a fast drop. It made alarms so that we couldn't ignore it. And Arden was able to take in some food without rushing and she avoided a low blood sugar. Her blood sugar kind of stopped right around 69 held held held the food kicked in. And right now she's 111 Without a Dexcom G six continuous glucose monitor. What I'm gonna guess would have happened instead would have been that we would not have had the nerve to be aggressive at dinner. And instead of a drop, Arden probably would have seen a significant rise in her blood sugar based on what she ate. I'm guessing that we would have then fought with for many hours this evening. Because we would just be testing randomly to see where she was. But with the Dexcom you're seeing her blood sugar in real time, now, okay, Fair's fair, we used a little too much insulin. But it was never a problem. Never a panic situation, because Dexcom was right there to say BBB, your blood sugar is getting low. And we were able to react calmly, rationally with a measured amount of carbohydrates and stop her low before it ever happened. kind of magical. Trust me, I raised the child without CGM, and I've raised one with them. I prefer this way. dexcom.com Ford slash juicebox. These are our results. And yours may vary. But there's nothing better than seeing it live. It really gives you a chance. There are links in the show notes of your podcast player to Dexcom. And all the sponsors. There's links at Juicebox Podcast COMM But you can always just go to a browser and type dexcom.com forward slash juicebox This is a piece of technology you want on your side, go check out the website. And when you try to leave it, it's going to give you a little pop up banner that says hello ducks calm, that's your opportunity to maybe get a free 10 day trial, give it a whirl.

Jennifer Smith, CDE 16:35
In the morning time, okay, that might be great and fine for other medications. But for thyroid medications, things like fiber, and caffeine, caffeine and even some of the macro micronutrients, just in food, which is why we recommend not taking it along with food and just with water is because it can really impair the absorption, again, of the dose of thyroid medication that you're supposed to be getting. So don't take it with your caffeine in the morning. Just take a glass of water,

Scott Benner 17:07
plenty of plenty of distance between them. If if you are taking an iron supplement, and thyroid ours, like you're gonna have to make a plan. And then that becomes an issue for people to you know, making a plan.

Jennifer Smith, CDE 17:22
And one interesting thing, especially in terms of diabetes, and a lot of the change that we've seen in just fueling plans, right, I hate the word diet. But the way that people choose to eat with diabetes to manage their blood sugar's better, you might be going from a typical, you know, diet to more high fat, or maybe you're going the complete opposite. And now you're just doing an all vegan, very low fat type of diet. Well, if you had been eating really high fat, and you go to a really low fat eating plan, you may actually need to change your dose of thyroid medication, it the dose might actually be too high. If you had gone from really high fat eating to really low fat eating, you might have to adjust your doses. So I you know, all those kinds of things. These, these are not on the printout list of how to take your thyroid meds when the doctor tells you the the majority of time what I hear. When I ask people how they're taking it is I take it first thing in the morning and then I wait to eat until I get to the office which is like an hour later because that's what the doctor told me to do. Just give it an hour. Well. Another one that often comes up on the list too, if you're really looking how to properly take it is foods that are high in calcium, calcium can impair the absorption of their thyroid meds. And actually the timeframe from calcium intake to taking your thyroid med is much longer than an hour. It's like you're supposed to wait like three to four hours.

Scott Benner 19:03
You know? Because if you're not getting the absorption, then you're not getting the medication and you really do need it. Listen, there's a great example Arden's been applying to colleges, right. She's done now, thank God, like my wife and I got in bed last night. We're like, Oh, like that was something, you know, just Yes. So Arden is applying to fashion schools. So she doesn't just apply. You know, it's not just an application. She's portfolios. Some schools want, like they were samples of things. They were making dresses in my house last week because of that, right? And so it's been a lot. She's got high school on top of this on top of everything else. She's been going to bed exhausted every night. And about, I don't know about four or five days ago. She comes by my office, she's going to bed she goes, Hey, I just realized I ran out a terrassen and I didn't go get it. And I was like when she goes I don't know like five days ago maybe. I was like Great. So. So we did, what we did was we did two terrorists and that night, and then we did two terrorists and the next night, and then we went back to a regular thing, because that is the other thing. If you miss it one night, just take to the next day is definitely that's how it's been explained to us. My doctor even told Arden, if you go away for the weekend and come back and go, Oh, I didn't bring it with me. She's like, just take it all.

Jennifer Smith, CDE 20:26
Oh, interesting. Yeah. And again, that would be something definitely to go over with your doctor of the what if this? What do I do? Because again, Arden's dose may be very specific to that works really well to double up the next day after you missed it the day before for somebody else, that might not be the case,

Scott Benner 20:43
it also brings up the problem is that some people then might think to skip it for seven days and take seven of them, which is not going to work. And I'm not saying that you should make a plan around skipping your medication. But if you do it, there's kind of a way to catch back up again. But the point is, is that yesterday, yesterday, about three days after she told me this happened, and probably about seven days after she stopped taking it. She was exhausted. And she's like, she's like, I can't I'm so tired. And I was like, Yo, you didn't take your thyroid medication for free. It's got to play catch up. And then finally, it caught up to you. And I said, your this is why it's important to know I'm trying to explain to a kid who's been taking thyroid medicine since she was little, she just thinks it's part of her life. She doesn't even I don't even think half the time knows what the hell it's for. You know? Yeah. So yeah, anyway, it's really important. You don't have to live like that. And if you're taking that medication, and it's not helping, there, there should be a mixture of amounts or T three and T four arm or whatever, that a doctor can get you to that will really help you you shouldn't have to struggle with this. So right, you know, exactly. Alright. Well, that's my passion project Jenni, thyroid disorder.

Jennifer Smith, CDE 21:55
Awesome.

Scott Benner 21:56
I think I think we've covered a lot. We I think we're done actually,

Jennifer Smith, CDE 22:00
we done with our thyroid stuff.

Scott Benner 22:01
I think we got through it all. I hope people listen to this, and that they're just like,

Jennifer Smith, CDE 22:06
well actually, I've heard from a couple of people that I work with that they've enjoyed. Although they don't have or they already have and they knew enough but they just like the explanation a little bit better. I've heard a couple of people say that it's nice that we're delving into something related to type one but a side note of how to manage something that could also be impacting your diabetes management if you're not managing your thyroid stuff well to begin with, so

Scott Benner 22:39
I know we've gone over it over and again but let's just leave it here at the end of this episode if your thyroid is mismanaged or are not working properly, and you're not managing it at all that does impact your your insulin 100%

Jennifer Smith, CDE 22:53
Yes, your dose of insulin your glucose control your sensitivity everything is impacted if your thyroid is not well managed.

Scott Benner 23:02
I'll take I'll tell you to the other thing is that you know when you I think that one of the things that might be keeps people away from looking into this stuff is that they don't want there to be another thing wrong with them. Like I say it's psychological sometimes like they just like we just found out we have type one I don't want to find out about this next thing

Jennifer Smith, CDE 23:21
well you know, the funny thing about it is I mean I keep really good I feel like visual on all of my health parameters right? When I get things tested, my lab results come back. Even if the note to me is like all parameters are in Target. I look at all the parameters I don't just go by that note that says everything looks good. I look at each of them. Well, since we started like doing this thyroid stuff. I actually went back like I think it was like six years just to see what have my like thyroid checks look like over the past six years. How have they flocked How have they changed and quite honestly, I'm very thankful and I should knock on some piece of wood somewhere. I mean, they don't mind don't really change. But everybody is doing right Yay, it's doing thyroid right

Scott Benner 24:12
just keep doing it that's all like I do think there's a spot like with diabetes that you do get into you know, he just get into a rhythm you take the pill at the right time your your life kind of goes like that. Like I want people to understand like if you're you know if you're doing this well over and over again and one night you take your multivitamin and your thyroid medication at the same time. Like don't beat yourself up just go DX day, but you're doing it every day at the same time. You could you could be completely crap. Yeah, just just making the thyroid medication. Again, it might as well you might as well not even be taking it because you're blocking its absorption.

Jennifer Smith, CDE 24:50
The other one that comes to mind just briefly, because of everything we've had going on in the past couple of years. People have really tried to get enough Back stash of products and even medications. Make sure your thyroid medication is not expired. Make sure it's not expired, don't take expired, get new.

Scott Benner 25:19
We you needed to work like you need to do what it's supposed to do. I think we Yes, Jenny, I'm, I think it's cool. We're done. Yay for us. Yay for us. For us, like I, you know, I'm gonna tell you that I think we're gonna be doing this more with other things like I want to, I do want to talk about just iron specifically, you know, people's iron levels are generally not high enough. Vitamin D, maybe we're going to go down a little supplement trail at some point,

Jennifer Smith, CDE 25:48
what I think kind of a piece of that, as we've kind of already gotten into even with some of the thyroid discussion is really gut level absorption. And really, maybe doings I know people like more like, link to this, like research. Why is this the information that you're kind of, you know, telling us, there's a lot of good information about gut health, specific to autoimmune disorder, and very specific to type one. That leads to the reason that your daughter's doctor is like, hey, get rid of those oral supplements for vitamin D, you need to be taken it under your tongue, so it gets absorbed through your oral mucosa. It doesn't get absorbed. For many people with type one through the gut, it just doesn't

Scott Benner 26:38
know. So I'm looking into the right people to talk to about some of this stuff. I there's one doctor I'm considering I'm actually also considering contacting the company that we sent the gut testing off to, like maybe they've got a medical who did you because I

Jennifer Smith, CDE 26:53
did that to Cat it was probably four years ago. Because I think Conan was like, a year or so old. Maybe he was like 18 months, so it was probably about four ish years ago that I did it. I'm curious what company you guys used

Scott Benner 27:07
to have the information downstairs? I don't have it here at my desk. Okay, I'm not sure. But I that's what I'm trying to figure out. Like, who do you get, they can really talk about this stuff, right down deep.

Jennifer Smith, CDE 27:19
And isn't just like a fufu kind of like, Oh, we're doing this fancy. Like, send us your poop and like, give you you know, you shouldn't be eating broccoli anymore. And you know, I was, you know, how did you nail it down to broccoli? I didn't even have broccoli for the past week, so it wouldn't have been in my poop Where are you getting that

Scott Benner 27:43
from? I'd like to know I definitely do and understand it better as well. So okay, yeah. All right. Cool. Thank you. Awesome. Yeah

how about that Jenny Smith huh? Round of applause. I'm not gonna clap because it mess up your audio. But I mean, like, she's terrific. Jenny's for hire if you're interested, she works at integrated diabetes.com. I'd like to thank Dexcom very much for being a longtime sponsor of the Juicebox Podcast and remind you that you may be eligible for a free 10 day trial of the Dexcom G six, head over to dexcom.com Ford slash juice box and say hello Dexcom Thanks again for listening to my defining thyroid series. I hope you found it valuable. Please don't forget I ran right in that music there. owe me a drink. Please don't forget there's a fantastic episode at episode 413. It's called thyroid disease explained is with myself and Dr. Addy, Benito. She's terrific. And if you really really want to dig down deep and understand thyroid, it's a great place to to keep going. All right. You guys good? Did you like this episode 616 Defining thyroid hypothyroidism and Hashimotos thyroiditis episode 619. Defining thyroid pituitary and thyroid glands 624 TSH testing 628 T four and T three 632 auto immune 636 goitre 640 thyroiditis 641 Graves disease and of course this the last episode 644 I think I'm going to call this one I don't know I didn't really think about it till now. And I got me on the spot. I mean, defining thyroid Alright, let's think about the other defining thyroid taking your medicine know how to take the meds, how to take the meds. proper dosing. We got that I got it Defining thyroid proper dosing, Episode 644. I hope you've enjoyed it. Hope you've gotten something out of it. I've enjoyed bringing it to you. I'll be back very soon with another episode of The Juicebox Podcast. If you're enjoying the show, please share it with someone else who you think may enjoy it. And my goodness, if you're not already subscribed, subscribe. Subscribe in your favorite audio app, Apple podcasts, Spotify. I don't care which app you use, hit subscribe please helps the show immensely.

---

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

#641 Defining Thyroid: Graves disease.

Scott and Jenny Smith define thyroid terms.

In this Defining Thyroid episode, Scott and Jenny explain Graves disease.

You can always listen to the Juicebox Podcast here but the cool kids use: Apple Podcasts/iOS - Spotify - Amazon Music - 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 0:00
This show is sponsored today by the glucagon that my daughter carries. G voc hypo Penn. Find out more at G voc glucagon.com forward slash juicebox Hello friends and welcome to episode 641 of the Juicebox Podcast

Today's episode is a short one, it is also the second to last in the defining thyroid series. Today Jenny Smith and I are going to define Graves disease. While you're listening, please remember 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. The defining thyroid theories began at episode 616 with hypothyroidism and Hashimotos thyroiditis. In episode 619. We defined pituitary and thyroid glands in Episode 624 T sh testing Episode 628, T four and T three and episode 632 auto immune episode 636 goitre episode 640 thyroiditis today in Episode 641 will be defining Graves disease. Then there's one more episode coming that episode number is 644 and it will be all about how to take your thyroid medication. G voc hypo pan has no visible needle, and it's the first premixed auto injector of glucagon for very low blood sugar in adults and kids with diabetes ages two and above. Not only is G voc hypo pen simple to administer, but it's simple to learn more about. All you have to do is go to G voc glucagon.com Ford slash juicebox. G voc shouldn't be used in patients with insulinoma or phaeochromocytoma. Visit G voc glucagon.com/risk. Can you just very quickly can we talk about Graves disease? Yes. All right. Well, I have always

Jennifer Smith, CDE 2:25
just ask and we'll talk about it.

Scott Benner 2:28
Nothing even years from now if I send you a note and I say Jenny, I just really want to talk about Graves disease, you'll say hold on I'll call you.

Jennifer Smith, CDE 2:36
Right I'll call you. Let's get on the

Scott Benner 2:39
phone and we'll chat about it. Well grave Graves is the one around thyroid that you don't hear about as much in my experience. But I have it here as Graves disease is caused by a malfunction in the body's disease fighting immune system so it's autoimmune. It is unknown why this happens. The immune system normally produces normally produces antibodies designed to target a specific virus bacterium or other foreign substance. But as we all know, once in a while it gets weird and goes after you

Jennifer Smith, CDE 3:10
which is so much fun and it does

Scott Benner 3:12
make my life perfect. It's an immune system disorder that results in the overproduction of thyroid hormones. That of course is called hyperthyroidism. Although a number of disorders may result in hyperthyroidism Graves' disease is a common cause thyroid hormones affect many blood systems so signs and symptoms of Graves disease can be wide ranging so Graves disease isn't isn't hyperthyroidism which is always how I had it mixed up in my head Graves disease is a thing that happens and then hyper hyperthyroidism comes from it. Am I understanding that right? Or no,

Jennifer Smith, CDE 3:50
I guess I mean, that's kind of a simplified, I guess. I'm trying to like digest what you just said to make sure. It's kind of like it's kind of like diabetes, right? Or type one diabetes specifically, right? I mean, it's the body's in auto immune system that is improperly doing something. And the result is a diagnosis of type one. So the result of the immune disorder and in Graves disease is specifically the immune disorder. That's named because your body over produces thyroid hormones, right hyperthyroidism? Essentially,

Scott Benner 4:38
I'm wrong about what I just said then so Graves disease is something that you that happens, it's autoimmune, and when it happens, you get hyperthyroidism. It's not like Arden got Coxsackie virus and then she got type one diabetes, it's Graves disease. It's not its own separate thing. Right, right. Okay.

Jennifer Smith, CDE 4:59
Yes. That's Yes, I'm good. Re Yes. redefinition there. Yes.

Scott Benner 5:04
Yeah, I'm just trying to understand it along because, you know, I have very simple brain I hear Graves disease, and I think, oh, they named it because it killed you. But I'm assuming probably some doctor that discovered it, but Right. But that

Jennifer Smith, CDE 5:16
I mean, Graves disease is a common. It's a common cause of hyperthyroidism, but it's not the only reason that you may have hyperthyroidism, right. Graves disease is specifically an immune system like an autoimmune disorder. Okay, one of the hype, one of the reasons for hyperthyroidism. So

Scott Benner 5:36
interesting. This You see, there's a first of all, by the way, Robert Graves, an Irish doctor who first described the condition in the 1800s, not because it put people in the grave, but I guess then all the diseases would be called Graves disease in the church, if that's

Jennifer Smith, CDE 5:52
especially those that had no treatment other than just, you know, go to bed and put a warm blanket on your body, I guess.

Scott Benner 6:00
He broke his knee, he's got Graves disease. So, you know, I'm going to give a couple symptoms here of it just because it's, you know, anxiety, irritability, a fine tremor of the hands or fingers, heat sensitivity, an increase in perspiration, warmer moist skin weight loss, despite normal eating habits, enlarged thyroid, which could be called a goiter, and a change in menstrual cycles are some common ways to know something's up, I'll tell you those things. In general, if those things are happening to you, my brain goes thyroid right away, they just write hair falls.

Jennifer Smith, CDE 6:42
And it's, and especially if you're a, a woman, again, most thyroid conditions are much more prevalent in women or in females than in the male population. Not that you can't be you know, male and have thyroid disorder, but it is much more common in women, and especially under the age of, I think it's under the age of 40 is much more common for it to, you know, come into play. And a lot of women especially around the time of a pregnancy, that change in hormones, especially in somebody who already has an autoimmune disorder to begin with. Much more common to have the potential for thyroid disorder, both hyper and hypo around that time to

Scott Benner 7:33
the bulging eyes are a real common sign of graves, right?

Jennifer Smith, CDE 7:37
It was something that was my mom's one of my mom's diagnostic along with obviously, you know, the goiter there's that word again, which we defined before. So no listen to

Scott Benner 7:50
everything was just sticking out of your mom's head. You guys thought something's wrong with mom. Yes, we

Jennifer Smith, CDE 7:55
were well, and we were I was it was actually after my before my brother was born. So I was my brother's younger than I am. So it must have been after I was born. So

Scott Benner 8:05
yes. So okay, so if you're seeing these symptoms, get to a doctor and then in the next episode, we'll explain how to how to take the medication because it's easy but you can miss time it and really take away from its effectiveness. Right. Am I making sense here? Yes. Yes. Good. Ah, hold on. See, Graves is one of those things like i don't i don't know like there's, you know what I'm saying right? Like there's, you get cancer, you have cancer, you lose weight, you your body dies, like cancer makes these things happen. But I know what cancer is. Right? I know that it's cells that are you know, that have mold doing the wrong thing. Wrong thing multiplied incorrectly, they've become diseased etc. I understand what cancer is. But I still don't in my heart know what Graves disease is.

Jennifer Smith, CDE 9:03
Yeah, I mean, I think it's just Graves disease is the autoimmune hyperthyroid sort of term, right? I mean Graves disease, you have hyperthyroidism, but the reason it is happening is because of your your immune system.

Scott Benner 9:21
So is Graves disease, the hyper thyroidism version of Hashimotos and Hashimotos

Jennifer Smith, CDE 9:28
is correct. They're both autoimmune derived, right?

Scott Benner 9:32
So you can shoot I know this is I know at this point, you're thinking like, Why can't this guy get this straight, but I don't know why it doesn't roll right in my head. So, hyperthyroidism, hypothyroidism, you can have hypothyroidism without Hashimotos. But if you have Hashimotos, that's an autoimmune disease that causes hypothyroidism. However, there yes there. So yes, you however, you could have hypothyroidism without having Hashimotos. Similarly, you can Couldn't have hyperthyroidism without graves. But if you have graves, you're going to have hyperthyroidism.

Unknown Speaker 10:06
Yes. There. Yes.

Scott Benner 10:09
I think I talked myself through it finally, my God. Alright, I'm going to leave this part in because my confusion is has to be other people's confusion

Jennifer Smith, CDE 10:18
there people's confusion. Absolutely. Because somebody you know, I know family member for you wise have issues with their thyroid, but not everybody in your family with thyroid disorder has an autoimmune thyroid disorder. Correct. So these are just the two main potential hypo or hyper that comes because their auto immune system is creating the problem. There are many other reasons you could have an Under or overactive thyroid issue that is not from autoimmune derived like problem

Scott Benner 10:57
yeah, to speak about. Oh my gosh, hold on. I don't know what's wrong, Amelia.

Jennifer Smith, CDE 11:03
Some water. Maybe it's winter, you know, dry house, I

Scott Benner 11:06
need hot tea. That's what I'm gonna get next time. So using my family as an example. My wife has hypothyroidism so does Arden. Neither of them are auto immune. My son had a real crazy like bout of like, like, I don't know, like it was a tough year in COVID. stressful and all that stuff. And then he got Hashimotos. As I look back on it now, we know because he did trial that when he was like 12 that Cole doesn't have any markers for type one diabetes, but I bet you if he did, he would have got type one diabetes. When this thing happened in his life. It's possible, you know,

Jennifer Smith, CDE 11:46
it's possible, just the body with the way that his body would deal with whatever environmental factor came in that turned it on.

Scott Benner 11:53
Right. So So then my kids are auto immune. Sensitive, let's just call it which is not a real thing. But it but probably and Oh, that's interesting.

Jennifer Smith, CDE 12:06
So yeah, well, and the other interesting thing is that Arden's thyroid disorder is not she has no autoimmune she that she has no antibodies for thyroid, right? So if those antibodies as we've defined kind of before, if those aren't there, then the reason for per thyroid problem is from something else, something else is going on, that's creating the havoc within her thyroid, right? Because, again, antibody positive would be autoimmune related in terms of like Hashimotos. So I'm gonna that's very interesting for her because she has an autoimmune disorder already.

Scott Benner 12:51
I'm gonna guess. Inflammation. Like I know that's such a word that people just throw around. But I think people with autoimmune issues have inflammation in their bodies and things go wonky because of it. And that is going to be my guess you have to treat our guts better than we do. We're doing that right now. For Arden are this take? Yes. All kinds of stuff. So I enjoy everyday arguing with her about taking the supplements.

Jennifer Smith, CDE 13:14
I'm sure that you do if she's still taking I'm curious if she's still taking or maybe one of you was taking Berberine for sensitivity my

Scott Benner 13:24
son was but but it stopped when we figured out those they were throwing at it before they realized he had Hashimotos Gotcha. Yes, she's um, she's just taking a couple of different probiotics like very, like, Target and Target potent probiotics. Fish oil. She's, we've had she's getting a blood draw today, actually. And then after that her vitamin D supplementation is going to go from pill form to liquid drops. Yeah, and some other things. So hopefully I'll report on that later with some success. Oh, well, there there we go. Now we're done with Graves disease, for sure. We muddled through. Yes. Well, that's my confusion. But I again, you know, I think that's what these these conversations are for to try to talk through this stuff because I don't know. Anyway.

A huge thank you to one of today's sponsors, G voc glucagon, find out more about Chivo Kibo pen at G Vogue glucagon.com Ford slash juicebox you spell that GVOKEGL You see ag o n.com. Forward slash juicebox. Thank you so much for listening. I'll be back very soon with another episode of The Juicebox Podcast. And hey, if you like Jenny and you'd like to hire her, she works at Integrated diabetes. dot com

---

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